Sleep Disorders

WHAT IS SLEEP DISORDER?
Sleep is not just "'time out" from daily life. It is an active state essential for mental and physical restoration. Recent studies on sleep disorders have shown that significant number of people of all ages fail to get a good night sleep.

At least 84 disorders of sleeping and waking interfere with the quality of life and personal health. These include problems with staying awake or staying with an irregular sleep /wake cycle, sleep walking, bed wetting, nightmares, insomnia, restless legs syndrome, snoring and sleep apnea syndrome. Some sleep disorders are potentially fatal.

MOST COMMON SLEEP DISORDERS

SLEEP APNEA SYNDROME
Sleep Apnea is a common disorder that affects as many as 2% of adult females and 4% of adult males. Sleep Apnea refers to the phenomenon of transient breathing cessation during sleep. Most people who suffer from this condition are snorers. In addition, Sleep Apnea is a condition in which breathing stops and starts during sleep. It is usually associated with snoring. This makes it one of the most common medical disorders that the adult population suffers.

Sleep Apnea syndrome is generally classified into three types:

Central.
Obstructive.
Mixed Apnea.

Central Sleep Apnea occurs when the brain neglects to send messages to the chest muscles so that a breathing effort is not initiated.

Obstructive Sleep Apnea occurs when a breathing effort is initiated, but air cannot enter the lungs because the upper air passages are collapsed.

Mixed Apnea occurs when initially there is no inspiratory effort, but subsequently when efforts are initiated the Apnea persists because the upper airway is collapsed. Combinations of central and obstructive are more common.

The Sleep Apnea syndromes refer to people with Sleep Apnea at night who also have excessive daytime somnolence.

Whom does it affect?
Obstructive Sleep Apnea can affect anyone, but tends to be more common in overweight population. Almost all obstructive Sleep Apnea patients are regular snorers. It is probably more common in people as they get older.

Who should be suspected of having it?
There is no way to be certain without detailed testing whether someone has Sleep Apnea. However, the following signs and symptoms or a combination of these should alert a person and his physician to the possibility of Sleep Apnea syndrome:

• Unusual sleep during the day, and snoring a lot at night.
• Told by spouse or partner that his/her snoring is interrupted by periods when he/she does not breathe properly.
• Obesity.
• Despite sufficient sleep, feeling unfresh in the morning.
• Wake up several times at night for no particular reason.
• Memory or construction problems that are not easily explained.
• Excessive daytime fatigue.
• Excessive daytime sleep.

Excessive daytime sleepiness is a frequent complaint with potentially severe consequences including impaired job performance, automobile accidents and a reduced ability to enjoy the pleasure of life. Daytime sleepiness can be a symptom of an undiagnosed medical disorder.

INSOMNIA

Insomnia is the inability to fall asleep or to stay asleep. Poor sleep during the night can be a serious problem in itself and can result in decreased wakefulness, concentration and performance during the day.

SLEEP-WALKING AND RELATED SYMPTOMS

Walking, talking, screaming and performance of other behaviors in sleep are important symptoms that are too often ignored. Sleep- walking presents a danger of accidental injury and, furthermore, can be a sign of medical illness or psychological stress.

NARCOLEPSY

Narcolepsy is characterized by inappropriate irresistible daytime sleep attacks. In this case, patients do get normal night sleep or extended, and daytime sleep attacks.

WHAT SORT OF INVESTIGATIONS CAN BE DONE FOR THESE SLEEP DISORDERS?

Several different types of investigations may be performed. First, some routine blood tests might be ordered to check the blood heamoglobin, oxygen level and carbon dioxide. There are several other tests that may or may not be ordered depending on how severely a physician feels that a particular patient is affected. These tests might include X-rays of the chest, neck or sinus, heart investigation such as ECG, and Echocardiogram. Ultimately, if it is suspected that a patient has a significant sleep disorder, some detailed evaluation of their breathing status at night will be required. This might vary from oxygen monitoring device that can be worn at home to a complete overnight sleep study referred to as POLYSOMNOGRAPHY. This is performed in a sleep laboratory.

WHAT IS POLYSOMNOGRAPHY?

Polysomnography consists of the simultaneous recording of several physiological variables. This involves monitoring of several body functions with electrodes that are attached to the surface of the body. Usually, sleep studies are performed during night to see the clinical changes and correlates with ECG recording. The entire sleep study facilitates are available at Aga Khan University Hospital.

THE GUIDELINES OF GOOD SLEEP

• Get up about the same time every day.
• Go to bed when you are sleepy.
• Establish relaxing pre-sleep rituals, such as warm bath, a light bedtime snack or 10 minutes of reading.
• Exercise regularly. If you exercise vigorously, do this at least 6 hours before bedtime. Mild exercise such as simple stretching or walking should be done at least 4 hours before bedtime.
• Maintain a regular schedule. Regular times for meals, medication, etc.
• Do not eat or drink anything containing caffeine within 6 hours of bedtime. Avoid drinking alcohol.
• Avoid smoking close to bedtime.
• If you take naps, try to do so at the same time everyday. For most people, a mid afternoon nap is most helpful.
• Avoid sleeping pills or use them conservatively. Most doctors avoid prescribing sleeping pills for the period of longer than 3 weeks. Never drink alcohol while taking sleeping pills.

NEUROLOGY FACULTY
Full Time

Dr. Shahid Masud Baig
MBBS (Lahore); MD, PhD (Sweden)

Dr. Saad Shafqat
MBBS (AKU); PhD (USA);
Diplomate American Board of Neurology & Psychiatry

Dr. Nadir Ali Syed
MBBS (AKU);
Diplomate American Board of Psychiatry & Neurology (Neurology);
Diplomate American Board of Psychiatry & Neurology ( Clinical Neurophysiology); Diplomate American Board of Electrodiagnostic Medicine

Dr.Imran Wahedna
MBBS (Karachi); Diplomate American Board of Neurology & Psychiatry;
Diplomate American Board of Neuroimaging;

Non-Full Time

Dr. Aziz Sonawalla
MBBS (Mumbai); MD (Medicine); DM (Neurology)

For Sleep Clinic, contact:

Neurologists:

Dr Shahid Masud Baig
Dr Nadir Ali Syed

Pulmonologists:

Full Time

Dr Ijlal Badar
MBBS (AKU);
Diplomate American Board of Internal Medicine;
Diplomate American Board of Pulmonary Medicine & Critical Care;

Dr. Raana Haqqee
MBBS (Karachi); MRCP,(UK)

Dr. Fayyaz Hussain
MBBS (Karachi) MRCP,(UK)

Dr Nawal Salahuddin
MBBS (AKU); FCCP (USA)
Diplomate American Board of Internal Medicine;
Diplomate American Board of Pulmonary Medicine & Critical Care;

Chief Technologist:

Mustafa Khan
ECNE, HNC (UK)

For further information, please contact:

NEUROPHYSIOLOGY SERVICES
Tel: 92-21-4861541, 4861542
Fax: 92-21-4934294, 4932095
email: neuro.reports@aku.edu