sleep disorder video on youtube.com

sleep disorder video on youtube.com

Sleep Terms, Definitions and Abbreviations

Definitions
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A B C
D E F G
H I J K
L M N O
P Q R S
T U V W X Y Z

Abbreviations
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Abdominal
Movement - In diagnostic sleep studies, abdominal movement
is recorded. This is one of the measures of respiratory effort, reflecting
movement of the diaphragm.

Advanced Sleep Phase Syndrome (ASPS)
- Phases of the daily sleep/wake cycle are advanced with respect to clock
time. This is classified as a circadian rhythm disorder. The sleep phase
occurs well ahead of the conventional bedtime and the tendency is to wake
up too early.

Alpha
rhythm - EEG oscillations, prominent over the occipital cortex, with
a frequency of 8-13 Hz in adults; indicative
of the awake state; present in most, but not all, normal individuals;
most consistent and predominant during relaxed wakefulness.

Alpha
intrusion - brief occurrence of alpha activity during a stage of sleep.

Ambulatory
Monitor - Portable system used to record (continuously) multiple physiological
variables during sleep.

Apnea
- Literally means "no breath";
the cessation of airflow at the nostrils and mouth for at least 10
seconds.

Apnea
index (AI) - A measure of the severity of sleep apnea; the number of apnea events per hour.

Apnea/Hypopnea
index (AHI) - the number of apneas and hypopneas per hour. 5-20=mild,
21-50=moderate, above 51 severe

Arousal
- abrupt change from sleep to wakefulness, or from a "deeper"
stage of non-REM sleep to a "lighter" stage

Arousal
Disorder - parasomnia disorder presumed to be due to an abnormal arousal
function. Classical arousal disorders:
sleepwalking, sleep terrors and confusional arousals.

Arousal
Threshold - ease that a sleeping person is awakened.

Arrhythmia
- irregularity or absence of the heart rhythm caused by disturbances in
transmission of electrical impulses through cardiac tissue.

Auto Adjusting Continuous Positive Airway
Pressure Device (SmartPAP) (Auto-PAP) - A type of CPAP machine monitoring
changes in breathing and compensates automatically by making appropriate
adjustments in pressure.

Automatism
- automatic action--especially any action performed apparently without intention
or awareness.

Basic
Sleep Cycle - progression through orderly succession
of sleep states and stages. For the healthy adult, the first cycle is begins
by going from wakefulness to non-REM sleep. The first REM period follows
the first period of non-REM sleep, and the two sleep states continue to
alternate throughout the night with an average period of about 90 minutes.
A night of normal human sleep usually consists of 4-6 non-REM/REM sleep
cycles.

Benzodiazepines - developed in the 1950's,
this class of compounds tranquilize and sedates.

Beta
Activity - brain waves with a frequency of greater than 13 Hz (Hertz).

Bi-Level - Bi-level pressure device
used to treat sleep apnea. The "bi" refers to two pressures:
a lower pressure for exhalation and a higher pressure for inhalation. Bi-Level
machines are more expensive than a standard CPAP, but some patients tolerate
it better because they can exhale comfortably against the constant inhalation
pressure. (Sometimes called Bi-PAP, but that is a trademark name
of one system)

Biological
Clock - term for the brain process causing us to have 24-hour fluctuations
in body temperature, hormone secretion, and other bodily activities. The
most important function fosters the daily alternation of sleep and wakefulness.
The biological clock is found in a pair of tiny bilateral brain areas called
the suprachiasmatic nuclei.

Body
Position - four positions are identified which a patient may be sleeping;
back, left side, right side or abdomen. The time spent sleeping in each
position and the number of respiratory events in a particular position are
tabulated.

Bradycardia
- heart rhythm with a rate lower than 60 beats per minute in an adult.

Brain
Waves – the brain’s spontaneous electrical activity studied by electroencephalography
(EEG).

Bruxism
– teeth grinding during sleep

Cardiac
Arrest - sudden cessation of the heart beat.

Cardiovascular
- Pertaining to blood vessels and
the heart

Cataplexy
- sudden, dramatic decrement in muscle tone and loss of deep reflexes that
leads to muscle weakness, paralysis, or postural collapse. Usually caused by outburst of emotion: laughter, startle, or sudden physical exercise;
one of the tetrad of symptoms of narcolepsy.

Central
apnea - absence of airflow and inspiratory effort; apnea caused by irregularity in the brain's control of breathing.

Central
Nervous System (CNS) - brain and spinal cord.

Cheyne-Stokes
respiration - breathing pattern typified by regular "crescendo-decrescendo"
or waxing and waning fluctuations in respiratory rate and tidal volume.

Chronotherapy
- treatment for circadian rhythm sleep disorder by systemically changing
sleeping and waking times to reset the biological clock.

Circadian rhythm - innate, daily, fluctuation
of behavioral and physiological functions, including sleep waking, generally
tied to the 24 hour day-night cycle but sometimes to a different (e.g.,
23 or 25 hour) periodicity when light/dark and other time cues are removed.

Compliance
- adhering to or conforming with a regimen of treatment such as CPAP

CPAP
- Continuous Positive Airway Pressure;
the device used to treat sleep apnea by sending positive airway pressure
at a constant, continuous pressure to help keep an open airway, allowing
the patient to breathe normally through his/her nose and airway

CPAP
Pressure - pressure needed to maintain an open airway in a sleep apnea
patient treated with CPAP, expressed in centimeters of water (cm H20). The
positive pressure can range from 5 - 20 cm H20. Different patients require
different pressures. The value is determined in a CPAP titration study.

Deep
Sleep - refers to combined non-REM sleep stages 3 and
4 in sleep studies

Delayed
sleep phase - A condition occurring when the clock hour at which sleep
normally occurs is moved back in time in a given, 24 hour sleep-wake cycle.
The result is a temporarily displaced (delayed) occurrence of sleep within
the 24 hour cycle.

Delta
sleep - stage(s) of sleep in which EEG delta waves are prevalent or
predominant (sleep stages 3 and 4, respectively).

Delta
waves - EEG activity with a frequency less than 4 Hz. In human sleep stage scoring, conventionally the minimum criteria
for scoring delta waves is 75 uV (peak-to-peak) amplitude, and 0.5 second
duration (2 Hz).

Diagnostic
Sleep Study - monitoring of several physiological activities in a sleeping
individual. Usually performed to determine the absence or presence of a
specific sleep disorder. The sleep study can occur in a sleep disorders
center or in a patient's home with portable recording equipment.

Diaphragm
- large, concave muscle attached to the rib cage at bottom of the chest
(top of the abdomen). Inhalation occurs when diaphragm contracts. Exhalation
is passive as the muscle relaxes.

Diurnal
- active and wakeful in the daytime versus active in the nighttime

DME - Durable Medical Equipment. Equipment
such as wheelchairs and walkers which are prescribed for use by or on the
order of a physician, also includes CPAP and BI-Level machines.

Drowsiness,
Drowsy - quiet wakefulness occurring prior to sleep onset.

Dyssomnia
- a disorder of sleep or wakefulness; not a parasomnia

Electrocardiography
(EKG) – a method of measuring the electrical activity of the heart.

Electrodes
- small devices transmitting biological electrical activity from subject
to polygraph

Electroencephalogram
(EEG) - recording through the scalp of electrical potentials from the
brain and the changes in these potentials. The EEG is one of the three basic
variables (along with the EOG & EMG) used to score sleep stages and
waking. Surface electrodes are used to record sleep in humans, recording
potential differences between brain regions and a neutral reference point,
or between brain regions.

Electromyogram
(EMG) - recording of electrical activity from the muscular system; in
sleep recording, synonymous with resting muscle activity or potential. The
chin EMG, along with EEG and EOG, is one of the three basic variables used
to score sleep stages and waking. Surface electrodes are used to record
sleep in humans, measuring activity from the submental or masseter muscles.
These reflect the changes in resting muscle activity.
During REM sleep the chin/cheek EMG is tonically inhibited.

Electro-oculogram
(EOG) - recording of voltage changes resulting from shifts in position
of the eyeball-possible because each globe is a positive (anterior) and
negative (posterior) dipole; along with the EEG and the EMG, one of the
three basic variables used to score sleep stages and waking. Human sleep
recordings utilize surface electrodes placed near the eyes to record the
movement of the eyeballs. Rapid eye movements in sleep indicate a certain
stage of sleep ( usually REM sleep).

ENT
- Ear, Nose and Throat. A doctor
specializing in diseases of the Ear, Nose and Throat. These specialists often do surgery as well, and may be referred
to as an ENT surgeon.

EPAP
- Expiratory Positive Airway Pressure. Pressure prescribed for the expiratory
(breathing out) phase of an individual on Bi-level CPAP therapy for OSA
(obstructive sleep apnea).

Epidemiology
- Scientific discipline studying the incidence, distribution, and control
of disease in a population. Includes the study of factors affecting the
progress of an illness, and, in the case of many chronic diseases, their
natural history.

Epoch
- A standard 30 second duration of the sleep recording that is assigned
a sleep stage designation; for special purposes, occasionally longer or
shorter epochs are scored.

Epworth
Sleepiness Scale - index of sleep propensity during the day as perceived
by patients, and derived from the answers to 8 questions.

Esophageal
Pressure - measurement used to determine respiratory effort and by inference,
airway resistance. Considered an invasive measure, generally used only in
polysomnographic testing, conducted in sleep disorders centers.

Excessive
daytime sleepiness or somnolence (EDS) -
subjective report of difficulty in staying awake, accompanied by
a ready entrance into sleep when the individual is sedentary

Expiratory
Phase - air is expelled during this phase of the breathing cycle

Fatigue
- feeling of tiredness or weariness usually associated with performance
decrements

Fiberoptic Nasopharyngoscope - flexible
fiberoptic scope used in the examination of nasal passages, pharynx, hypopharynx
and larynx.

Fibromyalgia - a disease syndrome whose
primary symptoms are muscle pain and fatigue.

Flattening
Index - number indicating the amount of airflow limitation caused by
partial closure of the upper airway. 0.3 indicates an open airway, 0.15
is mildly obstructed, 0.1 is severely limited airflow, and 0.0 reflects
a totally closed airway. Flattening
Index is used to identify the condition known as Upper Airway Resistance
Syndrome (UARS), and is continuously recorded in both diagnostic sleep studies
and CPAP titrations.

Flow
Limitation – the partial closure of the upper airway impeding the flow
of air into the lungs.

Forbidden
Zone – the period of strongest clock-dependent alerting, usually in
the evening. Prevents falling asleep.

Fragmentation (pertaining to Sleep Architecture)
- interruption of a sleep stage as a result of the appearance of a lighter
stage, or to the occurrence of wakefulness, which leads to disrupted non-REM-REM
sleep cycles.

GABA
(Gamma-Amniobutyric Acid) - major neurotransmitter in the brain, which
is considered to be involved in muscle relaxation, sleep, diminished emotional
reaction and sedation.

Gastroesphageal
Reflux Disease (GERD) - flow of stomach acid upwards into the esophagus
that can cause arousals and disrupt sleep.

Genioglossus
tongue advancement – a possible surgical treatment used for sleep apnea
and/or snoring, improving the airway behind the base of the tongue. The
genioglossus, the main tongue muscle, relaxes during sleep, often allowing
the tongue to fall into the airway. The muscle attaches to the middle of
the lower jaw. A segment of bone containing this muscle is
pulled forward and stabilized, opening the airway space behind the tongue.

Habitual
Snorers - those who snore nearly every night

Heart
Rate or beats per minute (bpm) – pace/speed of the heart measured in
beats per minute. 60-80 is considered normal in adults.

Hertz
(Hz) - unit of frequency; equal to cycles per second (cps).

Histogram
(sleep) - graph indicating sleep stages thoughout the night.

Humidification
- moisture is added to the airflow as an adjunct to CPAP (Continuous Positive
Airway Pressure) therapy in treating obstructive sleep apnea (OSA). Humidification
can be added to the CPAP by diverting the airflow over or through a cool
or heated water reservoir (humidifier) to prevent the upper airway from
drying out.

Hyoid Suspension – a possible surgical
procedure sometimes used in the treatment of sleep apnea and/or snoring,
designed to improve the airway behind the base of the tongue. The hyoid
bone is located in the neck where some tongue muscles attach. The hyoid
bone is pulled forward in front of the voice box and can open the airway
space behind the tongue.

Hyperactivity – typical behavior in
a child with a sleep disorder which is causing lack of quality sleep

Hypercapnia
– excessive or elevated carbon dioxide in the blood

Hyperirritability
- Extreme irritability; seen in sleep deprived subjects.

Hypersomnia
– excessive, prolonged sleep

Hypertension
-High blood pressure.

Hypnagogic
imagery (-hallucinations) - Vivid sensory images occurring at sleep
onset but particularly vivid with sleep-onset REM periods; feature of narcoleptic REM naps.

Hypnagogic
startle - "sleep start" or sudden body jerk, observed normally
just at sleep onset, resulting in at least momentary awakening

Hypnophobia
- Morbid fear of falling asleep.

Hypnotics
- Sleep-inducing drugs.

Hypopharynx
- lowermost portion of the pharynx leading to the larynx and esophagus.

Hypopnea
- shallow breathing in which the air flow in and out of the airway is less
than half of normal--usually associated with oxygen desaturation.

Hypoventilation
- reduced rate and depth of breathing.

Hypoxemia
- abnormal lack of oxygen in the blood in the arteries.

Hypoxia
- deficiency of oxygen reaching the tissues of the body.

Imidazopyridines
- New class of compounds inducing sleepiness. (Zolpidem, trade name Ambien,
is in this class).

Inappropriate
Sleep Episodes – unplanned sleep periods often occuring in an unsafe
situation (i.e., while driving). These episodes are always due to sleep
deprivation.

Insomnia
– complaint describing difficulty in sleeping

Inspiratory
Phase - part of the breathing cycle in which air is inhaled.

Invasive
– referring to a medical procedure in which a bodily orifice or the skin
must be penetrated for the purpose of collecting data, or for diagnosing
or treating a disorder

IPAP
- Inspiratory Positive Airway Pressure.
Physician prescribed pressure for the inspiratory phase on a Bi-level
CPAP device, used in the treatment of OSA.

Jet
Lag - disturbance induced by a major rapid shift in
environmental time during travel to a new time zone

K-Alpha
- type of microarousal; K complex
followed by several seconds of alpha rhythm.

K
complex - sharp, negative, high-voltage EEG wave, followed by a slower,
positive component. K complex, occurring spontaneously during NREM sleep,
beginning in (and defining) stage 2. K
complexes can be elicited during sleep by external (particularly auditory)
stimuli as well.

Laser
assisted uvulopalatoplasty (LAUP) - can eliminate or
decrease snoring but has not been shown to be effective in the treatment
of sleep apnea.

Leg
Movement - Leg movements are recorded in both diagnostic sleep studies
and titration studies.

Letter
of Medical Necessity (LMN) - certification by a physician that the prescribed
item(s) is/are medically indicated, reasonable and necessary with reference
to the standards of medical practice and treatment of a patient's condition

Light-Dark
Cycle - periodic pattern of light (artificial or natural) alternating
with darkness

Light
Sleep - term used to describe non-REM sleep stage 1, and sometimes,
stage 2.

Light
Therapy - used in the treatment of SAD (Seasonal Affective Disorder)
and other conditions. Exposes the eyes to light of appropriate intensity
and duration and at the appropriate time of day to effect the timing, duration
and quality of sleep.

Limit-Setting
Sleep Disorder – disorder due to child’s difficulty in falling asleep
by delaying and refusing to go to bed

Linear
Sleepiness Rating Scale - measure of subjective sleepiness. The scale contains a horizontal line, 100 mm
in length --the right extreme is labeled "Very Sleepy" and the
left extreme is labeled "Very Wide Awake."

Macroglossia
- large tongue; usually a congenital disorder (present at birth)

Maxillofacial
- pertaining to the jaws and face.

Mandibular
Maxillary Osteotomy and Advancement (MMOA) - procedure developed for
patients with retrolingual obstruction, patients with retropalatal and retrolingual
obstruction who have not responded to CPAP and uvulopalatopharyngoplasty
(UPPP).

Melatonin
- hormone secreted by the brain’s pineal gland

Micro-arousal
- partial awakening from sleep

Micro-sleep
- period lasting up to a few seconds during which the polysomnogram suddenly
shifts from waking characteristics to sleep.

Mixed
(sleep) apnea - interruption in breathing during sleep beginning as
a central apnea then becoming an obstructive apnea.

Monocyclic
- a single major sleep period and a single major wake period in a 24-hour
day.

Motor
Activity in Sleep - any muscular movement during sleep

Motor
Atonia – the absence of muscle activity during sleep

Movement
arousal - body movement associated with arousal or awakening; a sleep
scoring variable.

Movement
time - term used in sleep record scoring to denote when EEG and EOG
tracings are obscured for more than 15 seconds due to movement.

Multiple
sleep latency test (MSLT) - a series “nap tests” utilized in the assessment
of excessive daytime sleepiness.

Muscle
Tone – amount of tension in a muscle.

Myoclonus
- muscle contractions in the form of "jerks" or twitches.

Nap
- short period of planned sleep generally obtained at a time separate from
the major sleep period.

Narcolepsy
- sleep disorder characterized by excessive sleepiness, cataplexy, sleep
paralysis, hypnogogic hallucinations, and an abnormal tendency to pass directly
from wakefulness into REM sleep

Nasal
Airflow/Nasal Ventilation - recording of the complete respiratory cycle
by measuring inspiratory and expiratory airflow

National
Commission on Sleep Disorders Research (NCSDR) - the commission (created
by the U.S. Congress in 1990) conducted a comprehensive study of the social
and economic impact of sleep disorders in America and made recommendations
based on its findings to the Congress in January 1993

Neurology
- branch of medicine that referring to the nervous system and its diseases

Neurotransmitters
- endogenuous chemical components that are released from axon terminals
of one neuron and transmit the signal to the next neuron by combining with
its receptor molecules. Neurotransmitters
important in the control of sleep and wakefulness include: norepinephrine,
serotonin, acetylcholine, dopamine, adrenaline and histamine.

Nightmare
- unpleasant and/or frightening dream occurring in REM sleep (different
from a night terror)

Night
Terrors - also known as sleep terrors, or pavor nocturnus. Night terrors are characterized by an incomplete
arousal from slow wave sleep. If,
the individual is awakened during a night terror, he/she is usually confused
and does not remember details of the event. Night terrors are different from nightmares; if an individual is
awakened during a nightmare, he/she functions well and may have some recall
of the nightmare.

Nocturia
- excessive, often frequent, urination during the night

Nocturnal
- "Of the night;" pertaining to events happening during sleep
or the hours of darkness.

Nocturnal Confusion - episodes of delirium
and/or disorientation near or during nighttime sleep; often seen in victims
of Alzheimers Disease and more common in the elderly

Nocturnal sleep-related eating disorder
(NS-RED)- Getting up during the night and eating while sleepwalking.
No recall in the morning.

Nocturnal
Enuresis (Bedwetting) - urinating while asleep

Non-Invasive
- Medical procedure not penetrating the skin or a body cavity.

NREM
or non-REM sleep - characterized by slower and larger brain waves and
little or no dream behavior; quiet
sleep, slow-wave sleep; approximately
80% of sleep

NREM
Sleep Intrusion - brief period of NREM sleep patterns appearing in REM
sleep; a portion of NREM sleep not
appearing in its usual sleep cycle position

Obesity-Hypoventilation
Syndrome - term applied to obese individuals hypoventilating during
wakefulness.

Obstructive
apnea - cessation of airflow (at least 10 seconds) in the presence of
continued inspiratory effort; cessation
of breathing during sleep, due to a mechanical obstruction, such as a semi-collapsed
trachea, tongue relaxed to back of the throat, or a large among of tissue
in the uvula area.

Obstructive
Hypopnea - periodic and partial closure of the throat during sleep resulting
in reduced air exchange at the level of the mouth and/or nostril.

Ondine's
Curse - the respiratory center in the brain is unable to stimulate breathing
in response to an increased amount of carbon dioxide in the blood. Ondine's Curse or central alveolar hypoventilation
typically worsens during sleep.

Optimum
Sleep - average amount of sleep needed every night by an individual.

Oxygen
Desaturation - less than normal amount of oxygen carried by hemoglobin
in the blood; values below 90% are
considered abnormal

Oxygen
Saturation - measure of oxygen carried by hemoglobin in the blood. Normal
values 90% - 100%.

Oximeter
(Pulse) - gives estimates of arterial oxyhemoglobin saturation (SaO2)
by utilizing selected wavelengths of light to non invasively determine the
saturation of oxyhemoglobin (SpO2)

Oximetry
(Pulse) - continuous monitoring of oxygen saturation of arterial blood
from a pulse oximeter; the sensor
is usually attached to the finger.

O2
- Chemical symbol for oxygen. Criterion lowest percent O2 saturation: Greater
than 85%=mild, 80% to 85%=moderate, less than 80%=severe

Parasomnia
- an event happening during sleep, or induced or exacerbated by sleep, such
as sleepwalking or asthma; not a dyssomnia.

Paroxysmal
nocturnal dyspnea (PND) - respiratory distress and shortness of breath
due to pulmonary edema, appearing suddenly and often awakening the sleeping
individual.

Pathological
Sleep - abnormal sleep patterns.

Pavor
Nocturnus (Night Terrors) - See Night Terrors.

Perceptual
Disengagement - change in consciousness at the onset of sleep when environmental
stimuli are no longer perceived, and there is no longer any conscious, meaningful
interaction with the environment.

Periodic
Breathing - repetitive apneic pauses, common in premature infants.

Periodic
Limb Movement Disorder - also known as periodic leg movements and nocturnal
myoclonus. Characterized by periodic episodes of repetitive and highly stereotyped
limb movements occuring during sleep. The movements are often associated
with a partial arousal or awakening; however, the patient is usually unaware
of the limb movements or frequent sleep disruption. Between the episodes, the legs are still. There
can be marked night-to-night variability in the number of movements or in
the existence of movements.

Persistent
Insomnia - continuing insomnia responding poorly to treatment.

Pharynx
- area posterior to the nares and the oral cavity; passageway for air from the nasal cavity and/or the mouth to the
lungs via the larynx and the trachea, for food and liquids from the mouth
to the esophagus

Phase
advance - movement to a position earlier in the 24 hour sleep - wake
cycle of a period of sleep or wake; for example, a shift of the sleep phase
from 11 p.m. - 7 a.m. to 8 p.m. - 4 a.m.

Phase
delay - Phase delay is exactly the opposite of phase advance, i.e.,
a shift later in time.

Phasic
(Event/Activity) - brain, muscle, or autonomic related event of a brief
and episodic nature occurring in sleep. Usually
occur during REM sleep, such as eye movements and/or muscle twitches

Photoperiod
- duration of light in a light/dark cycle.

Pickwickian
Syndrome - obesity accompanied by somnolence, lethargy, chronic hypoventilation,
hypoxia, and secondary polycythemia (a condition marked by an abnormal increase
in the number of circulating red blood cells); usually has severe obstructive sleep apnea

Pineal
Gland - gland in the brain secreting the hormone melatonin.

PLMD-Arousal
Index - number of sleep-related periodic leg movements per hour of sleep
that are associated with an EEG arousal

Polycyclic
- multiple sleep periods and wake periods in a 24-hour day.

PO2
- partial pressure of oxygen (O2) in the blood. A value above 60 is usually
considered a safe level: lower than
60 indicated hypoxemia and potential danger for the patient.

Polysomnogram
(PSG) - continuous and simultaneous recording of physiological variables
during sleep, i.e., EEG, EOG, EMG (the three basic stage scoring parameters),
EKG, respiratory air flow, respiratory excursion, lower limb movement, and
other electrophysiological variables.

Polysomnograph
- biomedical instrument for the measurement of multiple physiological variables
of sleep

Polysomnographic
Technologist - health care professional trained in performing diagnostic
sleep studies

Post-Prandial
Drowsiness - sleepiness that occurs after a meal, usually lunch

Post-Traumatic
Stress Disorder - re-experiencing of a traumatic event in the form of
repetitive dreams, recurrent and intrusive daytime recollections, and/or
dissociative flashback episodes.

Premature
morning awakening - early termination of the sleep period in a sleep
maintenance DIMS due to inability to return to sleep after the last of several
awakenings

Prescribed
CPAP Pressure - pressure(s) or settings determined by a CPAP titration
sleep study, which a physician prescribes for a patient's CPAP therapy machine

Pulse
Oximetry - non-invasive measure of oxygen saturation; that is the amount
of oxygen saturated in the hemoglobin in terms of percentage; not as accurate as the values obtained from
an arterial blood gases (ABG) test and should only be used as a gauge of
oxygenation. Normal ranges are between
95-100%.

Quiet
Sleep - The term frequently used instead of NREM sleep
to describe the sleep of infants.

Radiofrequency
(RF) - Electromagnetic radiation in the frequency range 3 kilohertz
(kHz) to 300 gigahertz (GHz); considered to include microwaves and radio
waves. Microwaves occupy the spectral region between
300 GHz and 300 MHz, while RF or radio waves include 300 MHz to 3 kHz.

Radiofrequency
(RF) Procedure (also known as Somnoplasty) - procedure for treating
nasal obstruction, snoring and in some cases, sleep apnea. The procedure
uses radiowave energy to reduce snoring and the size of the soft palate.

RDI
- Respiratory Disturbance Index, includes all respiratory events per hour.

REM
sleep, rapid eye movement sleep - sleep characterized by the active
brain waves, flitting motions of the eyes, and weakness of the muscles;
most dreaming occurs in this stage, which accounts for about 20% of sleep
in adults.

REM
Density - A function that expresses the frequency of eye movements per
unit of time during REM sleep.

REM-Associated
Disorders - Sleep disturbances that occur in REM sleep.

REMS
latency - The period of time in the sleep period from sleep onset to
the first appearance of stage REMS.

REM
Motor Atonia - The active suppression of activity in the antigravity
and voluntary muscles during REM sleep. The muscles are completely flaccid
and limp.

REM
onset - designation for commencement of a REM period; used also as a shorthand term for a sleep-onset REM period

REM
period - REM portion of a NREM-REM cycle; early in the night it may
be as short as a half-minute, whereas in later cycles longer than an hour.

REM
rebound or recovery - lengthening and increase in frequency and density
of REM periods, which results in an increase in REM percent above base line.
REM rebound follows REM deprivation once the inhibitory influence is removed

REM
Sleep Behavior Disorder (RBD)- disorder in which REM motor atonia is
partially or completely absent and the individual acts out the ongoing dream.
The behavior in REM behavior disorder is often correlates with the ongoing,
hallucinatory REM dream episode.

REM
Sleep Episode - REM sleep portion of a NREM-REM sleep cycle. Early in
the first sleep period, episodes may be only several minutes in duration.
Later REM episodes almost are always longer, 20 to 30 minutes up to an hour.

REM
Sleep Intrusion - brief interval of REM sleep appearing out of its usual
positioning in the NREM-REM sleep cycle.

REM
Sleep Latency - interval from sleep onset to the first appearance of
REM sleep

REM
Sleep Onset - designation for the first epoch of a REM sleep episode

REM
Sleep Percent - proportion of total sleep time occupied by REM sleep

REM
Sleep Rebound - compensatory increase in REM sleep following experimental
reduction. Extension of time in, and an increase in frequency and density
of REM sleep episodes; usually an
increase in REM sleep percent of total sleep time above baseline values

Respiratory
Care Practitioner (RCP) - licensed health care professional specifically
trained in cardiopulmonary assessment, diagnostics, therapy administration,
and patient education, including the identification and treatment of sleep
disorders

Restless Legs Syndrome (RLS) - sleep
disorder characterized by a deep creeping, or crawling sensation in the
legs that tends to occur when an individual is not moving. There is an almost
irresistible urge to move the legs; the sensations are relieved by movement.

Restlessness
(Referring to Quality of Sleep) - Persistent or recurrent body movements,
arousals, and/or brief awakenings in the course of sleep

Sedatives
- compounds tending to calm, and reduce nervousness or excitement and foster
sleep

Sedentary
Situation - not requiring physical activity, e.g. working at a desk,
sitting in a meeting or in a theater, watching television.

Septoplasty
- surgery on the nasal septum (dividing the nasal passage)

Serotonin
- neurotransmitter in the brain that modulates mood, appetite, sexual activity,
aggression, body temperature and sleep

Shiftwork
- working hours outside of the conventional daytime hours of 9:00 a.m. to
5:00 p.m.

Sleep
- a state marked by lessened consciousness, lessened movement of the skeletal
muscles, and slowed-down metabolism

Sleep
Apnea - cessation of breathing for 10 or more seconds during sleep

Sleep
architecture - NREM/REM stage and cycle infrastructure of sleep understood
from the vantage point of the quantitative relationship of these components
to each other

Sleep
cycle - synonymous with NREM-REM cycle

Sleep
Debt - result of recurrent sleep deprivation which occurs over time
when an individual does not experience a sufficient amount of the restorative
daily sleep that is required to maintain a sense of feeling rested and refreshed.
.

Sleep
Deprivation - acute or chronic lack of sufficient sleep.

Sleep
Disorders - broad range of illnesses arising from many causes, including,
dysfunctional sleep mechanisms, abnormalities in physiological functions
during sleep, abnormalities of the biological clock, and sleep disturbances
that are induced by factors extrinsic to the sleep process

Sleep
efficiency (SE) - proportion of sleep in the period potentially filled
by sleep--ratio of total sleep time to time in bed

Sleep
Episode - interval of sleep that may be voluntary or involuntary

Sleep
Extension - extending sleep time by increasing the time in bed

Sleep
Fragmentation - brief arousals occurring throughout the night, reducing
the total amount of time spent in the deeper levels of sleep.

Sleep
hygiene - conditions and practices that promote continuous and effective
sleep, including regularity of bedtime and arise time; conforming time spent
in bed to the time necessary for sustained and individually adequate sleep
(i.e., the total sleep time sufficient to avoid sleepiness when awake); restriction of alcohol and caffeine beverages
in the period prior to bedtime; employment
of exercise, nutrition, and environmental factors so that they enhance,
not disturb, restful sleep

Sleep
Hyperhydrosis - excessive sweating during sleep.

Sleep
Inertia - feelings of grogginess and/or sleepiness that persist longer
than 10 to 20 minutes after waking up

Sleep
interruption - breaks in the sleep architecture resulting in arousal
and wakefulness

Sleep
latency - time period measured from "lights out," or bedtime,
to the beginning of sleep

Sleep
log (-diary) - daily, written record of an individual's sleep-wake pattern
containing such information as time of retiring and arising, time in bed,
estimated total sleep period, number and duration of sleep interruptions,
quality of sleep, daytime naps, use of medications or caffeine beverages,
nature of waking activities, and other data

Sleep-maintenance
DIMS or insomnia - disturbance in maintaining sleep once achieved; persistently interrupted sleep without difficulty
falling asleep

Sleep
Mentation - thoughts, feelings, images, perceptions, hallucinations,
and active dreams taking place during sleep

Sleep
onset - transition from wake to sleep, normally into NREM stage 1 (but
in certain conditions, such as infancy and narcolepsy, into stage REMS)

Sleep
Onset Imagery - images and experiences during the moments following
the transition from wake to sleep

Sleep-onset REM period - atypical beginning
of sleep by entrance directly into stage REM

Sleep paralysis - waking and not being
able to move for a short period of time, usually occurs out of REM (dream)
sleep.

Sleep
pattern (24 hour sleep-wake pattern) - individual's clock hour schedule
of bedtimes and rise times as well as nap behavior: may also include time
and duration of sleep interruptions

Sleeping
Pills - compounds that have a sedative effect,
used to produce sleepiness

Sleep
Related Accidents - accidents caused by individuals who were sleep deprived
and who, as a result, had impaired judgment

Sleep
Restriction - limitation of the number of hours in bed

Sleep
spindle - episodically appearing, spindle-shaped aggregate of 12-14
Hz waves with a duration of 0.5-1.5 seconds, one of the identifying EEG
phenomena of NREM stage 2 sleep

Sleep
Stage Demarcation - significant polysomnographic characteristics that
distinguish the boundaries of the sleep stages.

Sleep
stage NREM - major sleep state
apart from REMS; comprises sleep stages 1-4

Sleep
stage 1 - a stage of NREM sleep occurring after wake. Its criteria consist
of a low-voltage EEG with slowing to theta frequencies, alpha activity less
than 50%, EEG vertex spikes, and slow rolling eye movements; no sleep spindles,
K-complexes, or REMS. Stage 1 normally
assumes 4-5% of total sleep.

Sleep
stage 2 - a stage of NREM sleep characterized by sleep spindles and
K complexes against a relatively low-voltage, mixed-frequency EEG background;
high-voltage delta waves may comprise up to 20% of stage 2 epochs; usually
accounts for 45-55% of total sleep time.

Sleep
stage 3 - a stage of NREM sleep defined by at least 20 and not more
than 50% of the period (30 second epoch) consisting of EEG waves less than
2 Hz and more than 75 uV (high -amplitude delta waves); a "delta"
sleep stage; with stage 4, it constitutes "deep "NREM sleep; appears usually only in the first third of the sleep period; usually
comprises 4-6% of total sleep time.

Sleep
stage 4 - all statements concerning
NREM stage 3 apply to stage 4 except that high-voltage, slow EEG waves,
cover 50% or more of the record; NREM
stage 4 usually takes up 12-15% of total sleep time.
Somnambulism, sleep terror, and sleep-related enuresis episodes generally
start in stage 4 or during arousals from this stage

Sleep stage REM - the stage of sleep
found in all mammal studies, including man, in which brain activity is extensive,
brain metabolism is increased, and vivid hallucinatory imagery, or dreaming
occurs (in humans). Also called "paradoxical sleep" because,
in the face of this intense excitation of the CNS and presence of spontaneous
rapid eye movements, resting muscle activity is suppressed. The EEG is
a low-voltage, fast-frequency, non alpha record. Stage REMS is usually
20-25% of total sleep time.

Sleep
structure - similar to sleep architecture.
Sleep structure, in addition to encompassing sleep stage and cycle
relationships, assesses the within-stage qualities of the EEG and other
physiological attributes.

Sleepiness
(somnolence, drowsiness) - difficulty in maintaining the wakeful state so
that the individual falls asleep if not actively kept aroused; not simply a feeling of physical tiredness or
listlessness

Sleep
talking - talking in sleep takes place during stage REMS, representing
a motor breakthrough of dream speech, or in the course of transitory arousals
from NREMS and other stages. Full
consciousness is not achieved and no memory of the event remains.

Sleepwalker
or Sleepwalking - individual subject to somnambulism (one who walks
while sleeping). Sleepwalking typically
occurs in the first third of the night during deep NREM sleep (stages 3
and 4).

Sleep-wake, 24 hour cycle - the clock
hour relationships of the major sleep and wake phases in the 24 hour cycle:
similar to sleep pattern.

Sleep-wake
shift (-change, -reversal) – sleep wholly or partially moved to a time
of customary waking activity, and the latter is moved to the habitual sleep
period; common in jet lag and shift work.

Sleep-Wake
Transition Disorder - disorder occuring during the transition from wakefulness
to sleep or from one sleep stage to another;
a form of parasomnia

Slow
wave sleep (SWS) - sleep stages 3 and 4

SmartPAP
(Smart CPAP) - (Smart [Continuous] Positive Airway Pressure) Medical
device used in the treatment of obstructive sleep apnea providing preset
levels of continuous airflow, and automatically adjusting to keep the breathing
passages open by sensing changes in airway integrity. The air flows from
the device through a tube that connects to a nose or face mask.

Snoring
- noise produced primarily with inspiratory respiration during sleep owing
to vibration of the soft palate and the pillars of the oropharyngeal inlet. Many snorers have incomplete obstruction of
the upper airway, and may develop obstructive sleep apnea.

Soft
Palate - membranous and muscular fold suspended from the posterior margin
of the hard palate and partially separating the oral cavity from the pharynx

Somatic
Complaints - awareness of pain or problems in the body

Somnambulism
- walking while asleep

Somnifacient
- inducing sleep; hypnotic, as in a drug

Somnolence
- prolonged drowsiness or sleepiness.

Somnoplasty
- commercial name for radiofrequency treatment of certain sleep disorders

Soporific
- causing or tending to cause sleep

Spindle
REMS - condition in which sleep spindles persist atypically in REMS;
seen in chronic DIMS conditions

Stanford
Sleepiness Scale (SSS) - 7-point rating scale consisting of seven numbered
statements describing subjective levels of sleepiness/alertness

Subjective
Sleepiness - feelings of sleepiness

Substance
Abuse - excessive use of alcohol or drug;
substances can cause sleep disturbances

Subwakefulness
syndrome - syndrome defined as a defect in the CNS support system for
waking. The few individuals reported
with subwakefulness syndrome have daytime drowsiness and daytime sleep episodes
that are always composed of NREMS stages 1 or 2. The naps occur repetitively

Sudden
Infant Death Syndrome (SIDS) - sudden
and unexpected death of an apparently healthy infant, whose death remains
unexplained after the performance of an adequate postmortem investigation. Death usually occurs during sleep. SIDS is a classification that is used to describe
a deceased infant. It is not a disease, nor can it be a diagnosis for a
living baby.

Synchronization
- chronobiological term used to indicate that two or more rhythms recur
with the same phase relationship. In
an EEG tracing, the term is used to indicate an increased amplitude with
an occasional decreased frequency of the dominant activities.

Synchrony
- scheduling sleep to synchronize with the biological clock

Tachycardia
- rapid heart rate, usually defined by a pulse rate of over 100 beats per
minute (bpm).

Thermocouples
- small devices placed near the nostrils or mouth to measure air flow by
sensing temperature changes; expired air is warmer than inspired air.

Thermoregulation
- regulation of body temperature in mammals.

Theta
waves - EEG activity with a frequency of 4-8 Hz

Thoracic
Excursion - thoracic (chest) movement, indicating respiratory effort. Usually measured by the placement of a sensor
band, which includes a strain gauge around the chest. The sensor band records chest wall movement
associated with respirations..

Tidal
Volume - amount of air that
passes in and out of the lungs in an ordinary breath;
usually expressed in liters

Titration
- progressive, stepwise increase in CPAP pressure applied during a polysomnogram
to establish the optimal treatment pressure

Tolerance
- in pharmacology, refers to the reduced responsiveness to a drug's action
as the result of previous continued and/or multiple exposure

Tonic
(Event/Activity) - brain, muscle, or autonomic events, which are continuous.
Usually refers to continuous activity (e.g. muscle atonia) during
REM sleep.

Tonsils
- pair of prominent masses of lymphoid tissue that are located opposite
each other in the throat between the anterior and posterior pillars of the
fauces (the narrow passage from the mouth to the pharynx situated between
the soft palate and the base of the tongue). Composed of lymph follicles
grouped around one or more deep crypts.

Tonsillectomy
- surgical removal of the tonsils

Total
Recording Time - duration of time from sleep onset to final awakening.
I n addition to total sleep time, it is comprised of the time taken up by
wake periods and movement time until wake-up.

Total
sleep period - period of time measured from sleep onset to final awakening.
In addition to total sleep time, it is comprised of the time taken up by
arousals and movement time until wake-up

Total
sleep time (TST) - amount of actual sleep time in a sleep period; equal
to total sleep period less movement and awake time. Total sleep time is the total of all REMS and NREMS in a sleep period.

Tracheotomy
- surgical procedure to create an opening in the trachea (windpipe) so that
one can breathe

Tracheostomy
- refers to the opening in the trachea. As a treatment for severe obstructive
sleep apnea, a tube to assist oxygenation and ventilation and/or to overcome
an obstruction in the airway located superiorly.

Transducer
- device designed to convert energy from one form to another

Transient
Arousals - brief awakenings from sleep

Transient
Insomnia - difficulty sleeping for only a few nights

Tricyclic
Antidepressants - medication for depression.
Most tricyclic antidepressants also reduce REM sleep; also used to control cataplectic attacks, hypnogogic
hallucinations, and sleep paralysis.

Tumescence
(penile) - hardening and expansion of the penis: penile erection. Commonly
referred to as nocturnal penile tumescence (NPT) in sleep recordings.

Turbinate
- small, shelf-like, cartilaginous structures covered by mucous membranes,
which protrude into the nasal airway to help warm, humidify, and cleanse
inhaled air on its way to the lungs.

Twilight
Zone - slang popular term to describe the waking state of individuals
whose MSLT scores are 5 minutes or less. Such individuals are usually sleep
deprived or suffer from a sleep disorder.

Twitch
(Body Twitch) - very small body movement such as a local foot or finger
jerk which is not usually associated with an arousal.

Unattended
CPAP Titration Study - sleep study that is usually performed in the
home, after determining that a patient has a sleep related breathing disorder
such as OSA or Upper Airway Resistance Syndrome, and is likely to benefit
from CPAP therapy.

Unintended
Sleep Episode - sleep episode that is not planned and may happen during
an activity in which such an episode is hazardous, such as when driving
a car or working with machinery

Upper
Airway - part of the respiratory anatomy that includes the nose, nostrils,
sinus passages, septum, turbinates; the
tongue, jaws, hard and soft palate, muscles of the tongue and throat, etc.

Upper
Airway Resistance Syndrome (UARS) - part of the spectrum of obstructive
sleep-related breathing disorders in which repetitive increases in resistance
to airflow in the upper airway lead to brief arousals and daytime fatigue. Apneas and hypopneas (see RDI) may be totally
absent. Blood oxygen levels can
be in the normal range.

Uvula
- small soft structure hanging from the bottom of the soft palate in the
midline above the back of the tongue.

Uvulopalatopharyngoplasty
(UPPP) - also abbreviated as UPP or UP3 this operation is performed
on the throat to treat snoring and sleep apnea.
UPPP is an accepted means of surgical treatment has a curative rate
of less than 50%. Scientific evidence
suggests that UPPP works best in retropalatal and combination retropalatal
and retrolingual obstruction

Wake
time - total
time that is scored awake in a polysomnogram occurring between sleep onset
and final wake-up

White
Noise - mixture of sound waves extending over a wide frequency range
that may be used to mask unwanted noise that may interfere with sleep

Wilkinson
Addition Test - performance test; numbers
added for one hour. Often included in a battery of tests to measure the
impact of acute or chronic sleep loss.

Withdrawal
- effects experienced when a patient stops taking sleeping pills

Zeitgeber
- environmental time cue that entrains biological rhythms to a specific
periodicity. Known Zeitgebers are
light, melatonin and physical activity.
To be effective, these signals must occur when the biological clock
is in a responsive phase.

 

 

Abbreviations

AB - Automatic Behavior



AD - Alzheimer's Disease

ADA - Americans with Disabilities Act

ADD - Attention Deficit Disorder

ADHD - Attention Deficit Hyperactivity Disorder



AERMS - ambulatory electrocardiogram-respiration monitoring system

AHI – Apnea/Hypopnea Index

AI – Apnea Index



APAP (Auto-CPAP) - auto-titrating, self-adjusting device




BDZ – Benzodiazepine



Bi-PAP (BPAP) - Trademark name of a Bi-Level cpap machine.




BMI – Body Mass Index

BPM – Beats per minute

C - Cataplexy

CDC - Center for Disease Control

CFIDS - Chronic Fatigue Immune Dysfunction Syndrome

CFS - Chronic Fatigue Syndrome




CHF - Congestive Heart Failure

CNS – Central nervous system

CPAP - Continuous Positive Airway Pressure (a nasal device to relieve obstructed breathing in a sleeping patient)

cps – cycles per second




CSR – Cheyne-Stokes respiration

DIMS – Disorders of Initiating and Maintaining Sleep

DME - Durable Medical Equipment

DOES – Disorders of Excessive Somnolence

DSPS - Delayed Sleep Phase Syndrome



Dx - Diagnosis

EDS - Excessive Daytime Sleepiness

EEG – Electroencephalogram



EH - Essential Hypersomnia

EKG - Electrocardiogram

EMG – Electromyogram



ENT – Ear, nose, and throat

EOG – Electro-oculogram

EPAP - Expiratory Positive Airway Pressure

ENT - Ear, Nose, and Throat

GABA - Gamma-Amniobutyric Acid

GERD – Gastroesophageal Reflux Disease

GHB - Gammahydroxybutyrate (a substance occurring naturally in the brain.  To be sold as Xyrem)

HH - Hypnogogic Hallucinations

HLA - Human Leukocyte Antigen

Hz - Hertz (frequency)



Hx - Medical History

IH - Idiopathic Hypersomnia



IPAP - Inspiratory Positive Airway Pressure



IRM - Institute of Respiratory Medicine

ITS - I'm Tired Syndrome

LAUP - Laser assisted uvulopalatoplasty

LMN - Letter of Medical Necessity

LTD - Long Term Disability




LO - Lights Out (beginning of sleep recording)

MAO - Monoamine Oxidase (an enzyme in the brain tissue)

MAOI - Monoamine Oxidase inhibitor (a class of anti-depressant.MHC)




MIRS - mandibular inclined repositioning splint

MRI - Magnetic Resonance Imagry

MHC - Major Histocompatibility Complex

MMOA (MMA) - Mandibular Maxillary Osteotomy and Advancement

MSLT - Multiple Sleep Latency Test

MWT - maintenance of wakefulness test

N – Narcolepsy

NCSDR - National Commission on Sleep Disorders Research

NN - Narcolepsy Network

NMH - Neurally Mediated Hypotension

NPT – Nocturnal Penile Tumescence

NREM – Non-Rapid Eye Movement (sleep)



NS-RED – Nonturnal sleep related eating disorder

OCD - Obsessive Compulsive Disorder



ODI - Oxygen desaturation index

OLP - Online Psych

O2 - Oxygen



OSA - Obstructive sleep apnea



OSAS - Obstructive sleep apnea syndrome




PCP - Primary Care Physician

PET - Positron Emission Tomography

PLMD - Periodic Leg Movement Disorder

PLMS - Periodic Leg Movements of Sleep

PND – Paroxsymal Nocturnal Dyspnea

PO2 - partial pressure of oxygen (O2) in the blood.

PSG  - Polysomnogram

PTSD - post traumatic stress disorder

PWC - Persons w/CFIDS

PWN - Person (People) with Narcolepsy

PWON - Person (People) without Narcolepsy

POPWN - Parent of a person w/ Narcolepsy



PS – Paradoxical Sleep



QS – Quiet Sleep




RERA – Respiratory effort-related arousal



RBD – Rem Behavior Disorder

RCP – Respiratory Care Practitioner

RDI – Respiratory Disturbance Index

REM - Rapid Eye Movement (sleep)

REML – REM latency

RF - Radiofrequency

RLS - Restless Leg Syndrome



R/O - Rule out

RSD - Reflex Sympathetic Dystrophy

Rx - Prescription

SA - Sleep apnea

SAD - Seasonal Affective Disorder

SaO2 - % of normal Oxygen level in the blood.

SAS - Sleep Apnea Syndrome



SAHS - Sleep apnea/hypopnoea syndrome




SDB - Sleep disordered breathing

SEGS – Number of REM Segments

SEI – Sleep efficiency index




SEM – Slow Eye Movement



SIDS – Sudden Infant Death Syndrom

SL – Sleep latency

SO – Sleep onset

SOREM - Sleep onset REM

SOPWN - Spouse of a PWN

SP - Sleep Paralysis

SPT – Sleep Period Time



Squib - Use of sensitive, superconductor, Josephson junction detectors to map brain activity



SRBD - Sleep-related breathing disorder




SRRD - Sleep-related respiratory disturbance

SSDB - Social Security Disability Benefits

SSI - Supplemental Security Income

SSRI - Selective Serotonin Reuptake Inhibitor (the family of anti-depressants that include Prozac, Zoloft and Wellbutrin among others).




SSS - Stanford Sleepiness Scale

STD - Short Term Disability *OR* Sexually Transmitted Disease

SWL – Slow wave latency

SWS – Slow wave sleep



SWDS – Sleep-wake schedule disorder

Sz – Schizophrenia

S1-S4 – Sleep Stages 1-4



T&A – Tonsillectomy and adenoidectomy




TB – Body Temperature



TCA – Tricyclic antidepressant

TIB – Time in Bed




TLC – Total Lung Capacity

TMT – Total Movement Time



Trec – Rectal temperature




TRD - Tongue retaining device

TRT - Total recording time

TREM – Total REM Time

TST – Total Sleep Time

TSW – Total Slow Wave Sleep (Stage 3 and 4)

TT – Total Time

TWT – Total Wake Time

Tx - Treatment

UARS – Upper Airway Resistance Syndrome

UPPP - Uvulopalatopharyngoplasty




VPAP - Variable positive airway pressure



WAFA - Wake time after final awakening



WASO - Wake time after sleep onset




XPAP - Any type of positive airway pressure device

Insomnia

Insomnia is a symptom^[1] of a sleeping disorder characterized by persistent difficulty falling asleep or staying asleep despite the opportunity. Insomnia is a symptom, not a stand-alone diagnosis or a disease. By definition, insomnia is "difficulty initiating or maintaining sleep, or both" and it may be due to inadequate quality or quantity of sleep. It is typically followed by functional impairment while awake. Insomniacs have been known to complain about being unable to close their eyes or "rest their mind" for more than a few minutes at a time. Both organic and non-organic insomnia constitute a sleep disorder.^[2]

According to the U.S. Department of Health and Human Services in year 2007, approximately 64 million Americans suffer from insomnia on a regular basis each year.^[3] Insomnia is 1.4 times more common in women than in men.^[

Content: 1 Types of insomnia 2 Patterns of insomnia 3 Causes 4 Epidemiology 5 Diagnosis 6 Sleep duration and mortality 7 Insomnia versus poor sleep quality 8 Treatment for insomnia 8.1 Non-pharmacological strategies 8.1.1 Cognitive behavior therapy 8.2 Medications 8.2.1 Benzodiazepines 8.2.2 Non-benzodiazepines 8.2.3 Antidepressants 8.2.4 Melatonin and melatonin agonists 8.2.5 Antihistamines 8.2.6 Atypical antipsychotics 8.2.7 Other substances 8.3 Sexual activity 9 See also 10 References

Types of insomnia

Although there are several different degrees of insomnia, three types of insomnia have been clearly identified: transient, acute, and chronic.

1. Transient insomnia lasts from days to weeks. It can be caused by another disorder, by changes in the sleep environment, by the timing of sleep, severe depression, or by stress. Its consequences - sleepiness and impaired psychomotor performance - are similar to those of sleep deprivation.^[5]
2. Acute insomnia is the inability to consistently sleep well for a period of between three weeks to six months.^[6]
3. Chronic insomnia lasts for years at a time. It can be caused by another disorder, or it can be a primary disorder. Its effects can vary according to its causes. They might include sleepiness, muscular fatigue, hallucinations, and/or mental fatigue; but people with chronic insomnia often show increased alertness. Some people that live with this disorder see things as though they were happening in slow motion, whereas moving objects seem to blend together. Can cause double vision.^[5]

Patterns of insomnia

The pattern of insomnia often is related to the etiology.^[7] Insomnia affects 8 in 10 people.

1. Onset insomnia - difficulty falling asleep at the beginning of the night, often associated with anxiety disorders.
2. Middle-of-the-Night Insomnia - Insomnia characterized by difficulty returning to sleep after awakening in the middle of the night or waking too early in the morning. Also referred to as nocturnal awakenings. Encompasses middle and terminal insomnia.
3. Middle insomnia - waking during the middle of the night, difficulty maintaining sleep. Often associated with pain disorders or medical illness.
4. Terminal (or late) insomnia - early morning waking. Characteristic of clinical depression.

Causes

Insomnia can be caused by:

• Psychoactive drugs or stimulants, including certain medications, herbs, caffeine, cocaine, ephedrine, amphetamines, methylphenidate, MDMA, methamphetamine and modafinil
• Fluoroquinolone antibiotic drugs, see Fluoroquinolone toxicity, associated with more severe and chronic types of insomnia ^[8]
• Hormone shifts such as those that precede menstruation and those during menopause
• Life problems like fear, stress, anxiety, emotional or mental tension, work problems, financial stress, unsatisfactory sex life
• Mental disorders such as bipolar disorder, clinical depression, general anxiety disorder, post traumatic stress disorder, schizophrenia, or obsessive compulsive disorder.
• Disturbances of the circadian rhythm, such as shift work and jet lag, can cause an inability to sleep at some times of the day and excessive sleepiness at other times of the day. Jet lag is seen in people who travel through multiple time zones, as the time relative to the rising and setting of the sun no longer coincides with the body's internal concept of it. The insomnia experienced by shift workers is also a circadian rhythm sleep disorder.
• Estrogen is considered to play a significant role in women’s mental health (including insomnia). A conceptual model of how estrogen affects mood was suggested by Douma et al 2005 based on their extensive literature review relating activity of endogenous, bio-identical and synthetic estrogen with mood and well-being. They concluded the sudden estrogen withdrawal, fluctuating estrogen, and periods of sustained estrogen low levels correlated with significant mood lowering. Clinical recovery from depression postpartum, perimenopause, and postmenopause was shown to be effective after levels of estrogen were stabilized and/or restored.^[9][10]
• Certain neurological disorders, brain lesions, or a history of traumatic brain injury
• Medical conditions such as hyperthyroidism
• Abuse of over-the counter or prescription sleep aids can produce rebound insomnia
• Poor sleep hygiene, e.g., noise
• Parasomnia, which includes a number of disruptive sleep events including nightmares, sleepwalking, violent behavior while sleeping, and REM behavior disorder, in which a person moves his/her physical body in response to events within his/her dreams
• A rare genetic condition can cause a prion-based, permanent and eventually fatal form of insomnia called fatal familial insomnia
• Parasites can cause intestinal disturbances while sleeping.

A common misperception is that the amount of sleep a person requires decreases as he or she ages. The ability to sleep for long periods, rather than the need for sleep, appears to be lost as people get older. Some elderly insomniacs toss and turn in bed and occasionally fall off the bed at night, diminishing the amount of sleep they receive.^[11]

An overactive mind or physical pain may also be causes. Finding the underlying cause of insomnia is usually necessary to cure it. Insomnia can be common after the loss of a loved one, even years or decades after the death, if they have not gone through the grieving process. Overall, symptoms and the degree of their severity affect each individual differently depending on their mental health, physical condition, and attitude or personality.

Epidemiology

The National Sleep Foundation's 2002 Sleep in America poll showed that 58% of adults in the U.S. experienced symptoms of insomnia a few nights a week or more.^[12] Although insomnia was the most common sleep problem among about one half of older adults (48%), they were less likely to experience frequent symptoms of insomnia than their younger counterparts (45% vs. 62%), and their symptoms were more likely to be associated with medical conditions, according to the 2003 poll of adults between the ages of 55 and 84.^[12]

Diagnosis

Specialists in sleep medicine are qualified to diagnose the many different sleep disorders. Patients with various disorders including delayed sleep phase syndrome are often mis-diagnosed with insomnia. If a patient has trouble getting to sleep, but has normal sleep pattern once asleep, a circadian rhythm disorder is a likely cause.

Sleep duration and mortality

A survey of 1.1 million residents in America found that those who reported sleeping 7.5 hours or more had an increased rate of mortality whereas those who slept 6 hours or less had a reduced mortality ratio. Getting 8.5 or more hours of sleep per night increases the mortality rate by 15%. Severe insomnia - sleeping less than 3.5 hours in women and 4.5 hours in men - leads to a 15% increase in mortality. However, most of the increase in mortality from severe insomnia was discounted after controlling for comorbid disorders. After controlling for sleep duration and insomnia, use of sleeping pills was also found to be associated with an increased mortality rate. The lowest mortality was seen in individuals who slept between six and a half and seven and a half hours per night. Even sleeping only 4.5 hours per night is associated with very little increase in mortality. Thus mild to moderate insomnia for most people may actually increase longevity and severe insomnia has only a very small effect on mortality. As long as a patient refrains from using sleeping pills there is little to no increase in mortality associated with insomnia but there does appear to be an increase in longevity. This is reassuring for patients with insomnia in that despite the sometimes unpleasantness of insomnia, insomnia itself appears to be associated with increased longevity. It is unclear why sleeping longer than 7.5 hours is associated with excess mortality.^[13]

Insomnia versus poor sleep quality

Poor sleep quality can occur as a result of sleep apnea or clinical depression. Poor sleep quality is caused by the individual not reaching stage 4 or delta sleep which has restorative properties. There are, however, people who are unable to achieve stage 4 sleep due to brain damage who lead perfectly normal lives.

Sleep apnea is a condition that occurs when a sleeping person's breathing is interrupted, thus interrupting the normal sleep cycle. With the obstructive form of the condition, some part of the sleeper's respiratory tract loses muscle tone and partially collapses. People with obstructive sleep apnea often do not remember awakening or having difficulty breathing, but they complain of excessive sleepiness during the day. Central sleep apnea interrupts the normal breathing stimulus of the central nervous system, and the individual must actually wake up to resume breathing. This form of apnea is often related to a cerebral vascular condition, congestive heart failure, and premature aging.

Major depression leads to alterations in the function of the hypothalamic-pituitary-adrenal axis, causing excessive release of cortisol which can lead to poor sleep quality.

Nocturnal polyuria, excessive nighttime urination, can be very disturbing to sleep.^[14]

Treatment for insomnia

In many cases, insomnia is caused by another disease, side effects from medications or a psychological problem. It is important to identify or rule out medical and psychological before deciding on the treatment for the insomnia.^[15] Attention to sleep hygiene is an important first line treatment strategy and should be tried before any pharmacological approach is considered.^[16]

Non-pharmacological strategies

Non-pharmacological strategies are superior to hypnotic medication for insomnia because tolerance develops to the hypnotic effects as well as dependence can develop with rebound withdrawal effects developing upon discontinuation. Hypnotic medication is therefore only recommended for short term use. Non pharmacological strategies however, have long lasting improvements to insomnia and are recommended as a first line and long term strategy of managing insomnia. The strategies include attention to sleep hygiene, stimulus control, behavioral interventions, sleep-restriction therapy, patient education and relaxation therapy.^[17]

Cognitive behavior therapy

A recent study found that cognitive behavior therapy is more effective than hypnotic medications in controlling insomnia. In this therapy, patients are taught improved sleep habits and relieved of counter-productive assumptions about sleep. Hypnotic medications are equally effective in the short term treatment of insomnia but their effects wear off over time due to tolerance. The effects of cognitive behavior therapy have sustained and lasting effects on treating insomnia long after therapy has been discontinued.^[18][19] The addition of hypnotic medications with CBT adds no benefit in insomnia. The long lasting benefits of a course of CBT shows superiority over pharmacological hypnotic drugs. Even in the short term when compared to short term hypnotic medication such as zolpidem (Ambien), CBT still shows significant superiority. Thus CBT is recommended as a first line treatment for insomnia.^[20]

Medications

Many insomniacs rely on sleeping tablets and other sedatives to get rest. All sedative drugs have the potential of causing psychological dependence where the individual cannot psychologically accept that they can sleep without drugs^{[citation needed]}. Certain classes of sedatives such as benzodiazepines and newer nonbenzodiazepine drugs can also cause physical dependence which manifests in withdrawal symptoms if the drug is not carefully titrated down. The benzodiazepine and nonbenzodiazepine hypnotic medications also have a number of side effects such as day time fatigue, motor vehicle crashes, cognitive impairments and falls and fractures. Elderly people are more sensitive to these side effects.^[21]

In comparing the options, a systematic review found that benzodiazepines and nonbenzodiazepines have similar efficacy which was not significantly more than for antidepressants.^[22] Benzodiazepines did not have a significant tendency for more adverse drug reactions.^[22] Chronic users of hypnotic medications for insomnia do not have better sleep than chronic insomniacs who do not take medications. In fact, chronic users of hypnotic medications actually have more regular nighttime awakenings than insomniacs who do not take hypnotic medications.^[23] A further review of the literature regarding benzodiazepine hypnotic as well as the nonbenzodiazepines concluded that these drugs caused an unjustifiable risk to the individual and to public health and lack evidence of long term effectiveness. The risks include dependence, accidents and other adverse effects. Gradual discontinuation of hypnotics in long term users leads to improved health without worsening of sleep. Preferably hypnotics should be prescribed for only a few days at the lowest effective dose and avoided altogether wherever possible in the elderly.^[24]

Benzodiazepines

Main article: Benzodiazepine

The most commonly used class of hypnotics prescribed for insomnia are the benzodiazepines. Benzodiazepines bind unselectively to the GABA_A receptor.^[22] These include drugs such as temazepam, flunitrazepam, triazolam, flurazepam, midazolam, nitrazepam and quazepam. These drugs can lead to tolerance, physical dependence and the benzodiazepine withdrawal syndrome upon discontinuation, especially after consistent usage over long periods of time. Benzodiazepines while inducing unconsciousness, actually worsen sleep as they promote light sleep whilst decreasing time spent in deep sleep such as REM sleep.^[25] A further problem is with regular use of short acting sleep aids for insomnia, day time rebound anxiety can emerge.^[26]

Non-benzodiazepines

Main article: Nonbenzodiazepine

Nonbenzodiazepine sedative-hypnotic drugs, such as zolpidem, zaleplon, zopiclone and eszopiclone, are a newer classification of hypnotic medications. They work on the benzodiazepine site on the GABA_A receptor complex similarly to the benzodiazepine class of drugs. Some but not all of the nonbenzodiazepines are selective for the α₁ subunit on GABA_A receptors which is responsible for inducing sleep and may therefore have a cleaner side effect profile than the older benzodiazepines. Zopiclone and eszopiclone like benzodiazepine drugs bind unselectively to α₁, α₂, α₃ and α₅ GABA_A benzodiazepine receptors.^[27] Zolpidem is more selective and zaleplon is highly selective for the α₁ subunit thus giving them an advantage over benzodiazepines in terms of sleep architecture and a reduction in side effects.^[28][29] However, there are controversies over whether these non-benzodiazepine drugs are superior to benzodiazepines. These drugs appear to cause both psychological dependence and physical dependence though less than traditional benzodiazepines and can also cause the same memory and cognitive disturbances along with morning sedation.

Antidepressants

Main article: Antidepressants

Some antidepressants such as amitriptyline, doxepin, mirtazapine, and trazodone can often have a very strong sedative effect, and are prescribed off label to treat insomnia. ^[30] The major drawback of these drugs is that they have antihistaminergic, anticholinergic and antiadrenergic properties which can lead to many side effects. Some also alter sleep architecture. As with many benzodiazepines, the use of antidepressants in the treatment of insomnia can lead to physical dependence; withdrawal may induce rebound insomnia and actually further complicate matters in the long-term.

Mirtazapine is known to decrease sleep latency, promoting sleep effiency and increasing the total amount of sleeping time in patients suffering from both depression and insomnia ^{[31] [32]}

Melatonin and melatonin agonists

The hormone and supplement melatonin is effective in several types of insomnia. Melatonin has demonstrated effectiveness equivalent to the prescription sleeping tablet zopiclone in inducing sleep and regulating the sleep/waking cycle.^[33] One particular benefit of melatonin is that it can treat insomnia without altering the sleep pattern which is altered by many prescription sleeping tablets. Another benefit is it does not impair performance related skills.^[34][35]

Melatonin agonists, including ramelteon (Rozerem) and tasimelteon, seem to lack the potential for abuse and dependence. This class of drugs has a relatively mild side effect profile and lower likelihood of causing morning sedation. While these drugs show good effects for the treatment of insomnia due to jet lag,^[36] the results for other forms of insomnia are less promising.^[37]

Natural substances such as 5-HTP and L-Tryptophan have been said to fortify the serotonin-melatonin pathway and aid people with various sleep disorders including insomnia.^[38]

Antihistamines

The antihistamine diphenhydramine is widely used in nonprescription sleep aids such as Tylenol PM®, with a 50 mg recommended dose mandated by the FDA. In the United Kingdom, Australia, New Zealand, South Africa, and other countries, a 25 mg to 50 mg recommended dose is permitted. While it is available over the counter, the effectiveness of these agents may decrease over time and the incidence of next-day sedation is higher than for most of the newer prescription drugs. Dependence does not seem to be an issue with this class of drugs.

Cyproheptadine is a useful alternative to benzodiazepine hypnotics in the treatment of insomnia. Cyproheptadine may be superior to benzodiazepines in the treatment of insomnia because cyproheptadine enhances sleep quality and quantity whereas benzodiazepines tend to decrease sleep quality.^[39]

Atypical antipsychotics

Low doses of certain atypical antipsychotics such as quetiapine, olanzapine and risperidone are also prescribed for their sedative effect but the danger of neurological and cognitive side effects make these drugs a poor choice to treat insomnia. Over time, quetiapine may lose its effectiveness as a sedative. The ability of quetiapine to produce sedation is determined by the dosage. Higher doses (300 mg - 900 mg) are usually taken for its use as an antipsychotic, while lower doses (25 mg - 200 mg) have a marked sedative effect, e.g. if a patient takes 300 mg, he/she will more likely benefit from the drug's antipsychotic effects, but if the dose is brought down to 100 mg, it will leave the patient feeling more sedated than at 300 mg, because it primarily works as a sedative at lower doses.

Eplivanserin is an investigational drug with a mechanism similar to these antipsychotics, but probably with less side effects.

Other substances

Some insomniacs use herbs such as valerian, chamomile, lavender, hops, and passion-flower. Valerian has undergone multiple studies and appears to be modestly effective.^[40][41][42] Cannabis has also been proven as an effective treatment for insomnia. ^[43]

Middle-of-the-night awakenings due to polyuria or other effects from alcohol consumption are common, and hangovers can also lead to morning grogginess.

Insomnia may be a symptom of magnesium deficiency, or low magnesium levels, but this has not yet been proven. A healthy diet containing magnesium, can help to improve sleep in individuals without an adequate intake of magnesium.^[44]

Other reports cite the use of an elixir of cider vinegar and honey but the evidence for this is only anecdotal.^[45]

Another reported effective natural treatment of insomnia is the use of the amino acids L-Tryptophan or 5-HTTP (not both at the same time) thirty minutes prior to sleeping. These amino acids serve to aid your body and brain in the production of Serotonin and Melatonin, both essential for proper sleep ^[46]. These must be taken on an empty stomach for proper absorption. If the amino acids alone are insufficient at treating the insomnia, then you may suffer from a blood-sugar related issue such as hypoglycemia or hyperglycemia. In this case, people have reported that taking Chromium/Vanadium together with Alpha Lipoic Acid - both of which aid in balancing blood sugar - fifteen minutes after taking the amino acids seems to be fairly effective.

Sexual activity

In several cases, sexual intercourse has been found to heavily reduce stress patterns. Although in many cases stress is not the cause of insomnia.

See also

• Sleep
• Sleep disorder
• Fatal familial insomnia
• Sleep deprivation
• Delayed sleep phase syndrome
• Actigraphy
• Thai Ngoc

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Source : http://en.wikipedia.org/wiki/Insomnia