Sleep Disorders (Sleep Disorder)
1) Disease Description (Causes and Symptoms)
- Definition: A condition in which daily functioning is impaired due to problems with the amount, quality, or timing of sleep. Includes insomnia, hypersomnia (narcolepsy/excessive daytime sleepiness), sleep apnea, narcolepsy, and parasomnias (night terrors, sleepwalking, REM sleep behavior disorder, etc.).
- Causes and pathophysiology: Stress, aging, irregular sleep habits·shift work, medications and substances (caffeine, alcohol, analgesics, etc.), physical diseases (respiratory, endocrine, and pain disorders), psychiatric disorders (depression, anxiety), neurological disorders (narcolepsy, REM sleep abnormalities), and anatomical factors (obesity, deviated nasal septum, etc.). Major mechanisms include abnormal regulation of normal sleep stages (REM/Non‑REM) or frequent oxygen desaturation/arousals caused by airway obstruction.
- Main symptoms: Difficulty falling asleep at night, frequent awakenings or difficulty maintaining continuous sleep, excessive daytime sleepiness, snoring·temporary cessation of breathing (sleep apnea), cataplexy (narcolepsy), confusion caused by nighttime terror (night terrors), getting up and walking while asleep (sleepwalking), hypnagogic/hypnopompic hallucinations, sleep paralysis, and dream-related behaviors caused by REM sleep behavior (with a risk of injury to others or oneself), etc.
2) Treatment Methods and Precautions
- Non-pharmacological treatment (recommended as first-line treatment for all types)
- Improving sleep hygiene: Maintain regular sleep/wake times, keep the bedroom dark and quiet, use the bed only for sleeping, limit screen use before bedtime, avoid caffeine·nicotine·alcohol, and avoid vigorous exercise immediately before bedtime.
- Cognitive behavioral therapy (especially CBT‑I for chronic insomnia): Reduces reliance on sleeping pills and has long-term effects.
- Sleep restriction, stimulus control, relaxation techniques, etc.
- Diagnostic·specific treatment
- Sleep apnea (OSA): Weight loss, lateral sleeping (sleeping on one’s side), oral appliances (mandibular advancement devices), and continuous positive airway pressure (CPAP) are first-line treatments. Nasal·upper airway surgery may be considered when structural problems are present.
- Narcolepsy/hypersomnia: Stimulants (modafinil·armodafinil), methylphenidate·amphetamine-based medications, and for cataplexy, sodium oxybate (to improve nighttime sleep efficiency) or an SSRI/SNRI may sometimes be used in combination. Lifestyle management (such as regular naps) should also be implemented.
- REM sleep behavior disorder: Sleep safety measures (removing dangerous objects around the bed) and medication treatment (such as clonazepam or melatonin).
- Parasomnias (night terrors·sleepwalking): Ensure safety, control triggers (sleep deprivation·fever), and use medication if necessary (caution is needed in children).
- Medications for insomnia: Short-acting sleeping pills for short-term use (zolpidem·zaleplon·eszopiclone), low-dose doxepin (used for sleep maintenance), orexin antagonists (suvorexant), etc. Benzodiazepines should be used cautiously because of the risk of dependence·residual effects.
- Complications·precautions
- Long-term sleep deprivation can cause cognitive decline, increase the risk of traffic accidents/industrial accidents, worsen cardiovascular·metabolic diseases, and worsen depression.
- Because sleeping pills carry risks of dependence·cognitive decline·falls, short-term use at the minimum effective dose is recommended.
- In cases of narcolepsy·severe daytime sleepiness or sleep apnea, driving and operating heavy machinery should be prohibited or undertaken with caution.
- Exercise caution during pregnancy·breastfeeding and with drug interactions (antidepressants·anticoagulants, etc.).
3) Checklist Before an Outpatient Visit (Items to Bring and Records)
- Essential items/materials
- List of medications·supplements currently being taken (including dosage·time of administration)
- Sleep diary (recommended for 2 weeks): Bedtime/wake-up time, sleep latency, nighttime awakenings, naps, caffeine·alcohol consumption, and whether you work shifts
- Observation records from a companion (such as a spouse): Snoring·breathing pauses·dream-related behaviors, etc.
- Previous test results (polysomnography (PSG), Multiple Sleep Latency Test (MSLT), previous prescription records)
- Weight·BMI, neck circumference (information indicating a high risk of sleep apnea)
- Medical history: Psychiatric diagnoses, thyroid/cardiopulmonary diseases, pain disorders, etc.
- Examples of questions for recording symptoms (write these down yourself before visiting the doctor)
- "What is my average nighttime sleep duration? How many times do I wake up, and why?"
- "How severe is my daytime sleepiness? (If possible, complete the Epworth Sleepiness Scale score.)"
- "Do I exhibit behaviors during sleep (vocalizations·movements), or experience memory loss?"
4) Examples of General Questions to Ask the Doctor
- What tests are needed for these symptoms? (For example, polysomnography, MSLT)
- What are the expected effects and side effects of medication treatment?
- How likely is improvement with non-pharmacological treatment (sleep hygiene·CBT‑I)?
- What restrictions will there be on driving·work after starting treatment?
- What is the long-term prognosis, and how can I manage the condition to prevent recurrence?
5) Examples of Condition-Specific Questions
- If sleep apnea is suspected
- "Do I need polysomnography? If CPAP treatment is recommended, how will initiation and management (mask selection·pressure adjustment) proceed?"
- If narcolepsy or excessive daytime sleepiness is suspected
- "I have symptoms of cataplexy. Which medications are effective, and what measures do you recommend to improve nighttime sleep?"
- If REM sleep behavior disorder is suspected
- "Violent movements are observed while I am asleep. In addition to safety measures, how necessary is medication treatment (clonazepam·melatonin)?"
(If necessary, referral to a sleep specialty clinic·neurology·psychiatry department may be considered)