Sleep Disorders

So, have you recovered yet from the switch to daylight saving’s time? Or are you still having trouble getting yourself out of bed in the morning?

Although the adjustment is slight and easily made, what you’ve been through is called Situational Circadian Rhythm Sleep Disorder (SWSD), a minor instance of the disruption of sleep patterns caused by shift work or a flight through multiple time zones.

SWSD is one of the least serious of more than a dozen recognized conditions that have millions of people walking about like zombies for lack of sleep. The good news is that sleep deprivation has been recognized in recent decades as a serious medical problem, and it is now being addressed on many fronts.

Sleep clinics, which first appeared in the 1970s, are now widespread. Sleep medicine is now a recognized specialty in the US, and there is even something called the American Board of Dental Sleep Medicine, that certifies specialists in the treatment of bruxism (grinding of the teeth in sleep). And if none of this is specialized enough for you, there’s always the polysomnogram, for which you are wired up like a Christmas tree and tested for 14 different indicators as you snooze.

Not to make light of a serious matter, but there is an undeniable comic element to the naming of some of these disorders. Take, for instance, Exploding Head Syndrome (imaginary loud noises), Periodic Limb Movement Disorder and Hypnic Jerk (woken by bedmate enraged by being kicked repeatedly).

There is also the inexplicable, such as Narcolepsy, a congenital condition, possibly genetic, that causes those who suffer it to nod off without warning at any time during the day. Its cause is unknown. Not to be confused with similar symptoms exhibited by people in long meetings.

To make sense of all these disorders, clinicians divide them into three categories: intrinsic (arising from within the body, i.e. apnea, a blockage of the air passage), extrinsic influences like alcohol or drugs, and situational, which could be just about anything in the environment, from shift work to disturbing noise or light.

I find these categories confusing and overlapping and, leaving aside the situational, prefer to think of sleep disorders as either psychologically or physically engendered, though not necessarily mutually exclusive to either.

As with all medical conditions, it is essential to look for the cause, rather than merely treating symptoms. In disorders with a psychological origin, the patient must understand that, by its very nature, sleep takes us into the subconscious mind, where repressed memories, thoughts and fears may lie. These may surface as nightmares, anxiety attacks and, eventually, even fear of sleep itself. Psychological conditions require psychological treatment, not just papering over the cracks with sleeping pills or anti-depressants.

Physical causes run the whole gamut of disease and chronic pain from cancer to sciatica, and while often more easily diagnosed than conditions of the mind, they may be even harder to treat.

Some physical causes are not necessarily so obvious. Endocrine imbalance, for instance, particularly when it involves the hormone cortisol, can disrupt sleep patterns, most often in days preceding menstruation or at the time of menopause.

In the absence of any apparent organic or psychological cause, you may have to experiment to find what works for you. There are many possibilities, from acupuncture to melatonin to herbal remedies and avoiding caffeine after noon.

And then of course there is snoring, the greatest sleep robber of them all, though it’s the innocent bystander, not the sleeper who suffers. Minor surgery can usually silence the buzz saw.

Finally, if you sleep badly, don’t put up with it. Consult a health care provider. Chronic exhaustion lowers your resistance to all manner of far more serious conditions.