Sleep Disorders—a Medical Challenge

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By Salvador Quiroz

 

“To sleep: perchance to dream.” Hamlet, Act III, i, 56

When we decide to call it a day and turn out the light, all of us want a sound and restful sleep. However, 40 percent of us will not be able to achieve that goal. This group suffers from insomnia, and, at one point or another in life, members of this group will seek help from their family physician. As a consequence, they will be prescribed one of the many sleeping pills available on the market.

What few people know is that sleep disorders, as a human malady, are not usually taught in most medical schools. It is only recently that sleep clinics have begun to appear in some large teaching hospitals. In other words, physicians who know very little about the subject are managing a large percentage of these insomniacs.

A good definition of insomnia is still missing from medical textbooks. The international classification of sleep disorders published by the American Association of Sleep Disorders mentions 84 different disorders—sort of like losing sight of the forest because the trees get in your way.

So even though a good many definitions of insomnia have been proposed, the tendency is to not only consider objective criteria—the time it takes to go to sleep, the number of sleep interruption episodes, the early awakening, or the total sleep time—but to include subjective criteria, the patient’s perception of the difficulty they have falling asleep. Does the patient feel their sleep is insufficient or unsatisfactory or that the lack of sleep leads to deleterious effects on his or her diurnal activities?

The time element in sleep disorders is essential for good diagnosis and therapy. Basically, the acute problem is that which lasts no more than three weeks and is usually associated with stress. The general consensus is that the acute type of insomnia may be treated with, and respond adequately to, most hypnotic drugs (sleeping pills).

Chronic insomnia, on the other hand—that which is present for more than three weeks or appears repeatedly for long periods of time—is a different matter entirely. Sleeping pills only work in the short term. These cases should be managed by, or at least have a consultation with, a sleep medicine specialist. Usually, a polisomno graphic examination is warranted. This includes an electroencephalogram, an electrooculogram, an electrocardiogram, and an electromyogram, all performed during sleep periods. Objective and subjective parameters are noted; a complete medical evaluation is performed to identify or rule out pre-existing medical problems that may cause, magnify, or perpetuate the problem. Also, a therapeutic plan is designed for that particular patient.

This is the first part of a two-part series. Next week we will analyze the complexity of sleep management, including the use and abuse of sleeping pills. A parting thought may be that sleeping more hours is not the answer. It is also essential to have a good night’s sleep.

Dr. Salvador Quiroz, Internal Medicine and Kidney Disease, Hospital H+, Graduated from the Mayo Clinic. Tel: 152 2329.

 

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