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The Neurology of Sleep

Updated: Apr 9, 2023


Article by Sucharita Desu


Sleep is essential to our health. When we don’t have enough sleep or if it's regularly disturbed, it can negatively affect our life. But, why do you struggle to get a full night’s rest? Or maybe, why do you struggle to stay awake during the day? The answer(s) to these questions all relate to sleep neurology.


Sleep neurology is a multidisciplinary field of study that combines neurology with sleep medicine. Professionals in the field diagnose and treat conditions related specifically to sleep disturbances. These disturbances may be the result of neurological sleep disorders (e.g., central sleep apnea, narcolepsy, REM sleep behvaiour disorder, sleepwalking, etc.) or other neurological conditions (e.g., epilepsy, Alzheimer’s disease, Parkinson’s disease, stroke, etc.).


Now, for a little more detail. Sleep-related disorders are a group of illnesses that affect one’s quality of life and functional ability. These disorders are categorized and diagnosed based on 3 cardinal symptoms: inability to fall asleep or sleep through the night, excessive daytime sleepiness, and sleep-related movement phenomena. It is important to accurately diagnose the disorders as effective treatments vary from condition to condition. For example, if you’re suffering from a primary sleep disorder like insomnia, you may benefit from cognitive behavioral therapy whereas you may need drug treatment for secondary sleep disorders. Keep in mind that drug use should only be short-term as you may develop tolerance and dependence on the drugs. This also means that treatments must address the underlying condition; you shouldn’t rely on sleeping pills. In addition, a proper diagnosis and treatment are essential for preventing secondary diseases and the worsening of existing conditions.


Obstructive Sleep Apnea Syndrome


One of the classifications of sleep disorders is sleep-related breathing disorders, such as obstructive sleep apnea syndrome (OSAS). It is the most common sleep-related breathing disorder and causes you to repeatedly stop and start breathing as you sleep.


OSAS occurs because your throat muscles intermittently relax and block your airway during sleep, hampering breathing for 10 or more seconds, lowering oxygen levels, and causing a buildup of carbon dioxide. Your brain senses the impaired breathing and briefly wakes you up to reopen your airway (however, you may not remember these awakenings). You may also wake up out of breath, making a snorting, choking, or gasping sound as you try to recover your breathing. This can repeat from five to 30 times every hour, all night long.


Risk factors of OSAS include excess weight, older age, a naturally narrowed airway, high blood pressure, chronic nasal congestion, smoking, diabetes, and asthma. In addition to these risk factors, there are some complications associated with OSAS, such as cardiovascular problems, eye problems (i.e., glaucoma), memory issues, mood swings, depression, complications with medications and surgery, and more.


IMPORTANT NOTE: OSAS is a risk factor for COVID-19, it increases the chance of developing a severe form of the virus and needing hospital treatment. If you contract the virus, please be sure to follow the precautionary measures advised by your local government to ensure the safety of everyone.


Some of the symptoms of OSAS include excessive daytime sleepiness as a result of interrupted sleep during the night, morning headaches, high blood pressure, mood changes (i.e., depression or irritability), and awakening with a dry mouth or sore throat. While snoring is normal, loud snoring (especially if it’s interrupted by periods of silence) may be a sign of OSAS.


If you experience any of the symptoms or notice that you are pausing your breathing during sleep, or waking up gasping or choking, be sure to check it out with your doctor. You can also ask your doctor about other problems with those symptoms as many sleep disorders have overlapping indicators.


Narcolepsy


Continuing on, another category of sleep disorders is central disorders of hypersomnolence. An example of a disorder in this category is narcolepsy, a chronic sleep disorder that causes overwhelming daytime drowsiness and sudden attacks of sleep. People with this disorder find it hard to stay awake for long periods of time, which causes serious disruptions in their daily routines.


Narcolepsy comes in two types. Type 1 narcolepsy is accompanied by a loss of muscle tone called cataplexy and is triggered by strong emotions. Type 2 narcolepsy is not accompanied by cataplexy.


Although the exact cause of narcolepsy is unknown, it is suspected that type 1 narcolepsy may be a result of low levels of the chemical hypocretin. Hypocretin is an important neurochemical in the brain that is responsible for regulating wakefulness and rapid eye movement (REM) sleep. The reason for these low levels of this chemical and the loss of its production cells is thought to be related to an autoimmune reaction of some sort. In addition, narcolepsy has a slight chance (about 1%) of being passed down genetically. There is also suspicion that the development of the disorder is associated with exposure to the swine flu virus and a certain form of vaccine administered in Europe, however, it is unclear as to why this is the case.


Risk factors of narcolepsy are age (narcolepsy starts between ages 10 and 30) and family history. There are also some complications with the disorder including public misunderstanding of the condition, interference with intimate relationships, physical harm (to others and yourself), and obesity.


Symptoms of narcolepsy are excessive daytime sleepiness, cataplexy (sudden loss of muscle tone), sleep paralysis, changes in REM sleep, and hallucinations. In addition to these symptoms, those with narcolepsy may also have other sleep disorders such as restless legs syndrome, OSAS, and insomnia.


Interestingly enough, during a sleep attack, those with narcolepsy experience automatic behaviour. For example, even if they fall asleep while performing a task (i.e., writing, typing, and driving) they continue to perform that task. When they wake up again, they may have no memory of the action.


If you experience any of these symptoms and find that your drowsiness is affecting your personal and/or professional life, it is highly recommended to see a doctor. Although there isn’t a cure, symptoms can be managed with medications and lifestyle changes. Plus, it is beneficial to have support from others to help cope with the disorder.


Keep in mind, there are other categories of sleep disorders, such as insomnias like chronic insomnia, parasomnias like somnambulism (sleepwalking), sleep-related movement disorders like restless legs syndrome, and circadian rhythm sleep disorders like jet lag. As always, this article is only a brief introduction to these disorders, therefore it is highly encouraged that you do more research. Here are some sites to get you started:

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