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When you come for your appointment please remember to obtain and bring the following
For all appointments & enquiries, please call (02) 4252 7333 We are happy to hear from you.
Consultant Paediatrician and Sleep Specialist
Virginia sees children with suspected developmental disorders, with an expertise in Autism Spectrum Disorder.
Virginia sees patients in Corrimal on Tuesdays.
Respiratory and Sleep Physician
Dr Samuel is a Respiratory and Sleep Physician and is a Senior Conjoint lecturer at the University of Wollongong.
His main interests include asthma, COPD, lung cancer, Interstitial lung disease, sleep medicine and respiratory failure.
Dr Samuel is widely involved in research including COPD, asthma, sleep medicine and rare lung diseases.
Sameh consults in Corrimal on Fridays.
Respiratory and Sleep Physician
Haider consults with patients who may have sleep issues such as sleep apnoea, insonmia and excessive sleepiness.
Haider consults in Corrimal on Mondays.
Respiratory and Sleep Physician
Dr Peter Jones graduated from Sydney University in 1993, completed physician training at Concord and Prince of Wales Hospital, and has been in specialist clinical practice since 2000. Dr Jones moved to Canberra in 2010 and works in hospital and private practice, specialising in Respiratory and Sleep disorders. Prior to 2010, he worked in a busy solo Respiratory and Sleep practice in Central West NSW, and acute general medicine in Orange and Bathurst. He commenced regular visits to SHS clinic in 2019. In his spare time he likes travelling, flying and playing the banjo.
Peter consults in Corrimal on Fridays.
Dr Catherine Jonas is a Consultant Paediatrician and a Paediatric Sleep Physician
Catherine sees children for general consultations as well as sleep issues.
Catherine has her clinic at Southern Healthcare Specialists on Thursdays.
Diagnostic Sleep Studies
Polysomnography (PSG) is used in the study of sleep and as a diagnostic tool in sleep medicine.
Polysomnography is a comprehensive recording of the biophysiological changes that occur during sleep and monitors many body functions including brain waves, eye movements, breathing, oxygen levels, muscle activity and heart rhythm during sleep. It is used to diagnose, or rule out, many types of sleep disorders and the testing procedure is called a diagnostic sleep study.
During a diagnostic sleep study, the sensors used are non-invasive and do not hurt. Tiny sensors are applied to the skin of your scalp, face, chest, fingers and legs in order to monitor and record the biological signals of sleep.
We perform full, level 1 attended polysomnography, the international gold standard for sleep studies.
Attended studies (sleep studies that are performed with the oversight of a sleep technologist or sleep scientist) with full sleep staging (sleep staging monitors the transition through the sleep stages, traditionally with the use of EEG electrodes that monitor the brain). Type I devices must include the following channels:
Continuous Positive Airway Pressure Titration Studies (CPAP)
Continuous positive airway pressure (CPAP) was invented by Professor Colin Sullivan in June 1980 whilst a Physician at Royal Prince Alfred Hospital, Sydney and is the international gold standard for the treatment of obstructive sleep apnoea (OSA).
Continuous positive airway pressure (CPAP) delivers mild air pressure on a continuous basis to keep the airway continuously open in patients who snore or experience complete upper airway collapse (apnoea) during sleep. CPAP devices apply continuous positive airway pressure throughout the breathing cycle and functions as a ‘splint’, maintaining upper airway patency.
The Institute of Sleep Medicine uses the latest state of the art CPAP equipment for these pressure titrations. A full Polysomnogram (PSG) similar to that used during a diagnostic sleep study is also used during a CPAP titration study. We perform only manual in-lab CPAP titration studies and not “Autoset” titration studies.
Some CPAP machines have other features as well, such as heated humidifiers. CPAP is the gold standard treatment for obstructive sleep apnoea, in which the mild pressure from CPAP prevents the airway from collapsing or becoming blocked.
Delivery of CPAP through a nasal mask is the most common modality of treatment, however, other systems exist for interfacing including oral masks and naso-oral masks.
By treating your sleep apnoea, you can reduce your risk of heart disease. Sleep apnea is linked to a variety of heart problems because it causes you to stop breathing many times each night. These breathing pauses increase the pressure in your chest, causes changes in your blood pressure and can reduce your blood oxygen levels. This puts an enormous strain on your heart.
If you have sleep apnoea, consistent CPAP use can reduce your risk of stroke, one of the leading causes of death and long-term disability. A stroke is a sudden loss in brain function. It occurs when there is a blockage or rupture in one of the blood vessels leading to the brain. People with untreated sleep apnoea are two to four times more likely to have a stroke.
Using CPAP to treat your sleep apnoea can improve insulin sensitivity. Sleep apnoea is related to glucose intolerance and insulin resistance, both factors in type 2 diabetes.Untreated sleep apnoea increases your risk of getting type 2 diabetes.
Motor Vehicle Accidents
CPAP can help you become a safer driver by reducing your daytime sleepiness. Untreated sleep apnoea makes you more likely to be involved in a deadly crash. Many people with sleep apnoea have a hard time staying awake and concentrating while driving.
Sleepiness and daytime fatigue are common symptoms of sleep apnoea. CPAP can restore your normal sleep pattern and increase your total sleep time by eliminating breathing pauses in your sleep. This will help you wake up feeling more refreshed and boost your energy throughout the day.
Untreated, severe sleep apnoea can damage your brain tissue. As a result you may have trouble concentrating. You also may suffer from memory loss. Using CPAP may improve your ability to think, concentrate and make decisions.
Untreated sleep apnoea increases your risk of depression. CPAP can help improve your mood, reduce your risk of depression and improve your overall quality of life.
Snoring is partial upper airway collapse and by keeping your airway open as you sleep, CPAP eliminates the sound of your snoring. While you may not notice, your bed partner will also benefit from a quieter sleep environment.
By improving your health, CPAP therapy can reduce your medical expenses. Sleep apnoea can lead to more health problems and more doctors’ visits. Treatment for serious health risks linked to sleep apnoea such as heart disease, stroke and diabetes can be costly. Medical expenses will decrease when you use CPAP to treat your sleep apnoea.
Mandibular Advancement Splint Efficacy Studies
Sleep apnoea is a condition characterised by periods of reduced or arrested breathing during sleep. Obstructive sleep apnoea refers to the repeated episodes of upper respiratory tract blockage during sleep. During these episodes, breathing reduces or stops and then resumes with a snort, gasp or jerk.
A mandibular splint or mandibular advancement splint (MAS) is a device worn in the mouth that is used to treat orofacial disorders including: obstructive sleep apnoea (OSA) and snoring. The splint is customised to the precise shape of your mouth, and treats snoring and sleep apnoea by moving the lower jaw forward slightly, which tightens the soft tissue and muscles of the upper airway to prevent obstruction of the airway during sleep. The tightening created by the device also prevents the tissues of the upper airway from vibrating as air passes over them – the most common cause of loud snoring. The splint design helps to maintain an open and unobstructed airway which improves breathing and sleep patterns preventing daytime fatigue. It is usually recommended for patients who have trouble using a CPAP machine (continuous positive airway pressure device which consists of a mask connected to a pump that delivers pressurised air).
Your doctor will perform a sleep study and other diagnostic tests to evaluate your breathing patterns and the degree of apnoea. Mandibular advancement splints are usually designed by a dentist experienced in making these devices in collaboration with the sleep specialist. The splint is constructed on a mould made from a dental impression. The device is supported by the teeth and causes the lower jaw to protrude forward opening the airway. Further adjustments are dependent on the degree of mandibular advancement and the level of comfort. Sleep studies may be performed with the device on to assess the success of treatment.
Mandibular advancement splints are not recommended in individuals with severe or complicated form of sleep apnoea, stiff jaws or limited tooth support.
A well-fitted splint should be comfortable during use. Initially, some individuals feel discomfort but this tends to get better with prolonged use. You may experience a slight pain in the jaw due to the protrusion which usually disappears in the morning when the appliance is removed. Tooth tenderness and excess salivation are the other associated potential drawbacks.
Multiple Sleep Latency Test (MSLT)
The Multiple Sleep Latency Test (MSLT) is a sleep disorder diagnostic tool. It is used to measure the time elapsed from the start of a daytime nap period to the first signs of sleep, called sleep latency. The test is based on the idea that the sleepier people are, the faster they will fall asleep.
The MSLT is used extensively to test for narcolepsy, to distinguish between physical tiredness and true excessive daytime sleepiness, or to assess whether treatments for breathing disorders are working. Its main purpose is to discover how readily a person will fall asleep in a conducive setting, how consistent or variable this is, and the way they fall asleep in terms of Rapid Eye Movement sleep. This can be used to identify and differentiate between various sleep problems.
The test consists of four or five 20-minute nap opportunities set two hours apart, often following an overnight sleep study. During the test, data such as the patient’s brain waves, electroencephalograph, muscle activity, and eye movements are monitored and recorded. The entire test normally takes about 7 hours during the course of a day.Running a holiday sale or weekly special? Definitely promote it here to get customers excited about getting a sweet deal.
Maintenance of Wakefulness Test (MWT)
The Maintenance of Wakefulness Test (MWT) is used to measure how alert you are during the day. It shows whether or not you are able to stay awake for a defined period of time. This is an indicator of how well you are able to function and remain alert in quiet times of inactivity.
The test is based on the idea that your ability to stay awake may be more important to know in some cases than how fast you fall asleep. This is the case when the MWT is used to see how well a sleep disorders patient is able to stay awake after starting treatment. It is also used to help judge whether a patient is too tired to drive or perform other daily tasks.
The test isolates you from outside factors that can influence your ability to fall asleep. These factors include such things as the following:
The MWT is used to see if someone with a sleep disorder is responding well to treatment. Results of multiple tests may be compared over a period of time. This can show if treatment is helping a patient overcome sleepiness.
The MWT may be used to evaluate how well a person with a sleep disorder is able to stay awake. This is critical when the person’s job involves public transportation or safety. The results of the test will be only one factor used to assess the potential risk of a work-related accident.Have you opened a new location, redesigned your shop, or added a new product or service? Don't keep it to yourself, let folks know.
Home Sleep Studies
If our Respiratory Physicians view you as a suitable candidate, you may be offered a portable, home-based sleep study. This would involve attending our centre in the late afternoon/evening so that the necessary leads can be attached by an experienced Sleep Technician. All data regarding your sleep is then recorded onto a battery-operated device attached to a belt around your chest. When you wake up, you remove the leads yourself and return the equipment to us, at your convenience. The majority of the leads which are attached to your body are the same as an in-centre sleep study, the major difference is that you will not be monitored overnight by a Sleep Technician.
There is a strong and proven relationship between allergy and sleep apnoea. This test screens you for allergies to the most common inhaled allergens in NSW, including dust mite, moulds, grasses, cats, dogs and cockroaches.
Anterior Rhinomanometry (Nasal Resistance)
This test allows us to determine the resistance of air flow through the nasal passages, which is important when assessing and treating sleep apnoea and snoring.
This allows our doctors to inspect, using an endoscopic camera, your nasal passages, as well as the back of your tongue, soft palate, pharynx and the larynx (voice box). During this examination, the doctors will ask you to perform some manoeuvres to gain a better understanding of what may be causing your snoring and breathing problems in sleep.
Most babies do not sleep all night. They wake up a lot during the night. They do not do this on purpose to drive parents crazy. They are in need and signalling to parents is telling them that. Research says sleeping “through the night” is usually only between 12- 5 AM and that this is more normal than 7 PM – 7 AM. Some babies sleep “through the night” at 3 months, some take longer.
Not only that but, babies only understand “day” and ‘night” – that is, know the difference between night sleep and day sleep – at about 4 months.
Babies under approximately 6 months:
Cannot sleep all night without a feed. This is normal and unavoidable.
Often fall asleep feeding – the older they are the more they can be encouraged to be awake when they are put down – this helps them learn to fall asleep without a parent
Call to you during the night because they NEED something. Attending to their needs can alleviate the need. Therefore going to take care of their needs at this age is NOT spoiling them.
After approximately 9 months babies:
Are beginning to learn and associate the understanding that “I cry = Parent comes = I feel good.”
Can learn and remember this behaviour pattern.
How they fall asleep after the parents have attended to them depends on how the parent settles them to back to sleep. If a parent rocks them to sleep, they will come to depend on that.
They can be left to cry a little longer before being attended to at this age (but ideally not until they get distressed) so they have the opportunity to learn how to self soothe.
WHAT CAN YOU DO?
Regulating baby’s daytime schedule is helpful. This can make it easier to understand if the baby is hungry or tired. It can take time.
Put a baby and toddler down in their bed or cot awake, not asleep. Start with them drowsy and then put them down more and more awake. They may need some “cot rocking” or “patting in their cot” to make this transition easier.
Teach young children how to ‘self-soothe’ by allowing them the opportunity to learn how to do it and by making them as comfortable as they can be alone – comfort toys, dummies, nightlights can comfort them.
Remember that an infant communicates with you by CRYING. What are they asking for? Is it a NEED or is it a WANT? So when they cry for you, attend to their needs (food, nappy, thirst, anxiety) not their wants (want to be cuddled, rocked or fed to sleep, want parent to be there while they sleep). This may need some gentle but persistent teaching after about 6-7 months old.
Many problems in this age group stem from a child’s struggles between a need to develop independence and the need to be close to those they love. Common sleep disturbance in this age group include:
There are quite a few things that contribute to these sleep problems.
Poor sleep habits or poor sleep “hygiene”. This includes things like irregular bed and wake times or too much television before bed
Parent’s being inconsistent or unable to follow through on bedtime rules or routines or in the middle of the night.
The child associates something which stops them from being able to get to sleep alone. Sometimes a parent will stay or sleep with a child until they fall asleep or the child will sleep in the parental bed.
WHAT CAN YOU DO?
Teach young children how to put themselves back to sleep alone. Withdraw your presence from their sleep environment slowly but surely.
Regulate bed and wake times. Set limits at bedtime.
Be aware of the signs of fatigue in this age group during the day (hyperactivity, acting out, irritability).
Have a soothing and gentle routine before bed. Negotiate the routine with your child and make a deal.
For example: “We can ???? (e.g. read two books) if you want, but then you have to do ???? (e.g. go to bed now) “
“Would you like to do ???, then you have to do ???”
Example: Kelly was 13. Her cousin Ben was 16. They would talk on the phone until late at night. They would always get into trouble but they said they were just not tired. They had a lot of trouble getting to sleep and getting up in the morning was always hard – sometimes too hard. Ben would often fall asleep in science class in the morning.
Sound familiar? Adolescents can have delayed sleep phases. That is – they get tired later than they did before. Their bodies are not ready to sleep when the clock says it is time.
This is due to both hormonal changes and social pressures.
These all compete for sleep – sleep is low on the priority list and is often given up for these other things.
Circadian (sleep/wake) rhythm Factors:
During adolescence there is a delay in the time when melatonin (one of our sleep hormones which makes us sleepy) is released from our brains to our bodies.
Therefore adolescents are not tired until later in the evening
So their bodies are not ready to fall asleep until later – so they do things to stop being bored (TV, phone).
They find it hard to get up in the morning because they fell asleep later and have not had enough sleep.
As a result, adolescents are usually very sleepy during the week as they miss out on a couple of hours sleep per night. By the end of the week they may have a ‘sleep debt’ of 10 hours. They may sleep in on the weekend to catch up that ‘debt’. Adolescents are sleep deprived – How can they learn like that?
WHAT CAN YOU DO?
Don’t let the weekend or holiday bedtime get too late . This will push the body clock further forward and make it harder to get to sleep earlier when school or work starts again.
Be aware of the signs of fatigue in young people during the day (withdrawal, anxiety, depression, aggression, poor learning and attention).
Be realistic with bedtimes.
Napping 20 minutes at about 4 PM is better than sleeping in TOO much on weekend to pay back sleep debt.
Promote good sleep hygiene.”
Sleep apnoea is a condition characterised by cessation of breathing during sleep. Obstructive sleep apnoea refers to episodes of upper airway blockage during sleep. During these episodes, breathing stops but the effort to breathe continues until the blockage is overcome and breathing resumes with a snort, gasp or jerk. Sleep apnoea can make you wake up feeling unrefreshed.
Obstructive sleep apnoea is more common in the obese and in individuals with thick necks and small, reduced or obstructed airway passages due to excessive weight, swollen tonsils, a large tongue, a deviated nasal septum or craniofacial morphology.
To diagnose obstructive sleep apnoea a sleep study such as a polysomnogram is conducted which measures breathing patterns, air flow, blood oxygen levels, electrical activity of the brain, heart rate, muscle activity and eye movements. A Polysomnogram can be performed either at a sleep laboratory or at home.
Treatment depends on the cause of airway obstruction. The aim of treatment is to restore normal breathing during sleep and prevent excessive daytime sleepiness.Having a big sale, on-site celebrity, or other event? Be sure to announce it so everybody knows and gets excited about it.
The term central sleep apnoea encompasses a group of sleep-related breathing disorders in which respiratory effort is diminished or absent in an intermittent or cyclical fashion during sleep. In most cases, central sleep apnoea is associated with obstructive sleep apnoea syndromes or is caused by an underlying medical condition, recent ascent to high altitude, or narcotic use. Primary central sleep apnoea is a rare condition, the etiology of which is not entirely understood.
During polysomnography (PSG), a central apnoeic event is conventionally defined as cessation of airflow for 10 seconds or longer without an identifiable respiratory effort. In contrast, an obstructive apnoeic event has a discernible ventilatory effort during the period of airflow cessation.
In general, treatment of central sleep apnoea is often more difficult than treatment of obstructive sleep apnoea and treatment varies according to the specific syndrome. Central sleep apnoea in adults includes primary central sleep apnoea, Cheyne-Stokes breathing-central sleep apnoea (CSBCSA) pattern, high-altitude periodic breathing, central sleep apnoea due to medical conditions other than Cheyne-Stokes, and central sleep apnoea due to drugs or substances.
During sleep, behavioural control is lost and chemical control is the major mechanism regulating ventilation. Central sleep apnoea is most often seen during non–rapid eye movement (NREM) sleep, when behavioural influence is least, followed by rapid eye movement (REM) sleep, while a fully awake person is least likely to manifest it. Despite these changes, ventilatory control during sleep remains similar to that during wakefulness.
The types of pathophysiologic phenomena which can cause central sleep apnoea syndromes are ventilatory instability or depression of the brainstem respiratory centres or chemoreceptors.Are your customers raving about you on social media? Share their great stories to help turn potential customers into loyal ones.
Snoring is the vibration of respiratory structures and the resulting sound due to obstructed air movement during breathing while sleeping. In some cases, the sound may be soft, but in most cases, it can be loud and unpleasant. Snoring during sleep may be a sign, or first alarm, of obstructive sleep apnoea (OSA).
Snoring is known to cause sleep deprivation to snorers and those around them, as well as daytime drowsiness, irritability, lack of focus and decreased libido. It has also been suggested that it can cause significant psychological and social damage to sufferers. Multiple studies reveal a positive correlation between loud snoring and risk of heart attack (+34% chance) and stroke (+67% chance).
Though snoring is often considered a minor affliction and accepted as normal, snorers can sometimes suffer severe impairment of lifestyle. Snoring is associated with the development of carotid artery atherosclerosis. It has been demonstrated that snoring vibrations are transmitted to the carotid artery, identifying a possible mechanism for snoring-associated carotid artery damage and atherosclerotic plaque development. The amplification of the snoring energy within the carotid lumen at certain frequencies, adding to this scenario. Vibration of the carotid artery with snoring also lends itself as a potential mechanism for atherosclerotic plaque rupture and consequently ischemic stroke. Researchers also hypothesise that loud snoring could create turbulence in carotid artery blood flow. Increased turbulence irritates blood cells and has previously been implicated as a cause of atherosclerosis.Running a holiday sale or weekly special? Definitely promote it here to get customers excited about getting a sweet deal.
Periodic limb movement disorder (PLMD) or periodic leg movements is a sleep disorder characterised by repetitive cramping or jerking movements of the legs that often disturb sleep and cause daytime sleepiness. The condition usually develops after middle age and may coexist with other sleep disorders. Periodic leg movement disorder may be primary in origin without an identified cause or may be associated with medical conditions such as diabetes, sleep apnoea (periods of reduced or arrested breathing during sleep), conditions affecting the spinal cord, and intake or withdrawal of certain medications.
The leg movements are repetitive movements that occur every 20-40 seconds during sleep and usually involve the joints of the knee, ankle and big toe. The limb jerks last about 2 seconds and are often reported by bed partners. Individuals with periodic leg movement disorder experience day time lethargy/sleepiness and restless legs syndrome (a condition characterised by unpleasant sensations in the legs when at rest and an urge to move the legs).
PLMD should not be confused with restless leg syndrome (RLS). RLS occurs while awake as well as when asleep, and when awake, there is a voluntary response to an uncomfortable feeling in the legs. PLMD on the other hand is involuntary, and the patient is often unaware of these movements altogether.
Patients with PLMD will complain of excessive daytime sleepiness, falling asleep during the day, trouble falling asleep at night, and difficulty staying asleep throughout the night. Patients also display involuntary limb movements that occur at periodic intervals anywhere from 20–40 seconds apart. They often only last the first half of the night during non-REM sleep stages. Movements do not occur during REM because of muscle atonia.
To diagnose periodic limb movement, your medical and drug history is reviewed and a thorough physical examination is performed. Possible neurological disorders are ruled out. An overnight sleep study called a polysomnogram may be conducted to identify periodic leg movements or any other sleep disorders. The study measures breathing patterns, air flow, blood oxygen levels, electrical activity of the brain, heart rate, muscular activity, limb and eye movements. Blood and urine tests may also be performed to diagnose underlying medical conditions or identify the presence of drugs.
Periodic leg movements due to secondary causes may be treated by addressing the underlying medical condition. Primary periodic leg movements cannot be completely cured.Your doctor will prescribe medications to reduce the leg movements or help you sleep through the jerks. These medicines usually act on the nervous system by reducing muscle contractions regulating muscle movements, or intensifying sleep.
Talk with your doctor if you have any questions about your medications or notice any side effects.
Narcolepsy is a rare neurological disorder that affects the brain’s ability to regulate normal sleepwake cycles. The term narcolepsy derives from the Greek νάρκη (narkē, "numbness" or "stupor"), and λῆψις (lepsis), "attack" or "seizure". It is a chronic disease most commonly affecting adolescents and young adults. It is characterized by daytime fatigue, sleep attack (falling asleep suddenly), temporary loss of control over the muscles in response to certain emotions (such as anger and laughter), and sleep paralysis, a temporary inability to move or talk when waking or falling asleep.
Narcolepsy is often caused due to a deficiency of orexin, a chemical in the brain that regulates sleep. However the exact cause of narcolepsy is not always clear. Hormonal changes during puberty and menopause, psychological stress, a sudden change in sleep cycles or an infection may trigger narcolepsy. To confirm a diagnosis of narcolepsy, your doctor may ask you to maintain a sleep log. Your levels of orexin may be measured, and tests such as polysomnography (measures body functions during sleep) and multiple sleep latency tests (measures brain activity during the day) may be ordered.
There is no cure for narcolepsy, patients with narcolepsy can be substantially helped, but not cured. Treatment is tailored to the individual, based on symptoms and therapeutic response. The time required to achieve optimal control of symptoms is highly variable, and may take several months or longer. Medication adjustments are frequently necessary, and complete control of symptoms is seldom possible. While oral medications are the mainstay of formal narcolepsy treatment, lifestyle changes are also important.
Hypersomnolence is a condition characterised by excessive sleepiness, which interferes with your daily activities. Patients usually fall asleep during the day at inappropriate times such as during work, while conversing and eating. This condition may also be characterised by symptoms such as difficulty in waking, irritation, hallucinations, loss of appetite, and slow speech and thinking. This condition is mainly caused due to an underlying sleep disorder or neurological condition, sleep deprivation, drug or alcohol abuse, being overweight, head injuries or heredity.
Hypersomnolence can be diagnosed by evaluating your sleeping habits and sleep cycle, i.e. how much sleep you get and how often you wake up during the night. Polysomnography (measures body functions during sleep) and an electroencephalogram (measures the electrical activity of the brain) may also be ordered to confirm the diagnosis. Hypersomnolence can be treated with the help of medications such as stimulants or antidepressants. Some life style changes can also be applied to overcome this condition such as:
Insomnia is a sleep disorder characterised by a difficulty in falling asleep or inconsistent sleep throughout the night resulting in too little or poor-quality sleep and a feeling of exhaustion when you wake up.
Insomnia can be acute or chronic. Acute insomnia lasts from one night to a few weeks while with chronic insomnia, the sleep disturbances occur at least three nights per week, for more than a month.
Acute or short term insomnia does not require any treatment and can be often prevented or cured by practicing proper sleep habits. However, if insomnia affects your functional abilities, your physician may prescribe sleep inducing medication, for a limited period of time.
To treat chronic insomnia, your doctor will first treat any underlying medical health problems that are interfering with your sleep. If insomnia continues, behavioural therapy may be recommended to modify behaviours, which can worsen insomnia, and also learn new behaviours to promote good sleep. Other behavioural techniques such as relaxation therapy sleep restriction therapy and reconditioning may also be helpful in improving your sleep.
Relaxation Therapy: This helps reduce or eliminate night-time stress, body tension and anxiety. The goal is to calm the mind so you are able to fall asleep.
Sleep Restriction Therapy: This is a type of behavioural treatment in which your sleep efficiency is improved by initially limiting your sleep time.
Reconditioning: This approach helps your body to associate bed and bedtime with sleep. The person is usually advised to use bed only for sleep and sex. You are taught to go to bed only when sleepy. During the reconditioning process you should avoid short naps and go to bed at the same time every night. If unable to sleep, leave your bedroom and do something else until you feel sleepy.
Humans follow a 24-hour biological rhythm called the circadian rhythm, controlled by light and darkness of the surrounding environment. This determines the body’s temperature, hormone production and sleep cycles. Circadian disorders are caused due to the disruption of your circadian rhythm by changes in time zones, pregnancy, working in shifts, certain medications and changes in routine activities.
Parasomnias are abnormal events or experiences that disrupt the sleep and include unwanted perceptions, feelings, behaviours or movements. Parasomnias mostly occur during the phase of deep sleep but can also occur while falling asleep or waking up. People who have parasomnias usually don’t remember the events the next morning. Parasomnias may prevent you from getting a good night’s sleep and can affect your daily activities.
Parasomnias may be hereditary or triggered by stress, traumatic episodes, medications, alcohol or other sleep disorders.
Confusional Arousal: Acting in a strange and confused way when you wake up from sleep by a noise or some other stimulus. You are sluggish and may respond nonsensically to questions and have poor memory of the episode.
Sleepwalking: A parasomnia in which you arise from bed and move around or perform some activity in a state of sleep. Sleepwalkers are usually confused and angry if awoken and may respond aggressively if restrained. Sleepwalking can be dangerous as the sleepwalker is unaware of their surroundings and can injure themselves.
Night Terrors: You awake in a fearful state, confused and unable to communicate as you are not fully awake. You fall asleep again after some time and are unable to remember the event the next day.
Nightmares: You may awake from an unpleasant dream and experience feelings of fear and anxiety. The person having a nightmare has difficulty going back to sleep and usually remembers the terrible dream.
Sleep Paralysis: Sleep paralysis refers to the temporary inability to move that happens when you are going to sleep or waking up. During these episodes you will be unable to move or speak and may have hallucinations. Sleep paralysis may last a few seconds or minutes or may end when someone touches you or speaks to you.
REM Sleep Behaviour Disorder: People with REM sleep behaviour disorder act out action and sometimes violent dreams and may hurt themselves or others.
Other parasomnias include sleep-related eating disorders, bedwetting, groaning, and sleep talking.
Parasomnias can occur in individuals of all age groups but sleep walking/talking and bed wetting are more common in children.
Potentially dangerous parasomnias or those affecting your health and daily activities require medical attention. It’s important to consult with a sleep specialist to evaluate and treat the condition. Your sleep specialist may ask you to maintain a diary of your sleep habits and will review your sleep symptoms. Your specialist may also ask about your medical and social history to identify the type of parasomnia and the associated cause. A sleep study such as a polysomnogram is conducted which measures breathing patterns, air flow, blood oxygen levels, electrical activity of the brain, heart rate, muscle activity and eye movements.
To treat parasomnia, your specialist may prescribe medication or recommend lifestyle changes or behavioural therapy. You will be instructed on safety measures to reduce the risk of injury associated with some types of parasomnias. Treating the underlying sleep disorder may help improve the symptoms of parasomnias.