Sleep Disorders

actual storyline of the dream, while latent content is the hidden meaning of the dream, which is usually sexual according to Freud. Carl Jung also believed that dreams tap into the unconscious. It was felt that certain themes are the same across all cultures.

Dreams are thought to be a way to construct a virtual reality that can be used to manage issues in the wakefulness period. Lucid dreaming happens when there is partial wakefulness so that the person has some control over the outcome of the dream.

SLEEP DISORDERS

There are several different types of sleep disorders. In general, sleep disorders are very common, affecting up to half the population at any given point in time.

Insomnia is the most common sleep disorder and represents the inability to fall asleep or the inability to stay asleep during the night. The criterion for the disorder is having problems at least three nights per week for at least one month s time. There is associated anxiety around falling asleep, which further exacerbates the sleep problem. The patient with chronic anxiety often has depressive symptoms.

Insomnia can be due to poor sleep habits and may be related to exercise, mental health issues, drug use, and age. Interventions that can help insomnia include increased physical activity during the day, OTC or prescription sleeping medications, limitation of caffeine, and improved sleep habits. Those with severe insomnia should see a doctor for management. Cognitive behavioral therapy can help to some degree.

There are some types of parasomnias, which are disruptive sleep experiences that can happen in REM sleep or non-REM sleep. Examples of parasomnias include restless leg syndrome, sleepwalking, and night terrors.

Sleep walking is called somnambulism. The sleepwalker will participate in complex behaviors while actually asleep. It happens in slow-wave sleep most often but can happen in any stage of sleep. It is largely treated with medications like benzodiazepines and antidepressants but the value of these is questionable.

REM sleep behavior disorder involves a lack of muscle paralysis during REM sleep. In a sense, the person acts out their dreams, which can be dangerous to the person or their

sleeping partner. While the most effective treatment is clonazepam, it often predates the onset of Parkinson s disease. Melatonin and keeping the person safe while sleeping are other adjunctive treatments.

Another parasomnia is restless leg syndrome. The patient will have unusual or uncomfortable feelings in their legs while drowsy or trying to sleep. The person gets relief from moving the legs, which feel restless. This leads to difficulty getting to sleep. It is commonly seen in chronic kidney disease or in those who have diabetes.

Night terrors involve a feeling of panic and fear, in which the patient appears to be awake but later will not recall the event. It is much more common in young children, who are inconsolable but will eventually fall asleep. Most children will outgrow the problem without sequelae.

Sleep apnea often affects older individuals but can affect children. There are two types. One is obstructive sleep apnea, in which the patient frequently snores but airflow stops, even with efforts at trying to breathe, because of upper airway obstruction. The second is central sleep apnea, where efforts to breathe during sleep are not made. Both types lead to disrupted sleep and daytime fatigue and lack of concentration. A big risk for this is cardiovascular disease. The individual is often obese but it doesn t necessarily have to be the case. The primary treatment for sleep apnea is CPAP, which stands for continuous positive airway pressure. It is a sleeping mask that keeps the airway open during sleep.

Sudden infant death syndrome (SIDs) is a sleep disorder in which a young infant stops breathing during sleep, resulting in death. It is more often seen in prematurity, high body temperatures, and smoking in the home. Infants who sleep on their back have a decreased risk of this, while prone infants have an increased risk.

Narcolepsy involves the need to sleep at inappropriate times. It can be associated with cataplexy, which is a sudden loss of muscle tone while awake. Some individuals will have very vivid hallucinations during the attack, making a narcoleptic episode similar to REM sleep. The episodes are triggered by stress or high arousal situations. It is potentially dangerous if it happens while driving or using heavy equipment. It is treated