When Forty Winks fail

 
 

Ekaterina Tikhoniouk investigates the world of sleep disorders and finds some funny – and some not-so-funny – consequences of not getting a regular night’s sleep

For something that consumes about a third of our lives, sleep does not always go smoothly – because when some of the brain’s sleep mechanisms malfunction, serious medical problems can develop.

These disorders aren’t as uncommon as is believed. Almost everyone has had some experience with a sleeping disorder – like having trouble getting to sleep the night before a big event, or being unable to get up for 9am after 12 hours of solid sleep – or even waking up on your living room floor, with no idea how you got there.

In fact, surveys have shown that approximately 30 per cent of the general population has a sleeping disorder. More than half of those over 65 experience disturbed sleep, while a quarter of under-5s have some problem sleeping.

There are a total of 84 classified sleep disorders, which can be lumped into two broad categories: parasomnias and dyssomnias. Parasomnias involve unnatural movements, emotions and perceptions while sleeping or awakening. These include sleep-sex, sleep-walking and sleep-talking, teeth grinding and night terrors. On the other hand, dyssomnias are sleep disorders involving either too little or too much sleep, such as insomnia, sleep paralysis and hypersomnia.

Disorders such as insomnia are increasingly frequent around the globe, affecting one in ten people. There’s no single definition of insomnia that applies to all sufferers, but a general definition is having difficulty initiating or maintaining sleep over a period of at least three weeks. This deficit of nighttime sleep can create daytime fatigue, impairing mental and physical function during the waking hours. There can be many triggers, but one of the most commonly reported causes is stress – especially job-related anxiety. Other triggers include depression, lack of exercise, and poor sleeping habits.

There are many different ways to treat insomnia. Often a doctor may prescribe sleeping medication, but these can exacerbate the situation. Insomnia is not a disease that can be corrected with medication; it is rather a symptom of other personal or physical problems, such as high levels of stress, or physical pain or discomfort. Patients who take medications develop a tolerance to them, meaning that larger and larger doses are needed with time. Insomniacs also suffer rebound symptoms if they cease taking the medication, or try to take smaller doses, finding that they can’t sleep properly without a full dose. This common syndrome is called drug dependency insomnia.

On the other side of the scale lies hypersomnia, characterised by excessive amounts of sleep. Patients with hypersomnia will have no problem getting to sleep – in fact, they often experience recurrent bouts of drowsiness during the day, but even frequent naps do nothing to relieve symptoms. Even after 12-14 hours of sleep every night, they will have trouble waking up the next morning, and often be tired and unresponsive.

The Klein-Levin Syndrome, also nicknamed the Sleeping Beauty Disease, is the most known form of recurrent hypersomnia, involving long periods of acute drowsiness. These episodes can last from several days to several weeks, with the person sleeping close to 23 hours a day, only waking up to eat or go to the bathroom. Very little is known about its causes and treatments.

Narcolepsy is another sleeping disorder where the person has abnormal and unpredictable sleep patterns, and is characterised by recurrent “sleep attacks” that the patient cannot fight, usually lasting about 10-20 minutes. The sufferer feels refreshed by the sleep, but will often feel sleepy again several hours later.

A narcoleptic attack can include not only a bout of severe sleepiness, but also a loss in muscle tone and stability (cataplexy), which often forces the sufferer to collapse. This means that a person with narcoleptic cataplexy can enter deep sleep at inopportune moments – the sufferer could be walking down the street, watching TV, cooking dinner, or – even more worryingly – driving or doing something that requires full attention.

The exact causes of narcolepsy have not been fully documented, but some scientists believe that it is caused by the brain’s inability to adjust to a normal sleep-wake cycle. Other researchers have found that a malfunction in the immune system could be to blame. Both sides agree, however, that certain people are genetically predisposed to this disorder.

Narcolepsy is one of the most unusual and least common sleep disorders, affecting one in 4,000 people, but it’s not limited to humans – there have been case studies of narcoleptic dogs, and cats suffering bouts of cataplexy. There is no cure for narcolepsy, but in humans, it’s often treated by prescribing stimulant amphetamines, while antidepressants can help control cataplexy attacks.

Parasomnias are quite different from dyssomnias. The patient usually finds no problem with getting to sleep and staying asleep. Parasomnias are sometimes described as disorders of physiological arousal during sleep. The most well-known parasomnias are sleepwalking and sleeptalking, and some bizarre instances have even involved sleep-sex.

Sleepwalking (or ‘somnambulism’) occurs when the states of being awake and being asleep occur at the same time. The eyes are open and the muscles active, allowing sleepwalkers to act on the whims of their half-conscious brains – to quote Shakespeare, their “eyes are open, but their sense is shut.”

Sleepwalking is most common in children, with up to 17 per cent of under-12s experiencing one or more episodes during their childhoods, though this is something the child often grows out of. Roughly four per cent of adults still experience somnambulism, and the disorder appears to have a genetic factor, running in families. One researcher reported a family of grown members who were reunited for a holiday celebration. In the middle of the night they awoke to find that they had all gathered in the living room – in their sleep.

Somnambulists can do other bizarre things in their sleep, from merely walking around, and unlocking doors, to raiding the fridge, or having conversations with themselves or others in their sleep. This writer was privy to seeing an unnamed friend sit up in bed, eyes half-closed, bellowing “The key, the key! Where is the key?” before falling back to sleep. Other instances include waking up to find said friend sleepwalking repeatedly into the wall, or trying and failing to open the bedroom door.

Most people perceive sleepwalking as a comic, mildly embarrassing occurrence, and there are many anecdotes like the ones above – of sleepwalkers eating half the contents of the fridge and contentedly curling up on the kitchen floor, ‘redecorating’ the living room with muesli and moving furniture around, or putting their slippers in the microwave.

Although it is true that most instances of sleepwalking cause the individual no harm, others can be extremely dangerous – and even fatal – to the sleepwalker and those around them. Recently there have been many tragic examples of death through somnambulism, such as that of teenager Troy Heather who sleepwalked off a balcony during a holiday abroad.  There’s also a frightening increase in the number of ‘sleepdriving’ cases, in which sleepwalkers have gotten into their cars and driven for sometimes long distances, paying very little attention to traffic lights or other cars, and sometimes causing horrific road accidents.

Scientists are still not fully sure what exactly causes somnambulism, but they have discovered many relevant factors. In chronic sleepwalkers, for example, scientists have identified an accompanying respiratory disorder, which when fixed, lessens the recurrance of sleepwalking over time. Other factors include alcohol, drugs, and sleep deprivation, which is known to trigger sleepwalking in susceptible persons. Spending over 30 consecutive hours awake greatly increases the chance that a person will sleepwalk during their ‘recovery sleep’ that night.

Sleeptalking can be triggered by similar causes, but is much more common. Those who are awake can carry a conversation with the sleeptalker, as well as implant ideas into their heads. Sleeptalkers are usually very suggestible during this time.

Another disorder similar to sleepwalking is sleep-sex, a parasomnia that causes people to engage in sexual acts in their sleep. They may even go as far as sexual assault or rape, and have no memory of it the next morning. People who have a history of sleepwalking or sleep talking are more likely to exhibit sexsomnia episodes. There have been relatively few case studies of this disorder; the first legal case of sleep-sex was brought as recently as 2005 when a York man, charged with rape, was acquitted after being diagnosed with sexomnia. On the other side of the globe, an Australian woman was reported as leaving her house at night and having sex with strangers while sleepwalking.

So from insomnia to hypersomnia, sleepwalking to sleeptalking, there are many things that can go wrong during sleep. Sweet dreams…

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