guide to sleep disorders symptoms, treatment, and solutions brought to you by the alliance health network

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1 guide to sleep disorders symptoms, treatment, and solutions brought to you by the alliance health network The content in this guide is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on the DiabeticConnect.com website or The Guide to Controlling Your Diabetes.

2 You Don t Have to Live With a Sleep Disorder According to the National Institute of Neurological Disorders and Stroke, chronic sleep disorders affect at least 40 million Americans each year. Left untreated, sleep disorders and the resulting sleep deprivation can interfere with your work, driving, and social activities. Over time, sleep disorders can even have negative effects on your physical and mental well-being. You don t have to suffer from the effects of a sleep disorder. New treatments and solutions have been developed for the wide range of sleep disorders affecting millions of Americans today. This guide provides you with important information about sleep disorders, their symptoms, and available treatments, to help guide conversations with your health care professional. 1 SleepDisorderAlliance.com

3 What Is a SLEEP DISORDER? A sleep disorder (somnipathy) is any disruption in the sleep patterns of an individual. While some sleep disorders may leave you feeling unrefreshed, a number of symptoms are more severe including excessive sleepiness, snoring, difficulty falling asleep during normal sleeping hours and abnormal behaviors such as restless leg syndrome. There are even disorders that cause you to get too much sleep. Particular behaviors during normal daytime activities are telltale signs of sleep deprivation. If you are experiencing one or more of the following symptoms during the day, you may not be getting enough restful sleep at night, and you may even have a sleep disorder. Do you: Feel irritable or sleepy during the day? Have difficulty staying awake when sitting still, such as when watching television or reading? Occasionally fall asleep while driving? Have difficulty paying attention or concentrating at work, school, or home? Perform below your potential in work, school, or sports? Often hear that you look tired? Have difficulty with your memory? Have emotional outbursts? Feel tired enough to require a nap almost every day? Require caffeinated beverages to keep yourself awake? Each type of sleep disorder has its own particular symptoms, but each results in some of the above signs of sleep deprivation. If you suspect that you are not getting enough sleep or that you might have a sleep disorder, speak to your physician or a sleep specialist. If your health care professional feels that you may have a sleep disorder they may ask that you keep a sleep diary, or they may even have you stay overnight at a sleep center for observation. 2 SleepDisorderAlliance.com

4 Evaluating and Diagnosing Your Sleep Disorder If you suspect you have a sleep disorder, a sleep specialist can confirm if your suspicions are correct and he or she can make a careful and detailed medical evaluation to find the source of your sleep problem. If you suspect you have a sleep disorder, a sleep specialist can confirm if your suspicions are correct and make a careful and detailed medical evaluation to find the source of your sleep problem. A doctor or a sleep specialist can diagnose your sleep disorder based on a number of factors, including: A description of your symptoms Your age Your gender Your psychological history Your medical history A partner s or loved one s observation of your sleep patterns Keeping a Sleep Diary Keeping a sleep diary may be helpful in discussing your daily patterns with your doctor or sleep specialist. The information in your diary gives your health care professional clues about what is causing your problem and how to correct it. A sleep diary records information about your sleep routine and daily life activities that can affect your sleep. Your doctor can give you a diary, or there are several free sleep diaries that you can download off the Internet. Whichever version you choose to use, a sleep diary should track: What time you went to bed each night What time you got up in the morning How many times you woke up during the night Whether you felt rested when you woke up If you took naps during the day Whether you felt sleepy or rested throughout the day Once your doctor or sleep specialist has reviewed your sleep diary and given you a sleep questionnaire, he or she may determine that a sleep study is the most important next step. Sleep Studies In a sleep study, sensors are used to monitor how your body acts while you sleep. Charts are made of many physical measurements including your brain waves, heartbeats and breathing. Your sleep study provides doctors with the data that can help them find the cause of your sleep problem. 3 SleepDisorderAlliance.com

5 SleEP DISORDER DIAGNOSIS TESTS Epworth Sleepiness Scale This sleep questionnaire asks you to rank whether certain situations make you sleepy and, if so, how sleepy. Nocturnal polysomnogram This test measures the electrical activity of your brain (electroencephalogram) and heart (electrocardiogram), and the movement of your muscles (electromyogram) and eyes (electro-oculogram), and usually requires an overnight stay at a sleep clinic for observation purposes. Daytime Multiple Sleep Latency Test (MSLT) This test measures how long it takes for you to fall asleep during the day, plus the kind of sleep you get during such a nap. Repeated test of sustained wakefulness (RTSW) This test measures how long it takes for you to fall asleep in a situation that challenges you to stay awake. Blood test Depending upon the description of your symptoms and your personal and family medical histories, your sleep specialist may also conduct a blood test. 4 Major CaTEGORIES of Sleep Disorders There are over 100 different types of sleep disorders. Each has its own causes, symptoms, and treatments. Dyssomnias Disturbance in the amount, timing, or quality of sleep. Dyssomnias result in excessive daytime sleepiness or an inability to fall asleep or stay asleep. Dyssomnias can originate from causes inside or outside the body. Insomnia Narcolepsy Inability to stay awake (hypersomnia) Sleep apnea Restless Legs Syndrome (RLS) Periodic Limb Movement in Sleep (PLMS) Circadian rhythm sleep disorder Parasomnias Disorders of partial arousal from sleep, or disorders that interfere with sleep stage transitions. Behaviors not normally associated with sleeping may occur during sleep. Sleepwalking Sleeptalking Nightmares Sleep terrors / night terrors Nocturnal leg cramps Sleep paralysis Grinding or clenching of the teeth (bruxism) Bedwetting Sudden Infant Death Syndrome (SIDS) Sleep disorders due to medical, neurological, or psychiatric disorders. Dementia Depression Alcoholism Proposed sleep disorders Similar to other classified sleep disorders, but different enough to be considered distinct sleep disorders. Night sweats Short-sleeping Long-sleeping 4 SleepDisorderAlliance.com

6 Of these sleep disorders, the most common are: Obstructive Sleep Apnea (OSA) Sleep apnea is characterized by episodes of cessation of breathing during night time sleep that can occur as often as several hundred times in a night. Snoring is a warning that the sleeper may be a victim of sleep apnea. Insomnia Insomnia may mean you have a hard time going to sleep or that you have a hard time staying asleep. Usually, you will know if you are experiencing insomnia because you will remember tossing and turning or being awake at night. Narcolepsy Narcolepsy is a chronic neurological disorder which impairs the ability of your central nervous system to regulate sleep. Because falling asleep during some activities like walking, driving, or cooking can have drastic effects, narcolepsy is a dangerous sleep disorder. Am I at Risk for Developing a Sleep Disorder? Some sleep disorders can be triggered, and conversely, managed through your behavior and lifestyle. The following habits and conditions are risk factors for developing a sleep disorder: Poor sleep environment (e.g., too noisy, too brightly lit, too hot, or too cold) Excessive use of caffeine, alcohol, or certain medications and drugs Smoking or chewing tobacco Illness Obesity Anxiety, depression, or another mood disorder Stress, such as the death of a loved one or job pressure Unhealthy or irregular sleep routine Early or late-night bedtimes Traveling between time zones Daytime napping Shift work with a rotating schedule Restless Leg Syndrome Restless Legs Syndrome is a neurological disorder characterized by uncomfortable, tingly, or creeping sensations in your legs, which create an uncontrollable urge to keep them moving. RLS is not necessarily confined to your sleep time. 5 SleepDisorderAlliance.com

7 Obstructive Sleep Apnea (OSA) Sleep apnea is a sleep disorder characterized by pauses in breathing during sleep. These episodes, called apneas (literally, without breath ), each last long enough so one or more breaths are missed, and occur repeatedly throughout sleep. Sleep apnea is diagnosed with an overnight sleep test called a polysomnogram. The individual with sleep apnea is rarely aware of having difficulty breathing, even upon awakening. Sleep apnea is recognized as a problem by others witnessing the individual during episodes or is suspected because of its effects on the body. Symptoms may be present for years or even decades without identification, during which time the sufferer may become conditioned to the daytime sleepiness and fatigue associated with significant levels of sleep disturbance. Symptoms of Sleep Apnea Loud snoring. Cessation of breathing or choking spells in the night. Excessive daytime sleepiness. This can indicate breathing problems or blocked air passages. In severe cases, this can occur over fifty times an hour with each spell lasting as long as ten seconds. Daytime sleepiness can become so excessive that working becomes difficult and driving is dangerous. Frequent visits to the bathroom. Individuals with sleep apnea often find that they require repeated trips to the bathroom throughout the night. Severe mood swings. Sleep deprivation can affect mental health, often causing moods to shift rapidly from depression to irritability to anger. Obesity. Although some slim people do suffer from sleep apnea, the majority are overweight or obese. Low sex drive and a general lack of energy. Because individuals with sleep apnea suffer from sleep deprivation, they often find they lack the energy to perform daily activities, and even lose interest in sex. Dry mouth and sore throat in the morning. Because individuals with sleep apnea suffer from sleep deprivation, they often find they lack the energy to perform daily activities, and even lose interest in sex. Lack of concentration and forgetfulness. Sleep deprivation affects motor skills and memory. Morning headaches. Lack of sufficient air throughout the night can cause headaches. 6 SleepDisorderAlliance.com

8 Causes of Sleep Apnea Sleep apnea causes the throat to collapse during sleep, blocking the airway and preventing air from getting to the lungs. Generally, your throat muscles keep the throat and airway open. Causes of an obstructed airway include: Shape of head and neck some head and neck shapes can create a smaller than normal airway. Large tonsils or adenoids this or other anatomical differences such as a deviated septum, enlarged tongue, or receding chin can also create difficulties breathing during sleep. Excess weight or obesity although slim people can suffer from sleep apnea, obesity is a risk factor for sleep apnea. Abnormally relaxed throat muscles and tongue this can be due to alcohol or sedative use before bedtime. Other risk factors for sleep apnea include: Irregular sleep hours Snoring Smoking or exposure to secondhand smoke Nasal congestion, nasal blockages, and nasal irritants Family history of sleep apnea Other physical conditions, such as immune system abnormalities, severe heartburn or acid reflux and high blood pressure are also commonly associated with sleep apnea. It isn t clear whether these conditions are among causes or merely the result of sleep apnea. Disorders and syndromes associated with sleep apnea Hypothyroidism Acromegaly Amyloidosis Vocal cord paralysis Post-polio syndrome Neuromuscular disorders Marfan s syndrome Down Syndrome How Sleep Apnea is Diagnosed Speak with your health care professional if you suspect you might have sleep apnea or any other sleep disorder. You will most likely be asked to keep a sleep diary for a few nights.. If necessary, your health care professional may schedule a sleep test overnight in a sleep center. Sleep centers are set up much like hotels, with private rooms and baths. You will be observed while sleeping using cameras as well as monitors attached to your body. Treatments for Sleep Apnea Sleep apnea is highly treatable, and most individuals find that they experience relief from employing one or sometimes a combination of treatments. Mild to moderate sleep apnea can often be treated with behavioral modification, but most cases of sleep apnea require a physician s assistance to find the most effective treatment. The following treatments are for informational purposes only. Sleep apnea is a serious condition it s important to consult with your physician to find the treatment that is best for you. 7 SleepDisorderAlliance.com

9 Behavioral Treatments for Sleep Apnea Weight loss Reduce consumption of alcohol, tobacco, and sedatives such as sleeping pills Sleep on your side Establish a regular sleep routine Losing even 10% of your weight can reduce sleep apnea incidents and dramatically improve the quality of your sleep Avoiding the use of stimulants and depressants can reduce the likelihood of airway closure during the night Some individuals with sleep apnea find that they experience temporary relief when sleeping on the side, rather than the back Irregular sleep hours can throw off your sleep cycles and lead to breathing problems during the most important sleep stages Medical Treatments for Sleep Apnea Continuous Positive Airway Pressure (CPAP) Bilevel Positive Airway Pressure (BiPAP) Oral Devices Surgery Oxygen Administration A CPAP machine blows pressurized air into a mask worn over the nose to keep the patient s airway open during sleep. This is the most common long-term treatment for severe sleep apnea. An electronic circuit monitors the patient s breathing and provides two different pressures: one for inhalation and one for exhalation. This treatment is sometimes used for patients who find breathing out against increased pressure to be uncomfortable or disruptive to their sleep. Oral devices such as dental appliances open the patient s airway by bringing the lower jaw or tongue forward during sleep. Two common oral devices are the Mandibular Respositioning Device and the Tongue Retaining Device. Surgically removing tissue such as tonsils, adenoids, or excess tissue at the back of the throat or inside the nose increases the size of the patient s airway, allowing better airflow during sleep. Oxygen is provided to the patient via a small tube that fits inside the nose. This treatment is rarely used, although it is occasionally employed in conjunction with CPAP. 8 SleepDisorderAlliance.com

10 Insomnia Insomnia is a sleep disorder characterized by an inability to sleep and/or inability to remain asleep for a reasonable period. Insomniacs typically complain of being unable to close their eyes or rest their mind for more than a few minutes at a time. Insomnia can be caused by fear, stress, anxiety, medications, herbs, caffeine, depression, or other mental conditions and sometimes occurs for no apparent reason. An overactive mind or physical pain may also be causes. Finding the underlying cause of insomnia is usually necessary to cure it. Symptoms of Insomnia Difficulty getting to sleep and staying asleep. Waking up unrefreshed. This symptom continues night after night for a month or more in cases of chronic insomnia. Individuals with insomnia often feel like they haven t slept at all. Morning headaches. Difficulty concentrating. This is often called the hangover effect, when, in fact, the person did no drinking the night before. Sleep deprivation affects motor skills and memory. Irritability. Bloodshot eyes. Daytime sleepiness. Sleep deprivation can affect mental health, often causing moods to shift rapidly from depression to irritability to anger. Insufficient oxygen to the cornea causes small blood vessels in the eyes to become inflamed. Fatigue can cause your eyes to become bloodshot. Daytime sleepiness can become so excessive that working becomes difficult and driving is dangerous. 9 SleepDisorderAlliance.com

11 Causes of Insomnia There are many possible causes of insomnia. Sometimes there is one main cause, but often several factors interacting together will cause a sleep disturbance. Possible causes of insomnia include: Psychological or mental health issues issues such as stress, fear, anxiety, depression, or even more serious conditions such as bipolar disorder can adversely affect sleep cycles. Food and drug consumption consuming stimulants such as caffeine can disrupt sleep. In addition, drinking alcohol or using nicotine, herbal supplements, recreational drugs, or some medications can cause insomnia. Lifestyle Working shifts, traveling, napping during the day, or even exercising just before bedtime can interfere with sleep. Medical or physical conditions Pain, disease, or sleep disorders such as sleep apnea can often cause insomnia. Insomnia Statistics According to the U.S. Department of Health and Human Services, approximately 60 million Americans suffer from insomnia. Insomnia is more likely to affect women about 40 percent of sufferers are women, as opposed to 30 percent of men. Insomnia is a serious condition that can have negative affects your health and wellbeing, particularly if you have a chronic sleep problem. Surveys report that people with severe insomnia experience a quality of life similar to those who have chronic conditions such as heart failure. Effects of insomnia Poor health and diminished quality of life Impaired social functioning Increased impatience and irritability Diminished mental alertness and memory Slower reaction times and impaired concentration Increased risk of disorders such as major depression, anxiety disorder, and substance abuse Increased likelihood of automobile, home, and workplace accidents Poor job performance, missed work days, and school absences How Insomnia is Diagnosed Speak with your health care professional or a sleep specialist if you have trouble sleeping for a week or more. If your insomnia is severe, your doctor may recommend a visit to a sleep center where a team of sleep specialists will use the latest technology to monitor you while you sleep. A sleep center can also provide you with equipment to monitor your activities (awake and asleep) at home. Treatments for Insomnia Insomnia can be treated through behavioral modification, medication, sleep aids, or a combination of treatments. It is a serious disorder that can affect all aspects of your life mental, physical, and social. The treatments outlined below are for informational purposes only. It is important to consult with your physician to find the treatment that is best for you. 10 SleepDisorderAlliance.com

12 Behavioral Treatments for Insomnia Progressive Muscle Relaxation (PMR) Autogenic training Meditation Stress management Stimulus control Diet management Acupuncture, acupressure, and massage This relaxation technique is practiced by tensing certain muscle groups and then totally relaxing them. A relaxation method that calls for an individual to repeat a set of visualizations to induce a state of relaxation. Concentration on an object of thought or awareness that can calm and relax the body and mind. Being aware of and managing the amount of stress in your life can allow you to more easily relax at night when it s time to sleep. Stimulus Control therapy reassociates the bed and bedroom with sleeping by limiting the amount of time spent in the bedroom for non-sleep activities. Reducing the use of stimulants and depressants and avoiding big meals just before bed can help reduce the risk of insomnia episodes. These alternative treatments can have an extremely calming effect on your nervous system. Medicinal Treatments for Insomnia Benzodiazepines Non-benzodiazepine prescription drugs Melatonin Over-the-counter sleep aids The most commonly-used class of drugs prescribed for insomnia. Includes drugs such as temazepam, diazepam, lorazepam, and midazolam. Includes drugs such as Ambien and Lunesta. These drugs have a cleaner side effect profile than benzodiazepines but do appear to cause psychological dependence and physical dependence. A hormone that has proved effective for some insomniacs in regulating the sleep/waking cycle. Many of these sleep aids use the antihistamine diphenhydramine. The effectiveness of these aids often decrease over time and next-day sedation is common. 11 SleepDisorderAlliance.com

13 Narcolepsy Narcolepsy is a chronic neurological condition which impairs the ability of your central nervous system to regulate sleep. Individuals with narcolepsy typically experience disturbed nocturnal sleep (often confused with insomnia) and abnormal rapid eye movement (REM) sleep. Narcolepsy affects about 1 in 2,000 people. Most individuals experience their first symptoms between the ages of 10 and 25. Evidence suggests that the condition is genetic, and while it is a lifelong condition, it does not usually get progressively worse. However, narcolepsy is a serious disorder with potential physical, mental, and social consequences. Symptoms of Narcolepsy Excessive daytime sleepiness. Abnormal REM sleep. Hypnagogic hallucinations. Cataplexy. Sleep paralysis. Nighttime wakefulness. Narcoleptics may find it impossible to stay awake and often have uncontrollable episodes of sleep during the day. People with narcolepsy enter the REM, or dream, phase of sleep right after falling asleep, whereas most people take about 90 minutes to enter the REM phase. Some people with narcolepsy experience vivid, sometimes frightening, visual or auditory sensations while falling asleep or upon awakening. People with narcolepsy often have a sudden loss of muscle control while awake, usually experienced during strong emotion such as anger, grief, or while laughing. Sleep paralysis is the inability to move or talk at the beginning or end of sleep. About 25 to 50% of narcolepsy sufferers experience sleep paralysis. People with narcolepsy may have periods of wakefulness at night. This disrupted nighttime sleep adds to daytime sleepiness. 12 SleepDisorderAlliance.com

14 Causes of Narcolepsy Researchers continue to seek out the root cause of narcolepsy. Currently, the general consensus is that genetics, accompanied by an environmental trigger of some sort a virus, for example may affect brain chemicals and contribute to the disorder. Scientists have recently discovered that people with narcolepsy are lacking in hypocretin (also called orexin), a chemical in the brain that activates arousal and regulates sleep. Narcoleptics generally do not have as many Hcrt cells or neurons that secrete hypocretin, inhibiting their ability to fully control their alertness and sleep cycles. Heredity appears to be a factor in narcolepsy, but environmental triggers also play a strong role. Research is also investigating these triggers. Narcolepsy affect MANY AREAS of life: Physical well-being and safety Mental health Social and professional relationships Intimate relationships Memory and attention How Narcolepsy is Diagnosed Narcolepsy is often misdiagnosed or undiagnosed. The most common and sometimes the only symptom of narcolepsy is excessive daytime sleepiness. Because excessive daytime sleepiness is a symptom of other sleep disorders and of depression, narcolepsy can be difficult to diagnose. Diagnosis of narcolepsy can take a very long time, sometimes more than one year, or even up to several decades. Tests used to diagnose narcolepsy Epworth Sleepiness Scale This sleep questionnaire asks you to rank whether certain situations make you sleepy and, if so, how sleepy. Nocturnal polysomnogram This test will measure the electrical activity of your brain (electroencephalogram) and heart (electrocardiogram), and the movement of your muscles (electromyogram) and eyes (electro-oculogram), and usually requires an overnight stay at a sleep clinic for observation purposes. Multiple sleep latency test (MSLT) This test measures how long it takes for you to fall asleep during the day. People with narcolepsy tend to fall asleep very quickly. Spinal fluid analysis The lack of hypocretin in the cerebrospinal fluid may be a marker for narcolepsy. Examining spinal fluid is a new diagnostic test for narcolepsy. Treatments for Narcolepsy Although no cure yet exists for narcolepsy, a combination of treatments can control the symptoms. The most commonly recommended treatment for narcolepsy includes a combination of counseling, medication, and behavioral changes. The following treatments are for informational purposes only. Narcolepsy is a serious condition it s important to consult with your physician to find the treatment that is best for you. 13 SleepDisorderAlliance.com

15 Behavioral Treatments for Narcolepsy Schedule sleep periods Avoid caffeine, alcohol, and nicotine Exercise on a regular basis Wear a medical alert bracelet or necklace Individuals with narcolepsy find that a few brief, scheduled naps (no longer than 15 minutes at a time) during the day can prevent unplanned lapses into sleep during the daytime. Stimulants and depressants can interfere with sleep cycles during your normal sleeping hours. Exercise can make you feel more awake during the day and stimulate normal sleep patterns at night. A medical ID is useful to alert others to your condition if you suddenly fall asleep or become unable to move or speak. Medicinal and Herbal Treatments for Insomnia Methylphenidate (such as Ritalin) and various amphetamines Modafinil (Provigil) Antidepressants such as Vivactil, Prozac, and Zoloft Sodium oxybate (Xyrem) Effective in treating narcolepsy but can have strong side effects and can be addictive. A stimulant which acts on the central nervous system to help individuals stay alert and awake during the day. Effective, with not as many side effects. Chance of addiction is also lower than with amphetamines. These drugs suppress REM sleep and alleviate the symptoms of cataplexy, hallucinations, and sleep paralysis. Controls cataplexy and daytime sleepiness. Has strong side-effects. 14 SleepDisorderAlliance.com

16 Restless Legs Syndrome Restless Legs Syndrome is frequently misdiagnosed and often left untreated, yet RLS is a treatable condition. RLS affects about 10% of adults in North America and Europe, and incidence increases with age. Restless Legs Syndrome (RLS) is a central nervous system disorder that can interfere with resting or falling asleep. Many people describe the feeling of Restless Legs Syndrome as creeping, crawling, tingling, or pulling within the leg, along with an overwhelming need to get up and move around. Although the symptoms are distinctive, many people dismiss the feelings as muscle aches or restlessness, and do not suspect that they have RLS. Symptoms of Restless Legs Syndrome Irritating sensations in the legs. Overwhelming urge to move around. Increased discomfort in different positions and at different times of the day. Sensations such as creeping, crawling, tingling or pulling they can be painful or just uncomfortable. Getting up and moving around can relieve the discomfort when experiencing this sensation. Discomfort tends to increase when sitting or lying down and during the evening or night. 15 SleepDisorderAlliance.com

17 Causes of Restless Legs Syndrome Restless Legs Syndrome is a central nervous system disorder (a disorder based in the brain or spinal column) which may have a genetic basis. It is also possible that RLS may be a brain chemical disorder. Psychiatric conditions or stress may exacerbate RLS, but they do not cause RLS. Restless Legs Syndrome can be brought on by other conditions, including: An underlying medical problem such as diabetes mellitus, kidney disease, Parkinson s Disease, or rheumatoid arthritis. Iron deficiency anemia the way the body metabolizes iron and certain proteins in the brain may be related to restless legs syndrome. Pregnancy many women experience RLS in the last months of pregnancy, possibly as a result of an iron deficiency. Left untreated, the symptoms often go away after delivery. Neurologic lesions people with spinal cord tumors, peripheral nerve lesions, or spinal cord injury often report symptoms of RLS. Particular medications medications including tricyclic antidepressants, anti-nausea, and some cold and allergy drugs may increase or trigger RLS symptoms. Varicose veins when vein valves fail, the backward flow of blood pools and stagnates in the veins, which can lead to aching, throbbing, cramping and fatigue in the legs. Effects of Restless Legs Syndrome Restlessness An inability to sit still because the leg sensations are too annoying or painful Insomnia Difficulty falling asleep or staying asleep Daytime sleepiness RLS can keep you from getting a restful night s sleep, resulting in exhaustion during the day How Restless Legs Syndrome Syndrome is Diagnosed Talk to your doctor or sleep specialist to explore available treatments. To diagnose RLS, your doctor will request: A medical history A familial survey to see if anyone else in your family has similar symptoms Interview about other medical conditions you have A blood test for low iron levels Treatments for Restless Legs Syndrome Although no cure exists for Restless Legs Syndrome, different types of treatment can be used to manage the condition. There are three treatment approaches for RLS: Self-help If your symptoms are mild, selfhelp may be sufficient treatment. Medications For those with severe RLS, where the disorder disrupts sleep or daily activities, medications may be the proper treatment approach. Treatment of the underlying condition If your Restless Legs Syndrome is caused by an underlying condition, your doctor will treat that condition. 16 SleepDisorderAlliance.com

18 Behavioral Treatments for Restless Legs Syndrome Exercise Apply compression to your legs Take iron supplements Reduce the use of stimulants and depressants Keep a regular sleep schedule Work with your healthcare professional to determine if there is an exercise program that relieves your RLS symptoms. Wrap your legs in an ace bandage or wear tight pantyhose. For individuals with low iron levels, iron supplements sometimes offer relief. Note that too much iron in your system is dangerous, so be sure to speak with your health care professional before starting this type of supplement. Cut out coffee, chocolate, and caffeinated soda, particularly in the evening. Because exhaustion can increase symptoms, a regular sleep schedule is important to ensuring you get enough rest. Medical Treatments for Restless Legs Syndrome Dopaminergic agents (Ropinirole, Pramipexole) Benzodiazepines Non-benzodiazepine sedatives Opiates/Narcotics (Darvon, Percodan) Anticonvulsants (Neurontin) Hypertensive medications The most common treatment for RLS, these drugs increase the brain chemical dopamine (a neurotransmitter that regulates muscle movements) Sleep medications or central nervous system depressants which also suppress muscle contractions. Short-acting hypnotic agents or sleeping pills. Helpful in mild cases of RLS that occur primarily at bedtime. Pain killers. These drugs are addictive and should be used only in low dosages. Drugs normally used to prevent seizures which can reduce muscle contractions in some individuals. Most often prescribed for high blood pressure, these drugs can reduce the symptoms of RLS in some individuals. 17 SleepDisorderAlliance.com

19 Basic Tips for a Good Night s Sleep Whether you suffer from a sleep disorder or would simply like to get a better night s sleep, there are some simple things you can do to increase your chances of feeling more rested when you wake up in the morning. Create an Optimal Sleep Environment Make sure your bed is comfortable. Different types of mattresses help with different issues. Some mattresses are made to accommodate different types bedmates sleeping habits and comfort levels. Others are made to adjust to your firmness preferences. In addition, try therapeutic-shaped foam pillows that cradle your neck or extra pillows that help you sleep on your side. Make sure your sheets are comfortable and clean. Ensure your bedroom remains primarily a place for sleeping. Don t use your bed for paying bills, doing work, etc. Help your body recognize that this is a place for rest or intimacy. Keep your bedroom peaceful and comfortable. Make sure your room is well ventilated and the temperature is consistent, and try to keep it quiet. If you have a problem with outside noise, a fan or a white noise machine can help block it out. Hide your clock. A big, illuminated digital clock may cause you to focus on the time and make you feel stressed and anxious. Place your clock so you can t see the time when you are in bed. Keep Good Daytime Habits Do not nap during the day. If you are having trouble sleeping at night, try not to nap during the day. If you are feeling especially tired and feel as if you absolutely must nap, be sure to sleep for less than 30 minutes, early in the day. Limit caffeine and alcohol. Avoid drinking caffeinated or alcoholic beverages for several hours before bedtime. Don t smoke. Nicotine is a stimulant and can make it difficult to fall asleep and stay asleep. Expose yourself to bright light/sunlight soon after awakening. This will help to regulate your body s natural biological clock. Likewise, try to keep your bedroom dark while you are sleeping so that the light will not interfere with your rest. Exercise early in the day. Twenty to thirty minutes of exercise every day can help you sleep, but be sure to exercise in the morning or afternoon. Exercise stimulates the body and aerobic activity before bedtime may make falling asleep more difficult. Check your iron level. Iron deficient women tend to have more problems sleeping, so if your blood is iron poor, a supplement might help your health and your ability to sleep. 18 SleepDisorderAlliance.com