Sleep Disorders

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What do you mean by sleep disorders?

Sleep disorders include insomnia, hypersomnia, advanced sleep wake phase disorder, delayed sleep wake phase disorder, parasomnias, sleep related movement disorders and sleep related breathing disorders. Sleep disorders might be an outcome of the pathophysiology of psychiatric disorders or outcome of the treatment modalities offered.

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    What are the factors affecting my sleep?

    The factors that impact the typical night sleep are time to fall asleep, wake time, time taken to get up from bed, quality of nocturnal sleep, daytime Napping, timing, duration, quality of sleep during naps, number of naps, regularity of this schedule, pre-bedtime behaviour, use of addictive substances before going to bed and the environment in bedroom.

    What is insomnia?

    Insomnia is a condition encompassing problems related to initiation of sleep, maintenance of sleep or there is early morning awakening. Insomnia can be diagnosed only if the individuals are given adequate opportunity to fall asleep and they experience such difficulty for at least 3 out of 7 days a week for upto a month. A person experiencing insomnia is significantly distressed and persistently preoccupied with it.

    What is our current understanding of Insomnia?

    Our understanding regarding insomnia has changed over the years. Earlier we used to differentiate between primary and secondary insomnia, however, the recent research has challenged this belief. Current literature suggests that insomnia cannot be considered merely as a symptom of psychiatric disorders. It is rather co-morbid with the psychiatric and other medical conditions, and if not treated early, through the process of kindling it becomes chronic which has multiple health and economic implications.

    What are the disorders that might mimic insomnia ?

    Sleep related breathing disorders

    • Obstructive sleep apnea
    • Central sleep apnea

    Central disorders of hypersomnolence Narcolepsy
    Sleep related movement disorders

    • Restless Legs Syndrome
    • Nocturnal Myoclonus (sleep starts)
    • Sleep Related leg cramps
    • Sleep related bruxism
    • Sleep related rhythmic movement disorder

    Parasomnias

    • Sleep‐walking
    • Sleep terrors
    • Nightmare disorder

    Circadian Rhythm Sleep Disorders

    • Advanced Sleep Wake Phase disorder • Delayed Sleep Wake phase disorder
    • Shift worker disorder
    • Irregular Sleep wake rhythm disorder

    What treatment is available for insomnia?

    The management plan made for insomnia is often individualized. Based on personalized case history the clinician advices pharmacotherapy or psychotherapy like cognitive behaviour therapy as indicated.

    What are the goals of treatment of insomnia?

    The treatment given for insomnia focuses on reducing the latency for sleep onset, improve the sleep time and overall quality of sleep and reduce early morning awakenings.

    What is Hypersomnia?

    International Classification of Sleep Disorder (ICSD 3) defines daytime sleepiness as: “the inability to stay awake and alert during the major waking episodes of the day, resulting in periods of irrepressible need for sleep or unintended lapses into drowsiness or sleep”. Sleepiness varies in severity and is more common during sedentary, boring, and monotonous situations that require little active participation. Some patients are aware of increasing sleepiness before falling asleep, whereas others can fall asleep with little or no prodromal symptoms (“sleep attacks”).mExcessive daytime sleepiness impairs productivity and exponentially increases the risk of accidents, particularly in occupations like transportation, military, healthcare, factory workers etc. excessive sleepiness is reported by 10-25% of the general population in different parts of the world. However, as of now there are no prevalence studies from India on hypersomnia/ excessive sleepiness.

    What is Restless legs Syndrome?

    Restless legs syndrome is characterized by an urge to move legs that is often accompanied by dysesthesias in the muscles. The urge improves with the movement of the legs or application of a counterirritant. Symptoms are seen only in the evening and rest worsens the symptoms. This condition interferes with the sleep significantly. In some patients, significant sleep fatigue or poor concentration is reported in absence of RLS, but with polysomnographic evidence of periodic limb movements during sleep (PLMS), in all such cases the term periodic limb movement disorder (PLMD) is used. It is an autosomal dominant, sensorimotor disorder in which patient complains of a peculiar creepy or crawling sensation in the extremities Prevalence varies between 2-11% across different studies depending upon the geographical locations and populations included.

    Best Treatment of Sleep Disorders in Delhi & Noida

    rTMS in
    Sleep Disorders

    • The man should be the sexual leader
    • Masturbation is wrong
    • A woman should not initiate sex
    • Men should not express their emotions
    • A woman should always have sex when her partner makes sexual
    • approaches
    • All physical contact must lead to sex
    • Good sex leads to a wild orgasm
    • A man feels like having sex at any time
    • Sex equals intercourse

    Medications in
    Sleep Disorders

    • Sex happens automatically
    • A `respectable’ woman should not enjoy sex too much and should
    • certainly never masturbate
    • All other couples have sex several times a week; have orgasm every time
    • they have sex & orgasm simultaneously
    • There must be something wrong with the relationship if sex is not good
    • Cultural beliefs about formation of Semen and genital secretions

    Psychotherapy in
    Sleep Disorders

    • Role of ‘Physical strength’ or ‘Muscle power’ in sexual performance
    • Size of the penis
    • Circumcision and sexual performance
    • Bending of Penis
    • Vasectomy/tubectomy decreases sexual potency
    • Drugs enhance sexual potency in normal persons
    • Porn increases sexual drive

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