Sleep Disorders; Diagnosis.

If you have a sleep-related problem, diagnosis may be as simple as talking to your primary health care professional about the amount of sleep you're getting and taking simple steps (going to bed earlier, avoiding caffeine and alcohol) to sleep longer and better each night.

However, if you experience long-term sleep and fatigue issues that don't improve with simple lifestyle changes, consultation with a board-certified specialist is recommended. The American Board of Sleep Medicine (ABSM) certifies physicians and researchers in sleep medicine. (The ABSM's Web site, located at www.absm.org, has information on board-certified sleep specialists.)

For information on board-certified psychiatrists and/or neurologists, the American Psychiatric Association (APA) and the American Academy of Neurology (AAN) provide resources on their respective Web sites: www.psych.org and www.aan.com.

An overnight diagnostic procedure in which various body functions are measured while you sleep may be required for an accurate diagnosis of your symptoms and their potential underlying causes. A current listing of accredited sleep disorder centers and laboratories may be obtained from the American Academy of Sleep Medicine at its Web site, located at www.aasmnet.org.

As a first step in gauging the severity of your sleepiness and fatigue symptoms, consider answering the questions on the Epworth Sleepiness Scale (available online here) and the Fatigue Severity Scale (available online here), self-administered tests designed to measure an individual's general level of daytime sleepiness and fatigue. These tests are useful as screening tools and should not be used to diagnose a condition.

The typical diagnostic procedures and criteria for the most common sleep disorders are as follows:

Insomnia

The key to accurate diagnosis of insomnia is talking with your health care professional about your overall health situation. If you are experiencing chronic insomnia, be aware that one of the following conditions may be the cause of your sleeplessness.

* Medical, emotional and psychological problems.

* Depression, anxiety and emotional crises, such as a death, illness, divorce or other stressful events can interfere with sleep cycles. Chronic insomnia also can result from arthritis, kidney disease, heart failure, heartburn, asthma, Parkinson's disease and hyperthyroidism.

* Circadian rhythm disruptions such as shift work.

* Prescription or non-prescription medications.

* Use of stimulants such as caffeine and nicotine.

* Alcohol and other drug use.

* Other specific sleep disorders such as restless legs syndrome or sleep apnea.

Intermittent and transient insomnia (insomnia that lasts only for a few nights and returns from time to time) can result from:

* Temporary changes in the surrounding environment

* Stress

* Extreme temperatures

* Circadian rhythm disruptions such as jet lag

* Side effects from medication taken on a short-term basis

Patients with insomnia often are evaluated with the help of a sleep history as well as a medical history. The sleep history may be obtained from a sleep diary filled out at home or by an interview with a health care professional concerning the quantity and quality of your sleep. Your bed partner may be invited to participate in the evaluation as he or she can provide insight into snoring, movements or other symptoms of which you may be unaware. Specialized sleep studies may be recommended by your health care professional if another primary sleep disorder is suspected.

Narcolepsy

It's not unusual for individuals suffering from narcolepsy to visit a variety of health care professionals over a period of years before their symptoms are accurately diagnosed. To get an accurate diagnosis, it is a good idea to visit an accredited sleep center. Sleep specialists will use the following two tests to diagnose narcolepsy:

* The nocturnal polysomnogram ('sleep study'). This test involves continuous recording of sleep brain waves and a number of nerve and muscle functions during nighttime sleep. It also includes monitoring of one's breathing pattern and oxygen levels during sleep. When tested, people with narcolepsy fall asleep rapidly, enter REM (rapid eye movement) sleep early and may awaken often during the night. The polysomnogram also helps to detect other possible sleep disorders-such as sleep apnea - that could cause daytime sleepiness.

* The Multiple Sleep Latency Test (MSLT). During this test, a patient is given a chance to sleep every two hours during normal wake times. A sleep specialist observes the time it takes to fall asleep. This test measures the degree of daytime sleepiness and also detects when REM sleep begins. Again, people with narcolepsy fall asleep rapidly and enter REM sleep very early in their sleep cycle.

Sleep Apnea

If you suffer from sleep apnea, you might have as many as 100 or more involuntary cessations in airflow, or "apneic events," each night. It's important that sleep apnea be recognized and treated early because the condition is associated with cardiac arrhythmias, high blood pressure (experienced by up to 50 percent of sleep apnea patients), and a higher risk of heart attack and stroke. Other possible consequences of sleep apnea include depression, irritability, sexual dysfunction, nocturia (the need to urinate multiple times nightly), learning and memory difficulties and falling asleep while at work, on the phone or driving.

Sleep partners often are the first ones to suspect that something is wrong, usually from their partner's heavy snoring and apparent struggle to breathe. If you suffer from sleep apnea, you may not realize you aren't sleeping normally and may not believe it when someone tells you. For proper diagnosis, consult a health care professional with special training in sleep disorders for an evaluation. Diagnostic tests include a nocturnal polysomnogram, which is usually performed in a sleep center, but new technology may allow some sleep studies to be conducted in an individual's home.

Restless Legs Syndrome (RLS) and Periodic Limb Movements (PLM) in Sleep

Although the cause is unknown in most cases, certain factors may be associated with RLS:

* Family history: RLS is known to run in some families; parents may pass the condition on to their children

* Pregnancy: Some women experience RLS during pregnancy, especially in the last months. The symptoms usually disappear after delivery.

* Low iron levels or anemia: If you have low iron levels or anemia, you are prone to developing RLS. The symptoms may improve once the iron level or anemia is corrected. Low ferritin levels have also been associated with RLS; ferritin is a protein that the body uses to carry iron in the blood. There are some reports that supplementing iron in RLS patients with low ferritin levels may improve their symptoms.

* Chronic diseases: Kidney failure often leads to RLS as do other chronic diseases such as diabetes, rheumatoid arthritis and peripheral neuropathy.

* Caffeine intake: Decreasing caffeine consumption may improve symptoms.

* Pinched nerve root from arthritis in the lower back (sciatica).

There is no specific laboratory test that can diagnose RLS, and structural or other abnormalities usually don't contribute to the disorder. Diagnosis therefore depends on the symptoms you describe.

To help make a diagnosis, your health care professional may ask about all current and past medical problems, family history and current medications. He or she may request basic laboratory tests to assess your general health and a blood test to rule out anemia. A complete physical, a neurological exam and additional diagnostic and/or serum chemistry testing may help identify other conditions that may be secondarily associated with RLS.

Secondary causes may include: uremia (kidney failure), diabetes, rheumatoid arthritis, nerve damage (neuropathy or a pinched nerve), disorders associated with claudication (cramping, aching, tired and sometimes burning pain in the legs), abnormalities in the blood vessels and taking certain medications (such as tricyclic antidepressants like amitriptyline [Elavil] and imipramine [Tofranil]), selective serotonin reuptake inhibitors, such as fluoxetine (Prozac) and paroxetine (Paxil), as well as venlafaxine (Effexor) and lithium (Eskalith, Lithobid). In some cases, a health care professional may suggest an overnight sleep study to determine whether PLMS or other sleep problems are present. In most people with RLS, no medical problem are discovered during the physical exam or on any tests; a sleep study would detect PLMS if present, however.

Circadian Rhythm Disorders

Circadian rhythm disorders, like insomnia, can be categorized as either transient disorders or chronic disorders. Transient circadian rhythm disruptions are typically caused by temporary disturbances to sleep patterns, such as jet lag, altered sleep schedules due to work, social responsibilities or illness.

There are three types of chronic circadian rhythm disorders: (1) delayed sleep-phase syndrome (DSPS); (2) advanced sleep-phase syndrome (ASPS); and (3) irregular sleep-wake cycle. Individuals with DSPS have a persistent inability (more than six months) to fall asleep and awaken at socially accepted times. They tend to retire to bed very late and to awaken in the late morning or afternoon. Once asleep, these individuals can maintain their sleep and have normal total sleep times. Individuals with ASPS experience persistent early evening sleep onset (between 6:00 and 9:00 pm) and wake up early, generally between 3:00 and 5:00 a.m.

As with all sleep disorders, a thorough medical history is the first step to accurately diagnose circadian rhythm disorders. Be prepared to discuss your symptoms, specifically:

* which symptoms are present

* how long they last

* how severe your symptoms are

* how they affect day-time functioning

Questions should also include what, if any, medications you're taking that could interfere with sleep patterns; what steps you've tried to improve sleep patterns; and any medical or mental health conditions you have that could affect sleep. During a diagnostic examination, your health care professional likely will ask you questions about your mental health and lifestyle.

Fatigue-Related Conditions

The fatigue associated with multiple sclerosis (MS) and Parkinson's disease (PD) is intense and debilitating. If this symptom is accompanied by other markers of these conditions, such as numbness, weakness or loss of coordination (for MS) and muscle stiffness, cramping, and tremors (for PD), then your health care professional will request a complete physical examination and discuss symptoms with you to make a diagnosis. For both conditions, there is no single diagnostic test. In the case of MS, a neurologist would perform tests of reflexes and muscle strength, as well as ordering an MRI (magnetic resonance imaging test) to see if any scarring in the brain is present. If the fatigue you are experiencing is associated with depression, your health care professional will look for changes in mood, as well as disruptions in normal sleep patterns.

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Editorial Staff of the National Women's Health Resource Center 2002/03/01 2005/03/17 Adequate restful sleep, like diet and exercise, is critical to good health. Many people don't get the ideal amount of sleep they need and become chronically sleep deprived. For others who suffer from sleep disorders, such as narcolepsy and other illnesses, sleep is not refreshing. Insufficient restful sleep can result in mental and physical health problems.As many as 40 million Americans have incapacitating sleep-related problems Cataplexy,Hypnagogic hallucinations,Insomnia,Narcolepsy,Restless legs syndrome,Sleep apnea,Sleep disorders,Sleep paralysis