In the Diagnostic and Statistical Manual of Mental Disorders 5, sleep-wake disorders encompass 10 conditions manifested by disturbed sleep, distress, and impairment in daytime functioning.1 Sleep disorders include insomnia, narcolepsy, restless leg syndrome, and breathing-related disorders (obstructive sleep apnea).
Excessive daytime sleepiness, or sudden somnolence, is a symptom that can occur with several sleep disorders. Excessive daytime sleepiness may include mild sleepiness, unrecognized episodes of “micro-sleep” or uncontrolled sleep attacks that result in falling asleep while in conversation, reading or watching television, or even while driving. Excessive daytime sleepiness may be caused by not getting enough hours of sleep or enough hours of quality sleep. On average, adults between 26 and 64 years of age need 7 to 9 continuous hours of sleep per day.2
Disturbed Sleep Can Affect Your Health
Disturbed sleep can have many adverse health consequences, including fatigue, decreased cognitive focus, and altered mood, and can be a potential warning sign for medical issues—researchers believe that a lack of sleep may trigger inflammatory pathways that exacerbate arthritis pain.3 About two-thirds of patients who suffer from chronic pain also report poor or non-refreshing sleep due to a mutually reinforcing relationship between these 2 conditions.4,5
The problem of pain and sleep becomes even more complicated because many medications commonly prescribed to relieve pain, such as oxycodone (OxyContin, others), morphine (MS Contin, others), and codeine, can fragment sleep, or break up the sleep cycle.6 If a patient experiences poor sleep due to pain one night, he or she is likely to experience more pain the next night and so on, creating a vicious cycle. Chronic pain frequently is associated with a sleep-wake disorder, and these coexisting problems can be difficult to treat.
Sleep-wake disorders are diagnosed through a comprehensive assessment that includes a detailed patient history, physical exam, questionnaires, sleep diaries, and sleep studies. During a typical sleep study, patients are connected to testing equipment that measures various biological functions, including brain activity, muscle activity, respiratory effort, eye movements, heart rhythm, oxygen saturation, and sleep latency, duration, and efficiency.7 The temperature of the room is maintained at a comfortable level, and the lights are turned off. After the study is completed, the patient follows up with a specialist to review the outcomes and develop a treatment plan.
By David Cosio, PhD, ABPP and Erica H. Lin, PharmD, BCACP
08/11/2015
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