Frequently Asked Questions

Primary insomnia is sleeplessness that is not attributable to a medical, psychiatric, or environmental cause. The diagnostic criteria for primary insomnia from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) is as follows:

Predominant complaint is difficulty initiating or maintaining sleep or non-restorative sleep for at least 1 month. Sleep disturbance (or associated daytime fatigue) causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. Sleep disturbance does not occur exclusively during the course of narcolepsy, breathing-related sleep disorder, circadian rhythm sleep disorder, or parasomnia. Disturbance does not occur exclusively during the course of another mental disorder (eg, major depressive disorder, generalized anxiety disorder, delirium). Disturbance is not due to the direct physiologic effects of a substance (eg, drug abuse, medication) or a general medical condition.

Psycho-physiological insomnia The primary components involved are intermittent periods of stress, which result in poor sleep and generate 2 maladaptive behaviours,

a vicious cycle of trying harder to sleep and becoming tenser, expressed as "trying too hard to sleep," and
bedroom and other sleep-related activities (eg, brushing teeth) conditioning the patient to frustration and arousal.

Bad sleep habits such as those naturally acquired during periods of stress occasionally are reinforced and, therefore, are prevented from extinction and become persistent. Thus, the insomnia continues for years after the stress has abated and is labelled persistent psycho-physiological insomnia. Idiopathic insomnia Lifelong sleeplessness is attributed to an abnormality in the neurological control of the sleep-wake cycle involving many areas of the reticular activating system (promoting wakefulness) as well as areas such as solitary nuclei, raphe nuclei, and medial forebrain area (promoting sleep). Possibly, a so-called neuroanatomic, neurophysiologic, or neurochemical lesion exists in the sleep system in which patients tend to be on the extreme end of the spectrum toward arousal.

Sleep state misperception Complaint of insomnia occurs without objective evidence of any sleep disturbance. Frequency: Primary insomnia is diagnosed in approximately 15% of patients with insomnia who are referred to sleep disorder centres following exclusion of other predisposing conditions. However, true incidence is not known. Mortality/Morbidity: Whether the consequences associated with chronic insomnia outweigh the costs of treatment remains debatable.

Despite that, the following associations have been noted: Increased risk of mortality is associated with short sleep lengths. Insomnia is the best predictor of the future development of depression. Increased risk exists of developing anxiety, alcohol and drug use disorders, and nicotine dependence. Poor health and decreased activity occur. Onset of insomnia in older patients is related to decreased survival. Primary insomnia is more common in women than men.

Q. Can I bring my favorite pillow?

Yes, if it will make you feel more comfortable.

Q. I work nights and sleep during the day. Can I have the test during the day?

Yes, we provide daytime testing as well. Let us know you are a shift worker when you make the appointment.

Q. Why do I need a sleep study?

A sleep study is commonly performed to investigate the following symptoms: - Unrefreshing sleep - Daytime sleepiness - Breath-holding episodes during sleep - Loud snoring (to look for evidence of sleep apnea) - Leg twitching / restless legs at night - Abnormal behaviors at night (violent and non-violent behaviors in sleep) - During sleep there are important changes in the brain and body, and disrupted or poor quality sleep can have an effect on mood, performance and our ability to function during the day.

Q. What is a sleep study (Polysomnogram)?

Sleep study, or polysomnogram, is a recording that contains several types of measurements that are used to identify different sleep stages, monitor breathing, heart rate and body movements and to assist in the diagnosis of various sleep problems. Although sleep is a time of resting, some of the body systems are actually more active during sleep than when awake. Many parts of the brain control and influence the different stages of sleep.

These sleep stages include drowsiness (stage 1 sleep), light sleep (Stage 2), deep sleep (slow wave sleep), and rapid eye movement sleep (REM sleep - the sleep stage when most dreaming occurs). We can tell which stage of sleep a person is in by measuring different activities of the brain and body. These activities include brain waves, eye movements, and muscle tone.

For some sleep disorders such as sleep walking or talking, restless limb movements, or teeth grinding, you may also be videotaped during the sleep study for later review of any abnormalities observed during the study. The sleep technologist will let you know if this will be done and will ask for your signed consent.

Q. How are various body activities measured at the sleep lab?

The activities that occur during sleep (brain waves, muscle movements, eye movements, breathing, snoring, heart rate and leg movements) are monitored by applying small metal discs called electrodes to the head and skin. The majority of these electrodes are taped to the skin using hypoallergenic tape and those on the scalp and beards are kept in place using a water-soluble paste. Flexible, stretchy belts are placed around your chest and abdomen in order to monitor your breathing. The level of oxygen in you blood and your heart rate are monitored by a device which clips on to your finger or earlobe. Please inform the sleep technologist on arrival at the sleep laboratory if you have any allergies to certain tape or to latex.

Q. How do you expect me to sleep in such a different environment with all those wires on me?

This is the most frequently asked question by patients prior to their sleep studies. In fact, most patients have no trouble sleeping in the Sleep Laboratory despite wearing the recording equipment. During the test, you will sleep in your own private room. We have attempted to make the surrounding as comfortable as possible.

The rooms are equipped for patients requiring oxygen during the night. If you have a particular pillow or blanket that you find comfortable to sleep with, please feel free to bring it with you for your sleep study. Each patient has his/her own separate bedroom. You may read in bed prior to the study or go to the television room in order to try and maintain your nightly routine. We prefer to have all our patients in bed by 11:00pm, so that we will have at least 6 hours of recording available to analyze.

The electrodes are gathered together in a kind of "ponytail" behind your head so that you will be able to roll over and change position almost as easily as you would at home. The sleep lab staff encourage patients to inform them if something is uncomfortable so that it can be fixed to help you sleep better. During the sleep study you will be able to sleep in any position, turn over in bed, and get up to the bathroom.

You may feel strange at first with the electrodes on your skin, however, most people do not find them an obstacle to falling asleep. The sleep specialist recognizes that you may not sleep in the lab exactly as you do at home, but in most cases this does not cause a problem in obtaining the necessary information from your study

Q. Sleep Problems in Pregnancy

In the last three months of pregnancy women may have difficulty sleeping. They might have problems falling asleep, getting comfortable or be troubled by unpleasant dreams and nightmares. Women who were able to sleep a lot in the early stages of pregnancy may find themselves sleeping very little during the final stage mainly because of the many physical changes taking place. Various physical and mental conditions can disturb sleep.

Leg cramps.
Awareness of their heartbeats and shortness of breath.
Needing to pass urine more often.

A very active baby who seems to be an expert at landing kicks in the mother's bladder or some other tender spot. Difficulty turning over in bed as the uterus gets bigger. Backache, especially pains in the lower back. More dreams than usual. Nightmares that are easier to remember. Feeling nervous about the forthcoming delivery. Worries about the baby. Worrying about whether it's normal to be worried. Thes are all common conditions during any pregnancy.

Q. How can I get a good night's sleep?

If you have cramps in your legs, pressing the feet hard against the wall or standing up on the cramped leg will help ease the discomfort. Lack of calcium can make cramps worse, so it's important to get enough calcium through milk products, for example. A pounding heartbeat or shortness of breath is due to an increase in the volume of blood in the body.

If you are anaemic, the heart must do more work in order to transport enough oxygen around the body. Ask your doctor or midwife if an iron supplement might help. The best resting position when pregnant is to lie on your side with your knees bent. This makes the heart's job easier because it stops the weight of the baby applying pressure to your large veins, which carry the blood back to the heart. It is also much better for your lower back to lie on your side. If you have pain in your lower back, experiment with extra pillows to see how you can make yourself more comfortable when lying down. For example, try one pillow under your abdomen, one between your legs, a firm one behind your back and an extra pillow under your head.

Wanting to pass urine at night is common during pregnancy because the growing baby puts constant pressure on the bladder. It is probably unavoidable, but trying not to drink too much late in the evenings might help a little. Avoid drinks containing caffeine such as tea, coffee, fizzy drinks since these stimulate your kidneys to produce more urine and are also mild mental stimulants.

It might also help to lie on your side instead of on your back. If it hurts when you urinate, you might have cystitis, so take a sample of your urine to your doctor or midwife. The bigger your baby becomes, the more difficult it will be for you to turn over in bed. If this is a real problem, you could consider buying a turning sheet. This is a two-ply sheet with two glossy sides, which makes it easier to turn over because they help reduce friction.

Dreams and nightmares can be disturbing and many women suddenly remember much more of their dreams when they are pregnant. Being in a different state such as pregnancy creates a lot of new material for the subconscious. Talking to someone else about your dreams can help you make more sense of them and can make them less frightening.

If you are afraid of the delivery and the pain it may cause, it is advisable to join antenatal classes. Here you will be told what is going to happen to you and which exercises will be helpful during the delivery. It is also an opportunity to ask questions. Talk with your doctor or midwife if you are afraid. Almost all women worry now and then whether their child is normal and fear that something could be wrong. What can I do when I can't sleep? Remember that sleeping pills are not recommended for pregnant women. If you simply can't sleep, this is not dangerous provided it does not exhaust you. Many people benefit from relaxation exercises or from listening to music. If you feel tired during the day, see if you can take a little nap. Go to your doctor or midwife and discuss your problem. They can help you find a solution to your problem.

Q. What Is Narcolepsy?

Narcolepsy is a chronic sleep disorder which has recently been discovered to be genetic in origin. The main characteristic of narcolepsy is excessive and overwhelming daytime sleepiness, even after adequate nighttime sleep.
A person with narcolepsy is likely to become drowsy or to fall asleep, often at inappropriate times and places. Daytime sleep attacks may occur with or without warning and may be irresistible. These attacks can occur repeatedly in a single day. Drowsiness may persist for prolonged periods of time. In addition, nighttime sleep may be fragmented with frequent awakenings.

Three other classic symptoms of narcolepsy, which may not occur in all patients, are:

Cataplexy: Sudden episodes of loss of muscle function, ranging from slight weakness (such as limpness at the neck or knees, sagging facial muscles, or inability to speak clearly) to complete body collapse. Attacks may be triggered by sudden emotional reactions such as laughter, anger, or fear and may last from a few seconds to several minutes. The person remains conscious throughout the episode.
Sleep paralysis: Temporary inability to talk or move when falling asleep or waking up. It may last a few seconds to minutes.
Hypnagogic hallucinations: Vivid, often frightening, dream-like experiences that occur while dozing or falling asleep.

Daytime sleepiness, sleep paralysis, and hypnagogic hallucinations can also occur in people who do not have narcolepsy. In most cases, the first symptom of narcolepsy to appear is excessive and overwhelming daytime sleepiness. The other symptoms may begin alone or in combination months or years after the onset of the daytime sleep attacks.

There are wide variations in the development, severity, and order of appearance of cataplexy, sleep paralysis, and hypnagogic hallucinations in individuals. Only about 20 to 25 percent of people with narcolepsy experience all four symptoms.

The excessive daytime sleepiness generally persists throughout life, but sleep paralysis and hypnagogic hallucinations may not. The symptoms of narcolepsy, especially the excessive daytime sleepiness and cataplexy, often become severe enough to cause serious disruptions in a person's social, personal, and professional lives and severely limit activities.

Q. When Should You Suspect Narcolepsy?

You should be checked for narcolepsy if:

you often feel excessively and overwhelmingly sleepy during the day, even after having had a full night's sleep;
you fall asleep when you do not intend to, such as while having dinner, talking, driving, or working;
you collapse suddenly or your neck muscles feel too weak to hold up your head when you laugh or become angry, surprised, or shocked;
you find yourself briefly unable to talk or move while falling asleep or waking up.

Q. How Common Is Narcolepsy?

Although it is estimated that narcolepsy afflicts as many as 200,000 Americans, fewer than 50,000 are diagnosed. It is as widespread as Parkinson's disease or multiple sclerosis and more prevalent than cystic fibrosis, but it is less well known. Narcolepsy is often mistaken for depression, epilepsy, or the side effects of medications.

Q. Who Gets Narcolepsy?

Narcolepsy can occur in both men and women at any age, although its symptoms are usually first noticed in teenagers or young adults. There is strong evidence that narcolepsy may run in families; 8 to 12 percent of people with narcolepsy have a close relative with the disease.

Q. What Happens In Narcolepsy?

Normally, when an individual is awake, brain waves show a regular rhythm. When a person first falls asleep, the brain waves become slower and less regular. This sleep state is called non-rapid eye movement (NREM) sleep. After about an hour and a half of NREM sleep, the brain waves begin to show a more active pattern again, even though the person is in deep sleep. This sleep state, called rapid eye movement (REM) sleep, is when dreaming occurs.

In narcolepsy, the order and length of NREM and REM sleep periods are disturbed, with REM sleep occurring at sleep onset instead of after a period of NREM sleep. Thus, narcolepsy is a disorder in which REM sleep appears at an abnormal time. Also, some of the aspects of REM sleep that normally occur only during sleep--lack of muscle tone, sleep paralysis, and vivid dreams--occur at other times in people with narcolepsy. For example, the lack of muscle tone can occur during wakefulness in a cataplexy episode. Sleep paralysis and vivid dreams can occur while falling asleep or waking up.

Q. How Is Narcolepsy Diagnosed?

Diagnosis is relatively easy when all the symptoms of narcolepsy are present. But if the sleep attacks are isolated and cataplexy is mild or absent, diagnosis is more difficult. Two tests that are commonly used in diagnosing narcolepsy are the polysomnogram and the multiple sleep latency test. These tests are usually performed by a sleep specialist. The polysomnogram involves continuous recording of sleep brain waves and a number of nerve and muscle functions during nighttime sleep. When tested, people with narcolepsy fall asleep rapidly, enter REM sleep early, and may awaken often during the night. The polysomnogram also helps to detect other possible sleep disorders that could cause daytime sleepiness.

For the multiple sleep latency test, a person is given a chance to sleep every 2 hours during normal wake times. Observations are made of the time taken to reach various stages of sleep. This test measures the degree of daytime sleepiness and also detects how soon REM sleep begins. Again, people with narcolepsy fall asleep rapidly and enter REM sleep early.

Q. How Is Narcolepsy Treated?

Although there is no cure for narcolepsy, treatment options are available to help reduce the various symptoms. Treatment is individualized depending on the severity of the symptoms, and it may take weeks or months for an optimal regimen to be worked out. Complete control of sleepiness and cataplexy is rarely possible. Treatment is primarily by medications, but lifestyle changes are also important. The main treatment of excessive daytime sleepiness in narcolepsy is with a group of drugs called central nervous system stimulants. For cataplexy and other REM-sleep symptoms, antidepressant medications and other drugs that suppress REM sleep are prescribed. Caffeine and over-the-counter drugs have not been shown to be effective and are not recommended.

In addition to drug therapy, an important part of treatment is scheduling short naps (10 to 15 minutes) two to three times per day to help control excessive daytime sleepiness and help the person stay as alert as possible. Daytime naps are not a replacement for nighttime sleep.

Ongoing communication among the physician, the person with narcolepsy, and family members about the response to treatment is necessary to achieve and maintain the best control.