Overview

A sleep disorder is one of the most common neurological diseases. It has been typically found in both men and women. A sleep disorder can largely affect overall health, safety and quality of life. Sleep deprivation can impair ability to safely continue daily activities. It also increase risks of other health problems if this condition is left untreated.

The number of affected patients with sleep disorder has continued to rise. In accordance with these incidences, Bangkok Hospital has realized the importance of the appropriate and effective treatments provided to patients with sleep disorders. Our “Sleep Center”  is well equipped with experienced and well-trained physicians specialized in sleep disorders and neurology. To be known as one of the best neurological centers in Thailand, our multidisciplinary team comprises of neurologists, rehabilitation specialists, physiotherapists, psychiatrists, mental health specialists, nurses, clinical pharmacists and other medical personal specialized in sleep and neurological care. With international standard supported by cutting edge technology in sleep disorder and neurology, our broad spectrum of services covers accurate diagnosis, effective treatment and rehabilitation therapy. A sleep disorder has profound effects on the patient’s normal life, the safety of their families and the welfare of society. At our Sleep Center, patients can always rest assured that they always receive the appropriate treatments while taking into a great consideration of patient’s quality of life and other social and emotional aspects.

Symptoms

Common Symptoms Of Sleep Disorder Include:

• Snoring: Snoring can be diagnosed as primary snoring or obstructive sleep apnea. Primary snoring is characterized by loud upper airway breathing sounds during sleep without episodes of cessation of breath (apnea). Obstructive sleep apnea involves a decrease or complete halt in airflow despite an ongoing effort to breathe. The brain senses an inability to breathe and briefly rouses body from sleep so that airway can be opened. If left untreated, obstructive sleep apnea can increase the risk of health problems, including high blood pressure, heart failure, irregular heart beats, heart attacks, diabetes, gastroesophageal reflux disease, stroke and dementia.
• Cessation of breathing while asleep: It is the most commonly found symptom in patients with obstructive sleep apnea. During sleep, breathing stops periodically during the night. It symptom is unnoticeable unless other symptoms are co-presented such as waking up choking and waking up gasping especially when patients sleep on their own without observation.
• Nocturnal urination: Although frequent urination at night is common symptom of certain diseases such as diabetes and BPH (Benign Prostatic Hyperplasia) or even in people with drinking a large amount of water before going to bed, nighttime urination is prevalent in obstructive sleep apnea patients.
• Morning headache: Obstructive sleep apnea can contribute to morning headaches because of rising carbon dioxide levels.
• Restless legs: Restless legs make an overwhelming urge to move the legs. It is difficult to get comfortable enough to fall asleep. The symptoms are usually worse at night. It is frequently found in patients with anemia (iron deficiency), pregnant patients, patient with chronic kidney failure and more.
• Periodic limb movement disorder: It is characterized as repetitive cramping or jerking of the legs during sleep.
• Excessive daytime sleepiness (hypersomnia): The repeated awakenings associated with sleep apnea make severe daytime drowsiness, fatigue and irritability. All related effects largely interfere patient’s functions and daily activities such as ability to work and drive safely. Excessive daytime sleepiness is an important warning sign to indicate that immediate medical attention must be sought in order to get an accurate diagnosis and appropriate treatment. This symptom is typically found in any sleep abnormalities  g. insomnia, obstructive sleep apnea, narcolepsy and more.
• Impaired cognitive functions: Disrupted circadian rhythm due to lack of proper sleep is strongly linked with poor cognition and risk of cognitive impairment, in both short- and long-term. If left untreated, it might lead to memory disorders.

Types of sleep disorders

Sleep Disorders Are Classified As Follows:

1. Insomnia: It has been typically found nearly in all age groups. Insomnia is usually considered to be either acute or chronic. Insomnia becomes chronic if having trouble falling asleep or staying asleep at least three nights per week for three months or longer. Insomnia mainly includes:
   • Psychophysiological insomnia is one of the most common types of insomnia. A patient with psychophysiological insomnia focuses on their sleep, and worries about not getting enough which make it more difficult to treat.
   • Paradoxical insomnia is characterized by complaints of little or lack of sleep over long periods of time without the level of impairment expected with such a level of sleep deprivation. After conducting a sleep lab or polysomnography, the result usually reveals that patient can actually sleep with decreased sleep depth, resulting in morning weakness or fatigue which is generally perceived as lack of sleep.
   • Insufficient sleep syndrome: Insufficient sleep syndrome, also known as sleep deprivation and inadequate sleep, is a behavioral induced sleep disorder in which the sufferer simply fails to make adequate time for sufficient sleep. It has been increasingly happening in teenagers from the overuse of internet and smartphones. This sleep insufficiency leads to non-restorative sleep that results in morning weakness which profoundly affects the learning ability.
2. Central Origin of Hypersomnolence: Hypersomnias of central origin are a rare cause of excessive daytime sleepiness. It is typically caused by the abnormality of neurological system. The definite diagnosis is highly required to identify whether hypersomnolence is not generated due to lack of sufficient sleep (insufficient sleep syndrome)
3. Circadian Rhythm Disorder
   • Advanced sleep phase disorder: It is a condition that is characterized by a recurrent pattern of early evening sleepiness and early morning awakening. Nocturnal awakenings might be also found in some cases.
   • Delayed sleep phase disorder: It is a disorder in which a person’s sleep is delayed by 2 or more hours beyond the socially acceptable or conventional bedtime. This delay in falling asleep causes difficulty in waking up at the desired time especially in early morning.
   • Irregular sleep – wake rhythm: This is a rare form of circadian rhythm sleep disorder, described by numerous naps throughout the 24-hour period, no main nighttime sleep episode and irregularity from day to day. It is usually found in patients with neurodegenerative disorders.
   • Non 24 hour sleep –wake disorder (free running): It is a circadian rhythm sleep disorder in which an individual’s biological clock fails to synchronize to a 24-hour day. Most of patients are blind people especially in total blindness cases.
   • Jet lag disorder: Jet lag is a temporary disorder that causes fatigue, insomnia and other symptoms as a result of air travel across time zones. It is caused by a disruption of the internal body clock. Symptoms normally improve after resting.

Scope of services

Sleep Center is a specialized center which provides a comprehensive care for sleep disorders and other related diseases. Out dedicated sleep lab is well equipped with 4 examination rooms with a 24 hour-control room safely monitored by specialized and well-trained sleep specialists and technicians.

Our Sleep Lab (Polysomnography) is used to assess and diagnose sleep problems. Patients will be tested by using electroencephalography to monitor electrical activity of the brain, electromyography to determine electrical activity of the muscles under the chin and legs and electrocardiograms to monitor electrical activity of the heart. Other related tests include the monitoring and analysis of eye movements, blood oxygen levels and chest muscle capacity while breathing.

Sleep Lab

Sleep lab (polysomnography) is a test used to diagnose and determine the severity of sleep disorders. During the test, the continuous records include  brain waves, the oxygen level in the blood, heart rate and breathing via mouth and nose, as well as eye and leg movements and chest muscle function. The test records night time and day time sleep patterns. In case of obstructive sleep apnea, during sleep, when throat and tongue muscles are more relaxed, this soft tissue can cause the airway to become blocked. Continuous positive airway pressure (CPAP) is often used to keep airways open in patients who are not able to breathe spontaneously on their own. It is a form of positive airway pressure ventilator.

With this treatment, the pressure of the air breathed is continuous, constant and greater than that of the surrounding air, which is enough to keep the upper airway passages open. This air pressure prevents obstructive sleep apnea and snoring. In some cases, Actigraphy might be additionally recommended. Actigraphy, watch like devices are used to assess behavior while both sleeping and awakening. These devices resemble wristwatches and are used to track the sleep habits of patients day and night. The resulting data is interpreted by a doctor specializing in sleep disorders. It will be used for treatment planning customized in individual patients.

Source: https://www.bangkokinternationalhospital.com/coe/brain/bangkok-sleep-and-epilepsy-center/overview