A Growing National Concern Sleep-wake disorders have become a growing national concern. About 40 percent of all adults suffer from sleep problems, such as fragmented sleep or frequent awakenings during the night. Most adults need seven to eight hours of sleep a night although some may need less or more. Sleep patterns also change with the aging process. While infants may sleep up to 16 hours per day, the elderly may sleep less. Whatever the case, a person’s sleep needs can be measured by how alert he or she feels during the day. Feeling sleepy during the day and ongoing trouble falling asleep at night is not normal at any age and is a sign that you may be suffering from a sleep disorder. There are nearly 100 classified sleep disorders, some of which are quite serious and at times life threatening or extremely disabling. Some of the most common disorders treated at the institute include: Snoring/Sleep Apnea: Snoring, common as it may seem, may be a sign that something is seriously wrong with your breathing during sleep. Snoring indicates that the airway is not fully open and air has to be forced through the narrowed passageway. Approximately 10 to 30 percent of adults snore and for the most part, there are no serious medical consequences. However, habitual snoring may be an indication of obstructive sleep apnea, a potentially life-threatening disorder. Someone with obstructive sleep apnea may stop breathing for a short while, sometimes dozens or even hundreds of times each night, with awakenings so brief that the sleeper does not remember them. Ultimately, sleep apnea can cause daytime sleepiness, as well as high blood pressure, heart failure, heart attack, and stroke. Insomnia: Trouble falling asleep or staying asleep is known as insomnia. One in three Americans suffer from insomnia, which afflicts people of all ages. Insomnia can be caused by a variety of factors such as stress, stimulants taken near bedtime such as caffeine or nicotine, environmental factors such as noise, late hours or shift work, medications, and physical illness, among others. Although insomnia can last from a few days to a few weeks (transient and short-term insomnia), for some people it can last for months or years. If your sleep has been disturbed for more than a month and interferes with the way you feel or function during the day, you should seek the help of a sleep-disorders specialist. Narcolepsy and Idiopathic Hypersomnia: Narcolepsy is defined as undesirable sleepiness at inappropriate times. This disorder includes one or a combination of the following: excessive daytime sleepiness; cataplexy, or brief loss of muscle control; sleep paralysis; and hypnagogic hallucinations or vivid dreamlike experiences that occur during drowsy episodes. The exact cause of narcolepsy is not known. However, it appears to come from the part of the central nervous system that controls sleep and wakefulness. Narcolepsy is not a psychiatric problem and is often mistaken for laziness, depression, or inability to concentrate. This disorder can be managed through medications and psychosocial treatment. Parasomnias: Parasomnias refers to a wide variety of disruptive sleep-related events such as confusional arousals, night terrors, teethgrinding, sleepwalking and sleeptalking, among others. Although usually infrequent and mild, these events may occur often enough to require medical attention. Parasomnias can affect children, as well as adults. Restless Legs and Periodic Limb Movement Disorder: People experiencing twitching in the legs or arms during the night suffer from periodic limb movement disorder (PLMD). These muscle jerks may occur infrequently or as often as once or twice each minute. PLMD seldom awakens the sleeper. However, it interferes with sound sleep and many people suffering from PLMD suffer from insomnia and feel excessively sleepy during the day. In addition, people who have PLMD may also have restless leg syndrome   when awake. This syndrome causes a peculiar crawling sensation in the calves or thighs that occurs when the patient is sitting or lying down. Professionals at the institute will be able to determine the best medication or treatment. Diagnosis The first step in diagnosing a sleep disorder is an initial consultation with a board-certified sleep physician, including a complete history and physical examination. Whether a patient is unable to sleep or is excessively sleepy during the day, the most important thing is to collect the facts about the patient, specifically the sleep-wake patterns. If testing is recommended by the physician, the patient will be required to stay one or two nights in the sleep lab so that a specially trained technologist can record data about the sleep patterns, breathing, nervous system, and cardiac function. The primary tests used to diagnose sleep disorders are nocturnal polysomnography (PSG) and the multiple sleep latency test (MSLT). Both of these are performed in the medical center’s sleep laboratory. Patients are admitted to the sleep lab in the evening, usually about three hours before bedtime. Before going to sleep, the polysomnographer applies the electrodes and sensors, which are used to determine sleep stages. The electrodes, which are lightweight and painless, are placed on the scalp and near the eyes and chin to record brain, eye movements, and muscle tone. Other sensors are attached to monitor the heart, as well as to determine nasal and oral airflow, oxygen saturation, and chest and abdominal movement. A technician monitors the polysomnogram through the entire night, and all of these functions are recorded on a state-of-the-art computer system. The recorded data helps the physician determine what is causing the disorder, as well what treatment to prescribe. A multiple sleep latency test may also be conducted to determine how long it takes a person to fall asleep. This test requires the patient to take four naps, one every two hours, on the day after polysomnography. The multiple sleep latency test objectively measures daytime tiredness. It is also the diagnostic test for narcolepsy. Treatment Since the range of problems can be psychological or medical, treatment varies in each case depending on the data gathered about the patient’s sleep-wake patterns. Patients with sleep apnea may be treated through C-PAP (continuous positive airway pressure), surgery, special dental devices, and/or weight loss. While a disorder such as narcolepsy may require the use of medications, other disorders are treated differently. Whatever a patient’s problem may be, it is important to note that for each patient, treatments vary widely, and what works for one individual may not work for another. A careful review of sleep hygiene with a patient is a necessary diagnostic step for most, if not all, sleep disorders. Pediatric Sleep Center Children like adults may also suffer from a variety of sleep disorders such as snoring, sleep apnea, narcolepsy, sleep walking, night terrors, and insomnia. In most cases, however, daytime sleepiness in children manifests itself as a behavioral disorder such as hyperactivity, short attention span, and crankiness. Diagnosis and treatment of sleep disorders in children requires specialized facilities and expertise. The institute has a specially designed unit equipped for the diagnosis and treatment of children with all types of sleep disorders. Additional Services Psychosocial Services. Sleep disorders can be triggered by a variety of psychosocial problems including depression and anxiety. At the Institute for Sleep-Wake Disorders, a trained Ph.D., specializing in sleep disorders, is available for treatment of insomnia and psychosocial management of sleep disorders. Support Groups. The Institute for Sleep-Wake Disorders offers support groups for patients and their family members. Nutritional Counseling. Obesity and improper nutritional habits can contribute to some sleep disorders, such as snoring and apnea. The Institute for Sleep-Wake Disorders offers nutritional counseling and weight management to its patients. Access to Hackensack University Medical Center’s Resources. As part of Hackensack University Medical Center, the institute has access to all of the medical center’s facilities and services. Pediatric subspecialty services, for example, are available on-site should your child require treatment in more than one area. Specialty consultants with certification in neurology, pulmonary medicine, psychiatry, and psychology are also available on-site.