Missionary
Medical
Moment
A brief summary of a current topic of medical interest to missionaries.
Topics are updated frequently; if you have a topic or question, let us know!
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MISSIONARY MEDICAL MOMENT
Sleep Disorders - Part One
"...when you lie down, you will not be afraid; when you
lie down, your sleep will be sweet..."
Proverbs 3:24
Obtaining a restful night of sleep is necessary to be able to
work and serve well. A study of normal sleep patterns, which is
done by recording the electrical activity of the brain during
sleep, reveals that there are different stages which the brain
goes through during a normal sleep period. If there is a deficiency
in the overall amount of sleep, or a disturbance in the different
stages of sleep, then the person might experience not just
subsequent tiredness and sleepiness, but also difficulty with
concentration and irritability.
Disturbances of sleep may be caused by certain psychological
disorders, by some types of general medical conditions, or as a
result of medication or substance effect. The great majority of
sleep disorders, however, are known as primary sleep
disorders; these in turn can be divided into
dysomnias (too little or too much sleep, or sleep scheduling
abnormalities) and parasomnias (where sleep is disrupted
by episodes of unwanted, unusual physical events, such as sleep
walking). In this edition of MMM, we will look at the different
types of dysomnias; next month we will discuss the parasomnias.
The most common form of dysomnia is insomnia, difficulty in
initiating or maintaining sleep. It is estimated that as many as
35% of adults residing in the United States complain of insomnia
of at least one month duration. Women suffer from insomnia more
often than men; young adults have more problem falling asleep,
while older adults experience more difficulty staying asleep.
Fewer people experience the dysomnia known as hypersomnia, when
excessive sleepiness occurs; whether prolonged night sleep or
increased daytime sleep episodes, neither provide a sense of
restfulness on awakening. Often, increased appetite and weight
accompany hypersomnia, and spells of hypersomnia may be prevalent
during winter (see a pior Missionary Medical Moment:
Seasonal Affective Disorder).
A rare but
fascinating dysomnia is narcolepsy, in which a person has
repeated irresistible attacks of sleep, as well as brief
episodes of loss of muscle tone and intensely vivid dreaming
immediately upon falling asleep or awakening. Still another
dysomnia is breathing-related sleep disorder, better known as
sleep apnea. In this condition a person actually stops breathing
or experiences blocked breathing passages soon after falling
asleep; they abruptly awaken (and usually don’t remember it),
resume breathing, and then fall back asleep only to repeat the
process throughout the night. The result is that they never
are able to progress through the normal stages of sleep, and
awaken feeling exhausted. Often, people with sleep apnea have
a history of loud snoring.
Another prevalent dysomnia is that of the "sleep-wake schedule
disorder", now known as the circadian rhythm sleep disorder. This
is the sleep disruption that occurs from a mismatch between a
person’s normal sleep pattern and their environment’s demands.
Examples would be shift work effects on sleep patterns, and the
effect of traveling to different time zones (see prior MMM:
Jet Lag).
Treatment of the different types of dysomnia depends of the
specific type involved. The best known but not always the best
treatment for insomnia is the use of medications known as
"hypnotics", sleeping pills. Many people use over-the-counter
sleeping pills, which usually contain an antihistamine such as
the same ingredient found in Benadryl.
These are not necessarily safer preparations than prescription
hypnotics, and may actually cause more restlessness in addition
to the more common side effect of dry mouth. Prescription
hypnotics include the older class of barbiturates (such as
phenobarbital and amobarbital), but most prescribed sleeping
pills belong to the class known as benzodiazepines, and include
longer acting agents such as flurazepam (Dalmane) and temazepam
(Restoril) and the short acting agent zolpidem (Ambien).
The diagnosis of sleep disorders is sometimes quite complex
and may require monitoring sleep while recording brain waves,
breathing patterns, and muscle activity. For more detailed
information concerning specific approaches to sleep problems,
contact us at the e-mail address at the bottom of this page.
Whether one sleeps too much or sleeps too little, one can rest
in the assurance that we are watched over by a loving Father
who is always available to us: "...Behold, He who keeps
Israel will neither slumber nor sleep..."
(Psalm 121:4)
View Other Missionary Medical Moments
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