Page 61 - IDF Journal 2023

are more suitably used in thinner patients with a degree of mandibular retrusion.
There is a marked rise in the number
of patients being seen with obesity and hypoventilation at night, and this can lead to severe oxygen desaturation and sleep disturbance with nocturia. This condition requires consideration of bilevel or non- invasive ventilation, whilst Cheyne-Stokes respiration can be treated with adaptive servo ventilation (ASV) in suitable patients.
The combination of OSA with chronic obstructive pulmonary disease is termed overlap syndrome.
Disorders of central hypersomnolence
This refers to patients who have excessive amounts of daytime sleepiness which seems to be central in origin, rather than due to external factors during sleep.
The condition most clinicians will have heard of its narcolepsy which is a defect in the sleep/wake neurochemical switch, and causes REM sleep to constantly bubble under wakefulness, trying to get in on the act.
Narcolepsy is divided into two types: Type 1 narcolepsy includes cataplexy or drop attacks due to REM sleep atonia in wakefulness, usually triggered by
emotion and particularly laughter, whilst Type 2 narcolepsy includes patients with excessive daytime sleepiness but without evidence of cataplexy.
The narcoleptic tetrad includes excessive daytime sleepiness, combined with hypnagogic or hypnopompic hallucinations which are dream like states at the beginning or end of sleep respectively, sleep paralysis which is described as waking unable to move often with an aura of an evil presence in the room, and cataplexy itself.
Other rare conditions that cause excessive daytime sleepiness include Klein Levin Syndrome.
If all other causes of central hypersomnolence are ruled out, the patient may be diagnosed as suffering from idiopathic hypersomnia and treated with brain stimulant drugs.
Parasomnias
Parasomnias a common in childhood and include night terrors which are regarded as developmentally normal. In young adults, parasomnias include non-REM states of sleep walking and sleep talking, confusional arousal and sexsomnia. Sexsomnia includes masturbation or sexual approaches to a bed partner in
sleep, and if sex occurs it is usually raw and rough with no finesse which can be unpleasant for the bed partner or lead to accusations of attempted rape at teenage sleepovers.
REM behaviour disorder (REM-BD) is
an important condition in which patients act out dreams which are usually violent. They may fall out of bed, punch and kick their partner, swear and shout during sleep. This condition is more common
in middle-aged and elderly men and is important because it may be a heralding factor in neurodegeneration including Parkinson’s disease.
Circadian rhythm disorders
This group of conditions refers to normal sleep which is not aligned with the social clock for the geographical location in which the subject is living. A common example is a temporary misalignment of sleep time due to jetlag from long haul aircraft flights.
Shift work related to sleep disorder
has also become increasingly frequent because of the 24/7 society in which we live.
In young people, delayed sleep phase syndrome is prevalent and may be referred to as “I can’t get to sleep and
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