Sleep Disorders

 Paramonias are in the REM Sleep Disorder category where one acts out their dreams. One good example could be when you sleep walk, or probably sleep talk, however people that fall into the category of a sleep disorder, they typically get violent. These reenactments can be so violent to where they put themselves or others in harm's way 

without any conscious awareness (Imran Khawaja; Benjamin C. Spurling; Shantanu Singh, 2023). But weirdly enough, when the person wakes up, they remember everything that happened in the dream (Imran Khawaja; Benjamin C. Spurling; Shantanu Singh, 2023). But why do these things happen? When a person has Sleep Behavior Disorder (RBD) there is a  failure to inhibit spinal motor neurons during REM sleep (Imran Khawaja; Benjamin C. Spurling; Shantanu Singh, 2023), meaning that when someone falls asleep your brain should shut off your motor movements but with RBD that is not the case. Your mind is asleep but not your body, so you end up acting out whatever is happening in your dream. 

Unfortunately when people have RBD, it is linked to future disease like parkinsonism, narcolepsy, or the use of antidepressant medications (Imran Khawaja; Benjamin C. Spurling; Shantanu Singh, 2023). A patient may be warned about the future development of these neurological disorders (Imran Khawaja; Benjamin C. Spurling; Shantanu Singh, 2023).

 Treatment consists of preventive measures while sleeping to avoid injury to the patient as well as the bed partner. In severe cases, the patient may be prescribed melatonin or clonazepam (Imran Khawaja; Benjamin C. Spurling; Shantanu Singh, 2023) . Unfortunately, being diagnosed with RBH can be tricky. Many people aren’t aware of the symptoms because this happens when they are not awake. In one of the studies that the article talked about was that about half of the people knew they were experiencing symptoms (Imran Khawaja; Benjamin C. Spurling; Shantanu Singh, 2023). These symptoms can range from minor movements to drastic. Some of them include punching, kicking, falling out of bed, gesturing, or knocking over the nightstand. Patients may have vocalizations during an attack. Schenck et al.[13] reported dream enactment in 87% of their study population.” (Imran Khawaja; Benjamin C. Spurling; Shantanu Singh, 2023). 

Usually symptoms show up during the last REM sleep period and there are patients that can sleep through their episodes and then there can be patients that wake up during the episode and then fall back asleep (Imran Khawaja; Benjamin C. Spurling; Shantanu Singh, 2023). 

In conclusion, the goal for people with these situations is to create a safe sleeping environment for both parties (Imran Khawaja; Benjamin C. Spurling; Shantanu Singh, 2023). Some of those solutions can be going to counseling and if the person with this disease has a partner, for them to go as well, and be educated on it (Imran Khawaja; Benjamin C. Spurling; Shantanu Singh, 2023). Many would be highly advised to remove any possible weapons and anything else that can harm the affected and the unaffected (Imran Khawaja; Benjamin C. Spurling; Shantanu Singh, 2023). In extreme cases, the affected person might have to sleep in a separate bedroom, have padded bed rails or must sleep in a sleeping bag (Imran Khawaja; Benjamin C. Spurling; Shantanu Singh, 2023). 

Insomnia is categorized as difficulty in going to sleep, staying asleep or experiencing poor sleep quality (Harleen Kaur; Benjamin C. Spurling; Pradeep C. Bollu, 2023). Importantly, insomnia has affected at least one-third of the United States’ population (Harleen Kaur; Benjamin C. Spurling; Pradeep C. Bollu, 2023). These symptoms can present themselves when you have the perfect opportunity to sleep but it doesn’t happen and you end up with tiredness during the day. (Harleen Kaur; Benjamin C. Spurling; Pradeep C. Bollu, 2023). When somebody has chronic insomnia, it can affect their health, quality of life, academic performance, increase the risk of motor vehicle accidents, decrease the productivity at work, irritability and increase daytime sleepiness (Harleen Kaur; Benjamin C. Spurling; Pradeep C. Bollu, 2023). Insomnia can also trigger other diseases like cardiovascular problems, chronic pain syndrome, depression, anxiety, diabetes, obesity, and asthma (Harleen Kaur; Benjamin C. Spurling; Pradeep C. Bollu, 2023). 

There are many types of insomnia a person can have, for example chronic insomnia disorder is where sleep disturbances occur at least three times a week and have to be present within the last three months (Harleen Kaur; Benjamin C. Spurling; Pradeep C. Bollu, 2023). Another one is short-term insomnia disorder and the sleep disturbances have been going on  for over a period of 3 months. (Harleen Kaur; Benjamin C. Spurling; Pradeep C. Bollu, 2023). Last but not least, there is another insomnia disorder which is difficulty in initiating or maintaining sleep that does not meet the criteria of chronic insomnia or short-term insomnia disorder. (Harleen Kaur; Benjamin C. Spurling; Pradeep C. Bollu, 2023). This means that anyone that has trouble falling asleep, or staying asleep but it doesn’t meet the criteria of a chronic or short term insomnia can still be insomnia. Unfortunately many people that are light sleepers end up having insomnia (Harleen Kaur; Benjamin C. Spurling; Pradeep C. Bollu, 2023). There is also a strong relationship between insomnia and those people who suffer with mental health like depression (Harleen Kaur; Benjamin C. Spurling; Pradeep C. Bollu, 2023). 

To add on, if someone had development issues during childhood, for example separation anxiety, can have a risk of chronic insomnia (Harleen Kaur; Benjamin C. Spurling; Pradeep C. Bollu, 2023). Last but not least people with certain personality traits like perfectionism, ambitiousness, neuroticism, low extraversion, and susceptibility to depression and worry are more likely to develop insomnia over time. Insomnia is also more commonly seen in individuals with psychosocial stress like disrupted family life, divorce, the death of a spouse, and alcohol or substance abuse. (Harleen Kaur; Benjamin C. Spurling; Pradeep C. Bollu, 2023). Why does insomnia occur? It is because the orexin mediated increased neuronal firing in the wake-promoting area and inhibition of the sleep-promoting area (ventrolateral preoptic nucleus and median preoptic nucleus) is one of the possible mechanisms contributing to insomnia (sleep switch model)”( Harleen Kaur; Benjamin C. Spurling; Pradeep C. Bollu, 2023).

In other words the chemical orexin increases in the parts of your brain that not only are in charge of keeping you awake during the day but also in the parts of your brain that are in charge of making you fall asleep. Hence, why people don’t feel sleepy. 

To determine what is going on, it is recommended to see the person’s sleep history and see what can be causing the sleep disturbances (Harleen Kaur; Benjamin C. Spurling; Pradeep C. Bollu, 2023). People who have depression can have symptoms of waking up early in the morning and having early morning insomnia ( Harleen Kaur; Benjamin C. Spurling; Pradeep C. Bollu, 2023). They can also look into what is your night routine and figure out if your consumption of alcohol and caffeinated beverages, use of electronic gadgets at bedtime and frequency of daytime naps) can also be helpful to determine the ways to mitigate the sleep disturbances, (Harleen Kaur; Benjamin C. Spurling; Pradeep C. Bollu, 2023). The treatments to make insomnia a little easier are limiting the daytime naps, avoiding late night dinner or evening intake of alcohol, caffeine, or smoking (Harleen Kaur; Benjamin C. Spurling; Pradeep C. Bollu, 2023). They can also recommend to have a healthy diet, maintain a regular sleep and wake time schedules (Harleen Kaur; Benjamin C. Spurling; Pradeep C. Bollu, 2023). There is also sleep restriction therapy, stimulus control therapy, relaxation therapy, and cognitive behavioral therapy for insomnia (Harleen Kaur; Benjamin C. Spurling; Pradeep C. Bollu, 2023). 

Finally, the last sleep disorder that I will talk about is bruxism. Bruxism is a condition  that involves rhythmic contractions of the masseter muscles, accompanied by teeth grinding and mandible thrusting, (Sona J. Lal; Abdulghani Sankari; Kurt K. Weber, DDS, 2024). These events happen during sleep or when the person is awake and this condition is more common with children from 15% to 40% then adults who are ranging from  8% to 10% (Sona J. Lal; Abdulghani Sankari; Kurt K. Weber, DDS, 2024). In severe cases bruxism can cause damage to the teeth and dental work, leading to morning jaw pain, headaches, and motion restriction of the temporomandibular joint (Sona J. Lal; Abdulghani Sankari; Kurt K. Weber, DDS, 2024). How does this happen and why? Well bruxism is believed to be regulated by the central nervous system, involving autonomic and brain activity related to arousal or alertness (Sona J. Lal; Abdulghani Sankari; Kurt K. Weber, DDS, 2024). Sleep bruxism appears to be an exaggerated oral motor response to natural sleep-related microarousals distinguished by a rise in autonomic cardiac and respiratory activity occurring 8 to 14 times per hour during sleep. Seconds before these episodes, affected patients demonstrate rapid-frequency cortical electroencephalogram activity, heart rate elevation, increased jaw and oropharyngeal muscle tone, and increased respiratory effort and nasal airflow. (Sona J. Lal; Abdulghani Sankari; Kurt K. Weber, DDS, 2024). In other words, people who have this condition experience teeth grinding episodes 8 to 14 times every hour. During these episodes heart rate increases, your jaw tightness, and your breathing changes. Many people who have bruxism may have gotten it passed from a family member (Sona J. Lal; Abdulghani Sankari; Kurt K. Weber, DDS, 2024). Other factors that can cause bruxism is if people have anxiety, Alzheimer's disease, Huntington's disease, traumatic brain injury and many others (Sona J. Lal; Abdulghani Sankari; Kurt K. Weber, DDS, 2024). In addition bruxism usually accompanies other sleep disorders like restless leg syndrome, periodic limb movement during sleep, sleep-related gastroesophageal reflux disease, rapid eye movement behavior disorder, and sleep-related epilepsy (Sona J. Lal; Abdulghani Sankari; Kurt K. Weber, DDS, 2024). 

To diagnose a person who could have bruxism, self reports have to be made or inputs from a bed partner could be useful (Sona J. Lal; Abdulghani Sankari; Kurt K. Weber, DDS, 2024). The only flaw of a self report is that the healthy provider can lack details on the intensity and duration of muscle activity (Sona J. Lal; Abdulghani Sankari; Kurt K. Weber, DDS, 2024). For treatments, there are many options, for example occlusal devices like a mouth guard, behavioral interventions like a routine, and pharmacological therapies (medications)  (Sona J. Lal; Abdulghani Sankari; Kurt K. Weber, DDS, 2024). Sometimes even counseling can help with bruxism. My mom has bruxism, and what helped her was putting a mouth guard in the night and she’s good to go but of course it may not help for somebody else who has this. 

In summary, paramonias are when people act out their dreams on extreme levels. They can be harmful to themselves and others. In order to be diagnosed, the person who is experiencing it may be aware of the symptoms, such as kicking, punching, falling off the bed, or knocking items down. It is more helpful if the person has a sleep partner and they can report the symptoms.

 The treatments to this sleep disorder can range from as simple as going to counseling to having to sleep in a sleep bag. The goal for everyone that has paramonias and those who have a partner with this disorder is to create a safe environment. Moving on, we have insomnia, one of the most heard sleep disorders and this is where people can’t fall asleep, can’t stay asleep or are experiencing poor sleep quality.

Symptoms can appear once you have the perfect opportunity to sleep but sleep doesn’t happen. There are many types of insomnia, some of them are chronic insomnia, morning insomnia, and  short-term insomnia. As for treatments, they can be as simple as having a healthy life routine, and avoiding naps to going to therapy. Finally, the last sleep disorder that I talked about is bruxism. This doesn't affect many people but there are those who are unlucky. This is where a person grinds their teeth in the night. People who experience them have noted having a sore jaw, headaches, and damage to their teeth or dental work. Diagnoses require a self report or a report from a bed partner however, this is flawed because the provider doesn’t know how many times it happens and how long it happens. Treatments include occlusal devices like a mouth guard, behavioral interventions like a routine, and pharmacological therapies (medications). 

As for future directions for most of these sleep disorders, it always comes partnered up with other underlying diseases. When people are being diagnosed with parasomnias, insomnia, or bruxism, they should also look at how their mental and physical health is. Usually the underlying diseases that come with sleep disorders are Parkinson's, depression, anxiety, neurological disorders. These three sleep disorders are not the only ones. There are many more and so many people experience them. It’s so important to know how we are sleeping and if our sleep quality is good enough. Sleep is what gets us through the day and without it, it can cause health problems.