Other sleep disorders

Hypersomnia refers to excessive sleepiness, i.e. abnormal daytime tiredness with a compulsive need to fall asleep. Abnormal daytime sleepiness can be caused, for example, by a lack of sleep, certain medications, substance abuse, psychiatric causes and certain illnesses.

Treatment of hypersomnia

The treatment of excessive sleepiness is based on treating the underlying cause of the symptom. As self-care, you should make sure that you have a regular circadian rhythm and get enough sleep as well as check that your ways of life are regular.

Chronic Fatigue Syndrome (ME/CFS, in which ME stands for Myalgic Encephalomyelitis and CFS, Chronic Fatigue Syndrome) includes symptoms which are dominated by PEM (Post Exertional Malaise) and prolonged, deep exhaustion after even a minor exertion. In the syndrome, fatigue does not subside with rest and it worsens as a result of exertion. The factors that trigger the syndrome have been studied for a long time, but the actual cause of the syndrome is still unclear.

Since typical findings caused by ME/CFS, such as biomarkers or imaging findings, have not yet been identified in the body, the diagnosis of ME/CFS is based on different criteria. However, laboratory tests and imaging examinations can exclude other causes of the symptoms, which is why examinations are often justified before the diagnosis is made.

Treatment of chronic fatigue syndrome

The treatment of chronic fatigue syndrome aims to improve the patient’s functional capacity by alleviating and controlling the symptoms of the syndrome. It is important to balance between rest and activity according to the individual’s personal limits, and support from a physiotherapist, occupational therapist, dietitian as well as psychosocial and psychiatric support may help depending on the situation. Healthy nutrition combined with adequate sleep and appropriate exercise are beneficial for recovery. The need for medication is assessed by a doctor.

Unpleasant sensations in the lower limbs when going to sleep are quite common. Restless leg syndrome (RLS), where the legs feel uncomfortable and painful at rest, can disturb sleep and the symptoms typically ease when moving the legs. RLS can make it difficult to fall asleep and, in the worst case, lead to severe insomnia.

Restless legs symptoms also occur as a secondary symptom associated with some diseases or medications. The most typical diseases or conditions that increase the risk of RLS are iron deficiency, kidney failure, certain neurological disorders and pregnancy. For example, tiring antihistamines and certain antidepressants can provoke RLS symptoms.

People with restless legs may also experience periodic limb movements of sleep (PLMS) during sleep. In periodic limb movement disorder (PLMD), the movements of the limbs during sleep are frequent and can disturb sleep and, cause daytime fatigue.

Although RLS and PLMD often occur simultaneously, they are separate disorders which have their own diagnoses.

Treatment of restless legs

If the symptoms are mild and do not interfere with sleep, no medication is needed. All you need to do is to avoid factors that aggravate the symptoms. Avoiding alcohol, coffee and other caffeinated substances as well as fast-absorbing carbohydrates in the evening can be particularly beneficial. Stretching and light exercise, such as walking, can help to control your symptoms. In addition, you can try, for example, a warm bath, massage, locally targeted heat or cold packs and painkillers, if necessary.

Restless legs can be treated with certain medicines that affect the central nervous system, and iron medication can improve the quality of life of people with iron deficiency. As symptoms such as restless legs can also occur in other illnesses, it is important that a specialist examines and assesses the situation before starting any medication.

Narcolepsy is a rare hypersomnolence disorder. Narcolepsy most commonly occurs in early adolescence, during the primary and lower secondary school age, but can also occur later. Narcolepsy causes abnormal daytime sleepiness after a normal amount of sleep, which means that you fall asleep exceptionally easily in passive situations, but it may also occur during active situations. Narcolepsy may include, for example, a momentary loss of muscle tension and reflexes (cataplexia) triggered by emotional reactions, episodes of sleep paralysis, hallucinations and interrupted night sleep.

Narcolepsy examinations

In narcolepsy examinations, the patient’s symptoms are carefully mapped and sleep studies are also carried out. Sleep studies of narcolepsy include extensive polysomnography and a sleep latency test taken the following day. Sleep studies are supplemented, if necessary, with blood or spinal fluid samples.

Treatment of narcolepsy

In the treatment of narcolepsy, the key points are a regular lifestyle and an adequate amount of sleep. If necessary, narcolepsy can also be treated with medication aimed at affecting daytime sleepiness, cataplexia and/or disrupted sleep. A person with narcolepsy may benefit from scheduled naps of 10–30 minutes and from avoiding situations that trigger symptoms. It may also be necessary to avoid accident-prone tasks.

Parasomnias, or special sleep disorders, refer to unwanted physical events, such as motion disturbances or abnormal behaviour, or experiences, such as emotions and dreams, that occur when falling asleep, during sleep or when awakening from sleep. Parasomnias are classified as parasomnias related or unrelated to NREM or REM sleep. Talking in sleep is considered to be a normal activity during sleep, which occurs with most people at some point in their life.

Parasomnias include, for example, confusional arousals, sleep walking, teeth grinding or bruxism, sleep terror attacks, nocturnal sex parasomnia or nocturnal eating disorder, recurrent sleep paralysis episodes, nocturnal hallucinations, nightmares, bed-wetting and catathrenia (exhalation-related, intense and prolonged sound production). Parasomnia symptoms usually last from a few seconds to about half an hour at a time. Parasomnia is characterised by unresponsiveness to external stimuli, fear, confusion and some degree of memory loss.

Treatment of parasomnias

When mild and occurring rarely, these phenomena are normal and do not require treatment. If parasomnia occurs frequently, the symptoms are severe or cause other significant harm, treatment is necessary. The treatment of parasomnia focuses in particular on the regular sleep rhythm and the avoidance and treatment of factors that increase sleep disruption and stress factors. Learning-theory and behavioural therapies can also help to manage anxiety that predisposes to parasominias and the anxiety caused by them.

Parasomnias include teeth grinding during sleep, i.e. sleep bruxism, which is usually treated by dentists who have specialised themselves in the topic.

A regular circadian rhythm promotes both a good night’s sleep and a suitable level of alertness during the day. The circadian rhythm is regulated by the central circadian clock in your brain. Your body follows approximately 24-hour cycles. The rhythm is synchronised by the variation of light and darkness. Other synchronising factors include regular meal times as well as regular bedtimes and wake-up times. The need for sleep varies between ages, and different life situations affect which factors may interfere with your circadian rhythm. Children and adolescents need more sleep, and as they get older, the need for sleep decreases.

The circadian rhythm may be disturbed. The disturbances include, among other things, delayed or early sleep, seasonal insomnia, irregular sleep rhythm, circadian rhythm disorder, shift work sleep disorder and jet lag. Circadian rhythm disorders typically manifest as insomnia, excessive sleepiness and/or fatigue.

Examining circadian rhythm disorders

In the examination of circadian rhythm disorders, the patient is usually interviewed and examined, a sleep-wake diary and other sets of questions are used and movement activity can be recorded (actigraphy).

Treatment of circadian rhythm disorders

The treatment varies depending on the disorder and its cause. Treatments include bright light and/or natural light therapy, melatonin, pacing of work and everyday activities and cognitive behavioral therapy for insomnia (CBT-I). For self-treatment, we recommend sleeping long enough at night, avoiding evening meals (particularly high-fat foods) and alcohol, regular exercise (heavier exercise should be scheduled during the day) and utilising daylight in the morning or a daylight lamp during the dark season.