Potential for sleep disorders varies throughout life cycle, experts report

By Hunter Kaller

Although sleep disorders may develop at any time in a patient's life, there are certain periods across the life cycle during which patients face an increased risk of particular disorders, according to a panel of experts.

Part of this changing susceptibility is because individuals' sleep needs and sleep cycles change during their lifetime, according to Dr. David Neubauer, associate director of the Johns Hopkins Sleep Disorders Center.

"If...

By Hunter Kaller

Although sleep disorders may develop at any time in a patient's life, there are certain periods across the life cycle during which patients face an increased risk of particular disorders, according to a panel of experts.

Part of this changing susceptibility is because individuals' sleep needs and sleep cycles change during their lifetime, according to Dr. David Neubauer, associate director of the Johns Hopkins Sleep Disorders Center.

"If you look at the first few weeks of life, [the sleep cycle] is utter chaos; it really doesn't make much difference if it's daytime [or] nighttime," he said, adding that this changes slowly until approximately 3 months of age, when sleep has largely coalesced at nighttime periods. "It's a very gradual process that's a little bit different for each child."

By the time infants become toddlers, he continued, sleep problems occur in approximately 25% to 30% of children and are often behavior-based, including limit-setting--not wanting to go to sleep--and sleep-onset associations, such as when a child can fall asleep only when held.

By preschool age, children may begin to develop obstructive sleep apnea, as well as partial arousal parasomnias such as sleepwalking and night terrors, and these risks may persist into school age, at which time approximately 33% of children have sleep problems, according to Dr. Neubauer.

By adolescence, insufficient sleep is common, as is poor sleep hygiene, including extensive caffeine use near bedtime, he said. Circadian phase delay may also be a problem, along with primary insomnia, obstructive sleep apnea, and restless legs syndrome.

In children and adolescents, the sequelae of obstructive sleep apnea closely mirror and overlap those of attention-deficit/hyperactivity disorder, including behavioral problems, mood lability, poor impulse control, hyperactivity, and poor school performance, and obstructive sleep apnea is often mistaken for ADHD, Dr. Neubauer noted.

In children with obstructive sleep apnea, as with older individuals, the disorder is often unrecognized by patients and is most likely to be identified by other family members, according to Dr. Dimitri Markov, assistant professor of psychiatry at the Jefferson Sleep Disorders Center in Philadelphia.

Risk factors for obstructive sleep apnea throughout the life cycle include obesity, increasing age, male sex, a family history of sleep apnea, alcohol or sedative use, and smoking, according to Dr. Markov.

Treatments for sleep apnea include nasal continuous positive airway pressure; weight loss in overweight patients; improved upper airway patency using nasal steroids, surgery, or a dental device; and sleep drugs such as hypnotics, he said, noting that there is currently no approved pharmacological treatment for sleep apnea.

Restless legs syndrome can also develop at nearly any point in the life cycle, Dr. Markov noted, adding that it often leads to discomfort, sleep disturbance, excessive daytime somnolence, travel and social restrictions, and cognitive attention problems, and it may be disruptive to partners' sleep.

When treating the disorder, more than 90% of patients have responded to dopamine agonist therapy in randomized, controlled trials, according to Dr. Markov, and patients may also have success with opioids, benzodiazepines, or anticonvulsants, although most of these uses are not approved by the Food and Drug Administration.

Additionally, a woman's reproductive cycle may affect sleep patterns throughout the life cycle, according to Dr. Mary O'Malley, fellowship director of the sleep medicine program at Norwalk Hospital.

"There are differences between men and women," Dr. O'Malley said. "Probably the most important reason is our hormones, and the menstrual cycle [is] the epitome of how it varies in women."

Some women with premenstrual syndrome may report insomnia--both initial and maintenance types--nightmares, and restless sleep, according to Dr. O'Malley, whereas others may report recurrent hypersomnia.

Pregnancy can also contribute to disordered sleep, she said, causing excessive sleepiness and urinary frequency during the first trimester; restless legs syndrome, gastroesophageal reflux disease, insomnia, snoring, and risk for obstructive sleep apnea during the second and third trimesters; and sleep deprivation and insomnia during the postpartum period.

Sleep-related symptoms are a common complaint among women who seek treatment for menopause, Dr. O'Malley noted. She said that women in the perimenopausal stage face increased incidence of restless legs syndrome and obstructive sleep apnea, as well as primary insomnia, which can occur in as many as half of these patients.

This information concerns uses that have not been approved by the FDA.