MONSTERS OF SLEEP || Sleep Disorders 101: Night Terrors

If you are the parent of a child who experiences night terrors, you know these are no ordinary nightmares. It will seem as if your child has suddenly become possessed! Your child, in the throes of a night terror, might suddenly bolt upright, shout and scream in defense and be utterly inconsolable regardless your efforts to calm them. Their breathing may be rapid, their heart pounding out of their chest, and they may be sweating, thrashing around for several minutes until they finally calm down and return to sleep. 

Night terrors can often leave parents nearly as traumatized as it seems their child is during an episode. Usually the child going through a night terror isn't even aware that you are trying to calm them down, and when you ask them the next day about their nightmares, you discover they have absolutely no memory of them.

That's because night terrors are not nightmares at all, but a disruption to sleep that occurs during transitional sleep between deep Stage 3 sleep and lighter REM or non-REM stages. 

Night terrors occur during the first three hours of the night. These passages between sleep stages are smooth, but they can lead to stress responses in the child. Children's bodies and brains are still developing, and changes in growth hormones and other brain chemistry might be at work at this time. Thus, this physical (not emotional) expression of fear, caused by the sudden release of stress hormones into the bloodstream, can panic the child, leading to a full-blown, dramatic episode of terror. 

Anyone who has witnessed a child in the middle of a night terror knows to put the emphasis on the word Terror, as this is an extremely accurate representation of what happens. 

Dreams and nightmares, on the other hand, are the fodder of REM (rapid eye movement) sleep and never happen in deep Stage 3 sleep. Consider this: during REM sleep, the body is more or less paralyzed from the neck down as part of the brain's effort to keep one from acting out the compelling content of dreams. If your child is terrified in the night but does not move about, and the episode occurs later in the night, they might be having a nightmare. You also might have better luck consoling them, and they stand a good chance of remember the content of their bad dream in the morning because in REM sleep, visual imagery is processed and remembered. In stage 3 sleep there is no imagery for the brain to process.

The good news? Night terrors are actually normal and do not suggest any underlying medical condition. Kids grow out of them, thankfully, so parents can hope for more peaceful nights as their children age.

Guest Post || Edward Grandi on Sleep Apnea: What is it and what can I do about it?

"My bed partner tells me I snore and sometimes stop breathing while I am asleep... Should I be concerned?"

Snoring and pauses in breathing happen even in healthy people, especially when they sleep on their back or consume alcoholic beverages too close to bedtime.

Edward Grandi served as
executive director of the
American Sleep Apnea
Association from 2004 to
2014. During his tenure he
contributed significantly to
raising the visibility of the
ASAA in the public media
and the sleep community. He
is considered a subject matter
expert on sleep apnea and
continues to serve as a
resource on the subject.

These events, called apneas or hypopneas (partial or complete obstructions that result in reduced airflow to the lungs) become an issue when they happen often during sleep and over many sleeping periods during the week.

There are two issues related to apnea that can have far-reaching effects on someone's health. First is the fragmentation of sleep. Second is the reduction in blood oxygen necessary to support vital organs.

Fragmented sleep 
This happens when sleep interrupted by brief awakenings or arousals that take place as the body restarts breathing after these pauses occur. Such pauses in breathing, to be medically significant, must last 10 seconds or longer and occur, on average, more than 5 times per hour of time asleep. 

The arousals that follow do not necessarily result in waking up, but often move the sleeper to a lighter stage of sleep. These pauses and consequent arousals disrupt the normal sleep cycle, leading to fragmented sleep. This prevents the sleeper from benefiting from deeper stages of sleep, when the body is most relaxed and key restorative processes can take place, including during Rapid Eye Movement (REM) or dream sleep. People experiencing fragmented sleep complain of waking up not feeling refreshed from their sleep.

Reduction in blood oxygen
The frequent pauses in breathing that cause partial or complete obstruction of air entering the lungs (hypopneas and apnea) result in less oxygen in the bloodstream and, in turn, to organs like the heart, kidneys and brain. The result is hypoxia, the medical term for no oxygen in the blood. This can be serious if it occurs frequently or chronically. The body, starved of oxygen, will take measures to keep breathing, including arousing as mentioned above. The result to a human body subjected to this oxygen starvation for long enough is death.

What is sleep apnea? 
The symptoms of obstructive sleep apnea (OSA), the medical condition that results from experiencing many apneas and hypopneas during the course of the night, can vary. Among them are excessive daytime sleepiness, morning headaches, increased irritability, depression, high blood pressure, weight gain and erectile dysfunction. The list continues to grow as more research is done.

Risk factors for OSA
Simply put, everybody is at risk for OSA--both old and young, male and female, obese and normal weight, adults and children. It is a fallacy to think that OSA only affects overweight middle-aged males. 

It doesn't take much for the opening to the upper airway to be blocked either partially or completely. A large tongue, a narrow or crowded opening to the upper airway due to fatty tissue, a long uvula... all these can contribute to having OSA.

Diagnosing and Treating OSA 

The best way to know for certain if you have OSA is to have a physical examination that includes medical history plus a sleep study, which can take place either in the home or in a sleep lab. Depending on the type of sleep study you need, the test will gather information about your breathing (or lack of breathing) during sleep. 

On the basis of that information, the severity of your condition is determined by way of a measurement called the Apnea Hypopnea Index (AHI). The basic index formula is: 

AHI = apneas+hypopneas/
hours asleep or in bed

On the basis of these results, the treating physician will make some recommendations on how to improve your sleep by reducing or eliminating these apneas and hypopneas.

There are a number of treatment options for OSA, with more being developed based on research. Which treatment is right for you depends a lot on the severity of your OSA and what you can tolerate. This should be the subject of a discussion between you and your treating physician.

In the meantime, if your bed partner tells you that you snore and sometimes stop breathing while asleep, and if you also awaken not feeling refreshed in the morning, here are some things you can do right away that may help:

1. Avoid sleeping on your back. When you sleep on your back, you increase the likelihood that your mouth will come open and your tongue will slide back to block the opening to your upper airway.
2. Breath through your nose. Make certain not to experience nasal congestion when going to sleep. This will reduce the chances of mouth breathing.
3. Practice good sleep hygiene. Check out these 12 simple tips to improve sleep

If, after you try these tips, you are still snoring and having frequent pauses in breathing, and you continue to awaken feeling unrefreshed after a night's sleep, please consult a physician qualified in sleep medicine to further determine the kind of problem you have and how to treat it.

Healthy sleep is the key to a healthy life. --Edward Grandi

© Edward Grandi 2014, All Rights Reserved