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Insomnia can be precipitated by psychiatric illness, medical conditions, unhealthy sleep habits and specific substances like alcohol use

Scientists do understand sleep’s critical functions, and the reasons we need it is for optimal health and well being.

One of the vital roles of sleep is to help us solidify and consolidate memories.

Healthy sleep is critical for everyone, since we all need to retain information and learn skills to thrive in life.

While adults need 7-9 hours of sleep per night, one-year-olds need roughly 11 to 14 hours, school age children between 9 and 11 and teenagers between 8 and 10.

During these critical periods of growth and learning, younger people need a heavy dose of slumber for optimal development and alertness.

I will discuss an excessive sleep disorder called narcolepsy

Narcolepsy is a sleep disorder characterised by excessive sleepiness, sleep paralysis, hallucinations, and in some cases episodes of cataplexy, which is partial or total loss of muscle control, often triggered by a strong emotion such as laughter.

Narcolepsy occurs equally in men and women and is thought to affect roughly one in 2 000 people.

The symptoms appear in childhood or adolescence, but many people have symptoms of narcolepsy for years before getting a proper diagnosis.

Main symptoms of narcolepsy are:

• Very sleepy during the day and may involuntarily fall asleep during normal activities.
• Cataplexy is muscle paralysis during REM sleep occurring during waking hours. It causes sudden loss of muscle tone that leads to a slack jaw, or weakness of the arms, legs, or trunk.
• Dream-like hallucinations and paralysis as they are falling asleep or waking up, as well as disrupted night time sleep and vivid nightmares.

Narcolepsy is caused by the loss of a chemical in the brain called hypocretin.

Hypocretin acts on the alerting systems in the brain, keeping us awake and regulating sleep-wake cycles.

In narcolepsy, the cluster of cells that produce hypocretin located in a region called the hypothalamus is damaged or completely destroyed.

Without hypocretin, the person has trouble staying awake.

Currently, there is no cure for narcolepsy, but medications and behavioural treatments can improve symptoms for people so they can lead normal and productive lives.

If you are experiencing extreme sleepiness, you should talk to your doctor about the duration and intensity of your symptoms, they will in turn refer you to a psychiatrist.

Diagnosis is by means of a physical exam, taking of medical history and psychiatric history as well as conducting sleep studies.

Getting a diagnosis of narcolepsy and managing the symptoms can be overwhelming and the disorder is not well understood by the general public.

The most effective treatment is often a combination of medications and behavioural changes.

It helps to learn best practices and access support through others who have the disorder.

Insomnia

Insomnia is difficulty in falling asleep or staying asleep, even when a person has the chance to do so.

People with insomnia can feel dissatisfied with their sleep. Insomnia is a very common sleep problem for adults. Health experts estimate that roughly 30 percent of the general population complains of sleep disruption and approximately 10 percent have associated symptoms of daytime functional.

According to sleep guidelines, people with insomnia have one or more of the following symptoms:

• Difficulty falling asleep
• Difficulty staying asleep (waking up during the night and having trouble returning to sleep)
• Waking up too early in the morning
• Unrefreshing sleep
• Fatigue or low energy
• Cognitive impairment, such as difficulty concentrating
• Mood disturbance, such as irritability
• Behaviour problems, such as feeling impulsive or aggression
• Difficulty at work or school
• Difficulty in personal relationships, including family, friends and caregivers.

There are multiple ways to describe insomnia:

Acute insomnia: A brief episode of difficulty sleeping usually caused by a life event, such as a stressful change in a person’s job, receiving bad news or travel.

Chronic insomnia: A long-term pattern of difficulty in falling asleep or staying asleep at least three nights per week for three months or longer.

Comorbid insomnia: Insomnia that occurs with another condition such as anxiety, depression or medical conditions like arthritis or back pain, which may make it hard to sleep.

Insomnia can be precipitated by psychiatric illness, medical conditions, unhealthy sleep habits and specific substances like alcohol use.

Insomnia is thought to be a problem of the brain being unable to stop being awake. The brain has a sleep cycle and a wake cycle, which when one is turned on the other is turned off. Insomnia can be a problem with either part of this cycle either as too much wake drive or too little sleep drive.

In some cases, insomnia may be caused by certain neurotransmitters (brain chemicals that signal brain cells) that are known to be involved with sleep and wakefulness.

There are many possible chemical interactions in the brain that could interfere with sleep and may explain why some people are biologically prone to insomnia and seem to struggle with sleep for many years without any identifiable cause.

You should seek help if your insomnia has become a pattern, or if you often feel fatigued or unrefreshed during the day and it interferes with your daily life.

Many people have brief periods of difficulty sleeping for example, a few days after starting a new job, but if insomnia lasts longer or has become a regular occurrence, you should ask for help.

Start by visiting your primary care, who in turn will refer you to a psychiatrist; a medical doctor knowledgeable about sleep disorders.

He or she will guide you through the next steps, which may involve an assessment and appropriate treatment.

Next week I will look in more detail on how you could have better sleep. — sleepfoundation.org