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About Physiatry

Sleep Disorders in Diseases of the Central Nervous System

Condition: Difficulty falling asleep, too much sleep, and difficulty while asleep are examples of sleep disorders.  Sleep disorders are common in people with diseases of the central nervous system (CNS). 

Background: Sleep problems may be caused by damage to part of the brain, or other CNS-related diseases might affect sleep. Some CNS disorders cause sleep apnea, where a person stops breathing for a few seconds while asleep. Other disorders upset the body’s internal clock, resulting in difficulty sleeping at night. Other factors that make it difficult to sleep include pain and depression.

Risk Factors: More than half of people who have had a traumatic brain injury or stroke will have sleep problems. People with brain diseases like Parkinson’s and Alzheimer's disease also often have sleep problems. Obesity is a risk factor for sleep apnea and stroke.

History and Symptoms: The physician may take a detailed history of a patient’s sleep patterns, including fatigue, napping, medications used and any other conditions that may impact sleep (such as pain or depression).    Morning headaches, snoring or family reports of apnea are important to note.  Fatigue is the most common symptom of a sleep disorder and may lead to problems with thinking, mood, behavior, movement, balance, coordination, and self-care. Other symptoms include morning headaches, snoring and bad dreams. 

Physical Exam: The physician will perform a thorough physical examination, with special attention to the neurological and breathing examination, as well as examination of the mouth and throat.  Fatigue, which is the most common symptom of a sleep disorder, may result in problems with balance, coordination and thinking.  The physician may check for the presence of these problems during the physical examination.

Diagnostic Process: Blood tests, magnetic resonance imaging (MRI), sleep studies and EEGs are tools that the physician may use to determine the cause of the sleep disorder.

Rehab Management: The rehab management of sleep disorders depends on the type of sleep disorder that a person has.   For most patients, good “sleep hygiene” is recommended.  This consists of changing routines around going to sleep to optimize going to sleep.  This may include avoiding napping, exercising regularly (but not before bedtime, avoiding caffeine and alcohol after dinner.  Depending on the type of sleep disorder that one has, other treatments might be appropriate for use, such as medications or devices to improve breathing at night.

Other Resources for Patients and Families: Family support can help patients change their sleep-related habits. Counseling may be needed if sleep problems are affecting one’s family or work life. 

For Patients and Families:

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