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Signs and symptoms of sleep problems

The signs and symptoms of sleep problems vary according to which disorder is present. For example, people with insomnia have difficulty falling asleep or staying asleep. They often feel tired even after they have had a full night’s sleep.

Meanwhile, people with sleep apnea may experience breathing that stops during sleep. Loud snoring and choking or gasping associated with sleep may also occur. Patients with movement disorders, such as restless leg syndrome (RLS) and periodic limb movement disorder (PLMD), may experience discomfort in their legs or rapid jerking motions in their limbs during sleep. RLS and PLMD may cause excessive daytime fatigue and insomnia at night.

Diagnosis methods for sleep problems

Older people often attribute their sleep difficulties to the aging process and may not realize that their symptoms are actually the result of an illness or condition such as a sleep disorder. Patients are encouraged to consult a physician if they notice a change in their sleep patterns or if they find themselves frequently tired during the day.

In diagnosing sleep problems, a physical examination is performed to determine if there is a medical cause for the problem. During this examination, the physician will look for signs of conditions that may affect sleep, including heart disease, Parkinson’s disease, obesity and stroke. A medical history, which may include the patient’s current medications and a psychiatric history, will also be taken. Patients may be given a neurological (nervous system) examination if a neurological cause is suspected.

Patients may be asked questions regarding sleep patterns and symptoms experienced during waking hours. Family members or sleep partners may be asked to describe sleep patterns and behavior of patients. Patients will also likely be asked questions regarding lifestyle habits, such as smoking or the use of alcohol or caffeine. A sleep diary detailing times and patterns of sleep may help discussions with a physician or sleep specialist.

Sleep disorders can sometimes be diagnosed by identifying medications that patients take. Because older patients are more likely to take medications than younger patients, it is important to inform the physician of all medications presently being used, including over-the-counter drugs and dietary supplements.

Patients are also urged to disclose information about any medical or neurological conditions, psychiatric disorders or other factors that may be causing sleep problems. In some cases, patients may be referred to a sleep center where sleep patterns are analyzed in depth by health professionals who specialize in sleep disorders. Some common tests that are performed to diagnose sleep disorders include:

• Sleep questionnaire. The Epworth Sleepiness Scale uses questions to measure the likelihood of dozing in certain circumstances, such as while sitting and reading.
  
  
• Polysomnogram (sleep study). Painless test conducted overnight while patients are sleeping. Electrodes placed on the body before sleep are used to monitor electrical activity of the brain (electroencephalogram), heart (electrocardiogram), movements of the muscles (electromyogram) and eye movements (electro-oculogram). These are measured as patients experience the different stages of sleep.
  
  
• Multiple sleep latency test (MSLT). Conducted in a similar method as a polysomnogram, but it is performed during daytime hours. It may be used to diagnose narcolepsy by determining how quickly a person falls asleep during regular waking hours.
  
  
• Repeated test of sustained wakefulness (RTSW). This test measures how long it takes for a patient to fall asleep by challenging the ability to stay awake. During the test, patients are placed in a quiet room with dim lighting and asked to remain awake. It is also used to diagnose narcolepsy.

However, most older patients do not require these specialized tests for their sleep problems to be diagnosed and treated.