Sleep Medicine

Dr Paul Miller has a special interest in Sleep Medicine and especially in the interface of sleep abnormalities with mental health. At TMR Health Professionals we have a specialist group of clinicians and technicians skilled in the clinical assessment, physiologic testing, diagnosis, management and prevention of sleep and circadian rhythm disorders. We treat patients of any age and use multidisciplinary approaches, which includes involvement and onward referral to a highly specialised group including ENT and Faciomaxillary Surgeons, if required. Disorders that are managed by the sleep specialist team include, but are not limited to, sleep related breathing disorders, insomnia, hypersomnia, circadian rhythm sleep disorders, parasomnias and sleep related movement disorders

Definitions

Sleep related breathing disorders – stopping breathing during sleep (sleep apnoea); breathing ineffectively during sleep (sleep hypopnoea); sleep disturbed breathing

Insomnia – difficulty in the phases of sleep and this can be initial (problems with falling asleep); middle (wakening up during sleep); or early morning wakening

Hypersomnia - There are two main categories of hypersomnia: primary hypersomnia (sometimes called idiopathic hypersomnia) and recurrent hypersomnia (sometimes called recurrent primary hypersomnia). Both are characterized by the same signs and symptoms and differ only in the frequency and regularity with which the symptoms occur.

Primary hypersomnia is characterized by excessive daytime sleepiness over a long period of time. The symptoms are present all, or nearly all, of the time. Recurring hypersomnia involves periods of excessive daytime sleepiness that can last from one to many days, and recur over the course of a year or more. The primary difference between this and primary hypersomnia is that persons experiencing recurring hypersomnia will have prolonged periods where they do not exhibit any signs of hypersomnia, whereas persons experiencing primary hypersomnia are affected by it nearly all the time. One of the best documented forms of recurrent hypersomnia is Kleine-Levin syndrome, although there are other forms as well.

Excessive daytime sleepiness - There are many different causes for daytime sleepiness that are not considered hypersomnia, and there are many diseases and disorders in which excessive daytime sleepiness is a primary or secondary symptom. Feelings of daytime sleepiness are often associated with the use of common substances such as caffeine, alcohol, and many medications. Other common factors that can lead to excessive daytime sleepiness that is not considered hypersomnia include shift work and insomnia. Shift work can disrupt the body's natural sleep rhythms. Insomnia can cause excessive daytime sleepiness because of lack of nighttime sleep, and is a separate disorder.

Circadian rhythm sleep disorders – These are a family of sleep disorders affecting the timing of sleep. People with circadian rhythm sleep disorders are unable to sleep and wake at the times required for normal work, school, and social needs. They are generally able to get enough sleep if allowed to sleep and wake at the times dictated by their body clocks. Unless they have another sleep disorder, their sleep is of normal quality. The circadian rhythm sleep disorders are:

Jet lag, which affects people who travel across several time zones.
Shift work: People who work at night often have trouble sleeping during the day.
Delayed sleep phase syndrome (DSPS), which causes difficulty falling asleep at night and waking up in the morning.
Advanced sleep phase syndrome (ASPS), which causes difficulty staying awake in the evening and staying asleep in the morning.
Non-24-hour sleep-wake syndrome, which causes patients to stay up later and later each night, then wake up later each morning.
Irregular sleep-wake pattern, which presents as sleeping at very irregular times, and usually more than once per day (waking frequently during the night and taking naps during the day).

Parasomnias - A parasomnia is any sleep disorder such as sleepwalking, sleep sex, teeth grinding, night terrors, rhythmic movement disorder, REM behaviour disorder, restless leg syndrome, and somniloquy (or sleep talking), characterized by partial arousals during sleep or during transitions between wakefulness and sleep. Parasomnias are often associated with stress and depression, and biological factors may also be involved. Many parasomnias are more common in children than in adults.

Unlike dyssomnias, parasomnias do not involve abnormalities of the mechanisms generating sleep-wake states, nor of the timing of sleep and wakefulness. Rather, parasomnias represent the activation of physiological systems at inappropriate times during the sleep-wake cycle. In particular, these disorders involve activation of the autonomic nervous system, motor system, or cognitive processes during sleep or sleep-wake transitions.

Many parasomnias, such as sleepwalking, are often used as themes in comedy, but can actually have serious consequences. For example, a person with REM behavior disorder, while trying to swing a tennis racket in a dream, can potentially injure their bedmate. People with night terrors can prevent others from sleeping well, as well as waking themselves up. For these reasons, parasomniacs sometimes need medical treatment.

Referrals

Normally we will not be your first ‘port-of-call’ but you can be referred by your GP, or other health professional.