Australian Doctor 4th August 2023 AD 4th Aug Issue | Page 28

28 HOW TO TREAT : DIGITAL HEALTH INTERVENTIONS IN SLEEP DISORDERS

28 HOW TO TREAT : DIGITAL HEALTH INTERVENTIONS IN SLEEP DISORDERS

4 AUGUST 2023 ausdoc . com . au from the exacerbation of underlying medical conditions , such as hypertension , diabetes , mental health and cardiovascular disease , which may in turn have a bi-directional effect on sleep quality . 8-11 When considered together , unmanaged sleep disorders contribute to significant socioeconomic burden both in Australia and worldwide .
The International Classification of Sleep Disorders — Third Edition ( ICSD-3 ) broadly classifies sleep disorders into seven categories ( see box 1 ). 12 Many presenting symptoms of a sleep disorder can overlap , and the GP has an important role to play in determining the underlying cause of the sleep-related symptoms and directing patients to appropriate care . Generally , the prevalence of sleep disorders increases with age , with older adults being more likely to experience sleep-related problems than younger adults . 13 Of the sleep disorders , insomnia , obstructive sleep apnoea and restless legs syndrome are the most common in primary care . 14 However , it is prudent for GPs to also be aware of other less common sleep disorders , including narcolepsy , rapid eye movement behaviour disorders and shift work sleep disorder . Figure 1 outlines the prevalence of the more common sleep disorders in primary care .
Insomnia
Insomnia is among the most common symptoms reported by primary care patients . It is a disorder characterised by self-reported difficulty falling asleep , staying asleep , and / or waking up too early with associated daytime impairment . It can be acute or chronic ( three months or longer ).
Insomnia can be initially caused by a variety of factors , including stress , anxiety , depression , medical conditions and medications . 19 However , in the case of chronic insomnia , psychological and behavioural factors are often established and perpetuate insomnia over time , independently of these initial triggers . An estimated 30 % of individuals will experience insomnia symptoms at any given time , and about 6-10 % will reach diagnostic criteria for chronic insomnia disorder where long-term symptoms of insomnia are accompanied by
15 , 20 daytime consequences . Insomnia is more common in women than in men , and more prevalent in older adults . 20 It frequently co-occurs with other mental and physical health conditions , and should be viewed as a comorbid condition rather than a secondary symptom . 12
Circadian rhythm sleep disorders
Restless legs syndrome
Insomnia symptoms
Obstructive sleep apnoea
Figure 1 . Prevalence estimates of common sleep disorders in primary care .
0 %
10 %
20 %
30 %
40 %
Prevalence *
* Although the respective sleep disorders are represented as discrete conditions in this figure , in practice these frequently co-exist . This figure does not indicate the prevalence of other less common sleep disorders , such as narcolepsy or REM behaviour disorder .
Adapted from Ohayon MM et al 2009 15 , Netzer NC et al 2003 16 , Allen RP et al 2003 17 , Kim M et al 2013 18
Obstructive sleep apnoea
Obstructive sleep apnoea ( OSA ) is a
disorder characterised by repeated episodes of airway closure or narrowing during sleep . It can cause excessive daytime sleepiness , fatigue and cardiovascular sequalae . 21
The apnoea-hypopnea index refers to the average number of apnoea and hypopnoea events occurring per hour of sleep . It is commonly used to classify the severity of OSA into : mild ( 5-15 events / hour ), moderate ( 15-30 events / hour ) and severe ( more than 30 events / hour ). 22
OSA syndrome — that is , experiencing daytime consequences — has a prevalence of approximately 5 %, but estimates of individuals at risk of OSA can be as high as 32 %. 16 Sleep apnoea is more common in men than in women , and is more prevalent in
23 , 24 older adults .
Figure 2 . Individuals who work night shifts or have irregular sleep schedules are at a higher risk of developing circadian rhythm disorders .
Box 1 . Classification of sleep disorders
• Insomnia .
• Sleep-related breathing disorders .
• Central disorders of hypersomnolence .
• Circadian rhythm sleep-wake disorders .
• Sleep-related movement disorders .
• Parasomnias .
• Other sleep disorders .
Further complicating the identification of sleep disorders is the overlap between conditions . Some 30-40 % of those with insomnia have comorbid OSA , while 30-50 % of people with OSA meet the criteria for insomnia . 25
Circadian rhythm disorders
Circadian rhythm disorders are a
group of sleep disorders where an individual ’ s internal biological clock is not in sync with the external environment . These disorders affect sleep-wake cycles , causing individuals to struggle with sleeping and
waking at appropriate times . 26 , 27 An estimated 10 % of the population may experience some form of circadian rhythm disorder , with the most common being delayed sleep phase syndrome ( DSPS ) in younger adults , advanced sleep phase syndrome ( ASPD ) in older adults , and non-24-hour sleep-wake disorder . 18
Individuals who work night shifts ( see figure 2 ) or have irregular sleep schedules are at a higher risk of developing circadian rhythm disorders , with 10-38 % of the shift work population affected
28 , 29
.
Restless legs syndrome
Restless legs syndrome ( RLS ) is a nocturnal
neurological disorder characterised by an irresistible urge to move and an associated abnormal sensation in the legs . Some patients describe this as a crawling , creeping , aching or itching sensation . 30 These symptoms are worse at rest and can be relieved by movement .
The prevalence of RLS in primary care for those experiencing any symptoms is 11 %, with about 2.4 % of patients reporting that RLS has a significantly negative impact PAGE 30