What Are Sleep-Wake Transition Disorders?
Sleep-wake transition disorders are a group of sleep disorders in which a person experiences pain or problems during the transformation from one stage of sleep to another. These disorders are parasomnias that present with behavioral abnormalities during the transition between wakefulness and sleep. The condition can occur during or before sleep, or arousal during sleep.
How Are Sleep Disorders Classified?
Sleep-related disorders are very common, but they do not get much attention due to their mild severity or complications. Unlike other sleeping disorders, these disorders do not require medical attention or treatment unless complicated by their consequences or underlying medical conditions. The prognosis in patients with sleep-wake transition is generally good.
The International Classification of Sleep Disorders has categorized these disorders into four types, which are as follows:
1. Rhythmic Movement Disorder:
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This disorder presents with the rhythmic movement of large muscle groups immediately before and during sleep. The movement can be noticed in any part of the body, and the frequency ranges from 0.5 to 2 Hz; these movements are commonly seen in children during early infancy and sometimes in adults. The occurrence of rhythmic movement is considered to be a pathological as well as a physiological phenomenon. Episodes of these movements last for a maximum of 15 minutes.
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The rhythmic movement is discontinued upon noticing disturbances like someone calling the person’s name or any sudden loud noise. The episodes are not reported as the children, who can speak but cannot recall the incident in the morning or when they wake up. During the episode, rhythmic humming, or rapid movements like body rocking, head banging, and head rolling, can be noted; just the noise or rapid moments do not qualify rhythmic movement as a disorder; a child who gets severely injured or has disturbed sleep can be considered to have a rhythmic movement disorder.
2. Sleep Starts:
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Sleep starts, also termed hypnic jerks, are sudden contractions of the body that occur at the onset of sleep. These hypnic jerks generally shake one’s body but do not always wake them up. The exact etiology remains unknown, but sleep starts are commonly seen, especially in a young person who is stressed, tired, or consumes a lot of caffeine. Sleep starts are often presented with the feeling of falling during sleep or a visual hallucination.
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This disorder is often left undiagnosed till the partner brings it to one’s attention, as people usually forget the episode on waking up. Still, frequent rapid attacks can be a point of concern as it develops a fear of falling asleep, which may cause other medical complications like anxiety, insomnia, etc. These repeated jerks can also cause bruises or injuries to the extremities when hit hard against the bed and all the adjacent walls.
3. Sleep Talking:
Sleep talking is an abnormal behavior noticed during sleep. It is one of the most common sleep abnormalities that every person experiences at least once in a lifetime. Sleep talking mainly occurs during the rapid eye movement and non-rapid eye movement stages of sleep. Each episode ranges from about 30 sec, and the frequency of the episode may vary from person to person.
4. Nocturnal Leg Cramps:
These are musculoskeletal disorders that are persistently painful and episodic, involving involuntary contraction of the calf and foot (hamstrings) muscles. These mainly occur due to sleep disturbance, especially in the elderly population.
What are the Causes of Sleep Talking?
The exact cause of sleep talking is not known, but it has been evident among people with mental health disorders like
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Anxiety.
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Genetic etiology has also been noted.
It is commonly found to have an association with nightmares. In most cases, sleep talking is harmless, and a person is found to have unclear murmuring speech. However, the situation can get complicated when talking while sleeping disturbs the partner.
How Is Sleep Talking Treated?
Sleep talking does not have any definitive treatment as it is harmless; steps can be taken to reduce the episodes of sleep talking, which include:
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Keep a sleep diary.
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Make sure one is getting enough sleep.
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Limit caffeine and alcohol.
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Eat light and healthy.
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Create a relaxing bedtime routine.
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Follow sleep hygiene to permit a higher quality of sleep.
What Are Nocturnal Leg Cramps?
Nocturnal leg cramps are painful sensations caused by sudden, intense contraction of the muscles, generally of the calf or small muscles of the feet. These severe cramps disturb sleep, and the person is awakened with pain.
What Causes Nocturnal Leg Cramps?
The exact etiology of the disorders remains unknown, but they is noted to have some correlation with:
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Muscle fatigue and nerve disorders.
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Pregnancy.
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Old age.
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Drugs like diuretics have also caused night cramps in some patients.
How Are Nocturnal Cramps Treated?
Treatment in such conditions usually aims at curing the underlying disease.
Symptomatic relief in patients with nocturnal cramps can be obtained by:
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Stretching calf and foot muscles and keeping them healthy.
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Drinking plenty of water.
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Regular exercises can prove helpful.
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Use comfortable footwear.
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The use of shoes is recommended.
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Wear loose clothes, and use loose covers while sleeping.
Conclusion:
Sleep-wake transitions are a type of sleep disorder with minimal complications or are comparatively less harmful but most commonly occurring; these disorders include nocturnal cramps, sleep talking, sleep starts, and rhythmic movement disorder. The exact cause of the disorder is unknown. Still, it is usually found in association with other medical conditions like nocturnal cramps, which can be found in patients with diabetic neuropathy.
All these disorders affect the quality of sleep, leading to other complications like insomnia, anxiety, or difficulty concentrating due to a lack of sleep. Any definitive medicinal or therapeutic treatment for these disorders has yet to be introduced, as these disorders often go unnoticed and unreported.
Thus, precautions can be taken to decrease the episodes and their severity; medical help must be taken immediately if these disorders cause any secondary complications, like injury to the head or leg during the episode.
