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Sleep Disorders in ADSleep Disorders as Triggers and Symptoms in Autoimmune Disease
Sleep disorders can occur in conjunction with various autoimmune diseases and they can also act as triggers for autoimmune diseases.
More than 70 distinct sleep disorders have been described. Many of these sleep disorders, particularly obstructive sleep apnea, restless leg syndrome, and periodic limb movement disorder occur in association with various autoimmune disorders. And according to recent studies, long-term untreated obstructive sleep apnea is a risk factor for cell-mediated autoimmune diseases such as scleroderma and Graves' disease, making sleep disorders triggers as well as symptoms in autoimmune disease. In addition, patients with autoimmune as well as radiation-induced hypothyroidism are at increased risk for obstructive sleep apnea, and patients with systemic sclerosis have impaired esophageal motility and shortness of breath. Sleep disorders are diagnosed by sleep studies in which a combination of diagnostic parameters such as oxygen saturation and movement are monitored during sleep. Obstructive Sleep Apnea Obstructive sleep apnea is a potentially life-threatening disorder in which breathing is interrupted during sleep. An estimated 12 million Americans have sleep apnea, and many of these people have associated sleep disorders such as restless leg syndrome and periodic limb movement disorder. In obstructive sleep apnea, sleep is interrupted by as many as 20-30 repetitive episodes per hour of no effective breath, very shallow breaths, or adequate breaths but with high airway resistance. When sleep apnea is caused by limitations in upper-airway dimensions, for instance excess soft tissues at the back of the throat and palate, obstructive sleep area is typically associated with chronic loud snoring and increased cardiovascular risk. Over time, chronic sleep deprivation leads to excessive daytime sleepiness and conditions of morning headache, high blood pressure, heart attacks, heart-rhythm disorders, stroke, and decreased life expectancy. Restless Leg Syndrome Restless leg syndrome, which is also known as Witttmaack-Ekbons syndrome, Jimmy legs, spare legs, and nocturnal myoclonus, is a sensory motor neurologic disorder causing uncontrollable urges to move the limbs especially during sleep. Restless leg syndrome is frequently associated with an underlying condition of iron deficiency, diabetes, Sjogren's syndrome, celiac disease, rheumatoid arthritis, fibromyalgia, osteoarthritis, anemia or peripheral neuropathy. Restless leg syndrome has four major characteristics: an urge to move, usually due to uncomfortable sensations (of creeping, crawling, pins and needles, tingling, pulling, twitching, tearing, throbbing, prickling or aching) occurring primarily in the legs, particularly the calves; motor restlessness, expressed as activity, that relieves the urge to move; worsening of symptoms by relaxation, with symptoms increasing during long periods of sitting; variability over the course of the day-night cycle, with symptoms worse in the evening and early in the night. Another common feature is having a co-existing periodic limb movement disorder, with 80-90 percent of patients with restless leg syndrome also having periodic limb movement disorder. About 15 percent of the adults in North American and Europe have restless leg syndrome, and in these populations there is a high incidence of familial cases, suggesting a genetic tendency. Symptoms usually appear at about age 45 although they may occur in childhood. Surgery of any kind, as well as back injuries, may precipitate or worsen restless leg syndrome. Medications known to worsen symptoms include anti-nausea drugs, caffeine antihistamines, antidepressants, antipsychotic drugs, and anti-seizure medications. Patients with gluten sensitivity enteropathy may notice a worsening of symptoms when gluten is ingested. Because restless leg syndrome is associated with low iron levels, all patients with symptoms should have iron and ferritin levels. Iron supplements are often used as a treatment for restless leg syndrome. In familial cases, folic acid supplements, vitamin E and ginkgo biloba are reported to improve symptoms. Other treatments include dopamine agonists such as ropinirole, levodopa, and pramipexole, opiates, benzodiazepines and gabapentin (Neurontin), compression stockings, mild exercise, heating pads, and yoga. Periodic Limb Movement Disorder Periodic limb movement disorder is a condition characterized by slow repetitive stereotyped "jerks" of flexions of the affected body part, usually the legs and arms, that occur during sleep and sometimes while awake. Periodic limb movement disorder usually occurs in association with restless leg syndrome, and it is detected by monitoring patients during sleep studies. Treatment is the same as that used for restless leg syndrome. Resources: University of Illinois Medical Center Sleep Study Group The International Scleroderma Network National Institute of Neurological Disorders and Stroke
The copyright of the article Sleep Disorders in AD in Autoimmune Disease is owned by Elaine Moore. Permission to republish Sleep Disorders in AD in print or online must be granted by the author in writing.
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