About sleep disorders
Because sleep sits between several specialties, our clinic is run jointly. Neurologist Dr Ibrahim Imam sees sleep disorders of the nervous system; consultants in respiratory and sleep medicine Dr Eddy Ferrufino Rivera and Dr Abhilash Sahadevan see sleep-related breathing disorders and run the sleep study service. You are directed to the right consultant at referral.
Untreated sleep disorders are not just tiring. Sleep apnoea raises blood pressure and the risk of heart disease, stroke and diabetes. Chronic insomnia worsens mood and pain. Excessive daytime sleepiness is a road safety issue. Assessment matters.
Symptoms we assess
Reasons to be assessed include:
- Loud snoring with pauses in breathing, choking or gasping in sleep
- Waking unrefreshed, morning headaches or falling asleep during the day
- Difficulty falling asleep or staying asleep for more than three nights a week over three months
- An urge to move the legs in the evening or at night, relieved by movement
- Acting out dreams, sleepwalking, night terrors or other unusual behaviour in sleep
- Sudden sleep attacks, muscle weakness with emotion, or vivid hallucinations on falling asleep
- A body clock that is badly out of step with work or school
How we diagnose it
A sleep assessment starts with the story: your sleep pattern, bed partner observations, daytime function, medication, alcohol and caffeine, mood and medical history. A sleep diary and validated questionnaires such as the Epworth sleepiness scale are used. The examination looks for the physical factors that predispose to sleep apnoea and for neurological signs.
Where a breathing disorder is suspected, an overnight sleep study is arranged, often at home with a portable monitor and where needed in the hospital sleep laboratory with full polysomnography. Narcolepsy is assessed with an overnight study followed by a multiple sleep latency test. Blood tests check iron stores (important in restless legs), thyroid function and other contributors.
Treatment and follow-up
Obstructive sleep apnoea is treated with CPAP, a mask worn at night that keeps the airway open, or with a mandibular advancement device for milder cases, alongside weight and lifestyle measures. Treatment usually transforms daytime energy within weeks. Chronic insomnia responds best to cognitive behavioural therapy for insomnia (CBT-I), with medication used sparingly and briefly.
Restless legs syndrome is treated by correcting iron deficiency and, where needed, with medication. Narcolepsy is managed with scheduled naps and medicines that improve wakefulness and reduce cataplexy. REM sleep behaviour disorder is treated with medication and, because it can precede other neurological conditions, is kept under neurological review.
Every plan is written up for your GP, with the driving advice that Irish law requires where sleepiness is a factor.
When to see a GP, and when to see a consultant
Talk to your GP first about sleep problems; simple measures and a review of medicines solve many. Ask for a consultant referral if snoring comes with witnessed pauses or daytime sleepiness, if insomnia has lasted more than three months, if there are unusual behaviours in sleep, or if you are falling asleep without warning. Do not drive if you are excessively sleepy.
