SLEEP DISORDERS CENTRE

 

 

Dr Olajide Obembe [MBBS, MBA, FWACP]

Consultant Psychiatrist,

Head of Sleep Disorder Centre, FNPH, Yaba.

 

  The Federal Neuro-psychiatric hospital, Yaba, also known as Psychiatric hospital, Yaba, is the   foremost psychiatric hospital in Nigeria responsible for provision of mental health services to   Nigerians, especially people residing in Lagos and environs. Since its establishment in 1907 as an asylum,it has gone through several developmental stages as a mental health services provider and metamorphosed into a modern day mental health care services provider.

    One of the recent additions to the broad range of mental health care services available at the   psychiatric hospital, Yaba, is the Sleep Disorders Centre [SDC]. Services at the sleep disorders   Centre kicked off  last quarter of year 2017. The SDC offers services for both assessment and   management of various sleep problems in children, adults and old people. The SDC runs a weekly   (Tuesdays) out-patient clinic where both old and new patients are assessed and their needs are   met.The SDC also runs a sleep laboratory service where sleep studies are done either as part of   assessment processes of patients seen at sleep out-patient clinic or referrals from other   hospitals.The sleep laboratory is equipped with state-of-the-art technology.The sleep study at the Centre is Level 1.

 

VARIOUS SLEEP PROBLEMS MANAGED AT THE SLEEP DISORDERS CENTRE INCLUDES:

• Insomnia Disorder: inadequate ability to generate good sleep with consequent dissatisfaction with sleep quantity or quality (e.g., difficulty falling asleep, staying sleep, early-morning awakening), feeling unrefreshed in the morning and suffering significant distress or daytime impairment.

 

• Hypersomnia: this is a condition of either excessive daytime sleepiness or sleep attacks (in spite of an adequate amount of sleep in the night) or prolonged transition to the fully aroused state upon awakening. The daytime functioning is impaired by inability to stay fully awake as required.

 

• Narcolepsy: this condition may present with (1) continuous daytime sleepiness, with exacerbations (sleep attacks), (2) Muscle weakness triggered by emotion, most commonly hearing or telling a joke, with duration of Seconds to minutes, (3) Vivid dreamlike images that occur at sleep-wake transitions, (4) A partial or complete paralysis of the skeletal muscles that occurs at sleep onset or sleep offset.

 

• Breathing-Related Sleep Disorders e.g. Obstructive Sleep Apnea: there are complaints of unintentional daytime sleepiness, unrefreshing sleep, fatigue, or insomnia, with history of awakenings with breath-holding, gasping, or choking. Bed partner reports loud snoring and/or breathing interruptions during the patient’s sleep.

 

• Circadian Rhythm Sleep Disorder—Delayed Sleep Phase Type:: characterized by a delay in sleep period relative to clock time, characterized by late sleep onset and late natural awakening. If undisturbed by social obligations, patients will have good sleep maintenance and awaken feeling refreshed.  

 

•  Circadian Rhythm Sleep Disorder—Advanced sleep phase type: characterized by an advance in the sleep period relative to clock time characterized by early sleep onset and early awakening. It occurs most commonly in elderly individuals. There is recurrent inability to remain awake until a desired conventional clock time and inability to remain asleep until a desired socially accepted time.

 

•  Circadian Rhythm Sleep Disorder— Irregular sleep-wake type: This is characterized by lack of a clearly defined circadian rhythm of sleep and wake behavior. Typically, sleep and wake periods are interspersed throughout the day.

 

•  Circadian Rhythm Sleep Disorder—Shift work type: There is a complaint of insomnia or excessive daytime sleepiness that is temporally associated with a recurring work schedule that overlaps the usual time for sleep.

 

•  Confusional arousals: Recurrent mental confusion or Confusional behavior occurs during arousal or awakening from nocturnal sleep or a daytime nap.

 

•  Sleepwalking:  Sleepwalking or somnambulism is a state of altered consciousness in which phenomena of sleep and wakefulness are combined. During a sleepwalking episode the individual arises from bed while sleeping, and walks about, exhibiting low levels of awareness, reactivity, and motor skill. A sleepwalker will sometimes leave the bedroom and at times may actually walk out of the house. Most often, however, he or she will return quietly to bed, either unaided or when gently led by another person. Upon awakening either from the sleepwalking episode or the next morning, there is usually no recall of the event.

 

• Sleep terror: Sudden episode of terror occurs during sleep, usually initiated by a cry or loud scream that is accompanied by high level of autonomic activation and behavioral (potentially dangerous) manifestations of intense fear. There is difficulty in arousing the person, there is confusion when awakened from episode. There is complete or partial amnesia for the episode.

 

• Nightmare Disorder: Nightmares are dream experiences loaded with anxiety or fear, of which the individual has very detailed recall. The dream experiences are extremely vivid and usually include themes involving threats to survival, security, or self-esteem. Upon awakening, the individual rapidly becomes alert and oriented.

 

• REM Sleep Behavior Disorder: characterized by dream-enactment behavior that is often violent in nature. Patient may or may not remember associated dream material when awakened during an episode.

 

• Substance/Medication-Induced Sleep Disorders: these are sleep problems arising from drug use or abuse.

  Patients with the above-listed sleep disorders have been managed successfully at the Sleep Disorders Centre in Federal Neuro-psychiatric Hospital, Yaba, Lagos.