Sleep Doctor Questions - Answered

Restless legs syndrome (RLS) is characterised by a desire to move the legs, often accompanied by creepy-crawly sensations. It is typically worse at night and can therefore stop people falling asleep. People with RLS often also have periodic leg movement disorder (PLMD) during sleep. These are short movements of one or more of the legs at regular intervals (usually about every 15-60 seconds) during sleep. After one of these movements, there may be an “arousal”, a brief awakening, which may disturb sleep. Therefore some people with PLMD may complain of poor sleep or daytime tiredness; however, others do not experience any symptoms. RLS is diagnosed on the basis of symptoms and PLMD from a sleep study. Although treatment is often not required, if they cause significant problems, then drugs such as pramipexole or ropinirole may be used, and you should therefore consult your doctor.  More information about Restless legs syndrome and periodic leg movement disorder can be found on our medical pages.

Provent is relatively new a device used in the treatment of obstructive sleep apnea (OSA). Small circular devices are inserted into both nostrils and secured in place with an adhesive strip. They act as one-way valves that provide resistance on expiration (breathing out). This resistance on exhalation creates back pressure which is transmitted to the throat and helps to keep it open during sleep.

One large study of patients with moderate OSA demonstrated that Provent did reduce severity of OSA but did not abolish it completely. It also improved daytime sleepiness and was well tolerated by patients. Provent is a potential alternative to therapies such as continuous positive airways pressure (CPAP) or oral appliances, which may be less well tolerated. CPAP however usually abolishes OSA completely, and Provent is unlikely to be effective in severe OSA.

Provent is available in Canada but must be prescribed by a doctor. Therefore, assuming you have already had a sleep study diagnosing OSA, you should consult a sleep physician who can discuss treatment options with you.

Feeling sleepy after sleeping in is a relatively common observation, although sleeping late can have both good and bad effects. For some people who are deprived of sleep during the working week, sleeping late at weekends allows them to catch up on sleep and can be beneficial. It is not uncommon for individuals to complain of being excessively sleepy or tired following this prolonged sleep time. This is called sleep drunkenness, whereby, people have difficulty functioning following waking.  The medical reason for this has not been determined, although, disruption of the body clock (circadian rhythm) may be a factor.  Sleeping in late may disrupt the body clock and therefore, you may feel sleepy at a time when you are usually quite awake.  Another factor may be waking from REM sleep or deep sleep, rather than lighter stages of sleep.   

In order to mitigate this feeling, a shower or caffeine may stimulate individuals. However, often exposure to bright light outdoors for 15 minutes or exercise (preferably outdoors in light) will help with this, by resetting your body clock.   In general, going to bed and getting up at similar times each day will result in better quality sleep and reduced daytime sleepiness.

For those individuals, who persistently sleep for long periods of time at night and constantly complain of feeling sleepy, review by a family physician may be necessary to make sure that other underlying medical conditions such as sleep apnea are not present.