CLINICAL INFORMATION
Who We Are
We aim to provide high quality care for patients with a broad spectrum of sleep disorders. We believe that a clear diagnosis is a pre-requisite for effective treatment. A diagnosis helps us have a clear understanding of the underlying causes and mechanisms of disease and direct treatment. For this, we need appropriate diagnostic testing and accurate interpretation aids the diagnostic process.
Dr Jose Thomas
Dr Thomas’ clinical experience spans over three decades and he has been a Consultant Physician since 1995. He is accredited as ‘European Somnologist-Expert in Sleep Medicine’ by the European Sleep Research Society (2014).
Dr Thomas leads the Aneurin Bevan Sleep Centre, the “tertiary” referral centre for Sleep Medicine in Wales. He has an interest in legal aspects of medicine and has prepared medico-legal reports for over 20 years.
Specialist in
Sleep Medicine
Dr Thomas’ main speciality is Sleep Medicine. He has special interests in Neurological sleep disorders, Circadian Rhythm Sleep Disorders and Behavioural Sleep Medicine in addition to Sleep and Breathing Disorders. He has special expertise in the treatment of chronic insomnia. He also has extensive experience in general respiratory medicine particularly in the diagnosis and management of unexplained breathlessness.
Excessive daytime sleepiness
Sleepiness is a perception of the need to sleep. It can also be considered as the ability to fall asleep. Sleepiness manifests as yawning, eye rubbing, drooping of eyelids, and lapses of attention. The loss of muscle tone in sleep leads to head-nodding if the person is sitting or standing.
Daytime Sleepiness is the inability to remain awake and alert during the day time. If this causes concern or interferes with day-to-day functioning it is considered Excessive Daytime Sleepiness (EDS). When sleepiness occurs only in circumstances that require relatively little attention, it is considered as mild EDS. Sleepiness occurring while engaged in activities that require higher degrees of attention can have dangerous consequences. At times sleepiness can be overwhelming and can occur without warning when it is called a ‘sleep attack’.
It is common to feel a bit groggy immediately upon waking up from sleep. This state of sleep inertia usually lasts only for a few minutes, rarely exceeding 30 minutes. If sleep inertia is severe and lasts longer, it is known as sleep drunkenness. Those with severe sleep inertia find it difficult to wake up from sleep. They may repeatedly fall back asleep, and be irritable, aggressive or confused.
EDS affects up to 25% of the population. it may be caused by inadequate sleep duration, lack of sleep continuity, primary sleep disorders, general medical conditions, side effects of drugs or psychological/psychiatric conditions.
Sleepiness is a contributory factor in 27% of all road traffic accidents and is the sole cause in some 13% of accidents. A lorry driver falling asleep at the wheel causing an accident is the most common cause of accidental death of a person at work. It is also the most common cause of death of another person caused by someone at work. The loss of truck, load and clean-up is estimated to cost an average of £ 1.2 million per accident.
Tiredness and Fatigue: Tiredness is a non-specific term which many people use for ‘fatigue’ and ‘sleepiness’. Fatigue refers to an inability to perform physical exertion at an intensity or for a duration one might expect. There may be associated sense of mental fatigue, lack of attention and concentration and poor memory.
Insomnia
Insomnia is difficulty in falling asleep, staying asleep, waking up too early from sleep or feeling not refreshed after sleep. Most patients with insomnia complain of one or more of these symptoms. If these are associated with daytime symptoms such as fatigue, difficulty in attention, concentration, memory mood, etc., it is known as insomnia disorder.
Most of us would have experienced insomnia at some time in our lives. Approximately 10% of the population suffers from Chronic Insomnia Disorder.
Sleep Apnoea
‘Sleep Apnoea’ is a condition in which you develop ‘apnoea’ during sleep. Apnoea means ‘stoppage of breathing’. In fact, your breathing may not completely stop, but become very shallow, to the extent that you are not able to get adequate amount of air in to your lungs (technically known as ‘hypopnoea’).
Apnea and hypopnea can occur either because the air passage in your throat is obstructed (when it is known as ‘Obstructive’ sleep apnoea or OSA) or because your brain does not send signals to your chest muscles instructing the chest to expand to fill your lungs (known as ‘Central sleep apnoea’). Obstructive Sleep Apnoea is the commonest type of Sleep Apnoea.
Restless Legs Syndrome (RLS) – the least diagnosed sleep disorder
RLS is a common neurological sleep disorder affecting 10-15% of the population. Approximately 10% of patients with RLS have significant symptoms that would require medical intervention for control. If you answer ‘yes’ to the question ‘when you try to relax in the evening or sleep at night, do you ever have unpleasant, restless feelings in your legs that can be relieved by walking or movement?’ you are likely to have RLS. RLS affects men and women and may start in childhood. It often runs in families.
Circadian Rhythm Sleep Wake Disorders
The timing of sleep is determined by actions of our ‘body clock’ (Circadian Rhythm). Alterations of the Circadian Rhythm can cause various sleep complaints, of which the best known is ‘jet lag’. Patients may experience insomnia at night, excessive sleepiness and in the daytime, or irregular periods of sleep and wake through the 24-hour day.
Narcolepsy
Narcolepsy is perhaps the best known neurological sleep disorder. It usually starts in adolescence or early adult life and manifests as excessive sleepiness in the wake time. Patients with narcolepsy may also have ‘cataplexy’ – sudden loss of muscle power when one is emotionally excited, such as when you her a joke or are taken by surprise. Other features of narcolepsy include vivid dreams, sleep-related hallucinations, sleep paralysis and frequent interruption of sleep at night. Patients with narcolepsy may also have other sleep disorders such as obstructive sleep apnoea, restless legs syndrome and REM Sleep Behaviour Disorder.
Sleep Walking
Abnormal behaviors arising from sleep are known as parasomnias. Parasomnias occurring during NREM Sleep are known as NREM parasomnias. The best known NREM parasomnia is Sleep Walking, also known as somnambulism. There are other types of NREM parasomnias including Sleep Terrors, Confusional Arousals, Sleep Related Eating and Sleep Sex (Sexsomnia).
Distressing Dreams
All of us dream during Rapid Eye Movement Sleep, although many do not remember the dreams. However, dreams are often distressing when they are known as nightmares. All of us a familiar with the occasional nightmares. Nightmares are very vivid dreams that become more disturbing as they unfold. The content of nightmares involves scenes of imminent physical danger or other distressing themes. They are usually associated with anxiety, fear or terror. Upon waking, the person is able to give a vivid description of the scenes of the nightmare.
Distressing dreams may occur in a number of settings. When nightmares occur immediately following traumatic life events it is known as Acute Stress Disorder. Vivid dreams and nightmares, often related to the traumatic events, may occur after a month or more of the event. This is part of Post-Traumatic Stress Disorder (PTSD).
Nightmare Disorder: In nightmare disorder, there are repeated, well-remembered distressing dreams that usually involve threat to safety, security, integrity or survival of the person. The experience of the dream and sleep disturbance results in impairment of functioning on the following day.
REM Sleep Behaviour Disorder (RBD): RBD is a neurological sleep disorder in which we ‘act out’ our dreams. This means that we will perform the actions that we dream. It usually occurs in the early hours of the morning when we get most of our REM Sleep. Patients often remember vivid dreams with violent or distressing content. They may talk, shout or scream. They may flail their arms or legs, punch, kick out etc., and may injure themselves or their bed partners in the process.
Sleep Paralysis
Sleep paralysis (SP) is an inability to make voluntary movements, either as one falls asleep or when waking up from sleep. The person is unable to speak or move the body. Consciousness, memory and breathing are unaffected. An episode of SP may last seconds or minutes. A person may recover quickly if spoken to or, touched during the episode. Occasional episodes of SP occurs in normal individuals. If it occurs frequently in the absence of narcolepsy, it is known as Recurrent Isolated Sleep Paralysis (RISP).
Abnormal movements in Sleep
There are a number of conditions that cause abnormal movements in sleep. The commonest condition is Restless Legs Syndrome. Another condition closely related to RLS is Periodic Limb Movement Disorder of Sleep (PLMD). There are a number of other conditions that may cause abnormal movements in sleep.
Other Sleep Disorders
There are many other medical and neurological disorders that present with symptoms in sleep. Examples include sleep-related epilepsy, sleep related ‘acid reflux’, sleep related headaches and others.
