Sleep Disorder and Peripheral Neuropathy - Term Paper Example

SLEEP DISORDER AND PERIPHERAL NEUROPATHY (Student Name) (Course Number) (University) (Date) 1. Introduction Neuropathy is a medical condition that affects the nerves of the body. The nervous system is an important component of the body as it is involved in the transmission of information from the brain to various parts of the body. Through the nervous system, therefore, an individual can feel, move or even hear. The nerves also have an important function of carrying signals to important organs of the body such as the heart and the lungs, hence enabling the beating of the heart and breathing. Any damage to these nerves can cause adverse effects on the body (Goetz, 2007, p. 105). The human nervous system is divided into the peripheral nervous system and the central nervous system. The central nervous system is a combination of nerve tissues that controls the functioning of the body. The spinal cord and the brain are its major components in the mammalian body. The peripheral nervous system (PNS) consists of the set of nerves found outside the central nervous system. The main function of the peripheral nerves is to link the central nervous system with the organs of the body such as the glands, the eye and the ear. In the human body, peripheral nerves consist of the autonomic nerves, spinal nerves and the cranial nerves. Peripheral neuropathy, therefore, is a medical disorder caused by the disruption or damage of the peripheral nerves. In any general population, neuropathy is known to affect 2.4 percent of the population with 8 percent of the people above age 55 likely to be affected. Peripheral neuropathy affects three types of nerves in the human body. These nerves are; the sensory nerves responsible for the transmission of information from the sensory organs to the brain. The autonomic nerves responsible for the automatic body functions and the motor nerves which regulate muscle movement. There three basic types of peripheral neuropathy. The first one, also called mononeuropathy occurs when a single nerve is affected. Example include the radial neuropathy that affects the arm and ulnar neuropathy of the elbow. The second type of neuropathy occurs when two or more nerves located in different areas of the body are damaged and is called multiplex neuropathy. In other cases, multiple peripheral nerves can be damaged simultaneously, resulting in a third condition called polyneuropathy. The causes of neuropathy are many and varied in nature. Its causes include systemic problems such as malfunctioning of the kidney, viral infections such as HIV that can interfere with the nerves and immune disorders such as multiple sclerosis. Neuropathy results in numbness, sexual dysfunction in men, digestion difficulties, and increased pain in the body, excessive sweating and thinning of the skin. 1.1. Neuropathic pain Neuropathic pain is a persistent state of pain that results from the damage or malfunctioning of the nerve fibres. The damaged nerve fibres deliver wrong information to the pain centres. Nerve fibre injury can change the function of the nerve at the injury site and the surrounding areas. An example of neuropathic pain is the phantom limb syndrome in which the brain receives pain messages from nerves that initially transmit impulses from a limb that has been removed as a result of sickness or injury. This kind of confusion causes a lot of pain in the body (Goetz, 2007, p. 126). The causes of neuropathic pain include; alcoholism, diabetes, HIV and AIDS, chemotherapy, back, leg and hip problems, spine surgery and amputation. Neuropathic pain which results from excessive consumption of alcohol, for instance, can affect the movement of an individual and eventually cause permanent disability. Excessive consumption of alcohol offsets the balance of substances such as thiamine, folate, niacin and vitamin E needed for the efficient functioning of the nerves. Excessive alcohol consumption, therefore, results in the damage of the peripheral nerves hence causing neuropathic pain in severe conditions. The symptoms of neuropathic pain are numbness and severe pains in the body. Diagnosis of the disease involves clinical interviews and physical tests, including blood and nerve tests. The treatment of neuropathic pain involves the use of drugs such as Motrin to regulate pain. Other forms of treatment are physical and relaxation therapy. The patient can also visit a counsellor to help with management of the condition. A multidisciplinary approach to treatment is however required because of the slow response of the condition to treatment. 1.2. Sleep disorders Good sleep is crucial for the appropriate body functioning of an individual. Additionally, Sleep has a direct effect on the quality of life of an individual. It affects the hormonal balance within the body as well as weight and mood of an individual. Individuals who lack sleep are characterized with daytime sleepiness and increased levels of irritability. Sleep is, therefore, an important aspect in life which is capable of making or breaking an individual. Sleep disorders are caused when individuals have insufficient quality and quantity of sleep. These disorders can interfere with the daytime functioning of an individual, causing a range of medical, social and psychiatric problems. The different types of medical disorders today include; sleep apnea, insomnia, restless legs syndrome, narcolepsy and parasomnia. These sleep disorders affect millions of people today. The commonest sleep disorder today is insomnia, caused by the inability to sleep and rise up early in the morning. Insomnia is more common in adults than in the youths, with 50% of adults suffering from the disease, 10% of whom suffer the adverse effects of the disease. The condition is also more common in women than in men. The effects of insomnia include inactivity and sleepiness during the day, irritability and memory problems. Diagnosis is done by examining the sleep history and the medical history of an individual. Treatment of the condition is done through having a bedtime routine, creation of a good sleeping environment and abstinence from alcohol and smoking (Goetz, 2007, p. 135). 1.3. Comorbidity The concurrent presence of one or more severe diseases in a patient is called comorbidity. This occurrence of a disease with a primary disorder at the same time can result in mental retardation. In the medical field, comorbidity refers ti the independent existence of diseases in the human body simultaneously. Many tests have been conducted to measure comorbidity in human beings. All these test attempt to normalize comorbid behaviour, regardless of it being a secondary or triennial illness. These measurements are used to anticipate the future effects of the condition under investigation. The Charlson index is used in the finding out the likelihood of death from of range comorbid diseases such as cancer and HIV. A condition is assigned a score number depending on its likelihood to cause death, enabling doctors to know the condition that require proper medical attention. 1.4. Screening of pain Pain is often not treated well in hospitals or in other instances undetected in hospitals and nursing homes. The first step towards pain management is screening of the pain. Apart from improving the lives of individuals, screening acts as a motivator for change. In pain assessment studies, reports by patients are commonly used because of the lack of biological markers for pain. Pain is relative and varies from patient to patient. However, chronic pain occurs when an individual is unable to perform normal duties, unable to sleep and has pain daily. These assessments can help physicians in pain screening and finding treatment for the condition. Pain screening is commonly done in hospitals using the interview forms. It helps the experts in establishing the location of the pain and its severity. Screening of pain involves asking patients questions concerning the location, intensity and duration including the medication used to relieve the pain. The best method of screening for pain in patients is through self -reporting, where patients are allowed to give their views on the kind of pain they feel based on a reporting scale. However, this can be challenging in a population where people have sensory nerve problems causing inability to feel. 1.5. Recent studies Neuropathic pain is caused by many disease complications in the body. It is also associated with the genetic disorders and there is the lack of proper treatments since there is no medication that can completely alleviate the pain. However, recent studies have revealed that a compound derived from the soft coral in Taiwan can help scientists in developing treatment for peripheral neuropathy that has for long been treated only using analgesics, which are not effective. Neuropathies affect millions of people worldwide today. Today research focuses on the breakdown of the cellular energy factories in the nerve cells as a cause of peripheral neuropathy. New research in Washington University, School of Medicine, reveals that the damage of the energy factories in the nerve cell is also a contributing factor to neuropathy. Schwann cells grow close to the neurons, enabling the transmission of signals from the spinal cord to the fingers and the toes. This finding is aimed to give new insights to the treatment of the neuropathic syndrome. This way, the field of neurology is expected to advance in the recent years. According to the research, disabling of the energy factories in the Schwann cells is caused by a toxic substance, causing damage of the nerves in the same manner that neuropathies occur. The research revealed that inefficient burning of the fatty acids causes build -up of the compound acylcarnitines in the Schwann cells. The leaking of the toxin outside the cells into the nerves causes damage to the nerves, resulting in numbness, pain and disruption of the ability of the nerves to relay the correct signals. The research tries to evaluate the drugs that can be used to prevent the accumulation of the toxin in the Schwann cells that could lead to the treatment of the neuropathies. The new research reveals that the drugs that inhibit the build-up of the toxin can help in reducing the development of neuropathic syndrome (Goetz, 2007, p.104). 1.6. Aim of the research Peripheral neuropathy is a disease that affects millions of elderly people worldwide. The symptoms are so severe that urgent medical attention is required for patients diagnosed with the condition. The damage or injury of the peripheral nerves is associated with many diseases in the human body. The main aim of the research is to establish the relationship between peripheral neuropathy and sleep disorder in adults aged between 55 and 70 years in Glasgow city. 1.7. Null hypothesis There is no association between peripheral neuropathy and sleep disorders. 2. METHOD 2.1. Design Interview schedules are expected to be used by the researcher in the collection of data from medical practitioners. The researcher visited the hospitals within the city and gather information from the doctors on the nature and extent of peripheral neuropathy case dealt with in the hospitals and whether or not they are associated with sleep disorders. The aim of conducting interview schedules was to get first -hand information from practitioners, which was important for formulating the basis of this research. 2.2. Research questionnaires Questionnaires were used by the researcher for the collection of information. The questionnaire was designed to contain three parts. The first part contained the personal information of the patient including their name, age and occupation. The second part of the questionnaire dealt with the neuropathic condition of the patient including the sleep issues that are associated with the problem. The patients were required to give an account of their medical and sleep history and the kind of sleep problems which they undergo. The last part of the questionnaire included the medical treatment that the patient has undergone since the diagnosis of the condition and whether or not the treatment offered is efficient. The questionnaire also included assessment of diseases such as diabetes and heart problems related to nerve failure. The patients were required to give an account of the pain felt in the limbs and its time span. If the patient had acute pain in the limbs for more than three months, they were required to state the kind of medical treatment that has been received within that period of time. Patients with chronic pain were also be required to rate the potency of the pain felt. 2.3. Subjects The study involved an assessment of a hundred patients from different hospitals within Glasgow. The selection criterion for the patients was an age requirement of 55 years and above with sleep disorders and diabetic disorders. The selection of subjects for the study also included gender balance where 51 percent of women and 49 percent of men were assessed. Other requirement for the patients is the lack of diabetic ulcers on the limbs, the patients were required to have good clinical conditions with no history of neuropathic disorders caused by the genes or any other condition such as alcoholism. The patients were required to have a good understanding of English. 2.4. Procedure An experimental design was used to conduct the study. The Semmes-Weinstein monofilament was used in screening neuropathic pain in the patients. The test was conducted on both feet of the patients. The researcher first made the patient conversant with the monofilament by touching it on the patient’s head so that the stimuli is understood. The monofilament was applied to the dorsum of the toes next to the nail bed and left for a second before being removed from the skin. The stimulus was be performed at least four times. Each of the stimuli was assigned a score in relation to the initial stimulus on the forehead. A score of 0 illustrates a stimuli less than the initial one, 1 showed a normal perception, 3 indicated the presence of neuropathy while a score of 3.5 5 to 5 indicated the likelihood of occurrence of neuropathy in the patient in the next four years. A score of more than 5 indicates no likelihood of occurrence of neuropathy in the next five years. The sleep disorders such as sleep apnea was also studied in patients with diabetes and compared to those with the healthy individual. The other instrument for use in the detection of neuropathy in the participants was be the Michigan Neuropathy Screening Instrument (MNSI). This included the physical examination such as the inspection of dry skin, ulcers of the feet, abnormalities in the hair and the feet and deformities of the feet. A score index of greater than 7 was considered as indicating the presence of neuropathy in the patient. The Medical Outcomes Short sleep scale was used in the assessment of the sleep patterns of the patients. The scale was used to assess various sleep components such as the quality and quantity of sleep, snoring, and sleep awakening problems as well as sleep adequacy issues. The sleep index ranges from o to 100, with the higher values indicating high levels of sleep disorders. 2.5. Ethics The researcher submitted the proposal to the ethical committee of Glasgow for approval to carry out the research. Patients were issued with prior informed consent for their participation in the study. The patients were also given enough information on the safety of the study and the options of either participating in the study or not. As part of the ethical considerations also, the information provided by the respondents was used only for the purposes of the research and kept confidential. 3. Data Analysis According to the pain measurement using the MNSI, score of between 1 and 3 was considered to indicate less pain. The intensity of the pain was considered to increase with the numerical values. Data not provided by the patients was not used in the analysis process. Regression analysis was used in the determination of the possible causes of neuropathy in the sample population such as diabetes, age, and gender and pain intensity. A 95 % confidence level was used in the calculation of the odds ratio for important factors using the regression model. The analysis of variance (ANOVA) was used in the comparison of sleep disorders among the sample population. The relationship between neuropathic complications, sleep and mood disorders was also established using the analysis of variance. Logistic regression models were also used in establishing the factors that affect the scores when used independently. Data analysis was be done using the Statistical Analysis System from SAS institute. 4. Outcomes and Benefits of study and limitations From the population selected for use in the study, 30 patients withdrew from participation in the study. The study revealed that most of the patients with peripheral neuropathy had diabetes, with 78% having diabetes type 1. This helped the researcher to deduce that peripheral neuropathy commonly occurs in diabetic patients, with the study revealing that neuropathy occurs in 60% of the sample population with diabetes. Assessment of the patients sleep characteristics using the MSNI revealed that the patients with chronic neuropathy has low mental and physical health. The study also established that sleep disorders were associated with neuropathic pain resulting in reduced quality and quantity of sleep. Patients without neuropathic pain had less cases of sleep disturbance. The results of the study were significant in influencing a healthy lifestyle to enlightening people to reduce chances of getting neuropathy from alcoholism and diabetes. The study was however limited by the difficulty in getting the respondents uncover their health issues to be used in the research. Conclusion From the above discussion, neuropathy is an adverse health condition that can result in inability of a person to conduct regular activities and amputation under worse conditions. The damaging of the peripheral nervous system has a profound effect on the sleep patterns of individuals, causing sleep disorders such as sleep apnea and insomnia. It is important, therefore, for individuals to take good care of their health to avoid chances of having neuropathic complications. Reference Goetz, C. G. (2007). Textbook of clinical neurology. Philadelphia, Saunders Elsevier, p.102-567. Read More