Sleep disorders may affect the bed partner, family, friends, carers and even neighbours in addition to the patient. The partner may become concerned because of the implications of the sleep disorder, especially when the patient stops breathing, as in obstructive and central sleep apnoeas and Cheyne Stokes respiration, appears to choke and makes sudden vigorous movements, as with epilepsy and REM sleep behaviour disorder, and if there is a possibility of injury while sleep walking.

Snoring and abnormal movements during sleep due to, for instance, the restless legs and periodic limb movements may fragment the partner’s sleep and cause a significant degree of excessive daytime sleepiness.

Severe insomnia at night or sleep reversal can also put considerable strain on the family and carers, particularly if the patient also becomes confused at night and wanders from the bedroom.

These problems may lead to feelings of frustration, annoyance or anger which are often directed by the partner or family at the subject with the sleep disorder, who comes to feel guilty about causing the problem. Occasionally the partner may be aggressive or violent to the patient while he or she is asleep.

Partners often take hypnotics or alcohol, or both, in order to obtain adequate sleep. The patient and partner often decide to sleep in separate beds or separate bedrooms, at least for part of the night, or on some nights, and the sleep disorder is quite commonly considered as a factor leading to either separation or divorce.

The sleep disorder may also affect the partner less directly by impairing the daytime function of the patient. Excessive daytime sleepiness due to, for instance, obstructive sleep apnoeas or narcolepsy restricts or even prevents family and social activities.

Patients often fall asleep readily in the evenings and are unable to interact with other members of the household. The excessive sleepiness may cause difficulties at work, with job insecurity, failure to be promoted and loss of earnings for the family. Other symptoms such as cataplexy may prevent the patient from being left alone in the home or make it unsafe for the individual to care for children without another person being present. This can cause considerable difficulties and tensions.

The partner may also have to adjust to the treatment required for the sleep disorder. This may be intrusive, as with nasal continuous positive airway pressure (CPAP) systems for sleep apnoeas. Prescribed drugs may have side-effects which indirectly affect the partner’s sleep.

The presence of a bed partner can also modify the patient’s sleep and sleep complaints. The partner’s snoring, movements during sleep or nocturia can cause frequent awakenings leading to sleep fragmentation _[19]. This may exacerbate the patient’s underlying disorder, such as sleep walking, or worsen symptoms of conditions that lead to excessive daytime sleepiness, such as sleep apnoeas or periodic limb movements.

Sleeping in separate beds or bedrooms may help one or both partners to sleep.

Young children often wake their parents or carers during the night and the insomnia that this causes can become a long-term problem. Similarly, pets in the home, such as cats and dogs, often prefer to sleep in the bedroom or in or on the bed and can disturb the individual’s sleep. This may be due to movements, purring or barking, but their presence may also lead to nocturnal asthma through an allergic mechanism, or by disturbing the dust in the bed and increasing its inhalation.

Effective treatment of the patient’s sleep disorder has the advantage, compared with treatment of most other medical conditions, of often being directly of benefit to both the patient and the partner _[20]. Relief of obstructive sleep apnoeas, for instance, improves the patient’s daytime sleepiness and reduces the disturbance to the partner’s sleep as well. Treatment of REM sleep behaviour disorder not only reduces the risk of injury to the patient, but also to the partner.

The partner’s description of the changes in the patient’s sleep disorder with treatment is often important in evaluating its effectiveness, as it is in the initial assessment of the type and severity of the patient’s sleep problem.

References