Sleep disorders

Collectively, sleep disorders refer to conditions that impact sleep quality, timing, duration, or ability to function when awake. Sleep disorders are highly linked to many medical problems and mental health issues. Around 70 million Americans suffer from chronic sleep problems for a variety of reasons.

Sleep needs vary from person to person, but most healthy adults need about 7 to 9 hours of sleep a night.

Why is sleep important?

A good night’s sleep is not just resting or taking a break from busy routines. Sleep is a necessary part of good health.

Getting enough sleep may help the body recover from illness and injury, and can affect hormone levels, mood, and weight. Sleep deprivation over a period of time is linked to health problems. They include obesity, diabetes, and heart disease.

Sleep and mental health

Sleep problems can make daily life feel more stressful and less productive.

Some people with chronic insomnia (trouble sleeping) are more likely to have mental health problems. Sleep problems are also tied to depression and anxiety.

Sleep disorders: an overview

Common characteristics

Today, over 100 specific sleep disorders have been identified. They all have the following characteristics in common:

  • You have trouble falling and staying asleep.
  • You have trouble staying awake during the day (daytime sleepiness).
  • Your circadian rhythm (internal clock) is imbalanced and interferes with your sleep schedule.
  • You are prone to behaviors that disrupt your sleep that exacerbate your sleep problem.

Around 70 million Americans suffer from chronic sleep problems for a variety of reasons. Although many people experience irregular sleep patterns at some point in their lives, when sleep disorders impair the daily function of an individual and hinders their mental, physical, or emotional health, it is considered a disability.

Problems from a lack of sleep

Loss of sleep can cause problems at home or on the job. It can lead to serious or even fatal accidents. The National Sleep Foundation notes that:

  • Sleep disturbances will get worse as you get older.
  • Poor sleep costs billions of dollars a year, from healthcare expenses and lost productivity.
  • Drowsy drivers cause about 40,000 vehicle crashes in the U.S. every year. This includes more than 1,500 deaths.

What are the symptoms of sleep disorders?

Symptoms vary by sleep disorder

Your symptoms may vary based on the specific sleep disorder you have. Some general signs of sleep disorders include:

  • Difficulty concentrating during the day and having trouble with performance and productivity in work or school.
  • Episodes of muscle weakness during moments of heightened emotion.
  • Excessive daytime sleepiness, frequent naps, or sleeping at incorrect times during the day. This is a prevalent symptom of insomnia and narcolepsy.
  • Falling asleep while driving.
  • Inability to move upon waking.
  • Legs or arms jerking during sleep
  • Loud snoring, gasping, choking, or stopped breathing when you sleep. These symptoms are often linked to sleep apnea.
  • Memory challenges, mental fogginess, and cognitive impairment
  • Taking longer than 30 minutes to fall asleep.
  • Regularly waking during sleep and having trouble getting back to sleep.
  • Waking up too early in the morning.
  • Vivid, dreamlike experiences while falling asleep.

Man with headlamp hiking on snowfield at night

Determining if you have a sleep disorder

For a proper diagnosis, it is important to visit your healthcare provider to test for sleep disorders and to determine what might be the cause. Your doctor will start by gathering your symptoms and medical history, including your sleep history. They may ask the following questions about your sleep:

  • How many hours do you sleep at night?
  • Do you take naps?
  • How restful is your sleep?
  • Do you toss and turn much during sleep?
  • How long does it take you to fall asleep?
  • Do you wake often in the middle of the night?
  • Do you feel sleepy during the day?
  • Do you work night shifts?

They may also perform a physical exam to identify anything physical that could be causing your difficulties sleeping. You may be asked to keep a sleep diary for a short period to record your sleep patterns and note any characteristics of interference.

Sleep studies. You may also be directed to take a sleep study (polysomnogram, PSG) at a sleep disorders center. During a polysomnogram, a sleep specialist will monitor and record data about your body responses during a full night of sleep. Your sleep medicine specialist may check how quickly you fall asleep, if you require naps due to daytime sleepiness, and your levels of alertness. During your sleep study, your doctors will monitor the following:

  • Blood pressure.
  • Brainwave change.
  • Breathing rate to test for sleep apnea.
  • Electrical activity of your heart and other muscles to evaluate if you experience restless legs syndrome.
  • Eye movements to evaluate your REM and NREM sleep.
  • Heart rate.

What are the causes of sleep disorders?

Some people who feel exhaustion during the day have a true sleep disorder, while others may just be experiencing a lack of sleep. If lack of sleep is not causing your disturbances, the following may be the cause of your sleep disorder:

Behavioral health issues

  • Depression.
  • Anxiety disorder.

Certain medications

  • Antidepressants, which can suppress REM sleep.
  • Decongestants.

Certain medical conditions

Lifestyle factors

  • Alcohol or tobacco consumption too close to bedtime.
  • Caffeine consumption late in the day.
  • Irregular schedule, such as working night shifts.
  • Obesity, which often contributes to sleep apnea.
  • Stressors from work, school, or interpersonal factors such as job loss or change, moving, or death of a loved one.

Aging

As people age, they sleep less and lighter, and may be more easily awakened. People going through menopause often experience sleep disorders due to hormonal changes.

Types of sleep disorders

There are many types of sleep disorders. They can affect health and quality of life.

  • If the disorder goes away in a short amount of time, it is considered an acute sleep disorder.
  • Any sleep disorder that lasts a long time and is hard to treat is considered a chronic sleep disorder.

The five main types of sleep disorders

Insomnia is the most common sleep disorder. Insomnia disorder is characterized by being unable to fall asleep and stay sleeping. Insomnia can be hereditary, or situational because of stress or other mental and physical ailments, including menopause. Insomnia can be short term (acute insomnia or adjustment insomnia), or chronic. Chronic insomnia is defined as insomnia that lasts at least three months and happens at least three times a week.

Sleep apnea is a breathing disorder in which you stop breathing for 10 seconds or longer during a sleep period due to an upper airway blockage.

  • Obstructive sleep apnea (OSA) refers to a physical blockage in your airways, such as adenoids, fluid, or fat deposits around the neck.
  • Central sleep apnea (CSA) refers to apnea caused by the brain failing to tell the body to breathe, leading to choking episodes.

Although central and obstructive sleep apnea are separate conditions, they can occur together.

Restless Legs Syndrome (RLS) occurs when a prickly or tingling sensation in your legs creates a powerful urge to move them. It is often brought on by resting, laying down, or sitting for prolonged periods of time, mostly happening during the evening. Periodic limb movement disorder during sleep occurs in about 80% of those with restless leg syndrome, making it difficult to fall and stay asleep.

Physician conferring with older male patient

Hypersomnia is a neurological disorder related to sleep regulation where you are unable to stay away during the day. Hypersomnia includes narcolepsy, which causes excessive sleepiness during the day and “sleep attacks,” bouts of micro-sleeps at inappropriate times, regardless of activity. Narcolepsy usually manifests between ages 15-25.

Circadian rhythm disorder is an umbrella term for problems with your wake-sleep cycle. If your circadian rhythm is off, you cannot sleep or wake at the correct times.

Other sleep disorders

  • Sleepwalking (somnambulism), which is common in children and involves getting up and walking or performing activities while asleep.
  • Bedwetting (nightmare incontinence), involuntary urination during sleep despite being of an appropriate age.
  • Frequent night terrors or nightmares (sleep terror disorder).
  • Sleep paralysis, temporary inability to move right after falling asleep or waking, often accompanied by troubling hallucinations.
  • Snoring, the hoarse, harsh sound from your throat that occurs when air passes through the relaxed throat tissues.
  • Non-24 sleep wake disorder, when the circadian clock does not sync to a regular 24-hour clock, causing sleep to be delayed by minutes or hours every day.
  • DSPS (Delayed Sleep Phase Sleep Disorder), which is when non-24 is exacerbated causing you to fall asleep and wake up two or more hours later every day.
  • REM sleep behavior disorder (Rapid Eye Movement behavior disorder), when you physically act out your dreams with violent limb movement and vocalizations.

Treatments for sleep disorders

A multidisciplinary team

For those who suffer from sleep disorders, help is available from many sources.

A sleeping problem can be treated or managed by different kinds of healthcare providers. You may be treated by a healthcare provider who specializes in any of these:

  • Family practice.
  • Gerontology.
  • Internal medicine.
  • Neurology.
  • Otolaryngology.
  • Pediatrics.
  • Psychiatry.
  • Pulmonary medicine.

Provider and patient having a discussion


A variety of available treatments

Just as there are a variety of sleep disorders, there are a variety of treatments suited for your needs. The following solutions may be recommended by your doctor:

Lifestyle changes

  • Avoid tobacco for at least four hours before bedtime and during the night – or quit smoking altogether.
  • Dietary changes. For people with sleep apnea, eating a healthier diet paired with exercise can help reduce weight-associated obstructions in the airway. By losing weight, sleep apnea can often be treated. For those who have sleep challenges not associated with weight, it is recommended not to consume alcohol or caffeine too close to bedtime to prevent sleep interference.
  • Exercise regularly. Exercise can help increase energy, overall fitness, and relieve stress, but should not be done within four hours of your bedtime.
  • Good sleep hygiene. Practice good sleep habits, such as keeping a regular sleep schedule, limiting screen-time before bed, and sleeping in a cool, quiet, and dark room.

Behavioral therapy

  • Cognitive behavioral therapy. Some sleep specialists recommend counselling through cognitive behavior therapy (CBT). This therapy helps you recognize, challenge, and change intrusive or stressful thoughts that may keep you awake at night.
  • Relaxation techniques. Bedtime yoga, breathing exercises, and meditation may be recommended to help reduce your anxiety about getting enough sleep.

Medications

  • Sleeping aids. Sleeping pills may be recommended by your provider for a short period of time to treat sleep disorders such as insomnia. These may include zolpidem, ramelteon, or doxepin, to name a few.
  • Gabapentin. This seizure medication effectively treats symptoms of restless legs syndrome.
  • Stimulants. Modafinil, Pitolisant, and solriamfetol are wake-promoting medications that can effectively relieve symptoms of narcolepsy.

Devices

  • A CPAP (Continuous Positive Airway Pressure) machine can help ease symptoms associated with obstructive sleep apnea and central sleep apnea.

Supplements

  • Melatonin. A hormone produced by the body to regulate your circadian rhythm. It may be recommended for short-term use to “right” your body clock and help with insomnia.

Pharmacist explaining medication to patient