Sleep Disorders

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Sleep disorders are medical conditions that can affect the quality and duration of your sleep. These can include sleep apnea, insomnia, and restless legs syndrome. Symptoms of a sleeping disorder can involve snoring and trouble falling asleep. This leads to sleep deprivation and impacts quality of life and overall health. Sleeping disorders can contribute to serious health issues like heart failure and diabetes.

This article presents information about sleep disorders, of which there are many types, some quite common and others less so. It explores the causes and symptoms, and how they may be treated. Knowing this information can help you and your healthcare provider determine a diagnosis and a course of action.

Woman laying awake in bed
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Who Is Affected by Sleep Disorders?

Several factors can cause sleep disorders or lead to them. These factors include:

  • Genetic predisposition
  • Lifestyle factors such as shift work, frequent travel, or irregular schedules
  • Mood issues, such as anxiety or depression
  • Dietary factors, including too much caffeine or alcohol
  • Being overweight or obese
  • Medical conditions, including pain, depression, and heart disease
  • Certain medications
  • Aging

Sleep Disorder Symptoms

Disordered sleeping can have a multitude of symptoms that vary based on the specific type. These could include any of the following nighttime symptoms:

  • Inability to fall asleep or taking a long time to do so
  • Sleep maintenance insomnia or waking in the middle of the night and not returning to sleep
  • Noisy sleep with sounds such as snoring, gasping, or even choking
  • Feeling the urge to move and movement relieves the feeling
  • Sleep paralysis when you feel conscious after waking but can't move

Sleep disorders can also cause signs and symptoms during the daytime such as:

  • Excessive drowsiness during waking hours
  • Difficulty focusing due to lack of adequate rest
  • Increase in negative moods and decrease in positive moods
  • Avoidable accidents or falls
  • Overall decrease in energy level

Causes of Sleep Disorders

Different types of sleep disorders can have different causes. Some common causes of this disruption to your body's sleep cycle include:

  • Alcohol and caffeine consumption
  • Medical conditions such as lung disease, heart disease, nerve disorders, and chronic pain
  • Side effects of medications
  • Genetic mutations
  • Mental health conditions like depression and anxiety
  • Aging
  • Working the night shift or any other irregular schedule

Sleep disorders may be caused by physical or psychological factors. In turn, they can also have a negative effect on physical and psychological health. Although sometimes the cause is unknown, if you can determine the factors contributing to disordered sleeping, you can better begin a course of treatment.

Types of Sleep Disorders

More than 100 different sleep disorders have been recognized and defined by the medical community.

There are four main categories of sleep disorders:

  • Problems falling asleep and staying asleep
  • Problems staying awake
  • Problems keeping a regular sleep-wake schedule
  • Unusual behaviors during sleep

Some of the most common sleep disorders include:

Insomnia

Insomnia is the most common sleep disorder, with about 10% of adults having a chronic problem with it and between 30% and 40% dealing with it now and then. It makes you unable to get enough sleep to feel rested and leaves you yawning all day.

Insomnia can take many forms. Some people have trouble falling asleep, which is defined as spending more than 20 to 30 minutes in bed before dozing off. Others wake up frequently or awaken hours too early and can't get back to sleep. Some people have a combination of different types.

People most affected by insomnia are likely to be shift workers and those who experience depression and/or anxiety. Insomnia also is more likely in older people and biological females. Methods of treatment include cognitive-behavioral therapy for insomnia (CBTI), short-term use of sleeping pills including sedative/hypnotic drugs, antidepressants, and antihistamines, and sleep hygiene education to instill good habits and correct bad ones.

Is There a Blood Test for Insomnia?

Blood tests for insomnia are usually meant to diagnose underlying conditions rather than the insomnia itself. For example, low iron can contribute to restless legs syndrome and thyroid dysfunction can disrupt sleep patterns. These tests may be a part of diagnosing your problem.

Snoring and Sleep Apnea

Snoring may seem harmless, however, you snore because your throat is closing while you sleep. If it's extreme enough to cut off breathing for a few seconds, then it becomes snoring's more serious cousin—sleep apnea—which is a chronic and potentially serious medical condition.

The effects of sleep apnea can cause and worsen other medical conditions, including hypertension, heart failure, and diabetes. Over time, it can also contribute to the risk of serious consequences such as a heart attack or heart failure, stroke, and sudden death.

The good news is that there are effective treatments. Treatments include changing sleeping positions or a continuous positive airway pressure machine (CPAP) if breathing patterns are interrupted. Positional sleep aids, dental devices, or mouth appliances are other methods. In more severe cases, surgical removal of excess throat tissue may be recommended.

Parasomnias

From the Latin meaning "around sleep," parasomnias are sleep disorders characterized by abnormal sleep behaviors or physiological events that occur during specific stages of sleep.

Common forms include: 

Sleep behaviors aren't limited to these, though. A number of potential behaviors can occur while you're sleeping. The underlying cause of parasomnias may be another sleep condition, such as sleep apnea. In that case, treating the underlying condition may stop the behavior. Other courses of action may include stopping medication that could be the cause, safety precautions against behaviors like sleepwalking, therapy, and counseling.

Sleep Paralysis

Imagine waking up in the morning and being unable to move. One may experience hallucinations or simply confusion. As you might imagine, sleep paralysis can be terrifying. It can happen during any transition between sleep and being awake, either as you drift off or as you wake up.

Episodes of sleep paralysis typically last only a few minutes, as your brain naturally either wakes up or falls asleep more fully. While the first few may be frightening, just knowing what's going on can make it less scary.

It's fairly common to have an isolated incident of sleep paralysis in your life. Researchers estimate that between 25% and 40% of people will experience it at least once. It sometimes has no identifiable cause. However, it can be a symptom of narcolepsy or mental health conditions such as bipolar disorder, a side effect of some medications, or a symptom of sleep deprivation. If sleep paralysis is severe, cognitive behavioral therapy is one course of treatment that may help to improve sleep quality and help cope with hallucination-related fear.

Restless Legs Syndrome

Restless legs syndrome (RLS) is a neurological movement disorder characterized by unpleasant feelings in the legs associated with a need to move. These are often described as burning, pulling, throbbing, or itching among others. They occur at bedtime but can also happen during inactive times.

Typically, symptoms come on when you're resting, sleeping, or trying to fall asleep. They can make it difficult to fall asleep, bring you out of deep sleep, or wake you from sleep. The end result is often a lack of quality rest.

RLS has many potential causes, including iron deficiency, pregnancy, obesity, and certain drugs (including medications, nicotine, alcohol, and caffeine), and supplements that can disrupt sleep. Treatments may include increasing iron intake, weight loss, or medications. Stretching, walking, or rubbing your legs may be good options, as well.

Periodic Limb Movements of Sleep

A movement disorder often associated with RLS is called periodic limb movements of sleep (PLMS). PLMS involves sudden, repetitive jerking movements of the legs or sometimes arms while you're asleep. They can be fairly rhythmic, typically happening between about 20 and 40 seconds apart, and can continue for several hours.

Many people with PLMS aren't aware that they have it until a sleeping partner tells them.

PLMS differs from RLS in that RLS can happen when you're resting or trying to sleep, but PLMS only happens when you're actually asleep. However, many people have both disorders. In most cases, the cause is unknown but researchers think it involves the nervous system. It can also occur as a result of obstructive sleep apnea or antidepressant use.

If PLMS doesn't disrupt your sleep, it may not require treatment. If you do experience excessive daytime sleepiness without another cause, though, your PLMS may be to blame. PLMS can be treated with medications like benzodiazepines and opioid painkillers. It's been shown that caffeine can exacerbate PLMS so eliminating caffeinated substances should also be considered.

Circadian Rhythm Disorders

Circadian rhythm disorders are conditions that may result from your internal biological clock being out of sync with external time cues, including the natural dark-light cycle. Causes can include blindness, shift work, jet lag, aging, and advanced or delayed sleep phase syndrome.

The mismatch may lead to insomnia or excessive sleepiness (hypersomnia) at inappropriate times. Circadian rhythm disorders can be treated with properly timed light exposure using a light box, melatonin, or adherence to a regular sleep-wake schedule.

Narcolepsy

Narcolepsy is a sleep disorder characterized by excessive daytime sleepiness. It may be caused by the lack of a brain chemical called hypocretin, which promotes wakefulness and maintains muscle tone. This may be due to an autoimmune process, genetics, brain tumors or lesions, or other brain damage.

Other symptoms include sleep paralysis, hypnagogic hallucinations while trying to fall asleep and cataplexy, also described as a "sudden loss of muscle tone."

Narcolepsy can have a profound effect on one's life and may lead to falling asleep in inappropriate situations, such as while working or driving a car. Narcolepsy is normally treated with medications including stimulants to stay awake and antidepressants to moderate symptoms.

How Are Sleep Disorders Diagnosed?

The first step to overcoming a sleep disorder is to see your healthcare provider and get a diagnosis. It can help if you keep a sleep journal so you can provide a thorough description of your sleep problems and any suspected causes. A healthcare provider will often do a physical exam to check your symptoms as well as blood tests and imaging tests.

You may also want to visit a sleep specialist. They can perform a sleep study or polysomnogram. This test electronically records specific body and brain activities during sleep and transmits the data to your doctor to analyze. The patterns established can help determine what kind of sleep disorder you have.

Other noninvasive tests to diagnose sleep orders include:

  • Overnight oximetry: Tracks oxygen levels and heart rate
  • Titration studies: Uses a CPAP and usually accompanies polysomnography
  • Multiple sleep latency testing: Polysomnography followed by periodic attempts at napping throughout the day
  • Actigraphy: A small wrist-watch-like device monitors sleep-wake cycles and movement for extended periods of time
  • Home sleep study: A study performed at home to diagnose obstructive sleep apnea and other problems

Treatment

There are several methods of treatment available for sleep disorders. These are recommended based on the specific type of sleep disorder and each individual situation. With proper treatment, sleep disorders can be vastly improved.

Medical Treatment

Medical treatment can be sought to treat sleep disorders. These may include:

  • Cognitive behavioral therapy or relaxation techniques to reduce anxiety about getting enough sleep
  • CPAP (continuous positive airway pressure) machine for sleep apnea
  • Sleeping pills. Usually, providers recommend that you use sleeping pills for a short period of time.
  • Natural products, such as melatonin. These products may help some people but are generally for short-term use. Make sure to check with your healthcare provider before you take any of them.
  • Bright light therapy (in the morning)
  • Stimulants or wake-promoting medication such as modafinil
  • Anti-convulsants like gabapentin

Your healthcare provider will advise you on which medical intervention will best treat the sleep disorder you have and any potential side effects.

Lifestyle Tips

Making simple lifestyle changes can also vastly improve a sleep disorder. This is known as improving sleep hygiene. Maintaining a healthy diet and exercising regularly alone will promote good sleep habits.

Other measures may include avoiding caffeine and alcohol especially close to bedtime, establishing a daily schedule of sleeping and waking at the same time, keeping stress at a minimum, and creating a healthy sleep environment.

Summary

Sleep plays an essential role in mental and physical well-being. Sleep disorders are medical conditions resulting in a variety of symptoms with a lack of quality sleep being the most prevalent. This lack can negatively affect your life and put you at a higher risk for health problems such as diabetes and heart disease.

Sleep deprivation can also affect your mood and cognitive function leading to a higher incidence of anxiety and depression among sufferers. Luckily there are methods of treatment to help with disordered sleeping. As getting enough sleep at the right time is vital for optimum health and safety, consult with your healthcare provider to determine the right course of treatment.

Frequently Asked Questions

  • Which sleep disorders are associated with obesity?

    Sleep disorders that are associated with obesity include:

    • Insomnia
    • Obstructive sleep apnea
    • Restless legs syndrome

    It's not always clear which condition causes the other. It may be that obesity is a causal factor of some sleep disorders, especially OSA and snoring, but sleep deprivation due to a sleep disorder can impact metabolism and lead to obesity as well.

  • What is REM sleep behavior disorder?

    Rapid eye movement (REM) behavior disorder is a type of parasomnia, which causes abnormal sleep behaviors. With REM behavior disorder, you physically act out dreams while in REM sleep. This can range from hand gestures to violent thrashing, kicking, or punching.

  • What sleep disorder do you have if you experience sleep attacks?

    Sleep attacks are a symptom of narcolepsy. They happen when you get a sudden, overwhelming feeling of sleepiness. Between sleep attacks, you may have a normal sense of feeling awake with the attacks seeming to come out of nowhere.

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Brandon Peters, M.D.

By Brandon Peters, MD
Dr. Peters is a board-certified neurologist and sleep medicine specialist and is a fellow of the American Academy of Sleep Medicine.