Common Sleep Disorders
What are the most common sleep disorders?
Do you think you might have a sleep disorder?
Circadian Sleep Disorders
Circadian sleep disorders are disorders of the timing of sleep and wakefulness. We all have an internal “clock.” This “clock” controls our rhythm of sleeping and wakefulness. There are times of the day when we are most alert. This is often mid-morning and early evening. And, there are times when we are more likely to be sleepy – like during early to mid-afternoon and late evening. One’s environment impacts this rhythm, and may either complement or disrupt our internal clock.
Excessive sleepiness can develop when our sleep rhythm is altered. We may want to sleep during times when we need to remain awake. On the other hand, insomnia occurs when we want to sleep at a time when our rhythm is to stay awake.
Disorders that are related to changes in the normal sleep-wake pattern include:
Advanced Sleep-Phase
This is a shift in nighttime sleep to a time earlier than the desired bedtime. Arising time the next morning is also earlier than desired. Bedtime often occurs between 6 pm and 9 pm Arising time often occurs between 1 am and 3 am.
Delayed Sleep-Phase
The usual nighttime sleep period occurs later than the desired bedtime. These “night owls” are unable to sleep until the early morning hours. They don’t arise until late morning to early afternoon.
Irregular Sleep-Wake Pattern
Sleep and wake times are disordered. Three or more naps replace the major nighttime sleep. The timing of sleep and wake activities are erratic. Evening insomnia and daytime sleepiness are common symptoms.
Jet Lag
After rapid travel across many time zones, our internal clock remains fixed to our home time zone. It may take a few days for the internal clock to adjust to the new time zone. For example, the advanced bedtime after an eastward flight may result in trouble falling asleep at a ‘normal time’. On the other hand, westward flights result in a delay in nighttime sleep. It also results in increased awakenings during the early morning hours. Luckily for the traveler, sleep tends to improve after two to three days.
Shift Work Sleep Disorder
Large numbers of people in this country perform shift work. Excessive sleepiness and insomnia may develop when people work outside the 8am to 5pm shift. Sleepiness and decreased concentration is common if one must work at night. A shift work sleep disorder poses a major hazard in the workplace.
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Excessive Sleepiness
Why should I worry about feeling tired during my day?
Excessive sleepiness becomes a problem when the person cannot stay awake and alert long enough to complete daily tasks. Sleep occurs during the day. Excessive sleepiness is different from fatigue or physical tiredness.
Excessive sleepiness may increase the risk of car, work, or home accidents. It may also cause poor school or work performance. Memory problems and changes in behavior can also occur.
What causes excessive sleepiness?
Chronic lack of sleep is a common cause of excessive sleepiness. It is important to get enough sleep. Getting enough sleep each night will help you maintain normal alertness and performance while awake.
A person may allow plenty of time for sleep, but sleep time can be interrupted by sleep apnea or periodic limb movements .
A simple disturbance of the body clock can cause excessive sleepiness. This occurs because the timing of wakefulness and sleep is altered. Two examples are jet lag or shift work.
Medicines can cause excessive sleepiness. Medicines that sedate as a side-effect can cause this. The routine use of sedating or opioid pain medicines may also cause excessive sleepiness. This is more likely to occur if large doses or long-acting medicines are taken during the night. Excessive sleepiness may occur if stimulant medicines are quickly stopped. Speak to your doctor if you are concerned that your medicines may be causing excessive sleepiness.
Excessive sleepiness occurs with sleep disorders such as narcolepsy and circadian rhythm disorders .
| Sleepiness is mild... |
...if it occurs during rest. It occurs when little attention is required for the activity. Examples including reading or watching television. |
| Moderate sleepiness... |
...is present if it occurs during activities. These activities require more attention. They may be physical or mental. One example is during a group meeting. |
| Severe sleepiness... |
...occurs during physical activities. These activities require full attention. Examples include talking, eating, or driving. |
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Insomnia
Insomnia is the failure to fall asleep and remain asleep. Sleep is light and easily disturbed. Other common symptoms include:
- fatigue
- irritability
- poor attention
Insomnia can increase the chance of accidents, decrease performance, and impair judgment.
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Mild Insomnia:
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Poor sleep has little effect on social function or work.
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Moderate Insomnia:
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Poor sleep impacts social and work function.
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Severe Insomnia:
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Poor sleep has a major impact on how a person functions during the day.
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Acute Insomnia:
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Poor sleep lasts only a few days.
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Chronic Insomnia:
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Poor sleep may last for several months or more. It may start in early childhood and be life-long.
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What causes insomnia?
Insomnia is the failure to fall asleep and remain asleep. Some common symptoms include fatigue, irritability and poor attention. There are many reasons for poor sleep and often there is more than one cause.
Causes and types of insomnia may include:
Acute stress - Acute stress, such as major life events (tragic loss, marriage, a job change, or an exam) can lead to insomnia. Sleeping in new settings such as a hotel or hospital room can also lead to insomnia. This type of sleep disturbance is brief. Sleep tends to return to normal once the stress is removed or reduced or when the person learns to cope with it.
Bedtime Behavior in Children - Children often attempt to delay bedtime. A child may ask for one more bedtime stories, take several trips to the bathroom, ask for food or water, or to watch a few more minutes of television. These attempts to delay the bedtime should be recognized by the caretaker and then limited before bedtime. Once this is accomplished, sleep often occurs naturally and quickly.
However, several other factors may also affect a child’s sleep. These include fear of the dark, fear of being left alone or an unreasonably early bedtime. Some children are unable to sleep unless a special blanket or pacifier is present.
Environmental Factors - Loud noise, bad odors, bright lights and extremes in room temperature can disturb sleep. A snoring sleep partner or an uncomfortable bed can also disturb sleep. Other disruptive environmental factors include concerns about safety in the house, caring for a family member and a rapid ascent to a high altitude.
Medical Conditions - Some medical conditions may cause insomnia. If you have a chronic illness and you are having sleep disturbances, talk with your doctor.
Medicine-induced Insomnia - Medications can be a major cause of insomnia. Stopping medicine that encourages sleep after long-term use can lead to severe insomnia. Some medicines have a stimulating effect, causing wakefulness and alertness. These can cause insomnia, often when taken close to bedtime or when the dose is increased. If you take any of these medicines and are having sleep disruptions talk with your doctor. Do not stop any medicines if you have not consulted with your doctor.
Poor Sleep Hygiene - Insomnia can begin with habits or activities that do not promote sleep. Caffeine, alcohol or smoking too close to bedtime can lead to poor sleep. Strenuous exercise or stimulating mental activity can affect sleep, as well. Frequent changes in bedtime or waking times and napping during the day can disrupt sleep. Performing activities in bed such as doing homework, talking on the telephone or watching television are also habits that may cause sleep problems.
Psychophysiologic Insomnia - Behaviors that disturb sleep can develop and become the major factors causing Insomnia. For instance, an insomniac may "try too hard" to fall sleep. He / she may become tense and even more aroused. This, in turn, increases anxiety about not being able to sleep. Thus, a vicious cycle begins.
Sleep often occurs when not trying too hard to fall asleep. Sleep may be better in any place other than the insomniac's bedroom.
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Narcolepsy
Excessive sleepiness occurs when there is a problem with the part of the brain that causes sleep and wakefulness. Narcolepsy affects 1 of every 2,000 people. Symptoms often begin in young adults, and may be hereditary. Symptoms may include:
Other symptoms of narcolepsy include disturbed sleep, waking up often, and abnormal behavior.
Excessive sleepiness - This is often the first symptom of narcolepsy. It is often lifelong. Sleep occurs during moments of inactivity or boredom. sudden and unexpected sleep "attacks" can also occur at any time. Brief napping is common. Each nap lasts 10 to 20 minutes. Sleepiness is reduced after awakening from a short nap. The sleepiness increases again within the next two to three hours.
Cataplexy - Cataplexy is the loss of muscle strength after an intense emotion. Emotions such as anger, fright, surprise, excitement, or laughter can cause this. It may occur without any cause and does not trigger loss of consciousness. Episodes may last from seconds to minutes. The loss of muscle strength may be mild, such as drooping of the eyelids, sagging of the jaw, or buckling at the knees. It may also be severe with complete lack of muscle strength causing the person to collapse.
Sleep paralysis - This is a brief loss of the ability to move. It occurs either at the start of sleep or upon awakening. Except for the eye muscles and those involved with breathing, all muscles are affected. Paralysis often lasts from one to a few minutes. Hallucinations and a sense of dread may also occur.
Sleep hallucinations - Sleep hallucinations may occur at sleep onset or upon wakening. A person may see shapes, colors, or actual figures; or, one may hear a sound or music, or feel movement. These feelings are often fearful, such as being attacked or escaping from danger.
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Obstructive Sleep Apnea
Sleep Apnea is a condition characterized by brief interruptions of breathing during sleep.
People with sleep apnea may have symptoms of:
There are two types of sleep apnea: central and obstructive. Obstructive Sleep Apnea (OSA) is the most common type. This is caused when the upper airways collapse during sleep, and air cannot flow into or out of one’s nose or mouth, although efforts to breathe continue. Breathing stops for several seconds to over a minute, and levels of blood oxygen may drop during these episodes. Each episode causes one to awaken and then go back to sleep. Central Sleep Apnea occurs when the brain does not send the appropriate signals to the breathing muscles for respiration.
Who develops sleep apnea?
Sleep apnea tends to affect middle-age people. People with sleep apnea are often overweight . It is seen more often in men than in women. However, it can affect children and persons in a normal weight range as well.
Why is it important to find out if you have sleep apnea?
Excessive sleepiness can become so severe it impacts daily activities. You may fall asleep while driving or during meetings, formal gatherings, or church services. Your performance at school or work may decline. Many people with sleep apnea become depressed or irritable. If left untreated, sleep apnea may lead to serious medical problems. These include an irregular heart rate, heart disease, heart attack, high blood pressure, and stroke.
How is obstructive sleep apnea treated and managed?
Parasomnias
Parasomnias are physical events that occur during sleep. They may or may not disrupt sleep. Often, it is the sleep partner who calls these events to the sleeper’s attention.
Confusional Arousals
Confusion and disorientation occur following arousals from sleep. This often happens in the first part of the night. There is often no memory of the event. Confusional arousals may be caused by lack of sleep. They may also be caused by abrupt awakenings from deep sleep.
Leg Cramps
A painful tightening of the muscles of the leg or foot awakens a person from sleep. Flexing or massaging the leg or foot relieves the sensation. Nighttime leg cramps are common. It may be more common among the elderly, during pregnancy, or after intense exercise.
Nightmares
Frightful dreams can quickly awaken the sleeper. Once awake, the person is fully alert. He or she can clearly remember the dream and is fearful and anxious. The person is unable to promptly return to sleep.
REM Sleep Behavior Disorder
Body movements occur with dreaming. They may be simple motions. They may also be highly complex acts such as screaming, punching, kicking, or running. These movements may result in sleep disruption and/or injury to the sleeper or sleep partner.
Rhythmic Movement Disorder
Repetitive movements of parts of the body start before falling asleep. They continue during early light sleep. This is called “head banging” if it involves motions of the head and neck. Other types include head rolling, body rolling, or body rocking. This is often seen in young children. Adolescent and adult cases are rare.
Sleep Starts
Sleep starts consist of abrupt jerks of parts of the body. These may startle a person out of sleep with a feeling of "falling" or "dreaming".
Sleep Talking
Words and sentences can be uttered during sleep. Sometimes, only unclear mumbles are heard.
Sleep Terrors
A person having a sleep terror appears to quickly awaken from sleep with profound fear. The person bolts upright from bed crying or yelling, breathing heavily with heart pounding, and with increased sweating. Unlike nightmares, people have a poor memory of these episodes and are confused. Sleep terrors occur more often in the first third of the night. They are more common in children and tend to resolve by adolescence.
Sleepwalking
The sleepwalker is difficult to arouse, may display "bizzare" behavior, and has little memory of the event. Sleepwalking can lead to physical injuries to the sleeping person. Sleepwalking is most often seen in young children. It is less common among adults.
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Periodic Limb Movement Disorder
Repeated body movements characterize periodic limb movement disorder. These movements may occur in the toes, feet, ankles and/or legs, during sleep. A person may be unaware of these movements during sleep, but a sleep partner may notice them.
Who gets periodic limb movement disorder?
This disorder is common in older adults and in people with restless legs syndrome.
Restless Legs Syndrome
Restless legs syndrome occurs when falling asleep. It is an uncomfortable feeling in the lower legs, and less often in the arms. These feelings have been described as "creeping,” "crawling,” or “aching.” Moving the legs or walking relieves these feelings. However, they quickly recur when leg motion stops. Restless legs syndrome can make it hard for a person to fall asleep when it occurs at bedtime. It can also cause frequent awakenings during the night and then make it hard to return to sleep.
Who gets restless legs syndrome?
Five to 15% of of people have restless legs syndrome. More women are affected than men. Restless legs syndrome is more common in people with anemia, kidney problems, and during pregnancy.
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This information has been approved by Teofilo Lee-Chiong, Jr., M.D. (December 2006).
