Sleep disorders involve any difficulties related to sleeping, including difficulty falling or staying asleep, falling asleep at inappropriate times, excessive total sleep time, or abnormal behaviors associated with sleep.
Causes
More than 100 different disorders of sleeping and waking have been identified. They can be grouped in four main categories:
Problems with falling and staying asleep
Problems with staying awake
Problems with adhering to a regular sleep schedule
Sleep-disruptive behaviors
PROBLEMS WITH FALLING AND STAYING ASLEEP
Insomnia includes any combination of difficulty with falling asleep, staying asleep, intermittent wakefulness and early-morning awakening. Episodes may be transient (come and go), short-term (lasting as long as 2 to 3 weeks), or chronic (long-lasting).
Common factors associated with insomnia include:
Physical illness
Depression
Anxiety or stress
Poor sleeping environment such as excessive noise or light
Caffeine
Alcohol or other drugs
Use of certain medications
Heavy smoking
Physical discomfort
Daytime napping
Counterproductive sleep habits:
Early bedtimes
Excessive time spent awake in bed
Disorders include:
Psychophysiological insomnia (learned insomnia)
Delayed sleep phase syndrome -- where a patient's internal clock is constantly out of synch with the "accepted" day / night phases; for example, patients feel best if they can sleep from 4AM to noon
Hypnotic-dependent sleep disorder -- insomnia resulting from building tolerance to, or stopping, certain types of sleep medications
Stimulant-dependent sleep disorder -- insomnia resulting depending on, or stopping, certain types of stimulants
PROBLEMS WITH STAYING AWAKE
Disorders of excessive sleepiness are called hypersomnias. These include:
Sleep apnea
Narcolepsy
Restless leg syndrome
Periodic limb movement disorder
Obstructive sleep apnea
Central sleep apnea
Idiopathic hypersomnia
Respiratory muscle weakness associated sleep disorder
Sleep apnea more commonly affects obese people, but it may affect anyone with a short neck or a small jaw, regardless of weight. The disorder causes breathing to stop intermittently during sleep, resulting in the person being awakened repeatedly. People with sleep apnea often have difficulty achieving prolonged deep sleep. This results in excessive daytime sleepiness.
Narcolepsy is a condition of daytime sleep attacks as well as other features that may include sleep paralysis and hypnagogic hallucinations (hallucinations that happen at the time between wakefullness and sleep). Sleep attacks occur despite adequate sleep at night. A person with narcolepsy may suddenly fall asleep in any situation, without warning.
Restless leg syndrome is characterized by an uncomfortable sensation, usually in the legs, that occurs primarily at night and when a person is relaxed. The uncomfortable sensation diminishes when the legs are moved. This is commonly associated with periodic limb movement disorder, in which a patient has limb movements during sleep. It usually causes insomnia and may cause daytime sleepiness.
PROBLEMS WITH ADHERING TO A REGULAR SLEEP SCHEDULE
Problems may also occur when maintaining a consistent sleep and wake schedule is disrupted. This occurs when traveling between times zones and with shift workers on rotating schedules, particularly nighttime workers.
Sleep disruption disorders include:
Sleep state misperception (the person actually sleeps a different amount than they think they do)
Shift work sleep disorder
Natural short sleeper (the person sleeps less hours than normal but suffers no ill effects)
Chronic time-zone-change syndrome
Irregular sleep-wake syndrome
SLEEP-DISRUPTIVE BEHAVIORS
Abnormal behaviors during sleep are called parasomnias and are fairly common in children. They include:
Sleep terror disorder
Sleep walking
REM sleep behavior disorder (a type of psychosis related to lack of REM sleep and lack of dreaming)
Sleep terror disorder is an abrupt awakening from sleep with fear, sweating, rapid heart rate, and confusion. Sleepwalking is usually not remembered by the person doing it, and usually affects children 2 to 12 years old.
In adults, sleepwalking may also be caused by an organic brain syndrome, reactions to drugs, psychological disorders, and certain medical conditions.
Symptoms
Awakening in the night
Difficulty falling asleep
Excessive daytime drowsiness
Loud snoring
Episodes of stopped breathing
Sleep attacks during the day
Daytime fatigue
Depressed mood
Anxiety
Difficulty concentrating
Apathy
Irritability
Loss of memory (or complaints of decreased memory)
Lower leg movements during sleep
The symptoms may vary with the particular disorder.
Signs and Tests
Polysomnography (recording brain activity, muscle activity and breathing during sleep)
Multiple sleep latency test -- a daytime test that uses polysomnography during multiple brief nap periods
Treatment
INSOMNIA
The treatment is related to the cause, if the cause can be determined. If there is an obvious physical or psychological disorder causing insomnia, it should be treated. Depression is a very common cause of insomnia and can usually be treated with medication, cognitive behavioral therapy, or interpersonal therapy.
Attempts to control environmental and lifestyle factors should be made; these factors include:
Erratic hours of wakefulness
Too much light
Too much noise
Too much caffeine or other stimulants
Sleeping drugs should be used only when prescribed by a health care provider.
HYPERSOMNIA
Sleep apnea is treated with weight reduction and the administration of air under pressure through the nose. Occasionally, surgery or other measures may be needed.
Narcolepsy is treated by use of stimulating medications during the daytime. A new medication called modafanil seems to have fewer side effects than traditional stimulants. It is FDA-approved for narcolepsy and has recently been approved for shift work sleep disorder.
Restless leg syndrome is treated by treating the underlying disorder and with opiate or dopaminergic agonists -- these are medications that work by stimulating the receptors for dopamine and opiates in the brain.
PARASOMNIA
Night terrors are treated with hypnosis, guided imagery techniques and benzodiazepines, but safety measures may be needed to prevent people from harm during nighttime walking.
Sleep disorder clinics often are able to help people restore normal sleeping patterns through various techniques.
Expectations (prognosis)
The outcome varies with the type of disorder. Some disorders may clear up on their own.
Complications
A complication is dependence upon sedatives or other medications prescribed for sleep disorders.
Calling Your Health Care Provider
Call for an appointment with your health care provider if lack of sleep or too much sleep is interfering with daily living.
Also call if non-breathing spells are observed during sleep.
Prevention
Maintaining regular sleep habits and a quiet sleep environment may prevent some sleep disorders.
Review Date: 7/25/2006
Reviewed By: Paul Ballas, D.O., Department of Psychiatry, Thomas Jefferson University Hospital, Philadelphia, PA. Review provided by VeriMed Healthcare Network.
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