Sleep disorder explained

If all the troubles of a sleep disorder are making you tired and irritable and giving you trouble in performing daily activities, then visiting professionals is something meaningful for enriching your quality of life. With strategies that focus on your specific issues and continued support, you can tackle the main causes and find restful, rejuvenating sleep for a healthier, well-balanced life.

What is a sleep disorder?

Sleep, just as vital as water is to life, is essential for our survival. You might still think there's not much going on when you're sleeping. In fact, most of us tend to think of sleep just as "downtime," when a tired brain gets to take a break.

But that's wrong. As you snooze, your brain is at work, too. For instance, sleep readies your brain to learn, remember, and even create. When we sleep, the brain totally changes function. Everything from blood vessels to the immune system uses sleep as a time for repair. If you don't get enough sleep, those processes are going to be disturbed.

It can easily be said that getting good sleep can equip you to deal with stress, solve problems, or even recover from illness. In contrast, not getting enough sleep causes hundreds of health concerns-from heart disease and stroke to obesity and dementia-and affects how you think and feel. Sleep disorders are technically called sleep-wake disorders, which describe a problem in the quality, timing, and quantity of sleep that leads to difficulties with daytime functioning.

Sleep Disorder Symptoms

Everyone occasionally experiences sleeping problems at some time or another; hence, how do you know whether your problem is just a transient nuisance or a symptom of a more serious sleep disorder or an underlying medical condition?

Start by evaluating your symptoms, especially looking for the classic signs of daytime manifestations of sleep deprivation. You are likely experiencing a sleep disorder if, for example, you:

• React slowly or have slow responses.
• Feel cranky or somnolent during the day

• Often hear that you look tired
• Trouble controlling your emotions
• Trouble with your memory
• Need caffeine products to keep going
• Feel like you need a nap almost every day
• Fall asleep or feel very sleepy while driving
• Difficulty with performance at work, school, or elsewhere
• Have trouble paying attention or concentrating at work, school, or home
• Trouble staying awake if you are sitting still, watching television, or reading

A Sleep Disorder Cause

Common sleep-wake disorders often co-occur with other medical conditions or other mental health conditions, including depression, anxiety, or cognitive disorders. Sleep disorders can also serve as the first indicator of a range of medical and neurological conditions, including congestive heart failure, osteoarthritis, or Parkinson's disease.

Still, research indicates that sleep disorders can stem from the following origins:

Physical conditions

Medical issues

Mental health problems

Environmental influences

Night shift work

Hereditary factors

Certain medications

Aging

Others include:

Allergies, colds, and acute upper respiratory infections can also contribute to problems with nocturnal breathing. Such an ailment could also be due to a failure to breathe through your nose.

‍Frequent Urination:

This is a term generally referred to as nocturia or frequent urination. It may disrupt your sleep at night in the sense that you may wake up. Conditions such as hormonal imbalance and diseases of the urinary tract may be the causative factors for this disease.

‍Chronic pain:

Pain can disrupt sleeping. It may be such that it wakes you up during the night. Some of the common causes of chronic pain include:

• Arthritis
• Chronic fatigue syndrome
• Fibromyalgia
• Inflammatory bowel disease
• Chronic headaches
• Lower back pain

In other cases, chronic pain can be caused by sleeping disorders. Doctors think that it might be related to the cause of developing a condition like fibromyalgia.

Stress and anxiety:

Both stress and anxiety often cause low quality of sleep. You tend to find it difficult to sleep or stay asleep. Nightmares, sleep talking, or sleepwalking can also cause disturbed sleep.

Whereas the root causes are different, the bottom line of any sleep disorder is that the natural cycle of sleep and daytime wakefulness of the body is disrupted or exaggerated.

Types of Sleep Disorder

There’s more to good sleep than just the hours spent in bed, says Dr. Marishka Brown, a sleep expert at NIH. “Healthy sleep encompasses three major things,” she explains. “One is how much sleep you get. Another is sleep quality—that you get uninterrupted and refreshing sleep. The last is a consistent sleep schedule.”

As such, Sleep disorders can manifest itself in several different ways:

Insomnia:

Insomnia is the most common sleep disorder. It involves problems getting to sleep or staying asleep. About one-third of adults report some insomnia symptoms, 10-15 percent report problems with functioning during the daytime and 6-10 percent have symptoms severe enough to meet criteria for insomnia disorder. An estimated 40-50 percent of individuals with insomnia also have another mental disorder.

People with insomnia have one or more of the following symptoms:

• Difficulty falling asleep.
• Waking up often during the night and having trouble going back to sleep.
• Waking up too early in the morning.
• Having unrefreshing sleep.

Having at least one daytime problem such as fatigue, sleepiness, problems with mood, concentration, accidents at work or while driving, etc. due to poor sleep.

Insomnia varies in how long it lasts and how often it occurs. It can be short-term (acute or adjustment insomnia) or can last a long time (chronic insomnia). It can also come and go, with periods of time when a person has no sleep problems. Acute or adjustment insomnia can last from one night to a few weeks. Insomnia is called chronic when a person has insomnia at least three nights a week for a month or longer.

Short-term or acute insomnia can be caused by life stresses (such as job loss or change, death of a loved one, or moving), an illness, or environmental factors such as light, noise, or extreme temperatures.

Long-term or chronic insomnia can be caused by factors such as depression, chronic stress and pain or discomfort at night.

In a condition called primary insomnia, where no clear environmental, psychiatric, or medical cause can be identified, experts suspect that individual differences in brain function may result in an overactive alerting signal that continues long after an individual would like to fall asleep.

In order to be diagnosed with insomnia disorder, the sleep difficulties must occur at least three nights a week for at least three months and cause significant distress or problems at work, school or other important areas of a person's daily functioning. Not all individuals with sleep disturbances are distressed or have problems functioning.

To diagnose insomnia, a physician will rule out other sleep disorders, medication side-effects, substance misuse, depression and other physical and mental illnesses. Some medications and medical conditions can affect sleep.

A comprehensive assessment for insomnia or other sleep problems may involve a patient history, a physical exam, a sleep diary and clinical testing (a sleep study). A sleep study allows the physician to identify how long and how well you’re sleeping and to detect specific sleep problems. A sleep diary is a record of your sleep habits to discuss with your physician. It includes information such as when you go to bed, get to sleep, wake up, get out of bed, take naps, exercise, eat and consume alcohol and caffeinated beverages.

Sleep problems can occur at any age but most commonly start in young adulthood. The type of insomnia often varies with age. Problems getting to sleep are more common among young adults. Problems staying asleep are more common among middle-age and older adults.

Excessive Daytime Sleepiness (EDS):

It is not unusual for people to have days when they struggle to stay awake. However, suddenly falling asleep on the job or while driving is not normal—and can be extremely dangerous. Excessive daytime sleepiness (EDS) is a symptom that can be seen in several sleep disorders, including obstructive sleep apnea, narcolepsy, and periodic limb movement disorder.

‍Sleep Apnea:

Sleep apnea is a potentially serious sleep disorder that occurs when a person's breathing is interrupted during sleep. People with untreated sleep apnea stop breathing repeatedly during their sleep.

Sleep apnea affects an estimated 2 to 15 percent of middle-age adults and more than 20 percent of older adults. Major risk factors for sleep apnea are obesity, male gender and family history of sleep apnea.

Sleep apnea is diagnosed with a clinical sleep study. The sleep study (polysomnography) involves monitoring the number of obstructive apneas (absence of airflow) or hypopneas (reduction in airflow) during sleep.

There are two types of sleep apnea: obstructive and central.

Obstructive sleep apnea (OSA) is the more common of the two. It is caused by a blockage of the airway, usually when the soft tissue in the back of the throat collapses during sleep. Symptoms of OSA may include snoring, daytime sleepiness, fatigue, restlessness during sleep, gasping for air while sleeping and trouble concentrating.

In central sleep apnea (CSA), the airway is not blocked, but the brain fails to tell the body to breathe. This type is called central apnea because it is related to the function of the central nervous system. People with CSA may gasp for air but mostly report recurrent awakenings during night.

Treatment for Sleep Apnea specifically is usually one of the following:

Weight loss is one of the most strongly recommended preventative therapies for weight-related OSA. Although results vary, weight loss may ease the severity of the disorder or eliminate the problem altogether.

Continuous positive airway pressure (CPAP) is the first line of treatment for moderate to severe cases of OSA. During sleep, the CPAP device keeps the airway open by sending a constant, low-pressure stream of air through the nose and into the airway.

Position therapy is somewhat less effective; however, some individuals have OSA only when they sleep on their back. This means they can successfully reduce OSA symptoms by sleeping on their side instead.

Dental devices, which are designed to reposition the lower jaw in a way that keeps the airway open, work well in some individuals with mild to moderate OSA.

Other treatment options include surgical procedures that widen the airway so that it is less likely to close during sleep.

As yet, no medications have been shown to be effective in treating OSA.

Sleep Related Hypoventilation:

People with sleep-related hypoventilation have episodes of shallow breathing, elevated blood carbon dioxide levels, and low oxygen levels during sleep. It frequently occurs along with medical conditions, such as chronic obstructive pulmonary disease (COPD), or medication or substance use. Those with sleep-related hypoventilation often have trouble with insomnia or excessive daytime sleepiness. Risk factors for sleep-related hypoventilation include medical conditions, such as obesity and hypothyroidism, and use of certain medications, such as benzodiazepines and opiates.

Narcolepsy:

Affecting approximately one in two thousand people, narcolepsy is a central nervous system disorder in which the brain cannot properly regulate cycles of sleep and wakefulness.

People with narcolepsy experience excessive daytime sleepiness and intermittent, uncontrollable episodes of falling asleep during the daytime. These sudden sleep attacks may occur during any type of activity at any time of the day. Some patients with narcolepsy experience sudden muscle weakness with laughter or other emotions.

Narcolepsy usually begins between the ages of 15 and 25, but it can become apparent at any age. In many cases, narcolepsy is undiagnosed and, therefore, untreated.

Other symptoms include:

Cataplexy—sudden muscle weakness or reversible paralysis in the legs, arms, or face. In extreme cases, an individual may fall down, appear to be asleep, and remain unable to move for seconds to minutes, yet remain fully conscious.

Hypnagogic hallucinations—intense dream-like experiences that occur during transitions to sleep.

Sleep paralysis—the inability to talk or move for a short time when waking up or falling asleep.

Narcolepsy nearly always results from the loss of hypothalamic hypocretin (orexin)-producing cells. This deficiency in hypocretin can be tested through cerebrospinal fluid via a lumbar puncture (spinal tap). Narcolepsy is rare, affecting and estimated 0.02%–0.04% of the general population. It typically begins in childhood, adolescence or young adulthood.

The diagnosis of narcolepsy sometimes requires daytime sleep testing as well as an overnight sleep study. While there is no cure, narcolepsy can be treated with stimulants to reduce daytime sleepiness and antidepressants and other medications to prevent cataplexy, sleep paralysis, and hypnagogic hallucinations. Scheduling daytime naps at convenient times may help to overcome the problems caused by unscheduled "sleep attacks."

Periodic Limb Movements of Sleep:

Periodic Limb Movements of Sleep (PLMS) is a condition affecting approximately 34 percent of adults over the age of 60. This condition causes involuntary kicking and jerking movements of the legs and arms, often repeated hundreds of times during the night. Like people with sleep apnea, people with PLMS are usually unaware of their multiple nighttime awakenings unless they are witnessed by a bed partner. In extreme cases, these brief arousals following the leg movements disturb sleep so much that they cause excessive daytime sleepiness. In that situation, this is called periodic limb movement disorder (PLMD) and treatment may help with the symptoms of EDS. Patients with restless legs syndrome (an uncomfortable urge to move the legs) often have periodic limb movements during sleep.

PLMD is typically treated using medications that have been shown to be useful in treating the movement disorder Parkinson’s disease. In some cases, sleeping pills may be used to prevent arousals caused by limb movements.

Restless Legs Syndrome:

Restless legs syndrome (RLS) is a sleep disorder that causes an intense, often irresistible urge to move the legs. This sensation is brought on by resting such as lying down in bed, sitting for prolonged periods such as while driving or at a theatre.

The symptoms occur at least three times per week, continue for at least three months, and cause significant distress or problems in daily functioning. Restless legs syndrome typically begins in a person’s teens or twenties and it affects an estimated 2% to 7.2% of the population.

RLS typically occurs in the evening, making it difficult to fall asleep and stay asleep. It can be associated with problems with daytime sleepiness, irritability and concentration. Often, people with RLS want to walk around and shake their legs to help relieve the uncomfortable sensation.

Other conditions that can cause EDS include advanced or delayed sleep phase syndromes, which result from abnormal time alignments between the preferred sleep-wake schedule and the phase of the internal clock. There are also numerous medical conditions, such as neuromuscular disorders, that can cause sleep to be fragmented and cause EDS.

‍Circadian Rhythm Sleep Disorders:

We all have an internal biological clock that regulates our 24-hour sleep-wake cycle, also known as our circadian rhythms. Light is the primary cue that influences circadian rhythms. At night, when there is less light, your brain triggers the release of melatonin, a hormone that makes you sleepy. When the sun comes up in the morning, the brain tells the body that it's time to wake up.

When your circadian rhythms are disrupted or thrown off, you may feel groggy, disoriented, and sleepy at inconvenient times. Circadian rhythms have been linked to a variety of sleeping problems and sleep disorders, as well as depression, bipolar disorder, and seasonal affective disorder (the winter blues)

Delayed Sleep Phase Disorder:

Delayed sleep phase disorder is a condition where your biological clock is significantly delayed. As a result, you go to sleep and wake up much later than other people. This is more than just a preference for staying up late or being a night owl, but rather a disorder that makes it difficult for you to keep normal hours—to make it to morning classes, get the kids to school on time, or keep a 9-to-5 job.

People with delayed sleep phase disorder are unable to get to sleep earlier than 2 to 6 a.m., no matter how hard they try.

When allowed to keep their own hours (such as during a school break or vacation), they fall into a regular sleep schedule.

Delayed sleep phase disorder is most common in teenagers, and many teens will eventually grow out of it.

For those who continue to struggle with a biological clock that is out of sync, treatments such as light therapy and chronotherapy can help. To learn more, schedule an appointment with your doctor or a local sleep clinic.

Shift Work Sleep Disorder:

Shift work sleep disorder occurs when your work schedule and your biological clock are out of sync. In our 24-hour society, many people have to work night shifts, early morning shifts, or rotating shifts. These schedules force you to work when your body is telling you to go to sleep, and sleep when your body is signaling you to wake.

While some people adjust better than others to the demands of shift work, most shift workers get less quality sleep than their daytime counterparts. As a result of sleep deprivation, you may struggle with sleepiness and mental lethargy on the job. This cuts into your productivity and puts you at risk of injury.

To reduce the impact of shift work on your sleep:

Take regular breaks and minimise the frequency of shift changes.

When changing shifts, request a shift that's later, rather than earlier as it's easier to adjust forward in time, rather than backward.

Naturally regulate your sleep-wake cycle by increasing light exposure at work (use bright lights) and limiting light exposure when it's time to sleep. Avoid TV and computer screens, and use blackout shades or heavy curtains to block out daylight in your bedroom.

Consider taking melatonin when it's time for you to sleep.

Jet Lag:

Jet lag is a temporary disruption in circadian rhythms that occurs when you travel across time zones. Symptoms include daytime sleepiness, fatigue, headaches, stomach problems, and insomnia. Symptoms are more pronounced the longer the flight and flying east tends to cause worse jet lag than flying west.

In general, it usually takes one day per time zone crossed to adjust to the local time. So, if you flew from Los Angeles to New York, crossing three time zones, your jet lag should be gone within three days.

Other Sleep Disorders

Non-Rapid Eye Movement Sleep Arousal Disorders:

Non-rapid eye movement (NREM) sleep arousal disorders involve episodes of incomplete awakening from sleep, usually occurring during the first third of a major sleep episode, and are accompanied by either sleepwalking or sleep terrors. The episodes cause significant distress or problems functioning. NREM sleep arousal disorders are most common among children and become less common with increasing age.

Sleepwalking:

Sleepwalking involves repeated episodes of rising from bed and walking around during sleep. While sleepwalking, the individual has a blank, staring face; is relatively unresponsive to others; and is difficult to wake up. Nearly 30% of people have experienced sleepwalking at some time in their lives. Sleepwalking disorder, with repeated episodes and distress or problems functioning, affects an estimated 1% to 5% of people.

Rapid Eye Movement Sleep Behavior Disorder:

Rapid eye movement (REM) sleep behaviour disorder involves episodes of arousal during sleep associated with speaking and/or movement. The person’s actions are often responses to events in the dream, such as being attacked or trying to escape a threatening situation. Speech is often loud, emotion-filled, and profane. These behaviours may be a significant problem for the individual and their bed partner and may result in significant injury (such as falling, jumping, or flying out of bed; running, hitting, or kicking). Upon awakening, the person is immediately alert and can often recall the dream.

These behaviours arise during REM sleep and usually occur more than 90 minutes after falling asleep. The behaviours cause significant distress and problems functioning and may include injury to self or the bed partner. Embarrassment about the episodes can cause problems in social relationships and can lead to social isolation or work-related problems.

The prevalence of REM sleep behaviour disorder is less than 1% in the general population and it overwhelmingly affects males older than 50.

Nightmare Disorder:

Nightmare disorder involves repeated occurrences of lengthy, distressing, and well-remembered dreams that usually involve efforts to avoid threats or danger. They generally occur in the second half of a major sleep episode.

The nightmares are typically lengthy, elaborate, story-like sequences of dream imagery that seem

real and cause anxiety, fear or distress. After waking up, people experiencing nightmares are quickly alert and generally remember the dream and can describe it in detail. The nightmares cause significant distress or problems functioning. Nightmares often begin between ages 3 and 6 years but are most prevalent and severe in late adolescence or early adulthood.

Hypersomnolence Disorder:

People with hypersomnolence disorder are excessively sleepy even when getting at least 7 hours sleep. They have at least one of the following symptoms:

Recurrent periods of sleep or lapses into sleep within the same day (such as unintentional naps while attending a lecture or watching TV)

Sleeping more than nine hours per day and not feeling rested

Difficulty being fully awake after abruptly waking up

Such extreme sleepiness occurs at least three times per week, for at least three months. Individuals with this disorder may have difficulty waking up in the morning, sometimes appearing groggy, confused or combative (often referred to as sleep inertia). The sleepiness causes significant distress and can lead to problems with functioning, such as issues with concentration and memory.

The condition typically begins in late teens or early twenties but may not be diagnosed until many years later. Among individuals who consult in sleep disorders clinics for complaints of daytime sleepiness, approximately 5%–10% are diagnosed with hypersomnolence disorder.

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