Types of Sleep Disorders

Insomnia, Restless Leg Syndrome, Shift Work Disorder and More.

Sleeping is a basic human need. Proper sleep is vital to various health aspects, including weight management, maintaining a good mood, and even our hormone levels. Although getting enough sleep is doable for a bigger percentage of the population, not everyone can achieve sound sleep independently.

Approximately 70 million Americans suffer from sleep disorders, characterized by conditions that prevent an individual from getting restful sleep. The actual danger isn't the sleep loss but the impact it has on how you function during the day and at night. Worse yet, these disorders can cause severe social, personal, and medical difficulties that could persist after the sleep disturbances are over.

There are many types of sleep disruptions, and learning about them can set you on the right track toward understanding your sleep patterns and getting treatment to resolve them. Here are ten major sleep disorders.

Insomnia

You've probably had nights when you couldn't sleep, irrespective of how exhausted you were or how desperately you tried. If this occurs to you often, you might have insomnia. This is one of the most common types of sleep disorders. It's a condition that encompasses several distinct sleep dysfunctions, each linked to the inability to fall asleep or stay asleep.

Some of these disorders are also known as DIMS (Disorder of Initiating and Maintaining Sleep). Besides having trouble sleeping, patients with DIMS have impaired daytime functioning. Most of them cannot take care of family responsibilities and run their daily activities due to fatigue and inability to concentrate.

There are two types of insomnia, chronic and acute. Chronic insomnia is long-term and can last for one month or even more. Acute insomnia, on the other hand, is short-term and can occur after a traumatic experience or due to jetlag.

Symptoms of insomnia

  • You can't fall asleep even when you're tired
  • You experience restless sleep and feel tired when you wake up
  • You have a hard time getting enough sleep to feel refreshed and well-rested

Diagnosis and Treatment

Depending on your condition, the diagnosis and treatment of insomnia may include;

Physical exam - If the cause of this disorder is unknown, your physician may conduct a physical exam that includes blood tests to check for thyroid issues or other problems that may be linked to poor sleep.

Sleep habits review - Aside from asking you sleep-related questions, your physician may request you fill a questionnaire to understand your level of daytime sleepiness and your sleep-wake pattern. They may also ask you to keep a sleep diary as you monitor your sleep for a week or two.

Sleep study - If the tests show that you have another disorder or the cause of your condition isn't clear, you may have to spend over the sleep center. Here, further tests are conducted to monitor and record your body activities, including heartbeat, breathing, brain waves, and body movements, while you sleep.

When it comes to treatment options, your doctor prescribes medications tailored to your specific needs. For instance, if depression is the underlying cause of your sleep disorder, your physician may give you anti-depressants or anti-anxiety medications.

Non-medical techniques, such as stimulus control and cognitive behavior therapy, are also effective at treating insomnia. Lifestyle changes like avoiding alcohol are also advised.

Sleep Apnea

Sleep apnea occurs when your breathing is interrupted when you're sleeping, thus causing you to wake up suddenly. This condition may force you to pause while breathing or release shallow breaths. When left unattended, sleep apnea can cause heart attack and high blood pressure, not to mention, reduce your sleep quality.
Most sleep apnea cases fall in these three categories;

Obstructive sleep apnea (OSA) - It happens when your upper airways are blocked temporarily during sleep. This causes loud, labored snoring and sleep interruptions frequently throughout the night.

Central sleep apnea - Happens when your brain stops transmitting signals to the muscles that regulate breathing, thus leading to choking episodes at night.

Complex sleep apnea syndrome - This is a combination of both central and obstructive sleep apnea.

Symptoms of Sleep Apnea

The signs of central and obstructive sleep apneas overlap, making it a bit challenging to know which type you have. Some of the most common symptoms include;

  • Morning headache
  • Excessive daytime sleepiness
  • Irritability
  • Loud snoring
  • Gasping for air during sleep

Diagnosis and Treatment

Your physician will make an evaluation depending on your sleep history and your symptoms, which your bed partner can help you provide. Tests to detect this sleep disorder include;

Home sleep tests
- Your doctor might give you simplified tests to use at home for diagnosing sleep apnea. These tests measure your blood oxygen level, breathing patterns, and heart rate.

Nocturnal polysomnography - This test involves hooking you up to equipment that monitors your breathing patterns, brain activity, and arm and leg movement while you sleep.

For milder cases, your physician will only recommend lifestyle changes like quitting smoking or losing weight. If the symptoms persist, techniques such as continuous positive airway pressure (CPAP) machines can help keep your airways passage open, preventing sleep apnea and snoring.

Narcolepsy

Narcolepsy is a rare chronic sleep dysfunction characterized by sudden sleep attacks and overwhelming daytime drowsiness. People with narcolepsy are often exhausted during the day and suffer from muscle deterioration, hallucinations, and sleep paralysis.

It also leads to cataplexy, a temporary and unexpected loss of muscle control. This condition can cause various physical changes from stuttered speech to complete weakness of your muscles. Also, patients with narcolepsy can have problems maintaining relationships, difficulty doing well in school, and keeping jobs.

Symptoms of Narcolepsy

  • Excessive daytime sleepiness
  • Decreased alertness and focus during the day
  • Sudden loss of muscle tone
  • Sleep paralysis
  • Changes in REM sleep

Diagnosis and Treatment

Formal diagnosis requires you to spend a night at a sleep center for a comprehensive sleep analysis by a sleep specialist. Techniques of diagnosing this condition and determining its severity include;

Polysomnography - It involves placing electrodes on your scalp and measuring various signals during sleep.

Sleep history - You'll be asked to provide a detailed sleep history. This process also includes filling out an Epworth Sleepiness Scale.

Multiple sleep latency test - This test measures the amount of time it takes you to fall asleep. Specialists will ask you to take about five naps to observe your sleep patterns. Generally, people with narcolepsy often fall asleep easily and quickly enter the REM stage.

Medications for narcolepsy include using stimulant drugs like modafinil, which can help you stay awake during the day. Doctors also prescribe selective serotonin reuptake inhibitors, such as fluoxetine, to help suppress REM sleep. This, in turn, alleviates the symptoms of hallucinations, sleep paralysis, and cataplexy.

Restless Leg Syndrome/Willis-Ekbom Disease

Restless leg syndrome (RLS) is a sleep condition characterized by an uncontrollable urge to shake or move your legs due to an unpleasant sensation. It often happens in the evening or nighttime, making it hard to fall asleep or stay asleep.

Although RLS can begin at any age, it's common in adults and worsens with age. Just like other sleep disorders, patients with RLS feel its impact during daytime in the form of irritability and difficulty concentrating.

Symptoms of Restless Leg Syndrome

  • Nighttime leg twitching
  • Sensations that begin after rest
  • Urge to move around
  • Relief with movement

Diagnosis and Treatment

RLS diagnosis involves a specialist conducting neurological and physical exams. Blood tests, especially for iron deficiency, may be done to rule out any other possible cause for your condition.

Sometimes, treating underlying conditions, like iron deficiency, significantly relieves symptoms of RLS. Drugs affecting calcium channels, such as gabapentin, can also work for some patients with RLS.

Parasomnias

A parasomnia is a sleep disorder characterized by unusual and undesirable experiences or physical events that disrupt sleep. It occurs before you fall asleep, during sleep, or during arousal from slumber. Some examples of parasomnias include sleepwalking, sleep talking, nightmares, sleep terror disorders, REM behavior disorder (RBD), and sleep eating disorder. You're deeply asleep, but your partner might think you're awake. Night terrors are most prevalent in children.

Diagnosis and Treatment

Your sleep medicine specialist will inquire about your sleep symptoms, family history, medical history, and any substance abuse. Your bed partner may be requested to monitor your sleep events. Other sleep disorders tests include neurologic exam, video electroencephalogram (EEG), and sleep study.

Treatment begins with analyzing and treating other sleep disorders and reviewing medications that may cause parasomnia. General management strategies for REM and NON-REM sleep disorders include following good sleep hygiene habits and maintaining your regular sleep-wake schedule.

Rapid Eye Movement (REM) Sleep Behavior Disorder

This sleep disorder is characterized by vocalizations and sudden body movements as you experience vivid, often unpleasant dreams during REM sleep. Its onset is usually gradual and gets worse with time.

During normal REM sleep, your body experiences atonia, a temporary muscle paralysis, while your brain shows wakefulness activities. Breathing becomes irregular, blood pressure increases, and your eyes dart rapidly in all directions. The temporary paralysis of this sleep stage enables you to dream safely and lie still while your brain is active.

It involves various skeletal muscles, excluding only those that help us digest, breathe, and some eye muscles. Normal muscle paralysis doesn't happen for people with REM sleep behavior disorder, thus allowing them to act out their dreams physically. This disorder manifests as quiet sleep talking and small muscle twitches to punching, kicking, loud shouting, and jumping out of bed. It can be linked to other sleep disorders like Parkinson's disease, Lewy body dementia, and multiple system atrophy.

Symptoms of REM Sleep Behavior Disorder

  • Noises, such as talking and laugh, and Movements, such as punching and kickingI
  • Intense and frightening dreams

Diagnosis and Treatment

To diagnose this condition, your doctor reviews your symptoms and medical history. The evaluation may involve;

  • Talking with your sleep partner
  • Physical and neurological exam
  • Nocturnal sleep study

Treating REM sleep disorder includes medication and physical safeguards like padding the floor near your body, protecting bedroom windows, and placing barriers on the sides of your bed. As for medication, your physician may prescribe melatonin, a dietary supplement, to help eliminate your symptoms. Clonazepam, which is often used to treat anxiety, can also help reduce the symptoms of REM sleep behavior disorder.

Non-24-Hour Sleep Wake Disorder (N24)

N24 is a circadian rhythm sleep dysfunction in which your biological clock fails to sync to a 24-hour day. Rather than sleeping at about the same time each day, you'll find that your sleep time gradually delays by minutes to hours each day. You'll sleep at later clock times until your sleeping periods go around the clock.

Your cycles of hormone rhythm and body temperature will also follow a non-24-hour rhythm. As an effect of this ever-shifting rhythm, you'll experience inappropriate fluctuations in mood alertness, and appetite. Attempts to maintain a typical sleep-wake cycle result in cumulative sleep deprivation.

Over the long term, this desynchronization can have adverse health consequences. Patients with N24 often have difficulty keeping social commitments, work, or school. They may also develop depression because of the stress of not keeping a normal schedule or as an effect of not getting enough sunlight due to sleep during the day.

Diagnosis and Treatment

Initial diagnosis is centered on home sleep logs that your doctor will ask you to keep. Your doctor will then confirm the diagnosis using an actigraph (a device that tracks the timing of sleep).

Though N24 is considered a lifelong condition, specific treatments can help restore the normal 24-hour rhythm. N24 in blind people is usually treated with melatonin supplements. Sighted people, on the other hand, will benefit the most from melatonin supplements at night and bright light therapy during the day.

Excessive Sleepiness

Excessive daytime sleepiness is characterized by an increased desire to sleep in the daytime or difficulty staying awake. The feeling of excessive sleepiness may become stronger when you're sedentary, like while sitting at work or driving. It's normal to feel a bit sleepy once in a while, especially after going short of sleep, but it's considered excessive when it occurs almost daily for about three months.

Symptoms of Excessive Sleepiness

  • Feelings of irritation
  • Trouble focusing
  • Slower reaction times
  • Memory problems

Diagnosis and Treatment

Your specialist will ask you questions about your sleeping habits and run tests to determine the cause of your sleepiness. Treatment methods generally depend on the underlying conditions that are triggering the increased desire to sleep.

You'll be advised to improve your sleep hygiene and get more sleep. Your doctor will adjust your medication accordingly and work with you to develop an effective treatment plan for your underlying disorders.

Shift Work Disorder

Shift work sleep disorder (SWSD) affects people who work non-traditional hours, such as graveyard shifts, rotating shifts, or early morning shifts. It's characterized by drowsiness, lack of refreshing sleep, and excessive sleepiness.

These symptoms can negatively impact both your work and leisure time. Napping during the day and working at night can cause misalignment between your body and the biological clock (circadian rhythm) that regulates wakefulness and sleepiness based on darkness and natural light cycles.

Symptoms of Shift Work Disorder

  • Lack of energy
  • Excessive sleepiness
  • Difficulty concentrating
  • Depression or moodiness

Diagnosis and Treatment

Your sleep medicine specialist will probably ask you questions about your sleep patterns and the type of shift you currently work. They're also likely to ask you about your medical history and current medication.

There are many lifestyle changes you can make to help relieve the symptoms of
shift work disorder. This includes keeping a regular sleep schedule and taking a few days off after a series of shifts. Sleep aids, such as melatonin, can also help improve your sleep quality.

Periodic Limb Movement Disorder

This is a movement disorder often linked to RLS that involves sudden and repetitive jerking or cramping of the legs, and sometimes even the arm during sleep. They can be rhythmic and occur between 20 and 40 seconds apart.

What distinguishes this condition from RLS is that RLS can occur even when you're still awake or trying to get sleep, whereas periodic limb movement disorder only occurs when you're asleep. The most common PLMD symptoms are poor sleep and daytime sleepiness. Most patients with PLMD are often unaware of their body movements unless their partner tells them.

Diagnosis and Treatment

If PLMD doesn't give you sleepless nights, it may not need treatment. Some of the medications used to treat PLMD include Requip, Mirapex, and painkillers, such as Vicodin.

Closing Thoughts
Sleep disorders may not be life-threatening, but they impact your quality of life so severely that they can affect your thinking, work performance, and your general health. If you're having trouble falling asleep, don't hesitate to contact your healthcare provider and talk to them about it. A diagnosis and an effective treatment plan will have you sleeping well and feeling better in no time.


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