Sleep Disorder

Sleep disorders are conditions that disrupt your ability to get the quality rest your body needs. More than 50 million people in the United States live with a sleep disorder, affecting their physical health, mental wellbeing, and daily functioning.

Table of contents

• What Are Sleep Disorders
• Categories of Sleep Disorders
• Common Types of Sleep Disorders
• How Much Sleep Do You Need
• What Causes Sleep Disorders
• Signs and Symptoms
• When to See a Doctor
• How Sleep Disorders Are Diagnosed
• Treatment Options
• Building Healthy Sleep Habits
• Impact on Health and Life

What Are Sleep Disorders

Sleep disorders are conditions that affect your ability to get the rest your body needs and maintain wakefulness. There are over 80 different sleep disorders that can impact how well you sleep (quality), when you fall asleep and if you can stay asleep (timing), and how much sleep and wakefulness you get (quantity or duration)^[1].

While everyone can experience problems with sleep from time to time, you might have a sleep disorder if you regularly have trouble sleeping, feel tired during the day even though you slept for at least seven hours the night before, or find it difficult to perform regular daytime activities^[1].

Sleep is a complex biological process. While you are sleeping, you are unconscious, but your brain and body functions are still active. They are doing a number of important jobs that help you stay healthy and function at your best^[2].

Categories of Sleep Disorders

The International Classification of Sleep Disorders (ICSD) provides a standardized way to classify sleep disorders. The most recent revision categorizes sleep disorders based on symptoms, how they affect a person, and the body system involved^[1][3].

The major categories include:

• Insomnia: Difficulty falling and staying asleep
• Sleep-related breathing disorders: Changes in breathing while you sleep
• Central disorders of hypersomnolence: Trouble feeling alert during the day
• Circadian rhythm sleep-wake disorders: Problems with your internal clock that make it difficult to fall asleep and wake up on time
• Parasomnias: Physical actions or verbal expressions that happen during sleep like walking, talking, or eating
• Sleep-related movement disorders: Physical movements or the urge to move that makes it difficult to fall asleep or stay asleep

Common Types of Sleep Disorders

Insomnia is the most common sleep disorder. It involves being unable to fall asleep and stay asleep^[2]. People with chronic insomnia have trouble falling asleep or staying asleep most nights for at least three months and feel tired or irritable as a result^[1].

Sleep apnea is a breathing disorder in which you stop breathing for 10 seconds or more during sleep^[2]. Obstructive sleep apnea involves snoring and moments during sleep when you stop breathing that disrupt your sleep^[1].

Restless legs syndrome causes a tingling or prickly sensation in your legs, along with a powerful urge to move them. This urge to move your legs worsens when you rest^[1][2].

Narcolepsy causes extreme daytime sleepiness. People with narcolepsy cannot regulate when they fall asleep or how long they stay awake^[1][2]. This condition is characterized by excessive sleepiness, cataplexy (sudden muscle weakness), sleep paralysis, and sleep hallucinations^[7].

Circadian rhythm disorders involve problems with the sleep-wake cycle. They make you unable to sleep and wake at the right times^[2]. Shift work sleep disorder causes trouble falling asleep and staying asleep, and sleepiness at unwanted times due to your work schedule^[1].

Parasomnias involve acting in unusual ways while falling asleep, sleeping, or waking from sleep, such as walking, talking, or eating^[2]. REM sleep behavior disorder occurs when you act out your dreams while in the rapid eye movement stage of sleep^[1].

How Much Sleep Do You Need

Everyone needs sleep. It is an essential part of what makes our bodies function. The amount of sleep you need might be more or less than others, but experts recommend adults get seven to nine hours of sleep per night^[1]. Most adults need about 7 to 8 hours each night^[2].

Sleep needs vary by age. Children and teenagers may need more sleep than adults^[1]. More specifically:

• Teens (age 13 to 17 years) need to sleep between 8 and 10 hours each night
• School-aged children (age 6 to 12 years) need to sleep between 9 and 12 hours each night
• Preschoolers (age 3 to 5 years) need to sleep between 10 and 13 hours a day, including naps
• Toddlers (age 1 to 2 years) need to sleep between 11 and 14 hours a day, including naps
• Babies (age 4 to 12 months) need to sleep between 12 and 16 hours a day, including naps
• Newborns (age 0 to 3 months) need to sleep between 14 and 17 hours a day^[16]

What Causes Sleep Disorders

There are different causes for different sleep disorders. Some contributing factors include environmental, genetic, psychological, and behavioral factors^[3][4].

Common causes and contributing factors include:

• Other health conditions, such as heart disease, lung disease, nerve disorders, and pain
• Mental illnesses, including depression and anxiety
• Certain medications
• Genetics
• Caffeine and alcohol
• An irregular schedule, such as working the night shift
• Stress or anxiety
• Some health conditions, like heartburn or asthma
• Aging. As people age, they often get less sleep or spend less time in the deep, restful stage of sleep. They are also more easily awakened^[2][4]

For obstructive sleep apnea, obesity plays a key role. If you carry excess weight, fat deposits around your nose and throat may block your breathing^[5].

Sometimes the cause is unknown^[2].

Signs and Symptoms

The symptoms of sleep disorders depend on the specific disorder. Some signs that you may have a sleep disorder include^[2]:

• You regularly take more than 30 minutes each night to fall asleep
• You regularly wake up several times each night and then have trouble falling back to sleep, or you wake up too early in the morning
• You often feel sleepy during the day, take frequent naps, or fall asleep at the wrong times during the day
• Your bed partner says that when you sleep, you snore loudly, snort, gasp, make choking sounds, or stop breathing for short periods
• You have creeping, tingling, or crawling feelings in your legs or arms that are relieved by moving or massaging them, especially in the evening and when trying to fall asleep
• Your bed partner notices that your legs or arms jerk often during sleep
• You have vivid, dreamlike experiences while falling asleep or dozing
• You have episodes of sudden muscle weakness when you are angry or fearful, or when you laugh
• You feel as though you cannot move when you first wake up

Common symptoms of sleep disorders can also include being very sleepy during the daytime, trouble falling asleep, waking up during the night and not being able to go back to sleep, breathing in a pattern that is not typical, feeling an urge to move that is uncomfortable while trying to fall asleep, or moving too much during sleep^[4].

When to See a Doctor

Anyone can have an occasional poor night’s sleep. However, you should talk with your doctor or other healthcare professional if you regularly have trouble getting enough sleep, if you do not feel rested when you wake up, or if you feel overly sleepy during the day^[4].

Common signs that require medical attention include^[16]:

• Trouble falling or staying asleep, even after making healthy changes to your sleep routine
• Still feeling tired after sleeping the recommended number of hours
• Sleepiness during the day that makes it difficult to do everyday activities, like driving or concentrating at work
• Frequent loud snoring
• Pauses in breathing or gasping while you sleep
• Tingling or crawling feelings in your legs or arms at night that feel better when you move or massage the area
• Feeling like it is hard to move when you first wake up

How Sleep Disorders Are Diagnosed

To make a diagnosis, your health care provider will use your medical history, your sleep history, and a physical exam^[2]. Your doctor will give you a checkup and talk with you about what is going on. They will ask you questions such as what medical conditions you have, what medications you are taking, how stressed you are feeling, and how much alcohol and caffeine you are getting^[14].

You may also have a sleep study, also called polysomnography. The most common types of sleep studies monitor and record data about your body during a full night of sleep^[2]. A sleep study records brain waves, oxygen levels in the blood, heart rate and breathing during sleep. It also measures eye and leg movements^[10].

The data recorded includes:

• Brain wave changes
• Eye movements
• Breathing rate
• Blood pressure
• Heart rate and electrical activity of the heart and other muscles^[2]

A sleep study may be done at a sleep disorders unit within a hospital or at a sleep center^[10]. Some people can have a test at home to diagnose sleep apnea. The small monitors usually record breathing rate and airflow, oxygen levels, and heart rate^[10].

It may help for your bed partner to share information about your symptoms^[10]. You may be asked to keep a sleep log that includes information about your daily activities and how you sleep^[10].

Treatment Options

Your treatment will depend on what type of sleep disorder you have^[14]. Treatment is available to help you get the rest you need^[1].

Treatment for Insomnia

Cognitive behavior therapy for insomnia is the first-line treatment for chronic insomnia^[7]. This therapy can be effectively administered in a primary care setting^[7]. Treatment also includes changing your sleep habits, such as going to bed the same time each night and getting up at the same time each morning^[14].

If needed, sleep medications may be used along with cognitive behavior therapy, but they should not be the primary therapy for chronic insomnia^[7].

Treatment for Sleep Apnea

Continuous positive airway pressure (CPAP) is the most effective treatment option for obstructive sleep apnea^[7]. With CPAP, you wear a mask while you sleep, and it raises the air pressure inside your throat. This keeps your airway more open, so you can sleep better^[14]. Treatment should be combined with weight loss^[7].

Other treatment options include dental devices that hold the lower jaw forward during sleep, and for some people, surgery. An implanted device called an upper airway stimulator is also available, which delivers mild stimulation to nerves that control airway muscles, keeping them open^[14].

Treatment for Restless Legs Syndrome

Nonpharmacologic interventions are first-line treatment for restless legs syndrome. If there is inadequate response, medications called alpha-2-delta ligands should be used. Dopaminergic agonists should be used if there is inadequate response to first-line treatments^[7].

Treatment for Narcolepsy

Narcolepsy is treated with behavior modifications and medications such as stimulants, selective serotonin reuptake inhibitors, sodium oxybate, and pitolisant^[3]. Modafinil is a common stimulant used for treatment^[7].

Treatment for Circadian Rhythm Disorders

A sleep-wake schedule and melatonin or a bright-light therapy regimen is recommended for treatment of delayed sleep phase syndrome^[7].

Treatment for REM Sleep Behavior Disorder

REM sleep behavior disorder is treated with environmental safety measures and melatonin or clonazepam^[7].

Building Healthy Sleep Habits

You can take steps to improve your sleep habits. First, make sure that you give yourself enough time to sleep^[9]. Making small changes to your daily routine can help you get the sleep you need^[16].

Tips for better sleep include:

• Keep a regular sleep schedule. Go to bed and wake up around the same time each day, even on the weekends^[1][9]
• Make your bedroom sleep friendly. Sleep in a cool, quiet, dark place^[1]
• Avoid watching TV or looking at electronic devices, as the light from these sources can disrupt your sleep-wake cycle^[1]
• Get regular physical activity during the daytime (at least 5 to 6 hours before going to bed). Exercising close to bedtime can make it harder to fall asleep^[9]
• Avoid caffeine, nicotine, and alcohol close to your bedtime^[9]
• Avoid naps, especially in the afternoon. This may help you sleep longer at night^[9]
• Eat meals on a regular schedule and avoid late-night dinners^[9]
• Limit how much fluids you drink close to bedtime^[9]
• Learn new ways to manage stress. Follow a routine that helps you wind down and relax before bed. For example, read a book, listen to soothing music, or take a hot bath^[9]
• If you cannot sleep, go into another room and read, or do something relaxing and quiet. Go back to bed when you are tired^[14]

Impact on Health and Life

Getting enough sleep is important for both physical and mental health. Sleep helps keep your mind and body healthy^[16]. While we sleep, the brain and body do a number of important jobs that help us stay in good health and function at our best^[6].

Getting the sleep you need improves your ability to learn, remember, and solve problems. It lowers blood pressure and gives the heart and blood vessels the rest they need. Sleep helps certain hormones control growth, the repair of cells and tissues, the immune system (to fight infection), blood sugar levels (which affect energy), and appetite^[6].

Sleep disorders are associated with adverse effects such as motor vehicle collisions, decreased quality of life, and increased mortality^[7]. Sleep disturbances have been associated with hypertension and increased all-cause mortality^[7]. A study showed significant impairment in the quality of life in patients with insomnia^[3].

Not getting enough sleep can put you at risk for short- and long-term problems, such as^[5][16]:

• Increased risk of obesity, diabetes, and depression
• Learning, emotional, and behavior issues
• Weakened immune system
• Increased risk of work or car accidents
• Relationship conflicts
• Getting sick more often
• Higher risk for serious health problems, like heart disease
• Reduced stress and improved mood

Sleep disorders can cause problems for people with cancer. You may not be able to remember treatment instructions and may have trouble making decisions. Being well-rested can improve energy and help you cope with side effects of cancer and treatment. Sleep problems that go on for a long time may increase the risk of anxiety or depression^[6].

Sleep disorders cost more than 94 billion dollars per year in healthcare use^[7]. More than 50 million people in the United States have a sleep disorder. In addition, more than 100 million Americans of all ages report that they do not get an adequate amount of sleep^[1].