About Sleep Disorders

Overview

Sleep disorders are conditions that affect the quality, duration, or timing of sleep, which results in the inability to properly function while awake and daytime sleepiness. These disorders can undermine the quality of life and occur along with, or contribute to, other medical and mental health conditions such as anxiety, depression, or cognitive disorders. There are several different types of sleep disorders, some of which are insomnia (which is the most common), sleep apnea, narcolepsy, restless leg syndrome, and circadian rhythm disorders. 

The signs and symptoms of sleep disorders can include an irregular sleep and wake cycle with difficulty falling asleep or range from excessive daytime sleepiness, irregular breathing, and increased movement during sleep.

Nearly 71% of adults in the United Kingdom do not have the recommended seven to nine hours of sleep a night.¹ Sleep is a basic human need and is critical to maintaining both physical and mental health status. 

There are several ways to help diagnose sleep disorders and once diagnosed correctly, doctors are usually able to treat the condition effectively.

Types of sleep disorders

There are approximately 80 different types of sleep disorders², with the main ones being:

Insomnia

Insomnia involves having trouble getting to sleep or staying asleep. It may be categorised as acute (short-term) or chronic (long-term). If you suffer from acute insomnia, it can last days or weeks and is usually brought on by stressful or traumatic events. Chronic insomnia can last for a month or longer and can also be referred to as insomnia disorder. Insomnia may happen on its own, in which case it is the primary problem; however, secondary insomnia can also occur as a symptom of another condition or circumstance. 

Sleep apnea

Sleep apnea is a sleep disorder in which breathing repeatedly stops and starts while you are asleep - it can be potentially serious. If you suffer from this condition, you may snore loudly or wake up choking or gasping for air.

The main types of sleep apnea are:

• Obstructive sleep apnea (OSA) - This is the more common form that occurs when throat muscles relax and block airflow into the lungs.
• Central sleep apnea (CSA) - This will occur when the brain's signals to the muscles that control breathing aren’t successfully transmitted. 
• Treatment-emergent central sleep apnea - Which can also be referred to as complex sleep apnea, happens when someone suffers from OSA, which then converts to CSA when receiving therapy for OSA.³

Narcolepsy

Narcolepsy is a sleep disorder in which the brain is unable to regulate sleeping and waking patterns typically and can be split into two types. Type 1 is associated with cataplexy (sudden loss of muscle tone), and type 2 is without cataplexy. This disorder can severely impact your daily life and may be difficult to deal with emotionally, as it is a life-long condition for which there is no cure. If you find it hard to stay awake for long periods and find yourself falling asleep suddenly, you may suffer from narcolepsy. 

Restless leg syndrome

Restless leg syndrome (RLS) is when you experience crawling or tingling sensations, causing an irresistible and overwhelming urge to move your legs. It typically occurs in the evening or nighttime hours when you’re sitting or lying down. RLS is a common nervous system condition and can also be referred to as Willis-Ekbom disease. Restless leg syndrome isn’t life-threatening, but severe cases can disrupt sleeping (leading to insomnia) and trigger depression and anxiety. 

Circadian rhythm disorders

Circadian rhythm disorders are a group of sleep disorders that disrupt the timing of sleep. Circadian rhythm is the name of our body's 24-hour clock, which controls the sleep-wake pattern. Exposure to light, more specifically the type of light/brightness, amount of time exposed, and when, will help ‘set your internal 24-hour clock’. Circadian rhythm disorders involve having one of the following problems:

• Difficult time falling asleep
• Struggling to stay asleep and frequently waking up during the sleep cycle
• Waking up too early and having trouble getting back to sleep

Some of the main types of circadian rhythm disorders are:

• Delayed Sleep Phase Disorder
• Advanced Sleep Phase Disorder
• Jet Lag
• Shift Work Disorder
• Irregular sleep-wake rhythm
• Non-24-hour-sleep-wake syndrome

Causes and risk factors

Medical conditions

Chronic physical conditions, mental health disorders, and neurological disorders all have the potential to contribute to sleep disturbance. The stress associated with most of these illnesses can cause insomnia and daytime drowsiness.

Here are some chronic physical conditions that could be a cause of sleep disorders:

• Heartburn
• Diabetes
• Heart failure
• Musculoskeletal disorders
• Kidney disease
• Nocturia
• Thyroid disease
• Breathing problems⁴

There are also several mental health disorders associated with sleep problems:

• Anxiety
• Phobias and panic attacks
• Depression
• Bipolar disorder
• Schizophrenia⁴

Neurological disorders associated with increased risk of sleep disorders include:

• Dementia
• Epilepsy
• Headaches
• Parkinson’s Disease⁴

Medications

Many over-the-counter and prescription medications commonly used to treat sleep disorders can also impair sleep quality and quantity as a side effect. 

• Beta-blockers, used to treat conditions like high blood pressure, heart dysrhythmias, and angina can cause insomnia, nighttime awakenings, and night terrors. Some common examples are metoprolol (Lopressor) and pindolol (Visken)⁴
• Corticosteroids, used to treat inflammation and asthma, can cause daytime jitters, insomnia, and decreased rapid eye movement (REM) sleep. A common example would be prednisone (Sterapred, others)⁴
• Selective serotonin reuptake inhibitors (SSRIs), used to treat depression and anxiety, can cause decreased REM sleep and daytime fatigue. Some common examples are fluoxetine (Prozac) and paroxetine (Paxil)⁴

There are several other medications and drugs that can steal sleep or cause unwanted drowsiness; if you are experiencing these symptoms, your doctor may be able to suggest alternatives that do not disrupt sleep.

Substance abuse

If you have a substance use disorder (SUD) in which you abuse substances such as alcohol, cannabis, and illegal drugs (cocaine, heroin, and methamphetamines) you may be at risk of insomnia and other sleep disorders. This is because most substance use acutely disrupts the sleep-regulatory systems in the brain, affecting the time it takes to fall asleep, the duration, and sleep quality.⁵ 

Sleep environment

A relaxing sleep environment is crucial for a good night's sleep. Studies have proven that people who have optimised light, noise, temperature, and comfort levels in their bedroom simply sleep better.⁶ A disruptive sleep environment may lead to difficulty in achieving adequate sleep. 

Genetics

Research suggests you can be genetically predisposed to having insomnia; for example, it is estimated that heritability accounts for 31% to 58% of your likelihood of experiencing insomnia.⁷

Symptoms and diagnosis

While each of the different sleep disorders discussed has its own unique symptoms associated with it, some general symptoms linked to sleep disorders are:

• Being very sleepy during the day
• Having trouble falling asleep at night
• Falling whilst driving or other inappropriate times
• An abnormal breathing pattern
• An overwhelming urge to move whilst trying to get to sleep
• Having an irregular sleep-wake cycle
• Unusual or unwanted movements or experiences during sleep

In order to make a diagnosis, a doctor will use your medical history, sleep history, and physical exam. You may also have a sleep study (polysomnogram) performed by a sleep specialist, which monitors and records data about your body during a full night of sleep. The data includes:

• Brain wave activity
• Eye movements
• Breathing rate
• Blood pressure
• Heart rate and electrical activity of the heart and other muscles

Other types of sleep studies may check whether you can stay awake and alert during the day or how quickly you fall asleep during daytime naps.⁸

Treatment of sleep disorders

Behavioural therapy

Cognitive behavioural therapy (CBT) helps you develop habits that promote a healthy sleep pattern by changing your actions or thoughts that may keep you from sleeping well. CBT is most often used to treat insomnia.⁹

Medications

Numerous different sleeping pills can be prescribed to help you fall asleep more easily or help you stay asleep for longer. In an article, the Mayo Clinic discusses prescription sleep medicine options and how each of them helps in terms of bettering your sleep and whether or not they can lead to dependence. 

Medical devices

A continuous positive air pressure (CPAP) device is used to help those suffering from sleep apnea. The device can be fitted over your face while you sleep and it uses air pressure to push your tongue forward and open your throat. This helps prevent sleep disturbances and snoring.¹⁰

Other devices include: 

• BiPAP machine
• AutoPAP machine
• Oral appliances 

Surgery

Some sleep disorder treatment plans may involve surgery. They can include but aren't limited to:

• Uvulopalatopharyngoplasty (UPPP)
• Upper airway stimulation therapy
• Radiofrequency volumetric tissue reduction (RFVTR)
• Septoplasty and turbinate reduction
• Genioglossus advancement

Lifestyle changes

There are various steps you can take to change behaviours and lifestyles to help improve sleep quality.

Introduce a sleep schedule where you wake up at the same time each day. For most people, having a routine is one of the best things for your body to obtain a good sleep pattern.

Give yourself time to wind down before bedtime. Try to de-stress and put aside any concerns of the day before going to sleep to help you get into the right frame of mind.

Put devices down. The lights used in most devices have a way of tricking your brain into thinking it's not nighttime. They do this by disrupting the release of chemicals that tell your brain that it is.

Don't eat or drink right before bed, especially if they contain caffeine, nicotine, and alcohol.

Stay active - exercising regularly can help you get better quality sleep.

Get comfortable - set up your sleep environment accordingly - including temperature, sounds, and lighting.

Coping with sleep disorders

If you’re struggling with a sleep disorder, try carrying out some of the lifestyle changes discussed earlier. You should talk to your healthcare provider or a sleep specialist after making the relevant lifestyle changes if the disorder still affects your daily routine, tasks, and activities. 

Complications of sleep disorders

The sleep loss and poor sleep associated with a sleep disorder can potentially lead to deleterious health consequences. Research suggests that having less than 7 hours of sleep per night can have wide-ranging effects on the cardiovascular, immune, endocrine, and nervous systems, including the following:

• Anxiety and depression
• Obesity
• Diabetes
• Heart disease and hypertension
• Alcohol use¹¹

Prevention of sleep disorders

You should avoid the following to help prevent sleep disorders:

• Caffeinated drinks (like coffee) before bed
• Diet pills
• Decongestants 
• Antidepressants (only discontinue antidepressants with permission from your healthcare provider)
• Tobacco
• Alcohol²

Summary

Sleep disorders may not be life-threatening, but they can gravely affect your quality of life to a point where they can disrupt your thinking, weight, school/work performance, and mental and general physical health. Insomnia, sleep apnea, restless leg syndrome, narcolepsy, and circadian rhythm disorder prevent you from getting that long, deep sleep needed for you to function at your best. The most common symptoms associated with sleep disorders are daytime sleepiness, difficulty falling asleep, and an irregular sleep-wake pattern. Luckily, there are various treatments such as behavioural therapy, medications, and surgery - as well as lifestyle and behavioural changes that you can make to promote better sleep.