Sleeping Disorders: Symptoms, Causes & How To Get Relief

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Sleep-related difficulties affect many people. The medical science around sleep and sleep health has evolved over the past four decades, and more than 100 specific sleep disorders have been identified. Today’s medical scientists categorize these disorders based on causes, symptoms, physiological and psychological effects, among other criteria. In 1979, the American Sleep Disorders Association published the first classification system dedicated to sleep disorders. Despite the evolution, sleeping disorders tend to still be apparent from four commons symptoms:

You have trouble falling or remaining asleep
You find it difficult to stay awake during the day
There are imbalances in your circadian rhythm that interfere with a healthy sleep schedule
You are prone to unusual behaviors that disrupt your sleep

Insomnia

Insomnia is characterized by the recurring difficulty in falling or remaining asleep despite one's best efforts. It may also take the form of early morning awakening in which the individual awakens several hours early and is unable to resume sleeping. People with insomnia experience excessive daytime sleepiness and other cognitive impairments while awake. Insomnia is considered a chronic condition when patients experience symptoms at least three times-a-week for three months or more.

Based on recent statistics, up to one-third of adults live with some form of insomnia.

Sleep-onset insomnia occurs when people have difficulty falling asleep, even when they are tired.
Sleep maintenance insomnia refers to difficulty staying asleep during the night.
Mixed insomnia is a hybrid condition characterized by sleep-onset and sleep maintenance insomnia symptoms.
Chronic psychophysiological insomnia (or “learned” or “conditioned” insomnia) may result from a stressor combined with fear of being unable to sleep. Sufferers often sleep better when not in their own beds.

Before arriving at a diagnosis of primary insomnia, the doctor will rule out other potential causes, such as other sleep disorders, side effects of medications, substance abuse, depression, or other previously undetected illness.

Chronic insomnia is most commonly treated with a combination of sedative-hypnotic or sedating antidepressant medications, along with behavioral techniques to promote regular sleep and good sleep hygiene.

Sleep Apnea

Like other sleep disorders, sleep apnea can cause excessive daytime sleepiness and fatigue, and, worse, a steady increase of cognitive impairments. Most sleep apnea cases fall into one of the following two categories.

Obstructive sleep apnea (OSA) is caused by a physical obstruction that blocks the upper airway. This obstruction may be attributed to large tonsils or adenoids, fluid buildup from advanced heart or kidney failure, or genetic syndromes that affect facial structure such as cleft palate. Obese people with fat deposits around their neck are also at higher risk of OSA, and back sleeping can lead to apnea episodes if the tongue falls back into the throat. For many patients, continuous positive air pressure (CPAP) therapy is the most effective treatment

Frequent symptoms of obstructive sleep apnea include:
- Excessive daytime sleepiness
- Loud snoring that is often punctuated by gasping or choking sounds
- Headaches in the morning that may persist for several hours after waking up
- Dry mouth upon awakening
- Restless sleep with periods of wakefulness during the night
- Increased need to get up from bed to urinate
- Irritability or frustration
- Reduced focus
Central sleep apnea (CSA) occurs when the brain stops sending signals to the muscles that control breathing, leading to choking episodes during the night. As with OSA, obesity is a common risk factor for CSA. The condition may also affect people who have experienced a stroke, brain infection, and other medical problems with the brain stem, as well as those who take narcotic painkillers and other sleep-inducing medications. CPAP therapy is often prescribed for CSA, though some patients find bi-level positive air pressure (BiPAP) therapy more effective.

The symptoms that are most often associated with central sleep apnea include:
- Abnormal breathing patterns, such as breathing that slows down, speeds up, and pauses during sleep
- Excessive daytime sleepiness
- Nighttime awakenings
- Sudden shortness of breath or chest pains at night
- Difficulty focusing
- Morning headaches

Treatment of sleep apnea is dependent on its cause. If other medical problems are present, such as congestive heart failure or nasal obstruction, sleep apnea may resolve with the treatment of these conditions. Gentle air pressure administered during sleep (typically in the form of a nasal continuous positive airway pressure device) may also be effective in the treatment of sleep apnea. As interruption of regular breathing or obstruction of the airway during sleep can pose serious health complications, symptoms of sleep apnea should be taken seriously. Diagnosis and treatment should be sought from your doctor.

Narcolepsy

Excessive daytime sleepiness (including episodes of irresistible sleepiness) combined with sudden muscle weakness are the hallmark signs of narcolepsy. The sudden muscle weakness seen in narcolepsy may be elicited by strong emotion or surprise. Episodes of narcolepsy have been described as “sleep attacks” and may occur in unusual circumstances, such as walking and other forms of physical activity. A physician may treat narcolepsy with stimulant medications combined with behavioral interventions, such as regularly scheduled naps, to minimize the potential disruptiveness of narcolepsy in the individual’s life.

Restless Legs Syndrome (RLS)

RLS is characterized by an unpleasant “creeping” sensation, often feeling like it originates in the lower legs, but is often associated with aches and pains throughout the legs. This often causes difficulty initiating sleep and is relieved by movement of the leg, such as walking or kicking. Abnormalities in the neurotransmitter dopamine have often been associated with RLS. Doctors often combine a medication to help correct the underlying dopamine abnormality along with a medicine to promote sleep continuity in the treatment of RLS.

Excessive Sleepiness

EDS is defined by feelings of intense grogginess during the day that can compel people to sleep at inopportune times. People who feel excessively groggy during the day may also be more prone to errors and accidents. A wide range of medical and psychological conditions can lead to EDS, such as diabetes, hypothyroidism, chronic pain, depression, and anxiety. Other causes include certain sleep disorders like sleep apnea and periodic limb movement disorder. EDS is believed to affect up to 18% of the population.

Parasomnias

Parasomnias are a group of unusual sleep behaviors that can occur before falling asleep, during sleep, or in the time between sleep and wakefulness. These are more commonly found in children, but some adults may experience them as well. These include sleepwalking, paralysis, bedwetting, night terrors, and more unique ones like exploding head syndrome. Parasomnias are broken down into three categories: NREM-related parasomnias, REM-related parasomnias, and others.

Non-24-Hour Sleep Wake Disorder

For most adults, the circadian rhythms that guide their sleep-wake cycle and other bodily processes will reset every 24 hours. The condition known as non-24-hours sleep-wake disorder occurs when someone’s circadian cycle exceeds the 24-hour mark. These individuals often experience delays of one to two hours in their sleep-onset and waking times. This disorder primarily affects those who are totally blind and people with dementia.

Author

Dr. Mark L. Meyer Dr. Meyer graduated from Haverford College with a Bachelor of Science, High Honors, in cellular and molecular biology, Phi Beta Kappa, Magna Cum Laude. He attended the Yale University School of Medicine, where he also completed a categorical residency in Internal Medicine, served for one year as an Emergency Department attending physician, and held the title of Clinical Instructor in the Department of Surgery. During this time, Dr. Meyer obtained a J.D. from the Yale Law School, concentrating on medical ethics, scientific research law, and FDA law. He then completed a fellowship in Cardiovascular Diseases at the Hospital of the University of Pennsylvania, where he obtained Level 3 Nuclear Cardiology training.