Sleep Disorders

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 sleep disorders that impact:

• How well you sleep (quality)
• When you fall asleep and if you can stay asleep (timing)
• How much sleep and wakefulness you get (quantity or duration)

Everyone can experience problems with sleep from time to time. But you might have a sleep disorder if:

• You regularly have trouble sleeping.
• You feel tired during the day even though you slept for at least seven hours the night before.
• It becomes difficult to perform regular daytime activities.

What are the major categories of sleep disorders?

The categories of sleep disorders have changed many times over the years. Most recently, the International Classification of Sleep Disorders (ICSD) categorized sleep disorders based on the symptoms, how they affect a person (pathophysiology) and the body system it affects. The brand-new revision to the third edition, ICSD-3R includes the following categories:

• Insomnia: You have difficulty falling and staying asleep.
• Sleep-related breathing disorders: Your breathing changes while you sleep.
• Central disorders of hypersomnolence: You have trouble feeling alert during the day.
• Circadian rhythm sleep-wake disorders: Your internal clock makes it difficult to fall asleep and wake up on time.
• Parasomnias: Physical actions or verbal expressions happen during sleep like walking, talking or eating.
• Sleep-related movement disorders: Physical movements or the urge to move makes it difficult to fall asleep and/or stay asleep.

The ICSD updates regularly to include the most recent information about sleep disorders and the types that fall under these categories.

What are the types of sleep disorders?

There are over 80 different types of sleep disorders. The most common include:

• Chronic insomnia: You have trouble falling asleep or staying asleep most nights for at least three months and feel tired or irritable as a result.
• Obstructive sleep apnea: You snore and have moments during sleep when you stop breathing that disrupt your sleep.
• Restless legs syndrome: You have the urge to move your legs when you rest.
• Narcolepsy: You can’t regulate when you fall asleep or how long you stay awake.
• Shift work sleep disorder: You have trouble falling asleep and staying asleep and feel sleepiness at unwanted times due to your work schedule.
• Delayed sleep phase syndrome: You fall asleep at least two hours after your desired bedtime and have difficulty waking up in time for school or work.
• REM sleep behavior disorder: You act out your dreams while in the rapid eye movement (REM) stage of sleep.

How much sleep do I need?

Everyone needs sleep. It’s 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. Optimal sleep time varies by age; for example, children and teenagers may need more sleep than adults.

How common are sleep disorders?

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 don’t get an adequate amount of sleep.

What are the symptoms of sleep disorders?

Symptoms of common sleep disorders vary based on the type, but could include:

• Difficulty falling asleep or it takes more than 30 minutes to fall asleep regularly.
• Trouble staying asleep through the night or you wake up often in the middle of the night and can’t fall back asleep.
• Snoring, gasping or choking happens during sleep.
• Feeling like you need to move when you relax. Movement relieves this feeling.
• Feeling like you can’t move when you wake up.

During the daytime, you may experience additional signs and symptoms caused by a lack of adequate sleep, including:

• Daytime sleepiness, taking frequent daytime naps or falling asleep while doing routine tasks
• Behavioral changes like difficulty focusing or paying attention
• Mood changes like irritability and trouble managing your emotions
• Difficulty meeting deadlines or performance expectations during school or work
• Frequent accidents or falls

If you feel like you’re not able to get a good night’s rest or have symptoms that interfere with your daytime activities, talk to a healthcare provider.

What causes sleep disorders?

A disruption to your body’s cycle of sleep and daytime wakefulness causes sleep disorders. Specific things may cause this to happen, and it varies based on the type of sleep disorder you have. They may include:

• A symptom of a medical condition like heart disease, asthma, pain or a nerve condition.
• A symptom of a mental health condition like depression or anxiety disorder.
• Genetic factors (a mutation).
• A side effect of a medication.
• Working the night shift.
• Substance use before bedtime like caffeine or alcohol.
• Low levels of certain chemicals or minerals in the brain.
• An unknown cause.

What are the risk factors for sleep disorders?

You may be more at risk of sleep disorders if you:

• Have an underlying health condition.
• Experience stress.
• Work late shifts.
• Have a history of sleep disorders in your biological family.

Research suggests that women and people assigned female at birth are more likely to experience sleep disorders than men and people assigned male at birth.

In addition, about half of all adults over the age of 65 have a type of sleep disorder.

What happens if I don’t get enough sleep?

If you don’t get the proper amount or quality of sleep that your body needs, it can affect you beyond feeling tired during the daytime. A lack of adequate sleep can lead to:

• Difficulty learning, remembering or making decisions
• Personality changes like irritability
• Lower reaction times (making accidents more likely to happen)

Sleep loss can also contribute to the development of health conditions like:

• Depression
• Obesity
• Type 2 diabetes
• Heart disease
• Dementia

While rare, some sleep disorders can be life-threatening.

How are sleep disorders diagnosed?

A healthcare provider will diagnose a sleep disorder after a physical exam to review your symptoms and testing. Tests can help your healthcare provider learn more about what’s causing your symptoms like blood tests or imaging tests.

They may ask you to keep a sleep diary. A sleep diary is a record of your sleeping habits. You’ll make note of when you go to bed, when you fall asleep and when you wake up each day. You should also make note of any naps you take during the daytime and how you feel before and after sleeping.

It helps to keep a pen and piece of paper near your bed so you don’t forget to write these items down. It can be difficult to know what time you fall asleep exactly, so you should estimate what that time is. You might choose to wear a smartwatch or a device (actigraph) that records your cycles of rest and activity. This can confirm what time you fell asleep and woke up.

Your primary care provider may recommend you visit a sleep specialist who’ll perform a sleep study (polysomnogram). A sleep study is a sleep disorder test that electronically transmits and records specific body and brain activities while you sleep. A healthcare provider will analyze the sleep study data to determine whether or not you have a sleep disorder.

What questions will my healthcare provider ask me during an exam for sleep disorders?

To learn more about concerns you have about your sleep patterns, a healthcare provider may ask the following questions during an exam:

• How many hours do you sleep at night?
• Do you toss and turn in your sleep?
• Do you take naps?
• How long does it take you to fall asleep?
• Do you wake up in the middle of the night?
• Do you work the night shift?
• How sleepy do you feel during the day?
• Do you snore?

Do I need to see a sleep specialist?

Your healthcare provider may refer you to a sleep specialist if they suspect you have a sleep disorder. A sleep specialist is a highly trained healthcare provider who specializes in how sleep affects your body.

How are sleep disorders treated?

There are several types of treatment options available for various sleep disorders, which could include:

• Changing your sleeping routine to promote a regular sleep schedule and proper sleep hygiene.
• Undergoing cognitive behavioral therapy.
• Taking medications (like sleeping pills or alerting agents) or supplements (like melatonin).
• Changing medications or dosages that cause excessive sleepiness (don’t stop taking a medication unless your healthcare provider approves it).
• Using a CPAP (continuous positive airway pressure) machine or having a neurostimulator implanted to control sleep apnea.
• Using light therapy.

Your healthcare provider will recommend treatments based on your situation. They’ll also discuss any side effects to look out for before you begin treatment.

What medications treat sleep disorders?

Your healthcare provider may recommend some of the following medications and supplements to treat common sleep disorders:

• Insomnia: Sleep aids, including melatonin, zolpidem, zaleplon, eszopiclone, ramelteon, suvorexant, lemborexant or doxepin
• Restless legs syndrome: Medication like gabapentin, gabapentin enacarbil or pregabalin
• Narcolepsy: Stimulants or wake-promoting medications, such as modafinil, armodafinil, pitolisant, mixed salt or sodium oxybate, and solriamfetol

How do I get better sleep?

A healthcare provider may recommend you make changes to your sleep hygiene so you can sleep better. Sleep hygiene includes making changes to your sleeping routine to create an optimal sleeping environment. You can get better sleep by:

• Creating a comfortable sleep environment: Make sure your bedroom is cool, quiet and dark. If noise keeps you awake, try using background sounds like “white noise” or earplugs. If light interferes with your sleep, try a sleep mask or blackout curtains.
• Minimizing stress: Try to reduce how much stress you feel before going to bed. You may choose to write things down like making a to-do list earlier in the evening. This is helpful if you tend to worry and think too much in bed at night. It also helps to stay positive rather than going to bed with a negative mindset, such as, “If I don't get enough sleep tonight, how will I ever get through the day tomorrow?”
• Avoid using your bed for anything other than sleep and intimate relations: Don’t watch television or videos on your phone, eat or work in your bedroom.
• Establishing a regular bedtime routine: Each night, create habits before you go to bed like taking a warm bath, listening to soothing music or reading. Try relaxation exercises or meditation. Wake up at the same time each morning, including days off and vacations.
• Not watching the clock: Turn the clock around or turn your phone screen-side down and use only the alarm for waking up. Leave your bedroom if you can’t fall asleep in 20 minutes. Read or engage in a relaxing activity in another room that doesn’t involve screen time
• Exercising regularly: Exercising is great to promote positive sleep, but don’t exercise within four hours of bedtime if you have trouble sleeping. Avoid strenuous exercises before you sleep.

Can sleep disorders be prevented?

You can’t prevent all types of sleep disorders, but you can reduce your risk by practicing good sleeping habits (sleep hygiene).

What should I avoid to get better sleep?

You should avoid the following three to four hours before bedtime if you want to improve your sleep:

• Caffeinated drinks such as soda, tea and coffee
• Tobacco
• Alcohol
• Naps after 3 p.m.
• Chocolate
• Heavy meals

What can I expect if I have a sleep disorder?

Sleep disorders can affect your overall health. You may not have the energy to do the things you want to do or even complete your daily routine. You may miss out on special moments or events because your sleep disorder prevents you from being fully present. In addition, you may put yourself and others at risk, especially if you drive or operate heavy machinery and aren’t getting the rest you need to stay safe.

If you’re struggling to get quality sleep where you wake up feeling refreshed, talk to a healthcare provider. Treatment is available to manage many sleep disorders and get you back to wellness.

How long do sleep disorders last?

There isn’t a specific time limit as to when a sleep disorder will stop affecting you. You may be able to find a treatment that makes you feel better within weeks to months. Others may need to manage the condition throughout their lifetime. Talk to your healthcare provider about your specific outlook.

When should I see a healthcare provider?

Talk to a healthcare provider if you’re having trouble with sleep and wakefulness. This could be falling asleep, staying asleep or awake, getting restful sleep or unexplained daytime sleepiness or tiredness.

What questions should I ask my healthcare provider?

• What kind of sleep disorder do I have?
• How severe is my sleep disorder?
• What type of treatment do you recommend?
• Are there side effects of the treatment?
• How can I improve my sleep hygiene?
• Should I see a sleep specialist?
• Do I need a referral to see a specialist?
• Do you recommend any medications to help with my sleep disorder?
• How often should I return to see you?
• Are there medicines I should stop taking?