SLEEP DISORDERS 101
Before there can be any discussion about specific sleep disorders, it’s important to understand more generally the critical importance of sleep health for optimal health.
SLEEP IS NOT OPTIONAL. IT IS AS CRITICAL TO OPTIMAL HEALTH AS WATER, HEALTHY DIET, AND REGULAR EXERCISE.
If you are not getting enough sleep (between 7 and 9 hours every night for all adults), please talk to your doctor.
Insufficient sleep, restricted sleep and/or sleep deprivation—whether voluntary or involuntary, and whether it is caused by other sleep problems, other health problems, or lifestyle—is a major cause of public safety problems like vehicle accidents, physical accidents and falls, dangerous mistakes in judgment on the job and poor cognitive response in emergency situations.
Sleep deprivation also has a negative impact on many important executive functions such as learning, memory, and articulation. This can lead to:
- the dangerous miscommunication of critical information
- failure to perform in an academic setting
- an impaired ability to easily recall words, ideas, or important details necessary to the functional activities of daily living
- poor judgment and perception in interpersonal relations
- decreased memory and comprehension
Finally, sleep deprivation, if left untreated, sets up a physiological imbalance that endangers your health by making your body more prone to chronic health conditions such as:
- diabetes and insulin resistance
- Alzheimer’s disease and dementia
- all kinds of cardiovascular problems
- mood disorders and behavior problems such as ADHD
- stroke and hypertension
- metabolic disease and obesity
- immune system dysfunction
- chronic kidney disease
Please don’t ignore your sleep problems; doing so is a guarantee that both your quality of life and overall health will decline.
SLEEP DISORDERS 101
Sleep disorders fall into several broad categories, which are then broken into further subcategories to cover the entire spectrum.
The main categories include:
- Sleep Breathing Disorders
- Circadian Rhythm Disorders
- Movement Disorders
- Other Disorders and Behaviors
As much as 50 percent of the general population experiences regular bouts of insomnia. Having acute (occasional) insomnia is normal, but chronic (long-term) insomnia is dangerous for public safety and long-term health.
More specifically, insomnia describes trouble with:
- falling asleep (sleep onset insomnia)
- staying asleep (maintenance insomnia)
- awakening too early and being unable to fall back asleep (terminal insomnia)
What is “sleep state misperception?”
This is a common situation in which you may feel like you haven’t slept at all during the night, despite objective evidence to the contrary.
Many patients in sleep laboratory environments report not getting any sleep, though clinical measures of their sleep and wake stages during a test show hours of varied stages of sleep.
Treatments for insomnia include medications and Cognitive Behavioral Therapy for Insomnia (CBT-i).
Recently, professional sleep organizations have come out in force to support CBT-i as the first line of therapy for insomnia, as it has been shown to be at least as effective, if not more effective, in the long term than medications.
Pharmaceutical sleep aids are known to be habit-forming and pose multiple adverse side effects that make them less ideal options, especially since they are not meant to be used in the long term.
Sleep Breathing Disorders
These include many kinds of problems related to getting enough oxygen while sleeping at night, such as:
- Obstructive Sleep Apnea || OSA (a mechanical disorder of the upper airway)
- Central Sleep Apnea || CSA (central nervous system dysfunction related to sleep breathing disruptions)
- Upper Airway Resistance Syndrome || UARS (problems with breathing during sleep that are due to issues like crowded airways, allergies, deviated septums, swollen turbinates, etc.)
- Hypoventilation || Sleep-breathing problems caused by pre-existing respiratory issues such as chronic obstructive pulmonary disease [COPD], asthma, emphysema, chronic bronchitis, pneumothorax, or due to high altitude
- Neuromuscular disorders || Sleep-breathing problems caused by the body’s inability to breathe properly (scoliosis, multiple sclerosis, or myasthenia gravis)
- Snoring || Though more often thought of as a symptom, snoring can suggest undiagnosed and untreated OSA or UARS and may contribute to a bed partner’s sleep deprivation and sleep debt if not corrected due to the volume and frequency of the noise
Treatments for sleep-breathing disorders include positive airway pressure (PAP) therapies (CPAP, BiPAP, AutoPAP, ASV); maxillomandibular advancement devices (oral appliances); surgeries; positional therapy; and exercises to strengthen the tone of the upper airway.
Also known as hypersomnolence, hypersomnia is comprised of less common—though no less severe—primary sleep disorders which leave patients excessively sleepy during the daytime, often to the extent that they can no longer function normally. These disorders include:
- Idiopathic Hypersomnia || Ongoing extreme daytime sleepiness without an identifiable cause
- Narcolepsy with or without Cataplexy || A shortage or depletion of neutrotransmitters which modulate sleep-wake cycles, leading to extreme daytime sleepiness, nighttime sleeplessness, and sudden shifts from wake to sleep (cataplexy). Other identifying symptoms include sleep paralysis and pre- or post-sleep hallucinations.
- Klein-Levin Syndrome || “Sleeping Beauty syndrome” causes individuals to sleep for extreme lengths of time days, with short periods of wakefulness in between. An unusually large appetite and ramped up sex drive are other aspects of this rare sleep disorder.
Hypersomnia may also be a symptom secondary to many other health problems; it can, in fact, mimic other much more critical chronic illnesses.
Treatments for conditions of hypersomnia generally involve pharmaceutical therapies.
Circadian Rhythm Disorders
The human body, like all living things, matches (entrains) its biological rhythms to the rhythms of the earth, moon, and sun. Plants, animals, and humans all respond to daylight and evening in what is known as a circadian fashion. Disorders of these natural rhythms include:
- Jet Lag || Disrupted circadian rhythms due to crossing several time zones in a short period of time
- Shift Work Disorder || Disrupted circadian rhythms due to late night or overnight shift work
- Sleep phase disorders || Disrupted circadian rhythms due to an irresistible need to fall asleep earlier or later than normal, known as Advanced Sleep Phase Disorder (ASPD) and Delayed Sleep Phase Disorder (DSPD)
- Non-24-hour or Free-Running Sleep-Wake Disorder (in which sleep patterns do not hold to a regular cycle but constantly shift; this is typical mostly for the blind, but rarely also found in sighted people)
- Irregular Sleep-Wake Disorder (in which sleep patterns are completely chaotic and do not follow a recognizable pattern)
These are sleep behaviors that involve disorders of arousal—abnormal dreaming behavior or unusual perceptions or misperceptions that occur while falling asleep, while sleeping, during transitions between REM and nonREM sleep stages, or during arousal from sleep. They include:
- Confusional Arousals || Also known as sleep drunkenness, this is a sensation that occurs when someone is awoken at a transition period during sleep; their brain chemistry and neurological function becomes distorted by the disruption in the way that gives the appearance of being drunk
- Sleepwalking || Also known as somnambulism, this night movement can be dangerous if the sleepwalker is unusually mobile
- Night Terrors || Unlike nightmares, these terrifying occurrences are not memorable to those who have them and are considered harmless
- Nightmare Disorder || Extremely graphic and terrifying dreams, often as the result of unmitigated anxiety or substance withdrawal
- Post-Traumatic Sleep Disorder (not to be confused with post-traumatic stress disorder) || Problems with sleeping following the sustaining of a traumatic brain injury
- Sleep Sex Disorder || Also known as sexsomnia, people who have this disorder attempt sexual activities while fully asleep
- Sleep-related Eating Disorder || People who eat throughout the night while completely asleep (also considered an eating disorder)
- REM Behavior Disorder || A parasomnia in which people act out their dream activities in REM sleep (dream sleep)
- Recurrent Isolated Sleep Paralysis || An awareness of being awake but completely unable to move, due to a neurochemical imbalance in the sleep-wake function
- Sleep (or Nocturnal) Enuresis || Also known as bedwetting; in adults, it is usually caused by undiagnosed and untreated sleep apnea, while in children it marks problems with development
- Catathrenia || Unlike snoring, this is a form of noise made during sleep that resembles groaning
Treatments primarily involve medications or CBT-i, though in some cases, there’s no real treatment (such as for night terrors or catathrenia).
These include involuntary body movements that can make it difficult to stay asleep or to achieve deep sleep, including:
- Restless Leg Syndrome || People who experience this have extremely uncomfortable sensations in their legs prior to bedtime which prevent them from being able to fall asleep
- Periodic Limb Movement Disorder || People who experience this often do not realize they are rhythmically moving their feet, legs, hands, or arms as they sleep, but doing so interrupts the depth and quality of their sleep
- Nocturnal Leg Cramps || These painful muscular spasms (also known as charleyhorses) are often the result of another medical condition, a drug side effect or deficiency, and they can severely disrupt sleep
- Sleep-related Epilepsy || For some people with epilepsy, the only time they experience seizures is while they sleep
- Sleep Bruxism || The grinding of one’s teeth or clenching of the jaw while asleep, usually related to undiagnosed and untreated sleep apnea, but sometimes linked to anxiety
- Rhythmic Movements of Sleep || These most often occur in children who use head banging or rocking while asleep as ways to self soothe
Other Sleep Disorders or Behaviors
Some of the most common of these include “long sleeping” (someone who best functions on more than 8 hours a night), “short sleeping” (someone who best functions on less than 8 hours of sleep), hypnic jerks (suddenly awakening just as one falls asleep), sleeptalking, sleep-related seizures (not epileptic in nature), and environmentally related problems with sleep (i.e. poor sleep hygiene).
- Long and short sleepers generally adjust their lives according to their sleep schedules, whenever possible.
- There are no treatments for hypnic jerks or sleeptalking as they are considered harmless, unless tied to another identified illness (such as epilepsy or PTSD).
- Environmental concerns (light, noise, or air pollution) can often be improved with little money or resources to help improve sleep quality and overall wellness.