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Sleep disorders Definition:Sleep disorders involve any difficulties related to sleeping, including difficulty falling or staying asleep, falling asleep at inappropriate times, excessive total sleep time, or abnormal behaviors associated with sleep.
Causes, incidence, and risk factors:More than 100 different disorders of sleeping and waking have been identified. They can be grouped in four main categories:
PROBLEMS WITH STAYING AND FALLING ASLEEP Insomnia includes any combination of difficulty with falling asleep, staying asleep, intermittent wakefulness and early-morning awakening. Episodes may be transient, short term (lasting as long as 2 to 3 weeks), or chronic. Common factors associated with insomnia include:
Disorders include:
PROBLEMS WITH STAYING AWAKE Disorders of excessive sleepiness are called hypersomnias. These include:
Sleep apnea more commonly affects obese people, but it may affect anyone with a short neck or a small jaw, regardless of weight. The disorder causes breathing to stop intermittently during sleep, resulting in the person being awakened repeatedly. People with sleep apnea often they have difficulty achieving prolonged deep sleep. This results in excessive daytime sleepiness. Narcolepsy is a condition of daytime sleep attacks as well as other features that may include sleep paralysis and hypnagogic hallucinations. Sleep attacks occur despite adequate sleep at night. A person with narcolepsy may suddenly fall asleep in any situation, without warning. Restless leg syndrome is a condition of periodic lower-leg movements during sleep with associated insomnia or daytime sleepiness. PROBLEMS WITH ADHERING TO A REGULAR SLEEP SCHEDULE Problems may also occur with maintaining a consistent sleep and wake schedule as a result of disruptions of normal times of sleeping and wakefulness. This occurs when traveling between times zones and with shift workers on rotating schedules, particularly nighttime workers. These disorders include:
SLEEP-DISRUPTIVE BEHAVIORS Abnormal behaviors during sleep are called parasomnias and are fairly common in children. They include:
Sleep terror disorder is an abrupt awakening from sleep with fear, sweating, rapid heart rate, and confusion. Sleepwalking is usually not remembered by the person doing it and usually affects children 2 to 12 years old. In adults, sleepwalking may also be caused by an organic brain syndrome, reactions to drugs, psychological disorders, and certain medical conditions. Symptoms:
Note: The symptoms may vary with the particular disorder.
Signs and tests:Multiple sleep latency test Polysomnography (recording brain activity, muscle activity and breathing during sleep)
Treatment:INSOMNIA The treatment is related to the cause, if the cause can be determined. If there is an obvious physical or psychological disorder causing insomnia, it should be treated. Depression is a very common cause of insomnia and can usually be treated with medication, cognitive/behavioral therapy, or interpersonal therapy. Attempts to control environmental and lifestyle factors such as too much light, noise, caffeine or other stimulants or erratic hours of wakefulness should be made. Sleeping drugs should be used only when prescribed by a health care provider.
HYPERSOMNIA Sleep apnea is treated with weight reduction and the administration of air under pressure through the nose. Occasionally, surgery or other measures may be needed. Narcolepsy is treated by use of stimulating medications during the daytime. A new medication called modafanil seems to have fewer side effects than traditional stimulants; it is FDA-approved for narcolepsy and may soon be approved for shift work sleep disorder. Restless leg syndrome is treated by treating the underlying disorder and with opiate or dopaminergic agonists.
PARASOMNIA Night terrors are treated with hypnosis, guided imagery techniques and benzodiazepines, but safety measures may be needed to prevent people from harm during nighttime walking. Sleep disorder clinics often are able to help people restore normal sleeping patterns through various techniques.
Expectations (prognosis):The outcome varies with the type of disorder. Some disorders may clear up on their own.
Complications:A complication is dependence upon sedatives or other medications prescribed for sleep disorders.
Calling your health care provider:Call for an appointment with your health care provider if lack of sleep or too much sleep is interfering with daily living. Also call if breath-holding spells are observed during sleep. Prevention:Maintaining regular sleep habits and a quiet sleep environment may prevent some sleep disorders.
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Problems with staying and falling asleep 