Sleep disorders get in the way of being truly rested and affect how awake you feel by causing interruption in your sleep cycle. Untreated it can lead to a serious toll on your mental and physical health, including your mood, energy, and ability to handle stress.
If the challenges of a sleep disorder are leaving you fatigued, irritable, and struggling with daily tasks, reaching out to professionals is a meaningful step towards improving your quality of life. With personalized strategies and continued support, you can address the root causes, and achieve restful and rejuvenating sleep for a healthier, more balanced life.
Sleep is as essential to our survival as freshwater is to a buffalo. In that certain biological constraints like not having enough sweat glands to cool oneself become mere inconveniences owing to an abundance of water in the vicinity.
For us the inconvenience is simply lying still for a number of hours while the sun visits the other half of the planet, but once you understand our biological constraint gives us the chance to rest and restore energy for the following day, it’ll seem like not much of an inconvenience at all.
You may still be tempted to think that not much is actually happening while you sleep. In fact most people often think that sleep is just “down time,” when a tired brain gets to rest, says Dr. Maiken Nedergaard, who studies sleep at the University of Rochester.
“But that’s wrong,” she says. While you sleep, your brain is working. For example, sleep helps prepare your brain to learn, remember, and create.
Nedergaard and her colleagues discovered that the brain has a drainage system that removes toxins during sleep. “When we sleep, the brain totally changes function,” she explains. “It becomes almost like a kidney, removing waste from the system.”
Her team found in mice that the drainage system removes some of the proteins linked with Alzheimer’s disease. These toxins were removed twice as fast from the brain during sleep.
Everything from blood vessels to the immune system uses sleep as a time for repair, says Dr. Kenneth Wright, Jr., a sleep researcher at the University of Colorado.
“There are certain repair processes that occur in the body mostly, or most effectively, during sleep,” he explains. “If you don’t get enough sleep, those processes are going to be disturbed.”
To put it simply, a good night’s sleep can help you cope with stress, solve problems or recover from illness. Conversely, NOT getting enough sleep can lead to many health concerns which range from heart disease and stroke to obesity and dementia, while also affecting how you think and feel.
Sleep disorders are what happens when poor sleep patterns accumulate like a bad debt. Sleep disorders (or sleep-wake disorders) involve problems with the quality, timing, and amount of sleep, which result in daytime distress and impairment in functioning.
Everyone experiences occasional sleeping problems, so how can you tell whether your difficulty is just a minor, passing annoyance or a sign of a more serious sleep disorder or underlying medical condition?
Start by scrutinising your symptoms, looking especially for the telltale daytime signs of sleep deprivation. You’re likely facing a sleep disorder if you:
The more you answer “yes”, the more likely it is that you have a sleep disorder.
Sleep-wake disorders often occur along with medical conditions or other mental health conditions, such as depression, anxiety, or cognitive disorders. Sleep disturbances can also be a warning sign for medical and neurological problems, such as congestive heart failure, osteoarthritis and Parkinson’s disease. But research suggests that sleep disorders can develop out of the following causes:
Furthermore, allergies, colds, and upper respiratory infections can make it challenging to breathe at night. The inability to breathe through your nose can also cause sleeping difficulties.
Frequent urination: Nocturia, or frequent urination, may disrupt your sleep by causing you to wake up during the night. Hormonal imbalances and diseases of the urinary tract may contribute to the development of this condition.
Chronic pain: Constant pain can make it difficult to fall asleep. It might even wake you up after you fall asleep. Some of the most common causes of chronic pain include:
In some cases, chronic pain may even be exacerbated by sleep disorders. For instance, doctors believe the development of fibromyalgia might be linked to sleeping problems.
Stress and anxiety: Stress and anxiety often have a negative impact on sleep quality. It can be difficult for you to fall asleep or to stay asleep. Nightmares, sleep talking, or sleepwalking may also disrupt your sleep.
Although causes might differ, the end result of all sleep disorders is that the body's natural cycle of slumber and daytime wakefulness is disrupted or exaggerated.
There’s more to good sleep than just the hours spent in bed, says Dr. Marishka Brown, a sleep expert at NIH. “Healthy sleep encompasses three major things,” she explains. “One is how much sleep you get. Another is sleep quality—that you get uninterrupted and refreshing sleep. The last is a consistent sleep schedule.”
Insomnia is the most common sleep disorder. It involves problems getting to sleep or staying asleep. About one-third of adults report some insomnia symptoms, 10-15 percent report problems with functioning during the daytime and 6-10 percent have symptoms severe enough to meet criteria for insomnia disorder. An estimated 40-50 percent of individuals with insomnia also have another mental disorder.
Insomnia varies in how long it lasts and how often it occurs. It can be short-term (acute or adjustment insomnia) or can last a long time (chronic insomnia). It can also come and go, with periods of time when a person has no sleep problems. Acute or adjustment insomnia can last from one night to a few weeks. Insomnia is called chronic when a person has insomnia at least three nights a week for a month or longer.
Short-term or acute insomnia can be caused by life stresses (such as job loss or change, death of a loved one, or moving), an illness, or environmental factors such as light, noise, or extreme temperatures.
Long-term or chronic insomnia can be caused by factors such as depression, chronic stress and pain or discomfort at night.
In a condition called primary insomnia, where no clear environmental, psychiatric, or medical cause can be identified, experts suspect that individual differences in brain function may result in an overactive alerting signal that continues long after an individual would like to fall asleep.
In order to be diagnosed with insomnia disorder, the sleep difficulties must occur at least three nights a week for at least three months and cause significant distress or problems at work, school or other important areas of a person's daily functioning. Not all individuals with sleep disturbances are distressed or have problems functioning.
To diagnose insomnia, a physician will rule out other sleep disorders, medication side-effects, substance misuse, depression and other physical and mental illnesses. Some medications and medical conditions can affect sleep.
A comprehensive assessment for insomnia or other sleep problems may involve a patient history, a physical exam, a sleep diary and clinical testing (a sleep study). A sleep study allows the physician to identify how long and how well you’re sleeping and to detect specific sleep problems. A sleep diary is a record of your sleep habits to discuss with your physician. It includes information such as when you go to bed, get to sleep, wake up, get out of bed, take naps, exercise, eat and consume alcohol and caffeinated beverages.
Sleep problems can occur at any age but most commonly start in young adulthood. The type of insomnia often varies with age. Problems getting to sleep are more common among young adults. Problems staying asleep are more common among middle-age and older adults.
It is not unusual for people to have days when they struggle to stay awake. However, suddenly falling asleep on the job or while driving is not normal—and can be extremely dangerous. Excessive daytime sleepiness (EDS) is a symptom that can be seen in several sleep disorders, including obstructive sleep apnea, narcolepsy, and periodic limb movement disorder.
Sleep apnea is a potentially serious sleep disorder that occurs when a person's breathing is interrupted during sleep. People with untreated sleep apnea stop breathing repeatedly during their sleep.
Sleep apnea affects an estimated 2 to 15 percent of middle-age adults and more than 20 percent of older adults. Major risk factors for sleep apnea are obesity, male gender and family history of sleep apnea.
Sleep apnea is diagnosed with a clinical sleep study. The sleep study (polysomnography) involves monitoring the number of obstructive apneas (absence of airflow) or hypopneas (reduction in airflow) during sleep.
People with sleep-related hypoventilation have episodes of shallow breathing, elevated blood carbon dioxide levels, and low oxygen levels during sleep. It frequently occurs along with medical conditions, such as chronic obstructive pulmonary disease (COPD), or medication or substance use. Those with sleep-related hypoventilation often have trouble with insomnia or excessive daytime sleepiness. Risk factors for sleep-related hypoventilation include medical conditions, such as obesity and hypothyroidism, and use of certain medications, such as benzodiazepines and opiates.
Affecting approximately one in two thousand people, narcolepsy is a central nervous system disorder in which the brain cannot properly regulate cycles of sleep and wakefulness.
People with narcolepsy experience excessive daytime sleepiness and intermittent, uncontrollable episodes of falling asleep during the daytime. These sudden sleep attacks may occur during any type of activity at any time of the day. Some patients with narcolepsy experience sudden muscle weakness with laughter or other emotions.
Narcolepsy usually begins between the ages of 15 and 25, but it can become apparent at any age. In many cases, narcolepsy is undiagnosed and, therefore, untreated.
Narcolepsy nearly always results from the loss of hypothalamic hypocretin (orexin)-producing cells. This deficiency in hypocretin can be tested through cerebrospinal fluid via a lumbar puncture (spinal tap). Narcolepsy is rare, affecting and estimated 0.02%–0.04% of the general population. It typically begins in childhood, adolescence or young adulthood.
The diagnosis of narcolepsy sometimes requires daytime sleep testing as well as an overnight sleep study. While there is no cure, narcolepsy can be treated with stimulants to reduce daytime sleepiness and antidepressants and other medications to prevent cataplexy, sleep paralysis, and hypnagogic hallucinations. Scheduling daytime naps at convenient times may help to overcome the problems caused by unscheduled "sleep attacks."
Periodic Limb Movements of Sleep (PLMS) is a condition affecting approximately 34 percent of adults over the age of 60. This condition causes involuntary kicking and jerking movements of the legs and arms, often repeated hundreds of times during the night. Like people with sleep apnea, people with PLMS are usually unaware of their multiple nighttime awakenings unless they are witnessed by a bed partner. In extreme cases, these brief arousals following the leg movements disturb sleep so much that they cause excessive daytime sleepiness. In that situation, this is called periodic limb movement disorder (PLMD) and treatment may help with the symptoms of EDS. Patients with restless legs syndrome (an uncomfortable urge to move the legs) often have periodic limb movements during sleep.
PLMD is typically treated using medications that have been shown to be useful in treating the movement disorder Parkinson’s disease. In some cases, sleeping pills may be used to prevent arousals caused by limb movements.
Restless legs syndrome (RLS) is a sleep disorder that causes an intense, often irresistible urge to move the legs. This sensation is brought on by resting such as lying down in bed, sitting for prolonged periods such as while driving or at a theatre.
The symptoms occur at least three times per week, continue for at least three months, and cause significant distress or problems in daily functioning. Restless legs syndrome typically begins in a person’s teens or twenties and it affects an estimated 2% to 7.2% of the population.
RLS typically occurs in the evening, making it difficult to fall asleep and stay asleep. It can be associated with problems with daytime sleepiness, irritability and concentration. Often, people with RLS want to walk around and shake their legs to help relieve the uncomfortable sensation.
Other conditions that can cause EDS include advanced or delayed sleep phase syndromes, which result from abnormal time alignments between the preferred sleep-wake schedule and the phase of the internal clock. There are also numerous medical conditions, such as neuromuscular disorders, that can cause sleep to be fragmented and cause EDS.
We all have an internal biological clock that regulates our 24-hour sleep-wake cycle, also known as our circadian rhythms. Light is the primary cue that influences circadian rhythms. At night, when there is less light, your brain triggers the release of melatonin, a hormone that makes you sleepy. When the sun comes up in the morning, the brain tells the body that it's time to wake up.
When your circadian rhythms are disrupted or thrown off, you may feel groggy, disoriented, and sleepy at inconvenient times. Circadian rhythms have been linked to a variety of sleeping problems and sleep disorders, as well as depression, bipolar disorder, and seasonal affective disorder (the winter blues)
Delayed sleep phase disorder is a condition where your biological clock is significantly delayed. As a result, you go to sleep and wake up much later than other people. This is more than just a preference for staying up late or being a night owl, but rather a disorder that makes it difficult for you to keep normal hours—to make it to morning classes, get the kids to school on time, or keep a 9-to-5 job.
People with delayed sleep phase disorder are unable to get to sleep earlier than 2 to 6 a.m., no matter how hard they try.
When allowed to keep their own hours (such as during a school break or vacation), they fall into a regular sleep schedule.
Delayed sleep phase disorder is most common in teenagers, and many teens will eventually grow out of it.
For those who continue to struggle with a biological clock that is out of sync, treatments such as light therapy and chronotherapy can help. To learn more, schedule an appointment with your doctor or a local sleep clinic.
Shift work sleep disorder occurs when your work schedule and your biological clock are out of sync. In our 24-hour society, many people have to work night shifts, early morning shifts, or rotating shifts. These schedules force you to work when your body is telling you to go to sleep, and sleep when your body is signalling you to wake.
While some people adjust better than others to the demands of shift work, most shift workers get less quality sleep than their daytime counterparts. As a result of sleep deprivation, you may struggle with sleepiness and mental lethargy on the job. This cuts into your productivity and puts you at risk of injury.
Jet lag is a temporary disruption in circadian rhythms that occurs when you travel across time zones. Symptoms include daytime sleepiness, fatigue, headaches, stomach problems, and insomnia. Symptoms are more pronounced the longer the flight and flying east tends to cause worse jet lag than flying west.
In general, it usually takes one day per time zone crossed to adjust to the local time. So, if you flew from Los Angeles to New York, crossing three time zones, your jet lag should be gone within three days.
Non-rapid eye movement (NREM) sleep arousal disorders involve episodes of incomplete awakening from sleep, usually occurring during the first third of a major sleep episode, and are accompanied by either sleepwalking or sleep terrors. The episodes cause significant distress or problems functioning. NREM sleep arousal disorders are most common among children and become less common with increasing age.
Sleepwalking involves repeated episodes of rising from bed and walking around during sleep. While sleepwalking, the individual has a blank, staring face; is relatively unresponsive to others; and is difficult to wake up. Nearly 30% of people have experienced sleepwalking at some time in their lives. Sleepwalking disorder, with repeated episodes and distress or problems functioning, affects an estimated 1% to 5% of people.
Rapid eye movement (REM) sleep behaviour disorder involves episodes of arousal during sleep associated with speaking and/or movement. The person’s actions are often responses to events in the dream, such as being attacked or trying to escape a threatening situation. Speech is often loud, emotion-filled, and profane. These behaviours may be a significant problem for the individual and their bed partner and may result in significant injury (such as falling, jumping, or flying out of bed; running, hitting, or kicking). Upon awakening, the person is immediately alert and can often recall the dream.
These behaviours arise during REM sleep and usually occur more than 90 minutes after falling asleep. The behaviours cause significant distress and problems functioning and may include injury to self or the bed partner. Embarrassment about the episodes can cause problems in social relationships and can lead to social isolation or work-related problems.
The prevalence of REM sleep behaviour disorder is less than 1% in the general population and it overwhelmingly affects males older than 50.
Nightmare disorder involves repeated occurrences of lengthy, distressing, and well-remembered dreams that usually involve efforts to avoid threats or danger. They generally occur in the second half of a major sleep episode.
The nightmares are typically lengthy, elaborate, story-like sequences of dream imagery that seem
real and cause anxiety, fear or distress. After waking up, people experiencing nightmares are quickly alert and generally remember the dream and can describe it in detail. The nightmares cause significant distress or problems functioning. Nightmares often begin between ages 3 and 6 years but are most prevalent and severe in late adolescence or early adulthood.
People with hypersomnolence disorder are excessively sleepy even when getting at least 7 hours sleep. They have at least one of the following symptoms:
Such extreme sleepiness occurs at least three times per week, for at least three months. Individuals with this disorder may have difficulty waking up in the morning, sometimes appearing groggy, confused or combative (often referred to as sleep inertia). The sleepiness causes significant distress and can lead to problems with functioning, such as issues with concentration and memory.
The condition typically begins in late teens or early twenties but may not be diagnosed until many years later. Among individuals who consult in sleep disorders clinics for complaints of daytime sleepiness, approximately 5%–10% are diagnosed with hypersomnolence disorder.
Sleep problems can often be improved with regular sleep habits. As such, the first step to overcoming a sleep disorder or problem is identifying and carefully tracking your symptoms and sleep patterns.
A sleep diary can pinpoint day and nighttime habits that may contribute to your problems at night. Keeping a record of your sleep patterns and problems will also prove helpful if you eventually need to see a sleep doctor.
The details can be important, revealing how certain behaviours can be ruining your chance for a good night's sleep. After keeping the diary for a week, for example, you might notice that when you have more than one glass of wine in the evening, you wake up during the night.
While some sleep disorders may require a visit to the doctor, you can improve many sleeping problems on your own.
Improve your daytime habits. Regardless of your sleep problems, sticking to a consistent sleep schedule, getting regular exercise, limiting your intake of caffeine, alcohol, and nicotine, and managing stress will translate into better sleep over the long term.
Develop a relaxing bedtime routine to prepare your mind and body for sleep. Make sure your bedroom is quiet, dark, and cool, avoid heavy meals and too many fluids late at night, take a warm bath, read, or listen to soothing music to unwind, and turn off screens at least one hour before bedtime.
Get back to sleep when you wake up at night. Whether you have a sleep disorder or not, it's normal to wake briefly during the night. If you're having trouble getting back to sleep, try focusing on your breathing, meditating, or practising another relaxation technique. Make a note of anything that's worrying you and resolve to postpone worrying about it until the next day when it will be easier to resolve.
Provide your doctor with as much supporting information as possible, including information from the sleep diary you’ve been keeping.
The physician can perform a physical exam and help you identify the difficulties you are having with sleep. Some illnesses can cause disturbed sleep, so your healthcare provider may order tests to rule out other conditions.
If your healthcare provider suspects that you have a sleep disorder, he or she may refer you to a sleep disorder clinic. A sleep specialist will review your symptoms and may suggest that you undergo a sleep study.
A sleep study or polysomnogram (PSG) is a test that electronically transmits and records specific physical activities while you sleep. A sleep study can be done at home (home sleep apnea testing) for select patients. The recordings become data that is analysed by a qualified healthcare provider to determine whether or not you have a sleep disorder.
A specialist will observe your sleep patterns, brain waves, heart rate, rapid eye movements and more using monitoring devices attached to your body. While sleeping with a bunch of wires attached to you might seem difficult, most patients find they get used to it quickly.
Treatment for sleep disorders can vary depending on the type and underlying cause. However, it generally includes a combination of medical treatments and lifestyle changes.
Going to bed and waking up at the same time every day can also significantly improve your sleep quality. While you might be tempted to sleep in on the weekends, this can make it more difficult to wake up and fall asleep during the workweek.
The effects of sleep disorders can be so disruptive that you will likely want immediate relief. Unfortunately, long-term cases can take a bit more time to resolve.
However, if you stick with your treatment plan and regularly communicate with your doctor, you can find your way to better sleep.
How much sleep you need changes with age. Experts recommend school-age children get at least nine hours a night and teens get between eight and 10. Most adults need at least seven hours or more of sleep each night.
There are many misunderstandings about sleep. One is that adults need less sleep as they get older. This isn’t true. Older adults still need the same amount. But sleep quality can get worse as you age. Older adults are also more likely to take medications that interfere with sleep.
Another sleep myth is that you can “catch up” on your days off. Researchers are finding that this largely isn’t the case.
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