Sleep disorders

Overview

Sleep disorders are conditions that change the way you sleep. If you have a sleep disorder, you may not get enough sleep or you may not feel rested when you wake up. You may be very sleepy during the daytime. You may have changes in breathing or move around a lot during sleep. Or you may have problems getting to sleep, staying asleep or waking too early.

A sleep disorder can affect your overall health, safety and quality of life. Not getting a good night's sleep can affect your ability to drive or work safely. It also can raise your risk of other health problems. But treatment can help you get the sleep you need.

Symptoms

Symptoms of common sleep disorders include:

• Being very sleepy during the daytime. You may fall asleep at times that aren't typical, such as while driving or while working at your desk.
• Trouble falling asleep, waking up during the night and not being able to go back to sleep. Or you may wake up too early.
• Breathing in a pattern that isn't typical. This may include snoring, snorting, gasping, choking or pausing during breathing.
• Feeling an urge to move that is not comfortable while you're trying to fall asleep. Your legs or arms may feel tingly or crawly.
• Moving too much or having movements that bother you during sleep, such as arm and leg movements or teeth grinding.
• Activities during sleep that are not usual, such as sleepwalking, sleep-eating or bed-wetting.

When to see a doctor

Anyone can have an occasional poor night's sleep. But talk with your doctor or other healthcare professional if you regularly have trouble getting enough sleep, if you don't feel rested when you wake up or if you feel overly sleepy during the day.

Causes

There are many different types of sleep disorders, and the causes vary widely. Sleep disorders are often grouped according to why they happen or their effects. Sleep disorders also can be grouped based on behaviors, problems with your natural sleep-wake cycles, breathing problems, difficulty sleeping or how sleepy you feel during the day.

Sometimes the exact cause is not known, but several factors can increase the risk of having a sleep disorder.

Risk factors

These issues can raise the risk of sleep disorders:

• Age. Sleep varies depending on age, and age may play a role in sleep disorders. Some sleep disorders, such as bed-wetting, may be more common in children. Other sleep disorders are more common with older age.
• Genetics. Having some sleep disorders, such as insomnia, restless leg syndrome, sleepwalking, and sleep apnea, may be more likely if a family member also has them.
• Medical conditions. Brain and nerve conditions, such as Parkinson's disease, multiple sclerosis and traumatic brain injury, may raise the risk of sleep disorders. Heart disease, lung disease, cancer, diabetes and chronic pain are linked with insomnia. Being overweight raises the risk of obstructive sleep apnea. Heart failure and atrial fibrillation raise the risk of central sleep apnea.
• Mental health conditions. Stress, depression, anxiety and other mental health conditions may affect sleep.
• Schedule changes. Jet lag or shift work can change your sleep-wake cycle and disrupt sleep.
• Medicines and drugs. Certain medicines, caffeine, alcohol, and legal or illegal drugs that may be sold on the streets, also called recreational drugs, can affect sleep.

Complications

Untreated sleep disorders are linked with serious complications. These can include a higher risk or worsening of medical conditions such as heart disease, stroke and diabetes. Sleep disorders also can affect mental health. And ongoing insomnia can raise the risk of suicidal thoughts and behavior.

Sleep disorders can affect your quality of life. Excessive daytime sleepiness can make it hard to focus and pay attention. This can impact driving safety, workplace errors and how well you do in school.

Diagnosis

To diagnose sleep disorders, you meet with sleep specialists who listen to your concerns and help create a plan to meet your needs. It may help for your bed partner to share information about your symptoms. Your sleep specialist does an exam. You may be asked to keep a sleep log that includes information about your daily activities and how you sleep.

You also may have tests, such as:

• Actigraphy. A small monitor, usually worn on the wrist, measures arm and leg movement during sleep. Worn for several days to weeks, the monitor gives information about sleep-wake cycles over time. The test also can show if treatment for a sleep disorder is working.
• Sleep study, also called polysomnography. A sleep study records brain waves, oxygen levels in the blood, and heart rate and breathing during sleep. It also measures eye and leg movements. A sleep study may be done at a sleep disorders unit within a hospital or at a sleep center. When you have testing for sleep apnea, a diagnosis may be made during the first half of the night, while data from the rest of the night is used to decide on the best settings for a continuous positive airway pressure (CPAP) machine. Sometimes the test is done over two different nights.
• Home sleep apnea test. Some people can have a test at home to diagnose sleep apnea. The small monitors usually record breathing rate and airflow, oxygen levels, and heart rate. Some tests also give information on blood vessel tone. This tells how well the muscles in the blood vessel walls control blood pressure and move blood around the body. After the test, information can be uploaded to a smartphone app and sent to the sleep medicine specialist for review.
• Multiple sleep latency test (MSLT). This test measures daytime sleepiness. During the test, you have time in a quiet, dark room. You can take 4 to 5 naps, each spaced two hours apart. The MSLT measures the time it takes to fall asleep each time.
• Maintenance of wakefulness test (MWT). This test measures daytime alertness. During the test, you have time in a quiet, dark room. Like the MSLT, you can take 4 to 5 naps spaced two hours apart. Unlike the MSLT, the MWT measures your ability to stay awake during this time.
• Upper airway nerve stimulation therapy evaluation. This may involve several tests that help decide if a small device surgically placed inside the body is the right treatment for obstructive sleep apnea.
• Overnight oximetry test. Using a small monitor that attaches to a finger, this test measures heart rate and oxygen levels in the blood throughout the night. Drops in oxygen levels while sleeping may happen with sleep apnea.

Treatment

Treatment depends on the type of sleep disorder you have and how much your symptoms affect your daily life. Treatment options may include:

• Healthy-lifestyle choices. These can include losing weight if needed, following good sleep habits, getting regular physical activity, cutting back on alcohol and caffeine near bedtime, and avoiding recreational drugs.
• Treatment of other health conditions. Treating medical and mental health conditions that may be causing or adding to sleep disorders may improve sleep.
• Cognitive behavioral therapy for insomnia (CBT-I). CBT-I involves looking at thoughts and behaviors that interfere with sleep. With guidance, you can create a plan for getting better rest. This may include finding ways to relax at bedtime, going to sleep and waking up at the same time each day, and not taking naps.

• Continuous positive airway pressure (CPAP) therapy. This is the standard treatment for obstructive sleep apnea. You use a CPAP machine to treat obstructive sleep apnea whenever you're sleeping. The machine has a hose that connects to a mask. You wear the mask over your face or nose. The machine provides airflow at a pressure that holds your airway open during sleep.

  A type of CPAP called bilevel positive airway pressure (BPAP) may be used in obstructive sleep apnea for people who can't tolerate CPAP. BPAP also may be used to help breathing in people who have conditions that keep their breathing muscles from working as they should.

• Oral appliances. Appliances worn in the mouth, known as oral appliances, may be an option instead of CPAP. These are custom-made mouthpieces that are used during sleep. The goal is to lessen airflow blockage in the throat area by pushing the lower jaw and tongue forward.

• Surgeries. Another option instead of CPAP is surgery. There are different surgical options designed to lessen airflow blockage during sleep. These include surgeries on the nose or jaws and surgeries to reduce upper airway soft tissue.

  A newer surgical option for obstructive sleep apnea is upper airway nerve stimulation therapy. In the U.S., the Food and Drug Administration has approved an upper airway nerve stimulation system called Inspire to treat obstructive sleep apnea in some people if CPAP therapy doesn't work.

  Surgery is needed to place the Inspire system. A small device called a generator is placed under the skin on the upper chest. When the breathing muscles don't move, the device sends a pulse to the nerve under the tongue. This causes the tongue to move forward, opening the airway.

• Medicines. Medicines and supplements may help treat some sleep disorders.