In our previous post, we discussed three common types of sleep disorders, their symptoms, and treatments. There are over 70 known sleep disorders that are recognized though some say there could be more than 100. Often, sleep disorders are broken down into six main types: circadian rhythm sleep-wake disorders, insomnia, hypersomnia disorders, parasomnias, sleep-related breathing disorders, and sleep-related movement disorders. In our previous post, we talked about circadian rhythm sleep-wake disorders, insomnia, and hypersomnia disorders. This post will be dedicated to parasomnias, sleep-related breathing disorders, and sleep-related movement disorders.

Parasomnias

Parasomnias are incredibly common and most people experience at least one of them during their lives. They are considered unwanted experiences during sleep that are not controllable by the person experiencing them. Parasomnias are not well understood as to what exactly causes them or any particular risk factors overall, but mood disorders and substance use seems to increase risk for some parasomnias but not others. Many parasomnias resolve on their own over time, which is especially true for children. Parasomnias are very common in children but as they age, the sleep disorders tend to disappear.

Sleep eating disorder and hallucinations

Sleep eating disorder is a parasomnia disorder that involves a person eating while sleeping. This is different from someone who eats excessively after bedtime while aware. An individual experiencing this parasomnia is not aware of what is happening. This can be distressing for the person experiencing it because of the lack of awareness or memory around the event.

A very common sleep disorder is hallucinations that happen right when falling asleep or as someone is waking up. Usually these are visual hallucinations but they can also be sensory or auditory hallucinations. They can sometimes be distressing for the person experiencing them, especially if they occur with sleep paralysis. Often these hallucinations are so vivid it is difficult for the person experiencing them to be able to tell if they are dreaming or not.

Sleep paralysis and night terrors

Sleep paralysis is another common sleep disorder that often is paired with others, like sleep hallucinations and narcolepsy. This disorder can be very distressing for the individual because it involves an inability to move the body or speak while being aware and conscious. If paired with hallucinations, it can be especially upsetting. The paralysis goes away on its own as the person wakes more and more but sometimes an individual can speed this process up by making extreme efforts to move.

Night terrors, or sleep terrors, are a well-known sleep disorder that involves the person sitting up in bed, while asleep, and screaming or thrashing around. Often, the person will be very difficult to wake up and may not recognize where they are or who is around them. When they do wake, many individuals are very confused and disoriented and may still be afraid. Very often, they do not remember what they were dreaming about or what caused the night terrors.

Sleep Walking

Sleep walking is a commonly occuring parasomnia in which the individual will leave bed while asleep and walk around. Sometimes this can just involve walking around the home but can sometimes be dangerous, for example if the person gets into a car to drive or if there is an open window on a second or higher floor. On occasion, the person can end up doing things that are not appropriate within their context (such as urinating in a closet). Often, it is better to gently guide the individual back to bed instead of trying to wake them up. This is especially true for children. If you know a child in your home sleepwalks, make sure that all doors and windows are locked in order to keep them from leaving the home while sleepwalking.

Sleep Apneas

Sleep-related breathing disorders are something many people have heard about but perhaps do not associate them with being sleep disorders. Obstructive sleep apnea is the most well-known by the general public, though there are others, such as central sleep apnea or infant or child sleep apnea. Groaning, snoring, and other related noises during sleep are also considered sleep-related breathing disorders when they occur on their own. In this post, we’ll focus on obstructive sleep apnea as it’s the most likely one that people will encounter.

Obstructive sleep apnea is a disorder in which there is an anatomical issue that is obstructing the airway of an individual while they sleep. This can be excess tissue in the neck or throat, a tongue that falls back, or enlarged tonsils. These obstructions cause the person to temporarily stop breathing in their sleep. This is often characterized by snoring, gasping, choking noises, or being woken up by the inability to breathe. However, the person usually does not remember waking up due to this. More commonly, it is the bed partner who notices these symptoms and encourages the individual to pursue treatment. It can happen either a few times a night or even a few hundred in extreme cases.

It is diagnosed by a sleep doctor, usually with an at home sleep apnea test or in a sleep lab.

Obstructive sleep apnea can have very negative consequences on an individual’s health, which highlights the importance of early diagnosis and treatment. These are related to the lack of oxygen that the person experiences during the night and include: high blood pressure and higher heart disease risk, depression, stroke, and diabetes.

Symptoms of Obstructive Sleep Apnea

Symptoms of obstructive sleep apnea include:

Loud or frequent snoring
Silent pauses in breathing
Choking or gasping sounds
Daytime sleepiness or fatigue
Unrefreshing or restless sleep
Insomnia
Morning headaches
Waking frequently during the night to go to the bathroom
Difficulty concentrating
Memory loss
Decreased sexual desire
Difficulty maintaining an erection
Irritability

There are effective treatments for obstructive sleep apnea. The first line treatment for this disorder is the use of a continuous positive airway pressure (CPAP) machine. This is a machine that uses gentle bursts of air to keep the airway open while the individual sleeps. If the CPAP is not a good fit for an individual, a doctor may recommend the use of oral appliance therapy which is a device that fits in the mouth that holds the tongue in place and keeps the airway from collapsing and looks like a retainer or sports guard. For very severe cases that do not respond to these treatments, surgery may be used to remove some of the excess tissue that is contributing to the obstruction.

Sleep Related Movement Disorders

The final type of sleep disorder we’re going to discuss is the category of sleep-related movement disorders. The most well-known of these is restless leg syndrome, or RLS. RLS is characterized by an urge to move the legs or an uncomfortable feeling in the legs while lying down or resting. It often makes it difficult for someone to fall asleep. Some people describe the feeling as a crawling sensation in the legs. This can also make it difficult for someone to sit down for long periods of time, such as in a car or at work.

RLS very commonly starts after the age of 40, but can affect people of any age. It is twice as common in people assigned female at birth. Some causes of RLS are low iron levels, diabetes, pregnancy, some medications, and can be sometimes linked to kidney problems (such as kidney failure).

This condition is often managed with medication.

Sleep Starts

Sleep starts are a sleep-related movement disorder that many people do not think of when they think about sleep disorders. It’s something that almost everyone will experience at least once in their lives. Most people compare it to a sense of falling while either going to sleep or waking up. Sleep starts or sleep jerks are caused by the major muscles in the body suddenly contracting all at once. This is usually not a problem for many people but for those who experience it often, or who become anxious due to sleep starts, this may contribute to insomnia. It can also sometimes cause injury if the individual hits a piece of furniture or a bed partner during a sleep start or jerk. They rarely need treatment or management but if they are causing distress or issues for the person experiencing them, they can be managed by reducing stress, making sure to get enough sleep, and avoiding stimulants (like caffeine).

One of the best ways of dealing with many sleep disorders or to just get better sleep in general is to focus on sleep hygiene and getting a regular bedtime routine. Our next post will discuss the ways in which you can contribute to having better sleep!

Feel you may need help with a sleep disorder? Look at our list of clinicians and see if you’d like to make an appointment with us!

Resources:

https://www.ncbi.nlm.nih.gov/books/NBK560720

https://www.nccih.nih.gov/health/sleep-disorders-what-you-need-to-know

https://www.psychiatry.org/patients-families/sleep-disorders/what-are-sleep-disorders

https://sleepeducation.org/sleep-disorders

Sleep disorders are more common than people think and most people experience one or more sleep disorders at least once in their lives. There are over 70 known sleep disorders that are recognized though some say there could be more than 100. Sleep disorders are especially common in children, though they commonly self-resolve with age, and adults over 65. Often, sleep disorders are broken down into six main types: circadian rhythm sleep-wake disorders, insomnia, hypersomnia disorders, parasomnias, sleep-related breathing disorders, and sleep-related movement disorders. In this post, we’ll be discussing circadian rhythm sleep-wake disorders, insomnia, and hypersomnia disorders.

Sleep-Wake Disorders

Circadian rhythm sleep-wake disorders are characterized by some kind of interruption in the natural circadian sleep cycle. For example, we see this often with people who do shift work or have unpredictable work hours, and we often see this affecting people who have traveled from one time zone to another (jet lag). Less common forms of this sleep disorder are delayed sleep-wake disorder or advanced sleep-wake disorder. For those experiencing this disorder due to shift work, unfortunately the only way to really treat this is to have a more predictable work schedule. Having a regular sleep-wake cycle is the best way to deal with this type of sleep disorder, however that is not always an option for everyone.

Insomnia

Insomnia is the most well known sleep disorder with most people experiencing at least one episode of insomnia during their lifetime. It can be short term or it can be chronic. Chronic insomnia is diagnosed after a period of three months, with at least three instances of insomnia a week. It can involve delayed sleep onset (30 minutes or more to fall asleep), poor sleep maintenance (waking and being unable to fall back asleep after 30 minutes or more), or a combination of both. It can be very disruptive to a person’s life, involving the following symptoms or outcomes:

Irritability
Daytime sleepiness
Brain fog
Attention issues
More likelihood of mistakes while at work or driving
Can interfere with work or relationships

Insomnia can be related to many things and have many root causes. For example, it could be related to mood disorders, other mental health disorders, chronic illness, stress, or some medications. Alcohol, caffeine, or nicotine use (or other drug use), especially in the evening, can also contribute to insomnia.

However, insomnia is also very treatable! Lifestyle changes are usually the first recommendation, such as avoiding caffeine in the evening or avoiding naps. However, CBT-I is also an effective treatment for insomnia. CBT-I is cognitive behavioral therapy for insomnia and can help treat insomnia for those who have suffered with very long term chronic insomnia.

Hypersomnia

In contrast, hypersomnia sleep disorders involve excessive sleepiness. The most well-known form of hypersomnia is narcolepsy, but there are other disorders in this category, such as Kleine-Levin syndrome and insufficient sleep syndrome. The important thing to note is that those with hypersomnia do not necessarily sleep more than the average population when it comes to total hours of sleep. However, the sleep they do get is rarely refreshing, causing intense fatigue.

Narcolepsy is a neurological disorder that disrupts the sleep-wake cycle. It is characterized by extreme bouts of sleepiness. For some people, it can also involve sudden muscle weakness, especially during times of intense emotion (even when laughing!) known as cataplexy. Cataplexy can be dangerous because it can happen while driving or working, which can open up the possibility for serious injury.

While someone with narcolepsy may feel refreshed immediately after sleeping or taking a nap, the individual will soon become fatigued again and not feel rested. Other common symptoms of narcolepsy are sleep hallucinations, sleep paralysis, and issues with memory.

Thankfully, narcolepsy is treatable. Available treatments for narcolepsy include:

Stimulants – This is the first line of treatment for most people
SSRIs
Sodium oxybate (a medication for daytime sleepiness and cataplexy)
Maintaining a consistent sleep-wake schedule
Scheduling short, 20-minute naps through the day
Regular exercise
Avoid alcohol, tobacco, and other drugs, especially in the evenings

Narcolepsy does not seem to have a hereditary component. Another recommendation for those who have narcolepsy is to seek accommodations at work or school. Narcolepsy is recognized by the ADA and a documented case of narcolepsy as diagnosed by a doctor must be accommodated in work or school settings within reason. Always discuss with a doctor what the options for these accommodations would be.

While these disorders are something most people experience, if they ever become a problem for you or someone you know, seek out help from a doctor or other professional (such as a therapist familiar with CBT-I in an insomnia case, for example) in order to treat them. Sleep disorders are often very treatable and many of the more disruptive symptoms can be dealt with under proper care.