According to the International Classification of Sleep Disorders (third edition) there are more than 60 recognized sleep disorders. However, these can be grouped into six general areas of sleep pathology (listed below with common examples/symptoms listed for each)
- Sleep-related Breathing Disorders (obstructive sleep apnea, central sleep apnea, treatment–emergent central sleep apnea, obesity–hypoventilation)
- Insomnias (chronic, short-term)
- Sleep-related Movement Disorders (restless legs syndrome, periodic Limb movements of sleep, sleep-related bruxism)
- Circadian Rhythm Sleep-Wake Disorders (delayed, advanced, shift-work)
- Parasomnias (REM behavior disorder, nightmares, sleep-eating, sleep paralysis, sleepwalking, sleep terrors)
- Central Disorders of Hypersomnolence (narcolepsy, idiopathic hypersomnia)
Sleep apnea is characterized by having one or more pauses in breathing effort or airflow during sleep. Each pause, called an apnea, can last from a few seconds to more than a minute, and may occur many times per hour resulting in reduced oxygen to the brain and heart.
There are three distinct forms of sleep apnea: central, obstructive, and complex (a combination of central and obstructive) constituting 0.4%, 84% and 15% of cases respectively. In central sleep apnea, breathing is interrupted due to a lack of respiratory effort. In obstructive sleep apnea, airflow is interrupted by a physical blockage in the airway (usually the tongue and soft palate) despite normal respiratory effort. In complex (or “mixed”) sleep apnea, there are both central & obstructive features during the events.
Individuals with sleep apnea are often unaware that these events are occurring during sleep. Symptoms may be present for years or even decades without identification, during which time the sufferer may become conditioned to the associated daytime sleepiness and fatigue. Individuals with sleep apnea most commonly experience the following symptoms:
- Daytime Sleepiness
- Morning Headaches
- Nocturnal grinding of teeth
- High Blood pressure
- Memory impairment
- Difficulty losing weight
- Sleep apnea is associated with an increased risk of heart attack, stroke, high blood pressure, cardiac arrhythmias, diabetes, and sleep-deprived driving accidents.
- Sleep apnea is diagnosed with a sleep study which can take place in the home or in the sleep lab. Recommended treatment options include CPAP, oral appliances, positional therapy, and surgery.
Insomnia is a symptom that can accompany several sleep, medical and psychiatric disorders, characterized by persistent difficulty falling asleep and/or difficulty staying asleep. It is estimated that about 70 million Americans regularly suffer from insomnia each year and is usually more common in women than in men.
In addition to difficulty falling asleep staying asleep many people with insomnia display the following symptoms:
- Low energy
- Lack of motivation
- Attention, concentration or memory problems
- Poor performance at school or work
- Extreme mood changes
- Daytime sleepiness
- Errors at work or while driving
- Tension headaches or stomach aches
- Frustration or worry about your sleep
- Decreased quality of life
The recommended treatment for Insomnia is Cognitive Behavioral Therapy. Recent research has shown that cognitive behavior therapy is more effective than hypnotic medications in controlling insomnia.
Statistics estimate that up to 60% of the general public may snore. Snoring is the vibration of respiratory structures and the resulting sound, due to obstructed air movement during breathing while sleeping. Snoring usually indicates obstructions in breathing, which may vary in severity. These obstructions usually result from one of the following:
- Airway weakness, causing the airway to close during sleep
- Malpositioned jaw, often caused by tension in the muscles
- Fat gathering in and around the airway
- Obstruction in the nasal passages
- Relaxants such as alcohol or drugs relaxing airway muscles
- Sleeping on one’s back, which may result in the tongue dropping to the back of the airway.
Recent research is suggesting that snoring may pose a negative impact on health. Treatment options for snoring include oral appliances, CPAP and or positional sleep therapy.
Circadian Rhythm Sleep Disorders
Circadian rhythm sleep disorders (CRSD) are a group of sleep disorders that are due to mis-timing of the biological clock. People with these disorders have sleep times that seem to be out of alignment and tend to go to bed late or wake up early.
- Delayed sleep phase disorder
You may fall asleep late (for example, between 1a.m. and 4 a.m.) and awaken late morning or early afternoon. This disorder is common in teenagers.
- Advanced sleep phase disorder
You may fall asleep early (for example at 6 p.m.) and awaken early (for example at 2 a.m.).
Individuals who may have a CRSD need to see a board certified sleep physician who can properly diagnose and treat the disorder. Treatment for CRSD may include light therapy, melatonin, and sleep scheduling.
Restless Legs Syndrome
Restless legs syndrome (RLS) is a condition that is characterized by an irresistible urge to move one’s body to reduce uncomfortable or odd sensations. It most commonly affects the legs, but can also affect the arms. Moving the affected body part modulates the sensations, providing temporary relief.
RLS causes a sensation in the legs or arms that can most closely be compared to a burning, itching, or tingling sensation in the muscles. It is a ‘spectrum’ disease with some people experiencing only a minor annoyance and others experiencing major issues.
Treatment for RLS may include pharmacotherapy and treating any underlying precipitating medical conditions.
Narcolepsy is a chronic disorder characterized by excessive daytime sleepiness (EDS) in which a person experiences extreme sleepiness and may fall asleep at inappropriate times, such as while at work or at school. Narcoleptics usually experience disturbed nocturnal sleep and an abnormal daytime sleep pattern.
In addition, some narcoleptics experience cataplexy, a sudden muscular weakness brought on by strong positive emotions such as laughing. It often manifests as muscular weaknesses ranging from a barely perceptible slackening of the facial muscles to the dropping of the jaw or head, weakness at the knees, or a total collapse. Usually speech is slurred, vision is impaired (double vision, inability to focus), but hearing and awareness remain normal. In some rare cases, an individual’s body becomes paralyzed and muscles become stiff.
Narcolepsy affects about one out of every 2,000 people and has a genetic component.