Almost everyone has trouble sleeping occasionally, but when you toss and turn often enough that it affects your health, moods and safety, your bad nights of sleeping may be elevated to the level of a sleep disorder.
Sleep disorders are among the most common medical problems that health care providers see in their practices, according to the book Sleep Disorder published on the National Center for Biotechnology Information government site. Many people with sleep disorders find they have trouble staying awake during the day because they haven’t gotten quality sleep at night.
There are more than 80 sleep disorders, according to the U.S. National Library of Medicine. Some common ones include:
- Insomnia
- Narcolepsy
- Sleep apnea
- Restless leg syndrome (RLS)
- REM sleep behavior disorder
- Shift work sleep disorder (SWSD)
Here, learn about the most common sleep disorders, their signs and symptoms, and what treatments may be available.
Insomnia
Insomnia, the most common sleep disorder, is defined as having difficulty falling asleep, staying asleep or being able to get quality sleep, according to the National Heart, Lung, and Blood Institute (NHLBI).
Insomnia may be:
- Short term (lasting a few days or weeks). This type may develop from stress or schedule or environment changes.
- Long term or chronic (lasting 3 months or more and for 3-plus nights per week). Chronic insomnia may increase your risk of high blood pressure, diabetes, heart disease and cancer. Often, the cause of chronic insomnia is difficult to determine.
Having another health issue may also contribute to insomnia.
Some things to try when sleep eludes you include:
- Establishing a routine and sticking to it. Go to bed close to the same time every night, and wake up at the same time each morning (yes, even on weekends and holidays).
- Getting regular exercise. Exercising at least 30 minutes most days of the week may help you sleep better. Be sure to finish at least 2 or 3 hours before bedtime though to keep your workout from affecting your sleep.
- Nixing caffeine and nicotine before bed. Both are stimulants, and their effects may last up to 8 hours. Plus, if you smoke, you may wake up because you feel a craving to smoke.
- Relaxing before you go to bed. Unwinding by reading, taking a bath or listening to calming music may make you feel sleepy.
If you can’t sleep, don’t toss and turn — it’ll only make you more anxious. Instead, get out of bed and do quiet activities until you feel sleepy again (such as reading), and then return to bed.
Narcolepsy
When you have narcolepsy, your brain is unable to regulate sleep-wake cycles properly, so even if you sleep well at night, you’re still severely sleepy during the day, and the sleep you get isn’t restful. Excessive daytime sleepiness may cause you to fall asleep in the middle of doing something else, such as driving, eating or talking. Narcolepsy can be very dangerous.
People with narcolepsy may also lose muscle tone, especially when they laugh, feel angry or feel excited. The effect can range from drooping eyes to looking like you’re having a seizure. While scary, episodes tend to be brief and over quickly.
Other symptoms include sleep paralysis, which is the inability to move or speak while you’re falling asleep or waking up, and hallucinations.
Narcolepsy is a chronic condition that doesn’t go away or get worse as you age. It affects men and women equally, and though it may start in childhood, it may occur at any time over the course of your lifetime.
While there’s no cure, narcolepsy may be treated with medications and certain lifestyle changes. According to the National Institute of Neurological Disorders and Stroke (NINDS), medications may include stimulants, antidepressants or an H3 receptor antagonist/inverse agonist. Talk to your health care provider if you think you may need medication to treat narcolepsy.
Lifestyle changes for those with narcolepsy include:
- Taking short naps
- Sticking to a regular sleep schedule
- Avoiding caffeine or alcohol, especially later in the day
- Exercising, making sure to finish at least 4 to 5 hours before bedtime
- Avoiding large, heavy meals before sleeping
- Making time to relax before bed
- Keeping your bedroom cool and comfortable, which is optimal for sleep
Sleep apnea
Sleep apnea is a sleep condition that causes you to stop breathing over and over again as you sleep, which prevents you from getting adequate oxygen. This lack of oxygen interferes with your ability to get a restful night’s sleep.
Sleep apnea can be one of two types:
- Obstructive sleep apnea, the most common type, is when your upper airway is blocked, reducing or stopping airflow. It may be caused by obesity, large tonsils or hormone level changes.
- Central sleep apnea is when your brain doesn’t send your body the signals required to tell you to keep breathing. If you have a health condition that affects how your brain controls your airway and chest muscles, you’re more susceptible to central sleep apnea.
A sleep study is often used to determine whether you have sleep apnea.
According to NHLBI, the most common treatment for sleep apnea is a breathing device known as a continuous positive air pressure (CPAP) machine. The machine keeps your airway open as you sleep by providing constant air pressure on your throat.
Other treatment options NHLBI notes include:
- Oral appliances. You may be fit with a customized oral device to wear in your mouth when sleeping to help prevent your upper airway from becoming blocked. There are two types:
- A mandibular repositioning mouthpiece to hold your jaw in a way to keep it from obstructing the upper airway
- A tongue retaining device to keep your tongue forward to keep it from obstructing the upper airway
- Surgery. Possible procedures include:
- Removing your tonsils and adenoids (called an adenotonsillectomy)
- Implanting a device that monitors breathing and helps control muscles that open your airways
- Removing soft tissue from your mouth and throat to help make your upper airway bigger
- Moving your upper jaw (maxilla) and lower jaw (mandible) forward, which also helps your upper airway become bigger
- Orofacial therapy. You may be given exercises to help position your tongue and strengthen certain muscles, such as muscles in the lips, tongue, upper airway and face.
Restless leg syndrome (RLS)
Restless leg syndrome (RLS) is a sleep disorder and a movement disorder that may start at any time over the course of your life. Women are more likely to have RLS than men, but it affects both sexes.
RLS causes uncomfortable sensations in your legs, most often and most intensely at night while you’re asleep. According to NINDS, the sensations cause you to move your legs and disrupt your sleep, and may feel like:
- Aching
- Throbbing
- Pulling
- Itching
- Crawling
- Creeping
Most often, the sensations affect both legs, but they may affect just one. Sensations in your arms, chest or head may occur, too, but are less common.
Symptoms may vary from day to day in frequency and severity, and they may become more frequent as you age.
According to NINDS, more than 80% of those with RLS also have periodic limb movement of sleep (PLMS), where your legs twitch and jerk usually every 15 to 40 seconds throughout the night.
While there’s no cure, RLS symptoms may be treated. Treatments may include:
- Iron supplements
- Anti-seizure medications
- Dopaminergic agents, which increase dopamine in the brain
- Certain opioids, such as methadone, codeine, hydrocodone and oxycodone
- Benzodiazepines, which may be used to treat anxiety, insomnia and muscle spasms
Lifestyle changes may also help, such as:
- Drinking little or no alcohol or caffeinated beverages
- Stopping smoking
- Maintaining a regular sleep schedule
- Getting moderate exercise on a regular basis, especially aerobic and leg-focused exercises
- Giving yourself a leg massage
- Taking a warm bath
- Applying heating pads or ice packs to legs
REM sleep behavior disorder
Most people spend about 20% of their sleep time in rapid eye movement (REM) sleep, which is the sleep stage where you dream. Typically, REM sleep is in the later part of the night.
People with REM sleep behavior disorder have unpleasant dreams and act them out with sudden, sometimes violent arm and leg movements.
REM sleep behavior disorder may come on gradually, and the condition may worsen over time.
The disorder may be associated with other neurological conditions, such as Parkinson’s disease, Lewy body dementia and multiple system atrophy (MSA).
According to the Mayo Clinic, symptoms may include:
- Punching, kicking, flailing limbs
- Jumping out of bed in reaction to dreams that are violent or action-filled
- Making noises, such as talking, laughing, shouting, cursing and crying out while dreaming
You may recall your dream if you wake up while having an episode.
REM sleep disorder is treated with medications. According to the Mayo Clinic, medication options may include:
- Melatonin. Most people are able to take this dietary supplement with little or no side effects.
- Clonazepam (Klonopin). This is a prescription medication used to treat anxiety. It may cause you to be sleepy during the day, and it may worsen sleep apnea if you have that condition as well.
If you have REM sleep behavior disorder, it’s imperative you make your sleeping environment safe for you and your bed partner. You may want to:
- Pad the floor near your bed
- Place rails on the side of the bed where you sleep
- Rid the room of dangers, such as weapons and sharp objects
- Remove furniture and clutter from the bedroom
- Fortify windows
Shift work sleep disorder (SWSD)
People who work different shifts and who work at night may have shift work disorder (SWSD). According to the Cleveland Clinic, up to 40% of people who work different shifts might have this disorder.
Symptoms may include:
- Trouble sleeping
- Sleepiness
- Difficulty concentrating when awake
- Headaches
- Lack of energy
According to the Cleveland Clinic, people with SWSD are also prone to:
- Accidents and making errors at work
- Dependency on drugs and alcohol
- Irritability or mood issues
- Gastrointestinal, cardiovascular and metabolic health conditions
Treatments may include:
- Aiming for 7 to 9 hours of sleep a day
- Making sleep a priority
- Limiting the number of night shifts in a row to 5 or fewer
- Having days off in between shifts
- Avoiding long commutes if possible
- Practicing good sleep hygiene, which includes sticking to a sleep schedule and avoiding stimulants such as caffeine, alcohol and nicotine
- Napping before starting a night shift
- Getting exposure to light during the early part of your shift
- Keeping a sleep diary to identify your problem and monitor your progress
If you live with others, ask them to respect your sleep time by keeping their voices down, not running noisy appliances such as the vacuum or dishwasher while you’re trying to sleep, and wearing headphones when they’re watching television or listening to music when you’re sleeping.
As a last resort for SWSD, you may want to talk to your health care provider about the use of prescription sleep aids.
References:
U.S. National Library Of Medicine National Center for Biotechnology Information (NCBI): Sleep disorder.
U.S. National Library of Medicine MedlinePlus: Sleep Disorders.
Mayo Clinic: Sleep disorders.
National Heart, Lung, and Blood Institute (NHLBI): What is Insomnia?
National Heart, Lung, and Blood Institute (NHLBI): Guide to Healthy Sleep.
National Institute of Neurological Disorders and Stroke (NINDS): Narcolepsy.
National Heart, Lung, and Blood Institute (NHLBI): What Is Sleep Apnea?
National Heart, Lung, and Blood Institute (NHLBI): Sleep Apnea Treatment.
National Institute of Neurological Disorders and Stroke (NINDS): Restless Leg Syndrome.
Mayo Clinic: REM sleep behavior disorder.
Cleveland Clinic:
Shift Work Sleep Disorder.
