Sleep disorders

Overview
Sleep disorders involve the inability to fall asleep, stay asleep, awake or get restorative sleep. Researchers have identified about 70 unique sleep disorders, including dyssomnias (disorders of sleep, wakefulness or circadian rhythm sleep) and parasomnias (disorders of arousal, partial arousal or sleep stage transitions). Parasomnias are most common in children. At least 40 million Americans struggle with chronic, long-term sleep disorders every year. The most common sleep disorders are described below.

Dyssomnias
Insomnia
Insomnia is a nearly universal experience, particularly as you age. About 60 million people in the United States have insomnia -- 40 percent are women and 30 percent are men. With insomnia, individuals complain of inadequate sleep, either in amount or quality. Insomnia can be related to various factors, including jet lag, diet and stress.

There are various types of insomnia. Initial insomnia or sleep-onset insomnia is difficulty falling asleep. It's often associated with an emotional disturbance, pain, respiratory problems, the use of stimulants or a variable sleep schedule. With early morning awakening or sleep maintenance insomnia, you fall asleep normally, but wake up early and then drift into a restless sleep, or simply remain awake until it's time to get up. Early morning awakening is a common phenomenon of aging, but it may also be associated with depression. Other types of insomnia include sleep rhythm reversals, in which you're sleepy in the morning and wide awake at bedtime, and rebound wakefulness, in which you get a second wind at bedtime.

Hypersomnia
Hypersomnia is excessive sleepiness despite significant amounts of deep or prolonged sleep. People who have hypersomnia may be difficult to wake. Hypersomnia typically begins between ages 15 and 30 with symptoms that last at least one month. To be diagnosed with hypersomnia, the increase in sleep must be severe enough to cause clinically significant distress or impaired functioning. For example, you might have time or attendance problems at work or daytime sleepiness that interferes with your functioning on the job.

Narcolepsy
Narcolepsy is characterized by an episode of hypersomnia with a sudden loss of muscle tone and sleep paralysis. Vivid hallucinations or illusions may appear when the sleep attack begins. Each sleep attack may last from several seconds to more than 30 minutes.

Sleep apnea
Sleep apnea is characterized by interrupted breathing during sleep. With obstructive sleep apnea, breathing in during sleep creates a suction that collapses the windpipe. The person's airflow is typically blocked for 10 to 60 seconds. When the level of oxygen in the blood falls, the brain responds by waking the person enough to tighten the upper airway muscles and open the windpipe. The person may snore or gasp, and then resume snoring. Episodes of obstructive sleep apnea may be repeated about 100 times per night. Logically, the frequent awakenings leave the person continually sleepy. Obstructive sleep apnea occurs in 2 to 5 percent of the population and is more common in men and older adults.

Delayed or advanced sleep phase syndrome
Delayed sleep phase syndrome is characterized by a sleep delay of two or more hours past the desired sleep time. As expected, this may cause difficulty waking up at the appointed time. A person who has delayed sleep phase syndrome often falls asleep after 2 a.m., has few or no awakenings during sleep, and rises as early as necessary for daily activities. Shorter sleep periods during the work or school week are balanced by longer periods of sleep on the weekends, when the person may not rise until later morning or even early afternoon. It tends to occur more frequently in young adults.

Advanced sleep phase syndrome is characterized by an earlier sleep time than desired. A person who has advanced sleep phase syndrome has a chronic inability to stay awake in the evening or sleep later in the morning. Daytime school or work activities are not affected by the sleepiness, but evening events may be affected or even eliminated due to the need to go to bed earlier than normal. Advanced sleep phase syndrome is most common in older adults.

Jet lag or time zone change syndrome
Jet lag or time zone change syndrome is a common problem for travelers. Symptoms typically begin within one to two days after air travel across at least two times zones. Symptoms may include insomnia, hypersomnia, excessive sleepiness despite a good night's sleep, decreased daytime performance, moodiness, appetite changes, poor concentration, gastrointestinal difficulties and poor short-term memory. Jet lag may last from 2 to 14 days depending on the number of time zones crossed, age, and the amount of time spent outside at the destination.

Night shift work
People who work between 11 p.m. and 7 a.m. often find themselves fighting their natural wake-sleep pattern, also known as the circadian rhythm. Staying awake and alert during nighttime working hours may be difficult, as well as sleeping during the day. Night shift workers usually hit their lowest period around 4 a.m. Some people are unable to adapt to this schedule and remain chronically sleep-deprived.


Parasomnias
Sleepwalking or somnambulism
Sleepwalking is characterized by sitting, walking or doing other activities during sleep. This occurs in sleep stages three and four, the deep-sleep stages of the five total sleep stages. The person's eyes may be open, but there's no evidence of recognition. There are no accompanying dreams, and the next day the person does not remember the incident. Sleepwalking is most common during late childhood and adolescence when stages three and four occur in greater lengths of time. Ten percent of children sleepwalk, and there's usually a family history of sleepwalking.

Restless legs syndrome
Restless legs syndrome is an unpleasant crawling, prickling or tingling sensation in the feet, legs and upper extremities. These sensations create an urge to move the affected limb for relief, which leads to frequent leg movement during the day and insomnia from periodic leg movements during the night. Restless legs syndrome affects about 5 percent of adults, making it one of the most common sleep disorders, especially in older people. Although restless legs syndrome may be related to a particular medication or accompany an underlying disorder, most often there's no identifiable, specific cause for the discomfort.

Nocturnal leg cramps
Nocturnal leg cramps are painful sensations in the leg associated with muscle hardness or tightness.

Night terrors
Night terrors are fearful, screaming, flailing episodes during sleep. Night terrors are most common in children and may accompany episodes of sleepwalking. Nightmares and night terrors are more common with fever and excess fatigue, as well as after using alcohol.

Sleep bruxism
Sleep bruxism involves the forceful grinding of the teeth during sleep. It occurs in 10 to 20 percent of the population, and onset is usually between the ages of 17 and 20. Sleep bruxism generally subsides after the age of 40.


Characteristics
Physical characteristics of a sleep disorder may include difficulty falling asleep or staying asleep, poor sleep quality, gasping for breath during sleep, snoring and daytime fatigue. Psychologically, you may become anxious, frustrated and irritable. You may have difficulty concentrating or making decisions, and you may experience increased stress. Socially, a sleep disorder may lead to problems with work performance and potentially a reduced quality of life. Some people who have sleep disorders turn to substance abuse.

Coping strategies
To improve your sleep habits, keep in mind these tips for a good night's sleep.
Exercise regularly, but not at night. Exercise at night may stimulate your body and interfere with falling asleep.

Watch your caffeine intake. Caffeine stimulates certain parts of the brain and can cause insomnia. Some people with sleep disorders are particularly sensitive to caffeine. If you follow a typical nighttime sleep schedule, avoid caffeine after midday. If you can't stop cold turkey, try to gradually withdraw from caffeine use to see if it helps your symptoms.

Avoid using alcohol to fall asleep. Alcohol may help you fall asleep more quickly, but it can disrupt the quality of your sleep, resulting in daytime drowsiness. If you consistently use alcohol to fall asleep, you'll build up a tolerance over time and require increasingly larger amounts of alcohol to produce the same effect.

Relax before bed. You might try reading something light and pleasurable, taking a hot bath, or drinking hot milk. Using visual imagery, progressive muscle relaxation or breathing exercises can also help induce sleep.

Don't lie awake in bed. If you can't fall asleep within 20 minutes, get up and do something until you feel sleepy.

Don't take naps. Try to maintain a regular bedtime routine and sleep schedule. Ideally, you should go to bed and wake up at the same time every day, even on weekends.

Create a good sleeping environment. Keep the room dark and control the temperature. If necessary, use a sleep mask to reduce light. Try using earplugs, fans or other sound devices to reduce or cover noise. Sleep until sunlight, if possible.

Learn to associate the bedroom with sleep. Only use the bedroom for sleep and sex. Don't use the bedroom to eat, watch television, etc.

Use over-the-counter medication only for short-term use. Most sleep aids are not intended for ongoing or long-term use.

Consult your doctor if your sleeping trouble continues. Various treatments are available to help combat sleep disorders.

The most common treatment for sleep apnea is continuous positive airway pressure (CPAP), which involves wearing a specially designed mask over your nose while sleeping. The nasal mask is connected to a motor that controls the airflow sent to your nose. CPAP forces air into your nasal passages and keeps them open -- it does not breathe for you. Some people wear specially designed mouthpieces while they sleep to help them breathe. If you have sleep apnea and are overweight, your doctor may recommend losing the excess pounds. Finally, in some cases, surgery may be recommended.

Treatment for insomnia may include relaxation training, progressive muscle relaxation, meditation or abdominal breathing exercises. Limiting the amount of time you spend in bed may be helpful. As suggested above, if you can't fall asleep within 20 minutes, get up and do something until you feel sleepy. Biofeedback is effective for some people. With this technique, you learn to voluntarily control bodily functions, such as blood pressure, muscle tension or heart rate, to improve health and performance. Stimulus control therapy, in which you're trained to associate the bedroom with only sleep and sex, may be another possibility. Cognitive therapy, understanding how your thoughts affect your behavior, may also be suggested. Drugs that induce sleep may be a short-term treatment option. Remember, however, it's best to try other measures first.

Sleep and road safety
Driver fatigue is responsible for an estimated 100,000 motor vehicle accidents and 1,500 deaths in the United States each year, according to the National Highway Traffic Safety Administration. For safe driving, consider these tips from the National Sleep Foundation:

Get a good night's sleep before driving long distances.
Plan to drive during times when you're normally awake.
Try to share the driving with a companion.
Schedule a break every two hours, or more often if necessary.
Be aware of early warning signs of drowsiness, such as difficulty focusing and staying in the correct lane, thinking clearly, and remembering the previous stretch of road.
Tips for shift workers
There are about 22 million shift workers in the United States and most do not get enough sleep. Those who work the 11 p.m. to 7 a.m. shift tend to get the least amount of sleep and the sleep is less restful. If you work the night shift, you may be fighting your natural wake-sleep pattern. Consider these tips to help adjust:

Take short breaks throughout each shift.

Try to exercise during your breaks. Even a walk down the hallway or a trip up and down the stairs may do wonders.

Try to work with a "buddy" when you can. Talking with co-workers can improve alertness.

Try to eat three healthy meals a day. Bring healthy snacks to eat during your shift.

If you drink caffeinated beverages, do so early in your shift, ideally before 3 a.m.

If you're sleepy after your shift, you may need to take a nap before driving home or consider other transportation arrangements. Driving home alone after a night shift can be risky.
If you're new to night-shift work, you might want to ask your doctor about phototherapy, which uses light boxes that simulate natural sunlight to help your body adapt to the circadian rhythms of working the night shift.