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Sleep disorders are sleep problems that, if untreated, can affect a person's physical health, daily activities, and mental health. More than the once-in-a-while tossing and turning or waking up early, sleep disorders are medical conditions that can potentially be serious. But, there is treatment for all of these disorders. Talk with your health care provider if you think you may have a sleep disorder.
Common sleep disorders include:
If you are having problems with sleeping, you are not alone. Studies show that 1 out of every 2 Americans has problems with not being able to sleep at some point in their lives. And, almost 40 million Americans have sleep disorders.
We all know how great we feel when we've had a good night's sleep - we are ready to take on the day and handle whatever may come. But when we've had a bad night's sleep, we also all know the toll it can take on every part of our lives the next day. Sleep can affect not only how we function during the day, but it can also affect our physical and mental health. Not getting enough sleep, even just for one night, can affect our moods and our ability to focus, make decisions, and remember things. When we don't get enough sleep over a period of time, our "sleep debt" adds up and can cause serious problems, such as heart problems, depression, and anxiety. Over time, long-term sleep problems can also affect relationships, work, and quality of life.
Many people think of sleep as a passive activity, but sleep is actually an active state. It restores us, helps the body to repair damage and grow new cells, keeps the body's nervous system working properly, and helps us to consolidate memory (helps us to remember what we learned during the day). During sleep, a person passes through 5 phases, or stages, of sleep - stages 1, 2, 3, 4 of quiet sleep and stage 5, called REM (rapid eye movement) sleep.
A person's breathing becomes more rapid, irregular, and shallow in REM sleep. The eyes jerk quickly in many directions, heart rate increases, and blood pressure rises. When people wake up during REM sleep, they often describe strange dreams that don't make any sense. Most dreaming happens during REM sleep. REM sleep is important, perhaps in part because it stimulates the parts of the brain that help us learn.
A person cycles through these 5 stages of sleep during the night. The first sleep cycles contain short REM periods and long periods of deep sleep. REM sleep periods become longer in length while deep sleep decreases. By morning, almost all sleep time is in stages 1, 2, and REM.
There is no hard and fast answer to this question. The amount of sleep a person needs depends on many things, including age. Most adults need at least 7 to 8 hours of sleep per night, although some people may need as many as 10 hours. Children and adolescents need about 9 hours of sleep, while young infants may need around 16 hours per day. Women in the first 3 months of pregnancy often need a few more hours of sleep than normal, and sleep quality is decreased. When people sleep too little over a period of a few days, they build up a "sleep debt," like being overdrawn at a bank. This debt needs to be repaid sooner or later. A person's body is not able to get used to less sleep than they need. Aging does not seem to change the amount of sleep a person needs, although older people tend to sleep more lightly and for shorter periods of time. About half of the people over 65 have frequent sleeping problems, such as insomnia, and deep sleep stages that are shortened or completely stopped. These changes in sleep may be a normal part of aging, or can be caused by medications or treatments for other health problems.
Because so many people "burn the candle at both ends" and have large sleep debts, sleep problems are common. Side effects from medications or treatments and stress and worry can also cause sleep problems. For women, hormone changes during pregnancy, menopause, and the menstrual cycle can cause sleep problems.
Sleep experts say that if you feel sleepy during the day, even when doing something boring, you haven't had enough sleep. If you usually fall asleep within 5 minutes of lying down, you probably have a severe sleep debt, maybe even a sleep disorder. Very short periods of sleep throughout the day (sometimes you may not even know that you are sleeping) are also another sign of a sleep disorder. To learn about the signs for the most common sleep disorders, read the sleep disorder-related FAQs (sleep apnea, narcolepsy, restless legs syndrome, and insomnia) on this site. Talk with your health care provider if you are having a problem with sleep or think that you may have a sleep disorder.
Good sleep habits can help you get a good night's sleep. Here are some tips:
See your health care provider if you think you have a sleep problem or a sleep disorder.
It is not unusual to have sleep troubles from time to time. But, if you feel that you do not get enough sleep or satisfying sleep, you may have insomnia, a sleep disorder. People with insomnia have one or more of the following:
Insomnia can cause problems during the day, such as sleepiness, fatigue, difficulty concentrating, and irritability. A person with insomnia may also have another sleep disorder such as sleep apnea, narcolepsy, and restless legs syndrome. Insomnia is not defined by the number of hours you sleep every night. The amount of sleep a person needs varies. While most people need between 7 and 8 hours of sleep a night, some people do well with less, and some need more. About 60 million Americans each year suffer from insomnia, which can lead to serious sleep deficits and problems. Insomnia tends to increase with age and affects about 40 percent of women and 30 percent of men.
A person can have primary or secondary insomnia. Primary insomnia means that a person is having sleep problems that are not directly associated with any other health condition or problem. Secondary insomnia means that a person is having sleep problems because of something else, such as a health condition (like depression, heartburn, cancer, asthma, arthritis), pain, medication they are taking, or a substance they are using (like alcohol). Insomnia can vary in how long it lasts and how often it occurs. Insomnia can be short-term (called acute insomnia) or last a long time (called chronic insomnia). It can also come and go (or be intermittent), with periods of time when a person has no sleep problems. Acute (short-term) insomnia can last from one night to a few weeks. It is often caused by emotional or physical discomfort, and can be related to a single specific event. Causes of acute insomnia can include:
Chronic (long-term) insomnia is when a person has insomnia at least 3 nights a week for 1 month or longer. It can be caused by many things and often occurs along with other health problems. Common causes of chronic insomnia are depression, chronic stress, and pain or discomfort at night.
If you think you have insomnia, talk to your health care provider. An evaluation may include a physical exam, a medical history, and a sleep history. You may be asked to keep a sleep diary for a week or two, keeping track of your sleep patterns and how you feel during the day. Your health care provider may want to interview your bed partner about the quantity and quality of your sleep. In some cases, you may be referred to a sleep center for special tests.
Acute, or short-term insomnia, may not require treatment. But if your insomnia makes it hard to function during the day because you are sleepy and tired, your health care provider may prescribe sleeping pills for a limited time. The rapid onset, short-acting medications now available avoid many of the earlier problems with continuing effects (like feeling drowsy or groggy) the following day. Some medications may be less effective after several weeks of nightly use, however, and long-term safety and effectiveness has not yet been established. Side effects of sleeping pills (and over-the-counter sleep medicines) can be a problem, too. Mild insomnia often can be prevented or cured by practicing good sleep habits (see below). Treatment for chronic (long-term) insomnia includes first treating any underlying conditions or health problems that are causing the insomnia. If insomnia continues, your health care provider may suggest behavioral therapy or medication. Most medicines that are used for sleep have side effects and must be used with caution. It is not recommended to use over-the-counter sleeping pills for insomnia. Behavioral approaches to treatment focus on changing behaviors that may worsen insomnia and learning new behaviors to promote sleep. Techniques such as relaxation exercises, sleep restriction therapy, and reconditioning may be useful.
Good sleep habits can help you get a good night's sleep. For example:
See your health care provider if you think that you have insomnia or another sleep disorder.
Sleep apnea (sleep-disordered breathing) is a serious and common sleep disorder affecting about 12 million Americans, according to the National Institutes of Health (NIH). Its name comes from a Greek word, apnea, meaning "without breath." People with sleep apnea stop breathing briefly many times during the night. The breathing pauses last at least 10 seconds, and there may be 20 to 30 or more pauses per hour.
The main symptoms of sleep apnea are persistent loud snoring at night and daytime sleepiness. Another symptom is frequent long pauses in breathing during sleep, followed by choking and gasping for breath. People with sleep apnea don't get enough restful sleep, and their daytime performance is often seriously affected. Sleep apnea may also lead to high blood pressure, heart disease, heart attack, and stroke. However, it can be diagnosed and treated.
Sleep apnea occurs in all age groups and both sexes but is more common in men, people who are overweight or obese, and older persons. The disorder is made worse by fat buildup in the neck or loss of muscle tone with aging. People most likely to have or develop sleep apnea include those who snore loudly and are overweight, have high blood pressure, or have some other limitation in size of the upper airways.
Intermittent (comes and goes) blockage in some part of the upper airways, often due to the throat muscles and tongue relaxing during sleep, can cause sleep apnea. When the muscles of the soft palate at the base of the tongue and the uvula (the small fleshy tissue hanging from the center of the back of the throat) relax and sag, the airway becomes blocked. The blockage makes breathing labored and noisy and even stops it altogether.
During the pauses in breathing, the oxygen level in your blood drops. Your brain reacts to the drop in oxygen by waking you enough to resume breathing (and snoring), but not necessarily enough to fully awaken you. The cycle of snoring, not breathing, waking, and resuming breathing means that you do not get good quality sleep. Because of this, you may often feel very sleepy during the day, find it hard to concentrate, and your daytime performance may suffer. The effects of sleep apnea range from annoying to life threatening. They include depression, high blood pressure, irritability, sexual dysfunction, learning and memory problems, and falling asleep while at work, on the phone, or driving. People with severe sleep apnea are two to three times more likely to have automobile crashes. Risk for heart attacks, high blood pressure, heart failure, and stroke also increase with sleep apnea.
People with sleep apnea are often not aware that they have it. You should suspect sleep apnea if you often feel sleepy during the day, and you have been told that you snore loudly and frequently, or seem to have trouble breathing during the night. Your bed partner may notice your heavy snoring and struggles to breathe during sleep. Coworkers or friends may notice that you tend to fall asleep during the day at inappropriate times. If you think that you have sleep apnea, it is important that you see a doctor for evaluation of the sleep problem.
In addition to your primary care provider, a sleep medicine specialist needs to be involved in the diagnosis, as well as treatment. Diagnosis of sleep apnea is not simple because there can be many different reasons for disturbed sleep. If sleep apnea is suspected, the sleep medicine specialist will need to perform a sleep study. This usually means going to a sleep center, where tests are done while you sleep. This test is called polysomnography, which records a variety of body functions during sleep. These recordings can sometimes be done at home.
The specific therapy for sleep apnea is based on your medical history, physical exam, and the results of polysomnography or other tests.
Possible treatments for sleep apnea include:
Medications are generally not effective in the treatment of sleep apnea. However, if nasal congestion is contributing to breathing problems, decongestants may help.
Avoiding weight gain as you age is probably one of the best ways to prevent sleep apnea. Avoiding the use of alcohol and sedating medicines may also help.
Narcolepsy is a chronic, or long-lasting, sleep disorder with no known cause. It affects the body's central nervous system, which is made up of nerves that carry messages from the brain to other parts of the body. When a person has narcolepsy, messages about when to sleep and when to be awake can get mixed up. This can cause a person to fall asleep when they do not want to, and often without any warning like feeling drowsy. The desire to sleep can be overwhelming and hard to resist, and can happen to a person several times during the day. Night sleep may also be poor, broken up by waking up often during the night. If not controlled with medication, narcolepsy can cause serious problems in a person's personal, social, and work life. It can also limit a person's activities, such as driving a car, work, and exercising. Studies indicate that narcolepsy may run in families.
While it can happen at any age, symptoms of narcolepsy most often begin between the ages of 15 and 30. The main symptoms are cataplexy and being extremely sleepy during the day, even after a good night's sleep. There are other symptoms of narcolepsy, listed below, which may not occur in all people. These symptoms often come and go. But being very sleepy during the day is a symptom that can be chronic, or long lasting. Other symptoms include waking up during the night, tossing and turning in bed, leg jerks, and nightmares.
Some 200,000 Americans are thought to have narcolepsy. It is sometimes mistaken for depression, epilepsy, or the side effects of medications. You should be checked by a sleep medicine specialist for narcolepsy if:
After having a complete medical history and physical exam, a person's doctor may order further tests. It is important to see a sleep medicine specialist at a sleep center for evaluation, since narcolepsy can be hard to diagnose and treat effectively. It can be mistaken for other conditions like depression and epilepsy, or the side effects of medications.
Two common tests for narcolepsy are:
There is no cure for narcolepsy. It is a life-long condition, but there is help for a person with this condition to have a good and productive life. Symptoms can be controlled with medicine and lifestyle changes. The extreme daytime sleepiness can be treated with stimulant drugs (or drugs that keep you awake) such as modafinil (Provigil). Caffeine and over-the-counter stimulants do not work to reduce daytime sleepiness. Antidepressants are sometimes used to treat cataplexy, hypnagogic hallucinations, and sleep paralysis.
People with narcolepsy who have other health conditions, such as high blood pressure, diabetes, or heart disease, should talk with their doctor about other medicines they are taking. Some over-the-counter and prescription drugs may interact with those drugs taken for narcolepsy. Changes in lifestyle can help to treat and control narcolepsy. Taking daytime naps and developing good sleep habits are important. Taking short naps (10 to 15 minutes) 2 to 3 times a day can help control extreme daytime sleepiness and sleep attacks. Having good sleep habits helps a person to get good quality nighttime sleep. What helps is to: not have caffeine or alcohol and not smoke in the late afternoon or evening; get regular exercise, but don't exercise up to 3 hours before you go to bed; don't use your bed for anything but sleeping; and get enough sleep (around 8 hours) every night. If you have narcolepsy, it is important to talk on a regular basis with your health care provider. This will help you to get the best treatment possible for your symptoms.
You can manage your condition so you can enjoy life the way you want to. Ways to manage narcolepsy include:
Restless legs syndrome (RLS) is a sleep disorder in which a person has unpleasant feelings or sensations in the legs. These feelings are described as creeping, crawling, tingling, pulling, or painful. While these sensations happen most often in the calf or lower leg area, they can be felt anywhere from the ankle to the upper thigh. RLS symptoms can occur in one or both legs and can also be felt in the arms. These symptoms occur most often when lying down, but can also occur when sitting for long periods of time, such as at a desk, riding in a car, or watching a movie. People with RLS talk about having an irresistible urge to move the legs. Moving the legs, walking, rubbing or massaging the legs, or doing knee bends can bring relief, at least for a short time. Unlike other conditions, RLS symptoms get worse when relaxing or lessening activity, particularly during the evening and nighttime sleeping hours. Many people with RLS have trouble falling asleep and staying asleep. If not treated, RLS can cause extreme tiredness and daytime fatigue. A person's job, personal life and daily activities can be strongly affected due to exhaustion. A person can lose their ability to focus and have memory loss. Many people with RLS also have a related sleep disorder called periodic limb movements in sleep (PLMS). With PLMS, a person jerks or bends their legs unintentionally during sleep. These movements can happen every 10 to 60 seconds, or hundreds of times, during the night. They can wake a person, disturb sleep, and wake bed partners. People who have both RLS and PLMS have trouble falling and staying asleep and can have extreme sleepiness during the day.
RLS affects about 2 to 15 percent of Americans. But, it may actually affect more people. Some people with RLS do not seek treatment because they fear they won't be taken seriously, their symptoms are too mild, or that the condition can't be treated. Health care providers sometimes think the symptoms of RLS are caused by something else, like nervousness, insomnia (not being able to sleep), stress, arthritis, muscle cramps, or aging. RLS is thought to affect women more often than men. It can start at any age, even in young children, but most people with RLS are middle-aged or older. And, older people with RLS have symptoms more often and for longer periods of time. Young people who have RLS are sometimes thought to have "growing pains" or may be considered "hyperactive" because they cannot sit still in school.
RLS symptoms are not the same for every person. They range from uncomfortable to painful and can vary in frequency. A person can have periods when RLS does not cause problems, but the symptoms usually return. Another person can have severe symptoms every day.
Common symptoms of RLS include:
Certain medications, such as drugs for nausea, seizures, and psychosis, as well as some cold and allergy medicines, may make symptoms worse. Talk with your health care provider if you are taking any prescription or over-the-counter medicines.
In most cases, the cause of RLS is not known. For about half of all RLS cases, there is a family history of the condition. People who have RLS in the family tend to be younger when symptoms start and develop symptoms slowly.
RLS is thought to be related to the following factors or conditions:
There are no tests for RLS. It can be hard to diagnose and is easily confused with other conditions. When someone with RLS goes to see a doctor, there is often nothing wrong that the doctor can see or detect with a physical exam. Diagnosis therefore depends on what a person describes to the doctor. To help make a diagnosis, the doctor may ask about all current and past medical problems, family history, and current medications. A complete physical and neurological exam may help identify other conditions that may be linked with RLS, such as nerve damage (neuropathy or a pinched nerve) or abnormalities in the blood vessels. Basic lab tests may be done to assess overall health and to rule out anemia.
There is no cure for RLS. Sometimes RLS can be controlled by diagnosing and treating an underlying condition, such as peripheral neuropathy or diabetes. Treating the underlying disease can relieve many of the symptoms of RLS. For people who have RLS with no diagnosed cause (like an underlying disease), treatment is focused on symptom relief. For those with mild to moderate symptoms, lifestyle changes are often suggested including:
Health care providers may prescribe medicine for symptom relief. Three types of drugs are most often prescribed:
American Academy of Sleep Medicine
Phone Number(s): 708-492-0930
Internet Address: http://www.aasmnet.org
American Sleep Apnea Association
Phone Number(s): (202) 293-3650
Internet Address: http://www.sleepapnea.org
Narcolepsy Network, Inc.
Phone Number(s): (513) 891-3522
Internet Address: http://www.narcolepsynetwork.org
National Center on Sleep Disorders Research
Phone Number(s): (301) 435-0199
Internet Address: http://www.nhlbi.nih.gov/sleep
National Center on Sleep Disorders Research (NCSDR) (NHLBI)
Phone Number(s): (301) 435-0199
Internet Address: http://www.nhlbi.nih.gov/sleep
National Heart, Lung, and Blood Institute
Phone Number(s): (301) 592-8573
Internet Address: http://www.nhlbi.nih.gov
National Institute of Neurological Disorders and Stroke
Phone Number(s): (800) 352-9424
Internet Address: http://www.ninds.nih.gov
National Sleep Foundation
Phone Number(s): (202) 347-3471
Internet Address:
http://www.sleepfoundation.org
National Sleep Foundation
Phone Number(s): (202) 347-3471
Internet Address: http://www.sleepfoundation.org
Restless Legs Syndrome Foundation, Inc.
Phone Number(s): (507) 287-6465
Internet Address: http://www.rls.org