Sleep is a basic human need, and is as important for good health as diet and exercise. When we sleep, our bodies rest but our brains are active. Sleep lays the groundwork for a productive day ahead. Although most people need seven to nine hours of sleep each night to function well the next day, the National Institute of Neurological Disorders and Stroke reports that about 40 million people in the United States suffer from chronic long-term sleep disorders each year and an additional 20 million people experience occasional sleep problems.
A 2005 NSF Sleep in America poll of all adults revealed that women are more likely than men to have difficulty falling and staying asleep and to experience more daytime sleepiness at least a few nights/days a week. Research has shown that too little sleep results in daytime sleepiness, increased accidents, problems concentrating, poor performance on the job and in school, and possibly, increased sickness and weight gain. Understanding the effects of body chemistry, environmental factors, and lifestyle habits can help individuals enjoy a good night’s sleep.
What types of sleep disorders are there and how are they classified? Below is a list of the more common types and subtypes of sleep disorders.
Insomnia: Difficulty falling or staying asleep with sleepiness, irritability, and decreased cognitive function throughout the day. Insomnia can be caused by stress, life transitions, environmental factors, some medications, depression, anxiety, or environmental problems.
- Chronic: Three nights a week for a month or longer
- Short Term (Acute): One night to a few weeks
Sleep Related Movement Disorders: simple, usually stereotyped movements during the night that can wake an individual up or make it difficult for them to fall asleep. Subtypes are:
- Restless Leg Syndrome (RLS): A sensorimotor disorder characterized by the urge to move one's legs (rarely arms). Associated with tingling, burning, aching sensations in the muscles so that one must move them. Symptoms can be worse at night, affecting sleep.
- Periodic Limb Movements of Sleep (PLMS): Short, jerky movements of the limbs that occur every 20-30 seconds throughout the night and can severely disrupt sleep causing fatigue during the day. More than 80% of people who have RLS also have PLMS.
- Sleep Related Leg Cramps: Muscle tightening and cramping that occurs very suddenly while an individual is asleep. Cramps can last a few seconds to a few minutes and cause sleep disturbance.
- Sleep Related Bruxism: Teeth grinding during sleep that can cause jaw pain, headaches, and tooth damage. Usually caused by anxiety and stress while awake.
Hypersomnia: Also known as Excessive Daytime Sleepiness (EDS). Characterized by an individual's ability to fall asleep during waking hours, even while driving or working. These individuals usually get normal amounts of sleep during the night but are sleepy during the day and have difficulty with cognitive functioning.
- Primary: Daytime sleepiness occurring most if not all of the time.
- Recurring: Occasional daytime sleepiness. Periods can last one-two days recurring over the span of a year.
- Narcolepsy: A disorder characterized by an individual falling asleep at inappropriate times such as driving or walking.
Sleep Related Breathing Disorders: A disruption in an individual's normal breathing patterns during sleep. If sleeping alone, an individual may not know he or she suffers from a breathing disorder.
- Sleep Apnea: The most common of Sleep Related Breathing Disorders.
- Obstructive Sleep Apnea (OSA): Occurs when the throat and upper airway collapse during sleep causing breathing to stop, which can happen ten-1,000 times per night. This disorder is associated with heart and circulatory problems due to the lack of oxygen in the body.
- Central Sleep Apnea (CSA): Occurs when the body stops automatic breathing during sleep. CSA can be related to certain medications, diseases that affect the central nervous system, or strokes.
- Other irregular breathing patterns during sleep can be caused by:
- High altitude: above 15,000 feet
- Medications or drugs such as opiates
- Cheyne-Stokes breathing pattern: a rhythmic increase and decrease of automatic breathing while sleeping
Parasomnias: Disorders classified by abnormal behavior of the nervous system during sleep. Many of these disorders are dissociated sleep states in which the individual is partially aroused between sleep and wake cycles. Subtypes are:
- Somnabulism (Sleep Walking): An individual gets up out of bed, walks around and does other activities while asleep such as urinating or talking. They will not remember these episodes and are very difficult to awaken.
- Sleep/Night Terrors: A disorder characterized by an individual screaming, shouting, and thrashing in bed caused by a nightmare and intense fear. Individuals usually do not remember these episodes and are not consolable at first.
- Sleep Enuresis (Bedwetting): Urinating in one's sleep caused by failure to wake up when the bladder is full, or lack of contraction in the bladder. Most common in children, as they do not have full bladder control yet.
- Sleep Related Eating Disorder: A disorder in which an individual gets up while asleep and binge eats. These episodes can cause fatigue during the day, weight gain, and stomach pain related to eating strange foods or objects.
Circadian Rhythm Sleep-Wake Disorders: Disorders in which an individual's circadian rhythm is disturbed caused by work-related changes or other environmental factors. Essentially the individual is awake when everyone else is sleeping and vice versa. Some of the more common include:
- Shift-Work Sleep Disorder: Affects individuals who work night shifts.
- Jet -Lag: Results in a circadian rhythm disturbance caused by traveling across multiple time zones in a short period of time.
How are sleep disorders treated?
Sleep disorders can be treated with improved sleep hygiene, programs such as CBTI, and/or medications to help the body fall asleep and rise appropriately.
Good sleep hygiene can also be effective in treating insomnia and other sleep disorders. The following are some guidelines for healthy sleep habits.
- Avoid caffeine and other stimulants 12 hours before bedtime.
- Avoid napping during the day.
- Avoid large meals right before bedtime.
- Ensure that you are properly hydrated throughout the day.
- Exercise! Working the body vigorously at any time can promote good and restful sleep.
- Create a sleep routine before bedtime. This may include relaxing activities such as having a cup of herbal tea, taking a bath, reading a book, or meditating.
- Go to sleep and wake at the same times to train your brain and body.
- Associate your bed ONLY with sleeping and sex. Avoid doing work or other activities in your bed.
- Turn off the TV and other noises, except for white noise or quiet, relaxing music.
- 30 minutes before bedtime, turn down lights and close the curtains to create a dark space. Do not use electronic devices that have a bright screen during this period as well. Darkness tells your brain that it's time to go to sleep.
- If you grind your teeth during sleep, ask your dentist for a mouth guard to protect your teeth and jaw and wear it to bed every night.
- If you are unable to fall asleep in 5-10 minutes, get up out of bed and do something relaxing until you get sleepy. If you watch the clock or become frustrated because you are not falling asleep quickly enough, this can impede your sleep even more.
CBT for Insomnia (CBTI) is a behavioral treatment course for those who have difficulty sleeping and already practice healthy sleep hygiene without success. Usually 4-8 sessions are completed with a therapist intended to teach skills for overcoming insomnia, and it is helpful for recurring episodes. CBTI includes education on sleep hygiene and normal sleep patterns, a review of the patient's sleep patterns and history, and an in-depth analysis of the thoughts, feelings, and behaviors that compromise sleep. The therapist and patient will then discuss skills for the patient to practice to counter the insomnia, such as using a sleep log or restricting sleep. CBTI may or may not include medications, depending on each individual's case.
Common medications for treating sleep disorders include:
- Ambien - Effective in helping individuals fall asleep but some may wake up throughout the night
- Lunesta - Helps to fall asleep quickly but may cause drowsiness the next day
- Rozerem - Works by targeting the sleep-wake cycle rather than depressing the nervous system
- Sonata - Stays active in the body for a short period of time so that if you wake at 2am and take a dose, you will not be groggy the next day
- Silenor - Works to inhibit the histamine receptors to help individuals stay asleep throughout the night
- Benzodiazepines - These medications depress the nervous system and are effective in treating sleep terrors and sleep walking. Common types are Xanax and Klonopin.
- Antidepressants - Effective in treating insomnia caused by depression and anxiety
- OTC Medications: These can be found in your local grocery or drug store. Doxylamine is a common OTC medication and is found in brand names like Unisom and Nighttime Sleep Aid. This medication may cause prolonged drowsiness. It also may not be safe if you're pregnant or breast-feeding or you have a history of enlarged prostate, asthma, or glaucoma. Benadryl and NyQuil can also be used to cause sleepiness.
Supplements: Supplements made from plants may reduce the amount of time it takes to fall asleep and help you sleep better. However, it's not clear what the active ingredient is. Also, the potencies of various ingredients vary from preparation to preparation. Melatonin and Valerian are examples of supplements that treat insomnia.
If you think you suffer from a serious sleep disorder, talk with your provider about beginning CBTI, completing a sleep study, or possible medications to aid your sleep routine. Always practice good sleep hygiene, even if you do not have trouble sleeping.