Having trouble falling asleep or staying asleep is incredibly frustrating. You may lay in bed for hours waiting to drift off, only to be wide awake thinking about your to-do list or replaying events from the day. This can leave you feeling exhausted the next day, which then makes it even harder to sleep that night, creating a vicious cycle of sleeplessness.
If you regularly have difficulty sleeping, you may have a sleep disorder. There are several different types of sleep disorders that can make it hard to get enough quality shut-eye. Understanding the root cause can help you find the right solutions to finally get the sleep you need.
Insomnia
Insomnia is one of the most common sleep disorders. The key symptom is difficulty falling or staying asleep even when you have the opportunity to sleep. This can include:
- Taking more than 30 minutes to fall asleep at night
- Waking up frequently throughout the night
- Waking up too early in the morning and being unable to fall back asleep
There are two main types of insomnia:
Acute Insomnia
Acute insomnia comes on suddenly and lasts for a short period of time. It may be caused by:
- Stress
- Environmental factors like noise, light, or uncomfortable temperatures
- Disruption from a different time zone or work schedule
- Illness
- Emotional difficulties like anxiety or depression
Acute insomnia often goes away on its own once the underlying cause has passed. For example, insomnia triggered by a stressful work project may resolve once the deadline is met.
Chronic Insomnia
Chronic insomnia is defined as difficulty sleeping for at least 3 nights per week for 3 months or longer. It may be caused by:
- Mental health disorders like depression, anxiety, bipolar disorder, PTSD
- Chronic stress
- Medications that disrupt sleep
- Chronic pain or discomfort
- Other health conditions like asthma, heart failure, hyperthyroidism, acid reflux, Alzheimer’s, Parkinson’s
- Behavioral factors like inconsistent sleep routines, using electronic devices before bed, consuming caffeine late in the day, or having an uncomfortable sleep environment
Treating any underlying medical or mental health issues can improve chronic insomnia. Making behavioral changes to promote healthy sleep hygiene may also help.
Sleep Apnea
Sleep apnea is a common disorder where breathing is disrupted briefly and repeatedly throughout the night. The most telltale sign is loud snoring with long pauses between breaths. This chronic condition can cause:
- Sleep fragmentation – Brief awakenings through the night you may not even remember
- Fatigue and sleepiness during the day
- Morning headaches
- Difficulty concentrating and mood changes
There are two types of sleep apnea:
Obstructive Sleep Apnea
This is the more common type, accounting for about 84% of sleep apnea cases. It occurs when the airway becomes blocked by the tongue, tonsils, or soft palate. The muscles supporting the airway relax during sleep, which can cause the airway to collapse and prevent air from getting through.
Central Sleep Apnea
Central sleep apnea happens when the brain does not properly signal the muscles that control breathing. As a result, breathing is disrupted periodically throughout sleep. It is much less common, accounting for only about 15% of sleep apnea cases.
Sleep apnea is usually treated with a CPAP machine that uses air pressure to keep the airway open. Oral appliances, surgery, and weight loss can also help in some cases.
Restless Leg Syndrome
Restless leg syndrome (RLS) is characterized by unpleasant sensations in the legs as well as an irresistible urge to move them. Symptoms typically occur in the evenings while relaxing or trying to fall asleep. Moving the legs temporarily relieves the uncomfortable sensations.
People with RLS describe the sensations in their legs in different ways. Some common descriptions include:
- itching
- crawling
- creeping
- pulling
- tingling
RLS can make it very difficult to fall or stay asleep. The constant leg movements and urges to move can significantly disrupt sleep quality.
Mild RLS may be managed by avoiding caffeine, alcohol, and nicotine. Establishing consistent sleep routines and using relaxation techniques before bedtime can also help. More severe RLS may require prescription medications to control symptoms.
Narcolepsy
Narcolepsy is a chronic neurological disorder that affects the brain’s ability to regulate normal sleep-wake cycles. The main symptom is excessive daytime sleepiness, even after getting enough nighttime sleep. People with narcolepsy tend to fall asleep frequently throughout the day.
Other common symptoms of narcolepsy include:
- Sleep paralysis – temporary inability to talk or move when falling asleep or waking
- Hallucinations when falling asleep or waking
- Disrupted nighttime sleep
Narcolepsy may also cause cataplexy, which is a sudden loss of muscle tone triggered by strong emotions like laughter, excitement, or anger. This can cause weakness or collapse, although people remain fully conscious.
There is no cure for narcolepsy, but medications can help regulate sleep-wake cycles and prevent daytime sleep episodes.
Parasomnias
Parasomnias are abnormal movements, behaviors, emotions, perceptions, and dreams that occur while falling asleep, during sleep, or when waking. Some examples of parasomnias include:
- Sleepwalking
- Sleep talking
- Nightmares
- Sleep paralysis
- Bedwetting
- Teeth grinding
Parasomnias are more common in childhood but can occur at any age. Treatment involves identifying and managing any underlying causes or triggers. Maintaining healthy sleep habits, sleeping alone, using relaxation techniques, and making the sleep environment safe can also help reduce episodes.
Circadian Rhythm Disorders
Circadian rhythm disorders occur when your biological clock is misaligned. This internal clock regulates your 24-hour sleep-wake cycle by controlling secretion of hormones like melatonin and cortisol. Jet lag is a temporary circadian rhythm disorder.
Chronic misalignment between your internal clock and the external day-night cycle can also develop, causing problems like:
- Advanced sleep phase disorder (ASP) – Falling asleep very early in the evening and waking up very early in the morning
- Delayed sleep phase disorder (DSP) – Struggling to fall asleep until very late at night and having difficulty waking in the morning
- Irregular sleep-wake rhythm – Inconsistent periods of sleep and wakefulness throughout the 24-hour day
Treatment focuses on resynchronizing the circadian rhythm using medications or supplemental melatonin as well as behavioral changes.
REM Sleep Behavior Disorder
REM sleep behavior disorder involves acting out vivid dreams by moving or even getting out of bed. This happens because the normal paralysis that occurs during REM sleep is disrupted.
Dream enactment can involve complex movements like walking, waving arms, grabbing, punching, kicking, or jumping out of bed. This can disturb sleep and poses a risk for injury to oneself or a bed partner.
This disorder is more common in older men but can occur in both genders at any age. Treating any underlying health conditions and making the sleep environment safe are key. Medications that reduce REM sleep may also help.
What Causes Sleep Problems?
Sleep disorders can have many underlying causes including:
- Mental health issues like anxiety, depression, bipolar disorder
- Chronic stress
- Grief
- Medications
- Genetics
- Poor sleep habits
- Medical conditions like chronic pain, asthma, Alzheimer’s, acid reflux, Parkinson’s
- Neurological disorders
- Hormonal imbalances
Identifying any underlying cause is key to finding the appropriate treatment. A sleep doctor can help diagnose the specific sleep disorder.
Getting a Sleep Disorder Diagnosed
If you regularly have trouble sleeping, start by discussing your symptoms with your primary care physician. They can perform an initial evaluation, screen for underlying conditions, and recommend lifestyle changes to promote healthy sleep.
Your doctor may refer you to a sleep specialist like a psychiatrist, neurologist, pulmonologist, or sleep medicine physician if needed. A sleep specialist can:
- Do an in-depth evaluation of your sleep health history
- Order specialized sleep tests if needed to confirm diagnosis
- Prescribe treatment options to help improve your ability to fall and stay asleep
Common diagnostic tests for sleep disorders may include:
Sleep Studies
Overnight sleep studies, also called polysomnography, are conducted at sleep centers or labs. Sensors monitor your breathing, heart rate, brain activity, and movement while you sleep. These comprehensive studies help identify sleep apnea, restless leg syndrome, narcolepsy, and parasomnias.
Home Sleep Tests
Simplified sleep monitoring equipment can be used at home to screen and diagnose sleep apnea. Home sleep tests involve wearing devices like portable oxygen sensors and heartbeat recorders while you sleep.
Sleep Logs and Questionnaires
Keeping a sleep diary where you record details about your sleep habits can help reveal patterns. Sleep questionnaires are also used to assess your symptoms and screen for common sleep disorders.
Treatments for Sleep Disorders
Treatment options will depend on the specific sleep disorder and underlying cause. But there are some general treatment categories that may help:
Lifestyle Changes
Steps like maintaining a consistent sleep-wake schedule, limiting naps, avoiding caffeine in the evenings, and using relaxation techniques before bedtime promote healthy sleep hygiene. Exercising regularly and limiting alcohol intake can also improve sleep.
Behavioral Therapy
Talk therapy helps address thought and behavior patterns that may be disrupting sleep. Cognitive-behavioral therapy (CBT) is commonly used to treat insomnia by identifying unhelpful thoughts about sleep and targeting behaviors sabotaging sleep.
Medications
Sleep medications like sedatives, hypnotics, melatonin supplements, and stimulants can help regulate sleep-wake cycles, prevent daytime sleepiness, or address underlying issues like anxiety and restless legs.
Breathing Devices
CPAP machines that deliver pressurized air through a face mask keep airways open for people with sleep apnea. Expiratory pressure devices provide resistance during breathing out to strengthen muscles.
Surgery
Surgeries like correcting a deviated septum, removing tonsils, or shrinking the tongue base help open up airways for some sleep apnea sufferers. Implanted nerve stimulators are also sometimes used for central sleep apnea.
Living with a Sleep Disorder
Having a sleep disorder can negatively impact your physical health, mental health, work performance, relationships, and quality of life. You may feel irritable or depressed and have difficulty focusing on tasks. Memory, decision-making abilities, reaction times, and alertness may also be impaired.
Poor sleep takes a major toll on the body over time. Ongoing sleep deprivation is linked to many health problems like obesity, high blood pressure, heart disease, stroke, weakened immunity, and diabetes. The risk for accidents and injuries also climbs.
But there are steps you can take in addition to treatment to better cope with and manage a chronic sleep disorder:
- Ask your doctor about any effects current medications may have on sleep.
- Avoid consumption of caffeine, nicotine, and alcohol, especially later in the day.
- Engage in relaxing activities before bedtime like light reading, gentle yoga, or meditation.
- Invest in a comfortable mattress and pillows.
- Keep the bedroom at a cool, comfortable temperature.
- Limit light exposure in the evenings and use blackout curtains.
- Use white noise machines or apps to mask disruptive sounds.
- Try to maintain a regular sleep-wake schedule, even on weekends.
- Take short daytime naps early in the day if needed.
- Exercise daily but not right before bed.
Getting support from loved ones also makes coping easier. Explain how your sleep disorder affects your functioning and mood. Enlist their help with healthy lifestyle changes and understanding when you are sleepy or irritable.
When to See a Doctor
Make an appointment with your primary care physician if you regularly:
- Need more than 30 minutes to fall asleep at night
- Wake up repeatedly through the night
- Wake up too early in the morning
- Feel unrested during the day despite enough time spent asleep
- Feel sleepy during the day, have trouble staying awake, or nod off unintentionally
- Are told you stop breathing or gasp/snore loudly during sleep
- Experience tingling, crawling, itching, pulling, twitching, or pain in your legs at night
- Wake up confused about where you are, feel weakness in your body, or are unable to move or speak
- Regularly engage in unusual behaviors during sleep like walking, talking, or eating
Paying attention to your sleep quality and discussing any concerns with your doctor are important first steps. They can rule out underlying health issues and determine if you should see a sleep specialist for a sleep disorder diagnosis.
Conclusion
Sleep disorders disrupt the quality and quantity of sleep you get each night. Common culprits include insomnia, sleep apnea, restless leg syndrome, narcolepsy, parasomnias, and circadian rhythm disorders. Treatment depends on identifying any underlying medical, mental health, or behavioral causes.
A combination of lifestyle changes, therapy, medications, devices, and sometimes surgery can help manage sleep disorders. Though challenging, there are many changes you can make and professional supports available to improve your ability to fall and stay asleep.
Pay attention to your symptoms and talk to your doctor if you regularly have trouble sleeping. Diagnosing and addressing any sleep problems is important for protecting both your physical and mental health.