Sleep Disorders

Sleep disorders are one of the most prevalent medical conditions, and nearly everyone will experience some sleep disturbance during their lifetime. However, this both understates and overstates the real problem. It’s true that most people will have some trouble with their sleep occasionally, but for millions of Americans, struggling with sleep is a nightly battle. For these people, sleep may seem like it’s never available when it’s needed, or that it’s impossible to escape it at times. Fortunately, there are treatment options for people looking for relief, and most patients will find some combination of those treatments to be effective.

What are some of the most common sleep disorders?

There are dozens of defined sleep disorders, and they truly run the gamut in their symptoms, their underlying causes and their severity. In fact, there is significant overlap between sleep disorders and behavioral or mood disorders, and this psychological link means that every condition is nearly unique. Effective treatment relies on understanding the patient’s medical history, psychological history and any other risk factors.

That said, there are many sleep disorders that are common and present the same way, for the most part, patient to patient. Some of those disorders include:

1. Insomnia – Far and away, insomnia is the most prevalent sleep disorder in the world, and close to half of all people will experience it, at least temporarily, during their life. Insomnia is among the nation’s most common chronic disorders as well, with up to 10 percent of all Americans reporting chronic instances of insomnia.

People with insomnia suffer from a general lack of sleep quality, which may be caused by an inability to fall asleep at night or stay asleep. Patients may wake up in the middle of the night for no reason and may feel completely alert. It’s also common for people with insomnia to wake up earlier in the morning than they intended.

Waking up and staying awake means the body and brain aren’t getting enough rest. As a result, people with insomnia often suffer from a lack of energy, daytime sleepiness, problems with concentration, forgetfulness, lowered cognitive performance, depression and altered mood or behavior. Sometimes, a chronic lack of sleep can put someone in a constant irritable and frustrated state that makes it difficult for them to maintain interpersonal relationships.

A physician will first assess whether a patient’s insomnia is acute or chronic, looking at recent sleep patterns to make this determination. There can be a single or many underlying causes, ranging from stress to serious disease or injury. In some cases, the insomnia may be idiopathic, which means there isn’t a single definable reason for the condition. Treatment can still be a help, though, even for those suffering from idiopathic insomnia.

2. Narcolepsy – Some believe that narcolepsy is the opposite of insomnia, but that’s not exactly correct. Narcolepsy and insomnia share much in common, in that both manifest as an inability to control sleeping rhythms. Unlike insomnia, though, narcolepsy refers to someone who tends to suffer from excessive sleepiness during the day.

Narcolepsy is much more rare than insomnia, affecting around 200,000 Americans. People who suffer from narcolepsy cannot control their sleep/wake cycle, falling into deep sleep with seemingly no warning. These sleep “attacks” can occur at any time, no matter what the person’s activity level is. This makes narcolepsy particularly dangerous, as sleep attacks can happen at times when it may cause immediate danger, like when driving or when eating.

Excessive daytime sleepiness is characteristic of narcolepsy, but other symptoms may present. Sleep paralysis, for example, occurs when the patient is entering or coming out of sleep. Their muscles have been “paralyzed” by the brain, as it is in the midst of REM sleep. This can occur even when the patient is fully awake and aware, which means they can perceive their surroundings but not move. Cataplexy is also a frequent symptom of narcolepsy and is similar to sleep paralysis. During a cataplectic attack, the muscles lose tone and become weak or give out entirely. This happens even when the patient is fully aware of their surroundings, and falls are common. Narcoleptic patients may also suffer from vivid hallucinations, especially when entering or coming out of sleep, and, ironically, fragmented nocturnal sleep.

While insomnia can have a multitude of causes, narcolepsy appears to be a wholly physical phenomenon, though the physical causes are not completely understood. One promising area of study appears to be neurotransmitter balance, which is greatly altered in people with narcolepsy.

3. Sleep apnea – Obstructive sleep apnea, or OSA, is second only to insomnia in prevalence. Approximately 20 million people in the U.S. suffer from it, though the vast majority of those people don’t even realize they have it. In fact, up to 80 percent of people with OSA may go to sleep every night without realizing that their respiratory and cardiovascular systems are put under great strain due to OSA.

During sleep, the softer tissues in the throat settle and relax, and this can cause them to block the airway. When partial blockage is present, the patient will begin snoring. If the airway is completely blocked off, the brain has to jump out of deep sleep to force air into the lungs. This constant disruption prevents the brain from staying in the critical deep stages of sleep that are essential for proper tissue repair. This cycle of disruption is also hard on the heart, which is why OSA is associated with many serious heart problems, like arrhythmia, heart failure or heart attack.

OSA is marked by restless sleep, irritability, snoring, excessive daytime sleepiness and headaches, and if these symptoms seem chronic, then a sleep evaluation may be required. Fortunately, OSA is the most treated sleep disorder in the world, and its causes are almost always physical and correctible.

4. Restless Leg Syndrome – Restless Leg Syndrome, or RLS, is a sensorimotor disorder that manifests as pain or as an unpleasant sensation in the legs when relaxing in bed. The sensations are most noticeable when the patient is inactive in bed. These sensations are often described as creeping or burning, and they may even be painful if the legs are not moved. RLS affects up to 10 percent of adults and about 2 percent of children, and is twice as likely to present in women.

RLS can be distressing to people and disrupt their sleep to the point of leaving them deprived of rest. However, RLS is a symptom of an underlying condition, and treating RLS means treating this condition. Diabetes, neuropathy, iron deficiency, kidney failure, Parkinson’s disease, certain medications and tobacco or alcohol use can all play a role in RLS aggravation or presentation.

These are the most common sleep disorders, but there are many more out there. Disorders like bruxism (teeth grinding at night), sleep phase disorders, sleepwalking and night terrors are other frequently seen disorders, and all can be addressed with the help of a physician.

Sleep is precious and essential to optimal daily functioning. Any disorder that compromises it to an extent can have profound effects on the patient, including long-term complications that pose a major threat to quality of life. Fortunately, primary care physicians can help and provide treatment, insight and guidance into the world of sleep disorders.