Sleep Disorders

What counts as a sleep disorder

Adults need about 7 to 9 hours of sleep a night, teenagers 8 to 10, and younger children more. Everyone has a bad night now and then. A sleep disorder is a persistent problem that affects your sleep and your daytime functioning: mood, concentration, safety, work, school or relationships.

The International Classification of Sleep Disorders groups them into seven categories. Understanding which group your symptoms fit helps point to the right test and treatment.

Types of sleep disorders

Insomnia

Insomnia is the most common sleep disorder. Chronic insomnia means trouble sleeping at least 3 nights a week for at least 3 months, despite adequate opportunity, with daytime effects. It often starts with stress and is kept going by habits such as lying awake in bed, napping and worrying about sleep. It is closely linked with anxiety, depression and chronic pain.

Obstructive sleep apnea

In obstructive sleep apnea, the throat repeatedly narrows or closes during sleep, cutting off breathing for 10 seconds or more. The brain briefly wakes you to reopen the airway, often hundreds of times a night without you knowing. Signs include loud snoring, witnessed pauses, gasping, unrefreshing sleep, morning headaches and daytime sleepiness. It raises the risk of high blood pressure, atrial fibrillation, stroke and car crashes. Risk factors include excess weight, a large neck, older age, male sex and menopause.

Restless legs syndrome

Restless legs syndrome causes an uncomfortable urge to move the legs in the evening or at rest, relieved by movement. Low iron, pregnancy, kidney disease and some medicines (antihistamines, some antidepressants) are common contributors.

Narcolepsy and hypersomnia

Narcolepsy causes overwhelming daytime sleepiness and sudden sleep attacks. Type 1 also causes cataplexy: brief loss of muscle tone triggered by laughter or emotion. Other features include sleep paralysis and vivid dream-like hallucinations when falling asleep or waking. Idiopathic hypersomnia causes long, unrefreshing sleep and great difficulty waking.

Circadian rhythm disorders

In circadian rhythm disorders, your body clock is out of step with the clock on the wall. Teenagers commonly have delayed sleep phase, falling asleep very late and struggling to wake. Older adults may have the opposite. Shift workers and travelers crossing time zones are also affected.

Parasomnias

• Sleepwalking and sleep terrors: common in children, arising from deep sleep in the first part of the night. The person is hard to wake and has little memory afterward.
• Nightmare disorder: frequent, distressing dreams, often linked to trauma or PTSD.
• REM sleep behavior disorder: acting out vivid dreams, often in men over 50. It can precede Parkinson's disease or Lewy body dementia by years and deserves specialist assessment.

Signs you may have a sleep disorder

• regularly taking more than 30 minutes to fall asleep, or lying awake for long stretches at night
• feeling tired or falling asleep during the day despite enough time in bed
• loud snoring, gasping or breathing pauses noticed by others
• waking with a headache or dry mouth
• needing caffeine to function, or dozing while reading, watching TV or driving
• uncomfortable leg sensations at night
• unusual behaviors during sleep
• irritability, poor concentration or low mood linked to poor sleep

How sleep disorders are diagnosed

• Sleep history: your doctor will ask about your sleep schedule, bedtime habits, snoring, naps, caffeine and alcohol, medicines, mood and medical conditions. A bed partner's observations are very useful.
• Sleep diary: a 1 to 2 week record of bed times, wake times, naps and how you felt.
• Questionnaires: the Epworth Sleepiness Scale scores daytime sleepiness; STOP-BANG screens for sleep apnea; the Insomnia Severity Index measures insomnia.
• Home sleep apnea test: a simple device worn overnight at home to measure breathing and oxygen levels.
• Polysomnography (overnight sleep study): done in a sleep lab, it records brain waves, eye movements, muscle activity, breathing, oxygen and heart rhythm. It diagnoses apnea, movement disorders and parasomnias.
• Multiple sleep latency test: a daytime nap study after polysomnography, used to diagnose narcolepsy and idiopathic hypersomnia.
• Actigraphy: a wrist-worn device that tracks sleep-wake patterns over weeks, useful for circadian disorders.
• Blood tests: such as ferritin for restless legs and thyroid tests for fatigue.

Treatment

Insomnia

Cognitive behavioral therapy for insomnia (CBT-I) is the recommended first treatment. It combines a fixed wake time, limiting time in bed to actual sleep, getting up if you cannot sleep, and changing unhelpful thoughts about sleep. It works as well as sleeping pills in the short term and better in the long term. It is available in person, by telehealth and through digital programs. Medicines may be added short term.

Sleep apnea

CPAP (continuous positive airway pressure), a machine that keeps the airway open with gentle air pressure through a mask, is the most effective treatment. Alternatives include oral appliances made by a dentist, weight loss (including with GLP-1 medicines for people with obesity), positional therapy, and in selected people, surgery or a hypoglossal nerve stimulator.

Other sleep disorders

• Restless legs: iron supplements if ferritin is low, avoiding triggers, and medicines such as gabapentin or pregabalin.
• Narcolepsy: scheduled naps and wake-promoting medicines; sodium oxybate or similar drugs for cataplexy.
• Circadian disorders: carefully timed bright light exposure and low-dose melatonin.
• Parasomnias: making the bedroom safe, treating triggers such as sleep deprivation, and sometimes medicines such as clonazepam or melatonin.

Healthy sleep habits

These help everyone and are part of treating most sleep disorders:

• Keep the same wake-up time every day, including weekends.
• Get outdoor light in the morning.
• Limit caffeine after midday and avoid alcohol close to bedtime. Alcohol helps you fall asleep but fragments sleep later in the night.
• Keep the bedroom cool, dark and quiet, and use it only for sleep and sex.
• Stop screens and work at least an hour before bed.
• Exercise regularly, but not right before bed.
• Avoid long naps, especially late in the day.

Why treating sleep disorders matters

Untreated sleep disorders raise the risk of car and work accidents, high blood pressure, heart disease, type 2 diabetes, obesity, depression and anxiety. They also reduce memory, mood and quality of life. Effective treatment usually improves daytime energy within weeks.

Frequently asked questions

What are the most common sleep disorders?

The most common are insomnia, obstructive sleep apnea, restless legs syndrome and circadian rhythm disorders such as delayed sleep phase and shift work disorder. Narcolepsy, idiopathic hypersomnia and parasomnias such as sleepwalking are less common.

How do I know if I have a sleep disorder?

Suspect one if you have trouble sleeping 3 or more nights a week for several months, feel very sleepy in the day despite enough time in bed, snore loudly with gasping, or have unusual movements or behaviors at night. A doctor can assess you and arrange a sleep study if needed.

What happens during a sleep study?

You sleep overnight in a private room in a sleep center while sensors on your head, face, chest, legs and finger record brain waves, breathing, oxygen, heart rhythm and movements. It is painless. For suspected sleep apnea, a simpler home test is often used instead.

What is the best treatment for insomnia?

Cognitive behavioral therapy for insomnia (CBT-I) is the first-line treatment recommended by major guidelines. It improves sleep in most people and the benefits last after treatment ends. Sleeping pills can help short term but carry side effects and dependence risk.

Can sleep disorders be cured?

Many can be resolved or well controlled. Insomnia often improves permanently with CBT-I. Sleep apnea can be controlled with CPAP and sometimes resolved with weight loss. Circadian disorders respond to light and melatonin. Narcolepsy is lifelong but treatable.