Sleep wake disorders
Overview
Sleep disorders are among the most common clinical problems encountered in medicine and psychiatry. Inadequate or nonrestorative sleep can markedly impair a patient’s quality of life.[1] Sleep disorders may be primary or may result from a variety of psychiatric and medical conditions.Primary sleep disorders result from an endogenous disturbance in sleep-wake generating or timing mechanisms, often complicated by behavioral conditioning.Some common types of sleep disorders include:
- Insomnia, in which you have difficulty falling asleep or staying asleep throughout the night.
- Sleep apnea, in which you experience abnormal patterns in breathing while you are asleep. There are several types of sleep apnea.
- Restless legs syndrome (RLS), a type of sleep movement disorder. Restless legs syndrome, also called Willis-Ekbom disease, causes an uncomfortable sensation and an urge to move the legs while you try to fall asleep.
- Narcolepsy, a condition characterized by extreme sleepiness during the day and falling asleep suddenly during the day.
Causes
There are many conditions, diseases, and disorders that can cause sleep disturbances. In many cases, sleep disorders develop as a result of an underlying health problem.
Allergies and respiratory problems
Allergies, colds, and upper respiratory infections can make it challenging to breathe at night. The inability to breathe through your nose can also cause sleeping difficulties.
Frequent urination
Nocturia, or frequent urination, may disrupt your sleep by causing you to wake up during the night. Hormonal imbalances and diseases of the urinary tract may contribute to the development of this condition.
Be sure to call your doctor right away if frequent urination is accompanied by bleeding or pain.
Chronic pain
Constant pain can make it difficult to fall asleep. It might even wake you up after you fall asleep. Some of the most common causes of chronic pain include: arthritis, chronic fatigue syndrome, fibromyalgia, inflammatory bowel disease, persistent headaches, continuous lower back pain.In some cases, chronic pain may even be exacerbated by sleep disorders. For instance, doctors believe the development of fibromyalgia might be linked to sleeping problems.
Stress and anxiety
Stress and anxiety often have a negative impact on sleep quality. It can be difficult for you to fall asleep or to stay asleep. Nightmares, sleep talking, or sleepwalking may also disrupt your sleep.
Symptoms
Symptoms differ depending on the severity and type of sleeping disorder. They may also vary when sleep disorders are a result of another condition.
However, general symptoms of sleep disorders include:
- difficulty falling or staying asleep
- daytime fatigue
- strong urge to take naps during the day
- unusual breathing patterns
- unusual or unpleasant urges to move while falling asleep
- unusual movement or other experiences while asleep
- unintentional changes to your sleep/wake schedule
- irritability or anxiety
- impaired performance at work or school
- lack of concentration
- Depression
- weight gain
Treatment
Cognitive behavioral therapy is the most widely-used therapy for sleep disorders. It may be conducted individually, in a group of people with similar sleeping problems, or even online. Since the causes and symptoms of sleep disorders vary considerably, CBT should always be tailored to your specific problems. Cognitive behavioral therapy for insomnia (CBT-I), for example, is a specific type of therapy designed for people who are unable to get the amount of sleep they need to wake up feeling rested and refreshed.
The length of therapy also depends on the type and severity of your sleep disorder. While CBT is rarely an immediate or easy cure, it is relatively short-term. Many CBT treatment programs for insomnia, for example, report significant improvement in sleep patterns following a course of 5 to 8 weekly sessions.
Lifestyle and behavior therapy: This approach encourages changes to improve sleep and to develop good sleep habits. Good sleep habits include maintaining regular sleep-wake times (even on weekends and vacations); avoiding naps (exception: shift workers); developing a regular routine of exercise (avoid high-intensity exercise within one hour of bedtime); and avoiding alcohol, caffeine, nicotine, and stimulating activities within several hours of bedtime.
Bright light therapy: Bright light therapy is used to advance or delay sleep. The timing of this treatment is critical and requires guidance from a sleep specialist. Bright light therapy works by resetting the circadian clock to be more in sync with the earth’s cycle of light and dark. A high intensity light (2,000 to 9,500 lux) is required and the duration and timing of exposure varies from one to two hours.
Exposure to bright light in the morning may help you if you have a delayed sleep disorder. You should also decrease your exposure to light in the evening and during the night by reducing indoor lighting and avoiding bright TV and computer screens. Exposure to bright light in the evening may help if you have advanced sleep disorder.
Medicines
Medications: Medications such as melatonin (available over-the-counter), wake-promoting agents (such as modafinil ) or caffeine, and short-term sleep aids may be used to adjust and maintain the sleep-wake cycle to the desired schedule. Tasimelteon is approved to treat non-24-hour sleep-wake disorder.