Written by Regina Gee of Wellspring Coaching
In the last two sleep articles we focused on why sleep is important for good health and how to get better sleep. For this month’s article on sleep, we discuss 8 common sleep disorders, their symptoms, and their typical treatments.
Insomnia
Insomnia is a sleep disorder that can make it hard to fall asleep, hard to stay asleep, or cause you to wake up too early and be unable to fall back asleep. Acute Insomnia (which lasts a couple of days or weeks) is usually the result of stress or trauma. Symptoms of insomnia include: difficulty falling asleep, waking up during the night, waking up too early, not feeling well-rested after a night’s sleep, daytime tiredness or sleepiness, irritability, depression, or anxiety, difficulty paying attention and remembering, difficulty focusing, increased errors or accidents, and ongoing worries about sleep. Insomnia may be a primary problem or the result of other conditions.
Some common causes of insomnia include: stress, travel or work schedule, poor sleep habits, or eating too much late in the evening. Certain medications (such as antidepressants, blood pressure medication, or asthma meds) can cause insomnia. Mental health disorders frequently disrupt sleep and cause insomnia, as well as other medical conditions such as chronic pain, cancer, diabetes, GERD, and heart disease. Other sleep disorders that disrupt sleep can cause insomnia. Substances such as caffeine, nicotine, and alcohol also impact your ability to fall asleep and prevent deeper sleep stages, leading to insomnia.
Developing good sleep habits (see previous post about sleep hygiene) help protect against insomnia. Treating insomnia normally looks like changing your sleep habits and addressing issues such as stress and medication. Biofeedback, cognitive behavioral therapy, and light therapy are other common treatments. Insomnia is complex and often related to a complicated web of other health problems and outcomes and so treating insomnia often requires a wholistic approach.
“Insomnia is a glamorous term for thoughts you forgot to have in the day.” Alain de Botton
Parasomnia (Nightmare Disorder)
Nightmare disorder is when nightmares happen often, cause distress, disrupt sleep, and cause problems with normal functioning or create a fear of going to sleep. Doctors refer to nightmare disorder as parasomnia. Symptoms of parasomnia include: vivid and upsetting dreams, dream storylines related to survival and safety threats, dreams waking you up, feeling scared/anxious/angry/sad/disgusted because of your dream, and dreams causing distress that keeps you from falling back to sleep easily. Nightmares are common and only considered a disorder if they occur frequently, cause major distress, cause problems in normal functioning, or cause behavior changes.
Nightmares usually occur during rapid eye movement (REM) sleep, which takes place in the later sleep stages and can be caused by stress or anxiety, trauma, sleep deprivation, medications, substance abuse, and some mental health disorders. Treatment for parasomnias includes treating underlying medical conditions, stress or anxiety treatment, imagery rehearsal therapy, and sometimes medication (most often used in cases of nightmares associated with PTSD).
“A ruffled mind makes a restless pillow.” Charlotte Bronte
Sleep Apnea
Sleep Apnea is when you repeatedly stop and start breathing during sleep. The common types of sleep apnea include: obstructive sleep apnea (occurs when throat muscles relax), central sleep apnea (occurs when the brain doesn’t send the proper signals to control breathing), and complex sleep apnea (the combination of the previous two). Symptoms of sleep apnea include: loud snoring, gasping for air during sleep, awakening with a dry mouth, morning headache, insomnia, excessive daytime sleepiness (hypersomnia), difficulty paying attention while awake, and irritability. For mild sleep apnea, lifestyle changes such as losing weight or quitting smoking may help alleviate it. Allergy treatment may also help. For more severe sleep apnea, the most common treatment is Continuous Positive Airway Pressure (CPAP).
“Without enough sleep, we all become tall two-year-olds.” Jojo Jensen
Narcolepsy
Narcolepsy is a chronic disorder with overwhelming daytime drowsiness and sudden “attacks” of sleep. Sometimes narcolepsy is accompanied by sudden loss of muscle tone (cataplexy), which can be triggered by strong emotion. This combination is called type 1 narcolepsy. Type 2 narcolepsy occurs without cataplexy. Symptoms of narcolepsy include excessive daytime sleepiness, sudden loss of muscle tone, sleep paralysis, changes in REM sleep, and hallucinations. Narcolepsy often co-occurs with other sleep disorders. Narcolepsy has no cure and its causes are unknown but can be managed with medication such as stimulants, SSRIs, and tricyclic antidepressants and lifestyle changes such as sticking to a schedule, taking naps, avoiding alcohol and nicotine, and exercising regularly.
“Your future depends on your dreams, so go to sleep.” Mesut Barazany
Restless Leg Syndrome (RLS)
Restless Leg Syndrome (aka Willis-Ekbom disease) is the uncontrollable urge to move your legs, typically happening in the evening or nighttime hours when you’re sitting or lying down. RLS symptoms include: sensations that begin after rest, relief with movement, worsening of symptoms in the evening, nighttime leg twitching. People with RLS describe unpleasant sensations in their feet or legs such as crawling, creeping, pulling, throbbing, aching, or itching. These sensations usually occur on both sides of the body. Treatment for RLS can involve treating an underlying condition (such as iron deficiency) and lifestyle changes. RLS treatment can also involve medication, such as meds that increase dopamine in the brain, meds that affect calcium channels, opioids, and muscle relaxants.
“The minute anyone’s getting anxious I say, ‘You must eat and you must sleep.’ They’re the two vital elements for a healthy life.” Francesca Annis
REM Sleep Behavior Disorder
REM sleep behavior disorder is a disorder in which you physically act out vivid (often unpleasant) dreams with vocal sounds and sudden arm and leg movements during REM sleep. Normally, people do not move during REM sleep, and the onset of this disorder is often gradual and worsens with age. This disorder is caused when the pathways in the brain that prevent movement during sleep no longer function correctly. Symptoms include episodes of movement (kicking, punching, arm flailing, jumping) and noise (talking, yelling, shouting) during sleep. Treatment for REM sleep behavior disorder can include physical safeguards such as padding the floor near the bed, removing dangerous objects from the bedroom, placing barriers on the side of the bed. It also includes medication such as melatonin and clonazepam.
“Happiness consists of getting enough sleep. Just that, nothing more.” Robert A. Heinlein
Non-24-Hour Sleep Wake Disorder (N24SWD)
Non-24-Hour Sleep Wake Disorder is characterized by a circadian rhythm (sleep wake cycle) that is either longer or shorter than 24 hours, leading to desynchronization from regular daylight hours. This results in irregular changes in appetite, mood, and alertness. People with N24SWD often have a hard time keeping work, school, or social commitments. While it is most common in people who are totally blind, sighted people can also have this disorder and it is often related to depression and other mental health disorders. Treatment for N24SWD involves sticking to a routine, melatonin supplements, and bright light therapy.
“Sleep is the golden chain that ties health and our bodies together.” Thomas Dekker
Excessive Daytime Sleepiness
Excessive daytime sleepiness is defined as difficulty staying awake or alert, or an increased desire to sleep during the day (not to be confused with fatigue). It is considered a disorder when it happens every day for at least three months. Symptoms of excessive daytime sleepiness include: trouble staying alert, feelings of irritation, memory problems, trouble focusing, difficulty retaining new concepts, difficulty making decisions, and risk-taking behaviors. Excessive sleepiness is caused by chronic lack of sleep (due to insomnia, irregular schedule, long work hours), poor sleep, and other sleep disorders. Treatment for excessive sleepiness involves improving your sleep hygiene, treating other underlying sleep disorders, and medication.
“In the midst of these hard times it is our good health and good sleep that are enjoyable.” Knute Nelson
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Sleep is a vital component of health, and like all things impacting health and wellbeing, it is deeply connected to other components of habit and life. If you have a sleep disorder or trouble sleeping, spend some time investigating your habits and question how you might shift some of them to get better sleep.
“Sleep is God. Go worship.” Jim Butcher
The information in this article is primarily from resources at The Mayo Clinic and The Sleep Foundation.
