Sleep Disorders

What are the different types of sleep disorders?

There are a number of different typessleep disorders, clinically called “sleep-wake disorders.” They include:

  • Insomnia Disorder
  • Hypersomnolence Disorder
  • Narcolepsy
  • Circadian Rhythm Sleep-Wake Disorders
  • Non-Rapid Eye Movement Sleep Arousal Disorder
  • Rapid Eye Movement Sleep Behavior Disorder
  • Nightmare Disorder
  • Restless Legs Syndrome
  • Substance/Medication-Induced Sleep Disorder
  • Other Specified and Unspecified Sleep-Wake Disorders

Breathing-related sleep disorders include:

  • Obstructive Sleep Apnea Hypopnea
  • Central Sleep Apnea
  • Sleep-Related Hypoventilation

In addition, other sleep-wake disorders may be diagnosed that do not fully meet the criteria for one of the disorders listed above but still cause significant distress or impairment in social, occupational, or other important areas of functioning.

What is Insomnia Disorder?

Insomnia is defined as having difficulty going to sleep or staying asleep. It is the most common sleep complaint. A diagnosis of “insomnia disorder” is based on one or more of the following symptoms:

  • Difficulty falling asleep.
  • Difficulty maintaining sleep, characterized by frequent awakenings or problems return to sleep.
  • Early-morning awakening with inability to return to sleep.

A diagnosis of insomnia disorder requires the following factors:

  • The sleep problems cause significant distress or impairment in social, occupational, educational, academic, behavioral, or other important areas of functioning.
  • The sleep difficulty occurs at least 3 nights per week and is present for at least 3 months.
  • The sleep difficulty occurs despite having adequate opportunity for sleep.
  • The insomnia is not better explained by another sleep-wake disorder (e.g., narcolepsy, a breathing-related sleep disorder, a circadian rhythm sleep-wake disorder, or parasomnia disorder).
  • The insomnia is not attributable to the physiological effects of a substance (e.g., a drug of abuse or medication), coexisting mental disorders, or coexisting medical conditions.
What causes Insomnia?

A brief period of insomnia is most often associated with anxiety, either in response to an anxious experience or in anticipation of an anxiety-provoking experience. In some persons, transient insomnia may be related to grief, loss, or almost any life change or stress.

Persistent insomnia involves anxiety that manifests as physical tension (somatization), apprehensive feelings, and/or ruminating thoughts.

Idiopathic insomnia, according to the American Sleep Association, is a form of chronic insomnia that lacks clear causes. It is theorized as being the result of neurochemical imbalances in the brain’s sleep system.

What are the treatments for Insomnia?
  • Pharmacological treatment
    Primary insomnia is commonly treated with benzodiazepines, zolpidem, eszopiclone (Lunesta), zaleplon (Sonata) and other hypnotic medications. A variety of over-the-counter sleep aids are also available. Nonprescription formulas include sedating antihistamines, protein precursors, and other substances. Melatonin is a leader among self-administered supplements believed by some to alleviate sleeplessness. Melatonin is an endogenous hormone produced by the pineal gland, which is linked to the regulation of sleep.

  • Cognitive-Behavioral Therapy
    Cognitive-behavioral therapy (CBT) as a treatment for insomnia uses a combination of behavioral and cognitive techniques to treat dysfunctional sleep behaviors, misperceptions, and distorted, disruptive thoughts about sleep. Behavioral techniques include universal sleep hygiene, stimulus control therapy, sleep restriction therapy, relaxation therapies, and biofeedback.
What is Hypersomnolence Disorder (Hypersomnia)?

Hypersomnolence disorder (hypersomnia) is based on self-reported excessive sleepiness despite a main sleep period lasting at least 7 hours, with at least one of the following symptoms:

  • Recurrent periods of sleep or lapses into sleep within the same day.
  • A prolonged period of sleep of more than 9 hours per day that is nonrestorative.
  • Difficulty being fully awake after abrupt awakening.

The excessive sleepiness occurs at least three times per week, for at least 3 months, causing significant distress or impairment in cognitive, social, occupational, or other important areas of functioning. A diagnosis of hypersomnolence disorder requires that the sleepiness is not better explained by another sleep disorder, use of a substance or medication, or a coexisting mental or medical disorder.

What are the different types of Hypersomnia?
  • Primary Hypersomnia is diagnosed when no other cause can be found for excessive sleeping occurring for at least 1 month. Some people are long sleepers who, as with short sleepers, show a normal variation. The pattern is without complaints about the quality of sleep, daytime sleepiness or difficulties with the awake mood, motivation and performance. Long sleep may be a lifetime pattern, and it appears to run in the family.
  • Kleine-Levin Syndrome is a relatively rare condition consisting of recurrent periods of prolonged sleep, from which patients may be aroused, with intervening periods of normal sleep and alert waking. Episodes typically last for a few days up to several weeks and appear one to 10 times per year.
  • Menstrual-Related Hypersomnia is a condition that affects some women during, or shortly before, the onset of their menses. The symptoms typically last for 1 week. Treatment with oral contraceptives is effective; therefore, the disorder is believed to be related to a hormone imbalance.
  • Idiopathic Hypersomnia is a disorder of excessive sleepiness in which patients do not have symptoms associated with narcolepsy. Age onset is usually between 15 and 30 years, and the hypersomnia becomes a lifelong problem.
  • Behaviorally Induced Insufficient Sleep Syndrome is diagnosed when an individual does not schedule an adequate amount of time for sleep and as a result suffers from daytime sleepiness, fatigue, loss of concentration, memory impairment, irritability, and moodiness.
  • Hypersomnia due to a Medical Condition may be caused by head trauma, stroke, encephalitis, Parkinson’s disease, inflammatory conditions, tumors, genetic diseases, and neurodegenerative diseases.
  • Hypersomnia due to Drug or Substance Use may result from use or abuse of sedative hypnotics, sedating antihistamines, sedating antidepressants, antiepileptics, neuroleptics, and opioid analgesics. Hypersomnia may also be provoked by withdrawal from traditional stimulants (cocaine, amphetamines) caffeine, or nicotine.
What are treatments for Hypersomnolence Disorder (Hypersomnia)?

Hypersomnia caused by insufficient sleep is treated by extending and regularizing the sleep period. If, however, the sleepiness arises from narcolepsy, medical conditions, or idiopathic hypersomnia, it is usually managed with medication.

What is Narcolepsy?

Narcolepsy is a condition characterized by excessive sleepiness. A diagnosis of narcolepsy is based on a recurrent periods of an irrepressible need to sleep, lapsing into sleep, or napping during the same day. These must have been occurring at least three times per week over the past 3 months.

In addition, a narcolepsy diagnosis requires at least one of the following:

  1. Episodes of cataplexy, defined as either (a) or (b), occurring at least a few times per month:
    • a. Brief episodes of sudden loss of muscle tone preceded by laughter or joking.
    • b. Spontaneous grimaces, or jaw-opening episodes with tongue thrusting, or decreased muscle tone, without any obvious emotional triggers.
  2. Nocturnal sleep polysomnography test results showing lower-than-normal levels of rapid eye movement (REM) sleep.
  3. Hypocretin deficiency, measured by inserting a needle into the spine (a test rarely used due to its dangers if something goes wrong).Hypocretin is a neuropeptide that transmits information between brain cells and plays a role in sleep regulation.

In addition to uncontrollable episodes of falling asleep during the day, other symptoms of narcolepsy include:

  • Hallucinations that occur at sleep onset or upon awakening.
  • Sleep paralysis, most often occurring when awakening in the morning.

Narcolepsy most frequently begins in adolescence or young adulthood, generally before the age of 30. The disorder either progresses slowly or reaches a plateau that is maintained throughout life.

What causes Narcolepsy?

Narcolepsy is caused by a basic central nervous system dysfunction of the brain involving the hypocretin system that regulates sleep and REM activity.Hypocretin is a neuropeptide that transmits information between brain cells and plays a role in sleep regulation.

What are treatments for Narcolepsy?

While no cure exists for narcolepsy, symptom management is possible. A regimen of forced naps at a regular time of day occasionally helps patients with narcolepsy. In some cases, this regimen alone can almost cure the condition without medication. When medication is required, stimulants are most commonly prescribed.

Sleep specialists often prescribe tricyclic drugs or SSRIs to reduce cataplexy. Although drug therapy is the treatment of choice, the overall therapeutic approach should include scheduled naps, lifestyle adjustment, psychological counseling, and drug holidays to reduce tolerance.

What are Breathing-Related Sleep Disorders?

Breathing-related sleep disorders include:

  • Obstructive Sleep Apnea Hypopnea
    Also referred to as obstructive sleep apnea, this sleep disorder occurs when the throat muscles intermittently relax and block one’s airway during sleep. This condition is diagnosed when a person experiences at least five occurrences of obstructive apnea or hypopnea(reduction of air flow) per hour of sleep evidenced by: (1) Snoring, snorting/gasping or breathing pauses, or (2) Daytime sleepiness, fatigue or unrefreshing sleep that is not better explained by another mental disorder or medical condition. The diagnosis may also be confirmed by polysomnography of 15 or more obstructive apneas and/or hypopneas per hour of sleep regardless of accompanying symptoms.

    Obstructive sleep apnea often occurs alongside hypertension, obesity, diabetes, cardiovascular disease, and heart failure.

  • Central Sleep Apnea
    This sleep disorder occurs when a person’s breathing repeatedly stops and starts during sleep.Central sleep apnea occurs because the brain does not send proper signals to the muscles that control breathing. This condition is diagnosed through evidence by polysomnography of five or more central apneas per hour of sleep.

This sleep disorder may occur as a result of other conditions, such as heart failure and stroke. Treatments for central sleep apnea may involve treating existing conditions, using a device to assist breathing, or using supplemental oxygen.

  • Sleep-Related Hypoventilation
    This sleep disorder occurs when a person’s breathing is restricted during sleep, leading to hyperventilation. This condition is diagnosed when polysomnography demonstrates episodes of decreased respiration associated with elevated carbon dioxide levels. Sleep-related hypoventilation can occur independently or, more commonly, with other medical or neurological disorders, substance abuse, or even the routine use of prescribed medications.
What are Parasomnias?

Parasomnias are disruptive sleep disorders that cause arousals and abnormal behavior while sleeping.  Diagnostic categories of parasomnias include:

  • Non-Rapid Eye Movement Sleep Arousal Disorders
    This type of sleep disorder involves recurrent episodes of incomplete awakening from sleep, usually occurring during the first third of a major sleep episode, accompanied by either one of the following:
    • Sleepwalking – Repeated episodes of rising from bed during sleep and walking about with a blank, staring face, unresponsive to others.
    • Sleep terrors – Recurrent episodes of abrupt terror arousals from sleep, usually beginning with a panicky scream.

During either of these type of sleep disorders, the person has no recollection of what happened, and recalls little or no dream imagery. A diagnosis is based on the episodes causing significant distress or impairment in social, occupational, or other important areas of functioning. The disturbance is not attributable to the physiological effects of a substance (e.g., drug of abuse or medication) or to a coexisting mental or medical disorder.

  • Nightmare Disorder
    With this sleep disorder, a person has repeated nightmares that usually involve efforts to avoid threats to survival, security, or physical safety. Generally, the nightmare occurs during the second half of a major sleep episode. Upon awakening from the nightmare, the individual rapidly becomes oriented and alert. The sleep disturbance causes significant distress or impairment in social, occupational, or other important areas of functioning, and is not attributable to the physiological effects of a substance (e.g., drug of abuse or medication).

  • Rapid Eye Movement Sleep Behavior Disorder
    This sleep disorder involves repeated episodes of arousal during sleep associated with vocalization and/or physical movements. The behaviors occur during rapid eye movement (REM) sleep and therefore usually occur more than 90 minutes after going to sleep. Upon awakening from these episodes, the individual is awake, alert, and not confused or disoriented. The behaviors cause significant distress or impairment in social, occupational, or other important areas of functioning (which may include injury to self or the bed partner). The disturbance is not attributable to the physiological effects of a substance (e.g., drug of abuse or medication) or another medical condition.

  • Restless Legs Syndrome
    With this condition, a person has the urge to movetheir legs, usually accompanied by discomfort in the legs, characterized by all of the following:
    • The urge to move the legs begins or worsens during periods of rest or inactivity.
    • The urge to move the legs is partially or totally relieved by movement.
    • The urge to move the legs is worse at night than during the day.

A diagnosis of restless legs syndrome is based on the symptoms above occurring at least three times per week over a period of at least 3 months. The symptoms cause significant distress or impairment in social, occupational, educational, academic, behavioral, or other important areas of functioning. The symptoms are not attributable to another mental disorder or medical condition (e.g., arthritis, leg edema, peripheral ischemia, leg cramps), are not better explained by a behavioral condition (e.g., positional discomfort, habitual foot tapping), and are not attributable to the physiological effects of a drug of abuse or medication.

  • Substance/Medication-Induced Sleep Disorder
    Thissevere sleep disturbance occurs during or soon after substance intoxication or after withdrawal from or exposure to a medication. The sleep disturbance causes significant distress or impairment in social, occupational, or other important areas of functioning.
What are Circadian Rhythm Sleep Disorders?

A circadian rhythm sleep disorder is a persistent pattern of sleep disruption that is primarily due to a misalignment between the body’s circadian rhythm (biological clock) and the sleep-wake schedule required by an individual’s physical environment or social or professional schedule. A diagnosis of a circadian rhythm sleep disorder is based on:

  • The sleep disruption leading to excessive sleepiness and/or insomnia.
  • The sleep disturbance causing significant distress or impairment in social, occupational, and other important areas of functioning.

There are several different types of circadian rhythm sleep disorders. They include:

  • Delayed Sleep Phase Type
    This type of sleep disorder occurs when a person’s biological clock runs slower than 24 hours or is shifted later than the desired schedule. This produces a phase delay in the sleepiness-alertness cycle. Individuals with delayed sleep phase are more alert in the evening and early nighttime, stay up later, and are more tired in the morning. These individuals are commonly referred to as “night owls.”

  • Irregular Sleep-Wake Type
    The irregular sleep-wake pattern occurs when the circadian sleep-wake rhythm is absent or diminished. Individuals with this condition have a normal amount of sleep during a 24-hour period; however, it is fragmented into three or more sleep episodes that occur irregularly. Long daytime naps and nocturnal wakefulness occur with symptoms of insomnia at night and excessive sleepiness during the day. A history of reclusion or isolation may be associated with this condition. This type of sleep disorder is typically associated with neurodegenerative disorders, such as Alzheimer’s disease and some neurodevelopmental issues in children.

  • Shift Work Type
    This irregular sleep-wake pattern occurs with individuals who work the night shift but retain an unshifted circadian rhythm. Furthermore, to meet social demands, shift workers often adopt a non-shifted sleep-wake schedule on weekends and holidays. The result can be severe insomnia when attempting to sleep and excessive sleepiness when trying to stay awake.

  • Jet Lag Type
    This irregular sleep-wake pattern can occur when an individual rapidly travels across many time zones. Those who frequently travel for business can find themselves quite impaired at the time they need to make important decisions. “Night owls” will experience greater difficulty adjusting to eastward travel, while “larks” will have more problems with westward travel. Normally, healthy individuals can easily adapt to one to two time zone changes per day. Natural adjustment to an 8-hour translocation may take 4 or more days.

  • Due to Medical Condition
    Patients who are bedridden, hospitalized, or dealing with some forms of dementia, often sleep ad lib. The resulting chaotic sleep-wake pattern adversely affects the circadian rhythm, which may be further exacerbated by medication with sedative properties.
What are treatments for Circadian Rhythm Sleep Disorders?

There are several approaches for treating circadian rhythm sleep disorders. These include the following:

  • Chronotherapy
    Chronotherapy is one technique used to reset the biological clock. It involves progressively phase-delaying a person’s sleep time until their biological clock is synchronized with the desired sleep-wake schedule. 

  • Light or Phototherapy
    Studies indicate that exposing an individual to bright lights (greater than 10,000 lux) can alter their biological rhythm. With precise timing of bright light exposure, the biological clock can be stopped and reset. The blue part of the light spectrum is the crucial ingredient in phase setting and shifting. Light therapy is used to reset the circadian rhythm of shift workers, astronauts, and individuals experiencing jet lag.

  • Melatonin
    Melatonin supplements have been proven effective in treating circadian rhythm disorders in blind patients. Under normal circumstances, melatonin levels begin to rise at dusk and remain elevated until dawn. Bright light suppresses the release of melatonin. Ramelteon, a synthetic melatonin agonist, is FDA-approved for treating patients with sleep-onset insomnia but is used off label for the entire spectrum of circadian rhythm sleep disorders.
  • Modafinil
    Modafinil is a wake-promoting drug used to treat excessive daytime sleepiness due to narcolepsy, obstructive sleep apnea, and shift work disorder. 
Return To Mental Health Library
Mental Health Library Sources:
Information included in all topics of the Mental Health Library comes from the Desk Reference to the Diagnostic Criteria From DSM-5 and Kaplan & Sadock’s Concise Textbook of Clinical Psychiatry. Complete diagnostic and treatment information may be found within these publications.
Disclaimer:
Information within the Mental Health Library is not intended to be used for self-diagnosis purposes. Rather, it is provided as a public educational service to make people aware of mental health conditions. Please consult a qualified mental health professional for a diagnosis of any suspected mental health illness.
Like our page on Facebook for the latest blogs and mental health tips!
Follow Us on Social Media
© Copyright 2021 HUPCFL All Rights Reserved.
linkedin facebook pinterest youtube rss twitter instagram facebook-blank rss-blank linkedin-blank pinterest youtube twitter instagram