There are a number of different typessleep disorders, clinically called “sleep-wake disorders.” They include:
Breathing-related sleep disorders include:
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.
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:
A diagnosis of insomnia disorder requires the following factors:
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.
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:
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.
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.
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:
In addition to uncontrollable episodes of falling asleep during the day, other symptoms of narcolepsy include:
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.
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.
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.
Breathing-related sleep disorders include:
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.
Parasomnias are disruptive sleep disorders that cause arousals and abnormal behavior while sleeping. Diagnostic categories of parasomnias include:
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.
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.
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:
There are several different types of circadian rhythm sleep disorders. They include:
There are several approaches for treating circadian rhythm sleep disorders. These include the following: