Sleep Disorders and Problems:

Sleep disorder symptoms

Getting a good night's sleep is essential for feeling refreshed and alert during the day  Did you know that the average adult needs eight hours of uninterrupted sleep every night in order to maintain optimal mental and physical health? Unfortunately, not everyone is able to get the restorative eight hours they need. According to the National Institute of Neurological Disorders and Stroke, over 40 million Americans a year will suffer from some sort or sleep disorder - many whom will go undiagnosed, or turn to over-the-counter sleep aids for relief. However, ignoring the underlying causes, or covering the symptoms with drugs usually makes the problem worse. And untreated sleep disorders can even be hazardous to your health - a British study released in September 2007 found that people who do not get enough sleep are twice as likely to die of heart disease. Luckily, through proper testing, diagnosis and care, sleep disorders can be managed and overcome.

Particular behaviors during normal daytime activities are telltale signs of sleep deprivation. If you are experiencing one or more of the following symptoms during the day, you may not be getting enough restful sleep at night, and you may even have a sleep disorder.

Each type of sleep disorder has its own particular symptoms, but all result in some of the above signs of sleep deprivation.

Common types of sleep disorders

While insomnia is the best-known sleep disorder, over 100 types of sleep disorders actually exist. In order to get a proper diagnosis, it’s important to understand the symptoms and causes of the most common forms of sleep problems – insomnia, sleep apnea, RLS, and narcolepsy.

Insomnia

Insomnia is a significant lack of high-quality sleep. It can be short-term or chronic. Insomnia may be caused by stress, a change in time zones or sleep schedule, poor bedtime habits, or an underlying medical or psychiatric condition.

Symptoms include:

• Difficulty falling asleep despite being tired
• Requiring sleeping pills or alcohol to fall asleep
• Awakening frequently during the night or lying awake in the middle of the night
• Awakening too early in the morning despite not feeling refreshed
• Daytime drowsiness, fatigue, and irritability

In most cases, insomnia can be helped by improving bedtime habits, relieving stress, and relaxation exercises. However, certain medications may be prescribed by your doctor if these alternative treatments do not have the desired effect.

  Sleep apnea sleep disorders

Sleep apnea is a common disorder that can be very serious, and even life-threatening. In sleep apnea, your breathing stops or gets very shallow while you are sleeping. Each pause in breathing typically lasts 10 to 20 seconds or more. These pauses can occur 20 to 30 times or more an hour.

The most common type of sleep apnea is obstructive sleep apnea. During sleep, enough air cannot flow into your lungs through your mouth and nose, even though you try to breathe. When this happens, the amount of oxygen in your blood may drop. Normal breaths then start again with a loud snort or choking sound.

Symptoms can be quite scary - frequent waking episodes at night, usually accompanied by a feeling of “choking” or gasping for air. Significant others or roommates of those with sleep apnea often report hearing gasping, gagging, or choking sounds from their partners. The severity of this disorder makes treatment essential. Treatment may include behavioral changes, physical and mechanical devices, and in some cases, surgery.

Restless Legs Syndrome (RLS) and Periodic Limb Movements in Sleep (PLMS)

Restless legs syndrome (RLS) is a sensory disorder causing an almost irresistible urge to move the legs. The urge to move the legs is usually due to uncomfortable, tingly, or creeping sensations that occur when at rest. Movement eases the feelings, but only for a while.
RLS is not necessarily confined to your sleep time. Symptoms most often occur when you are relaxed or lying down. You may also notice small, jerky movements of the toes, feet, and legs as you are trying to fall asleep.

Periodic Limb Movement Disorder (PLMD) is a related condition involving involuntary, rhythmic limb movements, either while asleep or when awake. While most people who have Restless Legs Syndrome also have PLMD, only some people with PLMD also have RLS. Because of the discomfort the symptoms cause, RLS can make it difficult falling (and staying) asleep.  Alternative therapies, lifestyle changes, and even nutritional supplements have proven helpful for RLS and PLMD sufferers.

Narcolepsy

Narcolepsy is a disorder that causes a person to have difficulty staying awake. Narcolepsy can cause a person to suddenly fall asleep during the day.
These “sleep attacks” occur even after getting enough sleep at night. The unusual sleep pattern that people with narcolepsy have can affect their schooling, work, and social life.
Falling asleep during activities like walking, driving, cooking, or talking can have dangerous results, both professionally and personally.

Symptoms include:

• Intermittent, uncontrollable episodes of falling asleep during the daytime
• Excessive daytime sleepiness
• Sudden, short-lived loss of muscle control during emotional situations (cataplexy)

As narcolepsy involves the nervous system, treatment requires a combination of medication, behavioral treatments, and counseling.

Diagnosing sleep disorders

Self-diagnosis

To determine if you have a sleep disorder, first pay attention to your sleep habits and daily routine. Whether you are trying to help yourself or planning to visit a doctor, it is helpful to record your sleep habits. Your sleep history will help you and your doctor find the cause of your sleep problems.

Keeping a sleep diary can help you identify lifestyle factors related to sleep disorders, and make it easier to discuss your daily patterns if you do decide to see a doctor or sleep specialist.  A sleep diary should record all sleep-related information, including:

• time you went to bed and woke up (total sleep hours)
• quality of your sleep - times that you were awake during the night and what you did (e.g., stayed in bed with eyes closed, or got up, had a glass of milk, and meditated)
• types and amount of food, liquids, caffeine, or alcohol you consumed before bed, and times of consumption
• feelings and moods before bed ­– happiness, sadness, stress, anxiety
• drugs or medications taken, amounts taken, and times of consumption

A sleep partner can add observations to your sleep diary as well. The details can be important, and a sleep diary might reveal that your pre-bedtime behavior is thwarting your chance for a good night’s sleep. For example, a two-week sleep diary might reveal that you don’t sleep well if you have had more than two alcoholic drinks before bedtime, or that you have more trouble falling asleep on days when you haven’t exercised.

Seeing a doctor

You can address most common sleep problems through lifestyle changes and improved sleep hygiene but it is important to see your doctor or a sleep specialist for a diagnosis if your sleep does not improve. A doctor who specializes in sleep problems is most skilled in diagnosing and treating sleep disorders. Sometimes sleep specialists work out of a sleep center; others are independent.

Medical professionals diagnose sleep disorders based on a number of factors including your description of symptoms, your age and gender, and your psychological and medical history. Along with your sleep diary and the answers to a sleep questionnaire, your doctor should interview you to figure out the cause of your sleeping problems. The doctor will want to rule out possible medical conditions and may want you to make behavioral and environmental changes as first steps of your treatment.  In addition, your doctor may recommend any number of common tests used to diagnose sleep disorders.

Sleep Centers

How sleep centers diagnose sleep disorders

If your physician refers you to a sleep center, a team of sleep specialists will use the latest technology to monitor you while you sleep. You will be given a private room, where a technician will attach a variety of monitoring devices to your body once you are ready for bed. Sleep specialists, who are on premises studying several patients at any given time, will observe your sleep patterns using these devices, which monitor brain waves, heart rate, rapid eye movements, and more. While sleeping with a bunch of wires attached to you might seem difficult, most patients find they fall asleep very easily.

The next morning, the technician will remove all the monitoring devices, and you will be able to go straight to work or on to your daily activities. The sleep specialists will analyze the results from your sleep study, and either they or your referring physician will set up a time with you to go over these results, and design a treatment program if necessary. A sleep center can also provide you with equipment to monitor your activities (awake and asleep) at home.

Common tests for diagnosing sleep disorders
Epworth Sleepiness Scale	This sleep questionnaire asks you to rank whether certain situations make you sleepy and, if so, how sleepy. Your responses assist your doctor in providing a formal diagnosis.
Overnight sleep study (polysomnogram)	This test measures the electrical activity of your brain (electroencephalogram) and heart (electrocardiogram), and the movement of your muscles (electromyogram) and eyes (electro-oculogram), and usually requires an overnight stay at a sleep clinic for observation purposes.
Multiple Sleep Latency Test (MSLT)	This test measures how long it takes for you to fall asleep during the day, plus the kind of sleep you get during such a nap. Sleep specialists analyze your brain waves (EEG), heart rate (EKG), muscle activity, and eye movements.
Repeated test of sustained wakefulness (RTSW)	This test measures how long it takes for you to fall asleep in a situation that challenges you to stay awake. During the test, you are placed in a quiet room with dim lighting, told to close your eyes, and asked to stay awake.
Blood test	Depending upon your description of your symptoms and your personal and family medical histories, your sleep specialist may also conduct a blood test. The blood test may not be conclusive but can be helpful in establishing the possibility and probability of certain sleep disorders.

Related links for sleep disorders

Helpguide Related Links for Sleep Disorders

Insomnia Causes and Cures – Comprehensive guide to conquering insomnia

Sleep Apnea – Symptoms, diagnosis ands treatment    

Restless Legs Syndrome (RLS): Finding Relief for Symptoms and Choosing a Treatment

Narcolepsy - Symptoms, diagnosis ands treatment

Sleep & Aging  -  Healthy habits to reduce sleep problems & prevent insomnia

Sleep Disorders General Information

Common Adult Sleep Problems/Disorders – Information on a number of sleep disorders (in children and adults) and treatment options. Includes relaxation techniques, sleep hygiene tips, and what to expect during an overnight sleep test at a sleep clinic or hospital. (University of Maryland Medical Center)

Sleep Disorders Information – Downloadable fact sheets on the most common sleep disorders, including insomnia, sleep apnea, Restless Legs Syndrome, and narcolepsy. Also information on how to sleep better. (National Heart, Lung, and Blood Institute, Department of Health and Human Services, National Institutes of Health)

Sleep disorders – Includes information on types, symptoms, causes, complications, and treatments of sleep disorders, along with the latest news and research. (MedlinePlus, U.S. National Library of Medicine / National Institutes of Health)

Sleep Centers

View a Sleep Study – A photo-guided tour of a typical sleep study at a sleep clinic. Helps you to know what to expect at your sleep study. (TalkAboutSleep and Stanford University Sleep Disorders Clinic)

Suzanne Barston, Heather Larson, Gina Kemp, M.A., and Robert Segal, M.A., Contributed to this article.  Last modified on 10/08/07.