SLEEP DISORDERS

Sleep Disorders and Sleeping Problems

SYMPTOMS, TREATMENT, AND HELP FOR COMMON SLEEP DISORDERS

At one time or another, most of us have experienced what it’s like to have trouble falling asleep, to lie awake in the middle of the night, or feel sleepy and fatigued during the day. However, when sleep problems are a regular occurrence—when they get in the way of your daily routine and hamper your ability to function—you may be suffering from a sleep disorder.
Sleep disorders and other sleep problems cause more than just sleepiness. A lack of quality sleep has a negative impact on your energy, emotional balance, productivity, and health. The good news? You don’t have to live with sleeping problems. Read on to learn about the signs and symptoms of common sleep disorders, what you can do to help yourself, and when to call the sleep doctor.

Understanding sleep disorders and sleeping problems

If you’re having trouble sleeping, you’re in good company. According to the National Commission on Sleep Disorders Research, at least 40 million Americans suffer from chronic, long-term sleep disorders and another 20 to 30 million experience occasional sleep problems.
Unfortunately, even minimal sleep loss takes a toll on your mood, energy, efficiency, and ability to handle stress. Ignoring sleep problems and disorders can lead to poor health, accidents, impaired job performance, and relationship stress. If you want to feel your best, stay healthy, and perform up to your potential, sleep is a necessity, not a luxury.
It’s not normal to feel sleepy during the day, to have problems getting to sleep at night, or to wake up feeling unrefreshed. But even if you’ve struggled with sleep problems for so long that it does seem normal, you can learn to sleep better. You can start by tracking your symptoms and sleep patterns, and then making healthy changes to your daytime habits and bedtime routine. If self-help doesn’t do the trick, you can turn to sleep specialists who are trained in sleep medicine. Together, you can identify the underlying causes of your sleeping problem and find ways to improve your sleep and quality of life.

Signs and symptoms of sleep disorders and sleeping problems

Everyone experiences occasional sleep problems. So how do you tell whether your sleeping problem is just a minor, passing annoyance or a sign of a more serious sleep disorder?
Start by scrutinizing your symptoms, looking especially for the telltale daytime signs of sleep deprivation. If you are experiencing any of the following symptoms on a regular basis, you may be dealing with a sleep disorder.

Is it a sleep disorder?

Do you . . .

• feel irritable or sleepy during the day?
• have difficulty staying awake when sitting still, watching television or reading?
• fall asleep or feel very tired while driving?
• have difficulty concentrating?
• often get told by others that you look tired?
• react slowly?
• have trouble controlling your emotions?
• feel like you have to take a nap almost every day?
• require caffeinated beverages to keep yourself going?

If you answered “yes” to any of the previous questions, you may have a sleep disorder.

Insomnia: The most common type of sleep disorder

Insomnia, the inability to get to sleep or sleep well at night, is an all-too common sleeping problem—in fact, it’s the most common sleep complaint. Insomnia can be caused by a wide variety of things including stress, jet lag, a health condition, the medications you take, or even the amount of coffee you drink. Insomnia can also be caused by other sleep disorders or mental health conditions such as anxiety and depression.

Common signs and symptoms of insomnia include:

• Difficulty falling asleep at night or getting back to sleep after waking during the night.
• Waking up frequently during the night.
• Your sleep is light, fragmented, or unrefreshing.
• You need to take something (sleeping pills, nightcap, supplements) in order to get to sleep.
• Sleepiness and low energy during the day.

Whatever the cause of your insomnia, being mindful of your sleep habits and learning to relax will help you sleep better and feel better. The good news is that most cases of insomnia can be cured with changes you can make on your own—without relying on sleep specialists or turning to prescription or over-the-counter sleeping pills.

Putting a stop to sleepless nights

Insomnia takes a toll on your energy, mood, and ability to function during the day. But you don’t have to put up with insomnia. Simple changes to your lifestyle and daily habits can put a stop to sleepless nights.

Other common types of sleep disorders

In addition to insomnia, the most common sleep disorders are sleep apnea, restless legs syndrome (RLS), and narcolepsy.

Sleep apnea

Sleep apnea is a common sleep disorder in which your breathing temporarily stops during sleep due to blockage of the upper airways. These pauses in breathing interrupt your sleep, leading to many awakenings each hour. While most people with sleep apnea don’t remember these awakenings, they feel the effects in other ways, such as exhaustion during the day, irritability and depression, and decreased productivity.
Sleep apnea is a serious, and potentially life-threatening, sleep disorder. If you suspect that you or a loved one may have sleep apnea, see a doctor right away. Sleep apnea can be successfully treated with Continuous Positive Airway Pressure (CPAP), a mask-like device that delivers a stream of air while you sleep. Losing weight, elevating the head of the bed, and sleeping on your side can also help in cases of mild to moderate sleep apnea.
Symptoms of sleep apnea include:

• Loud, chronic snoring
• Frequent pauses in breathing during sleep
• Gasping, snorting, or choking during sleep
• Feeling unrefreshed after waking and sleepy during the day, no matter how much time you spent in bed
• Waking up with shortness of breath, chest pains, headaches, nasal congestion, or a dry throat.

Restless legs syndrome

Restless legs syndrome (RLS) is a sleep disorder that causes an almost irresistible urge to move your legs (or arms). The urge to move occurs when you’re resting or lying down and is usually due to uncomfortable, tingly, aching, or creeping sensations.
Common signs and symptoms of restless legs syndrome include:

• Uncomfortable sensations deep within the legs, accompanied by a strong urge to move them.
• The leg sensations are triggered by rest and get worse at night.
• The uncomfortable sensations temporarily get better when you move, stretch, or massage your legs.
• Repetitive cramping or jerking of the legs during sleep.

Narcolepsy

Narcolepsy is a sleep disorder that involves excessive, uncontrollable daytime sleepiness. It is caused by a dysfunction of the brain mechanism that controls sleeping and waking. If you have narcolepsy, you may have “sleep attacks” while in the middle of talking, working, or even driving.
Common signs and symptoms of narcolepsy include:

• Seeing or hearing things when you’re drowsy or starting to dream before you’re fully asleep.
• Suddenly feeling weak or losing control of your muscles when you’re laughing, angry, or experiencing other strong emotions.
• Dreaming right away after going to sleep or having intense dreams
• Feeling paralyzed and unable to move when you’re waking up or dozing off.

Circadian rhythm sleep disorders

We all have an internal biological clock that regulates our 24-hour sleep-wake cycle, also known as our circadian rhythms. Light is the primary cue that influences circadian rhythms. When the sun comes up in the morning, the brain tells the body that it’s time to wake up. At night, when there is less light, your brain triggers the release of melatonin, a hormone that makes you sleepy.
When circadian rhythms are disrupted or thrown off, you may feel groggy, disoriented, and sleepy at inconvenient times. Circadian rhythms have been linked to a variety or sleeping problems and sleep disorders, including insomnia, jet lag, and shift work sleep difficulties. Abnormal circadian rhythms have also been implicated in depression, bipolar disorder, and seasonal affective disorder, or the winter blues.

Jet lag

Jet lag is a temporary disruption in circadian rhythms that occurs when you travel across time zones. Symptoms include daytime sleepiness, fatigue, headache, stomach problems, and insomnia. The symptoms typically appear within a day or two after flying across two or more time zones. The longer the flight, the more pronounced the symptoms. The direction of flight also makes a difference. Flying east tends to cause worse jet lag than flying west.
In general, it usually takes one day per time zone crossed to adjust to the local time. So if you flew from Los Angeles to New York, crossing three time zones, your jet lag should be gone within three days. However, jet lag can be worse if you:

lost sleep during travel are under a lot of stress

drink too much alcohol or caffeine didn’t move around enough during your flight

Shift work

Shift work sleep disorder is a circadian rhythm sleep disorder that occurs when your work schedule and your biological clock are out of sync. In our 24-hour society, many workers have to work night shifts, early morning shifts, or rotating shifts. These schedules force you to work when your body is telling you to go to sleep, and sleep when your body is signaling you to wake.
While some people adjust better than others to the demands of shift work, most shift workers get less quality sleep than their daytime counterparts. As a result of sleep deprivation, many shift workers struggle with sleepiness and mental lethargy on the job. This cuts into their productivity and puts them at risk of injury.
There are a numbers of things you can do to reduce the impact of shift work on sleep:

• Minimize the frequency of shift changes
• When changing shifts, request a shift that’s later, rather than earlier (it’s easier to adjust forward in time, rather than backward)
• Use bright lights at work and take regular breaks
• Take melatonin when it’s time for you to sleep
• Create a dark bedroom environment (for example, you may want to invest in black-out shades or heavy curtains that block the daylight).

Delayed sleep phase disorder

Delayed sleep phase disorder is a sleep disorder in which your 24-hour cycle of sleep and wakefulness—your biological clock—is significantly delayed. As a result, you go to sleep and wake up much later than other people. For example, you may not get sleepy until 4 a.m., at which time you go to bed and sleep soundly until noon, or at least you would if your daytime responsibilities didn’t interfere. Delayed sleep phase disorder makes it difficult for you to keep normal hours—to make it to morning classes, get the kids to school on time, or keep a 9-to-5 job.
It’s important to note that this sleeping problem is more than just a preference for staying up late or being a night owl. People with delayed sleep phase disorder are unable to get to sleep earlier than 2 to 6 a.m. no matter how hard they try. They struggle to go to sleep and get up at socially acceptable times. But when allowed to keep their own hours (such as during a school break or holiday), they fall into a regular sleep schedule.
Delayed sleep phase disorder is most common in teenagers, and many teens will eventually grow out of it. For those who continue to struggle with a biological clock that is out of sync, treatments such as light therapy and chronotherapy can help. To learn more, schedule an appointment with a sleep doctor or local sleep clinic.

Self-help for sleeping problems and sleep disorders

While some sleep disorders may require a visit to the sleep doctor, you can improve many sleeping problems on your own. The first step to overcoming a sleep problem is identifying and carefully tracking your symptoms and sleep patterns.

Keep a sleep diary

A sleep diary is an incredibly useful tool for identifying sleep disorders and problems and pinpointing both day and nighttime habits that may be contributing to your difficulties. Keeping a record of your sleep patterns and problems will also prove helpful if you eventually find it necessary to see a sleep doctor.

Download and print Helpguide’s sleep diary.

Your sleep diary should include:

• what time you went to bed and woke up
• total sleep hours and perceived quality of your sleep
• a record of time you spent awake and what you did (“stayed in bed with eyes closed,” for example, 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
• your feelings and moods before bed ­(e.g. happiness, sadness, stress, anxiety)
• any drugs or medications taken, including dose and time of consumption

The details can be important, revealing that your certain behaviors are ruining your chance for a good night’s sleep. After keeping the diary for a week, for example, you might notice that when you have more than one glass of wine in the evening, you wake up during the night.

Improve your sleep hygiene and daytime habits

Regardless of your sleep problem, a consistent sleep routine and improved sleep habits will translate into better sleep over the long term. You can address many common sleep problems through lifestyle changes and improved sleep hygiene. For example, you may find that when you start exercising regularly, your sleep is much more refreshing. The key is to experiment. Use your sleep diary as a jumping off point.
Try the following simple changes to your daytime and pre-bedtime routine:

• Keep a regular sleep schedule, going to sleep and getting up at the same time each day (including the weekends)
• Set aside enough time for sleep (most people need at least 8 hours each night in order to feel good and be productive)
• Make sure your bedroom is dark, cool, and quiet.
• Turn off your TV, smartphone, and computer a few hours before your bedtime. The type of light their screens emit are activating to your brain and interfere with your body’s internal clock.

Simple tips for better sleep

The cure to sleep difficulties and daytime fatigue can often be found in your daily routine. The following sleep tips will help you optimize your nightly rest, minimize insomnia, and lay the foundation for all–day energy and peak performance.

 

Do sleeping pills help?

When taken for a brief period of time and under the supervision of your doctor, sleeping pills may help your sleep problems. However, they are just a temporary solution. Insomnia can’t be cured with sleeping pills. In fact, sleeping pills can often make insomnia worse in the long run. Therefore, it’s best to limit sleeping pills to situations where a person’s health or safety is threatened.
In general, sleeping pills and sleep medications are most effective when used sparingly for short-term situations, such as traveling across many time zones or recovering from a medical procedure. If medications are used over the long term, they are best used “as needed” instead of on a daily basis to avoid dependence and tolerance.

Safety guidelines for sleeping pills

• Only take a sleeping pill when you will have enough time to get a full 7 to 8 hours of sleep. Otherwise, you may be drowsy the next day.
• Read the package insert that comes with your medication. Pay careful attention to the potential side effects, dosage instructions, and list of food and substances to avoid.
• Never mix alcohol and sleeping pills. Not only does alcohol disrupt sleep, it can interact dangerously with prescription and over-the-counter sleep medications.
• Never drive a car or operate machinery after taking a sleeping pill. Especially when you first start taking a new sleep aid, as you may not know how it will affect you.

When to call the sleep doctor

If you’ve tried a variety of self-help sleep remedies without success, schedule an appointment with a sleep specialist or ask your family doctor for a referral to a sleep clinic.
Call the sleep doctor if:

• Your main sleep problem is daytime sleepiness (and self-help hasn’t improved your symptoms)
• You or your bed partner gasps, chokes, or stops breathing during sleep.
• You sometimes fall asleep at inappropriate times, such as while talking, walking, or eating.

At your appointment, be prepared with information about your sleep patterns and provide the sleep doctor with as much supporting information as possible, including the information from your sleep diary.

What to expect at a sleep clinic or center

Find a sleep center

The American Academy of Sleep Medicine provides a sleep center locator with information on finding a sleep center near you.

If your physician refers you to a sleep center, the latest technology will be used to monitor you while you sleep. A sleep specialist will observe your sleep patterns, brain waves, heart rate, rapid eye movements and more using monitoring devices attached to your body. While sleeping with a bunch of wires attached to you might seem difficult, most patients find they fall asleep very easily.
The sleep specialist will analyze the results from your sleep study 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.

Sleep and Sleep Disorders in Children and Adolescents: Information for Parents and Educators

Physicians and psychologists estimate that as many as 30% of children may have a sleep disorder at some point during childhood. Sleep disorders have implications both for social-emotional adjustment and for school performance. For this reason it is important for both parents and educators to understand how sleep works and how disruptions in normal sleep patterns can affect children and teenagers. This handout will provide an introduction to normal sleep patterns, definitions and descriptions of the kinds of sleep disturbances that may affect children and adolescents, and a brief description of recommended treatments.

Normal Sleep Patterns

Types of Sleep Patterns
Sleep is broadly classified into two types: REM (rapid-eye-movement) sleep and non-REM sleep (NREM). By studying brain wave patterns we know that NREM sleep consists of several stages, ranging from drowsiness through deep sleep. In the early stages (Stages I and II) you awake easily and may not even realize that you have been sleeping. In the deeper stages (Stages III and IV) it is very difficult to wake up, and if you are aroused you are likely to find yourself disoriented and confused. In NREM sleep your muscles are more relaxed than when you are awake but you are able to move (although you do not because the brain is not sending signals to the muscles to move).
REM sleep is more active. Breathing and heart rate become irregular, your eyes move rapidly back and forth under your eyelids, and control of your body temperature is impaired so that you do not sweat when you are hot or shiver when you are cold. Below the neck, however, you are inactive because the nerve impulses that travel down the spinal cord to body muscles are blocked. Your body is essentially paralyzed. It is during this sleep stage that you dream.

Developmental Characteristics

Infants and children. Both these sleep states develop before birth. Infants cycle through many sleep periods throughout the day. As they develop, they sleep longer at night and have fewer sleep periods during the day. Newborns sleep almost all the time. By 6 months they sleep about 13 hours a day with the longest sustained period being about 7 hours. By 24 months children sleep for 12 hours, including naps, and by 4 years children sleep 10–12 hours with one daytime nap at most.
Throughout childhood children typically get about 10 hours of sleep a night. This drops significantly at adolescence, but less for biological reasons than for socio-cultural reasons. Sleep researchers studying the optimal sleep periods of teenagers have found that when the sleep-wake cycle is studied in the laboratory under controlled conditions (e.g., removing clocks and lighting cues), teenagers typically sleep 9 hours a night. In the real world—especially during the school year—very few teenagers get this much sleep and thus are constantly coping with sleep debt to a greater or lesser degree.
Whereas infants enter into REM sleep immediately, young children move quickly from drowsiness and the lighter sleep stages to Stage IV, then experience cycles of light to deep sleep, arousal, etc., eventually cycling between REM and Stage II sleep, much like the sleep patterns of adults.
Adolescents. Adolescent sleep patterns deserve particular attention because of the potential impact on school performance. It has only been in the last 20 years or so that sleep researchers have recognized that there are distinctive changes in sleep patterns in adolescence. There are changes in the biological clock (also called circadian rhythms) of teenagers. With the onset of puberty, teenagers begin to experience a sleep phase delay such that they develop a natural tendency both to fall asleep later in the evening and to wake up later in the morning. Even youngsters who have experienced sleep deprivation (and therefore accumulated some sleep debt) tend to feel more alert in the evening, thus making it more difficult to go to bed at what parents might consider a reasonable hour.
The onset of sleep is triggered by the release of melatonin, a natural body hormone. Toward dawn, melatonin shuts off as another hormone, cortisol, increases, signaling the youngster to wake up. Research shows that the pattern of melatonin secretion makes it hard for teenagers to fall asleep early in the evening and to wake up early in the morning. Schools with early start times (any time before 8:30 a.m.) place students at a disadvantage in terms of arousal and alertness—not only for early morning classes but throughout the day because the adolescent’s biological rhythms are out of sync with typical school routines.

Recognizing and Treating Sleep Disorders

Some sleep disturbances are mild, fairly common, and fairly easy to treat. Others may be more stubborn, or they may be signs of potential physical problems that could have long-term consequences if left untreated.
Diagnosis
Sleep disorders are generally diagnosed either by a pediatrician or a sleep specialist. If parents are concerned about possible sleep problems, they may want to begin by discussing their concerns with their child’s physician. Not all pediatricians recognize the variety of sleep problems children and teenagers experience, and if parents are not satisfied after meeting with their child’s physician, they may want to request a referral to a sleep specialist or to a sleep clinic.
At school parents might find some assistance from the school psychologist or social worker, who may use a diagnostic interview as part of an evaluation. This interview should include questions about the child’s normal sleep patterns, including bedtime routines, typical bedtime and wake time on school days and weekends, whether the child has trouble falling asleep or staying asleep, and the frequency of nightmares. When parents or teachers have concerns about both attention and behavior problems, sleep problems may be an issue. This is because side effects associated with sleep disturbance or deprivation include inattention, irritability, hyperactivity, and impulse control problems.
Treating Sleep Disorders
Different types of sleep disorders call for different treatments.
Night terrors. Night terrors are sudden, partial arousal associated with emotional outbursts, fear, and motor activity. Occurring most often among children ages 4–8 during NREM sleep, the child has no memory of night terrors once fully awake. If your child experiences night terrors, make sure he or she is comfortable but do not wake the child. In extreme cases, night terrors may require medical intervention.
Sleep walking. Sleep walking is most common among 8–12 year-olds. Typically, the child sits up in bed with eyes open but unseeing or may walk through the house. Their speech is mumbled and unintelligible. Usually children will outgrow sleepwalking by adolescence. In the meantime, take safety precautions (e.g., using a first floor bedroom), but keep efforts to intervene to a minimum. Awakening the child on a regular schedule can reduce or eliminate episodes.
Nighttime bedwetting. This type of bedwetting is a common sleep problem in children ages 6–12, occurring only during NREM sleep. Primary enuresis (the child has never been persistently dry at night) is associated with a family history of the problem, developmental lag, or lower bladder capacity, and is unlikely to signal a serious problem. Secondary enuresis (a recurrence of bedwetting after a year or more of bladder control) is more likely to be associated with emotional distress. Interventions include use of reinforcement and responsibility training (such as keeping a dry night chart), bladder control training, conditioning (e.g., bedwetting alarms), and sometimes medication. In the case of secondary enuresis it might be most helpful to determine any source of emotional stress and address it directly. (For example, if a child starts wetting the bed at night following parents’ separation or divorce, providing counseling to address loss issues might help alleviate bedwetting.)
Sleep-onset anxiety. Sleep-onset anxiety refers to difficulty falling asleep because of excessive fears or worries. The problem may be caused by stressful events or trauma or because of ruminating on more commonplace issues of the day. This type of sleep problem is most common among older elementary school children. Intervention strategies include reassurance, calming bedtime routines, and, in some cases, cognitive-behavioral therapy, which is designed to help children develop effective coping strategies to address their worries.
Obstructive sleep apnea. Although more common in adults, 1–3% of children experience difficulty breathing because of obstructed air passages. Symptoms include snoring, difficulty breathing during sleep, mouth breathing during sleep, or excessive daytime sleepiness. In children this type of sleep disturbance is usually not serious, but most children benefit from removal of the tonsils and adenoids. When this is not effective, the condition can be treated (by a physician) with a procedure known as nasal continuous positive airway pressure (CPAP).
Nacrolepsy. Nacrolepsy is a rare but potentially dangerous, neurologically based genetic condition that may include sleep attacks (irresistible urges to sleep), sleep-onset paralysis, or sleep-onset hallucinations. It affects 1 of every 2,000 adults and may first appear in adolescence. If this disorder is suspected, refer to the child to a sleep specialist. Treatment may include ensuring a full 12 hours of sleep per night or more, scheduled naps, or medication.
Delayed sleep-phase syndrome. This is a disorder of sleep (circadian) rhythm that results in an inability to fall asleep at a normal hour (e.g., sleep onset may be delayed until 2–4 a.m.) and results in difficulty waking up in the morning. Symptoms among children include excessive daytime sleepiness, sleeping until early afternoon on weekends, truancy and tardiness, and poor school performance. Treatment might include light therapy (exposure to very bright light in the morning), chronotherapy (gradually advancing the child’s sleep schedule 1 hour per night until a normal routine is achieved), maintaining a consistent sleep schedule, or a short course of sedative medication to help achieve a new schedule. It may be necessary and beneficial to (temporarily) adjust the child’s school day to allow for a later start.

Help for Children and Families

A sleep disorder not only results in a sleepy, cranky, and often poor-performing student at school, but also an irritable, unhappy child or teenager at home. A youngster with a disrupted sleep pattern more than likely is wreaking havoc on the sleep and patience of other family members.
If you suspect that your child or teen has a sleep problem that goes beyond a few nightmares or restless nights, do not delay seeking help. Start with your family physician. The earlier a sleep problem is identified and treated, the more quickly a normal sleep routine can be restored—for everyone.

Sleep Problems in Children

Children and adolescents need at least nine hours of sleep per night. Sleep problems and a lack of sleep can have negative effects on childcare's performance in school, during extracurricular activities, and in social relationships.
A lack of sleep may cause:

• Accidents and injuries
• Behavior problems
• Mood problems
• Memory, concentration, and learning problems
• Performance problems
• Slower reaction times

Signs of Sleep Problems in Children

Talk to your pediatrician if your child exhibits any of the following signs of a sleep problem:

• Snoring
• Breathing pauses during sleep
• Problems with sleeping through the night
• Difficulty staying awake during the day
• Unexplained decrease in daytime performance
• Unusual events during sleep

Tips for Helping Your Child's Sleep Problem

• Establish a regular time for bed each night and do not vary from it. Similarly, the waking time should not differ from weekday to weekend by more than one to one and a half hours.
• Create a relaxing bedtime routine, such as giving your child a warm bath or reading a story.
• Do not give children any food or drinks with caffeine less than six hours before bedtime.
• Make sure the temperature in the bedroom is comfortable and that the bedroom is dark.
• Make sure the noise level in the house is low.
• Avoid giving children large meals close to bedtime.
• Make after-dinner playtime a relaxing time as too much activity close to bedtime can keep children awake.
• There should be no television, radio, or music playing while the child is going to sleep.
• Infants and children should be put to bed when they appear tired but still awake (rather than falling asleep in the parent's arms, or in another room). Parents should avoid getting into bed with a child in order to get them to sleep. If this is difficult, they should consult their pediatrician or sleep specialist

Common Adult Sleep Problems/Disorders

Below is information - including symptoms, causes and possible treatment options -- on some of the more common sleep-related problems and disorders in adults. Click on any of the problems listed below, or scroll down to read more about them all.

Poor Sleep Habits
Poor sleep habits (referred to as hygiene) are one of the most common problems encountered in our society. We stay up too late and get up too early. We interrupt our sleep with drugs, chemicals, work, and we overstimulate ourselves with late-night activities such as television. 
Insomnia
Insomnia is the inability to sleep or inability to sleep well at night. Many different medical and mental health problems cause insomnia. Insomnia may be situational, lasting a few days to weeks, or chronic, lasting for more than 1 month.
Around 9-12 percent of the American population report chronic insomnia. In severe cases, patients experience fatigue, sleepiness, difficulty concentrating and difficulty with thinking. Many sufferers feel that they have been robbed of the joy of life. Insomnia may be a symptom of breathing problems at night like sleep apnea, of medical illness like heart failure, a side effect of medications, or a symptom of severe anxiety or depression illness.
While short-lasting insomnia periods are well treated with medication, chronic or long-lasting insomnia may not respond well to medications. Thus, throwing sleeping pills at many patients with chronic insomnia is not an effective way to treat the problem.
An evaluation by the patient's personal physician or a sleep specialist often helps get to the root of the problem. Many patients respond well to what is called "cognitive behavioral therapy." In this form of therapy, incorrect ideas about sleep are corrected. In addition, relaxation and behavioral techniques may be used to help patients fall asleep. This combined with treatment of any underlying disorders is often the best way to treat the devastating symptom of insomnia.

Sleep apnea is a common and potentially devastating sleep disorder. It is the most common reason that patients are referred to sleep centers around the country.
The word apnea means "not breathing." Patients with the usual form of sleep apnea actually close off their airway at night.
This airway closure occurs either behind the tongue or behind the nose. Patients continue to make efforts to breathe. Then after 10 to 120 seconds, the brain, realizing it is not getting any oxygen, actually "wakes up." The brain then tells the upper airway to open to let some air in.
This is associated with loud bothersome snoring, often described as snorting and gasping. Patients may take a few breaths of air, the brain goes to sleep again and the cycle may repeat itself several hundred times a night. Patients are often not even aware that they are doing this (although the bed partner is).
Sleep apnea is dangerous, common, relative easy to diagnose, and treatable. Patients with sleep apnea are at great risk for heart disease, heart attacks, strokes and high blood pressure. In addition, since the sleep is poor quality (remember the brain keeps waking up), patients are often sleepy during the day. Sleepiness is associated with inability to concentrate, remember or think. There is also increased risk in falling asleep while doing vital tasks such as driving or using heavy machinery.
Medical treatment involves weight loss if the patient is overweight, avoidance of drugs, which increase the risk of apneas such as sleeping pills, alcohol and sedative medicines, and sometimes sleeping semi-upright. However, in most cases additional treatment is warranted.
In some cases we use Continuous Positive Airway Pressure (CPAP for short) to treat patients. For this treatment a mask is fit over the nose or over the nose and mouth. The mask is pressurized slightly to hold the airway open and allow the patient to sleep normally. Newer technology has made the masks relatively comfortable to use.
Some patients may be candidates for surgery on the upper airway. In the usual upper airway surgery the uvula (that punching bag in the back of the throat) and some of the surrounding soft tissue is removed to enlarge the air passage. In other cases a dental device designed to move the lower jaw down and outwards slightly may be worn at night.
In a few cases, treatment is begun with an emergent tracheostomy when sleep apnea is considered to be immediately life-threatening. The decision about which form of treatment to use should be decided by the patient and his/her physician on the basis of the sleep studies and rest of the clinical data.
Narcolepsy
Narcolepsy is a chronic sleep disorder that commonly begins during adolescence and is characterized by excessive daytime sleepiness with the occurrence of sleep attacks. Narcolepsy can run in families, but can occur in the absence of any family history as well. There are several other characteristic symptoms that may or may not be present, including cataplexy, sleep paralysis and hypnogogic hallucinations.

• Cataplexy is the sudden loss of muscle tone, commonly associated with strong emotions. It may be a subtle sensation of weakness or a complete loss of strength with a fall to the ground.
  
  
• Sleep paralysis is a sensation of not being able to move on waking, usually for a few seconds.
  
  
• Hypnogogic hallucinations are very vivid and sometimes violent or bizarre sensations, almost dreamlike, that occur on waking or falling asleep.

The treatment of narcolepsy and its associated symptoms commonly requires a combination of behavioral modification and drug therapy. Many patients with narcolepsy will do well with naps scheduled at specific times during the day. Stimulant medication may be used to alleviate symptoms of daytime sleepiness. Other medications, such as certain anti-depressants, are used to treat cataplexy. A new promising treatment for cataplexy using a drug called sodium oxybate has recently become available. Treatment for each patient must be individualized and each patient with his/her physician needs to discuss this on a case-by-case basis.
Restless Legs Syndrome and Periodic Limb Movement Disorder
Restless legs syndrome (RLS) is characterized by an intolerable, internal itching sensation occurring in the lower extremities that causes an almost irresistible urge to move the legs. The sensation is commonly described as a "creepy" or "crawly" sensation and is typically relieved by movement of the legs or walking around. When movement stops, however, the sensations frequently return. The abnormal sensations are more common in the late afternoon or evening hours.
In some patients, this problem persists into the nighttime and may prevent patients from getting a restful night's sleep. Pregnancy and iron deficiency are associated with an increased frequency of this disease. In many patients, RLS is extremely distressing. Further, RLS is more common than previously thought, affecting 5-10% of adults and increasing with age.
Almost all patients with restless legs syndrome have a problem called period limb movement disorder. In this, there are leg (sometimes arm) movements occurring at regular intervals during the night. These movements may fragment sleep, leading to poor quality, non-refreshing sleep. Periodic limb movement disorder can also occur as an isolated problem, often reported by the bed partner.
Luckily, in most people, restless legs syndrome and periodic limb movement disorder are relatively easily treated. Treatment commonly includes the incorporation of both aerobic and leg stretching exercises. Leg stretching or even yoga exercises can be done prior to bedtime to alleviate symptoms and may be all that is needed in mild cases. Iron replacement therapy is used if patients are iron deficient. Drugs used to treat Parkinson's disease are very effective in treating most cases. These include the drug pramipexole (Mirapex®) and ropinirole (Requip®). Medications, such as valium-type medications, such as clonazepam (Klonopin®) or analgesic medications related to morphine and opium, can be also be used. In some cases, anti-seizure medications may be effective.
Sleepwalking/Somnambulism
Sleepwalking, also referred to as somnambulism, is characterized by walking or other physical activities during sleep. Sleepwalking is common in children -- up to 15 percent of children have had this problem -- but can occur at any age. In children, it can be associated with sleep deprivation or anxiety. In adults, it is more commonly associated with other medical disorders, medication use, or anxiety or depressive disorders.
Clinically, the person may simply sit up with their eyes open, appearing to be awake, or they may engage in a complex task. Episodes can last from seconds to minutes. Contrary to popular belief, it is safe to wake a sleepwalker, but they may be confused and disoriented on waking.
There is no specific treatment except to avoid triggers if known, or treat anxiety or depression. If severe, short-term use of sedatives may be considered. Otherwise it is best to keep the person safe and out of harm's way. We often advise families to make sure the windows are closed and that there is no possibility of sleepwalking leading to danger for the patient.
Sleep Disorders in Medical Illnesses
Many medical illnesses are associated with disturbances of sleep. Patients with chronic lung disease may experience low oxygen levels at night that disturb sleep. Patients with asthma may develop wheezing or shortness of breath at night, usually in the early morning hours. Patients with heart failure may develop abnormal breathing at night, which disturbs sleep much in the way that sleep apnea does. Patients with Parkinson's or other neurological diseases may develop disturbed sleep.
Sleep Disorders in Mental Illnesses
Many people with mental illnesses, notably depression, anxiety, post-traumatic stress syndrome, and panic attacks, develop profound sleep disturbances. Insomnia is a common symptom in many people with these problems. Evaluation and treatment by a health care provider skilled in these disorders, usually in conjunction with evaluation by a sleep specialist, often brings about great improvement.