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Sleep disorder

sleep disorders, sleep disorders in adults
A sleep disorder, or somnipathy, is a medical disorder of the sleep patterns of a person or animal Some sleep disorders are serious enough to interfere with normal physical, mental, social and emotional functioning Polysomnography and actigraphy are tests commonly ordered for some sleep disorders

Disruptions in sleep can be caused by a variety of issues, from teeth grinding bruxism to night terrors When a person suffers from difficulty falling asleep and/or staying asleep with no obvious cause, it is referred to as insomnia1

Sleep disorders are broadly classified into dyssomnias, parasomnias, circadian rhythm sleep disorders involving the timing of sleep, and other disorders including ones caused by medical or psychological conditions and sleeping sickness

Some common sleep disorders include sleep apnea stops in breathing during sleep, narcolepsy and hypersomnia excessive sleepiness at inappropriate times, cataplexy sudden and transient loss of muscle tone while awake, and sleeping sickness disruption of sleep cycle due to infection Other disorders include sleepwalking, night terrors and bed wetting Management of sleep disturbances that are secondary to mental, medical, or substance abuse disorders should focus on the underlying conditions


  • 1 Common disorders
    • 11 Types
  • 2 Risks
  • 3 Treatment
    • 31 Acupuncture treatment
    • 32 Hypnosis treatment
    • 33 Music therapy
    • 34 Melatonin
  • 4 Sleep medicine
  • 5 See also
  • 6 References
  • 7 External links

Common disordersedit

The most common sleep disorders include:

  • Bruxism, involuntarily grinding or clenching of the teeth while sleeping
  • Catathrenia, nocturnal groaning during prolonged exhalation
  • Delayed sleep phase disorder DSPD, inability to awaken and fall asleep at socially acceptable times but no problem with sleep maintenance, a disorder of circadian rhythms Other such disorders are advanced sleep phase disorder ASPD, non-24-hour sleep–wake disorder non-24 in the sighted or in the blind, and irregular sleep wake rhythm, all much less common than DSPD, as well as the situational shift work sleep disorder2
  • Hypopnea syndrome, abnormally shallow breathing or slow respiratory rate while sleeping
  • Idiopathic hypersomnia, a primary, neurologic cause of long-sleeping, sharing many similarities with narcolepsy
  • Insomnia disorder primary insomnia, chronic difficulty in falling asleep and/or maintaining sleep when no other cause is found for these symptoms Insomnia can also be comorbid with or secondary to other disorders
  • Kleine–Levin syndrome, a rare disorder characterized by persistent episodic hypersomnia and cognitive or mood changes3
  • Narcolepsy, including excessive daytime sleepiness EDS, often culminating in falling asleep spontaneously but unwillingly at inappropriate times About 70% of those who have narcolepsy also have cataplexy, a sudden weakness in the motor muscles that can result in collapse to the floor while retaining full conscious awareness4
  • Night terror, Pavor nocturnus, sleep terror disorder, an abrupt awakening from sleep with behavior consistent with terror5
  • Nocturia, a frequent need to get up and urinate at night It differs from enuresis, or bed-wetting, in which the person does not arouse from sleep, but the bladder nevertheless empties6
  • Parasomnias, disruptive sleep-related events involving inappropriate actions during sleep, for example sleep walking, night-terrors and catathrenia
  • Periodic limb movement disorder PLMD, sudden involuntary movement of arms and/or legs during sleep, for example kicking the legs Also known as nocturnal myoclonus See also Hypnic jerk, which is not a disorder
  • Rapid eye movement sleep behavior disorder RBD, acting out violent or dramatic dreams while in REM sleep, sometimes injuring bed partner or self REM sleep disorder or RSD7
  • Restless legs syndrome RLS, an irresistible urge to move legs RLS sufferers often also have PLMD
  • Shift work sleep disorder SWSD, a situational circadian rhythm sleep disorder Jet lag was previously included as a situational circadian rhythm sleep disorder, but it doesn't appear in DSM-5 see Diagnostic and Statistical Manual of Mental Disorders
  • Sleep apnea, obstructive sleep apnea, obstruction of the airway during sleep, causing lack of sufficient deep sleep, often accompanied by snoring Other forms of sleep apnea are less common8 When air is blocked from entering into the lungs, the individual unconsciously gasps for air and sleep is disturbed Stops of breathing of at least ten seconds, 30 times within seven hours of sleep, classifies as apnea Other forms of sleep apnea include central sleep apnea and sleep-related hypoventilation9
  • Sleep paralysis, characterized by temporary paralysis of the body shortly before or after sleep Sleep paralysis may be accompanied by visual, auditory or tactile hallucinations Not a disorder unless severe Often seen as part of narcolepsy
  • Sleepwalking or somnambulism, engaging in activities normally associated with wakefulness such as eating or dressing, which may include walking, without the conscious knowledge of the subject
  • Somniphobia, one cause of sleep deprivation, a dread/ fear of falling asleep or going to bed Signs of the illness include anxiety and panic attacks before and during attempts to sleep


  • Dyssomnias - A broad category of sleep disorders characterized by either hypersomnia or insomnia The three major subcategories include intrinsic ie, arising from within the body, extrinsic secondary to environmental conditions or various pathologic conditions, and disturbances of circadian rhythm10
    • Insomnia: Insomnia may be primary or it may be comorbid with or secondary to another disorder such as a mood disorder ie, emotional stress, anxiety, depression or underlying health condition ie, asthma, diabetes, heart disease, pregnancy or neurological conditions11
    • Primary hypersomnia Hypersomnia of central or brain origin
      • Narcolepsy: A chronic neurological disorder or dyssomnia, which is caused by the brain's inability to control sleep and wakefulness12
      • Idiopathic hypersomnia: a chronic neurological disease similar to narcolepsy in which there is an increased amount of fatigue and sleep during the day Patients who suffer from idiopathic hypersomnia cannot obtain a healthy amount of sleep for a regular day of activities This hinders the patients' ability to perform well, and patients have to deal with this for the rest of their lives13
      • Recurrent hypersomnia - including Kleine–Levin syndrome
      • Posttraumatic hypersomnia
      • Menstrual-related hypersomnia
    • Sleep disordered breathing SDB, including non exhaustive:
      • Several types of Sleep apnea
      • Snoring
      • Upper airway resistance syndrome
    • Restless leg syndrome
    • Periodic limb movement disorder
  • Circadian rhythm sleep disorders
    • Delayed sleep phase disorder
    • Advanced sleep phase disorder
    • Non-24-hour sleep–wake disorder
  • Parasomnias - A category of sleep disorders that involve abnormal and unnatural movements, behaviors, emotions, perceptions, and dreams in connection with sleep
    • Bedwetting or sleep enuresis
    • Bruxism Tooth-grinding
    • Catathrenia - nocturnal groaning
    • Exploding head syndrome - Waking up in the night hearing loud noises
    • Sleep terror or Pavor nocturnus- Characterized by a sudden arousal from deep sleep with a scream or cry, accompanied by some behavioral manifestations of intense fear14
    • REM sleep behaviour disorder
    • Sleepwalking or somnambulism
    • Sleep talking or somniloquy
    • Sleep sex or sexsomnia
  • Medical or psychiatric conditions that may produce sleep disorders
    • 22q112 deletion syndrome
    • Alcoholism
    • Mood disorders
      • Depression
    • Anxiety disorder
    • Panic
    • Psychosis such as Schizophrenia
  • Sleeping sickness - a parasitic disease which can be transmitted by the Tsetse fly


A systematic review found that traumatic childhood experiences such as family conflict or sexual trauma significantly increases the risk for a number of sleep disorders in adulthood, including sleep apnea, narcolepsy, and insomnia15 It is currently unclear whether or not moderate alcohol consumption increases the risk of obstructive sleep apnea16

In addition, an evidence-based synopses suggests that the sleep disorder, idiopathic REM sleep behavior disorder iRBD, may have a hereditary component to it A total of 632 participants, half with iRBD and half without, completed self-report questionnaires The results of the study suggest that people with iRBD are more likely to report having a first-degree relative with the same sleep disorder than people of the same age and sex that do not have the disorder17 More research needs to be conducted to gain further information about the hereditary nature of sleep disorders


Treatments for sleep disorders generally can be grouped into four categories:

  • Behavioral and psychotherapeutic treatment
  • Rehabilitation and management
  • Medication
  • Other somatic treatment

None of these general approaches is sufficient for all patients with sleep disorders Rather, the choice of a specific treatment depends on the patient's diagnosis, medical and psychiatric history, and preferences, as well as the expertise of the treating clinician Often, behavioral/psychotherapeutic and pharmacological approaches are not incompatible and can effectively be combined to maximize therapeutic benefits Management of sleep disturbances that are secondary to mental, medical, or substance abuse disorders should focus on the underlying conditions

Medications and somatic treatments may provide the most rapid symptomatic relief from some sleep disturbances Certain disorders like narcolepsy, are best treated with prescription drugs such as Modafinil13 Others, such as chronic and primary insomnia, may be more amenable to behavioral interventions, with more durable results

Chronic sleep disorders in childhood, which affect some 70% of children with developmental or psychological disorders, are under-reported and under-treated Sleep-phase disruption is also common among adolescents, whose school schedules are often incompatible with their natural circadian rhythm Effective treatment begins with careful diagnosis using sleep diaries and perhaps sleep studies Modifications in sleep hygiene may resolve the problem, but medical treatment is often warranted18

Special equipment may be required for treatment of several disorders such as obstructive apnea, the circadian rhythm disorders and bruxism In these cases, when severe, an acceptance of living with the disorder, however well managed, is often necessary

Some sleep disorders have been found to compromise glucose metabolism19

Acupuncture treatmentedit

A review of the evidence in 2012 concluded that current research is not rigorous enough to make recommendations around the use of acupuncture for insomnia20 The pooled results of two trials on acupuncture showed a moderate likelihood that there may be some improvement to sleep quality for individuals with a diagnosis insomnia20:15 This form of treatment for sleep disorders is generally studied in adults, rather than children Further research would be needed to study the effects of acupuncture on sleep disorders in children

Hypnosis treatmentedit

Research suggests that hypnosis may be helpful in alleviating some types and manifestations of sleep disorders in some patients21 "Acute and chronic insomnia often respond to relaxation and hypnotherapy approaches, along with sleep hygiene instructions"22 Hypnotherapy has also helped with nightmares and sleep terrors There are several reports of successful use of hypnotherapy for parasomnias2324 specifically for head and body rocking, bedwetting and sleepwalking25

Hypnotherapy has been studied in the treatment of sleep disorders in both adults25 and children26

Music therapyedit

Although more research should be done to increase the reliability of this method of treatment, research suggests that music therapy can improve sleep quality in acute and chronic sleep disorders In one particular study, participants 18 years or older who had experienced acute or chronic sleep disorders were put in a randomly controlled trial and their sleep efficiency overall time asleep was observed In order to assess sleep quality, researchers used subjective measures ie questionnaires and objective measures ie polysomnography The results of the study suggest that music therapy did improve sleep quality in subjects with acute or chronic sleep disorders, however only when tested subjectively Although these results are not fully conclusive and more research should be conducted, it still provides evidence that music therapy can be an effective treatment for sleep disorders27

In another study, specifically looking to help people with insomnia, similar results were seen The participants that listened to music experienced better sleep quality than those who did not listen to music28


In addressing sleep disorders and possible solutions, there is often a lot of buzz surrounding melatonin Research suggests that melatonin is useful in helping people to fall asleep faster decreased sleep latency, to stay asleep longer, and to experience improved sleep quality In order to test this, a study was conducted that compared subjects that had taken Melatonin to subjects that had taken a placebo pill in subjects with primary sleep disorders Researchers assessed sleep onset latency, total minutes slept, and overall sleep quality in the Melatonin and placebo groups to note the differences In the end, researchers found that melatonin decreased sleep onset latency, increased total sleep time, and improved quality of sleep significantly more than the placebo group2930

Sleep medicineedit

Main article: Sleep medicine

Due to rapidly increasing knowledge about sleep in the 20th century, including the discovery of REM sleep in the 1950s and circadian rhythm disorders in the 70s and 80s, the medical importance of sleep was recognized The medical community began paying more attention than previously to primary sleep disorders, such as sleep apnea, as well as the role and quality of sleep in other conditions By the 1970s in the USA, clinics and laboratories devoted to the study of sleep and sleep disorders had been founded, and a need for standards arose

Specialists in Sleep Medicine were originally certified by the American Board of Sleep Medicine, which still recognizes specialists Those passing the Sleep Medicine Specialty Exam received the designation "diplomate of the ABSM" Sleep Medicine is now a recognized subspecialty within internal medicine, family medicine, pediatrics, otolaryngology, psychiatry and neurology in the United States Certification in Sleep Medicine shows that the specialist:

"has demonstrated expertise in the diagnosis and management of clinical conditions that occur during sleep, that disturb sleep, or that are affected by disturbances in the wake-sleep cycle This specialist is skilled in the analysis and interpretation of comprehensive polysomnography, and well-versed in emerging research and management of a sleep laboratory"31

Competence in sleep medicine requires an understanding of a myriad of very diverse disorders, many of which present with similar symptoms such as excessive daytime sleepiness, which, in the absence of volitional sleep deprivation, "is almost inevitably caused by an identifiable and treatable sleep disorder", such as sleep apnea, narcolepsy, idiopathic hypersomnia, Kleine–Levin syndrome, menstrual-related hypersomnia, idiopathic recurrent stupor, or circadian rhythm disturbances32 Another common complaint is insomnia, a set of symptoms which can have a great many different causes, physical and mental Management in the varying situations differs greatly and cannot be undertaken without a correct diagnosis33

Sleep dentistry bruxism, snoring and sleep apnea, while not recognized as one of the nine dental specialties, qualifies for board-certification by the American Board of Dental Sleep Medicine ABDSM The resulting Diplomate status is recognized by the American Academy of Sleep Medicine AASM, and these dentists are organized in the Academy of Dental Sleep Medicine USA34 The qualified dentists collaborate with sleep physicians at accredited sleep centers and can provide oral appliance therapy and upper airway surgery to treat or manage sleep-related breathing disorders35

In the UK, knowledge of sleep medicine and possibilities for diagnosis and treatment seem to lag Guardiancouk quotes the director of the Imperial College Healthcare Sleep Centre: "One problem is that there has been relatively little training in sleep medicine in this country – certainly there is no structured training for sleep physicians"36 The Imperial College Healthcare site37 shows attention to obstructive sleep apnea syndrome OSA and very few other sleep disorders Some NHS trusts have specialist clinics for respiratory or neurological sleep medicine

See alsoedit

  • Chronotypes
  • Health effects from noise
  • International Classification of Sleep Disorders
  • Polysomnographic technologist
  • Sleep hygiene
  • Sleep study
  • Sundowning
  • Vegetative symptoms
  • White noise machine


  1. ^ Hirshkowitz, Max 2004 "Chapter 10, Neuropsychiatric Aspects of Sleep and Sleep Disorders pp 315-340" Google Books preview includes entire chapter 10 In Stuart C Yudofsky and Robert E Hales, editors Essentials of neuropsychiatry and clinical neurosciences 4 ed Arlington, Virginia, USA: American Psychiatric Publishing ISBN 978-1-58562-005-0 insomnia is a symptom It is neither a disease nor a specific condition from p 322 CS1 maint: Extra text: editors list link
  2. ^ American Academy of Sleep Medicine 2001 The International Classification of Sleep Disorders, Revised ICSD-R PDF ISBN 0-9657220-1-5 
  3. ^ Arnulf, Isabelle; Rico, Thomas; Mignot, Emmanuel 2012 "Diagnosis, Disease Course, and Management of Patients with Kleine-Levin Syndrome" The Lancet Neurology 11 10: 918–28 doi:101016/S1474-44221270187-4 PMID 22995695 
  4. ^ "Narcolepsy Fact Sheet" Retrieved 2011-06-23 
  5. ^ Hockenbury, Don H Hockenbury, Sandra E 2010 Discovering psychology 5th ed New York, NY: Worth Publishers p 157 ISBN 978-1-4292-1650-0 
  6. ^ wwwsleepfoundationorgfull citation needed
  7. ^ "REM Sleep Behavior Disorder" Mayo Clinic Retrieved 27 July 2016 
  8. ^ Mandell, Robert "Snoring: A Precursor to Medical Issues" PDF Stop Snoring Device Retrieved 27 July 2016 
  9. ^ http://wwwhealthscoutcom/ency/1/457/mainhtmlfull citation needed
  10. ^ MeSH 68020920
  11. ^ Melinda Smith, MA, Lawrence Robinson, Robert Segal, MA September 2011 "Sleep Disorders and Sleeping Problems" CS1 maint: Multiple names: authors list link
  12. ^ National Institute of Neurological Disorders and Stroke June 27, 2011 "NINDS Narcolepsy" 
  13. ^ a b Voderholzer, Ulrich; Guilleminault, Christian 2012 "Sleep disorders" Neurobiology of Psychiatric Disorders Handbook of Clinical Neurology 106 pp 527–40 doi:101016/B978-0-444-52002-900031-0 ISBN 978-0-444-52002-9 PMID 22608642 
  14. ^ Thorpy, Michael J "PARASOMNIACS" The International Classification of Sleep Disorders: Diagnostic and Coding Manual Rochester: American Sleep Disorders Association, 1990 Print
  15. ^ Kajeepeta, Sandhya; Gelaye, Bizu; Jackson, Chandra L; Williams, Michelle A 2015-03-01 "Adverse childhood experiences are associated with adult sleep disorders: a systematic review" Sleep Medicine 16 3: 320–330 doi:101016/jsleep201412013 ISSN 1878-5506 PMC 4635027  PMID 25777485 
  16. ^ Author, UTHSCSA Dental School CATs "UTCAT2395, Found CAT view, CRITICALLY APPRAISED TOPICs" catsuthscsaedu Retrieved 2016-03-08 
  17. ^ Schenck, Carlos H 2013-11-01 "Family history of REM sleep behaviour disorder more common in individuals affected by the disorder than among unaffected individuals" Evidence Based Mental Health 16 4: 114–114 doi:101136/eb-2013-101479 ISSN 1468-960X PMID 23970760 
  18. ^ Ivanenko A, Massey C October 1, 2006 "Assessment and Management of Sleep Disorders in Children" Psychiatric Times 23 11 
  19. ^ Keckeis, Marietta; Lattova, Zuzana; Maurovich-Horvat, Eszter; Beitinger, Pierre A; Birkmann, Steffen; Lauer, Christoph J; Wetter, Thomas C; Wilde-Frenz, Johanna; Pollmächer, Thomas 2010 Finkelstein, David, ed "Impaired Glucose Tolerance in Sleep Disorders" PLoS ONE 5 3: e9444 doi:101371/journalpone0009444 PMC 2830474  PMID 20209158 
  20. ^ a b Cheuk, Daniel KL; Yeung, Wing-Fai; Chung, Kf; Wong, Virginia 2012-09-12 "Acupuncture for insomnia" The Cochrane Library John Wiley & Sons, Ltd 9: CD005472 doi:101002/14651858cd005472pub3 ISSN 1465-1858 PMID 22972087 
  21. ^ Stradling, J; Roberts, D; Wilson, A; Lovelock, F 1998 "Controlled trial of hypnotherapy for weight loss in patients with obstructive sleep apnoea" International Journal of Obesity 22 3: 278–81 doi:101038/sjijo0800578 PMID 9539198 
  22. ^ Ng, Beng-Yeong; Lee, Tih-Shih 2008 "Hypnotherapy for Sleep Disorders" PDF Annals of the Academy of Medicine, Singapore 37 8: 683–8 PMID 18797562 
  23. ^ Graci, Gina M; Hardie, John C 2007 "Evidenced-Based Hypnotherapy for the Management of Sleep Disorders" International Journal of Clinical and Experimental Hypnosis 55 3: 288–302 doi:101080/00207140701338662 PMID 17558719 
  24. ^ Hauri, PJ; Silber, MH; Boeve, BF 2007 "The treatment of parasomnias with hypnosis: A 5-year follow-up study" Journal of Clinical Sleep Medicine 3 4: 369–73 PMC 1978312  PMID 17694725 
  25. ^ a b Hurwitz, Thomas D; Mahowald, Mark W; Schenck, Carlos H; Schluter, Janet; Bundlie, Scott R April 1991 "A retrospective outcome study and review of hypnosis as treatment of adults with sleepwalking and sleep terror" Journal of Nervous & Mental Disease 179 4: 181–241 
  26. ^ Owens, Laurence J; France, Karyn G; Wiggs, Luci 1999 "REVIEW ARTICLE: Behavioural and cognitive-behavioural interventions for sleep disorders in infants and children: A review" Sleep Medicine Reviews 3 4: 281–302 doi:101053/smrv19990082 PMID 12531150 
  27. ^ Wang, CF 2013-04-24 "Music therapy improves sleep quality in acute and chronic sleep disorders: a meta-analysis of 10 randomized studies" Centre for Reviews and Dissemination 51: 51–62 doi:101016/jijnurstu201303008 PMID 23582682 Retrieved 2016-03-08 
  28. ^ Jespersen, Kira V; Koenig, Julian; Jennum, Poul; Vuust, Peter Music for insomnia in adults doi:101002/14651858cd010459pub2 
  29. ^ Ferracioli-Oda, E 2013-06-06 "Meta-analysis: melatonin for the treatment of primary sleep disorders" Centre for Reviews and Dissemination Retrieved 2016-03-08 
  30. ^ "Meta-analysis: melatonin for the treatment of primary sleep disorders" wwwcrdyorkacuk Retrieved 2016-03-08 
  31. ^ "American Board of Medical Specialties : Recognized Physician Specialty and Subspecialty Certificates" Retrieved 2008-07-21 
  32. ^ Mahowald, Mark 2000 "What is causing excessive daytime sleepiness Evaluation to distinguish sleep deprivation from sleep disorders" Postgraduate Medicine 107 3: 108–10, 115–8, 123 doi:103810/pgm200003932 PMID 10728139 
  33. ^ "Sleep Disorder" sleepassociation Retrieved 18 February 2016 
  34. ^ "About AADSM" Academy of Dental Sleep Medicine 2008 Retrieved 2008-07-22 
  35. ^ "About the ADBSM" American Board of Dental Sleep Medicine Retrieved 2008-07-22 
  36. ^ Wollenberg, Anne July 28, 2008 "Time to wake up to sleep disorders" Guardian News and Media Limited Retrieved 2008-08-03 
  37. ^ "Sleep services" Imperial College Healthcare NHS Trust 2008 Retrieved 2008-08-02 

External linksedit

  • Sleep Problems - information leaflet from mental health charity The Royal College of Psychiatrists
  • 1 Sleep Disorders Health Center

sleep disorder center, sleep disorder clinics, sleep disorder doctors, sleep disorder medication, sleep disorder symptoms, sleep disorder test, sleep disorder treatment, sleep disorders, sleep disorders in adults, sleep disorders in children

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