4.4 - sleep problems and disorders

Sleep Disorders: Symptoms, Treatments, and Risk Factors

1. Insomnia

Definition:
Consistent difficulty falling or staying asleep, most common sleep disorder.

Symptoms:

• Trouble falling asleep (long delays after going to bed)

• Waking up multiple times during the night and difficulty returning to sleep

• Occurs at least 3 nights a week for at least 1 month

• Daytime fatigue, overtiredness

• Often associated with increased anxiety and sometimes depression (anxiety often worsens the insomnia in a self-perpetuating cycle)

Causes & Risk Factors:

• Age, drug/stimulant use (e.g., caffeine)

• Lack of exercise, high stress

• Mental health conditions (e.g., depression, anxiety)

• Poor sleep habits and irregular routines

Treatments:

• Limit stimulants (caffeine, nicotine)

• Increase daytime physical activity

• Establish regular sleep schedule

• Avoid stimulating activities before bed (exercise, screen time)

• Behavioral interventions:

  • Cognitive-Behavioral Therapy (CBT): Focuses on changing unhelpful beliefs and behaviors, teaching stress management and sleep-promoting habits

  • Stimulus control: Associate bed/bedtime only with sleep (not with studying/TV)

  • Sleep hygiene education

• Avoid long-term use of sleep medications—risk of dependence, altered sleep architecture, potential to worsen insomnia

• Seek professional help if persistent

2. Parasomnias

Group of sleep disorders involving unwanted motor activity or experiences during sleep; can occur in REM or NREM.

Sleepwalking (Somnambulism)

• Complex behaviors (wandering, driving) during sleep, usually slow-wave (deep NREM) sleep

• Eyes open, but unresponsive; can’t remember the event

• More common in children; can occur at any age

Treatment:

• Historically: Benzodiazepines or antidepressants, but limited efficacy

• Best outcomes when addressing underlying issues (e.g., sleep-related breathing disorders)

• Safety measures: Secure sleeping environment

REM Sleep Behavior Disorder (RBD)

• Lack of normal REM muscle paralysis; person acts out dreams (kicking, yelling, striking)

• Can cause injury to self or bed partner; dreams often vivid/disturbing

• Associated with neurodegenerative diseases like Parkinson’s

Treatment:

• Medications: Clonazepam (anti-anxiety/sedative); sometimes with melatonin

• Environmental safety modifications

Restless Leg Syndrome (RLS)

• Uncomfortable, often painful leg sensations, relieved by movement; worse during inactivity

• Leads to difficulty falling/staying asleep

• Associated with chronic conditions (diabetes, kidney disease)

Treatment:

• Medications: Benzodiazepines, opiates, anticonvulsants

Night Terrors

• Sudden, intense panic, screaming, attempts to escape

• Usually occur in NREM sleep; no memory after

• Most common in children

Treatment:

• Often not needed unless underlying medical/psychological issues present

• Usually diminish with age

3. Sleep Apnea

Definition:
Periods of stopped breathing during sleep, lasting 10-20+ seconds, causing frequent arousals.

Symptoms:

• Loud snoring, choking or gasping during sleep

• Daytime fatigue, poor concentration, increased accident risk

Types:

• Obstructive sleep apnea: Airway blockage (most common)

• Central sleep apnea: Brain does not send proper signals to maintain breathing

Risk Factors:

• Overweight/obesity

• Age

• Family history

• Loud snoring

Consequences:
Increased risk of cardiovascular disease, high blood pressure, accidents.

Treatment:

• First-line: CPAP machine (provides continuous positive airway pressure via a mask)

• Alternative devices: EPAP (expiratory positive airway pressure)

• Weight loss, avoiding alcohol, treating nasal/congestion issues

4. Sudden Infant Death Syndrome (SIDS)

Definition:
Unexplained death of an otherwise healthy infant under 1 year, usually during sleep.

Risk Factors:

• Age: Most common under 12 months

• Sex: Boys at higher risk

• Premature birth

• Smoking in the home

• Overheating during sleep

• Unsafe sleep environment (loose bedding, stuffed animals, crib bumpers)

Prevention Steps:

• Place infants on their backs to sleep

• Keep sleep area free from pillows, blankets, soft bedding, and toys

• Do not place hats/caps on sleeping infants (prevent overheating)

• No smoking in the home environment

• Recommendations and "Safe to Sleep" campaigns have decreased SIDS rates

5. Narcolepsy

Definition:
Disorder characterized by sudden, uncontrollable episodes of sleep, sometimes with muscle weakness (cataplexy).

Symptoms:

• Sudden "sleep attacks" at inappropriate times (can last minutes to half an hour)

• Cataplexy: Sudden loss of muscle tone/weakness, sometimes partial or complete, often triggered by strong emotions

• Some experience vivid, dream-like hallucinations during episodes

• Can occur at any time, often during heightened arousal/stress

• Person usually awakens refreshed

Causes:

• Low levels of hypocretin (orexin), a neurotransmitter that regulates arousal and wakefulness

Risks:
Dangerous when driving or operating heavy machinery; can interfere with social, academic, and work functioning

Treatment:

• Stimulant drugs (amphetamines) to promote wakefulness

• Antidepressants may be added (especially for cataplexy)

• Ongoing research on more targeted hypocretin-based drugs

Summary Table