Sleep disorder

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

## Overview

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A sleep disorder (somnipathy) is a disorder in the sleep patterns of a person or animal. Some sleep disorders can interfere with mental and emotional function. A test commonly ordered for some sleep disorders is the polysomnogram.

## Common Sleep Disorders

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The most common sleep disorders include:

* Bruxism: The sufferer involuntarily grinds his or her teeth while sleeping.
* Delayed sleep phase syndrome (DSPS): A sleep disorder of circadian rhythm, characterized by the inability to wake up and fall asleep at the desired times, but not by inability to stay asleep.
* Hypopnea syndrome: Abnormally shallow breathing or slow respiratory rate while sleeping.
* Narcolepsy: The condition of falling asleep spontaneously and unwillingly.
* Night terror or Pavor nocturnus or sleep terror disorder: abrupt awakening from sleep with behavior consistent with terror.
* Parasomnias: Include a variety of disruptive sleep-related events.
* Periodic limb movement disorder (PLMD): Involuntary movement of arms and/or legs during sleep. See also Hypnic jerk, which is not a disorder.
* Rapid eye movement behavior disorder (RBD): Acting out violent or dramatic dreams while in REM sleep.
* Restless legs syndrome (RLS): An irresistible urge to move legs while sleeping. Often accompanies PLMD.
* Shift work sleep disorder (SWSD).
* Sleep apnea: The obstruction of the airway during sleep.
* Sleepwalking or somnambulism: Engaging in activities that are normally associated with wakefulness (such as eating or dressing), which may include walking, without the conscious knowledge of the subject.
* Snoring: Loud breathing patterns while sleeping, sometimes accompanying sleep apnea.

## Broad Classifications of Sleep Disorders

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* Dysomnias \- A broad category of sleep disorders characterized by either hypersomnolence or insomnia. The three major subcategories include intrinsic (i.e., arising from within the body), extrinsic (secondary to environmental conditions or various pathologic conditions), and disturbances of circadian rhythm. MeSH
* Insomnia
* Narcolepsy
* Obstructive sleep apnea
* Restless leg syndrome
* Periodic limb movement disorder
* Hypersomnia
* Recurrent hypersomnia - including Kleine-Levin syndrome
* Posttraumatic hypersomnia
* "Healthy" hypersomnia
* Circadian rhythm sleep disorders
* Delayed sleep phase syndrome
* Advanced sleep phase syndrome
* Non-24-hour sleep-wake syndrome
* Parasomnias
* REM sleep behaviour disorder
* Sleep terror
* Sleepwalking (or somnambulism)
* Tooth-grinding
* Bedwetting or sleep enuresis.
* Sudden infant death syndrome (or SIDS)
* Sleep talking (or somniloquy)
* Sleep sex (or sexsomnia)
* Exploding head syndrome \- Waking up in the night hearing loud noises.
* Medical or Psychiatric Conditions that may produce sleep disorders
* Psychoses (such as Schizophrenia)
* Mood disorders
* Depression
* Anxiety
* Panic
* Alcoholism
* Sleeping sickness \- can be carried by the Tsetse fly
* Snoring \- Not a disorder in and of itself, but it can be a symptom of deeper problems.

## Common Causes of Sleep Disorders

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Changes in life style, such as shift work change (SWC), can contribute to sleep disorders.

Other problems that can affect sleep:

* Back pain
* Chronic pain
* Sciatica
* Neck problems
* Environmental noise
* Incontinence
* Babies that wake frequently
* Various drugs - Many drugs can affect the ratio of the various stages of sleep, thus affecting the overall quality of sleep. Poor sleep can lead to accumulation of Sleep debt.
* Lomefloxacin hydrochloride
* Endocrine imbalance mainly related with Cortisol but not limited to this hormone.
* Hyperparathyroidism
* Chrobiological disorders, mainly Circadian rhythm disorders

A sleep diary can be used to help diagnose, and measure improvements in sleep disorders. The Epworth Sleepiness Scale is another useful diagnostic tool.

According to Dr. William Dement, of the Stanford Sleep Center, anyone who snores and has daytime drowsiness should be evaluated for sleep disorders.

Any time back pain or another form of chronic pain is present, both the pain and the sleep problems should be treated simultaneously, as pain can lead to sleep problems and vice versa.

## General Principles of Treatment

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Treatments for sleep disorders generally can be grouped into three categories: 1) behavioral/psychotherapeutic treatments, 2) medications, and 3) other somatic treatments. 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. In general, medications and somatic treatments provide more rapid symptomatic relief from sleep disturbances. On the other hand, some emerging evidence suggests that treatment gains with behavioral treatment of insomnia may be more durable than those obtained with medications.

Some sleep disorders, such as narcolepsy, are best treated pharmacologically, whereas others, such as chronic and primary insomnia, are more amenable to behavioral interventions. The management of sleep disturbances that are secondary to mental, medical, or substance abuse disorders should focus on the underlying conditions.

For most sleep disorders, behavioral/psychotherapeutic and pharmacological approaches are not incompatible and can be effectively combined to maximize therapeutic benefits.

## Related Chapters

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* Excessive Daytime Sleepiness
* Auditory masking
* American Academy of Sleep Medicine
* Environmental noise health effects
* Reversed vegetative symptoms
* Sleep hygiene
* White noise machine

## References

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