Sleep disorder
Encyclopedia
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 and emotional functioning. A test commonly ordered for some sleep disorders is the polysomnography
.
Disruptions in sleep can be caused by a variety of issues, from teeth grinding (bruxism
) to night terror
s. When a person suffers from difficulty in sleeping with no obvious cause, it is referred to as insomnia
. In addition, sleep disorders may also cause sufferers to sleep excessively, a condition known as hypersomnia
. Management of sleep disturbances that are secondary to mental, medical, or substance abuse disorders should focus on the underlying conditions.
Some proposed Sleep Disorders include Sleep-Related NeurogenicTachypnea, Sleep-Related Laryngospasm and Sleep Choking Syndrome
Treatments for sleep disorders generally can be grouped into four categories:
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. Some disorders, such as narcolepsy, are best treated pharmacologically. 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 warranted.
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 metabolism.
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:
Competence in sleep medicine requires an understanding of a myriad of very diverse disorders, many of which present with similar symptom
s 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 central nervous system (CNS) hypersomnia
, Kleine-Levin syndrome
, menstrual-related hypersomnia, idiopathic
recurrent stupor, or circadian rhythm disturbances. 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 diagnosis.
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 (USA). 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 disorders.
In the UK, knowledge of sleep medicine and possibilities for diagnosis and treatment seem to lag. Guardian.co.uk 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." The Imperial College Healthcare site shows attention to obstructive sleep apnea syndrome (OSA) and very few other sleep disorders.
Sleep
Sleep is a naturally recurring state characterized by reduced or absent consciousness, relatively suspended sensory activity, and inactivity of nearly all voluntary muscles. It is distinguished from quiet wakefulness by a decreased ability to react to stimuli, and is more easily reversible than...
patterns of a person or animal. Some sleep disorders are serious enough to interfere with normal physical, mental and emotional functioning. A test commonly ordered for some sleep disorders is the polysomnography
Polysomnography
Polysomnography , also known as a sleep study, is a multi-parametric test used in the study of sleep and as a diagnostic tool in sleep medicine. The test result is called a polysomnogram, also abbreviated PSG...
.
Disruptions in sleep can be caused by a variety of issues, from teeth grinding (bruxism
Bruxism
Bruxism is characterized by the grinding of the teeth and typically includes the clenching of the jaw. It is an oral parafunctional activity that occurs in most humans at some time in their lives. In most people, bruxism is mild enough not to be a health problem...
) to night terror
Night terror
A night terror, also known as a sleep terror, incubus attack, or pavor nocturnus, is a parasomnia disorder that predominantly affects children, causing feelings of terror or dread, typically occur in the first few hours of sleep during stage 3 or 4 NREM sleep...
s. When a person suffers from difficulty in sleeping with no obvious cause, it is referred to as insomnia
Insomnia
Insomnia is most often defined by an individual's report of sleeping difficulties. While the term is sometimes used in sleep literature to describe a disorder demonstrated by polysomnographic evidence of disturbed sleep, insomnia is often defined as a positive response to either of two questions:...
. In addition, sleep disorders may also cause sufferers to sleep excessively, a condition known as hypersomnia
Hypersomnia
Hypersomnia is a disorder characterized by excessive amounts of sleepiness.There are two main categories of hypersomnia: primary hypersomnia and recurrent hypersomnia...
. Management of sleep disturbances that are secondary to mental, medical, or substance abuse disorders should focus on the underlying conditions.
Some proposed Sleep Disorders include Sleep-Related NeurogenicTachypnea, Sleep-Related Laryngospasm and Sleep Choking Syndrome
Common disorders
The most common sleep disorders include:- Primary insomniaInsomniaInsomnia is most often defined by an individual's report of sleeping difficulties. While the term is sometimes used in sleep literature to describe a disorder demonstrated by polysomnographic evidence of disturbed sleep, insomnia is often defined as a positive response to either of two questions:...
: Chronic difficulty in falling asleep and/or maintaining sleep when no other cause is found for these symptoms. - BruxismBruxismBruxism is characterized by the grinding of the teeth and typically includes the clenching of the jaw. It is an oral parafunctional activity that occurs in most humans at some time in their lives. In most people, bruxism is mild enough not to be a health problem...
: Involuntarily grinding or clenching of the teeth while sleeping. - Delayed sleep phase syndromeDelayed sleep phase syndromeDelayed sleep-phase syndrome , also known as delayed sleep-phase disorder or delayed sleep-phase type , is a circadian rhythm sleep disorder, a chronic disorder of the timing of sleep, peak period of alertness, the core body temperature rhythm, hormonal and other daily rhythms, compared to the...
(DSPS): inability to awaken and fall asleep at socially acceptable times but no problem with sleep maintenance, a disorder of circadian rhythmCircadian rhythmA circadian rhythm, popularly referred to as body clock, is an endogenously driven , roughly 24-hour cycle in biochemical, physiological, or behavioural processes. Circadian rhythms have been widely observed in plants, animals, fungi and cyanobacteria...
s. (Other such disorders are advanced sleep phase syndromeAdvanced sleep phase syndromeAdvanced sleep phase syndrome , also known as the advanced sleep-phase type of circadian rhythm sleep disorder, is a condition in which patients feel very sleepy and go to bed early in the evening and wake up very early in the morning Advanced sleep phase syndrome (ASPS), also known as the...
(ASPS), non-24-hour sleep-wake syndromeNon-24-hour sleep-wake syndromeNon-24-hour sleep-wake syndrome is a chronic circadian rhythm sleep disorder, classified within Chapter VI, Diseases of the Nervous System, in the ICD-10. It can be defined as "a chronic steady pattern comprising one- to two-hour daily delays in sleep onset and wake times in an individual living...
(Non-24), and irregular sleep wake rhythm, all much less common than DSPS, as well as the transient jet lagJet lagJet lag, medically referred to as desynchronosis, is a physiological condition which results from alterations to the body's circadian rhythms; it is classified as one of the circadian rhythm sleep disorders...
and shift work sleep disorderShift work sleep disorderShift work sleep disorder is a circadian rhythm sleep disorder characterized by insomnia and excessive sleepiness affecting people whose work hours are scheduled during the typical sleep period...
.) - Hypopnea syndrome: Abnormally shallow breathing or slow respiratory rate while sleeping.
- NarcolepsyNarcolepsyNarcolepsy is a chronic sleep disorder, or dyssomnia, characterized by excessive sleepiness and sleep attacks at inappropriate times, such as while at work. People with narcolepsy often experience disturbed nocturnal sleep and an abnormal daytime sleep pattern, which often is confused with insomnia...
: Excessive daytime sleepinessExcessive daytime sleepinessExcessive daytime sleepiness is characterized by persistent sleepiness, and often a general lack of energy, even after apparently adequate night time sleep...
(EDS) often culminating in falling asleep spontaneously but unwillingly at inappropriate times. - CataplexyCataplexyCataplexy is a sudden and transient episode of loss of muscle tone, often triggered by emotions. It is a rare disease , but affects roughly 70% of people who have narcolepsy...
: a sudden weakness in the motor muscles that can result in collapse to the floor. - Night terrorNight terrorA night terror, also known as a sleep terror, incubus attack, or pavor nocturnus, is a parasomnia disorder that predominantly affects children, causing feelings of terror or dread, typically occur in the first few hours of sleep during stage 3 or 4 NREM sleep...
: Pavor nocturnus, sleep terror disorder: abrupt awakening from sleep with behavior consistent with terrorFearFear is a distressing negative sensation induced by a perceived threat. It is a basic survival mechanism occurring in response to a specific stimulus, such as pain or the threat of danger...
. - ParasomniaParasomniaFor the 2008 horror film, see Parasomnia Parasomnias are a category of sleep disorders that involve abnormal and unnatural movements, behaviors, emotions, perceptions, and dreams that occur while falling asleep, sleeping, between sleep stages, or during arousal from sleep...
s: Disruptive sleep-related events involving inappropriate actions during sleep; sleep walking and night-terrors are examples. - Periodic limb movement disorder (PLMD): Sudden involuntary movement of arms and/or legs during sleep, for example kicking the legs. Also known as nocturnal myoclonusNocturnal myoclonusPeriodic limb movement disorder , previously known as nocturnal myoclonus, is a sleep disorder where the patient moves limbs involuntarily during sleep, and has symptoms or problems related to the movement....
. See also Hypnic jerkHypnic jerkA hypnic jerk, hypnagogic jerk, sleep start, or night start, is an involuntary myoclonic twitch which occurs during hypnagogia, just as a person is beginning to fall asleep, often causing them to awaken suddenly. Physically, hypnic jerks resemble the "jump" experienced by a person when...
, which is not a disorder. - Rapid eye movement behavior disorderRapid eye movement behavior disorderRapid eye movement sleep behaviour disorder is a sleep disorder that involves abnormal behaviour during the sleep phase with rapid eye movement . It was first described in 1986....
(RBD): Acting out violent or dramatic dreams while in REM sleep (REM sleep disorder or RSD) - Restless legs syndromeRestless legs syndromeRestless legs syndrome or Willis-Ekbom disease is a neurological disorder characterized by an irresistible urge to move one's body to stop uncomfortable or odd sensations. It most commonly affects the legs, but can affect the arms, torso, and even phantom limbs...
(RLS): An irresistible urge to move legs. RLS sufferers often also have PLMD. - Situational circadian rhythm sleep disorderCircadian rhythm sleep disorderCircadian rhythm sleep disorders are a family of sleep disorders affecting, among other things, the timing of sleep. People with circadian rhythm sleep disorders are unable to sleep and wake at the times required for normal work, school, and social needs. They are generally able to get enough sleep...
s: shift work sleep disorderShift work sleep disorderShift work sleep disorder is a circadian rhythm sleep disorder characterized by insomnia and excessive sleepiness affecting people whose work hours are scheduled during the typical sleep period...
(SWSD) and jet lagJet lagJet lag, medically referred to as desynchronosis, is a physiological condition which results from alterations to the body's circadian rhythms; it is classified as one of the circadian rhythm sleep disorders...
. - Sleep Apnea, and mostly Obstructive sleep apneaObstructive sleep apneaObstructive sleep apnea or obstructive sleep apnea syndrome is the most common type of sleep apnea and is caused by obstruction of the upper airway. It is characterized by repetitive pauses in breathing during sleep, despite the effort to breathe, and is usually associated with a reduction in...
: Obstruction of the airway during sleep, causing lack of sufficient deep sleep; often accompanied by snoring. Other forms of sleep apneaSleep apneaSleep apnea is a sleep disorder characterized by abnormal pauses in breathing or instances of abnormally low breathing, during sleep. Each pause in breathing, called an apnea, can last from a few seconds to minutes, and may occur 5 to 30 times or more an hour. Similarly, each abnormally low...
are less common. - Sleep paralysisSleep paralysisSleep paralysis is paralysis associated with sleep that may occur in healthy persons or may be associated with narcolepsy, cataplexy, and hypnagogic hallucinations. The pathophysiology of this condition is closely related to the normal hypotonia that occurs during REM sleep. When considered to be a...
: is characterized by temporary paralysisParalysisParalysis is loss of muscle function for one or more muscles. Paralysis can be accompanied by a loss of feeling in the affected area if there is sensory damage as well as motor. A study conducted by the Christopher & Dana Reeve Foundation, suggests that about 1 in 50 people have been diagnosed...
of the body shortly before or after sleep. Sleep paralysis may be accompanied by visual, auditorySoundSound is a mechanical wave that is an oscillation of pressure transmitted through a solid, liquid, or gas, composed of frequencies within the range of hearing and of a level sufficiently strong to be heard, or the sensation stimulated in organs of hearing by such vibrations.-Propagation of...
or tactile hallucinations. Not a disorder unless severe. Often seen as part of narcolepsy. - SleepwalkingSleepwalkingSleepwalking, also known as somnambulism, is a sleep disorder belonging to the parasomnia family. Sleepwalkers arise from the slow wave sleep stage in a state of low consciousness and perform activities that are usually performed during a state of full consciousness...
or somnambulism: Engaging in activities that are normally associated with wakefulness (such as eatingEatingEating is the ingestion of food to provide for all organisms their nutritional needs, particularly for energy and growth. Animals and other heterotrophs must eat in order to survive: carnivores eat other animals, herbivores eat plants, omnivores consume a mixture of both plant and animal matter,...
or dressingClothingClothing refers to any covering for the human body that is worn. The wearing of clothing is exclusively a human characteristic and is a feature of nearly all human societies...
), which may include walking, without the conscious knowledge of the subject. - NocturiaNocturiaNocturia , also called nycturia , is the need to get up in the night to urinate, thus interrupting sleep. Its occurrence is more frequent in pregnant women and in the elderly...
: A frequent need to get up and go to the bathroom to urinate at night. It differs from EnuresisEnuresisEnuresis refers to an inability to control urination. Use of the term is usually limited to describing individuals old enough to be expected to exercise such control.Types of enuresis include:* Nocturnal enuresis* Diurnal enuresis...
, or bed-wetting, in which the person does not arouse from sleep, but the bladder nevertheless empties. - SomniphobiaSomniphobiaHypnophobia or somniphobia is an abnormal fear of sleep. It may result from a feeling of control loss, or from repeating nightmares. The prefix Hypno- originates from the Greek word hupnos, which means sleep.-Causes of Hypnophobia:...
: a dread of sleep.
Types
- DyssomniaDyssomniaDyssomnias are a broad classification of sleeping disorders that make it difficult to get to sleep, or to remain sleeping.Dyssomnias are primary disorders of initiating or maintaining sleep or of excessive sleepiness and are characterized by a disturbance in the amount, quality, or timing of...
s - 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- InsomniaInsomniaInsomnia is most often defined by an individual's report of sleeping difficulties. While the term is sometimes used in sleep literature to describe a disorder demonstrated by polysomnographic evidence of disturbed sleep, insomnia is often defined as a positive response to either of two questions:...
: An inability to get the amount of sleep needed to restore our physical and mental condition. Insomnia is often a symptom of a mood disorder (i.e., emotional stress, anxiety, depression) or underlying health condition (i.e., asthma, diabetes, heart disease, pregnancy or neurological conditions). - NarcolepsyNarcolepsyNarcolepsy is a chronic sleep disorder, or dyssomnia, characterized by excessive sleepiness and sleep attacks at inappropriate times, such as while at work. People with narcolepsy often experience disturbed nocturnal sleep and an abnormal daytime sleep pattern, which often is confused with insomnia...
: A chronic neurological disorder (or dyssomnia), which is caused by the brain's inability to control sleep and wakefulness. - Sleep Disordered Breathing (SDBSDBSDB or sdb can stand for:* Safe deposit box, a type of safe* Salesians of Don Bosco, a Roman Catholic religious order* Schiller-Duval body, a pathologic finding pathognomonic for Endodermal sinus tumors...
), including (non exhaustive):- Several types of Sleep apneaSleep apneaSleep apnea is a sleep disorder characterized by abnormal pauses in breathing or instances of abnormally low breathing, during sleep. Each pause in breathing, called an apnea, can last from a few seconds to minutes, and may occur 5 to 30 times or more an hour. Similarly, each abnormally low...
- SnoringSnoringSnoring is the vibration of respiratory structures and the resulting sound, due to obstructed air movement during breathing while sleeping. In some cases the sound may be soft, but in other cases, it can be loud and unpleasant...
- Upper airway resistance syndrome
- Several types of Sleep apnea
- Restless leg syndrome
- Periodic limb movement disorder
- HypersomniaHypersomniaHypersomnia is a disorder characterized by excessive amounts of sleepiness.There are two main categories of hypersomnia: primary hypersomnia and recurrent hypersomnia...
- Recurrent hypersomnia - including Kleine-Levin syndromeKleine-Levin syndromeKleine-Levin Syndrome or KLS is aneurological disorder characterized by recurring periods of excessive amounts of sleeping and eating. At the onset of an episode the patient becomes drowsy and sleeps for most of the day and night , waking only to eat or go to the bathroom...
- Posttraumatic hypersomnia
- "Healthy" hypersomnia
- Recurrent hypersomnia - including Kleine-Levin syndrome
- Circadian rhythm sleep disorders
- Delayed sleep phase syndromeDelayed sleep phase syndromeDelayed sleep-phase syndrome , also known as delayed sleep-phase disorder or delayed sleep-phase type , is a circadian rhythm sleep disorder, a chronic disorder of the timing of sleep, peak period of alertness, the core body temperature rhythm, hormonal and other daily rhythms, compared to the...
- Advanced sleep phase syndromeAdvanced sleep phase syndromeAdvanced sleep phase syndrome , also known as the advanced sleep-phase type of circadian rhythm sleep disorder, is a condition in which patients feel very sleepy and go to bed early in the evening and wake up very early in the morning Advanced sleep phase syndrome (ASPS), also known as the...
- Non-24-hour sleep-wake syndromeNon-24-hour sleep-wake syndromeNon-24-hour sleep-wake syndrome is a chronic circadian rhythm sleep disorder, classified within Chapter VI, Diseases of the Nervous System, in the ICD-10. It can be defined as "a chronic steady pattern comprising one- to two-hour daily delays in sleep onset and wake times in an individual living...
- Delayed sleep phase syndrome
- ParasomniaParasomniaFor the 2008 horror film, see Parasomnia Parasomnias are a category of sleep disorders that involve abnormal and unnatural movements, behaviors, emotions, perceptions, and dreams that occur while falling asleep, sleeping, between sleep stages, or during arousal from sleep...
s - A category of sleep disorders that involve abnormal and unnatural movements, behaviors, emotions, perceptions, and dreams in connection with sleep. - REM sleep behaviour disorderRapid eye movement behavior disorderRapid eye movement sleep behaviour disorder is a sleep disorder that involves abnormal behaviour during the sleep phase with rapid eye movement . It was first described in 1986....
- Sleep terrorNight terrorA night terror, also known as a sleep terror, incubus attack, or pavor nocturnus, is a parasomnia disorder that predominantly affects children, causing feelings of terror or dread, typically occur in the first few hours of sleep during stage 3 or 4 NREM sleep...
(or Pavor nocturnus)- Characterized by a sudden arousal from deep sleep with a scream or cry, accompanied by some behavioral manifestations of intense fear. - SleepwalkingSleepwalkingSleepwalking, also known as somnambulism, is a sleep disorder belonging to the parasomnia family. Sleepwalkers arise from the slow wave sleep stage in a state of low consciousness and perform activities that are usually performed during a state of full consciousness...
(or somnambulism) - BruxismBruxismBruxism is characterized by the grinding of the teeth and typically includes the clenching of the jaw. It is an oral parafunctional activity that occurs in most humans at some time in their lives. In most people, bruxism is mild enough not to be a health problem...
(Tooth-grinding) - BedwettingBedwettingNocturnal enuresis, commonly called bedwetting, is involuntary urination while asleep after the age at which bladder control usually occurs. Nocturnal enuresis is considered primary when a child has not yet had a prolonged period of being dry...
or sleep enuresis. - Sleep talking (or somniloquy)
- Sleep sexSleep sexSleep sex, or sexsomnia, is a condition in which a person will do sexual acts while still asleep, acts such as masturbation, fondling themselves or others, having sex with another person and in more extreme cases sexual assault and rape....
(or sexsomnia) - Exploding head syndromeExploding head syndromeExploding head syndrome is a parasomnia condition that causes the sufferer occasionally to experience a tremendously loud noise as originating from within his or her own head, usually described as the sound of an explosion, roar, gunshot, loud voices or screams, a ringing noise, or the sound of...
- Waking up in the night hearing loud noises.
- Insomnia
- Medical or Psychiatric Conditions that may produce sleep disorders
- PsychosisPsychosisPsychosis means abnormal condition of the mind, and is a generic psychiatric term for a mental state often described as involving a "loss of contact with reality"...
(such as SchizophreniaSchizophreniaSchizophrenia is a mental disorder characterized by a disintegration of thought processes and of emotional responsiveness. It most commonly manifests itself as auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking, and it is accompanied by significant social...
) - Mood disorders
- DepressionClinical depressionMajor depressive disorder is a mental disorder characterized by an all-encompassing low mood accompanied by low self-esteem, and by loss of interest or pleasure in normally enjoyable activities...
- AnxietyAnxietyAnxiety is a psychological and physiological state characterized by somatic, emotional, cognitive, and behavioral components. The root meaning of the word anxiety is 'to vex or trouble'; in either presence or absence of psychological stress, anxiety can create feelings of fear, worry, uneasiness,...
- Depression
- PanicPanicPanic is a sudden sensation of fear which is so strong as to dominate or prevent reason and logical thinking, replacing it with overwhelming feelings of anxiety and frantic agitation consistent with an animalistic fight-or-flight reaction...
- AlcoholismAlcoholismAlcoholism is a broad term for problems with alcohol, and is generally used to mean compulsive and uncontrolled consumption of alcoholic beverages, usually to the detriment of the drinker's health, personal relationships, and social standing...
- Psychosis
- Sleeping sickness - a parasitic disease which can be transmitted by the Tsetse flyTsetse flyTsetse , sometimes spelled tzetze and also known as tik-tik flies, are large biting flies that inhabit much of mid-continental Africa between the Sahara and the Kalahari deserts. They live by feeding on the blood of vertebrate animals and are the primary biological vectors of trypanosomes, which...
.
General principles of treatment
- Behavioral and psychotherapeuticPsychotherapyPsychotherapy is a general term referring to any form of therapeutic interaction or treatment contracted between a trained professional and a client or patient; family, couple or group...
treatment
- Rehabilitation and management
- Medication
- Other somatic treatmentSomaticThe term somatic means 'of the body',, relating to the body. In medicine, somatic illness is bodily, not mental, illness. The term is often used in biology to refer to the cells of the body in contrast to the germ line cells which usually give rise to the gametes...
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. Some disorders, such as narcolepsy, are best treated pharmacologically. 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 warranted.
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 metabolism.
Sleep medicine
Due to rapidly increasing knowledge about sleep in the 20th century, including the discovery of REM sleep and sleep apnea, 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.Sleep Medicine is now a recognized subspecialty within internal medicine
Internal medicine
Internal medicine is the medical specialty dealing with the prevention, diagnosis, and treatment of adult diseases. Physicians specializing in internal medicine are called internists. They are especially skilled in the management of patients who have undifferentiated or multi-system disease processes...
, family medicine
Family medicine
Family medicine is a medical specialty devoted to comprehensive health care for people of all ages. It is a division of primary care that provides continuing and comprehensive health care for the individual and family across all ages, sexes, diseases, and parts of the body...
, pediatrics
Pediatrics
Pediatrics or paediatrics is the branch of medicine that deals with the medical care of infants, children, and adolescents. A medical practitioner who specializes in this area is known as a pediatrician or paediatrician...
, otolaryngology
Otolaryngology
Otolaryngology or ENT is the branch of medicine and surgery that specializes in the diagnosis and treatment of ear, nose, throat, and head and neck disorders....
, psychiatry
Psychiatry
Psychiatry is the medical specialty devoted to the study and treatment of mental disorders. These mental disorders include various affective, behavioural, cognitive and perceptual abnormalities...
and neurology
Neurology
Neurology is a medical specialty dealing with disorders of the nervous system. Specifically, it deals with the diagnosis and treatment of all categories of disease involving the central, peripheral, and autonomic nervous systems, including their coverings, blood vessels, and all effector tissue,...
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."
Competence in sleep medicine requires an understanding of a myriad of very diverse disorders, many of which present with similar symptom
Symptom
A symptom is a departure from normal function or feeling which is noticed by a patient, indicating the presence of disease or abnormality...
s such as excessive daytime sleepiness, which, in the absence of volitional sleep deprivation
Sleep deprivation
Sleep deprivation is the condition of not having enough sleep; it can be either chronic or acute. A chronic sleep-restricted state can cause fatigue, daytime sleepiness, clumsiness and weight loss or weight gain. It adversely affects the brain and cognitive function. Few studies have compared the...
, "is almost inevitably caused by an identifiable and treatable sleep disorder", such as sleep apnea, narcolepsy
Narcolepsy
Narcolepsy is a chronic sleep disorder, or dyssomnia, characterized by excessive sleepiness and sleep attacks at inappropriate times, such as while at work. People with narcolepsy often experience disturbed nocturnal sleep and an abnormal daytime sleep pattern, which often is confused with insomnia...
, idiopathic central nervous system (CNS) hypersomnia
Hypersomnia
Hypersomnia is a disorder characterized by excessive amounts of sleepiness.There are two main categories of hypersomnia: primary hypersomnia and recurrent hypersomnia...
, Kleine-Levin syndrome
Kleine-Levin syndrome
Kleine-Levin Syndrome or KLS is aneurological disorder characterized by recurring periods of excessive amounts of sleeping and eating. At the onset of an episode the patient becomes drowsy and sleeps for most of the day and night , waking only to eat or go to the bathroom...
, menstrual-related hypersomnia, idiopathic
Idiopathic
Idiopathic is an adjective used primarily in medicine meaning arising spontaneously or from an obscure or unknown cause. From Greek ἴδιος, idios + πάθος, pathos , it means approximately "a disease of its own kind". It is technically a term from nosology, the classification of disease...
recurrent stupor, or circadian rhythm disturbances. 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 diagnosis.
Sleep dentistry (bruxism
Bruxism
Bruxism is characterized by the grinding of the teeth and typically includes the clenching of the jaw. It is an oral parafunctional activity that occurs in most humans at some time in their lives. In most people, bruxism is mild enough not to be a health problem...
, snoring and sleep apnea), while not recognized as one of the nine dental specialties
Dentistry
Dentistry is the branch of medicine that is involved in the study, diagnosis, prevention, and treatment of diseases, disorders and conditions of the oral cavity, maxillofacial area and the adjacent and associated structures and their impact on the human body. Dentistry is widely considered...
, 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 (USA). 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 disorders.
In the UK, knowledge of sleep medicine and possibilities for diagnosis and treatment seem to lag. Guardian.co.uk quotes the director of the Imperial College Healthcare
Imperial College Healthcare NHS Trust
Imperial College Healthcare NHS Trust is an NHS trust based in London, United Kingdom. It is the largest NHS trust in England and together with Imperial College London forms an academic health science centre....
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." The Imperial College Healthcare site shows attention to obstructive sleep apnea syndrome (OSA) and very few other sleep disorders.
See also
- ChronotypeChronotypeChronotype is an attribute of animals, including human beings, reflecting at what time of the day their physical functions are active, change or reach a certain level...
s - Environmental noise health effectsNoise health effectsNoise health effects are the health consequences of elevated sound levels. Elevated workplace or other noise can cause hearing impairment, hypertension, ischemic heart disease, annoyance and sleep disturbance. Changes in the immune system and birth defects have been attributed to noise exposure...
- International Classification of Sleep DisordersInternational Classification of Sleep DisordersThe International Classification of Sleep Disorders is "a primary diagnostic, epidemiological and coding resource for clinicians and researchers in the field of sleep and sleep medicine."...
- National Sleep FoundationNational Sleep FoundationThe National Sleep Foundation is an independent nonprofit organization in the USA whose objectives are to improve public health and safety by achieving understanding of sleep and sleep disorders, and to support sleep-related education, research, and advocacy.Established in 1990, the NSF relies on...
- Reversed vegetative symptomsReversed vegetative symptomsReversed vegetative symptoms include only oversleeping and overeating , as compared to insomnia and loss of appetite . These features are characteristic of atypical depression ....
- Sleep hygieneSleep hygieneSleep hygiene can be defined as the controlling of "all behavioural and environmental factors that precede sleep and may interfere with sleep." It is the practice of following guidelines in an attempt to ensure more restful, effective sleep which can promote daytime alertness and help treat or...
- Sundowning (dementia)Sundowning (dementia)In medicine, sundowning, also known as sundown syndrome, is a syndrome involving the occurrence or increase of one or more abnormal behaviors in a circadian rhythm. Sundowning typically occurs during the late afternoon, evening, and night, hence the name. It occurs in persons with certain forms of...
- White noise machineWhite noise machineA white noise machine is a device that produces a sound that is random in character, which sounds like a rushing waterfall or wind blowing through trees...
- Sleep medicineSleep medicineSleep medicine is a medical specialty or subspecialty devoted to the diagnosis and therapy of sleep disturbances and disorders. From the middle of the 20th century, research has provided increasing knowledge and answered many questions about sleep-wake functioning. The rapidly evolving field has...
- PolysomnographyPolysomnographyPolysomnography , also known as a sleep study, is a multi-parametric test used in the study of sleep and as a diagnostic tool in sleep medicine. The test result is called a polysomnogram, also abbreviated PSG...
- Polysomnographic technician
External links
- Sleep Problems - information leaflet from mental health charity The Royal College of Psychiatrists
- List of sleeping disorders
- Sleep Disorders ePatient website