Herbie Murray
Sleep-wake disturbances, or sleep disorders, are conditions that affect your sleep patterns and quality of rest. There are over 80 types of sleep disorders, with insomnia being the most common. If you're experiencing a sleep disorder, you may have trouble falling asleep, staying asleep, or feel tired during the day despite a full night's rest. Other signs include snoring, gasping, choking, or even stopping breathing during sleep. Sleep disorders can be caused by various factors, including poor sleep habits, environmental changes, medications, and co-occurring medical conditions. Diagnosing a sleep disorder involves a comprehensive assessment of your medical and sleep history, a physical exam, and possibly a sleep study or sleep diary. Treatment options range from lifestyle changes to cognitive behavioural therapy and medication.
| Characteristics | Values |
|---|---|
| Difficulty falling asleep | Taking more than 30 minutes to fall asleep |
| Trouble staying asleep | Waking up often in the middle of the night and can't fall back asleep |
| Snoring, gasping or choking | Loud snoring, snorting, gasping, choking sounds, or stopping breathing for short periods |
| Feeling like you need to move | Creeping, tingling, or crawling feelings in your legs or arms that are relieved by moving or massaging |
| Feeling like you can't move | Feeling unable to move when you wake up |
| Daytime sleepiness | Taking frequent daytime naps or falling asleep while doing routine tasks |
| Behavioral changes | Difficulty focusing or paying attention |
| Mood changes | Irritability and trouble managing your emotions |
| Age | More likely to occur in elderly people |
| Genetics | Sleep traits and characteristics can be inherited from parents |
| Direction of air travel | Traveling east causes more severe jet lag than traveling west |
| Shift timing changes | Moving to an earlier shift may cause issues |
| Neurodevelopmental differences | People with ADHD or autism spectrum disorder may be more prone to developing sleep-wake disorders |
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What You'll Learn
Keep a sleep diary to record sleep habits
Keeping a sleep diary is a simple and effective way to track your sleep habits and patterns. It can be an insightful tool to help you and your doctor understand your sleep better and make any necessary adjustments to improve your sleep quality.
Firstly, decide on the format of your sleep diary. You can use a simple pen and paper, or, if you prefer, a smartphone app or wearable sleep tracker. If you are keeping a sleep diary on the advice of your doctor, they may provide you with a specific form to fill out and may suggest a template from organisations like the Sleep Foundation or the National Heart, Lung, and Blood Institute (NHLBI).
Place your sleep diary and a pen or pencil in an easily accessible place, such as on your bedside table, to encourage you to fill it out every day. It is important to complete your diary every day, ideally within an hour of waking up, to avoid any gaps in your memory.
In your sleep diary, you should record the following: the time you go to bed, the time you estimate you fell asleep, and the time you woke up. Additionally, note down any daytime naps you take, and how you feel before and after sleeping. You may also want to consider any factors that could be influencing your sleep, such as your level of physical activity that day, your exposure to blue light from electronic screens, or your consumption of alcohol, caffeine, or medications.
Over time, as you review your sleep diary, ask yourself a series of questions to evaluate your sleep. For example, is your sleep disrupted during the night, and are there any patterns in your diary that could explain why? Are you satisfied with your sleep, or do you feel drowsy during the day? Are your naps too long or too late in the day, and could they be affecting your nighttime sleep?
By keeping a sleep diary, you can gain valuable insights into your sleep habits and make informed decisions to improve your sleep quality.
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Take a sleep study test to monitor body and brain activity
If you're experiencing sleep disturbances, a sleep study test can help monitor your body and brain activity to identify any underlying issues. Sleep studies are typically conducted in a sleep lab during your normal sleeping hours. The test is non-invasive and usually takes just one night to complete. Here's what you can expect from the process:
Preparation
Before the test, your healthcare provider will explain the procedure and address any questions you may have. You may be instructed to limit your sleep beforehand, avoiding naps to ensure you're tired during the study. It's important to inform your healthcare provider about any medications or herbal supplements you're taking, as these can potentially influence the test results. Additionally, refrain from consuming caffeine for several days in advance, as it may impact your sleep patterns.
Sensors and Monitoring
During the sleep study, various sensors will be placed on your body to monitor different physiological parameters:
- Electroencephalography (EEG): Sensors coated with a sticky, electrically conductive gel will be placed on your head to record brain wave activity, which differs during various sleep stages.
- Electromyography (EMG): These sensors are attached to the skin, often on the face and legs, to track muscle movement.
- Electro-oculography (EOG): Adhesive sensors are placed around the eyes to detect eye movement and activity.
- Electrocardiography (EKG or ECG): A single sensor on your chest will record your heart's electrical activity, allowing providers to evaluate its rhythm and internal electrical system.
- Breathing sensors: These sensors detect air movement through your nose and mouth, and they also monitor the movement of breathing-related muscles in your chest and abdomen.
- Pulse oximetry: A small sensor attached to your fingertip measures the oxygen levels in your blood.
- Respiratory inductive plethysmography (RIP) belt: This device is used to detect the expansion of your torso, specifically the chest and abdomen, during breathing.
- Video and audio monitoring: This additional layer of monitoring helps sleep specialists observe and hear any unusual behaviours or sounds during your sleep.
Results and Diagnosis
The data collected from the sensors during the sleep study will be analysed to assess the quality of your sleep and identify any disruptions or abnormalities. Sleep studies can aid in diagnosing various sleep-related conditions, such as insomnia, sleep apnea, restless leg syndrome, and circadian rhythm disorders. Based on the findings, your healthcare provider can then recommend appropriate treatments or lifestyle changes to improve your sleep quality and overall health.
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Look out for signs of insomnia
Insomnia is a common sleep disorder, affecting around a third of adults. It is characterised by difficulty falling or staying asleep, and often feeling drowsy during the day. There are several types of insomnia, and it can be acute or chronic. Acute insomnia lasts from one night to a few weeks, while chronic insomnia occurs at least three nights a week for three months or more.
Signs and Symptoms
The signs of insomnia include trouble falling asleep, staying asleep, or both. You may also wake up too early. Insomnia can cause daytime impairments, such as fatigue, impaired attention or memory, and increased risk of accidents. It can also lead to behavioural changes, such as irritability, hyperactivity, or aggressiveness. In children, insomnia can manifest as consistent trouble falling asleep, refusing to go to bed, or both.
Other signs that you may be experiencing insomnia include regularly taking more than 30 minutes to fall asleep, and regularly waking up several times a night and having trouble falling back to sleep. You may also find yourself taking frequent naps during the day, or falling asleep at the wrong times, such as while doing routine tasks.
Diagnosis
If you think you may have insomnia, it is important to seek help. Your doctor will likely perform a physical exam and ask about your medical history, sleep history, and symptoms. They may ask you to keep a sleep diary for a couple of weeks, recording when you go to bed, when you fall asleep, and when you wake up. They may also recommend that you see a sleep specialist, who can perform a sleep study to monitor and record your body's activity during sleep.
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Understand your body's internal clock
Your body's internal clock, also known as your circadian rhythm, is a natural 24-hour cycle that plays a vital role in regulating your sleep-wake cycle. It is like a tiny conductor inside your body, orchestrating a symphony of biological processes that occur at specific times throughout the day. This internal clock is located in a small cluster of cells in your brain called the suprachiasmatic nucleus (SCN), which is part of the hypothalamus.
The SCN is sensitive to light, and this external stimulus helps to entrain or set your master clock. Changing the timing and amount of sunlight exposure can shift your natural circadian rhythm. For example, travelling across multiple time zones can disrupt your body's internal clock, resulting in jet lag. Similarly, shift work that requires you to be awake after sunset can also throw off your rhythms.
Your circadian rhythm influences not only your sleep patterns but also your eating habits, digestion, metabolism, and body temperature. For instance, eating later in the day, closer to when melatonin is typically released, can disrupt your body's natural rhythms, leading to potential weight gain and increased body fat. Additionally, the time of day can impact the effectiveness and side effects of certain medications.
To maintain a healthy circadian rhythm, it is essential to stick to a consistent daily routine and sleep schedule. This includes maintaining healthy habits such as avoiding heavy meals, caffeine, nicotine, and alcohol close to bedtime. Creating a sleep environment that is dark, quiet, and comfortable can also help. By understanding and respecting your body's internal clock, you can improve your overall health and well-being.
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Recognise the symptoms of sleep apnea
Sleep apnea is a common but manageable condition that affects your ability to get a good night's rest. It is a breathing disorder where you stop breathing for 10 seconds or more during sleep. There are two types of sleep apnea: obstructive sleep apnea (OSA) and central sleep apnea (CSA). In OSA, the muscles in your throat relax, causing the surrounding tissue to press on your windpipe and block air movement. CSA occurs when your brain doesn't send signals to keep the breathing-related muscles working while you sleep.
- Unusual breathing patterns during sleep, such as fast breathing that gets deeper, then shallower, until it stops briefly before starting again.
- Snoring loudly, snorting, gasping, or making choking sounds during sleep.
- Feeling extremely sleepy during the day or experiencing "microsleeps," brief periods of sleep during the day, which can be dangerous when driving or operating machinery.
- Waking up frequently during the night and having trouble falling back to sleep.
- Experiencing daytime sleepiness, taking frequent naps, or falling asleep at inappropriate times.
- Having difficulty focusing or paying attention, and suffering from mood changes like irritability.
- Having a higher risk of obesity, heart disease, high blood pressure, and stroke if sleep apnea is left untreated.
If you suspect you may have sleep apnea, it is important to consult a healthcare provider. They will ask about your symptoms and medical history and may recommend further testing, such as a polysomnogram or a home sleep apnea test, to confirm a diagnosis.
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Frequently asked questions
If you are experiencing any of the following, you may have a sleep-wake disorder:
- You regularly have trouble falling asleep or staying asleep.
- You feel tired during the day, even after a full night's sleep.
- You have difficulty performing regular daytime activities due to fatigue.
- You experience sleep disturbances such as snoring, gasping, or choking during sleep.
- You frequently wake up in the middle of the night and have trouble falling back asleep.
There are several types of sleep-wake disorders, including:
- Insomnia: Difficulty falling asleep or staying asleep, often accompanied by drowsiness during the day.
- Sleep apnea: Breathing interruptions during sleep, causing snoring, gasping, or choking.
- Restless leg syndrome: An urge to move your legs when trying to sleep.
- Circadian rhythm sleep disorders: Difficulty sleeping and waking at the right times due to disruptions in your internal body clock.
- Parasomnia: Unusual behaviours during sleep, such as walking, talking, or eating.
Insomnia is characterised by the following:
- Difficulty falling asleep or staying asleep.
- Feeling tired or irritable during the day.
- Symptoms occurring at least three nights a week for a duration of at least three months.
- Impairment in daily functioning, such as work or school.
Sleep-wake disturbances can be caused by various factors, including:
- Age: Older adults are more prone to sleep disorders, and elderly individuals experience more frequent awakenings.
- Genetics: Certain sleep traits can be inherited, and some genetic mutations are linked to a higher risk of circadian rhythm disorders.
- Travel: Jet lag can disrupt sleep patterns due to rapid travel across multiple time zones.
- Shift work: Working overnight or changing shifts can disturb the natural sleep-wake cycle.
- Medical conditions: Co-occurring medical issues such as asthma, sleep apnea, mental health disorders, or pain can contribute to sleep disturbances.
- Medications: Certain medications can interfere with sleep patterns.
- Lifestyle factors: Poor sleep habits, environmental changes, stress, and substance use can all impact sleep quality.
If you suspect you may have a sleep-wake disturbance, consider the following steps:
- Maintain a consistent sleep schedule, even on weekends.
- Create a calming bedtime routine and avoid electronic devices before sleep.
- Avoid naps, especially in the afternoon.
- Engage in daily exercise, but not too close to bedtime.
- Ensure your bedroom is quiet, cool, and dark.
- Limit alcohol, caffeine, and heavy meals in the evening.
- Keep a sleep diary to track your sleep patterns and habits.
- Consult a healthcare professional if concerns persist, as further assessment and treatment options are available.
