Miya Pearson
Sleep disturbances refer to disorders of initiating and maintaining sleep, disorders of excessive somnolence, disorders of the sleep-wake schedule, and dysfunctions associated with sleep, sleep stages, or partial arousals (parasomnias). Sleep disturbances can be caused by physical changes, side effects from treatment, or cancer-related anxiety. They can also be a warning sign for medical and neurological problems, such as heart disease, diabetes, obesity, osteoarthritis, and Parkinson's disease. Sleep disturbances can also be caused by external noise, which hampers uninterrupted sleep and affects human well-being and functionality. Sleep disturbances are common among young people and can have consequences for academic, emotional, and behavioural development.
| Characteristics | Values |
|---|---|
| Definition | Sleep disturbances encompass disorders of initiating and maintaining sleep (DIMS, insomnias), disorders of excessive somnolence (DOES), disorders of sleep-wake schedules, and dysfunctions associated with sleep, sleep stages, or partial arousals (parasomnias). |
| Types | Circadian rhythm disorders, Parasomnia, Insomnia, Obstructive sleep apnea, Narcolepsy, Restless leg syndrome, Central sleep apnea, Sleep-related hypoventilation |
| Symptoms | Feeling tired, unwell or sleepy, Delayed responses, Trouble remembering things, Slowed thought processes, confusion or trouble concentrating, Mood disruptions, especially anxiety, depression and irritability, Other disruptions in work, social activities, hobbies or other routine activities |
| Causes | Physical changes, Side effects from treatment, Cancer-related anxiety, Medical diseases, Psychiatric disorders, Drugs (prescribed and non-prescribed), Behavioral factors, Circadian dysrhythmias, Primary sleep disorders, External noise, Emotional and behavioural factors |
| Treatment | Medication, Mental healthcare, Cognitive-behavioural therapy (CBT-I), Digitally-delivered CBT-I (eCBT-I), Self-care activities (diet, exercise, sleep habits, stress reduction strategies) |
| Diagnosis | Patient history, Physical exam, Sleep diary, Clinical testing (sleep study or polysomnography), Sleep study |
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What You'll Learn
Sleep disorders (insomnia, parasomnias, narcolepsy, etc.)
Sleep disturbances refer to disorders that affect the quality, amount, and timing of sleep. Sleep disorders can impact an individual's mental and physical health. There are over 80 types of sleep disorders, with the most common ones being:
Insomnia
Insomnia is a common sleep disorder that affects roughly 1 in 3 adults worldwide and about 10% of adults meet the criteria for insomnia disorder. It is characterised by disruptions in sleep patterns, including trouble falling or staying asleep, or waking up too early. Insomnia can be acute (short-term) or chronic (long-term), with the latter being more severe and disruptive. It can also be primary, meaning it occurs on its own, or secondary, indicating it is a symptom of another condition. Insomnia can lead to daytime effects such as feeling tired, unwell, or experiencing delayed responses, trouble with memory and concentration, and mood disruptions.
Parasomnias
Parasomnias are undesirable experiences that occur during sleep, such as sleepwalking, talking in sleep, or having a racing heart after a frightening dream. They can be caused by various factors, including sleep deprivation, disturbed sleep, underlying medical conditions, stress, anxiety, and certain medications. Parasomnias are often classified by the stages of sleep they occur during, either non-rapid eye movement (NREM) sleep or rapid eye movement (REM) sleep. While they are typically not harmful, they can be disturbing, frustrating, or dangerous in certain cases.
Narcolepsy
Narcolepsy is a sleep disorder characterised by the inability to regulate sleep patterns, resulting in sudden sleep onset or prolonged wakefulness. Individuals with narcolepsy may benefit from wake-promoting medications or stimulants to help manage their sleep patterns.
Other Sleep Disorders
Other common sleep disorders include restless legs syndrome, which causes an urge to move the legs while resting, and sleep apnea, which involves snoring and moments of stopped breathing during sleep. These disorders can disrupt sleep quality and duration, impacting an individual's overall health and well-being.
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Causes (medical, psychiatric, drugs, behavioural, etc.)
Sleep disturbances can be caused by a variety of factors, including medical, psychiatric, drug-induced, and behavioural issues.
Medical Causes
Sleep disorders are often linked to other medical conditions, including heart disease, lung disease, nerve disorders, and chronic pain. Sleep apnea, for instance, is more prevalent in people with heart disorders or those who have had a stroke. Sleep-related hypoventilation, characterised by shallow breathing and low oxygen levels during sleep, frequently co-occurs with medical conditions such as chronic obstructive pulmonary disease (COPD). Additionally, sleep disturbances can be an early warning sign of more serious medical and neurological problems, such as congestive heart failure, osteoarthritis, and Parkinson's disease.
Psychiatric Causes
Psychiatric disturbances are a common cause of sleep disorders. Sleep disturbances are often seen in patients with depression, anxiety, bipolar disorder, and psychotic conditions. The severity of the sleep disturbance may correlate with the severity of the psychiatric illness. For example, patients with manic phases may seem to require little sleep, while those with general anxiety may experience difficulty falling asleep, restless sleep, or both.
Drug-Induced Causes
Certain medications can also affect sleep. Opioid pain medications, for instance, are associated with central sleep apnea. Additionally, sleep-related hypoventilation is linked to medication use, particularly opioid painkillers and substances such as alcohol.
Behavioural Causes
Sleep disturbances can also be caused by behavioural factors, such as poor sleep hygiene. This includes habits like watching television or videos on your phone, eating, or working in your bedroom. Establishing a regular bedtime routine, maintaining a consistent wake-up time, and engaging in relaxation techniques can help improve sleep habits and reduce disturbances.
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Diagnosis (sleep studies, sleep diaries, etc.)
Sleep disorders are classified into seven categories by the International Classification of Sleep Disorders, including problems falling asleep, disturbances during sleep, and excessive daytime sleepiness. Insomnia, the most common sleep disorder, is defined by difficulty falling asleep, staying asleep, or both, resulting in daytime consequences like fatigue, difficulty with memory and concentration, and disturbances in mood or irritability.
Diagnosis of sleep disturbances typically involves a detailed assessment of sleep habits, work schedules, medical history, and physical examinations. Here are some specific methods and tools used in the diagnosis of sleep disorders:
Sleep Studies
Polysomnography (PSG) is a common type of sleep study used to monitor and record data about an individual's body during sleep. This involves connecting various monitoring devices to the patient to assess parameters such as respiratory effort, sleep stages, electrocardiography, airflow, body position, and limb movements. PSG is particularly useful for diagnosing OSA and other sleep disorders. Another variation of PSG is the Multiple Sleep Latency Test (MSLT), which involves daytime napping studies used in conjunction with PSG to help diagnose narcolepsy.
Sleep Diaries
Sleep diaries are tools that individuals can use to self-monitor their sleep patterns and habits. By recording sleep and wake times, sleep duration, sleep quality, and any disturbances or dreams, individuals can gain insights into their sleep habits and identify potential issues. This information can also be valuable for healthcare providers in diagnosing sleep disorders.
Actigraphy
Actigraphy is a procedure that involves the use of a small, watch-like device worn on the wrist to monitor and record an individual's sleep and wake patterns over several days or weeks. It provides objective data on sleep duration, fragmentation, and timing, aiding in the diagnosis of sleep disorders.
Laboratory Studies
Certain laboratory studies may be appropriate for individuals with sleep disorders. These can include assessments of respiratory function, blood tests to evaluate for underlying medical conditions, and evaluations of hormone levels, particularly in cases where sleep disturbances may be related to hormonal imbalances.
Overnight Sleep Studies
For specific conditions like sleep apnea, overnight sleep studies in a sleep lab or at-home sleep apnea screening devices may be recommended. These studies help assess breathing patterns and identify apneas or hypopneas during sleep.
Differential Diagnosis
Differential diagnosis involves ruling out other conditions with similar symptoms to insomnia or other sleep disorders. This may include evaluating for underlying medical or psychiatric conditions, obtaining medication lists, and considering social and family history, including substance use that can affect sleep and breathing.
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Treatment (medication, CBT-I, self-care, etc.)
Sleep disturbances encompass disorders of initiating and maintaining sleep (DIMS, insomnias), disorders of excessive somnolence (DOES), disorders of sleep–wake schedules, and dysfunctions associated with sleep, sleep stages, or partial arousals (parasomnias). Sleep disturbances can be caused by various factors, including medications, chronic pain, and mental health issues.
Treatment
Medication
If sleep disturbances are caused by medication, it is important to talk to a pharmacist or a doctor about reducing its effects on sleep.
CBT-I
Cognitive Behavioral Therapy for Insomnia (CBT-I) is a short, structured, and evidence-based approach to treating insomnia. CBT-I focuses on exploring the connection between thoughts, feelings, and behaviors that contribute to insomnia symptoms. Treatment typically involves 6-8 sessions with a trained CBT-I provider, who helps to identify and address unhelpful thoughts and behaviors related to sleep. CBT-I also educates individuals about good sleep hygiene, including the impact of diet, exercise, and the sleeping environment. Homework assignments may include keeping a sleep diary and practicing relaxation techniques. CBT-I has been shown to be effective for both short-term and chronic insomnia, with improvements reported by 70-80% of patients.
Self-care
Self-care strategies for improving sleep disturbances include addressing sleep hygiene practices, such as reducing exposure to disturbing environmental factors like lighting and temperature, and establishing a regular sleep-wake schedule. Additionally, managing physical health issues that interfere with sleep, such as pain or bladder and bowel problems, can help improve sleep quality. It is also important to be mindful of thoughts and behaviors that may affect sleep, such as predicting that you won't sleep well, which can create a self-fulfilling prophecy.
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Impact (physical, mental, and daily life)
Sleep disturbances, or sleep disorders, are conditions that affect the quality, amount, and timing of sleep. They encompass disorders of initiating and maintaining sleep (DIMS, insomnias), disorders of excessive somnolence (DOES), disorders of sleep–wake schedules, and dysfunctions associated with sleep, sleep stages, or partial arousals (parasomnias). There are over 80 types of sleep disorders, including insomnia, restless leg syndrome, narcolepsy, and sleep apnea.
Impact on daily life
Sleep disturbances can significantly impact daily life and quality of life. They can affect your ability to complete your daily routine and perform regular daytime activities. You may not have the energy to do the things you want to do and may miss out on special moments or events because you are not fully present. Sleep disorders can also put you and others at risk, especially if you drive or operate heavy machinery without being well-rested.
Impact on mental health
Sleep disturbances can have a significant impact on mental health and cognitive skills. Poor sleep can make it more difficult to cope with stressors and can affect our ability to perceive the world accurately. It can increase the risk for mental health disorders, including depression, anxiety, and even suicidal ideation. Sleep disturbances have been linked to higher levels of psychological distress, with anxiety and depression rates being higher in individuals with sleep disorders.
Impact on physical health
Sleep disturbances can also affect physical health. They can lead to increased eating and a higher risk for weight gain and obesity. Sleep disorders can also be life-threatening in rare cases.
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