Gina Johnson
Sleep is a complex biological process that is critical to both physical and mental health. While you are sleeping, your brain and body functions remain active, performing important jobs that help you stay healthy and
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What You'll Learn
Insomnia
There are three types of insomnia: initial (sleep onset) insomnia, middle (maintenance) insomnia, and late (early waking) insomnia. Initial insomnia is when you have trouble falling asleep. Middle insomnia, the most common form, is when you wake up in the middle of the night but fall back asleep. Late insomnia is when you wake up too early and can't fall back asleep.
The effects of insomnia can be disruptive and, in some cases, dangerous. Insomnia can cause daytime symptoms such as feeling tired, unwell, or sleepy. It can also lead to delayed responses, trouble remembering things, slowed thought processes, confusion, trouble concentrating, and mood disruptions such as anxiety, depression, and irritability. These symptoms can impact work, social activities, hobbies, and other routine activities.
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Sleep-related breathing disorders
Obstructive sleep apnea (OSA) is a common sleep-related breathing disorder. It is characterised by recurrent episodes of partial or complete blockage of the upper airway, resulting in disturbed breathing during sleep. People with OSA may snore and experience moments during sleep when they stop breathing, disrupting their sleep. OSA is associated with a decreased quality of life and significant medical issues. If left untreated, OSA can lead to cardiovascular diseases such as coronary artery disease, stroke, and atrial fibrillation.
Central sleep apnea is a sleep-related breathing disorder where breathing stops and starts repeatedly during sleep due to issues with the brain's signalling to the muscles controlling breathing. This is often related to underlying illnesses, and treatment focuses on managing these contributing health issues.
Sleep-related hypoventilation disorders are characterised by elevated blood levels of carbon dioxide during sleep due to insufficient breathing. This condition is often tied to other health problems, particularly lung conditions such as chronic obstructive pulmonary disease (COPD) or pulmonary hypertension. Nervous system disorders and certain medications can also trigger hypoventilation. Obesity hypoventilation syndrome (OHS) is a specific type of sleep-related hypoventilation disorder that occurs in obese patients and often co-occurs with obstructive sleep apnea.
Sleep-related hypoxemia disorder is similar to hypoventilation disorder, but oxygen concentrations drop without the carbon dioxide levels rising high enough to meet the threshold for hypoventilation diagnosis. This disorder is often the result of another health issue affecting breathing, and treatment focuses on addressing the underlying cause.
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Parasomnias
Non-REM parasomnias are relatively rare and typically occur in individuals aged 5-25 with a family history of similar parasomnias. They involve physical and verbal activity, such as sleepwalking or sleep terrors, and the sleeper often has no memory of the event. These parasomnias are usually outgrown by young adulthood.
REM parasomnias, on the other hand, are more prevalent in late adult life and are associated with degenerative brain diseases. They are characterised by verbalisations and actions consistent with dream enactment, such as fight or flight behaviours. The sleeper usually awakens and can recall the dream and its associated actions. REM sleep behaviour disorder is the most common parasomnia in this category and is often associated with an underlying neurological condition.
Some parasomnias that do not fit neatly into either the non-REM or REM categories include sleep enuresis (bedwetting), sleep-related groaning (catathrenia), exploding head syndrome, sleep-related hallucinations, and sleep-related eating disorders.
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Sleep disorders and mental health
Sleep is a critical component of our health. A lack of quality sleep can cause disruptions in our overall health. Sleep is a complex biological process. While we are sleeping, our brain and body functions are still active, performing important jobs that help us stay healthy and function at our best.
Sleep disorders are conditions that affect the quality and duration of sleep and wakefulness. There are over 80 different types of sleep disorders. Sleep disorders can be a symptom of other mental health conditions or contribute to and exacerbate them. They often occur alongside medical conditions or other mental health conditions such as depression, anxiety, or cognitive disorders. Sleep difficulties are linked to both physical and emotional problems.
The most common sleep disorder is insomnia, which is when a person has trouble falling asleep or staying asleep most nights and feels tired or irritable as a result. Insomnia can be acute (short-term) or chronic (long-term). The chronic form is known as insomnia disorder. About one-third of adults report insomnia symptoms, and 4-22% meet the criteria for insomnia disorder. Other common sleep disorders include sleep apnea, parasomnias, narcolepsy, and restless leg syndrome.
If you are having trouble sleeping, it is a good idea to talk to your healthcare provider. They can help improve your sleep or refer you to a specialist. Treatment for sleep disorders depends on the specific disorder but may include good sleep habits and lifestyle changes, cognitive behavioral therapy, relaxation techniques, medication, or the use of devices such as a CPAP machine.
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Sleep disorders and ageing
Sleep disorders refer to conditions that affect the quality and duration of sleep. There are over 80 types of sleep disorders, with insomnia being one of the most common. Insomnia is characterised by difficulty falling asleep, staying asleep, or getting enough quality sleep. It can be acute (short-term) or chronic (long-term), and it affects roughly one-third of adults worldwide.
Ageing can significantly impact sleep patterns and increase the risk of sleep disorders. Older adults often experience shorter total sleep times, ranging from 6.5 to 7 hours per night. They may also find it harder to fall asleep and spend more time in bed trying to do so. Older individuals tend to wake up more frequently during the night and earlier in the morning, resulting in a more abrupt transition between sleep and wakefulness. The time spent in deep, dreamless sleep decreases, and they may experience more arousals and longer periods of wakefulness after initially falling asleep. Additionally, older adults are more likely to take naps during the day.
Several specific sleep disorders are more prevalent in older adults, including:
- Sleep-disordered breathing or sleep apnea: This disorder causes pauses in breathing during sleep due to the collapse or narrowing of the upper airway. It leads to fragmented sleep and can affect oxygen levels, causing headaches, daytime sleepiness, and cognitive difficulties.
- Restless Legs Syndrome (RLS): RLS affects 9-20% of older people and creates an urge to move the legs while resting or sleeping.
- Periodic Limb Movement Disorder (PLMD): PLMD involves involuntary movements in the lower limbs, primarily the feet, during sleep.
- REM Sleep Behavior Disorder (RBD): RBD causes individuals to physically act out their dreams, sometimes violently.
- Circadian rhythm sleep-wake disorders: These disorders are associated with shifts in the timing of circadian rhythms, resulting in disrupted sleep patterns.
Treating sleep disorders in older adults can be challenging due to multiple medical comorbidities, medication side effects, and age-related risk factors for sleep disruption. However, addressing these disorders can significantly improve functioning and quality of life. Older adults can also take proactive steps to improve their sleep, such as improving sleep hygiene, developing healthy habits, and incorporating regular exercise into their routines.
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