Colin Snow
Sleep disorders, or somnipathy, are medical conditions that affect an individual's sleep patterns, impacting their physical, mental, social, and emotional functioning. There are over 80 types of sleep disorders, including insomnia, sleep apnea, narcolepsy, hypersomnia, sleepwalking, and night terrors. Sleep pathologies can interfere with cerebral circuit organization, leading to negative consequences and the development of neurological disorders. Sleep disturbances can be caused by various factors, such as teeth grinding, medications, and underlying medical or psychological conditions. Sleep disorders are prevalent in palliative care and can significantly affect the quality of life for patients with terminal illnesses. Treatment options vary, and some individuals may need to manage their condition throughout their lifetime.
| Characteristics | Values |
|---|---|
| Number of sleep disorders | Over 80 |
| Types of sleep disorders | Dyssomnias, parasomnias, sleep disorders associated with mental, neurological, or other conditions, and proposed sleep disorders |
| Dyssomnias subcategories | Intrinsic, extrinsic, and disturbances of circadian rhythm |
| Parasomnias examples | Sleepwalking, night terrors |
| Sleep disorders associated with mental, neurological, or other conditions examples | Kleine-Levin Syndrome (KLS), sleep apnea, narcolepsy, hypersomnia, sleeping sickness, jet lag, restless legs syndrome (RLS), delayed sleep phase syndrome (DSPD) |
| Sleep disorders in palliative care | Insomnia, primary sleep disorders, sleep disturbances caused by anxiety and depression |
| Sleep disorders caused by other conditions | Diabetes, neurodegenerative diseases (multiple system atrophy, Parkinson's disease, Lewy body disease), viral infections of sleep-wakefulness mechanisms in the hypothalamus |
| Risk factors | Age, gender, medications, family and social history, comorbid psychiatric illnesses |
| Treatment | Medication, changes to sleep hygiene (sleep routine and environment), treatment of underlying conditions |
| Prognosis | May vary from weeks to months or may require lifelong management |
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What You'll Learn
- Insomnia: Difficulty falling or staying asleep without an obvious cause
- Sleep-related breathing disorders: Conditions like sleep apnea or sleep-disordered breathing
- Hypersomnia: Excessive sleepiness at inappropriate times, including narcolepsy
- Circadian rhythm disorders: Jet lag, delayed sleep phase syndrome, and non-24-hour sleep-wake syndrome
- Parasomnias: Sleepwalking, night terrors, teeth grinding, and other unusual behaviours during sleep
Insomnia: Difficulty falling or staying asleep without an obvious cause
Sleep is a basic human need that is critical to both physical and mental health. Sleep pathologies may interfere with cerebral circuit organization, leading to negative consequences and favoring the development of neurologic disorders. The pathologies of sleep can be divided into six major categories, with insomnia being the most common sleep-wake disorder. Insomnia is characterised by difficulty initiating or maintaining sleep without an obvious cause.
Chronic insomnia may be related to psychological disturbance. Insomnia can occur alongside medical conditions or other mental health conditions, such as depression, anxiety, or cognitive disorders. Sleep disorders can also be caused by anxiety and depression. Sleep quality can be improved with pharmacologic and nonpharmacologic interventions, requiring the concerted effort of the provider, patient, and caregiver.
A comprehensive assessment for insomnia may involve a patient history, a physical exam, a sleep diary, and clinical testing (a sleep study or polysomnography). A sleep diary is a record of your sleep habits to discuss with your physician. It can be helpful to make a note of any daytime naps and how you feel before and after sleeping. It is often difficult to know the exact time you fall asleep, so you should estimate this time.
The International Classification of Sleep Disorders, 3rd edition (ICSD-3) employs two criteria for 'pathological sleepiness' in the context of idiopathic hypersomnia. These are: sleep prolongation with a 24-hour total sleep time (TST) ≥ 660 minutes, measured either by 24-hour polysomnography (24-h PSG) or by wrist-actigraphy-based sleep time averaged for at least 7 days; and high sleep propensity with a mean sleep latency (mSL) of ≤8 minutes on the Multiple Sleep Latency Test (MSLT).
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Sleep-related breathing disorders: Conditions like sleep apnea or sleep-disordered breathing
Sleep disorders, or somnipathies, are medical conditions that affect an individual's sleep patterns, sometimes impacting their physical, mental, social, and emotional functioning. Sleep pathologies may interfere with cerebral circuit organisation, leading to negative consequences and favouring the development of neurological disorders. Sleep disorders can be classified into dyssomnias, parasomnias, sleep disorders associated with mental, neurological, or other medical or psychological conditions, and circadian rhythm sleep disorders involving the timing of sleep.
Sleep-related breathing disorders are a type of dyssomnia characterised by abnormal and difficult respiration during sleep. These disorders include chronic snoring and sleep apnea, with snoring being classified as a sleep-related breathing disorder when it occurs more than three nights per week. Obstructive sleep apnea (OSA) is one of the most common and serious sleep-related breathing disorders, often co-occurring with obesity. Sleep apnea can also be central, with treatment often directed at managing an underlying illness contributing to breathing problems.
Sleep-related hypoventilation disorders are associated with elevated blood levels of carbon dioxide resulting from insufficient breathing during sleep. These disorders are commonly 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.
Sleep-related hypoxemia disorder is another breathing disorder characterised by low oxygen concentrations in the blood without a corresponding rise in carbon dioxide levels to meet the threshold for diagnosis as a hypoventilation disorder. Hypoxemia frequently results from another health problem affecting breathing, such as lung conditions.
The symptoms, severity, causes, and treatment of sleep-disordered breathing vary based on the type, and in complex cases, an individual may be diagnosed with more than one type of sleep-related breathing disorder. These disorders can have serious consequences due to their potential effects on sleep and the balance of oxygen and carbon dioxide in the blood.
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Hypersomnia: Excessive sleepiness at inappropriate times, including narcolepsy
Sleep is a basic human need that is critical to both physical and mental health. Sleep pathologies may interfere with cerebral circuit organisation, leading to negative consequences and favouring the development of neurological disorders. The pathologies of sleep can be divided into six major categories: insomnia, sleep-related breathing disorders, hypersomnia of central origin, circadian rhythm disorders, parasomnias, and sleep-related movement disorders.
Hypersomnia is a condition characterised by excessive sleepiness at inappropriate times, including narcolepsy. People with hypersomnia experience prolonged sleep with a 24-hour total sleep time of at least 660 minutes and high sleep propensity with a mean sleep latency of no more than 8 minutes. This is assessed using the Multiple Sleep Latency Test (MSLT) and 24-hour polysomnography (24-hour PSG). The presence of multiple sleep-onset REM periods (SOREMPs) reflects the pathophysiology of narcolepsy, but their absence is not indicative of hypersomnia.
Narcolepsy is a sleep-wake disorder that can occur alongside medical conditions or other mental health conditions such as depression, anxiety, or cognitive disorders. It is important to note that sleep disorders can affect both mental and physical health, and treatment is available to help individuals get the rest they need. Sleep quality can often be improved with pharmacological and non-pharmacological interventions, requiring collaboration between healthcare providers, patients, and caregivers.
Additionally, sleep pathologies in palliative care patients often stem from their terminal disease condition. However, primary sleep disorders and sleep disturbances caused by anxiety and depression are also common in this population. It is the responsibility of healthcare providers to proactively inquire about sleep disturbances, as many terminally ill patients may not report them independently.
To diagnose sleep disorders, healthcare providers may conduct a comprehensive assessment that includes a patient history, physical exam, sleep diary, and clinical testing such as a sleep study or polysomnography. It is important to assess sleep quality when diagnosing patients with neurological disorders and during neurorehabilitation programs. Management of sleep disorders is patient-specific and based on the specific sleep pathology and associated symptoms.
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Circadian rhythm disorders: Jet lag, delayed sleep phase syndrome, and non-24-hour sleep-wake syndrome
Pathological sleep refers to excessive or disordered sleep. Sleep disorders, or somnipathy, are medical disorders that affect an individual's sleep patterns, sometimes impacting physical, mental, social, and emotional functioning.
Circadian rhythm disorders occur when an individual's body clock doesn't work correctly or sync with the day and night. This results in disrupted sleep and wake cycles. Circadian rhythm disorders include jet lag, shift work sleep disorder, advanced sleep-wake phase disorder, delayed sleep-wake phase disorder, and non-24-hour sleep-wake rhythm disorder.
Jet lag is a common circadian rhythm disorder that occurs when travelling across multiple time zones in a short period. The body struggles to adjust to the new day-night cycle, resulting in sleep problems and fatigue. Shift work sleep disorder affects those who work night shifts or rotating schedules, causing disruptions to their circadian rhythm.
Advanced sleep-wake phase disorder (ASWPD) or advanced sleep phase disorder (ASPD) is characterised by early sleep and early waking. Individuals with this disorder tend to get tired in the early evening and wake up very early in the morning, interfering with daily routines.
Delayed sleep-wake phase disorder (DSWPD) is associated with staying up late and sleeping in late. Individuals with this disorder may struggle to fall asleep at a reasonable hour and subsequently have difficulty waking up on time in the morning. This disorder is more common in children, teenagers, and young adults.
Non-24-hour sleep-wake rhythm disorder (N24SWD) is a condition where an individual's circadian rhythm is predictable but does not align with the standard 24-hour cycle. This often occurs when light exposure is limited, as in the case of individuals who are completely blind.
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Parasomnias: Sleepwalking, night terrors, teeth grinding, and other unusual behaviours during sleep
Parasomnias refer to a category of sleep disorders that involve abnormal behaviours, emotions, perceptions, and dreams that occur while falling asleep, sleeping, between sleep stages, or during arousal from sleep. These disorders are characterised by partial awakenings during the transition between sleep and wakefulness, with the person often having little or no awareness of their behaviour. Parasomnias can include sleepwalking, night terrors, sleep talking, sleep sex, sleep-related eating disorders, teeth grinding (bruxism), and rapid eye movement sleep behaviour disorder (where people act out their dreams).
Sleepwalking, or somnambulism, is a parasomnia that usually occurs during stage 3 non-rapid eye movement (NREM) sleep. It typically begins in childhood and affects about 4% of adults. Sleepwalkers may sit up in bed and perform actions such as walking around, opening their eyes, and even leaving the house. They may also perform complex activities such as cooking or cleaning. However, their actions are usually performed in a daze, and they often have no memory of the event the next day. Sleepwalking episodes can be triggered by factors such as sleep deprivation, stress, fever, or certain medications.
Night terrors, or sleep terrors, differ from nightmares and are more common in children than adults. They occur during stage 3 or stage 4 NREM sleep when the body is in its deepest sleep state. During a night terror, a person may scream, sit upright in bed, and exhibit signs of fear and panic. Their heart rate may increase, they may sweat, and they may breathe faster. However, unlike a nightmare, the person will not be fully awake and will usually have no memory of the event the next day. Night terrors can be triggered by similar factors as sleepwalking and may also have a genetic component.
Teeth grinding, or bruxism, is the involuntary clenching or grinding of the teeth during sleep. This parasomnia can occur during both REM and NREM sleep and may be associated with other sleep disorders such as sleep apnea or tongue thrust. Mild bruxism may not require treatment, but chronic teeth grinding can lead to jaw disorders, headaches, and damaged teeth. Mouth guards and dental appliances can be used to prevent teeth grinding, and behavioural therapies can help reduce stress and improve sleep habits.
Other parasomnias include sexsomnia, or sleep sex, which involves sexual behaviours during sleep, and sleep-related eating disorders, where individuals consume food or unusual items in their sleep. Rapid eye movement sleep behaviour disorder (RBD) is a parasomnia where people act out their dreams, potentially causing injury to themselves or their bed partner. Treatment for parasomnias depends on the specific disorder and its severity. It may include lifestyle changes, such as improving sleep hygiene, stress management, or establishing a consistent sleep schedule. In some cases, medication or behavioural therapies may be recommended.
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Frequently asked questions
Pathological sleep refers to sleep pathologies or sleep disorders that affect the quality and duration of sleep and wakefulness.
The pathologies of sleep can be divided into six major categories: insomnia, sleep-related breathing disorders such as sleep apnea, hypersomnia of central origin such as narcolepsy, circadian rhythm disorders such as jet lag, parasomnias such as sleepwalking, and sleep-related movement disorders such as restless legs syndrome (RLS).
Some common sleep disorders include insomnia, sleep apnea, narcolepsy, hypersomnia, sleepwalking, and night terrors.
Sleep disorders can be caused by various factors, including medical or psychological conditions, environmental factors, or neurological disorders. In palliative care, sleep pathology often stems from the terminal disease condition, but it can also be caused by anxiety and depression.
