Sleep Disorders

Sleep disorders are diagnosed when sleep-related difficulties cause distress or impairment in social, occupational, or other important areas of functioning.

Sleep disorders are a group of conditions that disturb regular sleep patterns, leading to difficulties with initiating or maintaining sleep, excessive daytime sleepiness, or abnormal behaviors during sleep. These disruptions can result in cognitive impairments, emotional instability, and a weakened immune system.

Types of Sleep Disorders

1) Insomnia

Insomnia is a common sleep disorder, it is a condition that impacts sleep in multiple ways like difficulty in falling asleep, difficulty in staying asleep and poor sleep quality overall. 

Diagnostic Criteria (DSM-5)

  • Dissatisfaction with sleep quantity or quality.
  • Sleep difficulty occurs despite adequate opportunity.
  • Sleep disturbance causes significant distress or impairment.
  • Not better explained by another sleep-wake disorder, substance use, or coexisting conditions.

Symptoms 

  • Finding it difficult to fall or stay asleep
  • Experiencing non restorative sleep
  • Frequent nighttime awakenings
  • Waking up too early and inability to go back to sleep. 
  • Daytime drowsiness
  • Poor executive function

2) Hypersomnolence

Also known as hypersomnia is any condition that makes you feel extremely sleepy during the day despite adequate sleep at night.

Diagnostic Criteria (DSM-5)

  • Excessive sleepiness despite a main sleep period lasting at least 7 hours.

One or more of the following:

  • Recurrent sleep or lapses into sleep within the same day.
  • A prolonged main sleep episode of more than 9 hours that is non-restorative.
  • Difficulty being fully awake after abrupt awakening.
  • Occurs at least 3 times per week, for at least 3 months.
  • Causes significant distress or impairment in social, occupational, or other areas of functioning.
  • Not better explained by another sleep disorder, the effects of a substance, or a medical or mental condition.

Symptoms

  • Struggling to stay awake during the day, even after adequate nighttime sleep
  • Long, unrefreshing naps that do not eliminate drowsiness
  • Sleeping for 9 or more hours but still feeling tired upon waking
  • Difficulty waking up (sleep inertia), often with confusion or grogginess
  • Impaired concentration, memory, and decision-making due to sleepiness
  • Low energy and motivation throughout the day

3) Narcolepsy

It is a chronic neurological sleep disorder characterized by excessive daytime sleepiness and sudden, uncontrollable episodes of falling asleep during the day.

Diagnostic Criteria (DSM- 5)

  • Recurrent periods of irrepressible need to sleep, lapses into sleep, or naps within the same day, occurring at least three times per week over the past three months.
  • One of more of the following must be present:
    • Episodes of cataplexy (sudden muscle weakness triggered by emotions).
    • Hypocretin deficiency, confirmed by cerebrospinal fluid testing.
    • REM sleep latency of 15 minutes or less on nocturnal polysomnography, or a mean sleep latency of 8 minutes or less with 2 or more sleep-onset REM periods on the Multiple Sleep Latency Test
  • Symptoms are not better explained by another medical or mental disorder or by substance use.

Symptoms 

  • Sudden, uncontrollable episodes of falling asleep during daytime activities
  • Cataplexy (sudden loss of muscle tone while awake) 
  • Sleep paralysis upon falling asleep or waking up
  • Vivid hallucinations at sleep onset or awakening
  • Fragmented or poor nighttime sleep despite excessive daytime sleepiness

4) Breathing-Related Sleep Disorders-

They are the conditions of abnormal or difficult respiration while the individual is asleep. Some of these disorders have serious consequences that are caused by the imbalances in oxygen and carbon dioxide in the blood. 

(4a) Obstructive Sleep Apnea- It is a common sleep disorder where the person repeatedly stops and starts breathing during sleep due to blockage in airways. 

  • Diagnostic Criteria: At least five obstructive apneas or hypopneas per hour of sleep with nocturnal breathing disturbances or daytime fatigue; or 15 or more events per hour regardless of symptoms.
  • Symptoms:
    • Loud snoring
    • Gasping or choking during sleep
    • Excessive daytime sleepiness
    • Morning headaches
    • Concentration problems

4b) Central Sleep Apnea- This is a disorder where the brain temporarily stops sending signals to the muscles responsible for breathing causing temporary stops or shallow breaths.

  • Diagnostic Criteria:  Five or more central apneas per hour of sleep caused by impaired brain signaling, without airway obstruction.
  • Symptoms: 
    • Interrupted breathing without snoring
    • Poor sleep quality
    • Daytime sleepiness
    • Difficulty concentrating

(4c) Sleep- related Hypoventilation- It’s a disorder characterized by reduced breathing effort while sleeping, leading to imbalances in the carbon dioxide and oxygen levels in the blood.

  • Diagnostic Criteria:  Elevated carbon dioxide levels during sleep due to decreased respiration, not explained by another condition.
  • Symptoms:
    • Shallow breathing during sleep
    • Morning fatigue and headaches
    • Breathlessness

5) Circadian Rhythm Sleep-Wake Disorders -

They are conditions that disrupt or affect the body’s natural sleep-wake cycle known as the circadian rhythm. They affect how well one sleeps, when one sleeps and even how one functions. 

Diagnostic Criteria:

Persistent or recurrent sleep disruption due to a misalignment between the sleep-wake pattern and the individual's environment or social schedule, leading to insomnia or hypersomnia and significant distress or impairment.

Subtypes and Symptoms

  • Delayed Sleep Type - Sleep is significantly delayed compared to desired time. Symptoms: Extreme and prolonged difficulty of awakening, difficulty in falling asleep despite several attempts. 
  • Advanced Sleep Type- Sleep-wake times are several hours earlier than conventional times. Symptoms: Sleepiness in the early evening, waking up very early in the morning, alertness fades in the evening.
  • Irregular Sleep-Wake Type – Characterized by a disorganized sleep pattern without a clear circadian rhythm. Symptoms: Fragmented sleep, multiple naps throughout the day and night, lack of a main sleep episode.
  • Non-24-Hour Type – A condition where the internal clock runs longer than 24 hours, leading to a shifting sleep schedule. Symptoms: Gradual delay in sleep and wake times, insomnia, daytime sleepiness; often seen in totally blind individuals.
  • Shift Work Type – Circadian misalignment caused by working during typical sleep hours, such as night shifts. Symptoms: Insomnia when trying to sleep, excessive sleepiness during work hours, poor sleep quality.
  • Unspecified Type – Cases of circadian disruption that do not match other defined subtypes. Symptoms: General symptoms of circadian misalignment such as insomnia, fatigue, and irregular sleep patterns.

6) Parasomnias-

They are characterized by abnormal behaviour, experiences that occur during sleep or sleep transitions. Common types include sleepwalking, night terrors, sleep talking, and REM Sleep Behavior Disorder.

(6a) Non- Rapid Eye Movement Sleep Arousal Disorder- Disorders involving incomplete awakenings from non-REM sleep, often with limited awareness or memory. It involves two types- Sleep terrors and Sleepwalking.

  • Diagnostic Criteria: 
    • Recurrent episodes of incomplete awakening from sleep, usually during the first third of sleep episodes usually accompanied by either sleepwalking or sleep terrors. 
    • No or little dream imagery is recalled.
    • Amnesia for the episodes is present.
    • The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
    • The episodes are not attributable to the effects of a substance or another medical or mental disorder.
  • Symptoms:
    • Involuntary motor activity (e.g., walking, sitting up) during sleep
    • Confusion and difficulty awakening the person
    • Autonomic symptoms like sweating and rapid breathing (in sleep terrors)
    • Lack of memory of the episode

(6b) Nightmare Disorder- also known as REM Sleep Parasomnia: this condition involves repeated occurrences of extended, extremely dysphoric, and well-remembered dreams. These nightmares usually occur during the second half of the sleep period (REM sleep) and result in awakening with lingering fear or distress.

  • Diagnostic Criteria:
    • Repeated occurrences of well-remembered, extremely dysphoric dreams that usually involve threats to survival or well-being and occur during REM sleep.
    • On awakening from the nightmares, the individual rapidly becomes alert.
    • The nightmares cause significant distress or impairment in functioning.
    • Not attributable to substances, medication, or another disorder.
  • Symptoms: 
    • Frequent disturbing dreams that wake the sleeper
    • Persistent anxiety or mood disturbance upon waking
    • Sleep avoidance due to fear of recurring nightmares
    • Sleep fragmentation and fatigue

(6c) Rapid Eye Movement Sleep Behaviour Disorder- This disorder is characterized when the individual acts out their dreams in their sleep. It involves episodes of vocalization or complex motor behaviours. 

  • Diagnostic Criteria:
    • Repeated episodes of arousal during sleep associated with vocalization and/or complex motor behaviors.
    • These behaviors arise during REM sleep, as evidenced by polysomnographic recording or history.
    • REM sleep without atonia (muscle paralysis) is present.
    • The behaviors cause clinically significant distress or impairment.
    • The disturbance is not due to a substance or another mental or medical condition.
  • Symptoms:
    • Dream-enacting behaviors (e.g., kicking, punching, talking)
    • Potential for injury to self or bed partner
    • Vivid dreams often recalled upon waking
    • Excessive daytime sleepiness due to disrupted sleep

7) Restless Legs Syndrome- 

It is described as a sensorimotor, neurological disorder characterized by the need to move the limbs due to uncomfortable sensations.

 Diagnostic Criteria:

  • Urge to move the legs due to unpleasant sensations.
  • Symptoms begin or worsen during rest or inactivity.
  • Partial or complete relief with movement.
  • Symptoms are worse in the evening or night.
  • Not due to another medical or behavioral condition.

Symptoms:

  • Tingling, crawling, or aching sensations in the legs.
  • Relief with movement (e.g., walking or stretching).
  • Difficulty falling or staying asleep.
  • Daytime tiredness due to disrupted sleep.

Causes of Sleep Disorders

  • Stress and Mental Health Conditions- Stress and psychological disorders are major contributors to sleep disturbances. Chronic stress can cause hyperarousal, making it difficult to fall or stay asleep. Anxiety leads to racing thoughts and physical tension, while depression often causes early morning awakenings or oversleeping. Insomnia frequently co-occurs with mood and anxiety disorders, creating a cycle where poor sleep worsens mental health and vice versa.
  • Poor Sleep Schedules and Lifestyle Factors- Irregular sleep routines, late-night screen use, and stimulant intake (like caffeine or nicotine) disrupt circadian rhythms and reduce sleep quality. Sleeping in noisy, bright, or uncomfortable environments also contributes to frequent awakenings or unrestful sleep. Poor sleep hygiene—such as using the bed for non-sleep activities—can weaken the brain’s association between bed and rest.
  • Medical Conditions- Chronic illnesses like arthritis, asthma, and acid reflux often interfere with sleep due to pain, breathing issues, or discomfort. Restless Legs Syndrome (RLS) and other sensory issues also disrupt rest, especially at night. In many cases, treating the underlying medical condition is essential to improving sleep.
  • Genetic Predispositions- Some sleep disorders, such as narcolepsy or RLS, have a genetic component. A family history of sleep problems can increase vulnerability, suggesting that traits like arousal levels or circadian rhythm regulation may be inherited. While not solely responsible, genetics interact with other factors to influence sleep health.
  • Substance Use and Withdrawal-  Alcohol, caffeine, and certain medications affect sleep by altering sleep stages or increasing nighttime awakenings. Alcohol may help with falling asleep but fragments rest later in the night. Withdrawal from substances like sleeping pills or stimulants can also lead to temporary but severe insomnia and disrupted sleep patterns.
  • Neurological Factors- Neurological disorders such as Parkinson’s disease, epilepsy, and multiple sclerosis can disturb sleep due to changes in brain function. In narcolepsy, loss of hypocretin-producing neurons affects the brain’s control over sleep-wake cycles. These disruptions often lead to excessive daytime sleepiness or fragmented nighttime rest.

Treatment 

  • Light Therapy- Used primarily for Circadian Rhythm Sleep-Wake Disorders, light therapy involves exposure to a bright light box that simulates natural sunlight, typically in the morning. This helps reset the body’s internal clock, regulate melatonin production, and improve daytime alertness and nighttime sleep.
  • Cognitive Behavioral Therapy for Insomnia (CBT-I)-  CBT-I is a widely recommended treatment that addresses the thoughts and behaviors disrupting sleep. It includes techniques like stimulus control (associating bed with sleep only), sleep restriction (limiting time in bed to build sleep efficiency), and relaxation training. CBT-I is effective for chronic insomnia and often preferred over medication.
  • CPAP Therapy (Continuous Positive Airway Pressure)- For individuals with Obstructive Sleep Apnea, CPAP is the primary treatment. The device delivers constant air pressure through a mask to keep airways open during sleep. This reduces snoring and apneic episodes, enhancing sleep quality and daytime functioning.
  • Lifestyle Modifications- Adopting good sleep hygiene can significantly improve sleep outcomes. Key strategies include maintaining a regular sleep schedule, limiting screen time before bed, avoiding caffeine and heavy meals late in the day, and creating a quiet, dark, and cool sleep environment. Relaxation techniques such as deep breathing, meditation, or warm baths can help signal the body it’s time to sleep.

Sleep disorders are diverse in origin and impact, but they are also manageable with proper understanding and care. Early identification, lifestyle changes, and targeted therapies can significantly restore restful sleep and improve overall quality of life.

Related Resources:

If you’re affected by sleep disorders, these resources can help you understand your condition, improve sleep habits, and access support.

  • Therapy care: Dealing with Stress, Decision Making
  • Guided Meditation:  Inner peace, Deep Sleep, Relieving Anxiety
  • Guided Visualization: Releasing Chronic Fatigue visualization, Refresh and Renew
  • Travel meditation: Mid-day recharge, Sunset Meditation, Walking meditation.
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