Sleep disorders are medical conditions that affect the quality and duration of your sleep. The sleep deprivation they cause can have a major impact on your daytime functioning, quality of life, and overall health.
There are many types of sleep disorders, and knowing the symptoms of each can help you and your healthcare provider figure out what’s causing you to be tired all the time and—most importantly—what to do about it.
Woman laying awake in bed
More than 100 different sleep disorders have been recognized and defined by the medical community.
The four main types of sleep disorders are:1
Problems falling asleep and staying asleep
Problems staying awake
Problems keeping a regular sleep-wake schedule
Unusual behaviors during sleep
Some of the most common sleep disorders include:
Snoring and sleep apnea
Restless legs syndrome
Periodic limb movements of sleep
Other conditions in which sleep disturbances and excessive daytime sleepiness figure prominently include:
Chronic fatigue syndrome
Seasonal affective disorder (SAD)
Sleep disorders may be caused by physical or psychological factors. In turn, they can also have a negative effect on physical and psychological health.2
What Causes Sleep Disorders?
Sleep disorders have many possible causes, including:3
Lifestyle factors such as shift work, frequent travel, or irregular schedules
Mood issues, such as anxiety or depression
Dietary factors, including too much caffeine or alcohol
Being overweight or obese
Medical conditions, including pain, depression, and heart disease
Insomnia is the most common sleep disorder, with about 10% of adults having a chronic problem with it and between 30% and 40% dealing with it now and then.4 It makes you unable to get enough sleep to feel rested and leaves you yawning all day.
Insomnia can take many forms. Some people have trouble falling asleep, which is defined as spending more than 20 to 30 minutes in bed before dozing off. Others wake up frequently or awaken hours too early and can’t get back to sleep. Some people have a combination of different types.
Insomnia can be either acute (short term) or chronic (long term). You can be diagnosed with chronic insomnia if your problem occurs at least three nights per week for at least three months.5
There are several types of insomnia, including fatal familial insomnia—a rare type that, as its name suggests, runs in families and can impair sleep so much that it becomes life-threatening.
Effective treatments for many types of insomnia include:6
Sleep hygiene education to instill good habits/correct bad habits
Cognitive-behavioral therapy for insomnia (CBTI)
Short term use of sleeping pills, including sedative/hypnotic drugs, antidepressants, and antihistamines
Everything You Need to Know About Insomnia
Snoring and Sleep Apnea
Snoring may seem harmless, other than keeping your bed partner awake. However, you snore because your throat is closing while you sleep. If it’s bad enough to cut off breathing for a few seconds, then it becomes snoring’s more serious cousin—sleep apnea, which is a chronic and potentially serious medical condition.
With sleep apnea, you may stop breathing multiple times per hour for 10 seconds or longer at a time. That makes the oxygen levels in your blood drop, and when your body senses that, it pulls you out of deep sleep to get you breathing again.
Breathing interruptions, or apneas, can be caused by:
Obstructive sleep apnea (OSA), a condition in which an obstruction of the upper airway interrupts breathing
Central sleep apnea (CSA), a serious condition caused by brain dysfunction
The effects of sleep apnea can cause and worsen other medical conditions, including hypertension, heart failure, and diabetes.7 Over time, it can also contribute to the risk of serious consequences such as a heart attack or heart failure, stroke, and sudden death.8
Sleep apnea is typically diagnosed with a sleep study, also called polysomnography. The good news is that there are effective treatments.9 The primary treatment for OSA is a continuous positive airway pressure machine (CPAP). CPAP also helps some people who have CSA.
Other treatments include:10
Dental devices or mouth appliances that pull the jaw and tongue forward so they can’t block the airways
Positional sleep aids that keep you from rolling onto your back
Surgical removal of excess throat tissues
Implanted device to stimulate throat muscles during sleep
When possible, treating the underlying cause of CSA
Understanding Sleep Apnea Treatments
From the Latin meaning “around sleep,” parasomnias are sleep disorders characterized by abnormal sleep behaviors or physiological events that occur during specific stages of sleep.11
Common forms include:
Rapid eye movement (REM) behavior disorder
Sleep behaviors aren’t limited to these, though. A number of potential behaviors can occur while you’re sleeping.
The underlying cause of parasomnias may be another sleep condition, such as sleep apnea. In that case, treating the underlying condition may stop the behavior.
Other treatments may include:
Stopping medication that could be causing it
Safety precautions, such as locking or putting alarms on doors and windows in case of sleepwalking
Therapy and counseling
Symptoms and Causes of Parasomnias
Imagine waking up in the morning and being unable to move. As you might imagine, sleep paralysis can be terrifying. It can happen during any transition between sleep and being awake, either as you drift off or as you wake up.
Some people also have hallucinations, which can be frightening—such as a stranger standing over you and trying to hurt you. Others may be mundane but still confusing, because you may think something happened when it didn’t.
Episodes of sleep paralysis typically last only a few minutes, as your brain naturally either wakes up or falls asleep more fully. While the first few may be frightening, just knowing what’s going on can make it less scary.
It’s fairly common to have an isolated incident of sleep paralysis in your life. Researchers estimate that between 25% and 40% of people will experience it at least once.12 It sometimes has no identifiable cause. However, it can be a symptom of narcolepsy or mental health conditions such as bipolar disorder,13 a side effect of some medications, or a symptom of sleep deprivation.
Is It Sleep Paralysis or a Night Terror?
Most of the time, sleep paralysis and the associated hallucinations, while unpleasant, don’t disrupt your sleep or have a significant impact on your life. If it’s frequent or disturbing enough to need treatment, options include:14
Getting more sleep
Cognitive behavioral therapy to improve sleep quality and duration and help cope with hallucination-related fear
Treating the underlying condition
Restless Legs Syndrome
Restless legs syndrome (RLS) is a neurological movement disorder characterized by unpleasant feelings in the legs associated with a need to move.
These sensations may include:
Crawling sensation on the legs
Typically, symptoms come on when you’re resting, sleeping, or trying to fall asleep. They can make it difficult to fall asleep, bring you out of deep sleep, or wake you from sleep. The end result is often a lack of quality rest.
RLS has many potential causes, including iron deficiency, pregnancy, obesity, and certain drugs (including medications, nicotine, alcohol, and caffeine), and supplements that can disrupt sleep.15
RLS treatments include:16
Increasing iron intake through supplements and/or diet if you are iron deficient
Medications, including dopaminergic agents such as Mirapex (pramipexole) and Requip (ropinirole) and anticonvulsants such as Lyrica (pregabalin)
During an episode of restless legs, moving your legs can help relieve the sensations. Stretching, walking, or rubbing your legs may be good options, as well.
Natural Remedies for Restless Leg Syndrome
Periodic Limb Movements of Sleep
A movement disorder often associated with RLS is called periodic limb movements of sleep (PLMS). PLMS involves sudden, repetitive jerking movements of the legs or sometimes arms while you’re asleep. They can be fairly rhythmic and typically happen between about 20 and 40 seconds apart and can continue for several hours. Many people with PLMS aren’t aware that they have it until a sleeping partner tells them.17
What distinguishes PLMS from RLS is that RLS can happen when you’re resting or trying to get to sleep, but PLMS only happens when you’re asleep. However, many people have both disorders. In most cases, the cause is unknown, and researchers think it involves the nervous system.17
PLMS can sometimes occur as a result of obstructive sleep apnea or antidepressant use. It’s typically diagnosed with a polysomnogram.
If PLMS doesn’t disrupt your sleep, it may not require treatment. If you do experience excessive daytime sleepiness without another cause, though, your PLMS may be to blame.
Medications, including Mirapex, Requip, Lyrica, benzodiazepines such as Klonopin (clonazepam), and opioid painkillers such as Vicodin (hydrocodone-acetaminophen)
Treating OSA, if it’s the suspected cause
Eliminating caffeine, which can exacerbate PLMS
If antidepressant use may be causing PLMS, talk to your healthcare provider about the potential benefits and risks of a medication change.
Circadian Rhythm Disorders
Circadian rhythm disorders are conditions that may result from your internal biological clock being out of sync with external time cues, including the natural dark-light cycle. The cause of being out of sync can include:18
Shift work or jet lag
Advanced or delayed sleep phase syndrome
The mismatch may lead to insomnia or excessive sleepiness (hypersomnia) at inappropriate times.
Treatments for circadian rhythm disorders include:18
Properly timed light exposure, which may include using a light box
Melatonin to help you fall asleep at an appropriate time
Adherence to a regular sleep-wake schedule
Chronotherapy for Treatment of Insomnia
Narcolepsy is a sleep disorder characterized by excessive daytime sleepiness. This can be profound and may lead to falling asleep in inappropriate situations, such as while working or driving a car.
Other common symptoms include:
Cataplexy: Often described as a “sudden loss of muscle tone,” cataplexy makes you physically collapse, often in response to things like being startled, getting excited, laughing, or experiencing a strong emotion. If you’re standing, your knees may buckle or you may fall to the ground and be unable to move for a few minutes.
Sleep paralysis: This is an inability to move upon waking or while falling asleep, during which you’re fully alert.
Hypnagogic hallucinations: These are hallucinations that occur while you’re trying to fall asleep. It’s as if you’re dreaming while also alert and aware of your surroundings. They’re often frightening and can include visual, auditory, or tactile sensations.
This potentially dangerous and downright scary condition is believed to be caused by the lack of a brain chemical called hypocretin, which promotes wakefulness and maintains muscle tone. This lack may be due to an autoimmune process, genetics, brain tumors or lesions, or other damage to the brain.19
Narcolepsy is treated with medications, including:20
Stimulants to keep you awake during the day
Xyrem (sodium oxybate) to improve sleep
Antidepressants to moderate symptoms
What’s the Difference? Narcolepsy Types 1 and 2
Chronic Fatigue Syndrome
Chronic fatigue syndrome (also called myalgic encephalomyelitis or ME/CFS) is not defined as a sleep disorder, but it has much in common with them.
It’s characterized by:
Unexplained, prolonged, intense fatigue
Fatigue and lack of energy that’s not improved by rest
Dozens of potential symptoms that may be worsened by physical or mental activity (this is called post-exertional malaise)
This disease is often likened to coming down with the flu and never getting better. It can be severe and incapacitating, making some people unable to even get out of bed. Much remains to be learned about ME/CFS, but the causes are believed to include:21
Immune system abnormalities
Central nervous system dysfunction
Exposure to toxins
ME/CFS is difficult to diagnose and other medical conditions, including sleep apnea and sometimes narcolepsy, should be ruled out before it’s considered.
Treatments can include:22
Antidepressants (to correct neurochemical imbalances)
Antiviral or antifungal medications (if infection is a cause)
Cognitive behavioral therapy and graded exercise therapy (which are highly controversial approaches)
Unrefreshing Sleep in ME/CFS
Fibromyalgia is a chronic pain condition that’s so closely related to sleep problems and several sleep disorders that some healthcare providers used to consider it a sleep disorder.23 One of the major symptoms of fibromyalgia is unrefreshing sleep that can involve numerous dysfunctions of the sleep cycle and is believed to be caused by complex abnormalities in brain chemicals and the immune system.
In addition, people with fibromyalgia frequently are diagnosed with other sleep disorders, including insomnia, obstructive sleep apnea, and restless legs syndrome. Poor sleep exacerbates fibromyalgia symptoms, including severe widespread pain, and increased pain can disrupt sleep, so it’s a vicious cycle many people can’t break.
Fibromyalgia medications may help improve sleep quality or decrease the symptoms that contribute to sleep deprivation. It’s also crucial to get proper treatment for any sleep disorders.
Other suggested treatments include:23
Regular mild or moderate exercise
Good sleep hygiene
Mindfulness meditation and other relaxation methods
Treating comorbid depression and anxiety
Jet lag is a temporary condition caused by travel across time zones—as may occur with long jet trips. It can leave you with symptoms resulting from disruption of your internal circadian rhythm, including:
Jet lag may be improved as your body adjusts over time, typically one day for each time zone you’ve traveled through. So, for example, if you travel from New York to California, you should expect to feel better in about three days.
You can also use:24
Sunlight or light box therapy to adjust your internal clock
Melatonin or sleeping pills
Pre-planning by adjusting the time you sleep and wake up in the weeks before you travel
Jet Lagged? How to Adjust to a New Time Zone
Seasonal Affective Disorder
Seasonal affective disorder (SAD) is a recurrent depressive disorder with a seasonal pattern. Its prominent symptoms are those of major depression and it often includes excessive sleepiness during the winter months.
SAD is often treated by the use of a lightbox, which simulates sunlight, to artificially extend the length of time you’re exposed to light.
Other treatments include:25
Diagnosing Sleep Disorders
Healthcare providers use several noninvasive tests to diagnose sleep disorders, including:
Polysomnography (sleep study): Performed in a lab using electrodes
Overnight oximetry: Tracks oxygen levels and heart rate
Titration studies: Uses a CPAP and usually accompanies polysomnography
Multiple sleep latency testing: Polysomnography followed by periodic attempts at napping through the day
Actigraphy: A small wrist-watch-like device monitors sleep-wake cycles and movement for extended periods of time
Home sleep study: A study performed at home to diagnose obstructive sleep apnea and other problems
Sleep Disorder Diagnostic Tests: How They Work
The first step to overcoming a sleeping disorder is to see your healthcare provider and get a diagnosis. It can help if you keep a sleep journal so you can provide a thorough description of your sleep problems and any suspected causes. Once you’re diagnosed, treatments vary by condition, but many of them include improved sleep hygiene.