What are sleep disorders?

Sleep disorders are conditions that affect how much and how well you sleep. The causes range from poor habits that keep you awake to medical problems that disrupt your sleep cycle. If you don't feel rested in the mornings, seek medical advice. Insufficient sleep is a serious problem that poses a threat to your health and safety.

The dangers of poor sleep

Lack of sleep can take a toll on nearly every aspect of daily life. Research has linked sleep deprivation to car accidents, relationship troubles, poor job performance, job-related injuries, memory problems and mood disorders. Studies also suggest sleep disorders may contribute to heart disease, obesity and diabetes.

Symptoms of sleep disorders

Symptoms vary depending on the type of sleep disorder but may include:

• Excessive sleepiness during the day
• Trouble falling asleep or staying asleep
• Snoring or episodes of stopped breathing during sleep
• Urge to move your legs at rest or an uncomfortable feeling in the legs at night

The sleep cycle

There are two forms of sleep: REM sleep and non-REM sleep. REM stands for rapid eye movement and is associated with dreaming. It accounts for 25% of normal sleep, coming in longer periods towards morning. The rest of our sleep time is spent in NREM, which consists of four stages from light sleep (stage 1) to deep sleep (stage 4). Sleep disorders interfere with normal sleep cycles, preventing a good night's rest.

How much sleep is enough?

Sleep needs vary widely from person to person, but general guidelines are:

• 16 hours for infants
• 9 hours for teenagers
• 7-8 hours for adults

Keep in mind that some adults do fine with five hours of sleep and others need as many as 10 hours per night.

Insomnia

Most people have trouble sleeping once in a while, but when the problem lingers night after night you may have insomnia. People with insomnia may lie awake for hours before falling asleep. They may wake up too early and be unable to drift off again. Or they may wake up repeatedly throughout the night. Bouts of insomnia affect a third of adults at some point in their life.

Insomnia and sleep hygiene

In many cases, insomnia is related to poor sleep hygiene. This refers to bad habits that interfere with sleep. Examples include drinking coffee in the afternoon or evening, smoking or eating heavy foods before bed, going to bed at a different time each night or falling asleep with the television on.

Insomnia and mental health

Mental health problems can lead to insomnia. These include depression, anxiety and post-traumatic stress disorder. Unfortunately, some of the medication used to treat these conditions may also cause sleep problems. If you suspect your medication is disrupting your sleep, seek medical advice about adjusting your treatment.

Insomnia and medical conditions

Insomnia is often related to medical problems, including:

• Arthritis
• Heartburn
• Other causes of chronic pain
• Asthma
• COPD (Chronic obstructive pulmonary disease)
• Heart failure (due to breathing problems)
• Thyroid problems
• Neurological disorders, such as stroke, Alzheimer's or Parkinson's

Other causes of insomnia

Insomnia can occur during pregnancy, especially in the first and third trimesters. The problem may return during menopause, when hot flushes can interrupt a good night's sleep. Both men and women tend to have more sleep problems over age 65. Shift workers and frequent fliers can develop a circadian rhythm disorder. In this case, a kind of "internal body clock" that controls sleep, hormone production and other body functions, is disturbed.

Sleep apnoea

People with this sleep disorder have episodes when they stop breathing many times while they sleep. The breathing pauses last several seconds and trigger a switch from deep sleep to light sleep. These interruptions can lead to daytime sleepiness. Many people with sleep apnoea don't know they have it. Snoring is a common warning sign, and a spouse may notice breathing pauses followed by a snort or gasp.

Risk factors for sleep apnoea

Sleep apnoea is most common in people who are male, overweight and over age 65. While it is more common in adults, sleep apnoea sometimes occurs in young children who have enlarged tonsils.

Restless legs syndrome

People with restless legs syndrome experience discomfort and the urge to move the legs at rest. The problem is usually at its worst during the evening and night. This can make it tough to fall asleep. Others experience twitching motions during sleep that may cause them to wake up briefly.

Narcolepsy

Narcolepsy causes extreme sleepiness during the day. People may find it hard to function as they may fall asleep suddenly without warning, despite spending enough time in bed at night. Other warning signs include:

• Being unable to move when you first wake
• Losing muscle control with strong emotions
• Dreaming during naps
• Dream-like hallucinations as you fall asleep or wake up

People with narcolepsy enter REM sleep almost immediately, without the NREM sleep stages that normally lead up to dream sleep.

Sleepwalking

People with this sleep problem can literally get up and walk while they are sleeping. The episodes occur during the deeper stages of NREM sleep, and the person may do a variety of activities without waking up. Sleepwalkers typically don't respond to questions and won't remember what they did once they wake up. Sleepwalking is most common in children but can last into adulthood.

When to seek medical advice

There are steps you can take to fight sleep disorders on your own, but some situations require medical attention. Seek medical advice if you snore loudly or gasp during sleep, if you think a medical condition or medication is keeping you up at night, if you're tired all the time or if you fall asleep during daytime activities.

Sleep diary

Charting your habits for one to two weeks can provide valuable information. Include:

• Your bedtime and wake time
• How long and well you slept
• Time awake during the night
• Caffeine or alcohol consumed and when
• What/when you ate and drank
• Emotion or stress
• Drugs or medication

Diagnosing sleep disorders

To diagnose a sleep disorder, your doctor will ask about your sleep habits and medical conditions. Next, you may be referred to a sleep clinic for testing. A polysomnogram, also called a sleep study, records brain activity, eye movements and breathing while you sleep. These patterns can indicate a disorder like sleep apnoea or a less common type of sleep disorder. Research has identified more than 85 sleep problems, including sleep or night terrors, REM sleep behaviour disorder and sleep starts.

Treating sleep disorders

For sleep apnoea, a CPAP device increases air pressure to keep airways open so you can rest more soundly without the breathing pauses that interrupt sleep. Narcolepsy and restless legs syndrome can be treated with lifestyle changes and prescription medication. There are also effective medications for insomnia. However, many people can beat insomnia without medication by changing poor sleep habits and taking care of related conditions.

Cognitive behavioural therapy

Several methods can ease sleep anxiety, which makes insomnia worse. Relaxation training and biofeedback help to calm your breathing, heart rate, muscles and mood. Talk therapy can help replace bedtime worries with positive thinking, so your mind can settle down at night. Cognitive behavioural therapy (CBT) works as well as prescription treatment for many people with chronic insomnia.

Sleep hygiene: Exercise

Adopting habits that promote sleep is known as good sleep hygiene. Regular exercise should be part of the plan, but the timing is important. Exercise in the late afternoon can make it easier to fall and stay asleep – just don't let it get too late. Exercise within a couple hours of bedtime can make it harder to fall asleep.

Sleep hygiene: Problem foods

Certain foods and drinks should be avoided in the four to six hours before bed:

• Caffeine, including coffee, tea and fizzy drinks.
• Heavy or spicy foods.
• Alcohol. (While alcohol helps some people fall asleep, it can cause waking up in the night.)

Sleep hygiene: Helpful foods

A light evening snack of complex carbs and protein can lead to better sleep. Cereal with milk or biscuits and cheese fit the bill, but they should be eaten at least an hour before bed. Warm milk and chamomile tea raise body temperature and make many people feel sleepy.

Sleep hygiene: Television

Late-night television may be part of your routine, but chances are it is not helping you sleep. Television engages the mind and can increase alertness, keeping you awake. Playing video games before bed or surfing the internet may have the same effect. Some experts recommend removing televisions and computers from your bedroom altogether.

Sleep hygiene: Bedtime rituals

You can signal to your mind and body that it's time for sleep by creating a bedtime ritual. This may include a warm bath, reading a chapter of a book or practicing relaxation techniques, such as deep breathing. It's also important to stick to a firm bedtime and wake-up time, even at the weekend. If you still have trouble sleeping despite improving your sleep hygiene, seek medical advice.

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