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A sleep disorder, or somnipathy, is a Disease that disrupts an individual's sleep patterns and quality. This can cause serious health issues and affect physical, mental, and emotional well-being. Polysomnography and actigraphy are tests commonly ordered for diagnosing sleep disorders.
Sleep disorders are broadly classified into , , circadian rhythm sleep disorders, and other disorders (including those caused by medical or psychological conditions). When a person struggles to fall or stay asleep without an obvious cause, it is referred to as insomnia, (2025). 9781585620050, American Psychiatric Publishing. ISBN 9781585620050 which is the most common sleep disorder. Other sleep disorders include sleep apnea, narcolepsy, hypersomnia (excessive sleepiness at inappropriate times), sleeping sickness (disruption of the sleep cycle due to infection), sleepwalking, and .
Sleep disruptions can be caused by various issues, including teeth grinding (bruxism) and night terrors. Managing sleep disturbances that are secondary to mental, medical, or substance abuse disorders should focus on addressing the underlying conditions.
Sleep disorders are common in both children and adults. However, there is a significant lack of awareness about sleep disorders in children, with many cases remaining unidentified. Several common factors involved in the onset of a sleep disorder include increased medication use, age-related changes in circadian rhythms, environmental changes, lifestyle changes,Roepke, S. K., & Ancoli-Israel, S. (2010). Sleep disorders in the elderly. The Indian Journal of Medical Research, 131, 302–310. pre-diagnosed physiological problems, and stress. Among the elderly, the risk of developing sleep-disordered breathing, periodic limb movements, restless legs syndrome, REM sleep behavior disorders, insomnia, and circadian rhythm disturbances are especially high.
An evidence-based synopsis suggests that idiopathic REM sleep behavior disorder may have a hereditary component. A total of 632 participants, half with idiopathic REM sleep behavior disorder and half without, completed self-report questionnaires. The study results suggest that people with the sleep disorder are more likely to report having a first-degree relative with the same sleep disorder than people of the same age and sex who do not have the disorder. More research is needed to further understand the hereditary nature of sleep disorders.
A population susceptible to the development of sleep disorders includes people who have experienced a traumatic brain injury. Due to the significant research focus on this issue, a systematic review was conducted to synthesize the findings. The results indicate that individuals who have experienced a traumatic brain injury are most disproportionately at risk for developing narcolepsy, obstructive sleep apnea, excessive daytime sleepiness, and insomnia.
Obstructive sleep apnea is a common condition affecting 10-20% of middle-aged and older adults, characterized by repeated breathing pauses during sleep, leading to poor sleep quality, and excessive daytime somnolence and, sometimes insomnia. Common factors include obesity, narrow airways, and certain neuromuscular conditions that cause airway collapse during sleep.
/ref>McCarter, S., & Howell, J. (2017). REM Sleep Behavior Disorder and Other Sleep Disturbances in Non-Alzheimer Dementias. Current Sleep Medicine Reports, 3(3), 193-203. For example, individuals diagnosed with PD frequently experience various sleep issues, such as insomnia (affecting approximately 70% of the PD population), hypersomnia (over 50%), and REM sleep behavior disorder (RBD) (around 40%), which is linked to increased motor symptoms. Moreover, RBD has been identified as a significant precursor for the future development of these neurodegenerative diseases over several years, presenting a promising opportunity for improving treatments.
Neurodegenerative conditions are commonly related to structural brain impairments, which may disrupt sleep and wakefulness, circadian rhythm, and motor or non-motor functioning. Conversely, sleep disturbances are often linked to worsening patients' cognitive functioning, emotional state, and quality of life. Additionally, these abnormal behavioral symptoms can place a significant burden on their relatives and caregivers. The limited research in this area, coupled with increasing life expectancy, highlights the need for a deeper understanding of the relationship between sleep disorders and neurodegenerative diseases.Dick-Muehlke, C. (2015). Psychosocial studies of the individual's changing perspectives in Alzheimer's disease (Premier Reference Source). Hershey, PA: Medical Information Science Reference.
In Alzheimer's disease, in addition to cognitive decline and memory impairment, there are also significant sleep disturbances with modified sleep architecture. These disturbances may consist of sleep fragmentation, reduced sleep duration, insomnia, increased daytime napping, decreased quantity of some sleep stages, and a growing resemblance between some sleep stages (N1 and N2). More than 65% of people with Alzheimer's disease experience this type of sleep disturbance.
One factor that could explain this change in sleep architecture is a disruption in the circadian rhythm, which regulates sleep. This disruption can lead to sleep disturbances. Some studies show that people with Alzheimer's disease have a delayed circadian rhythm, whereas in normal aging, an advanced circadian rhythm is present.
In addition to these psychological symptoms, there are two main neurological symptoms of Alzheimer's disease. The first is the accumulation of beta-amyloid waste, forming aggregate "plaques". The second is the accumulation of tau protein.
It has been shown that the sleep-wake cycle influences the beta-amyloid burden, a central component found in Alzheimer's disease (AD). As individuals awaken, the production of beta-amyloid protein becomes more consistent compared to its production during sleep. This phenomenon can be explained by two factors. First, metabolic activity is higher during waking hours, resulting in greater secretion of beta-amyloid protein. Second, oxidative stress increases during waking hours, which leads to greater beta-amyloid production.
On the other hand, it is during sleep that beta-amyloid residues are degraded to prevent plaque formation. The glymphatic system is responsible for this through the phenomenon of glymphatic clearance. Thus, during wakefulness, the beta-amyloid burden is greater because metabolic activity and oxidative stress are higher, and there is no protein degradation by glymphatic clearance. During sleep, the burden is reduced as there is less metabolic activity and oxidative stress, in addition to the glymphatic clearance that occurs.
Glymphatic clearance occurs during NREM SWS sleep, a stage that decreases with normal aging, leading to reduced glymphatic clearance and increased beta-amyloid burden, which forms plaques. Therefore, sleep disturbances in individuals with Alzheimer's disease will amplify this phenomenon.
The decrease in the quantity and quality of NREM SWS, along with sleep disturbances, will therefore increase the AB plaques. This initially occurs in the hippocampus, a brain structure integral to long-term memory formation. As hippocampus cell death occurs, it contributes to the diminished memory performance and cognitive decline found in AD.
Although the causal relationship is unclear, the development of AD correlates with the onset of prominent sleep disorders. Similarly, sleep disorders exacerbate disease progression, forming a positive feedback loop. As a result, sleep disturbances are not only a symptom of AD; the relationship between sleep disturbances and AD is bidirectional.
At the same time, it has been shown that memory consolidation in long-term memory, which depends on the hippocampus, occurs during NREM sleep. This indicates that a decrease in NREM sleep will result in less consolidation, leading to poorer memory performance in hippocampal-dependent long-term memory. This drop in performance is one of the central symptoms of AD.
Recent studies have also linked sleep disturbances, neurogenesis, and AD. The subgranular zone and subventricular zone continue to produce new neurons in adult brains. These new cells are then incorporated into neuronal circuits in the subgranular zone, which is found in the hippocampus. These new cells contribute to learning and memory, playing an essential role in hippocampal-dependent memory.
However, recent studies have shown that several factors can interrupt neurogenesis, including stress and prolonged sleep deprivation (more than one day). The sleep disturbances encountered in AD could therefore suppress neurogenesis and impair hippocampal functions. This suppression would contribute to diminished memory performance and the progression of AD, while the progression of AD would further aggravate sleep disturbances.
Changes in sleep architecture in patients with AD occur during the preclinical phase of the disease. These changes could potentially be used to detect those most at risk of developing AD. However, this is still only theoretical.
While the exact mechanisms and causal relationship between sleep disturbances and AD remain unclear, these findings provide a better understanding and offer possibilities to improve targeting of at-risk populations, as well as the implementation of treatments to curb the cognitive decline of AD patients.
Sleep deprivation can also produce hallucinations, delusions and depression. A 2019 study investigated the three above-mentioned sleep disturbances in schizophrenia-spectrum (SCZ) and bipolar (BP) disorders in 617 SCZ individuals, 440 BP individuals, and 173 healthy controls (HC). Sleep disturbances were identified using the Inventory for Depressive Symptoms - clinician rated scale (IDS-C). Results suggested that at least one type of sleep disturbance was reported in 78% of the SCZ population, in 69% individuals with BD, and in 39% of healthy controls. The SCZ group reported the most number of sleep disturbances compared to the BD and HC groups; specifically, hypersomnia was more frequent among individuals with SCZ, and delayed sleep phase disorder was three times more common in the SCZ group compared to the BD group. Insomnias were the most frequently reported sleep disturbance across all three groups.
None of these general approaches are sufficient for all patients with sleep disorders. Rather, the choice of a specific treatment depends on the patient's diagnosis, medical and psychiatric history, and preferences, as well as the expertise of the treating clinician. Often, behavioral/psychotherapeutic and pharmacological approaches may be compatible, and can effectively be combined to maximize therapeutic benefits.
Management of sleep disturbances that are secondary to mental, medical, or substance abuse disorders should focus on the underlying conditions. Medications and somatic treatments may provide the most rapid symptomatic relief from certain disorders, such as narcolepsy, which is best treated with prescription drugs such as modafinil. (2025). 9780444520029 ISBN 9780444520029 Others, such as chronic and primary insomnia, may be more amenable to behavioral interventions—with more durable results.
Chronic sleep disorders in childhood, which affect some 70% of children with developmental or psychological disorders, are under-reported and under-treated. Sleep-phase disruption is also common among adolescents, whose school schedules are often incompatible with their natural circadian rhythm. Effective treatment begins with careful diagnosis using sleep diaries and perhaps sleep studies. Modifications in sleep hygiene may resolve the problem, but medical treatment is often warranted.
Special equipment may be required for treatment of several disorders such as obstructive apnea, circadian rhythm disorders and bruxism. In severe cases, it may be necessary for individuals to accept living with the disorder, however well managed.
Some sleep disorders have been found to compromise glucose metabolism.
Hypnotherapy has been studied in the treatment of sleep disorders in both adults and children.
In another study specifically looking to help people with insomnia, similar results were seen. The participants that listened to music experienced better sleep quality than those who did not listen to music. Listening to slower pace music before bed can help decrease the heart rate, making it easier to transition into sleep. Studies have indicated that music helps induce a state of relaxation that shifts an individual's Circadian rhythm towards the sleep cycle. This is said to have an effect on children and adults with various cases of sleep disorders. Music is most effective before bed once the brain has been conditioned to it, helping to achieve sleep much faster.
Specialists in sleep medicine were originally and continue to be certified by the American Board of Sleep Medicine. Those passing the Sleep Medicine Specialty Exam received the designation "diplomate of the ABSM". Sleep medicine is now a recognized subspecialty within internal medicine, family medicine, pediatrics, otolaryngology, psychiatry and neurology in the United States. Certification in Sleep medicine shows that the specialist:
Competence in sleep medicine requires an understanding of a myriad of very diverse disorders. Many of which present with similar such as excessive daytime sleepiness, which, in the absence of volitional sleep deprivation, "is almost inevitably caused by an identifiable and treatable sleep disorder", such as sleep apnea, narcolepsy, idiopathic hypersomnia, Kleine–Levin syndrome, menstrual-related hypersomnia, idiopathic recurrent stupor, or circadian rhythm disturbances. Another common complaint is insomnia, a set of symptoms which can have a great many different causes, physical and mental. Management in the varying situations differs greatly and cannot be undertaken without a correct diagnosis.
Sleep dentistry (bruxism, snoring and sleep apnea), while not recognized as one of the nine dentistry, qualifies for board-certification by the American Board of Dental Sleep Medicine (ABDSM). The qualified dentists collaborate with sleep physicians at accredited sleep centers, and can provide oral appliance therapy and upper airway surgery to treat or manage sleep-related breathing disorders. The resulting diplomate status is recognized by the American Academy of Sleep Medicine (AASM), and these dentists are organized in the Academy of Dental Sleep Medicine (USA).
Occupational therapy is an area of medicine that can also address a diagnosis of sleep disorder, as rest and sleep is listed in the Occupational Therapy Practice Framework (OTPF) as its own occupation of daily living. Rest and sleep are described as restorative in order to support engagement in other occupational therapy occupations. In the OTPF, the occupation of rest and sleep is broken down into rest, sleep preparation, and sleep participation. Occupational therapists have been shown to help improve restorative sleep through the use of assistive devices/equipment, cognitive behavioral therapy for Insomnia, therapeutic activities, and lifestyle interventions.
In the UK, knowledge of sleep medicine and possibilities for diagnosis and treatment seem to lag. The Imperial College Healthcare shows attention to obstructive sleep apnea syndrome and very few other sleep disorders. Some NHS trusts have specialist clinics for respiratory and neurological sleep medicine.
Sleepwalking was found to be more common in males, with no gender disparity noted in any of the other common childhood sleep disturbances. Obstructive sleep apnea was found to be more common in African Americans, individuals with craniofacial abnormalities, Down syndrome, neuromuscular diseases, and choanal atresia. A number of the sleep disorders listed were found to have a familial pattern, meaning the incidence in a child was more likely to occur if one or both parents had a history of that sleep disorder; these include sleepwalking, confusional arousals, delayed sleep phase disorder, and restless legs syndrome.
A different systematic review examining Bruxism in children found prevalence rates ranging from 5.9% to 49.6%. In preschool-aged children, between 15.29% and 38.6% grind their teeth in their sleep for at least one night per week. In all but one of the included studies, the prevalence of bruxism decreases as age increases.
Between 20 and 26% of adolescents report a sleep onset latency of greater than 30 minutes, and 7-36% have difficulty initiating sleep. Asian teens tend to have a higher prevalence of adverse sleep outcomes than their North American and European counterparts.
Combining results from 17 studies on insomnia in China, a pooled prevalence of 15.0% is reported for the country. This result is consistent among other countries; however, this is considerably lower than a series of Western world (50.5% in Poland, 37.2% in France and Italy, 27.1% in USA). Men and women residing in China experience insomnia at similar rates.
A separate meta-analysis focusing on this sleeping disorder in the elderly mentions that those with more than one physical or psychiatric malady experience it at a 60% higher rate than those with one condition or less. It also notes a higher prevalence of insomnia in women over the age of 50 than their male counterparts.
A study which resulted from a collaboration between Massachusetts General Hospital and Merck describes the development of an algorithm to identify patients with sleep disorders using electronic medical records. The algorithm that incorporated a combination of structured and unstructured variables identified more than 36,000 individuals with physician-documented insomnia.
Insomnia can start off at the basic level but about 40% of people who struggle with insomnia have worse symptoms. Treatments that can help with insomnia include medication, creating and following a sleep routine, limiting one's caffeine intake, and cognitive behavioral therapy for insomnia.
In a meta-analysis of the various Asian countries, India and China present the highest prevalence of the disorder. Specifically, about 13.7% of the Indian population and 7% of Hong Kong's population is estimated to have obstructive sleep apnea. The two groups in the study experience daytime symptoms such as difficulties concentrating, mood swings, or high blood pressure, at similar rates (prevalence of 3.5% and 3.57%, respectively).
There are two2 types of narcolepsy. Type 1 is marked by the presence of cataplexy and/or low cerebrospinal fluid hypocretin levels. Type 2 is characterized by the absence of both.Literature reviews suggest that narcolepsy is typically caused by genetic and environmental factors . The disorder is also linked to autoimmune damage of Hypothalamus hypocretin-producing neurons.
Treatment of Narcolepsy focuses on managing symptoms since no cure has been found yet for narcolepsy. Given the disabling morbidity associated with narcolepsy, more research and drug trials are needed. Psychostimulants (methylphenidate, modafinil) and antidepressant (elective serotonin reuptake inhibitors and tricyclics) are used to manage narcolepsy symptoms. More recent targeted therapies such as pitolisant, solriamfetol, and sodium oxybate have been approved to improve wakefulness or reduce cataplexy.
Treatment, as in narcolepsy, focuses majorly on symptom management. It is mainly based on stimulants to improve alertness and wakefulness.
Idiopathic hypersomnia (IH)
A chronic neurological disease often compared to narcolepsy type 2, characterized by excessive daytime sleepiness, even after normal or prolonged sleep time, sometimes exceeding 10h in duration. There a two types of IH : with long nocturnal sleep time and without long nocturnal sleep time (marked by unintented unrefreshing naps). The disorder remains largely unclear, with no clear pathophysiological mechanism. Patients dealing with idiopathic hypersomnia cannot obtain a healthy amount of sleep for a regular day of activities. This hinders the patients' ability to perform well.
Kleine-Levin Syndrome
Kleine–Levin syndrome is a very rare sleep disorder, mainly affecting adolescent males. It is classified among recurrent and is marked by episodes that might last days to weeks. Diagnosis requires the presence of at least one of the following signs during the episodes: cognitive dysfunction, altered perception, eating disorder and Disinhibition behavior like hypersexuality. Between the episodes, patients usually return to normal and show no symptoms (ICSD-3-TR)
Sleep disordered breathing disorders
Sleep-Related Hypoventilation Disorders
Circadian rhythm sleep disorder
Parasomnia
A category of sleep disorders that involve abnormal and unnatural movements, behaviors, emotions, perceptions, and dreams in connection with sleep.
Sleep-Related Movement Disorders
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