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There are 88 different sleep disorders.
Disturbed sleep is often due to an underlying medical or psychiatric disorder. The
underlying cause should be sought.
Diagnosis
The history is most important and includes nature of complaint, nighttime and daytime
symptoms, sleep habits, drug and alcohol use (including caffeine and nicotine), and
medical and psychiatric history. Ask the patient about family history of narcolepsy
(sleeping at any time), apnea (not breathing for certain periods of time), restless legs,
sleepwalking, sleep terrors, etc. EEG may be useful in some disorders.
Common Types, Symtoms, and Treatment
A. Insomnia
1. Symptoms. Insomnia is a severe difficulty in sleeping. The doctor should look for
psychiatric and medical illnesses, especially those causing pain, nausea or vomiting,
respiratory distress, or frequent urination at night. Patients may complain of insomnia
itself or the effects of disturbed sleep, such as daytime drowsiness, morning headache, or
irritable mood. The doctor should inquire about recent travel (jet lag) and shift work.
Acute situational insomnia is the most common and is identified by the circumstances. Bed
partners may identify lack of breathing at various times during sleep, restless legs, or
periodic limb movements.
2. Treatment
a. Primary treatment. Treat the underlying cause, for example, prescribing an
antidepressant for depression or analgesic for pain. Caffeine, nicotine, alcohol, and
illicit drugs are stopped.
b. General measures. Teach patients good sleeping patterns: Establish a regular time to go
to bed and to rise, keep bedroom noise and light at sleep-promoting levels; if not asleep
within 20 minutes, get up, engage in quiet activity, then return to bed when sleepy
(repeat as needed); and take no naps.
c. Hypnotics. Do not overuse; usually give for less than 2 weeks. Examples include
Benzodiazepines and Nonbenzodiazepines.
B. Narcolepsy
1. Symptoms. Narcolepsy consists of active rapid eye movement (REM) sleep attacks lasting
minutes to hours during the daytime. It is familial beginning in young adults, and the
sexes are affected equally. The patient usually has a history of sleep attacks associated
with cataplexy (sudden loss of muscle tone triggered by strong emotion), hallucinations,
and interrupted sleep at night. Other causes of disturbed sleep causing daytime drowsiness
must be ruled out.
2. Treatment
a. General treatment. Take three to four scheduled daytime naps for 15–20 minutes
(this reduces spontaneous sleep attacks), avoid alcohol, and eat light meals. Emotional
support helps.
b. Medications. Stimulants are used to combat the daytime sleep urge; antidepressants are
used for other features, such as cataplexy, sleep paralysis, and hallucinations.
C. Sleep apnea
1. Symptoms. Sleep apnea consists of periodic nonbreathing during sleep. It may be due to
obstruction of the respiratory tract (obstructive sleep apnea syndrome: OSAS) or central
nervous system pathology (central sleep apnea). OSAS occurs mainly in obese, hypertensive
men. Sleep apnea may cause growth and behavioral problems in children and accidents, heart
attacks, and stroke in adults. Diagnosis is suggested by daytime drowsiness, lack of
refreshing sleep, irritability, morning headache, and excessive motor activity at night.
In OSAS, the patient often snores loudly, chokes, and may sit up fighting for breath. The
bed partner reports periodic cessation of breathing.
2. Treatment
a. General measures. The patient should lose weight if obese, stop smoking, avoid alcohol
before sleep, stop hypnotics, and treat associated medical disorders.
b. Specific therapy. For OSAS, the doctor may use continuous positive airway pressure (a
type of breathing aid) or surgery. Central sleep apnea may benefit from Vivactil, or
Prozac. Some cases may require tracheostomy (insertion of a tube to help breathing).
D. Sleep terror (pavor nocturnus)
1. Symptoms. Sleep terror is a sleep disorder that differs from nightmares in that there
is little to no recall of a frightening dream. Sleep terror is usually found in childhood.
The child suddenly sits up from sleep and screams but does not recall a dream. This occurs
during the last half of the night.
2. Treatment
a. General measures. Because the condition usually resolves spontaneously, parents usually
only require reassurance.
b. Medication. If the condition is quite disturbing, Valium may be used.
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