Common Sleep Conditions

Insomnia

Insomnia is a complicated sleep condition defined as difficulty falling or staying asleep, even when a person has the chance to do so. Insomnia causes a sleep deficit, meaning a person with insomnia hasn’t spent enough hours sleeping, which leads to issues like fatigue, low energy, difficulty concentrating, mood disturbances, and decreased performance in school or work.

Acute Insomnia vs Chronic Insomnia

Insomnia can be acute or chronic. Someone with acute insomnia is typically associated with a stressful life event, like not being able to sleep the night before a big exam. Many people have experienced insomnia in passing, and it typically resolves without any treatment. Chronic insomnia is characterized by disrupted sleep at least three times per week, lasting at least three times. The NIH estimates that roughly 30% of the general population complains of sleep disruption and that 10 percent of people will have symptoms associated with sleep deficits.

Causes of Insomnia

Chronic insomnia can have many causes like changes to the sleep environment, unhealthy sleep habits, shift work, certain medications, and other clinical disorders. There are many clinical disorders that are linked to insomnia, like allergies, gastrointestinal problems, endocrine problems, sleep apnea, arthritis and chronic pain, and certain neurological conditions like Parkinson’s disease or restless leg syndrome. Many prescription and over-the-counter medications may interfere with a person’s circadian rhythm and make it difficult to sleep.

Depression and Anxiety are known for their links to sleep disorders. Depression can make it hard to fall asleep due to feelings of sadness and hopelessness. Chronic insomnia almost always worsens depression, which causes a positive feedback loop of continuously worsening depression. Anxiety symptoms that can lead to insomnia include tension, getting caught up in thoughts, feeling overwhelmed, and overstimulation. A lot of times, excess worry about not being able to sleep can make it even more difficult to fall and stay asleep. Depression and anxiety medications can often complicate sleep. Selective serotonin reuptake inhibitors, one of the most common classes of antidepressants, artificially increase the amount of serotonin in the brain to alleviate symptoms of depression. Because serotonin plays a large role in the sleep-wakefulness cycle (see monoamines, above), the increase in serotonin is sometimes accompanied by insomnia.

Chronic insomnia can be treated with behavioral, psychological, or medical treatment, or can use combinations of these treatments. When treating chronic insomnia, you and your doctor will need to consider the particular history of insomnia, current conditions, and lifestyle habits. The Sleep Foundation lists several lifestyle habits that can be changed to help alleviate chronic insomnia. These include reducing alcohol and caffeine consumption, stopping use of nicotine products, eating lighter meals closer to bedtime, limiting screen time or blue light exposure, restricting naps or nap frequency, and waking up on time. Sleep deficits can often cause a person to sleep in late.

Insomnia Differences: Men vs Women

Insomnia is almost twice as prevalent in women than men. This is thought to be caused primarily by hormones: Women have larger fluctuations in hormones day-to-day. When insomnia is studied in children, there are no differences in female and male subjects until the onset of puberty. Once women have reached puberty, women sleep better than other times because of the fluctuations corresponding to their menstrual cycles. Other hormonal landmarks in a woman’s life: pregnancy, postpartum period, and menopause can also affect the ease at which women are able to fall asleep.

Mood disorders are also correlated with disruptions in sleep because the same neurotransmitters involved in mood disorders can also be off balance in sleep. Because women are more prone to mood disorders like anxiety and depression, this leaves them more vulnerable to sleep disorders.

Even as traditional gender roles are changing (for the better!) women are still more often the primary caregivers for their children. Later in life, women more often take over care for their parents or their partner’s parents. These time-consuming roles leave less time for sleep.

Sleep Apnea

Sleep Apnea is a sleep disorder in which breathing stops and starts throughout the night. There are three major different kinds of sleep apnea: obstructive sleep apnea, central sleep apnea, and complex sleep apnea syndrome.

 
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Types of Sleep Apnea

Obstructive Sleep Apnea

This is the most common form of sleep apnea. It is characterized by intermittent throat muscle relaxation during sleep which causes a blockage to the air pathway and can interrupt breathing during the night. When the air pathway is closed, the lungs and diaphragm will have to work harder to pull air into the lungs.

Risk Factors

Any person can develop sleep apnea at any time, but there are many risk factors that can contribute to an increased risk of developing it. Some of these risks are: excess weight, narrowed airway, high blood pressure, chronic nasal congestion, smoking, diabetes, sex, family history of sleep apnea, and asthma. Certain kinds of medication may increase the chance of developing sleep apnea.

Central Sleep Apnea

This kind of sleep apnea occurs when the brain isn’t sending proper signals to the muscles that control breathing. Central sleep apnea may occur as a result of other conditions, such as heart failure and stroke.

Causes

Central sleep apnea can be caused by conditions that affect the function of the brainstem, which connects the brain and spinal cord and controls many central automatic processes like heart rate and breathing.

Cheyne-Stokes breathing is a kind of sleep apnea correlated with heart failure or stroke. This kind of sleep apnea is characterized by a gradual increase then decrease in breathing effort and airflow.

Drug-induced apnea is caused by taking medications like opiods that cause breathing pattern and heart rate irregularity.

High-altitude periodic breathing can happen when a person is subjected to an especially high altitude. The difference in oxygen levels from a low to a high elevation can cause alternating hyperventilation and underbreathing.

Medical condition-induced central sleep apnea is any kind of central sleep apnea that is not a direct response to Cheyne-Stokes breathing.

Risk Factors

If you’re middle-aged or older, you’re more likely to develop sleep apnea. Especially in adults over the age of 65.

Men are more likely than women to develop sleep apnea.

People with atrial fibrillation or congestive heart failure are at a greater risk of central sleep apnea. Strokes, brain tumors, or a structural brainstem lesion are other factors that can contribute to the development of sleep apnea.

Sleeping in a higher altitude location than what your body is used to can increase risk for experiencing symptoms. Once the body has returned to a lower altitude, there are reduced symptoms.

Opioid medications increase the risk of developing sleep apnea. CPAP machines can also cause the development of central sleep apnea, however for some people, CPAPS cure obstructive sleep apnea.

Complex Sleep Apnea Syndrome

This type of apnea, also known as treatment-emergent central sleep apnea, occurs when someone has both central sleep apnea and obstructive sleep apnea. Some individuals with obstructive sleep apnea can eventually develop central sleep apnea through use of their CPAP, continuous positive airway pressure machine.

Symptoms of Sleep Apnea

Sleep apnea comes with a lot of symptoms. The Mayo Clinic defines these symptoms as excessive daytime sleepiness, loud snoring, observed episodes of breathing cessation during sleep, abrupt awakenings accompanied by gasping or choking, awakening with a dry mouth or sore throat, morning headaches, difficulty concentrating during the day, mood changes, high blood pressure, nighttime sweating, and decreased libido. It is recommended that a person who believes they have sleep apnea see a doctor if they’re snoring loud enough to disturb their sleep or that of others, waking up gasping or choking, having intermittent pauses in breathing during sleep, or experiencing excessive daytime drowsiness. If a person has any of these symptoms, it is recommended to visit a physician to get

Treatments for Sleep Apnea

Treatments depend on the kind of sleep apnea you are diagnosed with. There are several treatments available for obstructive sleep apnea. Some treatments involve using a device that keeps your airway open during sleep, called a CPAP, or continuous positive airway pressure machine, pictured below. Another option is a mouthpiece that forces your jaw open during sleep. In very severe cases, surgery is an option too.

Sleep Deprivation

Sleep deprivation happens when an individual doesn't get enough sleep the previous night to be alert and fully awake the next day. It affects every individual at some point in their life and causes an alteration of normal functioning of attention and memory, as well as a disruption in the ability to focus on typical environmental sensory input.  Occasional sleep interruptions are not a cause for concern, but when they start to become more regular, it could lead to other, more serious, issues like daytime sleepiness, emotional difficulties, poor performance, obesity, and a lower perceived quality of life. Sleep deprivation has the most dangerous potential when an individual is a child or young adult due to its negative impact on a developing brain.

Symptoms and effects of Sleep Deprivation

The main symptom of sleep deprivation is excessive daytime sleepiness, but other symptoms can include: yawning, moodiness, fatigue, irritability, depressed mood, difficulty learning new concepts, forgetfulness, inability to concentrate, lack of motivation, clumsiness, increased appetite and carb cravings, and reduced sex drive.

When you are chronically sleep deprived, your body has a hard time recharging and regenerating for the day. This is linked with several downstream effects. At night, the body strengthens the immune system by producing cytokines (immune cells) that can fight off infections. A person who is sleep deprived will take longer to recover from an illness and has an increased risk of developing a chronic illness, like new and advanced respiratory diseases. Not getting enough sleep is also linked to an increase in body weight. Leptin and ghrelin are two hormones produced by the body to control feelings of hunger and fullness. Without sufficient sleep, these hormones can become unbalanced, causing a person to consume more calories. Sleep deprivation causes the release of insulin, which can lead to an increase in fat storage and a higher risk of type 2 diabetes.

Regular sleep helps heart and blood vessels to heal and rebuild. Sleep also helps to regulate blood pressure, sugar levels, and inflammation. Not sleeping enough increases the risk of developing cardiovascular disease. Insufficient sleep is also linked to growth hormone imbalance, which can have numerous downstream effects.

Sleep Paralysis

Sleep paralysis is a sign that the body is not following the normal course of sleep stages. Sleep paralysis is a state of consciousness with the inability to move. This occurs when a person passes between stages of wakefulness and sleep. Sleep paralysis can either occur as someone is falling asleep, known as hypnagogic or predormital sleep paralysis, or when someone is waking up, known as hypnopompic or postdormital sleep paralysis. During these transitions, a person may not be able to move or sleep for a few seconds up to a couple minutes. Some individuals have reported a feeling of choking that accompanies sleep paralysis. There are several disorders that may accompany sleep paralysis like narcolepsy.

Risk Factors for Sleep Paralysis

Sleep paralysis is very common, as many as 40% of people may experience it at some point in their lives. It most often begins in teenage years, but women and men of any age may have an experience. It’s thought to have a genetic link, because it runs in some families. Some factors that may increase a person’s chance of having an episode of sleep paralysis are: lack of sleep, sleep schedule changes, medical conditions like chronic stress or bipolar disorder, narcolepsy or nighttime leg cramps, use of certain medications (particularly ADHD medications), and substance abuse.

Treatments for Sleep Paralysis

Most people who experience sleep paralysis do not need to seek medical treatment for the condition, but there are a couple of things that might reduce the number of episodes experienced like: improving sleep habits, changing sleep positions, using antidepressant medication to help regulate sleep cycles, treating mental health conditions that contribute to sleep paralysis, or treating other sleep disorders such as narcolepsy or leg cramps.

Sleepwalking

Sleepwalking, known as somnambulism, is a behavioral disorder that manifests during sleep. In this disorder, a person will walk or perform actions while asleep. Sleepwalking is more common in children than adults, and sleep deprivation is the largest risk factor for sleepwalking episodes. Infrequent bouts of sleepwalking are not cause for concern, but recurrent sleepwalking may be an indication of a larger underlying sleep disorder.

Sleepwalking occurs in the beginning of sleep - often one to two hours into falling asleep. It is very unlikely that someone will sleepwalk during a short nap. An episode generally lasts several minutes but can last longer. Someone who is sleepwalking may: get out of bed and walk around, sit up in bed and open their eyes, have a glazed expression, not respond or communicate with others, be difficult to wake up during an episode, be disoriented or confused for a short time after awakening, not remember the episode the following morning, have problems functioning during the next day, or have sleep terrors.

Occasionally, a person sleepwalking will do routine activities like getting dressed or eating, leave the house, drive a car, engage in unusual behavior, engage in sexual activity, get injured, or become violent. If these behaviors are seen in an individual, is is recommended that they consult a physician as soon as possible to reduce the likelihood of injury from a sleepwalking episode.

Causes of Sleepwalking

Sleepwalking is described as a parasomnia, an unwarranted behavior during typical sleep. Some factors that can contribute to sleepwalking include: sleep deprivation, stress, a fever, and sleep schedule disruptions like travel.

There are some underlying conditions that can manifest as sleepwalking like sleep-disordered breathing (like sleep apnea), taking medications (most commonly hypnotics, sedatives, or psychiatric medications), substance use, restless legs syndrome, and gastroesophageal reflux disease.

Risk Factors for Sleepwalking

There are only two identified risk factors for sleepwalking: age and genetics. Sleepwalking occurs much more frequently in children than adults. Adults that begin to sleepwalk for the first time typically have an underlying sleep condition. Sleepwalking runs in families. Your risk of sleepwalking increases if at least one parent has a history of the condition. If both parents sleepwalk, that risk goes up even higher.