Types of Sleep Disorders, Symptoms, Treatment | Advanced Sleep Medicine Services, Inc.

Snoring

Snoring is both a social and a medical problem, which affects approximately 45 percent of normal adults in the United States alone. It can be disruptive to family life, frequently forcing partners to sleep separately. Snorers tend to have poor quality sleep and thus are prone to reduced daytime alertness. In its most severe form, snoring can be an indicator of obstructive sleep apnea.

Snoring is more frequent in males and overweight persons and usually grows worse with age. Snoring sounds are caused when there is an obstruction to the free flow of air through the passages at the back of the mouth and nose.

Type of sleep study that may be ordered: Polysomnography (PSG) will record snoring. Insurance plans may not cover a sleep study for snoring alone.

Sleep Apnea

sleep apnea PAP machine Sleep apnea is defined as the cessation of breath during sleep. There are three different types of apnea: obstructive, central, and mixed. Of these three, obstructive sleep apnea (OSA) is the most common, and most severe. People with a severe case of sleep apnea may cease breathing hundreds of times during sleep. OSA can afflict all age groups, men and women alike, though most common in overweight men. An estimated 18 million Americans have sleep apnea, and approximately 38,000 people die annually from resulting complications. Loud, habitual snoring, waking up with headaches, and daytime sleepiness are some of the main symptoms. Effective diagnosis and treatment is available.

Learn more about sleep apnea.

Type of sleep study that may be ordered: Polysomnography (PSG) in-center or in-home (HST) may be ordered to diagnose or rule out sleep apnea. A split night study may also be ordered to both diagnose and treat sleep apnea in the same night, if possible.

Obstructive Sleep Apnea

Obstructive sleep apnea is a common and serious sleep disorder that causes you to stop breathing during sleep. The airway repeatedly becomes blocked, limiting the amount of air that reaches your lungs. When this happens, you may snore loudly or making choking noises as you try to breathe. Your brain and body becomes oxygen deprived and you may wake up. This may happen a few times a night, or in more severe cases, several hundred times a night.

In many cases, an apnea, or temporary pause in breathing, is caused by the tissue in the back of the throat collapsing. The muscles of the upper airway relax when you fall asleep. If you sleep on your back, gravity can cause the tongue to fall back. This narrows the airway, which reduces the amount of air that can reach your lungs. The narrowed airway causes snoring by making the tissue in back of the throat vibrate as you breathe.

Sleep apnea can make you wake up in the morning feeling tired or unrefreshed even though you have had a full night of sleep. During the day, you may feel fatigued, have difficulty concentrating or you may even unintentionally fall asleep. This is because your body is waking up numerous times throughout the night, even though you might not be conscious of each awakening.

The lack of oxygen your body receives can have negative long-term consequences for your health. This includes:

High blood pressure
Heart disease
Stroke
Pre-diabetes and diabetes
Depression

There are many people with sleep apnea who have not been diagnosed or received treatment. A sleep medicine physician can diagnose obstructive sleep apnea using an in-lab sleep study or a home sleep test. Sleep apnea is manageable using Continuous Positive Airway Pressure (CPAP), the front-line treatment for sleep apnea, oral appliance therapy or surgery.

Obstructive sleep apnea in adults is considered a sleep-related breathing disorder. Causes and symptoms differ for Obstructive Sleep Apnea in Children, and Central Sleep Apnea.

Learn more about sleep apnea.

Type of sleep study that may be ordered: Polysomnography (PSG) in-center or in-home may be ordered to diagnose or rule out sleep apnea. A split night study may also be ordered to both diagnose and treat sleep apnea in the same night, if possible.

Central Sleep Apnea

Central sleep apnea is a breathing disorder that causes your body to decrease or stop the effort of breathing during sleep. This occurs in an off-and-on cycle. It is a result of a problem in the brain or heart. It is different from obstructive sleep apnea (OSA) because the problem is not caused by a blockage of the airway.

The brain and heart normally interact to direct, monitor, and change the amount of air that we breathe. The problem in central sleep apnea syndromes (CSA) is that the brain and heart move an abnormal amount of air into the lungs. CSA syndromes in adults are divided into these five categories:

Primary Central Sleep Apnea — Cause is not known. The breathing pattern consists of the repetitive absence of breathing effort and air flow.
Cheyne-Stokes Breathing Pattern — Cause is heart failure, stroke, and possibly kidney failure. The breathing pattern consists of a rhythmic increase and decrease of the breathing effort and the amount of air flow.
Medical Condition Not Cheyne-Stokes — CSA caused by medical conditions, but without the typical Cheyne-Stokes breathing pattern. It is caused by heart and kidney problems. It may also result from a problem in the base of the brain where breathing is controlled.
High-Altitude Periodic Breathing — Caused by sleeping at altitudes higher than about 15,000 feet. The breathing pattern is similar to the Cheyne-Stokes Breathing Pattern. The difference is that there is no history of heart failure, stroke, or kidney failure. Also, the cycle time is shorter.
Due to Drug or Substance — Caused by the use of drugs, mainly pain medicines in the opioid category. Breathing may stop completely or increase and decrease in a regular pattern. Breathing can also be quite irregular. It can even have elements of obstruction such as the breathing that is seen in OSA.

Source: American Academy of Sleep Medicine

Type of sleep study that may be ordered: Polysomnography (PSG) in-center or in-home may be ordered to diagnose or rule out central sleep apnea. A split night study or second night titration with a variable setting PAP device may also be ordered.

Complex or Mixed Sleep Apnea

"Mixed" or "complex" sleep apnea is a combination of obstructive sleep apnea (anatomical) and central sleep apnea (neurological). It can be explained as a central event that turns into an obstructive event. Complex can be detected during an overnight sleep study in a sleep center and can treated with continuous or bi-level PAP or a more sophisticated device like servo ventilation.

Insomnia

The inability to fall asleep or stay asleep is called insomnia. Insomnia, in its chronic form, can last for weeks, months, or even years. It may be related to worry, anxiety, depression, medical/psychiatric problems, or substance abuse. Insomnia is a symptom and in order to treat it, physicians must find the cause. Most insomnia sufferers sleep better after the appropriate evaluation and treatment.

Type of sleep study that may be ordered: Polysomnography (PSG) in-center or in-home may be ordered to diagnose or rule out sleep apnea which may be a cause of insomnia.

Narcolepsy

Narcolepsy is a sleep disorder that involves the body's central nervous system and is characterized by attacks of sleep. A person with narcolepsy is likely to fall asleep at inappropriate times and places. Daytime sleep attacks may occur with or without warning and can occur repeatedly in a single day. Nighttime sleep may be fragmented with frequent arousals. While there is not yet a cure, recent technology and pharmacology has allowed those with this sleep disorder to live normal lives.

Type of sleep study that may be ordered: Polysomnography (PSG) in-center followed by multiple sleep latency testing (MSLT) may be ordered to diagnose or rule out suspected narcolepsy.

Restless Leg Syndrome

RLS is a "creepy, crawly" feeling in the legs when they are still, especially at bedtime. Stretching or moving the legs temporarily relieves these feelings. The constant need to stretch or move the legs to rid of the uncomfortable sensations often prevents the person from falling asleep, resulting in daytime sleepiness. Roughly 5 to 10% of people experience the pain of RLS at some point in their lives. RLS can occur at any age but is more common in the elderly. Approximately 30% of RLS cases have a hereditary case. Effective diagnosis and treatment is available.

Type of sleep study that may be ordered: Polysomnography (PSG) in-center (not at home) may be ordered to measure leg movements through out the night and diagnose RLS.

Periodic Leg Movement Disorder

PLMD refers to involuntary movements of the legs and arms during sleep. These movements cause arousals and sleep disturbances. PLMD is more common in people who have kidney disease or narcolepsy. Individuals with PLMD may also experience Restless Legs Syndrome (RLS).

Type of sleep study that may be ordered: Polysomnography (PSG) in-center (not at home) may be ordered to measure leg movements and arousals cuased by leg movements through out the night and diagnose PLMD.

Parasomnias

Parasomnia refers to a variety of disruptive sleep-related events that disrupt one's sleep and can lead to injury or disturbance of oneself or others in the bed or house. Parasomnias can often be effectively diagnosed and treated.

Parasomnias include:

Sleepwalking - Sleepwalking seems to be a temporary sleep mechanism malfunction that occurs during deeper stages of sleep and tends to run in families. Sleepwalking affects mostly children and tends to go away after puberty. People who sleepwalk do not remember their nocturnal walk the next day.
Sleep talking - Sleep talking is generally harmless and usually temporary, brought on by illness or stress. The sleeper has no memory of sleep talking. Sleep talking can sometimes be associated with sleep apnea or night terrors.
Night terrors - Night terrors are more common in children and typically do not continue into adulthood. Night terrors are marked by a sudden awakening with physical behaviors associated with intense fear and last about 15 minutes after which the person goes back to sleep.
REM movement disorder - In this type of disorder, the paralysis that normally occurs during REM sleep is incomplete or absent, allowing the sleeper to act out their dreams. This disorder is most common in men and can lead to violent behavior or injuries.

Type of sleep study that may be ordered: Polysomnography (PSG) in-center (not at home) may be ordered to record some sleep behaviors throughout the night.

Circadian Rhythm Disorders

Circadian Rhythm Disorders refer to a disruption, temporary or chronic, in a patient's sleep-wake cycle. Circadian rhythms are the body's 24-hour internal clock that govern feeling alert during the day and sleepy at night. People who suffer from these disorders are unable to properly time their sleeping periods because their body clock is not aligned with the time of day. These disorders can result in either insomnia or excessive sleepiness, difficulty functioning at work or school, and social impairment. Some common types of Circadian Rhythm Disorders include:

Shift Work Disorder - This affects people who work unusual or irregular hours, especially the night shift. Disrupted sleep patterns can result in excessive sleepiness, lack of concentration, and several other problems.
Jet Lag - The disruption in sleep patterns that occurs when traveling across time zones is an example of a circadian rhythm disruption.
Delayed/Advanced Sleep Phase Disorder - This describes when a person's sleep patterns become consistently shifted backward (going to bed in the middle of the night and waking up very late, even in the afternoon) or forward (going to bed early in the evening and waking up in the early morning).
Non-24-Hour Sleep-Wake Disorder - This describes when the body's internal clock runs on a cycle of more than 24 hours, so that sleep, and the period of peak alertness, becomes shifted further and further back each day.
Irregular Sleep-Wake Disorder - This describes when periods of sleeping and wakefulness are irregularly spaced, often occurring at least twice per day.

Type of sleep study that may be ordered: Since Circadian Rhythym Disorders primarily deal with when sleep is ocurring, as opposed to the quality of the sleep itself, they are not possible to diagnose with a sleep study alone. Identifying such a disorder requires a consultation with a doctor. Using a sleep log or motion-tracking (actigraphy) can help identify irregular sleep patterns.

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Sleep Disorders

There are over 100 different types of sleep disorders ranging from trouble falling asleep at night to excessive daytime sleepiness. Sleep disorders affect many Americans and can often be diagnosed with different types of sleep studies.

Most Common Sleep Disorders