Sleep Disorders Patient Information Fact Sheet

What are sleep disorders?
There are many different types of sleep disorders, ranging from difficulty in getting to sleep or waking during the night and being unable to go back to sleep, to early wakening or poor quality sleep in general. Humans spend about a third of their lives asleep and it is estimated than one in four complain of poor sleeping patterns. Sleep problems are particularly common among the elderly population, although the elderly do require less sleep than younger adults.

The term insomnia is defined as a chronic (long-term) inability to fall asleep or to enjoy uninterrupted sleep. Other sleep disorders include narcolepsy (daytime sleepiness), obstructive sleep apnea (a disorder of breathing occurring during sleep), sleepwalking, nocturnal leg cramps, nightmares, sleep enuresis (bed wetting), snoring and sudden infant death syndrome (SIDS).

What causes sleep disorders?
Short-term sleep problems can be caused by external factors such as jet lag, bereavement, work stress, and exam stress, all of which will usually resolve with time. A partner who snores can also disturb normal sleep patterns. Pain and other physical reasons such as prostate problems or pregnancy (both of which cause the need to urinate during the night) can also cause poor sleep. In these cases the physical problem responsible for the sleep disturbance should be treated when possible.

Stress, anxiety, and depression can all cause difficulty in sleeping and early wakening, while stimulants such as caffeine and nicotine can delay the onset of sleep. Alcohol has both stimulant and sedative effects. Alcohol acts as a short-acting sedative and although it promotes sleep to begin with, as blood levels fall it starts to act as a stimulant and sleep is disrupted.

Being very overweight can cause obstructive sleep apnea. In people with this condition the upper airways become narrowed during sleep to the extent that the throat may become partially or completely blocked. If this occurs the person will fight for breath causing them to wake up. The awakening is often so brief that the person is unaware of it. However, they may be woken up to a thousand times a night which, in turn, causes daytime tiredness. Sleep apnea is most common in overweight men.

Nightmares and sleep walking are more common in children than in adults and are thought to be caused by an immaturity of the central nervous system. In adults, however, these events are more likely to be the result of psychological problems.

What are the problems associated with poor sleep?
There are many general effects of unsatisfactory sleep. For example, the person may wake feeling tired and irritable which can cause problems with relationships and in carrying out work to a satisfactory level. It is estimated that a quarter of all car accidents are caused by the driver falling asleep at the wheel.

How are sleep disorders treated?
If a sleep problem is being caused by something specific, this cause should be addressed and treated appropriately. Medication may help to alleviate some sleep problems but will not deal with the root cause of poor sleeping patterns. In sleep problems caused by depression, for example, a combination of counseling and/or antidepressant therapy should be prescribed if necessary. Medication may be of use if the depression is not linked to anything in particular but, if there is a specific factor in the person's life which is causing the depression, then this needs to be looked at and help given to deal with the problem. If the sleep disturbance is being caused by another medical problem, such as pain, then painkillers or other appropriate medication should be given. If there is no underlying cause for a sleep problem, a hypnotic medicine may be prescribed.

Benzodiazepines dampen activity in the brain but the effects may last into the next day and cause drowsiness, particularly in elderly people. These medicines will be prescribed only for short-term treatment of insomnia. There are some newer treatments which act in a similar way to benzodiazepines and which are useful for people who have difficulty in falling asleep. These include zaleplon (Sonata), zolpidem (Ambien, Edluar, Zolpimist), eszopiclone (Lunesta), and ramelteon (Rozerem). The barbiturates are a very powerful class of drugs and are only prescribed when insomnia is very severe and other medication is not effective.

Self-help measures

  • Establish a routine for sleep. Aim to go to sleep at the same time each night and wake at the same time each morning.
  • Avoid any stimulants such as caffeine in coffee or carbonated drinks for four hours before going to bed. Try to avoid eating a fatty meal late at night.
  • Stretching exercises and sexual intercourse improve relaxation but vigorous exercise does not.
  • Avoid sleeping during the day to catch up on lost sleep.
  • Try relaxation tapes or aromatherapy.

Further information
National Sleep Foundation: www.sleepfoundation.org

Last Reviewed: May 2013