Sleep Disorders Guide: Symptoms, Treatments and Help

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Sleep disorders and other sleeping problems cause more than just
sleepiness. Poor quality sleep can have a negative impact on your
energy, emotional balance, productivity, and health. If you’re
experiencing sleeping problems, learn about the signs and symptoms
of common sleep disorders, what you can do to help yourself, and
when to see a doctor.

In This Article:

Understanding sleeping problems
Signs and symptoms
Insomnia
Other common sleep disorders
Circadian rhythm sleep disorders
Self-help for sleep disorders
Do sleeping pills help?
When to call the sleep doctor
Related links

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Understanding sleep disorders and sleeping
problems
Sleep can often be a barometer of your overall health. In many cases,
people in good health tend to sleep well, whereas repeated sleeping
problems may indicate an underlying medical or mental health
problem, be it minor or serious. Sleeping well is essential to your
physical health and emotional well-being. Unfortunately, even
minimal sleep loss can take a toll on your mood, energy, efficiency,
and ability to handle stress. Ignoring sleep problems and disorders
can lead to poor health, accidents, impaired job performance, and
relationship stress. If you want to feel your best, stay healthy, and
perform up to your potential, sleep is a necessity, not a luxury.

It’s not normal to feel sleepy during the day, to have problems
getting to sleep at night, or to wake up feeling unrefreshed. But even
if you’ve struggled with sleep problems for so long that it does seem
normal, you can learn to sleep better. You can start by tracking your
symptoms and sleep patterns, and then making healthy changes to
your daytime habits and bedtime routine. If self-help doesn’t do the

trick, you can turn to sleep specialists who are trained in sleep
medicine. Together, you can identify the underlying causes of your
sleeping problem and find ways to improve your sleep and quality of
life.

Signs and symptoms of sleep disorders and
sleeping problems
Everyone experiences occasional sleeping problems. So how do you
tell whether your sleeping problem is just a minor, passing
annoyance or a sign of a more serious sleep disorder or underlying
medical condition?

Start by scrutinizing your symptoms, looking especially for the
telltale daytime signs of sleep deprivation. If you are experiencing
any of the following symptoms on a regular basis, you may be
dealing with a sleep disorder.

Is it a sleep disorder?

Do you . . .

feel irritable or sleepy during the day?
have difficulty staying awake when sitting still, watching
television or reading?
fall asleep or feel very tired while driving?
have difficulty concentrating?
often get told by others that you look tired?
react slowly?
have trouble controlling your emotions?
feel like you have to take a nap almost every day?
require caffeinated beverages to keep yourself going?

If you answered ―yes‖ to any of the previous questions, you may
have a sleep disorder.

Insomnia: The most common type of sleep
disorder
Insomnia, the inability to get the amount of sleep you need to wake
up feeling rested and refreshed, is the most common sleep complaint.
Insomnia is often a symptom of another problem, such as stress,
anxiety, depression, or an underlying health condition. It can also be
caused by lifestyle choices, including the medications you take, lack

of exercise, jet lag, or even the amount of coffee you drink.

Common signs and symptoms of insomnia include:

Difficulty falling asleep at night or getting back to sleep after
waking during the night.
Waking up frequently during the night.
Your sleep feels light, fragmented, or unrefreshing.
You need to take something (sleeping pills, nightcap,
supplements) in order to get to sleep.
Sleepiness and low energy during the day.

Whatever the cause of your insomnia, being mindful of your sleep
habits and learning to relax will help you sleep better and feel better.
The good news is that most cases of insomnia can be cured with
lifestyle changes you can make on your own—without relying on
sleep specialists or turning to prescription or over-the-counter
sleeping pills.

Putting a stop to the problem of sleepless
nights

Insomnia takes a toll on your energy, mood, and ability to function
during the day. But you don’t have to put up with insomnia. Simple
changes to your lifestyle and daily habits can end sleepless nights.
Read Article

Other common types of sleep disorders
In addition to insomnia, the most common sleep disorders are sleep
apnea, restless legs syndrome (RLS), and narcolepsy.

Sleep disorder 1: Sleep apnea

Sleep apnea is a common sleep disorder in which your breathing
temporarily stops during sleep due to blockage of the upper airways.
These pauses in breathing interrupt your sleep, leading to many
awakenings each hour. While most people with sleep apnea don’t
remember these awakenings, they feel the effects in other ways, such
as exhaustion during the day, irritability and depression, and
decreased productivity.

Sleep apnea is a serious, and potentially life-threatening, sleep
disorder. If you suspect that you or a loved one may have sleep
apnea, see a doctor right away. Sleep apnea can be successfully
treated with Continuous Positive Airway Pressure (CPAP), a mask-
like device that delivers a stream of air while you sleep. Losing
weight, elevating the head of the bed, and sleeping on your side can
also help in cases of mild to moderate sleep apnea.

Symptoms of sleep apnea include:

Loud, chronic snoring
Frequent pauses in breathing during sleep
Gasping, snorting, or choking during sleep
Feeling unrefreshed after waking and sleepy during the day,
no matter how much time you spent in bed
Waking up with shortness of breath, chest pains, headaches,
nasal congestion, or a dry throat.

Sleep disorder 2: Restless legs syndrome (RLS)

Restless legs syndrome (RLS) is a sleep disorder that causes an
almost irresistible urge to move your legs (or arms). The urge to
move occurs when you’re resting or lying down and is usually due to
uncomfortable, tingly, aching, or creeping sensations.

Common signs and symptoms of restless legs syndrome include:

Uncomfortable sensations deep within the legs, accompanied
by a strong urge to move them.
The leg sensations are triggered by rest and get worse at
night.
The uncomfortable sensations temporarily get better when
you move, stretch, or massage your legs.
Repetitive cramping or jerking of the legs during sleep.

Sleep disorder 3: Narcolepsy

Narcolepsy is a sleep disorder that involves excessive, uncontrollable
daytime sleepiness. It is caused by a dysfunction of the brain
mechanism that controls sleeping and waking. If you have
narcolepsy, you may have ―sleep attacks‖ while in the middle of
talking, working, or even driving.

Common signs and symptoms of narcolepsy include:

Seeing or hearing things when you’re drowsy or starting to

dream before you’re fully asleep.
Suddenly feeling weak or losing control of your muscles
when you’re laughing, angry, or experiencing other strong
emotions.
Dreaming right away after going to sleep or having intense
dreams
Feeling paralyzed and unable to move when you’re waking
up or dozing off.

Circadian rhythm sleep disorders
We all have an internal biological clock that regulates our 24-hour
sleep-wake cycle, also known as our circadian rhythms. Light is the
primary cue that influences circadian rhythms. When the sun comes
up in the morning, the brain tells the body that it’s time to wake up.
At night, when there is less light, your brain triggers the release of
melatonin, a hormone that makes you sleepy.

When circadian rhythms are disrupted or thrown off, you may feel
groggy, disoriented, and sleepy at inconvenient times. Circadian
rhythms have been linked to a variety or sleeping problems and sleep
disorders, including insomnia, jet lag, and shift work sleep
difficulties. Abnormal circadian rhythms have also been implicated
in depression, bipolar disorder, and seasonal affective disorder, or the
winter blues.

Jet lag sleeping problems

Jet lag is a temporary disruption in circadian rhythms that occurs
when you travel across time zones. Symptoms include daytime
sleepiness, fatigue, headache, stomach problems, and insomnia. The
symptoms typically appear within a day or two after flying across
two or more time zones. The longer the flight, the more pronounced
the symptoms. The direction of flight also makes a difference. Flying
east tends to cause worse jet lag than flying west.

In general, it usually takes one day per time zone crossed to adjust to
the local time. So if you flew from Los Angeles to New York,
crossing three time zones, your jet lag should be gone within three
days. However, jet lag can be worse if you:

lost sleep during
drink too much alcohol or caffeine
travel
didn’t move around enough during
are under a lot of
your flight
stress

Shift work sleeping problems

Shift work sleep disorder is a circadian rhythm sleep disorder that
occurs when your work schedule and your biological clock are out of
sync. In our 24-hour society, many workers have to work night shifts,
early morning shifts, or rotating shifts. These schedules force you to
work when your body is telling you to go to sleep, and sleep when
your body is signaling you to wake.

While some people adjust better than others to the demands of shift
work, most shift workers get less quality sleep than their daytime
counterparts. As a result of sleep deprivation, many shift workers
struggle with sleepiness and mental lethargy on the job. This cuts
into their productivity and puts them at risk of injury.

There are a numbers of things you can do to reduce the impact of
shift work on sleep:

Take regular breaks and minimize the frequency of shift
changes.
When changing shifts, request a shift that’s later, rather than
earlier as it’s easier to adjust forward in time, rather than
backward.
Naturally regulate your sleep-wake cycle by increasing light
exposure at work (use bright lights) and limiting light
exposure when it’s time to sleep. Avoid TV and computer
screens, use black-out shades or heavy curtains to block out
daylight in your bedroom.
Consider taking melatonin when it’s time for you to sleep.

Delayed sleep phase disorder

Delayed sleep phase disorder is a sleep disorder in which your 24-
hour cycle of sleep and wakefulness—your biological clock—is
significantly delayed. As a result, you go to sleep and wake up much
later than other people. For example, you may not get sleepy until 4
a.m., at which time you go to bed and sleep soundly until noon, or at

least you would if your daytime responsibilities didn’t interfere.
Delayed sleep phase disorder makes it difficult for you to keep
normal hours—to make it to morning classes, get the kids to school
on time, or keep a 9-to-5 job.

It’s important to note that this sleeping problem is more than just a
preference for staying up late or being a night owl.

People with delayed sleep phase disorder are unable to get to
sleep earlier than 2 to 6 a.m. no matter how hard they try.
They struggle to go to sleep and get up at socially acceptable
times.
When allowed to keep their own hours (such as during a
school break or holiday), they fall into a regular sleep
schedule.
Delayed sleep phase disorder is most common in teenagers,
and many teens will eventually grow out of it.
For those who continue to struggle with a biological clock
that is out of sync, treatments such as light therapy and
chronotherapy can help. To learn more, schedule an
appointment with a sleep doctor or local sleep clinic.

Self-help for sleeping problems and sleep
disorders

Learn more about the medical causes of sleep problems and
disorders.

Read Article by Harvard Health Publications

While some sleep disorders may require a visit to the sleep doctor,
you can improve many sleeping problems on your own. The first step
to overcoming a sleep problem is identifying and carefully tracking
your symptoms and sleep patterns.

Keep a sleep diary

A sleep diary is a very useful tool for identifying sleep disorders and
sleeping problems and pinpointing both day and nighttime habits that
may be contributing to your difficulties. Keeping a record of your
sleep patterns and problems will also prove helpful if you eventually
find it necessary to see a sleep doctor.

Download and print Helpguide’s sleep diary.

Your sleep diary should include:

what time you went to bed and woke up
total sleep hours and perceived quality of your sleep
a record of time you spent awake and what you did (―stayed
in bed with eyes closed,‖ for example, or ―got up, had a glass
of milk, and meditated.‖)
types and amount of food, liquids, caffeine, or alcohol you
consumed before bed, and times of consumption
your feelings and moods before bed (e.g. happiness, sadness,
stress, anxiety)
any drugs or medications taken, including dose and time of
consumption

The details can be important, revealing how certain behaviors can be
ruining your chance for a good night’s sleep. After keeping the diary
for a week, for example, you might notice that when you have more
than one glass of wine in the evening, you wake up during the night.

Improve your sleep hygiene and daytime habits

Learn to recognize & reduce hidden stress

Watch 4 min. video: Quick Stress Relief

Regardless of your sleep problems, a consistent sleep routine and
improved sleep habits will translate into better sleep over the long
term. You can address many common sleep problems through
lifestyle changes and improved sleep hygiene. For example, you may
find that when you start exercising regularly and managing your
stress more effectively, your sleep is much more refreshing. The key
is to experiment. Use your sleep diary as a jumping off point.

Try the following simple changes to your daytime and pre-bedtime
routine:

Keep a regular sleep schedule, going to sleep and getting up
at the same time each day, including the weekends.
Set aside enough time for sleep. Most people need at least 7
to 8 hours each night in order to feel good and be productive.
Make sure your bedroom is dark, cool, and quiet. Cover
electrical displays, use heavy curtains or shades to block light
from windows, or try an eye mask to shield your eyes.
Turn off your TV, smartphone, iPad, and computer a few

hours before your bedtime. The type of light these screens
emit can stimulate your brain, suppress the production of
melatonin, and interfere with your body’s internal clock.

Simple tips for better sleep

The cure to sleeping problems and daytime fatigue can often be
found in your daily routine. Making some simple lifestyle changes
can help ensure you get the sleep you need. Read Article

Do sleeping pills help sleep disorders and
sleeping problems?
When taken for a brief period of time and under the supervision of
your doctor, sleeping pills may help your sleeping problems.
However, they are just a temporary solution. Insomnia can’t be cured
with sleeping pills. In fact, sleeping pills can often make insomnia
worse in the long run.

In general, sleeping pills and sleep medications are most effective
when used sparingly for short-term situations, such as traveling
across many time zones or recovering from a medical procedure. If
medications are used over the long term, they are best used ―as
needed‖ instead of on a daily basis to avoid dependence and
tolerance.

Safety guidelines for sleeping pills

Only take a sleeping pill when you will have enough time to
get a full 7 to 8 hours of sleep. Otherwise, you may be
drowsy the next day.
Read the package insert that comes with your medication. Pay
careful attention to the potential side effects, dosage
instructions, and list of food and substances to avoid.
Never mix alcohol and sleeping pills. Alcohol disrupts sleep
and can interact dangerously with sleep medications.
Never drive a car or operate machinery after taking a sleeping
pill, especially when you first start taking a new sleep aid, as
you may not know how it will affect you.

To learn more, see Sleeping Pills, Sleep Aids and Medications:
What’s Best for You?

When to call a doctor about sleep disorders
If you’ve tried a variety of self-help sleep remedies without success,
schedule an appointment with a sleep specialist or ask your family
doctor for a referral to a sleep clinic, especially if:

Your main sleep problem is daytime sleepiness and self-help
hasn’t improved your symptoms.
You or your bed partner gasps, chokes, or stops breathing
during sleep.
You sometimes fall asleep at inappropriate times, such as
while talking, walking, or eating.

At your appointment, be prepared with information about your sleep
patterns and provide the sleep doctor with as much supporting
information as possible, including information from your sleep diary.

What to expect at a sleep clinic or center

If your physician refers you to a sleep center, the latest technology
will be used to monitor you while you sleep. A sleep specialist will
observe your sleep patterns, brain waves, heart rate, rapid eye
movements and more using monitoring devices attached to your
body. While sleeping with a bunch of wires attached to you might
seem difficult, most patients find they get used to it quickly.

The sleep specialist will analyze the results from your sleep study
and design a treatment program if necessary. A sleep center can also
provide you with equipment to monitor your activities (awake and
asleep) at home.

Related Links

How to Sleep Better
Tips for Getting a Good Night’s Sleep

How Much Sleep Do You Need?
Sleep Cycles & Stages, Lack of Sleep & Getting the Hours You

Need

More Helpguide Articles:

How to Stop Snoring: Cures, Remedies, and Tips For You
and Your Partner
Sleeping Pills, Sleep Aids, and Medications: What’s Best for
You?
Can't Sleep? Insomnia Causes, Cures, and Treatments
Sleeping Well As You Age: Helpful Sleep Tips for Seniors

Resources and references for sleep
disorders and sleeping problems
General information about sleep disorders and sleeping
problems

An Overview of Sleep Disorders – Guide to the symptoms and
treatment of common sleep disorders . Includes video clips from
sleep expert Dr. Lawrence Epstein. (Division of Sleep Medicine,
Harvard Medical School)

Sleep Disorders – Introduction to common sleep disorders and
sleeping problems, as well as sleep hygiene tips for combatting
insomnia. (Healthier You, UBM Medica)

Common Adult Sleep Problems/Disorders – Information on a
number of sleep disorders and treatment options. Learn what to
expect during an overnight sleep test at a sleep clinic or hospital.
(University of Maryland Medical Center)

Sleep problems in children – Discusses common sleep issues with
young children including babies, young children and teenagers.
(University of Michigan Health System)

Signs and symptoms of sleep disorders and sleeping
problems

Facts About Problem Sleepiness (PDF) – Downloadable fact sheet on
problem sleepiness, including its symptoms, causes, and link to
common sleep disorders. (National Heart, Lung, and Blood Institute,
National Institutes of Health)

Sleep Disorder Indicators – Series of questions to help you identify
whether you or a loved one is suffering from a sleep disorder.
(Columbus Community Health Regional Sleep Disorders Center)

Sleep clinics, centers, and sleep studies for treating sleep
disorders

Sleep Studies – Learn about the sleep tests and overnight sleep
studies that specialists use to diagnose sleep disorders. (American
Academy of Sleep Medicine)

View a Sleep Study – Take a photo-guided tour of the Stanford
University Sleep Disorders Clinic and learn what to expect from a
typical overnight sleep study at a sleep clinic. (Talk About Sleep,
Inc.)

Find a sleep center in the U.S.

The American Academy of Sleep Medicine provides a sleep center
locator with information on finding a sleep center near you.

Authors: Melinda Smith, M.A., Lawrence Robinson, and Robert
Segal, M.A. Last updated: September 2011.

© 2001-2011. All rights reserved. This reprint is for information and
support only and NOT a substitute for professional diagnosis and
treatment. Visit WWW.HELPGUIDE.ORG for more information
and related articles.

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Restlessness is a common side effect of the over-the-counter products that can be used as sleep aids
because the active ingredient is an antihistamine. I would advise making an appointment with your
doctor or health care provider for further evaluation, and advise them of the side effect you experience
with the OTC products. You may require prescription medication instead because they work differently
and are not antihistamines.

http://women.webmd.com/pharmacist-11/answers-sleep-restlessness

oes your child with ADHD toss and turn all night long? The reason might be a sleep disorder. In
a recent study, researchers said that about half the parents in the study said their child with
ADHD had difficulty sleeping. Parents reported that their child felt tired on awakening, had
nightmares, or had other sleep problems such as sleep apnea or restless legs syndrome. Another
study involving children with ADHD found the children had less refreshing sleep, difficulty
getting up, and significantly more daytime sleepiness.

Sleep problems and ADHD seem to go hand-in-hand. Let's find out why.

Is snoring related to ADHD?

Large tonsils and adenoids can partially block the airway at night. This can cause snoring, poor
sleep quality, and perhaps ADHD.

Because snoring can result in poor sleep, it may lead to attention problems the next day. A study
involving 5- to 7-year-olds found that snoring is significantly more common among children
with mild ADHD than it is in the general population. In another study, children who snored were
almost twice as likely as their peers to have ADHD.

Children who snore perform significantly worse on tests of attention, language abilities, and
overall intelligence.Some studies have shown that taking out the tonsils and adenoids may result
in better sleep and improved behavior without the need for medications.

What is sleep apnea?

In simplest terms, apnea literally means without breathing. The word is used to describe an
interruption of airflow of at least ten seconds. While there are three different kinds of apneas, the
most common type is obstructive. Obstructive apnea makes up 65 percent of all apneas.

During obstructive sleep apnea, there is no airflow from the nose and mouth to the lungs. This is
because the entrance to the trachea is completely blocked. The cause of the blockage is different
structures in the pharynx that have collapsed. During this closure the respiratory muscles
continue to make efforts to get air into the lungs.

People with sleep apnea have episodes of breathing cessation. They are aroused then from deep
sleep to lighter stages of sleep. But they have these arousals while remaining completely
unaware of the apneas or awakenings. These episodes can happen frequently throughout the
night.

About 2% of kids in the U.S. have some form of obstructed breathing during sleep. Enlarged
tonsils and adenoids are the most common causes of sleep apnea in children. But obesity and
chronic allergies can also be a cause. As with adults, children with sleep apnea will be tired
during the day. They may have problems concentrating and might have other symptoms related
to lack of sleep. For instance, they may display irritability.

How is sleep apnea diagnosed and treated?

Sleep apnea in children is treatable. Yet only your pediatrician or an ear, nose, and throat
specialist can determine whether your child's tonsils are enlarged enough to possibly block the
airway and cause sleep apnea. Confirmation of sleep apnea should be determined by a
polysomnogram. A polysomnogram is a sleep study that's done in a special laboratory. Not every
child with enlarged tonsils or with loud snoring has sleep apnea.

Surgery is the treatment of choice for kids with enlarged tonsils and adenoids. Other treatments
are available for those with restricted nighttime breathing due to allergies or other causes.

Further Reading:

Brain Scans Reveal ADHD Differences
Divorce More Likely in ADHD Families?
ADHD at 6, Alcoholic at 16?
10 ADHD Questions for Your Doctor
Attention Deficit Hyperactivity Disorder Treatment
Understanding the Basics of ADHD
Diagnosis and Treatment of ADHD
See All ADHD in Children Topics

ADHD and Sleep Disorders
(continued)

Is restless legs syndrome related to ADHD?

Studies show some correlation between sleep disruption and ADHD and restless legs syndrome
(RLS) and ADHD. With restless legs syndrome, there is a creeping, crawling sensation in the
legs and sometimes in the arms. This sensation creates an irresistible urge to move. Restless legs
syndrome causes sleep disruption and daytime sleepiness.

People with restless legs syndrome and subsequent sleep disruption tell of feeling inattentive,
moody, and/or hyperactive -- all symptoms of ADHD. Because of this and other findings, some
researchers believe that people with restless legs syndrome and a subset of people with ADHD
may have a common dysfunction in the neurotransmitter dopamine.

Restless legs syndrome is diagnosed with a polysomnogram or sleep study. Medications can help
both restless legs syndrome and ADHD.

How can I help my child with ADHD get the sleep he needs?

It's important to establish a bedtime ritual for children with ADHD. A regular bedtime regimen
will help your child relax and get the healthful sleep that's needed. Try these tips:

Meet with your doctor and discuss ADHD medications. Ask your doctor if you can give the
morning dose of ADHD medication earlier in the day. Or talk to your doctor about shorter-acting
medications. Find the right ADHD medication that lets your child relax at night and get healthy
sleep.
Be a "no caffeine" family.Watch for hidden caffeine in your child's diet. Caffeine is one of the
few food products that mimic the stress response. When it does, it increases nervousness and
causes sleepless nights. Keep caffeinated beverages and foods out of your kitchen.
Be consistent. Have a consistent, daily routine with specific bedtimes, waking times, meals, and
family times.
Make sure the child's room is sound attenuated.If your child is bothered by noises while
sleeping, try a "white noise" machine. Use one that produces a humming sound or turn the
radio to a station that has gone off air. Get ear plugs for kids who are extra sensitive to noise.
Avoid sleep medications. If medications are absolutely necessary, talk to your child's doctor
about safe and effective treatments.
Consider medical problems. Allergies, asthma, or conditions that cause pain can disrupt sleep. If
your child snores loudly and/or pauses in breathing, medical evaluation is necessary. Consult
your doctor for help with the possible medical causes of sleep problems.
See that your child gets plenty of exercise. Make sure your child gets daily exercise. But avoid
exercising right before bedtime. Studies show that regular exercise helps people sleep more
soundly.
Give your child a hot bath well before bedtime. Sleep usually follows the cooling phase of the
body's temperature cycle. After your child takes a bath, keep the temperature in your child's
bedroom cool to see if you can influence this phase.

Further Reading:

Brain Scans Reveal ADHD Differences
Divorce More Likely in ADHD Families?
ADHD at 6, Alcoholic at 16?
10 ADHD Questions for Your Doctor
Attention Deficit Hyperactivity Disorder Treatment
Understanding the Basics of ADHD
Diagnosis and Treatment of ADHD
See All ADHD in Children Topics

http://www.webmd.com/add-adhd/guide/adhd-sleep-disorders

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Sleep Disorders ▪ Fibro ▪ Mental
sleep Health
Definition ▪ sleep ▪
Disorder Insomnia
Sleep disorders are a group of syndromes characterized by disturbance in the
▪ Cures
patient's amount of sleep, quality or timing of sleep, or in behaviors or
Insomnia ▪ sleep
physiological conditions associated with sleep. There are about 70 different
sleeping Sweating
sleep disorders. To qualify for the diagnosis of sleep disorder, the condition
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must be a persistent problem, cause the patient significant emotional distress,
Apnea sleep
and interfere with his or her social or occupational functioning.
▪ sleep ▪

Although sleep is a basic behavior in animals as well as humans, researchers RemediesWomen
still do not completely understand all of its functions in maintaining health. In sleep
the past 30 years, however, laboratory studies on human volunteers have
yielded new information about the different types of sleep. Researchers have ?My Word List
learned about the cyclical patterns of different types of sleep and their
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relationships to breathing, heart rate, brain waves, and other physical
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functions. These measurements are obtained by a technique called
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Stage 1 NREM sleep. This stage occurs while a person is falling asleep.
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It represents about 5% of a normal adult's sleep time.
Stage 2 NREM sleep. In this stage, (the beginning of "true" sleep), the
person's electroencephalogram (EEG) will show distinctive wave forms
called sleep spindles and K complexes. About 50% of sleep time is stage
2 REM sleep.
Stages 3 and 4 NREM sleep. Also called delta or slow wave sleep, these
are the deepest levels of human sleep and represent 10-20% of sleep
time. They usually occur during the first 30-50% of the sleeping period.
REM sleep. REM sleep accounts for 20-25% of total sleep time. It
usually begins about 90 minutes after the person falls asleep, an
important measure called REM latency. It alternates with NREM sleep
about every hour and a half throughout the night. REM periods
increase in length over the course of the night.

Sleep cycles vary with a person's age. Children and adolescents have longer
periods of stage 3 and stage 4 NREM sleep than do middle aged or elderly
adults. Because of this difference, the doctor will need to take a patient's age
into account when evaluating a sleep disorder. Total REM sleep also declines
with age.
The average length of nighttime sleep varies among people. Most people sleep
between seven and nine hours a night. This population average appears to be
constant throughout the world. In temperate climates, however, people often
notice that sleep time varies with the seasons. It is not unusual for people in
North America and Europe to sleep about 40 minutes longer per night during
the winter.

Description

Sleep disorders are classified based on what causes them. Primary sleep

disorders are distinguished from those that are not caused by other mental
disorders, prescription medications, substance abuse, or medical conditions.
The two major categories of primary sleep disorders are the dyssomnias and
the parasomnias.

Dyssomnias
Dyssomnias are primary sleep disorders in which the patient suffers from
changes in the amount, restfulness, and timing of sleep. The most important
dyssomnia is primary insomnia, which is defined as difficulty in falling asleep or
remaining asleep that lasts for at least one month. It is estimated that 35% of
adults in the United States experience insomnia during any given year, but the
number of these adults who are experiencing true primary insomnia is
unknown. Primary insomnia can be caused by a traumatic event related to
sleep or bedtime, and it is often associated with increased physical or
psychological arousal at night. People who experience primary insomnia are
often anxious about not being able to sleep. The person may then associate all
sleep-related things (their bed, bedtime, etc.) with frustration, making the
problem worse. The person then becomes more stressed about not sleeping.
Primary insomnia usually begins when the person is a young adult or in middle
age.

Hypersomnia is a condition marked by excessive sleepiness during normal
waking hours. The patient has either lengthy episodes of daytime sleep or
episodes of daytime sleep on a daily basis even though he or she is sleeping
normally at night. In some cases, patients with primary hypersomnia have
difficulty waking in the morning and may appear confused or angry. This
condition is sometimes called sleep drunkenness and is more common in
males. The number of people with primary hypersomnia is unknown, although
5-10% of patients in sleep disorder clinics have the disorder. Primary
hypersomnia usually affects young adults between the ages of 15 and 30.

Nocturnal myoclonus and restless legs syndrome (RLS) can cause either
insomnia or hypersomnia in adults. Patients with nocturnal myoclonus wake up
because of cramps or twitches in the calves. These patients feel sleepy the next
day. Nocturnal myoclonus is sometimes called periodic limb movement
disorder (PLMD). RLS patients have a crawly or aching feeling in their calves
that can be relieved by moving or rubbing the legs. RLS often prevents the
patient from falling asleep until the early hours of the morning, when the
condition is less intense.

Kleine-Levin syndrome is a recurrent form of hypersomnia that affects a person
three or four times a year. Doctors do not know the cause of this syndrome. It
is marked by two to three days of sleeping 18-20 hours per day, hypersexual

behavior, compulsive eating, and irritability. Men are three times more likely
than women to have the syndrome. Currently, there is no cure for this
disorder.

Narcolepsy is a dyssomnia characterized by recurrent "sleep attacks" that the
patient cannot fight. The sleep attacks are about 10-20 minutes long. The
patient feels refreshed by the sleep, but typically feels sleepy again several
hours later. Narcolepsy has three major symptoms in addition to sleep attacks:
cataplexy, hallucinations, and sleep paralysis. Cataplexy is the sudden loss of
muscle tone and stability ("drop attacks"). Hallucinations may occur just before
falling asleep (hypnagogic) or right after waking up (hypnopompic) and are
associated with an episode of REM sleep. Sleep paralysis occurs during the
transition from being asleep to waking up. About 40% of patients with
narcolepsy have or have had another mental disorder. Although narcolepsy is
often regarded as an adult disorder, it has been reported in children as young
as three years old. Almost 18% of patients with narcolepsy are 10 years old or
younger. It is estimated that 0.02-0.16% of the general population suffer from
narcolepsy. Men and women are equally affected.

Breathing-related sleep disorders are syndromes in which the patient's sleep is
interrupted by problems with his or her breathing. There are three types of
breathing-related sleep disorders:

Obstructive sleep apnea syndrome. This is the most common form of
breathing-related sleep disorder, marked by episodes of blockage in
the upper airway during sleep. It is found primarily in obese people.
Patients with this disorder typically alternate between periods of
snoring or gasping (when their airway is partly open) and periods of
silence (when their airway is blocked). Very loud snoring is a clue to
this disorder.
Central sleep apnea syndrome. This disorder is primarily found in
elderly patients with heart or neurological conditions that affect their
ability to breathe properly. It is not associated with airway blockage
and may be related to brain disease.
Central alveolar hypoventilation syndrome. This disorder is found most
often in extremely obese people. The patient's airway is not blocked,
but his or her blood oxygen level is too low.
Mixed-type sleep apnea syndrome. This disorder combines symptoms
of both obstructive and central sleep apnea.

Circadian rhythm sleep disorders are dyssomnias resulting from a discrepancy
between the person's daily sleep/wake patterns and demands of social
activities, shift work, or travel. The term circadian comes from a Latin word
meaning daily. There are three circadian rhythm sleep disorders. Delayed sleep
phase type is characterized by going to bed and arising later than most people.

Jet lag type is caused by travel to a new time zone. Shift work type is caused by
the schedule of a person's job. People who are ordinarily early risers appear to
be more vulnerable to jet lag and shift work-related circadian rhythm disorders
than people who are "night owls." There are some patients who do not fit the
pattern of these three disorders and appear to be the opposite of the delayed
sleep phase type. These patients have an advanced sleep phase pattern and
cannot stay awake in the evening, but wake up on their own in the early
morning.
PARASOMNIAS. Parasomnias are primary sleep disorders in which the patient's
behavior is affected by specific sleep stages or transitions between sleeping
and waking. They are sometimes described as disorders of physiological
arousal during sleep.

Nightmare disorder is a parasomnia in which the patient is repeatedly
awakened from sleep by frightening dreams and is fully alert on awakening.
The actual rate of occurrence of nightmare disorder is unknown.
Approximately 10-50% of children between three and five years old have
nightmares. They occur during REM sleep, usually in the second half of the
night. The child is usually able to remember the content of the nightmare and
may be afraid to go back to sleep. More females than males have this disorder,
but it is not known whether the sex difference reflects a difference in
occurrence or a difference in reporting. Nightmare disorder is most likely to
occur in children or adults under severe or traumatic stress.

Sleep terror disorder is a parasomnia in which the patient awakens screaming
or crying. The patient also has physical signs of arousal, like sweating, shaking,
etc. It is sometimes referred to as pavor nocturnus. Unlike nightmares, sleep
terrors typically occur in stage 3 or stage 4 NREM sleep during the first third of
the night. The patient may be confused or disoriented for several minutes and
cannot recall the content of the dream. He or she may fall asleep again and not
remember the episode the next morning. Sleep terror disorder is most
common in children four to 12 years old and is outgrown in adolescence. It
affects about 3% of children. Fewer than 1% of adults have the disorder. In
adults, it usually begins between the ages of 20 and 30. In children, more males
than females have the disorder. In adults, men and women are equally
affected.

Sleepwalking disorder, which is sometimes called somnambulism, occurs when
the patient is capable of complex movements during sleep, including walking.
Like sleep terror disorder, sleepwalking occurs during stage 3 and stage 4
NREM sleep during the first part of the night. If the patient is awakened during
a sleepwalking episode, he or she may be disoriented and have no memory of
the behavior. In addition to walking around, patients with sleepwalking

disorder have been reported to eat, use the bathroom, unlock doors, or talk to
others. It is estimated that 10-30% of children have at least one episode of
sleepwalking. However, only 1-5% meet the criteria for sleepwalking disorder.
The disorder is most common in children eight to 12 years old. It is unusual for
sleepwalking to occur for the first time in adults.

Unlike sleepwalking, REM sleep behavior disorder occurs later in the night and
the patient can remember what they were dreaming. The physical activities of
the patient are often violent.

Sleep disorders related to other conditions
In addition to the primary sleep disorders, there are three categories of sleep
disorders that are caused by or related to substance use or other physical or
mental disorders.

SLEEP DISORDERS RELATED TO MENTAL DISORDERS. Many mental disorders,
especially depression or one of the anxiety disorders, can cause sleep
disturbances. Psychiatric disorders are the most common cause of chronic
insomnia.

SLEEP DISORDERS DUE TO MEDICAL CONDITIONS. Some patients with chronic
neurological conditions like Parkinson's disease or Huntington's disease may
develop sleep disorders. Sleep disorders have also been associated with viral
encephalitis, brain disease, and hypo- or hyperthyroidism.

SUBSTANCE-INDUCED SLEEP DISORDERS. The use of drugs, alcohol, and
caffeine frequently produces disturbances in sleep patterns. Alcohol abuse is
associated with insomnia. The person may initially feel sleepy after drinking,
but wakes up or sleeps fitfully during the second half of the night. Alcohol can
also increase the severity of breathing-related sleep disorders. With
amphetamines or cocaine, the patient typically suffers from insomnia during
drug use and hypersomnia during drug withdrawal. Opioids usually make short-
term users sleepy. However, long-term users develop tolerance and may suffer
from insomnia.

In addition to alcohol and drugs that are abused, a variety of prescription
medications can affect sleep patterns. These medications include
antihistamines, corticosteroids, asthma medicines, and drugs that affect the
central nervous system.

Sleep disorders in children and adolescents
Pediatricians estimate that 20-30% of children have difficulties with sleep that
are serious enough to disturb their families. Although sleepwalking and night
terror disorder occur more frequently in children than in adults, children can

also suffer from narcolepsy and sleep apnea syndrome.

Causes and symptoms

The causes of sleep disorders have already been discussed with respect to the
classification of these disorders.

The most important symptoms of sleep disorders are insomnia and sleepiness
during waking hours. Insomnia is by far the more common of the two
symptoms. It covers a number of different patterns of sleep disturbance. These
patterns include inability to fall asleep at bedtime, repeated awakening during
the night, and/or inability to go back to sleep once awakened.

Diagnosis

Diagnosis of sleep disorders usually requires a psychological history as well as a
medical history. With the exception of sleep apnea syndromes, physical
examinations are not usually revealing. The patient's sex and age are useful
starting points in assessing the problem. The doctor may also talk to other
family members in order to obtain information about the patient's symptoms.
The family's observations are particularly important to evaluate sleepwalking,
kicking in bed, snoring loudly, or other behaviors that the patient cannot
remember.

Sleep logs
Many doctors ask patients to keep a sleep diary or sleep log for a minimum of
one to two weeks in order to evaluate the severity and characteristics of the
sleep disturbance. The patient records medications taken as well as the length
of time spent in bed, the quality of the sleep, and similar information. Some
sleep logs are designed to indicate circadian sleep patterns as well as simple
duration or restfulness of sleep.

Psychological testing
The doctor may use psychological tests or inventories to evaluate insomnia
because it is frequently associated with mood or affective disorders. The
Minnesota Multiphasic Personality Inventory (MMPI), the Millon Clinical
Multiaxial Inventory (MCMI), the Beck Depression Inventory, and the Zung
Depression Scale are the tests most commonly used in evaluating this
symptom.

SELF-REPORT TESTS. The Epworth Sleepiness Scale, a self-rating form recently
developed in Australia, consists of eight questions used to assess daytime
sleepiness. Scores range from 0-24, with scores higher than 16 indicating

severe daytime sleepiness.

Laboratory studies
If the doctor is considering breathing-related sleep disorders, myoclonus, or
narcolepsy as possible diagnoses, he or she may ask the patient to be tested in
a sleep laboratory or at home with portable instruments.

POLYSOMNOGRAPHY. Polysomnography can be used to help diagnose sleep
disorders as well as conduct research into sleep. In some cases the patient is
tested in a special sleep laboratory. The advantage of this testing is the
availability and expertise of trained technologists, but it is expensive. As of
2001, however, portable equipment is available for home recording of certain
specific physiological functions.

MULTIPLE SLEEP LATENCY TEST (MSLT). The multiple sleep latency test (MSLT)
is frequently used to measure the severity of the patient's daytime sleepiness.
The test measures sleep latency (the speed with which the patient falls asleep)
during a series of planned naps during the day. The test also measures the
amount of REM sleep that occurs. Two or more episodes of REM sleep under
these conditions indicates narcolepsy. This test can also be used to help
diagnose primary hypersomnia.

REPEATED TEST OF SUSTAINED WAKEFULNESS (RTSW). The repeated test of
sustained wakefulness (RTSW) is a test that measures sleep latency by
challenging the patient's ability to stay awake. In the RTSW, the patient is
placed in a quiet room with dim lighting and is asked to stay awake. As with the
MSLT, the testing pattern is repeated at intervals during the day.

Treatment

Treatment for a sleep disorder depends on what is causing the disorder. For
example, if major depression is the cause of insomnia, then treatment of the
depression with antidepressants should resolve the insomnia.

Medications
Sedative or hypnotic medications are generally recommended only for
insomnia related to a temporary stress (like surgery or grief) because of the
potential for addiction or overdose. Trazodone, a sedating antidepressant, is
often used for chronic insomnia that does not respond to other treatments.
Sleep medications may also cause problems for elderly patients because of
possible interactions with their other prescription medications. Among the
safer hypnotic agents are lorazepam, temazepam, and zolpidem. Chloral
hydrate is often preferred for short-term treatment in elderly patients because
of its mildness. Short-term treatment is recommended because this drug may

be habit forming.

Narcolepsy is treated with stimulants such as dextroamphetamine sulfate or
methylphenidate. Nocturnal myoclonus has been successfully treated with
clonazepam.

Children with sleep terror disorder or sleepwalking are usually treated with
benzodiazepines because this type of medication suppresses stage 3 and stage
4 NREM sleep.

Psychotherapy
Psychotherapy is recommended for patients with sleep disorders associated
with other mental disorders. In many cases the patient's scores on the Beck or
Zung inventories will suggest the appropriate direction of treatment.

Sleep education
"Sleep hygiene" or sleep education for sleep disorders often includes
instructing the patient in methods to enhance sleep. Patients are advised to:

wait until he or she is sleepy before going to bed
avoid using the bedroom for work, reading, or watching television
get up at the same time every morning no matter how much or how
little he or she slept
avoid smoking and avoid drinking liquids with caffeine
get some physical exercise early in the day every day
limit fluid intake after dinner; in particular, avoid alcohol because it
frequently causes interrupted sleep
learn to meditate or practice relaxation techniques
avoid tossing and turning in bed; instead, he or she should get up and
listen to relaxing music or read

Lifestyle changes
Patients with sleep apnea or hypopnea are encouraged to stop smoking, avoid
alcohol or drugs of abuse, and lose weight in order to improve the stability of
the upper airway.

In some cases, patients with sleep disorders related to jet lag or shift work may
need to change employment or travel patterns. Patients may need to avoid
rapid changes in shifts at work.

Children with nightmare disorder may benefit from limits on television or
movies. Violent scenes or frightening science fiction stories appear to influence
the frequency and intensity of children's nightmares.

Surgery
Although making a surgical opening into the windpipe (a tracheostomy) for

sleep apnea or hypopnea in adults is a treatment of last resort, it is occasionally
performed if the patient's disorder is life threatening and cannot be treated by
other methods. In children and adolescents, surgical removal of the tonsils and
adenoids is a fairly common and successful treatment for sleep apnea. Most
sleep apnea patients are treated with continuous positive airway pressure
(CPAP). Sometimes an oral prosthesis is used for mild sleep apnea.

Alternative treatment

Some alternative approaches may be effective in treating insomnia caused by
anxiety or emotional stress. Meditation practice, breathing exercises, and yoga
can break the vicious cycle of sleeplessness, worry about inability to sleep, and
further sleeplessness for some people. Yoga can help some people to relax
muscular tension in a direct fashion. The breathing exercises and meditation
can keep some patients from obsessing about sleep.

Homeopathic practitioners recommend that people with chronic insomnia see
a professional homeopath. They do, however, prescribe specific remedies for
at-home treatment of temporary insomnia: Nux vomica for alcohol or
substance-related insomnia, Ignatia for insomnia caused by grief, Arsenicum
for insomnia caused by fear or anxiety, and Passiflora for insomnia related to
mental stress.

Melatonin has also been used as an alternative treatment for sleep disorders.
Melatonin is produced in the body by the pineal gland at the base of the brain.
This substance is thought to be related to the body's circadian rhythms.

Key terms

Apnea — The temporary absence of breathing. Sleep apnea consists of
repeated episodes of temporary suspension of breathing during sleep.

Cataplexy — Sudden loss of muscle tone (often causing a person to fall),
usually triggered by intense emotion. It is regarded as a diagnostic sign of
narcolepsy.

Circadian rhythm — Any body rhythm that recurs in 24-hour cycles. The sleep-
wake cycle is an example of a circadian rhythm.

Dyssomnia — A primary sleep disorder in which the patient suffers from
changes in the quantity, quality, or timing of sleep.

Electroencephalogram (EEG) — The record obtained by a device that measures
electrical impulses in the brain.

Hypersomnia — An abnormal increase of 25% or more in time spent sleeping.
Patients usually have excessive daytime sleepiness.

Hypnotic — A medication that makes a person sleep.

Hypopnea — Shallow or excessively slow breathing usually caused by partial
closure of the upper airway during sleep, leading to disruption of sleep.

Insomnia — Difficulty in falling asleep or remaining asleep.

Jet lag — A temporary disruption of the body's sleep-wake rhythm following
high-speed air travel across several time zones. Jet lag is most severe in people
who have crossed eight or more time zones in 24 hours.

Kleine-Levin syndrome — A disorder that occurs primarily in young males,
three or four times a year. The syndrome is marked by episodes of
hypersomnia, hypersexual behavior, and excessive eating.

Narcolepsy — A life-long sleep disorder marked by four symptoms: sudden
brief sleep attacks, cataplexy, temporary paralysis, and hallucinations. The
hallucinations are associated with falling asleep or the transition from sleeping
to waking.

Nocturnal myoclonus — A disorder in which the patient is awakened
repeatedly during the night by cramps or twitches in the calf muscles.
Nocturnal myoclonus is sometimes called periodic limb movement disorder
(PLMD).

Non-rapid eye movement (NREM) sleep — A type of sleep that differs from
rapid eye movement (REM) sleep. The four stages of NREM sleep account for
75-80% of total sleeping time.

Parasomnia — A primary sleep disorder in which the person's physiology or
behaviors are affected by sleep, the sleep stage, or the transition from sleeping
to waking.

Pavor nocturnus — Another term for sleep terror disorder.

Polysomnography — Laboratory measurement of a patient's basic
physiological processes during sleep. Polysomnography usually measures eye
movement, brain waves, and muscular tension.

Primary sleep disorder — A sleep disorder that cannot be attributed to a
medical condition, another mental disorder, or prescription medications or
other substances.

Rapid eye movement (REM) sleep — A phase of sleep during which the
person's eyes move rapidly beneath the lids. It accounts for 20-25% of sleep
time. Dreaming occurs during REM sleep.

REM latency — After a person falls asleep, the amount of time it takes for the
first onset of REM sleep.

Restless legs syndrome (RLS) — A disorder in which the patient experiences
crawling, aching, or other disagreeable sensations in the calves that can be
relieved by movement. RLS is a frequent cause of difficulty falling asleep at
night.

Sedative — A medication given to calm agitated patients; sometimes used as a
synonym for hypnotic.

Sleep latency — The amount of time that it takes to fall asleep. Sleep latency is
measured in minutes and is important in diagnosing depression.

Somnambulism — Another term for sleepwalking.

Practitioners of Chinese medicine usually treat insomnia as a symptom of
excess yang energy. Cinnabar is recommended for chronic nightmares. Either
magnetic magnetite or "dragon bones" is recommended for insomnia
associated with hysteria or fear. If the insomnia appears to be associated with
excess yang energy arising from the liver, the practitioner will give the patient
oyster shells. Acupuncture treatments can help bring about balance and
facilitate sleep.

Dietary changes like eliminating stimulant foods (coffee, cola, chocolate) and
late-night meals or snacks can be effective in treating some sleep disorders.
Nutritional supplementation with magnesium, as well as botanical medicines
that calm the nervous system, can also be helpful. Among the botanical
remedies that may be effective for sleep disorders are valerian (Valeriana
officinalis), passionflower (Passiflora incarnata), and skullcap (Scutellaria
lateriflora).

Prognosis

The prognosis depends on the specific disorder. Children usually outgrow sleep
disorders. Patients with Kleine-Levin syndrome usually get better around age
40. Narcolepsy is a life-long disorder. The prognosis for sleep disorders related
to other conditions depends on successful treatment of the substance abuse,
medical condition, or other mental disorder. The prognosis for primary sleep
disorders is affected by many things, including the patient's age, sex,

occupation, personality characteristics, family circumstances, neighborhood
environment, and similar factors.

Resources

Books
Moe, Paul G., and Alan R. Seay. "Neurologic & Muscular Disorders: Sleep
Disorders." In Current Pediatric Diagnosis & Treatment, edited by William W.
Hay Jr., et al. Stamford: Appleton & Lange, 1997.

Gale Encyclopedia of Medicine. Copyright 2008 The Gale Group, Inc. All rights
reserved.

disorder /dis·or·der/ (dis-or´der) a derangement or abnormality of function; a
morbid physical or mental state.

acute stress disorder an anxiety disorder characterized by development of
anxiety, dissociative, and other symptoms within one month following
exposure to an extremely traumatic event. If persistent, it may become
posttraumatic stress disorder.

adjustment disorder maladaptive reaction to identifiable stress (e.g., divorce,
illness), which is assumed to remit when the stress ceases or when the patient
adapts.

affective disorders mood d's.

amnestic disorders mental disorders characterized by acquired impairment in
the ability to learn and recall new information, sometimes accompanied by
inability to recall previously learned information.

anxiety disorders mental disorders in which anxiety and avoidance behavior
predominate, i.e., panic disorder, agoraphobia, social phobia, specific phobia,
obsessive-compulsive disorder, posttraumatic stress disorder, acute stress
disorder, generalized anxiety disorder, and substance-induced anxiety disorder.

attention-deficit/hyperactivity disorder a controversial childhood mental
disorder with onset before age seven, and characterized by inattention (e.g.,
distractibility, forgetfulness, not appearing to listen), by hyperactivity and
impulsivity (e.g., restlessness, excessive running or climbing, excessive talking,
and other disruptive behavior), or by a combination of both types of behavior.

autistic disorder autism; a severe pervasive developmental disorder with
onset usually before three years of age and a biological basis; it is characterized
by qualitative impairment in reciprocal social interaction, verbal and nonverbal
communication, and capacity for symbolic play, by restricted and unusual
repertoire of activities and interests, and often by cognitive impairment.

behavior disorder conduct d.

binge-eating disorder an eating disorder characterized by repeated episodes
of binge eating, as in bulimia nervosa, but not followed by inappropriate
compensatory behavior such as purging, fasting, or excessive exercise.

bipolar disorders mood disorders with a history of manic, mixed, or
hypomanic episodes, usually with present or previous history of one or more
major depressive episodes; included are bipolar I d., characterized by one or
more manic or mixed episodes, bipolar II d., characterized by one or more
hypomanic episodes but no manic episodes, and cyclothymic disorder. The
term is sometimes used in the singular to denote either bipolar I disorder,
bipolar II disorder, or both.

body dysmorphic disorder a somatoform disorder characterized by a normal-
looking person's preoccupation with an imagined defect in appearance.

breathing-related sleep disorder any of several disorders characterized by
sleep disruption due to some sleep-related breathing problem, resulting in
excessive sleepiness or insomnia.

brief psychotic disorder an episode of psychotic symptoms with sudden onset,
lasting less than one month.

catatonic disorder catatonia due to the physiological effects of a general
medical condition and neither better accounted for by another mental disorder
nor occurring exclusively during delirium.

character disorders personality d's.

childhood disintegrative disorder pervasive developmental disorder
characterized by marked regression in various developmental skills, including
language, play, and social and motor skills, after two to ten years of initial
normal development.

circadian rhythm sleep disorder a lack of synchrony between the schedule of
sleeping and waking required by the external environment and that of a
person's own circadian rhythm.

collagen disorder an inborn error of metabolism involving abnormal structure
or metabolism of collagen, e.g., Marfan syndrome, cutis laxa. Cf. collagen
disease.

communication disorders mental disorders characterized by difficulties with
speech or language, severe enough to interfere academically, occupationally,
or socially.

conduct disorder a type of disruptive behavior disorder of childhood and
adolescence marked by persistent violation of the rights of others or of age-
appropriate societal norms or rules.

conversion disorder a somatoform disorder characterized by conversion
symptoms (loss or alteration of voluntary motor or sensory functioning
suggesting physical illness) with no physiological basis and not produced
intentionally or feigned; a psychological basis is suggested by exacerbation of
symptoms during psychological stress, relief from tension (primary gain), or
gain of outside support or attention (secondary gains).

cyclothymic disorder a mood disorder characterized by alternating cycles of
hypomanic and depressive periods with symptoms like those of manic and
major depressive episodes but of lesser severity.

delusional disorder a mental disorder marked by well-organized, logically
consistent delusions of grandeur, persecution, or jealousy, with no other
psychotic feature. There are six types: persecutory, jealous, erotomanic,
somatic, grandiose, and mixed.

depersonalization disorder a dissociative disorder characterized by intense,
prolonged, or otherwise troubling feelings of detachment from one's body or
thoughts, not secondary to another mental disorder.

depressive disorders mood disorders in which depression is unaccompanied
by manic or hypomanic episodes.

developmental coordination disorder problematic or delayed development of
gross and fine motor coordination skills, not due to a neurological disorder or
to general mental retardation, resulting in the appearance of clumsiness.

disruptive behavior disorders a group of mental disorders of children and
adolescents consisting of behavior that violates social norms and is disruptive.

dissociative disorders mental disorders characterized by sudden, temporary
alterations in identity, memory, or consciousness, segregating normally
integrated parts of one's personality from one's dominant identity.

dissociative identity disorder a dissociative disorder characterized by the
existence in an individual of two or more distinct personalities, with at least
two of the personalities controlling the patient's behavior in turns. The host
personality usually is totally unaware of the alternate personalities; alternate
personalities may or may not have awareness of the others.

dream anxiety disorder nightmare d.

dysthymic disorder a mood disorder characterized by depressed feeling, loss
of interest or pleasure in one's usual activities, and other symptoms typical of
depression but tending to be longer in duration and less severe than in major
depressive disorder.

eating disorder abnormal feeding habits associated with psychological factors,
including anorexia nervosa, bulimia nervosa, pica, and rumination disorder.

expressive language disorder a communication disorder occurring in children
and characterized by problems with the expression of language, either oral or
signed.

factitious disorder a mental disorder characterized by repeated, intentional
simulation of physical or psychological signs and symptoms of illness for no
apparent purpose other than obtaining treatment.

factitious disorder by proxy a form of factitious disorder in which one person
(usually a mother) intentionally fabricates or induces physical (Munchausen
syndrome by proxy) or psychological disorders in another person under their
care (usually their child) and subjects that person to needless diagnostic
procedures or treatment, without any external incentives for the behavior.

female orgasmic disorder consistently delayed or absent orgasm in a female,
even after a normal phase of sexual excitement and adequate stimulation.

female sexual arousal disorder a sexual dysfunction involving failure by a
female either to attain or maintain lubrication and swelling during sexual
activity, after adequate stimulation.

functional disorder a disorder of physiological function having no known
organic basis.

gender identity disorder a disturbance of gender identification in which the
affected person has an overwhelming desire to change their anatomic sex or
insists that they are of the opposite sex, with persistent discomfort about their
assigned sex or about filling its usual gender role.

generalized anxiety disorder (GAD) an anxiety disorder characterized by
excessive, uncontrollable worry about two or more life circumstances for six
months or more.

hypoactive sexual desire disorder a sexual dysfunction consisting of
persistently or recurrently low level or absence of sexual fantasies and desire
for sexual activity.

impulse control disorders a group of mental disorders characterized by
repeated failure to resist an impulse to perform some act harmful to oneself or
to others.

induced psychotic disorder shared psychotic d.

intermittent explosive disorder an impulse control disorder characterized by
multiple discrete episodes of loss of control of aggressive impulses resulting in
serious assault or destruction of property that are out of proportion to any
precipitating stressors.

learning disorders a group of disorders characterized by academic functioning
that is substantially below the level expected on the basis of the patient's age,
intelligence, and education.

lymphoproliferative disorders a group of malignant neoplasms arising from
cells related to the common multipotential lymphoreticular cell, including
lymphocytic, histiocytic, and monocytic leukemias, multiple myeloma,
plasmacytoma, and Hodgkin's disease.

lymphoreticular disorders a group of disorders of the lymphoreticular system,
characterized by the proliferation of lymphocytes or lymphoid tissues.

major depressive disorder a mood disorder characterized by the occurrence
of one or more major depressive episodes and the absence of any history of
manic, mixed, or hypomanic episodes.

male erectile disorder a sexual dysfunction involving failure by a male to
attain or maintain an adequate erection until completion of sexual relations.

male orgasmic disorder consistently delayed or absent orgasm in a male, even
after a normal phase of sexual excitement and stimulation adequate for his
age.

manic-depressive disorder former name for a mood disorder now known as
bipolar I d. or bipolar II d. and often called bipolar d. (q.v.).

mendelian disorder a genetic disease showing a mendelian pattern of

inheritance, caused by a single mutation in the structure of DNA, which causes
a single basic defect with pathologic consequences.

mental disorder any clinically significant behavioral or psychological syndrome
characterized by the presence of distressing symptoms, impairment of
functioning, or significantly increased risk of suffering death, pain, or other
disability.

minor depressive disorder a mood disorder closely resembling major
depressive disorder and dysthymic disorder but intermediate in severity
between the two.

mixed receptive-expressive language disorder a communication disorder
involving both the expression and the comprehension of language, either
spoken or signed.

monogenic disorder mendelian d.

mood disorders mental disorders characterized by disturbances of mood
manifested as one or more episodes of mania, hypomania, depression, or
some combination, the two main subcategories being bipolar disorders and
depressive disorders.

motor skills disorder any disorder characterized by inadequate development
of motor coordination severe enough to restrict locomotion or the ability to
perform tasks, schoolwork, or other activities.

multifactorial disorder one caused by the interaction of genetic and
sometimes also nongenetic, environmental factors, e.g., diabetes mellitus.

multiple personality disorder dissociative identity d.

myeloproliferative disorders a group of usually neoplastic diseases possibly
related histogenetically, including granulocytic leukemias, myelomonocytic
leukemias, polycythemia vera, and myelofibroerythroleukemia.

neurotic disorder neurosis.

nightmare disorder repeated episodes of nightmares that awaken the sleeper,
with full orientation and alertness and vivid recall of the dreams.

obsessive-compulsive disorder (OCD) an anxiety disorder characterized by
recurrent obsessions or compulsions, which are severe enough to interfere
significantly with personal or social functioning. Cf. obsessive-compulsive
personality disorder, under personality .

obsessive-compulsive personality disorder see under personality.

oppositional defiant disorder a type of disruptive behavior disorder
characterized by a recurrent pattern of defiant, hostile, disobedient, and
negativistic behavior directed toward those in authority.

organic mental disorder a term formerly used to denote any mental disorder
with a specifically known or presumed organic etiology. It was sometimes used
synonymously with organic mental syndrome.

orgasmic disorders sexual dysfunctions characterized by inhibited or
premature orgasm; see female orgasmic d., male orgasmic d., and premature
ejaculation.

pain disorder a somatoform disorder characterized by a chief complaint of
severe chronic pain which is neither feigned nor intentionally produced, but in
which psychological factors appear to play a major role in onset, severity,
exacerbation, or maintenance.

panic disorder an anxiety disorder characterized by attacks of panic (anxiety),
fear, or terror, by feelings of unreality, or by fears of dying, or losing control,
together with somatic signs such as dyspnea, choking, palpitations, dizziness,
vertigo, flushing or pallor, and sweating. It may occur with or, rarely, without
agoraphobia.

paranoid disorder older term for delusional d.

personality disorders a category of mental disorders characterized by
enduring, inflexible, and maladaptive personality traits that deviate markedly
from cultural expectations and either generate subjective distress or
significantly impair functioning. For specific disorders, see under personality.

pervasive developmental disorders disorders in which there is impaired
development in multiple areas, including reciprocal social interactions, verbal
and nonverbal communications, and imaginative activity, as in autistic
disorder.

phagocytic dysfunction disorders a group of immunodeficiency conditions
characterized by disordered phagocytic activity, occurring as both extrinsic and
intrinsic types. Bacterial or fungal infections may range from mild skin infection
to fatal systemic infection.

phobic disorders see phobia.

phonological disorder a communication disorder characterized by failure to

use age- and dialect-appropriate sounds in speaking, with errors occurring in
the selection, production, or articulation of sounds.

plasma cell disorders see under dyscrasia.

postconcussional disorder see under syndrome.

posttraumatic stress disorder (PTSD) an anxiety disorder caused by an
intensely traumatic event, characterized by mentally reexperiencing the
trauma, avoidance of trauma-associated stimuli, numbing of emotional
responsiveness, and hyperalertness and difficulty in sleeping, remembering, or
concentrating.

premenstrual dysphoric disorder premenstrual syndrome viewed as a
psychiatric disorder.

psychoactive substance use disorders substance use d's.

psychosomatic disorder one in which the physical symptoms are caused or
exacerbated by psychological factors, as in migraine headaches, lower back
pain, or irritable bowel syndrome.

psychotic disorder psychosis.

reactive attachment disorder a mental disorder of infancy or early childhood
characterized by notably unusual and developmentally inappropriate social
relatedness, usually associated with grossly pathological care.

rumination disorder excessive rumination of food by infants, after a period of
normal eating habits, potentially leading to death by malnutrition.

schizoaffective disorder a mental disorder in which symptoms of a mood
disorder occur along with prominent psychotic symptoms characteristic of
schizophrenia.

schizophreniform disorder a mental disorder with the signs and symptoms of
schizophrenia but of less than six months' duration.

seasonal affective disorder (SAD) depression with fatigue, lethargy,
oversleeping, overeating, and carbohydrate craving recurring cyclically during
specific seasons, most commonly the winter months.

separation anxiety disorder prolonged, developmentally inappropriate,
excessive anxiety and distress in a child concerning removal from parents,
home, or familiar surroundings.

sexual disorders

1. any disorders involving sexual functioning, desire, or performance.

2. specifically, any such disorder that is caused at least in part by psychological
factors; divided into sexual dysfunctions and paraphilias.

sexual arousal disorders sexual dysfunctions characterized by alterations in
sexual arousal; see female sexual arousal d. and male erectile d.

sexual aversion disorder feelings of repugnance for and active avoidance of
genital sexual contact with a partner, causing substantial distress or
interpersonal difficulty.

sexual desire disorders sexual dysfunctions characterized by alteration in
sexual desire; see hypoactive sexual desire d. and sexual aversion d.

sexual pain disorders sexual dysfunctions characterized by pain associated
with intercourse; it includes dyspareunia and vaginismus not due to a general
medical condition.

shared psychotic disorder a delusional system that develops in one or more
persons as a result of a close relationship with someone who already has a
psychotic disorder with prominent delusions.

sleep disorders chronic disorders involving sleep, either primary (dyssomnias,
parasomnias) or secondary to factors including a general medical condition,
mental disorder, or substance use.

sleep terror disorder a sleep disorder of repeated episodes of pavor
nocturnus.

sleepwalking disorder a sleep disorder of the parasomnia group, consisting of
repeated episodes of somnambulism.

social anxiety disorder social phobia.

somatization disorder a somatoform disorder characterized by multiple
somatic complaints, including a combination of pain, gastrointestinal, sexual,
and neurological symptoms, and not fully explainable by any known general
medical condition or the direct effect of a substance, but not intentionally
feigned or produced.

somatoform disorders mental disorders characterized by symptoms
suggesting physical disorders of psychogenic origin but not under voluntary
control, e.g., body dysmorphic disorder, conversion disorder, hypochondriasis,
pain disorder, somatization disorder, and undifferentiated somatoform
disorder.

somatoform pain disorder pain d.

speech disorder defective ability to speak; it may be either psychogenic (see
communication d. ) or neurogenic. See also aphasia, aphonia, dysphasia, and
dysphonia.

stereotypic movement disorder a mental disorder characterized by repetitive
nonfunctional motor behavior that often appears to be driven and can result in
serious self-inflicted injuries.

substance-induced disorders a subgroup of the substance-related disorders
comprising a variety of behavioral or psychological anomalies resulting from
ingestion of or exposure to a drug of abuse, medication, or toxin. Cf. substance
use d's.

substance-related disorders any of the mental disorders associated with
excessive use of or exposure to psychoactive substances, including drugs of
abuse, medications, and toxins. The group is divided into substance use d's and
substance-induced d's .

substance use disorders a subgroup of the substance-related disorders, in
which psychoactive substance use or abuse repeatedly results in significantly
adverse consequences. The group comprises substance abuse and substance
dependence.

undifferentiated somatoform disorder one or more physical complaints, not
intentionally produced or feigned and persisting for at least six months, that
cannot be fully explained by a general medical condition or the direct effects of
a substance.

unipolar disorders depressive d's.

Dorland's Medical Dictionary for Health Consumers. © 2007 by Saunders, an
imprint of Elsevier, Inc. All rights reserved.

sleep [slēp]

a period of rest for the body and mind, during which volition and CONSCIOUSNESS
are in partial or complete abeyance and the bodily functions partially
suspended. Sleep has also been described as a behavioral state marked by
characteristic immobile posture and diminished but readily reversible
sensitivity to external stimuli.

NREM AND REM SLEEP. Prior to the discovery and reporting of rapid eye
movements during sleep, it was thought that sleep was a single state of passive
recuperation in which the central nervous system was deactivated. Studies
concerned with the measurement of central and autonomic activities during
sleep have led to its division into two types: non–rapid eye movement (NREM)
sleep, also called orthodox or synchronized (S) sleep; and rapid eye movement
(REM) sleep (so called because of the rapid eye movements during this stage),
also called paradoxical or desynchronized (D) sleep.

On the basis of electroencephalographic (EEG) criteria, NREM sleep is
subdivided into four stages. Stage 1 is observed immediately after sleep begins
or after momentary arousals and is characterized by low-voltage, mixed-
frequency EEG tracing, with predominantly theta-wave activity (four to seven
hertz, that is, cycles per second). Stage 2 is characterized by intermittent waves
of 12 to 16 hertz, known as sleep spindles.Stages 3 and 4 consist of relatively
high voltage EEG tracings with a predominance of delta wave activity (one to
two hertz).

The EEG patterns of NREM sleep suggest that this is the kind of apparently
restful state that supports the recuperative functions assigned to sleep. NREM
sleep is increased after physical activity and has a relatively high priority among
humans in the recovery sleep following extended periods of wakefulness.

Within 90 minutes after sleep begins, an adult progresses through all four
stages of NREM sleep and then proceeds into the first of a series of REM
periods of sleep. Brief cycles of about 10 to 30 minutes of REM sleep recur
throughout the night, alternating with various stages of NREM sleep. With each
cycle, NREM sleep decreases and REM sleep increases so that by the end of the
night most of the sleep is REM sleep, which is when dreams occur. While
everyone dreams every night, many do not remember dreaming; most people
are aware, however, that they dream more just before rising.

In addition to the rapid eye movements that can be observed through closed
eyelids, REM sleep can be recognized by complete relaxation of the lower jaw.
Convulsions, myocardial infarction, and cardiac arrhythmias are more likely to
occur during REM sleep. This is probably because of increased autonomic
activity, irregular pulse, and fluctuations in blood pressure, which are all typical
of REM sleep.
PATTERNS OF SLEEP. Although the average adult spends approximately 25 percent
of total accumulated sleep in REM sleep and 75 percent in NREM sleep, the
cyclic changes vary with individuals. The pattern of sleep, in addition to the
REM and NREM states, also includes the periods of sleep and wakefulness

within a 24-hour period.

Factors affecting the total sleep pattern include age, state of physical health,
psychological state, and certain drugs. Newborns follow a pattern of several
hours of sleep followed by a period of wakefulness. REM sleep occurs at the
onset of sleep in infants; it rarely does in adults. As the child matures there is
an increasing tendency toward longer periods of nocturnal sleep. Elderly
persons sometimes return to the shorter periods of sleep that are typical of
infants.

BENEFITS OF SLEEP. Sleep requirements vary greatly among individuals. Infants
usually require 16 to 20 hours of total sleep during a 24-hour period, and the
amount decreases as the child matures. An adult usually requires 6 to 9 hours
of total sleep, and requirements continue to decrease with aging.

Most theorists agree that sleep has value as a recuperative and adaptive
function in the lives of humans. The relatively high metabolic needs of
mammals and birds to maintain a constant body temperature in a wide range
of environmental temperatures suggests that the periodic decreases in
metabolic rate and body temperature that occur in NREM sleep allow for
recuperation and restitution of body tissues. For example, even though the
function of stage 2 NREM sleep is not clear, approximately half of human sleep
time is spent in this stage. It is also theorized that REM sleep provides a period
of recuperation of mental activities and preparation for wakefulness. During
REM sleep it is believed that there is increased metabolic activity in the brain
so that during waking hours it is more receptive to new information and can
assimilate it more easily.

sleep apnea syndrome episodes of APNEA (cessation of breathing) occurring at
the transition from NREM to REM sleep, with repeated wakening and excessive
daytime sleepiness; it occurs most often in middle-aged, obese males and is
thought to have several causes, one being collapse or obstruction of the airway
with the inhibition of muscle tone that characterizes REM sleep. The condition
is arbitrarily defined as more than five cessations of airflow for at least 10
seconds each per hour of sleep.

sleep disorders chronic disorders involving sleep; primary sleep disorders are
classified as DYSSOMNIAS or PARASOMNIAS. Among the minor disorders are
SLEEPWALKING, SLEEPTALKING, ENURESIS, BRUXISM (tooth grinding), and NIGHTMARES.

Sleepwalking is not considered serious if it occasionally occurs in childhood. It
should be considered pathological, however, if it persists into adulthood.
Sleeptalking is common to many persons and, while it may annoy others whose
sleep it may disturb, it is not considered pathological.

A sleep disorder occurring in early childhood, and not to be confused with
nightmares, is SLEEP TERROR DISORDER. The child awakens with a scream, is in
panic and cannot be consoled, and often is incoherent; the following morning,
there is poor recall of the event. Treatment usually involves reassurance of the
parents. Adults who experience night terrors often have some psychological
problem requiring treatment. More serious disorders of sleep include
persistent INSOMNIA, NARCOLEPSY, and chronic HYPERSOMNIA. Hypersomnia can
occur with central nervous system damage or may be secondary to some
physical and mental illnesses, particularly depression.

sleep terror disorder a sleep disorder of the parasomnia group, consisting of
repeated episodes of pavor nocturnus (sleep terrors).

Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied
Health, Seventh Edition. © 2003 by Saunders, an imprint of Elsevier, Inc. All
rights reserved.

sleep

a period of rest during which volition and consciousness are in partial or
complete abeyance and the bodily functions partially suspended; a behavioral
state marked by characteristic immobile posture and diminished but readily
reversible sensitivity to external stimuli.

sleep deprivation

caused in animals by constant stimulation, e.g. preventing them from lying
down, is followed by a compensatory period of prolonged sleep whenever the
opportunity arises.

sleep disorders

see narcolepsy, cataplexy.

put to sleep

a common euphemism for euthanasia.

rapid eye movement sleep

that type of sleep characterized by low voltage but fast
electroencephalographic activity and little muscular activity except of the
ocular muscles. Believed to be the critical or necessary component of sleep.
Called also 'sleep of the body' and paradoxical sleep. Called also REM.

Saunders Comprehensive Veterinary Dictionary, 3 ed. © 2007 Elsevier, Inc. All
rights reserved

sleep disorders

Neurology Any disruptive pattern of sleep Categories (1) Difficulty with falling
or staying asleep–insomnias; (2) falling asleep at inappropriate times; (3)
excessive total sleep time; (4) abnormal behaviors associated with sleep. See
Insomnia, Pseudoinsomnia, Sleep apnea syndrome. Cf Shift work.

Sleep disorders

Insomnias Difficulty in initiating and maintaining sleep

Hypersomnias Disorder of excessive somnolence–eg, narcolepsy, sleep
deprivation and obstructive sleep apnea

Disorders of sleep-wake schedule–eg jet lag and shift work

Dysfunctions associated with sleep, sleep stages or partial arousal–eg night
terrors and enuresis

McGraw-Hill Concise Dictionary of Modern Medicine. © 2002 by The
McGraw-Hill Companies, Inc.

Patient discussion about sleep disorders.

Q. is there anything i can do to help me get to sleep at night?
Sincerely, Ashley Nicole Cross shipp i mean to be alittle bit more
specific i have my thoughts at night everywhere and i was just wondering
is this normal or is just me

A. melatonine, helps you relax and go to sleep

Q. I dont want to take sleeping pills but how do I fix this!? I have
been sleeping on and off for a long time. I have taken sleeping pills once
because I really needed the sleep, but I have just been letting it happen
because I dont want to become addicted to sleeping pills. My mind
doesnt stop! I toss and turn, sleep an hour, lie awake another... Some way
to help this without medicine?! Please and thank you.

A. There is Valerian (it can be strong)also Hops (a potpori) bag under your
pillow ,if it is hot or where your pain if you have it Liac is good to spray under
the covers ,I don't know if their is a law again yet Kava Kava (look for high
Kavalectones)is verty relaxing ,I figure if someone found out it can relax people
it will be made illegal .With Valerian mix Hops and Peppermint leaves and
flowers (Peppermint is for your stomach also) I worked when I was 16 for Dr
Wu a very old Chinese Herbalogist he would travel to the patients
house,because each person is differebnt with different needs . I do know yoga
is wonderful and it got my wifes figure b ack for her after babies ,many
Healthfood Stores have experts in Herbalogy and other things that will help
you sleep ,but be it a pill from the Doc or the inocuous herbal tea try not to use
every night and if your Doc is worth (his or her ,I have 9 specialist ,therapist
NPs I see and all are women and I have the best health care I ever had

Q. My grandma passed away a month ago and since then my
grandpa has been drinking himself to sleep every night I know it’s his
way of grieving, but I am very worried about him. Right now he doesn’t
stop drinking because he doesn’t want to, but if this will go on for a
while, can’t it happen that when he will want to stop he won’t be able to?
Is it at all possible to become an alcoholic at the age of 83? I mean are
there even rehabs for seniors?

A. everyones grieving period is different,try getting all the family involved in
supporting him to quit,get him out of the alot more,find him a
hobby,something that will take his mind off things,get him to talk about his
feelings,every little thing can help.

Read more or ask a question about sleep disorders

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? Mentioned in ? References in periodicals archive

dyssomnia parasomnia This is why it is so important to try and raise
insomnia Primary sleep disorder awareness about sleep disorders so that more
people can learn to diagnose the problem before it is
too late.

Information About Sleep Disorder by alleysmith /
Health, general community

What are the common sleep disorders Work at night
?

Can Sleep Disorder Affect Your Mental Health? by
Semul Johnson / Food/cooking/nutrition community

Cleveland Clinic's "Top 10 Medical Innovations"
features a wide range of new techniques and
therapies that are being developed to treat
everything from deafness and Parkison's disease to
pneumonia and sleep disorders.

Whole-slide imaging a "Top 10" innovation by
Medical Laboratory Observer

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