Sleep Disorders

Screening for sleep disorders, such as insomnia, narcolepsy, restless legs syndrome (RLS) and sleep apnea, involves participating in a sleep study using surveillance systems to monitor sleep duration and quality. You might also complete a questionnaire that asks the following questions:

• On average, how many hours of sleep do you get in a 24-hour period?
• Over the past two weeks, how many days have you had trouble falling asleep or staying asleep? 
• Over the past two weeks, how many days did you unintentionally fall asleep during the day?
• Have you ever been told that you snore loudly?
• Has anyone ever observed that you stop breathing during your sleep?

Signs of sleep disorders are disrupted sleep, an irregular wake cycle and general sleep challenges (falling asleep and staying asleep). Sleep-disordered individuals appear sleepy and unrested during the day.

Those with insomnia awaken several hours early and are unable to resume sleeping. Difficulty initiating or maintaining sleep may often manifest itself as excessive daytime sleepiness, which characteristically results in functional impairment throughout the day.

Excessive daytime sleepiness (including episodes of irresistible sleepiness) combined with sudden muscle weakness are the hallmark signs of narcolepsy. The sudden muscle weakness seen in narcolepsy may be elicited by strong emotion or surprise. Episodes of narcolepsy have been described as “sleep attacks” and may occur in unusual circumstances, such as walking and other forms of physical activity.

Restless leg syndrome (RLS) is characterized by an unpleasant “creeping” sensation, often feeling like it is originating in the lower legs, but often associated with aches and pains throughout the legs. This often causes difficulty initiating sleep and is relieved by movement of the leg, such as walking or kicking.

Snoring may be more than just an annoying habit—it may be a sign of sleep apnea. Persons with sleep apnea characteristically make periodic gasping or “snorting” noises, during which their sleep is momentarily interrupted. Those with sleep apnea may also experience excessive daytime sleepiness, as their sleep is commonly interrupted and may not feel restorative.

In addition to conducting a physical exam, your physician will review your medical and sleep histories. You might also complete a questionnaire that asks the following questions:

• On average, how many hours of sleep do you get in a 24-hour period?
• Over the past two weeks, how many days have you had trouble falling asleep or staying asleep? 
• Over the past two weeks, how many days did you unintentionally fall asleep during the day?
• Have you ever been told that you snore loudly?
• Has anyone ever observed that you stop breathing during your sleep?

Screening for sleep disorders, such as insomnia, narcolepsy, restless legs syndrome (RLS) and sleep apnea involves participating in a sleep study using surveillance systems to monitor sleep duration and quality. By using electrodes connected to your body, sleep studies monitor your whole system during a full night’s sleep, collecting the following data:

• Breathing rate
• Blood pressure
• Heart rate
• Changes in brain waves
• Eye movements
• Electrical activity of the heart and muscles

You can take steps to improve your sleep habits. First, make sure that you give yourself enough time to sleep. With enough sleep each night, you may find that you’re happier and more productive during the day.

To improve your sleep habits, it also may help to:

• Make your bedroom sleep-friendly. Sleep in a cool, quiet, dark place. Avoid watching TV or looking at electronic devices, as the light from these sources can disrupt your sleep-wake cycle.
• Go to sleep and wake up around the same time each day, even on the weekends. If you can, avoid night shifts, a schedule that changes, or other things that may disrupt your sleep schedule. This can be challenging for new parents or shift workers. 
• Avoid caffeine, nicotine and alcohol close to your bedtime. Although alcohol can make it easier to fall asleep, it can cause you to have a sleep that tends to be lighter than normal. This makes it more likely that you will wake up during the night.
• Get regular physical activity during the daytime (at least five to six hours before going to bed). Exercising close to bedtime can make it harder to fall asleep.
• Avoid naps, especially in the afternoon. This may help you sleep longer at night.
• Eat meals on a regular schedule and avoid late-night dinners.
• Limit the amount of fluids you drink close to bedtime. This may help you sleep longer without having to use the bathroom.
• Learn new ways to manage stress. Follow a routine that helps you wind down and relax before bed. For example, read a book, listen to soothing music or take a hot bath. Your healthcare provider may also recommend other ways to relax, including massage therapy, meditation or yoga. 
• Talk to your healthcare provider about over-the-counter and prescription medicines that may be disrupting your sleep (for example, some cold and allergy medicines).

Light therapy involves sitting in front of a light box, which produces bright light similar to sunlight. Light visors and light glasses may also be effective. Light therapy may help adjust the amount of melatonin your body needs to make to reset your sleep-wake cycle.

To move your sleep and wake times earlier, use the light box when you wake up in the morning. This may also help reduce daytime sleepiness. This method may be used to help treat delayed sleep-wake phase disorder, irregular sleep-wake rhythm disorder and jet lag disorder when you travel east.

To move your sleep and wake times later, use the light box late in the afternoon or early in the evening. This method may be used to help treat advanced sleep-wake phase disorder, shift work disorder and jet lag disorder when you travel west.

Side effects of light therapy may include agitation, eye strain, headaches, migraines and nausea. Ask your healthcare provider before using light therapy if you have an eye condition or use medicines that make you sensitive to light.

Exercises for your mouth and facial muscles, also called orofacial therapy, may help treat sleep apnea in children and adults. This therapy helps improve the position of your tongue and strengthens the muscles that control your lips, tongue, upper airway and face.

CBT-I is a six- to eight-week treatment plan to help you learn how to fall asleep faster and stay asleep longer. This is usually recommended as the first treatment option for long-term insomnia and can be very effective. CBT-I can be done by a healthcare provider, nurse or therapist; you can do it in person, by telephone or online. It involves the following parts:

• Cognitive therapy helps you feel less nervous about not being able to sleep.
• Relaxation or meditation therapy teaches you how to relax and fall asleep faster.
• Sleep education helps you learn good sleep habits.
• Sleep restriction therapy gives you a specific amount of time to spend in bed, even if you are not able to sleep during this time. With time, this helps you sleep better when you go to bed. Your sleep time can be increased when you start to sleep better.
• Stimulus control therapy helps you have a regular sleep-wake cycle so you can link being in bed with being asleep. This involves going to bed only when you are sleepy, getting out of bed if you cannot sleep, and using your bed only for sleep and sexual activity.

If you are having trouble falling asleep or staying asleep, and improving your sleep habits and other therapies have not helped, your healthcare provider may talk to you about medicines to help you sleep. Many of these medicines have side effects and should not be taken long term.

Some prescription medicines used to treat other health conditions can also increase your risk of developing sleep conditions.

• Benzodiazepine receptor agonists are medicines such as zolpidem, zaleplon and eszopiclone. Side effects may include anxiety. Rare side effects may include having a severe allergic reaction or doing activities while asleep such as walking, eating or driving.
• Melatonin receptor agonists are medicines such as ramelteon. Side effects can include dizziness and fatigue. Some people experience the rare side effects of doing activities while they are asleep, like walking, eating or driving, or they may have a severe allergic reaction.
• Orexin receptor antagonists such as suvorexant are not recommended for people who have narcolepsy. Rare side effects may include doing activities while asleep such as walking, eating or driving, or not being able to move or speak for several minutes while going to sleep or waking up.
• Benzodiazepines may be prescribed for insomnia if other treatments and medicines have not worked. Talk to your healthcare provider about the side effects of these medicines, which can include dizziness, confusion and muscle weakness. Benzodiazepines can also interact dangerously with other medicines. They can be habit-forming and should be taken for only a few weeks.

Tell your healthcare provider about any over-the-counter (OTC) products that you are taking.

• OTC products that contain antihistamines are sold as sleep aids. Although these products might make you sleepy, talk to your provider before taking them, as antihistamines can be unsafe for some people.
• Melatonin supplements are lab-made versions of the sleep hormone melatonin. Many people take melatonin supplements to improve their sleep. These supplements are not regulated by the U.S. Food and Drug Administration like medicines. Because of this, the doses and purity of these supplements can vary between brands. Talk with your provider about how to find safe, effective melatonin supplements, and also about possible side effects or medicine interactions, especially if you are pregnant or trying to become pregnant. Side effects of melatonin may include excess sleepiness, headaches, high blood pressure, low blood pressure, stomach upsets and worsening symptoms of depression.
• Dietary supplements may help you sleep, but they can also have health risks. Talk to your healthcare provider before using dietary supplements.

The U.S. Food and Drug Administration (FDA) regulates dietary supplements under a different set of regulations than those covering "conventional" foods and medicines. The FDA does not currently review dietary supplement products for safety and effectiveness before they are marketed.

Some people with sleep conditions, like narcolepsy, need to take medicine to help them stay awake during the day. Sometimes, people can use caffeine to help promote wakefulness, but other times, prescription medicine is required.

• Stimulants, or wakefulness-promoting agents, can help with daytime alertness. The effects of these medicines may last only for a short time, and you may still experience some sleepiness.
• Depressants, such as sodium oxybate, treat daytime sleepiness and cataplexy, the sudden loss of voluntary muscle control. Side effects can include bedwetting, headache and dizziness.

Continuous positive airway pressure (CPAP) is a device that uses mild air pressure to keep your airways open while you sleep. A CPAP machine includes a mask that fits over your nose or your nose and mouth with straps that position the mask. It also includes a tube that connects the mask to the machine’s motor and a motor that blows air into the tube.

For the treatment to work, you should use your CPAP machine every time you sleep, including during naps. You should also take your CPAP machine with you when you travel. It will take some time and patience to get used to your CPAP machine.

Oral devices are devices that you wear in your mouth while you sleep. These are often custom-made by a dentist or orthodontist (a dentist who specializes in correcting teeth or jaw problems) to fit your mouth or jaw. Oral devices hold your jaw or tongue in a position that helps keep your airway open. You may need an oral device if you have mild sleep apnea or if your apnea happens only when you are lying on your back. If you have sleep apnea, your doctor may prescribe an oral device if you do not want to use CPAP or cannot tolerate CPAP.

There are two types of oral devices that work differently to open the upper airway while you sleep. Some hybrid devices have features of both types.

• Mandibular advancement devices cover the upper and lower teeth and hold the jaw in a position that prevents it from blocking the upper airway.
• Tongue-retaining devices are mouthpieces that hold the tongue in a forward position to prevent it from blocking the upper airway.

A new type of oral device was recently approved by the FDA for use while awake. The device delivers electrical muscle stimulation through a removable mouthpiece that sits around the tongue. You wear the mouthpiece once a day for 20 minutes at a time, for six weeks. The device stimulates the tongue muscle while awake to help prevent the tongue from collapsing backward and obstructing the airway during sleep.

Your dentist or orthodontist will make sure your device is comfortable and teach you how to use it to get the best results.

For the treatment of sleep apnea, if a CPAP or other oral devices do not work, you may need surgery.

• Adenotonsillectomy surgery removes the tonsils and adenoids.
• Surgery to place an implant may help monitor your breathing patterns and control certain muscles that open your airways during sleep. Other types of implants, called nerve stimulators, can help control your tongue muscles while you sleep. This helps prevent your tongue from blocking your airway.
• Surgery to remove some soft tissue from your mouth and throat can make your upper airway bigger.
• A maxillary or jaw advancement surgery moves your upper jaw (maxilla) and lower jaw (mandible) forward. This helps make your upper airway bigger.