Your Health A-Z

Sleep disorders

Normal sleep is when people achieve a state of inactivity and are unaware of their environment. It is usually uninterrupted and assists to rejuvenate the mind, but sleep disorders alter sleep patterns and behaviours, commonly leading to additional neurological conditions. Sleep disorders can be identified by assessing any possible symptoms a patient may be suffering, causing interrupted or unfulfilling sleep that leaves them feeling fatigued or unrested.

Alternative names

Insomnia, hypersomnia, sleep apnea, restless leg syndrome, narcolepsy, circadian rhythm sleep disorders, REM sleep behaviour disorders.

Symptoms

Patients may experience any of the following symptoms:

  • Difficulty falling/staying asleep
  • Snoring
  • Fatigue/feeling sleepy during the day
  • Waking up early
  • Irritability
  • Slow reaction times
  • Difficulty concentrating
  • Feeling fatigued even after a full night’s sleep
  • Halted breathing while sleeping
  • Choking/gasping during sleep
  • Anxiety
  • A sense of decreased energy
  • Cataplexy (sudden loss of muscle function)
  • Sleep paralysis
  • Vivid and often frightening hallucinations
  • Increased energy during the evening

Possible causes

Sleep disorders can result from any of the following:

  • Anxiety
  • Stress
  • Depression or other anxiety disorders
  • Certain medication
  • Medical conditions like high blood pressure or Parkinson’s disease
  • Pain
  • Ageing
  • Life stresses (for instance, a new baby, illness, or death of a loved one)
  • Anatomical abnormalities (upper airway)

Home care/self-treatment

People with a sleep disorder can manage the condition themselves by taking the necessary steps. These include:

  • Exercise/losing excess weight;
  • Sleeping on their sides rather than their backs; and
  • Avoiding sleeping pills.

When to see a doctor

Consult your GP if you believe you are experiencing irregular sleep patterns, particularly if they result in you waking up early or if you do not get enough sleep.

What to expect

Depending on what condition a patient is diagnosed with, the following tests may be performed:

  • Insomnia Your doctor would perform physical and mental health examinations, taking medical and sleep history into consideration. The following tests would then be performed:
    • Sleep diary – sleep patterns are monitored and noted for several weeks. This allows the patient and the doctor to better understand the patient’s sleeping patterns.
    • Epworth sleepiness scale – a questionnaire used to gauge daytime tiredness.
    • Actigraphy – a small, wrist-worn device that measures movements and is used to assess sleep-wake patterns over time.
  • Sleep apnea Your doctor may recommend taking a test at a sleep disorders centre. You would be assigned to a private room at a sleep centre or hospital on the night of your sleep study. Tests and equipment used include:
    • Electroencephalogram (EEG) – used to measure and record brain wave activity.
    • Electromyogram (EMG) – used to measure muscle activity. It is also performed to ascertain the presence of the REM sleep stage.
    • Electro-oculogram (EOG) – used to record eye movements.
    • Electrocardiogram (ECG) – used to measure heart rate/rhythm.
    • Nasal airflow sensor – used to record airflow.
    • Snore microphone – used to measure snoring activity.
  • Restless legs syndrome Diagnosing restless leg syndrome is not a simple procedure. Your GP will ask about your family’s health history, noting if any family members have previously been diagnosed with this syndrome. Presence of other disorders like insomnia would be acknowledged as well.
  • Narcolepsy Diagnosing narcolepsy requires several tests, the two most essential of which are a polysomnogram (PSG) and a multiple sleep latency test (MSLT). Patients suffering from narcolepsy would be subjected to a clinical examination that takes medical history into account. Specific, specialised tests would also be performed at a sleep clinic. The following tests would also be performed:
    • Epworth sleepiness scale.
    • Sleep studies administration of the MSLT and PSG tests performed in a sleep disorders centre.
  • Hypersomnia Diagnosing hypersomnia involves questioning a patient about their sleeping habits, whether they may be suffering from any emotional trauma or if they take any medication that seems to be altering their sleep patterns. The following tests may also be performed:
    • Blood tests to determine whether the patient suffers from anaemia or a faulty thyroid gland.
    • Computed tomography (CT) or MRI scans to determine whether the patient suffers from multiple sclerosis.
    • PSG to determine the cause of the sleep disorder.
    • EEG to measure and record brain wave activity.
  • Circadian rhythm disorder After assessing the patient’s immediate health through a physical examination, the following tests are performed:
    • Sleep logs are used to determine the patient’s sleep-wake cycles in their normal environment. The use of a sleep diary is also encouraged.
    • Sleep studies are performed in a sleep lab, where patients are monitored while they sleep at night and during the day.
    • Epworth sleepiness scale.
    • Actigraphy.
  • REM sleep behaviour disorder (RBD) Diagnosis is administered through the application of several tests. These include:
    • Neurologic examination – a common method used to diagnose RBD.
    • EEG – used to measure and record brain wave activity.
    • ECG – used to measure heart rate/rhythm
    • EMG – used to measure muscle activity. It is also performed to ascertain the presence of the REM sleep stage.
    • Electro-oculogram – performed to monitor eye movement.

Treatment

Lifestyle and bedtime surrounding changes would be the most immediate measures patients can make. Behavioural therapies may also be conducted, such as:

  • Reconditioning: a method that teaches a patient to associate a bed with sleep and sexual activity only. It also involves educating the patient to sleep at night only, and to avoid taking daytime naps.
  • Sleep restriction: a method that allows only a few hours of sleep per night but gradually extends the total amount of sleep over time.
  • Relaxation therapy: techniques similar to yoga that relax muscles and mind.
  • Neurobiofeedback: Training the brain to generate more optimal frequencies.

Over-the-counter sleeping medication and herbal products like chamomile or valerian may promote sleep. Other therapies like relaxation therapy and cognitive behavioural therapy (CBT) are also used to treat sleep disorders. Support groups are also recommended, particularly for patients suffering from narcolepsy.

The information provided in this article was correct at the time of publishing. At Mediclinic we endeavour to provide our patients and readers with accurate and reliable information, which is why we continually review and update our content. However, due to the dynamic nature of clinical information and medicine, some information may from time to time become outdated prior to revision.

In the interest of our patients, in accordance with SA law and our commitment to expertise, Mediclinic cannot subscribe to the practice of online diagnosis. Please consult a medical professional for specific medical advice. If you have any major concerns, please see your doctor for an assessment. If you have any cause for concern, your GP will be able to direct you to the appropriate specialists.