Common causes of sleep disorders Changes in life style, such as shift work change (SWC), can contribute to sleep disorders.

Other problems that can affect sleep:

  • Anxiety
  • Back pain
  • Chronic pain
  • Sciatica
  • Neck pain
  • Environmental noise
  • Incontinence
  • Various drugs - Many drugs can affect the ratio of the various stages of sleep, thus affecting the overall quality of sleep. Poor sleep can lead to accumulation of Sleep debt.
  • Endocrine imbalance mainly due to Cortisol but not limited to this hormone. Hormone changes due to impending menstruation or during the menopause transition years.
  • Chronobiological disorders, mainly Circadian rhythm disorders
A sleep diary can be used to help diagnose, and measure improvements in, sleep disorders. The Epworth Sleepiness Scale and the Morningness-Eveningness Questionnaire[1] (MEQ) by Horne and Östberg are other useful diagnostic tools.

According to Dr. William Dement, of the Stanford Sleep Center, anyone who snores and has daytime drowsiness should be evaluated for sleep disorders.

Any time back pain or another form of chronic pain is present, both the pain and the sleep problems should be treated simultaneously, as pain can lead to sleep problems and vice versa.

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What is a sleep disorder?     A sleep disorder interferes with one’s ability to sleep normally. For many people, it is a chronic, nightly problem that can affect daytime behavior. Activities at work and school and relations with loved ones can be affected. A sleep disorder can worsen existing medical conditions, and it can also lead to new medical problems.

What are the symptoms of sleep disorders?     If you experience one or more of these symptoms, discuss your sleeping problems or concerns with your healthcare provider:

  • Excessive sleepiness or fatigue during the day.
  • Difficulty sleeping, including trouble falling asleep, waking frequently during the night, waking too early not being able to fall back asleep, or waking unrefreshed.
  • Loud snoring.
  • Pauses in breathing or gasping for breath during sleep, as reported by others.
  • Difficulty concentrating or memory problems.
  • Irritability or depression.
  • Morning headaches.
  • Nighttime leg discomfort or movement of your arms or legs while sleeping.
  • Weakness or loss of muscle strength, often in response to a strong emotion.
  • Sleepwalking or sleep talking.
  • Hypertension, or high blood pressure.
What are the most common sleep disorders?
  • Circadian Sleep Disorders
  • Excessive Sleepiness
  • Insomnia
  • Narcolepsy
  • Obstructive Sleep Apnea
  • Parasomnias
  • Periodic Limb Movement Disorder
  • Restless Legs Syndrome
    Do you think you might have a sleep disorder?

Circadian Sleep Disorders     Circadian sleep disorders are disorders of the timing of sleep and wakefulness. We all have an internal “clock.” This “clock” controls our rhythm of sleeping and wakefulness. There are times of the day when we are most alert. This is often mid-morning and early evening. And, there are times when we are more likely to be sleepy – like during early to mid-afternoon and late evening. One’s environment impacts this rhythm, and may either complement or disrupt our internal clock.

    Excessive sleepiness can develop when our sleep rhythm is altered. We may want to sleep during times when we need to remain awake. On the other hand, insomnia  occurs when we want to sleep at a time when our rhythm is to stay awake.

Disorders that are related to changes in the normal sleep-wake pattern include:

  • Advanced Sleep-Phase
  • Delayed Sleep-Phase
  • Irregular Sleep-Wake Pattern
  • Jet Lag
  • Shift Work Sleep Disorder
Advanced Sleep-Phase     This is a shift in nighttime sleep to a time earlier than the desired bedtime. Arising time the next morning is also earlier than desired. Bedtime often occurs between 6 pm and 9 pm Arising time often occurs between 1 am and 3 am.

Delayed Sleep-Phase     The usual nighttime sleep period occurs later than the desired bedtime. These “night owls” are unable to sleep until the early morning hours. They don’t arise until late morning to early afternoon.

Irregular Sleep-Wake Pattern     Sleep and wake times are disordered. Three or more naps replace the major nighttime sleep. The timing of sleep and wake activities are erratic. Evening insomnia and daytime sleepiness  are common symptoms.

Jet Lag     After rapid travel across many time zones, our internal clock remains fixed to our home time zone. It may take a few days for the internal clock to adjust to the new time zone. For example, the advanced bedtime after an eastward flight may result in trouble falling asleep at a ‘normal time’. On the other hand, westward flights result in a delay in nighttime sleep. It also results in increased awakenings during the early morning hours. Luckily for the traveler, sleep tends to improve after two to three days.

Shift Work Sleep Disorder     Large numbers of people in this country perform shift work. Excessive sleepiness and insomnia may develop when people work outside the 8am to 5pm shift. Sleepiness and decreased concentration is common if one must work at night. A shift work sleep disorder poses a major hazard in the workplace.

Excessive Sleepiness Why should I worry about feeling tired during my day?     Excessive sleepiness becomes a problem when the person cannot stay awake and alert long enough to complete daily tasks. Sleep occurs during the day. Excessive sleepiness is different from fatigue or physical tiredness.

    Excessive sleepiness may increase the risk of car, work, or home accidents. It may also cause poor school or work performance. Memory problems and changes in behavior can also occur.

What causes excessive sleepiness?     Chronic lack of sleep is a common cause of excessive sleepiness. It is important to get enough sleep. Getting enough sleep each night will help you maintain normal alertness and performance while awake.

    A person may allow plenty of time for sleep, but sleep time can be interrupted by sleep apnea  or periodic limb movements .

    A simple disturbance of the body clock can cause excessive sleepiness. This occurs because the timing of wakefulness and sleep is altered. Two examples are jet lag or shift work.

    Medicines can cause excessive sleepiness. Medicines that sedate as a side-effect can cause this. The routine use of sedating or opioid pain medicines may also cause excessive sleepiness. This is more likely to occur if large doses or long-acting medicines are taken during the night. Excessive sleepiness may occur if stimulant medicines are quickly stopped. Speak to your doctor if you are concerned that your medicines may be causing excessive sleepiness.

    Excessive sleepiness occurs with sleep disorders such as narcolepsy and circadian rhythm disorders .

Are some types of excessive sleepiness worse than others? Sleepiness is mild... ...if it occurs during rest. It occurs when little attention is required for the activity. Examples including reading or watching television. Moderate sleepiness... ...is present if it occurs during activities. These activities require more attention. They may be physical or mental. One example is during a group meeting. Severe sleepiness... ...occurs during physical activities. These activities require full attention. Examples include talking, eating, or driving. Insomnia     Insomnia is the failure to fall asleep and remain asleep. Sleep is light and easily disturbed. Other common symptoms include:

  • fatigue
  • irritability
  • poor attention
    Insomnia can increase the chance of accidents, decrease performance, and impair judgment.

Are some types of insomnia more severe than others? Mild Insomnia: Poor sleep has little effect on social function or work. Moderate Insomnia: Poor sleep impacts social and work function. Severe Insomnia: Poor sleep has a major impact on how a person functions during the day. Acute Insomnia: Poor sleep lasts only a few days. Chronic Insomnia: Poor sleep may last for several months or more. It may start in early childhood and be life-long. What causes insomnia?     Insomnia is the failure to fall asleep and remain asleep. Some common symptoms include fatigue, irritability and poor attention. There are many reasons for poor sleep and often there is more than one cause.

Causes and types of insomnia may include:

  • Acute stress
  • Bedtime Behavior in Children
  • Environmental Factors
  • Medical Conditions
  • Medicine-induced Insomnia
  • Poor Sleep Hygiene
  • Psychophysiologic Insomnia
Acute stress - Acute stress, such as major life events (tragic loss, marriage, a job change, or an exam) can lead to insomnia. Sleeping in new settings such as a hotel or hospital room can also lead to insomnia. This type of sleep disturbance is brief. Sleep tends to return to normal once the stress is removed or reduced or when the person learns to cope with it.

Bedtime Behavior in Children - Children often attempt to delay bedtime. A child may ask for one more bedtime stories, take several trips to the bathroom, ask for food or water, or to watch a few more minutes of television. These attempts to delay the bedtime should be recognized by the caretaker and then limited before bedtime. Once this is accomplished, sleep often occurs naturally and quickly.

However, several other factors may also affect a child’s sleep. These include fear of the dark, fear of being left alone or an unreasonably early bedtime. Some children are unable to sleep unless a special blanket or pacifier is present.

Environmental Factors  - Loud noise, bad odors, bright lights and extremes in room temperature can disturb sleep. A snoring sleep partner or an uncomfortable bed can also disturb sleep. Other disruptive environmental factors include concerns about safety in the house, caring for a family member and a rapid ascent to a high altitude.

Medical Conditions - Some medical conditions may cause insomnia. If you have a chronic illness and you are having sleep disturbances, talk with your doctor.

Medicine-induced Insomnia - Medications can be a major cause of insomnia. Stopping medicine that encourages sleep after long-term use can lead to severe insomnia. Some medicines have a stimulating effect, causing wakefulness and alertness. These can cause insomnia, often when taken close to bedtime or when the dose is increased. If you take any of these medicines and are having sleep disruptions talk with your doctor. Do not stop any medicines if you have not consulted with your doctor.

Poor Sleep Hygiene - Insomnia can begin with habits or activities that do not promote sleep. Caffeine, alcohol or smoking too close to bedtime can lead to poor sleep. Strenuous exercise or stimulating mental activity can affect sleep, as well. Frequent changes in bedtime or waking times and napping during the day can disrupt sleep. Performing activities in bed such as doing homework, talking on the telephone or watching television are also habits that may cause sleep problems.

Psychophysiologic  Insomnia - Behaviors that disturb sleep can develop and become the major factors causing Insomnia. For instance, an insomniac may "try too hard" to fall sleep. He / she may become tense and even more aroused. This, in turn, increases anxiety about not being able to sleep. Thus, a vicious cycle begins.

    Sleep often occurs when not trying too hard to fall asleep. Sleep may be better in any place other than the insomniac's bedroom.


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