Sleep Disorders


Snoring is the vibration of respiratory structures and the sound resulting from the obstructed air movement during breathing while sleeping. The sound may be soft, but in other cases, it can be rather loud and quite unpleasant.

Snoring is a symptom of a narrow or closed airway that can be caused by a number of things including:

  • Large tonsils or adenoids
  • A large base of the tongue
  • A large soft palate
  • Polyps, or bumps, in the nasal passages or septum
  • A deviated septum, which is when the inner part of the nose is crooked
  • Allergies

Some people snore only when they sleep on their backs. Others snore regardless of the position they sleep in. Snoring can be more severe after drinking alcohol or taking sedatives.

As much as 15 percent of the population snores.

There are a number of things that can help relieve snoring:

  • Weight Loss — If you are overweight, losing weight may help.
  • Surgery — There are many surgical procedures available to treat snoring and sleep apnea. These surgeries involve cutting or manipulating the upper airway, including the throat, tongue, jaw and nose.
  • Laser Surgery — This treatment requires four to five outpatient visits with an otolaryngologist, or ear, nose and throat surgeon, who aims a laser in your throat and lasers away excess tissue.
  • Somnoplasty — This procedure involves putting a needle into the tissue and turning on microwaves at the end of the needle to burn the tissue from the inside.
  • Dental Devices — A dentist specializing in dental devices for snoring can fit you with a dental guard that can either hold your jaw forward, or pull your tongue out to allow for more space in your airway.
  • Positional Training — If you snore only when on your back, then you can train yourself to sleep only on your sides.

Obstructive Sleep Apnea

Snoring can be a symptom of a serious sleep disorder called obstructive sleep apnea, which occurs when the airway becomes so narrow that it blocks your breathing. This can cause you to suffocate while asleep, and not realize it. With obstructive sleep apnea, your sleep becomes lighter and fragmented. The apneas can occur one after another, lasting for up to one minute or more.

If sleep apnea goes untreated, it can cause other serious disorders, such as heart disease and high blood pressure. It also can leave you feeling so tired during the day that you may fall asleep while driving.

If your snoring makes you tired or someone has noticed that you sometimes stop breathing when you snore, you should see a sleep specialist for diagnosis and treatment of sleep apnea.

Sleep Apnea

Sleep apnea is a disorder in which your breathing is interrupted for periods of 10 seconds or more while you are asleep. These interruptions may occur hundreds of times a night, causing you to gasp for air and disrupting your sleep.

Roughly one in every 15 North Americans are affected by at least moderate sleep apnea. It also estimated that in middle-age as many as 9% of women and 24% of men were affected, undiagnosed and untreated.

Sleep apnea is diagnosed with an overnight sleep test called a polysomnogram, or “sleep study”.

Some common symptoms of sleep apnea include:

  • Restless sleep
  • Loud, heavy snoring often interrupted by silence and gasps
  • Drowsiness or lack of energy, caused by the lack of sleep
  • Headaches in the morning
  • Irritability, forgetfulness, mood or behavior changes
  • Anxiety or depression

There are two main types of sleep apnea:

  • Obstructive Sleep Apnea — This type of sleep apnea is typically caused by an airway blockage and is more common. It occurs when the muscles in the wall of the throat relax during sleep, causing the walls to collapse and obstruct airflow.
  • Central Sleep Apnea — Believed to be related to a malfunction of the brain’s normal signal to breathe, with this type of sleep apnea the level of carbon dioxide in the blood rises, which may cause you to wake up.

If sleep apnea is not treated, it can lead to other serious health problems, including:

  • Hypertension or high blood pressure
  • Heart related conditions such as coronary artery disease, myocardial infarction and stroke
  • Psychiatric problems such as depression
  • Impotence and lack of interest in sex
  • Cognitive dysfunction or memory loss

Some treatments involve lifestyle changes, such as avoiding alcohol or muscle relaxants, losing weight, and quitting smoking. Many people benefit from sleeping with the upper body at a 30-degree elevation or higher, as if in a recliner. Doing so helps prevent the gravitational collapse of the airway. Sleeping on your side, as opposed to sleeping on your back, is also recommended as a treatment for sleep apnea.

Some people benefit from various kinds of oral appliances to keep the airway open during sleep. “Breathing machines” like the continuous positive airway pressure (CPAP) may help. There are also surgical procedures to widen the airway and remove and tighten tissue.

Periodic Leg Movements

Periodic leg movements are repetitive movements that occur about every 20 to 40 seconds in the lower limbs while a person is sleeping. These movements may be jerking, flailing and kicking motions, an upward flexing of the feet or brief twitches. The repetitive movement may last for a period of a few minutes to several hours.

Periodic leg movements are estimated to occur in approximately 4% of adults (aged 15–100), but it is more common in the elderly, especially females, with up to 11% experiencing symptoms. People who experience these movements may not even be aware of it and their bed partner may be the one to alert them of it.

Although it varies for each person, people with periodic leg movements may also experience insomnia or daytime fatigue, caused by interrupted sleep. In addition, they may suffer from restless legs syndrome (RLS), a sensation in a person’s legs that causes a strong, often irresistible urge to move them as they try to fall asleep or when they awaken at night. This sensation has been described as uncomfortable and, in some cases, painful. Other words used to describe these sensations include creeping, itching, pulling, creepy-crawly and tugging. Although rare, these sensations also may occur in the arms and other parts of the body.

It is mostly unknown what causes periodic leg movements, but in many cases the patient also suffers from other medical problems such as Parkinson’s disease or narcolepsy. Factors that increase the likelihood of periodic leg movements in the absence of restless leg syndrome include:

  • Being a shift worker
  • Snoring
  • Coffee drinking
  • Stress
  • Use of hypnotics

Being a woman, the presence of musculoskeletal disease, heart disease, obstructive sleep apnea, cataplexy, doing physical activities close to bedtime and the presence of a mental disorder were significantly associated with having a higher risk of both periodic leg movements and restless legs syndrome.

The first step in treating periodic leg movements or RLS is to determine if they result from an underlying medical condition and, if so, treating those causes. In many cases, this will eliminate the nighttime movements. If this is unsuccessful, there are various medications available to treat both periodic leg movements and RLS.

The three classes of drugs frequently used include benzodiazepines, Parkinson drugs and narcotics. These medications will not cure periodic leg movements or RLS, but will help to reduce or eliminate symptoms. It is important to know that they may cause side effects, which should be discussed with your doctor. Patients must stay on these medications in order to experience relief for there is no known cure for this disorder.

It is also advised to not consume caffeine, alcohol or antidepressants as these substances could worsen symptoms.


Narcolepsy is linked to a chemical in the brain called hypocretin, which normally stimulates arousal and helps regulate sleep. Most people with narcolepsy do not produce hypocretin in the deep part of the brain called the hypothalamus. As a result, the body’s messages about when to sleep and when to stay awake sometimes occur at the wrong times and places. If not treated, people with narcolepsy can fall asleep at any time, such as when at work, while driving and while engaged in a conversation.

Narcolepsy is a lifelong condition that affects an estimated one in 1,000 to 1,500 people. Although it occurs in both men and women, it is slightly more common among men. The condition can begin at any age, although its symptoms usually appear between the ages of 10 and 20. Narcolepsy has been found to be heredity in some cases.

The hallmark symptom of narcolepsy is an excessive daytime sleepiness (EDS), in which a person falls asleep at times when they want to be awake. EDS may include daytime sleep attacks that occur with or without warning, persistent drowsiness and fleeting moments of sleep that occur in between a person’s waking state.

Other symptoms may include:

  • Cataplexy — Most people with narcolepsy experience some degree of cataplexy, which is defined as a sudden loss of voluntary muscle control. An attack may involve only a slight feeling of weakness and limp muscles — such as sagging facial muscles, nodding head, buckling knees, loss of arm strength and garbled speech — or also may cause immediate total body collapse. These attacks are usually triggered by intense emotions, such as laughter, surprise, anger, stress and fear, and can last anywhere from a few seconds to thirty minutes.
  • Sleep Paralysis — For a brief period when falling asleep or waking up, a person with narcolepsy may be unable to talk or move.
  • Hypnagogic Hallucinations — These are defined as vivid, realistic and typically frightening dreams that occur when a person is falling asleep.
  • Automatic Behavior — This occurs when familiar or routine tasks — such as making coffee in the morning, getting the paper and taking a shower — are performed without full memory or awareness of them.
  • Fragmented Nighttime Sleep — In addition to having trouble with sleep during the day, people with narcolepsy also tend to sleep poorly at night, waking up often.

Treatment is tailored to the individual, based on symptoms and therapeutic response. The time required to achieve optimal control of symptoms varies, and may take several months or longer. Oral medications that stimulate the central nervous system are the mainstay of formal narcolepsy treatment. However, lifestyle changes are also important, including:

  • Reduced stress
  • More exercise
  • Less stimulant intake (such as coffee and nicotine)


Insomnia is most frequently defined by an individual’s report of sleeping difficulties.

Insomnia is a common problem that approximately half of North American adults report experiencing at some time. Both men and women experience insomnia, although females and elderly are typically affected the most. And, despite common belief, the need for sleep does not decrease with age.

The condition is classified into three groups depending on the length that it lasts:

  • Transient insomnia is defined as lasting for a few nights
  • Intermittent is periodic episodes of insomnia
  • Chronic insomnia occurs on most nights and lasting a month or more

Although insomnia is not considered a serious medical problem, lack of sleep can seriously impact your quality of life. It can cause a person to feel tired, depressed and irritable, as well as impair their concentration. Most adults need approximately seven to nine hours of sleep to feel completely rested, although it differs for each person.

Insomnia is most often thought of as both a sign and a symptom that can accompany several sleep, medical and psychiatric disorders, characterized by persistent difficulty falling asleep and/or staying asleep or sleep of poor quality. Insomnia is typically followed by functional impairment while awake. Some of the most common causes of insomnia include:

Other factors that also can cause insomnia include:

  • Drinking too much caffeine throughout the day
  • Drinking alcohol before bedtime
  • Excessive napping during the day
  • Changes in your surroundings and sleep schedule
  • Noise
  • Jet lag
  • Certain medications
  • Pain from medical problems, such as arthritis

Symptoms of insomnia include:

  • Trouble falling asleep
  • Experiencing restless sleep, in which you wake frequently throughout the night and then have trouble falling back asleep
  • Waking too early in the morning
  • Feeling tired and un-refreshed upon waking in the morning

It is important to identify or rule out medical and psychological causes before deciding on the treatment for insomnia. Attention to sleep hygiene is an important first line treatment strategy and should be tried before any pharmacological approach is considered.

Treatment may include the following:

  • Sleeping pills – not recommended for long-term use
  • Relaxation therapy
  • Sleep restriction therapy
  • Reconditioning


Hypersomnia is characterized by recurrent episodes of excessive daytime sleepiness or prolonged nighttime sleep.

Hypersomnia may be caused by another sleep disorder (such as narcolepsy or sleep apnea), dysfunction of the autonomic nervous system, or drug or alcohol abuse. In some cases it results from a physical problem, such as a tumor, head trauma, or injury to the central nervous system. Certain medications, or medicine withdrawal, may also cause hypersomnia. Medical conditions including multiple sclerosisdepressionencephalitisepilepsy, or obesity may contribute to the disorder.

Some people appear to have a genetic predisposition to hypersomnia; in others, there is no known cause. Typically, hypersomnia is first recognized in adolescence or young adulthood.

Different from feeling tired due to lack of or interrupted sleep at night, persons with hypersomnia are compelled to nap repeatedly during the day, often at inappropriate times such as at work, during a meal, or in conversation. These daytime naps usually provide no relief from symptoms. Patients often have difficulty waking from a long sleep, and may feel disoriented. Other symptoms may include:

  • Anxiety
  • Increased irritation
  • Decreased energy
  • Restlessness
  • slow thinking
  • Slow speech
  • Loss of appetite
  • Hallucinations
  • Memory difficulty

Some patients lose the ability to function in family, social, occupational, or other settings.

The prognosis for persons with hypersomnia depends on the cause of the disorder. While the disorder itself is not life threatening, it can have serious consequences, such as automobile accidents caused by falling asleep while driving. The attacks usually continue indefinitely.

Treatment is symptomatic in nature. Stimulants, such as amphetamine, methylphenidate, and modafinil, may be prescribed. Other drugs used to treat hypersomnia include clonidine, levodopa, bromocriptine, antidepressants, and monoamine oxidase inhibitors. Changes in behavior (for example avoiding night work and social activities that delay bed time) and diet may offer some relief. Patients should avoid alcohol and caffeine.

Sleep Disorders

A sleep disorder is a medical disorder of the sleep patterns of a person. Some sleep disorders are serious enough to interfere with normal physical, mental and emotional functioning. Experts say that if you feel drowsy during the day, you probably aren’t getting enough sleep. With the hectic pace of life today, there is so much sleep deprivation that sleepiness is almost the norm.

If we don’t get the amount of sleep we each need each night, this lack of sleep or sleep deprivation can be very dangerous. It can impair our ability to perform basic daily activities such as driving and routine on-the-job tasks. And it can have a longer-term impact on our physical and mental health.

More than 40 million Americans suffer from chronic, long-term sleep disorders and another 20 million have occasional sleeping problems. How much sleep we each need depends on many factors, including age. Infants generally require about 16 hours of sleep a day, while teenagers need about nine hours on average. Adults usually need about seven to eight hours.

The term “sleep disorders” refers to a variety of conditions that affect your ability to get regular, satisfying, restful sleep. Some of the most common sleep disorders include:

Treatments for sleep disorders vary, but generally can be grouped into four categories:

  • Behavioral/ psychotherapeutic treatments
  • Rehabilitation/management
  • Medications
  • Other somatic treatments

None of these general approaches is sufficient for all patients with sleep disorders. Rather, the choice of a specific treatment depends on the patient’s diagnosis, medical and psychiatric history, and preferences. Often, behavioral or psychotherapeutic and pharmacological approaches can effectively be combined to maximize therapeutic benefits.

Management of sleep disturbances that are secondary to mental, medical, or substance abuse disorders should focus on the underlying conditions.

Seasonal Affective Disorder

Seasonal affective disorder (SAD) is a form of depression that occurs during specific seasons, most commonly during the fall and winter. However, the condition can occur at any time of the year, including during the summer. People who get the mood disorder have normal mental health throughout most of the year and experience depressive symptoms around the same time repeatedly, year after year.

The incidence of the condition varies with geography. For example, it tends to be more common in the northern or polar regions.

The cause of SAD is not yet known, but it’s believed to be related to the availability of sunlight. Light affects your internal body clock, which helps you regulate when to sleep and when to be awake. Some scientists believe that a fluctuation in the body’s production of melatonin, a hormone that helps induce sleep, might be the cause of SAD. Other researchers speculate that a lack of serotonin, a brain chemical or neurotransmitter that seems to be triggered by sunlight, is the cause of SAD. People who are depressed often have decreased levels of serotonin in their brains.

Common symptoms of SAD include:

  • Excessive sleep
  • Inactivity and low energy levels
  • Negative feelings and depression
  • Increased appetite
  • Weight gain
  • Headaches
  • Anxiety
  • Self-imposed isolation

If you are diagnosed with seasonal affective disorder (SAD), your doctor may choose one of several approaches to your treatment.

  • Light Therapy — Short periods of exposure to light can help ease depression. Doses of sunlight are measured in “lux.” For example, the sun emits about 90,000 lux and blue sky reflects about 45,000 lux. Treatments could range from two hours of light at 2500 lux every morning to 30 to 40 minutes of light at 10,000 lux every morning. However, light therapy in the evening may interrupt sleep patterns.There are few, if any, side effects to the eyes from using light therapy. Sometimes, an hour walk in the morning can help without any other treatment.
  • Medication — Your doctor may prescribe an antidepressant in combination with light therapy or if light therapy isn’t effective. Antidepressants often are used when the condition occurs in the summer.
  • Psychotherapy — Psychotherapy may help you identify ways to avoid behaviors or environments that tend to trigger episodes of SAD, or to reduce stress in your life, which may worsen the symptoms.
  • Carefully timed supplementation of the hormone melatonin.

In addition to the treatments described above, there are a number of things you can do to help your body cope with seasonal depression. For example, try increasing the amount of light in your home or workplace by opening window shades. Increase your physical activity as exercising regularly can help relieve stress. Also, you may want to consider visiting a warm, sunny place during the winter, such as vacationing in a tropical location.

Restless Legs Syndrome

Restless legs syndrome (RLS), also known as Wittmaack–Ekbom syndrome, is a neurological disorder characterized by unpleasant sensations in the legs and an uncontrollable, and sometimes overwhelming, urge to move them for relief.

RLS may start at any age, including childhood, and is a progressive disease for some, while the symptoms may disappear permanently in others. More than 60% of cases of RLS are familial and are inherited in an autosomal dominant fashion with variable penetrance.

No one knows the exact cause of RLS.

Individuals affected with the disorder often describe the sensations as throbbing, polling, or creeping. The sensations range in severity from uncomfortable to irritating to painful. Some experience RLS only at bedtime, while others experience it throughout the day and night. Most sufferers experience the worst symptoms in the evening and the least in the morning.

RLS is generally a life-long condition for which there is no cure. Symptoms may gradually worsen with age. Nevertheless, current therapies can control the disorder, minimizing symptoms and increasing periods of restful sleep. In addition, some individuals have remissions, periods in which symptoms decrease or disappear for days, weeks, or months, although symptoms usually eventually reappear.

For those with mild to moderate symptoms, many physicians suggest certain lifestyle changes and activities to reduce or eliminate symptoms. Decreased use of caffeine, alcohol, and tobacco may provide some relief. Physicians may suggest that certain individuals take supplements to correct deficiencies in iron, folate, and magnesium. Taking a hot bath, massaging the legs, or using a heating pad or ice pack can help relieve symptoms in some patients.

Physicians also may suggest a variety of medications to treat RLS, including dopaminergics, benzodiazepines (central nervous system depressants), opioids, and anticonvulsants. The drugs ropinirole and pramipexole may be prescribed to treat moderate to severe RLS.