Signs and symptoms that you might have a sleeping disorder

Not-so-sweet dreams? A sleeping disorder could be the cause of your sleepless nights or tired days

We all struggle to get a good night’s sleep from time to time—tossing and turning, lying in bed wide awake with too much on our minds. But what if your difficulty sleeping is actually the result of a sleep disorder?

In broad terms, a sleep disorder is a disturbance of the normal sleep pattern. According to Dr. Adam J. Sorscher, Department of Psychiatry, Sleep Medicine Division and Department of Community and Family Medicine at the Geisel School of Medicine at Dartmouth-Hitchcock Medical Center in Lebanon, sleep disorders encompass a wide variety of conditions and fall into two broad categories.

The first includes patient complaints about their ability to initiate and maintain sleep, also known as insomnia; undesirable experienced or behavioral phenomena called parasomnias, which includes frequent nightmares; and difficulty maintaining wakefulness and normal levels of alertness in waking hours, called hypersomnolence.

The second category includes conditions that occur in sleep that impair its restorative function and diminish healthy physiological functioning, such as sleep apnea, which is a type of sleep disorder characterized by pauses in breathing or instances of shallow or infrequent breathing during sleep.

“In 2006, the National Institutes of Health released a landmark report in which it estimated that 50 to 70 million Americans struggle with disorders of sleep and wakefulness,” Sorscher said. “The most common sleep disorder is insomnia, and it affects approximately 25 million adults in the U.S., or about 10 to 15 percent of the population.”

Symptoms of insomnia include inability to initiate or maintain sleep adequately through the sleep period with diminished energy, mood, or cognitive ability in the wake time that follows. The treatment options for insomnia are typically some combination of cognitive and behavioral techniques and sleeping pills.

While sleep disorders may seem to be more prevalent or understood in adults, it’s important to note that children can and do suffer from the same variety of sleep disorders as adults.

According to Dr. Sazia Nowrin of St. Joseph Hospital Family Medical Center in Hudson, cited from “Prevalence of Diagnosed Sleep Disorders in Pediatric Primary Care Practices” published on May 10, 2010, in Pediatrics, 3.7 percent of children were given diagnosis of a sleep disorder. “Sleep disorder not otherwise specified” (SD-NOS) was the most common sleep disorder diagnosis at 1.4 percent, followed by nocturnal enuresis at 1.2 percent, sleep-disordered breathing (SDB) at 1 percent, infant apnea at 0.2 percent, insomnia at 0.05 percent, restless leg syndrome/periodic limb movement disorder at 0.02 percent, circadian rhythm disorder at 0.005 percent, bruxism at 0.004 percent, and narcolepsy at 0.003 percent.

“Twenty to 30 percent of children have significant bedtime problems and/or night waking,” says Nowrin. “In most cases, these have a behavioral cause. Behavioral sleep problems are found in all age groups.” She adds that behavioral insomnia in childhood is typically due to inappropriate sleep association or inadequate limit setting by the parent or caregiver.

Sorscher echoes this saying there are a large number of children who experience sleep disorders and that they occur at every age of development. Some of the pediatric disorders that sleep medicine physicians address, he says, include toddlers who won’t go to sleep (usually marked by inadequate ability to self-sooth), young children with frequent night terrors and nightmares, and adolescents with insufficient sleep due to behavioral choices.

The most common sleep disorder in adolescents is called “delayed sleep phase syndrome,” marked by very late fall-asleep times and subsequent sleepiness in school due to insufficient sleep overnight.

According to Sorscher, it is estimated that 7 to 16 percent of adolescents struggle with this disorder. The treatments for most pediatric sleep disorders are behavioral therapies.

“Sleep disorders in children are widely prevalent but preventable,” Nowrin said.“These can be present as a primary sleep disorder or secondary consequence of medical or psychiatric disorder.”

Obstructive sleep apnea is a breathing disorder marked by repeated collapsing of the airway when asleep. According to Sorscher, it affects an estimated 18 million adults, many of whom are not diagnosed. The consequences are daytime sleepiness and increased cardiovascular risk in the long term. Treatment options are continuous positive airway pressure (CPAP), dental appliances, certain surgical procedures on the throat, and, for those who are obese, weight loss.

Obstructive sleep apnea is diagnosed by monitoring a person’s breathing while they sleep, usually in an overnight sleep test. Nowrin said 1 to 3 percent of children are affected by obstructive sleep apnea, and it is most commonly caused by adenotonsillar hypertrophy, or enlarged adenoids. Other causes include allergies, obesity, neuromuscular diseases, and craniofacial abnormalities.

Restless Legs Syndrome (RLS) is a neurological movement disorder in which a person frequently experiences an urge to move their legs, along with discomfort that is heightened around the time of sleep, Sorscher said. Although this may occur infrequently in a large percentage of people, 3 to 4 percent of the adult population experience symptoms regularly and report problematic insomnia as a result. There are several different medications that are effective at alleviating the symptoms of RLS. In population-based studies from the UK, adds Nowrin, the prevalence of RLS in children and adolescents is 2 to 4 percent—and genetics, brain iron deficiency, and brain dopamine have been implicated in RLS.

Regardless of whether it is you or your child experiencing sleeping problems, the types of sleep disorders are typically the same and can be found in both adults and children—although perhaps with varying symptoms or degrees.

These disorders, in addition to being frustrating, can have other health implications, so if you or your child are experiencing persistent sleeping problems, it’s important to address this with a doctor to find out if a sleep disorder might be the culprit.

Julia K. Agresto works full-time in communications, as well as freelancing as a writer and volunteering.

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