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Sleep Disorders

Key points

Good sleep is essential for our health and emotional well-being.

Getting enough sleep and good sleep quality are essential for healthy sleep.

The amount of sleep you need changes as you age.

Talk to your healthcare provider if you have problems sleeping.

Sleep disorders are conditions that affect the quality, amount and timing of sleep you’re able to get at night. Common sleep disorders include insomnia, restless legs syndrome, narcolepsy and sleep apnea. Sleep disorders can affect your mental health and physical health. Treatment is available to help you get the rest you need.

What are sleep disorders?

Sleep disorders are conditions that affect your ability to get the rest your body needs and maintain wakefulness.

There are over 80 sleep disorders that impact:

How well you sleep (quality)

When you fall asleep and if you can stay asleep (timing)

How much sleep and wakefulness you get (quantity or duration)

Everyone can experience problems with sleep from time to time. But you might have a sleep disorder if:

You have trouble falling or remaining asleep

You find it difficult to stay awake during the day

There are imbalances in your circadian rhythm that interfere with a healthy sleep schedule

You are prone to unusual behaviors that disrupt your sleep

Getting enough sleep?

Everyone needs sleep. It’s an essential part of what makes our bodies function. The amount of sleep you need might be more or less than others, but experts recommend adults get seven to nine hours of sleep per night. Optimal sleep time varies by age; for example, children and teenagers may need more sleep than adults.

The daily recommended hours of sleep you need changes as you age.

Age Group	Age	Sleep Recommended Daily
Newborn	0–3 months	14–17 hours
Infant	4–12 months	12–16 hours (including naps)
Toddler	1–2 years	11–14 hours (including naps)
Preschool	3–5 years	10–13 hours (including naps)
School age	6–12 years	9–12 hours
Teen	13–17 years	8–10 hours
Adult	18–60 years	7 or more hours
Adult	61–64 years	7–9 hours
Adult	65 years and older	7–8 hours

How common are sleep disorders?

Sleep disorders, also known as sleep-wake disorders, are conditions that can affect the amount, timing, or quality of your sleep, causing you to feel tired in the daytime and have difficulty functioning as a result.

Millions of Americans aren’t getting enough sleep and 50 to 70 million Americans have one or more sleep disorders. If you or a loved one haven’t been sleeping well, it’s important to visit a healthcare provider for an evaluation.
Sleep is a complex biological process during which your brain and body perform a number of functions that help you stay healthy; therefore, in addition to making you feel tired, not sleeping well can also affect your mental and physical health.
Not getting enough sleep can also affect your academic or work performance, interpersonal relationships, and safety. A 2019 study notes that sleep disorders can have a serious impact on your quality of life.

Health benefits of sleep

Getting enough sleep can help you:

Get sick less often.

Stay at a healthy weight.

Reduce stress and improve your mood.

Improve your heart health and metabolism.

Lower your risk of chronic conditions like:

Type 2 diabetes.

Heart disease.

High blood pressure.

Stroke.

Lessen the risk of motor vehicle crashes and related injury or death.

Improve your attention and memory to better perform daily activities.

What to do?

Better sleep habits can help you get a good night's sleep. Habits that can improve your sleep include:

Going to bed and getting up at the same time every day.

Keeping your bedroom quiet, relaxing, and at a cool temperature.

Turning off electronic devices at least 30 minutes before bedtime.

Avoiding large meals and alcohol before bedtime.

Avoiding caffeine in the afternoon or evening.

Exercising regularly and maintaining a healthy diet.

Sleep quality

Quality sleep means you are getting uninterrupted and refreshing sleep. Getting quality sleep is not just about how many hours you sleep, but how well you sleep.

Signs of poor sleep quality include:

Trouble falling asleep.

Repeatedly waking up during the night.

Feeling sleepy or tired even after getting enough sleep.

5 Types of Sleep Disorders

There are a few broad categories that most sleep disorders fall into:

1. Dyssomnias: Dyssomnia disorders are sleep conditions in which a person has difficulty falling or staying asleep (further categorized as insomnia) or staying awake (hypersomnia). Chronic insomnia and narcolepsy are types of dyssomnia disorders. Chronic insomnia is a condition in which you struggle to fall asleep without a specific reason. Narcolepsy is characterized by extreme daytime sleepiness and periodic “sleep attacks,” cataplexy (sudden motor weakness), or stressful sleep paralysis.

2. Parasomnias: Parasomnia disorders are conditions in which a person experiences abnormal behaviors, movements, or dreams during sleep, often during transitions between different sleep cycle stages. Common parasomnia disorders include sleepwalking (walking while asleep), night terrors (experiencing intense emotions while sleeping), and REM sleep behavior disorders (acting out violent or active dreams during REM sleep).

3. Circadian rhythm sleep disorders: Circadian rhythm sleep-wake disorders occur when a person’s biological clock is misaligned with traditional waking and sleeping hours, causing them to experience extreme sleepiness and wakefulness at abnormal hours. A shift-work sleep disorder (occurs when working hours negatively affect sleep patterns) and jet lag are both forms of circadian rhythm sleep disorders. Learn about circadian rhythms and how they affect sleep.

4. Sleep-related breathing disorders: Sleep-related breathing disorders are any sleep disorders caused by abnormal breathing patterns during sleep. Sleep apnea is the most common sleep-related breathing disorder—a medical condition in which, during sleep, your body stops receiving oxygen through your upper airway (either due to a blockage, called obstructive sleep apnea, or a brain signal). People with sleep apnea may wake up choking or gasping for breath between sleep cycles.

5. Sleep-related movement disorders: Sleep-related movement disorders disrupt a person’s sleep due to uncontrollable or compulsive muscle movements. Common sleep-related movement disorders include restless legs syndrome (RLS), when you experience irritating sensations in your legs, especially in bed, and bruxism, when you grind or clench your teeth at night.

Sleep disorders

What they are.

The collective term sleep disorder refers to conditions that affect sleep quality, timing, or duration and impact a person’s ability to properly function while they are awake. These disorders can contribute to other medical problems, and some may also be symptoms for underlying mental health issues.

In 1979, the American Sleep Disorders Association published the first classification system dedicated to sleep disorders. Our knowledge and understanding of sleep health has evolved over the past four decades. More than 100 specific sleep disorders have been identified and today’s classifications use complex methodologies to categorize these disorders based on causes, symptoms, physiological and psychological effects, and other criteria. However, most sleep disorders can be characterized by one or more of the following four signs:

You have trouble falling or remaining asleep

You find it difficult to stay awake during the day

There are imbalances in your circadian rhythm that interfere with a healthy sleep schedule

You are prone to unusual behaviors that disrupt your sleep

Any of these signs could indicate a sleep disorder. People who experience issues with sleep or daytime energy should consult with their doctor.

Common sleep disorders

Common Sleep disorders include:

Insomnia. Insomnia is characterized by an ongoing difficulty to fall or remain asleep despite wanting to sleep and having enough time to sleep. People with insomnia also experience daytime sleepiness and may have difficulty functioning while they are awake. Chronic insomnia is diagnosed when someone has these symptoms at least three times per week for at least three months.

Up to two-thirds of adults periodically experience some form of insomnia.

Insomnia is more likely to occur with older age, lower socioeconomic status, and anxiety or depression.

Therapy, sleep aids, and other approaches can reduce or resolve insomnia symptoms.

Restless legs syndrome. People with restless legs syndrome (RLS) experience tingling or crawling sensations that create an irresistible urge to move their legs. The sensations and urge to move tend to get worse when sitting or lying down, making it difficult to sleep. RLS is linked with pregnancy, Parkinson’s disease, iron deficiency, and other factors, but the cause of most RLS cases is unknown.

Up to 15% of people have RLS, but only around 2% to 3% experience significant symptoms.

RLS symptoms are not only triggered by rest, they may also worsen with caffeine intake and use of certain medications.

Healthy sleep habits, dietary changes, exercise, medical devices, and medications are effective treatment strategies for RLS.

Narcolepsy. Narcolepsy is a sleep disorder that makes people feel excessively tired during the day despite getting an adequate amount of sleep. This can lead to an irrepressible urge to sleep, culminating in “sleep attacks” that typically last for a few minutes. These sleep attacks and other symptoms of narcolepsy are caused by disruptions in the brain’s ability to regulate the sleep-wake cycle.

Narcolepsy affects roughly 1 in 2,000 people in the United States.

Sleep attacks can be accompanied by cataplexy, a sudden loss of muscle tone that causes people to slump over as they nod off.

People with narcolepsy are at a high risk for accident or injury, but treatment with medication and lifestyle changes can help.

Sleep apnea. Sleep apnea is a common sleep-related breathing disorder that disrupts breathing at night. People with this condition often snore heavily and may wake up choking or gasping for air. There are two types of sleep apnea. Obstructive sleep apnea occurs when tissues in the mouth and throat relax, frequently blocking the upper airway. Central sleep apnea occurs when the brain temporarily stops sending signals to the muscles that control breathing.

Obstructive sleep apnea affects at least 30 million Americans, but many cases go undiagnosed.

People with sleep apnea often experience daytime sleepiness and fatigue, as well as morning headaches and dry mouth.

Treatment options for sleep apnea include CPAP therapy, oral appliances, and, in some cases, surgery.

Parasomnias. Parasomnias are a group of unusual sleep behaviors that can occur before falling asleep, during sleep, or in the transition between sleep and wakefulness. Parasomnias are most common in children, but they affect adults as well. They include sleepwalking, bedwetting, night terrors, and more unique ones like exploding head syndrome.

Parasomnias occur in up to 20% of children

Parasomnias are categorized based on when in a person’s sleep cycle they arise.

Managing parasomnias typically involves maintaining the safety of the sleeper and any bed partners and promoting sufficient healthy sleep.

Excessive Sleepiness. It is normal to feel sleepy after a night of sleep loss. But excessive daytime sleepiness (EDS) is a medical term that describes extreme grogginess occurring almost every day for at least three months. EDS makes it difficult or impossible to stay awake during the day. A wide range of medical and psychological conditions can lead to EDS, including sleep apnea, narcolepsy, hypothyroidism, chronic pain, depression, and anxiety.

EDS is believed to occur in up to 25% of the population.

EDS is not a sleep disorder itself but rather a symptom of many sleep disorders and other health conditions.

To determine the cause of EDS, a doctor may recommend a sleep study or other tests.

Shift Work Disorder. Shift work disorder develops in some people whose jobs require them to work late at night or early in the morning. Sleeping during the day and working at night can cause misalignment between a person’s daily schedule and the circadian rhythms that guide their body to feel alert or sleepy in response to light or darkness. People with this condition often feel excessively tired at work and struggle to get enough sleep during their allotted daytime rest period.
At least one-third of shift workers meet the criteria for a shift work disorder diagnosis.

People with shift work disorder get, on average, 90 minutes less sleep compared with people who work day shifts.

Treatment for shift work disorder focuses on strategies that encourage alertness while at work and quality sleep between shifts.

Non 24-Hour Sleep Wake Disorder. For most adults, the circadian rhythms that guide the sleep-wake cycle reset approximately every 24 hours. This is why many people start to get sleepy around the same time each night. In contrast, people with non-24-hour sleep wake disorder have circadian rhythms that are either shorter or longer than 24 hours. Affected individuals progressively shift their sleep and wake times one to two hours earlier or later each day.

Non-24-hour sleep wake disorder primarily affects people who are blind and unable to see light.

People with this condition cycle through days or weeks of sleeping during the day and days or weeks of sleeping at night.

Non-24-hour sleep wake disorder is one of the six circadian sleep-wake rhythm disorders.

All Sleep Disorders

Abnormal Sleep Behavior Disorders

Bruxism

Central Sleep Apnea

Chronic Fatigue Syndrome

Circadian Rhythm Sleep Disorders

Excessive Sleepiness

Hypersomnia

Insomnia

Narcolepsy

Night Terrors

Non-24-Hour Sleep Wake Disorder

Obstructive Sleep Apnea

Parasomnias

Periodic Limb Movements Disorder

Rhythmic Movement Disorder

REM Sleep Behavior Disorder

Restless Leg Syndrome (RLS)

Shift Work Disorder

Sleepwalking

Sleep Apnea

Sleep-Related Breathing Disorders

Sleep-Related Movement Disorders

Sleep Paralysis

Symptoms of Sleep Disorders

The symptoms you experience can vary depending on the type of sleep disorder you have. These are some common symptoms of sleep disorders:

Taking over half an hour to fall asleep every night

Waking up several times every night and having trouble going back to sleep

Waking up too early in the morning

Having difficulty moving when you first wake up

Often feeling sleepy in the day or frequently taking naps

Falling asleep at the wrong times in the day

Snoring loudly, gasping, snorting, making choking sounds, talking, or not breathing for short periods of time while sleeping

Experiencing creeping, crawling, or tingling feelings in your arms or legs that get better with movement or massage, particularly while trying to fall asleep

Frequently jerking your arms or legs while sleeping

Having vivid, dream-like experiences while falling asleep or lightly dozing

Experiencing sudden muscle weakness when you’re angry, scared, or laughing

How are sleep disorders diagnosed?

To make a diagnosis, your health care provider will use your medical history, your sleep history, and a physical exam. You may also have a sleep study (polysomnogram). The most common types of sleep studies monitor and record data about your body during a full night of sleep. The data includes:

Brain wave changes

Eye movements

Breathing rate

Blood pressure

Heart rate and electrical activity of the heart and other muscles

Other types of sleep studies may check how quickly you fall asleep during daytime naps or whether you are able to stay awake and alert during the day.

Management

How are sleep disorders treated?

There are several types of treatment options available for various sleep disorders, which could include:

Changing your sleeping routine to promote a regular sleep schedule and proper sleep hygiene.

Undergoing cognitive behavioral therapy.

Taking medications (like sleeping pills or alerting agents) or supplements (like melatonin).

Changing medications or dosages that cause excessive sleepiness (don’t stop taking a medication unless your healthcare provider approves it).

Using a CPAP (continuous positive airway pressure) machine or having a neurostimulator implanted to control sleep apnea.

Using light therapy.

Your healthcare provider will recommend treatments based on your situation. They’ll also discuss any side effects to look out for before you begin treatment.

What medications treat sleep disorders?

Your healthcare provider may recommend some of the following medications and supplements to treat common sleep disorders:

Insomnia: Sleep aids, including melatonin, zolpidem (Ambien), zaleplon, eszopiclone (Lunesta), ramelteon, suvorexant, lemborexant, diphenhydramine (Unisom, Benadryl) or doxepin (Silenor)

Restless legs syndrome: Medication like gabapentin, gabapentin enacarbil or pregabalin

Narcolepsy: Stimulants or wake-promoting medications, such as modafinil, armodafinil, pitolisant, mixed salt or sodium oxybate, and solriamfetol

How do I get better sleep?

A healthcare provider may recommend you make changes to your sleep hygiene so you can sleep better. Sleep hygiene includes making changes to your sleeping routine to create an optimal sleeping environment. You can get better sleep by:

Creating a comfortable sleep environment: Make sure your bedroom is cool, quiet and dark. If noise keeps you awake, try using background sounds like “white noise” or earplugs. If light interferes with your sleep, try a sleep mask or blackout curtains.

Minimizing stress: Try to reduce how much stress you feel before going to bed. You may choose to write things down like making a to-do list earlier in the evening. This is helpful if you tend to worry and think too much in bed at night. It also helps to stay positive rather than going to bed with a negative mindset, such as, “If I don't get enough sleep tonight, how will I ever get through the day tomorrow?”

Avoid using your bed for anything other than sleep and intimate relations: Don’t watch television or videos on your phone, eat or work in your bedroom.

Establishing a regular bedtime routine: Each night, create habits before you go to bed like taking a warm bath, listening to soothing music or reading. Try relaxation exercises or meditation. Wake up at the same time each morning, including days off and vacations.

Not watching the clock: Turn the clock around or turn your phone screen-side down and use only the alarm for waking up. Leave your bedroom if you can’t fall asleep in 20 minutes. Read or engage in a relaxing activity in another room that doesn’t involve screen time

Exercising regularly: Exercising is great to promote positive sleep, but don’t exercise within four hours of bedtime if you have trouble sleeping. Avoid strenuous exercises before you sleep.

Prevention

Can sleep disorders be prevented?

You can’t prevent all types of sleep disorders, but you can reduce your risk by practicing good sleeping habits (sleep hygiene).

What should I avoid to get better sleep?

You should avoid the following three to four hours before bedtime if you want to improve your sleep:

Caffeinated drinks such as soda, tea and coffee

Tobacco

Alcohol

Naps after 3 p.m.

Chocolate

Heavy meals

Prognosis

What can I expect if I have a sleep disorder?

Sleep disorders can affect your overall health. You may not have the energy to do the things you want to do or even complete your daily routine. You may miss out on special moments or events because your sleep disorder prevents you from being fully present. In addition, you may put yourself and others at risk, especially if you drive or operate heavy machinery and aren’t getting the rest you need to stay safe.

If you’re struggling to get quality sleep where you wake up feeling refreshed, talk to a healthcare provider. Treatment is available to manage many sleep disorders and get you back to wellness.

How long do sleep disorders last?

There isn’t a specific time limit as to when a sleep disorder will stop affecting you. You may be able to find a treatment that makes you feel better within weeks to months. Others may need to manage the condition throughout their lifetime. Talk to your healthcare provider about your specific outlook.

Living with sleep disorders

When should I see a healthcare provider?

Talk to a healthcare provider if you’re having trouble with sleep and wakefulness. This could be falling asleep, staying asleep or awake, getting restful sleep or unexplained daytime sleepiness or tiredness.

What questions should I ask my healthcare provider?

What kind of sleep disorder do I have?

How severe is my sleep disorder?

What type of treatment do you recommend?

Are there side effects of the treatment?

How can I improve my sleep hygiene?

Should I see a sleep specialist?

Do I need a referral to see a specialist?

Do you recommend any medications to help with my sleep disorder?

How often should I return to see you?

Are there medicines I should stop taking?

One Final Note..

Sleep disorders affect your quality of life. They can disrupt your thinking, school or work performance, mental health and physical health. Common sleep disorders prevent you from getting the restful, deep sleep you need to function at your best. If you’re struggling with your sleep, don’t hesitate to see a healthcare provider. Your health and, therefore, quality of life depends on good sleep. Practice good sleep hygiene and follow your healthcare provider’s instructions to feel better sooner.
Not getting a good night’s sleep can leave most people tired, irritable, and cranky. Not sleeping well for several days on end can have more serious consequences as it can affect your physical and mental health, work, relationships, and ability to function.

If you suspect you or a loved one might have a sleeping disorder, it’s important to visit a healthcare provider for a diagnosis and treatment. Your primary care provider can refer you to a sleep specialist, if needed. There are treatment options that can help.

Sleep Resources

Several organizations offer information and resources about sleep and sleep health.

Some of these organizations and their resources are described below.

American Academy of Sleep Medicine

The American Academy of Sleep Medicine (AASM) is a professional society for medical professionals and researchers who work to improve sleep health.

Resources include publicly available sleep education tools for patients, sleep medicine toolkits, clinical practice guidelines, and consensus statements for medical professionals. For members only, resources include trainings and webinars, continuing education certifications, and professional development opportunities.

National Center on Sleep Disorders Research

The National Center on Sleep Disorders Research (NCSDR) is a federal center in the National Heart, Lung, and Blood Institute, National Institutes of Health that supports research and education related to sleep disorders and the promotion of sleep health.

Patient resources include guides to healthy sleep, information about sleep deficiency, and videos on sleep disorders. For health care provides, resources include sleep publications and funding opportunities for sleep and sleep disorder research.

National Sleep Foundation

The National Sleep Foundation (NSF) is a nonprofit organization dedicated to improving health and well-being through sleep education and advocacy.

Resources include easy-to-follow tips for healthier sleep, blog articles related to sleep health, and educational campaigns for the general public. For health care providers, resources include guidelines and recommendations for sleep health, research publications on various aspects of sleep health, and research tools.

National Highway Traffic Safety Administration

The National Highway Traffic Safety Administration (NHTSA) is a federal agency in the U.S. Department of Transportation dedicated to preventing injuries from road traffic crashes through education, research, safety standards, and enforcement.

Resources include information about drowsy driving, helpful tips to avoid falling asleep while driving, and data on car crashes and deaths from drowsy driving.

Sleep Education

Sleep Education is a webpage from the American Academy of Sleep Medicine (AASM).

Resources include easy-to-understand information about sleep, sleep disorders, and treatment options for parents, educators, patients, and students.

Sleep Research Society

The Sleep Research Society (SRS) is a scientific organization of sleep researchers who study and teach others about the science of sleep.

Resources include publicly available podcasts on the latest sleep research and publications on various sleep and health topics. For members only, resources include educational webinars and courses, annual training seminars, and professional development opportunities.

Information on participating in clinical research on sleep

Alzheimers.gov Clinical Trials Finder (NIA): Search for clinical trials to advance sleep and dementia research among older adults.

Clinical Trials on Sleep (NICHD): Search for clinical trials that are actively recruiting participants to advance sleep research

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