List of common sleeping disorders
- Intrinsic Sleep Disorders
- Extrinsic Sleep Disorders
- Circadian Rhythm Sleep Disorders
- Arousal Disorders
- Sleep-Wake Transition Disorders
- Parasomnias Usually Associated with REM Sleep
- Other Parasomnias
3. Sleep Disorders Associated with Mental, Neurologic, or Other Medical Disorders
- Associated with Mental Disorders
- Associated with Neurologic Disorders
- Associated with Other Medical Disorders
4. Proposed Sleep Disorders
The dyssomnias are disorders that produce either excessive sleepiness or difficulty in initiating or maintaining sleep. The dyssomnias are the major, or primary, sleep disorders that are associated with disturbed sleep at night or impaired wakefulness.
The dyssomnias are divided into three major groups: intrinsic sleep disorders, extrinsic sleep disorders, and circadian rhythm sleep disorders.
Intrinsic Sleep Disorders
The intrinsic sleep disorders are primarily sleep disorders that either originate or develop within the body or that arise from causes within the body.
List of Intrinsic Sleep Disorders
- Psychophysiologic Insomnia - is a disorder of somatized tension and learned sleep-preventing associations that results in a complaint of insomnia andassociated decreased functioning during wakefulness.
- Sleep State Misperception - is a disorder in which a complaint of insomnia or excessive sleepiness occurs without objective evidence of sleep disturbance
- Idiopathic Insomnia - is a lifelong inability to obtain adequate sleep and is presumably due to an abnormality of the neurologic control of the sleepwake system.
- Narcolepsy - is a disorder of unknown etiology that is characterized by excessive sleepiness that typically is associated with cataplexy and other REMsleep phenomena, such as sleep paralysis and hypnagogic hallucinations
- Recurrent Hypersomnia – is a disorder characterized by recurrent episodes of hypersomnia that typically occur weeks or months apart.
- Idiopathic Hypersomnia - is a disorder of presumed CNS cause that is associated with a normal or prolonged major sleep episode and excessive sleepiness consisting of prolonged (1 to 2 hour) sleep episodes of NREM sleep.
- Post-traumatic Hypersomnia - is a disorder of excessive sleepiness that occurs as a result of a traumatic event involving the central nervous system.
- Obstructive Sleep Apnea Syndrome - is characterized by repetitive episodes of upper airway obstruction that occur during sleep, usually associated with areduction in blood oxygen saturation.
- Central Sleep Apnea Syndrome - is characterized by a cessation or decrease of ventilatory effort during sleep and is usually associated with oxygendesaturation.
- Central Alveolar Hypoventilation Syndrome – is characterized by ventilatory impairment, resulting in sleep-related arterial oxygen desaturation that occurs in patients with normal mechanical properties of the lung.
- Periodic Limb Movement Disorder - is characterized by periodic episodes of repetitive and highly stereotyped limb movements that occur during sleep.
- Restless Legs Syndrome - is a disorder characterized by disagreeable leg sensations that usually occur prior to sleep onset and that cause an almost irresistibleurge to move the legs.
Extrinsic Sleep Disorders
The extrinsic sleep disorders include those disorders that originate or develop from causes outside of the body. External factors are integral in producing these sleep disorders, and removal of the external factors leads to resolution of the sleep disorder.
List of Extrinsic Sleep Disorders
- Inadequate Sleep Hygiene – is a sleep disorder due to the performance of daily living activities that are inconsistent with the maintenance of good quality sleep and full daytime alertness.
- Environmental Sleep Disorder - is a sleep disturbance due to a disturbing environmental factor that causes a complaint of either insomnia or excessivesleepiness.
- Altitude Insomnia - is an acute insomnia, usually accompanied by headaches, loss of appetite, and fatigue, that occurs following ascent to high altitudes.
- Adjustment Sleep Disorder - represents sleep disturbance temporally related to acute stress, conflict, or environmental change that causes emotional arousal.
- Insufficient Sleep Syndrome - is a disorder that occurs in an individual who persistently fails to obtain sufficient nocturnal sleep required to support normally alert wakefulness.
- Limit-Setting Sleep Disorder – is primarily a childhood disorder that is characterized by the inadequate enforcement of bedtimes by a caretaker, with the patient then stalling or refusing to go to bed at an appropriate time.
- Sleep-Onset Association Disorder – occurs when sleep onset is impaired by the absence of a certain object or set of circumstances.
- Food Allergy Insomnia - is a disorder of initiating and maintaining sleep due to an allergic response to food allergens.
- Nocturnal Eating (Drinking) Syndrome - is characterized by recurrent awakenings, with the inability to return to sleep without eating or drinking
- Hypnotic-Dependent Sleep Disorder – is characterized by insomnia or excessive sleepiness that is associated with tolerance to or withdrawal from hypnotic medications.
- Stimulant-Dependent Sleep Disorder - is characterized by a reduction of sleepiness or suppression of sleep by central stimulants and resultant alterations in wakefulness following drug abstinence.
- Alcohol-Dependent Sleep Disorder - is characterized by the sustained ingestion of ethanol for its hypnotic effect.
- Toxin-Induced Sleep Disorder – is characterized by either insomnia or excessive sleepiness produced by poisoning with heavy metals or organic toxins.
Circadian Rhythm Sleep Disorders
The circadian rhythm sleep disorders comprise a third section of dyssomnias and are grouped because they share a common underlying chronophysiologic basis. The major feature of these disorders is a misalignment between the patient’s sleep pattern and the sleep pattern that is desired or regarded as the societal norm.
List of Circadian Rhythm Sleep Disorders
- Time Zone Change (Jet Lag) Syndrome – consists of varying degrees of difficulties in initiating or maintaining sleep, excessive sleepiness, decrements in subjective daytime alertness and performance, and somatic symptoms (largely related to gastrointestinal function) following rapid travel across multiple time zones.
- Shift Work Sleep Disorder – consists of symptoms of insomnia or excessive sleepiness that occur as transient phenomena in relation to work schedules.
- Irregular Sleep-Wake Pattern – consists of temporally disorganized and variable episodes of sleeping and waking behavior.
- Delayed Sleep-Phase Syndrome – is a disorder in which the major sleep episode is delayed in relation to the desired clock time, resulting in symptoms of sleep-onset insomnia or difficulty in awakening at the desired time.
- Advanced Sleep-Phase Syndrome – is a disorder in which the major sleep episode is advanced in relation to the desired clock time, resulting in symptoms of compelling evening sleepiness, an early sleep onset, and an awakening that is earlier than desired.
- Non-24-Hour Sleep-Wake Disorder - consists of a chronic steady pattern comprising one- to two-hour daily delays in sleep onset and wake times inan individual living in society.
The parasomnias consist of clinical disorders that are not abnormalities of the processes responsible for sleep and awake states per se but, rather, are undesirable
physical phenomena that occur predominantly during sleep. The parasomnias are disorders of arousal, partial arousal, and sleep-stage transition. Many of the parasomnias are manifestations of central nervous system activation.
The disorders of arousal are grouped together because impaired arousal from sleep has been postulated as a cause for these disorders. The onset of these disorders
in slow-wave sleep is a typical feature. Although originally included as a disorder of arousal, sleep enuresis can occur during any sleep stage and is not associated solely with an arousal from slow-wave sleep.
List of Arousal Disorders
- Confusional Arousals – consist of confusion during and following arousals from sleep, usually from deep sleep in the first part of the night.
- Sleepwalking – consists of a series of complex behaviors that are initiated during slow-wave sleep and result in walking during sleep.
- Sleep Terrors – are characterized by a sudden arousal from slow-wave sleep with a piercing scream or cry, accompanied by autonomic and behavioral manifestations of intense fear
Sleep-Wake Transition Disorders
The sleep-wake transition disorders occur in the transition from wakefulness to sleep; in the transition from sleep to wakefulness; or, more rarely, in sleep-stage transitions. All of these disorders can occur commonly in otherwise healthy persons and, therefore, are regarded as altered physiology rather than pathophysiology.
Each can occur with an exceptionally high frequency or severity, however, which can lead to discomfort, pain, embarrassment, anxiety, or disturbance of a bedpartner’s sleep.
List of Sleep-Wake Transition Disorders
- Rhythmic Movement Disorder – comprises a group of stereotyped, repetitive movements involving large muscles, usually of the head and neck; the movements typically occur immediately prior to sleep onset and are sustained into light sleep.
- Sleep Starts - are sudden, brief contractions of the legs, sometimes also involving the arms and head, that occur at sleep onset.
- Sleep Talking - is the utterance of speech or sounds during sleep without simultaneous subjective detailed awareness of the event.
- Nocturnal Leg Cramps – are painful sensations of muscular tightness or tension, usually in the calf but occasionally in the foot, that occur during thesleep episode.
Parasomnias Usually Associated with REM Sleep
These parasomnias typically are associated with the REM sleep stage. They are grouped together because some common underlying pathophysiologic mechanism related to REM sleep possibly underlies these disorders.
List of Parasomnias Usually Associated with REM Sleep
- Nightmares - are frightening dreams that usually awaken the sleeper from REM sleep.
- Sleep Paralysis – consists of a period of inability to perform voluntary movements at sleep onset (hypnagogic or predormital form) or upon awakening, either during the night or in the morning (hypnopompic or postdormital form).
- Impaired Sleep-Related Penile Erections - refers to the inability to sustain a penile erection during sleep that would be sufficiently large or rigid enough to engage in sexual intercourse.
- Sleep-Related Painful Erections – are characterized by penile pain that occurs during erections, typically during REM sleep
- REM-Sleep-Related Sinus Arrest - is a cardiac rhythm disorder that is characterized by sinus arrest during REM sleep in otherwise healthy individuals
- REM-Sleep Behavior Disorder – is characterized by the intermittent loss of REM sleep electromyographic (EMG) atonia and by the appearance of elaborate motor activity associated with dream mentation.
List of other Parasomnias
- Sleep Bruxism - is a stereotyped movement disorder characterized by grinding or clenching of the teeth during sleep.
- Sleep Enuresis - is characterized by recurrent involuntary micturition that occurs during sleep.
- Sleep-Related Abnormal Swallowing Syndrome - is a disorder in which inadequate swallowing of saliva results in aspiration, with coughing, choking, and brief arousals or awakenings from sleep.
- Nocturnal Paroxysmal Dystonia - is characterized by repeated dystonia or dyskinetic (ballistic, choreoathetoid) episodes that are stereotypicaland occur during NREM sleep.
- Sudden Unexplained Nocturnal Death Syndrome – is characterized by sudden death during sleep in healthy young adults, particularly ofSoutheast Asian descent.
- Primary Snoring – is characterized by loud upper-airway breathing sounds in sleep, without episodes of apnea or hypoventilation
- Infant Sleep Apnea – is characterized by central or obstructive apneas that occur during sleep.
- Congenital Central Hypoventilation Syndrome - is characterized by hypoventilation, which is worse during sleep than wakefulness and is unexplained by primary pulmonary disease or ventilatory muscle weakness
- Sudden Infant Death Syndrome - is unexpected sudden death in which a thorough postmortem investigation fails to demonstrate an adequate cause for death.
- Benign Neonatal Sleep Myoclonus - is characterized by asynchronous jerking of the limbs and trunk that occurs during quiet sleep in neonates
SLEEP DISORDERS ASSOCIATED WITH MENTAL, NEUROLOGIC, AND OTHER MEDICAL DISORDERS
Mental disorders are very common causes of sleep disturbance.
Sleep Disorders Associated with Mental Disorders
Although most mental disorders can have an associated sleep disturbance, the psychoses, mood disorders, anxiety disorders, panic disorder, and alcoholism are presented here because they are commonly seen in patients presenting with sleep complaints and need to be considered in differential diagnoses.
List of Sleep Disorders Associated with Mental Disorders
- Psychoses – are mental disorders characterized by the occurrence of delusions, hallucinations, incoherence, catatonic behavior, or inappropriate affect that causes impaired social or work functioning. Insomnia or excessive sleepiness is a common feature of the psychoses
- Mood Disorders – are mental disorders characterized by either one or more episodes of depression or partial or full manic or hypomanic episodes. Typically insomnia and, occasionally, excessive sleepiness, are features of mood disorders.
- Anxiety Disorders – are mental disorders that are characterized by symptoms of anxiety and avoidance behavior. The sleep disturbance associated with anxiety disorders is characterized by a sleep-onset or maintenance insomnia due to excessive anxiety and apprehensive expectation about one or more life circumstances.
- Panic Disorder - is a mental disorder that is characterized by discrete periods of intense fear or discomfort with several somatic symptoms that occurunexpectedly and without organic precipitation. Panic episodes can be associated with sudden awakenings from sleep.
- Alcoholism - refers to excessive alcohol intake and applies to both alcohol abuse and dependency. Insomnia or excessive sleepiness is a common feature of alcoholism.
Sleep Disorders Associated with Neurologic Disorders
Neurologic disorders that are commonly associated with sleep disturbance are listed and described here.
List of Sleep Disorders Associated with Neurologic Disorders
- Cerebral Degenerative Disorders – are slowly progressive conditions characterized by abnormal behaviors or involuntary movements, often with evidence of other motor system degeneration.
- Dementia - refers to a loss of memory and other intellectual functions due to a chronic, progressive degenerative disease of the brain. Sleep disturbance in demented patients is characterized by delirium, agitation, combativeness, wandering, and vocalization without ostensible purpose and occuring during early evening or nighttime hours.
- Parkinsonism – refers to a group of neurologic disorders characterized by hypokinesia, tremor, and muscular rigidity. Insomnia is the most common sleep-related symptom in patients with parkinsonism.
- Fatal Familial Insomnia - is a progressive disorder that begins with a difficulty in initiating sleep and leads to total lack of sleep within a few months and, later, to spontaneous lapses from quiet wakefulness into a sleep state with enacted dreams (oneiric stupor).
- Sleep-Related Epilepsy - is a disorder characterized by an intermittent, sudden discharge of cerebral neuronal activity. Sleep may have facilitatory effects on epileptic activity.
- Electrical Status Epilepticus of Sleep - is characterized by continuous and diffuse spike and slow-wave complexes persisting through non-REM (NREM) sleep.
- Sleep-Related Headaches – are severe, mainly unilateral, headaches that often have their onset during sleep.
Sleep Disorders Associated with Other Medical Disorders
A variety of other medical disorders that have features occurring during sleep or that cause sleep disturbance are listed here. Though sleeping sickness is rare outside the continent of Africa, the disorder is included here because it is commonly seen in Africa. Other infectious disorders, such as encephalitis lethargica, are not included here because they rarely occur.
List of Sleep Disorders Associated with Other Medical Disorders
- Sleeping Sickness - is a protozoan-caused illness characterized by an acute febrile lymphadenopathy; after a usual latency period of four to six months, the lymphadenopathy is followed by excessive sleepiness associated with a chronic meningoencephalomyelitis.
- Nocturnal Cardiac Ischemia - is characterized by ischemia of the myocardium that occurs during the major sleep episode.
- Chronic Obstructive Pulmonary Disease - is characterized by a chronic impairment of airflow through the respiratory tract between the atmosphere and the gas-exchange portion of the lung. Altered cardiorespiratory physiology during sleep or a complaint of insomnia can occur.
- Sleep-Related Asthma – refers to asthma attacks that occur during sleep.
- Sleep-Related Gastroesophageal Reflux - is characterized by regurgitation of stomach contents into the esophagus during sleep.
- Peptic Ulcer Disease - is characterized by gastric or duodenal ulceration by acid and pepsin that can produce awakenings from sleep with pain or discomfort in the abdomen.
- Fibromyalgia – is characterized by diffuse musculoskeletal pain, chronic fatigue, unrefreshing sleep, and increased tenderness in specific localized anatomic regions, without laboratory evidence of contributing articular, nonarticular, or metabolic disease
Proposed Sleep Disorders
Includes those sleep disorders for which insufficient or inadequate information is available to substantiate the unequivocal existence of the disorder.
List of Proposed Sleep Disorders
- Short Sleeper - is an individual who habitually sleeps substantially less during a 24-hour period than is expected for a person in his or her age group.
- Long Sleeper - is an individual who consistently sleeps substantially more in 24 hours than does the typical person of his or her age group. Sleep, although long, is basically normal in architecture and physiology.
- Subwakefulness Syndrome - consists of a complaint of an inability to sustain daytime alertness without polysomnographic evidence of nocturnal sleepdisruption or severe excessive sleepiness.
- Fragmentary Myoclonus - is characterized by jerks that consist of brief involuntary “twitchlike” local contractions that involve various areas of both sides of the body in an asynchronous and asymmetrical manner during sleep.
- Sleep Hyperhidrosis - is characterized by profuse sweating that occurs during sleep.
- Menstrual-Associated Sleep Disorder - is a disorder of unknown cause, characterized by a complaint of either insomnia or excessive sleepiness, that istemporally related to the menses or menopause.
- Pregnancy-Associated Sleep Disorder - is characterized by the occurrence of either insomnia or excessive sleepiness that develops in the course of pregnancy
- Terrifying Hypnagogic Hallucinations – are terrifying dream experiences that occur at sleep onset and are similar to, or at times indistinguishable from, those dreams that take place within sleep.
- Sleep-Related Neurogenic Tachypnea - is characterized by a sustained increase in respiratory rate during sleep. The respiratory rate occurs at sleep onset, is maintained throughout sleep, and reverses immediately upon return to wakefulness.
- Sleep-Related Laryngospasm - refers to episodes of abrupt awakenings from sleep with an intense sensation of inability to breathe and stridor.
- Sleep Choking Syndrome - is a disorder of unknown etiology characterized by frequent episodes of awakening with a choking sensation