Most everyone has had the frustrating experience of feeling fatigue and a lack of energy following a night of sleeping poorly. Fortunately, most people are able to catch up on their sleep the following evening. When falling asleep and or staying asleep becomes an ongoing problem, this is known as insomnia. Chronic insomnia is disruptive to a person’s health and well-being and can be especially dangerous when an exhausted or sleepy person is driving or operating heavy machinery.
Sometimes chronic insomnia is due to another condition, or parasomnia, occurring at night. A parasomnia is an abnormality that can happen while a person is falling asleep or at any point during the sleep cycle. There are numerous different parasomnias and unfortunately, most have no identifiable cause. They affect people of all ages and often run in families. Stress, depression, sleep apnea, and certain medications may be contributing factors to parasomnias.
Sleep Apnea is not a parasomnia. Sleep apnea is a common disorder when a person has pauses in breathing during sleep.These breathing pauses last from a few seconds to minutes. Typically, normal breathing will start again after a snort or choking sound.When breathing pauses occur, oxygen levels in the body drop, causing the person move from a deep sleep into a lighter, poor quality sleep.
Examples of Parasomnias Include:
Somnambulism (Sleepwalking): This is a disorder when a person walks or does another activity while still asleep. Sleepwalking most often occurs during deep, non-REM (rapid eye movement) sleep early on in the night.
Sleep paralysis: This parasomnia occurs while a person is falling asleep. An affected individual feels unable to move for a period of time lasting from just a few seconds to several minutes. Sleep paralysis can be very frightening and may involve hallucinations.
Bruxism: This is a condition where a person grinds their teeth or clenches their jaw unintentionally during deep sleep. It may be related to stress or misaligned teeth. Bruxism can cause headaches or earaches. Prolonged nighttime grinding can wear down tooth enamel, chip teeth, and cause facial pain or jaw problems.
Night Terrors: Night terrors occur during deep, non-REM sleep. In contrast, nightmares and most dreams occur during REM sleep. During a Night Terror, a person will suddenly sit up in bed, may scream out loud and develop a rapid heartbeat and fast breathing. Because these incidents do not occur during REM sleep and lack associated visual images, episodes are typically not remembered when a person wakes.
Restless Legs Syndrome: Restless legs syndrome (RLS) is a disorder that causes strong urges for a person to move their legs in order to relieve strange and unpleasant feelings. These uncomfortable sensations are often described as creeping, crawling, pulling, itching, tingling, burning, aching, or electric shocks. The symptoms of RLS tend to be worse in the evening hours and frequently disrupt sleep.
Rapid Eye Movement Behavior Disorder: In this disorder, a person acts out nightmares or violent dreams during the REM sleep cycle. It occurs most commonly in men over 50, but can affect anyone. Rapid Eye Movement Behavior Disorder can be associated with taking certain medications or having an underlying neurologic disease.
Hypersomnia: A person with hypersomnia has recurrent episodes of excessive daytime sleepiness or prolonged nighttime sleep. They nap at inappropriate times such as during a conversation. These naps provide no relief from their symptoms of hypersomnia. Waking from periods of long sleep can be difficult and disorienting. This condition can be caused by narcolepsy or sleep apnea.
Nocturia: Awakening from sleep with the recurring need to pass urine more than two times each night. It can be an early and subtle clue to important underlying medical problems. Nocturia can occur at any age, but is more common after age 60.
Hypopnea: When sleep is disrupted by a person’s shallow breathing or abnormally low respiratory rates. Like in sleep apnea, sudden drops in blood oxygen levels cause a person to wake up out of a deeper, more restorative stage of sleep. Hypopnea can be caused by a nasal passage defect, obesity, old age, certain medications, smoking, and alcohol abuse.
Desynchronosis (Jet Lag): Occurs when the body’s natural sleep wake cycle (circadian rhythm) is disrupted by travel to a different time zone or by shift work. The body’s eating and sleeping patterns become out of sync. Some symptoms include headaches, fatigue, disorientation, and irritability. Maintaining good sleep hygiene habits can help overcome these symptoms more quickly.
Narcolepsy: This is a disorder of the central nervous system where the brain cannot control sleep-wake cycles. This causes periods of extreme daytime sleepiness and may cause muscle weakness. Some people who have the disorder fall asleep suddenly during the day, even if they’re in the middle of speaking, eating, or other activities.
Delayed Sleep Phase Syndrome: Delayed sleep phase disorder is when a person’s circadian rhythm (internal sleep clock) is shifted to falling asleep later at night and waking later in the morning. Sleep quality is generally normal, but delayed sleep pattern often interferes with work and social demands.
Snoring: Snoring occurs when a person can’t move air freely through his or her nose and mouth during sleep. This noisy breathing can be caused by vibrations in the tongue, upper throat, soft palate, uvula, tonsils or adenoids.
Anyone experiencing chronic difficulties sleeping should see a doctor for evaluation. If the cause of your insomnia is not clear, your doctor may suggest that you fill out a sleep diary. The diary will help you keep track of when you go to bed, how long you are in bed before falling asleep, how often you wake up during the night, when you get up in the morning and how well you sleep. A sleep diary may help you and your doctor to identify patterns and conditions that are affecting your sleep.
Based on your symptoms and physical findings, your doctor can develop an appropriate treatment plan and determine if a referral to a sleep disorder specialist is needed. Many sleep disorders are manageable and improve with a variety of different treatment options. So, if needed, seek care to get that good night’s rest.
Cynthia Vanson, MD