Your Guide to Recognising Your Sleep Disorder
There are a wide variety of sleep disorders which can disturb your sleep and impact your quality of life. When there are so many sleep disorders, how can you tell which potential disorder is causing your sleep problems? This article will take you through all you need to know to help you identify your symptoms and recognise your sleep disorder.
What are sleep disorders?
Firstly, let’s take a look at what sleep disorders actually are. A sleep disorder is simply a condition which affects your sleep in some way. The National Sleep Foundation explains that there are many ways a disorder can affect your sleep including affecting:, “sleep quality, timing, or duration and impact a person’s ability to properly function while they are awake.”
This means that sleep disorders don’t only cause nighttime disturbance, they also lead to daytime symptoms. This is because sleep is vital for our mind and body to function correctly. When we’re asleep, there is actually a lot going on in our mind which helps us to function during the day.
Our sleep is divided into stages between two types of sleep: Non-rapid Eye Movement (NREM) and Rapid Eye Movement (REM). We move through these stages repeatedly throughout the night. Each individual stage of sleep has a vital job to do. When our sleep is regularly disturbed and we can’t engage in all of our sleep cycles, this can markedly impact our levels of functioning.
An ongoing sleep disorder can lead to issues with cognitive functioning, such as problems with memory, learning, focus, and reaction times. It can also cause us to be less alert and fatigued, which can make it challenging to function and can even be dangerous in certain situations.
Lack of sleep can also be extremely frustrating and worrying. Unfortunately, this worry only increases stress and makes it less likely that you will be able to sleep. This cycle can really take its toll emotionally. A sleep disorder can even contribute to changes in mood, leading to mental illness such as anxiety and depression. Our physical health is also affected, with increased risk of developing health conditions such as weight gain, diabetes, and heart disease to name only a few.
Sleep disorders and their effects can range in severity and duration depending on the individual, even within one type of disorder. It’s common for symptoms to change over time in reaction to external stimuli and of course, depending whether an individual gets treatment for their disorder. Sleep disorders are very common, affecting up to a third of adults. Thankfully, once you’ve identified a sleep disorder, there are plenty of effective treatments which can help you to get the sleep you need again!
Symptoms of sleep deprivation / disturbed sleep
We’ll summarize the potential consequences of not getting enough sleep each night or of having a disturbed sleep, as these will correspond with all of the sleep disorders we’ll discuss. We’ll focus on the symptoms you may notice within yourself in your waking hours. This will help to recognise the presence of a sleep disorder, and allow you to go on to pinpoint specific sleep disorder symptoms further.
- Fatigue and drowsiness
- Problems with focus and concentration
- Memory issues
- Problems with learning new things
- Reduced creativity
- Issues with problem solving
- Slow or ‘foggy’ thinking
- Poor balance
- Slower reaction times
- Increased risk of accidents and likelihood of making mistakes
- Mood disturbances: irritability, stress, and low mood
- Potential mental health impact: anxiety and depression
- Potential declining physical health
- Weight gain
- Low libido
How to recognise your sleep disorder
Now that we know what sleep disorders are, we can dive into how you can practically recognise your type of sleep disorder.
Keep track of your symptoms
The first step you can take if you’re struggling with disturbed sleep, is keeping track of your symptoms. You should be consistent and track your symptoms each day and night. You could do this very simply by jotting them down. However, to make it even easier to keep track of your symptoms over time, you could use a sleep diary. A sleep diary is an easy to use table which keeps track of a range of information about your sleep patterns. You could draw your own or find free templates online.
A sleep diary should include information such as:
- What time you went to bed and what time you woke up
- How easy or difficult you found it to fall asleep
- Whether your sleep was disturbed and if so, how many times you woke up
- Whether you could pinpoint anything specific which woke you up
- How many hours of sleep you got (don’t worry, this can be a rough estimate)
- How you felt emotionally when you were in bed
- How you felt when you woke up in the morning
- What you did just before you went to bed
- Your activity during the day (such as how active you were, whether you took medication, whether you napped, how your mood was, and so on)
- Any specific nighttime or daytime symptoms you want to note down
This information equips you, and your doctor if you decide to seek a professional diagnosis, with clear and detailed information about your symptoms. It can help you to identify individual symptoms so you can see how they match with a specific sleep disorder. It can also help you to notice any patterns and pinpoint any habits or events which may be worsening, or improving, your sleep.
Ask others in your home to share their point of view
Sometimes it can be hard to notice all of your behaviours, actions, and to be constantly aware of your mood. You naturally might miss things! If you live with others, it can be a great idea to ask them what symptoms they have noticed as an outsider looking in.
Of course, some of your symptoms may be displayed when you’re actually asleep so you may not be aware of them at all. It’s a good idea to ask those you live with if they have heard or seen any symptoms. If they have, ask them to describe the symptoms and take notice of how often they occur over the coming weeks. They could even keep their own record. This can help you to get a well rounded view of what’s happening when you sleep.
Do your research
Once you’ve got a clear record of your symptoms, it’s time to do some research into sleep disorders. Read articles and blogs online, read books, or watch videos. Take your time to educate yourself on sleep disorders so you can see what fits best with the symptoms you’ve identified.
We’ll go over each individual sleep disorder and provide information about all of the symptoms you might experience if you struggle with each disorder. We’ll also describe how they might feel to you or how they may appear to others. This information should help you to put a name to your disorder.
Insomnia is the most common type of sleep disorder, with up to 30% of adults struggling with insomnia in some form. This disorder can cause problems with falling asleep and staying asleep, despite there being no obvious cause for the lack of sleep. If you have insomnia you might have a wide range of symptoms, including:
- Finding it difficult to fall asleep at night
- Waking up during the night
- Waking up very early and not being able to go back to sleep
- Feeling very tired when you get up in the morning
- Feeling very tired throughout the day
- Finding your mood is low or that you feel irritable during the day
- Declining mental health, such as experiencing depression and anxiety
- The effects of sleep deprivation
- Being more accident prone or making more mistakes than you would usually
- Feeling very frustrated and worried about not being able to sleep
- High stress levels
To narrow it down even further, there are a few different types of insomnia you might struggle with. You can experience more than one type of insomnia at the same time. For example, you may have chronic, maintenance insomnia, which simply refers to how long your insomnia lasts and at which stage of the night it affects you.
If you have onset insomnia, this means that you will struggle to go to sleep at the beginning of the night when you first go to bed. If you had onset insomnia, there would be no other reason for you not being able to sleep, for example there would be no noises keeping you awake or nothing making your bed uncomfortable. You might find that you are lying awake in bed for a long time, unable to drift off to sleep. You may initially feel relaxed and comfortable, yet you still can’t get to sleep. You may become very restless and get increasingly frustrated the longer you lie awake.
If you struggle with maintenance insomnia, you will have problems staying asleep for the whole night. You might wake up during the night, sometimes multiple times. There would be no particular reason for you waking you up. For example, you wouldn’t be startled out of sleep by a loud noise, instead you would just wake up without being prompted. Once you are awake, you are likely to find it very difficult to get back to sleep. You might also wake up really early in the morning before you need to be up, but yet find it impossible to get back to sleep.
Acute insomnia refers to the length of time your insomnia lasts. If your insomnia is acute, it means it’s short term, usually only lasting a few weeks at the most. Typically if you have acute insomnia, it will be in reaction to something significant happening in your life. If you notice you start to develop sleep problems after a time of stress, a big change, or losing a loved one for example, then you may have acute insomnia.
If you have chronic insomnia, this simply means that your insomnia is long term. If your insomnia lasts for three months or longer, and you typically have sleeping problems three nights or more each week, then you could have chronic insomnia.
Comorbid insomnia means that your insomnia occurs as a result of, or alongside, another health condition. This could be a physical health condition, such as chronic pain, diabetes, heart disease, irritable bowel syndrome (IBS), and so on. If you have any physical condition which makes it difficult to get comfortable at night, or which wakes you up frequently during the night, then you may have comorbid insomnia. Sometimes the medications taken to treat physical conditions can also cause insomnia.
As well as physical health conditions, mental illness can cause insomnia. Sometimes the symptoms of mental illness can make it difficult to sleep. Often when we have a lot on our mind, it can be tough to relax enough to drift off to sleep at night. Just like with physical conditions, sometimes the medications taken to treat mental illness can contribute to insomnia. If you have a mental illness as well as sleep problems, you might have comorbid insomnia.
Hypersomnias are a group of sleep disorders which cause the individual to be very tired during the day, even if they’ve had the right amount of sleep during the night. This tiredness can be so severe that it can cause you to fall asleep at inappropriate times during the day. Let’s take a look at individual hypersomnias and their symptoms.
Narcolepsy is a lifelong disorder, although it can be managed so you can live a full life. If you have narcolepsy, you will feel uncontrollably tired during the day even if you have slept well the night before. You might find that this tiredness increases to an overwhelming degree at random times during the day, often without warning. You may even fall asleep suddenly.
Some people with narcolepsy struggle with a symptom called cataplexy, which causes the more well known ‘sleep attacks’. If you experience cataplexy this will cause you to lose control of your muscles. You might fall down, your head might droop, or you may experience slurred speech. Cataplexy is often triggered by strong emotions, such as if you get stressed, excited, if you laugh, or if you become angry. It’s important to note that not everyone with narcolepsy experiences cataplexy, so if you don’t experience it but have the other symptoms, you may still have narcolepsy.
If you have narcolepsy you might experience sleep paralysis when you wake up or while you’re falling asleep. This causes a temporary paralysis of your muscles. It can be frightening and is something you can’t control. However, it’s important to note that you can have sleep paralysis without narcolepsy, so you must also have other symptoms to identify narcolepsy.
If you struggle with narcolepsy, you might also experience automatic behaviour, which means that you ‘zone out’ or essentially fall asleep while carrying out a task. When you come to, you will still be carrying out that task automatically, although you might not remember what you’ve done.
It’s also important to note that someone with narcolepsy will experience changes in rapid eye movement (REM) sleep. We typically experience REM sleep a little while after we fall asleep. It’s when we do most of our dreaming! However, if you have narcolepsy you might experience REM sleep at any time you fall asleep, even when you nod off during the day.
Let’s summarize the symptoms you may experience if you have narcolepsy:
- Excessive daytime sleepiness
- Suddenly falling asleep
- Decreased alertness and problems with focus during the day
- Excessive dreaming
- Frequently waking up during the night
- Hallucinations when falling asleep or waking up
- Changes in REM sleep
- Memory problems
- Frequent headaches
- Automatic behaviour
Idiopathic hypersomnia (IH)
IH is a chronic sleep disorder which will cause you to feel a strong urge to sleep during the day, despite having a normal sleep schedule. IH is quite rare and the cause is not currently known. If you have IH, you may sleep for long periods during the night, perhaps 11 hours or more. However, when you wake up, you won’t feel refreshed and will instead still feel that you need more sleep. You may hear this referred to as non-restorative sleep.
You might take long naps during the day to try to satisfy your need for sleep, but will likely still feel tired and unfreshed. You may also struggle with a symptom called sleep inertia or sleep drunkenness, which causes you to feel confused, disoriented, and irritable when you wake up. This can take a while to pass as you try to reach a fully ‘awake’ state.
You may find that your symptoms might first appear in your teens or early twenties, although they can appear earlier or later than that in some cases. The disorder can make it very difficult to function and you might find that you are struggling to work, to maintain relationships, to do things you enjoy, and to function generally.
If you have IH, you might experience the follow symptoms:
- Excessive daytime sleepiness
- Long periods of sleep during the night
- Non-restorative sleep
- Sleep inertia
- The need to take naps during the day
- Mental ‘fog’
- Problems with memory, focus, and other cognitive functions
- Very deep sleep it’s hard to wake up from
- Automatic behaviour
- Mood disturbances such as irritability and depression
If you are a long sleeper, you will need more hours of sleep each night than is recommended for your age. You will regularly sleep for long periods of time, often between 10 and 12 hours every night. If you get the long period of sleep you need, you will feel rested and able to function normally throughout the day. However, if life responsibilities mean that you are unable to get the long sleep you need, then you will feel tired during the day and struggle with the effects of lack of sleep.
Some long sleepers are able to sleep less during the week and ‘catch up’ on weekends, sleeping very long periods of time of 15 hours or more. Needing so much sleep may also make it tough for you to keep up with social engagements, to maintain relationships, and to meet the demands of a full time job. You might feel as though there are never enough ‘awake’ hours during the day.
In summary, long sleeper symptoms include:
- Needing to sleep for a long period of time (up to 12 hours or even more)
- Struggling with the effects of lack of sleep if you can’t get the amount of sleep you need
- Feeling there’s not enough time in the day
- Finding it hard to fit in daily responsibilities and hobbies
Insufficient sleep syndrome
If you have insufficient sleep syndrome, you will find that you are regularly getting less sleep than you need at night. This will cause you to experience the consequences of lack of sleep during the day. Your lack of sleep will stem from choices you are making, but is unlikely to be deliberate. You are likely to be unaware that you need more sleep or that you are preventing yourself from getting the sleep you need.
These choices might include things like staying up late and getting up early. This might be because you have a lot to do and life responsibilities get in the way. It might be that you are going out socializing and not giving yourself enough time to get the sleep you need. It may be that you have poor sleep hygiene habits: this might include drinking caffeine before bed; not winding down before you go to bed; or not keeping a consistent sleep schedule.
It’s important to note that there will be no other medical reason for you not sleeping and when you do sleep, your sleep is of normal quality. You might find that your symptoms will markedly improve after nights where you do get enough sleep.
If you have insufficient sleep syndrome you may experience the following symptoms:
- Regularly spending less than eight hours in bed
- Having a lifestyle which limits the time you are in bed
- Struggling with concentration and focus
- Difficulty with memory and learning new things
- Feeling very tired during the day
- Mood disturbances such as irritability, getting distracted, and anxiety
- The effects of sleep deprivation during the day
Parasomnias are a group of sleep disorders which involve unwanted experiences when you’re falling asleep, during sleep, or when you’re waking up. The American Academy of Sleep Medicine explains that this can include, “abnormal movements, behaviors, emotions, perceptions or dreams.” Some parasomnias may happen when you’re asleep and you won’t recall much about them, so you may recognise the symptoms from what others you live with have told you.
Night terrors typically occur in children, but do sometimes happen in adults. You might also hear them referred to as sleep terrors. If you experience night terrors, you will experience moments of terror during sleep which can cause you to sit up in bed, to make noise, and to move around in a distressed manner. In some adults, this can lead to them getting up and moving around, and in rare cases can even cause aggressive behaviour.
When you wake up you might not remember anything that has happened, or you may remember brief moments of what was going on. You might feel very confused and frightened as you wake up. You might remember a nightmare that corresponds with your night terror. This might happen regularly or only once in a while. Depending on your behaviour during a night terror, your loved ones may be worried about your safety.
Symptoms of night terrors (most of which loved ones will notice) can include:
- Sitting up in bed
- Screaming or crying out in fear
- Kicking your legs or thrashing around the bed
- Saying or shouting things out loud (these words might make no sense or be hard to make out)
- Excessive sweating
- Breathing heavily
- Staring wide eyed
- Racing pulse
- Getting up and moving around
- Confusion upon waking
- Effects of disturbed sleep during the day
Sleepwalking used to be known as somnambulism. If you struggle with sleep walking, during the deeper stages of sleep you will get up from your bed and walk around while still asleep, as well as potentially carrying out other behaviours. These behaviours can range from sitting up in bed or slowly walking around, to getting dressed, moving items in the home, leaving the house, and even going to the toilet in inappropriate places.
If you sleepwalk, it’s likely that you will not remember what happened when you wake up. It’s your loved ones who will be likely to notice these symptoms and report them back to you. It can be quite distressing to watch for loved ones, and can be dangerous depending on the behaviours you carry out.
Symptoms of sleepwalking include:
- Carrying out a range of behaviours while you’re asleep
- Having a glazed expression while sleepwalking
- Not responding with others while sleepwalking
- Being difficult to wake up during sleepwalking
- Lack of memory of your sleepwalking
- Being confused as you wake up
- Experiencing issues with functioning during the day due to disturbed sleep
If you experience confusional arousals, you will feel very confused and disoriented when you wake up or just after waking. It may feel as though you are thinking through a fog. To those around you, it might seem like you don’t know where you are or what is going on. Your speech may be slow, your thinking may be distorted and foggy, and you may have reduced memory. You may also grind your teeth. To others you may seem to be acting very out of character.
These episodes can last from a few minutes to a few hours. You might have a vague memory of what happened, or you may not remember anything at all. Like the other parasomnias we’ve talked about, it’s likely that these symptoms will be noticed by loved ones rather than yourself.
A summary of symptoms includes:
- Being confused and disoriented upon waking
- Slow or slurred speech
- Poor memory
- Out of character behaviour
- Teeth grinding
- Feeling tired and confused after the episode is over
Sleep related eating disorder (SRED)
If you struggle with SRED, you will carry out binge eating and drinking behaviour during the night in a very out of control way. This happens even though you aren’t hungry or thirsty. How alert and aware you are can vary. It may be that you don’t remember anything of your episodes, and it’s loved ones who point your symptoms out. However, you might partially remember episodes or even be very aware. If someone tries to wake you or stop you during eating, you might be angry and resist their help.
If you have SRED, you will typically have an episode at least once at night, sometimes multiple times each night. Even if you don’t remember the episodes personally, there are other indicators you might notice. For example, it’s likely you will be very sloppy when finding food, preparing it, and eating. Therefore you might notice a mess in the kitchen in the morning.
You may notice food left in places where it wouldn’t usually be. You might notice you eat foods that you wouldn’t usually gravitate towards during the day. You might even consume things which aren’t safe. If you’ve tried to prepare hot food, you might have burnt or cut yourself. You may also find yourself feeling sick or unusually full in the morning. There might also be damage to your kitchen.
Symptoms of SRED include:
- Eating or drinking during sleep
- Being hard to wake up or interrupt
- Finding injuries which have occured during episodes
- Finding evidence of your behaviour in the morning
- Loss of appetite the next morning
- Stomach pain and nausea in the morning
- Unexpected weight gain
- Problems with daily functioning due to disturbed sleep
REM sleep behaviour disorder (RBD)
We do most of our dreaming during the REM stage of sleep. In order to keep us safe, our muscles are temporarily paraylzed during this stage of sleep to stop us acting out our dreams. However, if you have RBD, this paralysis doesn’t take place. This means you’re able to act out your dreams. You might thrash around, cry out, shout, or even get up and move around. This can potentially be dangerous for yourself and your partner if you share a bed with someone.
This is not something you are likely to recall in the morning, but you might remember the dream you were having if you wake up during an episode. Therefore, as with our other parasomnias, these symptoms are most likely to be pointed out by a loved one.
A summary of symptoms is shown below:
- Movement during dreaming
- Making noise during dreaming
- Potential injury to yourself or bed partner
- Feeling the effects of disturbed sleep during the day
If you experience sleep paralysis, you will find that you are unable to move or speak as you are waking up or falling asleep. You can see and hear what is happening around you and are fully aware. Some people might find they can’t open their eyes but their other senses are active. It’s easy to see how this can be really frightening, although it’s not actually dangerous. You might only have this experience once or twice, or it can happen more regularly. The episodes can last a few moments or up to 20 minutes.
Along with the paralysis, you might also experience hallucinations, which can make the experience more frightening. Hypnagogic hallucinations are hallucinations which happen while you’re falling asleep, while hypnopompic hallucinations happen while you’re waking up.
Hallucinations which accompany sleep paralysis can include you feeling as though there is an intruder or a dangerous presence in the room. You might also feel as though there is pressure being put on your chest. Vestibular-motor (V-M) hallucinations can cause you to feel as though you are moving even though you aren’t, such as the sensation of falling or of rising up off the bed.
A summary of sleep paralysis symptoms you may experience include:
- Being unable to move as you wake up or fall asleep
- Being full aware of what is going on
- Being able to see, hear, and smell
- Feeling frightened
- Experiencing fatigue and issues with functioning during the day due to disturbed sleep
Everyone has nightmares now and then, so you’ll likely already know how they feel. They are realistic, disturbing, or frightening dreams which can wake you up or leave you feeling unsettled. When this only happens now and then, it’s perfectly normal. However, some people have frequent nightmares and this is when it becomes a sleep disorder.
If you have frequent nightmares, you will regularly find that you are experiencing distressing nightmares. You will likely find that they jolt you awake or disturb you from your sleep. You might start to feel uncomfortable at the thought of sleep, because you don’t want to experience the nightmares you know are likely.
Symptoms you are likely to experience include:
- Vivid and realistic dreams which are frightening or disturbing
- Being startled awake by your nightmares
- Feeling very afraid
- Your heart pounding and sometimes sweating in fear
- The effects of sleep disturbance during the day
- Problems with anxiety and depression if nightmares are very frequent
Sleep related hallucinations are imagined experiences which feel very real. You might see, hear, feel, sense, or even taste something during a hallucination. As we mentioned earlier, hypnagogic hallucinations happen when you’re falling asleep, while hypnopompic hallucinations occur as you’re waking up.
If you experience sleep related hallucinations, they may happen now and then, or may occur often. They may be frightening, mundane, or even pleasant: the themes can vary greatly. If they are frightening, you may develop a lot of anxiety around going to sleep. Hallucinations can happen in conjunction with another sleep disorder, such as sleep paralysis or narcolepsy. However, they can also happen for seemingly no reason.
Symptoms of sleep related hallucinations include:
- Seeing, smelling, hearing, tasting, or sensing something which isn’t real as you’re falling asleep or waking up
- Feeling confused or frightened
- The effects of sleep disturbance during the day
- Beginning to fear going to bed at night
Sleep talking is also known as somniloquy and is simply talking in your sleep. Unless a loved one tells you are a sleep talker, it’s unlikely you will know. It is rare for it to wake you up and doesn’t typically disturb your quality of sleep. What you say might make sense, or it may be mumbling and nonsensical phrases. You may also laugh or make other noises. Sleep talking usually won’t cause any problems for you unless you find it embarrassing or awkward. However, it may disturb your partner if you share a bed or other housemates if you are particularly loud.
The only symptom of sleep talking is talking, mumbling, laughing, or making other noises while you’re asleep .
Exploding head syndrome
The name of disorder sounds dangerous and worrying, however it isn’t harmful. If you struggle with exploding head syndrome, you will hear loud explosion like noises either as you’re falling asleep, or as you’re waking up. These noises are a type of sleep hallucination: this means that they are ‘imagined’ but will sound as though they are external.
The experience can be very frightening and can understandably start you out of sleep. It can be difficult to get back to sleep afterwards if this happens as you’re trying to fall asleep. This can happen once or multiple times.
Symptoms you might notice if you have exploding head syndrome include:
- Loud ‘explosion’ noises as you’re falling asleep or waking up
- Being startled out of your sleep
- Flashes of light which may accompany the loud noise
- A racing heart rate
- Muscle twitches
- Sometimes a pain in your head along with the sound
- Fear and distress
- Daytime symptoms as a result of disturbed sleep
- Anxiety developing around going to bed at night
Sleep related breathing disorders
The National Sleep Foundation explains that sleep related breathing disorders are conditions which cause, “abnormal and difficult respiration during sleep”. These disorders can be harmless, such as snoring and groaning in your sleep: these rarely disturb your own sleep but may be annoying for bed partners. However, sleep related breathing disorders can also be more severe, like the sleep apneas we are going to discuss.
Obstructive sleep apnea
Obstructive sleep apnea is a common disorder. It’s a serious one because it stops you breathing while you’re asleep. This is typically caused by the muscles in the back of your throat relaxing too much during sleep, causing your tongue to fall back and obstruct your airway. You aren’t getting enough air into your lungs, so you might snore or make choking noise as you try to breathe while asleep.
The noises you make might wake you up, or the feeling of not being able to breathe might startle you awake. If you don’t wake up, a loved one might notice any noises you are making. Even if you are not consciously awake, your body wakes up each time it happens, so this causes disturbed sleep. This is likely to happen a few times a night, or in severe cases can happen hundreds of times each night.
Symptoms of obstructive sleep apnea include:
- Regularly stopping breathing while asleep
- Snoring or making choking noises
- Being woken up from your sleep
- Feeling unrefreshed in the morning
- Being very tired during the day
- Falling asleep during the day
- Frequent headaches
- The effects of disturbed sleep during the day
- Long term results of lack of oxygen (including high blood pressure, heart disease, diabetes, stroke and more)
- Mental illness (such as depression and anxiety)
- Loss of sex drive
- Leg swelling
Central sleep apnea
Central sleep apnea shares very similar symptoms to obstructive sleep apnea, as the condition stops you breathing while you’re asleep. However, rather than this happening as a result of an obstruction preventing you breathing, central sleep apnea occurs because of an issue with how your heart or brain functions. There are a few different types of central sleep apnea with various causes. They all have similar symptoms.
Sleep related movement disorders (SRMDs)
SMRDs are sleep disorders which involve movements which disturb sleep. This article states that SMRD’s, “are a group of relatively simple, stereotyped or monophasic movement disorders that disturb sleep.”
Restless leg syndrome
If you have restless leg syndrome you will feel like it’s almost impossible to keep your legs still at times, especially when you’re lying still at night. You might feel a crawling, creeping, tingling, or itchy sensation in your legs along with the powerful urge to move them. You may also feel a general sense of uncomfortableness in your legs when they are still.
This is likely to happen in both legs, although in some people it can happen in just one. Sometimes it can also happen in your arms and other areas of your body. It may not happen every night consistently, but is likely to occur regularly. You will typically find the symptoms make it very difficult to fall asleep or stay asleep.
Symptoms of restless leg syndrome you may notice include:
- An uncomfortable or strange sensation in your legs at night
- Feeling you must move your legs
- Feeling distressed and unable to relax
- The effects of disturbed sleep during the day
- Anxiety around going to bed
Periodic Limb Movement Disorder (PLMD)
If you have PLMD, you will experience uncontrollable, repetitive movements which disturb your sleep. These movements are usually in the legs, although they can sometimes occur in the arms and hands. The National Sleep Foundation describes the movements as, “brief muscle twitches, jerking movements or an upward flexing of the feet.”
Each individual episode can last up to an hour, with movements happening every 20-40 seconds. It can happen multiple times a night. For some people, their movements may not wake them up. If this is the case, you may only know you have PLMD if your bed partner notices the symptoms. However, PLMD can make it difficult to relax enough to sleep, and for many people the movements can startle you out of sleep during the night.
In summary, symptoms you may notice if you have PLMD include:
- Sudden, involuntary movements in your legs and feet at night
- An uncomfortable feeling in your legs when you’re trying to fall asleep
- Difficulty falling asleep
- Regularly being awoken by your movements
- Feeling unrefreshed when you wake up in the morning
- The effects of sleep disturbance during the day
Bruxism simply means that you clench your jaw and grind your teeth while you’re asleep. If your symptoms are mild or don’t happen regularly, you might not notice you have sleep bruxism at all as it won’t wake you up. However, if it’s a regular occurrence and symptoms are more severe, a loved one may notice and point it out to you.
You might also notice the effects of bruxism yourself which can indicate you have the disorder. This might include your jaw aching when you wake up or neck pain as a result of tight jaw muscles during the night. You might also wake up with a headache. You may notice damage to your teeth which you can’t explain.
To summarize, the symptoms of sleep bruxism can include:
- Teeth grinding and jaw clenching
- Damage to the teeth including teeth which are, “are flattened, fractured, chipped or loose.”
- Worn tooth enamel
- Tooth pain and sensitivity
- Pain in your jaw, face, or neck
- A stiff or tired jaw in the morning
- Tension headaches upon waking
- Damage to the inside of your cheek if you chew it during sleep
Circadian rhythm disorders
Our circadian rhythm is like our internal body clock. It uses environmental cues, such as sunlight and darkness, to control when we are awake and we are asleep. If you have a circadian rhythm disorder, this body clock is not functioning correctly. This article from the Division of Sleep Medicine at the University of Pennsylvania explains that: “In circadian rhythm disorders, endogenous sleep-wake rhythms (body clock) and the external light-darkness cycle become misaligned (desynchronized).”
Delayed sleep-wake phase disorder (DSP)
If you have DSP, your typical sleep pattern is delayed by two hours or more. This means that you will go to bed and wake up later than what is considered ‘normal’. If your schedule allows you to go to bed and get up later so that you can get the right amount of sleep, this won’t cause any problems.
However, a lot of people with DSP find that their preferred sleeping patterns don’t fit in with their responsibilities in life. This means that you might not have the time to get the amount of sleep you need, and you will find it very difficult to try to go to sleep earlier. This leads to sleep deficiency and its associated problems. You might find that you struggle to get up on time in the morning, even if you set an alarm. This can cause you to regularly be late for school or work.
Symptoms you might notice if you have DSP include:
- A regular delayed sleep pattern of two hours or more
- Trouble falling asleep at a ‘normal’ time of night
- Trouble waking up early in the morning
- Daytime fatigue
- The effects of sleep deprivation during the day
Advanced sleep-wake phase disorder (ASP)
ASP is like the opposite of DSP: if you have ASP your sleep pattern will be shifted forward causing you to go to sleep and get up much earlier than normal. You might find that you are ready to sleep by 7pm or 8pm, sometimes even earlier. You may find yourself exhausted if you try to stay up later and even find that you’re falling asleep involuntarily. Likewise, you will be awake in the very early hours of the morning, for example 3am or 4am. Even if you try, it’s likely you won’t be able to sleep until later in the morning.
To summarize the symptoms of ASP include:
- A regular advanced sleep pattern
- Feeling unable to stay awake until a ‘normal’ bedtime
- Being unable to sleep past the early hours of the morning
- The effects of sleep deprivation during the day
Irregular sleep-wake rhythm
If you have an irregular sleep-wake rhythm, this means that you don’t simply go to bed at night and sleep throughout the night. Instead your sleep schedule will be irregular and undefined. You will find that you are sleeping in short bursts, usually between one and four hours at a time. You might take lots of naps throughout the day. If you try to sleep for longer, you will likely find that you are unable to stay asleep and still wake up after a short time.
Even if the total time you are asleep in a 24 hour period matches with the amount of sleep you need for your age, you will still experience the effects of sleep deprivation because your sleep is so disturbed and broken up. You’ll likely feel almost constantly tired. You might find that you need to nap during the day, and if you are unable to do so due to life commitments, you might really struggle to function.
A summary of symptoms of irregular sleep-wake rhythm include:
- An irregular, undefined sleep pattern
- Sleeping in short bursts, usually four hours at the most
- Feeling very drowsy and fatigued much of the time
- The effects of sleep deprivation when you’re awake
Non 24 hour sleep-wake disorder
You might hear this disorder under a variety of other names, including shortened to Non-24 or N24: they all refer to the same disorder. If you have Non-24, your circadian rhythm is not synchronized with the ‘normal’ 24 hour clock. This might occur if you are blind, as your body cannot use the cues of daylight to determine when you should be asleep. However, it can also sometimes happen in sighted people.
It’s likely that you won’t be able to get the full amount of sleep you need, because life commitments will mean you need to be awake during the day. You will then feel very fatigued and experience the effects of sleep deprivation. Even if you are able to sleep for the full amount of hours you need, the unsociable hours you sleep can be difficult to cope with and interrupt normal functioning.
Symptoms of Non-24 include:
- An out of synch circadian rhythm
- Gradually going to sleep at a later time over time
- Problems with keeping up with daily commitments
- Confusion and disorientation
- The effects of sleep deprivation when you’re awake
Shift work sleep disorder
If you work shifts, you might find that your sleep schedule is understandably irregular, and that you are struggling with the effects of lack of sleep. You might feel very fatigued a lot of the time and struggle to function. You may find it difficult to sleep when you’re off work, especially if that is during the day and it’s light outside. You may find that your stress levels are increased and you struggle to keep a normal routine.
It’s possible that you might regularly find yourself trying to catch up on sleep when you have time off, for example sleeping very long hours on your day off. You might also find yourself ‘zoning out’ while you’re at work: this is actually known as a microsleep. It means that part of your brain has actually fallen asleep for a few seconds because you’re so tired. Depending on your job, this can potentially be dangerous.
Symptoms of shift work disorder you may notice include:
- Being unable to maintain a regular sleep schedule
- Regularly getting less sleep than you need
- Often feeling fatigued
- The effects of sleep deprivation when you’re awake
- Trying to catch up on sleep
What happens next?
So if you’ve managed to match up your symptoms and recognise your sleep disorder, what happens next? Firstly, try not to panic. Even though all of this sounds negative and quite worrying, identifying what’s wrong is the first step to putting it right! There are plenty of ways you can tackle your sleep disorder and get effective treatment, so you can start getting the sleep you need again.
Getting an official diagnosis and seeking treatment
Once you have an idea of which sleep disorder you are experiencing, you might want to get an official diagnosis. The information we’ve provided is guidance and of course, nothing can replace a professional diagnostic process. If your sleep disorder is more severe, it’s always a good idea to get a doctor’s guidance and specialist treatment.
A great place to start is your GP: you can take your sleep diary or notes, and explain what you think is wrong and what you’ve been going through. They might be able to give you some general guidance and pinpoint you to appropriate treatment. If your sleep disorder is more severe, they may refer you to a sleep specialist.
Seeing a sleep specialist will usually involve attending a sleep clinic. The specialist will talk to you about the symptoms you’ve been experiencing and do an examination. They might perform a sleep study, also known as a polysomnography. This involves you staying overnight at the sleep clinic so they can monitor you. You’ll usually be attached to some monitors so they can monitor your brainwaves and other vitals to get a more accurate insight into your symptoms. This isn’t painful and isn’t anything to worry about. After the sleep study, you’ll typically be given an official diagnosis and will be referred for specific treatment from there.
If your sleep disorder is less serious, you may feel happy continuing in the knowledge that you have figured out what is wrong, and seeking treatment from there. As we mentioned, your GP may be able to refer you for treatment. Alternatively you could seek treatment privately or use an online insomnia treatment programme, which allows you to access treatment in your own home, to fit in with your own schedule. It’s about what you feel comfortable with and what you feel will work for you.
Depending on your disorder and which treatment route you choose, treatments may vary. You may be offered medication, although this is usually a more short term option depending on your disorder. The primary treatments for sleep disorders are typically sleep hygiene and psychological therapies. Let’s take a look at the primary treatments and what they entail.
Sleep hygiene is one of the first steps you can take to tackle your sleep disorder. You can choose to do this on your own at home or under guidance as part of therapy. Sleep hygiene refers to positive habits and behaviours which help you to sleep more restfully. This includes things like:
- Keeping a regular sleep schedule
- Making your bedroom comfortable
- Keeping your bedroom for relaxation only
- Making time to wind down before bed
- Reducing or cutting out naps
- Not going to bed too hungry or full
- Cutting out stimulants near bedtime, such as nicotine and caffeine
- Avoiding alcohol close to bedtime
- Exercising during the day
- Getting out in natural light
Cognitive Behavioural Therapy for insomnia (CBT-i)
CBT-i is the primary recommended treatment for insomnia and other sleep disorders. CBT-i works by changing thought patterns and behaviours which are stopping you from sleeping restfully, and replacing them with helpful, productive thoughts and behaviours to enable you to get the sleep you need. The National Sleep Foundation explains that: “CBT is aimed at changing sleep habits and scheduling factors, as well as misconceptions about sleep and insomnia, that perpetuate sleep difficulties.”
Acceptance and Commitment Therapy for insomnia (ACT-i)
ACT-i works to help you realise that negative thoughts don’t need to lead to behaviours. The therapy teaches you to accept your thoughts, and to commit to positive behaviours which are going to help you to sleep restfully. ACT-i is particularly useful for those who experience a lot of stress and anxiety around bedtime and as a result of sleeping difficulties.
Mindfulness practices teach you to be present in the moment in a non-judgemental way. You will learn to accept your thoughts and feelings, and allow them to pass you by without worrying about them. This allows you to reach a state of deep relaxation. Mindfulness techniques often involve meditation, visualization, and breathing exercises.
Mindfulness is wonderful for reducing stress and regulating emotions, as well as being proven to help improve sleep. You might find that mindfulness techniques are integrated into other therapies to help produce the best results.
The National Sleep Foundation, (2020), “Sleep Disorders”.
The American Psychiatric Association, (2020), “What Are Sleep Disorders?”
The National Sleep Foundation, (2020), “Sleep Diary”.
American Academy of Sleep Medicine, (2020), “Parasomnias”. Sleep Education.
Eric Suni, (2020), “Sleep-Related Breathing Disorders”. The National Sleep Foundation
Reference Module in Neuroscience and Biobehavioral Psychology, (2017), “Diagnostic Algorithm for Sleep Related Movement Disorders (SRMDs)”.
The National Sleep Foundation, (2020), “Periodic Limb Movements Disorder”.
Mayo Clinic, (2017), “Bruxism (teeth grinding)”.
Richard J. Schwab, (2020), “Circadian Rhythm Sleep Disorders”. MSD Manual.
The National Sleep Foundation, (2020), “Cognitive Behavioral Therapy for Insomnia (CBT-I)”.
[a]I decided to leave out KLS as it’s extremely rare and symptoms mean an individual can’t take care of themselves etc, so would likely already be under medical care