Sleep Disorders

Introduction:

Sleep disorders are conditions that affect how well you sleep, how long you sleep, when you sleep, or what happens while you sleep. They are common and can affect mood, energy, concentration, physical health, and safety. Sleep and mental health also affect each other: depression, anxiety, stress, and hormonal changes can disrupt sleep, and poor sleep can make these conditions harder to manage.

Sleep medicine specialists group sleep disorders into six major categories, based on the American Academy of Sleep Medicine’s International Classification of Sleep Disorders. This guide explains each category in plain language so you can recognize common signs and know when to seek evaluation.

Types of Sleep Disorders:

1. Insomnia Disorders

Insomnia means ongoing trouble falling asleep, staying asleep, or waking too early, even when you have enough time and a comfortable place to sleep, along with daytime effects such as fatigue, irritability, or poor concentration. Short-term insomnia often follows stress or a life change. Chronic insomnia disorder is diagnosed when symptoms occur at least three nights a week for three months or longer.

• Common signs: Lying awake for a long time, waking during the night and struggling to fall back asleep, or waking much earlier than planned
• Daytime effects: Tiredness, low mood, irritability, or trouble focusing
• When to seek evaluation: If insomnia lasts more than a few weeks or affects daily life. Cognitive behavioral therapy for insomnia (CBT-I) is the recommended first-line treatment for chronic insomnia. Learn more in our Insomnia article.

2. Sleep-Related Breathing Disorders

These disorders involve abnormal breathing during sleep. The most common is obstructive sleep apnea (OSA), in which the airway repeatedly narrows or closes during sleep, briefly lowering oxygen levels and interrupting sleep. Central sleep apnea, a less common form, occurs when the brain does not send steady signals to breathe.

• Common signs: Loud, frequent snoring; pauses in breathing, choking, or gasping noticed by a bed partner; morning headaches; and waking unrefreshed
• In women: Sleep apnea may show up as insomnia, fatigue, or mood changes rather than loud snoring, and risk increases after menopause
• When to seek evaluation: Sleep apnea is diagnosed with a sleep study and treated by a primary care or sleep medicine provider. Untreated sleep apnea is linked to high blood pressure, heart disease, and drowsy driving, so evaluation is important.

3. Central Disorders of Hypersomnolence

These conditions cause excessive daytime sleepiness even after a full night of sleep. Narcolepsy is a long-term neurological condition that affects the brain’s control of sleep and wakefulness. Some people with narcolepsy experience cataplexy, which is sudden, brief muscle weakness triggered by strong emotions such as laughter or surprise. Idiopathic hypersomnia causes persistent sleepiness, long sleep times, and great difficulty waking, often with naps that do not feel refreshing.

• Common signs: Strong daytime sleepiness or falling asleep unexpectedly; sudden muscle weakness with strong emotions; sleep paralysis or vivid dreamlike images when falling asleep or waking; or sleeping 10 hours or more and still feeling unrested
• When to seek evaluation: These disorders are evaluated and diagnosed by a sleep medicine specialist. When indicated, testing commonly includes an overnight sleep study and a daytime nap test (multiple sleep latency test), but the specific tests depend on each person’s symptoms and history. If you are very sleepy, avoid driving until you have been evaluated.

4. Circadian Rhythm Sleep-Wake Disorders

Your circadian rhythm is your internal body clock. These disorders occur when your sleep timing is out of sync with your daily schedule or environment. Examples include delayed sleep-wake phase disorder (falling asleep and waking much later than desired), advanced sleep-wake phase disorder (very early bedtimes and wake times), shift work disorder, and jet lag disorder.

• Common signs: Being unable to fall asleep until very late and then struggling to wake on time; feeling sleepy very early in the evening and waking very early; sleep that improves when you can follow your own schedule; or sleep problems related to night shifts, rotating shifts, or travel across time zones
• When to seek evaluation: Consistent sleep and wake times and well-timed light exposure can help. If symptoms persist, a healthcare or sleep medicine provider can guide treatment, which may include carefully timed light therapy or melatonin.

5. Parasomnias

Parasomnias are unusual behaviors or experiences that happen while falling asleep, during sleep, or while waking. Some occur during deep non-REM sleep, such as sleepwalking, sleep terrors, and confusional arousals. These usually happen in the first part of the night, with little memory afterward. Others occur during REM (dreaming) sleep, including nightmare disorder and REM sleep behavior disorder.

Nightmare disorder involves frequent, distressing dreams that disrupt sleep and daytime functioning, and it often occurs with stress, anxiety, or trauma-related conditions. In REM sleep behavior disorder (RBD), the normal muscle relaxation of REM sleep is lost, so a person may physically act out dreams by talking, shouting, punching, or kicking.

• Common signs: Walking, talking, or other complex behaviors during sleep; episodes of screaming or intense fear with little memory afterward; frequent distressing nightmares; or acting out dreams, sometimes causing injury
• When to seek evaluation: If episodes are frequent, dangerous, or new in adulthood. Acting out dreams warrants evaluation by a sleep medicine specialist. Some medications, including certain antidepressants, can be associated with dream-enactment symptoms, but this does not by itself establish a diagnosis of RBD; a specialist evaluation, which usually includes a sleep study, is needed to confirm it. RBD can also be associated with some neurological conditions. Keep the sleep environment safe while you await evaluation.

6. Sleep-Related Movement Disorders

These disorders involve movements that disturb sleep. Restless legs syndrome (RLS), also called Willis-Ekbom disease, causes an uncomfortable urge to move the legs, usually in the evening or at rest, that is relieved by moving. Periodic limb movement disorder (PLMD) involves repeated jerking or twitching of the legs during sleep that disrupts rest; many people are unaware of the movements until a bed partner notices them.

• Common signs: Creeping, crawling, or aching leg sensations at rest; a strong urge to move the legs that eases with walking or stretching; repeated leg jerks during sleep; or restless, unrefreshing sleep
• When to seek evaluation: RLS can be linked to low iron levels, pregnancy, kidney disease, and certain medications, including some antidepressants and antihistamines. PLMD is confirmed with a sleep study. A primary care, neurology, or sleep medicine provider can evaluate these symptoms and check for contributing causes.

Causes:

Sleep disorders have many possible causes, including stress, mental health conditions, medical conditions, hormonal changes, medications, alcohol or substance use, irregular schedules, genetics, and differences in how the brain regulates sleep and breathing. Often, more than one factor is involved.

Symptoms:

Symptoms vary by disorder, but common warning signs include trouble falling or staying asleep, sleep that does not feel refreshing, excessive daytime sleepiness, loud snoring or pauses in breathing, unusual movements or behaviors during sleep, and changes in mood, focus, or energy.

Diagnosis:

Evaluation begins with a detailed sleep history, including sleep timing, habits, daytime functioning, medical and mental health history, medications, and substance use. Sleep diaries and questionnaires may help. Depending on the concern, a sleep medicine specialist may order an overnight sleep study (polysomnography), a home sleep apnea test, or a daytime nap test.

Treatment:

Treatment depends on the specific disorder. Chronic insomnia is usually treated first with CBT-I. Sleep apnea is often treated with positive airway pressure (PAP) therapy or other options managed by a sleep medicine provider. Narcolepsy, idiopathic hypersomnia, REM sleep behavior disorder, and restless legs syndrome are typically managed by sleep medicine or neurology specialists. Circadian rhythm disorders may improve with consistent schedules and timed light exposure. When sleep problems occur with depression, anxiety, or other mental health conditions, treating those conditions can also improve sleep.

Lifestyle Support:

Restorative sleep is one of the five elements of the Balanced Mind Framework™. The everyday strategies below support healthy sleep for most people and can complement evaluation and treatment when a sleep disorder is present. They are not a substitute for treatment of chronic insomnia, sleep apnea, or other sleep disorders.

• Consistent sleep schedule: Go to bed and wake up at about the same time every day, including weekends. A steady wake time is especially helpful for setting your body clock.
• Light exposure: Get natural light soon after waking, ideally outdoors, and dim bright lights and screens in the hour before bed to support your circadian rhythm.
• Stress management: Build a calming 30- to 60-minute wind-down routine with relaxation, slow breathing, prayer, or reading. If worry keeps you awake, try writing down your concerns and one next step earlier in the evening.
• Bed for sleep: Use your bed mainly for sleep. If you cannot fall asleep after about 20 minutes, get up, do something quiet in dim light, and return to bed when you feel sleepy.
• Caffeine, alcohol, and nicotine: Limit caffeine after midday, and avoid alcohol and nicotine close to bedtime, since they can make sleep lighter and more broken.
• Movement and meals: Regular physical activity supports deeper sleep, but finish vigorous exercise a few hours before bed. Avoid heavy meals late in the evening.
• Sleep environment: Keep your bedroom cool, dark, and quiet, and limit long or late-afternoon naps if they make nighttime sleep harder.
• When habits are not enough: If trouble sleeping lasts three months or longer, cognitive behavioral therapy for insomnia (CBT-I) is the recommended first-line treatment. Learn more in Restorative Sleep and Mental Wellness.

Prevention:

Not every sleep disorder can be prevented, but some steps may lower risk or help identify problems early. Practice the healthy sleep habits described in Lifestyle Support, address stress and mental health concerns early, limit alcohol, maintain a healthy weight to help reduce sleep apnea risk, and seek evaluation promptly if warning signs develop.

Anatomy:

Sleep is regulated by the brain through two main systems: a sleep drive that builds the longer you are awake, and the circadian rhythm, an internal clock influenced by light. Each night, sleep moves through cycles of non-REM sleep, including deep restorative sleep, and REM sleep, when most vivid dreaming occurs. Many sleep disorders involve a disruption in one of these systems or stages.

Risk Factors:

Risk factors vary by disorder and may include stress, depression, anxiety, irregular or shift-work schedules, excess weight, older age, menopause, pregnancy, certain medical conditions, some medications, alcohol or substance use, and family history.

Complications:

Untreated sleep disorders can affect mood, memory, concentration, and quality of life, and they may increase the risk of accidents, including drowsy driving. Some conditions, such as untreated sleep apnea, are also linked to high blood pressure, heart disease, and other health problems.

When to Seek Evaluation:

Talk with a healthcare provider if you:

• Have trouble sleeping most nights for more than a few weeks
• Snore loudly or have pauses in breathing, choking, or gasping during sleep
• Feel very sleepy during the day or have fallen asleep while driving
• Have sudden sleep attacks or muscle weakness triggered by strong emotions
• Act out your dreams or have unsafe behaviors during sleep
• Have an uncomfortable urge to move your legs at night
• Notice that poor sleep is affecting your mood, work, relationships, or safety

If you feel too sleepy to drive safely, do not drive until you have been evaluated.

Advancements:

Research continues to improve sleep care, including wider use of home sleep apnea testing, digital and telehealth-delivered CBT-I programs, and newer treatment options for sleep apnea, narcolepsy, and restless legs syndrome.

Balanced Mind Mental Health: Your Partner in Care and Wellness

Balanced Mind Mental Health provides outpatient telehealth psychiatric care for sleep concerns connected to mental health, such as insomnia symptoms related to depression, anxiety, stress, ADHD, or hormonal changes. Care may include a careful sleep history, lifestyle-informed sleep strategies, and medication review when clinically appropriate.

We do not perform sleep studies or diagnose or provide specialized treatment for sleep apnea, narcolepsy, idiopathic hypersomnia, REM sleep behavior disorder, restless legs syndrome, or other medical sleep disorders. When these conditions are suspected, we recommend evaluation by your primary care provider or a sleep medicine specialist. Learn more about Sleep & Mental Health care at Balanced Mind Mental Health.

References:

• American Academy of Sleep Medicine. International Classification of Sleep Disorders, Third Edition, Text Revision (ICSD-3-TR). 2023. Retrieved from https://aasm.org/clinical-resources/international-classification-sleep-disorders/
• Edinger JD, et al. Behavioral and psychological treatments for chronic insomnia disorder in adults: an American Academy of Sleep Medicine clinical practice guideline. Journal of Clinical Sleep Medicine. 2021;17(2):255–262.
• Qaseem A, et al. Management of chronic insomnia disorder in adults: a clinical practice guideline from the American College of Physicians. Annals of Internal Medicine. 2016;165(2):125–133.
• American Academy of Sleep Medicine. Sleep Education. Retrieved from https://sleepeducation.org

Disclaimer: If you are experiencing a mental health crisis or thoughts of suicide or self-harm, call or text 988, call 911, or go to the nearest emergency room.

This information is for educational purposes only (regardless of date or topic), offering generalized details. It is NOT comprehensive and does not include all relevant information about conditions, treatments, medications, side effects, or risks for specific patients. It aims to aid understanding of mental health conditions or treatments, not to replace medical advice or the evaluation, diagnosis, or treatment provided by a healthcare provider tailored to an individual’s unique circumstances. Use of this website or blog content does not establish a provider-patient relationship with Balanced Mind Mental Health or its providers. Always consult a healthcare professional for a thorough evaluation, diagnosis, and treatment plan. This information does not endorse any treatment or medication as safe, effective, or approved. Balanced Mind Mental Health and its affiliates disclaim any warranty or liability associated with this information or its use.