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https://www.sleepfoundation.org/restless-legs-syndrome

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Restless legs syndrome (RLS), also called Willis Ekbom disease, causes uncomfortable feelings in the legs, such as itching, prickling, pulling, or crawling. These sensations create an overwhelming urge to move the legs.

People with RLS may walk, stretch, or shake their legs to achieve relief. Symptoms tend to be worse when inactive, including when relaxing or lying down. As a result, the symptoms of RLS often disrupt sleep.

RLS affects of adults and 2 to 4% of children in the U.S. and it is found in women more often than men. People of all ages can develop RLS, but the most severe symptoms tend to occur in .

What Are the Symptoms of Restless Legs Syndrome?

The sensations associated with RLS are distinct from normal sensations experienced by those who don't have the disorder. This makes them difficult to characterize. According to the , the words and phrases most commonly used by RLS patients to describe the feelings are:

"Twitchy"

"Uncomfortable"

"Restless"

"Need to stretch"

"Urge to move"

"Legs want to move on their own"

Learn more about RLS symptoms here.

Restless Legs Syndrome and Insomnia

The desire to move one's legs makes falling asleep and staying asleep difficult for many people with RLS. A study found that with RLS reported at least one sleep-related symptom. RLS symptoms often appear shortly after laying down at night and patients will kick, squirm, or massage their legs to lessen the sensation. Some people with RLS are compelled to get out of bed and pace or stretch.

As a result of the sleep disturbances associated with RLS, patients often experience fatigue and daytime sleepiness. Sleep deficiency with depression, anxiety, heart disease, and obesity. RLS patients are at greater risk for these issues as well. Concerns about sleep are the main reason RLS patients seek medical care for their condition.

Restless Legs Syndrome and Periodic Limb Movement Disorder

who have RLS also have a condition called periodic limb movement disorder (PLMD). PLMD involves repetitive flexing or twitching of the limbs while asleep at night. It is different from RLS in that these movements are not accompanied by uncomfortable sensations and because they occur during sleep, patients are often not aware of them. However, PLMD-associated movements can cause a person to wake up and therefore can compound sleep issues in patients who also have RLS.

Although most people with RLS have PLMD, many with PLMD do not have RLS.

What Causes Restless Legs Syndrome?

Sometimes, RLS is associated with other medical conditions, such as late-stage kidney disease, iron deficiency, neuropathy, multiple sclerosis, or Parkinson's disease.

RLS can also occur temporarily during pregnancy, with around developing RLS during the third trimester. The symptoms of RLS typically decline after delivery.

However, the cause of most RLS cases is unknown. RLS may have a genetic component. Between 40% and 90% of patients with RLS have at least one first-degree relative (parent, sibling, or child) with the condition. Researchers have identified some genetic changes that increase risk for RLS, but it is likely that more have yet to be discovered.

Restless Legs Syndrome Triggers

Sitting or resting are common triggers for RLS symptoms. Additionally, some substances can make symptoms worse. These include:

Alcohol

Caffeine

Nicotine

Medications, including certain drugs used to treat nausea, colds and allergies, and mental health conditions

Incidentally, most of these substances when taken in excess or too close to bedtime can also adversely affect our sleep architecture.

How Is Restless Legs Syndrome Managed?

The goals of treatment for RLS are to stabilize symptoms and improve sleep consistency. There are both non-medicinal approaches and drug treatments available to manage RLS.

Home Care Tips for Restless Legs Syndrome

The following approaches can reduce symptoms in patients with mild or moderate RLS and may be used in combination with medication in RLS patients who have severe symptoms.

Sleep hygiene: Good sleep hygiene means maintaining a bedroom environment and a daily routine that supports high-quality sleep. Avoiding alcohol and caffeine is especially important for RLS patients because these substances can worsen symptoms.

Exercise: Because physical inactivity often triggers RLS symptoms, exercise may be helpful. A found that RLS patients showed af 39% reduction in symptom severity after six weeks of engaging in an exercise program compared to an 8% symptom reduction in patients who did not exercise.

the device improved Elsevier Elsevier is a publishing company that aims to help researchers and health care professionals advance science and improve health outcomes for the benefit of society. Pneumatic pressure therapy: Pneumatic compression devices increase blood flow to the legs by filling with air to squeeze the legs. Researchers found that View Source RLS symptoms, quality-of-life, and fatigue after one month of daily use compared to a control group.

widely recommended National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. Massage and hot baths: Using massage and hot baths to stimulate the legs is View Source in RLS literature; however, there is limited scientific evidence supporting the effectiveness of these methods at this time.

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References

1. MedlinePlus: National Library of Medicine (US). (2018, May 1). Restless legs syndrome., Retrieved September 16, 2020, from
https://medlineplus.gov/genetics/condition/restless-legs-syndrome/

2. National Institute of Neurological Disorders and Stroke. (2020, March 17). Restless Legs Syndrome Fact Sheet., Retrieved September 16, 2020, from
https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Restless-Legs-Syndrome-Fact-Sheet

3. American Academy of Sleep Medicine. (2014). The International Classification of Sleep Disorders - Third Edition (ICSD-3). Darien, IL.
https://aasm.org/

4. Bogan R. K. (2006). Effects of restless legs syndrome (RLS) on sleep. Neuropsychiatric Disease and Treatment, 2(4), 513-519.
https://pubmed.ncbi.nlm.nih.gov/19412499/

5. National Heart, Lung, and Blood Institute. (n.d.). Sleep deprivation and deficiency., Retrieved September 16, 2020, from
https://www.nhlbi.nih.gov/health-topics/sleep-deprivation-and-deficiency

6. Schwab, R.J. (2020, June). Merck Manual Professional Version: Periodic Limb Movement Disorder (PLMD) and Restless Legs Syndrome (RLS)., Retrieved September 16, 2020, from
https://www.merckmanuals.com/professional/neurologic-disorders/sleep-and-wakefulness-disorders/periodic-limb-movement-disorder-plmd-and-restless-legs-syndrome-rls

7. Darvishi, N., Daneshkhah, A., Khaledi-Paveh, B., Vaisi-Raygani, A., Mohammadi, M., Salari, N., Darvishi, F., Abdi, A., & Jalali, R. (2020). The prevalence of Restless Legs Syndrome/Willis-ekbom disease (RLS/WED) in the third trimester of pregnancy: a systematic review. BMC neurology, 20(1), 132.
https://pubmed.ncbi.nlm.nih.gov/32284042/

8. Aukerman, M. M., Aukerman, D., Bayard, M., Tudiver, F., Thorp, L., & Bailey, B. (2006). Exercise and restless legs syndrome: a randomized controlled trial. Journal of the American Board of Family Medicine : JABFM, 19(5), 487-493.
http://www.jabfm.org/cgi/doi/10.3122/jabfm.19.5.487

9. Lettieri, C. J., & Eliasson, A. H. (2009). Pneumatic compression devices are an effective therapy for restless legs syndrome: a prospective, randomized, double-blinded, sham-controlled trial. Chest, 135(1), 74-80.
https://linkinghub.elsevier.com/retrieve/pii/S0012369209600696

10. Mitchell U. H. (2011). Nondrug-related aspect of treating Ekbom disease, formerly known as restless legs syndrome. Neuropsychiatric disease and treatment, 7, 251-257.
https://pubmed.ncbi.nlm.nih.gov/21654870/

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Restless Legs Syndrome: Symptoms and Causes | Sleep Foundation

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Restless legs syndrome (RLS), also called Willis Ekbom disease, causes uncomfortable feelings in the legs, such as itching, prickling, pulling, or crawling. These sensations create an overwhelming urge to move the legs. People with RLS may walk, stretch, or shake their legs to achieve relief.

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https://www.sleepfoundation.org/advanced-sleep-phase-disorder

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What Is Advanced Sleep Phase Disorder?

Advanced sleep phase disorder (ASPD) describes a condition where a person has a sleep schedule that consistently . For example, a person with ASPD may fall asleep between 6 p.m. and 9 p.m. and wake up . A person with ASPD may still be able to get enough sleep overall, but their sleep schedule is shifted earlier than the average person.

ASPD is a type of circadian rhythm sleep-wake disorder, a category of sleep disorders that also includes jet lag, delayed sleep phase disorder, and non-24 hour sleep wake disorder. These disorders affect people whose circadian rhythms are irregular or run at times that are out of sync with their environment or social expectations.

The circadian rhythm is an internal biological clock that regulates sleep-wake cycles, as well as the related to sleep, appetite, and core body temperature. The circadian rhythm of a person with ASPD operates on an earlier schedule, so melatonin, the sleep hormone, is released earlier. This means someone with advanced sleep phase disorder is likely to .

ASPD vs. Delayed Sleep Phase Disorder

Advanced sleep phase disorder (ASPD) and delayed sleep phase disorder (DSPD) are both circadian rhythm sleep-wake disorders, but the symptoms are on opposite sides of the spectrum. While a person with ASPD has an internal body clock that runs earlier, a person with DSPD has a circadian rhythm that runs later. A person with ASPD may struggle to stay awake in the evening, while a person with DSPD can stay up late but has difficulty feeling alert in the morning.

ASPD and DSPD are also different in terms of who is likely to be affected by them. Older people are more likely to have ASPD, while younger people are more likely to have DSPD. ASPD is also less common than DSPD, but that could be because it is underdiagnosed, given that an earlier schedule generally works better with societal expectations.

People with either disorder can face challenges because their sleep schedule is out of sync with others', which can cause problems at work, at school, and in social situations.

How Common Is ASPD?

ASPD is more common in older adults. It affects about 1% of adults aged 40 to 64 years old.

Symptoms of ASPD

A person with advanced sleep phase disorder may show symptoms such as:

Falling asleep during the late afternoon or early evening

Waking up very early in the morning and being unable to fall back asleep

Falling asleep and waking up earlier than they would prefer

If a person with ASPD is allowed to sleep according to their natural schedule, their sleep quality often improves, and they are able to get enough sleep.

Effects of ASPD

Advanced sleep phase disorder can be challenging to live with. It can affect many aspects of a person's life beyond when they go to bed and when they wake up.

Sleepiness During Evening Events

Chronic Sleep Deprivation

Emotional Distress

People with advanced sleep phase disorder may have trouble staying awake during work, social, or family events that take place at night, which can cause distress or strain their relationships. Since they also have trouble getting back to sleep after waking up early in the morning, they may worry they have insomnia or depression. However, while people with depression may wake earlier, they typically do not feel the sleepiness people with ASPD experience in the evening.

Misuse of Stimulants, Alcohol, or Drugs

To help themselves stay awake, people with advanced sleep phase disorder may use caffeine or other stimulants in the afternoon or early evening. In the morning, they may use alcohol, sedatives, or sleeping pills to help them sleep in. However, using these substances will only further disrupt their sleep, leading to increased sleep deprivation and other adverse side effects.

Causes of ASPD

Several factors may contribute to advanced sleep phase disorder, including:

A family history of ASPD

Older age

Autism spectrum disorder

Too much exposure to morning light

Environmental factors, such as work schedules

Diagnosing ASPD

When diagnosing advanced sleep phase disorder, it is important to discuss specific symptoms and rule out any other potential causes. This is because the symptoms of ASPD could also be caused by a physical or mental health condition, or another sleep disorder. Medication side effects or substance abuse can also present with similar symptoms.

Tracking sleep quality and duration with a sleep diary can help rule out other conditions. A sleep diary can be also used to track both bedtime and waking time.

An actigraph, which is worn on the wrist like a smartwatch or fitness tracker, can provide additional important insights. This device records sleep activity and provides data that can be used with the sleep diary to diagnose ASPD. Monitoring body temperature and melatonin levels can also be helpful for diagnosis.

In rare cases, a doctor may recommend a polysomnogram. This is a sleep study that is performed overnight in a lab. During a polysomnogram, the patient's brain waves, heartbeat, breathing rate, body movements, and oxygen levels are . Polysomnograms can be helpful for ruling out other sleep disorders that may cause symptoms similar to ASPD, like obstructive sleep apnea.

Treatments for ASPD

Some people may make small adjustments to their lives in order to accommodate ASPD. For example, they may arrange their daily routine to work around their preferred sleep schedule. They may choose to treat their symptoms with a mix of lifestyle changes, bright light therapy, improved sleep hygiene, and melatonin.

Lifestyle Changes

Following good sleep hygiene, like keeping a regular sleep schedule, can help improve sleep quality. Doctors may also recommend avoiding caffeine, stimulants, alcohol, or other drugs. These substances disrupt sleep and can worsen symptoms of sleep deprivation or sleepiness.

Bright Light Therapy

Melatonin

Depending on the symptoms, doctors may recommend people with ASPD take melatonin to help regulate their sleep-wake cycles. However, there is not yet sufficient evidence that melatonin works as a treatment for ASPD.

Tips for Living With ASPD

In addition to various treatment options, there are also some more general habits that can help alleviate the symptoms of ASPD.

Follow a Regular Sleep Schedule

Healthy circadian rhythms are reinforced by consistent schedules, including exposure to light and darkness at regular times. For more energy and better sleep, try to follow the same sleep schedule every day, including weekends.

Avoid Caffeine, Alcohol, and Other Substances

Some people with ASPD may use caffeine, alcohol, or other drugs to boost their alertness in the late afternoon or to help them sleep in. However, these substances only further disrupt sleep.

Avoid Bright Light in the Morning

When to Talk to a Doctor

It is not always possible for people to adjust their work or social schedules to their early sleep schedule. For those whose natural sleep-wake schedule is interfering with their quality of life, a doctor may be able to help clarify symptoms and provide treatment recommendations.

Learn more about our Editorial Team

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Advanced Sleep Phase Disorder | Sleep Foundation

# data[].attributes.attachment_link.description
Advanced sleep phase disorder (ASPD) describes a condition where a person has a sleep schedule that consistently . For example, a person with ASPD may fall asleep between 6 p.m. and 9 p.m. and wake up . A person with ASPD may still be able to get enough sleep overall, but their sleep schedule is shifted earlier than the average person.

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https://www.nhlbi.nih.gov/health/insomnia#:~:text=Insomnia%20is%20a%20common%20sleep,feel%20sleepy%20during%20the%20day

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https://my.clevelandclinic.org/health/diseases/12119-insomnia

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Overview

What is insomnia?

Insomnia is a common sleep disorder that's characterized by difficulty:

Falling asleep initially.

Waking up during the night.

Waking earlier than desired.

What are the symptoms of insomnia?

Chronic insomnia may cause:

Difficulty falling asleep and/or waking up in the middle of the night.

Difficulty returning to sleep.

Feeling tired/fatigued during the daytime.

Irritability or depressed mood.

Issues with concentration or memory.

What are the types of insomnia?

Insomnia can come and go, or it may be an ongoing, longstanding issue. There are short-term insomnia and chronic insomnia:

Short-term insomnia tends to last for a few days or weeks and is often triggered by stress.

Chronic insomnia is when sleep difficulties occur at least three times a week for three months or longer.

How common is insomnia?

Sleep disorders are very common. They affect up to 70 million Americans every year.

Insomnia symptoms occur in approximately 33% to 50% of the adult population, while chronic insomnia disorder that's associated with distress or impairment is estimated at 10% to 15%.

How much sleep do most people need?

Most adults need around seven to nine hours of sleep per night, but the amount of sleep needed to function at your best varies among individuals. The quality of your rest matters just as much as the quantity. Tossing and turning and repeatedly awakening is as bad for your health as being unable to fall asleep.

Symptoms and Causes

What causes insomnia?

Many things can contribute to the development of insomnia, including environmental, physiological and psychological factors, such as:

Life stressors, including your job, relationships, financial difficulties and more.

Unhealthy lifestyle and sleep habits.

Anxiety disorders, depression and/or other mental health issues.

Chronic diseases like cancer.

Chronic pain due to arthritis, fibromyalgia or other conditions.

Gastrointestinal disorders, such as heartburn.

Hormone fluctuations due to menstruation, menopause, thyroid disease or other issues.

Medications and other substances.

Neurological disorders, such as Alzheimer's disease or Parkinson's disease.

Other sleep disorders, such as sleep apnea and restless legs syndrome.

What are the risk factors for insomnia?

Insomnia occurs more often in women and people assigned female at birth than in men and people assigned male at birth. Pregnancy and hormonal shifts can disturb sleep. Other hormonal changes, such as premenstrual syndrome (PMS) or menopause, can also affect sleep. Insomnia becomes more common over the age of 60. People who are older may be less likely to sleep soundly because of bodily changes related to aging and because they may have medical conditions or take medications that disturb sleep.

What are the consequences of insomnia?

When you can't fall asleep or your rest is fitful, you may:

Be irritable, anxious or depressed.

Feel fatigued or low on energy throughout the day.

Have memory issues or difficulty concentrating.

Struggle at work, school or in relationships.

Diagnosis and Tests

How is insomnia diagnosed?

There isn't a specific test to diagnose insomnia. A healthcare provider will perform a physical exam and ask questions to learn more about your sleep issues and symptoms. The key information for the diagnosis of insomnia is reviewing your sleep history with a doctor. They'll also review your medical history and the medications you're taking to see if they may be affecting your ability to sleep. You may also:

Get a blood test: Your doctor may want you to do a blood test to rule out certain medical conditions such as thyroid issues or low iron levels that can negatively impact sleep.

Keep a sleep diary: You may be asked to write down your sleep patterns for one to two weeks (bedtime, wake time, naps, caffeine use, etc.) This information can help your provider identify patterns or behaviors that interfere with rest.

Complete a sleep study: Sleep studies (polysomnograms) aren't necessary for diagnosing insomnia. If your doctor has concerns that your insomnia may be caused by sleep apnea or another sleep disorder, you may be referred. You may go to a sleep disorders center or do the study at home.

Management and Treatment

What are the complications of insomnia?

Over time, lack of sleep or poor quality sleep can negatively affect your physical and mental health. Insomnia can contribute to:

How is insomnia managed or treated?

Short-term insomnia often gets better on its own. For chronic (long-term) insomnia, your healthcare provider may recommend:

Cognitive behavioral therapy for insomnia (CBT-I): CBT-I is a brief, structured intervention for insomnia that helps you identify and replace thoughts and behaviors that cause or worsen sleep issues with habits that promote sound sleep. Unlike sleeping medication, CBT-I helps you overcome the underlying causes of your insomnia.

Medications: Behavior and lifestyle changes can best help you improve your sleep over the long term. In some cases, though, taking medication for a short time can help you sleep. Doctors recommend taking sleep medicines only now and then or only for a short time. They're not the first choice for treating chronic insomnia.

Can melatonin help me sleep?

Your body produces a hormone called melatonin that promotes sleep. Some people take melatonin supplements as a sleep aid. But there's no proof that these supplements work. Because the U.S. Food and Drug Administration (FDA) doesn't regulate supplements the same as medications, you should talk to your healthcare provider before taking one.

Prevention

How can I prevent insomnia?

Lifestyle changes and improvements to your bedtime routine and bedroom setup can often help you sleep better:

Avoid large meals, caffeine and alcohol before bed.

Be physically active during the day, outside if possible.

Cut back on caffeine, including coffee, sodas and chocolate, throughout the day and especially at night.

Go to bed and get up at the same time each day, including weekends.

Put away smartphones, TVs, laptops or other screens at least 30 minutes before bedtime.

Quit smoking.

Turn your bedroom into a dark, quiet, cool sanctuary.

Unwind with soothing music, a good book or meditation.

Outlook / Prognosis

What is the prognosis (outlook) for people who have insomnia?

Some people with insomnia sleep better after changing daytime and nighttime behaviors. When these changes don't help, therapy or medications can improve slumber.

Living With

When should I call my healthcare provider?

You should call your healthcare provider if you experience:

Difficulty concentrating or memory issues.

Extreme fatigue.

Mood changes, such as anxiety, depression or irritability.

More than three months of difficulty sleeping.

What should I ask my healthcare provider about insomnia?

If you have insomnia, you may want to ask your healthcare provider:

Am I taking any medications keeping me awake?

What changes can I make to sleep better?

How does cognitive behavioral therapy improve sleep?

How do I find a therapist?

Could I have other sleep disorders like sleep apnea?

A note from Cleveland Clinic
If you're experiencing insomnia, don't hesitate to reach out to a healthcare provider for help. They may offer tips for managing issues that interfere with your sleep. Many people with insomnia rest better after changing their diet, lifestyle and nighttime routines. Or they may benefit from medications or cognitive behavioral therapy.

# data[].attributes.attachment_link.description
Insomnia is a common sleep disorder that's characterized by difficulty: Falling asleep initially. Waking up during the night. Waking earlier than desired. Chronic insomnia may cause: Difficulty falling asleep and/or waking up in the middle of the night. Difficulty returning to sleep. Feeling tired/fatigued during the daytime. Irritability or depressed mood.

# data[].attributes.body
https://medlineplus.gov/insomnia.html

# data[].attributes.attachment_link.readable_text
What is insomnia?

Insomnia is a common sleep disorder. If you have it, you may have trouble falling asleep, staying asleep, or both. As a result, you may get too little sleep or have poor-quality sleep. You may not feel refreshed when you wake up.

What are the symptoms of insomnia?

Symptoms of insomnia include:

Lying awake for a long time before you fall asleep

Sleeping for only short periods

Being awake for much of the night

Feeling as if you haven't slept at all

Waking up too early

What are the types of insomnia?

Insomnia can be acute (short-term) or chronic (ongoing). Acute insomnia is common. Common causes include stress at work, family pressures, or a traumatic event. It usually lasts for days or weeks.

Chronic insomnia lasts for a month or longer. Most cases of chronic insomnia are secondary. This means they are the symptom or side effect of some other problem, such as certain medical conditions, medicines, and other sleep disorders. Substances such as caffeine, tobacco, and alcohol can also be a cause.

Sometimes chronic insomnia is the primary problem. This means that it is not caused by something else. Its cause is not well understood, but long-lasting stress, emotional upset, travel and shift work can be factors. Primary insomnia usually lasts more than one month.

Who gets insomnia?

?

Insomnia is common. It affects women more often than men. You can get it at any age, but older adults are more likely to have it. You are also at higher risk of insomnia if you

Have a lot of stress

Are depressed or have other emotional distress, such as divorce or death of a spouse

Have a lower income

Work at night or have frequent major shifts in your work hours

Travel long distances with time changes

Have an inactive lifestyle

Are African American; research shows that African Americans take longer to fall asleep, don't sleep as well, and have more sleep-related breathing problems than whites.

What other problems can insomnia cause?

Insomnia can cause daytime sleepiness and a lack of energy. It also can make you feel anxious, depressed, or irritable. You may have trouble focusing on tasks, paying attention, learning, and remembering. Insomnia also can cause other serious problems. For example, it could make you may feel drowsy while driving. This could cause you get into a car accident.

How is insomnia diagnosed?

To diagnose insomnia, your health care provider

Takes your medical history

Asks for your sleep history. Your provider will ask you for details about your sleep habits.

Does a physical exam, to rule out other medical problems that might cause insomnia

May recommend a sleep study. A sleep study measures how well you sleep and how your body responds to sleep problems.

What are the treatments for insomnia?

Treatments include lifestyle changes, counseling, and medicines:

Lifestyle changes, including good sleep habits, often help relieve acute (short-term) insomnia. These changes might make it easier for you to fall asleep and stay asleep.

A type of counseling called cognitive-behavioral therapy (CBT) can help relieve the anxiety linked to chronic (ongoing) insomnia

Several medicines also can help relieve your insomnia and allow you to re-establish a regular sleep schedule

If your insomnia is the symptom or side effect of another problem, it's important to treat that problem (if possible).

NIH: National Heart, Lung, and Blood Institute

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Insomnia is a common sleep disorder. If you have it, you may have trouble falling asleep, staying asleep, or both. As a result, you may get too little sleep or have poor-quality sleep. You may not feel refreshed when you wake up.

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https://www.sleepfoundation.org/insomnia

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Insomnia is one of the most common health concerns among adults. Insomnia causes sleep issues that interfere with daily life and can be debilitating for some people. Many factors may contribute to insomnia, including stress, medications, and an individual's sleep habits and environment.

Insomnia is a sleep disorder characterized by difficulty falling asleep, staying asleep, or both, even if you have ample time and a bedroom environment conducive to restful sleep. An insomnia diagnosis requires these sleep troubles to also cause daytime impairments, such as sleepiness or difficulty concentrating.

Up to two-thirds of people occasionally experience insomnia symptoms. These bouts of sleeplessness may or may not meet the criteria for a formal diagnosis of insomnia, depending on how long they last and whether they cause distress or interfere with daily functioning. But it is important for anyone who has concerns about their sleep to discuss them with a health professional for proper diagnosis and treatment.

A doctor can ask questions to better understand your situation and order tests to determine if an insomnia diagnosis is appropriate. Symptoms of insomnia can overlap with symptoms of other sleep disorders, so it is important to work with a professional rather than attempting to self-diagnose.

Insomnia that goes untreated, leading to long-term sleep deprivation, is linked with a number of , including lower quality of life and increased risk for substance abuse, chronic pain, heart disease, and diabetes.

Types of Insomnia

The two main types of insomnia are acute insomnia and chronic insomnia. Acute insomnia describes sleep difficulties that last for a few days or weeks, but not longer than three months. Short-term insomnia can often be traced to an external cause or life stressor like divorce, the death of a loved one, or a major illness. If acute insomnia persists over multiple months, it becomes classified as chronic insomnia.

Chronic insomnia is when a person experiences sleeping difficulties and related daytime symptoms, like sleepiness and attention issues, at least three days per week for longer than three months. It is estimated that about 10% to 15% of people have chronic insomnia.

People with chronic insomnia commonly feel distressed about their inability to sleep and the daytime symptoms caused by those sleep issues. Symptoms are generally severe enough to affect a person's work or school performance as well as their social or family life.

The symptoms of insomnia include various sleep-related difficulties and daytime problems. Common sleep issues that can signal the presence of insomnia include:

Trouble falling asleep

Trouble staying asleep throughout the night

Unwanted early morning waking

Resisting sleeping at bedtime in children and teens

Difficulty sleeping without a caregiver's help in children and teens

In addition, insomnia causes daytime symptoms related to sleep loss. Those with insomnia often report feeling fatigued during waking hours, which may lead to impaired attention or memory. Insomnia-related sleepiness can affect work, school or social performance, and increase the risk of accidents. Insomnia has the potential to negatively influence behavioral health and may contribute to instances of irritability, hyperactivity, or aggressiveness, especially in children.

There is no main cause of insomnia. However, research suggests that in many people insomnia likely results from certain types of physiological arousal at unwanted times, disrupting normal patterns of sleep. Examples of such arousal can include a heightened heart rate, a higher body temperature, and increased levels of specific hormones, like cortisol.

A person's family history, age, and gender may also play a role in their susceptibility to insomnia. Additionally, insomnia disorders often occur alongside mental health disorders, including depression and anxiety. It is believed that the cause of insomnia may be distinct in people who have both insomnia and mental health conditions.

Risk Factors for Insomnia

While there is no single cause of insomnia, studies have identified factors that can put a person at a . These include, but are not limited to:

Being a woman or assigned female at birth

Older age

Lower socioeconomic status

Medical conditions like diabetes and chronic pain

Other sleep disorders such as restless legs syndrome and sleep apnea

Mood disorders including depression and anxiety National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. View Source

Having an immediatefamily member with insomnia

It is important to note that not everyone who has one or more of these risk factors will have insomnia, and not everyone with insomnia will have one of these risk factors.

Doctors generally diagnose insomnia by evaluating a person's sleep habits and medical history.

Typically, a patient's description of their symptoms informs their insomnia diagnosis. A doctor may instruct patients to keep a sleep diary for a week or more, which can provide insight about a person's sleep duration, perceived sleep quality, and lifestyle choices that may contribute to sleep problems. Other self-reporting diagnostic tools, including the Pittsburgh Sleep Quality Index, may be used by medical professionals in a clinical setting to determine the severity of insomnia symptoms.

If a doctor needs to rule out other sleep disorders that could be causing a person's symptoms, other assessments, such as a sleep study, may be ordered.

Treatment for insomnia depends on how long a person has been experiencing sleep issues and any specific factors that are contributing to their sleep loss. If insomnia is associated with another condition, such as sleep apnea or depression, treatment of the other condition often improves sleep.

It is important to get help with insomnia sooner than later. For people with short-term insomnia, care may be focused on discussing practices to support sleep hygiene. Temporary use of a prescription sleep aid may be an option if the insomnia is causing high levels of concern or distress.

A few treatment approaches are available for people with insomnia that persists for weeks or months.

Cognitive Behavioral Therapy for Insomnia (CBT-I)

Experts consider cognitive behavioral therapy for insomnia (CBT-I) to be the most effective initial treatment for chronic insomnia. CBT-I helps people manage anxiety they feel about their sleep issues and establish better sleep habits.

Sleep Medications

If a person experiences significant symptoms from insomnia, or in cases where CBT-I does not help, medication may be recommended. Medication can help promote sleep but may also come with side effects, such as daytime drowsiness or confusion.

Homeopathic Treatments

Some people with insomnia may be interested in exploring other options, such as melatonin or dietary supplements, yoga, hypnosis, or aromatherapy. However, scientific evidence supporting the use of these methods to treat insomnia is .

Lifestyle Changes

Maintaining healthy sleep habits after insomnia treatment may help .

Set a sleep schedule: Maintain the same bedtime and wake time every day, even on weekends.

Establish a dedicated sleep space: Reserve use of the bed for only sex and sleep.

Be mindful of substance use: Curb consumption of caffeine, alcohol, or nicotine, especially near bedtime

Control light exposure: Try to keep the bedroom both dark and quiet, and refrain from watching television or using other electronics that emit blue light before bed.

Keep sleep-related anxiety in check: If you are experiencing anxiety about sleep troubles, get out of bed and try a relaxing activity like reading, taking a bath, or meditating.

Adjust your eating habits: Avoid eating large meals too close to bedtime.

Eric Suni has over a decade of experience as a science writer and was previously an information specialist for the National Cancer Institute.

Dr. Rehman, M.D., is a board-certified physician in Internal Medicine as well as Endocrinology, Diabetes, and Metabolism.

Learn more about our Editorial Team

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Insomnia: Symptoms, Causes, and Treatments | Sleep Foundation

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Insomnia is a sleep disorder that affects many people. Learn about symptoms, causes, and treatments.

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https://www.mayoclinic.org/diseases-conditions/insomnia/symptoms-causes/syc-20355167

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This disorder can make it hard to fall asleep, hard to stay asleep or both, even though you have the chance for enough sleep. It can drain your energy.

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https://sleepeducation.org/sleep-disorders/narcolepsy/

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Narcolepsy is a lifelong neurologic disorder that is characterized by the inability to control normal sleep wake cycles.

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https://medlineplus.gov/sleepapnea.html#:~:text=Sleep%20apnea%20is%20a%20common,or%20become%20blocked%20during%20sleep

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Sleep apnea is a common disorder that causes your breathing to stop or get very shallow. Breathing pauses can last from a few seconds to minutes. They may occur 30 times or more an hour.

The most common type is obstructive sleep apnea. It causes your airway to collapse or become blocked during sleep. Normal breathing starts again with a snort or choking sound. People with sleep apnea often snore loudly. However, not everyone who snores has sleep apnea.

You are more at risk for sleep apnea if you are overweight, male, or have a family history or small airways. Children with enlarged tonsils or adenoids may also get it.

Doctors diagnose sleep apnea based on medical and family histories, a physical exam, and sleep study results.

When your sleep is interrupted throughout the night, you can be drowsy during the day. People with sleep apnea are at higher risk for car crashes, work-related accidents, and other medical problems. If you have it, it is important to get treatment. Lifestyle changes, mouthpieces, surgery, and breathing devices can treat sleep apnea in many people.

NIH: National Heart, Lung, and Blood Institute

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Sleep apnea is a common disorder that causes your breathing to stop or get very shallow. Breathing pauses can last from a few seconds to minutes. They may occur 30 times or more an hour. The most common type is obstructive sleep apnea. It causes your airway to collapse or become blocked during sleep.

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https://www.ninds.nih.gov/health-information/disorders/narcolepsy

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The mission of the National Institute of Neurological Disorders and Stroke ( ) is to seek fundamental knowledge about the brain and nervous system and to use that knowledge to reduce the burden of neurological disease. The NINDS, a component of the National Institutes of Health ( ), along with several other Institutes and Centers, supports research on narcolepsy and other sleep disorders through grants to medical institutions across the country.

Genetics and biochemicals
NINDS-sponsored researchers are conducting studies devoted to further clarifying the wide range of genetic-both HLA genes and non-HLA genes-and environmental factors that may cause narcolepsy. Other investigators are using animal models to better understand hypocretin and other chemicals such as glutamate that may play a key role in regulating sleep and wakefulness. Researchers are also investigating wake-promoting compounds to widen the range of available therapeutic options and create treatment options that reduce undesired side effects and decrease the potential for abuse. A greater understanding of the complex genetic and biochemical bases of narcolepsy will eventually lead to new therapies to control symptoms and may lead to a cure.

Abnormalities in the immune system may play an important role in the development of narcolepsy. NINDS-sponsored scientists have demonstrated the presence of unusual immune system activity in people with narcolepsy. Further, strep throat and certain varieties of influenza are now thought to be triggers in some at-risk individuals. Other researchers are also working to understand why the immune system destroys hypocretin neurons in narcolepsy in the hopes of finding a way to prevent or cure the disorder.

continues to support investigations into the basic biology of sleep, such as examining the brain mechanisms involved in generating and regulating REM sleep and other sleep behaviors. Since sleep and circadian rhythms are controlled by networks of neurons in the brain, NINDS researchers are also examining how neuronal circuits function in the body and contribute to sleep disorders like narcolepsy. A more comprehensive understanding of the complex biology of sleep will give scientists a better understanding of the processes that underlie narcolepsy and other sleep disorders.

Learn About Clinical Trials

Clinical trials are studies that allow us to learn more about disorders and improve care. They can help connect patients with new and upcoming treatment options.

How can I or my loved one help improve care for people with narcolepsy?

serves as a central point of access to collections that span neurological, neuropsychiatric, and neurodevelopmental diseases and disorders. Tissue from individuals with narcolepsy is needed to enable scientists to study this disorder more intensely. Participating groups include brain and tissue repositories, researchers, program staff, information technology experts, disease advocacy groups, and, most importantly, individuals seeking information about opportunities to donate.

Additionally, supports genetic and immunological research in narcolepsy at the . Blood samples from individuals with narcolepsy can be sent by mail and are needed to enable scientists to study this disorder more intensely. Stanford University Center for Narcolepsy

All types of volunteers are needed- those who are healthy or may have an illness or disease- of all different ages, sexes, races, and ethnicities to ensure that study results apply to as many people as possible, and that treatments will be safe and effective for everyone who will use them.

For information about participating in clinical research visit NIH Clinical Research Trials and You . Learn about clinical trials currently looking for people with narcolepsy at

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The mission of the National Institute of Neurological Disorders and Stroke ( ) is to seek fundamental knowledge about the brain and nervous system and to use that knowledge to reduce the burden of neurological disease.

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https://www.mayoclinic.org/diseases-conditions/sleep-apnea/symptoms-causes/syc-20377631

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Snoring loudly could be an indication of sleep apnea, a disorder in which breathing stops and starts repeatedly during sleep.

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https://www.nhlbi.nih.gov/health/sleep-apnea

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Sleep apnea is a common condition in which your breathing stops and restarts many times while you sleep. Learn about the causes and symptoms of sleep apnea and how to manage your condition.

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https://www.sleepfoundation.org/sleep-apnea

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Sleep apnea is a condition marked by abnormal breathing during sleep. People with sleep apnea have multiple extended pauses in breath when they sleep. These temporary breathing lapses cause lower-quality sleep and affect the body's supply of oxygen, leading to potentially serious health consequences.

Sleep apnea is one of the most common sleep disorders in the United States. It can affect children and adults and people of both sexes, although it is more common in men.

Because of sleep apnea's prevalence and potential health impact, it is important for people to be aware of what sleep apnea is and to know its types, symptoms, causes, and treatments.

What Are the Types of Sleep Apnea?

There are three types of sleep apnea:

Obstructive Sleep Apnea (OSA): OSA occurs when the airway at the back of the throat becomes physically blocked. That obstruction causes temporary lapses in breath.

Central Sleep Apnea (CSA): CSA happens because there is a problem with the brain's system for controlling muscles involved in respiration, leading to slower and shallower breathing.

Mixed Sleep Apnea: When a person has both OSA and CSA at the same time, it is referred to as mixed sleep apnea or complex sleep apnea.

Because the underlying causes are distinct, there are important differences in the symptoms, causes, and treatments of OSA and CSA.

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Lofta WatchPAT is a FDA-approved portable diagnostic device that uses the most innovative technology to ensure the accurate screening, detection, and the follow-up treatment of sleep apnea. Click here for more information.

How Common Is Sleep Apnea?

Obstructive sleep apnea is estimated to affect between 2-9% of adults in the United States, but many cases are believed to go undiagnosed, which fits with studies that have found considerably higher rates of OSA. Precise prevalence is hard to determine because studies have used different criteria for diagnosing the condition. A consistent finding, though, is that OSA affects men more than women. It can occur in people of any age but is more common in older adults.

Central sleep apnea has been found to affect around .9% of adults over the age of 40. It is found much more frequently in men than in women.

As this data demonstrates, OSA is much more common than CSA. For this reason, when people talk about "sleep apnea," they are generally referring to OSA.

What Are the Symptoms of Sleep Apnea?

All three types of sleep apnea share certain common symptoms:

Disrupted breathing in which a person's respiration can become labored or even stop for up to a minute at a time

Excessive daytime sleepiness

Morning headaches

Irritability

Limited attention span or difficulty thinking clearly

Many of these symptoms arise because of poor sleep and decreased oxygen levels that occur as a result of interrupted breathing.

Some additional symptoms are connected to obstructive sleep apnea:

Snoring, including snoring that is especially loud and involves gasping, choking, or snorting that may cause a person to briefly wake up

Morning sore throat or dry mouth

Frequent need to wake up to urinate (nocturia)

Chronic snoring is the most common symptom of OSA, but that doesn't mean that everyone who snores has sleep apnea. Snoring is not a frequent symptom in people with CSA.

In general, a person with sleep apnea is not aware of their breathing problems at night. For that reason, they often only find out about the issue from a bed partner, family member, or roommate. Excessive daytime sleepiness is the most likely symptom to be noticed by people with sleep apnea that live alone.

What Are the Causes of Sleep Apnea?

Obstructive sleep apnea occurs when a person's airway becomes blocked during sleep. Multiple factors have been found to increase the risk of blockage and OSA:

Anatomical characteristics. The size and positioning of a person's neck, jaw, tongue, tonsils, and other tissue near the back of the throat can directly affect airflow.

Obesity. Being overweight is a leading cause of OSA and may be an underlying risk factor in up to 60% of cases. Obesity contributes to anatomical narrowing of the airway, and research has found that a 10% increase in weight can equate to a six-fold increase in OSA risk.

Use of sedatives, including alcohol. Sedative medications and drugs can cause tissue in the throat to relax, making it easier for the airway to become obstructed.

Family history. People who have one or more close relatives with OSA are more likely to develop OSA themselves.

Cigarette smoking. People who smoke, especially heavy smokers, have been found to have OSA at a higher rate than people who don't smoke.

Sleeping on your back. This sleeping position makes it easier for tissue to collapse around the airway and cause blockages.

Nasal congestion. People whose ability to breathe through the nose is reduced because of congestion are more likely to experience OSA.

Hormone abnormalities. Hormone conditions like hypothyroidism(underactive thyroid) and acromegaly (excess growth hormone) may increase the risk of OSA by causing swelling of tissue near the airway and/or contributing to a person's risk of obesity.

In CSA, breathing is affected in a different way than in OSA. Instead of an obstruction causing breathing lapses, the problem arises in how the brain communicates with the muscles responsible for respiration. In particular, the brain stem fails to adequately perceive the levels of carbon dioxide in the body, leading to breathing that is slower and shallower than it should be.

CSA is typically connected to an underlying medical condition. For example, a stroke, infection of the brain, or in rare cases a brain tumor may damage the brain stem. Pain medicines like opioids can also interfere with this normal process of breathing.

Heart failure is considered to be a risk factor for CSA, and CSA can also arise when a person's oxygen levels are thrown off because they are at high altitude.

What Are the Health Risks of Sleep Apnea?

Sleep apnea can lead to sleep deprivation from constant nightly interruptions and shallower overall sleep. Lack of sleep is associated with far-reaching health consequences that affect a person physically, mentally, and emotionally, and as a result, it comes as no surprise that sleep apnea has been tied to diverse health problems.

Because of how it affects oxygen balance in the body, untreated sleep apnea raises dangers for various types of cardiovascular issues including high blood pressure, heart attack, heart disease, and stroke.

What Are the Treatments for Sleep Apnea?

If you have symptoms of sleep apnea, you should make sure to talk with a doctor. Without understanding the root causes of your sleep apnea, it is difficult to treat. When necessary, the doctor can recommend an overnight sleep study to analyze your sleep, including your breathing.

If a person is diagnosed with OSA or CSA, treatment is often effective at improving sleep and reducing the risks of long-term health complications. A doctor familiar with a patient's situation is in the best position to address potential benefits and risks of treatments and make specific recommendations.

Lifestyle changes, such as losing weight, reducing use of sedatives, and sleeping on your side, can resolve some cases of OSA. Another common treatment is nightly use of a continuous positive airway pressure (CPAP) or bi-level positive airway pressure (BiPAP) machine. These devices push air through a mask and into the airway to keep it open during sleep.

Some types of mouthpieces that hold the jaw or tongue in a specific position are an option for people with certain anatomical features that trigger mild OSA. In addition, though usually not the first treatment option, surgery to remove tissue and expand the airway can be considered. Medications may be prescribed to help with daytime sleepiness in people with this symptom.

Treatment for CSA typically centers on managing the underlying condition, such as a brain infection, heart failure, or altitude adjustment, that causes disordered breathing. CPAP or BiPAP machines or supplemental oxygen may help some patients as well.

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Sleep Apnea - Causes & Symptoms | Sleep Foundation

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Sleep apnea is a condition marked by abnormal breathing during sleep. People with sleep apnea have multiple extended pauses in breath when they sleep. These temporary breathing lapses cause lower-quality sleep and affect the body's supply of oxygen, leading to potentially serious health consequences.

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https://www.sleepapnea.org/

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Sleep apnea is a serious medical condition that is also under-reported and underdiagnosed. Learn more about sleep apnea and its treatments.

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https://my.clevelandclinic.org/health/diseases/8718-sleep-apnea

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Understand Pap Therapy for Your Sleep Apnea

How is sleep apnea treated, and is there a cure?

There are many approaches to treating sleep apnea, depending on the specific type of sleep apnea and how severe it is. While none of these is a cure, they can help prevent apnea events or reduce how often they happen or how severe they are.

Many treatments should be a part of your daily (or nightly) routine. That can ultimately reduce or even eliminate sleep apnea's effects on your life for as long as you use these treatments.

Possible treatments include:

Conservative (nonmedical) treatments.

Positive airway pressure and adaptive ventilation devices.

Oral appliances (mouthpieces).

Nerve stimulators.

Surgery.

Medications (central sleep apnea only).

Conservative treatments

These nonmedical treatments or approaches can typically improve obstructive sleep apnea or resolve it. They aren't cures, but they can reduce apnea to the point where it stops happening or isn't severe enough to cause symptoms. These include:

Weight loss. A 10% decrease in body weight can significantly improve sleep apnea for people who have excess weight or obesity.

Position changes while sleeping and sleep aid items. Sleeping on your back makes sleep apnea more likely to happen. Special support pillows and similar items can help change the position in which you sleep, keeping you off your back so soft tissue doesn't press on your windpipe and block breathing.

Nasal sprays, adhesive strips, etc.These over-the-counter products improve breathing by making it easier for air to travel through your nose. While they can't help moderate or severe sleep apnea, they can sometimes help snoring and mild sleep apnea.

Treating the underlying condition.Treating conditions such as heart failure can often improve central sleep apnea.

Medication changes.Working with your doctor to decrease or stop opioid pain medications may be able to improve or even resolve central sleep apnea.

Positive airway pressure (PAP) and adaptive ventilation

Positive airway pressure is a method that uses a specialized device to increase the air pressure inside of your airway while you inhale. This method can treat obstructive, central and mixed sleep apneas.

Pushing pressurized air down your windpipe keeps it open so you can breathe. These devices push air through a hose that attaches to a special mask you wear on your face while you sleep. Masks can cover your nose, mouth or both, and there are many different types and styles to choose from.

The best-known PAP device is the Continuous Positive Airway Pressure (CPAP) machine. However, there are other types of PAP machines, too (see our CPAP Machine article for more about the different types of devices, including adaptive servo-ventilation devices). These devices increase the air pressure inside of your airway and lungs when you inhale, keeping surrounding tissue from pressing your airway shut.

Oral devices

Obstructive sleep apnea happens when soft tissue in your head or neck, especially around your mouth and jaw, press downward on your windpipe. Special mouthpiece devices can help hold your jaw and tongue in a position that keeps pressure off your windpipe. Dentists and sleep medicine specialists often work together to make these for people who need them.

Nerve stimulators

The hypoglossal nerve (the name comes from Greek and means "under the tongue") is what controls your tongue's movements. A nerve stimulator attached to this nerve can stimulate it, pushing your tongue slightly forward when you breathe while you're sleeping. That keeps your tongue from relaxing and pressing backward on your windpipe while you sleep, which is one of the ways that obstructive sleep apnea happens.

An electrode attaches to the nerve under your jaw and connects to a device implanted under the skin in your chest. You can turn the stimulator on before you sleep and turn it off after you wake up. The electrical current is strong enough to keep your tongue from relaxing too much, but mild enough that it's not uncomfortable.

A similar kind of nerve stimulation is also possible with central sleep apnea. This type of stimulation affects the phrenic nerves. This pair of nerves connect your spinal cord to the diaphragm, a layer of muscle underneath your lungs that controls your ability to inhale and exhale. Stimulating the phrenic nerve causes those muscles to flex, helping you breathe.

Surgery

Surgeries on your nose, mouth and throat can help prevent blockages of your nose, throat and windpipe. However, the impact of these in adults is usually limited and varies from person to person. These surgeries include:

Somnoplasty. This procedure uses radiofrequency (RF) to reduce soft tissue around the upper parts of your windpipe.

Tonsillectomy/adenoidectomy. Removing your tonsils and adenoids can widen the opening where your mouth, throat and nasal passages connect. That makes it easier for air to pass through and reduces soft tissue that can block your breathing. This procedure is most helpful for children with obstructive sleep apnea.

Uvulopalatopharyngoplasty (UPPP). This procedure removes your uvula (the teardrop-shaped soft tissue that hangs at the back of your mouth). It also removes soft tissue from your soft palate and pharynx. These widen the area where your mouth and throat meet, making it easier for air to pass through.

Jaw surgery. Different surgery procedures can subtly change the position of your jaw so soft tissue can't easily press back on your airway. These procedures are especially helpful for people who have sleep apnea for structural reasons like micrognathia.

Nasal surgery. One common form of nasal surgery is septoplasty, which straightens the soft tissue in your nose, making it easier for air to travel through your nose and nasal passages.

Medications for central sleep apnea

In addition to positive airway pressure, adaptive ventilation and phrenic nerve stimulators, there are some medications that may help central sleep apnea. Some examples of these medications include hypnotic (sleep-promoting) medications, respiratory-stimulating drugs and more. However, none of these medications are formally approved or definitively accepted for this use.

What can or can't I eat or drink with sleep apnea?

People who have sleep apnea should avoid heavy drinking, and frequent use of sleeping pills or other drugs (recreational and otherwise) that cause heavy sedation. These can make sleep apnea worse. Your healthcare provider can talk to you about drugs that can cause that and how you can avoid the effects.

Complications/side effects of the treatment

The complications and side effects of the treatments depend on many factors, especially the treatments themselves. Your healthcare provider is the best source of information for what you can do to minimize the side effects or prevent them when possible.

How to take care of myself/manage symptoms?

Sleep apnea is a condition that can severely disrupt your life and put you at risk for life-threatening complications and events (see more about these under the Outlook/Prognosis section below). Because of this, you shouldn't try to self-diagnose or self-treat it. If you think you have sleep apnea, you should schedule an appointment with a sleep specialist or ask a primary care provider to refer you to a sleep specialist.

How you can help with diagnosis

If you suspect you or a loved one has sleep apnea, you might be able to help a healthcare provider diagnose it. Video and audio recordings of a person sleeping, especially where the provider can hear breathing, can give a provider key evidence they need to speed up the diagnostic process.

How soon after treatment will I feel better?

The time it takes to recover or feel better after treatment for sleep apnea depends on the treatments themselves. Some people will feel better almost immediately, while others may need three to six months of consistent nightly treatment to see the full benefits. Your healthcare provider can tell you more about the timeline for your recovery and when you should expect to feel better.

Devices that treat sleep apnea, especially positive airway pressure devices, often bring very fast results. Older devices may take some tweaking and adjusting (a process known as "titration") of the settings, but many newer devices can often adjust automatically to meet your needs (especially if your sleep apnea is mild or on the low end of moderate).

While some people may need to get used to wearing a mask to sleep, most people can overcome that fairly quickly. Many people see improvements immediately when they sleep through the night using a positive airway pressure device.

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Sleep Apnea: What It Is, Causes, Symptoms & Treatment

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Sleep apnea is a disorder that causes you to stop breathing while asleep. This disrupts and prevents restful sleep, which can have a severe impact on your life.

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https://www.mayoclinic.org/diseases-conditions/narcolepsy/symptoms-causes/syc-20375497#:~:text=Narcolepsy%20is%20a%20sleep%20disorder,problems%20in%20their%20daily%20routine

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Overview

Narcolepsy is a sleep disorder that makes people very drowsy during the day. People with narcolepsy find it hard to stay awake for long periods of time. They fall asleep suddenly. This can cause serious problems in their daily routine.

Sometimes narcolepsy also causes a sudden loss of muscle tone, known as cataplexy (KAT-uh-plek-see). This can be triggered by strong emotion, especially laughter. Narcolepsy is divided into two types. Most people with type 1 narcolepsy have cataplexy. Most people who don't have cataplexy have type 2 narcolepsy.

Narcolepsy is a life-long condition for which there's no cure. However, medicines and lifestyle changes can help manage the symptoms. Support from others - family, friends, employers and teachers - can help people cope with the disorder.

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Symptoms

The symptoms of narcolepsy may get worse during the first few years of the disorder. Then they continue for life. They include:

Excessive daytime sleepiness. People with narcolepsy fall asleep without warning. It can happen anywhere and at any time. It may happen when you're bored or during a task. For example, you may be working or talking with friends and suddenly fall asleep. It can be especially dangerous if you fall asleep while driving. You might fall asleep for only a few minutes or up to a half-hour. After waking, you'll often feel refreshed but you'll get sleepy again.

You also may experience a decrease in how alert and focused you feel during the day. Daytime sleepiness often is the first symptom to appear. Feeling sleepy makes it hard to focus and function.

Some people with narcolepsy continue doing a task when they fall asleep briefly. For example, you may fall asleep while writing, typing or driving. You might continue to perform that task while asleep. When you awaken, you can't remember what you did, and you probably didn't do it well.

Sudden loss of muscle tone. This condition is called cataplexy. It can cause slurred speech or complete weakness of most muscles. Symptoms may last up to a few minutes.

Cataplexy can't be controlled. It's triggered by intense emotions. Often the emotions that cause cataplexy are positive. Laughter or excitement may cause the symptoms. But sometimes fear, surprise or anger can cause the loss of muscle tone. For example, when you laugh, your head may drop without your control. Or your knees may suddenly lose strength, causing you to fall.

Some people with narcolepsy experience only one or two episodes of cataplexy a year. Others have several episodes a day. Not everyone with narcolepsy has these symptoms.

Sleep paralysis. People with narcolepsy often experience sleep paralysis. During sleep paralysis, you can't move or speak while falling asleep or upon waking. It's usually brief - lasting a few seconds or minutes. But it can be scary. You may be aware of it happening and can recall it afterward.

Not everyone with sleep paralysis has narcolepsy.

Hallucinations. Sometimes people see things that aren't there during sleep paralysis. Hallucinations also may happen in bed without sleep paralysis. These are called hypnagogic hallucinations if they happen as you fall asleep. They're called hypnopompic hallucinations if they happen upon waking. For example, you might feel as if there is a stranger in your bedroom. These hallucinations may be vivid and frightening because you may not be fully asleep when you begin dreaming.

Changes in rapid eye movement (REM) sleep. REM sleep is when most dreaming happens. Typically, people enter REM sleep 60 to 90 minutes after falling asleep. But people with narcolepsy often move more quickly to REM sleep. They tend to enter REM sleep within 15 minutes of falling asleep. REM sleep also can happen at any time of the day.

Other characteristics

People with narcolepsy may have other sleep disorders. They might have obstructive sleep apnea, in which breathing starts and stops during the night. Or they may act out their dreams, known as REM sleep behavior disorder. Or they may have trouble falling asleep or staying asleep, called insomnia.

When to see a doctor

See your health care provider if you experience excessive daytime sleepiness that affects your personal or professional life.

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Causes

The exact cause of narcolepsy is unknown. People with type 1 narcolepsy have low levels of hypocretin (hi-poe-KREE-tin), also called orexin. Hypocretin is a chemical in the brain that helps control being awake and when you enter REM sleep.

Hypocretin levels are low in people who experience cataplexy. Exactly what causes the loss of hypocretin-producing cells in the brain isn't known. But experts suspect it's due to an autoimmune reaction. An autoimmune reaction is when the body's immune system destroys its own cells.

It's also likely that genetics plays a role in narcolepsy. But the risk of a parent passing this disorder to a child is very low - only about 1% to 2%.

Research also indicates that in some cases narcolepsy may be linked to exposure to the swine flu (H1N1 flu) virus. It also may be linked to a certain form of the H1N1 vaccine. The vaccine was administered in Europe.

Typical sleep pattern vs. narcolepsy

The typical process of falling asleep begins with a phase called non-rapid eye movement (NREM) sleep. During this phase, brain waves slow. After an hour or so of NREM sleep, brain activity changes and REM sleep begins. Most dreaming occurs during REM sleep.

In narcolepsy, you may suddenly enter REM sleep without going through NREM sleep. This can happen both at night and during the day. Cataplexy, sleep paralysis and hallucinations are similar to changes that occur in REM sleep. But in narcolepsy they happen while you're awake or drowsy.

Risk factors

There are only a few known risk factors for narcolepsy, including:

Age. Narcolepsy typically begins between ages 10 and 30.

Family history. Your risk of narcolepsy is 20 to 40 times higher if you have a close family member who has it.

Complications

Public misconception of the condition. Narcolepsy can cause problems at work or in your personal life. Your performance may suffer at school or work. Others might see people with narcolepsy as lazy or lethargic.

Effects on intimate relationships. Intense feelings, such as anger or joy, can trigger cataplexy. This can cause people with narcolepsy to withdraw from emotional interactions.

Physical harm. Falling asleep suddenly may result in injury. You're at increased risk of a car accident if you fall asleep while driving. Your risk of cuts and burns is greater if you fall asleep while cooking.

Obesity. People with narcolepsy are more likely to be overweight. Sometimes weight rapidly increases when sleepiness symptoms start.

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Narcolepsy is a sleep disorder that makes people very drowsy during the day. People with narcolepsy find it hard to stay awake for long periods of time. They fall asleep suddenly. This can cause serious problems in their daily routine. Sometimes narcolepsy also causes a sudden loss of muscle tone, known as cataplexy (KAT-uh-plek-see).

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https://my.clevelandclinic.org/health/diseases/12147-narcolepsy

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Overview

What is narcolepsy?

Narcolepsy is a sleep disorder that causes an urge to fall asleep suddenly during the daytime that's almost impossible to resist. Although this condition isn't common, it's widely known because of its symptoms and how they happen. Narcolepsy is usually treatable, but the condition can still cause severe disruptions in your life, ability to work and social relationships.

What are the symptoms of narcolepsy?

There are four main symptoms of narcolepsy, but most people with this condition don't have all four. The four symptoms are:

Excessive daytime sleepiness. This symptom happens to everyone with narcolepsy. People with narcolepsy and experts on the condition often describe these as "sleep attacks."

Sudden muscle weakness (cataplexy). This can have mild effects, affecting one side of your body or only light muscle weakness. (See below for more about this symptom.)

Sleep-related hallucinations. These happen right after falling asleep or right before waking up.

Sleep paralysis. When you have this symptom, you'll wake up - sometimes fully, but not always - but find yourself unable to move. (See below for more about this symptom.)

More about cataplexy

There are two main types of narcolepsy, and whether or not you have cataplexy separates the two. The two types are:

Narcolepsy type 1: This form involves cataplexy. About 20% of narcolepsy cases are type 1.

Narcolepsy type 2: This form doesn't involve cataplexy. The majority of narcolepsy cases - about 80% - are type 2.

Under ordinary circumstances, your brain shuts down most muscle control in your body to keep you from acting out your dreams. People with cataplexy will have sudden muscle weakness, similar to how your body blocks movements during REM sleep.

Mild cataplexy may only affect your face and neck - such as your jaw dropping involuntarily - or just one side of your body. Severe cataplexy can make you collapse to the ground, which can lead to injuries. These events usually last under a few minutes, but you may not be able to move or talk at all during that time.

Cataplexy is also unusual because certain emotions cause it to happen. Positive emotions are most likely to trigger cataplexy, especially laughing, making jokes or other humor-related behavior. Surprise, fear and anger can also trigger cataplexy, but aren't as likely to do so.

Cataplexy can take slightly different forms in children and in people whose symptoms started within the past six months. For them, cataplexy can look like sudden, uncontrollable grimacing or face-scrunching, sticking out their tongue or loss of muscle tone (making muscles feel soft and limbs "floppy") throughout their body without an emotion-related cause.

More about sleep paralysis

Your brain shuts down muscle control in your body to keep you from acting out your dreams, but this should end when you wake up. However, if you have sleep paralysis, your body doesn't regain muscle control as it should. You can still breathe and move your eyes, but you can't talk or move the rest of your body.

Hallucinations during sleep paralysis are very common, and they're often vivid and extraordinarily frightening. Fortunately, sleep paralysis is usually very short-lived, lasting only a couple of minutes at most (though people with this often describe that it feels longer).

Other symptoms

In addition to the four main symptoms, some other symptoms or behaviors are common in people with narcolepsy. Some of the more common or easily noticeable behaviors include:

Automatic movements. People with narcolepsy can often fall asleep, but may keep moving parts of their body like their hands.

Amnesia or forgetfulness. It's common for people with this condition to not remember what they were doing right before falling asleep.

Sudden outbursts around sleep attacks. A person with narcolepsy may suddenly speak up and say something (usually words or phrases that are nonsensical or unrelated to what's happening around them). When someone with narcolepsy does this, it might startle them back to being fully awake, but most people who do this also don't remember doing it.

Who does narcolepsy affect?

Healthcare providers usually diagnose narcolepsy in people between the ages of 5 and 50. However, it's most likely to appear in young adults in their late teens and early 20s. Men and people assigned male at birth (AMAB) have a higher risk of developing narcolepsy.

How common is narcolepsy?

Narcolepsy is uncommon. Available research shows that it affects 25 to 50 people out of every 100,000 worldwide. However, this condition often takes years to diagnose, so the actual number of people with it is difficult to estimate.

How does narcolepsy affect my body?

To understand narcolepsy, it helps to know more about the way the human sleep cycle works. That cycle involves the following stages:

Stage 1: Light sleep. This short stage begins right after you fall asleep and accounts for about 5% of your total sleep time.

Stage 2: Deeper sleep. This stage is deeper and makes up about 45% to 50% of all the time you spend sleeping (this number goes up as you get older).

Stage 3: Slow wave sleep. This stage makes up about 25% of the time you spend sleeping (this number goes down with age). It's very hard to wake someone up in stage 3 sleep, and waking up directly from it usually causes "sleep inertia," a state of "mental fog" and slowed thinking. This is also the stage where sleepwalking or sleeptalking typically happens.

REM sleep: REM stands for "rapid eye movement." This stage is when you dream. When a person is in REM sleep, you can see their eyes moving beneath their eyelids.

If you don't have narcolepsy, you typically enter stage 1 when you fall asleep and then move into stages 2 and 3. You'll cycle between these stages and ultimately go into REM sleep and start dreaming. After the first REM cycle, you start a new cycle and go back into stage 1 or 2. One cycle normally takes about 90 minutes before another begins. Most people go through four or five cycles per night (assuming they get a full eight hours).

If you have narcolepsy, your sleep cycle doesn't happen like that. Instead, you'll go into the REM stage shortly after falling asleep. The rest of the night, you'll sleep only in short stretches, often without going through the typical sleep cycle.

With narcolepsy, no matter how well you sleep at night, you'll feel extremely sleepy during the daytime. That urge to fall asleep is usually impossible to resist, but these sleep periods are also short (about 15 to 30 minutes) during the day. Once you wake up, you'll feel rested and ready to resume whatever you were doing before. However, this happens several times during the day, which is why narcolepsy is so disruptive.

Symptoms and Causes

What causes narcolepsy?

The causes of narcolepsy depend on the type of narcolepsy itself. However, they all have links to your hypothalamus, a specific area in your brain that helps regulate your sleep and wake times.

Type 1 narcolepsy

In 1998, researchers discovered orexins, a type of chemical molecule created and used by certain neurons (brain cells) for communication. The neurons that use orexins are in a part of your brain called the hypothalamus, and those neurons are key to how you stay awake.

Orexin (sometimes called hypocretins) is a molecule produced by neurons that's usually detectable in cerebrospinal fluid (CSF), a thin layer of fluid surrounding and cushioning your brain and spinal cord. However, CSF levels of orexin are very low - or undetectable - in people with narcolepsy. That means the cells that make orexin either stopped working or something destroyed them.

According to further research, the most likely reason those neurons stopped working is an autoimmune problem. That means your immune system attacked the neurons that make and use orexins, the orexins themselves or both.

About 90% to 95% of people with type 1 narcolepsy have a specific genetic mutation (the identifier for this mutation is HLA-DQB1*06:02) that affects their immune system. However, about 25% of all people also have this mutation but don't have narcolepsy. As a result, experts rarely test for this mutation and they aren't certain what role it plays. There's also some evidence that this condition runs in families, as having a first-degree relative (a parent, sibling or child) with narcolepsy puts you at higher risk for developing it.

However, people can also develop type 1 narcolepsy after certain viral and bacterial infections, especially strains of H1N1 influenza and bacteria like those that cause strep throat. Experts suspect that's because infections can sometimes trigger changes and malfunctions in your immune system.

Type 2 narcolepsy

While experts know much of why type 1 narcolepsy happens, that's not the case with type 2 narcolepsy. Experts still don't fully understand why type 2 narcolepsy happens. But they suspect it happens for similar reasons. Those include less-severe loss of the neurons that use orexin or a problem with how orexin travels in your brain.

Secondary narcolepsy

In rare cases, narcolepsy can happen because of damage to your hypothalamus. You can have this kind of damage from head injuries (such as concussions and traumatic brain injuries), strokes, brain tumors and other conditions.

Narcolepsy can also happen as a feature of unrelated conditions that you can inherit. Examples of this include:

Autosomal dominant cerebellar ataxia, narcolepsy and deafness (ADCADN).

Autosomal dominant narcolepsy, type 2 diabetes and obesity.

Is narcolepsy contagious?

Narcolepsy isn't contagious. You can't spread it to or catch it from others.

Diagnosis and Tests

How is narcolepsy diagnosed?

A healthcare provider can suspect narcolepsy based on your symptoms. However, narcolepsy shares symptoms with several other brain- and sleep-related conditions. Because of that, the only way to diagnose narcolepsy conclusively is with specialized diagnostic tests.

Before doing most of the main tests for narcolepsy, a healthcare provider will first make sure that you're getting enough sleep. That usually involves simple tracking methods for your sleep-wake patterns, such as actigraphy. This typically uses a watch-like device that you wear on your wrist to track movement patterns (such as when you're sleeping vs. when you're up and moving around while awake).

What tests will be done to diagnose narcolepsy?

Some possible tests for diagnosing narcolepsy include:

Sleep study (polysomnogram)

A sleep study involves multiple types of sensors that track how you sleep. A key part of a full sleep study, formally known as a polysomnogram, is that it includes electroencephalogram (EEG) sensors. Those sensors track your brain waves, allowing healthcare providers to see what stage of sleep you're in from minute to minute.

A sleep study can help diagnose narcolepsy because people who have this condition go into the REM stage sleep unusually fast compared to people who don't. They'll also have sleep broken up by periods of wakefulness, which the sleep study can also detect and record.

Another key reason why a sleep study is necessary is that excessive daytime sleepiness is also a main symptom of sleep apnea. A sleep study can rule out sleep apnea.

Multiple sleep latency test

This test involves testing whether or not you're prone to falling asleep during the daytime. This test involves timed naps that happen in a specific timeframe. This test can help determine if a person has excessive daytime sleepiness, which is a required symptom of narcolepsy. This test often happens the following day after an overnight sleep study.

Maintenance of wakefulness test

This test determines if you can stay awake during the daytime, even in situations where it would be easy to fall asleep. While it's not common in testing for narcolepsy, it's still possible and can rule out other issues. It's also useful for testing if stimulant treatments are helping.

Spinal tap (lumbar puncture)

This test can help determine if the orexin levels in your CSF are low. This is a key way to diagnose type 1 narcolepsy. Low orexin levels can also signal that someone with narcolepsy may develop cataplexy, even if they haven't yet shown that symptom. Unfortunately, orexin levels don't change in people with type 2 narcolepsy, so it isn't always a test that helps with diagnosis.

Other tests

Many other tests are also common for people who have narcolepsy. An example of why this might happen is having cataplexy as a symptom. Cataplexy is similar to several other motor (movement-related) symptoms of brain conditions, such as atonic seizures (also known as drop attacks).

Because of that, healthcare providers might first test for more severe conditions like seizures and epilepsy, which means narcolepsy may take longer for providers to pinpoint and diagnose. Other tests are possible, too, and your healthcare provider is the best person to explain what tests they recommend and why.

Management and Treatment

How is narcolepsy treated, and is there a cure?

Narcolepsy is treatable but not curable. Treatments usually start with medications, but changes to your daily routine and lifestyle can also help. In general, narcolepsy responds well to treatment, which helps limit the disruptions that symptoms can cause.

What medications or treatments are used to treat narcolepsy?

Medication is the main method for treating narcolepsy. Most medications target excessive daytime sleepiness, but some target other symptoms, too. Possible medications for this condition include:

Wakefulness medications. These are usually the first line of treatment. Examples of these drugs include modafinil and armodafinil. These medications stimulate your nervous system, which can help reduce the severity or frequency of daytime sleepiness.

Amphetamines and amphetamine-like stimulants. Drugs like methylphenidate (better known under several trade names, including Ritalin®, Concerta® or Qullivant®) or amphetamine/dextroamphetamine combinations (better known by the trade name Adderall®).

Antidepressants. Medications like serotonin-norepinephrine reuptake inhibitors (SNRIs) such as venlafaxine (commonly known by the trade name Effexor®), selective serotonin reuptake inhibitors (SSRIs) like fluoxetine (better known under the trade name Prozac®), or tricyclic antidepressants like clomipramine or protriptyline (but these are less common).

Sodium oxybate. This drug can help you sleep and also reduces how often cataplexy happens. Most countries control this drug very tightly because of its effects, but it's still used frequently for treating type 1 narcolepsy.

Histamine-affecting drugs. An example of this type of drug is pitolisant, a histamine receptor antagonist. Receptor antagonists are drugs that block specific chemicals in your body from attaching to cells. That slows down or prevents the cells from doing certain things.

While there are multiple treatment options for narcolepsy in adults, treatment options in children are very limited. Your child's pediatrician or a specialist provider is the best person to tell you what treatment options are available or what they recommend.

Complications/side effects of narcolepsy treatment

Many medications that treat narcolepsy or its symptoms are more likely to interact with other drugs. High blood pressure (hypertension) and irregular heart rhythms are just two possible complications with stimulant medications of any kind. Sodium oxybate in particular is dangerous if combined with other drugs that dampen how your central nervous system works, and you should never mix it with alcohol.

In general, your healthcare provider is the best person to tell you what side effects, complications or medication interactions to watch for or avoid. They can tailor the information to your specific case and situation, accounting for your health history and personal circumstances.

How do I take care of myself or manage my symptoms?

You shouldn't try to self-diagnose and self-treat narcolepsy. That's because the symptoms of this condition happen commonly with other conditions like sleep apnea or epilepsy, which are also dangerous. This condition can also make certain activities like driving or swimming dangerous, so you should always see a healthcare provider for diagnosis and treatment.

How soon after treatment will I feel better, and how long does it take to recover from this treatment?

The recovery time or time to feel the effects of treatments for narcolepsy depends on many factors. Your healthcare provider is the best person to tell you what to expect in your case, including the timeline on when you should see the effects of medications or changes in your symptoms.

Prevention

How can I reduce my risk or prevent narcolepsy?

Narcolepsy happens unpredictably in almost all cases. Because of that, it's impossible to reduce your risk of developing it or prevent it from happening.

Outlook / Prognosis

What can I expect if I have narcolepsy?

Narcolepsy isn't usually dangerous on its own, but the sudden, irresistible need to sleep is very disruptive. People with this condition may be unable to drive (either temporarily or permanently, depending on their specific symptoms and circumstances).

While narcolepsy usually isn't dangerous, type 1 narcolepsy does have added risks of injury from falls when cataplexy is severe. Narcolepsy can also create dangerous situations when driving, using power tools or heavy equipment, swimming and more.

Narcolepsy in children

Children with narcolepsy often struggle because of the effects of the condition. Daytime sleepiness can make it hard to pay attention in school, maintain social relationships and participate in school and non-school activities.

However, narcolepsy is a medical condition. Because of this, children with narcolepsy often have legal protections, and the law requires schools to provide suitable accommodations. Some examples include adjusting class schedules, having time built in time for naps or rest periods and taking medications while at school. Your child's pediatrician or other experts can help you navigate this and find solutions that can help your child.

Narcolepsy in working adults

Much like the legal protections for children in schools, adults with narcolepsy also commonly have legal protections because of this condition. The Americans with Disabilities Act prohibits discriminating against someone because of a medical condition (including narcolepsy) in the United States.

That legal protection means people with narcolepsy can often work out accommodations agreements with their employers to make it possible for them to have a career while still managing their condition.

How long does narcolepsy last?

Narcolepsy is permanent once you develop it, so it's a lifelong condition. However, it doesn't get worse over time.

What is the outlook for narcolepsy?

Narcolepsy isn't dangerous on its own, but it can make it hard to go to certain places or do certain activities. It also can disrupt going to school, having a job and other common parts of your life. While treatment isn't always totally effective, most cases of narcolepsy respond to treatment. That means you can usually manage this condition and limit how it affects your life.

Living With

How do I take care of myself?

If you have narcolepsy, there are several things you can do to help manage your condition and make treatments more effective. Most of these relate to practicing good sleep hygiene or otherwise adjusting your schedule and routine, including the following actions:

Be consistent with your sleep habits. Sticking to a sleep schedule can improve how well you sleep.

Make time for sleep. Set a bedtime that allows you to get the recommended amount of sleep for your age. You should also build some time into your schedule before going to sleep to wind down and relax.

Limit the time you spend around bright lights or using electronics. Light from these too close to bedtime can disrupt your body's natural sleep-wake functions.

Avoid drinking alcohol or caffeine, using tobacco or eating a meal too close to bedtime. A light snack is the best option if you feel hungry before bedtime. You should avoid alcohol entirely if you take certain medications (your healthcare provider can tell you if they prescribe any of these for you). Experts also strongly recommend quitting tobacco products entirely (including vaping and smokeless tobacco).

Be physically active. Staying active, even just going for a walk, can help with the quality of your sleep.

Have a nap. People with narcolepsy will often feel better after taking a short nap. Once you figure out the times of day you feel sleepiest, adjusting your schedule to nap at those times can help you.

Avoid dangerous activities or take precautions when you do them

Narcolepsy can - and does - lead to serious or even deadly auto crashes. To keep yourself and those around you safe, you should never drive unless a healthcare provider specifically clears you to drive.

If you notice that narcolepsy symptoms are happening while you're driving, you should stop driving entirely and contact your healthcare provider. While this is inconvenient even in the best of cases, it's also crucial to avoiding deadly or life-changing consequences of a car crash because you fell asleep behind the wheel.

Another key area where narcolepsy creates a specific danger is in the water. If you have narcolepsy, it's very important that you always wear a life preserver when swimming or are in any kind of boat or watercraft where a life preserver is recommended. Without a life preserver or lifejacket - worn properly at all times - a sleep attack in the water could have deadly consequences.

When should I see my healthcare provider?

Falling asleep suddenly without an expected reason is a sign that you need to see a healthcare provider. All of these are symptoms of many conditions, not just narcolepsy, and several of those conditions are severe. With many of these conditions, the longer you wait to get a diagnosis and treatment, the more likely you'll face complications or that treatment will be less effective.

When should I go to the ER?

You should seek medical care at a hospital or emergency room if you collapse or pass out unexpectedly. This is a key symptom of many conditions, including heart attack, stroke, irregular heart rhythms and more. Those conditions are medical emergencies and need immediate care.

Collapsing or passing out unexpectedly also puts you at risk for fall-related injuries. You should always get medical attention if you have a possible injury to your head, neck or any part of your back and spine. Fractures and injuries to your spinal cord at any level can cause permanent damage, paralysis or even death.

You should also get medical attention if you fall and you're taking blood-thinning medications of any kind, especially if you hit your head. Falls and injuries create a risk for dangerous internal bleeding, and you need medical attention to make sure you don't have injuries that could lead to deadly complications.
A note from Cleveland Clinic
Narcolepsy is a brain-related condition that causes disruptions in your body's natural sleep/wake processes. While this condition isn't usually dangerous directly, it can create risks in certain situations. It's also a condition that can seriously disrupt your life, routine and activities. Many people with this condition may have issues with routine activities like working and driving.

Fortunately, this condition is treatable, and most people with narcolepsy see at least some improvements from treatment. Adjusting sleep-related behaviors can also help. While it's not always possible to prevent the symptoms of narcolepsy, many people can manage this condition and adapt to most - if not all - of its effects.

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Narcolepsy: What It Is, Causes, Symptoms & Treatment

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Narcolepsy is a disorder that affects your brain's control over sleeping and waking up, making you fall asleep during the daytime. This condition is usually treatable.

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https://www.sleepfoundation.org/narcolepsy

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What is Narcolepsy

Narcolepsy is a sleep disorder characterized by excessive sleepiness, sleep paralysis, hallucinations, and in some cases episodes of cataplexy (partial or total loss of muscle control, often triggered by a strong emotion such as laughter). Narcolepsy occurs equally in men and women and is thought to affect roughly 1 in 2,000 people. The symptoms appear in childhood or adolescence, but many people have symptoms of narcolepsy for years before getting a proper diagnosis.

People with narcolepsy feel very sleepy during the day and may involuntarily fall asleep during normal activities. In narcolepsy, the normal boundary between awake and asleep is blurred, so characteristics of sleeping can occur while a person is awake. For example, cataplexy is the muscle paralysis of REM sleep occurring during waking hours. It causes sudden loss of muscle tone that leads to a slack jaw, or weakness of the arms, legs, or trunk. People with narcolepsy can also experience dream-like hallucinations and paralysis as they are falling asleep or waking up, as well as disrupted nighttime sleep and vivid nightmares.

Types of Narcolepsy

Narcolepsy symptoms can vary from person to person, with some cases more severe than others. There are two main types of narcolepsy:

Narcolepsy with Cataplexy

In addition to the other narcolepsy symptoms, people who have narcolepsy with cataplexy experience sudden muscle weakness and lose control of the muscles in their face, arms, legs, or torso. This causes the person to slur words, have a sagging jaw, collapse, or slump over and be unable to move. During cataplexy, the person is awake. An episode can last for seconds or up to one or two minutes and is often triggered by a strong emotion, such as excitement or laughter.

Narcolepsy without Cataplexy

A person with narcolepsy without cataplexy has all the symptoms of narcolepsy extreme sleepiness, sleep attacks, dream-like hallucinations and paralysis while falling asleep or waking up, and disrupted nighttime sleep), but without episodes of sudden muscle weakness triggered by strong emotions. This type of narcolepsy can be less severe than narcolepsy with cataplexy.

Narcolepsy and the Brain

Narcolepsy affects the systems in the brain that help us stay awake. Normally, alerting signals come from the brain stem, a region deep in the brain responsible for many basic functions. These signals spread out and "wake up" the rest of the brain. Meanwhile, a cluster of cells in another nearby region called the hypothalamus produce the chemical hypocretin. Hypocretin activates and maintains the action of those alerting signals coming from the brain stem.

In a person with narcolepsy, the cells in this specialized region of the hypothalamus have died off. Even though it's a relatively small cluster of cells, the impact on waking and sleep is dramatic. Without hypocretin, it's hard for a person to stay awake for long periods of time, and they experience overlaps between waking and sleep-such as vivid hallucinations and paralysis when falling asleep or waking up.

The loss of hypocretin also affects the action of other key chemicals in the brain, such as dopamine, serotonin, and norepinephrine. This is why antidepressants (which act on these neurotransmitters) are sometimes prescribed for narcolepsy.

Scientists are working on ways to target and stimulate hypocretin receptors, as a way to mimic the presence of the chemical. They are also working on understanding how hypocretin cells are lost in the first place (the autoimmune response) so they can target the first stage of the process and halt the development of narcolepsy symptoms.

What Causes Narcolepsy?

Narcolepsy with cataplexy is caused by a lack of the chemical hypocretin in the brain. Hypocretin is an important chemical for regulating wakefulness and rapid eye movement (REM) sleep. Narcolepsy without cataplexy includes most of the same symptoms, but its cause is unknown. Injuries to the hypothalamus and brain stem, tumors, and stroke are under investigation.

The current understanding of narcolepsy is that it begins with an underlying genetic predisposition; a person is born with certain genes that put them at greater risk for developing narcolepsy. In childhood or the teen years, an event like an infection may trigger the onset of narcolepsy. Instead of the immune system simply attacking the infection, it becomes confused and attacks the specialized cells in the brain that produce hypocretin. The loss of hypocretin-producing cells leads to the symptoms of narcolepsy. Because the immune system is believed to be responsible for the loss of these cells, narcolepsy is considered an autoimmune disease. One of the triggering events linked to narcolepsy is an infection of the H1N1 influenza virus.

The loss of hypocretin in the brain makes it hard for a person to stay awake. It also allows REM sleep to occur in moments when it normally does not. A person with narcolepsy can enter REM sleep directly from a waking state, rather than going through the normal progression from awake, through deep sleep, and eventually into REM sleep.

Sleep Cycles, REM Sleep, and Narcolepsy

During normal sleep cycles, we progress through stages of non-rapid eye movement (NREM) sleep and eventually into rapid eye movement (REM) sleep. When we enter REM sleep, we are more likely to dream, most muscles in the body become paralyzed, and our eyes move back and forth behind the eyelids.

For a person with narcolepsy, aspects of REM sleep overlap with being awake. This is why during the day, when the person is awake, a strong emotion can trigger cataplexy and the paralysis of REM, causing the loss of muscle control seen in cataplexy. This is also what causes a person with narcolepsy to experience vivid dream-like hallucinations and paralysis while falling asleep or waking up.

Living and Managing Narcolepsy

Currently there is no cure for narcolepsy, but medications and behavioral treatments can improve symptoms for people so they can lead normal, productive lives.

To vastly improve the quality of your life, consider implementing coping strategies such as,

Explain narcolepsy to friends, family, and co-workers if appropriate. Use a clear and accurate description of the disorder and symptoms. Educating them will increase their empathy and support for you.

Be flexible about social engagements and plans, knowing when you need to take a break and be okay with changing plans so you can take care of yourself.

Take short naps during the day. Experiment with naps and see if, when, and for how long they make you feel alert.

Get to know your triggers for intense sleepiness and cataplexy.

Pay attention to how medications affect your symptoms, including what time you take those medications and how that works for you.

Note what kinds of foods and regular exercises make you feel more alert.

Practice good sleep habits: avoid caffeinated beverages late in the day; have a short, consistent bedtime routine; keep a regular bedtime and wake up time when possible; do not use electronics close to bedtime; keep your bedroom cool, quiet and dark.

Find a support group for people with narcolepsy. Narcolepsy can be isolating. Learning from others is very helpful and will make you feel connected

Managing Narcolepsy at School

Narcolepsy often begins during childhood and teens year, so it's important to find ways to manage symptoms in the learning environment. Students with narcolepsy can learn and perform well in school with the right support.

The symptoms of narcolepsy can, at first, be difficult to distinguish from other issues like sleep deprivation-especially in teens. Behaviors like falling asleep in class, poor grades, or not being able to complete homework or other assignments can be early clues. If narcolepsy is diagnosed, it's an opportunity for the student, parents, and teachers to meet and discuss how to support the student in school. Educate teachers about narcolepsy, describing it as a sleep disorder that has a chemical cause in the brain and is not a result of bad sleep habits, lack of motivation, or the need for more sleep.

It may be helpful to make arrangements with the school nurse to understand the child's medications and accommodate the need for short, scheduled naps during school hours. A letter from the child's doctor to the school nurse may be needed.

Kids can develop self-awareness about what helps them feel best, for example taking a nap in the nurse's office, getting up and walking around the classroom, exercising, sitting on a yoga ball instead of a chair, chewing gum, sitting near the window or at the front of the class-all these habits can help, with the support of the teacher.

Managing Narcolepsy at Work

It may be a good idea to tell your co-workers, supervisor, or human resources department about your diagnosis, if it's appropriate. Give a short, clear definition of what narcolepsy is and what the symptoms look like. Describe possible scenarios where symptoms may occur (for example, an episode of cataplexy when laughing), and be ready with concrete plans that you believe help you manage symptoms and increase productivity at work. Depending on your work setting, employers may be obligated to make accommodations.

Helpful strategies for staying alert and productive at work are to stand up periodically, for example while talking on the phone or in conversation with a co-worker; and walk around the office or outside when possible. Taking brief naps during the workday may be essential, so assess the best strategy for this-whether it's napping in your office or signing up for another room for 30 minutes to allow for a nap. Explain to your co-workers and supervisor that a short nap increases your productivity.

Driving and Other Safety Risks

Narcolepsy symptoms can be very dangerous. Falling asleep or losing muscle control during normal daytime activities poses a serious safety risk. Some of the most dangerous scenarios are driving a car, operating machinery, and cooking. It takes only a few seconds of intense sleepiness or loss of muscle control at the wheel for an accident to occur. Research suggests that people with narcolepsy are more likely to fall asleep while driving and more likely to be involved in a car accident.

The safety risks of narcolepsy make it important to seek help, consider treatment options, and manage alertness and productivity through behavioral and lifestyle changes. Self-awareness and education is key in managing narcolepsy and maintaining a productive and safe daily life.

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Narcolepsy - Symptoms, Causes, Treatment | Sleep Foundation

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Narcolepsy is a sleep disorder characterized by excessive sleepiness, sleep paralysis, hallucinations, and in some cases episodes of cataplexy (partial or total loss of muscle control, often triggered by a strong emotion such as laughter). Narcolepsy occurs equally in men and women and is thought to affect roughly 1 in 2,000 people.

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https://www.hopkinsmedicine.org/health/conditions-and-diseases/narcolepsy

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Narcolepsy is a sleep disorder. It is a lifelong disease of the central nervous system.Narcolepsy causes excessive and overwhelming daytime sleepiness, even after getting plenty of nighttime sleep. If you have narcolepsy, you are likely to become drowsy or to fall asleep at inappropriate times and p…

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https://www.mayoclinic.org/diseases-conditions/restless-legs-syndrome/symptoms-causes/syc-20377168

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Overview

Restless legs syndrome (RLS) is a condition that causes an uncontrollable urge to move your legs, usually because of an uncomfortable sensation. It typically happens in the evening or nighttime hours when you're sitting or lying down. Moving eases the unpleasant feeling temporarily.

Restless legs syndrome, also known as Willis-Ekbom disease, can begin at any age and generally worsens as you age. It can disrupt sleep, which interferes with daily activities.

Simple self-care steps and lifestyle changes may help relieve symptoms. Medications also help many people with RLS.

Products & Services

Symptoms

The chief symptom is an urge to move the legs. Common accompanying characteristics of RLS include:

Sensations that begin after rest. The sensation typically begins after you've been lying down or sitting for an extended time, such as in a car, airplane or movie theater.

Relief with movement. The sensation of RLS lessens with movement, such as stretching, jiggling your legs, pacing or walking.

Worsening of symptoms in the evening. Symptoms occur mainly at night.

Nighttime leg twitching. RLS may be associated with another, more common condition called periodic limb movement of sleep, which causes your legs to twitch and kick, possibly throughout the night, while you sleep.

People typically describe RLS symptoms as abnormal, unpleasant sensations in their legs or feet. They usually happen on both sides of the body. Less commonly, the sensations affect the arms.

The sensations, which generally occur within the limb rather than on the skin, are described as:

Sometimes the sensations are difficult to explain. People with RLS usually don't describe the condition as a muscle cramp or numbness. They do, however, consistently describe the desire to move their legs.

It's common for symptoms to fluctuate in severity. Sometimes, symptoms disappear for periods of time, then come back.

When to see a doctor

Some people with RLS never seek medical attention because they worry they won't be taken seriously. But RLS can interfere with your sleep and cause daytime drowsiness and affect your quality of life. Talk with your doctor if you think you may have RLS.

Causes

Often, there's no known cause for RLS. Researchers suspect the condition may be caused by an imbalance of the brain chemical dopamine, which sends messages to control muscle movement.

Heredity

Sometimes RLS runs in families, especially if the condition starts before age 40. Researchers have identified sites on the chromosomes where genes for RLS may be present.

Pregnancy

Pregnancy or hormonal changes may temporarily worsen RLS signs and symptoms. Some women get RLS for the first time during pregnancy, especially during their last trimester. However, symptoms usually disappear after delivery.

Risk factors

RLS can develop at any age, even during childhood. The disorder is more common with increasing age and more common in women than in men.

RLS usually isn't related to a serious underlying medical problem. However, it sometimes accompanies other conditions, such as:

Peripheral neuropathy. This damage to the nerves in your hands and feet is sometimes due to chronic diseases such as diabetes and alcoholism.

Iron deficiency. Even without anemia, iron deficiency can cause or worsen RLS. If you have a history of bleeding from your stomach or bowels, experience heavy menstrual periods, or repeatedly donate blood, you may have iron deficiency.

Kidney failure. If you have kidney failure, you may also have iron deficiency, often with anemia. When kidneys don't function properly, iron stores in your blood can decrease. This and other changes in body chemistry may cause or worsen RLS.

Spinal cord conditions. Lesions on the spinal cord as a result of damage or injury have been linked to RLS. Having had anesthesia to the spinal cord, such as a spinal block, also increases the risk of developing RLS.

Complications

Although RLS doesn't lead to other serious conditions, symptoms can range from barely bothersome to incapacitating. Many people with RLS find it difficult to fall or stay asleep.

Severe RLS can cause marked impairment in life quality and can result in depression. Insomnia may lead to excessive daytime drowsiness, but RLS may interfere with napping.

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Restless legs syndrome - Symptoms and causes

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Restless legs syndrome (RLS) is a condition that causes an uncontrollable urge to move your legs, usually because of an uncomfortable sensation. It typically happens in the evening or nighttime hours when you're sitting or lying down. Moving eases the unpleasant feeling temporarily.

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https://www.ninds.nih.gov/health-information/disorders/restless-legs-syndrome

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Restless legs syndrome (RLS)-also known as Willis-Ekbom Disease, primary RLS, and idiopathic RLS- is a neurological disorder that causes unpleasant or uncomfortable sensations in your legs and an irresistible urge to move them. Symptoms commonly occur in the late afternoon or evening hours and are often most intense at night when you are resting. RLS can severely disrupt your sleep, making it difficult to fall asleep or return to sleep after waking up. Moving the legs or walking typically relieves the discomfort but the sensations often recur once the movement stops.

Who is more likely to have restless legs syndrome?

ttention deficit hyperactivity disorder

The National Institute of Neurological Disorders and Stroke ( ) is the primary federal funding agency for research on restless legs syndrome. NINDS is a component of the National Institutes of Health ( ), a leading supporter of biomedical research in the world.

For research articles and summaries on RLS, search , which contains citations from medical journals and other sites.

Learn About Clinical Trials

Clinical trials are studies that allow us to learn more about disorders and improve care. They can help connect patients with new and upcoming treatment options.

How can I or my loved one help improve care for people with restless legs syndrome?

Consider participating in a clinical trial so clinicians and scientists can learn more about restless legs syndrome. Clinical research uses human volunteers to help researchers learn more about a disorder and perhaps find better ways to safely detect, treat, or prevent disease.

For information about participating in clinical research visit NIH Clinical Research Trials and You . Learn about clinical trials currently looking for people with RLS at Clinicaltrials.gov , a database of federal and other clinical trials.

Where can I find more information about restless legs syndrome?

Information also is available from the following organizations:

Learn about related topics

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Restless legs syndrome (RLS)-also known as Willis-Ekbom Disease, primary RLS, and idiopathic RLS- is a neurological disorder that causes unpleasant or uncomfortable sensations in your legs and an irresistible urge to move them. Symptoms commonly occur in the late afternoon or evening hours and are often most intense at night when you are resting.

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https://www.rls.org/understanding-rls/symptoms-diagnosis

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How Do I Know If I Have RLS?
RLS is perhaps the most common condition you have never heard of, affecting more people than even type 2 diabetes. Up to 7-8% of the population has this neurological condition with 2-3% experiencing severe symptoms that affect their quality of life and require pharmaceutical treatment to manage their symptoms.

These five essential features must be present for a correct diagnosis of restless legs syndrome (RLS):

You have a strong urge to move your legs (sometimes arms and trunk), usually accompanied or caused by uncomfortable and unpleasant sensations in the legs.

Your symptoms begin or become worse when you are resting or inactive, such as when lying down or sitting.

Your symptoms get better when you move, such as when you walk or stretch, at least as long as the activity continues.

Your symptoms are worse in the evening or night than during the day, or only occur in the evening or nighttime hours.

Your symptoms are not solely accounted for by another condition such as leg cramps, positional discomfort, leg swelling or arthritis. RLS often causes difficulty in falling or staying asleep, one of the chief complaints of the disease. Many people who have RLS also have periodic limb movements (PLMs) - jerking of the arms or legs that is often associated with sleep disruption.

Remember, if you have RLS, you are not alone! How Do Doctors Diagnose RLS?

Listen to a description of your symptoms and complete a diagnostic interview checking for symptoms listed under the essential criteria.

Review your medical history.

Rule out conditions that are often confused with RLS.

Your doctor should:

Check your iron (ferritin) levels.

Ask you to stay overnight in a sleep study lab to determine other causes of your sleep disruption.

Your doctor might:

Find a Healthcare Provider
To better serve our members, the Foundation maintains a directory of healthcare providers who have experience and knowledge in the treatment of RLS.

You can locate a provider in your area below. If you do not find a doctor in your area, try to broaden your search criteria or search by state. It is not necessary to enter a city to search.

RLS Symptom Diary
The RLS Symptom Diary is a convenient tool to record information on your daily symptoms such as when they occur, how long they last and possible triggers such as nicotine, alcohol or caffeine.

Tips for filling out your symptom diary:

Fill out your symptom diary before you go to bed each night and when you wake up each morning.

The times you record in your symptom diary do not have be exact-just make a good guess.

Reviewing your symptom diary with your bed partner can help you identify unknown symptoms or time frames.

Download Your Symptom Diary How can I use my RLS Symptom Diary?
After about two weeks of recording in your symptom diary, you may find that some of your habits, such as drinking caffeinated beverages or exercising close to bedtime, may worsen your symptoms.

We have also developed a one-page symptom diary summary to share with your healthcare provider. Use it to record the main points from your symptom diary to summarize the information you collected each night.
Download Your Symptom Diary Summary

What is Augmentation?
Some individuals who have RLS may experience a worsening of symptoms as a side effect of a class of RLS medications called dopamine agonists. This effect, called augmentation, is one of the most common but least understood problems encountered in the treatment of RLS.

If augmentation occurs, you and your doctor can work together to find a new treatment strategy that will work for you. Be sure to talk with your doctor before making changes to your regimen.

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How Do I Know If I Have RLS? RLS is perhaps the most common condition you have never heard of, affecting more people than even type 2 diabetes.

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https://www.hopkinsmedicine.org/health/conditions-and-diseases/restless-legs-syndrome-rls

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Restless legs syndrome is a sleep disorder that causes creepy, crawly feelings in your legs. This often happens when you are trying to go to sleep or have been sitting for a long time.

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https://my.clevelandclinic.org/health/diseases/9497-restless-legs-syndrome

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Overview

What is restless legs syndrome (RLS)?

Restless legs syndrome (RLS), also called Willis-Ekbom disease, is a sleep disorder that causes an intense, often irresistible urge to move your legs (and even your arms or body). It occurs along with other sensations in your limbs described as pulling, creeping, tugging, throbbing, itching, aching, burning or crawling.

These sensations usually occur when lying down in bed or when sitting for long periods of time, such as while driving or while at a theater. RLS typically occurs in the evening, making it difficult to fall asleep. Often times people with RLS want to walk around and shake their legs (or arms) to help relieve the uncomfortable sensations.

Who gets restless legs syndrome (RLS)?

People of any age, including children, can have RLS. Symptoms of RLS may begin in childhood or adulthood, but the chance of having the syndrome increases significantly with age. RLS is more common in women than in men. Up to 10 percent of the United States population has RLS.

Symptoms and Causes

What causes restless legs syndrome (RLS)?

Restless legs syndrome (RLS) has been found to be a genetic syndrome in some cases, meaning that parents with RLS can pass it down to their children. Up to 92% of patients with RLS have a first-degree relative with the disorder. These patients tend to develop symptoms earlier in life (before age 45) than those with RLS without the genetic link.

In addition to the genetic source, many medical problems are closely associated with the development of RLS, including:

Medications can also contribute to the development of RLS. Such known medications include antidepressants, allergy drugs and anti-nausea medications. Caffeine, nicotine and alcohol can also make symptoms worse.

What are the symptoms of restless legs syndrome (RLS)?

Symptoms of restless legs syndrome include:

Leg (or arm) discomfort: These uncomfortable limb sensations are often described by adults as creeping, itching, pulling, crawling, tugging, throbbing, burning, or gnawing. These sensations usually occur at bedtime but can occur at other times of limb inactivity.

Urge to move legs (or arms): To relieve limb discomfort, you have an uncontrollable urge to move your limbs especially when resting, such as when sitting or lying down.

Sleep disruption: Additional time is often needed to fall asleep because of the urge to move your limbs to relieve the discomfort. Sometimes staying asleep may also be difficult.

Bedtime behavior problems: Because of the discomfort, you may need to get out of bed to stretch your limbs to relieve the discomfort.

Daytime sleepiness: Problems with falling asleep and staying asleep may result in daytime sleepiness.

Behavior and work performance problems: Again, due to sleep disruption, problems may emerge in daytime behavior (irritability, moodiness, difficulty concentrating, hyperactivity, etc) and work performance.

Diagnosis and Tests

How is restless legs syndrome (RLS) diagnosed?

Unfortunately, there is no specific test for restless legs syndrome (RLS). The diagnosis is made based on your symptoms. A medical history, complete physical and neurological exam and blood tests may be conducted to rule out any other possible health problems associated with RLS. An overnight sleep study may be recommended to evaluate for other sleep disorders, especially obstructive sleep apnea.

Your healthcare provider will ask about any family history of RLS. They will also ask if you have any sleep complaints, such as insomnia (difficulty falling asleep or staying asleep) due to your symptoms. Your healthcare provider will also ask if you have trouble staying awake during the day and ask about other behavior or work performance problems.

To confirm a diagnosis of RLS, you must meet the following five criteria:

Have an urge or desire to move your legs (or arms), usually occurring together with uncomfortable sensations such as pulling, tugging, crawling, itching, aching, or burning.

Also, the urge to move or uncomfortable sensations:

Begin or worsen during periods of rest or inactivity.

Are partially or totally relieved by activities such as stretching, walking or exercising the affected muscles.

Are worse or occur solely in the evening or at night.

Are not solely due to another medical or behavioral problem.

Management and Treatment

How is restless legs syndrome (RLS) treated?

Treatment of restless legs syndrome depends on the intensity of the symptoms. Treatment should be considered if quality of life is affected by insomnia and excessive daytime drowsiness. In cases of RLS due to ongoing medical disorders, specific treatment is also necessary.

Non-drug treatments. Non-drug treatments are tried first, especially if symptoms are mild. Non-drug treatments include:

Getting regular exercise, such as riding a bike/stationary bike or walking, but avoiding heavy/intense exercise within a few hours of bedtime.

Following good sleep habits, including avoiding reading, watching television or being on a computer or phone while lying in bed; getting 7 to 9 hours of sleep and following other healthy sleep habits. Not getting enough sleep can worsen RLS symptoms.

Avoiding or limiting caffeinated products (coffees, teas, colas, chocolates, and some medications [check labels]), nicotine, and alcohol.

Applying a heating pad, cold compress, or rubbing your legs to provide temporary relief to the leg discomfort. Also consider massage, acupressure, walking, light stretching or other relaxation techniques.

Soak in a warm tub.

Try magnesium supplements. They may be helpful.

Reduce stress as much as possible. Try meditation, yoga, soft music or other options.

Iron supplementation. Iron deficiency is a reversible cause of RLS. If blood tests reveal you have low iron levels, your doctor may recommend taking an iron supplement.

Prescription medications. When RLS symptoms are frequent or severe, your healthcare provider will likely prescribe medications to treat the disorder. Medications options include:

Dopamine agonists control the urge to move, sensory symptoms in the legs, and reduce involuntary leg jerks in sleep. Ropinirole (Requip®), pramipexole (Mirapex®) and the rotigotine patch (Neupro®) are the FDA-approved dopamine agonists used for RLS.

Anti-seizure medications can slow or block pain signals from nerves in the legs. Examples include gabapentin enacarbil (Horizant®), gabapentin (Neurontin®) and pregabalin (Lyrica®). These drugs are particularly effective in patients with painful RLS due to neuropathy. Gabapentin enacarbil is the only medication in this class that is FDA-approved for RLS. However, the others may be effective.

Benzodiazepines, clonazepam (Klonopin®) in particular, are sometimes prescribed for RLS but are usually reserved for more severe cases due to their addictive potential and side effects including daytime drowsiness.

Opioids, such as methadone or oxycodone, can be used to relieve symptoms of RLS but because of the risk of addiction, they are usually not prescribed unless the case is severe and other medications have not been effective.

You and your doctor will discuss the treatment that might be best for you.

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Restless Legs Syndrome (RLS): Causes, Symptoms, Diagnosis

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Restless legs syndrome (RLS), also called Willis-Ekbom disease, is a sleep disorder that causes an intense, often irresistible urge to move your legs (and even your arms or body). It occurs along with other sensations in your limbs described as pulling, creeping, tugging, throbbing, itching, aching, burning or crawling.

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https://sleepeducation.org/sleep-disorders/sleep-terrors/

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Sleep terrors, also called night terrors, is a parasomnia. A parasomnia involves undesired events that come along with sleep.

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https://www.mountsinai.org/health-library/diseases-conditions/night-terror

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The cause is unknown, but night terrors may be triggered by:

Fever

Lack of sleep

Periods of emotional tension, stress, or conflict

Night terrors are most common in children ages 3 through 7, and much less common after that. Night terrors may run in families. They can occur in adults, especially when there is emotional tension or alcohol use.

Night terrors. What are they and what do you do about them? I'm Dr. Alan Greene and want to discuss this common childhood issue with you called night terrors, or sometimes confusional arousals in some of the parenting books. What happens is a young child sometime shortly after bedtime will sit upright, open their eyes, start screaming, not recognize their parents, and seem extraordinarily frightened. What's going on? Well it turns out that they are not having a nightmare. They're not actually afraid of anything conscious that they can remember. And they're not awake. They're actually stuck between different stages of sleep and have this big adrenaline rush that is causing all of these behaviors that with no conscious thought going with it at all. Now the typical idea of what you should do during a night terror, confusional arousal, is perhaps hug the child. But sometimes it will make it even worse. My wife Cheryl came up with an idea for treating night terrors that I absolutely love. I've now heard from thousands of people that have tried it and it's the most effective thing I've ever come across. She reasoned that because night terrors happen at the same age where kids are learning to get this feeling of a full bladder up to their brains to wake them up, maybe it's a partial signal the bladder's full and not quite enough to wake them up. But it's enough to disrupt their sleep. So, she suggested taking a child, this happened with my youngest son, take them into the bathroom and see if they'll go to the bathroom. So, he woke up screaming. We were feeling bad about his screaming. Walked him into the bathroom. He didn't recognize us. He was screaming, eyes open, but he did for some reason recognize the toilet and went and immediately was calm again. So, we shared this with friends. We shared this with people online. Thousands of people have tried it. And for many, many children, that does indeed appear to be the cause and by far the most effective thing I've seen. You can also sometimes help by making bedtime and wake up time the same every day by keeping it very calm and the last hour before bed, maybe even a warm bath. And you can sort of do trial and error to what actually calms you child during a specific night terror.

Night terrors are most common during the first third of the night, often between midnight and 2 a.m.

Children often scream and are very frightened and confused. They thrash around violently and are often not aware of their surroundings.

The child may not be able to respond to being talked to, comforted, or awakened.

The spell may last 10 to 20 minutes, then the child goes back to sleep.

Most children are unable to explain what happened the next morning. They often have no memory of the event when they wake up the next day.

Children with night terrors may also sleep walk.

In contrast, nightmares are more common in the early morning. They may occur after someone watches frightening movies or TV shows, or has an emotional experience. A person may remember the details of a dream after waking up and will not be disoriented after the episode.

In many cases, no further examination or testing is needed. If night terror episodes occur often, the child should be evaluated by a health care provider. If needed, tests such as a sleep study can be done to rule out a sleep disorder.

In many cases, a child who has a night terror only needs to be comforted.

Reducing stress or using coping mechanisms may reduce night terrors. Talk therapy or counseling may be needed in some cases.

Medicines prescribed for use at bedtime will often reduce night terrors but are rarely used to treat this disorder.

Most children outgrow night terrors. Episodes usually decrease after age 10.

Minimizing stress or using coping mechanisms may reduce night terrors.

American Academy of Pediatrics website. Nightmares and night terrors in preschoolers. www.healthychildren.org/English/ages-stages/preschool/Pages/Nightmares-and-Night-Terrors.aspx. Updated October 18, 2018. Accessed June 11, 2021.

Avidan AY. Non-rapid eye movement parasomnias: clinical spectrum, diagnostic features, and management. In: Kryger M, Roth T, Dement WC, eds. Principles and Practice of Sleep Medicine. 6th ed. Philadelphia, PA: Elsevier; 2017:chap 102.

Owens JA. Sleep medicine. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 31.

Vaughn BV, Basner RC. Sleep disorders. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 377.

Version Info

Last reviewed on: 4/14/2021

Reviewed by: Charles I. Schwartz, MD, FAAP, Clinical Assistant Professor of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, General Pediatrician at PennCare for Kids, Phoenixville, PA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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The cause is unknown, but night terrors may be triggered by: Fever Lack of sleep Periods of emotional tension, stress, or conflict Night terrors are most common in children ages 3 through 7, and much less common after that. Night terrors may run in families.

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https://www.sleepfoundation.org/parasomnias/night-terrors

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Night terrors cause a person to wake up in a state of extreme fear. Studies estimate 30% to 40% of young children experience night terrors at some point. Night terrors become less common after age ten, but they can also occur in adults. Learn what causes night terrors, how they differ from nightmares, how to stop night terrors, and when to see a doctor.

also called sleep terrors, make a person wake up from sleep in a state of panic or terror. During a night terror, a person may suddenly sit up, jump out of bed, or scream. A person experiencing a night terror often displays other signs of fear,

A night terror can last between 10 and 40 minutes. Usually, others cannot calm down a person having a night terror. After the night terror ends, the person who experienced it often

Night terrors are a form of parasomnia, a category of sleep disorders that involve unusual movements or behaviors during sleep. Night terrors occur during non-rapid eye movement (NREM) sleep. NREM sleep encompasses both light and deep sleep, but not REM sleep, the stage most associated with vivid dreaming. Since people spend more time in NREM sleep earlier in the night, night terrors are more common during the first third of a night's sleep. This is especially true for children.

Night terrors are thought to occur when someone partially wakes up, but remains in a For this reason, night terrors may also be called an arousal parasomnia or a disorder of arousal. No clear cause of night terrors has been determined yet, but multiple factors make a person more likely to experience them.

Age: Young children are most likely to experience night terrors. They become less common with age, and most people stop having them by adolescence.

Genetics: Multiple studies suggest that parasomnias can run in families.

Sleep disorders: Sleep disorders that cause a person to briefly wake up throughout the night have been linked to night terrors. These include obstructive sleep apnea and periodic limb movement disorder, a condition that may be correlated with restless legs syndrome.

Anxiety: Although night terrors are common among children, they've been linked to separation anxiety in some children. Adults with post-traumatic stress disorder (PTSD) or another mood disorder may be more likely to have night terrors.

Sleep deprivation: After being deprived of sleep, a person spends more time in a deep sleep stage the next time they sleep. Since night terrors happen more from that stage, they may become more likely after sleep deprivation.

Fever: Similarly, a fever can cause an increase in deep sleep, which may then increase the chance of night terrors.

Night terrors and nightmares differ in that only from nightmares does a person wake up feeling scared. Nightmares involve the recall of vivid, frightening dreams. Night terrors involve waking, in a state of apparent fear, but there is no remembered dream, and the sleeper

Night terrors happen during NREM sleep stages, while nightmares generally happen during REM sleep. Because of this difference, night terrors are most common in the first third of the night, and nightmares are most common in the second half of the night as the duration of REM periods lengthen.

Night Terrors in Children

Night terrors occur commonly in young children, but most stop experiencing them once they reach adolescence. A child may have night terrors a few times a month or a few times a week.

Although witnessing night terrors can be upsetting for parents and caregivers, the children having them usually do not remember that they occurred. During a night terror, a child cannot be calmed down by others, and attempts to calm them may upset them more. Children who have night terrors may also be more likely to begin sleepwalking.

Up to 3% of adults experience night terrors. Night terrors among adults may be more dramatic than those in kids. An adult having a night terror may let out a piercing scream or move out of bed in a violent way. Night terrors in adults can lead to injury in some cases.

Night terrors can indicate an underlying problem in adults. Adults who have night terrors may also have post-traumatic stress disorder (PTSD), or another anxiety disorder or mental health issue.

Night terrors are usually only treated with medication when their frequency and intensity warrant. Otherwise, they're usually managed with at-home strategies.

Get adequate sleep: Since sleep deprivation can potentially trigger night terrors the next time a person sleeps, avoiding sleep deprivation is important. It can be important to keep a regular sleep-wake schedule with a consistent wake time and allow sufficient hours of rest to meet an individual's sleep needs.

Certain medications National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. Avoid triggering substances: Experts advise people with night terrors avoid consuming alcohol and caffeine, as both may increase the likelihood of night terrors. View Source may also trigger night terrors as a side effect and should be avoided.

Treat underlying disorders: Disorders such as obstructive sleep apnea and periodic limb movement disorder can trigger night terrors by causing brief awakenings. As a result, treating these disorders may stop or reduce a person's night terror episodes.

Avoid sleep disruptions: Since night terrors tend to occur during brief awakenings, eliminating sleep disruptions may help. For example, pets can be kept out of the bedroom and efforts can be taken to block potentially disruptive noises.

Should You Wake Your Child During Night Terrors?

Experts advise against trying to wake up your child during a night terror. Trying to wake them up, restrain them, or even calm them may backfire and cause them to be more upset. Instead, try to gently guide them back to bed while speaking slowly and quietly.

Altering the child's bedroom can help keep them safe during a night terror. For example, you could lower the mattress to the floor, set padding on the floor near the bed, keep potentially dangerous items in a separate room, lock doors and windows, and set up an alarm to indicate attempts to leave the room.

If you believe you or your child are experiencing night terrors, consider seeing a doctor.

Although night terrors are often considered normal in children, they can be difficult to distinguish from other disorders, like nocturnal seizures, panic attacks, and REM sleep behavior disorder. Night terrors may also occur more commonly in people who have other sleep or psychiatric disorders. A doctor can confirm a diagnosis of night terrors, rule out other issues, and advise on how to best manage the issue. This will usually involve undergoing an in-center sleep study.

Jay Summer is a health content writer and editor. She holds a B.S. in psychology and master's degrees in writing and public policy.

Brandon R. Peters, M.D., FAASM, is a double board-certified neurologist and sleep medicine specialist and fellow of the American Academy of Sleep Medicine who currently practices at Virginia Mason Franciscan Health in Seattle. He is a leading voice in sleep medicine who works at the cutting edge of medicine and technology to advance the field.

Learn more about our Editorial Team

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Night Terrors: Causes and Tips for Prevention

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Night terrors are common in children, and can cause them to wake up screaming and afraid. Learn why night terrors happen and how to stop them.

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https://stanfordhealthcare.org/medical-conditions/sleep/nighttime-sleep-behaviors/sleep-terrors.html

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Sleep terrors, or "night terrors", are characterized by extreme terror and a temporary inability to attain full consciousness.

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https://www.mayoclinic.org/diseases-conditions/sleep-terrors/symptoms-causes/syc-20353524

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Overview

Sleep terrors are episodes of screaming, intense fear and flailing while still asleep. Also known as night terrors, sleep terrors often are paired with sleepwalking. Like sleepwalking, sleep terrors are considered a parasomnia - an undesired occurrence during sleep. A sleep terror episode usually lasts from seconds to a few minutes, but episodes may last longer.

Sleep terrors affect almost 40 percent of children and a much smaller percentage of adults. However frightening, sleep terrors aren't usually a cause for concern. Most children outgrow sleep terrors by their teenage years.

Sleep terrors may require treatment if they cause problems getting enough sleep or they pose a safety risk.

Symptoms

Sleep terrors differ from nightmares. The dreamer of a nightmare wakes up from the dream and may remember details, but a person who has a sleep terror episode remains asleep. Children usually don't remember anything about their sleep terrors in the morning. Adults may recall a dream fragment they had during the sleep terrors.

Sleep terrors generally occur in the first third to first half of the night, and rarely during naps. A sleep terror may lead to sleepwalking.

During a sleep terror episode, a person may:

Begin with a frightening scream or shout

Sit up in bed and appear frightened

Stare wide-eyed

Sweat, breathe heavily, and have a racing pulse, flushed face and dilated pupils

Kick and thrash

Be hard to awaken, and be confused if awakened

Be inconsolable

Have no or little memory of the event the next morning

Possibly, get out of bed and run around the house or have aggressive behavior if blocked or restrained

When to see a doctor

Occasional sleep terrors aren't usually a cause for concern. If your child has sleep terrors, you can simply mention them at a routine well-child exam. However, consult your doctor if sleep terrors:

Become more frequent

Routinely disrupt the sleep of the person with sleep terrors or other family members

Lead to safety concerns or injury

Result in daytime symptoms of excessive sleepiness or problems functioning

Continue beyond the teen years or start in adulthood

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Causes

Sleep terrors are classified as a parasomnia - an undesirable behavior or experience during sleep. Sleep terrors are a disorder of arousal, meaning they occur during N3 sleep, the deepest stage of non-rapid eye movement (NREM) sleep. Another NREM disorder is sleepwalking, which can occur together with sleep terrors.

Various factors can contribute to sleep terrors, such as:

Sleep deprivation and extreme tiredness

Stress

Sleep schedule disruptions, travel or sleep interruptions

Fever

Sleep terrors sometimes can be triggered by underlying conditions that interfere with sleep, such as:

Sleep-disordered breathing - a group of disorders that include abnormal breathing patterns during sleep, the most common of which is obstructive sleep apnea

Restless legs syndrome

Some medications

Mood disorders, such as depression and anxiety

In adults, alcohol use

Risk factors

Sleep terrors are more common if family members have a history of sleep terrors or sleepwalking. In children, sleep terrors are more common in females.

Complications

Some complications that may result from experiencing sleep terrors include:

Excessive daytime sleepiness, which can lead to difficulties at school or work, or problems with everyday tasks

Disturbed sleep

Embarrassment about the sleep terrors or problems with relationships

Injury to oneself or rarely to someone nearby

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Sleep terrors (night terrors) - Symptoms and causes

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Sleep terrors are episodes of screaming, intense fear and flailing while still asleep. Also known as night terrors, sleep terrors often are paired with sleepwalking. Like sleepwalking, sleep terrors are considered a parasomnia - an undesired occurrence during sleep. A sleep terror episode usually lasts from seconds to a few minutes, but episodes may last longer.

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https://www.childrenscolorado.org/conditions-and-advice/conditions-and-symptoms/conditions/night-terrors/

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How are night terrors treated?

Treatment of night terrors is focused on calming your child back to sleep and keeping him or her safe during the episode. Parents can also follow some night terror prevention strategies. Doctors rarely use medication to treat night terrors in children.

Steps to help your child through a night terror

Try to help your child return to normal, calm sleep.

Don't try to wake your child; it is not possible during a night terror.

Turn on the lights so that your child is less confused by shadows.

Make soothing comments such as, "You are all right. You are home in your own bed. You can rest now."

Speak calmly and repetitively.

Such comments are usually better than silence and may help your child refocus.

Some children like to have their hand held during this time, but most will pull away.

Hold your child only if it seems to help them feel better.

Understand that there is no way to shorten the episode.

Shaking or shouting at your child will just cause the child to become more agitated and will prolong the episode.

Keep your child safe. During a night terror, a child can fall down a stairway, run into a wall or break a window. Gently direct your child back to bed.

Explain to babysitters and overnight caretakers what a night terror is and what to do if one happens. Understanding this will help them stay calm and control the situation if your child has a night terror.

How to prevent night terrors

Keep your child from becoming overtired. Sleep deprivation is the most common trigger for night terrors.

For preschoolers, restore the afternoon nap. If your child refuses the nap, encourage a one-hour "quiet time."

Avoid late bedtimes because they may trigger a night terror.

If your child needs to be awakened in the morning, that means he needs an earlier bedtime.

Move lights-out time 15 minutes earlier each night until your child can self-awaken in the morning.

Hot bedrooms stimulate these events; cool the room and use a fan if necessary.

Fever, inflammation, teething and illness can stimulate these events, so use an anti-inflammatory such as Motrin for fever or inflammation.

Some drugs, such as Benadryl, will trigger these events so avoid them when possible.

Hot baths just before bed may raise the body temperature; try a cool bath or shower earlier in the daytime.

A full bladder can also trigger night terrors.

If your child has frequent night terrors, you might try the "prompted awakening" technique to readjust your child's sleep patterns at the time the night terrors usually happen. Prompted awakening techniques include:

For several nights, note how many minutes elapse from the time your child falls asleep to the onset of the night terror.

Begin awakening your child every night 15 minutes before the expected time of the night terror.

Remind your child to "wake up fast." Keep your child fully awake and out of bed for 5 minutes.

Why choose Children's Colorado for your child's night terrors?

Night terrors are rarely, but sometimes, a symptom triggered by medical problems, including a disorder of dream sleep, a seizure or a movement disorder. At Children's Colorado, we are experts at diagnosing and treating night terrors, whether they are part of a more complicated sleep disorder or the common condition found in childhood. Often, we can help patients and their families learn to manage common night terrors after a meeting with our sleep psychologist.

At the Children's Colorado Sleep Center, we have providers known internationally for their expertise in sleep research and sleep treatments. The team is made up of sleep specialists trained in different aspects of sleep treatments, including sleep physicians who specialize in children's breathing issues and children's ear, nose and throat problems, a sleep-specialized psychologist, two sleep-specialized nurse practitioners, a sleep-specialized respiratory therapist and a dedicated sleep nurse.

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Treatment of night terrors is focused on calming your child back to sleep and keeping him or her safe during the episode. Parents can also follow some night terror prevention strategies. Doctors rarely use medication to treat night terrors in children. Try to help your child return to normal, calm sleep.

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https://stanfordhealthcare.org/medical-conditions/sleep/advanced-sleep-phase-syndrome.html

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Advanced phase sleep syndrome (ASPD) is a disruption of the circadian rhythm, causing the afflicted to go to sleep earlier than normal & wake up earlier than normal.

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https://www.sleephealthfoundation.org.au/advanced-sleep-phase-disorder-aspd.html

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What is ASPD?
This is a sleep disorder where you keep going to bed and waking up too early. For example, you might find it hard to stay up until a normal bed time such as 10pm. You might feel a strong urge to go to bed as early as 8-9pm. Once in bed you fall asleep quickly and sleep well for a few hours. However, you then wake up very early (e.g. 3-4 am) and find it very hard to go back to sleep. You often feel you don't get enough sleep, due to waking up so early in the morning. Importantly, if you went to bed even earlier (e.g. 6-7pm), you would be able to go to sleep then. But you would probably wake up even earlier after a few nights of this early-to-bed pattern.
What causes ASPD?
A vital part of what makes us feel sleepy is our 24 hour body clock. This is located deep inside our brain, behind the eyes. It controls when we feel sleepy and alert. For most adults their body clock makes them feel sleepy between the hours of 11pm to 7am and alert at other times, including the early evening (6-9 pm) and morning hours (8-11 am). Those with ASPD have an early timed body clock that shifts those alert and sleepy zones to earlier clock times. This makes them feel very sleepy in the early evening and alert as early as 3-4 am. How the ASPD body clock timing shifts in this way is not well understood. It may be due to a shorter than normal cycle length, tending to complete the sleep-wake cycle in less than 24 hours.
How common is ASPD?
ASPD is more common as we become older. This is in contrast to delayed sleep phase disorder that mainly affects young people. Roughly 1% of middle aged to older people experience ASPD.
How does it affect people?
Apart from being inconvenient, ASPD can cause insomnia in the early morning, insufficient sleep, daytime sleepiness and fatigue. It can also increase the risk of depression.
How is it treated?
Based on the knowledge that ASPD relates to an early timed body clock, the aim of treatment is to change the body clock to a more normal timing. Two treatments can re-time the body clock: getting bright light visual stimulation and taking melatonin.

The timing of when you have these is vital. Bright light visual stimulation should occur in the evening before you go to bed. The light should be brighter than normal indoor lighting. You can obtain it from specialized light boxes, or portable devices that you can wear, e.g. eye glasses. A few examples can be found by a web search for "bright light therapy". You may need an hour or two of bright light therapy before bed. Some will benefit from nightly use for a week. Others will need longer, sometimes several weeks, to get maximum benefit. It is best used late in the evening, perhaps turning the bright light device off half an hour before bed.

Melatonin(the hormone of sleep) also helps to reset the body clock. One option is to take a 2mg slow release melatonin tablet (Circadin™) as close to your new (later) bedtime as possible. A second option is to take a small dose of melatonin (0.5 mg), about half way through your sleep period. This could be at a time when you wake up on your own.

To change your hours of sleep, you should gradually delay your bed time (e.g. 20 minutes later each night) until you get it to the time that you want. As you delay your bedtime, you will also be delaying the time of your bright light exposure and melatonin intake.

As you can see, this treatment is quite complex. You may want to consult a sleep specialist, especially if you don't have success treating ASPD by yourself.
Can I prevent it coming back?
The reason that your body clock "sped up" in the first place may still be present, even after you move your sleep period back to the time you want. When you stop treatment, your sleep period may then slowly creep to be earlier again. So you may need to use the bright light and / or melatonin every now and then. To prevent relapse, you may also want to avoid bright light for the hour or two after you get up in the morning. Wearing sunglasses in the morning when outside can help, especially in the sunnier summer months.
What might your doctor do?
It would be easier for your doctor to be sure of this disorder if you keep a sleep diary for a least a week. Also record the times across the day and night that you feel most sleepy and most alert. Your doctor would be able to prescribe melatonin and, if felt necessary, refer you to a sleep specialist.
Where can I find out more about Advanced Phase Sleep Disorder? http://www.brightenyourlife.info/ch6.html http://www.sleepassociation.org/patients-general-public/advanced-sleep-phase-syndrome/

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What is ASPD? This is a sleep disorder where you keep going to bed and waking up too early. For example, you might find it hard to stay up until a normal bed time such as 10pm. You might feel a strong urge to go to bed as early as 8-9pm.

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http://www.brightenyourlife.info/ch6.html

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Advanced and Delayed Sleep Phase Treated With Bright Light | Chapter 6 of Brighten Your Life, an ebook by Daniel F. Kripke, M.D.

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Chapter 6 of an online book that tells you about bright light therapy, how light can be used to help low mood, sleep problems, shift work, and jet lag, and why we need bright light.

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https://sleepeducation.org/sleep-disorders/advanced-sleep-wake-phase/

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Advanced Sleep-Wake Phase - Sleep Education

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Advanced sleep-wake phase disorder (ASP) is one of several circadian rhythm sleep-wake disorders where you sleep at strange times.

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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2491504/

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I HAVE HAD THE OPPORTUNITY TO REVIEW THE EXCELLENT PUBLICATION ENTITLED, "PRACTICE PARAMETERS FOR THE EVALUATION AND TREATMENT of Circadian Rhythm Sleep Disorders" by the Standards of Practice Committee of the American Academy of Sleep Medicine. All of the recommendations are strongly evidence based, with the exception of the indication (option) of the use of melatonin for the treatment of advanced sleep phase disorder (ASPD).

In the evidence-based review by Sack et al the authors state, "There are no systematic reports of melatonin administration for ASPD, but consideration of the melatonin PRC provides a rationale for low dose administration after early morning awakenings and upon final arising in the morning." I agree that theoretically administering melatonin in the morning may be of value for delaying circadian rhythms in patients with ASPD. However, to my knowledge, there are no published studies or even case reports on its effectiveness in patients with ASPD. Furthermore, the safety of taking this potentially sleep promoting agent in the morning has not been studied, and may be associated with adverse effects, particularly in the elderly who are more likely to suffer from ASPD.

In the review by Sack et al, they also conclude that "There are insufficient data to assess the safety and efficacy of timed melatonin administration in the treatment of ASPD." Therefore, the available evidence does not support melatonin as an indication for the clinical management of ASPD. The scientific basis for its use needs to be tested in patients. Clearly, this is an area that calls for further research.

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Melantonin for the Treatment of Advanced Sleep Phase Disorder

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I HAVE HAD THE OPPORTUNITY TO REVIEW THE EXCELLENT PUBLICATION ENTITLED, "PRACTICE PARAMETERS FOR THE EVALUATION AND TREATMENT of Circadian Rhythm Sleep Disorders" by the Standards of Practice Committee of the American Academy of Sleep Medicine.

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https://srbr.org/advocacy/circadian-rhythm-sleep-wake-disorders/

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Circadian Rhythm Sleep-Wake Disorders (CRSDs) are sleep disorders in which the sleep-wake cycle is out of sync with the day-night cycle. Because of this mismatch between sleep timing and the external environment, people with a CRSD may experience an inability to sleep at certain times of the day and excessive sleepiness at other times of the day. This may impair their social life and performance at work or school. On this page, we'll explain the typical timing of sleep-wake cycles and describe the three most common CRSDs (Delayed Sleep Phase Disorder, Advanced Sleep Phase Disorder, and Non-24-Hour Sleep-Wake Disorder). For more information, visit the Circadian Sleep Disorders Network's website.

Typical sleep timing

Our sleep-wake cycles are driven by a homeostatic drive for sleep (sleep pressure) that builds up with increasing time spent awake and our internal circadian clock that generates periods of low and high sleep propensity across the 24-h day. For the majority of people, this results in a sleep-wake cycle of around 24 hours with sleep during the night - for example, from midnight until 8am. However, the timing of sleep onset and offset varies according to a person's age and physiology: everyone has their own personalized sleep timing called a 'chronotype'.

Delayed Sleep Phase Disorder (DSPD)

People with DSPD have a delayed onset of sleep. They are unable to fall asleep until very late at night or early morning, such as 3 or 4 am. This results in a need to sleep late into the morning or into the afternoon.

Advanced Sleep Phase Disorder (ASPD)

People with ASPD have an advanced onset of sleep. They tend to fall asleep very early in the evening or afternoon. As a result, they wake up very early in the morning, unable to sleep further.

Non-24-Hour Sleep-Wake Disorder (Non-24)

People with non-24 have a body clock that runs significantly longer than 24 hours. As a result,
sleep and wake times get later each day, drifting progressively around the clock.

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Circadian Rhythm Sleep-Wake Disorders (CRSDs) are sleep disorders in which the sleep-wake cycle is out of sync with the day-night cycle. Because of this mismatch between sleep timing and the external environment, people with a CRSD may experience an inability to sleep at certain times of the day and excessive sleepiness at other times of the day.

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https://stanfordhealthcare.org/medical-conditions/sleep/insomnia.html

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Insomnia is a sleep disorder that causes the inability to fall asleep or stay asleep. It affects your ability to function while awake.

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https://www.womenshealth.gov/a-z-topics/insomnia

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What is insomnia?

Insomnia is a common sleep disorder. It is defined as an inability to go to sleep, waking up too early, or feeling unrested after sleep for at least three nights a week for at least three months. Most adult women need to get seven or more hours of sleep a night to feel rested.³

Chronic or long-term insomnia makes it difficult to accomplish routine tasks like going to work or school and taking care of yourself. Insomnia can lead to or contribute to the development of other health problems, such as depression, heart disease, and stroke.

What are the different types of insomnia?

There are two types of insomnia:

Primary insomnia. Primary insomnia is a disorder. It is not a symptom or a side effect of another medical condition. Your doctor may diagnose your sleeplessness as primary insomnia after ruling out other medical conditions as a cause.

Secondary insomnia. Secondary insomnia is caused by or happens alongside other health conditions or as a side effect of prescribed medicines. It can be acute (short-term) or chronic (long-term). Most people with chronic insomnia have secondary insomnia.

What causes primary insomnia?

The exact cause of primary insomnia is unknown. It may be lifelong, or it can happen because of changes in your routine during travel or stressful life events.

What causes secondary insomnia?

Conditions that may trigger or happen at the same time as secondary insomnia include:

Mental health conditions, such as depression,⁴ anxiety,⁴ or post-traumatic stress disorder (PTSD)⁵

Traumatic brain injury (TBI)⁶

Neurological (brain) disorders, such as Alzheimer's disease or Parkinson's disease

Conditions that cause chronic pain, such as arthritis

Conditions that make it hard to breathe, such as asthma and sleep apnea

Trouble with hormones, including thyroid problems

Gastrointestinal disorders, such as heartburn

Stroke

Other sleep disorders, such as restless legs syndrome (RLS)

Menopause symptoms, such as hot flashes

Cancer

Side effects of medicines, like those to treat cancer, asthma, heart disease, allergies, and colds

Talk to your doctor or nurse if you think another health problem could be causing insomnia.

Other things that can keep you from getting enough sleep include:

Caffeine, tobacco, and alcohol. Caffeine and nicotine in tobacco products can disrupt sleep, especially if taken within several hours of going to bed. Alcohol may make it easier to fall asleep at first, but it can cause you to wake up too early and not be able to fall back asleep.

A traumatic event. People who witness or experience a traumatic event, such as an accident, natural disaster, physical attack, or war, can have trouble falling and staying asleep. Getting treatment for symptoms of anxiety or PTSD as a result of the trauma can help insomnia get better.

A bad sleep environment. Having a bed or place to sleep that is uncomfortable, unsafe, noisy, or too bright can make it difficult to fall asleep.

A partner with sleep problems. If you sleep with a partner who snores or has sleep apnea, your sleep may be more restless and interrupted. Snoring and sleep apnea can be treated.

Pregnancy. During pregnancy, especially in the third trimester, you may wake up more often than usual because of discomfort, leg cramps, or needing to use the bathroom.

Having a new baby. Changing hormone levels after childbirth can disrupt your sleep. Very young babies do not usually sleep longer than a few hours at a time and need to be fed every few hours.

Who gets insomnia?

Anyone can get insomnia, but it affects more women than men. More than one in four women in the United States experience insomnia, compared with fewer than one in five men.¹ In one study, women of all ages reported worse sleep quality than men, including taking longer to fall asleep, sleeping for shorter periods of time, and feeling sleepier when awake.⁷,⁸

Older women are at a higher risk of insomnia. Other people at risk for insomnia include those who:⁹,¹⁰

Have a lot of stress

Have depression ¹¹ or other mental health conditions⁴

Work nights or have an irregular sleep schedule, such as shift workers¹²

Travel long distances with time changes, such as air travelers

Have certain medical conditions, like sleep apnea, asthma, and fibromyalgia

Why do more women than men have insomnia?

Women may be more likely to have insomnia than men because women experience unique hormonal changes that can cause insomnia symptoms. These include hormonal changes during:

The menstrual cycle, especially in the days leading up to their period when many women report problems going to sleep and staying asleep.¹³ This is especially common in women who have premenstrual dysphoric disorder (PMDD), a more severe type of premenstrual syndrome (PMS).¹⁴

Pregnancy, especially in the third trimester, when women may wake up often because of discomfort, leg cramps, or needing to use the bathroom.

Perimenopause and menopause, when hot flashes and night sweats can disturb sleep.

Also, some health problems that can cause secondary insomnia are more common in women than in men. These include:

Depression and anxiety. People with insomnia are 10 times more likely to have depression, and 17 times more likely to have anxiety.¹⁵ Researchers aren't sure if mental health conditions lead to insomnia or if insomnia leads to mental health conditions.⁴ But not getting enough sleep may make mental health conditions worse.

Fibromyalgia. The pain experienced with fibromyalgia can make it difficult to fall asleep and stay asleep.

How long does insomnia last?

It depends. Insomnia can be acute (short-term) or chronic (long-term). While acute insomnia may last for only a few days or weeks, chronic insomnia can last for three months or more.¹⁶

What are the symptoms of insomnia?

The most common symptom of insomnia is difficulty sleeping - either going to sleep, staying asleep, or waking up too early. If you have insomnia, you may:

Lie awake for a long time without going to sleep

Wake up during the night and find it difficult to go back to sleep

Not feel rested when you wake up

Lack of sleep may cause other symptoms during the daytime. For example, you may wake up feeling tired, and you may have low energy during the day. It can also cause you to feel anxious, depressed, or irritable, and you may have a hard time concentrating or remembering things.

How does insomnia affect women's health?

Insomnia can cause you to feel tired, anxious, or irritable in the short term. Over time, lack of sleep may increase your risk for more serious problems, including:

Accidents

Health problems, including diabetes and high blood pressure³,⁹

Increased risk for falls, especially in older women¹⁷

Women who have long-term insomnia may be more at risk than men with long-term insomnia for mood problems, heart disease and stroke, and obesity.¹⁸

How is insomnia diagnosed?

To find out if you have insomnia, your doctor will do a physical exam and ask you about your symptoms, daily habits, and stress levels.

Your doctor may also:

Ask you about your sleep habits. Try to keep a sleep diary for one or two weeks before you see your doctor. Write down the times you go to sleep, wake up, and take naps. Keep track of how long you sleep each night and how you feel throughout the day. If you still have a menstrual period, track your cycle on your calendar also.

Do tests to rule out other medical problems that might cause insomnia. These might include blood tests to check for thyroid problems or other medical conditions.

Talk to you about the medicines you take. Some medicines, including some used to treat heart problems and depression, may cause sleep problems.¹⁹ Tell your doctor or nurse about all the medicines you take, including prescription and over-the-counter medicines. Your doctor or nurse will help you find medicines that work best for you.

Ask you to do a sleep study, called a polysomnogram (PSG). During a sleep study, you stay overnight at a sleep center or medical facility. You are hooked up to monitors that record brain activity, eye movements, heart rate, and blood pressure while you sleep. Machines also record snoring, chest movements, the amount of oxygen in your blood, and how much air moves through your nose while you breathe.

You can also get a diagnosis from a doctor who specializes in sleep medicine. Find a sleep medicine doctor near you.

How is insomnia treated?

If your insomnia is caused by a short-term change in your sleep/wake schedule, such as with jet lag, your sleep schedule will probably return to normal on its own.

Chronic or long-term insomnia can be treated with steps you can try at home to sleep better, cognitive behavioral therapy (CBT), and prescription medicines.

If insomnia is a symptom or side effect of another health problem, your doctor may recommend treating the other health problem at the same time. When the other health problem is treated, secondary insomnia often goes away on its own. For example, if menopause symptoms, such as hot flashes, are keeping you awake, your doctor might try treating your hot flashes first. Research suggests that older women who use hormone replacement therapy, eat healthy foods based on a Mediterranean diet, and limit how much caffeine and alcohol they drink may have fewer sleep problems than women who did not do those things.²⁰

Talk to your doctor or nurse if you have symptoms of insomnia, and ask about the best ways to treat insomnia.

How does cognitive behavioral therapy help treat insomnia?

Research shows that cognitive behavioral therapy (CBT) works as well as prescription medicine for many people who have chronic or long-term insomnia.²¹ CBT helps you change thoughts and actions that may get in the way of sleep.

This type of therapy is also used to treat conditions such as depression, anxiety disorders, and eating disorders. For success with CBT, you may need to see a therapist weekly for two months or more.²¹ CBT may involve:

Keeping a diary to track your sleep

Replacing negative thoughts about sleep with positive thinking. This includes linking being in bed to being asleep and not to the problems you have falling asleep.

Talking with a therapist alone or in group sessions. This can help you identify and change any unhelpful thoughts and behaviors about sleep.

Learning habits that can help you sleep better.

What prescription medicines treat insomnia?

Prescription medicines can help treat short-term or long-term insomnia.² But your doctor or nurse may have you try cognitive behavioral therapy first rather than medicine to treat insomnia.²

The types of prescription medicines used to treat insomnia include sedatives and certain kinds of antidepressants.²² Prescription sleep medicines can have serious side effects, including sleepiness during the daytime and increased risk of falls for older adults.²,¹⁷ They can also affect women differently than men. In 2013, the Food and Drug Administration (FDA) required drug companies to lower the recommended dose for women of certain prescription sleep medicines with zolpidem, because women's bodies do not break down the medicine as quickly as men's bodies do.²³

If you decide to use a prescription sleep medicine:

Ask your doctor, nurse, or pharmacist about any warnings and potential side effects of the medicine.

Take the medicine at the time of day your doctor tells you to.

Do not drive or do other activities that require you to be alert and sober.

Take only the amount of medicine prescribed by your doctor.

Tell your doctor, nurse, or pharmacist about all other medicines you take, both over-the-counter and prescription.

Call your doctor or nurse right away if you have any problems while using the medicine.

Do not drink alcohol.

Do not take medicines that your doctor has not prescribed to you.

Talk to your doctor or nurse if you want to stop using the sleep medicine. You need to stop taking some sleep medicines gradually (a little at a time).

When taking sleep medicine, make sure to give yourself enough time to get a full night of sleep. A full night of sleep is usually at least seven hours. Ask your doctor or pharmacist to tell you about any side effects of taking sleep medicine, such as grogginess that may make it difficult to drive. Talk to your doctor or nurse if your insomnia symptoms continue longer than four weeks.

Can I take an over-the-counter (OTC) medicine for insomnia?

OTC medicines, or sleep aids, may help some people with insomnia symptoms, but they are not meant for regular or long-term use. Many OTC sleep medicines contain antihistamines that are usually used to treat allergies.

If you decide to use an OTC sleep medicine:

Ask your doctor, nurse, or pharmacist about any warnings and potential side effects of the medicine.

Take the medicine at the time of day your doctor tells you to.

Do not drive or do other activities that require you to be alert and sober.

Take only the amount of medicine suggested by your doctor.

Tell your doctor, nurse, or pharmacist about all other medicines you take, both over-the-counter and prescription.

Call your doctor or nurse right away if you have any problems while using the medicine.

Do not drink alcohol.

Do not use drugs that your doctor has not prescribed to you.

Can I take a supplement or natural product for insomnia?

Some dietary supplements also claim to help people sleep. Manufacturers may label dietary supplements like melatonin as "natural" products.

The Food and Drug Administration (FDA) does not regulate dietary supplements in the same way it regulates medicines. The FDA does not test supplements for safety or effectiveness (to see if the supplement is safe for humans and works in the way it's supposed to). The FDA can remove supplements from the market if they are found to be unsafe.

Learn more about complementary and alternative sleep aids.

Do complementary or alternative sleep aids work?

There isn't enough scientific evidence to say whether most complementary and alternative sleep aids help treat insomnia.²⁴

Certain relaxation techniques may be safe and effective in treating long-term insomnia. These techniques include using music, meditation, and yoga to relax the mind and body before sleeping.²⁴

Some dietary supplements also claim to help people sleep. Manufacturers may label dietary supplements like melatonin as a "natural" product. Most of these products have not been proven to help people with insomnia. Melatonin may be useful for treating short-term insomnia for shift workers or people who have jet lag, but you should probably not take it long-term.²⁴

The Food and Drug Administration (FDA) does not regulate dietary supplements like vitamins, minerals, and herbs in the same way it regulates medicines. Use this Understanding Drug-Supplement Interactions tool to learn how dietary supplements may interact with the prescription and over-the-counter medicines you take.

Why is sleep important?

Sleep is essential for good health. During sleep, our bodies and brains repair themselves. Some research suggests our brains use the time during sleep to clear away toxins that build up during the day.²⁵ Sleep is also important to our ability to learn and form memories. Not getting enough sleep puts people at risk for health problems, including high blood pressure, obesity, and depression.

What can I do to sleep better?

It can be difficult to change everyday habits, but if you can stick with some of these changes, you might be able to improve your sleep. You may need to try these tips for several days in a row to improve sleep.

Try these tips at home to improve sleep:

Try to go to sleep at the same time each night or when you get sleepy.

Try to get up at the same time each morning, regardless of how well you slept.

Do not nap longer than 30 minutes or anytime between 3 p.m. and bedtime.

Go outside every day for at least 15 to 20 minutes. The natural light will help you get into a natural pattern of sleeping.

Before bedtime, try to avoid bright, artificial light from computer screens, mobile phones, or televisions. Do not allow electronic devices in the bedroom.

Follow a regular, relaxing routine at the same time each night when you get ready for bed.

Go to bed only after winding down and when you are ready to sleep. Do not read in bed, listen to music, or do other activities that engage your mind and can keep you awake.

Keep your bedroom dark, quiet, and cool for sleeping. Use a sleep mask or light-blocking curtains. Use earplugs, a fan, or a white noise machine or app on your phone to block out sounds.

Do not drink alcohol or caffeine or use nicotine for at least five hours before bedtime.

Get regular physical activity during the daytime. Exercise or physical activity close to bedtime, or anytime in the five or six hours before sleeping, can make it harder to fall asleep.

Do not eat heavy meals or drink a lot of liquids two to three hours before bed.

If you still cannot sleep after about 15 minutes of getting into bed and turning out the light, get out of bed and do something relaxing until you feel sleepy.

See your doctor or a sleep specialist if you think that you have insomnia or another sleep problem.

Did we answer your question about insomnia?

For more information on insomnia, call the OWH Helpline at 1-800-994-9662 or contact the following organizations:

Sources

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2. Sateia, M.J., Buysse, D.J., Krystal, A.D., Neubauer, D.N., Heald, J.L. (2017). Clinical Practice Guideline for the Pharmacologic Treatment of Chronic Insomnia in Adults: An American Academy of Sleep Medicine Clinical Practice Guideline (PDF, 1.83 MB). Journal of Clinical Sleep Medicine; 13(2): 307-349.

3. American Academy of Sleep Medicine and Sleep Research Society. (2015). Recommended Amount of Sleep for a Healthy Adult: A Joint Consensus Statement of the American Academy of Sleep Medicine and Sleep Research Society (PDF, 244 KB). Journal of Clinical Sleep Medicine; 11(6): 591-592.

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6. Viola-Saltzman, M., Watson, N.F. (2012). Traumatic Brain Injury and Sleep Disorders. Neurologic Clinics; 30(4): 1299-1312.

7. Zhang, B, Wing, Y.K. (2006). Sex differences in insomnia: a meta-analysis. Sleep: 29(1): 85-93.

8. Mallampalli, M.P., Carter, C.L. (2014). Exploring Sex and Gender Differences in Sleep Health: A Society for Women's Health Research Report. Journal of Women's Health; 23(7): 553-562.

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Insomnia is a common sleep disorder. It is defined as an inability to go to sleep, waking up too early, or feeling unrested after sleep for at least three nights a week for at least three months.