Sleep Disorders Guide
A guide to insomnia, sleep apnea, restless legs, REM sleep behavior disorder, and narcolepsy, including assessment and safer sleep habits.
Contents
Common sleep disorders
Sleep problems extend beyond difficulty falling asleep. Insomnia causes difficulty initiating or maintaining sleep, or poor-quality sleep, despite adequate opportunity and with daytime effects. Obstructive sleep apnea may cause snoring, breathing pauses, gasping, and daytime sleepiness. Restless legs causes an urge that worsens at rest and in the evening and improves with movement. REM sleep behavior disorder can cause dream enactment, while narcolepsy causes irresistible sleepiness and sometimes cataplexy.
| Disorder | Prominent sign | Why assess it? |
|---|---|---|
| Insomnia | Difficulty falling/staying asleep with daytime impact | Clarify duration, causes, and associated conditions |
| Sleep apnea | Snoring, breathing pauses, sleepiness | Assess breathing and driving safety |
| Restless legs | Evening urge to move at rest | Review iron status and medicines |
| REM behavior disorder | Kicking or punching during dreams | Prevent injury and investigate causes |
| Narcolepsy | Sleep attacks, sometimes cataplexy | Arrange specialist testing and safety planning |
When to seek assessment
Dozing while driving, witnessed pauses in breathing, injurious dream enactment, or sleepiness that threatens work or school safety needs prompt assessment. Chronic insomnia generally means sleep difficulty with daytime effects on at least three nights a week for more than three months. A diary of sleep times, shift work, medicines, caffeine, alcohol, and a bed partner’s observations helps assessment. Sudden blue or grey discoloration of the lips, tongue, or face, or severe breathing difficulty, must not wait for routine sleep assessment.
Polysomnography and other tests
Polysomnography is a painless sleep study that can record brain waves, eye movement, breathing, oxygen, heart rhythm, and muscle movement. It is useful for apnea, selected movement disorders, nocturnal seizures, or unusual behavior, but is not mandatory for every insomnia case or a single gold standard for every sleep disorder. Home respiratory testing may suit selected apnea cases; multiple sleep latency testing helps assess narcolepsy; and actigraphy can assess timing and rhythms. History and examination determine the test.
Treatment approaches
Cognitive behavioral therapy for insomnia (CBT-I) is usually the first treatment for chronic insomnia. For sleep apnea, PAP, oral devices, weight management, or selected surgery depends on anatomy and severity. Iron for restless legs should follow appropriate testing and clinical advice; some dopaminergic medicines can make symptoms start earlier and worsen over time. Making the bedroom safer matters in REM behavior disorder. Narcolepsy care may include protected nighttime sleep, planned naps, and prescribed treatment.
- Do not self-treat long-term with sleeping pills or sedating antihistamines.
- Report PAP problems so mask, humidity, and pressure can be reviewed.
- Do not use alcohol as sleep treatment; it can fragment sleep and worsen apnea.
Healthy sleep habits
A consistent wake time, enough opportunity to sleep, a dark and quiet room at a comfortable cool temperature, less bright-screen exposure before bed, and avoiding late caffeine, nicotine, heavy meals, and alcohol may help. A fixed 18–20 °C room or a universal 4 p.m. caffeine cutoff is not a biological requirement; sensitivity and schedules vary. Rather than remaining awake in bed for long periods, individualized stimulus control can be used as part of CBT-I.