🕷️ Crawler Inspector

URL Lookup

Direct Parameter Lookup

Raw Queries and Responses

1. Shard Calculation

Query:

Response:

Calculated Shard: 102 (from laksa126)

2. Crawled Status Check

Query:

curl -X POST \
  'http://laksa102.int.ahrefs:8124/' \
  -H 'Content-Type: text/plain' \
  -H 'X-ClickHouse-Database: crawler3' \
  -H 'Authorization: Basic YXBpOg==' \
  -d 'SELECT getAhrefsURLFromUnparsed(src_unparsed) AS found_url, ifNull(toUnixTimestamp(download_stamp), 0) AS crawl_time, ifNull(toUnixTimestamp(props_url_first_seen), 0) AS first_indexed_time, download_http_code AS http_code, src_unparsed AS src_unparsed, src_root_hash AS src_root_hash, history_drop_reason AS history_drop_reason, meta_title AS meta_title, meta_descriptions AS meta_descriptions, attrs_boilerpipe_text AS attrs_boilerpipe_text, attrs_markdown AS attrs_markdown, attrs_readable_markdown AS attrs_readable_markdown, meta_canonical AS meta_canonical FROM crawler3.page_info_local FINAL PREWHERE (src_root_hash, src_unparsed) IN ((getAhrefsRootHashFromUnparsed(getAhrefsUnparsedNoserviceFromURL(\'https://www.psychiatry.org/patients-families/sleep-disorders/what-are-sleep-disorders\')), getAhrefsUnparsedNoserviceFromURL(\'https://www.psychiatry.org/patients-families/sleep-disorders/what-are-sleep-disorders\'))) FORMAT JSONEachRow'

Response:

{"found_url":"https:\/\/www.psychiatry.org\/patients-families\/sleep-disorders\/what-are-sleep-disorders","crawl_time":1776149984,"first_indexed_time":1464590872,"http_code":200,"src_unparsed":"org,psychiatry!www,\/patients-families\/sleep-disorders\/what-are-sleep-disorders s443","src_root_hash":"3208705627035071702","history_drop_reason":null,"meta_title":"Psychiatry.org - What are Sleep Disorders?","meta_descriptions":["Sleep disorders (or sleep-wake disorders) involve problems with the quality, timing, and amount of sleep, which result in daytime distress and impairment in functioning."],"attrs_boilerpipe_text":"Sleep disorders (or sleep-wake disorders) involve problems with the quality, timing, and amount of sleep, which result in daytime distress and impairment in functioning. Sleep-wake disorders often occur along with medical conditions or other mental health conditions, such as depression, anxiety, or cognitive disorders. There are several different types of sleep-wake disorders, of which insomnia is the most common. Other sleep-wake disorders include obstructive sleep apnea, parasomnias, narcolepsy, and restless leg syndrome.\nSleep difficulties are linked to both physical and emotional problems. Sleep problems can both contribute to or exacerbate mental health conditions and can be a symptom of other mental health conditions.\nAbout one-third of adults report insomnia symptoms and 4-22 meet the criteria for insomnia disorder.\n1\nImportance of Sleep\nSleep is a basic human need and is critical to both physical and mental health. There are two types of sleep that generally occur in a pattern of three-to-five cycles per night:\nRapid eye movement (REM) – when most dreaming occurs\nNon-REM – has three phases, including the deepest sleep\nWhen you sleep is also important. Your body typically works on a 24-hour cycle (circadian rhythm) that helps you know when to sleep.\nHow much sleep we need varies depending on age and varies from person to person. According to the National Sleep Foundation most adults need about seven to nine hours of restful sleep each night, preferably with consistent sleep and wake times. \nMany of us do not get enough sleep. A third of adults report that they usually get less than the recommended amout of sleep and only about 30% of high school students get at least eight hours of sleep on an average school night.\n2\nAn estimated 34 percent of Americans report their sleep quality as “poor” or “only fair.”\n3\nMore than 50 million Americans have chronic sleep disorders.\n2\nConsequences of Lack of Sleep and Coexisting Conditions\nSleep helps your brain function properly. Not getting enough sleep or poor quality sleep has many potential consequences. The most obvious concerns are fatigue and decreased energy, irritability and problems focusing. The ability to make decisions and your mood can also be affected. Sleep problems often coexist with symptoms of depression or anxiety. Sleep problems can exacerbate depression or anxiety, and depression or anxiety can lead to sleep problems.\nLack of sleep and too much sleep are linked to many chronic health problems, such as heart disease, diabetes and obesity. Sleep disturbances can also be a warning sign for medical and neurological problems, such as congestive heart failure, osteoarthritis and Parkinson’s disease.\nTypes of Sleep Disorders - Insomnia Disorder\nInsomnia, the most common sleep disorder, involves problems getting to sleep or staying asleep. About one-third of adults report some insomnia symptoms, 10 to 15% report problems with functioning during the daytime and 4 to 22% have symptoms severe enough to meet criteria for insomnia disorder. An estimated 40 to 50% of individuals with insomnia also have another mental disorder.\n1\nSymptoms and Diagnosis\nTo be diagnosed with insomnia disorder, the sleep difficulties must occur at least three nights a week for at least three months and cause significant distress or problems at work, school or other important areas of a person's daily functioning. Not all individuals with sleep disturbances are distressed or have problems with functioning.\nTo diagnose insomnia, a physician will rule out other sleep disorders (see Related Conditions below), medication side effects, substance misuse, depression and other physical and mental illnesses. Some medications and medical conditions can affect sleep.\nA comprehensive assessment for insomnia or other sleep problems may involve a patient history, a physical exam, a sleep diary and clinical testing (a sleep study or polysomnography). A sleep diary is a record of your sleep habits to discuss with your physician. It includes information such as when you go to bed, get to sleep, wake up, get out of bed, take naps, exercise, eat and consume alcohol and caffeinated beverages. In additional, a sleep study allows the physician to identify howlong and how well you are sleeping and to detect specific sleep problems.\nSleep problems can occur at any age but most commonly start in young adulthood. The type of insomnia often varies with age. Problems getting to sleep are more common among young adults. Problems staying asleep are more common among middle-aged and older adults.\nSymptoms of insomnia can be:\nEpisodic (with an episode of symptoms lasting one to three months)\nPersistent (with symptoms lasting three months or more)\nRecurrent (with two or more episodes within a year)\nSymptoms of insomnia can also be brought on by a specific life event or situation.\nTreatment and Self-help\nSleep problems can often be improved with regular sleep habits. (See Sleep Hygiene section for tips.) If your sleep problems persist or if they interfere with how you feel or function during the day, you should seek evaluation and treatment by a physician.\nSleep disorders should be specifically addressed regardless of mental or other medical problems that may be present. Chronic insomnia is typically treated with a combination of sleep medications and behavioral techniques, such as cognitive behavior therapy. Several types of medications can be used to treat insomnia and to help you fall asleep or stay asleep. Most of these can become habit-forming and should only be used for short periods and under the care of a physician. Some antidepressants are also used to treat insomnia.\nMost over-the-counter sleep medicines contain antihistamines, which are commonly used to treat allergies. They are not addictive, but they can become less effective over time. They may also contribute to confusion, blurred vision, urinary retention, and falls in the elderly and should be used with caution in this population.\nMany people turn to complementary health approaches to help with sleep problems. According to the National Institutes of Health some may be safe and effective, others lack evidence to support their effectiveness or raise safety concerns.\nRelaxation techniques\n, used before bedtime, can be helpful for insomnia.\nMelatonin\nsupplements may be helpful for people with some types of insomnia. Long-term safety has not been investigated.\nMind and body approaches\n, such as mindfulness, meditation, yoga, massage therapy and acupuncture lack evidence to show their usefulness, but are generally considered safe.\nHerbs and dietary supplements\nhave not been shown to be effective for insomnia. There are safety concerns about some, including L-tryptophan and Kava, while others may interact with prescribed medications.\nLet your health care provider know about any alternative medicines or supplements you are taking.\nSleep Hygiene: Healthy sleep tips to address sleep problems.\nStick to a sleep schedule – same bedtime and wake up time even on the weekends.\nAllow your body to wind down with a calming activity, such as reading away from bright lights and avoiding electronic devices before sleep.\nAvoid naps especially in the afternoon.\nExercise daily.\nPay attention to bedroom environment (quiet, cool and dark is best) and your mattress and pillow (should be comfortable and supportive).\nAvoid alcohol, caffeine and heavy meals in the evening.\nOther Sleep Disorders\nIn central sleep apnea, the brain does not properly control breathing during sleep, causing breathing to start and stop. It is diagnosed when a sleep study identifies five or more central apneas (pauses in breathing) per hour of sleep. Central sleep apnea is rare and less prevalent than obstructive sleep apnea. It is more common in older adults, in people with heart disorders or stroke, and in people using opioid pain medications. It can be treated using a CPAP or other device during sleep.\nPeople with sleep-related hypoventilation have episodes of shallow breathing, elevated blood carbon dioxide levels, and low oxygen levels during sleep. It frequently occurs along with medical conditions, such as chronic obstructive pulmonary disease (COPD), or medication or substance use. Those with sleep-related hypoventilation often have trouble with insomnia or excessive daytime sleepiness, frequently waking up during sleep and headaches on awakening. Risk factors for sleep-related hypoventilation include medical conditions, such as obesity, hypothyroidism, pulminary disorders; neuromuscular disorders; the use of certain medications, such as benzodiazepines and opiates; and alcohol.\nReferences\nAmerican Psychiatric Association.\nDiagnostic and Statistical Manual of Mental Disorders (DSM-5-TR), Fifth edition - Text Rivision\n. 2022.\nCenters for Disease Control and Prevention.\nSleep and Sleep Disorders\n.\nNational Sleep Foundation.\nSleep Health Index\n. 2017.\nPhysician Review\nFelix Torres, M.D., MBA, FACHE, DFAPA, CCHP-MH\nMarch 2024","attrs_markdown":"[Skip to content](https:\/\/www.psychiatry.org\/patients-families\/sleep-disorders\/what-are-sleep-disorders#main)\n\n[Advocacy Action Center for Members: Federal Policy Updates. 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[District Branch Dues for General Members](https:\/\/www.psychiatry.org\/membership\/district-branches\/district-branch-dues-for-general-members)\n    \n    - [District Branch Dues for Residents and Fellows](https:\/\/www.psychiatry.org\/membership\/district-branches\/district-branch-dues-for-residents-and-fellows)\n# What are Sleep Disorders?\n- ## You are here:\n- [Patients and Families](https:\/\/www.psychiatry.org\/patients-families)\n- [Sleep Disorders](https:\/\/www.psychiatry.org\/patients-families\/sleep-disorders)\n- What are Sleep Disorders?\n\n- Share\n- Print\n\nSub Navigation\n\n- ## [Sleep Disorders](https:\/\/www.psychiatry.org\/patients-families\/sleep-disorders)\n  Toggle Sleep Disorders Page Listing\n  - [What are Sleep Disorders?](https:\/\/www.psychiatry.org\/patients-families\/sleep-disorders\/what-are-sleep-disorders)\n  - [Expert Q\\&A: Sleep Disorders](https:\/\/www.psychiatry.org\/patients-families\/sleep-disorders\/expert-q-and-a)\n\n## On This Page\n- [Importance of Sleep](https:\/\/www.psychiatry.org\/patients-families\/sleep-disorders\/what-are-sleep-disorders#section_0)\n- [Types of Sleep Disorders - Insomnia Disorder](https:\/\/www.psychiatry.org\/patients-families\/sleep-disorders\/what-are-sleep-disorders#section_2)\n- [Other Sleep Disorders](https:\/\/www.psychiatry.org\/patients-families\/sleep-disorders\/what-are-sleep-disorders#section_6)\n- [Physician Review](https:\/\/www.psychiatry.org\/patients-families\/sleep-disorders\/what-are-sleep-disorders#section_8)\n\nSleep disorders (or sleep-wake disorders) involve problems with the quality, timing, and amount of sleep, which result in daytime distress and impairment in functioning. Sleep-wake disorders often occur along with medical conditions or other mental health conditions, such as depression, anxiety, or cognitive disorders. There are several different types of sleep-wake disorders, of which insomnia is the most common. Other sleep-wake disorders include obstructive sleep apnea, parasomnias, narcolepsy, and restless leg syndrome.\n\nSleep difficulties are linked to both physical and emotional problems. Sleep problems can both contribute to or exacerbate mental health conditions and can be a symptom of other mental health conditions.\n\nAbout one-third of adults report insomnia symptoms and 4-22 meet the criteria for insomnia disorder.1\n\n## **Importance of Sleep**\nSleep is a basic human need and is critical to both physical and mental health. There are two types of sleep that generally occur in a pattern of three-to-five cycles per night:\n\n- Rapid eye movement (REM) – when most dreaming occurs\n- Non-REM – has three phases, including the deepest sleep\n\nWhen you sleep is also important. Your body typically works on a 24-hour cycle (circadian rhythm) that helps you know when to sleep.\n\nHow much sleep we need varies depending on age and varies from person to person. According to the National Sleep Foundation most adults need about seven to nine hours of restful sleep each night, preferably with consistent sleep and wake times.\n\nMany of us do not get enough sleep. A third of adults report that they usually get less than the recommended amout of sleep and only about 30% of high school students get at least eight hours of sleep on an average school night.2 An estimated 34 percent of Americans report their sleep quality as “poor” or “only fair.”3\n\nMore than 50 million Americans have chronic sleep disorders.2\n\n### Consequences of Lack of Sleep and Coexisting Conditions\nSleep helps your brain function properly. Not getting enough sleep or poor quality sleep has many potential consequences. The most obvious concerns are fatigue and decreased energy, irritability and problems focusing. The ability to make decisions and your mood can also be affected. Sleep problems often coexist with symptoms of depression or anxiety. Sleep problems can exacerbate depression or anxiety, and depression or anxiety can lead to sleep problems.\n\nLack of sleep and too much sleep are linked to many chronic health problems, such as heart disease, diabetes and obesity. Sleep disturbances can also be a warning sign for medical and neurological problems, such as congestive heart failure, osteoarthritis and Parkinson’s disease.\n\n## **Types of Sleep Disorders - Insomnia Disorder**\nInsomnia, the most common sleep disorder, involves problems getting to sleep or staying asleep. About one-third of adults report some insomnia symptoms, 10 to 15% report problems with functioning during the daytime and 4 to 22% have symptoms severe enough to meet criteria for insomnia disorder. An estimated 40 to 50% of individuals with insomnia also have another mental disorder.1\n\n#### Symptoms and Diagnosis\nTo be diagnosed with insomnia disorder, the sleep difficulties must occur at least three nights a week for at least three months and cause significant distress or problems at work, school or other important areas of a person's daily functioning. Not all individuals with sleep disturbances are distressed or have problems with functioning.\n\nTo diagnose insomnia, a physician will rule out other sleep disorders (see Related Conditions below), medication side effects, substance misuse, depression and other physical and mental illnesses. Some medications and medical conditions can affect sleep.\n\nA comprehensive assessment for insomnia or other sleep problems may involve a patient history, a physical exam, a sleep diary and clinical testing (a sleep study or polysomnography). A sleep diary is a record of your sleep habits to discuss with your physician. It includes information such as when you go to bed, get to sleep, wake up, get out of bed, take naps, exercise, eat and consume alcohol and caffeinated beverages. In additional, a sleep study allows the physician to identify howlong and how well you are sleeping and to detect specific sleep problems.\n\nSleep problems can occur at any age but most commonly start in young adulthood. The type of insomnia often varies with age. Problems getting to sleep are more common among young adults. Problems staying asleep are more common among middle-aged and older adults.\n\nSymptoms of insomnia can be:\n\n- Episodic (with an episode of symptoms lasting one to three months)\n- Persistent (with symptoms lasting three months or more)\n- Recurrent (with two or more episodes within a year)\n\nSymptoms of insomnia can also be brought on by a specific life event or situation.\n\n#### Treatment and Self-help\n![Sleep Disorders: Parents Medication Guide, American Academy of Child and Adolescent Psychiatry and American Psychiatric Association](https:\/\/www.psychiatry.org\/getmedia\/01d57cc0-ed95-4b12-8f77-a684844bde60\/PMG-Sleep-disorders_1.png)\n\n[Sleep Disorders: Parent's Medication Guide (.pdf)](https:\/\/www.aacap.org\/App_Themes\/AACAP\/Docs\/families_and_youth\/med_guides\/SleepDisorders_Parents-Medication-Guide-web.pdf)\n\nSleep problems can often be improved with regular sleep habits. (See Sleep Hygiene section for tips.) If your sleep problems persist or if they interfere with how you feel or function during the day, you should seek evaluation and treatment by a physician.\n\nSleep disorders should be specifically addressed regardless of mental or other medical problems that may be present. Chronic insomnia is typically treated with a combination of sleep medications and behavioral techniques, such as cognitive behavior therapy. Several types of medications can be used to treat insomnia and to help you fall asleep or stay asleep. Most of these can become habit-forming and should only be used for short periods and under the care of a physician. Some antidepressants are also used to treat insomnia.\n\nMost over-the-counter sleep medicines contain antihistamines, which are commonly used to treat allergies. They are not addictive, but they can become less effective over time. They may also contribute to confusion, blurred vision, urinary retention, and falls in the elderly and should be used with caution in this population.\n\nMany people turn to complementary health approaches to help with sleep problems. According to the National Institutes of Health some may be safe and effective, others lack evidence to support their effectiveness or raise safety concerns.\n\n- **Relaxation techniques**, used before bedtime, can be helpful for insomnia.\n- **Melatonin** supplements may be helpful for people with some types of insomnia. Long-term safety has not been investigated.\n- **Mind and body approaches**, such as mindfulness, meditation, yoga, massage therapy and acupuncture lack evidence to show their usefulness, but are generally considered safe.\n- **Herbs and dietary supplements** have not been shown to be effective for insomnia. There are safety concerns about some, including L-tryptophan and Kava, while others may interact with prescribed medications.\n\nLet your health care provider know about any alternative medicines or supplements you are taking.\n\n#### Sleep Hygiene: Healthy sleep tips to address sleep problems.\n- Stick to a sleep schedule – same bedtime and wake up time even on the weekends.\n- Allow your body to wind down with a calming activity, such as reading away from bright lights and avoiding electronic devices before sleep.\n- Avoid naps especially in the afternoon.\n- Exercise daily.\n- Pay attention to bedroom environment (quiet, cool and dark is best) and your mattress and pillow (should be comfortable and supportive).\n- Avoid alcohol, caffeine and heavy meals in the evening.\n## **Other Sleep Disorders**\nSleep Apnea\n\nObstructive sleep apnea hypopnea, most commonly called sleep apnea, involves breathing interruptions during sleep. A person with sleep apnea will have repeated episodes of airway obstruction during sleep causing snoring, snorting\/gasping or breathing pauses. This interrupted sleep causes daytime sleepiness and fatigue. Sleep apnea is diagnosed with a clinical sleep study. The sleep study (polysomnography) involves monitoring the number of obstructive apneas (absence of airflow) or hypopneas (reduction in airflow) during sleep.\n\nSleep apnea is a very common disorder with the prevalence particularly high among men as campared to women, inoder adults, and certain racial and ethnic groups (including African Americans, American Indians, and Hidpanics). Major risk factors for sleep apnea are obesity, male gender, family history of sleep apnea, menopause and certain genetic or endocrine disorders.\n\nLifestyle changes, such as losing weight if needed or sleeping on your side, can improve sleep apnea. In some cases a custom-fit plastic mouthpiece can help keep airways open during sleep. The mouthpiece can be made by a dentist or orthodontist. For moderate to severe sleep apnea, a physician can prescribe a CPAP (continuous positive airway pressure) device. The CPAP works to keep your airways open by gently blowing air through a tube and face mask covering your mouth and\/or nose.\n\nCentral Sleep Apnea\n\nIn central sleep apnea, the brain does not properly control breathing during sleep, causing breathing to start and stop. It is diagnosed when a sleep study identifies five or more central apneas (pauses in breathing) per hour of sleep. Central sleep apnea is rare and less prevalent than obstructive sleep apnea. It is more common in older adults, in people with heart disorders or stroke, and in people using opioid pain medications. It can be treated using a CPAP or other device during sleep.\n\nSleep-Related Hypoventilation\n\nPeople with sleep-related hypoventilation have episodes of shallow breathing, elevated blood carbon dioxide levels, and low oxygen levels during sleep. It frequently occurs along with medical conditions, such as chronic obstructive pulmonary disease (COPD), or medication or substance use. Those with sleep-related hypoventilation often have trouble with insomnia or excessive daytime sleepiness, frequently waking up during sleep and headaches on awakening. Risk factors for sleep-related hypoventilation include medical conditions, such as obesity, hypothyroidism, pulminary disorders; neuromuscular disorders; the use of certain medications, such as benzodiazepines and opiates; and alcohol.\n\nNon-Rapid Eye Movement Sleep Arousal Disorders\n\nNon-rapid eye movement (NREM) sleep arousal disorders involve episodes of incomplete awakening from sleep, usually occurring during the first third of a major sleep episode, and are accompanied by either sleepwalking or sleep terrors. The episodes cause significant distress or problems with functioning. NREM sleep arousal disorders are most common among children and become less common with increasing age.\n\nSleepwalking involves repeated episodes of rising from bed and walking around during sleep. While sleepwalking, the individual has a blank stare; is relatively unresponsive to others; is difficult to awaken, and will have limited recall for the episode once awake. Between 6.9 and 29.2% of people have experienced sleepwalking at some time in their lives.\n\nSleep terrors (also called night terrors) are episodes of waking abruptly from sleep, usually beginning with a panicky scream or cry. During each episode, the person experiences intense fear and associated physical signs such as rapid breathing, accelerated heart rate and sweating. The person typically does not remember much of the dream and is unresponsive to efforts of others to comfort them. Sleep terrors are common among very young children—at 18 months of age about 37% of children experience night terrors and at 30 months about 20% experience them. Only about 2% of adults experience night terrors.\n\nNightmare Disorder\n\nNightmare disorder involves repeated occurrences of lengthy, distressing, and well-remembered dreams that usually involve efforts to avoid threats or danger. They generally occur in the second half of a major sleep episode.\n\nThe nightmares are typically lengthy, elaborate, story-like sequences of dream imagery that seem real and cause anxiety, fear or distress. After waking up, people experiencing nightmares are quickly alert and generally remember the dream and can describe it in detail. The nightmares cause significant distress or problems with functioning. Nightmares often begin between ages 3 and 6 years but are most prevalent and severe in late adolescence or early adulthood.\n\nRapid Eye Movement Sleep Behavior Disorder\n\nRapid eye movement (REM) sleep behavior disorder involves episodes of arousal during sleep associated with speaking and\/or movement. The person’s actions are often responses to events in the dream, such as being attacked or trying to escape a threatening situation. Speech is often loud, emotion-filled, and profane. These behaviors arise during REM sleep and usually occur omore than 90 munites after falling asleep. Upon awakening, the person is immediately alert and can often recall the dream.\n\nREM sleep behavior disorders may cause significant distress and problems with functioning, including injury to the individual and their bed partner (such as falling, jumping, or flying out of bed; running, hitting, or kicking). Embarrassment about the episodes can cause problems in social relationships and can lead to social isolation or work-related problems.\n\nThe prevalence of REM sleep behavior disorder has been estimated at around 1% in the general population and may be greater in individuals with psychiatric disorers, possibl related to prescribed medications.\n\nHypersomnolence Disorder\n\nPeople with hypersomnolence disorder are excessively sleepy even when getting at least 7 hours sleep. They have at least one of the following symptoms:\n\n- Recurrent periods of sleep or lapses into sleep within the same day (such as unintentional naps while attending a lecture or watching TV)\n- Sleeping more than nine hours per day and not feeling rested\n- Difficulty being fully awake after abruptly waking up\n\nThe extreme sleepiness occurs at least three times per week, for at least three months. Individuals with this disorder may have difficulty waking up in the morning, sometimes appearing groggy, confused or combative (often referred to as sleep inertia). The sleepiness causes significant distress and can lead to problems with functioning, such as issues with concentration and memory.\n\nThe condition typically begins in late teens or adulthood but may not be diagnosed until many years later. Among individuals who consult in sleep disorders clinics for complaints of daytime sleepiness, approximately 5 to 10% are diagnosed with hypersomnolence disorder.\n\nNarcolepsy\n\nPeople with narcolepsy experience periods of an irrepressible need to sleep or lapsing into sleep multiple times within the same day.\n\nSleepiness typically occurs daily but must occur at least three times a week for at least three months for a diagnosis of narcolepsy. People with narcolepsy have episodes of cataplexy, brief sudden loss of muscle tone triggered by laughter or joking. This can result in head bobbing, jaw dropping, or falls. Individuals are awake and aware during cataplexy.\n\nNarcolepsy nearly always results from the loss of hypothalamic hypocretin-producing cells. This deficiency in hypocretin (also known as orexin) can be tested in the cerebrospinal fluid via a lumbar puncture (spinal tap). Narcolepsy is rare, affecting and estimated 0.02 to 0.05% of the adult general population. It typically begins in childhood, adolescence or young adulthood.\n\n**Read more**\n\n- Psychiatric News: [Why Narcolepsy Is Often Missed—and How to Spot It](https:\/\/psychiatryonline.org\/doi\/10.1176\/appi.pn.2025.12.12.7)\n- APA Blog: [Natcolepsy: An Overwhelming Need to Sleep](https:\/\/www.psychiatry.org\/News-room\/APA-Blogs\/Narcolepsy-An-Overwhelming-Need-to-Sleep)\n\nRestless Leg Syndrome\n\nRestless legs syndrome (RLS) involves an urge to move one’s legs, usually accompanied by uncomfortable and unpleasant sensations in the legs, typically described as creeping, crawling, tingling, burning, or itching.\n\nThe urge to move the legs:\n\n- Begins or worsens during periods of rest or inactivity;\n- Is partially or totally relieved by movement; and\n- Occurs only in the evening or at night (or is worse in the evening or at night than during the day).\n\nThe symptoms occur at least three times per week, continue for at least three months, and cause significant distress or problems in daily functioning. The symptoms of RLS can cause difficulty getting to sleep and can frequently awaken the individual from sleep, leading, in turn, to daytime sleepiness.\n\nRLS typically begins in a person’s teens or twenties, and it affects up to 3% of the poopulation.\n\nCircadian Rhythm Sleep-Wake Disorders\n\nWith circadian rhythm sleep-wake disorders, a person’s sleep-wake rhythms (body clock) and the external light-darkness cycle become misaligned. This misalignment causes significant ongoing sleep problems and extreme sleepiness during the day leading to significant distress or problems with functioning.\n\nCircadian rhythm disorders can be caused by internal factors (a person’s body clock is different than the light-dark cycle) or external factors (such as shift work or jet lag).\n\nPrevalence of delayed sleep phase type (staying up late and getting up late) in the adult population has been estaimated betweeen 0.2 and 1.7% but may be as high as 4.6% in adolescents. The estimated prevalence of advanced sleep phase type (going to sleep early and waking early) is approximately 1% in middle-aged adults and it is more common in older adults.\n#### References\n1. American Psychiatric Association. *Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR), Fifth edition - Text Rivision*. 2022.\n2. Centers for Disease Control and Prevention. [Sleep and Sleep Disorders](https:\/\/www.cdc.gov\/sleep\/index.html).\n3. National Sleep Foundation. [Sleep Health Index](https:\/\/www.sleephealthjournal.org\/article\/S2352-7218\\(17\\)30102-X\/fulltext). 2017.\n## Physician Review\nFelix Torres, M.D., MBA, FACHE, DFAPA, CCHP-MH\n\nMarch 2024\n\nOther resources\n\n## More on Sleep Disorders\n- [Sleep.org – National Sleep Foundation](https:\/\/thensf.org\/)\n- [Centers for Disease Control and Prevention (CDC) Sleep and Sleep Disorders](http:\/\/www.cdc.gov\/sleep\/index.html)\n- [American Academy of Sleep Medicine - Sleep Education](http:\/\/www.sleepeducation.org\/)\n- [AACAP & APA - Sleep Disorders: Parents’ Medication Guide (.pdf)](https:\/\/www.aacap.org\/App_Themes\/AACAP\/Docs\/families_and_youth\/med_guides\/SleepDisorders_Parents-Medication-Guide-web.pdf \"_blank\")\n\n## Medical leadership for mind, brain and body.\n[Join Today](https:\/\/www.psychiatry.org\/membership\/join-apa)\n\n### Explore APA Toggle List\n- [Psychiatrists](https:\/\/www.psychiatry.org\/psychiatrists)\n- [Residents & Medical Students](https:\/\/www.psychiatry.org\/residents-medical-students\/residents)\n- [Patients & Families](https:\/\/www.psychiatry.org\/patients-families)\n- [About APA](https:\/\/www.psychiatry.org\/about-apa)\n- [Work At APA](https:\/\/www.psychiatry.org\/about-apa\/work-at-apa)\n- [Annual Meeting](https:\/\/www.psychiatry.org\/psychiatrists\/meetings)\n\n### Newsroom Toggle List\n- [News Releases](https:\/\/www.psychiatry.org\/news-room\/news-releases)\n- [Psychiatric News](http:\/\/psychnews.psychiatryonline.org\/)\n- [Message from President](https:\/\/psychnews.psychiatryonline.org\/topic\/news-president?sortBy=Ppub&)\n- [APA Blogs](https:\/\/www.psychiatry.org\/news-room\/apa-blogs)\n\n### Join APA Toggle List\n- [General Members](https:\/\/www.psychiatry.org\/membership\/join-apa\/general-members)\n- [Early Career Psychiatrists](https:\/\/www.psychiatry.org\/membership\/join-apa\/early-career-psychiatrists)\n- [Residents & Fellows](https:\/\/www.psychiatry.org\/membership\/join-apa\/residents-and-fellows)\n- [Medical Students](https:\/\/www.psychiatry.org\/membership\/join-apa\/medical-students)\n- [International](https:\/\/www.psychiatry.org\/membership\/join-apa\/international)\n- [International Resident-Fellows](https:\/\/www.psychiatry.org\/membership\/join-apa\/international-resident-fellows)\n- [Semi-Retired & Retired](https:\/\/www.psychiatry.org\/membership\/join-apa\/semi-retired-and-retired)\n\n### APA Sites Toggle List\n- [APA Annual Meeting](https:\/\/www.psychiatry.org\/psychiatrists\/meetings\/annual-meeting)\n- [APA Communities](http:\/\/community.psychiatry.org\/)\n- [APA Foundation](https:\/\/www.apaf.org\/)\n- [APA JobCentral](https:\/\/jobs.psychiatry.org\/)\n- [APA Learning Center](https:\/\/education.psychiatry.org\/SSOLogin)\n- [APA Publishing](https:\/\/www.appi.org\/)\n- [Center for Workplace Mental Health](http:\/\/workplacementalhealth.org\/)\n- [Melvin Sabshin, M.D. Library & Archives](https:\/\/www.apaf.org\/library-archives\/)\n- [Psychiatric News](http:\/\/psychnews.psychiatryonline.org\/)\n- [Psychiatry Online](http:\/\/www.psychiatryonline.org\/)\n\n- [Terms of Use and Privacy Policy](https:\/\/www.psychiatry.org\/terms-of-use-and-privacy-policy)\n- [Copyright](https:\/\/www.psychiatry.org\/copyright)\n- [Contact](https:\/\/www.psychiatry.org\/about-apa\/contact-us)\n- [Conflict of Interest Policy](https:\/\/www.psychiatry.org\/conflict-of-interest-policy)\n- [Accessibility](https:\/\/www.psychiatry.org\/accessibility)\n- [Cookie Policy](https:\/\/www.psychiatry.org\/cookie-policy)\n- [Your Cookie Preference Settings](Javascript:OneTrust.ToggleInfoDisplay\\(\\);)\n\n- © 2026 American Psychiatric Association. 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Disorder](https:\/\/www.psychiatry.org\/patients-families\/autism\/expert-q-and-a)\n\n- Back\n- [**Bipolar Disorders**](https:\/\/www.psychiatry.org\/patients-families\/bipolar-disorders)\n- [What Are Bipolar Disorders?](https:\/\/www.psychiatry.org\/patients-families\/bipolar-disorders\/what-are-bipolar-disorders)\n- [Expert Q\\&A: Bipolar Disorder](https:\/\/www.psychiatry.org\/patients-families\/bipolar-disorders\/expert-q-and-a)\n\n- Back\n- [**Climate Change and Mental Health Connections**](https:\/\/www.psychiatry.org\/patients-families\/climate-change-and-mental-health-connections)\n- [How Extreme Weather Events Affect Mental Health](https:\/\/www.psychiatry.org\/patients-families\/climate-change-and-mental-health-connections\/affects-on-mental-health)\n- [Who Is Affected by Climate Change?](https:\/\/www.psychiatry.org\/patients-families\/climate-change-and-mental-health-connections\/who-is-affected-by-climate-change)\n\n- Back\n- [**Dementia and Alzheimer's Disease**](https:\/\/www.psychiatry.org\/patients-families\/alzheimers)\n- [What Are Dementia and Alzheimer’s Disease?](https:\/\/www.psychiatry.org\/patients-families\/alzheimers\/what-is-alzheimers-disease)\n- [Expert Q\\&A: Dementia and Alzheimer's Disease](https:\/\/www.psychiatry.org\/patients-families\/alzheimers\/expert-q-and-a)\n\n- Back\n- [**Depression**](https:\/\/www.psychiatry.org\/patients-families\/depression)\n- [What Is Depression?](https:\/\/www.psychiatry.org\/patients-families\/depression\/what-is-depression)\n- [Expert Q\\&A: Depression](https:\/\/www.psychiatry.org\/patients-families\/depression\/expert-q-and-a)\n\n- Back\n- [**Disruptive, Impulse-Control and Conduct Disorders**](https:\/\/www.psychiatry.org\/patients-families\/disruptive-impulse-control-and-conduct-disorders)\n- [What are Disruptive, Impulse Control and Conduct Disorders?](https:\/\/www.psychiatry.org\/patients-families\/disruptive-impulse-control-and-conduct-disorders\/what-are-disruptive-impulse-control-and-conduct)\n- [Expert Q\\&A: Disruptive, Impulse Control and Conduct Disorders](https:\/\/www.psychiatry.org\/patients-families\/disruptive-impulse-control-and-conduct-disorders\/expert-q-and-a)\n\n- Back\n- [**Dissociative Disorders**](https:\/\/www.psychiatry.org\/patients-families\/dissociative-disorders)\n- [What Are Dissociative Disorders?](https:\/\/www.psychiatry.org\/patients-families\/dissociative-disorders\/what-are-dissociative-disorders)\n- [Expert Q\\&A: Dissociative Disorders](https:\/\/www.psychiatry.org\/patients-families\/dissociative-disorders\/expert-q-and-a)\n\n- Back\n- [**Eating Disorders**](https:\/\/www.psychiatry.org\/patients-families\/eating-disorders)\n- [What are Eating Disorders?](https:\/\/www.psychiatry.org\/patients-families\/eating-disorders\/what-are-eating-disorders)\n- [Expert Q\\&A: Eating Disorders](https:\/\/www.psychiatry.org\/patients-families\/eating-disorders\/expert-q-and-a)\n\n- Back\n- [**Gambling Disorder**](https:\/\/www.psychiatry.org\/patients-families\/gambling-disorder)\n- [What is Gambling Disorder?](https:\/\/www.psychiatry.org\/patients-families\/gambling-disorder\/what-is-gambling-disorder)\n- [Expert Q\\&A: Gambling Disorder](https:\/\/www.psychiatry.org\/patients-families\/gambling-disorder\/expert-q-and-a)\n\n- Back\n- [**Gender Dysphoria**](https:\/\/www.psychiatry.org\/patients-families\/gender-dysphoria)\n- [What is Gender Dysphoria?](https:\/\/www.psychiatry.org\/patients-families\/gender-dysphoria\/what-is-gender-dysphoria)\n- [Expert Q\\&A: Gender Dysphoria](https:\/\/www.psychiatry.org\/patients-families\/gender-dysphoria\/expert-q-and-a)\n\n- Back\n- [**Hoarding Disorder**](https:\/\/www.psychiatry.org\/patients-families\/hoarding-disorder)\n- [What is Hoarding Disorder?](https:\/\/www.psychiatry.org\/patients-families\/hoarding-disorder\/what-is-hoarding-disorder)\n- [Expert Q\\&A: Hoarding Disorder](https:\/\/www.psychiatry.org\/patients-families\/hoarding-disorder\/expert-q-and-a)\n\n- Back\n- [**Intellectual Disability**](https:\/\/www.psychiatry.org\/patients-families\/intellectual-disability)\n- [What is Intellectual Disability?](https:\/\/www.psychiatry.org\/patients-families\/intellectual-disability\/what-is-intellectual-disability)\n- [Expert Q\\&A: Intellectual Disability](https:\/\/www.psychiatry.org\/patients-families\/intellectual-disability\/expert-q-and-a)\n\n- Back\n- [**Neurodevelopmental Disorders**](https:\/\/www.psychiatry.org\/patients-families\/neurodevelopment-disorders)\n- [Neurodevelopmental Disorders - Communication Disorders](https:\/\/www.psychiatry.org\/patients-families\/neurodevelopment-disorders\/neurodevelopment-disorders-communication-disorders)\n- [Neurodevelopmental Disorders - Motor Disorders](https:\/\/www.psychiatry.org\/patients-families\/neurodevelopment-disorders\/neurodevelopmental-disorders-motor-disorders)\n\n- Back\n- [**Obsessive-Compulsive and Related Disorders**](https:\/\/www.psychiatry.org\/patients-families\/obsessive-compulsive-disorder)\n- [What Is are Obsessive-Compulsive and Related Disorders?](https:\/\/www.psychiatry.org\/patients-families\/obsessive-compulsive-disorder\/what-is-obsessive-compulsive-disorder)\n- [Expert Q\\&A: Obsessive-Compulsive and Related Disorders](https:\/\/www.psychiatry.org\/patients-families\/obsessive-compulsive-disorder\/expert-q-and-a)\n\n- Back\n- [**Perinatal Depression (formerly Postpartum)**](https:\/\/www.psychiatry.org\/patients-families\/peripartum-depression)\n- [What is Perinatal Depression (formerly Postpartum)?](https:\/\/www.psychiatry.org\/patients-families\/peripartum-depression\/what-is-peripartum-depression)\n- [Expert Q\\&A: Perinatal Depression](https:\/\/www.psychiatry.org\/patients-families\/peripartum-depression\/expert-q-and-a)\n\n- Back\n- [**Personality Disorders**](https:\/\/www.psychiatry.org\/patients-families\/personality-disorders)\n- [What are Personality Disorders?](https:\/\/www.psychiatry.org\/patients-families\/personality-disorders\/what-are-personality-disorders)\n- [Expert Q\\&A: Personality Disorders](https:\/\/www.psychiatry.org\/patients-families\/personality-disorders\/expert-q-and-a)\n\n- Back\n- [**Posttraumatic Stress Disorder (PTSD)**](https:\/\/www.psychiatry.org\/patients-families\/ptsd)\n- [What is Posttraumatic Stress Disorder (PTSD)?](https:\/\/www.psychiatry.org\/patients-families\/ptsd\/what-is-ptsd)\n- [Expert Q\\&A: Posttraumatic Stress Disorder (PTSD)](https:\/\/www.psychiatry.org\/patients-families\/ptsd\/expert-q-and-a)\n\n- Back\n- [**Schizophrenia**](https:\/\/www.psychiatry.org\/patients-families\/schizophrenia)\n- [What is Schizophrenia?](https:\/\/www.psychiatry.org\/patients-families\/schizophrenia\/what-is-schizophrenia)\n- [Expert Q\\&A: Schizophrenia](https:\/\/www.psychiatry.org\/patients-families\/schizophrenia\/expert-q-and-a)\n\n- Back\n- [**Sleep Disorders**](https:\/\/www.psychiatry.org\/patients-families\/sleep-disorders)\n- [What are Sleep Disorders?](https:\/\/www.psychiatry.org\/patients-families\/sleep-disorders\/what-are-sleep-disorders)\n- [Expert Q\\&A: Sleep Disorders](https:\/\/www.psychiatry.org\/patients-families\/sleep-disorders\/expert-q-and-a)\n\n- Back\n- [**Somatic Symptom Disorder**](https:\/\/www.psychiatry.org\/patients-families\/somatic-symptom-disorder)\n- [What is Somatic Symptom Disorder?](https:\/\/www.psychiatry.org\/patients-families\/somatic-symptom-disorder\/what-is-somatic-symptom-disorder)\n- [Expert Q\\&A: Somatic Symptom Disorder](https:\/\/www.psychiatry.org\/patients-families\/somatic-symptom-disorder\/expert-q-and-a)\n\n- Back\n- [**Specific Learning Disorders**](https:\/\/www.psychiatry.org\/patients-families\/specific-learning-disorder)\n- [What Are Specific Learning Disorders?](https:\/\/www.psychiatry.org\/patients-families\/specific-learning-disorder\/what-is-specific-learning-disorder)\n- [Expert Q\\&A: Specific Learning Disorders](https:\/\/www.psychiatry.org\/patients-families\/specific-learning-disorder\/expert-q-and-a)\n\n- Back\n- [**Technology Addictions: Social Media, Online Gaming, and More**](https:\/\/www.psychiatry.org\/patients-families\/technology-addictions-social-media-and-more)\n- [What is Technology Addiction?](https:\/\/www.psychiatry.org\/patients-families\/technology-addictions-social-media-and-more\/what-is-technology-addiction)\n- [Expert Q\\&A: Technology Addiction](https:\/\/www.psychiatry.org\/patients-families\/technology-addictions-social-media-and-more\/expert-q-a-technology-addiction)\n\n- Back\n- [**La Salud Mental**](https:\/\/www.psychiatry.org\/patients-families\/la-salud-mental)\n- [Adicción a la tecnología: redes sociales, juegos en línea, y más](https:\/\/www.psychiatry.org\/patients-families\/la-salud-mental\/adiccion-a-la-tecnologia-redes-sociales-juegos-en)\n- [Ansiedad](https:\/\/www.psychiatry.org\/patients-families\/la-salud-mental\/ansiedad)\n- [Ayudar a un ser querido a sobrellevar una enfermedad mental](https:\/\/www.psychiatry.org\/patients-families\/la-salud-mental\/ayudar-a-un-ser-querido-a-sobrellevar-una-enfermed)\n- [Cigarrillos electrónicos y vapeo](https:\/\/www.psychiatry.org\/patients-families\/la-salud-mental\/cigarrillos-electronicos-y-vapeo)\n- [Comunicados de prensa en español](https:\/\/www.psychiatry.org\/patients-families\/la-salud-mental\/comunicados-de-prensa-en-espanol)\n- [Conexiones entre el cambio climático y la salud mental](https:\/\/www.psychiatry.org\/patients-families\/la-salud-mental\/conexiones-entre-el-cambio-climatico-y-la-salud-me)\n- [Estilo de vida para apoyar la salud mental](https:\/\/www.psychiatry.org\/patients-families\/la-salud-mental\/estilo-de-vida-para-apoyar-la-salud-mental)\n- [La Salud Mental Allies \/ Aliados de La Salud Mental](https:\/\/www.psychiatry.org\/patients-families\/la-salud-mental\/la-salud-mental-collaborators)\n- [Más temas de salud mental](https:\/\/www.psychiatry.org\/patients-families\/la-salud-mental\/mas-temas-de-salud-mental)\n- [Mitos y Realidades Sobre La Salud Mental](https:\/\/www.psychiatry.org\/patients-families\/la-salud-mental\/mitos-y-realidades-sobre-la-salud-mental)\n- [¿Qué es el DSM?](https:\/\/www.psychiatry.org\/patients-families\/la-salud-mental\/%C2%BFque-es-el-dsm)\n- [¿Qué es la psicoterapia?](https:\/\/www.psychiatry.org\/patients-families\/la-salud-mental\/que-es-la-psicoterapia)\n- [¿Qué es la psiquiatría?](https:\/\/www.psychiatry.org\/patients-families\/la-salud-mental\/%C2%BFque-es-la-psiquiatria)\n- [¿Qué es una enfermedad mental?](https:\/\/www.psychiatry.org\/patients-families\/la-salud-mental\/%C2%BFque-es-una-enfermedad-mental)\n- [Trastorno por consumo de alcohol](https:\/\/www.psychiatry.org\/patients-families\/la-salud-mental\/trastorno-por-consumo-de-alcohol)\n- [Trastorno por consumo de opioides](https:\/\/www.psychiatry.org\/patients-families\/la-salud-mental\/trastorno-por-consumo-de-opioides-1)\n- [Trastorno del espectro autista](https:\/\/www.psychiatry.org\/patients-families\/la-salud-mental\/trastorno-del-espectro-autista)\n- [Trastorno de estrés postraumático (TEPT)](https:\/\/www.psychiatry.org\/patients-families\/la-salud-mental\/trastorno-de-estres-postraumatico-tept)\n- [Hispanic Heritage Month Toolkit](https:\/\/www.psychiatry.org\/patients-families\/la-salud-mental\/hispanic-heritage-month-toolkit)\n- [Guía de medicamentos para padres](https:\/\/www.psychiatry.org\/patients-families\/la-salud-mental\/guia-para-familias-sobre-los-medicamentos)\n- [Trastornos 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[Components](https:\/\/www.psychiatry.org\/about-apa\/Meet-Our-Organization\/Councils)\n\n- Back\n- [**District Branches**](https:\/\/www.psychiatry.org\/about-apa\/Meet-Our-Organization\/district-branches)\n- [Resources for DB\/SA Leadership](https:\/\/www.psychiatry.org\/membership\/district-branches\/district-branch-resources)\n- [District Branch Dues for General Members](https:\/\/www.psychiatry.org\/membership\/district-branches\/district-branch-dues-for-general-members)\n- [District Branch Dues for Residents and Fellows](https:\/\/www.psychiatry.org\/membership\/district-branches\/district-branch-dues-for-residents-and-fellows)","attrs_readable_markdown":"Sleep disorders (or sleep-wake disorders) involve problems with the quality, timing, and amount of sleep, which result in daytime distress and impairment in functioning. Sleep-wake disorders often occur along with medical conditions or other mental health conditions, such as depression, anxiety, or cognitive disorders. There are several different types of sleep-wake disorders, of which insomnia is the most common. Other sleep-wake disorders include obstructive sleep apnea, parasomnias, narcolepsy, and restless leg syndrome.\n\nSleep difficulties are linked to both physical and emotional problems. Sleep problems can both contribute to or exacerbate mental health conditions and can be a symptom of other mental health conditions.\n\nAbout one-third of adults report insomnia symptoms and 4-22 meet the criteria for insomnia disorder.1\n\n**Importance of Sleep**\n\nSleep is a basic human need and is critical to both physical and mental health. There are two types of sleep that generally occur in a pattern of three-to-five cycles per night:\n\n- Rapid eye movement (REM) – when most dreaming occurs\n- Non-REM – has three phases, including the deepest sleep\n\nWhen you sleep is also important. Your body typically works on a 24-hour cycle (circadian rhythm) that helps you know when to sleep.\n\nHow much sleep we need varies depending on age and varies from person to person. According to the National Sleep Foundation most adults need about seven to nine hours of restful sleep each night, preferably with consistent sleep and wake times.\n\nMany of us do not get enough sleep. A third of adults report that they usually get less than the recommended amout of sleep and only about 30% of high school students get at least eight hours of sleep on an average school night.2 An estimated 34 percent of Americans report their sleep quality as “poor” or “only fair.”3\n\nMore than 50 million Americans have chronic sleep disorders.2\n\n### Consequences of Lack of Sleep and Coexisting Conditions\nSleep helps your brain function properly. Not getting enough sleep or poor quality sleep has many potential consequences. The most obvious concerns are fatigue and decreased energy, irritability and problems focusing. The ability to make decisions and your mood can also be affected. Sleep problems often coexist with symptoms of depression or anxiety. Sleep problems can exacerbate depression or anxiety, and depression or anxiety can lead to sleep problems.\n\nLack of sleep and too much sleep are linked to many chronic health problems, such as heart disease, diabetes and obesity. Sleep disturbances can also be a warning sign for medical and neurological problems, such as congestive heart failure, osteoarthritis and Parkinson’s disease.\n\n**Types of Sleep Disorders - Insomnia Disorder**\n\nInsomnia, the most common sleep disorder, involves problems getting to sleep or staying asleep. About one-third of adults report some insomnia symptoms, 10 to 15% report problems with functioning during the daytime and 4 to 22% have symptoms severe enough to meet criteria for insomnia disorder. An estimated 40 to 50% of individuals with insomnia also have another mental disorder.1\n\n#### Symptoms and Diagnosis\nTo be diagnosed with insomnia disorder, the sleep difficulties must occur at least three nights a week for at least three months and cause significant distress or problems at work, school or other important areas of a person's daily functioning. Not all individuals with sleep disturbances are distressed or have problems with functioning.\n\nTo diagnose insomnia, a physician will rule out other sleep disorders (see Related Conditions below), medication side effects, substance misuse, depression and other physical and mental illnesses. Some medications and medical conditions can affect sleep.\n\nA comprehensive assessment for insomnia or other sleep problems may involve a patient history, a physical exam, a sleep diary and clinical testing (a sleep study or polysomnography). A sleep diary is a record of your sleep habits to discuss with your physician. It includes information such as when you go to bed, get to sleep, wake up, get out of bed, take naps, exercise, eat and consume alcohol and caffeinated beverages. In additional, a sleep study allows the physician to identify howlong and how well you are sleeping and to detect specific sleep problems.\n\nSleep problems can occur at any age but most commonly start in young adulthood. The type of insomnia often varies with age. Problems getting to sleep are more common among young adults. Problems staying asleep are more common among middle-aged and older adults.\n\nSymptoms of insomnia can be:\n\n- Episodic (with an episode of symptoms lasting one to three months)\n- Persistent (with symptoms lasting three months or more)\n- Recurrent (with two or more episodes within a year)\n\nSymptoms of insomnia can also be brought on by a specific life event or situation.\n\n#### Treatment and Self-help\nSleep problems can often be improved with regular sleep habits. (See Sleep Hygiene section for tips.) If your sleep problems persist or if they interfere with how you feel or function during the day, you should seek evaluation and treatment by a physician.\n\nSleep disorders should be specifically addressed regardless of mental or other medical problems that may be present. Chronic insomnia is typically treated with a combination of sleep medications and behavioral techniques, such as cognitive behavior therapy. Several types of medications can be used to treat insomnia and to help you fall asleep or stay asleep. Most of these can become habit-forming and should only be used for short periods and under the care of a physician. Some antidepressants are also used to treat insomnia.\n\nMost over-the-counter sleep medicines contain antihistamines, which are commonly used to treat allergies. They are not addictive, but they can become less effective over time. They may also contribute to confusion, blurred vision, urinary retention, and falls in the elderly and should be used with caution in this population.\n\nMany people turn to complementary health approaches to help with sleep problems. According to the National Institutes of Health some may be safe and effective, others lack evidence to support their effectiveness or raise safety concerns.\n\n- **Relaxation techniques**, used before bedtime, can be helpful for insomnia.\n- **Melatonin** supplements may be helpful for people with some types of insomnia. Long-term safety has not been investigated.\n- **Mind and body approaches**, such as mindfulness, meditation, yoga, massage therapy and acupuncture lack evidence to show their usefulness, but are generally considered safe.\n- **Herbs and dietary supplements** have not been shown to be effective for insomnia. There are safety concerns about some, including L-tryptophan and Kava, while others may interact with prescribed medications.\n\nLet your health care provider know about any alternative medicines or supplements you are taking.\n\n#### Sleep Hygiene: Healthy sleep tips to address sleep problems.\n- Stick to a sleep schedule – same bedtime and wake up time even on the weekends.\n- Allow your body to wind down with a calming activity, such as reading away from bright lights and avoiding electronic devices before sleep.\n- Avoid naps especially in the afternoon.\n- Exercise daily.\n- Pay attention to bedroom environment (quiet, cool and dark is best) and your mattress and pillow (should be comfortable and supportive).\n- Avoid alcohol, caffeine and heavy meals in the evening.\n\n**Other Sleep Disorders**\n\nIn central sleep apnea, the brain does not properly control breathing during sleep, causing breathing to start and stop. It is diagnosed when a sleep study identifies five or more central apneas (pauses in breathing) per hour of sleep. Central sleep apnea is rare and less prevalent than obstructive sleep apnea. It is more common in older adults, in people with heart disorders or stroke, and in people using opioid pain medications. It can be treated using a CPAP or other device during sleep.\n\nPeople with sleep-related hypoventilation have episodes of shallow breathing, elevated blood carbon dioxide levels, and low oxygen levels during sleep. It frequently occurs along with medical conditions, such as chronic obstructive pulmonary disease (COPD), or medication or substance use. Those with sleep-related hypoventilation often have trouble with insomnia or excessive daytime sleepiness, frequently waking up during sleep and headaches on awakening. Risk factors for sleep-related hypoventilation include medical conditions, such as obesity, hypothyroidism, pulminary disorders; neuromuscular disorders; the use of certain medications, such as benzodiazepines and opiates; and alcohol.\n\n#### References\n1. American Psychiatric Association. *Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR), Fifth edition - Text Rivision*. 2022.\n2. Centers for Disease Control and Prevention. [Sleep and Sleep Disorders](https:\/\/www.cdc.gov\/sleep\/index.html).\n3. National Sleep Foundation. [Sleep Health Index](https:\/\/www.sleephealthjournal.org\/article\/S2352-7218\\(17\\)30102-X\/fulltext). 2017.\n## Physician Review\nFelix Torres, M.D., MBA, FACHE, DFAPA, CCHP-MH\n\nMarch 2024","meta_canonical":null}

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Boilerpipe Text	Sleep disorders (or sleep-wake disorders) involve problems with the quality, timing, and amount of sleep, which result in daytime distress and impairment in functioning. Sleep-wake disorders often occur along with medical conditions or other mental health conditions, such as depression, anxiety, or cognitive disorders. There are several different types of sleep-wake disorders, of which insomnia is the most common. Other sleep-wake disorders include obstructive sleep apnea, parasomnias, narcolepsy, and restless leg syndrome. Sleep difficulties are linked to both physical and emotional problems. Sleep problems can both contribute to or exacerbate mental health conditions and can be a symptom of other mental health conditions. About one-third of adults report insomnia symptoms and 4-22 meet the criteria for insomnia disorder. 1 Importance of Sleep Sleep is a basic human need and is critical to both physical and mental health. There are two types of sleep that generally occur in a pattern of three-to-five cycles per night: Rapid eye movement (REM) – when most dreaming occurs Non-REM – has three phases, including the deepest sleep When you sleep is also important. Your body typically works on a 24-hour cycle (circadian rhythm) that helps you know when to sleep. How much sleep we need varies depending on age and varies from person to person. According to the National Sleep Foundation most adults need about seven to nine hours of restful sleep each night, preferably with consistent sleep and wake times. Many of us do not get enough sleep. A third of adults report that they usually get less than the recommended amout of sleep and only about 30% of high school students get at least eight hours of sleep on an average school night. 2 An estimated 34 percent of Americans report their sleep quality as “poor” or “only fair.” 3 More than 50 million Americans have chronic sleep disorders. 2 Consequences of Lack of Sleep and Coexisting Conditions Sleep helps your brain function properly. Not getting enough sleep or poor quality sleep has many potential consequences. The most obvious concerns are fatigue and decreased energy, irritability and problems focusing. The ability to make decisions and your mood can also be affected. Sleep problems often coexist with symptoms of depression or anxiety. Sleep problems can exacerbate depression or anxiety, and depression or anxiety can lead to sleep problems. Lack of sleep and too much sleep are linked to many chronic health problems, such as heart disease, diabetes and obesity. Sleep disturbances can also be a warning sign for medical and neurological problems, such as congestive heart failure, osteoarthritis and Parkinson’s disease. Types of Sleep Disorders - Insomnia Disorder Insomnia, the most common sleep disorder, involves problems getting to sleep or staying asleep. About one-third of adults report some insomnia symptoms, 10 to 15% report problems with functioning during the daytime and 4 to 22% have symptoms severe enough to meet criteria for insomnia disorder. An estimated 40 to 50% of individuals with insomnia also have another mental disorder. 1 Symptoms and Diagnosis To be diagnosed with insomnia disorder, the sleep difficulties must occur at least three nights a week for at least three months and cause significant distress or problems at work, school or other important areas of a person's daily functioning. Not all individuals with sleep disturbances are distressed or have problems with functioning. To diagnose insomnia, a physician will rule out other sleep disorders (see Related Conditions below), medication side effects, substance misuse, depression and other physical and mental illnesses. Some medications and medical conditions can affect sleep. A comprehensive assessment for insomnia or other sleep problems may involve a patient history, a physical exam, a sleep diary and clinical testing (a sleep study or polysomnography). A sleep diary is a record of your sleep habits to discuss with your physician. It includes information such as when you go to bed, get to sleep, wake up, get out of bed, take naps, exercise, eat and consume alcohol and caffeinated beverages. In additional, a sleep study allows the physician to identify howlong and how well you are sleeping and to detect specific sleep problems. Sleep problems can occur at any age but most commonly start in young adulthood. The type of insomnia often varies with age. Problems getting to sleep are more common among young adults. Problems staying asleep are more common among middle-aged and older adults. Symptoms of insomnia can be: Episodic (with an episode of symptoms lasting one to three months) Persistent (with symptoms lasting three months or more) Recurrent (with two or more episodes within a year) Symptoms of insomnia can also be brought on by a specific life event or situation. Treatment and Self-help Sleep problems can often be improved with regular sleep habits. (See Sleep Hygiene section for tips.) If your sleep problems persist or if they interfere with how you feel or function during the day, you should seek evaluation and treatment by a physician. Sleep disorders should be specifically addressed regardless of mental or other medical problems that may be present. Chronic insomnia is typically treated with a combination of sleep medications and behavioral techniques, such as cognitive behavior therapy. Several types of medications can be used to treat insomnia and to help you fall asleep or stay asleep. Most of these can become habit-forming and should only be used for short periods and under the care of a physician. Some antidepressants are also used to treat insomnia. Most over-the-counter sleep medicines contain antihistamines, which are commonly used to treat allergies. They are not addictive, but they can become less effective over time. They may also contribute to confusion, blurred vision, urinary retention, and falls in the elderly and should be used with caution in this population. Many people turn to complementary health approaches to help with sleep problems. According to the National Institutes of Health some may be safe and effective, others lack evidence to support their effectiveness or raise safety concerns. Relaxation techniques , used before bedtime, can be helpful for insomnia. Melatonin supplements may be helpful for people with some types of insomnia. Long-term safety has not been investigated. Mind and body approaches , such as mindfulness, meditation, yoga, massage therapy and acupuncture lack evidence to show their usefulness, but are generally considered safe. Herbs and dietary supplements have not been shown to be effective for insomnia. There are safety concerns about some, including L-tryptophan and Kava, while others may interact with prescribed medications. Let your health care provider know about any alternative medicines or supplements you are taking. Sleep Hygiene: Healthy sleep tips to address sleep problems. Stick to a sleep schedule – same bedtime and wake up time even on the weekends. Allow your body to wind down with a calming activity, such as reading away from bright lights and avoiding electronic devices before sleep. Avoid naps especially in the afternoon. Exercise daily. Pay attention to bedroom environment (quiet, cool and dark is best) and your mattress and pillow (should be comfortable and supportive). Avoid alcohol, caffeine and heavy meals in the evening. Other Sleep Disorders In central sleep apnea, the brain does not properly control breathing during sleep, causing breathing to start and stop. It is diagnosed when a sleep study identifies five or more central apneas (pauses in breathing) per hour of sleep. Central sleep apnea is rare and less prevalent than obstructive sleep apnea. It is more common in older adults, in people with heart disorders or stroke, and in people using opioid pain medications. It can be treated using a CPAP or other device during sleep. People with sleep-related hypoventilation have episodes of shallow breathing, elevated blood carbon dioxide levels, and low oxygen levels during sleep. It frequently occurs along with medical conditions, such as chronic obstructive pulmonary disease (COPD), or medication or substance use. Those with sleep-related hypoventilation often have trouble with insomnia or excessive daytime sleepiness, frequently waking up during sleep and headaches on awakening. Risk factors for sleep-related hypoventilation include medical conditions, such as obesity, hypothyroidism, pulminary disorders; neuromuscular disorders; the use of certain medications, such as benzodiazepines and opiates; and alcohol. References American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR), Fifth edition - Text Rivision . 2022. Centers for Disease Control and Prevention. Sleep and Sleep Disorders . National Sleep Foundation. Sleep Health Index . 2017. Physician Review Felix Torres, M.D., MBA, FACHE, DFAPA, CCHP-MH March 2024
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Print Sub Navigation - ## [Sleep Disorders](https://www.psychiatry.org/patients-families/sleep-disorders) Toggle Sleep Disorders Page Listing - [What are Sleep Disorders?](https://www.psychiatry.org/patients-families/sleep-disorders/what-are-sleep-disorders) - [Expert Q\&A: Sleep Disorders](https://www.psychiatry.org/patients-families/sleep-disorders/expert-q-and-a) ## On This Page - [Importance of Sleep](https://www.psychiatry.org/patients-families/sleep-disorders/what-are-sleep-disorders#section_0) - [Types of Sleep Disorders - Insomnia Disorder](https://www.psychiatry.org/patients-families/sleep-disorders/what-are-sleep-disorders#section_2) - [Other Sleep Disorders](https://www.psychiatry.org/patients-families/sleep-disorders/what-are-sleep-disorders#section_6) - [Physician Review](https://www.psychiatry.org/patients-families/sleep-disorders/what-are-sleep-disorders#section_8) Sleep disorders (or sleep-wake disorders) involve problems with the quality, timing, and amount of sleep, which result in daytime distress and impairment in functioning. Sleep-wake disorders often occur along with medical conditions or other mental health conditions, such as depression, anxiety, or cognitive disorders. There are several different types of sleep-wake disorders, of which insomnia is the most common. Other sleep-wake disorders include obstructive sleep apnea, parasomnias, narcolepsy, and restless leg syndrome. Sleep difficulties are linked to both physical and emotional problems. Sleep problems can both contribute to or exacerbate mental health conditions and can be a symptom of other mental health conditions. About one-third of adults report insomnia symptoms and 4-22 meet the criteria for insomnia disorder.1 ## Importance of Sleep Sleep is a basic human need and is critical to both physical and mental health. There are two types of sleep that generally occur in a pattern of three-to-five cycles per night: - Rapid eye movement (REM) – when most dreaming occurs - Non-REM – has three phases, including the deepest sleep When you sleep is also important. Your body typically works on a 24-hour cycle (circadian rhythm) that helps you know when to sleep. How much sleep we need varies depending on age and varies from person to person. According to the National Sleep Foundation most adults need about seven to nine hours of restful sleep each night, preferably with consistent sleep and wake times. Many of us do not get enough sleep. A third of adults report that they usually get less than the recommended amout of sleep and only about 30% of high school students get at least eight hours of sleep on an average school night.2 An estimated 34 percent of Americans report their sleep quality as “poor” or “only fair.”3 More than 50 million Americans have chronic sleep disorders.2 ### Consequences of Lack of Sleep and Coexisting Conditions Sleep helps your brain function properly. Not getting enough sleep or poor quality sleep has many potential consequences. The most obvious concerns are fatigue and decreased energy, irritability and problems focusing. The ability to make decisions and your mood can also be affected. Sleep problems often coexist with symptoms of depression or anxiety. Sleep problems can exacerbate depression or anxiety, and depression or anxiety can lead to sleep problems. Lack of sleep and too much sleep are linked to many chronic health problems, such as heart disease, diabetes and obesity. Sleep disturbances can also be a warning sign for medical and neurological problems, such as congestive heart failure, osteoarthritis and Parkinson’s disease. ## Types of Sleep Disorders - Insomnia Disorder Insomnia, the most common sleep disorder, involves problems getting to sleep or staying asleep. About one-third of adults report some insomnia symptoms, 10 to 15% report problems with functioning during the daytime and 4 to 22% have symptoms severe enough to meet criteria for insomnia disorder. An estimated 40 to 50% of individuals with insomnia also have another mental disorder.1 #### Symptoms and Diagnosis To be diagnosed with insomnia disorder, the sleep difficulties must occur at least three nights a week for at least three months and cause significant distress or problems at work, school or other important areas of a person's daily functioning. Not all individuals with sleep disturbances are distressed or have problems with functioning. To diagnose insomnia, a physician will rule out other sleep disorders (see Related Conditions below), medication side effects, substance misuse, depression and other physical and mental illnesses. Some medications and medical conditions can affect sleep. A comprehensive assessment for insomnia or other sleep problems may involve a patient history, a physical exam, a sleep diary and clinical testing (a sleep study or polysomnography). A sleep diary is a record of your sleep habits to discuss with your physician. It includes information such as when you go to bed, get to sleep, wake up, get out of bed, take naps, exercise, eat and consume alcohol and caffeinated beverages. In additional, a sleep study allows the physician to identify howlong and how well you are sleeping and to detect specific sleep problems. Sleep problems can occur at any age but most commonly start in young adulthood. The type of insomnia often varies with age. Problems getting to sleep are more common among young adults. Problems staying asleep are more common among middle-aged and older adults. Symptoms of insomnia can be: - Episodic (with an episode of symptoms lasting one to three months) - Persistent (with symptoms lasting three months or more) - Recurrent (with two or more episodes within a year) Symptoms of insomnia can also be brought on by a specific life event or situation. #### Treatment and Self-help ![Sleep Disorders: Parents Medication Guide, American Academy of Child and Adolescent Psychiatry and American Psychiatric Association](https://www.psychiatry.org/getmedia/01d57cc0-ed95-4b12-8f77-a684844bde60/PMG-Sleep-disorders_1.png) [Sleep Disorders: Parent's Medication Guide (.pdf)](https://www.aacap.org/App_Themes/AACAP/Docs/families_and_youth/med_guides/SleepDisorders_Parents-Medication-Guide-web.pdf) Sleep problems can often be improved with regular sleep habits. (See Sleep Hygiene section for tips.) If your sleep problems persist or if they interfere with how you feel or function during the day, you should seek evaluation and treatment by a physician. Sleep disorders should be specifically addressed regardless of mental or other medical problems that may be present. Chronic insomnia is typically treated with a combination of sleep medications and behavioral techniques, such as cognitive behavior therapy. Several types of medications can be used to treat insomnia and to help you fall asleep or stay asleep. Most of these can become habit-forming and should only be used for short periods and under the care of a physician. Some antidepressants are also used to treat insomnia. Most over-the-counter sleep medicines contain antihistamines, which are commonly used to treat allergies. They are not addictive, but they can become less effective over time. They may also contribute to confusion, blurred vision, urinary retention, and falls in the elderly and should be used with caution in this population. Many people turn to complementary health approaches to help with sleep problems. According to the National Institutes of Health some may be safe and effective, others lack evidence to support their effectiveness or raise safety concerns. - Relaxation techniques, used before bedtime, can be helpful for insomnia. - Melatonin supplements may be helpful for people with some types of insomnia. Long-term safety has not been investigated. - Mind and body approaches, such as mindfulness, meditation, yoga, massage therapy and acupuncture lack evidence to show their usefulness, but are generally considered safe. - Herbs and dietary supplements have not been shown to be effective for insomnia. There are safety concerns about some, including L-tryptophan and Kava, while others may interact with prescribed medications. Let your health care provider know about any alternative medicines or supplements you are taking. #### Sleep Hygiene: Healthy sleep tips to address sleep problems. - Stick to a sleep schedule – same bedtime and wake up time even on the weekends. - Allow your body to wind down with a calming activity, such as reading away from bright lights and avoiding electronic devices before sleep. - Avoid naps especially in the afternoon. - Exercise daily. - Pay attention to bedroom environment (quiet, cool and dark is best) and your mattress and pillow (should be comfortable and supportive). - Avoid alcohol, caffeine and heavy meals in the evening. ## Other Sleep Disorders Sleep Apnea Obstructive sleep apnea hypopnea, most commonly called sleep apnea, involves breathing interruptions during sleep. A person with sleep apnea will have repeated episodes of airway obstruction during sleep causing snoring, snorting/gasping or breathing pauses. This interrupted sleep causes daytime sleepiness and fatigue. Sleep apnea is diagnosed with a clinical sleep study. The sleep study (polysomnography) involves monitoring the number of obstructive apneas (absence of airflow) or hypopneas (reduction in airflow) during sleep. Sleep apnea is a very common disorder with the prevalence particularly high among men as campared to women, inoder adults, and certain racial and ethnic groups (including African Americans, American Indians, and Hidpanics). Major risk factors for sleep apnea are obesity, male gender, family history of sleep apnea, menopause and certain genetic or endocrine disorders. Lifestyle changes, such as losing weight if needed or sleeping on your side, can improve sleep apnea. In some cases a custom-fit plastic mouthpiece can help keep airways open during sleep. The mouthpiece can be made by a dentist or orthodontist. For moderate to severe sleep apnea, a physician can prescribe a CPAP (continuous positive airway pressure) device. The CPAP works to keep your airways open by gently blowing air through a tube and face mask covering your mouth and/or nose. Central Sleep Apnea In central sleep apnea, the brain does not properly control breathing during sleep, causing breathing to start and stop. It is diagnosed when a sleep study identifies five or more central apneas (pauses in breathing) per hour of sleep. Central sleep apnea is rare and less prevalent than obstructive sleep apnea. It is more common in older adults, in people with heart disorders or stroke, and in people using opioid pain medications. It can be treated using a CPAP or other device during sleep. Sleep-Related Hypoventilation People with sleep-related hypoventilation have episodes of shallow breathing, elevated blood carbon dioxide levels, and low oxygen levels during sleep. It frequently occurs along with medical conditions, such as chronic obstructive pulmonary disease (COPD), or medication or substance use. Those with sleep-related hypoventilation often have trouble with insomnia or excessive daytime sleepiness, frequently waking up during sleep and headaches on awakening. Risk factors for sleep-related hypoventilation include medical conditions, such as obesity, hypothyroidism, pulminary disorders; neuromuscular disorders; the use of certain medications, such as benzodiazepines and opiates; and alcohol. Non-Rapid Eye Movement Sleep Arousal Disorders Non-rapid eye movement (NREM) sleep arousal disorders involve episodes of incomplete awakening from sleep, usually occurring during the first third of a major sleep episode, and are accompanied by either sleepwalking or sleep terrors. The episodes cause significant distress or problems with functioning. NREM sleep arousal disorders are most common among children and become less common with increasing age. Sleepwalking involves repeated episodes of rising from bed and walking around during sleep. While sleepwalking, the individual has a blank stare; is relatively unresponsive to others; is difficult to awaken, and will have limited recall for the episode once awake. Between 6.9 and 29.2% of people have experienced sleepwalking at some time in their lives. Sleep terrors (also called night terrors) are episodes of waking abruptly from sleep, usually beginning with a panicky scream or cry. During each episode, the person experiences intense fear and associated physical signs such as rapid breathing, accelerated heart rate and sweating. The person typically does not remember much of the dream and is unresponsive to efforts of others to comfort them. Sleep terrors are common among very young children—at 18 months of age about 37% of children experience night terrors and at 30 months about 20% experience them. Only about 2% of adults experience night terrors. Nightmare Disorder Nightmare disorder involves repeated occurrences of lengthy, distressing, and well-remembered dreams that usually involve efforts to avoid threats or danger. They generally occur in the second half of a major sleep episode. The nightmares are typically lengthy, elaborate, story-like sequences of dream imagery that seem real and cause anxiety, fear or distress. After waking up, people experiencing nightmares are quickly alert and generally remember the dream and can describe it in detail. The nightmares cause significant distress or problems with functioning. Nightmares often begin between ages 3 and 6 years but are most prevalent and severe in late adolescence or early adulthood. Rapid Eye Movement Sleep Behavior Disorder Rapid eye movement (REM) sleep behavior disorder involves episodes of arousal during sleep associated with speaking and/or movement. The person’s actions are often responses to events in the dream, such as being attacked or trying to escape a threatening situation. Speech is often loud, emotion-filled, and profane. These behaviors arise during REM sleep and usually occur omore than 90 munites after falling asleep. Upon awakening, the person is immediately alert and can often recall the dream. REM sleep behavior disorders may cause significant distress and problems with functioning, including injury to the individual and their bed partner (such as falling, jumping, or flying out of bed; running, hitting, or kicking). Embarrassment about the episodes can cause problems in social relationships and can lead to social isolation or work-related problems. The prevalence of REM sleep behavior disorder has been estimated at around 1% in the general population and may be greater in individuals with psychiatric disorers, possibl related to prescribed medications. Hypersomnolence Disorder People with hypersomnolence disorder are excessively sleepy even when getting at least 7 hours sleep. They have at least one of the following symptoms: - Recurrent periods of sleep or lapses into sleep within the same day (such as unintentional naps while attending a lecture or watching TV) - Sleeping more than nine hours per day and not feeling rested - Difficulty being fully awake after abruptly waking up The extreme sleepiness occurs at least three times per week, for at least three months. Individuals with this disorder may have difficulty waking up in the morning, sometimes appearing groggy, confused or combative (often referred to as sleep inertia). The sleepiness causes significant distress and can lead to problems with functioning, such as issues with concentration and memory. The condition typically begins in late teens or adulthood but may not be diagnosed until many years later. Among individuals who consult in sleep disorders clinics for complaints of daytime sleepiness, approximately 5 to 10% are diagnosed with hypersomnolence disorder. Narcolepsy People with narcolepsy experience periods of an irrepressible need to sleep or lapsing into sleep multiple times within the same day. Sleepiness typically occurs daily but must occur at least three times a week for at least three months for a diagnosis of narcolepsy. People with narcolepsy have episodes of cataplexy, brief sudden loss of muscle tone triggered by laughter or joking. This can result in head bobbing, jaw dropping, or falls. Individuals are awake and aware during cataplexy. Narcolepsy nearly always results from the loss of hypothalamic hypocretin-producing cells. This deficiency in hypocretin (also known as orexin) can be tested in the cerebrospinal fluid via a lumbar puncture (spinal tap). Narcolepsy is rare, affecting and estimated 0.02 to 0.05% of the adult general population. It typically begins in childhood, adolescence or young adulthood. Read more - Psychiatric News: [Why Narcolepsy Is Often Missed—and How to Spot It](https://psychiatryonline.org/doi/10.1176/appi.pn.2025.12.12.7) - APA Blog: [Natcolepsy: An Overwhelming Need to Sleep](https://www.psychiatry.org/News-room/APA-Blogs/Narcolepsy-An-Overwhelming-Need-to-Sleep) Restless Leg Syndrome Restless legs syndrome (RLS) involves an urge to move one’s legs, usually accompanied by uncomfortable and unpleasant sensations in the legs, typically described as creeping, crawling, tingling, burning, or itching. The urge to move the legs: - Begins or worsens during periods of rest or inactivity; - Is partially or totally relieved by movement; and - Occurs only in the evening or at night (or is worse in the evening or at night than during the day). The symptoms occur at least three times per week, continue for at least three months, and cause significant distress or problems in daily functioning. The symptoms of RLS can cause difficulty getting to sleep and can frequently awaken the individual from sleep, leading, in turn, to daytime sleepiness. RLS typically begins in a person’s teens or twenties, and it affects up to 3% of the poopulation. Circadian Rhythm Sleep-Wake Disorders With circadian rhythm sleep-wake disorders, a person’s sleep-wake rhythms (body clock) and the external light-darkness cycle become misaligned. This misalignment causes significant ongoing sleep problems and extreme sleepiness during the day leading to significant distress or problems with functioning. Circadian rhythm disorders can be caused by internal factors (a person’s body clock is different than the light-dark cycle) or external factors (such as shift work or jet lag). Prevalence of delayed sleep phase type (staying up late and getting up late) in the adult population has been estaimated betweeen 0.2 and 1.7% but may be as high as 4.6% in adolescents. The estimated prevalence of advanced sleep phase type (going to sleep early and waking early) is approximately 1% in middle-aged adults and it is more common in older adults. #### References 1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR), Fifth edition - Text Rivision. 2022. 2. Centers for Disease Control and Prevention. [Sleep and Sleep Disorders](https://www.cdc.gov/sleep/index.html). 3. National Sleep Foundation. [Sleep Health Index](https://www.sleephealthjournal.org/article/S2352-7218\(17\)30102-X/fulltext). 2017. ## Physician Review Felix Torres, M.D., MBA, FACHE, DFAPA, CCHP-MH March 2024 Other resources ## More on Sleep Disorders - [Sleep.org – National Sleep Foundation](https://thensf.org/) - [Centers for Disease Control and Prevention (CDC) Sleep and Sleep Disorders](http://www.cdc.gov/sleep/index.html) - [American Academy of Sleep Medicine - Sleep Education](http://www.sleepeducation.org/) - [AACAP & APA - Sleep Disorders: Parents’ Medication Guide (.pdf)](https://www.aacap.org/App_Themes/AACAP/Docs/families_and_youth/med_guides/SleepDisorders_Parents-Medication-Guide-web.pdf "_blank") ## Medical leadership for mind, brain and body. 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Readable Markdown	Sleep disorders (or sleep-wake disorders) involve problems with the quality, timing, and amount of sleep, which result in daytime distress and impairment in functioning. Sleep-wake disorders often occur along with medical conditions or other mental health conditions, such as depression, anxiety, or cognitive disorders. There are several different types of sleep-wake disorders, of which insomnia is the most common. Other sleep-wake disorders include obstructive sleep apnea, parasomnias, narcolepsy, and restless leg syndrome. Sleep difficulties are linked to both physical and emotional problems. Sleep problems can both contribute to or exacerbate mental health conditions and can be a symptom of other mental health conditions. About one-third of adults report insomnia symptoms and 4-22 meet the criteria for insomnia disorder.1 Importance of Sleep Sleep is a basic human need and is critical to both physical and mental health. There are two types of sleep that generally occur in a pattern of three-to-five cycles per night: - Rapid eye movement (REM) – when most dreaming occurs - Non-REM – has three phases, including the deepest sleep When you sleep is also important. Your body typically works on a 24-hour cycle (circadian rhythm) that helps you know when to sleep. How much sleep we need varies depending on age and varies from person to person. According to the National Sleep Foundation most adults need about seven to nine hours of restful sleep each night, preferably with consistent sleep and wake times. Many of us do not get enough sleep. A third of adults report that they usually get less than the recommended amout of sleep and only about 30% of high school students get at least eight hours of sleep on an average school night.2 An estimated 34 percent of Americans report their sleep quality as “poor” or “only fair.”3 More than 50 million Americans have chronic sleep disorders.2 ### Consequences of Lack of Sleep and Coexisting Conditions Sleep helps your brain function properly. Not getting enough sleep or poor quality sleep has many potential consequences. The most obvious concerns are fatigue and decreased energy, irritability and problems focusing. The ability to make decisions and your mood can also be affected. Sleep problems often coexist with symptoms of depression or anxiety. Sleep problems can exacerbate depression or anxiety, and depression or anxiety can lead to sleep problems. Lack of sleep and too much sleep are linked to many chronic health problems, such as heart disease, diabetes and obesity. Sleep disturbances can also be a warning sign for medical and neurological problems, such as congestive heart failure, osteoarthritis and Parkinson’s disease. Types of Sleep Disorders - Insomnia Disorder Insomnia, the most common sleep disorder, involves problems getting to sleep or staying asleep. About one-third of adults report some insomnia symptoms, 10 to 15% report problems with functioning during the daytime and 4 to 22% have symptoms severe enough to meet criteria for insomnia disorder. An estimated 40 to 50% of individuals with insomnia also have another mental disorder.1 #### Symptoms and Diagnosis To be diagnosed with insomnia disorder, the sleep difficulties must occur at least three nights a week for at least three months and cause significant distress or problems at work, school or other important areas of a person's daily functioning. Not all individuals with sleep disturbances are distressed or have problems with functioning. To diagnose insomnia, a physician will rule out other sleep disorders (see Related Conditions below), medication side effects, substance misuse, depression and other physical and mental illnesses. Some medications and medical conditions can affect sleep. A comprehensive assessment for insomnia or other sleep problems may involve a patient history, a physical exam, a sleep diary and clinical testing (a sleep study or polysomnography). A sleep diary is a record of your sleep habits to discuss with your physician. It includes information such as when you go to bed, get to sleep, wake up, get out of bed, take naps, exercise, eat and consume alcohol and caffeinated beverages. In additional, a sleep study allows the physician to identify howlong and how well you are sleeping and to detect specific sleep problems. Sleep problems can occur at any age but most commonly start in young adulthood. The type of insomnia often varies with age. Problems getting to sleep are more common among young adults. Problems staying asleep are more common among middle-aged and older adults. Symptoms of insomnia can be: - Episodic (with an episode of symptoms lasting one to three months) - Persistent (with symptoms lasting three months or more) - Recurrent (with two or more episodes within a year) Symptoms of insomnia can also be brought on by a specific life event or situation. #### Treatment and Self-help Sleep problems can often be improved with regular sleep habits. (See Sleep Hygiene section for tips.) If your sleep problems persist or if they interfere with how you feel or function during the day, you should seek evaluation and treatment by a physician. Sleep disorders should be specifically addressed regardless of mental or other medical problems that may be present. Chronic insomnia is typically treated with a combination of sleep medications and behavioral techniques, such as cognitive behavior therapy. Several types of medications can be used to treat insomnia and to help you fall asleep or stay asleep. Most of these can become habit-forming and should only be used for short periods and under the care of a physician. Some antidepressants are also used to treat insomnia. Most over-the-counter sleep medicines contain antihistamines, which are commonly used to treat allergies. They are not addictive, but they can become less effective over time. They may also contribute to confusion, blurred vision, urinary retention, and falls in the elderly and should be used with caution in this population. Many people turn to complementary health approaches to help with sleep problems. According to the National Institutes of Health some may be safe and effective, others lack evidence to support their effectiveness or raise safety concerns. - Relaxation techniques, used before bedtime, can be helpful for insomnia. - Melatonin supplements may be helpful for people with some types of insomnia. Long-term safety has not been investigated. - Mind and body approaches, such as mindfulness, meditation, yoga, massage therapy and acupuncture lack evidence to show their usefulness, but are generally considered safe. - Herbs and dietary supplements have not been shown to be effective for insomnia. There are safety concerns about some, including L-tryptophan and Kava, while others may interact with prescribed medications. Let your health care provider know about any alternative medicines or supplements you are taking. #### Sleep Hygiene: Healthy sleep tips to address sleep problems. - Stick to a sleep schedule – same bedtime and wake up time even on the weekends. - Allow your body to wind down with a calming activity, such as reading away from bright lights and avoiding electronic devices before sleep. - Avoid naps especially in the afternoon. - Exercise daily. - Pay attention to bedroom environment (quiet, cool and dark is best) and your mattress and pillow (should be comfortable and supportive). - Avoid alcohol, caffeine and heavy meals in the evening. Other Sleep Disorders In central sleep apnea, the brain does not properly control breathing during sleep, causing breathing to start and stop. It is diagnosed when a sleep study identifies five or more central apneas (pauses in breathing) per hour of sleep. Central sleep apnea is rare and less prevalent than obstructive sleep apnea. It is more common in older adults, in people with heart disorders or stroke, and in people using opioid pain medications. It can be treated using a CPAP or other device during sleep. People with sleep-related hypoventilation have episodes of shallow breathing, elevated blood carbon dioxide levels, and low oxygen levels during sleep. It frequently occurs along with medical conditions, such as chronic obstructive pulmonary disease (COPD), or medication or substance use. Those with sleep-related hypoventilation often have trouble with insomnia or excessive daytime sleepiness, frequently waking up during sleep and headaches on awakening. Risk factors for sleep-related hypoventilation include medical conditions, such as obesity, hypothyroidism, pulminary disorders; neuromuscular disorders; the use of certain medications, such as benzodiazepines and opiates; and alcohol. #### References 1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR), Fifth edition - Text Rivision. 2022. 2. Centers for Disease Control and Prevention. [Sleep and Sleep Disorders](https://www.cdc.gov/sleep/index.html). 3. National Sleep Foundation. [Sleep Health Index](https://www.sleephealthjournal.org/article/S2352-7218\(17\)30102-X/fulltext). 2017. ## Physician Review Felix Torres, M.D., MBA, FACHE, DFAPA, CCHP-MH March 2024
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