Sleep disorders have six classifications: insomnia, sleep-related breathing disorders, central disorders of hypersomnolence, circadian rhythm sleep-wake disorders, parasomnias, and sleep-related movement disorders (including restless leg syndrome).
Excessive Daytime Sleepiness
Excessive daytime sleepiness refers to difficulty staying awake and alert during daytime hours. Can be due to extrinsic (circumstantial) or intrinsic (disease-related processes.
| Intrinsic Causes | Extrinsic Causes |
|---|---|
| Sleep-disordered breathing syndromes, such as obstructive sleep apnea and central sleep apnea | Insufficient sleep duration (or inadequate opportunity for sleep) |
| Narcolepsy | Circadian rhythm disturbance |
| Idiopathic hypersomnia | Drug, substance, psych, medical related hypersomnia |
| Restless leg syndrome and periodic limb movement disorder | Environmental sleep disorder (noise, pets) |
| Circadian rhythm sleep disorders (misalignment of the intrinsic circadian timing with the desired sleep schedule; for example, dementia and blindness) |
- Take a good history. Ask about sleep hygiene, the effect of sleepiness on activities, caffeine use, duration of symptoms, etc.
- Are there features of specific sleep disorders such as snoring, apnea, leg discomfort, sleep attacks?
- Take a sleep-wake diary for 1-2 weeks.
- When a primary sleep disorder is suggested, then perform objective sleep testing with in-lab or at-home testing.
- Counsel about drowsy driving.
Circadian Rhythm Disorders
Jet Lag
Occurs with travel across >3 t time zones. Occurs within 1-2 days after travel, and includes insomnia, daytime sleepiness, and neuropsychiatric impairment. Eastward travel is more difficult to adapt to, that Westward travel.
Avoid sleep deprivation and dehydration, consider bright light therapy 3 days before travel with the intention of advancing the circadian phase. On arrival, use timed bright light exposure and melatonin, caffeine intake, and naps as needed.
Shift-Work Sleep Disorder
Symptoms of neurocognitive dysfunction, sleepiness, and mood disturbances that last for at least 3 months. Try to change the work schedule. Then, avoid bright light in the morning, maintain a structured sleep-wake pattern even when off work, and use melatonin to shift the sleep cycle.