A Review on Sleeping Disorders

Emtenan Bukhari, Orjwan Badghaish, Atheer Bahamil, Weam Alfaidi, Imtinan Saati, Rozan Abdali.

King Saud bin Abdulaziz University for Health sciences

Abstract

Sleep is a regular pattern of inactivity in the nervous system and closed eyes for hours. This
pattern is an essential need for each person, but in several people, this pattern disturbed by
conditions called sleep disorders. Sleep disorders are medical conditions in which people suffer
from abnormal behavior during sleep or sleeplessness. These disorders vary from mild that is
treated by changing behaviors to severe that need surgical treatment. This review focuses on
illustrating several sleep disorders, the causes of them, the symptoms associated with each one,
and the recommended treatment. The results of this review give a further understanding of
several sleep disorders, distinguish their symptoms, and know the possible treatment plans.

Introduction
About 1/3 of human life spent in sleep. Sleep is a
universal requirement that human needs, but the Also, it is one of the rarest and most debilitating
absence of it Leads to significant implications. The sleep disorders affecting less than 0.02% of human
science of sleep begins in the middle of the 20th beings [3]. It is worth mentioning that genetic
century with the discovery of rapid eye movement disorders are a vital cause of Narcolepsy, leading to
(REM); however, the recognition of sleep disorders disturbance in the central nervous system.
was limited to the conditions about which the person Moreover, its symptoms can range from mild
reported or observed by others during waking hours. fragmented sleep to more complicated and severe
Recently, with the development of sleeping science, ones such as irresistible daytime sleepiness, sleep
the recognizing of sleep disorders in people increase paralysis, Hallucinations, and Cataplexy [4]. The
which leads to the discovery of new sleep disorders. chronic nature of the disorder requires a long-term
treatment. The primary treatment to help patients
Sleep disorders are conditions that disturb the struggling with Narcolepsy in staying alert is central
natural sleep cycle. These conditions frequently are nervous system stimulants. In addition, Newer
comorbid with other diseases of sleep or other stimulants such as Sunosi (solriamfetol) and
conditions. Disorders of sleep are considered a Pitolisant (Wakix) are known to be useful for
significant health problem across the world. treating Narcolepsy [5]. Other patients may need
Researchers estimated that 50 to 70 million people treatment with methylphenidate. While these
in America suffer from sleep disorders of sleep. medications are highly efficient, unfortunately, they
These disorders affect the daily routine and disturb result in addiction.
normal health functions. Moreover, the researchers
found that about 110,000 injuries in vehicles Obstructive Sleep Apnea
accident were associated with these disorders.
There are nearly 90 different types of sleep Obstructive sleep apnea (OSA) is a severe sleeping
disorders. Most of which, are characterized by one disorder that causes breathing to stop and begin
of these symptoms: difficulty in maintaining sleep, during sleep. It happens when the throat muscles
sensation during sleep, abnormal movements, relax and obstruct the airway(figure 1). The primary
excessive daytime sleepiness, or behaviors. While descriptions of this disorder were of severe apnea in
there are various types of sleep disorders, these obese middle-aged men, but now women present
disorders could be rare conditions such as one-third of obstructive sleep apnea patients [6].
Narcolepsy or common conditions such as OSA patients usually suffer from loud snoring and
obstructive sleep apnea, Insomnia, and Non-rapid episodes of stopped breathing during sleep, so they
Eye Movement Parasomnias [1]. awake with a sore throat or dry mouth. Also, they
experience daytime tiredness, difficulty in
Narcolepsy concentration, and morning headache even if they
had an adequate sleep. Furthermore, some
Necropsy is a sleep disorder in which people suffer researchers indicate that OSA may lead to
from excessive and uncontrollable sleepiness depression and mood alterations [7]. To diagnose
this disorder, physicians use polysomnography that
demands an overnight stay at a sleep laboratory and
monitoring some parameters, such as oxygen
saturation level, nasal airflow, heart rate, and sleep completes sleeping in the bed. It is experienced by
stage. There are several treatments for OSA disorder approximately 2.5% of adults [10]. Furthermore, up
[2]. Primarily, doctors recommend lifestyle changes, to 4 out of 5 adults who are experiencing
such as quitting smoking, reducing drinking alcohol, sleepwalking had a childhood history of it, and it is
and reducing weight. Secondly, they advise using twice likely to find similar history in family
other therapies like continuous positive airway members. To manage any danger of sleepwalking, it
pressure (CPAP), which is a process using a is advised to get rid of sharp instruments in the room,
machine to deliver air pressure through a mask while set an alarm doorbell, close the windows with locks.
sleeping [7]. Lastly, doctors suggest surgery if the Most sleepwalkers experience both confusional
other treatments failed. There are several surgical arousal and sleep terrors which have a more
options, such as correcting a pharyngeal obstruction, dramatic appearance than the other disorders of
creating a new airway (tracheostomy), and removing arousal . 34% of pre-school children, under seven
the tonsils. years old, are more likely to experience sleep terrors
[11]. It starts as confusional arousal and
sleepwalking start, but with extreme confusion,
panic, and cry loudly asking for help. In some cases,
the child may injure himself by hitting a sharp edge
or wall while running. This episode ends when the
individual awakens or complete sleeping as there is
nothing happened.

Insomnia

Insomnia is a sleeping disorder in which individuals

have trouble falling asleep, sleeping, or waking up
too early. With a recorded incidence of 10% to 15%,
Insomnia is the most common sleeping disorder
[12]. Older adults, especially females, are more
often affected than younger ones. Insomnia usually
causes severe psychological depression and
impairment in the working of the day. Consequently,
Figure 1: obstructive sleep apnea insomnia patients typically suffer from fatigue or
By:https://www.mayoclinic.org/diseases- low energy, daytime sleepiness, impaired attention,
conditions/obstructive-sleep-apnea/symptoms- mood disturbance, and behavioral difficulties.
causes/syc-20352090 Moreover, It may lead to an increased risk of acute
myocardial infarction and coronary heart disease,
Non-rapid Eye Movement Parasomnias heart failure, hypertension, diabetes, and death. The
diagnosis of insomnia patients should include a full
Non-rapid Eye Movement (NREM) Parasomnias are clinical and psychological history and a thorough
common types of sleeping disorders characterized evaluation of sleep-related behavior and symptoms.
by abnormal behavior, and they usually occur during There are several treatments for Insomnia. The first-
the first third of the sleep period. They categorize line therapy for Insomnia is cognitive-behavioral
into three disorders of arousal (DOAs) which are therapy. It includes recognizing and modifying
confusional arousal, sleepwalking, sleep terrors. assumptions that influence Patients' ability to sleep,
Confusional arousal, which is considered partial restricting time spent in bed, and practicing relaxing
awakenings, is prevalent in childhood more than in methods. The second line of therapy is medications.
other group ages, especially in children who are Patients with an acute onset of short-term insomnia
under five years old as infants and toddlers [8]. The often recommend using Food and Drug
child usually is sitting in bed and seems in a Administration (FDA)–approved hypnotic
confused manner [9]. Besides, some characteristics medicines. In patients with chronic Insomnia, even
such as disorientation, grogginess, and crying may with treatment and adequate care of these coexisting
occur and last for a few minutes. Similarly, conditions, Insomnia often continues [13].
sleepwalking begins suddenly with an identical
episode that occurs in confusional arousal. Conclusion
Unsuitable behaviors are done after walking away
from the bed with opening eyes such as urinating, In conclusion, Sleep disorders are a group of
jumping on the bed, answering questions conditions that frequently affect the ability to sleep
inappropriately, getting dressed, and searching well. They may cause unrest in the central nervous
behaviors. The end of this episode is when the system, impaired attention, cause disorientation, or
individual finds himself in a different place or reduce concertation in patients with Narcolepsy,
Obstructive sleep apnea (OSA), Non-rapid eye 7.Sánchez, A., Buela-Casal, G., Bermúdez, M., &
movement parasomnias (NREM), or Insomnia. Due Casas-Maldonado, F. (2001, December). The effects
to the importance of sleep at all age stages, it is of continuous positive air pressure treatment on
vital to detect unusual daily sleepiness early by anxiety and depression levels in apnea patients.
healthcare professionals and other primary health Retrieved November 12, 2020, from
care staff. Moreover, multiple studies indicate that https://www.ncbi.nlm.nih.gov/pubmed/11737799
both physical and mental well-being are commonly 8.Ekambaram V, Maski K. Non-Rapid Eye
affected by sleeping disorders. For instance, Movement Arousal Parasomnias in Children.
sleeping disorders can cause depression, weight Pediatric Annals. 2017;46(9). Available from:
gain, excessive daytime sleepiness, or increased https://pubmed.ncbi.nlm.nih.gov/28892547/
movement during sleep, and thus understanding 9.Pressman MR, Broughton R. NREM Arousal
them and assimilating how they are managed could Parasomnias. Sleep Medicine. 2015;:375–89.
help manage their adverse effects, as well as Available from:
minimize exposure to other diseases. Modifications https://www.sciencedirect.com/science/article/abs/p
to lifestyles can dramatically improve the quality of ii/S0733861905702802?via%3Dihub
sleep, for example, drinking less water before 10.Erickson J, Vaughn BV. Non-REM Parasomnia.
bedtime, decreasing anxiety and stress by Sleep Medicine Clinics. 2019;14(3):363–70.
exercising and stretching, developing and adhering Available from:
to a daily sleeping routine, and limiting the use of https://pubmed.ncbi.nlm.nih.gov/31375204/
caffeine. 11.Castelnovo A, Lopez R, Proserpio P, Nobili L,
Dauvilliers Y. NREM sleep parasomnias as
disorders of sleep-state dissociation. Nature
References Reviews Neurology. 2018;14(8):470–81. Available
from: https://pubmed.ncbi.nlm.nih.gov/29959394/
1.Colten HR, Altevogt BM. Sleep disorders and 12.MM; O. (n.d.). Epidemiology of insomnia: What
sleep deprivation: an unmet public health problem. we know and what we still need to learn. Retrieved
Washington, DC, Washington: Institute of November 22, 2020, from
Medicine; https://pubmed.ncbi.nlm.nih.gov/12531146/
2006. https://docs.wind-watch.org/Sleep-Disorders- 13.Winkelman, J., Author AffiliationsFrom the
Sleep-Deprivation.pdf Sleep Disorders Clinical Research Program, J.,
2.DerSarkissian C. Narcolepsy: Definition, & D, M. (2014). Insomnia Disorder: NEJM.
Symptoms,Causes, Diagnosis, Treatment [Internet]. Retrieved November 12, 2020, from
2019[cited2020Nov22].Available from: https://www.nejm.org/doi/full/10.1056/NEJMcp14
https://www.webmd.com/sleepdisorders/guide/narc 12740
oleps
3.Lin L, Faraco J, Li R, Kadotani H, Rogers W, Lin
X, et al. The Sleep Disorder Canine Narcolepsy Is
Caused by a Mutation in the Hypocretin (Orexin)
Receptor 2 Gene [Internet]. Cell. Cell Press; 2001
[cited2020Nov12].Available from:
https://www.sciencedirect.com/science/article/pii/S
0092867400819650
4.Lights V. Narcolepsy: Symptoms, Treatment,
Tests, Causes, and More [Internet]. 2020 [cited
2020Nov12].Available from:
https://www.healthline.com/health/narcolepsy
5.Dauvilliers Y, Arnulf I, Mignot E. Narcolepsy
with cataplexy [Internet]. The Lancet. Elsevier;
2007 [cited 2020Nov12]. Available from:
https://www.sciencedirect.com/science/article/abs/p
ii/S0140673607602372
6.Lattimore, J., Cardiology, D., Celermajer, D.,
Wilcox, I., A report of the National Commission on
Sleep Disorders Research, T, Y., . . . J, H. (2003,
May 01). Obstructive sleep apnea and
cardiovascular disease. Retrieved November 12,
2020, from
https://www.jacc.org/doi/10.1016/S0735-
1097(03)00184-0