Sleep Disorders: Causes, Symptoms and Treatment

Sleep disorders in neurology

Sleep disorders are common in neurology and can significantly affect the quality of life of those affected. In the following, the different types of sleep disorders that can manifest in patients will be described.

Restless legs syndrome

Restless legs syndrome is a neurological disorder characterised by the need to move the legs due to an uncomfortable sensation in the legs. Restless legs syndrome can cause difficulty falling asleep and night-time awakenings, leading to poor sleep quality.

Sleep apnoea and other respiratory disorders

Breathing disorders such as sleep apnoeas are caused by a collapse of the airways during sleep. This can affect the quality of sleep and lead to excessive daytime sleepiness and even increase the risk of cardiovascular disease.

Narcolepsy and other disorders of excessive daytime sleepiness

Narcolepsy is a sleep disorder that causes excessive daytime sleepiness during the day. Patients may also experience cataplexy, hallucinations and sleep paralysis.

Parasomnias: sleepwalking, night terrors and others

Parasomnias are highly disruptive disorders that occur during sleep and can affect the quality of sleep. For example, sleepwalking causes the patient to perform activities during sleep without being aware of what they are doing.

Circadian rhythm disorders

Circadian rhythm disorders are a type of sleep disorder that is related to the disruption of the body's biological clock. These disorders can lead to difficulty falling asleep and daytime sleepiness.

Sleep-related movement disorders

Sleep-related movement disorders are characterised by abnormal movements during sleep, as occurs for example in periodic limb movement syndrome. These movements can disrupt sleep and cause daytime sleepiness.

Other sleep disorders

In addition to the sleep disorders mentioned above, there are other disorders that can affect sleep quality, such as Kleine-Levin syndrome and chronic fatigue syndrome. 

The following part of the article will address the diagnosis and treatment of sleep disorders to help improve the quality of life of affected patients.

Diagnosis and treatment of sleep disorders

Diagnosis and treatment of sleep disorders is essential to improve the quality of life of affected patients. It is important to perform a thorough clinical evaluation, including an assessment of medical history and symptoms, a physical examination and sometimes, when the above is not sufficient, a neurophysiological sleep assessment: Sleep studies, such as polysomnography and others, may be necessary to reach an accurate diagnosis.

Clinical assessment of the patient with sleep disorders

The clinical assessment of the patient with sleep disorders should begin with the collection of information from both the patient and his or her close environment. It is important to know the sleep patterns, both in terms of duration and quality of sleep, as well as any significant events during sleep, such as snoring episodes, apnoeas or nightmares.

The physical examination should include an evaluation of the respiratory and neurological system, as well as examination of the throat and nose for signs of a propensity to sleep apnoea. It is also necessary to rule out other pathologies that may be the cause of sleep disorders, such as depression or anxiety.

Sleep studies: polysomnography and others

Sleep studies are essential tools in the diagnosis of sleep disorders. Polysomnography is a test performed during sleep, where several variables are recorded, such as electrical activity of the brain, breathing, muscle movement and cardiac activity. A multiple latency sleep test (MLST) may also be performed to assess excessive daytime sleepiness.

In addition to polysomnography, there are other sleep studies such as the home sleep study (HST) or the actigraphic record, which allows the assessment of activity and sleep patterns during the days and nights.

Pharmacological and non-pharmacological treatments for sleep disorders

Treatment of sleep disorders can be pharmacological or non-pharmacological. Non-pharmacological measures include changes in sleep habits, such as establishing a bedtime and wake-up routine, avoiding alcohol, tobacco and caffeine, exercising regularly and monitoring the sleep environment. Complementary therapies such as cognitive behavioural therapy or progressive muscle relaxation may also be helpful.

As for pharmacological treatments, these must be prescribed and supervised by a doctor specialised in sleep disorders. Sedatives, hypnotics or specific medications may be prescribed to treat underlying conditions such as narcolepsy or restless legs syndrome.

• Clinical assessment is essential for the accurate diagnosis of sleep disorders.
• Sleep studies, such as polysomnography, are sometimes necessary tools for the diagnosis of sleep disorders.
• Non-pharmacological treatment includes changes in sleep habits and complementary therapies.
• Pharmacological treatments must be prescribed and monitored by a doctor specialised in sleep disorders.

Sleep disorders in patients with other diseases

Neurological diseases: Parkinson's, Alzheimer's and others

The neurological diseases can be associated with a variety of sleep disorders. These include Parkinson's disease, which may present with sleep disorders such as insomnia, nightmares, periodic leg movements and restless legs syndrome. In addition, Parkinson's patients may have snoring and obstructive sleep apnoea.

On the other hand, the Alzheimer's patients often experience a reduction in total sleep time and an increase in sleep fragmentation, which in turn affects their quality of life, and that of their family. Breathing disorders are also common in Alzheimer's patients and may manifest as snoring or sleep apnoea.

Psychiatric illnesses: depression, anxiety disorders and others

Sleep disorders are common in patients with psychiatric disorders such as depression and anxiety disorders. The depression may present with symptoms such as early insomnia, early awakening and frequent awakening at night, while anxiety disorders may manifest as nightmares or nocturnal awakenings.

In addition, sleep disorders may also be a risk factor for the development of psychiatric disorders. For example, chronic sleep deprivation may increase the risk of depression and anxiety.

Other diseases: cancer, renal failure and iron deficiency anaemia.

Patients with chronic diseases such as cancer, kidney failure and iron deficiency anaemia may experience sleep disorders related to their diseases. For example, cancer patients may experience insomnia related to anxiety, pain and medication.

In the meantime, the patients with renal failure may experience restless legs syndrome, sleep apnoea and periodic leg movements during sleep. Finally, patients with iron deficiency anaemia may have fragmented sleep and may experience daytime sleepiness.

It is important to keep in mind that the treatment of these diseases can also affect sleep patterns, so it is essential to monitor and evaluate patients with chronic diseases for the presence of sleep disorders. A multidisciplinary approach involving neurologists, psychiatrists and sleep medicine specialists may be beneficial for these patients.

Risk factors and preventive measures in sleep disorders 

Risk factors associated with sleep disorders: obesity and stress

Sleep disorders may be related to certain risk factors. One of them is obesity, as it can cause sleep apnoea. People with sleep apnoea have breathing problems during sleep that prevent them from getting adequate rest. Another common cause of sleep disorders is emotional stress.. Stress can affect sleep quality and increase the likelihood of sleep disorders.

Preventive and hygienic sleep habits measures

There are many preventive measures to minimise the risk factors for sleep disorders. One of them is maintain a regular sleep-wake routine, that allows for adequate rest and recovery. It is also essential to avoid stimulants such as caffeine, nicotine and alcohol before going to bed.

Other hygienic measures include exercising regularly but not just before going to sleep, wearing comfortable and cool clothing during sleep, and keeping the room dark and cool.

The importance of family and educational support for patients with sleep disorders

Family and educational support can make a big difference in the quality of life of patients with sleep disorders. Some ways in which the family can help include making sure there is a calm and comfortable sleeping environment, supporting adherence to sleep and wake routines, and offering encouragement and understanding when the patient feels overwhelmed.

On the other hand, education of the patient and their environment about sleep disorders, the importance of sleep and best practices may also help to improve the disorder. In general, it is important to reduce the risk factors associated with sleep disorders through preventive measures and hygienic sleep habits. It is essential to seek family and educational support to improve the quality of life of patients, and we must not forget that sleep disorders are problems that affect many people and require treatment by sleep specialists.