Strange nocturnal behaviors may indicate one of these conditions.
There are more than 80 different sleep disorders, or conditions known to disturb your normal sleep patterns, according to the US National Library of Medicine’s MedlinePlus resource.
Most adults need about eight hours of sleep each night. And though having trouble sleeping may seem like a common, harmless issue, it can actually have a huge impact on your life, aside from just feeling tired—it can affect your physical and mental health, thinking, and daily functioning.
Sleep disorders are varied—which means that the symptoms, causes, and treatments of each one vary too—but here are the most common sleep disorders, according to experts, what to do about them, and when you should seek medical assistance.
Obstructive sleep apnea
Symptoms: Loud snoring is a major symptom, and snoring can be interrupted by a long silent period while your breathing stops. That’s followed by a loud snort and gasp, as you struggle to breathe. “That can make people have poor sleep and sleepiness during the day,” Matthew Scharf, M.D., Ph.D., medical director, RWJ Sleep Laboratory Comprehensive Sleep Center at the Rutgers/Robert Wood Johnson Medical School, tells Health. Grumpiness, forgetfulness, falling asleep while working, reading, or watching TV, and having hard-to-treat headaches can also be symptoms.
Causes: There can be a lot. When you sleep, your airways relax but, under normal circumstances, your throat stays open enough to let air pass through. Some people have a narrow throat that causes the tissues to close in and block the airway. Other causes include having a lower jaw that’s short compared to your upper jaw, a large neck, a large tongue, obesity, and large tonsils (lumps of tissue at the back of the throat) and adenoids (a patch of tissue that is high up in the throat, just behind the nose) that can block the airway.
When to see a specialist: “The earlier the better,” Christopher Winter, M.D., of Charlottesville Neurology and Sleep Medicine and author of The Sleep Solution: Why Your Sleep Is Broken and How To Fix It, tells Health. Your doctor will likely want to do to an at-home sleep study to try to see what’s going on. Don’t be intimidated by the sound of a sleep study. “The process of figuring out whether or not you have the condition is easy,” Dr. Winter says. “Home sleep studies are cheap and a piece of cake.”
Treatment: Lifestyle changes, like avoiding alcohol or medicines that make you feel sleepy at bedtime and losing excess weight can help. Some people may be asked to use a continuous positive airway pressure (CPAP) device to help keep your airways open while you sleep. Dental devices may also help.
Insomnia
Symptoms: The main symptom is trouble falling asleep or staying asleep, even when the conditions are good for sleep. If you have insomnia, you might lie awake for a long time before you fall asleep, wake up a lot during the night, wake up too early in the morning and are unable to get back to sleep, and wake up feeling unrested.
Causes: Short-term insomnia, which happens for a few days or weeks, might be caused by stress or changes in your schedule or environment. Chronic insomnia, which occurs three or more nights a week and lasts for more than three months, can have similar causes or no known cause.
When to see a specialist: If you’re struggling and the problem isn’t going away, it never hurts to see your doctor, Michael Awad, M.D., chief of sleep surgery at Northwestern Medicine, tells Health. That’s especially true if it’s impacting your relationships and personal or professional life. He recommends trying to talk to your doctor within 30 days of the insomnia starting. “If it’s persistent for greater than 30 days, it can develop into chronic insomnia,” he says.
Treatment: There are a lot of different options. Your doctor will generally suggest that you try practicing good sleep hygiene, and may also recommend a type of counseling called cognitive behavioral therapy for insomnia. There are several medicines can also help manage insomnia, including benzodiazepines (for the short term) and melatonin receptor agonists.
Hypersomnia
Symptoms: Hypersomnia causes people to have repeated episodes of sleepiness during the day, often making them want to nap at inappropriate times, like during work or a meal. The naps usually don’t help. This is different from “regular” fatigue, Dr. Winter says. “Regular fatigue is more about energy and enthusiasm. A marathon runner at mile marker 22 is going to be fatigued,” he says. “But it would be a real red flag if they laid down in the road and fell asleep.” People also may have trouble waking up from a long sleep and can feel disoriented. Patients can struggle with anxiety, irritability, decreased energy, slow speech, and hallucinations.
Causes: Hypersomnia can be caused by other sleep disorders like narcolepsy or sleep apnea, nervous system dysfunction, or drug or alcohol abuse. Some medications can also cause hypersomnia.
When to see a specialist: If you consistently feel drowsy during the day, or you’ve developed a habit of napping when you shouldn’t be, Dr. Awad recommends seeing your doctor for an evaluation.
Treatment: There is a range. Your doctor may prescribe stimulants like amphetamine, methylphenidate, or modafinil, and may recommend that you make behavioral changes, like trying to avoid night work and socializing late at night, along with avoiding alcohol and caffeine.
Restless legs syndrome
Symptoms: People with restless legs syndrome feel a constant need to move, along with uncomfortable sensations in their lower limbs that can feel like aching, throbbing, pulling, itching, crawling, or creeping. The feeling usually affects both sides, and can alternate between sides. “It generally occurs in the evening, and it’s often most bothersome when people go to sleep,” Dr. Scharf says. “It can be very distressing for people.”
Causes: It’s not entirely clear, but restless legs syndrome seems to have a genetic link (meaning, if someone in your family has it, you’re at higher risk of developing it, too). Low levels of iron in the brain, certain medications like anti-depressants or anti-nausea drugs, and use of alcohol, nicotine, and caffeine can also raise your risk.
When to see a specialist: Dr. Scharf recommends talking to your doctor about your symptoms as soon as you notice them. “It’s really important to see your doctor about it,” he says. “Restless legs syndrome can interfere with life quite a bit.”
Treatment: While there is no cure for restless legs syndrome, there is a variety of treatment options. Lifestyle treatments, like cutting back on the use of alcohol or tobacco, and exercising regularly may help. Iron supplements and anti-seizure medication may also provide relief.
Narcolepsy
Symptoms: The most common symptoms of narcolepsy are excessive daytime sleepiness, cataplexy (sudden muscle weakness), sleep paralysis, and hallucinations, according to the National Institute of Neurological Disorders and Stroke (NINDS). People with narcolepsy may also have difficulties falling or staying asleep at night, and may experience disruptions in sleep via insomnia, vivid dreaming, sleep apnea, acting out while dreaming, and periodic leg movements. Though narcolepsy is a lifetime problem, it doesn’t worsen as people age—it may actually improve, though it will never resolve completely.
Causes: The NINDS says nearly all people who have cataplexy caused by narcolepsy have extremely low levels of a naturally-occurring chemical called hypocretin in their bodies, a chemical that promotes wakefulness and regulates REM Sleep. Aside from that, narcolepsy in general may have other contributing factors including certain autoimmune disorders, a family history of narcolepsy, and a history of brain injuries.
When to see a specialist: As soon as you experience any of the symptoms on a regular basis. Not only can narcolepsy result in dangerous situations, but there is also an increased risk for REM sleep behavior disorder (RBD), which involves violently acting out dreams.
Treatment: Stimulants, such as Modafinil, are used as to help you stay awake during the day. Tricyclic antidepressants are also used to suppress REM sleep and treat cataplexy.
Sleep talking
Symptoms: Sleep talking—aka somniloquy—occurs when a person talks out loud during sleep without being aware of it, as the name suggests. This “talking” can range from senseless mumblings to angry, vulgar rants. It can occur by itself or in addition to REM sleep behavior disorder, sleepwalking, sleep terrors, and sleep-related eating disorders. Tone of voice and type of language may differ from normal speech.
Causes: According to the Sleep Foundation, experts aren’t entirely sure what causes people to talk in their sleep, though it may have a genetic component. Sleep talking may also occur more often in those with mental health conditions, specifically people dealing with post-traumatic stress disorder (PTSD).
When to see a specialist: It is harmless, but in the event that it is emotional or vulgar, you may want to see a sleep specialist.
Treatment: There is no cure, but sleep talking generally declines if you are well rested, haven’t consumed alcohol, and have a normal sleep schedule.
Sleepwalking
Symptoms: The technical name for sleepwalking is somnambulism, according to KidsHealth from Nemours—and it’s more common in children than adults, though it can occur in both groups. On the surface, sleepwalking involves walking during sleep, but it can lead to other behaviors like wandering outside, or going to the bathroom in unintended spaces. It can last for up to 30 minutes, and upon being awakened, sleepwalkers can feel groggy, disoriented, and may have little to no recollection of their actions.
Causes: Your chances of being a sleepwalker can more than double if one or both parents have had episodes. Sleepwalking episodes may be brought on by external or internal stressors, like poor sleep schedule, stress, illness or fever, or some medicatons.
When to see a specialist: Sleepwalking in children is relatively common, but it doesn’t always require medical treatment. More than 4% of adults suffer from sleepwalking. If the episodes become dangerous or uncomfortable, you should see a sleep specialist.
Treatment: Obtaining regular and sufficient amounts of sleep, avoiding alcohol in the evenings, and dealing effectively with stress. Self-hypnosis and the use of relaxation techniques. Benzodiazepines, such as Klonopin (generic name clonazepam), may also help treat sleepwalking.
Night terrors
Symptoms: Also called sleep terrors, these episodes occur when a person quickly wakes up from sleep in a terrified state, according to Mount Sinai. Common symptoms include sitting up in bed, thrashing movements, screaming, sweating, heavy breathing, and violent actions. Unlike with nightmares, people who suffer from sleep terrors remain asleep and rarely remember their dreams the next day. Sleep terrors are most prevalent in young children, but affect more than 2% of adults. They can be spontaneous or affect adults who suffer with bipolar and anxiety disorders.
Causes: The cause for night terrors is largely unknown, but they may be triggered by fevers, a lack of sleep, or a period of high stress or emotional tension. Alcohol abuse may also cause sleep terrors.
When to see a specialist: Though they are fairly normal for children, if sleep terrors continue in adulthood, it may benefit an adult to seek medical help.
Treatment: The best treatment is proper sleep hygiene and stress management, although benzodiazepines and antidepressants such as imipramine, may also be prescribed.
Sleep paralysis
Symptoms: Paralysis when falling asleep (hypnagogic) and waking up (hypnopompic), lasting for anywhere from 30 seconds to longer than five minutes. You may be unable to move your arms, legs, body and head, and may even be unable to speak. It is often accompanied by hallucinations, per MedlinePlus, a resource of the US National Library of Medicine.
Causes: Sleep paralysis is common, and many people may experience at least one episode during their lives. Causes of sleep paralysis, however, aren’t fully known, though some lifestyle habits are linked to the condition including not getting enough sleep, not having a regular sleep schedule (commonly seen in shift workers), having mental stress, and even sleeping on your back. Medical conditions like narcolepsy, bipolar disorder, substance abuse, and use of certain medications may also lead to sleep paralysis.
When to see a specialist: Though sleep paralysis has not been linked to health problems, consult a doctor if you experience repeated episodes. It is often a sign of narcolepsy and can lead to anticipatory anxiety about sleeping.
Treatment: Behavioral treatment includes changing your sleep position and avoiding naps. Tricyclic antidepressants can be prescribed, especially if you suffer from narcolepsy.
Nightmare disorder
Symptoms: Everyone has had a bad dream at least once in their lives, but in nightmare disorder, these dreams happen often, and cause distress, disrupt sleep, cause problems functioning during the daytime, and may even make someone scared to go to bed at night, per the Mayo Clinic.
Causes: Nightmares in general usually occur during the REM (rapid eye movement) stage of sleep, and they can be triggered by a variety of things including stress or anxiety, trauma, sleep deprivation, certain medications, substance abuse, and even scary books or movies. People with a family history of nightmares or other parasomnias may also be more at risk for nightmare disorder.
When to see a specialist: Though very common, you should see a sleep therapist if your nightmares consistently disrupt your sleep.
Treatment: Because nightmares can be linked with psychological trauma, psychotherapy and psychoanalysis are commonly used as treatment, and medications are also available.
Teeth grinding
Symptoms: Also known as bruxism, teeth grinding occurs when you unconsciously grind or clench your teeth at night (you may also do this during the day without even realizing it), per Johns Hopkins Medicine. The symptoms are all pretty confined to the mouth and face area and include: chipped or cracked teeth, facial pain, overly sensitive teeth, tense face and jaw muscles, headaches, jaw dislocation, locking of the jaw, worn-down teeth enamel, tongue indentations, and cheek damage.
Causes: Stress, of course, is a huge factor here, but certain aspects of a person’s personality may also contribute: nervousness, anger, pain, frustration, aggression, and competitiveness may all contribute to bruxism. Some medicines, like fluoxetine and paroxetine, may also cause teeth grinding, per Johns Hopkins.
When to see a specialist: Grinding can cause severe dental damage. See your dentist as soon as you have symptoms.
Treatment: Use of cigarettes and caffeine before sleep and stress can increase incidences. Plastic oral appliances, fitted by a dentist, are typically used to prevent damage.
Advanced/delayed sleep phase syndrome
Symptoms: These sleep syndromes are patterns that occur before or after the times that most people sleep. In advanced sleep phase syndrome, patients wake early in the morning and have trouble staying awake in the evenings. In delayed sleep phase syndrome, patients are up well into the early morning, and have trouble functioning in the morning.
Causes: According to the American Sleep Association, the exact cause of either ASPD or DSPD isn’t totally understood, but there appears to be a strong genetic link—those who have it have a 50% chance of passing it onto their children.
When to see a specialist: See a doctor if this issue if affecting your work or school life.
Treatment: A sleep doctor will be able to determine factors that may intensify this problem, such as not getting enough natural light during the day. Treatment ranges from taking melatonin to behavioral counseling. Chronotherapy, shifting your bedtime a few hours later each day until you reach a normal sleep schedule, is commonly used to treat delayed sleep phase syndrome.
Sleep starts
Symptoms: You know that feeling, right as you’re drifting off to sleep, when your body jerks awake? That’s known as a hypnic jerk, or sleep start. As the body shifts into the first levels of sleep, muscles can contract with sharp, sudden jerks. An audible cry or a sensation of falling may accompany the movements.
Causes: According to Sleep.org, there’s no real consensus on what causes hypnic jerks, though they do know it originates in the brain. But regardless of the specific cause, certain factors like anxiety, sleep deprivation, late-nigh exercise, and excessive use of caffeine or stimulants may contribute.
When to see a specialist: Sleep starts are very common, occurring in about 60% to 70% of people. You only need to see a doctor if the jerks, or your fear of experiencing them, keep you (or your bed partner) from getting adequate sleep.
Treatment: A sleep doctor will try to determine whether underlying conditions are affecting your ability to stay asleep, such as sleep apnea, periodic limb movement disorder, or a mental health condition.
REM sleep behavior disorder (RBD)
Symptoms: This disorder occurs when you start acting out vivid dreams as your body enters REM-stage sleep. These actions may include shouting, swearing, flailing, grabbing, punching, kicking, and jumping, and episodes tend to get worse over time. It is usually easy to wake someone with RBD (unlike those who sleepwalk or have sleep terrors), and they can easily recall clear details of their dreams.
Causes: Typically, nerve pathways in the brain prevent muscles from moving during normal REM sleep—but in REM sleep behavior disorder, those pathways no longer work, per the Mayo Clinic. People who are male and over 50 years old, have certain neurodegenerative disorders, narcolepsy, or are taking certain medications may be more at risk for this disorder.
When to see a specialist: As soon as symptoms occur. RBD is often ignored for years, and at some point it is likely to result in an injury either of the person dreaming or their bed partner.
Treatment: Medications such as Klonopin (generic name clonazepam) are often used, as well as taking bedroom safety precautions.
While it’s relatively normal to experience occasional strange behavior during sleep, you should see your doctor if the problem causes injury or the risk of injury or begins to affect your daytime life. “I’ve had patients who would rather tie themselves to the bed every night than tell a doctor that they’re having violent episodes or sexual behaviors during sleep,” Carlos H. Schenck, MD, senior staff psychiatrist at the Minnesota Regional Sleep Disorders Center and author of Sleep: A Groundbreaking Guide to the Mysteries, the Problems, and the Solutions, tells Heatlh. “Many do not realize that effective treatments are available.”
