Causes

Issues like irregular work schedules, stress, urbanization, late-night social activities, anxiety, depression, hypertension, and diabetes are the social and medical factors that contribute to the high prevalence of sleep disorders in the country.  Nocturnal use of digital social media (DSM) platforms such as Facebook, Instagram, YouTube, and so on for pleasure and entertainment is one of the factors leading to sleep deprivation and thus sleep disorders nowadays. The digital devices affect sleep by releasing artificial blue light, Delaying Circadian rhythm, Suppressing melatonin and delaying the onset of REM sleep. Sleep can also be affected by the recreational use of drugs such as  Alcohol, Nicotine, Stimulants and Cannabis; as well as psychotropic medications such as Hypnotics, Antidepressants, Antipsychotics and Cholinesterase inhibitors.

Classification

• Dyssomnias (Amount, Quality, Timing)

1. 1. 1. Intrinsic sleep disorders
      2. Extrinsic sleep disorders
      3. Circadian rhythm sleep disorders 

• Parasomnias (Disruptive)

1. 1. 1. Arousal disorders 
      2. Sleep-wake transition disorders 
      3. Parasomnias usually associated with REM sleep

• Sleep disorders associated with mental, neurological or other medical disorders. 

The commonest sleep disorder is insomnia and is also classified as:

• Early insomnias: Initial insomnia of finding ti difficult falling asleep
• Middle of the night insomnia: Intermittent wakefulness
• Late insomnia: Early-morning awakening.

Symptoms

Insomnia, sleep apnea, narcolepsy (hallucination, cataplexy, and sleep paralysis), restless legs syndrome, sleep-related breathing disorders, central disorders of hypersomnolence, 

Circadian rhythm sleep-wake disorders are the common symptoms experienced among people with sleep disorders.

Clinical Findings

Clinical findings depend on the particular type of sleep disorder; some of the common findings include: 

• Signs of fatigue
• Irritability and mood swings.
• Short attention span
• Obesity (in sleep apnea), 
• Leg movements (in RLS), 
• General signs of sleep deprivation (e.g, dark circles under the eyes). 

Differential Diagnosis

Other conditions to be considered are: primary sleep disorders like insomnia, sleep apnea, narcolepsy, parasomnias, etc. Issues related to other medical conditions, such as depression, anxiety, chronic pain, hyperthyroidism, cardiovascular diseases, and substance use disorders. 

Investigations

The following assessments can be carried out in sleep disorders: 

• Polysomnography: This is also known as a sleep study, and it checks for brain waves, eye and leg movements, heart rate, the oxygen level of the blood,  and breathing during sleep. 

• Actigraphy: A small monitor worn on the wrist to track arm and leg movement during sleep. It helps to give information about sleep patterns over time.
• Multiple sleep latency tests to measure daytime sleepiness.
• Other tests like home sleep apnea test, overnight oximetry test, maintenance of wakefulness test, and use of the Pittsburgh Sleep Quality also aid in diagnosis and monitoring.

Treatment

Treatment of sleep disorders includes the use of medications such as benzodiazepines, sleeping pills, and melatonin supplements to treat insomnia. Undergoing cognitive behavioral therapy or continuous Positive Airway Pressure therapy for sleep apnea. Inclusion of relaxation routines and sleep hygiene is also a beneficial approach for treatment. 

Follow-Up

Regular patient monitoring is recommended every two to four weeks, and then less frequently as the patient stabilizes.

Prevention and Control

Prevention and management of sleep disorders involves a combination of lifestyle changes, like regular sleep schedule, consistent physical exercise, practicing good sleep hygiene, and managing stress. Other preventive methods include creating a conducive sleep environment, addressing any underlying medical conditions, and seeking professional help when needed. 

Conclusion

Sleep disorders are conditions that make one unable to fall asleep and stay asleep. Examples include insomnia, sleep apnea, narcolepsy, parasomnias, etc. Addressing sleep problems is important for improving overall health, as they can worsen other conditions and lead to serious health complications.