Excessive sleepiness is a prominent symptom of a variety of disorders of sleep and wakefulness. Shift work sleep disorder (SWD) and narcolepsy are two conditions that commonly present with this symptom.

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Narcolepsy

Narcolepsy is a sleep disorder that causes extreme daytime sleepiness (EDS). People with this condition often fall asleep at the most inappropriate times, such as during work or while talking to friends. They also have trouble staying awake during the night and may experience cataplexy, a sudden loss of muscle control.

The condition disrupts how the brain handles the sleep-wake cycle and affects everyone differently. For example, narcoleptics enter REM sleep much earlier than normal during the night. This is when dreams occur, but they can also cause a feeling of being unable to move (sleep paralysis).

EDS can be dangerous, especially for young children and teenagers. It can lead to problems at school and work, and it can even prevent people from having healthy relationships. Fortunately, there are ways to manage this condition and treat the symptoms with lifestyle changes. Taking short naps evenly spaced throughout the day can help, as can exercise and avoiding caffeine.

Shift Work Sleep Disorder

Shift work sleep disorder (SWSD) is when you have trouble sleeping due to a schedule that requires you to be awake at times your body is expecting to sleep. The problem with this is that it can affect your ability to concentrate, and it may also cause you to feel excessively tired during the day.

The problem is more common among night shift workers and those who work early morning shifts, but it can occur for anyone who works a nontraditional schedule. The exact symptoms can vary by individual, but you may experience insomnia or hypersomnia that interferes with your ability to get adequate rest.

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Diagnosing SWSD typically involves keeping a record of your sleep patterns and symptoms over several weeks. Then, your doctor can make a diagnosis based on this information. Occasionally, a sleep study may be needed to ensure that your symptoms are not caused by another condition. If you have SWSD, your treatment may include changes to your work schedule and routines at home, bright light therapy or other methods of managing your symptoms.

Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) is a disorder of repeated episodes of partial or complete collapse of the upper airway during sleep, with subsequent arousals and hypoxemia. It is the most common sleep disorder seen in clinical practice, affecting up to 4% of middle-aged adults. OSA causes excessive daytime sleepiness and may also lead to irritability, depression, headache, erectile dysfunction, and poor concentration.

Treatment of obstructive sleep apnea is based on lifestyle changes and in many cases involves weight loss, stopping smoking, and reducing the amount of alcohol consumed. In addition, a person with this condition may be treated with nasal continuous positive airway pressure, oral appliances, or surgery in refractory cases.

GPs can refer patients to specialist sleep clinics for tests to identify this condition, such as portable monitoring devices that measure a person’s heart rate and breathing during sleep or an in-lab polysomnography test. However, these tests are limited in that they can underestimate the number of apneic events.

Other Sleep Disorders

Sleep disorders interfere with a person’s quality of life and impact their mental health, work or school performance, and physical health. They may even put a person at risk of accidents or injury while driving or operating heavy machinery.

The International Classification of Sleep Disorders focuses on symptomatic categories to help clinicians establish a rational differential diagnosis. The ICSD-2 classification system improves upon previous versions by including relevant diagnostic and epidemiological information.

REM sleep behaviour disorder happens during the dreaming stage of the sleep cycle (Rapid Eye Movement, or REM). A person with this condition will act out their dreams – which can be very violent and lead to injuries for themselves and others.

Other sleep disorders include narcolepsy, shift work sleep disorder, chronic paroxysmal hemicrania and cluster headache, and obstructive sleep apnea. Many of these disorders affect children differently than adults, with a different range of symptoms. Children can present with motor overactivity, irritability or oppositional behavior rather than overt sleepiness.