Sleep Disruption
Jacob Shaw , Anne E. Ruble, M.D., M.P.H.
DEFINITION
DEFINITION
DEFINITION
- Sleep disruptions exist when sleep is insufficient to support adequate alertness, performance, and health, either because of reduced total sleep time or fragmentation of sleep by brief arousals.
- May be volitional or involuntary
- Acute sleep deprivation refers to no sleep or a reduction in the usual total sleep time, usually lasting one or two days.
- Chronic sleep deprivation (also called sleep restriction) exists when the individual routinely sleeps less than required for optimal functioning.
EPIDEMIOLOGY
EPIDEMIOLOGY
EPIDEMIOLOGY
- Most adults require 7.5-9 hours of sleep per night to feel rested the next day.
- Adolescents require 8.5-10 hours per night.
- Insomnia is highly prevalent in the general population and particularly in primary care patients, with estimates ranging from 10-20%.[1]
- Excessive sleepiness is a leading cause of car and truck crashes in the U.S.[2]
- Sleep disruption may also be associated with other adverse cardiovascular, immune system, and metabolic changes.
- With an increased risk of mortality[3]
- Vulnerability to sleep deprivation has been shown to be higher in younger adults and to have trait-like qualities, indicating a possible genetic contribution.[4]
DIFFERENTIAL DIAGNOSIS
DIFFERENTIAL DIAGNOSIS
DIFFERENTIAL DIAGNOSIS
ADULT
ADULT
- Short duration sleep (short sleep requirement)
- Insomnia disorder
- Hypersomnolence disorder
- Narcolepsy
- Breathing-related sleep disorders
- Obstructive sleep apnea, central sleep apnea, sleep-related hypoventilation
- Bronchial/nocturnal asthma
- Circadian rhythm sleep-wake disorders
- Delayed sleep phase type, advanced sleep phase type, irregular sleep-wake type, non-24-hour-sleep-wake type, shift-work type
- Non-rapid eye movement (NREM) parasomnias
- Sleepwalking, confusional arousals, sleep terrors
- Rapid eye movement (REM) parasomnias
- Nighttime disorder, REM sleep behavior disorder, isolated sleep paralysis
- Restless leg syndrome
- Substance/medication-induced sleep disorder
- Delirium
- Depression
- Anxiety
- Post traumatic stress disorder (PTSD)
- Arthritis
- Fibromyalgia
- Chronic pain
- Endocrine problems (hyperthyroidism, menopause)
- Urinary problems (nocturia, prostatitis, benign prostatic hypertrophy)
- Gastroesophageal reflux disorder (GERD)
- Neurologic causes (headache syndromes, post traumatic brain injury insomnia)
PEDIATRIC
PEDIATRIC
- In addition to the above differential, other considerations include:
- Some pediatric patients carry a diagnosis of ADHD until their sleep disorder is identified.
- Periodic limb movement disorder is also associated with disruptions in sleep.
GERIATRIC
GERIATRIC
- In addition to the above differential, other considerations include:
TREATMENT
TREATMENT
TREATMENT
- Focus on treatment of the underlying disorder, if identified.
- Initial treatment should involve cognitive behavioral therapy for insomnia.[5]
- Identify and, if possible, eliminate stressors prior to bed time to improve sleep hygiene.
- Consider sleep aid medications (e.g., benzodiazepines, non-benzodiazepines, melatonin agonists, antihistamines [e.g., low-dose doxepin], and orexin receptor antagonists) in adults for whom cognitive behavioral therapy was unsuccessful
- Use caution when prescribing benzodiazepines and other potentially addictive medications.
- Sleep disruptions may not require medical treatment if they do not interfere with everyday activities.
WHEN TO REFER
WHEN TO REFER
WHEN TO REFER
- When a patient feels it is affecting his/her quality of life
- When a patient has associated mood symptoms or changes in personality
- When increasing amounts of medications are being required for sleep
COMMENTS
COMMENTS
COMMENTS
- Sleep disruption may result in a mental state that resembles depression or anxiety with patients reporting dysphoria, irritability, low energy, decreased libido, poor judgment, and other signs of psychological dysfunction.
- These symptoms often disappear when normal sleep is restored.
References
References
References
- Yamamoto M, Lim CT, Huang H, et al. Insomnia in primary care: Considerations for screening, assessment, and management. J Med Access. 2023;7:27550834231156727. [PMID:36938324]
- Gottlieb DJ, Ellenbogen JM, Bianchi MT, et al. Sleep deficiency and motor vehicle crash risk in the general population: a prospective cohort study. BMC Med. 2018;16(1):44. [PMID:29554902]
- Ge L, Guyatt G, Tian J, et al. Insomnia and risk of mortality from all-cause, cardiovascular disease, and cancer: Systematic review and meta-analysis of prospective cohort studies. Sleep Med Rev. 2019;48:101215. [PMID:31630016]
- Zitting KM, Münch MY, Cain SW, et al. Young adults are more vulnerable to chronic sleep deficiency and recurrent circadian disruption than older adults. Sci Rep. 2018;8(1):11052. [PMID:30038272]
- Qaseem A, Kansagara D, Forciea MA, et al. Management of Chronic Insomnia Disorder in Adults: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. 2016;165(2):125-33. [PMID:27136449]
- Karna B, Gupta V. Sleep Disorder. StatPearls. StatPearls Publishing; 2021. [PMID:32809555]
- American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787
- Arroll B, Fernando A, Falloon K, et al. Prevalence of causes of insomnia in primary care: a cross-sectional study. Br J Gen Pract. 2012;62(595):e99-103. [PMID:22520782]
- Baranwal N, Yu PK, Siegel NS. Sleep physiology, pathophysiology, and sleep hygiene. Prog Cardiovasc Dis. 2023;77:59-69. [PMID:36841492]
- Goel N, Basner M, Rao H, et al. Circadian rhythms, sleep deprivation, and human performance. Prog Mol Biol Transl Sci. 2013;119:155-90. [PMID:23899598]
- Gradisar M, Crowley SJ. Delayed sleep phase disorder in youth. Curr Opin Psychiatry. 2013;26(6):580-5. [PMID:24060912]
- Léger D, Bayon V, Ohayon MM, et al. Insomnia and accidents: cross-sectional study (EQUINOX) on sleep-related home, work and car accidents in 5293 subjects with insomnia from 10 countries. J Sleep Res. 2013. [PMID:24237855]
- Sateia, M. J. (2014). International classification of sleep disorders. Chest, 146(5), 1387-1394.Chicago
- Scott AJ, Webb TL, Martyn-St James M, et al. Improving sleep quality leads to better mental health: A meta-analysis of randomised controlled trials. Sleep Med Rev. 2021;60:101556. [PMID:34607184]
- Shochat T, Umphress J, Israel AG, et al. Insomnia in primary care patients. Sleep. 1999;22 Suppl 2:S359-65. [PMID:10394608]
- Trotti LM, Bliwise DL. Treatment of the Sleep Disorders Associated with Parkinson's Disease. Neurotherapeutics. 2013. [PMID:24272458]
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