A sleep disorder (somnipathy) is a disorder in the sleep patterns of a person or animal. Some sleep disorders can interfere with mental and emotional function.

Common sleep disorders

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The most common sleep disorders include:

• Bruxism: The sufferer involuntarily grinds his or her teeth while sleeping
• Delayed sleep phase syndrome (DSPS): a sleep disorder of circadian rhythm
• Hypopnea syndrome
• Insomnia: While not considered a sleep disorder in its own right, Insomnia is characterized by the inability to fall asleep and/or remain asleep for a reasonable amount of time.
• Jet lag or desynchronosis: Temporary condition resulting in out of sync sleep patterns as a result of rapidly travelling across multiple time zones
• Narcolepsy: The condition of falling asleep spontaneously and unwillingly
• Night terror or Pavor nocturnus or sleep terror disorder: abrupt awakening from sleep with behavior consistent with terror
• Parasomnias: Include a variety of disruptive sleep-related events
• Periodic limb movement disorder (PLMD): Involuntary movement of arms and/or legs during sleep. See also Hypnic jerk, which is not a disorder.
• Rapid eye movement behavior disorder (RBD): Acting out violent or dramatic dreams while in REM sleep
• Restless legs syndrome (RLS): An irresistible urge to move legs while sleeping. Often accompanies PLMD.
• Shift work sleep disorder (SWSD)
• Sleep apnea: The obstruction of the airway during sleep
• Sleep paralysis: Conscious paralysis upon waking or falling asleep
• Sleepwalking or somnambulism: Engaging in activities that are normally associated with wakefulness (such as eating or dressing), which may include walking, without the conscious knowledge of the subject
• Snoring: Loud breathing patterns while sleeping, sometimes accompanying sleep apnea

Broad classifications of sleep disorders

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• Dysomnias - A broad category of sleep disorders characterized by either hypersomnolence or insomnia. The three major subcategories include intrinsic (i.e., arising from within the body), extrinsic (secondary to environmental conditions or various pathologic conditions), and disturbances of circadian rhythm. MeSH
  • Insomnia
  • Narcolepsy
  • Obstructive Sleep Apnea
  • Restless Leg Syndrome
  • Periodic limb movement disorder
  • Hypersomnia
    • Recurrent Hypersomnia - including Kleine-Levin Syndrome
    • Posttraumatic Hypersomnia
    • "Healthy" Hypersomnia
  • Circadian rhythm sleep disorders
    • Delayed sleep phase syndrome
    • Advanced sleep phase syndrome
    • Non-24-hour sleep-wake syndrome
• Parasomnias
  • REM Sleep Behaviour Disorder
  • Sleep Terror
  • Sleepwalking (or Somnambulism)
  • Tooth-grinding
  • Bedwetting or sleep enuresis.
  • Sudden infant death syndrome (or SIDS)
  • Sleep talking (or Somniloquy)

More on [ Sleep disorder ]

Sleep Medicine | Penn Medicine In the News

Sleeping on the Job: How Innovative Employers Encourage Nap ...
pennmedicinenews Wed, 17 Aug 2011 15:47:24 -0000
Office naptime is zonking workplaces across the country, according to an article on business newssite INC.com. The story notes that NASA has teamed up with the National Space Biomedical Research Institute and the Perelman School of Medicine at the University of Pennsylvania to teach astronauts how to nap better during long missions.
Dawn of A New Sleep Drug?
pennmedicinenews Wed, 20 Jul 2011 14:31:25 -0000
Several pharmaceutical companies are working on new approaches to treat insomnia, reports the Wall Street Journal. Studies show that cognitive behavioral therapy for insomnia, known as CBT-I, can be as effective as medication for treating chronic insomnia. CBT-I typically includes "sleep restriction," or limiting the amount of time patients spend in bed when they're unable to sleep, and "stimulus...
Can Too Little Sleep Make you Gain Weight?
pennmedicinenews Wed, 13 Jul 2011 16:40:15 -0000
Although a new study doesn't prove that sleeplessness causes people to pack on extra pounds, or exactly how the relationship between sleep and body weight might work, they do show that "sleep should be a priority," said Michael Grandner, PhD, of the Center for Sleep and Respiratory Neurobiology. "If you're making your diet a priority and trying to be healthy, don't forget that getting healthy...
From Z's To A's
pennmedicinenews Tue, 28 Jun 2011 17:24:11 -0000
Sleep’s function has long been a mystery, but many researchers have gathered evidence that it is important for learning and memory. Two new studies confirm that sleep plays a central role in solidifying memories and preparing the brain for new learning. Tickling a few neurons located at the top of the fruit fly brain triggers the insects to sleep, researchers at Washington University in St. Louis...
Sleepy Wife May Take It Out on Hubby
pennmedicinenews Wed, 15 Jun 2011 14:14:48 -0000
After a bad night’s sleep women — but not men — tend to have more negative interactions with their spouses, a new study shows. Grace Pien, MD, MSCE, DASBM, suspects that women may just be more sensitive to sleep problems. “They are more conscious about how their sleep is affecting them,” said Pien, an assistant professor of Medicine. “And that may translate into their interactions with their...
Is FAA Asleep to Night's Real Risks?
pennmedicinenews Tue, 24 May 2011 19:03:34 -0000
Since March, authorities have disclosed a rash of incidents in which a controller is believed to have dozed off on the midnight shift. The toll for any type of employee who works night shifts or rotating shifts - there are about 15 million such workers in the U.S. - can be heavy. "Basically everything in our body, every chemical, every hormone, every physiological process, is on a 24-hour cycle,"...

SLEEP Articles

The Emerging Role of Hypocretin (Orexin-A) in the Developing Central Nervous System

Seeking Useful Biomarkers for the Quality and Effectiveness of Sleep

Insomnia Research Is Coming of Age

Maturation of Heart Rate and Blood Pressure Variability during Sleep in Term-Born Infants
Study Objectives:Abnormal blood pressure control is implicated in the sudden infant death syndrome (SIDS). However, no data exist on normal development of blood pressure control during infancy. This study assessed maturation of autonomic control of blood pressure and heart rate during sleep within the first 6 months of life.Participants:Term infants (n = 31) were studied longitudinally at 2-4 weeks, 2-3 months, and 5-6 months postnatal age.Interventions:Infants underwent daytime polysomnography at each age studied. Blood pressure and heart rate were recorded during quiet (QS) and active (AS) sleep in undisturbed baseline and head-up tilt conditions.Measurements and Results:Autonomic control was assessed using spectral indices of blood pressure and heart rate variability (BPV and HRV) in ranges of low frequency (LF, reflecting sympathetic + parasympathetic activity) and high frequency (HF, parasympathetic activity), total power (LF+HF), and LF/HF ratio (sympathovagal balance).With increasing postnatal age and predominantly during QS, HRV-LF, HRV-HF, and HRV total power increased, while HRV-LF/HF decreased. BPV-LF/HF also decreased with postnatal age. All changes were evident in both baseline and head-up tilt conditions. BPV-LF and BPV total power during tilts were markedly reduced in QS versus AS at each age.Conclusions:In sleeping infants, sympathetic vascular modulation of the circulation decreases with age, while parasympathetic control of heart rate is strengthened. These normative data will aid in the early identification of conditions where autonomic function is impaired, such as in SIDS.Citation:Yiallourou SR; Sands SA; Walker AM; Horne RSC. Maturation of heart rate and blood pressure variability during sleep in term-born infants. SLEEP 2012;35(2):177-186.
CSF Levels of Hypocretin-1 (Orexin-A) Peak during Early Infancy in Humans
Study Objectives:Hypocretin (orexin) is a unique neuropeptide involved in the consolidation of wakefulness and sleep. Although hypocretin-1 levels in the cerebrospinal fluid (CSF) are stable after infancy, how levels change in preterm and term human infants is unknown.Design, Patients, and Setting:Hypocretin-1 levels were measured in CSF samples, obtained from 284 preterm (25-37 gestational weeks) and full-term infants in the first 4 months of life and 35 older children (ages 0.5-13 years), in a tertiary hospital.Measurements and Results:Detailed clinical and laboratory data were collected for each of the 319 participants. Based on that data, 108 neurologically intact children were selected (95 infants [43 preterm and 52 term] and 13 older children). CSF hypocretin-1 was measured by direct radioimmunoassay. Hypocretin-1 levels at the first weeks of the 3rd embryonic trimester (gestational age [GA] 28-34 weeks) were 314 ± 65 pg/mL (n = 17). The levels linearly increased during the third trimester and early infancy (r = 0.6), peaking in infants of 2-4 months ages (476 ± 72 pg/mL; n = 16) and decreasing thereafter; hypocretin levels in 2- to 4-month-old infants were significantly higher than those in children 0.5-13 years old (353 ± 78 pg/mL, n = 13; P = 0.0001).Conclusions:The present findings indicate that in human infants, CSF hypocretin-1 increases during the third embryonic trimester and is highest at 4 months of life. Thereafter, and consistent with previously published results, hypocretin levels are lower and stable until the geriatric age. This pattern may reflect the role of hypocretin in the dramatic process of sleep and wakefulness consolidation that occurs during early infancy.Citation:Aran A; Shors I; Lin L; Mignot E; Schimmel MS. CSF levels of hypocretin-1 (orexin-A) peak during early infancy in humans. SLEEP 2012;35(2):187-191.
An Adaptive-Duration Version of the PVT Accurately Tracks Changes in Psychomotor Vigilance Induced by Sleep Restriction
Study Objectives:The Psychomotor Vigilance Test (PVT) is a widely used assay of behavioral alertness sensitive to the effects of sleep loss and circadian misalignment. The standard 10-minute duration of the PVT is often considered impractical for operational or clinical environments. Therefore, we developed and validated an adaptive-duration version of the PVT (PVT-A) that stops sampling once it has gathered enough information to correctly classify PVT performance.Design:Repeated-measures experiments involving 10-minute PVT assessments every 2 hours across both acute total sleep deprivation (TSD) and 5 days of chronic partial sleep deprivation (PSD).Setting:Controlled laboratory environment.Participants:Seventy-four healthy subjects (34 women), aged 22 to 45 years.Interventions:A TSD experiment involving 33 hours awake (n = 31 subjects), and a PSD experiment involving 5 nights of 4 hours time in bed (n = 43 subjects).Measurements and Results:The PVT-A algorithm was trained with 527 TSD test bouts and validated with 880 PSD test bouts. Based on our primary outcome measure “number of lapses (response times ≥ 500 ms) plus false starts (premature responses or response times < 100 ms),” 10-minute PVT performance was classified into high (≤ 5 lapses and false starts), medium (> 5 and ≤ 16 lapses and false starts), or low (> 16 lapses and false starts). The decision threshold for PVT-A termination was set so that at least 95% of training data-set tests were classified correctly and no test was classified incorrectly across 2 performance categories (i.e., high as low or low as high), resulting in an average test duration of 6.0 minutes (SD 2.4 min). In the validation data set, 95.7% of test bouts were correctly classified, and there were no incorrect classifications across 2 categories. Agreement corrected for chance was excellent (κ = 0.92). Across the 3 performance categories, sensitivity averaged 93.7% (range 87.2%-100%), and specificity averaged 96.8% (range 91.6%-99.9%). Test duration averaged 6.4 minutes (SD 1.7 min), with a minimum of 27 seconds.Conclusions:We developed and validated a highly accurate, sensitive, and specific adaptive-duration version of the 10-minute PVT. Test duration of the adaptive PVT averaged less than 6.5 minutes, with 60 tests (4.3%) terminating after less than 2 minutes, increasing the practicability of the test in operational and clinical settings. The adaptive-duration strategy may be superior to a simple reduction of PVT duration in which the fixed test duration may be too short to identify subjects with moderate impairment (showing deficits only later during the test) but unnecessarily long for those who are either fully alert or severely impaired.Citation:Basner M; Dinges DF. An adaptive-duration version of the PVT accurately tracks changes in psychomotor vigilance induced by sleep restriction. SLEEP 2012;35(2):193-202.

Sleep and Breathing (Online First™)

Role of leptin as antioxidant in obstructive sleep apnea: an in vitro study using electron paramagnetic resonance method
Fri, 03 Feb 2012 17:11:08 -0000
Abstract Introduction  As in obstructive sleep apnea (OSA), the chronic cycles of hypoxia and reoxygenation are thought to be conducive of oxidative stress (OS) with generation of reactive oxygen species, identifying effective mechanisms of protection against oxidant-mediated tissue damage becomes of outmost importance. Leptin’s role had been recently extended into that of participant to OS; while its exact role in this process is yet to be defined, elevated leptin levels correlate significantly with several indices of OSA disease severity such as nocturnal hypoxemia, possibly acting as a counteractive mechanism against the chronic intermittent hypoxia-related OS and serving as a marker of future risk of atherosclerotic disease. We therefore investigated leptin’s antioxidant mechanism on superoxide (O2−•) anions using spectrophotometry and electron paramagnetic resonance (EPR). Methods  The O2−• was generated by oxidation of xanthine (XAN) by xanthine oxidase (XO) in the presence of spin trap 5-diethoxyphosphoryl-5-methyl-1-pyrroline N-oxide with various concentrations of leptin (0.001, 0.01, 0.1, and 1 mg/ml) and without leptin. Signal intensity between 3,440 and 3,540 G was expressed as standard means ± SD. The activity of leptin on XO was determined by monitoring the conversion of XAN to uric acid at 293 nm using a Beckman DU 800 UV–visible spectrophotometer. Results  Leptin added to aqueous solutions at 0.1 and 1 mg/ml concentrations was associated with a statistically significant decrease in the EPR signal due to leptin’s direct scavenging activity towards the O2−•. Conclusion  Leptin is an antioxidant agent of possible use as a marker of OS and future risk of atherosclerotic disease in OSA. Content Type Journal ArticleCategory Original ArticlePages 1-6DOI 10.1007/s11325-012-0656-8Authors Madalina Macrea, Salem VA Medical Center, affiliate of the University of Virginia School of Medicine, Charlottesville, VA, USAThomas Martin, Salem VA Medical Center, affiliate of the University of Virginia School of Medicine, Charlottesville, VA, USALeon Zagrean, Physiology Department, “Carol Davila” School of Medicine, Bucharest, RomaniaZhenquan Jia, Department of Biology, University of North Carolina at Greensboro, Greensboro, NC 27410, USAHara Misra, Edward Via Virginia College of Osteopathic Medicine, Virginia Tech Corporate Research, Blacksburg, VA, USA Journal Sleep and BreathingOnline ISSN 1522-1709Print ISSN 1520-9512
A case–control study of craniofacial features of children with obstructed sleep apnea
Fri, 03 Feb 2012 07:22:04 -0000
Abstract Objective  This study aims to analyze differences in the skeletal, dental, and soft tissue components of craniofacial structure predisposing to the pediatric obstructive sleep apnea, by a comparison of the cephalograms between children with obstructive sleep apnea (OSA) and controls. Materials and methods  The study enrolled a total of 30 children who were composed of the following two groups: 15 OSA patients and 15 controls. The two groups were strictly matched by age and sex. Lateral head radiographs were obtained and then cephalometric measurements were compared between the two. Fifty-six measurements were determined to study various skeletal, soft tissue, and airway structure. Results  Marked differences were demonstrated in terms of SNB, PG-NB, lower facial height, H-C3Me, and adenoid (A) and tonsil (T/P). The SNB angle (75.82 ± 4.30) in case group was smaller than in the control (78.71 ± 2.61; p = 0.035), the PG/NB value in case group (1.32 ± 0.84 mm) was higher than that in the control (0.62 ± 0.60 mm; p = 0.015). The anterior lower facial height was 65.12 ± 5.91 mm in case group (p = 0.048), while the anterior lower facial height in control was 61.51 ± 3.22 mm. The position of hyoid was lower in case group (5.30 ± 3.67 mm) compared with the control one (2.64 ± 2.58 mm; p = 0.029). Furthermore, the patients with OSA had larger As and T/Ps than the controls. Conclusions  The case group differed from the control group in the length of mandible, anterior lower facial height, position of hyoid and the chin, and the size of the As and T/Ps. Content Type Journal ArticleCategory Original ArticlePages 1-9DOI 10.1007/s11325-011-0636-4Authors Jinrong Deng, 3rd dental centre, School and Hospital of Stomatology, Peking University, Beijing, ChinaXuemei Gao, Department of Orthodontics, School and Hospital of Stomatology, Peking University, 22 Zhongguancun Nandajie, Haidian District, Beijing 100181, China Journal Sleep and BreathingOnline ISSN 1522-1709Print ISSN 1520-9512
Obstructive pressure peak: a new method for differentiation of obstructive and central apneas under auto-CPAP therapy
Thu, 02 Feb 2012 18:13:56 -0000
Abstract Purpose  Auto-CPAP devices (APAP) are controlled, e.g., by the respiratory flow and pressure to adjust the treatment pressure to the variable obstruction in sleep apnea syndromes. By obstruction of the upper airway during inspiration, a pressure difference between the lower airways and the mask can be measured. In case of an opening of the pharynx at the end of the obstruction, the pressure decreases immediately. This brief negative pressure, the so-called obstructive pressure peak (OPP) can be used to identify obstruction or open airways with the algorithm of an APAP device. Useless pressure increases, e.g., after central apneas without obstruction may be avoided. We therefore investigated the association of the OPP signal with respiratory events during APAP therapy. Methods  In this pilot study, 13 patients with obstructive sleep apnea syndrome were evaluated. Attended automatic CPAP titration (SOMNObalance, Fa Weinmann Hamburg/Germany) was performed. The OPP signal was recorded synchronously in parallel with the polysomnographic data. If the OPP signal was within a time range of ±5 s of the resumption of normal breathing, it was assigned to the event. Results  A total of 480 sleep-related breathing disorders events were studied. The most common were the mixed apneas associated with more than 90% of all cases with an OPP signal, followed by obstructive sleep apneas (66.7%) and central apneas (38%). The difference in OPP frequency distribution between central apneas and obstructive apneas was significant with p < 0.001. Conclusions  The analysis of the pressure characteristics of APAP treatment with the registration of OPP allows a further differentiation in obstructed and not obstructed upper airways. Content Type Journal ArticleCategory Original ArticlePages 1-5DOI 10.1007/s11325-012-0657-7Authors K. H. Ruhle, Department of Pneumology, HELIOS Clinic Ambrock, Ambrockerweg 60, 58091 Hagen, GermanyU. Domanski, Department of Pneumology, HELIOS Clinic Ambrock, Ambrockerweg 60, 58091 Hagen, GermanyG. Nilius, Department of Pneumology, HELIOS Clinic Ambrock, Ambrockerweg 60, 58091 Hagen, Germany Journal Sleep and BreathingOnline ISSN 1522-1709Print ISSN 1520-9512

pubmed: 1389-9457

Algorithm for the diagnosis and treatment of pediatric OSA: A proposal of two pediatric sleep centers.
Kaditis A, Kheirandish-Gozal L, Gozal D Algorithm for the diagnosis and treatment of pediatric OSA: A proposal of two pediatric sleep centers. Sleep Med. 2012 Jan 31; Authors: Kaditis A, Kheirandish-Gozal L, Gozal D Abstract There is currently no consensus on the best method of managing of obstructive sleep apnea (OSA) in childhood. In the present paper, an algorithm for the diagnosis and treatment of the disorder is proposed. Sleep apnea is suspected when parents report relevant symptoms or when there are abnormalities that predispose to OSA such as adenotonsillar hypertrophy, obesity, craniofacial anomalies, or neuromuscular disorders. OSA-associated morbidity including elevated blood pressure, daytime sleepiness or learning problems, growth failure, and enuresis should be recognized. Severity of intermittent upper airway obstruction during sleep can be determined objectively by polysomnography or, if polysomnography is not available, by nocturnal pulse oximetry. Risk factors predicting persistence of OSA in adolescence (male gender, development of obesity) need to be identified. Children with moderate-to-severe OSA, or with mild OSA, but accompanied by morbidity, or by risk factors predicting persistence of the disorder should have priority for treatment. An individualized and multifaceted therapeutic approach which addresses in a step-by-step fashion all abnormalities that contribute to upper airway obstruction during sleep is necessary. PMID: 22300748 [PubMed - as supplied by publisher]

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