14 Signs You Might Have A Sleep Disorder

While it's normal to occasionally have a night or two of crummy sleep, an estimated 50–70 million Americans have a sleep disorder that causes chronic problems (via the American Sleep Association). The American Psychiatric Association defines sleep disorders as "problems with the quality, timing, and amount of sleep, which result in daytime distress and impairment in functioning." According to the Sleep Foundation, 10%–30% of Americans have insomnia, while 15%-30% of men and 10%-30% of women meet a broad definition of obstructive sleep apnea (OSA). Restless legs syndrome affects as many as 10% of adults. Narcolepsy, another type of sleep disorder, affects between 135,000 and 200,000 people in the United States.

As explained in a 2012 paper published in Neurotherapeutics, the International Classification of Sleep Disorders (ICSD) recognizes 81 distinct sleep disorders, broadly classified into six main categories and two "catch-all" categories for isolated symptoms and other issues. The six main categories are insomnias, sleep-related breathing disorders (including sleep apnea), hypersomnias of central origin (including narcolepsy), circadian rhythm disorders, parasomnias (including sleepwalking, sleeptalking, and night terrors), and sleep-related movement disorders (including restless legs syndrome).

Many sleep disorder symptoms, such as daytime sleepiness, are common across multiple conditions. But some sleep disorders have more telltale symptoms. If you're consistently having any of these symptoms, it may be a good idea to contact a sleep specialist.

Difficulty falling asleep may be a sign of insomnia

Consistently having trouble falling asleep once you lay down in bed at night is the quintessential symptom of insomnia. According to WebMD, "insomnia is a sleep disorder in which you have trouble falling and/or staying asleep." Insomnia is considered acute if it lasts less than a few weeks, whereas chronic insomnia is the diagnosis when difficulty sleeping happens at least three nights a week for three months or more. In the case of primary insomnia, sleep difficulties aren't linked to another medical cause. Key triggers of primary insomnia include stress, disruptions in the sleep environment such as too much light or noise, and changes in sleep schedule (such as jetlag or changing shifts at work). Poor sleep habits like staying up late watching TV can also contribute. Genetics may also play a role in primary insomnia. Secondary insomnia, however, is triggered by other health conditions (like asthma or depression), pain, use of certain medications, or use of certain substances (such as caffeine or alcohol).

Women are more likely than men to have insomnia, thanks to hormonal changes during the menstrual cycle and at menopause. Insomnia is also more common in individuals over 60. If left unaddressed, insomnia can degrade both physical and mental well-being. Regularly not getting enough sleep increases the risk for accidents, worsens reaction times and cognitive performance, and increases the risk for and severity of chronic conditions such as heart disease (via the Mayo Clinic).

You might also have insomnia if you regularly wake up during the night

There are several types of insomnia, and while sleep-onset insomnia (difficulty falling asleep) is the one people usually think of, sleep-maintenance insomnia is also common. In this form of insomnia, individuals fall asleep just fine, but have trouble staying asleep through the entire night or wake up too early (via WebMD).

If you aren't getting the quantity or quality of sleep you need to feel rested because of insomnia or any other sleep disorder, it's best to see a sleep specialist — a doctor or mental health professional who's undergone special training in sleep science. In addition to asking questions about your sleep, sleep specialists often perform a sleep study (polysomnogram), in which approximately 25 electrodes are attached to your body and relay information about what your brain and body are doing while you sleep to a technician. By collecting information about your brainwaves, heart rate, eye movements, leg movements, and breathing patterns during sleep, doctors can get a better idea of what sleep disorder may be at the root of your symptoms (via WebMD). In the case of insomnia specifically, individuals may be asked to keep a sleep diary to record their symptoms. The doctor may also order blood tests to check for underlying medical conditions that could be causing difficulty sleeping (via the Cleveland Clinic).

Feeling like you got much less sleep than you did may be a sign of insomnia

If you regularly wake up feeling like you only got a few hours of sleep but a quick glance at the clock shows you slept a normal amount, you could have paradoxical insomnia. As WebMD explained, "when you have paradoxical insomnia, you underestimate the time you're asleep. It feels like you sleep a lot less than you really do."

There are several approaches to treating insomnia. In some cases, doctors may prescribe prescription sleep aids. In most cases, however, these medications are only prescribed for a few weeks because they can be habit-forming and can increase daytime grogginess (and thus the risk for accidents). It's also important to work on controlling or eliminating thoughts and behaviors that encourage insomnia. In fact, a specific type of therapy known as cognitive behavioral therapy for insomnia (CBTI) has been developed specifically to help individuals with this sleep disorder. CBTI helps individuals confront and deconstruct their negative thoughts and beliefs surrounding sleep, and prevent them from getting into a vicious cycle in which worrying about not being able to sleep perpetuates insomnia. Behavioral changes that CBTI employs include light therapy, relaxation techniques, establishing a consistent bedtime and sleep routine, and leaving the bedroom rather than laying awake in bed. Of course, if insomnia is the result of an underlying medical condition, it's important to identify and manage that (via the Mayo Clinic).

Loud snoring could be a sign of sleep apnea

While almost everyone snores sometimes, persistent, loud snoring during sleep is a classic sign of sleep apnea. Other sleep breathing issues commonly seen with sleep apnea include gasping for breath and periods when breathing momentarily stops.

In fact, breathing issues are at the heart of this sleep disorder, which is marked by repeated episodes of breathing stopping and starting during sleep. There are three types of sleep apnea. Obstructive sleep apnea is the most common, and occurs when the muscles in the throat relax, narrowing or closing the airway. In central sleep apnea, on the other hand, the sleeping brain fails to transmit signals to the individual's breathing muscles, so breathing briefly stops. In both cases, oxygen levels in the body drop, which triggers the brain to wake the person up briefly in order to take a proper breath. People often don't even realize they've woken up. It's also possible to have complex sleep apnea syndrome, in which an individual has both obstructive and central sleep apnea. Men are two to three times more likely than women to have obstructive sleep apnea. Other risk factors include being overweight or obese, having a naturally narrow airway, nasal congestion, and certain medical conditions such as high blood pressure and type 2 diabetes (via the Mayo Clinic). The American Sleep Apnea Association estimates that 22 million Americans have sleep apnea, but 80% of moderate and severe cases go undiagnosed.

You could have sleep apnea if you regularly wake up with a headache

Another common symptom of sleep apnea is waking up in the morning with a headache. As many as 18% of individuals with sleep apnea get morning headaches (via the Sleep Foundation). These headaches are usually felt on both sides of the head and produce a pressing (rather than pulsing) type of pain. Thankfully, they aren't accompanied by nausea or sensitivity to light, but they can last up to four hours. 

Women — especially those who are prone to other types of headaches — are most at risk for sleep apnea headaches. Researchers aren't sure exactly what's behind these headaches. Some hypothesize that low oxygen levels in the blood caused by frequent breathing disruptions triggers the headaches. Others believe that it's the short but frequent disruptions in the person's sleep cycle caused by sleep apnea that lead to the headaches. Sleep apnea is also associated with higher incidence of other types of headaches, including cluster headaches and migraines.

The primary treatment for sleep apnea is the use of a continuous positive airway pressure (CPAP) machine to keep the airway open at night. Other assistive devices and even surgery may be needed to treat sleep apnea. If untreated, sleep apnea can cause a number of health problems, including high blood pressure, heart attack, type 2 diabetes, metabolic syndrome, and liver issues. Sleep apnea may also lead to complications during or after surgery (via the Mayo Clinic).

Cataplexy can be a symptom of narcolepsy

The media portrays people with narcolepsy as falling asleep whenever they get excited, but that's not exactly how the condition works (via the Cleveland Clinic). Individuals with type 1 narcolepsy sometimes experience instances of cataplexy when they feel strong emotions such as fear, surprise, or elation. 

Cataplexy is a sudden loss of muscle tone and strength. In mild cases, this is simply a buckling of the knees or a drooping of the eyelids, but in more extreme cases, it causes whole-body paralysis. While it may look like the person has suddenly fallen asleep, they are fully conscious the entire time. Cataplexy attacks can last a few seconds to a few minutes. Some individuals only have them a few times in their life, while others have them several times a day. But those with type 2 narcolepsy don't experience cataplexy at all.

Narcolepsy is a neurological condition in which the brain has difficulty regulating the sleep-wake cycle. People with narcolepsy have low levels of the neurotransmitter hypocretin, which helps regulate the sleep cycle, especially REM sleep. The underlying cause for this chemical imbalance, however, is unknown. In addition to cataplexy, people with narcolepsy experience excessive daytime sleepiness that interferes with daily life. They also have disrupted sleep at night. Narcolepsy is managed with a variety of medications, including sodium oxybate and several classes of antidepressants to treat cataplexy.

Uncomfortable sensations in your legs at night are a sign of restless legs syndrome

According to the Mayo Clinic, "restless legs syndrome (RLS) is a condition that causes an uncontrollable urge to move your legs, usually because of an uncomfortable sensation." The feeling usually happens at night when a person has been sitting or laying down for a while, and movement temporarily eases the sensation. 

The unpleasant sensations are usually felt on both sides of the body and within the leg, rather than on the skin. The sensations have been described as a crawling, creeping, pulling, throbbing, aching, itching, or electric shock feeling, accompanied by a very strong desire to move the legs. Although known as restless legs syndrome, sometimes it's the arms that are affected. Symptoms can start at any age, but tend to worsen over time. Experts aren't sure what causes RLS, but it may be triggered by an imbalance of the neurotransmitter dopamine. In some cases, RLS may be related to an underlying medical condition, such as damage to the peripheral nerves, kidney failure, and iron deficiency. 

Women are more likely than men to get RLS, and pregnancy may cause the appearance of RLS or a worsening of RLS symptoms. Medications to treat RLS include drugs that increase dopamine levels. Opioids and muscle relaxants may also provide some relief, but come with significant risks. Hot or cold packs, massage, exercise, and specially designed wraps that put pressure on the bottom of the foot may also help.

Sleep bruxism can cause jaw pain in the morning

If you regularly wake up with an achy jaw, you may have sleep bruxism. Bruxism is the repeated clenching or grinding of the teeth, and while many people sometimes do it when awake because of strong emotions like anger, bruxism is also a common sleep disorder (via the Sleep Foundation). Sleep bruxism affects 10%–14% of children, about 15% of teens, 8% of young adults, and 3% of older adults. While the mouth movements of sleep bruxism resemble chewing, they're done with much more force — up to 250 pounds. People with this condition don't grind their teeth continuously, however; they experience episodes of bruxism throughout the night. Sleep bruxism is most common during the lighter stages of the sleep cycle. The cause of sleep bruxism varies, although high levels of stress or anxiety are common culprits. Genetics also appears to play some role, as nighttime teeth grinding tends to run in families.

Left untreated, sleep bruxism can cause major damage to the teeth, wearing them down, loosening them, and causing significant pain. Sleep bruxism can also damage fillings and crowns, and increases the likelihood of problems with the temporomandibular joint (TMJ), which controls movement of the lower jawbone. Mouthguards that protect the teeth are a common option for managing sleep bruxism. Botox injections into the jaw may also help, as can practicing relaxation techniques before bed.

If you can't move when falling asleep or waking up, you may be experiencing sleep paralysis

As the Cleveland Clinic explains, "during the rapid eye movement (REM) sleep stage ... the brain prevents muscles in your limbs from moving to protect yourself from acting dreams out and hurting yourself. Sleep paralysis happens when you regain awareness going into or coming out of REM." Individuals are aware of the world around them, but they can't move their body or speak. (They can, however, move their eyes and breathe.) People may also feel like they're being suffocated or choked, and may see or hear things that aren't there. It can be an extremely frightening experience.

Isolated instances of sleep paralysis can happen to anyone, especially if an individual is sleep-deprived or their regular sleep schedule has been disrupted. Although chronic sleep paralysis is considered a sleep disorder in its own right, it often accompanies narcolepsy, another sleep disorder. The Cleveland Clinic noted that "there are no proven therapies that can stop a sleep paralysis episode, but most people who experience it routinely report that focusing on making small body movements ... helps them to recover more quickly." Keeping a regular sleep schedule, avoiding sleep deprivation, and relaxing before bed can minimize the risk of a sleep paralysis episode, although there's no surefire way to prevent them.

Sleep terrors cause you to scream and thrash around while asleep

While everyone occasionally gets nightmares, sleep terrors (also known as night terrors) are different. Nightmares occur during REM sleep, and individuals usually awaken because of them and can remember at least some detail about them. Sleep terrors, on the other hand, occur during stage 3 sleep, the deepest stage of non-REM sleep. Individuals don't wake up during their sleep terror, and either have no recollection of it the next morning or can only remember a vague fragment of the episode. 

Sleep terrors affect as many as 40% of children, but become much less common during adulthood. In addition to beginning with a frightened scream or loud shout, sleep terrors can cause individuals to sit up in bed, thrash or kick, or even get out of bed. In fact, sleep terrors are often accompanied by sleepwalking. Individuals may have a wide-eyed stare, but they're still asleep and will have little to no memory of the event the next morning. It can be extremely difficult to wake someone during a sleep terror.

The exact cause of sleep terrors is unknown, but factors such as extreme tiredness, sleep deprivation, stress, disruptions to the normal sleep schedule, fever, alcohol use, and certain medications can bring on episodes. Occasional episodes aren't usually cause for concern, but frequent episodes may cause daytime sleepiness and disturbed sleep patterns. Sometimes, individuals may accidentally hurt themselves during an episode (via the Mayo Clinic).

If you physically act out your dreams, you probably have REM sleep behavior disorder

During REM sleep, people experience temporary bodily paralysis so that they remain still and safe as their sleeping brain dreams. For those with REM sleep behavior disorder, however, paralysis doesn't occur, and they're able to move and vocalize, allowing them to physically act out the dream they're having (via the Sleep Foundation). Unfortunately, these dreams are usually intense and frightening. 

While some people may only experience slight muscle twitches or quiet murmuring, others may violently kick, punch, or yell. This can lead to injury to both themselves or others. The individual isn't aware of the episode as it's happening, and it's generally easy to wake them. This condition is relatively rare, affecting only about 0.5%–1% of people. It's more common in men and those over 50, and is often seen with neurodegenerative conditions such as Parkinson's disease or dementia. Symptoms tend to get worse over time.

People with REM sleep behavior disorder can cause injury to themselves or their bed partner when they act out their dreams. In fact, up to 81% of individuals with the condition and 60% of their spouses have sustained a physical injury. Treatment includes medications (particularly melatonin) and adaptations to prevent injury, such as placing the mattress on the floor and removing any sharp objects from the room.

Being a real night owl could mean you have delayed sleep-wake phase disorder

We all occasionally have trouble falling asleep when we know we "should," but for some people, it's a chronic issue that's a recognized sleep disorder. Individuals with delayed sleep-wake phase syndrome, also known as delayed sleep-wake phase disorder (DSPD), have difficulty falling asleep and waking up at socially acceptable times (via the Sleep Foundation). Those with DSPD are essentially extreme "night owls" who don't feel sleepy until, say, 4am and, if they had their way, might sleep until noon. DSPD occurs because the body doesn't release melatonin, the hormone that triggers sleepiness, at the proper time. In circadian aligned DSPD, melatonin is released less than three hours before sleep begins. In circadian misaligned DSPD, melatonin is released more than three hours before sleep or even after sleep has begun. The exact cause of the condition is unknown

Trying to conform to the hours other people keep can be extremely difficult for those with DPSD and often results in individuals not getting enough sleep, leading to excessive daytime sleepiness and difficulty concentrating. Taking supplemental melatonin can be extremely helpful, because it allows those with DSPD to trigger sleepiness hours before they'd naturally start winding down.

You probably have non-24 hour sleep-wake disorder if your sleep schedule is constantly shifting

Our circadian rhythm is tied to the phases of light and dark that make up a day, but some people's internal clocks are out of sync with this 24-hour cycle (per the Sleep Foundation). Individuals with non-24-hour sleep-wake disorder (N24SWD) have a circadian rhythm that is either shorter or (more often) longer than 24 hours. This discrepancy between the length of their circadian rhythm and the 24-hour day progressively shifts their sleep and wake times. As an extreme example, if someone's rhythm is only 20 hours long, they may feel sleepy at 10pm one day, but 6pm the next day and 2pm the day after. For most individuals with the condition, however, the discrepancy is smaller — usually an hour or so.

This constant shifting can make it extremely difficult or impossible to keep a regular work, social, or meal schedule. Most people with N24SWD are totally blind, and the condition is caused by their inability to perceive light. In fact, an estimated 50% of individuals with no light perception have N24SWD. The condition can also affect sighted individuals, although the cause is unclear. When it occurs in sighted individuals, N24SWD is more common in males and tends to appear in the late teens or early 20s. These individuals often have another mental health diagnosis, such as depression or schizophrenia. Melatonin and bright light therapy (for sighted individuals) are used to treat N24SWD.

If you hear a loud noise when you fall asleep, you probably have exploding head syndrome

A person with exploding head syndrome (EHS) hears a sudden loud noise or crashing sound in their head as they're falling asleep or when they wake at night (via the Cleveland Clinic). This may sound like an explosion, gunshots, thunder, or other loud noises. Sometimes, the person may also see flashes of light or have muscle jerks. The episode isn't painful and doesn't cause any damage to the ears or other parts of the body, but it can be very startling and can make it difficult to fall asleep afterward. Each episode lasts less than a second. Some individuals have multiple episodes every night, while others have "clusters" of episodes for several nights followed by weeks or months without any episodes. It's unclear how common EHS is, and it can begin at any age.

Researchers aren't clear on what causes the auditory hallucination, but being stressed or extremely tired may bring on an episode in susceptible individuals. Some hypotheses for the underlying cause of EHS include a momentary increase in sensory neuron activity, damage to or dysfunction of the inner ear, or abnormal attention processing in the brain during the transition between wakefulness and sleep. It may also be a side effect from suddenly stopping selective serotonin reuptake inhibitors (a type of antidepressant) or benzodiazepines (a class of anti-anxiety medication). Treatment usually isn't needed, though some drugs may help, including the antiseizure medicine topiramate.