Types of Sleep Disorder
| Disorder | Key Feature | Diagnosis |
|---|---|---|
| Insomnia | Difficulty falling or staying asleep >3 nights/week for >3 months | Clinical history + sleep diary |
| Obstructive sleep apnoea (OSA) | Breathing stops repeatedly during sleep; snoring, daytime sleepiness | Overnight sleep study (polysomnography or oximetry) |
| Restless legs syndrome | Overwhelming urge to move legs at night; creeping sensations | Clinical + ferritin check (low iron worsens RLS) |
| Narcolepsy | Excessive daytime sleepiness; cataplexy (sudden muscle weakness with emotion) | Sleep study with MSLT test; CSF orexin levels |
| Circadian rhythm disorder | Sleep-wake cycle misaligned with desired schedule | Sleep diary; light therapy history |
Sleep Apnoea — Symptoms and Diagnosis
- Loud snoring
- Witnessed breath pauses during sleep (partner-reported)
- Waking gasping or choking
- Unrefreshing sleep despite adequate hours
- Excessive daytime sleepiness (falling asleep at desk, while driving — danger!)
- Morning headaches
- Poor concentration and irritability
Driving with Undiagnosed OSADriving while excessively sleepy is illegal and dangerous. In the UK and many countries, you must inform the DVLA if you have excessive daytime sleepiness. Untreated severe OSA significantly increases road accident risk.
Blood Tests for Sleep Disorders
| Test | Why Ordered |
|---|---|
| Ferritin (iron stores) | Low iron worsens restless legs syndrome |
| Thyroid (TSH) | Hypothyroidism causes excessive sleepiness |
| FBC | Anaemia causes fatigue mimicking sleep problems |
| Glucose / HbA1c | Diabetes disturbs sleep; OSA worsens diabetes |
| Vitamin D | Deficiency associated with poor sleep quality |
| Testosterone (men) | OSA is associated with low testosterone |
STOP-BANG Score for OSAQuick OSA screening: Snoring? Tired? Observed apnoeas? high Pressure (blood pressure)? BMI >35? Age >50? Neck circumference >40cm? Male Gender? Score ≥3 = high risk for OSA. Refer for sleep study.
Evidence-Based Treatments
| Condition | First-Line Treatment | Second-Line |
|---|---|---|
| Insomnia | CBT-I (Cognitive Behavioural Therapy for Insomnia) | Melatonin (short-term); low-dose medications |
| OSA (mild-moderate) | CPAP (continuous positive airway pressure) | Mandibular advancement device |
| OSA (positional) | Positional therapy (avoid sleeping on back) | CPAP if positional therapy insufficient |
| RLS | Iron supplementation if ferritin <75 ng/mL | Pramipexole, ropinirole; gabapentin |
| Narcolepsy | Modafinil, pitolisant (stimulants) | Sodium oxybate (GHB) |
Is insomnia all in the mind?
No — insomnia involves real changes in brain arousal systems, cortisol patterns, and body temperature regulation. However, thought patterns and behaviours maintain it, which is why CBT-I (not just sleep hygiene tips) is so effective.
Will CPAP cure my sleep apnoea?
CPAP treats OSA while you use it — it doesn't cure the underlying anatomy. However, significant weight loss (10–15%) can resolve OSA in many overweight patients. Bariatric surgery cures OSA in 80% of patients.
Can melatonin help insomnia?
Melatonin works best for circadian rhythm disorders (jet lag, shift work, delayed sleep phase). Evidence for primary insomnia is weaker. 0.5–1 mg (much lower than sold OTC) taken 30–60 minutes before target sleep time is most effective.
Medical Disclaimer: This page is for general education only and does not replace professional medical advice. Always consult a qualified healthcare provider.