Sleep disorders

Both children and adults can have night terrors, and it can be a frightening experience for both. During a night terror, you may talk and move about, but you’ll still be asleep. It’s rare to remember having a night terror. They are most common in children between the ages of 3 and 8.

Some facts about night terrors are:

• They mainly affect children

• You probably won’t remember it

• You may scream, shout, thrash about and jump out of bed

• Your eyes might be open but you’re not awake

• They happen in the early part of the night, sometimes more than once

• They can last up to 15 minutes

• They’re more common in people with family members who’ve had night terrors or who sleepwalk

Night terrors can be caused by various things such as:

• Being very tired or unwell

• Sudden noises at night 

• Needing to wee during the night

• Something that’s scared you like watching a scary film

• Something that’s made you stressed, anxious or worried

• Taking certain medications 

• Conditions that impact your sleep like restless leg syndrome or sleep apnoea

• Mental health conditions like post-traumatic stress disorder (PTSD)

• Conditions that affect the brain like dementia

For most people who have night terrors, things can get better on their own, but there are also some things you can do to help like:

• Having a relaxing bedtime routine 

• Keeping a sleep diary which can include what you did that day, what you did in the evening, how you were feeling and the quality of your sleep. This can help identify any triggers

• Try to tackle things that might have made you feel stressed or anxious

If someone is having night terrors, you can help by:

• Staying calm and waiting for the person to calm down

• Not talking to the person, or trying to move them— unless there’s a risk of them hurting themselves or another person

• Not trying to wake them as they might not recognise you. This can make them more upset

• Looking out for patterns in the timings of their night terrors. If they are having them at the same time every night, you can try waking them up 15 minutes before the night terror to try and stop them from happening

Treating night terrors is very individual and depends on the cause. It’s important to speak to your GP if:

• Your child has night terrors multiple times a night or has them almost every night

• Your child has lots of nightmares about the same thing 

• You’re having regular night terrors that are having an impact on your sleep or your quality of life

• You have an underlying condition which may be causing the night terrors

They can offer help which may include counselling. 

Snoring is very common, and it doesn’t usually have a serious cause. It can be caused by your tongue, mouth, throat or airways in your nose vibrating as you breathe. When you sleep, those parts of your body relax and narrow, which can cause snoring.

You’re more likely to snore if:

• You’re overweight

• You smoke

• You drink too much alcohol

• You sleep on your back

Sometimes, it’s caused by a condition called sleep apnoea, which you can learn more about below. If snoring is becoming a problem for you there are some simple lifestyle changes that can help either stop snoring or reduce snoring like:

• Trying to lose weight if you’re overweight

• Sleeping on your side. You can try buying a special pillow or wedge that can keep you on your side such as a Kally Sleep Anti-Snore Pillow

• Try asking your partner to use earplugs if your snoring is affecting their quality of sleep 

• Stopping smoking

• Limiting alcohol intake to within the UK government's recommended amount. 

• Trying nasal strips and throat sprays which may help

It’s advisable to speak to your GP if:

• Any lifestyle changes aren’t helping

• Your snoring is having a big impact on your or your partner’s life or quality of sleep

• You’re feeling sleepy during the day, or making gasping or choking noises when you sleep

Insomnia means you regularly have problems sleeping. It’s a common sleep disorder, affecting around one in five people. It can sometimes get better by changing sleeping habits. You may have insomnia if you’re repeatedly:

• Finding it hard to go to sleep

• Waking up several times during the night

• Lying awake at night

• Waking up early and can’t get back to sleep

• Still feeling tired after waking up

• Finding it hard to nap during the day even though you’re tired

• Feeling tired and irritable during the day

• Finding it difficult to concentrate during the day because you’re tired

There are two types of insomnia:

• Short-term insomnia— if you have insomnia for a short time (less than three months)

• Long-term insomnia — if your insomnia lasts for three months or longer

Insomnia can be caused by lots of different things, but the most common causes are:

• Stress, anxiety or depression

• Noise

• A room that’s too hot or cold

• Uncomfortable beds

• Alcohol, caffeine or nicotine

• Recreational drugs like cocaine or ecstasy

• Jet lag

• Shift work

There are some lifestyle changes that can help you manage insomnia like:

• Going to bed and waking up at the same time every day even if you have a bad night’s sleep

• Relaxing at least one hour before bed like taking a bath or reading a book. Sleep sprays and mists may also help you relax 

• Making sure your room is dark and quiet. You can use blackout blinds, eye masks or ear plugs if you need 

• Exercising regularly, but not at least four hours before bed

• Making sure your mattress, pillows and covers are comfortable 

• Avoiding smoking, drinking alcohol, tea or coffee at least six hours before going to bed 

• Avoiding eating big meals late at night

• Avoiding watching TV or using devices like phones right before going to bed

• Avoiding napping during the day

• Avoiding driving when you feel sleepy

Lifestyle changes can only help with short-term sleep difficulties which may last for a few nights. 

It’s advisable to speak to your GP if:

• Changing your sleeping habits hasn’t worked

• You’ve had trouble sleeping for more than three months

• Your insomnia is affecting your quality of life and your daily life and you’re struggling to cope 

• You’re planning to take any medication

Your GP will try to find out the cause of your insomnia. If there is no obvious cause they may refer you to a therapist for cognitive behavioural therapy (CBT) which can help you change any thoughts and behaviours that might be stopping you from sleeping.

Sleep apnoea is when your breathing stops and starts whilst you’re asleep. There are different types, with the most common being obstructive sleep apnoea (OSA). Sleep apnoea needs treatment as it can lead to more problems if left unmanaged. 

Sleep apnoea has been linked to:

• Obesity

• Having a large neck

• Getting older (children and young adults can still get it)

• Having other family members with it

• Smoking and drinking alcohol

• Having large tonsils or adenoids

• Sleeping on your back

• Having chronic obstructive pulmonary disease (COPD)

Symptoms of sleep apnoea mainly happen while you’re asleep. They include:

• Your breathing stopping and starting 

• Making gasping, snorting or choking noises

• Waking up a lot 

• Loud snoring 

If you do have any symptoms of sleep apnoea, it’s important to speak to your GP as it can be serious if it’s not diagnosed, treated and managed. It can be hard to tell if you have sleep apnoea as the symptoms are happening while you’re asleep, so it might help to ask someone to stay with you while you’re asleep, and they can check for any symptoms. Because of the impact on your quality of sleep, during the day you might also:

• Feel very tired

• Find it hard to concentrate

• Have mood swings 

• Have a headache when you wake up

If your GP thinks you might have sleep apnoea, they might refer you to a sleep clinic to check things like your breathing and heartbeat. You’ll be asked to wear devices overnight so the doctors can check for signs of sleep apnoea. The test can show if you’ve got sleep apnoea and let you know the severity.

Lifestyle changes like losing weight, stopping smoking and reducing alcohol intake can sometimes help with sleep apnoea, but many people may need to use a CPAP machine (it’s available free on the NHS if you need it). 

A CPAP machine gently pumps air into a mask you wear while you’re asleep, and it can help:

• Improve your breathing while you sleep by stopping the narrowing of your airways

• Improve your sleep quality and help you feel less tired 

• Reduce the risk of problems linked to sleep apnoea like high blood pressure

Other treatments for sleep apnoea may be:

• A gum shield-like device that holds your airways open while you’re asleep

• Surgery to help breathing like removing large tonsils

Lifestyle changes to help with sleep apnoea, which may be really effective if your sleep apnoea is mild are:

• Trying to lose weight if you’re overweight

• Exercising regularly as being active can help improve your symptoms

• Focusing on your sleep hygiene and creating a good environment to sleep

• Sleeping on your side

• Stopping smoking

• Reducing your alcohol intake, especially close to bedtime

• Not taking sleeping pills unless your doctor recommends them

Without treatment and management, sleep apnoea can lead to other problems.

Restless leg syndrome is also known as Willis-Ekbom disease. It’s a common condition of the nervous system that can affect anyone at any point in their life. Women are twice as likely to develop RLS as men, and it’s more common in middle age. It causes an overwhelming irresistible urge to move your legs.

Idiopathic or primary RLS is when there’s no obvious cause, and it can run in families.

Some specialists who treat conditions that affect the nervous system (neurologists) believe the RLS is linked to dopamine. Dopamine is involved in controlling muscle movement and may be responsible for the leg movements in RLS.

Secondary RLS can be caused by an underlying health condition like iron deficiency anaemia or kidney failure. Some research has also shown a link between RLS and being pregnant. Approximately one in five pregnant women may have symptoms in the last three months of their pregnancy, but the cause of this isn’t clear. In cases like this, RLS usually stops after birth.

Mild RLS can be managed with lifestyle changes including:

• Focusing on your sleep hygiene

• Avoiding alcohol and caffeine close to bedtime

• Quitting smoking 

• Exercising regularly during the daytime

If you’re having an episode of RLS, you can try:

• Massaging your legs

• Taking a hot bath in the evening 

• Applying a hot compress to your leg muscles

• Doing activities that can distract you like reading or watching TV

• Relaxation exercises like yoga 

• Walking and stretching

With more severe RLS, medication might be needed to regulate the amount of dopamine and iron in the body using medicine. 

Daily stress, overthinking and anxious feelings can often lead to problems with sleep. This relationship linked to not getting enough sleep, can make you feel more stressed, so sometimes this becomes a cycle. Understanding and managing one of these issues can often lead to the other one improving. 

When you’re feeling stressed or anxious, your body produces a stress hormone called cortisol. Cortisol wakes us up and suppresses the production of melatonin, the sleep hormone. If we have too much cortisol in our bodies before bed, it can stop us falling asleep easily and cause sleep problems like:

• Finding it hard to fall asleep, stay asleep or wake up earlier than you’d like

• Having problems that disturb your sleep like nightmares

• Finding it hard to wake up or get out of bed

• Feeling tired or sleepy

Anxious feelings, overthinking and daily stresses can affect the quality of our sleep. However, there are steps you can take to manage your worries like:

• Talking to someone

• Writing in a journal

• Making a to-do list for the next day

• Trying breathing exercises

• Taking steps to relax before bedtime

Most people experience feelings of stress, anxiety, or low mood during difficult times. A low mood may improve after a short period of time, however if low mood and anxious feelings persist, you’re worried about your symptoms, or they’re getting worse, speak to your GP.

Pain is an unpleasant sensation we have when nerves send a signal to the brain to let us know something is wrong. It can be acute or chronic. Acute pain is pain that lasts for a short time, and chronic pain refers to pain that lasts for longer than a few months.

People living with chronic pain may suffer from long-term lack of sleep. Some people might have pain that doesn’t get better at night, meaning that they sleep for a shorter time and may spend more time awake. Lack of sleep can affect people in different ways and some people may experience a heightened sensitivity to pain.

Pain can make you feel stressed, anxious, or depressed so it’s important to speak to your GP if pain is affecting your sleep. Your GP may wish to review your medication, advise pain management strategies, or refer you to a specialist pain service. 

Hypersomnia also known as excessive daytime sleepiness, is a condition where people fall asleep repeatedly during the day. There are several things that could cause hypersomnia, including pre-existing medical conditions such as sleep apnoea, RLS, narcolepsy or depression. Certain medicines, drinking too much alcohol and taking recreational drugs also cause hypersomnia. Hypersomnia is different from feeling tired all the time. If you have hypersomnia, you might:

• Have regular naps during the day

• Fall asleep during the day

• Sleep for long hours at night despite the above

It’s advisable to speak to your GP if:
• You fall asleep during the day a lot

• Sleepiness is having an effect on your life

At your GP appointment, they might:

• Suggest you log your sleeping patterns in a diary

• Refer you to a doctor who specialises in sleep disorders

• Ask about any medications you’re taking or any pre-existing mental or physical health conditions 

Lifestyle changes may not cure your hypersomnia, but they might help you feel better. You can try:

• Going to bed at the same time every night

• Avoid drinking alcohol and caffeine 

• Create a peaceful sleeping environment

• If possible, avoid medicines that can make you drowsy

• Avoid working late into the night 

It’s important to note that if you’re diagnosed with hypersomnia, you’ll need to tell the DVLA and you might not be able to drive.

Narcolepsy is a rare long-term brain condition that can stop someone from choosing when to wake up or go to sleep. This means that the brain can’t regulate sleeping and waking patterns normally. This can result in:

• Hypersomnia

• Sleep attacks — falling asleep suddenly without warning

• Cataplexy — temporary loss of muscle control which can make you weak or cause you to collapse

• Sleep paralysis — a temporary inability to move or speak when waking up or falling asleep

• Excessive dreaming and waking up at night

Narcolepsy doesn’t cause serious or long-term problems, but it can impact daily life and be hard to cope with emotionally. A lack of the brain chemical which regulates being awake (hypocretin) can often cause narcolepsy. This lack of hypocretin may be caused by the immune system not working properly, but this doesn’t explain all cases of narcolepsy.

Potential triggers of narcolepsy include:

• Hormonal changes which can happen during puberty or the menopause

• Major psychological stress

• Infections like swine flu, or the swine flu vaccination

Many cases of narcolepsy are unreported so it’s difficult to know how many people have it. It’s estimated that about 30,000 people in the UK have it. It’s thought to affect men and women equally, but some studies have suggested it might be more common in men. Symptoms often start during the teenage years, but it’s usually diagnosed between age 20 and 40. 

If you think you have narcolepsy, it’s important to speak to your GP so you can talk about your symptoms and sleeping habits. If needed, you’ll be referred to a sleep specialist and your sleep patterns will be analysed. 

There’s no cure for narcolepsy at the moment, but lifestyle changes might help to minimise its impact on your quality of life. Keeping to a strict bedtime routine and taking frequent, brief naps is one of the best ways to manage excessive daytime drowsiness. If you’re really struggling with your symptoms, you might be prescribed medication to prevent cataplexy attacks and help improve the quality of your sleep.

If you are diagnosed with narcolepsy, you must tell the DVLA as it can affect your ability to drive.