Defining Dyssomnia
Dyssomnias are a category of sleep disorders marked by issues in falling asleep, staying asleep, or excessive sleepiness during waking hours. Unlike parasomnias (which involve unusual behaviors during sleep), dyssomnias primarily affect sleep duration, sleep onset, and sleep continuity.
In the International Classification of Sleep Disorders (ICSD-3), dyssomnias are grouped under disorders of initiating and maintaining sleep (DIMS) and disorders of excessive sleepiness (DOES).
A 2023 systematic review in Sleep Medicine Reviews reported dyssomnias as a growing public health concern, contributing to impaired cognitive function, mood disturbances, and increased risk for chronic illnesses like hypertension and diabetes.
Types of Dyssomnias
There are three primary groups of dyssomnias:
Intrinsic Sleep Disorders
These originate from internal physiological or psychological factors, including:
- Insomnia Disorder: Chronic difficulty falling or staying asleep.
- Narcolepsy: Excessive daytime sleepiness, sudden sleep attacks, and sometimes cataplexy (sudden muscle weakness).
- Idiopathic Hypersomnia: Persistent daytime sleepiness without clear cause.
- Restless Legs Syndrome (RLS): Urge to move legs, often worsening at night.
Extrinsic Sleep Disorders
These result from external factors:
- Poor Sleep Hygiene: Irregular sleep schedules, excessive screen time, caffeine use.
- Environmental Sleep Disorder: Noises, light, or temperature disrupting sleep.
- Altitude Insomnia: Sleep disturbances at high altitudes.
Circadian Rhythm Sleep-Wake Disorders
These disorders involve a misalignment between a person’s internal clock and external environment:
- Delayed Sleep Phase Disorder: Falling asleep and waking much later than socially acceptable.
- Shift Work Sleep Disorder: Insomnia and sleepiness due to night shifts or rotating schedules.
- Jet Lag Disorder: Sleep issues following rapid travel across time zones.
Symptoms and Diagnosis
Symptoms vary based on the dyssomnia subtype but often include:
- Difficulty falling asleep or frequent awakenings.
- Daytime fatigue or excessive sleepiness.
- Irritability, anxiety, or mood changes.
- Reduced focus or memory issues.
- Decreased performance at work or school.
Diagnosis typically involves:
- Detailed sleep history.
- Sleep diaries or questionnaires.
- Polysomnography (sleep study) for complex cases.
- Actigraphy, which tracks movement patterns during sleep.
The American Academy of Sleep Medicine emphasizes early diagnosis to prevent long-term health consequences.
Causes and Risk Factors
Dyssomnias can stem from:
- Stress and Anxiety: Heightened cortisol disrupts sleep architecture.
- Lifestyle Habits: Irregular sleep times, excessive screen exposure, stimulants.
- Genetics: Narcolepsy and certain circadian disorders have genetic links.
- Medical Conditions: Pain disorders, neurological diseases, hormonal imbalances.
- Medications: Some antidepressants, steroids, or stimulants can disrupt sleep.
A 2024 analysis in The Lancet Neurology highlighted how modern life, particularly constant digital engagement, significantly increases dyssomnia prevalence.
Treatment Options
Treatment depends on the underlying disorder:
- Cognitive Behavioral Therapy for Insomnia (CBT-I): Proven first-line treatment for chronic insomnia.
- Medications: Hypnotics for short-term use, wake-promoting agents for narcolepsy.
- Light Therapy: Used for circadian rhythm disorders.
- Sleep Hygiene Education: Limiting caffeine, creating a consistent sleep schedule, reducing screen time before bed.
- Lifestyle Changes: Regular exercise (not too close to bedtime), mindfulness practices, and stress management.
Experts caution against relying solely on sleeping pills due to risks of dependency and side effects.
