What Tests Are Used to Diagnose Sleep Disorders?

The International Classification of Sleep Disorders (ICSD) includes seven major categories of sleep disorders and symptoms depend on the particular sleep disorder.

Insomnia is the most common type of sleep disorder that involves problems falling asleep or staying asleep despite adequate opportunity to do so. Symptoms of insomnia include: 

• Difficulty falling asleep or staying asleep
• Variable sleep
• Daytime fatigue or sleepiness
• Inability to concentrate
• Forgetfulness
• Irritability
• Depression
• Anxiety
• Decreased motivation or energy
• Persistent worry about sleep
• Increased errors or accidents

Sleep-related breathing disorders are characterized by abnormal breathing during sleep and include disorders such as sleep apnea. Symptoms of sleep-related breathing disorders include:

• Morning headache
• Loud snoring
• Fatigue
• Daytime sleepiness
• Awakening with choking, gasping, or smothering
• Awakening unrested, groggy
• Restless sleep
• Dry mouth or sore throat
• Frequently waking to urinate
• Low energy
• Memory problems
• Difficulty concentrating
• Dry mouth or sore throat

Central disorders of hypersomnolence are characterized by a primary complaint of daytime sleepiness that is not due to another sleep disorder. Narcolepsy is a type of hypersomnolence sleep disorder. Symptoms of central disorders of hypersomnolence include:

• Excessive daytime sleepiness (EDS)
• Sudden muscle weakness (cataplexy)
• Frequent short naps during the day
• Transitioning from being awake to being asleep (hypnagogic hallucinations)
• Sleep paralysis
• Difficulty sleeping at night 
• Night-time compulsive behaviors such as eating and nocturnal smoking 
• Obesity

Circadian rhythm sleep-wake disorders are characterized by a chronic or recurrent sleep disturbance due to changes in the patient’s circadian system or misalignment between the environment and an individual's sleep-wake cycle. Types of circadian rhythm disorders include shift work disorder and jet lag disorder. Symptoms of circadian rhythm sleep-wake disorders include:

• Extreme daytime sleepiness
• Insomnia (see above)
• Decreased alertness
• Tiredness
• Problems with memory and decision-making
• Headache

Parasomnias are undesirable physical events (movements or behaviors) or experiences (emotions, perceptions, dreams) that occur during sleep such as sleepwalking, sleep terrors, sleep-related eating disorder, and sleep paralysis. Symptoms of parasomnias include:

• Sleepwalking 
• Night terrors
• Sleep talking
• Act in a way that is strange and confused on waking up
• Acting out vivid dreams in your sleep: may be violent and can cause injury to the patient
• Nightmares
• Sleep paralysis
• Bedwetting (enuresis)
• Groaning
• Hearing a loud imaginary noise just before falling asleep or awakening
• Binge eating and drinking in the night with minimal or no memory of the binge

Sleep-related movement disorders are characterized by movements that disturb sleep. Some types of sleep-related movement disorders include restless legs syndrome, sleep-related cramps, and sleep-related bruxism (teeth grinding). Symptoms of sleep-related movement disorders include:

• Overwhelming urge to move the legs
• Itchy, crawling, burning, creepy, throbbing sensation in the legs
• Trouble sitting still for long periods of time
• Daytime sleepiness
• Irritability
• Memory problems 
• Short attention span 
• Fatigue
• Depression 
• Anxiety

Treatment for sleep disorders depends on the specific disorder.

Treatment for insomnia includes:

• Sleep hygiene 
• Relaxation exercises 
• Cognitive behavioral therapy for insomnia (CBT-I)
• Sleep restriction or sleep compression  
• Sleep education 
• Stimulus control 
• Sleep medications, both over-the-counter (OTC) and prescription

Treatment for sleep-related breathing disorders includes:

• Continuous positive airway pressure (CPAP) 
• Weight loss
• Avoiding alcohol and other sedatives 
• Adjusting sleep position (to stay off the back) 
• Dental devices 
• Surgery

Treatment for central disorders of hypersomnolence includes:

• Behavior changes
• Medications
  • Stimulants
  • Medications to treat cataplexy
  • Histamine H3 antagonists/inverse agonists 

Treatment for circadian rhythm sleep-wake disorders includes:

• Light therapy
• Light restriction (dark therapy)
• Sleep deprivation/phase advance
• Chronotherapy
• Medicines to help with falling asleep or staying awake
• Healthy lifestyle changes including steps to improve sleep habits

Treatment for parasomnias includes:

• Creation of safe environment
• Education to avoid triggers 
• Stopping medications that may be causing the problem such as serotonergic antidepressants for rapid eye movement (REM) sleep behavior disorder (RBD) or short-acting hypnotics for complex sleep-related behaviors 
  • Do not stop taking a prescribed medication without first talking to your doctor
• Medications
  • Melatonin 
  • Clonazepam
  • Dopamine agonists
  • Alpha-2-delta calcium channel ligands
  • Medications used to treat restless legs syndrome

Treatment for sleep-related movement disorders includes:

• Exercise
• Stress reduction techniques
• Behavioral changes
• Not smoking 
• Reducing or avoiding caffeine and alcohol consumption
• Massaging legs or soak in a hot bath
• Medications
  • Sleeping pills
  • Parkinson's disease medications
  • Certain anti-seizure medications
  • Narcotic pain medications
  • Iron treatment