Sleep disorders

What are sleep disorders?

People with sleep disorders have difficulty getting to sleep, they stay awake for long periods, or they wake up too often or too early, as a result of which they do not feel fit the next day.

 

Sleeplessness can have many different causes, such as stress, suddenly stopping drinking or taking sleeping pills, excessive use of caffeine products or alcohol, excessive smoking, physical discomfort (such as itching, pain, thirst, heartburn, coughing, urination, tightness in the chest, night sweats, palpitations), chronic somatic conditions, some medication, and certain psychiatric conditions (such as anxiety disorder, mania or psychosis).

 

Specific sleep disorders include the following:

 

  • Restless legs syndrome
  • Sleep apnoea (OSAS: obstructive sleep apnoea syndrome): more than five ten-second pauses in breathing during one hour when sleeping (risk factors are overweight, COPD and diabetes)
  • Narcolepsy: neurological abnormality involving an overwhelming need to sleep during the day even after enough sleep at night
  • Delayed sleep phase syndrome (DSPS): an individual's biological clock is not synchronised with those of others; the affected individual goes to sleep very late and finds it difficult to get up in the morning
  • Parasomnia: unusual behaviour during sleep like sleepwalking, talking in one's sleep, nightmares and anxiety attacks at night


Somebody who falls asleep regularly during the day may be suffering from chronic sleep deprivation, sleep apnoea syndrome, narcolepsy, depression or certain neurological conditions. 497

 

What are the complaints associated with a sleep disorder?

Sleep disorders may be accompanied by: fatigue, sleepiness, irritability, restlessness, concentration problems, forgetfulness. If sleeplessness persists, the following symptoms may be seen: headache, low energy levels, weight gain, feeling of illness or malaise, fatigue, apathy, depression. In people who are particularly susceptible, such as elderly people, people with dementia, sensory disorders or polypharmacy, severe sleep deprivation is associated with an increased risk of delirium: a reduction in consciousness involving disorientation, delusions and hallucinations, usually with, but sometimes without, agitation. 157 .


The sleep apnoea syndrome (OSAS) results in additional symptoms: high blood pressure and a possible relationship between OSAS, cardiovascular morbidity and cardiovascular mortality. 158


There is a proven correlation between increased irritability and severe sleep problems in people with intellectual disabilities. 159 , 160
There is also a proven link between sleep disorders and behaviour problems but the causal relationship is unclear because the studies in this area have been exclusively cross-sectional. 160

 

How common are sleep disorders in the general population?

Twenty to thirty percent of adults have problems sleeping. Only 10 to 15% of them consult a doctor. Sleep problems become more prevalent with age. Sleeplessness is twice as common in women as in men. The lifetime prevalence of sleep apnoea syndrome after the age of 35 years is thought to be at least 0.45%. 161


US research found a prevalence for sleep apnoea syndrome in 4% of men and 2% of women in the 30 to 60 age category. 158

 

How common are sleep disorders in people with intellectual disabilities?

Sleep problems are common in people with intellectual disabilities, although the rates found vary quite widely: from 15% to 88% depending on the study design, the characteristics of the group studied, and the definition of sleep disorders. Severe sleep disorders are seen in 9.2%. 162


A Dutch study of older people with intellectual disabilities found that 72% had at least one sleep problem and that 12% had more than one sleep problem (difficulty getting to sleep, interrupted sleep, short sleep or waking up early). 163


A large Australian survey of 2540 people with intellectual disabilities (in which questionnaires were answered by carers and parents) found that 43% of the study sample had sleep problems. 164


A UK cohort study in the open population looking at 1023 adults with intellectual disabilities found a one-month prevalence rate for sleep problems of 9.2%. The sleep problems were identified with the PAS-ADD. The risk factors were the presence of a psychiatric disorder, behaviour problems and lung problems. 165


A study of 155 adults with intellectual disabilities in the UK found a prevalence rate of 17% for difficulty getting to sleep and 11% for difficulty sleeping through. 166

The factors associated with a sleep disorder in people with intellectual disabilities are: behaviour problems, psychiatric conditions, autistic spectrum disorder, severe intellectual disability, blindness, spasticity, incontinence, respiratory problems and/or lung diseases, nutritional problems, epilepsy, acid reflux, constipation, the use of benzodiazepines and the use of anti-epileptics, and medication to control behaviour (psychotropic medication and antidepressants). Non-pharmacological interventions have proven effective. 162


Sleep problems are also common in the following syndromes: Angelman syndrome, Down syndrome, fragile-X syndrome, Smith Magenis syndrome, Sanfillipo syndrome, tuberous  sclerosis complex (TSC), Prader Willi syndrome, Williams syndrome. 167
Sleep apnoea (OSAS) is common in people with Down syndrome. A study of 108 children between 1 and 18 years found a prevalence rate of 55%. Risk factors were male gender and enlarged tonsils. Body weight did not affect the prevalence. 168
In another study of 65 children with Down syndrome aged 2 to 4 years, 75% had OSAS. 169


A study of 16 adults with Down syndrome found that 94% had OSAS with an average interruption of breathing 37 times an hour. 170  

20% to 30% General population
15% to 88% People with intellectual disabilities

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