Sleep and Circadian Disturbances and Disorders: Resources and Tips for Health Professionals

An estimated 50–70 million Americans suffer from a sleep or circadian (the body’s natural 24-hour cycle) disorder. Sleep deficiency and untreated sleep disorders can add an immense burden to individuals and society by raising the risk of long-term health problems, including heart disease, stroke, diabetes, obesity, and other diseases and conditions. Untreated sleep disorders are also associated with a greater risk of injuries in the workplace, car accidents, and falls in the elderly.

The Magnitude of Sleep and Circadian Disturbances and Disorders

Sleep and circadian disturbances and disorders affect an estimated 25–30 percent of children, adolescents, and adults in the United States. When you combine the number of people who have chronic sleep deficiency and circadian disruption as a result of increasingly demanding schedules with those who are affected by the more than 90 clinically defined sleep disorders, it should come as no surprise that sleep deficiency among Americans is pervasive, and its incidence is much higher than inferred from clinical data.

• 70 percent of adults report that they obtain insufficient sleep or rest at least once each month, and 11 percent report insufficient sleep or rest every day of the month.
• 65 percent of Americans report frequent sleep problems, such as difficulty falling asleep, waking during the night, and waking feeling unrefreshed.
• Obese adults are 40–70 percent more likely to experience periods of insufficient sleep or rest.
• Nearly 70 percent of high school adolescents sleep less than the recommended 8–9 hours on school nights. Teens who routinely sleep less than 5 hours a night are 4–6 times more likely to attempt suicide.
• A third of Americans report falling asleep unintentionally during the day once per month, and 5 percent report falling asleep while driving each month.
• 15–25 percent of U.S. adults experience symptoms of sleep-disordered breathing. Symptoms are 2–3 times more prevalent among adults with heart disease, diabetes, or obesity, and among the elderly.
• More than 1 in 20 adults have restless legs syndrome.
• Approximately 1 in 250 adults is affected by REM sleep behavior disorder.
• About 1 in 2,000 people has narcolepsy/cataplexy and other forms of hypersomnia.

Health Risks Associated With Sleep and Circadian Disturbances and Disorders

Unfortunately, the health consequences of sleep disorders can be extensive and serious:

• Sleep-disordered breathing, including obstructive sleep apnea, is associated with an increased risk of heart attack, stroke, and mortality in adults. In children, sleep-disordered breathing is associated with cardiovascular and metabolic risk factors, attention-related behavioral problems, and poor academic performance.
• Chronic insomnia is a risk factor for depression and substance abuse.
• REM sleep behavior disorder is associated with an increased risk of Parkinson’s disease and other neurodegenerative conditions.
• Chronic circadian disruptions and disorders, such as shift work syndrome and delayed sleep phase disorder, are associated with an increased risk of cardiovascular disease, cerebrovascular disease, breast cancer, colorectal cancer, prostate cancer, obesity, diabetes, and gastrointestinal disease.

Research on Sleep and Circadian Disturbances and Disorders

Building on scientific advances that link sleep problems to health and safety risks, the National Institutes of Health (NIH) recently published the 2011 NIH Sleep Disorders Research Plan. The plan identifies research opportunities to be pursued over the next 3 to 5 years to spur new approaches to the prevention and treatment of sleep disorders. The plan expands on previous and current research programs identified in the 1996 and 2003 plans.

The research plan outlines five key goals:

1. Advance the understanding of sleep and circadian functions and of basic sleep and circadian mechanisms, in both the brain and the body, across the lifespan.
2. Identify genetic, pathophysiological, environmental, cultural, and lifestyle factors, and sex and gender differences, contributing to the risk of sleep and circadian disorders and disturbances, and their role in the development and pathogenesis of comorbid diseases and disability.
3. Improve the prevention, diagnosis, and treatment of sleep and circadian disorders, chronic sleep deficiency, and circadian disruption, and evaluate the resulting impact on human health.
4. Enhance the translation and dissemination of sleep and circadian research findings and concepts to improve health care, inform public policy, and increase community awareness to enhance human health.
5. Enable sleep and circadian research training to inform science in cross-cutting domains, accelerate the pace of discovery, and spur the translation of enhanced therapies from bench to bedside to community.

Clinical Trial Participation

Clinical trials are research studies that explore whether a medical strategy, treatment, or device is safe and effective for humans. These studies also may show which medical approaches work best for certain illnesses or groups of people. Clinical trials produce the best data available for health care decisionmaking.

Clinical trials are a key research tool for advancing medical knowledge and patient care. Currently, numerous studies on sleep and circadian disturbances and disorders are enrolling participants, including individuals with Alzheimer’s disease, cancer, chronic migraine, osteoarthritis, restless legs syndrome, or sleep apnea. There are also clinical trials for combat veterans with post-traumatic stress disorder (PTSD), for adults who smoke and have sleep problems, and for children with autism who have sleep disturbances.

Health care providers can encourage and guide patients to enroll in clinical trials. Individuals can talk with their doctors about relevant clinical trials near them.

Key Steps for Health Professionals

Many common sleep disorders go unrecognized and therefore go untreated. Health professionals should consider asking patients about the quality of their sleep. Further evaluation by a sleep disorder specialist may be warranted in patients who report signs and symptoms of sleep disorders.

Individuals may have a sleep disorder if they have any of the below common signs on three or more nights a week:

• Take more than 30 minutes to fall asleep at night.
• Awaken frequently in the night and then have trouble falling back to sleep again.
• Awaken too early in the morning.
• Often don’t feel well rested despite spending 7–8 hours or more asleep at night.
• Feel sleepy during the day and fall asleep within 5 minutes if given the opportunity to nap, or fall asleep unexpectedly or at inappropriate times during the day.
• Have creeping, tingling, or crawling feelings in their legs that are relieved by moving or massaging them, especially in the evening and when they try to fall asleep.
• Have vivid, dreamlike experiences while falling asleep or dozing.
• Have episodes of sudden muscle weakness when they are angry or fearful, or when they laugh.
• Feel as though they cannot move when they first wake up.
• Regularly need to use stimulants to stay awake during the day.
• Have a bed partner who notes that their legs or arms jerk often during sleep.
• Have a bed partner who claims they snore loudly, snort, gasp, or make choking sounds while they sleep, or who notices that their breathing stops for short periods.

People who have signs and symptoms of sleep disorders or feel burdened by excessive daytime sleepiness should consult their health care provider for advice.

Popular NHLBI Materials

• Your Guide to Healthy Sleep (newly updated 64-page patient and public booklet)
• In Brief: Your Guide to Healthy Sleep (4-page fact sheet)
• NHLBI Health Topics: Insomnia, Narcolepsy, Restless Legs Syndrome, Sleep Apnea, Continuous Positive Airway Pressure (CPAP), Sleep Studies
  

NHLBI Resources

• 2011 NIH Sleep Disorders Research Plan
• National Center on Sleep Disorders Research
• Sleep Disorders Research Advisory Board
• Updated NIH Sleep Disorders Research Plan Seeks To Promote and Protect Sleep Health(NIH news release, November 9, 2011)
• Sleep Apnea Tied To Increased Risk of Stroke—Even Mild Sleep Apnea Puts Men in Danger (NIH news release,
  April 8, 2010)
• Media Availability: Severe Sleep Apnea Tied To Increased Risk of Death (NIH news release, August 17, 2009)

Other Resources

• Leading Health Indicators for Healthy People 2020—Letter Report (Institute of Medicine)
• Healthy People 2020 (U.S. Department of Health and Human Services)
• Sleep and Sleep Disorders: Data and Statistics (Centers for Disease Control and Prevention)
• ClinicalTrials.gov, Sleep Studies
• Morbidity and Mortality Weekly Report (MMWR): Unhealthy Sleep-Related Behaviors—12 States, 2009.

November 2011