Sleep disorders go beyond insomnia

Almost one in ten people in the UK ask their doctor for sleeping tablets, but sleep disorders go beyond insomnia and can have wide-ranging consequences on health, as Liz Bestic reports

According to sleep experts, one in four adults are walking around like zombies feeling like death warmed up as a result of disrupted sleep.

Sleep disorders range in severity from snoring and insomnia to restless leg syndrome and obstructive sleep apnoea, and are far more common than people think.

Some 40 per cent of the UK adult population snore and around 30 per cent suffer from insomnia, either finding it hard to fall asleep and stay asleep or waking up too early still feeling tired. There are no specific triggers for insomnia, but traumatic events, injury, loss of a loved one or difficulties at work can all contribute.

As we get older, the risk of insomnia increases and 50 per cent of people over 65 will suffer from it at some time, according to private healthcare providers Bupa. More women suffer from insomnia than men.

A crammed lifestyle can make it a struggle to strike an effective work-life balance and this causes many of us to go short of precious sleeping time. Yet this trend could be a health time bomb.

Scientists believe that, if we sleep less than six hours a night and have disturbed sleep, we stand a 48 per cent greater chance of dying from heart disease and a 15 per cent greater chance of developing or dying from a stroke. So our work-hard, play-hard society encourages us to sacrifice sleep to the detriment of our health.

The numbers are worrying. More than 3.5 million of us suffer from excessive sleepiness, usually caused by poor sleep, which most people blame on the pressures of a 24/7 society. Occasional nights of disrupted sleep won’t harm our health, but the corrosive mental impact increases as it becomes a trend.

Difficulty concentrating and poor decision-making, described as brain fog by some, follow and some people can nod off during the day risking injury at work, on the road or in the home.

Conversely, too much sleep – hypersomnia – can also derail health. Oversleeping can result in extreme sleepiness through the day, which causes anxiety, reduced energy and memory issues. Studies in the United States indicate that people sleeping more than nine hours a night are 50 per cent more likely to get diabetes than those sleeping seven hours a night, giving it a similar risk profile as undersleeping.

Some people just love sleeping, but for others it could be a sign of underlying health problems caused by poor diet and lifestyle. The Mental Health Foundation says oversleeping occurs in up to 40 per cent of those with depression.

Occasional nights of disrupted sleep won’t harm our health, but the corrosive mental impact increases as it becomes a trend

Sleep disorders are a major contributing factor to fatal road accidents, heart disease, strokes, absenteeism, lost productivity and the breakdown of marriages, so their impact should not be underestimated.

Most people elect to soldier on, but there is help. GPs can chart a “sleep history” to detect behaviour patterns that can be changed to encourage better regimes. Sleeping tablets are sometimes prescribed in the short term, but GPs mostly believe this does not treat the cause. Chronic insomnia sufferers – problems lasting more than a month – may be treated with cognitive behavioural therapy to break the sleepless cycle.

Alternative therapies, such as acupuncture, have been shown in clinical trials to improve sleep quality and several studies have shown that regular meditation, either alone or as part of a yoga session, for example, results in higher blood levels of melatonin, which is an important regulator of sleep.

Self-help steps, such as abstaining from caffeine and alcohol six hours before bedtime, mentally switching off from work and creating a calming environment can help recalibrate sleep patterns.

But there are more serious sleep disorders including restless leg ayndrome (RLS) and sleepwalking. RLS, which can be triggered by anaemia or iron deficiency, can cause misery with severely disrupted sleep, while sleepwalking carries the risk of injuries. Sleepwalking normally involves episodes that last some ten minutes, but extreme cases have involved people leaving their houses and driving cars.

By far the most serious condition is obstructive sleep apnoea (OSA) which, if left untreated, can be life threatening. OSA occurs when some locations in the upper airway, from nose to windpipe, become blocked. This may be due to large tonsils, the muscles of the soft palate at the base of the tongue and the uvula (the small fleshy piece of tissue hanging at the back of the throat) relaxing or the tongue flopping backwards. Potential obstructions become more frequent with age.

OSA is usually seen in loud snorers who, while asleep, may stop breathing for between ten and twenty five seconds at a time, depriving the bloodstream and brain of vital oxygen. The brain responds by sending a signal to the snorer to wake up and people with OSA often come round struggling to breathe and gasping for air. Severe sufferers may experience 30 or more such events every hour.

“Having OSA is like being regularly strangled during sleep,” says Professor Ram Dhillon, of Northwick Park Hospital, London, an ear, nose and throat expert with a special interest in snoring and sleep apnoea. “The sufferer’s body goes into fight or flight mode pumping out adrenaline into the blood stream, raising the heart rate and increasing the risk of heart attack, irregular heartbeat and hypertension.

“Many patients with hypertension are treated with beta blockers when the root of the problem may be their sleep pattern and they probably don’t need to be on expensive drugs.”

A recent Dutch study in the European Journal of Preventative Cardiology showed that good quality sleep could reduce 57 per cent of heart-related deaths each year. It looked at the risk of chronic disease in 14,000 people over a 12-year period and showed that poor sleep is as important a risk factor for cardiovascular disease as other lifestyle factors, such as being overweight or smoking.

Around 90 per cent of patients seen at London’s Royal Brompton Centre for Sleep suffer from OSA, which is on the increase as the population gets heavier and less active. Untreated cases of OSA are costing the NHS £432 million a year, according to the Sleep Alliance.

The presence of long-term OSA is detrimental to the brain as well as the heart, research at Imperial College London is beginning to show. “Fragmented sleep plus low oxygen levels at night caused by OSA can potentially accelerate memory loss,” says Professor Mary Morrell, a sleep and respiratory physiology expert at Imperial College London, who is working on a study into sleep deprivation and cognitive decline in older patients.

But Dr Mathew Hind at the Royal Brompton emphasises that sleep disorders can be treated. “They can have a serious effect on people’s lives as they become accustomed to feeling unrefreshed when they wake up and generally sleepy during the day,” he says. “Yet once treated, people improve dramatically.”



Around 3.5 million people in the UK suffer frequent nights of disturbed sleep due to snoring.

Far from a joke, snoring can affect many aspects of life if left untreated. It can cause excessive tiredness and poor concentration as well as relationship problems.

Snoring occurs because of the vibration generated as air rushes past the tissues of the mouth, nose and throat.

Most people picture snorers as overweight, beer-drinking males. Yet snoring is not confined to men. Older women and children also snore. In fact, after the menopause women catch up with their male counterparts in the snoring stakes.

Snoring can be caused by a number of factors. Being overweight often means you have extra fat around the throat, which can stop air flowing smoothly during breathing. Sleeping on the back also causes the tongue to fall back into the throat narrowing the airway.

Colds and allergies can trigger snoring as suffers end up breathing through the mouth. Drinking too much alcohol or taking sleeping tablets can cause the throat muscles to relax and create blockages.

People with respiratory disorders, such as asthma and chronic obstructive pulmonary disorder are also more prone.

Lifestyle changes, such as losing weight, can sometimes improve the problem. There are also a range of anti-snoring devices, such as mouth guards and nasal strips.