Sleep disorders: main types, tests and treatment

NICE Clinical Knowledge Summaries stress that other sleep disorders, such as obstructive sleep apnoea, restless legs syndrome and parasomnias, should be considered when someone presents with insomnia, because they often coexist. A single complaint of poor sleep may therefore have several layers.

The table below summarises the four conditions this page covers, using NHS descriptions.

The NHS says you have insomnia if you regularly find it hard to get to sleep, wake several times, lie awake, wake early, feel tired after waking or struggle to concentrate in the day. Clinical Knowledge Summaries add that disturbed sleep without daytime impairment is not counted as insomnia disorder.

The NHS lists common causes: stress, anxiety or depression, noise, a room that is too hot or cold, an uncomfortable bed, alcohol, caffeine or nicotine, illegal drugs, jet lag and shift work. Conditions that can contribute include restless legs, an overactive thyroid and menopause, and many medicines.

Short-term insomnia often accompanies stressful events or illness. Chronic insomnia often coexists with anxiety, depression, pain and other long-term conditions, say the summaries, and can work in both directions.

Sleep apnoea is when breathing stops and starts during sleep. The NHS lists gasping, snorting or choking noises, loud snoring and daytime tiredness. See our dedicated page for testing and CPAP.

Restless legs syndrome is a strong urge to move the legs, usually when resting at night, with tingling, throbbing, itching or pain. The NHS says treatment depends on the cause. For example, iron supplements may help if iron is low, and doctors may review medicines that make it worse. Pregabalin, gabapentin and dopamine-raising medicines can be used.

Narcolepsy is a rare condition in which the brain cannot control sleeping and waking normally. The NHS lists daytime sleepiness, suddenly falling asleep, cataplexy, disturbed night sleep, sleep paralysis and vivid dreams. Symptoms usually start in children and young adults.

For insomnia, Clinical Knowledge Summaries recommend a thorough history and a sleep diary kept for 1 to 2 weeks to show patterns and lifestyle factors. Referral to a sleep clinic or neurology may be needed if another sleep disorder is suspected, the diagnosis is uncertain, or chronic insomnia has not responded to primary care.

For narcolepsy, the NHS says a sleep specialist asks about symptoms and habits. Tests may include polysomnography, which measures breathing, brain activity, heart rate and movement overnight, a multiple sleep latency test to see how quickly you fall asleep, and sometimes a lumbar puncture. Results divide narcolepsy into type 1 or type 2.

For suspected sleep apnoea, overnight devices record breathing and heartbeat, and results are summarised by an AHI score.

The NHS suggests getting up at the same time every day, going to bed only when sleepy, relaxing for an hour beforehand, keeping the room dark and quiet, exercising regularly and avoiding caffeine, alcohol, big late meals, daytime naps and screens close to bedtime. The Every Mind Matters guidance adds that if you are still awake after about 20 minutes, get up and do something relaxing until you feel sleepy.

Clinical Knowledge Summaries recommend CBTi as first-line treatment for both short and chronic insomnia and say hypnotic medicines should be avoided where possible. A short course of 3 to 7 days of a z-drug may be considered for severe short-term insomnia likely to resolve soon, and they should be avoided if possible in older people.

The NHS says pharmacy sleep aids, including valerian, lavender or antihistamine products, may help for 1 to 2 weeks at most, and can cause drowsiness.

The NHS says narcolepsy needs to be reported to the DVLA if you drive. GOV.UK says the same for any sleep condition causing excessive sleepiness for at least 3 months. The NHS also advises not driving when you feel sleepy and avoiding home or work tasks that would be dangerous if you fell asleep or lost muscle control suddenly.

GPs manage most insomnia, using self-help and CBTi, including online programmes. Sleep clinics on the NHS assess suspected apnoea, narcolepsy and complex cases, with waits that vary.

Private sleep clinics offer consultations, home sleep studies and overnight polysomnography. Which test is right depends on the suspected disorder, so a clinician should choose it.