Differential Diagnosis of Sleep Disorders in Adults (Podcast)

Approximately 40% of American adults get six hours or less of sleep a night, which is significant sleep deprivation. That can lead to medical and psychiatric illnesses, as well as social issues.

“We need sleep to restore every cell in every organ of our body, and the lack of sleep is having long-term consequences,” says Nancy Foldvary-Schaefer, DO, MS, Director of the Sleep Disorders Center and a staff neurologist in the Epilepsy Center at Cleveland Clinic. “Sleep care becomes a part of brain health over the long haul.”

In the latest episode of Cleveland Clinic’s Neuro Pathways podcast, Dr. Foldvary-Schaefer discusses differential diagnosis of sleep disorders in adults. She talks about:

• The six major categories of sleep disorders
• The diagnostic workup for sleep disorders
• Common treatments, including medications and behavioral therapies
• Guidelines for eating, exercising and drinking caffeine close to bedtime
• Clinical trials of investigational therapies for sleep apnea and narcolepsy

Click the podcast player above to listen to the 25-minute episode now, or read on for a short edited excerpt. Check out more Neuro Pathways episodes at clevelandclinic.org/neuropodcast or wherever you get your podcasts.

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Excerpt from the podcast

Podcast host Glen Stevens, DO, PhD: I would imagine that most of us have experienced difficulty with sleep at some point, on and off, for many different reasons. But when does it really become a sleep disorder?

Dr. Foldvary-Schaefer: Most sleep disorders are diagnosed when the symptoms have lasted at least three months. So, for example, most adults have had a night or two of insomnia at some point in their lives — just traumatic life events or whatever the case may be, major stressors — and have trouble sleeping. But when that happens on a regular basis, say three nights a week for at least three months, we would consider that a chronic insomnia problem.

The vast majority of adults have had nights of insomnia, and 10% of adults have chronic insomnia. Almost 30% of adults have sleep apnea. Those are the two most common sleep disorders, but there are four other major categories of disorders that most people don’t even recognize that can also have significant morbidity.

Dr. Stevens: Please share those with us.

Dr. Foldvary-Schaefer: There are circadian rhythm disorders, the hypersomnias, sleep-related movement disorders and the parasomnias. To explain, the hypersomnias are narcolepsy and related disorders; the primary sleep-related movement disorder is restless legs syndrome; and the parasomnias include REM behavior disorder and the non-REM parasomnias, which may be a bit more benign than REM behavior disorder.

Some of these disorders we now recognize are intimately associated with neurological conditions. This is why it’s useful for neurologists to have a sense of how to take a sleep history, or at least how to recognize the big disorders. These include severe hypersomnia, which can coexist in the form of narcolepsy or a medically induced hypersomnia in some patients with neurological conditions, and REM behavior disorder, because of its association with subsequent development of the synucleinopathies, which is now a well-established phenomenon.

So, sometimes in the sleep center, sleep doctors see REM behavior disorder and refer to our colleagues in cognitive neurology or movement disorders when we begin to see or hear about other signs and symptoms of neurological disease, because often this will be a progression into a clearly defined neurological disease.