At a glance
What it is
Sleep disorders fall into two broad categories: primary (not caused by another medical or psychological condition) and secondary (caused by an underlying condition such as depression, thyroid disease, or chronic pain). Primary disorders are further subdivided into dyssomnias (disrupted sleep quantity or quality) and parasomnias (abnormal behaviours during sleep). Dyssomnias are the most clinically significant group — they encompass sleep apnoea, restless legs syndrome, periodic limb movements, and the various forms of insomnia.
Symptoms
Difficulty falling asleep (sleep onset insomnia) or maintaining sleep (sleep maintenance insomnia). Non-restorative sleep — waking unrefreshed. Excessive daytime sleepiness or fatigue impairing concentration, mood, and function. In sleep apnoea: witnessed apnoeas, loud snoring, morning headaches. In restless legs syndrome: an irresistible urge to move the legs, worse at night and at rest, relieved by movement. In periodic limb movement disorder: repetitive leg jerks during sleep causing arousals (often reported by a bed partner).
Approach
Sleep hygiene and cognitive behavioural therapy for insomnia (CBT-I) are first-line treatments for primary insomnia. CPAP therapy for obstructive sleep apnoea. Dopaminergic agents (pramipexole, ropinirole) or alpha-2-delta ligands (gabapentin, pregabalin) for restless legs syndrome and periodic limb movements. Neuromodulation (rTMS) for sleep quality and insomnia refractory to conventional treatment. Pharmacotherapy (z-drugs, melatonin, low-dose tricyclics) when indicated.
What primary sleep disorders are
Sleep is not a passive state — it is an actively regulated, neurologically complex process that cycles between NREM (non-rapid eye movement) and REM stages throughout the night. Adequate sleep is essential for cognitive consolidation, immune function, metabolic regulation, and psychological health. Sleep disorders disrupt these functions with consequences extending far beyond daytime tiredness.
**Classification of sleep disorders**
*Dyssomnias* affect the amount, quality, or timing of sleep: - *Insomnia disorders:* difficulty falling or staying asleep, or early morning awakening, causing daytime impairment - *Hypersomnolence disorders:* excessive daytime sleepiness despite adequate nocturnal sleep (e.g., narcolepsy, idiopathic hypersomnia) - *Circadian rhythm disorders:* misalignment between internal circadian timing and the sleep-wake schedule (e.g., delayed sleep phase disorder, shift work disorder) - *Sleep-related breathing disorders:* obstructive sleep apnoea, central sleep apnoea - *Sleep-related movement disorders:* restless legs syndrome, periodic limb movement disorder
*Parasomnias* involve abnormal behaviours or experiences during sleep: sleepwalking, sleep terrors, REM sleep behaviour disorder.
**Primary insomnia**
Insomnia disorder is characterised by a complaint of difficulty initiating or maintaining sleep, or early awakening, occurring at least 3 nights per week for more than 3 months, causing significant daytime impairment, and not accounted for by another sleep or medical disorder.
*Psychophysiological insomnia:* the most common type; learned arousal associated with the bedroom environment. The bed becomes a conditioned stimulus for wakefulness — the reverse of its intended function. CBT-I directly targets this conditioning.
*Paradoxical insomnia (sleep state misperception):* patients complain of chronic insomnia but objective sleep studies show near-normal sleep — the subjective experience of wakefulness does not match the electroencephalographic record.
**Restless legs syndrome (RLS)**
A neurological sensorimotor disorder characterised by an uncomfortable, irresistible urge to move the legs — typically in the evening and at rest. The urge is partially or completely relieved by movement. RLS impairs sleep onset and causes significant daytime fatigue. Associated with iron deficiency, pregnancy, chronic kidney disease, and peripheral neuropathy; often idiopathic. Treated with dopaminergic agents or alpha-2-delta ligands.
**Central sleep apnoea**
Unlike obstructive sleep apnoea (where breathing effort continues against a blocked airway), central sleep apnoea results from failure of the brainstem to send signals to the respiratory muscles — breathing effort and airflow both cease. Common in heart failure, stroke, and opioid use. CPAP alone may be insufficient; adaptive servo-ventilation is often used.
**Neuromodulation for sleep disorders**
Repetitive TMS targeting the dorsolateral prefrontal cortex or primary motor cortex modulates neural circuits involved in sleep regulation. Evidence supports rTMS for improving sleep quality and reducing insomnia severity, including in cases refractory to pharmacotherapy.
Treatment options at Alimran Medical Center
Injection therapies
- Botox® injections
- Ozone injection
- Trigger point injections
Advanced therapies
Physiotherapy
- Electrical stimulation
- Short and long wave therapy
- Laser therapy
- Ultrasound therapy
- Exercise and sleep hygiene programme
Book a consultation
The secretary schedules first appointments during clinic hours; please have prior imaging, operative notes and a current medication list available at the time of the call.
This page provides general information about primary sleep disorders: dyssomnias and is not a substitute for individual medical assessment. If your symptoms are severe or worsening, contact a clinician promptly.