Stanford Health Care Sleep Medicine Center

• Obstructive sleep apnea: When the soft tissues in your throat block your airway, causing your breathing to temporarily stop 
• Central sleep apnea: Pauses in breathing while you are asleep that occur because your brain doesn’t tell your muscles to breathe
• Sleep-related hypoventilation/hypoxemic syndromes: Shallow breathing (hypoventilation) and low blood oxygen levels (hypoxemia) during sleep
• Snoring: Noisy vibrations in your throat caused by obstructed air flow into your lungs when you sleep
• Upper airway resistance syndrome (UARS): A less severe form of obstructive sleep apnea

In insomnia, you are unable to fall and stay asleep. It is one of the most common sleep disorders.

Circadian rhythm disorders are conditions that affect your ability to sleep and wake at times required for your daily needs. Types of circadian rhythm disorders include:

• Advanced sleep phase syndrome: The timing of falling asleep and waking up are several hours earlier than a typical sleep-wake cycle.
• Delayed sleep phase syndrome: You sleep and wake up several hours later than a typical sleep-wake cycle.
• Shift work sleep disorder: You have an inconsistent sleep-wake cycle due to shift work.
• Jet lag: A temporary sleep disorder that results from traveling across multiple time zones

• Restless legs syndrome (RLS): Pain or discomfort in your legs that causes an uncontrollable urge to move them, which interferes with your sleep
• Periodic limb movement disorder (PLMD): Repetitive, uncontrolled movements of your legs or arms that interrupt your sleep

• Narcolepsy: Sudden attacks of sleep during the day
• Idiopathic hypersomnia: Sleepiness that lasts for more than 3 months and may include difficulty waking, long sleep periods (10 hours or more), and daytime grogginess
• Recurrent hypersomnia (Kleine Levin syndrome): Frequent episodes of extreme sleepiness that cause you to sleep as much as 16 to 20 hours per day

The main types of abnormal behaviors at night (parasomnias) include:

• Sleep walking and talking: When you mimic waking activities while still asleep
• Sleep terrors: Fear, panic, or bewilderment during sleep, along with an inability to fully wake up
• Nightmares: Vivid and frightening dreams that can cause terror and anxiety
• Confusional arousals: An episode of disorientation or stupor where you seem to be awake but later have little or no memory what happened 
• REM behavior disorder: Episodes that occur during rapid eye movement (REM) sleep where you move and act out your dreams
• Sleep paralysis: An inability to move as you fall asleep or wake up, sometimes accompanied by intense hallucinations

Children as young as 3 months old can have sleep disorders, such as insomnia, sleep apnea or disruptive nighttime sleep behaviors. While these disorders also occur in adults, their causes, symptoms, and effects are unique in young people. Diagnosing and treating pediatric sleep disorders requires specialized expertise. 

When you come to us for care, we assess your sleep issues and their underlying causes. Our goal is to understand your condition fully so we can create a customized treatment plan.

Your first step is to meet with a Stanford sleep medicine specialist for a consultation. This visit involves a physical exam and a review of your symptoms and medical history. Based on this information, your provider may recommend one or more tests, including:

• Sleep diary: This daily log tracks sleep-related factors such as your sleep and wake times, naps, caffeine and alcohol use, and general mood.
• Actigraphy: An actigraph is a small watch-like instrument you wear for a period of time to measure your sleep-wake cycles. 
• Home sleep test: This test involves the use of one or more sensors to monitor you while you sleep at home. The sensors record your breathing, oxygen levels, and heart rate. You return the sensors, and we analyze the information to make a diagnosis. 
• Overnight attended (in-laboratory) sleep study: In this test, you spend the night in our state-of-the-art Sleep Medicine Center. A trained sleep technologist applies sensors to your body that provide comprehensive measurements during each stage of sleep.
• Daytime attended (in-laboratory) sleep study: A daytime sleep study provides information about daytime sleepiness and measures your ability to fall asleep or stay awake during the day. This may include a multiple sleep latency test (MSLT) or maintenance of wakefulness test (MWT).
• Nasopharyngoscopy: This in-office procedure involves inserting a thin tube with a camera into your nose and throat to look for blockages in your airway. Your physician may also perform a nasopharyngoscopy while you are sedated to observe your airways during a sleep state.

Behavioral treatments are often the first approach for sleep disorders. Ranging from lifestyle changes to therapy, they include:

• Cognitive behavioral therapy (CBT): CBT helps change your thoughts and behaviors. Our specialists offer CBT for insomnia (CBTI), which involves a multistep process that is individually customized to help you overcome sleep difficulties.
• Avoiding alcohol and sedative medications before bedtime: Alcohol and sedative medications relax the muscles that support your airway, making sleep-related breathing disorders worse.
• Environmental changes: Changes to your sleep environment may include blocking light or noise, or reducing hazards if you sleepwalk.
• Light therapy: This therapy for circadian rhythm disorders uses light to shift your sleeping pattern.
• Muscle stretching: Regular stretching can improve restless legs syndrome.
• Physical exercise: Routine exercise during the day can help you sleep better at night.
• Positional therapy: This therapy trains you to avoid sleeping on your back—a position that makes some sleep disorders worse.
• Relaxation exercises: Relaxation techniques can help reduce racing thoughts that contribute to insomnia.
• Sleep schedule: Keeping regular bedtimes and wake times and avoiding napping can help you sleep better.
• Weight loss: For sleep-related breathing disorders, losing weight can be an effective treatment.

Your sleep specialist  may recommend prescription or nonprescription medications, depending on your specific condition. Our physicians follow safety precautions when prescribing medications.

Positive airway pressure (PAP) therapy uses a machine to help keep your airway open while you sleep. You wear a mask that blows pressurized air into your nose that prevents the collapse of the tissues in your throat. Types of PAP therapy include:

• Continuous positive airway pressure (CPAP): Delivers a continuous flow of air
• Automatic positive airway pressure (APAP): Adjusts airflow based on changes in your breathing throughout the night
• Bilevel positive airway pressure (BiPAP): Blows two levels of air, one during inhalation and one during exhalation

We also offer more advanced breathing modes and devices. They may benefit patients with sleep-related breathing disorders associated with lung disease and nerve disorders.

Oral appliances are a treatment for sleep apnea and other airway-obstruction sleep disorders. The appliance moves your jaw forward while you sleep to keep the soft tissues in your airway open.

Surgery may be an option for severe sleep apnea and snoring if other treatments are not successful. Surgeons in our Sleep Surgery Program are uniquely trained in procedures to open blockages so you can breathe better at night. These procedures may involve expanding your jaw or tightening tissues in your mouth, tongue, throat, nose, or sinuses. 

At Stanford Health Care, you also have access to the latest nerve stimulation treatments for obstructive and central sleep apnea. These procedures are minimally invasive, so you can get back to your daily routine in less time than traditional surgery. Options include:

• Hypoglossal nerve stimulation: This obstructive sleep apnea treatment stimulates your hypoglossal nerve, which controls tongue movement. Your surgeon implants a nerve stimulator under your chin and a monitoring device under the skin on your chest. The monitor detects changes in your breathing. If your breathing stops, the stimulator delivers a pulse to your hypoglossal nerve, which pushes your tongue forward to open your airway.
• Phrenic nerve stimulation: This treatment for central sleep apnea stimulates the phrenic nerve in your chest, which controls breathing. An implanted monitoring device tracks your breathing. If your breathing pauses, the stimulator sends a pulse to your phrenic nerve, which tells your chest muscles to breathe.