Sleep Disorders
Key Takeaways
- Sleep disorders are a group of conditions that negatively impact normal sleep patterns.
- Between 50–70 million people in the United States struggle with sleep disorders.
- Insomnia is the most common sleep disorder.
- Half of all adults 65 and older have a sleep disorder.
- Common symptoms of sleep disorders include daytime sleepiness, inability to fall asleep at night, and gasping for air when you’re sleeping.
- More than 80 sleep disorders exist.
We all know what it feels like after a crummy night’s sleep. You’re tired, irritable, and might struggle to function normally. For some people, this doesn’t just happen occasionally—it’s their daily experience and reality. When this happens, it’s possible that someone may be suffering from an undiagnosed sleep disorder.
Between 50–70 million people in the United States have chronic sleep disorders. And these are just the ones who report the issue [1] National Heart, Lung, and Blood Institute. What Are Sleep Deprivation and Deficiency? March 24, 2022. Found on the internet at https://www.nhlbi.nih.gov/health/sleep-deprivation . Unfortunately, not getting enough sleep has health consequences. Sleep disorders can lead to fatigue, irritability, high blood pressure, high cholesterol, and diabetes. It’s important to understand what causes sleep disorders, the impact these disorders can have on your mind and body, and what treatment options are available to help you get a restful night’s sleep.
What are sleep disorders?
When you have a terrible night’s sleep, night after night, you could be dealing with a sleep disorder. According to Lauri Leadley, founder, president, and clinical sleep educator at Valley Sleep Center based in Mesa, Arizona, a sleep disorder is a health condition that impacts a person’s quality of sleep, disrupting the natural sleep cycle: “Sleep disorders are every bit as serious as any other chronic illness, but, generally speaking, people don’t seek medical attention at the same rate as they would if they were suffering chest pain.
Sleep disorders are sometimes called sleep-wake disorders and often make it hard to get enough quality sleep.
Categories of sleep disorders
Sleep disorders can be grouped together according to a person’s symptoms, how the disorder impacts sleep and waking hours, whether movement occurs during sleep, and if there is an arousal from a sleeping state. Research shows there are eight sleep disorder categories [2] Thorpy M. Classification of Sleep Disorders. Neurotherapeutics. Sept. 14, 2012. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3480567 :
- Insomnia disorders: People in this category have trouble falling or staying asleep. Even if they doze off, they aren’t getting good quality sleep.
- Sleep-related breathing disorders: This category involves disorders in which your breathing is abnormal when you sleep. These disorders can cause you to snore, gasp, or choke during sleep.
- Circadian rhythm sleep disorders: Circadian rhythms control the way some systems in your body function, such as body temperature, appetite, alertness, and sleepiness. This disorder disrupts the body’s natural internal clock, leading to sleep problems.
- Hypersomnia of central newin: People with this disorder struggle with excessive daytime sleepiness. These disorders are unrelated to sleeping at night, a breathing problem, or a circadian rhythm disorder. One example is narcolepsy.
- Parasomnias: With parasomnia, you experience unwelcome movements, behaviors, dreams, or emotions while sleeping, like night terrors. This category also includes behaviors like sleepwalking, talking while asleep, or even eating while asleep
[3]
Yale Medicine. Parasomnias. Found on the internet at https://www.yalemedicine.org/conditions/parasomnias
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- Sleep-related movement disorder: While parasomnia disorders can include movements during sleep, this disorder consists of small, seemingly normal movements that disturb sleep, such as occasional limb movements.
- Isolated symptoms and unresolved issues: Disorders in this category hover between normal sleep behavior and problems. For example, someone who sleeps 10 hours, which is more than the normal seven to nine hours an adult needs, is considered a long sleeper. A short sleeper, by contrast, may only get five hours of sleep or less.
- Other sleep disorders: This final category is a catch-all for disorders not categorized in another grouping. It can include environmental-related sleeping disorders, problems sleeping due to gastroesophageal reflux, sleep-related epilepsy, and fibromyalgia, among other causes.
Types of sleep disorders
So far, more than 80 sleep disorders have been discovered. Insomnia is the most common one, affecting roughly one out of every three adults worldwide [4] Roth T. Insomnia: Definition, Prevalence, Etiology, and Consequences. Journal of Clinical Sleep Medicine. Nov. 14, 2019. Found on the internet at https://jcsm.aasm.org/doi/10.5664/jcsm.26929 . Symptoms include consistently having trouble falling asleep and staying asleep, as well as not getting good quality sleep throughout the night. If your sleep problems occur more than three times per week and go on for three months or longer, you may be dealing with insomnia.
Other common sleep disorders include:
- Narcolepsy: Narcolepsy is a chronic neurological disorder that causes extreme daytime drowsiness. This disorder has two types. In narcolepsy type 1 (NT1), a person is extremely sleepy during the day and may experience dream-like hallucinations when dozing off or falling asleep and sleep paralysis
[5]
National Institute of Neurological Disorders and Stroke. Narcolepsy. Nov. 28, 2023. Found on the internet at https://www.ninds.nih.gov/health-information/disorders/narcolepsy
. Cataplexy is also a symptom of NT1, which is a sudden loss of muscle control, typically experienced during a strong emotion, like laughter or anger. Narcolepsy type 2 (NT2) is considered less severe and is characterized by extreme daytime sleepiness with short naps throughout the day but not the restful REM sleep that people need. A person may also sleep more than 10 hours but still wake up feeling tired
[6]
Stanford Medicine: Center for Narcolepsy. Narcolepsy & Hypersomnia. Found on the internet at https://med.stanford.edu/narcolepsy/symptoms.html
.
- Sleep apnea: With this disorder, you stop breathing at various times throughout the night. Sleep apnea has two types: obstructive sleep apnea and central sleep apnea. “Obstructive sleep apnea is caused when the muscles in the back of your throat cannot keep your airway open during sleep. Central sleep apnea occurs less frequently and is caused when your brain fails to send the proper messages needed to regulate and control breathing,” said Leadley.
With obstructive sleep apnea, you stop breathing for at least 10 seconds while sleeping. It’s considered a mild case if it happens five to 15 times in an hour; a moderate case is 15–30 times in an hour; and more than 30 times in an hour is severe sleep apnea [7] Johns Hopkins Medicine. Obstructive Sleep Apnea. Found on the internet at https://www.hopkinsmedicine.org/health/conditions-and-diseases/obstructive-sleep-apnea . Recent research suggests 30 million people in the United States have sleep apnea, but only 6 million have been properly diagnosed [8] Berg S. What Doctors Wish Patients Knew About Sleep Apnea. American Medical Association. April 1, 2022. Found on the internet at https://www.ama-assn.org/delivering-care/public-health/what-doctors-wish-patients-knew-about-sleep-apnea .
“Regardless of which type of sleep apnea you may have, the effects can drastically affect the amount of oxygen that gets into your blood and body and can contribute to heart disease and memory issues,” Leadley said. - Restless leg syndrome: Known as RLS, this disorder causes a creeping sensation or aches and pains in a person’s legs. As a result, someone with RLS may feel like they have to move their legs. It can also look like uncontrolled kicking and twitching during sleep. Sometimes, walking around or jiggling their legs helps lessen the pain but this also disrupts sleep [9] Mayo Clinic. Restless Legs Syndrome. Jan. 26, 2024. Found on the internet at https://www.mayoclinic.org/diseases-conditions/restless-legs-syndrome/symptoms-causes/syc-20377168 . RLS is genetic and can begin at any age. Up to 10% of people in the United States are diagnosed with it [10] National Institute of Neurological Disorders and Stroke. Restless Legs Syndrome. Nov. 28, 2023. Found on the internet at https://www.ninds.nih.gov/health-information/disorders/restless-legs-syndrome .
- Sleep paralysis: During deeper REM sleep, you may experience nightmares or have times when you’re unable to move your limbs. Sleep paralysis falls under parasomnias, which is characterized by unexpected actions that disrupt sleep
[11]
Cleveland Clinic. Parasomnias & Disruptive Sleep Disorders. Found on the internet at https://my.clevelandclinic.org/health/diseases/12133-parasomnias–disruptive-sleep-disorders
.
“Sleep paralysis occurs when a person passes between stages of wakefulness and sleep. During these transitions, they may be unable to move or speak for a few seconds up to a few minutes. Some people may also feel pressure or a sense of choking,” Leadley said.
Causes and symptoms of sleep disorders
Just as there are numerous types of sleep disorders, there are many causes. The reasons people get them and the symptoms are just as individualized as the people who experience them, although people with sleeping disorders can share common experiences. Knowing what to look for can be your first step toward getting treatment.
What are the causes of sleep disorders?
If you’re experiencing symptoms that you think might be a sleep disorder, talk to your health care provider or a sleep specialist, who can help you figure out the reasons behind your sleep disorder. Sometimes, you can control the factors causing your sleep disorders. In other situations, you may need prescription medicine or a device to help you.
Any combination of the following factors can lead to problems with sleeping in general:
- Stress: We all deal with it, but more than 40% of U.S. adults say stress keeps them up at night
[12]
American Psychological Association. Stress and Sleep. Found on the internet at https://www.apa.org/news/press/releases/stress/2013/sleep
. This is a problematic cycle because stress keeps them awake, and then they become stressed about being awake.
- Schedules: A consistent sleep schedule is important. “Adults need seven to nine hours of sleep each night to fully rest and rejuvenate for the next day. You can enjoy more regular and peaceful sleep if you go to bed and wake up around the same time each day,” Leadley said.
- Mental health disorders: Mental health conditions can affect your ability to get a good night’s sleep. Research shows bipolar disorder is strongly linked to insomnia, while schizophrenia is associated with sleep apnea. Other mental health conditions related to sleep disorders are depression and obsessive-compulsive disorder
[13]
Merrill R. Mental Health Conditions According to Stress and Sleep Disorders. International Journal of Environmental Health and Public Health. June 29, 2022. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9265846/
.
- Medications: Medication can affect people in different ways and cause sleep disruptions. Some of the biggest offenders include decongestants, antidepressants, stimulants, beta-blockers, diuretics, and steroids
[14]
Godman H. Are Your Medications Keeping You Up at Night? Harvard Health Publishing. Dec. 1, 2022. Found on the internet at https://www.health.harvard.edu/diseases-and-conditions/are-your-medications-keeping-you-up-at-night
.
- Alcohol consumption: Although alcohol is known for its sleep-inducing effects, studies show it can be disruptive to your sleep patterns and rhythms. Alcohol also can contribute to sleep-related problems, like snoring, and lower your quality of sleep
[15]
Colrain I. Alcohol and Sleeping Brain. Handbook of Clinical Neurology. Feb. 21, 2018. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5821259/
.
- Illness or disease: Cancer
[16]
National Cancer Institute. Sleep Disorders. March 20, 2023. Found on the internet at https://www.cancer.gov/about-cancer/treatment/side-effects/sleep-disorders-pdq
, Alzheimer’s disease
[17]
Brzecka A, et al. Sleep Disorders Associated With Alzheimer’s Disease: A Perspective. Frontiers in Neuroscience. May 31, 2018. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5990625
, and stroke are just a few of the chronic diseases that disrupt sleep and cause sleep disorders. Cardiovascular disease, diabetes
[18]
Centers for Disease Control and Prevention. Sleep Deprivation, Sleep Disorders, and Chronic Disease. Aug. 31, 2023. Found on the internet at https://www.cdc.gov/pcd/issues/2023/23_0197.htm
, and kidney disease are other conditions that can negatively impact sleep
[19]
Maung SC, et al. Sleep Disorders and Chronic Kidney Disease. World Journal of Nephrology. May 6, 2016. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4848147
.
- Breathing problems: If you have breathing problems, it can be hard to feel like you’re getting enough air when you sleep. Gastroesophageal reflux disease and bronchial asthma can cause breathing issues during the day and sleep issues at night
[20]
Memon J and Manganaro SN. Obstructive Sleep-Disordered Breathing. StatPearls. Aug. 8, 2023. Found on the internet at https://www.ncbi.nlm.nih.gov/books/NBK441909
.
- Genetic factors: A mutation in certain genes can predispose a person to sleep disorder issues
[21]
Bidaki R, et al. A Review on Genetics of Sleep Disorders. Iranian Journal of Psychiatry and Behavioral Sciences. Spring-Summer 2012. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3939950
. The genes affecting your internal clocks can wreak havoc with your ability to sleep at night.
- Poor sleep hygiene: Trying to sleep in a noisy environment, taking naps during the day, drinking caffeine close to bedtime, or scrolling your screens right before you sleep can prompt sleep issues. Good sleep habits can help create a more sleep-positive environment.
What are the symptoms of sleep disorders?
Each sleep disorder has its own set of symptoms. But many symptoms are not exclusive to just one disorder. It’s important to understand that everyone occasionally sleeps poorly or wakes up feeling less than refreshed. You should contact your physician if you’re experiencing symptoms longer than a week or two and are impacted during the day.
Signs to watch out for include but are not limited to [22] Cleveland Clinic. Sleep Disorders. June 19, 2023. Found on the internet at https://my.clevelandclinic.org/health/diseases/11429-sleep-disorders :
- Trouble falling asleep at night
- Continually waking up during the night
- Snoring
- Gasping for air or choking during your sleep
- Feeling paralyzed or unable to move when you wake up
- Constant tiredness and fatigue throughout the day
- Moodiness and irritability associated with a lack of sleep
- Involuntary movements in your sleep
- Frequent accidents or falls
Sleep disorders in older adults
Sleep problems can intensify as we get older. Research shows that our sleep patterns change as we age. In fact, while more than 20% of the general population deals with sleep problems, the number jumps to 50% in adults 65 and older [23] Tatineny P. Sleep in the Elderly. Missouri Medicine. September-October 2020. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7723148 .
People with Type 2 diabetes often do not get enough sleep. The combination of having Type 2 diabetes and not getting adequate sleep has been linked to developing dementia [24] Holingue C, et al. Disturbed Sleep and Diabetes: A Potential Nexus of Dementia Risk. Metabolism. Feb. 1, 2018. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5995651 .
Older adults are more likely to have sleep disorders due to diseases, like Alzheimer’s or heart failure. Certain medications can also interfere with sleep (for example, beta-blockers for hypertension). Disruptions to your sleep cycle, like the frequent need to urinate, or a sedentary lifestyle, can also lead to sleep problems [23] Tatineny P. Sleep in the Elderly. Missouri Medicine. September-October 2020. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7723148 .
Sleep disorders treatment
Though sleep disorders are a serious issue and can cause significant problems, many of the symptoms can be treated. Options for treatment include actions you can do at home and doctor-prescribed recommendations:
- Therapy sessions: Cognitive behavioral therapy for insomnia (CBTI) helps you change or address habits that may be impacting your sleep. A therapist will help you identify sleep-related behaviors you can change, like establishing a consistent schedule, and will also address any anxiety-related sleeping issues through different tactics, including stress management and relaxation
[25]
Stanford Medicine. CBTI. Found on the internet at https://stanfordhealthcare.org/medical-treatments/c/cognitive-behavioral-therapy-insomnia.html
.
- Medication: Prescription medicines, like melatonin receptor agonists (for example: ramelteon), can induce sleep, and benzodiazepines (depressants that can serve as sedatives, like Xanas and Valium) can treat the symptoms leading to sleep disorders
[26]
Chawla J, et al. Insomnia Medication. Medscape. Aug. 31, 2022. Found on the internet at https://emedicine.medscape.com/article/1187829-medication
. Other medications include Lunesta, Sonata, Ambien, and more. Be sure to ask the doctor prescribing the medication about any adverse reactions you may experience. Some medications can be dangerous to take for people with certain diseases. They can also increase the risk of nighttime falls or injury in older adults, so your physician might prescribe a lower dose
[27]
Mayo Clinic. Prescription Sleeping Pills: What’s Right for You? Sept. 16, 2022. Found on the internet at https://www.mayoclinic.org/diseases-conditions/insomnia/in-depth/sleeping-pills/art-20043959
.
- Sleep hygiene: To maintain good sleep hygiene, Leadley recommended keeping the same sleep schedule every day. Good sleep hygiene also includes avoiding large meals right before bedtime, implementing a relaxation routine before bed, avoiding digital devices right before bed, and restricting your bedroom to sleep and sex only.
- Environment: Making your bedroom a calm and relaxing place is key. Don’t work in your bedroom. Sleep on clean linens, and get the best mattress for you. You may even want to hide or cover electronics, like your clock, so they don’t disturb you. Also consider choosing a mattress that addresses any pain issues, such as the best mattresses for back pain.
- Continuous positive airway pressure (CPAP) machine: A CPAP machine draws air into the machine, filters it, and pushes it through the mouth and nose in a steady light stream that keeps airways open for people with sleep apnea. You need a prescription from a doctor to purchase a CPAP machine, but most health insurance, including Medicare, should provide some coverage.
- Oral device: An oral device, like a mouthguard, is designed to provide a similar effect as a CPAP. It is custom-made by a specialty-trained dentist or orthodontist and keeps your jaw and mouth in place and airways open while you sleep.
- Surgical procedures: Adenotonsillectomy surgery can help people with sleep apnea breathe easier by removing their tonsils and adenoids. In addition, jaw advancement surgery can move the upper or lower jaw, making breathing easier. While surgery is an option, speaking with your orthodontist or primary care doctor is important to determine the best course of action
[28]
National Heart, Lung, and Blood Institute. Sleep Disorder Treatments. March 24, 2022. Found on the internet at https://www.nhlbi.nih.gov/health/sleep-disorder-treatments
.
- Sleep study: An overnight sleep study is called polysomnography (PSG). While some studies occur at sleep centers, you can often use a sleep study device from the comfort of your home. A sleep study measures airflow, blood oxygen level, sleep position, brain waves, breathing, muscle activity, eye movement, and heart rate [29] Medline Plus. Polysomnography. Jan. 1, 2022. Found on the internet at https://medlineplus.gov/ency/article/003932.htm . You must have a doctor’s referral to participate in a sleep study.
Bottom line
Headaches, nausea, and irritability are just a few of the negative consequences of a sleep disorder. Not getting the rest you need impacts the quality of your life physically, mentally, and emotionally. While the symptoms and causes can be daunting, there are clear steps you can take to address your concerns. If you suspect you have a sleep disorder, visit your primary health care doctor or get a referral to a sleep specialist to get the help you need.
“Sleep is crucial to living. Don’t ignore the signs of sleep apnea and/or any other sleep disorders. Poor sleep quality causes health conditions that can be avoided,” Leadley said.
Have questions about this article? Email us at reviewsteam@ncoa.org.
Sources
- National Heart, Lung, and Blood Institute. What Are Sleep Deprivation and Deficiency? March 24, 2022. Found on the internet at https://www.nhlbi.nih.gov/health/sleep-deprivation
- Thorpy M. Classification of Sleep Disorders. Neurotherapeutics. Sept. 14, 2012. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3480567
- Yale Medicine. Parasomnias. Found on the internet at https://www.yalemedicine.org/conditions/parasomnias
- Roth T. Insomnia: Definition, Prevalence, Etiology, and Consequences. Journal of Clinical Sleep Medicine. Nov. 14, 2019. Found on the internet at https://jcsm.aasm.org/doi/10.5664/jcsm.26929
- National Institute of Neurological Disorders and Stroke. Narcolepsy. Nov. 28, 2023. Found on the internet at https://www.ninds.nih.gov/health-information/disorders/narcolepsy
- Stanford Medicine: Center for Narcolepsy. Narcolepsy & Hypersomnia. Found on the internet at https://med.stanford.edu/narcolepsy/symptoms.html
- Johns Hopkins Medicine. Obstructive Sleep Apnea. Found on the internet at https://www.hopkinsmedicine.org/health/conditions-and-diseases/obstructive-sleep-apnea
- Berg S. What Doctors Wish Patients Knew About Sleep Apnea. American Medical Association. April 1, 2022. Found on the internet at https://www.ama-assn.org/delivering-care/public-health/what-doctors-wish-patients-knew-about-sleep-apnea
- Mayo Clinic. Restless Legs Syndrome. Jan. 26, 2024. Found on the internet at https://www.mayoclinic.org/diseases-conditions/restless-legs-syndrome/symptoms-causes/syc-20377168
- National Institute of Neurological Disorders and Stroke. Restless Legs Syndrome. Nov. 28, 2023. Found on the internet at https://www.ninds.nih.gov/health-information/disorders/restless-legs-syndrome
- Cleveland Clinic. Parasomnias & Disruptive Sleep Disorders. Found on the internet at https://my.clevelandclinic.org/health/diseases/12133-parasomnias–disruptive-sleep-disorders
- American Psychological Association. Stress and Sleep. Found on the internet at https://www.apa.org/news/press/releases/stress/2013/sleep
- Merrill R. Mental Health Conditions According to Stress and Sleep Disorders. International Journal of Environmental Health and Public Health. June 29, 2022. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9265846
- Godman H. Are Your Medications Keeping You Up at Night? Harvard Health Publishing. Dec. 1, 2022. Found on the internet at https://www.health.harvard.edu/diseases-and-conditions/are-your-medications-keeping-you-up-at-night
- Colrain I. Alcohol and Sleeping Brain. Handbook of Clinical Neurology. Feb. 21, 2018. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5821259
- National Cancer Institute. Sleep Disorders. March 20, 2023. Found on the internet at https://www.cancer.gov/about-cancer/treatment/side-effects/sleep-disorders-pdq
- Brzecka A, et al. Sleep Disorders Associated With Alzheimer’s Disease: A Perspective. Frontiers in Neuroscience. May 31, 2018. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5990625
- Centers for Disease Control and Prevention. Sleep Deprivation, Sleep Disorders, and Chronic Disease. Aug. 31, 2023. Found on the internet at https://www.cdc.gov/pcd/issues/2023/23_0197.htm
- Maung SC, et al. Sleep Disorders and Chronic Kidney Disease. World Journal of Nephrology. May 6, 2016. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4848147
- Memon J and Manganaro SN. Obstructive Sleep-Disordered Breathing. StatPearls. Aug. 8, 2023. Found on the internet at https://www.ncbi.nlm.nih.gov/books/NBK441909
- Bidaki R, et al. A Review on Genetics of Sleep Disorders. Iranian Journal of Psychiatry and Behavioral Sciences. Spring-Summer 2012. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3939950
- Cleveland Clinic. Sleep Disorders. June 19, 2023. Found on the internet at https://my.clevelandclinic.org/health/diseases/11429-sleep-disorders
- Tatineny P. Sleep in the Elderly. Missouri Medicine. September-October 2020. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7723148
- Holingue C, et al. Disturbed Sleep and Diabetes: A Potential Nexus of Dementia Risk. Metabolism. Feb. 1, 2018. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5995651
- Stanford Medicine. CBTI. Found on the internet at https://stanfordhealthcare.org/medical-treatments/c/cognitive-behavioral-therapy-insomnia.html
- Chawla J, et al. Insomnia Medication. Medscape. Aug. 31, 2022. Found on the internet at https://emedicine.medscape.com/article/1187829-medication
- Mayo Clinic. Prescription Sleeping Pills: What’s Right for You? Sept. 16, 2022. Found on the internet at https://www.mayoclinic.org/diseases-conditions/insomnia/in-depth/sleeping-pills/art-20043959
- National Heart, Lung, and Blood Institute. Sleep Disorder Treatments. March 24, 2022. Found on the internet at https://www.nhlbi.nih.gov/health/sleep-disorder-treatments
- Medline Plus. Polysomnography. Jan. 1, 2022. Found on the internet at https://medlineplus.gov/ency/article/003932.htm