Sleep Symptoms

Sleep related symptoms are common and, when present in isolation, generally do not indicate an underlying neurological condition.

Who to Refer

New and persistent sleep related behaviours (such as shouting out and acting out dreams).These may suggest an underlying neurological condition
Narcolepsy / cataplexy. These are rare sleep disorders characterised by persistent and excessive daytime sleepiness with an irresistible urge to sleep.

Chronic insomnia (Further information can also be found below to assist with management in primary care).
Suspected Obstructive Sleep Apnoea Syndrome (Respiratory Medicine).

SCI Gateway/Neurology

Chronic insomnia

Mood disturbance, alcohol, and drug problems may all cause sleep disturbance and should be addressed.
Self-management should be promoted with sleep hygiene and self-referral for sleep training (Sleepio) and the Sleep Charity which includes a National Sleep Helpline

Sleep hygiene advice to patients:

During day
- Ensure a regular sleep pattern: retire to bed at the same time each night and rise at the same time each morning, even if poor sleep overnight
- Avoid daytime naps, if taken, limit to 20 minutes to maintain normal sleep cycles
- Regular moderate exercise such as swimming and walking can help, however, try not to exercise too close to bedtime
- Ensure adequate exposure to day light (UV exposure helps to regulate sleep cycles)
In evening
- Avoid computer and phone screens for at least 1 hour before going to bed: screen light reduces natural melatonin production and disrupts natural sleep cycles
- Avoid caffeinated drinks in the evening: these interfere with sleep initiation and deep sleep
- Smoking should be avoided before bed: smoking is a stimulant and leads to disruption of sleep initiation and maintenance
- Alcohol should be avoided before bed: alcohol may help with sleep initiation but leads to sleep disruption later in the night
Bedtime
- Writing lists can help clear the mind before going to bed
- Try a relaxing bedtime routine including a bath, music, relaxation music, and mindfulness to help clear the mind
During night
- The bedroom environment is important. Avoid electronic devices in the bedroom, including televisions.
- Bedrooms should be cool, quiet and dark.
- Avoid clock watching. Try not to lie in bed if not sleeping; get up and do a relaxing activity and re-try when sleepy.

Pharmacological Management

Sleeping tablets do not have a role in the management of those with chronic insomnia
There may be a role for medication to address mood disturbance leading to insomnia, where appropriate

Patient support

Excessive daytime sleepiness

In those with excessive daytime sleepiness please consider STOP-BANG questionnaire . See Obstructive Sleep Apnoea Syndrome page for more information

Sleep related movements

Sleep related movements (such as hypnic jerks and sleep paralysis) and sleep onset hallucinations may be secondary to sleep disruption. Please refer to above insomnia management in 1st instance.

Periodic limb movements of sleep may be related to restless leg syndrome. For information of restless leg syndrome, please refer to our Restless Leg Syndrome RefGuide page and to the National Restless Legs Factsheet .