Deep Dive: Sleep Disorders—What Coaches Should Know¶

Reading time: ~6 minutes
Prerequisite: Chapter 2.11 (Sleep Optimization)

The Big Picture¶

Sleep coaching is part of longevity work. But some sleep problems aren't solvable with better sleep hygiene. They're medical conditions requiring diagnosis and treatment.

Knowing the difference keeps you in scope and keeps your clients safe. This primer covers the major sleep disorders you should recognize, when to refer, and how to support clients who have diagnosed conditions.

The Sleep Disorders You'll Encounter¶

1. Obstructive Sleep Apnea (OSA)

What it is: Repeated episodes where the upper airway collapses during sleep, stopping breathing for 10+ seconds, often hundreds of times per night.

Prevalence: Affects 10-30% of adults; majority undiagnosed

Warning signs:
- Loud snoring (especially with gasping or choking)
- Witnessed breathing pauses
- Waking with headaches or dry mouth
- Excessive daytime sleepiness despite adequate time in bed
- Large neck circumference, obesity
- High blood pressure, especially resistant to treatment

Why it matters for longevity: Untreated OSA dramatically increases cardiovascular disease risk, including hypertension, stroke, heart attack, and arrhythmias. It also impairs cognitive function and quality of life.

Your role: Recognize warning signs → refer to physician → sleep study → support CPAP adherence if prescribed

2. Insomnia Disorder

What it is: Persistent difficulty falling asleep, staying asleep, or waking too early, despite adequate opportunity, causing daytime impairment.

Prevalence: 10-15% of adults have chronic insomnia

Key distinction: Poor sleep habits ≠ insomnia disorder. True insomnia persists even with good sleep hygiene.

Warning signs:
- Problem persists >3 months
- Significant daytime impairment
- Anxiety about sleep itself
- Good sleep hygiene doesn't help
- Co-occurring anxiety or depression

First-line treatment: Cognitive Behavioral Therapy for Insomnia (CBT-I), more effective than medication for long-term outcomes

Your role: Recognize when hygiene isn't working → refer for CBT-I or medical evaluation → support behavioral components under provider guidance

3. Restless Legs Syndrome (RLS)

What it is: Uncomfortable sensations in legs (creeping, crawling, aching) with irresistible urge to move, worse at rest and evening/night, relieved by movement.

Prevalence: 5-15% of adults; often undiagnosed or misattributed

Warning signs:
- Can't sit still in evenings
- Symptoms worse lying down
- Walking or moving provides relief
- Sleep onset problems due to leg discomfort
- May be linked to iron deficiency

Your role: Recognize symptoms → refer to physician → rule out iron deficiency → support treatment adherence

4. Circadian Rhythm Disorders

What it is: Misalignment between internal body clock and desired sleep schedule.

Types:
- Delayed Sleep Phase: Natural sleep time very late (2-6 AM); can't fall asleep earlier
- Advanced Sleep Phase: Natural sleep time very early; wakes at 3-4 AM
- Shift Work Disorder: Problems sleeping due to work schedule conflicting with circadian rhythm

Warning signs:
- Consistent sleep timing that doesn't match life demands
- Feels fine when sleeping at natural time, but can't adjust
- Not just "being a night owl", genuinely unable to shift.

Your role: Recognize patterns → refer for chronotherapy or light therapy evaluation → support implementation of prescribed protocols

Red Flags That Require Medical Evaluation¶

Refer clients promptly if you observe:

Supporting Clients With Diagnosed Disorders¶

Once a client has a diagnosis and treatment plan, you can play a valuable supportive role:

CPAP Adherence (Sleep Apnea)

CPAP (continuous positive airway pressure) is highly effective but has poor adherence. Only 40-60% of patients use it consistently.

You can help by:
- Normalizing the adjustment period (2-4 weeks to get used to it)
- Problem-solving fit and comfort issues
- Encouraging persistence through initial discomfort
- Celebrating improvements in energy and function
- Connecting adherence to longevity goals

CBT-I Support (Insomnia)

CBT-I typically involves:
- Sleep restriction (initially limiting time in bed)
- Stimulus control (bed only for sleep)
- Cognitive restructuring (changing beliefs about sleep)

You can support by:
- Reinforcing the therapist's protocol
- Helping problem-solve implementation barriers
- Managing expectations (it often gets worse before better)
- Celebrating progress

Lifestyle Factors That Affect Sleep Disorders

Even with medical treatment, lifestyle matters:

Scope Reminders¶

You CAN:
- Recognize warning signs of sleep disorders
- Refer clients for medical evaluation
- Support adherence to prescribed treatments
- Coach lifestyle factors that affect sleep
- Provide education about sleep conditions

You CANNOT:
- Diagnose sleep disorders
- Interpret sleep study results
- Recommend specific treatments
- Adjust CPAP settings or medication
- Provide CBT-I (unless separately qualified)

What This Means for Coaches¶

• Sleep hygiene has limits: Not all sleep problems are behavioral. Know when to refer.
• Recognition is your superpower: Many sleep disorders go undiagnosed. Your awareness can change lives.
• Support adherence: The biggest impact you can have with diagnosed clients is helping them stick with treatment.
• Lifestyle still matters: Even with medical treatment, your coaching on weight, alcohol, exercise, and schedule adds value.
• Stay in scope: Refer early and often. Sleep disorders are medical conditions.

Key Takeaway¶

Coaches should recognize the warning signs of sleep disorders—especially sleep apnea and chronic insomnia—and refer promptly for medical evaluation, while supporting treatment adherence and lifestyle factors that affect outcomes.

References¶

1. Peppard PE, et al. Increased Prevalence of Sleep-Disordered Breathing in Adults. Am J Epidemiol. 2013.
2. Morin CM, et al. Chronic Insomnia. Lancet. 2012.
3. Ohayon MM. Epidemiology of Insomnia: What We Know and What We Still Need to Learn. Sleep Med Rev. 2002.
4. Qaseem A, et al. Management of Chronic Insomnia Disorder in Adults: A Clinical Practice Guideline. Ann Intern Med. 2016.
5. Allen RP, et al. Restless Legs Syndrome: Diagnostic Criteria, Special Considerations, and Epidemiology. Sleep Med. 2003.
6. Weaver TE, et al. Adherence to Continuous Positive Airway Pressure Treatment. Sleep Med Rev. 2010.
7. American Academy of Sleep Medicine. International Classification of Sleep Disorders. 3rd ed. 2014.