Sleep Disorders and Sickle Cell Disease

Many people with sickle cell disease (SCD) experience poor sleep or sleep disruptions. Usually, it is caused by a type of sleep disordered breathing called obstructive sleep apnea. Obstructive sleep apnea is most common in children because of enlarged tonsils, but can affect adults with SCD as well.

If left untreated, sleep disruptions can increase your risk of developing other complications of SCD, including severe acute pain and depression. If you or your child experience symptoms of a sleep disorder, talk to your doctor. They can refer you to a sleep specialist who can perform tests and help plan your treatment.

What sleep disorders do people with sickle cell disease experience?

Many people with SCD experience a group of conditions called sleep disordered breathing. This refers to complete or partial blocking of breathing while sleeping. The most common form of sleep disordered breathing is called obstructive sleep apnea (OA). About 2 to 4 percent of adults are affected by OSA.¹

People with OSA experience episodes of reduced or absent breathing during sleep. These episodes last for several seconds and can occur multiple times during sleep. This decreases the level of oxygen in the blood and can interfere with normal sleep cycles. OSA causes sleepiness and fatigue during the day and leads to a lower quality of life.²

People with SCD may also experience other sleep disorders, such as:¹

• Delayed sleep phase syndrome (an altered biological clock that affects when you sleep and have peak alertness)
• Insomnia (an inability to fall asleep or stay asleep)
• Periodic limb movement disorder (involuntary movements during sleep that cause symptoms or problems)

What causes these disorders?

About 65 percent of children with sickle cell disease have obstructive sleep apnea. A major risk factor for OSA in children with SCD is enlarged tonsils. Children with SCD often have chronically enlarged tonsils because of an increased risk for infection. Enlarged tonsils can block airways and cause episodes of low oxygen during sleep.³

About 50 percent of adults with SCD also show symptoms of sleep disordered breathing. Adults with SCD do not have enlarged tonsils, so other factors contribute to sleep disorders in adults.¹

Sleep disorders in SCD are closely related to pain, fatigue, and depression. Acute pain crises disturb sleep and increase the severity of sleep disorders. Sleep disruptions may also be a symptom of depression, which is a common complication for people with SCD.^4,5

Poor sleep increases the risk of developing other complications of SCD. Reduced oxygen during sleep creates an environment that increases the sickling of red blood cells, leading to complications such as pain and stroke. Fatigue from poor sleep can also increase stress and reduce participation in general activities, leading to depression.^4,6

What are the symptoms?

Some common symptoms of sleep disorders, especially obstructive sleep apnea, include:⁷

• Excessive daytime sleepiness
• Loud snoring
• Periods of stopped breathing during sleep
• Sudden awakenings with gasping or choking
• Waking up with a dry mouth
• Morning headaches
• Difficulty concentrating
• Mood changes, such as depression and irritability
• Nighttime sweating

Sleep disordered breathing can contribute to behavioral changes in children. Some symptoms in children include:²

• Learning difficulties
• High blood pressure
• Nighttime bed-wetting

Many of these symptoms are also caused by other complications of SCD. Talk to your doctor if you experience any of these symptoms. They can refer you to a sleep specialist who can diagnose the condition and plan treatment.

What prevention and treatment options exist?

Certain risk factors increase the risk of developing sleep disordered breathing. Some of these can be controlled, while others cannot. This includes:⁷

• Excess weight
• Narrow airway
• High blood pressure
• Nasal congestion
• Smoking
• Diabetes
• Asthma
• Family history of sleep apnea

Sleep disorders can lead to serious complications for anyone if untreated. Treating sleep disorders is especially important in people with sickle cell disease because it can reduce pain, fatigue, and depression and lead to a higher quality of life. For mild cases, your doctor may recommend lifestyle changes, including:⁷

• Losing weight
• Exercising
• Reducing alcohol consumption, especially before bedtime
• Quitting smoking
• Using a nasal decongestant or allergy medications
• Trying not to sleep on your back
• Avoiding sedative medications

If your sleep disorder is more severe or does not improve with lifestyle changes, your doctor may recommend devices that help keep the airway open. A common device is called continuous positive airway pressure (CPAP). Sometimes, surgery to open your airway may be necessary.⁷