Sleep is not always an easy activity. Some people have trouble falling asleep. Others can’t stay asleep. And still others may have difficulty waking up or staying awake. Some people snore and some people kick and some people talk or walk in their sleep.
Some sleep issues can be fixed simply by changing one’s routine or sleep environment. For instance, if you have trouble falling asleep, it may be resolved by reducing nighttime caffeine intake and screen time. You may wake up at night because of a pet or a child. If you have trouble waking up in the morning, be sure that you are getting enough sleep for your age.
However, sleep disorders can require a consultation with a sleep specialist, who is capable of diagnosing and treating certain sleep-related issues.
Lifestyle or Behavioral Treatment
Sleep problems run the gamut from those that require minor lifestyle changes to those that must be treated by a professional sleep specialist. Lifestyle and behavioral treatments can include sleep hygiene, relaxation training, cognitive therapy, stimulus control (SC), or sleep restriction therapy (SRT).
When utilizing sleep hygiene to treat sleep disorders, you will be focusing on factors such as sleep practices, nighttime habits, and environmental considerations. There are four general areas of sleep hygiene, which include:
- Circadian rhythm, which consists of the 24-hour cycle in a day: Circadian rhythm can be affected by daytime naps, the time one goes to sleep, exercise, and exposure to light.
- Aging, which affects sleep requirements: After age 40, an individual’s sleep patterns can change, and there may be more nighttime awakenings, affecting overall feelings of restfulness.
- Psychological stressors, which can cause minor awakenings throughout the night: Psychological stressors can include daily pressures, such as deadlines, exams, financial struggles, or family issues. Facing such issues with relaxation techniques can break the connection between stress and sleep.
- Substances, which includes items such as nicotine, alcohol, and caffeine: Caffeine and nicotine tend to keep you awake at night. Alcohol appears to sedate you; however, once it has been metabolized in the body, it can cause periods of insomnia that can last several hours in the middle of the night.
Additionally, environmental factors, such as noise and temperature, can affect sleep. A dark, cool, quiet atmosphere is best for a good night of sleep.
Some people benefit from relaxation methods to help with sleep disorders, particularly those related to stress. Some tactics include:
- Progressive muscle relaxation (PMR)
- Deep breathing techniques
Relaxation practices prior to bedtime – and preferably throughout the day – can help both the body and mind calm and de-stress to prepare for a good night’s sleep.
Cognitive therapy is meant to assist individuals in pinpointing the factors that lead to sleep problems. If certain thoughts or beliefs are resulting in too much or too little sleep, cognitive sleep practices can help. Once a person has an understanding of issues contributing to sleep issues, he or she can address and overcome those issues, which may include:
- Sleep norms
- Age-related sleep changes
- Acceptable sleep goals
- Influence of factors such as naps or exercise
The bedroom should only be associated with sleep and marital relations. Stimulus control involves removing other concepts that have become linked with the bed, which may include eating, watching TV, playing on the phone, or a number of other things.
Sleep Restriction Therapy:
SRT is a theory that involves getting out of bed when you are not sleeping. Too much time in bed, even if you are trying to sleep, may make your sleep problems worse. It is recommended that you get out of bed if you are unable to sleep. Sit in a dimly lit room and read a book, take a bath, or drink warm milk. Whatever it takes to ease yourself back into a sleep mindset. Only return to bed once you are feeling drowsy enough to fall asleep.
Seeing a Sleep Specialist
If you have had a particular sleep problem that has continued for a period of time or if you find yourself regularly experiencing daytime drowsiness, you may have a sleep disorder that requires seeking assistance from a sleep specialist. Sleep specialists are trained to evaluate and identify sleep-related problems. These issues tend to be chronic and may even lead to other health complications, including heart problems, high blood pressure, stroke, and diabetes. Thankfully, sleep disorders are usually treatable once appropriately diagnosed.
Sleep problems which require medical intervention can be classified into six broad categories, which include:
- Insomnias: Disorders that relate to the inability to fall asleep or stay asleep
- Hypersomnias: Conditions which cause excessive sleepiness
- Sleep-related breathing disorders: Disorders involving difficulty breathing during sleep, such as sleep apnea
- Circadian rhythm sleep-wake disorders: Illnesses in which sleep times are out of sync
- Parasomnias: Conditions involving unwanted experiences or activities during sleep periods
- Sleep movement disorders: Disorders involving movement prior to or during sleep which may affect one’s ability to get a restful sleep
Each of these disorders cause symptoms which can affect one’s ability to get a full night’s sleep and often interfere with one’s daytime activities as a result. Sleep disorders can disturb your ability to function, your concentration, and many other aspects of your daily life. Talking to your primary physician is the first step towards healing.
Approximately 60 million Americans suffer from insomnia, or the inability to fall asleep or stay asleep. These individuals wake up feeling groggy and are affected by daytime fatigue, lack of concentration, depression, headache, or irritability. The effects of this sleep disorder can interfere with many aspects of one’s daily life.
Short-term insomnia affects 15 to 20 percent of individuals and lasts up to three months, while chronic insomnia, affecting ten percent of people, occurs at least three times a week and lasts for at least three months.
Treatment: While insomnia can often be treated with sleep hygiene practices or cognitive therapy, sometimes chronic insomnia requires a sleep medicine physician for effective results. A sleep specialist may prescribe medications to help alleviate problems involving insomnia.
Sleeping pills used to treat insomnia, called hypnotics, can temporarily improve sleep problems; however, you may build up a tolerance to them over time. Sometimes, the issues that are causing the insomnia must be treated, particularly when sleep problems are a result of stress, medical problems, or mental health issues. Additionally, a doctor may determine that the underlying cause of your insomnia is a current medication, which may be changed or taken at a different time of day.
Some individuals are affected by sleep disorders that cause excessive sleepiness. These hypersomnias cause you to fall asleep at any time, even when at work or while driving. Narcolepsy is the most well-known hypersomnia, but others include:
- Idiopathic Hypersomnia: Those affected experience an uncontrollable need to sleep that involves typically around twelve hours of sleep within a 24-hour period.
- Kleine-Levin Syndrome: Patients are overcome with recurrent periods of excessive sleepiness and sleep duration which persists anywhere from two days to five weeks.
- Insufficient Sleep Syndrome: Individuals with insufficient sleep syndrome suffer from sleep deprivation due to the inability to regularly get enough sleep throughout the night.
- Long Sleeper: Some individuals simply require more sleep than others in their age group, and due to pressures of work or school, may not get the amount of sleep that their bodies require.
Narcolepsy is the most well-known and common hypersomnia. It causes an individual to feel overwhelmingly tired with uncontrollable attacks of sleep. Narcolepsy affects approximately 200,000 Americans; however, it is estimated that only 25 percent of those affected have been diagnosed. Some individuals affected by this sleep disorder also undergo cataplexy, sudden partial or complete paralysis while still awake.
Treatment: While there is no cure for narcolepsy, the disorder is manageable through medicine and lifestyle adjustments. The first step towards healthier sleep is to see a sleep physician who can help create a treatment plan that is individualized for your symptoms.
Stimulants are often a first resource to treat narcolepsy, including modafinil (Provigil), methylphenidate (Ritalin), or amphetamines. SSRIs or antidepressants are used to treat cataplexy and other narcolepsy problems, such as hallucinations and sleep paralysis.
Sleep-Related Breathing Disorders
Obstructive sleep apnea is the most common sleep disorder that involves difficulting breathing while asleep; however, there are other variations of this type of sleep issue.
- Obstructive Sleep Apnea: Individuals with sleep apnea tend to stop breathing while asleep due to obstructions in the airway, causing loud snoring and choking sounds.
- Snoring: Snoring is caused when the flow of air into the body vibrates the tissues in the back of the throat.
- Central Sleep Apnea: This apnea condition causes the individual to stop or decrease breathing in cycles due to an issue in the brain or heart, rather than a blockage.
- Sleep-Related Groaning: Known as catathrenia, groaning during sleep is rare, but more common in men and, like snoring, can be bothersome to a sleep partner.
Obstructive sleep apnea is fairly common, with around 22 million Americans suffering from it; however, the majority of individuals remain undiagnosed. When the airway becomes blocked, you may snore or make loud noises as your body tries to resume air flow to the lungs. Your body becomes oxygen deprived and will wake you to regain oxygen flow, even if you are not conscious of it. In most cases, the obstruction is caused by the tissue in the back of the throat collapsing. This obstruction of breathing may occur just a few times a night to hundreds of times each night.
Treatment: In addition to lifestyle changes, such as quitting smoking or eliminating alcohol consumption, both of which can improve the symptoms of sleep apnea, your doctor may want to look into a variety of options for treatment.
The most common response to a sleep apnea diagnosis is the use of a CPAP (Continuous Positive Airway Pressure) machine. You place a mask over your nose and/or mouth which connects to the machine with a flexible hose. The small, bedside machine gently pushes a steady stream of air through the hose to keep your airway open throughout the night. There are a variety of masks and machines to help accommodate all patients with this highly effective treatment of sleep apnea.
Another option available to those who are unable or unwilling to use a CPAP machine is an oral appliance device. This small apparatus fits in your mouth over your teeth and resembles an orthodontic retainer or sports mouth guard. An oral appliance prevents the airway from collapsing by holding the tongue in place or sliding the jaw slightly forward to allow you to breathe easily while sleeping.
Other treatment options include surgery to reduce or eliminate extra tissue within the throat, weight management for overweight or obese patients, and positional therapy to readjust the body and open the airway while asleep.
Circadian Rhythm Sleep-Wake Disorders
- Delayed sleep-wake phase: You tend to fall asleep two or more hours later than a normal person and sleep in later during the next morning.
- Advanced sleep-wake phase: You fall asleep several hours before the normal bedtime and awake earlier in the morning than most people.
- Irregular sleep-wake rhythm: Your sleep schedule is very disorganized with no perceptible pattern of going to sleep or waking up, with a full night’s sleep even being comprised of a series of naps within a 24-hour period.
- Non-24-hour sleep-wake rhythm: Your circadian clock shifts slightly each day, making your sleep times go in and out of sync with other people’s over time.
- Shift work: You work a schedule that involves evenings or nights, making you have to adjust your sleep time to accommodate work.
- Jet lag: You travel across multiple time zones, making it difficult for your body to adjust to the new time.
Treatment: While treatment may vary with diagnoses, circadian rhythm sleep-wake patients are often prescribed melatonin. This hormone can be taken at timed instances to help regulate the sleep-wake cycle and induce sleep at the correct time. Melatonin tends to be more effective in teenagers than adults.
Bright light therapy is another effective option for circadian rhythm sleep-wake patients, although it is not been proven effective in all disease categories. With this treatment, you are exposed to bright light upon waking, but stay in dimly lit areas in the evening to train the body to be prepared for sleep.
Parasomnia patients experience undesirable activities and experiences during sleep or while falling asleep or waking up. This disorder can include a wide variety of strange movements, behaviors, emotions, perceptions, or dreams. In parasomnias, the patient remains asleep and has no memory of the event. Types of this disorder include:
- Confusional arousals: You awake confused and may not know where you are or what is going on.
- Sleepwalking: While still asleep, you may get up out of bed and walk around, sometimes returning to bed, but often awaking without knowing how you got to where you are.
- Sleep terrors (night terrors): You awake in intense fear without memory of a nightmare or understanding of why you are afraid. Patients often experience a racing heart as well as kicking or screaming.
- Sleep eating disorder: You may eat strange combinations or highly caloric foods while only partially awake with little or no memory of the episode.
- REM sleep behavior disorder: You begin to act out dreams by punching, kicking, or flailing in response to dream activities.
- Sleep paralysis: As you are falling asleep or waking up, you may lose control of your body and unable to move at all.
- Nightmares: Regularly experiencing nightmares may prevent you from getting a good night’s sleep as well as causing a fear of going to bed or falling back to sleep after an episode.
- Bedwetting: Even adults can experience bedwetting due to a failure to awaken when the bladder is full. This may also be caused by medical conditions or emotional or mental problems.
- Sleep hallucinations: You may experience very real-feeling hallucinations that involve the senses of sound, touch, smell, and taste. You may not be sure if you are awake or asleep.
- Exploding head syndrome: Just as you are falling asleep, you may hear a loud, painless explosion which is frightening and often prevents sleep.
- Sleep talking: This common parasomnia involves speaking aloud, often nonsensically, while asleep.
Treatment: Parasomnia patients should seek a sleep specialist to receive treatment aimed at their specific type of disorder. Many of these conditions may be symptoms of underlying sleep disorders. However, therapy options may include medications, such as Clonazepam, as well as bedroom safety precautions, maintaining a regular sleep pattern, getting enough sleep, avoiding certain medications and alcohol, and testing for other sleep disorders or neurological symptoms.
Sleep Movement Disorders
Sleep disorders involving involuntary movements can make it difficult to fall asleep or stay asleep, disrupting one’s abilities to perform normally during the day. They often include a variety of categories, including:
- Restless leg syndrome: Patients feel a painful burning or itching when laying down and trying to sleep, causing one to move one’s limbs to ease the sensation.
- Periodic limb movements: You experience uncontrollable movements, typically in the lower legs, which are repeated and tend to interrupt sleep.
- Sleep leg cramps: You may feel an intense and overwhelming pain in the foot or leg which is caused from muscle contractions.
- Sleep rhythmic movement: Patients feel repetitive movements while falling asleep or sleeping, often in children involving rocking of the body or rolling of the head.
- Bruxism: You may clench or grind your teeth while sleeping.
Treatment: Oftentimes, sleep specialists first try behavioral therapy for these sleep movement conditions; however, if symptoms to not decrease or cease, your doctor may try additional treatments, including medications. Sometimes Parkinson’s disease medications may be successful in preventing symptoms of sleep movement disorders such as restless legs syndrome. Hypnotic medications (sleeping pills) or anti-seizure medications may be considered by your sleep specialist. Your iron levels may be monitored and an iron pill may be prescribed only in instances where you have an iron deficiency. In severe cases, narcotic pain medications are prescribed to relieve pain associated with nighttime movement disorders.
Certain sleep issues can be treated with behavioral or cognitive therapy, while other disorders require medical attention and treatment which vary depending on the category of sleep-related affliction. If you experience sleep issues which are affecting your ability to function properly during the day, it is recommended that you seek the assistance of your family physician. He or she can review your symptoms with you and discuss your options as well as recommend a qualified sleep specialist to assist you further with treatment.