May 19th, 2020 BY HealthNetwork
You probably know that you need good sleep, but it may sometimes seem that your body doesn’t agree.
Unfortunately, tossing and turning all night can lead to daytime problems like lack of focus, indecisiveness and poor emotional regulation. Chronic sleep troubles can also contribute to physical illnesses like heart disease and diabetes.
If you’re struggling to get a good night’s sleep, it’s time to take action. Through lifestyle changes and your doctor’s help, you can find the rest that your body and mind crave.
Note: always talk to your doctor for specific medical advice. The following tips are for information only and shouldn’t be used as/to replace actual medical guidance.
Problem: You aren’t sleepy when it’s time to sleep.
Solution: Turn off your screens a few hours before bed.
It’s a common scenario. You drag yourself through the day only to feel perfectly perky once bedtime rolls around. This second wind can cost you considerable rest each night, and the tired-all-day cycle is likely to start fresh the next morning.
And despite your daily fatigue, the night-after-night routine of staring at the ceiling as the clock ticks by can leave you wondering if there’s any use in going to bed at a reasonable hour.
Instead of ditching bedtime, try breaking up with your screens a little earlier each night. Bright electronic devices like phones and computers give off blue light. Its wavelength is similar to that of the natural light that’s prominent at midday
Exposing yourself to blue light around bedtime interferes with melatonin production. Melatonin is a hormone that contributes to sleepiness. If your body doesn’t start putting out melatonin early enough in the evening, it throws off your circadian rhythm, leaving you wide awake at bedtime.
To avoid this problem, put your devices away a few hours before you plan to turn in. Other tips for cutting your evening exposure include wearing glasses that filter out blue light and replacing your standard nightlight with a red bulb.
Problem: Your legs keep you up at night.
Solution: Boost your iron intake.
If your legs rebel against you as soon as you lie down, you’re not alone. Around 10% of American adults may be afflicted with restless leg syndrome (RLS).
This condition is characterized by a sensation that your lower limbs are prickling, tingling or throbbing. The natural response is an urge to move your legs. But doing so can make it hard to fall asleep.
RLS could have a variety of causes. One common explanation is iron deficiency. In that case, iron supplements can help. Oral pills may be effective, but some people do better with intravenous supplementation instead.
Before you assume you need iron, talk to your doctor about getting your iron level tested. Never start a supplement regimen without asking a professional.
Plus, your doctor may want to evaluate you for related conditions. RLS is sometimes associated with kidney failure or diabetic neuropathy.
Many people with RLS benefit from a combination of treatments. In addition to taking iron, you may need to reduce your alcohol intake, perform evening stretches or soak in a warm bathtub before bed each night. Prescription medications normally used for treating seizures, Parkinson’s disease or anxiety may be effective as well.
Problem: You’re wide awake just a few hours after hitting the hay.
Solution: Create and stick to a bedtime routine.
Did you know that insomnia isn’t just the inability to go to sleep? It’s also characterized by nighttime waking. In other words, you go to sleep just fine but wake up shortly after and can’t get back to bed. Nighttime waking can be just as disruptive to a good night’s sleep as not being able to doze off in the first place.
You may notice that the problem flares up whenever you find yourself particularly stressed and anxious. And staying awake for half the night may further add to your stress.
Sleeping should come naturally, right? Well, that’s not always the case.
Overnight success can take a good deal of work. Developing healthy sleep habits may help you overcome insomnia so you can get the rest your body needs. Translation: you need a reliable bedtime routine, stat.
Start a routine to ease yourself toward bedtime the same time every night. Options abound.
- Drink a cup of sleepytime (caffeine-free) tea, play quiet music or perform gentle stretches.
- Once you’re ready to head to bed, turn the thermostat below 67 degrees Fahrenheit, and darken the room as much as possible. People sleep best in cool, dark environments.
- For good measure, put your clock out of sight in case you do wake up in the night. That way, you won’t be tempted to stress about the minutes that are ticking by.
Over time, these bedtime habits can help you sleep better all night long.
Also, while a midday snooze may feel good at the time, it can disrupt your overnight rest. If you’re prone to waking up at night, try skipping your siestas. Forgoing naps for a few days in a row may help reset your sleep cycle.
Problem: Your nighttime snoring keeps others awake.
Solution: Talk to your doctor about obstructive sleep apnea.
If you rumble like a grizzly bear all night long, your bedfellows may have a hard time getting solid sleep. You may even wake yourself with your grunts and snorts. These little interruptions to your sleep can add up to big exhaustion the next day.
With some people, snoring is no more than a nuisance. For others, it’s a sign of a bigger problem: obstructive sleep apnea.
This condition is characterized by interrupted breathing throughout the night. Instead of maintaining calm, steady respiration, you repeatedly stop breathing for several seconds at a time. Sound scary? It is.
Loud snoring is one of sleep apnea’s primary symptoms. Your partner may report that your breath pauses and then resumes with a sudden snort or gasp. You may also be fatigued during the day even after a full night’s sleep.
Your doctor can diagnose apnea after an exam and a sleep study.
Once you have a diagnosis, you may be outfitted with equipment to help you breathe more normally. One example is a continuous positive airway pressure (CPAP) machine that supplies a steady stream of air throughout the night. Another option is a dental appliance that properly positions your tongue and jaw as you sleep. In some cases, surgery may be a viable approach to apnea treatment.
Good sleep is essential for good health.
A well-rested brain works better — as does the human body it controls. You don’t have to settle for a fitful night of tossing and turning. If you’re having trouble going to sleep, staying asleep or getting quality rest when you’re sleeping, make an appointment with your doctor to get it sorted out. Good shut-eye isn’t just a luxury. It’s a necessity.
Having trouble sleeping? Below are 10 of the most common reasons why with suggestions on how to correct them.
1. Your room isn’t dark enough.
Ideally, your bedroom shouldn’t have any lights on, especially light emitted from a TV or any electronic device. When your eyes are exposed to light during the night, your brain is tricked into thinking it’s time to wake up and reduces the production of melatonin, a hormone released by your pineal gland that causes sleepiness and lowers body temperature. Light emitted by electronic devices is especially troublesome because it mimics sunlight.
2. Exercising too late.
If you exercise within three hours of trying to sleep, you’ll overstimulate your metabolism and raise your heart rate causing restlessness and frequent awakenings throughout the night. Try to exercise in the morning or no later than mid to late afternoon, which will result in sounder sleep.
3. Drinking alcohol too late.
We tend to think of alcohol as a sleep inducer, but it actually interferes with REM sleep, causing you to feel more tired the next morning. Granted, you may feel sleepy after you drink it, but that’s a short-term effect. Here’s a great video at WebMD about alcohol and sleep.
4. Room temperature too warm.
Your body and brain wants to cool down when you sleep, but if your room is too warm you’ll thwart the cool-down process. Having a fan in your room is a good idea because it will keep you cool and produce a consistent level of white noise that will help you fall asleep. Just don’t get too cold, because that will disrupt sleep as well. (You can also try cooling your brain.)
5. Caffeine still in your system.
The average half-life of caffeine is 5 hours, which means that you still have one-quarter of the first dose of caffeine rolling around in your system 10 hours after you drink it. Most of us drink more than one cup of coffee, and many of us drink it late in the day. If you’re going to drink coffee, drink it early.
Though it’s hard not to do, don’t look at your clock when you wake up during the night. In fact, it’s best to turn it around so it’s not facing you. When you habitually clockwatch, you’re training your circadian rhythms the wrong way, and before long you’ll find yourself waking up at exactly 3:15 every night.
7. Getting up to watch TV until you’re sleepy.
This is a bad idea for a few reasons. First, watching TV stimulates brain activity, which is the exact opposite of what you want to happen if your goal is to sleep soundly. Second, the light emitted from the TV is telling your brain to wake up (see #1 above).
8. Trying to problem-solve in the middle of the night.
All of us wake up at times during the night, and the first thing that pops into our heads is a big problem we’re worried about. The best thing you can do is stop yourself from going there and redirect your thoughts to something less stressful. If you get caught up on the worry treadmill, you’ll stay awake much longer.
9. Eating protein too close to bedtime.
Protein requires a lot of energy to digest, and that keeps your digestive system churning away while you’re trying to sleep — bad combination. Better to have a light carbohydrate snack.
10. Smoking before bedtime.
Smokers equate smoking with relaxing, but that’s a neurochemical trick. In truth, nicotine is a stimulant. When you smoke before trying to sleep, you can expect to wake up several times throughout the night; much as you would if you drank a cup of coffee.
What to do when pain keeps you up at night.
Your back is throbbing and has been for weeks. You can barely move from your bed, but you are not getting any sleep because of the intense pain.
This is a pretty common scenario, explains David Neumeyer, MD, the associate director of the Sleep Disorder Center at theLahey Clinic Medical Center in Burlington, Mass.
вЂњPain and sleep are integrally connected,вЂќ he says. вЂњChronic pain is very common in the population and even more common in people who have poor sleep, and it sort of becomes a vicious cycle.вЂќ Pain affects your ability to sleep, and the lack of sleep makes the pain seem worse.
The Link Between Pain and Sleep Problems
Exactly how the two conditions are connected varies from person to person. вЂњYou have to determine what is the chicken and what is the egg,вЂќ he says. вЂњIs pain a manifestation of, or made worse by, a sleep disorder or is pain causing the poor quality of sleep?вЂќ
Charles Bae, MD, a neurologist in the Sleep Disorders Center at the Cleveland Clinic in Ohio, puts it this way: вЂњPain can be the main reason that someone wakes up multiple times a night, and this results in a decrease in sleep quantity and quality, and on the flip side, sleep deprivation can lower your pain threshold and pain tolerance and make existing pain feel worse.вЂќ
вЂњIf you have arthritis and roll or turn while you are sleeping, pain can wake you up,вЂќ says David S Kloth, MD, the founder, medical director, and president of Connecticut Pain Care in Danbury, and a past president of the American Society of Intervention Pain Physicians.
The first step is to figure out if the lack of sleep is causing pain or if the pain is causing a lack of sleep, and then you treat whichever came first, he says.
The Pain-Reducing Benefits of Better Sleep
Pain may not be the only problem interfering with your sleep. Some people may also have an underlying sleep disorder, such as sleep apnea. Neumeyer recommends an evaluation by a sleep specialist to be sure there is not underlying sleep disorder.
Once youвЂ™re correctly diagnosed, sleep experts say good treatment can significantly help those living with chronic pain.
Getting better quality sleep — and more of it — may improve your pain threshold so you will ache less, says Neumeyer.
вЂњPeople in pain donвЂ™t sleep, and people who sleep have less pain,вЂќ agrees Michael Breus, PhD, author of Beauty Sleepand the clinical director of the sleep division for Arrowhead Health in Glendale, Ariz.
Treating Pain-Related Sleep Problems
Improving sleep in people with chronic pain such as low back pain, arthritis, fibromyalgia, and diabetic nerve pain is difficult because these individuals often donвЂ™t want to take any more drugs, says Breus.
These individuals are often already taking several medications to treat their pain disorder. WhatвЂ™s more, certain prescription sleeping pills may interact with their pain medications, so they couldnвЂ™t take them even if they wanted to, says Breus.
In essence, Breus becomes the Sherlock Holmes of sleep problems. He looks at each individualвЂ™s sleep habits and bedroom environment. вЂњI have to investigate how old their mattress and pillows are, and make sure they are offer proper support,вЂќ he says. He asks about their diet and habits. Do they avoid beverages with caffeine after 2 p.m.? Do they exercise regularly? Do they use the bedroom only for sleep and sex? All these things may also help people in pain get their ZZZs.
The bottom line, according to Cleveland ClinicвЂ™s Bae, is вЂњif you have chronic pain and trouble sleeping, bring it up to your doctor to see if anything can be done to help your sleep while getting your pain treated.вЂќ
David Neumeyer, MD, associate director, Sleep Disorder Center, Lahey Clinic Medical Center, Burlington, Mass.
Charles Bae,В MD, neurologist, Sleep Disorders Center, Cleveland Clinic, Ohio.
David S Kloth, MD, founder, medical director, president, Connecticut Pain Care, Danbury, Conn.
Michael Breus, PhD, author, Beauty Sleep; clinical director, sleep division, Arrowhead Health, Glendale, Ariz.
Articles On Nightmares and Night Terrors
- Why Do Kids Have Nightmares?
- Night Terrors in Toddlers
- Sleep Disorders in Children
Children and adolescents need at least 9 hours of sleep every night. Sleep problems and a lack of sleep can have negative effects on children’s performance in school, during extracurricular activities, and in social relationships.
A lack of sleep may cause:
- Accidents and injuries
- Behavior problems
- Impulsive behavior
- Mood problems
- Memory, concentration, and learning problems
- Performance problems
- Slower reaction times
Signs of Sleep Problems in Children
Talk to your pediatrician if your child shows any of the following signs of a sleep problem:
- Breathing pauses during sleep
- Trouble falling asleep
- Problems with sleeping through the night
- Trouble staying awake during the day
- Unexplained decrease in daytime performance
- Unusual events during sleep such as sleepwalking or nightmares
- Teeth grinding
- Restless sleep
- Trouble waking up in the morning
Tips for Improving Your Child’s Sleep
- Set a regular time for bed each night, and donвЂ™t vary from it. And donвЂ™t encourage sleeping in on the weekends. Wake-up time shouldnвЂ™t differ by more than 1 to 1 ВЅ hours.
- Create a relaxing bedtime routine, such as giving your child a warm bath or reading a story.
- DonвЂ™t give children any food or drinks with caffeine less than 6 hours before bedtime.
- Make sure the temperature in the bedroom is comfortable and the bedroom is dark.
- Make sure the noise level in the house is low.
- Avoid giving children large meals close to bedtime.
- Make after-dinner playtime a relaxing time, as too much activity close to bedtime can keep children awake.
- There should be no television, computer, mobile phone, radio, or music playing while the child is going to sleep. TV and video games should be turned off at least 1 hour before bedtime.
- Infants and children should be put to bed when they appear tired but still awake (rather than falling asleep in your arms, or in another room). Avoid getting into bed with your child in order to get them to sleep.
Talk to your child’s health care provider if these tips don’t help or if you need additional guidance.
The National Sleep Foundation.
WebMD Feature: “Good, Sound Sleep for Your Child.”
Our moms and grandmothers called it the “change of life” — that dreaded age of hot flashes and mood swings, and the unofficial start of middle age. Many women expect those unwelcome symptoms during menopause . But along with sweating and weight gain comes something many women don’t anticipate: disturbed sleep.
Poor sleep quality and sleep disturbance are lesser-known changes during this phase of life, says Grace Pien, M.D., M.S.C.E. , an assistant professor of medicine at the Johns Hopkins Sleep Disorders Center , but they’re very common.
You might think that a good night’s sleep is nothing but a dream once you reach a certain age. Many women experience sleep problems during perimenopause , the period of time before menopause when hormone levels and menstrual periods become irregular. Often, poor sleep sticks around throughout the menopausal transition and after menopause. Fortunately, says Pien, there’s help.
What’s “good” sleep? Women should aim for between seven and eight hours of quality, uninterrupted sleep per night, Pien says. The rule isn’t hard and fast, though; some people need less sleep and others need more. “In general, if you’re waking up regularly during the night and feel that your sleep isn’t restful, those are signs that maybe you’re not getting good sleep,” she says.
Hot Flashes and Sleep
Sleeplessness due to menopause is often associated with hot flashes. These unpleasant sensations of extreme heat can come on during the day or at night. Nighttime hot flashes are often paired with unexpected awakenings.
Pien says that though it’s common to feel like a hot flash has awakened you, research shows that many menopausal women actually wake just before a hot flash occurs.
“There are changes in the brain that lead to the hot flash itself, and those changes — not just the feeling of heat — may also be what triggers the awakening,” she says. “Even women who don’t report sleep disturbances from hot flashes often say that they just have more trouble sleeping than they did before menopause.”
Other Menopausal Sleep Disruptors
At this stage of life, women can also develop sleep disorders such as sleep apnea , which may come from a loss of reproductive hormones like estrogen and progesterone. These can go undiagnosed because women often attribute symptoms and effects of sleep disorders (like daytime fatigue) to menopause itself.
“Postmenopausal women are two to three times more likely to have sleep apnea compared with premenopausal women,” Pien says. “Before we become menopausal, we’re fairly protected, but the protective effect of hormones seems to be lost with menopause. Furthermore, women often have more subtle symptoms of sleep apnea than men. Thus, they may be less likely to seek evaluation for sleep apnea. Their health care providers may also be less likely to recognize sleep apnea as a possibility, further delaying evaluation and diagnosis of sleep apnea.”
Depressive symptoms and anxiety may also be risk factors for poor sleep during menopause.
How to Get a Better Night’s Rest
The good news is that you don’t have to kiss a good night’s rest goodbye once you hit menopause. There are steps you can take to get better sleep.
Regular exercise can help menopausal women fall and stay asleep, Pien says. “We see that athletes, for example, tend to be highly efficient sleepers. But even for those of us who aren’t professional athletes, exercise can help with sleep quality.”
Medication and Therapies
Some selective serotonin reuptake inhibitors (SSRIs) have been shown to help with sleep symptoms in menopausal women. Hormone replacement therapies can improve sleep quality, though few objective differences in sleep have been observed with their use, and the detrimental effects of hormone therapy can outweigh any benefit. Alternative therapies like acupuncture can also be helpful. Speak with your doctor about what might be right for you.
As for over-the-counter sleep aids? While occasional use isn’t harmful, it’s also important to make lifestyle changes that enhance sleep, like winding down an hour before bedtime, going to bed at the same time every night and not watching television or using an electronic device before dozing off.
“Just as we recommend that kids have a regular bedtime and wake time, trying to do that as an adult also helps your body know when it’s time to go to bed,” Pien says.
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by Hannah Furfaro / 6 February 2020
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This article was originally published in November 2017. It has been revised to reflect more recent research.
A good night’s rest isn’t guaranteed for anyone, but it is downright elusive for many people with autism. Individuals on the spectrum often have trouble falling and staying asleep.
And that may worsen certain features of their condition, such as repetitive behaviors, which can, in turn, make sleeping even more difficult.
Given this disruptive feedback loop, sleep problems are among the most urgent concerns for families grappling with autism. But so far, this also happens to be among the least-studied aspects of autism.
Here’s what researchers know so far about the causes and consequences of — and treatments for — sleep problems in autism.
How common are sleep problems in children with autism?
A 2019 study, one of the largest to investigate the prevalence of sleep problems in autism, suggested that nearly 80 percent of autistic preschoolers have disrupted sleep. Sleep problems are twice as common among children with autism as they are among typical children or those with other developmental conditions.
What types of sleep problems are common in autism?
People with autism tend to have insomnia: It takes them an average of 11 minutes longer than typical people to fall asleep, and many wake up frequently during the night. Some people with the condition have sleep apnea, a condition that causes them to stop breathing several times during the night.
Sleep in people with autism may also be less restorative than it is for people in the general population. They spend about 15 percent of their sleeping time in the rapid eye movement (REM) stage, which is critical for learning and retaining memories. Most neurotypical people, by contrast, spend about 23 percent of their nightly rest in REM.
Does this lack of good sleep have consequences?
There is mounting evidence that too little sleep can exacerbate autism features, such as poor social skills. Children who do not get enough sleep often have more severe repetitive behaviors and a tougher time making friends than other people on the spectrum. They also tend to score lower on tests of intelligence. However, it is unclear whether these problems stem from poor sleep, contribute to it or both.
One 2009 study found that children with autism who have sleep difficulties are more hyperactive and easily distracted than those who sleep well 1 .
Why do people with autism have difficulty sleeping?
Many people with autism have other conditions, such as gastrointestinal problems, attention deficit hyperactivity disorder (ADHD) or anxiety, and each of those is known to disrupt sleep. Cramps from constipation, for instance, may keep a person with autism up at night. Sensory sensitivities to light, sound or touch may contribute to difficulty sleeping. Sleep problems may also be an indicator of depression in autistic people, though whether it is a cause or a result of sleep difficulties is unclear.
People with these other conditions may also take medications that affect sleep. For example, many people with ADHD take stimulants, which are known to cause insomnia.
In some cases, people on the spectrum carry mutations that make them prone to sleep problems. Studies suggest that individuals with autism are more likely than typical people to have mutations in genes that govern the sleep-wake cycle or those that have links to insomnia. Some studies suggest that people on the spectrum carry mutations that affect levels of melatonin, a natural hormone that controls sleep.
How can researchers assess sleep problems in people with autism?
Polysomnography is the most common and thorough type of sleep test. It tracks a person’s brain waves, eye and limb movement, and breathing patterns during sleep. Because it requires multiple sensors, wires and computers, it is typically done in a lab.
But this gold-standard method is not always practical for people with autism, many of whom require specific routines at bedtime. At least one research group has brought polysomnography equipment into the homes of people with autism to try to get around this problem.
A less cumbersome sleep test is actigraphy, in which a wristwatch-like device records a person’s movements throughout the night. People can use the device at home to record the amount of time a person sleeps each night.
Researchers can also learn about sleep patterns by interviewing families or asking them to maintain sleep diaries. But these methods are error-prone because they rely on people’s memories.
Are there treatments available to help people with autism sleep better?
In some ways, the fix can be straightforward: Establishing a routine, such as an order of activities at bedtime, can often help a person fall asleep; so can changing the temperature or lighting in a bedroom. Sticking with regular bed and wake times can put the brain and body on a schedule that makes sleep more reliable.
The U.S. Food and Drug administration has approved insomnia drugs, such as Ambien, for adults with autism but not for children. For more serious problems such as sleep apnea, clinicians sometimes recommend a nighttime breathing device such as a continuous positive airway pressure (CPAP) machine or, in rare cases, surgery.
But for many sleep issues, melatonin supplements may be a good option. Some research suggests the supplements help children with autism fall asleep faster and get better-quality sleep.
Would better sleep improve quality of life for people on the spectrum?
Maybe. No large, definitive study exists on this topic. But research has shown that typical children and those with autism who undergo surgery to alleviate breathing trouble during sleep show better social communication and attention as well as fewer repetitive behaviors. Parents reported similar improvements in a small study of children with autism who took melatonin supplements.
Better sleep is “not going to cure autism,” says pediatrician Angela Maxwell-Horn, assistant professor of pediatrics at Vanderbilt University in Nashville, Tennessee. But, she says, children with autism who get back on a regular sleeping schedule seem to learn better, are less irritable and have fewer problem behaviors.
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What is sleep?
Sleep is a complex biological process. While you are sleeping, you are unconscious, but your brain and body functions are still active. They are doing a number of important jobs that help you stay healthy and function at your best. So when you don’t get enough quality sleep, it does more than just make you feel tired. It can affect your physical and mental health, thinking, and daily functioning.
What are sleep disorders?
Sleep disorders are conditions that disturb your normal sleep patterns. There are more than 80 different sleep disorders. Some major types include
- Insomnia – being unable to fall asleep and stay asleep. This is the most common sleep disorder.
- Sleep apnea – a breathing disorder in which you stop breathing for 10 seconds or more during sleep
- Restless leg syndrome (RLS) – a tingling or prickly sensation in your legs, along with a powerful urge to move them
- Hypersomnia – being unable to stay awake during the day. This includes narcolepsy, which causes extreme daytime sleepiness.
- Circadian rhythm disorders – problems with the sleep-wake cycle. They make you unable to sleep and wake at the right times.
- Parasomnia – acting in unusual ways while falling asleep, sleeping, or waking from sleep, such as walking, talking, or eating
Some people who feel tired during the day have a true sleep disorder. But for others, the real problem is not allowing enough time for sleep. It’s important to get enough sleep every night. The amount of sleep you need depends on several factors, including your age, lifestyle, health, and whether you have been getting enough sleep recently. Most adults need about 7-8 hours each night.
What causes sleep disorders?
There are different causes for different sleep disorders, including
- Other conditions, such as heart disease, lung disease, nerve disorders, and pain
- Mental illnesses, including depression and anxiety
Sometimes the cause is unknown.
There are also some factors that can contribute to sleep problems, including
- Caffeine and alcohol
- An irregular schedule, such as working the night shift
- Aging. As people age, they often get less sleep or spend less time in the deep, restful stage of sleep. They are also more easily awakened.
What are the symptoms of sleep disorders?
The symptoms of sleep disorders depend on the specific disorder. Some signs that you may have a sleep disorder include that
- You regularly take more than 30 minutes each night to fall asleep
- You regularly wake up several times each night and then have trouble falling back to sleep, or you wake up too early in the morning
- You often feel sleepy during the day, take frequent naps, or fall asleep at the wrong times during the day
- Your bed partner says that when you sleep, you snore loudly, snort, gasp, make choking sounds, or stop breathing for short periods
- You have creeping, tingling, or crawling feelings in your legs or arms that are relieved by moving or massaging them, especially in the evening and when trying to fall asleep
- Your bed partner notices that your legs or arms jerk often during sleep
- You have vivid, dreamlike experiences while falling asleep or dozing
- You have episodes of sudden muscle weakness when you are angry or fearful, or when you laugh
- You feel as though you cannot move when you first wake up
How are sleep disorders diagnosed?
To make a diagnosis, your health care provider will use your medical history, your sleep history, and a physical exam. You may also have a sleep study (polysomnogram). The most common types of sleep studies monitor and record data about your body during a full night of sleep. The data includes
- Brain wave changes
- Eye movements
- Breathing rate
- Blood pressure
- Heart rate and electrical activity of the heart and other muscles
Other types of sleep studies may check how quickly you fall asleep during daytime naps or whether you are able to stay awake and alert during the day.
What are the treatments for sleep disorders?
Treatments for sleep disorders depend on which disorder you have. They may include
- Good sleep habits and other lifestyle changes, such as a healthy diet and exercise
- Cognitive behavioral therapy or relaxation techniques to reduce anxiety about getting enough sleep
- CPAP (continuous positive airway pressure) machine for sleep apnea
- Bright light therapy (in the morning)
- Medicines, including sleeping pills. Usually, providers recommend that you use sleeping pills for a short period of time.
- Natural products, such as melatonin. These products may help some people but are generally for short-term use. Make sure to check with your health care provider before you take any of them.
More than 70 million Americans struggle with a sleep disorder, and there are more than 90 different types.
Sleep disorders: An overview
Roughly one in three American adults doesn’t get enough sleep at night.  That’s a problem, and not just because a lack of sleep leaves many feeling groggy during the day. According to the Centers for Disease Control and Prevention (CDC), poor sleep is associated with elevated risks for a number of diseases—from obesity and diabetes to depression. 
A sleep disorder is any recurring issue that disrupts the quality or amount of sleep you get at night. While some sleep disorders are caused by an underlying medical condition, others are not.
By some estimates, nearly 75 percent of adults experience symptoms of a sleep disorder each week, and up to 30 percent of children also grapple with some form of sleep disturbance.  While a high percentage of both men and women suffer from sleep disorders, there’s some evidence that women—especially those between the ages of 30 and 60—are more likely to suffer from a sleep disorder than men. 
What are the common types of sleep disorders?
While many people think of insomnia when they hear the term “sleep disorder,” there are several other common conditions that can harm a person’s slumber. In some cases, sleep disorder symptoms may even strike during the daytime—not at night. 
There are over 90 different types of sleep disorders. The most common include:
Insomnia is an inability to fall asleep, stay asleep, or sleep through the night. It’s the most common sleep disorder, and it comes in two varieties:
Primary insomnia: This is not caused by an underlying medical condition.
Secondary insomnia: This type stems from another medical problem.
Roughly half of all adults report occasional bouts of insomnia, which are stretches of poor sleep lasting anywhere from one night to several weeks. Insomnia becomes “chronic” if it lasts longer than one month. Roughly 10 percent of adults experience chronic insomnia.
Sleep apnea is a condition in which a person repeatedly stops breathing during the night, which harms the depth and quality of his or her sleep. In some cases, these breathing stoppages can occur hundreds of times each night. There are two types:
Obstructive sleep apnea: This is caused by the partial or total blockage of breathing airways during sleep. It’s the more common type of sleep apnea.
Central sleep apnea: The type of sleep apnea in which the muscles that control a person’s breathing don’t work properly during sleep. This is often a result of “signaling problems” in a person’s brain, or as a result of other conditions, like heart failure and stroke.
Narcolepsy is a neurological disorder in which the brain doesn’t properly manage the body’s sleep-wake states. There are two types:
Type 1 narcolepsy: This term is used to describe patients who either have low levels of a brain chemical called hypocretin, which helps regulate the body’s sleep-wake cycles, or those who experience some specific narcolepsy symptoms. (More on those below.)
Type 2 narcolepsy: Patients with this condition do not have low levels of hypocretin, but experience other narcolepsy symptoms.
Restless Leg Syndrome
Restless leg syndrome (RLS) is just what it sounds like: a strong inclination or urge to move your legs while they’re at rest. RLS usually happens once a person lies down in bed or after they’ve been sitting for long periods.
For some, RLS can be so severe that it becomes difficult to fall or stay asleep. This can lead to excessive daytime drowsiness and insomnia.
Circadian Rhythm Disorders
This group of related sleep issues is caused by disruptions to a person’s internal circadian rhythm, or sleep clock. This biological clock determines the release of neurochemicals that either initiate sleep or chase it away. For people with a circadian rhythm disorder, there’s a mismatch between their internal clocks and their desired sleep-wake schedule, and this leads to problems sleeping.
Circadian rhythm disorders come in a variety of subtypes. These include:
Shift work disorder: This occurs among people who work irregular schedules or night shifts, and are often trying to stay awake or fall asleep at times that don’t align with their body’s internal clocks.
Delayed sleep phase disorder: This could be thought of as “night owlism.” It’s most common among teens and young adults, and it’s defined as an inability to fall asleep until very late at night—2 or 3 a.m.—and a desire to sleep until midday or later. While this may not seem like a problem for some, it can be a considerable challenge if a person’s work or school obligations require them to go to bed and get up at earlier hours.
Advanced sleep phase disorders: This is basically the opposite of delayed sleep phase disorder. This type, which is most common among the elderly, typically involves going to bed at a very early hour—sometime between 6 and 9 p.m.—and rising in the middle of the night.
There are many other types of sleep disorders, but the above are the most common.
Simple changes can make recovery more restful, and better overall.
The importance of sleep is perhaps most realized when we become sick. When we are hospitalized and most in need of every ounce of health, though, hospital care practically guarantees that we won’t get good sleep. Fortunately, two approaches hold promise to improve sleep for patients: one organizational, and the other a common trick of the trade among those of us working in behavioral economics.
Recently I was all-too-miserably reminded of the challenges of hospital sleep when I spent a fitful night recovering from surgery to remove a small kidney tumor. Unlike some patients in that situation, my sleep was not disturbed by pain or nausea; I was lucky to avoid both of those postoperative complications. Instead, my sleep was interrupted, hourly, by clinicians taking care of me. There were vital sign checks every four hours, a frequency that makes sense given that I had just had part of my left kidney removed. Sometimes sleep interruptions are necessary in order to monitor patient conditions. But those vital sign checks, at midnight and 4 a.m., were not the only interruptions I experienced that night. At 3 a.m., if my very foggy memory serves me correctly, someone came into my room to draw blood for follow-up laboratory tests. Several other times that evening, the machine hovering near my left ear beeped to tell me that one of my IV medications had run out; I would push the nursing button and tell the person at the desk about the beeping, and eventually someone would come in and either replace the empty IV bag or turn the alarm off.
Between 10 p.m. and 6 a.m., I did not go more than an hour without some kind of interruption.
As I have already suggested, some of these interruptions are necessary. But many are not. And the consequence of too many sleep interruptions is that patients do not heal as quickly as they would otherwise, thereby not only reducing their quality of life but also driving up medical costs. Indeed, as I have written elsewhere: sleep disturbance is a leading cause of hospital complications, such as falls and delirium. Poor sleep has also been linked to reduced immune function,worsening blood pressure control and mood disorders. All of these problems potentially impair the ability of patients to recover from the acute illnesses that caused them to be hospitalized.
How do we improve hospital sleep?
First, hospitals could make simple organizational changes. During my recent hospital stay, for example, a major contributor to my interrupted sleeping was the specialization of tasks across different hospital personnel. When the IV machine beeped, it was the nurse who helped out, her training being necessary to monitor the IV lines and medications. When it came to measuring my vital signs, though, a nurse’s aide was sent to accomplish the task. And a phlebotomist came to draw my blood. Specialization matters. The doling out of these duties to different people — with different skills and different pay grades — makes great economic sense, and in many ways improves hospital quality of care. But such specialization interferes with sleep, because the different people performing each of these duties enter patient rooms at different times of the night.
There is a better way to coordinate these various clinicians to reduce sleep interruptions. For example, phlebotomists could coordinate their work with nursing aides. Imagine that instead of coming into patient rooms one hour apart from each other, the two came in together: “We are here to check your blood pressure and draw some blood,” they would say (maybe even in unison!). That little change would eliminate one interruption. A second change could also improve patient sleep: more flexibility in the timing of vital sign measures. If, for example, a patient’s IV machine beeps at 11 p.m. and the next check of her vital signs is due at midnight, the nurse could bump up the vital sign measures by an hour, since the patient is already awake.
Indeed, it was an 11 p.m. vital signs wake-up call that led to research that proves the value of my second approach to improving patient sleep: increasing the use of sleep protocols designed to minimize unnecessary interruptions. More on sleep protocols in a bit, but first let me tell you about that 11 p.m. wake-up call.
Melissa Bartick is a hospitalist in the Harvard medical system, a physician who focuses mainly on inpatient rather than outpatient care, treating patients who have been hospitalized with acute or chronic illnesses. Spending as much time in hospitals as she does, Bartick has long recognized the problems created when patients have difficulty sleeping. But it took her own hospitalization to convince her how fixable this problem is.
Bartick had spent an exhausting evening being evaluated for an acute illness in her hospital’s emergency department. She finally made it up to a hospital bed around 10 p.m., where the nurse checked her vital signs and made sure she was receiving appropriate treatments. Finally allowed to rest, Bartick quickly fell asleep only to be awoken at 11 p.m. for . another vital sign check! She was not awoken because her illness was so acute that she needed hourly assessments. Instead, she was awoken because hospital protocol required nurses to check vital signs each shift, and the night shift began at 11 p.m.
“By the time I left the next morning, I had half of my research design worked out,” Bartick told me. When Bartick was healthy again, she conducted the clinical trial she had begun designing that night. In the trial, some patients, at random, were cared for under a sleep protocol, an order that alerts nursing staff to eliminate all unnecessary middle of the night intrusions — eight hours of quiet time for patients, with darkening of the room and avoidance of waking patients for nonurgent matters. The protocol reduced sleep disturbances by 38 percent.
How do we make sleep protocols the norm among stable hospitalized patients? We change hospital practice so that minimization of sleep disturbances becomes the default condition for how to care for non-critically ill patients, with more frequent sleep interruptions only occurring when physicians actively indicate that such interruptions are clinically necessary. Research in behavioral economics has demonstrated that people are strongly influenced by default options when making decisions. Employees are more likely to contribute to retirement funds when such contributions are automatic. People are more likely to donate their loved ones’ organs in countries where such donations are default policy.
Currently, the default setting in most hospitals is to prioritize testing over patient sleep. While patients in intensive care usually do need to have their vital signs monitored closely, and often need multiple blood draws each day to monitor rapidly changing clinical circumstances, many hospitalized patients do not change enough in their clinical course to require routine middle-of-the-night interruptions. Patient sleep would be improved overnight, literally, if hospitals established new default procedures — for instance: “all patients in non-ICU settings will be cared for under sleep protocols after 36 hours in the hospital, unless the physician indicates otherwise.”