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Sleeping Problems

At some time, most of us have experienced what it’s like to have trouble falling asleep, to lie awake in the middle of the night, or feel sleepy and fatigued during the day. However, when sleep problems are a regular occurrence—when they get in the way of your daily routine and hamper your ability to function—you may be suffering from a sleep disorder.

Sleep disorders and other sleeping problems cause more than just sleepiness. Poor quality sleep can have a negative impact on your energy, emotional balance, productivity, and health. If you’re experiencing sleeping problems,  learn about the signs and symptoms of common sleep disorders, what you can do to help yourself, and when to see a doctor.

Understanding sleep disorders and sleeping problems:

Sleep can often be a barometer of your overall health. In many cases, people in good health tend to sleep well, whereas repeated sleeping problems may indicate an underlying medical or mental health problem, be it minor or serious. Sleeping well is essential to your physical health and emotional well-being. Unfortunately, even minimal sleep loss can take a toll on your mood, energy, efficiency, and ability to handle stress. Ignoring sleep problems and disorders can lead to poor health, accidents, impaired job performance, and relationship stress. If you want to feel your best, stay healthy, and perform up to your potential, sleep is a necessity, not a luxury.

It’s not normal to feel sleepy during the day, to have problems getting to sleep at night, or to wake up feeling unrefreshed. But even if you’ve struggled with sleep problems for so long that it does seem normal, you can learn to sleep better. You can start by tracking your symptoms and sleep patterns, and then making healthy changes to your daytime habits and bedtime routine. If self-help doesn’t do the trick, you can turn to sleep specialists who are trained in sleep medicine. Together, you can identify the underlying causes of your sleeping problem and find ways to improve your sleep and quality of life.

Signs and symptoms of sleep disorders and sleeping problems:

Everyone experiences occasional sleeping problems. So how do you tell whether your sleeping problem is just a minor, passing annoyance or a sign of a more serious sleep disorder or underlying medical condition?

Start by scrutinizing your symptoms, looking especially for the telltale daytime signs of sleep deprivation. If you are experiencing any of the following symptoms on a regular basis, you may be dealing with a sleep disorder.

Is it a sleep disorder? Do you . . .

  • feel irritable or sleepy during the day?

  • have difficulty staying awake when sitting still, watching television or reading?

  • fall asleep or feel very tired while driving?

  • have difficulty concentrating?

  • often get told by others that you look tired?

  • react slowly?

  • have trouble controlling your emotions?

  • feel like you have to take a nap almost every day?

  • require caffeinated beverages to keep yourself going?

If you answered “yes” to any of the previous questions, you may have a sleep disorder.

Insomnia: The most common type of sleep disorder:

Insomnia, the inability to get the amount of sleep you need to wake up feeling rested and refreshed, is the most common sleep complaint. Insomnia is often a symptom of another problem, such as stress, anxiety, depression, or an underlying health condition. It can also be caused by lifestyle choices, including the medications you take, lack of exercise, jet lag, or even the amount of coffee you drink.

Common signs and symptoms of insomnia include:

  • Difficulty falling asleep at night or getting back to sleep after waking during the night.

  • Waking up frequently during the night.

  • Your sleep feels light, fragmented, or unrefreshing.

  • You need to take something (sleeping pills, nightcap, supplements) in order to get to sleep.

  • Sleepiness and low energy during the day.

Whatever the cause of your insomnia, being mindful of your sleep habits and learning to relax will help you sleep better and feel better. The good news is that most cases of insomnia can be cured with lifestyle changes you can make on your own—without relying on sleep specialists or turning to prescription or over-the-counter sleeping pills.

Other common types of sleep disorders:

In addition to insomnia, the most common sleep disorders are sleep apnea, restless legs syndrome (RLS), and narcolepsy.

Sleep disorder 1: Sleep apnea:

Sleep apnea is a common sleep disorder in which your breathing temporarily stops during sleep due to blockage of the upper airways. These pauses in breathing interrupt your sleep, leading to many awakenings each hour. While most people with sleep apnea don’t remember these awakenings, they feel the effects in other ways, such as exhaustion during the day, irritability and depression, and decreased productivity.

Sleep apnea is a serious, and potentially life-threatening, sleep disorder. If you suspect that you or a loved one may have sleep apnea, see a doctor right away. Sleep apnea can be successfully treated with Continuous Positive Airway Pressure (CPAP), a mask-like device that delivers a stream of air while you sleep. Losing weight, elevating the head of the bed, and sleeping on your side can also help in cases of mild to moderate sleep apnea.

Symptoms of sleep apnea include:

  • Loud, chronic snoring

  • Frequent pauses in breathing during sleep

  • Gasping, snorting, or choking during sleep

  • Feeling unrefreshed after waking and sleepy during the day, no matter how much time you spent in bed

  • Waking up with shortness of breath, chest pains, headaches, nasal congestion, or a dry throat.

Sleep disorder 2: Restless legs syndrome (RLS):

Restless legs syndrome (RLS) is a sleep disorder that causes an almost irresistible urge to move your legs (or arms). The urge to move occurs when you’re resting or lying down and is usually due to uncomfortable, tingly, aching, or creeping sensations.

Common signs and symptoms of restless legs syndrome include:

  • Uncomfortable sensations deep within the legs, accompanied by a strong urge to move them.

  • The leg sensations are triggered by rest and get worse at night.

  • The uncomfortable sensations temporarily get better when you move, stretch, or massage your legs.

  • Repetitive cramping or jerking of the legs during sleep.

Sleep disorder 3: Narcolepsy:

Narcolepsy is a sleep disorder that involves excessive, uncontrollable daytime sleepiness. It is caused by a dysfunction of the brain mechanism that controls sleeping and waking. If you have narcolepsy, you may have “sleep attacks” while in the middle of talking, working, or even driving.

Common signs and symptoms of narcolepsy include:

  • Seeing or hearing things when you’re drowsy or starting to dream before you’re fully asleep.

  • Suddenly feeling weak or losing control of your muscles when you’re laughing, angry, or experiencing other strong emotions.

  • Dreaming right away after going to sleep or having intense dreams

  • Feeling paralyzed and unable to move when you’re waking up or dozing off.

Circadian rhythm sleep disorders:

We all have an internal biological clock that regulates our 24-hour sleep-wake cycle, also known as our circadian rhythms. Light is the primary cue that influences circadian rhythms. When the sun comes up in the morning, the brain tells the body that it’s time to wake up. At night, when there is less light, your brain triggers the release of melatonin, a hormone that makes you sleepy.

When circadian rhythms are disrupted or thrown off, you may feel groggy, disoriented, and sleepy at inconvenient times. Circadian rhythms have been linked to a variety or sleeping problems and sleep disorders, including insomnia, jet lag, and shift work sleep difficulties. Abnormal circadian rhythms have also been implicated in depression, bipolar disorder, and seasonal affective disorder, or the winter blues.

Jet lag sleeping problems:

Jet lag is a temporary disruption in circadian rhythms that occurs when you travel across time zones. Symptoms include daytime sleepiness, fatigue, headache, stomach problems, and insomnia. The symptoms typically appear within a day or two after flying across two or more time zones. The longer the flight, the more pronounced the symptoms. The direction of flight also makes a difference. Flying east tends to cause worse jet lag than flying west.

In general, it usually takes one day per time zone crossed to adjust to the local time. So if you flew from Los Angeles to New York, crossing three time zones, your jet lag should be gone within three days. However, jet lag can be worse if you:

  • lost sleep during travel

  • are under a lot of stress

  • drink too much alcohol or caffeine

  • didn’t move around enough during your flight

Shift work sleeping problems:

Shift work sleep disorder is a circadian rhythm sleep disorder that occurs when your work schedule and your biological clock are out of sync. In our 24-hour society, many workers have to work night shifts, early morning shifts, or rotating shifts. These schedules force you to work when your body is telling you to go to sleep, and sleep when your body is signaling you to wake.

While some people adjust better than others to the demands of shift work, most shift workers get less quality sleep than their daytime counterparts. As a result of sleep deprivation, many shift workers struggle with sleepiness and mental lethargy on the job. This cuts into their productivity and puts them at risk of injury.

There are a number of things you can do to reduce the impact of shift work on sleep:

  • Take regular breaks and minimize the frequency of shift changes.

  • When changing shifts, request a shift that’s later, rather than earlier as it’s easier to adjust forward in time, rather than backward.

  • Naturally regulate your sleep-wake cycle by increasing light exposure at work (use bright lights) and limiting light exposure when it’s time to sleep. Avoid TV and computer screens, use black-out shades or heavy curtains to block out daylight in your bedroom.

  • Consider taking melatonin when it’s time for you to sleep.

Delayed sleep phase disorder:

Delayed sleep phase disorder is a sleep disorder in which your 24-hour cycle of sleep and wakefulness—your biological clock—is significantly delayed. As a result, you go to sleep and wake up much later than other people. For example, you may not get sleepy until 4 a.m., at which time you go to bed and sleep soundly until noon, or at least you would if your daytime responsibilities didn’t interfere. Delayed sleep phase disorder makes it difficult for you to keep normal hours—to make it to morning classes, get the kids to school on time, or keep a 9-to-5 job.

It’s important to note that this sleeping problem is more than just a preference for staying up late or being a night owl.

  • People with delayed sleep phase disorder are unable to get to sleep earlier than 2 to 6 a.m. no matter how hard they try. They struggle to go to sleep and get up at socially acceptable times.

  • When allowed to keep their own hours (such as during a school break or holiday), they fall into a regular sleep schedule.

  • Delayed sleep phase disorder is most common in teenagers, and many teens will eventually grow out of it.

  • For those who continue to struggle with a biological clock that is out of sync, treatments such as light therapy and chronotherapy can help.

Self-help for sleeping problems and sleep disorders:

While some sleep disorders may require a visit to the doctor, you can improve many sleeping problems on your own. The first step to overcoming a sleep problem is identifying and carefully tracking your symptoms and sleep patterns.

Keep a sleep diary:

A sleep diary is a very useful tool for identifying sleep disorders and sleeping problems and pinpointing both day and nighttime habits that may be contributing to your difficulties. Keeping a record of your sleep patterns and problems will also prove helpful if you eventually find it necessary to see a doctor.

Your sleep diary should include:

  • what time you went to bed and woke up

  • total sleep hours and perceived quality of your sleep

  • a record of time you spent awake and what you did (“stayed in bed with eyes closed,” for example, or “got up, had a glass of milk, and meditated.”)

  • types and amount of food, liquids, caffeine, or alcohol you consumed before bed, and times of consumption

  • your feelings and moods before bed ­(e.g. happiness, sadness, stress, anxiety)

  • any drugs or medications taken, including dose and time of consumption

The details can be important, revealing how certain behaviours can be ruining your chance for a good night’s sleep. After keeping the diary for a week, for example, you might notice that when you have more than one glass of wine in the evening, you wake up during the night.

Improve your sleep hygiene and daytime habits:

Regardless of your sleep problems, a consistent sleep routine and improved sleep habits will translate into better sleep over the long term. You can address many common sleep problems through lifestyle changes and improved sleep hygiene. For example, you may find that when you start exercising regularly and managing your stress more effectively, your sleep is much more refreshing. The key is to experiment. Use your sleep diary as a jumping off point.

Try the following simple changes to your daytime and pre-bedtime routine:

Simple tips for better sleep The cure to sleeping problems and daytime fatigue can often be found in your daily routine. Making some simple lifestyle changes can help ensure you get the sleep you need.

  • Keep a regular sleep schedule, going to sleep and getting up at the same time each day, including the weekends.

  • Set aside enough time for sleep. Most people need at least 7 to 8 hours each night in order to feel good and be productive.

  • Make sure your bedroom is dark, cool, and quiet. Cover electrical displays, use heavy curtains or shades to block light from windows, or try an eye mask to shield your eyes.

  • Turn off your TV, smartphone, iPad, and computer a few hours before your bedtime. The type of light these screens emit can stimulate your brain, suppress the production of melatonin, and interfere with your body’s internal clock.

Do sleeping pills help sleep disorders and sleeping problems?

When taken for a brief period of time and under the supervision of your doctor, sleeping pills may help your sleeping problems. However, they are just a temporary solution. Insomnia can’t be cured with sleeping pills. In fact, sleeping pills can often make insomnia worse in the long run.

In general, sleeping pills and sleep medications are most effective when used sparingly for short-term situations, such as traveling across many time zones or recovering from a medical procedure. If medications are used over the long term, they are best used “as needed” instead of on a daily basis to avoid dependence and tolerance.

Safety guidelines for sleeping pills:

  • Only take a sleeping pill when you will have enough time to get a full 7 to 8 hours of sleep. Otherwise, you may be drowsy the next day.

  • Read the package insert that comes with your medication. Pay careful attention to the potential side effects, dosage instructions, and list of food and substances to avoid.

  • Never mix alcohol and sleeping pills. Alcohol disrupts sleep and can interact dangerously with sleep medications.

  • Never drive a car or operate machinery after taking a sleeping pill, especially when you first start taking a new sleep aid, as you may not know how it will affect you.

When to call a doctor about sleep disorders:

If you’ve tried a variety of self-help sleep remedies without success, schedule an appointment with your doctor, especially if:

  • Your main sleep problem is daytime sleepiness and self-help hasn’t improved your symptoms.

  • You or your bed partner gasps, chokes, or stops breathing during sleep.

  • You sometimes fall asleep at inappropriate times, such as while talking, walking, or eating.

At your appointment, be prepared with information about your sleep patterns and provide the sleep doctor with as much supporting information as possible, including information from your sleep diary.

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