Over 50 million American adults have chronic sleep and wakefulness disorders. There are many different kinds of sleep disorders, but the most common ones deal with insomnia (not being able to fall asleep or stay asleep) and sleep apnea (poor sleep due to physical or neurological problems with breathing during sleep) and narcolepsy (excessive daytime sleepiness).
Restless leg syndrome (need to move while falling asleep), and sleepwalking are less common, but often cause considerable distress and disability. Treatments for sleep disorders generally can be grouped into four categories: behavioral treatments, rehabilitation management, medications and other somatic treatments.
Diagnosis is often made by the patient going to a sleep lab, where breathing, heart rate, and brain activity is measured while the patient sleeps. Medications include sleep aids for insomina (Ambien, Sonata, Lunesta), as well as over the counter remedies (Benadryl, Unisom, and melatonin).
Sleep apnea is a common disorder in which you have one or more pauses in breathing or shallow breaths while you sleep.
Breathing pauses can last from a few seconds to minutes. They often occur 5 to 30 times or more an hour. Typically, normal breathing then starts again, sometimes with a loud snort or choking sound.
Sleep apnea usually is a chronic (ongoing) condition that disrupts your sleep 3 or more nights each week. You often move out of deep sleep and into light sleep when your breathing pauses or becomes shallow.
This results in poor sleep quality that makes you tired during the day. Sleep apnea is one of the leading causes of excessive daytime sleepiness.
Narcolepsy is a disorder that causes periods of extreme daytime sleepiness. It also may cause muscle weakness.
Rarely, people who have this disorder fall asleep suddenly, even if they're in the middle of talking, eating, or another activity. Most people who have narcolepsy also have trouble sleeping at night.
Narcolepsy affects between 50,000 and 2.4 million people in the United States. Symptoms usually begin during the teen or young adult years. Due to extreme tiredness, people who have narcolepsy may find it hard to function at school, work, home, and in social situations.
Insomnia is a common condition in which you have trouble falling or staying asleep. This condition can range from mild to severe, depending on how often it occurs and for how long.
Insomnia can be chronic (ongoing) or acute (short-term). Chronic insomnia means having symptoms at least 3 nights a week for more than a month. Acute insomnia lasts for less time.
Some people who have insomnia may have trouble falling asleep. Other people may fall asleep easily but wake up too soon. Others may have trouble with both falling asleep and staying asleep.
One of the most common signs of obstructive sleep apnea is loud and chronic (ongoing) snoring. Pauses may occur in the snoring. Choking or gasping may follow the pauses.
The snoring usually is loudest when you sleep on your back; it may be less noisy when you turn on your side. Snoring may not happen every night. Over time, the snoring may happen more often and get louder.
You're asleep when the snoring or gasping occurs. You will likely not know that you're having problems breathing or be able to judge how severe the problem is. Your family members or bed partner will often notice these problems before you do.
Not everyone who snores has sleep apnea.
Another common sign of sleep apnea is fighting sleepiness during the day, at work, or while driving. You may find yourself rapidly falling asleep during the quiet moments of the day when you're not active.
Others signs and symptoms of sleep apnea may include:
- Morning headaches
- Memory or learning problems and not being able to concentrate
- Feeling irritable, depressed, or having mood swings or personality changes
- Urination at night
- A dry throat when you wake up
The main symptom of insomnia is trouble falling and/or staying asleep, which leads to lack of sleep. If you have insomnia, you may:
- Lie awake for a long time before you fall asleep
- Sleep for only short periods
- Be awake for much of the night
- Feel as if you haven't slept at all
- Wake up too early
The lack of sleep also can cause other symptoms. You may wake up feeling tired or not well-rested, and you may feel tired during the day. You also may have trouble focusing on tasks. Insomnia can cause you to feel anxious, depressed, or irritable.
Insomnia may affect your daily activities and cause serious problems. For example, you may feel drowsy while driving. Driving while sleepy leads to more than 100,000 car crashes each year. In older women, research shows that insomnia raises the risk of falling.
If insomnia is affecting your daily activities, see your doctor. Treatment may help you avoid symptoms and problems related to the condition. Also, poor sleep may be a sign of other health problems. Finding and treating those problems could improve both your health and your sleep.
Doctors diagnose sleep apnea based on your medical and family histories, a physical exam, and results from sleep studies. Usually, your primary care doctor evaluates your symptoms first. He or she then decides whether you need to see a sleep specialist.
These specialists are doctors who diagnose and treat people with sleep problems. Such doctors include lung, nerve, or ear, nose, and throat specialists. Other types of doctors also can be sleep specialists.
Your doctor will check your mouth, nose, and throat for extra or large tissues. The tonsils often are enlarged in children with sleep apnea. A physical exam and medical history may be all that's needed to diagnose sleep apnea in children.
Adults with the condition may have an enlarged uvula or soft palate. The uvula is the tissue that hangs from the middle of the back of your mouth. The soft palate is the roof of your mouth in the back of your throat.
A sleep study is the most accurate test for diagnosing sleep apnea. It captures what happens with your breathing while you sleep.
A sleep study is often done in a sleep center or sleep lab, which may be part of a hospital. You may stay overnight in the sleep center.
A polysomnogram (poly-SOM-no-gram), or PSG, is the most common study for diagnosing sleep apnea. This test records:
- Brain activity
- Eye movement and other muscle activity
- Breathing and heart rate
- How much air moves in and out of your lungs while you're sleeping
- The amount of oxygen in your blood
A PSG is painless. You will go to sleep as usual, except you will have sensors on your scalp, face, chest, limbs, and finger. The staff at the sleep center will use the sensors to check on you throughout the night.
The goals of treating obstructive sleep apnea are to:
- Restore regular breathing during sleep
- Relieve symptoms such as loud snoring and daytime sleepiness
- Treatment may help other medical problems linked to sleep apnea, such as high blood pressure. Treatment also can reduce your risk for heart disease, stroke, and diabetes.
Specific Types of Treatment
Lifestyle changes, mouthpieces, breathing devices, and/or surgery are used to treat sleep apnea. Currently, there are no medicines to treat sleep apnea.
If you have sleep apnea, talk to your doctor or sleep specialist about the treatment options that are most appropriate for your specific condition.
Lifestyle changes and/or mouthpieces may be enough to relieve mild sleep apnea. People who have moderate or severe sleep apnea may need breathing devices or surgery.
Lifestyle changes often can help relieve acute (short-term) insomnia. These changes may make it easier to fall asleep and stay asleep.
A type of counseling called cognitive-behavioral therapy (CBT) can help relieve the anxiety linked to chronic (ongoing) insomnia. Anxiety tends to prolong insomnia.
Several medicines also can help relieve insomnia and re-establish a regular sleep schedule. However, if your insomnia is the symptom or side effect of another problem, it's important to treat the underlying cause (if possible). Your doctor also may prescribe medicine to help treat your insomnia.
Many prescription medicines are used to treat insomnia. Some are meant for short-term use, while others are meant for longer use.
Talk to your doctor about the benefits and side effects of insomnia medicines. For instance, insomnia medicines can help you fall asleep, but some people may feel groggy in the morning after taking them.
Rare side effects may include sleep eating, sleep walking, or driving while asleep. If you have side effects from an insomnia medicine, or if it doesn't work well, tell your doctor. He or she may prescribe a different medicine.
Some insomnia medicines may be habit forming. Talk to your doctor about the benefits and risks of insomnia medicines.
Some over-the-counter (OTC) products claim to treat insomnia. These products include melatonin, L-tryptophan supplements, and valerian teas or extracts.
The Food and Drug Administration doesn't regulate “natural” products and some food supplements. Thus, the dose and purity of these products can vary. How well these products work and how safe they are isn't well understood.
Some OTC products that contain antihistamines are marketed as sleep aids. Although these products may make you sleepy, talk to your doctor before taking them.
Antihistamines pose risks for some people. Also, these products may not offer the best treatment for your insomnia. Your doctor can advise you whether these products can benefit you.
Lifestyle changes also may help relieve some narcolepsy symptoms. You can take steps to make it easier to fall asleep at night and stay asleep.
- Follow a regular sleep schedule. Go to bed and wake up at the same time every day.
- Do something relaxing before bedtime, such as taking a warm bath.
- Keep your bedroom or sleep area quiet, comfortable, dark, and free from distractions, such as a TV or computer.
- Allow yourself about 20 minutes to fall asleep or fall back asleep after waking up. After that, get up and do something relaxing (like reading) until you get sleepy.
Certain activities, foods, and drinks before bedtime can keep you awake. Try to follow these guidelines:
- Exercise regularly, but not within 3 hours of bedtime.
- Avoid tobacco, alcohol, chocolate, and drinks that contain caffeine for several hours before bedtime.
- Avoid large meals and beverages just before bedtime.
- Avoid bright lights before bedtime.
Light therapy may help you keep a regular sleep and wake schedule. For this type of therapy, you sit in front of a light box, which has special lights, for 10 to 30 minutes. This therapy can help you feel less sleepy in the morning.
When you're awake, throat muscles help keep your airway stiff and open so air can flow into your lungs. When you sleep, these muscles are more relaxed. Normally, the relaxed throat muscles don't stop your airway from staying open to allow air into your lungs. But if you have obstructive sleep apnea, your airways can be blocked or narrowed during sleep because:
Your throat muscles and tongue relax more than normal.
Your tongue and tonsils (tissue masses in the back of your mouth) are large compared to the opening into your windpipe.
You're overweight. The extra soft fat tissue can thicken the wall of the windpipe. This causes the inside opening to narrow and makes it harder to keep open.
The shape of your head and neck (bony structure) may cause a smaller airway size in the mouth and throat area.
The aging process limits the ability of brain signals to keep your throat muscles stiff during sleep. This makes it more likely that the airway will narrow or collapse.
When your airways are fully or partly blocked during sleep, not enough air flows into your lungs . This can cause loud snoring and a drop in your blood oxygen levels. When the oxygen drops to dangerous levels, it triggers your brain to disturb your sleep. This helps tighten the upper airway muscles and open your windpipe. Normal breaths then start again, often with a loud snort or choking sound.
Primary insomnia isn't a symptom or side effect of another medical condition. This type of insomnia usually occurs for periods of at least 1 month.
A number of life changes can trigger primary insomnia. It may be due to major or long-lasting stress or emotional upset. Travel or other factors, such as work schedules that disrupt your sleep routine, also may trigger primary insomnia.
Even if these issues are resolved, the insomnia may not go away. Trouble sleeping may persist because of habits formed to deal with the lack of sleep. These habits may include taking naps, worrying about sleep, and going to bed early.
Researchers continue to try to find out whether some people are born with a greater chance of having primary insomnia.
Often, people with sleep apnea don't know they have it. They're not aware that their breathing stops and starts many times while they're sleeping. Family members or bed partners usually are the first to notice signs of sleep apnea.
Family members can do many things to help a loved one who has sleep apnea.
- Let the person know if he or she snores loudly during sleep or has breathing stops and starts.
- Encourage the person to get medical help.
- Help the person follow the doctor's treatment plan, including CPAP.
- Provide emotional support.
Secondary insomnia is the symptom or side effect of another problem. This type of insomnia often is a symptom of an emotional, neurological, or other medical or sleep disorder.
Emotional disorders that can cause insomnia include depression, anxiety, and posttraumatic stress disorder. Alzheimer's disease and Parkinson's disease are examples of common neurological disorders that can cause insomnia.
A number of other conditions also can cause insomnia, such as:
- Conditions that cause chronic pain, such as arthritis and headache disorders
- Conditions that make it hard to breathe, such as asthma and heart failure
- An overactive thyroid
- Gastrointestinal disorders, such as heartburn
- Sleep disorders, such as restless legs syndrome and sleep-related breathing problems
- Menopause and hot flashes
Secondary insomnia also may be a side effect of certain medicines. For example, certain asthma medicines, such as theophylline, and some allergy and cold medicines can cause insomnia. Beta blockers also may cause the condition. These medicines are used to treat heart conditions.
Commonly used substances also may cause insomnia. Examples include caffeine and other stimulants, tobacco or other nicotine products, and alcohol or other sedatives.
Obstructive sleep apnea can be very serious. However, following an effective treatment plan can often improve your quality of life quite a bit.
Treatment can improve your sleep and relieve daytime tiredness. It also may make you less likely to develop high blood pressure, heart disease, and other health problems linked to sleep apnea.
Treatment may improve your overall health and happiness as well as your quality of sleep (and possibly your family's quality of sleep).
Ongoing Health Care Needs
Follow up with your doctor regularly to make sure your treatment is working. Tell him or her if the treatment is causing side effects that you can't handle.
This ongoing care is especially important if you're getting continuous positive airway pressure (CPAP) treatment. It may take a while before you adjust to using CPAP.
If you aren't comfortable with your CPAP device or it doesn't seem to be working, let your doctor know. You may need to switch to a different device or mask. Or, you may need treatment to relieve CPAP side effects.
Try not to gain weight. Weight gain can worsen sleep apnea and require adjustments to your CPAP device. In contrast, weight loss may relieve your sleep apnea.
Until your sleep apnea is properly treated, know the dangers of driving or operating heavy machinery while sleepy.