I’m a sleep doctor. These are the signs you have a real sleep problem
Sarah Silverman
For many people, poor sleep has become so normalized that they no longer see it as a potential medical problem. Feeling constantly tired is attributed to stress. The snoring of a freight train becomes a family joke at the dinner table. Trying not to doze off during the weekly meeting means your job is boring.
All of these signs point to a possible sleep disorder. But most people suppress them and ignore them.
As a sleep specialist who primarily treats people with chronic insomnia, I can say with confidence that even common sleep disorders are underrecognized, underdiagnosed, and undertreated.
Sleep disorders deserve medical attention and are often highly treatable. Here are the most common ones (there are more than 80 clinical sleep disorders, by the way) and the symptoms you might have.
Insomnia
Insomnia disorder is defined as difficulty falling asleep, staying asleep, or waking up too early at least three nights a week for at least three months. It causes serious disruptions in daily life.
Sleep onset insomnia is the inability to fall asleep within a reasonable time frame (30 minutes) after getting into bed; Sleep maintenance insomnia involves waking up throughout the night and having difficulty returning to sleep (30 minutes or more) or waking up much earlier than desired.
Insomnia can be acute, lasting days or weeks, often triggered by an identifiable stressor and often self-resolving, or chronic, lasting three months or longer and typically requiring intervention.
Decades of epidemiological studies show that 10 to 15 percent of the general population meets criteria for chronic insomnia disorder, with higher rates found in women, older adults, and people who also have mental health problems.
Additional symptoms of insomnia disorder:
- Feeling exhausted even after a full night’s sleep
- Experiencing irritability, low mood, mood swings, difficulty concentrating or paying attention, or memory problems on a regular basis
- Fear or anxiety as bedtime approaches
- You feel exhausted when you go to bed, but when your head hits the pillow you’re wide awake (“tired but tense”)
The gold standard treatment is cognitive behavioral therapy for insomnia, also known as CBT-I, but some medications, as well as other forms of sleep therapy, may also be appropriate.
Obstructive sleep apnea
Obstructive sleep apnea is a medical condition in which the muscles in the throat relax during sleep, causing the airway to narrow or close completely; this often manifests as snoring, even if you don’t to have Snoring to have OSA. When the airway collapses, breathing stops (sometimes for a few seconds, sometimes longer) until the brain partially awakens the body to restore airflow. This cycle can repeat hundreds of times throughout the night, and sleep is disrupted so frequently that most people wake up exhausted.
Compared to men, who are more likely to snore loudly or gasp/choke, women are overwhelmingly underdiagnosed because their symptoms often present differently (fatigue, mood swings, insomnia, morning headaches).
I hear this all the time from women in my practice. They did not fit the typical OSA stereotype and instead their symptoms were attributed to depression, thyroid problems, stress or another sleep disorder.
Additional symptoms of OSA:
- Waking up with a dry mouth, sore throat, or headache
- Excessive sleepiness during the day
- Waking up frequently throughout the night to use the toilet (known as nocturia; this occurs when apnea puts strain on the heart and the body secretes more of the hormone that increases urination)
- Difficulty concentrating, memory problems, or cognitive slowing
- Increased irritability, mood changes, anxiety, or depression that do not fully improve with treatment
- History of chronic insomnia, especially difficulty staying asleep
- High blood pressure or heart problems that are difficult to control
Sleep apnea is usually treated with continuous positive airway pressure therapy, which involves using a breathing machine that keeps the airways open during sleep, but other treatments and even surgery may be helpful for some. Lifestyle changes such as weight loss and avoiding alcohol use may also help.
restless legs syndrome
Restless legs syndrome, also known as Willis-Ekbom disease, is characterized by an irresistible urge to move the legs (and/or arms), often accompanied by uncomfortable sensations: crawling, tingling, pulling, pain, burning, itching, or an indescribable inner restlessness.
Symptoms occur or worsen at rest; Moving, stretching, or walking often provides temporary relief. It is extremely uncomfortable, making it impossible to stay still and extraordinarily difficult to fall asleep.
Because RLS cannot be detected visually on standard tests and the sensation is difficult to explain, it was long considered psychological or simply “growing pains.”
Additional symptoms of RLS:
- Your bedmate complains that you repeatedly kick or jerk your legs (and/or arms) during sleep
- Excessive daytime sleepiness, mood swings, cognitive slowing, and increased anxiety or depression
Along with anti-seizure medications and prescription-strength iron supplements, treatment of other health conditions and lifestyle interventions such as regular exercise, good nutrition, avoiding stimulants, massage, compression garments, hot/cold packs, and magnesium supplements may also help.
Circadian rhythm sleep-wake disorders
Circadian rhythm sleep-wake disorders, or CRSWDs, occur when a person’s internal biological clock, which governs sleep timing, hormone release, body temperature, and dozens of other physiological functions, becomes misaligned with the external environment or with the person’s desired sleep schedule. These are not sleep quality disorders per se, but sleep disorders. timing.
This can result in a sleep-wake schedule that is very different from typical social norms; This may mean that no matter how early you try, you won’t be able to fall asleep until very late at night, or you may feel sleepy in the early evening and wake up very early in the morning.
Additional symptoms of circadian rhythm disorders:
- You describe yourself as an “extreme night owl” or “extreme early bird”
- When you’re allowed to sleep freely on vacation or non-work days, you shift to a dramatically different schedule.
- You work rotating shifts and feel exhausted but have trouble sleeping when you have the chance.
- You’ve been told you have insomnia, but sleeping pills or standard sleep hygiene advice haven’t worked
- Your “insomnia” or “fatigue” has never fully responded to treatment
The best “cure” is to adapt your lifestyle so that you can sleep within your natural, biological sleep-wake window. When this is not possible, behavioral strategies such as circadian rhythm management (e.g., microdose melatonin, bright light therapy) or CBT-I may be appropriate.
What should you do if you suspect a sleep disorder?
If any of the symptoms described above sound familiar, and especially if they have persisted for more than a few weeks, the first step is to talk to your doctor and ask specifically about sleep disorders.
Don’t just say you’re tired or can’t sleep. Be specific: Explain when the problems occurred, how long they lasted, how they affected your daytime functioning, and whether your bed partner noticed anything unusual.
From there, your doctor may refer you to a sleep specialist (or you may need to seek a direct referral) who can perform a comprehensive sleep assessment and sleep study when appropriate. The above list is not comprehensive; Other sleep disorders, such as narcolepsy and idiopathic hypersomnia, are less common but can also cause excessive daytime sleepiness despite spending long hours in bed and require proper diagnosis and treatment.
If you’ve been tired for months or years and standard sleep hygiene tips haven’t helped improve your sleep, you’re not a sleep failure. Your sleep problems probably aren’t “just stress” or “how you are” and your exhaustion isn’t a badge of honor. Your sleep struggles deserve more attention.
Sarah Silverman, PsyD, is a sleep psychologist and behavioral sleep medicine specialist in private practice specializing in women’s sleep health and insomnia.
Washington Post
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