Sleeping Disorders

Doctors normally classify sleep-related problems into two broad categories:

Insomnia — any problem related to falling asleep, staying asleep or waking up too early. When insomnia symptoms occur more than a few times a week, and impact a person’s daytime functions, the symptoms should be discussed with a doctor or other health care provider.  Insomnia can be a problem in itself (primary insomnia), or due to another condition (secondary insomnia).  Insomnia can be acute (lasting less than a month) or chronic (lasting more than a month).  Acute insomnia is often due to short-term stressors in our lives.  Chronic insomnia can be due to medical, physical, medications or psychological conditions and should be discussed with your doctor.

Hypersomnia — a set of problems characterized by sleeping too much, especially during the day when trying to attend to work or studies. Disorders of excess sleepiness can be due to medical conditions, such as sleep apnea (a serious breathing problem); excessive movements during sleep (restless legs); narcolepsy (a neurological order characterized by sudden sleep onset); or due to side effects of medication.

Sleep problems can be signs of serious medical problems, like depression, thyroid problems or sleep apnea.  They can also be due to side effects of medications.  Talk to your doctor if you are experiencing problems with insomnia or hypersomnia.

Sleep Apnea

What is sleep apnea?

Sleep apnea is a sleep disorder that causes a person to stop breathing for 10-30 seconds while sleeping. People with sleep apnea can stop breathing up to 400 times per night, which disrupts their sleep cycle.

Who is at risk for sleep apnea?

Anyone can develop sleep apnea. Men, people who are overweight and those over 40 are at increased risk for sleep apnea.

How is sleep apnea treated?

There are a number of treatments available for sleep apnea, including simple surgical procedure, devices worn during sleep and weight loss. All treatment should be monitored by a qualified physician.

What if sleep apnea goes untreated?

Untreated sleep apnea can cause high blood pressure, daytime sleepiness, fatigue, irritability, problems concentrating and morning headaches. It can also increase risk of stroke, irregular heartbeat and heart disease.

What Can I Do If I Can’t Sleep?

Most treatments for insomnia fall into two general categories:

  1. Examining and changing your bedtime and daytime behaviors. This is known as SLEEP HYGIENE or behavioral therapy.  We outline sleep hygiene techniques below.  Most experts feel that improving chronic insomnia involves using elements of sleep hygiene with or without the use of medications.  Sleep hygiene involves developing healthy sleep habits as well as making sure there are no physical, psychological or environmental causes (uncomfortable bed, annoying partner, etc.) for your sleep problems.
  2. Sleep medications.  Doctors call these medications “hypnotics”.   About 25% of Americans took some type of sleeping medication last year. Many medications are available “over the counter”.  Others require a prescription.  Your doctor should be able to answer any questions you have about medications and will offer advice based on your medical history, use of alcohol, and sensitivity to side effects.  Like everything else, medications have risks and benefits.  In general, most hypnotics should be taken on a limited basis.  Most experts agree that a short course of these medications (a week or two) is often helpful.  If the medications are taken on a long-term basis, your doctor will probably suggest using the medication intermittently, rather than every night.  Side effects are numerous and depend on the type of medication chosen.  In general, the most common side effects are next day drowsiness and mental impairment.  Chronic use of hypnotic agents, prescription or over the counter, may lead to elements of dependency and withdrawal symptoms, including “rebound insomnia”, if discontinued abruptly.  People who have sleep apnea (a sleep-related breathing disorder often characterized by excessive snoring and irregular breathing) should refrain from using hypnotics and should seek medical evaluation.

Sleep Hygiene — Steps to Try Before or With Medications:

The National Sleep Foundation recommends that anyone with insomnia work on improving their sleep-friendly practices.  These are some of the most common suggestions:

  1. Maintain a regular wake-time and bedtime. Getting your body’s internal clock regulated is important for proper sleep.   A regular waking time in the morning strengthens the circadian rhythm and can help with sleep onset. That is why it is important to keep a regular bedtime and wake-time, even on the weekends when there is the temptation to sleep-in.  Some experts believe exposing yourself to bright light in the morning helps synchronize your internal clock.
  2. Establish a relaxing bedtime routine. Relaxation is a skill that can be developed with practice.  Some people use a hot bath or calming music to help them relax.  If you are unable to avoid tension and stress, it may be helpful to learn relaxation therapy from a trained professional.  Avoid arousing activities before bedtime like working, paying bills, engaging in competitive games or heated discussions.
  3. Exercise regularly but do so at least 4-5 hours before bedtime.
  4. Avoid caffeine for at least 4-6 hours prior to bedtime.
  5. Avoid excessive napping during the day.
  6. Avoid alcohol, nicotine and heavy meals close to bedtime.
  7. Create a sleep-conducive environment that is dark, quiet, comfortable, and cool. Reduce interruptions that make it difficult to stay asleep.
  8. Use the bed only for sleeping and sex.

Over the Counter (OTC) Sleeping Medicines

The FDA has approved several medications to help people fall or stay asleep. The majority of these products contain an antihistamine, such as Benadryl (generic name diphenhydramine). Antihistamines are used to treat symptoms of allergies, but they also cause drowsiness and can help people sleep.

  1. Which OTC medicines have antihistamines?
  2. There are two antihistamines that are used commonly in OTC sleep aids: doxylamine and diphenhydramine. Check the ingredient list for these substances. Common OTC antihistamine medicines include Unisom, Compoz, Nytol and Sominex. Many medicines, such as Tylenol PM and others, contain a combination of ingredients, including an antihistamine.
  3. Are these medications safe?
  4. Generally OTC antihistamine sleep medicines are safe for short term, occasional use. Most doctors recommend using these medicines for no more than two or three consecutive days. It is always best to check with your doctor prior to beginning any medicine, especially if you have medical conditions or are taking other medications.
  5. Why can’t I take the sleep medicine every night?
  6. Regular use of a sleep medicine makes the medicine less effective because our bodies adapt to them. This effect is called tolerance. Tolerance occurs with almost all sleep medications, whether they are OTC or prescription medicines. Because of this, you should not take sleep medicines every night.
  7. Do these medications have side effects?
  8. All medications have some side effects. Most common side effects of antihistamine sleep aides include dry mouth, next day sedation (hangover) and constipation.