- You have trouble falling or remaining asleep
- You find it difficult to stay awake during the day
- There are imbalances in your circadian rhythm that interfere with a healthy sleep schedule
- You are prone to unusual behaviors that disrupt your sleep
Insomnia is characterized by the recurring difficulty in falling or remaining asleep despite one's best efforts. It may also take the form of early morning awakening in which the individual awakens several hours early and is unable to resume sleeping. People with insomnia experience excessive daytime sleepiness and other cognitive impairments while awake. Insomnia is considered a chronic condition when patients experience symptoms at least three times-a-week for three months or more.
Based on recent statistics, up to one-third of adults live with some form of insomnia.
- Sleep-onset insomnia occurs when people have difficulty falling asleep, even when they are tired.
- Sleep maintenance insomnia refers to difficulty staying asleep during the night.
- Mixed insomnia is a hybrid condition characterized by sleep-onset and sleep maintenance insomnia symptoms.
- Chronic psychophysiological insomnia (or “learned” or “conditioned” insomnia) may result from a stressor combined with fear of being unable to sleep. Sufferers often sleep better when not in their own beds.
Before arriving at a diagnosis of primary insomnia, the doctor will rule out other potential causes, such as other sleep disorders, side effects of medications, substance abuse, depression, or other previously undetected illness.
Chronic insomnia is most commonly treated with a combination of sedative-hypnotic or sedating antidepressant medications, along with behavioral techniques to promote regular sleep and good sleep hygiene.
Like other sleep disorders, sleep apnea can cause excessive daytime sleepiness and fatigue, and, worse, a steady increase of cognitive impairments. Most sleep apnea cases fall into one of the following two categories.
- Obstructive sleep apnea (OSA) is caused by a physical obstruction that blocks the upper airway. This obstruction may be attributed to large tonsils or adenoids, fluid buildup from advanced heart or kidney failure, or genetic syndromes that affect facial structure such as cleft palate. Obese people with fat deposits around their neck are also at higher risk of OSA, and back sleeping can lead to apnea episodes if the tongue falls back into the throat. For many patients, continuous positive air pressure (CPAP) therapy is the most effective treatment
Frequent symptoms of obstructive sleep apnea include:
- Excessive daytime sleepiness
- Loud snoring that is often punctuated by gasping or choking sounds
- Headaches in the morning that may persist for several hours after waking up
- Dry mouth upon awakening
- Restless sleep with periods of wakefulness during the night
- Increased need to get up from bed to urinate
- Irritability or frustration
- Reduced focus
- Central sleep apnea (CSA) occurs when the brain stops sending signals to the muscles that control breathing, leading to choking episodes during the night. As with OSA, obesity is a common risk factor for CSA. The condition may also affect people who have experienced a stroke, brain infection, and other medical problems with the brain stem, as well as those who take narcotic painkillers and other sleep-inducing medications. CPAP therapy is often prescribed for CSA, though some patients find bi-level positive air pressure (BiPAP) therapy more effective.
The symptoms that are most often associated with central sleep apnea include:
Treatment of sleep apnea is dependent on its cause. If other medical problems are present, such as congestive heart failure or nasal obstruction, sleep apnea may resolve with the treatment of these conditions. Gentle air pressure administered during sleep (typically in the form of a nasal continuous positive airway pressure device) may also be effective in the treatment of sleep apnea. As interruption of regular breathing or obstruction of the airway during sleep can pose serious health complications, symptoms of sleep apnea should be taken seriously. Diagnosis and treatment should be sought from your doctor.
Excessive daytime sleepiness (including episodes of irresistible sleepiness) combined with sudden muscle weakness are the hallmark signs of narcolepsy. The sudden muscle weakness seen in narcolepsy may be elicited by strong emotion or surprise. Episodes of narcolepsy have been described as “sleep attacks” and may occur in unusual circumstances, such as walking and other forms of physical activity. A physician may treat narcolepsy with stimulant medications combined with behavioral interventions, such as regularly scheduled naps, to minimize the potential disruptiveness of narcolepsy in the individual’s life.
Restless Legs Syndrome (RLS)
RLS is characterized by an unpleasant “creeping” sensation, often feeling like it originates in the lower legs, but is often associated with aches and pains throughout the legs. This often causes difficulty initiating sleep and is relieved by movement of the leg, such as walking or kicking. Abnormalities in the neurotransmitter dopamine have often been associated with RLS. Doctors often combine a medication to help correct the underlying dopamine abnormality along with a medicine to promote sleep continuity in the treatment of RLS.