Sleep can often be a barometer of your overall health. In many cases, people in good health tend to sleep well, whereas those suffering from repeated sleeping problems might have 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 exhausted. But even if you’ve struggled with sleep problems for so long that it seems normal, you can still 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.
Everyone experiences occasional sleeping problems, but how can 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 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:
Putting a stop to the problem of sleepless nights
Insomnia takes a toll on your energy, mood, and ability to function during the day. But you don’t have to put up with insomnia. Simple changes to your lifestyle and daily habits can end sleepless nights.
- 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 exhausting
- 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.
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 the 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 might feel exhausted during the day, irritable and depressed, or see a decrease in 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 exhausted 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
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 your 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 (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.
Resetting your internal clock: How to reduce jetlag
When you travel, it usually takes time for your internal clock to reset itself. In the meantime, you feel tired, get hungry at the wrong hours, and want to go to sleep at inopportune times. However, there are ways to help reset your internal clock when you travel through time zones. If you'll be traveling through several time zones, as when flying coast to coast, you can gradually adjust your sleep time. For example, three days before you plan to travel from the West Coast to the East Coast, go to bed half an hour earlier than usual, and get up half an hour earlier the next morning. The next night, go to bed an hour earlier than usual and get up an hour earlier. The day before you travel, make it 90 minutes. By the fourth day—the day of your trip—you'll find it easier to adjust to your new time zone.
More tips to help you adjust:
- Switch as rapidly as possible upon arrival. On a long trip, don’t turn in until it’s bedtime in the new time zone. For the first day or two, spend as much time outdoors as possible to let daylight reset your internal clock.
- Use the sun. If you need to wake up earlier in the new setting (flying west to east), get out in the early morning sun. If you need to wake up later (flying east to west), expose yourself to late afternoon sunlight.
- Drink plenty of fluids, but not caffeine or alcohol. Caffeine and alcohol promote dehydration, which worsens the physical symptoms of jet lag. They can also disturb sleep.
- Don’t time-shift. On a brief trip just one or two time zones away, it may be possible to wake up, eat, and sleep on home time. If so, schedule appointments for times when you would be alert at home.
Adapted with permission from Boosting Your Energy, a special health report published by Harvard Health Publications.
Shift work sleeping problems
Shift work sleep disorder 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 numbers 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 blackout 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 condition where 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. To learn more, schedule an appointment with a sleep doctor or local sleep clinic.
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 sleep 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 behaviors 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.
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.
Try the following simple changes to your daytime and pre-bedtime routine:
- 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 seven to eight 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 a sleep 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.
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 seven to eight 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.
If you’ve tried a variety of self-help sleep remedies without success, schedule an appointment with a sleep specialist or ask your family doctor for a referral to a sleep clinic, 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 doctor with as much supporting information as possible, including information from your sleep diary.
What to expect at a sleep clinic or center
If your physician refers you to a sleep center, a specialist will observe your sleep patterns, brain waves, heart rate, rapid eye movements and more using monitoring devices attached to your body. While sleeping with a bunch of wires attached to you might seem difficult, most patients find they get used to it quickly.
The sleep specialist will analyze the results from your sleep study and design a treatment program if necessary. A sleep center can also provide you with equipment to monitor your activities (awake and asleep) at home.
Resources & References
General information about sleep disorders and sleeping problems
An Overview of Sleep Disorders – Guide to the symptoms and treatment of common sleep disorders. Includes video clips from sleep expert Dr. Lawrence Epstein. (Division of Sleep Medicine, Harvard Medical School)
Sleep Disorders – Introduction to common sleep disorders and sleeping problems, as well as sleep hygiene tips for combatting insomnia. (Healthier You, UBM Medica)
Common Adult Sleep Problems/Disorders – Information on a number of sleep disorders and treatment options. Learn what to expect during an overnight sleep test at a sleep clinic or hospital. (University of Maryland Medical Center)
Sleep Problems in Children – Discusses common sleep issues with young children including babies, young children and teenagers. (University of Michigan Health System)
Signs and symptoms of sleep disorders and sleeping problems
Facts About Problem Sleepiness (PDF) – Downloadable fact sheet on problem sleepiness, including its symptoms, causes, and link to common sleep disorders. (National Heart, Lung, and Blood Institute, National Institutes of Health)
Sleep clinics, centers, and sleep studies for treating sleep disorders
Sleep Studies – Learn about the sleep tests and overnight sleep studies that specialists use to diagnose sleep disorders. (American Academy of Sleep Medicine)
View a Sleep Study – Take a photo-guided tour of the Stanford University Sleep Disorders Clinic and learn what to expect from a typical overnight sleep study at a sleep clinic. (Talk About Sleep, Inc.)
Find a sleep center in the U.S.
The American Academy of Sleep Medicine provides a sleep center locator with information on finding a sleep center near you.