Is there a medical condition that makes it difficult to wake up?

Overview

What are sleep disorders?

Sleep disorders are conditions that impair your sleep or prevent you from getting restful sleep and, as a result, can cause daytime sleepiness and other symptoms. Everyone can experience problems with sleep from time to time. However, you might have a sleep disorder if:

• You regularly experience difficulty sleeping.
• You are often tired during the day even though you slept for at least seven hours the night before.
• You have a reduced or impaired ability to perform regular daytime activities.

There are more than 100 million Americans of all ages who are not getting an adequate amount of sleep. Sleep is very important. Not getting enough sleep can have untoward consequences on school and work performance, interpersonal relationships, health and safety.

How common are sleep disorders?

About 70 million people in the United States suffer from sleep disorders.

How many types of sleep disorders are there?

There are approximately 80 different types of sleep disorders. The top ones are:

• Insomnia.
• Sleep apnea.
• Restless legs syndrome.
• Narcolepsy.

How much sleep is necessary?

Experts generally recommend that adults sleep at least seven to nine hours per night, although some people require more and others require less.

A recent National Sleep Foundation Sleep in America poll found that adults (ages 18-54) sleep an average of 6.4 hours per night on weekdays and 7.7 hours on weekends. The poll showed a downward trend in sleep time over the past several years. People sleeping less hours tend to use the internet at night or bring work home from the office.

The National Sleep Foundation also reported that older adults (age 55-84) average seven hours of sleep on weekdays and 7.1 hours on weekends. Sleep is most often disturbed by the need to use the bathroom and physical pain or discomfort in older adults.

A downward trend in sleep time has also been observed in children. Optimal sleep time varies by age. An earlier Sleep in America poll found a discrepancy between recommended and actual sleep time in children, with actual sleep time 1.5 to two hours less than recommended. Caffeine consumption caused a loss of three to five hours of sleep and having a television in the bedroom contributed to a loss of two hours of sleep each week in children.

What happens when a person doesn’t get enough sleep?

Not getting the proper amount or quality of sleep leads to more than just feeling tired. Sleepiness interferes with cognitive function, which can lead to learning disabilities in children, memory impairment in people of all ages, personality changes and depression.

People who are deprived of sleep experience difficulty making decisions, irritability, have problems with performance, and slower reaction times, placing them at risk for automobile and work-related accidents. Sleep loss can also adversely affect life by contributing to the development of obesity, diabetes and heart disease.

Who is more likely to have a sleep disorder?

Disorders associated with daytime sleepiness affect females more than males.

Symptoms and Causes

What causes sleep disorders?

Sleep problems can be caused by various factors. Although causes might differ, the end result of all sleep disorders is that the body's natural cycle of slumber and daytime wakefulness is disrupted or exaggerated. Eight factors include:

• Physical (such as ulcers).
• Medical (such as asthma).
• Psychiatric (such as depression and anxiety disorders).
• Environmental (such as alcohol).
• Working the night shift (this work schedule messes up “biological clocks.”)
• Genetics (narcolepsy is genetic).
• Medications (some interfere with sleep).
• Aging (about half of all adults over the age of 65 have some sort of sleep disorder. It is not clear if it is a normal part of aging or a result of medicines that older people commonly use).

What are the symptoms of sleep disorders?

You might have a sleep disorder if you experience one or more of the following symptoms. Do you:

• Fall asleep while driving?
• Struggle to stay awake when inactive, such as when watching television or reading?
• Have difficulty paying attention or concentrating at work, school, or home?
• Have performance problems at work or school?
• Often get told by others that you look sleepy?
• Have difficulty with your memory?
• Have slowed responses?
• Have difficulty controlling your emotions?
• Need to take naps almost every day?

What is insomnia?

Insomnia is a sleep disorder where people have difficulty falling or staying asleep. People with insomnia have one or more of the following symptoms:

• Difficulty falling asleep.
• Waking up often during the night and having trouble going back to sleep.
• Waking up too early in the morning.
• Having unrefreshing sleep.
• Having at least one daytime problem such as fatigue, sleepiness, problems with mood, concentration, accidents at work or while driving, etc. due to poor sleep.

Insomnia varies in how long it lasts and how often it occurs. About 50% of adults experience occasional bouts of insomnia and one in 10 suffer from chronic insomnia. Insomnia can occur by itself or can be associated with medical or psychiatric conditions. Insomnia can be short-term (acute or adjustment insomnia) or can last a long time (chronic insomnia). It can also come and go, with periods of time when a person has no sleep problems. Acute or adjustment insomnia can last from one night to a few weeks. Insomnia is called chronic when a person has insomnia at least three nights a week for a month or longer.

Short-term or acute insomnia can be caused by life stresses (such as job loss or change, death of a loved one, or moving), an illness, or environmental factors such as light, noise, or extreme temperatures.

Long-term or chronic insomnia (insomnia that occurs at least three nights a week for at least three months or longer) can be caused by factors such as depression, chronic stress and pain or discomfort at night.

A common cause of chronic insomnia is a conditioned emotional response. Thoughts about the sleep problem (e.g., "What if I don’t fall asleep tonight?") and behaviors that develop around the sleep problem (e.g., sleeping in and napping, ruminating in bed) tend to prolong insomnia symptoms.

What is sleep apnea?

Sleep apnea is a potentially serious sleep disorder that occurs when a person's breathing is interrupted during sleep. People with untreated sleep apnea stop breathing repeatedly during their sleep.

There are two types of sleep apnea: obstructive and central.

• Obstructive sleep apnea (OSA) is the more common of the two. It is caused by a blockage of the airway, usually when the soft tissue in the back of the throat collapses during sleep. Symptoms of OSA may include snoring, daytime sleepiness, fatigue, restlessness during sleep, gasping for air while sleeping and trouble concentrating.
• In central sleep apnea (CSA), the airway is not blocked, but the brain fails to tell the body to breathe. This type is called central apnea because it is related to the function of the central nervous system. People with CSA may gasp for air but mostly report recurrent awakenings during night.

What is restless legs syndrome?

Restless legs syndrome (RLS) is a sleep disorder that causes an intense, often irresistible urge to move the legs. This sensation is brought on by resting such as lying down in bed, sitting for prolonged periods such as while driving or at a theatre. RLS typically occurs in the evening, making it difficult to fall asleep and stay asleep. It can be associated with problems with daytime sleepiness, irritability and concentration. Often, people with RLS want to walk around and shake their legs to help relieve the uncomfortable sensation.

What is narcolepsy?

Narcolepsy is a neurological disorder of sleep regulation that affects the control of sleep and wakefulness. People with narcolepsy experience excessive daytime sleepiness and intermittent, uncontrollable episodes of falling asleep during the daytime. These sudden sleep attacks may occur during any type of activity at any time of the day. Some patients with narcolepsy experience sudden muscle weakness with laughter or other emotions.

Narcolepsy usually begins between the ages of 15 and 25, but it can become apparent at any age. In many cases, narcolepsy is undiagnosed and, therefore, untreated.

Diagnosis and Tests

How are sleep disorders diagnosed?

If you suspect that you may have a sleep disorder, discuss your symptoms with your healthcare provider. He or she can perform a physical exam and help you identify the difficulties you are having with sleep. Keeping a sleep diary for two weeks may be helpful to your healthcare provider. Some illnesses can cause disturbed sleep, so your healthcare provider may order tests to rule out other conditions.

If your healthcare provider suspects that you have a sleep disorder, he or she may refer you to a sleep disorder clinic. A sleep specialist will review your symptoms and may suggest that you undergo a sleep study.

A sleep study or polysomnogram (PSG) is a test that electronically transmits and records specific physical activities while you sleep. A sleep study can be done at home (home sleep apnea testing) for select patients. The recordings become data that is analyzed by a qualified healthcare provider to determine whether or not you have a sleep disorder.

In order to determine if you have a sleep disorder, it is important to pay attention to your sleep habits by keeping a sleep diary and discussing patterns and characteristics of your sleep with your healthcare provider. Many common sleep problems can be treated with behavioral treatments and an increased attention to proper sleep hygiene. Consult your healthcare provider if you have any concerns about your sleep patterns.

What questions might my healthcare provider ask to diagnose a sleep disorder?

• How many hours do you sleep at night?
• Do you toss and turn in your sleep?
• Do you take naps?
• How long does it take you to fall asleep?
• Do you wake up in the middle of the night?
• Do you work a night shift?
• How sleepy do you feel during the day?

Management and Treatment

How are sleep disorders treated?

There are a variety of treatments recommended by healthcare providers:

• Counseling: Some sleep specialists recommend cognitive behavior therapy. Such counseling helps you “recognize, challenge and change stress-inducing thoughts” that can keep you awake at night.
• Medications and/or supplements.
• Practice sleep hygiene such as keeping a regular sleep schedule.
• Get regular exercise.
• Minimize noise.
• Minimize light.
• Manage the temperature so that you’re comfortable.

Your healthcare provider will recommend treatments based on your unique situation.

What medicines may help with sleep disorders?

Your healthcare provider may recommend some of the following medications and supplements:

• Sleep aids may be helpful in some cases of insomnia, including melatonin, zolpidem, zaleplon, eszopiclone, ramelteon, suvorexant, lamborexant, or doxepin.
• Restless legs syndrome can be treated with gabapentin, gabapentin enacarbil, or pregabalin.
• Narcolepsy may be treated with a number of stimulants or wake-promoting medications, such as modafinil, armodafinil, pitolisant and solriamfetol.

Should I see a specialist?

Ask your healthcare provider for a referral to a sleep specialist, if necessary.

What are some tips for getting a good night's sleep?

• Create an optimal sleep environment by making sure that your bedroom is comfortable, cool, quiet and dark. If noise keeps you awake, try using background sounds like "white noise" or earplugs. If light interferes with your sleep, try a sleep mask or blackout curtains.
• Think positive. Avoid going to bed with a negative mind set, such as "If I don't get enough sleep tonight, how will I ever get through the day tomorrow?"
• Avoid using your bed for anything other than sleep and intimate relations. Do not watch television, eat, work, or use computers in your bedroom.
• Try to clear your mind before bed time by writing things down or making a to-do list earlier in the evening. This is helpful if you tend to worry and think too much in bed at night.
• Establish a regular bedtime and a relaxing routine each night by taking a warm bath, listening to soothing music, or reading. Try relaxation exercises, meditation, biofeedback, or hypnosis. Wake up at the same time each morning, including days off and vacations.
• Stop clock watching. Turn the clock around and use only the alarm for waking up. Leave your bedroom if you cannot fall asleep in 20 minutes. Read or engage in a relaxing activity in another room.
• Avoid naps. If you are extremely sleepy, take a nap. But limit naps to less than 30 minutes and no later than 3 p.m.
• Avoid stimulants (coffee, tea, soda/cola, cocoa and chocolate) and heavy meals for at least four hours before bedtime. Light carbohydrate snacks such as milk, yogurt, or crackers may help you fall asleep easier.
• Avoid alcohol and tobacco for at least four hours before bedtime and during the night.
• Exercise regularly, but not within four hours of bedtime if you have trouble sleeping.

Prevention

What foods or drinks should I take or avoid to reduce my risk of a sleep disorder?

Avoid the following:

• Caffeinated drinks such as soda and coffee in the late afternoon or evening.
• Diet pills.
• Decongestants.
• Antidepressants (these can suppress REM sleep, but never discontinue antidepressants without permission from your healthcare provider).
• Tobacco.
• Alcohol.

Outlook / Prognosis

How long will I have a sleep disorder?

Times vary, and it also depends on what type of sleep disorder you have. Discuss a timeline with your healthcare provider, taking treatments into consideration.

Living With

When should I see my healthcare provider?

See a healthcare provider about your sleep if it’s disrupting your quality of life.

What questions should I ask my healthcare provider about sleep disorders?

• What kind of sleep disorder do I have?
• How severe is my sleep disorder?
• Do you think my sleep disorder will go away on its own, or will I need treatment?
• How can I improve my sleep hygiene?
• Should I see a specialist?
• Do I need a referral to see a specialist?
• Do you recommend any medications to help with my sleep disorder?
• How often should I return to see you?
• Are there medicines I should take?
• Are there medicines I should stop taking?

A note from Cleveland Clinic

Sleep disorders may not be deadly, but they affect your quality of life so often and so severely that they can disrupt your thinking, weight, school/work performance, mental health and your general physical health. Common ones like narcolepsy, insomnia, restless legs syndrome and sleep apnea prevent you from getting the long, deep sleep you need to function at your best.

If you’re struggling with your sleep, don’t hesitate to see your healthcare provider. Your health, and therefore your quality of life, depends on good sleep. Practice good sleep hygiene and follow your healthcare provider’s instructions.