Finding the Cause of Sleep Disorders

Q. My husband is 45. He can no longer sleep through the night. At least once every night he wakes up and often can’t go back to sleep for an hour or more. Is this just what happens when you get older? Can you suggest ways to alleviate this?

A. No matter what your age, everyone has an occasional sleepless night. Usually this isn't a problem. However, if getting a good night's sleep is a daily challenge, it is not normal and can become a medical concern. In your particular situation, let me reassure you that 45 is not old; having difficulty sleeping, while more common in our elderly population, is not automatic with advancing years; and in many cases, we can help people get a better night's sleep.

Okay, let's talk about sleep. Some people say, "Doc, I sleep all the time, but I am still tired.” Well, then we need to find out if they’re getting restful sleep. For starters, everyone has different sleep needs. For some, that may be 10 hours per night, for others, five hours. What is most important is not the length of time you sleep but the quality of your Z’s. You could lie in bed all day, but if your sleep is often interrupted, you’ll most likely still be tired when it’s time to get up. This condition is known as insomnia and here are some of its telltale signs:

• You have difficulty in falling asleep.
• You wake up early in the morning.
• You wake up frequently during your sleep.

To get your husband back on the road to a better sleep, it is important to record a diary. He should keep track of the time he goes to sleep, the times he wakes up during the night and if he feels feel refreshed and energized upon awakening. Also he should write down what wakes him up at night. For example, is he depressed, in pain, gasping for breath? Whatever the reason, it is important to gather this information. When your husband is ready to speak with his physician, this diary will help to find out the reason for his sleeping difficulty.

Common roadblocks to a sound sleep

• Depression or anxiety
• Nicotine, alcohol, caffeine or food at bedtime
• The need to urinate during the night, often due to an enlarged prostate in men or from cystitis in women
• Side effect of a new medication
• Sleep apnea
• Gastro-esophageal reflux disease (or GERD)
• Your bedtime partner snores
• Exercise too close to bedtime
• Restless leg syndrome
• Unable to get comfortable due to pain
• Nighttime asthma
• Clenching of teeth

In general, here are some guidelines for when to consult a health care professional about a sleeping problem:

• It occurs more than three nights per week for at least one month
• It's accompanied by physical symptoms, such as shortness of breath, chest pain or upper-abdominal pain.
• Common-sense remedies such as avoiding caffeine don't help.
• The lack of sleep is affecting your mental health, such as increased anxiety, depression or trouble concentrating.
• You are having difficulty losing weight, have high blood pressure or other medical concerns.

Helping a person overcome a sleep problem often takes a tincture of time combined with some investigative work. In addition to a physical exam and screening for anxiety or depression, we may need to get diagnostic testing, including blood work, breathing tests, checking for GERD or even refer you to a sleep disorder center to check for sleep apnea.

In the meantime, here are some tips for a better night's sleep:

• Use your bedroom for the two S's: sleep and sex, and not necessarily in that order.
• Avoid caffeine at least eight hours before bedtime.
• Take the television out of the bedroom—if your brain is stimulated from TV shows, it will take a while to rev down to relax.
• Establish a regular bedtime routine.
• Turn bright lights down several hours before going to sleep.
• Create a calm and soothing bedtime environment.

Many people don't want to "sleep their life away." I can certainly understand. But if you don't get enough restful sleep, you will lose quality time when you are awake. So when it comes to your sleep, don't be cheap!

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Robert Danoff, D.O., M.S., is a family physician and program director of The Family Practice Residency, as well as the combined Family Practice/Emergency Medicine Residency programs at Frankford Hospitals, Jefferson Health System, Philadelphia, Pa. He is the medical correspondent for CN8, The Comcast Network, a regular contributor to Discovery Health Online and a contributing writer to The New York Times Special Features. (Read his full bio.)