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Sleep Disorders

Not gettting enough sleep



Dear Sir or Ma-am, When I go to bed at night I am wide awake until 4:30 to 6:30 am. Then I get up 1 to 2 hours later because I wake up from the slightest noise and then I can`t fall back asleep. Then during the day I am so exhausted that I can`t really function properly and if I take a nap, I am awake for the rest of the evening. I could take a 15 minute nap and this still happen only then there is absolutely no sleep at all. So my question to you is what can I do? Maybe the question that I should be asking why can`t I sleep? Anyway whatever the answer may be whether to this Q maybe you know the Q that I am trying to ask, so if you don`t mind answering that would be great. The last time that I actually got a good nights sleep was 2 weeks ago and I am not kidding when I say this, i seriously haven`t had much sleep. So right now I am very exhausted, all that I am asking for is one good nights rest. Sincerly Yours


It sounds as though you are really frustrated! Insomnia can be very troubling and have a profound impact on our daily lives. Probably the most important piece of information missing from your question is exactly how long you have been having this problem. The evaluation and treatment are likely to be different if this just developed in the last 2 weeks versus if this has been a problem for many months or years.

A large percentage of the population reports insomnia of several weeks duration at least once in their lifetime. The causes are numerous and include social and job stressors, changes in one's regular routine due to work, family obligations, travel, grief, depression, medical illness, bed partner issues, and medications, to name a few. If your insomnia has only been present for a short period of time, it would be important to review and recognize the possible event or stressor that may have contributed to the insomnia as further evaluation and management of this problem may be needed (such as counseling). In conjunction with management of any underlying problems, medication therapy can be considered for the short-term to help you sleep. A number of effective medications are now available as sleep aids and these are generally well-tolerated. However, they are really recommended for short-term use only.

In cases where the insomnia is more chronic in nature (has been going on for a longer period of time), identifying the issues that may lead to and contribute to insomnia are also important to ensure appropriate treatment. Chronic insomnia can usually be divided into two broad categories: trouble falling asleep at the start of the night (also known as sleep onset insomnia) and difficulty staying asleep during the night (also known as sleep maintenance insomnia). Some individuals may experience problems with both.

Factors affecting one's ability to fall asleep at the start of the night are quite varied and may include one or more of the following; a poor sleep environment (i.e. the bedroom is too noisy, too bright or too warm), learned poor sleep habits (i.e. watching TV to fall asleep), excessive use of stimulants (both medications and common substances such as caffeine and nicotine), certain medications, stress or anxiety, pain, medical conditions that may make it uncomfortable or difficult to breath well when lying down, heartburn, restless legs syndrome (an irresistible need to move the legs when awake at night) and circadian rhythm disturbances (when the body's biologic rhythms are out of synchrony or delayed).

The problem of maintaining sleep, or staying asleep once you fall asleep, can be caused by some of the same issues as sleep onset-insomnia, but may also be due to other factors, such as; depression, substance abuse (especially alcohol use, that can result in withdraw in the middle of the night), leg jerks in sleep and circadian rhythm disturbances (when the biologic rhythms are advanced earlier in the night). Occasionally some individuals will not have any of these underlying causes contributing to their insomnia and their condition is often labeled as primary insomnia.

Most cases of chronic insomnia can be managed without the use of sleep-inducing medications. If a specific cause of the insomnia can be identified, then treatment should be directed at that issue. Often times, behavioral therapy can be very effective for patients whose insomnia is the result of a poor sleep environment, poor sleep habits or psychological conditions. Improving "Sleep Hygiene" can make a dramatic impact in some cases (see the "Steps You Can Take to Improve Your Sleep" on the website).

As you can see, insomnia is a complex problem that requires a detailed evaluation to help sort out important underlying factors that may need to be addressed. This type of evaluation often starts with your primary care physician, but may require the help of specialist in insomnia. Referral to a Sleep Specialist is necessary in some cases. A Sleep Specialist will take a detailed history and perform a physical examination. Based on this information, they will determine if further testing is needed or if a treatment strategy can be initiated.

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Response by:

James   Knepler, MD James Knepler, MD
Formerly, Assistant Professor
College of Medicine
University of Cincinnati