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Sleep Disorders

I`m Not Sleeping At Night

02/19/2009

Question:

I`m just turned fifty years old, and I just cant seem to fall asleep at night or stay asleep. Every night I go to bed at 9:00 o`clock, lay there for a couple of hours, and not fall asleep, or if I do fall asleep, its for a short period of time. I`m extremely tired all the time, but still can`t sleep and I dont know why. I lay there with my eyes closed, hoping to fall asleep but nothing happens. I go to bed the same time every night, I get up the same time every morning, I take my medicine the same time everyday and I also exercise the same time everyday. I went to a sleep center and was told that they can`t seem to find anything wrong except when I`m asleep my heart is doing extra work. They also said I went to sleep at the center but only for a short time, I asked them how could that be when I could here everthing going on around me, I even told them what they was talking about. My eyes feel like they`re burning constantly, and they are so tired, I just can`t seem to sleep no matter how hard I try. Do you maybe have any suggestions? at this point, anything will help. Please help me I am so scared that madybe something is wrong with me, like I`m not going to be here long.

Answer:

Thank you for using NetWellness. It appears that you suffer from both sleep onset insomnia (difficulty falling asleep) and sleep maintenance insomnia (difficulty staying asleep). There are many reasons for having insomnia and in order to determine how best to treat you, a clear understanding of what factors may be causing your insomnia is needed.

The is a long list of potential causes of insomnia, some of which include: depression, anxiety, other psychiatric disorders, medications (often a significant component), stimulant use (tobacco, illicit drugs, caffeine), poor sleep hygiene (for example watching TV or reading in bed, a noisy or warm bedroom environment, pets in the bedroom), and medical conditions (chronic pain syndromes, asthma, heartburn, menopause). There is also something called psychophysiologic insomnia where an individual develops a short spell of insomnia that continues as the person starts to believe that he/she has difficulty falling asleep, and thus the cycle continues.

Certainly sleep apnea (airway closure during sleep) can be associated with insomnia. There are a number of other sleep-related disorders, such as PLMD (periodic limb movement disorder – frequent leg jerks in sleep) that can result in sleep disruption and lead to the perception of insomnia. If your history suggests one or both of these conditions, then it is reasonable to have undergone a sleep study. Based on what you describe, your sleep study may have been an inadequate test to exclude the above mentioned sleep disorders if you did not have sufficient sleep time, although keep in mind that patients with insomnia are not good at determining how long they slept in the sleep lab. It should be up to the sleep specialist who interpreted your sleep study to determine if the study was adequate. If not, you may require another study.

As mentioned earlier, in order to best determine how to treat your insomnia, a detailed history and physical examination are necessary to look for factors that may lead to the problem. Excluding poor sleep hygiene or undiagnosed depression or anxiety (usually by completing a screening questionnaire in the clinic) is very important. Certainly, the rest of the medical and medication history is extremely important too.

In all cases of insomnia, a fair amount education is required about sleep and sleep habits. Again, depending on the cause of the insomnia, there are a number of therapeutic options available, including short and long term prescription sleep aids, and cognitive and behavioral therapy (both of which are forms of psychotherapy). Patience is key as it can take some time to break the cycle of poor sleep and restore a normal sleep-wake cycle.

With regards to your "heart doing extra work", I think that you need to speak to your sleep physician so that they can clarify this important issue for you. What is meant by the statement is unclear and it may or may not represent something important.

If you are less than satisfied with the service that you have obtained at your local Sleep Center, you should consider seeking a second opinion. Seeking the advice of a recognized insomnia expert at an academic medical center may be helpful.

I hope this response answers some of your questions. Once again thank you for using NetWellness.

Related Resources:

American Academy of Sleep Medicine
Find a Sleep Center

For more information:

Go to the Sleep Disorders health topic, where you can:

Response by:

Steven  Kadiev, MBBCh Steven Kadiev, MBBCh
Formerly:
Assistant Professor
College of Medicine
The Ohio State University