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Sleep Disorders

Disturbed Sleep

03/20/2009

Question:

Initially for 2-2 1/2 hrs I sleep very soundly. However, I am awake after this time. Than I cannot sleep for next 2 hrs. Later I get sleep for balance 3 hrs. I am not on any medication. What should be done for a complete sleep for 7 hrs? Please guide.

Answer:

Thank you for using NetWellness. It certainly sounds as if you have disrupted and insufficient sleep. As this problem can be complex, additional information will be needed to help you improve your sleep. You will need a comprehensive evaluation by a Sleep Specialist and you should ask your primary care physician to refer you to such a specialist.

The problem you describe is a form of insomnia known as "sleep maintenance insomnia" and may result from a number of varied causes. Some of the more common conditions or problems that may result in sleep maintenance insomnia include breathing disorders in sleep, leg jerks during sleep or wakefulness (known as periodic limb movement disorder or restless legs syndrome, respectively), depression, anxiety, conditions associated with pain, heartburn, side effects from medications or substances (such as caffeine, alcohol, or nicotine), circadian rhythm disturbances, and a poor sleep environment.

An example of evaluating your history in more detail would include ascertaining your risk factors for sleep apnea (cessation of breathing during sleep), as this is a very common cause of sleep disruption and nighttime awakenings. Risk factors include the following: obesity, a narrowed upper airway, craniofacial abnormalities (i.e. large tonsils), and male gender, to name a few. If there is a suspicion of sleep apnea, you would need a sleep study (polysomnogram) to determine whether or not you have the disorder or some other sleep-related problem that could cause sleep disruption.

Sometimes, simply improving sleep hygiene and sleep-related behaviors can help. This may include simple measures such as keeping a regular sleep schedule, avoiding caffeine and alcohol within 4-6 hours of bedtime, avoiding exercise and/or hot showers near bedtime, and making sure the bedroom is quite, dark and comfortable. In addition, how your friend behaves once they awaken can be a significant cause of trouble getting back to sleep. Behaviors such as lying in bed when you can’t sleep, clock watching or getting up and doing something stimulating (such as smoking, watching TV, etc.) can all be counterproductive for returning to sleep.

As you can see you, insomnia is complex and needs a comprehensive evaluation by a Sleep Specialist. You can visit the American Academy of Sleep Medicine website to find a list of Sleep Centers across the country so that you may locate one near you. Once again thank you for using NetWellness.

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Response by:

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