Difficulty Sleeping: Symptoms, Causes, and Treatment

From verywellhealth.com

Difficulty sleeping is a common problem that affects us all at one point or another. Having trouble falling or staying asleep, waking up feeling tired, and having challenges with your memory, decision-making, and irritability due to not getting good rest are all associated with sleep difficulties or even a sleep disorder. If the symptoms associated with your difficulty sleeping interfere with your quality of life and daily functioning, a healthcare provider can help you figure out what might be causing it and how it can be treated.

This article will provide an overview of sleep difficulties, common symptoms, causes, how to test for sleep disorders, and when to seek medical care.

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Symptoms of Difficulty Sleeping

Depending on the severity and cause, symptoms related to having trouble sleeping include:

• Daytime sleepiness, which may be excessive
• Needing to take naps during the daytime
• Having trouble getting to sleep or staying asleep
• Waking up especially early and being unable to go back to sleep
• Impairment of daily functioning, including thinking, retaining memories, and slower reaction times
• Changes in mood, which may also include irritability and depression

Causes of Difficulty Sleeping

Anyone can have difficulty getting the sleep they need from time to time. However, those who regularly experience sleep difficulties or significant impacts on their daily functioning and quality of life may have a sleep disorder.

In the United States, about 70 million people live with a sleep disorder. Common sleep disorders include:

Insomnia

Sleep apnoea

Restless leg syndrome (RLS)

Narcolepsy

Sleep difficulties arise from these types of causes because the disorders disrupt your body's sleep/wake cycle, which is also known as the circadian rhythm.

What Is the Circadian Rhythm?

Circadian rhythms are the body's natural processes for changes that occur physically, mentally, and behaviourally. These rhythms respond to exposure to light and darkness. For example, you are more likely to feel tired when you are exposed to darkness and more awake when you're exposed to light.

Your genes and cues from your environment can impact your body's circadian rhythm. Factors such as genetic mutations that change the way it functions, exposure to light when we typically don't have it (such as light emitted from mobile phones at night), and changes to the timing of when you're awake or asleep (like when you experience jet lag or work the night shift) can all alter your circadian rhythm.

There are physical, psychological, and environmental causes for various sleep disorders, ranging from work schedules, genetics, older age, and even some medications.

What Medications Can Cause Difficulty Sleeping?

In addition to other causes, several medications can impact sleep quality and your ability to get enough sleep. Some types of medications that can cause sleep problems include:

• Some beta-blockers, such as Lopressor (metoprolol) and Inderal (propranolol), may cause insomnia, nightmares, or waking up during the night.
• Over-the-counter (OTC) medications that contain alcohol or caffeine, such as cold and flu medications, pain relievers, and caffeine supplements, can disrupt sleep or delay sleepiness.
• Selective serotonin reuptake inhibitors (SSRIs), including Prozac (fluoxetine) and Zoloft (sertraline), can impact REM sleep and make you feel tired during the day.
• Diuretics may increase the need to pee at night or cause leg cramps that may keep you awake. 
• Certain antihistamines, such as those included in some OTC cold medicines and motion sickness tablets, may make you drowsy.
• Stimulant medications used to treat attention deficit-hyperactivity disorder (ADHD) such as Ritalin (methylphenidate) and Adderall (dextroamphetamine-amphetamine) can make falling asleep difficult and impact deeper stages of sleep.
• Nicotine replacement therapy products like Nicoderm and Nicorette may contribute to nightmares and insomnia.
• Medications that treat thyroid conditions, such as Levoxyl and Synthroid, can cause difficulty falling asleep, fragmented sleep, and insomnia. 
• Corticosteroids, such as prednisone, can make you feel jittery, reduce the amount of REM sleep you get, and cause insomnia.

How to Treat Sleep Difficulties

For occasional or mild sleep difficulties, there are a number of healthy sleep hygiene practices you can establish to get your sleep/wake cycle back on track. These include:

• Going to bed and waking up around the same time each day. Maintaining a regular sleep schedule can help your body naturally feel tired and awake at the same time on a daily basis.
• Keeping your sleep environment cool, dark, and quiet. Exposure to warm temperatures, light, and noise can keep you awake or make it hard to go to sleep.
• Limiting or avoiding the use of electronic devices where you sleep. Electronics such as tablets, laptops, televisions, and smartphones can emit blue light, which can trigger your body to feel more awake.
• Eating light before bed. Heavy meals and too many liquids can keep you up. Further, substances such as alcohol and caffeine can make it hard to get to sleep or disrupt your sleep cycle, so aim to limit or avoid those before bed.
• Getting active during the daytime. Getting physical activity during daylight hours can improve your sleep quality at night.

If you continue to experience sleep difficulties, or your symptoms are severely impacting your daily functioning, a healthcare provider can help you treat the symptoms. Treatment will vary depending on the specific cause, which can include medicine, counselling, and the use of devices such as a continuous positive airway pressure (CPAP) machine.

Your provider will likely give you a physical exam and ask about any medications or other medical conditions you have that could be contributing to your symptoms. If an undiagnosed condition or issue is suspected, you may also undergo tests to rule those out. If your provider suspects you may have a sleep disorder, they may refer you to a sleep specialist for further testing.

Are There Tests to Diagnose the Cause of Sleep Difficulties?

There are several tests that can help determine the root cause of sleep difficulties and disorders. A healthcare provider may want to test you for any underlying conditions, particularly chronic issues such as heartburn, diabetes, thyroid problems, depression, anxiety, and arthritis. Keeping a sleep diary in which you take notes on your sleep patterns for a period of a few weeks can help further inform what may be causing your difficulties.

To test for sleep disorders, there are a number of options that are typically available in a clinical sleep centre setting:

• Polysomnogram: This test requires you to go to a sleep centre to be observed while you sleep. While you sleep, your brain waves, heartbeat, oxygen levels, and eye movements are monitored.
• Multiple sleep latency test: This test measures how sleepy you are during the daylight hours and is often used to assess for narcolepsy. It's also conducted in a sleep centre. During the testing period, how quickly you're able to fall asleep and the stage of sleep you reach during a series of 20-minute nap periods are measured.
• Maintenance of wakefulness test: This test measures how alert you are in a quiet environment. Instead of measuring your ability to fall asleep in a series of time periods, your sleep specialist will measure alertness in several trials over the course of a day in a sleep centre.
• Titration: During a stay at a sleep centre, your specialist will fit you with a CPAP machine to observe how well the device helps you breathe while you sleep during this test. This can help determine the most appropriate settings for the machine for home use to help with sleep apnoea and obstructed breathing during your sleep.

You may be able to conduct some studies and tests for assessing possible sleep disorders at home, where you often can get a better night's sleep than in a clinical setting. Your sleep specialist will give you certain devices to use while you sleep to take the necessary measurements.

When to See a Healthcare Provider

If you have a poor quality of life because of sleep difficulties, speaking with a healthcare provider can help you investigate and treat what may be the cause of:

• Having a hard time getting to sleep or staying asleep
• Feeling overly tired during the day
• Needing to take naps during the day
• Experiencing challenges with day-to-day functioning, including while driving, at work, or at school

Summary

Many people have sleep difficulties occasionally. Regularly experiencing them may indicate chronic sleep difficulties or a sleep disorder. Common sleep disorders include insomnia, sleep apnoea, restless leg syndrome, and narcolepsy. These disorders are caused by a number of factors, such as certain medications, genes, work schedules, and health conditions.

Speaking with a healthcare provider can help you investigate the cause and appropriate treatment for sleep difficulty symptoms. If a sleep disorder is suspected, you may get a referral to a sleep specialist and further testing in a sleep centre. Treatment can range from adopting healthy sleep hygiene habits to certain medications, counselling, or devices to help you breathe at night.

A Word From Verywell

Sleep is critical to your overall well-being and daily functioning. It's not just about the ability to get to sleep and stay asleep; the quality of your sleep matters as well. Not addressing chronic sleep difficulties can lead to other health issues. Reaching out to a healthcare provider can help you work towards getting high-quality sleep and reduce the risk for longer-term health issues.

https://www.verywellhealth.com/difficulty-sleeping-5667211