Sleep Problems, Treatment and Prevention for Age 12 and Older

Topic Overview
Everyone has a "bad night" once in a while. Dogs barking, the wind howling, or overeating may make it difficult to sleep. It is estimated that 35% of adults have occasional sleep problems, which can have many causes.

Insomnia
The medical term for difficulty falling asleep or staying asleep is insomnia. Insomnia can include:

Difficulty getting to sleep (taking more than 45 minutes to fall asleep).
Frequent awakenings with inability to fall back to sleep.
Early morning awakening.
Feeling very tired after a night of sleep.
However, insomnia usually is not a problem unless it makes you feel tired during the day. If you are less sleepy at night or wake up early but still feel rested and alert, there usually is little need to worry. Fortunately, home treatment measures successfully relieve occasional insomnia.

Occasional insomnia may be caused by noise, extreme temperatures, jet lag, changes in your sleep environment, or a change in your sleep pattern, such as shift work. Insomnia may also be caused by temporary or situational life stresses, such as a traumatic event or an impending deadline. Your insomnia is likely to disappear when the cause of your sleep problem goes away.

Short-term insomnia may last from a few nights to a few weeks and be caused by worry over a stressful situation.
Long-term insomnia, which may last months or even years, may be caused by:
Advancing age. Insomnia occurs more frequently in adults older than age 60.
Mental health problems, such as anxiety, depression, or mania.
Medications. Many prescription and nonprescription medications can cause sleep problems.
Chronic pain, which often develops after a major injury or illness, such as shingles or back problems, or after a limb has been amputated (phantom limb pain).
Other physical problems, such as asthma, coronary artery disease, or chronic obstructive pulmonary disease (COPD).
Alcohol and illegal drug use or withdrawal.
Sleep apnea

Sleep apnea is one of several sleep disorders. Sleep apnea refers to repeated episodes of not breathing during sleep for at least 10 seconds (apneic episodes). It usually is caused by a blockage in the nose, mouth, or throat (upper airways). When airflow through the nose and mouth is blocked, breathing may stop for 10 seconds or longer. People who have sleep apnea usually snore loudly and are very tired during the day. It can affect children and adults. See illustrations of a normal upper airway during sleep and a blocked upper airway.

Narcolepsy
Narcolepsy is a sleep disorder that has distinct symptoms, including:
Sudden sleep attacks, which may occur during any type of activity at any time of day. You may fall asleep while engaged in an activity such as eating dinner, driving the car, or carrying on a conversation. These sleep attacks can occur several times a day and may last from a few minutes to several hours.
Sudden, brief periods of muscle weakness while you are awake (cataplexy). This weakness may affect specific muscle groups or may affect the entire body. Cataplexy is often brought on by strong emotional reactions, such as laughing or crying.
Hallucinations just before a sleep attack.
Brief loss of the ability to move when you are falling asleep or just waking up (sleep paralysis).

Parasomnias
Parasomnias are undesirable physical activities that occur during sleep involving skeletal muscle activity, nervous system changes, or both. Night terrors and sleepwalking are two types of parasomnias. Sleep can be difficult for people who experience parasomnias. While “asleep,” a person with parasomnia may walk, scream, rearrange furniture, eat odd foods, or wield a weapon.

Parasomnia can cause odd, distressing, and sometimes dangerous nighttime activities. These disorders have medically explainable causes and usually are treatable.

Restless legs syndrome
Restless legs syndrome (RLS) is a condition that produces an intense feeling of discomfort, aching, or twitching deep inside the legs. Jerking movements may affect the toes, ankles, knees, and hips. Moving the legs or walking around usually relieves the discomfort temporarily.

The exact cause of restless legs syndrome is unknown. The symptoms of restless legs syndrome most often occur while a person is asleep or is trying to fall asleep. The twitching or jerking leg movements may wake the person up, causing insomnia, unrestful sleep, and daytime sleepiness.

When a sleep problem or lack of time keeps you from getting a good night's sleep, excessive daytime sleepiness may occur. While almost everyone experiences daytime sleepiness from time to time, it can have serious consequences such as motor vehicle accidents, poor work or school performance, and work-related accidents.

Sleep problems may be a symptom of a medical or mental health problem. It is important to consider whether a medical or mental health problem is causing you to sleep poorly. Treating a long-term sleep problem without looking for the cause may hide the real reason for your poor sleep.

Home Treatment
How much sleep a person needs varies from person to person. The number of hours you sleep is not as important as how you feel when you wake up. If you to do not feel refreshed, you probably need more sleep. Feeling tired during the daytime is another sign you are not getting enough sleep. The average total nightly sleep time is 7.5 to 8 hours. Healthy adults can require anywhere from 4 to 10 hours of sleep. Many times, simple home treatment can help you get the sleep you need.

If your sleep problem does not require a visit to your health professional, establish a routine to promote good sleep habits:

Set a bedtime and time to get up, and stick to them, even on weekends. This will help your body get used to a regular sleep time.
Exercise during the day. Avoid strenuous exercise within 2 hours of bedtime.
Wind down toward the end of the day. Don't take on problem-solving conversations or challenging activities in the evening.
Take a warm bath before bed.
Keep your bedroom dark, cool, and quiet.
Remove distractions, such as a clock, telephone, or radio, from your bedroom.
Use a humidifier or "white noise" machine to block out background noise in your bedroom throughout the night.
Try using a sleep mask and ear plugs at night.
If you take medication that may be stimulating, such as antihistamines, decongestants, or asthma medications, take them as long before bedtime as possible.
Reserve the bedroom for sleeping and sexual activities so that you come to associate it with sleep. Go to another room to read, watch television, or eat.
After getting into bed, make a conscious effort to let your muscles relax. Imagine yourself in a peaceful, pleasant scene. For more information, see the topic Stress Management.

When you cannot get to sleep, try the following:
If you are still awake after 15 or 20 minutes, get up and read in dim light or do a boring task until you feel drowsy. Don't lie in bed and think about how much sleep you're missing or watch TV.

Avoid activities that might keep you from a good night's sleep:
Do not take naps during the day, especially in the evening.
Do not drink or eat caffeine after 3:00 p.m. This includes coffee, tea, cola drinks, and chocolate.
Do not smoke or use other tobacco products. Nicotine can disrupt sleep and reduce total sleep time. Smokers report more daytime sleepiness and minor accidents than do nonsmokers, especially in younger age groups.

Prevention
Many sleep problems can be prevented. Avoid activities that might keep you from a good night's sleep.

Use your bed only for sleeping. Do not read, watch television, or do paperwork in bed. Reserve the bedroom for sleeping and sexual activities so that you come to associate it with sleep.
Do not take naps during the day, especially in the evening.
Do not drink or eat caffeine after 3:00 p.m. This includes coffee, tea, cola drinks, and chocolate.
Avoid eating large meals close to bedtime.
Exercise during the day. Avoid strenuous exercise within 2 hours of bedtime.
Do not smoke or use other tobacco products. Nicotine can disrupt sleep and reduce total sleep time. Smokers report more daytime sleepiness and minor accidents than do nonsmokers, especially in younger age groups