Having difficulty maintaining sleep is a very common problem; you are definitely not alone! Insomnia, in all its forms, is the commonest sleep disorder. There are many causes of sleep maintenance insomnia. Some common ones include sleep hygiene/habits that prevent sleep continuity (such as alcohol or caffeine use in the evening), poor sleep environment (pets in bed, bad mattress, snoring from bed partner, etc.), use of certain medications at night, certain medical and psychiatric disorders, and various sleep disorders (such as sleep apnea, leg movements at night). The list of disorders that can cause this problem is large. You should definitely discuss this with your family physician. He/she may be able to recommend ways to improve your sleep; if not, he/she may refer you to a sleep specialist. However, I would not necessarily simply get a sleep study as that in of itself may not lead to a diagnosis.
Insomnia in children is quite common. It can become very problematic for parents as this disturbs their sleep as well. Often the children do not seem too bothered by their insomnia. There can be many causes for this type of insomnia. Use of caffeine, refined sugars and heavy meals, particularly at night, can cause this problem. Another common reason for insomnia in kids is sleep association disorder. In this disorder children learn to fall asleep with a particular object or activity (such as rocking or patting). When they wake up periodically at night (as all of us do normally), they are unable to fall back asleep until they again have the same object or activity. Sleep apnea can also occur in children and can cause insomnia. These are only a few of the reasons a child can have sleep maintenance insomnia. I would suggest talking first with your pediatrician. Often it is a problem that they can easily address. If not, they may recommend further consultation depending on what they think is going on.
Mike, the Narcolepsy Network is an excellent patient support group. They also have a list of sleep physicians that treat narcolepsy in various states. You may want to check their website: www.narcolepsynetwork.org . Also, you may want to visit the professional organization of sleep physicians known as a the American Academy of Sleep Medicine website: www.aasmnet.org . They will likely also have a list of "physicians near you". Hope this helps.
Dear Tony5573 and others with severe daytime sleepiness,
As many of you have come to realize this is a very common problem. There are many causes of this as well. The commonest disease that results in severe sleepiness is sleep apnea, however that does not generally make it so difficult to wake up in the morning. Narcolepsy is another sleep disorder that is more common than many realize. In this disorder, patients have daytime sleepiness coupled with very vivid dreams, episodes of feeling paralyzed upon awakening, disrupted night time sleep and episodes of muscle weakness induced by strong emotions such as laughing. Several people have described these symptoms. The most difficult to treat, however, is idiopathic hypersomnia, which Tony 5573 has alluded to. In this condition people just cannot seem to get enough sleep regardless of how much they sleep. Getting up in the morning is very difficult. Physicians will typically do sleep studies and daytime sleep studies to arrive at this diagnosis and will treat it with various stimulants such as Provigil, Nuvigil, Adderall, and others. All these medications often have only marginal effect, and physicians and patients must try various combinations to get to the best possible effect. Sometimes when getting up in the morning is difficult, physicians administer these medications at different times to fascilitate morning awakening. Other disorders such as circadian rhythm disorders (maladjustment of the internal body clock) can also cause difficulty waking up and sleepiness during the day. Persisting with a sleep specialist is very important. Often more than one or two visits are needed to get to the bottom of such difficult problems. I hope this helps.
It sounds like your husband may have a sleep disorder. There are sleep disorders in which individuals start to act out their dreams or move about excessively in their sleep. As you note, many times this is not terribly bothersome to the patient but can be very distressing to the bed partner, and in rare instances dangerous as well. Moreover, the movements can be a symptom of an underlying neurological condition as well. I would suggest talking with your primary care doctor about this and describing to her/him exactly what he does. If possible, taking a video recording of him doing these things in his sleep would be very helpful. You may end up needing to see a sleep specialist.View Thread
There are many types of insomnia, and difficulty staying alseep is a common type of insmonia. There are many reasons for this, just as there are many reasons for not being able to fall aslsep (please also refer to my comment posted under Ambien and Alprazolam discussion). Some of the more common things that have already been suggested include depression, other mental health issues, and fibromyalgia. Some other causes might have to do with behaviors that occur before sleep, such as caffeine and alcohol consumption at night. Many times these problems can not be fiexed with medications, rather the underlying cause must be addressed. For this, the behavior therapy with the help of a sleep specialist (usually sleep psychologist) should be sought. They can often help get to a permanent cure without medications.
In the near future I will invite one of my colleagues who is a sleep psychologist as a guest expert to direct readers to resources available for behavioral therapy.
Hope you are able to get to see the correct people.View Thread
Sorry to hear about your daughter's sleep problems. You ended your post by saying, "Not driving is not an option..." I must say, you and she should consider not driving in the short term the only option. Drowsy driving is one of the leading causes of motor vehicle accidents and are very often fatal.
However, hopefully her driving restriction will only be short term, until her symptoms can be properly diagnosed. Certainly insufficient sleep is the commonest cause of sleepiness in Americans, however there are many sleep disorders that also cause this problem. Common sleep problems in young adults that cause sleepiness include narcolepsy and circadian rhythm disturbances. You should definitely consider talking in detail with the primary care doctor or asking for a referral to a sleep specialist who deals with a broad spectrum of sleep disorders (not just sleep apnea).
It is always good to be persistent about getting the health care that you need. But please, do not let her drive drowsy!View Thread
Whereas there has been some controversy about whether "sexsomnia" is a separate disorder or a variation of a common sleep disorder known as an arousal parasomnia, there is no doubt that it does happen. During this the patient is typically in deep sleep and will perform sexual acts on a bed partner or him/herself. Of course these episodes are very distressing to both the patient and partner. As you note, the episodes happen during periods of sleep disruption. This might be due to stress, alcohol intake, irregular sleep schedule, a sleep disorder, etc. In each patient such inciting factors should be sought and corrected where possible. A sleep physician should be consulted to determine if there might be an underlying sleep disorder, such as sleep apnea, that might be causing sleep disruption leading to these episodes.
Sorry to hear about your problems with night time sleep. The short answer to your question is that you should NOT combine the two medications unless your doctor specifically approves it. The long answer is this: insomnia is a symptom, not a diagnosis. It is like saying that you have a stomach ache. If you had a stomach ache you would probably take something over the counter for it; you might continue this for a week or two. But if the pain did not go away, you would want to know what is causing it. Once that was determined you would take medication for the problem rather than the over the counter medication you initially used. The same is true for insomnia. You should try to find out what is causing it, and then try to fix that problem. Ambien and other drugs are not meant to be taken for months and years. They are short term drugs for a short term insomnia. Many doctors are in the habit of prescribing Ambien like drugs since it is much easier to do than to find out what is causing the insomnia. Many insomnia sufferers can use behavioral therapy prescribed by a physician or psychologist to treat their insomnia and not need medicines. Consider talking with your physician, a sleep doctor, or best of all, an insomnia expert about your problem to see if you might be able to get a more lasting solution.
Your situation is not unusual. Over time CPAP may become less effective. The usual reasons for this are weight gain, lack of CPAP mask to fit appropriately, use of certain medications that may worsen sleep apnea or cause daytime sleepiness, and other medical illnesses.
Once a new pressure has been found to adequately treat all the apneas and the mask is fitting well, the symptoms usually resolve. If they do not, physicians will look for other reasons for daytime sleepiness such as medications and other medical problems. Further testing with a multiple sleep latency test (MSLT) may be needed. Lastly, if sleepiness is persistent and apnea is adequately treated with CPAP, medications may be considered to treat the sleepiness in addition to the CPAP. This is typically a last case resort.
Surgery and dental appliances are options. However, discussing the utility of surgery with your doctor is very important. Not everyone gets better with surgery. Typically both of these options are used if you cannot tolerate/use CPAP, rather than those who can use CPAP but are not getting better.
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