We’ve all experienced it at one time or another: not being able to get to sleep and waking up in the morning not feeling refreshed. These are common problems in America today, and whether your unrestful time in bed is caused by insomnia, sleep apnea, an inability to stay asleep, sleep walking or even restless leg syndrome, all of these issues can impact your ability to get a good night’s rest. All of them can also be handled by a doctor who specializes in treating sleep disorders.
It seems the services of these specialists are in great demand these days. According to the American Sleep Association, 50 to 70 million U.S. adults have a sleep disorder, and nearly half of all adults (48 percent) report snoring, which is often associated with sleep apnea. Insomnia — difficulty falling or staying asleep — is the most common sleep disorder, and it affects an estimated 30 percent of American adults.
[See: Trouble Sleeping? Ask Yourself Why.]
“Let’s just make the math simple,” says Dr. Michael J. Breus, a clinical psychologist and board-certified sleep medicine specialist in private practice in Los Angeles. “We have roughly 350 million people in the United States, so you’re talking about 105 million people at any given time who can’t sleep, with 10 percent of those people having chronic insomnia,” he says. The causes of this widespread insomnia range from anxiety and our overloaded modern lifestyle to other underlying diseases. But sleep doctors offer options to relieve some of these issues and get you back on track if you’re struggling to sleep.
In addition to insomnia, another common sleep issue is sleep apnea, a condition in which patients actually stop breathing in the middle of the night. This break in breathing causes them to wake up. People with sleep apnea may not even be aware they’re waking up, and it can happen dozens of times during the night, leading to feeling sleepy and groggy the next day. Breus says this disorder affects about 10 to 12 percent of American men and between 6 and 10 percent of women. “The reason it varies so much for women is because once women reach menopause, the ratio goes from 2-to-1 male-female to 1-to-1 male-female, because as women’s hormones change, there’s a tendency to put on weight,” which is a contributing factor to developing sleep apnea.
Dr. Timothy I. Morgenthaler, co-director of the Mayo Clinic Center for Sleep Medicine and professor of medicine at the Mayo Clinic College of Medicine, says “disorders of the biological clock, called circadian rhythm disorders,” are also relatively common. Jet lag is an example of a circadian rhythm disorder that’s usually resolved quickly, but people who work the night shift or blind people sometimes develop more severe circadian rhythm disorders that can elevate their risk for other disease such as certain cancers, diabetes, mental health problems and even car accidents. Parasomnias (sleep walking and other abnormal behaviors and movements during sleep), narcolepsy (a neurological condition characterized by overwhelming sleepiness), seizures at night, restless leg syndrome and advanced sleep phase disorder (sleeping and waking too early, which is common among elderly people) are other problems a sleep medicine specialist may be able to help with.
[See: 10 Ways to Get Better Sleep (and Maybe Cure Your Insomnia).]
Although the range of disorders, their causes and health impacts vary, the common thread is finding a way to help you get better sleep so you can be more functional during the day and wake feeling rested. “Because sleep is a global human process,” it’s important for your doctor to understand how it can affect all of the body’s systems, Breus says, noting that sleep medicine encompasses elements of pediatrics, internal medicine, neurology, psychiatry, epidemiology and endocrinology and more.
Morgenthaler says many sleep specialists were pulmonologists, neurologists or internists first and then specialized in sleep medicine. “At the time that you apply for board-certification in sleep medicine, you have to be previously certified by one of six other medical boards. Sleep medicine is a multi-disciplinary practice and sleep disorders can arise from a whole bunch of different symptoms,” he says. This means the doctor you see should be well-versed in how sleep impacts various aspects of health.
If you’re having trouble sleeping or are struggling with sleepiness during the day, Morgenthaler recommends speaking with your primary care doctor first to rule out any obvious culprits. If the problem persists, you may then be referred to a sleep specialist, who will likely conduct a sleep study to determine the source of the problem.
Most sleep studies are conducted in the lab and involve you arriving later in the evening, getting into your bedclothes and then being hooked up to various monitors and machines. “They attach 27 electrodes to your body and you have two belts across your chest that look at respiration. Then, they put you in a room all wired up and tell you to go to sleep,” Breus says, noting that this isn’t always the best process to diagnose all sleep disorders. “However, it is very effective in diagnosing sleep apnea because usually people with sleep apnea are so doggone tired, they don’t care that they have 27 electrodes attached to them. They just want to figure out what’s going on and they’ll go through almost anything to get there.” As the night progresses, the machines and sleep technicians gather data.
If you’re looking for a sleep specialist or need to have a sleep study done, both Morgenthaler and Breus recommend looking for a board-certified sleep specialist affiliated with a sleep laboratory that’s been accredited by the American Academy of Sleep Medicine. Morgenthaler, who’s a past president of the AASM, says “the accreditation process is like hospital accreditation. It doesn’t guarantee that the center is top notch, but it does guarantee that they’re meeting the minimum standards.” To earn accreditation, the center must meet certain criteria, one of which is having a board-certified sleep medicine specialist on staff. Insurance companies may be more likely to cover the cost of a sleep study if it’s conducted at an accredited sleep center, Breus says.
Prior to your first meeting with a sleep specialist, Morgenthaler recommends keeping a sleep diary for a week or two. “It’s really good if you can try to boil down your complaints” to the most prevalent and consistent issues, he says. And while bringing data from any wearable fitness devices you might have can be helpful, “that’s supplementary to a written sleep diary.” (You can download a sleep diary guide from the AASM to help focus on what to track.) “An early part of our conversation is going through your sleep-wake schedule and talking about what’s happening at each point. We need to get an understanding of the whole cycle,” in order to pinpoint the problem, Morgenthaler says.
[See: 8 Steps to Fall Asleep Fast.]
Once your doctor has a diagnosis, you’ll be given an appropriate course of treatment, which in the case of sleep apnea often means wearing a continuous positive airway pressure device, or CPAP machine, at night to eliminate breaks in your breathing. Other conditions may require the use of medicines, and Breus says cognitive behavioral therapy can root out and alter fallacious thoughts about sleeping, which many people with insomnia and some other sleep disorders may find very helpful. Good sleep hygiene — putting away electronic devices an hour before bed; keeping the room quiet, cool and dark; maintaining consistent sleep and wake times; and avoiding alcohol and caffeine before bed — is also recommended for everyone who wants a good night’s sleep.
The bottom line, Breus says, is that no matter how tired you might feel, help is available. “You’re not alone, so don’t feel like you’re on an island and nobody can help. There are sleep specialists in every community in the United States and almost every hospital has a sleep laboratory. So help is around the corner.”
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Which Doctor Should I See for Sleep Problems? originally appeared on usnews.com
