Before your doctor can treat your sleep disorder, he or she first needs to determine whether you’re experiencing a sleep disruption, or whether it is indeed a sleep disorder.
Sleep disruptions have a discernible cause, such as work stress, financial problems or temporary illness, whereas sleep disorders are more long-term and don’t resolve themselves over time.
As sleep disorders (and even sleep disturbances) are so disruptive and potentially harmful, several health professionals should ideally be involved in diagnosing and treating the condition. These professionals include a dietician, a psychiatrist, a pulmonologist, a neurologist, a sleep specialist, and possibly a psychologist if anxiety or depression is contributing to the problem.
Always remember that sleep disruptions, if not resolved swiftly, can become sleeping disorders.
Treatment options include:
Cognitive behavioural therapy. This can address the anxiety you experience because of not being able to fall asleep. When experiencing sleep disturbances, anxiety over specific issues is often an underlying factor. These need to be addressed and managed before the sleep disturbance becomes a sleep disorder.
Lifestyle changes / better sleep hygiene. Better sleep habits can go a long way towards treating sleep disturbances, and sometimes managing certain sleeping disorders.
- Avoid daytime naps.
- Avoid heavy meals and exercise late at night.
- Go to bed at the same time every night and get up at the same time every morning.
- Make sure your bedroom environment is conducive to sleep (it should be cool, dark and quiet).
- Try to maintain your ideal weight.
Identify and treat underlying conditions. In serious cases, your medical team should preferably include a psychiatrist, a neurologist, a pulmonologist, a dietician and a sleep specialist. Many conditions, such as diabetes, arthritis, heart problems, depression, thyroid disease, nocturia and heartburn, can affect the quality of your sleep and so a team of experts should be involved.
A disrupted sleeping pattern is also often one of the first symptoms of other conditions.
It’s furthermore important for a doctor to check whether your sleep disorder could be related to medication that you’re taking to treat other conditions.
Medication. Treatment options for sleep disorders include over-the-counter and prescription medicines. Note, however, that most doctors will try to find other solutions for sleeping problems before they resort to medication, as these are often habit-forming and could lose their efficacy over time.
Different sleeping tablets have very different effects: some are for short-term use only, such as the benzodiazepines. Others merely help initiate sleep, and yet others are there to help you maintain sleep.
Some medicines increase melatonin levels (melatonin is a naturally occurring hormone involved in the sleeping process). Over-the-counter melatonin tablets can, for example, be used in the treatment of circadian rhythm disorder and jet lag.
There are also those medications that help you fall asleep, but which don’t stay in the body for long and don’t cause a feeling of fatigue the following day, as some sleeping medications do. Then there are antidepressants that cause drowsiness and which promote sleep by increasing serotonin levels.
Sedatives are often used to treat insomnia, while stimulants are used to treat narcolepsy and sleep apnoea.
Use of devices. This is only considered when treating sleep apnoea. A device called CPAP (continuous positive airway pressure) sends a constant stream of air through the nose and into the airway, keeping the airway open during sleep. This puts an end to the breathing problems experienced by people with sleep apnoea.
Surgery. Snoring and sleep apnoea can sometimes be treated by removing the sites of obstruction in the nose, throat, tongue and palate. CPAP, while being the first-line treatment option, can be uncomfortable (it involves a tight mask and some people find it difficult to fall asleep with air blown into the nose) and isn’t always successful.
When to call your doctor
If you find that, despite getting enough sleep, you’re still waking unrefreshed or are tired and sleepy during the day, it’s worth checking in with your doctor.
If you’ve been getting a reduced quantity of sleep for more than one week, and you’re feeling tired, sleepy, irritable or depressed as a result of it, it’s also worth visiting a doctor.
Reviewed by Dr Irshaad Ebrahim, specialist neuropsychiatrist in sleep disorders at The London Sleep Centre and The Constantia Sleep Centre. FRCPsych. April 2018.