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What is Insomnia?


If you can't sleep, you may be wondering if you have insomnia. Insomnia is a complicated condition.

What is the definition of insomnia?

According to guidelines from a physician group, insomnia is difficulty falling asleep or staying asleep, even when a person has the chance to do so. People with insomnia can feel dissatisfied with their sleep and usually experience one or more of the following symptoms: fatigue, low energy, difficulty concentrating, mood disturbances, and decreased performance in work or at school.

How long does insomnia last?

Insomnia may be characterized based on its duration. Acute insomnia is brief and often happens because of life circumstances (for example, when you can't fall asleep the night before an exam, or after receiving stressful or bad news). Many people may have experienced this type of passing sleep disruption, and it tends to resolve without any treatment.

Chronic insomnia is disrupted sleep that occurs at least three nights per week and lasts at least three months. Chronic insomnia disorders can have many causes. Changes in the environment, unhealthy sleep habits, shift work, other clinical disorders, and certain medications could lead to a long-term pattern of insufficient sleep. People with chronic insomnia may benefit from some form of treatment to help them get back to healthy sleep patterns. Chronic insomnia can be comorbid, meaning it is linked to another medical or psychiatric issue, although sometimes it's difficult to understand this cause and effect relationship.

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People with insomnia tend to have difficulty falling asleep (onset), staying asleep (maintenance), and/or they wake up too early in the morning. Treatment for insomnia can include behavioral, psychological, medical components or some combination thereof. You and your doctor will need to talk about your particular situation and history of insomnia, as well as its causes, to decide on the best treatment plan.

What are some facts about insomnia?

Insomnia is a common sleep problem for adults. The National Institutes of Health estimates that roughly 30 percent of the general population complains of sleep disruption, and approximately 10 percent have associated symptoms of daytime functional

Insomnia: Everything you need to know

Last updated Thu 7 December 2017

By Peter Crosta

Reviewed by Daniel Murrell, MD


   Causes Signs and symptoms Types Treatment Home remedies Diagnosis Risk factors

Insomnia is a sleep disorder that regularly affects millions of people worldwide. In short, individuals with insomnia find it difficult to fall asleep or stay asleep. The effects can be devastating.

Insomnia commonly leads to daytime sleepiness, lethargy, and a general feeling of being unwell, both mentally and physically. Mood swings, irritability, and anxiety are common associated symptoms.

Insomnia has also been associated with a higher risk of developing chronic diseases. According to the National Sleep Foundation, 30-40 percent of American adults report that they have had symptoms of insomnia within the last 12 months, and 10-15 percent of adults claim to have chronic insomnia.

Here, we will discuss what insomnia is, its causes, symptoms, diagnosis, and possible treatments.

Fast facts on insomnia:

   There are many possible causes of insomnia.

   An estimated 30-40 percent of Americans report experiencing insomnia each year.

   Often, insomnia is due to a secondary cause, such as illness or lifestyle.

   Causes of insomnia include psychological factors, medications, and hormone levels.

   Treatments for insomnia can be medical or behavioral.


Insomnia can be caused by physical and psychological factors. There is sometimes an underlying medical condition that causes chronic insomnia, while transient insomnia may be due to a recent event or occurrence. Insomnia is commonly caused by:


   Disruptions in circadian rhythm - jet lag, job shift changes, high altitudes, environmental noise, extreme heat or cold.

   Psychological issues - bipolar disorder, depression, anxiety disorders, or psychotic disorders.

   Medical conditions - chronic pain, chronic fatigue syndrome, congestive heart failure, angina, acid-reflux disease (GERD), chronic obstructive pulmonary disease, asthma, sleep apnea, Parkinson's and Alzheimer's diseases, hyperthyroidism, arthritis, brain lesions, tumors, stroke.

   Hormones - estrogen, hormone shifts during menstruation.

   Other factors - sleeping next to a snoring partner, parasites, genetic conditions, overactive mind, pregnancy.


What is REM sleep behavior disorder (RBD)?

What is REM sleep behavior disorder (RBD)?

For some people, REM sleep can be disrupted by unusual actions and behaviors. Learn more about REM sleep behavior disorder (RBD) here.

Read now

Media technology in the bedroom

Several small studies in adults and children have suggested that an exposure to light from televisions and smartphones prior to going to sleep can affect natural melatonin levels and lead to increased time to sleep.


Suffering From COPD? - It Might Be Alpha-1

COPD Symptoms May Be A Sign Of Alpha-1. Get A Test Kit & Bring To Your Doctor.


In addition, a study conducted by Rensselaer Polytechnic Institute found that backlit tablet computers can affect sleep patterns. These studies suggest that technology in the bedroom can worsen insomnia, leading to more complications.


According to the American Association of Retired Persons (AARP), the following medications can cause insomnia in some patients:




   alpha blockers

   beta blockers

   SSRI antidepressants

   ACE inhibitors

   ARBs (angiotensin II-receptor blockers)

   cholinesterase inhibitors

   second generation (non-sedating) H1 agonists



Signs and symptoms


Insomnia itself may be a symptom of an underlying medical condition. However, there are many signs and symptoms that are associated with insomnia:


   Difficulty falling asleep at night.

   Waking during the night.

   Waking earlier than desired.

   Still feeling tired after a night's sleep.

   Daytime fatigue or sleepiness.

   Irritability, depression, or anxiety.

   Poor concentration and focus.

   Being uncoordinated, an increase in errors or accidents.

   Tension headaches (feels like a tight band around head).

   Difficulty socializing.

   Gastrointestinal symptoms.

   Worrying about sleeping.


Sleep deprivation can cause other symptoms. The afflicted person may wake up not feeling fully awake and refreshed, and may have a sensation of tiredness and sleepiness throughout the day.


Having problems concentrating and focusing on tasks is common for people with insomnia. According to the National Heart, Lung, and Blood Institute, 20 percent of non-alcohol related car crash injuries are caused by driver sleepiness.


woman unable to sleep

Insomnia has a wide range of causes including stress.


Insomnia includes a wide range of sleeping disorders, from lack of sleep quality to lack of sleep quantity. Insomnia is commonly separated into three types:


   Transient insomnia - occurs when symptoms last up to three nights.

   Acute insomnia - also called short-term insomnia. Symptoms persist for several weeks.

   Chronic insomnia - this type lasts for months, and sometimes years. According to the National Institutes of Health, the majority of chronic insomnia cases are side effects resulting from another primary problem.



Good sleep hygiene, including avoiding electronics before bed, can help treat insomnia.

Good sleep hygiene, including avoiding electronics before bed, can help treat insomnia.


Some types of insomnia resolve when the underlying cause is treated or wears off. In general, insomnia treatment focuses on determining the cause.


Once identified, this underlying cause can be properly treated or corrected.


In addition to treating the underlying cause of insomnia, both medical and non-pharmacological (behavioral) treatments may be used as therapies.


Non-pharmacological approaches include cognitive behaviorlal therapy (CBT) in one-on-one counseling sessions or group therapy:


Medical treatments for insomnia include:


   prescription sleeping pills


   sleep aids available online or over-the-counter


   melatonin, which can be purchased online


Home remedies

Home remedies for insomnia include:

   Improving "sleep hygiene": Not sleeping too much or too little, exercising daily, not forcing sleep, maintaining a regular sleep schedule, avoiding caffeine at night, avoiding smoking, avoiding going to bed hungry, and ensuring a comfortable sleeping environment.

   Using relaxation techniques: Examples include meditation and muscle relaxation.

   Stimulus control therapy - only go to bed when sleepy. Avoid watching TV, reading, eating, or worrying in bed. Set an alarm for the same time every morning (even weekends) and avoid long daytime naps.

   Sleep restriction: Decreasing the time spent in bed and partially depriving the body of sleep can increase tiredness, ready for the next night.


A sleep specialist will start by asking questions about the individual's medical history and sleep patterns.

A physical exam may be conducted to look for possible underlying conditions. The doctor might screen for psychiatric disorders and drug and alcohol use.


The Stanford Center for Sleep Sciences and Medicine explains that the term "insomnia" is often used to refer to "disturbed sleep."


For a diagnosis of insomnia, the disturbed sleep should have lasted for more than 1 month. It should also negatively impact the patient's wellbeing, either through the causing distress or disturbing mood or performance.


The patient may be asked to keep a sleep diary to help understand their sleeping patterns.


Other tests may include a polysomnograph. This is an overnight sleeping test that records sleep patterns. In addition, actigraphy may be conducted. This uses a small, wrist-worn device called an actigraph to measure movement and sleep-wake patterns.

Risk factors


Insomnia can affect people of any age; it is more common in adult females than adult males. It can undermine school and work performance, as well as contributing to obesity, anxiety, depression, irritability, concentration problems, memory problems, poor immune system function, and reduced reaction time.


Some people are more likely to experience insomnia. These include:


   travelers, particularly through multiple time zones

   shift workers with frequent changes in shifts (day vs. night)

   the elderly

   users of illegal drugs

   adolescent or young adult students

   pregnant women

   menopausal women

   those with mental health disorders


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Related coverage

How does bipolar disorder affect women? Bipolar disorder affects both men and women, but triggers, symptoms, and treatments may be different for women. Find out how gender affects this condition. Read now

Insomnia increases asthma risk in adults A new study suggests people who experience insomnia symptoms are at a higher risk of developing asthma in adulthood compared with insomnia-free adults. Read now

What is tendinosis? In this article, learn about the symptoms, causes, and treatments for tendinosis, as well as what makes it different from tendinitis. Read now

Could sleep disorders raise the risk of preterm birth? Sleep disorders among pregnant women are associated with early birth. Insomnia and sleep apnea have been shown to double the risk of early preterm birth. Read now

How to deal with becoming a new parent The prospect of becoming a parent can be overwhelming. In this Spotlight feature, we give some basic but vital tips to help you to weather the storm. Read now



Sleep / Sleep Disorders / Insomnia

Additional information


   Article last updated by Yvette Brazier on Thu 7 December 2017.

   Visit our Sleep / Sleep Disorders / Insomnia category page for the latest news on this subject, or sign up to our newsletter to receive the latest updates on Sleep / Sleep Disorders / Insomnia.


   All references are available in the References tab.




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Sleep Apnea

   Home Symptoms Treatment Coping

Man Sleeping on Side

Obstructive sleep apnea is a sleep disorder in which breathing is briefly and repeatedly interrupted during sleep. The "apnea" in sleep apnea refers to a breathing pause that lasts at least ten seconds. Obstructive sleep apnea occurs when the muscles in the back of the throat fail to keep the airway open, despite efforts to breathe. Another form of sleep apnea is central sleep apnea, in which the brain fails to properly control breathing during sleep. Obstructive sleep apnea is far more common than central sleep apnea.

Obstructive sleep apnea, or simply sleep apnea, can cause fragmented sleep and low blood oxygen levels. For people with sleep apnea, the combination of disturbed sleep and oxygen starvation may lead to hypertension, heart disease and mood and memory problems. Sleep apnea also increases the risk of drowsy driving.


The National Sleep Foundation offers a number of resources to help patients who are currently suffering from or think that they may have sleep apnea. Explore the sections below for more information:


   Sleep Apnea Symptoms

   Treatment for Sleep Apnea

   Coping with Sleep Apnea

Who Has Sleep Apnea?

More than 18 million American adults have sleep apnea. It is very difficult at present to estimate the prevalence of childhood OSA because of widely varying monitoring techniques, but a minimum prevalence of 2 to 3% is likely, with prevalence as high as 10 to 20% in habitually snoring children. OSA occurs in all age groups and both sexes.

What Causes Sleep Apnea?

Four Sleep Apnea Tests You Can Take Right Now

Sleep TestIf you think you may suffer from obstructive sleep apnea or some other sleep breathing disorder, there are several simple tests you can take that may suggest you should discuss the possibility with your health care provider. Remember, though, that one of the best tests may be a complaint by your bed partner that you snore loudly or that you stop breathing repeatedly while you’re asleep.


Four tests that you can take right now are the American Sleep Apnea Association’s own Snore Score, the Epworth Sleepiness Scale, and the Berlin Sleep Questionnaire. STOP-BANG asks for you to enter your body-mass index. If you don’t know what your BMI is, the National Heart Lung and Blood Institute will help you calculate it.


Click for information on STOP-BANG

Getting a Sleep Apnea Diagnosis


If you suspect that you have sleep apnea, the usual first step is to discuss your suspicions with your primary care physician. If you don’t have a primary care physician, you can go directly to a clinician who is a sleep specialist. But check your health care insurance coverage first. Some policies require you to see a primary care physician first, and some policies limit the sleep centers and testing facilities whose services they will pay for. Unfortunately, you may discover that your policy offers limited or no coverage for the diagnosis and treatment of sleep apnea, in which case you may wish to switch insurers if and when you can.

Whichever kind of physician you consult initially, it can be helpful for you to prepare in advance a detailed account of your medical history as it may be relevant to sleep apnea.


Sleep specialists come from a variety of medical backgrounds. They may be pulmonologists (lung specialists), otolaryngologists (ears, nose, and throat), neurologists (brain and nerves), psychiatrists (mental health), or primary care physicians–internists and family practitioners. Some dentists also have special training in the treatment of sleep disordered breathing, which includes sleep apnea. You can check the credentials of specialists at the web sites of the American Board of Internal Medicine and the American Board of Sleep Medicine. You should feel free to ask any doctor you see about his or her credentials and the diagnostic procedures to be followed.

A definitive diagnosis of sleep apnea can be made only with a sleep study conducted during a visit to a sleep lab, usually overnight, or a home study performed with special equipment. Some sleep centers are accredited by the American Academy of Sleep Medicine and you can find them listed here. Others that are just as qualified, however, may choose not to pay the cost of accreditation or may be in the process of obtaining it.


A sleep study generates several records of activity during several hours of sleep, usually about six. Generally, these records include an electroencephalogram, or EEG, measuring brain waves; an electroculogram, or EOG, measuring eye and chin movements that signal the different stages of sleep; an electrocardiogram, EKG, measuring heart rate and rhythm; chest bands that measure respiration; and additional monitors that sense oxygen and carbon dioxide levels in the blood and record leg movement. None of the devices is painful and there are no needles involved. The testing procedure as a whole is known formally as “polysomnography,” and the technician who supervises it is usually a “registered polysomnographic technologist,” or RPT. Usually the bedroom where the test is conducted is more like a comfortable hotel room than a hospital room.


Your doctor might prescribe a “split-night study,” in which the first hours are devoted to diagnosis. If obstructive sleep apnea is found, the patient is awakened and fitted with a positive airway pressure device. The remainder of the patient’s slumber is then devoted to determining how well he or she responds to PAP therapy.

A substantial amount of data is generated by a sleep study, but the most crucial is the apnea-hypopnea index, or AHI. An apnea is a complete cessation of breathing for 10 seconds or longer. A hypopnea is a constricted breath (more than one-fourth, less than three-fourths) that lasts 10 seconds or longer. The index number is the number of apneas and hypopneas the sleeper experiences each hour. An AHI of 5 to15 is classified as mild obstructive sleep apnea; 15 to 30 is moderate OSA; 30 or more is severe OSA. Here is more information about understanding the results of your sleep study. If you are diagnosed with OSA, its severity is one of the factors you and your sleep specialist will weigh as you explore your treatment options.


While polysomnography in a fully equipped sleep lab is regarded as the “gold standard” for sleep apnea diagnostics, your sleep specialist may decide that given your circumstances and your symptoms the findings produced in a home study will be sufficient to make an accurate diagnosis. A home study, especially if it is self-administered (as most are), is definitely cheaper, and some patients are unable to conform to the sleep lab’s procedures. Home studies are coming into steadily wider use.


The cost of diagnosing and treating sleep apnea is significant, generally well over $1,000, and if PAP therapy is prescribed, charges will be ongoing. If you are uninsured or underinsured, you may be tempted to delay action. Be aware, though, that the consequences of untreated sleep apnea, described elsewhere on this web site, could lay a heavy cost on you as well. Diagnosis and, if necessary, treatment may be well worth the price.

After the Sleep Apnea Diagnosis

Tracy R. Nasca


Check list of things to ask your sleep doctor and CPAP provider


You have been diagnosed with sleep apnea. For most patients, sleep apnea is for life and this is the time to be proactive in your prescribed treatment therapy. You are most likely in a sleepy fog when you visit the sleep doctor for your follow up visit. You will be given the results of your overnight sleep study, have a follow up visit with the sleep doctor; then be referred to a CPAP provider and not necessarily in that order. This is a critical time as you begin CPAP therapy and the information you will be receiving is important yet may seem overwhelming; your brain may be on overload. This is all new to you and so how will you know what questions to ask?

The following is a checklist of important information you should receive and questions you should ask your healthcare providers.

-Sleep Doctor

What is my specific diagnosis and what is sleep apnea?


Obstructive sleep apnea, Central Sleep Apnea or Mixed Sleep Apnea (both obstructive and central)

What is the difference between the diagnoses?


If you are diagnosed with central sleep apnea, ask for a thorough explanation of what it is, why you have it and how it may be treated differently in your case.

WHY do I have sleep apnea?

Ask the doctor what your physical/anatomical reasons are for having sleep apnea and discuss your treatment options. CPAP is typically first line treatment, but familiarize yourself with other options such as oral appliance therapy, that are appropriate for your condition. Treatment options are dependent on WHY YOU have sleep apnea in the first place.

Please provide me with my sleep study summary report

Your overnight sleep study summary report should be considered your diagnosis and baseline. It contains a summary of the data collected in your overnight stay. It is very likely that you will have subsequent visits to the sleep lab in the future to monitor your CPAP pressure requirements. It is important that you have and maintain a folder with all of the paperwork you will receive at diagnosis and afterwards. It is prudent for you to keep copies of your records rather than relying on requesting copies in the future as often doctors move, close their doors or send your records to their archives which make it more difficult for you to obtain them.

Please explain the relevance and details noted on my summary report


On your sleep study summary report, you will see AHI – apnea hypopnea index – it applies to the severity of your apnea condition, ask for details. You will also see information about your oxygen levels, limb movements and other notable details. Ask your doctor to go over each category of details so that you fully understand them.

Please provide me with a physical copy of my prescription for CPAP and equipment


In most cases, the doctor will fax this to your CPAP provider, but you should have a physical copy to keep with you. Should you move or wish to buy equipment from any other source, you will need the prescription. Should you be traveling outside your home area and need equipment, you will need the prescription. Should you decide to change CPAP providers, you will need the prescription. It is your right to have the prescription, ask for it.

What is your protocol for after care?


How often will I have a follow up with you, my doctor? You may have been referred to the sleep doctor by your primary care physician and never see the sleep doctor again outside of the initial follow up visit. Your follow up may be with your primary care doctor who will now manage your condition. Ask what the plan is and be comfortable with it.

How often do you recommend future titrations?


Titrations may be routine annual visits to the sleep lab to confirm or change CPAP pressures if needed. Find out what your doctors philosophy is on this important subject.

-CPAP Provider

Will I be allowed to choose my own CPAP machine, mask and humidifier, or has my doctor chosen specific brands?


Ask to be informed about the difference between CPAP, Auto CPAP and BiLevel machines. Generally, CPAP is prescribed first and then if patient is not successful, more expensive Auto or BiLevel is tried. Inform yourself about these different machines and how they work so that you will be able to suggest upgrading if CPAP is not affective. Depending on your insurance coverage, upgrade to AutoCPAP or BiLevel may only be covered if the patient fails on CPAP, so YOU must keep THEM informed of your progress or challenges. Learn what your insurance provides for. What are the features of the machine I have been given? Some features are preset and controlled by physician or home healthcare provider only. There are other patient controlled comfort features like ramp, expiratory pressure relief, auto on/auto off, altitude adjustment. Some features must be enabled before patient use. Find out if your machine features have been enabled for your use and learn how to use and change settings if needed. Don’t throw away the instruction booklets that come with your equipment!

Do you have a 30 day mask exchange program, if so, how does it work?


Most CPAP providers have a 30 day mask exchange program that allows you to choose a mask, try it at home for up to 30 days and if it does not work, exchange it for another mask of the same manufacturer’s brand.

How should we communicate during the adjustment period as I am starting CPAP therapy and beyond?


Beginning CPAP therapy can definitely be challenging and you should not feel alone in the process. Find out how often they will contact you to check on your progress or if they expect YOU to contact them with any difficulties you face. Each CPAP provider has their own follow up program, some better than others. This is where you need to be proactive and make sure to keep your healthcare team in the loop. Your CPAP provider is charged with the responsibility of assisting you, so don’t be shy in keeping them informed and asking for their help; this is part of what they are paid to do!

How often should I replace my CPAP mask cushion, CPAP Tubing, machine filters?


Equipment supply replacement will depend on your insurance coverage. Some CPAP providers may offer you an automatic replacement program where they will simply send you replacement items as often as your insurance allows. You may choose to only replace as needed. Masks for instance may be covered by your insurance to replace every 2-3 months, yet most patients can use the same mask for 6 months or more with good care and cleaning.

How should I care for and clean my equipment?

Regardless of whether or not you have insurance, CPAP equipment and supplies are expensive and you want to clean regularly to get the longest life out of your machine and other supplies.

The information included on this site is for educational purposes only. It is not intended nor implied to be a substitute for professional medical advice. Contact your physician or health care provider when you have health related questions. Never disregard or delay medical advice because of information you have obtained on this site.

Sleep Apnea Treatment Options

Positive Airway Pressure Devices


Positive airway pressure machines, used with a variety of breathing masks, are the most widely used treatment for moderate and severe sleep apnea.


The mask, worn snugly over the nose, or sometimes nose and mouth, during sleep, supplies pressurized air that flows continuously or intermittently into the sleeper’s throat. The increased air pressure prevents the sleeper’s airway from collapsing.


The pressurized air is supplied through a flexible tube from one of several types of machines: CPAP (continuous positive airway pressure), BiPAP (bilevel positive airway pressure), VPAP (variable positive airway pressure), and so on. Studies of the effect of PAP therapy show that people with sleep apnea who consistently use their machines feel better and, as a result of the reduction of apnea and hypopnea episodes during sleep, encounter fewer complications of the disease. There’s more information about PAP therapy here.

Although PAP devices are not used to treat snoring alone, they do eliminate snoring in addition to treating obstructive sleep apnea.

Oral Appliances

Oral appliances for the treatment of sleep apnea continue to increase in popularity as awareness grows amongst the public that oral appliances are an effective first line treatment for many sleep apnea sufferers. Over 100 different oral appliances are FDA approved for the treatment of snoring and obstructive sleep apnea. These appliances are worn in the mouth, just like a sports mouth guard or an orthodontic appliance, while you sleep. Oral appliances hold the lower jaw forward just enough to keep the airway open and prevent the tongue and muscles in the upper airway from collapsing and blocking the airway.


The American Academy of Sleep Medicine (AASM) has approved oral appliance therapy (OAT) as a first line treatment for patients diagnosed with mild to moderate OSA. The AASM also recommends oral appliances for patients with severe OSA, who are unable to tolerate or cannot wear CPAP devices. Another option for people with severe OSA is combination therapy (wearing CPAP and an oral appliance together) to help reduce the pressure on a CPAP machine, making it more comfortable to use.

Advantages of Oral Appliance Therapy


Oral appliance therapy is an effective, non-invasive treatment that fits easily into your lifestyle. Patients like oral appliance therapy because it is:



   Easy to wear



   Convenient for travel

   Easy to care for

Custom Made Oral Appliance vs. Boil and Bites


Although there are a few over-the-counter appliances you can purchase at drug stores or even online, remember that these oral appliances are not FDA approved for sleep apnea. When not fitted properly over-the-counter appliances can cause unwanted side effects, such as jaw problems or tooth movement or can even have the opposite effect and inadvertently worsen sleep apnea.

If you snore or believe you have sleep apnea, contact your primary care physician (PCP) to help schedule a sleep study to determine if you do have OSA. If it’s determined that an oral appliance is an option for you, it should be fitted by a dentist specially trained in Dental Sleep Medicine.

Finding a Dentist

Trained dental professionals will conduct a full evaluation of your teeth, mouth, and temporomandibular joint to ensure that your teeth and jaw structure are healthy enough to wear an oral appliance. Following the examination, you will have models of your teeth made and a follow-up appointment is scheduled to fit your custom oral appliance.  The American Academy of Dental Sleep Medicine can help you find a trained dentist here

Adjusting to Oral Appliance Therapy


Since custom made oral appliances are adjustable, your dentist will work with you to maintain your jaw position by continuously monitoring your progress. It is important to maintain a prescribed follow-up schedule with your dentist to ensure the device is working, fitting properly and that you see an improvement in your symptoms. It usually takes only a few days to adjust to wearing the oral appliance all night while sleeping. Your dentist will review the details with you as well as the best way to maintain your oral appliance at home.

Types of Oral Appliances


Below are just a few examples of custom made oral appliances (also known as mandibular advancement devices or MADs) that are available.


Sleep Review’s oral appliance comparison guide (up to date as of August 2015) compares 21 oral appliances side-by-side. It compares features such as fitting description, adjustment description, materials, and recommended cleaning for the different devices. Click the image to view the full 4-page comparison guide.


Medical Insurance for Oral Appliance Therapy


Although a dentist will be placing your custom oral appliance, the great news is that oral appliances are generally covered under your health insurance plan, not your dental plan. Prior to treatment, you or your dentist may want to contact your health insurance, directly, for an estimate of insurance coverage. Due to variations in medical insurance plans, coverages do vary.


Medicare provides reimbursement for oral appliances for those 65 or older under the durable medical equipment (DME) benefit. In order to help Medicare patients with a portion of the reimbursement for oral appliances, many dentists around the country have enrolled as Medicare DME Suppliers for oral appliance therapy for obstructive sleep apnea.

Upper Airway Stimulation (UAS) Therapy


Some people with obstructive sleep apnea, or OSA, are unable to use continuous positive airway pressure (CPAP) therapy, the most commonly prescribed OSA treatment, despite best efforts.  Now there’s a new, clinically proven therapy for some people with moderate to severe OSA who are unable to use CPAP.


This is a new therapy that works inside your body, and with your natural breathing process, to treat moderate to severe sleep apnea. This therapy might be right for you if:

   You have been diagnosed with obstructive sleep apnea

   You can’t use or don’t get relief from CPAP

The system consists of three components: a small generator, a breathing sensor lead, and a stimulation lead—all controlled by the small handheld Inspire sleep remote. Simply turn the therapy on at night before bed, and off in the morning when you wake up. When activated, Inspire therapy continuously monitors your breathing patterns during sleep and delivers mild stimulation to key airway muscles, which keeps the airway open. Your UAS therapy doctor will also evaluate your airway anatomy and overall health status to determine if Inspire therapy is right for you.

To find a doctor in your area, please visit

Weight Loss

About 70 percent of people with obstructive sleep apnea are overweight or obese. Their health care professionals usually encourage them to lose weight.

Surprisingly, there have been few formal studies of how effectively weight loss leads to lesser, lighter snoring and diminished incidents of apnea and hypopnea during sleep. Despite this, anecdotally practitioners report striking improvements in both OSA and snoring among patients who lose weight.

In some situations a physician may wish to prescribe weight loss medications to an overweight or obese patient with OSA.1

Nasal Decongestant

Nasal decongestants are more likely to be effective in cases of snoring or mild sleep apnea. In some cases, surgery is an effective way to improve airflow through the nose.


Positional Therapy


Some people snore or have sleep apnea only when sleeping on their back. Such people can eliminate or reduce airway blockage simply by learning to sleep on their side.

The traditional technique to induce side-sleeping is dropping a tennis ball in a sock and then pinning the sock to the back of the pajama top. There are also a couple of companies that make a products designed to discourage supine sleeping.

Positional therapy generally works only in mild cases of OSA. In more severe cases, the airway collapses no matter what position the patient assumes.

Surgery (Adults)

Surgery is often effective in treating snoring. It is less effective in treating obstructive sleep apnea.

The challenge that confronts the surgeon is determining what part of the upper airway is causing the obstruction to airflow. There are many possible sites, and conventional sleep testing does not identify the area the surgeon should modify. If the surgeon does not treat that site in the airway, or if there are multiple sites of obstruction, it is unlikely that the sleep apnea will diminish to a degree that eliminates the need for other treatment.

Given the several sites where airway obstruction may exist, there are several types of operations currently used to treat sleep apnea. The most common is uvulopalatopharyngoplasty, or UPPP. The success rate of this operation is about 50 percent. Some surgeons have achieved very high success rates using multiple, staged operations.2 Nonetheless, most authorities recommend routine re-assessment for sleep apnea after surgery. See the caution below.  There’s more about surgery here.

Surgery (Children)

Most children with snoring or sleep apnea have enlarged tonsils, or adenoids, or both. In 75 percent of those cases, surgical removal of these tissues cures sleep breathing problems.

The American Academy of Pediatrics has endorsed removal of the tonsils and adenoids as the initial treatment of choice for sleep breathing problems in children. There is more information children’s sleep apnea and its treatment here.


Abstinence from alcohol before bedtime is an important part of treating sleep apnea.

In one study, several persons who received cardiac pacemakers were reported to have shown an improvement in their sleep apnea. No major organizations have endorsed this type of treatment, however. Further studies are underway.


Alternative healing methods are also in use. There is some evidence that playing the didgeridoo or other wind instruments may help in managing OSA. In Brazil, acupuncture researchers who are physicians report positive results in treating OSA with acupuncture.


Snoring, and certain details of snoring, can be a valuable early-warning alarm that sleep apnea is present. Treating snoring can remove this warning system. Just as seeing smoke is a warning that a fire may be burning, hearing snoring is a warning that sleep apnea may be present. And just as smokeless fires may be discovered late, with unfortunate consequences, so too may snore-free sleep apnea. Thus, when surgery or oral appliances are used to treat snoring, it is important to check for sleep apnea on a regular basis afterwards.

Anesthesia and Pain Medicine

The presence of sleep apnea presents special challenges to the administration of anesthesia and pain medications that may affect respiration or relax muscles. Since most people who have sleep apnea don’t know it, the anesthesiologist or pain clinician is well advised to screen the patient for OSA before proceeding. Should it be determined there is a likelihood that OSA is present, the next move is to order a sleep study to make sure or, at a minimum, to take the precautionary steps that should be taken with a patient whose sleep apnea has been diagnosed. These procedures are laid out in greater detail here.  See also this article from two Mayo Clinic physicians




This summary of obstructive sleep apnea treatments is adapted from an article written by John Sotos, M.D., a member of the American Sleep Apnea Association’s board of directors, and appears here by permission. The original may be viewed at Obstructive sleep apnea and snoring respond to several types of treatment.


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1 National Heart Lung and Blood Institute.Identification, Evaluation, and Treatment of Overweight and Obesity in Adults.NIH Publication number 00-4084. October 2000. Page 11.


2 Riley, R.W., et al., “Surgical therapy for obstructive sleep apnea-hypopnea syndrome.” Chapter 77 in: Principles and Practice of Sleep Medicine. 3rd ed. Kryger, M.H., et al. (eds.) Philadelphia: WB Saunders, 2000.

CPAP Therapy


You have been diagnosed with sleep apnea and prescribed therapy. As treatment begins, questions and challenges occur. Learn what you need to know about living with sleep apnea, overcoming treatment challenges, and more.

Attitudes and Expectations

Yes, CPAP therapy is challenging.  The challenge is to find the best combination of the 3 components which are CPAP device, CPAP heated humidifier and CPAP mask. Approximately 50% of all patients diagnosed with sleep apnea and prescribed CPAP therapy will abandon treatment or fail on CPAP. Learn how to be successful on CPAP. Read More

After the Sleep Apnea Diagnosis – Check list of things to ask your sleep doctor and CPAP provider


You have been diagnosed with sleep apnea. For most patients, sleep apnea is for life and this is the time to be proactive in your prescribed treatment therapy. This is a critical time as you begin CPAP therapy and the information you will be receiving is important yet may seem overwhelming; your brain may be on overload. This is all new to you and so how will you know what questions to ask? Read More

The Difference between CPAP, AutoCPAP and BiLevel

Have you ever wondered what the difference is between CPAP, AutoCPAP and BiLevel devices? How do you know which one is the best for your treatment? Great questions and although the answers can be complex, it’s a good place to start your patient education after the sleep apnea diagnosis. All 3 are referred to as flow generators and are FDA controlled medical devices, which requires dispensing by prescription. Read More

Which Mask is Best for Me?

With dozens of CPAP masks available, which one is right for me? All of the mask types are explained in this article and I give you tips on choosing the best option for you. Read More

Mask Seating

Patients complain of leak and pressure point soreness on their face.  They have spent a small fortune trying a variety of masks and frankly are just frustrated and ready to give up.  When asked which masks they have tried and what their specific complaints are about each of them, they tick off a list of dual wall cushion masks. Read More

The Importance of CPAP Humidification

So what’s the big deal about using a CPAP humidifier? Why would you want to add another piece of equipment beyond the CPAP machine and mask? It’s just something else you have to buy, fill each night with water, clean, or add to your CPAP bag when you travel….why bother? Read More

More Information you Should Know about CPAP Humidification


I think it is important for sleep apnea patients who use CPAP therapy to have a thorough understanding of how and why it is necessary to use humidification.  Thanks to Fisher & Paykel who generously shared this information for me to pass on to you. Read More

Troubleshooting Guide for CPAP Use Problems

Get tips, tricks and find answers to common CPAP compliance issues such as mask leaks, pressure point soreness, PAP gas and more. Learn from an experience CPAP user. Read More

CPAP Tubing Tips

While your CPAP tubing may seem like an insignificant component of your medical equipment, it plays a vital role in comfort and accuracy of therapy delivery. Learn how to keep it functioning at its best. Read More

Overcoming the Challenges of Breathing on CPAP


Sleep apnea is a life threatening disorder that should be taken seriously.  For most of us, sleep apnea is “for life”. CPAP treatment is the gold standard treatment and although it has its challenges, with proper follow up care, most patients can expect a resolution of restorative sleep and return to a fully energized lifestyle. Read More

Care and Replacement of CPAP Equipment

You are about to experience the beginning of a new and improved period in your overall health and well being that only quality sleep without the presence of apneas can provide. CPAP therapy is the cornerstone of sleep apnea treatment and with consistent use, you will benefit greatly. Read More

CPAP Titration


When sleep apnea is diagnosed during the overnight sleep study, a titration is then performed to determine the optimal CPAP pressure setting required to resolve apnea episodes. Sometimes the titration is performed during the second half of the overnight sleep study; this would be called a split night study. Read More

Mouth Breathing


Some people always have been and always will be mouth breathers due to their anatomical make up.  Some of us lack muscle tone causing the jaw to drop. Others have chronic nasal congestion from allergies or other nasal anomalies and if one cannot breathe well through the nose, it may unconsciously forces us to mouth breathe. Read More

Aerophagia Causes and Resolutions

CPAP users who experience excessive belching, stomach bloating, stomach distension and agonizing gas pains may be suffering from aerophagia. It’s the medical term for the phenomenon when air enters the esophagus, goes into the belly and causes bloating. Read More

Nighttime Urination and Sleep Apnea


Nocturia (nighttime urination) is so prevalent in sleep apnea patients it has become a screening tool as significant as snoring.  A research study showed that over 84% of patients with sleep apnea reported frequent nighttime urination while 82% acknowledged snoring. Read More

What you need to know about Sleep Apnea and Surgery


If you are contemplating any medical or dental procedures or surgery in the future, the following information is provided to assist you. Read More

US Travel Tips for CPAP Users


Whether you are traveling for business or pleasure, it is important that you sleep well while away from the comfort and routine of your own bedroom. To assure the best chance of achieving restorative sleep, the following tips for traveling with CPAP are suggested. Read More

The information included on this site is for educational purposes only. It is not intended nor implied to be a substitute for professional medical advice. Contact your physician or health care provider when you have health related questions. Never disregard or delay medical advice because of information you have obtained on this site.

Healthy Sleep Tips

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Healthy sleep habits can make a big difference in your quality of life. Having healthy sleep habits is often referred to as having good sleep hygiene. Try to keep the following sleep practices on a consistent basis:

   Stick to a sleep schedule of the same bedtime and wake up time, even on the weekends. This helps to regulate your body's clock and could help you fall asleep and stay asleep for the night.

   Practice a relaxing bedtime ritual. A relaxing, routine activity right before bedtime conducted away from bright lights helps separate your sleep time from activities that can cause excitement, stress or anxiety which can make it more difficult to fall asleep, get sound and deep sleep or remain asleep.

   If you have trouble sleeping, avoid naps, especially in the afternoon. Power napping may help you get through the day, but if you find that you can't fall asleep at bedtime, eliminating even short catnaps may help.

   Exercise daily. Vigorous exercise is best, but even light exercise is better than no activity. Exercise at any time of day, but not at the expense of your sleep.

   Evaluate your room. Design your sleep environment to establish the conditions you need for sleep. Your bedroom should be cool – between 60 and 67 degrees. Your bedroom should also be free from any noise that can disturb your sleep. Finally, your bedroom should be free from any light. Check your room for noises or other distractions. This includes a bed partner's sleep disruptions such as snoring. Consider using blackout curtains, eye shades, ear plugs, "white noise" machines, humidifiers, fans and other devices.

   Sleep on a comfortable mattress and pillows. Make sure your mattress is comfortable and supportive. The one you have been using for years may have exceeded its life expectancy – about 9 or 10 years for most good quality mattresses. Have comfortable pillows and make the room attractive and inviting for sleep but also free of allergens that might affect you and objects that might cause you to slip or fall if you have to get up

Sleep Disorders (How to Get a Good Night's Sleep)

   What is sleep?

   What causes the body to sleep?

   What are the stages of sleep?

   How long does it take to get REM sleep?

   Why is REM sleep important?

   What percentage of sleep should be deep sleep?

   How much sleep does a person need?

   Does the amount of sleep we need change as we age?

   What are signs and symptoms of sleep deprivation?

   What are and what causes sleep disorders?

   How are sleep problems diagnosed?

   How are sleep problems treated?

   Sleep hygiene

   Other therapies

   Sleep aids (prescription and OTC)

   Are sleep problems and disease related?

   How can I get a good night's sleep?

   Sleep Disorders (How to Get a Good Night's Sleep) Center

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   Find a local Sleep Specialist in your town


   What is sleep?

   What causes the body to sleep?

   What are the stages of sleep?

   How long does it take to get REM sleep?

   Why is REM sleep important?

   What percentage of sleep should be deep sleep?

   How much sleep does a person need?

   Does the amount of sleep we need change as we age?

   What are signs and symptoms of sleep deprivation?

   What are and what causes sleep disorders?

   How are sleep problems diagnosed?

   How are sleep problems treated?

   Sleep hygiene

   Other therapies

   Sleep aids (prescription and OTC)

   Are sleep problems and disease related?

   How can I get a good night's sleep?

What is sleep?

Physiologically, sleep is a complex process of restoration and renewal for the body. Scientists still do not have a definitive explanation for why humans have a need for sleep. We do know that sleep is not a passive process or "switching off" of body functions; sleep is believed to be important in many physiologic processes including the processing of experiences and the consolidation of memories. It is also clear that sleep is essential, not only for humans but for almost all animals.

The importance of sleep is underscored by the symptoms experienced by those suffering from sleep problems. People suffering from sleep disorders do not get adequate or restorative sleep, and sleep deprivation is associated with a number of both physical and emotional disturbances.

What causes the body to sleep?

Sleep is influenced by the circadian rhythms (regular body changes in mental and physical characteristics that occur in the course of about 24 hours). These are controlled by brain neurons that respond to light, temperature and hormones and other signals and comprise the body's biological clock. This clock helps regulate the "normal" awake and sleep cycles. Disruption of these cycles can make people sleepy, or somnolent, at times people want to be awake. For example, travelers experience "jet lag" when they cross time zones. When a New Yorker arrives in Paris at midnight Paris time, his or her body continues to operate (their biological clock) on New York time. It may take several days to reset a person's biologic clock, depending on how much it has been altered by the time change. Different organ systems in the body recover at different rates.

There is evidence that some aspects of sleep are under genetic influence; a gene termed DEC2 is being investigated as causing people that possess it to require only about 6 hours of sleep. Researchers have only begun to examine the genetics involved in sleep.

Quick GuideSleep Disorders: Insomnia, Sleep Apnea, and More

Sleep Disorders: Insomnia, Sleep Apnea, and More

Are you sleep deprived?

Sleep Apnea

Sleep apnea is defined as a reduction or cessation of breathing during sleep. The three types of sleep apnea are central apnea, obstructive apnea, and a mixture of central and obstructive apnea.

   Central sleep apnea is caused by a failure of the brain to activate the muscles of breathing during sleep.

   Obstructive sleep apnea is caused by the collapse of the airway during sleep.

   The complications of obstructive sleep apnea include high blood pressure, strokes, heart disease, automobile accidents, and daytime sleepiness as well as difficulty concentrating, thinking and remembering.

Read more sleep apnea »


What are the stages of sleep?


There are two general states of sleep: rapid eye movement (REM) sleep and non-rapid eye movement (NREM) sleep. NREM sleep is further subdivided (see below).

   REM sleep (rapid-eye movement): REM sleep is unlike any of the other stages of sleep. It was first described in 1953 when sleep researchers noticed a unique pattern of brain waves (signals recorded on an electroencephalogram (EEG), a type of test that measures the electrical impulses within the brain). These brain waves had a fast frequency and low voltage, similar to the brain waves seen in the normal awake state. Other characteristics of REM sleep include complete inactivity of the voluntary muscles in the body, with the exception of the muscles that control eye movements. Rapid eye movements are also observed during REM sleep. People who are awakened during REM sleep often report that they were dreaming at the time. About 20% to 25% of sleep time is REM sleep; in infants it can comprise about 40%.

   NREM (non-rapid eye movement): NREM sleep occurs in 3 stages, according to the pattern of brain electrical activity:

       Stage N1 sleep, or the transition from wakefulness to deeper sleep. This is the lightest stage of sleep, and people may not always perceive they are asleep when in this stage.

       Stage N2 sleep is a true sleep state, and accounts for 40% to 50% of sleep time.

       Stage N3 sleep has been called deep sleep, delta sleep, or slow wave sleep. This stage accounts for about 20% of sleep in young adults.

Disruptions in the entire sleep cycle or in the individual phases are believed to account for the various types of sleep disorders.


How long does it take to get REM sleep?


Sleep typically occurs in cycles that range from 90 to 120 minutes in length, with 4 to 5 cycles occurring during each night's sleep. In the first half of the night, there is a transition from wakefulness into stage N1 sleep, then to stages N2, and N3. Stages N2 and N3 then reappear, followed by the first instance of REM sleep. Cycles of stage N2 and REM sleep alternate with each other for the second half of the night. Typically, there is a greater portion of N sleep in the first half of the night and REM sleep in the later portion of the night.

Why is REM sleep important?

REM sleep makes up less than 25% of total sleep time, and the reason for its importance is not fully understood. Some studies have suggested that REM sleep is necessary for the brain to preserve memories and maintain appropriate neurological connections.


What percentage of sleep should be deep sleep?


Deep (N3) sleep, as defined above, only accounts for about 20% of total sleep. The largest amount of deep sleep takes place in the first half of the night.

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Sleep Disorders: Foods That Help You Sleep or Keep You Awake


Sleep Slideshow: Foods That Help or Harm Your Sleep


How much sleep does a person need?


Individuals vary greatly in their need for sleep; there are no established criteria to determine exactly how much sleep a person needs. Eight hours or more may be necessary for some people, while others may consider this to be too much sleep.


The National Institutes of Health (NIH) suggests that most average adults need about 7 to 9 hours of sleep each night. Newborn babies, by contrast, sleep from 16 to 18 hours a day. Preschool-aged children typically sleep between 10 and 12 hours a day. Older, school-aged children and teens need at least 9 hours of sleep a night. Women in the first trimester of pregnancy have been observed to need a few more hours' sleep than is usual for them.


Does the amount of sleep we need change as we age?


Changes in the sleep cycle do occur with aging. Deep or slow wave sleep (Stage N3) sleep declines as we age, while light sleep (Stage N1) increases with age, so that older adults may spend less time in the more restorative stages of sleep and more time in lighter sleep. Older people are also more easily aroused from sleep. While some people believe that older adults need less sleep as they get older, there is no scientific evidence that older people need less sleep than younger adults.


What are signs and symptoms of sleep deprivation?


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Feeling tired or drowsy at any time during the day is one symptom of not having enough sleep. Being able to fall asleep within 5 minutes of lying down in the evening also may be a sign a person may be suffering from sleep deprivation. People who suffer from sleep deprivation often experience so-called "microsleeps," which are short bursts of sleep in an otherwise awake person.


Sleep-deprived people perform poorly on tests such as driving simulators and tests of hand-eye coordination. Sleep deprivation can also magnify the effects of alcohol, meaning that a sleep-deprived person will be more susceptible to becoming impaired after alcohol consumption than a well-rested person. Caffeine and other stimulants cannot successfully overcome the drowsiness associated with sleep deprivation.

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What are and what causes sleep disorders?


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Sleep disorders are disruptions of the sleep cycle or the quality of sleep. About 50 to 70 million Americans are believed to suffer from chronic sleep disorders, with millions more affected on an occasional basis. Doctors have defined over 70 different types of sleep disorders, but the most common sleep disorders are insomnia, sleep apnea, restless legs syndrome, and narcolepsy.


   Insomnia is the perception of poor-quality sleep, including the inability to fall asleep or stay asleep. Because people differ in their need for sleep, there are no fixed criteria that define insomnia. Insomnia is very common and occurs in 30% to 50% of the general population. Approximately 10% of the population may suffer from chronic (long-standing) insomnia. Sleep onset insomnia is characterized as occurring at the beginning of the desired sleep time and lasting for greater than 30 minutes. Sleep maintenance insomnia is when individuals fall asleep, but awaken periodically or for lengthy periods during the night, increasing the wake-after-sleep-onset (WASO).

   Sleep apnea is another common sleep disorder characterized by a reduction or pause of breathing (airflow) during sleep. Central sleep apnea (CSA) occurs when the brain does not send the signal to the muscles to take a breath, and there is no muscular effort to take a breath. Obstructive sleep apnea (OSA) occurs when the brain sends the signal to the muscles and the muscles make an effort to take a breath, but they are unsuccessful because the airway becomes obstructed and prevents an adequate flow of air. Mixed sleep apnea occurs when there is both central sleep apnea and obstructive sleep apnea.

   Restless leg syndrome (RLS), also known as nocturnal myoclonus, is a type of sleep disorder characterized by uncomfortable sensations in the legs and an uncontrollable desire to move the legs. These abnormal sensations usually occur in the lower legs during the evening. Periodic leg movements (PLMs) are related to RLS, but occur after the onset of sleep and are labeled as a sleep disorder or syndrome when the movements cause increased activity in the brain. During the early stages of sleep, these episodes of leg movement often last up to an hour. The abnormal sensations of RLS are quite variable. They have been described as a crawling, creeping, pulling, drawing, tingling, pins and needles, or prickly discomfort. They are not cramping in character. Patients with RLS may have difficulty falling asleep because of the difficulty getting comfortable and an increased urge to move their legs. Many patients with RLS will have PLMs and vice versa, but they are not the same disorder.

   Narcolepsy is a disease of the central nervous system that results uniformly in excessive daytime sleepiness (EDS). Other primary symptoms of narcolepsy include the loss of muscle tone (cataplexy), distorted perceptions (hypnagogic hallucinations), and the inability to move or talk (sleep paralysis). Additional symptoms can include disturbed nocturnal sleep and automatic behaviors (affected persons carry out certain actions without conscious awareness). All of the symptoms of narcolepsy may be present in various combinations and degrees of severity.

Other sleep disorders include:

   periodic limb movement disorder




   REM sleep behavior disorder

   nightmares, and

   circadian rhythm disorders, and

   night shift work sleep disorder

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How are sleep problems diagnosed?

Doctors use a number of different tests to evaluate sleep and determine whether a sleep disorder is present. A careful medical history and physical examination are performed to help identify any medical conditions that may be interfering with the person's sleep. The health care practitioner will also ask about the use of prescription and non-prescription medications as well as alcohol, tobacco, and caffeine use. Laboratory tests may also be used to help diagnose any medical conditions that may cause sleep problems.

In some cases, specialized testing is recommended to help determine whether or not a person may be suffering from a sleep disorder. Some of the most common sleep tests include the following:


   Polysomnography is often simply referred to as a "sleep study." Full sleep studies with additional information about the patterns and events during sleep are most commonly performed in specially designed labs in hospitals or clinics. In this test, functions such as airflow, breathing effort, blood oxygen levels, leg movements, electrocardiogram (ECG), and body position may be measured along with electrodes attached to the face and scalp to measure brain waves (electroencephalogram or EEG) and muscle tone during a night's sleep. Newer technologies have allowed the assessment of sleep disordered breathing in a patient's home setting. This type of out-of-lab testing with a portable sleep monitor usually follows a clinical evaluation by a sleep specialist.

   The multiple sleep latency test (MSLT) is designed to measure daytime sleepiness. The test is based upon the fact that the sleepier an individual is, the faster he or she will fall asleep. In this test, the patient is given four to five opportunities to nap in a quiet, dark room, usually at two hour intervals during the day. Body functions such as EEG and muscle tone are measured as in polysomnography. The time period needed from wakefulness to sleep onset is measured to determine the "sleep latency." This is repeated during each of the naps, and an average time for sleep latency across all the naps is calculated. Usually a sleep latency of 5 minutes or less is signifies severe daytime sleepiness.

   Related to the MSLT is the maintenance of wakefulness test (MWT), which measures the individual's ability to stay awake when reclining in a quiet, darkened room.

   The Epworth sleepiness scale is a questionnaire that is given to patients, often as part of an office visit to a health care practitioner. The test asks individuals to rate how likely they would be to fall asleep in a number of situations (such as a passenger in a car, sitting quietly after lunch, etc.).

Quick GuideSleep Disorders: Insomnia, Sleep Apnea, and More

Sleep Disorders: Insomnia, Sleep Apnea, and More

How are sleep problems treated?

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The treatment of sleep disorders depends upon the exact disorder and the degree of severity of the symptoms. Both medical and non-medical approaches are generally used in the treatment of sleep disorders. In some cases, such as sleep apnea, surgical treatments may be considered. In some patients, more than one type of sleep disorder may be present, requiring a combination of treatment considerations.


Sleep hygiene


Non-medical treatment options are often referred to as sleep hygiene. Sleep hygiene is the practice of behavioral habits that offer the maximum potential for restorative and sound sleep. Good sleep hygiene practices include:


   Avoid caffeine, nicotine, and alcohol use before bedtime. Some studies have shown that caffeine consumed early in the day can have an effect on the ability to fall asleep at night.

   Have and adhere to a regular bedtime and waking schedule.

   Maintain a comfortable sleep environment, including a comfortable temperature.

   Avoid watching television or using electronics with backlit screens in bed and falling asleep with the TV on in the room.

   Do not lie in bed awake, worrying about not sleeping (or anything else negative). This produces anxiety that can actually make the problem worse.

   Get regular daily exercise (it is recommended that individuals avoid exercise two hours prior to bedtime).

Other therapies

Of course, many people with sleep disorders will require treatment beyond sleep hygiene measures. Behavioral therapies are successful for many people who suffer from insomnia. These therapies may consist of stimulus control measures, such as using the bed for sleeping and sex only and not for other activities such as reading or TV watching. Sleep restriction therapies are often used to help individuals avoid staying in bed too long and actually over-sleeping after a night of insomnia.

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Sleep Slideshow: Foods That Help or Harm Your Sleep


Sleep aids (prescription and OTC)


Medications can be of value in treating some types of sleep disorders. However, since sedating medications typically have the potential for addiction and abuse, their use must be carefully supervised by a health care practitioner. Among the types of prescription drugs that have been prescribed for specific sleep disorders include:


   Benzodiazepines, such as triazolam (Halcion), temazepam (Restoril), and lorazepam (Ativan)

   Newer, non-benzodiazepine sedative drugs: zaleplon (Sonata), zolpidem (Ambien or Ambien CR, Zolpimist), and eszopiclone (Lunesta).

   Ramelteon (Rozerem), an insomnia drug that acts by mimicking the action of melatonin (see below)

   Suvorexant (Belsomra) is the first in a new class of drugs known as orexin receptor antagonists (ORAs for the treatment of insomnia. Suvorexant works by promoting the natural transition from wakefulness to sleep by inhibiting the wakefulness-promoting orexin neurons of the arousal system.

   Antidepressant medications have been used to treat insomnia in people who may also suffer from depression. Examples are trazodone (Desyrel), amitriptyline (Elavil, Endep), and doxepin (Sinequan, Adapin).

   A number of prescription drugs have been used to treat restless legs syndrome, including carbidopa-levodopa, opioids (such as propoxyphene [Darvon, Darvon-N, Dolene]) or tramadol (Ultram) for intermittent symptoms, carbamazepine (Tegretol, Tegretol XR , Equetro, Carbatrol),clonazepam (Klonopin), diazepam (Valium, Diastat), triazolam (Halcion), temazepam (Restoril), baclofen, bromocriptine, clonidine (Catapres, Catapres-TTS, Jenloga), gabapentin (Neurontin), ropinirole (Requip) and pramipexole (Mirapex).

   In sleep apnea and other sleep disorders in which airway obstruction is a problem, topical nasal decongestants may provide some relief. However, many clinicians warn people with sleep apnea never to use sleeping pills or medications that are sedative as the person could be prevented from waking enough to stimulate breathing, which could lead to brain damage or sudden death.

OTC sleep medications are sometimes used for the short-term treatment of insomnia. These include the sedating antihistamines such as diphenhydramine (Benadryl). However, this is not a recommended use of these or other similar drugs due to their many side effects and the possibility of long-term drowsiness the following day.

Melatonin, a chemical released from the brain which induces sleep, has been tried in supplement form and promoted as a natural sleep remedy for treatment of insomnia. But studies have shown that it has been generally ineffective in treating common types of insomnia, except in specific situations in patients with known low levels of melatonin.

CPAP devices (continuous positive airway pressure; a device worn over the face that holds the airway open by maintaining constant air pressure) or AutoPAP (PAP delivered over a range of pressures) and dental appliances have been effective in the management of sleep-related breathing disorders, including sleep apnea. CPAP is typically the first line of therapy for most adult patients with obstructive sleep apnea. Surgery can be effective for some patients and may help patients respond to CPAP. Newer, implantable devices that stimulate the muscles of the upper airway during sleep may also be a treatment option for some patients.

Quick GuideSleep Disorders: Insomnia, Sleep Apnea, and More

Sleep Disorders: Insomnia, Sleep Apnea, and More


Are sleep problems and disease related?


Sleep problems occur in a number of different medical and psychiatric conditions. For example, asthma attacks and stroke are conditions that tend to occur frequently during the night or early morning hours. The relationship between sleep stages and certain types of epileptic seizures is complex and not completely understood, but certain sleep stages tend to either exacerbate or prevent the spread of seizure activity in the brain.


Sleep problems occur with chronic pain and conditions in which pain is worse at night, because the pain may interfere with sleep. Pain medications and other types of medications taken on a regular basis for chronic conditions can also have an effect on an individual's sleep pattern. Those suffering from cancer, Alzheimer's disease, and brain injury are also commonly affected by sleep disturbances.


Psychiatric diseases such as depression are also associated with sleep problems. This condition can be associated with both too much sleep and too little sleep. In fact, sleep problems are associated with a majority of mental disorders, and poor quality or insufficient sleep can worsen the symptoms of mental or psychiatric conditions.


How can I get a good night's sleep?


Practicing good sleep hygiene (see above), including maintenance of a regular bedtime and awakening schedule, is the best way to ensure restful and restorative sleep. Avoidance of caffeine, alcohol, nicotine, and strenuous exercise in the hours prior to bedtime can also help improve the quality of your sleep. Many people report that they lie awake at night worrying about problems or situations they will face during the coming day. In this case, it can be helpful to write a to-do list or a list of items to act upon the following day prior to bedtime, giving yourself permission to "let go" of these items during the night.


If you are concerned about the quality of your sleep or if you have the symptoms of a sleep disorder, it is important to consult your health care practitioner. He or she can help you determine the cause of your sleep problem and recommend appropriate therapy.

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