Sleep Problems: When to Contact Your Doctor
Trouble sleeping or insomnia is very common. As you may know, short-term (acute) insomnia means a person has trouble falling asleep, staying asleep, or waking too early 3 or more nights a week. As a result they do not feel rested.
In fact, about 1 out of 5 people have a diagnosis of insomnia at some time in their lives. Of those about 1 out 2 have long-term (chronic) insomnia; meaning it occurs at least 3 nights a week for 3 months or more.
Goodpath is able to help most people with insomnia. A person completes our sleep assessment. They answer questions about their symptoms, health history, and lifestyle. From the answers, our medical team creates a personalized program.
There are times, however, when a person’s sleep assessment answers may mean something other than insomnia. There may be other problems that worsen insomnia or there may be another type of sleep disorder.
There are a few situations in which we will only recommend that the person should: contact their doctor and make an appointment; contact their doctor for an urgent appointment; or, rarely, get emergency medical care.
Causes, Conditions, & Factors
The following information describes symptoms, conditions, and other factors that when associated with a problem sleeping, may mean something else. In each instance, we provide important information, such as symptoms and tests or treatments that might be done.
This helps each individual make an informed decision about seeking medical care. Again, Goodpath’s sleep assessment is designed so that those who have moderate to serious sleep problems, get medical care.
1. Symptoms of Obstructive Sleep Apnea (OSA)
Obstructive sleep apnea or OSA means there are periods during sleep when a person briefly stops breathing. It is the result of the muscles in the throat relaxing and blocking the airway.
The risk of OSA is increased in older adults, males, and those who have weight problems. OSA can be very serious since it is also a risk factor for heart disease and automobile accidents.
If a person has symptoms of moderate or severe OSA, as described below, they should make an appointment to see their doctor.
Symptoms include: snoring; sleepiness during the day; waking up gasping or choking; and episodes of interrupted breathing during sleep (as reported by a sleep partner).
With mild symptoms the person receives a personalized program. With moderate symptoms, they receive a program and a recommendation to contact their doctor; with severe symptoms, only a recommendation to contact their doctor.
The doctor will examine the person and ask questions about sleep. A referral to a sleep specialist is common. The specialist will often order a sleep study, either in a sleep lab or at home. Additional tests may also be needed.
Treatment for moderate to severe OSA includes sleeping with a device, most commonly a continuous positive airway pressure (CPAP) machine. Oral appliances, surgery, or other treatments may also be recommended. Lifestyle changes like weight loss and exercise may also be part of the therapy. Follow-up with the doctor is part of the care. Those using CPAPs receive support from the medical device company.
2. Stress-Related Symptoms
Emotional stress may cause sleep problems. When symptoms are severe a person may have what is called generalized anxiety disorder (GAD). A person feeling severe emotional stress should see their doctor as soon as possible or get immediate medical care.
For additional help and information, go to the National Institute of Mental Health website at: https://www.nimh.nih.gov/health/find-help/index.shtml
In addition to sleep problems, the symptoms of GAD include:
Feeling, anxious, irritable, restless, worried, afraid
With a diagnosis of GAD, symptoms occur on most days, for at least 6 months and interfere with social, work, and school activities.
With mild symptoms a person receives a personalized program. With moderate symptoms, they receive a program and a recommendation to contact their doctor; with serious symptoms, only a recommendation to contact their doctor.
A person’s doctor may prescribe medicines to help lessen symptoms. They may also refer the person for medicine or talk therapy (psychotherapy). To help lessen stress, complementary therapies, like yoga, meditation, and mindfulness may be used. GAD requires additional appointments.
3. Symptoms of Depression
Trouble sleeping or insomnia may be a symptom of, as well as a risk factor for depression. A person with signs or symptoms of depression should contact their doctor or a mental health professional as soon as possible.
Problems with sleep increase the risk of suicidal thoughts and actions. Anyone with thoughts or plans of suicide needs immediate medical care. This may mean calling for emergency help.
The person, or someone else on behalf of them, can call the National Suicide Prevention Lifeline (https://suicidepreventionlifeline.org) number: 1-800-273-TALK (8255).
In addition to trouble sleeping-which may also be sleeping too much, a person with some of the following signs and symptoms may mean depression:
Feeling sad, empty
Feeling anxious, irritable, restless
Feeling hopeless, worthless
Loss of interest in activities
Moving, talking more slowly
Trouble concentrating, remembering, or making decisions
Changes in appetite or weight
Having aches and pains, headaches, or digestive problems with an unknown cause
Suicidal thoughts or actions
For a diagnosis of depression, these symptoms would be present on most days, for most of each day, for 2 weeks or more.
With mild symptoms, a person receives a personalized program. With moderate symptoms, a person receives a personalized program and a recommendation to contact their doctor; with serious symptoms, only a recommendation to contact their doctor.
The doctor may treat the person’s depression with medicine. They may recommend a therapist for talk therapy (psychotherapy), different medicine, or other treatments. For severe depression, intense care or hospitalization may be necessary. Close follow-up is necessary to check on symptoms and medicine side effects.
Part of treatment may be measures to help with sleep. And, trouble sleeping may improve once depression is successfully treated.
4. Night-time Teeth Grinding
Teeth grinding while sleeping is also known as sleep-related bruxism. When it happens occasionally it isn’t usually a problem. However, if it happens often it may interrupt sleep, damage the teeth and gums, and cause pain and morning headaches. A person with moderate to severe symptoms (see below) should see their dentist.
The factors that increase the risk of teeth grinding include:
Sleep problems, like obstructive sleep apnea
Medicines, like antidepressants
Mental health problems, like anxiety
Gastric reflux (GERD)
Family history of tooth grinding
The symptoms of teeth grinding at night include: clenching or grinding of the teeth (may be reported by the sleep partner); damage to teeth or dental work; poor sleep quality; and fatigue.
Serious teeth grinding may also result in: injuries to the tongue, lips and cheeks; fractured or loose teeth, trouble chewing; muscle spasms; and jaw, head, or neck pain.
With mild symptoms a person receives a personalized program. With moderate symptoms, they receive a program and a recommendation to contact their dentist; with serious symptoms, only a recommendation to contact their dentist.
The dentist examines the person’s teeth and mouth for signs of damage. They may suggest an oral device and behavioral changes to help lessen symptoms. They are checked at the next preventive dental visit or sooner if needed.
The person may receive care from other healthcare professionals including: their doctor to discuss medicines, treat associated conditions, and suggest sleep hygiene methods and relaxation techniques; to a sleep specialist for testing; or to a therapist for evaluation and treatment of anxiety.
5. Restless Legs Syndrome
Restless legs syndrome (RLS) is a movement disorder in which a person has a strong urge to move their legs (or arms). It is associated with trouble sleeping and not feeling rested.
RLS may occur with low blood iron levels, severe kidney disease, pregnancy, and certain medicines.
A person may have short-term, periodic RLS. Or they may have chronic, persistent RLS - it occurs at least 2 times a week, causes moderate-to-severe discomfort, and requires daily treatment.
A person with RLS has a strong urge to move their legs and usually has uncomfortable feelings in the legs (for example, throbbing or itching) at rest or at night. Movement helps to relieve the symptoms.
A person with mild to moderate symptoms of RLS receives a personalized program and a recommendation to contact their doctor; with serious symptoms of RLS, only a recommendation to contact their doctor.
The doctor may recommend that the person see a sleep specialist. They may order diagnostic tests to check for causes (for example, blood tests for low iron). They may recommend lifestyle changes, like exercise, to help lessen symptoms. They may also review and change current medicines if associated with RLS.
Treatment may include medicine to lessen symptoms. Treatment for RLS related to other causes varies. For example, taking an iron supplement for a low iron level. The person will also have follow-up care.
6. Shift Work Disorder
Shift work disorder is one type of circadian rhythm disorder - when a person’s sleep-wake rhythm (body clock) is not in sync with the normal light-dark cycle (working night shift or changing between day/night shifts).
Adjusting to repeated shift work changes is very difficult. Even those who only work night shifts may have poor sleep quality due to daytime noise and light. And, some people sleep less during the day in order to go to activities, events, or appointments. Additionally, ongoing shift work disorder increases risk of heart disease and metabolic problems, like diabetes.
A person with continuous symptoms that interfere with the ability to function should see their doctor.
The severity of symptoms is dependent on the: frequency and extent of shift changes; number of shifts worked in a row; length of shifts; and frequency of sleep advancing changes (earlier waking up for shifts and sleeping times).
The symptoms include trouble sleeping and daytime sleepiness. And, because body temperature and hormone levels may also be affected, a person may have nausea, irritability, depression, and general unease (malaise).
With mild symptoms of shift work disorder, a person receives a personalized program; with moderate symptoms a program and a recommendation to contact their doctor; and with serious symptoms, only a recommendation to contact their doctor.
The doctor will ask questions about symptoms, patterns of sleep-wake, and self-treatment. They will ask about alcohol, prescription, and illegal drug use, since misuse of substances is common among those with circadian rhythm disorders.
They may suggest sleep hygiene measures like: scheduled sleep; planned light exposure; and sleep masks and white-noise machines. And they may recommend the use of melatonin (a hormone produced by the body that helps with sleep).
The doctor may refer the person to a sleep specialist for further evaluation and treatment. Sleep studies are usually not recommended, unless another type of sleep problem is suspected. Treatment may include prescriptions, like sleep medicines (hypnotics). The doctor will schedule follow-up to check on the person’s progress.
7. Symptoms of Narcolepsy
Narcolepsy is a chronic sleep disorder within a group called hypersomnias - meaning excessive (daytime) sleepiness. In most people, narcolepsy first occurs before 25 years of age but may be undiagnosed for many years.
Narcolepsy impacts a person’s mental health, work and school performance, as well as social activities.
It also affects personal safety in that a person may suddenly fall asleep or lose muscle control when driving or taking part in other activities. Because it can be very dangerous, a person with symptoms of narcolepsy should contact their doctor as soon as possible.
Hypersomnia increases the risk of suicidal thoughts and actions. Anyone with thoughts or plans of suicide needs immediate medical care. This may mean calling for emergency help. The person, or someone else on behalf of them, can call the National Suicide Prevention Lifeline (https://suicidepreventionlifeline.org) number: 1-800-273-TALK (8255).
Common symptoms of narcolepsy include:
Excessive daytime sleepiness
Suddenly falling asleep for seconds to minutes or sleep attacks
Sudden weakness and loss of muscle control (cataplexy)
Inability to move (sleep paralysis) upon waking up or falling asleep
Interrupted nighttime sleep
With symptoms of narcolepsy, we recommend that the person contact their doctor. Due to the increased risk of accidents and injuries and interference with daily activities, determining the diagnosis and starting treatment is critical. The doctor will refer the person to a sleep specialist for testing and treatment.
The sleep specialist will ask a lot of questions about the person’s general health and sleep-related symptoms. Sleep testing, and perhaps, laboratory tests are done. A person may be asked to keep a sleep diary.
Once a diagnosis is made, depending on the person’s specific symptoms, different types of medicines are usually prescribed. Behavior changes (like increasing exercise) and sleep hygiene (like scheduling naps or relaxing before bedtime) are also part of treatment. On-going monitoring is part of the care.
8. Current Smoking
The effects of cigarette smoking on a person’s health (as well as the risks of second-hand smoke) are well known. Smoking increases the risk of many chronic diseases, and death.
Experts have found that smoking, including the exposure to nicotine, interferes with sleep.
The more a person smokes, the greater the trouble sleeping.
Smokers sleep less. This is associated with increased risk of disease and death.
Smoking increases the risk and severity of other sleep problems, like obstructive sleep apnea.
Smoking increases the risk of other conditions that are also associated with sleep problems, like gastroesophageal reflux (GERD).
Smokers, in general, should consider smoking cessation. Smokers with sleep problems should consider smoking cessation to improve health, overall and to lessen sleep problems, specifically.
The symptoms of sleep problems in smokers include:
Poor quality of sleep
Not getting enough sleep
Trouble falling asleep and waking up
Snoring and sleep-disordered breathing
Waking up at night due to cigarette cravings
A person receives a personalized program to help with their sleep problems. A person may contact their doctor about their sleep problems and for help with smoking cessation.
Deciding to quit is the first step in smoking cessation. Once that decision is made there are resources and treatments to support a person’s efforts to quit. Smokefree.gov (https://smokefree.gov/quit-smoking) offers information, advice, and support.
The person’s doctor can help support smoking cessation and may recommend treatment like nicotine replacement therapy, which is available over-the-counter. Other medicines may also be prescribed. Both can be very effective in helping smokers quit.
9. Symptoms of Gastroesophageal Reflux Disease (GERD)
Gastroesophageal reflux disease (GERD) is caused when contents from the stomach move up and into the esophagus. It is due to a weakening in the muscle that separates the esophagus and stomach.
GERD is long-term (chronic) acid reflux with disruptive symptoms. If untreated, it may affect a person’s overall quality of life. And, it increases the risk of damage, and even, cancer of the esophagus.
GERD contributes to trouble sleeping; likewise trouble sleeping is a risk factor for GERD. It is also associated with other sleep problems, like obstructive sleep apnea.
Generally, a person with chronic, troublesome GERD symptoms, including those with GERD symptoms affecting sleep, should see their doctor.
Again, GERD often interferes with sleep. Common symptoms specific to GERD include heartburn or indigestion, sour taste in the mouth (regurgitation), and trouble swallowing. Although most people have these symptoms, some people do not. Other symptoms may include chest pain, cough, sore throat, hoarseness, wheezing, and nausea and vomiting.
A person with mild to moderate symptoms of GERD receives a personalized program and a recommendation to contact their doctor; with serious symptoms, only a recommendation to contact their doctor.
The doctor will ask the person questions about GERD symptoms. For some people, lifestyle changes and medicine are all that is needed. There are follow-up visits with the doctor to check symptoms and treatment.
The doctor may refer a person to a specialist in gastrointestinal disease (gastroenterologist). The gastroenterologist may order diagnostic tests, suggest other lifestyle changes, and prescribe different medicines. Surgery is another possible treatment.
Some of the behavior changes help to lessen GERD symptoms while sleeping. For example, avoiding large meals close to bedtime and raising the head of the bed.
Sleep problems are usually not something serious, although it is possible. If you have concerns about your sleep problems, please follow our guidance and contact your doctor or see them as soon as possible.