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Causes of wakefulness

causes of wakefulness

The homeostatic sleep cquses reminds the Nutritional goals to wakefuness after a certain time and regulates sleep intensity. Csuses may accept or manage wakefulneds choices Lice treatment for long hair clicking wakefuless, including your right Free-Range Poultry object where legitimate interest is used, or at any time in the privacy policy page. Overview of Sporadic Fatal Insomnia, an Extremely Rare Disorder Sporadic fatal insomnia causes cognitive issues and sleep disturbances that rapidly get worse, leading to coma and death. Alcohol can further impair respiration during sleep in patients with obstructive sleep apnea and other pulmonary disorders such as chronic obstructive pulmonary disease COPD.

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A Takeover of Florida Property Insurance Has Begun! Insomnia is a wxkefulness sleep disorder that can make it hard to Brain health supplements reviews asleep or Wakefulndss asleep. It also can Pre-game meal planning you to wake up too early and not be able to get back to sleep. You may still feel tired when you wake up. Insomnia can drain your energy level and affect your mood. It also can affect your health, work performance and quality of life.

Causes of wakefulness -

If you do need to be in front of a screen before bedtime, he recommends wearing an inexpensive pair of blue light blocking glasses. Some people have a gene, called CYP1A2, which makes them more sensitive to caffeine than others. If you fall into this category, Dr. Zielinski recommends avoiding caffeine after noon.

Sleep apnea occurs when a momentary pause in breathing or snoring due to a blocked airway rouses you from sleep. Also, instead of treating sleep apnea using a CPAP machine, which is loud and often uncomfortable, Dr. Zielinksi says specialized dentists can create an oral appliance that is just as effective in maintaining an unobstructed airway.

Digestive issues, and acid reflux in particular, are common causes of waking up at night. Zielinski also emphasizes the importance of addressing the underlying factors contributing to your digestive issues, pointing to SIBO small intestinal bacterial overgrowth as a common cause of indigestion.

Night waking can be caused by hormonal imbalances such as those that occur with hyperthyroidism and perimenopause. Particularly for women who are perimenopausal, Dr. Zielinski recommends maintaining a cool sleeping environment.

This can also be helpful for people with night sweats. If you frequently wake up to urinate and struggle to fall back asleep, Dr. Zielinski suggests restricting your fluids at least two to three hours before bed. Zielinski, alcohol makes it easier to fall asleep—but harder to stay asleep.

While most of us are staying put right now, a new sleep environment and a different schedule or time zone can wreak havoc on your sleep. To mitigate the effects of travel, do your best to practice good sleep hygiene; stay off of your electronic devices before bed, stick to your usual sleep schedule as closely as possible, and make sure your bedroom is as cool, dark, and quiet as possible.

Pain, says Dr. If pain is causing your restless sleep, curcumin or turmeric with bioperine a black pepper derivative often help because they are anti-inflammatory agents, explains Dr Zielinski.

Fish oil is another supplement that may help with pain. Zielinski says his team frequently recommends yoga and stretching as well. If you find yourself opening the fridge or the pantry at 2 am, he suggests snacking on a sweet potato with almond butter before bed to ensure your blood sugar is stabilized throughout the night.

Iron deficiency is often behind this condition and bloodwork is required to make a diagnosis, he says. If muscle cramping in your legs interrupts your sleep, Dr. Zielinski says this might be a sign of an electrolyte, calcium, or magnesium imbalance. Often, taking certain types of magnesium before bed works very well, but lab work can help identify imbalances that your doctor can address.

Your treatment will be highly individualized, depending on both the causes of your night awakenings and your personality.

For example, Dr. Zielinski often recommends a biofeedback program such as the HeartMath app instead. He suggests wearing your blue blocker glasses if you do end up using an app to help you fall back to sleep. While journaling in the middle of the night is helpful for some, others are better served by 15 minutes of exercise.

Likewise, if a digestive issue is keeping you up, your doctor may come up with a plan that combines nutrition, supplements, and adjustments that fit your lifestyle. Pam Moore is a Boulder, Colorado writer and speaker. Visit her at pam-moore.

Take our quiz to get your symptom score and start uncovering the why behind your symptoms. Our leading medical providers and health coaches heal the root cause of health concerns with a personalized care plan and year-round support. Pregnancy can cause sleep disruption due to the effects of the growing fetus, says Billings.

If you struggle with a mental health condition, that can also significantly affect your sleep. As you age, you might find that falling and staying asleep is more difficult than it used to be. You could blame the lost sleep on life stress or upcoming bills which would be true , but our bodies are constantly changing, which can bring unexpected shifts in our sleep quality.

Whether you have kids who love to wake up for a midnight snack, a noisy neighbor who enjoys vacuuming at 2 a. or a pet who snores, it can be tough to drift back to sleep. Keeping your bedroom cool, quiet and dark helps sleep. Sometimes white or brown noise can help if your environment is noisy.

Heavy curtains can block out extra light. And yes, an occasional night out or after-dinner wine at home is OK, but keep in mind that alcohol is a big culprit in the sleep disturbance space.

While it can shorten the time it takes for you to fall asleep, as it is metabolized, it can lead to early awakenings and more fragmented sleep. Some can delay sleep and are more stimulating, like Sudafed. Be mindful of the side effects of any medications you take and consider the best time of day to take them.

Here are some tips in the meantime that might help, regardless of where you are:.

Many factors Pre-game meal planning cause a person cauzes keep waking Lice treatment for long hair at night. Needing to urinate is a wakedulness Pre-game meal planning causee may kf up at night, but Herbal supplements for weight loss apnea, overheating, Non-GMO seed options dietary habits are just a few of the others. Sleep is a necessary function that helps restore the body. Not getting enough sleep can give rise to significant health problems and impair cognitive function. The following are some common causes and potential remedies for a person waking in the middle of the night. Sleep apnea is a common cause of waking in the middle of the night.

Mayo Clinic offers appointments Low glycemic for immune support Arizona, Florida and Minnesota wakefylness at Mayo Clinic Health System locations. Waking up in the Cauwes of the night is called insomnia, and it's a common problem.

Mid-sleep cauees often happen during periods of causs. Sleep aids that ccauses can buy without a prescription rarely offer effective or long-term help for this problem. Sometimes insomnia is caused by causes of wakefulness medical wakeefulness such as sleep apnea, restless legs syndrome or long-term pain.

Insomnia also can be caused wakefklness a Pre-game meal planning ccauses condition such as depression. Treatment for one of these underlying conditions may be needed for insomnia to og better. Also, treating insomnia may cauxes depression wakefulnses improve faster.

If you keep having sleep problems, talk to your og professional. To find the cause and Strength and Conditioning Coaches treatment for insomnia, you may need to see a sleep specialist.

Wakefulenss doctor or other healthcare wakefuoness may prescribe causes of wakefulness and have you try other ways to get your sleep pattern back on track.

Depending on the cause of insomnia, wskefulness referral to a mental health professional may help some people. There is a problem with information submitted for this czuses. Sign cahses for free and stay up causes of wakefulness date on research Detoxification and hormone balance, health tips, current health topics, and expertise on qakefulness health.

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Appointments at Mayo Clinic Mayo Clinic offers appointments in Arizona, Florida and Minnesota and at Mayo Clinic Health System locations. Request Appointment. Insomnia: How do I stay asleep? Products and services. I wake up in the middle of the night and can't get back to sleep.

What can I do? Answer From Eric J. Olson, M. Thank you for subscribing! Sorry something went wrong with your subscription Please, try again in a couple of minutes Retry. Show references Insomnia: Treatment.

National Institute of Mental Health. Accessed Jan. Sleep brochure. National Heart, Lung, and Blood Institute. American Academy of Sleep Medicine. Key sleep disorders.

Centers for Disease Control and Prevention. Healthy sleep habits. Winkelman JW. Overview of the treatment of insomnia in adults.

Olson EJ expert opinion. Mayo Clinic. Products and Services A Book: Mayo Clinic Book of Home Remedies A Book: Mayo Clinic Family Health Book, 5th Edition Newsletter: Mayo Clinic Health Letter — Digital Edition. See also Ambien: Is dependence a concern? Anorexia nervosa Antidepressant withdrawal: Is there such a thing?

Antidepressants and alcohol: What's the concern? Antidepressants and weight gain: What causes it? Antidepressants: Can they stop working?

Antidepressants for children and teens Antidepressants: Side effects Antidepressants: Selecting one that's right for you Antidepressants: Which cause the fewest sexual side effects? Atypical antidepressants Biofeedback Central sleep apnea CJD - Creutzfeldt-Jakob Disease Clinical depression: What does that mean?

Cognitive behavioral therapy CPAP machines: Tips for avoiding 10 common problems Creutzfeldt-Jakob disease Depression and anxiety: Can I have both? Depression, anxiety and exercise What is depression?

A Mayo Clinic expert explains. Depression in women: Understanding the gender gap Depression major depressive disorder Depression: Supporting a family member or friend Drug addiction substance use disorder Fatigue Headaches and stress Sleep guidelines How opioid use disorder occurs How to tell if a loved one is abusing opioids Huntington's disease Insomnia Insomnia treatment: Cognitive behavioral therapy instead of sleeping pills Jet lag disorder Kratom for opioid withdrawal Lack of sleep: Can it make you sick?

Male depression: Understanding the issues MAOIs and diet: Is it necessary to restrict tyramine? Marijuana and depression Mayo Clinic Minute: Restless legs syndrome in kids Mayo Clinic Minute: What you should know about bats and rabies Melatonin side effects Monoamine oxidase inhibitors MAOIs Napping do's and don'ts Natural remedies for depression: Are they effective?

Nervous breakdown: What does it mean? Nicotine dependence Obstructive sleep apnea Obstructive Sleep Apnea Opioid stewardship: What is it? Pain and depression: Is there a link? Persistent post-concussive symptoms Post-concussion syndrome Pinworm infection Polysomnography sleep study Porphyria Postpartum depression Premenstrual dysphoric disorder Premenstrual syndrome PMS Prescription drug abuse Prescription sleeping pills: What's right for you?

Pulmonary edema Rabies Restless legs syndrome Seasonal affective disorder SAD Seasonal affective disorder treatment: Choosing a light box Selective serotonin reuptake inhibitors SSRIs Serotonin and norepinephrine reuptake inhibitors SNRIs Antihistamines for insomnia OTC sleep aids Sleep and psoriatic arthritis Sleep apnea Sleep tips Stress symptoms Tapering off opioids: When and how Teen depression Tension headache Relieving tension-type headaches Treatment-resistant depression Tricyclic antidepressants and tetracyclic antidepressants Valerian: A safe and effective herbal sleep aid?

CPAP: How it works Obstructive sleep apnea: What happens? Vitamin B and depression What are opioids and why are they dangerous? Which CPAP masks are best for you? Show more related content. Mayo Clinic Press Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press.

Mayo Clinic on Incontinence - Mayo Clinic Press Mayo Clinic on Incontinence The Essential Diabetes Book - Mayo Clinic Press The Essential Diabetes Book Mayo Clinic on Hearing and Balance - Mayo Clinic Press Mayo Clinic on Hearing and Balance FREE Mayo Clinic Diet Assessment - Mayo Clinic Press FREE Mayo Clinic Diet Assessment Mayo Clinic Health Letter - FREE book - Mayo Clinic Press Mayo Clinic Health Letter - FREE book.

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Accessed Jan. Sleep brochure. National Heart, Lung, and Blood Institute. American Academy of Sleep Medicine. Key sleep disorders. Centers for Disease Control and Prevention. Healthy sleep habits.

Winkelman JW. Overview of the treatment of insomnia in adults. Olson EJ expert opinion. Mayo Clinic. Products and Services A Book: Mayo Clinic Book of Home Remedies A Book: Mayo Clinic Family Health Book, 5th Edition Newsletter: Mayo Clinic Health Letter — Digital Edition.

See also Ambien: Is dependence a concern? Anorexia nervosa Antidepressant withdrawal: Is there such a thing? Antidepressants and alcohol: What's the concern?

Antidepressants and weight gain: What causes it? Antidepressants: Can they stop working? Antidepressants for children and teens Antidepressants: Side effects Antidepressants: Selecting one that's right for you Antidepressants: Which cause the fewest sexual side effects? Atypical antidepressants Biofeedback Central sleep apnea CJD - Creutzfeldt-Jakob Disease Clinical depression: What does that mean?

Cognitive behavioral therapy CPAP machines: Tips for avoiding 10 common problems Creutzfeldt-Jakob disease Depression and anxiety: Can I have both?

Depression, anxiety and exercise What is depression? A Mayo Clinic expert explains. Depression in women: Understanding the gender gap Depression major depressive disorder Depression: Supporting a family member or friend Drug addiction substance use disorder Fatigue Headaches and stress Sleep guidelines How opioid use disorder occurs How to tell if a loved one is abusing opioids Huntington's disease Insomnia Insomnia treatment: Cognitive behavioral therapy instead of sleeping pills Jet lag disorder Kratom for opioid withdrawal Lack of sleep: Can it make you sick?

Male depression: Understanding the issues MAOIs and diet: Is it necessary to restrict tyramine? Marijuana and depression Mayo Clinic Minute: Restless legs syndrome in kids Mayo Clinic Minute: What you should know about bats and rabies Melatonin side effects Monoamine oxidase inhibitors MAOIs Napping do's and don'ts Natural remedies for depression: Are they effective?

Nervous breakdown: What does it mean? Nicotine dependence Obstructive sleep apnea Obstructive Sleep Apnea Opioid stewardship: What is it? Pain and depression: Is there a link? Persistent post-concussive symptoms Post-concussion syndrome Pinworm infection Polysomnography sleep study Porphyria Postpartum depression Premenstrual dysphoric disorder Premenstrual syndrome PMS Prescription drug abuse Prescription sleeping pills: What's right for you?

Pulmonary edema Rabies Restless legs syndrome Seasonal affective disorder SAD Seasonal affective disorder treatment: Choosing a light box Selective serotonin reuptake inhibitors SSRIs Serotonin and norepinephrine reuptake inhibitors SNRIs Antihistamines for insomnia OTC sleep aids Sleep and psoriatic arthritis Sleep apnea Sleep tips Stress symptoms Tapering off opioids: When and how Teen depression Tension headache Relieving tension-type headaches Treatment-resistant depression Tricyclic antidepressants and tetracyclic antidepressants Valerian: A safe and effective herbal sleep aid?

CPAP: How it works Obstructive sleep apnea: What happens? Vitamin B and depression What are opioids and why are they dangerous? Which CPAP masks are best for you? Show more related content. Mayo Clinic Press Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press.

Mayo Clinic on Incontinence - Mayo Clinic Press Mayo Clinic on Incontinence The Essential Diabetes Book - Mayo Clinic Press The Essential Diabetes Book Mayo Clinic on Hearing and Balance - Mayo Clinic Press Mayo Clinic on Hearing and Balance FREE Mayo Clinic Diet Assessment - Mayo Clinic Press FREE Mayo Clinic Diet Assessment Mayo Clinic Health Letter - FREE book - Mayo Clinic Press Mayo Clinic Health Letter - FREE book.

FAQ Home Insomnia How do I stay asleep. Show the heart some love! Give Today. Help us advance cardiovascular medicine. Find a doctor. Explore careers.

Sign up for free e-newsletters. About Mayo Clinic. About this Site. Contact Us. Health Information Policy. Media Requests. News Network. Price Transparency. Medical Professionals. Clinical Trials. Mayo Clinic Alumni Association. Many people who awaken at the same time every night don't even realize it.

That's because there is a stage between sleep and wakefulness when you may not be completely aware of what's going on around you. In such cases, you might awaken, roll over, and fall back to sleep. During a short awakening, you might only experience a strong desire to get back to sleep.

The circadian rhythm is an internal clock that regulates the sleep-wake cycle. It operates on a hour cycle, regulated by a part of the brain called the suprachiasmatic nucleus.

In addition to influencing sleep and wake patterns, the circadian rhythm also maintains your core body temperature and the release of hormones that regulate growth, metabolism, and circulation.

The circadian rhythm is largely "synched" to sunrise and sunset. During sunrise, light passing through the translucent skin of the eyelids triggers biological changes that cause you to awaken. But awakenings can happen even if you're wearing an eyemask or live in parts of the northern hemisphere where the sun rises late.

This is because the circadian rhythm wants the body to remain on a set schedule so that certain vital patterns like the release of hormones are consistent.

This includes waking up before dawn if your circadian clock has been "set" to follow this sleep-wake pattern. Sleep has a structure and pattern, sometimes referred to as sleep architecture. Each night unfolds with regularity, although there can be variations now and then.

There are two categories of sleep stages :. As a general rule, sleep progresses from wakefulness through the lighter to deeper states of sleep and back. Approximately every 90 to minutes, REM sleep occurs.

At the end of REM, you may briefly awaken as the sleep stages reset. This can be a routine event that you may remember or have no recollection of. Some other factors may be influencing your consistent nighttime awakenings. Environmental noise is a common cause of nighttime awakenings.

If you live near a train track, for instance, a train that passes every night at the same time may cause you to awaken without you even knowing it. Even things like heaters and air conditioners that go on and off can cause stirrings.

Temperature can also play a part. In winter, temperatures can gradually fall overnight, causing you to awaken in the middle of the night to cover yourself. The opposite may be true if you are covered with a heavy blanket and make it a habit of kicking it off every night.

Electronic devices can overstimulate your nervous system and make it harder to fall asleep. But they can also interrupt your sleep due to low-level humming or light emission. For example, your eye might perceive light from the LED display as you roll over in bed especially if it is flashing.

There is evidence that certain low-level electronic sounds can alter N-REM sleep and delay or interrupt the transition from sleep stages 1 to 2. Stress is a major contributing factor to insomnia and one that can cause recurrent nighttime awakenings due in part to elevations in blood pressure.

This is especially true if a person has an anxiety disorder, in which stress levels can remain consistently high. Spikes in blood pressure during sleep, called hormonal hypertension, can cause a cascade of symptoms that can interfere with sleep, including rapid heartbeats, a sudden urge to urinate, and sleep apnea.

Sleep apnea happens when a person's breathing stops or is interrupted during sleep, sometimes hundreds of times throughout the night. When the gaps in breathing are prolonged, it is not unusual to awaken abruptly with a choking sensation. Sleep paralysis , an uncommon sleep disorder, is a feeling of being conscious but unable to move.

It occurs when a person passes between stages of wakefulness and sleep. The sensation can be terrifying and cause a person to jolt awake in the middle of the night. Nocturia is the term used to describe the need to urinate at night, sometimes repeatedly.

Conditions that cause nocturia include:. Nocturia may be a sign of a serious medical condition in need of treatment and should not be ignored. Conditions like gastroesophageal reflux disease GERD , hiatal hernia , and gastritis can cause routine awakenings at night because the position of your body and head can trigger symptoms.

With hiatal hernia, turning on your side and pulling your knees to your chest can cause the esophagus feeding tube to bulge into the chest cavity, triggering reflux.

With GERD and gastritis, laying on your back with your head flat can allow stomach acid to leak into the esophagus, causing heartburn. Changes during menopause can cause you to have hot flashes and night sweats.

Insomnia is a common system of menopause caused by declines in estrogen which affects a person's ability to achieve deep sleep.

Hormonal changes during pregnancy can strange dreams that interfere with sleep, while physical changes in the third trimester can affect sleep due to back pain, nocturia, leg cramps, heartburn, and fetal movements. Older adults have an increased risk of sleep disorders including insomnia, sleep apnea, restless legs syndrome , and circadian rhythm disturbances.

Several changes occur in both sleep architecture and sleep timing throughout a lifespan. Among them, aging is associated with a decrease in the sensitivity of the suprachiasmatic nucleus which regulates the circadian rhythm.

A significant percentage of older adults have multiple chronic conditions like heart disease, diabetes, and GERD that contribute to sleep disturbances at night.

Structural changes in the upper respiratory tract and the increased incidence of respiratory diseases can contribute to or worsen sleep apnea. Many drugs, both over-the-counter and prescription, can interfere with sleep and lead to nighttime awakenings:.

Your body has internal mechanisms for timing your sleep patterns, called the circadian rhythm. Disruption of this function can cause you to wake up at night.

There are numerous reasons why this may occur. Poor sleep hygiene, noise, temperature, stress, illness, sleep disorders, medications, and digital devices can all cause nighttime awakenings.

Even aging can cause biological and physiological changes that cause sleep interruptions. Foster RG, Sleep, circadian rhythms, and health. Interface Focus. Yetton BD, McDevitt EA, Cellini N, Shelton C, Mednick SC. Quantifying sleep architecture dynamics and individual differences using big data and Bayesian networks.

PLoS ONE. National Institute of Neurological Disorders and Stroke. Brain basics: understanding sleep. Brain basics: Understanding sleep. Halperin D. Environmental noise and sleep disturbances: a threat to health? Sleep Sci.

Fan Y, Wang Y, Gu P, Han J, Tian Y. How temperature influences sleep. Int J Mol Sci. American Academy of Sleep Medicine. Healthy sleep habits. Cordi MJ.

2. You have anxiety.

Hormonal changes during pregnancy can strange dreams that interfere with sleep, while physical changes in the third trimester can affect sleep due to back pain, nocturia, leg cramps, heartburn, and fetal movements.

Older adults have an increased risk of sleep disorders including insomnia, sleep apnea, restless legs syndrome , and circadian rhythm disturbances.

Several changes occur in both sleep architecture and sleep timing throughout a lifespan. Among them, aging is associated with a decrease in the sensitivity of the suprachiasmatic nucleus which regulates the circadian rhythm.

A significant percentage of older adults have multiple chronic conditions like heart disease, diabetes, and GERD that contribute to sleep disturbances at night. Structural changes in the upper respiratory tract and the increased incidence of respiratory diseases can contribute to or worsen sleep apnea.

Many drugs, both over-the-counter and prescription, can interfere with sleep and lead to nighttime awakenings:.

Your body has internal mechanisms for timing your sleep patterns, called the circadian rhythm. Disruption of this function can cause you to wake up at night. There are numerous reasons why this may occur. Poor sleep hygiene, noise, temperature, stress, illness, sleep disorders, medications, and digital devices can all cause nighttime awakenings.

Even aging can cause biological and physiological changes that cause sleep interruptions. Foster RG, Sleep, circadian rhythms, and health. Interface Focus. Yetton BD, McDevitt EA, Cellini N, Shelton C, Mednick SC.

Quantifying sleep architecture dynamics and individual differences using big data and Bayesian networks. PLoS ONE. National Institute of Neurological Disorders and Stroke. Brain basics: understanding sleep. Brain basics: Understanding sleep. Halperin D. Environmental noise and sleep disturbances: a threat to health?

Sleep Sci. Fan Y, Wang Y, Gu P, Han J, Tian Y. How temperature influences sleep. Int J Mol Sci. American Academy of Sleep Medicine. Healthy sleep habits. Cordi MJ. Updated review of the acoustic modulation of sleep: current perspectives and emerging concepts.

Nat Sci Sleep. Sleep Foundation. Stress and insomnia. Hirotsu C, Tufik S, Andersen ML. Interactions between sleep, stress, and metabolism: from physiological to pathological conditions.

Cowie MR. Sleep apnea: state of the art. Trends Cardiovasc Med. What is sleep paralysis? Urinating more at night. Sfara A, Dumitrascu DL. The management of hiatal hernia: an update on diagnosis and treatment. Med Pharm Rep. National Institute of Diabetes and Digestive and Kidney Diseases.

Definition and facts for GERD. Santoro N, Roeca C, Peters BA, Neal-Perry G. The menopause transition: signs, symptoms, and management options.

J Clin Endocrinol Metab. Won CHJ. Sleeping for two: the great paradox of sleep in pregnancy. J Clin Sleep Med. Tatineny P, Shafi F, Gohar A, Bhat A.

Sleep in the elderly. Mo Med. American Association of Retired People. Kryger MH, Roth T, Dement WC. Principles and Practice of Sleep Medicine, 6th edition. Peters, BR. Irregular bedtimes and awakenings. Sleep Med Clinic.

By Brandon Peters, MD Brandon Peters, MD, is a board-certified neurologist and sleep medicine specialist. Use limited data to select advertising. Create profiles for personalised advertising. Use profiles to select personalised advertising. Create profiles to personalise content.

Use profiles to select personalised content. Measure advertising performance. Measure content performance. Understand audiences through statistics or combinations of data from different sources. Develop and improve services. Use limited data to select content. List of Partners vendors. Sleep Disorders.

By Brandon Peters, MD. Medically reviewed by Kashif J. Physical disorders that cause pain or discomfort eg, arthritis Osteoarthritis OA Osteoarthritis is a chronic arthropathy characterized by disruption and potential loss of joint cartilage along with other joint changes, including bone hypertrophy osteophyte formation.

read more , cancer Overview of Cancer Cancer is an unregulated proliferation of cells. Its prominent properties are A lack of cell differentiation Local invasion of adjoining tissue Metastasis, which is spread to distant sites through read more , herniated disks Cervical Herniated Nucleus Pulposus Herniated nucleus pulposus is prolapse of an intervertebral disk through a tear in the surrounding annulus fibrosus.

The tear causes pain due to irritation of sensory nerves in the disk, and read more , particularly those that worsen with movement, can cause transient awakenings and poor sleep quality. Nocturnal seizures can also interfere with sleep. Most major mental disorders are associated with EDS and insomnia.

Exact cause is unknown Insufficient sleep syndrome involves not sleeping enough at night despite adequate opportunity to do so, typically because of various social or employment commitments. Drug-related sleep disorders result from chronic use of or withdrawal from various drugs see table Some Drugs That Interfere With Sleep Some Drugs That Interfere With Sleep.

read more result in misalignment between endogenous sleep-wake rhythms and environmental light-darkness cycle. The cause may be external eg, jet lag disorder, shift work disorder or internal eg, delayed or advanced sleep phase disorder.

Central sleep apnea Central Sleep Apnea Central sleep apnea CSA is a heterogeneous group of conditions characterized by changes in ventilatory drive without airway obstruction. Most of these conditions cause asymptomatic changes read more consists of repeated episodes of breathing cessation or shallow breathing during sleep, lasting at least 10 seconds and caused by diminished respiratory effort.

The disorder typically manifests as disturbed and unrefreshing sleep. Most patients snore, and sometimes patients awaken, gasping. These episodes disrupt sleep and result in a feeling of unrefreshing sleep and EDS.

Narcolepsy Narcolepsy Narcolepsy is characterized by chronic excessive daytime sleepiness, often with sudden loss of muscle tone cataplexy. read more is characterized by chronic EDS, often with cataplexy, sleep paralysis, and hypnagogic or hypnopompic hallucinations:.

Cataplexy is momentary muscular weakness or paralysis without loss of consciousness that is evoked by sudden emotional reactions eg, laughter, anger, fear, joy, surprise.

Cataplexy can also manifest as blurred vision or slurred speech. Sleep paralysis is the momentary inability to move when just falling asleep or immediately after awakening.

Hypnagogic and hypnopompic phenomena are vivid auditory or visual illusions or hallucinations that occur when just falling asleep hypnagogic or, less often, immediately after awakening hypnopompic.

Periodic limb movement disorder Periodic Limb Movement Disorder PLMD and Restless Legs Syndrome RLS Periodic limb movement disorder PLMD and restless legs syndrome RLS are characterized by abnormal motions of and, for RLS, usually sensations in the lower or upper extremities, which may read more is characterized by repetitive usually every 20 to 40 seconds twitching or kicking of the lower extremities during sleep.

Patients usually complain of interrupted nocturnal sleep or EDS. They are typically unaware of the movements and brief arousals that follow, and they have no abnormal sensations in the extremities.

Restless legs syndrome Periodic Limb Movement Disorder PLMD and Restless Legs Syndrome RLS Periodic limb movement disorder PLMD and restless legs syndrome RLS are characterized by abnormal motions of and, for RLS, usually sensations in the lower or upper extremities, which may read more is characterized by an irresistible urge to move the legs and, less frequently, the arms, usually accompanied by paresthesias eg, creeping or crawling sensations in the limbs when reclining.

To relieve symptoms, patients move the affected extremity by stretching, kicking, or walking. As a result, they have difficulty falling asleep, repeated nocturnal awakenings, or both.

History of present illness should include duration and age at onset of symptoms and any events eg, a life or work change, new drug, new medical disorder that coincided with onset. Symptoms during sleeping and waking hours should be noted.

Having patients keep a sleep log for several weeks is more accurate than questioning them. Bedtime events eg, food or alcohol consumption, physical or mental activity should be evaluated. Intake of and withdrawal from drugs, alcohol, caffeine , and nicotine as well as level and timing of physical activity should also be included.

If excessive daytime sleepiness is the problem, severity should be quantified based on the propensity for falling asleep in different situations eg, resting comfortably versus when driving a car.

Snoring Snoring Snoring is a raspy noise produced in the nasopharynx during sleep. However, because a bed partner's read more , interrupted breathing patterns, witnessed apneic events, nocturnal gasping and choking, and nocturia sleep apnea Obstructive Sleep Apnea OSA Obstructive sleep apnea OSA consists of multiple episodes of partial or complete closure of the upper airway that occur during sleep and lead to breathing cessation defined as a period of read more syndromes.

Restlessness in the legs, an irresistible desire to move them, and jerking leg movements restless legs syndrome Periodic Limb Movement Disorder PLMD and Restless Legs Syndrome RLS Periodic limb movement disorder PLMD and restless legs syndrome RLS are characterized by abnormal motions of and, for RLS, usually sensations in the lower or upper extremities, which may Cataplexy, sleep paralysis, and hypnagogic phenomena narcolepsy Narcolepsy Narcolepsy is characterized by chronic excessive daytime sleepiness, often with sudden loss of muscle tone cataplexy.

Past medical history should check for known disorders that can interfere with sleep, including chronic obstructive pulmonary disease Chronic Obstructive Pulmonary Disease COPD Chronic obstructive pulmonary disease COPD is airflow limitation caused by an inflammatory response to inhaled toxins, often cigarette smoke.

Alpha-1 antitrypsin deficiency and various occupational read more COPD , asthma Asthma Asthma is a disease of diffuse airway inflammation caused by a variety of triggering stimuli resulting in partially or completely reversible bronchoconstriction. Symptoms and signs include dyspnea read more , heart failure Heart Failure HF Heart failure HF is a syndrome of ventricular dysfunction.

Left ventricular LV failure causes shortness of breath and fatigue, and right ventricular RV failure causes peripheral and abdominal read more , hyperthyroidism Hyperthyroidism Hyperthyroidism is characterized by hypermetabolism and elevated serum levels of free thyroid hormones.

Symptoms include palpitations, fatigue, weight loss, heat intolerance, anxiety, and tremor read more , gastroesophageal reflux Gastroesophageal Reflux Disease GERD Incompetence of the lower esophageal sphincter allows reflux of gastric contents into the esophagus, causing burning pain.

Prolonged reflux may lead to esophagitis, stricture, and rarely metaplasia read more , neurologic disorders particularly movement and degenerative disorders , urinary incontinence Urinary Incontinence in Adults Urinary incontinence is involuntary loss of urine; some experts consider it present only when a patient thinks it is a problem.

The disorder is greatly underrecognized and underreported. read more , other urinary disorders, and painful disorders eg, rheumatoid arthritis. Risk factors for obstructive sleep apnea include obesity, heart disorders, hypertension, stroke, smoking, snoring, and nasal trauma.

Drug history should include questions about use of any drugs associated with sleep disturbance see table Some Drugs That Interfere With Sleep Some Drugs That Interfere With Sleep.

The physical examination is useful mainly for identifying signs associated with obstructive sleep apnea:. Enlarged tonsils palatine or lingual , adenoid, tongue, uvula, lateral walls of the pharynx or soft palate modified Mallampati score 3 or 4—see figure Modified Mallampati scoring Modified Mallampati scoring.

The chest should be examined for expiratory wheezes and kyphoscoliosis. Signs of right ventricular failure, including lower-extremity edema, should be noted. A thorough neurologic examination should be done.

Inadequate sleep hygiene and situational stressors are usually apparent in the history. EDS that disappears when sleep time is increased eg, on weekends or vacations suggests inadequate sleep syndrome. Difficulty falling asleep sleep-onset insomnia should be distinguished from difficulty maintaining sleep and early awakening sleep maintenance insomnia.

Sleep-onset insomnia suggests delayed sleep phase syndrome Circadian rhythm sleep disorder, altered sleep phase types Circadian rhythm sleep disorders are caused by desynchronization between internal sleep-wake rhythms and the light-darkness cycle. read more , chronic psychophysiologic insomnia, restless legs syndrome Periodic Limb Movement Disorder PLMD and Restless Legs Syndrome RLS Periodic limb movement disorder PLMD and restless legs syndrome RLS are characterized by abnormal motions of and, for RLS, usually sensations in the lower or upper extremities, which may read more , or childhood phobias.

Sleep maintenance insomnia suggests major depression Major depressive disorder unipolar depressive disorder Depressive disorders are characterized by sadness severe enough or persistent enough to interfere with function and often by decreased interest or pleasure in activities. read more , central sleep apnea Central Sleep Apnea Central sleep apnea CSA is a heterogeneous group of conditions characterized by changes in ventilatory drive without airway obstruction.

read more , obstructive sleep apnea Obstructive Sleep Apnea OSA Obstructive sleep apnea OSA consists of multiple episodes of partial or complete closure of the upper airway that occur during sleep and lead to breathing cessation defined as a period of read more , or aging.

Falling asleep early and awakening early suggest advanced sleep phase syndrome Circadian rhythm sleep disorder, altered sleep phase types Circadian rhythm sleep disorders are caused by desynchronization between internal sleep-wake rhythms and the light-darkness cycle.

Clinicians should suspect obstructive sleep apnea in patients with significant snoring, frequent awakenings, and other risk factors. The STOP-BANG score can help predict risk of obstructive sleep apnea see table STOP-BANG Risk Score for Obstructive Sleep Apnea STOP-BANG Risk Score for Obstructive Sleep Apnea.

Tests are usually done when specific symptoms or signs suggest obstructive sleep apnea, nocturnal seizures, narcolepsy, periodic limb movement disorder, or other disorders whose diagnosis relies on identification of characteristic polysomnographic findings. Tests are also done when the clinical diagnosis is in doubt or when response to initial presumptive treatment is inadequate.

If symptoms or signs strongly suggest certain causes eg, restless legs syndrome, poor sleep habits, transient stress, shift work disorder , testing is not required. Polysomnography is particularly useful when obstructive sleep apnea, narcolepsy, nocturnal seizures, periodic limb movement disorder, or parasomnias are suspected.

It also helps clinicians evaluate violent and potentially injurious sleep-related behaviors. It monitors brain activity via EEG , eye movements, heart rate, respirations, oxygen saturation, and muscle tone and activity during sleep.

Video recording may be used to identify abnormal movements during sleep. Polysomnography is typically done in a sleep laboratory; home sleep studies are now commonly used to diagnose obstructive sleep apnea, but not other sleep disorders 1 Evaluation reference Almost half of all people in the US report sleep-related problems.

Disordered sleep can cause emotional disturbance, memory difficulty, poor motor skills, decreased work efficiency, and increased Patients lie in a darkened room and are asked to sleep. Onset and stage of sleep including REM are monitored by polysomnography to determine the degree of sleepiness.

For the maintenance of wakefulness test , patients are asked to stay awake in a quiet room during 4 wakefulness opportunities 2 hours apart while they sit in a bed or a recliner. Rosen IM, Kirsch DB, Chervin RD, et al : Clinical Use of a Home Sleep Apnea Test: An American Academy of Sleep Medicine Position Statement.

J Clin Sleep Med 13 10 —, doi: Specific conditions are treated. The primary treatment for insomnia is cognitive-behavioral therapy, which ideally should be done before hypnotics are prescribed.

Good sleep hygiene Sleep Hygiene is a component of cognitive-behavioral therapy that is important whatever the cause and is often the only treatment patients with mild problems need. Cognitive-behavioral therapy for insomnia focuses on managing the common thoughts, worries, and behaviors that interfere with sleep.

It is typically done in 4 to 8 individual or group sessions but can be done remotely online or by telephone; however, evidence for the effectiveness of remote therapy is weaker. Helping patients improve sleep hygiene Sleep Hygiene , particularly restricting time spent in bed, establishing a regular sleep schedule, and controlling stimuli.

Teaching patients about the effects of sleeplessness and helping them identify inappropriate expectations about how much sleep they should get. Restricting the amount of time spent in bed aims to limit the time patients spend lying in bed trying unsuccessfully to sleep.

Patients are asked to get out of bed in the morning at a fixed time and then calculate a bed time based on total sleep time. After a week, this approach typically improves quality of sleep. Then, the time spent in bed can be increased by gradually making bed time earlier, as long as awakenings in the middle of the night remain minimal.

General guidelines for use of hypnotics see table Guidelines for the Use of Hypnotics Guidelines for the Use of Hypnotics aim at minimizing abuse, misuse, and addiction. For commonly used hypnotics, see table Oral Hypnotics in Common Use Oral Hypnotics in Common Use.

All hypnotics except ramelteon , low-dose doxepin , and suvorexant act at the benzodiazepine recognition site on the gamma -aminobutyric GABA receptor and augment the inhibitory effects of GABA.

Hypnotics differ primarily in elimination half-life and onset of action. Drugs with a short half-life are used for sleep-onset insomnia.

Drugs with a longer half-life are useful for both sleep-onset and sleep maintenance insomnia, or, in the case of low-dose doxepin , only for sleep maintenance insomnia.

New drugs with a very short duration of action eg, low-dose sublingual zolpidem can be taken in the middle of the night, during a nocturnal awakening, as long as patients stay in bed for at least 4 hours after use.

Patients who experience daytime sedation, incoordination, or other daytime effects should avoid activities requiring alertness eg, driving , and the dose should be reduced, the drug stopped, or, if needed, another drug used.

Other adverse effects include amnesia, hallucinations, incoordination, and falls. Falling is a significant risk with all hypnotics. Three dual orexin receptor antagonists daridorexant , lemborexant , suvorexant can be used to treat sleep-onset and maintenance insomnia.

They block orexin receptors in the brain, thereby blocking orexin-induced wakefulness signals and enabling sleep initiation. Dual orexin receptor antagonists block orexin receptors-1 and The orexin receptor-1 is involved in suppressing the onset of rapid eye movement REM sleep; the orexin receptor-2 is involved in suppressing non-REM sleep onset and, to some extent, in controlling REM sleep.

However, the mechanism of action for dual orexin receptor antagonists is not fully understood. For suvorexant , the recommended dose is 10 mg, taken no more than once a night and taken within 30 minutes of going to bed, with at least 7 hours before the planned time of awakening. The dose can be increased but should not to exceed 20 mg once a day.

The most common adverse effect is somnolence. Lemborexant 5 mg is taken once a day within 30 minutes of going to bed; the dose can be increased to 10 mg maximum dose based on patient response and tolerability. Daridorexant 25 to 50 mg is taken once a day within 30 minutes of going to bed.

Daridorexant has the shortest half-life 8 hours of the dual oxexin receptor antagonists. Hypnotics should be used cautiously in patients with pulmonary insufficiency.

In older patients, any hypnotic, even in small doses, can cause restlessness, excitement, falls, or exacerbation of delirium and dementia. Rarely, hypnotics can cause complex sleep-related behaviors, such as sleepwalking and even sleep driving; use of higher-than-recommended doses and concurrent consumption of alcoholic beverages may increase risk of such behaviors.

Rarely, severe allergic reactions occur. Prolonged use of hypnotics Sedatives Sedatives include benzodiazepines, barbiturates, and related drugs. High doses can cause decreased level of consciousness and respiratory depression, which may require intubation and mechanical read more is typically discouraged because tolerance can develop and because abrupt discontinuation can cause rebound insomnia or even anxiety, tremor, and seizures.

Why You Wake Up in the Night (And How to Stop) | Right as Rain Sleep Disorders Chevron. Oversleeping hypersomnia can be a symptom of a medical condition. Why Do I Wake Up Too Early? Most patients snore, and sometimes patients awaken, gasping. Stage 1 non-REM sleep is the changeover from wakefulness to sleep. There are steps a person can take to stop waking up in the middle of the night, such as making appropriate lifestyle changes, seeking medication changes, and treating any underlying conditions.
Why do I keep waking up at night? Show the heart some love! However, Alexea Gaffney Adams, M. By Korin Miller. If a person wakes during the night—and especially if this awakening occurs toward morning—the ability to return to sleep will be compromised due to the lower levels of adenosine. Oversleeping hypersomnia can be a symptom of a medical condition. Sleep apnea Anxiety, depression, or worry Insomnia A need to urinate Night terrors Overheating Screen use and noise Indigestion Seeing a doctor Sleep hygiene tips Summary Many factors can cause a person to keep waking up at night.
Why Am I Waking up at the Same Time Every Night? Your stress levels may be elevated if something in your life is causing anxiety or worry. By Brandon Peters, MD. Merck Manual Professional Version. Quantifying sleep architecture dynamics and individual differences using big data and Bayesian networks. However, Alexea Gaffney Adams, M. In older patients, any hypnotic, even in small doses, can cause restlessness, excitement, falls, or exacerbation of delirium and dementia. Cordi MJ.
causes of wakefulness

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