When you can’t sleep, you know it. But what about when you can, yet
you wake up feeling tired and achy or you’re groggy again a few hours
later? What’s that about? All too often, it turns out, the problem is
one that doesn’t keep you awake but does sabotage your sleep in more
subtle ways, so the hours you spend in bed don’t refresh and revitalize
you the way they should. Here are seven signs that you have a sleep
problem that’s secretly stealing your rest.
1. You sleep poorly and wake with a bad taste in your mouth.
What it’s a symptom of: “Morning mouth” can
be a signal of gastroesophageal reflux disease (GERD) or asymptomatic
heartburn. Recent sleep studies have shown that up to 25 percent of
people who report sleeping poorly without a diagnosed cause have
sleep-related acid reflux. But because they don’t have obvious heartburn
symptoms, they’re unaware of the condition.
How it interrupts sleep: Acid reflux causes
the body to partially awaken from sleep, even when there are no
symptoms of heartburn. The result of this “silent reflux” is fitful,
uneven sleep, but when you wake up digestion is complete and you can’t
tell why you slept poorly.
What to do: Follow treatment suggestions
for heartburn, even though you aren’t experiencing classic heartburn
symptoms: Don’t eat for at least two hours before hitting the sack, and
avoid acid-causing foods in your evening meals. (Alcohol, chocolate,
heavy sauces, fatty meats, spicy foods, citrus fruits, and tomatoes all
contribute to heartburn and acid reflux.) Some doctors also recommend
chewing gum before bed, because it boosts the production of saliva,
which neutralizes stomach acid.
Certain medications, particularly aspirin and other painkillers, are
hard on the stomach and esophageal lining, so don’t take them just
before bed.
Sleep studies have shown that sleeping on the left side reduces
symptoms, and sleeping on the right side causes them to worsen because
acid takes longer to clear out of the esophagus when you’re on your
right side. If you prefer to sleep on your back — a position that can
increase reflux — elevating your head and shoulders can help.
Losing weight can do wonders to banish heartburn and acid reflux. And if all else fails, try taking an over-the-counter antacid.
2. You toss and turn or wake up often to use the bathroom.
What it’s a symptom of: Nocturia is the official name for waking up in the middle of the night to use the bathroom.
The National Sleep Foundation estimates that 65 percent of older adults
are sleep deprived as a result of frequent nighttime urination.
Normally, our bodies have a natural process that concentrates urine
while we sleep so we can get six to eight hours without waking. But as
we get older, we become less able to hold fluids for long periods
because of a decline in antidiuretic hormones.
How it interrupts sleep: For some people,
the problem manifests as having to get up to use the bathroom, and then
being unable to get back to sleep. Once middle-of-the-night
sleeplessness attacks, they lie awake for hours. But for others the
problem is more subtle; they may sleep fitfully without waking fully, as
the body attempts to send a signal that it needs to go.
What to do: Start with simple steps. Don’t
drink any liquids for at least three hours before going to bed. This
includes foods with a lot of liquid in them, like soups or fruit. Lower
your coffee and tea consumption; the acids in coffee and tea can
irritate the bladder. Don’t drink alcohol, which functions as a diuretic
as well as a bladder irritant.
Go to the bathroom last thing before getting in bed and relax long
enough to fully empty your bladder. It’s also important to get checked
for conditions that cause urination problems. Guys, this means getting
your prostate checked. Inflammation of the prostate, benign prostatic
hyperplasia (BPN), and prostate tumors can all cause frequent urination.
In women, overactive bladder, urinary tract infections, incontinence, and cystitis are common causes of urinary problems.
Diabetes
can also cause frequent urination, so if you haven’t been tested for
diabetes recently, see your doctor. Certain drugs such as diuretics and
heart medications can contribute to this problem; if that’s the case,
talk to your doctor about taking them earlier in the day. A prescription
antidiuretic can cut down on nighttime urination if all else fails and
there’s no underlying issue.
3. Your jaw clicks, pops, or feels sore, or your teeth are wearing down.
What it’s a symptom of: Teeth grinding, officially known as bruxism,
is a subconscious neuromuscular activity. Bruxism often goes on without
your being aware of it; experts estimate that only 5 percent of people
who grind their teeth or clench their jaws know they do it until a sleep
partner notices the telltale sound or a dentist detects wear on the
teeth. Jaw clenching is another form of bruxism, except you clench your
teeth tightly together rather than moving them from side to side. Jaw
clenching can be harder to detect than grinding, but one sign is waking
with pain or stiffness in the neck.
How it interrupts sleep: Bruxism involves
tensing of the jaw muscles, so it interferes with the relaxation
necessary for deep sleep. And if you’re fully grinding, your body is
engaged in movement rather than resting.
What to do: See a dentist. If you don’t
have one, dental schools often offer low-cost dental care provided by
students supervised by a professor. A dentist can look for underlying
causes, such as problems with your bite alignment, and can prescribe a
mouth-guard-type device such as a dental splint. If jaw clenching is
your primary issue, there are specific dental devices for that.
Experts also suggest giving up gum chewing during the day, because
the habitual chewing action can continue at night. Some people who grind
their teeth have experienced relief from botox injections to the jaw
muscle. Others have had success using a new biofeedback device called
Grindcare, approved by the FDA in 2010.
4. You move all over the bed or wake tangled in the covers.
What it’s a symptom of: That kind of movement indicates restless leg syndrome or a related problem, periodic limb movement disorder (PLMD).
How it interrupts sleep: Doctors don’t know
exactly what causes these sleep movement disorders, but they do know
they’re directly related to a lack of deep, restful, REM sleep. The
restlessness can prevent you from sinking into deep sleep, or a muscle
jerk can wake or partially rouse you from deep sleep.
What to do: See a doctor to discuss your
symptoms and get a diagnosis, which may also involve looking for
underlying conditions related to restless leg syndrome or PLMD. Diabetes, arthritis,
peripheral neuropathy, anemia, thyroid disease, and kidney problems can
all contribute to restless leg syndrome and PLMD. Make sure to tell
your doctor about any medications you’re taking; a number of
medications, including antidepressants, antihistamines, and lithium, can
cause restless leg syndrome as a side effect.
You can also try making dietary changes to make sure you’re getting
enough iron and B vitamins, particularly folic acid, since iron and
folate deficiency have been linked to restless leg syndrome. Red meat,
spinach, and other leafy greens are good sources of both nutrients, but
you may want to take supplements as well. If your doctor diagnoses
restless leg syndrome or PLMD, medications used to treat Parkinson’s can
relieve symptoms by eliminating the muscle jerks. Your doctor may also
prescribe medication to help you sleep more deeply, with the idea of
preventing the involuntary movements from keeping you in light sleep.
5. You wake up with a dry mouth or horrible morning breath.
What it’s a symptom of: Mouth breathing and
snoring both disrupt sleep by compromising breathing. Look for drool on
your pillow or in the corners of your mouth. If you have a partner, ask
him or her to monitor you for snoring, gasping, or overloud breathing.
How it interrupts sleep: Mouth breathing
and snoring can interrupt sleep because you’re not getting enough air to
fully relax. Severe snoring — particularly when accompanied by gasps or
snorts — can also indicate a more serious problem with obstructed
breathing during sleep.
What to do: Train yourself to breathe
through your nose. Try snore-stopping nose strips, available over the
counter at the drugstore, or use saline nasal spray to irrigate your
nasal passages. Experiment with sleep positions; most people have a
tendency to snore and breathe through their mouths when sleeping on
their backs. Use pillows to prop yourself on your side, or try the
tennis ball trick: Put a tennis ball in the back pocket of your pajama
bottoms (or attach it some other way), so it alerts you when you roll
over.
If you typically drink alcohol in the evening, try cutting it out.
Alcohol, a sedative, relaxes the muscles of the nose and throat,
contributing to snoring. Other sedatives and sleeping pills do the same
thing, so avoid using anything sedating. Alcohol also can trigger
snoring in two other ways: It makes you sleep more deeply initially and
is dehydrating.
Losing weight — even just ten pounds — can eliminate snoring, studies
show. If none of these solutions work, consult a doctor to get tested
for sleep-disordered breathing conditions such as apnea.
6. You sleep fitfully, feel exhausted all the time, and wake with a sore throat or neck pain.
What it’s a symptom of: Obstructive sleep apnea is a disorder defined as breathing interrupted by intervals of ten seconds or more. A milder sleep breathing problem is upper airway resistance syndrome
(UARS), in which breathing is obstructed but stops for shorter
intervals of under ten seconds. The number of people who have sleep
apnea and don’t know it is astounding; experts estimate that 20 million
Americans have sleep apnea, and 87 percent of those are unaware they
have the problem. One mistaken assumption is that you have to snore to
have sleep apnea. In fact, many people with apnea don’t snore.
How it interrupts sleep: Obstructive sleep
apnea results when the throat closes and cuts off airflow, preventing
you from getting enough oxygen. UARS is similar, but it’s usually tongue
position that blocks air from getting into the throat. Blood oxygen
levels drop, and when the brain knows it’s not getting enough oxygen, it
starts to wake up. This causes fitful, unproductive sleep. Weight gain
is a major factor in sleep apnea, because when people gain weight they
end up with extra-soft tissue in the throat area, which causes or
contributes to the blockage.
What to do: See an otolaryngologist, who
will examine your nose, mouth, and throat to see what’s interrupting
your breathing and how to fix the problem. It’s also important to have
your oxygen levels measured during sleep. Your doctor will likely
recommend using a Continuous Positive Airway Pressure (CPAP) device, a
mask that blows air directly into your airways. Studies have shown CPAP
masks to be extremely effective in treating sleep apnea. Another mask
called a BiPap (Bilevel positive airway pressure device) works similarly
but has dual pressure settings. Airway masks only work if you wear
them, so work closely with your doctor to choose a model that’s
comfortable for you.
Other options include oral appliances, which change your mouth
position by moving your jaw forward to open up the throat, and surgery,
which aims to remove the excess tissue from the throat. Newer, minimally
invasive outpatient surgical treatments include the Pillar procedure,
which involves using permanent stitches to firm up the soft palate;
coblation, which uses radiofrequency to shrink nasal tissues; and use of
a carbon dioxide laser to shrink the tonsils.
7. You get a full night’s sleep but feel groggy all the time or get sleepy while driving.
What it’s a symptom of: This signals
circadian rhythm problems or, more simply, getting out of sync with
night and day. Irregular sleep patterns, staying up late under bright
lights, working a shift schedule, using computers and other devices in
bed, and having too much light in the room while you sleep can disrupt
your body’s natural sleep-wake cycle.
Why it interrupts sleep: The onset of
darkness triggers production of the hormone melatonin, which tells the
brain it’s time to sleep. Conversely, when your eyes register light, it
shuts off melatonin production and tells you it’s time to wake up. Even a
small amount of ambient light in the room can keep your body from
falling into and remaining in a deep sleep. The use of devices with
lighted screens is especially problematic in terms of melatonin
production because the light shines directly into your eyes. This light
is also at the blue end of the spectrum, which scientists believe is
particularly disruptive to circadian rhythms.
What to do: Try to get on a regular sleep
schedule that’s not too far off from the natural cycle of night and day —
and preferably the same schedule all week. (Experts recommend 10 p.m.
to 6 a.m. or 11 p.m. to 7 a.m. every night, but that’s just a general
outline.) If you struggle with not feeling alert in the morning, go
outside and take a brisk walk in daylight to feel more awake; you’ll
find that it’s much easier to fall asleep the following night. This is
also a trick experts recommend to help night owls reset their internal
clocks. Force yourself to get up and get into bright light one or two
mornings in a row and you’ll be less likely to get that “second wind”
and burn the midnight oil or experience nighttime sleeplessness.
As much as possible, banish all screens (TVs, computers, and iPads)
for at least an hour before bed. Reading is much more sleep-inducing
than looking at a lighted screen, but make sure your reading light isn’t
too bright and turn it so it doesn’t shine in your eyes. Remove
night-lights; if you need to get up in the middle of the night, keep a
small flashlight next to your bed, being careful to turn it away from
you. Check your bedroom for all sources of light, however small. Does
your smoke alarm have a light in it? Put tape over it. Use an alarm
clock without a lighted dial, or cover it. If your windows allow
moonlight and light from streetlights to shine in, install blackout
curtains or shades tightly fitted to the window frames. Don’t charge
laptops, phones, cameras, and other devices in your bedroom unless you
cover the light they give off.
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