Sleep Problems, Age 12 and Older
Everyone has trouble sleeping once in a while. Dogs barking, the wind howling, or overeating may make it hard for you to sleep. But sleep problems may be a symptom of a medical or mental health problem. Think about whether a medical or mental health problem is causing you to sleep poorly. Treating a long-term sleep problem without looking for the cause may hide the real reason for your poor sleep.
Sleep problems can have many causes.
Insomnia is a common sleep problem that can affect your quality of life. It can cause you to have trouble falling asleep or staying asleep. You may wake up during the night or wake up too early in the morning.
Short-term insomnia can last for days to weeks. It may get better in less than a month. Chronic insomnia is ongoing. It lasts at least 3 months.
Insomnia is linked to many things. A stressful event or a change in your usual habits can lead to short-term insomnia. Examples include a death in your family or loss of a job. Many medical conditions are linked to insomnia. Examples include anxiety, chronic pain, depression, and sleep apnea. Many prescription and over-the-counter medicines also may lead to insomnia. Your bedtime habits may also affect insomnia. Examples include drinking caffeine before bedtime, watching TV or using your phone in bed, and not keeping a regular schedule for bedtime and waking up.
Sleep apnea is one of several sleep disorders. It refers to repeated episodes of not breathing during sleep for at least 10 seconds (apneic episodes). It usually is caused by a blockage in the nose, mouth, or throat (upper airways). When airflow through the nose and mouth is blocked, breathing may stop for 10 seconds or longer. People who have sleep apnea usually snore loudly and are very tired during the day. It can affect children and adults.
Narcolepsy is a sleep disorder that has distinct symptoms. They include:
- Sudden sleep attacks. They may occur during any type of activity at any time of day. You may fall asleep while doing things like eating dinner, driving the car, or carrying on a conversation. These sleep attacks can occur several times a day. They may last from a few minutes to several hours.
- Sudden, brief periods of muscle weakness while you are awake (cataplexy). This weakness may affect specific muscle groups or may affect the entire body. It's often brought on by strong emotional reactions, such as laughing or crying.
- Hallucinations before falling asleep.
- Brief loss of the ability to move when you are falling asleep or just waking up (sleep paralysis).
Parasomnias are undesirable physical activities that occur during sleep. They involve skeletal muscle activity, nervous system changes, or both. Night terrors and sleepwalking are two types. Sleep can be hard for people who have parasomnias. While "asleep," the person may walk, scream, rearrange furniture, or eat things that are not normally eaten.
Parasomnia can cause odd, distressing, and sometimes dangerous nighttime activities. These disorders sometimes have medically explainable causes. They may be able to be treated.
Restless legs syndrome
Restless legs syndrome (RLS) is a condition that produces an intense feeling of discomfort, aching, or twitching deep inside the legs. Jerking movements may affect the toes, ankles, knees, and hips. Moving the legs or walking around usually relieves the discomfort for a short time.
The exact cause of RLS isn't known. The symptoms most often occur while a person is asleep or is trying to fall asleep. The twitching or jerking leg movements may wake the person up. This can cause insomnia, unrestful sleep, and daytime sleepiness.
Excessive daytime sleepiness
When a sleep problem or lack of time keeps you from getting a good night's sleep, excessive daytime sleepiness may occur. While almost everyone has daytime sleepiness from time to time, it can cause serious problems. It can lead to car crashes, poor work or school performance, and work-related accidents.
Talk to a doctor if you're sleepy during the day and this gets in the way of the normal things you do. Do not drive or use machinery while you're drowsy.
Health Tools help you make wise health decisions or take action to improve your health.
Check Your Symptoms
The medical assessment of symptoms is based on the body parts you have.
- If you are transgender or nonbinary, choose the sex that matches the body parts (such as ovaries, testes, prostate, breasts, penis, or vagina) you now have in the area where you are having symptoms.
- If your symptoms aren’t related to those organs, you can choose the gender you identify with.
- If you have some organs of both sexes, you may need to go through this triage tool twice (once as "male" and once as "female"). This will make sure that the tool asks the right questions for you.
Many things can affect how your body responds to a symptom and what kind of care you may need. These include:
- Your age. Babies and older adults tend to get sicker quicker.
- Your overall health. If you have a condition such as diabetes, HIV, cancer, or heart disease, you may need to pay closer attention to certain symptoms and seek care sooner.
- Medicines you take. Certain medicines, such as blood thinners (anticoagulants), medicines that suppress the immune system like steroids or chemotherapy, herbal remedies, or supplements can cause symptoms or make them worse.
- Recent health events, such as surgery or injury. These kinds of events can cause symptoms afterwards or make them more serious.
- Your health habits and lifestyle, such as eating and exercise habits, smoking, alcohol or drug use, sexual history, and travel.
Try Home Treatment
You have answered all the questions. Based on your answers, you may be able to take care of this problem at home.
- Try home treatment to relieve the symptoms.
- Call your doctor if symptoms get worse or you have any concerns (for example, if symptoms are not getting better as you would expect). You may need care sooner.
Many prescription and nonprescription medicines can cause sleep problems. A few examples are:
- Cold medicines.
- Steroid medicines.
- Nonprescription diet aids.
Symptoms of sleep apnea may include:
- Loud snoring. (But not all people who snore have sleep apnea.)
- Often feeling very sleepy during the daytime.
- Episodes of not breathing during sleep.
- Nighttime choking spells.
- Waking with an unrefreshed feeling after sleep.
There are many things you can do at home for sleep problems. For example:
- Use your bed for sleeping and sex only.
- Keep the bedroom quiet, cool, and dark.
- Try to go to bed at the same time every night and wake up at the same time every day.
- Don't take naps.
- Limit caffeine (coffee, tea, sodas with caffeine) during the day, and don't have any for at least 4 to 6 hours before bedtime.
- Avoid alcohol and nicotine, especially in the evening.
Many illnesses can cause sleep problems. A few examples are:
- Heart problems, such as heart failure or chest pain (angina).
- Circulation problems in your legs, such as peripheral arterial disease.
- Chronic breathing problems, such as asthma or chronic obstructive pulmonary disease (COPD).
- Digestive problems, such as gastroesophageal reflux disease (GERD).
The risk of a suicide attempt is highest if:
- You have the means to kill yourself, such as a weapon or medicines.
- You have set a time and place to do it.
- You think there is no other way to solve the problem or end the pain.
Seek Care Today
Based on your answers, you may need care soon. The problem probably will not get better without medical care.
- Call your doctor today to discuss the symptoms and arrange for care.
- If you cannot reach your doctor or you don't have one, seek care today.
- If it is evening, watch the symptoms and seek care in the morning.
- If the symptoms get worse, seek care sooner.
Make an Appointment
Based on your answers, the problem may not improve without medical care.
- Make an appointment to see your doctor in the next 1 to 2 weeks.
- If appropriate, try home treatment while you are waiting for the appointment.
- If symptoms get worse or you have any concerns, call your doctor. You may need care sooner.
Call 911 Now
Based on your answers, you need emergency care.
Call 911 or other emergency services now.
Sometimes people don't want to call 911. They may think that their symptoms aren't serious or that they can just get someone else to drive them. Or they might be concerned about the cost. But based on your answers, the safest and quickest way for you to get the care you need is to call 911 for medical transport to the hospital.
Seek Care Now
Based on your answers, you may need care right away. The problem is likely to get worse without medical care.
- Call your doctor now to discuss the symptoms and arrange for care.
- If you cannot reach your doctor or you don't have one, seek care in the next hour.
- You do not need to call an ambulance unless:
- You cannot travel safely either by driving yourself or by having someone else drive you.
- You are in an area where heavy traffic or other problems may slow you down.
How much sleep a person needs varies from person to person. The number of hours you sleep and how you feel when you wake up are both important. If you don't feel refreshed, you probably need more sleep.
Experts recommend that adults get at least 7 or more hours of sleep per day. Children and older adults need more sleep.
Here are some things you can do to help you get the sleep you need.
- Have a bedtime routine. For example, have a set bedtime, read a little before bed, and keep your bedroom dark, cool, and quiet.
- Avoid activities that might keep you from a good night's sleep. For example, limit naps during the day. Try not to smoke or drink alcohol. And avoid drinking or eating caffeine at least 6 hours before bedtime.
- If you can't get to sleep and are still awake within about 20 minutes, get up and read in dim light or do a boring task until you feel drowsy. Avoid lying in bed and thinking about how much sleep you're missing. And try not to use your TV, computer, smartphone, or tablet while you are in bed.
If you have several nights of trouble sleeping, review all of your prescription and nonprescription medicines with your doctor or pharmacist. They can help you find out if the medicines you take could be the cause of your sleep problem.
When to call for help during self-care
Call a doctor if any of the following occur during self-care at home:
- Feeling very tired or having a hard time functioning during the day.
- Symptoms occur more often or are more severe.
Preparing For Your Appointment
You can help your doctor diagnose and treat your condition by being prepared for your appointment.
Current as of: March 1, 2022
Author: Healthwise Staff
William H. Blahd Jr. MD, FACEP - Emergency Medicine
Kathleen Romito MD - Family Medicine
Adam Husney MD - Family Medicine
David Messenger MD - Emergency Medicine, Critical Care Medicine