Frequently Asked Questions

Yes, up to 50% of people with the disease have trouble falling and especially staying asleep. This can be due to frequent urination, inability to move easily and find a comfortable position, painful muscle spasms and restless legs syndrome and sleep apnea, to name a few. I would urge your mother to discuss this with his neurologist. Most of these are treatable.

Yes. In fact, several studies have pointed out that in children with significant weight gain, the incidence of recurrent sleep apnea is high. Considering the symptoms you are describing, I would discuss it with his health care provider. Retesting for sleep apnea is probably a good idea.

The occurrence of cardiac arrhythmias, which happen predominantly at night, always raises the suspicion of sleep-disordered breathing. I agree with your doctor that screening you with a home sleep test is a good idea. Treating the sleep apnea, if present, can significantly improve treatment of the arrhythmia.

Yes, very definitely. In fact, a study published in the Journal of Clinical Sleep Medicine addresses just that point. In a survey of Iraq and Afghanistan veterans with PTSD, they found that 70% had sleep apnea. In addition, the worse the PTSD, the more likely they were to have sleep apnea. We know that untreated sleep apnea makes PTSD worse, so it is very important that veterans such as your husband inform their health care providers about symptoms suggestive of sleep apnea. The authors of the study concluded that all returning veterans with PTSD should be carefully screened for sleep apnea.

Yes, quite important. Several studies have shown the dangers of untreated sleep apnea in patients with coronary disease. The most recent was published in the journal Chest. The study was done on men and women who had undergone bypass surgery and showed that when followed long term, the risk of revascularization, heart attack, stroke, and atrial fibrillation was much higher after the surgery when sleep apnea was not treated.

Overall, 25 million Americans have sleep apnea. In fact, a study in 2014 showed that 26% of all adults between 30 and 70 have sleep apnea.

We know that vagal nerve stimulators can affect the throat muscles and cause sleep apnea. In fact, in a recent study the incidence of developing sleep apnea was 25% after implantation. I would recommend, as did the authors of the study, that your husband bring this to the attention of his doctor. He probably should be studied for sleep apnea.

According to the National Sleep Foundation, 9 to 11 hours is an appropriate amount of sleep. Certainly, her symptoms could be due to inadequate sleep.

Personally, I would prefer she not be placed on zolpidem. Several studies have shown the risk of fractures, especially hip fracture, increases by as much as 70% in patients on this drug. I would recommend cognitive behavioral therapy be the first approach to her insomnia. Another approach, in the elderly, is low doses of melatonin taken about one hour before bedtime.

Yes, about 40% of people with low back pain suffer from insomnia. The lack of sleep lowers their pain threshold by several mechanisms. The first is due to decreased production of growth hormone, which is predominantly produced during deep sleep. The second is due to the release of inflammatory mediators associated with poor sleep. Finally, insufficient sleep triggers the release of stress hormones that tighten muscles. I would recommend you discuss with your health care provider ways to treat your insomnia. Most studies have shown an improvement in pain when the sleep issue is treated.

Snoring alone has little adverse consequences on the person. However, one study showed an increase in carotid atherosclerosis in snorers believed to be due to vibratory damage. More importantly, it can be a sign of sleep apnea. If your husband stops breathing in his sleep, complains of fatigue and/or sleepiness, awakens with morning headaches or gets up to urinate frequently, he may have sleep apnea. If he has any of these symptoms, I would bring it to the attention of your health care provider.

Yes, if the test indicates normal, less than five events per hour other than on your back, you may be a candidate for positional therapy. This can be accomplished by sewing a tennis ball into the back pocket of a shirt or by purchasing a device called the Zzoma Positional Therapy Belt. I would recommend you first discuss the test with your sleep physician to be sure that this is a viable option.

Yes. In a recent study in Sweden, 50-year-old men were followed for over 20 years concerning sleep duration. They found that middle-aged men who slept five hours or less per night had twice the risk of developing a major cardiovascular event during the following two decades than men who slept seven to eight hours. This research was presented at the 2018 European Society of Cardiology Congress. The events included heart attacks, strokes, heart failure, and sudden cardiac death. I would try to impress upon your husband the importance of sleeping at least 6.5 hours.

Up to 59% of patients with atrial fibrillation have sleep apnea. Untreated, it is a major cause of recurrent fibrillation and significantly decreases the chances of procedures such as ablation to work.

I think grandma knows best. An 11-year-old needs a minimum of 9 to 10 hours of sleep. 7 1/2 is insufficient and may be the cause of problems with focusing and paying attention. I would first ensure he is getting enough sleep before anything else.

Yes, about 8% of people with sleep apnea after treatment still have a hard time with sleepiness. There are several medications approved by the FDA for just such circumstances. I would speak to your health care provider and see if you are a candidate.

Yes, they probably do. A recent study showed preschool children’s eyes are much more sensitive to light than at any age. In the study, the suppression of melatonin by light was greatest in this age group. Melatonin is the hormone we produce to induce sleep. The study found even brief exposures suppressed melatonin for up to 90 minutes.

First, there are behavioral techniques you can use. The two that come to mind are sleep restriction therapy and stimulus control. I discuss both of these in detail in my book Sleep Soundly Every Night, Feel Fantastic Every Day. Second, are you suffering from anxiety or depression? Both of these disorders can manifest with insomnia such as you describe. Finally, are you on any medications that might cause insomnia or could you have a sleep disorder that unbeknownst to you is waking you up? I would not write it off to hypoglycemia, and getting a consultation with a sleep specialist is probably the best way to go.

Yes, start by making sure your sleep apnea is being adequately treated. Any number of other sleep disorders can be secondary to untreated or incompletely treated sleep apnea.

This could be any number of things, from sleepwalking or confusional arousals to nighttime seizures. What I would recommend is that you see a board certified sleep specialist. He or she will undoubtedly order an overnight sleep study. This will go a long way to help determine what is going on. As complicated as your sleep problem sounds, this is definitely the next step required, There are no quick answers to a problem such as yours. It must be addressed systematically and carefully.

Tinnitus is a very difficult problem. First, make sure you have an audiology study performed to insure that a hearing deficit is not responsible. There are devices called tinnitus maskers that generate what we call white noise. I have had several patients who have benefited from this type of device. In addition, although preliminary, a recent study showed melatonin might be beneficial in tinnitus.

Yes, in fact a study published this month in the Journal of Clinical Sleep Medicinedemonstrated just that. It showed that diets that were low in fiber and high in saturated fat and sugar intake were associated with lighter, less restorative sleep with more arousals. The take home message is what we have suspected for a long time–a bad diet negatively affects your sleep, which in turn has adverse consequences on your health. I have been stressing good nutrition as part of treating sleep disorders for years. I’m glad to see a study that reinforces that.

Your new neurologist is obviously up on the latest studies. A study published in the journal Sleep Medicine just showed that 80% of all patients with stroke have sleep apnea. The conclusions of the authors are in agreement with your doctor. They feel all patients with stroke should be screened for sleep apnea.

Yes. Make sure the room temperature is comfortable–65 to 70 degrees works for most of us. Use white noise such as a fan or white noise machine if it helps. Keep pets out of the room if they tend to disturb your sleep. Eliminate electronics such as cell phones, iPads, and laptops within 60 minutes of bedtime. Consider lavender oils or incense at bedtime. If you need a night light, make it red. Red is the least disruptive type of light when it comes to sleep.

This is a common sign of sleep apnea. I would suggest you have a sleep study done to find out and get treatment.

Definitely the medication. Ambien (zolpidem) causes what we call antegrade amnesia. That means that while it is active in your blood stream, it inhibits your memory for things that are happening. This is common. In fact, many people who get up to eat at night while on medications such as Ambien may find signs that they were eating in the morning and have no recollection.

No, in fact a study published this month from China looked at just that question. People with sleep apnea with an average age of 77 were followed over five years. They compared those that were compliant with treatment versus those who refused therapy. In the therapy group, 94% were still alive after five years whereas in the non-therapy group 69% were alive. The major cause of death in the refusal to treat group was heart disease and stroke. This is another of several studies showing benefit in treatment regardless of age.

Yes, your wife needs to be worked up for her sleepiness. I would request that your health care provider make a referral to a sleep specialist. First, home sleep tests are good in their place, but they cannot diagnose anything but sleep apnea. Your wife needs to be evaluated by a sleep specialist for other disorders that a home sleep test cannot detect which might be disrupting her sleep. This would include disorders such as narcolepsy, as well as neurological, hormonal, and metabolic disorders that can present with excessive sleepiness.

Yes, what you are describing is called sundowning. This is very common in Alzheimer’s disease. People with Alzheimer’s frequently lose their normal sleep wake cycle. This is because the disease attacks the area of the brain that controls our circadian rhythms. Several studies have shown promising results in restoring normal rhythms with nighttime melatonin and exposure to bright light in the morning. I would address this problem with your dad’s health care provider soon. This is a major reason that many with Alzheimer’s end up in nursing homes. It causes excessive stress and anxiety for the caregiver who themselves become sleep deprived.

First, turn off all electronics, especially interactive electronics, one hour before bed and eliminate caffeine after noon. Consider a technique called constructive worrying. In this technique, you write down your problems and solutions three to four hours before bedtime and leave them in the desk drawer. Finally, meditation and a technique called progressive muscle relaxation, which I discuss in my new book Sleep Soundly Every Night, Feel Fantastic Every Day are quite useful.

You do it with the help of your health care provider or a sleep specialist. Despite many studies demonstrating that a person can stop it suddenly without side effects, I usually taper my patients off it over several weeks while instituting cognitive behavioral therapy and good sleep hygiene.

I have had many patients such as yourself. It is a common problem. First, you might discuss with your health care provider the use of an oral appliance to treat your sleep apnea. Second, you should see a board certified sleep specialist. There are many techniques, some of which involve desensitization and others that use short-term medications to get someone such as yourself acclimated to CPAP.

In most cases of central sleep apnea, weight loss will not work. However, in the case of complex sleep apnea, a condition where the central apneas arise because of the CPAP or BIPAP treatment of obstructive sleep apnea, weight loss by eliminating the obstructive component can work. Another example is central sleep apnea resulting from opioid use–in this case, it resolves when the opioids are stopped. Finally, in some cases of central sleep apnea due to heart disease, there may be resolution of the central sleep apnea with effective therapy of the heart disease.

I think you are correct. Several recent studies have shown the relationship between sleep deprivation and coronary artery disease. Lack of sleep increases the release of stress hormones, as well as inflammatory mediators, that accelerate atherosclerosis. In fact, we can measure these elevations in the blood of those who do not get enough sleep. I would advise your husband to change his sleep habits. It should be part of a prevention strategy to lower his risk of further heart disease.

Oral pressure therapy is a new treatment that involves a mouthpiece connected to a suction device. When turned on, it brings the tongue and soft palate forward, theoretically opening the airway. The preliminary reports look quite promising. Although statistically not as effective as CPAP, it may be a viable alternative for those intolerant to CPAP. It has been approved by the FDA.

It just so happens I have the perfect study for you. In this month’s Journal of Clinical Sleep Medicine, a study about the effects of treating sleep apnea in golfers was published. The study showed that average golfers decreased their handicaps by 11% and skilled golfers by 30% after treating their sleep apnea. As a golfer, your husband should recognize what a significant improvement in performance this represents. Try that one on him and see if he will come to his senses.

No. When we talk about “some carbohydrates at bedtime,” we mean complex carbohydrates such as starches, whole grains, or legumes such as beans. Candy has no fiber and is what we call a simple sugar. The sugar is released almost immediately into the blood stream. This can result in excessive amounts of insulin being produced causing low blood sugar. The body then produces stress hormones such as cortisol to get the blood sugar back up. These stress hormones make it very difficult to fall or remain asleep. Therefore, simple sugars such as candy or sodas may keep you awake.

C-Reactive Protein is a marker of inflammation, especially of the blood vessels.  It has been associated with an increased risk of heart attack and stroke.  It is frequently elevated in sleep apnea and some think it may be one of the major links of sleep apnea to atherosclerosis.  Therefore, I understand your physician’s desire to get you tested.  Most studies have shown that with treatment of sleep apnea, the C-Reactive Protein normalizes.

A recent study funded by the NIH done on 464 children demonstrated the benefits of the surgery in children with sleep apnea.  Children who underwent surgery showed improvement in sleep quality, impulse control, and quality of life.  Beneficial effects were observed, even among overweight children in whom there has been particular uncertainty about the role of surgery.  I hope that answers your question.

Yes, it is true that many children with sleep problems improve as they get older.  However, there may be a problem with that.  According to a study published in the British Medical Journal, children with irregular sleep schedules before the age of three continued to lag developmentally, even by age seven.  So it may be that the crucial first three years for brain development in a child is sleep dependent.  Therefore, I would urge that you try to maintain a regular sleep schedule with your toddler.

No, it sounds like it is much more complicated than that.  I can’t make a diagnosis based on your question but certainly you are describing the sleep-related symptoms of PTSD.  I would urge you to have him seen either at your local VA or by a psychiatrist.  The sooner this is attended to the better for your son.

Yes, it can. Aged cheeses and cured meats contain an amino acid called tyramine. This amino acid, when ingested, increases the release of a hormone called norepinephrine. Norepinephrine is a wake-promoting hormone that is part of the fight or flight sympathetic nervous system. I would definitely avoid it close to bedtime if you have problems with sleep.

Great question. It is true that cataplexy is present in the majority of narcoleptics. In fact, it is rarely, if ever, seen with any other disorder. However, up to 25% of people with narcolepsy do not experience cataplexy. Additionally in some, the cataplexy may not occur until five years after the sleepiness.

Catathrenia is a groaning sound made on exhalation during sleep. It was originally thought to be a form of parasomnia such as sleepwalking or night terrors. However, several studies published over the last few years show it may be a form of sleep-disordered breathing such as sleep apnea. In fact, in one study done at Stanford, the majority of people treated with CPAP had a resolution of the catathrenia. I would seek the advice and expertise of someone board certified in sleep medicine.

It sounds like you are sleep talking. Sleep talking can arise from dream or non-dream sleep. The higher brain centers in the prefrontal cortex of the sleep talker are not functioning. These centers control impulses and are involved in self-awareness. I would assure my loved ones that these utterances have no real meaning. For instance, your vocalizations might be directed at someone or something in a dream and are being misinterpreted by your bed partner.

C-Reactive Protein is a marker of inflammation, especially of the blood vessels.  It has been associated with an increased risk of heart attack and stroke.  It is frequently elevated in sleep apnea and some think it may be one of the major links of sleep apnea to atherosclerosis.  Therefore, I understand your physician’s desire to get you tested.  Most studies have shown that with treatment of sleep apnea, the C-Reactive Protein normalizes.

A recent study funded by the NIH done on 464 children demonstrated the benefits of the surgery in children with sleep apnea.  Children who underwent surgery showed improvement in sleep quality, impulse control, and quality of life.  Beneficial effects were observed, even among overweight children in whom there has been particular uncertainty about the role of surgery.  I hope that answers your question.

Yes, it is true that many children with sleep problems improve as they get older.  However, there may be a problem with that.  According to a study published in the British Medical Journal, children with irregular sleep schedules before the age of three continued to lag developmentally, even by age seven.  So it may be that the crucial first three years for brain development in a child is sleep dependent.  Therefore, I would urge that you try to maintain a regular sleep schedule with your toddler.

No, it sounds like it is much more complicated than that.  I can’t make a diagnosis based on your question but certainly you are describing the sleep-related symptoms of PTSD.  I would urge you to have him seen either at your local VA or by a psychiatrist.  The sooner this is attended to the better for your son.

Yes. What you are describing is rather classic–Restless Legs Syndrome. Unfortunately, most physicians do not know that Benadryl (diphenhydramine) will make it worse. The first thing is to stop taking the Benadryl. If the pain persists, you need to talk to your health care provider about treatments for Restless Legs Syndrome. There are several excellent FDA approved therapies.

I think the medication is quite likely causing the problem. Theophylline is a good bronchodilator. Unfortunately, in some respects it has similar properties and effects as caffeine. As a result, it can interfere with sleep.

It sounds like your son is probably struggling to wake up in the morning, which can be due to many things. A common reason is poor sleep hygiene, which entails staying up too late with excessive blue light exposure such as iPods, iPads, TV, and computers. The second is a circadian disorder called delayed sleep phase syndrome. In this disorder, one’s biological clock is set for late bedtime and late awakenings. Considering how severely you say this is affecting his life, I would recommend he see a sleep specialist to sort this out.

There is no reason to repeat a sleep study unless the individual is having breakthrough symptoms suggestive of sleep apnea while on CPAP. In this case, there may be a need to readjust the pressure setting. Another indication would be an intolerance to CPAP and the need to switch to a different pressure delivery system such as BIPAP. Finally, if you were diagnosed with narcolepsy but there is some doubt as to how the test was performed or its validity, that would be a valid indication for a new study.

Yes. For an unknown reason the incidence of depression is much higher in people with narcolepsy than the general population. The most recent study put the incidence of depression at 27% and social anxiety at 25% in those with narcolepsy. We don’t yet know why this happens but it needs to be addressed and treated.

Until recently I would have said that the answer is no. However, a study from Korea published this month in the journal Sleep Medicine, came to a different conclusion. People who slept six hours or less were two times more likely to develop hypertension. However, extending their sleep time on the weekend by one hour a day served to decrease the odds of developing hypertension. Therefore, there may be some real benefit to those who don’t sleep seven to eight hours on the weekdays to catch up on their sleep on the weekends.

This is a technique called unmodified extinction or the “cry it out method.” In a recent study, children who were exposed to this technique were followed for five years and no long-term physical or psychological damage was noted. There are other techniques in which parents more gradually remove themselves from the child’s bedroom. These may be easier on the parent. However, the technique your daughter is planning on using is safe and effective. In fact, it is listed by the American Academy of Sleep Medicine as acceptable.

Yes it is. Up until recently, it was felt that as long as the parent did not consume alcohol or sedating medications that this was a safe practice. A recent study showed that even in the absence of these mitigating factors the incidence of SIDS was much higher in babies sleeping with their parents. There does not appear to be a problem with bringing babies into bed for breast feeding or other activities as long as the parents are awake.

Yes it is. It is not uncommon for sleep apnea, especially in the elderly, to present with problems using memory and focusing. In fact, a particular area of the brain involved in memory called the hippocampus is very likely to be damaged by low oxygen levels associated with sleep apnea. I would advise you to urge your mom to be tested. If positive, there could be a significant improvement in her mental status.

Yes it is. However, the success rate of adenotonsillectomy drops in obese children. In fact, the surgery cures over 80% of children, but only 50% of those who are obese. Since we know the severe physical and cognitive damage that untreated sleep apnea can cause in children, it is important to be sure that the surgery has worked.

Yes, light is the strongest stimulus that affects the circadian system. If exposed to light in the morning, one tends to go to bed earlier or at a normal time. If exposed to light at night, sleep will be delayed..

The incidence of insomnia in HIV is much higher than the national average. Causes range from associated anxiety and depression to sleep apnea resulting from HIV medications. Additionally, in advanced stages, HIV can affect the brain and disrupt the normal sleep pattern. Therefore, it would be doing you a disservice to advise you about tapering off your medications. I would recommend you be seen by a board certified sleep physician. A case such as yours requires that degree of expertise.

Yes, there are several medications other than Alertec (modafinil). One in particular, called Xyrem (sodium oxybate), is very effective for both the symptoms of cataplexy and excessive sleepiness. Additionally, there is a longer lasting form of modafinil, called Nuvigil (armodafinil) available. Finally, there are several other medications being developed. The most likely of these to be released soon are called H3 receptor antagonists. Initial studies with these drugs in narcolepsy have been very encouraging.

The third option is surgery, but without knowing the results of your study or your oral anatomy, I cannot recommend whether this would be a good choice. However, I am wondering if your oral appliance was made by a dentist skilled in making oral appliances for sleep apnea? If you tried one of those boil and bite devices over the internet they rarely work. Another thing to consider, is your sleep apnea position-related? If the majority of events occur while you are sleeping on your back, various devices available will prevent you from sleeping in the supine position. Finally, I would not give up on the CPAP. There are many accredited sleep centers that can work with you in getting you compliant. My own center has over a 90% success rate with patients who were noncompliant previously. We use a technique called a PAP-NAP. My specially trained technicians utilize desensitization and imagery techniques with great success. You might want to inquire as to whether a center near you is versed in this or other techniques useful in patients struggling with CPAP. I hope this helps.

REM Behavior Disorder is a disease where those afflicted paradoxically move while dreaming. The dreams are frequently violent and can result in self-injury or injury to one’s bed partner. It is estimated that 65% of those with the disorder will go on to develop a neurodegenerative disorder, most often of the Parkinson’s type. These include Parkinson’s, Dementia with Lewy bodies and Multisystem Atrophy. The lag time from diagnosis of REM Behavior Disorder until the development of one of these disorders averages ten to twenty years.

Great question. Actually, there has been some recent work done by researchers at the National Institutes of Health that point to this problem as we age. It would appear that delta (deep) sleep is very important for memory. As we get older, we progressively have less delta sleep and more of the lighter stages of sleep. This may be one reason that it becomes more difficult to retain new information with advancing years. Researchers are working on ways to increase deep sleep with aging. In the future, this may no longer be a problem.

Not exactly. First, you have to find out how severe your sleep apnea is. If it is mild to moderate, you can proceed to the dentist but you will need a referral from a physician. If your sleep apnea is severe, then you must first demonstrate intolerance to CPAP (Continuous Positive Airway Pressure) before you can qualify for an oral appliance. I hope this helps.

I suspect your husband probably has a form of sleep apnea called Cheyne-Stokes Central Sleep Apnea. This is very common in patients with congestive heart failure. In this form of sleep apnea, the person will hyperventilate while sleeping. This is then followed by long pauses in which no effort is made to breathe. During these pauses, oxygen levels tend to drop. Untreated, this form of sleep apnea is very damaging to the heart and will result in further deterioration and hasten death. I would strongly recommend that you have this checked out. There are excellent treatments available.