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Inability to sleep
Restless leg syndrome
Insomnia
Sleep apnea symptoms
Anxiety attack
Snoring
Bad dreams every night
Waking up in the middle of the night
Feeling depressed for no reason
Excessive daytime sleepiness
Not seeing your symptoms? No worries!
What is Sleep Disorder?
Sleep disorders are conditions that affect the quality, timing, or duration of your sleep, impacting your ability to function when you're awake. There are many types of sleep disorders, including disturbances in sleep quality or quantity, excessive daytime sleepiness, abnormal behaviors during sleep, sleep disorders related to mental disorders, and more. Narcolepsy is one such disorder, often grouped under hypersomnias - a category of conditions characterized by excessive daytime sleepiness - and can be mistaken for or coexist with other sleep disorders like sleep apnea. Accurate diagnosis is essential for effective treatment.
Typical Symptoms of Sleep Disorder
- Recent changes in mental state
- Headache that worsens with lack of sleep
- I have been told my breathing stops for brief periods while sleeping
- Fatigue or low energy that is worse in the morning
- Stressed over daily life
- History of anxiety disorder or panic attacks
- History of using narcotics or illegal drugs
- Difficulty concentrating
Diagnostic Questions for Sleep Disorder
Your doctor may ask these questions to check for this disease:
- Recently, are you more confused than before?
- Does your headache get worse when you haven't slept enough?
- Have you been told that your breathing stops briefly during sleep?
- Do you experience fatigue or low energy that is worse in the morning?
- Do you feel stressed or unhappy about going to work or school?
Treatment of Sleep Disorder
Treatment for sleep disorders depends on the specific cause and type of the condition. Approaches may include lifestyle changes, behavioral therapies, medical devices, or medications tailored to address the underlying issue. For example, obstructive sleep apnea is often treated with CPAP machines or oral appliances, while insomnia may benefit from cognitive behavioral therapy or sleep aids. Managing contributing factors such as stress, poor sleep hygiene, or medical conditions is also important. In the case of narcolepsy, treatment focuses on controlling excessive daytime sleepiness and related symptoms through stimulants, antidepressants, and lifestyle adjustments such as scheduled naps, regular sleep–wake routines and avoiding alcohol or heavy meals before bed.
Reviewed By:
Weston S. Ferrer, MD (Psychiatry)
Weston Ferrer is a physician leader, psychiatrist, and clinical informaticist based in San Francisco. With nearly a decade of experience in academia and more recent immersion in industry, he has made significant contributions to the fields of digital health, health tech, and healthcare innovation. | As an Associate Professor at UCSF, Weston was involved in teaching, leadership, and clinical practice, focusing on the intersection of technology and mental health. He recently led mental health clinical for Verily (formerly Google Life Sciences), where he applied his expertise to develop innovative solutions for mental healthcare using the tools of AI/ML, digital therapeutics, clinical analytics, and more.. | Weston is known for his unique ability to innovate and support product development while bringing pragmatism to technology entrepreneurship. He is a strong advocate for patient-centered care and is committed to leveraging technology to improve the health and well-being of individuals and communities. |
Shohei Harase, MD (Neurology)
Dr. Harase spent his junior and senior high school years in Finland and the U.S. After graduating from the University of Washington (Bachelor of Science, Molecular and Cellular Biology), he worked for Apple Japan Inc. before entering the University of the Ryukyus School of Medicine. He completed his residency at Okinawa Prefectural Chubu Hospital, where he received the Best Resident Award in 2016 and 2017. In 2021, he joined the Department of Cerebrovascular Medicine at the National Cerebral and Cardiovascular Center, specializing in hyperacute stroke.
Content updated on Aug 5, 2025
Following the Medical Content Editorial Policy
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- Confusion
- Change in mental status
- Restless sleep
- Appears dazed
- Doesn't know the time
- Doesn't know where he/she is
- Sleep apnea
- Doesn't know who he/she is
- Sleep problems
- Breathing stops during sleep
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(May 1, 2025)
Symptoms Related to Sleep Disorder
Diseases Related to Sleep Disorder
FAQs
Q.
Always Tired? Idiopathic Hypersomnia Symptoms in Women 65+
A.
Idiopathic hypersomnia in women 65+ is a neurological sleep disorder that can cause persistent daytime sleepiness despite a full night of sleep, difficulty waking with prolonged grogginess, long unrefreshing naps, and brain fog that is often mistaken for normal aging. There are several factors to consider; below you will find warning signs that merit a doctor visit, common look-alike causes to rule out, and practical diagnosis and treatment options that can guide your next steps.
References:
* Singh B, Sunderam S. Diagnostic Challenge of Idiopathic Hypersomnia in Older Adults. Sleep Med Clin. 2021 Mar;16(1):153-162.
* Ohayon M, et al. Prevalence of Idiopathic Hypersomnia and Narcolepsy in the Elderly. Sleep. 2013 Sep 1;36(9):1321-7.
* Evin M, et al. Clinical characteristics of idiopathic hypersomnia: A retrospective analysis of 150 patients. J Sleep Res. 2020 Feb;29(1):e12918.
* Thorpy MJ. Hypersomnia Associated With Medical Disorders in Older Adults. Sleep Med Clin. 2017 Mar;12(1):111-124.
* Maski K, et al. Idiopathic Hypersomnia: Diagnosis, Treatment, and Future Directions. J Clin Sleep Med. 2023 Jul 1;19(7):1317-1335.
Q.
Can’t Sleep? Essential Sleep Hygiene Tips for Women Over 65
A.
Essential sleep hygiene tips for women over 65 include consistent sleep and wake times, a calming 60 minute wind down, a dark quiet cool bedroom, morning sunlight with fewer evening screens, smart timing of caffeine, alcohol, food and fluids, regular daytime activity, and simple relaxation practices. Because medicines and health conditions often disrupt sleep and disorders like insomnia, sleep apnea, and restless legs are common, review your medications and speak with a doctor for red flags such as gasping, chest discomfort, frequent leg movements, or excessive daytime sleepiness. There are several factors to consider, and the complete guidance below adds important details that can shape your next steps and lower risks like falls, depression, diabetes, and heart disease.
References:
* Wolkove N, et al. Sleep disturbances in older women: current recommendations for diagnosis and management. Maturitas. 2018 Dec;118:50-57. doi: 10.1016/j.maturitas.2018.10.007. Epub 2018 Oct 18. PMID: 30345097.
* Mezick EJ, et al. Cognitive Behavioral Therapy for Insomnia in Older Adults: A Meta-Analysis. J Am Geriatr Soc. 2020 Dec;68(12):2845-2856. doi: 10.1111/jgs.16853. Epub 2020 Sep 24. PMID: 32970725.
* Sun LL, et al. Factors associated with poor sleep quality among community-dwelling older adults: a systematic review and meta-analysis. Sleep Med. 2022 Feb;89:121-131. doi: 10.1016/j.sleep.2021.11.025. Epub 2021 Nov 27. PMID: 35160934.
* Kim K, et al. Non-pharmacological interventions for insomnia in older adults: A systematic review and meta-analysis of randomized controlled trials. J Adv Nurs. 2021 Oct;77(10):3946-3959. doi: 10.1111/jan.14925. Epub 2021 Jul 22. PMID: 34292850.
* Kim G, et al. Effectiveness of sleep education programs on sleep quality and insomnia in older adults: A systematic review and meta-analysis. Sleep Med. 2023 Jun;106:174-187. doi: 10.1016/j.sleep.2023.04.015. Epub 2023 Apr 20. PMID: 37024250.
Q.
Managing Sleep Disorders After 65: How to Finally Sleep Better
A.
To finally sleep better after 65, focus on targeted steps: identify the specific sleep disorder, build strong sleep habits, align diet and exercise timing, review medications with a clinician, and use CBT-I as first-line for chronic insomnia while keeping sleep aids limited due to fall and memory risks. There are several factors to consider; see below for urgent warning signs, how apnea, restless legs, circadian shifts, and REM sleep behavior disorder differ, and step-by-step guidance on symptom checks and when to talk with a doctor.
References:
* Suni, E. J., & Buysse, D. J. (2020). Sleep and circadian rhythms in older adults. *Neurologic Clinics*, *38*(4), 733-743.
* Qaseem, A., Kansagara, D., Forciea, M. A., Cooke, M., & Denberg, T. D. (2016). Management of Chronic Insomnia Disorder in Adults: A Clinical Practice Guideline From the American College of Physicians. *Annals of Internal Medicine*, *165*(2), 125-133.
* Espie, C. A., Kyle, S. D., Miller, C. B., & Ong, J. C. (2022). CBT for insomnia (CBT-I) and beyond: Evidence-based practice and future directions. *Sleep Medicine Clinics*, *17*(1), 129-140.
* Ohayon, M. M. (2018). Sleep in the elderly: A review of the literature on sleep habits, sleep complaints, and sleep disorders. *Sleep Medicine Clinics*, *13*(1), 1-13.
* Masa, J. F., Mokhlesi, B., Mayoral, M. G., Barbé, F., Benítez, I., Corral, J., ... & Peces-Barba, G. (2020). Management of Sleep Apnea in Older Adults: An Official ATS Clinical Practice Guideline. *American Journal of Respiratory and Critical Care Medicine*, *201*(4), e22-e35.
Q.
Need a Nap Every Day? Why It’s Not Just Aging for Women 65+
A.
Daily naps in women 65+ are common, but needing one every day, especially if they are long, unplanned, or not refreshing, is not automatically just aging and often points to a treatable issue. There are several factors to consider; see below for details on sleep disorders, medication side effects, hormonal or metabolic problems, heart or lung conditions, and mood or cognitive changes, plus when a short planned nap is fine versus when to talk to a doctor and the practical steps to take next.
References:
* Mander, B. A., Winer, J. R., & Jagust, W. J. (2020). Sex Differences in Sleep Health: A Focus on Aging. *Journal of Clinical Sleep Medicine*, *16*(2), 303–313.
* Ancoli-Israel, S. (2023). Common Sleep Problems in Older Adults. *Clinics in Geriatric Medicine*, *39*(1), 1–14.
* Nienhuis, A. G. (2018). Sleep disturbances in the elderly: beyond natural aging. *Current Opinion in Pulmonary Medicine*, *24*(6), 578–583.
* Zheng, Y., & Wei, R. (2020). Prevalence and Factors Associated With Napping in Community-Dwelling Older Adults: A Systematic Review. *Sleep Medicine Clinics*, *15*(3), 383–397.
* Sivertsen, B., & Pallesen, S. (2020). Pharmacological Management of Insomnia and Sleep Disturbances in Older Adults: A Review of the Literature. *Drugs & Aging*, *37*(1), 3–16.
Q.
Stop Waking Up: Essential Sleep Hygiene for Women Over 65
A.
There are several proven sleep hygiene steps that help women over 65 stop waking at night, like a steady wake time, morning light and daytime movement, a dark cool bedroom without screens, limiting caffeine, alcohol, and late fluids, and using relaxation instead of clock watching; aging alone does not cause insomnia. See the complete details below, including red flags that warrant medical care such as snoring or gasping, severe nighttime pain or breathlessness, frequent urination, medication effects, and the risks of sleeping pills, which can change the next steps you take with your doctor.
References:
* Rytovaara L, Varkila M, Vanhala M. Nocturnal Awakenings in Women with Insomnia: The Role of Chronotype and Age. Int J Environ Res Public Health. 2020 Sep 17;17(18):6768. doi: 10.3390/ijerph17186768. PMID: 32958742; PMCID: PMC7558661.
* Trapp SK, Gander P, Pischke CR. Behavioral and Psychological Treatments for Insomnia in Older Adults: A Systematic Review and Meta-analysis. J Gerontol A Biol Sci Med Sci. 2020 Mar 18;75(4):783-793. doi: 10.1093/gerona/glz177. PMID: 32185246.
* Vitiello MV, Rybarczyk BD. Sleep Disturbances in Older Adults: A Focus on Women. Curr Psychiatry Rep. 2018 Nov 15;20(12):107. doi: 10.1007/s11920-018-0975-2. PMID: 30438686.
* Bubu OM, Brannick B, Hernandez AB, Brubaker D, Varga AW, Jean-Louis G, Ogedegbe G, McFarlane SI. Sleep in Older Adults: An Update for Providers. Curr Sleep Med Rep. 2019 Jun;5(2):92-104. doi: 10.1007/s40675-019-00146-w. PMID: 31338692; PMCID: PMC6636737.
* Armitage R, Echeverria S, Buysse DJ. Sleep and Sleep Disorders in Women: Evidence for Gender Differences. Sleep Med Clin. 2021 Jun;16(2):169-183. doi: 10.1016/j.jsmc.2021.03.003. Epub 2021 May 26. PMID: 34149265; PMCID: PMC8790510.
Q.
Better Sleep After 65: How Magnesium Helps Seniors Rest
A.
Magnesium can support better sleep after 65 by calming the nervous system, relaxing muscles, and helping regulate melatonin, which may make it easier to fall asleep and reduce nighttime awakenings, and it is generally safe when used appropriately. There are several factors to consider. See below to understand more about the best forms and doses for seniors, timing, food sources, safety with kidney or heart issues and medications, and when persistent symptoms mean you should speak with a doctor.
References:
* Abbasi B, Kimiagar M, Sadeghniiat K, Shirazi M, Omidi R, Paknahad M. The effect of magnesium supplementation on primary insomnia in elderly: A double-blind placebo-controlled clinical trial. J Res Med Sci. 2012 Dec;17(12):1161-9. PMID: 23379250.
* Sarrafzadeh S, Aghajani H, Ebrahimi P, Esmaeili M. Magnesium supplementation in the treatment of insomnia in older adults: A systematic review. J Pak Med Assoc. 2021 May;71(5):1412-1416. PMID: 33965942.
* Cao Y, Sun F, Li C, Yin X, Dong Y, Sun W, Gong Q. The effects of magnesium supplementation on sleep quality, sleep onset latency, sleep duration, and early morning awakening in older adults: A systematic review and meta-analysis. Sleep Med Rev. 2022 Dec;66:101704. doi: 10.1016/j.smrv.2022.101704. Epub 2022 Oct 29. PMID: 36395346.
* Mah H, Man K, Snelgrove J, Loong J, Man C, Lam T, Li J, Chan R, Woo J, Li P. Nutritional interventions for improving sleep in older adults: A systematic review. J Am Geriatr Soc. 2020 Feb;68(2):401-411. doi: 10.1111/jgs.16239. Epub 2019 Dec 9. PMID: 31816576.
* Kim Y, Kim Y, Kim B, Shim J, Choe Y, Kim H. The effects of magnesium on sleep and mental health: A meta-analysis and systematic review of clinical trials. J Affect Disord. 2023 Feb 1;322:18-29. doi: 10.1016/j.jad.2022.10.021. Epub 2022 Oct 11. PMID: 36240751.
Q.
Magnesium Benefits for Seniors: Preventing Deficiencies
A.
Magnesium benefits for seniors include support for heart rhythm and blood pressure, bone strength, muscle relaxation with fewer cramps, steadier mood and sleep, and healthier blood sugar, yet deficiency is common with aging due to reduced absorption, certain medications, and chronic conditions. There are several factors to consider; see below for daily needs, top food sources, safe supplement choices and cautions, key deficiency symptoms, and when to seek medical care, since these details can shape your next steps in a healthcare plan.
References:
* Larsson SC, Wolk A. Magnesium intake and risk of cardiovascular disease: a meta-analysis of prospective studies. Am J Clin Nutr. 2012 Feb;95(2):362-6. doi: 10.3945/ajcn.111.026770. Epub 2011 Dec 21. PMID: 22190022.
* Uwitonze AM, Razzaque MS. Role of Magnesium in Vitamin D Activation and Function. J Am Osteopath Assoc. 2018 Mar 1;118(3):181-189. doi: 10.7556/jaoa.2018.037. PMID: 29480918.
* DiNicolantonio JJ, O'Keefe JH, Wilson W. Subclinical magnesium deficiency: a principal driver of cardiovascular disease and a public health crisis. Open Heart. 2018 Jan 13;5(1):e000668. doi: 10.1136/openhrt-2017-000668. PMID: 29497576; PMCID: PMC5786912.
* Schwalfenberg GK, Genuis SJ. The importance of magnesium in clinical healthcare. Scientifica (Cairo). 2017;2017:4179326. doi: 10.1155/2017/4179326. Epub 2017 Sep 28. PMID: 29093987; PMCID: PMC5637837.
* Grober U, Schmidt J, Kisters A. Magnesium in Prevention and Therapy. Nutrients. 2015 Sep 23;7(9):8199-8226. doi: 10.3390/nu7095388. PMID: 26404370; PMCID: PMC4586547.
Q.
Magnesium for Sleep: A Woman’s Guide to Restful Nights
A.
Magnesium may gently improve sleep for women by calming the nervous system, supporting melatonin, relaxing muscles, and reducing stress; commonly used forms are glycinate, citrate, and threonate, with typical supplemental doses of 100 to 300 mg taken in the evening. There are several factors to consider, including menstrual or menopausal changes, safety in pregnancy or kidney disease, medication interactions, and the importance of sleep hygiene. See the complete guidance below to choose the right form and dose and to know when to consult a clinician or screen for a sleep disorder.
References:
* Almerie MQ, et al. The effect of magnesium on sleep quality: A systematic review and meta-analysis. Front Psychiatry. 2023 Mar 15;14:1145821. doi: 10.3389/fpsyt.2023.1145821. PMID: 36993952.
* Mah J, et al. Oral Magnesium Supplementation for Primary Insomnia in Older Adults: A Systematic Review and Meta-Analysis. Int J Mol Sci. 2022 Mar 22;23(6):3474. doi: 10.3390/ijms23063474. PMID: 35328574.
* Cao Y, et al. Magnesium Intake and Sleep Quality among Middle-Aged and Older Adults: A Systematic Review and Meta-Analysis of Prospective Studies. Nutrients. 2022 Dec 15;14(24):5346. doi: 10.3390/nu14245346. PMID: 36558450.
* Boyle NB, Lawton C, Dye L. The Effects of Magnesium Supplementation on Subjective Measures of Anxiety and Stress in Healthy Adults - A Systematic Review. Nutrients. 2017 Apr 26;9(5):429. doi: 10.3390/nu9050429. PMID: 28441483.
* Zhang C, et al. Association of Magnesium Intake with Sleep Quality in Middle-Aged and Older Adults: A Population-Based Study. Nutrients. 2022 Oct 26;14(21):4479. doi: 10.3390/nu14214479. PMID: 36364966.
Q.
Top Magnesium Benefits for Women: Bone & Heart Health
A.
Magnesium is key for women’s bones and heart, strengthening bones by activating vitamin D and optimizing calcium use, and supporting a steady heart rhythm, healthy blood pressure, and better insulin sensitivity. There are several factors to consider, including life stage needs, food sources, safe supplement types and doses, medication interactions, and when to see a clinician; see the complete details below to guide your next steps.
References:
* Castiglioni, S., Cazzaniga, A., Albisetti, M., & Maier, J. A. M. (2013). Magnesium and osteoporosis: current state of knowledge and future research directions. *Nutrients, 5*(8), 3022-3033. [PMID: 23900232]
* Rosique-Esteban, N., Guasch-Ferré, M., Hernández-Alonso, P., & Salas-Salvadó, J. (2018). Dietary Magnesium Intake and Cardiovascular Disease and Mortality in the Predimed Study. *Nutrients, 10*(6), 661. [PMID: 29795000]
* Al-Shawwa, M., & Shahab, H. (2020). The Impact of Magnesium on Bone Health: An Update. *Current Osteoporosis Reports, 18*(2), 176-184. [PMID: 32185610]
* Guerrero-Romero, F., & Rodríguez-Morán, M. (2019). Magnesium: a nutritional intervention for preventing and treating chronic diseases. *Clinical and Experimental Pharmacology and Physiology, 46*(2), 132-137. [PMID: 30456677]
* Del Gobbo, L. C., Imamura, F., Wu, J. H. Y., de Oliveira Otto, M., Post, S., & Mozaffarian, D. (2013). Circulating and dietary magnesium and risk of cardiovascular disease: a systematic review and meta-analysis of prospective studies. *The American Journal of Clinical Nutrition, 98*(1), 160-173. [PMID: 23761485]
Q.
The "Dizzy Buzz": Why Tingling Hands and Lightheadedness Often Happen Together
A.
Tingling hands with lightheadedness often occur together because the brain and peripheral nerves are sensitive to changes in blood flow, oxygen or carbon dioxide, and stress responses. Common causes include panic attack symptoms, low blood pressure, anemia, and breathing or sleep problems, with other contributors like low blood sugar, vitamin B12 deficiency, neck tension, and some medications. There are several factors to consider and important red flags that change next steps, such as symptoms that are new, severe, persistent, happen at rest, or occur with chest pain, shortness of breath, fainting, weakness on one side, or vision or speech changes. See below for the complete explanation, practical self-care tips, and when to talk to a doctor.
References:
* pubmed.ncbi.nlm.nih.gov/31761244/
* pubmed.ncbi.nlm.nih.gov/26233543/
* pubmed.ncbi.nlm.nih.gov/31764104/
* pubmed.ncbi.nlm.nih.gov/35830644/
* pubmed.ncbi.nlm.nih.gov/31939626/
Q.
That "Flutter" Under Your Right Rib: Is It a Muscle Spasm or Just a Result of Shallow Breathing?
A.
Most right-rib flutters are not dangerous and are usually muscle related, most often diaphragm flutter or intercostal spasm tied to shallow, stress-related breathing. There are several factors to consider. See below to understand practical fixes like diaphragmatic breathing and posture changes, other triggers such as fatigue, dehydration and caffeine, plus the red flags like persistent or worsening symptoms, shortness of breath, chest pain, dizziness, or symptoms after injury that should prompt medical care.
References:
* Smith, M. D., Russell, F. D., & Davies, B. (2018). Breathing dysfunction and its effects on the musculoskeletal system. *Physical Therapy Reviews, 23*(3), 193-200. PMID: 29775317.
* Boussuges, A., Gole, Y., & Blanc, P. (2020). The Diaphragm: An Integrated Review of Anatomy, Physiology, and Clinical Considerations. *Ultrasound in Medicine & Biology, 46*(10), 2824-2834. PMID: 32662237.
* Courtney, R. (2017). The impact of altered breathing patterns on human health. *Physiotherapy Research International, 22*(4), e1672. PMID: 28989599.
* Mills, K. R., & Swash, M. (2018). Muscle fasciculations: a review of the pathophysiology and clinical significance. *Clinical Neurophysiology, 129*(9), 1774-1786. PMID: 29891001.
* Lanza, G. A., & Sgueglia, M. (2022). Respiratory Muscle Fatigue: Recent Advances in Pathophysiology and Clinical Significance. *Diagnostics (Basel, Switzerland), 12*(1), 168. PMID: 35056976.
Q.
The "Toilet Faint": Why Your Vagus Nerve Is Making You Dizzy in the Bathroom
A.
Bathroom dizziness or fainting is most often vasovagal syncope, where vagus nerve overstimulation during straining, urinating, or standing up quickly briefly drops heart rate and blood pressure, causing lightheadedness, nausea, sweating, and a short loss of consciousness that is usually benign. Hydrate, avoid straining, rise slowly, sit to urinate, and lie down at warning signs, but seek medical care for episodes without warning, with chest pain, palpitations, during exercise, confusion, frequent recurrences, or a family history of sudden death; there are several factors to consider, and the complete guidance below includes important details about risks, evaluation, sleep and medication contributors, and next steps.
References:
* Gauer, R. L., & Vesely, R. B. (2011). Defecation syncope: a case report and review of the literature. *Journal of Clinical Gastroenterology, 45*(7), 643-644. PMID: 21825969
* Benítez-Cabrera, M. A., Torres-Vázquez, J., Santana-Cabrera, L., Machín-Hamad, V., & Hernández-Betancor, I. (2015). Syncope due to defecation: review of a case and literature review. *Revista Española de Enfermedades Digestivas, 107*(7), 444-445. PMID: 26190479
* Singh, R., Bopari, N., Sandhu, J., & Ahmad, N. (2023). A unique case of vasovagal syncope induced by defecation. *Cureus, 15*(6), e39923. PMID: 37397738
* Grubb, B. P. (2004). Physiological basis of vasovagal syncope. *Journal of the American College of Cardiology, 44*(9), 1735-1741. PMID: 15519001
* Pstras, L., Zieliński, J., & Woźniak, A. (2009). The Valsalva maneuver: a critical review of its cardiovascular effects and clinical relevance. *Journal of Applied Physiology, 107*(1), 329-336. PMID: 19372338
Q.
Women's Sleep Needs: Why am I sleepy all day? What doctors wish you knew
A.
All-day sleepiness in women has several common causes doctors want you to know about, including hormone shifts across the menstrual cycle, pregnancy, and menopause, plus insufficient or poor-quality sleep, sleep disorders like sleep apnea, restless legs, or insomnia, mental health conditions, medical issues such as hypothyroidism or anemia, medication effects, and lifestyle habits. See below for practical fixes, key warning signs that mean you should talk with a doctor, and how to choose next steps like a symptom check, sleep study, or blood tests, since details like snoring, gasping, leg crawling sensations, mood changes, or where you are in your cycle can change what you should do next.
References:
Moline ML, Broch L, Zak R, & Gross S. (2003). Sleep in women across the life cycle from adulthood through menopause. Sleep Med, 12615216.
Zhang B, & Wing YK. (2006). Sex differences in insomnia: a meta-analysis. Sleep, 16471268.
Leger D, Bayon V, & Metlaine A. (2012). Prevalence of sleepiness in a sample of French adults. Sleep Med, 22381607.
Q.
Can sleep apnea kill you?
A.
Yes, sleep apnea can be life-threatening over time if untreated, since it raises the risk of heart disease, stroke, dangerous heart rhythms, high blood pressure, diabetes, and serious accidents, though most people do not die suddenly from it and it is highly treatable. There are several factors to consider, including severity, other health conditions, warning signs, and proven treatments like CPAP that reduce risk; see below for key details and guidance on when to see a doctor and what to do next.
References:
* https://pubmed.ncbi.nlm.nih.gov/27143615/
* https://pubmed.ncbi.nlm.nih.gov/25771031/
* https://pubmed.ncbi.nlm.nih.gov/18703472/
* https://pubmed.ncbi.nlm.nih.gov/23715104/
* https://pubmed.ncbi.nlm.nih.gov/29903387/
Q.
65+ Sleep apnea causes, concerns, and cures
A.
Sleep apnea after age 65: there are several causes, key risks, and warning signs to consider. Age related muscle tone loss, anatomical narrowing, weight gain, certain illnesses and medications, and back sleeping raise risk, while consequences include daytime sleepiness and falls, high blood pressure and heart disease, diabetes, and memory or mood problems; see below for symptoms, diagnosis, and urgent red flags. Treatments that work include CPAP, oral appliances, weight and position changes, positional devices, selected surgeries, and addressing contributing conditions and medications, with adherence and follow up improving outcomes. For the complete step by step guidance and details that can shape your next healthcare steps, see below.
References:
Jordan AS, McSharry DG, & Malhotra A. (2014). Adult obstructive sleep apnoea. Lancet, 24087750.
Drager LF, Togeiro SM, Polotsky VY, & Lorenzi-Filho G. (2013). Obstructive sleep apnea: a cardiometabolic risk in obesity a… J Am Coll Cardiol, 23972343.
Sutherland K, Vanderveken OM, Tsuda H, et al. (2014). Oral appliance therapy for obstructive sleep apnea: an updat… J Clin Sleep Med, 24533051.
Q.
An uncontrollable urge to sleep can have one surprisingly specific pattern.
A.
An uncontrollable urge to sleep can follow a specific night-day reversal pattern, with fragmented nights and irresistible mid-afternoon sleep attacks, often pointing to minimal hepatic encephalopathy from liver dysfunction that alters ammonia and melatonin handling. There are several factors to consider, since narcolepsy, sleep apnea, and circadian rhythm problems can also cause profound daytime sleepiness, and liver-linked clues like confusion, slowed thinking, tremor, or a history of liver disease raise concern. See below for key red flags, how to track symptoms, lifestyle steps that may help, and when to seek medical care, which can affect your next steps.
References:
Bajaj JS, & Heuman DM. (2009). Sleep disturbances and daytime sleepiness in patients with minimal hepatic encephalopathy are correlated with… Sleep, 19786738.
D'Amico G, & Garcia-Tsao G, & Pagliaro L. (2006). Natural history and prognostic indicators of survival in cirrhosis… J Hepatol, 16427127.
Tsochatzis EA, & Bosch J, & Burroughs AK. (2014). Liver cirrhosis… Lancet, 24613306.
Q.
Can’t keep my eyes open during the day: what causes this beyond ‘not enough sleep’?
A.
There are several factors to consider beyond sleep quantity, including sleep apnea, narcolepsy or idiopathic hypersomnia, circadian rhythm disorders, liver and electrolyte problems, thyroid dysfunction, anemia or nutrient deficiencies, mental health conditions, and medication side effects. See below for the key symptoms, tests, and treatments that can narrow the cause, plus red flags for when to call a doctor and practical next steps like keeping a sleep diary, trying light or melatonin at the right times, ordering blood work, and reviewing medications.
References:
Montagnese S, et al. (2009). Sleep in cirrhosis: a neglected complication. J Hepatol, 19159521.
Montagnese S, & Morgan MY. (1998). Alterations of circadian rhythms and sleep in cirrhosis. J Hepatol, 9813049.
Kim WR, Biggins SW, & Kremers WK. (2008). Hyponatremia and mortality among patients on the liver-transplant wait… N Engl J Med, 18319203.
Q.
Could insomnia be a signal of something serious? Warnings signs, tips, and more
A.
Insomnia is common, but when it persists or appears with red flags it can signal depression, cardiometabolic disease, dementia risk, thyroid issues, sleep apnea, chronic pain, or other mood and neurological conditions; there are several factors to consider, and full details are below. Seek care urgently if it lasts more than 3 months or causes daytime impairment, breathing problems at night, unexplained weight change, morning headaches, painful or uncontrollable leg movements, cognitive decline, or suicidal thoughts, and see below for practical sleep tips, when to get tests or CBT-I, and which next steps to take with your clinician.
References:
Baglioni C, Battagliese G, Feige B, et al. (2009). Insomnia as a predictor of depression: a meta-analytic evaluation of… Journal of Affective Disorders, 19261318.
Vgontzas AN, Liao D, Pejovic S, et al. (2009). Insomnia with objective short sleep duration is associated with a high… Sleep, 19413169.
Shi L, Chen S-J, Ma M-Y, et al. (2018). Sleep disturbances increase the risk of dementia: a systematic review… Sleep Med Rev, 29213503.
Q.
Daily naps aren’t always ‘healthy’—here’s when it’s a red flag.
A.
Short, early power naps of about 10 to 20 minutes can be healthy. Needing daily naps over 30 minutes or feeling unrefreshed, dangerously drowsy, or noticing signs like loud snoring, headaches, mood or memory changes, weight or skin changes, swelling, or jaundice is a red flag for sleep disorders or medical issues such as sleep apnea, narcolepsy, anemia, thyroid disease, diabetes, heart or liver disease, as well as medication or mental health factors. There are several factors to consider. The complete guidance below covers what to track, when to see a doctor or sleep specialist, basic tests to request, sleep and lifestyle fixes, medication reviews, and urgent red flags that need immediate care.
References:
D'Amico G, Garcia-Tsao G, & Pagliaro L. (2006). Natural history and prognostic survival indicators in cirrhosis… Journal of Hepatology, 16879802.
Kamath PS, & Wiesner RH. (2001). A model to predict survival in patients with end‐stage liver disease. Hepatology, 11157951.
European Association for the Study of the Liver. (2014). EASL clinical practice guidelines for management of decompensated cirrhosis… Journal of Hepatology, 24986678.
Q.
Dreaming as soon as I fall asleep: how fast is ‘too fast’ for REM?
A.
In healthy sleep, the first REM period usually starts about 70 to 100 minutes after you fall asleep; REM within 45 to 60 minutes is short, and REM within 15 minutes is especially concerning and may suggest narcolepsy. Early REM can be caused by sleep deprivation, irregular schedules, alcohol or medications, mood disorders, or sleep disorders like narcolepsy; if you often dream right away plus have extreme daytime sleepiness, muscle weakness, paralysis at sleep wake transitions, or hallucinations, speak with a clinician. There are several factors to consider and important red flags and next steps are outlined below.
References:
Ohayon MM, Carskadon MA, Guilleminault C, & Vitiello MV. (2004). Meta-analysis of quantitative sleep parameters from childhood… Sleep, 15586779.
Dauvilliers Y, Arnulf I, & Mignot E. (2007). Narcolepsy with cataplexy. Lancet, 17307377.
Tsochatzis EA, Bosch J, & Burroughs AK. (2014). Liver cirrhosis. Lancet, 24672050.
Q.
Dreaming instantly after you fall asleep? That’s a clue.
A.
Dreaming right as you fall asleep can signal a sleep-onset REM period, often from sleep loss or irregular schedules, stress or PTSD, medication effects or withdrawal, and occasionally from narcolepsy or advanced liver disease. There are several factors to consider; see below for specific red flags like severe daytime sleepiness, sudden muscle weakness, confusion, jaundice, or hallucinations, plus the key steps you can take now and when to see a doctor.
References:
D'Amico G, Garcia-Tsao G, & Pagliaro L. (2006). Natural history and prognostic indicators of survival in cirrhosis… Hepatology, 16447272.
Tsochatzis EA, Bosch J, & Burroughs AK. (2014). Liver cirrhosis… Lancet, 24651225.
Garcia-Tsao G, Abraldes JG, Berzigotti A, & Bosch J. (2017). Portal hypertensive bleeding in cirrhosis: risk stratification… Journal of Hepatology, 27061189.
Q.
Falling asleep in meetings: could this be microsleep or excessive daytime sleepiness?
A.
Falling asleep in meetings may be brief microsleeps lasting seconds from fatigue or monotony, or persistent excessive daytime sleepiness that can signal disorders like sleep apnea or narcolepsy. There are several factors to consider; see below to understand more. Track how often it happens and any red flags such as loud snoring, cataplexy, or unrefreshing sleep; improve sleep habits, try the Epworth Sleepiness Scale, and seek a sleep specialist if it persists. Complete details and step-by-step next actions are below.
References:
Johns MW. (1991). A new method for measuring daytime sleepiness: the Epworth S… Sleep, 1798888.
Carskadon MA, Dement WC, Mitler MM, Roth TM, Westbrook PR, & Keenan S. (1986). Guidelines for the Multiple Sleep Latency Test: A Standard M… Sleep, 3813027.
Kamath PS, & Wiesner RH. (2001). A model to predict survival in patients with end-stage liver… Hepatology, 11157951.
Q.
Falling asleep standing up: what conditions can cause this and what’s urgent?
A.
There are several factors to consider; falling asleep on your feet can result from severe sleep deprivation, medication effects, sleep disorders like sleep apnea, idiopathic hypersomnia or narcolepsy with cataplexy, and even look-alikes such as seizures or fainting from heart rhythm issues or blood pressure drops when standing; see below to understand the differences. Urgent warning signs that need immediate medical care include actual loss of consciousness, chest pain, palpitations, severe shortness of breath, seizure-like movements, head injury, or known heart disease; see below for the full list of red flags, what your doctor may check, and practical safety steps that can guide your next steps.
References:
Dauvilliers Y, Arnulf I, & Mignot E. (2007). Narcolepsy. Lancet, 17387676.
Brignole M, Moya A, de Lange FJ, et al. (2018). 2018 ESC guidelines for the diagnosis and management … Eur Heart J, 29121344.
Castéra L, Forns X, & Alberti A. (2008). Non-invasive evaluation of liver fibrosis using transient … Journal of Hepatology, 17936527.
Q.
Falling asleep while eating: what does that suggest about sleep pressure and disorders?
A.
Falling asleep while eating usually signals abnormally high sleep pressure and often an underlying sleep disorder, not just a post-meal slump. There are several factors to consider, including obstructive sleep apnea, narcolepsy, idiopathic hypersomnia, severe sleep deprivation, and sedating medications or alcohol; see below to understand more. Because this can raise choking risk and may require tests like a sleep study, review the details below for warning signs and next-step guidance you can take to your clinician.
References:
Borbély AA. (1982). A two process model of sleep regulation. Human neurobiology, 7165797.
Scammell TE. (2015). Narcolepsy. The New England Journal of Medicine, 25587504.
European Association for the Study of the Liver. (2015). EASL-ALEH clinical practice guidelines: non-invasive tests for eval… Journal of Hepatology, 25867816.
Q.
Hearing voices as you fall asleep can be normal—until it isn’t.
A.
Hearing brief voices as you fall asleep is often a normal hypnagogic experience, especially with poor sleep, irregular schedules, stress, or stimulant use. There are several factors to consider. See below for details on what is benign and what can improve with simple sleep-habit changes. It becomes concerning if the voices persist when fully awake, are frequent or distressing, or come with daytime sleepiness, mood or thinking changes, neurologic symptoms, substance or medication issues, or signs of liver disease, which can indicate conditions like narcolepsy, psychiatric illness, seizures, dementia, or metabolic causes. See the full guidance below for specific red flags and when to seek medical care, testing, and specialist evaluation.
References:
Cheyne JA, Rueffer SD, & Sherratt Y. (1999). EEG and subjective correlates of the hypnagogic state. Conscious Cogn, 10545322.
Montagnese S, Amodio P, Morgan MY, et al. (2014). Hepatic encephalopathy in chronic liver disease: 2014 Practice guideline by the American Association for the Study of Liver… Journal of Hepatology, 25069511.
Wai CT, Greenson JK, Fontana RJ, et al. (2003). A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis… Hepatology, 12715365.
Q.
Hypersomnia vs narcolepsy: how do clinicians tell them apart?
A.
Clinicians tell idiopathic hypersomnia from narcolepsy by patterns of symptoms and sleep studies: hypersomnia usually involves very long night sleep and pronounced sleep inertia with no cataplexy, whereas narcolepsy shows sudden sleep attacks, REM-related hallucinations or paralysis, and cataplexy in type 1. On testing, an overnight polysomnogram followed by an MSLT with mean sleep latency of 8 minutes or less and two or more sleep onset REM periods suggests narcolepsy, and low CSF hypocretin confirms type 1. There are several factors to consider that affect treatment choices, safety, and next steps; see below for key differences, red flags, and exactly which tests to ask about.
References:
Trotti LM. (2011). Idiopathic hypersomnia: update and differential diagnosis. Curr Treat Options Neurol, 21371397.
Dauvilliers Y, Arnulf I, & Mignot E. (2007). Narcolepsy with cataplexy. Lancet, 17241558.
D'Amico G, & Garcia-Tsordi M. (2005). Systematic review: natural history of cirrhosis. Aliment Pharmacol Ther, 16120148.
Q.
If laughter makes your legs quit, your nervous system is sending a signal.
A.
Leg weakness during laughter is a nervous system signal that can stem from cataplexy related to narcolepsy, a vasovagal faint, atonic seizures, orthostatic blood pressure drops, medication effects, dehydration, or heart rhythm problems. There are several factors to consider; see below for how to tell them apart, key warning signs, and next steps. Seek urgent care for fainting, chest pain, persistent confusion, seizure-like activity, or injuries, and ask your clinician about tests like sleep studies, EEG, tilt-table, and ECG; treatment and self-care options are outlined below.
References:
Foucher J, Chanteloup E, Vergniol J, Castéra L, Le Bail B, Adhoute X, et al. (2006). Diagnosis of cirrhosis by transient elastography (FibroScan)… Gut, 16344460.
Sterling RK, Lissen E, Clumeck N, Sola R, Correa MC, Montaner J, et al. (2006). Development of a simple noninvasive index to predict significant fibrosi… Hepatology, 15871386.
Castera L, Forns X, Alberti A. (2008). Non-invasive evaluation of liver fibrosis using transient elastog… J Hepatol, 17964208.
Q.
If meetings knock you out, it’s not the meeting.
A.
There are several factors to consider, from sleep deprivation and poor sleep habits to sleep apnea, medication effects, depression or anxiety, narcolepsy, and serious liver-related causes such as hepatic encephalopathy. See below for key red flags, when to seek urgent care, and practical next steps including tracking symptoms, reviewing medications, and getting sleep studies or liver testing with treatments that can restore alertness.
References:
D'Amico G, Garcia-Tsao G, & Pagliaro L. (2006). Natural history and prognostic indicators of survival in cirr… J Hepatol, 16310515.
Vilstrup H, Amodio P, Bajaj J, Cordoba J, Ferenci P, Mullen KD, et al. (2014). Hepatic encephalopathy in chronic liver disease: 2014 practice guidel… J Hepatol, 24837833.
Castera L. (2011). Non-invasive assessment of liver fibrosis: hepatic elastographe… J Hepatol, 21785243.
Q.
If naps make you feel worse, you’re napping ‘wrong’—or it’s not just naps.
A.
There are several factors to consider: naps often feel worse due to sleep inertia from sleeping longer than 20 minutes, poor timing late in the day, irregular habits, or a disruptive environment, so aim for a 10 to 20 minute early afternoon nap in a dark, cool, quiet space and ensure 7 to 9 hours of nighttime sleep. If you still wake groggy, look beyond naps since conditions like sleep apnea, thyroid problems, anemia, diabetes, or liver disease can cause nonrestorative sleep; see the complete guidance below for targeted fixes like alarms and coffee naps, red flags, and when to seek medical care.
References:
Pugh RN, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R. (1973). Transection of the oesophagus for bleeding oesophageal… Br J Surg, 4580474.
Sandrin L, Fourquet B, Hasquenoph JM, et al. (2003). Transient elastography: a new noninvasive method for assessment… Ultrasound Med Biol, 14698335.
D'Amico G, Garcia-Tsao G, Pagliaro L. (2006). Natural history and prognostic indicators of survival in cirrhosis:… J Hepatol, 16472747.
Q.
If you fall asleep mid-conversation, don’t ignore this detail.
A.
There are several factors to consider: nodding off mid-conversation can be due to narcolepsy, obstructive sleep apnea, sedating medicines or substances, metabolic issues like low sodium, liver problems such as hepatic encephalopathy, or other neurological conditions. See below to understand warning signs that need urgent care, including confusion, tremors, jaundice, chest pain, shortness of breath, and stroke signs, plus practical next steps like keeping a sleep diary, reviewing medications, improving sleep habits, getting blood tests and a sleep study, and using a symptom checker to guide your care.
References:
Vilstrup H, Amodio P, Bajaj J, et al. (2014). Hepatic encephalopathy in chronic liver disease: 2014 practice guideline by… Hepatology, 24746729.
Bajaj JS, Schubert CM, Saeian K, et al. (2009). Sleep disturbances in cirrhosis: relationship to hepatic… Clin Gastroenterol Hepatol, 19154751.
Kim WR, Biggins SW, Kremers WK, Wiesner RH, Kamath PS. (2008). Hyponatremia and mortality among patients on the… N Engl J Med, 18471714.
Q.
If you’re falling asleep while eating, your body is overriding you.
A.
Falling asleep mid bite is not normal post meal drowsiness and suggests your body is overriding wakefulness, with causes ranging from postprandial hypotension or low blood sugar to medication side effects, sleep disorders, and metabolic or liver disease. There are several factors to consider, and red flags like fainting, confusion, or injuries should prompt urgent care; see below for specific self care steps, when to involve a clinician, and the evaluations your doctor may use to find and treat the cause.
References:
European Association for the Study of the Liver. (2018). EASL clinical practice guidelines for the management of patients… Journal of Hepatology, 29843481.
Garcia-Tsao G, Abraldes JG, Berzigotti A, & Bosch J. (2017). Portal hypertensive bleeding in cirrhosis: risk stratification… Hepatology, 27711777.
D'Amico G, Garcia-Tsao G, & Pagliaro L. (2006). Natural history and prognostic indicators of survival in cirrhosis: a systematic… Journal of Hepatology, 16309526.
Q.
If your jaw drops when you laugh, this is what it can mean.
A.
Jaw dropping when you laugh is usually from TMJ hypermobility or strain, sometimes from prior injury, arthritis, or connective tissue disorders, and it is typically benign unless it recurs with pain, locking, clicking, or trouble chewing. There are several factors to consider, and urgent red flags such as inability to close your mouth, severe pain, airway swelling, or numbness need immediate care; see the complete guidance below for key signs, home steps like rest and ice, and when to see a doctor or consider neurologic causes.
References:
Kamath PS, & Wiesner RH. (2001). A model to predict survival in patients with end-stage liver disease. Hepatology, 11157951.
D'Amico G, Garcia-Tsao G, & Pagliaro L. (2006). Natural history and prognostic indicators of survival in… Journal of Hepatology, 16361040.
European Association for the Study of the Liver. (2018). EASL Clinical Practice Guidelines on decompensated cirrhosis. Journal of Hepatology, 29843082.
Q.
Microsleep can happen with your eyes open—here’s how to spot it.
A.
Microsleep episodes are involuntary, seconds-long sleep lapses that can happen even with eyes open, showing up as blank stares, head nods, slowed reactions, memory gaps, and automatic behaviors, especially with sleep deprivation, shift work, monotonous tasks, certain medications or alcohol, and sleep disorders like sleep apnea. They pose serious danger when driving or operating machinery, and there are several factors to consider. See below for full warning signs, who is most at risk, prevention strategies, and when to seek medical care or use a symptom check, as these details can shape your next healthcare steps.
References:
Torsvall L, & Akerstedt T. (1987). Sleepiness on the job: continuously measured EEG changes in… Scand J Work Environ Health, 3490836.
Lal SKL, & Craig A. (2001). A critical review of the psychophysiology of driver fatigue… Biol Psychol, 11732947.
Wong GLH, Choi PCY, Wong VW-S, Chan AW-H, Chim AML, Chan HLY. (2013). Risk prediction of clinical decompensation in patients with compensated cirrhosis… J Hepatol, 23402815.
Q.
Microsleep: what is it, why does it happen, and why it can be dangerous?
A.
Microsleep is a brief, involuntary lapse into sleep lasting a fraction of a second up to about 30 seconds, and it can be dangerous by causing attention failures that lead to crashes, workplace injuries, and serious errors. There are several factors to consider, including sleep deprivation, circadian low points, monotonous tasks, and sleep disorders such as sleep apnea; see below for complete details on warning signs, prevention, and when to seek medical care that could affect your next steps.
References:
Vyazovskiy VV, Olcese U, Hanlon EC, Nir Y, Cirelli C, & Tononi G. (2011). Local sleep in awake rats. Nature, 21572411.
Doran SM, Van Dongen HP, & Dinges DF. (2001). Sustained attention performance during sleep deprivation: evide… Arch Ital Biol, 11407972.
Schuppan D, & Afdhal NH. (2008). Liver cirrhosis. Lancet, 18328931.
Q.
Narcolepsy symptoms aren’t what most people think—here’s the real list.
A.
Narcolepsy involves more than feeling sleepy: beyond excessive daytime sleepiness, key signs include cataplexy, sleep paralysis, vivid hallucinations at sleep-wake transitions, fragmented nighttime sleep, and automatic behaviors, with possible weight changes, brain fog, mood issues, and safety risks. There are several factors to consider to get the right diagnosis and plan, including when to seek urgent help, how testing like PSG and MSLT works, and which lifestyle and medication options fit your situation. See below for the complete list of symptoms, common pitfalls and misdiagnoses, and next steps that could change your care.
References:
Barateau L, Lopez R, & Dauvilliers Y. (2017). Narcolepsy with cataplexy: Clinical features, pathophysiology, management… Sleep Med Rev, 27914642.
Dauvilliers Y, Arnulf I, & Mignot E. (2007). Narcolepsy with cataplexy. Lancet Neurol, 17681593.
Tsochatzis EA, Bosch J, & Burroughs AK. (2014). Liver cirrhosis. Lancet, 24270534.
Q.
Seeing things after you wake up? Your sleep stage may be to blame.
A.
Seeing things right after waking is usually brief and harmless hypnopompic hallucinations, caused by REM dream imagery spilling into wakefulness and often triggered by sleep loss, irregular schedules, stress, or sleep disorders like narcolepsy. There are several factors to consider, and persistent or distressing episodes or added symptoms can point to other causes such as low sodium or liver-related encephalopathy; red flags, practical sleep steps, and when to see a doctor are detailed below.
References:
Sharpless BA, & Barber JP. (2011). Lifetime prevalence rates of sleep paralysis: a systematic review… Sleep Med Rev, 21412036.
Kim WR, Biggins SW, Wiesner RH, Kamath PS, Benson JT, Kremers WK, Therneau TM, et al. (2008). Hyponatremia and mortality among patients on the liver-transplant waiting list… N Engl J Med, 18799558.
European Association for the Study of the Liver. (2014). EASL clinical practice guidelines for the management of patients with decompensated cirrhosis… Journal of Hepatology, 24986678.
Q.
Seeing things when waking up: sleep-related hallucinations vs mental health causes.
A.
Seeing things as you fall asleep or wake up is common and usually benign hypnagogic or hypnopompic hallucinations, typically brief and sometimes linked to poor sleep, stress, irregular schedules, or narcolepsy, and they often improve with better sleep habits. If hallucinations occur during full wakefulness, are frequent or frightening, involve voices or loss of insight, or come with mood changes, confusion, daytime sleepiness or cataplexy, substance use, or neurological symptoms, they may signal a mental health or medical condition and should be evaluated. There are several factors to consider, with key red flags, when to seek care, and the right next steps outlined below.
References:
Ohayon MM, Priest RG. (1999). Hypnagogic and hypnopompic hallucinations in the general popu… Sleep, 10367468.
Kamath PS, Wiesner RH. (2001). A model to predict survival in patients with end-stage liver disea… Hepatology, 11231850.
European Association for the Study of the Liver. (2014). EASL clinical practice guidelines for the management of patients with decompensated cirrh… Journal of Hepatology, 24986678.
Q.
Sleep apnea causes, concerns, and cures for women
A.
Sleep apnea in women is common yet often missed, driven by smaller airways, hormonal shifts around menopause, weight and neck fat, and conditions like hypothyroidism or PCOS, and it can lead to fatigue, insomnia, headaches, high blood pressure, heart disease, diabetes risk, mood changes, and safety concerns. Effective treatments include CPAP, oral appliances, weight loss and side sleeping, limiting alcohol and sedatives, surgical options, and in select postmenopausal cases hormone therapy. There are several factors to consider; see below for symptoms that can look different in women, how testing works, tips to make treatment succeed, and urgent warning signs so you can choose the right next steps.
References:
Ip MS, Lam B, Lauder IJ, et al. (2004). A community study of sleep-disordered breathing in middle-aged Chin… Respirology, 15352903.
Pien GW, Schwab RJ, Keenan BT, et al. (2006). Influence of sex hormones on sleep-disordered breathing in wo… Sleep, 16973626.
Sawyer AM, Gooneratne NS, Marcus CL, et al. (2011). A systematic review of CPAP adherence: real-world outco… Sleep Med Rev, 21258305.
Q.
Sleep apnea symptoms: What men should know
A.
Men are at higher risk for obstructive sleep apnea, and common signs include loud snoring with gasps or witnessed pauses, waking unrefreshed with morning headaches or dry mouth, excessive daytime sleepiness, trouble concentrating or irritability, and lower libido. There are several factors to consider, and untreated sleep apnea can raise the risk of high blood pressure, heart disease, stroke, diabetes, and accidents. See the complete details below for risk factors after 40, how to screen yourself, when to seek a sleep study, and the treatments that work such as CPAP, oral appliances, positional and lifestyle changes.
References:
Young T, Palta M, Dempsey J, Skatrud J, Weber S, & Badr S. (1993). The occurrence of sleep-disordered breathing among middle-aged… N Engl J Med, 8460120.
Heinzer R, Vat S, Marques-Vidal P, Marti-Soler H, Andries D, Tobback N, et al. (2015). Prevalence of sleep-disordered breathing in the general population: The HypnoLaus… Lancet Respir Med, 25747669.
Senaratna CV, Perret JL, Lodge CJ, Lowe AJ, Campbell BE, Matheson MC, et al. (2017). Prevalence of obstructive sleep apnea in the general population: A systematic… Sleep Med Rev, 27986995.
Q.
Sleep apnea symptoms: What women should watch for
A.
Women’s sleep apnea symptoms can be different and subtler than men’s, often showing up as insomnia and fragmented sleep, daytime fatigue and brain fog, mood changes, morning headaches or jaw pain, night sweats, frequent nighttime urination, palpitations, and dry mouth, with risk increasing after menopause. There are several factors to consider that could affect your next steps, from health risks and when to seek urgent care to how to track symptoms and get tested and treated; see below for the complete answer and a quick symptom check.
References:
Pien GW, & Schwab RJ. (2008). Sleep in women: Part 1: Epidemiology of sleep and its disorders in wome… Chest, 18685729.
Heinzer R, Vat S, Marques-Vidal P, Marti-Soler H, Andries D, Tobback N, et al. (2015). Prevalence of sleep-disordered breathing in the general populatio… Lancet Respir Med, 25713223.
Oldenburg O, Lamp B, Faber L, Penzel T, Peter JH, Herold J. (2009). Gender differences in obstructive sleep apnea: clinical polysomnograp… Sleep Med, 19586431.
Q.
Sleeping ‘enough’ but still tired? Here’s the plot twist.
A.
There are several factors to consider: even with 7 to 9 hours, poor sleep quality, sleep apnea, mood conditions, medications, nutrient deficits, chronic illnesses, and lifestyle patterns can still leave you exhausted; see below to understand more. The plot twist is that hidden liver problems, including cirrhosis and minimal hepatic encephalopathy, can disrupt your sleep wake cycle and cause brain fog, mood changes, digestive or bleeding signs, and may require specific testing and treatment, so check the important details, next steps, and red flags to act on below.
References:
Montagnese S, Middleton B, Laidler A, Morgan MY. (2011). Sleep and mood disturbances are common in cirrhotic patients… minimal hepatic encephalopathy. Journal of Hepatology, 21750015.
Ripoll C, Groszmann RJ, Garcia-Tsao G, et al. (2005). Hepatic venous pressure gradient predicts development of complications… in compensated cirrhosis. Journal of Hepatology, 15954736.
European Association for the Study of the Liver. (2018). EASL clinical practice guidelines for the management of patients with decompensated cirrhosis. Journal of Hepatology, 29374628.
Q.
Sleeping 10 hours and still tired: when is hypersomnia a concern?
A.
Sleeping 10 hours and still tired can be a concern if daytime sleepiness lasts for months, you unintentionally doze, or naps do not help; these features suggest hypersomnia and warrant evaluation. Common contributors include sleep apnea, depression or anxiety, thyroid problems, sedating medications, and liver disease, and doctors may use sleep studies, MSLT, and blood or liver tests to find the cause. There are several factors to consider, including red flags like loud snoring or gasping, confusion, or jaundice, plus practical self care and treatment options. See below for the complete answer and step-by-step next moves you can take with your clinician.
References:
Barateau L, & Arnulf I. (2017). Clinical and polysomnographic features of idiopathic hypersomnia… Sleep, 28748556.
Jepsen P, Ott P, Andersen PK, Sørensen HT, & Vilstrup H. (2014). Clinical course of cirrhosis: its complications and mortality. Journal of Hepatology, 24878320.
Castéra L, Vergniol J, Foucher J, Le Bail B, Chanteloup E, & Haaser A. (2005). Prospective comparison of FibroScan, FibroTest, APRI and liver biopsy… Gastroenterology, 15649754.
Q.
Sudden weakness when excited: cataplexy vs fainting vs anxiety—how to tell.
A.
Sudden weakness with excitement has three common patterns: cataplexy is emotion triggered limpness with full awareness for seconds, fainting usually starts with lightheadedness or sweating and leads to a brief blackout, and anxiety causes shakiness and generalized weakness without loss of muscle tone or consciousness. There are several factors to consider. See below for key triggers, duration differences, warning signs, when to seek urgent care, and what to track before talking with a doctor.
References:
Nishino S, Ripley B, Overeem S, Lammers GJ, & Mignot E. (2000). Hypocretin (orexin) deficiency in human narcolepsy. Lancet, 11085762.
Shen WK, Sheldon RS, Benditt DG, et al. (2017). 2017 ACC/AHA/HRS guideline for the evaluation and management of… Circulation, 28628650.
Castera L, Friedrich-Rust M, & Loomba R. (2019). Noninvasive assessment of liver disease in patients with nonalcoholic… Gastroenterology, 30682439.
Q.
Uncontrollable urge to sleep: when does it suggest a central hypersomnia?
A.
There are several clues that point to a central hypersomnia: an uncontrollable urge to sleep that persists despite 7 to 9 hours of regular sleep, daily unintended naps or pronounced sleep inertia, and narcolepsy features such as cataplexy, vivid hallucinations, or sleep paralysis; long unrefreshing sleep also supports this. There are several factors to consider, and confirmation typically involves a sleep specialist with sleep logs or actigraphy, an overnight polysomnogram, and a Multiple Sleep Latency Test, with urgent attention if safety is at risk such as drowsy driving; see below for important details that can guide your next steps.
References:
Morgenthaler TI, Kapur VK, Brown T, et al. (2007). Practice parameters for the treatment of narcolepsy and other… Sleep, 18246955.
D'Amico G, Garcia-Tsao G, Pagliaro L. (2006). Natural history and prognostic indicators of survival in cirrhosis… Journal of Hepatology, 16359928.
Castera L. (2012). Noninvasive methods to assess liver disease in patients with… Gastroenterology, 22484705.
Q.
Unrefreshing sleep: what does it suggest about sleep stages and disorders?
A.
Unrefreshing sleep often means your deep N3 and REM stages are fragmented or shortened, which can point to insomnia, obstructive sleep apnea, restless legs or periodic limb movements, narcolepsy, parasomnias, circadian rhythm disorders, and medical issues like depression, chronic pain, chronic fatigue syndrome, neurologic disease, or liver disease. There are several factors to consider; see below for how it is evaluated (sleep history, diaries, actigraphy, sleep studies), red flags that warrant prompt care, and targeted treatments such as CBT-I, CPAP, iron when ferritin is low, circadian therapies, lifestyle changes, and management of underlying conditions.
References:
Sateia MJ. (2014). International classification of sleep disorders-third edi… Chest, 25251262.
Schutte-Rodin S, Broch L, Buysse D, Dorsey C, & Sateia M. (2008). Clinical guideline for the evaluation and management of chro… J Clin Sleep Med, 19783910.
European Association for the Study of the Liver. (2018). EASL clinical practice guidelines for the management of patients… Journal of Hepatology, 30145933.
Q.
Warning signs to watch for if sleep is becoming an issue
A.
Warning signs include trouble falling or staying asleep, feeling unrefreshed, taking over 30 minutes to fall back asleep, and daytime problems like persistent sleepiness, poor concentration, irritability, headaches, weight or blood pressure changes, and safety risks such as microsleeps or acting out dreams. There are several factors to consider, so see below to understand more, including when symptoms that occur at least three times a week for more than three weeks, reliance on sleep aids, loud snoring with gasping, or severe daytime drowsiness should prompt medical evaluation and guide your next steps in care.
References:
Morin CM, LeBlanc M, Daley M, Grégoire JP, Mérette C. (2006). Epidemiology of insomnia: prevalence, course, risk factors… Sleep Med Rev, 16581296.
Owens J. (2014). Insufficient sleep in adolescents and young adults: an update… Pediatrics, 25349335.
Chattu VK, Yadav S, Kumar R, Free RC, Pandi-Perumal SR. (2019). The global problem of insufficient sleep and its serious public… Healthcare (Basel), 31591624.
Q.
What causes insomnia in women?
A.
Insomnia in women often results from hormonal changes (menstrual cycle, pregnancy, perimenopause and menopause), mental health issues (stress, anxiety, depression, trauma), lifestyle patterns (irregular schedules, caffeine, alcohol, nicotine, evening screens or late workouts), medical conditions and pain (arthritis, reflux, asthma or sleep apnea, thyroid problems), and side effects from medications or supplements. There are several factors to consider. See below to understand more, including how caregiving and work demands influence sleep, which red flags mean you should see a clinician, and the specific steps and treatments like CBT-I and sleep hygiene that can guide your next moves.
References:
Bromberger JT, & Assmann SF. (2010). Correlates of insomnia, short sleep, and daytime sleepiness in a multiethnic… Sleep, 20308657.
Woods NF, & Mitchell ES. (2001). Sleep symptoms during the menopausal transition and early postmenopause: observat… Sleep, 11704978.
Mallampalli MP, & Carter CL. (2015). Exploring sex and gender differences in sleep health: a Society for Women's Health Resea… J Womens Health (Larchmt), 25153527.
Q.
What causes insomnia?
A.
Insomnia is usually caused by a combination of medical factors (pain, sleep apnea, hormonal or neurologic conditions, medications and substances), psychological factors (stress, anxiety, depression, trauma), and behavioral or environmental factors (irregular schedules, screen use before bed, stimulating activities late, noise, light, circadian disruption). There are several factors to consider. See below to understand more about specific triggers, risk factors, warning signs, and evidence-based treatments like CBT-I and targeted lifestyle changes, which can influence the right next steps in your healthcare journey.
References:
Roth T. (2007). Insomnia: definition, prevalence, etiology, and consequences. J Clin Sleep Med, 18274273.
Perlis ML, Giles DE, Mendelson WB, Bootzin RR, & Wyatt JK. (2001). Psychophysiological insomnia: the behavioural model and a neu… Sleep Med Rev, 11568856.
Harvey AG. (2002). A cognitive model of insomnia. Behav Res Ther, 12126253.
Q.
What is obstructive sleep apnea?
A.
Obstructive sleep apnea is a common sleep disorder in which throat muscles relax too much during sleep, repeatedly narrowing or blocking the airway and causing brief breathing pauses that lower oxygen and disrupt restorative sleep. It can cause loud snoring and daytime sleepiness and raises risks for high blood pressure, heart disease, stroke, and diabetes, but it is diagnosable and treatable with options like lifestyle changes, CPAP, and oral appliances. There are several factors to consider for symptoms, testing, and treatment choice, so see the complete details below to guide your next steps.
References:
Jordan AS, McSharry DG, & Malhotra A. (2014). Adult obstructive sleep apnoea. Lancet, 24309402.
Senaratna CV, Perret JL, Lodge CJ, Lowe AJ, Campbell BE, Matheson MC, & Hamilton GS. (2017). Prevalence of obstructive sleep apnea in the general population: a systematic review. Sleep Med Rev, 28319246.
Epstein LJ, Kristo D, Strollo PJ Jr, Friedman N, Malhotra A, Patil SP, Ramar K, Rogers R, Schwab RJ, Weaver TE, & Weinstein MD. (2009). Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med, 19330858.
Q.
Why am I so sleepy during the day—even after a full night’s sleep?
A.
There are several factors to consider; even after a full night in bed, daytime sleepiness often comes from irregular sleep schedules, fragmented sleep, diet or hydration issues, limited activity, or underlying problems like sleep apnea, narcolepsy, restless legs, thyroid or iron deficiency, liver disease, medication side effects, depression, or anxiety. See below to understand more. If sleepiness persists or you have red flags such as loud snoring with gasping, morning headaches, confusion, or sudden sleep attacks, seek medical care, and see below for the full checklist of when to worry, the Epworth Sleepiness Scale, testing your doctor may order, and practical steps to improve alertness.
References:
Johns MW. (1991). Reliability and factor analysis of the Epworth Sleepiness… Sleep, 1798888.
D'Amico G, Garcia-Tsao G, & Pagliaro L. (2006). Natural history and prognostic… Journal of Hepatology, 16517467.
Castera L, Forns X, & Alberti A. (2008). Non-invasive evaluation of liver fibrosis using… Journal of Hepatology, 15982761.
Q.
Women over 30: What doctors wish you knew about sleep hygiene
A.
Women over 30, sleep hygiene is essential for mood, focus, weight, heart, and hormone health; perimenopausal shifts, stress, evening screens and caffeine, irregular schedules, late vigorous workouts, and light or heat in the bedroom commonly disrupt sleep. Consistent bed and wake times, a cool dark quiet room, earlier exercise and meals, limited alcohol and caffeine, and a screen free wind down often restore deeper sleep and energy. There are several factors to consider that can shape your next steps. See below for pitfalls to avoid, how to track your sleep, and when to seek care for red flags like loud snoring or gasping, restless legs, or insomnia beyond 3 months, plus effective treatments such as CBT-I.
References:
Irish LA, Kline CE, Gunn HE, Buysse DJ, & Hall MH. (2015). The role of sleep hygiene in promoting public health: a revi… Sleep Medicine Reviews, 25459849.
Mastin DF, Bryson J, & Corwyn R. (2006). Assessment of sleep hygiene using the Sleep Hygiene Index. Journal of Behavioral Medicine, 16712403.
Morgenthaler TI, Kramer M, Alessi C, Friedman L, Boehlecke B, Brown T, Coleman J Jr, Kapur V, Lee-Chiong T Jr, Pancer J, & Swick TJ. (2006). Practice parameters for the psychological and behavioral trea… Sleep, 17162976.
Q.
65+ How to cure insomnia fast
A.
For fast relief, focus on tonight: keep your room cool, dark, and quiet, follow a 30 to 60 minute wind-down without screens, stop caffeine by early afternoon, avoid late alcohol, practice 4-7-8 breathing, and get out of bed after 15 to 20 minutes awake to reset. For adults 65+, the most effective path combines CBT-I for lasting results with careful use of melatonin (consider 2 mg prolonged-release) and only short-term sleep meds if needed because of higher risks like falls and next-day grogginess, and rule out sleep apnea, restless legs, or mood disorders. There are several factors to consider; see below for key details that can guide your next steps.
References:
Trauer JM, Qian MY, Doyle JS, Rajaratnam SM, & Cunnington D. (2015). Cognitive behavioral therapy for chronic insomnia: a systematic revie… Ann Intern Med, 25560703.
Sateia MJ, Buysse DJ, Krystal AD, Neubauer DN, & Heald JL. (2017). Clinical practice guideline for the pharmacologic treatment… J Clin Sleep Med, 28334728.
Wade AG, Ford I, Crawford G, McMahon AD, Nir T, Laudon M, & Zisapel N. (2007). Efficacy of prolonged‐release melatonin in insomnia… Curr Med Res Opin, 17538944.
Q.
65+ How to improve sleep hygiene
A.
For adults 65 and older, better sleep comes from a consistent schedule, a cool dark quiet bedroom, a screen free wind down, limiting afternoon caffeine and evening alcohol, regular daytime exercise and morning light, brief early naps, and evidence based tools like stimulus control, sleep restriction, relaxation, and mindfulness. There are several factors to consider; see below for step by step routines, environment upgrades, and tips tailored to older adults. Seek medical advice for loud snoring or gasping, restless legs, significant daytime sleepiness, mood symptoms, pain, or medication related sleep disruption, since these can change the best next steps; details on when to get help and how to implement changes safely are outlined below.
References:
Lichstein KL, Wilson NM, Johnson CT. (1994). Sleep hygiene and stimulus control instructions for late-f... Psychol Aging, 7787881.
Reid KJ, Baron KG, Lu B, Naylor E, Wolfe L, Zee PC. (2010). Aerobic exercise improves self-reported sleep and quality of f... Sleep Med, 20561557.
Edinger JD, Arnedt JT, Bertisch SM, Carney CE, Harrington JJ, Lichstein KL, Sateia MJ. (2021). Behavioral and psychological treatments for chronic insomnia... J Clin Sleep Med, 33599008.
Q.
8 hours and still tired? This is the thing nobody checks.
A.
There are several factors to consider: the often missed culprit is circadian misalignment, and other common causes include poor sleep quality from apnea or limb movements, underlying conditions, certain medications or substances, and an unhelpful sleep environment. See below for the complete answer with specific next steps like sleep diary tips, morning light and schedule resets, bedroom tweaks, which labs to ask for, when to consider a sleep study, and the red flags that should change your plan.
References:
D'Amico G, Garcia‐Tsao G, & Pagliaro L. (2006). Natural history and prognostic indicators of survival in cirrhosis: a systematic… Journal of Hepatology, 16730683.
Kamath PS, & Wiesner RH. (2001). A model to predict survival in patients with end‐stage liver disease. Hepatology, 11157951.
Montagnese S, Middleton B, Skene DJ, & Morgan MY. (2010). Sleep‐wake abnormalities in patients with cirrhosis. Clinical Gastroenterology and Hepatology, 19854064.
Q.
Brain fog + sleepiness? This combo points somewhere specific.
A.
Brain fog with daytime sleepiness has several causes, from lifestyle factors to medical conditions like sleep apnea, anemia, hypothyroidism, blood sugar problems, and, if you have liver disease risk, hepatic encephalopathy. There are several factors to consider and important differences that change next steps; see the complete details below, including red flags, specific tests to ask for, and when to seek urgent care.
References:
Ferenci P, & Lockwood A. (2002). Hepatic encephalopathy—definition, nomenclature, diagnosis, and quantification: final report of the working party at the 11th World Congress of Gastroenterology, Vienna, 1998. Hepatology, 11870315.
Kamath PS, & Wiesner RH. (2001). A model to predict survival in patients with end‐stage liver disease. Hepatology, 11157951.
D'Amico G, Morabito A, D'Amico M, Pasta L, Malizia G, Rebora P, & Pagliaro L. (2004). Clinical states of cirrhosis and competing risks. Journal of Hepatology, 14975425.
Q.
Can sleep apnea be cured?
A.
Sleep apnea is usually managed rather than permanently cured, but some people can achieve resolution depending on the cause and treatment. Mild obstructive cases may resolve with weight loss and lifestyle changes; CPAP controls breathing while used but is not a cure; oral appliances can help in mild to moderate cases; and select surgeries like hypoglossal nerve stimulation or maxillomandibular advancement can be curative with proper follow-up. There are several factors to consider and important tradeoffs, so see the complete details below to understand options and which next steps to take with your clinician.
References:
Strollo PJ, & Soose RJ. (2014). Upper-airway stimulation for obstructive sleep apnea… New England Journal of Medicine, 24293614.
Iftikhar IH, & Curcio AC. (2014). Weight loss for obstructive sleep apnea: a systematic… Cochrane Database Syst Rev, 24978086.
Holty JE, & Guilleminault C. (2010). Maxillomandibular advancement for treatment of… Chest, 20495183.
Q.
Can sleep apnea kill you and what to do right now
A.
Yes, untreated sleep apnea can be life threatening, increasing the risk of heart attack, stroke, arrhythmias, and early death, but prompt diagnosis and treatment such as CPAP can sharply reduce these dangers; there are several factors to consider, and key details that could change your next steps are outlined below. Right now, do an online symptom check, speak with a doctor about a sleep study, and start simple steps like side sleeping, avoiding alcohol at night, elevating the head of the bed, and working on weight loss if needed. If you have chest pain, severe sleepiness while driving, or new palpitations, seek urgent care and then review the complete guidance below.
References:
Marin JM, Carrizo SJ, Vicente E, & Agusti AG. (2005). Long-term cardiovascular outcomes in men with obstructive… Lancet, 15781100.
Gottlieb DJ, Yenokyan G, Newman AB, et al. (2010). Association of sleep-disordered breathing and daytime sleepiness… JAMA, 20194870.
Yu J, Zhou Z, McEvoy RD, et al. (2016). Continuous positive airway pressure reduces the risk of cardiovascular ev… Respirology, 25523678.
Q.
Can’t stay awake at work: what symptoms point to a sleep disorder vs burnout?
A.
There are several factors to consider. See below to understand more. Clues for a sleep disorder include excessive daytime sleepiness despite enough time in bed, nonrestorative or fragmented sleep, insomnia, loud snoring or gasping, leg discomfort or an irresistible urge to move, and dozing in inappropriate situations, while burnout more often shows emotional exhaustion, cynicism, reduced effectiveness, and loss of motivation with otherwise normal sleep and quick sleep onset; see below for guidance on tracking symptoms, the Epworth Sleepiness Scale, practical sleep and stress steps, when to see a specialist, and urgent red flags like nodding off while driving or choking gasps at night.
References:
Ohayon MM. (2002). Epidemiology of insomnia: what we still need to learn. Sleep Med Rev, 14580670.
Johns MW. (1991). A new method for measuring daytime sleepiness: the Epworth sleepiness … Sleep, 1798888.
European Association for the Study of the Liver; Asociacion Latinoamericana para el Estudio del Higado. (2019). EASL-ALEH clinical practice guidelines: non-invasive … J Hepatol, 30849875.
Q.
Cataplexy symptoms: what do episodes look like, and what triggers are classic?
A.
Cataplexy episodes are sudden, brief drops in muscle tone with preserved awareness, lasting seconds to a couple of minutes and ranging from eyelid or jaw slackening and knee buckling to complete collapse. Classic triggers are strong emotions like laughter, humor, surprise, excitement, anger, and pleasure, sometimes even a mild smile. There are several factors to consider; see below for key differences from seizures or fainting, when to seek evaluation, and treatments that could guide your next steps.
References:
Scammell TE. (2015). Narcolepsy: clinical features, pathophysiology, and… N Engl J Med, 26283068.
Nishino S, Ripley B. (2008). Mechanisms of cataplexy in narcolepsy: insights… Sleep Med Rev, 18402703.
European Association for the Study of the Liver. (2018). EASL clinical practice guidelines for the management of patients with decompensated cirrhosis… J Hepatol, 30434533.
Q.
Collapse when laughing but still awake: is this cataplexy and what should you do next?
A.
Sudden collapse with full awareness during laughter strongly suggests cataplexy, a hallmark of narcolepsy type 1, but conditions like vasovagal syncope, seizures, or cardiac problems can present similarly. Next steps include documenting episodes, seeing your primary care doctor, and asking for a sleep specialist or neurologist evaluation with tests such as overnight polysomnography and a Multiple Sleep Latency Test; seek urgent care if you have blackout, chest pain, shortness of breath, confusion, or seizure-like activity. There are several factors to consider; see below for specific red flags, diagnostic criteria, and treatment options that may change what you do next.
References:
Dauvilliers Y, Arnulf I, & Mignot E. (2007). Narcolepsy with cataplexy. Lancet, 17208040.
Marcellin P, Ziol M, Bedossa P, et al. (2005). Non-invasive assessment of liver fibrosis by transient elastography (FibroScan): a… Lancet, 16198767.
D'Amico G, Garcia-Tsao G, & Pagliaro L. (2006). Natural history and prognostic indicators of survival in cirrhosis. Semin Liver Dis, 16555063.
Q.
Daytime sleepiness causes: how do you narrow down what’s actually driving it?
A.
There are several factors to consider: start by scoring yourself with the Epworth Sleepiness Scale, then systematically review sleep habits, screen for sleep disorders like obstructive sleep apnea or narcolepsy, check for medical causes with basic labs, review medications and substances, assess lifestyle and stress, track patterns, and consider targeted sleep studies; see details below. Because persistent or severe sleepiness can signal urgent problems, the red flags and step by step guidance below can change which next steps you take with your clinician.
References:
Bassetti CL, & Aldrich MS. (2005). Excessive daytime sleepiness: clinical spectrum and pathophysi… Sleep Med Rev, 16142305.
Johns MW. (1991). A new method for measuring daytime sleepiness: the Epworth… Sleep, 1798888.
Wai CT, Greenson JK, Fontana RJ, et al. (2003). A simple noninvasive index can predict both significant… Hepatology, 12849779.
Q.
Do I have narcolepsy: what symptoms matter most and what tests diagnose it?
A.
The symptoms that matter most are persistent excessive daytime sleepiness that disrupts life, cataplexy triggered by strong emotions, and REM-related events such as sleep paralysis and vivid hallucinations. Diagnosis is made with an overnight polysomnography and a Multiple Sleep Latency Test showing a mean sleep latency of 8 minutes or less and at least two sleep onset REM periods, with CSF hypocretin testing and HLA typing used in select cases after ruling out other causes like sleep apnea and medications. There are several factors to consider; see below for important details and next steps, including what to track and when to see a sleep specialist.
References:
Arnulf I, & Mignot E. (2015). Narcolepsy: clinical features, diagnosis, and treatment of exces… Sleep Med Rev, 25619611.
D'Amico G, Garcia-Tsao G, & Pagliaro L. (2006). Natural history and prognostic indicators of survival in cirrhosis… Hepatology, 16934884.
Castera L, Forns X, & Alberti A. (2005). Prospective comparison of transient elastography, serum markers, and… Gastroenterology, 15649714.
Q.
Do I have sleep attacks: how are sleep attacks defined clinically?
A.
Clinically, sleep attacks are irresistible, sudden episodes of involuntary sleep and overwhelming daytime sleepiness that occur despite adequate opportunity for nighttime sleep. They are classically linked to narcolepsy, which is diagnosed after at least 3 months of excessive daytime sleepiness plus an MSLT showing mean sleep latency 8 minutes or less with at least two sleep onset REM periods, with cataplexy or low hypocretin supporting Type 1; idiopathic hypersomnia presents similar sleepiness without the REM findings. There are several factors to consider, including other causes like sleep apnea, circadian disruption, and sedating medications, and diagnosis typically requires an overnight sleep study followed by an MSLT. See below for red flags, next steps, and treatment options that could affect what you should do now.
References:
Sateia MJ. (2014). International classification of sleep disorders-third edition: hig… Chest, 25403585.
D'Amico G, Garcia-Tsao G, Pagliaro L. (2006). Natural history and prognostic indica… Hepatology, 16893334.
Garcia-Tsao G, Friedman S, Iredale J, Pinzani M. (2010). Now there are many 'stages' in cirrhosis. Journal of Hepatology, 20701666.
Q.
Eyes won’t stay open? This is what your nervous system may be doing.
A.
Difficulty keeping your eyes open during the day often comes from the nervous system, either lowered arousal in brainstem wakefulness pathways or faulty signaling to the eyelid-lifting muscles. There are several factors to consider, including excessive daytime sleepiness from poor sleep, sleep apnea, narcolepsy or medications, eyelid and movement disorders like blepharospasm or myasthenia, and metabolic problems such as hypothyroidism or anemia; see below for specific warning signs, self-checks like the Epworth scale, which tests and treatments may help, and when to seek care.
References:
Johns MW. (1991). A new method for measuring daytime sleepiness: the Epworth Sleepiness Scale. Sleep, 14(6):540–545. 1798888.
Jankovic J, Orman J. (1989). Botulinum toxin treatment of blepharospasm. Neurology, 39(1):40–44. 2915947.
Kim WR, Biggins SW. (2010). Sodium improves the Model for End-Stage Liver Disease (MELD) score prediction of mortality on the liver transplant waiting list. Liver Transpl, 16(9):1131–1137. 20431017.
Q.
Face droops when I laugh: how to separate cataplexy-like episodes from stroke signs.
A.
Facial droop that happens only with laughter, resolves in seconds, and often affects both sides with full awareness suggests cataplexy, whereas one-sided droop that persists or comes with arm weakness, speech trouble, vision changes, confusion, severe headache, or balance issues points to stroke or TIA and needs emergency care. There are several factors to consider, including triggers, duration, laterality, and associated symptoms. See below for details, red flags, and next steps, including when to call 911 and when to arrange a sleep specialist evaluation.
References:
Dauvilliers Y, Arnulf I, & Mignot E. (2007). Narcolepsy with cataplexy. Lancet Neurol, 17542576.
Zinkstok SM, Ramos LA, & Siegert CE, et al. (2013). Stroke mimics: frequency, aetiology, and outcome. J Neurol Neurosurg Psychiatry, 23704918.
Foucher J, Chanteloup E, & Vergniol J, et al. (2006). Transient elastography for the noninvasive evaluation of liver fibrosis. Hepatology, 16624233.
Q.
Falling asleep at work: when should you talk to a doctor or sleep specialist?
A.
See a doctor or sleep specialist if you keep nodding off at work three or more times a week, have microsleeps, feel drowsy while driving or using equipment, need caffeine to function, or have morning headaches, loud snoring, gasping at night, or fatigue that disrupts daily life. There are several factors to consider, from poor sleep habits and shift work to sleep apnea, narcolepsy, anemia, thyroid or blood sugar problems, and more. See below for the full list of red flags, safety risks, what to expect at an appointment, and practical steps you can start now.
References:
Philip P, Sagaspe P, Taillard J, et al. (2014). Impact of daytime sleepiness on occupational accidents: a systematic review. Sleep Med Rev, 24365305.
European Association for the Study of the Liver & Asociacion Latinoamericana para el Estudio del Higado. (2015). EASL–ALEH clinical practice guidelines: non-invasive tests for evaluation of liver disease severity and prognosis. Journal of Hepatology, 25865602.
Kamath PS & Kim WR. (2007). The model for end-stage liver disease (MELD). Hepatology, 17159428.
Q.
Falling asleep while talking: is this microsleep, seizures, or a sleep disorder?
A.
There are several factors to consider: brief microsleeps from sleep loss often last seconds and resolve quickly, seizures such as nocturnal frontal lobe epilepsy tend to be stereotyped around sleep transitions with amnesia, and sleep disorders like narcolepsy or sleep apnea cause persistent daytime sleepiness with features like cataplexy, snoring, or sleep paralysis. Seek care promptly if episodes are frequent, longer than a few seconds, cause injuries, or include confusion, jerking, weakness, or vision changes; evaluation may include sleep studies, EEG, and blood tests, with treatments ranging from sleep hygiene and CPAP to antiepileptic or wake‑promoting medications. See below for how to tell them apart and next steps, including a free online symptom check, because details like duration, triggers, witness reports, and associated symptoms can change what you should do next.
References:
Scammell TE. (2015). Narcolepsy. New England Journal of Medicine, 26066714.
Goulding MR, & So EL. (1995). Differentiation of nocturnal frontal lobe epilepsy… Neurology, 7784564.
Gines P, & Quintero E. (1987). Compensated cirrhosis: natural history and prognostic… Journal of Hepatology, 2953420.
Q.
Falling asleep while working: what’s the medical workup for excessive sleepiness?
A.
There are several factors to consider. See below for details on how a medical workup starts with a detailed sleep history, a two-week sleep diary, the Epworth Sleepiness Scale, a physical exam, and basic labs to rule out sleep deprivation, medication effects, anemia, thyroid or metabolic issues, mood disorders, and other common causes. If risks point to a sleep disorder, testing typically proceeds to in-lab polysomnography and, if needed, a Multiple Sleep Latency Test to evaluate for sleep apnea, narcolepsy, idiopathic hypersomnia, circadian disorders, or limb movement disorders, with red flags like drowsy driving, witnessed apneas, or sudden weakness requiring urgent care. Important nuances that may change your next steps are outlined below.
References:
Chesson AL Jr, Anderson WM, Littner M, et al. (2005). Practice parameters for the indications for polysomnography and… Sleep, 15898576.
Johns MW. (1991). A new method for measuring daytime sleepiness: the Epworth Sleepiness… Sleep, 1798888.
Castera L, Foucher J, Bernard PH, et al. (2005). Prospective comparison of transient elastography, FibroTest, APRI, and liver biopsy for… Gastroenterology, 16337874.
Q.
Feeling paralyzed as you fall asleep? Your brain may be misfiring a switch.
A.
Feeling paralyzed as you drift off is usually sleep paralysis, a brief and generally harmless misfire of the brain’s REM atonia switch that leaves you conscious while your muscles stay temporarily offline. There are several factors to consider, including sleep loss, irregular schedules, stress, back-sleeping, and related conditions like sleep apnea or narcolepsy; improving sleep habits and changing sleep position often helps, but seek care if episodes are frequent, very distressing, or you have daytime sleepiness or loud snoring. See below for key warning signs, prevention steps, and how to decide on next steps in your healthcare journey.
References:
Mahowald MW, & Schenck CH. (2005). Insights from studying human sleep disorders… Nature, 16221010.
Kamath PS, & Wiesner RH. (2001). A model to predict survival in patients with end-stage liver disease… Hepatology, 11157951.
D'Amico G, Garcia-Tsao G, & Pagliaro L. (2006). Natural history and prognostic indicators of survival in cirrhosis… Journal of Hepatology, 16387305.
Q.
Fighting sleep at work? There’s one pattern that matters.
A.
The single pattern that matters most is your 24-hour light and dark exposure, which sets your circadian rhythm; get bright morning light, dim evening light, and keep a consistent sleep and wake schedule to boost alertness at work. There are several factors to consider. See the complete answer below for quick daytime fixes like movement, hydration, smart snacking, caffeine timing, and brief early afternoon naps, plus red flags that suggest sleep apnea, thyroid or iron problems, and how to use a simple symptom check and seek medical care.
References:
Wright KP Jr, McHill AW, Birks BR, Griffin BR, Rusterholz T, Chinoy ED. (2013). Entrainment of the human circadian clock to the natural ligh… Curr Biol, 23972892.
Sandrin L, Fourquet B, Hasquenoph JM, Yon S, Fournier C, Mal F, et al. (2003). Transient elastography: a new noninvasive method for assessmen… Ultrasound Med Biol, 14711332.
European Association for the Study of the Liver. (2018). EASL clinical practice guidelines on decompensated cirrhosis… Journal of Hepatology, 29613289.
Q.
Hallucinations when waking up: when are hypnopompic hallucinations a concern?
A.
Hypnopompic hallucinations are vivid, dream-like experiences on waking that are usually brief and harmless; there are several factors to consider. See below to understand more. They are a concern if they are frequent or last more than a few minutes, are intensely frightening, occur with sleep paralysis longer than a minute, cause daytime sleepiness or concentration problems, or come with neurological symptoms or signs of narcolepsy. See below for key red flags, triggers, evaluation steps, and treatments that could change your next steps.
References:
Sateia MJ, Buysse DJ, Krystal AD, Neubauer DN, & Schnyer DM. (2014). Hypnagogic and hypnopompic hallucinations: evaluation and management of sleep‐related… Sleep Medicine Reviews, 25468195.
Kamath PS, Wiesner RH, Malinchoc M, et al. (2001). A model to predict survival in patients with end‐stage liver disease… Hepatology, 11157951.
Foucher J, Chanteloup E, Vergniol J, Castéra L, Le Bail B, Adhoute X, Bertet J, Couzigou P, & de Lédinghen V. (2006). Diagnosis of cirrhosis by transient elastography (FibroScan): a prospective… Hepatology, 16963571.
Q.
Hearing voices when falling asleep: sleep transition phenomenon or something else?
A.
Most brief voices as you fall asleep are hypnagogic hallucinations, a common and usually harmless sleep transition that often improves with consistent sleep, stress reduction, and limiting substances. There are several factors to consider, including sleep loss, medications or alcohol, and sleep disorders like narcolepsy; see a clinician if episodes are frequent or distressing, occur when fully awake, or come with daytime sleepiness or sudden muscle weakness. See below for important details and specific next steps that could guide your care.
References:
Ohayon MM, Priest RG, Caulet M, & Guilleminault C. (1996). Hypnagogic and hypnopompic hallucinations in the general population:… Sleep, 9029101.
Kamath PS, & Wiesner RH. (2001). A model to predict survival in patients with end-stage liver disease. Hepatology, 11157951.
European Association for the Study of the Liver. (2015). EASL-ALEH clinical practice guidelines: Non-invasive tests for evaluation of liver disease… J Hepatol, 26115386.
Q.
Idiopathic hypersomnia symptoms: what defines it and how is it diagnosed?
A.
There are several factors to consider: idiopathic hypersomnia is defined by persistent, overwhelming daytime sleepiness despite adequate or long nighttime sleep, unrefreshing long naps, and difficulty waking, without cataplexy and without another condition explaining it. Diagnosis is clinical plus testing after ruling out other causes and typically includes sleep diaries or actigraphy, overnight polysomnography, and a next-day multiple sleep latency test showing mean sleep latency 8 minutes or less with fewer than two SOREMPs, or extended monitoring documenting more than 11 hours of total sleep time; there are important nuances that can change next steps, so see below for key criteria, look-alikes to rule out, and when to seek specialist care.
References:
Dauvilliers Y, Arnulf I, & Mignot E. (2013). Idiopathic hypersomnia: epidemiology, pathophysiology, and management… Neuropsychiatric Disease and Treatment, 23539721.
American Academy of Sleep Medicine. (2014). International classification of sleep disorders–third edition: diagnostic criteria for idiopathic hypersomnia… Sleep, 24482479.
Castera L, Foucher J, Bernard PH, et al. (2005). Comparison of transient elastography (FibroScan) with liver biopsy for the assessment of liver fibrosis in chronic hepatitis C… Gastroenterology, 15633165.
Q.
If 10 hours isn’t enough… it’s not laziness.
A.
Sleeping more than 10 hours and still feeling exhausted is rarely laziness and often points to fixable causes like sleep apnea, hypothyroidism, anemia, depression or anxiety, medication effects, poor sleep habits, chronic fatigue syndrome, and sometimes serious problems such as advanced liver disease or electrolyte imbalances; seek urgent care for red flags like confusion, chest pain, shortness of breath, swelling, severe headache, or fainting. There are several factors to consider. Key next steps include tracking sleep, optimizing sleep hygiene, reviewing medications, and asking a clinician about tests such as a CBC, TSH, liver function tests, electrolytes, and a sleep study, plus mental health support and exercise; see below for complete details that can guide which actions to take and when to contact a doctor right away.
References:
European Association for the Study of the Liver. (2018). EASL clinical practice guidelines on decompensated cirrhosis. Journal of Hepatology, 30282811.
Kim WR, Biggins SW, Kremers WK, Wiesner RH, Kamath PS, Benson JT, Therneau TM, & Rosen CB. (2006). Hyponatraemia and mortality among patients on the liver-transplant… N Engl J Med, 16879930.
D'Amico G, Garcia-Tsao G, & Pagliaro L. (2001). Natural history, prognostic indicators, and risk stratification… Gastroenterology, 11141109.
Q.
If laughter makes you weak, it’s not ‘just being tired.’
A.
Sudden muscle weakness with laughter is not just fatigue; it can point to cataplexy from narcolepsy, neuromuscular conditions like myasthenia gravis or Lambert Eaton myasthenic syndrome, electrolyte disturbances, or liver issues such as cirrhosis or hepatic encephalopathy. There are several factors to consider. See below for red flags like confusion, drooping eyelids or swallowing trouble, jaundice, or excessive daytime sleepiness, along with the tests and treatments that could change your next steps.
References:
Tandon P, Low G, Mourtzakis M, et al. (2012). Severe muscle depletion in patients with cirrhosis predicts post… Liver transplantation, 22689494.
D'Amico G, Garcia-Tsao G, Pagliaro L. (2006). Natural history and prognostic indicators of survival in cirrhosis: a systematic review… Journal of Hepatology, 16466611.
Vilstrup H, Amodio P, Bajaj J, et al. (2014). Hepatic encephalopathy in chronic liver disease: 2014 practice guidelines… Journal of Hepatology, 24612506.
Q.
If you can’t move when waking up, don’t just blame ‘bad sleep.’
A.
There are several factors to consider. Brief, self limited sleep paralysis is common, but waking immobility can also signal urgent problems like stroke or seizure, metabolic issues such as hepatic encephalopathy or severe electrolyte disturbances, or neuromuscular disorders. Seek care now for one sided weakness, slurred speech, facial droop, severe headache, confusion, or episodes lasting more than a few minutes or recurring, and see below for key red flags, what to track, and the tests and treatments that can guide your next steps.
References:
Felipo V. (2013). Hepatic encephalopathy: pathophysiological aspects and clinical management. World J Gastroenterol, 23667729.
Castera L, Forns X, & Alberti A. (2005). Prospective comparison of transient elastography, FibroTest, and APRI for the… Gastroenterology, 15833273.
European Association for the Study of the Liver. (2022). EASL Clinical Practice Guidelines on decompensated cirrhosis. Journal of Hepatology, 34905740.
Q.
If you fall asleep in class, you might be fighting your brain’s wiring.
A.
Falling asleep in class often reflects brain wiring, not laziness, when your homeostatic sleep drive fueled by adenosine and your circadian clock are out of sync with lecture times. There are several factors to consider, including sleep debt, poor sleep quality, late night light exposure, classroom environment, nutrition and hydration, medications, and underlying health issues. See below for simple in-class tactics, longer term circadian realignment tips, and red flags that should prompt medical care.
References:
D'Amico G, Garcia-Tsao G, & Pagliaro L. (2006). Natural history and prognostic indicators of survival in cirrhosis… Journal of Hepatology, 16466668.
Kim WR, Biggins SW, Kremers W, Wiesner RH, Kamath PS, & Benson JT. (2008). Hyponatremia and mortality on the liver-transplant waiting list. New England Journal of Medicine, 18799545.
Ripoll C, Groszmann R, Garcia-Tsao G, et al. (2007). Hepatic venous pressure gradient predicts clinical decompensation… Gastroenterology, 17631160.
Q.
If you have cataplexy symptoms, emotions may be the ‘on switch.’
A.
Emotions can be the on switch for cataplexy: sudden, brief loss of muscle tone with preserved awareness that is often triggered by laughter, surprise, excitement, or anger, commonly in narcolepsy type 1 where hypocretin is low. There are several factors to consider; see below for key symptoms to watch for, when to seek urgent care, how diagnosis is confirmed with sleep studies, and which treatments and safety strategies can guide your next steps.
References:
D'Amico G, Garcia-Tsao G, & Pagliaro L. (2006). Natural history and prognostic indicators of survival in cirrhosis: a systematic review of 118 stud… Journal of Hepatology, 16723596.
Castera L, Forns X, & Alberti A. (2008). Non-invasive evaluation of liver fibrosis using transient elastography… Journal of Hepatology, 17644066.
Abraldes JG, Villanueva C, & Aracil C. (2009). Hepatic venous pressure gradient predicts clinical decompensation in patients with compensated cirrhosis… Journal of Hepatology, 19501330.
Q.
If you have excessive daytime sleepiness, this is what you’re missing.
A.
Excessive daytime sleepiness often means you’re missing restorative sleep, key nutrients, or the diagnosis of an underlying condition such as obstructive sleep apnea, narcolepsy, restless legs syndrome, hypothyroidism, diabetes, heart or lung disease, or liver disease with subtle brain changes. There are several factors to consider; see below for a step by step plan to track sleep, improve habits, get targeted labs and sleep studies, screen for liver issues, and know when to seek urgent care, since these details can change your next steps.
References:
D'Amico G, Garcia-Tsao G, & Pagliaro L. (2006). Natural history and prognostic indicators of survival in cirrhosis. A syste… J Hepatol, 16343868.
Castera L, Forns X, & Alberti A. (2008). Non-invasive evaluation of liver fibrosis using transient elastograph… J Hepatol, 18471592.
Angeli P, Bernardi M, Villanueva C, Francoz C, Mookerjee RP, Trebicka J, et al. (2018). EASL clinical practice guidelines for the management of patients with decompensat… Journal of Hepatology, 29793250.
Q.
If you’re sleepy during the day, your body may be dropping a clue.
A.
Daytime sleepiness can be a simple sign of not getting enough or good-quality sleep, but it can also be a clue to conditions like obstructive sleep apnea, hypothyroidism, anemia, kidney disease, neurological disorders, or liver disease such as hepatic encephalopathy. There are several factors and warning signs to consider; see the complete answer below for key symptoms that need urgent evaluation, practical steps to improve alertness, and which tests and specialists to ask about. If your sleepiness persists or you notice confusion, mood changes, abdominal symptoms, or jaundice, seek medical care promptly.
References:
Kamath PS, & Wiesner RH. (2001). A model to predict survival in patients with end-stage liver disease. Hepatology, 11157951.
European Association for the Study of the Liver. (2014). EASL clinical practice guidelines for the management of patients with decompensated cirrhosis. Journal of Hepatology, 24986678.
American Association for the Study of Liver Diseases, & European Association for the Study of the Liver. (2014). Hepatic encephalopathy in chronic liver disease: 2014 Practice Guideline. Hepatology, 25069516.
Q.
If your neck goes weak when you laugh, your body is doing something specific.
A.
Neck weakness when you laugh is usually cataplexy, a brief emotion-triggered drop in muscle tone that can be tied to narcolepsy type 1, though conditions like myasthenia gravis, muscle loss, or cervical spine problems can also play a role. There are several factors to consider and important next steps about when to seek care, which tests may help, and how treatment differs by cause; see the complete information below to guide your healthcare decisions.
References:
Tandon P, Montano-Loza AJ, Meza-Junco J, et al. (2012). Severe muscle depletion in patients on the liver transplant wait list… Liver Transpl, 22358380.
Garcia-Tsao G, Sanyal AJ, Grace ND, et al. (2007). Prevention and management of gastroesophageal varices and variceal… Hepatology, 17688382.
Tsochatzis EA, Gurusamy KS, Ntaoula S, et al. (2011). Elastography for the diagnosis of severity of fibrosis in chronic liver… Ann Intern Med, 21282695.
Q.
Insomnia causes, concerns, and cures
A.
Insomnia often stems from stress, mental health conditions, medical illnesses, medications or substances, and irregular routines, and it can impair daytime function while increasing risks for heart, metabolic, immune, and safety problems. The most effective treatment is cognitive behavioral therapy for insomnia, supported by consistent sleep hygiene and, when needed short term under medical supervision, medications. There are several factors to consider, and important details that could change your next steps are explained below.
References:
Morin CM, & Benca R. (2012). Chronic insomnia. Lancet, 22305702.
Riemann D, Baglioni C, Bassetti C, et al. (2017). European guideline for the diagnosis and treatment of insomnia. J Sleep Res, 29051350.
Trauer JM, Qian MY, Doyle JS, Rajaratnam SMW, & Cunnington D. (2015). Cognitive behavioral therapy for chronic insomnia: a systematic… Ann Intern Med, 26109014.
Q.
Insomnia tips: 5 warning signs to watch for if sleep is becoming an issue
A.
Five warning signs to watch for include persistent trouble falling or staying asleep at least 3 nights a week for 3 months, daytime fatigue and cognitive lapses, increasing reliance on sleep aids or alcohol, mood changes, and noticeable effects on work, school, or relationships. There are several factors to consider. See below for practical insomnia tips, evidence-based options like CBT-I, and critical red flags that need prompt care such as suspected sleep apnea, chest pain or fainting, and thoughts of self-harm, which can shape your next steps.
References:
Morin CM, & Benca R. (2012). Chronic insomnia. Lancet, 22305708.
Buysse DJ. (2013). Insomnia. JAMA, 23347412.
Ohayon MM. (2002). Epidemiology of insomnia: what we know and what we still ne… Sleep Med Rev, 12419739.
Q.
insomnia tips: medical-grade, doctor-approved tips, tricks, and more
A.
Doctor-approved, evidence-based strategies include CBT-I as the gold standard, plus consistent sleep schedules, a cool dark bedroom, pre-bed wind-down, and relaxation techniques; low-dose melatonin 0.5–1 mg 30–60 minutes before bed may help, while prescription sleep aids are a short-term, secondary option that need close follow up. There are several factors to consider, including red flags like loud snoring or gasping, severe daytime sleepiness, mood changes, chest pain, or breathing problems that warrant medical evaluation. For step-by-step protocols, dosing details, and when to seek specialist care, see below.
References:
Qaseem A, Kansagara D, Forciea MA, Cooke M, Denberg TD. (2016). Management of chronic insomnia disorder in adults: A clinical… Ann Intern Med, 27371491.
Trauer JM, Qian MY, Doyle JS, Rajaratnam SMW, Cunnington D. (2015). Cognitive behavioral therapy for chronic insomnia: A system… Ann Intern Med, 26171736.
Ruan Y, Wang Q, Yang K, Lu M. (2020). Melatonin for insomnia in older adults: a meta-analysis of… J Pineal Res, 31878705.
Q.
Insomnia: What your problems sleeping could be telling you and how to fix it fast
A.
Insomnia often signals stress or anxiety, mood disorders, poor sleep habits, circadian misalignment, medication effects, or medical problems such as pain, thyroid issues, restless legs, or sleep apnea. Fast fixes include optimizing your sleep environment and schedule, stimulus control, sleep restriction, relaxation techniques, and CBT-I, with short-term medication considered selectively and clear signs for when to seek care. There are several factors to consider; see below for step-by-step guidance, specific options and precautions, and other details that could shape your next healthcare steps.
References:
Riemann D, Baglioni C, Bassetti C, Bjorvatn B, Ellis JG, Espie CA, et al. (2017). European guideline for the diagnosis and treatment of insomnia.... J Sleep Res, 29027814.
Trauer JM, Qian MY, Doyle JS, Rajaratnam SMW, Cunnington D. (2015). Cognitive Behavioral Therapy for Chronic Insomnia: A… Ann Intern Med, 26061433.
Herring WJ, Connor KM, Ivgy-May N, Zhang Y, Michelson D. (2016). Suvorexant in patients with insomnia: results from two 3-month… Biol Psychiatry, 26321127.
Q.
Is sleep apnea genetic and how to fix it fast
A.
Genetics contribute to sleep apnea, with about 35 to 40 percent of risk tied to inherited factors, but airway anatomy, weight, age, and habits are major drivers too; if close relatives have OSA your risk is higher. There are several factors to consider; see below to understand more. To improve symptoms fast, start evidence based treatments like CPAP for moderate to severe cases, or dentist fitted oral appliances and positional therapy for milder cases; also avoid alcohol and sedatives before bed, optimize sleep habits, and pursue weight loss if needed. Key tips and when to seek medical help are detailed below.
References:
Redline S, Tishler PV, Tosteson TD, Hans MG, Lin X, Kump K, & Leibel RJ. (2003). Heritability of sleep apnea and sleepiness in the Cleveland… Sleep, 12879838.
Jackson CL, Redline S, Schwartz JE, & Patel SR. (2018). Genome-wide association study of obstructive sleep apnea in Hispanic/Latino… Am J Respir Crit Care Med, 30245039.
Radwan H, McNicholas WT, & Sadaf Z. (2013). Continuous positive airway pressure for obstructive sleep apnoea… Cochrane Database Syst Rev, 23450798.
Q.
Jaw drops when I laugh: could this be cataplexy or muscle weakness?
A.
There are several factors to consider: a jaw that suddenly gives way with laughter for seconds, with full awareness and often accompanied by excessive daytime sleepiness, favors cataplexy related to narcolepsy, whereas pain, clicking, progressive fatigue with chewing, or eyelid drooping point more to muscle or joint causes such as TMJ disorders or myasthenia gravis. See below for key differences, red flags, simple self-checks, and the tests and treatments doctors use, since these details can change which next steps you should take.
References:
Bassetti CL, Adamantidis A, Burdakov D, et al. (2019). Narcolepsy—clinical features, pathophysiology, and manag… Nat Rev Neurol, 31225456.
Wai CT, Greenson JK, Fontana RJ, et al. (2003). A simple noninvasive index can predict both significant fibros… Hepatology, 12883497.
Ziol M, Handra-Luca A, Kettaneh A, et al. (2005). Noninvasive assessment of liver fibrosis by transient elastogr… Gastroenterology, 15649777.
Q.
Laughing shouldn’t make your knees buckle—why is it happening?
A.
Knee buckling during laughter happens because laughing spikes knee joint load and quad demand, so instability often reveals quadriceps weakness or imbalance; it can also reflect osteoarthritis, ligament or meniscus injury, patellar instability, or rarely a neurological issue. There are several factors to consider; see below to understand more, including red flags that need prompt evaluation and practical next steps like targeted strengthening, balance training, bracing, pain management strategies, and when to see a specialist.
References:
McLean MD, Crosbie J, Winzenberg TM, & Jones G. (2018). Knee buckling: patient characteristics, falls, fear of falling, and activity… Arthritis Care Res (Hoboken), 29530266.
Ripoll C, Groszmann RJ, Garcia-Tsao G, Bosch J, Grace ND, Burroughs A, Planas R, & Garcia-Pagán JC. (2007). Hepatic venous pressure gradient predicts clinical decompensation… Journal of Hepatology, 17586232.
Castera L, Foucher J, Bernard PH, Carvalho F, Allaix D, Merrouche W, Couzigou P, & de Ledinghen V. (2008). Prospective comparison of transient elastography, FibroTest, APRI, FIB-4, and… Journal of Hepatology, 18539333.
Q.
Narcolepsy symptoms: what’s typical, what’s not, and what else can look similar?
A.
Narcolepsy symptoms at a glance: excessive daytime sleepiness, emotion-triggered cataplexy, sleep paralysis, vivid hallucinations at sleep onset or awakening, and fragmented nighttime sleep. Not typical are long confusion after waking, hallucinations during full wakefulness, violent dream enactment, seizure-like events, or systemic red flags, and look-alikes include idiopathic hypersomnia, obstructive sleep apnea, circadian rhythm disorders, depression, medication effects, and seizure or fainting disorders; there are several factors to consider, so see the complete details below for what testing, safety steps, and urgent signs may change your next steps.
References:
Scammell TE. (2015). Narcolepsy. N Engl J Med, 25607420.
Dauvilliers Y, Arnulf I, & Mignot E. (2007). Narcolepsy with cataplexy. Lancet Neurol, 17549400.
European Association for the Study of the Liver. (2018). EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis. Journal of Hepatology, 29677514.
Q.
Neck weakness when laughing: what does emotion-triggered weakness suggest clinically?
A.
Neck weakness brought on by laughter or strong emotions most often points to cataplexy, the hallmark feature of narcolepsy type 1. Episodes are brief, with sudden loss of muscle tone and preserved awareness. There are several factors to consider, including less common causes such as myasthenia gravis, functional weakness, or cervical spine problems, but a consistent laughter trigger makes cataplexy most likely; see below for key symptoms to track, when to seek care, diagnostic steps, and treatment options.
References:
Dauvilliers Y, Arnulf I, & Mignot E. (2007). Narcolepsy with cataplexy. Lancet Neurol, 17531326.
Kamath PS, & Wiesner RH. (2001). A model to predict survival in patients with end-stage liver disease. Hepatology, 11157951.
Tsochatzis EA, Bosch J, & Burroughs AK. (2014). Liver cirrhosis. Lancet, 24725323.
Q.
Need a nap every day: what’s normal vs a sign of excessive sleepiness?
A.
Daily naps can be normal or a sign of excessive sleepiness; they are typically normal when tied to an early afternoon circadian dip, short or poor sleep, shift work, recovery, or older age, and when short naps restore energy without disrupting night sleep. Be concerned if you nod off unintentionally, feel unrefreshed after naps, have difficulty waking, score above 10 on the Epworth Sleepiness Scale, or have loud snoring, gasping, sudden muscle weakness, or mood and concentration problems, which can signal sleep apnea, narcolepsy, thyroid problems, anemia, medication effects, or depression. There are several factors to consider; see below for quick self-checks, targeted fixes, and when to see a doctor, as these details can change your next steps and safety at work or on the road.
References:
Johns MW. (1991). A new method for measuring daytime sleepiness: the Epworth slee… Sleep, 1798888.
Foley D, Ancoli-Israel S, Britz P, & Walsh J. (2004). Sleep complaints among elderly persons: an epidemiologic study of thr… Sleep, 15527692.
D'Amico G, Garcia-Tsao G, & Pagliaro L. (2006). Natural history and prognostic indicators of survival in cirrh… J Hepatol, 16427205.
Q.
Paralyzed when falling asleep: what happens during REM and why it can ‘leak’ early.
A.
Sleep paralysis happens when REM sleep’s normal muscle atonia intrudes into wakefulness, leaving you conscious but unable to move and sometimes causing vivid hallucinations or chest pressure. It occurs because REM switches on too early as you fall asleep or lingers as you wake, and is more likely with irregular sleep, stress, sleep loss, certain medications, or narcolepsy; it is usually benign but frequent or impairing episodes should be discussed with a clinician. There are several factors to consider. See below for important details that can guide your next steps.
References:
Sharpless BA, & Barber JP. (2011). Lifetime prevalence rates of sleep paralysis: a systematic… Sleep Med Rev, 21785518.
Peever JH, & Fuller PM. (2017). The biology of REM sleep… Annu Rev Neurosci, 28256500.
Serste T, Verslype C, Nevens F, & Laleman W. (2014). Platelet count predicts hepatic decompensation… Liver Int, 24350927.
Q.
Randomly falling asleep isn’t random—look for this trigger.
A.
Sudden daytime sleep episodes are often not random but a warning sign of hepatic encephalopathy in people with liver disease, caused by toxin buildup like ammonia; common triggers include gastrointestinal bleeding, infection, dehydration, electrolyte imbalances, constipation, sedatives or narcotics, and high protein intake. Because this can progress quickly and may be preceded by confusion, coordination problems, or hand flapping, see the complete details below on early warning signs, diagnostic steps, treatments such as lactulose and rifaximin, prevention tips, and when to seek urgent care, as these could change your next steps.
References:
Ferenci P, Lockwood A, Mullen K, Tarter R, Weissenborn K, & Blei AT. (2002). Hepatic encephalopathy: definition, nomenclature, diagnosis, and quantification: final report of the Working Party at the 11th World Congress of Gastroenterology, Vienna, 1998. Hepatology, 11870361.
Cordoba J. (2014). Hepatic encephalopathy: present and future. Gut, 25071123.
European Association for the Study of the Liver. (2018). EASL clinical practice guidelines for the management of patients with decompensated cirrhosis. Journal of Hepatology, 29790633.
Q.
Sleep apnea causes, concerns, and cures
A.
Sleep apnea is a serious sleep disorder in which breathing repeatedly stops during sleep, most often from obstructed airflow and less often from brain signaling problems; risks include excess weight, anatomical narrowing, alcohol or sedative use, smoking, opioid medicines, and conditions like heart failure or stroke. Left untreated it raises the risk of high blood pressure, heart attack, stroke, diabetes, and dangerous daytime sleepiness, but effective treatments include CPAP, oral appliances, weight loss, positional therapy, surgery, and targeted lifestyle changes; there are several factors to consider, and the complete details on symptoms, testing, red flags, and how to choose next steps are outlined below.
References:
White DP, & Malhotra A. (2006). Pathophysiology of obstructive sleep apnoea. Thorax, 16365371.
Peppard PE, Young T, Palta M, & Skatrud J. (2000). Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med, 10926550.
Barbé F, Durán-Cantolla J, Capote F, de la Peña M, Chiner E, Masa JF, Carmona C, Diaz de Atauri MJ, & Esteban E. (2012). Effect of continuous positive airway pressure on the incidence of hypertension and cardiovascular events in nonsleepy patients with obstructive sleep apnea: a randomized controlled trial. JAMA, 22412038.
Q.
Sleep hygiene: Instant tuneup tips from doctors
A.
Instant sleep hygiene tuneups from doctors include a consistent sleep and wake time, a cool dark quiet bedroom, limiting screens and caffeine at night, a relaxing wind down, morning light exposure, smart hydration and meal timing, and reserving your bed for sleep so you fall asleep faster and wake more refreshed. There are several factors to consider, including troubleshooting frequent awakenings, shift-work strategies, quick breathing techniques, and signs that need medical evaluation like persistent insomnia, loud snoring or excessive daytime sleepiness; see below for details and next steps.
References:
Irish LA, Kline CE, Gunn HE, Buysse DJ, & Hall MH. (2015). The role of sleep hygiene in promoting public health: a revie… Sleep Med Rev, 25480873.
Stepanski EJ, & Wyatt JK. (2003). Use of sleep hygiene in the treatment of chronic insomnia. Sleep Med Rev, 12821374.
Morin CM, Bootzin RR, Buysse DJ, Edinger J, Espie C, & Lichstein KL. (2006). Psychological and behavioral treatment of insomnia: update o… Sleep, 17162977.
Q.
Sleep hygiene: The mental health / sleep connection, tips, tricks, and more
A.
Good sleep hygiene is strongly tied to mental health, influencing mood, anxiety, focus, and long-term risks like depression and physical illness. There are several factors to consider; see below to understand how routines, light exposure, environment, and stress management work together. Key tips and next steps include a consistent schedule, a relaxing wind-down, limiting evening screens and caffeine, timing exercise wisely, keeping the bedroom cool dark and quiet, brief early naps, mindful breathing, and knowing when to seek care for persistent insomnia, daytime sleepiness, or possible sleep apnea; if problems continue, consider CBT-I, with important details and guidance below.
References:
Irish LA, Kline CE, Gunn HE, Buysse DJ, & Hall MH. (2015). The role of sleep hygiene in promoting public health: a review of empiri… Sleep Med Rev, 25747942.
Edinger JD, & Means MK. (2005). Cognitive-behavioural therapy for primary insomnia. Clin Psychol Rev, 15893038.
Brown FC, Buboltz WC Jr, & Soper B. (2006). Development and evaluation of the Sleep Treatment and Educa… J Am Coll Health, 17083524.
Q.
Sleep paralysis feels supernatural—here’s the real reason.
A.
The experience feels supernatural because your brain awakens while REM muscle paralysis lingers and dream imagery intrudes, triggering fear circuits that can create shadow figures, chest pressure, and a sensed presence. There are several factors to consider, including sleep loss, stress, back-sleeping, and narcolepsy, as well as prevention steps and red flags for when to seek care. See the complete details below to guide your next steps.
References:
Sharpless BA, & Barber JP. (2011). Sleep paralysis: phenomenology, neurobiology, and… Sleep Med Rev, 21723109.
Tsochatzis EA, Gurusamy KS, Ntaoula S, Cholongitas E, Davidson BR, & Burroughs AK. (2011). Elastography for the diagnosis of severity of fibrosis in chronic liver disease: a meta-analysis… J Hepatol, 21288426.
Kamath PS, & Wiesner RH. (2001). A model to predict survival in patients with end-stage liver… Hepatology, 11157951.
Q.
Sleep paralysis hallucinations aren’t random—here’s what triggers them.
A.
Sleep paralysis hallucinations stem from REM intrusion, sensory mismatches, and threat-oriented brain activity, and they are more likely with irregular or short sleep, back-sleeping, stress or anxiety, certain meds or substances, mental health conditions, and REM-related disorders like narcolepsy or sleep apnea. See below for practical steps and warning signs, including how to reduce episodes with consistent schedules, sleep hygiene, side sleeping, relaxation and cognitive techniques, and when to seek evaluation for frequent attacks, severe distress, cataplexy, or loud snoring and gasping.
References:
Cheyne JA, Rueffer SD, & Newby-Clark IR. (1999). Hypnagogic and hypnopompic hallucinations during sleep paralysis. Journal of Sleep Research, 9510635.
Tsochatzis EA, Bosch J, & Burroughs AK. (2014). Liver cirrhosis. Lancet, 24429195.
Kim WR, Biggins SW, Benson JT, Kremers WK, Therneau TM, et al. (2008). Hyponatremia and outcome of patients with cirrhosis. Hepatology, 18158082.
Q.
Sleep paralysis: what causes it, and when is it linked to sleep disorders?
A.
Sleep paralysis occurs when REM sleep muscle atonia lingers as you fall asleep or wake, and it is more likely with sleep loss, irregular schedules, stress or anxiety, certain medications or substances, and sometimes family history. There are several factors to consider; prevention strategies and key nuances are outlined below. It is usually harmless, but frequent or distressing episodes with daytime sleepiness, emotion-triggered weakness, loud snoring or gasping, PTSD symptoms, or panic can signal narcolepsy, sleep apnea, or related disorders and should prompt a medical evaluation, with red flags and next steps detailed below.
References:
Sharpless BA, & Grom JL. (2011). Isolated sleep paralysis: a systematic review of the literature… Sleep Med Rev, 21112037.
Dauvilliers Y, Arnulf I, & Mignot E. (2007). Narcolepsy with cataplexy: diagnosis and management… Lancet, 17336637.
Cholongitas E, Papatheodoridis GV, & Vangeli M. (2005). Review article: the model for end-stage liver disease–should it replace Child–Pugh's classification for assessing prognosis in cirrhosis? Aliment Pharmacol Ther, 15613321.
Q.
Sudden muscle weakness when laughing: what symptoms make it more likely cataplexy?
A.
Key signs that sudden weakness with laughter is cataplexy include episodes consistently triggered by strong emotion, preserved awareness throughout, and brief spells lasting seconds to about 2 minutes that often involve jaw, eyelid, neck, or knee buckling without incontinence. It is even more likely if you also have narcolepsy features like excessive daytime sleepiness, sleep paralysis, or vivid hallucinations at sleep-wake transitions; there are several factors to consider, and important details about what makes it less likely and next steps are outlined below.
References:
Scammell TE. (2015). Narcolepsy. N Engl J Med, 26631199.
Dauvilliers Y, Arnulf I, & Mignot E. (2007). Narcolepsy with cataplexy. Lancet, 17230113.
D'Amico G, Garcia-Tsao G, & Pagliaro L. (2006). Natural history and prognostic indicators of survival in cirrhosis: a systematic… J Hepatol, 16427125.
Q.
Suddenly falling asleep? It’s often not about willpower.
A.
Sudden sleepiness is often not about willpower but about underlying issues such as insufficient or irregular sleep, circadian disruption, sleep apnea or narcolepsy, medication or alcohol effects, stress or depression, thyroid or blood sugar problems, and even liver disease that can disturb the sleep wake cycle. There are several factors to consider; for the key red flags, when to seek medical care, what testing may be needed, and practical steps that could change your next decisions, see the complete information below.
References:
Montagnese S, Sellaro R, Hartley RA, & Morgan MY. (2010). Abnormal circadian sleep–wake rhythms in cirrhotic patients with minimal… Journal of Hepatology, 20517139.
Tsochatzis EA, Gurusamy KS, Ntaoula S, Cholongitas E, Davidson BR, & Burroughs AK. (2014). Elastography for the diagnosis of severity of liver fib… Aliment Pharmacol Ther, 24387237.
Biggins SW, Kim WR, Kremers W, Wiesner RH, & Kamath PS. (2006). Evidence-based incorporation of serum sodium into the Model for End-Stage Liver… Gastroenterology, 16530513.
Q.
That ‘pressure on your chest’ during sleep paralysis has an explanation.
A.
The chest pressure during sleep paralysis is usually explained by REM-related muscle atonia that keeps the chest wall muscles offline while the diaphragm still works, combined with the brain misinterpreting normal breathing and an anxiety surge that can feel like weight or an intruder. There are several factors to consider; see below for common triggers like irregular sleep, sleep deprivation, stress, supine sleep, and substances, practical steps to reduce episodes such as consistent sleep habits, relaxation, and side sleeping, and the red flags that warrant medical care such as frequent episodes, loud snoring or daytime sleepiness, or any true chest pain or shortness of breath when fully awake.
References:
Kamath PS, & Wiesner RH. (2001). A model to predict survival in patients with end-stage liver disease. Hepatology, 11157951.
Groszmann RJ, & Abraldes JG. (2005). Hepatic venous pressure gradient predicts clinical decompensation… Gastroenterology, 16285927.
Ziol M, & Handra‐Luca A. (2005). Non-invasive assessment of liver fibrosis by measurement of liver… Hepatology, 15891330.
Q.
Think you have narcolepsy? This is the part most people miss.
A.
The most overlooked clues are cataplexy triggered by strong emotions and fragmented, unrefreshing sleep at night, not just daytime sleepiness; together with hallucinations and sleep paralysis, these point more directly to narcolepsy. Because these symptoms can mimic sleep apnea, depression, anxiety, or medication effects, a proper diagnosis usually requires a detailed sleep history, an overnight study, and a daytime MSLT. Key red flags, practical self check steps, and what to do next to protect your safety are outlined below.
References:
Tsochatzis EA, Bosch J, & Burroughs AK. (2014). Liver cirrhosis. Lancet, 24635669.
D'Amico G, Morabito A, D'Amico M, et al. (2011). Clinical states of cirrhosis and competing risks. Journal of Hepatology, 21067892.
Kim BK, Kim SU, Park JY, et al. (2017). Longitudinal changes in liver stiffness measurement predict clinical… Journal of Hepatology, 28238114.
Q.
This narcolepsy quiz question is uncomfortably revealing.
A.
There are several factors to consider. These quizzes use pointed, personal questions about things like sudden sleep episodes, cataplexy, sleep paralysis, and vivid dreams to reliably screen for narcolepsy, which often goes undiagnosed; honest responses and trusted sites help protect accuracy and privacy. If your answers raise concern, see a primary care clinician or sleep specialist, track symptoms, and consider a reputable online symptom check, since safety issues like drowsy driving warrant prompt care. See below for the fuller explanation and step-by-step next moves that could affect your healthcare decisions.
References:
De Lédinghen V, & Boursier J, et al. (2010). Liver stiffness measurement predicts risk of decompensation, liver cancer, and death in patients with… Clin Gastroenterol Hepatol, 20836715.
Kamath PS, & Wiesner RH. (2001). A model to predict survival in patients with end-stage liver disease. Hepatology, 11157951.
European Association for the Study of the Liver. (2018). EASL clinical practice guidelines for the management of patients with decompensated cirrhosis. Journal of Hepatology, 29854622.
Q.
Why do I fall asleep when I’m bored—sleep deprivation, circadian rhythm, or hypersomnia?
A.
There are several factors to consider: feeling sleepy when bored is most commonly due to sleep deprivation or normal circadian dips, but circadian misalignment, environmental factors, medications, and hypersomnia conditions such as sleep apnea or idiopathic hypersomnia can also contribute. See below for practical ways to stay alert and the red flags that warrant medical evaluation, like unrefreshing long sleep, daytime sleep attacks, or dozing despite adequate sleep, which could change your next steps in care.
References:
Dijk DJ, Duffy JF, & Czeisler CA. (2001). Contribution of circadian physiology and sleep homeostasis to age-rela… J Neurosci, 11245633.
Van Dongen HPA, Maislin G, Mullington JM, & Dinges DF. (2003). The cumulative cost of additional wakefulness: dose-response effects on neurobehavi… Sleep, 12683469.
Tsochatzis EA, Gurusamy KS, Ntaoula S, Cholongitas E, Davidson BR, & Burroughs AK. (2011). Elastography for the diagnosis of severity of fibrosis in chronic liver diseas… J Hepatol, 20965325.
Q.
Why do I get sleepy after eating: blood sugar, meal size, medications, or sleep debt?
A.
Post-meal sleepiness most often comes from blood sugar spikes and dips from high-GI foods, large or high-fat meals that slow digestion, sedating medications like antihistamines, and sleep debt amplified by the early afternoon circadian dip. There are several factors to consider; see below to understand more, including practical fixes, which meds or supplements to review, and red flags that suggest when to seek care so you can choose the right next steps.
References:
Wolever TM, Jenkins DJ, Jenkins AL, & Josse RG. (1991). The glycemic index: methodology and clinical implications… American Journal of Clinical Nutrition, 1751051.
Banks S, & Dinges DF. (2007). Behavioral and physiological consequences of sleep restricti… Seminars in Neurology, 17960992.
Tsochatzis EA, Bosch J, & Burroughs AK. (2014). Liver cirrhosis: pathophysiology and clinical spectrum… The Lancet, 24798702.
Q.
Why do I suddenly fall asleep: what’s the difference between sleep attacks and fatigue?
A.
Sleep attacks are sudden, irresistible episodes of sleep (often linked to narcolepsy and sometimes cataplexy, hallucinations, or sleep paralysis), while fatigue is a gradual, lingering tiredness with low energy and brain fog that usually does not make you nod off instantly. There are several factors to consider, and the specifics below explain common causes, red flags, and how doctors test for these problems. Because the right next step can range from lifestyle changes to sleep studies and blood work, review the details below to decide when to seek urgent care versus scheduled evaluation.
References:
Morgenthaler TI, Lee‐Chiong T, Alessi C, et al. (2007). Practice parameters for the multiple sleep latency test… Sleep, 17282958.
Kamath PS, & Wiesner RH. (2001). A model to predict survival in patients with end‐stage… Hepatology, 11157951.
Castera L, Forns X, & Alberti A. (2005). Noninvasive evaluation of liver fibrosis using transient… Hepatology, 15748489.
Q.
Woke up and can’t move: is this sleep paralysis, a panic response, or something else?
A.
Most episodes of waking up unable to move are caused by sleep paralysis or a panic response, though seizures with post-ictal weakness, stroke or TIA, narcolepsy, medication effects, and electrolyte problems can also present this way. Get urgent care for red flags like one-sided weakness, facial droop, slurred speech, confusion, tongue-biting, or loss of bladder control. There are several factors to consider that change next steps, such as duration, hallucinations or chest pressure versus palpitations and hyperventilation, and daytime sleepiness. See the complete guidance below for how to tell them apart, prevention strategies, and when to see a clinician.
References:
Sharpless BA, & Barber JP. (2011). Lifetime prevalence rates of sleep paralysis: a systematic revie… Sleep Med Rev, 21567142.
Hinton DE, Pich V, Chhean D, & Pollack MH. (2005). The "ghost pushes you down": sleep paralysis-type panic attacks i… Transcult Psychiatry, 15833668.
Foucher J, Chanteloup E, Vergniol J, Castéra L, Le Bail B, Couzigou P, & de Lédinghen V. (2006). Diagnosis of cirrhosis by transient elastography: a prospective s… Hepatology, 16340031.
Q.
Always tired even after sleeping: what conditions should you rule out first?
A.
There are several conditions to rule out first: sleep apnea, anemia, thyroid problems, depression or anxiety, diabetes, medication or substance effects, and common lifestyle or circadian sleep issues; also consider heart or lung disease, kidney or liver disease, and nutritional deficiencies. See below for the key red flags, simple labs to request, when to consider a sleep study, and the urgent symptoms that mean seek care now.
References:
Hickie IB, Davenport T, Wakefield D, Vollmer-Conna U, Cameron B, Vernon SD, Reeves WC, & Lloyd AR. (2006). Post-infective and chronic fatigue syndromes precipitated by viral and non-viral pathogens: prospective cohort study. BMJ, 16510274.
D'Amico G, Garcia-Tsao G, & Pagliaro L. (2006). Natural history and prognostic indicators of survival in cirrhosis: systematic review of 118 studies. Journal of Hepatology, 16563995.
Castera L, Forns X, & Alberti A. (2008). Prospective comparison of transient elastography and FibroTest for assessing liver fibrosis in chronic hepatitis C. Journal of Hepatology, 18513712.
Q.
Bored = asleep? That ‘quirk’ can be a clue.
A.
Falling asleep when bored is usually a normal dip in arousal from low stimulation, especially if it happens only in dull settings and you feel refreshed otherwise. There are several factors and warning signs to consider, since frequent or dangerous dozing can point to sleep apnea, narcolepsy, anemia, hypothyroidism, liver disease, depression, or medication effects, so see below for stay-awake tips, red flags, and when to seek care or use a symptom checker.
References:
Mason MF, Norton MI, Van Horn JD, Wegner DM, Grafton ST, & Macrae CN. (2007). Wandering minds: the default network and stimulus-independent thought… Science, 17938276.
Kamath PS, Wiesner RH, Malinchoc M, Kremers W, Therneau TM, & Kosberg CL. (2001). A model to predict survival in patients with end-stage liver disease… Hepatology, 11157951.
D'Amico G, Garcia-Tsao G, & Pagliaro L. (2006). Natural history and prognostic indicators of survival in cirrhosis: a systematic… Hepatology, 17033603.
Q.
Can’t move when waking up: how to tell sleep paralysis from a neurological problem.
A.
There are several factors to consider. Briefly, sleep paralysis is a short, REM-related inability to move right as you fall asleep or wake, usually with full awareness and sometimes chest pressure or hallucinations, while neurological causes tend to occur outside sleep transitions, last longer, or include persistent weakness, numbness, speech or vision changes, severe headache, confusion, or seizure-like activity. If red flags are present or episodes are frequent or prolonged, seek medical evaluation since next steps can include a neurological exam, sleep study, imaging, or EEG and treatment varies by cause. See the complete guidance below to understand more and to choose the right next steps, including when to go urgently.
References:
Cheyne JA, Rueffer SD, & Newby-Clark IR. (1999). Hypnagogic and hypnopompic hallucinations during sleep paralysis: event… J Sleep Res, 11813109.
Sharpless BM, & McCarthy KS. (2017). Prevalence and correlates of isolated sleep paralysis: a systematic… Sleep Med Rev, 27012529.
European Association for the Study of the Liver. (2015). EASL-ALEH Clinical Practice Guidelines: non-invasive… J Hepatol, 25523598.
Q.
Collapsing while fully awake is a big clue—especially if laughter triggers it.
A.
Sudden collapse while fully awake, especially triggered by laughter, strongly points to cataplexy, a hallmark of narcolepsy type 1 in which muscle tone abruptly drops but you remain conscious. There are several factors to consider, so see below for how to tell it from fainting, common triggers and risks, recommended tests, treatment and safety strategies, and the red flags that mean you should seek urgent care.
References:
Ripoll C, Groszmann RJ, Garcia-Tsao G, Grace ND, Burroughs AK, Planas R, et al. (2007). Hepatic venous pressure gradient predicts clinical decompensation in comp… Gastroenterology, 17765314.
Serste T, Vandeputte C, Gustot T, Deprele C, François C, Quertinmont E, et al. (2011). Prognostic value of liver stiffness by transient… Liver Int, 21668701.
Kim WR, Biggins SW, Kremers WK, Wiesner RH, Kamath PS, Benson JT, Edwards E, Therneau TM. (2008). Hyponatremia and mortality on the liver transplant… N Engl J Med, 18784108.
Q.
Face drooping when you laugh sounds scary—here’s the key difference.
A.
Face drooping that shows up only when you laugh is often normal asymmetry, but new or sudden drooping at rest, especially with arm weakness, speech trouble, severe headache, or vision changes, can point to Bell’s palsy or a stroke and needs urgent care. There are several factors to consider. See the complete breakdown below for the key differences to watch for, when to call emergency services, and step by step next moves including self checks, symptom tools, and treatments that can change outcomes.
References:
American Academy of Otolaryngology–Head and Neck Surgery Foundation. (2013). Clinical practice guideline: Bell's palsy. Otolaryngol Head Neck Surg, 24532141.
European Association for the Study of the Liver, & ALEH. (2018). EASL-ALEH clinical practice guidelines: non-invasive tests for evaluation of liver disease severity and prognosis. Journal of Hepatology, 29628231.
de Franchis R, & Dell'Era A. (2007). Non-invasive diagnosis of cirrhosis and the natural history …. Best Pract Res Clin Gastroenterology, 17223493.
Q.
Falling asleep in class: how to tell sleep deprivation from a sleep-wake disorder.
A.
There are several factors to consider. If extra, consistent sleep quickly fixes the problem, it is likely sleep deprivation; if sleepiness persists despite 8-10 hours or includes sleep attacks, cataplexy, long unrefreshing naps, or loud snoring with gasps, suspect a sleep-wake disorder. See below for the key tools and next steps that can change your plan, including the Epworth Sleepiness Scale, a 1-2 week sleep diary, practical sleep hygiene, and when to see a sleep specialist or seek urgent care.
References:
Johns MW. (1991). A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep, 1798888.
Carskadon MA. (2011). Sleep in adolescents: the perfect storm. Pediatr Clin North Am, 21961719.
Tsochatzis EA, Gomaa AI, & Burroughs AK. (2014). Liver cirrhosis. Lancet, 24613382.
Q.
Falling asleep while driving: what to do now, and what conditions can cause it?
A.
There are several factors to consider, but the immediate priority is safety: pull over safely, take a 15 to 20 minute nap, have one caffeinated drink after you stop, and switch drivers if possible; more step by step tips are below. Causes can include sleep apnea, narcolepsy, shift work disorder, chronic insomnia, hypothyroidism, anemia, diabetes, cirrhosis with hepatic encephalopathy, depression or anxiety, and sedating medications; see below for the full list of causes, key warning signs that need urgent care, and guidance on when to see a doctor.
References:
Connor J, Norton R, Ameratunga S, et al. (2002). Driver sleepiness and risk of serious injury to car occupants… BMJ, 12424138.
Schuppan D, & Afdhal NH. (2008). Liver cirrhosis. Lancet, 18291254.
D'Amico G, Garcia-Tsao G, & Pagliaro L. (2006). Natural history and prognostic indicators of survival in cirrhos… Journal of Hepatology, 16431015.
Q.
Hallucinations when falling asleep: are these hypnagogic hallucinations?
A.
These are usually hypnagogic hallucinations, vivid dream-like sensations as you fall asleep that are common, brief, and generally harmless. There are several factors to consider; seek care if they are frequent or disruptive, or if you also have severe daytime sleepiness, sleep paralysis, or sudden muscle weakness that could suggest narcolepsy. See below for practical steps to reduce them, what causes them, and when a sleep evaluation or other next steps may be appropriate.
References:
Cheyne JA, Rueffer SD, & Newby‐Clark IR. (1999). Hypnagogic and hypnopompic hallucinations: contents and frequencies in a general population sample… Journal of Sleep Research, 10485231.
Castera L, Vergniol J, Le Bail B, et al. (2005). Prospective comparison of transient elastography, FibroTest, APRI, and liver biopsy for the assessment of liver fibrosis in chronic hepatitis C… Gastroenterology, 15649703.
Tsochatzis EA, Bosch J, & Burroughs AK. (2014). Liver cirrhosis… Lancet, 24506418.
Q.
If food knocks you out, it might not be the carbs.
A.
There are several factors to consider. See below to understand more. Post-meal sleepiness often reflects normal blood-flow shifts, insulin and neurotransmitter effects, circadian dips, and the impact of large, high-fat or protein-heavy meals, not just carbohydrates. If tiredness is frequent or intense, it may signal postprandial hypotension, reactive hypoglycemia, or liver disease, and the key red flags, simple fixes, and when to seek tests or care are outlined below to guide your next steps.
References:
Ripoll C, & Groszmann RJ. (2007). Hepatic venous pressure gradient predicts development of hepatocellular carcinoma and clinical decompensation… Journal of Hepatology, 17630945.
Kamath PS, & Wiesner RH. (2001). A model to predict survival in patients with end-stage liver disease. Hepatology, 11157951.
Sandrin L, & Fourquet B. (2003). Transient elastography: a new noninvasive method for assessment of hepatic… Ultrasound in Medicine & Biology, 14734506.
Q.
If you dream the moment you doze off, your sleep architecture might be different.
A.
Dreaming as soon as you fall asleep often reflects shortened REM latency and altered sleep architecture. It can happen after sleep loss, stress, or schedule changes, but frequent onset dreams plus daytime sleepiness, cataplexy, vivid hallucinations, snoring or gasping can indicate narcolepsy, sleep apnea, mood disorders, or medication effects. There are several factors to consider. See below for what is normal, red flags, practical at-home steps, and when to seek tests like a sleep study or MSLT that could shape your next healthcare decisions.
References:
Castéra L, Foucher J, Bernard PH, et al. (2005). Prospective comparison of transient elastography, FibroTest, APRI, and liver biopsy for the assessment of liver fibrosis in chronic hepatitis C… Hepatology, 15780121.
Kim WR, Biggins SW, Kremers W, et al. (2008). Hyponatremia and mortality among patients on the liver-transplant waiting list… Gastroenterology, 18395067.
European Association for the Study of the Liver. (2018). EASL clinical practice guidelines for the management of patients with decompensated cirrhosis… Journal of Hepatology, 29475205.
Q.
If you have ‘sleep attacks,’ your brain may be flipping a switch.
A.
Sleep attacks are sudden, irresistible bouts of sleep; in narcolepsy the brain’s sleep-wake switch can flip because hypocretin neurons are lost, leading to abrupt sleep and REM-like symptoms. Other causes to consider include obstructive sleep apnea, circadian rhythm problems, liver disease or cirrhosis, certain medications or alcohol, and idiopathic hypersomnia. If these episodes disrupt daily life or happen in risky situations, seek medical care, since diagnosis may involve sleep studies and treatment can include lifestyle changes, wake-promoting medicines, CPAP, or addressing liver disease. There are several factors to consider, and important details that could affect your next steps are explained below.
References:
Montagnese S, Middleton B, Skene DJ, & Morgan MY. (2009). The timing of melatonin secretion is delayed in patients with cirrhosis… Journal of Hepatology, 19134566.
Tsochatzis EA, Bosch J, & Burroughs AK. (2014). Liver cirrhosis… Lancet, 24388012.
Salerno F, Gerbes A, Gines P, Wong F, & Arroyo V. (2007). Diagnosis, prevention, and treatment of hepatorenal syndrome in cirrhosis… Gut, 17287200.
Q.
If you keep falling asleep at work, your body may be forcing a reset.
A.
There are several factors to consider. See below to understand more. Repeatedly nodding off at work often means your brain is forcing a reset from built-up sleep pressure due to sleep debt or circadian disruption, but it can also signal sleep disorders like sleep apnea, shift work strain, sedating medications, or medical problems such as depression, thyroid disease, diabetes, or liver disease with hepatic encephalopathy; if it persists despite good sleep habits or you notice red flags like confusion, gasping during sleep, or sudden sleep attacks, seek care and use the guidance below for practical fixes, testing, and when to see a specialist.
References:
Vilstrup H, Amodio P, Bajaj J, Cordoba J, Ferenci P, Mullen KD, Weissenborn K, Wong P. (2014). Hepatic encephalopathy in chronic liver disease: 2014 practice guideline by the… Hepatology, 25069596.
Prakash R, & Mullen KD. (2010). Mechanisms, diagnosis and management of hepatic encephalopathy. Nat Rev Gastroenterol Hepatol, 20440208.
European Association for the Study of the Liver. (2018). EASL clinical practice guidelines for the management of patients… Journal of Hepatology, 29420911.
Q.
Legs give out when I laugh: what’s the medical explanation for emotion-triggered weakness?
A.
Sudden leg weakness with laughter is most often cataplexy, a hallmark of narcolepsy type 1 where REM-like muscle atonia intrudes into wakefulness due to orexin deficiency, so people go limp yet remain conscious. There are several other possibilities to consider, including atonic seizures, vasovagal syncope, orthostatic hypotension, and rare neuromuscular disorders; see below for key signs to tell them apart, diagnostic testing, proven treatments, safety steps, and when to seek urgent care.
References:
Overeem S, Lammers GJ, & Mignot EJ. (2002). Clinical and pathophysiological aspects of narcolepsy and catap... Sleep Med Rev, 12458654.
Tsochatzis EA, Bosch J, & Burroughs AK. (2014). Diagnosis and management of cirrhosis and its complications:... JAMA, 24570250.
D'Amico G, Garcia-Tsao G, & Pagliaro L. (2006). Natural history and prognostic indicators of survival in cirrh... J Hepatol, 16427710.
Q.
Narcolepsy quiz: what screening questions actually predict a sleep disorder?
A.
The strongest predictors of a narcolepsy-related sleep disorder are high daytime sleepiness on the Epworth Sleepiness Scale, especially when paired with cataplexy, REM-intrusion symptoms like sleep paralysis or hypnagogic hallucinations, and sometimes fragmented sleep or automatic behaviors. Only a sleep specialist can make the diagnosis. There are several factors to consider; see below for a quick self-quiz, how to interpret risk using cutoffs like an ESS of 10 or higher with additional symptoms, and practical next steps such as keeping a sleep diary, seeking formal sleep studies, and knowing when to get care.
References:
Johns MW. (1991). A new method for measuring daytime sleepiness: the Epworth slee… Sleep, 1798888.
Douglass AB, Bornstein R, Nino-Murcia G, Zarcone VP Jr, Guilleminault C, & Dement WC. (1994). The Sleep Disorders Questionnaire: I. Creation and multivariate st… Sleep, 8029101.
Ripoll C, Groszmann RJ, García-Tsao G, et al. (2007). Hepatic venous pressure gradient predicts clinical decompensation i… Gastroenterology, 17575004.
Q.
Sleep attacks: what are they, and what diagnoses should be considered?
A.
Sleep attacks are sudden, irresistible bouts of sleepiness that can strike without warning and are not normal when recurrent, especially if they occur while driving; tracking timing, triggers, duration, and associated symptoms helps distinguish them from routine fatigue. Diagnoses to consider include narcolepsy, idiopathic hypersomnia, obstructive sleep apnea, medication or substance effects, shift work or circadian rhythm disorders, medical or neurologic conditions such as hypothyroidism, multiple sclerosis, Parkinson disease, or liver disease with encephalopathy, and psychiatric disorders like depression or bipolar disorder; there are several factors to consider, and important details on evaluation, red flags, testing, and treatments are outlined below.
References:
Scammell TE. (2015). Narcolepsy. Lancet Neurol, 25563677.
Foucher J, Chanteloup E, Vergniol J, Castéra L, Le Bail B, Adhoute X, Bertet JS, Couzigou P, de Ledinghen V. (2006). Diagnosis of cirrhosis by transient elastography (FibroScan)… Gut, 16754708.
Kamath PS, & Wiesner RH. (2001). A model to predict survival in patients with end‐stage liver disease. Hepatology, 11157951.
Q.
Sleep paralysis + daytime sleepiness is a combo you shouldn’t ignore.
A.
There are several factors to consider. Sleep paralysis with daytime sleepiness can signal treatable sleep disorders like narcolepsy, obstructive sleep apnea, or idiopathic hypersomnia, or be linked to anxiety, depression, medications, or irregular schedules; red flags include persistent fatigue despite 7 to 9 hours of sleep, loud snoring or gasping, hallucinations at sleep onset or waking, and sudden emotion triggered weakness. See below for how to get evaluated and treated, including the Epworth Sleepiness Scale, sleep diaries, overnight and daytime sleep studies, and targeted options from sleep hygiene to CPAP and medications, so you can choose the right next steps.
References:
Jalal B, Romanelli A, & Hinton DE. (2015). Sleep paralysis in a general population sample: prevalence, cor… Lancet Psychiatry, 23238413.
Johns MW. (1991). A new method for measuring daytime sleepiness: the Epworth… Sleep, 1798888.
Kamath PS, & Wiesner RH. (2001). A model to predict survival in patients with end-stage liver… Hepatology, 11157951.
Q.
Sleep paralysis hallucinations: why they happen and when to get evaluated.
A.
Sleep paralysis hallucinations happen when REM sleep muscle paralysis and dream imagery intrude into wakefulness, often felt as a presence in the room, chest pressure, or floating, with risk rising from sleep deprivation, irregular schedules, stress, and some sleep disorders. There are several factors to consider. See complete details below. Get evaluated if episodes are frequent or disabling, you have severe anxiety about sleep, excessive daytime sleepiness or sudden muscle weakness, hallucinations when fully awake, or symptoms of sleep apnea; seek urgent care for severe breathing difficulty, chest pain, or overwhelming distress.
References:
Ferri R, Lamberti P, Vandi S, Bruni O, & Terzano MG. (2016). Spotlight on sleep paralysis: a disorder at the crossroads… Sleep Med, 25842019.
Sharpless BA, & Barber JP. (2011). Lifetime prevalence rates of sleep paralysis: a systematic review… Sleep Med Rev, 21641836.
European Association for the Study of the Liver. (2018). EASL clinical practice guidelines for the management of patients… Journal of Hepatology, 29797513.
Q.
Sleeping 8 hours and still tired: is it sleep quality, timing, or a health issue?
A.
There are several factors to consider. Feeling tired after 8 hours often comes from sleep quality issues, misaligned sleep timing, or health problems like sleep apnea, anemia, thyroid disorders, or medication effects; see below for specific signs and how to tell which applies to you. Start by optimizing your sleep environment and schedule, tracking with the PSQI and aligning to your chronotype, then seek care if fatigue persists 2 to 4 weeks or if red flags like loud snoring, gasping, unexplained weight change, chest pain, or major mood shifts occur; full next steps and decision points are detailed below.
References:
Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ. (1989). The Pittsburgh Sleep Quality Index: a new instrument for psychiatric… Psychiatry Res, 2748771.
Wittmann M, Dinich J, Merrow M, Roenneberg T. (2006). Social jetlag: misalignment of biological and social time. Chronobiol Int, 16930814.
Moreau R, Jalan R, Gines P, Pavesi M, Angeli P, Cordoba J, et al. (2013). Acute-on-chronic liver failure is a distinct syndrome that develops in… Gastroenterology, 23357658.
Q.
Standing up and still falling asleep? That’s not normal sleepiness.
A.
Falling asleep while upright is not normal tiredness and can signal serious conditions, from sleep disorders like narcolepsy or sleep apnea to medical and neurologic problems such as diabetes, hypothyroidism, heart failure, depression, seizures, Parkinson’s, and in those with liver disease, hepatic encephalopathy due to toxin buildup. There are several factors to consider, including urgent red flags and treatment steps that could change what you do next in your care; see the complete guidance below, including when to seek care and therapies for hepatic encephalopathy like lactulose and rifaximin.
References:
Ferenci P, Lockwood A, Mullen K, Tarter R, Weissenborn K, & Blei AT. (2002). Hepatic encephalopathy–definition, nomenclature, diagnosis… Journal of Hepatology, 12093199.
American Association for the Study of Liver Diseases, & European Association for the Study of the Liver. (2014). Hepatic encephalopathy in chronic liver disease: 2014 practice guideline… Hepatology, 24606191.
European Association for the Study of the Liver. (2018). EASL clinical practice guidelines on decompensated cirrhosis… Journal of Hepatology, 30104182.
Q.
Vivid dreams when falling asleep: what does early REM suggest?
A.
Vivid dreams right as you fall asleep usually mean REM sleep is arriving unusually early, signaling a shift in sleep architecture from causes like sleep deprivation or REM rebound, stress, circadian disruption, medications or alcohol, and less commonly narcolepsy or other medical issues. This is often harmless, but if you also have severe daytime sleepiness, cataplexy, frequent sleep paralysis or hallucinations, or mood and memory changes, talk to a doctor; consistent sleep habits, limiting caffeine and alcohol, managing stress, and medication review can help, and more specific next steps are outlined below.
References:
Scammell TE. (2003). Narcolepsy… N Engl J Med, 12582061.
European Association for the Study of the Liver. (2018). EASL clinical practice guidelines for the management of patients with decompensated cirrhos… Journal of Hepatology, 29409313.
Kim WR, Biggins SW, & García KD. (2008). Hyponatremia and mortality among patients on the liver-transplant wai… N Engl J Med, 18483351.
Q.
Why am I sleepy all day?
A.
There are several factors to consider. All-day sleepiness most often stems from poor sleep habits or sleep disorders such as obstructive sleep apnea or insomnia, but medical conditions like hypothyroidism, anemia or diabetes, mental health issues, certain medications or substances, and lifestyle choices can also play a role. See below for a step-by-step guide to evaluating your symptoms with tools like the Epworth Sleepiness Scale and a sleep diary, what tests and sleep studies might be needed, urgent red flags, and evidence-based treatments and self-care so you can choose the right next steps.
References:
Johns MW. (1991). A new method for measuring daytime sleepiness: The Epworth Sleepiness… Sleep, 1798888.
Epstein LJ, et al. (2009). Clinical guideline for the evaluation, management and long-term care… J Clin Sleep Med, 20191931.
Castera L, Forns X, & Alberti A. (2008). Non-invasive evaluation of liver fibrosis using transient elast… Journal of Hepatology, 18280337.
Q.
Why do naps make me feel worse: sleep inertia, timing, or a sleep disorder?
A.
There are several factors to consider; see below to understand more. Feeling worse after a nap is usually due to sleep inertia from waking during deep sleep and from nap timing or length, with brief 10 to 20 minute naps in the early afternoon typically helping more than 30 to 60 minute or late-day naps. If even short, well-timed naps leave you unrefreshed, a sleep disorder such as obstructive sleep apnea, insomnia, or narcolepsy could be involved, and the details below include specific nap strategies and warning signs that indicate you should talk to a clinician.
References:
Tassi P, & Muzet A. (2000). Sleep inertia… Sleep Med Rev, 11791919.
Tietzel AJ, & Lack LC. (2001). The short-term benefits of brief and full-length naps following nocturnal sleep restriction… J Sleep Res, 11707566.
Kamath PS, & Wiesner RH. (2001). A model to predict survival in patients with end-stage liver disease… Hepatology, 11157951.
Q.
Woke up and can’t move? This one pattern tells you a lot.
A.
There are two key patterns to consider. Full awareness with a brief whole‑body freeze lasting seconds usually points to benign sleep paralysis, while confusion, one‑sided weakness, or risks like cirrhosis or low potassium suggest urgent issues such as stroke, hepatic encephalopathy, or hypokalemic periodic paralysis. Triggers and next steps differ, from improving sleep habits to calling emergency services or checking potassium depending on the pattern. See below for important details, red flags, and guidance that could change what you do next.
References:
Kamath PS, & Wiesner RH. (2001). A model to predict survival in patients with end-stage liver disease. Hepatology, 11157951.
Foucher J, & Chanteloup E. (2006). Diagnosis of cirrhosis by transient elastography (FibroScan)… Gut, 16371504.
D'Amico G, & Garcia-Tsao G. (2006). Natural history and prognostic indicators of survival in cirrhosis: a systematic review of 118 studies. Journal of Hepatology, 16581148.
Q.
Idiopathic hypersomnia can feel like ‘sleep glue’—here’s what that means.
A.
Idiopathic hypersomnia can feel like being stuck in sleep glue, with severe, prolonged sleep inertia that leaves you heavy, foggy, and irresistibly sleepy even after very long, unrefreshing nights. It is a neurological sleep disorder marked by excessive daytime sleepiness despite adequate sleep, often diagnosed after ruling out other causes with tests like overnight polysomnography and the MSLT, and treated with wake-promoting medications, structured sleep schedules, and strategic naps. There are several factors to consider. See below for symptoms to track, safety risks, and step-by-step next moves to discuss with your doctor.
References:
Bassetti CL, & Aldrich MS. (2000). Idiopathic hypersomnia. Sleep Medicine Reviews, 11477182.
Dauvilliers Y, & Bassetti CL. (2013). Narcolepsy and idiopathic hypersomnia: diagnostic and manage… ment guidelines by the European Narcolepsy Network. Sleep Medicine Reviews, 23098881.
European Association for the Study of the Liver. (2018). EASL clinical practice guidelines for the management of pati… ents with decompensated cirrhosis. Journal of Hepatology, 29762455.
Q.
Brain fog and sleepiness: what conditions commonly show up together?
A.
There are several conditions that commonly present together with brain fog and sleepiness: obstructive sleep apnea and chronic liver disease with hepatic encephalopathy are leading causes, because disrupted sleep and toxin buildup can impair attention, memory, and alertness. Other frequent contributors include hypothyroidism, anemia, depression or anxiety, vitamin B12, D, or folate deficiency, medication side effects, chronic fatigue syndrome, and long COVID. There are important warning signs, tests, and treatment options that could shape your next steps; see below for the complete answer.
References:
Kim H, & Dimsdale JE. (2007). The effect of obstructive sleep apnea on cognitive function: evidence for selective impairment… Sleep Med Rev, 17884586.
Vilstrup H, Amodio P, Bajaj J, Cordoba J, Ferenci P, Mullen KD, Weissenborn K, & Wong PW. (2014). Hepatic encephalopathy in chronic liver disease: 2014 Practice… Hepatology, 25069534.
Castera L, Forns X, & Alberti A. (2008). Non-invasive evaluation of liver fibrosis using transient… Journal of Hepatology, 18155334.
Q.
Excessive daytime sleepiness: what are the most common medical causes?
A.
The most common medical causes are sleep disorders such as obstructive sleep apnea, narcolepsy, restless legs or periodic limb movements, and insomnia; too little or irregular sleep and circadian rhythm problems; sedating medications or alcohol; depression and anxiety; and systemic illnesses like hypothyroidism, anemia, diabetes, kidney or liver disease, and heart or lung disease. There are several factors to consider. See below for important details on warning signs, when to seek care, and how evaluation and treatments like sleep studies, medication review, and targeted therapies can guide your next steps.
References:
Johns MW. (1991). A new method for measuring daytime sleepiness: the Epworth… Sleep, 1798888.
Kamath PS, & Wiesner RH. (2001). A model to predict survival in patients with… Hepatology, 11157951.
European Association for the Study of the Liver. (2018). EASL clinical practice guidelines for the management of patients… Journal of Hepatology, 29833426.
Q.
Excitement shouldn’t make you collapse—here’s what to watch.
A.
Sudden weakness or collapse with excitement is usually caused by a vasovagal response, orthostatic blood pressure drops, heart rhythm problems, hyperventilation, or metabolic issues like dehydration or low blood sugar, and it can be worsened by underlying conditions such as anemia or liver disease. Seek urgent care for fainting, chest pain, palpitations, shortness of breath, one-sided weakness, vision or speech changes, or confusion especially with known liver disease, and discuss recurrent episodes with a clinician since tests like an ECG, blood work, or a tilt table test may be needed. There are several factors to consider. See below for important details that can guide your next steps.
References:
D'Amico G, Garcia‐Tsao G, & Pagliaro L. (2006). Natural history and prognostic indicators of survival in cirrhosis… Hepatology, 16871567.
Vilstrup H, Amodio P, Bajaj J, et al. (2014). Hepatic encephalopathy in chronic liver disease: 2014 practice guideline by… Journal of Hepatology, 24736022.
Runyon BA. (2012). Management of adult patients with ascites due to cirrhosis: an update… Hepatology, 22416103.
Q.
Hypersomnia vs narcolepsy: the difference is smaller—and stranger—than you think.
A.
Hypersomnia and narcolepsy both cause excessive daytime sleepiness and cognitive fog, and even overlap on sleep studies with SOREMs. The clearest separators are cataplexy and often low hypocretin in narcolepsy type 1, versus severe sleep inertia and longer total sleep with fewer SOREMs in idiopathic hypersomnia. Because the boundary is blurry but treatment choices differ, a careful evaluation with sleep history, PSG and MSLT matters; there are several factors to consider, so see the complete details below to guide your next steps.
References:
Mignot E. (2018). Narcolepsy … Nat Rev Dis Primers, 29363413.
Thorpy MJ, & Mayer G. (2014). Narcolepsy and other hypersomnias of central origin: a European guideline… Sleep Med Rev, 24942201.
Castera L, Forns X, & Alberti A. (2005). Non-invasive evaluation of liver fibrosis using transient elastography. J Hepatol, 16081130.
Q.
If work makes you crash, it may not be ‘stress.’
A.
Crashing at work is often not just stress; common medical causes include sleep disorders, anemia or B12 deficiency, thyroid or diabetes related issues, medication side effects, mental health conditions, and even liver problems like hepatic encephalopathy. There are several factors to consider. For red flags, how to tell stress from a medical issue, and practical next steps like tracking symptoms and getting the right tests, see the complete details below.
References:
European Association for the Study of the Liver. (2018). EASL Clinical Practice Guidelines for the management of patients wi… Journal of Hepatology, 29336867.
Berzigotti A, Abraldes JG, Tandon P, Vizzutti F, Garcia-Pagán JC, & Bosch J. (2013). Non-invasive evaluation of portal hypertension using transient elastogr… Gut, 23236168.
Vilstrup H, Amodio P, Bajaj J, Córdoba J, Ferenci P, & Hepatic Encephalopathy Guideline Group. (2014). Hepatic encephalopathy in chronic liver disease: 2014 Practice Guideline b… Hepatology, 25499231.
Q.
If you hallucinate when waking up, this is the detail to track.
A.
Track the date and exact sleep and wake times, the type of hallucination, how long it lasts, your emotions, potential triggers like sleep loss, stress, medications, alcohol or drugs, your sleep environment, any accompanying symptoms like sleep paralysis or confusion, and your medical history including sleep disorders or liver disease. There are several factors to consider; causes can include normal hypnopompic phenomena, narcolepsy, sleep apnea, medication or substance effects, psychiatric or neurological conditions, and liver-related issues like hepatic encephalopathy. Key red flags, self-care steps, and when to seek urgent care are outlined below.
References:
Ferenci P, Lockwood A, Mullen K, Tarter R, Weissenborn K, & Blei AT. (2002). Hepatic encephalopathy–definition, nomenclature, diagnosis, and quantification: final report of the working party at the 11th World Congress of Gastroenterology… Journal of Hepatology, 11869844.
Vilstrup H, Amodio P, Bajaj J, Cordoba J, Ferenci P, Mullen KD, Weissenborn K, Schnitzler A, Montagnese S, & Buyse S. (2014). Hepatic encephalopathy in chronic liver disease: 2014 practice guideline by the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver. Hepatology, 24612833.
Biggins SW, Kim WR, Terrault NA, Saab S, Balan V, Schiano T, Benson JT, Therneau T, & Kamath PS. (2006). Evidence-based incorporation of serum sodium concentration into MELD. Gastroenterology, 16840600.
Q.
If you think you have sleep attacks, this question changes everything.
A.
Sudden, irresistible daytime sleep episodes can be more than ordinary tiredness and may signal narcolepsy or idiopathic hypersomnia, obstructive sleep apnea, medication effects, or liver-related problems like hepatic encephalopathy, with red flags such as cataplexy, loud snoring with gasping, confusion, or jaundice guiding urgency. There are several factors to consider; see below for the full list of warning signs, when to seek emergency care, and step-by-step next actions including sleep tracking, diagnostic tests, and treatment options that could change your next move.
References:
Kamath PS, & Wiesner RH. (2001). A model to predict survival in patients with end-stage liver disease. Hepatology, 11157951.
D'Amico G, Garcia-Tsao G, & Pagliaro L. (2006). Natural history and prognostic indicators of survival in cirrhosis: a systematic review of… Semin Liver Dis, 16618876.
Ferenci P, Lockwood A, Mullen K, Tarter R, Weissenborn K, & Blei AT. (2002). Hepatic encephalopathy—definition, nomenclature, diagnosis, and qu… Hepatology, 11870376.
Q.
If you’re sleepy while driving, this one symptom matters most.
A.
Microsleeps are the most important warning sign to watch for, since these brief involuntary mini naps mean your brain is already shutting down and your crash risk is extremely high. There are several factors to consider. See below to understand more, including how to recognize microsleep cues, what to do immediately such as pulling over or switching drivers, and when to seek care for underlying issues like sleep apnea, sedating medications, or liver disease.
References:
Bajaj JS, Thacker LR, & Heuman DM. (2015). Minimal hepatic encephalopathy is associated with poor sleep qualit… Clin Gastroenterol Hepatol, 25241275.
Montagnese S, Middleton B, & Morgan MY. (2014). Sleep-wake disturbances in cirrhosis and hepatic encephalo… Journal of Hepatology, 24512813.
Kamath PS, & Wiesner RH. (2001). A model to predict survival in patients with end-stage liver dise… Hepatology, 11157951.
Q.
If your sleep isn’t refreshing, your brain might not be ‘finishing the job.’
A.
There are several factors to consider. Unrefreshing sleep often means your brain is not completing deep and REM sleep tasks like waste clearance, repair, and memory consolidation, which can be disrupted by fragmented sleep, circadian misalignment, stress, certain medications or substances, sleep apnea or restless legs, and medical issues including liver disease with encephalopathy, ascites, hyponatremia, thyroid problems, chronic pain, and some neurological conditions. Key warning signs and step by step fixes are outlined below and can shape your next steps, from sleep hygiene changes and a sleep study to urgent medical evaluation if there is severe daytime sleepiness, confusion, loud snoring with gasping, chest pain, or swelling.
References:
Butterworth RF. (2007). Hepatic encephalopathy: a guide for the clinician… Nat Clin Pract Gastroenterol Hepatol, 17645917.
Runyon BA. (2009). Management of adult patients with ascites due to cirrhosis:… Hepatology, 19391691.
Kim WR, & Biggins SW. (2008). Hyponatremia and mortality among patients on the liver-transplant… N Engl J Med, 18799511.
Q.
Knees buckle when laughing: could this be cataplexy or something else?
A.
Knees buckling with laughter can be cataplexy, a narcolepsy type 1 feature, especially if episodes are brief, you stay fully aware, and there is no pain; however, joint or ligament issues, muscle fatigue, blood pressure dips, electrolyte or thyroid problems, and certain neurologic conditions can also cause it. There are several factors to consider. See below for key ways to tell cataplexy from other causes, red flags that need urgent care, and the evaluations and treatments your clinician may recommend.
References:
Dauvilliers Y, Arnulf I, & Mignot E. (2007). Narcolepsy with cataplexy. Lancet Neurol, 17956703.
Friedrich-Rust M, Ong MF, Martens S, Sarrazin C, Bojunga J, Zeuzem S, & Herrmann E. (2008). Performance of transient elastography for the staging of liver fibrosi… Gastroenterology, 17905136.
Kamath PS, & Kim WR. (2007). The model for end-stage liver disease (MELD). Hepatology, 17692985.
Q.
Most people blame sleep—these daytime sleepiness causes are sneakier.
A.
There are several sneakier causes of daytime sleepiness beyond not sleeping enough, including hidden sleep disorders (obstructive sleep apnea, narcolepsy, restless legs), blood and metabolic problems (anemia, thyroid or glucose issues), mental health factors, early liver disease with minimal encephalopathy, and common medication or lifestyle traps. See below for key symptoms to watch for, simple tests your clinician may order (CBC, TSH, glucose, liver tests or FibroScan), practical fixes like medication review and sleep hygiene, and the red flags that should prompt urgent medical care.
References:
Foucher J, Chanteloup E, Vergniol J, et al. (2006). Diagnosis of cirrhosis by transient elastography (FibroScan): a prospective stud… Gastroenterology, 16079155.
Montano-Loza AJ, Meza-Junco J, Baracos VE, et al. (2012). Sarcopenia is associated with increased mortality in patients… Liver Transpl, 22166430.
Vilstrup H, Amodio P, Bajaj J, et al. (2014). Hepatic encephalopathy in chronic liver disease: 2014 practice guideline by t… Hepatology, 24643626.
Q.
Randomly falling asleep: what medical conditions can cause sudden sleep episodes?
A.
Several medical conditions can cause sudden sleep episodes, including primary sleep disorders (narcolepsy, idiopathic hypersomnia, obstructive sleep apnea), neurological diseases (Parkinson’s, multiple sclerosis, epilepsy, brain lesions), metabolic and endocrine problems (hypothyroidism, hepatic encephalopathy from liver disease, uremia from kidney failure), as well as medication or alcohol effects, circadian disruption, chronic sleep loss, mood disorders, and vitamin deficiencies. Key red flags and the tests and treatments that guide next steps, like when cataplexy, near-miss accidents, new sedating medicines, or worsening sleepiness with liver or kidney disease appear, are explained below and can change how urgently you should seek care.
References:
Scammell TE. (2015). Narcolepsy. N Engl J Med, 26700229.
Kamath PS, & Wiesner RH. (2001). A model to predict survival in patients with end-stage… Hepatology, 11157951.
Wai CT, Greenson JK, Fontana RJ, Kalbfleisch JD, Marrero JA, Conjeevaram HS, & Lok AS. (2003). A simple noninvasive index can predict both significant… Hepatology, 12746959.
Q.
Seeing things as you fall asleep? It’s a known phenomenon—here’s why.
A.
Seeing things as you fall asleep is usually a benign hypnagogic hallucination caused by a brief overlap of wakefulness with REM dream activity, often triggered by sleep loss, stress, irregular schedules, or certain medications. There are several factors and red flags to consider, since frequent or distressing episodes or symptoms like excessive daytime sleepiness, cataplexy, sleep paralysis, or confusion can signal conditions such as narcolepsy or liver disease; for practical ways to reduce episodes and clear guidance on when to seek care, see the complete answer below.
References:
Dauvilliers Y, Arnulf I, & Mignot E. (2007). Narcolepsy with cataplexy. Lancet, 17888927.
European Association for the Study of the Liver. (2015). EASL clinical practice guidelines for the management of patients with decompensated cirrhosis. Journal of Hepatology, 26174375.
Schuppan D, & Afdhal NH. (2008). Liver cirrhosis. Lancet, 18207065.
Q.
Sleep paralysis and daytime sleepiness together: what conditions connect these symptoms?
A.
Sleep paralysis plus daytime sleepiness is most often linked to narcolepsy, obstructive sleep apnea, idiopathic hypersomnia, circadian rhythm disorders or sleep debt, and can also occur with PTSD or anxiety, migraine, and substance use or withdrawal. There are several factors to consider; red flags include cataplexy, loud snoring with breathing pauses, and safety-impairing sleepiness. See below for the specific signs, tests, and treatments that can guide your next steps.
References:
Ohayon MM, Priest RG, Caulet M, & Guilleminault C. (1997). Prevalence of narcolepsy symptoms in the general population. Neurology, 9103322.
Nishino S, Ripley B, Overeem S, Lammers GJ, & Mignot E. (2000). Hypocretin (orexin) deficiency in human narcolepsy. Nat Med, 10952634.
Wai CT, Greenson JK, Fontana RJ, Kalbfleisch JD, Marrero JA, Conjeevaram HS, & Lok AS. (2003). A simple noninvasive index can predict both significant fibrosis and cirrhosis… Hepatology, 12883497.
Q.
Sleep paralysis with chest pressure: anxiety, REM physiology, or something else?
A.
There are several factors to consider: most chest pressure during sleep paralysis arises from REM-related muscle atonia blending with vivid hallucinations, with anxiety often triggering or amplifying episodes, though sleep loss, shift work, substances, narcolepsy, and sleep apnea can also contribute. See the complete guidance below for red flags that need urgent care, how to tell anxiety or REM physiology from medical causes, and actionable steps to prevent episodes and know when to talk to a clinician.
References:
Sharpless BA, & Barber JP. (2011). Lifetime prevalence rates of sleep paralysis: a systematic review… Sleep Med Rev, 21638187.
Cheyne JA, Rueffer SD, & Newby-Clark IR. (1999). Hypnagogic and hypnopompic hallucinations during sleep paralysis… Conscious Cogn, 10497373.
Tsochatzis EA, Bosch J, & Burroughs AK. (2014). Liver cirrhosis. Lancet, 25092467.
Q.
Life after 65: Are melatonin gummies safe?
A.
Generally safe at low doses for adults over 65, melatonin gummies can help you fall asleep and modestly improve sleep quality when taken 30 to 60 minutes before bed, with typical effective doses around 0.5 to 2 mg. There are several factors to consider; interactions with blood thinners, diabetes and blood pressure medicines, and caution with significant liver disease mean you should start low, monitor side effects, and talk to your clinician if problems persist. See the complete details below to guide your next steps.
References:
Brzezinski A, Vangel MG, Wurtman RJ, Norrie G, Zhdanova I, Ben-Shushan A, & Ford I. (2005). Effects of exogenous melatonin on sleep: a meta-analysis… Sleep Med Rev, 16154318.
Wade AG, Ford I, Crawford G, McMahon AD, Nir T, Laudon M, & Zisapel N. (2007). Night-time prolonged-release melatonin for insomnia in patients aged 55 years or older: a randomised double-blind placebo-controlled multicentre trial… Curr Med Res Opin, 17635620.
European Association for the Study of the Liver. (2018). EASL clinical practice guidelines for the management of patients with decompensated cirrhosis… Journal of Hepatology, 30070858.
Q.
Sleep problems during chemotherapy: Why you feel tired but can't sleep?
A.
Feeling exhausted but unable to sleep during chemotherapy is common and usually stems from a mix of circadian rhythm disruption, inflammation, steroids or other meds, physical side effects like pain or hot flashes, and stress, anxiety or depression. There are several factors to consider and targeted steps that can help, from sleep routine changes, morning light and gentle activity to medication timing, CBT-I and safe short-term aids like melatonin, plus red flags that need urgent care; see the complete guidance below to understand what applies to you and which next steps to take with your oncology team.
References:
Savard J, Morin CM. (2001). Insomnia in the context of cancer: a survey of oncology patients… J Clin Oncol, 11470930.
Ancoli-Israel S, Rissling M, Natarajan L, Mills PJ, Sadler GR, Parker BA. (2006). Sleep, fatigue, depression, and circadian activity rhythms in women with breast cancer before and after chemotherapy… Support Care Cancer, 16612598.
D'Amico G, Garcia-Tsao G, Pagliaro L. (2006). Natural history and prognostic indicators of survival in cirrhosis: a systematic review… Journal of Hepatology, 15100658.
Q.
Can Obesity Hypoventilation Syndrome (OHS) be confused with COPD or heart failure?
A.
Obesity Hypoventilation Syndrome (OHS) can sometimes be confused with COPD or heart failure because they share similar symptoms like breathing problems and fatigue.
References:
Msaad S, Gargouri R, Kotti A, Kallel N, Saidane A, Jmel Y, et al. (2022). Characteristics of Obese Patients with Acute Hypercapnia .... Sleep disorders, 35223103.
Q.
Can weight loss alone improve or reverse Obesity Hypoventilation Syndrome (OHS)?
A.
Weight loss can help improve or even reverse Obesity Hypoventilation Syndrome (OHS) by reducing the burden on the lungs and improving breathing.
References:
Kakazu MT, Soghier I, Afshar M, Brozek JL, Wilson KC, Masa JF, & Mokhlesi B. (2020). Weight Loss Interventions as Treatment of Obesity .... Annals of the American Thoracic Society, 31978317.
https://pubmed.ncbi.nlm.nih.gov/31978317/
Sugerman HJ, Baron PL, Fairman RP, Evans CR, & Vetrovec GW. (1988). Hemodynamic dysfunction in obesity hypoventilation .... Annals of surgery, 3377570.
https://pubmed.ncbi.nlm.nih.gov/3377570/
Sugerman HJ. (1987). Pulmonary function in morbid obesity. Gastroenterology clinics of North America, 3319903.
Q.
How are GLP-1 receptor agonists (like semaglutide or tirzepatide) used in Obesity Hypoventilation Syndrome (OHS) care?
A.
GLP-1 receptor agonists, like semaglutide and tirzepatide, can help manage weight in people with Obesity Hypoventilation Syndrome (OHS), which may improve breathing and overall health.
References:
Griffin W, le Roux CW, Heneghan HM, O'Shea D, & Garvey JF. (2025). The role of weight management in sleep disordered .... Breathe (Sheffield, England), 40964177.
https://pubmed.ncbi.nlm.nih.gov/40964177/
Pépin JL, Baillieul S, & Tamisier R. (2025). Obesity hypoventilation syndrome: Current status and .... Sleep medicine, 40203613.
https://pubmed.ncbi.nlm.nih.gov/40203613/
Moiz A, Filion KB, Toutounchi H, Tsoukas MA, Yu OHY, Peters TM, & Eisenberg MJ. (2025). Efficacy and Safety of Glucagon-Like Peptide-1 Receptor .... Annals of internal medicine, 39761578.
Q.
How is Obesity Hypoventilation Syndrome (OHS) diagnosed and what tests are required?
A.
Obesity Hypoventilation Syndrome (OHS) is diagnosed by checking for low oxygen and high carbon dioxide levels in the blood, often using tests like blood gas analysis and sleep studies.
References:
Neborak JM, & Mokhlesi B. (2025). Evaluation and Management of Obesity Hypoventilation .... Sleep medicine clinics, 41136085.
Mokhlesi B, Masa JF, Brozek JL, Gurubhagavatula I, Murphy PB, Piper AJ, et al. (2019). Evaluation and Management of Obesity Hypoventilation .... American journal of respiratory and critical care medicine, 31368798.
https://pubmed.ncbi.nlm.nih.gov/31368798/
Kaw R, Wong J, & Mokhlesi B. (2021). Obesity and Obesity Hypoventilation, Sleep .... Anesthesia and analgesia, 33857968.
Q.
How is Obesity Hypoventilation Syndrome (OHS) different from sleep apnea?
A.
Obesity Hypoventilation Syndrome (OHS) is a condition where people with obesity have trouble breathing deeply, especially during the day, while sleep apnea mainly affects breathing during sleep.
References:
Basoglu OK, & Tasbakan MS. (2014). Comparison of clinical characteristics in patients with .... The clinical respiratory journal, 24028180.
https://pubmed.ncbi.nlm.nih.gov/24028180/
Bingol Z, Pıhtılı A, Cagatay P, Okumus G, & Kıyan E. (2015). Clinical predictors of obesity hypoventilation syndrome in .... Respiratory care, 25587164.
https://pubmed.ncbi.nlm.nih.gov/25587164/
Kessler R, Chaouat A, Schinkewitch P, Faller M, Casel S, Krieger J, & Weitzenblum E. (2001). The obesity-hypoventilation syndrome revisited. Chest, 11502631.
Q.
What are the early signs of Obesity Hypoventilation Syndrome (OHS) that people often overlook?
A.
Early signs of Obesity Hypoventilation Syndrome (OHS) include feeling very tired during the day and having trouble breathing, especially at night.
References:
Mokhlesi B, Masa JF, Brozek JL, Gurubhagavatula I, Murphy PB, Piper AJ, et al. (2019). Evaluation and Management of Obesity Hypoventilation .... American Journal of Respiratory and Critical Care Medicine, 6680300.
https://pmc.ncbi.nlm.nih.gov/articles/PMC6680300/
Msaad S, Gargouri R, Kotti A, Kallel N, Saidane A, Jmal Y, et al. (2022). Characteristics of Obese Patients with Acute Hypercapnia .... Sleep Disorders, 8872695.
https://pmc.ncbi.nlm.nih.gov/articles/PMC8872695/
Liu C, Chen MS, & Yu H. (2017). The relationship between obstructive sleep apnea and obesity .... Oncotarget, 5696252.
Q.
What is Obesity Hypoventilation Syndrome (OHS)?
A.
Obesity Hypoventilation Syndrome (OHS) is a condition where being very overweight makes it hard to breathe properly, especially during sleep, leading to low oxygen and high carbon dioxide levels in the blood.
References:
Masa JF, Pépin JL, Borel JC, Mokhlesi B, Murphy PB, & Sánchez-Quiroga MÁ. (2019). Obesity hypoventilation syndrome. European respiratory review : an official journal of the European Respiratory Society, 30872398.
https://pubmed.ncbi.nlm.nih.gov/30872398/
Chau EH, Lam D, Wong J, Mokhlesi B, & Chung F. (2012). Obesity hypoventilation syndrome: a review of .... Anesthesiology, 22614131.
https://pubmed.ncbi.nlm.nih.gov/22614131/
Mokhlesi B. (2010). Obesity hypoventilation syndrome: a state-of-the-art review. Respiratory care, 20875161.
Q.
What is the role of arterial blood gas testing in Obesity Hypoventilation Syndrome (OHS) diagnosis?
A.
Arterial blood gas testing is important in diagnosing Obesity Hypoventilation Syndrome (OHS) because it helps check for low oxygen and high carbon dioxide levels in the blood, which are common in this condition.
References:
Macavei VM, Spurling KJ, Loft J, & Makker HK. (2013). Diagnostic predictors of obesity-hypoventilation syndrome .... Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 23997700.
https://pubmed.ncbi.nlm.nih.gov/23997700/
Povitz M, James MT, Pendharkar SR, Raneri J, Hanly PJ, & Tsai WH. (2015). Prevalence of Sleep-disordered Breathing in Obese .... Annals of the American Thoracic Society, 25822569.
https://pubmed.ncbi.nlm.nih.gov/25822569/
Berry RB, Chediak A, Brown LK, Finder J, Gozal D, Iber C, et al. (2010). Best clinical practices for the sleep center adjustment of .... Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 20957853.
Q.
When is BiPAP or other non-invasive ventilation recommended instead of CPAP?
A.
BiPAP is often recommended over CPAP for people who need extra help with breathing, like those with obesity hypoventilation syndrome or certain sleep-related breathing problems.
References:
Masa JF, Pépin JL, Borel JC, Mokhlesi B, Murphy PB, & Sánchez-Quiroga MÁ. (2019). Obesity hypoventilation syndrome - PMC - PubMed Central. European Respiratory Review, 9491327.
https://pmc.ncbi.nlm.nih.gov/articles/PMC9491327/
Selim B, & Ramar K. (2020). Sleep-Related Breathing Disorders: When CPAP Is Not Enough. Neurotherapeutics, 8116389.
https://pmc.ncbi.nlm.nih.gov/articles/PMC8116389/
Ghosh D, & Elliott MW. (2019). Acute non-invasive ventilation – getting it right on the acute .... Clinical Medicine, 6542238.
Q.
Why does excess weight affect breathing during sleep and wakefulness?
A.
Excess weight can make it harder to breathe both during sleep and when awake because it affects how well the lungs and chest can move.
References:
Koenig SM. (2001). Pulmonary complications of obesity. The American journal of the medical sciences, 11307867.
https://pubmed.ncbi.nlm.nih.gov/11307867/
Rabec C, Janssens JP, & Murphy PB. (2025). Ventilation in the obese: physiological insights and .... European respiratory review : an official journal of the European Respiratory Society, 40368425.
https://pubmed.ncbi.nlm.nih.gov/40368425/
Salome CM, King GG, & Berend N. (2010). Physiology of obesity and effects on lung function. Journal of applied physiology (Bethesda, Md. : 1985), 19875713.
Q.
Why is CPAP often the first treatment for Obesity Hypoventilation Syndrome (OHS)?
A.
CPAP is often used first for Obesity Hypoventilation Syndrome (OHS) because it helps improve breathing during sleep and is generally easy to use.
References:
Soghier I, Brożek JL, Afshar M, Tamae Kakazu M, Wilson KC, Masa JF, & Mokhlesi B. (2019). Noninvasive Ventilation versus CPAP as Initial Treatment .... Annals of the American Thoracic Society, 31365842.
https://pubmed.ncbi.nlm.nih.gov/31365842/
Mokhlesi B, Masa JF, Brozek JL, Gurubhagavatula I, Murphy PB, Piper AJ, et al. (2019). Evaluation and Management of Obesity Hypoventilation .... American journal of respiratory and critical care medicine, 31368798.
https://pubmed.ncbi.nlm.nih.gov/31368798/
Yan H, Qinghua L, Mengyuan P, Yaoyu C, Long Z, Mengjie L, et al. (2022). High flow nasal cannula therapy for obstructive sleep .... Sleep & breathing = Schlaf & Atmung, 34383275.
Q.
Are GLP-1 agonists like semaglutide used to support weight loss for SAS?
A.
GLP-1 agonists like semaglutide are being studied for weight loss and other benefits, but their role in SAS is still being researched.
References:
Li M, Lin H, Yang Q, Zhang X, Zhou Q, Shi J, & Ge F. (2025). Glucagon-like peptide-1 receptor agonists for the treatment .... Sleep, 39626095.
https://pubmed.ncbi.nlm.nih.gov/39626095/
Yang R, Zhang L, Guo J, Wang N, Zhang Q, Qi Z, et al. (2025). Glucagon-like Peptide-1 receptor agonists for obstructive .... Journal of translational medicine, 40181368.
https://pubmed.ncbi.nlm.nih.gov/40181368/
Kow CS, Ramachandram DS, Hasan SS, & Thiruchelvam K. (2025). Efficacy and safety of GLP-1 receptor agonists in the .... Sleep medicine, 39978242.
Q.
Are over-the-counter sleep aids like diphenhydramine safe for regular use?
A.
Over-the-counter sleep aids like diphenhydramine are not recommended for regular use due to potential side effects and the risk of next-day drowsiness.
References:
Almond SM, Warren MJ, Shealy KM, Threatt TB, & Ward ED. (2021). A Systematic Review of the Efficacy and Safety of Over- .... The Senior care pharmacist, 33509331.
https://pubmed.ncbi.nlm.nih.gov/33509331/
Abraham O, Schleiden L, & Albert SM. (2017). Over-the-counter Medications Containing Diphenhydramine .... International journal of clinical pharmacy, 28466395.
https://pubmed.ncbi.nlm.nih.gov/28466395/
Zhang D, Tashiro M, Shibuya K, Okamura N, Funaki Y, Yoshikawa T, et al. (2010). Next-day residual sedative effect after nighttime .... Journal of clinical psychopharmacology, 21105284.
Q.
Are there medications that directly treat sleep apnea itself?
A.
Currently, there are no medications that directly treat sleep apnea, but some drugs may help manage symptoms or related conditions.
References:
Luu S, Chan DECY, Marshall NS, Phillips CL, Grunstein RR, & Yee BJ. (2025). Pharmacotherapy for obstructive sleep apnea: a critical .... Sleep medicine reviews, 40974973.
https://pubmed.ncbi.nlm.nih.gov/40974973/
Hedner J, Grote L, & Zou D. (2008). Pharmacological treatment of sleep apnea. Sleep medicine reviews, 18201662.
https://pubmed.ncbi.nlm.nih.gov/18201662/
Mason M, Welsh EJ, & Smith I. (2013). Drug therapy for obstructive sleep apnoea in adults. The Cochrane database of systematic reviews, 23728641.
Q.
Are there medications that should not be combined with sleep aids due to risk of confusion or wandering?
A.
Some medications, when combined with sleep aids, can increase the risk of confusion or wandering, such as valproic acid with sleep aids or methamphetamine with zolpidem.
References:
Dokkedal-Silva V, Galduróz JCF, Tufik S, & Andersen ML. (2020). Combined cocaine and clonazepam administration .... Pharmacology, biochemistry, and behavior, 32795565.
https://pubmed.ncbi.nlm.nih.gov/32795565/
Sattar SP, Ramaswamy S, Bhatia SC, & Petty F. (2003). Somnambulism due to probable interaction of valproic acid .... The Annals of pharmacotherapy, 14519043.
https://pubmed.ncbi.nlm.nih.gov/14519043/
Hart CL, Haney M, Nasser J, & Foltin RW. (2005). Combined effects of methamphetamine and zolpidem on .... Pharmacology, biochemistry, and behavior, 15936062.
Q.
Can anxiety medications reduce sleepwalking behaviors?
A.
Anxiety medications might not help with sleepwalking and could even make it worse. It's important to talk to a doctor if you have concerns about sleepwalking.
References:
Kierlin L, & Littner MR. (2011). Parasomnias and Antidepressant Therapy: A Review of the .... Frontiers in Psychiatry, 3235766.
https://pmc.ncbi.nlm.nih.gov/articles/PMC3235766/
Dumont S, Bloch V, Lillo‐Lelouet A, Le Beller C, Geoffroy PA, & Veyrier M. (2024). Parasomnias and sleep‐related movement disorders induced .... Journal of Sleep Research, 11911033.
https://pmc.ncbi.nlm.nih.gov/articles/PMC11911033/
Markov D, Jaffe F, & Doghramji K. (2006). Update on Parasomnias: A Review for Psychiatric Practice. Psychiatry (Edgmont), 2958868.
Q.
Can buspirone help if stress is preventing sleep?
A.
Buspirone is not typically used to help with sleep problems caused by stress, as its effects on sleep are not well-defined.
References:
Manfredi RL, Kales A, Vgontzas AN, Bixler EO, Isaac MA, & Falcone CM. (1991). Buspirone: sedative or stimulant effect?. The American journal of psychiatry, 1883000.
https://pubmed.ncbi.nlm.nih.gov/1883000/
Maher MJ, Rego SA, & Asnis GM. (2006). Sleep disturbances in patients with post-traumatic stress .... CNS drugs, 16800716.
https://pubmed.ncbi.nlm.nih.gov/16800716/
Wheatley D. (1988). Use of Anti-Anxiety Drugs in the Medically Ill. Psychotherapy and psychosomatics, 2905817.
Q.
Can cetirizine or fexofenadine help if nasal congestion worsens sleep apnea?
A.
Cetirizine or fexofenadine might help with nasal congestion that can worsen sleep apnea, as they are known to alleviate symptoms of allergic rhinitis, which is linked to sleep disturbances.
References:
Chirakalwasan N, & Ruxrungtham K. (2014). The linkage of allergic rhinitis and obstructive sleep apnea. Asian Pacific journal of allergy and immunology, 25543037.
https://pubmed.ncbi.nlm.nih.gov/25543037/
Pagel JML, & Mattos JL. (2024). Allergic Rhinitis and Its Effect on Sleep. Otolaryngologic clinics of North America, 37867109.
https://pubmed.ncbi.nlm.nih.gov/37867109/
Muliol J, Maurer M, & Bousquet J. (2008). Sleep and allergic rhinitis. Journal of investigational allergology & clinical immunology, 19123431.
Q.
Can daytime stimulants influence nighttime sleepwalking?
A.
Daytime stimulants might affect nighttime sleep behaviors, including sleepwalking, especially in children with certain conditions.
References:
Corkum P, Moldofsky H, Hogg-Johnson S, Humphries T, & Tannock R. (1999). impact of subtype, comorbidity, and stimulant medication. Journal of the American Academy of Child and Adolescent Psychiatry, 10517062.
Q.
Can omeprazole help reduce nighttime choking caused by reflux?
A.
Omeprazole is used to reduce stomach acid, which may help with reflux symptoms, but it can sometimes cause a cough.
References:
Vanderhoof JA, Moran JR, Harris CL, Merkel KL, & Orenstein SR. (2003). Efficacy of a pre-thickened infant formula: a multicenter, .... Clinical pediatrics, 12921449.
https://pubmed.ncbi.nlm.nih.gov/12921449/
Howaizi M, & Delafosse C. (2003). Omeprazole-induced intractable cough. The Annals of pharmacotherapy, 14565840.
https://pubmed.ncbi.nlm.nih.gov/14565840/
Johnson T, Gerson L, Hershcovici T, Stave C, & Fass R. (2010). Systematic review: the effects of carbonated beverages on .... Alimentary pharmacology & therapeutics, 20055784.
Q.
Can sleep medications lose effectiveness over time?
A.
Yes, sleep medications can lose effectiveness over time because the body can get used to them.
References:
Richardson GS, Roehrs TA, Rosenthal L, Koshorek G, & Roth T. (2002). Tolerance to daytime sedative effects of H1 antihistamines. Journal of clinical psychopharmacology, 12352276.
https://pubmed.ncbi.nlm.nih.gov/12352276/
Wong PT, Yoong YL, & Gwee MC. (1986). Acute tolerance to diazepam induced by benzodiazepines. Clinical and experimental pharmacology & physiology, 3086004.
https://pubmed.ncbi.nlm.nih.gov/3086004/
Wagner J, & Wagner ML. (2000). Non-benzodiazepines for the treatment of insomnia. Sleep medicine reviews, 12531036.
Q.
Do oxymetazoline nasal sprays worsen symptoms if used too long?
A.
Using oxymetazoline nasal sprays for too long can cause your nose to become more blocked, a condition called rhinitis medicamentosa.
References:
Vaidyanathan S, Williamson P, Clearie K, Khan F, & Lipworth B. (2010). Fluticasone reverses oxymetazoline-induced tachyphylaxis .... American journal of respiratory and critical care medicine, 20203244.
https://pubmed.ncbi.nlm.nih.gov/20203244/
Graf P. (1997). Rhinitis medicamentosa: aspects of pathophysiology and .... Allergy, 9353558.
https://pubmed.ncbi.nlm.nih.gov/9353558/
Graf P, Hallén H, & Juto JE. (1995). Four-week use of oxymetazoline nasal spray (Nezeril) .... Acta oto-laryngologica, 7762389.
Q.
How can sleep medications be tapered safely when stopping?
A.
To safely stop sleep medications, it's important to gradually reduce the dose over time with guidance from a healthcare provider. This process, known as tapering, helps prevent withdrawal symptoms and can sometimes be supported with other treatments like melatonin.
References:
Nardi AE, Freire RC, Valença AM, Amrein R, de Cerqueira AC, Lopes FL, et al. (2010). Tapering clonazepam in patients with panic disorder after .... Journal of clinical psychopharmacology, 20473065.
https://pubmed.ncbi.nlm.nih.gov/20473065/
Brogan K, Siefert A, Whitson E, Kirsh L, & Sweetan V. (2019). Psychotropic Drug Withdrawal and Holistic Tapering .... Advances in mind-body medicine, 32738037.
https://pubmed.ncbi.nlm.nih.gov/32738037/
Wright A, Diebold J, Otal J, Stoneman C, Wong J, Wallace C, & Duffett M. (2015). The Effect of Melatonin on Benzodiazepine Discontinuation .... Drugs & aging, 26547856.
Q.
How does fluticasone nasal spray affect nighttime breathing?
A.
Fluticasone nasal spray can help improve nighttime breathing by reducing nasal blockage, which may lead to better sleep quality.
References:
Segsarnviriya C, Chumthong R, & Mahakit P. (2021). Effects of intranasal steroids on continuous positive airway .... Sleep & breathing = Schlaf & Atmung, 33104981.
https://pubmed.ncbi.nlm.nih.gov/33104981/
Craig TJ, Hanks CD, & Fisher LH. (2005). How Do Topical Nasal Corticosteroids Improve Sleep and .... The Journal of allergy and clinical immunology, 16337455.
https://pubmed.ncbi.nlm.nih.gov/16337455/
Demirhan H, Aksoy F, Ozturan O, Yildirim YS, & Veyseller B. (2010). Medical treatment of adenoid hypertrophy with "fluticasone .... International journal of pediatric otorhinolaryngology, 20430451.
Q.
How does ramelteon help regulate circadian rhythm?
A.
Ramelteon helps regulate the sleep-wake cycle by acting like melatonin, which is a hormone that tells the body when it is time to sleep.
References:
Neubauer DN. (2008). A review of ramelteon in the treatment of sleep disorders. Neuropsychiatric disease and treatment, 18728808.
https://pubmed.ncbi.nlm.nih.gov/18728808/
Srinivasan V, Pandi-Perumal SR, Trahkt I, Spence DW, Poeggeler B, Hardeland R, & Cardinali DP. (2009). Melatonin and melatonergic drugs on sleep. The International journal of neuroscience, 19326288.
https://pubmed.ncbi.nlm.nih.gov/19326288/
Hardeland R, Poeggeler B, Srinivasan V, Trakht I, Pandi-Perumal SR, & Cardinali DP. (2008). Melatonergic drugs in clinical practice. Arzneimittel-Forschung, 18368944.
Q.
How should drowsiness-causing medications be adjusted in SAS patients?
A.
For patients with Sleep Apnea Syndrome (SAS), adjusting medications that cause drowsiness involves careful consideration to avoid worsening breathing issues during sleep.
References:
Pino RM, Dunn PF, Kacmarek RM, Bryan RJ, & Bigatello LM. (2021). An algorithm for the sedation of patients with obstructive .... Current medical research and opinion, 33565898.
https://pubmed.ncbi.nlm.nih.gov/33565898/
Eckert DJ, Malhotra A, Wellman A, & White DP. (2014). Trazodone increases the respiratory arousal threshold in .... Sleep, 24899767.
https://pubmed.ncbi.nlm.nih.gov/24899767/
Schmickl CN, Orr JE, Alex RM, Gruenberg E, Parra G, White S, et al. (2025). Combination Drug Therapy with Acetazolamide, Eszopiclone .... Annals of the American Thoracic Society, 39514000.
Q.
Is zolpidem known to trigger sleepwalking episodes in some people?
A.
Yes, zolpidem can cause sleepwalking and other unusual behaviors while asleep in some people.
References:
Stallman HM, Kohler M, & White J. (2018). Medication induced sleepwalking: A systematic review. Sleep medicine reviews, 28363449.
https://pubmed.ncbi.nlm.nih.gov/28363449/
Paulke A, Wunder C, & Toennes SW. (2015). Sleep self-intoxication and sleep driving as rare zolpidem .... International journal of legal medicine, 24770472.
https://pubmed.ncbi.nlm.nih.gov/24770472/
Dolder CR, & Nelson MH. (2008). Hypnosedative-induced complex behaviours : incidence, .... CNS drugs, 18998740.
Q.
Should sedatives like lorazepam be avoided in people prone to sleepwalking?
A.
Sedatives like lorazepam might not be the best choice for people who sleepwalk, as they could make the problem worse.
References:
Limbekar N, Pham J, Budhiraja R, Javaheri S, Epstein LJ, Batool-Anwar S, & Pavlova M. (2022). NREM Parasomnias: Retrospective Analysis of Treatment .... Clocks & Sleep, 9397000.
https://pmc.ncbi.nlm.nih.gov/articles/PMC9397000/
Gilat M, Marshall NS, Testelmans D, Buyse B, & Lewis SJ. (2021). A critical review of the pharmacological treatment of REM .... Journal of Neurology, 8739295.
https://pmc.ncbi.nlm.nih.gov/articles/PMC8739295/
Roehrs T, & Roth T. (2012). Insomnia Pharmacotherapy - PMC - PubMed Central - NIH. Neurotherapeutics, 3480571.
Q.
What is the difference in how zolpidem and eszopiclone work?
A.
Zolpidem and eszopiclone are both sleep medications, but they work in slightly different ways in the brain to help people sleep.
References:
Drover DR. (2004). zaleplon, zolpidem and zopiclone. Clinical pharmacokinetics, 15005637.
https://pubmed.ncbi.nlm.nih.gov/15005637/
Fox SV, Gotter AL, Tye SJ, Garson SL, Savitz AT, Uslaner JM, et al. (2013). Quantitative Electroencephalography Within sleep/wake .... Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology, 23722242.
https://pubmed.ncbi.nlm.nih.gov/23722242/
Ramirez AD, Gotter AL, Fox SV, Tannenbaum PL, Yao L, Tye SJ, et al. (2013). Dual orexin receptor antagonists show distinct effects on .... Frontiers in neuroscience, 24399926.
Q.
Which medications are reviewed first if sleepwalking becomes frequent?
A.
If sleepwalking happens a lot, doctors first check medications like antidepressants and sedatives, as they might be causing it.
References:
Mainieri G, Loddo G, Provini F, Nobili L, Manconi M, & Castelnovo A. (2023). Diagnosis and Management of NREM Sleep Parasomnias .... Diagnostics (Basel, Switzerland), 37046480.
Q.
Which medications should patients with sleep apnea avoid due to sedation risk?
A.
Patients with sleep apnea should avoid medications that cause sedation, such as certain sleep aids, opioids, and benzodiazepines, as they can worsen breathing problems during sleep.
References:
Ostroumova OD, Isaev RI, Kotovskaya YV, & Tkacheva ON. (2020). [Drugs affecting obstructive sleep apnea syndrome]. Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova, 33076645.
https://pubmed.ncbi.nlm.nih.gov/33076645/
Javaheri S, Randerath WJ, Safwan Badr M, & Javaheri S. (2024). Medication-induced central sleep apnea: a unifying concept. Sleep, 38334297.
https://pubmed.ncbi.nlm.nih.gov/38334297/
Cozowicz C, & Memtsoudis SG. (2021). Perioperative Management of the Patient With Obstructive .... Anesthesia and analgesia, 33857965.
Q.
Why are trazodone and mirtazapine sometimes used for sleep?
A.
Trazodone and mirtazapine are sometimes used to help with sleep because they can make you feel drowsy, which can help you fall asleep.
References:
Wiegand MH. (2008). Antidepressants for the treatment of insomnia : a suitable .... Drugs, 19016570.
https://pubmed.ncbi.nlm.nih.gov/19016570/
Atkin T, Comai S, & Gobbi G. (2018). Drugs for Insomnia beyond Benzodiazepines. Pharmacological reviews, 29487083.
https://pubmed.ncbi.nlm.nih.gov/29487083/
Bruni O, Angriman M, Melegari MG, & Ferri R. (2019). Pharmacotherapeutic management of sleep disorders in .... Expert opinion on pharmacotherapy, 31638842.
Q.
Why do antihistamine sleep aids often cause morning grogginess?
A.
Antihistamine sleep aids can cause morning grogginess because they have lingering sedative effects that last into the next day.
References:
Zhang D, Tashiro M, Shibuya K, Okamura N, Funaki Y, Yoshikawa T, et al. (2010). Next-day residual sedative effect after nighttime .... Journal of clinical psychopharmacology, 21105284.
https://pubmed.ncbi.nlm.nih.gov/21105284/
Richardson GS, Roehrs TA, Rosenthal L, Koshorek G, & Roth T. (2002). Tolerance to daytime sedative effects of H1 antihistamines. Journal of clinical psychopharmacology, 12352276.
https://pubmed.ncbi.nlm.nih.gov/12352276/
Kay GG. (2000). The effects of antihistamines on cognition and performance. The Journal of allergy and clinical immunology, 10856168.
Q.
How can patients manage their sleep disorders at home?
A.
Start with evidence-based habits: keep a consistent sleep–wake schedule, optimize your bedroom (cool, dark, quiet), manage light exposure, limit caffeine/alcohol, exercise regularly, and use CBT‑I techniques like stimulus control, sleep restriction, relaxation, and a wind‑down routine while tracking progress. There are several factors to consider, including when to seek care (insomnia lasting 3+ months, severe daytime sleepiness/accidents, loud snoring or breathing pauses, or restless legs) and special considerations for chronic conditions—see the complete, step-by-step guidance below.
References:
Trauer JM, Qian MY, Doyle JS, Rajaratnam SM, & Cunnington D. (2015). Cognitive behavioral therapy for chronic insomnia: a systematic review and… Sleep, 25675033.
Irish LA, Kline CE, Gunn HE, Buysse DJ, & Hall MH. (2015). The role of sleep hygiene in promoting public health: a review of… Sleep Med Rev, 25482686.
European Association for the Study of the Liver. (2018). EASL clinical practice guidelines for the management of patients with… J Hepatol, 29759364.
Q.
What are the top 5 questions I should ask my doctor about sleep problems or possible narcolepsy?
A.
Start with five key questions: what might be causing your daytime sleepiness and related symptoms; which tests could confirm or rule out narcolepsy (overnight polysomnography, Multiple Sleep Latency Test, and in select cases HLA typing or CSF hypocretin); what treatment options’ pros and cons fit you; which lifestyle/work adjustments improve safety; and how progress and follow-up will be handled. There are several factors to consider—how to prepare for testing, medication side effects, nap scheduling, symptom diaries, and when to seek urgent care—see the complete guidance below to inform the right next steps and what to bring to your visit.
References:
Dauvilliers Y, Bassetti C, Partinen M, et al. (2013). Diagnostic methods for narcolepsy and hypersomnia. Sleep Med Rev, 23206667.
D'Amico G, Garcia-Tsao G, Pagliaro L. (2006). Natural history and prognostic indicators of survival in cirrhosis: a systematic… Journal of Hepatology, 16494637.
Castera L, Forns X, Alberti A. (2008). Non-invasive evaluation of liver fibrosis using transient… Journal of Hepatology, 18322478.
Q.
What should I write in a sleep diary, and how do I keep one correctly?
A.
A proper sleep diary should record the date; bedtime and lights-off time; how long it took to fall asleep; number and duration of awakenings; final wake and rise times; total sleep time and sleep quality; naps; plus daily factors like caffeine, alcohol, medications, exercise, screens, bedroom environment, and stress. To keep it correctly, use a consistent template (paper or app), fill it out every morning for at least 1–2 weeks, note any night awakenings, be honest and specific, review weekly for patterns, and share with a clinician. There are several factors to consider—see below for examples, optional items, tips, and when to seek professional help, which could influence your next healthcare steps.
References:
Buysse DJ, Ancoli-Israel S, Edinger JD, Lichstein KL, & Morin CM. (2006). Recommendations for a standard research assessment of insomnia… Sleep, 16930899.
Carney CE, Buysse DJ, Ancoli-Israel S, Edinger JD, Lichstein KL, & Morin CM. (2012). Consensus sleep diary: standardizing prospective sleep self-… Sleep, 22379287.
European Association for the Study of the Liver. (2018). EASL clinical practice guidelines for the management of patients… Journal of Hepatology, 29731146.
Q.
Can sleepwalking continue into adulthood?
A.
Yes, sleepwalking can continue into adulthood and sometimes even start then. It can be treated with different methods.
References:
Guilleminault C, Kirisoglu C, Bao G, Arias V, Chan A, & Li KK. (2005). Adult chronic sleepwalking and its treatment based on .... Brain : a journal of neurology, 15817520.
https://pubmed.ncbi.nlm.nih.gov/15817520/
Bargiotas P, Arnet I, Frei M, Baumann CR, Schindler K, & Bassetti CL. (2017). and Adult-Onset Sleepwalking in Adults. European neurology, 29073634.
https://pubmed.ncbi.nlm.nih.gov/29073634/
Baldini T, Loddo G, Sessagesimi E, Mignani F, Cirignotta F, Mondini S, et al. (2019). A Window Into the Sleeping Brain. Frontiers in neurology, 31164861.
Q.
Does sleepwalking affect daytime alertness or concentration?
A.
Sleepwalking can affect how alert and focused someone feels during the day, making it harder to concentrate.
References:
Lopez R, Jaussent I, Scholz S, Bayard S, Montplaisir J, & Dauvilliers Y. (2013). Functional Impairment in Adult Sleepwalkers: A Case- .... Sleep, 23450499.
https://pubmed.ncbi.nlm.nih.gov/23450499/
Labelle MA, Dang-Vu TT, Petit D, Desautels A, Montplaisir J, & Zadra A. (2015). Sleep deprivation impairs inhibitory control during .... Journal of sleep research, 26087833.
https://pubmed.ncbi.nlm.nih.gov/26087833/
Uguccioni G, Pallanca O, Golmard JL, Leu-Semenescu S, & Arnulf I. (2015). Is sleep-related verbal memory consolidation impaired in .... Journal of sleep research, 25212397.
Q.
How long does sleepwalking typically last during a night?
A.
Sleepwalking episodes usually last a few minutes during the night.
References:
Baldini T, Loddo G, Sessagesimi E, Mignani F, Cirignotta F, Mondini S, et al. (2019). A Window Into the Sleeping Brain. Frontiers in neurology, 31164861.
https://pubmed.ncbi.nlm.nih.gov/31164861/
Castelnovo A, Amacker J, Maiolo M, Amato N, Pereno M, Riccardi S, et al. (2022). High-density EEG power topography and connectivity .... Cortex; a journal devoted to the study of the nervous system and behavior, 35985125.
https://pubmed.ncbi.nlm.nih.gov/35985125/
Castelnovo A, Loddo G, Provini F, Miano S, & Manconi M. (2021). Mental Activity During Episodes of Sleepwalking, Night .... Nature and science of sleep, 34188578.
Q.
What treatment options are available for chronic or severe sleepwalking?
A.
Chronic sleepwalking can be treated with behavioral and psychological techniques, as well as hypnotherapy.
References:
Mundt JM, Schuiling MD, Warlick C, Dietch JR, Wescott AB, Hagenaars M, et al. (2023). Behavioral and psychological treatments for NREM ... - PubMed. Sleep medicine, 37716336.
https://pubmed.ncbi.nlm.nih.gov/37716336/
Ng BY, & Lee TS. (2008). Hypnotherapy for sleep disorders. Annals of the Academy of Medicine, Singapore, 18797562.
Q.
When should sleepwalking be considered a medical emergency?
A.
Sleepwalking becomes a medical emergency if the person is at risk of harming themselves or others, or if they exhibit unusual behaviors like leaving the house. Seek help if these situations occur.
References:
Mainieri G, Loddo G, Provini F, Nobili L, Manconi M, & Castelnovo A. (2023). Diagnosis and Management of NREM Sleep Parasomnias .... Diagnostics, 10093221.
https://pmc.ncbi.nlm.nih.gov/articles/PMC10093221/
Lopez R, Lefevre L, Barateau L, Micoulaud-Franchi JA, Dauvilliers Y, & Schenck CH. (2022). A series of 8 cases of sleep-related psychogenic .... Journal of Clinical Sleep Medicine : JCSM : Official Publication of the American Academy of Sleep Medicine, 8804993.
https://pmc.ncbi.nlm.nih.gov/articles/PMC8804993/
Sousa-Santos PE, & Peres MF. (2025). Practical issues in the management of sleep, anxiety, and .... Arquivos de Neuro-Psiquiatria, 12221693.
Q.
Are there medications that can help reduce sleepwalking episodes?
A.
Certain medications may help reduce sleepwalking episodes, but treatment often depends on the specific circumstances and underlying causes.
References:
Drakatos P, Marples L, Muza R, Higgins S, Gildeh N, Macavei R, et al. (2019). NREM parasomnias: a treatment approach based upon .... Sleep medicine, 29753639.
https://pubmed.ncbi.nlm.nih.gov/29753639/
Chiaro G, Caletti MT, & Provini F. (2015). Treatment of sleep-related eating disorder. Current treatment options in neurology, 26037737.
https://pubmed.ncbi.nlm.nih.gov/26037737/
Horváth A, Papp A, & Szűcs A. (2016). Progress in elucidating the pathophysiological basis of .... Nature and science of sleep, 27022307.
Q.
Can emotional trauma contribute to sleepwalking?
A.
Emotional trauma can affect sleep, but the provided references do not specifically link it to sleepwalking.
References:
McNally RJ, & Clancy SA. (2005). Sleep paralysis, sexual abuse, and space alien abduction. Transcultural psychiatry, 15881271.
https://pubmed.ncbi.nlm.nih.gov/15881271/
Richter K, Baumgärtner L, Niklewski G, Peter L, Köck M, Kellner S, et al. (2020). Sleep disorders in migrants and refugees: a systematic .... The EPMA journal, 32549917.
Q.
Can fever or illness trigger sleepwalking in children?
A.
Fever or illness can sometimes trigger sleepwalking or sleep terrors in children, making it more likely for them to happen.
References:
Gau SF, & Soong WT. (1999). Psychiatric comorbidity of adolescents with sleep terrors or .... The Australian and New Zealand journal of psychiatry, 10544999.
https://pubmed.ncbi.nlm.nih.gov/10544999/
Bharti B, Malhi P, & Kashyap S. (2006). Patterns and problems of sleep in school going children. Indian pediatrics, 16465004.
https://pubmed.ncbi.nlm.nih.gov/16465004/
Wang X, Yuan N, Zhu J, Wang B, Zhang W, & Liu Y. (2024). Fever-induced acute sleep terrors in children and .... Sleep & breathing = Schlaf & Atmung, 38689200.
Q.
Can medications cause or worsen sleepwalking?
A.
Yes, some medications can cause or make sleepwalking worse. These include certain sleep aids and antipsychotic drugs.
References:
Stallman HM, Kohler M, & White J. (2018). Medication induced sleepwalking: A systematic review. Sleep medicine reviews, 28363449.
https://pubmed.ncbi.nlm.nih.gov/28363449/
Seeman MV. (2011). Sleepwalking, a possible side effect of antipsychotic .... The Psychiatric quarterly, 20734137.
https://pubmed.ncbi.nlm.nih.gov/20734137/
Dolder CR, & Nelson MH. (2008). Hypnosedative-induced complex behaviours : incidence, .... CNS drugs, 18998740.
Q.
Can meditation or relaxation techniques reduce sleepwalking?
A.
Meditation and relaxation techniques might help reduce sleepwalking by promoting relaxation and reducing stress, which can be triggers for sleepwalking.
References:
Harris M, & Grunstein RR. (2009). Treatments for somnambulism in adults: assessing the .... Sleep medicine reviews, 19046651.
https://pubmed.ncbi.nlm.nih.gov/19046651/
Ng BY, & Lee TS. (2008). Hypnotherapy for sleep disorders. Annals of the Academy of Medicine, Singapore, 18797562.
https://pubmed.ncbi.nlm.nih.gov/18797562/
Cochen De Cock V. (2016). Sleepwalking. Current treatment options in neurology, 26874839.
Q.
Can nighttime noises trigger sleepwalking?
A.
Nighttime noises can contribute to sleepwalking, as they may act as triggers for this behavior.
References:
Blanchette-Carrière C, Pilon M, Trudeau S, Hébert-Tremblay L, Desautels A, Montplaisir J, & Zadra A. (2025). Self-Reported Precipitating and Priming Factors for .... Journal of sleep research, 40556414.
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Xu S, Pan Z, Guo Y, Zhou Q, Wang Q, Pan S, & Li L. (2024). Associations between abnormal sleep behavior and indoor .... BMC pediatrics, 39164656.
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Wolke D, & Lereya ST. (2014). Bullying and parasomnias: a longitudinal cohort study. Pediatrics, 25201799.
Q.
Can sleep deprivation lead to sleepwalking?
A.
Yes, sleep deprivation can lead to sleepwalking by disrupting normal sleep patterns and increasing the likelihood of sleep disturbances.
References:
Zadra A, Pilon M, & Montplaisir J. (2008). Polysomnographic diagnosis of sleepwalking. Annals of neurology, 18351640.
https://pubmed.ncbi.nlm.nih.gov/18351640/
Bušková J, Piško J, Pastorek L, & Šonka K. (2015). The course and character of sleepwalking in adulthood. Behavioral sleep medicine, 24597508.
https://pubmed.ncbi.nlm.nih.gov/24597508/
Pressman MR. (2007). Factors that predispose, prime and precipitate NREM .... Sleep medicine reviews, 17208473.
Q.
Can sleepwalking be a sign of REM sleep behavior disorder?
A.
Sleepwalking is not a sign of REM sleep behavior disorder; it usually happens during non-REM sleep stages.
References:
Manni R, Terzaghi M, & Repetto A. (2008). The FLEP scale in diagnosing nocturnal frontal lobe .... Epilepsia, 18410366.
https://pubmed.ncbi.nlm.nih.gov/18410366/
Drakatos P, Marples L, Muza R, Higgins S, Nesbitt A, Dongol EM, et al. (2019). Video polysomnographic findings in non-rapid eye .... Journal of sleep research, 30295353.
Q.
Can sleepwalking episodes cause injury?
A.
Yes, sleepwalking can cause injuries, some of which can be life-threatening.
References:
Rauch PK, & Stern TA. (1986). Life-threatening injuries resulting from sleepwalking and .... Psychosomatics, 3952247.
https://pubmed.ncbi.nlm.nih.gov/3952247/
Madigand-Tordjman MA, Egler PJ, Bertran F, Jokic M, & Guénolé F. (2017). [Life-threatening sleepwalking (Elpenor's syndrome) in a .... Archives de pediatrie : organe officiel de la Societe francaise de pediatrie, 28416429.
https://pubmed.ncbi.nlm.nih.gov/28416429/
Stallman HM, & Bari A. (2017). A biopsychosocial model of violence when sleepwalking. BJPsych open, 28446961.
Q.
Can stress management reduce the frequency of sleepwalking?
A.
Yes, managing stress can help reduce how often sleepwalking happens by using special treatments like behavioral therapy.
References:
Mundt JM, & Baron KG. (2021). Integrative behavioral treatment for NREM parasomnias. Journal of Clinical Sleep Medicine : JCSM : Official Publication of the American Academy of Sleep Medicine, 8314652.
https://pmc.ncbi.nlm.nih.gov/articles/PMC8314652/
Galbiati A, Rinaldi F, Giora E, Ferini-Strambi L, & Marelli S. (2015). Behavioural and Cognitive-Behavioural Treatments of .... Behavioural Neurology, 4458546.
https://pmc.ncbi.nlm.nih.gov/articles/PMC4458546/
Hauri PJ, Silber MH, & Boeve BF. (2007). The Treatment of Parasomnias with Hypnosis: a 5-Year .... Journal of Clinical Sleep Medicine : JCSM : official publication of the American Academy of Sleep Medicine, 1978312.
Q.
Do genetics play a role in sleepwalking?
A.
Yes, genetics can play a role in sleepwalking. Studies show that sleepwalking can run in families, suggesting a hereditary component.
References:
Kales A, Soldatos CR, Bixler EO, Ladda RL, Charney DS, Weber G, & Schweitzer PK. (1980). Hereditary factors in sleepwalking and night terrors. The British journal of psychiatry : the journal of mental science, 7426840.
https://pubmed.ncbi.nlm.nih.gov/7426840/
Hublin C, Kaprio J, Partinen M, Heikkilä K, & Koskenvuo M. (1997). Prevalence and genetics of sleepwalking: a population- .... Neurology, 9008515.
https://pubmed.ncbi.nlm.nih.gov/9008515/
Hublin C, Kaprio J, Partinen M, & Koskenvu M. (2001). Parasomnias: co-occurrence and genetics. Psychiatric genetics, 11525419.
Q.
Do sleepwalkers remember their actions the next day?
A.
Most sleepwalkers do not remember what they did during the night when they wake up the next day.
References:
Popat S, & Winslade W. (2015). While You Were Sleepwalking: Science and Neurobiology .... Neuroethics, 4506454.
https://pmc.ncbi.nlm.nih.gov/articles/PMC4506454/
Castelnovo A, Loddo G, Provini F, Miano S, & Manconi M. (2021). Mental Activity During Episodes of Sleepwalking, Night .... Nature and Science of Sleep, 8232850.
https://pmc.ncbi.nlm.nih.gov/articles/PMC8232850/
Siclari F. (2024). Consciousness in non‐REM‐parasomnia episodes - PMC. Journal of Sleep Research, 11744254.
Q.
Does improving sleep schedule help prevent sleepwalking episodes?
A.
Improving your sleep schedule can help reduce sleepwalking episodes by promoting better sleep quality.
References:
Fleetham JA, & Fleming JA. (2014). Parasomnias - PMC - PubMed Central. CMAJ : Canadian Medical Association Journal, 4016090.
https://pmc.ncbi.nlm.nih.gov/articles/PMC4016090/
Kierlin L, & Littner MR. (2011). Parasomnias and Antidepressant Therapy: A Review of the .... Frontiers in Psychiatry, 3235766.
https://pmc.ncbi.nlm.nih.gov/articles/PMC3235766/
Picard‐Deland C, Cesari M, Stefani A, Maranci J, Hogl B, & Arnulf I. (2025). The Future of Parasomnias - PMC - PubMed Central - NIH. Journal of Sleep Research, 12426708.
Q.
Does stress or anxiety trigger sleepwalking episodes?
A.
Stress and anxiety can trigger sleepwalking episodes by affecting the sleep cycle.
References:
Pressman MR. (2007). Factors that predispose, prime and precipitate NREM .... Sleep medicine reviews, 17208473.
https://pubmed.ncbi.nlm.nih.gov/17208473/
Szelenberger W, Niemcewicz S, & Dabrowska AJ. (2005). Sleepwalking and Night Terrors: Psychopathological and .... International review of psychiatry (Abingdon, England), 16194798.
https://pubmed.ncbi.nlm.nih.gov/16194798/
Tucker P, Masters B, & Nawar O. (2004). Topiramate in the treatment of comorbid night eating .... Eating disorders, 16864305.
Q.
How does alcohol consumption affect sleepwalking?
A.
Alcohol can make sleepwalking worse by affecting how the brain works during sleep, leading to unusual behaviors.
References:
Chakraborty R, Biswas T, Mishra BR, & Parmar A. (2024). Acute REM sleep behaviour disorder associated with .... Drug and alcohol review, 38287722.
https://pubmed.ncbi.nlm.nih.gov/38287722/
Cochen De Cock V. (2016). Sleepwalking. Current treatment options in neurology, 26874839.
https://pubmed.ncbi.nlm.nih.gov/26874839/
McLaughlin T, Blum K, Oscar-Berman M, Febo M, Agan G, Fratantonio JL, et al. (2015). Putative dopamine agonist (KB220Z) attenuates lucid .... Journal of behavioral addictions, 26132915.
Q.
How does cognitive behavioral therapy help with sleepwalking?
A.
Cognitive behavioral therapy (CBT) can help manage sleepwalking by addressing behaviors and thoughts that contribute to the condition.
References:
Mundt JM, Schuiling MD, Warlick C, Dietch JR, Wescott AB, Hagenaars M, et al. (2023). Behavioral and psychological treatments for NREM ... - PubMed. Sleep medicine, 37716336.
https://pubmed.ncbi.nlm.nih.gov/37716336/
Carter KA, Hathaway NE, & Lettieri CF. (2014). Common sleep disorders in children. American family physician, 24695508.
Q.
How is sleepwalking diagnosed by a doctor?
A.
Doctors diagnose sleepwalking by discussing your sleep habits, medical history, and sometimes using tests to check your sleep patterns.
References:
Kohler WC, Kurz PJ, & Kohler EA. (2015). A Case of Successful Use of Hypnosis in the Treatment .... Behavioral sleep medicine, 24738970.
https://pubmed.ncbi.nlm.nih.gov/24738970/
Vela-Bueno A, & Soldatos CR. (1987). Episodic sleep disorders (parasomnias). Seminars in neurology, 3332462.
https://pubmed.ncbi.nlm.nih.gov/3332462/
Wills L, & Garcia J. (2002). Parasomnias: epidemiology and management. CNS drugs, 12421114.
Q.
Is frequent sleepwalking a sign of an underlying medical condition?
A.
Frequent sleepwalking can sometimes be linked to underlying medical issues, as it may be part of a group of sleep disorders called parasomnias.
References:
Correa VM, Vitrai J, & Szűcs A. (2024). Parasomnias manifest different phenotypes of sleep- .... Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia, 37989677.
https://pubmed.ncbi.nlm.nih.gov/37989677/
Morgenthaler TI, & Silber MH. (2002). Amnestic sleep-related eating disorder associated with .... Sleep medicine, 14592194.
https://pubmed.ncbi.nlm.nih.gov/14592194/
Manfredi RL, & Kales A. (1987). Clinical neuropharmacology of sleep disorders. Seminars in neurology, 3332464.
Q.
Is it dangerous to wake up a sleepwalker?
A.
Waking up a sleepwalker is not dangerous, but it can be confusing for them. It’s usually better to gently guide them back to bed.
References:
Popat S, & Winslade W. (2015). While You Were Sleepwalking: Science and Neurobiology .... Neuroethics, 4506454.
https://pmc.ncbi.nlm.nih.gov/articles/PMC4506454/
El Shakankiry HM. (2011). Sleep physiology and sleep disorders in childhood - PMC. Nature and Science of Sleep, 3630965.
https://pmc.ncbi.nlm.nih.gov/articles/PMC3630965/
Parrino L, Halasz P, Szucs A, Thomas RJ, Azzi N, Rausa F, et al. (2022). Sleep medicine: Practice, challenges and new frontiers - PMC. Frontiers in Neurology, 9616008.
Q.
Is sleepwalking associated with other sleep disorders?
A.
Yes, sleepwalking can be linked to other sleep disorders like night terrors and confusional arousals.
References:
Ohayon MM, Guilleminault C, & Priest RG. (1999). Night terrors, sleepwalking, and confusional arousals in the .... The Journal of clinical psychiatry, 10221293.
https://pubmed.ncbi.nlm.nih.gov/10221293/
Martynowicz H, Smardz J, Wieczorek T, Mazur G, Poreba R, Skomro R, et al. (2018). The Co-Occurrence of Sexsomnia, Sleep Bruxism and .... Journal of clinical medicine, 30142877.
https://pubmed.ncbi.nlm.nih.gov/30142877/
Howell MJ. (2012). Parasomnias: an updated review. Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics, 22965264.
Q.
Is sleepwalking ever linked to epilepsy?
A.
Yes, sleepwalking can sometimes be linked to epilepsy, especially certain types like nocturnal frontal lobe epilepsy, which can look similar to sleepwalking.
References:
Plazzi G, Vetrugno R, Provini F, & Montagna P. (2005). Sleepwalking and other ambulatory behaviours during sleep. Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology, 16331395.
https://pubmed.ncbi.nlm.nih.gov/16331395/
Derry C. (2012). Nocturnal Frontal Lobe Epilepsy vs Parasomnias. Current treatment options in neurology, 22865379.
https://pubmed.ncbi.nlm.nih.gov/22865379/
Drakatos P, Marples L, Muza R, Higgins S, Nesbitt A, Dongol EM, et al. (2019). Video polysomnographic findings in non-rapid eye .... Journal of sleep research, 30295353.
Q.
Is sleepwalking more common in children than adults?
A.
Yes, sleepwalking is more common in children than in adults.
References:
Hublin C, Kaprio J, Partinen M, Heikkilä K, & Koskenvuo M. (1997). Prevalence and genetics of sleepwalking: a population- .... Neurology, 9008515.
https://pubmed.ncbi.nlm.nih.gov/9008515/
Stallman HM, & Kohler M. (2016). Prevalence of Sleepwalking: A Systematic Review and .... PloS one, 27832078.
https://pubmed.ncbi.nlm.nih.gov/27832078/
Soldatos CR, & Lugaresi E. (1987). Nosology and prevalence of sleep disorders. Seminars in neurology, 3332458.
Q.
Is sleepwalking related to nightmares or night terrors?
A.
Sleepwalking is related to night terrors but not directly to nightmares, as they all occur during different stages of sleep.
References:
Szelenberger W, Niemcewicz S, & Dabrowska AJ. (2005). Sleepwalking and Night Terrors: Psychopathological and .... International review of psychiatry (Abingdon, England), 16194798.
https://pubmed.ncbi.nlm.nih.gov/16194798/
Hartman D, Crisp AH, Sedgwick P, & Borrow S. (2001). Is there a dissociative process in sleepwalking and night .... Postgraduate medical journal, 11264487.
https://pubmed.ncbi.nlm.nih.gov/11264487/
Uguccioni G, Golmard JL, de Fontréaux AN, Leu-Semenescu S, Brion A, & Arnulf I. (2013). Fight or flight? Dream content during sleepwalking/sleep .... Sleep medicine, 23601752.
Q.
What are the signs that someone may be sleepwalking?
A.
Sleepwalking signs include walking around while asleep, having a blank expression, and not remembering the event afterward.
References:
Kotagal S. (2017). Sleep-Wake Disorders of Childhood. Continuum (Minneapolis, Minn.), 28777180.
https://pubmed.ncbi.nlm.nih.gov/28777180/
Guilleminault C, & Anders TF. (1976). The pathophysiology of sleep disorders in pediatrics. Part II .... Advances in pediatrics, 57711.
https://pubmed.ncbi.nlm.nih.gov/57711/
Kaur H, Jahngir MU, & Siddiqui JH. (2018). Sleep-related Eating Disorder in a Patient with Parkinson's .... Cureus, 30473978.
Q.
What causes someone to sleepwalk during the night?
A.
Sleepwalking can be caused by a mix of sleep deprivation, stress, and genetics, and often happens when someone is in deep sleep.
References:
Leu-Semenescu S, & Arnulf I. (2010). [Disruptive nocturnal behavior in elderly subjects: could it .... Psychologie & neuropsychiatrie du vieillissement, 20525541.
https://pubmed.ncbi.nlm.nih.gov/20525541/
Guilleminault C, Palombini L, Pelayo R, & Chervin RD. (2003). Sleepwalking and Sleep Terrors in Prepubertal Children. Pediatrics, 12509590.
https://pubmed.ncbi.nlm.nih.gov/12509590/
Mayer G, Neissner V, Schwarzmayr P, & Meier-Ewert K. (1998). [Sleep deprivation in somnambulism. Effect of arousal, .... Der Nervenarzt, 9673973.
Q.
What exactly is sleepwalking, and how does it occur?
A.
Sleepwalking is when a person gets up and walks around while still asleep, often not remembering it afterward. It occurs during deep sleep and can be influenced by various factors like genetics, stress, or sleep deprivation.
References:
Zadra A, Desautels A, Petit D, & Montplaisir J. (2013). Somnambulism: clinical aspects and pathophysiological .... The Lancet. Neurology, 23415568.
https://pubmed.ncbi.nlm.nih.gov/23415568/
Nomura T. (2025). [Parasomnias Excluded RBD]. Brain and nerve = Shinkei kenkyu no shinpo, 41097923.
Gill JS, Pillai SK, Koh OH, & Jambunathan ST. (2011). Low dose quetiapine in the treatment of an adolescent with .... Acta neurologica Belgica, 21748939.
Q.
What should I do if a family member is sleepwalking?
A.
If a family member is sleepwalking, gently guide them back to bed and make sure their environment is safe to prevent injury.
References:
Idir Y, Lopez R, Barbier A, Saint-Auret S, Morain E, Vollhardt R, et al. (2025). Talking to sleepwalkers? Response to communication .... Sleep, 39569604.
https://pubmed.ncbi.nlm.nih.gov/39569604
Attarian H, & Zhu L. (2013). Treatment options for disorders of arousal: a case series. The International journal of neuroscience, 23510075.
https://pubmed.ncbi.nlm.nih.gov/23510075/
Soca R, Keenan JC, & Schenck CH. (2016). Parasomnia Overlap Disorder with Sexual Behaviors .... Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 27166304.
Q.
When is a sleep study recommended for suspected sleepwalking?
A.
A sleep study is recommended for sleepwalking when there are safety concerns, frequent episodes, or if other sleep disorders are suspected.
References:
Espa F, Dauvilliers Y, Ondze B, Billiard M, & Besset A. (2002). Arousal reactions in sleepwalking and night terrors in adults. Sleep, 12489893.
https://pubmed.ncbi.nlm.nih.gov/12489893/
Blanchette-Carrière C, Montplaisir J, Boucetta S, Desautels A, & Zadra A. (2024). Differential effects of sleep deprivation on sleepwalking. Sleep medicine, 38972128.
https://pubmed.ncbi.nlm.nih.gov/38972128/
Pressman MR. (2007). Factors that predispose, prime and precipitate NREM .... Sleep medicine reviews, 17208473.
Q.
Why does sleepwalking sometimes involve unusual or complex behaviors?
A.
Sleepwalking can involve complex behaviors because it may include acting out dreams or being triggered by factors like sleep deprivation.
References:
Pillmann F. (2009). Complex dream-enacting behavior in sleepwalking. Psychosomatic medicine, 19073753.
https://pubmed.ncbi.nlm.nih.gov/19073753/
Wills L, & Garcia J. (2002). Parasomnias: epidemiology and management. CNS drugs, 12421114.
https://pubmed.ncbi.nlm.nih.gov/12421114/
Mayer G, Neissner V, Schwarzmayr P, & Meier-Ewert K. (1998). [Sleep deprivation in somnambulism. Effect of arousal, .... Der Nervenarzt, 9673973.
Q.
Why does sleepwalking typically happen during deep sleep?
A.
Sleepwalking usually happens during deep sleep because this is a time when the brain is less conscious, making it easier for sleepwalking to occur.
References:
Cavanna AE, Shah S, Eddy CM, Williams A, & Rickards H. (2011). Consciousness: a neurological perspective. Behavioural neurology, 21447904.
https://pubmed.ncbi.nlm.nih.gov/21447904/
Guilleminault C, & Anders TF. (1976). The pathophysiology of sleep disorders in pediatrics. Part II .... Advances in pediatrics, 57711.
https://pubmed.ncbi.nlm.nih.gov/57711/
Gottesmann C. (2002). GABA mechanisms and sleep. Neuroscience, 11983310.
Q.
Are sleep disorders linked to heart disease or stroke?
A.
Yes, sleep disorders can be linked to heart disease and stroke.
References:
Miller MA, & Howarth NE. (2023). Sleep and cardiovascular disease. Emerging topics in life sciences, 38084859.
https://pubmed.ncbi.nlm.nih.gov/38084859/
Grandner MA, Jackson NJ, Pak VM, & Gehrman PR. (2012). Sleep disturbance is associated with cardiovascular ... - PubMed. Journal of sleep research, 22151079.
https://pubmed.ncbi.nlm.nih.gov/22151079/
Sarode R, & Nikam PP. (2023). The Impact of Sleep Disorders on Cardiovascular Health. Cureus, 38161933.
Q.
Are sleep mecidations safe to use long-term?
A.
Long-term use of sleep medications can be risky and should be carefully managed with a healthcare provider.
References:
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https://pubmed.ncbi.nlm.nih.gov/12531036/
Conn DK, & Madan R. (2006). Use of sleep-promoting medications in nursing home .... Drugs & aging, 16732687.
https://pubmed.ncbi.nlm.nih.gov/16732687/
Magnusson DH, Albertsson TI, Jonsdottir F, & Sigurdsson MI. (2023). The epidemiology of new persistent hypnotic/sedative use .... Anaesthesia, 37188390.
Q.
Can sleep disorders be prevented?
A.
Some sleep disorders can be prevented by practicing good sleep habits and focusing on overall sleep health.
References:
Baranwal N, Yu PK, & Siegel NS. (2023). Sleep physiology, pathophysiology, and sleep hygiene. Progress in cardiovascular diseases, 36841492.
https://pubmed.ncbi.nlm.nih.gov/36841492/
Chaput JP. (2025). Focusing on sleep health for all, not just sleep disorders. Canadian journal of public health = Revue canadienne de sante publique, 40100339.
https://pubmed.ncbi.nlm.nih.gov/40100339/
Chaput JP, & Stranges S. (2025). Sleep: The silent hero in cardiometabolic health. Nutrition, metabolism, and cardiovascular diseases : NMCD, 39643476.
Q.
Do diet and nutrition influence sleep disorders?
A.
Yes, diet and nutrition can affect sleep disorders. Eating habits and the types of food you consume may influence how well you sleep.
References:
Godos J, Grosso G, Castellano S, Galvano F, Caraci F, & Ferri R. (2021). Association between diet and sleep quality: A systematic review. Sleep medicine reviews, 33549913.
https://pubmed.ncbi.nlm.nih.gov/33549913/
Wilson K, St-Onge MP, & Tasali E. (2022). Diet Composition and Objectively Assessed Sleep Quality. Journal of the Academy of Nutrition and Dietetics, 35063665.
https://pubmed.ncbi.nlm.nih.gov/35063665/
Zhao M, Tuo H, Wang S, & Zhao L. (2020). The Effects of Dietary Nutrition on Sleep and Sleep Disorders. Mediators of inflammation, 32684833.
Q.
Does taking a nap help or worsen nighttime sleep?
A.
Taking naps can sometimes affect nighttime sleep, but it depends on the length of the nap and individual differences.
References:
Mograss M, Abi-Jaoude J, Frimpong E, Chalati D, Moretto U, Tarelli L, et al. (2022). The effects of napping on night-time sleep in healthy young .... Journal of sleep research, 35253300.
https://pubmed.ncbi.nlm.nih.gov/35253300/
Pilcher JJ, Michalowski KR, & Carrigan RD. (2001). The prevalence of daytime napping and its relationship to .... Behavioral medicine (Washington, D.C.), 11763827.
https://pubmed.ncbi.nlm.nih.gov/11763827/
Boukhris O, Suppiah H, & Driller M. (2025). The Influence of 25- and 90-Min Afternoon Nap .... Journal of sleep research, 40537913.
Q.
How can I stop relying on sleeping pills?
A.
To stop relying on sleeping pills, gradually reduce the dosage with medical guidance and consider Cognitive Behavioral Therapy (CBT) to improve sleep habits.
References:
Kim CH, Kim KH, Lee YU, Kang S, & Lee S. (2023). Two case reports of tapering sedative-hypnotic drugs .... Explore (New York, N.Y.), 36229404.
https://pubmed.ncbi.nlm.nih.gov/36229404/
Morin CM, Bélanger L, Bastien C, & Vallières A. (2005). Long-term outcome after discontinuation of benzodiazepines .... Behaviour research and therapy, 15531349.
https://pubmed.ncbi.nlm.nih.gov/15531349/
Chapoutot M, Peter-Derex L, Bastuji H, Leslie W, Schoendorff B, Heinzer R, et al. (2021). Cognitive Behavioral Therapy and Acceptance .... International journal of environmental research and public health, 34639523.
Q.
Is melatonin helpful for sleep disorders, and when should it be used?
A.
Melatonin can help with sleep disorders, especially in older adults, by regulating sleep-wake cycles. It is most effective for people over 55 years old or those with disrupted circadian rhythms.
References:
Bueno APR, Savi FM, Alves IA, & Bandeira VAC. (2021). Regulatory aspects and evidences of melatonin use for .... Arquivos de neuro-psiquiatria, 34550191.
https://pubmed.ncbi.nlm.nih.gov/34550191/
Lyseng-Williamson KA. (2012). in the treatment of insomnia in patients aged ≥55 years. Drugs & aging, 23044640.
https://pubmed.ncbi.nlm.nih.gov/23044640/
Zhdanova IV, & Tucci V. (2003). Melatonin, Circadian Rhythms, and Sleep. Current treatment options in neurology, 12670411.
Q.
What is Cognitive Behavioral Therapy for Insomnia (CBT-I)?
A.
Cognitive Behavioral Therapy for Insomnia (CBT-I) is a treatment that helps people who have trouble sleeping by changing their thoughts and habits related to sleep.
References:
Rossman J. (2019). Cognitive-Behavioral Therapy for Insomnia: An Effective .... American journal of lifestyle medicine, 31662718.
https://pubmed.ncbi.nlm.nih.gov/31662718/
Alimoradi Z, Jafari E, Broström A, Ohayon MM, Lin CY, Griffiths MD, et al. (2022). Effects of cognitive behavioral therapy for insomnia (CBT-I) .... Sleep medicine reviews, 35653951.
https://pubmed.ncbi.nlm.nih.gov/35653951/
Muench A, Vargas I, Grandner MA, Ellis JG, Posner D, Bastien CH, et al. (2022). We know CBT-I works, now what? - PubMed - NIH. Faculty reviews, 35156100.
Q.
What treatment options are available for chronic sleep disorders?
A.
Chronic sleep disorders can be treated with therapy, lifestyle changes, and sometimes medication. It's important to find the right approach for each person.
References:
Matheson EM, Brown BD, & DeCastro AO. (2024). Treatment of Chronic Insomnia in Adults. American family physician, 38393799.
https://pubmed.ncbi.nlm.nih.gov/38393799/
Rosenberg R, Citrome L, & Drake CL. (2021). Advances in the Treatment of Chronic Insomnia. Neuropsychiatric disease and treatment, 34393484.
https://pubmed.ncbi.nlm.nih.gov/34393484/
Qaseem A, Kansagara D, Forciea MA, Cooke M, Denberg TD, & Clinical Guidelines Committee of the American College of Physicians. (2016). Management of Chronic Insomnia Disorder in Adults. Annals of internal medicine, 27136449.
Q.
Why do children and adults experience different sleep disorders?
A.
Children and adults have different sleep disorders because their bodies and brains are at different stages of growth and development.
References:
Alsubie HS, & BaHammam AS. (2017). Obstructive Sleep Apnoea: Children are not little Adults. Paediatric respiratory reviews, 27262609.
https://pubmed.ncbi.nlm.nih.gov/27262609/
Hoban TF. (2004). Sleep and its disorders in children. Seminars in neurology, 15449225.
https://pubmed.ncbi.nlm.nih.gov/15449225/
Hoban TF. (2010). Sleep disorders in children. Annals of the New York Academy of Sciences, 20146688.
Q.
Can alcohol help with sleep, or does it make sleep worse?
A.
Alcohol might help you fall asleep faster, but it can make your sleep worse by waking you up during the night.
References:
Zheng JW, Ai SZ, Chang SH, Meng SQ, Shi L, Deng JH, et al. (2024). Association between alcohol consumption and sleep traits. Molecular psychiatry, 38233469.
https://pubmed.ncbi.nlm.nih.gov/38233469/
Colrain IM, Nicholas CL, & Baker FC. (2014). Alcohol and the sleeping brain - PubMed - NIH. Handbook of clinical neurology, 25307588.
https://pubmed.ncbi.nlm.nih.gov/25307588/
Thakkar MM, Sharma R, & Sahota P. (2015). Alcohol disrupts sleep homeostasis - PubMed - NIH. Alcohol (Fayetteville, N.Y.), 25499829.
Q.
Can anxiety or depression cause sleep disorders?
A.
Yes, anxiety and depression can cause sleep disorders. They are closely linked and can affect each other.
References:
Akpoveta ED, Okpete UE, & Byeon H. (2025). Sleep disorders and mental health: Understanding the .... World journal of psychiatry, 40574781.
https://pubmed.ncbi.nlm.nih.gov/40574781/
Yasugaki S, Okamura H, Kaneko A, & Hayashi Y. (2025). Bidirectional relationship between sleep and depression. Neuroscience research, 37116584.
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Nyer M, Farabaugh A, Fehling K, Soskin D, Holt D, Papakostas GI, et al. (2013). Relationship between sleep disturbance and depression .... Depression and anxiety, 23681944.
Q.
Can chronic sleep deprivation affect brain structure or function?
A.
Yes, chronic sleep deprivation can change how the brain works and even affect its structure.
References:
Cirelli C, Faraguna U, & Tononi G. (2006). Changes in brain gene expression after long-term sleep .... Journal of neurochemistry, 16923172.
https://pubmed.ncbi.nlm.nih.gov/16923172/
McEwen BS. (2006). Sleep deprivation as a neurobiologic and physiologic .... Metabolism: clinical and experimental, 16979422.
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Q.
Can lack of sleep trigger or worsen migraines?
A.
Yes, not getting enough sleep can trigger or make migraines worse.
References:
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Wang S, Ma L, Wang S, Duan C, Wang X, Bian X, et al. (2025). Effects of acute sleep deprivation on the brain function .... The journal of headache and pain, 40155843.
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Tiseo C, Vacca A, Felbush A, Filimonova T, Gai A, Glazyrina T, et al. (2020). Migraine and sleep disorders: a systematic review. The journal of headache and pain, 33109076.
Q.
Can sleep disorders cause daytime fatigue even if I sleep "enough" hours?
A.
Yes, sleep disorders can cause daytime fatigue even if you get enough hours of sleep because the quality of sleep can be poor.
References:
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Santander P, Sievers D, & Moser N. (2016). Sleep-related breathing disorders and dentistry. Quintessence international (Berlin, Germany : 1985), 27319815.
Q.
Can sleep disorders increase the risk of accidents?
A.
Yes, sleep disorders can increase the risk of accidents, especially when driving or working with machines.
References:
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Duffy JF, Zitting KM, & Czeisler CA. (2015). The Case for Addressing Operator Fatigue - PubMed - NIH. Review of human factors and ergonomics, 26056516.
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Hiestand D, & Phillips B. (2011). assessing and managing risk in the motor vehicle operator. Current opinion in pulmonary medicine, 21921796.
Q.
Can untreated sleep disorders lead to long-term health problems?
A.
Untreated sleep disorders can lead to long-term health problems, including issues with the heart and brain.
References:
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Jan JE, Reiter RJ, Bax MC, Ribary U, Freeman RD, & Wasdell MB. (2010). Long-term sleep disturbances in children: a cause of .... European journal of paediatric neurology : EJPN : official journal of the European Paediatric Neurology Society, 20554229.
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Khan MS, & Aouad R. (2017). The Effects of Insomnia and Sleep Loss on Cardiovascular .... Sleep medicine clinics, 28477772.
Q.
Do sleep disorders get worse with age?
A.
Yes, sleep disorders often become more common and can worsen as people age. This is due to changes in sleep patterns and health conditions that are more frequent in older adults.
References:
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Asplund R. (1999). Sleep disorders in the elderly. Drugs & aging, 10084363.
Q.
Does caffeine help or worsen sleep deprivation?
A.
Caffeine can help people feel less sleepy for a short time, but it might make it harder to sleep well later.
References:
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Carrier J, Fernandez-Bolanos M, Robillard R, Dumont M, Paquet J, Selmaoui B, & Filipini D. (2007). Effects of caffeine are more marked on daytime recovery .... Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology, 16936703.
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Wurts SW, & Edgar DM. (2000). sleep tendency and dynamics of recovery sleep in rats. Pharmacology, biochemistry, and behavior, 10638649.
Q.
Does sleep deprivation affect reproductive or hormonal health?
A.
Yes, not getting enough sleep can affect your hormones and reproductive health by changing how your body releases certain hormones.
References:
Spiegel K, Leproult R, & Van Cauter E. (1999). Impact of sleep debt on metabolic and endocrine function. Lancet (London, England), 10543671.
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Leproult R, & Van Cauter E. (2010). Role of sleep and sleep loss in hormonal release ... - PubMed. Endocrine development, 19955752.
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Q.
How can I tell if my sleep problem is temporary or a true sleep disorder?
A.
Temporary sleep problems can happen due to stress or changes in routine, but if sleep issues last a long time or affect daily life, it might be a true sleep disorder.
References:
Lack LC, Gradisar M, Van Someren EJ, Wright HR, & Lushington K. (2008). The relationship between insomnia and body temperatures. Sleep medicine reviews, 18603220.
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Hernandez AB, & Patil SP. (2016). Pathophysiology of central sleep apneas. Sleep & breathing = Schlaf & Atmung, 26782104.
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Griffiths MF, & Peerson A. (2005). Risk factors for chronic insomnia following hospitalization. Journal of advanced nursing, 15660548.
Q.
How do hormonal changes affect sleep?
A.
Hormonal changes, such as those during the menstrual cycle and perimenopause, can affect sleep patterns, leading to disturbances like difficulty falling asleep or staying asleep.
References:
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Rugvedh P, Gundreddy P, & Wandile B. (2023). The Menstrual Cycle's Influence on Sleep Duration and .... Cureus, 38022155.
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Baker FC, & Lee KA. (2022). Menstrual Cycle Effects on Sleep. Sleep medicine clinics, 35659080.
Q.
How do new surgical options help in severe cases of sleep apnea?
A.
New surgeries for severe sleep apnea, like moving the jaw forward or stimulating nerves, can help keep the airway open during sleep.
References:
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Woodson BT, Strohl KP, Soose RJ, Gillespie MB, Maurer JT, de Vries N, et al. (2018). Upper Airway Stimulation for Obstructive Sleep Apnea. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 29582703.
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Choi AY, Kaffenberger TM, Soose RJ, & Whelan RL. (2025). Hypoglossal Nerve Stimulation for Obstructive Sleep .... The Laryngoscope, 39953924.
Q.
How does blue light exposure before bed affect sleep quality?
A.
Blue light from screens before bed can make it harder to fall asleep and reduce sleep quality.
References:
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Heo JY, Kim K, Fava M, Mischoulon D, Papakostas GI, Kim MJ, et al. (2017). Effects of smartphone use with and without blue light at .... Journal of psychiatric research, 28017916.
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Chang AM, Aeschbach D, Duffy JF, & Czeisler CA. (2015). Evening use of light-emitting eReaders negatively ... - PubMed. Proceedings of the National Academy of Sciences of the United States of America, 25535358.
Q.
How does caffeine impact sleep disorders?
A.
Caffeine can make it harder to fall asleep and stay asleep, especially if you drink it regularly or close to bedtime.
References:
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Weibel J, Lin YS, Landolt HP, Berthomier C, Brandewinder M, Kistler J, et al. (2021). Regular Caffeine Intake Delays REM Sleep Promotion and .... Journal of biological rhythms, 34024173.
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Karacan I, Thornby JI, Anch M, Booth GH, Williams RL, & Salis PJ. (1976). Dose-related sleep disturbances induced by coffee and .... Clinical pharmacology and therapeutics, 186223.
Q.
How does sleep disorder affect concentration and memory?
A.
Sleep disorders can make it hard to focus and remember things. They can affect how well your brain works during the day.
References:
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Durmer JS, & Dinges DF. (2005). Neurocognitive consequences of sleep deprivation - PubMed. Seminars in neurology, 15798944.
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Q.
How does stress contribute to sleep disorders?
A.
Stress can make it hard to sleep by affecting the brain's ability to relax, leading to sleep disorders.
References:
Han KS, Kim L, & Shim I. (2012). Stress and sleep disorder. Experimental neurobiology, 23319874.
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Antila H, Kwak I, Choi A, Pisciotti A, Covarrubias I, Baik J, et al. (2022). A noradrenergic-hypothalamic neural substrate for stress .... Proceedings of the National Academy of Sciences of the United States of America, 36331996.
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Broderick ML, Khan Q, & Moradikor N. (2025). Understanding the connection between stress and sleep. Progress in brain research, 40222777.
Q.
How is sleep deprivation different from insomnia?
A.
Sleep deprivation happens when you don't get enough sleep, while insomnia is when you have trouble falling or staying asleep even if you have the chance to sleep.
References:
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Altena E, Van Der Werf YD, Strijers RL, & Van Someren EJ. (2008). Sleep loss affects vigilance: effects of chronic insomnia and .... Journal of sleep research, 18844819.
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Williams AB, Dzierzewski JM, Griffin SC, Lind MJ, Dick D, & Rybarczyk BD. (2020). Insomnia Disorder and Behaviorally Induced Insufficient Sleep .... Behavioral sleep medicine, 30789063.
Q.
Is difficulty falling asleep treated differently from difficulty staying asleep?
A.
Yes, difficulty falling asleep and difficulty staying asleep can be treated differently because they are different types of insomnia.
References:
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Yue JL, Chang XW, Zheng JW, Shi L, Xiang YJ, Que JY, et al. (2023). A systematic review and network meta-analysis. Sleep medicine reviews, 36701954.
https://pubmed.ncbi.nlm.nih.gov/36701954/
Lack LC, Gradisar M, Van Someren EJ, Wright HR, & Lushington K. (2008). The relationship between insomnia and body temperatures. Sleep medicine reviews, 18603220.
Q.
Should I use melatonin to recover from sleep deprivation?
A.
Melatonin might not be the best option for recovering from sleep deprivation, as it primarily helps with adjusting sleep cycles rather than addressing the effects of sleep debt.
References:
Spiegel K, Leproult R, & Van Cauter E. (2003). [Impact of sleep debt on physiological rhythms] - PubMed - NIH. Revue neurologique, 14646794.
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Q.
What are the most common types of sleep disorders?
A.
The most common sleep disorders include insomnia, sleep apnea, restless legs syndrome, and narcolepsy. These conditions can affect how well you sleep and how you feel during the day.
References:
Chokroverty S. (2010). Overview of sleep & sleep disorders. The Indian journal of medical research, 20308738.
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Holder S, & Narula NS. (2022). Common Sleep Disorders in Adults: Diagnosis and .... American family physician, 35426627.
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Nodine PM, & Matthews EE. (2013). Common sleep disorders: management strategies and .... Journal of midwifery & women's health, 23855316.
Q.
What causes delayed sleep phase disorder?
A.
Delayed sleep phase disorder (DSPD) happens when a person's internal clock is out of sync, making them fall asleep and wake up much later than usual. This can be caused by genetics, lifestyle habits, or changes in the body's natural rhythms.
References:
Magee M, Marbas EM, Wright KP Jr, Rajaratnam SM, & Broussard JL. (2016). Diagnosis, Cause, and Treatment Approaches for Delayed .... Sleep medicine clinics, 27542884.
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Wu A. (2023). Updates and confounding factors in delayed sleep-wake .... Sleep and biological rhythms, 37363638.
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Gradisar M, & Crowley SJ. (2013). Delayed sleep phase disorder in youth - PubMed - NIH. Current opinion in psychiatry, 24060912.
Q.
What happens during an overnight sleep study (polysomnography)?
A.
An overnight sleep study, or polysomnography, monitors your sleep patterns, breathing, and movements to help diagnose sleep disorders.
References:
Rundo JV, & Downey R 3rd. (2019). Polysomnography. Handbook of clinical neurology, 31277862.
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Markun LC, & Sampat A. (2020). Clinician-Focused Overview and Developments in .... Current sleep medicine reports, 33251088.
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Chesson AL Jr, Ferber RA, Fry JM, Grigg-Damberger M, Hartse KM, Hurwitz TD, et al. (1997). The indications for polysomnography and related procedures. Sleep, 9302726.
Q.
What is considered a sleep disorder, and how is it diagnosed?
A.
Sleep disorders are problems with sleeping, like trouble falling asleep or staying awake. They are diagnosed by doctors using special tests and looking at symptoms.
References:
Gauld C, Lopez R, Morin C, Geoffroy PA, Maquet J, Desvergnes P, et al. (2022). Symptom network analysis of the sleep disorders .... Journal of sleep research, 34269498.
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Sateia MJ. (2014). International classification of sleep disorders-third edition. Chest, 25367475.
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Gauld C, Lopez R, Philip P, Taillard J, Morin CM, Geoffroy PA, & Micoulaud-Franchi JA. (2022). A Systematic Review of Sleep-Wake Disorder Diagnostic .... Biomedicines, 35884924.
Q.
What tests are used to evaluate sleep disorders?
A.
To evaluate sleep disorders, doctors often use tests like polysomnography, which records brain waves and other body functions during sleep, and other specialized procedures to diagnose different sleep problems.
References:
Shelgikar AV, & Chervin R. (2013). Approach to and evaluation of sleep disorders. Continuum (Minneapolis, Minn.), 23385693.
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Chesson AL Jr, Ferber RA, Fry JM, Grigg-Damberger M, Hartse KM, Hurwitz TD, et al. (1997). The indications for polysomnography and related procedures. Sleep, 9302726.
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Markun LC, & Sampat A. (2020). Clinician-Focused Overview and Developments in .... Current sleep medicine reports, 33251088.
Q.
When should I see a doctor about my sleep difficulties?
A.
If sleep problems last a long time or affect your daily life, it's important to talk to a doctor.
References:
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Marchant JM, Chang AB, Kennedy E, King D, Perret JL, Schultz A, et al. (2024). Cough in Children and Adults: Diagnosis, Assessment and .... The Medical journal of Australia, 37982357.
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Häuser W, Ablin J, Perrot S, & Fitzcharles MA. (2017). practical guides from recent evidence-based guidelines. Polish archives of internal medicine, 28075425.
Q.
When should I see a doctor about suspected sleep deprivation?
A.
See a doctor about sleep deprivation if it affects your daily life or lasts a long time.
References:
Aikens JE, & Rouse ME. (2005). Help-seeking for insomnia among adult patients in primary .... The Journal of the American Board of Family Practice, 15994471.
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Torrens Darder I, Argüelles-Vázquez R, Lorente-Montalvo P, Torrens-Darder MDM, & Esteva M. (2021). Primary care is the frontline for help-seeking insomnia .... The European journal of general practice, 34633282.
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Q.
Why do I crave sugar or carbs when I'm sleep-deprived?
A.
When you're sleep-deprived, your body makes more of a hormone that makes you feel hungry, especially for sugary and carb-rich foods.
References:
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Greer SM, Goldstein AN, & Walker MP. (2013). The impact of sleep deprivation on food desire in the human .... Nature communications, 23922121.
Q.
Why do some people wake up frequently during the night?
A.
People wake up at night for several reasons, including sleep disorders, menopause, and conditions like sleep apnea that can cause frequent urination.
References:
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Maki PM, Panay N, & Simon JA. (2024). Sleep disturbance associated with the menopause. Menopause (New York, N.Y.), 38916279.
Q.
Why does stress make it hard to sleep, and lack of sleep increase stress?
A.
Stress can make it hard to sleep, and not getting enough sleep can make you feel more stressed. This happens because stress and sleep affect each other in a cycle that can be hard to break.
References:
Lo Martire V, Caruso D, Palagini L, Zoccoli G, & Bastianini S. (2020). Stress & sleep: A relationship lasting a lifetime. Neuroscience and biobehavioral reviews, 31491473.
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He M, Li Y, Chen M, Li H, Liang C, Chen Y, et al. (2024). Insomnia and stress: the mediating roles of frontoparietal .... Brain imaging and behavior, 39269599.
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Q.
Are there alternatives to CPAP for treating sleep apnea?
A.
Yes, oral appliances are an alternative to CPAP for treating sleep apnea.
References:
Doff MH, Hoekema A, Wijkstra PJ, van der Hoeven JH, Huddleston Slater JJ, de Bont LG, & Stegenga B. (2013). Oral appliance versus continuous positive airway pressure .... Sleep, 23997361.
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Ghosh P, Janakiram C, Nk SV, K S, & Vv A. (2025). Oral appliance therapy for the management of obstructive .... JBI evidence synthesis, 40159944.
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Q.
Can dentists help with sleep apnea using oral devices?
A.
Yes, dentists can help with sleep apnea using special mouthpieces called mandibular advancement devices.
References:
Manetta IP, Ettlin D, Sanz PM, Rocha I, & Meira E Cruz M. (2022). Mandibular advancement devices in obstructive sleep apnea. Sleep science (Sao Paulo, Brazil), 35371398.
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Leibovitz S, Levi S, Hanut A, Yanko R, Sharav Y, & Haviv Y. (2025). Evaluating the effectiveness of mandibular advancement .... Sleep & breathing = Schlaf & Atmung, 39833552.
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Kostrzewa-Janicka J, Śliwiński P, Wojda M, Rolski D, & Mierzwińska-Nastalska E. (2017). Mandibular Advancement Appliance for Obstructive Sleep .... Advances in experimental medicine and biology, 27826882.
Q.
Can losing weight really help reduce sleep apnea symptoms?
A.
Yes, losing weight can help reduce symptoms of sleep apnea. Studies show that weight loss can lead to less severe sleep apnea and better breathing during sleep.
References:
Kuna ST, Reboussin DM, Strotmeyer ES, Millman RP, Zammit G, Walkup MP, et al. (2021). Effects of Weight Loss on Obstructive Sleep Apnea Severity .... American journal of respiratory and critical care medicine, 32721163.
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Anandam A, Akinnusi M, Kufel T, Porhomayon J, & El-Solh AA. (2013). Effects of dietary weight loss on obstructive sleep apnea. Sleep & breathing = Schlaf & Atmung, 22374151.
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Kuna ST, Reboussin DM, Borradaile KE, Sanders MH, Millman RP, Zammit G, et al. (2013). Long-term effect of weight loss on obstructive sleep apnea .... Sleep, 23633746.
Q.
Can pregnancy increase the risk of sleep apnea?
A.
Yes, pregnancy can increase the risk of sleep apnea due to changes in the body that affect breathing.
References:
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Venkata C, & Venkateshiah SB. (2009). Sleep-disordered breathing during pregnancy. Journal of the American Board of Family Medicine : JABFM, 19264939.
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Q.
Can sleep apnea be cured without using a machine?
A.
Sleep apnea can sometimes be improved without a machine using methods like weight loss, oral devices, or surgery, but it depends on the individual case.
References:
Verbraecken J, Dieltjens M, Op de Beeck S, Vroegop A, Braem M, Vanderveken O, & Randerath W. (2022). Non-CPAP therapy for obstructive sleep apnoea. Breathe (Sheffield, England), 36340820.
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Abid R, Zhang L, & Bhat A. (2024). Non-CPAP Therapies for Obstructive Sleep Apnea in Adults. Missouri medicine, 39421466.
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Q.
Can sleep apnea cause learning or behavioral problems in kids?
A.
Yes, sleep apnea can cause learning and behavior problems in kids.
References:
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Q.
Can sleep apnea cause memory loss or brain fog?
A.
Yes, sleep apnea can cause memory loss and brain fog due to poor sleep quality affecting brain function.
References:
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Gagnon K, Baril AA, Gagnon JF, Fortin M, Décary A, Lafond C, et al. (2014). Cognitive impairment in obstructive sleep apnea. Pathologie-biologie, 25070768.
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Q.
Can sleep apnea cause morning headaches?
A.
Yes, sleep apnea can cause morning headaches. This happens because breathing problems during sleep can reduce oxygen levels and increase carbon dioxide levels in the blood.
References:
Spałka J, Kędzia K, Kuczyński W, Kudrycka A, Małolepsza A, Białasiewicz P, & Mokros Ł. (2020). Morning Headache as an Obstructive Sleep Apnea .... Brain sciences, 31963788.
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Provini F, Vetrugno R, Lugaresi E, & Montagna P. (2006). Sleep-related breathing disorders and headache. Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology, 16688620.
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Q.
Can sleep apnea return after treatment or surgery?
A.
Yes, sleep apnea can come back after treatment or surgery, even if you don't gain weight.
References:
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Contencin P, Guilleminault C, & Manach Y. (2003). Long-term follow-up and mechanisms of obstructive sleep .... International journal of pediatric otorhinolaryngology, 14662182.
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Sato M, Suzuki M, Oshima T, Ogura M, Shimomura A, Suzuki H, et al. (2000). Long-term follow-up of obstructive sleep apnea syndrome .... The Tohoku journal of experimental medicine, 11249146.
Q.
Can sleep apnea worsen other health conditions?
A.
Yes, sleep apnea can make other health problems worse, like heart and lung issues, and can also be linked to conditions like diabetes.
References:
Gleeson M, & McNicholas WT. (2022). Bidirectional relationships of comorbidity with obstructive .... European respiratory review : an official journal of the European Respiratory Society, 35508332.
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Sircu V, Colesnic SI, Covantsev S, Corlateanu O, Sukhotko A, Popovici C, & Corlateanu A. (2023). The Burden of Comorbidities in Obstructive Sleep Apnea .... Clocks & sleep, 37366660.
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Harding SM. (2000). Complications and consequences of obstructive sleep apnea. Current opinion in pulmonary medicine, 11100957.
Q.
Can thin people also have sleep apnea?
A.
Yes, thin people can have sleep apnea. It is not only a condition seen in people who are overweight.
References:
Antonaglia C, & Passuti G. (2022). Obstructive sleep apnea syndrome in non-obese patients. Sleep & breathing = Schlaf & Atmung, 34324126.
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Gray EL, McKenzie DK, & Eckert DJ. (2017). Obstructive Sleep Apnea without Obesity Is Common and .... Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 27655455.
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Dacal Quintas R, Tumbeiro Novoa M, Alves Pérez MT, Santalla Martínez ML, Acuña Fernández A, & Marcos Velázquez P. (2013). Obstructive sleep apnea in normal weight patients. Archivos de bronconeumologia, 23871526.
Q.
Can untreated sleep apnea increase your risk of stroke or diabetes?
A.
Yes, untreated sleep apnea can increase your risk of stroke and diabetes.
References:
Henning RJ, & Anderson WM. (2025). Sleep apnea is a common and dangerous cardiovascular .... Current problems in cardiology, 39242062.
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Morsy NE, Farrag NS, Zaki NFW, Badawy AY, Abdelhafez SA, El-Gilany AH, et al. (2019). Obstructive sleep apnea: personal, societal, public health, .... Reviews on environmental health, 31085749.
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Rasool G, Alenezi WH, Alanazi RMS, Almadai HA, & Alsharif NN. (2024). Knowledge of Obstructive Sleep Apnea Among the .... Cureus, 38304649.
Q.
How can sleep apnea affect your heart and blood pressure?
A.
Sleep apnea can make your heart work harder and increase your blood pressure, which is not good for your heart health.
References:
Henning RJ, & Anderson WM. (2025). Sleep apnea is a common and dangerous cardiovascular .... Current problems in cardiology, 39242062.
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Rajachandran M, Nickel N, & Lange RA. (2023). Sleep apnea and cardiovascular risk. Current opinion in cardiology, 37382140.
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Dredla BK, & Castillo PR. (2019). Cardiovascular Consequences of Obstructive Sleep Apnea. Current cardiology reports, 31707504.
Q.
How can you tell if your partner might have sleep apnea?
A.
If your partner snores loudly and seems tired during the day, they might have sleep apnea.
References:
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Smith AK, Togeiro SM, Tufik S, & Roizenblatt S. (2009). Disturbed sleep and musculoskeletal pain in the bed .... Sleep medicine, 19303357.
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Punjabi NM. (2008). The epidemiology of adult obstructive sleep apnea - PubMed. Proceedings of the American Thoracic Society, 18250205.
Q.
How does alcohol or smoking affect sleep apnea?
A.
Drinking alcohol and smoking can make sleep apnea worse by increasing snoring and breathing problems during sleep.
References:
Burgos-Sanchez C, Jones NN, Avillion M, Gibson SJ, Patel JA, Neighbors J, et al. (2020). Impact of Alcohol Consumption on Snoring and Sleep Apnea. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 32513091.
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Gunes FE, Agan K, Aktac S, Karadeniz D, Sunter G, Vural E, & Benbir-Senel G. (2024). Assessment of Impact of Dietary Patterns on Obstructive .... Sleep science (Sao Paulo, Brazil), 38545237.
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Bjorvatn B, Rajakulendren N, Lehmann S, & Pallesen S. (2018). Increased severity of obstructive sleep apnea is associated .... Journal of sleep research, 29193447.
Q.
How does sleep apnea impact daytime fatigue and concentration?
A.
Sleep apnea can make you feel very tired during the day and can make it harder to focus and think clearly.
References:
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Jackson ML, Howard ME, & Barnes M. (2011). Cognition and daytime functioning in sleep-related .... Progress in brain research, 21531244.
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Cheshire K, Engleman H, Deary I, Shapiro C, & Douglas NJ. (1992). Factors impairing daytime performance in patients with .... Archives of internal medicine, 1546916.
Q.
How is CPAP therapy used to treat sleep apnea?
A.
CPAP therapy helps people with sleep apnea breathe better at night by using a machine that gently blows air into their nose and mouth.
References:
Schwab RJ, Badr SM, Epstein LJ, Gay PC, Gozal D, Kohler M, et al. (2013). continuous positive airway pressure adherence tracking .... American journal of respiratory and critical care medicine, 23992588.
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Kushida CA, Chediak A, Berry RB, Brown LK, Gozal D, Iber C, et al. (2008). Clinical guidelines for the manual titration of positive .... Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 18468315.
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Kushida CA, Littner MR, Hirshkowitz M, Morgenthaler TI, Alessi CA, Bailey D, et al. (2006). Practice parameters for the use of continuous and bilevel .... Sleep, 16553024.
Q.
How is sleep apnea diagnosed in a sleep study?
A.
Sleep apnea is diagnosed using sleep studies, either at home or in a lab, to monitor breathing and other body functions during sleep.
References:
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Zancanella E, do Prado LF, de Carvalho LB, Machado Júnior AJ, Crespo AN, & do Prado GF. (2022). Home sleep apnea testing: an accuracy study. Sleep & breathing = Schlaf & Atmung, 33837916.
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Green A, Nagel N, Kemer L, & Dagan Y. (2022). Comparing in-lab full polysomnography for diagnosing .... Sleep and biological rhythms, 35309258.
Q.
How is sleep apnea linked to acid reflux or GERD?
A.
Sleep apnea and acid reflux, or GERD, are linked because both can make each other worse, especially at night. This happens because sleep apnea can change how the body works during sleep, leading to more acid reaching the throat.
References:
Zhu Q, Hua L, Chen L, Mu T, Dong D, Xu J, & Shen C. (2023). A bidirectional two-sample Mendelian randomization study. Frontiers in genetics, 37091806.
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Shibli F, Skeans J, Yamasaki T, & Fass R. (2020). Nocturnal Gastroesophageal Reflux Disease (GERD) and .... Journal of clinical gastroenterology, 32657961.
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Fujiwara Y, Arakawa T, & Fass R. (2013). Gastroesophageal reflux disease and sleep. Gastroenterology clinics of North America, 23452631.
Q.
Is snoring always a sign of sleep apnea?
A.
Snoring is not always a sign of sleep apnea. While snoring can be a symptom of sleep apnea, many people snore without having this condition.
References:
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De Meyer MMD, Jacquet W, Vanderveken OM, & Marks LAM. (2019). Systematic review of the different aspects of primary snoring. Sleep medicine reviews, 30978609.
Q.
What are the early warning signs of sleep apnea?
A.
The early warning signs of sleep apnea include loud snoring, choking or gasping during sleep, and feeling very tired during the day.
References:
Prisant LM, Dillard TA, & Blanchard AR. (2006). Obstructive sleep apnea syndrome. Journal of clinical hypertension (Greenwich, Conn.), 17028491.
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Q.
What are the signs of sleep apnea in children?
A.
Signs of sleep apnea in children include loud snoring, pauses in breathing during sleep, and daytime sleepiness or behavioral problems.
References:
Rosen CL. (1996). Obstructive sleep apnea syndrome (OSAS) in children. Sleep, 9085530.
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Bower CM, & Gungor A. (2000). Pediatric obstructive sleep apnea syndrome. Otolaryngologic clinics of North America, 10637344.
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Guilleminault C, & Pelayo R. (1998). Sleep-disordered breathing in children. Annals of medicine, 9783833.
Q.
What happens if sleep apnea is left untreated for years?
A.
If sleep apnea is left untreated, it can lead to serious health problems like heart disease, high blood pressure, and daytime sleepiness.
References:
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Morsy NE, Farrag NS, Zaki NFW, Badawy AY, Abdelhafez SA, El-Gilany AH, et al. (2019). Obstructive sleep apnea: personal, societal, public health, .... Reviews on environmental health, 31085749.
Q.
What happents to your body when you stop breathing during sleep?
A.
When you stop breathing during sleep, your body doesn’t get enough oxygen, which can cause you to wake up and feel tired.
References:
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https://pubmed.ncbi.nlm.nih.gov/21859276/
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Harper RM, Kumar R, Macey PM, Woo MA, & Ogren JA. (2014). Affective brain areas and sleep-disordered breathing - PubMed. Progress in brain research, 24746053.
Q.
What is positional sleep apnea, and how can sleeping posture help?
A.
Positional sleep apnea happens when breathing stops during sleep because of the way someone is lying. Changing sleeping positions, like avoiding sleeping on the back, can help reduce this problem.
References:
Ravesloot MJL. (2024). Positional Treatment of Obstructive Sleep Apnea. Otolaryngologic clinics of North America, 38311472.
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Battaglia E, Poletti V, Volpato E, & Banfi P. (2025). A Real Opportunity in the Treatment of Obstructive Sleep .... Life (Basel, Switzerland), 40868823.
Q.
Why does obesity increase the risk of sleep apnea?
A.
Obesity increases the risk of sleep apnea because extra body weight can press on the airways, making it harder to breathe during sleep.
References:
Gami AS, Caples SM, & Somers VK. (2003). Obesity and obstructive sleep apnea - PubMed - NIH. Endocrinology and metabolism clinics of North America, 14711066.
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Q.
Can antidepressants cause dependence?
A.
Antidepressants do not cause addiction, but some people might experience withdrawal symptoms when stopping them. See below to understand more.
References:
Haddad P. (1999). Do antidepressants have any potential to cause addiction?. Journal of psychopharmacology (Oxford, England), 10512092.
https://pubmed.ncbi.nlm.nih.gov/10512092/
Lichtigfeld FJ, & Gillman MA. (1998). Antidepressants are not drugs of abuse or dependence. Postgraduate medical journal, 10211325.
https://pubmed.ncbi.nlm.nih.gov/10211325/
Horowitz MA, Framer A, Hengartner MP, Sørensen A, & Taylor D. (2023). Estimating Risk of Antidepressant Withdrawal from a .... CNS drugs, 36513909.
Q.
Can sleeping pills cause memory problems?
A.
Sleeping pills can sometimes cause memory issues, especially if used frequently or in high doses. See below to understand more.
References:
Dokkedal-Silva V, Oliveira MGM, Galduróz JCF, Tufik S, & Andersen ML. (2021). The effect of sleep medications on prospective and .... Progress in neuro-psychopharmacology & biological psychiatry, 32682875.
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Wagner J, & Wagner ML. (2000). Non-benzodiazepines for the treatment of insomnia. Sleep medicine reviews, 12531036.
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(2008). Whenever possible, avoid the use of sleeping pills. Prescrire international, 19536941.
Q.
Is it safe to stop antidepressants suddenly?
A.
It is not safe to stop antidepressants suddenly because it can cause withdrawal symptoms. It's important to gradually reduce the dose under a doctor's guidance. See below to understand more.
References:
Horowitz MA, & Taylor D. (2019). Tapering of SSRI treatment to mitigate withdrawal symptoms. The lancet. Psychiatry, 30850328.
https://pubmed.ncbi.nlm.nih.gov/30850328/
Kendrick T. (2021). Strategies to reduce use of antidepressants. British journal of clinical pharmacology, 32656861.
https://pubmed.ncbi.nlm.nih.gov/32656861/
Bschor T, Bonnet U, Pitzer M, Baethge C, Lieb K, Gertz HJ, & Müller-Oerlinghausen B. (2022). withdrawal symptoms and rebound effects : Review and .... Der Nervenarzt, 34978577.
Q.
What is the difference between benzodiazepines and sleeping pills?
A.
Benzodiazepines and sleeping pills like z-hypnotics both help with sleep, but they work differently in the brain and may have different safety and side effect profiles. See below to understand more.
References:
Mellingsaeter TC, Bramness JG, & Slørdal L. (2006). [Are z-hypnotics better and safer sleeping pills than .... Tidsskrift for den Norske laegeforening : tidsskrift for praktisk medicin, ny raekke, 17117195.
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Wagner J, & Wagner ML. (2000). Non-benzodiazepines for the treatment of insomnia. Sleep medicine reviews, 12531036.
https://pubmed.ncbi.nlm.nih.gov/12531036/
Terzano MG, Rossi M, Palomba V, Smerieri A, & Parrino L. (2003). comparative tolerability of zopiclone, zolpidem and zaleplon. Drug safety, 12608888.
Q.
Why do antidepressants take weeks to work?
A.
Antidepressants take weeks to work because they need time to change the brain's chemistry and affect mood and behavior. See below to understand more.
References:
Harmer CJ, Goodwin GM, & Cowen PJ. (2009). Why do antidepressants take so long to work? A cognitive .... The British journal of psychiatry : the journal of mental science, 19648538.
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Derivan AT. (1995). Antidepressants: can we determine how quickly they work? .... Psychopharmacology bulletin, 7675984.
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van Calker D, Zobel I, Dykierek P, Deimel CM, Kech S, Lieb K, et al. (2009). Time course of response to antidepressants: predictive .... Journal of affective disorders, 18849079.
Q.
How common is sleep apnea and who is most at risk?
A.
Sleep apnea is a common condition where breathing stops and starts during sleep. People who are overweight, older, or have certain physical traits are more likely to have it.
References:
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Franklin KA, & Lindberg E. (2015). Obstructive sleep apnea is a common disorder in the .... Journal of thoracic disease, 26380759.
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Garvey JF, Pengo MF, Drakatos P, & Kent BD. (2015). Epidemiological aspects of obstructive sleep apnea. Journal of thoracic disease, 26101650.
Q.
How does ADHD affect sleep and what sleep disorders are common with ADHD?
A.
ADHD can make it hard to sleep, and people with ADHD often have sleep disorders like insomnia and restless legs syndrome.
References:
Hvolby A. (2015). Associations of sleep disturbance with ADHD: implications .... Attention deficit and hyperactivity disorders, 25127644.
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Weiss MD, & Salpekar J. (2010). Sleep problems in the child with attention-deficit .... CNS drugs, 20839894.
Q.
How does pregnancy affect restless leg syndrome and what are the safe treatments?
A.
Pregnancy can worsen restless legs syndrome, but there are safe treatments available to help manage it.
References:
Prosperetti C, & Manconi M. (2015). Restless Legs Syndrome/Willis-Ekbom Disease and .... Sleep medicine clinics, 26329442.
https://pubmed.ncbi.nlm.nih.gov/26329442/
Jahani Kondori M, Kolla BP, Moore KM, & Mansukhani MP. (2020). Management of Restless Legs Syndrome in Pregnancy .... Journal of primary care & community health, 32054396.
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Garbazza C, & Manconi M. (2018). Management Strategies for Restless Legs Syndrome/Willis .... Sleep medicine clinics, 30098751.
Q.
How does restless leg syndrome affect sleep quality and daily life?
A.
Restless leg syndrome can make it hard to sleep and can cause fatigue during the day, affecting daily activities.
References:
Manconi M, Garcia-Borreguero D, Schormair B, Videnovic A, Berger K, Ferri R, & Dauvilliers Y. (2021). Restless legs syndrome. Nature reviews. Disease primers, 34732752.
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Gossard TR, Trotti LM, Videnovic A, & St Louis EK. (2021). Restless Legs Syndrome: Contemporary Diagnosis and .... Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics, 33880737.
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Allen RP, Walters AS, Montplaisir J, Hening W, Myers A, Bell TJ, & Ferini-Strambi L. (2005). Restless legs syndrome prevalence and impact. Archives of internal medicine, 15956009.
Q.
How does shift work sleep disorder impact health and what are the treatments?
A.
Shift work sleep disorder can make you feel really tired and affect your health. There are treatments like changing sleep habits and using light therapy or medicine to help.
References:
Moreno CRC. (2025). Shift work sleep disorder. Handbook of clinical neurology, 39864934.
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Wickwire EM, Geiger-Brown J, Scharf SM, & Drake CL. (2017). Shift Work and Shift Work Sleep Disorder: Clinical and .... Chest, 28012806.
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Cheng P, & Drake C. (2019). Shift Work Disorder. Neurologic clinics, 31256790.
Q.
How does sleep apnea affect life expectancy and overall health?
A.
Sleep apnea can lower life expectancy and affect health by increasing the risk of other health problems, but treatment can help improve outcomes.
References:
Chaouat A. (2003). [Mortality in treated sleep apnea syndrome]. Revue neurologique, 14646808.
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Agrawal R, Sharafkhaneh A, Gottlieb DJ, Nowakowski S, & Razjouyan J. (2023). Mortality Patterns Associated with Central Sleep Apnea .... Annals of the American Thoracic Society, 36375082.
Q.
How effective is a jaw strap for treating sleep apnea?
A.
Jaw straps might help with sleep apnea, but they are not the best solution for everyone. It's important to talk to a doctor to find the right treatment.
References:
Bhat S, Gushway-Henry N, Polos PG, DeBari VA, Riar S, Gupta D, et al. (2014). The efficacy of a chinstrap in treating sleep disordered .... Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 25126035.
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Freiser ME, Schell AE, & Soose RJ. (2020). DISE-PAP: a method for troubleshooting residual AHI .... Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 32003733.
Q.
How effective is a snoring mouthpiece in reducing snoring?
A.
Snoring mouthpieces, also known as mandibular advancement devices, are generally effective in reducing snoring for many users.
References:
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Lindman R, & Bondemark L. (2001). A review of oral devices in the treatment of habitual snoring .... Swedish dental journal, 11392605.
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Demko BG. (2018). The Evolution of Oral Appliance Therapy for Snoring and .... Sleep medicine clinics, 30396442.
Q.
How is sleep apnea rated for disability benefits and what factors are considered?
A.
Sleep apnea can affect work ability and may be considered for disability benefits. Factors like how severe the apnea is and how it affects daily life are important.
References:
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Sjösten N, Vahtera J, Salo P, Oksanen T, Saaresranta T, Virtanen M, et al. (2009). Increased risk of lost workdays prior to the diagnosis of .... Chest, 19318680.
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Rod NH, Kjeldgård L, Åkerstedt T, Ferrie JE, Salo P, Vahtera J, & Alexanderson K. (2017). Sleep Apnea, Disability Pensions, and Cause-Specific .... American journal of epidemiology, 28520881.
Q.
How should I interpret my sleep apnea test results and what do they mean?
A.
Sleep apnea test results show how often you stop breathing at night. The results help doctors understand if you have sleep apnea and how severe it is.
References:
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Rundo JV. (2019). Obstructive sleep apnea basics. Cleveland Clinic journal of medicine, 31509498.
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Q.
Is it normal to have nightmares every night and when should I seek help?
A.
Having nightmares every night might not be normal, especially if they cause distress or affect daily life. If this happens, it's a good idea to seek help from a healthcare professional.
References:
Krakow B, Schrader R, Tandberg D, Hollifield M, Koss MP, Yau CL, & Cheng DT. (2002). Nightmare frequency in sexual assault survivors with PTSD. Journal of anxiety disorders, 12194543.
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Abdul-Razzak KK, & Alkhatatbeh MJ. (2021). Nightmares and bad dreams among individuals with .... Research in psychotherapy (Milano), 34568104.
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Q.
Is sleep apnea genetic and what are the hereditary risk factors?
A.
Sleep apnea can be influenced by genetics, and having family members with the condition can increase your risk.
References:
Mukherjee S, Saxena R, & Palmer LJ. (2018). The genetics of obstructive sleep apnoea. Respirology (Carlton, Vic.), 29113020.
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Redline S, & Tishler PV. (2000). The genetics of sleep apnea. Sleep medicine reviews, 12531037.
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Strausz S, Ruotsalainen S, Ollila HM, Karjalainen J, Kiiskinen T, Reeve M, et al. (2021). Genetic analysis of obstructive sleep apnoea discovers a .... The European respiratory journal, 33243845.
Q.
What are common reasons for being unable to sleep after surgery and how can it be addressed?
A.
Trouble sleeping after surgery can be due to pain, stress, or changes in sleep patterns. Addressing these issues might involve managing pain, creating a calming sleep environment, and seeking support for emotional health.
References:
Bakry AM, Abdelmohty H, Badawy AE, Shorbagy MS, & Eldib OS. (2022). The overlooked side after open heart surgery in adults. Asian cardiovascular & thoracic annals, 34111966.
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Gögenur I, Middleton B, Burgdorf S, Rasmussen LS, Skene DJ, & Rosenberg J. (2007). Impact of sleep and circadian disturbances in urinary 6 .... Journal of pineal research, 17645696.
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Shulman BS, Liporace FA, Davidovitch RI, Karia R, & Egol KA. (2015). Sleep disturbance after fracture is related to emotional well .... Journal of orthopaedic trauma, 25072285.
Q.
What are common reasons for waking up in the middle of the night?
A.
Waking up in the middle of the night can be caused by stress, medical conditions, or disturbances in sleep patterns.
References:
Moline M, DiBonaventura Md, Shah D, & Ben-Joseph R. (2014). Impact of middle-of-the-night awakenings on health status, .... Nature and science of sleep, 25093001.
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Ohayon MM. (2010). Nocturnal awakenings and difficulty resuming sleep. Journal of psychosomatic research, 21109044.
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Ohayon MM. (2008). Nocturnal awakenings and comorbid disorders in the .... Journal of psychiatric research, 18374943.
Q.
What are common sleep disorders in adults and how can they be treated?
A.
Common sleep disorders in adults include insomnia, sleep apnea, and restless legs syndrome, which can be treated with lifestyle changes, medications, or therapies.
References:
Holder S, & Narula NS. (2022). Common Sleep Disorders in Adults: Diagnosis and .... American family physician, 35426627.
https://pubmed.ncbi.nlm.nih.gov/35426627/
Jaqua EE, Hanna M, Labib W, Moore C, & Matossian V. (2023). Common Sleep Disorders Affecting Older Adults. The Permanente journal, 36503403.
https://pubmed.ncbi.nlm.nih.gov/36503403/
Bloom HG, Ahmed I, Alessi CA, Ancoli-Israel S, Buysse DJ, Kryger MH, et al. (2009). Evidence-based recommendations for the assessment and .... Journal of the American Geriatrics Society, 19484833.
Q.
What are common sleep disorders in children and how are they treated?
A.
Common sleep disorders in children include insomnia, sleep apnea, and night terrors, often treated with behavioral changes and sometimes medication.
References:
Deshpande P, Salcedo B, & Haq C. (2022). Common Sleep Disorders in Children. American family physician, 35166510.
https://pubmed.ncbi.nlm.nih.gov/35166510/
Carter KA, Hathaway NE, & Lettieri CF. (2014). Common sleep disorders in children. American family physician, 24695508.
https://pubmed.ncbi.nlm.nih.gov/24695508/
Shelton AR. (2023). Sleep Disorders in Childhood. Continuum (Minneapolis, Minn.), 37590830.
Q.
What are sleep-wake disorders and how are they diagnosed?
A.
Sleep-wake disorders affect when you sleep and wake up. They are diagnosed by looking at your sleep patterns and sometimes using special tests.
References:
Sun SY, & Chen GH. (2022). Treatment of Circadian Rhythm Sleep-Wake Disorders. Current neuropharmacology, 34493186.
https://pubmed.ncbi.nlm.nih.gov/34493186/
Steele TA, St Louis EK, Videnovic A, & Auger RR. (2021). Circadian Rhythm Sleep-Wake Disorders: a Contemporary .... Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics, 33844152.
https://pubmed.ncbi.nlm.nih.gov/33844152/
Abbott SM, Reid KJ, & Zee PC. (2015). Circadian Rhythm Sleep-Wake Disorders. The Psychiatric clinics of North America, 26600110.
Q.
What are the 5 main types of sleep disorders and their characteristics?
A.
The five main types of sleep disorders are insomnia, sleep apnea, restless legs syndrome, narcolepsy, and circadian rhythm disorders. Each affects sleep differently, from trouble falling asleep to issues with staying awake during the day.
References:
Chokroverty S. (2010). Overview of sleep & sleep disorders. The Indian journal of medical research, 20308738.
https://pubmed.ncbi.nlm.nih.gov/20308738/
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https://pubmed.ncbi.nlm.nih.gov/35426627/
Sateia MJ. (2014). International classification of sleep disorders-third edition. Chest, 25367475.
Q.
What are the common causes of an inability to sleep and how can it be treated?
A.
Trouble sleeping, called insomnia, can be caused by stress, poor sleep habits, or medical problems. It can be improved with good sleep routines, relaxation, and sometimes medicine.
References:
Sutton EL. (2021). Insomnia. Annals of internal medicine, 33683929.
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Lareau SC, & Bonnet MH. (1985). Sleep disorders: insomnias. The Nurse practitioner, 4047525.
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Hauri PJ, & Esther MS. (1990). Insomnia. Mayo Clinic proceedings, 2195248.
Q.
What are the common causes of insomnia and how can it be treated?
A.
Insomnia can be caused by stress, poor sleep habits, or medical conditions, and it can often be treated with lifestyle changes, therapy, or medication.
References:
Sutton EL. (2021). Insomnia. Annals of internal medicine, 33683929.
https://pubmed.ncbi.nlm.nih.gov/33683929/
Perlis ML, Posner D, Riemann D, Bastien CH, Teel J, & Thase M. (2022). Insomnia. Lancet (London, England), 36115372.
https://pubmed.ncbi.nlm.nih.gov/36115372/
Matheson EM, Brown BD, & DeCastro AO. (2024). Treatment of Chronic Insomnia in Adults. American family physician, 38393799.
Q.
What are the different types of bad dreams and their causes?
A.
Bad dreams include nightmares and are often caused by anxiety or stress, but they can also be part of a sleep disorder or linked to emotional experiences.
References:
Spoormaker VI, Schredl M, & van den Bout J. (2006). Nightmares: from anxiety symptom to sleep disorder. Sleep medicine reviews, 16377217.
https://pubmed.ncbi.nlm.nih.gov/16377217/
Zadra A, Pilon M, & Donderi DC. (2006). Variety and intensity of emotions in nightmares and bad .... The Journal of nervous and mental disease, 16614545.
https://pubmed.ncbi.nlm.nih.gov/16614545/
Abdul-Razzak KK, & Alkhatatbeh MJ. (2021). Nightmares and bad dreams among individuals with .... Research in psychotherapy (Milano), 34568104.
Q.
What are the most common sleep disorders and how are they diagnosed?
A.
Common sleep disorders include insomnia, sleep apnea, and restless legs syndrome, diagnosed through medical history, sleep studies, and sometimes questionnaires.
References:
K Pavlova M, & Latreille V. (2019). Sleep Disorders. The American journal of medicine, 30292731.
https://pubmed.ncbi.nlm.nih.gov/30292731/
Holder S, & Narula NS. (2022). Common Sleep Disorders in Adults: Diagnosis and .... American family physician, 35426627.
https://pubmed.ncbi.nlm.nih.gov/35426627/
Sateia MJ. (2014). International classification of sleep disorders-third edition. Chest, 25367475.
Q.
What are the potential causes of being unable to sleep through the night?
A.
Not being able to sleep through the night can be caused by changes in hormones, body temperature, and other factors like stress or lifestyle habits.
References:
Vgontzas AN, Bixler EO, Lin HM, Prolo P, Mastorakos G, Vela-Bueno A, et al. (2001). Chronic insomnia is associated with nyctohemeral .... The Journal of clinical endocrinology and metabolism, 11502812.
https://pubmed.ncbi.nlm.nih.gov/11502812/
Lack LC, Gradisar M, Van Someren EJ, Wright HR, & Lushington K. (2008). The relationship between insomnia and body temperatures. Sleep medicine reviews, 18603220.
https://pubmed.ncbi.nlm.nih.gov/18603220/
Fatovich B, Winkler RC, & James R. (1983). 'Doctor I can't sleep at night'. Australian family physician, 6667178.
Q.
What are the psychological and physiological causes of bad dreams?
A.
Bad dreams can be caused by psychological factors like trauma and stress, as well as changes during adolescence. Early trauma can also play a role in nightmares.
References:
Hartmann E. (1998). Nightmare after trauma as paradigm for all dreams. Psychiatry, 9823032.
https://pubmed.ncbi.nlm.nih.gov/9823032/
Nielsen TA, Laberge L, Paquet J, Tremblay RE, Vitaro F, & Montplaisir J. (2000). Development of disturbing dreams during adolescence .... Sleep, 11007439.
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Arvanitakis K, Jodoin RM, Lester EP, Lussier A, & Robertson BM. (1993). Early sexual abuse and nightmares in the analysis of adults. The Psychoanalytic quarterly, 8284332.
Q.
What are the reasons for waking up hungry in the middle of the night?
A.
Waking up hungry at night can be linked to sleep habits.
References:
Melo MCA, de Oliveira Ribeiro M, de Araújo CFC, de Mesquita LMF, de Bruin PFC, & de Bruin VMS. (2018). Night eating in bipolar disorder. Sleep medicine, 29859477.
https://pubmed.ncbi.nlm.nih.gov/29859477/
McAlpine T, Mullan B, & Clarke PJF. (2024). Re-considering the Role of Sleep Hygiene Behaviours in .... International journal of behavioral medicine, 37672195.
https://pubmed.ncbi.nlm.nih.gov/37672195/
Leidy HJ, Tang M, Armstrong CL, Martin CB, & Campbell WW. (2011). The effects of consuming frequent, higher protein meals on .... Obesity (Silver Spring, Md.), 20847729.
Q.
What are the sensations associated with restless leg syndrome?
A.
Restless leg syndrome (RLS) causes uncomfortable sensations in the legs, often described as burning, itching, or tingling.
References:
Karroum EG, Golmard JL, Leu-Semenescu S, & Arnulf I. (2012). Sensations in restless legs syndrome. Sleep medicine, 22296915.
https://pubmed.ncbi.nlm.nih.gov/22296915/
Karroum EG, Golmard JL, Leu-Semenescu S, & Arnulf I. (2015). Painful restless legs syndrome: a severe, burning form .... The Clinical journal of pain, 25167326.
https://pubmed.ncbi.nlm.nih.gov/25167326/
Page RL 2nd, Ruscin JM, Bainbridge JL, & Brieke AA. (2008). Restless legs syndrome induced by escitalopram. Pharmacotherapy, 18225972.
Q.
What are the signs and symptoms of sleep apnea in kids?
A.
Sleep apnea in kids can cause loud snoring, pauses in breathing during sleep, and daytime sleepiness. It may also lead to behavior problems and trouble paying attention.
References:
Chan J, Edman JC, & Koltai PJ. (2004). Obstructive sleep apnea in children. American family physician, 15023015.
https://pubmed.ncbi.nlm.nih.gov/15023015/
Bitners AC, & Arens R. (2020). Evaluation and Management of Children with Obstructive .... Lung, 32166426.
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Wang RC, Elkins TP, Keech D, Wauquier A, & Hubbard D. (1998). Accuracy of clinical evaluation in pediatric obstructive .... Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 9450831.
Q.
What are the specific symptoms of sleep apnea in men?
A.
Men with sleep apnea often experience loud snoring, gasping for air during sleep, and excessive daytime sleepiness.
References:
Ambrogetti A, Olson LG, & Saunders NA. (1991). Differences in the symptoms of men and women with .... Australian and New Zealand journal of medicine, 1818545.
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Kales A, Vela-Bueno A, & Kales JD. (1987). Sleep disorders: sleep apnea and narcolepsy. Annals of internal medicine, 3544995.
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Peter JH, Amend G, Faust M, Meinzer K, Penzel T, Schneider H, et al. (1989). [Snoring and sleep apnea syndrome]. Wiener medizinische Wochenschrift (1946), 2669355.
Q.
What are the symptoms of central sleep apnea and how is it different from obstructive sleep apnea?
A.
Central sleep apnea is when your brain doesn't send the right signals to help you breathe during sleep, while obstructive sleep apnea is when something blocks your airway. Symptoms can include pauses in breathing, waking up often, and feeling tired during the day.
References:
Eckert DJ, Jordan AS, Merchia P, & Malhotra A. (2007). Central sleep apnea: Pathophysiology and treatment. Chest, 17296668.
https://pubmed.ncbi.nlm.nih.gov/17296668/
Malhotra A, & Owens RL. (2010). What is central sleep apnea?. Respiratory care, 20799999.
https://pubmed.ncbi.nlm.nih.gov/20799999/
Chowdhuri S, & Badr MS. (2010). Central sleep apnoea. The Indian journal of medical research, 20308740.
Q.
What are the symptoms of mild sleep apnea and how is it treated?
A.
Mild sleep apnea can cause snoring, tiredness during the day, and trouble focusing. Treatment often includes lifestyle changes, like losing weight or sleeping on your side, and sometimes using a CPAP machine.
References:
Semelka M, Wilson J, & Floyd R. (2016). Diagnosis and Treatment of Obstructive Sleep Apnea in .... American family physician, 27583421.
https://pubmed.ncbi.nlm.nih.gov/27583421/
Prisant LM, Dillard TA, & Blanchard AR. (2006). Obstructive sleep apnea syndrome. Journal of clinical hypertension (Greenwich, Conn.), 17028491.
https://pubmed.ncbi.nlm.nih.gov/17028491/
Victor LD. (2004). Treatment of obstructive sleep apnea in primary care. American family physician, 14971838.
Q.
What are the symptoms of obstructive sleep apnea and how is it diagnosed?
A.
Obstructive sleep apnea (OSA) causes loud snoring, daytime tiredness, and breathing pauses during sleep. It is diagnosed using a sleep study, which monitors breathing and other body functions while you sleep.
References:
Patel SR. (2019). Obstructive Sleep Apnea. Annals of internal medicine, 31791057.
https://pubmed.ncbi.nlm.nih.gov/31791057/
Stansbury RC, & Strollo PJ. (2015). Clinical manifestations of sleep apnea. Journal of thoracic disease, 26543619.
https://pubmed.ncbi.nlm.nih.gov/26543619/
Prisant LM, Dillard TA, & Blanchard AR. (2006). Obstructive sleep apnea syndrome. Journal of clinical hypertension (Greenwich, Conn.), 17028491.
Q.
What are the treatment options available for various sleep disorders?
A.
Sleep disorders can be treated with lifestyle changes, medications, and therapies like cognitive behavioral therapy. Each treatment depends on the specific sleep disorder a person has.
References:
Ramar K, & Olson EJ. (2013). Management of common sleep disorders. American family physician, 23944726.
https://pubmed.ncbi.nlm.nih.gov/23944726/
Pagel JF, & Parnes BL. (2001). Medications for the Treatment of Sleep Disorders. Primary care companion to the Journal of clinical psychiatry, 15014609.
https://pubmed.ncbi.nlm.nih.gov/15014609/
Holder S, & Narula NS. (2022). Common Sleep Disorders in Adults: Diagnosis and .... American family physician, 35426627.
Q.
What are the typical symptoms of sleep apnea and when should I see a doctor?
A.
Sleep apnea often causes loud snoring, daytime tiredness, and trouble staying asleep. See a doctor if these symptoms affect your daily life.
References:
Stansbury RC, & Strollo PJ. (2015). Clinical manifestations of sleep apnea. Journal of thoracic disease, 26543619.
https://pubmed.ncbi.nlm.nih.gov/26543619/
Kimoff RJ. (2015). When to Suspect Sleep Apnea and What to Do About It. The Canadian journal of cardiology, 26112305.
https://pubmed.ncbi.nlm.nih.gov/26112305/
Patel SR. (2019). Obstructive Sleep Apnea. Annals of internal medicine, 31791057.
Q.
What are the underlying causes of restless leg syndrome?
A.
Restless leg syndrome (RLS) can be caused by problems in how the brain uses iron and also how the brain processes dopamine, a chemical that helps control movement.
References:
Trenkwalder C, & Paulus W. (2010). Restless legs syndrome: pathophysiology, clinical .... Nature reviews. Neurology, 20531433.
https://pubmed.ncbi.nlm.nih.gov/20531433/
Gossard TR, Trotti LM, Videnovic A, & St Louis EK. (2021). Restless Legs Syndrome: Contemporary Diagnosis and .... Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics, 33880737.
https://pubmed.ncbi.nlm.nih.gov/33880737/
Satija P, & Ondo WG. (2008). Restless legs syndrome: pathophysiology, diagnosis and .... CNS drugs, 18484792.
Q.
What can cause waking up with heartburn in the middle of the night and how can it be managed?
A.
Waking up with heartburn at night can be caused by eating too close to bedtime. To manage it, try eating earlier and consider medications like pantoprazole.
References:
Kindt S, Imschoot J, & Tack J. (2011). Prevalence of and impact of pantoprazole on nocturnal .... Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus, 21418126.
https://pubmed.ncbi.nlm.nih.gov/21418126/
Fujiwara Y, Machida A, Watanabe Y, Shiba M, Tominaga K, Watanabe T, et al. (2005). Association between dinner-to-bed time and gastro .... The American journal of gastroenterology, 16393212.
https://pubmed.ncbi.nlm.nih.gov/16393212/
Gallagher R, Lynch F, Paul G, Petkovski D, Kandl B, Lang S, et al. (2008). Chest symptoms following coronary stenting in the first 10 .... European journal of cardiovascular nursing, 17888741.
Q.
What causes excessive daytime sleepiness in the elderly and how is it treated?
A.
Excessive daytime sleepiness in the elderly can be caused by poor sleep at night, medications, or medical conditions, and is treated by addressing these underlying issues.
References:
Zalai D, Bingeliene A, & Shapiro C. (2017). Sleepiness in the Elderly. Sleep medicine clinics, 28778240.
https://pubmed.ncbi.nlm.nih.gov/28778240/
Pack AI, Dinges DF, Gehrman PR, Staley B, Pack FM, & Maislin G. (2006). Risk factors for excessive sleepiness in older adults. Annals of neurology, 16718691.
https://pubmed.ncbi.nlm.nih.gov/16718691/
Happe S. (2003). Excessive daytime sleepiness and sleep disturbances in .... Drugs, 14664652.
Q.
What conditions can lead to excessive daytime sleepiness and how can it be managed?
A.
Excessive daytime sleepiness can be caused by conditions like sleep apnea, narcolepsy, and poor sleep habits. Managing it involves treating the underlying condition and improving sleep hygiene.
References:
Gandhi KD, Mansukhani MP, Silber MH, & Kolla BP. (2021). Excessive Daytime Sleepiness: A Clinical Review. Mayo Clinic proceedings, 33840518.
https://pubmed.ncbi.nlm.nih.gov/33840518/
Bittencourt LR, Silva RS, Santos RF, Pires ML, & Mello MT. (2005). [Excessive daytime sleepiness]. Revista brasileira de psiquiatria (Sao Paulo, Brazil : 1999), 16082450.
https://pubmed.ncbi.nlm.nih.gov/16082450/
Pérez-Carbonell L, Mignot E, Leschziner G, & Dauvilliers Y. (2022). Understanding and approaching excessive daytime .... Lancet (London, England), 36115367.
Q.
What could be causing bad dreams every night and how can they be stopped?
A.
Bad dreams can be caused by stress, mental health issues, or conditions like ADHD. Reducing stress and seeking help for mental health problems may help stop them.
References:
Schredl M, Bumb JM, Alm B, & Sobanski E. (2017). Nightmare frequency in adults with attention-deficit .... European archives of psychiatry and clinical neuroscience, 26975614.
https://pubmed.ncbi.nlm.nih.gov/26975614/
Abdul-Razzak KK, & Alkhatatbeh MJ. (2021). Nightmares and bad dreams among individuals with .... Research in psychotherapy (Milano), 34568104.
https://pubmed.ncbi.nlm.nih.gov/34568104/
Garcia O, Slavish DC, Dietch JR, Messman BA, Contractor AA, Haynes PL, et al. (2021). Nightmares and daily stress are bidirectionally associated .... Stress and health : journal of the International Society for the Investigation of Stress, 33749112.
Q.
What could be the meaning of having bad dreams every night?
A.
Having bad dreams every night can be linked to stress, poor sleep quality, and emotional challenges. These nightmares might be a sign that something is bothering you or that you're not sleeping well.
References:
Zadra A, Pilon M, & Donderi DC. (2006). Variety and intensity of emotions in nightmares and bad .... The Journal of nervous and mental disease, 16614545.
https://pubmed.ncbi.nlm.nih.gov/16614545/
Liu X, Chen H, Bo QG, Fan F, & Jia CX. (2017). Poor sleep quality and nightmares are associated with non .... European child & adolescent psychiatry, 27383464.
https://pubmed.ncbi.nlm.nih.gov/27383464/
Garcia O, Slavish DC, Dietch JR, Messman BA, Contractor AA, Haynes PL, et al. (2021). Nightmares and daily stress are bidirectionally associated .... Stress and health : journal of the International Society for the Investigation of Stress, 33749112.
Q.
What could be the reasons why I can't sleep and how can I address them?
A.
Trouble sleeping can be caused by various factors, including sleep-wake rhythm disorders and anxiety.
References:
Okawa M, Mishima K, Nanami T, Shimizu T, Iijima S, Hishikawa Y, & Takahashi K. (1990). Vitamin B12 treatment for sleep-wake rhythm disorders. Sleep, 2305167.
https://pubmed.ncbi.nlm.nih.gov/2305167/
Mao X, Zhang F, Wei C, Li Z, Huang C, Sun Z, et al. (2023). The impact of insomnia on anxiety and depression. BMC psychiatry, 37226120.
https://pubmed.ncbi.nlm.nih.gov/37226120/
Chellappa SL, & Aeschbach D. (2022). Sleep and anxiety: From mechanisms to interventions. Sleep medicine reviews, 34979437.
Q.
What does the number of sleep apnea events per hour indicate about severity?
A.
The number of sleep apnea events per hour helps determine how severe sleep apnea is, with more events indicating more severe conditions.
References:
De Backer W. (2013). Obstructive sleep apnea/hypopnea syndrome. Panminerva medica, 23676959.
https://pubmed.ncbi.nlm.nih.gov/23676959/
Malhotra A, Ayappa I, Ayas N, Collop N, Kirsch D, Mcardle N, et al. (2021). Metrics of sleep apnea severity: beyond the .... Sleep, 33693939.
https://pubmed.ncbi.nlm.nih.gov/33693939/
Kulkas A, Tiihonen P, Eskola K, Julkunen P, Mervaala E, & Töyräs J. (2013). Novel parameters for evaluating severity of sleep .... Journal of medical engineering & technology, 23360196.
Q.
What is a circadian rhythm sleep disorder and how is it treated?
A.
Circadian rhythm sleep disorders are problems with the sleep-wake cycle, making it hard to sleep at normal times. Treatments include light therapy, melatonin, and good sleep habits.
References:
Steele TA, St Louis EK, Videnovic A, & Auger RR. (2021). Circadian Rhythm Sleep-Wake Disorders: a Contemporary .... Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics, 33844152.
https://pubmed.ncbi.nlm.nih.gov/33844152/
Barion A, & Zee PC. (2007). A clinical approach to circadian rhythm sleep disorders. Sleep medicine, 17395535.
https://pubmed.ncbi.nlm.nih.gov/17395535/
Sun SY, & Chen GH. (2022). Treatment of Circadian Rhythm Sleep-Wake Disorders. Current neuropharmacology, 34493186.
Q.
What is excessive daytime sleepiness disorder and how is it diagnosed?
A.
Excessive daytime sleepiness is a condition where a person feels very sleepy during the day, even after a good night's sleep. It is diagnosed by a doctor who will ask questions about sleep habits and may do special sleep tests.
References:
Gandhi KD, Mansukhani MP, Silber MH, & Kolla BP. (2021). Excessive Daytime Sleepiness: A Clinical Review. Mayo Clinic proceedings, 33840518.
https://pubmed.ncbi.nlm.nih.gov/33840518/
Pérez-Carbonell L, Mignot E, Leschziner G, & Dauvilliers Y. (2022). Understanding and approaching excessive daytime .... Lancet (London, England), 36115367.
https://pubmed.ncbi.nlm.nih.gov/36115367/
Pagel JF. (2009). Excessive daytime sleepiness. American family physician, 19275068.
Q.
What is fatal familial insomnia and how does it affect individuals?
A.
Fatal familial insomnia is a rare genetic disorder that causes severe sleep problems and eventually leads to death. It affects the brain and results in symptoms like trouble sleeping, confusion, and memory loss.
References:
Gallassi R, Morreale A, Montagna P, Cortelli P, Avoni P, Castellani R, et al. (1996). Fatal familial insomnia: behavioral and cognitive features. Neurology, 8780067.
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Cortelli P, Gambetti P, Montagna P, & Lugaresi E. (1999). Fatal familial insomnia: clinical features and molecular .... Journal of sleep research, 10389103.
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Rossi G, Macchi G, Porro M, Giaccone G, Bugiani M, Scarpini E, et al. (1998). Fatal familial insomnia: genetic, neuropathologic, and .... Neurology, 9521257.
Q.
What is RBD sleep disorder and what are its symptoms?
A.
RBD sleep disorder is a condition where people act out their dreams during REM sleep, often with movements or sounds. Symptoms include talking, shouting, or moving violently while asleep.
References:
Dauvilliers Y, Schenck CH, Postuma RB, Iranzo A, Luppi PH, Plazzi G, et al. (2018). REM sleep behaviour disorder. Nature reviews. Disease primers, 30166532.
https://pubmed.ncbi.nlm.nih.gov/30166532/
Sobreira-Neto MA, Stelzer FG, Gitaí LLG, Alves RC, Eckeli AL, & Schenck CH. (2023). REM sleep behavior disorder: update on diagnosis and .... Arquivos de neuro-psiquiatria, 38157884.
https://pubmed.ncbi.nlm.nih.gov/38157884/
Rodriguez CL, Jaimchariyatam N, & Budur K. (2017). Rapid Eye Movement Sleep Behavior Disorder: A Review .... Chest, 28322726.
Q.
What is REM sleep disorder and how does it affect sleep quality?
A.
REM sleep disorder makes people act out their dreams while sleeping, which can lead to poor sleep and possible injury.
References:
Dauvilliers Y, Schenck CH, Postuma RB, Iranzo A, Luppi PH, Plazzi G, et al. (2018). REM sleep behaviour disorder. Nature reviews. Disease primers, 30166532.
https://pubmed.ncbi.nlm.nih.gov/30166532/
Sobreira-Neto MA, Stelzer FG, Gitaí LLG, Alves RC, Eckeli AL, & Schenck CH. (2023). REM sleep behavior disorder: update on diagnosis and .... Arquivos de neuro-psiquiatria, 38157884.
https://pubmed.ncbi.nlm.nih.gov/38157884/
Rodriguez CL, Jaimchariyatam N, & Budur K. (2017). Rapid Eye Movement Sleep Behavior Disorder: A Review .... Chest, 28322726.
Q.
What is sleep disordered breathing and how is it treated?
A.
Sleep disordered breathing is when a person has trouble breathing while sleeping, like snoring or stopping breathing for a bit. It can be treated with lifestyle changes, devices to help with breathing, or sometimes surgery.
References:
Foldvary-Schaefer NR, & Waters TE. (2017). Sleep-Disordered Breathing. Continuum (Minneapolis, Minn.), 28777178.
https://pubmed.ncbi.nlm.nih.gov/28777178/
Panossian L, & Daley J. (2013). Sleep-disordered breathing. Continuum (Minneapolis, Minn.), 23385696.
https://pubmed.ncbi.nlm.nih.gov/23385696/
Mohammadieh A, Sutherland K, & Cistulli PA. (2017). Sleep disordered breathing: management update. Internal medicine journal, 29105265.
Q.
What is sleep terror disorder and how is it managed?
A.
Sleep terror disorder involves episodes of intense fear during sleep, mostly affecting children. It is managed by ensuring a safe environment and sometimes using medications if needed.
References:
DiMario FJ Jr, & Emery ES 3rd. (1987). The natural history of night terrors. Clinical pediatrics, 3652596.
https://pubmed.ncbi.nlm.nih.gov/3652596/
Irfan M. (2024). Sleep Terrors. Sleep medicine clinics, 38368070.
https://pubmed.ncbi.nlm.nih.gov/38368070/
Gigliotti F, Esposito D, Basile C, Cesario S, & Bruni O. (2022). Sleep terrors-A parental nightmare. Pediatric pulmonology, 33647192.
Q.
What is the definition of insomnia and how is it diagnosed?
A.
Insomnia is when someone has trouble falling or staying asleep. It is diagnosed by looking at sleep patterns and how it affects daily life.
References:
Sutton EL. (2021). Insomnia. Annals of internal medicine, 33683929.
https://pubmed.ncbi.nlm.nih.gov/33683929/
Ohayon MM. (2002). Epidemiology of insomnia: what we know and what we still .... Sleep medicine reviews, 12531146.
https://pubmed.ncbi.nlm.nih.gov/12531146/
Kayukawa Y, Kitajima T, Tomita S, & Okada T. (2009). [Primary insomnia]. Nihon rinsho. Japanese journal of clinical medicine, 19768930.
Q.
What lifestyle changes can help an insomniac improve their sleep?
A.
Lifestyle changes like having a regular sleep schedule and reducing stress can help insomniacs sleep better.
References:
Fleming JA. (1993). The difficult to treat insomniac patient. Journal of psychosomatic research, 8445586.
https://pubmed.ncbi.nlm.nih.gov/8445586/
Bonnet MH, & Arand DL. (1995). 24-Hour metabolic rate in insomniacs and matched normal .... Sleep, 8552929.
https://pubmed.ncbi.nlm.nih.gov/8552929/
Navelet Y. (1989). [The child insomniac]. La Revue du praticien, 2919265.
Q.
What questions are typically included in a sleep apnea quiz to assess risk?
A.
A sleep apnea quiz often includes questions about snoring, daytime sleepiness, and observed breathing interruptions during sleep to assess risk.
References:
Kapoor M, & Greenough G. (2015). Home Sleep Tests for Obstructive Sleep Apnea (OSA). Journal of the American Board of Family Medicine : JABFM, 26152443.
https://pubmed.ncbi.nlm.nih.gov/26152443/
Rosen IM, Kirsch DB, Chervin RD, Carden KA, Ramar K, Aurora RN, et al. (2017). An American Academy of Sleep Medicine Position Statement. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 28942762.
https://pubmed.ncbi.nlm.nih.gov/28942762/
Rosen IM, Kirsch DB, Carden KA, Malhotra RK, Ramar K, Aurora RN, et al. (2018). Clinical Use of a Home Sleep Apnea Test. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 30518456.
Q.
What quick solutions can help stop snoring immediately?
A.
To quickly stop snoring, try sleeping on your side and improving nasal breathing. Weight loss can also help over time.
References:
Braver HM, Block AJ, & Perri MG. (1995). Treatment for snoring. Combined weight loss, sleeping on .... Chest, 7750319.
https://pubmed.ncbi.nlm.nih.gov/7750319/
Fairbanks DN. (1989). Nonsurgical treatment of snoring and obstructive sleep .... Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 2501744.
https://pubmed.ncbi.nlm.nih.gov/2501744/
Löth S, & Petruson B. (1996). Improved nasal breathing reduces snoring and morning .... Archives of otolaryngology--head & neck surgery, 8956746.
Q.
What services are provided by a sleep disorders institute?
A.
A sleep disorders institute helps people with sleep problems by providing diagnosis, treatment, and education about sleep issues.
References:
Chokroverty S. (2010). Overview of sleep & sleep disorders. The Indian journal of medical research, 20308738.
https://pubmed.ncbi.nlm.nih.gov/20308738/
Reynolds AC, Loffler KA, Grivell N, Brown BW, & Adams RJ. (2024). Diagnosis and management of sleep disorders in shift .... Sleep medicine, 38016359.
https://pubmed.ncbi.nlm.nih.gov/38016359/
Conway SG, Tufik S, Frussa Filho R, & Bittencourt LR. (2006). Repercussions of a sleep medicine outreach program. Brazilian journal of medical and biological research = Revista brasileira de pesquisas medicas e biologicas, 16906280.
Q.
What services does a sleep disorder center provide for diagnosis and treatment?
A.
Sleep disorder centers help diagnose and treat sleep problems by using tests and providing treatments like counseling and medication.
References:
Hauri PJ, Hayes B, Sateia M, Hellekson C, Percy L, & Olmstead E. (1982). Effectiveness of a sleep disorders center: a 9-month follow-up. The American journal of psychiatry, 7072857.
https://pubmed.ncbi.nlm.nih.gov/7072857/
Mahowald MW, Schenck CH, Rosen GM, & Hurwitz TD. (1992). The role of a sleep disorder center in evaluating .... Archives of neurology, 1596195.
https://pubmed.ncbi.nlm.nih.gov/1596195/
Mendelson WB. (1997). Experiences of a sleep disorders center: 1700 patients later. Cleveland Clinic journal of medicine, 9014384.
Q.
What tests are used to diagnose excessive daytime sleepiness?
A.
To diagnose excessive daytime sleepiness, doctors use tests like the Multiple Sleep Latency Test (MSLT) and sometimes check for microsleep episodes.
References:
Taillard J, Micoulaud-Franchi JA, Martin VP, Peter-Derex L, & Vecchierini MF. (2024). Objective evaluation of excessive daytime sleepiness. Neurophysiologie clinique = Clinical neurophysiology, 38401239.
https://pubmed.ncbi.nlm.nih.gov/38401239/
Tirunahari VL, Zaidi SA, Sharma R, Skurnick J, & Ashtyani H. (2003). Microsleep and sleepiness: a comparison of multiple sleep .... Sleep medicine, 14592362.
https://pubmed.ncbi.nlm.nih.gov/14592362/
Johns MW. (2000). Sensitivity and specificity of the multiple sleep latency test .... Journal of sleep research, 10733683.
Q.
When should I consult a sleep disorder doctor and what can I expect from the visit?
A.
Consult a sleep disorder doctor if you have trouble sleeping that affects your daily life. During the visit, the doctor will ask about your sleep habits and may do tests to find the cause.
References:
Bartlett DJ, Marshall NS, Williams A, & Grunstein RR. (2008). Predictors of primary medical care consultation for sleep .... Sleep medicine, 17980655.
https://pubmed.ncbi.nlm.nih.gov/17980655/
Bailes S, Baltzan M, Rizzo D, Fichten CS, Grad R, Wolkove N, et al. (2009). Sleep disorder symptoms are common and unspoken in .... Family practice, 19491151.
https://pubmed.ncbi.nlm.nih.gov/19491151/
Senthilvel E, Auckley D, & Dasarathy J. (2011). Evaluation of sleep disorders in the primary care setting. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 21344054.
Q.
When should I see a doctor for restless leg syndrome symptoms?
A.
See a doctor if your restless leg syndrome symptoms are severe, impact your daily life, or don't improve with self-care.
References:
Silber MH, Becker PM, Earley C, Garcia-Borreguero D, Ondo WG, & Medical Advisory Board of the Willis-Ekbom Disease Foundation. (2013). Willis-Ekbom Disease Foundation revised consensus .... Mayo Clinic proceedings, 24001490.
https://pubmed.ncbi.nlm.nih.gov/24001490/
Happe S, Vennemann M, Evers S, & Berger K. (2008). Treatment wish of individuals with known and unknown .... Journal of neurology, 18575924.
https://pubmed.ncbi.nlm.nih.gov/18575924/
Guinand S, Pedrazzini B, Heinzer R, Cornuz J, & Favrat B. (2013). [Doctor, I have pain and pins and needles in my legs at night]. Revue medicale suisse, 24383246.
Q.
Who is most likely to suffer from insomnia and what are the risk factors?
A.
Insomnia is more common in older adults, women, and those with stress or mental health issues. Risk factors include age, gender, stress, and health problems.
References:
Morin CM, & Jarrin DC. (2022). Epidemiology of Insomnia: Prevalence, Course, Risk .... Sleep medicine clinics, 35659072.
https://pubmed.ncbi.nlm.nih.gov/35659072/
Doghramji K. (2006). The epidemiology and diagnosis of insomnia. The American journal of managed care, 16686591.
https://pubmed.ncbi.nlm.nih.gov/16686591/
Bhaskar S, Hemavathy D, & Prasad S. (2016). Prevalence of chronic insomnia in adult patients and its .... Journal of family medicine and primary care, 28348990.
Q.
Why am I always tired even after getting a full night's sleep?
A.
Feeling tired even after a full night's sleep can be due to various reasons like persistent fatigue, depression, or neurological issues.
References:
Broddadóttir E, Flóvenz SÓ, Gylfason HF, Þormar Þ, Einarsson H, Salkovskis P, & Sigurðsson JF. (2021). "I'm So Tired": Fatigue as a Persistent Physical Symptom .... International journal of environmental research and public health, 34444405.
https://pubmed.ncbi.nlm.nih.gov/34444405/
Baldwin DS, & Papakostas GI. (2006). Symptoms of fatigue and sleepiness in major depressive .... The Journal of clinical psychiatry, 16848671.
https://pubmed.ncbi.nlm.nih.gov/16848671/
Maestri M, Romigi A, Schirru A, Fabbrini M, Gori S, Bonuccelli U, & Bonanni E. (2020). Excessive daytime sleepiness and fatigue in neurological .... Sleep & breathing = Schlaf & Atmung, 31444679.
Q.
Why do I experience weird dreams every night and how can I address this?
A.
Weird dreams can be caused by certain medications or health issues. To address this, consider talking to a healthcare provider to explore possible causes and solutions.
References:
Yanto TA, Huang I, Kosasih FN, & Lugito NPH. (2018). Nightmare and Abnormal Dreams: Rare Side Effects .... Case reports in endocrinology, 29581904.
https://pubmed.ncbi.nlm.nih.gov/29581904/
Abdul-Razzak KK, & Alkhatatbeh MJ. (2021). Nightmares and bad dreams among individuals with .... Research in psychotherapy (Milano), 34568104.
https://pubmed.ncbi.nlm.nih.gov/34568104/
Thompson DF, & Pierce DR. (1999). Drug-induced nightmares. The Annals of pharmacotherapy, 9972389.
Q.
Why do I feel always tired after eating a meal?
A.
Feeling tired after eating might be due to the types of food you eat, like sugary or fatty foods, or it could be related to digestive issues
References:
Wells AS, Read NW, Uvnas-Moberg K, & Alster P. (1997). Influences of fat and carbohydrate on postprandial .... Physiology & behavior, 9145937.
https://pubmed.ncbi.nlm.nih.gov/9145937/
Cherian D, Paladugu S, Pathikonda M, & Parkman HP. (2012). Fatigue: a prevalent symptom in gastroparesis. Digestive diseases and sciences, 22669206.
https://pubmed.ncbi.nlm.nih.gov/22669206/
Thayer RE. (1987). Energy, tiredness, and tension effects of a sugar snack .... Journal of personality and social psychology, 3820066.
Q.
Why is it difficult to sleep when sick and how can I improve my sleep quality?
A.
When you're sick, your body temperature changes, which can make it hard to sleep. To sleep better, try to keep your room cool and comfortable.
References:
Lack LC, Gradisar M, Van Someren EJ, Wright HR, & Lushington K. (2008). The relationship between insomnia and body temperatures. Sleep medicine reviews, 18603220.
https://pubmed.ncbi.nlm.nih.gov/18603220/
Gallup AC, & Gallup JA. (2013). Frequent yawning as an initial signal of fever relief. Medical hypotheses, 24119765.
https://pubmed.ncbi.nlm.nih.gov/24119765/
Simpson RJ, Campbell JP, Gleeson M, Krüger K, Nieman DC, Pyne DB, et al. (2020). Can exercise affect immune function to increase .... Exercise immunology review, 32139352.
Q.
Why might I be unable to sleep after a total knee replacement and what can I do about it?
A.
After a total knee replacement, you might have trouble sleeping because of pain, discomfort, or changes in your daily routine. To help, try using relaxation techniques or talk to your doctor about possible treatments.
References:
Purcell KF, Scarcella N, Chun D, Holland C, Stauffer TP, Bolognesi M, & Lachiewicz P. (2023). Treating Sleep Disorders After Total Hip and Total Knee .... The Orthopedic clinics of North America, 37718079.
https://pubmed.ncbi.nlm.nih.gov/37718079/
Whale K, & Gooberman-Hill R. (2022). Development of a novel intervention to improve sleep and .... Trials, 35918742.
https://pubmed.ncbi.nlm.nih.gov/35918742/
Pilc E, Bankuru SV, Brauer SF, Cyrus JW, & Patel NK. (2025). Which Interventions Are Effective in Treating Sleep .... Clinical orthopaedics and related research, 39255465.
Q.
Why might I be unable to sleep after drinking alcohol and how can I improve my sleep?
A.
Drinking alcohol can make it hard to sleep because it can cause sleep problems and make your legs move a lot at night. To sleep better, try not to drink before bedtime.
References:
Huang R, Ho SY, Lo WS, Lai HK, & Lam TH. (2013). Alcohol consumption and sleep problems in Hong Kong .... Sleep medicine, 23777753.
https://pubmed.ncbi.nlm.nih.gov/23777753/
Aldrich MS, & Shipley JE. (1993). Alcohol use and periodic limb movements of sleep. Alcoholism, clinical and experimental research, 8452202.
https://pubmed.ncbi.nlm.nih.gov/8452202/
Zhang Y, Wang J, Lu X, Che B, & Yu J. (2021). A Large Cross-Sectional Study in Shaanxi Province, China. International journal of environmental research and public health, 33573245.
Q.
Why might someone feel tired with no energy all the time and what can be done?
A.
Feeling tired all the time can be due to depression, thyroid disorders, neurological issues, or vitamin deficiencies. Addressing the underlying cause can help improve energy levels.
References:
Baldwin DS, & Papakostas GI. (2006). Symptoms of fatigue and sleepiness in major depressive .... The Journal of clinical psychiatry, 16848671.
https://pubmed.ncbi.nlm.nih.gov/16848671/
Maestri M, Romigi A, Schirru A, Fabbrini M, Gori S, Bonuccelli U, & Bonanni E. (2020). Excessive daytime sleepiness and fatigue in neurological .... Sleep & breathing = Schlaf & Atmung, 31444679.
https://pubmed.ncbi.nlm.nih.gov/31444679/
Khawaja I, Yingling K, Bukamur H, & Abusnina W. (2019). Vitamin B12 Deficiency: A Rare Cause of Excessive .... Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 31538608.
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https://www.amjmed.com/article/S0002-9343(18)30944-6/fulltext