Dr. Patricia Yarberry Allen is a collaborative physician who writes a weekly “Medical Monday” column for Women’s Voices for Change.  (Search our archives for her posts, calling on the expertise of medical specialists, on topics from angiography to vulvar melanoma.)

This week, Dr. Pat has asked Megan Riddle, M.D./Ph.D.—a psychiatry resident at the University of Washington and a graduate of the Weill Cornell/Rockefeller/Sloan-Kettering Tri-Institutional M.D.-Ph.D. Program—to counsel a 44-year-old woman troubled by sleeplessness.

Dear Dr. Pat:

I am 44 and am generally in good health, even though I am 50 pounds over what I should weigh.  I still have regular periods and don’t have any menopausal symptoms, except a big sleep problem. I can’t sleep. Well, that’s not completely true. I do sleep every night, but some nights it takes me a while to fall asleep, and often I wake up multiple times throughout the night. My husband tells me that even after I finally fall asleep, I gasp and snore, sometimes waking myself up. Once I’m awake, I lie there trying desperately to fall back to sleep, but mostly just tossing and turning. Each morning, it’s a battle to get out of bed. I have to drink a significant amount of coffee to get through the day, although I do switch over to decaf by the late afternoon in a hope that I’ll be able to fall asleep. I drink a glass or two of red wine at night to help relax, but by the time I get to bed, it’s as if I get a second wind and can’t fall asleep. By the end of the week, I’m exhausted. On the weekend, it is glorious—I sleep late and nap, catching up. But then Sunday night rolls around and I’m lying in bed staring at the clock as the hours tick by.  I’ve read your past columns and know that trouble with sleep can be a sign of depression, but my mood is actually pretty good, despite the sleep deprivation.  I’d rather avoid sleep medications. What would you recommend?

Sincerely,
Shawna

Dr. Riddle Responds:

Dear Shawna:

You are not alone. Trouble with sleep is extremely common. Over half of Americans suffer from sleep problems in any given year.  Issues include trouble falling asleep, waking too often, not sleeping long enough, and having a poor quality of sleep.  Fortunately, there are a number of steps you can take to help improve your sleep.  

First, it’s important to ensure that you do not have a medical condition that is contributing to your sleep difficulties.  These conditions include disorders that we commonly think of as being related to sleep, such as obstructive sleep apnea and restless leg syndrome, but other medical conditions can affect sleep as well, such as thyroid, heart, and kidney problems.  A number of the symptoms you mention—snoring and gasping in particular—make me concerned that you could be dealing with obstructive sleep apnea (OSA).  OSA is a condition in which you intermittently stop and restart breathing as you sleep. Those who are overweight or who have thick necks are also at greater risk. Further discussion with your doctor and possibly a sleep study will be helpful in establishing a diagnosis. A breathing device worn at night called a CPAP uses positive pressure to keep the upper airway open and can significantly improve the quality of sleep for those struggling with OSA.