Insomnia sufferers have a hard time falling or staying asleep and often feel drowsy. Insomnia often spikes during stress but can become chronic if symptoms last for three months or longer.

Poor sleep habits, environmental changes, medications and co-occurring medical conditions such as asthma or sleep apnea can all aggravate the problem.

The leading treatment is cognitive behavioral therapy for insomnia, which coaches a patient on sleep cycles and personal sleep barriers. Providers may also prescribe supplementary medications.

Snoring is frustrating—but it can also be dangerous. More than 20 million Americans have sleep apnea. The frequent choking and breathing interruptions—at least 5 times an hour—affect sleep quality and oxygen levels.

Without treatment, it's tied to high blood pressure, heart disease and stroke. The gold standard of care, continuous positive airway pressure therapy, or CPAP, facilitates airflow.

Other options move the lower jaw and tongue forward with a mandibular advancement device and nerve stimulator to prevent airway collapse. Patients might also benefit from surgery on excess nose and throat tissue that interferes with breathing.

Read: Treating Obstructive Sleep Apnea. Both run on an internal clock circadian rhythm different from the outside day-night cycle. While many people make this quirk work, it becomes problematic when it affects functioning during the time you want to be awake, Dr.

Rojanapairat explains. Traveling across two or more time zones jet lag or working overnight shift work disorder can also throw off rhythms.

A body clock that's out of balance with your schedule may trigger insomnia or repeated waking at times that don't allow a full seven to eight hours of sleep, leading to sleepiness and focus and mood problems.

Treatment is aimed at creating brain cues for rest and wakefulness: a tiny. Use lights and healthy sleep hygiene—a consistent routine and avoiding electronics before bed—to help shift your cycle and reinforce your preferred schedule. Restless leg syndrome in the legs and feet makes sitting still at night feel almost impossible.

Doctors may cut out contributing drugs and supplement iron, if needed. They may also prescribe symptomatic relief through medication, foot wraps and other aids. Read: Teeth Grinding: Causes, Treatments and Consequences. These uncontrollable sleep episodes include sleepwalking , sleep talking, hallucinations, sleep paralysis and night terrors the person doesn't remember afterward.

Some parasomnias such as nightmares can be set off by post-traumatic stress or sleep deprivation. Since they're more common in kids, many people outgrow them, Dr. Rojanapairat says, but providers often try to reduce the risk of injury and resolve any triggers.

Unlike most other sleep disorders, people with hypersomnias often oversleep over 10 hours a night —but still feel groggy no matter how early they go to bed. They might have sleep attacks or hallucinations. Narcolepsy , a nervous system disorder caused by a lack of orexin brain chemicals, has an added symptom: sudden-onset muscle weakness cataplexy that gets worse with strong emotions.

Providers will conduct a nap study and treat hypersomnias with a mixture of sleep hygiene, napping, driving safety and stimulant medications.

Don't suffer needlessly trying to shake off fatigue on your own. Worrying about sleep or trying to self-medicate often backfires. If you're having ongoing concerns, your primary care doctor can refer you to a sleep specialist, or you can self-refer for a full assessment.

Read: Trouble Sleeping? What to Know Before Trying Medication. The amphetamines are Schedule II prescription drugs and are considered to have a high potential for abuse.

Side effects of amphetamines include personality changes, tremor, hypertension, headaches, and gastroesophageal reflux. The use of activating agents is inappropriate in hypersomnolent patients with untreated OSA—although daytime sleepiness may be improved with these agents, the patient remains at risk from the pathophysiologic consequences of untreated OSA.

Legal requirements for reporting excessive daytime sleepiness that may impair driving vary from state to state. A physician should report patients who fail to comply with treatment, particularly high-risk persons such as airline pilots, truck, bus, and occupational drivers, and those with a history of recent sleepiness-associated incidents.

Johnson EO. Sleep in America: Washington, DC: The National Sleep Foundation; Accessed October 28, Friedman NS. Determinants and measurements of daytime sleepiness. In: Pagel JF, Pandi-Perumal SR, eds. Primary Care Sleep Medicine: A Practical Guide. Totowa, N. Buysse DJ. Drugs affecting sleep, sleepiness, and performance.

In: Monk TH, ed. Sleep, Sleepiness, and Performance. Chichester: Wiley; — National Sleep Foundation. State of the states report on drowsy driving. November Accessed October 17, Factors that affect fatigue in heavy truck accidents safety study. Washington, DC: National Transportation Safety Board; Masa JF, Rubio M, Findley LJ.

Habitually sleepy drivers have a high frequency of automobile crashes associated with respiratory disorders during sleep. Am J Respir Crit Care Med. Pagel JF, Forister N, Kwiatkowki C. Adolescent sleep disturbance and school performance: the confounding variable of socioeconomics.

J Clin Sleep Med. Sforza E, de Saint Hilaire Z, Pelissolo A, Rochat T, Ibanez V. Personality, anxiety and mood traits in patients with sleep-related breathing disorders: effect of reduced daytime alertness.

Sleep Med. Grunstein RR, Banerjee D. Chen I, Vorona R, Chiu R, Ware JC. A survey of subjective sleepiness and consequences in attending physicians.

Behav Sleep Med. American Academy of Sleep Medicine. Westchester, Ill. Van Dongen H, Maislin G, Mullington JM, Dinges DF. The cumulative cost of additional wakefulness: dose-response effects on neurobehavioral functions and sleep physiology from chronic sleep restriction and total sleep deprivation [published correction appears in Sleep.

Pagel JF. Sleep disorders in primary care: evidence-based clinical practice. Medications that induce sleepiness. In: Lee-Chiong TL, ed. Sleep: A Comprehensive Handbook. Hoboken, N.

Sateia MJ, Doghramji K, Hauri PJ, Morin CM. Evaluation of chronic insomnia. An Amerrican Academy of Sleep Medicine review. Verster JC, Volkerts ER. Antihistamines and driving ability: evidence from on-the-road driving studies during normal traffic [published corrections appear in Ann Allergy Asthma Immunol.

Ann Allergy Asthma Immunol. Young T, Evans L, Finn L, Palta M. Estimation of the clinically diagnosed proportion of sleep apnea syndrome in middle-aged men and women.

Young T, Peppard PE, Gottlieb DJ. Epidemiology of obstructive sleep apnea: a population health perspective. World Health Organization. Obesity and overweight. Fact sheet September Accessed October 27, Sassani A, Findley LJ, Kryger M, Goldlust E, George C, Davidson TM.

Reducing motor-vehicle collisions, costs, and fatalities by treating obstructive sleep apnea syndrome. Findley LJ, Levinson MP, Bonnie RJ. Driving performance and automobile accidents in patients with sleep apnea.

Clin Chest Med. Lindberg E, Carter N, Gislason T, Janson C. Role of snoring and daytime sleepiness in occupational accidents. Thorpy MJ. Cataplexy associated with narcolepsy: epidemiology, pathophysiology and management. CNS Drugs. Johns MW. A new method for measuring daytime sleepiness: the Epworth Sleepiness Scale.

Kushida CA, Littner MR, Morgenthaler T, et al. Practice parameters for the indications for polysomnography and related procedures: an update for Centers for Medicare and Medicaid Services. Medicare Coverage Database. Polysomnography and sleep studies. Accessed December 9, Roehrs T, Carskadon MA, Dement WC, Roth T.

Daytime sleepiness and alertness. In: Kryger MH, Roth T, Dement WC, eds. Principles and Practice of Sleep Medicine. Philadelphia, Pa. George CF. Vigilance impairment: assessment by driving simulators. Kreiger J. Clinical approach to excessive daytime sleepiness. Findley L, Smith C, Hooper J, Dineen M, Suratt PM.

Treatment with nasal CPAP decreases automobile accidents in patients with sleep apnea. Veasey SC, Guilleminault C, Strohl KP, Sanders MH, Ballard RD, Magalang UJ.

Medical therapy for obstructive sleep apnea: a review by the Medical Therapy for Obstructive Sleep Apnea Task Force of the Standards of Practice Committee of the American Academy of Sleep Medicine.

Kushida CA, Morgenthaler TI, Littner MR, et al. Practice parameters for the treatment of snoring and obstructive sleep apnea with oral appliances: an update for

Information about sleep patterns from the patient and his or her bed partner, if applicable, may indicate restless legs syndrome or OSA, the latter of which may occur even in persons who are not obese or who do not have the common comorbidities of hypertension, diabetes, and coronary disease.

In most cases, overnight polysomnography is required to confirm the diagnosis of OSA and to determine the appropriate pressure levels for treatment using continuous positive airway pressure CPAP or a similar system.

Subjective assessment of symptoms using questionnaires and clinical assessment of behavioral impact may not accurately reflect the degree of physiologic sleepiness.

The most common tests for assessing psychological variations in daytime sleepiness are the Multiple Sleep Latency Test MSLT and the Maintenance of Wakefulness Test MWT.

Both of these tests use modified polysomnography to assess sleep onset latency i. Overnight polysomnography is required before the MSLT or MWT to assess the disordered sleep pattern and test for significant OSA. To diagnose narcolepsy without cataplexy, the MSLT must demonstrate hypersomnolence and early onset of rapid eye movement sleep.

The MWT can be used to assess improvements in waking performance after treatment in persons with excessive daytime sleepiness who could potentially be dangerous to self and others, such as commercial drivers and airplane pilots. Addressing the underlying cause is the mainstay of treatment of excessive daytime sleepiness.

In OSA—the most dangerous and physiologically disruptive cause of excessive daytime sleepiness—treatment with positive pressure devices e.

Modafinil Provigil is considered to be the first-line activating agent for the treatment of excessive daytime sleepiness. It is indicated for the treatment of persistent sleepiness associated with OSA in patients already being treated with CPAP, and for the treatment of daytime sleepiness in patients with shift work disorder.

Other medications that must be used with caution to induce alertness in somnolent patients include the amphetamines dextroamphetamine [Dexedrine], methylphenidate [Ritalin] and pemoline Cylert, not available in the United States.

The amphetamines are Schedule II prescription drugs and are considered to have a high potential for abuse. Side effects of amphetamines include personality changes, tremor, hypertension, headaches, and gastroesophageal reflux.

The use of activating agents is inappropriate in hypersomnolent patients with untreated OSA—although daytime sleepiness may be improved with these agents, the patient remains at risk from the pathophysiologic consequences of untreated OSA.

Legal requirements for reporting excessive daytime sleepiness that may impair driving vary from state to state. A physician should report patients who fail to comply with treatment, particularly high-risk persons such as airline pilots, truck, bus, and occupational drivers, and those with a history of recent sleepiness-associated incidents.

Johnson EO. Sleep in America: Washington, DC: The National Sleep Foundation; Accessed October 28, Friedman NS. Determinants and measurements of daytime sleepiness. In: Pagel JF, Pandi-Perumal SR, eds. Primary Care Sleep Medicine: A Practical Guide.

Totowa, N. Buysse DJ. Drugs affecting sleep, sleepiness, and performance. In: Monk TH, ed. Sleep, Sleepiness, and Performance.

Chichester: Wiley; — National Sleep Foundation. State of the states report on drowsy driving. November Accessed October 17, Factors that affect fatigue in heavy truck accidents safety study. Washington, DC: National Transportation Safety Board; Masa JF, Rubio M, Findley LJ. Habitually sleepy drivers have a high frequency of automobile crashes associated with respiratory disorders during sleep.

Am J Respir Crit Care Med. Pagel JF, Forister N, Kwiatkowki C. Adolescent sleep disturbance and school performance: the confounding variable of socioeconomics.

J Clin Sleep Med. Sforza E, de Saint Hilaire Z, Pelissolo A, Rochat T, Ibanez V. Personality, anxiety and mood traits in patients with sleep-related breathing disorders: effect of reduced daytime alertness. Sleep Med. Grunstein RR, Banerjee D. Chen I, Vorona R, Chiu R, Ware JC.

A survey of subjective sleepiness and consequences in attending physicians. Behav Sleep Med. American Academy of Sleep Medicine. Westchester, Ill. Van Dongen H, Maislin G, Mullington JM, Dinges DF.

The cumulative cost of additional wakefulness: dose-response effects on neurobehavioral functions and sleep physiology from chronic sleep restriction and total sleep deprivation [published correction appears in Sleep.

Pagel JF. Sleep disorders in primary care: evidence-based clinical practice. Medications that induce sleepiness. In: Lee-Chiong TL, ed. Sleep: A Comprehensive Handbook. Hoboken, N. Sateia MJ, Doghramji K, Hauri PJ, Morin CM. Evaluation of chronic insomnia.

An Amerrican Academy of Sleep Medicine review. Verster JC, Volkerts ER. Antihistamines and driving ability: evidence from on-the-road driving studies during normal traffic [published corrections appear in Ann Allergy Asthma Immunol. Ann Allergy Asthma Immunol.

Young T, Evans L, Finn L, Palta M. Estimation of the clinically diagnosed proportion of sleep apnea syndrome in middle-aged men and women.

Young T, Peppard PE, Gottlieb DJ. Epidemiology of obstructive sleep apnea: a population health perspective. World Health Organization. Obesity and overweight. Fact sheet September Accessed October 27, Sassani A, Findley LJ, Kryger M, Goldlust E, George C, Davidson TM.

Reducing motor-vehicle collisions, costs, and fatalities by treating obstructive sleep apnea syndrome. Findley LJ, Levinson MP, Bonnie RJ. Driving performance and automobile accidents in patients with sleep apnea. Clin Chest Med. Lindberg E, Carter N, Gislason T, Janson C.

Role of snoring and daytime sleepiness in occupational accidents. Thorpy MJ. Cataplexy associated with narcolepsy: epidemiology, pathophysiology and management. CNS Drugs. Johns MW. A new method for measuring daytime sleepiness: the Epworth Sleepiness Scale.

Kushida CA, Littner MR, Morgenthaler T, et al. Practice parameters for the indications for polysomnography and related procedures: an update for Centers for Medicare and Medicaid Services.

Medicare Coverage Database. Polysomnography and sleep studies. Accessed December 9, Roehrs T, Carskadon MA, Dement WC, Roth T. Daytime sleepiness and alertness. OSA might also increase your risk of recurrent heart attack, stroke and irregular heartbeats, such as atrial fibrillation.

If you have heart disease, multiple episodes of low blood oxygen hypoxia or hypoxemia can lead to sudden death from an irregular heartbeat. Complications with medicines and surgery. Obstructive sleep apnea is also a concern with certain medicines and general anesthesia.

People with sleep apnea might be more likely to have complications after major surgery because they're prone to breathing problems, especially when sedated and lying on their backs. The repeated awakening associated with sleep apnea makes typical, restorative sleep impossible.

People with central sleep apnea often have severe fatigue, daytime drowsiness and irritability. You might have difficulty concentrating and find yourself falling asleep at work, while watching television or even while driving. Cardiovascular problems. Sudden drops in blood oxygen levels that occur during central sleep apnea can adversely affect heart health.

If there's underlying heart disease, these repeated multiple episodes of low blood oxygen — known as hypoxia or hypoxemia — worsen prognosis and increase the risk of irregular heart rhythms. Mayo Clinic does not endorse companies or products. Advertising revenue supports our not-for-profit mission.

Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. This content does not have an English version. This content does not have an Arabic version. Overview Sleep apnea is a potentially serious sleep disorder in which breathing repeatedly stops and starts.

The main types of sleep apnea are: Obstructive sleep apnea OSA , which is the more common form that occurs when throat muscles relax and block the flow of air into the lungs Central sleep apnea CSA , which occurs when the brain doesn't send proper signals to the muscles that control breathing Treatment-emergent central sleep apnea , also known as complex sleep apnea, which happens when someone has OSA — diagnosed with a sleep study — that converts to CSA when receiving therapy for OSA.

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Obstructive sleep apnea Enlarge image Close. Obstructive sleep apnea Obstructive sleep apnea occurs when the muscles that support the soft tissues in your throat, such as your tongue and soft palate, temporarily relax. By Mayo Clinic Staff.

Show references Kline LR. Clinical presentation and diagnosis of obstructive sleep apnea in adults. Accessed June 28, Selim BJ, et al. The association of nocturnal cardiac arrhythmias and sleep-disordered breathing: The DREAM study. Journal of Clinical Sleep Medicine. Jameson JL, et al.

Sleep apnea. In: Harrison's Principles of Internal Medicine. McGraw-Hill; National Heart, Lung, and Blood Institute.

Badr MS. Central sleep apnea: Risk factors, clinical presentation, and diagnosis. Kryger MH, et al. Management of obstructive sleep apnea in adults. Aurora RN, et al. Practice parameters for the surgical modification of the upper airway for obstructive sleep apnea in adults.

Amali A, et al. A comparison of uvulopalatopharyngoplasty and modified radiofrequency tissue ablation in mild to moderate obstructive sleep apnea: A randomized clinical trial.

Parthasarathy S. Treatment-emergent central sleep apnea. Accessed June 29, Mehra R. Sleep apnea and the heart. Cleveland Clinic Journal of Medicine.

Central sleep apnea: Treatment. Accessed July 1, Olson EJ expert opinion. Mayo Clinic. June 30, Related Continuous positive airway pressure CPAP CPAP machines: Tips for avoiding 10 common problems CPAP: How it works Which CPAP masks are best for you?

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