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What are the Main Sleep Problems?

The 19th century English Poet, Charlotte Bronte once wrote, “A ruffled mind makes a restless pillow.” Put another way, peaceful, healthy sleep is dependent on a relaxed mind, but that’s not all. Sleep problems are a huge medical problem affecting over 30% of people. Sleeping occupies one-third of our lifetimes and impacts every facet of waking life. 

Sleep problems that last more than a couple of months can enter the realm of becoming sleep disorders. Sleep disorders affect or disrupt your sleep at some point in the night, whether it's falling asleep at the beginning of the night or staying asleep throughout the night. 

Aside from snoring, which alone is not a medical problem, Insomnia, sleep apnea, restless leg syndrome, and sleepwalking are some of the most common sleep disorders. 

Sleep disorders affect about 70 million Americans and the effect of their sleep disturbances have a profound and unmeasured effect on individuals’ quality of life, public health trends and even economic productive.

What is insomnia?

Insomnia is defined as less than the optimal duration of sleep, inability to fall asleep quickly, or frequent awakenings. Chronic insomnia is a sleep disorder that can cause other more serious health conditions. 

Women are more likely to experience insomnia for a variety of hormone-related reasons while men are more likely to experience sleep apnea, which is a sleeping condition when breathing stops for short periods and is often associated with snoring.

Types of Insomnia

Insomnia comes in multiple forms that affect different parts of your sleep schedule resulting in less sleeplessness. Here are a few of the different types.

Initial insomnia 

This sleep issue is defined as the inability to fall asleep at the beginning of the sleep cycle. It can be remedied by going to sleep when you are truly tired, winding down for 1-2 hours prior to bedtime. Reading and meditation can help in these cases.

Middle-of-the-night (MOTN) insomnia 

Sufferers of MOTN insomnia have difficulty staying asleep throughout the entire night often due to sleep disturbances. This version of insomnia is characterized by waking up in the middle of the night and having trouble falling back to sleep.

This form of insomnia is less likely to respond to behavioral changes unless the reason is a sleep disturbance requiring use of the bathroom in the middle of the night. In this case, limiting one’s fluids in the evening can be helpful in minimizing sleep disturbances. 

Terminal insomnia 

This form of insomnia isn’t what it sounds like. Terminal insomnia just means early morning awakening before the intended time or before adequate rest has occurred. 

Lifestyle changes will not generally help this problem because underlying medical problems may be the culprit. Learn more about Terminal insomnia here.

Medical Conditions and Sleep Disorders

Medical conditions can have a direct impact on both the quality and quantity of sleep and can be the result or the cause for sleep disturbances and daytime sleepiness. 

Heart problems 

Heart problems can impair sleep. When the heart does not pump well, there can be fluid backing up in the lungs, which causes breathing difficulties and the need to sit upright or use oxygen. Chest pain and leg swelling are other reasons for insomnia caused by heart problems. 

Neurologic conditions 

Neurologic conditions such as stroke, dementia, restless legs syndrome (RLS), narcolepsy, and sleep apnea impact restful sleep. The sleep center is in the brain so any disease that affects the brain can impact sleep either directly or indirectly through the symptoms themselves causing sleep deprivation. 

Abnormal periodic limb movement, inability to change sleep position, medications, vivid dreams may be sources of sleep problems in Parkinson’s disease.

Hormonal imbalances 

Hormonal imbalances such as an overactive thyroid, not only cause hot flashes from low estrogen in the case of menopause, pregnancy can aggravate sleep for women. For men, low testosterone can also hamper sleep.

Diabetes and low glucose 

Diabetes and low glucose can cause sleep disturbances including sudden awakenings. Any time one awakens in the night, returning to sleep can be a problem.

Lung problems 

Lung problems such as emphysema and asthma can make sleep difficult if lower oxygen levels cause anxiety and strained breathing requiring either oxygen or elevation of the bed.

Sleep apnea

Sleep apnea can be obstructive from enlarged tonsils, a small jawbone, the collapse of the throat, and obesity. Sleep apnea can cause excessive daytime sleepiness and a host of health problems if left unchecked.

Chronic or acute pain syndromes

Chronic or acute pain syndromes such as arthritis, fibromyalgia, endometriosis can be the underlying cause of insomnia. 

Medications and substances

Medications and substances such as opioids, alcohol, stimulants like caffeine or cold medications (decongestants), steroids, asthma medications. Sleep aids can cause rebound insomnia.

Gastrointestinal problems

Digestive tract issues such as heartburn and reflux, leaky gut syndrome, irritable bowel syndrome, diarrhea, low glucose, or even just going to bed hungry can keep you up or awaken you at night.

Psychiatric conditions

Mental health and quality sleep are very closely linked. Approximately 40% of sufferers of psychiatric conditions including depression also report struggling from insomnia. PTSD, anxiety, and panic disorders are other causes of insomnia.

Lifestyle and environmental causes of poor sleep

  • Night shift work 
  • Jet lag
  • Bereavement
  • Warm room
  • Noise
  • Lights
  • TV
  • Frequent interventions from nurses in a hospital environment

Poor sleep hygiene contributes to sleep problems

  • Napping in the day
  • Sleeping later on weekends
  • Eating or drinking before bedtime
  • Exercise too close to bedtime
  • Playing stimulating video games
  • Sleeping with the TV on
  • Caffeine late in the day
  • Spending prolonged time in bed
  • Not winding down 1-2 hours before bed  

How does poor sleep affect you?

Sleep problems can affect nearly all facets of waking life and can have a direct impact on our job performance, interpersonal relationships, memory, and mood. It’s often associated with all forms of accidents from cars to heavy machinery. Remember, quantity of sleep is important, but sleep quality is even more important because it’s about your body passing through all the necessary stages and cycles of sleep each night. 


  1. American Academy of Sleep Medicine. ICSD2 - International Classification of Sleep Disorders. Diagnostic and Coding Manual. 2nd. Westchester, Ill: American Academy of Sleep Medicine; 2005. 1-32.
  2. [Guideline] Schutte-Rodin S, Broch L, Buysse D, Dorsey C, Sateia M. Clinical guideline for the evaluation and management of chronic insomnia in adults. J Clin Sleep Med. 2008 Oct 15. 4(5):487-504. [Medline][Full Text].
  3. Buysse DJ. Diagnosis and Classification of Insomnia Disorders. In: Insomnia: Principles and Management. Szuba MP, Kloss JD, Dinges DF, Eds. Cambridge University Press, Cambridge UK, 2003, et al.
  4. Chokroverty S. Sleep Disorders Medicine: Basic Science, Technical Considerations, and Clinical Aspects, 3rd edition, p361. WB Saunders, Philadelphia, et al.
  5. The Gallup organization. The Gallup study of sleeping habits. Princeton, NJ,: The Gallup Organization; 1979.
  6. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fifth. Arlington, VA: American Psychiatric Association; 2013.

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