insomnia or REM apnea?

Hi Carrie—

Thanks for writing in with a great question.

I agree with your doctor that your lack of good sleep most likely is responsible for your daytime tiredness. The question that needs to be answered though, is why aren’t you sleeping well? Is it insomnia, like your doctor thinks? Or is there another reason?

If your arousals are due to anxiety, then the sleeping pills likely will help. Sleeping pills are designed to assist us through periods of stress and emotional turmoil—a divorce, the death of a loved one, even the pressures of school and career. You are correct to be wary about using the pills, however. Sleeping pills are not—and never have been—designed for long-term use. They are prescribed only to treat temporary, “transient insomnia”—and their use should be eliminated as quickly as possible.

In the second scenario—where you may have “sleep apnea”—I am curious if anyone ever tells you that you snore during sleep. Frequent arousals from dreaming, or REM sleep, often are caused by difficulty breathing. The reason for this is because during REM, the body’s muscle tone is profoundly relaxed. As a consequence, breathing can be difficult during REM, (which can cause us to snore). If we get low on oxygen, the brain will wake us up repeatedly to open our airways and get air into our lungs. If the arousals are frequent, we will remember a lot of our dreams—but we also will be tired during the day.

If it turns out that you do snore during the night—or if anyone has ever noticed “pauses” in your breathing—I recommend that you convey this information to your doctor, and ask her about the possibility that you may have “REM-related sleep apnea”—rather than insomnia. If you do snore, and if you are tired, you will need to have a sleep test performed at a sleep laboratory to determine the amount of disruption the apnea is causing. (As a final note, it deserves mentioning that if you do have sleep apnea, then sleeping pills will only cause it to be worse. Sleeping pills will relax your muscles even more than usual, and they will make it harder for you to wake up when your body becomes short on breath.)

If you want a second opinion, visit a doctor who is a specialist in sleep disorders medicine. They will take an in-depth history of your sleep complaint, and most likely will solve your problem in very little time. To locate a sleep specialist in your area, visit the web site for the American Academy of Sleep Medicine. You’ll also be able to receive some free information through the mail.

Good luck!

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