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Sleep Disorders

Lack of sleep

06/18/2008

Question:

For the past 11 days I fall asleep between 4:30 and 6:30 am and then I have to get up anywhere from 1 hour to 2 hours later and I am extremely exhausted. What can I do?

Answer:

If I understood your problem correctly, you are having difficulty falling asleep before 4:30-6:30 AM in the last 1-2 weeks, while you were able to do that just 11 days prior. And then you must awaken shortly thereafter and thus are getting little sleep at night. This would be considered a form of acute insomnia resulting in inadequate sleep.

A large percentage of the population reports insomnia of several weeks duration at least once in their lifetime. The causes are numerous and include social and job stressors, changes in one's regular routine due to work, family obligations, travel, grief, depression, medical illness, bed partner issues, and medications, to name a few.

You mention a distinct period of time for the onset of your symptoms. This is indicative of an event or stressor that may have precipitated the problem. It would be important to review and recognize the possible event or stressor, as further evaluation and management of this problem may be needed (such as counseling). In conjunction with management of any underlying problems, medication therapy can be considered for the short-term to help you sleep. A number of effective medications are now available as sleep aids and these are generally well-tolerated. However, they are really recommended for short-term use only.

An alternative approach to medications would be to attempt behavioral changes, which can be effective as well. Some of these include going to bed only when very sleepy, but maintaining a set wakeup time. In addition, you should get out of bed if you haven't fallen asleep in 15-20 minutes and do something that is not stimulating (i.e. reading in a dimly lit environment or listening to soothing music). Exercise about 5 hours before bedtime can be very helpful. Avoiding alcohol and caffeine within 4-6 hours of bedtime is a good idea as well.

If you find you continue to have problems falling asleep, then you should discuss this issue with your primary care physician. Specific factors in your history may be useful in tailoring a strategy that might work for you. Referral to a Sleep Specialist in your area may also be helpful if the problems persist.

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Response by:

Rami N Khayat, MD Rami N Khayat, MD
Clinical Associate Professor of Pulmonary, Allergy, Critical Care & Sleep
College of Medicine
The Ohio State University