Day 13: When broken sleep needs specialist help

How do you know if broken nights actually signal a sleep disorder? Dr Harris guides you through the tell-tale signs, plus explains how to assess your sleep journal for clues to the causes.


Day 13 Article: How do I know if I have a sleep disorder?

“If you’re routinely struggling with sleep, and basic rules just aren’t doing the trick, it’s definitely worth considering whether a sleep disorder is to blame. I’ll focus on three of the most common, but as a rule of thumb: if you think something is off, talk with your doctor. You are the expert on you.”


Chronic Insomnia

Common signs: This is more than the occasional bad night’s sleep. It means regularly having problems falling asleep, staying asleep and waking up too early.


How might you feel: Tired during the day, being late for things, more irritable, feeling anxious as the night draws in, mentally fatigued and depressed. 


How it’s diagnosed: Using the 30/ 3/ 3 rule. Are you awake for 30 minutes or more at the beginning and/or during the night? Does it occur 3 or more nights/ week? Has it gone on for at least 3 months? If you answered yes to all 3 questions, you might have chronic insomnia.


What can be done? It can be treated with medication as well as non-medication treatments such as Cognitive Behaviour Therapy.


Obstructive Sleep Apnea

Common signs: Snoring, choking or gasping and/ or pauses in breathing during sleep.


How might you feel: Excessively sleepy during the day, irritable and needing to urinate frequently at night. You may also experience nighttime heartburn and waking with headaches.


How’s it diagnosed: You don’t need to have all the symptoms, but if you have at least some snoring, pauses in breathing or excessive daytime sleepiness it needs to be investigated.


What can be done? Sleep studies are commonly used to diagnose sleep apnea and there are lots of effective treatments such as a PAP (positive airway pressure) machine.


Restless Leg Syndrome (RLS) aka ‘Willis-Eckbom Disease’

Common signs: An irresistible urge to move the arms or legs - it doesn’t need to only be in the legs!


How you might feel: Like you have pins and needles, creepy crawly sensations or itchiness. RLS gets worse at night and when sitting or laying in bed. The sensations are not typically present during the day. Falling asleep can be challenging.

How’s it diagnosed: It is more frequently seen in women and especially present during pregnancy and peri menopause. It is also thought to be genetic and certain medications can also cause RLS.


What can be done? People with RLS typically have to get up, move and stretch to find relief, but there is a link between RLS and a lack of iron. As many women tend to be deficient because of the menstrual period, it is a useful thing to have checked when having RLS diagnosed.


Day 13 Task: Assess your sleep diary

Your sleep diary should now be filled with lots of information. So what does it all mean?


“There are two main pieces of information you need to consider when looking at your sleep diary,” says Dr Harris. “Firstly, how consolidated was your sleep. That means how long were you physically in your bed and how much of that time were you asleep. The aim is to be spending 85% or more of your time in bed asleep, at least 5 nights a week - this then allows for any nights where you don’t get as good a night’s sleep. The next thing I want you to think about is the quality of your sleep. Were you content with the majority of your sleep in your diary? If you are, stick with what you’re doing because it’s working.”


If you’re not getting enough good sleep then this is where your data in the diary can help improve things. “Look for patterns in your diary that you may not have noticed otherwise. For example, on the day you had coffee at 4pm, did it take you longer to get to sleep? If so, make sure you finish your caffeine consumption earlier in the day. On the day you had a nap did you have to go to bed later? Another factor may be your wake times - if they have been inconsistent has that impacted on your night’s sleep?”


And it’s not all about focusing on the negative, look at the things that helped you have a good night’s sleep too. If exercising slightly later in the day, instead of first thing, resulted in a better night’s sleep, make that part of your routine. If taking a warm bath a few hours before bed helped you go to sleep quicker, then definitely do that again.


And the good news is that if the changes work, you can stop writing your sleep data down, because a good night’s sleep will become instinctive and the norm. But if they don’t impact on your sleep quality and quantity and you want to investigate further, then you are armed with a lot of information that a sleep doctor would then want to know.


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Shelby Harris

Shelby Harris

Dr. Shelby Harris is a Rituals Ambassador for Sleep, and a licensed clinical psychologist. With years of experience treating a wide variety of sleep disorders she uses evidence-based methods and non-pharmacological treatments to improve sleep for everyone from babies to adults. Dr. Harris currently holds a dual academic senior-level appointment as Clinical Associate Professor at the Albert Einstein College of Medicine in both the Neurology and Psychiatry Departments. and is board certified in Behavioral Sleep Medicine (BSM) by the American Academy of Sleep Medicine. She’s also the author of The Women’s Guide to Insomnia.