You’re ready for a great night. Conditions are perfect. You’ve got a 68-degree room, mattress with your sleep number, a pillow that cradles your head, and curtains that block out all light. But, once again, you’re tossing and turning. You’re pacing in the middle of the night and tired in the morning. Poor sleep leaves you irritable, moody, and unable to focus. It also compromises your immune system, and increases your susceptibility to viruses, heart disease, and cancer.
“Quality sleep belongs up there with exercise and nutrition in the pantheon of healthy living,” says Carl Bazil, the director of the Division of Epilepsy and Sleep at Columbia University’s medical school. “It’s so integral to health, it should be part of your primary care.”
But meanwhile, poor sleep is a great communicator, often revealing an easily curable problem lurking beneath the surface. Here, the reasons behind several common sleep idiosyncrasies. If something sounds familiar to you, talk to your doctor before self-medicating with quadruple-shot venti lattes.
Symptom: If you don’t set the alarm clock, you’d sleep for 14-hour stretches.
What it might mean: An underactive thyroid or a latent infection
Most people require seven to nine hours of sleep to feel refreshed. “It should give you pause if you’re sleeping more than 10 hours day-in, day-out,” says Andrew Varga of the Division of Pulmonary, Critical Care and Sleep Medicine at NYU Langone Medical Center. One possible cause ishypothyroidism, which tends to affect women over 60. Its insidious, slow onset causes weight gain and fatigue, which many erroneously chalk up to aging. But sleeping too many hours may indicate a need to test your thyroid’s ability to regulate metabolism. Oversleeping can also be your body’s response to a latent infection, Varga says. In that case, the lengthy slumbers should be short-lived.
Symptom: You wake up tired every single morning.
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What it might mean: Sleep-apnea or depression
If you’re able to get enough hours in bed but still feel sleepy when you wake up, it’s likely that you have sleep apnea, a problem with breathing during sleep that affects 30 million Americans (at least—that number doesn’t include undiagnosed cases or all the spouses awakened by snores). Sleep apnea messes with your sleep cycles, constantly interrupting them—but you won’t remember it. “Somebody might wake up hundreds of times a night, but think they woke up only once or twice,” says John Winkelman, a sleep researcher at Massachusetts General Hospital. If you think you might have sleep apnea, try sleeping on your back and seeing if you feel more well-rested come morning. If that doesn’t work, talk to your doctor about the problem. Sleep apnea is linked to a number of undesirable health outcomes, including heart attack, so it’s worth fixing.
Another consideration for the always-weary: Depression, which goes go hand-in-hand with sleep problems. So, if you’re still feeling withered after a full night’s sleep, consider that it might be a mood disorder and talking to a therapist. (Check out this list of surprising signs of depression to see if any sound familiar.)
The symptom: You wake up at 5 am no matter what time you went to bed.
What it might mean: Circadian Rhythm Disorder
Sleep drive is part of the circadian rhythm. It increases as the day goes on, until we fall asleep, and diminishes during the night. So, if you awaken before the sun is up and can’t get back to sleep, you may have simply spent your sleep-drive, according to Winkelman. No big deal. But, if you’re consistently up too early, you may have a circadian disorder called advanced sleep phase syndrome. The early bird life may have its advantages, but those diminish when you’re anti-social because you go to bed when others sit down to dinner. Taking melatonin and restricting artificial lights when you wake up are effective treatments for circadian rhythm disorders.
The symptom: You can’t sleep without late night TV.
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What it might mean: Anxiety
If you’ve always fallen asleep to Letterman, Law & Order reruns, or infomercials, the television may just be part of your nightly routine (hey, better that than a nightcap, right?). But the TV may also distract you from your own thoughts, Winkelman says. “A dark and quiet room may bring psychological problems to the fore,” he says. “The television helps deflect feelings and compensates for worries.” Another reason to reconsider your crutch: The television’s light increases our stress hormones, so sleep experts advise finding more legitimately calming strategies before bed, like meditation or reading fiction
You wake up and can’t get back to sleep
What it might mean: Restless Leg Syndrome
If you need to stretch before bed, and then in the middle of the night you’re kicking your spouse or need to get up and move, you might have a neurological disorder called Restless Leg Syndrome, which affects 3% of the population. “It’s a terrible feeling in the legs that’s temporarily relieved with movement,” says Winkelman. Restless Leg Syndrome stems from an abnormality in dopamine, the brain chemical involved in motor control and nerve cells. It usually starts in the early evening and peaks in the middle of the night to rouse you from sleep. Like sleep apnea, it’s linked to an increase in heart attacks and strokes. On the bright side, it’s easy to test for and to control with prescription medicine.
The symptom: You slept your way through 3 ham sandwiches and an entire pound cake.
What it might mean: Parasomnia and REM Behavior Disorder (RBD)
Erik St. Louis, a Mayo clinic sleep physician, recently ended up with a patient who spread jelly on his Nook and left it in the fridge. Sleepwalkers may make a snack, take a walk, and then return to bed with no idea they ever left. The really scary ones drive.
A bigger risk is REM behavior disorder, a neurological problem where people act out dreams because their brains fail to shut down the muscles. This can lead to dangerous behavior—think jumping through a window. “There’s a rich connection between psychology, mood disorders, and REM behavior,” says St. Louis. He warns that many antidepressants are known triggers of parasomnia and RBD.
Sleepwalking does signal a larger problem with the brain’s control of muscles. It can even be an early signal that Parkinsons might develop. Parasomnia and RBD may be treated with melatonin or prescription Clonazepam.
The symptom: You’re in the bathroom. Again.
What it might be: Diabetes.
If you’re getting up to pee more than once or twice per night, you could have diabetes or be pre-diabetic. Frequent urination is a by-product of high-blood sugar, because the kidneys work overtime to absorb and filter out the excess sugar. The kidneys then take on an increased fluid load and make more urine to handle it. Then again, you might have just had too much water before bed. If it persists, loop in your doc.
The symptom: You’re tossing and turning; your heart is racing.
What it may be: overactive thyroid
Maybe you’re rattled by The Walking Dead or anxious about tomorrow’s meetings. But, if you have consistent insomnia, a rapid heartbeat, and irritability, you may have hyperthyroidism, which disturbs sleep, according to Winkelman. Too much thyroid-hormone production wreaks havoc on your metabolism and causes rapid weight loss. Another possibility is Graves’ disease, an immune disorder that causes restlessness and trouble sleeping.