One of our Can't Sleep Cafe group members says that she is sleeping a lot better after starting CPAP therapy for sleep apnea.We don't usually think about insomnia and sleep apnea in the same person, so I wanted to tell all what the pattern of your insomnia might suggest is the cause of your insomnia. These are general rules, not absolutely true all the time.
The first pattern is called sleep-onset insomnia. This is difficulty falling asleep in the beginning of the night, but sleeping pretty well through the night. This pattern of insomnia can be typical of anxiety, restless legs syndrome, or delayed sleep phase syndrome (typical in teenagers). In addition, so called "primary insomnia," which is sometimes called conditioned insomnia, learned insomnia, or psychophysiologic insomnia, usually causes difficulty falling asleep at the beginning of the night.
A second pattern of insomnia is sleep-offset insomnia, also called "end of night awakening," or terminal insomnia. This is the problem of falling asleep easily at the start of the night, but waking up too early and being unable to fall back to sleep, say at 3 am. This pattern of insomnia is famous as a symptom of depression, but can be caused by any type of stress as well, and our sleep is lighter in the last half of the night so thoughts can more easily intrude. It is also typical of advanced sleep phase syndrome, in which the body clock is running early, so the person gets sleepy in the evening but then is awake too early. This pattern of insomnia is more common in older people. A similar pattern is to wake up for a few hours in the night and then fall back to sleep just in time for the alarm—stress or alcohol intake are typical causes.
Lastly, sleep-maintenance insomnia is when you keep waking up in the night but falling back to sleep. Needing to get up to urinate 4 times in an older man is an example. However, for others, frequent awakenings are a sign that something physical is happening in the night that awakens you. Breathing disturbances, pain, or leg jerks are perhaps the most common. It is this pattern of insomnia that is more likely to cause daytime sleepiness, and it is this pattern of insomnia that should definitely make you see a doctor and get a sleep study.
