If mornings find you feeling like you just drifted off a few hours before, or if you droop with weariness no matter how much coffee you drink, you just might be suffering from a sleep problem. But wait, wouldn't you know about it, if you were? Not necessarily, experts say. In many cases, instead of keeping you awake, a sleep problem sabotages your sleep in more subtle ways, leaving you frazzled and frustrated without knowing why. Here are six signs that you have a sleep problem that's secretly stealing your rest.
Sleeping poorly and waking up with "morning mouth" or a sour taste in your mouth can be a signal of gastroesophageal reflux disease (GERD) or asymptomatic heartburn.
What's going on: Acid reflux causes the body to partially awaken from sleep, even when you're not aware of typical heartburn symptoms. The result of this "silent reflux" is fitful, uneven sleep -- but by the time you wake up, you've finished digesting and you don't know why you slept poorly.
Alarming stat: Recent sleep studies have shown that up to 25 percent of people who report sleeping poorly without a diagnosed cause have sleep-related acid reflux. But because they don't have obvious heartburn symptoms, they're unaware of the condition.
What helps: Luckily, there are many ways to minimize acid reflux and prevent it from interfering with sleep.
Don't eat for at least two hours before going to bed.
Avoid acid-causing foods, such as heavy sauces, spicy food, fatty meats, citrus, and tomatoes at dinner and afterward.
Don't drink after dinner; alcohol stimulates reflux.
Don't take aspirin or other painkillers, which are hard on the stomach and esophageal lining, just before bed.
Try chewing gum before bed; it can boost the production of saliva, which neutralizes stomach acid.
Sleep on your left side; acid clears out of the esophagus faster when you're on your left side. (Sleeping on the right side can actually make acid reflux worse.)
If you sleep on your back, elevate your head and shoulders.
If all else fails, take an antacid.
Limb movement disorders
Waking up tangled in the covers or in a different part of the bed than where you started out could signal restless leg syndrome or a related problem, periodic limb movement disorder (PLMD), which is characterized by involuntary jerking, kicking, or twitching. Pain, numbness, or a tingling sensation are also common signs. If moving your legs relieves symptoms, that's another clue.
Alarming stat: Restless leg syndrome affects up to 10 percent of the population, and the chance of developing it goes up with age. Symptoms tend to increase over time.
What's going on: Doctors don't know what causes sleep movement disorders, but they do know they set up a vicious cycle that interrupts deep, restful, REM sleep. The restlessness can prevent you from sinking into deep sleep, or a muscle jerk can wake or partially rouse you from deep sleep.
What helps: Try some tactics to get at symptoms, the cause, or both.
Symptoms ease with exercise and stretching. Take a walk before bed, and do stretching exercises such as hamstring stretches a few times a day. See a doctor to discuss your symptoms and get a diagnosis, which may also involve looking for underlying conditions related to restless leg syndrome or PLMD.
Eat a diet high in iron and B vitamins, particularly folic acid, since iron and folate deficiency have been linked to restless leg syndrome. Red meat, spinach, and other leafy greens are good sources of both nutrients.
If your doctor diagnoses restless leg syndrome or PLMD, medications used to treat Parkinson's can relieve symptoms by eliminating the muscle jerks. Your doctor may also prescribe medication to help you sleep more deeply, with the idea of preventing the involuntary movements from keeping you in light sleep.
The inability to get through the night without urinating more than once both interrupts sleep and decreases the amount of restful REM sleep. Known as nocturia, it includes both waking up with an urgent need to use the bathroom and needing to go so frequently that your sleep is fractured by physical tension.
Alarming stat: The National Sleep Foundation estimates that 65 percent of older adults are sleep deprived as a result of frequent nighttime urination.
What's going on: Normally, our bodies have a natural process that concentrates urine while we sleep so we can get six to eight hours without waking. But as we get older, we become less able to hold fluids for long periods because of a decline in antidiuretic hormones.
What helps: Experiment with a number of strategies to see what works to decrease nighttime urination.
Don't drink any liquids for at least three hours before going to bed. This includes foods with a lot of liquid in them, like soups or fruit.
Lower your coffee and tea consumption; the acids in coffee and tea can irritate the bladder.
Don't drink alcohol, which functions as a diuretic as well as a bladder irritant.
Use the bathroom last thing before getting in bed, relaxing long enough to empty your bladder all the way.
Get checked for conditions that cause urination problems. In men, prostate problems are the most common culprit; inflammation of the prostate, benign prostatic hyperplasia (BPN), and prostate tumors can all cause frequent urination. In women, overactive bladder (OAB), bladder infections, cystitis, and incontinence can cause nocturia.
If you haven't been tested for diabetes recently, consider it a possible cause.
Evaluate your medication list; certain drugs such as diuretics and heart medications can increase urination. If that's the case, talk to your doctor about taking them earlier in the day or making other changes.
Consider taking a prescription antidiuretic to cut down on nighttime urination if all else fails and there's no underlying issue.
More surprising sleep stealers
Teeth grinding or jaw clenching
Officially known as bruxism, teeth grinding or jaw clenching often occurs without your being aware of it; experts estimate that 95 percent of people who grind their teeth or clench their jaws don't know they do it until a sleep partner notices the telltale sound or a dentist detects wear on the teeth. Jaw clenching is even harder to detect than grinding; one sign is waking with pain or stiffness in the neck.
Alarming stat: Experts estimate that during sleep bruxism, the upper and lower teeth can come into contact up to 40 minutes per hour, and with a force of up to 250 pounds on particular teeth. (Under normal chewing circumstances, your teeth make contact for a total of about 20 minutes a day, with only 20 to 40 pounds of pressure.)
What's going on: Bruxism is considered a "subconscious neuromuscular activity," which means your brain is affecting your muscles without you being aware of it. The exact cause is still unknown, though scientists are investigating the role of neurotransmitters such as dopamine. Stress, smoking, caffeine, and alcohol are all known to contribute to or worsen nighttime bruxism. Because grinding or clenching involves tensing of the jaw muscles, it interferes with the relaxation necessary for deep sleep. Also, when you're grinding or clenching, your body is engaged in movement -- even though you don't know it -- rather than resting.
What helps: Start with some professional advice.
Get a dental checkup. A dentist can look for underlying causes, such as problems with your bite alignment, and can prescribe a mouth-guard-type device such as a dental splint.
If jaw clenching is your primary issue, there are specific dental devices for that.
Experts also suggest giving up gum chewing during the day, because the habitual chewing action can continue at night.
Botox injections to the jaw muscle are one of the newest treatments for bruxism.
Some people have had success using a new biofeedback device called Grindcare, approved by the FDA in 2010.
It's common to drink enough to feel drowsy, fall asleep suddenly, and sleep heavily. But if you wake several hours later and can't get back to sleep, or you toss and turn for the rest of the night, that's a sure sign of alcohol rebound.
Alarming stat: Even a moderate dose of alcohol, such as two drinks, consumed as much as six hours before bedtime (think happy hour), has been shown in studies to increase wakefulness during the second half of sleep. By this time, the alcohol has already been eliminated from the body, which shows that drinking causes a long-lasting effect on sleep rhythms.
What's going on: As your body metabolizes alcohol during the night, sleep becomes increasingly disturbed. Sleep is deeper than normal during the first half of the night but much lighter during the second half, and nightmares are more common. Some experts call this syndrome "glutamine rebound" because alcohol inhibits glutamine, one of the body's natural stimulants. Once you stop drinking, your body produces more glutamine than it needs to make up for it. The increase in glutamine levels stimulates the brain, keeping you from reaching the deepest, most healing levels of sleep.
Also, alcohol is extremely dehydrating, so your body reacts after a few hours by craving water, which is why you wake up thirsty during the night. And because alcohol is a sedative, it relaxes the muscles of the nose and throat, exacerbating snoring. If you suffer from a sleep breathing problem such as apnea, alcohol is known to worsen it considerably.
What helps: How and when you drink can have a big effect.
Drink in moderation.
Don't drink within two hours of bedtime, which, studies show, has the worst effect on sleep.
Drink a lot of water along with your alcohol to help prevent dehydration and to "water down" the alcohol in your system. (That's why experienced drinkers always order a water chaser.)
Sleep breathing problems
If you sleep fitfully, feel exhausted all the time, and wake with a sore throat or neck pain, breathing problems might be to blame. Severe snoring -- particularly when accompanied by gasps or snorts -- can also indicate a more serious problem with obstructed breathing during sleep. There are two stages of sleep-disordered breathing. Obstructive sleep apnea is diagnosed when sleep is interrupted by intervals of ten seconds or more. A milder sleep breathing problem, upper airway resistance syndrome (UARS), occurs when breathing is obstructed but the intervals between breaths are under ten seconds. Although snoring can be a clue to sleep apnea, many people with apnea don't snore.
Alarming stat: Experts estimate that 20 million Americans have sleep apnea, but 87 percent of them are unaware they have the problem.
What's going on: The throat closes and cuts off airflow, preventing you from getting enough oxygen. When blood oxygen levels drop, the brain knows it's not getting enough oxygen and wakes you up, either fully or partially. This causes fitful, unproductive sleep and decreases REM sleep, but you may not be aware that it's happening. In UARS, it's often tongue position that blocks air from getting into the throat. In sleep apnea, weight gain is a major factor because when people gain weight they end up with extra-soft tissue in the throat area, which causes or contributes to the blockage.
What helps: Experiment with different methods of tackling nighttime breathing issues.
Try snore-stopping nose strips, available over the counter at drugstores, or use saline nasal spray to irrigate your nasal passages.
Experiment with sleep positions; obstructed breathing is more common when you're sleeping on your back. Use pillows to prop yourself on your side. Some experts recommend the tennis ball trick, in which you use an elastic band to attach a tennis ball to the back of your pajamas or T-shirt so it presses into your back when you start to roll over.
Losing weight -- even just ten pounds -- can decrease or even eliminate sleep-disordered breathing.
If problems persist, schedule an exam by an otolaryngologist to determine if a structural problem with your nose, mouth, or throat is causing your interrupted breathing.
It's also important to have your oxygen levels measured during sleep, which can be done during a sleep study or with a take-home device.
More and more, doctors are recommending oral appliances that change your mouth position by moving your jaw forward to open up the throat as first step for some types of obstructed breathing, particularly UARS.
One of the most effective cures for disordered breathing is a Continuous Positive Airway Pressure (CPAP) device, a mask that blows air directly into your airways. Another mask called a BiPap (Bilevel Positive Airway Pressure Device) works similarly but has dual pressure settings. However, compliance is a problem with airway masks, so be careful to choose a model that's comfortable for you, so you'll continue to use it.
Surgery to remove excess tissue from the throat or shrink nasal tissues can be a successful approach to treating apnea and UARS as well.