When you can't sleep, you know it. But what about when you can, yet you wake up feeling tired and achy or you're groggy again a few hours later? What's that about? All too often, it turns out, the problem is one that doesn't keep you awake but does sabotage your sleep in more subtle ways, so the hours you spend in bed don't refresh and revitalize you the way they should. Here are seven signs that you have a sleep problem that's secretly stealing your rest.
1. You sleep poorly and wake with a bad taste in your mouth.
What it's a symptom of: "Morning mouth" can be a signal of gastroesophageal reflux disease (GERD) or asymptomatic heartburn. 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.
How it interrupts sleep: Acid reflux causes the body to partially awaken from sleep, even when there are no symptoms of heartburn. The result of this "silent reflux" is fitful, uneven sleep, but when you wake up digestion is complete and you can't tell why you slept poorly.
What to do: Follow treatment suggestions for heartburn, even though you aren't experiencing classic heartburn symptoms: Don't eat for at least two hours before hitting the sack, and avoid acid-causing foods in your evening meals. (Alcohol, chocolate, heavy sauces, fatty meats, spicy foods, citrus fruits, and tomatoes all contribute to heartburn and acid reflux.) Some doctors also recommend chewing gum before bed, because it boosts the production of saliva, which neutralizes stomach acid.
Certain medications, particularly aspirin and other painkillers, are hard on the stomach and esophageal lining, so don't take them just before bed.
Sleep studies have shown that sleeping on the left side reduces symptoms, and sleeping on the right side causes them to worsen because acid takes longer to clear out of the esophagus when you're on your right side. If you prefer to sleep on your back -- a position that can increase reflux -- elevating your head and shoulders can help.
Losing weight can do wonders to banish heartburn and acid reflux. And if all else fails, try taking an over-the-counter antacid.
Nocturia and bruxism
2. You toss and turn or wake up often to use the bathroom.
What it's a symptom of: Nocturia is the official name for waking up in the middle of the night to use the bathroom. The National Sleep Foundation estimates that 65 percent of older adults are sleep deprived as a result of frequent nighttime urination. 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.
How it interrupts sleep: For some people, the problem manifests as having to get up to use the bathroom, and then being unable to get back to sleep. Once middle-of-the-night sleeplessness attacks, they lie awake for hours. But for others the problem is more subtle; they may sleep fitfully without waking fully, as the body attempts to send a signal that it needs to go.
What to do: Start with simple steps. 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.
Go to the bathroom last thing before getting in bed and relax long enough to fully empty your bladder. It's also important to get checked for conditions that cause urination problems. Guys, this means getting your prostate checked. Inflammation of the prostate, benign prostatic hyperplasia (BPN), and prostate tumors can all cause frequent urination. In women, overactive bladder, urinary tract infections, incontinence, and cystitis are common causes of urinary problems.
Diabetes can also cause frequent urination, so if you haven't been tested for diabetes recently, see your doctor. Certain drugs such as diuretics and heart medications can contribute to this problem; if that's the case, talk to your doctor about taking them earlier in the day. A prescription antidiuretic can cut down on nighttime urination if all else fails and there's no underlying issue.
3. Your jaw clicks, pops, or feels sore, or your teeth are wearing down.
What it's a symptom of: Teeth grinding, officially known as bruxism, is a subconscious neuromuscular activity. Bruxism often goes on without your being aware of it; experts estimate that only 5 percent of people who grind their teeth or clench their jaws know they do it until a sleep partner notices the telltale sound or a dentist detects wear on the teeth. Jaw clenching is another form of bruxism, except you clench your teeth tightly together rather than moving them from side to side. Jaw clenching can be harder to detect than grinding, but one sign is waking with pain or stiffness in the neck.
How it interrupts sleep: Bruxism involves tensing of the jaw muscles, so it interferes with the relaxation necessary for deep sleep. And if you're fully grinding, your body is engaged in movement rather than resting.
What to do: See a dentist. If you don't have one, dental schools often offer low-cost dental care provided by students supervised by a professor. 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. Some people who grind their teeth have experienced relief from botox injections to the jaw muscle.
Restless leg syndrome and snoring
4. You move all over the bed or wake tangled in the covers.
What it's a symptom of: That kind of movement indicates restless leg syndrome or a related problem, periodic limb movement disorder (PLMD).
How it interrupts sleep: Doctors don't know exactly what causes these sleep movement disorders, but they do know they're directly related to a lack of 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 to do: 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. Diabetes, arthritis, peripheral neuropathy, anemia, thyroid disease, and kidney problems can all contribute to restless leg syndrome and PLMD. Make sure to tell your doctor about any medications you're taking; a number of medications, including antidepressants, antihistamines, and lithium, can cause restless leg syndrome as a side effect.
You can also try making dietary changes to make sure you're getting enough 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, but you may want to take supplements as well. 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.
5. You wake up with a dry mouth or horrible morning breath.
What it's a symptom of: Mouth breathing and snoring both disrupt sleep by compromising breathing. Look for drool on your pillow or in the corners of your mouth. If you have a partner, ask him or her to monitor you for snoring, gasping, or overloud breathing.
How it interrupts sleep: Mouth breathing and snoring can interrupt sleep because you're not getting enough air to fully relax. Severe snoring -- particularly when accompanied by gasps or snorts -- can also indicate a more serious problem with obstructed breathing during sleep.
What to do: Train yourself to breathe through your nose. Try snore-stopping nose strips, available over the counter at the drugstore, or use saline nasal spray to irrigate your nasal passages. Experiment with sleep positions; most people have a tendency to snore and breathe through their mouths when sleeping on their backs. Use pillows to prop yourself on your side, or try the tennis ball trick: Put a tennis ball in the back pocket of your pajama bottoms (or attach it some other way), so it alerts you when you roll over.
If you typically drink alcohol in the evening, try cutting it out. Alcohol, a sedative, relaxes the muscles of the nose and throat, contributing to snoring. Other sedatives and sleeping pills do the same thing, so avoid using anything sedating. Alcohol also can trigger snoring in two other ways: It makes you sleep more deeply initially and is dehydrating.
Losing weight -- even just ten pounds -- can eliminate snoring, studies show. If none of these solutions work, consult a doctor to get tested for sleep-disordered breathing conditions such as apnea.
Sleep apnea and being out of sync
6. You sleep fitfully, feel exhausted all the time, and wake with a sore throat or neck pain.
What it's a symptom of: Obstructive sleep apnea is a disorder defined as breathing interrupted by intervals of ten seconds or more. A milder sleep breathing problem is upper airway resistance syndrome (UARS), in which breathing is obstructed but stops for shorter intervals of under ten seconds. The number of people who have sleep apnea and don't know it is astounding; experts estimate that 20 million Americans have sleep apnea, and 87 percent of those are unaware they have the problem. One mistaken assumption is that you have to snore to have sleep apnea. In fact, many people with apnea don't snore.
How it interrupts sleep: Obstructive sleep apnea results when the throat closes and cuts off airflow, preventing you from getting enough oxygen. UARS is similar, but it's usually tongue position that blocks air from getting into the throat. Blood oxygen levels drop, and when the brain knows it's not getting enough oxygen, it starts to wake up. This causes fitful, unproductive sleep. Weight gain is a major factor in sleep apnea, because when people gain weight they end up with extra-soft tissue in the throat area, which causes or contributes to the blockage.
What to do: See an otolaryngologist, who will examine your nose, mouth, and throat to see what's interrupting your breathing and how to fix the problem. It's also important to have your oxygen levels measured during sleep. Your doctor will likely recommend using a Continuous Positive Airway Pressure (CPAP) device, a mask that blows air directly into your airways. Studies have shown CPAP masks to be extremely effective in treating sleep apnea. Another mask called a BiPap (Bilevel positive airway pressure device) works similarly but has dual pressure settings. Airway masks only work if you wear them, so work closely with your doctor to choose a model that's comfortable for you.
Other options include oral appliances, which change your mouth position by moving your jaw forward to open up the throat, and surgery, which aims to remove the excess tissue from the throat. Newer, minimally invasive outpatient surgical treatments include the Pillar procedure, which involves using permanent stitches to firm up the soft palate; coblation, which uses radiofrequency to shrink nasal tissues; and use of a carbon dioxide laser to shrink the tonsils.
7. You get a full night's sleep but feel groggy all the time or get sleepy while driving.
What it's a symptom of: This signals circadian rhythm problems or, more simply, getting out of sync with night and day. Irregular sleep patterns, staying up late under bright lights, working a shift schedule, using computers and other devices in bed, and having too much light in the room while you sleep can disrupt your body's natural sleep-wake cycle.
Why it interrupts sleep: The onset of darkness triggers production of the hormone melatonin, which tells the brain it's time to sleep. Conversely, when your eyes register light, it shuts off melatonin production and tells you it's time to wake up. Even a small amount of ambient light in the room can keep your body from falling into and remaining in a deep sleep. The use of devices with lighted screens is especially problematic in terms of melatonin production because the light shines directly into your eyes. This light is also at the blue end of the spectrum, which scientists believe is particularly disruptive to circadian rhythms.
What to do: Try to get on a regular sleep schedule that's not too far off from the natural cycle of night and day -- and preferably the same schedule all week. (Experts recommend 10 p.m. to 6 a.m. or 11 p.m. to 7 a.m. every night, but that's just a general outline.) If you struggle with not feeling alert in the morning, go outside and take a brisk walk in daylight to feel more awake; you'll find that it's much easier to fall asleep the following night. This is also a trick experts recommend to help night owls reset their internal clocks. Force yourself to get up and get into bright light one or two mornings in a row and you'll be less likely to get that "second wind" and burn the midnight oil or experience nighttime sleeplessness.
As much as possible, banish all screens (TVs, computers, and iPads) for at least an hour before bed. Reading is much more sleep-inducing than looking at a lighted screen, but make sure your reading light isn't too bright and turn it so it doesn't shine in your eyes. Remove night-lights; if you need to get up in the middle of the night, keep a small flashlight next to your bed, being careful to turn it away from you. Check your bedroom for all sources of light, however small. Does your smoke alarm have a light in it? Put tape over it. Use an alarm clock without a lighted dial, or cover it. If your windows allow moonlight and light from streetlights to shine in, install blackout curtains or shades tightly fitted to the window frames. Don't charge laptops, phones, cameras, and other devices in your bedroom unless you cover the light they give off.