We are completely oblivious to what wakes us up at night.  Urologists have realized that when someone wakes up multiple times at night to urinate and complains about their prostate, that they should also investigate for sleep apnea, as nighttime gasping arousals can be confused for a need to urinate given the lack of memory of the instigating event.  Often times before diagnosis, severe sleep apnea sufferers will tell me that "I woke up several times for back aches, the next night I woke up because of intense itching, the other night I woke up because I felt so hot and last night it was too stuffy and I didn't sleep."  Because sleep apnea is so common and poorly realized by patients, (often with random reasons for nighttime arousals that are mostly impossible to solve), we almost always test for it in our investigations for Sleep Maintenance Insomnia here at Sleep Doc LA.

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Because we take time with each patient and read and interpret our own sleep studies, we can make diagnoses that are frequently missed by conventional sleep studies demonstrating normal "AHI," which is the traditional way of diagnosing Sleep Apnea.  We look for patterns that demonstrate Upper Airway Resistance Syndrome, which can be devastating in young chronic insomnia sufferers who have gone undiagnosed thanks to conventional scoring methods with algorithms more likely to identify problems in the elderly than the young.  Furthermore, some respiratory dysfunction only occurs at the onset of deep stages of sleep, quickly causing the patient to wake-up out of it.  Because those events are so infrequent, such profound sleep dysfunction is often missed.

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There are other night specific conditions that can cause patients to wake up and require study in a formal sleep lab.  These notorious conditions managed by Sleep Physicians include disruptive kicking of the legs at night (PLMD), acting out of dreams (RBD), nocturnal seizures and other nighttime behavioral conditions such as sleep walking (parasomnias).

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There are medical conditions uniquely provoked by the nighttime environment that can awaken people from sleep.  Asthma can be exacerbated by acid reflux when lying on the back or by the nighttime cold air.  By being flat on the back, those with congestive heart failure can have sudden breathing difficulties and nasal congestion and sinus issues can be provoked in that position.  The quiet of the nighttime sleep environment can potentiate tinnitus, a difficult to tolerate condition where the ears are continuously ringing.

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​Bothersome medical conditions that are disruptive during the day are often more bothersome at night when there are no distractions.  Uncontrolled neuropathy as well as various other pains can be a challenge to deal with.  Prostate problems with the need for frequent urination can be a source of frustration

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Various substances are notorious for causing sleep disruptions.  While alcohol makes people tired initially, it can wake people up in the middle of the night as its metabolism can give rebound energy.  Some medication can cause vivid and disruptive dreaming or give a stimulant like effect hours after ingestion. As previously suggested, diuretics can make nighttime urination disruptive of good sleep.  Medically trained physicians, like our team at Sleep Doc LA, have the necessary knowledge to make challenging diagnoses that can be missed by sleep therapists, counselors and psychologists, and can manage the associated medications that common sleep medicine specialists are unable to.

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Finally, when waking frequently at night, it is important not to develop negative associations with the bed and bedroom.  When frustrated and restless, people angrily stare at a clock and wait for the morning to arrive.  Such behavior can lead to developing negative associations of the bedroom.  To avoid this, sleep scientists recommend leaving the bed and doing light (non-physically or mentally stimulating) activities outside of the bedroom until sleepiness returns.