Sleep Medicine

Sleep problems can range from very common sleep issues to complex sleep and breathing disorders.

Obstructive sleep apnea (OSA)

People with obstructive sleep apnea briefly stop breathing while they are asleep, often hundreds of times during the night. Snoring is a common symptom. Without treatment, sleep apnea can lead to serious health problems, such as heart disease, stroke or diabetes.

Insomnia

Insomnia occurs when a person has difficulty falling asleep or staying asleep through the night. Chronic insomnia happens at least three nights per week. 

Circadian rhythm sleep disorders (CRSD)

Circadian rhythm is generated by an internal body clock in the brain (known as the suprachiasmatic nucleus) that regulates the 24-hour biological processes. It makes you become sleepy at night and awake in the morning. Disorders of the circadian rhythm are often under-recognized or misdiagnosed, and can result in school, work or social impairment. CRSD include delayed sleep-wake phase disorder, advanced sleep-wake phase disorder, jet lag, shift work disorder, irregular sleep-wake rhythm disorder and non-24 hour sleep-wake rhythm disorder.

Parasomnias

Parasomnias include any abnormal behaviors or movements that occur during sleep, such as sleepwalking, sleep paralysis, nightmares and sleep-related eating.

Sleepwalking

Sleepwalking is quite common in childhood, but it typically goes away in adulthood. If persistent, it may be a sign of other sleep disorders.

Sleep movement disorder

This condition involves involuntary movements during sleep, such as twitching, moving the limbs, or clenching or grinding teeth. 

Restless leg syndrome (RLS)

Restless leg syndrome refers to an uncontrollable need to move the legs, often while trying to fall sleep. A similar condition called periodic limb movement in sleep (PLMS) involves twitching or jerking of the legs or feet while asleep.

Hypersomnia

People who sleep too much, are excessively sleepy during the day or can fall asleep at any time may have hypersomnia.

Narcolepsy

Narcolepsy is similar to hypersomnia, but people with narcolepsy may also experience hallucinations and a feeling of weakness or paralysis (called cataplexy).

Sleep deprivation

Sleep deprivation is common in children and adults. Even small amounts of sleep loss can impact your performance, mood and health. Sleep loss can zap productivity and impair school and job performance.

Some sleep disorders have physical causes, while others may be linked to psychological, lifestyle or emotional issues. Common risk factors for sleep disorders include:

Aging

After age 65, many adults find it more difficult to sleep through the night.

Environmental factors

Noise, light, temperature, air quality and bedding can all affect your quality of sleep.

Genetics

Some sleep disorders, such as narcolepsy, may be related to genetics. 

Lifestyle factors

Working non-traditional hours or drinking alcohol or caffeine may disrupt normal sleep cycles. 

Medical conditions 

Asthma, diabetes, chronic pain and other conditions can cause sleep problems.

Medications

Some medications can make it difficult to sleep or can make you too sleepy.

Psychological or emotional issues

Anxiety, depression, stress and other psychological conditions often interfere with sleep.

If you have risk factors that may be affecting your sleep, talk to your doctor.

If there are no underlying physical or psychological factors affecting your sleep, the following tips may help you sleep better.

• Go to bed and wake up at the same times every day. Staying up late or sleeping in on weekends can disrupt your sleep cycle.
• Reduce your use of caffeine and alcohol, especially after noon. 
• Aerobic exercise can improve sleep quality, but try not to exercise within a few hours of going to bed.
• Try to keep your bedroom dark, quiet and at a comfortable sleeping temperature.
• Avoid using electronic devices within an hour of bedtime.
• Develop a routine that tells your body it is time to sleep, such as listening to music or reading.

However, if an underlying condition is affecting your sleep, you may need treatment in order to resolve your sleep disorder.

Symptoms can vary depending on the type of sleep disorder. Below are the most common symptoms.

Obstructive sleep apnea symptoms

• Feeling tired even after a full night’s sleep
• Dry mouth upon waking
• Your partner says you snore, stop breathing or gasp for breath while asleep
• Frequent awakenings
• Frequent urination at night (nocturia)
• Acid reflux or gastroesophageal reflux disease (GERD)

Insomnia symptoms

• Trouble falling asleep or staying asleep at least three nights per week
• Depression

Sleep movement disorder or restless leg syndrome symptoms

• Twitching or making other involuntary movements
• Needing to move your legs or feet
• Clenching or grinding your teeth

Hypersomnia or narcolepsy symptoms

• Excessive nighttime sleeping
• Excessive daytime sleepiness
• Falling asleep during normal activities
• Daytime hallucinations
• Feeling weak or paralyzed (cataplexy)

Circadian rhythm sleep disorders symptoms

• Difficulty falling asleep during usual times
• Difficulty waking up 
• Early morning awakening
• Excessive daytime sleepiness

Parasomnia symptoms 

• Sleepwalking
• Sleep paralysis (being unable to move upon waking)
• Nightmares or night terrors
• Eating while asleep
• Aggressive behavior while asleep

Office consultation

The first step in diagnosing a sleep disorder is a consultation with a sleep specialist. Your sleep doctor will review your symptoms, talk with you about potential causes for your sleep problems and recommend further testing if needed.

Physical examination

A physical exam with a sleep expert can reveal medical issues that may be causing your symptoms, such as respiratory disorders or diabetes. 

Sleep studies (polysomnography)

Your doctor may recommend a sleep study to help diagnose the cause of your condition and determine the appropriate treatment. In addition to our sleep lab, Scripps offers a few at-home options.

• Sleep laboratory study: Many of our diagnostic and treatment services are performed in our comfortable, specially equipped sleep laboratory, which is fully accredited by the American Academy of Sleep Medicine. You’ll spend the night with non-invasive monitors placed on your body as you sleep. The devices will track your heart, brain, breathing, blood oxygen levels and body movements throughout the night. The detailed information from the sleep lab helps your doctor find the right diagnosis and treatment for your sleep disorder.

• Home sleep study: In some cases, a more limited home sleep test can be done, depending on your specific condition. 

• Actigraphy: Another type of sleep study called actigraphy monitors both your sleep and wake cycles while you’re at home. Actigraphy uses a wristwatch-like device called an actigraph to track your activity through light and movement. 

If you are diagnosed with a sleep disorder, your Scripps team will help you understand your condition and your treatment options. Here are some questions you may want to ask your doctor or health insurance provider regarding your diagnosis:

• What is causing my sleep problem?
• Should I get a second opinion?
• What is my treatment plan?
• What costs will be covered by insurance?

Our goal is to accurately identify your sleep disorder, offer specific treatment of your sleep disorder and help you develop a healthy sleep-wake cycle. Your Scripps team will create a personalized treatment plan tailored to your disorder, your lifestyle and your overall health.

Depending on the root of your sleep disorder, your treatment plan may include one or more of the following options. A sleep specialist can help you find the right therapy for you.

Lifestyle changes

Making changes to your daily routine may treat mild insomnia and circadian rhythm sleep disorders. Some people find it easier to sleep if they avoid alcohol and caffeine or adjust their sleep schedule to be more consistent. Creating a more sleep-friendly environment also may help with mild sleep issues.

Cognitive-behavioral therapy

Anxiety, depression and stress can interfere with your sleep. In such cases, talking with a behavioral therapist is often quite effective. In addition to finding the potential cause of your sleep issue, a therapist can share strategies for coping with the issue and improving your sleep. 

Medications

Over-the-counter medications and natural supplements (such as melatonin) that help you relax may help people with mild sleep disorders. Depending on your diagnosis, your doctor may prescribe medication to help you fall asleep, treat asthma or other respiratory problems, correct hormonal imbalances that affect sleep, or decrease anxiety.   

Oxygen therapy

If a breathing problem prevents you from getting enough oxygen, you may need to use a portable device called an oxygen concentrator. The device delivers extra oxygen through your nose while you sleep. 

Positive airway pressure (PAP)

Ventilator therapies are non-invasive devices that treat sleep apnea by delivering air pressure through a mask to keep your airways open while you sleep. These therapies include continuous positive airway pressure (CPAP), bilateral positive airway pressure (BiPAP) and auto-positive airway pressure (AutoPAP). 

Surgery 

If non-invasive treatments are not effective, your doctor may recommend surgery. Several types of surgery can adjust the bones or tissues in your mouth to help you breathe better while you sleep.

Scripps Clinic Viterbi Family Sleep Center in San Diego is one of the oldest sleep disorder programs in the United States. Our physicians are recognized nationally and internationally as experts in their field. We have programs that focus specifically on sleep and breathing, restless legs, insomnia and circadian rhythms (for example, jet lag).

Many of the diagnostic and treatment services offered at Scripps are performed in the sleep laboratory at Viterbi Family Sleep Center. The sleep lab is fully accredited by the American Academy of Sleep Medicine. 

We were designated as a site of excellence by the National RLS Foundation. We have maintained full AASM accreditation while providing the fullest scope of care for patients. We have a team of doctors, physician assistants (PAs), nurse practitioners (NPs), registered nurses (RNs) and respiratory therapists (RTs) to meet our patients’ needs and work closely with durable medical equipment (DME) suppliers to provide therapies.

Viterbi Family Sleep Center is located on the Scripps Green Hospital campus in La Jolla, with services in both the hospital and the adjoining Geisel Pavilion at Scripps Clinic Torrey Pines.

Our teams collaborate and coordinate your care throughout your treatment. Depending on your condition, your team may include many professionals to ensure you have the expertise and support you need.

Your team may include: 

• Sleep medicine specialists from various disciplines of pulmonology, neurology and psychology
• Pulmonologists
• Respiratory therapists
• Behavioral therapists
• Physician assistants, nurse practitioners, registered nurses and medical assistants