You should discuss all of these issues with your family doctor, and perhaps the next step would be to see a sleep specialist or a neurologist. Sometimes sleep specialists are also neurologists.

MODERATOR:
Dr. Kryger, can you explain what is involved in a sleep test?

KRYGER:
In a sleep test, the brain waves are measured to tell the doctor whether you were asleep during the test, how deeply you were asleep and whether you were in rapid eye movement (REM) sleep. It is during REM sleep that sleep breathing problems are usually at their worst.

In addition, the blood oxygen level is measured, and it's determined whether the person is trying to breathe, and whether they are actually breathing -- verified by measurements in front of the nose and mouth. There will be a measurement of the electrocardiogram, and whether the person has excessive movements or twitches in their extremities.

These tests are usually done in a sleep disorder center or in a hospital and increasingly such tests are being done in a home setting. There is a list of sleep disorder centers that are available on the web site of the American Academy of Sleep Medicine (www.aasmnet.org).

Generally, if sleep apnea is found, additional testing is often done on treatment, most often a CPAP machine. This machine generates pressure that's delivered via a mask over the nose, most of the time, and this opens up the breathing passage.

Again, to emphasize the point because it is so important, people with sleep apnea should not use sleeping pills or alcohol.

MEMBER QUESTION:
Why not sleeping pills?

KRYGER:
Sleeping pills can reduce the tone of the muscles in your throat that keep the breathing passage open when sleeping, and can make the problem worse.

MEMBER QUESTION:
Neurontin is what my doctor prescribed for me to take to stay asleep. How does it differ from a sleeping pill?

KRYGER:
There are many products that doctors use to treat sleep problems. Sometimes they will use medications whose side effect is sleepiness, for example, sometimes they might use antidepressants.

The best way for someone to decide whether they are on the right medication, is simply for them to speak to their doctor or to check on the web to make sure they are comfortable with the medication they're using and whether they, in fact, need the medication.

If someone has a chronic problem with their sleep the first thing they'll need is an accurate diagnosis, because the problem could be something entirely different that is interfering with their sleep. They may not require a sleeping pill at all. A few examples are: if someone is having trouble sleeping because of a painful condition such as arthritis or cancer effecting bone, which is quite painful, they might require, for example, anti-inflammatory medicines for the arthritis, and pain medications for the bone problem. People with heart failure may develop an abnormal breathing pattern which interferes with their sleep, and they might need more aggressive treatment of their heart failure or a treatment such as oxygen. If a person's problem is, for example, depression, and problems sleeping are common with depression, it is the depression that needs to be treated. None of the treatments that I've just mentioned include sleeping pills. The important first step for someone who has a chronic sleep problem is an accurate diagnosis.

There is one important cause of a sleep problem which people should be aware of which is that low levels of iron in the body may cause restless legs syndrome. In women, this problem may be there because of heavy menstrual bleeding and in both men and women, the problem may be related to excessive blood donation or even having had a condition in which they have lost a great deal of blood.

I have also seen in my clinical practice in the past few years restless legs syndrome caused by iron deficiency in people who are on an extreme vegan diet who shun virtually all products that may contain iron. If someone is on an extreme diet, they should be careful to make sure they're taking the right kind of supplements to make sure they do not become deficient in iron, and also other nutrients or vitamins including folic acid and vitamin B12.

MEMBER QUESTION:
Dr. Kryger, I work late -- until 11:30 p.m. -- and usually stay up until 3:00 or 4:00 a.m. and tend to sleep in until 11:00 a.m. or noon the next afternoon. I also wake up with backaches, soreness and stiff. Is this because of sleep patterns or could it be that my body lacks water? I tend to drink nothing but caffeinated drinks all day and hardly a drop of water. Can you explain?