Help Me Sleep: Ways to Sleep Better Tonight

By Brandon Peters, MD

It seems like sleep should come naturally, but when it doesn't, you might quickly find yourself pleading, "Help me sleep!" It can be a frustrating, unnerving experience to have difficulty falling or staying asleep. When you awaken without feeling refreshed, this problem quickly becomes a drag on the rest of your life and health. What are reasons why you can't sleep? Are there tried and true ways to sleep better tonight? What should you do if you have tried everything and it just isn't working? Let's explore these issues and discover the help you need to sleep.

What Is Wrong with My Sleep?

We have an expectation of perfect sleep; that we will crawl into bed, fall asleep within minutes, sleep without interruption, and awaken fully refreshed and ready to start our day. But is this a reasonable standard?

Children are often hailed as a model of perfect sleep because (for the most part) they are able to do just what we've described. As we mature, our bodies change and our sleep seems to likewise deviate from the ideals of childhood. Life, in a sense, gets complicated. There are new time pressures, our sleep is disrupted by others (including bed partners and our own children), and other health problems (such as nocturia, heartburn, and even pain) compromise our sleep.

As a result, we may not enjoy the sleep we knew in your youth. Indeed, even the timing of our sleep may shift. Those who are in the twilight of their lives may more often find themselves waking early, unable to stay asleep as they once did.

Some of our expectations regarding our sleep may be slightly misguided. As an example, the thought that we will fall asleep almost immediately upon retiring to our beds may be improper. In fact, people who fall asleep in less than 5 minutes may be "pathologically sleepy". This means that they are so sleepy that they fall asleep quicker than might be normal. In some cases, this ability to fall asleep quickly -- and enter rapid eye movement (REM) sleep quickly -- can be seen in excessive daytime sleepiness that might occur in sleep deprivation or narcolepsy.

Some sleep researchers believe that it might be normal to be awake some during the night. The fact that you sleep straight through the night without budging may again be a sign of inadequate time spent sleeping. This phenomenon is called "quiet wakefulness" and is often observed when the sleep habits of other non-Western cultures are studied. When people sleep in a group in close quarters, there is more time spent awake during the night. This makes sleep a more fluid concept. Time may be spent chatting, eating a snack, or engaging others around you. In history, fragmented sleep with periods of wakefulness in the middle of the night were common, reflected in the midnight adventures seen in the plays of Shakespeare, for example.

When we find ourselves waking in the night, no matter the cause, we may conclude that something is wrong. If there are no consequences in daytime function, however, this may not be the case. (Waking to go to the bathroom is so common as we get older that you would be hard-pressed to call it "abnormal".) The problem begins when our poor sleep compromises our lives. If difficulty falling or staying asleep at night begins to have consequences, there is a motivation to seek the cause.

Common Causes of Difficulty Sleeping

When we find ourselves lying awake, watching the minutes tick past in the red light of our alarm clocks, the desperation to sleep quickly escalates. There are many reasons this could occur and getting to the bottom of it may require some reflection on your situation. 

The most common reason why you can't sleep is also the most obvious: you are not tired. Your desire to sleep will be greatly diminished if you are trying to sleep at the wrong time. Imagine lying down three hours before your normal bedtime. The chance of you being able to fall right to sleep is pretty slim. This has to do with the circadian rhythm of our bodies. This system helps to coordinate our activities, including our desire for food and sleep, to the external environment. Problems with the timing of sleep may occur in the circadian rhythm sleep disorders as well as in temporary conditions like jet lag. If you spend more time in bed than required by your sleep needs, you will also be subject to long periods of wakefulness. Another reason you might be diminishing your desire to sleep at night is because of naps you take during the day.

A very common cause of difficulty sleeping relates to stress and the intrusion of stimulating substances and activities. You may have trouble falling asleep the night before a big test or presentation. In periods of emotional stress, such as after the death of a loved one, you may also have trouble sleeping. This is called acute insomnia. It usually passes when these stressors resolve. Similarly, stimulants such as caffeine and even nicotine can disrupt your sleep. You may be surprised to learn that exposure to light at night -- such as from a television or computer screen -- may make it difficult for some people to fall asleep. Additionally, late-night exercise may rev you up and provoke insomnia. For those who have chronic insomnia, the bedroom space may become a trigger for insomnia through conditioning.

The sleep environment is meant to be comfortable and facilitate sleep.

It should be cool, quiet, and free of distractions. Ideally you would not allow a television or pets in your bedroom. Bed partners may be disruptive and some people choose to maintain separate sleep spaces for this reason.

Another common cause of difficulty falling asleep is the activities that precede your bedtime. If you eat or drink too late, you may suffer from heartburn or frequent nighttime trips to the bathroom. There are general guidelines to improve sleep and many of these are meant to reinforce positive sleep habits. You should go to bed and get up the same time every day. Irregular sleep schedules may set you up for sleep disruption. You should follow a bedtime routine, including quiet, relaxing activities to help transition to sleep. If you fail to unwind prior to bed, you may find yourself struggling to drift off to sleep.

Finally, there are medical conditions that may keep you from sleeping well at night. These may be common problems such as heartburn or pain, but there are also multiple sleep disorders that might cause difficulty sleeping. Some of these include:

• Insomnia

• Sleep apnea

• Restless legs syndrome

• Circadian rhythm sleep disorders

Whether you suffer from one of these conditions or not, you may be interested in learning about some of the treatment options if you find yourself struggling to sleep at night.

Home Remedies When You Can't Sleep

The first task to sleep better at night is to improve your sleep hygiene, which refers to following the guidelines for better sleep. These steps may initially seem straightforward but because they involve modifying your behaviors in relation to your sleep, this can be challenging. If you have mastered these changes, you may be compelled to look at other options.

For those who have difficulty with insomnia, there are a handful of options to help you sleep. One treatment option is sleep restriction. This involves limiting the amount of time that you spend in bed, so that the time you are there you are more likely to spend asleep. It can also be useful to make a behavioral change called stimulus control. Stimulus control helps to break the association between not being able to sleep and your bedroom.

There are other non-medication options that might be helpful. Some people find benefit with the use of aromatherapy. Various relaxation techniques, including the use of biofeedback, may also establish a connection between your mind and body. This can be incorporated into your bedtime rituals and make it easier to relax and transition into sleep.

Finally, you may find yourself turning to over-the-counter medications to help your sleep. One of the most common is the naturally occurring hormone called melatonin. It is sold in many pharmacies and herbal supplement stores. It can be highly effective if you have insomnia related to a poorly timed circadian rhythm. As it has a low risk of major side effects (the most frequent is sleepiness), it might be an option to consider. Other herbal supplements (such as valerian root) do not have a lot of research supporting their efficacy.

If you still struggle to sleep, you may be compelled to look at other options.

Serious Help for Difficulty Sleeping

For those who still need help sleeping after exhausting changes in your sleep routine and at-home remedies, it may be necessary to turn to a professional. You may want to start by discussing the matter with your primary health care provider, but you may also choose a sleep doctor.

There are diagnostic tests that can be helpful for assessing your sleep problems, with special tests for insomnia. It may be helpful to keep a sleep log or use an actigraph to track your sleep patterns. Further testing with a home sleep apnea test or an overnight sleep study called a polysomnogram can also be helpful to identify sleep apnea or leg movements related to restless legs syndrome.

The other benefit of speaking with a health care professional is that you can discuss the use of sleeping pills. In addition, you can ask for a referral to a psychologist who might be able to teach you cognitive behavioral therapy for insomnia (CBTI) techniques to help your sleep.

This is a very serious matter, as the consequences of poor sleep can undermine your health and may even lead to your death. There are serious symptoms and physical effects of sleep deprivation, including hallucinations. For all these reasons – and more – it is absolutely worthwhile to get the help that you need in order to sleep well and wake refreshed.

Why Does Insomnia Happen?

By Brandon Peters, MD

There are few things more frustrating than an inability to sleep. Insomnia may undermine your night’s rest, leading to important daytime consequences. Why does insomnia happen? Learn about the factors that may lead to an inability to sleep at night and consider what you might do about them.

Insomnia is defined as the inability to fall or stay asleep or sleep that is unrefreshing in the absence of another sleep disorder (such as sleep apnea). It is the most common of all the various sleep disorders, and it may be a significant problem in about 1 in 4 people. Nearly everyone has experienced some degree of insomnia, even if only transiently, but why does this occur?

Spielman’s theoretical model of insomnia underpins our current understanding of the disorder. This theory suggests that three things contribute to the development of chronic insomnia, including: predisposing, precipitating, and perpetuating factors.

Predisposition: The Threshold for Insomnia

It is believed that everyone has the capacity to develop difficult sleeping at night. This predisposition is likely genetically determined. Some of the contributions to it likely include our individual circadian rhythm, homeostatic sleep drive, and level of arousal. The circadian rhythm directs the timing of our sleep, and it may be either advanced or delayed in some people. The homeostatic sleep drive is dependent on the build of sleep-promoting chemicals, including the compound called adenosine. The longer we stay awake, the sleepier we become, due in part to these chemicals. Finally, the baseline level of arousal also is factored in. Some people are more “wired” – also likely due to varying levels of neurotransmitters that promote wakefulness – and this may make sleep disruption more likely.

The predisposition towards insomnia can be thought of as a threshold. Below the threshold at which insomnia will develop, you sleep fine. Given the proper scenario, however, and the balance tips toward sleep disruption. The things that provoke the development of insomnia are known as the precipitating factors.

The Precipitating Factors for Insomnia

What might cause insomnia? There will be some variability in what provokes insomnia in you. Triggers for insomnia may not be the same for every person. Something that is particularly disruptive to your sleep may have no effect on someone else’s. This varying sensitivity is normal, and it shouldn’t be a source of additional distress.

Some of the most common triggers for insomnia include stress, mood disorders, pain, substance use, and poor sleep environment. Stress of every imaginable type is highly likely to make it difficult to sleep. The night before a big examination or presentation at work may be fitful. Major life events such as moving, the loss of a job, relationship problems including divorce, or the death of a close friend or relative may also lead to insomnia. If these problems lead to anxiety or depression, the risk of insomnia may be compounded.

There are other causes of insomnia as well. In particular, chronic medical conditions, especially those that cause pain, may disrupt sleep. Sleep is usually an anesthetic state, in which pain is not sensed, but nevertheless pain can make it hard to fall asleep. There are certain substances that may contribute to difficulty falling or staying asleep as well. The most common, caffeine, is notorious for sleep disruption. Nicotine is another stimulating substance that disrupts sleep. Alcohol may cause drowsiness initially, but when it starts to wear off, sleep becomes fragmented. Other medications and drugs can also undermine sleep.

Finally, the sleep environment can also make it hard to sleep. If your bedroom is too warm or too cold, too bright, or too noisy, sleep may be fleeting. An uncomfortable bed, or none at all, may also cause insomnia. If someone is snoring nearby, or a baby cries out to be fed, sleep becomes light and fragmented. Studies have also shown that environmental noise, such as may be present in a busy city, can also disrupt sleep.

It should also be noted that working against your natural ability to sleep can also cause insomnia. If you try to sleep at a time that your body expects you to be awake (contradicting your circadian rhythm), you will likely lie awake. If you took a prolonged nap in the afternoon, your desire for sleep will be diminished due to a weakened sleep drive. In addition, if you are wound up after a fight with your spouse (with increased arousal), insomnia will likewise result.

Perpetuating an Inability to Sleep

Once your threshold for insomnia has been crossed, incited by one of the precipitating factors, you will find yourself lying awake at night. This may quickly pass, as occurs in acute insomnia. If you had insomnia due to an examination that has come and gone, for example, the difficulty sleeping goes away with it. However, there are scenarios where insomnia will persist, and unintentional behavioral or cognitive changes may actually make things worse.

If the precipitating factor has not resolved, it is very likely that it will continue to disrupt your sleep. It is possible to adapt to some of these triggers, depending on the nature of the disruption, but this may not always happen. Therefore, it can be important to identify the cause of the insomnia and try to resolve it. This will require a careful self-assessment of the factors that are important to your situation.

Unfortunately, some triggers are not easily remedied. It may require a tincture of time to grieve a death. A mood disorder may require medication or psychotherapy. A new baby may take months to sleep through the night. Focus on what you have control over, and avoid making things worse.

Many people with insomnia unintentionally make their insomnia more sustained. Several bad nights of sleep (or dozens, for that matter) may lead you to change your pattern of sleep. This can be particularly true if you find yourself waking and lying awake in the night. You may think, “I am not sleeping well, so I am going to go to bed earlier to try to get enough sleep.” By extending your time in bed, you have introduced a new problem: you are now going to bed earlier than your body wants you to. If your body says you will get sleepy at 11 PM, but you crawl into bed at 9 PM, guess what happens? You will now have trouble falling asleep as well.

There can be a lot of emotions and thoughts that become associated with insomnia. Chronic insomnia is deeply frustrating. Feelings of distress, hopelessness, inadequacy, and failure become part of the scenario. People who sleep well do not wake in the morning and assess how well they slept. Insomniacs often do. Sleep becomes a focus in insomnia, and when it does, it becomes a challenge. There can also be an element of catastrophization, in which the worst possible scenario is imagined during the periods of wakefulness: “If I don’t get enough sleep, I’m going to get fired.” Many of these thoughts and feelings must be defused, and cognitive behavioral therapy for insomnia (CBTI) can be very helpful in this regard.

It is clear that insomnia can happen for multiple reasons, as detailed above. Everyone has a specific threshold at which insomnia will develop. The precipitating factors will vary for each person, but there are common triggers related to stress, mood, pain, and substance use. Acute insomnia becomes chronic when behaviors, thoughts, and emotions change surrounding sleep. If you find yourself stuck in the pattern of insomnia, it can be helpful to speak to a sleep specialist to begin to make changes that can correct the problem. Insomnia can be treated effectively, so reach out to get the help that you need.

Source:

Kryger, MH et al. “Principles and Practice of Sleep Medicine.” Elsevier, 5th edition. 2011.

Explore Causes of Restless Legs Syndrome

By Brandon Peters, MD

Although many people with restless legs syndrome (RLS) may never be able to identify a cause to their disorder, often it results from other secondary causes. This thus results in two categories of the condition, the former being primary RLS (of unknown cause) and the latter deemed secondary RLS. There are many conditions that may independently lead to symptoms of RLS and these are described here.

1. Iron Deficiency

The relationship between iron deficiency and RLS symptoms has been extensively studied. In several research studies, low iron levels have been found in the blood and spinal fluid of individuals suffering from RLS. The lower the iron levels, the worse the symptoms. Magnetic resonance imaging (MRI) has shown that the iron content in an area of the brain called the substantia nigra is lower in those with RLS compared to normal individuals, which may contribute to the disorder. In addition, pathological studies have confirmed this change within the brain.

It is therefore recommended that you have your serum ferritin level (a marker of iron stores) checked if you have symptoms of RLS. If the ferritin level is low, generally at a value <75, a trial of oral iron replacement should be undertaken. Even if the levels are normal, some individuals respond to iron replacement.

2. End-stage Kidney Disease

RLS is very common among individuals suffering from end-stage kidney disease, especially those who are dependent upon dialysis. The incidence has been reported to range from 6 to 60 percent. It is unclear what may be contributing to RLS in this group. Anemia, iron deficiency, or even low parathyroid hormone levels may have a role based on various studies. In some cases, treating anemia with erythropoietin therapy or iron replacement has been effective.

3. Diabetes

In people with Type 2 or adult-onset diabetes, RLS may develop. If diabetes is left uncontrolled, nerve damage can result. This is thought to occur because of high levels of glucose within the blood. This can lead to damage of small blood vessels that supply the nerves called vaso nervorum. When these become clogged, the nerve itself will become damaged. Often this leads to a peripheral neuropathy, which consists of pain and a pins-and-needles sensation in the feet. This may progress up the legs and even involve the hands. Associated with these sensory changes, some people will also have symptoms of RLS. Therefore, it is thought that diabetes may be an independent risk factor for developing RLS. In people who have undergone pancreas and kidney transplants, their symptoms of RLS have improved.

4. Multiple Sclerosis

There is a growing body of evidence that multiple sclerosis seems to be associated with an increased risk of having RLS. Some of the studies are conflicting, however. In one of the larger studies that included 1500 subjects, the prevalence of RLS was 19 percent in people with MS compared to only 4 percent of those people without it.

5. Parkinson’s Disease

It is thought that RLS and Parkinson’s disease may be caused by a similar problem, namely disruptions in the neurotransmitter called dopamine. This is not fully understood, however. Regardless, RLS may be present in individuals who have Parkinson’s disease, with a prevalence ranging from 0 to 20.8 percent, based on the study. Parkinson’s disease often involves a sense of restlessness (called akathisia) that may also occur in RLS, which may make it difficult to discriminate between the disorders. When both conditions are present, RLS usually occurs after Parkinson’s disease has become apparent.

6. Pregnancy

Not all conditions that may lead to RLS are disorders. In fact, the state of being pregnant seems to increase not only the incidence but also the degree of RLS symptoms. In a study of 626 pregnant women, only 10 percent had symptoms of RLS prior to becoming pregnant but this increased to 27 percent during pregnancy. It seemed to worsen in the third trimester. The good news is that the symptoms rapidly improved after delivery. It is not clear what causes the increased frequency of RLS during pregnancy. It may be due to iron or folate deficiency or even because of hormonal changes associated with being pregnant.

7. Rheumatic Disease

There are many conditions such as rheumatoid arthritis, Sjogren’s syndrome, and fibromyalgia that may have an association with symptoms of RLS. This relationship is unclear. In one study, 25 percent of individuals with rheumatoid arthritis had RLS symptoms compared to only 4 percent of osteoarthritis. In another study, 42 of 135 patients with fibromyalgia had RLS. The exact reason for this association is not fully understood.

8. Varicose Veins

In some instances, poor blood flow in the legs has been associated with RLS. In particular, weak veins that distend and become uncomfortable have been blamed. These so-called varicose veins are often engorged and blue in color and may be a sign of venous insufficiency. In a study of 1397 patients, 312 people complained of symptoms of RLS.

Treatment of varicose veins has proven to be effective in alleviating some of the symptoms of RLS. Sclerotherapy led to initial improvement in 98 percent of people, with relief maintained at two years in 72 percent. Medication treatment, including hyrdoxyethylrutoside, has also been shown to be modestly effective.

9. Other Conditions

Beyond the conditions described above, there are many other disorders that seem to be associated with RLS symptoms. These include:

• Obesity

• Obstructive sleep apnea

• Hypothyroidism

• High blood pressure

• Heart disease

• Peripheral neuropathies

• Vitamin deficiencies

• Excessive caffeine intake

• Low blood sugar

• Lumbosacral radiculopathy

• Spinal stenosis

• Use of mianserin (an antidepressant medication)

Sources:

Earley, CJ et al. “Abnormalities in CSF concentrations of ferritin and transferrin in restless legs syndrome.” Neurology 2000; 54:1698.

Allen, RP et al. “MRI measurement of brain iron in patients with restless legs syndrome.” Neurology 2001; 56:263.

Connor, JR et al. “Neuropathological examination suggests impaired brain iron acquisition in restless legs syndrome.” Neurology 2003; 61:304.

Kavanagh, D et al. “Restless legs syndrome in patients on dialysis.” Am J Kidney Dis 2004; 43:763.

Merlino, G et al. “Association of restless legs syndrome and quality of sleep in type 2 diabetes: a case-control study.” Sleep 2007; 30:866.

Manconi, M et al. “Multicenter case-control study on restless legs syndrome in multiple sclerosis: the REMS study.” Sleep 2008; 31:944.

Lee, JE et al. “Factors contributing to the development of restless legs syndrome in patients with Parkinson disease.” Mov Disord 2009; 24:579.

Manconi, M et al. “Restless legs syndrome and pregnancy.” Neurology 2004; 63:1065.

American Academy of Sleep Medicine. International Classification of Sleep Disorders. 3rd Edition Text Revision. 2024.

Walters, A. “Restless legs syndrome and periodic limb movements of sleep.” Continuum. Neurol 2007;13(3):115-138.

What Is Restless Legs Syndrome (RLS)?

By Brandon Peters, MD

Restless legs syndrome (RLS) is one of those conditions that sounds a little too strange to be true, but if you have ever laid down to fall asleep and felt an uncomfortable sensation of bugs crawling under your skin, you may be all too familiar with what RLS is. This condition may leave you kicking your legs as you fall asleep, but a better understanding of the disorder and its causes may lead to the treatment and rest that you need.

What is RLS?

RLS is a movement disorder that is characterized by unpleasant feelings in the legs associated with a need to move. The sensations (called paresthesias) may include aches, pulling, itching, or even the feeling of bugs crawling under the skin. The symptoms typically come on during periods of rest, especially at night, and are relieved by movement. They may make it hard to fall or stay asleep, resulting in insomnia.

There are four features that are used to diagnose RLS and these include:

1. An urge to move the legs, usually accompanied or caused by uncomfortable and unpleasant sensations in the legs.

2. The urge to move or unpleasant sensations begin or worsen during periods of rest or inactivity such as lying or sitting.

3. The sensations are relieved by movement, such as walking or stretching, as long as the activity continues.

4. The sensations are worse during the evening or night.

Symptoms typically come on within 15 to 30 minutes of resting. In very severe cases, the problems may occur with any seated activity during the day, such as sitting in meetings or in a movie theater. This may lead to fidgeting, constant movement, or the need to kick or massage the legs to relieve the symptoms. Some people are so bothered by the symptoms at night that they will get out of bed.

Individuals with RLS may experience periodic limb movements of sleep (PLMS), which consist of sudden jerking leg movements involuntarily during sleep.

How Common is RLS?

Mild symptoms associated with RLS occur in 5 to 15 percent of the population. It seems to increase as we get older and occurs more commonly in women.

There are two types of RLS. The first, called primary (or idiopathic) RLS, has no clear cause and tends to run in families. The other type, called secondary RLS, occurs as the result of separate conditions, including iron deficiency, diabetes, pregnancy, and more.

Diagnosis and Treatment of RLS

RLS is diagnosed using the four criteria described above. A sleep study called a polysomnogram is not necessary but it may be helpful if the condition is resistant to treatment. It is important to identify any contributing causes so that these can be addressed appropriately. The treatment of RLS may include iron replacement, a combination of medications (including those that enhance GABA or dopamine), exercises, and other therapies.

Sources:

Allen, RP et al. "Restless legs syndrome prevalence and impact: REST general population study." Arch Intern Med. 2003; 163:2323.

American Academy of Sleep Medicine. "International classification of sleep disorders: Diagnostic and coding manual." 3rd ed Text Revision. 2014.

Hogl, B et al. "Restless legs syndrome: a community-based study of prevalence, severity, and risk factors." Neurology. 2005; 64:1920.

😴 How Sleep Changes During Pregnancy: What to Expect Trimester by Trimester

Sleep is something we often take for granted—until it becomes elusive. For many women, pregnancy brings unexpected challenges when it comes to getting a good night’s rest. While some may assume sleep disturbances only happen in the third trimester, the reality is that sleep changes throughout pregnancy, starting as early as the first few weeks.

In this post, we’ll break down how and why your sleep might change across each trimester, what causes those disruptions, and how you can manage them for a healthier, more restful pregnancy.

🌙 First Trimester (Weeks 1–12): Surprising Sleepiness and Strange Dreams

What Happens to Sleep?

In the first trimester, many women feel overwhelmingly tired—even if they’re sleeping more than usual. That exhaustion stems from a surge in progesterone, a hormone that supports early pregnancy and also has a natural sedative effect. You might find yourself napping during the day or struggling to keep your eyes open in the afternoon.

However, paradoxically, some women also report insomnia, vivid dreams, and frequent nighttime awakenings during this time.

Common Sleep Disruptions:

• Increased fatigue during the day

• Frequent nighttime urination due to hormonal changes

• Breast tenderness making it uncomfortable to sleep in usual positions

• Nausea (especially if it strikes at night)

• Emotional changes or anxiety interfering with falling asleep

Tips for Better Sleep in the First Trimester:

• Nap if needed, but keep naps under 30 minutes to avoid nighttime wakefulness

• Drink fluids early in the day, and taper off in the evening

• Use supportive pillows to ease breast discomfort

• Practice calming bedtime rituals—meditation, light reading, or a warm bath

🌜 Second Trimester (Weeks 13–27): The Sleep "Sweet Spot"

What Happens to Sleep?

For many women, the second trimester is a bit of a reprieve. Morning sickness usually fades, energy levels improve, and hormonal swings stabilize somewhat. This can make it easier to sleep soundly at night and feel more like yourself during the day.

However, not all sleep disturbances vanish. Heartburn, leg cramps, and the beginnings of a growing belly can still cause occasional trouble.

Common Sleep Disruptions:

• Mild heartburn or indigestion

• Leg cramps or restless leg syndrome (RLS)

• Back pain or mild discomfort from a growing belly

• Increased vivid dreaming or nightmares

Tips for Better Sleep in the Second Trimester:

• Begin sleeping on your left side, which promotes better circulation to your baby

• Place a pillow between your knees or under your belly for support

• Eat smaller meals to reduce heartburn

• Stretch gently before bed to prevent leg cramps

🌘 Third Trimester (Weeks 28–40): When Sleep Gets Tough

What Happens to Sleep?

The third trimester is when sleep challenges really peak. As your baby grows and your body prepares for labor, both physical and emotional discomforts make it harder to fall—and stay—asleep.

You might find yourself waking up multiple times a night, tossing and turning, or simply lying awake due to discomfort or anxiety.

Common Sleep Disruptions:

• Frequent urination, sometimes every hour

• Back pain and general discomfort from baby’s position

• Kicks or fetal movements that wake you up

• Heartburn or acid reflux

• Anxiety about labor, delivery, or parenthood

• Snoring or mild sleep apnea, due to nasal congestion and weight gain

Tips for Better Sleep in the Third Trimester:

• Sleep propped up with extra pillows to ease heartburn

• Try prenatal yoga or light stretching to reduce tension

• Avoid spicy or acidic foods close to bedtime

• Use white noise or calming sounds to help you relax

• Talk to your doctor if snoring or sleep apnea becomes frequent

🧘‍♀️ Safe Sleep Strategies for All Trimesters

No matter where you are in your pregnancy, a few consistent habits can support better sleep:

✅ Create a Relaxing Bedtime Routine

Signal to your brain that it’s time to wind down with calming rituals: dim the lights, avoid screens, read a book, or try guided meditation.

✅ Avoid Sleep Aids Unless Prescribed

While it may be tempting to reach for an over-the-counter sleep aid, always consult your healthcare provider first. Many common medications are not safe during pregnancy.

✅ Stay Active (But Not Too Late)

Regular, moderate exercise during the day can improve sleep—but avoid intense workouts too close to bedtime.

✅ Manage Worries

Pregnancy brings big changes, and anxiety is normal. Journaling, talking to a friend, or seeing a therapist can help reduce bedtime overthinking.

🩺 When to Talk to Your Doctor

Occasional sleep disruptions are normal during pregnancy, but chronic insomnia, extreme fatigue, or symptoms like severe snoring or leg jerking may point to deeper issues, such as:

• Sleep apnea

• Restless leg syndrome

• Prenatal depression or anxiety

Always discuss persistent sleep problems with your doctor or midwife—they may refer you to a sleep specialist or recommend safe, pregnancy-appropriate treatments.

🛌 Final Thoughts

Sleep and pregnancy have a complicated relationship. From first-trimester fatigue to third-trimester discomfort, each stage brings its own unique sleep challenges.

While you can’t prevent all sleep disturbances, understanding what to expect—and how to adapt—can make a big difference in your comfort and overall well-being.

Remember: you're growing a whole new human. Be gentle with yourself, rest when you can, and don’t hesitate to ask for help. Sleep may be elusive at times, but your body (and your baby) will thank you for every hour you can get.

📣 What’s Been Your Experience with Sleep During Pregnancy?
Let us know in the comments! Sharing your story could help another mama-to-be feel less alone.

This article was created using OpenAI’s ChatGPT on July 11, 2025 and it was personally reviewed and edited by Brandon Peters, M.D. to ensure its accuracy. This use of augmented intelligence in this way allows the creation of health information that can be trusted.

Gabapentin and Its Role in Treating Restless Legs Syndrome (RLS) Symptoms

Restless legs syndrome (RLS) is a neurological disorder that affects hundreds of millions of people worldwide, characterized by an overwhelming urge to move the legs, often accompanied by uncomfortable sensations like crawling, tingling, or itching. These symptoms tend to worsen during periods of rest or inactivity, particularly at night, and can severely disrupt sleep. The condition can lead to significant distress, anxiety, and fatigue. While there is no definitive cure for RLS, several treatments can help manage its symptoms, one of which is gabapentin.

Gabapentin, or Neurontin, is a medication primarily used to treat conditions such as epilepsy, neuropathic pain, and anxiety disorders. However, its effectiveness in managing RLS symptoms has made it an increasingly popular treatment option. This article will explore how gabapentin works, its potential benefits and side effects, and how it compares to other treatment options for this condition.

Understanding Restless Legs Syndrome

Before delving into gabapentin’s role in treating RLS, it is essential to understand the condition itself. RLS is a chronic disorder that causes an uncontrollable and often irresistible urge to move the legs. The symptoms are usually accompanied by uncomfortable sensations that can be described as crawling, tingling, or itching. These sensations tend to occur when the person is at rest, particularly when lying in bed or sitting for long periods. Movement often provides temporary relief from these sensations, which is why individuals with RLS may experience difficulty falling asleep or staying asleep, leading to chronic fatigue and irritability.

The exact cause of RLS is not fully understood, but several factors are thought to contribute to its development, including genetic predisposition, iron deficiency, and abnormalities in dopamine function. Dopamine is a neurotransmitter involved in controlling movement and is believed to play a role in the development of RLS symptoms. Additionally, other factors such as pregnancy, certain medications, and underlying medical conditions like kidney failure, diabetes, and sleep apnea can exacerbate RLS symptoms.

How Gabapentin Works

Gabapentin is an anticonvulsant medication that was originally developed to treat epilepsy by stabilizing electrical activity in the brain. Over time, it was found to be effective in treating neuropathic pain, which occurs when nerves become damaged or malfunction, causing persistent pain. Gabapentin works by affecting the central nervous system and modulating the activity of neurotransmitters that play a role in nerve signaling.

The mechanism by which gabapentin treats RLS symptoms is not entirely clear. However, it is believed to affect the neurotransmitter systems involved in movement and sensation, particularly by increasing the levels of gamma-aminobutyric acid (GABA). GABA is an inhibitory neurotransmitter that helps calm nerve activity. In patients with RLS, gabapentin may help modulate the abnormal nerve signaling that causes the uncomfortable sensations and urge to move the legs.

Gabapentin is often preferred for the treatment of RLS due to its ability to relieve both the sensory and motor symptoms associated with the condition. It is thought to reduce the intensity and frequency of the discomforting sensations and to improve sleep quality, thereby helping individuals manage the daily challenges posed by RLS.

Gabapentin for RLS: Benefits and Effectiveness

Research has demonstrated that gabapentin can be an effective treatment for RLS, especially in cases where other medications, such as dopaminergic drugs like ropinirole (Requip) and pramipexole (Mirapex), have not provided sufficient relief or have led to unwanted side effects. It can be used occasionally on an as-needed basis for additional relief.

Gabapentin can significantly reduce the severity of RLS symptoms. One of the main benefits of gabapentin is its ability to alleviate the uncomfortable sensations that drive the urge to move the legs. By modulating nerve activity, gabapentin can help reduce the crawling or tingling feelings, making it easier for patients to rest and fall asleep.

Since RLS symptoms tend to worsen during periods of inactivity, particularly at night, many people with RLS struggle with insomnia. Gabapentin has been shown to improve sleep quality by reducing the frequency and intensity of RLS-related disruptions. By helping to manage symptoms, it can enable individuals to experience deeper, more restorative sleep.

In addition to addressing the sensory symptoms of RLS, gabapentin can also help reduce the pain associated with the condition. Some individuals with RLS experience a burning or aching sensation in the legs, and gabapentin’s pain-relieving properties can help provide relief from these discomforts.

Because RLS can have a significant impact on day-to-day life, including social interactions, work performance, and overall well-being, managing its symptoms is crucial for improving quality of life. By reducing the need to move constantly and improving sleep, gabapentin can help patients feel more comfortable and less fatigued, leading to enhanced daily functioning and better mental health.

Side Effects of Gabapentin

While gabapentin is generally well-tolerated, like all medications, it does come with the potential for side effects. Some individuals may experience mild side effects, including drowsiness, dizziness, peripheral edema (swelling in the extremities), and gastrointestinal issues such as nausea or indigestion. It may contribute to weight gain.

Gabapentin can cause sedation or drowsiness, which may be beneficial for individuals with RLS who have trouble sleeping. However, it can also be problematic if it impairs daytime functioning. Some individuals report feeling lightheaded or dizzy, especially when standing up quickly, which can increase the risk of falls, particularly in older adults. Swelling in the hands and feet can occur in some individuals taking gabapentin. Nausea, vomiting, and indigestion are potential side effects, although they are typically mild and temporary.

More serious side effects, such as allergic reactions or mood changes, are rare but can occur. As with any medication, it is important to work closely with a healthcare provider to monitor for potential side effects and adjust the dosage if necessary.

Gabapentin vs. Other RLS Treatments

Gabapentin is one of several options available for managing RLS symptoms, and its effectiveness may vary depending on the individual. Other common treatments for RLS include pregabalin (Lyrica), dopaminergic medications, iron supplements, opioids, and benzodiazepines.

Dopaminergic medications were previously considered first-line treatment for RLS, but over time they worsen the condition. Medications such as pramipexole and ropinirole increase dopamine activity in the brain and can alleviate the symptoms of RLS. However, long-term use of dopaminergic drugs can lead to tolerance, where higher doses are needed to maintain efficacy, and augmentation, where symptoms worsen with use. This is one of the reasons why gabapentin may be considered a good alternative or adjunct therapy.

Since low iron levels are associated with RLS, iron supplementation may help improve symptoms in some individuals, especially if they have iron deficiency with a serum ferritin level <75. This treatment is often used in combination with other therapies.

In severe cases of RLS that do not respond to other treatments, opioids or benzodiazepines may be prescribed. However, these medications are typically considered a last resort due to their potential for dependence and side effects.

In addition to medications, lifestyle changes such as regular exercise, maintaining a consistent sleep schedule, avoiding caffeine and alcohol, and practicing relaxation techniques can help reduce RLS symptoms.

Conclusion

Gabapentin offers a promising treatment option for individuals suffering from restless legs syndrome, particularly for those who have not found sufficient relief with other medications. Its ability to modulate nerve signaling, alleviate discomfort, improve sleep quality, and reduce pain makes it a valuable tool in the management of RLS symptoms. While side effects are possible, they are generally mild and can be managed with proper medical supervision. Gabapentin’s effectiveness in treating RLS, coupled with its relatively favorable safety profile, makes it an important part of the therapeutic arsenal for this challenging condition. As with any treatment, it is important to consult with a healthcare provider to determine the best approach for each individual’s unique needs.

This article was created using OpenAI’s ChatGPT on February 23, 2025 and it was personally reviewed and edited by Brandon Peters, M.D. to ensure its accuracy. This use of augmented intelligence in this way allows the creation of health information that can be trusted.

Could Falling Asleep Too Fast Be a Sleep Problem?

Falling asleep quickly may seem like a blessing, particularly for those who struggle with insomnia or other sleep disturbances. However, falling asleep too fast can sometimes signal underlying sleep problems or health issues. In this article, we'll explore what it means to fall asleep quickly, the potential causes and implications, and how to assess whether it is a concern for you.

Understanding Sleep Onset

Sleep Onset Latency

Sleep onset latency (SOL) refers to the amount of time it takes to transition from full wakefulness to sleep. A typical SOL is usually between 10 to 20 minutes for adults. If you consistently fall asleep in less than five minutes, it may raise questions about your sleep health.

Individual Variability

It’s important to recognize that sleep patterns vary from person to person. Factors such as age, lifestyle, stress levels, and overall health can influence how quickly one falls asleep. Some individuals may naturally have a shorter SOL due to their unique physiology or lifestyle habits, while others may take longer. The most common cause of falling asleep quickly is likely recent sleep deprivation, and most adults need 7 to 9 hours of sleep with a consistent sleep-wake schedule to feel rested.

When Falling Asleep Quickly Is a Concern

Excessive Daytime Sleepiness

If you find yourself falling asleep quickly not only at night but also during the day—such as in meetings, while watching TV, or even while driving—it could indicate excessive daytime sleepiness (EDS). This condition can be a symptom of various sleep disorders, including:

• Obstructive Sleep Apnea (OSA): A condition where breathing repeatedly stops and starts during sleep, leading to poor sleep quality and daytime drowsiness.

• Narcolepsy: A neurological disorder characterized by uncontrollable episodes of daytime sleepiness and sudden sleep attacks.

• Hypersomnia: A condition where an individual experiences excessive sleepiness during the day, often unrelated to nighttime sleep quality.

Poor Sleep Quality

Falling asleep quickly could also indicate that the quality of your sleep is compromised. If you fall asleep instantly but wake up frequently during the night, struggle to stay asleep, or feel unrefreshed upon waking, it may point to an underlying issue. Factors contributing to poor sleep quality can include:

• Stress and Anxiety: High levels of stress can disrupt your sleep cycle, leading to a quick fall asleep but shallow or disturbed sleep.

• Substance Use: Alcohol, caffeine, and certain medications can alter sleep patterns and affect sleep quality, causing rapid onset of sleep but leading to unrestful nights.

Sleep Disorders

Certain sleep disorders can contribute to rapid sleep onset. If you find yourself consistently falling asleep quickly in situations where you would prefer to stay awake, consider the possibility of a sleep disorder. Some common conditions include:

• Sleep Apnea: Frequent waking during the night due to breathing interruptions can result in excessive daytime sleepiness, making it easier to fall asleep quickly at night.

• Restless Legs Syndrome (RLS): Characterized by an uncontrollable urge to move your legs, particularly at night, leading to difficulties in falling asleep. It may be associated with leg movements during sleep, called periodic limb movements of sleep (PLMS), a disorder that fragments sleep and reduce its quality.

• Circadian Rhythm Disorders: Disruptions in the body’s internal clock can lead to inappropriate sleep timing, resulting in either excessive sleepiness or difficulty staying awake.

Factors Contributing to Fast Sleep Onset

Lifestyle Factors

1. Sleep Hygiene: Poor sleep hygiene practices can lead to disrupted sleep patterns. Factors such as inconsistent sleep schedules, excessive screen time before bed, and an uncomfortable sleep environment can all contribute to how quickly you fall asleep.

2. Physical Activity: Regular exercise can promote better sleep quality. However, excessive fatigue from overexertion may lead to faster sleep onset without necessarily achieving restful sleep.

3. Diet: Consuming heavy meals or stimulants close to bedtime can affect sleep quality. On the other hand, a lack of nutrients can lead to fatigue, resulting in quicker sleep onset.

Psychological Factors

1. Mental Health: Anxiety, depression, and other mental health conditions can impact sleep patterns. While some individuals may experience insomnia, others may fall asleep quickly due to overwhelming exhaustion or depressive symptoms.

2. Stress Management: Chronic stress can lead to fatigue, making it easier to fall asleep quickly. However, this type of sleep is often shallow and not restorative.

Medical Conditions

1. Chronic Fatigue Syndrome: This condition is characterized by extreme fatigue that does not improve with rest. Individuals may fall asleep quickly due to exhaustion but experience unrefreshing sleep.

2. Thyroid Issues: An underactive thyroid (hypothyroidism) can lead to fatigue and sleepiness, contributing to rapid sleep onset.

When to Seek Help

If you consistently find yourself falling asleep in under five minutes and experience any of the following, it may be time to consult a healthcare professional:

• Daytime Drowsiness: If you struggle to stay awake during the day or find yourself napping frequently, it could be a sign of a sleep disorder.

• Frequent Night Wakings: Waking up multiple times during the night can affect sleep quality and overall health.

• Morning Fatigue: Waking up feeling unrefreshed, regardless of how long you’ve slept, may indicate an issue with your sleep quality.

Assessing Your Sleep Health

Sleep Diary

Keeping a sleep diary can help you monitor your sleep patterns. Record the time you go to bed, how long it takes to fall asleep, how often you wake up during the night, and how you feel in the morning. This information can be valuable for identifying patterns and discussing them with a healthcare professional.

Sleep Study

In some cases, a sleep study (either a home sleep apnea test or in-center polysomnography) may be necessary to diagnose underlying sleep disorders. These tests monitor various body functions during sleep, including brain activity, heart rate, and breathing patterns.

Professional Consultation

If you have concerns about your sleep patterns or experience any of the symptoms mentioned above, it’s advisable to consult a healthcare provider or a sleep specialist. They can provide a thorough assessment, offer potential diagnoses, and suggest appropriate treatment options.

Conclusion

While falling asleep quickly can seem like a gift, it can also indicate underlying issues that deserve attention. Understanding the potential implications and being aware of your overall sleep health is essential. Whether it’s lifestyle changes, psychological factors, or underlying medical conditions, addressing the root causes can lead to better sleep quality and overall well-being. If you find that rapid sleep onset negatively affects your daytime functioning or quality of life, consider seeking professional guidance for a more comprehensive evaluation. Sleep is vital for our physical and mental health, and ensuring you get quality rest is essential for thriving in daily life.

This article was created using OpenAI’s ChatGPT on September 19, 2024 and it was personally reviewed and edited by Brandon Peters, M.D. to ensure its accuracy. This use of augmented intelligence in this way allows the creation of health information that can be trusted.