Patients with obstructive sleep apnea become drowsy in the morning, sleep or doze much of the day, and have fitful, interrupted sleep at night. If the dose of a sedative is increased because of an incorrect diagnosis, restlessness and wandering in a clouded or confused state may occur at night. Rebound wakefulness commonly occurs when hypnotics are withdrawn from a patient who regularly takes heavy doses. Most patients wrongly interpret this effect as recurrence of chronic insomnia. However, insomnia may reflect a normal need for little sleep.
Difficulty falling asleep is usually due to anxiety.
For persistent unexplained insomnia, evaluation in a sleep laboratory may help. Treatment Treatment depends on the underlying cause. Many patients respond to reassurance that their sleeplessness is a result of normal anxieties or is secondary to a treatable physical disorder. Discussing anxieties with the patient often eases distress and helps reestablish normal sleep patterns. Elderly patients experiencing normal changes in sleep patterns should be reassured, instructed in relaxation, and encouraged to exercise more during the day and to avoid daytime naps.