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Health education · SleepSaint‑Hyacinthe
Difficulty sleeping, frequent awakenings, snoring, fatigue, sleepiness or unusual behaviours at night: sleep disorders take many forms.
Sleep plays an essential role in physical recovery, brain function, alertness, mood and overall health. An occasional bad night is normal; when problems become frequent, persist or affect your days, an assessment may be appropriate.
Sleep disorders are not just insomnia. At Clinique IPS du Palais, the assessment first aims to understand the nature of the problem in order to guide management and, if needed, the appropriate investigations.
Where to start?
Choose the situation that best describes your problem to go directly to the corresponding section.
Know the difference
A person can be very tired without being sleepy, and vice versa.
This distinction helps guide the assessment and differentiate the possible causes.
Understanding
Two people who say “I sleep poorly” can have completely different problems.
The assessment seeks to find out not only how many hours you sleep, but also how you sleep, what happens during your sleep, how you feel when you wake up and how your sleep affects your days.
Canadian benchmarks are 7 to 9 hours per night from 18 to 64 years of age, and 7 to 8 hours at 65 and over.1 But sleeping eight hours does not guarantee restorative sleep if the night is often interrupted.
A sleep disorder repeatedly or persistently disrupts:
1 · Insomnia
When these difficulties persist and have daytime consequences, an assessment may be indicated. A person who wakes up often may, for example, have sleep apnea rather than insomnia.
Stress, anxiety, depressed mood, pain, reflux, medications, caffeine, alcohol, night work, irregular schedules, menopause symptoms, sleep apnea, restless legs or certain medical conditions.
The cause must be investigated before simply concluding that it is insomnia.
2 · Breathing
The best known is obstructive sleep apnea: during sleep, the upper airway repeatedly narrows or closes, which reduces or temporarily stops airflow. Sleep is then fragmented by micro-arousals, sometimes without the person realizing it.
According to the CHUM.3
According to the CHUM.3 However, snoring does not automatically mean you have apnea.
Left untreated, sleep apnea can lead to complications. The Public Health Agency of Canada mentions, among others, high blood pressure, stroke, heart attack, road collisions, depression and workplace injuries.2
Symptoms alone are generally not enough. Depending on the situation, a sleep study may be indicated: a test done at home with sensors, or a more complete polysomnography in hospital.3
The choice depends on the symptoms, the medical history and the suspected disorder.
Apnea is not always obstructive. In central apnea, breathing stops because the signal that controls it becomes temporarily insufficient or unstable.
It can be associated with certain conditions or medications and requires an appropriate investigation.
3 · Sleepiness
Lack of sleep, sleep apnea, work schedules, medications, alcohol or other substances, circadian rhythm disorder, certain diseases, narcolepsy, idiopathic hypersomnolence or other neurological sleep disorders.
Persistent or unexplained sleepiness warrants an assessment.
Narcolepsy is a sleep disorder characterized by excessive daytime sleepiness.4 Depending on the form, it may also include:
Idiopathic hypersomnia is characterized by a great need for sleep, great difficulty waking up and persistent sleepiness. These disorders generally require a specialized assessment.
5 · Biological clock
The brain has a biological clock that regulates sleep, wakefulness, alertness, body temperature and certain hormonal functions. When it is out of sync with the desired or imposed schedule, a circadian rhythm disorder may be present.
Falling asleep and waking up very late, having great difficulty going to bed early and getting up in the morning.
When the person follows their natural schedule, their sleep can be relatively normal.
The opposite situation: a strong urge to sleep very early in the evening and spontaneous waking very early in the morning.
When the work schedule conflicts with the biological clock: difficulty sleeping during the day, shortened sleep, fatigue, sleepiness at work and reduced alertness.
6 · Legs
It shows up as unpleasant sensations in the legs and an irresistible urge to move them when the body is at rest or inactive. Symptoms occur mainly in the evening and at night and are relieved by movement.5
They can make falling asleep particularly difficult.
The Fondation Sommeil lists iron deficiency among the possible causes of the syndrome.5 When it is suspected, the professional may check certain lab results depending on the context.
Taking iron just because you have leg symptoms, without a prior assessment, is not recommended.
Repetitive leg movements during sleep may be observed by a partner or detected during a sleep study. They are not automatically a sign of disease.
8 · Nighttime behaviours
Parasomnias include unusual behaviours or phenomena during sleep: sleepwalking, night terrors, confusional arousals, nightmares, acting out dreams, vocalizations or movements.
Some are relatively benign.
An assessment becomes more important when they:
Overall health
Chronic pain, reflux, respiratory disorders, cardiovascular or thyroid diseases, anemia or iron deficiency, neurological disorders, anxiety, depression: several conditions can affect sleep.
The assessment should consider overall health.
Perimenopause and menopause can be accompanied by hot flashes and night sweats, repeated awakenings and less restorative sleep.
However, not everything should be attributed to hormones: another disorder may be present at the same time.
Some medications can cause drowsiness, difficulty falling asleep, awakenings, unusual dreams or restlessness.
The assessment includes a review of medications, over-the-counter and natural products, caffeine, alcohol and other substances.
Assessment
A good assessment generally begins with a detailed sleep history.
Bedtime, time taken to fall asleep, number and duration of awakenings, wake-up time, snoring, breathing pauses, movements, nighttime behaviours.
Fatigue, sleepiness, concentration, irritability, naps, falling asleep involuntarily, alertness behind the wheel.
Caffeine, alcohol, nicotine, physical activity, night work, schedule, screens, pace of life.
Medical conditions, mental health, medications, hormonal changes, weight changes, cardiovascular or respiratory symptoms.
Yes. Some signs go unnoticed by the person who is sleeping. A partner can report snoring, breathing pauses, movements, restlessness, shouting, unusual behaviours or sleepwalking.
Recording, for a few days or weeks, the time you go to bed, fall asleep, wake up during the night and get up, naps, sleep quality and sometimes caffeine, alcohol or medications.
It helps identify patterns and your natural rhythm.
It can provide approximate sleep times, activity, heart rate and general trends, but it does not replace a clinical assessment or a diagnostic test.
Its data can, however, be useful to show the health professional.
There is no single test for all sleep disorders. Depending on the symptoms, the health professional may consider a sleep diary, validated questionnaires, certain blood tests, a home sleep study, polysomnography or a referral to sleep medicine.
Polysomnography can record breathing, oxygen, heart rhythm, movements, and brain and muscle activity. It is not necessary for everyone: simple difficulty falling asleep does not automatically justify it.
Sometimes.
There is no “sleep blood test.” Tests are chosen according to symptoms: complete blood count, iron status, thyroid function, blood glucose, metabolic parameters or other targeted tests.
Treatment
There is no single treatment: management depends on the diagnosis.
A structured behavioural approach, including cognitive behavioural therapy for insomnia (CBT-I), which practice guidelines recommend as first-line treatment.6
Depending on the situation: continuous positive airway pressure (CPAP), lifestyle changes or other treatments.2
Structured changes to schedules and light exposure, and sometimes other interventions.
Depending on symptoms, aggravating factors, medications and sometimes iron status.
Specialized assessment and specific treatments.
Depending on the type of parasomnia and the risk of injury.
The goal is to treat the cause rather than simply induce sleep.
Day to day
They are not enough to treat all sleep disorders, but they can promote more regular sleep.
The SAAQ points out that fatigue behind the wheel reduces concentration, slows reactions and can cause memory gaps about the last kilometres travelled.7 Opening the window, turning up the radio, singing, changing position, chewing gum or talking to passengers are not effective solutions.7
The SAAQ also specifies that persistent fatigue may reveal an undiagnosed sleep disorder or another medical condition.7
If you have trouble staying awake behind the wheel, stop in a safe place and have the cause assessed if the problem recurs.
A consultation may be appropriate if your sleep has been disturbed for several weeks, if you never feel rested, if your sleep affects your activities, if those around you notice breathing pauses or if you fall asleep involuntarily during the day.
A medical emergency should not wait for a regular consultation for a sleep problem.
At Clinique IPS du Palais, we can carry out an initial assessment: your symptoms, your schedule, the quality of your sleep, your fatigue and sleepiness, your habits, your medications and your history.
Depending on the situation, the assessment can help identify contributing factors, review certain medications, target relevant changes, determine whether tests are indicated, assess the possibility of a sleep-related breathing disorder or determine whether investigation or a referral is necessary.
Frequently asked questions
No. Canadian recommendations are population-level benchmarks. Your daytime functioning and your individual situation must also be considered.
Sleep duration is only one factor. Fragmented sleep, sleep apnea, certain medications or another medical condition can, among other things, contribute to fatigue.
Not necessarily. Snoring can occur without apnea. However, snoring accompanied by pauses in breathing, choking at night or daytime sleepiness warrants an assessment.
Yes. The pauses in breathing and micro-arousals occur during sleep. A partner is sometimes the first to notice the problem.
Yes. Apnea is only one of many sleep disorders. The absence of snoring does not rule out other conditions.
No. Fatigue is mainly a lack of energy. Sleepiness is an actual tendency to fall asleep.
Usually not. However, tests can look for certain conditions that contribute to the symptoms.
No. Treatment varies depending on the cause: behavioural interventions, devices, schedule changes, medical treatments or a combination of approaches.
Sleep disorders are a group of very different conditions: falling asleep, staying asleep, breathing, alertness, the biological clock, nighttime movements or behaviours. The first step is to understand which problem is actually present.
Appropriate management begins with a good assessment rather than an immediate search for a sleeping pill.
The information on this page is provided for informational purposes and does not replace an assessment by a health professional.
