Advice from Carlos H. Schenck, MD, on Sleep Problems, Strange Behaviors, and When to See a Doctor


"Because these disorders occur while the patient is asleep, its easy to deny symptoms. Patients are relying on others to tell them about their actions while sleeping."(PARASOMNIAS-RBD.COM)

Carlos H. Schenck, MD, is a senior staff psychiatrist at the Minnesota Regional Sleep Disorders Center and author of Sleep: The Mysteries, The Problems, and The Solutions (Penguin/Avery Press, 2007). He has served as co-chairman of the Parasomnias Committee for the International Classification of Sleep Disorders, and is a member of the American Academy of Sleep Medicine (AASM) Nosology Committee as well as the AASM Movement Disorders Task Force.

Q: I dont always sleep well. At what point should I see a sleep doctor?

A: As soon as your sleep problems begin interfering with your physiological or psychological functioning—or if your actions in sleep negatively affect the sleep of your bed partner. Its always good to see your general practitioner first. A lot of medication can cause sleep issues, so altering your prescription can help. If the problem persists, you can get a reference to an accredited sleep center.

Q: Are sleep disorders treatable?

A: Yes. Because of advances in diagnosis and treatment, most patients can be treated successfully with medications, behavioral changes, or both.

Q: How much sleep do I need?

A: Its all about how you feel in the morning. Most adults need 7½ to 8 hours. However, you have to consider the functional impact of sleep. There are long sleepers and there are short sleepers. People can function with anywhere from 6 hours to 10 hours of sleep.

Q: I feel like I sleep fine, but Im always tired during the day. What could be the problem?

A: If you usually dont feel rested, its because youre not getting restorative sleep. You may notice a lack of concentration and irritability. Sleep disorders, such as obstructive sleep apnea, can lead to chronic sleep deprivation and daytime sleepiness, even if you dont realize anything is wrong at nighttime. You should see your doctor to try to determine the cause.

Q: Why should someone seek help for a sleep problem?

A: Sleep should be a good experience. You have to get enough sleep to function properly. Without restorative sleep, your concentration and decision-making ability decrease, your motor function is impaired, and your ability to fight illness and disease declines.

Q: Sleep problems seem to run in my family. Is it possible theyre hereditary?

A: Yes, but only partially. Most sleep disorders are a combination of genetics and behavior. If your parents have sleep disorders, you are at an increased risk. The genetic basis, which you dont have any control over, can make you vulnerable. Insomnia and restless legs syndrome have been shown to run in the family, and risk factors for obstructive sleep apnea, including obesity, are also hereditary.

But at the same time, there are factors that you can change. Our lifestyles are high-stress, 24/7, and caffeine-filled. People keep irregular schedules and dont manage stress, because they think sleep can be abused. You can inherit this type of behavior from a parent or family member—but you can also control it and reduce your risk.

Q: Sometimes I act strangely in my sleep: I talk, move around, and bother my wife while shes sleeping. Should I be worried?

A: If these episodes are infrequent enough and youre not losing much sleep, you probably shouldnt worry. Sleep-talking and tossing and turning is relatively normal, as long as it seems harmless. If you are acting out vivid dreams, however, you could have REM sleep behavior disorder (RBD)—a serious condition that should be addressed right away.

With RBD, you can injure others by throwing a punch or putting someone in a head lock or strangle hold, or you can injure yourself by running into the furniture or walls. Also, we now know that two-thirds of RBD patients will eventually develop Parkinsons disease. If you are diagnosed with RBD, chances are you can develop Parkinsons earlier.

Q: Im embarrassed to talk to my doctor about my sleep problem. What can I do?

A: Numbers show that at least 20 million Americans have sleep disorders, but people still fear the stigma of being labeled with a psychological disorder. Dont worry: Except in rare cases, that wont happen. The medical community used to believe that people who exhibited violent or aggressive or sexual behavior in their sleep probably had unaddressed psychological problems. Weve found thats not true. Another factor is ignorance. Because these disorders occur while the patient is asleep, its easy to deny symptoms. Patients are relying on others to tell them about their actions while sleeping.

Q: What are the top three general things people can do to get a good nights sleep?

A: First, you can minimize overstimulation. Try to cut down on light, sound, or anything that will cause anxiety. Second, use your bedroom only for sleep. Dont use your bedroom as an office or game room. And finally, keep close track of caffeine, alcohol, tobacco, or any stimulant use. If you suffer from insomnia, especially, limit caffeine after lunch.

Q: I noticed that I started sleeping poorly and gaining weight at the same time. Could these be connected?

A: Yes, there have been studies that link lack of sleep to weight gain. Obstructive sleep apnea, for example, can be both a cause and an effect of being overweight. Sleep-related eating disorders can negatively affect your metabolic system. Plus, lack of sleep in general can put you at risk for heart disease, type 2 diabetes, and other chronic illnesses also related to being overweight.

Q: What are some of the more outlandish things people do in their sleep?

A: All of us are capable of any type of behavior in our sleep. All the basic instincts—sex, eating, aggression—can come out during sleep. In the realm of sleep-related eating, Ive seen people eat cat food, salt-and-sugar sandwiches, or butter on cigarettes. They just dont have good judgment. One woman put a head of lettuce in her bathroom, because thats where she thought it was safest.