Lawrence Epstein, MD, is the regional medical director for the Harvard-affiliated Sleep HealthCenters, an instructor at Harvard Medical School, and past president of the American Academy of Sleep Medicine. He is coauthor of The Harvard Medical School Guide to a Good Night's Sleep.
Q: When I have trouble sleeping, I depend on coffee to get through my morning. Will that make it harder to fall asleep the next night, too?
A: Coffee can make insomnia worse. You've got to remember that the effect of caffeine can be long-lasting. The half-life of caffeine is four to seven hours, so it will be in your system for longer than you think, affecting your behavior, your alertness, and your ability to fall asleep. Some people drink caffeine in the afternoon when they feel tired, but it becomes hard to fall asleep at night, which perpetuates the problem. I recommend avoiding all caffeine after noon.
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Q: Some nights it takes me an hour or two of tossing and turning to fall asleep. When--and how--should I seek medical help?
A: Almost everyone will have an occasional problem sleeping, but you can usually directly relate that to a cause, like a fight with your significant other, work trouble, jet lag from multiple-time-zone travel, etc. These problems can often resolve themselves in a few days.
But if you have trouble sleeping for more than a month even after those issues have been resolved, you may want to see a doctor. Additionally, if you're having symptoms suggestive of a sleep disorder--such as gasping or snoring, frequent kicking or movement at night, disruptive sensations in the legs or arms, or difficulty getting to sleep when you used to be a good sleeper--make an appointment with a physician. Your primary care doctor may refer you to a specialist trained in sleep medicine.
Q: Recently, I've been waking every night to use the bathroom between 2 a.m. and 4 a.m. Why could this be?
A: First, you should try to figure out if you're waking up because you have to go to the bathroom, or if you're waking up for another reason and then deciding to go while you're up. If you're waking up with the urge to urinate, look at your fluid intake and cut down on the amount you drink in the evening. If that doesn't help, see a doctor to rule out a bladder or prostate problem; it may not even be a sleep problem.
If you aren't being awakened by the urge, aging could be the culprit. Your sleep need doesn't change over the course of your lifetime, but your sleep habits do. You wake more as you get older, and your sleep becomes less continuous, so you may need more time in bed to get the same amount of sleep. Most people start to notice a change in their 40s and 50s or during menopause. Waking once or twice at night as you get older is very common and doesn't indicate a problem.