Sleep Medicine

Obstructive sleep apnea (OSA) is a common sleep disorder. It happens when the airway (the passage that carries air to your lungs) becomes blocked during sleep.

When you fall asleep, the muscles in your throat relax. In people with OSA, the soft tissues in the back of the throat—such as the tongue, tonsils, or uvula—relax too much and partially or completely block the airway.

This can cause:

• Apnea – a pause in breathing
• Hypopnea – very shallow breathing

These breathing pauses can happen many times each hour, sometimes hundreds of times a night. When this happens, your oxygen level drops and your brain briefly wakes you up to restart breathing—even if you don’t remember it. This leads to poor-quality, disrupted sleep.

Common Symptoms

People with obstructive sleep apnea may experience:

• Loud, chronic snoring
• Gasping or choking during sleep
• Waking up frequently during the night
• Frequent nighttime urination
• Feeling very tired during the day
• Trouble falling or staying asleep
• Difficulty concentrating
• Morning headaches
• Irritability or mood changes
• Erectile or sexual dysfunction

What Causes It?

Common risk factors and causes include:

• Being overweight or obese
• Enlarged tonsils or adenoids
• A naturally narrow airway
• Menopause
• Certain medical conditions, such as heart failure or prior stroke

Why Treatment Is Important

If left untreated, obstructive sleep apnea can increase the risk of:

• High blood pressure
• Heart disease
• Stroke
• Type 2 diabetes
• Memory and concentration problems
• Work-related or motor vehicle accidents

Central sleep apnea (CSA) is a sleep disorder in which breathing repeatedly stops and starts during sleep.

Unlike obstructive sleep apnea (where the airway is blocked), central sleep apnea happens because there is not a steady signal to the muscles that control breathing. In other words, the problem is not a blocked airway—it is a communication.

What Causes Central Sleep Apnea?

CSA can happen for several reasons:

• Medications: Some medicines—especially opioids and benzodiazepines—can slow or suppress breathing.
• Heart failure: Heart problems can affect how the body regulates breathing.
• Brainstem problems: The brainstem controls breathing. Damage from a stroke or other neurologic condition can affect this control.
• Unknown cause (idiopathic): Sometimes, no clear cause is found.

Common Symptoms

People with central sleep apnea may experience:

• Pauses in breathing during sleep (often without loud snoring)
• Excessive daytime sleepiness
• Fatigue
• Irritability
• Morning headaches
• Difficulty concentrating

Because breathing pauses may not cause loud snoring, CSA can be harder to notice without a sleep study.

How Is It Diagnosed?

Central sleep apnea is diagnosed with a sleep study. During this test, your breathing, heart rate, oxygen levels, and brain activity are monitored while you sleep.

If central sleep apnea is suspected, an in-lab sleep study may be recommended so your breathing can be closely observed.

How Is It Treated?

Treatment often includes a device called a positive airway pressure (PAP) machine. This machine delivers pressurized air through a mask worn during sleep to help stabilize breathing.

A special type of PAP device called Adaptive Servo-Ventilation (ASV) may be recommended. This device:

• Monitors your breathing
• Adjusts pressure as needed
• Can deliver a breath if your breathing pauses for too long

In some cases, treatment may also involve:

• Adjusting or reducing certain medications
• Treating underlying heart or neurologic conditions

Snoring is common and can have many causes. Sometimes it is harmless. In other cases, it may be a sign of a more serious condition, such as sleep apnea.

Your sleep provider can help determine the cause of your snoring and whether further testing is needed.

Step 1: Rule Out Sleep Apnea

If your snoring is loud, frequent, or combined with symptoms such as daytime fatigue, choking during sleep, or pauses in breathing, a sleep study may be recommended.

In many cases, this test can be done at home in your own bed. The results help guide the best treatment options.

Lifestyle Changes That May Help

Simple changes can often improve snoring:

Sleep Position

• Avoid sleeping on your back.
• Sleeping on your side can help prevent the tongue and throat tissues from blocking the airway.
• Body pillows or specific positional therapy devices may help you stay off your back.

Elevate Your Head

• Raising the head of your bed 10–30 degrees (with a wedge pillow, bed risers, or an adjustable bed) may reduce snoring.
• Regular pillows alone are usually not effective.
• Elevation may also help with nasal congestion or acid reflux (GERD).

Weight Loss

• Extra weight can put pressure on the airway and worsen snoring.

Avoid Alcohol and Sedatives Before Bed

• These relax throat muscles and can make snoring worse.

Exercise

• Regular aerobic exercise can improve muscle tone.
• Throat exercises (including singing or tongue exercises) may also strengthen airway muscles.

Use a Humidifier

• Moist air may reduce airway dryness and irritation.

Treat Nasal Congestion or Allergies

• Managing allergies or sinus problems can improve airflow.

Medical Devices

If lifestyle changes are not enough, medical devices may help:

Nasal Strips

• Adhesive strips placed on the outside of the nose.
• May help open nasal passages and improve airflow.

Oral Appliances

• Custom-made devices worn in the mouth during sleep.
• They reposition the lower jaw or tongue to keep the airway open.
• Your provider can refer you for evaluation if appropriate.

CPAP (Continuous Positive Airway Pressure)

• Typically used if snoring is caused by sleep apnea.
• Delivers pressurized air through a mask to keep the airway open during sleep.

Surgical Options (For Select Patients)

Surgery is considered only in specific situations:

Uvulopalatoplasty (UVP)

• Removes extra tissue from the soft palate and uvula.

Tonsillectomy or Adenoidectomy

• Removes enlarged tonsils or adenoids that block airflow.

Important

The best treatment depends on the cause of your snoring. A healthcare professional can help determine the safest and most effective option for you.

At The Oregon Clinic, we often use a device called WatchPAT for home sleep apnea testing.

WatchPAT is a small, FDA-cleared device that allows you to complete a sleep study in your own home. It helps screen for and diagnose sleep apnea and other sleep-related breathing disorders — without needing to stay overnight in a sleep lab.

How It Works

The WatchPAT study is simple and non-invasive.

• You wear a small device on your wrist.
• You place a soft sensor on your fingertip.
• You sleep in your own bed overnight.

The device measures:

• Heart rate
• Oxygen levels
• Breathing patterns
• Snoring
• Changes in blood flow related to sleep stages

The fingertip sensor collects detailed information about changes in blood flow that help determine sleep stages and breathing events. This provides more information than a basic oxygen monitor alone.

After the study, the data is securely uploaded for your provider to review.

Important to Know

A home WatchPAT study can often diagnose sleep apnea.

However:

• A normal or unclear result does not completely rule out sleep apnea.
• If results are inconclusive, your provider may recommend a more detailed in-lab sleep study.

Not everyone is a candidate for WatchPAT. Certain medical conditions, medications, or other factors may make an in-lab study more appropriate. Your provider will recommend the best option for you.

Benefits of WatchPAT

Convenient

• Done at home
• No overnight lab visit
• Sleep in your own bed

Comfortable

• No mask
• No multiple wires attached to your body

Accurate

• Provides detailed data to guide diagnosis and treatment

Faster Access

• Often scheduled sooner than an in-lab study

Getting Your Results

In most cases, your provider will send your results and treatment recommendations through MyChart.

If you have questions about whether a home sleep study is right for you, your provider can help guide you.

A split-night sleep study is an overnight test done in a sleep lab. It combines two tests in one night:

1. Diagnosis – to see if you have sleep apnea or another sleep disorder.
2. Treatment testing (CPAP titration) – to find the right CPAP pressure if sleep apnea is found.

This approach can speed up diagnosis and treatment, especially for people with moderate to severe sleep apnea.

Why Is This Test Done?

A split-night study helps:

• Diagnose sleep apnea and other sleep disorders
• Measure how severe the problem is
• Guide treatment decisions

If moderate or severe sleep apnea is detected during the first part of the night, you may be asked to wear a CPAP mask for the second half of the study to determine the right pressure settings.

What Happens During the Study?

The study takes place in a sleep lab, often located in at Providence hospital or similar medical facility.

Before You Sleep

Small sensors are placed on:

• Your scalp
• Near your eyes
• Chin
• Chest
• Abdomen
• Legs

These sensors monitor:

• Brain waves
• Eye movements
• Heart rate
• Breathing patterns
• Oxygen levels
• Body movements

The sensors are painless and designed to be as comfortable as possible.

The Two Phases of the Night

1. Diagnostic Phase

For the first part of the night (at least two hours of sleep), the team monitors your sleep to look for signs of sleep apnea or other disorders.

• If sleep apnea is not severe enough, the entire night may remain diagnostic (no CPAP used).
• If moderate or severe sleep apnea is detected, the study moves to the second phase.

2. Treatment (CPAP) Phase

You will wear a CPAP mask for the rest of the night.

A sleep technologist will:

• Adjust the air pressure
• Find the most effective and comfortable setting

You can easily disconnect from the equipment if you need to use the bathroom.

After the Study

A sleep medicine specialist carefully reviews the results.

Based on the findings, your provider may recommend:

• CPAP therapy
• An oral appliance
• Medication
• Lifestyle changes

Benefits

• Provides a detailed and accurate diagnosis
• Allows treatment to begin more quickly
• Helps identify other sleep or medical issues

Limitations

• May be costly (check with your insurance about coverage and copays)
• Sleeping in a lab may feel unfamiliar or uncomfortable
• Not appropriate for everyone (for example, some people with severe mobility issues or certain medical conditions)

Most of the time, your sleep study results will be communicated through Epic MyChart. Epic MyChart is a secure online patient portal used by healthcare providers at The Oregon Clinic.

It allows you to manage your healthcare online or through a mobile app — anytime, from anywhere. From MyChart you can: view health information, manage appointments, send messages, make billing payments and more!

How to Get Started

1. Sign Up
   Create an account through The Oregon Clinic’s website or download the MyChart mobile app.
2. Log In
   Use your username and password. You can also set up quick login options, such as a passcode or fingerprint, on your mobile device.
3. Connect Other Accounts (Optional)
   If other healthcare organizations you use also have Epic, you may be able to link accounts to manage your information in one place.

AHI stands for Apnea-Hypopnea Index.

It is a number used in sleep studies to measure how severe sleep apnea is.

AHI tells us how many times per hour your breathing slows down or stops during sleep.

What Do the Numbers Mean?

• 0–5: Normal
• 5–14: Mild sleep apnea
• 15–29: Moderate sleep apnea
• 30 or more: Severe sleep apnea

The higher the AHI, the more severe the sleep apnea.

AHI helps providers:

• Diagnose sleep apnea
• Measure how serious it is
• Guide treatment decisions, such as CPAP therapy

Important Things to Know

AHI is important—but it is not the only factor your provider considers.

Other things that matter include:

• Your symptoms (such as daytime sleepiness)
• How low your oxygen levels drop
• Overall sleep quality
• Other medical conditions

Results can also be affected by:

• Sleeping on your back (sleep apnea is often worse in this position)
• Time spent in REM sleep (when apnea can be more severe)
• The overall quality and duration of the sleep study

Your provider will review your AHI along with the rest of your results to recommend the best treatment plan for you.

When you have sleep apnea, your airway can relax and narrow or fully close during sleep.

This can cause pauses or very shallow breathes while you are asleep.

These events can happen many times each night. When this occurs, oxygen levels may drop and sleep becomes disrupted, even if you do not fully wake up.

What Is CPAP?

CPAP stands for Continuous Positive Airway Pressure.

A CPAP machine treats sleep apnea by gently blowing a steady stream of air through a mask you wear while sleeping.

This airflow:

• Keeps your airway open
• Prevents breathing pauses
• Improves oxygen levels
• Helps you sleep more soundly

What Does a CPAP Machine Include?

A CPAP system has several parts:

• Mask – Fits over your nose or over both your nose and mouth
• Straps (Headgear) – Hold the mask comfortably in place
• Tubing – Connects the mask to the machine
• Motor – Blows room air through the tubing
• Air Filter – Cleans the air before it reaches you
• Humidifier (Water Chamber) – Adds moisture to the air to prevent dryness
• Pressure Settings – Adjusted by your provider to give you the right level of support

Your provider will help select the right mask and pressure settings to make treatment as comfortable and effective as possible.

Auto CPAP (Automatic Continuous Positive Airway Pressure) is a type of treatment for obstructive sleep apnea (OSA) that adjusts the air pressure automatically while you sleep.

Unlike a regular CPAP, which delivers a fixed pressure all night, an Auto CPAP changes the pressure based on your needs in real time. 

How It Works

• The machine monitors your breathing throughout the night.
• If it detects a pause in breathing (apnea) or shallow breathing (hypopnea), it increases the air pressure to keep your airway open.
• When your breathing improves, the machine reduces the pressure to a more comfortable level. 

Benefits

• Provides personalized treatment for your specific breathing needs.
• Reduces discomfort from high or unnecessary pressure (like dry mouth or nasal irritation).
• Can improve sleep quality and reduce daytime sleepiness. 

Who Might Benefit

Auto CPAP may be recommended for patients who:

• Have trouble tolerating a fixed-pressure CPAP
• Have sleep apnea that varies during the night, such as with different sleep positions or sleep stages 

Limitations

• May require some trial and error to find the optimal pressure range
• Not suitable for every patient with OSA

Your provider will help determine if Auto CPAP is the right choice for you and guide you on proper use.

A CPAP machine is the most common type of PAP device used to treat sleep apnea, but there are several other options depending on your needs.

1. Auto CPAP

• Adjusts the air pressure automatically throughout the night.
• Can be used to find the optimal pressure for someone starting CPAP or to fine-tune settings for existing users.

2. Bi-level PAP (BiPAP)

• Uses two different pressures: higher pressure when you breathe in, lower pressure when you breathe out.
• May be more comfortable for people who struggle to exhale against standard CPAP pressure.
• Can also help patients with other respiratory conditions, such as COPD.

3. Auto BiPAP

• Works like Auto CPAP, but automatically adjusts both inhalation and exhalation pressures.

4. Bi-level ASV (Adaptive Servo-Ventilation)

• Designed for certain types of central sleep apnea.
• Monitors your breathing and adjusts pressures to stabilize it.
• Can also deliver a breath if long pauses in breathing occur.

5. Bi-level AVAPS (Average Volume Assured Pressure Support)

• A specialized device for patients who need guaranteed breath volume.
• Automatically adjusts pressure to ensure proper ventilation.
• May also ensure a minimum number of breaths per minute.
• Often used for patients with chronic respiratory failure, COPD, or obesity hypoventilation syndrome.

Your provider will help determine the right device based on your diagnosis, comfort, and breathing needs.

Choosing the right CPAP mask and ensuring it fits properly is one of the most important steps for successful treatment. A well-fitting mask helps you breathe comfortably and prevents leaks. 

CPAP Mask Types

1. Nasal Mask

• Covers only your nose.
• Often recommended for people who move a lot while sleeping.

2. Nasal Pillow Mask

• Covers just your nostrils (sometimes with small prongs inside).
• Lightweight and allows you to wear glasses comfortably.

3. Full Mask

• Covers both your nose and mouth.
• Best for people who breathe through their mouth or have nasal blockages.

4. Hybrid Mask

• A full-face mask that covers the mouth but has cushions or prongs for the nostrils.
• Does not cover the bridge of the nose.

5. Chin Strap

• Helps keep your mouth closed during sleep.
• Often used with a nasal mask or nasal pillow mask if your mouth tends to open. 

How to Get Your Mask

• Your Durable Medical Equipment (DME) provider will supply your CPAP machine and mask.
• They will review your mask options and help you find the best type and fit.
• Most people try more than one mask before finding the most comfortable option.
• If your mask is leaking or uncomfortable, contact your DME provider as soon as possible for adjustments.

Tip: The DME contact number is usually on a sticker on your CPAP machine.

Your insurance company works with certain Durable Medical Equipment (DME) suppliers to provide CPAP machines and supplies.

At The Oregon Clinic:

• We will review your insurance-approved options with you.
• We will put you in contact with a DME company.
• The DME company will:
  • Submit billing to insurance
  • Provide your CPAP machine and mask
  • Fit your mask and teach you how to use the machine

If you have any problems or questions with your CPAP or mask, contact your DME company.

• Tip: Their phone number is usually on a sticker on your CPAP machine. 

Picking Up Your CPAP

The DME company will schedule a time for you to pick up your machine and mask.

Things to Ask About and Check During Pickup

It’s helpful to take notes or a screenshot of these points:

• Mask style and fit – Try the mask with the machine on and at pressure, lying down if possible.
• Claustrophobia or glasses – Let the provider know if this is an issue.
• Dentures or bridges – Mention if you will wear them while sleeping; the mask can be fitted accordingly.
• Humidifier and comfort settings – Ask how to adjust for comfort.
• Ramp function – Learn how to use it if your machine has one.
• Replacement schedule – Ask when to replace your mask and supplies; automatic resupply may be available.
• Cleaning instructions – How to care for your mask and machine.
• DME contact info – Make sure you know how to reach them for questions.

Your insurance company works with a limited number of CPAP Durable Medical Equipment (DME) suppliers.

At The Oregon Clinic:

• We will review your insurance-approved options with you.
• We will connect you with a DME company.

What your DME company does:

• Provides your CPAP machine, mask, and supplies
• Submits billing to your insurance
• Fits your mask and sets up the machine
• Offers support for any questions or issues with your CPAP

Tip: The DME contact number is usually on a sticker on your CPAP machine.

If You Have Trouble With CPAP

If you:

• Have difficulty with the mask fit
• Need adjustments to the humidifier or pressure settings
• Continue having trouble sleeping with CPAP

…contact your DME supplier first for equipment help.

If problems persist despite adjustments, reach out to our clinic. We can help troubleshoot and ensure your therapy is effective and comfortable.

Using a CPAP or BiPAP machine can take some time to get used to. Don’t give up! The most important factors for success are a positive attitude, motivation to improve your health, and persistence. Small adjustments can make a big difference—and we are here to help.

Getting Started

• Practice during the day: Wear your CPAP/BiPAP while watching TV or doing another activity to get used to the mask and airflow.
• Use it while sleeping: Gradually wear it overnight once you feel comfortable.
• Nasal mask tips:
  • Breathe slowly through your nose.
  • Try not to open your mouth, as air escaping can increase pressure.
• Set reminders: If you tend to fall asleep before putting on your mask, set an alarm to prompt you.
• If it falls off: Simply put it back on — the more you wear it, the more natural it will feel.

Mask Comfort & Adjustments

• If the mask leaks or feels uncomfortable, contact your DME supplier:
  • They can adjust the mask or headgear
  • Swap it for a new mask
  • Refit the mask if needed
• Tip: DME contact info is usually on a sticker on your CPAP machine.
• If the pressure feels uncomfortable even after several nights, contact our clinic for guidance.

How Much to Use

• Try to wear your CPAP for all sleep periods.
• Aim for at least 6 hours per night, but more is better.
• Adequate usage is required by insurance and is key to seeing benefits.

Follow-Up Visit

• The clinic will schedule a follow-up visit 30–90 days after starting CPAP.
• This visit is required by insurance and helps your provider review your progress and address any issues.

CPAP Compliance Requirements

Insurance requires “compliance” to continue coverage:

• Wear the mask for at least 4 hours per night
• On 70% of nights (about 5 out of 7 days)

Your CPAP machine automatically records:

• Hours used each night
• Mask leaks
• Whether your sleep apnea is being controlled

This data is reviewed at your follow-up appointment.

Remember: Studies show that consistent use of at least 4 hours per night is necessary to start getting benefits from CPAP. Optimal success comes from wearing it every night for all sleep hours.

Proper cleaning of your CPAP equipment is important for health, comfort, and machine function.

General Cleaning Guidelines

Daily

• Empty the humidifier chamber
• Wash mask or nasal pillows with warm water and a tiny bit of gentle dish soap, or use CPAP-specific disposable wipes
• Let all parts dry completely before use

Weekly

• Wash tubing, mask, headgear, and humidifier reservoir
• Optional: Use a solution of 1 part vinegar to 4 parts water for tubing and humidifier reservoir

Tips for Drying

• Allow all components to air dry completely before reassembling
• Never use alcohol, bleach, ammonia, or moisturizing soaps

Replacing Parts

• Mask cushion:
  • Nasal pillows: Replace twice per month
  • Full masks: Replace once per month

Regular cleaning and timely replacement help keep your CPAP working properly and ensure your treatment is effective.

Important:

• Devices that use ozone or ultraviolet (UV) light are not FDA-approved and may cause problems.
• Always follow the cleaning instructions provided by your CPAP manufacturer.
• Check with your DME provider for their recommendations—improper cleaning can affect your warranty.
• Tip: Your DME contact number is usually on a sticker on your CPAP machine.

CPAP supplies replacement schedule may vary by Durable Medical Equipment (DME) provider. Check with your specific DME for details. In most cases your DME contact number can be found on a sticker on your CPAP machine.

General recommendations for replacement are as follows:

• Tubing: Every 3-6 months
• Filters: Varies by model but usually monthly
• Humidifier chamber: Every 6 months
• Nasal cushions: 2/month
• Nasal pillow cushions: 2/month
• Full face cushion: 1/month
• Mask frame: Every 3 months
• Headgear: Every 6 months
• Chinstrap: every 6 months
• CPAP machine: no earlier than 5 years or if malfunctioning

Dry mouth is a common side effect of CPAP therapy. It happens when the pressurized air dries out tissues in your mouth and throat.

Common Causes

• Mask leaks: Air escaping from a poor mask seal can dry your mouth.
• CPAP airflow: Pressurized air may bypass the natural humidifying effect of your nose and mouth.
• Nasal masks: Air may escape through your mouth, increasing dryness.
• Reduced saliva production: CPAP may stimulate saliva, but sometimes it’s not enough.

Prevention & Management

1. Use a Heated Humidifier

• Adds moisture to the air.
• Adjust the comfort settings on your CPAP machine.

2. Check Mask Fit

• A different style or size may reduce leaks.
• Contact your DME supplier for help.

3. Keep Your Mask Clean

• Oils and dirt can worsen leaks.
• Clean your mask daily and replace it regularly.

4. Adjust Headgear or Use Pillows

• Replace stretched straps or adjust headgear for a better fit.
• A contoured pillow can prevent the mask from being pushed off while side sleeping.

5. Consider Mask Type

• Switching to a full-face mask may prevent air from escaping through your mouth.
• A chin strap can help keep your mouth closed at night.

6. Oral Hygiene & Saliva

• Brush your teeth and use oral rinses to help saliva production.
• Over-the-counter saliva substitutes can moisturize your mouth.

7. Medications & Lifestyle

• Some medications (like diuretics or antidepressants) may worsen dry mouth — review with your doctor.
• Drink plenty of fluids, avoid caffeine and alcohol, and quit smoking.

Additional Tips

• Contact your DME provider for guidance — the contact number is usually on a sticker on your CPAP machine.
• Be patient — finding the right combination of adjustments may take time.

Takeaway: Dry mouth is common but manageable. With the right mask, humidification, and habits, you can reduce discomfort and get a restful night’s sleep.

Hypoglossal nerve stimulation (HNS) is a treatment for obstructive sleep apnea (OSA), a condition where your airway collapses during sleep and interrupts breathing.

One such device is called Inspire.

How It Works

1. Surgical Implant
   • A small, battery-powered device is placed under the skin in your chest.
   • A wire is tunneled under the skin to connect to the hypoglossal nerve, which controls tongue movement.
2. Electrical Stimulation
   • The device sends gentle impulses to the nerve during sleep.
   • These impulses move the tongue forward with each breath, helping keep the airway open.

Benefits

• May reduce the number and severity of sleep apnea episodes
• Improves sleep quality and reduces daytime sleepiness
• Can improve overall health and well-being

Who May Be a Candidate

HNS may be considered for patients who:

• Have moderate to severe OSA
• Do not respond well to CPAP therapy
• Are in good overall health

Possible Side Effects

• Temporary discomfort or pain at the incision site
• Temporary changes in tongue sensation
• Risk of infection or device malfunction
• Some patients may not tolerate ongoing use
• Battery replacement may be needed in the future

Important: Your provider can help determine if HNS is a safe and effective option for you.

Restless Legs Syndrome (RLS) is a common sleep disorder that causes an irresistible urge to move your legs, usually accompanied by unpleasant sensations like tingling, crawling, or pulling.

RLS is not the same as leg cramps or peripheral neuropathy.

Symptoms

• Strong urge to move the legs, especially when sitting or lying down
• Unpleasant sensations in the legs: tingling, crawling, or pulling
• Movement relieves the discomfort
• Symptoms are usually worse in the evening or at night

Causes

The exact cause is unknown, but factors may include:

• Genetics
• Dopamine system dysfunction
• Iron deficiency
• Pregnancy

Who Gets RLS?

• Affects 5–10% of people
• More common in women than men
• More prevalent in older adults

Diagnosis

• Based on symptoms and medical history
• No specific diagnostic tests are required
• Sleep studies are not needed to diagnose RLS, but may show periodic limb movements

Treatment

The goal of treatment is to reduce symptoms and improve sleep. Options include:

Lifestyle Changes

• Regular exercise
• Avoid caffeine and alcohol before bed
• Create a relaxing bedtime routine
• Take a warm bath

Physical Relief

• Leg massage or use of heat/compression massagers

Medications

• Some medications can worsen RLS: most antidepressants (except bupropion), antipsychotics, certain anti-nausea medications (e.g., metoclopramide), and some antihistamines (e.g., diphenhydramine/Benadryl)
• Helpful medications may include:
  • Gabapentin
  • Dopamine agonists such as pramipexole or ropinirole

Iron Supplements

• If a documented iron deficiency is present

Prognosis

• RLS is chronic, but it can be managed effectively
• Most people with RLS can lead full and active lives with proper care

Additional Information

• RLS is also called Willis-Ekbom disease
• Can sometimes be confused with leg cramps or peripheral neuropathy
• Always consult a healthcare professional for an accurate diagnosis and treatment plan

Disclaimer: This information is for general knowledge only and does not replace medical advice.

Sleep hygiene is a set of healthy habits and environmental practices that help you fall asleep more easily, stay asleep, and wake up feeling refreshed.

It’s basically everything you do—and don’t do—that affects your sleep.

Practicing good sleep hygiene is important because it helps your body fall asleep more easily, stay asleep, and wake up feeling refreshed. Good sleep hygiene is essentially a set of habits and environmental practices that support healthy, restorative sleep.

Here’s why it matters:

1. Improves Sleep Quality

• Following consistent routines helps your body know when it’s time to sleep.
• Good habits reduce nighttime awakenings and improve deep, restorative sleep.

2. Boosts Daytime Alertness and Function

• Better sleep improves concentration, memory, and decision-making.
• Helps reduce daytime sleepiness, fatigue, and irritability.

3. Supports Physical Health

• Sleep regulates hormones, blood pressure, and metabolism.
• Poor sleep is linked to higher risks of heart disease, diabetes, obesity, and stroke.

4. Supports Mental Health

• Adequate sleep helps regulate mood and stress levels.
• Poor sleep can worsen anxiety, depression, and other mental health conditions.

5. Enhances Effectiveness of Sleep Treatments

• If you have sleep apnea, RLS, insomnia, or other sleep disorders, good sleep hygiene can make therapies like CPAP, medications, or behavioral treatments more effective.

One of the most important sleep hygiene practices is to spend an appropriate amount of time asleep in bed, not too little or too much. Sleep needs vary across ages and are especially impacted by lifestyle and health. However, there are recommendations that can provide guidance on how much sleep you need generally. Other good sleep hygiene practices include:

1. Eliminate naps. Napping does not make up for inadequate nighttime sleep. However, a short nap of 20-30 minutes can help to improve mood, alertness and performance.
2. Avoiding stimulants such as caffeine and nicotine close to bedtime. And when it comes to alcohol, moderation is key. Too much alcohol or alcohol too close to bedtime can disrupt sleep in the second half of the night as the body begins to process the alcohol.
3. Exercising to promote good quality sleep. As little as 10 minutes of aerobic exercise, such as walking or cycling, can drastically improve nighttime sleep quality.  For the best night’s sleep, most people should avoid strenuous workouts close to bedtime. However, the effect of intense nighttime exercise on sleep differs from person to person, so find out what works best for you.
4. Steering clear of food that can be disruptive right before sleep. Heavy or rich foods, fatty or fried meals, spicy dishes, citrus fruits, and carbonated drinks can trigger indigestion for some people. When this occurs close to bedtime, it can lead to painful heartburn that disrupts sleep.
5. Ensuring adequate exposure to natural light. This is particularly important for individuals who may not venture outside frequently. Exposure to sunlight during the day, as well as darkness at night, helps to maintain a healthy sleep-wake cycle.
6. Establishing a regular relaxing bedtime routine. A regular nightly routine helps the body recognize that it is bedtime. This could include taking warm shower or bath, reading a book, or light stretches. When possible, try to avoid emotionally upsetting conversations and activities before attempting to sleep.
7. Making sure that the sleep environment is pleasant. Mattress and pillows should be comfortable. The bedroom should be cool – between 60 and 67 degrees – for optimal sleep. Bright light from lamps, cell phone and TV screens can make it difficult to fall asleep, so turn those lights off or adjust them when possible. Consider using blackout curtains, eye shades, ear plugs, “white noise” machines, humidifiers, fans and other devices that can make the bedroom more relaxing.
8. Eliminate electronic devices at least 1 hour before bedtime. This includes phones, computers and tablets.

Poor sleep hygiene means your habits or sleep environment are interfering with your ability to get good, restorative sleep. Common signs include:

1. Difficulty Falling Asleep

• Taking more than 20–30 minutes to fall asleep at night
• Lying awake in bed feeling frustrated

2. Frequent Nighttime Awakenings

• Waking up multiple times during the night
• Difficulty falling back asleep after waking

3. Feeling Tired During the Day

• Persistent daytime sleepiness or fatigue
• Trouble concentrating, remembering things, or staying alert

4. Mood Changes

• Increased irritability, anxiety, or depression
• Feeling low energy or unmotivated

5. Reliance on Sleep Aids

• Needing alcohol, caffeine, or over-the-counter sleep aids to fall asleep regularly

6. Inconsistent Sleep Schedule

• Going to bed and waking up at different times every day, especially on weekends

7. Poor Sleep Environment

• Sleeping in a room that is too bright, noisy, or uncomfortable
• Using your bed for work, screens, or other stimulating activities

Takeaway:
If you notice any of these signs, it may be time to review your sleep habits and environment. Improving sleep hygiene can help you fall asleep faster, stay asleep, feel more rested, and improve overall health.

These resources are available to help you start to improve your sleep.

• Currently available electronic or digital sleep apps. Free CBT-I apps include:
  CBT-I Coach              iOS/Android             Available in English or Spanish
• Insomnia Coach        iOS/Android
• Sleep EZ                    iOS/Android/Web app
• Slumber Camp

Self-help books for treatment of insomnia:

• Quiet Your Mind and Get to Sleep: Solutions to Insomnia for Those with Depression, Anxiety, or Chronic Pain. Colleen E. Carney and Rachel Manber
• Say Goodnight to Insomnia. Gregg Jacobs