Why Do I Always Wake Up After 5 hours of sleep?

Julia was at wit’s end. She has been suffering from insomnia for the past 10 years, since she entered menopause. She keeps waking up after 5 hours, despite trying every over-the-counter and prescription medication available. She has no trouble falling asleep, but is not able to stay asleep for more than 5 hours, typically waking up at 3AM after falling asleep at 10PM. Oftentimes, she has to go to the bathroom when she awakens, but it’s not too much urine. She even saw a behavioral sleep specialist who offered cognitive behavioral therapy for insomnia (CBT-i), which only helped temporarily. 
 
Julia’s history is typical for what’s called sleep maintenance insomnia, where you can’t stay asleep or keep waking up after you’re able to fall asleep. This differs from sleep onset insomnia, where you’re not able to fall asleep within 20 to 30 minutes of getting into bed. The accepted explanation for insomnia is that it’s a complex interaction between poor sleep routines, behavior and thoughts, in addition to a baseline hyperarousal of your brain. Essentially, you can’t shut down your brain when you want to go to sleep.
 
One of the potential consequences of sleep maintenance insomnia is that with continuous awakenings at AM and not being able to go back to sleep is that your sleep clock becomes advanced, or gets pushed backwards. This could potentially lead to advanced sleep phase syndrome, a condition that’s commonly seen in the elderly. In this condition, you’ll want to go to sleep much earlier in the evening, such as 8PM, rather than at 10PM.
 
I’ve always wondered why people tend to wake up around 3AM,  whether it’s insomnia, nighttime urination, or asthma. The most obvious connection between these three connections is that you spend longer periods of REM sleep (your dream stage), starting around 3AM. Stage REM is also when your muscles are most relaxed, which can predispose you to have breathing problems. I’ve been doing thought experiments about his concept, and I’m convinced that we need to think about sleep maintenance insomnia in a completely different way—perhaps it’s a consequence of a breathing problem.
 
Before I go over my arguments, a few basic sleep concepts need to be reviewed.
 
Sleep Position
 
If you see photos or drawing of people sleeping, you’ll often see sleep being depicted as someone sleeping on the back. However, most modern Western people prefer to sleep on their sides or stomach. One of many reasons is that supine (back) sleep will allow the soft tissues of the tongue and soft palate and fall back more due to gravity when supine.
 
Menopause
 
As women go through menopause, throat muscles will relax somewhat due to lowered progesterone levels. This study found that genioglossus muscle (tongue) activity is lower in post-menopausal women compared to pre-menopausal women. This is why women on hormone replacement therapy tend to sleep slightly better.
 
Your Circadian Rhythm 
 
Another major sleep concept that’s important to understand are two processes that are involved in sleep regulation. The first one is the well-known circadian rhythm. For many of us here on Earth, we are on a 24 hour cycle. The circadian rhythm, which is regulated by light, cycles up and down between two 12-hour intervals. This is called the C process. This is what makes you alert during the day and drowsy at night.
 
 
 
Your Drive for Sleep
 
There’s another simultaneous sleep-related phenomena called the S process. This is your drive for sleep, which is minimal in the morning when you first wake up, but then increases gradually reaching its peak before you fall asleep. Once you’re asleep, it drops back down to the baseline low level at which point you’ll wake up. 
 
Process S also corresponds to your level of adenosine that builds up in your brain. Adenosine inhibits wakefulness. As the day progresses, adenosine levels slowly increase. Ingesting caffeine from drinking coffee is one way that we block the effects of adenosine. 
 
The Importance of Sleep Stage 
 
Now there’s one more piece to the puzzle that’s critical. This is your sleep cycle. Normally, you’ll cycle between 4 defined stages of sleep: Wake, N1, N2, N3, REM. N1 and N2 are the lighter stages of sleep and N3 is deep sleep. During N1 through N3, your muscles become gradually more relaxed, but in REM sleep (rapid eye movement and dream stage),  your muscles are completely relaxed. 
 
 
 
You’ll reach deep sleep (N3) in the early part of the night, but as you progress through 4 to 5 sleep cycles (90 to 120 minutes long), N3 gets shorter and shorter and REM becomes longer and longer. Around 3 to 4 AM is when you begin to have longer periods of REM sleep. 
 
There are many different explanations on what causes us to wake up prematurely in the morning, but it’s probably a combination of  these three processes, along with sunlight that arrives in the morning. When you’re about to wake up, your circadian (wake forces) are beginning to increase from its lowest point, your sleep drive (S) is at its lowest point, and you’re most likely in REM sleep, when muscles are most relaxed, leading to possible obstructed breathing. This  can be a natural, normal waking mechanism. Notice that in many cases you’re waking up during a dream in the morning. Adding sunlight is another cue for you to wake up. 
 
In addition, the lowest point in the circadian cycle is called the singularity. It typically occurs around 2 hours before your natural wake up time. It’s also the time when your core body temperature is at its lowest. On the C&S figure, notice that this dip is about 2 hours before wake time. We also know that as core body temperature rises, you’re more likely to wake up. 
 
In the figure below, I’ve juxtaposed the hypnogram (sleep stages) underneath the C&S figure during 8 hours of sleep. 
 
 
 
All of the above is assuming that you have normal upper airway anatomy and you are able to wake up after sleeping 7 to 8 hours without any problems. However, if you have upper airway narrowing due to large tonsils or small jaws with dental crowding, you’re more likely to partially or totally stop breathing, whether it’s for 3 seconds or 25 seconds. Totally obstructed breathing for more than 10 seconds is called an apnea if detected during a sleep study. A breathing pause for less than 10 seconds won’t be counted as a formal respiratory event (apneas, hypopnea or RERA) but will most likely be counted as an arousal. 
 
We also know that obstructed breathing is more likely to occur during REM sleep, especially when you’re on your back. If you have more narrow upper airways, then the higher the likelihood of more frequent breathing pauses around 3-4 AM, when you’re in longer periods of REM sleep. If you add the various other factors mentioned above (circadian factors, sleep drive, sleep position, sleep stage, light, etc.), then you’re more likely to wake up around this time. 
 
Brain hyperarousal
 
One of the hallmarks of insomniacs is the inability shut down the brain when going to sleep, or after a nighttime arousal. It think you’ll agree with me that waking up due to choking and breathing pauses can be a major cause of physiologic, emotional and psychological stress.
 
Nighttime urination
 
Some of you may have to go to the bathroom to urinate. This is a common condition (nocturia) in people with obstructive sleep apnea or upper airway resistance syndrome due to a hormone (atrial natriuretic peptide) that’s created by your heart in response to stimulation from obstructed breathing, leading to more urine production. Some of you are able to go back to sleep, but some of you can’t fall back asleep. Whether or not you can fall back asleep may depend on how violently you woke up. If you just had a 30 second choking episode, this will lead to a major stress response, with heart rate blood pressure elevations. It’s unlikely you’ll be able to fall back asleep. 
 
Putting the pieces together
 
In medicine, and especially sleep medicine, we like to categorize medical conditions into separate categories. It assumes that obstructive sleep apnea is completely different from insomnia. However, when it comes to these two conditions, there is compelling evidence that there can be a great deal of overlap when it comes to presenting symptoms. 
 
One example of this overlapping phenomenon is a study performed by Dr. Barry Krakow. He and his colleague reviewed 218 patients with prescription medication resistant insomnia, and 75% were found to have obstructive sleep apnea based on formal sleep studies.
 
Julia eventually made her way to find me and not surprisingly, she was found to have moderately obstructive sleep apnea (AHI 20).  She began using CPAP, and finally able to sleep for 7 hours again like she used to when she was in her teens. Looking back on her history, she suffered a shoulder about 8 years ago. This forced her to sleep on her back, when she normally preferred to sleep on her side. She began to gain weight later, and began to snore heavily. 
 
This alternative explanation for sleep maintenance insomnia may seem a bit fat fetched for traditional sleep scientists, but looking at this from a sleep-breathing standpoint, it makes a lot of sense. How many of you keep waking up much earlier than your preferred time? What have to tried so far? Please enter your responses in the text box below.
 
 
 
 
 
 
 
 
 
 

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83 thoughts on “Why Do I Always Wake Up After 5 hours of sleep?

  1. I’m only 36 years old, but haven’t slept more than 4.5 hours at a time for years.
    I do tend to sleep on my side, but this may just be habit.
    Of late, I’m not using a prescribed sleep aid after 1 year of 50mg Trazedone use didn’t actually help break the 3.5-4.5 issue and I was waking with very vivid distressing dreams, and had very low blood pressure throughout
    the day that was eventually governing my whole life. Since stopping the drug, my sleep is essentially the same, but my blood pressure (which is naturally around 90/60 in the morning) has recovered somewhat and I don’t feel deflated to the point of collapse come midday or 1pm, anymore.
    Obviously, that is a huge payoff and I think that Trazedone was probably never appropriate for someone with such low BP.
    That said, the issue remains: I keep waking up with stressed out thoughts at 4.30, after getting to bed and sleep at 11.30, or 10.30 to 3.30 etc. I have a much better sleep schedule now and am strict about when I work until. Sometimes exercise before bed helps, as well as in the morning, but I don’t have enough info about that.
    What I do know is: if I get 6+ hours sleep, I feel like a whole new person.
    I recently came home from an overseas trip and for a few days slept like that. It was amazing. I was fairly sure I slept somewhat like that when I was there, but one of those nights was aided by Zopiclone, to try to beat jetlag.
    Now home and back at my 2 jobs and full time study alone in my house and thousands of kms from my family, my mind is back to it’s old tricks. I guess a constant factor is stress. Despite the low BP, I’m a pretty UP person, mentally. I enjoy a wide range of activities, foods, the company of others and I exercise every day. But I do have periods (literally, in every cycle) where I feel like something else is controlling my thoughts. Intellectually, I go, wow, why am I stuck thinking about this? The answer to that more often than not is: you’ve been sitting at your desk too long (I.e.an hour) and need to get up and get the blood pumping again
    I deflate, and compression socks don’t help! The same happens sometimes if I stand up too long, but different (incoordination, forgiveness, heart fluttering).
    So between stress, very low BP and maybe not enough aerobic exercise, am I just screwed until (maybe) after this PhD is done?
    I would love some advice as my doctor is now wary of prescribing more drugs, and I’m wary of taking them.

  2. I have been waking up arrond 3 or past 3 for c
    Some time now.atimes I wake up with headache

  3. I’ve suffered with insomnia for years and I always have to get up at 3am to urinate. I’ve tried using my phone and smart watch to monitor my sleep patterns and it always shows a disruption before I wake. I even managed to get an audio recording one time. Doctors constantly ignore it though or try putting it down to my ptsd (which I feel is a separate issue in terms of nightmares/flashbacks etc on the rare occasion that I do sleep most of the night as this insomnia and nighttime urination is something I’ve had a lot longer than ptsd)

  4. My sleep habits along with everything else changed at the age of 50 and still the same at 54. I sleep on my left side and wake up 5 hours later, sometimes I wake up laying on my back and other times having to use the bathroom. I’ve always had whats called high pressure since my teen years at age 50 medication brought it down until I noticed that was slowing everything that I’ve been used to down so I stopped taking and back to what’s normal for me. So now I question , what’s really normal? Normal for me is how I’m feeling.

  5. Dear Dr. Park , an update from my side , i recently about 3 -4 wks back started sleeping with a very thin pillow after hearing about it on an NPR show (Pulse – https://www.npr.org/podcasts/381443461/the-pulse listen from 22.35 ) and that really seems to have helped me esp increasing the amount of deep sleep i am getting . maybe bcs it forces me to sleep n my side more using my bent arm as a pillow. Most nights i am getting about 6-7.5 hrs of undisturbed sleep , sometimes i still get up earlier but if i cant seem to go back to sleep instead of fighting it now i get up go the bathroom , brush my teeth etc and then come back and lie down again and just let the sleep come to me and mostly i have managed to fall back asleep again and get sufficient sleep . I know this might not be of help for everyone but some of the ppl may benefit from using a thin pillow or no pillow at all

    thanks

  6. Ribhu,

    Thanks for the suggestion. I’ve had some patients tell me that they prefer to sleep with no pillow at all, especially if they like to sleep in the back position. The reason why this may be helpful is that when you tilt your head back (with no pillow), you’re opening up your airway. This is not as effective if you’re sleeping on your side. Another option is to use a “contour” -type pillow which tilts your head back somewhat.

  7. Cathy,

    Your “normal” is on your side, but it’s not good enough to prevent you from stopping breathing at night when your throat muscles relax. Lower progesterone during menopause relaxes your tongue muscle even more. Nighttime urination is due to the breathing pauses creating a hormone from your heart (called ANP) that makes you urinate more. It sounds like you need to be checked for possible obstructive sleep apnea. Good luck!

  8. I have always been a light sleeper, but it was since I got pregnant with my first child I couldn’t stay asleep through the night. Typically I woke up every couple of hours, sometimes even less than an hour in between. My first child is now 14, and I never slept through the night since. Then I seemed to have started peri menopausal period, and I have been having all sorts of symptoms on top of the sleep problem. So I was put on a light hormone treatment and now I always wake up after about 5 hours of sleep no matter how tired I may be, and I may not be able to go back to sleep for a while.

  9. can sleep apnea occur even if your thin and petite? Everytime I go to a sleep doctor they tell me I don’t have sleep apnea because I don’t fit what someone who has apnea looks like

  10. Adriana,

    It’s been proven that thin/petite women that don’t snore can still have obstructive sleep apnea. Most doctors are not aware of the studies showing this and are misinformed. And even if you don’t have sleep apnea on a sleep study, you can still stop breathing a lot at night with severely disrupted sleep. Please see my other articles on UARS.

  11. I have been a terrible sleeper for a long time now. I am at the point I wake up everynight after 4 hours of solid sleep (usually) then I will feel like I am in a half wake / half sleep state. Until I need to get up at 4:45am . Can anyone suggest anything? I am in need of sleep.

  12. I came across your blog because I was looking at side-affects for Zolpidem that I take nightly to fall asleep. I take about an hour (10 pm) before bedtime along with an over the counter Quanol or melatonin gummie. I fall asleep but wake up about 3 pm and then take another over the counter UltraSURGE pill with 8 oz of water and wake up around 6:30 7 am. I have not been feeling well (stomach problems and light headedness plus tired all the time)but don’t know if it is the side affects from Zolpidem or my age 71 year old male. I was prescribed Zolpidem for insomnia

  13. During the day when I’m trying to take a afternoon nap there is something that wakes me up as soon as I doze off. I feel extremely fearful when I wake up at that time. In the morning i wake up everyday at 5am.

  14. I’ve been dealing with sleep disorder since 2017, where I was dx via sleep study w hypersomnia. However, I believe it’s something else, perhaps sleep maintenance insomnia as mentioned above in your article re: Julia. I am dealing w the same exact thing; I can fall asleep no problem but have been waking up religiously at 3am like a robot my eyes just pop open. For the life of me I cannot figure out why. I have DONE everything. Dark cold room, sleeping pills, eat, no eat, cry and pray. Nothing works.

    I am female in my 50’s and believe it may be a hormonal thing but not 100% sure. I’m trying to pay close attention to the subtleties and clues and so far the only thing I can figure out is that around that time I am definitely in REM bc I am dreaming, but also my body temperature seems to change or get much warmer. And like Julia I do get the urge to urinate but nothing really there. I go back to bed and ruminate for the next 1-2 hours. I fall asleep (around 4-5 am) and on my days off I wake up around 8:45. When I need to work I wake up w alarm at 8:00 (looking and feeling like crap). It’s as though I am using every inch of energy I have just to brush my hair and teeth.

    If you have any thoughts I’d be more than appreciative.

  15. Tee, thanks for sharing your story. I just published a video on this topic on YouTube. Yes, it’s definitely made worse during peri-menopause, since progesterone levels slowly go down, long before estrogen. Take a look at the video and follow the steps recommended. I didn’t add this one since it only applied to women, but you can try over-the-counter bio-identical progesterone cream. Some women find it helpful. Good luck!

  16. Hi. I’m Debby I keep waking up at 3 am as well. However, I usually am asleep by 9:30 pm. It’s more like 5.5 hours. I am 50 years old. I have to work full time. I do dream earlier in the night, but I set my alarm for 4 am. It is upsetting. I think I have entered menopause. I feel like my nose is clogged when I lie down. I do sleep on my back frequently. I have chronic pain from an accident, so I take Gabapentin and I have a little bit of Diazepam for panic attacks since the accident caused PTSD. When I wake up I usually have to go to the bathroom. Hyperarousal begins and I have to just get up. I depend on caffeine now to get me through my work days. On Saturdays after my grocery shopping I am so tired I take a 4 hour long nap and then i sleep in on Sundays till 6 am after going to sleep at 1p pm Saturday night. I heard it isn’t possible to get sleep back. There could be several explanations. I just started a new hob, or rather i was transferred to a new location. Maybe its stress. I am not sure. I see a doctor Friday. I will bring this up. Thank you. I loved your article.

  17. Debby,

    Sorry to hear about your accident. Did your accident force you to sleep more on your back? If so, you’ll have more apneas and make more urine as a result. Poor sleep will also aggravate PTSD. It can also aggravate more stress. Menopause also makes things worse due to lower progesterone, which ends up weakening your tongue muscle tone, leading to more obstructed breathing. Try doing something to sleep on your side only. Another option is to get a wedge mattress. And lastly, don’t eat or snack within 3-4 hours of bedtime. Good luck!

  18. I have no problem falling asleep, or staying asleep for about the first 5 hours. After that, I’ll get up to urinate, then easily go back to sleep, but I’ll wake every hour after that for my remaining hours of sleep. So it’s like this: go to bed at 6pm. Sleep perfectly & uninterruptedly till 11pm. Then get up at 11pm to urinate. Then go right back to sleep without any trouble. Then, I awake at 12am, then go back to sleep. Then, I awake at 1am, then go back to sleep. Then, I finally awake at 2am and get out of bed. Why are the last 3 hours of my sleep always disrupted and fragmented every hour??

  19. Jon,

    First of all, it sounds like you have advanced sleep phase syndrome, where your body wants to (or you have to) go to bed at 6 PM. About 5-6 hours into sleep, you’ll go into longer periods of REM sleep, when you’re dreaming, and when your muscles are most relaxed. This predisposes you to stop breathing and wake up. Since your sleep drive is much lower later at night, you won’t stay in deep sleep anymore and keep waking up. I recommend seeing a sleep doctor to help you get back to a normal sleep schedule. And also to screen for obstructive sleep apnea. Good luck!

  20. I always wake up at least 3 times a night….the other night it was about 10 times in an 8 hour period…..I am on sleep meds….either Ambien or Diazepam but never ever taken together….I also use benadryl sometimes but don’t like to use it in the winter because it dries me out way too much..

  21. I am a 73-year-old thin retired female who exercises regularly and eats healthy but is very sensitive. My lifelong insomnia continues to worsen although my life is not particularly stressful. I take .25 mg Ambien to fall asleep at 11-12 am and wake up 2-3 hours later, take .25 mg Ambien and wake up between 4-5 am, not worrying about things, but I can no longer fall asleep. Recent testing for sleep apnea came back negative. Eight weeks of CBT-i did not improve my insomnia. I have an estrogen patch but cannot take progesterone which worsens my depression. TMS has greatly improved my mood and reduced my anxiety but paradoxically it has made my insomnia slightly worse. Any suggestions you have would be greatly appreciated.

  22. Karen,

    Sorry to hear about your lifelong chronic insomnia problem. Take a look at Dr. Barry Krakow’s landmark paper showing that treatment-resistant chronic insomniacs with no obvious sleep apnea responded to ASV with a 68% cure rate vs. 24% for CPAP. I’m not suggesting that you try ASV since no sleep doctor will order this for you for insomnia, and it won’t be covered by insurance. Plus it will be difficult to find a sleep doctor who will adjust the settings for you. My point in even mentioning this study is that you can still stop breathing every 2-3 hours, but not long enough to qualify as apneas. With upper airway resistance syndrome (UARS), you can stop breathing over 15 times every hour and have no apneas on a sleep study. There are a number of conservative steps to start with, to more aggressive device options to even purchasing an ASV machine. It’s a long discussion. I recommend watching my YouTube videos (Doctor Park) on UARS. Worse case scenario, if you need more customized help, I do have a virtual coaching option available.

  23. I have the same experience.
    I have tried melatonin when I wake up and it helps me to me go to sleep about an hour afterwards.
    I use to take banana and drink water too. Also seemed to help a bit.
    I don’t know of any sleep expect I could consult. I’m disturbed because I can’t take melatonin always.

  24. Thank you for this post. I have been prescribed 150 mgs if Trazedone for the last 5 years as I have always had trouble falling asleep. I don’t take my full dosage so I usually just take 50 mgs which helps me fall asleep. After about 5 hours, I wake up feeling wide awake and energized. I’ve noticed that I sleep a lot better if I mix the Trazedone with my anxiety medication which is 50 mgs of Hydroxyzine. I usually just do that on the weekends because I know that I don’t have to get up early for work therefore I won’t feel drowsy. I’m just not sure what I can do during the week to be able to get 7 – 8 hours of sleep.

  25. I’m a 44 year old male. A backslapper since my teens, I have always been able to fall asleep within 30-minutes of going to bed at 11pm, and generally sleep through to about 7am. This began to change in 2020, after a suspected bout of Covid (I say suspected, this was before testing and the symptoms were mild).

    May that year, about a month after symptoms first appeared, I began to experience very mild breathlessness, even when at rest. I have never suffered serious heartburn before, but the tingling sensation in my mouth that often accompanied the mild breathlessness, was diagnosed as a symptom of acid reflux, and I was described omeprazole.

    However, one of the side effects of this condition was I was no longer able to sleep on my back; if I tried, I’d awake with breathlessness and a dull pain in my lower chest. I also found I couldn’t sleep on my left side, though the symptoms were less. The only way I could sleep was on my right side. I have been doing that since 2020, and mostly have been able to sleep without waking.

    One thing I did notice was very vivid dreams, generally throughout the night, but especially before waking. Before 2020 I rarely remembered a dream. Since October this year I have started waking anywhere between 4:30 and 5:30am. Waking is usually preceded by intense dreams, but not generally by breathlessness.

    I have been trying to work out what has changed that might have prompted this. In the last six months I have got a grip of my exercise and eating, and have gone from 94kgs to 82kgs. My job, while marginally stressful (I teach 11 to 18 year olds), is no more stressful than it has been in the past. It has been a horrible season for colds – I’m a single parent to a 7 year old who likes to bring home everything he catches, and I’ve felt a general sense of malaise since about October.

    The only other thing that has changed is the end of daylight savings. It’s as if my circadian rhythms haven’t adapted to the hour’s difference. That having been said, in winter it stays dark here until about 7:30am, so it’s not a light issue. I’m not experiencing much in the way of tiredness during the day (yet), but I am concerned that I have gone from sleeping 11pm to 7am without difficulty, to now waking up before 5:30am most mornings.

  26. Hi Dr Park. It is comforting to see I’m not alone. I am a 48 year old physically fit male. Starting two months ago, i could no longer fall asleep on my back and had to switch to my side. I’ve had chronic insomnia for 25 years and have managed it with Seroquel and melatonin in recent times. I also have nasal issues and have had two turbinectomies and a surgery to fix deviated septum, but the surgeries did nothing. I already use Neti Pot, Breathe right strips and Nasal cone. The only nasal spray that opens my passages is Afrin, which recently gave me a panic attack while sleeping and sent me to the emergency room. Meditation and deep breathing techniques also do nothing.

    I can fall asleep ok, but wake after 4-5 hours unable to fall asleep. My lousy Kaiser Permanente health insurance can’t get me a sleep test for two more months. Do you have any Short term recommendations to sleep longer?

  27. Josh,

    Sorry to hear. It sounds like you’ve already tried all the conservative options. But have you tried CBT for insomnia? There’s also a good chance that you may not have sleep apnea or it’s very “mild” so no treatment will be offered. But if you’re still having problems while sleeping on your side, then it’s an issue that must be addressed. There are a number of issues to consider, but that required a more formal discussion. I do offer virtual coaching sessions for this purpose.

  28. Tried them all from ashwaganda, relora, 5htp, ltryptophan, holy basil, seriphos, ltheanine just to name a few. Low dose melatonin does nothing that I can discern and high doses make me groggy, increases my anxiety but doesn’t help me sleep. I meditate and exercise both vigorously or gently and doesn’t really move the needle. On my better nights I can get a bit over 6 hours which makes me feel great, but most night it is 4.5-5 hours sleep which is not optimal and makes me feel like crap. I’m not overweight and don’t snore, but wondering if there is undetected sleep apnea at play. Desperate for relief

  29. Mike, you don’t have to be overweight or snore to stop breathing multiple times at night. Many people stop breathing 10 to 20 times every hour but don’t show up as having obstructive sleep apnea in sleep studies because the duration is less than 10 seconds. Getting a sleep study is a good place to start, but you may find more help by seeing an airway-centric dentist for appliance therapy. Good luck!