When to see a doctor about sleep or tiredness — a checklist for adults over 50

Sleep tips are everywhere. What's harder to find is a clear answer to a simple question: is this something I can fix with better habits, or should I see someone?

This checklist brings together the signs that health organizations — including the National Heart, Lung, and Blood Institute, the National Institute on Aging and the NHS — say deserve a professional's opinion. It's the same list that appears in the Calmer Nights, Easier Mornings kit, free to read, print and share.

The checklist

If any of these apply to you, make an appointment with your doctor. You can keep working on your everyday routines alongside.

• Loud snoring most nights, or someone has seen you stop breathing, choke or gasp in your sleep. These can be signs of sleep apnea — common, treatable and worth checking. A partner often notices first.
• Morning headaches, or feeling unrefreshed however long you sleep. Also seen with sleep apnea and other conditions a doctor can look for.
• Nodding off in the day without meaning to — reading, watching TV, talking — or feeling drowsy at the wheel. Strong daytime sleepiness needs a proper look. Don't drive while drowsy.
• Trouble getting to sleep or staying asleep on 3 or more nights a week for more than 3 months, and it affects your days. This is how chronic insomnia is described. It has an effective treatment, called CBT-I.
• An urge to move your legs that's hard to resist, worse when resting in the evening or at night, and eased by moving. This describes restless legs syndrome, which a clinician can assess and treat.
• Acting out dreams — shouting, punching or kicking in your sleep — or a partner says you do. This can be a sleep condition that deserves assessment, partly for safety.
• Night-time trips to the bathroom that are new, happening more often, or come with thirst, swelling, or snoring. Often just age-related, but sometimes linked to treatable conditions.
• Feeling tired or low on energy for several weeks with no relief, or with other changes such as weight loss, breathlessness or thirst. Tiredness has many possible causes — from anemia to thyroid problems to depression — that a doctor can check.
• Low mood, loss of interest, or worry on most days for more than two weeks. Sleep and mood affect each other. Both are worth raising.
• Your sleep changed after you started, stopped or changed a medicine — including over-the-counter sleep aids. Ask your doctor or pharmacist. Don't stop a prescribed medicine without advice.

Making the most of the appointment

Appointments are short, and it's easy to forget details. Bring:

• A sleep diary for one to two weeks. The National Heart, Lung, and Blood Institute suggests keeping one before you see your doctor. Note roughly when you went to bed, how long it took to fall asleep, how often you woke, when you woke for the day, naps, and caffeine and alcohol.
• A list of every medicine and supplement, including over-the-counter sleep aids, allergy and cold remedies, melatonin and herbal products.
• Your partner's observations, if you share a bed: snoring, pauses in breathing, kicking, talking or acting out dreams.
• Your questions. For example: Could my medicines be affecting my sleep? Should I be checked for sleep apnea? Would CBT-I suit me?

If insomnia is the problem: ask about CBT-I

For chronic insomnia, the first-choice treatment recommended by the American College of Physicians and the American Academy of Sleep Medicine is cognitive behavioral therapy for insomnia (CBT-I) — a structured program, usually over 6 to 8 weeks, available in person, by phone or online. Ask your doctor for a referral, or look for a clinician in the American Academy of Sleep Medicine's sleep center directory or the Society of Behavioral Sleep Medicine's provider directory. The US Department of Veterans Affairs also offers a free self-help app, Insomnia Coach, which anyone can use.