Baseer Maroof, LCSW · Raleigh, NC · Adults 21+
When to see a doctor
Insomnia is common. So are the sleep disorders that look like it. Here’s how to tell when it’s worth a medical look.
In short
- Some “insomnia” is another sleep disorder, and that changes treatment.
- Sleep apnea: loud snoring, pauses in breathing, gasping, heavy daytime sleepiness. Get it checked before sleep restriction.
- Restless legs: an urge to move the legs at rest in the evening that eases with movement. Iron levels matter.
- If you’re very sleepy during the day, not just tired, mention it to your doctor.
Sleep apnea
Benjafield 2019.
Why it matters here
Apnea fragments sleep and can look like insomnia; the two often overlap. Sleep restriction isn’t used when breathing problems during sleep are untreated. The AASM patient guide says to ask about other sleep disorders, like apnea, if you’re sleepy during the day. (Spielman et al. 2011; AASM patient guide)
Quick check: STOP-Bang
STOP-Bang sleep apnea screen
Tap each one that applies to you.
STOP-Bang (University Health Network), scoring as in BC Guidelines Appendix C. A screen, not a diagnosis. Nothing you tap is saved or sent.
How good is it?
A score of 3 or more catches about 93% of moderate-to-severe and 100% of severe sleep apnea. It’s built to miss few cases, so a high score means “get checked,” not “you have it.” (Chung 2016)
Restless legs syndrome
The five criteria
- An urge to move the legs, usually with uncomfortable sensations.
- It starts or gets worse at rest.
- Moving relieves it, at least while you move.
- It’s worse in the evening or at night.
- It isn’t explained by something else, like cramps or position discomfort.
(IRLSSG, Allen 2014)
What a doctor checks
Iron studies (ferritin and transferrin saturation). Iron is recommended when ferritin is 75 ng/mL or less, or saturation is under 20%. Common triggers to review: alcohol, caffeine, and some medications such as sedating antihistamines and certain antidepressants. The 2025 AASM guideline now advises against standard use of dopamine agonists because of worsening over time (augmentation). Talk to your doctor before changing any medication. (Winkelman 2025; AASM summary)
Other reasons to get checked
Bring these up
- Falling asleep while driving or in conversation.
- Acting out dreams, sleepwalking or other unusual night behavior.
- Insomnia that hasn’t budged with a good course of CBT-I. The European guideline suggests a sleep study when another sleep disorder is suspected or insomnia is treatment-resistant.
- New pain, breathing, heart, thyroid or mood changes alongside the sleep problem.
(Riemann 2023)
Sources
All sources, linked9 references⌄
- Benjafield AV, et al. (2019). Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis. Lancet Respir Med 7(8):687–698. pubmed.ncbi.nlm.nih.gov/31300334/
- Chung F, Abdullah HR, Liao P (2016). STOP-Bang questionnaire: a practical approach to screen for obstructive sleep apnea. Chest 149(3):631–638. pubmed.ncbi.nlm.nih.gov/26378880/
- BC Guidelines (2021). Obstructive Sleep Apnea, Appendix C: STOP-Bang Questionnaire (University Health Network). www2.gov.bc.ca/assets/gov/health/practitioner-pro/bc-guidelines/appenidxc_sleepapnea-guideline-2021-v2.pdf
- Allen RP, et al. (2014). Restless legs syndrome/Willis–Ekbom disease diagnostic criteria: updated IRLSSG consensus criteria. Sleep Med 15(8):860–873. pubmed.ncbi.nlm.nih.gov/25023924/
- Winkelman JW, et al. (2025). Treatment of restless legs syndrome and periodic limb movement disorder: an AASM clinical practice guideline. J Clin Sleep Med 21(1):137–152. pubmed.ncbi.nlm.nih.gov/39324694/
- American Academy of Sleep Medicine. Summary of new clinical practice guideline for RLS and PLMD. aasm.org/summary-of-new-clinical-practice-guideline-for-rls-and-plmd/
- Spielman AJ, Yang C-M, Glovinsky PB (2011). Sleep restriction therapy. In Perlis M, et al. (eds), Behavioral Treatments for Sleep Disorders. Elsevier (chapter hosted by the Penn CBT-I program). www.med.upenn.edu/cbti/assets/user-content/documents/BTSD%20Spielman%20Chapter%20on%20SRT.pdf
- American Academy of Sleep Medicine (2021). A patient’s guide to behavioral and psychological treatments for chronic insomnia disorder in adults. aasm.org/wp-content/uploads/2021/08/Behavioral-and-Psychological-Treatments-for-Insomnia-Patient-Guide.pdf
- Riemann D, et al. (2023). The European Insomnia Guideline: an update on the diagnosis and treatment of insomnia 2023. J Sleep Res 32(6):e14035. doi.org/10.1111/jsr.14035
Related on this site