Sick and tired: Sleep disorders are taking a toll

Still, people are coming around, beginning to recognize that they may lose that extra hour but gain in improved productivity, these experts say.

Dupont says he prefers "to do behavioral treatments, cognitive behavioral therapy, with medication intermittently as a backdrop."

He examines sleep habits and schedules first. And he has patients keep a sleep diary, which "almost always finds things we can fix."

Farney believes some people will benefit from long-term use of medications, something that has changed in recent years. The Food and Drug Administration used to limit use to about three week. Those who need medication should take it, he says. To do otherwise is "irrational avoidance." Concerns about becoming dependent on them are "not particularly valid," although some people do have addictive personalities. He's not an advocate of patients taking dietary supplements that claims to help sleep. Better, he says, are treatments tested in very carefully controlled studies and whose quality is well vetted.

Sleep breathing problems are a big target addressed by sleep specialists, says Jones. Some individuals breathe too shallowly, called sleep hypoventilation. That's most common in people who are severely obese or who have lung diseases like emphysema. It can co-exist with sleep apnea. But unlike the latter, it may be silent — "no dramatic gasping episodes," as Jones puts it. It make take a combination of morning headache, daytime fatigue, trouble staying asleep and medical history to suggest the diagnosis. In mild cases, doctors add a little oxygen through a nasal canula at night. In more severe cases, an air pressure machine similar to the CPAP (Continuous Positive Airway Pressure) mask used for sleep apnea helps the sleeper breathe deeper.

Sleep apnea, in which someone stops breathing briefly multiple times during sleep, then gasps in air, is common, but the diagnosis is often missed. Doctors may treat symptoms such as depression and high blood pressure without connecting the symptoms to a likely cause. And care providers tend to look where they're most familiar, so a psychiatrist presented with the symptoms might consider depression, while an endocrinologist might order a thyroid test or other metabolic study.

Common symptoms include nonrefreshing sleep, morning headaches, daytime fatigue and tiredness, loud snoring and irregular breathing at night. It is more common in men than women until menopause, when it evens out. Even children can have it, usually for anatomical reasons like enlarged tonsils or being overweight.