We successfully help non-respiratory sleep concerns with an integrative approach that targets the source of your complaint. Everyone feels sleepy at times. However, when sleepiness interferes with your daily routines and activities, or reduces your ability to function, it is called “problem sleepiness.”
Problem sleepiness can be due to a disruption of the body’s natural daily sleep-wake cycles, inadequate sleep, sleep disorders, inadequate nutrition as well as the use of certain drugs. The CDC estimates that approximately 70 million Americans suffer from chronic sleep problems. Sleep deprivation is associated with injuries, chronic diseases, mental illnesses, poor quality of life and well-being, increased health care costs, and lost work productivity.
Do you ever feel sleepy or are you “zone out” during the day? Do you find it hard to wake up on Monday mornings? If so, you are familiar with the powerful need for sleep. However, you may not realize that sleep is as essential for our well-being as food and water.
It is estimated that 70 million Americans chronically suffer from a disorder of sleep and wakefulness, hindering daily functioning and adversely affecting health and longevity.
What is sleep?
Until the 1950s, most people thought of sleep as a passive, dormant part of our daily lives. We now know that our brains are very active during sleep. Moreover, sleep affects our daily functioning and our physical and mental health in many ways that we are just beginning to understand.
During sleep, we usually pass through four phases of sleep: stages 1, 2, 3, and REM (rapid eye movement) sleep. These stages progress in a cycle from stage 1 to REM sleep, then the cycle starts over again with stage 1. We spend almost 50 percent of our total sleep time in stage 2 sleep, about 20 percent in REM sleep, and the remaining 30 percent in the other stages. Infants, by contrast, spend about half of their sleep time in REM sleep.
During stage 1, which is light sleep, we drift in and out of sleep and can be awakened easily. Our eyes move very slowly and muscle activity slows. People awakened from stage 1 sleep often remember fragmented visual images. Many also experience sudden muscle contractions called hypnic myoclonia, often preceded by a sensation of starting to fall. These sudden movements are similar to the “jump” we make when startled.
When we enter stage 2 sleep, our eye movements stop and our brain waves (fluctuations of electrical activity that can be measured by electrodes) become slower, with occasional bursts of rapid waves called sleep spindles.
Formerly divided into stages 3 and 4, Stage 3 is called slow wave sleep or deep sleep. It is characterized by extremely slow brain waves called delta waves. There is no eye movement or muscle activity. People awakened during deep sleep do not adjust immediately and often feel groggy and disoriented for several minutes after they wake up. Some children experience bed-wetting, night terrors, or sleepwalking during deep sleep.
REM, stands for Rapid Eye Movements, which are inherent to this stage of sleep. When we switch into REM sleep, our breathing becomes more rapid, irregular, and shallow, our eyes jerk rapidly in various directions, and our limb muscles become temporarily paralyzed. Our heart rate increases, our blood pressure rises, and males develop penile erections. When people awaken during REM sleep, they often describe bizarre and illogical dreams.
The first REM sleep period usually occurs about 70 to 90 minutes after we fall asleep. A complete sleep cycle takes 90 to 110 minutes on average. The first sleep cycles each night contain relatively short REM periods and long periods of deep sleep. As the night progresses, REM sleep periods increase in length while deep sleep decreases. By morning, people spend nearly all their sleep time in stages 1, 2, and REM.
If our REM sleep is disrupted one night, our bodies don’t follow the normal sleep cycle progression the next time we doze off. Instead, we often slip directly into REM sleep and go through extended periods of REM until we “catch up” on this stage of sleep.
What affects sleep?
Since sleep and wakefulness are influenced by different neurotransmitter signals in the brain, anything in our environment that changes the balance of these signals affects whether we feel alert or drowsy and how well we sleep. You can find some common environmental factors that can affect sleep in the list below.
- Emotional and cognative status; anxiety, depression and oveall brain funtion
- Our exposure to light including sunlight man-made light as well as light sources found withing the sleeping environment
- Medication and drug use including over-the-counter products and alcohol;
- Nutritional Status; the type, quality and timing of our food intake and how our bodies assimilate it.
- Temperature: the ability for us to regulate our body temperature and/or the ambient temperature of our sleep environment.
- Exercise; though research shows that exercise is certainly good for one’s body and health, properly timing exercise is necessary to maximize the beneficial effects. For example, a good workout can make you more alert, speed up your metabolism and energize you for the day ahead, but exercise right before bedtime can lead to a poor night’s sleep. Sleep experts recommend exercising at least three hours before bedtime.
How much sleep do we need?
The amount of sleep each person needs depends on many factors, including age. Infants generally require more and this need steadily decreases with age until adulthood.
This chart represents the sleep needs by age according to the National Sleep Foundation.
|Newborns (0–2 months)||12 to 18 hours|
|Infants (3–11 months)||14 to 15 hours|
|Toddlers (1–3 years)||12 to 14 hours|
|Preschoolers (3–5 years)||11 to 13 hours|
|School-age children (5–10 years)||10 to 11 hours|
|Adolescents (10–17 years)||8.5 to 9.25 hours|
|Adults, including elderly||7 to 9 hours|
When to sleep
The optimal amount of sleep is not a meaningful concept unless the timing of that sleep is seen in relation to an individual’s circadian rhythms. Circadian rhythms are regular changes in mental and physical characteristics that occur in the course of a day (circadian is Latin for “around a day”). Most circadian rhythms are controlled by the body’s biological “clock.” This clock, called the suprachiasmatic nucleus or SCN, is actually a pair of pinhead-sized brain structures that together contain about 20,000 neurons.
Signals from the SCN travel to several brain regions, including the pineal gland, which responds to light-induced signals by switching off production of the hormone melatonin. The body’s level of melatonin normally increases after darkness falls, making people feel drowsy. The SCN also governs functions that are synchronized with the sleep/wake cycle, including body temperature, hormone secretion, urine production, and changes in blood pressure. Our biological cycles normally follow the 24-hour cycle of the sun, unless we are light deprived.
What does sleep do for us?
Although scientists are still trying to learn exactly why people need sleep, animal studies show that sleep is necessary for survival. For example, while rats normally live for two to three years, those deprived of REM sleep survive only about 5 weeks on average, and rats deprived of all sleep stages live only about 3 weeks.
Sleep appears necessary for our nervous systems to work properly. Too little sleep leaves us drowsy and unable to concentrate the next day. It also leads to impaired memory and physical performance and reduced ability to carry out math calculations. If sleep deprivation continues, hallucinations and mood swings may develop. Some experts believe sleep gives neurons used while we are awake a chance to shut down and repair themselves. Without sleep, neurons may become so depleted in energy or so polluted with byproducts of normal cellular activities that they begin to malfunction. Sleep also may give the brain a chance to exercise important neuronal connections that might otherwise deteriorate from lack of activity.
Deep sleep coincides with the release of growth hormone in children and young adults. Many of the body’s cells also show increased production and reduced breakdown of proteins during deep sleep. Since proteins are the building blocks needed for cell growth and for repair of damage from factors like stress and ultraviolet rays, deep sleep may truly be “beauty sleep.” Activity in parts of the brain that control emotions, decision-making processes, and social interactions is drastically reduced during deep sleep, suggesting that this type of sleep may help people maintain optimal emotional and social functioning while they are awake. A study in rats also showed that certain nerve-signaling patterns which the rats generated during the day were repeated during deep sleep. This pattern repetition may help encode memories and improve learning.
REM sleep stimulates the brain regions used in learning. One study found that People taught a skill and then deprived of non-REM sleep could recall what they had learned after sleeping, while people deprived of REM sleep could not.
Some scientists believe dreams are the cortex’s attempt to find meaning in the random signals that it receives during REM sleep. The cortex is the part of the brain that interprets and organizes information from the environment during consciousness.
Sleep deprivation and its effects
Experts say that if you feel drowsy during the day, even during boring activities, you haven’t had enough sleep. If you routinely fall asleep within 5 minutes of lying down, you probably have severe sleep deprivation, possibly even a sleep disorder. Microsleeps, or very brief episodes of sleep in an otherwise awake person, are another mark of sleep deprivation. In many cases, people are not aware that they are experiencing microsleeps.
The cumulative long-term effects of sleep loss and sleep disorders have been associated with a wide range of deleterious health consequences. Studies suggest that sleep loss may have pervasive effects on the cardiovascular, endocrine, immune, and nervous systems, other effects include the following:
|• Anxiety symptoms||• Depressed mood|
|• Decreased attention and working memory||• Impaired physical and cognitive abilities|
|• Impaired learning||• Emotional reactivity|
|• Obesity in adults and children||• Gastrointestinal disorders|
|• Diabetes and impaired glucose tolerance||• Cardiovascular disease and hypertension|
|• Impaired healing||• Alcohol use|
The widespread practice of “burning the candle at both ends” has created so much sleep deprivation that what is really abnormal sleepiness is now thought of as the norm. So if you’re suffering from sleepiness give us a call at 516.208.9360 to set up your free phone consultation and find out what can be done to help.
Institute of Medicine (US) Committee on Sleep Medicine and Research; Colten HR, Altevogt BM, editors. Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem. Washington (DC): National Academies Press (US); 2006. 3, Extent and Health Consequences of Chronic Sleep Loss and Sleep Disorders. Available from: http://www.ncbi.nlm.nih.gov/books/NBK19961/ http://articles.mercola.com/sites/articles/archive/2010/02/02/lost-sleep-can-never-be-made-up.aspx http://en.wikipedia.org/wiki/Sleep#Siesta_or_nap http://www.ninds.nih.gov/disorders/brain_basics/understanding_sleep.htm
Science has described more than 70 sleep disorders, most of which can be managed effectively once they are correctly diagnosed. Sleep disorders account for an estimated $16 billion in medical costs each year, while the indirect costs due to lost productivity and other factors are much greater. The most common sleep disorders include insomnia, Circadian rhythm disorders, sleep apnea, narcolepsy, restless leg syndrome and sleepwalking. If you’re suffering from sleepiness its possible that you are suffering from one or more of the conditions below.
Insomnia, which is Latin for “no sleep,” is the inability to fall asleep or remain asleep adequately. Insomnia is often practically defined as a positive response to either of two questions: “Do you experience difficulty sleeping?” or “Do you have difficulty falling or staying asleep?”
Insomnia is most often thought of as both a sign and a symptom that can accompany several sleep, medical, and emotional disorders. Half of all those who have experienced insomnia blame the problem on stress and worry. Insomnia is characterized by a persistent difficulty falling asleep and/or staying asleep or sleep of poor quality.
If you have difficulty sleeping, it is essential to determine whether an underlying disease or condition is causing the problem. Insomnia can be caused by pain, digestive problems or another sleep disorder. Insomnia may also be the result of emotional or cognitive disorders such as anxiety and depression. If insomnia is indeed caused by an underlying condition, often times, it will make this condition worse.
If your sleep trouble is confined to difficulty falling asleep, or waking too early, the time you are choosing to go to sleep may not be synchronized with your biological clock (see circadian rhythm disorders below).
Another cause of insomnia is poor sleep hygiene. Sleep hygiene, as defined by the national sleep foundation is define as a variety of different practices that are necessary to have normal, quality nighttime sleep and full daytime alertness. See how we help insomnia.
Circadian rhythms are regular changes in mental and physical characteristics that occur in the course of a day (circadian is Latin for “around a day”). Also called Non-24 Hour Sleep Wake Disorder (N24HSWD), a Circadian rhythm disorder affects the normal 24-hour synchronization of your body’s natural internal clock.
Sleep disorders and difficulties caused by the miss-timing of the body clock include:
• Delayed Sleep Phase Disorder (Sleep onset insomnia) is a sleep disorder in which your sleep patter is delayed by two or more hours.
• Advanced Sleep Phase Disorder (Early morning awakening insomnia) is a condition in which patients have a natural tendency to go to sleep and wake up at times considered early than what is normal.
• Irregular and free-running circadian rhythm is characterized by chaotic or drifting later timing of sleep patterns. Most totally blind people have circadian rhythms that are “free-running” (i.e., that are not synchronized to environmental timing cues.
• Jet-Lag – When travelers pass from one time zone to another, they suffer from disrupted circadian rhythms, an uncomfortable feeling known as jet lag. For instance, if you travel from California to New York, you “lose” 3 hours according to your body’s clock. It usually takes several days for your body’s cycles to adjust to the new time.
• Shift Work Disorder – Symptoms much like jet lag are common in people who work nights or who perform shift work. Because these people’s work schedules are at odds with powerful sleep-regulating cues like sunlight, they often become uncontrollably drowsy during work, and they may suffer insomnia or other problems when they try to sleep.
Sleep apnea is a common disorder in which you have one or more pauses in breathing or shallow breaths while you sleep. Breathing pauses can last from a few seconds to minutes. They may occur 30 times or more an hour. Typically, normal breathing then starts again, sometimes with a loud snort or choking sound.
Sleep apnea usually is a chronic (ongoing) condition that disrupts your sleep. When your breathing pauses or becomes shallow, you’ll often move out of deep sleep and into light sleep. As a result, the quality of your sleep is poor, which makes you tired during the day. Sleep apnea is a leading cause of excessive daytime sleepiness and often may be accompanied by another sleep disorder.
• Obstructive sleep apnea is the most common type of sleep apnea. In this condition, the airway collapses or becomes blocked during sleep. This causes shallow breathing or breathing pauses. Obstructive sleep apnea is more common in people who are overweight, but it can affect anyone. For example, small children who have enlarged tonsil tissues in their throats may have obstructive sleep apnea.
• Central sleep apnea is a less common type of sleep apnea. This disorder occurs if the area of the brain that controls breathing doesn’t send the correct signals to the diaphragm. As a result, no effort to breathe is made for brief periods. Snoring typically doesn’t happen with central sleep apnea. Central sleep apnea can affect anyone. However, it’s more common in people who have certain medical conditions or use certain medicines.
• Complex Sleep Apnea, in rare cases, central sleep apnea can occur with obstructive sleep apnea.
Narcolepsy is a disorder that causes periods of extreme daytime sleepiness. The disorder also may cause muscle weakness.
Most people who have narcolepsy have trouble sleeping at night. Some people who have this disorder fall asleep suddenly, even if they’re in the middle of talking, eating, or another activity.
• Cataplexy -This condition causes a sudden loss of muscle tone while you’re awake. Muscle weakness can affect certain parts of your body or your whole body. For example, if cataplexy affects your hand, you may drop what you’re holding. Strong emotions often trigger this weakness. It may last seconds or minutes.
• Hallucinations -These vivid dreams occur while falling asleep or waking up.
• Sleep paralysis – This condition prevents you from moving or speaking while waking up and sometimes while falling asleep. Sleep paralysis usually goes away within a few minutes.
The two main phases of sleep are nonrapid eye movement (NREM) and rapid eye movement (REM). Most people are in the NREM phase when they first fall asleep. After about 90 minutes of sleep, most people go from NREM to REM sleep. Dreaming occurs during the REM phase of sleep. During REM, your muscles normally become limp. This prevents you from acting out your dreams. For more information about the stages of sleep click here.
People who have narcolepsy often fall into REM sleep quickly and wake up directly from it. As a result, they may have vivid dreams while falling asleep and waking up. This may also account for the aforementioned cataplexy, hallucinations and sleep paralysis.
Hypocretin, a chemical in the brain, helps promote wakefulness. Most people who have narcolepsy have low levels of this chemical. What causes these low levels isn’t well understood. However, researchers have postulated that certain factors may work together to cause a lack of hypocretin. These factors may include heredity, infections, functional brain deficits, and autoimmune disorders.
Restless Leg Syndrome
Restless legs syndrome (RLS) is a neurological disorder characterized by throbbing, pulling, creeping, or other unpleasant sensations in the legs. This results in an uncontrollable, and sometimes overwhelming, urge to move them. Symptoms occur primarily at night when a person is relaxing or at rest and can increase in severity during the night. Moving the legs relieves the discomfort. Often called paresthesias (abnormal sensations), or dysesthesias (unpleasant abnormal sensations), the sensations range in severity from uncomfortable to irritating to painful.
Another type of RLS usually starts later in life (after 45 years of age). It generally doesn’t run in families. This type of RLS tends to have a more abrupt onset. The symptoms usually don’t get worse over time.
Some diseases, conditions, and medicines may trigger RLS. For example, the disorder has been linked to kidney failure, Parkinson’s disease, diabetes, rheumatoid arthritis, pregnancy, and iron deficiency. When a disease, condition, or medicine causes RLS, the symptoms usually start suddenly.
Medical conditions or medicines often cause or worsen the type of RLS that starts later in life.
Sleepwalking is a disorder that originates during deep sleep and results in walking or performing other complex behaviors while asleep. It is much more common in children than adults and is more likely to occur if a person is sleep deprived.
The prevalence of sleepwalking is highest for children between the ages of three and seven, and occurs more often in children with obstructive sleep apnea. Sleepwalking often occurs with other sleep disorders such as sleep terrors and bed-wetting.
Other symptoms of sleepwalking include:
• Inappropriate behavior such as urinating in closets (more common in children)
• Screaming (when sleepwalking occurs in conjunction with sleep terrors)
• Violent attacks on the person trying to awaken the sleepwalker
Bed-wetting, known as nighttime incontinence or nocturnal enuresis, is defined as the involuntary urination during sleep. It fairly common in fact, it is estimated that seven million children in the United States wet their beds on a regular basis. The age at which children develop bladder control is variable and bed-wetting most often is a result of immaturity or developmental delay. Bed-wetting has been linked with behavioral issues and poor self-esteem.
There are both primary and secondary forms of bed-wetting. With primary bed-wetting, the child has never had nighttime control over urination. The secondary form is less common and refers to bed-wetting that occurs after the child has been dry during sleep for 6 or more months.
Primary nocturnal enuresis (PNE) is the most common form of bed-wetting. Medical guidelines vary on when a child is old enough to stay dry. Common medical definitions allow doctors to diagnose PNE beginning at between 4 to 5 years old.
Some researchers, however, recommend a different starting age range. This guidance says that bedwetting can be considered a clinical problem if the child regularly wets the bed after turning 7 years old.
Secondary nocturnal enuresis
Secondary enuresis occurs after an individual goes through an extended period of dryness at night (roughly six months or more) and then reverts to nighttime wetting. Secondary enuresis can be caused by emotional stress or a medical condition, such as a bladder infection or a hormonal imbalance.
Bedwetting has a strong genetic component. Children whose parents were not bedwetters have only a 15% incidence of bedwetting. When one or both parents were bedwetters, the rates jump to 44% and 77% respectively.
Other causes include:
|• Immaturity||• Developmental delay||• Physical abnormalities|
|• Genetics||• Caffeine consumption||• Psychological, emotional|
|• Alcohol consumption||• Hormonal imbalance||• Other Sleep Disorders|
Night terrors (sleep terrors) are a sleep disorder in which a person quickly wakes from sleep in a terrified state.
Night terrors are most common in males, although they also can occur in females. The prevalence of sleep terror episodes has been estimated at 1%-6% among children and at less than 1% of adults. Sleep terrors begin between ages 3 and 12 years and then usually dissipate during adolescence. In adults, they most commonly occur between the ages of 20 to 30. Night terrors may run in families and occur in adults, especially when there is emotional tension or the use of alcohol.
Night terrors are most common during the first third of the night, often between midnight and 2 a.m.
- The universal feature of night terrors is inconsolability
- The individual often screams and is very frightened and confused. He may thrash around violently and often is not aware of his surroundings, so caution should be taken.
- You may be unable to talk to, comfort, or fully wake up a person who is having a night terror.
- The person may be sweating, breathing very fast (hyperventilating), have a fast heart rate, and widened (dilated) pupils.
- The spell may last 10 – 20 minutes, then the person goes back to sleep.
Most are unable to explain what happened the next morning. They often have no memory of the event when they wake up the next day.
Children with night terrors may also sleep walk.
In contrast, nightmares are more common in the early morning. They may occur after someone watches frightening movies or TV shows, or has an emotional experience. A person may remember the details of a dream when he or she wakes up, and will not be disoriented after the episode.