Today each person seems to be plagued with a busy schedule that keeps increasing the demands on their personal performance. When this is the trend how can people catch up and stay ahead with this ever-increasing pressure? Sleep. The Merriam-Webster's dictionary defines sleep as the natural periodic suspension of consciousness during which the powers of the body are restored. Therefore, it appears that sleep is not an option for our lives, but a necessity. That may seem like an easy conclusion that is known by all, but current research shows that only Fifty-nine percent of Americans get seven or more hours of sleep at night, while 40% get less than seven hours. Here is the table from this study that shows the decline in sleep in America:
Why is sleep so important, and why has there been such little focus on trying to encourage this quality of life issue in our society by the medical community? Surprisingly there has been a lot of research conducted on the importance of sleep and brain function that was actually initiated as far back as 1929. During that decade of American history there was a phenomenal invention that opened the door into brain activity. The EEG (electroencephalograms) finally allowed scientist to look at brain activity, and study what occurred in our minds during the hours while we slept. What they found was brain activity continued functioning throughout the night. Through the work of the EEG, electrical activity in the brain was measured, and divided into two distinct types of sleep.
An EEG of REM sleep.
In contrast, people that were studied during the NON-REM period of sleep reported dreaming significantly less of the time. NREM sleep can be broken down into three distinct stages: N1, N2, and N3. In the progression from stage N1 to N3, brain waves become slower and more synchronized, and the eyes remain still. In stage N3, the deepest stage of
NREM, EEGs reveal high-amplitude (large), low-frequency (slow) waves and spindles. This stage is referred to as "deep" or "slow-wave" sleep. (http://healthysleep.med.harvard.edu/healthy)
Once the type of sleep had been defined, researchers began to uncover patterns in sleep that related to the type, duration, and frequency people cycled through while they slept. What was discovered was that people travel through specific stages of sleep in a sequential manner that is represented by the graph to the right. This graph indicates that as the night progresses the the REM cycles gets longer up until the point of waking. The full cycle corresponds to an 8 hour period of time which has become the recommended time allotted by sleep specialists by all adults. The reality highlighted earlier proves that people statistically are not successful in getting 8 hours of sleep, and may experience detrimental effects in their life due to the deficiency.(http://healthysleep.med.harvard.edu/healthy)
The following things may occur with a lack of sleep:
Although alcohol may help bring on sleep, after a few hours it acts as a stimulant, increasing the number of awakenings and generally decreasing the quality of sleep later in the night. It is therefore best to limit alcohol consumption to one to two drinks per day, or less, and to avoid drinking within three hours of bedtime.As any coffee lover knows, caffeine is a stimulant that can keep you awake. So avoid caffeine (found in coffee, tea, chocolate, cola, and some pain relievers) for four to six hours before bedtime. Similarly, smokers should refrain from using tobacco products too close to bedtime.
The two main types of sleep were defined as rapid-eye-movement (REM) sleep and non-rapid-eye-movement (NREM) sleep. Researchers named the REM sleep as "active sleep," that was identified by characteristic low-amplitude(small), high-frequency (fast) waves and alpha rhythm, as well as the eye movements for which it is named. The REM sleep cycle was believed to be the time period where people were engaged in dreams because people that were studied reported numerous dreams in conjunction with this time after they awakened.
NREM, EEGs reveal high-amplitude (large), low-frequency (slow) waves and spindles. This stage is referred to as "deep" or "slow-wave" sleep. (http://healthysleep.med.harvard.edu/healthy)
Once the type of sleep had been defined, researchers began to uncover patterns in sleep that related to the type, duration, and frequency people cycled through while they slept. What was discovered was that people travel through specific stages of sleep in a sequential manner that is represented by the graph to the right. This graph indicates that as the night progresses the the REM cycles gets longer up until the point of waking. The full cycle corresponds to an 8 hour period of time which has become the recommended time allotted by sleep specialists by all adults. The reality highlighted earlier proves that people statistically are not successful in getting 8 hours of sleep, and may experience detrimental effects in their life due to the deficiency.(http://healthysleep.med.harvard.edu/healthy)
The following things may occur with a lack of sleep:
- Contributes to Safety issues (on the job injuries or accidents)
- Impairs ability to think and make decisions
- Can produce serious health concerns
- Heart disease
- Heart attack
- Heart failure
- Cardiac arrhythmia
- Hypertension
- Stroke
- Reduces sex drive
- Contributes to depression
- Can affect physical appearance with early aging
- Impacts memory
- Causes hormonal challenges that lead to weight gain
- Significantly increases mortality risk
With so many risks that people can experience due to skipping sleep, the question should be what is the cause of all these sleep issues? Research has determined that there are currently a number of actual medical conditions or sleep disorders that are impacting people's ability to sleep well. Here is the list of disorders outlined:
Insomnia
On an average night, 30 to 40 million Americans have difficulty falling asleep, staying asleep, or wake earlier than they would like and cannot get back to sleep. These are the major symptoms of insomnia, the most common category of sleep disorders. Although many people with insomnia may accept their symptoms as a part of life, poor quality sleep takes a toll. Studies show that people with insomnia are more likely to become clinically depressed, suffer from poor concentration, and have accidents.
Many people have experienced periods of short-term, or acute, insomnia due to stress or environmental changes, such as job loss or jet lag. Fortunately, for most people these disruptions in sleep may last only a few nights. But in some cases, sleep disruptions persist for long periods and evolve into what specialists call chronic insomnia.
Causes of Chronic Insomnia
Insomnia often results from poor sleep habits, such as an overstimulating nighttime routine, or consuming too much alcohol or caffeine near bedtime. Certain medications, such as antidepressants, steroids, and allergy and cold products can also bring on bouts of insomnia.
In many people, insomnia is caused or made worse by a psychiatric or medical condition. For example, insomnia is a common symptom of many psychiatric disorders, such as anxiety and depression. It may also arise from painful or uncomfortable medical conditions, such as arthritis, or those that affect breathing, such as asthma.
In a condition called primary insomnia, where no clear environmental, psychiatric, or medical cause can be identified, experts suspect that individual differences in brain function may result in an overactive alerting signal that continues long after an individual would like to fall asleep.
In many people, insomnia is caused or made worse by a psychiatric or medical condition. For example, insomnia is a common symptom of many psychiatric disorders, such as anxiety and depression. It may also arise from painful or uncomfortable medical conditions, such as arthritis, or those that affect breathing, such as asthma.
In a condition called primary insomnia, where no clear environmental, psychiatric, or medical cause can be identified, experts suspect that individual differences in brain function may result in an overactive alerting signal that continues long after an individual would like to fall asleep.
Treatment
An overnight sleep study helps doctors determine why an individual sleeps poorly.
In many instances, resolving underlying health issues or changing external factors may be the best approach to relieving the symptoms of insomnia. If underlying health issues cannot be quickly resolved, or environmental factors cannot be identified or changed, then a variety of other treatment options can help.
Behavioral techniques
- Improved sleep habits, also called sleep hygiene, include such steps as regularizing one's sleep and wake-up times (including on weekends), ensuring the environment is conducive to sleep, and avoiding daytime naps and other behaviors, as well as substances that can interfere with sleep (e.g., caffeine, exercise).
- Cognitive behavioral therapy addresses the worries and fears of not falling asleep that sometimes can keep you awake.
- Meditation and biofeedback ease stress and promote relaxation.
Prescription medications
- Hypnotics are the most common and effective drugs for treating sleep problems.
- Some antidepressants can also promote sleep.
Over-the-counter sleep medications and remedies
Some of these may be successful in individual cases. Sleep aids often contain an antihistamine, which causes sleepiness but also can cause daytime drowsiness. Of the many herbal sleep remedies promoted as sleep aids, none has been conclusively found to be effective.
Excessive Daytime Sleepiness (EDS)
Sixty percent of adult drivers have driven a vehicle drowsy; more than one-third have fallen asleep at the wheel.
It is not unusual for people to have days when they struggle to stay awake. However, suddenly falling asleep on the job or while driving is not normal—and can be extremely dangerous. Excessive daytime sleepiness (EDS) is a symptom that can be seen in several sleep disorders, including obstructive sleep apnea, narcolepsy, and periodic limb movement disorder.
Obstructive Sleep Apnea (OSA) is an extreme form of snoring in which an individual’s airway becomes partially or completely blocked many times during a night of sleep, leading to repetitive awakenings. As we sleep, muscles in the throat relax. In some people, this relaxation causes tissue at the back to the throat to block the airway. In someone with a severe form of OSA, this may occur hundreds of times per night, interrupting breathing for 30 seconds or more during each instance.
The result of this interrupted breathing pattern is severely disrupted sleep, as the individual must wake up enough to regain muscle control in the throat and to reopen the airway. Surprisingly, despite dozens or even hundreds of awakenings per night, most individuals with OSA have no recollection of these events. In fact, often the only evidence of this serious condition is daytime fatigue and reports of loud snoring from bed partners.
One of the biggest risk factors for OSA is obesity. This may be because excessive weight increases the amount of tissue in the throat and thus makes airway obstruction more likely. Other risk factors include inherited traits, such as small jaw size or large overbite, as well as behavioral factors such as the use of alcohol before sleep.
OSA is a serious condition that can lead to high blood pressure, heart disease, and mood and memory problems. As such, those who suspect they may have OSA should consult their primary care physician, who may in turn refer them to a sleep specialist for an overnight sleep evaluation.
Obstructive Sleep Apnea (OSA) is an extreme form of snoring in which an individual’s airway becomes partially or completely blocked many times during a night of sleep, leading to repetitive awakenings. As we sleep, muscles in the throat relax. In some people, this relaxation causes tissue at the back to the throat to block the airway. In someone with a severe form of OSA, this may occur hundreds of times per night, interrupting breathing for 30 seconds or more during each instance.
The result of this interrupted breathing pattern is severely disrupted sleep, as the individual must wake up enough to regain muscle control in the throat and to reopen the airway. Surprisingly, despite dozens or even hundreds of awakenings per night, most individuals with OSA have no recollection of these events. In fact, often the only evidence of this serious condition is daytime fatigue and reports of loud snoring from bed partners.
One of the biggest risk factors for OSA is obesity. This may be because excessive weight increases the amount of tissue in the throat and thus makes airway obstruction more likely. Other risk factors include inherited traits, such as small jaw size or large overbite, as well as behavioral factors such as the use of alcohol before sleep.
OSA is a serious condition that can lead to high blood pressure, heart disease, and mood and memory problems. As such, those who suspect they may have OSA should consult their primary care physician, who may in turn refer them to a sleep specialist for an overnight sleep evaluation.
Treatment
- Weight loss is one of the most strongly recommended preventative therapies for weight-related OSA. Although results vary, weight loss may ease the severity of the disorder or eliminate the problem altogether.
- Continuous positive airway pressure (CPAP) is the first line of treatment for moderate to severe cases of OSA. During sleep, the CPAP device keeps the airway open by sending a constant, low-pressure stream of air through the nose and into the airway.
- Position therapy is somewhat less effective; however, some individuals have OSA only when they sleep on their back. This means they can successfully reduce OSA symptoms by sleeping on their side instead.
- Dental devices, which are designed to reposition the lower jaw in a way that keeps the airway open, work well in some individuals with mild to moderate OSA.
- Other treatment options include surgical procedures that widen the airway so that it is less likely to close during sleep.
- As yet, no medications have been shown to be effective in treating OSA.
Narcolepsy is best known as an almost uncontrollable need to fall asleep at various times throughout the daytime. Although excessive daytime sleepiness is common among people with narcolepsy, the sudden onset of sleep, or "sleep attacks," are less so. Affecting approximately one in two thousand people, narcolepsy is a central nervous system disorder in which the brain cannot properly regulate cycles of sleep and wakefulness. This results in an inability to stay awake for prolonged periods of time, and sleep itself can also be quite disturbed.
Other symptoms include:
- Cataplexy—sudden muscle weakness or reversible paralysis in the legs, arms, or face. In extreme cases, an individual may fall down, appear to be asleep, and remain unable to move for seconds to minutes, yet remain fully conscious.
- Hypnagogic hallucinations—intense dream-like experiences that occur during transitions to sleep.
- Sleep paralysis—the inability to talk or move for a short time when waking up or falling asleep.
Treatment
The diagnosis of narcolepsy sometimes requires daytime sleep testing as well as an overnight sleep study. While there is no cure, narcolepsy can be treated with stimulants to reduce daytime sleepiness and antidepressants and other medications to prevent cataplexy, sleep paralysis, and hypnagogic hallucinations. Scheduling daytime naps at convenient times may help to overcome the problems caused by unscheduled "sleep attacks."
Periodic Limb Movements of Sleep (PLMS) is a condition affecting approximately 34 percent of adults over the age of 60. This condition causes involuntary kicking and jerking movements of the legs and arms, often repeated hundreds of times during the night. Like people with sleep apnea, people with PLMS are usually unaware of their multiple nighttime awakenings unless they are witnessed by a bed partner. In extreme cases, these brief arousals following the leg movements disturb sleep so much that they cause excessive daytime sleepiness. In that situation, this is called periodic limb movement disorder (PLMD) and treatment may help with the symptoms of EDS. Patients with restless legs syndrome (an uncomfortable urge to move the legs) often have periodic limb movements during sleep.
Periodic Limb Movements of Sleep (PLMS) is a condition affecting approximately 34 percent of adults over the age of 60. This condition causes involuntary kicking and jerking movements of the legs and arms, often repeated hundreds of times during the night. Like people with sleep apnea, people with PLMS are usually unaware of their multiple nighttime awakenings unless they are witnessed by a bed partner. In extreme cases, these brief arousals following the leg movements disturb sleep so much that they cause excessive daytime sleepiness. In that situation, this is called periodic limb movement disorder (PLMD) and treatment may help with the symptoms of EDS. Patients with restless legs syndrome (an uncomfortable urge to move the legs) often have periodic limb movements during sleep.
Treatment
PLMD is typically treated using medications that have been shown to be useful in treating the movement disorder Parkinson’s disease. In some cases, sleeping pills may be used to prevent arousals caused by limb movements.
Other conditions that can cause EDS include advanced or delayed sleep phase syndromes, which result from abnormal time alignments between the preferred sleep-wake schedule and the phase of the internal clock. There are also numerous medical conditions, such as neuromuscular disorders, that can cause sleep to be fragmented and cause EDS.
Other conditions that can cause EDS include advanced or delayed sleep phase syndromes, which result from abnormal time alignments between the preferred sleep-wake schedule and the phase of the internal clock. There are also numerous medical conditions, such as neuromuscular disorders, that can cause sleep to be fragmented and cause EDS.
Parasomnias
Night terrors are parasomnias and are experienced most commonly in children.
Sleep can be a harrowing time for people who experience parasomnias. The symptoms of these disorders range from the mundane to the horrifying, and worrying about what might happen during a night of sleep can cause some people who experience parasomnias to want to avoid sleep. The three most common types of parasomnia are:
- Sleepwalking—Once thought to be an acting out of dreams, sleepwalking actually takes place during deep sleep (not REM sleep, when dreams typically occur). Sleepwalkers often perform routine activities such as dressing and cleaning. Sleepwalking is quite common in children and affects approximately 1 percent of adults. Bouts of sleepwalking can be triggered by stress, anxiety, excessive alcohol, or epilepsy.
- Night terrors—These severe attacks cause people, usually children, to appear to wake up and scream in fear or panic. However, these individuals are typically inconsolable, and tend to have no recollection of the event the following day.
- Sleep-eating disorders—These episodes, like sleepwalking, occur during partial awakenings from deep sleep and cause individuals to eat without any knowledge of what they are doing, or any memory of what they have done.
- If a sleepwalker or sleep-eater poses a threat to himself or herself, the disorder may be treated using relaxation techniques, such as self-hypnosis and/or sleep medications and antidepressants that prevent the partial awakenings that cause sleepwalking episodes.Treatment
- Night terrors that occur frequently or cause anxiety for individuals or for their family members can be treated with sleep medications, antidepressants, or relaxation techniques.
- Sleep specialists also recommend taking steps to make the sleep environment safe for sleepwalkers, such as removing objects that may cause injury during a sleepwalking episode.
Is there any way people can turn around their sleep challenges and take advantage of a better life performance? Yes, the following 12 suggestions and tips are recommendations made by sleep specialists that can contribute to a better night's sleep, and result in improving both physical and mental health:
#1 Avoid Caffeine, Alcohol, Nicotine, and Other Chemicals that Interfere with Sleep
Although alcohol may help bring on sleep, after a few hours it acts as a stimulant, increasing the number of awakenings and generally decreasing the quality of sleep later in the night. It is therefore best to limit alcohol consumption to one to two drinks per day, or less, and to avoid drinking within three hours of bedtime.As any coffee lover knows, caffeine is a stimulant that can keep you awake. So avoid caffeine (found in coffee, tea, chocolate, cola, and some pain relievers) for four to six hours before bedtime. Similarly, smokers should refrain from using tobacco products too close to bedtime.
#2 Turn Your Bedroom into a Sleep-Inducing Environment
A quiet, dark, and cool environment can help promote sound slumber. Why do you think bats congregate in caves for their daytime sleep? To achieve such an environment, lower the volume of outside noise with earplugs or a "white noise" appliance. Use heavy curtains, blackout shades, or an eye mask to block light, a powerful cue that tells the brain that it's time to wake up. Keep the temperature comfortably cool—between 60 and 75°F—and the room well ventilated. And make sure your bedroom is equipped with a comfortable mattress and pillows. (Remember that most mattresses wear out after ten years.)
Also, if a pet regularly wakes you during the night, you may want to consider keeping it out of your bedroom.
It may help to limit your bedroom activities to sleep and sex only. Keeping computers, TVs, and work materials out of the room will strengthen the mental association between your bedroom and sleep.
Also, if a pet regularly wakes you during the night, you may want to consider keeping it out of your bedroom.
It may help to limit your bedroom activities to sleep and sex only. Keeping computers, TVs, and work materials out of the room will strengthen the mental association between your bedroom and sleep.
#3 Establish a Soothing Pre-Sleep Routine
Light reading before bed is a good way to prepare yourself for sleep.
Ease the transition from wake time to sleep time with a period of relaxing activities an hour or so before bed. Take a bath (the rise, then fall in body temperature promotes drowsiness), read a book, watch television, or practice relaxation exercises. Avoid stressful, stimulating activities—doing work, discussing emotional issues. Physically and psychologically stressful activities can cause the body to secrete the stress hormone cortisol, which is associated with increasing alertness. If you tend to take your problems to bed, try writing them down—and then putting them aside.
#4 Go to Sleep When You’re Truly Tired
Struggling to fall sleep just leads to frustration. If you’re not asleep after 20 minutes, get out of bed, go to another room, and do something relaxing, like reading or listening to music until you are tired enough to sleep.
#5 Don’t Be a Nighttime Clock-Watcher
Staring at a clock in your bedroom, either when you are trying to fall asleep or when you wake in the middle of the night, can actually increase stress, making it harder to fall asleep. Turn your clock’s face away from you.
And if you wake up in the middle of the night and can’t get back to sleep in about 20 minutes, get up and engage in a quiet, restful activity such as reading or listening to music. And keep the lights dim; bright light can stimulate your internal clock. When your eyelids are drooping and you are ready to sleep, return to bed.
And if you wake up in the middle of the night and can’t get back to sleep in about 20 minutes, get up and engage in a quiet, restful activity such as reading or listening to music. And keep the lights dim; bright light can stimulate your internal clock. When your eyelids are drooping and you are ready to sleep, return to bed.
#6 Use Light to Your Advantage
Natural light keeps your internal clock on a healthy sleep-wake cycle. So let in the light first thing in the morning and get out of the office for a sun break during the day.
#7 Keep Your Internal Clock Set with a Consistent Sleep Schedule
Having a regular sleep schedule helps to ensure better quality and consistent sleep.
Going to bed and waking up at the same time each day sets the body’s "internal clock" to expect sleep at a certain time night after night. Try to stick as closely as possible to your routine on weekends to avoid a Monday morning sleep hangover. Waking up at the same time each day is the very best way to set your clock, and even if you did not sleep well the night before, the extra sleep drive will help you consolidate sleep the following night. Learn more about the importance of synchronizing the clock in The Drive to Sleep and Our Internal Clock.
#8 Nap Early—Or Not at All
Many people make naps a regular part of their day. However, for those who find falling asleep or staying asleep through the night problematic, afternoon napping may be one of the culprits. This is because late-day naps decrease sleep drive. If you must nap, it’s better to keep it short and before 5 p.m.
#9 Lighten Up on Evening Meals
Eating a pepperoni pizza at 10 p.m. may be a recipe for insomnia. Finish dinner several hours before bedtime and avoid foods that cause indigestion. If you get hungry at night, snack on foods that (in your experience) won't disturb your sleep, perhaps dairy foods and carbohydrates.
#10 Balance Fluid Intake
Drink enough fluid at night to keep from waking up thirsty—but not so much and so close to bedtime that you will be awakened by the need for a trip to the bathroom.
#11 Exercise Early
Exercise helps promote restful sleep if it is done several hours before you go to bed.
Exercise can help you fall asleep faster and sleep more soundly—as long as it's done at the right time. Exercise stimulates the body to secrete the stress hormone cortisol, which helps activate the alerting mechanism in the brain. This is fine, unless you're trying to fall asleep. Try to finish exercising at least three hours before bed or work out earlier in the day.
#12 Follow Through
Some of these tips will be easier to include in your daily and nightly routine than others. However, if you stick with them, your chances of achieving restful sleep will improve. That said, not all sleep problems are so easily treated and could signify the presence of a sleep disorder such as apnea, restless legs syndrome, narcolepsy, or another clinical sleep problem. If your sleep difficulties don’t improve through good sleep hygiene, you may want to consult your physician or a sleep specialist.
This information was compiled from: (http://healthysleep.med.harvard.edu/healthy/glossary/q-s#sleep-apnea)
If you're looking to improve your quality of life by improving your personal and professional performance, then making sleep a priority. Take advantage of this information to implement proven strategies that can work in helping you to become a better sleeper. Take care.
Dave
