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Understanding Sleep Health

Many people view sleep as a waste of time disrupting our ambitious daytime activities.  Yet sleep is absolutely critical for our health, safety and success.

Are we getting enough sleep?

Nearly70 percent of adults report insufficient sleep or rest at least once a month and 11 percent report insufficient sleep every day of the month.

Sleep loss causes issues with memory and attention, mood regulation, complex thought, motor responses to stimuli, and performance at work or school. Sleep loss may also disrupt thermoregulation and increase the risk of various physical and mental disorders. Short and long sleep duration is associated with up to a two-fold increased risk of obesity, diabetes, hypertension, incident cardiovascular disease, stroke, depression, substance abuse, and all-cause mortality in multiple studies.

In addition, an estimated 100,000 car crashes each year are believed to be the result of drivers’ drowsiness or fatigue behind the wheel.

Nearly 70 percent of high school adolescents sleep less than the recommended 8-9 hours recommended despite a physiological need. Short sleep in this group is associated with suicide risk, obesity, depression, mood problems, low grades, and delinquent behavior.

SLEEP DISORDERS:

An estimated 50 to 70 million Americans chronically suffer from a sleep or circadian disorder. Sleepiness is a serious health concern and cannot alwaysbe mitigated by healthy sleep habits. Sleep disorders are real and need to be addressed by a sleep specialist.

Could I have a sleep disorder?

Ask the basic questions:

1. “Do I have trouble sleeping at night?”

2. “Do I have trouble maintaining wakefulness during the day?”

What do sleep disorders look like?

Sleep disorders are often invisible and may be hard to detect. Sleepiness may manifest as issues with behavior, mood regulation, memory, concentration or sustained attention.  It’s important to learn about the real signs and symptoms of common and serious sleep disorders.

What kind of doctor should I visit about possible sleep disorder?

Be pro-active! Not all doctors are familiar with sleep disorders. Your journey will likely begin with your primary care doctor, but it’s important to consult a AASM Board Certified sleep specialist.  Find a sleep specialist familiar with your possible condition’s symptoms and treatments.

What are sleep disorders?

Common and serious sleep disorders include obstructive sleep apnea, narcolepsy, idiopathic hypersomnia, restless leg syndrome (or Willis-Ekbom disease), circadian rhythm sleep disorders, and insomnia.

Common and serious sleep disorders:

Circadian Rhythm Sleep Disorders (CRSDs or CSDs) are neurological disorders in which the sleep-wake cycle is out of sync with the day-night cycle. As a result, individuals may experience insomnia-like symptoms at night and excessive sleepiness during the day, greatly impacting typical work, school, and social schedules. Circadian Rhythm Disorders include Delayed Sleep Phase Disorder, Non-24-Hour Sleep-Wake Disorder, Advanced Sleep Phase Disorder, Irregular Sleep Wake Disorder, Shift Work Disorder, and Jet Lag Disorder.

Idiopathic Hypersomnia is a chronic sleep disorder involving persistent sleepiness lasting more than 3 months without abnormal tendencies to enter REM sleep.  In addition to excessive daytime sleepiness, symptoms include daily sleep amounts of 10 hours or more and extreme sleep inertia, difficulties waking up with alarm clocks, feeling groggy for long period of times. Idiopathic hypersomnia is diagnosed when a person displays symptoms for at least 3 months, the disorder has a significant impact on the person’s life, and other causes of excessive daytime sleepiness have been excluded.

Insomnia: Insomnia is a chronic or acute sleep disorder characterized by a complaint of difficulty falling asleep, waking up frequently during the night, waking up too early, or feeling unrefreshed after waking. Chronic insomnia affects nearly one out of five adults and is a risk factor for depression, substance abuse, and impaired waking function.

Kleine-Levin Syndrome (KLS) is a rare and complex neurological disorder characterized by recurring periods of excessive amounts of sleep, altered behavior, and a reduced understanding of the world. The disorder strikes adolescents primarily but can occur in younger children and adults. At the onset of an episode the patient becomes progressively drowsy and sleeps for most of the day and night (hypersomnolence), sometimes waking only to eat or go to the bathroom. Each episode lasts days, weeks or months during which time all normal daily activities stop. Individuals are not able to care for themselves or attend school and work. In between episodes, those with KLS appear to be in perfect health with no evidence of behavioral or physical dysfunction.

Narcolepsy is a chronic neurological disorder of the sleep/wake cycle that usually develops during childhood or young adulthood. Symptoms of narcolepsy include excessive daytime sleepiness, fragmented nighttime sleep, cataplexy (sudden muscle weakness triggered by emotions like laughter, surprise, annoyance, or exhilaration), sleep paralysis (temporary inability to talk or move when falling asleep or waking up) and hypnagogic hallucinations (vivid hallucinations that may be terrifying while falling asleep or waking up). One in 2,000 people have narcolepsy worldwide.

Obstructive Sleep Apnea (OSA) is a chronic disorder characterized by inability to maintain adequate ventilation during sleep due to sleep-related increase in upper airway resistance, while breathing during wakefulness is satisfactory. Sleep-disordered breathing, including obstructive sleep apnea, affects more than 15% of the population.

Restless Leg Syndrome (RLS) or Willis-Ekbom disease (WES) is a neurological movement disorder that is often associated with a sleep complaint. RLS may affect up to 15 percent of the population. People with RLS suffer an almost irresistible urge to move their legs, usually due to disagreeable leg sensations that are worse during inactivity and often interfere with sleep. RLS sufferers report experiencing creeping, crawling, pulling, or tingling sensations in the legs (or sometimes in the arms), which are relieved by moving or rubbing them. Sitting still for long periods becomes difficult; symptoms are usually worse in the evening and night and less severe in the morning. Periodic leg movements, which often coexist with restless leg syndrome, are characterized by repetitive, stereotyped limb movements during sleep. Periodic limb movement disorder can be detected by monitoring patients during sleep.

FAQ

What’s “good sleep”?

Sleep health factors to consider:

• Quantity (are you getting optimal hours?)
• Quality (are you getting the right amounts of restorative NREM & REM sleep?)
• Timing (is your sleep schedule in sync with your body’s circadian clock’s rhythm?)

8 Simple Sleep Hygiene Tips:

#1 Create a Cave

Your bedroom should be quiet, dark, and cool for sleep, just like a cave!  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. 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.

#2 Establish a Soothing Pre-Sleep Routine

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.

#3 Set an Alarm to Wind-Down

Going to bed and waking up at the same time each day helps keep the body’s “internal clock” in rhythm. Setting an alarm clock to remind oneself that it’s time to begin your pre-sleep shut down routine will help you stick to your routine.  Try staying on the same schedule on weekends to avoid a Monday morning sleep inertia.

#4 Avoid Caffeine, Alcohol, Nicotine, and Other Chemicals that Interfere with Sleep

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. Although alcohol may help us fall asleep, but after a few hours it acts as a stimulant, decreasing the quality of sleep later in the night. Limit alcohol consumption to one to two drinks per day, or less, and to avoid drinking within three hours of bedtime.

#5 Lighter Late Night Munchies

Eating a sirloin steak or fast food at 10 p.m. may cause insomnia. Finish dinner several hours before bedtime and avoid foods that cause indigestion. If you get hungry at night, snack on simple foods like carbohydrates.

#6 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.

#7 Walking on Sunshine

Natural light keeps your internal clock on a healthy sleep-wake cycle. Let light in first thing in the morning and get out of the office for a sun break during the day.

#8 Seek Expert Help

If your sleep difficulties don’t improve through good sleep hygiene, consult your physician or a sleep specialist. Not all sleep problems are improved with healthy sleep habits. Your excessive sleepiness could be a sign of a sleep disorder.