Table of Contents

Why do we sleep?

Most experts believe sleep is a time when we "recharge " the mind and body.

A typical human spends a third of his/ her life asleep.

The nature and quality of this time can have a dramatic impact on our waking hours.

Each individual needs a certain amount of sleep per day

-- typically 8 hours.

• Older people need less sleep
  -- someone from 35-50 will need 7 hours sleep

  -- someone over 50 will need 6 hours of sleep

• Young people need more sleep
  -- children under six should have 10 hours per day

  -- those from 6 to 14 typically need 9 hours per day

Subtracting the person's sleep requirement from 24 will give their normal day length (usually 16 hours).

A person who has lost enough sleep can appear drunk, staggering and slurring their words.

Factors that influence the quality of sleep will have the same effect as not getting enough hours of sleep.

• Sleeping all night in an uncomfortable place will have the same as waking up two hours early, as would waking up several times during the night.

Deep sleepers rarely suffer any ill effects due to the quality of their sleep.

Approximately 20% of the general population suffer from sleep disorders.

Common sleep problems:

• Insomnia-- sleeplessness
• Sleep deprivation-- lack of sleep
• Sleep apnea-- snoring and interrupted breathing
• Narcolepsy-- suddenly falling asleep

Insomnia

Insomnia can be in different forms:

- Difficulty falling asleep

- No problem falling asleep but difficulty staying asleep (many awakenings)

- Waking up too early

3 types of insomnia

Transient Insomnia-- lasting for a few nights

Short term Insomnia-- two to three weeks of poor sleep

Chronic Insomnia-- poor sleep that last three weeks or longer

Difficulty sleeping at night is only one of the symptoms. Daytime symptoms include:

• sleepiness
• anxiety
• impaired concentration
• impaired memory
• irritability

Causes of insomnia:

• A predisposition to insomnia in times of stress, much as others get headaches or indigestion.
• Persistent stresses
• Psychiatric problems, such as depression
• Use of drugs, caffeine, alcohol, and/ or nicotine
• Erratic hours, like shift work
• Sedentary lifestyle
• Learned insomnia, due to worrying about not being able to sleep
• Noisy environment
• Physical illness, such as breathing problems during sleep

When insomnia doesn't respond to changes in lifestyle alone, there are numerous products which can help. Be sure to consult your doctor even before self medicating even with non-prescription remedies. None of the following medications should be given to children.

• Antihistamines. Over the counter drugs that are commonly used to combat allergy symptoms also induce drowsiness. Don't take them for longer than one week.
• Hypnotics. Benzodiazepines are a class of prescription drugs which helps "relax" the mind and prepare it for sleep. These medications are potentially addictive.
• Non-benzodiazepine. A new class drug to help people sleep better. It was recently introduced. It is a non-benzodiazepine and has less side-effects and potential for addiction.
• Barbiturates. These powerful prescription drugs are effective-- but also addictive and dangerous if abused. Never take them except as your doctor directs.

If you have insomnia:

• Jot down when you go to bed, get up, consume coffee and alcohol, and exercise. Keep a sleep log for a week or two.
• Avoid caffeine, carbonated beverages, and alcohol.
• Don't smoke. Smoking is a stimulant.
• Don't take a nap unless you've found they don't interfere with sleep later on.
• Reserve your bed for sleep and sex; don't use your bed or bedroom as an office or a place to watch television.
• Relaxation techniques such as meditation, yoga, and biofeedback can be used before bedtime.
• If you are a bedroom worrier, dedicate another time -- say, 30 minutes after dinner-- to writing down problems and solutions.
• If you can't sleep, don't stay in bed. Get up and go to another room and read or do some other quiet activity until you feel sleepy.
• Forget the clock. Turn it around so you aren't staring at it when you're in bed. It only makes you anxious and worried because it shows how long you've stayed awake.

Am I getting enough sleep?

• Do you feel like you need a nap during the day?
• Do you fall asleep while watching TV?
• Have you ever fallen asleep while waiting at a red light in your car?

If you answered "yes" to any of these questions, you may not be getting enough sleep.

Sleep Apnea

What is sleep apnea?

"Obstructive sleep apnea is an illness characterized by snoring, partial or complete cessation of breathing during sleep reductions in blood oxygen levels, severe sleep fragmentation, and excessive daytime sleepiness. Researchers and clinicians have recognized sleep apnea as one of the most common sleep disorders and with perhaps the greatest medical and social impact on society in terms of morbidity and mortality. The syndrome strikes both sexes and all races, ages, socioeconomic strata, and ethnic groups, though it is less common in women prior to menopause, and may be more common in blacks than in whites.

Sleep apnea is a disorder of breathing during sleep.

-- Typically it is accompanied by loud snoring.

-- Apnea during sleep consist of brief periods throughout the night in which breathing stops.

-- People with sleep apnea do not get enough oxygen during sleep.

The impact of sleep apnea and snoring on sleep and health in the individual and for the public should not be ignored. According to the national commission of sleep disorders research: 40 million Americans are chronically ill with various sleep disorders... sleep apnea alone is the cause of excessive daytime sleepiness experienced by almost 20 million Americans... overwhelming evidence from testimony and specific surveys suggests that the vast majority of Americans with sleep disorders remain undiagnosed and untreated.

There are two major types.

• Obstructive sleep apnea-- most common type.

  It is due to an obstruction in the throat during sleep. Bed partners notice pauses approximately 10 to 60 seconds between loud snores. The narrowing of the upper airway can be a result of several factors including inherent physical characteristics, excess weight, and alcohol consumption before sleep.

• Central sleep apnea -- caused by a delay in the signal from the brain to breath

  With both obstructive and central apnea you must wake up briefly to breath, sometimes hundreds of times during the night. Usually there is no memory of these brief awakenings.

Most common symptoms:

• loud snoring
• waking up un-refreshed and having trouble staying awake during the day
• waking up with headaches
• waking up during the night sometimes with the sensation of choking
• waking up sweating

Sleep Apnea can cause depression

Sleep apnea can cause symptoms of apparent clinical depression which may respond quickly to treatment of the sleep disorder. A knowledge of the intellectual and emotional impact of sleep apnea may be important in making a correct diagnosis. Unfortunately, many physicians, psychiatrists and psychologists may be unaware of this connection.

It is estimated that the cardiovascular deaths attributable to obstructive sleep apnea alone may be as high as 38,000 annually.

Narcolepsy

Some people, no matter how much they sleep, continue to experience a irresistible need to sleep. People with Narcolepsy can fall asleep while at work, talking, and driving a car. These "sleep attacks" can last from 30 seconds to 30 minutes.

Narcolepsy is a chronic disorder affecting the brain where regulation of sleep and wakefulness take place. Narcolepsy can be thought of as an intrusion of dreaming sleep (REM) into the waking state.

Only about .03% of the general population have Narcolepsy. It has been found to be hereditary along with some environmental factors.

Symptoms:

• excessive sleepiness
• temporary decrease or loss of muscle control, especially when getting excited
• vivid dream-like images when drifting off to sleep or waking up
• waking up unable to move or talk for a brief time

Test for Narcolepsy

• Do you feel like you could sleep for days and still wake up sleepy?
• Do you ever collapse when laughing?
• Are you afraid you may fall asleep while swimming?
• Did one of your parents or close relatives have the "sleeping sickness" ?

General Sleep Information

Sleep has two alternating states (four to six times per night)

• Non-REM (non rapid eye movement ) sleep-- deep and dreamless.

  -- Metabolism slows down-- heart rate, breathing and brain waves slow down

• REM (rapid eye movement ) sleep-- deep muscle relaxation and vivid dreaming.

  -- Metabolism speeds up-- heart rate and breathing speed up.

Sleep appears to reorganize previously learned information into more useful units

-- Improving memory.

Sleep Problems: Some facts

36% of adults experience sleep problems...of these:

• 72% wake up feeling drowsy or tired
• 67% wake up in the middle of the night
• 57% have difficulty falling back to sleep after waking
• 55% have difficulty falling asleep

56,000 annual injury crashes on the highways of America due to drowsiness/ fatigue.

Tips toward a good night's sleep:

• Spend the time before retiring doing something relaxing, such as reading or taking a hot bath. Do not exercise or engage in vigorous mental activity.
• Keep your bedroom as quiet and dark as possible. This often requires the use of opaque shades and heavy curtains that can muffle disruptive intermittent noise from outside.
• Avoid daytime naps. This can seriously interfere with nighttime sleep. If you do nap, limit the nap to 40 minutes or less (anymore sleep can leave you feeling groggy ).
• Go to bed and get up on a regular schedule.
• Do not cheat on one night's sleep in the hope of catching up the next night.
• Avoid caffeine and nicotine late in the day.
• Avoid more than one alcoholic drink. Rather than promoting relaxation and sleep, excessive alcohol has the opposite effect, diminishing the quality of sleep and producing wakefulness when it wears off. Used regularly, alcohol tends to lose its sedative effects.

Ask your doctor before you buy or take any over-the-counter sleep medications.

Good sleep habits:

• Get up about the same time every day, regardless of when you go to bed.
• Go to bed only when sleepy.
• Establish relaxing pre-sleep rituals, such as a warm bath, light bedtime snack (such as juice and cookies) or 10 minutes of reading.
• Exercise regularly. Try jogging or aerobics in the late afternoon. Mild exercise -- such as stretching or walking -- is OK two or three hours before bedtime.

Benefits of good sleep:

• Add energy to your days and nights!
• Improve the quality of your life.
• Allow you to handle stress and minor irritations more effectively.

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