Sleep

It may seem that nothing is going on when you sleep. But your body is going through some definite changes. Normally, when you're awake, your brain waves show a regular rhythm. When you first fall asleep, those brain waves become slower and less regular. This sleep state is called non-rapid eye movement (NREM) sleep. After about an hour and a half of NREM sleep, the brain waves begin to show a more active pattern again, even though you're still asleep. This deep sleep state, called rapid eye movement (REM) sleep, is when dreaming occurs. The best sleep is a mix of REM and non-REM sleep that leaves us feeling rested and refreshed the next day. But for many people, that's not what happens.

Sometimes the harder we try to fall asleep, the more we keep ourselves wide-awake. We should also be aware of the fact that our sleep patterns may change as we get older. (Read about "Sleep and Age") And sometimes, there's a serious sleep disorder present that needs attention.

If you think your sleep problems need medical attention, talk with your doctor. You may need to spend a night or two in a hospital sleep laboratory where your brain waves, muscle activity, leg and arm movements, heart rhythms, and other body functions can be monitored while you sleep. (Read about "EEG - Electroencephalograph")

Below you'll find information to learn about conditions that can affect our sleep patterns, as well as some tips to get a good night's sleep.

Insomnia

Insomnia is the perception or complaint of inadequate or poor-quality sleep. According to the National Heart, Lung, and Blood Institute (NHLBI) people with insomnia may experience:

• difficulty falling asleep
• waking up frequently during the night, and finding it hard to go back to sleep
• waking up too early in the morning
• unrefreshing sleep

Insomnia is not defined by the number of hours of sleep a person gets or how long it takes to fall asleep. NHLBI says we all vary in how much sleep we need to feel good. Therefore, insomnia is a very individual thing.

One thing people with insomnia may share is that their perceived sleep problems are causing other issues during the day, such as tiredness, a lack of energy, difficulty concentrating, and irritability. Insomnia is considered to be chronic if it occurs on most nights and lasts a month or more.

NHLBI says chronic insomnia often results from a combination of factors, including underlying physical or mental disorders. (Read about "Mental Health") One of the most common causes of chronic insomnia is depression. (Read about "Depressive Illnesses") Stress can also lead to insomnia. (Read about "Stress") Other underlying causes include arthritis, kidney disease, asthma, Parkinson's disease, hyperthyroidism and alcohol abuse. (Read about "Arthritis and Rheumatic Diseases" " Kidney Disease" "Asthma" "Parkinson's Disease" "Thyroid" "Alcoholism") In addition, insomnia can be caused by any of the sleep disorders listed below including sleep apnea, narcolepsy and restless legs syndrome.

Because there are so many potential causes, treatment for insomnia often starts with a thorough medical exam, to determine if any physical or mental problems do exist. Treatment for the underlying medical condition may help the insomnia. In addition, behavioral therapy, including relaxation techniques, can be useful. Short-term use of sleep medications may be helpful. Keep in mind, however, that these drugs may have side effects, especially in older people. (Read about "Medicine Safety") If insomnia is interfering with your daily life, a doctor or accredited sleep disorder center can provide more information on treatments.

Restless Legs Syndrome

Restless legs syndrome (RLS) is a sleep disorder in which a person experiences unpleasant sensations in the legs described as creeping, crawling, tingling, pulling or pain. The feelings can occur in one or both legs, often in the calf area, but they can also be felt anywhere from the thigh to the ankle, or even the arms. These sensations are strongest when the person with RLS lies down or sits for prolonged periods of time. They often get worse at night. People with RLS say that when the sensations occur, the urge to move their limbs becomes intense.

NHLBI says RLS may have a tendency to run in families. Other causes include low iron levels or anemia, (Read about "Anemia") as well as kidney disease, diabetes, and rheumatoid arthritis. (Read about "Kidney Disease" "Diabetes" "Rheumatoid Arthritis") A complete physical and neurological exam may help identify other conditions that may be associated with RLS, such as nerve damage (neuropathy or a pinched nerve) or abnormalities in the blood vessels. (Read about "Peripheral Neuropathy") NHLBI says massage (Read about massage in "CAM Therapies"), baths, as well as hot or cold therapy can help RLS. Decreasing caffeine consumption may also improve symptoms.

In addition, medication may be prescribed. Medication options include opioids, central nervous system depressants, anticonvulsants and dopaminergic agents, which are largely used to treat Parkinson's disease. (Read about "Parkinson's Disease") Ropinirole is another drug that is used for RLS. Unfortunately, no one drug is effective for everyone with RLS. What may be helpful to one person may actually worsen symptoms for another. In addition, medications taken regularly may lose their effect, making it necessary to change medications periodically. You also need to discuss potential side effects with your doctor. (Read about "Medicine Safety") If RLS is causing problems, your doctor or an accredited sleep disorders center can provide more information on the best treatments.

Periodic Limb Movement

NHLBI says many people with Restless Legs Syndrome also have a related sleep disorder called periodic limb movements in sleep (PLMS). PLMS is characterized by involuntary jerking or bending leg movements during sleep that typically occur every 10 to 60 seconds. Some people may experience hundreds of such movements per night, which can wake them, disturb their sleep and awaken bed partners.

According to the National Sleep Foundation, over a third of all people aged 65 and older experience PLMS, with men and women equally affected. A number of medications have been shown to be effective in treating PLMS. If PLMS is causing problems, your doctor or an accredited sleep disorders center can provide more information on the best treatments.

Sleep Apnea

One specific sleep disorder that can be dangerous, even deadly, is sleep apnea. The National Sleep Foundation estimates that millions of Americans may be affected with this problem.

In many cases of sleep apnea, breathing actually stops for up to ten seconds or longer at a time. This can occur when muscles in the mouth and throat relax and obstruct the airway. It can also occur when the diaphragm and chest muscles stop working correctly. Whenever this happens, the sleeper then wakes up gasping for air. In the most serious cases of sleep apnea, this can happen dozens, even hundreds of times a night. Many times, however, the sleeper doesn't remember it.

Sleep apnea can be dangerous. It can cause oxygen levels in the blood to fall. If the condition is severe enough, some studies suggest it can even lead to pulmonary hypertension. (Read about "Pulmonary Hypertension")

According to the National Institutes of Health (NIH), sleep apnea is more common in middle-aged men and overweight people. (Read about "Obesity" "Losing Weight") Some of the common symptoms can include:

• excessive snoring
• excessive daytime sleepiness
• insomnia
• headaches upon wakening
• poor memory and concentration

There are three types of apnea:

• Obstructive apnea - Obstructive apnea is the most common, according to the National Sleep Foundation. In this form of apnea, the muscles at the back of the throat relax to the point of obstructing the upper airway. Loud snoring is a common symptom. Obstructive apnea can result from excess weight. It can also result in someone with a large neck, large tongue, nasal obstruction, or narrow windpipe. Using alcohol or sedatives to fall asleep use has also been linked to apnea.
• Central apnea - Central apnea, which is less common, is when the airways stay open but the diaphragm and chest muscles stop working. This forces the sleeper to wake up several times a night to resume breathing. Central apnea can occur when the brain doesn't send proper signals to the muscles which control breathing. This can often be the result of medical conditions such as heart failure or stroke. (Read about "Congestive Heart Failure" "Stroke")
• Mixed apnea - Mixed apnea is a combination of the two, usually a short period of central apnea followed by a longer period of obstructive apnea.

The condition can also occur in children. According to the American Lung Association, sleep apnea in children is often due to enlarged tonsils and adenoids. A child who is sleepy during the day and snores at night should be medically evaluated. (Read about "Tonsils and Adenoids")

Treatment of sleep apnea varies depending on the type and severity of the apnea. NIH says mild sleep apnea frequently can be overcome through weight loss (Read about "Losing Weight") or by preventing the person from sleeping on his or her back. For someone with central apnea, treatment of the underlying condition may relieve the apnea. Those with obstructive apnea may need special devices or surgery to correct the obstruction. One device provides what is called continuous positive airway pressure (CPAP). It uses a mask and a fan to blow air into your mouth and nose. The tongue is pressed forward and the throat is kept open. Air is then allowed to pass unheeded to your lungs. In another procedure, tiny inserts are placed in the soft palate. This can help reduce the vibration that causes snoring, and reduce obstruction of the airway. Once in place, the inserts are designed to add structural support to the soft palate. Somnoplasty is another procedure. Somnoplasty uses low radiofrequency energy to reduce tissue mass in the area of obstruction. An overnight stay in a specialized sleep disorders center may be needed to help settle on the appropriate treatment.

NIH stresses that people with sleep apnea should never take sedatives or sleeping pills, which can prevent them from awakening enough to breathe.

Narcolepsy

Narcolepsy is another sleep disorder which causes people to have frequent "sleep attacks" at various times of the day, even if they have had a normal amount of sleep the night before. These attacks last from several seconds to more than 30 minutes. There may also be loss of muscle control during emotional situations, hallucinations, temporary paralysis when they awaken and disrupted nighttime sleep. NIH says symptoms usually appear during adolescence, with a variety of medications including stimulants, antidepressants or other drugs used for treatment, depending on the individual.

NHLBI says it's estimated that narcolepsy afflicts as many as 200,000 Americans, though fewer than 50,000 are diagnosed. There is also evidence that narcolepsy may run in families; 8 to 12 percent of people with narcolepsy have a close relative with the disease. If you suspect you or a loved one has this condition, your doctor or an accredited sleep disorders center can provide more information on the best treatments.

Parasomnias

Parasomnias is the name given to a group of sleep disorders that disturb, not only our sleep, but the sleep of those around us. According to the Sleep Foundation (SF), they include:

• Sleepwalking - Sleepwalking occurs when a person appears to be awake and is moving about but is actually asleep. The most dangerous aspect is the person is unaware of their surroundings and can fall or bump into things. The SF says it is important to protect sleepwalkers by keeping doors and windows closed. The American Academy of Family Physicians (AAFP) advises gently guiding a person who is sleepwalking back to bed. AAFP says there is no need to yell or shake the person to wake them up. Sleepwalkers have no memory of their actions.
• Sleep talking - Sleep talking can range from simple sounds to long speeches. It is harmless according to SF. The major problem may be that it wakes up others and can cause them consternation. A person who sleep talks has no recollection of the actions.
• Sleep terrors - Sleep terrors differ from nightmares, according to AACAP. The person will be screaming and act like they are trying to escape. They may appear to be awake but act confused and can't communicate. SF says sleep terrors will last about 15 minutes and then the person will lie down and appear to go back to sleep, remembering nothing in the morning. A person suffering from night terrors can be a danger to themselves and others from the thrashing they may do.

These disorders generally strike children, with most outgrowing them by the time they reach adolescence. The American Academy of Child and Adolescent Psychiatry (AACAP) says they tend to run in families and impact boys more than girls.

General Sleep Tips

Even someone without a sleep disorder may experience a night of tossing and turning. What can you do? Here are some suggestions from the American Academy of Family Physicians to help you sleep better:

• Go to bed and wake up at the same time every day, including weekends, even if you didn't get enough sleep. This will help train your body to sleep at night.
• Develop a bedtime routine. Do the same thing every night before going to sleep. For example, take a warm bath and then read for 10 minutes. Soon you'll connect these things with sleeping, and doing them will help make you sleepy.
• Use the bedroom only for sleeping or having sex. Don't eat, talk on the phone or watch TV while you're in bed.
• Make sure your bedroom is quiet and dark. If noise is a problem, use a fan to mask the noise or use earplugs. If you must sleep during the day, hang dark blinds over the windows or wear an eye mask.
• If you're still awake after trying to fall asleep for 30 minutes, get up and go to another room. Sit quietly for about 20 minutes before going back to bed. Do this as many times as you need to until you can fall asleep.
• Avoid caffeine. Caffeine consumed later in the day can keep you up at night. And coffee isn't the only culprit; make sure you don't overlook hidden sources of caffeine such as regular tea or cola. Even some non-cola sodas contain caffeine, so read the label.
• Avoid alcohol. Even if alcohol makes you drowsy, it interrupts your body's sleep rhythms and can cause sleep disturbances.

Children have some special sleep issues. According to the National Center on Sleep Disorders Research (NCSDR) at NHLBI, children need at least nine hours of sleep each night on a regular basis for their health, safety and best performance in school and other activities. Inadequate sleep in children can lead to attention difficulties, easy frustration and difficulty controlling emotions.

For parents, NHLBI is offering some simple tips that highlight what will help children get a good night's sleep.

• Establish a regular bedtime and stick to it.
• Setting a regular bedtime and wake up time reinforces a child's biological clock, making it easier to fall asleep quickly and awake feeling fully rested and alert.
• Eliminate distractions in your child's room.
• If there's a television or computer in the bedroom, establish another place where kids can use them.
• Avoid feeding your child a big meal too close to bedtime.
• A heavy meal close to bedtime can keep a child awake at night.
• Avoid sodas and other beverages with caffeine.
• Consuming anything with caffeine less than six hours before bedtime can interfere with a good night's sleep.
• Build in quiet time before bedtime.
• During the summer when the days are longer, children may want to go outside to play after dinner. But make sure they come back inside in enough time to allow some time to relax before bedtime.
• Establish a relaxing bedtime routine. Is it a bath in the evening, followed by a book? Or the reverse? Try different routines; find out what works best, and stick to it.
• Make sure the room is dark and quiet and the bed is comfortable.
• Use a nightlight if your child finds the dark scary.
• Maintain a comfortable room temperature.
• Be sure the bedroom isn't too hot or too cold, and that pajamas are comfortable and seasonal.

Although many people have problems falling asleep now and then, it's important to remember that persistent trouble sleeping can be very serious, and a possible indication of a sleep disorder. Sleep disorders are nothing to take lightly. If you suspect that you, your partner or your child has narcolepsy, sleep apnea or any other sleep disorder, talk with your doctor.