Sleep

Newborn baby and puppy

two Sleeping newborn babies with a dachshund puppy.

Definitions, Sleep Physiology, Sleep Disorders, Insomnia, Sleep Hygiene, Sleep Testing, Therapies for Insomnia

Introduction

Definition of sleep:
Sleep is an immediately reversible unconsciousness. Sleeping individuals can respond to exogenous (burglar alarm) and endogenous stimuli (you can scratch an itch without waking).
in contrast to a coma or anesthesia, or hybernation

Physiology of sleep:
The brain doesn’t rest. It’s engaged in 2 distinct stages of sleep. REM and non-REM. Deep sleep occurs in non-REM. Deep sleep has 4 stages. REM is when dreaming occurs, about 20-25% of night. REM and non-REM alternate through the night, in cycles of 60-90 minutes.

Definition of Sleep Disorder or insomnia:
Difficulty falling asleep, staying asleep or getting back to sleep resulting in impairment such as fatigue occurring at least 3 days per week.

Prevalence of sleep disorders:
Insomnia affects up to 30%-50% of adults.

What factors affect our sleep?

Sleep hygiene

  • environment, schedule, TV in bedroom, computers in evening
  • emotions
    • drama and stress in evening
    • bereavement
    • disorganization (mind racing due to subconscious mind)
      • use a calendar
      • make to-do lists and project lists
  • diet
    • eating within 2-3 hours of bedtime
  • obesity
    • causes OSA, sleep apnea
  • meds and drugs
    • cold medicine, stimulants, steroids, antidepressants, diuretics
    • substance withdrawal
    • sleeping pills, sedatives, alcohol, pain meds
    • caffeinealcohol
      • within 4 hours of bedtime
      • within 4-6 hours of bedtime
    • Alcohol worsens sleep.
      • Distorts the REM, non-REM cycle,
      • worsens snoring and apnea and increases early morning awakenings.
    • smoking and chewing tobacco
  • exercise
    • too close to bedtime
  • naps
    • long naps in closer to bedtime
  • environment,
  • schedules.
    • swing shifts
    • travel/ jet lag
  • Medical conditions
    • Overactive Bladder Syndrome
    • IBD, Inflammatory Bowel Disease (Colitis, Crohn’s)
    • prostate disease (BPH, enlargement)
    • cancer
  • psychiatric conditions
  • pain

What testing is available to measure sleep physiology?

Polysomnography-a sleep lab study

  • Study brain waves, eye movement, oxygen, limb movements, chest movements, snoring, and body position
  • cost about $2,000

Home Testing:

  • Nocturnal oximeters
  • Home Sleep Studies
  • Wearables:
    • Apple watches
      • smart watches
    • brain wave monitors
      • sync to smart phone and record stages of sleep and wakefulness
      • provide tips and tricks and hygiene advice.
      • ZEO brand home sleep system is what I have.

What are some of the consequences of sleep disorders?

  • Strokes
  • Heart disease
  • Hypertension
  • Mood disorders
    • behavioral disorders
    • Depression
    • Anxiety
  • Motor Vehicle Accidents-more car accidents are associated with sleep disorders than alcohol.
  • Obesity
    • sleep deprivation causes stress hormones which stimulate appetite.
  • Fatigue and malaise

What can be done for people with sleep disorders?

Multifaceted approach:

  • Gather information
    • Keep a sleep diary,
  • Rule out OSA, RLS (Restless Limb Syndrome) with sleep study or oximeter
  • CPAP, APAP and biPAP devices
    • Positive Airway Pressure devices (ventilator type devices)
      with or without oxygen added
    • Dental devices
    • oxygen
  • See your doctor for medical evaluation
    • rule out depression
    • thyroid disease
    • diabetes
    • medication side effects.
  • Assess environment and lifestyle
    • sleep environment,
    • schedule,
    • stress,
    • habits (alcohol, smoking,exercise)
      • evening habits
        • relaxing bedtime routine
        • no late, prolonged napping
          • short afternoon naps are good for your
          • avoid evening naps longer than 30 minutes
        • avoid alcohol,
        • quit smoking and chewing tobacco,
        • computers and TV
          • “blue light” distorts your Circadian Rhythm
        • get a routine
    • Work on sleep hygiene
      • bedtime
        • same each night
      • environment
        • cool, dark, quiet
      • get out of bed if not asleep in 15 minutes
        • pursue a quiet activity until sleepy
    • Cognitive behavioral therapy with relaxation training.
    • Lastly consider medications
      • Sleeping medications can be addictive,
      • tolerance can develop,
      • side effects are common and can be serious.
      • not recommended for more than few weeks
      • OK for travel, “stress”, or bereavement

 

Conclusion:

Sleep disorders are very common. Prioritize your sleep, it is vital to being healthy and feeling your best. Shoot for 7 hours of good sleep. Schedule and plan your sleep time. Don’t be afraid to take a short nap, 20-30 minutes during the day to catch up on your sleep. Work on your sleep hygiene, and see your doctor if you think you have a sleep disorder.

References:

  • AAFP Home Study
  • American Family Physician journal

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