Sleep Part 2
Several different processes fall into the broad category of sleep disorder. But first, we should understand a few things about what constitutes a sleep disorder.
Not everyone requires the same amount of sleep; children and adolescents require more sleep than adults. Once we reach adulthood, our individual need for sleep usually becomes fairly consistent for the remainder of our lives. However, the amount of sleep needed varies from person to person.
A common misconception is that we require less sleep as we age. It is true that older adults frequently get less sleep but it’s not necessarily because we require less. Admittedly there is some controversy among sleep specialists, but we shouldn’t dismiss the concerns of older people because we don’t think they need as much sleep as they used to.
To diagnosed as a sleep disorder, it must be a relatively long-term process. An occasional night of sleeplessness does not constitute a sleep disorder; there must be some impact on the waking hours. For example, a person who only sleeps 5 to 6 hours a night but never has any daytime sleepiness, fatigue, difficulty concentrating, or completing tasks probably does not have a sleep disorder. Another person who gets 7 to 8 hours of sleep a night but feels drowsy, is unable to concentrate on tasks and drifts off to sleep midafternoon may have a sleep disorder.
A sleep disorder is never diagnosed by the time spent in bed. It is diagnosed based on how a lack of sleep impacts daily life and ability to function at the desired level. It’s very common for people to overestimate the amount of time they are awake at night. A sleep disorder is something that requires careful investigation. It is important to contact your doctor for a definitive diagnosis.
If there is another reason for sleeplessness, then a sleep disorder diagnosis should not be made. Common causes of sleep disturbance are pain and environmental factors such as noise, bright lights, and temperature extremes. Rotating shift work is another common cause.
It is important to determine if the person reporting sleep problems has adequate opportunity to sleep. Family demands or work requirements may often limit the ability to get sufficient sleep. Additionally, some older men make frequent trips to the bathroom during the night, but this doesn’t necessarily constitute a sleep disorder.
To diagnose a sleep disorder, the patient must have had the opportunity for adequate sleep but is still suffering from the symptoms of sleep deprivation. The first step in evaluating a sleep disturbance is to identify and eliminate as many external factors as possible.
Sleep Apnea
Sleep apnea is perhaps the best known sleep disorder. There are two types of sleep apnea, the fairly common obstructive sleep apnea (OSA) and central sleep apnea. Central sleep apnea is extremely rare and well beyond what we’re talking about here.
Most OSA patients complain of daytime sleepiness. A patient’s bed partner may report loud snoring, gasping, or snorting, or the patient seeming to stop breathing while asleep. Not everyone who snores has OSA. While about 80 to 90% of people who have OSA snore, fewer than 50% of snorers have OSA.
If you are concerned that you may have OSA, talk to your doctor. It’s not something that can be diagnosed by you at home. Diagnosis requires a formal assessment.
Sleep apnea is treatable with the infamous CPAP machine. It isn’t generally considered to be curable although some people who have lost a significant amount of weight have been able to wean themselves from the CPAP machine.
Insomnia
Insomnia is one of those catchall medical terms that covers a variety of clinical situations. The broad definition of insomnia is difficulty sleeping. But that includes many causes, both those understood and those not well understood.
During a sleep assessment, it’s important to determine if it is chronic insomnia. That is a pattern of difficulty falling asleep or staying asleep that occurs at least three nights a week and lasts for at least three months. But that’s only the beginning, there are many unrelated factors that can cause chronic insomnia and there are also different types of insomnia that may be unrelated to any other factors.
Onset insomnia is difficulty falling asleep. The patient may be awake for very long periods, but once they fall asleep, they’re usually able to sleep for several hours. Unfortunately, they are usually awakened by the alarm clock before they have experienced adequate restorative sleep.
The other broad category is maintenance insomnia, the difficulty staying asleep. These patients often wake up in the middle of the night and are unable to return to sleep for several hours. Frequently they report falling back asleep just before the alarm goes off.
Some people have mixed insomnia. Sometimes they will have difficulty falling asleep and at others, staying asleep. Occasionally, they will suffer from both types on the same night, making for a very long night indeed.
Both types of insomnia can have similar underlying causes. Some of them fit in the broad category of comorbid insomnia, whether it’s a medical, psychiatric, or other problem. This can include depression, anxiety, or somatic disorders such as restless leg or chronic pain. Medical disorders include pulmonary disease, diabetes, and congestive heart failure. Treatment of the underlying medical condition is the key to dealing with these types of sleep disorders.
In a self-fulfilling cycle, some people suffer from insomnia because they worry about their inability to sleep.
Another type of sleep disturbance frequently included in the category of insomnia is disruption of the circadian rhythm. The circadian rhythm is the body’s internal clock. It is generally a 24-hour cycle that follows the light-dark cycle of the day. Major circadian disruptions include jet lag and intermittent shift work. The use of LED screens such as televisions, computers, and E readers exposes us to a large amount of blue light which may confuse our body’s circadian rhythm into thinking it is a daylight period. The many effects of disrupting the circadian rhythm are beyond the scope of this post, but if your circadian rhythm is interrupted it can affect your sleep, at least in the short term.
In Part 3 we will look at those things that may help you sleep.
A quote to end this post:
“I’ve always envied people who sleep easily. Their brains must be cleaner, the floorboards of the skull well swept, all the little monsters closed up in a steamer trunk at the foot of the bed.” – David Benioff, author, and TV producer
To Sleep, Perchance to Dream -Wm. Shakespeare, Hamlet
By John Turley
On September 2, 2023
In Commentary, Medicine
Sleep – Part I
The other night, about 3:00 AM I was lying in bed wide awake thinking about…. sleep. It’s natural to think about sleep when you’re having trouble doing it. I’ve had intermittent insomnia for my entire adult life. Sometimes I’ll go several days with not much more than two or three hours of sleep a night and then I’ll go several days where I can sleep six, seven or eight hours. I’m not sure what causes insomnia at one time but not another.
I’ve spent a lot of time thinking about sleep. Mostly, I think about why I can’t sleep and what I can do to get to sleep. I’ve read a lot about specific tips and techniques to improve sleep. I’ve tried many of the so-called “sleep hygiene” regimens. I’ve tried herbal preparations and prescription sleep medications. Lately I’ve been using a sleep mask with some positive results. I’m easily awakened, and it has helped with that.
But, with one of those middle of the night revelations, I realized that in all my years of thinking about sleep I’ve never really thought about what sleep is and why we need to do it. So, I’m going to embark on a three-part post about sleep. This is Part 1; it’s a look at what sleep is and why we do it. In Part 2 we’ll look at why we can’t sleep and the various things that cause us to lose sleep. Part 3 will be a survey of the many things available that may or may not help us to get that good night’s sleep.
What Is Sleep?
We will spend anywhere from 25 to 30% of our lives asleep so we really ought to have a better understanding of exactly what it is.
Merriam-Webster defines sleep as: The natural, easily reversible periodic state of many living things that is marked by the absence of wakefulness and by the loss of consciousness of one’s surroundings, is accompanied by a typical body posture (such as lying down with the eyes closed), the occurrence of dreaming, and changes in brain activity and physiological functioning….
As with many dictionary definitions my first response is “What?” So, let’s see if I can come up with something that’s a little more than a physical description of someone laying on the couch asleep.
Our bodies crave sleep just like they crave food. The major difference is your body can’t force you to eat but it can force you to sleep.
The reasons why we sleep and what happens during sleep are not completely understood. People used to believe that sleep was a passive activity when the brain and the body were dormant. But, according to sleep specialist and neurologist Dr. Mark Wu, MD “… it turns out that sleep is a period during which the brain is engaged in a number of activities necessary to life which are closely linked to the quality of life.”
Cycle of Sleep
Everyone’s heard of the sleep cycle so I’m just going to briefly touch on it here. There are two basic types of sleep. The first is non-REM sleep which also has three stages of its own and the second is the rapid eye movement (REM) sleep.
The three stages of non-REM are Stage 1 which is the transition into sleep and is relatively light. It is when brain waves begin to slow down. Stage 2 is the period just before you enter into deeper sleep when your heart rate and breathing slow, your muscles relax, your body temperature starts to drop, and eye movements stop. This is the stage where you spend most of your sleeping time. Stage 3 of non-REM sleep is the period of deep sleep that you need to feel refreshed in the morning. It occurs more during the first half of the night. Your heartbeat and breathing are slowed to their lowest level, and you are most relaxed. Brain waves are at their slowest.
REM sleep first occurs about 90 minutes after falling asleep. Your eyes move rapidly even though your eyelids are closed. Your brain waves are closer to those when you are awake. Breathing becomes faster and your heart rate and blood pressure increase. This is when most of your dreaming occurs. Although, some can occur during non-REM sleep periods. During REM sleep your arm and leg muscles may become temporarily paralyzed which prevents you from acting out your dreams. As you age, you spend less time in REM sleep.
What Happens When We Sleep?
If we’re going to spend this much time sleeping there must be some benefit to it, right? Surely it is not just a way to pass the time until we have something better to do.
There have been a lot of theories over the years about why we sleep. Some of the older ones include the adaptive or evolutionary theory that says animals sleep during periods of vulnerability, such as darkness, so that they won’t attract attention. However, this seems to be counterintuitive. During periods of vulnerability, I would certainly want to be most alert. Another theory is that of energy conservation. During periods of sleep the body has less need for energy and will not require food as often. For most of human history, and continually for the rest of the animal world, food is a scarce item and energy conservation is important to survival.
People have always recognized that somehow sleep helped rejuvenate us. Newer research points to this as probably the main reason why we sleep. Sleep helps clear the brain of waste products that accumulate when we are awake allowing it to function more efficiently.
Sleep also helps us consolidate the day’s memories. It facilitates the conversion of short term to long term memories so that they are more readily accessible. Sleep also improves alertness, concentration, and cognitive performance. This may be why some people recommend a good night’s sleep rather than an all-night cramming session prior to finals.
Sleep helps regulate various hormones that are responsible for appetite control, growth, and metabolism. Poor sleep can exacerbate physical problems such as diabetes, hypertension, and obesity. Sleep is essential to our immune function; prolonged periods of sleep deprivation put us at risk for opportunistic infections. Sleep is also important for our emotional well-being and for helping to prevent anxiety and depression.
I will finish this post with two quotes that I particularly like about why we sleep.
Sleep is an investment in the energy you need to be effective tomorrow.
-Tom Rath, American author and consultant
Sleep is the golden chain that ties health and our bodies together.
-Thomas Dekker, 17th Century English poet and playwright