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How Much Sleep Do You Need? ( courtecy;- medicineNet.com )
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Learn about the different types of sleep disorders such as
insomnia and sleep apnea. Explore symptoms, causes, and treatments.
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What Are Sleep
Disorders?
Sleep disorders are
conditions that impair a person's ability to get normal restorative sleep. The
causes of these conditions are variable and range from habits people have
developed before they go to sleep to a number of medical problems that disrupt
the normal sleep cycle. If you notice you have a pattern of not feeling rested
in the mornings after you wake up, you should probably see your doctor to
determine if you have a sleep disorder. Sleep disorders can have a profound
effect on a person’s overall health.
Why Is Sleep Important?
Lack of sleep
can be life-threatening! For example, car accidents, personal problems, poor
job performance, injuries, memory problems, and mood disorders have been linked
to poor sleep. In addition, researchers have concluded sleep disorders likely
contribute to heart disease, obesity, and diabetes.
Symptoms of Sleep Disorders
Symptoms of
sleep disorders vary depending on the type of sleep disorder. The symptoms may
range from mild to severe and usually include one or more of the following:
hypersomnia (excessive daytime sleepiness), insomnia (decreased sleep
efficiency with unrestful sleep with frequent waking up in the night), loud
snoring and/or brief pauses in breathing (short periods of apnea), leg
movements or an urge to move the legs at night, sleepwalking, or night terrors
(nightmares).
The Sleep Cycle
A normal sleep
cycle has two major categories termed REM and non-REM. REM stands for rapid eye
movement. REM sleep is characterized by muscle relaxation, dreaming, episodic
rapid eye movements, and low amplitude waves on an EEG (encephalograph).
Non-REM sleep is divided into four stages from light sleep (stage 1) to stage
IV (Delta or deep sleep). Non-REM sleep occupies about 75% of normal sleeping
time while REM occupies the remaining 25% and usually occurs more toward
morning. Sleep disorders disrupt these sleep cycles.
How Much Sleep Do I Need?
The sleeping
time needs of individuals are variable, and sleep times vary between kids and
adults.
Adults
Some adults can
vary in their sleep requirements from about 5 to as many as 10 hours per night.
However, several studies have suggested the majority of normal adults average
about 7 to 8 hours per night.
Younger People
In general, the
younger the person, the more sleep they need. For example, teenagers require
about nine hours of sleep while infants require about 16 hours per night.
What Is Insomnia?
Insomnia is the
inability to initiate or maintain sleep. Most people in their lifetime will
have some difficulty falling asleep occasionally. However, if trouble falling
asleep occurs either frequently or steadily, the individual may have insomnia.
People with insomnia have difficulty falling asleep, sometimes for hours at a time,
and they may wake up too early or they may wake up repeatedly through the
night. Insomnia is considered the most common sleep disorder in the U.S. and
studies suggest as many as 95% of Americans have reported an episode of
insomnia at some time during their life.
Causes of Insomnia: Sleep Hygiene
Poor sleep
hygiene refers to bad habits that interfere with an individual's ability to
fall asleep. For example, drinking coffee or other caffeinated drinks in the
evening, smoking, eating heavy foods late in the evening, falling asleep with
the lights on and/or leaving the television on, or using a cell phone,
computer, or tablet right before bed are bad habits or poor sleep hygiene can
lead to insomnia.
Causes of Insomnia: Mental Health
Poor sleep
hygiene is not the only cause of insomnia. Mental health problems such as
depression, anxiety, and stress (for example, posttraumatic stress disorder,
loss of spouse or financial problems) may also cause insomnia. In addition,
medications used to treat some of these mental health problems may also cause
or increase sleep problems. Discuss any sleep-related problems you think are
caused by medications with your physician.
Cause of Insomnia:
Medical Conditions
Insomnia is often
associated with other medical conditions. These medical conditions often
interfere with the normal sleep cycle. Some of the more common conditions are
listed as follows:
·
chronic pain
·
COPD
·
asthma
·
sleep apnea
·
heart failure
·
arthritis
·
thyroid problems
·
neurological problems
(strokes, Alzheimer's disease, Parkinson's disease)
·
depression
·
endocrine problems
Causes of Insomnia: Pregnancy, Menopause, and
Age
Other fairly
common causes of insomnia are pregnancy, menopause, and age (both men and women
over age 65), all of which may be due to hormonal and other body chemistry
changes. In addition, shift workers can develop problems because their sleep
cycle is interrupted due to their irregular work schedule. Part of the reason
for this development of insomnia is due to resetting of our internal body clock
that controls the time of day that hormones are produced; also, the timing of
other routine body functions such as urination, defecation, and exposure to
light and darkness are altered because of schedule changes.
What Is Sleep Apnea?
Sleep apnea is
a disorder that causes a person to stop breathing many times while they are
sleeping. The breathing pauses may last a few seconds or longer and trigger the
body to switch from non-REM stage IV sleep to the very light stage I sleep;
occasionally the patient may wake up. These multiple interruptions of the
normal sleep cycle can lead to insomnia and daytime sleepiness. Many people
have this problem but do not realize it.
Sleep Apnea Symptoms
Symptoms of
sleep apnea are often noted by the patient's spouse. The symptoms are snoring,
pauses in breathing often followed by a gasp or snort sound, and sleepiness
during daytime hours.
Sleep Apnea Treatment
Sleep apnea can
be treated in various ways.
·
Lifestyle changes (losing weight, avoiding alcohol, sleeping on
one’s side instead of back, quit smoking)
·
Mouthpieces (oral appliances)
·
Breathing devices (CPAP)
·
Surgery
Who Gets Sleep Apnea?
The common risk
factors for sleep apnea include being overweight, over age 65, male, Hispanic,
African-American, and of Pacific Island descent. Also, individuals who smoke,
use alcohol, sedatives and/or tranquilizers, and individuals with nasal congestion,
heart disorders, strokes, or brain tumors are also at higher risk for sleep
apnea. Occasionally, individuals who have some blockage of their airway (for
example, enlarged tonsils or narrowed airway) are also at risk of developing
sleep apnea.
What Is Restless Legs Syndrome?
Another
disorder of the nervous system, restless leg syndrome (RLS), can lead to
insomnia and is considered a sleep disorder. It is a disorder of the nervous
system that affects the legs by causing abnormal urges to move them.
Unfortunately, these urges seem to occur more frequently at night and cause
sleep interruption.
What Causes Restless Leg Syndrome?
The cause of
restless leg syndrome is unknown in most cases, though genetics may play a
part. Low levels of iron in the brain may also lead to restless leg syndrome.
Restless Leg Syndrome Symptoms
·
Legs feel uncomfortable, especially when lying down, causing the
afflicted person to feel the need to move them around. Similar sensations may
be felt in the arms, trunk, or head.
·
These sensations may disrupt sleep.
·
RLS frequently comes on worse at night.
·
Frequency of these episodes varies depending on the severity of
the case
Restless Leg Syndrome Treatment
·
Move the affected limbs
·
Treat associated medical conditions (for examples, peripheral
neuropathy, diabetes)
·
Change lifestyle (stop smoking, reduce caffeine and alcohol, take
iron supplements, get moderate exercise, take hot baths)
·
Medication (dopamingergic agents, gabapentin enacarbil,
benzodiazepines, opioids, anticonvulsants)
What Is Narcolepsy?
Narcolepsy is a
neurological disorder that causes extreme sleepiness during the day; some
patients experience intermittent and uncontrollable episodes of falling asleep
during any type of activity.
Narcolepsy Symptoms
·
Excessive daytime sleepiness
·
Cataplexy (sudden loss of muscle tone)
·
Hallucinations
·
Sleep paralysis (a temporary inability to move or speak while
falling asleep or waking up) that lasts a few seconds up to several minutes
after which the person fully recovers.
Narcolepsy Treatment
·
Lifestyle changes (practice good sleep hygiene, limit caffeine,
tobacco and alcohol, exercise, get more sunlight, schedule naps, keep a to-do
list and stay organized)
·
Medications (stimulants, antidepressants, sodium oxibate)
Sleepwalking (Somnambulism)
Sleepwalking,
also known as somnambulism, is a behavior disorder that occurs during deep
sleep and results in an individual either walking or performing complex
behaviors while still asleep. Sleepwalking is more common in children than in
adults and more likely to occur in people who are sleep deprived. The person
may be difficult to awaken and will likely not remember anything about
sleepwalking once they wake up.
Sleepwalking Causes
·
Sleep deprivation
·
Chaotic sleep schedule
·
Stress
·
Drunkenness
·
Use of certain drugs like sedative-hypnotics, neuroleptics,
stimulants, and antihistamines
Sleepwalking Treatment
·
Medication (ProSom, Klonopin, Trazodone)
·
Relaxation and mental imagery techniques
·
Anticipatory waking (waking the person shortly before sleepwalking
usually begins)
Shift Work Sleep Disorder
Shift work
sleep disorder commonly affects people who work non-traditional hours,
typically between 10 p.m. and 6 a.m. About 20 percent of the US workforce is
employed during non-traditional hours, meaning one in five Americans’ work
schedules have the potential to interfere with their bodies natural circadian
rhythms.
Shift Work Sleep Disorder Symptoms
Difficulty
sleeping and excessive sleepiness are most typical of shift work sleep
disorder. Shift work sleep disorder may also make it difficult to concentrate.
Shift Work Sleep Disorder Treatment
·
Maintain a sleep diary
·
Decrease the number of consecutive night shifts
·
Avoid extended work hours
·
Avoid long commutes
·
Avoid frequent shift rotations
·
When not working, be sure to sleep as much as you need
·
Try napping during a night shift
·
Sleep aids may be needed
Sleep Disorder Treatment: Sleep Diary
A sleep diary
can help you and your physician gain valuable insight into your sleep problems.
You can help your physician if you chart your habits for 1 to 2 weeks before
you see your doctor. Alternatively, your doctor may ask you to keep a sleep
diary before your next visit.
The sleep diary
can help document potential problems in your living habits that inhibit sleep
or cause insomnia. Items included in a sleep diary may be the following: what
time you go to bed, what time you fall asleep, the time you wake up, how many
times you wake up during the night, when caffeine or alcohol is consumed, when
and what you eat and drink before you go to bed, emotional challenges and/or
stress factors, and finally, a list of your medications.
Sleep Disorder Diagnosis: Sleep Study
Diagnosing
sleep disorders usually begins with your physician obtaining a physical exam, a
history of your sleep problems, and a review of potential risk factors along
with a review of your sleep diary if you have one. Your physician may then refer
you to a sleep clinic for additional testing termed a "sleep study"
or polysomnogram. This study usually occurs overnight and the patient's eye
movements, breathing, brain activity, and other measurements are performed. The
results may indicate a disorder such as sleep apnea or other sleep-related
problems.
Sleep Disorder Treatments
The treatment
for a sleep disorder depends upon the cause. Narcolepsy and restless leg
syndrome can be treated with lifestyle changes and prescription medications;
the same is true for insomnia. However, insomnia may only require lifestyle
changes. Sleepwalking has no specific treatment other than lifestyle changes
such as good sleep hygiene – some patients respond to hypnosis.
Breathing Machines
A breathing
device (CPAP device) may be prescribed to keep airways open at night so you can
rest if you have sleep apnea.
Biofeedback
Biofeedback is
a method of training the mind to develop greater awareness and control over its
own stress. A computer monitors heart rate and other stress indicators, and
sends back signals to help a person become more aware of their own stress
level. This technique can be useful in treating anxiety-based insomnia, sleep
apnea, or other sleep disorders.
Sleep Disorders in Children
Sleep disorders
do affect children and adolescents. Even infants can experience sleep
disorders. These can include trouble falling or staying asleep, sleep apnea,
sleepwalking, restless leg syndrome and excessive sleepiness.
Sleep Disorders in Children: Causes
Because there
are many different kinds of sleep disorders in children, their causes vary as
well. Stress can cause nightmares, which can lead to night terrors. Bedwetting
can be caused by a family history of bedwetting, low bladder control, or
emotional distress, among other causes. Insomnia in children may be caused by
stress, pain, or mental disorders.
Sleep Disorder in Children: Treatment
Like the causes
of sleep disorders in children, treatments for these conditions vary. Positive
bedtime routines, restricting screen time before bed, setting strict routines
for bedtime and wakeup time and making sure kids get plenty of exercise can all
help with many childhood sleep disorders like restless leg syndrome.
How to Sleep Better: Exercise
Regular
exercise is another part of a good sleep hygiene program. However, choosing the
times of day that you exercise is important. Exercising in the late afternoon
can make it easier to fall asleep and stay asleep. However, exercise within a
few hours (about 2 to 4 hours) before going to sleep may actually make it more
difficult to get a good night's sleep. People who exercise regularly, in general,
have less incidence and risk for insomnia.
How to Sleep Better: Foods to Avoid
Food and drink
make up another aspect of good sleep hygiene. Foods to avoid are those
containing caffeine (coffee, tea, and soda drinks), heavy (large quantity)
evening meals, spicy foods, and alcohol consumption. Alcohol may cause some
people to become sleepy but it can lead to early nighttime awakening.
How to Sleep Better: Helpful Foods
Foods that help
establish good sleep hygiene would include reasonable levels of complex
carbohydrates and protein in the evening meal. Small or moderate quantities of
food should be consumed in the evening, preferably several hours before going
to bed. In addition, cereals with milk or a few crackers and cheese may be
helpful. Some nutritionists suggest eating nothing
g at least one hour before attempting to sleep.
How to Sleep Better: Reduce Technology Before
Bed
Another aspect
of good sleep hygiene is to reduce items that may stimulate you to think or act
right before bedtime. Perhaps one of the best examples is late-night
television. Some programming may increase mental alertness or cause you to
think about subjects. Similar situations occur with children playing video
games right before bed or teenagers and/or adults using computers, cell phones,
or tablets.
Good sleep
hygiene suggests you start reducing brain stimulation as you prepare to go to
sleep. Sleep researchers suggest you stop using TV, video games, or the
Internet about an hour or so before going to bed; others suggest individuals
should prepare for bed by reading and by prohibiting TVs or computer use in the
bedroom.
How to Sleep Better: Bedtime Rituals
You can take
some positive actions to establish good sleep hygiene habits. For example, you
can "wind down" your activity levels about an hour or so before bed
by taking a warm bath, reading, or practicing relaxation biofeedback
techniques. It is good sleep hygiene to establish routine bedtimes and wake-up
times to key your body's chemistry into expecting fairly routine times to occur
for bedtime and wake-up time.
Following the
do's and don'ts for good sleep hygiene may help reduce or even solve some sleep
disorders.
Reviewed by William C. Shiel Jr., MD,
FACP, FACR on Thursday, August
18, 2016
Sleep Disorders: Insomnia,
Sleep Apnea, and More
This tool does not
provide medical advice
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