3.3.4. Sleep
Common sleep disorders
Sleep-related difficulties affect many people. The following is a description of some of the major sleep disorders. If you, or someone you know, is experiencing any of the following, it is important to receive an evaluation by a healthcare provider or, if necessary, a provider specializing in sleep medicine. Insomnia Insomnia is characterized by an inability to initiate or maintain sleep. It may also take the form of early morning awakening in which the individual awakens several hours early and is unable to resume sleeping. Difficulty initiating or maintaining sleep may often manifest itself as excessive daytime sleepiness, which characteristically results in functional impairment throughout the day. Before arriving at a diagnosis of primary insomnia, the healthcare provider will rule out other potential causes, such as other sleep disorders, side effects of medications, substance abuse, depression, or other previously undetected illness. Chronic psychophysiological insomnia (or "learned" or "conditioned" insomnia) may result from a stressor combined with fear of being unable to sleep. Individuals with this condition may sleep better when not in their own beds. Health care providers may treat chronic insomnia with a combination of use of sedative-hypnotic or sedating antidepressant medications, along with behavioral techniques to promote regular sleep. Narcolepsy Excessive daytime sleepiness (including episodes of irresistible sleepiness) combined with sudden muscle weakness are the hallmark signs of narcolepsy. The sudden muscle weakness seen in narcolepsy may be elicited by strong emotion or surprise. Episodes of narcolepsy have been described as "sleep attacks" and may occur in unusual circumstances, such as walking and other forms of physical activity. The healthcare provider may treat narcolepsy with stimulant medications combined with behavioral interventions, such as regularly scheduled naps, to minimize the potential disruptiveness of narcolepsy on the individual's life. Restless Legs Syndrome (RLS) RLS is characterized by an unpleasant "creeping" sensation, often feeling like it is originating in the lower legs, but often associated with aches and pains throughout the legs. This often causes difficulty initiating sleep and is relieved by movement of the leg, such as walking or kicking. Abnormalities in the neurotransmitter dopamine have often been associated with RLS. Healthcare providers often combine a medication to help correct the underlying dopamine abnormality along with a medicine to promote sleep continuity in the treatment of RLS. Sleep Apnea Snoring may be more than just an annoying habit - it may be a sign of sleep apnea. Persons with sleep apnea characteristically make periodic gasping or "snorting" noises, during which their sleep is momentarily interrupted. Those with sleep apnea may also experience excessive daytime sleepiness, as their sleep is commonly interrupted and may not feel restorative. Treatment of sleep apnea is dependent on its cause. If other medical problems are present, such as congestive heart failure or nasal obstruction, sleep apnea may resolve with treatment of these conditions. Gentle air pressure administered during sleep (typically in the form of a nasal continuous positive airway pressure device) may also be effective in the treatment of sleep apnea. As interruption of regular breathing or obstruction of the airway during sleep can pose serious health complications, symptoms of sleep apnea should be taken seriously. Treatment should be sought from a health care provider.
Sleep and chronic disease
As chronic diseases have assumed an increasingly common role in premature death and illness, interest in the role of sleep health in the development and management of chronic diseases has grown. Notably, insufficient sleep has been linked to the development and management of a number of chronic diseases and conditions, including diabetes, cardiovascular disease, obesity, and depression. Diabetes Research has found that insufficient sleep is linked to an increased risk for the development of Type 2 diabetes. Specifically, sleep duration and quality have emerged as predictors of levels of Hemoglobin A1c, an important marker of blood sugar control. Recent research suggests that optimizing sleep duration and quality may be important means of improving blood sugar control in persons with Type 2 diabetes.1 Cardiovascular Disease Persons with sleep apnea have been found to be at increased risk for a number of cardiovascular diseases. Notably, hypertension, stroke, coronary heart disease and irregular heartbeats (cardiac arrhythmias) have been found to be more common among those with disordered sleep than their peers without sleep abnormalities. Likewise, sleep apnea and hardening of the arteries (atherosclerosis) appear to share some common physiological characteristics, further suggesting that sleep apnea may be an important predictor of cardiovascular disease.2 Obesity Laboratory research has found that short sleep duration results in metabolic changes that may be linked to obesity. Epidemiologic studies conducted in the community have also revealed an association between short sleep duration and excess body weight. This association has been reported in all age groups—but has been particularly pronounced in children. It is believed that sleep in childhood and adolescence is particularly important for brain development and that insufficient sleep in youngsters may adversely affect the function of a region of the brain known as the hypothalamus, which regulates appetite and the expenditure of energy.3 Depression The relationship between sleep and depression is complex. While sleep disturbance has long been held to be an important symptom of depression, recent research has indicated that depressive symptoms may decrease once sleep apnea has been effectively treated and sufficient sleep restored. The interrelatedness of sleep and depression suggests it is important that the sleep sufficiency of persons with depression be assessed and that symptoms of depression be monitored among persons with a sleep disorder. 4, 5
Overview of sleep health
Goal Increase public knowledge of how adequate sleep and treatment of sleep disorders improve health, productivity, wellness, quality of life, and safety on roads and in the workplace. Overview Poor sleep health is a common problem with 25 percent of U.S. adults reporting insufficient sleep or rest at least 15 out of every 30 days.1 The public health burden of chronic sleep loss and sleep disorders, coupled with low awareness of poor sleep health among the general population, health care professionals, and policymakers, necessitates a well-coordinated strategy to improve sleep-related health. Why Is Sleep Health Important? Sleep, like nutrition and physical activity, is a critical determinant of health and well-being.2 Sleep is a basic requirement for infant, child, and adolescent health and development. Sleep loss and untreated sleep disorders influence basic patterns of behavior that negatively affect family health and interpersonal relationships. Fatigue and sleepiness can reduce productivity and increase the chance for mishaps such as medical errors and motor vehicle or industrial accidents.3, 4 Adequate sleep is necessary to: Fight off infection Support the metabolism of sugar to prevent diabetes Perform well in school Work effectively and safely Sleep timing and duration affect a number of endocrine, metabolic, and neurological functions that are critical to the maintenance of individual health. If left untreated, sleep disorders and chronic short sleep are associated with an increased risk of: Heart disease High blood pressure Obesity Diabetes All-cause mortality5, 6 Related Topic Areas Educational and Community-Based Programs Heart Disease and Stroke Injury and Violence Prevention Occupational Safety and Health Respiratory Diseases Sleep health is a particular concern for individuals with chronic disabilities and disorders such as arthritis, kidney disease, pain, human immunodeficiency virus (HIV), epilepsy, Parkinson's disease, and depression. Among older adults, the cognitive and medical consequences of untreated sleep disorders decrease health-related quality of life, contribute to functional limitations and loss of independence, and are associated with an increased risk of death from any cause.7 Back to Top Understanding Sleep Health The odds of being a short sleeper (defined as someone who sleeps less than 6 hours a night) in the United States have increased significantly over the past 30 years.8 Competition between sleep schedules, employment, and lifestyle is a recent trend. Intermittent sleep disturbances due to lifestyle choices are associated with temporary fatigue, disorientation, and decreased alertness. Sleep-disordered breathing (SDB), which includes sleep apnea, is another serious threat to health. SDB is characterized by intermittent airway obstruction or pauses in breathing. People with untreated SDB have 2 to 4 times the risk of heart attack and stroke.9, 10 Obesity is a significant risk factor for SDB, and weight loss is associated with a decrease in SDB severity.11 SDB in Children: African American children are at least twice as likely to develop SDB than children of European descent.12 The risk of SDB during childhood is associated with low socioeconomic status independent of obesity and other risk factors.13 Left untreated, SDB in children is associated with difficulties in school, metabolic disorders, and future heart disease risk.14 SDB in Older Adults: SDB may affect 20 to 40 percent of older adults and, if left untreated, is associated with a 2- to 3-fold increased risk of stroke and mortality.15, 16 Sleep health education and promotion strategies are needed to address disparities in sleep health across age, race, education, and socioeconomic groups. Health education and promotion programs can increase awareness of common sleep disorders, such as insomnia, restless leg syndrome, and SDB. Sleep health education programs in workplaces can promote better work schedule patterns and motivate managers and workers to adopt strategies that reduce risks to health and safety. Without sleep health education, individuals often prioritize other activities over sleep and accept constant sleepiness and sleep disruption as inevitable. Emerging Issues in Sleep Health Progress in the following areas will yield more information on sleep health over the coming decade: Further evolution of biomedical sleep research Quantification of health risks associated with untreated SDB across the lifespan Findings from the first U.S.-based phase III SDB treatment trials in children and adults Learn More The Surgeon General's Vision for a Healthy and Fit Nation [PDF - 841 KB] National Commission on Sleep Disorders Research. Sleep Deprivation and Sleepiness Physical Activity Guidelines Advisory Committee Report References 1Centers for Disease Control and Prevention, Epidemiology Program Office. Perceived insufficient rest or sleep among adults: United States, 2008. MMWR. 2009 Oct 30;58(42):1175-9. 2Institute of Medicine, Committee on Sleep Medicine and Research. Sleep disorders and sleep deprivation: An unmet public health problem. Washington: National Academies Press; 2006.
Sleep hygiene
Good sleep habits (sometimes referred to as "sleep hygiene") can help you get a good night's sleep. Some habits that can improve your sleep health: Be consistent. Go to bed at the same time each night and get up at the same time each morning, including on the weekends Make sure your bedroom is quiet, dark, relaxing, and at a comfortable temperature Remove electronic devices, such as TVs, computers, and smart phones, from the bedroom Avoid large meals, caffeine, and alcohol before bedtime Get some exercise. Being physically active during the day can help you fall asleep more easily at night.