Chapter 4- Improving Your Sleep

Create a Sleep-Promoting Environment

-chill -create a sleep "cave" -associate bed with sleep -go to bed only when you are tired -establish bedtime and waking rituals

sleep study

A clinical assessment of sleep in which the patient is monitored while spending the night in a sleep disorders center.

excessive daytime sleepiness or excessive sleepiness

A condition in which a person feels a major compulsion to sleep during normal waking hours along with persistent sluggishness and fatigue

cognitive-behavioral therapy for insomnia (CBT-I)

A form of therapy that helps people better understand the thoughts and feelings that influence their behaviors and focus on changing habits that disrupt sleep.

Narcolepsy

A neurological disorder that causes people to fall asleep involuntarily during the day.

Non-REM (NREM) sleep

A period of restful sleep dominated by slow brain waves; during non-REM sleep, rapid eye movement is rare

As noted on their warning labels, many prescription drugs and over-the-counter drugs can lead to excessive sleepiness, as can some illicit drugs

Antihistamines, anxiety drugs, Parkinson's medications, antidepressants, certain blood pressure and antinausea drugs, muscle relaxants, alcohol, and marijuana, are among key culprits

Turn down the thermostat. The best sleep occurs in a cool bedroom—according to experts, one that is around 65 degrees. Normally, as you get sleepy, your body temperature starts to drop, and the body conserves energy through most of the sleeping hours, gradually increasing your temperature just before dawn

As light hits your room, your body temperature goes up along with your energy levels as part of normal circadian rhythms

Sleep restores you both physically and mentally

Certain reparative chemicals are released while you sleep. There is also evidence that during sleep, the brain is cleared of daily minutiae, learning is synthesized, and memories are consolidated

If you get in bed and can't sleep within 20 to 30 minutes, get up, keep the lights dim, and listen to relaxing music or meditate

Don't get into heavy studying on your computer or try to memorize complex details for an exam, and don't watch TV or grab your phone. This will keep you awake

Let's say that last week you managed just 4 to 5 hours of sleep a night Monday through Thursday

Even if you get 7 to 8 hours a night Friday through Sunday, your unresolved sleep debt of 8 to 12 hours will leave you feeling tired and groggy when you start the week again

nocturia

Frequent urination at night caused by an overactive bladder. Pregnant women often suffer from nocturia, particularly in their first trimester

The FDA recently approved an implantable upper airway stimulator (UAS) called Inspire for use by people who cannot tolerate CPAP devices

Implanted under the skin in the upper chest, Inspire is a small pulsing device that stimulates airway muscle action and improved breathing and can be programmed remotely by a doctor. It is turned on before bed each night and turned off in the morning

The sensations of restless legs syndrome are often described as burning, creeping, or tugging or like insects crawling inside the legs

In general, symptoms are more pronounced in the evening or at night. Lying down or trying to relax activates the symptoms, and moving the legs relieves the discomfort, so people with RLS often have difficulty falling and staying asleep

Avoid nicotine, alcohol, and liquids before bed

Like caffeine, nicotine, alcohol, and liquids—even plain water—will increase the likelihood of sleep disturbances

Go to bed and get up at the same times each day. Establishing a bedtime ritual signals to your body that it's time for sleep

Listen to a quiet song, practice meditation and deep-breathing exercises, take a warm shower, or read something that lets you quietly wind down

Of concern for young adults are the results of a recent study of healthy undergraduate males indicating that short sleep cycles resulted in significant prolonged elevations in heart rate and diastolic pressure recovery after exposure to stressful stimuli as compared to those with longer sleep cycles

Many scientists believe that diabetes, obesity, and other metabolic disorders may be linked with biological clock activity. In general, people who get adequate sleep live longer and enjoy more good-quality days than those who don't

Sleep improves motor tasks, particularly driving

Motor function is affected by sleep throughout the life span among otherwise healthy individuals

It is worth noting that sleep patterns change over the lifespan

Newborns need 16 to 18 hours of sleep daily, and teens and younger adults need 8 to 9 hours per night, slightly more than the adult average. Older adults may experience sleep difficulties that result in fewer hours of rest per night, owing to health conditions, pain, and the need to use the bathroom more frequently

Because OSA runs in some families, genetics may also play a role

OSA is associated with higher risks for chronic high blood pressure, irregular heartbeats, heart attack, and stroke

During the night, you alternate between periods of NREM and REM sleep, repeating one full cycle about once every 90 minutes

Overall, you spend about 75 percent of each night in NREM sleep and 25 percent in REM sleep

Sleep contributes to a healthy metabolism

Several recent studies suggest that sleep contributes to healthy metabolism and possibly to a healthy body weight

can you make up for lost sleep by sleeping in on the weekend?

Some research shows that you can catch up if you go about it sensibly. Trying to catch up may make you feel more wide awake, as well as reducing those dark circles and eye bags. It also may reduce stress-related cortisol levels that shoot up while you are sleep deprived

Sleep hygiene

The wide range of practices that can help you manage and create a systematic approach leading to normal, quality nighttime sleep and full daytime alertness.

Research indicates that deep phases of slow-wave sleep consolidate and organize the day's information, while REM sleep stabilizes consolidated memory

Without adequate slow-wave sleep and REM sleep, your short-term memory may suffer.

During stages 3 and 4, your brain generates slow, large-amplitude delta waves

Your blood pressure drops, your heart rate and respiration slow considerably, and you enter deep sleep. The hypothalamus stimulates the pituitary gland to release human growth hormone, signaling the body to repair worn tissues

Stage 1 is the lightest stage of sleep, lasts only a few minutes, and involves the transition between waking and sleep

Your brain begins to produces theta waves (slow brain waves), and you may experience sensations of falling with quick, jerky muscle reactions

melatonin

a hormone that affects sleep cycles, increasing drowsiness

Restless legs syndrome (RLS)

a neurological disorder characterized by unpleasant sensations in the legs when at rest combined with an uncontrollable urge to move in an effort to relieve these feelings

Parasomnias

all of the abnormal things that disrupt sleep, not including some of the major problems such as sleep apnea.

Insomnia

difficulty in falling asleep, frequent arousals during sleep, or early morning awakening (is the most common sleep complaint)

Sleep apnea

disorder in which breathing is briefly and repeatedly interrupted during sleep

somnolence

drowsiness, slugginsheness, and lack of mental alertness that can affect your daily performance and lead to life-threatening sleepiness while driving

night terrors

he person wakes up frightened and screaming, often without knowing why (probably because this often occurs in non-REM sleep cycles)

sleepwalking

in which the individual may wander around the house or even go for a drive and not remember it

snoring

inhaled air passes over loose tissue in the back of the throat or nasal passages and causes a rattling sound

primary idiopathic hypersomnia

refers to excessive daytime sleepiness without narcolepsy or the associated features of other sleep disorders

Sleep helps you cope with life's challenges

sleep refreshes you; it helps you consolidate cognitive, physiological, and emotional processes and autonomic functions. Well-rested individuals tend to be happier, have more vigor in their lives, and have a more positive outlook than do those who are sleep deprived. People who get enough rest are also more likely to control their emotions and have more positive social interactions

slept debt

the difference between the number of hours sleep an individual needed in a given time period and the number of hours he or she actually slept

sleep phase disorder

the person either wakes up or goes to sleep too early

sleep-related eating disorder

the person may be found munching away in the kitchen but later has no memory of eating an entire cake or bucket of ice cream

sexsomnia

the person may have sex while asleep and have no recollection of the event

sleep inertia

which is characterized by cognitive impairment, grogginess, queasiness, and a disoriented feeling

several factors that can lead to sleep deprivation:

-shift work -long-haul driving -drugs and medications -pain -sleep habits -gender -sleep disorders

sleep deprivation

A condition that occurs when sleep is insufficient.

In most cases, the cause of RLS is unknown

A family history of the condition is seen in approximately 50 percent of cases, suggesting some genetic link. In other cases, RLS appears to be related to other conditions, including Parkinson's disease, kidney failure, diabetes, peripheral neuropathy, and anemia. Pregnancy or hormonal changes can worsen symptoms

REM sleep

A period of sleep characterized by brain-wave activity similar to that seen in wakefulness; rapid eye movement and dreaming occur during REM sleep

Go easy on the caffeine

Long recognized for its ability to increase vigilance and alertness and decrease sleepiness when you need to stay awake, caffeine can be bad news for your sleep, particularly when consumed in the late afternoon or evening

Dreaming takes place primarily during REM sleep

On an EEG, a REM sleeper's brain-wave activity is almost indistinguishable from that of someone who is wide awake, and the brain's energy use is higher than that of a person performing a difficult math problem

If you want to stay awake in the daytime and sleep at night, get as much exposure to natural light outdoors during the day as you can

Open your blinds. Look for lamps and light bulbs that are recommended as therapy for seasonal ailments and to help with daytime alertness

In most cases, narcolepsy appears to be caused by a deficiency of sleep-regulating chemicals in the brain. Genetics may also play a role

Other possible factors include having another sleep disorder, using certain medications, or having a mental disorder or substance abuse disorder

Twin studies have provided strong evidence that habitually sleep-deprived adults are much more susceptible to diseases such as the common cold, inflammatory responses, and other risks than their twins who habitually slept the recommended number of hours per night

Other studies have shown that sleep disruption, particularly when circadian rhythms are disturbed repeatedly, disrupts overall immune function

While millions of people don't get enough sleep on any given night, as many as 70 million people suffer from an actual sleep-related disorder

Over 61 percent of college students aged 18 to 29 years report staying awake late and getting up early—a recipe for sleep deprivation

Although many people who don't get enough sleep suffer the consequences, a small group of people—perhaps fewer than 1 percent—seem to thrive on less than 6 hours of sleep per night

Recent research points to a possible gene—the DEC2 gene—that affects circadian rhythms and changing normal day/night cycles

Sleep plays a role in stress management and mental health

The relationship between sleep and stress is highly complex: Stress can cause or contribute to sleep problems, and sleep problems can cause or increase your level of stress

Short sleep increases the risk of type 2 diabetes

There is evidence that sleep deficiencies, particularly sleep disorders such as sleep apnea, can increase the risk of type 2 diabetes, a disorder of glucose metabolism

Narcolepsy is characterized by overwhelming and uncontrollable sleepiness during the day. Narcoleptics are prone to falling asleep at inappropriate times and places—in class, at work, while driving or eating, or even in the middle of a conversation

These sleep attacks can last from a few seconds to several minutes

Typically, OSA occurs when a person's throat muscles and tongue relax during sleep and block the airway, causing snorting, snoring, and gagging

These sounds occur because falling oxygen saturation levels in the blood stimulate the body's autonomic nervous system to trigger inhalation, often via a sudden gasp of breath

Jet lag happens because the new day/night pattern disrupts the 24-hour biological clock by which you are accustomed to going to sleep, waking up, and performing habitual behaviors throughout your day

This cycle, known as your circadian rhythm, is regulated by a master clock that coordinates the activity of nerve cells, protein, and genes

The pons, one of the smallest areas of the brain, is a major message transmitter and is responsible for much of what happens in the sleep-wake cycle

Unless disrupted, the pons helps you enter REM sleep and keeps you down and out, with muscles essentially immobilized. You may dream that you're rock climbing, but your body is incapable of movement. Almost the only exceptions are your respiratory muscles, which allow you to breathe, and the tiny muscles of your eyes, which move your eyes rapidly as if you were following the scenario of your dream

Turn off screens

Watching TV, playing computer games, hanging out on Facebook or other social media sites, working on your latest paper on your laptop or tablet into the wee hours of the morning—all of these things can keep your mind alert and expose you to blue light, wrecking your chances for a good night's sleep

Sleep conserves body energy

When you sleep, your core body temperature and the rate at which you burn calories drop. This leaves you with more energy to perform activities throughout your waking hours

bedwetting or enuresis

the person wets the bed without being aware of it

People who experience chronic or acute pain along with high stress levels are more likely to report worse quality of life, more depression, and more physical and mental health problems

Add poor environmental conditions such as excessive noise, too much light, temperature extremes, and uncomfortable mattresses, and you have a perfect storm of sleeplessness

Recently, a major U.S. consensus statement was published, providing guidelines for how much sleep a healthy adult should get each night. The key recommendations are as follows:

Adults should sleep 7 or more hours each night to promote optimal health. Getting fewer than 7 hours of sleep per night on a regular basis increases risks of adverse health outcomes. Regularly getting more than 9 hours of sleep may be appropriate for young adults, people trying to recover from sleep debt, and those recovering from illness. For others, it's not clear whether getting that much sleep is associated with health risks

Tune out conflict

Avoid late-night phone calls, texts, or e-mails that can end up in arguments, disappointments, and other emotional stressors. If something does rile you up before bed, journal about it briefly, then promise yourself that you'll make time the next day to explore your thoughts and feelings more deeply

You just need to make sure you exercise 3 to 4 hours before you go to bed. Why?

Because exercise revs up your metabolism, makes you more alert, and depletes energy stores while raising body temperature. It takes hours to bring physiological changes down

During non-REM (NREM) sleep, the body rests

Both your body temperature and your energy use drop; sensation is dulled; and your brain waves, heart rate, and breathing slow

Avoid eating heavy meals within 2 to 3 hours of bedtime

Foods containing tryptophan, an amino acid (found in nut butters, bananas, tuna, eggs, chicken, turkey, yogurt, milk, and pork as well as in high-carbohydrate foods such as bread and pastries) may encourages sleepiness, particularly if you eat foods containing tryptophan on an empty stomach

Keep in mind that sleep needs vary from person to person. Your gender, health, and lifestyle will also affect how much rest your body demands

For example, women need more sleep than men, overall

Studies of college students consistently show pulling an all-nighter to be a bad idea if you want to perform well on exams or be productive

Sleep before and after a task improves performance and is important to memory consolidation and retention

Sleep helps to maintain your immune system

The common cold, strep throat, flu, mononucleosis, cold sores, and a variety of other ailments are more common when your immune system is depressed

The American Academy of Sleep Medicine identifies more than 80 sleep disorders

The most common disorders in adults are insomnia, sleep apnea, restless legs syndrome, and narcolepsy