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Sleep Guide: Understanding and Troubleshooting Sleep
Table of Contents
1. Introduction: Sleep Statistics
2. Effects of Sleep Deprivation
3. Sleep Stages
4. Common Causes of Sleep Problems
5. Good Sleep Solutions
6. Sounds for Sleep
7. Sleep Clinics
8. Best At-Home Sleep Environment
9. Supplements for Sleep
10. When to See a Doctor Questionnaire
Introduction: Sleep Statistics
If you have trouble sleeping, you are not alone. U.S. sleep statistics show a stark contrast between how much sleep Americans get in the twenty-first century versus the past. Statistics show that Americans got on average 6.8 hours of sleep every night in 2013 versus 7.9 hours on average in 1942 (a wartime era), which shows a 13 percent decrease. Fortune Magazine estimates that a lack of sleep is costing the U.S. economy over $411 billion annually. According to the CDC, 35 percent of U.S. adults don’t get enough sleep (at least 7 hours per day), and 20 percent of teenagers are sleeping less than 5 hours every night. Over 37 percent of U.S. adults reported unintentionally falling asleep at work or during the day within the last 30 days. Fifty to 70 million people in the U.S. have one or more sleep disorders. Nearly 20 percent of car crash accidents (including injuries) are associated with sleepiness. Also, over 100,000 deaths are a result of medical errors caused by sleep deprivation. Clearly, not getting enough sleep can be very damaging.
Effects of Sleep Deprivation
Sleep is an essential part of a healthy lifestyle, and getting a sufficient amount of sleep regularly helps you in several ways. Sleep helps to curb inflammation, spurs creativity, improves performance, and sharpens attention. Sleeping enough very night will lower your stress, help you maintain a healthy weight, and improve your quality of life. Some doctors believe that a lack of sleep causes ADHD symptoms in children. Doctors also believe that getting the average amount of sleep per night (not too much or too little) leads to a longer lifespan, although this is only a correlation. Sleep is also important for improved memory and boosting your mood and heart health. Sleep problems are also linked to depression and cardiovascular disease.
Sleep deprivation causes fatigue which then causes more accident prone behavior. It also impairs judgement affecting levels of alertness and responsiveness which causes nodding off. A lack of sleep deserves your attention and maybe even a doctor’s opinion, because it affects your mood, memory, and health in surprising ways. It can also affect your judgement so that you don’t notice its affects. Here is an outline of the effects of sleep deprivation:
- 6,000 fatal car crashes caused by drowsy driving each year (ex. falling asleep at the wheel).
- Linked to more cravings for sweet, salty, and starchy food.
- Leads to higher levels of the hunger hormone gherkin and lower levels of the appetite-control hormone leptin.
- 50% higher risk for obesity if you get less than 5 hours of sleep nightly.
- Less active immunity protectors called natural killer cells.
- 36% increase in risk of colorectal cancer.
- Nearly 3 times risk for Type 2 diabetes.
- Increased risk of high blood pressure.
- 48% increase in developing heart disease.
- 3 times more likely to catch a cold.
- Brain Effects:
- 33% increase in dementia risk.
- Greater risk for: depression, anxiety, irritability, forgetfulness, fuzzy thinking.
- Ages your brain 3-5 years.
Sleep Stages: The Science of Sleep
The Circadian Rhythm and Sleep Stages
Your body’s typical day-to-day rhythms are controlled by frameworks in the brain that aid in establishing when you sleep and wake up. A person proceeds through a sequence of specific physiological stages throughout sleep. Each phase of sleep serves a critical function in maintaining the health of your body and brain. Throughout the night, the stages of “quiet sleep” rotate with periods of rapid eye movement sleep called REM sleep or dreaming. Quiet sleep is necessary because it aids in repairing the body, while REM sleep rejuvenates the mind and is essential for both memory and learning.
Your Circadian Rhythm or Internal Clock
A pacemaker-like structure in the brain controls the circadian rhythm. “Circadian” translates to “about a day,” and “circadian rhythm” is often referred to as the internal clock. Your internal clock is established during the first months of your life. The circadian rhythm regulates the day-to-day ups and downs of bodily patterns, such as your body temperature, your blood pressure, and the release of hormonal agents. A typical person’s circadian rhythm makes them want sleep the most between midnight and sunrise. It also provides a lesser desire for sleep in mid-afternoon. Most U.S. adults sleep at night, but some people can also react to their bodies’ day-to-day periodic decreases in alertness with a one to two-hour midday nap and shorter sleep during the night.
There are a few factors that affect your circadian rhythm. One factor is light. Your exposure to light at the appropriate time aids in maintaining your circadian rhythm and keep it on the right time schedule. On the other hand, if you are exposed to light at the wrong times it can shift your sleep and wakefulness cycle to undesirable times. Another factor is cognitive pressure to keep a schedule that is typical of daily life, like for work or school. This is because work and school schedules demand alertness for certain tasks and events which affects your circadian rhythm. A third factor affecting your internal clock is melatonin. Melatonin is a hormone that induces drowsiness. Researchers believe the daily light-sensitive cycles of melatonin assists in keeping the circadian rhythm on track.
Quiet sleep (non-REM sleep)
There are two major types of sleep. The first type is quiet sleep or non-REM sleep. The second type is REM sleep or dreaming sleep. Quiet sleep is described as “idle brain” but “a moveable body.” In this phase of sleep, thinking slows down as well as most bodily functions. Movement can still happen during quiet sleep which is why people often shift position during this sleep phase.
Going into Quiet Sleep
While you’re awake, billions of neurons in the brain receive and evaluate sensory input and direct behavior by sending out neural impulses to each other. When your eyes are shut and your brain is no longer getting visual stimuli, your brain waves go into a rhythmic pattern of around 10 cycles per one second. This is called the alpha-wave pattern. It is described as a relaxed and calm type of wakefulness. Making the transition into quiet sleep is like flipping a switch. When you’re awake, the switch is on; and when you’re asleep, the switch is off. Without interruption, you will progress seamlessly through the three stages of quiet sleep.
The Three Stages of Quiet (non-REM) Sleep
Stage N1 Sleep
There are three stages of quiet sleep, and the first stage is stage N1. You stay in stage N1 sleep as you cross over from wakefulness into light sleep. Your prominent brain waves gradually slow to four to seven cycles per one second. This pattern is called theta waves. In this phase of sleep your body temperature will drop and your muscles will relax. Your eyes will also frequently move from side to side. When you are in stage N1 of sleep, you lose awareness of your environment but you can be easily jarred awake. Some people experience this stage differently: some describe it as being drowsy, while others describes it as being asleep.
Stage N2 Sleep
The next stage of quiet sleep is stage N2 sleep. This is the first phase of authentic sleep, and it lasts from 10 to 25 minutes. In this stage of quiet sleep, your eyes are static (not moving). Your breathing and heart rate are slower compared to being awake. The electrical activity in the brain is irregular, and sleep spindles occur. A sleep spindle is when brain waves briefly speed up for around a half second or longer. Some researchers think the brain becomes disconnected from outside stimuli during sleep spindles, and this is when memory consolidation (organization) occurs. A pattern called K-complex also occurs in this stage. The K-complex is believed to express a vigilance system that positions you to awaken if it is necessary. Provocation from internal or external stimuli can cause K-complexes. An example would be someone whispering your name in your ear during stage N2 sleep. You actually spend half the night in stage N2 of quiet sleep.
Stage N3 Sleep (Deep Sleep, or Slow-wave Sleep)
The third and final stage of quiet sleep is stage N3 sleep. During this stage of sleep, large and slow brain waves develop called delta waves. This is when you enter deep sleep. Your breathing becomes more consistent, and your blood pressure will fall. Your heart rate will decrease to about 20 to 30 percent below your normal waking heart rate. Your brain will also have a decrease in responsiveness, which makes it more difficult to wake up.
Deep sleep is thought to be a time for your body to repair and renew itself.
During deep sleep, your blood stream is directed less toward your brain, and this is why the brain cools during this stage. At the onset of deep sleep, your pituitary gland releases a growth hormone that boosts muscle repair and tissue growth. There are also increased levels of agents that activate your immune system in your blood.
Younger people spend one fifth of their sleep time in periods of deep sleep that can last up to 30 minutes. However, people over 65 hardly experience deep sleep. After a span of sleep deprivation, you will proceed faster through the stages of lighter sleep into the stages of deeper sleep and spend more time there. This implies that deep sleep is important for restoring alertness and plays a necessary role in optimal functioning.
Dreaming (REM) Sleep
REM sleep is when dreaming occurs, and it is described as an “active brain in a paralyzed body.” Your brain activity is heightened in REM sleep because you are thinking and dreaming. Under your eyelids, your eyes quickly shoot back and forth. The temperature of your body also increases, as well as your blood pressure. Your breathing and heart rate also quicken to waking levels. Your body also creates a fight-or-flight response that is twice as engaged as when you are awake. In spite of this, your body barely has movement during this sleep stage with the exception of occasional twitches. Any muscles not involved with eye movement or breathing are still or “quiet.”
The Role of REM Sleep
Researchers believe that REM sleep replenishes your mind by clearing out unnecessary information. It is also believed that your brain processes information through the night and REM sleep enhances memory and learning. This implies that your performance is better with a good night’s sleep versus being subjected to intermittent awakenings that hinder REM sleep.
Around 3-5 times a night, or around every 90 minutes, you enter REM sleep.
The initial episode of REM sleep typically lasts for only a couple of minutes. However, the time you spend in REM sleep increases steadily through the night. The final episode of REM sleep has a duration of around a half hour. If you have a period of sleep deprivation where you are prevented from entering REM sleep, then you will enter the stage sooner and spend more time in it the next time you do get sleep. This phenomenon is called REM rebound.
Why People Have Problems Sleeping – Common Culprits
Sleep can be elusive to people for several reasons. As mentioned above, the number of health problems associated with inadequate sleep is nearly endless. Heart disease, dementia, obesity, and diabetes are some of the more serious issues. But if sleep is so important, why is it so hard to control for so many people? Why are you always tired? It turns out there are several common culprits that may be at the root of why you’re not getting enough rest. Whether you are waking up throughout the night or just not feeling rested in the morning, find out if one of these variables is disrupting your sleep cycle or sleep quality.
These days, it’s common knowledge that electronics emit blue light that can suppress melatonin, which can negatively affect your sleep cycle. In order to avoid this, you are told to turn off electronics about an hour before you go to bed. However, research shows that blue light can still suppress melatonin anywhere from three to four hours before you tuck in to go to sleep. Turning off electronics in this time frame is not always convenient or possible, because you may have work to do, whether for a job or school, that requires the use of electronics. Or perhaps you just want to be entertained during these hours. Whatever your situation is, you don’t have to turn off your electronics three to four before you sleep. You can use blue light blocking products instead. For instance, several online retailers offer blue light blocking glasses or screen covers.
For some people, declining levels of estrogen induce hot flashes that can cause sleep disturbances through out the night. One in four people with menopause have serious problems sleeping that negatively affects their functioning during the day. Using pajamas and sheets that absorb dampness helps to avoid hot, sweaty wake-ups in the night. Using a buckwheat pillow also has a cooling affect.
Coffee is an obvious culprit when it comes to consuming caffeine. You probably understand that drinking coffee in the afternoon will negatively affect your ability to sleep later. But what you may not know is that caffeine comes in many other products like chocolate or iced tea. The caffeine levels in non-coffee food items is may be lower, but if you consume them in combinations or in large amounts, the caffeine in them could be enough to disrupt your sleep cycle. Also, people metabolize caffeine at different rates. You should try to understand you own body to determine when you should cut off caffeine intake each day. If you have no idea when this time might be, after lunch is a good starting point.
Lack of a Schedule
While having continual free, unstructured time, such as in retirement, is less stressful, there are still advantages to having a regular schedule when it comes to sleep. The time you go to bed and wake up should be important to you, even if you don’t have anything to do. Fluctuating these times often will have an impact on how your body releases melatonin at bedtime. This is why when your schedule goes out the window (due to retirement or other reasons), you should still try to keep a regular sleep schedule, even on the weekends.
Many adults end up taking naps by accident due to inactivity or while watching entertainment. It is most common to get drowsy between two and three in the afternoon. This is when your body experiences a natural dip in energy. Napping during the day could prevent you from feeling tired at night. To avoid this, try to schedule an active event at this time of day, such as exercise. Research shows that this will help you feel refreshed and will also improve your sleep quality.
Your bed should only be used for sleeping and other bed-appropriate activities – like having relations with your partner. Other non-bed specific activities should be done in other spaces. For example, people often read in their beds, because it is a relaxing activity. However, it would be better to read in a non-bed space, like an armchair. You should also avoid doing daytime activities in your bed, because it could affect your ability to drift off to sleep at night.
Having a drink can simmer down your nerves and make it easier for you to fall asleep. However, there is also a rebound effect that can cause fragmented sleep as well as lighter sleep in the second part of the night – around 3 a.m. Drinking before bedtime also reduces sleep quality, so you feel less refreshed in the morning. If you choose to drink in the evenings, try to do so no less than three hours before you go to bed. Even then, you should only drink moderately (around one to two drinks).
Some medications taken close to your bedtime can be disruptive to your sleep cycle. An example would be diuretics used to control blood pressure, because they cause frequent urination. Making more than one or two bathroom trips per night is abnormal. Also, antidepressant medications (SSRIs) can have a sedating or energizing affect, and this can influence your sleep cycle. Your doctor can best advise you when to take these medications to avoid interfering with your sleep.
People with anxiety may have no trouble falling asleep initially, but they still find themselves awake in the wee hours of the mourning due to worrying. If this is the case for you, then you should try to deal with the root cause of the problem. You can do this by training your thoughts to calm down, and this will slow the speed of your brain activity allowing you to sleep. This can be accomplished with the help of a cognitive behavioral therapist if necessary. Or you can also use apps to develop this important skill. If you choose to use an app, be sure to practice with it throughout the day rather than just when you need it (like at 3 a.m.). Also, if you do use an app at night, you can set you phone to a night setting so the blue light doesn’t affect your sleep.
When you lay awake in bed and try to force sleep to occur, it usually backfires. In fact, this practice actually has the opposite affect. When you lay awake in bed, it trains your body to think that being awake in bed is normal. You will have better results by going into another room to do a relaxing, calming activity, like reading a book. This will actually work best if you just accept that you can’t fall asleep just yet. In other words, let sleep come when it comes. If you don’t get much sleep in the night, then don’t sleep in to make up for it. Just get proper sleep the next night.
Doctors describe insomnia as both a disease and a symptom. If you have done everything to shape up your sleep hygiene with good habits (like avoiding caffeine in the afternoon and keeping a regular sleep schedule), then you may have insomnia as a result of another health issue. Some examples are sleep apnea or depression. If you think you have a serious sleep problem, and it has persisted for a month or more, then it may be best to get a doctor’s evaluation.
Keeping on the same note of insomnia caused by other health issues, there are chronic conditions that may affect your ability to sleep. Some of these underlying conditions have already been mentioned like depression and anxiety (when your mood makes it hard to fall asleep), and also sleep apnea (loud snoring that can cause brief awakenings in the night due to pauses in breathing). Other underlying conditions that can affect your sleep cycle are an enlarged prostate, chronic pain, and neuropathy. An enlarged prostate gland causes a feeling of urgency to empty your bladder through the night. Chronic pain makes it hard to get sleep because you are hurting. Neuropathy issues may involve numbness, tingling, or even pain, usually in the hands and feet, that causes waking in the night.
Good Sleep Solutions
There are numerous factors you can manipulate to promote fulfilling sleep and good sleep hygiene. So, what exactly is sleep hygiene? The term “sleep hygiene” is defined as the habits that you can implement to promote good sleep. Basically, sleep hygiene uses behavioral interventions. Here are some sleep hygiene tips.
The first tip is to keep a regular sleep routine. This means going to bed at the same time every night and waking up at the same time. You should aim to keep your sleep and waking times within 20 minutes, more or less, of the same time daily. You should also avoid taking naps in the daytime. During the day when you are active, a kind of sleep pressure builds up that makes you drowsy at night and enables you to fall asleep faster. Sometimes this is referred to as “sleep debt” which is essential for the easy onset of sleep. You only need a certain amount of sleep in one 24-hour span of time and not any more than that. Daytime napping takes away from your sleep debt at night which can cause problems initiating sleep and sleep fragmentation. These issues can lead to sleep deprivation and insomnia. If for some reason you absolutely need to nap (due to extenuating circumstances), try to do so earlier in the day. You can also try exercising or doing something active during the afternoon when your body typically experiences a dip in energy.
Another tip is to not remain awake in bed for more than 10 minutes. For example, if your mind is racing with worry or other thoughts that are preventing you from falling asleep, you should get out of bed. You can go sit in a chair in a dark or dim room to think until you get sleepy. Try to avoid watching TV or using the internet during this time, and go to bed when you feel tired. If this happens several times throughout the night, still try to maintain a regular waking time. If you do end up watching TV or internet surfing because you can’t resist, don’t do so in your bed. Also, use a blue light blocking product to protect your eyes from the blue light emitted from these electronics. For instance, you can use blue light blocking screen covers or wear blue light blocking glasses.
As mentioned above, you should also be weary of your caffeine intake, because the affects can last for several hours. Caffeine makes the onset of sleep more difficult and may cause sleep fragmentation, so try to consume caffeine products only before noon or lunchtime. Keep in mind that some soft drinks and teas contain caffeine. Other substances can also disrupt your sleep such as products containing nicotine and alcohol. Some over-the-counter medications can also have the same affect.
You can also make your sleeping environment more comfortable. One way to do this is by providing fresh air while you sleep. You can crack a window or use an air purifier to remove odors and bacteria from the air. Another factor in your sleep environment that you can control is the temperature. You should set your thermostat at a comfortable setting. Also, make sure your environment is relatively quiet (having low background white noise is okay). If pets disrupt your sleep, try to keep them outside your bedroom. Use a comfortable mattress that gives the proper support for your body, and avoid bright lights. If it’s your habit to watch your clock while trying to fall asleep, hide your clock.
Another tip is to have a comfy pre-bedtime regimen. This can include taking a cozy bath or shower, quiet time, and/or meditation. You should also avoid strenuous exercise prior to going to bed. Working out before bedtime releases endorphins into your blood stream that can cause problems initiating sleep. If you exercise regularly, try to do so before 2 p.m.
There are a few other tips to keep in mind for good sleep hygiene. One is that you should use light to your advantage. Natural light is one of the factors that regulate your circadian rhythm (your internal clock). Getting natural light during the day can help you keep a healthy sleep-wake cycle. If you find yourself inside all day regularly, it’s not a bad idea to take short breaks to go outside and soak up some sun.
You can also lighten up on your evening meals to promote good sleep hygiene. Avoid meals with food the cause indigestion, and eat dinner at least a few hours before bedtime. You should also balance your fluid intake before bedtime. Drink just enough fluid to quench your thirst to avoid nighttime bathroom trips. Finally, the best tip for good sleep hygiene is for you to follow through with these behavioral changes mentioned above that are appropriate for you. Some tips are easier to implement than others. If you suspect that you have a serious sleep problem due to a medical condition, such as sleep apnea, narcolepsy, or restless leg syndrome, speak to your doctor.
Sound Therapy for Sleep: Why Nature Sounds Work
Insomnia is usually caused by stress. Sound therapy actually decreases stress which may help you sleep better. Sound therapy helps to clear your mind of internal chatter due to slow rhythms and helps you find your “off” button. When you use sound therapy, your brain feels energized because it gets a break from the exhaustion caused by stress. Sound therapy relaxes your nervous system by stimulating the production of sleep-targeting neurotransmitters. Specific sounds that help calm the nerves are nature sounds. These sounds have a steady, pleasant pitch that your brain interprets as non-threatening noise. This is referred to as reducing your fight-or-flight response. It is also possible that nature sounds mask other sounds that keep you awake, like traffic or apartment noises.
There’s a bit more of an explanation of the power of nature’s soothing sounds. Scientists believe that nature sounds trigger a change in certain connections in the brain that results in the reduction of the fight-or-flight response. The fight-or-flight response happens when your under extreme duress like a threatening situation, and your body is preparing to either fight or flea. During this response, your nervous system releases hormones such as adrenaline, cortisol, and noradrenaline (a precursor to adrenaline). These are all stress hormones, and they make it quite difficult for you to get to sleep. Nature sounds actually build an opposing response called the “rest-digest” response. This response relaxes you and encourages you to fall asleep. Furthermore, artificial sounds seem to stimulate the brain into a state of inner-focused attention that includes anxiety, depression, and worrying. This kind of reaction in your brain at night discourages sleep, but can be remedied with nature sounds like a waterfall or rainforest, which will stimulate the rest reaction.
Advanced Sleep Solutions: Sleep Clinics
If sleep hygiene tips or sound therapy don’t help, and your sleep issues persist past a month, you can ask for your doctor’s opinion. Your physician may recommend that you undergo a sleep study at a sleep clinic. Sleep clinics provide diagnoses for clinical sleep disorders like sleep apnea, insomnia, narcolepsy, restless leg syndrome, and more issues. There are several sleep clinics in the U.S., and you can research which one suits you.
What exactly is a sleep clinic?
A sleep clinic is basically a medical lab where you’ll be monitored either during the day (outpatient) or over night (inpatient) while you sleep. In sleep clinics, there are rooms outfitted with medical monitoring equipment used in sleep medicine. This equipment will provide the data necessary in a sleep study for a doctor to determine if you have a clinical sleep disorder. So, sleep clinics operate as diagnostic centers. Sometimes sleep clinics are located in a hospital, but most of them are standalone with an overseeing doctor. Those running your tests and monitoring you will be technicians, and the overseeing doctor will interpret the results to provide a diagnosis.
In the patient rooms, there will be a bed next to the monitoring equipment with wires and sensors. You will have your vital signs recorded as well as your breathing pattern, brain waves, and body and eye movement. Your room will also have an intercom and observation window. If you go to a standalone sleep clinic, your room may look more like a hotel room rather than a hospital one.
Why should you do a sleep study?
Reasons people do sleep studies include trouble falling asleep, trouble staying asleep, chronic snoring, or excessive sleepiness during the day. Your doctor may provide a referral for a sleep study if behavioral changes are ineffective. If you have a sleep disorder, the symptoms will show at night while you are sleeping nor at least attempting to sleep. Doing a sleep study will provide the data needed for an informed diagnosis. You can’t exactly record this sort of data at home, like brain activity. Your brain wave activity is actually a very important diagnostic tool in sleep medicine since your brain waves can tell how long you spend in each stage of sleep.
What does a sleep study diagnose?
The sleep disorders a sleep study can diagnose include sleep apnea, insomnia, narcolepsy, restless leg syndrome, periodic limb movement disorder, sleep walking, rhythmic movement disorder, REM behavior disorder, and sleep bruxism.
Sleep apnea has been mentioned here before. Remember that it is a sleep disorder that involves problems with sleep-related breathing. The disorder is characterized by momentary stops in breathing while you are asleep. The breathing cessations cause you to awaken just enough to start breathing again. These constant interruptions to your sleep cycle cause daytime sleepiness. Having sleep apnea is also dangerous due to the health issues associated with the stoppage of breathing.
There are two types of sleep apnea: obstructive sleep apnea or OSA, and central sleep apnea or CSA. OSA results from a physical blockage of your airways. This type of sleep apnea is more common than CSA, and it is often associated with obesity. CSA is the result of an error in communication between your breathing muscles and your brain. A sleep study can properly diagnose which kind of sleep apnea you have. As a health condition, apnea is categorized based on frequency or severity of episodes. This categorization is called the Apnea/Hypoapnea index.
Insomnia is a highly common sleep disorder, and it is estimated that at least one in three Americans suffer from mild insomnia or worse. The disorder is characterized by difficulty either initiating sleep or staying asleep. An example would be if you frequently wake up throughout the night. If you have the symptoms of insomnia that continue for months at a time, you may have chronic insomnia. Having insomnia causes long-term sleep deprivation.
Testing for insomnia may take multiple days at a sleep clinic. Fortunately, you can usually leave during the day to do your normal activities like running errands and going to work. As a condition, insomnia is often influenced by environmental factors and can be connected to mental health issues like depression and anxiety. Your insomnia could also be caused by another sleep disorder. A sleep study could uncover the sleep disorder that is the root cause of your sleep problems.
Narcolepsy is a sleep disorder that is not caused by insufficient sleep at night. It is characterized by excessive sleepiness during the day. When you have narcolepsy, you experience spontaneously falling asleep during the day despite the fact that you got enough sleep at night. This sleep disorder severely disrupts your day-to-day life and puts you at risk of accident and/or injury.
Sleep clinics diagnose narcolepsy with two exams; one exam is overnight and the other exam is during the day. Your daytime exam will measure the frequency and spontaneity of your episodes, and your nighttime exam will determine if another sleep disorder is causing your daytime sleepiness.
Restless leg syndrome, or RLS, is a movement disorder associated with sleep. When you have RLS, you experience tingling or numbness in your lower limbs when you lay down, including when you go to bed. The only way to relieve this feeling is by moving your legs. The experience is described as an uncontrollable urge to repeatedly move your legs to dissipate the pain, tingling, or numbness you feel. This makes it very difficult to fall asleep.
It is common for RLS to be diagnosed based on self-reported symptoms. However, a sleep study can determine if your RLS is caused by an underlying sleep disorder.
Other sleep disorders associated with movement include periodic limb movement disorder or PLMD, sleep walking, and rhythmic movement disorder. Having PLMD means you repeatedly and involuntarily move your lower limbs often during non-REM sleep. PLMD is often associated with other sleep disorders. Sleep walking is referred to as a parasomnia, which is a term that refers to having undesirable and unusual physical events occur that disrupt your sleep cycle (like talking or walking in your sleep). When you sleep walk you stand up and maybe walk during your sleep in the first half of the night, and these actions make you vulnerable to injury. Some children suffer from sleep walking but later grow out of it. A sleep study can determine if your sleep walking is caused by another disorder or even sleep seizures. Rhythmic movement disorder is also more common in children. When you have this sleep disorder, you repeatedly rock your body when initialing sleep. If these movements are violent, you can hurt yourself. This condition is often confused with epilepsy, but a sleep study can accurately diagnose the real problem.
REM behavioral disorder, or RBD, is a sleep disorder linked to the REM sleep stage. When you have RBD, you shout out during your sleep and you may violently act out your dreams with movements like running, yelling, or jumping. RBD is dissimilar to night terrors, because you remember what happened when you wake up.
RBD is more common in older adults. The disorder is often confused with other sleep movement disorders. A neurological exam and a sleep study can narrow down the symptoms of RBD from other health problems.
Sleep bruxism is another movement disorder associated with sleep, but it’s different from the other movement disorders mentioned above. When you have sleep bruxism, you grind your teeth together and your related face muscles tense up during sleep. This leads to serious dental health problems and decreases the quality of your sleep. If you have sleep bruxism, you may wake up with headaches and you might have damage to your teeth. A prescribed oral appliance can be used to prevent you from grinding your teeth at night, and a sleep study can get you the required prescription.
What tests do sleep clinics perform?
There are four main types of tests sleep clinics perform, and these include a polysomnogram, multiple sleep latency test, maintenance of wakefulness test, and CPAP titration. A polysomnogram, or PSG, is the most common type of test performed by sleep clinics. A PSG involves attaching sensors and electrodes to your body during an overnight exam to measure several of your vital signs. These measurements include your heart rate, oxygen levels, brain activity, blood pressure, and your eye and body movements. A PSG test is important in diagnosing most sleep disorders including insomnia, sleep apnea, and sleep-related movement disorders.
A multiple sleep latency test, or MSLT, is used for suspected sleep apnea and narcolepsy cases after completing a PSG test. An MSLT exam is done during the day. If you undergo an MSLT test, you will have five nap times, each 20 minutes long, that are two hours apart. Your eye movements and brain waves will be recorded to measure how sleepy you get and how often you enter REM sleep. A MSLT test can also determine if your sleep apnea treatments are effective.
If you have sleep apnea, a CPAP titration test can measure the needed amount of air pressure for your CPAP machine that is particular to you. A correctly calibrated CPAP machine can make you comfortable enough to sleep at night. This is why CPAP therapy is often the best treatment for sleep apnea.
What are some good tips for doing a sleep study?
If you decide to do a sleep study, and you find a good one near you, you will be provided instructions to follow to prepare for your test(s). Even so, there are still some good tips you could follow. During the week before your sleep study, try to live life normally (work and leisure). Don’t try to do anything special to try and get your exam “to work.” A sleep study does not cure your sleep issues, it only provides an accurate diagnosis.
On the day of your sleep study, avoid drinking alcohol. Don’t consume caffeine after lunchtime, and avoid napping. You don’t want to make it more difficult to fall asleep at the appropriate time. You can also do a few things to make your tests go smoother. For instance, washing and drying your hair will remove oils and gel, and the electrodes will attach easier to your scalp. You can also remove any nail polish from your index fingers so the oxygen monitor can read your oxygen levels more accurately.
What is a good sleep clinic?
There are many sleep clinics in the U.S. There are a few criteria you can use to determine if a sleep clinic is reputable. First, look for proper medical certification. The overseeing physician and the technicians should have the appropriate sleep certifications to run your test(s). A sleep doctor should have an MD or DO degree and should have a board certification in sleep medicine. There is also additional certification offered for doctors through the American Academy of Sleep Medicine. Sleep technologists should have one or more of these certifications: Sleep Disorder Specialist (SDS), Registered Polysomnographic Technologists (RPSGT), Registered Sleep Technologist (RST), and Certified Polysomnographic Technician (CPSGT).
In addition to an overseeing doctor and technicians, there may also be a sleep respiratory therapist at a sleep clinic. A sleep respiratory therapist can show you how to properly use a CPAP machine if you have sleep apnea. This type of health care provider should have a Sleep Disorder Specialist (SDS) certification and one of these: Certified Respiratory Therapyst (CRT), or Registered Respiratory Therapist (RRT) certification. This type of therapist might also have accreditation through the National Board for Respiratory Care. The American Board of Medical Specialties can provide verification of certification for you.
Sometimes a sleep clinic has an accreditation of its own. The American Academy of Sleep Medicine, or AASM, typically provides this accreditation. Having this accreditation means that a sleep clinic’s doctor and technicians meet certain education and certification requirements. It also means that a sleep clinic was inspected by an AASM board certified sleep doctor, which includes a review of sleep test records.
There are a few other things you should keep in mind when you choose a sleep clinic. For instance, you should check for positive reviews. Even if a sleep clinic has the needed expertise to diagnose your sleep issues, you still want to know what the patient experience is like. Online reviews could provide valuable insights in that regard. In-network insurance coverage is something else to consider. You should also look for a sleep clinic with available resources to you, like educational information. Check if a sleep clinic offers a blog or ebooks online. If you go in person, check for pamphlets and other printed material meant to help you understand the clinic’s services offered. Another thing to consider is the location of the sleep clinic. If you live in a big city, you probably have a sleep clinic near you. You should visit one in person to see if you like the environment before you schedule a sleep study.
Create Your Own At-Home Sleep Clinic
A sleep clinic is designed specifically to provide a diagnose(s). However, a clinic can just be a place where resources are gathered (such as people with certain skills and equipment) to analyze and provide solutions to certain problems or to acquire specific knowledge (like data). With this second definition of a clinic, you can make your own at-home sleep clinic – a gathering of resources to collect data, analyze your problems, and maybe provide solutions to your problems. Also consider that some sleep studies are conducted at home, and having a sleep-inducing environment at home that’s designed to collect data can be really helpful. To be clear, your at-home sleep clinic can’t provide you a diagnosis, but it may help you sleep better and/or collect some data that could aid in the diagnostic process. Actions and items you can implement to create an at-home sleep clinic can be grouped in three categories: low-tech, mid-tech, and hi-tech. Low-tech actions and items don’t involve complex technology. Mid-tech actions and items involve technology that is easy and/or inexpensive to obtain. Hi-tech actions and items involve complex technology that can be expensive.
Low-tech actions and items you can implement are simple and inexpensive. These things mostly involve providing a quiet, dark, and cool environment to sleep – like bats in a cave. To reduce noise in your bedroom, you can use ear plugs or a white noise appliance, such as a fan, to cover other noises bothering you (like traffic sounds). You should also consider keeping pets outside of your bedroom. For darkness, you can use heavy curtains, blackout shades, or maybe an eye mask. For coolness, keep your thermostat between 60 and 75 degrees Fahrenheit. Other things to consider besides temperature are air freshness, smells, and humidity. For fresh air, you can ventilate your room by cracking open a window or use an air filter to remove dust and bacteria. You should also keep your bedroom clean to avoid smells. This should include vacuuming and changing your linens. To decrease humidity in your bedroom, you can use your air conditioner and/or a dehumidifier. Dehumidifiers come in all sizes, and you can usually find a small inexpensive one that works for a bedroom-sized space. Other low-tech things to consider are a comfortable mattress and pillows and keeping computers and TVs outside your bedroom.
Mid-tech actions and items you can implement for your at-home sleep clinic involve more technology and may cost some money, but prices are usually affordable. You can use white noise apps to muffle other sounds in your bedroom. These apps may be free or paid. You can also play white noise videos online for free. The videos features nature sounds like rushing water or rain storms. Blue light blocking glasses or screen covers help to protect your eyes from the blue light from electronics which can influence your melatonin levels. Sticky screen filters come in different sizes for laptops, tablets, and mobile phones. Apps can also be used to filter blue light by using software that adjusts your screen color temperature based on what time of day it is. There are also wristband monitors you can use to track your sleep cycle; they record nighttime wake-ups and measure how much deep sleep and light sleep you get. There are also apps that can monitor your movements during sleep. Wakeup lights mimic the gentle light of sunrise and play natural sounds to awaken you rather than the harsh sounds of an alarm clock. This could have a positive impact on setting your circadian rhythm to appropriate waking times. You can also use products that help calm you down by syncing your breathing to a transitioning LED light. This helps to get you into a relaxed pre-sleep state.
High-tech actions and items you can use for your at-home sleep clinic are pricier and use more advanced technology. For instance, you could use a bio alarm clock to wake up at the perfect time. A bio alarm clock detects your brain waves or body movements by using electrode sensors under your pillow that sense what stage of sleep you are in. Bio alarm clocks aim to wake you during the light sleep stages rather than deep sleep. You could also use a SMART thermostat to control the temperature of your home. A SMART thermostat is WiFi and app enabled, and it is used with home automation. You can control your home’s air conditioning, heating, and ventilation from your mobile phone or tablet. Also, a SMART thermostat has sensors that detect when you are home or out so that it can adjust energy use and save money. SMART thermostats can also be voice-activated with virtual assistants like Siri, Alexa, and more. SMART beds incorporate sleep tracking and monitoring technology in your mattress. A SMART bed collects data on your vital signs like your breathing rate, heart rate, and movements. This data is usually sent to an app on your phone or tablet. SMART beds can also be voice activated. Advanced technology items like these can be combined with other SMART home devices to create a SMART home environment if that’s what you want. Just keep in mind that these technologies can be expensive.
Supplements for Sleep
If you have sleep problems that have persisted for a while and you are considering taking sleeping pills, you could try natural sleep supplements first. Sleeping pills may have a negative affect on your daytime activities, which is why you should start with sleep supplements first. Some of the most popular natural sleep aids are melatonin, magnesium, and GABA. Talk to your doctor to see if one of these supplements is right for you. Also, be sure to ask your doctor if any of these supplements will interfere with any prescription drugs you are currently taking. Here’s more information on the these top natural sleep aids.
Melatonin is probably the most common sleep supplement people use. In fact, melatonin is so central to sleep that it is referred to as the ‘sleep hormone.’ Melatonin is made from the amino acid called I-tryptophan, and it is secreted by the pineal gland around sunset. From then on, your melatonin levels continue to rise until the middle of the morning. It is believed that your ability to secrete melatonin is increased by moderate levels of exercise or other forms of positive stress. When you have disruptive and inconsistent sleep patterns, it tampers with the ebb and flow of your melatonin secretion levels. As you get older, you secrete less melatonin. This is why older adults tend to sleep less. If you are an older adult, you should consider taking melatonin. The supplement also helps you adjust to new sleep schedules and traveling across different time zones. Melatonin also helps other health issues besides sleep problems, such as headaches, chronic fatigue, healthy cholesterol levels, fibromyalgia, inflammation levels, and depression.
Magnesium is a very impressive mineral. It is used in over 300 of your internal bodily reactions. Magnesium regulates your circadian rhythm and keeps it steady. It is linked to reducing feelings of anxiety and stress and also regulates the excitation levels of your central nervous system. The supplement also helps to relax your muscles. In fact, magnesium deficiency is thought to be a possible contributor to Restless Leg Syndrome. Magnesium is also believed to improve how many hours you sleep as well as help you fall asleep. This is why older adults could also benefit from taking a magnesium supplement. Magnesium also helps improve melatonin levels and may also help reduce insomnia. Magnesium threonate is a form of magnesium that is believed to have brain health benefits. However, most magnesium supplements usually come in other forms of magnesium such as magnesium citrate or magnesium oxide.
GABA stands for gamma-aminobutyric acid. It is a naturally occurring acid in your body. GABA is a chemical messenger that acts as a neurotransmitter in the brain. The role of GABA in your body is to block certain signals which leads to a decrease in the activity of your nervous system; and this has a calming effect. This is how GABA can help you fall sleep. Just be cautious with your dosage, because taking GABA can cause excessive drowsiness. This is why you should ask your doctor if GABA is right for you, and you should only take it before bedtime (and not before other activities like driving).
Conclusion: Know when to get help and see a doctor.
In conclusion, the most important concept to take away from this sleep guide is to know when you need help. Although many people experience sleep problems from time to time, there are warning signs that you may have a sleep disorder. Review the following list of questions to determine if it is the time to ask your doctor if you have a sleep disorder.
- Do you have trouble falling asleep?
- Do you have trouble staying asleep?
- After seven hours or more of sleep, do you still feel tired during the day?
- Is it difficult for you to do regular activities during the day?
- Do you snore very loudly and regularly while you sleep?
- Do you fall asleep while driving?
- Do you struggle to stay awake during inactive activities like watching TV or reading a book?
- Do you have trouble concentrating or paying attention at school, work, or home?
- Do you have performance problems at school or work?
- Do you often get told that you look tired?
- Do you have difficulty remembering things?
- Do you have slowed responses?
- Do you have trouble controlling your emotions?
- Do you feel the urge to take naps everyday?
- Do you fall asleep at unusual times often?
- Do you have issues with restless legs during bedtime?
- Do you lose muscle and movement control while you are awake?
- Do you sleep too much?
If you answered ‘yes’ to one or more of these questions, and your symptoms have lasted a month ore more, then you may have a sleep disorder. Some of these questions are generalized, but if you feel your symptoms are persistent and due to sleep issues, then seek help from your doctor by asking if you have a sleep disorder. Also, keeping a sleep diary can help you figure out the root cause of your problems. Keeping a sleep diary will help you track your sleep habits and may reveal certain patterns that could be useful when talking to your doctor. Most sleep problems can be resolved with behavioral changes and good sleep hygiene. However, if this is not the case for you, a sleep diary could help your doctor determine if you need a sleep study.