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Sleep and InsomniaCauses, Symptoms, Cures, Treatments, and RemediesOf Sleeplessness and InsomniaHow To Sleep WellSleep Is a Basic Human Need!Sleep is a natural part of everybody's life, but many people know very little about how important it is, and some even try to get by with little sleep. Sleep is something our bodies need to do; it is not an option. Even though the exact reasons for sleep remain a mystery, we do know that during sleep many of the body's major organ and regulatory systems continue to work actively. Some parts of the brain actually increase their activity dramatically, and the body produces more of certain hormones.
Sleep, like diet and exercise, is important for our minds and bodies to function normally. In fact, sleep appears to be required for survival. Rats deprived of sleep die within two to three weeks, a time frame similar to death due to starvation. An internal biological clock regulates the timing for sleep. It programs each person to feel sleepy during the nighttime hours and to be active during the daylight hours. Light is the cue that synchronizes the biological clock to the 24-hour cycle of day and night. Problem Sleepiness Has Serious Consequences Sleepiness due to chronic lack of adequate sleep is a big problem
in the
When we get less sleep (even one hour less) than we need each night, we develop a "sleep debt." If the sleep debt becomes too great, it can lead to problem sleepiness – sleepiness that occurs when you should be awake and alert, that interferes with daily routine and activities, and reduces your ability to function. Even if you do not feel sleepy, the sleep debt can have a powerful negative effect on your daytime performance, thinking, and mood, and cause you to fall asleep at inappropriate and even dangerous times. Problem sleepiness has serious consequences – it puts adolescents and adults at risk for drowsy driving or workplace accidents. In children, it increases the risk of accidents and injuries. In addition, lack of sleep can have a negative effect on children's performance in school, on the playground, in extracurricular activities, and in social relationships. Inadequate sleep can cause decreases in:
Inadequate sleep can cause increases in:
Signs of Sleep Disorders Some children who are sleepy become agitated rather than lethargic and may be misdiagnosed as hyperactive. Not getting enough sleep is one cause of problem sleepiness. Undiagnosed/untreated sleep disorders can also cause problem sleepiness. Children as well as adults can suffer from sleep disorders. Parents should talk to their pediatrician about a possible sleep disorder if their child has any of the following:
NORMAL SLEEPWhat is sleep? Sleep is a behavioral state characterized by little physical activity and almost no awareness of the outside world. Most scientists think that sleep does something important -- something vital for life, although research has not yet identified specifically what sleep does. Nevertheless, we
all know when we need to sleep -- we can feel this need. We also know when sleep has done its work -- we feel rested and that we have slept enough. Another important feature of normal sleep is that it can end quickly. Although a sleeper may appear to be unconscious; unlike someone who is actually knocked-out, anesthetized or in a coma; a sleeping person can be easily awakened and can resume normal waking activity within a minute or two. Sleep Stages
Deep Sleep Doctors have tried to determine what type of sleep is the deepest sleep. To do this, they measure how much noise or other alerting stimulation is required to awaken a sleeper from the various types of sleep. It is always possible to awaken someone who is sleeping, as opposed to, say, someone who is in a coma. However, people
in stages 3 and 4 sleep require the most stimulation to awaken. Therefore,
this phase of sleep is often thought of as 'deep sleep'. Also, large
spurts of growth hormone are secreted during stages 3 and 4 NREM sleep.
Consequently, these stages of sleep are thought to restore the body
from the wear and tear of waking activity. REM or Dream Sleep People in REM sleep also tend to be quite difficult to awaken, but this finding is variable -- sometimes even the slightest noise can awaken a person in REM sleep. Nevertheless, because it is often difficult to awaken a person from REM sleep, many doctors think also of REM sleep as a 'deep' phase of sleep. There are many theories about the function of REM sleep and dreaming -- ranging from 'safe, socially acceptable, wish fulfillment' to 'consolidation of memories' to 'providing necessary stimulation to the entire nervous system during development'. Researchers used
to think that REM sleep was necessary for normal psychological function,
because experimental REM deprivation Some experiments have shown that REM deprivation improves depression. However, REM sleep must still do something, because rats will die after 2 - 3 weeks if they are deprived of REM sleep by a special experimental computer that wakes them up each time REM sleep is achieved. Whatever REM sleep does, it is clear that every aspect of existence, from the body's manufacture of proteins to sexual arousal including orgasm, is influenced by REM sleep. It is likely that the ultimate explanation of REM sleep will be very broad -- not simply focused on one physiologic function. Why do we sleep? We sleep because
we get sleepy and we cannot work if we get too sleepy. That is the
simplest and yet the most profound answer to this question. The scientific
truth is, however, that we do not yet know why we get sleepy. We know that all mammals as well as some birds and reptiles sleep. Many doctors think sleep comes in order to get rid of certain chemicals that build up in our bodies during the day's activities. Brain research in the 1960's and 1970's has identified several molecules involved in cell-to-cell communication within the brain as being important for sleep. More recent work has isolated products of the body's immune system that seem to be sleep-inducers. Circadian Rhythm or Our Biological Clock Feeling sleepy is not the whole story of our sleep-wake cycle. Some timing mechanism is also involved. We know that every living thing composed of cells with a nucleus has a daily cycle of activity and inactivity (if not actual wakefulness and sleep). The timing and control of the wakefulness-sleep cycle depends on one or more biological clocks in our bodies. These clocks are sensitive to light and have evolved over the ages in close approximation to the 24-hour light-dark cycle of our world. Thus, sleep seems to be an unavoidable part of human behavior. In humans, sleep is physiologically programmed to come each day, either in one long bout (about 6 - 8 hours each night) or in two shorter bouts (a 5 - 6 hour sleep at night and a 1 - 2 hour nap in the afternoon). The timing of sleep
and wakefulness is controlled to a great extent by our exposure to
the natural light and dark cycles of the earth. All humans tend to
sleep in the dark and move about in the light. It takes the human
body several days to change to a different light-dark schedule such
as when one flies from New York to New Dehli.
In fact, the influence of light on the timing of sleep is so powerful
that doctors are now using exposure to bright light as a treatment
to reset the sleep clock of people who have somehow disrupted their
schedule. In the extreme,
sleep does seem to be necessary for life. Experimental rats die The figure illustrates this interplay and shows over a period of 48 hours, a two-peak pattern for each day. There is a period with markedly increased sleep tendency in the early morning hours between 3 and 6 AM and a smaller but reliable afternoon peak between 1 and 3 PM. This is the so-called siesta effect or afternoon slump. Both periods of increased sleep tendency can be exaggerated by sleep promoting factors such as alcohol consumption and sleep deprivation. Errors and reduced productivity peak at the times of maximum sleep tendency.
There is no 'normal' amount of sleep. The average amount of sleep for adults is 7 - 8 hours. But the range of nighttime sleep duration must be expanded to between 6 - 9 hours in order to include the large majority of people. Therefore, a few people feel fine with as little as 5 hours of sleep, while others require more than 10 hours to feel refreshed and alert throughout the day. The amount of sleep you need is that optimum amount which allows you to function throughout the day without feeling drowsy when you sit quietly and try to pay attention to something. We cannot, for very long, force ourselves to sleep much less or much more than this optimum amount. Several nights of sleeping an hour less than our usual amount will leave us sleepy and ineffective in the day. Conversely, several nights of staying in bed and trying to sleep an hour more than our optimum amount will leave us sleeping poorly with more awakenings -- particularly in the early morning. Doctors believe
that the optimum amount of sleep each person needs to remain alert
during the day is biologically different from person to person.
Sleep and Aging Many people believe we need less sleep as we get older. This is probably not true. It seems that during infancy and in adolescence there are increases in sleep need, perhaps brought on by developmental changes. However, the best research available indicates that healthy elderly people sleep about as much as they did when they were young adults. The idea that the elderly sleep less probably comes from the fact that elders often have medical conditions that interfere with their sleep. This is why most elderly people are 'light sleepers' at night, yet they frequently dose-off during the day. This type of light sleep and dozing pattern is what sleep researchers would expect if a person is awakened again and again while they try to sleep. In fact, research on repetitive sleep disruption, called 'sleep fragmentation', has shown that the rate of sleep disruptions determines whether or not the sleep is felt to be satisfactorily restorative, and whether or not there is proper alertness the next day. These kinds of studies
show that disruptions every minute will greatly reduce the restorative
value of sleep. However, disruptions every five minutes will affect
restoration much less -- even when total sleep time is the same for
the one-per-minute and five-per-minute rates of disruption. Thus,
scientists believe that for refreshing sleep, it is
not just the total amount of sleep that is important. Sleep must be
continuous as well.
Napping and "Siestas" Certain cultures use the siesta very successfully. However, siesta cultures are relatively consistent in napping. In most western cultures, napping is not consistent day after day. If you want to nap, nap at the same time each day and for the same duration, particularly if you are prone to insomnia. Many people complain about Sunday-night insomnia. What usually happens in these cases is that the person napped on Sunday from, say, 2 to 5 in the afternoon and then could not get to sleep at the usual time Sunday night. That is why keeping a consistent schedule is the best strategy. With respect to occasional napping, one important advantage is that even a 30 - 60 minute nap greatly helps a person counter sleep loss. Studies have shown that the first hour or so of sleep is most potent in relieving the effects of missing a night's sleep. What should I do if I am not sleeping well? Try and identify
the nature of your sleep problem. Is it difficulty sleeping or excessive
sleepiness? There are a number of screening tests that can help you
determine if you have normal sleep or might have a sleep problem.
Take a sleep screening test and see if you fit in to one of the categories
identified. Then you can get more information about that problem and
how to help yourself or how and where to obtain professional help
if needed. Sleep Dos & Don'ts 'Sleep Hygiene' Solutions for Better SleepFrom having occasional difficulty sleeping to insomnia, there is a lot you can do to get a better night's sleep, feel refreshed when you awake, and remain alert throughout the day. It's called "sleep hygiene" and refers to those practices, habits, and environmental factors that are critically important for sound sleep. And most of it is under your control. There are four general areas important to sleep hygiene: · Our circadian rhythm, or 24-hour cycle ·
Aging · Psychological stressors -- those factors can cause difficulty falling asleep and disturb the quality of your sleep ·
Common social or recreational drugs like nicotine, caffeine Circadian Rhythm We all have a day-night cycle of about 24 hours called the circadian rhythm. It greatly influences when we sleep and the quantity and the quality of our sleep. The more stable and consistent our circadian rhythm is, the better our sleep. This cycle may be altered by the timing of various factors, including naps, bedtime, exercise, and especially exposure to light (from traveling across time zones to staring at that laptop in bed at night). Aging Aging also plays a role in sleep and sleep hygiene. After the age of 40 our sleep patterns change, and we have many more nocturnal awakenings than in our younger years. These awakenings not only directly affect the quality of our sleep, but they also interact with any other condition that may cause arousals or awakenings, like the withdrawal syndrome that occurs after drinking alcohol close to bedtime. The more awakenings we have at night, the more likely we will awaken feeling unrefreshed and unrestored. Psychological Stressors Psychological stressors like deadlines, exams, marital conflict, and job crises may prevent us from falling asleep or wake us from sleep throughout the night. It takes time to "turn off" all the noise from the day. No way around it. If you work right up to the time you turn out the lights, or are reviewing all the day's events and planning tomorrow (sound familiar?), you simply cannot just "flip a switch" and drop off to a blissful night's sleep. One must develop some kind of pre-sleep ritual to break the connection between all the stress and bedtime. This is perhaps even more important for children. These rituals can be as short as 10 minutes or as long as an hour. Some find relief in making a list of all the stressors of the day, along with
a plan to deal with them, as it serves to end the day. Combining this
with a period of relaxation, perhaps by reading something light, meditating,
or taking a hot bath Social or Recreational Drugs Social or recreational drugs like caffeine, nicotine, and alcohol may have a larger impact on your sleep than you realize. Caffeine, which can stay in your system as long as 14 hours, increases the number of times you awaken at night and decreases the total amount of sleep time. This may subsequently affect daytime anxiety and performance. The effects of nicotine are similar to those of caffeine, with a difference being that at low doses, nicotine tends to act as a sedative, while at high doses it causes arousals during sleep. Alcohol may initially sedate you, making it easier to fall asleep;
however, as it is metabolized and cleared from your system during
sleep, it causes arousals that can last as long as two
to three hours after it has been eliminated.
These arousals disturb sleep, often causing intense dreaming, sweating,
and headache. Smoking while drinking caffeine and alcohol can interact
to affect your sleep dramatically. These sleep disturbances may be
most apparent upon awakening, feeling unrefreshed, groggy, or hungover.
It is important to realize that not getting the proper amount of and the best quality sleep may have serious short-term and long-term consequences. Many studies have shown that sleep deprivation adversely affects performance and alertness. Reducing sleep by as little as one and a half hours for just one night reduces daytime alertness by about one-third. Excessive daytime sleepiness impairs memory and the ability to think and process information, and carries a substantially increased risk of sustaining an occupational injury. Long-term sleep deprivation from sleep disorders like apnea have recently been implicated in high blood pressure, heart attack, and stroke. All that said, here are some sleep hygiene tips to help you relax, fall asleep, stay asleep, and get better sleep so that you wake up refreshed and alert. 1. Avoid watching TV, eating, and discussing emotional issues in bed. The bed should be used for sleep and sex only. If not, we can associate the bed with other activities and it often becomes difficult to fall asleep. 2. Minimize noise, light, and temperature extremes during sleep with ear plugs, window blinds, or an electric blanket or air conditioner. Even the slightest nighttime noises or luminescent lights can disrupt the quality of your sleep. Try to keep your bedroom at a comfortable temperature -- not too hot (above 75 degrees) or too cold (below 54 degrees). 3. Try not to drink fluids after 8 p.m. This may reduce awakenings due to urination.
4. Avoid naps, but if you do nap, make it no more than about 25 minutes about eight hours after you awake. But if you have problems falling asleep, then no naps for you. 5. Do not expose your self to bright light if you need to get up at night. Use a small night-light instead. 6. Nicotine is a stimulant and should be avoided particularly near bedtime and upon night awakenings. Having a smoke before bed, although it may feel relaxing, is actually putting a stimulant into your bloodstream. 7. Caffeine is also a stimulant and is present in coffee (100-200 mg), soda (50-75 mg), tea (50-75 mg), and various over-the-counter medications. Caffeine should be discontinued at least four to six hours before bedtime. If you consume large amounts of caffeine and you cut your self off too quickly, beware; you may get headaches that could keep you awake. 8. Although alcohol is a depressant and may help you fall asleep, the subsequent metabolism that clears it from your body when you are sleeping causes a withdrawal syndrome. This withdrawal causes awakenings and is often associated with nightmares and sweats. 9. A light snack may be sleep-inducing, but a heavy meal too close to bedtime interferes with sleep. Stay away from protein and stick to carbohydrates or dairy products. Milk contains the amino acid L-tryptophan, which has been shown in research to help people go to sleep. So milk and cookies or crackers (without chocolate) may be useful and taste good as well. 10. Do not exercise vigorously just before bed, if you are the type of person who is aroused by exercise. If this is the case, it may be best to exercise in the morning or afternoon (preferably an aerobic workout, like running or walking). 11. Does your pet sleep with you? Good sleep hygiene can have a tremendous impact upon getting better sleep. You should wake-up feeling refreshed and alert, and you should generally not feel sleepy during the day. If this is not the case, poor sleep hygiene may be the culprit, but it is very important to consider that you may have an unrecognized sleep disorder. Many, many sleep disorders go unrecognized for years, leading to unnecessary suffering, poor quality of life, accidents, and great expense. Since it is clear how critical sound sleep is to your health and well-being, if you are not sleeping well, see your doctor or a sleep specialist. Mattress guidelines for sleep comfort Mattresses
impact sleep quality Mattresses are a personal
choice · There are many causes of back problems, and different back conditions may respond better to specific types of beds, mattresses and sleep positions · There is a high degree of personal preference for mattresses, and what works well for one person may not work well for another · There is very limited scientific study published on mattresses and back pain, and findings from the studies that have been completed are inconclusive · Overall, the causes of back pain can be quite complex, and it’s difficult to isolate whether or not a person’s mattress has played a significant role in improving the pain or making it worse. The bottom line is
that the type of mattress that is best for any particular person is
really a matter of personal preference. Factors in
addition to mattresses that affect sleep comfort · Medication side effects · Irregular sleep patterns · Caffeine/alcohol/tobacco use · Sleep apnea · Anxiety/stress If comfort is not the only thing making sleep difficult, it is advisable for the patient to consult his or her family physician to discuss other possible causes and treatments for sleeplessness. And if anyone experiences significant or persistent back pain, there may be an underlying back condition that has nothing to do with the mattress. It is always advisable for people with back pain to consult with a health care provider for a thorough exam, diagnosis and treatment program. As a final reminder,
sleep comfort is first and foremost a matter of personal preference.
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| 1. Stick to a regular schedule of going to bed and getting up at the same time every day. |
| 2. Be consistent about taking naps. Take one every afternoon or none at all. People who take a nap once in while usually find they do not sleep well that night. |
| 3. Exercise regularly in the morning or early afternoon, but do not engage in strenuous physical activity just before bedtime. |
| 4. Stay away from caffeine-containing drinks after about 4 p.m. |
| 5. Avoid alcohol after the dinner hour. Instead of promoting sleep, a nightcap actually disturbs sleep patterns and can cause early morning awakenings. |
| 6. Be careful about sleeping pills. These medications should not be taken for more than four weeks. Longer use leads to increased insomnia. |
| 7. Find the right room temperature for you and maintain it throughout the night. |
| 8. Try to relax before going to bed. Take a warm bath, read a light novel, listen to music, avoid stressful thoughts. |
| 9. Do not eat heavily just before going to bed. |
| 10. If you cannot sleep at night, do your best to preserve your usual 24-hour cycles of activity-rest and exposure to light and dark. For example, do not get up, turn on bright lights and read or exercise. It is best to remain reclining in the dark and listen to music or an audio book. |
Insomnia is too little or poor-quality sleep caused by one or more of the following:
Insomnia can cause problems during the day, such as excessive sleepiness, fatigue, trouble thinking clearly or staying focused, or feeling depressed or irritable. It is not defined by the number of hours you sleep every night. Although the amount of sleep a person needs varies, most people need between 7 and 8 hours of sleep a night.
What are the different types of insomnia and what causes them?
Insomnia can be:
Chronic insomnia is either primary or secondary:
Do women suffer from insomnia more than men?
Women are twice as likely to suffer from insomnia than men.
Some research suggests that certain social factors, such as being unemployed or divorced, are related to poor sleep and increase the risk of insomnia in women. Also, insomnia tends to increase with age.
Sometimes perimenopausal (the time leading up to menopause) women
have trouble falling asleep and staying asleep; hot
flashes and night sweats often can disturb sleep. Pregnancy
also can affect how well a woman sleeps. 
If you think you have insomnia, talk to your doctor. It might be helpful to complete a sleep diary for a week or two, noting your sleep patterns, your daily routine, and how you feel during the day.
Discuss the results of your sleep diary with your doctor. Your doctor may do a physical exam and take a medical history and sleep history. Your doctor may also want to talk to your bed partner to ask how much and how well you are sleeping. In some cases, you may be referred to a sleep center for special tests.
If insomnia is caused by a short-term
change in the sleep/wake schedule, as with jet lag, your sleep schedule
may return to normal on its own.
Treatment for chronic insomnia includes:
What can I do to sleep better?
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Call the National Women's Health Information Center at 1-800-994-9662 or contact the following organizations:
National Center on Sleep Disorders Research
NHLBI Health Information Center
Phone Number(s): (301) 592-8573
Internet Address: http://www.nhlbi.nih.gov/sleep
American Insomnia Association
Phone Number(s): (708) 492-0930
Internet Address: http://www.americaninsomniaassociation.org/
National Sleep Foundation
Phone Number(s): (202) 347-3471
Internet Address: http://www.sleepfoundation.org/
What is Delayed Sleep Phase Syndrome (DSPS)?
It is a disorder in which the major sleep episode is delayed by 2 or more hours of the desired bedtime. This causes difficulty awakening at the desired time.
What are the symptoms?
Associated features:
The DSPS patients are usuall perplexed that they cannot find a way to fall asleep more quickly. Their efforts to advance the timing of sleep onset such as going to bed early, having a friend or family member get them us in the morning, trying relaxation techniques or using sleeping pills is not permanently successful.
They often describe sleeping pills in normal doses as having little or no effect in helping them fall asleep. Sometimes the pills only aggravate the daytime symptoms of difficulty awakening and sleepiness.
DSPS patients typically are "owls" or "night people" and say they feel and function best and are more alert during the late evening and night hours.
If a sleep-wake log is kept, it usually shows a pattern of bedtime later than 2 a.m., few or no awakenings once they fall asleep, shorter sleep periods during the work/school week and lengthy (9-12 hour) sleeps with late morning to mid-afternoon wake up times on the weekend.
Depression or other psychiatric problems are present in about half of the adult DSPS patients, which is about the same for people that suffer from other forms of insomnia.
At what age does DSPS begin to show up?
Many DSPS patients report that their difficulties began after a period of late night studying or partying, or after employment on the evening or night shift. Following these activities, they found it impossible to sleep on a normal schedule even when they resumed normal work or school hours. Adolescence appears to be the most common period of life for the onset of DSPS, but childhood cases have been reported. It is rare for it to begin after age 30.
caused
some subjects to behave strangely. The notion that we need REM sleep
for our mental health is not accepted now, because, among other reasons,
people have uneventfully withstood long and almost complete REM deprivation.
if they are completely deprived of sleep for longer than 1 - 4 weeks.
However, do not worry. The experimental deprivation was done by means
of special computers and alarm systems -- it is not possible for even
the poorest of human sleepers to lose so much sleep that life is threatened.
To
a great degree, our optimum sleep need is determined by heredity.
Scientists have found, for instance, that strains of mice can be selectively
bred to sleep considerably more or considerably less than the average
mouse.
can also help you get better sleep. And don't look at that clock!
That tick-tock will tick you off. 
This,
too, may cause arousals from either allergies or their movements in
the bed. Thus, Fido and Kitty may be better off on the floor than
on your sheets. 
That
being said, there are a number of useful guidelines when selecting
a mattress or bed - as well as suggestions for sleep positions - that
are discussed in this article. These guidelines can be especially
important to help people with back conditions sleep more comfortably.
No
one should expect that switching mattresses or beds will cure their
lower back pain, and changes in the type of bed or mattress used should
be made solely for the sake of comfort when choosing Mattresses for
back conditions
to help keep stress off the hips and lower spine. 
and
on the type of back pain one has. 
Patients
who have inflammation of the bursa over their hips (greater 
Also,
large spurts of growth hormone are secreted during stages 3 and 4
NREM sleep. Consequently, these stages of sleep are thought to restore
the body from the wear and tear of waking activity. People in REM
sleep also tend to be quite difficult to awaken, but this finding
is variable -- sometimes even the slightest noise can awaken a person
in REM sleep. Nevertheless, because it is often difficult to awaken
a person from REM sleep, many doctors think also of REM sleep as a
'deep' phase of sleep.
Conversely,
several nights of staying in bed and trying to sleep an hour more
than our optimum amount will leave us sleeping poorly with more awakenings
-- particularly in the early morning. 
However, disruptions every five minutes will affect restoration much
less -- even when total sleep time is the same for the one-per-minute
and five-per-minute rates of disruption. Thus, scientists believe
that for refreshing sleep, it is not just the total amount of sleep
that is important. Sleep must be continuous as well.
can occur during other phases of sleep besides REM sleep. Second,
REM sleep cannot really be considered our 'deepest sleep'. 
