1/17 Managing sleep disorders
Introduction to Managing Sleep Disorders
There are many things you can say about sleep. It is one of the most vital things needed for a healthy lifestyle. It keeps our nervous system functioning. It is a conversation starter (“How was your sleep?”). It should be a natural transition that our bodies will go through every day. But roughly 50 – 70 million US adults have a sleep disorder of some type. (Sleep and Sleep Disorder Statistics, 2021) In our lesson this week, we will look at sleep and sleep disorders. We will discuss the types of sleep disorders keeping us awake, and what experts say can assist in better quality sleep.
What is sleep?
(What is Sleep, 2018)
Sleep is identified by common characteristics. It includes:
· A period of reduced activity
· A type of posture such as lying down
· A decreased responsiveness to external stimuli
· It is relatively easy to reverse (as compared to hibernation and coma)
Certain physiological changes occur during sleep. They include:
Change in neuron firing: There is a progressive decrease in the activation of most neurons as sleep progresses into non-REM sleep. In addition, although these neurons fire randomly during wakefulness, they are firing at a more coordinated and synchronous pattern in non-REM sleep. In REM stages of sleep (as we are dreaming), there is an increase in the firing of most neurons. In fact, the brain in REM sleep can be more active than when we are awake. This may account for the vivid dreaming in REM sleep.
Changes in body temperature: Just before we fall asleep, our bodies begin to lose some heat to the environment (perhaps to induce sleep). Our set temperature is reduced 1 to 2 degrees F, which requires less energy. Body temperature drops to the lowest during REM sleep.
Respiratory changes: Our breathing patterns change during sleep. The breathing rate decreases slightly and becomes more regular. However, REM sleep will increase the breathing rate, and the pattern will again be more variable.
Cardiovascular activities: During non-REM sleep, there is an overall reduction in blood pressure. However, in REM sleep, there is a more pronounced variation in cardiovascular activity with increases in blood pressure and heart rate.
Increased physiological activity during sleep: Many physiological activities are reduced during sleep. However, one of the greatest changes induced by sleep is an increase in the release of growth hormone. Physiological activities associated with digestion, cell repair and growth are often greatest in sleep, suggesting that cell repair and growth are an important function.
Patterns of sleep
(Natural Patterns of sleep, 2018)
The two main types of sleep are rapid-eye-movement (REM) sleep and non-rapid-eye-movement (NREM) sleep. REM sleep is identified by low-amplitude (small), high-frequency (fast) brain waves and alpha rhythm, as well as the eye movements associated with REM sleep. It is thought that dreaming occurs in REM sleep.
NREM sleep has three stages, N1, N2 and N3. In progressing from N1 to N3, brain waves become slower and more synchronized, and the eyes remain still. In stage N3, the deepest stage of NREM, brain waves are high-amplitude (large), low frequency (slow) waves. It is also known as “deep” or “slow-wave” sleep.
Sleep patterns can be affected by many factors, including age, the amount of sleep or wakefulness, the time of day or night, and other behaviors prior to sleep.
Introduction to sleep disorders
(Pacheco, 2020) (Sleep Disorders, 2020) (Roddick, 2020)
Signs and causes of sleep disorders
The term, sleep disorder, refers to conditions that affect sleep quality, timing or duration. They usually also impact a person’s ability to function well while awake. More than 100 specific sleep disorders have been identified. However, most can be characterized by one or more of the following four signs:
· You have difficulty falling or remaining asleep
· You have difficulty staying awake during the day
· There are imbalances in your circadian rhythm that interfere with a healthy sleep schedule
· You are prone to unusual behaviors that disrupt your sleep.
There are some factors that can contribute to sleep problems. They include:
· Caffeine and alcohol
· An irregular schedule (such as working a night shift)
· Aging: As we age, we often get less sleep or less time in the deep and restful stages of sleep.
There may also be conditions, diseases and disorders that can cause sleep disturbances. In many cases, they develop as a result of an underlying health problem. Some examples of conditions or diseases which may cause sleep disturbances include:
· Allergies (making it difficult to breathe at night)
· Frequent urination (nocturia)
· Chronic pain
· Stress and anxiety
How do you know that you have a sleep disorder? (Sleep Disorders, 2020)
Depending on the sleep disorder, you may experience some signs. They include:
More than 30 minutes to fall asleep each night
Waking frequently and having trouble getting back to sleep
Feeling sleepy during the day, frequent naps, or falling asleep at the wrong time
Snoring loudly, snorting, gasping, making choking sounds or stopping breathing for short periods (your sleep partner will have to fill you in)
Creeping, tingling or crawling feelings in your legs and arms relieved by moving or massaging them
Vivid dreamlike experiences while falling asleep or dozing
Episodes of sudden muscle weakness when you are angry or fearful or when you laugh
Feeling like you cannot move when you first wake up
Factors affecting sleep duration and quality
Symptoms of a sleep disorder
Examples of sleep disorders
(Sleep and Sleep disorders, 2020) (Roddick, 2020) (Common Sleep Disorders, 2019) (Sunni, 2020)
As we said earlier, there are over 100 different types of sleep disorders. Here are some of the major sleep disorders. If you or someone you know is experiencing a sleep disorder, it would be important to visit your healthcare provider or a provider specializing in sleep medicine.
· Insomnia: Inability to initiate or maintain sleep. Can also be seen when you wake up early in the morning and are not able to get back to sleep. Chronic psychophysiological insomnia (“learned” or “conditioned” insomnia) may also result from the fear of being able to sleep.
· Narcolepsy: “Sleep attacks” that occur when awake, causing you to suddenly feel tired and fall asleep without warning. It can also cause sleep paralysis, making you physically unable to move right after waking up. Excessive daytime sleepiness combined with sudden muscle weakness are signs of narcolepsy.
· Sleep Apnea: Sleep apnea is characterized by pauses in breathing during sleep. If you frequently snore or gasp during sleep, you may have sleep apnea. There are two types of sleep apnea: obstructive sleep apnea (airway space is obstructed or too narrow) or central sleep apnea (a problem in the connection between your brain and the muscles that control your breath).
· Parasomnias: Sleep disorders that cause abnormal movements and behaviors during sleep. They include sleepwalking, sleep talking, groaning, nightmares, bedwetting or teeth grinding.
· Restless leg syndrome (RLS): An overwhelming desire to move the legs. It may be accompanied by a tingling sensation in the legs. It may be associated with health conditions such as ADHD and Parkinson’s.
· Sleep-related hypoventilation disorders: Involves elevated blood levels of carbon dioxide during sleep resulting from a lack of air moving in and out of the lungs. It is commonly tied to other health problems such as chronic obstructive pulmonary disease (COPD) or pulmonary hypertension. There is also obesity hypoventilation syndrome (OHS), occurring in obese patients with obstructive sleep apnea.
· Snoring: Snoring occurs when air moves around the floppy tissue near the back of the throat and causes the tissue to vibrate. Light snoring once in a while is normal, but if it is more than three nights a week, it is considered a sleep-related breathing disorder. The main health concern is the possibility of sleep apnea, which you should talk with your doctor about.
· Catathrenia: A pattern of abnormal breathing and vocalization often referred to as sleep-related groaning. The sleeper takes a long inhaled breath and then exhales slowing while making a monotone, groan-like sound. The sleeper is unaware of the vocalizations. It is uncommon, and does not pose any known health risks to the sleeper.
Video:
Learn more about the main types of sleep disorders
Video:
Enjoy this animated discussion of 6 strange sleep disorders
Sleep Disorders and COVID-19
(Bhat, 2021)
If you have been having trouble sleeping since COVID began, you are not alone. Factors such as the fear and anxiety of potential infection, lockdowns and quarantine procedures have caused a great deal of sleep dysfunction in the general population as well as among healthcare workers. There is also concern about sleep dysfunction in patients diagnosed with COVID in both the acute and chronic phases of the illness. A recent chapter in Sleep Medicine describes what is known on COVID and sleep disorders.
Sleep disorders seen during COVID include:
· Insomnia (acute and persistent)
· Effect of COVID on obstructive sleep apnea
· Circadian rhythm abnormalities
· Excessive daytime sleepiness related to sleep-wake impairment
· Post-traumatic-like sleep dysfunction
· Abnormal dreams
· Transient restless legs syndrome related to insomnia
Part of the challenge of treating sleep disorders during COVID is the difficulty of taking part in a sleep laboratory. Test used to diagnose sleep disorders require intimate physical contact and less social distancing. Many sleep laboratories have closed because of the pandemic. There has been a trend towards home ambulatory sleep testing (HSAT), also known as out-of-center sleep testing (OCST). However, there was concerns about the disinfection process for HSAT devices.
Effects of COVID and Rheumatoid Arthritis patients and sleep
Diagnosing and treating sleep problems
(Roddick, 2020)
When visiting your doctor about sleep disturbances, they will first perform a physical exam and ask you about your symptoms and medical history. You may also be asked to take tests such as:
· Polysomnography (PSG): A lab sleep study evaluating oxygen levels, body movements and brain waves
· Electroencephalogram (EEG): Assesses electrical activity in the brain
· Multiple sleep latency test (MSLT): A daytime napping study used to diagnose narcolepsy
Treatment for sleep disorders can vary on the type and cause of the disorder. Generally, it includes medical treatments and lifestyle changes.
Medical treatments: Medical treatments may include sleeping pills or melatonin supplements, allergy medication, medication for other health issues, a breathing device or surgery (for sleep apnea) or a dental guard (for teeth grinding.
Lifestyle changes: You can consider making small changes in your lifestyle which may help your disorder. These include increasing vegetables and fish in your diet and reducing sugar, reducing stress by exercising and stretching, creating and sticking to a regular sleeping schedule, drinking less water before bedtime, limiting caffeine especially in the late afternoon or evening, decreasing tobacco and alcohol use, eater smaller, low carbohydrate meals before bedtime and maintaining a healthy weight. It also helps to go to bed and wake up at the same time each day.
Video
Do you use a CPAP machine? Learn more in this short video
Video:
A comparison between 3 types: CPAP, APAP and BiPAP. Great explanation of the various devices designed for different conditions.
Sleep in the brain
(Brain Basics: Understanding Sleep, 2015)
What would our brain fitness class be without discussing the role of the brain in sleep? There are several structures within the brain involved with sleep. They include:
· Hypothalamus: Affects sleep and arousal. Within the hypothalamus is the suprachiasmatic nucleus (SCN) cells which receive information about light exposure from your eyes and control your behavioral rhythm.
· Brain stem: Communicates with the hypothalamus to control transitions between wake and sleep. Sleep-promoting cells within the hypothalamus and brain stem produce a brain chemical known as GABA which reduces the activity of arousal centers in the hypothalamus and brain stem. The brain stem also sends signals to relax muscles essential for body posture and limb movements while you are in REM sleep.
· Thalamus: Acts as a relay of information from the senses to the cerebral cortex (interprets and processes information from short to long term memory). During most stages of sleep, the thalamus is quiet. But during REM, it is active, sending the cortex images, sounds and other sensations which fill our dreams.
· Pineal gland: Located between the brain’s hemispheres, this gland receives signals from the SCN and increases production of melatonin, which helps put you to sleep. Scientists believe that the peaks and valleys of melatonin over time and important for matching the body’s circadian rhythm.
· Basal forebrain: Promotes sleep and wakefulness, while the midbrain acts as an arousal system. Release of adenosine (a by-product of cellular energy consumption) supports sleep. Caffeine counteracts sleepiness by blocking the actions of adenosine
· Amygdala: The structure for processing emotions, which becomes increasingly active during REM sleep.
Video:
Your brain on sleep. Wonderful short video which describes what is happening in your brain during sleep.
Tips for a good night’s sleep
(Brain Basics: Understanding Sleep, 2015) (Sleep and Sleep disorders, 2020) (Sleep disorders: In Depth, 2020)
Barring any medical interventions (medication, CPAPs, dental guards), there are things that you can do to help you sleep better. These include:
A set schedule for sleep and waking up
Exercise 20 to 30 minutes a day, but no later than a few hours before going to bed
Include a healthy diet with lots of vegetables and fish
Avoid caffeine and nicotine late in the day, and alcohol before bed
Relax before bed (try a warm bath, reading or another relaxing routine)
Create a restful room (avoid bright lights and loud sounds, a comfortable temperature and no technology in the bedroom)
If you can’t get to sleep, do something instead of lying there. Listen to music or read until you feel tired.
Cognitive behavioral therapy or relaxation techniques
CPAP (continuous positive airway pressure) machine if prescribed by your doctor
Bright light therapy in the morning
Medicines like sleeping pills (not recommended for long term use)
Natural products like melatonin (also not recommended for long term use).
If you have osteoarthritis, yoga might be helpful.
Some treatments have shown little or no benefit, and some may be harmful. They include:
Hypnotherapy may be helpful during cognitive-behavioral therapy, but little research has been done.
Massage may help in postmenopausal women, but research is limited
Acupuncture has not confirmed whether it may help with insomnia.
There is no conclusive evidence on the use of chamomile tea.
There is also no consistent results from the use of valerian, a herb with sedative properties. It is also not known if it is safe for long term use.
Dietary supplements (“sleep formulas”) with herbs such as hops, lemon balm, passionflower and kava has not been shown to improve sleep.
Avoid kava products (linked to severe liver damage) and L-tryptophan supplements (which may be associated with a serious disorder called eosinophilia-myalgia syndrome).
Aromatherapy (the use of essential oils from plants) may be helpful, but there has not been any rigorous research on this.
Homeopathic medicines have not been shown to demonstrate significant effects.
See your doctor if you continue to have problems, or if you are unusually tired during the day.
Summary
Sleep is as important to your physical and mental health as food and water. It is necessary for bodily functions, to restore energy, to repair muscle tissue and to allow the brain to process new information. Sleep disorders can be frustrating but can also be dangerous to your body and your brain. If you are having trouble sleeping, consider the tips offered in the lesson. If you suspect that you have a sleep disorder, visit your healthcare provider to see if you can get some relief.
Works Cited
Bhat, S. a. (2021, July 18). Sleep disorders and COVID-19. Retrieved from ncbi.nlm.nih.gov: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8286239/
Brain Basics: Understanding Sleep. (2015, March). Retrieved from ninds.nih.gov: https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Understanding-Sleep
Commoon Sleep Disorders. (2019, January). Retrieved from my.clevelnadclinic.org: https://my.clevelandclinic.org/health/articles/11429-common-sleep-disorders
Natural Patterns of sleep. (2018, November). Retrieved from healthysleep.med.harvard.edu: http://healthysleep.med.harvard.edu/healthy/science/what/sleep-patterns-rem-nrem
Pacheco, D. (2020, December 1). Sleep Disorders. Retrieved from sleepfoundation.org: https://www.sleepfoundation.org/sleep-disorders
Roddick, J. a. (2020, July 28). Sleep Disorders. Retrieved from healthline.com: https://www.healthline.com/health/sleep/disorders
Sleep and Sleep Disorder Statistics. (2021, December). Retrieved from sleepassociation.org: https://www.sleepassociation.org/about-sleep/sleep-statistics/
Sleep and Sleep disorders. (2020, December). Retrieved from cdc.gov: https://www.cdc.gov/sleep/about_sleep/key_disorders.html
Sleep Disorders. (2020, November). Retrieved from medlineplus.gov: https://medlineplus.gov/sleepdisorders.html
Sleep disorders: In Depth. (2020, May). Retrieved from nccih.nih.gov: https://www.nccih.nih.gov/health/sleep-disorders-in-depth
Sunni, E. (2020, September 11). Sleep-Related Breathing Disorders. Retrieved from sleepfoundation.org: https://www.sleepfoundation.org/sleep-related-breathing-disorders
What is Sleep. (2018, February). Retrieved from healthysleep.med.harvard.edu: http://healthysleep.med.harvard.edu/healthy/science/what