Disorders

What is Sleep?

Sleep is a mental and physical state of rest, during which time the person is usually inactive. There is a relative lack of awareness of environment and, to a certain degree, the person is unaware of stimuli. Sleep is usually accompanied by a decrease in body temperature, blood pressure, respiration rate, and most bodily functions. However, one’s brain remains active during sleep. In fact, tasks such as storing of short-term memory material into long-term memory and replenishment of neurochemicals occur during sleep.

Structure of Normal Sleep

There are two distinct types of sleep: 1) Rapid Eye Movement (REM) sleep (also known as dreaming sleep), and 2) Non-REM (NREM) sleep. Sleep is composed of 5 stages. Stages I-IV are known as NREM sleep (with stages III & IV being deep sleep). Stage V is REM sleep. Humans generally alternate between REM and NREM in 90-110 minute cycles.

The process is as follows: once asleep, we move into stage I, then cycle through stages II – IV in roughly 30-40 minutes; we cycle back briefly through stage III and II, then REM. This process normally occurs 4-5 times per night.

Why Do We Sleep?

The two main reasons for sleeping are:

  • Restoration – rejuvenates, refreshes; allows brain to perform certain tasks (e.g., memory), allows certain physiological processes to take place (e.g., replenishment of biochemicals)
  • Functioning – amount and quality of sleep directly impacts how functional a person is during the day

Sleep is a necessary biological function, and deprivation can have many negative effects, such as: irritability, decreased short-term memory, decreased attention/concentration, mood swings, decrease in immune system function, and ultimately…death. It is estimated that approximately 50% of Americans are sleep deprived. This often results in accidents, and has resulted in the development of legislation against sleepy driving in some states.

When Do We Sleep?

Humans respond to circadian rhythms, or a “biological clock.” Certain structures in the brain (the superchiasmatic nucleus) are responsible for coordinating the biological clock. These brain structures are sensitive to light and dark. Some have argued that this results in daytime sleep being less restful than night sleep. Daylight normally triggers periods of wakefulness. As humans, we experience “sleepy peaks” which occur every 12 hours – at night and in the afternoon.

How Much Sleep Does One Need?

It is generally agreed that the average adult needs 6-8 hours. Some have argued that certain people need only a few hours of sleep per night, while other people may need as many as ten hours of sleep per night. If one is sleep deprived, a cumulative effect has been noted to occur over time, known as a “sleep debt.” This sleep debt must eventually be “repaid” in full, at which time a person feels rested.

Most experts agree with the table below that shows the average amounts of sleep needed based on a persons age.

Nevertheless, your specific sleep needs can be better determined through our Sleep assessment program.

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Symptoms of anxiety can be a sign of a psychological disorder (such as an anxiety disorder), or can occur in some cases due to medical problems or medications. Sleep is highly associated with symptoms of anxiety. Any disruption in the sleep pattern negatively impacts the brain’s ability to replenish certain types of neurochemicals (such as serotonin) during deep sleep. These neurochemicals are largely responsible for regulating mood/anxiety symptoms and cognitive function (related to such things as memory, focus, concentration). As such, the neurochemical deficiency that results from sleep disruption often results in anxiety symptoms. Anxiety is often a causal factor for insomnia, thus creating an endless cycle of sleep problems and anxiety.

Bedwetting, also known as enuresis, can occur as a primary disorder or as part of another disorder. Primary bedwetting occurs most frequently in children, and may be due to a lack of development of the brain’s “alarming” system that wakes us prior to urinating at night. This problem can be fixed using medication or various types of alarming devices. Secondary bedwetting can occur as part of a medical problem or another sleep disorder. Bedwetting can be strongly associated with obstructive sleep apnea (OSA) in both children and adults.

Jerking of the body (often times the whole body) can occur as we initiate sleep. These movements, known as hypnogogic jerks, often involve a sensation of falling as we transition from wake to sleep. They are a normal phenomenon occurring in most humans. They can sometimes interfere with one’s ability to get to sleep. Body jerks can also occur during sleep as part of another sleep disorder, such as obstructive sleep apnea (OSA), periodic limb movements (PLM’s), parasomnias (such as sleepwalking, night terrors), and others.

Like excessive daytime sleepiness (EDS), daytime fatigue can be caused by a long list of sleep problems, medical problems, medications, and behavioral issues. Daytime fatigue is often characterized by a generalized lack of energy, feeling “tired” or “drained”, or lethargy during the day. Daytime fatigue often interferes with one’s ability to function well. Those with daytime fatigue do not usually report fighting sleep or dozing during the day. One of the most common sleep disorders that causes daytime fatigue is obstructive sleep apnea (OSA). Other sleep-related problems that may contribute to daytime fatigue include periodic limb movements (PLM’s), parasomnias (such as sleepwalking, night terrors), insomnia, circadian rhythm disorders (such as jet lag, delayed sleep phase syndrome), and behaviorally induced insufficient sleep syndrome

Symptoms of anxiety can be a sign of a psychological disorder (such as an anxiety disorder), or can occur in some cases due to medical problems or medications. Sleep is highly associated with symptoms of anxiety. Any disruption in the sleep pattern negatively impacts the brain’s ability to replenish certain types of neurochemicals (such as serotonin) during deep sleep. These neurochemicals are largely responsible for regulating mood/anxiety symptoms and cognitive function (related to such things as memory, focus, concentration). As such, the neurochemical deficiency that results from sleep disruption often results in anxiety symptoms. Anxiety is often a causal factor for insomnia, thus creating an endless cycle of sleep problems and anxiety.

Patients with trouble getting to sleep, staying asleep, or both may be suffering from insomnia. Insomnia is best treated using cognitive behavioral treatment (CBT) techniques. Medications may also be appropriate to treat insomnia in some cases. Before deciding on treatment for insomnia, it is important to discuss the problems with difficulty sleeping with a sleep doctor to rule out other sleep disorders (such as circadian rhythm disorders, OSA, RLS/PLM’s), medical problems, or medication issues.

Waking from sleep with a dry mouth or a dry throat is frequently reported by patients with untreated obstructive sleep apnea (OSA). The symptom of dry mouth occurs because patients with OSA are usually “mouth breathers” during sleep.

Difficulty achieving or sustaining penile erections can occur as part of obstructive sleep apnea (OSA). Patients with untreated OSA experience repeated drops in the oxygen level (hypoxemia) during sleep, and research suggests that this phenomenon negatively impacts erectile functioning. Moreover, some of the medications frequently used to treat problems with erectile functioning work by relaxing certain types of muscles in the body. One muscle group that may relax in response to these types of medications is located around the upper airway (or throat) area. The relaxation of the muscles around the upper airway can increase the upper airway’s propensity to collapse, causing an obstruction (or apnea) in the airway. As such, OSA may in some cases be worsened by the medications used to treat erectile dysfunction.

Those who suffer from excessive daytime sleepiness (EDS) often find it difficult to get through the day without fighting sleep or dozing. EDS is measured subjectively by way of screening tests (such as the Epworth Sleepiness Scale) and can be measured objectively by way of sleep laboratory testing. One such laboratory test is a Multiple Sleep Latency Test (MSLT), during which a patient undergoes an overnight sleep study followed by a series of nap trials the following day. EDS can be the result of a host of different problems related to sleep, medical conditions, medications, or behavioral issues. One of the most common sleep disorders that causes EDS is obstructive sleep apnea (OSA). Other sleep-related problems that may contribute to EDS include periodic limb movements (PLM’s), parasomnias (such as sleepwalking, night terrors), insomnia, circadian rhythm disorders (such as jet lag, delayed sleep phase syndrome), and behaviorally induced insufficient sleep syndrome. If a patient suffers from significant EDS despite all of the above listed types of sleep problems being ruled out, a diagnosis of narcolepsy or idiopathic hypersomnia may be made.

Urinating frequently at night, also known as nocturia, is highly associated with obstructive sleep apnea (OSA). Untreated OSA often results in increased production of atrial natriuretic peptide (ANP), which is one of our body’s natural diuretics – a hormone that works to remove fluid from the body. The end result is frequent urination during nighttime hours while OSA is occurring. Frequent nighttime urination can also be the result of certain medical problems, such as prostate problems in men.

Waking from sleep with gasping or shortness of breath is often a sign of obstructive sleep apnea (OSA). This sensation, also reported as a feeling of “choking”, occurs when the muscles around the upper airway (or throat area) relax and collapse during sleep. The end result is a sensation of gasping or shortness of breath, often associated with a drop in the body’s oxygen level.

Gastroesophageal reflux can have many different causes, including certain types of bacteria, hernia, or diet. Gastroesophageal reflux can also occur secondary to untreated obstructive sleep apnea (OSA). In patients with OSA a negative pressure or “vacuum effect” is created in the thorax during apneic events, and the acid from the stomach is drawn up the esophagus to the back of the throat. Over time, exposure of the esophagus to stomach acid causes erosion of the esophageal lining, and the end result is gastroesophageal reflux. This reflux occurs most often at night, and can result in waking with a sore throat, bad taste in the mouth upon waking, or a choking/gagging sensation.

Patients with sleep problems will sometimes report a feeling of heart arrhythmias during sleep. They will frequently describe waking from sleep with a “racing heart”, or feeling that their heart is “skipping beats”. This could be a sign of a cardiac problem, or this could occur as part of a sleep disorder. The sleep disorder most commonly associated with heart arrhythmias is obstructive sleep apnea (OSA).

Problems with elevated blood sugar can have many different causes, one of which is untreated obstructive sleep apnea (OSA). As part of OSA, our oxygen level is compromised at night. Our brain senses the drops in oxygen and releases a “stimulating” neurotransmitter (norepinephrine) into our bloodstream. The release of this neurotransmitter helps to arouse us from sleep to take a breath and raise our oxygen level back to normal. However, norepinephrine is counterregulatory to insulin, and the end result of these repeated releases of norepinephrine into the bloodstream is elevation in blood sugar – particularly hemoglobin A1c. The elevation in hemoglobin A1c is often discovered as part of routine bloodwork, and patients will often get diagnosed as “insulin resistant” or “borderline diabetic” based in this finding. For patients with untreated OSA who have been diagnosed with diabetes, the elevations in hemoglobin A1c can result in poor diabetic control.

Leg Movements at Bedtime

Patients who experience an urge to move the legs at bedtime sometimes get diagnosed with restless legs syndrome (RLS). This disorder can be caused by multiple medical problems, issues related to our body’s iron stores, or medications. The urge to move the legs may also occur when at rest during the afternoon or evening hours. It should be noted that some patients move their legs at bedtime as part of a “self-soothing” technique to help them fall asleep, which is normal.

 

Leg Movements During sleep

Leg movements or leg “jerks” during sleep may be a sign of periodic limb movements (PLM’s). These limb movements during sleep are usually in the legs, and can also occur during wake. PLM’s are often associated with restless legs syndrome (RLS), and are frequently seen as part of a sleep study. PLM’s can be caused by multiple medical problems, issues related to our body’s iron stores, or medications.

Memory loss can be a sign of a serious neurological problem, a psychological disorder (such as a mood disorder), or can occur in some cases due to medical problems or medications. Problems with memory also can occur secondary to sleep disorders. Any disruption in the sleep pattern negatively impacts the brain’s ability to replenish certain types of neurochemicals (such as serotonin) during deep sleep. These neurochemicals are largely responsible for various different processes, including cognitive function. Cognitive function is related to factors such as our ability to store things into memory, and our ability to plan, focus, and concentrate. As such, the neurochemical deficiency that results from sleep disruption often results in memory problems (amongst other things) – a common complaint in those suffering from untreated sleep disorders. There is hope, however, in that those who suffer from memory problems as part of their sleep disorder often report a substantial improvement in memory, once their sleep disorder is treated.

Problems with nasal congestion can have many different causes, ranging from allergies to non-allergic rhinitis. Nasal congestion can worsen obstructive sleep apnea (OSA), in that patients suffering from problems breathing through the nose often resort to “mouth breathing” during sleep. This type of breathing increases the propensity of the base of the tongue to collapse over the upper airway (or throat) area, thus causing an obstruction (or apnea) in the airway. Problems with nasal congestion can also result from the use of positive airway pressure (PAP) therapy for OSA. Addressing the issues with nasal congestion can improve a patient’s response to PAP therapy, and in some rare cases can improve OSA.

Acute (short term) or chronic (long term) pain makes life difficult. Those suffering from pain issues often have many medical problems, are on medications, and are at risk for developing depression and/or anxiety due to their day to day struggles with pain. But did you know pain can be directly related to sleep? Research has shown that there is a bi-directional relationship between pain and sleep. First, pain can disrupt sleep, causing problems getting to steep or staying asleep. And since the brain is active during sleep replenishing certain types of neurochemicals and hormones that aid the body in healing itself, poor sleep can result in making pain issues much worse. Of course, it is important to be closely followed by a pain specialist to optimally address issues with pain. It is also important to note, however, that a sleep specialist may be able to improve the quality of sleep, thus ending the negative cycle occurring between pain and poor quality sleep.

Snoring is a noise produced from a collapse in the upper airway (usually the throat area) during sleep. It is the result of the muscles around the upper airway relaxing as we drift off to sleep, and the tissue around the airway vibrating to produce a snoring sound. Snoring (in particular, loud snoring) is usually a sign of obstructive sleep apnea. Snoring is more common in men, but occurs in both men and women. Snoring often worsens with age, and increases with weight gain.

Waking from sleep with a sore throat is frequently reported by patients with untreated snoring or obstructive sleep apnea (OSA). The sore throat occurs due to the continuous vibration of the tissue in the upper airway (mostly the throat area) during sleep that occurs as part of snoring or OSA. The continuous vibration of this upper airway tissue results in inflammation of this tissue, which is usually reported to be worse just after waking.

Many different problems can contribute to or cause tossing and tuning during sleep, including pain issues, environmental problems, or medications. Sleep disorders such as obstructive steep apnea (OSA), periodic limb movements (PLM’s), parasomnias (such as sleepwalking, night terrors), or insomnia also may contribute to this problem. Patients who toss and turn frequently during sleep often report feeling fatigued or sleepy during the day, and they often disrupt their bed partner’s sleep.