Sleep is nature’s restoration period and significantly affects your overall physical and mental health. While you sleep your body restores your immune system, your nervous system, and even your muscular and skeletal systems. Certain hormones and brain-related proteins also restore while you sleep. So if you don’t sleep well or enough (or both), your body doesn’t get the time it needs to rejuvenate itself, and it slowly lags behind in its optimal ability to function—over the long haul, you function less than optimally with many systems affected. Studies have shown that lack of sleep can lead to immune dysfunction and disrupted hormone regulation. Sleep deprivation is a form of stress on your body; you’re not regulating the hormones that can lead to long-term problems with chronic stress.
If you sleep well you wake up refreshed and energized. If you don’t sleep enough, sleep too long or the quality of your sleep is compromised, you wake up grumpy, sluggish and unproductive which affects your health, relationships and your work. Prolonged poor sleep has been linked to diabetes, obesity, heart disease, premature aging and anxiety disorders.
Understanding the stages of sleep
There are two types of sleep; rapid eye movement (REM) and non rapid eye movement (NREM). NREM comprises four stages and accounts for about 80 percent of sleep. As you sleep, you enter into sleep cycles that contain both REM and NREM sleep. For the first 75 to 80 minutes, you’re in NREM, and then you reach REM for about 15 to 20 minutes before the cycle starts over. The average person goes through four to six cycles per night. These cycles usually last around 90 minutes but can last up to 100 minutes and are important in figuring out the amount of sleep that you need. If you sleep well and don’t use an alarm clock, you’re likely to find that you wake up at times that are multiples of the 90-minute sleep cycle. For example, you may wake up after 4 ½, 6 or 7 ½ hours.
Many sleep experts direct you to figure your sleep needs in 90 minute increments. You want to complete each 90-minute cycle, because the slightest alteration of these sleep stages is enough to make you feel sleep deprived.
NREM sleep is known as the dreamless sleep. Your body is actually accomplishing some important tasks during NREM, although they may not seem very exciting. NREM puts you in relaxation mode; your pulse and blood pressure drop, and you have minimal eye movement during this stage. The body does its repair work during NREM, which is subdivided into four stages:
- Stage one: This stage usually lasts less than 10 minutes. Stage one is your body’s introduction to sleep—your breathing, brain waves and muscles slow down—your blood pressure falls. In this stage, you may experience muscle contractions (hypnotic jerks_) that suddenly jolt you out of sleep. These muscle contractions sometimes make you feel like you’re about to fall or trip. They’re weird but perfectly normal and usually occur as you transition from being awake to going to sleep.
Your eyes are closed during stage one sleep, but if someone wakes you up, you often feel as though you haven’t slept at all. People who suffer from insomnia spend more time in this first stage of sleep.
- Stage two: In this stage, your brain waves slow down even more, but they’re occasionally interrupted by a cluster of fast-moving waves. Your eye movements, which were slowing down in stage one, stop altogether. You spend about 40 minutes of your sleep cycle in stage two sleep. If someone wakes you up while you’re in stage two sleep, you may not be particularly happy about it, but you won’t be the walking dead either. When you take the occasional short nap, you enter stage two sleep. You awake refreshed but you couldn’t survive on naps alone.
- Stages three and four: These two stages are characterized by the appearance of very slow brain waves (delta waves). Delta wave sleep is the deepest sleep you achieve through the sleep cycle. The main difference between stages three and four is the amount of delta waves that occur. Stage three usually contains less than 50 percent of the sleep waves as delta waves while stage 4 has more than 50 percent of its waves as slow delta waves. Delta waves are mixed with faster waves in an up-and-down pattern. In these stages, it can sometimes take a very loud noise to wake you up.
When you finally reach stages three and four, your body does a lot of its repair work—the longer you stay in these stages, the more refreshed you feel in the morning. During this time, hormone levels and brain chemicals are restored. If someone wakes you up while you’re in this stage, you’re groggy and disoriented for quite some time. This is also the deep sleep when children wet the bed and sleep walk.
You stay in deep sleep for about 20 minutes of each of your sleep cycles and then you move on to the most interesting part of the night—the dream stage.
The random dreaming phase: REM
The last sleep stage is REM sleep, which accounts for about 20 percent of sleep time and about 20 minutes of each sleep cycle. Throughout this stretch of sleep, dreaming occurs, your breathing quickens, your heart rate increases, your blood pressure rises, your eyes move just as if you were watching a movie, men develop erections and your temperature regulation is impaired. If you’re awakened during REM sleep, you may find that you’re hot or cold (mostly hot) and have to adjust the covers accordingly. During this stage your muscles become temporarily paralyzed, but your brain activity increases to levels that are similar to when awake. Babies spend about 50 percent of their sleep in REM sleep.
Dreams rarely occur in NREM sleep and most often are a function of REM sleep. Dreams can be images, sounds, or thoughts and often provoke emotional responses. Dreams can run scripts related to events that happened during the day or they can be quite dynamic containing many details, leaving dreamers wondering what may have caused them to dream specific topics.
Researchers have a couple of theories about the reasons for dreams:
- The brain uses dreams as a mechanism for categorizing information and realigning brain-related pathways. In other words, the brain performs certain housecleaning tasks that it can’t do while a person is up and moving. Lending credence to this theory is the fact that REM sleep is most active during the first two years of life when a baby’s brain is growing and developing.
- Dreams are associated with a person’s emotions. If you’re very worried about a problem, there’s a strong possibility that you’ll dream about it at night. That’s not always bad—often, a discovery or a way to solve that problem also shows up in a dream.
On the flip side, bad dreams or nightmares can be reminders of issues or fears that need to be addressed. In other words, dreams may act as a pressure-cooker, allowing you to vent your feelings in the safety of your sleep.
Some of the most common causes of sleeping problems are completely preventable and fall under one category: sleep hygiene. Sleep hygiene isn’t specifically associated with cleanliness—it focuses on the everyday habits that induce good sleep. Often these routines are the first things investigated when visiting your doctor with a complaint that you can’t sleep, and often they require very simple changes.
Some of the most common remedies for poor sleep are listed here. Remember though, that these are general guidelines—you may be lucky enough to be able to drink a double espresso two hours before bedtime and not have it interfere with your sleep, but even if you can, you may not be sleeping as well as you could be!
Here are some bedtime tips:
- Reserve the bed as a sacred place for sleeping (or sex). Don’t watch television or read when you’re in bed. The bed is a place for sleep; don’t go there until you’re ready for that commitment. Do your socializing and television watching in another room because these types of activities can stimulate your mind enough to affect your sleep. Or you may find yourself so caught up in reading a book that you can’t put it down and are still wide awake reading until early in the morning.
- Go to bed and get up at the same time every day. The easiest way to reset your rhythm when it’s been thrown out of whack by travel, late nights or illness is to get back to your targeted sleep/wake cycle and stick to it. The body functions well on a fixed schedule. Your body can’t set a consistent schedule, or circadian rhythm, when you go to bed at 11 p.m. one day and then 2 a.m. the next. You’ll feel tired and often have difficulty sleeping. After you determine the time you want to go to bed and the time you want to wake up, you need to go to bed consistently at that time and set an alarm to get up at your desired time each morning.
- Steer clear of the caffeine at least six hours prior to bed. Some people are actually affected by caffeine longer than this timeframe, but six hours is a good rule of thumb. Remember that chocolate also falls into this category. Sorry, chocoholics!
- Exercise regularly but at a reasonable time. Yes, this advice is a constant for what ails you. Exercising regularly (at least 30 minutes a day; preferably in the morning) helps you sleep better at night. Remember to stay away from heavy exercise two to three hours before bed—the release of endorphins, which are natural stimulants, energizes and wakes your body up, and it can take a few hours to wind back down.
- Eat your last meal or snack at least three hours before going to bed. You don’t want to go to bed starving either. The important point to remember is to avoid eating a large meal or high-sugar content meal before bed. This intake can cause heartburn and other gastrointestinal upsets that interrupt sleep.
- Try not to nap during the day. If you don’t sleep well during the night, logically, you shouldn’t sleep during the day so that you can establish a pattern. You may have to work hard at skipping that afternoon snooze to get into a good sleep pattern, but you can do it.
- Avoid drinking alcohol four hours before bed. Many people drink alcohol because they feel that it makes them sleep better. Yes, it can make some people fall asleep, but the problem is that it often keeps you in the lighter stages of sleep.
- Consult your doctor before taking any sleeping medications. Don’t take any sleeping medication—even over-the-counter ones—without consulting your doctor. Sometimes medications that make one person sleepy may make you wide awake, and some pills make getting up in the morning harder and can make your body dependent on the medication. You also don’t want to treat sleeping problems if you can solve them—getting in sync may take a few days, but you’ll feel better in the long run.
If you have recurring, disturbing dreams that are adversely affecting you, talk to your doctor to see whether he or she can help. Getting a detailed medical history dating back to when the dreams or nightmares started may help you see whether any life-changing events, medication changes, or other major lifestyle changes could be the cause. Your doctor will make recommendations based on how it affects your activities.
Recognizing abnormal sleep issues
Many times people with sleeping problems complain of multiple medical symptoms and problems. For example, they may say that they can’t keep their eyes open during important meetings at work, or they may complain that they can’t return to sleep after they awake at night. Truthfully, people can blame just about anything on lack of sleep, but for some it’s more than just an excuse.
Good sleep hygiene can greatly reduce or eliminate some symptoms, such as waking up tired; however, some symptoms—such as gasping for air (sleep apnea)—can be serious or deadly; they require immediate medical attention. Others, like sleepwalking, can be symptoms of a serious sleep disorder or another medical problem.
Here are some signs that you may have a sleep disorder:
- Being unable to sleep at night or waking up numerous times during the night
- Being too tired to perform simple tasks
- Being irritable and unable to concentrate
- Snoring so loudly that you disrupt your sleep or the sleep of your partner
- Sleepwalking or talking in your sleep
- Gasping for air while you sleep
- Twitching in your legs at night
- Sleeping more than nine hours a night for an extended period of time
A sleep disorder is any condition that prevents you from getting a good night’s sleep for an extended period of time. If you haven’t slept well for about two weeks, you may have a sleep problem. So, if you experience any of these symptoms for at least two weeks and you maintain consistently good sleep hygiene, consult your primary care physician to discuss your situation and possible treatments.
Identifying and correcting sleep disorders
You can find several ways to treat sleep problems, and hopefully you see the difference between treating and resolving. Medications for insomnia and equipment for sleep apnea can treat problems, but proper sleep hygiene and weight loss can resolve them. If you do have a sleep disorder, shoot to find a resolution, not just a temporary solution when working on the treatment plan.
Medical conditions can have people flocking into their doctor’s office begging for sleep remedies. Medical conditions may respond to simple treatments and solutions, but they may also require more serious medical intervention. The following sections include some of the most common sleep disorders for adults.
Insomnia is a general word to describe the inability to fall asleep. When you have insomnia, you may feel tired but you just can’t sleep. Some people waken several times during the night or wake up and can’t fall asleep again until the early morning. Acute or transient insomnia lasts from one night to a couple of weeks, but insomnia must occur on most nights for more than a month to be considered chronic.
Having a couple of sleepless nights when you’re under stress is normal, but if sleepless nights become habitual—and you’ve already been through the sleep hygiene guidelines—talk to a doctor. When sleeplessness becomes a consistent problem, you begin to experience daytime drowsiness that affects your work and other daily activities.
Over time, insomnia can:
- Lead to poor performance on the job
- Affect your personal relationships\
- Leave you vulnerable to illness and disease
- Make you more accident-prone
Some effective treatments for insomnia include relaxation, cognitive behavioral therapy, and stress reduction. You may also need to take prescription and over-the-counter sleep aids. Note: With some prescriptions you run the risk of dependence, so talk to your doctor about your options.
The word apnea means “without breath” and is exactly what occurs when people are afflicted with sleep apnea. People who suffer from sleep apnea actually have episodes where they stop breathing during their sleep. These episodes can last for a few seconds to several seconds and can occur more than 100 times a night. People who have sleep apnea wake up feeling tired and irritable and may experience a sore throat or dry mouth when they wake up.
Some people with sleep apnea wake up gasping for air while others are aroused enough to breathe and then return to sleep without a clue to the problems. Oftentimes, if they don’t remember these episodes, their sleep partners do—it’s frightening to see and hear!
Sleep apnea is dangerous and has been implicate din conditions such as cognitive impairment, behavior problems, heart disease, and even sudden death. It’s unclear whether the apnea itself or ongoing apnea and its associated heart disease is what leads to sudden death.
The two kinds of sleep apnea are obstructive and central.
- Obstructive sleep apnea is the most common type, accounting for about 90 percent of sleep apnea. Obstructive sleep apnea occurs when the muscles in the back of your throat relax and then collapse.
- Central sleep apnea occurs when your brain doesn’t send the proper signals to the muscles that control breathing.
The risks of getting sleep apnea include excess weight, having a thick neck, being male, aging, smoking, and the use of sleep medications. To determine whether you suffer from sleep apnea, your doctor may request that you do some sleep testing.
Some treatments for sleep apnea include oral devices that open the blocked airways or the Continuous Positive Airway Pressure (CPAPP)—a device that blows air into your nose at night. Surgery may be recommended for serious cases; for less serious cases, losing weight is often enough to put an end to sleep apnea.
Restless leg syndrome
People with restless leg syndrome (RLS) feel like they constantly have to move their legs to find a more comfortable position. However, no position feels right for long. Their legs feel tight and tingly as if bugs were crawling up their calves. RLS negatively affects your sleep and may keep your partner from sleeping too.
RLS seems to be more prevalent in women. Conditions like pregnancy, anemia (low iron), and depression may be the underlying causes. Other more serious conditions like Parkinson’s, diabetes, and rheumatoid arthritis may also cause RLS.
Behavioral changes that may minimize the problem include taking warm baths before bedtime, doing yoga stretches, and walking slowly. If the problem is anemia, an iron supplement may eliminate the problem entirely. The bottom line is that RLS is a very treatable condition, so see your doctor.
We often recommend Trim® Calm to our patients with chronic sleep issues.
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Priority You MD provides personalized, integrative healthcare for general wellness, anti-aging, athletic performance and weight management as well as more complex medical issues. In addition, our facility also provides aesthetic services and fitness training. Combining diet, nutrition and exercise with evidence based medicine and preventative therapies, our goal is to help our patients achieve and maintain a healthy, active lifestyle.
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