Basics of Sleep Introduction
Sleep is defined as a state of unconsciousness from which a person can be aroused. In this state, the brain is relatively more responsive to internal stimuli than external stimuli. Sleep should be distinguished from coma Coma is unconscious state from which a person cannot be aroused. Sleep is essentialfor the normal, healthy functioning of the human body. It is a complicated physiological phenomenon that scientists do not fully understand. Historically, sleep was thought to be a passive state. However, sleep is now known to be a dynamic process, and our brains are active during sleep. Sleep affects our physical and mental health, and is essential for the normal functioning of all the systems of our body, including the immune system The effect of sleep on the immune system affects one’s ability to fight disease and endure sickness.
States of brain activity during sleep and wakefulness result from different activating and inhibiting forces that are generated within the brain. Neurotransmitters (chemicals involved in nerve signaling) control whether one is asleep or awake by acting on nerve cells (neurons) in different parts of the brain. Neurons located in the brainstem actively cause sleep by inhibiting other parts of the brain that keep a person awake.
We Don't Get Sleep Because We Don't 'Get' Sleep
I believe the main reason we struggle with epidemic sleep disorders is our failure to examine fundamental misconceptions that inform our understanding of and approach to sleep. These misconceptions are rooted in a tendency to define sleep negatively -- that is, in terms of what it's not. Like our conception of health, which is generally understood as the absence of disease, we naively conceive of sleep as the absence of waking. When we are asleep, we are "dead to the world" -- to the waking world. Even scientific and medical definitions of sleep cast it in terms of what it's not. Sleep specialists refer to sleep as "non-REM." It's not dreaming.Waking has become a synonym for consciousness; and sleep, considered its opposite, unconsciousness. Someone who exhibits limited awareness while awake may be accused of being 'asleep.' Noted sleep specialist, William Dement writes, "It is impossible to have conscious, experiential knowledge of non-dreaming sleep." Because it's unconscious, sleep is believed to lie outside the realm of subjective experience and, therefore, to be devoid of personal meaning. It's reduced to a functional physiological process. Nothing personal.
In fact, the most common presumption we hold about sleep, both scientifically and culturally, is that it functions to provide essential physiological support for waking life. Virtually all the research questions we ask about sleep focus on its role in supporting complex aspects of health and performance. Sleep serves waking life. Who would argue against this obvious truth? But is it the whole truth?
Well, if sleep is not waking and sleep is not dreaming, then what is it? Is it unconsciousness, impersonal and strictly functional? These common presumptions result in a blinding wake-centric bias. Trying to 'get' sleep solely from a waking perspective is like trying to understand darkness by illuminating it with a flashlight. This approach discourages us from developing a more intimate, personal relationship with sleep and, thereby, precludes our taking greater responsibility for it.
"If you only have a hammer," said Abe Maslow, "you tend to see every problem as a nail." Likewise, if you only have waking, you will view getting to sleep only as another waking activity. We simply can't go wakefully into sleep. The subtle though ludicrous notion that we have to be awake to get to sleep is depicted in a classic "Three Stooges" skit. After fighting with Curly to get him to sleep, Mo turns to Larry who is already sleeping, slaps the top of his head and yells, "Hey, wake up and go to sleep!" Twisted as such a reproach may be, it's the most common cognitive error underlying the nightly flood of sleep inhibiting anxiety experienced by millions of insomniacs.
From a wake-centric perspective, we have no alternative but to carry waking cognitive and behavioral ways of being into the night. We routinely smuggle information, entertainment, technology, light, food, substances and lots of worry into our bedrooms and beds. The single most critical factor impairing healthy sleep is not, as is commonly believed, that we are insufficiently sleepy at night. It's what sleep science calls hyperarousal -- that we are excessively wakeful.
Solid empirical evidence suggests that sleeping pills provide no significant improvement in sleep. They essentially mask poor sleep with amnesia. But because we confuse sleep with unconsciousness, we believe that substances and medications that mask waking can legitimately serve as sleep aids. I believe that this is the fundamental error that continues to perpetuate skyrocketing sleeping pill sales.
Sleep science pioneer Alan Rechtschaffen stated, "If sleep doesn't serve an absolutely vital function, it is the biggest mistake evolution ever made." But couldn't we say the same about personal experiences like eating and sex and even love? The fact that something is functional, however, does not preclude it from also being personally meaningful. Viewed as an unconscious physiological function, we cannot directly access sleep. We can only manage it indirectly through manipulating our physiology and our environment with ineffective sleeping pills and overpriced mattresses.
Our wake-centric views artificially bifurcate waking and sleep. In reality, sleep is no more the opposite and absence of waking than darkness is the opposite and absence of light. In fact, brain EEG models suggest that both sleep and waking can be understood in terms of a larger, all-encompassing, continuity of consciousness. They're on a continuum.
We could benefit greatly from a more nuanced sense of our own consciousness. We are capable, to varying degrees, of being simultaneously awake and asleep. The pendulum of consciousness swings through repeating circadian cycles of waking and sleep. Although waking is strongly informed by sensory input and sleep is not, it's the same pendulum.
The belief that sleep is unconsciousness discourages us from opening to a more direct experience of it. Rather than willingly descending into a mysterious sea of sleep, at lights out our attention typically drifts to the shore of the next morning's awakening. This is like spending an overnight getaway fixated only on our return home.
We can practice remaining mindful -- keeping our mind's eye open -- as we descend into the lovely restorative waves of sleep. This is more than a simple philosophical stance. It's about a critical shift in consciousness that provides a foundation for healthy sleep. As a complement to science based recommendations for better sleep, we can begin a personal relationship and conversation with sleep itself -- on its own dreamy terms.
There’s 2 different types of sleep. REM, which stands for rapid movement and NREM, non rapid eye movement. There’s also 3 variations of NREM, stage 1, 2 and 3.
In this article I will explain the differences between each type and stage of sleep and explain where they appear in your sleep cycle.
Understanding these different varieties of sleep and where they appear in your sleep cycle can help you get the very most out of your sleep and even tweak it a bit.
THE 2 TYPES OF SLEEP
NREM
NREM is the first type of sleep you enter when you first nod off. Most of our time asleep is spent here, making up for 75% of an adults sleep.NREM is split into 3 stages, with each stage taking you deeper and deeper into sleep.
NREM Stage 1
This is the first stage of NREM, starting from the moment you first fall asleep. Your brain begins preparing you for the deep sleep ahead. Your body slows down and your breathing becomes slow and steady.It’s a very light sleep. If you wake up at this stage, you might not even know you’d just been sleeping. People who stay in this stage of sleep for long periods often claim they slept much less than they actually did. Although they would certainly feel like they slept much less if they missed out on deep sleep.
At this stage you might experience what’s called sleep starts or hypnic jerks. This is where a strange sensation like you’re falling as if you’ve just tripped over something. While completely freaky, its completely normal and just a sign that your body is slowly shutting down and sleep will soon be upon you.
NREM Stage 2
Stage 2 is the next stage of sleep following on from stage 1. Here you’re in a deeper sleep than in stage 1. You can still be woken up pretty easily at this stage but you will certainly know that you had just been sleeping.Here your body functions slow down even more. Your brainwaves become longer and slower as your body prepares for the next stage of sleep.
NREM Stage 3
Stage 3, also known as slow wave sleep is the last stage of sleep. Here your body is in a deep sleep. Waking someone from this stage would be pretty difficult and if you managed it, they would feel very groggy, tired and disoriented. They certainly wouldn’t thank you for it!Brainwaves are now at their longest and slowest. Your body functions slow down to their fullest. This is where sleep is at its best, deeply nourishing and refreshing.
Dreams are more common in this stage than other stages of NREM sleep, although you would probably only remember fragments of your dreams if anything.
REM
REM sleep is the second type of sleep, often kicking in only after a full cycle of NREM sleep.This is the stage where most dreaming occurs with your brain activity much higher than NREM. However, while your brain is active, only your eyes and breathing muscles can move. There are exceptions though, some people can actually fully move in their dreams.
From the age of 2 onwards, we spend around 20% – 25% of our sleep at this stage. Newborns spend the most with around 50% of their sleep in REM.
Two Types of Sleep?
It’s not really known why we have two types of sleep. Logically, it’s easy to think we should only need the nourishing deep sleep NREM provides us.
The purpose of REM sleep is not fully understood. Some scientists think REM sleep may have something to do with the role of acting on our memories and making sense of the day, which could explain why newborns have more REM sleep than others as they explore their new world. However people who have been scientifically deprived of REM sleep show no change to their memory or any aspect of their lives, so it all remains a bit of a mystery. I’ll keep you updated on the latest developments!
Sleep Cycle
Our body’s cycle between REM and the stages of NREM several times during the night. Here’s an average sleep cycle:
As the night progresses, the amount of time you spend in the deeper stages of NREM sleep decreases and the amount of time you spend in REM and the lighter stages of NREM increases.
It’s natural to wake up a few times in the night after the REM stage. Most of the time you won’t even remember waking up at all.
Being aware of your own sleep cycle can help you effectively plan your sleep schedule. For example, it would be a bad idea to schedule in an hour nap, since you’re most likely to be woken by your alarm clock in NREM stage 3 where you would no doubt feel much worse than before the nap. A better time for a nap would be around 20 minutes to make sure you don’t go beyond NREM stage 1 or a little longer than hour so that you awake during REM after a complete cycle.
Deep sleep is where the party is at in the sleep world. But as you can see, it only happens during the first part of the night. So as it stands, sleep is a little inefficient. But if you were to some how experience more deep sleep, then you can forego the majority of time spent in the weaker staged of sleep. How can we do that? Well it’s not easy, but the answer lies in your sleep pattern, which eads us very nicely to the next article in the series.
Importance of Sleep
Animal studies have shown that sleep is necessary for survival. The normal life span of rats is 2-3 years. However, rats deprived of sleep live for only about 3 weeks. They also develop abnormally low body temperatures and sores on their tails and paws. The sores probably develop because of impairment of the rats’ immune systems.
In humans, it has been demonstrated that the metabolic activity of the brain decreases significantly after 24 hours of sustained wakefulness. Sleep deprivation results in a decrease in body temperature, a decrease in immune system function as measured bywhite blood cell count (the soldiers of the body), and a decrease in the release of growth hormone. Sleep deprivation can also cause increased heart ratevariability.
For our nervous systems to work properly, sleep is needed. Sleep deprivation makes a person drowsy and unable to concentrate the next day. It also leads to impairment ofmemory and physical performance and reduced ability to carry out mathematical calculations. If sleep deprivation continues, hallucinations and mood swings may develop.
Release of growth hormone in children and young adults takes place during deep sleep. Most cells of the body show increased production and reduced breakdown of proteins during deep sleep. Sleep helps humans maintain optimal emotional and social functioning while we are awake by giving rest during sleep to the parts of the brain that control emotions and social interactions.
Sleep is essential for a person’s health and wellbeing, according to the National Sleep Foundation (NSF). Yet millions of people do not get enough sleep and many suffer from lack of sleep. For example, surveys conducted by the NSF (1999-2004) reveal that at least 40 million Americans suffer from over 70 different sleep disorders and 60 percent of adults report having sleep problems a few nights a week or more. Most of those with these problems go undiagnosed and untreated. In addition, more than 40 percent of adults experience daytime sleepiness severe enough to interfere with their daily activities at least a few days each month - with 20 percent reporting problem sleepiness a few days a week or more. Furthermore, 69 percent of children experience one or more sleep problems a few nights or more during a week.
What are the signs of excessive sleepiness?
According to psychologist and sleep expert David F. Dinges, Ph.D., of the Division of Sleep and Chronobiology and Department of Psychiatry at the University of Pennsylvania School of Medicine, irritability, moodiness and disinhibition are some of the first signs a person experiences from lack of sleep. If a sleep-deprived person doesn’t sleep after the initial signs, said Dinges, the person may then start to experience apathy, slowed speech and flattened emotional responses, impaired memory and an inability to be novel or multitask. As a person gets to the point of falling asleep, he or she will fall into micro sleeps (5-10 seconds) that cause lapses in attention, nod off while doing an activity like driving or reading and then finally experience hypnagogic hallucinations, the beginning of REM sleep. (Dinges, Sleep, Sleepiness and Performance, 1991)
Amount of sleep needed
Everyone’s individual sleep needs vary. In general, most healthy adults are built for 16 hours of wakefulness and need an average of eight hours of sleep a night. However, some individuals are able to function without sleepiness or drowsiness after as little as six hours of sleep. Others can't perform at their peak unless they've slept ten hours. And, contrary to common myth, the need for sleep doesn't decline with age but the ability to sleep for six to eight hours at one time may be reduced. (Van Dongen & Dinges, Principles & Practice of Sleep Medicine, 2000)
What causes sleep problems?
Psychologists and other scientists who study the causes of sleep disorders have shown that such problems can directly or indirectly be tied to abnormalities in the following systems:
Physiological systems
Physiological systems
- Brain and nervous system
- Cardiovascular system
- Metabolic functions
- Immune system
- Pathological sleepiness, insomnia and accidents
- Hypertension and elevated cardiovascular risks (MI, stroke)
- Emotional disorders (depression, bipolar disorder)
- Obesity; metabolic syndrome and diabetes
- Alcohol and drug abuse
(Dinges, 2004)
How environment and behavior affect a person’s sleep
Stress is the number one cause of short-term sleeping difficulties, according to sleep experts. Common triggers include school- or job-related pressures, a family or marriage problem and a serious illness or death in the family. Usually the sleep problem disappears when the stressful situation passes. However, if short-term sleep problems such as insomnia aren't managed properly from the beginning, they can persist long after the original stress has passed.
Drinking alcohol or beverages containing caffeine in the afternoon or evening, exercising close to bedtime, following an irregular morning and nighttime schedule, and working or doing other mentally intense activities right before or after getting into bed can disrupt sleep.
If you are among the 20 percent of employees in the United States who are shift workers, sleep may be particularly elusive. Shift work forces you to try to sleep when activities around you - and your own "biological rhythms" - signal you to be awake. One study shows that shift workers are two to five times more likely than employees with regular, daytime hours to fall asleep on the job.
Traveling also disrupts sleep, especially jet lag and traveling across several time zones. This can upset your biological or “circadian” rhythms.
Environmental factors such as a room that's too hot or cold, too noisy or too brightly lit can be a barrier to sound sleep. And interruptions from children or other family members can also disrupt sleep. Other influences to pay attention to are the comfort and size of your bed and the habits of your sleep partner. If you have to lie beside someone who has different sleep preferences, snores, can't fall or stay asleep, or has other sleep difficulties, it often becomes your problem too!
Having a 24/7 lifestyle can also interrupt regular sleep patterns: the global economy that includes round the clock industries working to beat the competition; widespread use of nonstop automated systems to communicate and an increase in shift work makes for sleeping at regular times difficult.
Drinking alcohol or beverages containing caffeine in the afternoon or evening, exercising close to bedtime, following an irregular morning and nighttime schedule, and working or doing other mentally intense activities right before or after getting into bed can disrupt sleep.
If you are among the 20 percent of employees in the United States who are shift workers, sleep may be particularly elusive. Shift work forces you to try to sleep when activities around you - and your own "biological rhythms" - signal you to be awake. One study shows that shift workers are two to five times more likely than employees with regular, daytime hours to fall asleep on the job.
Traveling also disrupts sleep, especially jet lag and traveling across several time zones. This can upset your biological or “circadian” rhythms.
Environmental factors such as a room that's too hot or cold, too noisy or too brightly lit can be a barrier to sound sleep. And interruptions from children or other family members can also disrupt sleep. Other influences to pay attention to are the comfort and size of your bed and the habits of your sleep partner. If you have to lie beside someone who has different sleep preferences, snores, can't fall or stay asleep, or has other sleep difficulties, it often becomes your problem too!
Having a 24/7 lifestyle can also interrupt regular sleep patterns: the global economy that includes round the clock industries working to beat the competition; widespread use of nonstop automated systems to communicate and an increase in shift work makes for sleeping at regular times difficult.
Health problems and sleep disorders
A number of physical problems can interfere with your ability to fall or stay asleep. For example, arthritis and other conditions that cause pain, backache, or discomfort can make it difficult to sleep well.
Epidemiological studies suggest self-reported sleep complaints are associated with an increased relative risk of cardiovascular morbidity and mortality. For women, pregnancy and hormonal shifts including those that cause premenstrual syndrome (PMS) or menopause and its accompanying hot flashes can also intrude on sleep.
Finally, certain medications such as decongestants, steroids and some medicines for high blood pressure, asthma, or depression can cause sleeping difficulties as a side effect.
It is a good idea to talk to a physician or mental health provider about any sleeping problem that recurs or persists for longer than a few weeks.
According to the DSM IV, some psychiatric disorders have fatigue as a major symptom. Included are: major depressive disorder (includes postpartum blues), minor depression, dythymia, mixed anxiety-depression, SAD and bipolar disorder.
Epidemiological studies suggest self-reported sleep complaints are associated with an increased relative risk of cardiovascular morbidity and mortality. For women, pregnancy and hormonal shifts including those that cause premenstrual syndrome (PMS) or menopause and its accompanying hot flashes can also intrude on sleep.
Finally, certain medications such as decongestants, steroids and some medicines for high blood pressure, asthma, or depression can cause sleeping difficulties as a side effect.
It is a good idea to talk to a physician or mental health provider about any sleeping problem that recurs or persists for longer than a few weeks.
According to the DSM IV, some psychiatric disorders have fatigue as a major symptom. Included are: major depressive disorder (includes postpartum blues), minor depression, dythymia, mixed anxiety-depression, SAD and bipolar disorder.
Teenagers, sleep problems and drugs
According to a long-term study published in the 2004 April issue of Alcoholism: Clinical and Experimental Research, young teenagers whose preschool sleep habits were poor were more than twice as likely to use drugs, tobacco or alcohol. This finding was made by the University of Michigan Health System as part of a family health study that followed 257 boys and their parents for 10 years. The study found a significant connection between sleep problems in children and later drug use, even when other issues such as depression, aggression, attention problems and parental alcoholism were taken into account. Long-term data on girls isn't available yet. The researchers suggest that early sleep problems may be a "marker" for predicting later risk of early adolescent substance abuse—and that there may be a common biological factor underlying both traits. Although the relationship between sleep problems and the abuse of alcohol in adults is well known, this is the first study to look at the issue in children.
Infants have an overall greater total sleep time than any other age group. Their sleep time can be divided into multiple periods. In newborns, the total sleep duration in a day can be 14-16 hours. Over the first several months of life, sleep time decreases; by age 5-6 months, sleep consolidates into an overnight period with at least 1 nap during the day.
REM sleep in infants represents a larger percentage of the total sleep at the expense of stages III and IV. Until age 3-4 months, newborns transition from wakefulness into REM sleep. Thereafter, wakefulness begins to transition directly into NREM sleep.
Adulthood
In adults, sleep of 8-8.4 hours is considered fully restorative. In some cultures, total sleep is often divided into an overnight sleep period of 6-7 hours and a nap of 1-2 hours.
Some people may need as little as 5 hours or as much as 10 hours of sleep every day. The period of time a person sleeps depends also on the fact whether he or she has been deprived of sleep in previous days. Sleeping too little creates a "sleep debt." This debt needs to be adjusted by sleeping for longer periods over the next few days. People who sleep less have an impairment of judgment and reaction time.
Old age
People tend to sleep more lightly and for shorter periods as they get older. In elderly persons, the time spent in stages III and IV decreases by 10-15%, and the time in stage II increases by 5% compared to young adults, representing an overall decrease in total sleep duration.
Time taken to fall asleep and the number and duration of overnight arousal periods increase. Thus, to have a fully restorative sleep, the total time in bed must increase. If the elderly person does not increase the total time in bed, complaints of insomnia and chronic sleepiness may occur.
Sleep fragmentation results from the increase in overnight arousals and may be exacerbated by the increasing number of medical conditions related to old age, including sleep apnea (interrupted breathing during sleep), musculoskeletal disorders,cardiopulmonary and disease.
Children and Sleep Disturbances
Nightmares are dreams with vivid and disturbing content. They are common in children during REM sleep. They usually involve an immediate awakening and good recall of the dream content.
Sleep terrors are often described as extreme nightmares. Like nightmares, they most often occur during childhood, however they typically take place during non-REM (NREM) sleep. Characteristics of a sleep terror include arousal, agitation, large pupils, sweating, and increased blood pressure. The child appears terrified, screams and is usually inconsolable for several minutes, after which he or she relaxes and returns to sleep. Sleep terrors usually take place early in the night and may be combined with sleepwalking. The child typically does not remember or has only a vague memory of the terrifying events.
Sleep terrors are often described as extreme nightmares. Like nightmares, they most often occur during childhood, however they typically take place during non-REM (NREM) sleep. Characteristics of a sleep terror include arousal, agitation, large pupils, sweating, and increased blood pressure. The child appears terrified, screams and is usually inconsolable for several minutes, after which he or she relaxes and returns to sleep. Sleep terrors usually take place early in the night and may be combined with sleepwalking. The child typically does not remember or has only a vague memory of the terrifying events.
Sleepiness and Decision Making
In the August 2004 issue of the journal Sleep, Dr. Timothy Roehrs, the Director of research at the Sleep Disorders and Research Center at Henry Ford Hospital in Detroit published one of the first studies to measure the effect of sleepiness on decision making and risk taking. He found that sleepiness does take a toll on effective decision making.
Cited in the October 12, New York Times Science section, Dr. Roehrs and his colleagues paid sleepy and fully alert subjects to complete a series of computer tasks. At random times, they were given a choice to take their money and stop. Or they could forge ahead with the potential of either earning more money or losing it all if their work was not completed within an unknown remainder of time.
Dr. Roehrs found that the alert people were very sensitive to the amount of work they needed to do to finish the tasks and understood the risk of losing their money if they didn't. But the sleepy subjects chose to quit the tasks prematurely or they risked losing everything by trying to finish the task for more money even when it was 100 percent likely that they would be unable to finish, said Dr. Roehrs.
Each year the cost of sleep disorders, sleep deprivation and sleepiness, according to the NCSDR, is estimated to be $15.9 million in direct costs and $50 to $100 billion a year in indirect and related costs. And according to the NHSA, falling asleep while driving is responsible for at least 100,000 crashes, 71,000 injuries and 1,550 deaths each year in the United States. Young people in their teens and twenties, who are particularly susceptible to the effects of chronic sleep loss, are involved in more than half of the fall-asleep crashes on the nation's highways each year. Sleep loss also interferes with the learning of young people in our nation's schools, with 60 percent of grade school and high school children reporting that they are tired during the daytime and 15 percent of them admitting to falling asleep in class.
According to the Department of Transportation (DOT), one to four percent of all highway crashes are due to sleepiness, especially in rural areas and four percent of these crashes are fatal.
Risk factors for drowsy driving crashes:
Cited in the October 12, New York Times Science section, Dr. Roehrs and his colleagues paid sleepy and fully alert subjects to complete a series of computer tasks. At random times, they were given a choice to take their money and stop. Or they could forge ahead with the potential of either earning more money or losing it all if their work was not completed within an unknown remainder of time.
Dr. Roehrs found that the alert people were very sensitive to the amount of work they needed to do to finish the tasks and understood the risk of losing their money if they didn't. But the sleepy subjects chose to quit the tasks prematurely or they risked losing everything by trying to finish the task for more money even when it was 100 percent likely that they would be unable to finish, said Dr. Roehrs.
Consequences of lost sleep
According to the National Commission on Sleep Disorders Research (1998) and reports from the National Highway Safety Administration (NHSA)(2002), high-profile accidents can partly be attributed to people suffering from a severe lack of sleep.Each year the cost of sleep disorders, sleep deprivation and sleepiness, according to the NCSDR, is estimated to be $15.9 million in direct costs and $50 to $100 billion a year in indirect and related costs. And according to the NHSA, falling asleep while driving is responsible for at least 100,000 crashes, 71,000 injuries and 1,550 deaths each year in the United States. Young people in their teens and twenties, who are particularly susceptible to the effects of chronic sleep loss, are involved in more than half of the fall-asleep crashes on the nation's highways each year. Sleep loss also interferes with the learning of young people in our nation's schools, with 60 percent of grade school and high school children reporting that they are tired during the daytime and 15 percent of them admitting to falling asleep in class.
According to the Department of Transportation (DOT), one to four percent of all highway crashes are due to sleepiness, especially in rural areas and four percent of these crashes are fatal.
Risk factors for drowsy driving crashes:
- Late night/early morning driving
- Patients with untreated excessive sleepiness
- People who obtain six or fewer hours of sleep per day
- Young adult males
- Commercial truck drivers
- Night shift workers
- Medical residents after their shift
How to get a good night sleep
According to sleep researchers, a night's sleep is divided into five continually shifting stages, defined by types of brain waves that reflect either lighter or deeper sleep. Toward morning, there is an increase in rapid eye movement, or REM sleep, when the muscles are relaxed and dreaming occurs, and recent memories may be consolidated in the brain. The experts say that hitting a snooze alarm over and over again to wake up is not the best way to feel rested. “The restorative value of rest is diminished, especially when the increments are short,” said psychologist Edward Stepanski, PhD who has studied sleep fragmentation at the Rush University Medical Center in Chicago. This on and off again effect of dozing and waking causes shifts in the brain-wave patterns. Sleep-deprived snooze-button addicts are likely to shorten their quota of REM sleep, impairing their mental functioning during the day. (New York Times, October 12, 2004)
Certain therapies, like cognitive behavioral therapy teach people how to recognize and change patterns of thought and behavior to solve their problems. Recently this type of therapy has been shown to be very effective in getting people to fall asleep and conquer insomnia.
According to a study published in the October 2004 issue of The Archives of Internal Medicine, cognitive behavior therapy is more effective and lasts longer than a widely used sleeping pill, Ambien, in reducing insomnia. The study involved 63 healthy people with insomnia who were randomly assigned to receive Ambien, the cognitive behavior therapy, both or a placebo. The patients in the therapy group received five 30-minute sessions over six weeks. They were given daily exercises to “recognize, challenge and change stress-inducing” thoughts and were taught techniques, like delaying bedtime or getting up to read if they were unable to fall asleep after 20 minutes. The patients taking Ambien were on a full dose for a month and then were weaned off the drug. At three weeks, 44 percent of the patients receiving the therapy and those receiving the combination therapy and pills fell asleep faster compared to 29 percent of the patients taking only the sleeping pills. Two weeks after all the treatment was over, the patients receiving the therapy fell asleep in half the time it took before the study and only 17 percent of the patients taking the sleeping pills fell asleep in half the time. (New York Times, October 5, 2004)
According to leading sleep researchers, there are techniques to combat common sleep problems:
Certain therapies, like cognitive behavioral therapy teach people how to recognize and change patterns of thought and behavior to solve their problems. Recently this type of therapy has been shown to be very effective in getting people to fall asleep and conquer insomnia.
According to a study published in the October 2004 issue of The Archives of Internal Medicine, cognitive behavior therapy is more effective and lasts longer than a widely used sleeping pill, Ambien, in reducing insomnia. The study involved 63 healthy people with insomnia who were randomly assigned to receive Ambien, the cognitive behavior therapy, both or a placebo. The patients in the therapy group received five 30-minute sessions over six weeks. They were given daily exercises to “recognize, challenge and change stress-inducing” thoughts and were taught techniques, like delaying bedtime or getting up to read if they were unable to fall asleep after 20 minutes. The patients taking Ambien were on a full dose for a month and then were weaned off the drug. At three weeks, 44 percent of the patients receiving the therapy and those receiving the combination therapy and pills fell asleep faster compared to 29 percent of the patients taking only the sleeping pills. Two weeks after all the treatment was over, the patients receiving the therapy fell asleep in half the time it took before the study and only 17 percent of the patients taking the sleeping pills fell asleep in half the time. (New York Times, October 5, 2004)
According to leading sleep researchers, there are techniques to combat common sleep problems:
- Keep a regular sleep/wake schedule
- Don’t drink or eat caffeine four to six hours before bed and minimize daytime use
- Don’t smoke, especially near bedtime or if you awake in the night
- Avoid alcohol and heavy meals before sleep
- Get regular exercise
- Minimize noise, light and excessive hot and cold temperatures where you sleep
- Develop a regular bed time and go to bed at the same time each night
- Try and wake up without an alarm clock
- Attempt to go to bed earlier every night for certain period; this will ensure that you’re getting enough sleep
Insomnia and cognitive-behavioral treatment
In clinical settings, cognitive-behavior therapy (CBT) has a 70-80 percent success rate for helping those who suffer from chronic insomnia. Almost one third of people with insomnia achieve normal sleep and most reduce their symptoms by 50 percent and sleep an extra 45-60 minutes a night. When insomnia exists along with other psychological disorders like depression, say the experts, the initial treatment should address the underlying condition.
But sometimes even after resolving the underlying condition, the insomnia still exists, says psychologist Jack Edinger, Ph.D., of the VA Medical Center in Durham, North Carolina and Professor of Psychiatry and Behavioral Sciences at Duke University and cautions that treating the depression usually doesn’t resolve the sleep difficulties. From his clinical experience, he has found that most patients with insomnia should be examined for specific behaviors and thoughts that may perpetuate the sleep problems. When people develop insomnia, they try to compensate by engaging in activities to help them get more sleep. They sleep later in the mornings or spend excessive times in bed. These efforts usually backfire, said Edinger.
From his clinical work and research on sleep, psychologist Charles M. Morin, Ph.D., a Professor in the Psychology Department and Director of the Sleep Disorders Center at University Laval in Quebec, Canada says that ten percent of adults suffer from chronic insomnia. In a study released in the recent issue of Sleep Medicine Alert published by the NSF, Morin outlines how CBT helps people overcome insomnia. Clinicians use sleep diaries to get an accurate picture of someone’s sleep patterns. Bedtime, waking time, time to fall asleep, number and durations of awakening, actual sleep time and quality of sleep are documented by the person suffering from insomnia.
A person can develop poor sleep habits (i.e. watching TV in bed or eating too much before bedtime), irregular sleep patterns (sleeping too late, taking long naps during the day) to compensate for lost sleep at night. Some patients also develop a fear of not sleeping and a pattern of worrying about the consequences of not sleeping, said Morin. “Treatments that address the poor sleep habits and the faulty beliefs and attitudes about sleep work but sometimes,” said Morin, “medication may play a role in breaking the cycle of insomnia. But behavioral therapies are essential for patients to alter the conditions that perpetuate it.”
CBT attempts to change a patient’s dysfunctional beliefs and attitudes about sleep. “It restructure thoughts – like, ‘I’ve got to sleep eight hours tonight’ or ‘I’ve got to take medication to sleep’ or ‘I just can’t function or I’ll get sick if I don’t sleep.’ These thoughts focus too much on sleep, which can become something like performance anxiety – sleep will come around to you when you’re not chasing it,” said Edinger.
What works in many cases, said Morin and Edinger, is to standardize or restrict a person’s sleep to give a person more control over his or her sleep. A person can keep a sleep diary for a couple of weeks and a clinician can monitor the amount of time spent in bed to the actual amount of time sleeping. Then the clinician can instruct the patient to either go to bed later and get up earlier or visa versa. This procedure improves the length of sleeping time by imposing a mild sleep deprivation situation, which has the result of reducing the anxiety surrounding sleep. To keep from falling asleep during the day, patients are told not to restrict sleep to less than five hours.
Standardizing sleep actually helps a person adjust his or her homeostatic mechanism that balances sleep, said Edinger. “Therefore, if you lose sleep, your homeostatic mechanism will kick in and will work to increase the likelihood of sleeping longer and deeper to promote sleep recovery. This helps a person come back to their baseline and works for the majority.”
A person can also establish more stimulus control over his or her bedroom environment, said Dr Morin. This could include: going to bed only when sleepy, getting out of bed when unable to sleep, prohibiting non-sleep activities in the bedroom, getting up at the same time every morning (including weekends) and avoiding daytime naps.
Finally, a person can incorporate relaxation techniques as part of his or her treatment. For example, a person can give herself or himself an extra hour before bed to relax and unwind and time to write down worries and plans for the following day.
In CBT, said Morin, breaking the thought process and anxiety over sleep is the goal. “After identifying the dysfunctional thought patterns, a clinician can offer alternative interpretations of what is getting the person anxious so a person can think about his or her insomnia in a different way.” Morin offers some techniques to restructure a person’s cognitions. “Keep realistic expectations, don’t blame insomnia for all daytime impairments, do not feel that losing a night’s sleep will bring horrible consequences, do not give too much importance to sleep and finally develop some tolerance to the effects of lost sleep.
According to Dr. Edinger, aging weakens a person’s homeostatic sleep drive after age 50. Interestingly, the length of the circadian cycle stays roughly the same over the lifespan but the amplitude of the circadian rhythm may decline somewhat with aging.
But sometimes even after resolving the underlying condition, the insomnia still exists, says psychologist Jack Edinger, Ph.D., of the VA Medical Center in Durham, North Carolina and Professor of Psychiatry and Behavioral Sciences at Duke University and cautions that treating the depression usually doesn’t resolve the sleep difficulties. From his clinical experience, he has found that most patients with insomnia should be examined for specific behaviors and thoughts that may perpetuate the sleep problems. When people develop insomnia, they try to compensate by engaging in activities to help them get more sleep. They sleep later in the mornings or spend excessive times in bed. These efforts usually backfire, said Edinger.
From his clinical work and research on sleep, psychologist Charles M. Morin, Ph.D., a Professor in the Psychology Department and Director of the Sleep Disorders Center at University Laval in Quebec, Canada says that ten percent of adults suffer from chronic insomnia. In a study released in the recent issue of Sleep Medicine Alert published by the NSF, Morin outlines how CBT helps people overcome insomnia. Clinicians use sleep diaries to get an accurate picture of someone’s sleep patterns. Bedtime, waking time, time to fall asleep, number and durations of awakening, actual sleep time and quality of sleep are documented by the person suffering from insomnia.
A person can develop poor sleep habits (i.e. watching TV in bed or eating too much before bedtime), irregular sleep patterns (sleeping too late, taking long naps during the day) to compensate for lost sleep at night. Some patients also develop a fear of not sleeping and a pattern of worrying about the consequences of not sleeping, said Morin. “Treatments that address the poor sleep habits and the faulty beliefs and attitudes about sleep work but sometimes,” said Morin, “medication may play a role in breaking the cycle of insomnia. But behavioral therapies are essential for patients to alter the conditions that perpetuate it.”
CBT attempts to change a patient’s dysfunctional beliefs and attitudes about sleep. “It restructure thoughts – like, ‘I’ve got to sleep eight hours tonight’ or ‘I’ve got to take medication to sleep’ or ‘I just can’t function or I’ll get sick if I don’t sleep.’ These thoughts focus too much on sleep, which can become something like performance anxiety – sleep will come around to you when you’re not chasing it,” said Edinger.
What works in many cases, said Morin and Edinger, is to standardize or restrict a person’s sleep to give a person more control over his or her sleep. A person can keep a sleep diary for a couple of weeks and a clinician can monitor the amount of time spent in bed to the actual amount of time sleeping. Then the clinician can instruct the patient to either go to bed later and get up earlier or visa versa. This procedure improves the length of sleeping time by imposing a mild sleep deprivation situation, which has the result of reducing the anxiety surrounding sleep. To keep from falling asleep during the day, patients are told not to restrict sleep to less than five hours.
Standardizing sleep actually helps a person adjust his or her homeostatic mechanism that balances sleep, said Edinger. “Therefore, if you lose sleep, your homeostatic mechanism will kick in and will work to increase the likelihood of sleeping longer and deeper to promote sleep recovery. This helps a person come back to their baseline and works for the majority.”
A person can also establish more stimulus control over his or her bedroom environment, said Dr Morin. This could include: going to bed only when sleepy, getting out of bed when unable to sleep, prohibiting non-sleep activities in the bedroom, getting up at the same time every morning (including weekends) and avoiding daytime naps.
Finally, a person can incorporate relaxation techniques as part of his or her treatment. For example, a person can give herself or himself an extra hour before bed to relax and unwind and time to write down worries and plans for the following day.
In CBT, said Morin, breaking the thought process and anxiety over sleep is the goal. “After identifying the dysfunctional thought patterns, a clinician can offer alternative interpretations of what is getting the person anxious so a person can think about his or her insomnia in a different way.” Morin offers some techniques to restructure a person’s cognitions. “Keep realistic expectations, don’t blame insomnia for all daytime impairments, do not feel that losing a night’s sleep will bring horrible consequences, do not give too much importance to sleep and finally develop some tolerance to the effects of lost sleep.
According to Dr. Edinger, aging weakens a person’s homeostatic sleep drive after age 50. Interestingly, the length of the circadian cycle stays roughly the same over the lifespan but the amplitude of the circadian rhythm may decline somewhat with aging.
Sleep at Different Stages of Life
InfancyInfants have an overall greater total sleep time than any other age group. Their sleep time can be divided into multiple periods. In newborns, the total sleep duration in a day can be 14-16 hours. Over the first several months of life, sleep time decreases; by age 5-6 months, sleep consolidates into an overnight period with at least 1 nap during the day.
REM sleep in infants represents a larger percentage of the total sleep at the expense of stages III and IV. Until age 3-4 months, newborns transition from wakefulness into REM sleep. Thereafter, wakefulness begins to transition directly into NREM sleep.
Adulthood
In adults, sleep of 8-8.4 hours is considered fully restorative. In some cultures, total sleep is often divided into an overnight sleep period of 6-7 hours and a nap of 1-2 hours.
Some people may need as little as 5 hours or as much as 10 hours of sleep every day. The period of time a person sleeps depends also on the fact whether he or she has been deprived of sleep in previous days. Sleeping too little creates a "sleep debt." This debt needs to be adjusted by sleeping for longer periods over the next few days. People who sleep less have an impairment of judgment and reaction time.
Old age
People tend to sleep more lightly and for shorter periods as they get older. In elderly persons, the time spent in stages III and IV decreases by 10-15%, and the time in stage II increases by 5% compared to young adults, representing an overall decrease in total sleep duration.
Time taken to fall asleep and the number and duration of overnight arousal periods increase. Thus, to have a fully restorative sleep, the total time in bed must increase. If the elderly person does not increase the total time in bed, complaints of insomnia and chronic sleepiness may occur.
Sleep fragmentation results from the increase in overnight arousals and may be exacerbated by the increasing number of medical conditions related to old age, including sleep apnea (interrupted breathing during sleep), musculoskeletal disorders,cardiopulmonary and disease.
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