One in three adults do not regularly get the recommended amount of uninterrupted sleep they need to protect their health, and the NIH estimates that between 50 and 70 million Americans have sleep disorders.
According to the CDC, a number of chronic diseases and health disorders, including as type 2 diabetes, heart disease, obesity, and depression, are linked to sleep disruptions and insufficient sleep.
What is sleep?
- Sleep is a state where awareness to environmental stimuli is reduced and is a state of rest for the body and mind
- Nerve signaling chemicals known as neurotransmitters and chemical messengers known as hormones are involved in the sleep cycle
- Neurotransmitters acts on neurons in the brain and controls sleep and wakefulness
- Wakefulness Neurotransmitters
- Acetylcholine, Dopamine, Serotonin, Norepinephrine, Epinephrine, Cortisol
- Sleep Neurotransmitters
- Acetylcholine, Serotonin, GABA, Adenosine, Nitric Oxide
- Some hormones that effect sleep
- Cortisol, Melatonin, Thyroid, Insulin
What is the function of sleep?
- Facilitates
- Growth, repair, and healing
- Influences hormones
- Growth hormone, melatonin, insulin, cortisol, leptin, and ghrelin
- Supports brain function
- Cognition, concentration, productivity, and performance
- Effects changes in metabolism, appetite, and food selection
- Influences appetite hormones leptin and ghrelin
- Other health effects
- Decreases inflammation, supports immune function, improves mood and energy
Some of the most common sleep disorders?
Insomnia
- Definition
- Trouble falling asleep, staying asleep, or waking up too early
- Sleep disorder that affects as many as 35% of adults
- Signs and symptoms
- Difficulty falling asleep at night, waking up during the night and unable to return to sleep, waking up early, not feeling well-rested after a night’s sleep, daytime fatigue or sleepiness, irritability, depression, anxiety, poor concentration and focus, tension headaches, difficulty socializing, gastrointestinal symptoms, ongoing worries about sleep
- Causes
- Stress, travel or work schedule, poor sleep habits, eating too much late in the evening, mental health disorders, medications, medical conditions (GERD, obesity, hyperthyroidism, menopause, arthritis, fibromyalgia, etc.), sleep-related disorders, caffeine, nicotine, and alcohol
Sleep Apnea
Obstructive sleep apnea
- Most common, throat muscles relax, airway in the back of the throat is blocked, blockage causes windpipe obstruction, breathing repeatedly stops and starts, partner will often complain of snoring loudly
Central sleep apnea
- Brain doesn’t send proper signals to the muscles that control breathing causes periods of stopped or abnormal breathing
Complex sleep apnea syndrome
- Experiencing both obstructive sleep apnea and central sleep apnea
Common Signs and Symptoms
- Obstructive sleep apnea symptoms (OSA)
- Periods of stopped breathing during sleep, loud snorting, gasping for air during sleep, morning headaches, waking up with a dry mouth or sore throat, insomnia, fatigue, lack of concentration, mood swings, irritability, memory problems, night sweats, decreased sexual libido, depression, chronic high blood pressure
- Central sleep apnea
- Being very tired during the day, waking up often during the night, having headaches in the early morning, trouble concentrating, memory and mood problems, periods of stopped or abnormal breathing during sleep, snorting, gasping for air during sleep, shortness of breath during sleep that is relieved when sitting up, difficulty staying asleep (insomnia), excessive daytime sleepiness (hypersomnia), chest pain at night, irritability, reduced tolerance for exercise
- Obstructive sleep apnea symptoms (OSA)
- Obstructive sleep apnea (OSA)
- Excess weight, neck circumference, a narrowed airway, gender (male), old age, family history, smoking, alcohol, sedatives or tranquilizers, nasal congestion, medical conditions (congestive heart failure, high blood pressure, type 2 diabetes, etc.)
- Central sleep apnea
- Old age, gender (male), heart disorders, using narcotic pain medications, stroke
- Obstructive sleep apnea (OSA)
Restless Legs Syndrome
Definition
- Uncontrollable urge to move legs that occurs along with uncomfortable sensations in the legs. Moving legs eases unpleasant feeling.
Signs and symptoms
- Irresistible urge to move, sensations that begin after rest, relief with movement, worsening of symptoms in the evening, nighttime leg twitching, causes sensations described as creeping, itching, pulling, crawling, tugging, throbbing, burning, or gnawing
Causes
- Peripheral Neuropathy (nerve damage), low levels of iron (iron deficiency), hypothyroidism, depression, fibromyalgia, Parkinson’s disease, kidney disease, diabetes, rheumatoid arthritis, dialysis, certain medications may aggravate RLS symptoms, pregnancy, alcohol, nicotine, and caffeine
Substance/Medication induced sleep disorder
Definition
- Insomnia and other sleep problems caused by use of substance/medication
Types
- Insomnia type: difficulty falling asleep or staying asleep
- Daytime sleepiness type: excessive sleepiness/fatigue throughout the day
- Parasomnia type: abnormal behavioral events during sleep (sleepwalking, nightmares or night terrors)
- Mixed type: Combination of any of the three above
Causes
- Substance intoxication and/or withdrawal: alcohol, caffeine, cannabis, opioids, sedatives, hypnotics, anxiolytics, amphetamines, cocaine, tobacco, stimulants, and other substances
- Certain medications such as adrenergic agonists/antagonists, dopamine agonists/antagonists, cholinergic agonists/antagonists, serotonergic agonists/antagonists, antihistamines, and corticosteroids
Snoring
Definition
- Snoring is a sign that the air is not moving freely through the nose and throat and may be due to obstruction in the breathing pathways.
- Blockage causes the tissues around nose and throat to vibrate, creating the snoring sound.
Causes
- Short term snoring can be caused by a cold or flu, or seasonal allergies
- Long term snoring may be due to
- Obstructive sleep apnea
- Cardiovascular disease
- Age
- throat muscles lose strength and tone with age
- Overweight or obesity
- Nasal and sinus problems
- Sleep posture
How much sleep do we need?
What biological mechanisms regulates awake and sleep cycle?
- Circadian rhythm
- Sleep-wake homeostasis
What is Circadian rhythm?
Regulates cycles of alertness and sleepiness
- Sleepiness at night
- Wakefulness in the morning
Body’s biological clock
- Based on 24-hour day
Synchronize with environmental cues
- Light
- Temperature
The Role of Melatonin in the Circadian Rhythm Sleep-Wake Cycle
- Sleep hormone, central part of the body’s sleep-wake cycle
- Darkness causes the pineal gland to start melatonin production
- Released into the bloodstream
- Light causes the production to stop
- Promotes sleep and orients circadian rhythm
- Facilitates a transition to sleep
The Role of cortisol in the Circadian Rhythm Sleep-Wake Cycle
Cortisol
- Primary stress hormone that is produced in the adrenal glands (triangle shaped organs at the top of the kidneys)
Function
- Sleep/wake cycle, regulates blood pressure, inflammation, blood sugar (increases), etc.
Central and Peripheral Circadian Clocks
Circadian clock
- Responds to external stimuli including sunlight, nutrition, temperature, arousal, stress, and exercise
- The circadian clock divided into 2 parts regulated by hypothalamic–pituitary–adrenal (HPA) axis and sympathetic tones
- Central clock
- Resides in the hypothalamus receives light cues
- Peripheral clocks
- Resides in various tissues throughout the body (liver, kidney, heart, adrenal gland etc.)
Adrenal gland
- Controls cortisol production
- Cortisol levels are highest early in morning
- Cortisol levels reaches lowest at around midnight
What is sleep-wake homeostasis?
- Sleep-wake homeostasis keeps track of sleep needs
- Reminds body to sleep after a certain time and regulates sleep intensity
- Sleep drive gets stronger every hour awakes and it lengthens sleep duration after a period of sleep deprivation
- Sleep homeostatic response involves recovery of the amount of sleep lost due to sleep deprivation by compensating and extending subsequent sleep
What factors influences sleep-wake homeostasis?
- Medical conditions
- Medications
- Stress
- Sleep environment
- What you eat and drink
- Exposure to light
What is a sleep cycle?
- As you sleep, your brain cycles through five stages of sleep. Stage 1,2,3, and 4, are categorized as non-rapid eye movement (NREM) and the fifth stage, is REM sleep. Typically, there are 4-6 sleep cycles per night
- Not all sleep cycles are the same length
- On average, a complete sleep cycle takes 90 to 110 minutes
- First sleep cycles contain long periods of deep sleep (stage 3 and 4) and short periods of REM sleep
- As the night progresses, the length of deep sleep decreases and REM sleep periods increases
- By morning, nearly all sleep time contains stages 1, 2, and REM
What are the stages of a sleep cycle?
What affects sleep stages?
- As you sleep, your brain cycles through five stages of sleep. Stage 1,2,3, and 4, are categorized as non-rapid eye movement (NREM) and the fifth stage, is REM sleep. Typically, there are 4-6 sleep cycles per night
- Not all sleep cycles are the same length
- On average, a complete sleep cycle takes 90 to 110 minutes
- First sleep cycles contain long periods of deep sleep (stage 3 and 4) and short periods of REM sleep
- As the night progresses, the length of deep sleep decreases and REM sleep periods increases
- By morning, nearly all sleep time contains stages 1, 2, and REM
What is dreaming?
- Dreams are most vivid in REM sleep (can be experienced in all stages of sleep)
- During REM sleep, the body experiences temporary paralysis of limb muscles, prevents acting out dreams
- Dreaming may help process emotions, aids in consolidation of learning and short-term memory to long-term memory storage
- An extension of waking consciousness, reflecting the experiences of waking life
- Psychological and emotional balance
- Mind works through unsettling thoughts, emotions, and experiences
- Unites past, present and future in processing information
Parasomnias: sleep disorders that causes disruptive behavior while sleeping
- Confusional arousal
- Recurrent isolated sleep paralysis
- REM sleep behavior disorder
- Sleep enuresis
- Sleep related eating disorder
- Sleep related dissociative disorders
- Sleep terrors
- Sleepwalking, nightmare disorder
What are the health effects of sleep deprivation?
In children and teens sleep deprivation may lead to
- Anger and impulsiveness
- Mood swings
- Feel sad or depressed
- Lack motivation
- Face difficulty paying attention
- Feel stressed
Sleep deprivation increases the risk of
- Heart disease
- Kidney disease
- High blood pressure
- Diabetes
- Stroke
- Obesity
Sleep deprivation is known to effect mental health and it may lead to
- Lower alertness and concentration
- Impaired judgment
- Foggy thinking
- Forgetfulness
- Irritability
- Confusion
- Distorted perception
- Difficulty learning
- Mental health problems
- Depression: around 75% of depressed people show symptoms of insomnia
- Anxiety
- Panic attacks
- PTSD
Emotions that can cause sleep disturbance
- Feeling fearful, disappointed, angry, frustrated, entrapped, disempowered, overwhelmed, jealous, disrespected, offended, helpless, hurt, rejected, avoided, distressed, embraced, guilty, ashamed, lonely, humiliated, betrayed, violated, infuriated, isolated, pressured, insecure, threatened, excluded, hopeless, sad (from unresolved grief)
When to see a doctor
Seek a healthcare provider when experiencing sleep disturbance to assess and diagnose the potential root cause.
DISCLAIMER
This information is intended for educational purposes only and it is not intended to take the place of consultation with your physician.
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