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  1. 1. Sleep Hygiene Basics: How to Avoid Sleep Debt and Its Consequences You have probably long known that getting a good night’s sleep is an important part of a healthy lifestyle. After all, who hasn’t heard that we should all sleep 8 hours each night? You might even be aware that when you fail to get enough sleep you aren’t “yourself” and begin to feel “run-down.” But did you know that getting inadequate sleep can increase your appetite and cravings, especially for carbohydrates? Long-term your risks for obesity, cardiovascular diseases (hypertension, stroke, heart attack, heart failure), diabetes (and other disorders of glucose metabolism), mood disorders (depression, anxiety) and cognitive decline (poor recall, slowed thought processing) can increase directly as consequences of accumulating a sleep debt, or becoming chronically sleep deprived. New research suggests that a large number of people with sleep disorders remain undiagnosed, but that with treatment people suffering from sleep deprivation and sleep disorders can avoid all of the potential health problems just noted. So take a closer look at sleep disorders and sleep habits now, and decide whether you (or a loved one) should be further evaluated for a potential sleep disorder that might be unnecessarily putting you at risk for multiple chronic diseases, advanced aging, and early death. How much sleep is required by the average person? Teens: 9-10 hours per night Adults: 7-8 ½ hours per night Older Adults: 6 ½ - 7 ½ hours per night, plus a 1 hour nap each afternoon Quality of sleep is just as important as quantity of hours slept. In most cases of sleep deprivation it is the deep stages of sleep (stages 3 and 4) that have been sacrificed. The functions of deep sleep include: • Growth hormone essential for growth and development is produced only during this time. • Restorative functions such as tissue repair and growth occur. Muscles are rested. • Blood pressure is lowered, providing rest to the heart and circulatory system. • Metabolic processes including glucose utilization and storage, and the ratio of appetite-controlling hormones are adjusted in an attempt to preserve healthy weight and normal cell and receptor functions. • Important functions of the nervous system (nerves) including memory consolidation (improves recall) take place only during this time. The brain is fueled for the next day. • Stress hormone production (cortisol, adrenaline) is decreased to restore balance to the body. • Hormones that fuel the immune system are produced, aiding the body in fighting off infection. What are the daytime effects of sleep loss? Low Energy: • Daytime somnolence (extreme sleepiness); frequent napping
  2. 2. • Increased risk of accidents; beware of driving • May become difficult to family, maintain work and social obligations • Likely not to maintain exercise regimen or other self-care routines Impaired Cognition • Impaired psychomotor performance; longer periods of sleep loss lead to greater impact on speed of performance • Reduction in performance of reasoning tasks • Impaired short term memory or recall • Impaired decision making under conditions of uncertainty, worse with age • Typically affects tasks that are long or monotonous with no feedback or motivation (e.g.: driving leads to increased accidents and citations) Depressed Mood: • Irritability, depression, anxiety, others • Lack of motivation can interfere with performance of many activities such as increasing absence from work, or failure to make or carry out plans with friends or family leading to social isolation. • Mood disorders can lead to poor health habits, missed appointments, lack of routine care, and further sleep problems. • Lack of stamina may lead to the abandonment of one’s exercise regimen; this has been shown to worsen a depressed mood by altering the balance of “feel good” hormones produced during exercise. *There is strong evidence of the reversal of all of the effects of sleep loss following recovery from sleep deprivation. Energy improves as fatigue fades. Memory improves via restored brain neurons; recall and concentration improve. Mood gradually returns to what is normal for you. Some of these factors will improve more quickly than others, and each person’s experience will differ to some degree. Types of sleep problems and their causes: Insufficient Sleep Syndrome can result from: • Decreased/inadequate sleep time • Irregular sleep/wake patterns and poor sleep hygiene • Substance abuse including overuse of caffeine, alcohol and nicotine o Caffeine can affect sleep architecture up to 10-12 hours after consumption leading to frequent arousals and fragmented sleep, reduced total sleep time, and decreased sleep efficiency. o Alcohol causes frequent arousals and is associated with sleep apnea. • Shift work (e.g.: doctors, nurses, truck drivers, soldiers) Treatments include: adequate sleep time and good sleep hygiene; hypnotic medications are not encouraged. Secondary causes of sleep debt (common examples) • Pain from medical conditions (e.g.: headaches, arthritis aches, muscle cramps)
  3. 3. • COPD (Chronic Obstructive Pulmonary Disease) (breathing difficulty) • Chest pain (fear vs. anxiety?) • Post-stroke or MI (nervousness) • Psychiatric disorders (anxiety, depression, “racing thoughts”) Treatment involved working with your doctors to best manage your diseases and the pain associated with them. Common primary sleep disorders include: • Insomnia: the inability to fall asleep or remain asleep • Restless legs syndrome (RLS): unpleasant feelings in the legs like creepy, crawly or tingly feelings at night with an urge to move upon lying down to sleep • Narcolepsy: a neurological disorder caused by the brain's inability to regulate normal sleep-wake cycles. Daytime features include excessive daytime sleepiness (EDS), cataplexy (sudden muscle weakness, especially in the legs but also the face and neck, that is brought on by strong emotion, especially laughing), and sudden sleep attacks. Nighttime features include insomnia, dream-like hallucinations, and sleep paralysis. • OSAS (Obstructive Sleep Apnea Syndrome) Treatments include: biofeedback, meditation and other relaxation methods, cognitive behavioral therapy, good sleep hygiene, medications as warranted Obstructive Sleep Apnea: By far the most common sleep disorder is Obstructive Sleep Apnea (OSA). OSA is a sleep disorder characterized by pauses, known as apneas, in breathing during sleep due to upper airway collapse or shallow breathing. These episodes occur repeatedly throughout sleep leading to disturbance of normal sleep patterns (known as sleep architechture) that are important for health. Snoring is the most obvious sign of sleep apnea, although not all people who snore have sleep apnea. There are several ways that a physician may identify patients at risk for OSA, but a true diagnosis requires a polysomnogram which entails an overnight study in a controlled sleep laboratory. The consequences of untreated OSA are known collectively as Obstructive Sleep Apnea Syndrome (OSAS). Considerable data supports OSAS as an independent risk factor for cardiovascular diseases (CVD), including hypertension, stroke, heart failure and cardiac sudden death, as well as the Metabolic Syndrome (Syndrome X). In addition, it is now theorized that OSAS is independently associated with glucose intolerance, type 2 diabetes, and possibly insulin resistance. Treatment options for OSA may include one or more of the following: • Weight control • Continuous positive airway pressure (CPAP)/BIPAP Therapy *Gold standard • Surgical interventions • Dental/oral appliances • Positional therapy *The good news: Data indicates that compliance with CPAP therapy may provide a protective effect against OSAS and appears to improve the diseases associated with
  4. 4. it, as well as prevent death from CVD. Similarly, surgical weight loss methods have been shown to be very successful in treating OSA and its associated conditions. A Final Word about Sleep Restriction: Sleep Restriction in general appears to increase appetite and food cravings by altering levels of unique hormones in the body. Chronic Sleep Deprivation results from long-term inadequate sleep quantity and/or quality ultimately leading to weight gain, insulin resistance or glucose intolerance, and increased fatigue. This begins a forward- moving cycle of increased hunger coupled with decreased physical activity that is almost certain to result in weight gain. This cycle has been shown to cause the metabolic syndrome, cardiovascular diseases and diabetes in previously healthy people. The impact of sleep deprivation appears to affect so many systems that many experts are predicting that sleep hygiene will be added to diet, exercise and smoking as a major modifiable risk factor for a number of chronic diseases in the foreseeable future. Sleep hygiene for optimum health; How to Avoid Sleep Debt and Its Consequences: • Keep regular bed- and wake times, even on the weekends • Try not to nap during the day. If you must nap, limit naps to brief periods. (10-15 minutes rest) • Ensure bedroom conditions are conducive to sleep (dark, quiet, comfortable temperature, comfortable pillow and mattress; use earplugs or eyeshades if necessary) • Restrict caffeine to before 10:00 a.m.; give it up altogether ideally. • Do not smoke during the evening hours (if you must smoke at all). • Limit alcohol to light consumption (it can fragment sleep architecture leading to frequent waking) • Limit food and beverage intake for three hours prior to bedtime. • Regular exercise is a must, but finish at least four to six hours prior to bedtime. An exception is for those with anxiety, in which case light exercise before bedtime may help them to relax. • Get at least 30 minutes’ exposure to sunlight in the morning hours, and avoid bright lights in the evenings. This includes avoiding computer and TV screens in the hours prior to bedtime. (Bright lights suppress melatonin production.) • Do not bring business or homework into the bedroom; no TV either. Recreational reading is OK. Keep the bedroom a place for quiet and rest. • Practice stress management techniques as necessary or appropriate. • Keep a bedside diary to record problems, plans etc. so they don’t remain in your mind preventing sleep. Avoid reading or watching news about troubling events just before bed. • A warm bath one to two hours prior to bedtime may help promote sleep. A warm glass of milk helps for many people as well.