This is what we learned from Dr. David Claman who is a Professor of Medicine as well as the director of the Sleep Disorder Clinic. It has only been 60 years since Rapid Eye Movement (REM) during sleep has been recognized. There are five levels of sleep - S1, 2, 3, 4 and REM. S3 and 4 are Slow Wave Sleep which happened in the first 2 to 3 hours and it is typical to spend more time in that state than any other.
Researchers still don't understand why we need sleep other than we feel rotten when we don't!
Abnormal sleep patterns is what is called insomnia. In the US, 64% have none, 27% have occasional and 9% have chronic insomnia. There are several types: can't fall asleep, waking in the middle of the night, waking at 3-4AM and not getting back to sleep.
Causes of insomnia:
Phychatric - Stress and worry
Medical - ILD patients may be short of breath, high levels of Co2, coughing
Drugs - Caffeine (stay in a system 6-8 hours) and alcohol (causes drowsiness, sleep well but when wears off, have to urinate, more awake)
Psychophsiological - worry causes muscle tension, need relaxation techniques
Poor Sleep Hygiene - unhelpful sleeping habits, napping, irregular schedule
Curcadia rhythm issues - jet lag, shift work
Intervention:
Behavioral changes
- Keep regular bedtime and wake-up time
- Keep bedroom quiet, comfortable, dark
- Relax 10-30 minutes before bed (no computers or phones)
- Get regular exercise
- Don't nap
- Don't lie awake in bed for long periods - get up to read or play cards then go back to bed
- Don't use alcohol, caffeine, nicotine
- Paperback option: "Say Good Night to Insomnia"
Hypnotics Medication
Ambien, Sonata, Lunesta, Restoril.
These are good for onset insomnia. They won't cause physical addiction and are out of the system by breakfast. No sleeping pill works in the long run. They will not help anxiety. For that, Adovan is often prescribed.
What is normal? Adequate number of hours of sleep is considered 7-1/2 - 8 hours a night. The Bell Curve can go to 8-1/2 - 9 hours, also considered normal. Sleep depreciation is considered 6 hours or less.
Do sleep needs change when we get older? No. Research shows that there is no change when we are older. The difference may be when people retire, they feel they can take the time to sleep longer.
Another cause of insomnia is leg kicking during sleep.
- It is normal when sleep starts to jerk. It is muscles relaxing.
- Restless Legs Syndrome (RLS) is common in insomnia. Clinical diagnosis is based on symptoms.
- Periodic Limb Movement of Sleep (PLMS) is leg kicking and is most common. It can interrupt sleep if severe. It is visibly diagnosed in a sleep study or by a partner.
Treatment for RLS is a blood test for iron deficiency and levels of ferritin. Medications include ropinirole or pramipexole, clonazepan, gabapentin, opintes.
Nighttime cramping in the legs may be helped by stretching before bedtime.
Sleep Apnea -obstructive (sleep interruptions) and Hypophea (shallow breathing)
In middle age, 30-40% of men who snore have sleep apnea. Only 20-25% of women also have it. Treatment for Sleep Apnea includes:
- weight loss
- avoid alcohol
- sleeping only in the lateral position
- nasal patency (treat allergies)
- CPAP -airway pressure
- oral appliances - by dentists
- ENT surgery
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