According to a recent poll (National Sleep Foundation, 2009), 1 about one-fourth of American adults say they get a good night’s sleep only a few nights a month or less. These people are suffering from a sleep disorder known asinsomnia, defined as persistent difficulty falling or staying asleep. Most cases of insomnia are temporary, lasting from a few days to several weeks, but in some cases insomnia can last for years.
Insomnia can result from physical disorders such as pain due to injury or illness, or from psychological problems such as stress, financial worries, or relationship difficulties. Changes in sleep patterns, such as jet lag, changes in work shift, or even the movement to or from daylight savings time can produce insomnia. Sometimes the sleep that the insomniac does get is disturbed and nonrestorative, and the lack of quality sleep produces impairment of functioning during the day. Ironically, the problem may be compounded by people’s anxiety over insomnia itself: Their fear of being unable to sleep may wind up keeping them awake. Some people may also develop a conditioned anxiety to the bedroom or the bed.
People who have difficulty sleeping may turn to drugs to help them sleep. Barbiturates, benzodiazepines, and other sedatives are frequently marketed and prescribed as sleep aids, but they may interrupt the natural stages of the sleep cycle, and in the end are likely to do more harm than good. In some cases they may also promote dependence. Most practitioners of sleep medicine today recommend making environmental and scheduling changes first, followed by therapy for underlying problems, with pharmacological remedies used only as a last resort.
According to the National Sleep Foundation, some steps that can be used to combat insomnia include the following:
- Use the bed and bedroom for sleep and sex only. Do not spend time in bed during the day.
- Establish a regular bedtime routine and a regular sleep-wake schedule.
- Think positively about your sleeping—try not to get anxious just because you are losing a little sleep.
- Do not eat or drink too much close to bedtime.
- Create a sleep-promoting environment that is dark, cool, and comfortable.
- Avoid disturbing noises—consider a bedside fan or white-noise machine to block out disturbing sounds.
- Consume less or no caffeine, particularly late in the day.
- Avoid alcohol and nicotine, especially close to bedtime.
- Exercise, but not within 3 hours before bedtime.
- Avoid naps, particularly in the late afternoon or evening.
- Keep a sleep diary to identify your sleep habits and patterns that you can share with your doctor.
Another common sleep problem is sleep apnea, a sleep disorder characterized by pauses in breathing that last at least 10 seconds during sleep(Morgenthaler, Kagramanov, Hanak, & Decker, 2006). 2 In addition to preventing restorative sleep, sleep apnea can also cause high blood pressure and may raise the risk of stroke and heart attack (Yaggi et al., 2005). 3
Most sleep apnea is caused by an obstruction of the walls of the throat that occurs when we fall asleep. It is most common in obese or older individuals who have lost muscle tone and is particularly common in men. Sleep apnea caused by obstructions is usually treated with an air machine that uses a mask to create a continuous pressure that prevents the airway from collapsing, or with mouthpieces that keep the airway open. If all other treatments have failed, sleep apnea may be treated with surgery to open the airway.
Narcolepsy is a disorder characterized by extreme daytime sleepiness with frequent episodes of “nodding off.” The syndrome may also be accompanied by attacks of cataplexy, in which the individual loses muscle tone, resulting in a partial or complete collapse. It is estimated that at least 200,000 Americans suffer from narcolepsy, although only about a quarter of these people have been diagnosed (National Heart, Lung, and Blood Institute, 2008). 4
Narcolepsy is in part the result of genetics—people who suffer from the disease lack neurotransmitters that are important in keeping us alert (Taheri, Zeitzer, & Mignot, 2002) 5— and is also the result of a lack of deep sleep. While most people descend through the sequence of sleep stages, then move back up to REM sleep soon after falling asleep, narcolepsy sufferers move directly into REM and undergo numerous awakenings during the night, often preventing them from getting good sleep.
Narcolepsy can be treated with stimulants, such as amphetamines, to counteract the daytime sleepiness, or with antidepressants to treat a presumed underlying depression. However, since these drugs further disrupt already-abnormal sleep cycles, these approaches may, in the long run, make the problem worse. Many sufferers find relief by taking a number of planned short naps during the day, and some individuals may find it easier to work in jobs that allow them to sleep during the day and work at night.
Other sleep disorders occur when cognitive or motor processes that should be turned off or reduced in magnitude during sleep operate at higher than normal levels (Mahowald & Schenck, 2000). 6 One example is somnamulism(sleepwalking), in which the person leaves the bed and moves around while still asleep. Sleepwalking is more common in childhood, with the most frequent occurrences around the age of 12 years. About 4% of adults experience somnambulism (Mahowald & Schenck, 2000). 7
Sleep terrors is a disruptive sleep disorder, most frequently experienced in childhood, that may involve loud screams and intense panic. The sufferer cannot wake from sleep even though he or she is trying to. In extreme cases, sleep terrors may result in bodily harm or property damage as the sufferer moves about abruptly. Up to 3% of adults suffer from sleep terrors, which typically occur in sleep stage N3 (Mahowald & Schenck, 2000). 8
Other sleep disorders include bruxism, in which the sufferer grinds his teeth during sleep; restless legs syndrome, in which the sufferer reports an itching, burning, or otherwise uncomfortable feeling in his legs, usually exacerbated when resting or asleep; and periodic limb movement disorder, which involves sudden involuntary movement of limbs. The latter can cause sleep disruption and injury for both the sufferer and bed partner.
Although many sleep disorders occur during non-REM sleep, REM sleep behavior disorder (Mahowald & Schenck, 2005) 9 is a condition in which people (usually middle-aged or older men) engage in vigorous and bizarre physical activities during REM sleep in response to intense, violent dreams. As their actions may injure themselves or their sleeping partners, this disorder, thought to be neurological in nature, is normally treated with hypnosis and medications.