By Laura Sidlinger
The sleep-wake cycle* is a complicated process with many interconnected elements. It includes complex neurological circuitry and diverse endogenous molecules. Sleep onset is influenced by the circadian rhythm and sleep promoting neurons in various areas of the brain. The sleep cycle is comprised of several different phases with varying purposes.
Disruption to any element of the sleep process can produce significant alterations, including ineffective daily function, impaired physical health and decreased quality of life. Acute and chronic stressors can redirect circuitry to maintain wakefulness rather than allowing for sleep induction. Naturally, the body experiences a 24-hour cycle where hormones and neurotransmitters are released to maintain a sleep-wake pattern. The purpose of sleep is to restore equilibrium; thus, short-term sleep deprivation is typically followed by compensatory extra sleep. Should sleep restoration not occur, the effects on one’s well-being become more prominent.
COMMON SLEEP DISORDERS The most common sleep disorder is insomnia. Insomnia is defined as hyperarousal, which is induced by the stress response. Common symptoms are difficulty initiating or maintaining sleep and early morning awakenings without being able to return to sleep. Insomnia often results in distress or impairment in social and occupational/academic settings. It must occur three or more times per week, be present for at least three months and occur despite adequate opportunity to sleep. It cannot be explained by another sleep-wake disorder or be caused by a medical condition or substance use.
Shift workers have a unique type of sleep dysfunction. They often attempt to be alert at different times of the 24-hour cycle, causing disruptions in the circadian rhythm. These individuals often report dissatisfaction with the quality of the sleep, decreased alertness, impaired mental ability and lower quality of work performance. There is evidence to support that those who work the night shift have a shorter life expectancy.
Medical conditions that are commonly associated with sleep dysfunction include, Obstructive Sleep Apnea and Restless Leg Syndrome. OSA is diagnosed through the use of sleep studies and is often treated with weight loss and the use of Continuous Positive Pressure Airway. RLS is often treated successfully with specific medications.
TREATMENTS FOR SLEEP DISORDER One of the most effective treatments for sleep disorder is good sleep hygiene. Sleep hygiene requires a person to take specific steps to eliminate subtle triggers. Subtle triggers induce neurochemical stimulation, or alterations, which disrupt sleep. Consistent application of sleep hygiene techniques will often reverse sleep dysfunction.
If these interventions prove to be ineffective, medications may be required to augment sleep. Over-the-counter options include melatonin, a natural hormone produced by the pineal gland in the brain which may be producing insufficient quantities. Other over-the- counter sleep aids typically include diphenhydramine (generic name for Benadryl), which blocks wakefulness. A healthcare provider should be consulted for appropriate dosing.
It is important to remember that sleep disturbance may be a symptom of another mental health disorder or medical problem. Establishing and maintaining care with a primary care provider is an important first step in treating sleep dysfunction. Allow for adequate time for neurochemical imbalances to stabilize before moving on to more aggressive treatments. If improved sleep is not achieved, a referral to a sleep specialist or behavioral health provider may be warranted.
Tips for Good Sleep Hygiene
Establish a pre-bedtime routine. Turn off the TV, take a warm bath or shower, meditate, journal, decompress from the day.
Maintain a regular sleep routine. Go to bed and wake up at the same time every day. Ideally, your schedule should remain the same within about 20 minutes from day-to-day. One of the best examples of having to re-establish sleep routines is when children return to school after extended breaks; summer is even worse because of later daylight in the evenings.
Avoid naps if possible. Naps often will delay sleep onset as the body has not experienced sufficient fatigue. Naps may be followed by sleep fragmentation and progress to insomnia.
Don’t remain in bed for more than 10 minutes if you are awake. If you find your mind racing, get out of bed and sit in a chair in the dark. When you find yourself sleepy, return to the bed for sleep.
Don’t watch TV or engage with devices such as tablets, phones or other backlit devices while in bed. This artificial light prevents the brain from releasing melatonin which will interfere with drowsiness.
Don't drink fluids, especially caffeine, late in the day/evening. Some people are more sensitive than others to the stimulating effects of caffeine, but nearly all are affected by full bladders and the need to go to the bathroom at night. Minimize interruptions. Don’t forget about hidden caffeine in chocolate, some teas and energy drinks/herbal supplements.
Avoid other substances that interfere with sleep. Cigarettes, alcohol and some medications may increase fragmented sleep.
Exercise regularly. If possible, exercise before 2 p.m. as late exercise might be invigorating and interfere with sleep onset.
Maintain a quiet, comfortable bedroom. Maintain a comfortable temperature, turn off the lights, and consider replacing the mattress if you cannot maintain a relaxing sleep posture.
Avoid looking at the clock. Turn it away or upside down if you tend to look at the time.