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BrainBasics:UnderstandingSleep

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Doyoueverfeelsleepyor"zoneout"duringtheday?Doyoufindithardtowakeupon
Mondaymornings?Ifso,youarefamiliarwiththepowerfulneedforsleep.However,you
maynotrealizethatsleepisasessentialforyourwellbeingasfoodandwater.
Sleep:ADynamicActivity
HowMuchSleepDoWeNeed?
WhatDoesSleepDoForUs?
DreamingandREMSleep
SleepandCircadianRhythms
SleepandDisease
SleepDisorders
TheFuture
TipsforaGoodNight'sSleep
Sleep:ADynamicActivity
Untilthe1950s,mostpeoplethoughtofsleepasapassive,dormantpartofourdailylives.
Wenowknowthatourbrainsareveryactiveduringsleep.Moreover,sleepaffectsour
dailyfunctioningandourphysicalandmentalhealthinmanywaysthatwearejust
beginningtounderstand.
Nervesignalingchemicalscalledneurotransmitterscontrolwhetherweareasleepor
awakebyactingondifferentgroupsofnervecells,orneurons,inthebrain.Neuronsinthe
brainstem,whichconnectsthebrainwiththespinalcord,produceneurotransmitterssuch
asserotoninandnorepinephrinethatkeepsomepartsofthebrainactivewhileweare
awake.Otherneuronsatthebaseofthebrainbeginsignalingwhenwefallasleep.These
neuronsappearto"switchoff"thesignalsthatkeepusawake.Researchalsosuggests
thatachemicalcalledadenosinebuildsupinourbloodwhileweareawakeandcauses
drowsiness.Thischemicalgraduallybreaksdownwhilewesleep.
Duringsleep,weusuallypassthroughfivephasesofsleep:stages1,2,3,4,andREM
(rapideyemovement)sleep.Thesestagesprogressinacyclefromstage1toREM
sleep,thenthecyclestartsoveragainwithstage1(seefigure1).Wespendalmost50
percentofourtotalsleeptimeinstage2sleep,about20percentinREMsleep,andthe
remaining30percentintheotherstages.Infants,bycontrast,spendabouthalfoftheir
sleeptimeinREMsleep.
Duringstage1,whichislightsleep,wedriftinandoutofsleepandcanbeawakened
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easily.Oureyesmoveveryslowlyandmuscleactivityslows.Peopleawakenedfrom
stage1sleepoftenrememberfragmentedvisualimages.Manyalsoexperiencesudden
musclecontractionscalledhypnicmyoclonia,oftenprecededbyasensationofstartingto
fall.Thesesuddenmovementsaresimilartothe"jump"wemakewhenstartled.Whenwe
enterstage2sleep,oureyemovementsstopandourbrainwaves(fluctuationsof
electricalactivitythatcanbemeasuredbyelectrodes)becomeslower,withoccasional
burstsofrapidwavescalledsleepspindles.Instage3,extremelyslowbrainwavescalled
deltawavesbegintoappear,interspersedwithsmaller,fasterwaves.Bystage4,the
brainproducesdeltawavesalmostexclusively.Itisverydifficulttowakesomeoneduring
stages3and4,whichtogetherarecalleddeepsleep.Thereisnoeyemovementor
muscleactivity.Peopleawakenedduringdeepsleepdonotadjustimmediatelyandoften
feelgroggyanddisorientedforseveralminutesaftertheywakeup.Somechildren
experiencebedwetting,nightterrors,orsleepwalkingduringdeepsleep.
WhenweswitchintoREMsleep,ourbreathingbecomesmorerapid,irregular,and
shallow,oureyesjerkrapidlyinvariousdirections,andourlimbmusclesbecome
temporarilyparalyzed.Ourheartrateincreases,ourbloodpressurerises,andmales
developpenileerections.WhenpeopleawakenduringREMsleep,theyoftendescribe
bizarreandillogicaltalesdreams.
ThefirstREMsleepperiodusuallyoccursabout70to90minutesafterwefallasleep.A
completesleepcycletakes90to110minutesonaverage.Thefirstsleepcycleseach
nightcontainrelativelyshortREMperiodsandlongperiodsofdeepsleep.Asthenight
progresses,REMsleepperiodsincreaseinlengthwhiledeepsleepdecreases.By
morning,peoplespendnearlyalltheirsleeptimeinstages1,2,andREM.
Peopleawakenedaftersleepingmorethanafewminutesareusuallyunabletorecallthe
lastfewminutesbeforetheyfellasleep.Thissleeprelatedformofamnesiaisthereason
peopleoftenforgettelephonecallsorconversationsthey'vehadinthemiddleofthenight.
Italsoexplainswhyweoftendonotrememberouralarmsringinginthemorningifwego
rightbacktosleepafterturningthemoff.
Sincesleepandwakefulnessareinfluencedbydifferentneurotransmittersignalsinthe
brain,foodsandmedicinesthatchangethebalanceofthesesignalsaffectwhetherwe
feelalertordrowsyandhowwellwesleep.Caffeinateddrinkssuchascoffeeanddrugs
suchasdietpillsanddecongestantsstimulatesomepartsofthebrainandcancause
insomnia,oraninabilitytosleep.ManyantidepressantssuppressREMsleep.Heavy
smokersoftensleepverylightlyandhavereducedamountsofREMsleep.Theyalsotend
towakeupafter3or4hoursofsleepduetonicotinewithdrawal.Manypeoplewhosuffer
frominsomniatrytosolvetheproblemwithalcoholthesocallednightcap.While
alcoholdoeshelppeoplefallintolightsleep,italsorobsthemofREMandthedeeper,
morerestorativestagesofsleep.Instead,itkeepstheminthelighterstagesofsleep,from
whichtheycanbeawakenedeasily.
PeoplelosesomeoftheabilitytoregulatetheirbodytemperatureduringREM,so
abnormallyhotorcoldtemperaturesintheenvironmentcandisruptthisstageofsleep.If
ourREMsleepisdisruptedonenight,ourbodiesdon'tfollowthenormalsleepcycle
progressionthenexttimewedozeoff.Instead,weoftenslipdirectlyintoREMsleepand
gothroughextendedperiodsofREMuntilwe"catchup"onthisstageofsleep.
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Peoplewhoareunderanesthesiaorinacomaareoftensaidtobeasleep.However,
peopleintheseconditionscannotbeawakenedanddonotproducethecomplex,active
brainwavepatternsseeninnormalsleep.Instead,theirbrainwavesareveryslowand
weak,sometimesallbutundetectable.
ReturntoIndex
HowMuchSleepDoWeNeed?
Theamountofsleepeachpersonneedsdependsonmanyfactors,includingage.Infants
generallyrequireabout16hoursaday,whileteenagersneedabout9hoursonaverage.
Formostadults,7to8hoursanightappearstobethebestamountofsleep.Womenin
thefirst3monthsofpregnancyoftenneedseveralmorehoursofsleepthanusual.The
amountofsleepapersonneedsalsoincreasesifheorshehasbeendeprivedofsleepin
previousdays.Gettingtoolittlesleepcreatesa"sleepdebt,"whichismuchlikebeing
overdrawnatabank.Eventually,yourbodywilldemandthatthedebtberepaid.Wedon't
seemtoadapttogettinglesssleepthanweneedwhilewemaygetusedtoasleep
deprivingschedule,ourjudgment,reactiontime,andotherfunctionsarestillimpaired.
Peopletendtosleepmorelightlyandforshortertimespansastheygetolder,although
theygenerallyneedaboutthesameamountofsleepastheyneededinearlyadulthood.
Abouthalfofallpeopleover65havefrequentsleepingproblems,suchasinsomnia,and
deepsleepstagesinmanyelderlypeopleoftenbecomeveryshortorstopcompletely.
Thischangemaybeanormalpartofaging,oritmayresultfrommedicalproblemsthat
arecommoninelderlypeopleandfromthemedicationsandothertreatmentsforthose
problems.
Expertssaythatifyoufeeldrowsyduringtheday,evenduringboringactivities,you
haven'thadenoughsleep.Ifyouroutinelyfallasleepwithin5minutesoflyingdown,you
probablyhaveseveresleepdeprivation,possiblyevenasleepdisorder.Microsleeps,or
verybriefepisodesofsleepinanotherwiseawakeperson,areanothermarkofsleep
deprivation.Inmanycases,peoplearenotawarethattheyareexperiencingmicrosleeps.
Thewidespreadpracticeof"burningthecandleatbothends"inwesternindustrialized
societieshascreatedsomuchsleepdeprivationthatwhatisreallyabnormalsleepinessis
nowalmostthenorm.
Manystudiesmakeitclearthatsleepdeprivationisdangerous.Sleepdeprivedpeople
whoaretestedbyusingadrivingsimulatororbyperformingahandeyecoordinationtask
performasbadlyasorworsethanthosewhoareintoxicated.Sleepdeprivationalso
magnifiesalcohol'seffectsonthebody,soafatiguedpersonwhodrinkswillbecome
muchmoreimpairedthansomeonewhoiswellrested.Driverfatigueisresponsibleforan
estimated100,000motorvehicleaccidentsand1500deathseachyear,accordingtothe
NationalHighwayTrafficSafetyAdministration.Sincedrowsinessisthebrain'slaststep
beforefallingasleep,drivingwhiledrowsycanandoftendoesleadtodisaster.
Caffeineandotherstimulantscannotovercometheeffectsofseveresleepdeprivation.
TheNationalSleepFoundationsaysthatifyouhavetroublekeepingyoureyesfocused,if
youcan'tstopyawning,orifyoucan'trememberdrivingthelastfewmiles,youare
probablytoodrowsytodrivesafely.
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ReturntoIndex
WhatDoesSleepDoForUs?
Althoughscientistsarestilltryingtolearnexactlywhypeopleneedsleep,animalstudies
showthatsleepisnecessaryforsurvival.Forexample,whileratsnormallylivefortwoto
threeyears,thosedeprivedofREMsleepsurviveonlyabout5weeksonaverage,and
ratsdeprivedofallsleepstagesliveonlyabout3weeks.Sleepdeprivedratsalsodevelop
abnormallylowbodytemperaturesandsoresontheirtailandpaws.Thesoresmay
developbecausetherats'immunesystemsbecomeimpaired.Somestudiessuggestthat
sleepdeprivationaffectstheimmunesystemindetrimentalways.
Sleepappearsnecessaryforournervoussystemstoworkproperly.Toolittlesleepleaves
usdrowsyandunabletoconcentratethenextday.Italsoleadstoimpairedmemoryand
physicalperformanceandreducedabilitytocarryoutmathcalculations.Ifsleep
deprivationcontinues,hallucinationsandmoodswingsmaydevelop.Someexperts
believesleepgivesneuronsusedwhileweareawakeachancetoshutdownandrepair
themselves.Withoutsleep,neuronsmaybecomesodepletedinenergyorsopolluted
withbyproductsofnormalcellularactivitiesthattheybegintomalfunction.Sleepalsomay
givethebrainachancetoexerciseimportantneuronalconnectionsthatmightotherwise
deterioratefromlackofactivity.
Deepsleepcoincideswiththereleaseofgrowthhormoneinchildrenandyoungadults.
Manyofthebody'scellsalsoshowincreasedproductionandreducedbreakdownof
proteinsduringdeepsleep.Sinceproteinsarethebuildingblocksneededforcellgrowth
andforrepairofdamagefromfactorslikestressandultravioletrays,deepsleepmaytruly
be"beautysleep."Activityinpartsofthebrainthatcontrolemotions,decisionmaking
processes,andsocialinteractionsisdrasticallyreducedduringdeepsleep,suggesting
thatthistypeofsleepmayhelppeoplemaintainoptimalemotionalandsocialfunctioning
whiletheyareawake.Astudyinratsalsoshowedthatcertainnervesignalingpatterns
whichtheratsgeneratedduringthedaywererepeatedduringdeepsleep.Thispattern
repetitionmayhelpencodememoriesandimprovelearning.
ReturntoIndex
DreamingandREMSleep
Wetypicallyspendmorethan2hourseachnightdreaming.Scientistsdonotknowmuch
abouthoworwhywedream.SigmundFreud,whogreatlyinfluencedthefieldof
psychology,believeddreamingwasa"safetyvalve"forunconsciousdesires.Onlyafter
1953,whenresearchersfirstdescribedREMinsleepinginfants,didscientistsbeginto
carefullystudysleepanddreaming.Theysoonrealizedthatthestrange,illogical
experienceswecalldreamsalmostalwaysoccurduringREMsleep.Whilemost
mammalsandbirdsshowsignsofREMsleep,reptilesandothercoldbloodedanimalsdo
not.
REMsleepbeginswithsignalsfromanareaatthebaseofthebraincalledthepons(see
figure2).Thesesignalstraveltoabrainregioncalledthethalamus,whichrelaysthemto
thecerebralcortextheouterlayerofthebrainthatisresponsibleforlearning,thinking,
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andorganizinginformation.Theponsalsosendssignalsthatshutoffneuronsinthe
spinalcord,causingtemporaryparalysisofthelimbmuscles.Ifsomethinginterfereswith
thisparalysis,peoplewillbegintophysically"actout"theirdreamsarare,dangerous
problemcalledREMsleepbehaviordisorder.Apersondreamingaboutaballgame,for
example,mayrunheadlongintofurnitureorblindlystrikesomeonesleepingnearbywhile
tryingtocatchaballinthedream.
REMsleepstimulatesthebrainregionsusedinlearning.Thismaybeimportantfor
normalbraindevelopmentduringinfancy,whichwouldexplainwhyinfantsspendmuch
moretimeinREMsleepthanadults(seeSleep:ADynamicActivity).Likedeepsleep,
REMsleepisassociatedwithincreasedproductionofproteins.OnestudyfoundthatREM
sleepaffectslearningofcertainmentalskills.Peopletaughtaskillandthendeprivedof
nonREMsleepcouldrecallwhattheyhadlearnedaftersleeping,whilepeopledeprived
ofREMsleepcouldnot.
Somescientistsbelievedreamsarethecortex'sattempttofindmeaningintherandom
signalsthatitreceivesduringREMsleep.Thecortexisthepartofthebrainthatinterprets
andorganizesinformationfromtheenvironmentduringconsciousness.Itmaybethat,
givenrandomsignalsfromtheponsduringREMsleep,thecortextriestointerpretthese
signalsaswell,creatinga"story"outoffragmentedbrainactivity.
ReturntoIndex
SleepandCircadianRhythms
Circadianrhythmsareregularchangesinmentalandphysicalcharacteristicsthatoccurin
thecourseofaday(circadianisLatinfor"aroundaday").Mostcircadianrhythmsare
controlledbythebody'sbiological"clock."Thisclock,calledthesuprachiasmaticnucleus
orSCN(seefigure2),isactuallyapairofpinheadsizedbrainstructuresthattogether
containabout20,000neurons.TheSCNrestsinapartofthebraincalledthe
hypothalamus,justabovethepointwheretheopticnervescross.Lightthatreaches
photoreceptorsintheretina(atissueatthebackoftheeye)createssignalsthattravel
alongtheopticnervetotheSCN.
SignalsfromtheSCNtraveltoseveralbrainregions,includingthepinealgland,which
respondstolightinducedsignalsbyswitchingoffproductionofthehormonemelatonin.
Thebody'slevelofmelatoninnormallyincreasesafterdarknessfalls,makingpeoplefeel
drowsy.TheSCNalsogovernsfunctionsthataresynchronizedwiththesleep/wakecycle,
includingbodytemperature,hormonesecretion,urineproduction,andchangesinblood
pressure.
Bydeprivingpeopleoflightandotherexternaltimecues,scientistshavelearnedthat
mostpeople'sbiologicalclocksworkona25hourcycleratherthana24hourone.But
becausesunlightorotherbrightlightscanresettheSCN,ourbiologicalcyclesnormally
followthe24hourcycleofthesun,ratherthanourinnatecycle.Circadianrhythmscanbe
affectedtosomedegreebyalmostanykindofexternaltimecue,suchasthebeepingof
youralarmclock,theclatterofagarbagetruck,orthetimingofyourmeals.Scientistscall
externaltimecueszeitgebers(Germanfor"timegivers").
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Whentravelerspassfromonetimezonetoanother,theysufferfromdisruptedcircadian
rhythms,anuncomfortablefeelingknownasjetlag.Forinstance,ifyoutravelfrom
CaliforniatoNewYork,you"lose"3hoursaccordingtoyourbody'sclock.Youwillfeel
tiredwhenthealarmringsat8a.m.thenextmorningbecause,accordingtoyourbody's
clock,itisstill5a.m.Itusuallytakesseveraldaysforyourbody'scyclestoadjusttothe
newtime.
Toreducetheeffectsofjetlag,somedoctorstrytomanipulatethebiologicalclockwitha
techniquecalledlighttherapy.Theyexposepeopletospeciallights,manytimesbrighter
thanordinaryhouseholdlight,forseveralhoursnearthetimethesubjectswanttowake
up.Thishelpsthemresettheirbiologicalclocksandadjusttoanewtimezone.
Symptomsmuchlikejetlagarecommoninpeoplewhoworknightsorwhoperformshift
work.Becausethesepeople'sworkschedulesareatoddswithpowerfulsleepregulating
cueslikesunlight,theyoftenbecomeuncontrollablydrowsyduringwork,andtheymay
sufferinsomniaorotherproblemswhentheytrytosleep.Shiftworkershaveanincreased
riskofheartproblems,digestivedisturbances,andemotionalandmentalproblems,allof
whichmayberelatedtotheirsleepingproblems.Thenumberandseverityofworkplace
accidentsalsotendtoincreaseduringthenightshift.Majorindustrialaccidentsattributed
partlytoerrorsmadebyfatiguednightshiftworkersincludetheExxonValdezoilspilland
theThreeMileIslandandChernobylnuclearpowerplantaccidents.Onestudyalsofound
thatmedicalinternsworkingonthenightshiftaretwiceaslikelyasotherstomisinterpret
hospitaltestrecords,whichcouldendangertheirpatients.Itmaybepossibletoreduce
shiftrelatedfatiguebyusingbrightlightsintheworkplace,minimizingshiftchanges,and
takingschedulednaps.
Manypeoplewithtotalblindnessexperiencelifelongsleepingproblemsbecausetheir
retinasareunabletodetectlight.Thesepeoplehaveakindofpermanentjetlagand
periodicinsomniabecausetheircircadianrhythmsfollowtheirinnatecycleratherthana
24hourone.Dailysupplementsofmelatoninmayimprovenighttimesleepforsuch
patients.However,sincethehighdosesofmelatoninfoundinmostsupplementscan
buildupinthebody,longtermuseofthissubstancemaycreatenewproblems.Because
thepotentialsideeffectsofmelatoninsupplementsarestilllargelyunknown,mostexperts
discouragemelatoninusebythegeneralpublic.
ReturntoIndex
SleepandDisease
Sleepandsleeprelatedproblemsplayaroleinalargenumberofhumandisordersand
affectalmosteveryfieldofmedicine.Forexample,problemslikestrokeandasthma
attackstendtooccurmorefrequentlyduringthenightandearlymorning,perhapsdueto
changesinhormones,heartrate,andothercharacteristicsassociatedwithsleep.Sleep
alsoaffectssomekindsofepilepsyincomplexways.REMsleepseemstohelpprevent
seizuresthatbegininonepartofthebrainfromspreadingtootherbrainregions,while
deepsleepmaypromotethespreadoftheseseizures.Sleepdeprivationalsotriggers
seizuresinpeoplewithsometypesofepilepsy.
Neuronsthatcontrolsleepinteractcloselywiththeimmunesystem.Asanyonewhohas
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hadthefluknows,infectiousdiseasestendtomakeusfeelsleepy.Thisprobably
happensbecausecytokines,chemicalsourimmunesystemsproducewhilefightingan
infection,arepowerfulsleepinducingchemicals.Sleepmayhelpthebodyconserve
energyandotherresourcesthattheimmunesystemneedstomountanattack.
Sleepingproblemsoccurinalmostallpeoplewithmentaldisorders,includingthosewith
depressionandschizophrenia.Peoplewithdepression,forexample,oftenawakeninthe
earlyhoursofthemorningandfindthemselvesunabletogetbacktosleep.Theamount
ofsleepapersongetsalsostronglyinfluencesthesymptomsofmentaldisorders.Sleep
deprivationisaneffectivetherapyforpeoplewithcertaintypesofdepression,whileitcan
actuallycausedepressioninotherpeople.Extremesleepdeprivationcanleadtoa
seeminglypsychoticstateofparanoiaandhallucinationsinotherwisehealthypeople,and
disruptedsleepcantriggerepisodesofmania(agitationandhyperactivity)inpeoplewith
manicdepression.
Sleepingproblemsarecommoninmanyotherdisordersaswell,includingAlzheimer's
disease,stroke,cancer,andheadinjury.Thesesleepingproblemsmayarisefrom
changesinthebrainregionsandneurotransmittersthatcontrolsleep,orfromthedrugs
usedtocontrolsymptomsofotherdisorders.Inpatientswhoarehospitalizedorwho
receiveroundtheclockcare,treatmentschedulesorhospitalroutinesalsomaydisrupt
sleep.Theoldjokeaboutapatientbeingawakenedbyanursesohecouldtakea
sleepingpillcontainsagrainoftruth.Oncesleepingproblemsdevelop,theycanaddtoa
person'simpairmentandcauseconfusion,frustration,ordepression.Patientswhoare
unabletosleepalsonoticepainmoreandmayincreasetheirrequestsforpain
medication.Bettermanagementofsleepingproblemsinpeoplewhohaveotherdisorders
couldimprovethesepatients'healthandqualityoflife.
ReturntoIndex
SleepDisorders
Atleast40millionAmericanseachyearsufferfromchronic,longtermsleepdisorders
eachyear,andanadditional20millionexperienceoccasionalsleepingproblems.These
disordersandtheresultingsleepdeprivationinterferewithwork,driving,andsocial
activities.Theyalsoaccountforanestimated$16billioninmedicalcostseachyear,while
theindirectcostsduetolostproductivityandotherfactorsareprobablymuchgreater.
Doctorshavedescribedmorethan70sleepdisorders,mostofwhichcanbemanaged
effectivelyoncetheyarecorrectlydiagnosed.Themostcommonsleepdisordersinclude
insomnia,sleepapnea,restlesslegssyndrome,andnarcolepsy.
Insomnia
SleepApnea
RestlessLegsSyndrome
Narcolepsy
Insomnia

Almosteveryoneoccasionallysuffersfromshortterminsomnia.Thisproblemcanresult
fromstress,jetlag,diet,ormanyotherfactors.Insomniaalmostalwaysaffectsjob
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performanceandwellbeingthenextday.About60millionAmericansayearhave
insomniafrequentlyorforextendedperiodsoftime,whichleadstoevenmoreserious
sleepdeficits.Insomniatendstoincreasewithageandaffectsabout40percentofwomen
and30percentofmen.Itisoftenthemajordisablingsymptomofanunderlyingmedical
disorder.
Forshortterminsomnia,doctorsmayprescribesleepingpills.Mostsleepingpillsstop
workingafterseveralweeksofnightlyuse,however,andlongtermusecanactually
interferewithgoodsleep.Mildinsomniaoftencanbepreventedorcuredbypracticing
goodsleephabits(see"TipsforaGoodNight'sSleep").Formoreseriouscasesof
insomnia,researchersareexperimentingwithlighttherapyandotherwaystoalter
circadiancycles.
<back>
SleepApnea

Sleepapneaisadisorderofinterruptedbreathingduringsleep.Itusuallyoccursin
associationwithfatbuilduporlossofmuscletonewithaging.Thesechangesallowthe
windpipetocollapseduringbreathingwhenmusclesrelaxduringsleep(seefigure3).
Thisproblem,calledobstructivesleepapnea,isusuallyassociatedwithloudsnoring
(thoughnoteveryonewhosnoreshasthisdisorder).Sleepapneaalsocanoccurifthe
neuronsthatcontrolbreathingmalfunctionduringsleep.
Duringanepisodeofobstructiveapnea,theperson'sefforttoinhaleaircreatessuction
thatcollapsesthewindpipe.Thisblockstheairflowfor10secondstoaminutewhilethe
sleepingpersonstrugglestobreathe.Whentheperson'sbloodoxygenlevelfalls,the
brainrespondsbyawakeningthepersonenoughtotightentheupperairwaymusclesand
openthewindpipe.Thepersonmaysnortorgasp,thenresumesnoring.Thiscyclemay
berepeatedhundredsoftimesanight.Thefrequentawakeningsthatsleepapnea
patientsexperienceleavethemcontinuallysleepyandmayleadtopersonalitychanges
suchasirritabilityordepression.Sleepapneaalsodeprivesthepersonofoxygen,which
canleadtomorningheadaches,alossofinterestinsex,oradeclineinmental
functioning.Italsoislinkedtohighbloodpressure,irregularheartbeats,andanincreased
riskofheartattacksandstroke.Patientswithsevere,untreatedsleepapneaaretwoto
threetimesmorelikelytohaveautomobileaccidentsthanthegeneralpopulation.Insome
highriskindividuals,sleepapneamayevenleadtosuddendeathfromrespiratoryarrest
duringsleep.
Anestimated18millionAmericanshavesleepapnea.However,fewofthemhavehadthe
problemdiagnosed.Patientswiththetypicalfeaturesofsleepapnea,suchasloud
snoring,obesity,andexcessivedaytimesleepiness,shouldbereferredtoaspecialized
sleepcenterthatcanperformatestcalledpolysomnography.Thistestrecordsthe
patient'sbrainwaves,heartbeat,andbreathingduringanentirenight.Ifsleepapneais
diagnosed,severaltreatmentsareavailable.Mildsleepapneafrequentlycanbe
overcomethroughweightlossorbypreventingthepersonfromsleepingonhisorher
back.Otherpeoplemayneedspecialdevicesorsurgerytocorrecttheobstruction.
Peoplewithsleepapneashouldnevertakesedativesorsleepingpills,whichcanprevent
themfromawakeningenoughtobreathe.
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<back>
RestlessLegsSyndrome

Restlesslegssyndrome(RLS),afamilialdisordercausingunpleasantcrawling,prickling,
ortinglingsensationsinthelegsandfeetandanurgetomovethemforrelief,isemerging
asoneofthemostcommonsleepdisorders,especiallyamongolderpeople.This
disorder,whichaffectsasmanyas12millionAmericans,leadstoconstantlegmovement
duringthedayandinsomniaatnight.SevereRLSismostcommoninelderlypeople,
thoughsymptomsmaydevelopatanyage.Insomecases,itmaybelinkedtoother
conditionssuchasanemia,pregnancy,ordiabetes.
ManyRLSpatientsalsohaveadisorderknownasperiodiclimbmovementdisorderor
PLMD,whichcausesrepetitivejerkingmovementsofthelimbs,especiallythelegs.These
movementsoccurevery20to40secondsandcauserepeatedawakeningandseverely
fragmentedsleep.Inonestudy,RLSandPLMDaccountedforathirdoftheinsomnia
seeninpatientsolderthanage60.
RLSandPLMDoftencanberelievedbydrugsthataffecttheneurotransmitterdopamine,
suggestingthatdopamineabnormalitiesunderliethesedisorders'symptoms.Learning
howthesedisordersoccurmayleadtobettertherapiesinthefuture.
<back>
Narcolepsy

Narcolepsyaffectsanestimated250,000Americans.Peoplewithnarcolepsyhave
frequent"sleepattacks"atvarioustimesoftheday,eveniftheyhavehadanormal
amountofnighttimesleep.Theseattackslastfromseveralsecondstomorethan30
minutes.Peoplewithnarcolepsyalsomayexperiencecataplexy(lossofmusclecontrol
duringemotionalsituations),hallucinations,temporaryparalysiswhentheyawaken,and
disruptednighttimesleep.ThesesymptomsseemtobefeaturesofREMsleepthat
appearduringwaking,whichsuggeststhatnarcolepsyisadisorderofsleepregulation.
Thesymptomsofnarcolepsytypicallyappearduringadolescence,thoughitoftentakes
yearstoobtainacorrectdiagnosis.Thedisorder(oratleastapredispositiontoit)is
usuallyhereditary,butitoccasionallyislinkedtobraindamagefromaheadinjuryor
neurologicaldisease.
Oncenarcolepsyisdiagnosed,stimulants,antidepressants,orotherdrugscanhelp
controlthesymptomsandpreventtheembarrassinganddangerouseffectsoffalling
asleepatimpropertimes.Napsatcertaintimesofthedayalsomayreducetheexcessive
daytimesleepiness.
In1999,aresearchteamworkingwithcaninemodelsidentifiedagenethatcauses
narcolepsyabreakthroughthatbringsacureforthisdisablingconditionwithinreach.The
gene,hypocretinreceptor2,codesforaproteinthatallowsbraincellstoreceive
instructionsfromothercells.Thedefectiveversionsofthegeneencodeproteinsthat
cannotrecognizethesemessages,perhapscuttingthecellsofffrommessagesthat
promotewakefulness.Theresearchersknowthatthesamegeneexistsinhumans,and
theyarecurrentlysearchingfordefectiveversionsinpeoplewithnarcolepsy.
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ReturntoIndex
TheFuture
Sleepresearchisexpandingandattractingmoreandmoreattentionfromscientists.
Researchersnowknowthatsleepisanactiveanddynamicstatethatgreatlyinfluences
ourwakinghours,andtheyrealizethatwemustunderstandsleeptofullyunderstandthe
brain.Innovativetechniques,suchasbrainimaging,cannowhelpresearchers
understandhowdifferentbrainregionsfunctionduringsleepandhowdifferentactivities
anddisordersaffectsleep.Understandingthefactorsthataffectsleepinhealthand
diseasealsomayleadtorevolutionarynewtherapiesforsleepdisordersandtowaysof
overcomingjetlagandtheproblemsassociatedwithshiftwork.Wecanexpecttheseand
manyotherbenefitsfromresearchthatwillallowustotrulyunderstandsleep'simpacton
ourlives.
ReturntoIndex
TipsforaGoodNight'sSleep:
Adaptedfrom"WhenYouCan'tSleep:TheABCsofZZZs,"bytheNationalSleep
Foundation.
Setaschedule:
Gotobedatasettimeeachnightandgetupatthesametimeeachmorning.
Disruptingthisschedulemayleadtoinsomnia."Sleepingin"onweekendsalso
makesithardertowakeupearlyonMondaymorningbecauseitresetsyour
sleepcyclesforalaterawakening.
Exercise:
Trytoexercise20to30minutesaday.Dailyexerciseoftenhelpspeoplesleep,
althoughaworkoutsoonbeforebedtimemayinterferewithsleep.Formaximum
benefit,trytogetyourexerciseabout5to6hoursbeforegoingtobed.
Avoidcaffeine,nicotine,andalcohol:
Avoiddrinksthatcontaincaffeine,whichactsasastimulantandkeepspeople
awake.Sourcesofcaffeineincludecoffee,chocolate,softdrinks,nonherbalteas,
dietdrugs,andsomepainrelievers.Smokerstendtosleepverylightlyandoften
wakeupintheearlymorningduetonicotinewithdrawal.Alcoholrobspeopleof
deepsleepandREMsleepandkeepstheminthelighterstagesofsleep.
Relaxbeforebed:
Awarmbath,reading,oranotherrelaxingroutinecanmakeiteasiertofallsleep.
Youcantrainyourselftoassociatecertainrestfulactivitieswithsleepandmake
thempartofyourbedtimeritual.
Sleepuntilsunlight:
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Ifpossible,wakeupwiththesun,oruseverybrightlightsinthemorning.Sunlight
helpsthebody'sinternalbiologicalclockresetitselfeachday.Sleepexperts
recommendexposuretoanhourofmorningsunlightforpeoplehavingproblems
fallingasleep.
Don'tlieinbedawake:
Ifyoucan'tgettosleep,don'tjustlieinbed.Dosomethingelse,likereading,
watchingtelevision,orlisteningtomusic,untilyoufeeltired.Theanxietyofbeing
unabletofallasleepcanactuallycontributetoinsomnia.
Controlyourroomtemperature:
Maintainacomfortabletemperatureinthebedroom.Extremetemperaturesmay
disruptsleeporpreventyoufromfallingasleep.
Seeadoctorifyoursleepingproblemcontinues:
Ifyouhavetroublefallingasleepnightafternight,orifyoualwaysfeeltiredthe
nextday,thenyoumayhaveasleepdisorderandshouldseeaphysician.Your
primarycarephysicianmaybeabletohelpyouifnot,youcanprobablyfinda
sleepspecialistatamajorhospitalnearyou.Mostsleepdisorderscanbetreated
effectively,soyoucanfinallygetthatgoodnight'ssleepyouneed.
Forinformationonotherneurologicaldisordersorresearchprogramsfundedbythe
NationalInstituteofNeurologicalDisordersandStroke,contacttheInstitute'sBrain
ResourcesandInformationNetwork(BRAIN)at:
BRAIN
P.O.Box5801
Bethesda,MD20824
(800)3529424
www.ninds.nih.gov
Preparedby:
OfficeofCommunicationsandPublicLiaison
NationalInstituteofNeurologicalDisordersandStroke
NationalInstitutesofHealth
Bethesda,MD20892

NINDShealthrelatedmaterialisprovidedforinformationpurposesonlyanddoesnot
necessarilyrepresentendorsementbyoranofficialpositionoftheNationalInstituteof
NeurologicalDisordersandStrokeoranyotherFederalagency.Adviceonthetreatment
orcareofanindividualpatientshouldbeobtainedthroughconsultationwithaphysician
whohasexaminedthatpatientorisfamiliarwiththatpatient'smedicalhistory.
AllNINDSpreparedinformationisinthepublicdomainandmaybefreelycopied.Credit
totheNINDSortheNIHisappreciated.
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NIHPublicationNo.063440c
LastupdatedJuly25,2014

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