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Sleep: The Foundation for Good Health

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Sleep plays an integral role in helping each of us enjoy longer, healthier lives. Everybody experiences restless nights and the occasional struggle to fall asleep, but continuously experiencing sleep disturbance can affect your mental and physical well-being. Cooper Clinic Sleep Medicine Physician, Sonya Merrill, MD, PhD, FACP, discusses the importance of a good night’s rest and things that could be hindering you from obtaining the restorative rest you need. 

Normal Sleep
Most adults need seven to eight hours of sleep each night to feel fully rested and prepared for the day. Some individuals can function on five to six hours (short-sleepers) while others may need nine to ten (long-sleepers). A normal night of sleep is comprised of both Non-REM (“Rapid Eye Movement”) and REM sleep.  

Non-REM sleep has three stages:

  • N1 is a light, brief, transitional phase that occurs just after sleep onset. During this stage your heart rate and breathing start to slow down. You can be easily awakened in this stage.
     
  • N2 is the sleep stage you are in for the majority of the night. It is harder to be awakened from this stage. Your heart rate slows down and your body temperature drops even more as your muscles start to relax.
     
  • N3 is a deep sleep and is an important restorative stage of the sleep cycle. Your body is fully relaxed in this stage. If you wake from this stage, you may feel groggy and disoriented. 

The onset of REM sleep occurs approximately one to two hours after falling asleep. We spend about 20% of the night in this stage. REM sleep is characterized by rapid eye movements, hence the name, and vivid dreams. All muscles, including arms and legs, become temporarily paralyzed, preventing you from acting out your dreams. After completing both the Non-REM and REM sleep stages, the cycle begins again.

“Sleep is the foundation on which good health and wellness is built,” says Dr. Merrill. Not getting adequate sleep each night impedes your ability to function properly and do things you enjoy such as exercising and other activities with your friends and family. More seriously, sleep disorders such as sleep apnea can affect heart health and increase your risk of developing cardiovascular disease.

Common sleep disorders
Sleep disorders are common but often under-recognized. “There is a lot of complexity to the field of sleep medicine but there are not a lot of doctors trained in all areas of the field,” says Dr. Merrill. Some common sleep issues can include:

  • Insomnia: Difficulty falling or staying asleep, or waking up too early in the morning 
  • Sleep apnea: Pauses in breathing during sleep often associated with snoring
  • Restless legs syndrome: Creepy-crawly feelings in the legs with the urge to move, making it hard to fall asleep
  • Periodic limb movement disorder: Leg kicks or jerks during sleep
  • REM behavior disorder: Acting out dreams while still asleep
  • Sleepwalking: Common in children but not adults
  • Sleep paralysis: Waking up unable to move
  • Narcolepsy: Sudden “sleep attacks”
  • Idiopathic hypersomnia: Excessive sleepiness in the daytime for reasons not yet understood

“Many times, patients experiencing a sleep disorder will be less aware of it than their partner or spouse,” says Dr. Merrill. “The bed partner will be disturbed by snoring or be concerned that the breathing sounds heavy or otherwise abnormal and will point it out.” However, as time goes on people become more aware of their sleep problems through negative changes in their daily life. These could include not being able to focus at work or school, falling asleep during things you enjoy or are normally engaged in or even “zoning out” for brief periods of time. More serious effects from lack of sleep could include getting into a car accident or seeing a change in your health over a period of time. Dr. Merrill recommends seeing a doctor about your sleep issues if you notice these types of changes in your life and functions.   

What could be keeping you awake at night?
Nutrition, screen time and exercise all affect our quality of sleep at night. “Caffeine should be avoided eight to 10 hours before bed. If you often wake up hungry in the middle of the night, eating a protein-rich snack such as cheese or a handful of nuts before bed can help.” Avoiding sugary, spicy and high-carb snacks can help you sleep peacefully and prevent your gut from bothering you in the middle of the night. 

Participating in vigorous exercise in the evening could also be affecting your sleep. “It is best to avoid vigorous exercise 4-5 hours before bed,” says Dr. Merrill. Going to a gym with loud music and bright lights can be overly stimulating and keep your mind active long after you’ve left. Going on a walk or stretching shouldn’t affect your sleep and can actually promote sleep.

Light is another factor that can interfere with a good night’s rest. The pineal gland in the brain produces the equivalent of about 0.3 mg of melatonin to promote sleep, but when light is present, melatonin release is suppressed. Your phone produces blue light which can not only affect your eyes but also keep you awake. “Try to avoid having devices close to your face in the evening,” says Dr. Merrill. “Reading a book, stretching or meditating before bed can all aid in getting a better night’s rest.” If using your phone before bed, turn on nighttime mode, if available, to reduce the amount of light to your eyes. 

Diagnosing and treating sleep disorders
Sleep studies (“polysomnograms”) can be used to diagnose sleep disorders.  Painless surface electrodes are placed on the scalp, face and limbs to record information about sleep stages, eye movements and limb movements. Air flow sensors also are used to investigate the possibility of sleep apnea. Many sleep medicine practices offer in-home as well as on-site sleep studies. In-home sleep tests may be more convenient, but the results are less comprehensive and accurate than those obtained in the sleep lab setting. 

Over-the-counter sleep aids such as melatonin have grown in popularity over the years and can be found in most stores. “The problem with melatonin is you typically only find higher doses of 3 to 10 mg,” says Dr. Merrill. “Since the brain only produces a tiny amount of melatonin, the doses available for purchase are typically much too high. Many individuals who take high doses of melatonin experience side effects such as sluggishness in the morning and vivid nightmares or dreams.” The American Academy of Sleep Medicine does not recommend either prescription or over-the-counter sleep aids as the first course of action in treating insomnia, but instead cognitive behavioral therapy (CBT-I) and mindfulness practices such as meditation, progressive muscle relaxation and breathing exercises. 

For patients with sleep apnea, continuous positive airway pressure (CPAP) is the “gold standard” treatment. A CPAP machine delivers air pressure through a mask placed over the nose or over the nose and mouth while you sleep. This alleviates both snoring and sleep apnea, facilitating a more restful night of sleep.

“Most sleep disorders can be successfully treated if you just ask for help,” says Dr. Merrill. Your health is your responsibility and sleep is included in that. Asking your doctor more questions about your quality and quantity of sleep can help you maintain a healthy lifestyle. It may take some time to diagnose and treat your sleep disorder, but sticking to a plan created by you and your physician is critical in improving your overall health and well-being. 

Cooper Clinic offers Sleep Medicine as a specialty service—including sleep lab-based studies and in-home testing. To learn more about Cooper Clinic Sleep Medicine and the importance of sleep to improve your quality and quantity of life, visit cooper-clinic.com or call 866.906.2667.