Sleep Disorders

Good sleep is good medicine for the body. Sleep disorder or deprivation is dangerous to overall health and can expose individuals to the risk of chronic disease, worsen cognitive ability, and motor performance. 

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Normal Sleep Architecture:

Normal sleep architecture consists of 4-6 sleep cycles during a 6-8 hours of sleep. Each cycle is approximately 90-120 minutes long and consists of 4 stages. Each of these 4 stages is important and serves specific purpose. 

Stage 1 - Typically short NREM light sleep lasts 5-10 minutes and initiates sleep.

Stage 2 - Light NREM sleep - Shorter the better. This lasts about 10 - 40 minutes and does not provide much restoration. It is better to have less of this. 

Stage 3 - Deep NREM, delta or slow wave. This stage lasts 10 - 40 minutes. This is most critical for restorative benefits. This stage focuses on memory, critical thinking and almost all eight domains of cognitive function.

Stage 4 - Rapid eye movement REM sleep - This stage can last 10-60 minutes and gets shorter with advancing age. This stage focuses on creativity, consolidates thoughts patterns, behavior and personality. 

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Sleep - Quantity and Quality 

 

Conventional wisdom and scientific evidence based recommendations call for 6-8 hours of sleep each night with some variability based upon age group and physical activity. However, sleep quality is just as, if not more important than quantity. After all, the purpose of sleep is to provide restoration. 10 hours of non-restorative sleep is no better than 5 hours of restorative sleep.

Genetic mutations in the DEC2 gene can result in need for sleep but these mutations are exceedingly rare. 

Below are two different nights of my sleep pattern. 

At first glance, it may appear that the night with 6 hours and 30 minutes of sleep is better than the night night with 4 hours and 1 minute of sleep. But looking at the details,

4 hours of sleep consisted of 51 minutes amount of deep and restorative sleep. Conversely, 

6 hours and 30 minutes provided only 35 minutes of deep sleep. Needless to stay, I felt more refreshed, energized and had more energy toward the end of the day with just 4 hours of sleep than 6 and a half hours of sleep the night before. 

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5 TYPES OF SLEEP DISORDERS

1. Insomnia

This is characterized by difficulty in getting to sleep and staying asleep. It leads to excessive daytime sleepiness and resultant health problems due to continual sleep deprivation. This is commonly initiated by;

  • Lifestyle related causes such as, 

    • Stress of life, work, environment

    • Poor sleeping habits or irregular sleep schedule

    • Poor diet and unhealthy eating pattern

  • Medical and psychiatric conditions such as,

    • Physical illness or pain

    • Medications like antidepressants, anti-asthma medications, etc.

    • Mental health disorders like depression and anxiety

    • Degenerative causes such as old age

    • Neurological problems such as dementia and Alzheimer’s disease

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2. Excessive Sleepiness

Excessive sleepiness can have drastic long term effects on health and is characterized by drowsiness and sluggishness which interfere with daily activities. This is commonly caused by:

  • Poor sleeping habits like irregular sleep schedule

  • Side effects from certain medications

  • Underlying Medical conditions which lead to excessive fatigue such as 

    • chronic infections​

    • autoimmune conditions

    • metabolic disorders

    • endocrine or hormone disorders 

3. Excessive Sleepiness Associated with Obstructive Sleep Apnea

Just as the name implies; “apnea” refers to interruption or break in breathing.

 

Obstructive sleep apnea is an obstruction to breathing that occurs during sleep, which causes sleep fragmentation that results in excessive sleepiness during the day. Individuals with OSA snore loudly and choke/gasp between episodes.

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4. Shift Work Disorder

This is a sleep order directly related to an individual’s work schedules, in which case, the body’s internal clock, also known as ‘Circadian rhythm’, is disoriented due to irregular work schedules that cause irregular sleep habits.

 

Shift workers are prone to excessive sleepiness resulting from insufficient sleep or sleep deprivation, alongside other health risks like high blood pressure and cardiac diseases.

5. Circadian Rhythm or Non-24-Hour Sleep Wake Disorder

The ability to sleep at night and be awake in the day is controlled by an endogenously generated near-24-hour ‘circadian’ clock rhythm (that is, an “internal body clock”).

 

Patients with Non-24 hour disorder have disrupted circadian clock not in sync with the 24-hour day-night cycle due to the inability of light to reach the suprachiasmatic nuclei (SCN) in the brain that synchronizes the circadian system.

This condition is common among blind people for their visual disorder that causes loss of light perception, which resultantly prevents the light-dark cycle from synchronizing their internal body clock

Additional Common Conditions Associated with Sleep Disorder

 

1. Narcolepsy

Narcolepsy is a sleep disorder characterized by hallucinations, cataplexy, excessive daytime sleepiness, sleep disruption, and sleep paralysis. It has an underlying genetic influence and having a relative with narcolepsy might mean a possibility of developing the disorder.

2. Restless Legs Syndrome (RLS)

Also known as Willis-Ekbom-Disease, is a movement disorder characterized by an overwhelming urge to move the legs while they are at rest which is accompanied by unpleasant sensations. Symptoms are most severe in the night time or during inactivity and are temporarily relieved by movement or pressure.

Treating Sleep Disorders

Non Pharmacologic Solutions:

 

Some of the root causes of sleep disorders are nutritional, environmental, hormone imbalances., medication side effects, emotional and psychological causes.

 

These implicated causes can be treated via lifestyle modifications in the following ways:

  1. Optimizing diet, environment, and sleep hygiene.

  2. Removing stimulants

  3. Increasing physical activity

  4. Behavioral medicine, such as mindfulness, meditation, and breathing techniques

  5. Adaptogens such as ashwagandha, rhodeola, and Holy basil are prescribed to treat stress, anxiety, and depression.

  6. Polyphasic or Biphasic Sleep Routine can improve productivity and sleep efficiency if circumstances allow. 

    • Polyphasic sleepers rest in shorter periods throughout the day rather than one long sleep overnight. One of the most widely applied schedules involves a longer (1 to 6 hour) period of rest, complimented by several 20-minute naps. At the other end of the spectrum, another schedule involves napping only, resulting in a measly 2 to 3 hours sleep over a 24-hour period. 

    • Biphasic sleep involves sleeping for a long duration at night, for 5-6 hours, and having a shorter period of sleep or siesta during the day. The shorter period of rest typically lasts 30 minutes and gives an energy boost to finish the day. However, a siesta can last for longer, perhaps 90 minutes. An extended siesta of 90 minutes allows a person to have one complete cycle of sleep. Some say that biphasic sleep is a healthier sleep pattern than a monophasic pattern, and some countries have adopted a biphasic sleep pattern as the normal one.

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MEDICATIONS FOR TREATING SLEEP DISORDERS