Sleep is one of the most important parts of our day. The average adult needs between seven to nine hours, but there is variability among individuals. Children and adolescents need more sleep than adults.
Although we are still learning about what happens during sleep and why no living organism can survive without it, we have learned a great deal about the consequences of impaired sleep. Consistently getting less than five hours of sleep puts one at risk for a variety of health conditions and increased risk of early death. The World Health Organization has declared sleep loss an epidemic throughout industrialized nations.
Common Sleep Disorders
Sometimes sleep impairment is self-induced, caused by the demands of our busy lifestyles and our frequent use of technology. In other cases, it is caused by specific disorders, such as the following:
Obstructive Sleep Apnea is a very common disorder in which the airway narrows or closes when we sleep and this leads to cessation of breathing (apnea) or reduction in breathing (hypopnea). This leads to oxygen level reduction and arousals from sleep. Poor sleep, daytime tiredness, inability to concentrate, and high blood pressure are common signs and symptoms of obstructive sleep apnea. Snoring can also be a sign, but not everyone who snores has sleep apnea.
The risk factors for obstructive sleep apnea are obesity and age, but other factors are also considered. If you are worried you have sleep apnea, you will likely be given a screening tool called STOP-BANG to measure your risk. It stands for snoring, tiredness, observed breathing pauses, pressure (hypertension), body mass index, age, neck circumference and gender. If you have several risk factors, a sleep study in a sleep lab or a home sleep test would be ordered by your provider to confirm the diagnosis.
Treatment options depend on the severity of the sleep apnea. Mild sleep apnea may be treated with efforts at weight loss, oral appliance, surgery, or positive airway pressure (CPAP or BiPAP). Positive airway pressure is pressure that is delivered through some type of mask that keeps the airway open. More severe sleep apnea is treated CPAP or BiPAP.
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Insomnia, or the inability to fall or stay asleep, is the most common sleep disorder. Typically, it has to be associated with impairment or symptoms during the day, including daytime fatigue, poor concentration and even psychological distress. It is often associated with other medical conditions including depression and anxiety.
Unfortunately, many times, insomnia it is related to poor sleep habits. The first step in treating insomnia should be evaluating one’s sleep habits. Common mistakes are watching TV in bed or using electronics including phones and computers. This is an absolute no-no for anyone with insomnia. Electronics should be shut off at least one hour before bedtime so people can focus on unwinding. It is also very important to maintain a stable sleep schedule that doesn’t vary from night-to-night. Patients with insomnia should absolutely not nap. Caffeine should be limited and not used after noon, and alcohol should be avoided.
Cognitive behavioral therapy for insomnia is a highly effective treatment, but unfortunately it is not readily available. The cognitive part of CBT-I teaches you to recognize and change beliefs that affect your ability to sleep. This type of therapy can help you control or eliminate negative thoughts and worries that keep you awake. The behavioral part of CBT-I helps you develop good sleep habits and avoid behaviors that keep you from sleeping well. Sleep medications may be needed, but the risks versus benefits should be weighed carefully and ideally, it should only be used in the short-term, although there may be individuals who require long-term use.
Circadian Rhythm Disturbances are types of sleep disorders that affect our circadian rhythm, the internal pacemaker that assists with our sleep/wake cycles. They include shift work sleep problems, sleep phase delay and jet lag, which is a temporary condition related to travel across time zones.
When we work night shifts, we force ourselves to operate counter to natural circadian rhythms. This leads to the inability to sleep during the day and be awake at night. Shift work gets more difficult as we get older and there has been some evidence of long-term health consequences of long-term night shift work. Avoiding shift work sleep problems requires strict sleep hygiene. The same sleep schedule should ideally be maintained on days off to avoid fluctuation. Given the need to sleep during the day, the sleep room should be kept dark and quiet with no distractions. Occasionally, sleep medications or medications to help you stay awake during night hours may be needed.
Another common sleep disorder which is frequently seen in adolescents is circadian sleep phase delay. This is the inability to go to sleep at the usual time of 9 to 11 p.m., because the brain is not ready to go to sleep. Sleep may not come on until after midnight, but the awakening time because of school or work is still early, which leads to sleep deprivation. This disorder is often exacerbated by poor sleep hygiene such as the use of electronics at night. However, even with an individual doing everything correctly, it may be very difficult to address this problem. Besides good sleep hygiene and avoiding behaviors that can worsen this, allowing the individual to match their rhythm is a good solution. However, this may not be possible with education/work requirements. Treatment with melatonin and light box therapy may help to shift the rhythm, but should be done at the direction of a sleep specialist. Typically, as we get older, this issue resolves.
Sleep Disorder Resources
If you are having any of these or other sleep related concerns, you should make an appointment to speak with your doctor.
The Columbus Community Hospital Sleep Lab also offers comprehensive sleep testing to diagnose a wide variety of sleep-related disorders. The lab is staffed by registered polysomnography technologists, who are accredited by the American Academy of Sleep Medicine and are under the medical direction of board-certified sleep physician, Kevin Reichmuth, MD of Nebraska Pulmonary Specialties, LLC. For more information on these services, visit www.columbushosp.org.