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13. Common Sleep Disorders Overview.
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Effects of sleep deprivation:
The air pressure is adjusted so that it is just enough to prevent the throat from collapsing during sleep. The pressure is constant and continuous. Nasal CPAP prevents airway closure while in use, but apnea episodes return when CPAP is stopped or it is used improperly.
These treatments deliver room air to the sleeper’s nasal airway through a nose mask at a pressure that is sufficient to keep the upper airway open and facilitate normal breathing.
The machine must be used on a nightly basis, every time the patient sleeps, in order for it to be truly effective. This can be challenging for some people, who find it difficult to use the system regularly.
Others may experience “adverse effects” associated with nasal CPAP use, such as nasal congestion, dryness, or feelings of claustrophobia.
The difficulties one has accommodating to nasal CPAP can interfere with treatment compliance. Studies have shown that 20% - 60% of patients abandon the use of nasal CPAP despite the health consequences of doing so.
Variations of the CPAP device attempt to minimize side effects that sometimes occur, such as nasal irritation and drying, facial skin irritation, abdominal bloating, mask leaks, sore eyes, and headaches.
Some versions of CPAP vary the pressure to coincide with the person’s breathing pattern, and other CPAPs start with low pressure, slowly increasing it to allow the person to fall asleep before the full prescribed pressure is applied.
Dental appliances that reposition the lower jaw and the tongue have been helpful to some patients with mild to moderate sleep apnea or who snore but do not have apnea. A dentist or orthodontist is often the one to fit the patient with such a device.
However, most doctors usually recommend treatment with nasal continuous positive airway pressure (CPAP).
Surgery
Some patients with sleep apnea may need surgery. Although several surgical procedures are used to increase the size of the airway, none of them is completely successful or without risks.
More than one procedure may need to be tried before the patient realizes any benefits.
There are several physical factors that can contribute to the occurrence of sleep apnea.
Excessive or redundant tissue in the upper airway (the part of the airway between the tip of one’s nose to the base of one’s tongue) can be one important causative factor.
Therefore, some specialists, known as “Ear, Nose, and Throat” doctors have developed several techniques that can be used to effectively treat snoring and sleep apnea.
Somnoplasty is a simple, bloodless procedure that is used to treat snoring by using needle-tip radiofrequency to minimize the soft tissue in the upper airway.
Somnoplasty is a procedure that uses radiowaves to reduce the size of some airway structures such as the uvula and the back of the tongue. This technique is being investigated as a treatment for apnea
Uvulopalatopharyngoplasty (UPPP) is a procedure used to remove excess tissue at the back of the throat (tonsils, uvula, and part of the soft palate). The success of this technique may range from 30 to 60 percent.
The long-term side effects and benefits are not known, and it is difficult to predict which patients will do well with this procedure. Uvulopalatopharyngoplasty (UPPP) and laser-assisted uvulopalatoplasty (LAUP) are two procedures that excise (cut out) or reduce excessive tissue in the back of the throat.
Like UPPP, LAUP may decrease or eliminate snoring but not eliminate sleep apnea itself. Elimination of snoring, the primary symptom of sleep apnea, without influencing the condition may carry the risk of delaying the diagnosis and possible treatment of sleep apnea in patients who elect to have LAUP.
To identify possible underlying sleep apnea, sleep studies are usually required before LAUP is performed.
Tracheostomy is used in persons with severe, life-threatening sleep apnea. In this procedure, a small hole is made in the windpipe and a tube is inserted into the opening.
This tube stays closed during waking hours, and the person breathes and speaks normally. It is opened for sleep so that air flows directly into the lungs, bypassing any upper airway obstruction.
Although this procedure is highly effective, it is an extreme measure that is rarely used.
Other procedures: Patients in whom sleep apnea is due to deformities of the lower jaw may benefit from surgical reconstruction. Finally, surgical proced-ures to treat obesity are sometimes recommended for sleep apnea patients who are morbidly obese.
Some of the more common procedures include removal of adenoids and tonsils (especially in children), nasal polyps or other growths, or other tissue in the airway and correction of structural deformities.
Younger patients seem to benefit from these surgical procedures more than older patients.
Other surgical procedures such as genioglossus advancement, bimaxillary advancement, also may be attempted during the course of surgical treatment of sleep apnea.
Approximately 1/3 of patients who undergo surgical treatment for sleep apnea will realize improvement in respiration during sleep.
The well-documented relationship between obesity (overweight) and sleep apnea has led to the use of certain surgeries for obesity, known as bariatric surgery, used in the interest of treating some cases of sleep apnea.
Patients who are considering surgical treatments for sleep apnea should speak to their primary care doctors and/or Ear, Nose, & Throat doctors.
Thorough evaluation in an accredited sleep laboratory is appropriate before and after surgery in order to document the problem and improvement with treatment.
Oral Appliances
Snoring and mild sleep apnea may be treated with the use of an oral appliance. An oral appliance is a device that is worn over the teeth during sleep in order to keep the sleeper’s jaw fixed in a “forward” position.
Some devices also aid in maintaining a stationary position of the sleeper’s tongue. Oral appliances help to open the upper airway and facilitate airflow during sleep. A dental sleep specialist usually must fit these devices.
2. Restless Legs Syndrome
Restless legs syndrome (RLS) is not often discussed, but is actually fairly common, occurring in 10-15% of the population.
People with RLS complain of a discomfort in the legs (rarely the arms or chest) that is relieved only by walking. The feeling is often described as ants crawling on the skin.
This uncomfortable sensation only occurs when a person is not moving (either sitting still or lying down) and is always worse at night. Generally, people afflicted with RLS also notice that they unconsciously move their legs as well.
Sometimes they describe their legs as jumping on their own, or they notice that while sitting, they are constantly jiggling them. Since RLS occurs mostly at night while the body is at rest and is relieved by movement, falling asleep and staying asleep can become very difficult.
Even when RLS sufferers manage to fall asleep, they have frequent jerking of the limbs called periodic limb movements of sleep (PLMS).
Many elderly people develop PLMS – 34% of those over age 60 – even people who do not suffer from RLS and who have no other sleep complaints.
The number of people who have the symptoms of RLS increases with age, and some people who had mild symptoms when they were younger may find that the symptoms get much worse as they age.
There are many different medications available to treat both RLS and PLMS. These include medications that are usually used for Parkinson's disease, pain control and seizure disorders.
It is important never to treat yourself for this condition, but instead to see a doctor with special knowledge about the diagnosis and treatment of RLS.
If you have restless legs syndrome (RLS), you may recognize these symptoms:
An urge to move the legs, often accompanied by uncomfortable sensations in the legs, usually described as a creeping or crawling feeling, but sometimes as a tingling, cramping, burning or just plain pain.
Some patients have no definite sensation, except for the need to move. (The arms may also be affected, but that's much less common.)
The need to move the legs to relieve the discomfort, by stretching or bending, rubbing the legs, tossing or turning in bed, or getting up and pacing the floor. Moving usually offers some temporary relief of symptoms.
A definite worsening of the discomfort when lying down, especially when you're trying to fall asleep at night, or during other forms of inactivity, including just sitting.
A tendency to experience the most discomfort late in the day and at night. Sleep disturbances are common with RLS and are a major effect.
The sleep disturbances can range from mild to severe, but sleep problems are often the reason that people suffering from RLS seek a doctor's help.
If leg twitching or jerking is also present, a related disorder called periodic limb movements during sleep (PLMS) may be the cause. With PLMS, the leg movements may be severe enough to awaken you.
In RLS, PLMS-like symptoms can sometimes occur during wakefulness, as well as in sleep.
According to the National Center on Sleep Disorders Research, "restless legs syndrome is a common, under diagnosed, and treatable condition."
Recent research suggests it affects about 10% of adults in North America and Europe with rates increasing with age.
Lower prevalence has been found in India, Japan and Singapore, indicating that racial or ethnic factors are associated with RLS.
The cause of RLS is still unknown, but the symptoms tend to worsen over the years and become more severe in middle-to-old age.
The fact that it occurs three to five times more frequently in first-degree relatives of people with RLS than in people without RLS suggests that heredity may be involved. Pregnancy or hormonal changes may temporarily worsen RLS symptoms.
Some cases of RLS are associated with iron deficiency anemia or nerve damage in the legs due to diabetes, kidney problems, alcoholism and Parkinson's disease. Stress, diet or other environmental factors may play a role for some people.
All of these cases are said to be secondary RLS. If there is no family history of RLS and no associated condition causing the disorder, RLS is said to be idiopathic, meaning without a known cause.
Because RLS patients were found to respond positively to treatment with levodopa, scientists have been investigating whether RLS is caused by dopamine deficiency.
Dopamine is a chemical found naturally in the central nervous system where it largely functions as a neurotransmitter.
RLS can begin at any age and many individuals with RLS can trace their symptoms back to childhood, when their symptoms may have been called "growing pains" or attributed to hyperactivity because they had difficulty sitting quietly
The symptoms of RLS can range anywhere from bothersome to incapacitating. Fluctuations in severity are common, and occasionally the symptoms may disappear for periods of time.
Anxiety as bedtime approaches, frustration with nighttime awakenings, moodiness and depression, difficulty concentrating and excessive daytime sleepiness have all been reported in association with RLS.
It also can affect marital, family and social relations as well as having an adverse effect on school, work or other activities. Another effect can be increased drowsiness while driving or great difficulty performing overnight shift work.
The International Restless Legs Syndrome Study Group has established the following clinical criteria for diagnosis of RLS:
• A compelling urge to move the limbs.
• Motor restlessness; for example, floor pacing, tossing and turning,
and rubbing the legs.
• The symptoms may be worse or exclusively present at rest, with
variable and temporary relief by activity.
• Symptoms are worse in the evening and at night.
Other associated features commonly found in RLS include:
• Sleep disturbances and daytime fatigue.
• Normal neurological exam in primary RLS.
• Involuntary, repetitive, periodic, jerking limb movements, either
in sleep or while awake and at rest.
Most cases of RLS respond well to medical treatment. According to NCSDR, there are a number of pharmacological treatments for RLS.
Iron (ferrous sulfate), which is used in patients with serum ferritin levels of <50 mcg. Clonidine may be useful in hypertensive patients.
Try sleeping with your feet at a cooler temperature than the rest of your body, especially if you currently sleep with bed socks.
Simply stick your feet out from under the covers and let yourself adjust to the coolness of your feet. If very hot weather, soak your feet in cool water before going to bed.
NCSDR notes that dopaminergic agents are the first-line drugs for most RLS patients. They are usually used to treat Parkinson's disease, but they also help to relieve RLS symptoms.
Periodic limb movements in sleep are repetitive movements, most typically in the lower limbs, that occur about every 20-40 seconds.
If you have PLMS, or sleep with someone who has PLMS (also referred to as PLMD, periodic limb movement disorder), you may recognize these movements as brief muscle twitches, jerking movements or an upward flexing of the feet.
They cluster into episodes lasting anywhere from a few minutes to several hours.
Individuals with PLMS may also experience restless legs syndrome (RLS), an irritation or uncomfortable sensation in the calves or thighs, as they attempt to fall asleep or when they awaken during the night.
Walking or stretching may relieve the sensations, at least temporarily (see the RLS fact sheet).
However, research also shows that many individuals have PLMS without experiencing any symptoms at all. It's not unusual for the bed partner to be the one who's most aware of the movements, since they may disturb his/her sleep.
3. REM Behavior Disorder
REM behavior disorder (RBD) occurs when someone acts out a dream in his or her sleep.
Usually when you dream, your muscle tone is decreased – you are, in fact, partially paralyzed. In rare instances, some people do not have a decrease in their muscle tone and begin to act out their dreams.
In addition, the dreams frequently become more violent than normal, and are often described as nightmares. The classic situation is one in which someone wakes up punching a pillow and remembers dreaming he was in a fight.
RBD is very rare, occurring most frequently in older men. Common causes of RBD include the use of certain medications (especially anti-depressants such as Prozac and Paxil) and withdrawal from certain sedatives (such as alcohol).
RBD can also be associated with Parkinson's Disease, narcolepsy, and certain other neurologic diseases (e.g. rare brain degeneration disorders, strokes in certain areas of the brain).
Usually, however, the cause is a mystery. Fortunately, there is effective medication for this problem.
4. Insomnia
There is no medical test that can tell us conclusively whether a person has insomnia.
Sometimes, sleep tests can be normal in the face of severe sleep complaints
Simply stated, insomnia is the inability to fall asleep or stay asleep, the tendency to awaken early in the morning, or the sense of light and un-refreshing sleep.
Insomnia is simply an impression that the sufferer has regarding the quantity or quality of his sleep.
Insomnia is a common malady.
Half of the adult population has it over the course of a year; 35% experience insomnia on an occasional basis;12% on an ongoing basis.
It is not surprising that sleep difficulties are also among the most frequently encountered problems in clinical medicine.
Insomnia affects all ages, yet increases in prevalence with age.
Women are twice as likely to have it compared to men. It is seen in all cultures and races.
Physicians often overlook the misery and debilitation associated with insomnia. Additionally, only 5% of all insomniacs approach their physicians specifically for insomnia as a primary complaint.
Recent studies have shown, however, that insomnia can have profound negative effects on health and well being. Insomniacs report difficulties with memory and task completion, are often irritable, and have greater difficulty staying awake during daytime tasks than non-insomniacs.
Inadequate sleep is associated with decreased work efficiency. Although the long-term risks of insomnia have not been adequately assessed, there is an emerging sense that unrelenting insomnia can bring on depression and other emotional difficulties.
Insomnia has long been assumed to be simply the result of tension or stress. However, key developments over the past four decades have helped tease apart and identify the many physical and emotional disorders that can be responsible for insomnia.
The first of these was the discovery that sleep is not a uniform state, but a combination of five separate sleep stages. The second was the technical discovery of "polysomnography," the physiological study of sleep in a laboratory setting, which led to the establishment of the field of sleep disorders medicine.
It is now clear that insomnia is not one entity, but can be a symptom of many different types of disorders, each with its own set of treatments.
The first step in proper treatment, therefore, is accurate diagnosis.
Advice for people first experiencing insomnia
If someone's experiencing sleep problems and they find these problems distressing, or if they're associated with any impairment in daytime functioning, that's the time to talk to a doctor.
We know that insomnia is associated with a number of significant problems in daytime functioning, in health and so on, so there's no need really to go on with the problem unattended. Talk to a doctor whenever insomnia results in distress or impairment.
If you have trouble falling or staying asleep, or you wake up feeling un-refreshed, you may be suffering from insomnia.
Insomnia is a symptom. It may be caused by stress, anxiety, depression, disease, pain, medications, sleep disorders or poor sleep habits.
The cause of insomnia has been identified and is best treated with medication.
5. Adjustment Sleep Disorder
Sudden emotional stress, such as a job loss or a hospitalization, can induce transient insomnia. Sudden changes in work shift and travel across time zones can also cause difficulties with sleep.
However, these difficulties usually resolve within a brief period of time, typically a few weeks. Many insomniacs, however, unknowingly intensify the effect of, or unnecessarily prolong, these insomnias by engaging in behaviors that make matters worse.
Therefore, proper adherence to sleep hygiene rules can be helpful in producing a more rapid resolution to this type of insomnia. Examples of sleep hygiene measures include:
• Maintain a regular bedtime schedule.
• Avoid excessive time in bed.
• Avoid taking naps.
• Use the bed only for sleeping and sexual relations.
• Do not watch the clock.
• Do something relaxing before bedtime.
• Make the bedroom as quiet as possible.
• Avoid the consumption of alcohol and caffeine within 12 hours of bedtime
• Exercise moderately, regularly, and not within 4 hours of bedtime.
• Avoid going to bed hungry.
Learn strategies to make bedtime as relaxing and tension-free as possible.
In general, no formal medical treatment is necessary for such short-lasting insomnia.
In certain cases, however, such as when daytime fatigue begins to interfere with daily activities, seeking medical attention is warranted.
Medical treatment is also warranted if the insomnia lasts for more than just a few weeks. Although in many insomnia cases, self-help strategies such as those mentioned above are sufficient in overcoming insomnia rapidly, insomnia can escalate and become chronic.
In this case, the causes of insomnia may represent more significant medical or emotional disorders. Therefore, sufferers should seek help if their own strategies do not relieve insomnia within a few weeks.
The disorders below are examples of some of the more common chronic insomnia conditions that warrant further medical attention.
6. Psychophysiologic Insomnia
Psychophysiologic insomnia can follow a few nights of sleeplessness due to an adjustment sleep disorder.
Concern regarding the prospect of facing yet another night of sleeplessness can result in an escalation of tension and anxiety with each successive night.
The insomniac begins to dread going to bed and often feels tension increasing as bedtime approaches.
He may become preoccupied with insomnia. Sufferers often spend hours in bed awake focused upon and brooding over their sleeplessness.
In severe cases, the focus of their thoughts, and even conversations with others, may begin to revolve around insomnia.
Curiously, sufferers often have little difficulty falling asleep during the course of the day when their minds are focused on other issues, such as during meetings.
They also may experience relief from their own bedrooms as they fall asleep easily when away from home, such as on vacation on in a hotel room.
Psychophysiologic insomnia is often managed with a combination of behavioral measures and medications.
The most commonly utilized behavioral measures are relaxation training with EMG biofeedback training, psychotherapy (cognitive and insight-oriented), and stimulus control therapy (asking patients to use the bed only for sleep and to not stay in bed trying to sleep for more than ten minutes at a time, but to go into another room and to return to bed only after feeling sleepy).
Sleep hygiene measures should be closely adhered to during and after the termination of treatment, regardless of type.
7. Snoring
Snoring is a breathing noise that occurs during sleep. It is a common problem among all ages and both genders, and it affects approximately 90 million American adults — 37 million on a regular basis.
Persons most at risk are males and those who are overweight, and it usually becomes more serious as people age.
Snoring can cause disruptions to your bed partner's sleep and is also associated with cardiovascular problems such as high blood pressure, headaches and diabetes.
While breathing in, the air passage between the upper soft palate, or uvula, and the throat or base of the tongue may open and close.
During sleep, the muscles surrounding these structures relax and the air passage may narrow or close — causing a blockage of the airway.
Air cannot flow through easily and may need to be drawn between these structures. The tissues then vibrate — resulting in the familiar sound of snoring.
Snoring represents abnormal breathing during sleep. The loudness and tone of the noise is affected by how much air is going through the passage. The greater the obstruction, the greater is the effort to draw air and the louder the noise.
As it becomes harder to breath and snoring becomes worse, you may actually stop breathing. This is a sign of a serious condition called apnea (meaning "want of breath"), which requires medical attention and may lead to other serious conditions.
The National Sleep Foundation’s (NSF) 2002 Sleep in America Poll revealed that 37% of adults report they had snored at least a few nights a week during the previous year.
In fact, 27% said that they snore every night or almost every night. Males were more likely than females to report snoring at least a few nights a week (42% vs. 31%).
NSF’s 2003 poll, which focused on older adults between the ages of 55-84, reveals that about one-third of older adults overall (32%) report they had snored at least a few nights a week in the past year, with about four in ten 55-64 year-olds (41%) most likely to have said they snore compared to about one-fourth of 65-74 year-olds (28%) and 75-84 year-olds (22%).
Men were significantly more likely than women to report snoring at least a few nights a week (40% vs. 26%).
Snoring may occur due to any of a variety of illnesses, from the common cold to sleep apnea. Although snoring is often a sign of sleep apnea, most snorers do not, in fact, suffer from sleep apnea.
Obesity and a large neck can contribute to snoring. People who drink alcohol before bedtime may snore more than usual. And snoring is sometimes caused by an illness or a sleep disorder.
Risk factors for snoring include: obesity (overweight), hypothyroidism (low thyroid function), and tobacco use.
Some people are born with a small or narrow airway, while others have conditions that interfere with normal breathing (such as nasal polyps or deviated septum).
In either case, snoring is more likely to occur. Snoring also can arise with sleep deprivation, with common colds or allergies, when sleeping on one’s back, or as a result of the use of alcohol or certain sleeping pills
Snoring cures
Most snoring probably is not associated with health concerns, but is a problem that snorers and their loved ones would like resolved.
Simple treatments include weight loss, avoidance of alcohol or sleep aids that relax muscles, treatment of nasal congestion or allergies, or the use of over-the-counter devices such as tape strips that help open your nasal passages.
Every spouse of a snorer can tell you that sleeping on your side also reduces the likelihood of snoring.
Some people can sleep on their sides at will; others might want to try using an old tennis ball sewn into the center of the back of a T-shirt, which “reminds” the sleeper to roll over whenever he’s on his back.
Oral appliances, usually fit by a dentist, may be helpful. Finally, a variety of surgical procedures provided by Ear, Nose, and Throat specialists can provide a long-term solution to the problem of snoring.
Snoring actually may be a health concern for some. Medical reports have shown that snoring is associated with high blood pressure and reports of daytime dysfunction.
Snoring also may be a “warning sign” of a sleep-related breathing disorder known as “sleep apnea.”
Approximately five out of every 100 snorers has sleep apnea, a very serious medical condition that is associated with breathing pauses during sleep (see Sleep Apnea).
People with sleep apnea often suffer from debilitating daytime fatigue and sleepiness, and they are at significantly greater risk than others for stroke, irregular heartbeats, high blood pressure, and death.
The treatment plan for a person with sleep apnea is quite different from one for an individual with simple snoring, so medical evaluation and follow-up care is essential.
There are many different ways to reduce snoring:
• One of the most effective is through weight loss. Reducing your weight will reduce fat deposits in the throat, providing a more spacious airway and usually less snoring.
• Another way to reduce snoring is to improve nasal breathing by using a nasal strip that gently opens your nostrils during sleep. Dental appliances that are also available can be prescribed by your dentist or orthodontist.
• Sleeping on your side with a pillow is the preferable position to help alleviate snoring.
• Two lifestyle changes to consider are avoiding alcohol and cigarettes. Abstaining from alcohol, which relaxes muscles in the airway, at least four hours before bedtime; and abstaining completely from smoking, which is associated with nasal congestion, can help alleviate snoring.
• Finally, ask your doctor for recommendations, so he or she can address your specific snoring situation.
Snoring represents abnormal breathing during sleep. The loudness and tone of the noise is affected by how much air is going through the passage. The greater the obstruction, the greater is the effort to draw air and the louder the noise.
As it becomes harder to breath and snoring becomes worse, you may actually stop breathing. This is a sign of a serious condition called apnea (meaning "want of breath"), which requires medical attention and may lead to other serious conditions.
When your partner snores…..
Nothing is quite as frustrating as trying to sleep and hearing the guttural sounds of your loved one next to you snoring.
It was supposed to be for better or for worse, but no one told you anything about endless nights of being woken up by the frustrating sounds, the bags under your eyes that would follow, and the necessity for you to consume five cups of coffee a day just to stay awake.
So is there a way to get your partner to stop snoring, or will you have to resort to separate bedrooms in order to get the much-needed sleep that you have been deprived of? Don’t give up hope just yet.
Allergies, colds, and blocked airways are common causes of the condition. Sometimes snoring can be caused by a serious condition, but usually snoring can be treated with simple preventative measures.
Since snoring is most common when lying on the back, sometimes getting your partner to stop snoring is as easy as asking them to roll over and sleep on their side.
At other times, the remedy may be much more elusive. Sometimes adding a humidifier to the room will aid in moisturizing the airways and will help reduce snoring symptoms since a dry throat can contribute to soft palate vibrations.
There are also sprays and nose strips that one can use to prevent snoring, though these methods are not as effective as some other widely-available methods have proven to be.
One popular remedy for persistent snoring is the use of a “memory foam” pillow that will properly support the shoulder, neck and head areas. Since improper support of these areas can restrict airflow, a quality pillow can work wonders literally overnight.
If the above remedies don’t eliminate the snoring problem, there could potentially be a more serious condition causing your partner to snore and an appointment with a physician should be made to determine the underlying cause of the condition.
8. Pregnancy insomnia
Pregnancy is an exciting and physically demanding time. Physical symptoms (body aches, nausea, leg cramps, fetus movements and heart-burn), as well as emotional changes (depression, anxiety, worry) can interfere with sleep.
In the NSF poll, 78% of women reported more disturbed sleep during pregnancy than at other times although some women have few sleep problems.
Sleep related problems also become more prevalent as the pregnancy progresses.
One recent study reported that changes in sleep occur in 13-20% of women in the first trimester and increase to 66-90% by the third trimester.
In general, nausea can be experienced early whereas general discomfort may disrupt sleep later in the pregnancy.
First Trimester (Months 1-3)
Overall, women have lower quality of sleep during the last trimester of pregnancy. High levels of progesterone are produced, increasing feelings of sleepiness. Also, the enlarged uterus can press up against the diaphragm, making it more difficult to breathe.
The number of times a woman wakes up during the night to urinate increases as well. Disturbed sleep patterns may begin. Interrupted sleep can cause daytime sleepiness. Women tend to sleep more during this time than before they were pregnant, or later in pregnancy.
Second Trimester (Months 4-6)
During this trimester, the growing fetus reduces pressure on the bladder by moving above it and decreasing the need for frequent bathroom visits.
Sleep quality is still worse than it was before pregnancy and many women become restless as they search for a comfortable position.
Third Trimester (Months 7-9)
Women experience the most pregnancy-related sleep problems at this time although they may sleep longer and nap more by the end of the pregnancy. They may often feel physically uncomfortable.
Heartburn, leg cramps and sinus congestion are common reasons for disturbed sleep, as is an increased need to go to the bathroom. (The fetus puts pressure on the bladder again.)
One recent study reported, that by the end of pregnancy, 97% of women were waking during the night.
Post-Partum
As might be expected, mothers of newborn babies experience a lot of sleeplessness and daytime sleepiness, which may contribute to the "postnatal blues" experienced by 75-80% of most new mothers.
This is usually a temporary condition, but it can become extremely serious and even put a new mother at risk for suicide. In general, it is treatable with professional help and will improve as the baby develops and establishes regular, nighttime sleep.
Snoring and Severe Daytime Sleepiness
Pregnant women who have never snored before may begin doing so. About 30% of pregnant women snore because of increased swelling in their nasal passages. This may partially block the airways.
Snoring can also lead to high blood pressure, which can put both the mother and fetus at risk. If the blockage is severe, sleep apnea may result, characterized by loud snoring and periods of stopped breathing during sleep.
The lack of oxygen disrupts sleep and may affect the unborn fetus. If loud snoring and severe daytime sleepiness (another symptom of sleep apnea and other sleep disorders) occur, consult your physician.
Secondary Restless Legs in Pregnancy
Up to 15 percent of pregnant women develop Restless Legs Syndrome (RLS) during the third trimester. A contributing cause may be iron and/or folate acid deficiency. In general, RLS is more prevalent in women than men.
RLS symptoms make it difficult to fall and stay asleep due to an uncontrollable urge to move the legs in response to unpleasant, restless, creepy feelings in the legs.
These feelings appear when at rest and often disrupt sleep as well. Moving the legs can stop these symptoms temporarily, but the irritation returns when the limb is still.
Fortunately, RLS symptoms usually end after delivery of the baby. Medications used to treat RLS may cause harm to the fetus and should be discussed with a doctor.
Sleep Tips for Pregnant Women
1. In the third trimester, sleep on your left side to allow for the best blood flow to the fetus and to your uterus and kidneys. Avoid lying flat on your back for a long period of time.
2. Drink lots of fluids during the day, but cut down before bedtime.
3. To prevent heartburn, do not eat large amounts of spicy, acidic (such as tomato products), or fried foods. If heartburn is a problem, sleep with your head elevated on pillows.
4. Exercise regularly to help you stay healthy, improve your circulation, and reduce leg cramps.
5. Try frequent bland snacks (like crackers) throughout the day. This helps avoid nausea by keeping your stomach full.
6. Special "pregnancy" pillows and mattresses may help you sleep better. Or use regular pillows to support your body.
7. Naps may help. The NSF poll found that 51% of pregnant or recently pregnant women reported at least one weekday nap; 60% reported at least one weekend nap.
8. Learn to relax with relaxation and breathing techniques, which can also help when the contractions begin. A warm bath or shower before bed can be helpful.
9. Talk to your doctor if you develop medical problems and/or insomnia persists.
Once her baby is born, a mother's sleep is frequently interrupted, particularly if she is nursing.
Mothers who nurse and those with babies that wake frequently during the night should try to nap when their babies do.
Sharing baby care to the extent possible, especially during the night, is important for the mother's health, safety, performance and vitality.
Check out our site pages for natural herbal remedies as a sleep aid.Note: Although generally safe, clary sage and chamomile oils should be avoided during pregnancy. If in doubt about any essential oils, consult a medical practitioner.
Women’s Sleep Habits
Sleep loss in women has reached epidemic proportions. Unfortunately, many women are unaware of the negative impact sleep problems can have on their health and performance.
Identifying the unique complications that contribute to sleep problems in women is an important step in achieving better sleep.
Almost three out of four women do not get eight or more hours of sleep per night during the workweek. On average, women sleep approximately 6.5 hours per night during the workweek.
While many women experience difficulty sleeping, only 4% of adults currently see a physician regarding their sleep problems.2
Hormones Affect Sleep
Sleep is disturbed 2.5 days on average during the menstrual cycle. More women complain of sleep problems during menstruation (71%), when hormone levels are at their lowest, than during the premenstrual week (43%).
A majority (79%) of women report an increase in sleep problems during pregnancy.
Forty percent of menopausal women suffer from sleep problems, which are usually related to hot flashes. A majority of menopausal/postmenopausal women report frequent insomnia.
Medical Conditions
Depression and anxiety, conditions associated with sleep loss, are twice as common in women as they are in men.
More women than men suffer from nighttime pain, including pain due to arthritis, which may make it more difficult to get a good night’s sleep.
Maternal Responsibilities
Most moms develop a high sensitivity to the sounds of their children and awaken more easily than women without children. This heightened sensitivity may continue long after their children sleep through the night.
Consequences of Sleep Loss
Middle-aged women who sleep an average of five hours or less nightly may be more likely to have heart disease than women who sleep eight hours nightly.
Sleep loss may increase hunger and affect the body’s metabolism, which may make it more difficult to maintain or lose weight.
A majority of women surveyed say that sleep problems hinder their ability to perform daily activities at least a few days per month.
Of those women who report that their sleep problems hinder their daily activities, forty-six percent report that sleep problems interfere with household duties, and nearly two thirds say sleep problems interfere with their relationship with either their spouse or their children.
How Women Can Achieve Better Sleep
Avoid alcohol as well as foods or beverages high in caffeine (eg, coffee, colas, tea, chocolate), sugar (including honey), and salt.
Exercise regularly, but do so at least three hours before bedtime.
Try warming up your feet if you’re having trouble sleeping. Inadequate vasodilation (opening of blood vessels to increase blood flow) may cause sleep problems.
If you can’t fall asleep, participate in a quiet, relaxing activity in a dimly lit room.
Sleep Loss Affects Health and Performance
The amount of sleep a woman gets may directly affect her health. Studies published in the Journal of the American Medical Association and the Lancet suggest that sleep loss may increase hunger and affect the body’s metabolism, which may make it more difficult to maintain or lose weight.
Sleep loss may also interfere with the body’s ability to metabolize carbohydrates and cause high blood levels of glucose, a basic sugar.
Excess glucose promotes the overproduction of insulin, and can also lead to insulin resistance, a critical feature of adult-onset diabetes.
In addition, research shows that short-term sleep deprivation may increase blood pressure. In fact, a recent study published in the Archives of Internal Medicine demonstrated that chronic sleep loss is associated with an increased risk of heart disease.
Women between the ages of 45 and 65 who slept an average of five hours or less per night were 39% more likely to have heart problems than women who slept eight hours per night.
Sleep loss can also hinder a woman’s ability to perform daily responsibilities and may also impact her relationships.
According to the National Sleep Foundation’s Women and Sleep Poll, a majority of women (51%) say that their sleep problems hinder their ability to perform daily activities at least a few days per month.
Of those women, 46% report interference with carrying out household duties, 27% report interference with job performance, and nearly two thirds say that lack of sleep causes problems with their relationship with either their spouse or their children.
Sleep aid tips for Mothers
Avoid alcohol as well as foods or beverages high in caffeine (eg, coffee, colas, tea, chocolate), sugar (including honey), and salt.
Exercise regularly, but finish your workout at least three hours before bedtime. Exercise may relieve some PMS symptoms and promotes a good night’s sleep.
If you are having trouble falling asleep, try warming up your feet. Inadequate vasodilation (opening of blood vessels to increase blood flow) may cause sleep problems.
This remedy might be especially helpful to older women with poor circulation in their extremities.
If you can’t fall asleep in bed after a reasonable period, get up, go into a darkened or dimly lit room, and participate in a quiet activity such as reading, knitting, or listening to soothing music. Do not use this time to catch up on laundry or paperwork.
If you experience sleep disturbances for more than a few weeks, see your doctor. In addition to behavioral and lifestyle modifications, there are prescription sleep medications that may help individuals fall asleep quickly and increase their total sleep time with minimal next-day effects.
9. Talking in sleep
More than one in ten preschool and school-age children talk in their sleep at least a few nights a week (11% and 12% respectively), according to NSF’s 2004 Sleep in America poll
What is sleep talking? Has anyone ever accused you of sleep talking?
Long ago, people used to think sleep talking had other worldly connotations.
Some people were accused of being possessed by the devil or spirits. Some people thought it was a supernatural premonition of some sort. Well, for the most part we know better now, at least most of us do.
Sleep talking is the utterance of speech or sounds without awareness of the event. Sometimes you can even hold conversations with someone who is sleep talking.
Sleep talking episodes are not associated with awareness of talking. Sleep recordings show episodes of sleep talking that can occur in any stage of sleep.
It can be associated with other health disorders such as, psychiatric, anxiety, as well as other sleep disorders like sleepwalking, sleep apnea, or REM sleep behavior disorder.
Nobody really knows why sleep talking is so common, especially among children. Some experts believe certain factors in our lives have something to do with sleep talking.
What some people think are common causes of sleep talking are lack of sleep, stress, fever, extreme distress or even pain or sever trauma.
Again nobody is really sure what causes sleep talking, but it is an interesting phenomenon.
Talking, laughing or crying during sleep is not usually considered a problem.
10. Bed Wetting
“Enuresis” is what doctors call bedwetting. This can be quite embarrassing for older children, who are often fearful of having sleepovers at a friend's house, knowing they could have an "accident".
Bed-wetting (or nocturnal enuresis) is an inability to control the flow of urine during the night.
It is fairly common for kids to wet the bed, one or more times per night. At age 5, about 15 percent of children have enuresis.
By the age of 15, one to two percent of adolescents still have it. If left untreated, some will wet the bed for life.
Devices that set off an alarm to awaken the child when he urinates in bed can be quite effective for some.
Most medicines stop working after a period of time or the problem recurs as soon as the medicine is discontinued.
Most children grow out of this problem eventually and parents need to be patient and supportive.
Research revealed that enuresis is often inherited. There is a 77 percent chance that a child might inherit it if both parents were bed-wetters. It is more prevalent with boys.
Contrary to belief, bed-wetting is not a mental or behavior problem. Neither does it come from emotional stress, poor self-esteem or emotional maturity.
It is a common developmental phenomenon related to physical and physiologic factors.
There are two types of nocturnal enuresis: primary and secondary. Primary nocturnal enuresis is when a child has not yet developed complete night-time bladder control.
Secondary nocturnal enuresis is when a child accidentally wets the bed after having had bladder control for six or more months.
Some factors linked to bed-wetting include:
Bladder size - may be too little to hold the normal amount of urine. Infection - abnormalities due to diabetes or chronic urinary tract infection. Antidiuretic Hormone (ADH) hormone which suppresses the rate of urine production. Some bed-wetters make less ADH or have kidneys less responsive to ADH.
Delayed growth and development – nervous system is not mature enough to have the ability to stop the bladder from emptying at night. Imbalance of the bladder muscle – the muscle that contracts to squeeze the urine out is stronger than the sphincter muscles that holds the urine in. Diet – foods containing high levels of artificial color and sweetener such as dairy products, citrus fruits, caffeinated cola drinks and chocolate have been associated with bed-wetting. Constipation or encopresis (uncontrolled passing of stools) Difficulties waking up from sleep
Not much can be done to prevent children from bed-wetting. Most children outgrow it without treatment.
It is important to stress to the child that bed-wetting is natural and should not be viewed as humiliating or shameful.
Adult bed wetting
Adult Bed Wetting remedies
Obviously, go to the toilet before you go to bed, even if you don’t think you “need to,” go anyway and see if you can empty your bladder.
It makes sense to limit your fluid intake for up to 6 hours before you go to sleep. Experiment to see how much you need to reduce your drinks.
It may simply be a case of working backwards for a few nights until you realize that as long as you have your last drink at XX p.m. you are OK for the whole night.
Avoid caffeine if possible, as it is a diuretic and stimulant.
Alcohol is a stimulant and also dulls your system, so you are less likely to easily wake up in time when you need to, to be able to get to the bathroom in time.
Definitely avoid drinking yourself into a stupor, as obviously you have little chance of being mentally alert and fully functional when you need to respond to the call of nature.
If you are not experiencing any insomnia problems, try setting the alarm clock to wake you halfway in the night, to allow you to go to the bathroom and empty your bladder before you go back to sleep.
If you only have light bed wetting problems, purchase the adult pads that can be placed in your underwear to catch any light spillage during the night.
EXERCISES: One of the best natural remedies is to exercise your bladder muscles. Simply tense your lower abdominal muscles – pretend you are trying to stop yourself while you are urinating.
Only practice this exercise in “theory” as stopping yourself when you are actually urinating can lead to back leakage and infections in your urinary tract.
Exercising your abdominal muscles also helps tone up your urinary muscles and tones you over all.
Also practice not going to the toilet the very instant you feel the need to urinate, instead try waiting 10 minutes, or more if you can. When we are home based we tend to “conveniently” go to the toilet more often than if we were out shopping, or in a work environment where we would have to wait for a “break”.
The more your bladder is naturally trained to “hold on” until it is convenient for you to “go” the better for you. It may even make the difference in being able to “hold on” at night until your body is able to wake you up, to leave the bed for the bathroom.
Women who have had children often have very weak bladders after childbirth and may need surgery to remedy this.
If the above home remedies don’t work, you need to see your doctor for the latest update on treatments available.
13. Sleep Walking
Parasomnias include a variety of disorders such as sleep walking (somnambulism), night eating, sleep-related bruxism (tooth grinding), nightmares, night terrors, and REM sleep behavior disorder.
Parasomnias occur most commonly in children, but adults can experience parasomnias at any age.
For example, night eating appears to occur most commonly in young female patients, and REM sleep behavior disorder appears to be most common in elderly men.
Most parasomnias involve some behavioral abnormality that occurs during sleep. For example, sleepwalkers may rise from bed, walk about the house, and finally come to rest somewhere other than their beds.
While most sleep walking is benign, some sleepwalkers engage in remarkable behaviors during their excursions, such as eating during sleep.
Some parasomnias involve some violent (e.g., hitting a spouse), bizarre or unhealthy (e.g., eating large amounts of food or unusual food items), or even criminal behavior during sleep.
Parasomnias require a careful evaluation by a physician. Behavioral treatments or medications may be appropriate.
One of the doctor’s primary concerns is the health and safety of the patient, as well as the safety of others in the patient’s environment.
Sleepwalking, often occurring very early in the night, is most common for children between the ages of three and seven.
Sleepwalking can run in the family, but sometimes suggests the presence of other problems, such as sleep apnea.
Sleepwalking is experienced by as many as 40 percent of children, usually between ages three and seven. Sleepwalking usually occur an hour or two after sleep onset and may last five to 20 minutes.
As sleep deprivation often contributes to sleepwalking, moving bedtime earlier can be helpful.
Sleepwalking, like night terrors, tends to run in families. This problem emerges more frequently sometime after age 6.
A child can get up and walk around while still in a sleep state.
Gently guide the sleepwalker back to bed; you may not be able to wake him up fully.
At times, the child can open doors and go outside. Make sure your house is safe for your child’s wanderings.
When the problem is this severe and can possibly endanger the child, medication is used.
Generally the child should be led back to bed without attempting to awaken him.
Sleepwalking tends to spontaneously resolve.
12. Narcolepsy
Narcolepsy is a chronic (long-lasting) neurological (affecting the brain or nerves) disorder that involves your body's central nervous system.
The central nervous system is the "highway" of nerves that carries messages from your brain to other parts of your body.
For people with narcolepsy, the messages about when to sleep and when to be awake sometimes hit roadblocks or detours and arrive in the wrong place at the wrong time.
This is why someone who has narcolepsy, not managed by medications, may fall asleep while eating dinner or engaged in social activities - or at times when he or she wants to be awake.
Recent discoveries indicate that people with narcolepsy lack a chemical in the brain called hypocretin, which normally stimulates arousal and helps regulate sleep.
They also discovered that there is a reduction in the number of Hcrt cells or neurons that secrete hypocretin. This may be due to a degenerative process or an immune response. How this occurs is unknown.
About one in 2,000 people suffers from narcolepsy. It affects both men and women of any age, but its symptoms are usually noticed after puberty begins. For the majority of persons with narcolepsy, their first symptoms appear between the ages of 15 and 30.
Major symptoms
Excessive daytime sleepiness is usually the first symptom to appear, and often the most troubling. It is an overwhelming and recurring need to sleep at times when you want to be awake. In addition to sleepiness, key symptoms of narcolepsy can include regular episodes of:
cataplexy - a sudden loss of muscle control ranging from slight weakness (head droop, facial sagging, jaw drop, slurred speech, buckling of knees) to total collapse.
It is commonly triggered by intense emotion (laughter, anger, surprise, fear) or strenuous athletic activity. Most persons with narcolepsy have some degree of cataplexy.
sleep paralysis - being unable to talk or move for a brief period when falling asleep or waking up. Many persons with narcolepsy suffer short-lasting partial or complete sleep paralysis.
hypnagogic hallucinations - vivid and often scary dreams and sounds reported when falling asleep. People without narcolepsy may experience hypnagogic hallucinations and sleep paralysis as well.
automatic behavior - familiar, routine or boring tasks performed without full awareness or later memory of them.
Diagnosing Narcolepsy
In addition to a medical history and physician examination, a diagnosis is made from polysomnogram tests in an overnight sleep laboratory to measure brain waves and body movements as well as nerve and muscle function.
A diagnosis also includes the results of the Multiple Sleep Latency Test (MSLT), which measures the time it takes to fall asleep and to go into deep sleep while taking several naps over a period of time.
Many physicians are not familiar with identifying the symptoms and diagnostic procedures specific to narcolepsy. Often, these symptoms are associated with other disorders.
Asking for a referral to a sleep specialist or sleep center will avoid the delay in both diagnosis and treatment so often experienced by those who suffer from this serious disorder.
Treatment options
The best treatment plan is the one that works for you. Treatment with medications is the first line of defense.
The goal in using medications should be to approach normal alertness while minimizing side effects and disruptions to daily activities.
Changes in behavior combined with drug treatment have helped most persons with narcolepsy improve their alertness and enjoy an active lifestyle.
Common medications and side effects
Doctors generally prescribe stimulants to improve alertness and antidepressants to control cataplexy, hypnagogic hallucinations and sleep paralysis.
Common stimulants include: dextroamphetamine sulfate (DexedrineTM), methylphenidate hydrochloride (RitalinTM), and pemoline (CylertTM). Methamphetamine hydrochloride (DesoxynTM) is prescribed less frequently for narcolepsy.
Some of the most common side effects of stimulants are headache, irritability, nervousness, insomnia, irregular heart beat, and mood changes.
A wake-promoting drug, modafinil (ProvigilTM) was approved by the U.S. Food and Drug Administration (FDA) in 1999 for use in treating the excessive daytime sleepiness associated with narcolepsy.
It does not act as a stimulant for other body systems and studies have shown that modafinil is effective in improving alertness with few side effects and low abuse potential.
Several classes of antidepressants are prescribed to treat cataplexy, hypnagogic hallucinations and sleep paralysis. One class, multicyclics, includes imipramine (TofranilTM), desimpramine (NorpraminTM), clomipramine (AnafranilTM), and protriptyline (VivactilTM).
Another class are selective serotonin re-uptake inhibitors (SSRIs). These include fluoxetine (ProzacTM), paroxetine (PaxilTM), and sertraline (ZoloftTM).
Side effects vary from one class of antidepressants to another. Those most often reported are drowsiness, sexual dysfunction and lowered blood pressure.
In a small percentage of patients, SSRIs cause overexcitement, anxiety, insomnia, nausea and reduced sexual drive.
Sodium oxybate (XyremTM) is the first and only FDA-approved medication for the treatment of cataplexy associated with narcolepsy. It produces consolidation of sleep and improvement of disturbed nighttime sleep characteristic of narcolepsy.
It is sedating and should only be used at night. Xyrem is a Schedule III controlled drug substance with abuse potential that is available by prescription.
Narcolepsy patients who have other health conditions (like high blood pressure, heart disease or diabetes) should ask their doctor or pharmacist how medications for those conditions may interact with those taken for narcolepsy.
If you take over-the-counter cold and allergy medications, keep in mind that they may make you sleepy.
Narcolepsy is a rare condition that affects approximately 0.05% of the population, with symptoms peaking between the ages of 15 and 20.
Narcolepsy is marked by excessive daytime sleepiness which can be so severe that it interferes with functioning and sometimes results in unexpected “sleep attacks.”
People with narcolepsy often report the associated symptoms of sleep paralysis, hypnogogic hallucinations, cataplexy, and automatic behavior.
Sleep paralysis usually occurs when the sleeper is lying in bed prior to sleep onset or after awakening. He or she is unable to move for a few seconds, minutes, or longer. Sometimes sleepers can move only their eyes. The episodes are generally harmless, although they can result in genuine distress for the sufferer.
Narcolepsy is a chronic (long-lasting) neurological (affecting the brain or nerves) disorder that involves your body's central nervous system. The central nervous system is the "highway" of nerves that carries messages from your brain to other parts of your body.
For people with narcolepsy, the messages about when to sleep and when to be awake sometimes hit roadblocks or detours and arrive in the wrong place at the wrong time.
This is why someone who has narcolepsy, not managed by medications, may fall asleep while eating dinner or engaged in social activities - or at times when he or she wants to be awake.
Recent discoveries indicate that people with narcolepsy lack a chemical in the brain called hypocretin, which normally stimulates arousal and helps regulate sleep.
They also discovered that there is a reduction in the number of Hcrt cells or neurons that secrete hypocretin. This may be due to a degenerative process or an immune response. How this occurs is unknown.
About one in 2,000 people suffers from narcolepsy.
It affects both men and women of any age, but its symptoms are usually noticed after puberty begins. For the majority of persons with narcolepsy, their first symptoms appear between the ages of 15 and 30.
Hypnogogic hallucinations also generally occur when the sleeper is lying in bed prior to sleep onset or after awakening. The sufferer may experience auditory, visual, tactile, or olfactory (smell) hallucinations for brief periods.
People sometimes describe these as brief, dreamlike experiences. Although these experiences are not concerning to many, some people can have terrifying or disturbing hallucinations that cause them great distress.
Cataplexy is characterized by the sudden loss of muscle tone while awake. The sufferer may experience a mild, transient drop in muscle tone (e.g., a droopy arm or periods of clumsiness associated with dropping things), or may experience severe loss of muscle tone that literally results in falling to the floor, and speech can be affected during the attacks.
Cataplexy often is brought on by stress, fatigue, or the experience of intense emotion such as anger or laughter. Narcolepsy and cataplexy are so rare that healthcare providers often fail to accurately diagnose the problem.
Automatic behavior refers to actions for which the person has no memory. Sometimes the sufferer reports that she is acting in a “fog.” For example, one woman with narcolepsy entered her dining room to find a beautiful vase on her table.
She had no idea where it came from until she looked at her checkbook and realized that she had purchased it on a recent shopping trip. Both the vase and the shopping trip had been forgotten! Automatic behavior probably is due to severe sleepiness.
Narcolepsy often is diagnosed in a sleep laboratory facility. One diagnostic indicator of narcolepsy is the occurrence of rapid-eye-movement (REM) sleep on daytime nap testing.
Narcolepsy usually is treated with stimulant medication to address daytime sleepiness, and tricyclic or other medications to address sleep paralysis, hypnogogic hallucinations, and cataplexy. These medications include stimulants such as methylphenidate
Try a local search of our sleep aid tips site for your answers
LIFE STAGES – sleep cyles:
Baby sleep:
Newborn Babies daily sleep requirements:
0-2 months: 10.5-18.5 hours
Despite their small size, babies can wield tremendous power over their parents.
Some new parents will go to extreme lengths to get their baby to sleep, rocking them to sleep in their arms for hours or driving them around town until their eyelids finally flutter shut.
Bedtime doesn't have to make parents and their babies crazy.
A newborn’s sleep cycle is disorganized. In the first few weeks, you can expect your baby’s sleep to be distributed throughout the 24 hours, with each sleep period lasting anywhere from 30 minutes to 3 hours, and with frequent waking periods through the night. In about six weeks a more regular, defined sleep pattern should begin to emerge.
While sleeping, your baby may be very busy twitching, jerking, sucking, snuffling—even smiling. This is normal. Even with all this activity, your baby is actually getting a perfectly sound sleep.
When addressing difficulties that your child may be having with sleep, it is important to be aware of the general developmental progression of sleep behavior in kids. Newborns alternate between sleep and wakefulness every 3-4 hours, awakening often associated with hunger.
As the child grows this develops into what is called a "diurnal" pattern. This means there are progressively longer periods of wakefulness during the daytime as well as longer periods of sustained sleep at nighttime.
By about 12 weeks, an infant may sleep at night for periods up to 8 hours.
At 3-4 months, more than 70% of infants are sleeping for sustained periods of time at night. This is sometimes referred to as "settling in" and it occurs as the infant's brain matures.
If we look at EEG patterns (an EEG is an instrument that measures brain waves) we can see the patterns becoming increasingly organized into distinctive stages differentiating sleep from wakefulness.
An infant probably spends 16 hours of a 24-hour period asleep. This decreases to 12 hours in the second year of life, 10 hours by age 3, and to 9 hours from ages 8-12.
Remember that this varies according to the child. With some children, this kicks in quite early and with others it happens much later on. This is simply a variation in normal development.
While the development of the brain plays a very important role in the establishment of the sleep-wake cycle, learning and conditioning are equally important.
This is good news for parents because it means they can also play a role in enhancing and facilitating the development of their child's sleep behavior.
Just as parents pay attention to their children's general hygiene, they can also address their sleep hygiene.
This can help to establish life-long patterns of good sleep. It's much easier to prevent a sleep problem than to treat one.
Here are some guidelines on what to expect, from the time you bring your tightly swaddled bundle home to your baby’s third birthday.
Every living creature needs to sleep. It is the primary activity of the brain during early development.
Circadian rhythms, or the sleep-wake cycle, are regulated by light and dark and these rhythms take time to develop, resulting in the irregular sleep schedules of newborns.
The rhythms begin to develop at about six weeks, and by three to six months most infants have a regular sleep-wake cycle.
By the age of two, most children have spent more time asleep than awake and overall, a child will spend 40 percent of their childhood asleep.
Sleep is especially important for children as it directly impacts mental and physical development.
There are two alternating types or states of sleep:
Non-Rapid Eye Movement (NREM) or “quiet” sleep. During the deep states of NREM sleep, blood supply to the muscles is increased, energy is restored, tissue growth and repair occur, and important hormones are released for growth and development.
Rapid Eye Movement (REM) or “active” sleep. During REM sleep, our brains are active and dreaming occurs. Our bodies become immobile, breathing and heart rates are irregular.
Babies spend 50 percent of their time in each of these states and the sleep cycle is about 50 minutes. At about six months of age, REM sleep comprises about 30 percent of sleep. By the time children reach preschool age, the sleep cycle is about every 90 minutes.
For newborns, sleep during the early months occurs around the clock and the sleep-wake cycle interacts with the need to be fed, changed and nurtured.
Newborns sleep a total of 10.5 to 18 hours a day on an irregular schedule with periods of one to three hours spent awake.
The sleep period may last a few minutes to several hours. During sleep, they are often active, twitching their arms and legs, smiling, sucking and generally appearing restless.
Newborns express their need to sleep in different ways. Some fuss, cry, rub their eyes or indicate this need with individual gestures. It is best to put babies to bed when they are sleepy, but not asleep.
They are more likely to fall asleep quickly and eventually learn how to get themselves to sleep. Newborns can be encouraged to sleep less during the day by exposing them to light and noise, and by playing more with them in the daytime. As evening approaches, the environment can be quieter and dimmer with less activity.
GO WITH THE FLOW
The first few weeks of your baby’s life are all about adjustment—for your baby and for you.
It’s simply too soon to expect structured sleep patterns, so it makes sense to take your cues from your baby. Do what works for your baby now, and before long you’ll have the beginnings of a sleep routine.
Every child is different. Your baby’s sleep habits will be different from your friend’s baby, or from an older sibling at the same age.
Build your routines and rhythms around your baby’s sleep needs and patterns. Once you’re familiar with your own baby’s sleep patterns, you can begin establishing regular routines to help your baby—and the whole family—get to sleep and sleep well.
Learn your baby’s signs of being sleepy. Many babies become fussy or cry when they get tired, but others will rub their eyes, pull on their ears, or even stare off into space. Put your baby down for bedtime or a nap when your baby first lets you know he or she is tired.
Follow your baby’s cues. Your newborn may prefer to be rocked or fed to sleep. This is fine for the first few weeks or months. By three months, however, begin to establish good sleep habits.
Always put your baby down to sleep on his or her back. A baby should sleep on a firm mattress, with no fluffy or loose bedding.
After the first few weeks, start to actively encourage nighttime sleep if your baby is awake a lot at night and sleeps much of the day. Do this by making sure the bedroom is dark or dim and cutting down on nighttime play
Have realistic goals about sleep. Your baby will not be able to sleep for long stretches at a time for the first few months.
Make sleep a family priority. It’s usual to be sleep-deprived with a newborn.
But no one benefits if you’re crying from exhaustion while the baby’s crying to be calmed. Tell your spouse (or a friend who’s offered) when you need a break.
And, tempting as it is to use naptimes to get things done, you’ll be able to cope better if you nap when your baby does.
Take the first steps toward a bedtime routine.
The important thing is that it’s built around things that both you and your baby enjoy.
Your newborn’s bedtime routine could include:
Taking a bath
Getting a massage
Changing into pajamas
Rocking and cuddling
Sharing a song
Or whatever works best for you and your baby
Sleep Tips for Newborns
• Observe baby’s sleep patterns and identify signs of sleepiness.
• Put baby in the crib when drowsy, not asleep.
• Place baby to sleep on his/her back with face and head clear of blankets and other soft items.
• Encourage nighttime sleep.
Infants daily sleep requirements:
2-12 months: 14-15 hours
A 3- or 4-month-old is taking three to four naps a day, and a 12-month-old is typically taking two naps a day.
One of the problems answering that question is the definition of “sleeping through the night.”
The original definition in 1957 was a baby who sleeps from midnight to 5 a.m. is sleeping through the night.
Gradually, over the first few months, your baby will begin to develop a more predictable pattern. Between 2 and 4 months, you will notice a regular rhythm of sleepiness and alertness throughout the day.
Between 3 and 6 months most babies begin to sleep for longer stretches at night. In the first year, babies naturally cut down their daily naps from 3 or 4 a day to 1 or 2 a day.
Note that developmental milestones, such as rolling over and pulling up to stand, can temporarily upset sleep
So if you're looking for 12 hours straight, they will be at least 6 months of age until they can sleep for that long without a nighttime feeding.
By six months of age, nighttime feedings are usually not necessary and many infants sleep through the night; 70-80 percent will do so by nine months of age.
Infants typically sleep 9-12 hours during the night and take 30 minute to two-hour naps, one to four times a day – fewer as they reach age one.
When infants are put to bed drowsy but not asleep, they are more likely to become “self-soothers” which enables them to fall asleep independently at bedtime and put themselves back to sleep during the night.
Those who have become accustomed to parental assistance at bedtime often become “signalers” and cry for their parents to help them return to sleep during the night.
Social and developmental issues can also affect sleep. Secure infants who are attached to their caregiver may have less sleep problems, but some may also be reluctant to give up this engagement for sleep.
During the second half of the year, infants may also experience separation anxiety. Illness and increased motor development may also disrupt sleep.
For all children, adolescents and adults, you want a bedroom that's cool, quiet, dark and comfortable.
All babies should sleep on a firm surface. There should be very little bedding in their crib, so that there's no concern about suffocation.
And, of course, all babies should be put down on their backs to sleep to decrease the risk of sudden infant death syndrome.
A consistent sleep schedule with set nap times and a set bedtime is going to set their internal clock and make it so they fall asleep quickly and stay asleep. A typical baby bedtime is between 7:30 and 8:30 at night.
One of the key things in getting a baby to have good sleep habits is a bedtime routine.
You want that bedtime routine to be 20 to 30 minutes long and include about two to three activities, which are exactly the same every single night.
A typical bedtime routine may include taking a bath, massaging the baby, reading, singing lullabies.
You want activities that are soft and soothing. Now, if your baby hates taking a bath or can't sit still for books, you want to do that at a different part of the day.
One of the most important things that you want to do as a parent is figure out the sign your baby gives when he or she is sleepy.
Does she rub her eyes? Does she pull her ears? Does she twirl her hair? One baby I knew used to stare off into space.
The mom thought the baby was bored so she would sort of do antics, but, really, that was a sign for the baby that he wanted to go to sleep.
The moment your baby gives you that sign, that's your window of opportunity.
You want to go right away and put them down for their nap or for bedtime.
All babies naturally awaken between three and six times throughout the night.
As they change from one sleep stage to another, they're going to have a normal arousal. The question is whether or not a baby can fall back to sleep on their own.
A baby who can fall asleep on their own at bedtime is a baby who's going to fall right back to sleep when they waken during the night.
The National Sleep Foundation data from the Sleep in America poll found that 46 percent of children are being put down awake in their cribs rather than asleep.
So the majority of children are being put down asleep. But children who are put down awake fall asleep faster and sleep, on average, one hour more at night.
A baby who's rocked to sleep, nursed to sleep, driven in the car to sleep, pushed in a stroller to fall asleep at bedtime is going to need that exact same thing to fall back asleep at 1:00, 3:00 and 5:00 every time they naturally awaken.
If a parent has a baby who's having a difficult time falling asleep or staying asleep, they may choose to do what we often refer to as sleep training. So you do your bedtime routine, you put your baby down awake in their crib and then leave the room.
At that point, you want to check on your child. How often you check is going to depend upon your tolerance as a parent and your baby's temperament.
For some babies, it makes them more upset to check on them than not to check on them.
Every time you go in to check on your child, you want to go in for just a minute or two, be really calm, let them know everything is OK and leave.
It's best not to pick them up, but, if you need to, that's OK, as long as you put them back down.
The first night, they will often fuss (that's our nice way of saying they may be upset) for 30 to 45 minutes.
The second night is going to get worse, because it's sort of "last night was a fluke, tonight I really mean it."
By third night, you're going to see dramatic improvement and, if you stick with it for a week, what you're going to find is a baby who falls asleep very quickly at bedtime and will start sleeping through the night.
The most important thing parents should do when they start sleep training is consistency. If they're consistent, they are going to see a major improvement.
When there are two parents in the household, sleep training always takes some negotiation. You both need to come up with a plan that you're going to stick to.
If there is one parent who can't tolerate any crying by their child, you may want to send them out to the store or to a friend's house, so you can help the baby get over the hump.
The other thing that's important for parents to realize is that they're doing this for the benefit of their baby.
Some parents feel as if they're being selfish. You have to realize that a baby waking three times a night is going to feel as awful the next day as a parent waking three times per night. Also, having a parent who's well rested is going to have huge benefits for babies.
Create a bedtime routine that works for both you and your Infant.
From 6 weeks to 3 months, start creating a familiar sequence of calming events that unfolds night after night and clearly says, “It’s time to settle down and go to sleep.”
Now that your baby’s sleep patterns are becoming more organized, it’s time for a bedtime routine that will fit in with your family’s needs as well as your baby’s needs.
Keep the sequence of events basically consistent even with caregivers or when away from home. It can also be helpful to have parents take turns putting their baby to bed.
Learn your infant’s signs of being sleepy. Many babies become fussy or cry when they get tired, but others will rub their eyes, pull on their ears, or even stare off into space. Put your baby down for bedtime or a nap when your baby first lets you know he or she is tired.
Start developing a bedtime routine. Make sure your routine is not too long or too impractical to stick to. Rock your baby to sleep at 6 months, and you may end up doing the same when the baby wakes in the night—as all babies do for short periods—or even when your little one turns two.
Set a regular sleep schedule for your baby. Settle on regular naptimes and a bedtime that allow your baby to get all the sleep he or she needs. Contrary to what you may think, cutting down on naps won’t help at night. It can be a recipe for overtiredness and a worse night’s sleep. But you’ll also want to avoid naps too close to bedtime.
Give your infant soothing surroundings. Keep the bedroom dark, cool and quiet. And make sure lights and environment, are the same at bedtime as they will be throughout the night.
Wind down your routine where you want your baby to sleep. The last part of the routine should happen in the room where your baby sleeps.
Put your infant to bed drowsy but awake. This may teach your baby to soothe himself or herself to sleep, as well as to go back to sleep in the night on his or her own, with little if any intervention from you.
Make sleep a family priority. Remember, you need sleep, too. If friends and family have offered help, take them up on the offer. Resist as much as you can treating your baby’s naptime as your chore time. Take a nap when your baby does.
Avoid making bedtime feedings a permanent fixture. They rarely help either how long or how well your baby sleeps. And after 6 months nighttime feedings are rarely necessary. Move a bottle or nursing time earlier in the evening, to avoid the association between eating and sleeping.
Create a consistent bedtime routine you and your infant enjoy, this could include:
• Develop regular daytime and bedtime schedules
• Create a consistent and enjoyable bedtime routine.
• Establish a regular “sleep friendly” environment.
• Encourage baby to fall asleep independently and to become a “self-soother.”
• Develop Taking a bath routine
• Getting a massage routine
• Changing into pajamas routine
• Hearing a story routine
• Sharing a song routine
Or whatever works best for you and your infant
Toddler - Children’s daily sleep requirements:
1-3 Years Toddlers – kids sleep
12-18 months: 13-15 hours
18 months-3 years: 12-14 hours
3-5 years: 11-13 hours
5-12 years: 9-11 hours
Toddlers need about 12-14 hours of sleep in a 24-hour period. When they reach about 18 months of age their naptimes will decrease to once a day lasting about one to three hours. Naps should not occur too close to bedtime as they may delay sleep at night.
Many toddlers experience sleep problems including resisting going to bed and nighttime awakenings. Nighttime fears and nightmares are also common.
Many factors can lead to sleep problems. Toddlers’ drive for independence and an increase in their motor, cognitive and social abilities can interfere with sleep.
In addition, their ability to get out of bed, separation anxiety, the need for autonomy and the development of the child’s imagination can lead to sleep problems. Daytime sleepiness and behavior problems may signal poor sleep or a sleep problem.
Your toddler may be finished with morning naptime by around 18 months, and naps will disappear altogether between 2 1/2 and 5 years.
At the same time, most toddlers will have learned to sleep through the night, although stressful events and other interruptions (an illness, a trip) can temporarily upset this welcome pattern.
Switching to a bed is another change that can be disruptive for a toddler, especially if it happens too early. Most toddlers switch to a bed between 2 and 4 years.
If you regularly have to wake your child in the morning, it could be a sign that he or she isn’t getting enough sleep. The number of hours a toddler sleeps will be different for each child. However, most toddlers are consistent in how much they sleep from one day to the next.
Build a regular bedtime routine everyone enjoys.
For a toddler, this could include:
Taking a bath
Changing into pajamas
Reading books together
Sharing a song
Or whatever works best for you and your toddler
Your toddler’s sleep patterns will continue to change. Toddlers can generally sleep through the night, although change and stressful events (a trip or illness, for example) can cause temporary setbacks.
All children wake briefly at regular intervals throughout the night. A toddler who’s learned to fall asleep on his or her own will be able to return to sleep in the middle of the night without help from you—although normal bedtime fears and nightmares may need your reassurance.
Set a regular sleep schedule. Establish regular naptimes and a bedtime that allow your toddler to get all the sleep he or she needs. Restricting naps won’t help a toddler sleep better at night.
Quite the opposite—it can lead to overtiredness and more sleep problems. But avoid naps late in the afternoon.
Many babies become fussy or cry when they get tired, but others will rub their eyes, pull on their ears, or even stare off into space. Put your baby down for bedtime or a nap when your baby first lets you know he or she is tired.
Wind down your routine where your child sleeps. Make sure the last few soothing minutes of the bedtime routine happen right in your toddler’s room.
Give your toddler soothing surroundings. Keep the bedroom dark, cool and quiet. A night-light is fine. A television isn’t. And make sure the environment is the same at bedtime—lighting, for example—as it will be throughout the night.
Put your child to bed drowsy but awake. This may teach your toddler to fall asleep, as well as to go back to sleep in the night on his or her own, with little if any help from you.
Whatever routine you have established at bedtime will need to occur again if your child wakes in the middle of the night. So create a routine that helps your child fall asleep on his or her own.
Set limits. If your child stalls at bedtime, set clear limits, such as how many books you will read or how many drinks of water you will allow.
Make sleep a family priority. Remember, looking after a toddler takes plenty of energy. You need your sleep, too.
Sleep Tips for Toddlers:
• Maintain a daily sleep schedule and consistent bedtime routine.
• Make the bedroom environment the same every night and throughout the night.
• Set limits that are consistent, communicated and enforced.
• Encourage use of a security object such as a blanket or stuffed animal.
Preschoolers daily sleep requirements:
(3-5 years) Preschoolers typically sleep 11-13 hours each night and most do not nap after five years of age.
As with toddlers, difficulty falling asleep and waking up during the night are common.
With further development of imagination, preschoolers commonly experience nighttime fears and nightmares. In addition, sleepwalking and sleep terrors peak during preschool years.
Sleep Tips for Preschoolers:
• Maintain a regular and consistent sleep schedule.
• Have a relaxing bedtime routine that ends in the room where the child sleeps.
• Child should sleep in the same sleeping environment every night, in a room that is cool, quiet and dark – and without a TV.
School-aged Children daily sleep requirements:
Children aged five to 12 need 10-11 hours of sleep.
At the same time, there is an increasing demand on their time from school (e.g., homework), sports and other extracurricular and social activities.
In addition, school aged children become more interested in TV, computers, the media and Internet as well as caffeine products – all of which can lead to difficulty falling asleep, nightmares and disruptions to their sleep.
In particular, watching TV close to bedtime has been associated with bedtime resistance, difficulty falling asleep, anxiety around sleep and sleeping fewer hours.
Sleep problems and disorders are prevalent at this age. Poor or inadequate sleep can lead to mood swings, behavioral problems such as hyperactivity and cognitive problems that impact on their ability to learn in school.
Sleep Tips for School-aged Children
• Teach school-aged children about healthy sleep habits.
• Continue to emphasize need for regular and consistent sleep schedule and bedtime routine.
• Make child’s bedroom conducive to sleep – dark, cool and quiet. Keep TV and computers out of the bedroom.
• Avoid caffeine.
Kid’s Sleep Disorders:
Problems with sleep behaviors are commonly seen in children. Sleep is of primary importance at all stages of human development, and in the newborn, is the primary activity other than eating.
Childhood sleep disturbances affect not only the child but also the whole family. There is an abundance of different beliefs and lore on this topic. Sifting through the enormous amount of material, approaches, and opinions about kids' sleep can be daunting for parents.
There is not one correct way to deal with your child in regard to sleep. Each child is unique and has his own special set of circumstances and needs. What's important is for parents to identify what they feel comfortable with and what they feel is best for their child.
Just as parents pay attention to their children's general hygiene, they can also address their sleep hygiene. This can be made a pleasurable event.
This can help to establish life-long patterns of good sleep. It's much easier to prevent a sleep problem than to treat one.
The important keyword in sleep hygiene is consistency. Bedtime should occur at the same time each night.
A regular habit of storytelling, reading a book, or talking about the day's events are often nightly rituals that parents can implement.
This can be a meaningful period of engagement for both the parent and the child.
Typical bedtime sequences take around 30 minutes. Often children engage in what has been referred to as "curtain call" behaviors.
These are behaviors by the child that delay separation from the parents before bedtime. Kids will often get up and say they need to go to the bathroom, or that they need to get a glass of water.
Sometimes these behaviors become problematic. I recommend children be asked to do these things for themselves. This avoids reinforcing these behaviors by granting more contact with the parents.
Different sleep difficulties tend to cluster around different ages. Before the age of three it is common for infants to have problems going to sleep and nighttime awakening.
Nightmares, fear of the dark, and night terrors usually begin to occur between ages 3-6, and sleepwalking usually has its onset after age 6.
Sleep problems appearing later and in adolescence are more frequently associated with underlying psychiatric disorders, drug abuse, or medical conditions like narcolepsy.
At what stage should kids sleep in their own beds? There are different philosophies about children sleeping in the same bed as their parents. Western culture expects children to sleep alone from a very early age.
In non-Western cultures, families tend to sleep together for a much longer period of time. Parents generally have to decide what works for them and their lifestyle. This issue can sometimes be a source of conflict between parents.
The older a baby is when he is sleeping with his parents, the more difficulty they are likely to experience when making the transition from their bed to the child's own bed.
Kids generally love to sleep with their parents. Once used to this they can be quite resistant to changing. It's important for parents to be aware of the impact that this has on their own time for both sexual and emotional intimacy.
Night Wakings Infants sleeping alone often wake at night and fall back asleep without the parents being aware of the arousal. Some infants, as most parents know, cry upon awakening and this can become a regular and frequent habit.
The concerned parent may rush in to see that the child is okay and to provide comfort. If a healthy baby continuously awakens this can be a source of distress for the parents. One popular intervention is "Ferberizing."
This is a method popularized by Dr. Richard Ferber. Basically it involves letting the child continue to cry for increasingly longer periods of time without intervening.
The goal is to foster the child's ability to "self-sooth" or put themselves back to sleep. This is effective after a few days for many children.
However, some parents don't feel comfortable with what they perceive as a "cold turkey" approach. Parents need to do what they feel comfortable with and often do well with modified approaches.
I advise parents to try and not respond instantaneously to the child's awakening and crying. An instant response is likely to be gratifying to the child and increase the likelihood that this behavior will recur.
Frequently a baby will cry for 20-30 minutes and then fall back asleep. A timer is often useful to keep track of how long your child has been crying (20 minutes at 2 am can seem like 2 hours).
Children often respond rather quickly to methods like "Ferberizing." However, transitions, changes in environment, travel, and illnesses can causes these difficulties to recur.
Night Terrors versus Nightmares Night terrors start to occur in the 3-5 age range, as well. Night terrors are distinct from nightmares. With night terrors, children will begin to scream and cry in the middle of the night but still be asleep.
These episodes are self-limited and it is best to hold the child, not attempt to awaken them, but comfort them until they have settled down again. Night terrors tend to run in families and usually resolve spontaneously.
At times the problem will be frequent and severe enough that medication is used.
Nightmares are frightening dreams that occur during REM sleep and awaken a child. They usually occur in the later part of the night. Most children have at least one nightmare during childhood; three percent of preschool and school aged children experience frequent nightmares, according to NSF’s 2004 Sleep in America poll.
They can be upsetting and a child will need reassurance when they occur. Nightmares can result from a scary event, stress, a difficult time or change in a child’s routine. Use of a nightlight or security object is often helpful.
Sleep terrors occur early in the night. A child may scream out and be distressed, although s/he is not awake or aware during a sleep terror.
Sleep terrors may be caused by not getting enough sleep, an irregular sleep schedule, stress, or sleeping in a new environment. Increasing sleep time will help reduce the likelihood of a sleep terror.
Insomnia is a sleep problem that occurs when a child complains of difficulty falling asleep, remaining asleep, and/or early morning awakenings. Insomnia can be short-term due to stress, pain, or a medical or psychiatric condition.
It can become long-term if the underlying cause is not addressed or healthy sleep practices are not employed.
Treating underlying conditions, developing good sleep practices and maintaining a consistent sleep schedule can improve the ability to fall asleep and stay asleep.
Restless Legs Syndrome (RLS) is a movement disorder that includes uncomfortable and unpleasant feelings (e.g. crawly tingly or itchy) in the legs causing an overwhelming urge to move.
These feelings make it difficult to fall asleep. RLS can be treated with changes in bedtime routines, increased iron, and possibly medications.
Snoring occurs when there is a partial blockage in the airway that causes a noise due to the vibration of the back of the throat.
About l0-12 percent of normal children habitually snore. Snoring can be caused by nasal congestion or enlarged adenoids or tonsils that block the airway. Some children who snore may have sleep apnea.
Sleep apnea – when snoring is loud and the child is having difficulty breathing, it may be a sign of a more serious disorder, obstructive sleep apnea.
Sleep apnea is characterized by pauses in breathing during sleep caused by blocked airway passages, resulting in repeated arousals from sleep.
Sleep apnea has been associated with daytime sleepiness, academic problems, and hyperactivity. Treatment for sleep apnea is available.
Sleeptalking occurs when the child talks, laughs or cries out in his/her sleep. As with sleep terrors, the child is unaware and has no memory of the incident the next day. There is usually no need to treat sleeptalking.
Sleepwalking is experienced by as many as 40 percent of children, usually between ages three and seven.
Sleepwalking usually occur an hour or two after sleep onset and may last five to 20 minutes. As sleep deprivation often contributes to sleepwalking, moving bedtime earlier can be helpful.
Sleepwalking, like night terrors, tends to run in families. This problem emerges more frequently sometime after age 6.
A child can get up and walk around while still in a sleep state.
At times, the child can open doors and go outside. When the problem is this severe and can possibly endanger the child, medication is used.
Generally the child should be led back to bed without attempting to awaken him.
Sleepwalking tends to spontaneously resolve.
Pointers for parents: Talk to your child’s doctor if any of the following symptoms are observed:
• A child is having problems breathing or breathing is noisy.
• A child snores, especially if snoring is loud.
• Unusual nighttime awakenings.
• Difficulty falling asleep and maintaining sleep, especially if you see daytime sleepiness and/or behavioral problems.
Teen sleep
Adolescents – Teens Sleep daily requirements
8.5-9.5 hours
Getting enough continuous quality sleep contributes to how we feel and perform the next day, but also has a huge impact on the overall quality of our lives.
Getting enough sleep refers to the amount of sleep you need to not feel sleepy the next day.
If sleepiness interferes with or makes it difficult to do your daily activities, you probably need more sleep.
Although sleep experts generally recommend an average of 7-9 hours per night, some people can get along with less while others need as much as ten hours to feel alert the next day.
Sleep requirements vary over the life cycle. Newborns and infants need a lot of sleep and have several periods of sleep throughout a 24-hour time period.
Naps are important to them as well as to toddlers who may nap up to the age of 5. As children enter adolescence, their sleep patterns shift to a later sleep-wake cycle, but they still need around 9 hours of sleep.
Throughout adulthood, even as we get older, we need 7-9 hours of sleep. Sleep patterns may change, but the need for sleep remains the same.
Quantity of Sleep – Sleep Deprivation has Consequences
Planning your day so that you allow enough time to sleep is essential to your overall well-being and quality of life.
Such planning includes allowing enough time to awaken naturally – without an alarm clock – so you get as much sleep as you need!
According to the 2002 poll, over 80% of American adults believe that not getting enough sleep leads to poor performance at work, risk for injury and poor health, and difficulty getting along with others.
Often, people become irritable due to lack of sleep, resulting in serious consequences. Studies show that lack of sleep leads to problems completing a task, concentrating, making decisions and unsafe actions.
Recent research suggests that sleep deprivation impacts on aging and diabetes.
Insufficient sleep may also make it difficult to exercise and can reduce the benefit of hormones released during sleep.
Just as compelling are the serious consequences of sleep deprivation that lead to approximately 100,000 sleep-related vehicle crashes each year and result in 1,500 deaths.
Why Nighttime Sleep is Important
Sleep is regulated by two brain processes. One is the restorative process when sleep occurs naturally in response to how long we are awake; the longer we are awake, the stronger is the drive to sleep.
The second process controls the timing of sleep and wakefulness during the day-night cycle. Timing is regulated by the circadian biological clock that is located in our brain.
This part of the brain, the SCN or suprachiasmatic nucleus, is influenced by light so that we naturally tend to get sleepy at night when it is dark and are active during the day when it is light.
In addition to timing the sleep-wake cycle, the circadian clock regulates day-night cycles of most body functions, ensuring that the appropriate levels occur at night when you are sleeping.
For example, important hormones are secreted, blood pressure is lowered and kidney functions change. Research even indicates that memory is consolidated during sleep.
This “clock” in the brain runs on a 24-hour cycle with the result that we feel most sleepy around 2:00-4:00 am and in the afternoon between 1:00-3:00 pm.
We need to have continuous sleep that becomes restorative and results in feeling refreshed and alert for the day ahead.
Quality of Sleep – Poor Sleep has Consequences
Quality sleep also means that it is continuous and uninterrupted. As we get older, sleep can be disrupted due to pain or discomfort, the need to go to the bathroom, medical problems, medications, and sleep disorders as well as poor or irregular sleep schedules.
Establishing a regular bed and wake schedule and achieving continuous sleep helps you sleep in accordance with your internal biological circadian clock and experience all of the sleep stages necessary to reap the restorative, energizing and revitalizing benefits of sleep.
Teen Sleep Tips
Sleep is food for the brain: Get enough of it, and get it when you need it.
Even mild sleepiness can hurt your performance -- from taking school exams to playing sports or video games.
Lack of sleep can make you look tired and feel depressed, irritable, and angry.
Keep consistency in mind: Establish a regular bedtime and waketime schedule, and maintain it during weekends and school (or work) vacations.
Don't stray from your schedule frequently, and never do so for two or more consecutive nights.
If you must go off schedule, avoid delaying your bedtime by more than one hour, awaken the next day within two hours of your regular schedule, and, if you are sleepy during the day, take an early afternoon nap.
Learn how much sleep you need to function at your best. You should awaken refreshed, not tired. Most adolescents need between 8.5 and 9.25 hours of sleep each night.
Know when you need to get up in the morning, then calculate when you need to go to sleep to get at least 8.5 hours of sleep a night.
Get into bright light as soon as possible in the morning, but avoid it in the evening.
The light helps to signal to the brain when it should wakeup and when it should prepare to sleep.
Understand your circadian rhythm. Then, you can try to maximize your schedule throughout the day according to your internal clock.
For example, to compensate for your "slump (sleepy) times," participate in stimulating activities or classes that are interactive, and avoid lecture classes or potentially unsafe activities, including driving.
After lunch (or after noon), stay away from coffee, colas with caffeine, and nicotine, which are all stimulants. Also avoid alcohol, which disrupts sleep.
Relax before going to bed. Avoid heavy reading, studying, and computer games within one hour of going to bed.
Don't fall asleep with the television on -- flickering light and stimulating content can inhibit restful sleep.
If you work during the week, try to avoid working night hours. If you work until 9:30 pm, for example, you will need to plan time to "chill out" before going to sleep.
Become a Teen sleep-smart trendsetter!
Be a bed head, not a dead head. Understand the dangers of insufficient sleep -- and avoid them! Encourage your friends to do the same.
Ask others how much sleep they've had lately before you let them drive you somewhere. Remember: Friends don't let friends drive drowsy.
Brag about your bedtime. Tell your friends how good you feel after getting more than 8 hours of sleep!
Do you study with a buddy? If you're getting together after school, tell your pal you need to catch a nap first, or take a nap break if needed. (Taking a nap in the evening may make it harder for you to sleep at night, however.)
Say no to all-nighters. Staying up late can cause chaos to your sleep patterns and your ability to be alert the next day ... and beyond.
Remember, the best thing you can do to prepare for a test is to get plenty of sleep.
All nighters or late-night study sessions might seem to give you more time to cram for your exam, but they are also likely to drain your brainpower.
POINTERS FOR PARENTS
If your kids have teen sleep problems or insomnia, educate yourself about adolescent development, including physical and behavioral changes you can expect, including those that relate to their sleep needs and patterns.
Look for signs of sleep deprivation (insufficient sleep) and sleepiness in your teen -- keep in mind that they are not always obvious.
Signs include difficulty waking in the morning, irritability late in the day, falling asleep spontaneously during quiet times of the day, and sleeping for extra long periods on the weekends.
In addition, sleepiness can also look similar to attention deficit hyperactivity disorder. Above all, don't allow any family member to drive when sleep deprived or drowsy.
Enforce regular sleep schedules for all children and maintain appropriate schedules as they grow older.
To help induce sleepiness in adolescents, establish a quiet time in the evening when the lights are dimmed and loud music is not permitted.
Talk with your children about their individual sleep/wake schedules and level of sleepiness. Assess the time spent in extracurricular and employment activities with regard to their sleep patterns and needs, and make adjustments if necessary.
Encourage your children to complete a sleep diary for 7 to 14 consecutive (and typical) days. The diary can provide immediate information on poor sleep hygiene, and it can be used to measure the effectiveness of efforts to change.
Be sure to share the sleep logs or diaries with any sleep experts or other health professional who later assesses your child's sleep or sleepiness. (Why not keep your own sleep diary as well?)
If your child's sleep schedule during vacation is not in sync with the upcoming school schedule, help him or her adjust it for a smooth transition. This process can take from several days to several weeks, so plan ahead!
If conservative measures to shift your child's circadian rhythm are ineffective, or if your child practices good sleep hygiene and still has difficulty staying awake at times throughout the day:
Consult a sleep expert. Excessive daytime sleepiness can be a sign of narcolepsy, apnea, periodic limb movement disorder and other serious but treatable sleep disorders.
Discuss with teachers and school officials ways to accommodate your child's needs, if necessary. Excessive daytime sleepiness due to sleep disorders or other medical conditions are covered under the Americans with Disabilities Act and the Disabilities Education Act of 1997.
Be a good role model: Make sleep a high priority for yourself and your family and practice good sleep hygiene. Listen to your body. If you are often sleepy, get more sleep at night, take naps, or sleep longer when possible. Consult a sleep expert if needed.
Actively seek positive changes in your community by increasing public awareness about sleep and the harmful effects of sleep deprivation, and by supporting sleep-smart policies.
Request sleep education in school curricula at all levels and encourage your school district to provide optimal environments for learning, including adopting healthy and appropriate school start times for all students.
NSF poll shows that most parents heard their children complain of being tired during the day.
Mature / Elderly daily sleep requirement:
On average: 7-9 hours
Never before in the young history of America have so many people lived to be so old.
The elderly are, in fact, the fastest growing segment of the American population today.
Though the older among us are living longer, healthier, and more productive lives than ever before, there are many changes that often accompany aging.
Chronic illness becomes more common, the body itself grows frailer, and worries or concerns about the future often grow more acute with age as well.
As adolescents continue to grow into adulthood, the pattern shifts back, so that most adults get sleepy around 11 pm.
They'll sleep about 8 hours because now we need less sleep as we get into adulthood, which means that they're waking up around 6 or 7 in the morning.
There are individual differences in how much sleep adults need, and people need to figure that out for themselves. The way you do that is by finding out how much sleep it takes for you to feel fully alert during the day.
And what fully alert means is that you're able to stay awake until it's time to go to bed at night.
There is this myth that as we get older, we need less sleep. The truth is that our ability to sleep changes as we get older, but the need for sleep probably doesn't. As we get older, the amount of deep sleep that we have decreases. It actually starts decreasing at around age 20.
As we get older, our sleep architecture changes. We begin losing some of our deep sleep and the less deep sleep you have, the more time you'll spend in lighter stages of sleep.
If you're spending more time in lighter stages, that means that you're more likely to react to noises or things in the environment that will wake you up.
It's not entirely clear if we actually need less sleep as we age. We do know that there are a lot of changes in the sleep-wake cycle as we age.
As we age, we tend to lose the ability to sleep as deeply at nighttime, so there's a natural degradation of the sleep-wake process as we get older.
Just as the body changes with age, so too does the brain. Unfortunately, we tend to lose certain aspects of brain function with age.
The parts of brain function that we lose are areas of the cortex, and the cortex is responsible for generating sleep at nighttime.
When we lose some of that cortical function, we're just not able to generate the same degree of sleep as we were when we were younger. And these changes start earlier than you may think, when we're in our early 30s and 40s.
One of the biggest problems we see in sleep disorders medicine is sleep issues in older people. In part it's the result of the changes in brain function, but it's also a result of the stresses and difficulties inherent in later life.
Generally, older people complain of waking up in the middle of the night and having only fragmented sleep after that.
They tend not to have too much difficulty falling asleep, but after a few hours of sleep, their brains say, "I'm done," then they start waking up and having fragmented sleep throughout the nighttime.
They tend to wake up very early in the morning, four or five o'clock or so, not being able to return to sleep.
And without that restorative sleep at nighttime, they tend to take catnaps throughout the daytime, falling asleep periodically. They feel a little more sleepy at certain times during the daytime.
All these factors associated with growing older can result in ever-elusive nights of good sleep.
Other factors include - Changing Sleep Patterns as we age
Sleep changes as we age – as any one over the age of 50 knows. Not only do changes in sleep patterns occur, but there is also an increased incidence of many sleep disorders.
Frequent awakenings
One of the most common changes in the elderly is the occurrence of frequent awakenings during the night. While these awakenings are sometimes caused by physical conditions (pain, the need to urinate) it has been shown that the aging process itself causes sleep to become more fragmented.
Changes in the biological clock
Another change that can occur with aging is a shifting of the biological clock. Many elderly people are surprised that they fall asleep earlier in the evening and may awaken before sunrise.
The biological clock – the part of the brain that regulates sleep, temperature, and certain hormones – shifts sleep and wake times, so that it becomes more difficult to stay awake in the evening and easier to wake up early in the morning.
Changes in the level of sleep
In addition to the timing of sleep, the levels of sleep change as you age. There is less of the very deep sleep known as delta or slow wave sleep and more light sleep. While the level of sleep may change, the total number of hours of sleep may not change much from when you were younger.
Hormonal changes
The hormones involved with sleep also change in the elderly. You have probably heard of melatonin, which is sometimes referred to as the "hormone of darkness" because it is produced in the absence of light.
The role of melatonin in sleep is controversial. We know that melatonin levels decrease with age but we do not know the significance of this reduction, or if melatonin pills help elderly people (or others, for that matter) who have trouble falling or staying asleep.
Also, many people who try melatonin take it an incorrect times, and may not reap its benefits.
Sleep Tips during Menopause
Eat healthy. Avoid large meals, especially before bedtime. Maintain a regular, normal weight. Some foods that are spicy or acidic may trigger hot flashes. Try foods rich in soy as they might minimize hot flashes.
Avoid nicotine, caffeine and alcohol, especially before bedtime.
Dress in lightweight clothes to improve sleep efficiency. Avoid heavy, insulating blankets and consider using a fan or air conditioning to cool the air and increase circulation.
Reduce stress and worry as much as possible. Try relaxation techniques, massage and exercise. Talk to a behavioral health professional if you are depressed, anxious or having problems.
Sleep Hygiene
Ironically, many of the above symptoms are made worse by the things that people do to try to compensate for their changing sleep patterns. At any age, it is important to have proper sleep habits – what we refer to as "good sleep hygiene".
But as we grow older, it becomes increasingly vital to maintain healthy sleep hygiene, since many older people unknowingly violate it trying to correct their altered sleeping habits.
The following are five important points to remember about sleep hygiene:
Do not spend too much time in bed and avoid naps when you can: It is important to spend only the time in bed you truly need.
When you have had a poor night's sleep and feel awful the next morning, you might believe that if you spend more time in bed you will get more sleep.
Unfortunately, what generally happens when you spend extra time in bed is that your sleep becomes fragmented.
Periods of sleep alternate with frequent awakening. In other words, if you only need 5 hours of sleep but spend 7 hours in bed, you will lie awake for at least 2 out of the 7 hours.
These alternating periods of sleep and awakening will cause the 'unrefreshed feeling' you were trying to avoid by staying in bed longer.
The solution is to figure out how much sleep time you need, which might be different from how much sleep you want.
You can do this by keeping track of the total number of hours spent sleeping in a 24 hour period (remember to include any daytime naps) for two weeks and then calculate the average sleep you get in 24 hours.
You should stay in bed only for the time you need to sleep plus 30 minutes (to allow for some time to fall asleep) each night. For example, if you need 6 hours of sleep, spend only 6.5 hours in bed.
The corollary is to avoid naps (if you like to nap, just decrease your time in bed at night) since napping will take away from the time you will sleep at night.
Use the bed only for sleeping: It sounds silly but our bodies pick up on a lot of subconscious clues.
If you have trouble falling asleep, try avoiding non-sleep-related activities in bed. Therefore, do not pay bills, watch television or read in bed. Use the bed only for sleeping
Avoid alcohol, tobacco, and coffee in the evening: Alcohol relaxes you and can help you fall asleep.
However, when the alcohol wears off it has the opposite effect, causing awakening and fragmented sleep during the remainder of the night.
Therefore, avoid the "nightcap" and do not drink alcohol within six hours of bedtime.
Cigarettes are relaxing but make you more alert – and therefore make it more difficult for you to fall asleep. If you must smoke, have your last cigarette at least three hours before going to bed.
Caffeine, as we all know, helps us wake up, so you should avoid it after 3:00 p.m.
Exercise: Exercise is great at any age and when you exercise in the late afternoon, it increases the amount of deep sleep that you will experience. However, exercise in the evening can get your adrenaline pumping and keep you awake.
Wind down: Don't expect yourself to fall asleep immediately. Wind down in the evenings. Develop a relaxing routine such as reading (in a chair) before getting into bed.
If maintaining healthy sleep hygiene doesn't help, it is possible that you might have a more serious problem.
Any type of major brain change—structural problems or dementia—can severely fragment sleep at night.
Parkinson's disease, for instance, causes a very specific change in how our brains work at nighttime, and people with Parkinson's disease sometimes experience a 50% reduction in their ability to sleep.
It's not uncommon for people with Parkinson's to get only two or three hours of sleep at night.
Also, most of the mental disorders that can affect younger people also affect late-life individuals, but older people may be more vulnerable to them. Depression is a major problem that we see.
Grief and bereavement, major stressors of late life, going into retirement and suddenly having a lot of time on your hands, not being as active during the daytime—all these factors can lead to difficulties and anxiety disorders, which can lead to sleep problems.
It is important to establish a regular pattern of getting ready to go to bed, and learn to avoid anything that will activate or arouse a person right before bed.
Thinking about complex problems or emotional problems, or trying to deal with legal issues right before going to bed—all of these types of thoughts are best avoided before bedtime because they can be activating or arousing and make it very difficult to sleep soundly.
It's best to try and relax in the evening for an hour or two before bed, without heavy thoughts, without alcohol or stimulating activities. Eating a light snack roughly an hour before bedtime might actually promote good sleep.
Additionally, it's sometimes wise to delay bedtime in order to consolidate the sleep hours at night. Instead of going to bed at seven or eight o'clock, delay that time by a half hour or hour. And try not to stay in bed during the times you are not sleeping.
Sleeping medications are effective but some have a number of side effects. They can cause problems with concentration, memory or sedation that may carry over into the daytime.
This can happen because the medication remains in the body for long periods of time or they have active byproducts (which are produced during the normal drug breakdown in the body) that can lead to these types of problems.
The other problem in the elderly is sometimes they experience rebounding insomnia or withdrawal problems.
Over the past ten years or so there have been some newer prescription sleeping medications that tend to have fewer side effects and fewer addictive or dependence problems.
And I think since the elderly are vulnerable to so many problems, we have to try to treat them with medications that may be milder, that may have fewer side effects, that are shorter acting, and that are a little bit easier to control.
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