Sleep is necessary for survival and health, but we do not fully understand why or how it benefits people. The sleep needs of individuals are very different; some healthy adults need only 4 hours of sleep, while others need as much as 9 hours of sleep per day. Most people sleep at night, but many people have to sleep during the day due to their work schedule, which often leads to sleep disorders. Most sleep disorders are common.
SLEEP and SLEEP DISORDERS: General | Average daily sleep requirements | Stages of the Sleep Cycle | Insomnia | Put to sleep | Hypersomnia | Narcolepsy | Syndromes of sleep apnea | Parasomnias | Questions and Answers | Sources/references
How long a person sleeps and how rested he feels when he wakes up depends on many factors, e.g., excitement or emotional distress, and the medications he is taking; some medicines make a person sleepy, while others make it difficult to sleep.
Some food ingredients or additives, e.g., caffeine, solid spices, and monosodium glutamate, can affect sleep.
Image: Most sleep disorders are common.
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The person has difficulty falling asleep and cannot sleep for a long time without interruption, sleeps for too short or too long, or has abnormal sleep behavior, e.g., nightmares or monthly.
Average daily sleep needs:
| Age | Total number of hours | REM sleep (percentage of total sleep) | Stage 4 sleep (percentage of total sleep) |
| newborn | 13 to 17 | 50% | 25% |
| Two years | 9 to 13 | 30 to 35% | 25% |
| Ten years | 10 to 11 | 25% | 25 to 30% |
| 16 to 65 years | 6 to 9 | 25% | 25% |
Sleep is not a single state; it has several stages that usually cycle through five or six times each night. Sleep progresses from stage 1 (the lightest level in which the sleeper can be easily awakened) to stage 4 (the most profound level in which it is difficult to wake the sleeper). In stage 4, the muscles are relaxed, the blood pressure is the lowest, and the heart and breathing rates are the slowest.
In addition to these four stages, there is a form of sleep accompanied by rapid eye movement (REM) and behavioral activity. During REM sleep, the electrical activity in the brain is unusually high, sometimes similar to wakefulness. Eye movements and the resulting brain wave changes can be recorded electrically on an electroencephalogram (EEG).
Image: Sleep apnea is much less common in women.
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In REM sleep, the frequency and depth of breathing increase, and the muscles are very relaxed—even more so than in the deepest levels of non-REM sleep. We dream primarily during REM and stage 3 sleep, while sleep talking, nightmares, and sleepwalking occur most often in stages 3 and 4. In a normal night's sleep, REM sleep closely follows each of the five or six cycles of four-stage non-REM sleep, but it can appear in any of the stages.
Stages of the sleep cycle
The term "sleep cycle stages" refers to the stages of sleep we go through during a night's sleep. Different theories about how sleep is organized exist, but most research agrees that sleep is divided into several phases.
The most common model includes the following stages:
- Awake phase: this is the state when we are fully conscious and active. The waking phase represents the beginning of sleep.
- Asleep phase (sleep with non-RIM eye movements): this is the phase when we begin to relax and prepare for sleep slowly. Brain activity begins to slow down, muscles relax, and we become less sensitive to external stimuli.
- Stage NREM 1 (light sleep): In this stage, sleep is very easily interrupted. Brain activity slows down, muscles continue to relax, heart rate slows down, and movement slows down.
- Stage NREM 2 (deeper sleep): this is the stage in which we are aware that we have fallen asleep. Sporadic eye movements occur, and the brain processes information from the previous day.
- Stage NREM 3 (deep sleep) is also known as slow-wave sleep. It is the deepest stage of sleep, during which it is difficult to wake up. In this phase, physical energy is restored, and tissues are renewed.
- REM phase (rapid eye movement): this is the phase that is also called paradoxical sleep. The brain is active in this phase, while the muscles are completely relaxed. Dreams are most frequent and vivid during this stage. It only lasts briefly at the beginning of sleep, but it lengthens throughout the night over time.
These phases repeat in cycles throughout the night, with the relationship between them changing. At the beginning of the night, most of the sleep is in deep sleep (NREM 3), while in the second half of the night, there is more REM sleep. We must pass through all these phases at night, as each has a role in physical and cognitive recovery.
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- insomnia,
- addiction to sleeping pills,
- hypersomnia,
- Severe snoring or choking,
- nightmares,
- According to the witnesses' description, it was abnormal sleep.
The initial sleep lab evaluation may include the following:
- Sleep history, often together with a sleep diary,
- general medical history,
- physical examination,
- blood tests,
- laboratory sleep testing.
Two examples of laboratory sleep tests are overnight polysomnography and the multiple sleep latency test. In nocturnal polysomnography, a person spends the night in a sleep laboratory with attached electrodes measuring sleep stages and other physiological parameters.
This test is used to assess sleep apnea or sleep movement disorders. In the multiple sleep latency test, a person goes through the day in a sleep laboratory and takes occasional naps. This test is used to assess daytime sleepiness, especially in narcolepsy.
Insomnia
A person with insomnia has difficulty falling asleep, cannot sleep for long periods without interruptions, or has sleep disorders that make them feel like they have slept too little after waking up. Insomnia is not a disease - it is a symptom with many causes, including emotional disorders and physical illnesses. Both younger and older people often have difficulty falling asleep; this often happens with emotional disorders, e.g., anxiety or depression.
Image: Sometimes insomnia can be a side effect of medication.
An early morning waking pattern is more common in older people. Some people fall asleep usually but wake up after a few hours and cannot quickly go back to sleep. Sometimes, they oscillate between wakefulness and restless, unsatisfying sleep. Waking up early in the morning can be a sign of depression at any age.
People with disturbed sleep patterns may experience a reversal of their sleep rhythm: they fall asleep at an inappropriate time when they should have been asleep, but they cannot. These plants often occur due to traveling between time zones (especially when traveling from east to west), working irregular night shifts, frequently changing work hours, or drinking too much alcohol. Sometimes, they are side effects of some medicines. A malfunction of the brain's built-in clock (e.g., due to encephalitis, stroke, or Alzheimer's disease) can also disrupt sleep patterns.
To diagnose insomnia, a doctor evaluates a person's sleep pattern, medication, alcohol and drug use, level of mental stress, medical history, and level of physical activity. Doctors can classify insomnia as primary insomnia, which is a long-term condition without a clear connection to any stress or life event, or secondary insomnia, which is caused by pain, anxiety, medication, depression, or stress.
Sleeping pills: not to be taken lightly
Hypnotics (sedatives, minor tranquilizers, anxiolytics) are among the drugs most often prescribed by doctors. Mostly, they are safe, but all can lose effectiveness once a person gets used to them. They can also cause withdrawal symptoms when taking is stopped.
If a person takes a hypnotic for more than a few days and then stops taking it, the original sleep problem may worsen ("reversal insomnia"), and anxiety may increase. Doctors recommend slowly reducing the dose; it may take several weeks to stop taking the drug completely.
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Most hypnotics cannot be bought without a doctor's prescription because they can be habit-forming or addictive, and an overdose is also possible. These drugs are hazardous in older people and in people who have breathing problems (hypnotics often inhibit the activity of the brain areas that control breathing). They also reduce alertness during the day so that driving a car or operating machinery becomes dangerous.
Hypnotics are especially dangerous if they are consumed simultaneously with alcohol, other hypnotics, narcotics, antihistamines, and antidepressants. All these drugs cause drowsiness and can suppress breathing, so the combined effects are more dangerous.
The most common and safest hypnotics are benzodiazepines. Because they do not reduce the total amount of REM sleep, they do not reduce dreaming. Some benzodiazepines stay in the body longer than others. Older people who cannot metabolize and eliminate medications, as well as younger people, are more likely to experience daytime sleepiness, slurred speech, and a tendency to fall. Therefore, doctors try to prescribe as little as possible long-acting benzodiazepines, such as flurazepam, chlordiazepoxide, and diazepam.
Image: Sleeping pills can cause instability, dizziness, and forgetfulness.
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Barbiturates, once the most commonly used hypnotics, and meprobamate are not as safe as benzodiazepines. Chloral hydrate is relatively safe but is much less commonly used than benzodiazepines. Some antidepressants, e.g., amitriptyline, can relieve insomnia associated with depression or early morning awakenings caused by panic attacks, but unwanted side effects may occur, especially in the elderly.
Diphenhydramine and dimenhydrinate can relieve mild or occasional sleep problems, but they are not primarily used as sedatives and have potential unwanted side effects, especially in older people.
The treatment of insomnia depends on its cause and severity. Older people who experience age-related sleep changes usually do not need treatment because these changes are expected. Since the length of daily sleep tends to decrease with age, it often helps older adults to go to bed later or get up earlier.
It helps people with insomnia if they are calm and relaxed in the last hour before going to sleep and if the bedroom environment is conducive to sleep. You need semi-darkness, as little noise as possible, and a pleasant room temperature.
If the insomnia is causing emotional stress, a treatment to alleviate the stress is more helpful than taking sleeping pills. When insomnia occurs along with depression, the depression should be thoroughly investigated and treated by a physician. Some antidepressants can improve sleep because they have a soothing effect. When sleep disorders interfere with everyday tasks and cause discomfort, the occasional use of drugs that promote sleep (tranquilizers, hypnotics) may help.
Hypersomnia
Hypersomnia is an extension of the period of daily sleep by about one-quarter. It is less common than insomnia and is a symptom that often indicates the possibility of a serious illness. Temporary hypersomnia can occur in healthy people for a few nights or days after a period of prolonged sleep deprivation or unusual physical exertion.
If excessive sleepiness occurs suddenly, the doctor will ask about the patient's mood, awareness of recent events, and any medications the person may be taking. The doctor will examine the heart and lungs and suggest laboratory tests.
Image: Hypersomnia is rarer than insomnia.
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Hypersomnia that has occurred recently and cannot be explained by illness or excessive medication may be caused by a psychiatric illness (e.g., depression) or a neurological problem (e.g., encephalitis, meningitis, or an intracranial tumor). A neurological examination may show depression, memory impairment, or abnormal neurological signs. A person with signs of a neurological problem is referred by a doctor for computed tomography (CT) or magnetic resonance imaging (MRS) and sent to a neurologist.
Narcolepsy
Narcolepsy, which is an unusual sleep disorder, is characterized by repeated uncontrollable sleep attacks during a period when a person is otherwise usually awake, as well as cataplexy, sleep paralysis, and hallucinations. The cause of narcolepsy is unknown, but this disease occurs in families, which indicates a hereditary predisposition. Narcolepsy does not have serious health consequences, but it can frighten the patient and those around him and increase the risk of accidents.
Symptoms
A person with narcolepsy may momentarily become paralyzed without losing consciousness (this condition is called cataplexy) in response to a sudden emotional reaction, e.g., anger, fear, joy, laughter, or surprise. The person may become limp, drop something he is holding in his hand, or fall to the ground.
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Intermittent periods of sleep paralysis are also possible; right when a person falls asleep or immediately after waking up, he experiences the feeling that he wants to move but cannot. This experience can be terrifying. Vivid hallucinations, during which a person sees or hears things that are not there, can occur at the beginning of sleep and less often when waking up. Hallucinations are similar to those in ordinary dreams but more intense. Only about 10 percent of people with narcolepsy have all of these symptoms; most of them only have a few.
Diagnosis
While diagnosis is usually based on symptoms, similar symptoms do not necessarily mean that a person has narcolepsy. Cataplexy, sleep paralysis, and hallucinations are common in young children and sometimes occur in otherwise healthy adults. If the doctor is unsure about the diagnosis, he can send the patient to a sleep study laboratory.
An electroencephalogram (EEG) recording the brain's electrical activity may show that REM sleep patterns occur when a person is dozing off, characteristic of narcolepsy. No structural changes were observed in the brain, and no abnormalities were observed in the blood tests.
Treatment
Incentives, e.g., ephedrine, amphetamine, dextroamphetamine, and methylphenidate, can help relieve narcolepsy. The dose should be adjusted so that side effects do not occur.
Syndromes of sleep apnea
Nocturnal apnea is a group of severe sleep disorders in which a sleeping person repeatedly stops breathing (apnea) for so long that the concentration of oxygen in the blood and brain decreases and the concentration of carbon dioxide increases. Sleep apnea can be either obstructive or central. A blockage in the throat or upper airways causes obstructive sleep apnea.
Central sleep apnea is caused by a malfunction in the part of the brain that controls breathing. Sometimes, in obstructive sleep apnea, the combination of long-term low oxygen concentration and high carbon dioxide concentration in the blood reduces the brain's sensitivity to these abnormalities, adding an element of central apnea to the problem.
Image: Sleep apnea can be either obstructive or central.
Obstructive sleep apnea usually occurs in obese men, most of whom try to sleep on their backs. The disease is much rarer in women. Obesity, perhaps in combination with the aging of body tissues and other factors, causes the narrowing of the upper airways.
Smoking, excessive alcohol consumption, and lung diseases, e.g., emphysema, increase the risk of developing obstructive sleep apnea. A tendency to sleep apnea - a narrowing of the throat and upper airways - can be inherited and run in several family members.
Symptoms
Since the symptoms occur during sleep, they must be described by someone who observes the person while he sleeps. The most common symptom is snoring, which is associated with episodes of gasping and choking, periods of periodic cessation of breathing, and periods of sudden awakening. In complex cases, the patient has repeated attacks of sleep-related obstructive sleep apnea both at night and during the day.
Sooner or later, these attacks interfere with daily work and increase the risk of complications. Long-term severe sleep apnea can result in headaches, excessive sleepiness during the day, slowed mental activity, and sooner or later heart failure and pulmonary insufficiency, in which the lungs cannot supply the body with sufficient amounts of oxygen and remove carbon dioxide.
Diagnosis
In the early stages, the doctor often diagnoses sleep apnea with the help of information obtained from a person who sleeps with the patient, who may describe loud snoring or gasping and startled awakening from sleep associated with choking or increasing fatigue during the day.
Treatment
The first measures for people with obstructive sleep apnea are to stop smoking, give up excessive alcohol consumption, and lose weight. People who snore heavily and people who often suffocate during sleep should not take sedatives, sleeping pills, and other sedatives.
People with central sleep apnea are usually helped by an artificial respiration device they use while sleeping. Changing the sleeping position is essential; snoring people should sleep on their side or stomach.
Suppose such simple procedures do not eliminate night apnea. In that case, we can try permanent positive pressure in the respiratory tract, provided by a device worn by the patient as an oxygen mask, which supplies air and oxygen through the nose. Such a device ensures the opening of the airways and thus contributes to regular breathing. Most people, except alcoholics, quickly get used to these devices.
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Rarely, a person with severe sleep apnea needs a tracheostomy, a surgical procedure that creates a permanent opening in the trachea through the neck. Other surgical procedures are sometimes used to widen the upper airway and relieve the problems. However, such extreme measures are only necessary in exceptional cases and are usually carried out by specialists.
Parasomnias
Parasomnias are vivid dreams and physical activities that occur during sleep. Many unconscious movements can occur during sleep, which the person mostly does not remember (these movements occur more often in children than adults).
Almost all people sometimes experience short, individual, involuntary jerks of the whole body just before falling asleep. Some people also experience sleep paralysis or short-term hallucinations. In sleep, people normally twitch their lower limbs occasionally; in adults, there may be wild grinding of teeth, occasional movements, and must. Sleepwalking (menstruation), head banging, night terrors, and nightmares are more common and very debilitating in children. Epileptic seizures can occur in people of all ages.
Restless legs syndrome (akathisia) is a relatively common disorder that often occurs just before falling asleep, especially in people over 50 years of age. In particular, when people with akathisia are overworked, they get vague, uncomfortable sensations in the lower limbs, along with spontaneous, uncontrollable movements of the lower limbs. We do not know the cause, but it appears in the family in at least a third of people with the mentioned disorder. Akathisia is sometimes relieved by benzodiazepine drugs, which the patient takes before going to bed.
Night terrors are terrifying episodes during which a person screams, flails his limbs, and often walks in his sleep. These attacks usually occur during periods of non-rapid eye movement sleep. Treatment with benzodiazepines, e.g. with diazepam.
The sea is a vivid, terrifying dream in children and adults. A sudden awakening follows a dream. Nightmares occur during REM sleep and are more common during periods of stress, heat, excessive fatigue, or after consuming alcohol. No specific treatment is known.
Image: Nightmares are vivid, terrifying dreams in children and adults.
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Menstruation (somnambulism), most common in late childhood and adolescence, is semi-conscious walking that the patient is unaware of. People are not dreaming during sleepwalking—the brain activity during sleepwalking, although not normal, is actually more indicative of wakefulness than sleep. Months can keep muttering something and bump into obstacles, injuring themselves. They mostly don't remember sleepwalking.
There is no specific treatment for this sleep disorder; however, we gently take the menstruator back to bed. Sometimes, the tendency to sleepwalk is reduced if we leave a light on in the bedroom or hall. Violently waking the menstruator can provoke an angry reaction and is not recommended. We must remove obstacles or breakable objects on the path that the moonshine could follow, and low windows should permanently be closed and locked.
Questions and answers
What causes sleep paralysis?
Insomnia, disturbed sleep patterns – such as due to shift work or jet lag, narcolepsy – a long-term condition that causes a person to fall asleep suddenly, and post-traumatic stress disorder (PTSD)[1].< /p>
How common is narcolepsy?
The incidence of narcolepsy is approximately 1 in 2,000, and most researchers believe that the disorder remains undiagnosed or misdiagnosed in many affected individuals[2].
How do we treat insomnia?
The treatment of insomnia depends on its cause and how severe it is. It helps people with insomnia if they are calm and relaxed in the last hour before bed and if the bedroom environment is conducive to sleep. If the insomnia is causing emotional stress, a treatment to relieve the stress is more helpful than taking sleeping pills. When insomnia occurs together with depression, the depression should be thoroughly investigated and treated by a doctor.
How many hours of sleep do we need on average per day?
- newborn: 13 to 17 hours
- Two years: 9 to 13 hours
- Ten years: 10 to 11 hours
- 16 to 65 years: 6 to 9 hours
How safe are sleeping pills for the treatment of insomnia?
One of the main risks of sleeping pills is that you can become dependent on them. This means that sleeping pills become less effective over time, and you cannot sleep well without them. When you try to quit, you may also start to feel sick or experience more severe insomnia. Sleeping pills can also cause instability, dizziness, and forgetfulness[3].
Can sleep apnea occur suddenly and for no reason?
Medical conditions such as congestive heart failure, high blood pressure, and type 2 diabetes are some of the conditions that can increase the risk of obstructive sleep apnea. Polycystic ovary syndrome, hormonal disorders, previous stroke, and chronic lung diseases such as asthma[4] can also increase the risk.
Sources and references
Extensive health manual for home use, Youth Book Publishing House
- Sleep paralysis - https://www.nhs.uk
- Narcolepsy - https://rarediseases.org
- Safe use of sleeping pills - https://www.healthdirect.gov.au
- Sleep apnea - https://www.mayoclinic.org
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