Extreme Sleepiness

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Each of us has a specific sleep requirement. Some people need nine hours every night in order to feel their best while others feel great with just seven. But imagine getting ten or more hours of sleep at night plus a couple of hour-long naps during the day and still feeling sleepy. There can be a number of reasons why this would occur but a sleep specialist would consider the possibility of a condition called “idiopathic hypersomnia,” a serious and debilitating disorder with no known cause.

People with idiopathic hypersomnia may suffer either constant or recurrent episodes of extreme sleepiness. There are other causes of extreme sleepiness, such as narcolepsy, obstructive sleep apnea, movement disorders during sleep, and a variety of medications. Chronic sleep deprivation may also cause extreme sleepiness, but in this case getting extra sleep usually alleviates the sleepiness. This is called paying off a sleep debt. Idiopathic hypersomnia, in contrast, persists even after a sleep debt is paid off.

If you are experiencing extreme sleepiness, you should talk to your doctor about the duration and intensity of your symptoms. Your doctor may refer you to a sleep specialist who will take a complete medical history in order to rule out other conditions that may be involved. You may be scheduled to have a sleep study, in which certain criteria must be present for a diagnosis of idiopathic hypersomnia. They are:

Having had symptoms for at least six months that have not occurred within 18 months of head trauma. The absence of medical or mental disease that may account for the symptoms, including other sleep disorders such as narcolepsy or post-traumatic hypersomnia. Normal polysomnography results. A Multiple Sleep Latency Test of less than 10 minutes.

The most common treatments for excessive sleepiness are stimulant medications. However, these drugs are not a substitute for sleep. People with idiopathic hypersomnia often must allow more time in their schedules for sleep than most people, even while using such medications. Here are some additional tips for coping with extreme sleepiness:

Take naps whenever possible. Maintain a regular sleep schedule. Avoid alcohol and medications that may cause drowsiness. Talk to your friends, family, and co-workers about your symptoms so that they know what to expect and how to help.

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COPD and Difficulty Breathing

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Chronic obstructive pulmonary disease (COPD) is a term used for lung disorders such as emphysema, chronic bronchitis, and in some cases chronic asthma. People with COPD may have difficulty breathing, chronic cough, fatigue, and chest tightening. COPD can also result in reduced blood oxygen levels, causing fatigue and leading to adverse health conditions. Sleep problems and sleepiness are common in COPD patients, partly due to symptoms but also because of the medications used to treat COPD. In addition, changes in breathing patterns that occur during normal sleep that do not affect healthy people may lead to more severe consequences in people with COPD, which may worsen and complicate COPD since they reduce blood oxygen. Even COPD patients without?obstructive sleep apnea (OSA)?may experience a drop in oxygen during sleep.

COPD develops slowly and is rare in people under the age of 40. It is progressive, meaning that it does not go away and may worsen over time, depending on when treatment is initiated. According to COPD International, 12 million Americans currently have COPD and an estimated 12 million more are undiagnosed. Smoking is the main cause of COPD but it is also linked with exposure to second hand smoke and/or other environmental pollutants. COPD is the fourth leading cause of death in the United States, according to a report by the Centers for Disease Control and Prevention.

For people with COPD, symptoms such as coughing, chest pain, and frequent nighttime urination may profoundly impact sleep. In addition, medications used to treat COPD may cause insomnia or daytime sleepiness. Simply having to wake up and take prescriptions on schedule may also disturb sleep.

Overlap syndrome is a term used for patients with both COPD and OSA. Overlap syndrome, which research suggests occurs in 10-15% of COPD patients, is associated with a reduction of blood oxygen levels during sleep, which may cause extreme fatigue and other health problems. If you have COPD and suspect that you may also suffer from OSA, talk to your physician about treatment options, including continuous positive airway pressure (CPAP). Research suggests that treatment of overlap syndrome with CPAP improves lung function. Another study suggests that it may improve erectile dysfunction in men with overlap syndrome.

COPD is linked with heart disease. Specifically, COPD is one of the most common causes of “cor pulmonale,” an enlargement in the right ventricle which leads to failure of the right side of the heart, according to a recent study. When COPD is combined with OSA, the prevalence of cor pulmonale can be as high as 80%, according to one analysis, which also found that less than a third of COPD patients with cor pulmonale survive longer than five years.

COPD is a life-threatening disease that requires major medical intervention and may result in early death. Unfortunately, COPD is often diagnosed once it has progressed from mild to severe and there is little opportunity for stopping or reversing its course. If you feel you may suffer from COPD, see a physician about your symptoms as soon as possible. If you have already been diagnosed with COPD, follow your treatment plan as directed and be vigilant about eating healthy and sleeping well.

Morning cough is often the earliest sign of the disease, followed by noisy breathing, chest pain, and breathlessness. People with COPD sometimes develop a barrel-shaped chest due to an enlargement of the lungs. Other symptoms include:

Difficulty breathing Chronic cough that produces sputum Wheezing, whistling, or hissing sound with breathing Chest pain or tightening Skin discolorations Erectile dysfunction Frequent nighttime urination Insomnia Weight loss Daytime sleepiness Fatigue

There is no cure for COPD, but there are treatments for its symptoms, including drug therapies, and behavioral remedies, and – rarely – surgery. In some cases, it is possible to alleviate symptoms by quitting smoking or avoiding environmental pollutants. Medications and rehabilitation therapies may also minimize or eliminate symptoms. In rare cases, surgery to reduce lung volume or lung transplantation is recommended, but these procedures carry severe risks. Supplemental oxygen is commonly prescribed for COPD patient and has been shown to increase the quality and quantity of patients’ lives.

Getting adequate sleep is essential to maintaining health in COPD patients. If you have symptoms of insomnia such as difficulty falling asleep, staying asleep, or waking up unrefreshed, talk to your doctor about treatment options. Keep in mind that certain store-purchased and prescription sleep aids may impair breathing in COPD patients. One exception is ramelteon, which was studied in mild and moderate COPD patients and found to not harm their breathing.

In addition to spending enough time sleeping, sleep quality is also important. Conditions such as overlap syndrome – having both COPD and?OSA – can seriously undermine health. If you have COPD as well as symptoms of OSA, talk to your physician about treatment options, including the use of continuous positive airway pressure (CPAP).

In addition to quitting smoking and the other self-directed therapies mentioned under “treatment,” getting adequate sleep is essential to feeling well and maintaining overall health. This can be challenging for COPD patients. Here are some tips for getting the sleep you need:

Maintain a regular sleep and wake schedule Establish a regular relaxing bedtime routine Use your bed only for sleep and sex, not for other stimulating activities Create a sleep environment that is cool, dark, and comfortable Avoid caffeine in the hours before bedtime

In addition to healthy sleep, try these tips for coping with COPD:

Conserve energy by limiting activities and getting adequate sleep Develop an exercise plan in consultation with your physician Keep your home free of smoke and airborne irritants Join a respiration rehabilitation group Take naps as needed, but not close to bedtime Eat healthy high-protein foods Seek support from family and friends

NSF’s 2003 Sleep in America poll found that untreated sleep problems may interfere with the ability to cope with chronic medical conditions. In addition, NSF’s 2005 Sleep in America poll found that 26% of American adults are at high risk for OSA.

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Pain and Sleep: What is Fibromyalgia?

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Fibromyalgia is a medical syndrome that causes widespread pain and stiffness in the muscles and joints as well as sleep problems and chronic daytime fatigue. According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases at the National Institutes of Health, between 80 and 90% of people diagnosed with fibromyalgia are middle-aged women, although it can affect both sexes and people of all ages. Fibromyalgia is a confusing and often misunderstood condition. In the past, people who sought treatment for fibromyalgia symptoms were frequently told that their symptoms were “all in the head” and that they did not represent any known disease. However, in recent decades medical studies have proven that fibromyalgia does indeed exist, and that it is estimated to affect between 2% and 6% of people worldwide.

For people with fibromyalgia, the combination of pain and sleep disturbance is a double-edged sword: the pain makes sleep more difficult and sleep deprivation exacerbates pain. The good news is that reduction in sleep disturbance is usually followed by improvement in pain symptoms. This also highlights the importance of healthy sleep and access to sleep specialists in treating this disease.

Medical researchers have long sought to clarify the association between sleep disturbance and pain. Very little is known but a few key findings indicate that sleep and pain are intricately linked. For example, studies of patients experiencing pain after surgery show disturbed sleep, reduced rapid eye movement (REM) sleep, and a normalization of sleep as recovery proceeds. People with fibromyalgia may also experience an alteration in their patterns of slow wave sleep, which is the deepest stage of sleep. In one study, researchers selectively deprived a group of healthy middle-aged women of slow wave sleep for a period of three days. In response, the women showed a decreased tolerance for pain and increased levels of discomfort and fatigue, suggesting that such sleep disruption may play an important role in the development of fibromyalgia symptoms.

In addition, sleep aides are widely and increasingly used by people with fibromyalgia, although their long-term effectiveness for alleviation of pain is doubtful. Further research is needed to understand the nature of the relationship between pain and sleep and to develop treatments that can help to improve both pain symptoms and sleep disturbance.

The cause of fibromyalgia is not known but there may be several factors involved. Clinicians who care for patients with fibromyalgia report a range of possible causes such as repetitive stress injuries, automobile accidents or other traumatic events. In some cases, fibromyalgia seems to run in families, although researchers are not sure if this is due to genetic or environmental factors. Fibromyalgia is considered a rheumatoid condition, but it is not truly a form of arthritis. However, people with arthritis are more likely to have fibromyalgia.

A variety of studies have been conducted to find connections between fibromyalgia and other medical conditions such as irritable bowel syndrome, chronic fatigue syndrome, migraines, arthritis, lupus, and major depressive disorder. The results of these studies have been largely inconclusive with respect to specific relationships, but many have established a link between fibromyalgia and heavy use of physician services. In other words, people with fibromyalgia tend to seek medical treatment significantly more often than people without it.

About 20% of fibromyalgia patients also have depression or anxiety disorder. Scientists have recently looked at whether chronic pain may cause depression or whether depression may play a role in people’s perception of pain. For example, researchers at the University of Michigan and the University of Cologne in Germany conducted a study of people with fibromyalgia which sought to reveal why symptoms of depression are sometimes associated with increased sensitivity to pain. The researchers were aware that fibromyalgia patients typically show a higher than normal sensitivity to pain regardless of whether they had been diagnosed with major depressive disorder or reported any depressive symptoms. What they were trying to determine was whether antidepressant medication might alleviate this heightened sensitivity. Based on the results of this study, the researchers concluded that treating depression in people with fibromyalgia will not necessarily have an impact on the patients’ complaints of pain. Instead, they recommend treating pain and fatigue symptoms separately from depressive symptoms, should they exist at all.

There may also be an association between fibromyalgia and restless legs syndrome (RLS), a neurologic sensorimotor disorder characterized by an overwhelming urge to move the legs when they are at rest. RLS is more common among patients with fibromyalgia and those with rheumatoid arthritis than among people who don’t have these conditions. An awareness of this association will help doctors look for and manage RLS symptoms among patients with fibromyalgia.

There are a variety of conditions that could lead to widespread pain and chronic fatigue. However, fibromyalgia typically also includes cognitive difficulties and psychological distress and a complaint of fatigue that is debilitating, unexplained, and unrelieved by rest. It is possible to experience symptoms similar to fibromyalgia if a person is suffering from sleep apnea. In addition, people with fibromyalgia may also suffer from sleep disorders such as sleep disordered breathing. Before seeking medical intervention for fibromyalgia, keeping a sleep diary as well as a sleepiness diary is recommended.

Fibromyalgia usually includes a broad range of symptoms including some combination of the following:

widespread pain sleep disturbances chronic daytime fatigue morning stiffness in the joints and muscles migraine headaches irritable bowel syndrome painful menstrual periods numbness or tingling of the extremities restless legs syndrome temperature sensitivity dizziness and balance problems cognitive and memory problems mood disturbance such as depression and anxiety

There are no FDA-approved drugs specifically developed for fibromyalgia but there are medications commonly used for other conditions that are effective treatments for fibromyalgia symptoms. In treating fibromyalgia, many physicians focus primarily on pharmacologic treatment, but self-directed and behavioral methods such as exercise and massage therapies have been shown to benefit patients as well. Also, improving sleep usually reduces pain and fatigue and improves daytime functioning.

No one treatment plan is uniformly effective for every fibromyalgia patient; those consisting of a combination of pharmacologic and nonpharmacologic therapies should be designed for each patient, and the clinician may have to try several different combinations before reaching improvement in the patient’s symptoms. The important thing to keep in mind is that any treatment plan must address both alleviation of pain and minimization of sleep disturbance.

Fibromyalgia is a persistent condition for which there is no cure. It is common for symptoms of fibromyalgia to wax and wane; they may be more severe at certain times of the day, month, or year and they may remit for an extended period of time only to reappear later either for no apparent reason or following a traumatic event such as an automobile accident. But there are ways of coping with fibromyalgia symptoms and preventing exacerbation of pain. Here are some tips:

Prioritize sleep ? it is important for people with fibromyalgia to maintain a regular sleep schedule and to get treatment for sleep disorders if necessary. Create a quiet environment ?chronic pain has been known to intensify in the presence of sound stress. Exercise ? regular exercise is known to improve symptoms in some patients. For people with fibromyalgia, low-impact activities such as walking, yoga or swimming are the best choice. Medication ? work with a physician to develop an effective medication regime. Massage ? gentle massage, deep breathing, and relaxation techniques are all generally considered beneficial with respect to chronic pain management.

According to the 1996 NSF Gallup poll, more women (58%) suffer from nighttime pain than men (48%). In the 2000 NSF Sleep in America poll, one in four women reported that pain or physical discomfort interrupted their sleep three nights a week or more.

Reviewed by Sherwood M. Chetlin, MD and Carol Landis, DNSc, RN, FAAN.

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Can’t Sleep? What To Know About Insomnia

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Insomnia, which is Latin for “no sleep,” is the inability to fall asleep or remain asleep. Insomnia is also used to describe the condition of waking up not feeling restored or refreshed. According to Dr. Mark Mahowald, Professor of Neurology at the University of Minnesota Medical School and Director of the Minnesota Regional Sleep Disorders Center at Hennepin County Medical Center, insomnia refers to the inability to get the amount of sleep you as an individual need to wake up feeling rested.

Insomnia is the most common sleep complaint among Americans. It can be either acute, lasting one to several nights, or chronic, even lasting months to years. When insomnia persists for longer than a month, it is considered chronic. According to the National Center for Sleep Disorders Research at the National Institutes of Health, about 30-40% of adults say they have some symptoms of insomnia within a given year, and about 10-15 percent of adults say they have chronic insomnia. People who have trouble sleeping every night without exception for months or years are fairly rare. More often, people experience chronic-intermittent insomnia, which means difficulty sleeping for a few nights, followed by a few nights of adequate sleep before the problem returns.

Insomnia can be a disorder in its own right, but often it is a symptom of some other disease or condition. Half of all those who have experienced insomnia blame the problem on stress and worry. In the case of stress-induced insomnia, the degree to which sleep is disturbed depends on the severity and duration of the stressful situation. Sometimes this may be a disturbing occurrence like loss of a loved one, loss of a job, marital or relationship discord or a tragic occurrence. Anticipation of such things as weddings, vacations, or holidays can also disturb sleep and make it difficult to fall asleep or remain asleep. Insomnia can also occur with jet lag, shift work and other major schedule changes.

If you have difficulty sleeping, it is essential to determine whether an underlying disease or condition is causing the problem. Sometimes insomnia is caused by pain, digestive problems or a sleep disorder. Insomnia may also signal depression or anxiety. Often times, insomnia exacerbates the underlying condition by leaving the patient fatigued and less able to cope and think clearly. For insomnia related to a medical condition or pain, ask your doctor about nighttime pain aids.

If your sleep trouble is confined to difficulty falling asleep, the time you are choosing to go to sleep may not be synchronized with your biological clock. The biological processes that initiate and maintain sleep in humans are active throughout the night. Opposing this sleep tendency, however, is the alerting action of the biological clock that is active throughout the day. When the biological clock is active at your scheduled bedtime, you will have sleep-onset insomnia.

The prevalence of insomnia is higher among older people and women. Women suffer loss of sleep in connection with menstruation, pregnancy, and menopause. Rates of insomnia increase as a function of age but most often the sleep disturbance is attributable to some other medical condition.

Some medications can lead to insomnia, including those taken for:

colds and allergieshigh blood pressureheart diseasethyroid diseasebirth controlasthmapain medicationsdepression (especially SSRI antidepressants)

?Some common sleep disorders such as restless legs syndrome and sleep apnea can also lead to insomnia.

Sleep is as essential as diet and exercise. Inadequate sleep can result in fatigue, depression, concentration problems, illness and injury.

Symptoms of insomnia include:

difficulty falling asleepwaking up frequently during the nightdifficulty returning to sleepwaking up too early in the morningunrefreshing sleepdaytime sleepinessdifficulty concentratingirritability

Left untreated, insomnia is linked to increased illness or morbidity. There is a wealth of research indicating that people with insomnia have poorer overall health, more work absenteeism, and a higher incidence of depression. Sleep deprivation is not insomnia. It is not actually clear that insomniacs “lose sleep,” particularly when it is primary. Many do not exhibit daytime distress or symptoms. Although people with acute insomnia may experience daytime sleepiness, most chronic insomnia patients experience an unpleasant sense of excessive arousal during the daytime.

If you are experiencing difficulty sleeping, consider whether an event or particular stress could be the cause. If so, the problem may resolve in time. If not, and the problem persists for a few weeks or more, or if you experience distress and discomfort as a result of the insomnia, talk to your doctor about your symptoms. Bring with you a record of your sleep, fatigue levels throughout the day, and any other symptoms you might be having.

There are a number of approaches to treating insomnia. A health care professional will ask about your sleep experience, your sleep schedule, and your daily routine. A thorough medical history and physical examination may be called for.

Because of the close connection between behavior and insomnia, behavioral therapy is often part of any treatment for insomnia. This is because people with insomnia may begin to associate certain sleep-related stimuli with being awake. For example, bedtime routines or the bedroom itself may become linked with anxiety for a person who is experiencing insomnia because they dread the thought of another sleepless night. A combination of several behavioral treatments is typically the most effective approach. Some examples of behavioral treatments are:

Stimulus Control Therapy: creating a sleep environment that promotes sleepCognitive Therapy: learning to develop positive thoughts and beliefs about sleepSleep Restriction: following a program that limits time in bed in order to get to sleep and stay asleep throughout the night

Relaxation techniques, such as yoga, meditation, and guided imagery may be especially helpful in preparing the body to sleep. Exercise, done early in the day, can also be helpful in reducing stress and promoting deeper sleep.

Behavioral therapies alone may not be enough. Treating insomnia with medication is the most common treatment for these sleep problems, particularly once a combination of behavioral approaches has been tried. Sleep medications for the treatment of insomnia are called hypnotics. They should only be taken when:

The cause of your insomnia has been evaluatedThe sleep problems are causing difficulties with your daily activitiesAppropriate sleep promoting behaviors have been addressed

All hypnotics induce sleep and some will help to maintain sleep. They work by acting at areas in the brain believed to be involved in sleep promotion. They are the drugs of choice because they have the highest benefit and the lowest risk as sleep-promoting drugs. Talk to your doctor about the possible side effects of taking hypnotics, such as morning sedation, memory problems, headaches, sleepwalking and a night or two of poor sleep after stopping the medication.

Women who are pregnant or nursing should not take hypnotics. Talk to your doctor about how to cope with insomnia during this time.

Finally, practicing good sleep hygiene may improve the quality of your sleep.

Regardless of what’s causing your sleep problems, it is important to establish and maintain healthy sleep habits. Here are some tips that will help you sleep well:

At night:

Use the bed and bedroom for sleep and sex onlyEstablish a regular bedtime routine and a regular sleep-wake scheduleDo not eat or drink too much close to bedtimeCreate a sleep-promoting environment that is dark, cool and comfortableAvoid disturbing noises ? consider a bedside fan or white-noise machine to block out disturbing sounds

During the day:

Consume less or no caffeine, particularly late in the dayAvoid alcohol and nicotine, especially close to bedtimeExercise, but not within three hours before bedtimeAvoid naps, particularly in the late afternoon or eveningKeep a sleep diary to identify your sleep habits and patterns that you can share with your doctor

According to NSF polls dating back to 1999, over 1/2 of America’s adults experience one or more symptom of insomnia at least a few nights a week. ?In 2005, the following percentages of adults reported having the following symptoms this often:? 38% woke up feeling unrefreshed; 32% wake often during the night; and 21% of the population reports waking too early, not being able to get back to sleep and difficulty falling asleep. ?Of this last group, almost 1?4 state that it takes them at least 30 minutes to fall asleep. ?These people are likely to be women (28% vs. 16%) and not to have a bed partner (27% vs. 19%).?

People who drink >4 caffeinated beverages a day are more likely to have difficulty falling asleep and wake unrefreshed.? Those who are obese are more likely to have a symptom of insomnia.? Adults who have daytime sleepiness at least 3 times a week are experiencing a symptom of insomnia (86%) compared to those who rarely or never have such symptoms (31%).? This is also true for those who say sleepiness has a strong impact on their daily activities (83%) versus those who experience very little impact (44%). ?More people who take >2 naps a day report symptoms of insomnia (62%) compared to those who do not take a nap (48%).?

Reviewed by David N. Neubauer, M.D., M.A

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Frequent Urination at Night

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A frequent need to get up and go to the bathroom to urinate at night is called nocturia. It differs from enuresis, or bed-wetting, in which the person does not arouse from sleep, but the bladder empties anyway. Nocturia is a common cause of sleep loss, especially among older adults. In fact, nearly two-thirds (65%) of those responding to NSF’s 2003 Sleep in America poll of adults between the ages of 55 and 84 reported this disturbance at least a few nights per week.

Most people without nocturia can sleep for 6 to 8 hours without having to urinate. Some researchers believe that one event per night is within normal limits; two or more events per night may be associated with daytime tiredness. Patients with severe nocturia may get up five or six times during the night to go to the bathroom.

Nocturia is often a symptom of other medical conditions including urological infection, a tumor of the bladder or prostate, a condition called bladder prolapse, or disorders affecting sphincter control. It is also common in people with heart failure, liver failure, poorly controlled diabetes mellitus, or diabetes insipidus. Diabetes, pregnancy and diuretic medications are also associated with nocturia.

Until recently, nocturia was thought to be caused by a full bladder, but it is also a symptom of obstructive sleep apnea. According to Michael J. Thorpy, MD, and Jan Yager, PhD, authors of The Encyclopedia of Sleep and Sleep Disorders, relief of the obstructive sleep apnea syndrome will alleviate the nocturia.

Nocturia becomes more common as we age. As we get older, our bodies produce less of an anti-diuretic hormone that enables us to retain fluid. With decreased concentrations of this hormone, we produce more urine at night. Another reason for nocturia among the elderly is that the bladder tends to lose holding capacity as we age. Finally, older people are more likely to suffer from medical problems that may have an effect on the bladder.

Nocturia or frequent nighttime urination may occur only occasionally or nightly. Symptoms of nocturia include excessive urination (need to urinate too much fluid), frequent urination (too many visits to the bathroom for various reasons), urinary urgency (need to urinate sometimes without much result), or reduced urine. Nocturia may result when a person’s normal “body clock” allows for daytime urination pattern to occur at night. Sometimes, nocturia may simply be the result of drinking too many fluids, especially caffeinated beverages, before going to bed.

If you are experiencing nocturia, consult your doctor as soon as possible and follow his or her recommended therapy. It may be helpful to keep a diary of times and amounts of urine voided to bring with you to the doctor. Also, bring a record of your sleep habits as well as any daytime fatigue you may be experiencing. After an initial evaluation, your doctor may prescribe medications, diagnostic testing such as urinalysis, cystometry (a measurement of the pressure within the bladder), neurological tests (for some urgency problems), or ultrasound, or refer you to a sleep center for testing.

Drink your normal amount of liquid but do so earlier in the day. Cut down on any drinks in the last two hours before you go to bed – especially alcohol, coffee or tea as these stimulate urine production. Keep a diary of how much you drink, what you drink, and when. This may be helpful in identifying situations which may make the nocturia worse. While there is limited scientific research and no proof of their effectiveness, some people believe that homeopathic medicines, hypnosis or acupuncture can be beneficial. Be sure to seek advice from a trained practitioner.

In the 2003 Sleep in America poll, 65% of adults age 55-84 report the need to get up to go to the bathroom a few nights a week or more (53% every or almost every night).

Reviewed By:

Donald L. Bliwise, PhD

Professor of Neurology at Emory University Medical School in Atlanta, Georgia. He serves as Director of the Program in Sleep, Aging and Chronobiology in the Department of Neurology and as a Professor at the Nell Hodgson Woodruff School of Nursing at Emory University. His specific area of interest has been the description, elucidation of pathophysiology, and treatment of sleep disorders in the aged, with special interest in sleep in neurodegenerative conditions such as Alzheimer’s disease and Parkinson’s disease.

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Narcolepsy and Sleep

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Narcolepsy is a neurological disorder caused by the brain’s inability to regulate sleep-wake cycles normally. The main features of narcolepsy are excessive daytime sleepiness and cataplexy. The disease is also often associated with sudden sleep attacks, insomnia, dream-like hallucinations, and a condition called sleep paralysis. Its prevalence in the developed world is approximately the same as that of multiple sclerosis or Parkinson’s disease. However, with increased public education about narcolepsy and physician training in the diagnosis and treatment of sleep disorders, these figures are expected to rise.

In order to understand the basics of narcolepsy, it is important to first review the features of “normal sleep.” Sleep happens in cycles. When we fall asleep, we initially enter a light stage of sleep and then progress into increasingly deeper stages. Both light and deep sleep stages are called non-REM (rapid eye movement) sleep. After about 90 minutes, we enter the first stage of REM sleep, which is the dreaming portion of sleep, and throughout the night we alternate between stages of REM and non-REM sleep. For people with narcolepsy, sleep begins almost immediately with REM sleep and fragments of REM occur involuntarily throughout the waking hours. When you consider that during REM sleep our muscles are paralyzed and dreaming occurs, it is not surprising that narcolepsy is associated with paralysis, hallucinations, and other dream-like and dramatically debilitating symptoms.

Despite the perception that people with narcolepsy are perpetually sleepy, they do not typically sleep more than the average person. Narcolepsy is considered a “state boundary” control abnormality. That is, narcolepsy patients sleep a normal amount but cannot control the timing of sleep.

Narcolepsy affects both sexes equally and develops with age; symptoms usually first develop in adolescence or young adulthood and may remain unrecognized as they gradually develop. The instance of a familial connection with narcolepsy is quite small but a combination of genetic and environmental factors may be at the root of this sleep disorder.

Narcolepsy patients typically endure many years of daytime sleepiness before seeking treatment because sleepiness is not indicative of disease to most people. Yet the devastating potential of this disorder is reflected in studies showing that narcoleptic patients are more accident-prone and have difficulty with interpersonal relationships.

Researchers believe that narcolepsy may be caused by a deficiency in hypocretin production in the brain. The results of one recent study, in which hypocretin was directly administered to the brain, suggest that using hypocretin derivatives may be an effective way to prevent cataplexy and improve wakefulness.

The main symptoms associated with narcolepsy are:

Excessive daytime sleepiness – this is usually the first symptom to appear in people who have narcolepsy. Unless they’re being treated for the disorder, the need to sleep can be overwhelming for narcolepsy patients: someone who has narcolepsy is prone to falling asleep while engaged in conversation, driving, eating dinner, or at other inappropriate times. The sleepiness occurs in spite of a full night’s sleep and may persist throughout the day. Cataplexy – cataplexy is a sudden loss of muscle tone, usually triggered by emotional stimuli such as laughter, surprise, or anger. It may involve all muscles and result in collapse. It may only affect certain muscle groups and result in slurred speech, buckling of the knees, or weakness in the arms. Consciousness is maintained throughout the episode but the patient is usually unable to speak. Hypnogogic hallucinations – during transition from wakefulness to sleep, the patient has bizarre, often frightening dream-like experiences that incorporate his or her real environment. Sleep paralysis ? a temporary inability to move during sleep-wake transitions. Sleep paralysis may last for a few seconds to several minutes and may accompany hypnagogic hallucinations. Disturbed nocturnal sleep ? waking up repeatedly throughout the night. Leg jerks, nightmares, and restlessness.

In order to make a determination of narcolepsy, your doctor will ask you for a complete medical and family history and may refer you to a sleep center for evaluation. You should keep a sleep diary as well as a record of your symptoms and their severity for at least a week or two. Bring this information with you when you visit your doctor.

There is currently no widely-accepted cure for narcolepsy but symptoms can be alleviated to the point of near-normal functioning in many patients. Treatment for narcolepsy includes the use of medication as well as behavioral therapy.

Behavioral therapies may help control symptoms, including taking three or more scheduled naps throughout the day. Patients should also avoid heavy meals and alcohol, which can disturb or induce sleep.

Counseling is very important for people with narcolepsy. The particular symptoms of this disorder are not widely understood by the general public and this may cause patients to feel uncomfortable, alienated, or depressed. The disease can also be quite frightening and the fear of falling asleep inappropriately often significantly alters life for people with narcolepsy.

In treating narcolepsy, doctors typically prescribe stimulants to improve alertness and diminish excessive daytime sleepiness. Antidepressants are also often used to treat cataplexy, hypnagogic hallucinations and sleep paralysis. Finally, sodium oxybate, a strong sleep-inducing agent, may be given at night to improve disturbed nocturnal sleep and reduce daytime sleepiness and cataplexy. All these treatments may have side effects. Stimulants can cause headaches, irritability, mood changes, nervousness, insomnia, anorexia, and irregular heartbeat. Side effects from the use of antidepressants vary and can include nausea, weight gain, anxiety or decreased emotions, drowsiness, sexual dysfunction and changes in blood pressure. Sodium oxybate can induce nausea, excessive sedation, mood changes and enuresis.

The goal in using medications to treat narcolepsy is to achieve normal alertness with minimal side effects.

Behavior treatment of narcolepsy includes:

Several short daily naps (10-15 minutes) to combat excessive sleepiness Establish a routine sleep schedule Maintain a regular exercise and meal schedule Avoid alcohol, caffeine, nicotine

Reviewed by Emmanuel Mignot, MD, PhD.

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REM Behavior Disorder and Sleep

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For most people, dreams are purely a “mental” activity: they occur in the mind while the body is at rest. But people who suffer from REM behavior disorder (RBD) act out their dreams. They physically move limbs or even get up and engage in activities associated with waking. Some talk, shout, scream, hit, punch, or fly out of bed while sleeping! RBD is usually noticed when it causes danger to the sleeping person, their bed partner, or others they encounter. Sometimes ill effects such as injury to self or bed partner sustained while asleep trigger a diagnosis of RBD. The good news is that RBD can usually be treated successfully.

What we call “sleep” involves transitions between three different states: wakefulness, rapid eye movement (REM) sleep, which is associated with dreaming, and non rapid eye movement (N-REM) sleep. There are a variety of characteristics that define each state, but to understand REM Behavior Disorder it is important to know that it occurs during REM sleep. During this state, the electrical activity of the brain, as recorded by an electroencephalogram, looks similar to the electrical activity that occurs during waking. Although neurons in the brain during REM sleep are functioning much as they do during waking, REM sleep is also characterized by temporary muscle paralysis.

In some sleep disorders such as narcolepsy and parasomnias, like REM behavior disorder, the distinctions between these different states breaks down; characteristics of one state carry over or “invade” the others. Sleep researchers believe that neurological “barriers” that separate the states don’t function properly, though the cause of such occurrences is not entirely understood.

Thus, for most people, even when they are having vivid dreams in which they imagine they are active, their bodies are still. But, persons with RBD lack this muscle paralysis, which permits them to act out dramatic and/or violent dreams during the REM stage of sleep. Sometimes they begin by talking, twitching and jerking during dreaming for years before they fully act out their REM dreams.

In the course of “acting out their dreams,” people with RBD move their arms and legs in bed or talk in their sleep, or they might get out of bed and move around without waking or realizing they’re dreaming. The only sensations the sleeper experiences are what is occurring in their dream. And many of these dreams can be violent or frightening, causing injury to the sleeper and his bed partner.

The first series of cases of RBD was described in 1985 by Mark Mahowald, MD, and Carlos Schenck, MD, of the University of Minnesota. In Principles and Practice of Sleep Medicine (W.B. Saunders Company, 2000), they outlined several case histories of people with RBD:

A 77-year old minister had been behaving violently in his sleep for 20 years, sometimes even injuring his wife. A 60-year old surgeon would jump out of bed during nightmares of being attacked by “criminals, terrorists and monsters.” A 62-year old industrial plant manager who was a war veteran dreamt of being attacked by enemy soldiers and fights back in his sleep, sometimes injuring himself. A 57-year old retired school principal was inadvertently punching and kicking his wife for two years during vivid nightmares of protecting himself and family from aggressive people and snakes.

“Past history and current neurological and psychiatric evaluations were unremarkable, apart from the findings reported,” the authors noted. “All four men were known by day to be calm and friendly individuals.”

Drs. Mahowald and Schenck and others have found that more than 90% of RBD patients are male, and that the disorder usually strikes after the age of 50, although some patients are as young as nine years old. Most RBD patients are placid and good-natured when awake; however, many of them display rhythmic movements in their legs during non-REM and slow-wave sleep.

A telephone survey of more than 4,900 individuals between the ages of 15 and 100 indicated that about two percent of those surveyed experience violent behaviors during sleep; Mahowald and Schenck estimate that one-quarter of them were probably due to RBD, which means it may be experienced by 0.5% of the population.

Studies of animals may explain REM behavior disorder. Animals who have suffered lesions in the brain stem have exhibited symptoms similar to RBD. Cats with lesions affecting the part of the brain stem that involves the inhibition of locomotor activity will have motor activity during REM sleep: they will arch their backs, hiss and bare their teeth for no reason, while their brain waves register normal REM sleep.

“REM behavior disorder underscores the importance of basic science research in animals,” says Mahowald, “because without the information obtained in basic science animal research, the disorder could never have been identified. Sleep is such a young field that we have the opportunity to take advantage of the fact that there is a close collaboration between basic science and clinicians.”

Because a number of parasomnias may be confused with RBD, it is necessary to conduct formal sleep studies performed at sleep centers that are experienced in evaluating parasomnias in order to establish a diagnosis. In RBD, a single night of extensive monitoring of sleep, brain, and muscle activity will almost always reveal the lack of muscle paralysis during REM sleep, and it will also eliminate other causes of parasomnias.

Clonazepam, a benzodiazapine, curtails or eliminates the disorder about 90% of the time. The advantage of the medication is that people don’t usually develop a tolerance for the drug, even over a period of years. When clonazepam doesn’t work, some antidepressants or melatonin may reduce the violent behavior. However, it’s a good idea to make the bedroom a safe environment, removing all sharp and breakable objects.

Drs. Schneck and Mahowald have conducted research indicating that 38% of 29 otherwise healthy patients with REM behavior disorder went on to develop a parkinsonian disorder, presumably Parkinson’s disease (PD), a degenerative neurological disease characterized by tremors, rigidity, lack of movement or loss of spontaneous movement, and problems with walking or posture. Other studies have found associations between RBD and other neurodegenerative diseases related to Parkinson’s. “We don’t know why RBD and PD are linked,” says Dr. Mahowald, “but there is an obvious relationship, as about 40% of individuals who present with RBD without any signs or symptoms of PD will eventually go on to develop PD.”

“People with RBD will understandably be concerned about the possibility of the later development of PD, given the statistics,” says Mahowald. “We are not aware of anything that can be done to prevent or delay the development of PD in those destined to do so. We recommend an annual evaluation by a neurologist, so if PD is going to develop, it can be detected and treated at the earliest possible time.

“Given the fact that the majority of patients with RBD who went on to develop PD were already taking clonazepam, it is unlikely that clonazepam will reduce the likelihood of developing PD in those so predisposed.”

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Epilepsy and Sleep

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Epilepsy is a neurological disorder involving recurrent seizures. A seizure, also called convulsion, is a sudden change in behavior caused by increased electrical activity in the brain. The increase in electrical activity may result in unconsciousness and violent body shakes or simply a staring spell that may go unnoticed. There is no known exact cause for epilepsy but a number of factors may be at work. It can be brought on by anything that affects the brain, including tumors and strokes. Sometimes epilepsy is inherited. Often, no cause can be found.

Epilepsy is just one of many conditions that may cause seizures. Others include head injuries, infections in the brain, low blood sugar, drug use, and alcohol withdrawal. On the other hand, seizures are just the tip of the iceberg for people with epilepsy. In addition to working to prevent seizures, people with epilepsy typically face an array of other challenges including cognitive, social and medical problems. The good news is that epilepsy is not considered a degenerative disorder. That is, it can be controlled without getting worse and most epilepsy patients lead full and long lives.

There is an inherent relationship between sleep and epilepsy. Sleep activates the electrical charges in the brain that result in seizures and seizures are timed according to the sleep wake cycle. For some people, seizures occur exclusively during sleep. This is especially true for a particular type of epilepsy known as benign focal epilepsy of childhood, also known as Rolandic epilepsy. When seizures occur during sleep, they may cause awakenings that are sometimes confused with insomnia. Epilepsy patients are often unaware of the seizures that occur while they sleep. They may suffer for years from daytime fatigue and concentration problems without ever knowing why.

For people with epilepsy, sleep problems are a double-edged sword; epilepsy disturbs sleep and sleep deprivation aggravates epilepsy. The drugs used to treat epilepsy may also disturb sleep. Because lack of sleep is a trigger for seizures, achieving healthy sleep on a nightly basis is essential for people with epilepsy.

People with epilepsy also have a high incidence of obstructive sleep apnea (OSA). In fact, a University of Michigan study found that as many as one third of epilepsy patients also has OSA. The University of Michigan researchers also found that epilepsy patients who have sleep apnea were more likely to have seizures at night than epilepsy patients without OSA. These results highlight the need for further investigation into whether receiving treatment for OSA lessens the frequency and severity of epileptic seizures.

Children with epilepsy must cope with a variety of problems as a result of their disorder that goes beyond seizure control. Sleep problems are among the most critical. A team of researchers from the University of Calgary in Alberta, Canada recently conducted a study of the sleep patterns of children with epilepsy and the sleep patterns of their siblings without epilepsy. The results indicate that epileptic children had a significantly higher rate of sleep disturbance and that their disturbed sleep is associated with greater social and attention problems and a reduced quality of life. They also have a higher rate of attention deficit hyperactivity syndrome and other learning, emotional and behavioral difficulties compared to children without epilepsy. The results of this study support the idea that healthy sleep is essential for children with epilepsy.

If you are the parent of a child with epilepsy, it is very important that you make healthy sleep a priority for yourself as well. A recent study done by researchers at West Virginia University looked at the sleep habits of 50 parents of children under the age of 5 with epilepsy. They found that these parents slept 4 hours per night on average and that they woke up an average of 3 times per night to check on their children. A secondary finding in this study showed a correlation between nighttime awakenings and reports of decreased marital satisfaction and maternal health. If your child has epilepsy, pay careful attention to your sleep habits. If you or your spouse is having trouble sleeping, talk to your doctor about ways in which to address the problem.

According to the National Institutes of Health, between 1.5% and 5.0% of Americans have a seizure at some point in their lives and about 0.5% have epilepsy. For most people, epilepsy is a lifelong condition. However, the majority of people with epilepsy are able to prevent seizures with medication and lead normal lives. In some cases, the need for medication may be reduced or eliminated over time or once a patient enters adulthood. On the other hand, it is very important that people with epilepsy take proper precautions to avoid accidents as a result of their condition. Serious injuries can result if seizures occur while driving or operating machinery.

Epilepsy affects people in varying degrees. Epileptic seizures range from simple staring spells to loss of consciousness and violent convulsions. The type of seizure a person has depends on a number of factors, such as what triggered the seizure and where in the brain it originates. Most seizures only last a minute or two and are accompanied by an aura or euphoric sensation that occurs prior to the event and may last for several minutes after the event.

Different types of seizures include:

Petit mal seizure ? symptoms of petit mal seizures include a brief loss of consciousness, little or no movement, and a blank stare. They occur most often in children and may be mistaken for a learning disability. Grand mal seizure ? symptoms of grand mal seizures include violent body contractions, loss of consciousness, a pause in breathing, urinary incontinence, tongue or cheek biting, and confusion and weakness following the event. Partial seizures – symptoms include muscle contractions or jerking movements in certain parts of the body, sensations such as numbness or tingling, nausea, sweating and dilated pupils. Partial seizures affect only a portion of the brain and consciousness is maintained. Partial complex seizures ? symptoms of partial complex seizures include a blank stare, unresponsiveness, automated non-purposeful movements, inappropriate emotions, strange smell or taste hallucinations, and loss of consciousness.

Any plan for the treatment of epilepsy will include a physician-prescribed drug regimen for the control of seizures. However, it is important that physicians also take into consideration the particular concerns of each epilepsy patient. Each antiepileptic drug has a particular effectiveness profile. Some have side effects that include cognitive impairments, sleep disturbance and other adverse effects. If you or your child has epilepsy, discuss your primary concerns about side effects with your doctor in order to develop a treatment plan that allows you or your child to live as normally as possible. Also, keep in mind that therapy and strong social support are likely to play a critical role in achieving this goal.

In addition to drug treatment, there are several alternative therapies for people with epilepsy. They include:

Vagus Nerve Stimulation ? surgical implantation of a generator into the chest that stimulates the vagus nerve in the neck and thus reduces seizure activity (side effects may include cough, sore throat, voice alteration and sleep apnea) Surgery ? for some epilepsy patients, it is possible to have surgery to remove the seizure producing areas of the brain. Surgery may be done on children or adults when medicines fail to effectively prevent seizures. Alternative/complementary medicines ? these are therapeutic approaches that have not been studied and tested using the rigorous methods of modern medical science, but that have been known to help some people. Some examples are herbal remedies and vitamin therapies. Before beginning any alternative therapy, talk to your doctor about possible side effects or negative interactions with your current treatment regimen.

Epilepsy is often associated with other health problems. Evidence from recent clinical investigations indicates that epilepsy may raise a person’s risk of developing other disorders such as depression, anxiety, migraine headaches, and obesity. In some cases, the presence of one or more of these other conditions may impact a person’s health more than their incidence of seizures. If you experience symptoms related to other medical conditions, talk to your doctor about managing them while maintaining your treatment for epilepsy.

In addition to the treatment options described above, acknowledging and avoiding seizure triggers may improve seizure control for many epilepsy patients. A Norwegian study of 794 patients with epilepsy concluded that the most common triggers for seizures were emotional stress, sleep deprivation and tiredness. For people with epilepsy, healthy sleep is essential for effective control of seizures.

If you have epilepsy, always take your medication as prescribed and wear a medical alert bracelet.

When a seizure does occur, there are things people can do to keep the person having the seizure from injuring himself or herself. If you or your child has epilepsy, be sure that your family, friends, co-workers, and classmates are aware of the condition and know how to help in the event of a seizure.

Here are some tips for what to do if someone is having a seizure:

Lay the person down on his or her side in an area free of sharp objects Cushion the person’s head Loosen clothing, especially around the neck Check for a medical ID bracelet that gives instructions on what to do Monitor the person’s vital signs Stay with the person until the episode is over or medical personnel arrive

Here are some tips for what NOT to do if someone is having a seizure:

Do not restrain the person Do not put anything in the person’s mouth during the episode Do not move the person unless he or she is in danger

If someone is having a seizure, call 911 if:

This is the first time the person has had a seizure The seizure lasts more than 2-5 minutes The person does not awaken or have normal behavior after the seizure Another seizure starts soon after a seizure ends The person had a seizure in water The person is pregnant, injured, or has diabetes The person does not have a medical ID bracelet There is anything different about this seizure compared to the person’s usual seizures

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Fatigue and Excessive Sleepiness

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Do you find it difficult to get out of bed in the morning? Do you sometimes feel sleepy while watching television or driving? If so, you may be one of the millions of Americans who suffer from excessive sleepiness, a condition that can significantly reduce quality of life, decrease productivity and interfere with relationships. Most people feel tired occasionally, but excessive sleepiness that persists is neither normal nor healthy.

One of the primary causes of excessive sleepiness among Americans is self-imposed sleep deprivation. In the U.S. and many other parts of the world, sleep loss may occur as a result of economic or societal pressures. People may skimp on sleep in hopes of getting more done, and widespread access to technology makes it possible to stay busy (at the computer, for example) around the clock. By some estimates, people now sleep about 20 percent less than they did a century ago.

Working at night and sleeping during the day can also cause excessive sleepiness. Some people are able to adjust to such a schedule. However, others may never overcome the body’s natural tendency to be awake during the day and asleep at night. A similar phenomenon occurs with jet lag, in which the body is “out of sync” with the natural environment. In general, symptoms of jet lag increase with the number of time zones crossed. That is, someone flying from Beijing to San Francisco is more likely to suffer worse jet lag than someone flying from San Francisco to New York.

Excessive sleepiness is also linked with a number of primary sleep disorders. For example, sleep disordered breathing (SDB), which includes snoring and obstructive sleep apnea (OSA), is often associated with excessive sleepiness. Because SDB may result in frequent interruptions during sleep, it can lead to abnormal sleepiness during waking hours no matter how many hours a person actually spent in bed.

Insomnia is another main cause of perceived daytime sleepiness or fatigue. Insomnia symptoms may include difficulty falling asleep, difficulty staying asleep, and/or waking up still tired as well as daytime impairments such as excessive sleepiness, cognitive deficits (e.g., concentration and memory problems), fatigue, and irritability.

Narcolepsy is a neurological disorder characterized by disabling sleepiness. Most patients begin to experience symptoms in their teens or 20s, but symptoms may appear in younger children or older adults. Narcolepsy is also recognized by insomnia at bedtime, sudden sleep attacks, cataplexy (sudden muscular weakness), hallucinations, and sleep paralysis.

Restless legs syndrome (RLS) is a neurological disorder characterized by unpleasant sensations in the legs and a strong urge to move them. ?People who suffer from RLS may mistake the problem for insomnia since RLS symptoms are usually worse at night, leading to insomnia at night and excessive sleepiness during the day.

The good news is that these sleep disorders can be easily diagnosed and effectively treated.?If you have excessive daytime sleepiness and/or feel you may suffer from a sleep disorder, talk to a healthcare professional about the problem as soon as possible.

Excessive sleepiness may also be caused by a variety of physical and mental illnesses as well as some medications. ?If you suffer from a medical condition and you are experiencing excessive sleepiness, talk to your healthcare professional about the problem. ?In many cases, properly treating the medical condition may alleviate sleepiness. In other cases, sleepiness must be treated independently.

Excessive sleepiness is not just a matter of feeling lousy ? it can also affect mood, relationships, work, and quality of life. ?According to the results of NSF’s 2008?Sleep in America poll:

36 percent of American drive drowsy or fall asleep while driving 29 percent of Americans fall asleep or become very sleepy at work 20 percent have lost interest in sex because they are too sleepy 14 percent report having to miss family events, work functions, and leisure activities in the past month due to sleepiness

Each of these consequences can have an enormous impact on an individual’s health and happiness.??

One of the most serious risks associated with excessive sleepiness is drowsy driving. ?NSF’s 2008 poll revealed that a whopping 36 percent of American adults have nodded off or fallen asleep while driving. ?Sleepiness and driving do not mix. ?If you feel sleepy, you should not drive. Visit drowsydriving.org to learn how to prevent a drowsy driving-related crash.

There are several tools used to evaluate a person for excessive sleepiness. ?An individual’s personal report of how they feel is also important in characterizing a sleepiness problem. ?Interviewing a person’s bed partner or those sleeping nearby is also helpful in identifying things that occur during sleep (e.g., snoring and breathing pauses during sleep).

Special questionnaires developed specifically to provide insight regarding daytime sleepiness (these include the Epworth Sleepiness Scale and Stanford Sleepiness Scale).?Sleep diaries may also be helpful in assessing and evaluating sleepiness as well as any underlying factors. ?Additionally, there are several tests that may be employed when a sleep disorder such as SDB or narcolepsy is suspected. ?Such tests may include an overnight sleep study or “polysomnogram,” and the Multiple Sleep Latency Test (MSLT).

Once a cause for excessive sleepiness is determined, there are generally a range of treatment options available to patients, including behavioral and pharmacological (drug) therapies. ?For example, if the primary cause of sleepiness is OSA, continuous positive airway pressure (CPAP) or an oral appliance may be prescribed. If excessive sleepiness persists in OSA patients using CPAP or is the result of narcolepsy, approved medications may be appropriate.?For sleepiness caused by voluntary sleep deprivation or poor sleep habits, treatment will center on adopting behavioral measures to make getting adequate sleep a top priority.

Although everyone should employ all the elements of good sleep hygiene, this is particularly important for anyone with excessive sleepiness. ?These are behaviors and habits that can promote healthy sleep, which helps improve alertness during the day. ?They include:

Maintaining a consistent sleep schedule, even on the weekends Developing a regular, relaxing bedtime routine Using your bedroom only for sleep and sex; if you do this, you will strengthen the association between bed and sleep Create a sleep environment that is dark, quiet, comfortable and slightly cool Removing all work materials, televisions, phones, and other distractions from the bedroom Avoiding caffeine in the second half of the day Limiting alcohol ? it can disturb sleep

For some people with excessive sleepiness, adopting healthy sleep habits is enough to resolve the problem.

People vary in their need for sleep, but experts agree that for most adults the amount needed to feel one’s best is somewhere between seven and nine hours per night. ?Teens and young adults usually need nine hours of sleep or more per night. ?If you suffer from excessive sleepiness that persists for more than three weeks despite allowing adequate time for sleep, discuss the problem with your healthcare professional.

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Nightmares and Sleep

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Many Americans experience sleep disorders that involve dreaming. These include nightmares, sleep terrors, and REM sleep behavior.

Nightmares are dreams with vivid and disturbing content. They are common in children during REM sleep. They usually involve an immediate awakening and good recall of the dream content.

Sleep terrors are often described as extreme nightmares. Like nightmares, they most often occur during childhood, however they typically take place during non-REM (NREM) sleep.

Characteristics of a sleep terror include arousal, agitation, large pupils, sweating, and increased blood pressure. The child appears terrified, screams and is usually inconsolable for several minutes, after which he or she relaxes and returns to sleep. Sleep terrors usually take place early in the night and may be combined with sleepwalking. The child typically does not remember or has only a vague memory of the terrifying events.

Similar to sleep terrors, but more common in adults, is REM sleep behaviors. This involves complex, vigorous, or violent behaviors, sometimes associated with dream-like thoughts and images. Patients with REM sleep behaviors may complain of sleep disruption, violent behavior with injuries to themselves or to their bed partner, or unpleasant and vivid dreams. Patients are usually middle-aged or elderly, and about one third have an associated neurological disease.

If you or someone you know is experiencing distributed sleep or incurring injuries due to any of these problems, they should consult their doctor. Sleep disorders can often be treated.

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