Over the past century, the average American has reduced his/her average nightly total sleep time by more than 20 percent. The resulting daytime sleepiness and decreased daytime functioning is likely to contribute to decreased work productivity and increased industrial, automobile and other transportation accidents ¹. Unfortunately, the effects of sleep disruption and deprivation appear to be poorly understood by society. When patients have excessive daytime sleepiness from a sleep disorder, a belief may develop that the person is lazy, is not ambitious, cannot function adequately in school or work or is generally a social misfit. By the time an appropriate diagnosis is made, an assortment of psychosocial problems may exist, including severe problems relating to family and friends, academic failure, and inability to maintain work. It is estimated that, in the United States, treatment for sleep-related disabilities costs over $150 billion annually ¹.

Patients who present to their health care provider for evaluation of sleep problems typically have one or more of the following complaints – insomnia, excessive daytime sleepiness, and/or abnormal behaviors, sensations, or movements during sleep or awakenings from sleep ².

Insomnia is a complaint of insufficient sleep or not feeling rested after the habitual sleep period. It may take the form of difficulty falling asleep, staying asleep, or early morning awakenings. Depending on its severity, insomnia can be associated with disturbances of social and occupational function as well as irritability, restlessness, daytime fatigue, anxiety, and tiredness. Insomnia is more prevalent in the elderly, women, abusers of drugs/alcohol, suffers of mental illness, and those who are divorced, widowed, or separated ³.

Excessive daytime sleepiness (EDS) describes unintentional sleep episodes that occur during the day in situations normally requiring mild to moderate attention such as reading a book, sitting in a meeting, talking, driving, and even walking ². EDS affects up to an estimated 13% of the general population and is the most common complaint of patients seen in sleep disorder centers across the United States ⁴. Due to its often vague and nonspecific clinical presentation, the condition is frequently unrecognized by health care providers in other clinical settings. Patients themselves may have very little insight into the nature and severity of the problem and the negative effects that EDS has on their lives. This is because in its milder forms, the disorder may cause only minor, barely perceived decrements in social and occupational functioning. When severe, however, it can be debilitating, causing a broad range of neuro-psychological deficits affecting both daytime functioning and quality of life. EDS can even be life threatening because of associated alterations in alertness and reactivity ⁴.

Abnormal behaviors, sensations, or movements (parasomnias) during sleep or during episodes of waking include such problems as restless legs, snoring, tooth- grinding, bed-wetting, night terrors, sleep-waking and sleep-talking. ². Depending on the context and severity of the problem, these symptoms may indicate the presence of one or more important sleep disorders. Many of these problems are seen in childhood and tend to disappear during adolescence. The implications in the adult population can be more serious and may indicate sleep disorders such as sleep apnea syndrome, period leg movement disorder and epilepsy.

The International Classification of Sleep Disorders ² describes 88 distinct sleep disorders characterized by insomnia, EDS, abnormal nocturnal behaviors, sensations, and movements as well as a variety of other associated signs and symptoms (see Table 1). They are classified into one of four categories including:

1. Dyssomnias – those disorders associated with insomnia, excessive daytime sleepiness, or both

2. Parasomnias – those disorders that intrude into the sleep process such as sleepwalking, sleep-talking, and sleep terrors;

3. Sleep disorders associated with mental, neurologic, or other medical disorders such as depression, anxiety, dementia, epilepsy, nocturnal cardiac ischemia, and peptic ulcer disease and

4. Proposed sleep disorders for which there is not enough evidence to determine their unequivocal existence.

Tips for a Good Night Sleep

Most individuals are familiar with the importance of diet and exercise in maintaining health. Unfortunately, there is much less awareness of the importance of obtaining consistently good sleep. It is, however, becoming increasingly evident that sleep is absolutely essential for optimal health and well-being. Healthy sleep behaviors begin with good sleep hygiene. Some of the most current recommendations⁵ are as follows:

Avoid caffeinated beverages after noontime. Limit consumption to two or fewer cups per day.
Do not drink alcoholic beverages in the evening because alcohol lightens and fragments sleep.
Do not smoke just before bedtime or during the night because nicotine can disturb sleep.
Exercise regularly during the day, but do not exercise within 3 hours of going to bed.
Maintain a regular bedtime and awakening time. Get out of bed at the regular time even if sleep was poor, as “sleeping-in” can disrupt sleep the following night. Most people require 7 to 8 hours of sleep to maintain maximal alertness during the day.
Keep the bedroom dark and quiet. Try to screen out any disturbing noise or light.
Maintain a comfortable temperature in the bedroom.
Establish a relaxing routine in preparation for sleep. Engaging in frustrating activities or excessive worry close to bedtime may result in arousal and prevent sleep.
Do not use the bed or bedroom for anything other than sleep or sexual activities. If the bedroom is used for non-sleep activities such as balancing the checkbook or watching TV, it becomes a stimulus for alertness, not sleep.
Avoid use of melatonin (a hormone produced by the pineal gland that is associated with sleep onset) for treating sleep problems on a routine basis.

If sleep problems persist, the individual should consult a health care provider for possible referral to a sleep disorders center. Important symptoms to report include insomnia, daytime sleepiness, problems with memory and concentration, sexual difficulties, irritability, snoring, breath holding during the night, restless/jerking legs, and abnormal behaviors occurring during the night.

Sleep has become a “casualty” of our complex, 24-hour society and time spent sleeping is often believed to be time wasted. However, research is increasingly demonstrating that a well-rested individual is clearly more productive, has less depression and anxiety, performs better on a wide variety of tasks, is safer on the road, has better life quality, and may even live longer. Thus, science is documenting what we have actually known all along—there is nothing like a good night’s sleep.

References

1. National Commission on Sleep Disorders Research (NCSDR). (1993). Wake up America: A national sleep alert. Washington, D.C.: U.S. Department of Health and Human Resources.

2. American Sleep Disorders Association: The international classification of sleep disorders, Rochester, MN, 1997.

3. Chokroverty, S: Sleep disorders medicine: Basic science, technical considerations, and clinical aspects. Butterworth-Heinemann, Boston, 1999.

4. Roehrs, T, Carskadon, M, Dement, W, Roth, T: Daytime sleepiness and alertness. In Kryger, M, Roth, T, and Dement, W (eds): Principles and Practice of Sleep Medicine 3nd edition. W.B. Saunders Company,
Philadelphia, 43-52, 2000.

5. Zarcone, V: Sleep hygiene. . In Kryger, M, Roth, T, and Dement, W (eds): Principles and Practice of Sleep Medicine 3nd edition. W.B. Saunders Company, Philadelphia, 624-632, 2000.


	click here for author biography Over the past century, the average American has reduced his/her average nightly total sleep time by more than 20 percent. The resulting daytime sleepiness and decreased daytime functioning is likely to contribute to decreased work productivity and increased industrial, automobile and other transportation accidents ¹. Unfortunately, the effects of sleep disruption and deprivation appear to be poorly understood by society. When patients have excessive daytime sleepiness from a sleep disorder, a belief may develop that the person is lazy, is not ambitious, cannot function adequately in school or work or is generally a social misfit. By the time an appropriate diagnosis is made, an assortment of psychosocial problems may exist, including severe problems relating to family and friends, academic failure, and inability to maintain work. It is estimated that, in the United States, treatment for sleep-related disabilities costs over $150 billion annually ¹. Patients who present to their health care provider for evaluation of sleep problems typically have one or more of the following complaints – insomnia, excessive daytime sleepiness, and/or abnormal behaviors, sensations, or movements during sleep or awakenings from sleep ². Insomnia is a complaint of insufficient sleep or not feeling rested after the habitual sleep period. It may take the form of difficulty falling asleep, staying asleep, or early morning awakenings. Depending on its severity, insomnia can be associated with disturbances of social and occupational function as well as irritability, restlessness, daytime fatigue, anxiety, and tiredness. Insomnia is more prevalent in the elderly, women, abusers of drugs/alcohol, suffers of mental illness, and those who are divorced, widowed, or separated ³. Excessive daytime sleepiness (EDS) describes unintentional sleep episodes that occur during the day in situations normally requiring mild to moderate attention such as reading a book, sitting in a meeting, talking, driving, and even walking ². EDS affects up to an estimated 13% of the general population and is the most common complaint of patients seen in sleep disorder centers across the United States ⁴. Due to its often vague and nonspecific clinical presentation, the condition is frequently unrecognized by health care providers in other clinical settings. Patients themselves may have very little insight into the nature and severity of the problem and the negative effects that EDS has on their lives. This is because in its milder forms, the disorder may cause only minor, barely perceived decrements in social and occupational functioning. When severe, however, it can be debilitating, causing a broad range of neuro-psychological deficits affecting both daytime functioning and quality of life. EDS can even be life threatening because of associated alterations in alertness and reactivity ⁴. Abnormal behaviors, sensations, or movements (parasomnias) during sleep or during episodes of waking include such problems as restless legs, snoring, tooth- grinding, bed-wetting, night terrors, sleep-waking and sleep-talking. ². Depending on the context and severity of the problem, these symptoms may indicate the presence of one or more important sleep disorders. Many of these problems are seen in childhood and tend to disappear during adolescence. The implications in the adult population can be more serious and may indicate sleep disorders such as sleep apnea syndrome, period leg movement disorder and epilepsy. The International Classification of Sleep Disorders ² describes 88 distinct sleep disorders characterized by insomnia, EDS, abnormal nocturnal behaviors, sensations, and movements as well as a variety of other associated signs and symptoms (see Table 1). They are classified into one of four categories including: 1. Dyssomnias – those disorders associated with insomnia, excessive daytime sleepiness, or both 2. Parasomnias – those disorders that intrude into the sleep process such as sleepwalking, sleep-talking, and sleep terrors; 3. Sleep disorders associated with mental, neurologic, or other medical disorders such as depression, anxiety, dementia, epilepsy, nocturnal cardiac ischemia, and peptic ulcer disease and 4. Proposed sleep disorders for which there is not enough evidence to determine their unequivocal existence. Tips for a Good Night Sleep Most individuals are familiar with the importance of diet and exercise in maintaining health. Unfortunately, there is much less awareness of the importance of obtaining consistently good sleep. It is, however, becoming increasingly evident that sleep is absolutely essential for optimal health and well-being. Healthy sleep behaviors begin with good sleep hygiene. Some of the most current recommendations⁵ are as follows: Avoid caffeinated beverages after noontime. Limit consumption to two or fewer cups per day. Do not drink alcoholic beverages in the evening because alcohol lightens and fragments sleep. Do not smoke just before bedtime or during the night because nicotine can disturb sleep. Exercise regularly during the day, but do not exercise within 3 hours of going to bed. Maintain a regular bedtime and awakening time. Get out of bed at the regular time even if sleep was poor, as “sleeping-in” can disrupt sleep the following night. Most people require 7 to 8 hours of sleep to maintain maximal alertness during the day. Keep the bedroom dark and quiet. Try to screen out any disturbing noise or light. Maintain a comfortable temperature in the bedroom. Establish a relaxing routine in preparation for sleep. Engaging in frustrating activities or excessive worry close to bedtime may result in arousal and prevent sleep. Do not use the bed or bedroom for anything other than sleep or sexual activities. If the bedroom is used for non-sleep activities such as balancing the checkbook or watching TV, it becomes a stimulus for alertness, not sleep. Avoid use of melatonin (a hormone produced by the pineal gland that is associated with sleep onset) for treating sleep problems on a routine basis. If sleep problems persist, the individual should consult a health care provider for possible referral to a sleep disorders center. Important symptoms to report include insomnia, daytime sleepiness, problems with memory and concentration, sexual difficulties, irritability, snoring, breath holding during the night, restless/jerking legs, and abnormal behaviors occurring during the night. Sleep has become a “casualty” of our complex, 24-hour society and time spent sleeping is often believed to be time wasted. However, research is increasingly demonstrating that a well-rested individual is clearly more productive, has less depression and anxiety, performs better on a wide variety of tasks, is safer on the road, has better life quality, and may even live longer. Thus, science is documenting what we have actually known all along—there is nothing like a good night’s sleep. References 1. National Commission on Sleep Disorders Research (NCSDR). (1993). Wake up America: A national sleep alert. Washington, D.C.: U.S. Department of Health and Human Resources. 2. American Sleep Disorders Association: The international classification of sleep disorders, Rochester, MN, 1997. 3. Chokroverty, S: Sleep disorders medicine: Basic science, technical considerations, and clinical aspects. Butterworth-Heinemann, Boston, 1999. 4. Roehrs, T, Carskadon, M, Dement, W, Roth, T: Daytime sleepiness and alertness. In Kryger, M, Roth, T, and Dement, W (eds): Principles and Practice of Sleep Medicine 3nd edition. W.B. Saunders Company, Philadelphia, 43-52, 2000. 5. Zarcone, V: Sleep hygiene. . In Kryger, M, Roth, T, and Dement, W (eds): Principles and Practice of Sleep Medicine 3nd edition. W.B. Saunders Company, Philadelphia, 624-632, 2000.