Understanding Sleep-Related Problems

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Sleep is one of the great mysteries and joys of life—and a bad night’s sleep, or a series of them, is one of its great miseries. Sleep is pretty much a uni­versal in the animal kingdom reaching down to very primitive forms. The many variations of the sleep-wake cycle all undoubtedly evolved as dif­ferent and creative adaptations to the day-night rhythm of our planet.

While all humans must sleep for a substantial fraction of each day, there are wide individual differences in sleep quantity and quality. This is proba­bly no accident and serves its own adaptive purpose. A tribe would benefit from having very different types of sleepers—from early birds to night owls—so that there would be a continuity of lookouts, night watchmen, and fire tenders. The fitfulness of our sleep can be a nuisance but is also use­ful—humans are easy to rouse because being sluggish could be fatal.

Sleep patterns also undergo considerable change across the life span of any one person. Newborns sleep an average of sixteen hours a day. This decreases to an adult average of about seven to nine hours, with women requiring about one hour more each day than men. Starting in middle age, sleep efficiency progressively declines and there is more difficulty falling asleep, more awaken­ings during the night, and less really deep sleep. It is a good idea to tailor your sleep expectations to your gender and age. If a man and wife keep the same hours, she is likely to be sleep-deprived. If you expect to sleep as well at sev­enty-five as you did at twenty-five, you will be frustrated, disappointed, and risk resorting to sleeping pills that will end up making your sleep much worse.
Sleep Related Problems
Reasonably adequate sleep is essential for normal physiological and mental functioning. Individuals subjected to sleep deprivation exhibit irri­tability, inability to concentrate, blurred vision, slurred speech, memory lapses, and poor performance on tests of cognition and coordination. In extreme cases of continuous sleep deprivation, some people develop brief hallucinations and other psychotic symptoms. Nonetheless, most people probably get more sleep than they realize and have unrealistic expectations of perfect sleep.

Sleep has a characteristic architecture. There are five different stages each with a characteristic pattern on sleep electroencephalography—four stages of non-rapid eye movement (NREM) sleep and one stage of rapid eye movement (REM). Normal sleep begins with a transition from the state of wakefulness to the lightest form of “falling” asleep. This NREM Stage 1 is the shortest of sleep stages, accounting only for 5 percent of the time spent asleep. NREM Stage 2 Sleep occupies half to about three quarters the sleep time of healthy adults and is when sleep talking occurs. Stages 3 and 4 of NREM Sleep occupy about 20 percent of the total sleep period and repre­sent the deepest levels of sleep with much slower EEG wave-forms. It is during these stages that sleepwalking and night terrors occur.

REM Sleep is among the most fascinating of human experiences. It is during the bursts of eye movements that our dreams occur. If we under­stand surprisingly little about the function of sleep, we still understand next to nothing about how and why we dream. Typically, episodes of REM Sleep occur about every 90 minutes throughout the sleep cycle, and increase in length as the night progresses. Other phenomena occurring during REM Sleep include erections, sleep paralysis, and blood pressure increases.

There are basically four types of sleep difficulty: sleeping too little (insom­nia), sleeping too much (hypersomnia), sleeping at the wrong times (circadian rhythm disturbance), or having unusual events during sleep, like sleepwalking. The Sleep Disorders are also distinguished from one another based upon whether it is possible to identify the underlying cause—substance abuse or a medication taken for a medical illness, a psychiatric condition, or a mismatch between body rhythms and external demands. If no specific cause can be determined, then the diagnosis is Primary Insomnia, Primary Hypersomnia, or one of the Parasomnias (Nightmare Disorder, Sleep Terror Disorder, or Sleepwalking Disorder).

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