Sleep disorders

Among the most common clinical problems encountered in medicine and psychiatry.

See sleep, sleep problems, insomnia.

A sleep disorder is a condition that frequently impacts the ability to get enough quality sleep, leaving one feeling exhausted or sleepy during the day.

Poor or insufficient sleep is associated with abnormalities including: endocrine, metabolic, higher cortical function, and neurologic disorders.

Defined as persistent difficulty with sleep initiation, maintenance, duration, or quality accompanied by some form of daytime impairment, which occurs despite adequate opportunity for sleep.

Comprise nearly 100 diagnostic entities in ICSD coding manual.

Can result in mental or physical dysfunction.

Sleep restriction is associated with decreased insulin sensitivity.l

The most common sleep disorders include insomnia, sleep apnea, narcolepsy, restless less syndrome (RLS), and circadian rhythm sleep disorders often triggered by shift work or jet lag.

Inadequate or nonrestorative sleep can impair quality of life.

Sleep disorders may be primary or may result from a variety of psychiatric and medical conditions.

Primary sleep disorders result from an endogenous disturbance in sleep-wake generating or timing mechanisms, often complicated by behavioral conditioning.

Primary sleep disorders may be divided into 2 broad categories: Parasomnias and Dyssomnias.

Parasomnias refer to unusual experiences or behaviors that occur during sleep.

Parasomnias include sleep terror disorder and sleepwalking and nightmare disorder.

Dyssomnias are characterized by abnormalities in the amount, quality, or timing of sleep.

Dyssomnias include primary insomnia and hypersomnia, narcolepsy, breathing-related sleep disorder (ie, sleep apnea), and circadian rhythm sleep disorder.

It is important to distinguish primary sleep disorders from secondary sleep disorders.

Primary insomnia refers to difficulty in initiating or maintaining sleep.

There are multiple ways to describe insomnia:

Acute insomnia refers to a brief episode of difficulty sleeping.

Acute insomnia is usually caused by a life event, such as a stressful change in a person’s job, receiving bad news, or travel.

Often acute insomnia resolves without any treatment.

Chronic insomnia refers to a long-term pattern of difficulty sleeping.

Insomnia is one of the most common sleep disorders, affecting as many as 1/3 of the worlds population.

Getting less sleep is associated with poor blood sugar control.

Patients with habitually short durations of sleep or poor sleep quality have increased hemoglobin A-1 C levels, diabetes or the metabolic syndrome.

The shortening or interruption of sleep tends to increase insulin resistance and glucose intolerance.

Insomnia is usually considered chronic if a person has trouble falling asleep or staying asleep at least three nights per week for three months or longer.

Some people with chronic insomnia have a long-standing history of difficulty sleeping.

Chronic insomnia has many causes.

Sleep requirements vary from individual to individual, therefore, insomnia is considered clinically significant when a patient perceives the loss of sleep as a problem.

Insomnia may be further characterized as either transient or chronic.

Sleep is divided into 2 categories, each of which is associated with distinct patterns of central nervous system (CNS) activity:

REM sleep and Non-REM sleep.

REM sleep is characterized by muscle atony, episodic REMs, and low-amplitude fast waves on electroencephalography (EEG).

Dreaming occurs mainly during REM sleep.

Non-REM (NREM) sleep is subdivided into 4 progressive categories, termed stages 1-4 sleep.

The arousal threshold rises with each stage, and stage 4 (delta), characterized by high-amplitude slow waves.

Stage 4 sleep is the sleep state from which arousal is most difficult.

Disturbances in the pattern of REM and NREM sleep are often found with sleep disorders.

Sleep-wake cycles are governed by a biologic processes that serve as internal clocks.

The suprachiasmatic nucleus, located in the hypothalamus, is thought to be the body’s timekeeper.

The suprachiasmatic nucleus is responsible for the release of melatonin on a 25-hour cycle.

The pineal gland secretes less melatonin when exposed to bright light.

The level melatonin is lowest during the daytime hours of wakefulness.

The major causes of insomnia are medical conditions, psychological conditions, and environmental problems.

Cardiac conditions associated with disordered sleep include ischemia and congestive heart failure.

Neurologic conditions associated with sleep disorders include stroke, degenerative conditions, dementia, peripheral nerve damage, myoclonic jerks, restless leg syndrome, hypnic jerk, and central sleep apnea.

There is a myriad of very diverse disorders, which present with excessive daytime sleepiness, which, in the absence of volitional sleep deprivation, is caused by an identifiable and treatable sleep disorder, such as sleep apnea, narcolepsy, idiopathic hypersomnia, Kleine–Levin syndrome, menstrual-related hypersomnia, idiopathic recurrent stupor, or circadian rhythm disturbances.

Endocrine conditions affecting sleep include hyperthyroidism, menopause, the menstrual cycle, pregnancy, and hypogonadism in elderly men.

Pulmonary conditions associated with sleep disorders include chronic obstructive pulmonary disease, asthma, central alveolar hypoventilation and obstructive sleep apnea syndrome.

Gastrointestinal (GI) conditions associated with sleep disorders include gastroesophageal reflux disease.

Hematologic condition associated with sleep disorders is paroxysmal nocturnal hemoglobinuria.

Substances that may result in sleep disorders include stimulants, opioids, caffeine, and alcohol, or, withdrawal from any of these substances.

Medications associated with sleep disorders include decongestants, corticosteroids, and bronchodilators.

Sleep disorders associated with fever, pain, and infection.

Psychiatric conditions are associated with sleeping disorders.

Depression may affect REM sleep, so that as many as 40% of people with depression have insomnia.

Posttraumatic stress disorder (PTSD) can produce nightmares.

Anxiety disorders predispose to insomnia.

Psychotropic medications, such as antidepressants, may interfere with normal REM sleep patterns.

Rebound insomnia from benzodiazepines or other hypnotic agents is common.

Stressful or life-threatening events may cause insomnia.

Shift work may disturb the sleep cycle.

Jet lag or changes in altitude can cause sleep disturbances.

Sleep deprivation may occur as a result of an overly warm sleeping environment, noise, or frequent intrusions.

The prognosis varies widely, depending on the cause of the insomnia or other sleep disorder.

Chronic insomnia is associated with an increased risk of depression and accompanying danger of suicide, anxiety, excess disability, reduced quality of life, and increased use of health care resources.

Comorbid insomnia occurs with another condition.

People who suffer from insomnia or sleep disorders suffer from a host of co-occurring conditions, including pain, obesity, cardiovascular problems, diabetes, hyperactivity, low sex drive, moodiness, anxiety / depression, addiction, gastrointestinal problems, and more.

A shorter sleep duration associated with a higher BMI in children.

Insufficient sleep can result in industrial and motor vehicle crashes, somatic symptoms, cognitive dysfunction, depression, and decrements in daytime work performance owing to fatigue or sleepiness.

It is suggested that older women with sleep-disordered breathing, with recurrent arousals from sleep and intermittent hypoxemia, have an increased risk of developing cognitive impairment compared with those without sleep-disordered breathing.

Sleep disorders are common and are significantly associated with an increased risk of self-reported adverse outcomes in terms of health, performance, and safety.

Sleep tips:

Stick to a sleep schedule

Being consistent reinforces your body’s sleep-wake cycle and helps promote better sleep at night.

If one doesn’t fall asleep within about 15 minutes, do something relaxing, and go back to bed when tired.

Agonizing over falling asleep, might make it tougher to fall asleep.

Certain medical conditions can either cause insomnia or make a person uncomfortable at night-as in the case of arthritis or back pain, which may make it hard to sleep.

Paying attention to what is eaten and drinken prior to sleep.

One should not go to bed either hungry or stuffed.

Limiting how much one drinks before bed, to prevent disruptive middle-of-the-night trips to the toilet.

The stimulating effects of nicotine and caffeine take hours to wear off and can wreak havoc on quality sleep.

Alcohol might make one feel sleepy at first, it can disrupt sleep later in the night.

Create a bedtime ritual doing the same things each night to tell your body it’s time to wind down.

Bedtime rituals might include taking a warm bath or shower, reading a book, or listening to soothing music, preferably with the lights dimmed.

Relaxing activities can promote better sleep by easing the transition between wakefulness and drowsiness.

Be wary of using the TV or other electronic devices as part of your bedtime ritual, as research suggests that screen time or other media use before bedtime interferes with sleep.

Creating comfort in a room that’s ideal for sleeping-this means cool, dark and quiet.

Consider using room-darkening shades, earplugs, a fan or other devices to create an environment that suits individual needs.

Your mattress and pillow can contribute to better sleep, too.

Good bedding is subjective, and choosing what feels most comfortable can contribute to better sleep.

If the bed is shared there should be enough room for two.

For children and pets, insist on separate sleeping quarters.

Limit daytime naps as long daytime naps can interfere with nighttime sleep.

Naps during the day, should be limited to about 10 to 30 minutes and make it during the midafternoon.

Night workers are exceptions to this day time sleep rule, and should use window coverings so that sunlight doesn’t interrupt daytime sleep.

Include physical activity in daily routine, as it promotes better sleep, helps you to fall asleep faster and to enjoy deeper sleep.

Exercise too close to bedtime should be avoided as it may make one too energized to fall asleep.

Stress must be managed.

Following healthy sleep habits can make the difference between restlessness and restful slumber.

Sleep hygiene that can help anyone maximize the hours they spend sleeping, even those whose sleep is affected by insomnia, jet lag, or shift work.

Sleep hygiene: Avoid caffeine, alcohol, micotine, and other chemicals that interfere with sleep.

Caffeinated products decrease a person’s quality of sleep.

Avoiding caffeine found in coffee, tea, chocolate, cola, and some pain relievers for four to six hours before bedtime.

Smokers should refrain from using tobacco products too close to bedtime.

Best to limit alcohol consumption to one to two drinks per day, or less, and to avoid drinking within three hours of bedtime.

A quiet, dark, and cool environment can help promote sound sleep.

Use heavy curtains, blackout shades, or an eye mask to block light.

Light is a powerful cue that tells the brain that it’s time to wake up.

Keep the temperature comfortably cool, between 60 and 75 degrees and the room well ventilated.

Keeping computers, TVs, and work materials out of the room will strengthen the mental association between your bedroom and sleep.

Light reading before bed is a good way to prepare for sleep.

It is a good idea to transition from wake time to sleep time with a period of relaxing activities an hour or so before bed.

Taking a bath causes a rise, then fall in body temperature promoting drowsiness.

Reading a book, watching television, or practice relaxation exercises promotes sleep.

One should avoid stressful, stimulating activities, such as work, or discussing emotional issues.

Stressful activities, either physical or mental can cause the body to secrete the stress hormone cortisol, which is associated with increasing alertness

Struggling to fall sleep just leads to frustration.

If not asleep after 20 minutes, get out of bed, and do something relaxing, like reading or listening to music until you are tired enough to sleep.

Staring at a clock when you are trying to fall asleep or when you wake in the middle of the night, can actually increase stress, making it harder to fall asleep.

Turn the clock’s face away so it cannot be observed.

If one wakes up in the middle of the night and can’t get back to sleep in about 20 minutes, they should get up and engage in a quiet, restful activity such as reading or listening to music.

Lighting should be dim under these circumstances, as bright light can stimulate the internal clock.

When eyelids are drooping and if ready to sleep, return to bed.

Natural light keeps the internal clock on a healthy sleep-wake cycle.

It is helpful to let light in the first thing in the morning and get out for a sun break during the day.

Try to stick as closely as possible to your routine on weekends to avoid a Monday morning sleep hangover.

Waking up at the same time each day is the best way to set the biological clock.

If one does not sleep well the night before, the extra sleep drive will help you consolidate sleep the following night.

It is important to wake up at the same time each day.

Nap early or not at all.

For those who find falling asleep or staying asleep through the night problematic, afternoon napping may be one of the culprits.

Late-day naps decrease sleep drive.

If one must nap, it’s better to keep it short and before 5 p.m.

Lightening up on evening meals is appropriate.

Finishing dinner several hours before bedtime and avoiding foods that cause indigestion.

If one gets hungry at night, snacking on foods that won’t disturb your sleep, such as dairy foods and carbohydrates.

Drink enough fluid at night to keep from being thirsty.

Do not drink so much fluid close to bedtime that you will need a trip to the bathroom.

Exercise helps promote restful sleep if it is done several hours before you go to bed.

Exercise stimulates the body to secrete cortisol, which helps activate the alerting mechanism in the brain.

Finish exercising at least three hours before bed or should occur earlier in the day.

Not all sleep problems are so easily treated and could signify the presence of a sleep disorder such as apnea, restless legs syndrome, narcolepsy, or another clinical sleep problem.

Patients should be evaluated for other primary sleep disorders, the impact of prescribed medication; and underlying medical, psychiatric, and substance abuse disorders.

Teach good sleep hygiene, and if necessary, consider medication.

Educating patients in good sleep hygiene is the keystone of treatment.

Sleep apnea can be alleviated by losing weight, the use of continuous positive airway pressure (CPAP), and, sometimes, surgical treatment.

Light-phase shift therapy is useful for sleep disturbances associated with circadian rhythm abnormalities.

Patients may be exposed to bright light, from either a light box or natural sunlight, to help normalize the sleep schedule.

Cognitive behavioral therapy (CBT) are efficacious for short-term treatment of insomnia, as are hypnotic medications, but few patients achieve complete remission with any single treatment.

Short-term drug therapy is preferred to restore a normal sleep pattern.

Generally, hypnotic drugs are approved for 2 weeks or less of continuous use.

In chronic insomnia, longer courses may be indicated, which require long-term monitoring to ensure ongoing appropriate use of the medication.

Barbiturates and chloral hydrate are seldom used now, because of safety concerns.

Drugs that block the histamine type 1 receptor are used primarily in over-the-counter preparations, which are inexpensive and help some patients.

In view of the anticholinergic properties of these agents, they should be used cautiously in older patients and in patients who have conditions such as prostatic hypertrophy, cognitive disorders, and constipation.

Drugs that block the histamine type 1 receptor have a long duration of action, and their sedative effects may persist well into the following day.

Zolpidem and zaleplon are the newest and among the safest agents that have been approved for short-term hypnotic use.

Eszopiclone as the first agent for long-term use in the management of chronic insomnia.

Tasimelteon (Hetlioz) approved for treatment of non–24-hour sleep-wake disorder in the totally blind.

Tasimelteon entrains the master clock of both melatonin and cortisol and has clinically meaningful effects on the sleep-wake cycle in terms of the timing and amount of sleep, and improved measure of global functioning.

Suvorexant (Belsomra) is the first orexin receptor antagonist for insomnia.

It is indicated for the treatment of insomnia characterized by difficulties with sleep onset and/or sleep maintenance.

The orexin neuropeptide signaling system is a central promoter of wakefulness.

Blocking the binding of wake-promoting neuropeptides orexin A and orexin B to receptors OX1R and OX2R by suvorexant is thought to suppress wake drive.

The recommended dose is 10 mg for most patients.

No special diet is needed to treat insomnia, but large meals and spicy foods should be avoided in the 3 hours before bedtime.

Nicotine and caffeine are stimulating and should be avoided in the second half of the day, from late afternoon on.

Consumption of tryptophan-containing foods may help induce sleep; the classic example is warm milk.

Strenuous exercise during the day may promote better sleep, but this same exercise during the 3 hours before bedtime can cause initial insomnia.

Stimulating activities should be avoided 3 hours before bedtime, including tense movies, exciting novels, thrilling television shows, arguments, and vigorous physical exercise other than coitus.

Inpatient care is rarely, if ever, required for treatment of insomnia.

Only a severe underlying medical, psychiatric, or substance abuse disorder would warrant inpatient care.

The numerous possible medical causes of sleep disorders make them difficult to diagnose and necessitate regular appropriate follow-up care until the final diagnosis has been made and successful treatment has been implemented.

Regular follow-up care, even if infrequent, is necessary once appropriate care is successfully in use.

Recent research suggests that the use of light-emitting electronic devices – tablets, some e-readers, smart phones, and laptops – in the hours before bedtime can negatively impact overall health, alertness, and the circadian clock, which synchronizes the daily rhythm of sleep to external environmental cues.

Blue light has adverse effects on sleep-related processes.

Poor-quality sleep can have a significant impact on physical health, including an increased risk of heart disease, diabetes, obesity, and certain cancers.

Pharmacologic treatments of sleep disorders are not supported by adequate and significant empiric data.

Given the lack of supporting data, it is advisable to employ behavioral and cognitive strategies initially in most cases.

Pharmacotherapy data are limited to treatment in select sleep disorders.

Adenotonsillectomy may be indicated for obstructive sleep apnea syndrome (OSAS).

Weight loss is recommended for patients with obesity and obstructive sleep apnea.

Family dynamics should be explored and addressed.

Sleep patterns of parents and their adolescent children reveal similarities.

Limit-setting problems, bedtime resistance, and frequent nightly awakenings represent common problems encountered in pediatric practice.

Treatment for sleep-related fears and anxiety includes relaxation training, guided imagery, positive self-talk, positive reinforcement for increasingly successful efforts, systematic desensitization, and gradual exposure to a determined hierarchy of sleep-related fears or anxiety.

In patients with periodic limb movement during sleep (PLMS) or restless legs syndrome (RLS), CBT should focus alleviating stress and promoting relaxation.

In patients with circadian rhythm disorders, light therapy in the morning can help reset the suprachiasmatic nuclei.

The individual is exposed immediately upon awakening to 8,000–10,000 lux of bright light for 20 to 30 minutes.

If a light box is used, it is placed at 18 to 24 inches from the face.

Chronic use of a light box can lead to development of cataracts.

Melatonin can be used at night to help induce sleep.

In manipulating the internal sleep-wake clock, gradually delaying sleep onset resynchronizes the internal clock.

Sleep onset should be delayed in 3-hour increments each night until the desired sleep time is established.

For patients with PLMS or RLS, dopaminergic therapy may be necessary.

Low-dose valproic acid has been shown to be effective in a small case series of adults.

In patients with circadian rhythm disorders, melatonin may be used.

Melatonin acts directly on suprachiasmatic nuclei.

Ramelteon, a melatonin receptor agonist, is an approved medication for the treatment of insomnia in adults.

Tasimelteon, for the treatment of non–24-hour disorder in totally blind adults, it is also a melatonin receptor agonist.

Tongue and facial muscle exercises improve adult obstructive sleep apnea.

Weight loss can be helpful for obese patients.

Behavioral therapy for insomnia, often called CBT-I, is an approved method for treating insomnia without the use of sleeping pills.

CBT is aimed at changing sleep habits and scheduling factors, as well as misconceptions about sleep and insomnia, that perpetuate sleep difficulties.

CBT-I is a safe and effective means of managing chronic insomnia.

Cognitive behavioral therapy for insomnia includes regular, often weekly, visits to a clinician, who will give you a series of sleep assessments, ask you to complete a sleep diary and work with you in sessions to help you change the way you sleep.

Stimulus control Instructions are created by looking at the patient’s sleep habits and pinpointing different actions that may be prohibiting sleep: not spending time in the bedroom when not sleeping, leaving the bedroom when not able to sleep and not to return until ready to sleep.

CBT-I includes sleep hygiene education , a customized list of things you should and should not do, in order to sleep.

Sleep hygiene education is most helpful when tailored to an analysis of the patient’s sleep/wake behaviors.

The tailoring process allows the clinician to:

1. Demonstrate the extent to which they comprehend the patient’s individual circumstances.

2. Critically review the rules,

Cognitive behavioral therapy for insomnia in many instances needs to be customized for the patient.

A clinician looks at an individuals assessments and diaries, and finds the elements of lifestyle that may prohibit one from falling or staying asleep.

For someone with insomnia, watching the clock can become a routine.

Relapse prevention is an important element of cognitive behavioral therapy.

The patient needs to learn how to maintain what they’ve learned and prepare for the possibility of a future flare up.

I have trouble sleeping nights each week.

On average, I get total hour(s) of sleep each night.

I wake up times a night and I usually stay awake minutes each time I wake up.

When I wake up and can’t get back to sleep for the night, it’s usually around .

My level of sleep satisfaction is: 1 2 3 4 5

I am currently taking medication to help me sleep.

A vicious cycle of sleepless nights and daytime fatigue takes a toll on mood, energy, and overall health.

CBT can help to relax the mind, change outlook, improve your daytime habits, and set one up for a good night’s sleep.

Identify the negative thoughts that keeps one awake at night.

Sleep medication does not cure the problem or address the underlying symptoms.

Sleep medication can often make sleep problems worse in the long term.

To avoid dependence and tolerance, sleeping pills are most effective when used sparingly for short-term situations—such as traveling across time zones or recovering from a medical procedure.

Even if a sleep disorder requires the use of prescription medication, experts recommend combining a drug regimen with therapy and healthy lifestyle changes.

Cognitive-behavioral therapy (CBT) can improve your sleep by changing your behavior before bedtime as well as changing the ways of thinking that keep you from falling asleep.

CBT focuses on improving relaxation skills and changing lifestyle habits that impact sleeping patterns.

CBT may be more effective at treating chronic insomnia than prescription sleep medication.

CBT produces the greatest changes in patients’ ability to fall asleep and stay asleep, and the benefits remained even a year after treatment ended.

Cognitive behavioral therapy (CBT) for sleep disorders may be conducted individually, in a group of people with similar sleeping problems.

CBT is rarely an immediate or easy cure, it is relatively short-term.

Many CBT treatment programs for insomnia, for example, report significant improvement in sleep patterns following a course of 5 to 8 weekly sessions.

CBT addresses negative thoughts and behavior patterns that contribute to insomnia or other sleeping problems.

Cognitive behavioral therapy involves two main components:

Teaches individuals to recognize and change negative beliefs and thoughts that contribute to your sleep problems.

Behavioral therapy teaches how to avoid behaviors that keep one awake at night and replace them with better sleep habits.

A sleep diary is used in CBT to identify patterns of sleeping problems and decide on the best treatment approach.

A sleep diary reveals how certain behaviors are ruining one’s chance for a good night’s sleep.

Cognitive restructuring challenges the negative thinking patterns that contribute to sleep problems, replacing them with more positive, realistic thoughts.

The concept that if you change the way one thinks, you can change the way one feels, and ultimately how one sleeps.

Cognitive restructuring involves three steps:

1. Identifying negative thoughts.

2. Challenging your negative thoughts.

3. Replacing negative thoughts with realistic thoughts.

Since negative thoughts are often part of a lifelong pattern of thinking, replacing negative thoughts with more realistic ones is rarely easy.

CBT works to change the habits and behaviors that can prevent you from sleeping well.

Sleep restriction therapy (SRT) reduces the time one spends lying in bed awake by eliminating naps and forcing one to stay up beyond your normal bedtime.

This method of sleep deprivation can be especially effective for insomnia.

It makes one more tired the next night and builds a stronger association between bed and sleep rather than bed and lying awake.

Remaining passively awake, also known as “paradoxical intention”.

Worrying about not being able to sleep generates anxiety that keeps you awake, letting go of this worry and making no effort to sleep may, paradoxically, help you to unwind and fall asleep.

When practiced regularly, relaxation techniques such as mindfulness meditation, progressive muscle relaxation, and breathing exercises can help one to relax at night, relieving tension and anxiety and preparing you for sleep.

Biofeedback uses sensors that measure specific physiological functions—such as heart rate, breathing, and muscle tension.

Biofeedback teaches you to recognize and control the body’s anxiety response that impacts sleep patterns.

Hypnosis can also sometimes be used in CBT for sleep disorders.

Relaxation techniques for insomnia includes abdominal breathing.

Abdominal breathing is deep and full, involving not only the chest, but also the belly, lower back, and ribcage, and can help relaxation, progressive muscle relaxation, and mindfulness meditation.

The patient should close their eyes and take deep, slow breaths, making each breath even deeper than the last.

Breathe through the nose and out through the mouth.

Progressive muscle relaxation starts with your feet, tense the muscles as tightly as possible.

Tenseness holds for a count of 10, and then relax action occurs.

This is continued to for every muscle group in your body, working up from your feet to the top of your head.

Mindfulness meditation refers to sitting quietly and focusing on natural breathing and how the body feels in the moment.

Mindfulness meditation allows thoughts and emotions to come and go without judgment, always returning to focus one’s breathing and body.

Avoid late meals within two hours of bed.

Stop drinking caffeinated beverages at least eight hours before bed.

Like caffeine, nicotine and sugary foods are stimulants, and while alcohol can make you sleepy, it interferes with the quality of your sleep and can make sleep disorder symptoms worse.

Reduce stress and anxiety in your life.

Restless nights and weary mornings can become more frequent as we get older and our sleep patterns change—which often begins around the time of menopause, when hot flashes and other symptoms awaken us.

Later in life there tends to be a decrease in the number of hours slept.

Sleep medications can have side effects—including appetite changes, dizziness, drowsiness, abdominal discomfort, dry mouth, headaches, and strange dreams.

Postmenopausal women who exercise for about three-and-a-half hours a week have an easier time falling asleep than women who exercise less often.

Morning workouts are ideal.

Exposing oneself to bright daylight first thing in the morning helps the natural circadian rhythm.

Staying away from anything acidic before bedtime such as citrus fruits and juices or spicy, foods which can promote heartburn.

An urge to move legs, snoring, and a burning pain in the stomach, chest, or throat are symptoms of three common sleep disrupters—restless legs syndrome, sleep apnea, and gastroesophageal reflux disease or GERD.

Sleep medications: take only the lowest possible effective dose, for the shortest possible period of time.

Sleep medications may make a patient walk unsteadily if they get out of bed in a drowsy state.

If a patient gets out of bed during the night to urinate, the path to the bathroom should be clear of obstacles or loose rugs

As part of sleep disorder treatment, your sleep physician may recommend a consultation with a sleep psychologist, psychiatrist, otolaryngologist, dentist or a physician specializing in weight reduction.

For a stable mental health and a full life, you need your sleep.

Positional therapy enables patients with sleep apnea or other obstruction disorders to train them to sleep on their sides, effectively resolving or reducing sleep disordered breathing.

Sleep specialists normally treat RLS with a combination of pharmacological treatments and behavioral advices.

Normally treat narcolepsy with a combination of behavioral changes (primarily scheduling nocturnal sleep and naps) and medications.

There is no specific, definitive treatment to cure or control Kleine-Levin syndrome, also known as recurrent hypersomnia.

Sleep apnea occurs when the muscles in the back of the throat relax.

That causes an airway obstruction that can stop a person’s breathing for several seconds — even minutes. It causes restless sleep and, sometimes, dangerously-low blood oxygen levels.

Obstructive sleep apnea can be diagnosed by monitoring a snorer’s sleep patterns, either in an overnight visit to a sleep lab or at home using a portable testing device.

It’s then often treated with a CPAP machine that helps keep a snorer’s airway open during sleep.

Sleep apnea has likely become more common because the population has grown older and more obese — two major risk factors for the disorder.

More than 12 million Americans suffer from the apnea, and many are never diagnosed.

A home sleep test costs less than a fifth as much as a lab test, and is considered effective for most patients.

CBT for insomnia has been assessed in over 100 randomized controlled studies and the results show that on average 70% of people with even very long term poor sleep obtain lasting benefit from the treatment.

CBT helps most people achieve sustained long-term improvements in their sleep, whereas the effects of sleeping pills are mostly short-term.

CBT is advocated as the preferred option for persistent poor sleep problems.

Sleep medications can be an effective short-term treatment — for example, they can provide immediate relief during a period of high stress or grief.

Cognitive behavioral therapy for insomnia may be a good treatment choice for long-term sleep problems, worry about becoming dependent on sleep medications, or if medications aren’t effective or cause bothersome side effects.

An oral appliance for sleep looks similar to a sports mouth guard or orthodontic retainer, except it is worn only during sleep.

The device pushes the jaw forward to help open up the airways.

Sometimes they are recommended for people who snore, and for people who suffer from bruxism.

Continuous airway pressure therapy (CPAP) is often prescribed for sleep apnea, and sometimes for snoring.

The mask, which blows air into the airways to keep them open, is worn in bed.

Management of sleep disturbances that are secondary to mental, medical, or substance abuse disorders should focus on the underlying conditions.

Narcolepsy, including excessive daytime sleepiness, often culminating in falling asleep spontaneously but unwillingly at inappropriate times.

About 70% of those who have narcolepsy also have cataplexy, a sudden weakness in the motor muscles that can result in collapse to the floor while retaining full conscious awareness.

Stoppage of breathing of at least ten seconds, 30 times within seven hours of sleep, classifies as apnea.

Somniphobia, is one cause of sleep deprivation, a dread/ fear of falling asleep or going to bed.

A systematic review found that traumatic childhood experience significantly increases the risk for a number of sleep disorders in adulthood, including sleep apnea, narcolepsy, and insomnia.

Research suggests that hypnosis may be helpful in alleviating some types and manifestations of sleep disorders in some patients.

Hypnotherapy has also helped with nightmares and sleep terrors.

There are several reports of successful use of hypnotherapy for parasomnias, specifically for head and body rocking, bedwetting and sleepwalking.

Research suggests that music therapy can improve sleep quality in acute and chronic sleep disorders.

Research suggests that melatonin is useful in helping people to fall asleep faster (decreased sleep latency), to stay asleep longer, and to experience improved sleep quality.

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