Sleep Disordered: Goldilocks

So, I'm a bit of a Goldilocks when it comes to sleep arrangements. Believe it or not, your dear RMT is a bit on the high strung control freak side of the cool cucumber - hot head spectrum. We've been talking about consequences of sleep loss and today we are talking about the barriers to sleep and some of what you can do about them. Below we discuss delayed sleep onset, insomnia and sleep apnea, as well as some common interventions and recommendations for sleep hygiene ie. how to be Goldilocks in your own room. Interruptions to Sleep

There are different ways our sleep can be interrupted. Probably one of the more common and easily relatable is delayed sleep onset. This is when it takes you longer to actually fall asleep. You're in bed at a good hour, but still awake more than 30 minutes later. Highly efficient sleepers will fall asleep within 20 minutes of getting into bed. There is likely a bit of a buffer here, depending on an individuals unique make up but, ultimately, beyond 30 minutes and you're definitely experiencing delayed sleep onset. This problem usually also includes a delayed wake-up response meaning one needs to have an alarm clock to be up on time, regardless of how late the were awake.

And it is REALLY EASY to delay sleep, just keep thinking or opening your eyes. Mental activity and eye opening, plus light stimulation, wrong bedroom temperature, an uncomfortable bed, irritating noises and pain can all make it harder to get to sleep (hey there Goldilocks...). General restlessness or an inability to settle can be a problem, even going so far as Restless Legs Syndrome, when the legs are besot with feelings of creeping, crawling or achiness, relieved only by movement or stretching. Anxiety or heightened stress can exacerbate delayed sleep onset, as well as working too late into the evening, late hour screen time, child care or shift work. These issues can lead to insomnia, an inability to sleep. Insomnia is defined by an inability to get adequate sleep for at least 2 weeks, even napping is evasive. Typically with these conditions a combination of neurological or hormonal dysregulation is the culprit and treatments focus on assisting the nervous system to restore it's natural diurnal rhythm, medications to induce excessive sleepiness or to treat neurological activities and mineral imbalances.

Another common problem is sleep apnea. While the person may remain unconscious throughout the night, never waking fully, the condition involves brief periods of breath stoppage as the airway closes, causing choking and very loud snoring, forcing the body to rouse during the night a bit. For some, full arousal and awakenings do occur, leading to an accumulated loss of deeper levels of sleep. This is usually treated with a CPAP (continuous positive airway pressure) machine, a device that forces air into the respiratory passageways to ensure they remain open.

How to help your sleep

Generally speaking, these problems do warrant a visit to your primary care provider, be they a nurse practitioner or your family doctor. Treatments can range from melatonin dosing and light therapy, to medications intended to induce sleep or alter nervous system function. Sometimes, attending to your sleeping quarters can make a difference. Goldilocks says the right temperature, the right amount of darkness, sound control and a comfortable bed are all things that can be attended to by the troubled sleeper. Another practice is assessing your sleep hygiene. It is often recommended that people use the bedroom only for bedroom activities, primarily sleeping. Eating in bed, watching tv in bed, reading in bed or other activities can alter your brain's normal conditioning to sleep cues. By introducing “sleep rituals” you may be able to condition your brain to move towards sleep mode and away from activity mode.

A personal tale As I have alluded to over these articles, I've had my doses of poor sleep, with an extended period of insomnia. Getting to sleep was almost impossible, though thankfully, once asleep I remained asleep. However, I frequently would get between 4-6 hours of sleep each night, which for me was not at all enough. In my quest for sleep, I realized I needed to address some personal problems that were resulting in a fair degree of nighttime anxiety. Once I had that under control I attended to my sleep hygiene; I found spending time in a dimly lit room reading a book of minimal interest helped get me ready for sleep. I have a firm cut off time for work of 8pm (ok ok I push it from time to time) and spend my last hour or two in the evening watching dumb or fantastical stuff on Netflix or Crave. Additionally, reaching out to my friends and having some physical contact with a trusted human for comfort during times of heightened stress or anxiety has made a big difference for me too.

So what is the value of rest?

We are coming to a close with our sleep reading and I am wondering, through all of this, have we arrived at an answer for why sleep is important? Why do we need it? We have gotten pretty clear on the consequences of not having it but is that enough to clarify why we need it?

Funny we should ask that because even the scientists still aren't sure. We know we need it for our brains to function well, but WHY is still an elusive answer. Presently the most readily accepted/supported theory is that during sleep we recover and replenish our physical energy stores. Sleep is one of the only times when your heart rate and respiratory rates are actually at their lowest; sleep may give the most enduring muscle of your body a break, and one of the only real breaks it gets. It's possible too that during this period, as our muscular system is achieving total relaxation, metabolic activities in the muscles may decrease, perhaps giving these parts a rest. After all, we are not machines, but energy consuming and producing entities. Sleep may just be the ticket to allowing our whole selves the time it takes to restore the whole body – brain and muscles – to get back up and at it for another day. In addition, it would appear that sleep affects out basic regulatory systems from cognition and emotion to metabolic processes. Whatever the WHY of sleep, it's clear that it truly is a necessity for normal human animal processes.

If for no other reason, sleep and resting enable us to be that much more happy and able to contribute meaningfully to our relationships. And that on it's own is pretty darn good.

References

Max Hirshkowitz, Ph.D DABSM, Normal human sleep: an overview. Med Clin N Am (2004) 88: 551–565

Lee K. Brown, Can sleep deprivation studies explain why human adults sleep? Curr Opin Pulm Med (2012) 18: 541–545

Eva Van Cauter et al. Metabolic consequences of sleep and sleep loss. Sleep Med. 2008 September 9(01): S23–S28

Adam J. Krause et al. The sleep deprived human brain. Nat Rev Neurosci. 2017 July 18(7): 404–418

Flavie Waters et al. Severe sleep deprivation causes hallucinations and a gradual progression toward psychosis with increasing time awake. Front Psychiatry. July 2018 9: 303

Carey, R. N., & Sarma, K. M. (2017). Impact of daylight saving time on road traffic collision risk: a systematic review. BMJ open, 7(6), e014319.

Kannan Ramar, and Eric J, Olson, MD. Management of common sleep disorders. Am Fam Physician. 2013 Aug 15;88(4):231-238.