The ABCs of Zs What Happens During Sleep

Given how much time we spend sleeping, it's remarkable how little many of us know about what actually happens to our brains and bodies during sleep. While there's no need for you to be an expert on sleep physiology to address your own sleep difficulties, the more you understand about the need for sleep and the mechanics of good sleep, the better able you'll be to prevent sleep problems from developing, fix problems that do occur, and know when to seek help to treat a sleep disorder. It's time...

Case History

By the time twenty-three-year-old Kim came to see me, she had suffered from problems with excessive sleepiness for many years. She recalled difficulty staying awake during class in high school. In college, she was frequently embarrassed when she fell asleep during class, even when she sat directly in front of her professor to help stay awake. Kim also often had vivid, frightening dreams just as she was falling asleep. She fell asleep quickly and stayed asleep, but even though she slept about...

Antidepressants

Antidepressants are now frequently prescribed to treat insomnia, and many people find that they help. However, a small but significant percentage of people who take antidepressants for emotional problems find the drugs actually worsen insomnia. The class of antidepressants known as selective serotonin reuptake inhibitors is most often problematic, with 10 to 20 percent of patients reporting insomnia. SSRIs include fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), citalopram...

Additional Resources

General health and disease topics, including sleep Sleep education, general sleep information, sleep centers Newletters special reports books on general health and disease topics, including sleep National Center on Sleep Disorders Research Sleep disorders and related research Sleep medicine and related research, sleep centers Scientific research, including abstracts of published studies on sleep Restless legs syndrome and periodic limb movement disorder Health-related news, including drug and...

Selecting the Right Medication

If I decide that sleep medication is warranted, here's how the different classes of drugs typically come in to play. Benzodiazepine receptor agonists are the first medications considered for insomnia. For problems with sleep onset only, I will choose one of the short-acting agents, such as Halcion, Sonata, or Ambien. For problems staying asleep or early-morning awakenings, I select a medium-acting agent such as Restoril or Lunesta. Antidepressants are the second medications to consider. I...

Chronotherapy

Chronotherapy means deliberately changing one's bedtime and wake-up time to shift the circadian rhythm. For DSP, chrono-therapy entails successively delaying bedtime by three hours per day, until the desired bedtime is reached. Then the person must rigidly adhere to the new sleep wake schedule. Let's look at an example of someone who falls asleep at 2 a.m. but wants to fall asleep at 11 p.m. During chronotherapy, his or her bedtime would move to 5 a.m. on Sunday, 8 a.m. on Monday, 11 a.m. on...

Nonsurgical Treatments for Snoring

There are numerous treatments for snoring that do not entail surgery Lifestyle changes. If you're significantly overweight, losing weight often eliminates snoring, since it reduces the amount of fatty tissue in the neck and throat. Quitting smoking, foregoing alcohol in the evening, and avoiding sleeping pills 126, and muscle relaxants may also help. Home solutions. If you snore only when lying on your back, sewing a tennis or golf ball into the back of your pajamas will prod you to sleep on...

Benzodiazepine Receptor Agonists

Agonists are drugs that bind to a receptor site on a cell and cause an action to occur. Benzodiazepine receptor agonists work by increasing the efficiency of gamma-aminobutryric acid (GABA), a neurotransmitter that reduces how often neurons fire alertness-promoting messages to each other. The drugs attach themselves to receptor sites on nerve cell molecules, changing the shape of the site slightly, so it's more attractive to GABA molecules. The binding of GABA opens pores in the cell, allowing...

Rhythmic Movement Disorders

It's common for infants to try to soothe themselves with rhythmic movements such as body rocking, head rolling, or in extreme cases, head banging. The movements occur as the child is getting ready to drift off to sleep. Although the sound of the child's bed moving can be disturbing, in most cases, there are no negative health effects and medical intervention isn't necessary. The movements usually go away by age five. If you're concerned about injury or bothered by the sound, modify the baby's...

Falling Asleep During the Day Is a Sign of Laziness

Falling asleep during daytime hours is not a character defect it's a sign of physiological need. Lazy people may fritter away their time at unproductive or pointless tasks, but they don't necessarily have trouble staying awake in the daytime. Sleeping during the day is a sign of sleep deprivation. This can be self-induced (that is, from staying up late), or it may result from poor sleep hygiene insomnia sleep apnea, narcolepsy, or another sleep disorder or an underlying illness. It can also be...

Dramatic Improvements in Diagnosis and Treatment

Much has happened in recent decades to make it easier to recognize and treat sleep problems. Sleep disorders are now more easily diagnosed, thanks to a better understanding of patient needs and improvements in technology. Overnight sleep centers are now designed to resemble hotels rather than hospitals, making patients feel more comfortable. The monitoring equipment is more sensitive than in the past, making for more accurate diagnoses. And computerization and miniaturization have led to the...

Thyroid Disease

Thyroid hormones, which are produced by the thyroid gland in the lower front of the neck, regulate the body's energy level. When levels of thyroid hormones are unusually high, a condition known as hyperthyroidism, the body burns energy faster and many vital functions speed up. Hyperthyroidism can make it hard to fall asleep, and night sweats cause nighttime arousals. The most common treatment is radioactive iodine, which stops excessive production of thyroid Coping with Frequent Nighttime...

Symptoms of Delayed and Advanced Sleep Phase Disorders

People with DSP are natural night owls who, left to their own devices, stay up late, often not falling asleep until 2, 3, or even 4 a.m. Then they sleep until the late morning or early afternoon. If your job entails working the evening shift and you can sleep in afterward, this isn't a drawback in fact, it's ideal. But if you need to be at work by 9 a.m., then it's a problem. People with DSP have great difficulty falling asleep at a traditional bedtime. At an hour when most people start to...

Reconditioning

In the 1970s, Northwestern University Professor Richard Boot-zin developed a technique to train people with insomnia to break harmful associations between their sleep environment and wake-fulness and frustration and to begin to associate the bedroom with sleep. Reconditioning, also known as stimulus control, has six rules 1. Go to bed only when you're sleepy. 2. Use the bed only for sleeping or sex. Do not read, watch television, eat, or worry in bed. 3. If you're unable to sleep quickly within...

Periodic Limb Movement Disorder

Like RLS, periodic limb movement disorder is a neurological condition that affects the legs and arms and your ability to sleep at night. During the night, leg muscles involuntarily contract, which causes kicking or jerking movements, typically every twenty to forty seconds. The same movement (involving the hip, knee, or ankle) may be repeated hundreds of times. There are two key differences between RLS and PLMD RLS occurs while you're awake PLMD occurs while you're asleep. The movements of RLS...

Hot Baths

A handful of studies have looked at a method known as passive body heating to treat insomnia. You take a long, hot bath an hour or two before bedtime, which raises your core body temperature and delays its eventual nighttime drop. Although the effect is not huge, altering the body temperature cycle seems to help some people fall sleep more easily and get more deep sleep. This treatment causes no harm and it feels good, so there's no harm in trying it. Sleep-Related Breathing Disorders Snoring...