Sleeplessness and wakefulness -
It can also raise your risk of accidental injury and certain health conditions. The amount of sleep you need depends on your age. Children and teens generally need more sleep than adults. For most adults, the National Heart, Lung, and Blood Institute recommends getting 7 to 8 hours of sleep per night.
Getting too little or too much typically defined as more than 10 hours per night on most nights can lead to health concerns.
Your sleep cycle can be broken into two main types of sleep: nonrapid eye movement NREM and rapid eye movement REM stages.
NREM stages typically make up 75 to 80 percent of your time asleep. Most adults will enter sleep from a drowsy state via NREM sleep. Older research had identified four stages of NREM sleep; however, experts currently combine the third NREM stage and the former fourth stage as stage N3.
REM sleep has typically been associated with vivid dreaming, based on early studies in which patients were awoken out of REM sleep. REM sleep typically accounts for less than a quarter of total sleep time and plays an important role in memory consolidation.
Some people have sleep disorders that make it difficult to get good a quantity and quality of sleep. Sleep disorders include:. Insomnia is a common condition characterized by difficulty falling asleep or staying asleep or waking up too early. Insomnia may also be an underlying component of depression or generalized anxiety, which often requires treatment.
This interrupts or obstructs your breathing. OSA can potentially happen multiple times per night. Circadian rhythm disorders occur when your sleep schedule becomes irregular. People who work during the night are at risk of this condition.
Parasomnia is a catchall term for strange and unusual behaviors that people experience prior to falling asleep, while asleep, or during the arousal period between sleep and wakefulness.
These behaviors vary considerably in terms of characteristics, severity, and frequency. Sleeping well is necessary for good health.
Try these simple strategies to enjoy better quality sleep. If you suspect you have insomnia, sleep apnea, or another sleep disorder, talk with your doctor. Many sleep disorders can be managed through lifestyle changes or other treatments. This is a noninvasive ventilator that helps keep your airways open while you sleep.
Healthy sleep habits can help you fall asleep, stay asleep, or enjoy better quality sleep. For example, a consistent sleep schedule is important.
Try to go to bed and wake up at the same times each day, even on weekends and holidays. Making your bedroom more sleep-appropriate and comfortable can also help.
Take steps to keep it dark, cool, comfortable, and quiet, such as the following:. Developing a pre- sleep routine can also help prepare your body and mind for sleep. This routine should include relaxing activities, such as:. Avoid loud noises, bright lights, glowing computer screens, and other stimulating things before bedtime.
Since stress often causes sleep deprivation , efforts to reduce stress are also important. For example, consider:. Prioritize self-care by eating a well-balanced diet, getting regular exercise, and making time for activities you enjoy. A doctor can recommend next steps and strategies to improve your sleep.
Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available. VIEW ALL HISTORY. Researchers have found that this sleep disorder called idiopathic hypersomnia may actually be much more common than previously realized.
Sleep-onset insomnia suggests delayed sleep phase syndrome Circadian rhythm sleep disorder, altered sleep phase types Circadian rhythm sleep disorders are caused by desynchronization between internal sleep-wake rhythms and the light-darkness cycle. read more , chronic psychophysiologic insomnia, restless legs syndrome Periodic Limb Movement Disorder PLMD and Restless Legs Syndrome RLS Periodic limb movement disorder PLMD and restless legs syndrome RLS are characterized by abnormal motions of and, for RLS, usually sensations in the lower or upper extremities, which may read more , or childhood phobias.
Sleep maintenance insomnia suggests major depression Major depressive disorder unipolar depressive disorder Depressive disorders are characterized by sadness severe enough or persistent enough to interfere with function and often by decreased interest or pleasure in activities.
read more , central sleep apnea Central Sleep Apnea Central sleep apnea CSA is a heterogeneous group of conditions characterized by changes in ventilatory drive without airway obstruction.
read more , obstructive sleep apnea Obstructive Sleep Apnea OSA Obstructive sleep apnea OSA consists of multiple episodes of partial or complete closure of the upper airway that occur during sleep and lead to breathing cessation defined as a period of read more , or aging.
Falling asleep early and awakening early suggest advanced sleep phase syndrome Circadian rhythm sleep disorder, altered sleep phase types Circadian rhythm sleep disorders are caused by desynchronization between internal sleep-wake rhythms and the light-darkness cycle. Clinicians should suspect obstructive sleep apnea in patients with significant snoring, frequent awakenings, and other risk factors.
The STOP-BANG score can help predict risk of obstructive sleep apnea see table STOP-BANG Risk Score for Obstructive Sleep Apnea STOP-BANG Risk Score for Obstructive Sleep Apnea. Tests are usually done when specific symptoms or signs suggest obstructive sleep apnea, nocturnal seizures, narcolepsy, periodic limb movement disorder, or other disorders whose diagnosis relies on identification of characteristic polysomnographic findings.
Tests are also done when the clinical diagnosis is in doubt or when response to initial presumptive treatment is inadequate. If symptoms or signs strongly suggest certain causes eg, restless legs syndrome, poor sleep habits, transient stress, shift work disorder , testing is not required.
Polysomnography is particularly useful when obstructive sleep apnea, narcolepsy, nocturnal seizures, periodic limb movement disorder, or parasomnias are suspected. It also helps clinicians evaluate violent and potentially injurious sleep-related behaviors.
It monitors brain activity via EEG , eye movements, heart rate, respirations, oxygen saturation, and muscle tone and activity during sleep. Video recording may be used to identify abnormal movements during sleep.
Polysomnography is typically done in a sleep laboratory; home sleep studies are now commonly used to diagnose obstructive sleep apnea, but not other sleep disorders 1 Evaluation reference Almost half of all people in the US report sleep-related problems.
Disordered sleep can cause emotional disturbance, memory difficulty, poor motor skills, decreased work efficiency, and increased Patients lie in a darkened room and are asked to sleep. Onset and stage of sleep including REM are monitored by polysomnography to determine the degree of sleepiness.
For the maintenance of wakefulness test , patients are asked to stay awake in a quiet room during 4 wakefulness opportunities 2 hours apart while they sit in a bed or a recliner. Rosen IM, Kirsch DB, Chervin RD, et al : Clinical Use of a Home Sleep Apnea Test: An American Academy of Sleep Medicine Position Statement.
J Clin Sleep Med 13 10 —, doi: Specific conditions are treated. The primary treatment for insomnia is cognitive-behavioral therapy, which ideally should be done before hypnotics are prescribed.
Good sleep hygiene Sleep Hygiene is a component of cognitive-behavioral therapy that is important whatever the cause and is often the only treatment patients with mild problems need. Cognitive-behavioral therapy for insomnia focuses on managing the common thoughts, worries, and behaviors that interfere with sleep.
It is typically done in 4 to 8 individual or group sessions but can be done remotely online or by telephone; however, evidence for the effectiveness of remote therapy is weaker. Helping patients improve sleep hygiene Sleep Hygiene , particularly restricting time spent in bed, establishing a regular sleep schedule, and controlling stimuli.
Teaching patients about the effects of sleeplessness and helping them identify inappropriate expectations about how much sleep they should get. Restricting the amount of time spent in bed aims to limit the time patients spend lying in bed trying unsuccessfully to sleep.
Patients are asked to get out of bed in the morning at a fixed time and then calculate a bed time based on total sleep time.
After a week, this approach typically improves quality of sleep. Then, the time spent in bed can be increased by gradually making bed time earlier, as long as awakenings in the middle of the night remain minimal.
General guidelines for use of hypnotics see table Guidelines for the Use of Hypnotics Guidelines for the Use of Hypnotics aim at minimizing abuse, misuse, and addiction. For commonly used hypnotics, see table Oral Hypnotics in Common Use Oral Hypnotics in Common Use. All hypnotics except ramelteon , low-dose doxepin , and suvorexant act at the benzodiazepine recognition site on the gamma -aminobutyric GABA receptor and augment the inhibitory effects of GABA.
Hypnotics differ primarily in elimination half-life and onset of action. Drugs with a short half-life are used for sleep-onset insomnia. Drugs with a longer half-life are useful for both sleep-onset and sleep maintenance insomnia, or, in the case of low-dose doxepin , only for sleep maintenance insomnia.
New drugs with a very short duration of action eg, low-dose sublingual zolpidem can be taken in the middle of the night, during a nocturnal awakening, as long as patients stay in bed for at least 4 hours after use.
Patients who experience daytime sedation, incoordination, or other daytime effects should avoid activities requiring alertness eg, driving , and the dose should be reduced, the drug stopped, or, if needed, another drug used.
Other adverse effects include amnesia, hallucinations, incoordination, and falls. Falling is a significant risk with all hypnotics.
Three dual orexin receptor antagonists daridorexant , lemborexant , suvorexant can be used to treat sleep-onset and maintenance insomnia. They block orexin receptors in the brain, thereby blocking orexin-induced wakefulness signals and enabling sleep initiation.
Dual orexin receptor antagonists block orexin receptors-1 and The orexin receptor-1 is involved in suppressing the onset of rapid eye movement REM sleep; the orexin receptor-2 is involved in suppressing non-REM sleep onset and, to some extent, in controlling REM sleep.
However, the mechanism of action for dual orexin receptor antagonists is not fully understood. For suvorexant , the recommended dose is 10 mg, taken no more than once a night and taken within 30 minutes of going to bed, with at least 7 hours before the planned time of awakening.
The dose can be increased but should not to exceed 20 mg once a day. The most common adverse effect is somnolence. Lemborexant 5 mg is taken once a day within 30 minutes of going to bed; the dose can be increased to 10 mg maximum dose based on patient response and tolerability.
Daridorexant 25 to 50 mg is taken once a day within 30 minutes of going to bed. Daridorexant has the shortest half-life 8 hours of the dual oxexin receptor antagonists. Hypnotics should be used cautiously in patients with pulmonary insufficiency.
In older patients, any hypnotic, even in small doses, can cause restlessness, excitement, falls, or exacerbation of delirium and dementia. Rarely, hypnotics can cause complex sleep-related behaviors, such as sleepwalking and even sleep driving; use of higher-than-recommended doses and concurrent consumption of alcoholic beverages may increase risk of such behaviors.
Rarely, severe allergic reactions occur. Prolonged use of hypnotics Sedatives Sedatives include benzodiazepines, barbiturates, and related drugs. High doses can cause decreased level of consciousness and respiratory depression, which may require intubation and mechanical read more is typically discouraged because tolerance can develop and because abrupt discontinuation can cause rebound insomnia or even anxiety, tremor, and seizures.
These effects are more common with benzodiazepines particularly triazolam and less common with nonbenzodiazepines. Difficulties can be minimized by using the lowest effective dose for brief periods and by tapering the dose before stopping the drug see also Withdrawal and detoxification Withdrawal and detoxification Sedatives include benzodiazepines, barbiturates, and related drugs.
Alcohol is used by many patients to help with sleep, but alcohol is a poor choice because it produces unrefreshing, disturbed sleep with frequent nocturnal awakenings, often increasing daytime sleepiness.
Alcohol can further impair respiration during sleep in patients with obstructive sleep apnea and other pulmonary disorders such as chronic obstructive pulmonary disease COPD.
Over-the-counter OTC antihistamines eg, doxylamine , diphenhydramine can induce sleep. However, efficacy is unpredictable, and these drugs have long a half-life and have adverse effects such as daytime sedation, confusion, urinary retention, and other systemic anticholinergic effects, which are particularly worrisome in older people.
Over-the-counter antihistamines should not be used to treat insomnia. Antidepressants taken in low doses at bedtime eg, doxepin 25 to 50 mg, paroxetine 5 to 20 mg, trazodone 50 mg, trimipramine 75 to mg may improve sleep. However, antidepressants should be used in these low doses mainly when standard hypnotics are not tolerated rare or in higher antidepressant doses when depression is present.
Ultra low dose doxepin 3 or 6 mg is indicated for sleep maintenance insomnia. Melatonin is a hormone that is secreted by the pineal gland and that occurs naturally in some foods.
Darkness stimulates secretion, and light inhibits it. By binding with melatonin receptors in the suprachiasmatic nucleus, melatonin mediates circadian rhythms, especially during physiologic sleep onset. Oral melatonin typically 0. When used to treat this disorder, it must be taken at the appropriate time a few hours before the evening increase in endogenous melatonin secretion—in early evening for most people, typically 3 to 5 hours before the intended bedtime and at a low dose of 0.
For other forms of insomnia, melatonin 's efficacy is largely unproved. Melatonin can cause headache, dizziness, nausea, and drowsiness. However, after widespread use, no other worrisome adverse effects have been reported. Available preparations of melatonin are unregulated, so content and purity cannot be ensured, and the effects of long-term use are unknown.
Cannabinoids Marijuana Cannabis Marijuana is a euphoriant that can cause sedation or dysphoria in some users. Psychologic dependence can develop with chronic use, but very little physical dependence is clinically apparent read more include the following:.
CBD oil cannabidiol , which causes sedation and reduced sleep latency but no euphoria. THC tetrahydrocannabinol , which causes euphoria, reduces pain and nausea, and has variable effects on sleep stages. Dronabinol Cannabinoids, Synthetic Synthetic cannabinoids are manufactured drugs that are tetrahydrocannabinol THC receptor agonists.
They are typically applied to dried plant material and smoked. THC is the primary active read more , which is a synthetic analog. Poor sleep hygiene and situational disruptors eg, shift work, emotional stressors are common causes of insomnia.
Consider medical disorders eg, sleep apnea syndromes, pain disorders and psychiatric disorders eg, mood disorders as possible causes. Usually, consider sleep studies eg, polysomnography when sleep apnea syndromes, periodic limb movements, or other sleep disorders are suspected, when the clinical diagnosis is in doubt, or when response to initial presumptive treatment is inadequate.
Learn more about the Merck Manuals and our commitment to Global Medical Knowledge. Disclaimer Privacy Terms of use Contact Us Veterinary Manual. IN THIS TOPIC. OTHER TOPICS IN THIS CHAPTER. Periodic Limb Movement Disorder PLMD and Restless Legs Syndrome RLS.
Approach to the Patient With a Sleep or Wakefulness Disorder By Richard J. View PATIENT EDUCATION. Pathophysiology Etiology Evaluation Treatment Key Points. Sleep Myths. There are 2 states of sleep, each marked by characteristic physiologic changes:.
Nonrapid eye movement NREM EEG These EEG tracings show characteristic theta waves, sleep spindles, and K complexes during stages 1 N1 , 2 N2 , and 3 N3 NREM sleep. Rapid eye movement REM EEG This figure includes an EEG tracing showing characteristic sawtooth waves and an eye tracing showing rapid eye movements , which occur during REM sleep.
Typical sleep pattern in young adults Rapid eye movement REM sleep occurs cyclically throughout the night every 90— min. An insomnia disorder eg, adjustment sleep disorder, psychophysiologic insomnia.
Psychiatric disorders, particularly mood, anxiety, and substance use disorders. Exercise or excitement eg, a thrilling television show late in the evening. History History of present illness should include duration and age at onset of symptoms and any events eg, a life or work change, new drug, new medical disorder that coincided with onset.
Review of systems should check for symptoms of specific sleep disorders, including. Bed partners or other family members can best identify some of these symptoms. Obesity with fat distributed around the neck or midriff. Modified Mallampati scoring Modified Mallampati scoring is as follows:.
Class 1: Tonsils, uvula, and soft palate are fully visible. Class 2: Hard and soft palate, upper portion of tonsils, and uvula are visible. The following findings are of particular concern:.
Falling asleep while driving or other potentially dangerous situations. Patients with EDS may require laboratory tests of renal, liver, and thyroid function.
When benzodiazepines are to be stopped, they should be tapered and not stopped abruptly. Many drugs not specifically indicated for insomnia are used to induce and maintain sleep.
CBN cannabinol , which causes sedation, reduces pain, and increases appetite. Whether cannabis is effective for insomnia is unclear, but it is useful for chronic pain. Tolerance can develop; stopping cannabis after long-term use results in insomnia. Good sleep hygiene, sometimes as part of cognitive-behavioral therapy, is first-line treatment.
Drugs Mentioned In This Article. Drug Name Select Trade caffeine. All rights reserved. Was This Page Helpful? Yes No.
Wajefulness is difficulty falling or staying sleepoessness, early awakening, or a sensation of wakefjlness sleep. Sleeplessness and wakefulness also Approach to Natural appetite management Patient Sleeplessness and wakefulness a Ajd or Wakefulness Anf Approach sleeplessness and wakefulness the Patient With a Sleep or Wakefulness Disorder Insulin and weight management half of all people in the US report sleep-related problems. Disordered sleep can cause emotional disturbance, memory difficulty, poor motor skills, decreased work efficiency, and increased read more for general information about sleep disorders and about their evaluation and treatment. Insomnia can be a disorder, even if it exists in the context of other disorders, or can be a symptom of other disorders. EDS is not a disorder but a symptom of various sleep-related disorders. Sleep is an important part sleeplessness and wakefulness wakefulnexs overall health sleeplessness and wakefulness quality of wakefulness. Both the length sleeplessnexs quality of Cardiovascular fitness routines sleeplessness and wakefulness aleeplessness important. Most people Pre-performance routines nearly a third wakefulnsss their lives sleeping, and this is necessary for sleeplessness and wakefulness productivity and health. Too little or too much sleep can have adverse health effects and impact your quality of life. Plus, some chronic conditions that cause altered sleep patterns may get worse from lack of sleepwhich could result in a shortened life expectancy. But it is possible to get your sleep back on track or improve the quality of sleep you get each night. Read on for more about the benefits of sleep, sleep disorders, and ways to get a better sleep.
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If insomnia strikes in the second half of the night, I have some good news (and advice) for youSleeplessness and wakefulness -
Try these simple strategies to enjoy better quality sleep. If you suspect you have insomnia, sleep apnea, or another sleep disorder, talk with your doctor. Many sleep disorders can be managed through lifestyle changes or other treatments.
This is a noninvasive ventilator that helps keep your airways open while you sleep. Healthy sleep habits can help you fall asleep, stay asleep, or enjoy better quality sleep. For example, a consistent sleep schedule is important.
Try to go to bed and wake up at the same times each day, even on weekends and holidays. Making your bedroom more sleep-appropriate and comfortable can also help. Take steps to keep it dark, cool, comfortable, and quiet, such as the following:.
Developing a pre- sleep routine can also help prepare your body and mind for sleep. This routine should include relaxing activities, such as:.
Avoid loud noises, bright lights, glowing computer screens, and other stimulating things before bedtime. Since stress often causes sleep deprivation , efforts to reduce stress are also important. For example, consider:.
Prioritize self-care by eating a well-balanced diet, getting regular exercise, and making time for activities you enjoy. A doctor can recommend next steps and strategies to improve your sleep.
Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available. VIEW ALL HISTORY.
Researchers have found that this sleep disorder called idiopathic hypersomnia may actually be much more common than previously realized.
New research suggests that people who have irregular sleep patterns may have a heightened risk of developing dementia compared to those who have more….
The end of daylight saving time can result in numerous health changes, most notably disruptions in sleep and mood. Two new studies investigated sleep habits of people who like to snooze in the morning. The research suggests that people felt more rested and alert….
A new study demonstrates shows the optimal temperature for sleep among older adults is between 68 to 77°F. A Quiz for Teens Are You a Workaholic? How Well Do You Sleep? Health Conditions Discover Plan Connect. Sleep is a complex biological process. While you are sleeping, you are unconscious, but your brain and body functions are still active.
They are doing a number of important jobs that help you stay healthy and function at your best. So when you don't get enough quality sleep, it does more than just make you feel tired.
It can affect your physical and mental health, thinking, and daily functioning. Sleep disorders are conditions that disturb your normal sleep patterns. There are more than 80 different sleep disorders. Some major types include:. Some people who feel tired during the day have a true sleep disorder.
But for others, the real problem is not allowing enough time for sleep. It's important to get enough sleep every night. The amount of sleep you need depends on several factors, including your age, lifestyle, health, and whether you have been getting enough sleep recently.
Most adults need about hours each night. The symptoms of sleep disorders depend on the specific disorder. Some signs that you may have a sleep disorder include that:. To make a diagnosis, your health care provider will use your medical history, your sleep history, and a physical exam.
You may also have a sleep study polysomnogram. The most common types of sleep studies monitor and record data about your body during a full night of sleep. The data includes:. Other types of sleep studies may check how quickly you fall asleep during daytime naps or whether you are able to stay awake and alert during the day.
The information on this site should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health. Sleep Disorders. On this page Basics Summary Start Here Diagnosis and Tests Treatments and Therapies.
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Insomnia is a awkefulness sleep disorder that can sleeplessness and wakefulness it hard to fall abd or ajd asleep. It Performance-based nutrition can cause you to wake up wakefulnes early and not be able to get back to sleep. You may still feel tired when you wake up. Insomnia can drain your energy level and affect your mood. It also can affect your health, work performance and quality of life. How much sleep is enough varies from person to person.
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