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Sleep History Questions
Are you having difficulty sleeping throughout the night? Here are further guidelines. |
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What is sleep? What are the stages of sleep? How much sleep does a person need? Does the amount of sleep we need change as we age? What are signs and symptoms of sleep deprivation? What are and what causes sleep disorders? How are sleep problems diagnosed? How are sleep problems treated? |
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What is sleep?
Sleep is a naturally recurring state characterized by reduced or absent consciousness, relatively suspended sensory activity, and inactivity of nearly all voluntary muscles. It is distinguished from quiet wakefulness by a decreased ability to react to stimuli, and is more easily reversible than being in a coma. What are the stages of sleep? There are two general states of sleep: 1) rapid eye movement (REM) sleep, and 2) non-rapid eye movement (NREM) sleep. NREM sleep is further subdivided into stages (see below). 1. REM sleep (rapid-eye movement): REM sleep is unlike any of the other stages of sleep. It was first described in 1953 when sleep researchers noticed a unique pattern of brain waves (signals recorded on an electroencephalogram (EEG), a type of test that measures the electrical impulses within the brain). These brain waves had a fast frequency and low voltage, similar to the brain waves seen in the normal awake state. Other characteristics of REM sleep include complete inactivity of the voluntary muscles in the body, with the exception of the muscles that control eye movements. Rapid eye movements are also observed during REM sleep. People who are awakened during REM sleep often report that they were dreaming at the time. About 20% to 25% of sleep time is REM sleep; in infants it can comprise about 40%. 2. NREM (non-rapid eye movement): NREM sleep has traditionally been considered to be divided into 4 stages. However, new guidelines from the American Academy of Sleep Medicine (AASM) published in 2007 have recharacterized NREM sleep as occurring in 3 stages, according to the pattern of brain electrical activity: Stage N1 sleep, or the transition from wakefulness to deeper sleep. This is the lightest stage of sleep, and people may not always perceive they are asleep when in this stage. Stage N2 sleep is a true sleep state, and accounts for 40% to 50% of sleep time. Stage N3 sleep has been called deep sleep, delta sleep, or slow wave sleep. This stage accounts for about 20% of sleep in young adults. Sleep typically occurs in cycles that range from 90 to 120 minutes in length, with 4-5 cycles occurring during each night's sleep. In the first half of the night, there is a transition from wakefulness into stage N1 sleep, then to stages N2, and N3. Stages N2 and N3 then reappear, followed by the first instance of REM sleep. Cycles of stage N2 and REM sleep alternate with each other for the second half of the night. Disruptions in the entire sleep cycle or in the individual phases are believed to account for the various types of sleep disorders. How much sleep does a person need? Individuals vary greatly in their need for sleep; there are no established criteria to determine exactly how much sleep a person needs. Eight hours or more may be necessary for some people, while others may consider this to be too much sleep. Newborn babies, by contrast, sleep from 16 to 18 hours a day. Preschool-aged children typically sleep between 10 and 12 hours a day. Older, school-aged children and teens need at least 9 hours of sleep a night. Women in the first trimester of pregnancy have been observed to need a few more hours' sleep than is usual for them.
Does the amount of sleep we need change as we age? Changes in the sleep cycle do occur with aging. Deep or slow wave sleep (Stage N3) sleep declines as we age, while light sleep (Stage N1) increases with age, so that older adults may spend less time in the more restorative stages of sleep and more time in lighter sleep. Older people are also more easily aroused from sleep. While some people believe that older adults need less sleep as they get older, there is no scientific evidence that older people need less sleep than younger adults. What are signs and symptoms of sleep deprivation? Feeling tired or drowsy at any time during the day is a symptom of not having enough sleep. Being able to fall asleep within 5 minutes of lying down in the evening also may be a sign a person may be suffering from sleep deprivation. People who suffer from sleep deprivation often experience so-called "microsleeps," which are short bursts of sleep in an otherwise awake person. Sleep-deprived people perform poorly on tests such as driving simulators and tests of hand-eye coordination. Sleep deprivation can also magnify the effects of alcohol, meaning that a sleep-deprived person will be more susceptible to becoming impaired after alcohol consumption than a well-rested person. Caffeine and other stimulants cannot successfully overcome the drowsiness associated with sleep deprivation. What are and what causes sleep disorders? Sleep disorders are disruptions of the sleep cycle or the quality of sleep. About 40 million Americans are believed to suffer from chronic sleep disorders, with millions more affected on an occasional basis. Doctors have defined over 70 different types of sleep disorders, but the most common sleep disorders are insomnia, sleep apnea, restless legs syndrome, and narcolepsy. Insomnia is the perception of poor-quality sleep, including the inability to fall asleep or stay asleep. Because people differ in their need for sleep, there are no fixed criteria that define insomnia. Insomnia is very common and occurs in 30% to 50% of the general population. Approximately 10% of the population may suffer from chronic (long-standing) insomnia. Sleep apnea is another common sleep disorder characterized by a reduction or pause of breathing (airflow) during sleep. Central sleep apnea (CSA) occurs when the brain does not send the signal to the muscles to take a breath, and there is no muscular effort to take a breath. Obstructive sleep apnea (OSA) occurs when the brain sends the signal to the muscles and the muscles make an effort to take a breath, but they are unsuccessful because the airway becomes obstructed and prevents an adequate flow of air. Mixed sleep apnea occurs when there is both central sleep apnea and obstructive sleep apnea. Restless leg syndrome (RLS), also known as nocturnal myoclonus, is a type of sleep disorder characterized by uncomfortable sensations in the legs and an uncontrollable desire to move the legs. These abnormal sensations usually occur in the lower legs shortly after going to bed. During the early stages of sleep, these episodes of leg movement often last up to an hour. The abnormal sensations of RLS are quite variable. They have been described as a crawling, creeping, pulling, drawing, tingling, pins and needles, or prickly discomfort. They are not cramping in character. Narcolepsy is a disease of the central nervous system that results uniformly in excessive daytime sleepiness (EDS). Other primary symptoms of narcolepsy include the loss of muscle tone (cataplexy), distorted perceptions (hypnagogic hallucinations), and the inability to move or talk (sleep paralysis). Additional symptoms can include disturbed nocturnal sleep and automatic behaviors (affected persons carry out certain actions without conscious awareness). All of the symptoms of narcolepsy may be present in various combinations and degrees of severity. Other sleep disorders include: periodic limb movement disorder problem sleepiness hypersomnia sleepwalking snoring nightmares, and night shift work sleep disorder How are sleep problems diagnosed? Doctors use a number of different tests to evaluate sleep and determine whether a sleep disorder is present. A careful medical history and physical examination are performed to help identify any medical conditions that may be interfering with the person's sleep. The health care practitioner will also ask about the use of prescription and non-prescription medications as well as alcohol, tobacco, and caffeine use. Laboratory tests may also be used to help diagnose any medical conditions that may cause sleep problems. In some cases, specialized testing is recommended to help determine whether or not a person may be suffering from a sleep disorder. Some of the most common sleep tests include the following: Polysomnography is often simply referred to as a "sleep study." In this test, doctors use electrodes attached to the face and scalp to measure brain waves (electroencephalogram or EEG) and muscle tone during a night's sleep. Other body functions such as airflow, breathing effort, blood oxygen levels, leg movements, electrocardiogram (ECG), and body position may also be measured if needed. Sleep studies are most commonly performed in specially designed labs in hospitals or clinics. The multiple sleep latency test (MSLT) is designed to measure daytime sleepiness. The test is based upon the fact that the sleepier an individual is, the faster he or she will fall asleep. In this test, the patient is given four to five opportunities to nap in a quiet, dark room, usually at two hour intervals during the day. Body functions such as EEG and muscle tone are measured as in polysomnography. The time period needed from wakefulness to sleep onset is measured to determine the "sleep latency." This is repeated during each of the naps, and an average time for sleep latency across all the naps is calculated. Usually a sleep latency of 5 minutes or less is signifies severe daytime sleepiness. Related to the MSLT is the maintenance of wakefulness test (MWT), which measures the individual's ability to stay awake when reclining in a quiet, darkened room. The Epworth sleepiness scale is a questionnaire that is given to patients, often as part of an office visit to a health care practitioner. The test asks individuals to rate how likely they would be to fall asleep in a number of situations (such as a passenger in a car, sitting quietly after lunch, etc.). How are sleep problems treated? The treatment of sleep disorders depends upon the exact disorder and the degree of severity of the symptoms. Both medical and non-medical approaches are generally used in the treatment of sleep disorders. Sleep hygiene Non-medical treatment options are often referred to as sleep hygiene. Sleep hygiene is the practice of behavioral habits that offer the maximum potential for restorative and sound sleep. Good sleep hygiene practices include: Avoid caffeine, nicotine, and alcohol use before bedtime. Some studies have shown that caffeine consumed early in the day can have an effect on the ability to fall asleep at night. Have and adhere to a regular bedtime and waking schedule Maintain a comfortable sleep environment, including a comfortable temperature Do not lye in bed awake, worrying about not sleeping (or anything else negative). This produces anxiety that can actually make the problem worse. Get regular daily exercise (it is recommended that individuals avoid exercise two hours prior to bedtime) Other therapies Of course, many people with sleep disorders will require treatment beyond sleep hygiene measures. Behavioral therapies are successful for many people who suffer from insomnia. These therapies may consist of stimulus control measures, such as using the bed for sleeping and sex only and not for other activities such as reading or TV watching. Sleep restriction therapies are often used to help individuals avoid staying in bed too long and actually over-sleeping after a night of insomnia. Sleep aids (prescription and OTC) Medications can be of value in treating some types of sleep disorders. However, since sedating medications typically have the potential for addiction and abuse, their use must be carefully supervised by a health care practitioner. Among the types of prescription drugs that have been prescribed for specific sleep disorders include: Benzodiazepines, such as triazolam (Halcion), temazepam (Restoril), and lorazepam (Ativan) Newer, non-benzodiazepine sedative drugs: zaleplon (Sonata), zolpidem (Ambien or Ambien CR, Zolpimist), and eszopiclone (Lunesta). Ramelteon (Rozerem), an insomnia drug that acts by mimicking the action of melatonin (see below) Antidepressant medications have been used to treat insomnia in people who may also suffer from depression. Examples are trazodone (Desyrel), amitriptyline (Elavil, Endep), and doxepin (Sinequan, Adapin). A number of prescription drugs have been used to treat restless legs syndrome, including carbidopa-levodopa, opioids (such as propoxyphene [Darvon, Darvon-N, Dolene]) or tramadol (Ultram) for intermittent symptoms, carbamazepine (Tegretol, Tegretol XR , Equetro, Carbatrol), clonazepam (Klonopin), diazepam (Valium, Diastat), triazolam (Halcion), temazepam (Restoril), baclofen, bromocriptine, clonidine (Catapres, Catapres-TTS, Jenloga), gabapentin (Neurontin), ropinirole (Requip) and pramipexole (Mirapex). In sleep apnea and other sleep disorders in which airway obstruction is a problem, topical nasal decongestants may provide some relief. However, many clinicians warn people with sleep apnea never to use sleeping pills or medications that are sedative as the person could be prevented from waking enough to stimulate breathing, which could lead to brain damage or sudden death. OTC sleep medications are sometimes used for the short-term treatment of insomnia. These include the sedating antihistamines such as diphenhydramine (Benadryl). However, this is not a recommended use of these or other similar drugs due to their many side effects and the possibility of long-term drowsiness the following day. Melatonin, a chemical released from the brain which induces sleep, has been tried in supplement form and promoted as a natural sleep remedy for treatment of insomnia. But studies have shown that it has been generally ineffective in treating common types of insomnia, except in specific situations in patients with known low levels of melatonin. Dental appliances and CPAP devices (continuous positive airway pressure; a device worn over the face that holds the airway open by maintaining constant air pressure) have been effective in the management of sleep-related breathing disorders, including sleep apnea. Are sleep problems and disease related? Sleep problems occur in a number of different medical and psychiatric conditions. For example, asthma attacks and stroke are conditions that tend to occur frequently during the night or early morning hours. The relationship between sleep stages and certain types of epileptic seizures is complex and not completely understood, but certain sleep stages tend to either exacerbate or prevent the spread of seizure activity in the brain. Sleep problems occur with chronic pain and conditions in which pain is worse at night, because the pain may interfere with sleep. Pain medications and other types of medications taken on a regular basis for chronic conditions can also have an effect on an individual's sleep pattern. Those suffering from cancer, Alzheimer's disease, and brain injury are also commonly affected by sleep disturbances. Psychiatric diseases such as depression are also associated with sleep problems. This condition can be associated with both too much sleep and too little sleep. In fact, sleep problems are associated with a majority of mental disorders, and poor quality or insufficient sleep can worsen the symptoms of mental or psychiatric conditions. How can I get a good night's sleep? Practicing good sleep hygiene (see above), including maintenance of a regular bedtime and awakening schedule, is the best way to ensure restful and restorative sleep. Avoidance of caffeine, alcohol, nicotine, and strenuous exercise in the hours prior to bedtime can also help improve the quality of your sleep. Many people report that they lie awake at night worrying about problems or situations they will face during the coming day. In this case, it can be helpful to write a to-do list or a list of items to act upon the following day prior to bedtime, giving yourself permission to "let go" of these items during the night. If you are concerned about the quality of your sleep or if you have the symptoms of a sleep disorder, it is important to consult your health care practitioner. He or she can help you determine the cause of your sleep problem and recommend appropriate therapy. What is insomnia? What causes insomnia? How is insomnia diagnosed? How is insomnia treated? What is snoring and what can I do about it? What causes insomnia and what is the best way to treat it? How is sleep affected by health problems like heart disease and depression? What is sleep apnea and could I have it? Which medications cause excessive sleepiness or sleeplessness? What are the best treatments for restless leg syndrome and narcolepsy? Do older adults need as much sleep as younger people? What are the consequences of poor sleep for older adults? I have trouble falling asleep at night. Is that just a normal part of aging? What is the most common reason older adults wake up at night? As I get older, why do I tend to become tired earlier in the evening? Do older adults get enough sleep? How many types of sleep are there? What are the most common sleep disorders among older adults? What are the symptoms of insomnia? What are some suggestions for getting a good night's sleep? What causes a person to snore? What is obstructive sleep apnea? What is central sleep apnea? How is sleep apnea usually treated? Are there other treatments for sleep apnea? What are movement disorders and how do they affect sleep? What are the symptoms of periodic limb movement disorder? What are the symptoms of restless legs syndrome? What is REM sleep behavior disorder? How are movement disorders treated? At what point should I see a doctor about a sleeping problem? What can I expect during my visit to the doctor? How does a sleep center diagnose sleep problems? Sleep Loss What can I do about stress-related sleep loss? Are there certain lifestyle factors that can cause sleep loss? Can napping during the day cause sleep loss at night? What medical conditions could be causing my sleep loss? Could any of the medications I'm taking be causing my sleep loss? Sleep Problems How do I know if I'm not getting enough sleep? What defines having difficulty falling asleep? What could be causing me to wake up frequently during the night and have trouble returning to sleep? How can I tell the difference between a few nights of un-refreshing sleep and a more serious sleep problem? Sleep Tips How can I change my sleep environment to help? What lifestyle changes can I make to improve my sleep? Are there relaxation techniques that can help? How could a sleep medication help? Over-the-Counter Sleep Medications (available without a prescription) How do these products work? Are these any safer than prescription sleep medications? Will I feel groggy when I wake afterwards? What are the side effects? Prescription Sleep Medications What are the advantages of taking a prescription sleep medication instead of an over-the-counter (non-prescription) medication? How safe is treatment with sleep medications? What are the side effects? If I am prescribed prescription sleep medication, does this mean I should take it every night? Does the frequency I take a prescription sleep aid impact its effectiveness – or can I take it as I feel is necessary? 1. How long does it usually take you to fall asleep? a) 0 - 5 minutes b) 5 - 15 minutes c) 15 - 30 minutes d) More than 30 min. 2. On the average, how many times do you wake up during the night (circle the correct response)? None, 1, 2, 3, 4, 5, 6, more than 6 3. Why do you wake up during the night? a) nature calls b) dreams or nightmares c) external noise d) other: 4. How many hours of sleep do you normally get each night? a) 4 or less b) 4 - 6 c) 6 - 8 d) 8 - 10 e) More than 10 5. Have you been diagnosed with a sleep disorder? a) Yes b) No If so, please name it: 6. How are you treating the sleep disorder (circle all that apply): a) nonprescription sleeping product b) prescription drug c) light therapy d) mechanical device e) no treatment other: What is insomnia? Every person varies in how much sleep they need. Some people get by with less sleep than others, yet are satisfied with their functioning the next day. With insomnia, your sleep feels inadequate or poor-quality. You don’t feel refreshed in the morning. You may have had difficulty falling asleep. Or you woke up frequently during the night, with difficulty returning to sleep. You might wake up too early in the morning. You suffer the next day -- you’re tired, have little energy, can’t concentrate, and you’re irritable. Insomnia can be classified as transient (short-term), intermittent (on and off), and chronic (long-lasting). Insomnia lasting from a single night to a few weeks is referred to as transient. If episodes of transient insomnia occur from time to time, the insomnia is said to be intermittent. Insomnia is chronic if it occurs on most nights and lasts a month or more. What causes insomnia? You are more likely to develop insomnia if you are over age 60, if you are female, and if you have a history of depression. If you also have stress, anxiety, chronic medical conditions (such as arthritis or heart failure), or use certain medications, you are at increased risk for insomnia. Temporary Insomnia Transient and intermittent insomnia generally can occur if you have: * Periods of excess stress in your life * Noisy surroundings (like outside street noise) * Extreme temperatures (too hot or cold in the bedroom) * Change of environment (hotel rooms) * Sleep/wake schedule problems (jet lag or work shifts) * Medication side effects Chronic Insomnia Chronic insomnia is a more complex sleep disorder and often involves several factors, like physical or mental disorders. Depression is one of the most common causes of chronic insomnia. Arthritis, kidney disease, heart failure, asthma, sleep apnea, restless legs syndrome, Parkinson's disease, and hyperthyroidism can also cause insomnia. Lifestyle factors can trigger insomnia, too. If these factors don’t change, they can also prolong the insomnia cycle. They include: * Too much caffeine * Drinking alcohol before bedtime * Smoking cigarettes before bedtime * Excessive napping in the afternoon or evening * Irregular or continually disrupted sleep/wake schedules * Expecting to have difficulty sleeping and worrying about it How is insomnia diagnosed? If you have insomnia, your doctor will ask questions about your medical history and sleep history. You may need to keep a sleep diary. Specialized sleep studies (a night spent in a laboratory) may be necessary - but only if there is suspicion of a medical problem like sleep apnea or narcolepsy. How is insomnia treated? Insomnia is a problem either falling asleep or staying asleep that causes personal distress or interferes with your daytime functioning in some way. There are two main types of insomnia: "primary" and "secondary". Primary insomnia is having difficulties with sleep which are not caused by a medical or psychiatric disorder. Although primary insomnia often begins with stress or physical injury, it continues long after the factors that first started it have been resolved. Secondary insomnia is caused by a medical or psychiatric disorder. Examples of such conditions are an overactive thyroid, major depression, a medication side effect, and another sleep disorder (e.g. sleep apnea). WHAT IS SLEEP LOSS? While insomnia is an involuntary inability to sleep, many people suffer from sleep loss by deliberately restricting their sleep either for work-related reasons or other purposes. Individuals vary on the amount of sleep needed to feel refreshed and function at their best. Studies show that when you get less sleep than you need, this negatively affects you physically and mentally. The effect can be cumulative. This is sometimes referred to as "sleep debt". It is believed that millions of Americans do not get adequate amounts of sleep on a regular basis. Although everyone has a different need for sleep, most people seem to require more than 6.5 hours per night. Restricting sleep time may negatively affect a variety of important cognitive and physiologic functions. Sleep restriction can also lead to daytime sleepiness, which can increase the rates of accidental injuries and automobile crashes. How many of hours sleep do you generally need per night? What time do you usually go to bed? What time do you usually wake up? Do you manage to sleep as much as you need? If not, why not? Have you ever suffered from insomnia? Do you suffer from insomnia? Are you a light sleeper or a heavy sleeper? What keeps you awake at night? (e.g. worrying too much about stuff, too much coffee, your partner's snoring, your neighbors' parties, an uncomfortable bed, a hot summer) Do you use, or have you ever used, any special methods that help you get to sleep?
* Sleeping pills? * Herbal remedies? * Counting sheep? * Meditation? Do you snore? Do you talk in your sleep? Do you ever oversleep? Do you need an alarm clock to wake up? Do you ever sleep in? (Sleep late in the morning) Do you fall asleep while watching the TV or reading? Do you have a nap at lunchtime or at another time of the day? Does it help? What do you wear in bed? (I hope this question's not too personal!) Do you have a duvet, or do you prefer sheets and a blanket? How big is your bed? Do you remember your dreams? Do you have a recurring dreams? Tell us about a memorable, enjoyable, or strange dream you've had? Do you suffer from nightmares? Can you remember any specific nightmare? Do you believe that it's possible to interpret dreams? Have you ever tried to interpret your own dreams? Have you ever walked in your sleep? Do you know anyone who does? Sleep Disorders * Insomnia * Sleep-disordered Breathing * Movement Disorders 1. How long does it usually take you to fall asleep? 2. On the average, how many times do you wake up during the night (circle the correct response)? 3. Why do you wake up during the night? 4. How many hours of sleep do you normally get each night? 5. Have you been diagnosed with a sleep disorder? 6. How are you treating the sleep disorder (circle all that apply): |