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Sleep
Disorder
What is sleep?
What is good quality sleep?
You know you are having good quality sleep when you wake
feeling refreshed, alert and energised. A person with a
sleep disorder usually reports sleeping poorly or not enough.
How much sleep do I need?
Most people need about 6 to 8 hours of good quality sleep
per day.
What is the purpose of sleep?
Sleep is necessary to sustain good health and well-being.
It provides the mind and body with the opportunity to restore
balances and repair itself. The immune system works to manufacture
the necessary cells to fight off infection and disease,
the pituitary gland produces growth hormones that help to
repair tissues, and the overall chemical balance in the
body is restored. At the same time the mind is working to
organise and store memories from the day’s activities. Sleep
is a dynamic process that involves 5 main stages that are
outlined below. Stage 1 to 4 involves non-REM (rapid eye
movement) sleep or Quiet Sleep. At this time the
brain is at it’s least active. Stage 5 is REM sleep – the
time when we tend to dream. The brain cycles through these
stages several times during the course of a night. Each
cycle lasts between 90 and 120 minutes
5 stages of sleep
Stage 1 This stage involves the transition between
sleep and wakefulness. The mind and body relax, breathing
becomes more regular, and muscle activity gradually ceases.
This stage of sleep is very light and, if awakened, the
person may not feel as though they have been asleep at all.
Feeling as if you are falling, making jerky movements or
hearing indistinct voices during this stage is considered
normal and no cause for alarm. Generally a healthy person
will only stay a few minutes in this stage of sleep although
someone with a sleep disorder may spend much longer in this
phase.
Stage 2 At stage 2 the heart rate and blood pressure
drop and the person relaxes more deeply. Waking them will
be harder. Stage 2 accounts for approximately 50% of all
sleep time.
Stage 3 & 4 During stage 3 and 4 sleep is at
its deepest. The body is very relaxed, breathing and heart
rates are slow and steady. It is difficult to wake someone
during these stages and if you do the person will feel groggy
and be slow to respond. There is no visible movement in
the body. During this stage most of the repair and restorative
work in the body takes place.
Stage 5 REM sleep occurs in stage 5. The first episode
lasts for about 10 minutes and thereafter each REM episode
becomes progressively longer until the final one lasting
about 1 hour. The brain is active but the body is effectively
immobilised, allowing us to dream without incurring damage
from acting out our dreams. During this stage blood flow
to the brain increases, heart rate speeds up, and breathing
becomes more rapid. REM sleep accounts for approximately
20 to 25% of total sleep time.
What are the signs and symptoms of sleep problems?
Age more rapidly
More susceptible to illness
Increased risk of accidents
More emotional problems such as depression and anxiety
Mood swings and irritability
Concentration problems, impaired judgement, difficulty
making decisions
Reduced ability to deal with stress
Increased risk of general health concerns such as heart
disease, diabetes; increased blood pressure
Apathy, low energy, fatigue
Headache
General feeling of malaise or sickness
Weight gain
Insomnia: the most common sleep disorder
Insomnia is best thought of as a symptom rather than a
disease. It occurs when basic sleep-wake mechanisms go awry.
People with insomnia may complain about not being able to
fall or stay asleep easily, waking too early in the morning,
or excessive tiredness and irritability during the day.
It is the most common of the sleep disorders. Almost anyone
can suffer from insomnia but certain groups are more likely
(women, older people and those suffering from depression).There
are various types of insomnia and a range of different things
can make it difficult for people to fall asleep or stay
asleep. Treatment is best directed at identifying and rectifying
the causes of the problem, rather than the insomnia itself.
Jet Lag
Jet lag results when the biological clock has not adjusted
to the new local time. Usually proper adjustment takes approximately
one day for each hour difference, although this differs
between individuals and can be influenced by the direction
of travel (adaptation is faster when flying westward rather
than eastward). Adaptation can be assisted by:
Adopting the local routine as soon as possible
Allow time to rest and adjust on arrival
Exposure to natural light on arrival (i.e., go for
an hours walk in the afternoon local time)
Avoid alcohol during the flight (it is dehydrating)
and drink plenty of water or noncarbonated juices
Exercise lightly on the plane (e.g., walk the aisles
when possible) to overcome fatigue and reduce the effects
of cramped and confined conditions
If you are staying in the new time zone for five days
or less, a mild sleep medication may be prescribed for
the first night or two if necessary.
Shift Work
Shift workers experience significant disruption to their
normal biorhythms as a consequence of having to alter their
sleep patterns regularly. As a result, some shift workers
report symptoms of sleep disorder. The effects of shift
work can be lessened by:
Increased light while working at night
Changing the order of the usual work-leisure-sleep
pattern to a work-sleep leisure pattern
Try to follow as many of the strategies listed below
as possible to promote good sleep habits. These include
relaxation, regular exercise, diet and stress management
10 common causes of sleep problems
eating the wrong foods at the wrong time
emotional upset (including depression)
bedroom environment not conducive to good sleep patterns
(too hot, too cold, too noisy)
exercising too close to bed time (exercise stimulates
your system by boosting your metabolism and the effect
can linger for hours afterwards)
snoring
medications including diet pills, some blood pressure,
allergy or asthma medications
chronic pain
stimulants including caffeine, alcohol and nicotine
poor sleep habits
anxiety / stress
Quick tips
Good sleep quality is essential to overall well-being
When thinking about your sleep patterns you should
consider both the sleep and wake function
Sleep is individual: different for different people
The human body is adaptable and problems associated
with poor sleep quality may only become apparent after
some time experiencing sleep deprivation
Common treatments for sleep disorders
Treatments for sleep disorders vary depending on the specific
condition identified. The form of therapy chosen also needs
to take into account all of the factors that may be influencing
the quality and quantity of your sleep on a daily basis.
Treatment options include medication, behavioural treatments
(such as stress management and relaxation strategies) or
a combination of these approaches. It is important that
you discuss your concerns regarding your sleep patterns
with your treating MO or a psychologist in order to confirm
whether you have a sleep disorder and, if so, the type of
treatment approach best suited to addressing the problem.
Do you have a sleep problem?
Everyone experiences sleep disturbances occasionally for
example due to specific and upsetting incidents (i.e., spouse
leaving, parent dying, bills piling up). These types of
events can cause a temporary disruption to your general
well-being and your good quality sleep in particular.
If sleep problems persist for a month or more you may need
to consider whether you have a sleep disorder. If the problems
persist after trying the suggestions listed below, start
keeping a sleep diary and evaluating your sleep habits.
Discuss this information with your MO.
Waking in the middle of the night, waking too early in
the morning, not being able to get back to sleep, and waking
feeling unrefreshed, can be indicators of a sleep disorder.
But even if the problem is temporary you should evaluate
those factors that may be affecting you. Poor quality sleep
is a concern no matter its cause or duration.
Epworth Sleepiness Scale
How likely are you to fall asleep
in the following situations? Choose the most appropriate number for each situation:
0 = would never doze
1 = slight chance of dozing
2 = moderate chance of dozing
3 = high chance of dozing
A score of 10 or above indicates you
may be having a problem with daytime sleepiness but
below 10 does not necessarily mean that you don’t have
a problem. Please see your healthcare professional for
advice if you snore, have been told that you awake gasping
for breath or if you are sleepy during the day.
10 ways to improve your sleep that you can start today!
Manage your stress. Learn to relax. Effective
stress management strategies include imagery, deep breathing,
progressive muscular relaxation, and relaxation exercises.
It is important to practice and master these exercises
before you intend to start using them at bedtime so
you do not have to concentrate too hard on what you
are doing. These exercises will not take away your worries,
but they should help to relax you sufficiently that
you can fall asleep and be more refreshed in the morning
and be better equipped to cope with your concerns.
Dim the lights. Sleeping in near or total darkness
if possible is recognised as most conducive to good
sleep patterns. Nightlights are typically about 15 watts
and offer just enough light to be able to see but are
not bright enough to affect sleep. Use heavy curtains
to block street light illumination.
Set the mood. Ensure the sleeping environment
is comfortable and relaxing. A good quality mattress
and pillow with comfortable bedding will go a long way
towards helping you get a good night’s sleep. Keep the
room temperature around 18 degrees Celsius wherever
possible. Remove clutter (use screens to hide computer
or exercise equipment from sight). Air quality can be
significant if you are prone to breathing problems.
A commercially available air filter can assist in removing
irritants and pollutants from the air and reducing nighttime
coughing or breathing difficulties.
Develop a bedtime routine. Create rituals that
help you to wind down from the day’s activities and
prepare yourself physically and mentally for sleep.
Incorporate some activities that are relaxing for you,
like soaking in a bath, spending quiet time with the
family. Your brain needs at least 30 minutes to wind
down enough to begin to be receptive to the idea of
sleep. Turn off the TV and stop doing anything (e.g.,
dishes, folding the washing, paperwork) that stimulates
your brain about 30 to 60 minutes before you anticipate
going to bed. Reading before bed is fine if you find
it relaxing rather than stimulating.
Eat right at the right time. Eating a large
meal close to bed time stimulates the digestive system
when it should be "shutting down" for the
day. Also, lying down is not the best position for digestion
to work effectively. As a rule of thumb try to leave
at least 2 hours between your evening meal and going
to bed.
Caffeine. Caffeine tea, coffee, soft drink,
diet pills, chocolate, some over-the-counter medications.
Consuming 300 milligrams of caffeine (equivalent of
3 cups of strong coffee or 6 cola drinks) during the
day causes disruption to your sleep patterns. Also,
caffeine sensitivity increases with age. Suggest you
restrict caffeine intake to mainly morning hours or
at least 3 or more hours before bedtime. If you decide
that you need to reduce your caffeine intake cut back
slowly over 2 weeks to give your brain time to adjust.
Nicotine. Although many people report a relaxation
effect first, the stimulation effect follows closely
behind. Nicotine also raises blood pressure, speeds
up heartbeat, stimulates brain wave activity, and affects
breathing. To reduce the chance that nicotine affects
your sleep, try to have your last cigarette of the day
progressively further from bedtime until your last is
4 to 6 hours before your anticipated bedtime. For further
information on ways to avoid a cigarette even when you
are desperate www.quitnow.info.au or phone the Quitline 131 848.
Napping. Some experts suggest napping is like
snacking before dinner – you risk spoiling a good meal.
But others claim the important thing with napping is
the timing. If you nap in the early afternoon, say between
2pm and 4pm when your metabolism has a natural dip,
there is less risk of it affecting sleep later that
night. The best naps last between 20mins to 1 hour;
longer than that and you tend to wake feeling groggy
and unrefreshed.
Establish a sleep schedule. Make sleep a priority
and establish a daily schedule that allows sufficient
time for you to get adequate sleep. Work out how much
sleep you need (for most people this is between 6-8
hours per night of good quality sleep) and ensure you
go to bed at the same time every night and wake at the
same time every morning. When this is not possible,
focus more on maintaining the morning wake time while
keeping the evening curfew as often as possible. Set
the alarm and get up at the same time each day, regardless
of how much sleep you had the night before.
If you cant get to sleep. Sometimes you may
find that you are not able to fall asleep easily. Don’t
continue to lie there trying hard to get to sleep. If
after 15 minutes you still feel fully awake, get up
and do something boring (but do not watch TV as this
may have the counter effect of stimulating your brain
further). When you feel sleepy, go back to bed. Repeat
this process as often as necessary throughout the night.
When should you be concerned?
When you have tried all the suggestions listed above with
no significant improvement in your sleep quality consider
the possibility that you may have a sleep disorder. If sleepiness
persists over one month or more start keeping a sleep diary,
evaluate your sleep habits and visit your MO.
Keeping a sleep diary
This is a process that allows you to evaluate your sleeping
habits and provides a sound basis for your MO to begin the
diagnostic process.
You will need to keep the diary for between 2 and 4 weeks.
It is a daily record of:
What time you went to bed and woke up
What you had to eat and/or drink before bed
How long it took you to go to sleep
Any awakenings during the night and whether you were
able to quickly go back to sleep
Caffeine consumption since noon
Medications you take
Other factors that may have disturbed your sleep (stress,
snoring, hot room and so forth)
Naps
Levels of sleepiness
Personal assessment of the quality of sleep
Exercise periods during the day
The diary should be completed when you get up in the morning.
If you forget, do not fill it in later in the day because
your recollection may not be as accurate. Clearly, with
some of these items you will need the help of a partner
who can verify, for instance, how long it took you to fall
asleep. But even if you are not in a position to obtain
that information, keeping this kind of record can prove
extremely useful as the starting point to assessing your
sleep patterns and habits.
Where to go for help with a suspected sleep problem
If you are concerned about the quality and/or quantity
of your sleep it is important to talk with either your treating
MO or you may seek assistance from a psychologist for assistance
with relaxation techniques and behavioural strategies designed
to improve the quality of your sleep.
8 signs that your partner has a sleep problem
Sometimes the person with a sleep disorder is not the only
one affected! Listed below are 10 signs that might indicate
a sleep disorder. These are not the only symptoms that might
be evident and it is important that if you are concerned
about your partner’s sleeping patterns you discuss this
with him or her. If they have tried all the suggestions
listed here to promote healthy sleep and feel no significant
relief from their symptoms it is wise to encourage your
partner to discuss the matter further with their treating
MO or a psychologist.
Excessive daytime sleepiness. Sleepiness refers
to a desire to lie down and sleep and is different from
tiredness which is more about a lack of energy. Fatigue,
on the other hand, is feeling abnormally tired early
into an activity. These terms are not interchangeable
and can be important distinctions when exploring the
nature of a sleep disorder, although, of course, it
is possible that a person can feel tired, fatigued and
sleepy at the same time. Excessive daytime sleepiness
(narcolepsy) is diagnosed when people fall asleep
describe an irresistible need to fall asleep during
the day. The symptoms can fluctuate over time and the
sleepiness feeling need not persist continuously throughout
the day. Treatment options range from adapting their
routine to include regular naps throughout the day,
to behavioural treatments and/or medications.
snoring really loudly or seems to stop breathing
several times during the night. Snoring on its own
(i.e., without periods where breathing seems to stop)
is primarily a social problem and experts do not believe
it causes ill-health in the short or long-term. The
most commonly effective treatment is to lose weight,
eliminate alcohol consumption in the three hours immediately
prior to going to bed, and ensuring the nasal passages
are unobstructed. Other options involve utilising a
mouthguard or surgery. Stopping breathing is only considered
harmful if it occurs more than five times in one hour.
At this stage it is called obstructive sleep apnoea (OSA) or sleep apnoea. The effect of sleep apnoea
is to reduce the amount of oxygen in the blood, which
subsequently triggers the body to wake up. Sometimes
the person wakes completely, but often the effect is
a lightening of their sleep, causing them to become
restless and to wake feeling unrefreshed and lethargic.
It is important that you talk to your treating MO if
you believe you may be suffering from sleep apnoea.
It is a condition well-known to medical practitioners
and a range of treatment options are available to assist.
sleep walking. This can also be associated with sleep talking. The person is difficult to wake
and, once woken, is disoriented and groggy, having no
recollection of their actions. Usually, sleep walking
is a childhood disorder that tends to desist by adolescence.
When sleep walking starts in adulthood it is
necessary to explore it further. While physical tiredness
and sleep deprivation can trigger sleep walking episodes,
it may also be associated with a form of epilepsy, and
should be discussed with your treating MO
grinding their teeth while asleep. Teeth grinding
is a common problem that may be a persistent complaint
or an occasional event, occurring only during periods
of stress. It is often diagnosed by a dentist who notices
damage to the teeth caused by the grinding action. Treatment
is not needed for occasional episodes. However, if the
complaint is more frequent dental treatment may be required
and strategies designed to reduce stress or anxiety
can be useful.
restlessly moving their limbs regularly and repetitively
all night. The cause of restless limbs is
not known. Sleep starts (feeling of falling or imbalance,
sudden jerking movements) are common and appear harmless.
If they are causing distress avoiding emotional distress
and excess coffee and tea during the day is likely to
reduce their frequency. Restless legs and limb movement are both relatively common conditions. Restless leg
suffers complain of discomfort in the legs which is
sometimes associated with a cramping or pins and needles
sensation. Limb movement sufferers experience brief
jerks of the legs or arms which occur during sleep.
The severity of these disorders ranges from being an
inconvenience to quite debilitating. Symptoms may be
alleviated by correcting any iron deficiencies identified
and avoiding excess caffeine and certain medications.
For very severe conditions medication can be useful
and it is therefore important to discuss this issue
with your treating MO.
more cranky and irritable than usual over a longer
time period. Sleep deprived people tend to be cranky
and have short fuses. This can have a significant effect
on their relationships with others both at home and
at work.
poor judgement and memory lapses more than usual. Sleep deprivation often affects people’s memory and
concentration. The individual is not able to respond
as quickly or think as clearly as they usually might.
This can have a negative affect on the performance both
at home and on the job.
recurrent night terrors (more than bad dreams).Sleep terrors are different from nightmares.
Sleep terrors come on suddenly. The person may sit up
in bed often screaming or vocalising. They might fight
if someone tries to comfort them. The person usually
settles spontaneously. Sleep terrors are more common
with younger children, and onset in adolescence or adulthood
may be associated with a psychiatric illness. Treatment
is not usually required. Nightmares are frightening
dreams that occur during REM sleep and cause anxiety.
They can start at any age. Treatment may be needed if
they are frequent.
Sleep and Children
We all expect to experience sleep deprivation when caring
for a newborn baby. But how long should that go on for?
In the first 12 months of life children need to learn to
sleep. If your child is 4 or 5 years old and still not sleeping
through the night - is that normal? The simple answer is
that many children experience sleep disorders and many more
have developed poor sleep habits that keep them from sleeping
through the night. The end result is the child is fractious
and cranky during the day and you as a parent end up feeling
exhausted and frazzled. Consistency in parents behaviour
at children’s bedtime is one of the most important keys
to developing good sleep habits in children and there are
many excellent resources available to parents as paediatricians
are recognising the extent of this problem. Most books on
sleep disorders contain a section on children and sleep
and a search of the web will produce a multitude of hits,
many of which will contain relevant information. One site
which, at the time of writing, offers practical and clear
guidelines for parents is http://www.betterhealth.vic.gov.au for information on sleep and babies, children and adolescents.
Naturally, if you have tried several of the strategies recommended
in these type of texts and still feel your child is experiencing
sleep problems, consult your general practitioner.
Resources for commanders:
Because sleep is so important to overall well-being and
effective functioning, commanders may have a particular
interest in managing the level of fatigue experienced by
defence personnel, particularly during intensive and prolonged
operations. Below is a resource developed specifically for
the military context providing information and guidelines
to commanders for the practical management of fatigue and
tiredness in troops. Further information is available from
the local mental health team or medical practitioners.
What is good quality sleep?
