1. The Basics Of Sleep
Essential to our performance, safety and health as well as the quality of our lives

2. What You Will Learn: Importance and Benefits of Sleep
States and Stages of the Sleep Cycle
Sleep Needs, Patterns and Characteristics for All Ages
Sleep Deprivation and Its Consequences
Prevalence, Symptoms and Risks Associated with Major Sleep Problems/Disorders
Healthy Sleep Tips

3. Why is Sleep Important?
Key to our health, performance, safety and quality of life
As essential a component as good nutrition and exercise to optimal health
As necessary as the water we drink, the air we breathe and the food we eat to function and live at our best.
Sleep is a biological requirement. All animals sleep. It is the….
Key to our health, productivity, safety and quality of life
It is an active process that energizes and restores your brain and body, making it as…
Essential and valuable as good nutrition and exercise
Getting enough uninterrupted and restorative - or quality sleep - for 7-9 hours throughout the night prepares you for the daytime – the other 2/3’s of your life. Sleep gives you the potential to thrive and makes it possible to live a full life. It becomes….
Essential to your ability to perform both cognitive and physical tasks at your peak, engage fully in life and function in an effective, safe and productive way
Materials
Let Sleep Work for You brochure

4. Sleep is regulated by two body systems:
Sleep/Wake Restorative Process Balances Sleep and Wakefulness
Circadian Biological Clock Regulates Timing of Sleep and Wakefulness
Sleep is regulated by two biological systems, the…
Sleep/Wake Restorative Process, which tells us, after a period of being awake, that a need for sleep is accumulating and it is time to sleep. It also helps us maintain enough sleep throughout the night to make-up for the hours of wakefulness.
The other key process to our understanding of sleep is the..
Intrinsic Circadian Biological Clock, that regulates and balances when we feel sleepy and when we are alert over a 24-hour time period. The circadian rhythm dips and rises. During this time, it dips during two periods when we experience our strongest sleep drive: between 2:00 and 4:00 am, and then again, in the afternoon between 1:00 and 3:00 pm when you may feel like taking a nap. Keeping a sleep-wake schedule that is in sync with these natural rhythms helps promote healthy sleep.

5. Circadian Biological Clock
The internal mechanism that regulates when we feel sleepy and when we feel alert
Resides in the brain and is affected by light and dark
Retino-hypothalamic
tract
The Circadian Biological Clock that regulates our 24-hour sleep-wake cycle resides in and is controlled by a group of cells in our hypothalamus called the Suprachiasmatic Nucleus or SCN.
From the optic nerve of the eye, light travels to the SCN, signaling the clock that it is light and daytime. When it is dark, we are driven to sleep and when it is light, we are alert.
This clock knows “what time it is” by being synchronized with the eye’s exposure to light. The clock is like an orchestra conductor controlling the timing of body temperature and the secretion of several hormones.
Suprachiasmatic
nuclei
Hypothalamus

6. The Sleep Cycle
Alternating states and stages of sleep that occur over an 8-hour time period:
NREM: Non-Rapid Eye Movement; Stages 1-4; 75% of the night
REM: Rapid Eye Movement; Dreams occur; 25% of the night
During sleep, we experience two alternating types or states of sleep over an 8-hour time period: NREM sleep and REM sleep. The cycle repeats itself every 90 minutes. This slide shows you our sleep architecture.
NREM or Non-Rapid Eye Movement includes 4 stages of sleep. As we shut our eyes for sleep, we first enter light sleep or Stage 1, the link between being awake and falling asleep.
Stage 2 marks the actual onset of sleep when you become disengaged from the environment, breathing and heart rate are regular and body temperature continues to go down. We spend about ½ of our sleep cycle in the first two stages.
Stage 3 and 4 are the deepest states of sleep when we experience the most restorative sleep, so essential to functioning. Muscles are completely relaxed, blood pressure drops and breathing is slower. During these deep stages of sleep, blood supply to the muscles is increased, energy is restored, tissue growth and repair occur and important hormones are released for growth and development.
REM or Rapid-Eye Movement sleep occurs increasingly over the later part of the night and is also necessary for providing energy to our brains and body. During REM sleep, our brains are active and dreaming occurs. As we enter REM sleep, our bodies actually become immobile, muscles shut down, and again, we are relaxed. Breathing and heart rate may become irregular. During this stage of active brain activity, the eyes dart back and forth under the eyelids - giving REM sleep its name. Because getting enough REM sleep may contribute to memory consolidation, it is especially important following a learning experience. REM sleep typically comprises about ¼ of our night.

7. During the Sleep Cycle
Brain waves represent different stages of sleep.
NREM Stages of Sleep
REM Sleep
During a sleep study, electrodes are attached to the head to measure our brain waves at different stages of sleep. This study is called an electroencephelogram or EEG. It measures the brain’s activity by observing brain waves that appear in amplitude, or height, and frequency.
During Stage 1, we see theta, or short, frequent waves, which get higher as we progress through the sleep cycle. During Stage 2, an EEG will reveal more theta waves with a mix of high wave bursts of energy, which are called sleep spindles. As sleep becomes deeper at Stage 3 and 4 and we become more difficult to arouse, more delta or high amplitude, slow-wave sleep appears.

8. During the Sleep Cycle (cont.)
Body temperature lowers
Hormone levels rise and fall
Changes in body temperature occur in accordance with the circadian clock and the sleep cycle. At night, before bedtime, the body’s temperature drops, making sleeping in a cool room conducive to sleep. Sleep accelerates this drop and temperature changes can actually disrupt sleep.
It is also important to allow enough time between exercise and bedtime to allow the body to cool down. The body cools down after taking a warm bath, which in itself can be relaxing and help ease the transition into sleep.
During the sleep cycle, especially during the first part of the night when in deep sleep, critical hormones that are important to body functions and your health are released. These include:
Growth hormone, which is released during the deep stages of sleep in the earlier part of the night. It is essential for growth and development, particularly for young children, but also plays a role in muscle development and tissue repair. Sleeping long enough to allow secretion of growth hormone is important.
Cortisol is normally released when we are stressed. It is also released during sleep and increases over the night to promote alertness when it is time to wake up. Corisol levels peak around 6:00 am and dips to their lowest around bedtime.
In response to light and dark signals entering the brain, the pineal gland—located in the base of the brain—produces melatonin. As night approaches and it becomes darker, melatonin is released and may help to induce sleep. Animals also produce melatonin. In humans, its production tends to drop during puberty and is much lower in older people than children.
Getting a full night’s sleep provides enough time for all of these functions to occur and contribute to optimal health and performance. Thus, spending 1/3 of your life in sleep provides you with what you need to function during the other 2/3’s of your waking life.
Materials
Melatonin: The Facts brochure
Helping Yourself to a Good Night’s Sleep brochure

9. We need consolidated, restorative sleep for:
Functioning in a safe, efficient and effective way
Cognitive, social and physical performance
Emotional enhancement and relating well with others
Learning and memory consolidation
Prevention of health problems and optimal health
To benefit from the full restorative powers of sleep, it is important to get continuous, quality sleep. We need consolidated restorative sleep that is continuous quality sleep without disruptions. Without disturbances, we get enough sleep to allow us to fully experience all of the stages of sleep and reap its benefits during the day, that include:
Functioning in a safe, efficient and effective way
Our best cognitive, social and physical performance
Emotional enhancement and relating well to others
Learning well and memory consolidation
Prevention of health problems and optimal health

10. Sleep needs vary over the life cycle.
Newborns/Infants
0 - 2 months:
months:
hours
14-15 hours
Toddlers/Children
12 mo - 18 mo:
18 mo - 3 years:
3 - 5 years:
years:
13-15 hours
12-14 hours
11-13 hours
10-11 hours
Adolescents
On Average:
9.25 hours
Adults/Older Persons
7-9 hours
Over the life cycle, our sleep needs and the amount of hours required to sustain a quality lifestyle vary as we develop and age.
Infants or newborn babies (up to 2 months) need hours over a 24-hour cycle. Sleep is definitely a priority for new babies and they need a lot of sleep to grow and develop. Although sleep patterns will change, establishing a a regular schedule at this time and putting babies to bed early in the evening helps them get all the sleep they need.
From 2-18 months, the average baby requires hours of sleep. From 2-6 months, most sleep will occur at night; from 9-12 months, a baby will be taking 2 naps a day and by 18 months, only 1 nap. Naps are independent ofnighttime sleep and just as important.
Around 18 months and during the toddler or pre-school age, children need around hours of sleep. When children reach the age of 5 they need 10 hours at night. Most children give up a nap by the age of 5.
Recent research indicates that adolescents need about as much sleep as when they were younger, a minimum of 8 ½ hours to an average of 9 ¼ hours. Although teens are often involved in more activities that deprive them of sleep and experience a lot of daytime sleepiness, sleep is just as important to their development.
Adults perform best with 7-9 hours although most adults get betwee 4 and 10 hours of sleep. Allow yourself to sleep naturally and without waking to an alarm clock, then observe how you function during the day. You need enough sleep to perform optimally during the day.
Contrary to a common myth, older adults need just as much sleep as younger adults; however, they often have more medical or sleep problems, they often do not sleep as efficiently due to pain, discomfort or disruptions and may not experience as much deep sleep as they age.
Reference
Mindell J, Owens J. A clinical guide to pediatric sleep. Philadelphia, PA: Lippincott Williams & Wilkins, 2003.
Materials
Pediatric Sleep Guidelines Sleep Diary brochure
Children & Sleep sleep sheet Adolescent Sleep Needs and Patterns report
Children’s Sleep Diary Sleep & Aging brochure

11. Sleep patterns and characteristics change over the life cycle.
Newborns/Infants
More active in sleep; 50% REM; several periods of sleep; need naps
Toddlers
Sleep begins to resemble adult patterns
Children
Experience more deep sleep
Adolescents
Shift to later sleep-wake cycle; experience daytime sleepiness
Adults
Need regular sleep schedule to obtain sufficient, quality sleep
Older Adults
More likely to have medical problems; sleep disrupters & disorders; sleep less efficiently
There are clear differences in sleep patterns and characteristics throughout our lives.
Until the age of 6 weeks, the sleep of newborns occurs around the clock; each period lasting 30 minutes to 3 hours. Between 2-4 months, a regular sleep pattern develops.
Infants are generally more active in their sleep than adults. This activity occurs during REM sleep and takes up about 50% of the infants sleep time. They start the night in REM sleep when they are generally not quiet and may smile, whimper, squeak, or move their arms or legs during sleep. The other half of the time is quiet when they are in non-REM sleep. In NREM, they lie still and have regular breathing. At 6 months of age, they develop 4 stages of NREM. Cycles of NREM and REM last about 60 minutes each. The best time to establish good sleep habits and help children sleep through the night is 6 weeks-3 months
Although newborns experience several periods of sleep and need naps, by 3-6 months, longer periods of sleep occur at night. By the end of the first year, babies are taking 1-2 naps per day. It is best for them to nap in the same place and there should be no less than 4 hours between afternoon nap and bedtime.
The American Academy of Pediatrics recommends that babies should be placed on their backs while sleeping to decrease the risk of sudden infant death syndrome (SIDS). They also caution parents against using water beds, sofas, soft mattresses or soft materials as infant sleep surfaces.
Most toddlers sleep through the night. By 3-4 years of age, or as toddlers, the sleep of children starts to resemble that of adults. Overall, they go into the deeper stages of sleep earlier and they still have several periods of sleep as compared to adults who have one consolidated period of sleep.
At this age, children often go from a crib to a bed. It is important that they have learned to go to sleep on their own at bedtime so they are better able to all asleep on their own if they wake in the middle of the night. This is a good time to establish a regular bedtime routine.
When children learn healthy sleep habits and establish a positive association with sleep, they are less likely to experience difficulties sleeping and may have less behavioral problems. Many children, between the ages of 5-12, begin to have a number of sleep problems. A regular, relaxing sleep routine before bed that does not include TV watching or other alerting activities will help promote good sleep practices and may prevent nightmares, difficulty falling asleep and getting enough sleep as well as other sleep problems. Sleep is absolutely fundamental for school-age children, particularly as it contributes to their growth and development.
During adolescence, there is a shift to a delayed bed and wake time. Teens are often not naturally sleepy until around 11:00 pm or later, yet they often have to wake early to meet school starting times or other responsibilities. As they become more independent and experience peer pressure, a hectic schedule may leave them sleep deprived.
Older Persons experience changes in their sleep patterns and tend to sleep less efficiently. Although they may be in bed 8 hours, they may actually be sleeping only 80% of the time and may experience less deep sleep. There may be more disturbances to sleep such as medical conditions, sleep disorders, medications, pain or discomfort, and greater sensitivity to the environment. Older adults are more sensitive to external conditions including bedding, noise, light and temperature.
Materials
Children and Sleep sleep sheet
Sleep & Aging brochure

12. Americans are not getting sufficient, quality sleep.
39% of Americans are NOT getting the 7-9 hours recommended for optimal health
74% experience sleep problems that affect the quality of their sleep
Sleep deprivation is a common and prevalent problem among adults. In a recent NSF poll, 39% of American adults reported that they get less than the 7-9 hours of sleep generally recommended for optimal health and daytime functioning. Fifteen percent of the population get 6 hours or less. While the average amount of sleep during the work week is 7 hours, adults with children as well as those who work 50 hours a week or more get even less sleep.
Almost ¾ or 74% of adults experience some type of sleep problem or symptom of a sleep disorder a few nights a week or more.
References
National Sleep Foundation, Sleep in America poll, 2002.

13. Excessive daytime sleepiness is a serious consequence of sleep deprivation.
Daytime sleepiness affects all aspects of our lives.
37% of American adults experience daytime sleepiness that interferes with daily activities
Sleep deprivation results from an insufficient amount of sleep or poor sleep due to difficulty sleeping, disruptions and/or a sleep disorder. When you do not get enough quality sleep, you are unable to be as alert during waking hours and your quality of life suffers. A sizable portion—37%—of American adults report daytime sleepiness that interferes with their daily activities a few times per month; nearly 16% state that this happens at least a few days a week. Among those who are years of age, 44% report daytime sleepiness a few days a month.
Reference: National Sleep Foundation, Sleep in America, 2002.

14. Cognitive abilities and mood are affected by sleep deprivation.
Memory is impaired when sleep is not consolidated
Paying attention to and completing tasks is compromised
Mood is impaired
Over ½ of adults report that sleepiness makes it hard to concentrate, solve problems and make decisions at work
Recent studies indicate that memory is impaired unless at least 6, preferably 8 hours of consolidated sleep, is experienced close to the time of learning. Do not delay sleep: it appears that sleep “nails down” what is learned.
Paying attention to tasks and the ability to perform well, particularly after a period of time, becomes more difficult and safety may also be compromised when you are sleep deprived. It becomes increasingly hard to stay focused, complete a task, make decisions or think clearly. Children, in particular, become irritable, restless, moody and may lose control.
In a recent poll, those who slept less than 6 hours each night were more likely to report negative moods such as feeling tired, sad, stressed or angry whereas those who obtained more sleep were more optimistic and satisfied with life.
Over ½ of adults report that sleepiness makes it more difficult to concentrate, solve problems and make decisions at work. Some types of sleep disorders also put us at risk for anxiety and depression.
References
National Sleep Foundation, Sleep in America poll, 2002 (mood)
National Sleep Foundation, Sleep in America poll, 2000 (workplace)

15. Safety is compromised.
100,000 sleep-related crashes per year; 1,500 fatalities and 71,000 injuries
51% of adults report driving drowsy; 17% dozed off at the wheel
27% report being sleepy at work at least 2 days/week
19% of adults report making errors at work; 2% injured
One of the most serious consequences of sleep deprivation is driving drowsy – leading to injury, and possibly, death. Approximately 100,000 sleep-related crashes are reported each year, resulting in 1,500 fatalities. In a recent NSF poll, 51% of American adults reported driving drowsy in the last year and 17% stated that they had actually dozed off at the wheel. It is interesting to note that after hours without sleep, performance at the wheel is equal to being legally drunk.
Important fatigue signs to watch for while driving are difficulty remaining alert or keeping your eyes on the road, shifting to another lane, yawning repeatedly and daydreaming.
Productivity, performance, difficulty completing a task and making errors are all signs of sleep deprivation on the job. Over ¼ of American adults report feeling sleepy at work at least 2 days a week and 19% state that they have made errors due to sleepiness.
Fatigue on the job has been considered as a contributing factor to major disasters such as Three Mile Island, the Exxon Valdez spill and the Challenger Space Shuttle disaster.
References
National Highway Traffic Safety Administration
National Sleep Foundation, Sleep in America poll, 2002 (drowsy driving)
National Sleep Foundation, Sleep in America poll, 2000 (workplace)
Materials
Driving Drowsy sleep sheet

16. Health Consequences of Inadequate or Poor Sleep
Body systems associated with major diseases such as diabetes function less effectively.
Hormonal changes can accelerate the “paunch process” and lead to obesity.
Some recent significant studies show that sleep plays an important role in our health, particularly in regard to the hormones that are released when we get sufficient, uninterrupted, quality sleep.
When healthy, young people were deprived of sleep, they experienced early signs of aging, glucose intolerance and insulin resistance, which may be markers for the development of cardiovascular disease and diabetes. A study of adult men showed that, when sleep deprived, they secrete less growth hormone, which can “accelerate the paunch process” and lead to middle-age spread.
Some studies have even indicated a link with weight gain and obesity. The hormone, leptin, is secreted during sleep and makes us feel full. When we do not get enough sleep, leptin levels drop and we crave carbohydrates.
Many researchers believe that our immune system is strengthened during sleep, which helps you to repair tissue and fight infection. Perhaps, this is why sleepiness accompanies illness.
References
Spiegel, L et al. Impact of sleep debt on metabolic and endocrine function. Lancet, 354, , (diabetes)
Van Cauter, E , Leproult, R, Plat, L. Age-related changes in slow wave sleep and REM sleep and relationship with growth hormone and cortisol levels in healthy men. JAMA, 284 (7): (“paunch process”)

17. Common Circadian Disruptions
Shift Work
Jet Lag
We live in a 24/7 society with approximately 20 million shift workers. Shift work, defined as working evening, night, irregular or rotating shifts (working hours other than 9-5), puts us in conflict with our natural sleep pattern. Shift workers find it more difficult to stay alert during a night shift and often get less sleep during the day. Because the body never fully adjusts to shift work, not only do they get less sleep, they tend to not perform as well and have more sleep and medical problems.
This is also true for people who choose a 24/7 lifestyle – working or engaging in activities for long or irregular hours. Not allowing enough hours for sleep or sleeping at irregular times results in poor sleep or sleep deprivation – leaving them at the same risk as shift workers. Recent polls tell us that a significant number of American adults do not get the recommended 7-9 hours of sleep, that they are sleeping less than they did 5 years ago and 40% report that they are working more.
As many Americans travel across time zones for business or leisure, they also experience jet lag, which puts them in conflict with their natural sleep patterns. The shift in time and light cues on the brain forces the body to alter from its normal pattern and adjust to the new time zone. The more time zones traveled, the harder is the adjustment. In fact, it is estimated that the brain needs about 10 days to recover from a round trip through several time zones. Jet lag often leaves travelers feeling poorly and having more difficulty performing. A recent study of flight attendants who cross many time zones indicates that memory can become impaired as well.
References
Bureau of Labor Statistics. “Workers on Flexible and Shift Schedules in 2001.”
National Sleep Foundation. “Sleep in America Poll: 2001.”
Materials
Sleep Strategies for Shiftworkers brochure
Sleep and the Traveler II brochure
Working evening, night, irregular
or rotating shifts
Traveling across time zones disrupts sleep

18. Recognizing Sleep Problems and Disorders
Exercise
Complete the sleep assessment tool, How’s Your Sleep? This short checklist presents key questions to ask yourself and alert you to the possibility that you may have a sleep problem or disorder. The questions include symptoms of the major sleep problems including insomnia, sleep apnea and restless legs syndrome as well as sleep disruptions that may call for a change in lifestyle. Questions represent what a doctor might ask in the diagnosis of a sleep problem, and you are encouraged to be prepared to discuss your responses and these experiences with your doctor.
Materials
How’s Your Sleep assessment tool

19. Insomnia Inadequate or poor quality sleep: Difficulty falling asleep
Frequent awakenings during the night
Waking too early and can not go back to sleep
Unrefreshed or non-restorative sleep
Insomnia is very common sleep problem characterized by complaints of inadequate or poor quality sleep. In NSF’s 2002 Sleep in America poll, over ½ of the adult population reported having experienced symptoms of insomnia a few nights a week or more within the last two weeks. These symptoms include difficulty falling asleep – especially if it takes you 30 minutes or longer, frequent awakenings during the night, waking too early and unable to fall back to sleep and/or waking feeling unrefreshed or still groggy in the morning.

20. Prevalence of Insomnia
Approximately 40% of American adults experience occasional insomnia; 10-15% on a chronic basis
Those most at risk:
Women
Older Adults
Depressed Persons
Insomnia can be experienced over time in response to a life change, for example, or unusual pressures, which cause stress or worry. At least 40% of American adults struggle with occasional insomnia whereas 10-15% have reported chronic stress, which occurs at least 3 nights a week for a month or longer.
Those most at risk include women, sometimes because biological changes such as menstrual periods, pregnancy or menopause may contribute to bouts of insomnia. Older adults report disruptions to their sleep due to medical conditions, sleep disorders or discomfort. They are also more sensitive to environmental stimuli. Likewise, those who are depressed are more likely to experience insomnia.
References
National Sleep Foundation. “Treating Insomnia in the Primary Care Setting” monograph, 2000.
National Center on Sleep Disorders Research, National Heart, Lung and Blood Institute, National Institute of Health. “Insomnia: Assessment and Management in Primary Care,” 1998.

21. Causes and Types of Insomnia
Duration
Change: acute illness; jet lag, emotional stress
Stress: loss of loved one or job
Acute
Transient: few nights a week
Short Term: 1 – 2 weeks
Variety of physical, medical, psychiatric or environmental conditions
Chronic
> 1 month (at least 3 nights a week)
Not associated with underlying or known cause.
Primary
> 1 month
Chronic stress, hyperarousal, or behavioral conditioning may contribute.
There are many causes of insomnia and doctors first look for these underlying issues and conditions when treating this problem. How long someone experiences insomnia will indicate if it is acute or short-term, lasting for 1-2 weeks or chronic, experienced for a month or longer.
Most acute insomnia can be attributed to a recent change or loss (e.g. death, divorce, job), which may be very stressful. Feeling stressed, anxious, depressed or when you are consumed with thinking about something can make it difficult to sleep.
When insomnia is chronic, it is essential to get a medical diagnosis and treatment.
Addressing the cause of the insomnia is the first line of action. Often, this will resolve the problem. In the course of acute insomnia, some people may become anxious about sleep and adopt poor sleep habits that lead to long-term insomnia. Seeking assistance from a professional with expertise in behavioral therapy can be very helpful.
In some cases, the underlying cause cannot be identified and the insomnia continues indefinitely. This situation may require referral to a sleep specialist and an overnight sleep study for a more in-depth assessment and comprehensive treatment.

22. Treatment of Insomnia Pharmacological Treatment Behavioral Management
Over-the-Counter (OTC’s)
Prescription Medications
Behavioral Management
Stimulus Response
Sleep Restriction
Cognitive Behavioral Therapy
Relaxation Training
Treatment of insomnia may include both pharmacological treatment and behavioral management as well as addressing the underlying cause. It is important to work with a doctor or sleep specialist to develop a plan that best meets the individual needs of the person with insomnia.
Over-the-counter medications, or those bought in a health-related store without a prescription, are often antihistamines prescribed for allergies that have sedating effects. Some of these medications may even cause insomnia. In general, OTCs have not been tested as rigorously for safety and effectiveness as prescription medications. This is also true for some herbal products and nutritional supplements, such as valerian and melatonin, which have not been solidly recommended by sleep specialists.
The most effective prescription medications available for insomnia are hypnotics, which are often used for acute or occasional insomnia and may be helpful for some for long-term use. Hypnotics have been tested and approved, and they are safe and effective for treating insomnia.
Insomnia is often treated with prescription medications in conjunction with behavioral management, which is particularly effective for resolving long-term insomnia. Along with education about good sleep habits, the best approach is developed with a health practitioner who has specialized training.
Stimulus response therapy trains people to associate and use their bed for sleep and sex only. If you are unable to sleep after 15 minutes, you are encouraged to leave the room and engage in a relaxing activity until you are sleepy enough to return to bed and sleep. With this approach, napping is discouraged.
Sleep restriction therapy also involves limiting your time in bed. A sleep diary is maintained and a special schedule is developed until you are able to sleep efficiently and follow a routine of normal sleep.
Cognitive behavioral therapy, also conducted with a specialist, helps the person with insomnia develop more positive, healthy attitudes and beliefs about sleep.
One of the more common techniques for helping people with insomnia is relaxation training. People learn to relax and reduce tension and stress through muscle relaxation exercises, proper breathing and focused thinking.
Materials
Sleep Aids: Everything You Wanted to Know..But Were Too Tired to Ask brochure

23. Snoring
Partial blockage of airway causing abnormal breathing and sleep disruptions
90 million; 37 million experience on a regular basis
Males, those who are overweight and with large neck size most at risk
Loud snoring can be a symptom of sleep apnea and can be associated with high blood pressure.
Snoring is a breathing noise that occurs during sleep and can be very disruptive to you or your bed partner. While breathing in, the air passage between the upper soft palate and the throat or base of the tongue opens and closes. As muscles relax, there is a partial obstruction to the air passage as noted in the red area, causing the tissues to vibrate and make the snoring noise.
This abnormal breathing that causes sleep disruptions affects approximately 90 million American adults; 37 million on a regular basis. Persons most at risk are males and those who are overweight. It often increases with age.
Loud snoring is particularly serious as it can be a symptom of sleep apnea and can be associated with high blood pressure and other health problems.
References
Kryger, Meir, et al. “Snoring: Causes and Treatments,” 1998: American Sleep Apnea Association.

24. Sleep Apnea
Pauses in breathing due to obstruction in airway that causes gasps and arousals during sleep
18 million; mostly males, those who are overweight and/or have high blood pressure and persons with upper airway physical abnormality
Lowers blood-oxygen levels, puts a strain on the heart and is associated with cardiovascular problems and daytime sleepiness
Sleep apnea can be a serious sleep disorder. The airway becomes blocked during sleep causing breathing to pause or stop. As a result, oxygen levels drop and the brain is alerted to wake up the body. These “apneic events” cause gasps and arousals so that breathing can resume. They may last seconds and occur as often as or more times per hour, and are usually accompanied by snoring
As many as 18 million Americans suffer from sleep apnea. It is more common among men, those who snore, are overweight, have high blood pressure or physical abnormalities in their upper airways. Sleep apnea requires treatment, particularly as it lowers blood-oxygen levels, puts a strain on the heart and has been associated with high blood pressure, stroke, headaches, depression and daytime sleepiness.
References
Young T, Evans L, Finn L, Palta M. Estimation of the clinically diagnosed proportion of sleep apnea syndrome in middle-aged men and women. Sleep; 20 (9):
National Heart, Lung and Blood Institute, National Institute of Health. “Facts about Sleep Apnea,”  
Materials
Sleep Apnea brochure

25. Treatment of Sleep Apnea
Behavioral Therapy
Avoid alcohol, nicotine and sleep medications
Lose weight if overweight
Physical or Mechanical Treatment
CPAP (Continuous Positive Airway Pressure)
Dental appliance
Surgery
Following a diagnosis of sleep apnea and depending on the severity of the condition, treatment will be tailored to the individual patient. In all cases, the patient should avoid sleep promoting medications and alcohol. In less severe cases and as appropriate, the use of alcohol and nicotine should be avoided. Also, just losing weight or sleeping on one’s side may minimize apneic events.
The most common treatment for apnea is the continuous positive airway pressure device or mask that is worn over the nose during sleep and pushes a prescribed amount of air through the nasal passage to prevent obstruction and collapse of the airway. Dental appliances can be prescribed that reposition the jaw and tongue so that persons who snore or have mild apnea can breath freely.
Several surgical procedures are available to open the airway, but they are not always successful. In general, they remove or reduce excess tissue and other airway structures or correct structural deformities.

26. Restless Legs Syndrome
Unpleasant, tingling, creeping feelings or nervousness in legs during inactivity and sleep with an irresistible urge to move; 80% may have involuntary jerking of limbs
12 million persons; can be genetic
A neurological movement disorder leading to daytime sleepiness; can be associated with other medical conditions/problems
Over 12 million persons in this country experience unpleasant, tingling, creeping feelings in their legs during sleep or inactivity as a symptom of a disorder called restless legs syndrome. This neurological movement disorder causes an uncontrollable urge to move to relieve the sensations in the legs. As a result, sleep is either disrupted and people sleep poorly, become sleep-deprived and experience daytime sleepiness. About 80% may also experience involuntary jerking of the arms or legs. Some forms may be genetic or associated with other medical conditions including iron deficiency. Symptoms may be mild to severe, and treatment is available.
References:
National Institutes of Health, NHLBI, NCSDR, Restless Legs Syndrome-Detection and Management in Primary Care. No March 2000.
Restless Legs Syndrome Foundation, Living with Restless Legs
References
National Center on Sleep Disorders. “Restless Legs Syndrome: Detection and Management in Primary Care,” 2000.
National Center on Sleep Disorders. “2003 National Sleep Disorders Research Plan.”
Materials
Restless Legs Syndrome sleep sheet

27. Narcolepsy
Involuntary excessive daytime sleepiness; may include sudden loss of muscle tone in response to strong emotion, hallucinations and sleep paralysis
,000 or 1/2000 persons; often diagnosed in 2nd decade of life
Chronic neurological and disabling disorder that impairs ability to engage in daily activities; can lead to injuries if not treated
People with narcolepsy have involuntary excessive daytime sleepiness while engaged in daily activities and when it is not expected. They have sleep attacks even when they have gotten enough sleep the previous night. About 60-80% of people with narcolepsy also experience cataplexy when they suddenly lose muscle tone and may just feel weak or actually collapse in response to a strong emotion such as laughter, fear or anger. Other symptoms may include hallucinations or vivid or scary dreams upon falling asleep or sleep paralysis, an inability to move when falling asleep or waking up.
About ,000 or 1/2000 persons have been diagnosed with narcolepsy in this country, the first signs usually appearing in the teen or early adult years. However, often narcolepsy is not diagnosed for up to 15 years after onset of symptoms.
Narcolepsy is a serious chronic neurological and disabling disorder that can significantly impair one’s life and could possibly lead to injury.
References
Siegel, J. “Narcolepsy.” Scientific American: January 2000
Guilleminault, C, Anagnos, A. “Narcolepsy,” Principles and Practice of Sleep Medicine , Third Edition, W.B. Saunders Company. Philadelphia, PA
National Heart, Lung and Blood Institute. “Facts About Narcolepsy,” 1996.
Materials
Living with Narcolepsy brochure
An overview of the diagnosis and treatment of narcolepsy for primary care physicians. Sleep Medicine Alert, Volume 7, Number 1, Winter 2003.
Narcolepsy: A Guide for Understanding, Diagnosing and Treating Narcolepsy. CD Rom

28. A Word about Napping When is a nap helpful? What time of day is best?
How long should a nap last?
What are the real benefits?
It is always best to get 7-9 hours of consolidated sleep. But, when you do not get enough sleep or have difficulty sleeping, a nap can be helpful to relieve daytime sleepiness. Naps become particularly important if you are going to drive for long distances or to get extra sleep before traveling into another time zone.
Naps should be taken in the late morning or early afternoon – not too close to bedtime or they will interfere with your ability to get a good night’s sleep.
It is best to nap for minutes and no longer than 45 minutes or you will get into deep sleep and wake-up feeling groggy.
Naps – strategically scheduled and timed - can be beneficial for increasing alertness, enhancing performance and improving mood.

29. Sleep problems/disorders can be serious.
Symptoms and experiences of sleep problems should be discussed with a doctor.
Snoring, sleep apnea, restless legs syndrome and narcolepsy are all treatable.
Inability or unwillingness to get sufficient, quality sleep due to a sleep disorder is a serious problem that should be discussed with a doctor - particularly as poor sleep is associated with health problems. Together with a doctor, the person with a sleep problem can determine the best treatment or course of action, which may include referral to a sleep specialist.
There are over 80 sleep disorders. The most common problems are snoring, sleep apnea, restless legs syndrome and narcolepsy, which are all treatable. A sleep specialist is a doctor who has completed special training in sleep medicine. These specialists and technologists are trained to administer sleep tests at sleep centers, which are located across the country. They have the training and equipment to conduct overnight sleep studies and can most effectively diagnose and treat sleep disorders.
Materials
Sleep Talk with your Doctor sleep sheet

30. Seeking medical help at a sleep center
When difficulty sleeping continues, you do not get enough sleep or you experience excessive daytime sleepiness on a regular basis, it is time to seek professional medical help at a sleep center for an overnight sleep study. Staffed by professionals who have special training in sleep medicine, these specialists can diagnose and treat a variety of sleep disorders.
A sleep center offers a quiet, home-like environment with separate sleep rooms. Each room is equipped with video monitoring and computerized diagnostic instruments to observe, monitor and record your sleep.

31. Diagnosing and Treating Sleep Disorders
Diagnosis:
Polysomonography measures brain waves, heart rate, body movements and breathing in an overnight sleep study
MSLT (Multiple Sleep Latency Test) measures daytime sleepiness
Treatment:
Behavioral Therapy
Medications
Devices or Appliances
Surgery
In addition to using a medical history and physical examination, several tests are available for diagnosing sleep problems. Two major tests that may be used are polysomonography and the multiple sleep latency test. In an overnight sleep study, electrodes are attached to the patient’s head to record brain activity. Heart rate, oxygen levels and breathing are monitored over the sleep period.
During the day the MSLT or multiple sleep latency test offers an opportunity, over several time periods, to take a nap and measures daytime sleepiness by recording the length of time (latency) it takes to fall asleep.
Different types of treatment options are available for sleep problems and disorders that may include the practice of good sleep hygiene habits or behavioral therapy. For some sleep problems, medications are available whereas special breathing devices or dental appliances might be appropriate for disorders such as sleep apnea.

32. Sleep Tips to Promote Sleep and a Healthy Lifestyle
Establish a regular sleep schedule.
During the day:
Avoid caffeine, alcohol and nicotine
Exercise, but not too close to bedtime
Avoid naps
Establish a regular sleep schedule: going to bed and waking at the same time every day
Creating a lifestyle that includes establishing a regular sleep schedule is a key step toward getting a good night’s sleep. This will allow you to get in sync with your natural circadian clock and sleep will come easier. A regular schedule keeps our brain and body in balance. This is just as important for the weekend. Keeping to this schedule at all times will improve your ability to fall asleep, maintain sleep and achieve restorative sleep - so essential to your quality of life.
Here are some tips for developing a healthy sleep style during the day:
Avoid caffeine, alcohol and nicotine, especially close to bedtime. Caffeine is a stimulant that has alerting properties, so consuming products like coffee, tea, cola and chocolate within 6 hours before bed can cause disruptions to your sleep
Nicotine is also a stimulant and may keep you from falling asleep. After it loses its effect and when you are sleeping, you may experience withdraw, which can again disrupt sleep or cause problems waking in the morning. Nicotine has been known to cause nightmares.
Alcohol helps to relax people and promotes sleep, but just like nicotine, can cause disrupted sleep during withdrawal.
Exercise, but not too close to bedtime. Overall, exercise helps to promote good sleep, but not too close to bedtime. During exercise our body temperature rises and we become more alert. After about 6 hours, the body cools down and helps to signal the body that it is time for sleep. Try exercising in the afternoon for best results.
Avoid naps, particularly in the late afternoon or evening.

33. Sleep Tips (cont.) Establish a regular bedtime routine.
About an hour before going to bed:
Engage in a relaxing, non-alerting activity
Do not drink or eat too much
Maintain a quiet, dark and preferably cool, but comfortable sleep environment
Establish a regular bedtime routine as a cue to your body that you are getting ready for sleep. Here are some tips to help promote sleep about an hour before going to bed:
To enhance this process, engage in a relaxing, non-alerting activity such as reading or listening to music. Soaking in warm water can be helpful. Avoid job-related work and household chores that are mentally or physically stimulating.
Do not drink or eat too much, especially a heavy meal. You do not want to feel hunger or discomfort because you are too full. Try a light snack, but avoid spicy foods that may cause heartburn. Also, restrict fluids to avoid nighttime awakenings to the bathroom
Create and maintain a maintain a sleep-promoting environment that is quiet, dark and preferably cool, but comfortable sleep room. Check your room for noise or other distractions, including a bed partner’s sleep disruptions or an environment that is too bright, too dry or humid or too hot or cold. Make sure your mattress is comfortable for you and your bed partner. This is so important for preventing disruptions that keep you from gaining the benefits of a consolidated good night of sleep.
Materials
Helping Yourself to a Good Night’s Sleep brochure
Sleep Tips sleep sheet

34. Keep a sleep diary to identify your sleep habits and patterns.
A sleep diary is a useful tool for recording your sleep habits and patterns. It is best to maintain a diary for at least 7 days to identify any problems or practices that may contribute to difficulties sleeping. After recording your hours of sleep, practices, patterns and disruptions, take your completed sleep diary to your doctor or health practitioners for a discussion about your sleep.
Materials
Sleep Diary brochure

35. Summary
Sleep is a basic biological need that is essential to our health, performance, safety and quality of life.
Sleep deprivation has serious negative consequences.
Establishing healthy sleep practices prevents sleep problems and promotes optimal sleep.
Signs and symptoms of sleep difficulties need to be identified and discussed with a doctor.

36. The National Sleep Foundation is an independent nonprofit organization dedicated to improving public health and safety by achieving public understanding of sleep and sleep disorders, and by supporting public education, sleep-related research and advocacy. Address: 1522 K Street, NW, Suite 500, Washington, DC Telephone: Web site: