Let’s Talk About Sleep

When my son was born, the first five months he was actually oversleeping. Soon, alarm bells began to go off as his sleeping increased over those months and he was experiencing some other concerning symptoms. In time, we faced many health challenges with him, culminating in an array of diagnoses  and eventually he was diagnosed with a very rare genetic syndrome, encompassing most of his health challenges.

Suddenly, at around six months, his sleep did a complete 180 degrees. Going from sleeping up to 20 hours in a day, to sleeping less than  four hours. And that was not 4 solid hours but only 3-4 hours of sleep combined in “naps” throughout the day. At the same time, he was diagnosed with Partial-Secondary Generalized Seizure Disorder (Epilepsy) which demonstrated to be refractory and intractable. In simple terms, he had seizures that started in one part of the brain, and quickly spread to the entire brain and involved his full body. Plus, he would also have smaller seizures. And, he was not responding to treatment, nor was there any biological reason for the seizures. We were having to stay awake when he was awake in case he had a seizure that was longer than 5 minutes, which was a weekly occurrence.

Sleep Challenges

So then, why do I share this? Well, he was not getting proper sleep, but neither were we! We were severely sleep deprived, and although we didn’t see it, the impact on our bodies was building up. By the time he was 3, I had had a series of seizures of my own, determined to be the result of stress and sleep deprivation. My husband, a few years later, had to go on medical leave as his body was ripe with the effects of sleep deprivation and stress.

(photo: He’d come home from daycare and fell asleep mid-walking to the fridge for a snack. When he slept he slept hard, but not long!)

Through Challenges, We Learned

Certainly, understand sleep, or lack of it. Because of our experience, we know from experience how important a good sleep is. Above all, sleep is not a luxury. It’s a biological necessity. In today’s world, there seems to be this celebrations of being overworked, overbooked and the so called “burning the candle at both ends”, as if neglecting self-care, and sleep is something that indicates self importance, and a successful life. Probably more concerning is that it seems todays youth are being groomed this way too.

To be honest, don’t come to us bragging about how busy you are, and exhausted you are, we won’t celebrate. We are all busy and have things in our lives that are beyond our control. This was certainly true for us and we learned the hard way that you can’t ignore it. We didn’t think we could change our circumstances. What we learned though was that we couldn’t change our son’s health but we HAD to address the impact on our family, and MAKE the changes.  If we could do it, so can most readers out there. I suggest you don’t wait until the impact of poor sleep grab hold before you do something about your sleep habits.

We’re not the norm

Certainly, our story isn’t the norm but I am also aware that as a whole, we are not getting adequate rest and the effects are adding up. It was for this reason I wanted to explore some basic information about sleep, the mechanics of sleep, and sleep problems to see what we could learn. The result – this blog!

So, What is Sleep?

Who doesn’t crave a good sleep?  Waking up from a restful sleep feeling refreshed and ready to take on the day can sometimes feel like the elusive holy grail, leaving us wondering if we ever actually slept like a baby. But what is sleep? Why do we need it? What actually happens?

Sleep Basics

Our sleep/wake cycle functions with our Circadian Rhythm, a 24 hour internal clock that runs on autopilot and affect our body temperature, sleep-cycle and hormones.

Our sleep/wake cycle functions within the Circadian Rhythm and is light-based where physical, mental and behavioural changes follow a daily schedule and is triggered by light. As the day-light increases or decreases our Circadian Rhythm triggers us to wake up or go to sleep.  As day turns into night, our sleep hormone, melatonin, is released trigger our sleep cycle.

To complicate matters, our Circadian Rhythm can be affected by:

  • Diet
  • Exercise
  • Hormones
  • Medications
  • Work/School
  • Lifestyle (stress, burning the candle at both ends)
  • Shift Work/ Night Shift
  • Jet Lag

Stages of Sleep

There are 4 stages of sleep and REM sleep.  In normale sleep, we pass through stage 1 through Rem Sleep and then cycle starts over with stage 1. Below is a chart summarizing these stages of sleep.

STAGECHARACTERISTICSNOTES
1Light sleepCan be woken easilySlow eye movement Muscles activity slows* see note belowMay have sudden muscle contractions (jumps, startled reactions) called hypnic myoclonia
2Eye movement stopsBrain waves slow with occasional bursts in rapid waves50% time spent here
3 Extremely slow brain wavesMay have some faster wavesDelta waves begin to appear*see note belowCombined with stage 4 is deep sleep
4Almost all delta wavesNo eye movementNo muscle activity *see note belowCombined with stage  is deep sleepIf woken – groggy and disoriented
REM (rapid eye movement)Breathing becomes rapid, irregular and shallowEye movements- jerk rapidly in various directionsLimb muscles become temporarily paralyzedHeart rate increase, bp rises20% time spent hereIf woken – often describe bizarre and illogical dreams
1st REM – about 70-90 min after we fall asleepLater in night- REM period increases while deep sleep decreasesBy morning – most of time spent in stages 1, 2 and REM
  • Remaining 30% in these stages – amount varies
  • Complete cycle 90-110 min. On average
  • First cycle- short REM with long deep sleep

How much Sleep do you need?

Needs vary throughout our lifespan.

Infants need 16 hours of sleep on average, while teenagers tend to need about 9 hours of sleep. As we age, our needs tend to change with senior needing about 6 hours on average.

It’s interesting to note that as teenagers, it is a normal part of the Circadian Rhythm to need to stay up, thus wake up later; and as seniors, we tend to need to go to bed earlier and awaken earlier. So if you’re a parent of a teenager, take comfort, they are not lazy!

Our need for sleep is also affected by:

  • Lifestyle
  • Shift work
  • Health issues/dx
  • Diet and exercise
  • Caffeine
  • Medications
  • Stress
  • Environment (lights, noise, etc)

For Adults, generally 7-8 hours in the norm, but some need as few as 5 hours up to as much as 10 hours. Women in their first trimester of pregnancy of need several hours more sleep then their norm.

However, don’t get stuck on the numbers. Sleep experts will tell you that generally if you feel rested in the morning and alert throughout the day, you are getting enough sleep.

Signs of Sleep Deprivation:

  1. Feel drowsy during the day
  2. Fall asleep with 5 minutes of lying down can indicate severe sleep deprivations and possibly a sleep disorder
  3. Microsleeps – brief episodes of sleep in an otherwise awake person, and you may not notice you are experiencing these – others around you may notice

There is no sleep bank – you can’t deprive yourself today and catch up on the weekend.

Why do we need sleep?

Science is still unclear about this. However, sleep is required for our nervous system to work properly.

Without adequate sleep, we are left unable to focus, feeling tired and coping skills diminish.  Our reaction times decrease, as well as our memory retention. It’s interesting to note that severe sleep deprivations has been linked to hallucination,and moods swings.

One theory supports that sleep gives our neurons used during the day a chance to replenish, and for our overall nervous system to have a “reboot”.

Sleep Diseases:

Insomnia – trouble falling and/or staying asleep

Sleep Apnea – is a potentially serious sleep disorder in which breathing repeatedly stops and starts.There are varying degrees of sleep apnea, with as many varied treatment options

Restless Legs Syndrome – uncomfortable sensation in legs with uncontrollable urge to move to relieve sensation

Narcolepsy- a condition characterized by an extreme tendency to fall asleep whenever in relaxing surroundings.

Are We Getting Enough Sleep?

In Canada, stats show that about ⅓ of adults are not meeting their sleep needs for optimal physical and mental health. It is reported that about 40% of Canadians are affected by sleep disorder. The Canadian Sleep Society states:

About 10% of the adult population in Canada experience persistent insomnia and an additional 20% to 25% reports occasional insomnia symptoms. Insomnia can be a problem in children, adolescents and adults. It is more common among women, older adults, shift workers, and people with medical or psychological problems.

Studies have shown that people who live with two or more chronic diseases or conditions (called comorbidity) are more likely to have sleep problems. The more chronic diseases or conditions, the greater the risk for sleep problems.  In facet, person with 3-6 conditions are twice as likely to report problems with sleep, while those with 7 or more conditions being three-times more likely to have sleep problems.

Effect of Lack of Sleep:

Poor quality and/or duration of sleep results in insufficient sleep. Studies have shown a wide range of negative health outcomes resulting from insufficient sleep. Sleep disturbance influence the risk of:

  • Infectious disease
  • Obesity
  • Type 2 diabetes
  • Cardiovascular disease
  • Cancer
  • Injuries
  • Depression
  • Irritability
  • Reduced well-being
  • Decreased cognitive functioning

What can you do to improve your sleep?

First, you need to be honest with yourself and ask how important is change?  What we want and what we are actually willing to do to reach our goals are two different things. Be non-judgmental with yourself. Assess your sleep needs, and determine if you’re getting enough rest. If not, you’ll need to take a look to see where there is room for improvement. In an ideal world, we could just snap our fingers, and all factors influencing our lifestyle and sleep would be fixed. In the real world, we have jobs, family, responsibilities etc. Some things we have no control over, others we do.  Only you can determine those and once you have, only you can decide if your want and are willing to do the things to help promote your health and sleep.

If you’re looking for a sleep hygiene routine, here is what the Canadian Sleep Society suggests:

  • table is copied from the Canadian Sleep Society website.

References:

https://css-scs.ca/resources/brochures/insomnia

https://doi.org/10.1146/annurev-psych-010213-115205

https://www.nigms.nih.gov/education/pages/factsheet_circadianrhythms.aspx

https://www150.statcan.gc.ca/n1/pub/82-003-x/2017009/article/54857-eng.htm

http://www.mentalhealthcanada.com

https://doi.org/10.1146/annurev-psych-010213-115205

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