There are many myths and misconceptions about healthy sleep. This may be, in part, because as research shows, different people do have different sleep needs—making it difficult to give a single definition of healthy sleep. Research does show, however, that the majority of adults need at least 7 hours of sleep within every 24-hour period, and some need more than that. Healthy sleep is also consistent from night to night and relatively uninterrupted—with very little waking during the night.
Most everyone will experience the occasional sleepless or restless night that results in being exceptionally tired the next day, this is normal as long as it doesn’t happen too often. During adolescence and young adulthood, the typical time to fall asleep naturally shifts to later in the night making people in this age group more prone to stay up late into the night and sleep during the day. However, when sleepless nights or daytime sleepiness occur with regular frequency--whether daily, weekly, or monthly--it may be a sign of a sleep disorder.
Sleep disorders can be broadly categorized into:
It is important to talk with your family physician or primary care doctor about your sleep and sleep habits, because healthy sleep effects overall health and can improve or worsen many other health conditions. Thinking about and understanding how well you sleep and how often you are tired is an important first step.
If you or your primary care physician have concerns about your sleep, it is a good idea to see a sleep specialist and be tested. There are 4 major tests for sleep disorders.
The technical term for a sleep study is polysomnography (paul-ee-som-nog-ra-fee). Many measurements are taken during a sleep study to understand what is happening to your body and breathing while you sleep. These include:
A full sleep study is done at a sleep center where people are monitored around the clock by sleep technologists and nurses. Video recordings may be taken simultaneously to match behaviors with the body signals measured. At home studies to test the likelihood of sleep apnea include some, but not all of the above measurements.
Multiple Sleep Latency Test
Also called a daytime nap test, the multiple sleep latency test (MSLT) measures how easily a person falls asleep during the daytime after a night of at least 6 hours of sleep. The MSLT is also done in a sleep study center, usually the day after a sleep study. During the MSLT, a person takes 4-5 naps, each 2 hours apart, while being monitored for body signals similar to the polysomnogram. If they do not fall asleep after 20 minutes, that nap is ended. If they do fall asleep, they are allowed to nap for 15 minutes before being awoken to wait for the next nap.
Maintenance of Wakefulness Test
During the maintenance of wakefulness test (MWT) a person spends 4 periods, separated by breaks, of up to 40 minutes in bed trying to stay awake the whole time. Monitors are used to determine when sleep begins and if someone does fall asleep, they are woken and take a break until the next period of the test. This test is also taken after a night of at least 6 hours of sleep.
Actigraphy (with or without sleep diaries)
A clinical activity-and-light monitor (somewhat similar to consumer products like Fitbit) is worn on the wrist for about 2 weeks in order to monitor daily sleep patterns. This test gives information on sleep habits in a person’s natural environment and can be used to screen for circadian rhythm disorders as well as to gather data on disorders of excessive or insufficient sleep.
Maintaining a healthy sleep routine, also called sleep hygiene, are often the first steps people take to improve and keep sleep healthy regardless of what disorders are present. Good sleep hygiene consists of the following:
Sleep related breathing disorders are treated with devices that keep a person’s airway (the path to the lungs) open. This may be a breathing mask that delivers positive airway pressure (PAP) through a mask in order to keep the airway puffed open, like blowing up a balloon. Some people have a hard time wearing a PAP mask and sleeping. Oral devices that fit over the teeth and keep the lower jaw in a forward position can also be used to keep the airway open during sleep. Achieving and maintaining a healthy weight is another important part of managing sleep related breathing disorders.
The proven most effective treatment for insomnia is a specific therapy program, cognitive-behavioral therapy for insomnia (CBT-I). In this program, people work with a therapist to change the way they think and act in relation to sleep. When good sleep hygiene and CBT-I are not enough to improve sleep, medications, including melatonin and sedatives, may be helpful.
Occasionally, individuals will have a physical (genetics, central nervous system dysfunction, etc.) cause for excessive sleepiness. For people with severe hypersomnias, stimulants or antidepressants may be prescribed by a doctor. If the excessive sleepiness is caused by a sleep disorder or a behavioral issue, the treatment is to correct the underlying problem, rather than to treat the symptom.
Circadian cycle disorders are most effectively treated with a structured sleep-wake schedule including bright light therapy, exercise and diet timing recommendations, and sometimes melatonin.
Behaviors during parasomnia can be very disturbing and sometimes violent but are typically not a sign of psychiatric or mental health problems. Good sleep hygiene and medications (eg, melatonin, antidepressants, and sedatives) are used to treat parasomnias. A person performing activities of any kind while unconscious and sleeping can endanger themselves and others. It is important to make the bedroom a safe environment by padding sharp corners, removing dangerous weapons and sharp objects, and sometimes having timed locks on doors and windows.
Sleep movement disorder treatment varies depending on the disorder. Restless leg syndrome may be treated with iron supplements and other medications. Teeth grinding may be managed with dental devices that fit over the teeth and keep the jaw from fully closing during sleep. Other sleep movement disorders are treated similarly to the parasomnias.
Convention Question: What Aspect of Sleep Hygiene Is Most Difficult For People To Achieve?
From attendees of SLEEP2019, the 33rd annual meeting of the Associated Professional Sleep Societies.
Sleep Disorders & Dementia
Sleep disorders are emerging as a biomarker for prodromal dementia.
Winnie Pao, MD
Sleep & Elite Athletic Performance
Elite athletes commonly have sleep disturbances and poor sleep quality made worse by the environmental demands of athletics.
Scott Kutscher, MD
Sleep & Neurodegenerative Disease
Sleep problems are common and treatable in neurodegenerative disorders, and may also be a treatable risk factor and early biomarker.
Raman K. Malhotra, MD
Sleep, Sleeplessness, & Neuropsychiatric Conditions
Sleep disturbances are symptoms of psychiatric conditions that can worsen prognosis; however, nonpharmacologic treatments are available and effective.
Fiona Barwick, PhD
Sleep & Traumatic Brain Injury
Sleep disorders are a common symptom of traumatic brain injury and treating them is also part of promoting recovery.
Michael S. Jaffee, MD, FAAN
Update on Treating Sleep Disorders
New treatments hold promise of increasing efficacy with precision medicine.
Charlene E. Gamaldo, MD, FAAN, FAASM; Tyler M. Pugeda, BA; and Rachel Marie E. Salas, MD, MEdHP, FAAN
Cover Focus: The Importance Of Sleep
Sleep & Neurodevelopment
Sleep characterization in children may have a role in evaluation for risk of impaired development, behavior, mood, and self-regulation.
Anne M. Morse, DO
Spotlight Topic: Neuropsychiatry
Cognitive Complaints and Neuropsychologic Testing
When should neuropsychologic tests be ordered and what questions should testing answer?
Nabil Ali, MD; Laura M. Clark, PhD, ABPP; and Kendra Corning, PsyD, HSPP
Healthy Cognitive Aging
There are evidence-based tools for staying sharp throughout the lifespan.
Brian K. Lebowitz, PhD, ABPP-CN; Elizabeth Londen, PhD; and Thomas Preston, PhD, ABPP-CN
Cover Focus: Technology & Wellness
Treating Stress to Improve Neurologic Outcomes
Research on the interaction between hormones and seizures supports the importance of helping patients manage stress.
Riley Bove, MD, MMSc; and Graham R. Huesmann, MD, PhD
Guest Medical Editor's Page
Wellness and Neurology
There is clear evidence for promoting wellness practices to all patients with neurologic disorders.
Patricia K. Coyle, MD, FAAN, FANA
A recently graduated resident and new professor recommends ways to attract medical students to the specialty of neurology.
Rachel Gottlieb-Smith, MD
Seeking Breakthroughs: The Physician Perspective
A roundtable discussion with Claudia A. Chiriboga, MD, MPH; Jeffrey L. Cummings, MD, ScD; and Nir Lipsman, MD, PhD
Claudia A. Chiriboga, MD, MPH; Jeffrey L. Cummings, MD, ScD; and Nir Lipsman, MD, PhD
Seeking Breakthrough Treatments
Seeking Breakthroughs: The Industry Perspective
A roundtable discussion with Gregory Went, PhD, Adamas Pharmaceuticals; Lynn Kramer, MD, Eisai; Paulo Fontoura, MD, PhD, Genentech/Roche; Justin Gover, BSc, MBA, GW Pharmaceuticals; Marc Kamin, MD, SK Life Sciences; and Mike Davis, BSc, MBA, UCB
Guest Medical Editor's Page
Seeking Breakthroughs—We Want You!
The challenges we must overcome to find breakthrough treatments in neurology are many and the potential is great.
Shamik Bhattycharyya, MD, MS
Sleep Disorders in Patients With Multiple Sclerosis
Identifying and treating sleep problems can help optimize the well-being and function of patients with multiple sclerosis.
Tiffany J. Braley, MD, MS
Sleep, Circadian Rhythms, and Alzheimer's Disease
Sleep and circadian rhythm disturbances are symptoms of Alzheimer's disease that may also contribute to disease pathogenesis.
Erik S. Musiek, MD, PhD
Obstructive Sleep Apnea and Epilepsy
It is important to consider comorbid sleep disorders for patients with epilepsy.
Michelle L. Dougherty, MD; and Karin G. Johnson, MD