MODERN DISEASE PREVENTION
Your Subtitle text
Early to bed and early to rise makes a man healthy, wealthy, and wise. — Benjamin Franklin
SLEEP: A DYNAMIC ACTIVITY
Until the 1950s, most people thought of sleep as a passive, dormant part of our daily lives. We now know that our brains are very active during sleep. Moreover, sleep affects our daily functioning and our physical and mental health in many ways that we are just beginning to understand.
Nerve-signaling chemicals called neurotransmitters control whether we are asleep or awake by acting on different groups of nerve cells, or neurons, in the brain. Neurons in the brainstem, which connects the brain with the spinal cord, produce neurotransmitters such as serotonin and norepinephrine that keep some parts of the brain active while we are awake. Other neurons at the base of the brain begin signaling when we fall asleep. These neurons appear to "switch off" the signals that keep us awake. Research also suggests that a chemical called adenosine builds up in our blood while we are awake and causes drowsiness. This chemical gradually breaks down while we sleep.
During sleep, we usually pass through five phases of sleep: stages 1, 2, 3, 4, and REM (rapid eye movement) sleep. These stages progress in a cycle from stage 1 to REM sleep, then the cycle starts over again with stage 1 (see figure 1 ). We spend almost 50 percent of our total sleep time in stage 2 sleep, about 20 percent in REM sleep, and the remaining 30 percent in the other stages. Infants, by contrast, spend about half of their sleep time in REM sleep.
During stage 1, which is light sleep, we drift in and out of sleep and can be awakened easily. Our eyes move very slowly and muscle activity slows. People awakened from stage 1 sleep often remember fragmented visual images. Many also experience sudden muscle contractions called hypnic myoclonia, often preceded by a sensation of starting to fall. These sudden movements are similar to the "jump" we make when startled. When we enter stage 2 sleep, our eye movements stop and our brain waves (fluctuations of electrical activity that can be measured by electrodes) become slower, with occasional bursts of rapid waves called sleep spindles. In stage 3, extremely slow brain waves called delta waves begin to appear, interspersed with smaller, faster waves. By stage 4, the brain produces delta waves almost exclusively. It is very difficult to wake someone during stages 3 and 4, which together are called deep sleep. There is no eye movement or muscle activity. People awakened during deep sleep do not adjust immediately and often feel groggy and disoriented for several minutes after they wake up. Some children experience bedwetting, night terrors, or sleepwalking during deep sleep.
When we switch into REM sleep, our breathing becomes more rapid, irregular, and shallow, our eyes jerk rapidly in various directions, and our limb muscles become temporarily paralyzed. Our heart rate increases, our blood pressure rises, and males develop penile erections. When people awaken during REM sleep, they often describe bizarre and illogical tales – dreams.
The first REM sleep period usually occurs about 70 to 90 minutes after we fall asleep. A complete sleep cycle takes 90 to 110 minutes on average. The first sleep cycles each night contain relatively short REM periods and long periods of deep sleep. As the night progresses, REM sleep periods increase in length while deep sleep decreases. By morning, people spend nearly all their sleep time in stages 1, 2, and REM.
People awakened after sleeping more than a few minutes are usually unable to recall the last few minutes before they fell asleep. This sleep-related form of amnesia is the reason people often forget telephone calls or conversations they've had in the middle of the night. It also explains why we often do not remember our alarms ringing in the morning if we go right back to sleep after turning them off.
Since sleep and wakefulness are influenced by different neurotransmitter signals in the brain, foods and medicines that change the balance of these signals affect whether we feel alert or drowsy and how well we sleep. Caffeinated drinks such as coffee and drugs such as diet pills and decongestants stimulate some parts of the brain and can cause insomnia, or an inability to sleep. Many antidepressants suppress REM sleep. Heavy smokers often sleep very lightly and have reduced amounts of REM sleep. They also tend to wake up after 3 or 4 hours of sleep due to nicotine withdrawal. Many people who suffer from insomnia try to solve the problem with alcohol – the so-called night cap. While alcohol does help people fall into light sleep, it also robs them of REM and the deeper, more restorative stages of sleep. Instead, it keeps them in the lighter stages of sleep, from which they can be awakened easily.
People lose some of the ability to regulate their body temperature during REM, so abnormally hot or cold temperatures in the environment can disrupt this stage of sleep. If our REM sleep is disrupted one night, our bodies don't follow the normal sleep cycle progression the next time we doze off. Instead, we often slip directly into REM sleep and go through extended periods of REM until we "catch up" on this stage of sleep.
People who are under anesthesia or in a coma are often said to be asleep. However, people in these conditions cannot be awakened and do not produce the complex, active brain wave patterns seen in normal sleep. Instead, their brain waves are very slow and weak, sometimes all but undetectable.
Sleep: A Dynamic Activity. Brain Basics: Understanding Sleep. National Institutes of Health (NIH) National Institute of Neurological Disorders and Stroke. NIH Publication No.06-3440-c, May 21, 2007.
SLEEP TIPS FOR PREGNANT WOMEN
1. In the third trimester, sleep on your left side to allow for the best blood flow to the fetus and to your uterus and kidneys. Avoid lying flat on your back for a long period of time.
2. Drink lots of fluids during the day, but cut down before bedtime.
3. To prevent heartburn, do not eat large amounts of spicy, acidic (such as tomato products), or fried foods. If heartburn is a problem, sleep with your head elevated on pillows.
4. Exercise regularly to help you stay healthy, improve your circulation, and reduce leg cramps.
5. Try frequent bland snacks (like crackers) throughout the day. This helps avoid nausea by keeping your stomach full.
6. Special "pregnancy" pillows and mattresses may help you sleep better. Or use regular pillows to support your body.
7. Naps may help. The NSF poll found that 51% of pregnant or recently pregnant women reported at least one weekday nap; 60% reported at least one weekend nap.
8. Learn to relax with relaxation and breathing techniques, which can also help when the contractions begin. A warm bath or shower before bed can be helpful.
9. Talk to your doctor if you develop medical problems and/or insomnia persists.
Once her baby is born, a mother's sleep is frequently interrupted, particularly if she is nursing. Mothers who nurse and those with babies that wake frequently during the night should try to nap when their babies do. Sharing baby care to the extent possible, especially during the night, is important for the mother's health, safety, performance and vitality.
The information contained on the National Sleep Foundation (NSF) Web site is for informational and educational purposes only, and is not intended to be used for diagnosis or treatment of any medical condition or to otherwise replace medical advice by qualified health professionals.
NSF encourages all individuals to make informed decisions about their health, safety, and well being by consulting with health professionals and other reputable sources before making significant lifestyle changes, including but not limited to alterations in diet, exercise, sleep habits, medications, and herbal or other substances.
Sleep Tips for Pregnant Women. National Sleep Foundation (NSF). Accessed 26 July 2011. http://www.sleepfoundation.org/article/hot-topics/sleep-tips-pregnant-women
©2011 National Sleep Foundation., All rights reserved.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only. Modern Disease Prevention does not provide medical advice, diagnosis or treatment.
WHAT DOES SLEEP DO FOR US?
Although scientists are still trying to learn exactly why people need sleep, animal studies show that sleep is necessary for survival. For example, while rats normally live for two to three years, those deprived of REM sleep survive only about 5 weeks on average, and rats deprived of all sleep stages live only about 3 weeks. Sleep-deprived rats also develop abnormally low body temperatures and sores on their tail and paws. The sores may develop because the rats' immune systems become impaired. Some studies suggest that sleep deprivation affects the immune system in detrimental ways.
Sleep appears necessary for our nervous systems to work properly. Too little sleep leaves us drowsy and unable to concentrate the next day. It also leads to impaired memory and physical performance and reduced ability to carry out math calculations. If sleep deprivation continues, hallucinations and mood swings may develop.
Some experts believe sleep gives neurons used while we are awake a chance to shut down and repair themselves. Without sleep, neurons may become so depleted in energy or so polluted with byproducts of normal cellular activities that they begin to malfunction. Sleep also may give the brain a chance to exercise important neuronal connections that might otherwise deteriorate from lack of activity.
Deep sleep coincides with the release of growth hormone in children and young adults. Many of the body's cells also show increased production and reduced breakdown of proteins during deep sleep. Since proteins are the building blocks needed for cell growth and for repair of damage from factors like stress and ultraviolet rays, deep sleep may truly be "beauty sleep." Activity in parts of the brain that control emotions, decision-making processes, and social interactions is drastically reduced during deep sleep, suggesting that this type of sleep may help people maintain optimal emotional and social functioning while they are awake.
A study in rats also showed that certain nerve-signaling patterns which the rats generated during the day were repeated during deep sleep. This pattern repetition may help encode memories and improve learning. Some scientists believe dreams are the cortex's attempt to find meaning in the random signals that it receives during REM sleep. The cortex is the part of the brain that interprets and organizes information from the environment during consciousness. It may be that, given random signals from the pons during REM sleep, the cortex tries to interpret these signals as well, creating a "story" out of fragmented brain activity.
What Does Sleep Do For Us? Brain Basics: Understanding Sleep. National Institutes of Health (NIH) National Institute of Neurological Disorders and Stroke. NIH Publication No.06-3440-c, May 21, 2007.
INTERRUPTED SLEEP IMPAIRS MEMORY IN MICE
With the novel use of a technique that uses light to control brain cells, Stanford University researchers have shown that fragmented sleep causes memory impairment in mice. The study was co-led by Luis de Lecea, PhD, and H. Craig Heller, PhD. Dr. de Lecea is associate professor of psychiatry and behavioral sciences whose work focuses on the neural circuitry underlying wakefulness; and Dr. Heller is a professor of biology.
Until recently scientists have been unable to tease out the effects on the brain of different yet intertwined features of sleep. But these investigators were able to overcome that problem and come to their findings by using the novel method known as optogenetics to manipulate brain cells to affect just one aspect of sleep.
The study shows that “regardless of the total amount of sleep, a minimal unit of uninterrupted sleep is crucial for memory consolidation,” the authors write in the study published online (25 July 2011) in the Proceedings of the National Academy of Sciences. Experts have long hypothesized that sleep is important for memory, but this has been a difficult area to study — in part because of the sleep-deprivation techniques used in research.
Gentle handling is one way to keep animal subjects from sleeping but, as de Lecea explained, “Rodents are very sensitive to physical awakenings. If you wake an animal up it’s going to be up for awhile, and it will experience stress.” And stress itself has been shown to affect memory.
In addition, any kind of sleep manipulation affects all features of the sleep — not only duration, but also quality, continuity and composition (percentage of rapid eye movement and non-REM sleep). It hasn’t been possible to distinguish the role of a specific characteristic of sleep, such as sleep continuity, on memory.
The Stanford team, as well as other scientists, assumed that memory would become impaired with a lack of sleep continuity. Memory deficits are often seen in people with certain neurological and psychiatric conditions, such as alcoholism and sleep apnea, during which sleep continuity — though perhaps not total sleep time or type of sleep — is affected.
Patients with apnea can stop breathing and experience so-called “micro-arousals” as many as hundreds of times a night. The challenge for the Stanford researchers was this: How could they fragment sleep into shorter episodes without affecting sleep intensity or duration and without invoking a stress response, so they could see its effects on memory?
Knowing the traditional methods of sleep deprivation wouldn’t allow them to do what they needed, the team turned to optogenetics, a technique in which specific cells can be genetically engineered to be controlled by pulses of visible light. The researchers used the method on the type of neurons that play a key role in switching between sleep and wake, and they found that by stimulating these cells with 10-second bursts of light, they could fragment the animals’ sleep without affecting total sleep time or quality and composition of sleep.
The technique, de Lecea said, represented “a very fine, very subtle way of sleep fragmentation.” After manipulating the mice’ sleep, the researchers had the animals undergo a task during which they were placed in a box with two objects: one to which they had previously been exposed, and another that was new to them.
A rodent's natural tendency is to explore novel objects; so if the animal spent more time with the new object, it would indicate that they remembered the other, now familiar object. In this case the researchers found that unlike the control mice, the mice with fragmented sleep did not explore the novel object longer than the familiar one — showing that their memory was affected.
The findings, Professor Heller explained, “point to a specific characteristic of sleep — continuity — as being critical for memory.” While the study does not reach any conclusions about the amount of sleep needed to avoid memory impairment in humans, it does suggest that memory difficulties in people with sleep apnea and other sleep disorders are likely connected to the compromised continuity of sleep caused by such conditions.
Noting that this is just “the first step in looking at one aspect of sleep,” first author and postdoctoral scholar Asya Rolls, PhD, said she and her colleagues are planning to further study the sleep mechanisms used to preserve memory.
The team expects other research groups to use the method in animals to manipulate and study different features of sleep. The optogenetic technique cannot be used in humans at this time as it requires still-experimental genetic modifications to brain cells.
The study was funded by the National Institute of Mental Health and the Klarman Family Foundation. Other authors on the study were research associate Damien Colas, PhD; Antoine Adamantidis, PhD; postdoctoral scholar Matt Carter, PhD; and medical student Tope Lanre-Amos.
MICHELLE L. BRANDT. Scientists use new technology to show that interrupted sleep impairs memory in mice. Inside Stanford Medicine, Stanford School of Medicine. 25 JULY 2011. Accessed 27 July 2011. http://med.stanford.edu/ism/2011/july/memory.html
Although scientists are still trying to learn exactly why people need sleep, animal studies show that sleep is necessary for survival. For example, while rats normally live for two to three years, those deprived of REM sleep survive only about 5 weeks on average, and rats deprived of all sleep stages live only about 3 weeks. Sleep-deprived rats also develop abnormally low body temperatures and sores on their tail and paws. The sores may develop because the rats' immune systems become impaired. Some studies suggest that sleep deprivation affects the immune system in detrimental ways.
Sleep appears necessary for our nervous systems to work properly. Too little sleep leaves us drowsy and unable to concentrate the next day. It also leads to impaired memory and physical performance and reduced ability to carry out math calculations. If sleep deprivation continues, hallucinations and mood swings may develop.
Some experts believe sleep gives neurons used while we are awake a chance to shut down and repair themselves. Without sleep, neurons may become so depleted in energy or so polluted with byproducts of normal cellular activities that they begin to malfunction. Sleep also may give the brain a chance to exercise important neuronal connections that might otherwise deteriorate from lack of activity.
Deep sleep coincides with the release of growth hormone in children and young adults. Many of the body's cells also show increased production and reduced breakdown of proteins during deep sleep. Since proteins are the building blocks needed for cell growth and for repair of damage from factors like stress and ultraviolet rays, deep sleep may truly be "beauty sleep." Activity in parts of the brain that control emotions, decision-making processes, and social interactions is drastically reduced during deep sleep, suggesting that this type of sleep may help people maintain optimal emotional and social functioning while they are awake.
A study in rats also showed that certain nerve-signaling patterns which the rats generated during the day were repeated during deep sleep. This pattern repetition may help encode memories and improve learning. Some scientists believe dreams are the cortex's attempt to find meaning in the random signals that it receives during REM sleep. The cortex is the part of the brain that interprets and organizes information from the environment during consciousness. It may be that, given random signals from the pons during REM sleep, the cortex tries to interpret these signals as well, creating a "story" out of fragmented brain activity.
What Does Sleep Do For Us? Brain Basics: Understanding Sleep. National Institutes of Health (NIH) National Institute of Neurological Disorders and Stroke. NIH Publication No.06-3440-c, May 21, 2007.
INTERRUPTED SLEEP IMPAIRS MEMORY IN MICE
With the novel use of a technique that uses light to control brain cells, Stanford University researchers have shown that fragmented sleep causes memory impairment in mice. The study was co-led by Luis de Lecea, PhD, and H. Craig Heller, PhD. Dr. de Lecea is associate professor of psychiatry and behavioral sciences whose work focuses on the neural circuitry underlying wakefulness; and Dr. Heller is a professor of biology.
Until recently scientists have been unable to tease out the effects on the brain of different yet intertwined features of sleep. But these investigators were able to overcome that problem and come to their findings by using the novel method known as optogenetics to manipulate brain cells to affect just one aspect of sleep.
The study shows that “regardless of the total amount of sleep, a minimal unit of uninterrupted sleep is crucial for memory consolidation,” the authors write in the study published online (25 July 2011) in the Proceedings of the National Academy of Sciences. Experts have long hypothesized that sleep is important for memory, but this has been a difficult area to study — in part because of the sleep-deprivation techniques used in research.
Gentle handling is one way to keep animal subjects from sleeping but, as de Lecea explained, “Rodents are very sensitive to physical awakenings. If you wake an animal up it’s going to be up for awhile, and it will experience stress.” And stress itself has been shown to affect memory.
In addition, any kind of sleep manipulation affects all features of the sleep — not only duration, but also quality, continuity and composition (percentage of rapid eye movement and non-REM sleep). It hasn’t been possible to distinguish the role of a specific characteristic of sleep, such as sleep continuity, on memory.
The Stanford team, as well as other scientists, assumed that memory would become impaired with a lack of sleep continuity. Memory deficits are often seen in people with certain neurological and psychiatric conditions, such as alcoholism and sleep apnea, during which sleep continuity — though perhaps not total sleep time or type of sleep — is affected.
Patients with apnea can stop breathing and experience so-called “micro-arousals” as many as hundreds of times a night. The challenge for the Stanford researchers was this: How could they fragment sleep into shorter episodes without affecting sleep intensity or duration and without invoking a stress response, so they could see its effects on memory?
Knowing the traditional methods of sleep deprivation wouldn’t allow them to do what they needed, the team turned to optogenetics, a technique in which specific cells can be genetically engineered to be controlled by pulses of visible light. The researchers used the method on the type of neurons that play a key role in switching between sleep and wake, and they found that by stimulating these cells with 10-second bursts of light, they could fragment the animals’ sleep without affecting total sleep time or quality and composition of sleep.
The technique, de Lecea said, represented “a very fine, very subtle way of sleep fragmentation.” After manipulating the mice’ sleep, the researchers had the animals undergo a task during which they were placed in a box with two objects: one to which they had previously been exposed, and another that was new to them.
A rodent's natural tendency is to explore novel objects; so if the animal spent more time with the new object, it would indicate that they remembered the other, now familiar object. In this case the researchers found that unlike the control mice, the mice with fragmented sleep did not explore the novel object longer than the familiar one — showing that their memory was affected.
The findings, Professor Heller explained, “point to a specific characteristic of sleep — continuity — as being critical for memory.” While the study does not reach any conclusions about the amount of sleep needed to avoid memory impairment in humans, it does suggest that memory difficulties in people with sleep apnea and other sleep disorders are likely connected to the compromised continuity of sleep caused by such conditions.
Noting that this is just “the first step in looking at one aspect of sleep,” first author and postdoctoral scholar Asya Rolls, PhD, said she and her colleagues are planning to further study the sleep mechanisms used to preserve memory.
The team expects other research groups to use the method in animals to manipulate and study different features of sleep. The optogenetic technique cannot be used in humans at this time as it requires still-experimental genetic modifications to brain cells.
The study was funded by the National Institute of Mental Health and the Klarman Family Foundation. Other authors on the study were research associate Damien Colas, PhD; Antoine Adamantidis, PhD; postdoctoral scholar Matt Carter, PhD; and medical student Tope Lanre-Amos.
MICHELLE L. BRANDT. Scientists use new technology to show that interrupted sleep impairs memory in mice. Inside Stanford Medicine, Stanford School of Medicine. 25 JULY 2011. Accessed 27 July 2011. http://med.stanford.edu/ism/2011/july/memory.html
SLEEP AND DISEASE
Do you ever feel sleepy or "zone out" during the day? Do you find it hard to wake up on Monday mornings? If so, you are familiar with the powerful need for sleep. However, you may not realize that sleep is as essential for your well-being as food and water. Doctors have described more than 70 sleep disorders, most of which can be managed effectively once they are correctly diagnosed. The most common sleep disorders include insomnia, sleep apnea, restless legs syndrome, and narcolepsy.
Sleep research is expanding and attracting more and more attention from scientists. Researchers now know that sleep is an active and dynamic state that greatly influences our waking hours, and they realize that we must understand sleep to fully understand the brain. Innovative techniques, such as brain imaging, can now help researchers understand how different brain regions function during sleep and how different activities and disorders affect sleep.
Sleep and sleep-related problems play a role in a large number of human disorders and affect almost every field of medicine. For example, problems like stroke and asthma attacks tend to occur more frequently during the night and early morning, perhaps due to changes in hormones, heart rate, and other characteristics associated with sleep. Sleep also affects some kinds of epilepsy in complex ways. REM sleep seems to help prevent seizures that begin in one part of the brain from spreading to other brain regions, while deep sleep may promote the spread of these seizures. Sleep deprivation also triggers seizures in people with some types of epilepsy.
Neurons that control sleep interact closely with the immune system. As anyone who has had the flu knows, infectious diseases tend to make us feel sleepy. This probably happens because cytokines, chemicals our immune systems produce while fighting an infection, are powerful sleep-inducing chemicals. Sleep may help the body conserve energy and other resources that the immune system needs to mount an attack.
Sleeping problems occur in almost all people with mental disorders, including those with depression and schizophrenia. People with depression, for example, often awaken in the early hours of the morning and find themselves unable to get back to sleep. The amount of sleep a person gets also strongly influences the symptoms of mental disorders. Sleep deprivation is an effective therapy for people with certain types of depression, while it can actually cause depression in other people. Extreme sleep deprivation can lead to a seemingly psychotic state of paranoia and hallucinations in otherwise healthy people, and disrupted sleep can trigger episodes of mania (agitation and hyperactivity) in people with manic depression.
Sleeping problems are common in many other disorders as well, including Alzheimer's disease, stroke, cancer, and head injury. These sleeping problems may arise from changes in the brain regions and neurotransmitters that control sleep, or from the drugs used to control symptoms of other disorders. In patients who are hospitalized or who receive round-the-clock care, treatment schedules or hospital routines also may disrupt sleep. The old joke about a patient being awakened by a nurse so he could take a sleeping pill contains a grain of truth. Once sleeping problems develop, they can add to a person's impairment and cause confusion, frustration, or depression. Patients who are unable to sleep also notice pain more and may increase their requests for pain medication. Better management of sleeping problems in people who have other disorders could improve these patients' health and quality of life.
Sleep and Disease. Brain Basics: Understanding Sleep. National Institutes of Health (NIH) National Institute of Neurological Disorders and Stroke. NIH Publication No.06-3440-c, May 21, 2007.
Do you ever feel sleepy or "zone out" during the day? Do you find it hard to wake up on Monday mornings? If so, you are familiar with the powerful need for sleep. However, you may not realize that sleep is as essential for your well-being as food and water. Doctors have described more than 70 sleep disorders, most of which can be managed effectively once they are correctly diagnosed. The most common sleep disorders include insomnia, sleep apnea, restless legs syndrome, and narcolepsy.
Sleep research is expanding and attracting more and more attention from scientists. Researchers now know that sleep is an active and dynamic state that greatly influences our waking hours, and they realize that we must understand sleep to fully understand the brain. Innovative techniques, such as brain imaging, can now help researchers understand how different brain regions function during sleep and how different activities and disorders affect sleep.
Sleep and sleep-related problems play a role in a large number of human disorders and affect almost every field of medicine. For example, problems like stroke and asthma attacks tend to occur more frequently during the night and early morning, perhaps due to changes in hormones, heart rate, and other characteristics associated with sleep. Sleep also affects some kinds of epilepsy in complex ways. REM sleep seems to help prevent seizures that begin in one part of the brain from spreading to other brain regions, while deep sleep may promote the spread of these seizures. Sleep deprivation also triggers seizures in people with some types of epilepsy.
Neurons that control sleep interact closely with the immune system. As anyone who has had the flu knows, infectious diseases tend to make us feel sleepy. This probably happens because cytokines, chemicals our immune systems produce while fighting an infection, are powerful sleep-inducing chemicals. Sleep may help the body conserve energy and other resources that the immune system needs to mount an attack.
Sleeping problems occur in almost all people with mental disorders, including those with depression and schizophrenia. People with depression, for example, often awaken in the early hours of the morning and find themselves unable to get back to sleep. The amount of sleep a person gets also strongly influences the symptoms of mental disorders. Sleep deprivation is an effective therapy for people with certain types of depression, while it can actually cause depression in other people. Extreme sleep deprivation can lead to a seemingly psychotic state of paranoia and hallucinations in otherwise healthy people, and disrupted sleep can trigger episodes of mania (agitation and hyperactivity) in people with manic depression.
Sleeping problems are common in many other disorders as well, including Alzheimer's disease, stroke, cancer, and head injury. These sleeping problems may arise from changes in the brain regions and neurotransmitters that control sleep, or from the drugs used to control symptoms of other disorders. In patients who are hospitalized or who receive round-the-clock care, treatment schedules or hospital routines also may disrupt sleep. The old joke about a patient being awakened by a nurse so he could take a sleeping pill contains a grain of truth. Once sleeping problems develop, they can add to a person's impairment and cause confusion, frustration, or depression. Patients who are unable to sleep also notice pain more and may increase their requests for pain medication. Better management of sleeping problems in people who have other disorders could improve these patients' health and quality of life.
Sleep and Disease. Brain Basics: Understanding Sleep. National Institutes of Health (NIH) National Institute of Neurological Disorders and Stroke. NIH Publication No.06-3440-c, May 21, 2007.
