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Sleep disorders

Getting a good night’s sleep is critical to our overall health and well being, but too many Canadians are falling behind in both the quality and duration of sleep. If you’re not getting the sleep you need it’s important to understand the reasons why, and to understand how to make the practice of good sleep hygiene a part of your life’s routine.

Sleep: Your Health’s Best Friend

a woman who can not fall asleep

Sleeping is one of the human body’s most critical biological functions — just as important as breathing, eating and digestion, and the beating of our heart. About a third of our life span will be spent sleeping, an absolutely necessary period of restoration for which there is no substitute. Even a minimal disruption in our sleep cycles can have a significant impact on our health and wellbeing, in both the short and long term.

We may think that our bodies are inactive and our minds are resting as we sleep, but in reality there’s a lot of essential electrical activity going on in our brain and other core functions. While sleeping, the body is hard at work recharging for the next day, fighting off infections, replenishing our capacity for memory and learning new skills, reducing stress and improving overall mood. All that, and much, much more.

Unfortunately, many of us don’t sufficiently value the quality or duration of our sleep. We allow obligations and commitments to cut into our sleep time. Instead of going to bed at a reasonable hour, we are doing other things — office work, bookkeeping, watching television, or scrolling on our phones — that may seem more important than going to sleep. If you are having trouble sleeping, you are not alone. According to Statistics Canada:

  • 32% of Canadians report having trouble sleeping
  • 36% say they don’t find time to sleep eight hours a night
  • The longer the hours we work, the less we sleep
  • Canadians who are married and/or have children sleep less than single people with no children
  • 50% of Canadians are willing to sacrifice sleep when they are too busy

A “good night’s sleep” means something different for everybody, but the habits that get you there are consistent. Practising good sleep hygiene is so important to our overall health, and the adverse effects of not regularly getting a good night’s sleep are manifold. What happens to your metabolism at night is just one example – when we don’t sleep well we don’t metabolize properly, and that can negatively affect our diet by causing us to eat too much or eat unhealthily during the day. If you’re diabetic, having a bad sleep can make it especially hard for to control your symptoms.

The intention of this guide is to provide you with the knowledge and tools to help improve your sleep hygiene, ensuring your mind and body benefit from more restful nights, and hopefully enhancing your overall quality of life.

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The Science of Sleep

Frequent waking or sleepless nights can be extremely detrimental to your health. The quality of your sleep is important in order to feel refreshed and rested when you wake up. After a good night’s sleep, your energy levels are usually higher the next day. Deep sleep allows your body to recover and helps restore your muscles and tissues while strengthening your immune system. During REM sleep, your mind recharges, which explains the vital role of good sleep in learning and memory.

If you slept well, you feel rested when you wake up. You did not sleep well if:

  • The sound of your alarm clock makes you want to go back to sleep
  • Getting out of bed is hard
  • You feel as tired as when you went to bed the night before
  • You yawn all day, and minutes seem like hours
  • You are irritable, hypersensitive or impatient

The Impact on Your Health and Well-being

Sleep disorders, in all their forms, can have serious effects on your physical and mental health.

Consequences of Inadequate or Disturbed Sleep (short term)

  • Problems with concentration and memory
  • Decreased vigilance
  • Fatigue
  • Irritability
  • Emotional fragility
  • Increased appetite (weight gain due to disruption of leptin and ghrelin hormones that help control appetite)
  • Risk of motor vehicle accidents

Consequences of Inadequate or Disturbed Sleep (long term)

  • Impact at school or work, social life as well
  • Decreased immune system
  • Risk of obesity
  • Risk of diabetes
  • Risk of cardiovascular disease
  • Risk of certain cancers
  • Risk of depression
  • Risk of high blood pressure

Sleep Cycles and Structure

“Sleep” is not a single, constant state – what your body is up to during sleep will vary over the course of a night. The various stages follow one another to constitute a series of 90- to 120-minute sleep cycles. During your sleep, each cycle, composed of 4 distinct stages, repeats itself 4 to 6 times. So if you go to bed at 10:30 pm, the first cycle ends at midnight with the others following throughout the night.

Stage 1

  • Falling asleep, sometimes accompanied by muscle contractions or jerking motions
  • You are between wakefulness and sleep. This period is generally short.
  • You are aware of any surrounding noise

Stage 2

  • Slow-wave light sleep — eye movements stop, heart rate slows, body decreases in temperature.
  • You spend between 45 and 55 percent of your night in stage 2. This stage is important for your physical and mental health, among other things.

Stage 3

  • Slow-wave deep sleep — brain waves slow down but heighten in amplitude.
  • This stage is important for physical recovery, strengthening of the immune system, appetite control and growth, among other things.

Paradoxical Sleep Stage (or REM, for “Rapid Eye Movement”)

  • You start to dream
  • Your heart rate and breathing accelerates and your blood pressure increases
  • Your eye movements become rapid and irregular
  • The muscles in your arms and legs are paralyzed

During the night’s earlier cycles, you spend more time in stage 3. The longer the night progresses, the longer the REM stages. If you have been deprived of sleep, your body first tries to catch up on its deep sleep (stage 3) and REM sleep.

No one stage of the sleep is more important than any other. It is the continuity of the cycles that is important.

An adult needs about 8 hours of sleep per night, but for some people, 6 hours is enough and for others, 10 hours is required. You will know what feels right for you.

Good morning with a cup of coffee

Types of Sleep Disorders

There are several types of sleep disorder that cause cognitive or behavioural issues. If you think you may be suffering from a sleep disorder, your doctor can refer you to a specialist for diagnosis and a recommended treatment.

Disorders as defined in the International Classification of Sleep Disorders (ICSD):

Insomnia (acute or chronic)

  • Characterized by difficulty falling asleep and staying asleep
  • There are three distinct types of insomnia: initial insomnia when we have difficulty falling asleep at night, middle insomnia when we have prolonged wakefulness at night, and terminal insomnia when it occurs at the end of the night
  • May be caused by poor sleep hygiene habits. The more you can focus on good sleep habits, the better chance you have of avoiding insomnia
  • May be caused by psychological factors (anxiety, depression) or physical factors (pain)

Hypersomnia

  • Excessive sleep (prolonged night sleeping or involuntary daytime sleeping)
  • Decreased quality in wakefulness (drowsiness during waking hours)

Narcolepsy

  • Neurological disorder characterized by excessive daytime sleepiness
  • May or may not be accompanied by cataplexia, short episodes (seconds to minutes) of loss of muscle tone triggered by strong emotions (surprise, laughing or anger)
  • Visual hallucinations (hypnagogic) during sleeping or waking (hypnopompic) are part of sleep paralysis symptoms
  • Not all of these symptoms are always present

Breathing Disorders

  • Obstructive sleep apnea
  • Central sleep apnea
  • Sleep hypoventilation syndrome

Circadian Rhythm Sleep Disorders

  • Sleep disturbance caused by changes in circadian system often related to night shift work

Partial brain awakening during REM sleep

  • Repeated incomplete awakening, especially during first third of the night
  • Includes sleep walking night terrors
  • People have no recollection of what happened during the night

Nightmares

  • Long and complex dream sequences that seem real and cause anxiety, fear or other dysphoric emotions
  • They occur mostly late at night during the REM phase
  • People remember their nightmares

Restless Leg Syndrome (RLS)

  • A sensorimotor and neurological disorder characterized by repeated and continuous muscle spasms in the arms or legs during sleep. These occur especially at the end of the day, either in the evening or at night
  • A “pins and needles” or tingling sensation in the legs may be felt during the day

Bruxism

  • Gnashing of teeth and/or tightness of the jaws during sleep
  • Causes jaw pain, abrasion of the teeth, and temporomandibular pain
  • Bruxism can occur in people suffering from sleep apnea

Substance or Drug-induced Disorders

  • Substances such as alcohol, cannabis, caffeine, opioids, amphetamines, sedatives, hypnotic and anxiety medications (sleeping pills) and tobacco can disrupt normal sleep patterns or cause sleep disorders.

Sleep Apnea : Serious Respiratory Disorder

Sleep apnea is a breathing disorder associated with sleep. Respiratory obstruction of the pharynx (at the throat level) may be complete (apnea) or partial (hypopnea) and it can cause a decrease in the blood oxygen level (hypoxemia), an increased heart rate and/or microarousals. These microwakes are very short, they can occur regularly during the night, and though you won’t be aware of them, they will disrupt your normal sleep cycles.

On average, these breaks last 10 to 30 seconds, until the brain responds to the problem. Each time, your sleep is disturbed, even if you don’t fully wake up and have no memory of waking up. These respiratory stops are repeated throughout the night, disrupting the sleep pattern you need to complete to feel rested and awake in the morning.

There are two types of sleep apnea. The most common type is the obstructive sleep apnea that occurs when your upper airway is obstructed during your sleep. Central sleep apnea occurs when, for a variety of reasons, your brain does not report to your body that it must continue to breathe. Mixed sleep apnea occurs when a person suffers from both types of apnea, obstructive and central.

Two Types of Sleep Apnea

Obstructive Apnea

You may be aware that obesity is one of the primary causes of obstructive sleep apnea, but it’s important to know that it’s not the only one. Though the risk to obese people is four times higher, 40 percent of people with obstructive sleep apnea are not obese. You can be a tall and thin person and have this sleep disorder. Other risk factors include:

  • A family history of sleep apnea
  • Narrowed airways
  • Neck circumference (excess weight around neck can narrow airway when laying down)
  • Small jaw: recessed chin
  • Tonsils become enlarged
  • Age
  • Consumption of alcohol, tobacco, sedatives and tranquilizers
  • Nasal congestion
Central Apnea

In this case, breathing is not obstructed, but rather the respiratory system is not getting the biofeedback signal it requires to breath. Risk factors include:

  • Age
  • A history of heart problems
  • Drug use
  • Stroke victims

Symptoms

In addition to sleep disturbances, several other symptoms can be a sign of sleep apnea:

  • Noisy snoring that disturbs your partner’s or family’s sleep
  • Stops in breathing observed by another person
  • Awakens with choking sensation
  • Gets up regularly to urinate during the night
  • Feeling of un-restorative sleep
  • Morning headaches that disappear when the day begins
  • Insomnia (observed mostly in women)
  • Hypersomnia (sleepiness during the day)
  • Irritability, anxiety, impatience
  • Problems with memory, attention and concentration
  • Decreased libido or erectile dysfunction

Tips for Better Sleep Hygiene

Good sleep hygiene can help prevent certain sleep disorders or reduce their consequences. It can also help in cases of sleep apnea, though it will not actually treat the condition or make it go away; for that you need proper treatment.

It is important to relax before bedtime and, as best as possible, always go to bed at the same time. A routine before bedtime helps the body and brain to slow down, reduces the stress of the day and promotes falling asleep.

Here are a few tips for practicing better sleep hygiene:

  • Avoid stimulants such as alcohol, caffeine and nicotine, or intense exercise near bedtime
  • As your bedtime approaches, relax (read, listen to music, take a bath) and stop all interaction with your electronic devices (smartphones, Internet, TV)
  • Learn to recognize when you are getting sleepy (e.g. nighttime chill, heavy eyelids). If you’re working night shifts, watch for the sensation of sand in the eyes
  • Keep your bedroom environment calm, dark, and comfortable
  • If you’re still awake after 30 minutes, get up and do a monotonous or repetitive activity that doesn’t require physical effort but does require mental effort (reading, crossword puzzle, sudoku). These activities will tire your brain without physical stimulation. As soon as you feel the signs of sleep, go back to bed
  • Go to sleep and wake up at the same time every day

Diagnosis and Treatment

Sleep-related disorders and sleep apnea can have significant negative impacts on your health and quality of life. These include, but are not limited to:

  • Excessive daytime sleepiness
  • Decreased quality of life (fatigue, lack of energy, social isolation)
  • Weakened cognitive functions (e.g., loss of memory and poor concentration, decreased alertness)
  • Drowsiness increases risk of motor vehicle collisions and workplace accidents
  • Fatigue

There’s no single answer for what’s a good amount of sleep. On average, an adult needs about 8 hours of sleep per night, but for some, 6 hours is enough and for others, 10 hours is required.

Practice good sleep hygiene, including a regular routine before bedtime, as much as possible.

If you suffer from sleep apnea, seek medical treatment; practicing good sleep hygiene can alleviate symptoms but will not make the condition go away.

The Biron team is here to help you. We offer a full range of tests, at home and in the laboratory.

We can diagnose sleep apnea and other sleep disorders and assess the best treatment options for you. Our team of trained sleep care professionals are here to listen to your needs, and will be there for you before, during, and after examinations to provide you with personalized and tailored treatment options that make sense for your lifestyle.

At Biron, we offer a range of services covering all aspects of diagnostic testing. Learn more!

If you have any questions or need more information, please don’t hesitate to call our customer service number at 1 833 590-2715.

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