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Disorders related to breathing during sleep can partially or fully block a person’s airway, leading to several serious issues such as decreased oxygen levels in the blood, elevated blood pressure, and even heart attacks or strokes. These conditions vary in severity, encompassing obstructive sleep apnea, central and mixed sleep apnea, and sleep-related hypoventilation, among others. The most prevalent of these, the obstructive sleep apnea (OSA), affects roughly 20% of men and 9% of women in the United States, marking a significant rise from the estimated 3% in the 1990s. Factors contributing to this increase include higher rates of obesity and asthma, increased pollution, and improvements in diagnostic techniques, notably the refinement of polysomnography towards the late 20th century. Polysomnography, which tracks respiratory airflow and other breathing-related functions during sleep, has become an essential tool for diagnosing this disorder. It also monitors the heart rhythm, brain activity, and eye movements, among other parameters.

Several options exist for treating OSA, the most widespread and efficient one involving a CPAP machine. This choice has been proven time and time again as the most effective and remains a go-to option in most circumstances unless it isn’t adhered to for a period long enough to work. Many people find CPAP uncomfortable and stop using it as soon as their OSA starts to feel better. As a result, the disorder symptoms return in full swing, and a recent study highlights this as the main reason for hospital readmissions among OSA patients. Before we get into the study, we will review OSA and CPAP treatments for some context and clarification first.

Obstructive Sleep Apnea (OSA)

OSA is frequently accompanied by loud snoring, interrupted by periods when the airflow is reduced or blocked. This is followed by choking or gasping for air which usually wakes up the person, but only for a brief moment before they resume sleep. Depending on how often this happens, OSA can be:

• Mild – the episode happens 5-14 times every hour
• Moderate – the incident occurs 15-30 times every hour
• Severe – the event occurs over 30 times every hour

Everybody is at a lower or higher risk of developing OSA, depending on some contributing factors such as:

• Weight. High blood pressure, heart disease, and diabetes are all linked to obesity and known to increase your chance for developing OSA as well.
• Neck size – over 17 inches for men, and over 16 inches for women increase the risk of OSA.
• Age. The older you are, the more chances you have at developing OSA, at least until you hit 60. Statistically, the incidence rate drops after that age.
• Sex. Men are at least two times more likely to develop OSA than women, possibly due to their higher obesity rates and larger neck dimensions.
• Allergies and asthma both increase the risk because of more sensitive airways, increased mucus production and congestion.
• Family history. The exact predisposing genetic factor isn’t known yet, but its existence is evident, given that you are more likely to experience OSA if you have a relative who suffers it, too.
• Retrognathia, meaning that your lower jaw is smaller than the upper one.
• Narrow airways. These sometimes naturally “happen,” perhaps due to a larger than average tongue or enlarged tonsils.

Treatments usually consist of some lifestyle changes and some specialty therapy with machines like CPAP (more about that in a bit).

Lifestyle changes include:

• Weight loss – beneficial for everybody whose BMI is outside of the optimal.
• Switching sleeping positions from back to the side, preferably left, as this aligns the organs and the spine properly while reducing snoring and airway obstruction.
• Avoiding opioids such as alcohol, pills, cigarettes, etc.
• Managing secondary conditions if they are present – asthma or allergies, GI issues or another medical condition.
• Nasal sprays if congestion is what disrupts the breathing.

CPAP therapy

Continuous positive air pressure (CPAP) is a type of PAP treatment most suitable for OSA and some other breathing conditions. It is a machine that is put next to a patient’s bed, connected to a mask they’re supposed to put on at bedtime via a hose. The treatment lasts the entire night. The machine humidifies the air and provides it with high pressure directly into the mask, hence the name. This enables the patient’s airways to remain open, or reduces their obstruction and improves their sleep quality. The duration of this treatment and the specific settings on the CPAP machine depend on the doctor’s prescription based on the severity of your OSA and your overall health. For example, if you have OSA but also some gastrointestinal issue that causes acid reflux, CPAP therapy is not the best option – the air will sometimes stray and pass through the esophagus which is already weak enough, thus exacerbating acid reflux.

Nonadherence to CPAP associated with increased 30-day hospital readmissions

Specialists sought out to discover the effect of nonadherence to CPAP on hospital readmissions expecting to get the general overview of the situation so they conducted this study including 345 patients at the VA Long Beach Medical Center that satisfied the criteria (they were diagnosed with OSA, hospitalized at some point or another from January 2007 to December 2015 and prescribed CPAP therapy). Out of that number, 183 people adhered to their CPAP therapy while 162 didn’t. The purpose of the study was to establish the effect of nonadherence in terms of all-cause, cardiovascular-cause and pulmonary-cause hospital readmissions within thirty days after the initial, index admission discharge from the hospital. Excluded were patients without records of adherence to CPAP therapy and polysomnography to confirm OSA, those who passed away in the hospital during index admission and those transferred to another facility within the same day of index admission.

All-cause readmissions include cardiovascular and pulmonary-cause, as well as other cause readmissions such as renal, urologic, gastrointestinal, neurologic, psychiatric, infection, etc.

Cardiovascular-cause readmissions refer to those of congestive heart failure, coronary syndrome, arrhythmia, peripheral cardiovascular disease, and some others.

Pulmonary-cause readmissions were due to pulmonary hypertension, asthma, hypoxia, obesity hypoventilation, pulmonary embolism, and interstitial lung disease.

The average age of the patients from the adherent group was 66.3 years, and 62.3 in the nonadherent group. This, along with the patients’ sex, BMI, race, environment, and home conditions, the overall state of health and medical history was taken into account before measuring the results. Although the CPAP adherent group was older on average, the expected increase, especially in cardiovascular-cause of readmission, wasn’t apparent. The incidence rate both for all-cause and cardiovascular-cause readmissions was significantly higher in the nonadherent group, and their stay in the hospital was slightly longer, too.

Results

The study confirmed an existing hypothesis that not sticking with your CPAP treatment plan is more likely to get you back into the hospital.

The cardiovascular causes were due to atrial fibrillation (29.0%), myocardial ischemia (22.5%), and congestive heart failure (19.3%), and to no surprise, because these are often the result of frequent apnea episodes and hypoxemia, both of which are neutralized with CPAP therapy.

The pulmonary-related readmissions were also higher among the nonadherent group, but not as much as initially expected, and not of significance to this study.

All-cause readmission unrelated to the two causes mentioned was mostly urologic (10.7%), infection (8.0%), and psychiatric (5.3%). Specialists are just starting to take a closer look into these factors and their association with OSA and sleep in general.

Limitations and critique

Although its significance is notable if only as a single study, this work has faced a couple of flaws from the start and they are worth mentioning for clarification and readjustments for future studies.

For starters, it was conducted in a Veterans Affairs Medical Center, which is a specific target group and not as general as one would hope for a study of this sort. People from this subject group were predominantly white, male, have a lower income, have a history of substance abuse or have a second existing chronic condition. Cause-consequence effect wasn’t completely transparent either, as with most studies. One can’t be sure that CPAP nonadherence was the reason for a future event, only that the event was more likely to happen to people from the nonadherent group, although researchers did include many other contributing factors.

Further, most of the patients who didn’t make the criteria for this study were excluded because of the lack of sleep clinic follow-up within a year after the first hospitalization.  That excludes their results as well, whether they continued the prescribed CPAP therapy or not.

Lastly, because of its small dimensions, the study might have missed some patterns, while some of the patterns noticed could have proved irrelevant on a larger subject group. For this reason, the study remains more a stepping stone for future research, than a sole authoritative source of information.

When it comes to laying the foundation for good sleep, there are several factors you need to consider and tackle. It’s common knowledge how much of an impact a new mattress can have, the necessity for frequent replacements, or how the right pillow has fixed someone’s neck issues, among other things. If you’re relocating, dealing with ongoing problems, or just keen on exploring this topic, you might find yourself swamped by a flood of information and products that were previously off your radar. The variety is vast, ranging from standard bed frames to memory foam mattresses, not to mention countless other specialized products. With so much to sift through, the decision-making process can feel overwhelming initially. Considering how ubiquitous these items are, it’s understandable to think that they’re essential for you too.

People are not wrong to recommend a lot of these items; a comfortable, sensibly designed and uncluttered environment is essential for establishing and maintaining healthy sleep. But the question might have already crossed your mind – what do you need out of all these things to achieve that goal? Do you even need a pillow?

The question you should be asking instead is, does your sleeping position require a pillow for support? Because the answer mainly depends on whether you are a side, back or stomach sleeper, as each of these positions aligns the body differently and needs a different type of support, or rather, support in a different area. A pillow is sometimes necessary, but sometimes does more damage than good.

We will cover sleeping positions one by one in a second to explain what we mean and offer a couple of possible answers.

Side Sleeping

The universally favorite position occurs in three common forms:

• Fetal position, curled-up position, with arms in front or under the pillow, and legs bent in the knees. This position is twice as prevalent in women than men and is reported in 41% of people.
• Log position, featuring straight, stretched out legs and arms naturally falling as if the person was standing up. 15% of people sleep in this position.
• Yearner position, similar to the log, except here the arms are reaching forward. 13% of people reported sleeping like this.

Sleeping on your side is beneficial for a number of reasons: it prevents sleep apnea, snoring, and acid reflux while keeping the spine aligned with ease. This position is therefore optimal for people with gastrointestinal issues or chronic back pain, as well as pregnant women.

However, the downsides include potential face wrinkling and shallow breathing, although the latter applies only to people who sleep in the fetal position. By pulling the knees too high up, or tilting the head downwards, you are restricting your diaphragm which makes it harder to take deep breaths. Other than this, people who have arthritis also tend to have more issues the tighter they are curled up. Luckily, both of these matters can easily be solved if one only remembers to stretch out a bit more than usual.

Do Side Sleepers Need a Pillow?

The answer, in this case, is: absolutely yes, side sleepers without a dilemma need a good pillow. While sleeping on your side (especially left side) is considered the healthiest way to position yourself, without a combination of proper mattress and pillow support, that claim is out of the window. Without a pillow, your head will pull your neck downwards and out of alignment from the rest of your body, and sleeping on your shoulder is another bad idea – you’re likely to wake up with a numb arm, which is even worse because only one side will be affected.

What side sleepers need is a good contouring mattress that allows the pressure points of your body to sink in, and a thick pillow to lift your head to match the rest of your body. Consider either a cervical pillow or a memory foam pillow, which will have a higher loft right below your neck, and lower under your head.

Beware of pillows that are too thick though, as they will tilt your head upwards and cause issues with your back and neck. A pillow too soft will have the same effect as no pillow at all, so choose wisely and try out different kinds to gain some perspective. The good way to start would be to simply measure the distance from your head to your shoulders, then work your way from there.

Besides the pillow for your head, you might benefit from keeping a thin pillow between your knees to relieve some of the pressure from your hips and keep the spine straight.

What to consider when choosing a pillow as a side sleeper:

• Material. The variety is more abundant than one might initially think. Down pillows (filled with geese feathers) are durable, adjustable and lightweight, but not very allergy-friendly, affordable, and often aren’t supportive enough for side sleepers. Down alternatives have a shorter lifespan but are less allergenic. Latex pillows provide good support and keep cool during sleep, but the thickness isn’t adjustable. The list goes on and on; you will have some homework to do before you even get to shopping.
• Thickness. Side sleepers prefer the thickest pillows of the bunch, but that doesn’t mean the super-thick pillow will fit you in particular. Remember that your head shouldn’t be angled in any direction.
• Price. Depending on the characteristics mentioned above, pillow prices can be very expensive or really cheap. But as you just saw, the most expensive ones (usually down pillows) don’t automatically tick all the boxes when it comes to your specific needs. Good quality pillows can be found in all categories, and it all comes down to finding an option that works for you – that might as well be a cheap polyester pillow, as long as you aren’t compromising something important to fit into the budget.
• Firmness. Firm pillows are appropriate for side sleepers. They provide the necessary support and don’t flatten out as soon as softer pillows. It is especially remarkable if you are overweight, as your head would otherwise easily sink into the pillow and the whole point of having one would be lost.

Back Sleeping

About 8% of people sleep in savasana or soldier position (arms are down, legs either both straight or one bent), while only around 5% sleep in the so-called “starfish” position, with their arms above the head. Back sleeping is good for preventing neck pain along with the wrinkling that comes from side sleeping (as it keeps the face open). It also prevents acid reflux. It is not difficult to keep the body in a straight line in this position either. However, back sleeping is known to worsen sleep apnea and snoring (which can directly decrease the quality and duration of one’s sleep), as well as cause lower back pain, if not done correctly. We are just about to address that, too.

Do Back Sleepers Need a Pillow?

Once again, yes. Not as firm a yes as in the case of side sleepers, because there are some pillow-free scenarios that could potentially work for back sleepers. Don’t insist on it though, because the number one option definitely includes a pillow, and here’s why:

Back sleepers naturally have gaps between their neck and the mattress and under the lower part of their spine when laying on a firm or innerspring mattress. The lower back gap can be addressed with the help of contouring or memory foam mattresses, as these allow one’s hips to dig a little deeper and straighten the spine. However, the issue with the neck remains, and this is where the pillow comes into play. If you were to sleep without one, your head would dig into the mattress and leave the uncomfortable room, whereas a big, thick pillow would be the opposite extreme as your head would be forced forward and into your chest. Both scenarios could result in next-day pain or stiffness which could easily be avoided by finding the comfortable middle ground.

A thinner, contouring pillow might be the answer here. It will fill the space as needed, but won’t awkwardly angle your head, ensuring good posture and sound sleep. There are plenty of such options to check out between cervical pillows, pillows with built-in neck support, or rounded pillows similar to those one might bring along to a flight or train ride.

Aside from that, a second, small pillow could be positioned under the knees, much like what side sleepers might use as well, to help lessen the pressure from the lower back. Additionally, another good option for back sleepers would be to place the pillow under the lumbar spine to minimize the back strain.

Things to consider when choosing a pillow as a back sleeper:

• Shape – The most common type of pillows has a full or flat surface and a neutral effect on your body, whereas a contoured pillow might be more suitable for people with back or neck pain as they are elevated right below the neck.
• Price – The range of different models’ prices is wide enough to suit everybody’s needs, just be sure to research them beforehand and not settle for low quality because of the low price. In the end, that money will be wasted, and you will have to find another pillow as your problems won’t be solved. Investing a bit in the start will pay off more in the longer run.
• Thickness – Back sleepers tend to go for pillows around 3 inches thick on average. Do feel free to suit yourself though, as other factors like shoulder width, head size, and weight are also important to consider. Having a pillow that’s a bit thinner or thicker might feel more comfortable, and that is not a bad thing. Don’t follow the general rule blindly – it is just the average, after all.

Stomach Sleeping

With the single benefit of preventing sleep apnea and snoring, sleeping on your stomach compromises just about everything else. The cons include face wrinkling, breast sag, neck and back pain, pressure on joints and muscles, as well as the misalignment of one’s spine. As the center of your weight is located in your core, when you sleep on your stomach, it sinks into the bed and creates pressure on the rest of your body. This discomfort causes stomach sleepers to change positions more often during sleep, resulting in a reduced overall quality of sleep for over 7% of people who sleep in this way.

Do Stomach Sleepers Need a Pillow?

We have finally reached the one case in which an individual might actually benefit from not using a pillow. Sleeping on your stomach is generally viewed as the worst sleeping position for your health. This is largely because of the inevitable curving of your neck which steps out of alignment with the rest of your body. Along with the neck and head problems, additional issues can arise if a stomach sleeper uses a mattress that is too soft or too firm – either the pressure points of their body will sink even lower, or their back and shoulders will be pushed too far out and distort the straight line.

Experts often recommend you sleep without a pillow in this case. For some people, though, sleeping without a pillow can seem strange, as we’ve become so accustomed to having at least one, if not more of them on our beds. If you feel this way, simply buying the thinnest pillow you can find isn’t guaranteed to provide optimal results.

If you do opt for purchasing one, we’ve listed some features to look for below. Additionally, whether you end up sleeping with or without a pillow, putting a second, thin pillow below your hips can also prove beneficial when sleeping on your stomach.

Things to consider when choosing a pillow as a stomach sleeper:

• Thickness – Between 2-5 inches is the preferred pillow thickness of most stomach sleepers. This, of course, also depends on an individual’s weight, shoulder width and so forth, but a pillow thicker than five inches is considered unsuitable here.
• Price – If you are on a budget, it’s useful information to keep in mind here as well that real down models are typically the most expensive types, while polyester pillows are the cheapest. Before you go shopping, figure out a maximum you are okay with spending and do some research on types of pillows to know what you want.
• Moldability – Because of the frequent position switching and the general discomfort of sleeping on your stomach, this is a key characteristic to consider. If a pillow can’t re-shape efficiently to attend to your needs, it’s a clear sign to avoid it and keep searching. Your head should be in a neutral position, facing forward or downwards, like it would be were you standing up. The curved shape of the pillow, similar to the kind you would lie on while being massaged, might prove useful as it will leave some space between your face and the bed, making breathing easier.

In conclusion, there’s a reason that pillows are so wide-spread, as sleeping without one is a bad idea most of the time. Establishing a proper support for your body during sleep might not seem like such an important thing until chronic back pain or a stiff neck changes your mind, but let’s not wait for that to happen – the urgency of the necessary switch in mattresses or pillows will only rush you and potentially make you settle for less.

Are they even real? ― that’s probably the initial thought that crosses people’s minds. And for good reason. Apart from common symptoms like feeling tired and having a decreased ability to focus, there doesn’t seem to be much more evidence to base opinions on. Indeed, the precise workings of sleep remain a bit of a puzzle, even for researchers. Sleep disorders, such as insomnia, often lack a specific root cause. Narcolepsy is somewhat less mysterious but remains baffling. Hypersomnia, and Insufficient Sleep Syndrome, in particular, usually have believable explanations. Generally, they are associated with an individual’s personal choices, behavior, and lifestyle. Yet, these conditions are often acknowledged as symptoms and, once linked with some observable disorder, as syndromes― but the exact causes behind them remain a mystery.

Have you ever tried your hand at guessing why you couldn’t get a good shut-eye the night before some appointment? Why does your headache even if you had? Maybe you’ve written it off as ‘stress,’ ‘anxiety’ or something else, caused by anticipation. Well, you might as well be correct, but the exact problem  ― what caused this negative bodily reaction ― is a probably a tad bit more complex. Going through regular and irregular routines, our sleep-adjustment changes and modifies itself in turn. But what in our body brings this change about? What is it? That’s precisely the overarching question we’d like to share with you.

What Their Discovery Entails

Experts all around the world would relish the chance to get to the bottom of this problem. More than anything else, it would provide a coherent set of measurables. Once measured and ascertained, this problem would be reduced to something more quantifiable. We would have a clearer picture of the exact graphs and numbers behind our sleep and sleeping schedule. And this alone should prove a great impetus to aspiring chemists and doctors. Ideally, the discovery of such a biomarker would give us insight into:

1. The relationship between bodily functions and the quality and quantity of sleep
2. The way certain sleep disorders function in regard to the presence/absence of particular biomarkers
3. Finally, how we might effectively manage these biomarkers and even get the better of them in the long run

Plainly put, these biomarkers would indicate with great precision the many variables involved with sleep. They would show us people’s personal propensity to sleep and the mechanisms behind sleep disorders. Perhaps, but only perhaps, we would even have a glimpse into the anthropological history of  such a mundane activity. The answer is, you’ll have noticed, really of great importance, scientifically. But it is also tremendously important to every non-specialist and us as its repercussions affect that great third part of our lives ― our convalescence in dreamland.

Since a good deal of life is indeed spent dozing off, one way or another, wouldn’t it be nice if we knew why we had to sleep? If that’s asking far too much, then it would be undoubtedly handy if we at least knew what causes it. Is it not true that all mysteries are made to be unraveled. If not that, then at least pondered. It does affect both our memory and mental, as well as physical well-being, after all. And so finding, or coming close to finding sleep biomarkers, might not be just a scientific adventure, chemicals, brains and all that jazz. It might also be a deeply human search for the meaning of our nocturnal and diurnal visitations into dreams. Still, better not get ahead of ourselves!

Sleep Biomarkers, Sleep Disorders and Sleep Debt

Quite a few articles in recent years have shown a correlation between sleep or lack thereof, and the multitude of effects it can have on us. From our daily jobs to personal relationships, and from physical consequences to mental health, it does seem to be one of the pressing issues of the modern world. More and more, in fact. Not knowing how to manage one’s sleep can lead to loneliness, social withdrawal, ill health, and so on. Hence, resolving the issue of sleep biomarkers is fast becoming, if it has not already become, an urgent matter. The pace of life is such that one simply has to optimize one’s sleep or, sadly, suffer the consequences. This is why we’d like to draw attention to this. For the everyman, it could make all the difference between a quality life and one of just ‘getting by’  ― getting by tired, baggy-eyed and wretched.

More to the point, the human body is, needless to say, a complex organism. The intricacies of its many biomarkers and their relationship can be hard to pinpoint. How many times have you felt something ― a back-pain or a headache ― and been unable to specify its cause? Science tells us there are usually several. The same, in all probability, holds true for anything that bothers or enhances our ability to sleep. One thing leads to the next and back again. Many conditions, whatever they are, exist in a sort of link. For example, some studies have shown parallels between ADHD and sleep disorders. Other such cases abound and show us a profound interconnectedness between one facet of our body and another. And this is where we encounter a major problem ― in this vast matrix of cause-and-effect, how are we to determine what is primary and what secondary? Well, no objective methods have been as yet employed on a large scale to give a satisfactory answer. But this is just some food for thought. Raising awareness of this issue is but the first step to solving it, especially in this technology-dominated age. And on that point, it might be wise to consider how tech influences our biorhythm. It is of such profound importance to modern society that it just cannot be overlooked. Indeed, the developments in technical sciences have added yet another layer on top of this. Our biorhythm is less and less in tune with the ‘natural’ world and more and more ‘online.’ For better or worse, this certainly makes finding select biomarkers that much more difficult.

In any case, it can be safely assumed that sleep disorders and abnormalities must have something to do with their putative biomarkers. More often than not, however, they can also be misleading in regards to biomarkers of sleep per se. For example, biomarkers for sleep debt status showed little overlap with previously identified biomarkers for circadian phase. Biomarkers for acute and chronic sleep loss also showed little overlap. We can see, then, that even amongst themselves, sleep disorder biomarkers can diverge into separate categories. If it’s like that regarding relatively similar biomarkers, then we can only imagine how subtle the one we’re searching for is!

In (Re)Search of the Elusive Sleep Biomarkers

So far, there has been experimental research conducted in order to identify the chemical basis of sleep. How? This is done mostly by analyzing subjects in instances of sleep deprivation and chronic sleep restriction or sleep reduction. The samples taken are usually blood, urine, and saliva. And though the nature of these tests is a bit of a hit-and-miss affair, some facts can at least be established.  This study shows several things. Firstly, a change in metabolism has been observed in both humans and non-human animals, as well as certain changes in the bloodstream. Whether this is indicative of a biomarker is questionable. Still more promising, however, is the usual saliva test which has shown reduced mRNA encoding amylase in sleep-deprived patients. This, again, may be a useful signal for showing us the culprit. And many other tests ― the so-called multivariate tests ― have been performed to that end.  These have so far been used to detect biomarkers for cancer and dementia, for example. So they show some promise, despite the rather more complex nature of the biomarkers we’re talking about.

The main problem with this is the very nature of sleep. It is an emergent property of the brain that takes over when enough cortical columns go to sleep. There is not a point in time in which all ‘shut down’ ― some are always active. Thus the presence or absence of certain chemicals in the blood/saliva is simply not precise enough to determine, by itself, whether a person is asleep, or even sleepy. And even if handled with greater precision, this method still sorely lacks the ability to specify what the trigger was. So the specific biomarker again eludes us.

An even more perplexing issue emerges, however, when we take into consideration variable daily sleep. It is become all the more common, especially for younger people, to have flexible sleeping schedules. This is, technically speaking, unhealthy. Not only that, but it appears that it can further muddle the precise nature of the underlying sleep biomarkers. Apparently, changing your sleeping schedule can shift the balance of bodily and sensory secretions. However, bluntly put, it is most noticeable when going to bed later than usual. This is as apparent from changes in body temperature and specific inflammatory functions. From this, we see that sleep variability is associated with a biomarker strongly influenced by sleep and circadian regulations. So we can see the change, yet again, and what set off at least one biomarker ― the one showing a shift in sleeping behavior. Alas, though it may exist, no study has yet shown us what it is exactly. Who knows? It might even be that it’s not a single biomarker, a sole culprit. Perhaps it is. But then again, it just as well might be a whole array of processes that bring sleep about. After all, there is so much we don’t know about it. Besides the peripheral knowledge of what influences sleeping, the question still stands open.

Sleep or Sleepiness Biomarkers?

Could it all be a mistake? ― would be the appropriate punchline. Well, not quite. But I would draw your attention this anyway. Namely, what’s been so far neglected is the rather significant difference between sleep and sleepiness. And, of course, the difference between their biomarkers. That is if they even correspond on a one-to-one basis. A die-hard skeptic may also ask, ‘Do they correspond at all?’ In certain points, sleepiness and actual sleep are assuredly linked, however tentative that bond may be. But as to whether one leads to the other  ― well, let’s get down to that.

All of us yawn, and most of us yawn when other people yawn. It is also one of the most socially-recognized cues that one is tired. The latter has little scientific backing, though. Still, this is what most people would conjure up when asked what they thought was a prototypical sign of sleepiness. And the relationship between sleep and sleepiness is just as deceptive as this. This is why I’ve mentioned yawning, as a sort of symbol for this divide.

Droopy-eyes, on the other hand, is a quite clear indication of one’s fatigue. You can be as dopey when utterly tired as when you’ve had an excellent meal (and a lot of it). In the first case, if one is genuinely exhausted after a long day, this might be indicative of a biomarker playing its part. But is it the sleep biomarker, and is it possible to differentiate it from the others? In the second case, we might be tempted to say that the lack of blood supply to the brain is responsible. And partially it is. But how then to separate this biomarker of a metabolic function, i.e., digestion, from another that is, nonetheless, noticed by us through the same symptoms — droopy eyes, in this case.

Conclusion

The precise sleep biomarker or biomarkers remain an enigma. But a less puzzling one, we would like to think. To wrap this up, we do hope this article has offered its readers some good food for thought (from which you won’t get droopy eyes!) and stimulated them to think about the role sleep plays in their own lives.

When it comes to diagnosing sleep-related issues, Polysomnography, commonly referred to as PSG, is considered the gold standard. It’s only fitting that it leads the discussion in an article about such monitoring devices. PSG is renowned for its capability to identify indicators of a range of sleep disorders, from the less severe to the more serious conditions, including obstructive sleep apnea, periodic limb movement disorder, and narcolepsy, among others. This has made it extremely popular and widely used worldwide. Polysomnography tracks several different functions that take place during a person’s sleep:

Eye movements via electrooculography (EOG);

Brain activity via electroencephalography (EEG);

Heart rhythms via electrocardiography (ECG);

Muscle movements via electromyography (EMG).

Besides these aspects, PSG frequently measures blood oxygen levels, respiratory airflow, and includes video or audio recordings to detect patient’s body movements and snoring.

This study is performed in a laboratory during the night, or at a customized time window to accommodate the patient’s usual bedtime circumstances (useful for people with circadian rhythm disorders who sleep at different times of day or night compared to the average nightly bedtime), and its results are reviewed by a licensed professional.

Despite its wide utility, PSG’s high cost and the mere inconvenience a lab sleepover poses for the patients have prompted the discoveries and development of many novel devices similar in purpose, but versatile in logistic aspects and indications of use. Many of them carry potential clinical value, but the particular interest among the audience has arisen for at-home sleep monitoring gadgets. Hence will they also be the focus of our attention in this article.

Devices for Sleep Monitoring at Home

Although the idea is relatively new, home-based sleep monitors are already quite a few, and the numbers are only expected to grow. They mostly target breathing abnormalities and circadian rhythm deviations; most are worn somewhere on the individual’s body, and some aren’t even initially meant for sleep scanning purposes, but their targeted aspects may also be sleep-informative. The devices we will discuss in some depth can be categorized into the following categories, depending on the way they work:

• Monitoring based on brain activity
• Monitoring based on autonomic signals
• Bed-based monitoring
• Monitors based on body movements
• Devices with “accidental” sleep-monitoring properties, or other devices

Sleep Monitoring Based on Brain Activity Signals – ZEO

This exemplary device works via a headband that is intended to be worn during sleep. It detects electroencephalogram (EEG), electrooculogram (EOG) and electromyogram (EMG) signals through the night and transfers them to an iPhone or similar receiver station for analysis.

Zeo was evaluated in research where healthy adult subjects underwent polysomnography while also wearing the headband. The results showed around 75% of overall matching between the screenings from PSG and Zeo. Such a study wasn’t conducted on patients with diagnosed sleep disorders, so the accuracy of Zeo monitoring isn’t known – the possible effects of medication, as well as opioids like caffeine, cigarettes or alcohol on Zeo’s precision,  aren’t yet explored. Still, the device may be useful to have in a sleep disorder-free household if only to keep track of one’s general state.

Sleep Monitoring Based on Autonomic Signals – M1

A representative model in this category is M1 (SleepImage). Working via a patch containing a wire electrode that one wears on their chest, along with a small processing unit, this device records ECG signals, actigraphy, and the person’s body position. A limitation established with this model is the fact that some people don’t have a typical response to ECG – such is the case with patients experiencing autonomic dysfunction and some types of arrhythmia.

Bed-Based Sleep Monitors

EarlySense Mattress is indicated to be placed under one’s mattress to measure snoring, coughing, heart rate, respiration, and body movement.

Air Cushion is a pressure-sensitive thin cushion that you are supposed to put on top of your mattress. It measures heart rhythm, snoring, respiratory airflow and movements you make during sleep. Compared to PSG screenings, wake and NREM stages are accurately scanned by the Air Cushion the majority of the time, while REM was correctly displayed only about 38% of the time.

Home Health Station (TERVA) is a more complex system that screens and shows heart rhythm, respiratory airflow, blood pressure, body movements and even contains a diary for subjective entries of the individual who is only to position this station somewhere in their house. It has been shown to provide accurate results for sleep-wake differentiating and also was able to record a significantly increased disordered breathing rate in sleep apnea patients versus the people who don’t have this disorder.

SleepMinder is a sleep monitor placed above and near the bed, preferably in the radius of less than a meter away. It works by measuring movements through a radiofrequency monitor and is estimated to recognize slow wave sleep in 96% of the cases, although it has some issues with identifying REM and NREM sleep phases. Much like other movement-measuring devices, SleepMinder overestimates the amount of time a person spends asleep, which makes sense seeing as how one usually stays still while first attempting to fall asleep.

Touch-Free Life Care (TLC) is a wireless data transmitting system that works via a device placed below one’s mattress. It screens heart and respiratory rate as well as one’s activity during sleep but requires a more careful examination and validation from experts.

Other Devices

This category includes many gadgets that weren’t initially intended for sleep surveillance like SmartShirt or Zio. SmartShirt is a T-shirt that has sensors in the cotton material which track heart rhythm, body movement and one’s temperature in real-time. Zio is a gadget designed to scan cardiac arrhythmias and heart rate via a patch with two electrodes intended to be worn on one’s chest for up to 14 days.

Device Hardware and Software Issues

For an at-home sleep surveillance method to work, it needs to live up to certain standards. Cost and convenience are two essential factors to keep in mind, as patients could simply undertake PSG if these two didn’t present as difficulties. A device that is to be worn by a person needs to be light in weight and comfortable to a degree to ensure they won’t be reluctant to keep using it after the initial time. Further, the software needs to provide information in a form that anybody could understand with minimum guidance. If a person is to receive their results in a complicated, technical language, they will get discouraged from using the device or misinterpret the feedback it provided. Clarity is key with such sensitive information.

Combining the Objective and Subjective

Doctors are used to complementing PSG with a sleep diary to make up for the personal angle that PSG lacks. Not only does the sleep log make sure patients don’t forget to mention an important medical event, but its two or three weeks minimum duration creates enough of a chance for a visible pattern to form. Potential circumstantial events that would have been confusing in a single-day model can thus easily be spotted and disregarded. This harmonious combination should be the aim of all home-based sleep monitoring systems. The setting in the patient’s home would automatically eliminate the sterile atmosphere encountered during a lab sleepover while keeping track of specific bodily functions and their fluctuations. On top of that, a sleep log provided as a second part of the procedure would cover for the personal outlook moment, and the whole system would be able to last as long as necessary to eliminate “accidentals” and leave only real, contributing factors.

Of course, such an ideal mechanism remains out of reach so far but is a goal in mind for the development of future tools and devices.

How Do We Measure “Normal”?

By now, everybody knows the rule of thumb that adults need an average of eight hours of sleep per night in order to function to their best ability. Uninterrupted, quality sleep is what we are all going for, but measuring how long a person has been asleep, or how long they spent in various stages per night isn’t enough to tell whether their sleep is normal, let alone optimal. The tendency of researchers to combine the total of time one had spent in each stage during sleep and view them as blocks to compare amongst one another is still present and often harmful. Such a practice disregards the importance of the number of transitions between phases and their order, which can very well be the indicator that something is wrong and help with diagnosing a sleep disorder. For instance, patients with sleep apnea tend to rush through sleep stages and switch between them many times during the night. However, the total amount of time the person cumulatively spent in each phase will summarize to the same amount as that of healthy sleep and their apnea, characterized by fragmented sleep, might pass under the radar.

Furthermore, many medications and stimulants have been shown to interfere with and even suppress some sleep phases (REM and slow wave most commonly). Other factors like a person’s age, overall health state, other present conditions, immediate environment, etc. must all be taken into account as well to neutralize the otherwise out of context results, but these variables have their own dimensions, and it’s their average that’s used as the reference.

To summarize, perfectly correct algorithms don’t exist, and we can only get so close to calculating exact measurements of optimal sleep. Experience-based predictions and statistics are all we’ve really got in our arsenal when faced with such issues.

Device Validation

All measuring devices are evaluated based on how they compare to the “golden standard” which is PSG. Although the best we’ve got at the moment, PSG itself scores about 85% when it comes to precision and reliability, which automatically affects the validity of other devices measured against it.

Other than that, all of these devices simply register the events in one’s body, but don’t necessarily indicate as to why they might occur, or take into account the influence of another present condition or external factors such as age, sex, body mass index (BMI) and so forth.

Most of these devices measure relatively correctly the time spent awake and asleep but have issues distinguishing between exact stages, the REM stage being particularly tricky. A generally accepted time frame of stage duration is thirty consecutive seconds. If a monitor measures intervals as longer or shorter than that, the results might present differently, and comparison to PSG will be more difficult.

Finally, it is crucial to note that these devices get developed faster than specialists are able to test them thoroughly and validate them. Using a monitoring device at home can be helpful for an individual to grasp some basic knowledge about what goes on in their sleep, experiment with their routine and potentially notice when something goes downhill, but these gadgets, in reality, are as efficient as a weight scale or a thermometer (but less accurate). They are by no means intended to replace sleep clinic appointments, studies, and diagnostic procedures! Even if there were a home-based sleep screening system as sophisticated as PSG, sleep specialists would be the ones to review and analyze the collected data, diagnose patients and plan any future action.

The verdict on at-home sleep tracking systems is that, albeit more lazy and practical, they aren’t to be overestimated and used without consultation with professionals. Most of the gadgets one comes across on internet platforms haven’t yet been validated, so patients need to be cautious and responsible. If you suspect an issue, reach out to a sleep doctor. Not only are they trained to know all the problems related to the individual aspects of diagnostic criteria you may have only heard of, but they will also know how best to combine them in order to take the most advantage of them, all in your benefit.

The field of sleep science has vastly expanded its knowledge on sleep disorders compared to what was known twenty years ago. Beginning with the initial identification of phenomena like nightmares, sleepwalking, and sleep talking, we now have a sophisticated categorization of more than 81 distinct disorders. This considerable progress owes much to groundbreaking advancements in technology, enabling the development of refined scanning technologies, more precise diagnoses, and a deeper, more nuanced comprehension of the various sleep disorders. Innovations and in-depth research, including polysomnography, have propelled the field forward remarkably, making it possible to identify even the most subtle symptoms that are crucial for accurate diagnoses.

However, as advanced as they are, these methods of diagnostics are often not the first or only steps in identifying sleep disorders. Reasons for this are a few: polysomnography can be expensive and requires a person to sleep over at a sleep clinic, which is not always necessary – for people whose symptoms are milder, this study won’t be cost-effective and might merely be an inconvenience. Besides that, this type of study isn’t able to identify all sleep disorders – people with insomnia often won’t find much use having polysomnography done. For these reasons, specialists at clinics leave such tests as a last resort, unless something changes their minds before. Polysomnography, in particular, is the one sure way to diagnose sleep apnea, and if a doctor suspects this disorder, or wants to eliminate something potentially as urgent, they will request polysomnography.

In most cases, doctors will start a patient with some sort of a questionnaire, physical examination, and above all, medical history. This step is crucial for any diagnosis and future treatment plan, as inaccurate history might result in serious complications. Here’s what it is.

Medical History

One of the first steps in every possible appointment scenario in a sleep clinic will include you talking about your medical history. Pills you may or may not be taking, past medical events, allergies, psychiatric or other medical conditions need all be discussed with your doctor prior to any plan of action they may propose. This is not just to initially engage you in a conversation; all of the factors mentioned in this category have the potential to either make your diagnosis faster and easier. Not only do you risk leaving your condition untreated because of the potential lack of diagnosing, but the treatment for a wrong disorder may make matters even worse.

Medication and Substance Use

If your doctor manages to diagnose you correctly based on your symptoms even with the incomplete medical history, the prescribed treatment could still put you at risk. Let’s say you’ve just been appropriately diagnosed with a rather severe case of insomnia. You have been working at cognitive behavioral therapy (CBT) for a while now, and your symptoms still aren’t under control. After perhaps attempting another treatment route, your doctor decides it’s time you gave prescription sleep medication a shot. Only, they don’t know you stopped another medication just weeks ago. You may have forgotten to mention it, thinking that it wasn’t important, or that their effect would have passed by now. As a result, the combination of those leftovers and the new sleep drug you were just prescribed may wreak havoc on your entire organism.

To avoid such a scenario, currently used sleep and other meds, as well as those used in the past or recently stopped, need to enter the medical history. Medications like beta-blockers, sedatives, bronchodilators, and glucocorticoids can all be sleep-disruptive, too, and as such need to be considered when identifying a root cause of a sleep issue. It isn’t uncommon for high blood pressure drugs and medications for respiratory problems to have a side-effect on sleep.

Caffeine, nicotine, and alcohol are all linked to poor sleep quality. The first two stimulate you and prolong sleep latency, while alcohol is a depressant that may get you to fall asleep, but it disrupts it later. Antihistamines have a sedative effect, and some over-the-counter drugs that contain ephedrine can also cause sleep delay. These substances are relatively addictive, too, and abruptly stopping their consummation after a prolonged period of using them can cause problems, and even some withdrawal symptoms.

Another Medical Condition

Lack of treatment of another medical condition may also worsen sleep, which brings us to the next point. A sleep issue or disorder may be primary (unrelated to some other condition) or secondary (related to another, root condition present in an individual). This means that the sleep issue is directly caused by this other condition, which means it can’t be treated alone – the cause must be addressed first. For example, if your insomnia coexists with depression, treating just insomnia won’t be practical or attainable.

In some cases, treating both at the same time is possible, and sometimes even the treatment for one might accidentally help ease the other condition, too. Such a case may occur in patients who are diagnosed with asthma and obstructive sleep apnea – continuous positive airway pressure (CPAP) therapy, used to treat apnea, also aids nocturnal asthma symptoms. This picture goes downhill quickly for some other combinations, like GERD and obstructive sleep apnea (OSA). The same CPAP therapy that was just a one size fits all causes further damage for people dealing with acid reflux problems; the pressurized air meant to keep your airways open and treat OSA might send the air through your esophagus in a detour. This stomach-gateway muscle is already weakened if you have GERD and even worse with CPAP therapy, resulting in your stomach acid traveling the upwards to your mouth easier than ever.

Psychological history plays the next role in the story. This should include your overall state, mood, stressful events in home and work environment, etc. If you have a bad spell of insomnia right after getting divorced, this is no surprise, and mentioning it will save everyone the unnecessary tests and evaluations. You will probably still be required to fill out some questionnaire or otherwise be briefly checked just in case, depending on your symptoms, their duration, severity, and so on. Other than psychiatric illnesses, some health conditions that regularly disrupt sleep include heart disease, endocrine diseases, respiratory conditions, menopause, gastrointestinal issues, etc.

Subjective Overview and Steps to Take

After this, your doctor will want to know about your sleep habits, the position you predominantly sleep in, your exact issues (like whether you can’t fall asleep or keep waking up, etc.) and your basic, subjective grasp of what’s happening. To make things much more comfortable, the doctor may ask you to keep a sleep journal.

Here, you are to write and describe everything you experience within at least two or three weeks:

• how fast you fall asleep
• how many times you wake up and at what times of night/morning
• how you feel upon waking
• whether you are tired during the day
• what else you feel
• what issues you face
• how you go about your bedtime routine etc.

Anything you can remember counts – your doctor knows this will be subjective and possibly not precise, but you will still write down much more than you would be able to remember cumulatively while being interrogated at the clinic.

This is something you can do even before you schedule your first appointment, especially if you are hesitant about it. If it’s written, you are sure not to miss mentioning it. To make the journal even more useful, it is recommended that you ask your sleeping partner, parent or other household members to write a parallel one as well. This will provide a significant angle outside of your own, as you might not remember some things that happened during your sleep – your spouse may notice sleeptalking, walking, snoring, choking, etc.

Sleep hygiene is something else you can work on before scheduling a doctor’s appointment. Some of its elements you’ve undoubtedly heard of many times:

• Set a bedtime at the same time each day, and get up at the same time in the morning, too. This will train your mind to expect sleep at a certain moment and over time, improve your sleep latency. Waking up at the same time every morning benefits you the same way; as your body gets used to the schedule, you might not even need an alarm after a while, as your body will automatically be alert in set time.
• Set up a calming evening ritual. You may have attempted this before but got overly excited, wrote an endless to-do list instead of a few steps worth routine and then threw it away altogether after a week. What you should do is set up such habits that you won’t want to procrastinate and delay sleep as a result. Only do what needs be done but is attainable – maybe not an hour-long bath, but a shower and a 15-minute meditation. Perhaps just getting into your pajamas, brushing teeth and reading a calming book. You know yourself best.
• Adhere to the treatment of another existing condition. If it wasn’t clear enough before, you can’t expect to have optimal sleep, if you don’t take all of the present issues seriously.

Diagnostic steps that follow the medical history

Doctors will often give sleepiness tests and questionnaires for patients to fill out as a personal outlook on the matter. The Stanford and Epworth sleepiness scales are just some of the most common tests of the sort. A sleep log serves that purpose, too, but it takes some weeks before its information gains significance. If you haven’t started it before reaching out to a specialist, they might still advise you write it, if only to keep track of progress.

Multiple sleep latency test (MSLT) is the golden standard of sleepiness measuring tests. A patient is given opportunities to nap throughout the day, but for no longer than an hour. How fast they fall asleep, and whether or not they reach the REM-stage can tell us how sleepy they are and what type of disorder may be present.

Next, you may be prescribed a sleep monitoring device like an actigraph. Worn around your wrist or ankle, this machine records your movement during sleep to provide a more complete picture of what your body goes through at that time. It is usually prescribed if polysomnography isn’t available, affordable or necessary.

Finally, polysomnography is as advanced as sleep monitoring gets. A patient is required to sleep over at a laboratory for the night while this machine records their brain activity, heart rate, blood oxygen flow, respiratory airflow, and more. A licensed sleep specialist looks after the procedure and reviews the results.

Inequality persists in various forms around us, encompassing aspects like race and economic status, among others that might not immediately come to mind. It appears that sleep quality also falls under the influence of one’s race, socioeconomic status, and additional factors. Individuals with lesser financial security are often found to get less sleep than those with more wealth. Moreover, on average, black individuals experience shorter sleep lengths and poorer quality than Caucasians. We’ve attempted to uncover the reasons behind this disparity, so continue reading if you’re interested in understanding more about the sleep disparity in America.

What Does Research Say about This Link?

The CDC regularly conducts surveys to assess health status across the USA. In the latest survey, almost 500,000 adults all across the country reported about their sleep patterns as well. The results show that one-third of adults are not getting the recommended minimum of 7 hours each night. That is a very troubling fact, and that’s why a public sleep quality improvement is one of the current health priorities.

The CDC also compared some socioeconomic factors to see if there is any relationship with the sleep quality of individuals. Specifically, they looked at how poverty affects rest. They defined poverty status in comparison to the federal poverty threshold, which was $11,670 for a household with one individual, and a $23,850 for a four-person family. There was a direct correlation between poverty and the quantity of sleep. Household income below the threshold had 33.6% of people sleeping less than 7 hours a night. Income from above the threshold to 2x of poverty limit had 32.2% of people with insufficient sleep, while these numbers are 30.4% for people with a salary of 2x to 4x the poverty threshold, and 26.8% for those of 4x and above.

The CDC also found a link between racial background and short sleep. It looks like white people sleep the most, while Native Hawaiians and Pacific Islanders are found to have the least rest. Here is how other ethnicities compare:

Depending on the employment status, students and homemakers sleep the most on average, 69.5% of the respondents reported to sleep more than 7 hours. Only around 50% of the people who aren’t able to work stated so, while for retired and unemployed individuals, the numbers are about 60%. 65% of employed individuals got sufficient rest daily.

The education levels showed some impact on sleep quantity as well. Individuals with a college degree or higher reported to have more sleep than people with some college, high school, or less than that. Marital status was also included in the CDC survey. It showed that married people sleep better on average, followed by the members of unmarried couples, singles, and the least amount of sleep was reported by the divorced, separated, and widowed people.

Other research on the link between ethnicity, socioeconomic status and sleep is consistent with the results from the CDC. Despite the incredible improvement in health care in the last century, there is still a higher prevalence of some conditions between socially disadvantaged populations. Diabetes, asthma, cardiovascular disease, HIV/AIDS, and tuberculosis are more common in African Americans and Hispanic compared to non-Hispanic Whites. Even after adjusting for education and income, there is still a higher prevalence in these populations, which means that they are affected by a number of things. Such health disparities are most likely a combination of structural, psychological, physiological and behavioral differences between the populations. Environment and education play a huge role in improving public health, so teaching the public about these conditions, how to prevent them, and how to spot the initial symptoms, and ask for the professional help is crucial.

A 2010 study found a strong relationship between ethnicity, income levels, and sleep. African Americans and Latinos who participated in this study was over 50% more likely to have poor quality sleep compared to white individuals. Those below the poverty level were also three times more likely to experience poor sleep, than the wealthy participants.

A smaller study looked into differences in sleep architecture between the African Americans and Caucasians, and the results were quite surprising. Black individuals spent more time in Stage 2 of light sleep, while they spent less time in Stage 3, which is also known as deep sleep. The difference was about a little more than 5% in Stage 2, and a bit less than 5% in Stage 3. Deep or slow wave sleep is crucial for body rejuvenation. It is the time when the brain does the needed maintenance, and when muscles and different tissues around the body are repaired. Slow wave sleep is also vital for good cognitive performance, so when you don’t get enough of it, your memory is impaired, you can’t focus as good, and you have a decreased ability to learn new things. Individuals who reported experiencing more discrimination spent less time in deep sleep. That means that stress plays a huge role in sleep architecture and that it needs to be looked at when studying sleep habits.

Another study from 2008 investigated this link and found similar results. They measured sleep patterns using polysomnography, actigraphy, and also sleep questionnaires. Black individuals needed more time to fall asleep; they rested for a shorter durations, had more disturbances that led to fragmented sleep, and spend less time in slow wave sleep. Researches tried ruling out the socioeconomic factors in the statistical analyses, and the results between different ethnicities persisted. That isn’t quite usual, as most of the research on this topic found that the difference is mostly due to those factors. However, the authors acknowledged some limitations to the study, such as smaller sample size, so further research into this link is still needed.

A review from 2015 looked into all the research of the topic. The study pointed out the use of a “race” as a category in this type of studies, as there is a debate going on in a scientific community about this. The race is not a biologically supported category, as there are no evident genes, features, and other markers that would make a difference between the races. There is more variability between individuals of the same race than there is between races. That would mean that this is more of a social construct and that the following sleep problems are a result of socioeconomic factors. Ethnicity might be a more suitable alternative, as it includes shared history, culturally and usually a geographic ancestry.

Besides this, they looked into the literature of how ethnicity, social, environmental and other factors impact sleep. They found out that non-whites slept less on average, had more difficulty falling and staying asleep, but also that they were a lot less likely to report the sleep problems. There is also a higher risk among the African Americans of having a sleep-related breathing disorder such as sleep apnea. They suggested many possible explanations for these findings, including socioeconomic factors such as income, education, and marital status, as well as the environment, culture, various stressors including discrimination, and many other things. They also suggested that additional research is needed to unpack this relationship between ethnicity and sleep quality further, and they propose to look at the more socioeconomics and other factors that may play a vital role in this link.

What Is the Reason for This Sleep Gap in America?

It looks like the problem is not that people who are at the social disadvantage don’t know about the good sleep hygiene, it’s just that they have a much harder time enforcing it. It is a cyclical problem; disadvantaged people face more obstacles to getting the right amount of sleep, and then insufficient sleep also prevents them from performing in the best way they could. Some of these obstacles are:

• Less time for rest. Poor people often have to work multiple jobs to make ends meet. When you are working daytime, and also a night shift, there is just not enough time when you can rest, even though you might feel exhausted. Due to lower income, people are also made to move more to the outside of the city, where the housing is cheaper. That means longer commutes to the jobs that are usually located at the center of the town. Even if using public transportation, which is a cheaper alternative than driving a car to work, longer commutes just cost too much. That additionally takes a toll on an already limited budget. It is estimated that 10-15% of American work multiple jobs, and as much as 60% of them sleep for fewer than 6 hours on a weeknight. People working various jobs have a disrupted circadian rhythm because they are more likely to work more extended hours and also later at night. This decreases performance and increases the risk of job-related injuries. People working shifts are at the highest risk of this since having to stay awake at night brings a lot of consequences. Switching day for a night might not seem like a problem when you are young, but the chronic sleep deprivation is awful for your health.
• Poor health. Unfortunately, higher quality food costs more, and because of that, people who struggle with money often go for lower quality options. That usually means high sugar and fat content, and junk food that is terrible for overall health and sleep. Less sleep also makes you crave unhealthier food and increases your appetite. That leads to weight gain and obesity, which is linked to a number of health conditions like diabetes, high blood pressure, and cardiovascular diseases. Obesity is linked with sleep-related breathing disorders, like obstructive sleep apnea, and it also leads to snoring. All of that results in the decreased quality of sleep, and overall quality of life in general. To make things worse, these people often don’t have health insurance to cover the treatment of their conditions. That’s why they often ignore the symptoms as they can’t afford to treat them, and that leads to worsening of the situation. Poor people often seek professional help when the diseases progress so much that the treatment is much more complicated. Mental health disorders are much more common among poor people, especially the homeless. 25% of the homeless have some mental condition, compared to 6% of the general population. Sleep problems go hand in hand with conditions such as depression, anxiety, and bipolar disorder.
• Home environment. Non-white people often have a hard time finding better jobs and housing due to discrimination. Housing and job instability leads to increased stress in the family, which can affect children the most. A stressful home environment can make them sleep less, which additionally impacts their cognitive performance, meaning that they have more troubles with homework assignments and keeping up with school work. That leads to impaired academic performance and worse grades. Poorer neighborhoods also tend to be more crowded, noisy and light polluted. All of that makes them a bad sleep environment since it ideally should be dark, quiet, cool, and free of any distractions.
• Increased stress. Racial discrimination is a huge stressor. Additionally, housing and food insecurity are growing stress in more unfortunate people. When you always have to think about what are you going to eat tomorrow, how to get the next months rent, and whether it is safe to walk in your neighborhood, it is hard to fall asleep. When you are under stress, your nervous system is active, and you produce some hormones like cortisol that are keeping you more alert. That’s why people who live in safer areas, and with a steady income have better sleep quality.
• Lower education. People with a college or a higher education degree usually sleep better than those with lower education. It makes sense since education usually correlates with income. That’s why a good education is the best way for the more unfortunate people out of poverty, but it is hardly achievable due to the extremely harsh conditions that they are facing.

Sleep inequality is a serious problem in America and fixing it will take a lot of work. We need the core changes in our system and an active fight against poverty and racism. Doing this, combined with stimulating people to get more education can improve public sleep quality, and overall health and quality of life as well.

In the sleep product industry, gel-infused memory foam has often been lauded for its ability to keep things cool, but one might wonder, just how effective is gel at cooling, and how does it stack up against traditional memory foam? What sets them apart, and why isn’t gel used in all memory foam items if it offers more benefits than those lacking it?

Sleeping cool is a relative term since it depends on various factors including the individual feel of what is hot or cool for someone, body temperature, room temperature, and so on, but somehow it became preferred and desired feature of mattresses and pillows. We usually have issues with hot temperatures during the summer nights, and since sleeping with AC on is not recommended, even a slightly higher temperature can keep as awake in bed. Having a cooling gel-infused mattress does not necessarily mean that sleeping on top of it would be as cool as sleeping on ice; instead, it should help with heat regulation which is something that regular memory foam material struggles with.

Memory Foam 101

Before the memory foam revolution, we were sleeping on feather-stuffed pillows and spring mattresses, which we all quickly forgot in order to try out this new and revolutionary comfortable material. We opened the door of our bedrooms to memory foam during the 80s and 90s, quickly after NASA developed their first products from this material. While trying to improve the safety of air cushions, NASA created this temperature-sensitive foam, which subsequently became widely used for many different purposes.

Also known as viscoelastic foam, memory foam is a type of foam which reacts and molds in touch with body temperature, and since it contours the body so well, it became popular material among many mattress and pillow manufacturers. At first, it was mostly recommended and used for medical purposes as it was claimed that it could alleviate aches such as back pain, or be beneficial for people with fibromyalgia. Heat-retaining feature of memory foam made it suitable for people who deal with chronic pains since additional warmth can decrease the aches.

But, as much as it can be considered an advantage, that extra heat provided by memory foam is mainly a disadvantage for most sleepers. Companies and manufacturers of memory foam pillows and mattresses tried solving that problem by releasing the second generation of memory foam products, designed with open cell structure to enhance the breathability. Since that was not enough, in 2006. the third generation of memory foam sleep products was introduced, and they consisted out of gel-infused visco foam which was supposed to deal properly with heat regulation finally. After the development of gel memory foam, other components have been frequently added to it to reduce the odor, some of them are aloe vera, silver-ions, activated charcoal, green tea extract, etc.

Gel Memory Foam

Gel-infused foam is probably the most innovative foam on the market, it has all the benefits of regular memory foam, but it does not heat up as quickly. The way material feels is the same, amount of nice and even body support and motion transfer isolation is also the same, so basically adding gel did not cause any change that would significantly affect sleepers experience of sleeping on a memory foam pillow or mattress in terms of form, comfort, and support. It is still the same memory foam just mixed with gel microbeads.

However, different brands use various ways to incorporate gel into memory foam; some insert a gel-pad layer beneath or on top of other foam layers, others insert gel beads into foam or pour it onto foam while it is setting.

Gel microbeads create a structure similar to the design of open cell memory foam, providing that much-needed extra space for airflow through the foam. In that way, more heat can be drawn away from the body in addition to the heat already absorbed by the gel, but the efficiency of heat regulation depends on the quality and the amount of gel which was used.

Two types of gel can be incorporated in the foam this way. The first one is thermally conducted, which feels cool at a touch, almost as a stone countertop. The second one is phase-changing material which transforms from a solid to the liquid condition once it gets in contact with body heat and can store and release heat within the specific range of temperature, regulating the temperature as the body cools down during the sleep.

Besides the fact that it can contribute to heat regulation, gel microbeads also contribute to the density of the foam, which will add up to its durability and comfort. But, in terms of durability, it has been proven that gel-infused memory foam mattresses can degrade quicker than the regular ones due to the amount of gel beads. The level of degradation varies and depends mostly on the size of gel beads, larger beads are more likely to break the cellular structure of a mattress over time. Another concern is the heat regulation which does not last as long as some sleepers would expect, and we will discuss that topic separately below.

When it comes to price, people are often willing to pay more for greater quality and durability, especially if it is up to something essential that they have to use each day, such as pillows and mattresses. Gel foam products come with a slightly higher price than the ones made from regular memory foam, so there is no significant difference in cost, but keep in mind that the gel foam can deteriorate faster, so seek for the one with smaller gel beads, or go for the regular foam if you do not tend to sleep hot.

Besides all-foam products, gel material can also be founded in some hybrid mattresses which include a layer of gel memory foam in their comfort system. Also, there are some gel-infused latex and polyfoam mattresses.

Is Gel Memory Foam Cooler?

Memory foam products over flooded the market, but most consumers agreed in one thing, they overheat and sleep hot on them, that is why gel-infused foam and its heat regulating abilities fall under top innovations in the industry. That cooling claim became the key selling point of memory foam products since many are willing to pay more for that enhancement. But, there are yet no official or science backed up evidence that gel can impact heat regulation that much, although the idea of using a gel to cool down dense foam is somewhat scientific.

Liquids can be an effective way of cooling down the surface, and since the gel used for memory foam products is a semi-liquid, it can draw away the heat from the human body. But, the question is, what happens with that heat, where does it go? The thing is, this semi-liquid is not able to evaporate, so it just stays there with the temperature of its surroundings. Gel encased in memory foam will quickly adapt to the temperature of the foam around it, it will probably warm up slower than the regular foam, but in the end, it cannot stay cool during the entire night. So at first, gell will take on the room temperature, which is cooler than the temperature of our bodies, that is why at first when we lay down on gel memory foam mattress or pillow, we might think that it is indeed cooling, because opposed to our warm bodies it does provide somewhat cooler feeling and temperature. However, sooner or later, it will reach and match the temperature of our body, and that cooling effect will fade away.

One more important thing to look after is the amount of gel infused in the foam, lower percentage of gel will have little or no effects of cooling, and some mattresses with such low percentage of gel perhaps do not have it at all. Anything below 30% is not enough to provide the “cooling” benefits at least during the first period of bedtime while you are trying to fall asleep.

Although most brands continue to sell their products under the claim that gel-infused foam products are cooling, recently a few studies which refute those claims have shown up. For example, one of the foam manufacturers, Cargill, performed studies which showed that plant-based memory foam sleeps around 25% cooler than gel infused one, which is a significant difference and perhaps a hint of the direction in which the memory foam industry will develop in the upcoming years.

Another interesting situation regarding the cooling claim is the issue between some of the leading brands on the market of memory foam products, Serta and Tempur-Pedic. Serta claimed that their iComfort foam sleeps cooler than the Tempur-Pedic foam, so at the end of 2012. the National Advertising Board brought up a decision that if Serta wants to continue using that statement, they need to provide scientific evidence that supports such a statement. As we are familiar with the situation, that did not happen.

So, if you naturally tend to sleep hot, the chances are high that neither the gel-infused memory foam would not work for you. Although they are not as heat conductive as the regular foam and would not make you sweaty or anything like that, it still can be not enough for some sleepers. But, be careful because many brands tend to exaggerate in their claims in order to sell more or make their products look better than the others. The point is to keep your expectations realistic and don’t entirely trust everything they claim.

Gel Memory Foam Vs. Others

As you know, there any many types of mattresses on the market, and we are now going to compare their heat regulation abilities with the ones from gel-infused foam, and to summarize their pros and cons.

• Gel-infused memory foam – one or more layers of foam in mattresses adapt to body contours and conform closely. Their comfort system usually consists of a base made from high-density foam and one or more layers of polyfoam or viscoelastic foam. As we mentioned previously, the heat retention can be a problem for those sleepers who tend to sleep hot, since cooling gel has its limitations.
• Latex – this highly durable material that comes from rubber tree is becoming a more and more popular material for sleep-related products, and although it may seem that latex is another heat-trapping material, it actually sleeps cooler than the regular memory foam. Its support core is a dense polyfoam, on top of which latex layers are settled.
• Hybrid – according to customers experiences, this type of mattresses is probably the best one on the market when it comes to temperature regulation. Its comfort system is more complicated than the others since it can combine all the other material in order to provide the best sleeping experience. It consists of a pocketed coils core, layers of latex, micro coils, and memory foam or polyfoam.
• Innerspring – this type of bed also sleeps fairly cool, even cooler than the foam mattresses, but it lacks that close conforming and softness of memory foam. In its base, there is a layer of steel coils and on top of them is one or more layers of conventional polyfoam.
• Airbed – heat retention can be an uncomfortable problem with many airbeds, but that depends on the type and thickness of used material. Their support core usually consists of adjustable air chambers, and they can include foam layers.

Unlike sedatives and hypnotics, stimulants boost our alertness and interfere with our ability to sleep by stimulating the body and the central nervous system. This is the reason stimulants are often associated with wakefulness, yet they also have the potential to enhance mood and reduce daily stress. Administered in specific amounts, stimulants can even aid in improving sleep.

A stimulant is basically any substance that impacts the body by increasing its nervous or psychological activity. Most often they affect the nervous system to reduce sleepiness and increase mental alertness. One widely available and probably the most common stimulant is caffeine, which many people use on their own to handle excessive daytime sleepiness.

For more severe cases, such as sleep apnea or narcolepsy, a more profound approach is needed, so some legal stimulants such as Modafinil (Nuvigil), Amphetamines (Adderall), Armodafinil (Nuvigil) or Methylphenidate (Ritalin), may be the best option.

Before treating the condition, the underlying cause of sleepiness should be examined to see if it is possible to solve it naturally by adjusting the sleep schedule or routine, reducing stress or creating a more sleep-friendly environment. For example, shift workers that have irregular sleep schedule due to their job, often feel excessive sleepiness and fatigue while they are working. For them, changing something in their sleep pattern is not an option, so they have to reach for medications and stimulants to stay awake and complete their obligations.

Adderall

The US Food and Drug Administration (FDA) has approved the use of Adderall in only one case, to treat the disorder of attention deficit hyperactivity. But, regardless of that fact, Adderall is most commonly used off the label as a stimulant that keeps us awake and in focus. Many college students use it as a study aid, as well as people who work under high pressure. Adderall improves abilities of certain neurotransmitters such as dopamine, a brain chemical which boosts our alertness and energy. Besides that, Adderall will increase the heart rate, decrease the blood flow and open up breathing passages, as a result of it, this drug causes a feeling of invigoration and energy, something similar to what cocaine does too. Also, it creates that rewarding feeling of euphoria which is why it has become so popular as one of the recreational drugs.

Some short-term adverse effects can include dry mouth, restlessness, suppression of appetite and weight loss, cardiac issues, heart palpitations, etc.

Even in the countries where Adderall is available through prescription, it is still recognized as a drug with high potential for abuse, so its supplies are often limited, and in some countries, like Japan, it is completely banned.

Long-term consequences of Adderall abuse are paranoia, erratic behavior, psychological disorders, increased risk of heart attack, extremely high blood pressure, vitamin deficiency, etc.

Addiction to Adderall might be either physical or psychological.

• Physical dependence occurs when a user is so used to the presence of Adderall in its brain that if he stops using it, it will cause some of the withdrawal symptoms.
• Psychological addiction happens when someone uses Adderall compulsively, and their addiction and urge became so strong that they are willing to put their well-being at risk in order to attain and use the drug.

When it comes to withdrawal treatments, there are yet no medications that can assist users during the process of withdrawal, although there is some evidence that antidepressants might manage some of its psychological aspects such as include depression, anxiety, and fatigue.

Ritalin

Besides Adderall, Ritalin is the second most popular stimulative study drug, taken to keep people awake and enhance their memory and focus. The most common side effect of taking this drug is sleep issues, which many are willing to ignore. Since 1950s doctors use Ritalin to treat different conditions such as depression, narcolepsy, and fatigue. The FDA also approves Ritalin as a drug for ADHD, but it has also been proven that it helps patients with brain injuries, but it does not restore their memory. Some research hinted that small doses of Ritalin actually improved cognitive performance and working memory among healthy people, while higher doses impaired their focus and performance.

Ritalin improves the action of a brain neurotransmitter called catecholamines, and it achieves that by blocking dopamine and noradrenaline reabsorption by neurons.

Because Ritalin is a stimulant similar to cocaine because they have a very similar chemical structure, it has the potential for abuse and may cause some undesirable changes in the brain. Since it is a legal prescription drug, it is easy to abuse since many neglect its potential side effects. Studies of long-term use were performed on animals and have shown that extended use may cause anxiety, sleeping issues, psychosis, nervousness, nausea, reduced appetite, brain plasticity, and weakened memory.

Nuvigil

Nuvigil belongs to a group of stimulants called eugeroics which all promote mental arousal and wakefulness. It is often prescribed to patients dealing with obstructive sleep apnea, excessive daytime sleepiness, narcolepsy or shift work sleep disorders.

Some reported side effects include nausea, headache, insomnia, dry mouth, and dizziness. Using a higher dosage than it is prescribed can lead to overdose, symptoms of it are disorientation, mania, hallucinations, chest pain, increased blood pressure, etc.

The exact way of how Nuvigil works is still unknown since it does not bind or inhibit any of the receptors in charge of regulation of the sleep-wake cycle.

How Caffeine Acts as a Stimulant

Caffeine is the mostly used stimulant that keeps millions of people awake each day, and many even develop caffeine addiction as they cannot function without it. Most of us rely on a cup of coffee in the morning or/and later in the afternoon to push us through the next few hours. It has been estimated that around 80% of adult Americans take caffeine in some form each day.

Apart from using caffeine to stay awake, this substance can affect your body in other ways too. Although caffeine temporarily and almost immediately eliminates the symptoms of fatigue and drowsiness, too much caffeine can cause headaches, heartburn, vomiting, and nausea, and also raise your blood pressure. On the other hand, some other benefits besides keeping us awake and alert are decreased risk of oral and throat cancer, lower risk of Alzheimer and dementia, and according to one study, even 45% lower risk of suicide since caffeine has mood-enhancing abilities. These benefits are only related to high-octane coffee, not to decaf.

Although we mostly connect caffeine to coffee, it can be found in some medications, or even in food, since it does not have any taste and nutritional values on its own we can hardly know if it is present. A safe amount of caffeine for adults per day is anything below 400 milligrams, which is around four cups of coffee, but the amount of caffeine in coffee varies among different types of it. One standard coffee cup has eight ounces, a mug or a cup at certain coffee shops can contain even up to 16 ounces or more.

If we consume approximately the same amount of caffeine every day, our body will develop a sort of tolerance to it. Our age and other personal preferences determine our caffeine tolerance. Sudden decrease or increase of caffeine is not recommended, so if you are thinking about withdrawal, you might do it by slowly reducing the amount you consume each day. Caffeine withdrawal can be harsh, and some symptoms include headaches, irritability, drowsiness, and anxiety.

Caffeine stimulates our central nervous system, once it reaches to the brain, the most noticeable effect is alertness, the feeling of tiredness will be erased, and that is why caffeine is a common ingredient in many medications that are meant for drowsiness, migraines, and headaches.

It is possible to overdose with caffeine, but it is extremely rare, some signs of it are hallucinations, vomiting, and confusion, and sometimes convulsions can lead to death. Overdosing is a result of large consumption of caffeine, usually in pills or energy drinks, or if you drink more than 400 milligrams of it.

Can Stimulants Improve Sleep For People With ADHD?

ADHD stands for attention-deficit/hyperactivity disorder, and it is one of the most common mental disorders that affect children. Their brains develop differently, affecting their attention, self-control, focus, ability to sit still, and so on. Many children and adults who suffer from it usually develop some sleep disorder over time. Studies have shown that people with ADHD have troubles with falling and staying asleep because when they are tired, their ADHD symptoms get worse, which prevents them from falling asleep. Around 67% with ADHD reported this problem, while approximately 50% of children with ADHD has signs of some sleep-related breathing disorders.

Common sleep disorders among adults with ADHD include disorders of the circadian rhythm, sleep apnea, restless leg syndrome, and periodic limb movement syndrome. There are some differences in behavior among sleep-deprived children and adults with ADHD. When adults are tired they slow down, but children tend to accelerate and overcompensate, they can also often be very moody, aggressive or emotionally explosive as a result of sleepiness.

A study from 2018. gathered 34 adults who were ADHD diagnosed in childhood, and showed that methylphenidate, which is a central nervous system stimulant, can improve sleep among adults with this disorder. The polysomnographic sleep study showed that stimulant reduced not only the sleep latency, a period between going to bed and falling asleep but also the number of nocturnal awakenings and sleep quality. This study also confirmed that ADHD symptoms developed during childhood continue into adulthood.

Side Effects of Stimulant Use

As with any other substances, downsides are always an option, and here are some things that you should take into consideration before you decide to use stimulants as a form of sleep-aid. Side effects depend on the type of drug, dosage, duration of usage, and individual characteristics. Since all of them promote wakefulness, sleep-related problems or disorders can be certainly expected. It is very easy to start abusing these drugs and get addicted to the feeling that these stimulants can provide. The best way of making stimulants work for you is to combine them with other behavioral changes and habits, and to not take it on your own.

Most common side effects include insomnia, hypertension, headache, back pain, dizziness, irritability, nausea, diarrhea, anxiety, etc. while some long-term effects can be more severe and potentially dangerous for our life.

Grief is a fundamental human emotion experienced universally at various moments in life, though its frequency and intensity can vary significantly among individuals.

Grief, or bereavement, is usually the result of losing a loved one. It can affect anyone, and it also invades all aspects of our lives. People are often occupied with their thoughts and feeling of grief, that they don’t have the will to do anything else. Our favorite food stops tasting good, things that we were looking forward don’t seem to interest us anymore, and we struggle to find the energy to do the most basic tasks and deal with everyday life.

Sleep is another important aspect of our lives that suffers while we are grieving. Thinking about your loss all the time often leads to the development of short-term insomnia, or our brains are so preoccupied that we don’t get enough quality sleep even if it seems that we are resting long enough. That leads to the feeling of fatigue and exhaustion during the day, making it even harder to do things.

What is Grief?

Grief is a feeling of distress and sadness that accompany the loss of a loved one. It could be a spouse, a family member, relative, friend, or any other individual that you thought dearly of, even a pet. That loss might be due to them passing, or it can be simply due to the current circumstances that they are gone from your life.

Symptoms of grief include:

• Changes in appetite that can lead to weight gain or loss
• Digestive problems
• Sleep disturbances and insomnia
• Daytime fatigue
• Anxiety
• Difficulty concentrating
• Impaired memory and cognitive abilities
• Headaches
• Low energy and motivation to do everyday tasks
• Depression

There are many emotional and physical symptoms to grief, but low energy and motivation, appetite problems, headaches, anxiety, and sleep problems are the most prevalent. Losing a loved one can lead to other issues. For example, if the passed person was a significant source of financial support, people might be afraid for their well-being and future survival. Or if somebody was a daily part of our lives, we might feel empty, lonely, and struggle to cope on our own.

When these symptoms exist for longer than six months, it can be diagnosed as a prolonged grieving period or complicated grief (CG). During this period, the person often saves the feeling of hopelessness, guilt or blaming themselves, depression, and some even think about harming themselves. If you are experiencing this, know that you are not alone, and maybe think about seeking a professional to help you cope with your loss.

Stages of Grief

Even though bereavement is present in all of the cultures around the world, there is a similarity in the way that we perceive those feelings. It has been observed that people who are grieving go through five phases:

1. Denial and isolation
2. Anger
3. Bargaining
4. Depression
5. Acceptance

Despite the popular opinion that everybody must go through these stages, and in this exact order, that is not the case. Many people don’t go through them all, and can jump between the phases, feeling anger at one point, the next they may feel depressed, and then angry again.

Denial and isolation is usually the first reaction to losing somebody. It is a common defense mechanism where we try to run away from the facts and protect our feelings. This reaction carries us through the initial wave of pain until we are ready to face reality.

Anger when the denial slowly fades, and we are left to face with a reality of the situation. Our vulnerable core produces this intense emotion, and it can be aimed at anybody or anything, or everything at once.

Bargaining is a normal reaction to feeling hopeless and vulnerable. It is a try to regain control, and it is accompanied by “If only” statements, like “If only we had acted better towards them,” or “If they had only sought medical help earlier.” It is an attempt at a bargain, and it’s a line of defense to protect us from painful reality. Guilt is often a partner of the bargain, as we feel like there was something that we could have done to change the outcome.

Depression comes with the mourning. Sadness and regret are a part of this phase, that can last for some time. Usually, our friends and family are there for us in these times, which makes it easier to go through this stage.

Acceptance is how all the mourning should end up ideally. Unfortunately, that is not the case for all people. Our loss can be so sudden and unexpected that we never see beyond anger or denial. This stage is characterized by calm and withdrawal. It is not the state of happiness, and it is different than depression.

Keep in mind that dealing with loss is deeply personal and singular experience. No one can go through it but yourself, but the help of others can go a long way. Just knowing that you are not alone and that there are people there who support you is essential, so don’t push away your friends and family and isolate yourself. The best thing you can do is to face the grief and the feelings it brings. Running away from it and resisting it will only prolong the healing process and might even make in incomplete. Embrace your feelings, and know that you are not alone; however hopeless it seems, it does get better.

How Grief Affects Sleep

Sleeping during bereavement is tough. The person often has intrusive thoughts about their loved one, such as anxieties, worries, and regrets. There is a great sadness present due to the realization that the time spent with this person is passed. It can be particularly challenging if the lost person is someone who shared a bad with you.

The stress of losing someone important can lead to anxiety, post-traumatic stress disorder (PTSD), and depression. Each of these conditions negatively impacts sleep as well. As much as one-quarter of people who lost their spouse experience anxiety and depression during the following year after the loss.

Even without developing some more severe disorder, losing somebody is stressful enough itself. It often develops into sleeping problems and insomnia. Sleep onset insomnia represents difficulty falling asleep, while sleep maintenance insomnia refers to a condition where a person has a hard time staying asleep.

Thoughts about the loss often leave people laying wide awake for hours after entering their bed. Also, dreaming about their loved one can wake them up during sleep, and cause sleep fragmentation. Dreaming mostly happens during REM sleep, when our brain does cognitive processing, so it has been argued that dreams play an essential role in our emotion processing as well.

When you don’t get sufficient sleep daily, it can lead to sleep deprivation. This condition worsens symptoms of grief and makes it even harder to deal with our everyday life, as it affects us in a very negative way. Sleep deprivation leads to:

• Cognitive impairment. Sleep is essential for processing memories, and our learning ability. Lack of it leads to decreased focus and concentration, impaired ability to learn and form memories, and lack of sound judgment. If you haven’t slept long in a long time, you are much more likely to make a bad decision or behave rashly.
• Emotional instability. Sleep deprived individuals have a tough time balancing their mood and positive outlook on life. These people are more negative, easily irritated, less friendly, less emphatic, and generally have a low tolerance for frustration. They are easily overwhelmed, and these feelings can even lead to being angry and hostile towards others. All of this could lead to feelings of isolation and depression.
• Disrupted appetite. People who sleep less tend to eat more and sleep deprivation also affects their metabolism and the way they react to food. Lack of sleep disrupts the production of ghrelin and leptin, two hormones that are in charge of feeling hungry, full and satisfied after a meal. Missing rest will make you more hungry, and when you mix that with impairment judgment, you are much more likely to go for that junk food full of sugar, instead of a healthy meal.
• Weakened immune system. Lack of sleep affects us physically as well, so it might make it harder for our body to fight off colds and infections, and makes us more likely to get sick.

Long-term sleep deprivation may lead to faster skin aging, higher obesity risk, stroke, heart disease, type 2 diabetes, cancer, decreased bone density, and shorter life expectancy. Lack of sleep in combination with complicated grief leads to even more severe symptoms of both of these conditions.

How to Sleep Better While Grieving

Grief is a natural process that you sort of need to get through to get to the other side. However, that doesn’t mean that you should experience it passively. Embrace your emotions, try to understand them, and it will help you heal faster. Getting control of some parts of your life such as your sleep can lead to more feeling of power and less hopelessness. Good sleep helps you recover faster, and it also makes complicated grief less likely to happen. That is particularly true in seniors who have LLSB (late life spouse bereavement). Spending a good chunk of your life with a person, and then losing them is extremely hard. Maintaining good sleep can however help with the symptoms a little bit, and also decrease chances of morbidity in seniors.

Here are some tips that should help you improve your sleep quality:

• Consider cognitive-behavioral therapy (CBT). If your grieving symptoms and lack of sleep persist for more than three months, maybe it is the time to seek professional help. CBT is an effective treatment for anxiety, depression, insomnia, and many more disorders. During the therapy, a patient works with their therapist to recognize the negative emotions that are making them feel worse, and lead to worse sleep, and increased anxiety. After that, they learn how to deal with those emotions, and how to substitute negative thoughts and behaviors with healthier ones. Facing your feelings, and going through the pain with the therapist’s help is shown to improve sleep in people who decided to try CBT.
• Follow a regular sleep schedule. This consistency will help you fall asleep faster, and not to wake up during the night, so you’ll get better quality rest. Try to go to sleep and wake up at the same time, even during the weekends when it is more tempting to stay up late, and also spend some more time in bed in the morning. Make sure to manage your daily naps, so don’t take them at least 8 hours before bedtime. Keep naps brief, and set the alarm to wake up after 30 minutes tops. Napping for longer than that might lead to entering the deep stage of sleep, feeling of grogginess after waking up, and also a hard time falling asleep in the evening.
• Make your bedroom comfortable. Your bedroom might be full of things that remind you of a passed loved one, and that can trigger your grief and make it harder to sleep. Consider removing those items from the bedroom, at least temporarily, until you can cope better with your loss. You can take time to redecorate as that will make your mind of mourning for a little bit. Paint the walls in a beautiful, relaxing color, consider getting blackout curtains if a street light is too bright, and consider investing in a smart bulb. Keep your bedroom dark, at an optimal temperature, and also quiet. To block any outside noise, you might get a white noise machine, or maybe a set of earplugs. Ban all the screens from your bedroom, as they emit blue light that can disrupt your sleep. Perhaps it’s even time to look for a new, more comfortable mattress, pillow, or bedding.
• Develop a soothing bedtime routine. There are some things you can do to help you fall asleep faster. Reading a book, doing light yoga exercises, meditation, breathing exercises, taking a hot bath, drinking a non-caffeinated herbal tea or a glass of warm milk can all help, you need to figure out what works best for you. Tending to a hobby can also be very helpful to direct your thoughts away from grief, and to help you relax before bed.
• Eat well and exercise. These can be extremely hard to do while grieving due to lack of motivation and energy but do your best. Eating healthy and exercising also helps with your sleep. Avoid drinking caffeinated drinks after 4 pm as they make it harder to fall asleep. A lot of people even try to soothe their pain with drugs and alcohol, but this is not a way to go. They make things worse, and harder to deal with in the long run.
• Spend time with your friends and family. It is so important to spend time with people who love and care about you during this period. Don’t isolate yourself, and enjoy some activities together.

If your sleep problems persist, and these tips don’t seem to work for you, you should see a sleep specialist. In combination with CBT, they might discover if any underlying disorder might be preventing you from getting a good night’s sleep. A sleep specialist will assess your situation and recommend melatonin supplements or some other kind of treatment.

It may seem like a broad statement, but as you age, you tend to sleep less. This holds particularly true from infancy through to 25 years old, as well as for older adults who experience lighter sleep. Discover in this article how sleep changes for both children and adults across the span of a lifetime.

Children Sleep Patterns

You sleep the most when you are a baby. Newborns sleep 16 to 18 hours a day, and half of their sleep time is spent in REM sleep, while the other half is spent in deep (slow wave) sleep. Very little time is spent in light sleep, also known as the first and second sleep stage. Once babies reach age one, they will sleep 13 to 14 hours a day. Their sleep time will decrease as they reach adolescence.

As the child grows, the time spent in REM sleep decreases until it reaches about 90 minutes per night. Ninety minutes per night is typically reached in the mid-teens. This is also the time when stage 2 sleep increases. Deep sleep also known as slow wave sleep is vital for children’s growth and development. It’s very hard to awaken anyone from deep sleep, but kids especially.

Teenagers at least 8 to 10 hours of sleep per day. Unfortunately, due to school and social pressure, as well as an abundance of extracurricular activities, teens rarely have enough time to sleep. What makes snoozing for them even harder is the fact that this is the age when their internal biological clocks shift and tend to keep them awake later in the evening and make it difficult for them to wake up early in the morning. Simply explained, teens are natural night owls. Some studies have found that moving school time just half an hour later would help improve teens’ performance in school.

Late teens in their early 20s are considered to be young adults. Young adults have the lowest rate of struggling with a sleep disorder except for babies. They are past common childhood disorders such as night terrors and somnambulism but are also too young to experience insomnia or fragmented sleep typical for older adults. We can say that young adulthood is the golden age of sleep.

Once you reach your mid-twenties, you won’t struggle with a circadian rhythm shift as you did in your teenage years. By the mid-20s the shift in our internal body clocks subsides, and your chronotype will be definitely established. You might stay a night owl or simply become an early bird. As an adult, you need around 7 to 8 hours of sleep to function well. Although many people claim they require less or function well on less sleep, studies have shown that only 10% require more or less sleep than the recommended amount.

Age and Sleep Disorders

Studies conducted on different population groups by sex, race, marital status, socioeconomic status, etc. show that age is one of the most significant demographic factor when it comes to sleep disorders and changes in sleep patterns. For women, pregnancy and menopause cause significant changes in sleep patterns. For example, in the first trimester of pregnancy, expecting mothers require more sleep than usual, and some experience insomnia due to hormone changes. Later in pregnancy, some mothers-to-be experience snoring or restless legs syndrome (RLS) but these issues disappear as soon as the baby is born. Hormonal changes may severely affect sleep during menopause. During these years, problems such as snoring, insomnia and sleep apnea are more common. Apart from hormonal imbalance, psychological factors associated with menopause may also disturb sleep.  

Many people believe that sleep needs decline as we age. However, this is not the truth. Unfortunately, elderly people do have more struggles with sleep, and frequently experience insomnia, delayed sleep/wake phase disorder or advanced sleep/wake phase disorder, but that doesn’t mean they need less sleep. On the contrary, they need about the same amount of sleep that they needed in early adulthood – seven to eight hours a night. Once we reach age 40, the number of nocturnal awakenings starts to increase. Older people have an increased need to nap during the day and make up for the lost sleep caused by fragmentation at night. Retired people often have a greater need to nap that working people do.

When it comes to insomnia in older people, studies have shown that people sleep shorter as they age. The scientists focused on examining both the S and the C process – homeostatic process for sleep regulation and the circadian process and found out that both processes decline over time. Homeostatic process declines earlier than the circadian one.

Stereotypes such as lazy teens who sleep all morning and grandparents who wake up before dawn and are in bed very early in the evening are heavily grounded in reality. The mentioned sleep patterns have nothing to do with someone’s lifestyle choices, but more with their biology. Scientists have found that the expression of some genes associated with the circadian cycle change with age. A study published in the Proceedings of the National Academy of Sciences has found out that a specific internal body clock starts ticking only in the brains of older people. So far, researchers have found over 230 genes that control circadian rhythms in the prefrontal cortex. When one reaches old age, some of these genes simply shift off or stop expressing actively. Instead of them, other genes start expressing and form a new circadian clock – forcing the affected person to become active earlier in the day than usual.

It’s also an interesting fact that poor people sleep worse than rich people, and that women sleep worse than men. However, in both cases, the correlations were weak. From a public health perspective, transitions from young adult to middle age and from middle age to old age are the most significant inflection points and periods when we should be careful the most.

Primitive Sleep Patterns

Communal sleep is actually more common in less developed societies than in the technologically advanced ones like the ones in the West. Studies have not yet indicated whether this is a cultural preference, a choice, or simply a consequence of having less space to sleep in.

An anthropologist Carol Worthman conducted research on primitive cultures and their sleep practices. She believes that the customs of primitive tribes such as surviving hunter-gatherer societies indicate how all humans slept in the past. She believes, for them, sleep was a very fluid state, and that is could happen whenever the individual felt sleepy. Nighttime sleep was a social activity – pretty different from the isolated environments most modern people snooze in today.

If this is true, people in the past didn’t sleep in one isolated block for seven to eight hours a day. Our sleep was rather polyphasic. It’s very hard to determine an ideal sleep pattern. Sleep experts advise individuals to follow a regimen that works best for their biological needs and lifestyle demands.

Tribal Sleep

The first thing that comes across our minds when you hear tribal sleep is probably sleeping together or every something that involves sleeping and waking up at the same time. However, this isn’t how slumber played out in big groups. Sleep patterns weren’t synchronized because some members of the tribe always have to be on the lookout and protect the tribe from potential threats. However, it is true that in social sleeping, some individuals affected the sleeping patterns of other individuals. In primitive living arrangements, it’s much easier to notice that sleep can be a social activity. The modern pattern or sleeping alone or only with one partner was rare in the past.

Historically, people slept with their kids, parents, siblings, neighbors, and so on. Babies and toddlers typically slept with their mothers. In primitive cultures, infants never sleep separately from their mothers, and according to one anthropologist, this separation contributes to the risk of SIDS (sudden infant death syndrome). According to some studies, when babies slept in separate rooms from their parents, SIDS incidents increased. One explanation for this is that when the baby is cradled with the mother, the mother sleeps shallower and may react to subtle changes in their baby such as breathing problems. Nighttime feedings are also a lot easier when parents don’t have to get out of bed.

Rituals and Religious Practices

Did you know that sleep is also tied with the supernatural, mysticism and the divine? Forced sleep deprivation (which often leads to vivid hallucinations) can be employed in religious ceremonies. For example, the ancient Egyptians were obsessed with death and spent a lot of their religious energy on sleep. Due to their elaborate hairstyles (typically worn by the upper class), they needed to create a special headrest to protect their hair during sleep. When a teen got a headrest, that was a symbol of transitioning from youth to adulthood. The headrests were also practical for keeping bugs off the head and allowed decent cooling in a pretty hot climate. The Egyptians also thought snoozing was a time when they could communicate with the dead.

So, you may be wondering if we slept so differently in the past, why did we give up the ancient practices. Did our sleep evolve? How are our sleep needs different from the ones in the past? Two historians, Craig Koslofsky and Roger Ekirch, were wondering the exact same thing. They mention that in the past, people were mostly bi-phasic sleepers and that a decline in bimodal sleep was noticed in Europe in the 17th century. Due to electrification and modern way of life that involved working 8 hours a day, people embraced monophasic sleep pattern. Ekirch has spent many years researching the history of sleep and found hundreds of literary references that mention first and second sleep. Historians believe that people went to sleep in the evening, woke up around midnight, stayed awake for around 2 hours and then went to sleep again. The time between first and second slumber was spent socializing, praying, working and similar.

Electrification and later the development of electronic devices has multiple times been identified as one of modern society’s sleep problems. However, the problem with artificial light is not so much in the fact that it mimics the sun and has the ability to disrupt our circadian rhythms, as much as it is in the fact that artificial light encourages people to work, socialize and similar over a greater period of the day, or simply decide to start their day very early or go to bed late. The real problem is that we now have the ability to push our sleep time to a smaller window. Due to our hectic schedules and pressures that come with the modern way of life, we often don’t have enough time to sleep and end up being sleep deprived and with a major sleep debt.

Due to our sleeping habits in the past, some people and even experts believe that sleep maintenance insomnia is not a defect, but simply a throwback on one of our natural sleep patterns – bimodal sleep. However, it is important to mention that sleep maintenance insomnia is a real problem and manifests differently. Occasionally waking up in the middle of the night and being unable to sleep in one consistent block is normal, especially if you still feel restful and refreshed in the morning. However, experiencing multiple awakenings during the night, waking up tired and groggy, and struggling with daytime sleepiness indicates you have a sleep disorder.

Biphasic Sleep – Daytime Napping

Nowadays, most people sleep in a single consolidated block of about eight hours during the night. However, this still doesn’t mean this is the only sleep pattern we embrace. In a way, many of us still practice bimodal sleep in the form of daytime naps. Daytime naps are a perfect way to replenish energy and restore our alertness.

In many cultures, particularly those in tropical regions, afternoon napping is very common and has become a part of one’s daily routine. The exact timing of the naps is not scheduled, but it’s kind of mandatory. It’s very interesting to mention that some stores or even government offices stop for an hour or two every afternoon.

Afternoon naps are typically short and are very beneficial for quickly replenishing our energy and alertness. By napping, we can decrease our sleep pressure a bit. Our sleep pressure or sleep drive increase through the day, as we spent energy and sleep-inducing chemical adenosine builds up in our body. According to studies, napping typically happens during the warmest period of the day and generally follows a large mid-day meal.

For most people, naps last from 30 to 60 minutes. Ideally, a nap shouldn’t last longer than 20 minutes. Any longer, you are increasing the risk of falling into deep sleep and have a very difficult time waking up. After a nap, you should feel refreshed and alert. Taking proper naps can help you stay awake and alert in the late afternoon and evening, and even sleep better at night. On the other hand, napping for too long can cause insomnia in the evening.

According to sleep experts, napping can be a good way for people who don’t sleep well at night to catch up a bit and restore their sleep debt. They do caution, however, that people with insomnia may make their nighttime sleep issues worse by sleeping during the day.