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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.

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.

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.

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.

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.

Down syndrome ranks as one of the most prevalent genetic conditions in the United States, impacting 1 in every 700 newborns annually. This condition arises from having an extra copy of chromosome 21. Individuals with Down syndrome experience various physical and cognitive developmental challenges, substantially complicating aspects of daily life. The effort required from parents of a child with Down syndrome is significantly greater compared to that of parents with children who do not have this condition, leading to a common oversight among the myriad of health concerns and preventative strategies – the significant challenge of ensuring adequate sleep for those affected by Down syndrome.

This article aims to help the parents of people with Down syndrome provide quality assistance when it comes to establishing a healthy sleeping routine, and will include information on Down syndrome in general. Let’s get into it:

A General Overview of Down Syndrome

Down syndrome has more than a handful of signs you can use to recognize it, in terms of the person’s physical appearance. When it comes to their face, one of the best ways to spot Down syndrome is a facial structure that looks flattened, especially around the bridge of the nose. The eyes may look odd-shaped, typically slanted upwards. Smaller ears and the presence of a tongue sticking out are also common physical indicators of Down syndrome.

The face isn’t the only part of the body that is affected, far from it. People who have Down syndrome are often shorter than average and tend to have noticeably shorter necks. Their hands and feet are also often on the small side, with the pinkies of each hand curving towards the thumb. Down syndrome people also tend to have poor muscle tone and loose joints. Other signs include stunted growth, mental impairment, teeth abnormalities, and similar symptoms.

Down syndrome has one known cause – the presence of either a part or an entire third copy of chromosome 21. This extra chromosome contains genes that are the direct cause of all the issues people with Down syndrome have to deal with. It’s a little known fact that there is more than one kind of Down syndrome – there are three, although two of these are very rare. Trisomy 21 is by far the most common type, affecting around 95% of all people with this syndrome. This type is characterized by the fact that every single cell in the person’s body has a third copy of chromosome 21. Translocation Down syndrome happens when only a part of the third chromosome manifests, attached to one of the other copies. It affects only around 3% of people with Down syndrome. Mosaic Down syndrome takes up the remaining 2% of the population who have to deal with this condition, and it’s defined by a state where only some cells have a third chromosome copy.

Unfortunately, doctors still haven’t been able to pinpoint what causes the appearance of a third copy of chromosome 21. The main factor that seems to affect the likelihood of a child being born with Down syndrome is the mother’s age. Mothers aged 35 or older have a considerably higher chance of birthing a child with Down syndrome than younger mothers, although research hasn’t shown why this is the case. While we will mainly focus on sleeping problems, it’s crucial to present a list of other health problems that unfortunately affect people with Down syndrome, some of which can be life-threatening during the first year of life. The list goes as follows:

–          Ear infections affect around 50-70% of all people with Down syndrome. On top of this issue, around three-quarters of all Down syndrome patients experience hearing loss at some point in their life.

–          Epilepsy can manifest in affected individuals. The older they are, the more likely it is, with around a half of Down syndrome adults older than 50 years having to deal with epilepsy.

–          People with Down syndrome are more susceptible to obstructive sleep apnea – to the point where a majority of them are affected by this sleep-related breathing disorder. We will go into more detail later on in the article.

–          Around 60% of all people dealing with Down syndrome also suffer from eye diseases or poor vision. It is very common for this problem to occur at a young age.

–          Half of Down syndrome patients suffer from heart defects

–          While they’re not as common as the above-mentioned conditions, people with Down syndrome can encounter one or more of the following problems: anemia, leukemia, thyroid disease, hip dislocation, etc. Caretakers should monitor Down syndrome patients carefully and regularly for signs of these conditions.

Diagnosis and Treatment

Down syndrome diagnosis tests are done during pregnancy. The first steps taken to determine whether a child will have Down syndrome (or another genetic disorder) are almost entirely non-invasive – these tests are used in the screening phase, and their purpose is to determine if a risk exists in the first place. The most typical tests you encounter at this stage are blood tests and ultrasound scans. The ultrasound scan looks for indicators like a pocket of fluid behind the baby’s neck – a clear sign of a possible genetic disorder, especially Down syndrome. If these tests return positive, further diagnostic steps are conducted, including chorionic villus sampling (CVS), percutaneous umbilical blood sampling (PUBS) and amniocentesis. These tests are designed to detect chromosomal changes in the mother that indicate the presence of Down syndrome in the child.

Unfortunately, Down syndrome cannot be treated in the conventional sense; there is no cure for this disorder. However, that doesn’t mean your hands are tied if a loved one is dealing with Down syndrome. There are methods of speech therapy, physical therapy and occupational therapy that improve the development of the patient, helping them function closer to what is considered “normal.” As a consequence of these methods, and recent medical advancements in general, the survival rate has drastically increased for people with Down syndrome.

How Down Syndrome Affects Sleep

Just by looking at the physical symptoms listed earlier in this article, you can imagine a whole host of potential sleeping disorders and complications – Down syndrome sadly causes a lot of sleeping issues for the person in question. Research has shown that people with this genetic disorder experience much more frequent nighttime awakenings and sleep significantly less. Children with Down syndrome have worryingly high levels of bedtime resistance and anxiety compared to those who do not have this genetic disorder. On top of that, around 40% of these children wake up at least once per night.

If you know anything about sleep architecture and circadian rhythms, you are already aware of how devastating this combination of problems can be. Nighttime awakenings lead to what is called fragmented sleep – a situation where your natural progression between sleep stages is disrupted. While sleeping, we transition in and out of three main stages – light sleep, deep sleep, and REM sleep. All of these are important for our physical and mental development and repair, learning and immune system maintenance. However, deep sleep and REM sleep are cut short if the sleeper keeps waking up, as it takes time to transition into these stages. As a result, the person’s circadian rhythm is ruined, and they suffer a number of health-related consequences such as increased risk of illness, fatigue and slower recovery from bruises and muscle strain.

Children with Down syndrome are significantly more prone to bedwetting, sleep bruxism, sleep talking and similar conditions. Luckily, these problems tend to subside with age, as long as the child is given proper care and developmental support. Unfortunately, that doesn’t mean they’re in the clear. No matter the age of the person in question, people with Down syndrome face an almost unavoidable sleep disorder – sleep apnea.

Obstructive sleep apnea has been discovered in around 31% of all infants in the United States, according to recent research. This statistic transitions into a value of around 30-60% of all children with Down syndrome. Adults with this genetic disorder have it the worst, by far – 80% of affected adults also suffer from obstructive sleep apnea. The main reason for this problematic statistic ties back to physical deformities found in individuals with Down syndrome. Their enlarged tongues, jaw abnormalities, and tighter airways lead to a much higher chance of physical blockages in the air canals. Factors like obesity and loose muscle tone contribute to OSA for basically everyone, and Down syndrome people often deal with both.

Here’s another scary fact – obstructive sleep apnea is a much bigger threat to people with Down syndrome. This genetic condition often comes with health complications and conditions that are not related to OSA directly, such as heart defects. These conditions get worse and worse thanks to the damaging effect of OSA-induced lapses in breathing during the night. This interaction between OSA and other conditions frequently leads to an early death.

Obstructive sleep apnea is also sometimes harder to diagnose in individuals with Down syndrome since the symptoms can get lost in a variety of other defects and problems. It lets OSA “sneak under the radar” and wreak havoc on the person’s health before proper treatment is administered. Down syndrome, when combined with OSA, causes a sleep time reduction of around one full hour on average. Because this is extremely harmful in the long run, experts strongly recommend a full sleep study to parents of children with Down syndrome, before the kids hit 4 years of age.

Helping People With Down Syndrome Sleep

For the sake of the long-term health of people with Down syndrome, caretakers and parents are often given lots of advice on how to provide quality assistance and help the person achieve a good sleep schedule. Some of these recommendations revolve around product purchases that make sleeping easier; others revolve around lifestyle guidance you can apply to their routine. Before making any significant changes in the patient’s daily routine, you may want to put them through a full sleep study, since that results in accurate and reliable professional advice.

Mattresses that are built to deal with regular bedwetting should be a priority purchase if you’re in charge of someone with Down syndrome. This mainly affects children but is not exclusive to them. Make sure the mattress and its covers are easy to clean and waterproof enough to retain their durability over years of use.

Due to how common sleep apnea (especially OSA) is in people with Down syndrome, you will almost surely be forced to purchase a CPAP machine. This machine provides pressurized and humidified air straight to the person’s airways, completely preventing night-time lapses in breathing.

If the patient is prone to falling out of bed or having seizures, you may want to invest in low-profile bedding. It’s all about giving them less room to potentially injure themselves. For the same reason, padding is often recommended for the bed rails, which drastically reduces the risks associated with head-banging and flailing.

One of the most important behavioral methods for dealing with Down syndrome is the establishment of a strict, regular sleeping routine. Try to spend an hour before bedtime each day engaging in relaxing activities with the person affected by Down syndrome. It trains their mind to associate these activities with sleep, and prepare for sleep in advance. Remove distractions from their room that could increase sleep onset latency (how long it takes for them to fall asleep) – this can be done by physically removing tempting objects or introducing white noise machines or bedroom fans that drown out any unwanted noise. Make sure to lower the bedroom temperature as you prepare to send the person to sleep, and eliminate all unnecessary light sources.

Carefully manage the person’s diet. It should go without saying that an unhealthy diet can lead to disastrous complications in Down syndrome patients, as they already potentially suffer from heart problems, digestive problems, and similar conditions. Avoid sweets, caffeine, and alcohol in particular, and count their calories – obesity is hard to prevent, and requires diligence and strict planning.

Make sure to offer positive reinforcement to the person with Down syndrome when they cooperate with these methods and accomplish things. Establish reward charts that let their mind create a positive association between healthy sleeping habits and desirable treats and rewards. It will make them happy to follow a good sleep schedule and it will pay off in the long run.

Epilepsy stands as one of the most common significant neurological conditions, marked by an increased likelihood of recurrent epileptic seizures. In the United States, approximately 1.2% of the population is affected by epilepsy, as reported in 2015 statistics. Nevertheless, 80% of epilepsy cases globally occur in developing countries rather than in more advanced nations. Historical records have always acknowledged epilepsy, with its identification, causes, and treatments subject to various interpretations across the ages. Initially considered a spiritual affliction, epilepsy continues to carry a social stigma, impacting those diagnosed with the condition. Historically, individuals with epilepsy faced ostracization and were often incarcerated; they were regarded and treated similarly to those thought to be mentally ill or criminally insane. People avoided consuming from the same dish as them and broadly avoided any contact with those who have epilepsy. Although the severity of the stigma has lessened over time, it persists in some regions. For instance, in parts of China, epilepsy can serve as a valid reason to deny marriage, and many cultures still believe that individuals with epilepsy are cursed. This prevailing negative perception compels some to conceal their illness for fear of societal judgment, endangering their health due to untreated conditions and increasing the risk of mortality from falls, accidents, and status epilepticus.

Due to their symptoms and the stress they regularly face, people who have epilepsy often have a comorbid condition such as migraines, anxiety, depression and a palette of sleep disturbances like nocturnal seizures, insomnia and sleep apnea. We will cover more about the relationship between epilepsy and sleep, as well as how to manage some common difficulties, but not before we dispel some myths and misconceptions about epilepsy.

What is Epilepsy?

Epilepsy is a chronic neurological condition which characteristic feature is recurring seizures that range from short and barely detectable to long-lasting and severe. It doesn’t mean that only people with epilepsy have seizures – about 10% of Americans will experience one at some point in their lives. A seizure can signify any sudden, different behavior of a person with symptoms like shaking, zoning out, limb jerking, loss of consciousness, etc.

What makes an epileptic seizure distinctive from others is its electric discharge from the brain and lack of traceable underlying cause. It means that only a seizure that isn’t a consequence of some reversible condition and isn’t caused by extremely low blood sugar, substance abuse or withdrawal, etc. counts as an epileptic seizure. Depending on their varying symptoms and duration, as well as in which area of the brain they occur, epileptic seizures are classified into three categories:

1. Focal onset means that the seizure started in one side of the brain. Focal onset aware seizure is a type where the person is conscious and aware of what’s happening. Focal onset impaired awareness means that the individual is awake but confused and not fully aware of their seizure.

• Motor symptoms of focal onset type may include tonic spasming, clonic simultaneous muscle jerking, myoclonic twitching, atonic limp muscles, epileptic spasms (when body repeatedly contracts and extends) and some automatic repetitions like hand rubbing, clapping or chewing.
• Non-motor symptoms would include changed cognitive ability, emotional state, thinking, feeling hot or cold, etc. A complete absence of movement, known as behavioral arrest, is also possible.

2. Generalized onset signals that the seizure started simultaneously in both brain hemispheres, or groups of cells from both sides. It includes seizure types such as tonic-clonic, absence and atonic seizures.

• Motor symptoms falling under this category may include sustained clonic jerking movements, brief myoclonic jerking or twitching muscles, limp or weak (atonic) muscles, tonic tense muscles, and epileptic spasms.
• Non-motor symptoms are commonly called typical or atypical absence seizures and may include myoclonic twitching of a specific area of the body such as the eyelids.

3. Unknown onset refers to a seizure whose onset region isn’t known, as it occurred when nobody else was present to witness it or during one’s sleep. A diagnose of the unknown onset might later be changed into generalized or focal onset as the case is examined and more information is gathered.

• Motor seizures are usually reported as epileptic spasms and tonic-clonic seizures.
• Non-motor seizures mostly involve behavioral arrest.

Tonic-clonic seizures start with tonic limb contractions, their extension and arching the back. It lasts for up to 30 seconds and is followed by a simultaneous clonic shaking of limbs. After such a seizure, it may take a person around 30 minutes to get back into their normal state. This period is called the postictal state or phase. Tonic-clonic seizure is a less common type than often assumed, accounting for only 10% of all epileptic seizures. Clonic seizures involve simultaneous, rhythmical motion or one or both sides of an individual’s body. Tonic seizures cause a person’s muscles to become rigid, and the person might fall if they were previously standing. Along with the atonic type, one of the shortest seizures. Atonic can also cause a person to fall over, but their body muscles become limp unlike in tonic seizures. Myoclonic seizures involve brief twitching of a body part, and the person is aware while that’s happening. However, since it rarely appears alone, it isn’t classified under the “aware” category.

An individual needs to experience at least two seizures that happen more than 24 hours apart and aren’t provoked by another condition to be diagnosed with epilepsy. The cause of this disorder can be environmental, genetic-related or in many cases, both. The exact cause is unknown in over 60% cases. Severe trauma, stroke, and tumors are some known environmental factors. In developed countries, at risk of epilepsy are the elderly and children, while developing countries have far more cases of occurrence in adolescents and young adults.

The cure for epilepsy doesn’t exist. That is to say, one’s possibility of having seizures cannot be treated as the exact root of their disorder isn’t known. However, preventing or lowering the chance of one triggering seizures is possible with the use of anti-epileptic drugs (AED). Treatment with these medications can put one’s seizures completely under control, but finding the right pill or combination of pills can sometimes take a while. Side-effects of AED often include sleep disturbances.

Epilepsy and Sleep Issues

The relationship between sleep and epilepsy is complex. Sleep and sleep deprivation can both contribute to or trigger seizures, while some sleep disturbances might mask the symptoms of nocturnal seizures. These, in turn, can also interfere with the diagnosis of some sleep disorders, which could potentially deal a whole lot of damage, as the real issue would not be treated, and the misplaced therapy for the mistakenly diagnosed condition could make matters even worse. Some common issues between sleep and epilepsy are as following.

• Seizures during daytime have been linked with a worsened quality and a fragmented structure of sleep the same night. Besides that, medication commonly used to treat epilepsy may disrupt sleep as well, resulting in excessive daytime sleepiness and an insufficient amount of sleep.
• The electrical activity in one’s brain during light NREM stages can trigger a nocturnal seizure.
• Sleep disorders that might comorbid epilepsy also have a negative impact on both sleep and epilepsy symptoms and may spur seizures, not to mention adding a bonus difficulty for a person to handle, making them less happy and functional as a result.
• Children who experience sleep deprivation due to nocturnal seizures or insomnia are more likely to underperform at school. Not only that, but according to numerous studies, their parents are regularly sleeping less as well, even as low as 4 hours a night, proportionally to the problematic nights their child has. Children with epilepsy, in general, have an increased risk of developing ADHD (attention deficit hyperactivity disorder) due to the stress of epilepsy and lack of sleep.

Nocturnal Seizures

Nocturnal seizures occur during sleep and affect over 45% of people with epilepsy who experience seizures exclusively at that time. This type of epileptic seizures is most common in children, with the incidence rate estimated to be around 60%.

People who only have epileptic seizures in daytime are more likely to have worsened sleep than unaffected people, but a more specific problem arises when recognizing the presence of a nocturnal seizure, as most people will not realize that it’s what woke them up from sleep. Confused or in pain from teeth grinding and tensing muscles, they will often assume the issue lies within sleep itself, guessing at maintenance-type insomnia or a similar disorder instead. If somebody else is present when such an episode happens, they might notice the shaking, jerking or hear a noise, but even then it isn’t guaranteed that epilepsy will appear first on the list. Sleep disorders like periodic limb movement or sleep bruxism are known to feature similar symptoms, and it would not be hard to mistake one for the other. Interestingly, if nocturnal seizures happen regularly enough, a secondary sleep disorder might actually develop, but the root issue remains the same.

If you suspect any of these conditions, you should ask your doctor to order polysomnography for you. This laboratory sleep study done overnight works by tracking your brain wave activity, eye movements, heart rhythm, breathing, movements of your limbs and more. Licensed specialists are required to be present the whole time, and they will be sure to get the picture if you have epilepsy, a sleep disorder or something else entirely. If you aren’t sure about this yet, try writing a sleep diary for a minimum of two weeks. Be as precise as possible about your nightly experiences, as well as how you feel during the day. If somebody else lives with you, ask them to keep track as well. The more details you manage to remember, the easier it will be for your doctor to potentially single out the exact problem. The smallest, seemingly irrelevant note could prove crucial for understanding the condition you are dealing with, even if you already have a diagnose.

Nocturnal seizures typically take place in the light sleep (stage 1 or 2) and prevent one from reaching the REM phase and slow wave sleep, which happen later during the night and are the most restorative stages. It significantly reduces sleep quality, and the individual might wake up tired, with impaired memory functions, cognitive ability, response time or other essential bodily functions. Sleep deprivation is known to cause irritability and emotional stress, which, along with excessive tiredness, ranks high on a seizure trigger list from a large study. That is to say that nocturnal seizures have a good chance of indirectly causing daytime seizures as well.

Sleep Apnea

About one-third of people who live with epilepsy also have undiagnosed sleep apnea. Obstructive sleep apnea (OSA) is a treatable sleep-related breathing condition that causes partial or complete airway obstruction during one’s sleep. When untreated, it can majorly disrupt sleep and result in sleep deprivation, which does nothing to help prevent seizures, as we previously established. The most effective treatment for this disorder is Continuous Positive Airway Pressure (CPAP) therapy. The method is simple: the CPAP machine draws in air, humidifies it and sends it directly into a mask that the patient put on before going to sleep. In patients with epilepsy and OSA, CPAP therapy has been shown not only to treat OSA but also to improve seizure control.

OSA risk group includes older people as well as those who are overweight. People with epilepsy should note this because many of the AED list weight gain as a side-effect.

Conclusion

Epilepsy alone can cause a lot of troubles to an individual who has it. Even in good attempts to improve their condition, one’s sleep can suffer. In the other direction, good and bad sleep can both exacerbate seizures, but insufficient sleep can cause many further complications as well, including sleep disorders and some other conditions – children with epilepsy are more likely to develop ADHD. Treatment for all of these conditions can be efficient if correctly diagnosed. As confusing as that might be, there are things to do and make it easier, such as keeping a sleep (and daytime) log, doing polysomnography and other necessary tests. In addition to that, we would note that healthy sleep hygiene, diet, exercise, and stress management are all key factors to ensure seizures, as well as sleep disorders, are under control.

Disorders related to breathing while asleep are characterized by interruptions in breath or challenges in breathing throughout the night. Without proper treatment, these can lead to severe complications, including heart attacks, strokes, hypertension, and diminished oxygen levels in the blood.

Among the symptoms of sleep-related breathing disorders are weight gain, extreme daytime fatigue, tooth decay, and gum disease. People with these disorders often feel exhausted, and they are not aware of their problems with wheezing, snoring or breathing interruptions during the night. They usually find out about their problems when a partner tells them they snore or when they’re evaluated by a doctor or healthcare professional. They can occur at any age, in both men and women. Certain issues like sinus problems, wheezing, or obesity can increase the risk of having a sleep-related breathing disorder.

Sleep-related breathing disorders can be a subset of a broader group of disorders, including insomnia (difficulty sleeping), restless leg syndrome, parasomnias (including sleep terrors and sleepwalking), and hypersomnias such as narcolepsy (inappropriately falling asleep).

Types

As we mentioned, sleep-related breathing disorders are defined by difficulty breathing during sleep. They involve a range of breathing anomalies from chronic or habitual snoring to upper airway resistance syndrome (UARS), central sleep apnea, obstructive sleep apnea (OSA), and even obesity hypoventilation syndrome (OHS).

Snoring

Snoring happens during sleep when air flow from your breathing forces tissues in your throat to vibrate. About fifty percent of people will snore at some period of life. Even though snoring is more common in men, many women also have this problem. About forty percent of men and twenty percent of women have habitual snoring. Research suggests that it runs in family and becomes more frequent as you get older, but men have a lesser chance of snoring after the age of 70. Snoring can also happen because the throat muscles are relaxed due to the consumption of alcohol or other depressants, or from congestion that you get from cold or allergies.

Snoring can be a nuisance for your partner because it can create a loud or harsh sound during your sleep, and it can cause difficulties for you as well. Light snoring will not disrupt your sleep, but heavy snoring might. Heavy snoring can be linked to other sleep disorders like obstructive sleep apnea or increase your risk of having a stroke, heart disease, or diabetes due to sleep deprivation. It can also cause a sore or irritated throat or a dry mouth in the morning.

Sleep Apnea

Sleep apnea is a disorder that includes a temporary loss of breath during the night, and it happens when airway gets complete or partial obstructions. These obstructions can stop your breathing for short periods, and cause shallow breathing and temporary breath loss repeatedly during the night. When you have an episode of sleep apnea, your body increases the adrenaline levels to try and stop this issue, which causes constant interruption, minimizes the quality of sleep, and increases your blood pressure.

If you have sleep apnea, you can be chronically sleep-deprived, have an increased risk of severe health issues including liver problems, weight gain, diabetes, and heart disease, and show symptoms of slow reflexes, irritability, daytime sleepiness, poor concentration, depression, and moodiness. For developing sleep apnea, many factors depend on your anatomy, but some were caused by certain injuries to the nose and nasal passageways. You can feel fatigued during the day while having difficulties concentrating and falling asleep.

Obstructive Sleep Apnea

Obstructive sleep apnea is the most common type of sleep apnea. It occurs when your airway is blocked, causing you to stop breathing for a brief period, have loud snoring, or even wake you up from sleep. The airway is repeatedly blocked, which limits the amount of air that will reach your lungs.

Obstructive sleep apnea is a serious condition that occurs when a person stops breathing during sleep due to obstruction in the airway. It causes loud and frequent snoring, deprives our brain of oxygen, and wakes us up several times a night. Such condition causes daytime sleepiness or fatigue, followed by a number of other health problems, starting from insomnia, loss of concentration, morning headaches, memory losses and so on. Also, sleep apnea in children is different from obstructive sleep apnea in adults, and there are lots of variations of this disorder. Although slim people can suffer from sleep apnea as well, excess body weight is a major risk factor this condition (it increases with higher body mass index (BMI) of 25 or more).

Central Sleep Apnea

One of the variations as mentioned above is central sleep apnea, which is not caused by a blockage of the airway, but rather by some brain or heart problems. It means your body decreases or stops the effort of breathing during sleep in an off-and-on cycle because the heart and brain fail to interact in monitoring the air flow. This causes problems such as frequent waking up, difficulty falling asleep again, and as a consequence, daytime sleepiness. People become tired, they are not capable of restoring their concentration even after daytime naps, so the quality of life is significantly reduced.

Child Sleep Apnea

The percentage of children having obstructive sleep apnea which needs to be treated is about two, and it mostly occurs before they start school, because their tonsils are too large, due to which they may also have troubles with swallowing (dysphagia). It appears to occur at the same rate in young boys and girls, but it is more likely to occur in a child who has a family member with OSA. The cause for child sleep apnea may also be immature brainstem or some other medical condition.

When they fall asleep, the muscles relax and, the soft tissue blocks the airway, causing partial reductions in breathing, called hypopneas. But these can also induce complete breathing pauses, called apneas, usually occurring during the sleeping stage known as rapid eye movement (REM). Reduced levels of oxygen in the blood which result from apneas are called hypoxemia and are common in children because of their smaller lungs and lesser oxygen reserves.  Their shallow breaths cause an increased level of carbon dioxide in the blood, which is called hypercapnia.

While snoring, younger children can show unusual chest and abdomen movement, causing their rib cage to move inward as they inhale, which is not normal for healthy children. If untreated, it can lead to serious problems, such as funnel chest or depression in the chest wall. Children suffering from OSA also tend to sleep in the sitting position, they may sweat during sleep and have headaches in the morning, and experience bedwetting. During the day, they may breathe through the mouth, thus being more susceptible to respiratory infections. The problem with children is establishing the right diagnosis on time, because otherwise, they may have a slower growth rate and higher blood pressure.

Furthermore, problems in behavior may occur, such as aggressiveness, hyperactivity disorder, development delays and similar. But, even healthy children can have brief central apnea, due to some instability in breathing, and such pauses could be isolated events, occurring after sighs or moves. In such cases, they last less than 20 seconds. However, if they have prolonged breathing pauses lasting more than 20 seconds, they may need to be checked for OSA.

Infant sleep apnea

The apneas for infants can be central, obstructive or mixed. Central apneas happen when the body minimizes or stops its effort to breathe. Obstructive apneas happen when the soft tissue in the back of the throat collapses, causing it to block the airway during sleep. Mixed apneas are essentially a central apnea that is followed by an obstructive apnea.

Sleep-Related Groaning

Catathrenia or sleep-related groaning happens when you create a prolonged sound while sleeping. This sound is quite loud, and it resembles groaning, which is where the name came from. During this episode, the breathing becomes very slow with deep breaths that end in a loud exhale that can last up to 40 seconds. The groans can end with a loud grunt, and they often repeat in groups from a couple of minutes to an hour. The condition is very rare but more frequent in men. The cause is still not known because it is not related to any breathing problems, mental disorders, or abnormal brain activity.

Diagnosis

Most sleep-related breathing disorders can be diagnosed the same way as any sleep disorder – with polysomnography, which is an overnight sleep study in a sleep lab or at home. The sleep study will determine if you have any breathing changes during sleep.

Treatment

The usual treatment for sleep-related breathing disorders requires major lifestyle changes. The first is behavior modification aimed towards improving sleep hygiene. You also need to avoid supine positioning during sleep, sedative medications, and ethanol.

Headaches hit everyone, young and old. They can be a minor nuisance or a major pain, messing with sleep and day-to-day life. Often, the go-to fix is catching some Z’s, stretching your legs outside, or popping a pain reliever to keep going until the ache fades. But, we’re diving into something a tad different here.

Migraines are the much more severe cousin of regular headaches, and they sadly often go undiagnosed or overlooked. If you’re suffering from migraines, it’s easy to classify them as regular headaches, since on the surface the two conditions function almost identically. Migraines affect more than 36 million people in the United States. Their effect on the person’s sleep quality and general daily performance is enough to cause workplace accidents or seemingly unrelated health issues. We will go into details to paint a picture of how problematic migraines can be, as well as how they’re connected to a person’s sleep and how to relieve their symptoms. Let’s get into it.

How Migraines Work

Migraines are not very difficult to explain. Imagine a severe regular headache, then make it worse and add a medium-sized list of unpleasant symptoms that can incapacitate a person for potentially a whole day – or a few days, in the worst case scenario. For this reason, people who have a history of dealing with migraines should focus on creating an environment or a single room to retreat to where they can rest without sharp noises and bright light. The list of symptoms goes as follows:

–          Blurred vision is a very common migraine symptom and one that makes any sort of precision-based work nearly impossible.

–          Throbbing and recurring headaches, of moderate or high severity, either localized to a specific region of your head (such as one side of your forehead) or spread across your whole head. Easily the most defining symptom of migraines, and the part that contributes the most towards disrupting your sleep schedule

–          Increased sensitivity to light can pose an issue. Noticing auras (which manifest as flashes of light or blind spots) is a key method of identifying a migraine. Make sure that you spend as little time as possible exposed to intense light during migraine episodes.

–          Nausea and stomach problems are quite common in migraine sufferers, too. Even taking a painkiller or two doesn’t resolve potential nausea that comes packaged in with the migraine, and the person can throw up multiple times as a result.

–          Fatigue accompanies a variety of neurological and sleep-related conditions, so it’s no surprise to see it show up on the list of migraine symptoms as well. Fatigue can cripple an individual’s daily performance in many areas of life. It’s responsible for workplace accidents, car crashes and more. Any condition that causes sleep deprivation also causes fatigue.

–          Vertigo is common among people with migraines and is also considered the most frequent form of dizziness. On its own, vertigo affects around 5% of the population each year. It’s characterized by the feeling that objects around the person are moving when they actually aren’t. Vertigo may cause trouble walking, vomiting or nausea in general.

–          Reduced appetite is another potential symptom and one that is often noticed alongside nausea and stomach pain caused by migraines. Try to consume foods such as bread and baked toast to minimize the chances of throwing up, since these foods can absorb some of the acids.

Any combination of these symptoms can crop up when a person experiences a migraine episode. It’s not always the same, and the overall migraine duration ranges from a few hours (enough to miss a day of work) to a few days (which causes considerable scheduling issues for the person and generally puts them out of commission for the whole duration). The intensity of the symptoms also tends to vary from migraine to migraine.

One of the biggest issues we have with migraines is that scientists and researchers don’t know the exact causes. Thanks to recent research, the idea that migraines are a neurological issue is becoming more and more widespread. Studies have shown that migraines share the same gene mutation as advanced sleep phase syndrome, a condition where your body wants to fall asleep much sooner than normal (to the point where the urge to go to sleep at 6 PM can be irresistible) and wakes up at around 2-5 AM. Because they’re tied to genetics, migraines often run in the family, although it doesn’t mean that every affected family member will experience a migraine the same way. Different lifestyle situations can trigger a migraine, but the most common ones are stress, poor sleep quality or quantity and weather conditions (particularly sudden shifts in the local weather).

How Migraines Affect Sleep

As you might imagine at this point, migraines have a considerable number of negative effects on your sleep quality, schedule and likelihood to experience a sleep disorder. The American Migraine Foundation (AMF) has determined that migraine sufferers have a 100-700% increased chance to have trouble getting enough uninterrupted rest. As a rule, the worse your migraine is, the more issues you’ll run into trying to fall asleep. Simply having migraines regularly can lead to a vicious cycle when it comes to sleep – a late night migraine can destroy your sleep for that night, which makes you sleep deprived and fatigued during the day. This sleep deprivation introduces a huge number of potential physical, emotional and mental health concerns, and worst of all – it causes migraines. Chronic sleep deprivation is an incredibly difficult obstacle to overcome for people who have migraines – and it’s far from the only sleep-related condition you can encounter. Here’s a list of problematic sleep disorders you should be on the lookout for:

Insomnia

Insomnia is characterized by an increased difficulty at which the patient can fall or stay asleep, and is possibly the most common sleep disorder. Insomniacs have trouble getting the recommended amount of sleep per night on average, which ranges between seven and nine hours for fully developed adults. As mentioned previously, the resulting sleep deprivation can itself be a trigger for new migraine episodes, which can create a seriously crippling loop of pain and exhaustion. Stress, anxiety, and depression can all be developed through sleep deprivation, and both stress and anxiety are common headache triggers.

Around a third of all the people with migraines in the US report getting an average of 6 hours of sleep per night, which can endanger them at work, damage their social life and lead to traffic accidents and a variety of health problems. Remember that fatigue weakens your immune system significantly – a seemingly unrelated illness could have a root cause in fatigue, and every single sleep disorder causes fatigue in one way or another. Short sleeping is sometimes considered a direct contributor to the risk of early death. Unfortunately, sleeping for six hours or less is one of the easiest ways to ensure a migraine activation the next day. Around 80% of people who have to deal with migraines have reported feeling very tired when they wake up.

Sleep Apnea and Snoring

Migraines have a surprising connection to sleep apnea and snoring in general. Children who experience migraines are around twice as likely to encounter sleep apnea or snore, and also have to deal with many more sleeping disturbances than children without migraine issues. Snoring is described as noisy breathing during sleep and is often treated as an early warning sign for potential sleep apnea. Fortunately, not everyone who snores has to eventually face sleep apnea, but it’s best to be on the safe side when it comes to sleep disorder prevention. Both snoring and sleep apnea cause sleep deprivation and fragmented sleep, which seriously increases the risk of migraines.

Sleep apnea generally falls into two main categories – obstructive sleep apnea (OSA) and central sleep apnea (CSA). Both of these result in temporary loss of breath during sleep, and they differ in how they obstruct airflow and the specific treatment plans. OSA occurs when there is a physical blockage in the patient’s airways, usually caused by the relaxation of muscles responsible for breathing. This muscle relaxation often causes the tongue to enter the airway, which blocks air passage. CSA is different in that instead of physical blockage, the “culprit” behind airflow prevention is the brain, and its inability to regulate breathing muscles properly through electrical signals. Both types of sleep apnea are treated through the use of a CPAP (continuous positive air pressure) generator. This generator is connected to a hose, which funnels humidified and pressurized air into the patient’s mouth and nose through an attached mask. Depending on which type of sleep apnea you have, the measurements for how humid the air is and how much pressure is applied are different.

Awakening and Hypnic Headaches

We’re grouping these two types of headaches together because it’s very easy for an uninformed person to mistake one for the other, as they behave similarly. Awakening headaches occur for around 70% of all migraine sufferers, usually between 4 AM and 9 AM (hence the name). If these headaches happen regularly, it often means there’s an underlying sleep disorder.

Hypnic headaches affect adults age 50 or older. They have an alternative name that hints at their behavior – alarm clock headaches. Hypnic headaches always occur at a consistent time every night they pop up, typically around 1-3 AM. They cause enough pain to instantly wake the person up, causing fragmented sleep and lasting up to three hours after waking. Hypnic headaches happen once in three days or so, and a quota of 10 days per month is required to diagnose them properly. Some researchers theorize that alarm clock headaches always occur during REM sleep.

Sleeping Tips for People With Migraines

As was shown, migraines are an obstacle that has to be worked around by the people who experience them. While you can never get rid of migraines altogether, there are steps you can take to alleviate the symptoms and achieve good enough rest to minimize how often you get headaches. Most of these steps are simple lifestyle changes that help you stay healthy in general, so you get a lot of benefits even outside of migraine prevention. Here’s the list:

–          Watch your diet. Diet problems cause a huge number of health risks, and migraines are no exception. In general, you should try to avoid stuffing yourself full of sugary and greasy foods, but the importance of this is doubled when you’re close to bedtime, as it can lead to a spike in blood sugar and an upset stomach, which prevents you from relaxing enough to fall asleep properly.

Alcohol and caffeine are well-known sleep-destroying substances by now, but they’re worth mentioning. Alcohol, in particular, has a negative effect on your overall sleep quality, so don’t be tempted by the initial relaxation benefit. Caffeine is only acceptable if you suffer from hypnic headaches, as it can minimize the odds of them occurring when consumed in calculated doses.

–          Establish and maintain a strict sleep schedule. One of the best ways to minimize the frequency of migraines and their severity is to force yourself into a healthy sleeping schedule. Aim for 7-8 hours of sleep each night, and don’t deviate from this schedule except during emergency situations. By doing this properly, you “train” your circadian rhythm to make you feel sleepy at the same time every day, which decreases sleep onset latency.

–          Try to create a “bedtime routine.” This routine can consist of a variety of relaxation exercises and sleep-friendly habits. You have a ton of options – drinking herbal tea, meditating, practicing yoga, doing regular breathing exercises, taking a warm bath, etc. Get creative, as long as you don’t develop a habit that indirectly leads to trouble sleeping.

–          Keep a sleep journal and headache diary. If you plan on visiting a doctor (which is a good idea if you suspect you’re dealing with a sleeping disorder), the best way to help them reach an accurate diagnosis is to keep track of your problems over the course of several weeks. Sleep tracking doesn’t necessarily have to be done by hand, but headache diaries don’t have a convenient app alternative we could recommend. Make sure to take note of what time of day you get headaches, how long they last, how severe they are, and how often they occur. Any information you can give the doctor is one step closer to proper treatment.