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Ever experienced a sudden jerk in your body just as you were drifting off to sleep? You find yourself suddenly awake, often with the sensation of having tripped, slipped, or fallen in a dream. Your pulse races, and settling back into sleep takes a moment or even proves challenging for a return visit from the Sandman. If this sounds familiar, rest assured, you’re in good company; it’s entirely normal.

These events are called sleep starts, or hypnic or hypnagogic jerks, and they are quite common. Almost everybody experiences it at some point in their lives, and they can also affect anybody, no matter your sex, racial background, or age.

Sleep starts are usually harmless, and they don’t require any medical assistance. However, there are some reported cases of hypnic jerk anxiety, where person’s events were so frequent and unpleasant, that they developed a negative attitude towards going to sleep. Sometimes, sleep starts can be a sign of some underlying sleep or a mental disorder.

Hypnic jerks are a part of a wider variety of involuntary movements called myoclonus. Sleep starts are not considered a sleep disorder, and they usually don’t require any treatment. There are some things you can try to lower the chances of these events if you experience them frequently or they feel startled by them.

What is Myoclonus?

Myoclonus refers to a sudden twitching of muscles. If sudden muscle contractions cause it, it is called positive myoclonus, and in case of muscle relaxation it is negative myoclonus. They can be single events, or they could happen in a sentence or a specific pattern.

Besides sleep starts, hiccups are another excellent example of myoclonus. While these are entirely harmless, severe cases of myoclonus affect a person’s ability to move, eat, or talk. Those are often a sign of some underlying condition, or brain and nerve damage, and need to be treated.

Myoclonus can develop as a result of head or spine injury, infections, liver or kidney failure, brain tumors, drug poisoning. Myoclonic jerks can also occur in patients who have multiple sclerosis, Alzheimer’s disease, Parkinson’s disease. They are frequent in people with epilepsy because the brain’s electrical signals are distorted.

Types of Myoclonus

There are some forms of myoclonus; here we listed the ones described by the National Institute of Neurological Disorders and Stroke (NINDS):

• Action myoclonus is characterized by the jerks when making a voluntary movement, or even thinking about it. It can affect legs, arms, face, even the voice. It is one of the more disabling types of myoclonus, and it’s usually caused by the nerve damage that is due to the lack of blood flow and oxygen delivered to the brain.
• Cortical reflex myoclonus is typically triggered by a specific action, just like action myoclonus, or it can be due to some sensation.
• Essential myoclonus is not caused by the abnormalities in nerves and brain, and the cause is still unknown. It usually occurs in the same families, hinting that it may be possible to inherit it. It seems stable over time, and people who are experiencing it are not reporting the increase of symptoms severity.
• Palatal myoclonus is a contraction of the soft palate, a back end of your mouth, and happens regularly. These may be accompanied by jerks in other parts of face, tongue, throat, or diaphragm. This condition mostly affects adults, and the contractions can be very rapid, as many as 150 per minute. It mostly happens at night, and for most of the people, it’s a minor problem, while others hear a clicking sound in their ears, or report pain and discomfort.
• Progressive myoclonus epilepsy (PME) refers to a group of disorders with symptoms like myoclonus, trouble walking or speaking, epileptic seizure, and other severe symptoms. There are many forms of PME. They usually begin in childhood, and get worse over time, with sometimes fatal outcome. Luckily, these disorders are extremely rare.
• Reticular reflex myoclonus is a type of generalized epilepsy that is correlated with the brain stem, a part of the brain responsible for vital functions like heart and breathing rate. These jerks usually happen in the whole body, but there are some cases where they affect only a part of the body, like the legs. They occur on both sides at the same time, and jerking involves all muscles in that body part. Reticular reflex myoclonus occurs voluntary movement or due to some some external stimulus.
• Stimulus-sensitive myoclonus as the name says, is caused by external stimuli like noise, movement, and light. Not expecting the stimuli may increase the chances of jerks appearances.
• Sleep myoclonus mostly occurs in the first stages of sleep, most likely at the very beginning. Some cases report that the external stimuli can trigger it. While mostly harmless, it can sometimes be a sign of a sleep disorder such as restless legs syndrome, and it may require medical treatment.

Why Do Hypnic Jerks Occur?

It is still unclear why do sleep starts happen, and researchers are trying to figure that out. It is most likely due to misfiring of neurons when some parts of the brain fall asleep faster than the others. Another interesting hypothesis says that hypnic jerks are an ancient primate reflex. They supposedly happen because of the relaxation that is sometimes misinterpreted as a falling out of the nest in the trees, so twitching happens to wake us up.

Whatever the cause, they are thought to affect most of the population, and they are more frequent in young children. Some risk factors are shown to increase the chances of sleep starts occurring. High intake of the caffeine and other stimulants, especially too close to bedtime may set it off. Emotional trauma, stress, poor sleeping habits, and high-intensity exercise before sleep are common triggers as well. Medication abuse, iron deficiency, and urea build up are also suspects for potential causes. Certain sleep disorders like obstructive sleep apnea can play a role too. Frequent unpleasant episodes of sleep starts need a medical examination, as they can lead to anxiety and sleep onset insomnia, or they can be a sign of a more complex underlying problem.

Other causes of sleep movements include:

• Restless legs syndrome is described by the uncomfortable feeling in the legs when resting, with an urge to move them and relieve the pain.
• Periodic limb movement disorder occurs during sleep, and it is described by the periodic rhythmic contraction and relaxation of the muscles. Unlike hypnic jerks, these are not single events.
• Shivering while sleeping in a cold environment can cause nocturnal movements as well. It affects the whole body and can be resolved by warming up or treating the fewer that is causing it.
• Fasciculations happen in a specific muscle or group of muscles. It appears as quivering, they are more persistent than hypnic jerks, and can occur during wakefulness.

How to Deal With Sleep Starts

In most cases, hypnic jerks can be improved through changing lifestyle habits like:

• Avoiding high-intensity exercise before bed. Although regular physical activity is one of the best ways to get better quality sleep, it seems that exercising too close to bedtime can be counterproductive and increase the chances of sleep starts.
• Avoiding caffeine. Caffeine is a stimulant, and it is found in coffee, tea, chocolate, and many other things. It helps us get alert in the morning, but having it later in the day might affect our sleep quality.
• Avoiding other stimulants. Alcohol and nicotine can lead to disrupted sleep and hypnic jerks, especially if taken close to bedtime.
• Creating a relaxing bedtime routine. It is essential that you unwind before bed as it will help you fall asleep faster, and stay sound asleep during the night. Different things work for different people, so you might try reading, taking a hot bath, drinking caffeine-free tea or a warm glass of milk, listening to mellow music, meditating, breathing exercises, light yoga, taking a hobby, or any other thing that helps you relax.
• Creating a pleasant sleep environment. Your bedroom should be dark, quiet, fresh, and free of screens and distractions. Also, try to stick to a regular sleep schedule, where you’re going to sleep and waking up at the same time every day.

If your symptoms are persistent, and these sleeping tips don’t help you, you should consult a medical professional. They may need to do an overnight sleep study called a polysomnogram, where they will observe your brain waves, respiration and heart rate, and many other things. That way they can determine what is causing your sleep problems and prescribe the right treatment. Sleep starts can be treated with leg exercise, iron supplements, dopamine agonists in really bad cases, as well as other medical supplements.

About half of the global population will face some sort of sleep disturbance throughout their lifetime. Although these issues vary in severity, with some posing serious health risks and others simply altering sleep patterns, they all cause discomfort to some degree. Among the most widespread issues are teeth grinding (also known as bruxism), insomnia, various parasomnias, and catathrenia, which involves making a moaning sound when exhaling in sleep rather than the more common snoring. These conditions affect different demographics in unique ways, with some being widespread, others targeting specific groups, and a few so rare they’re hardly recognized outside of specialized sleep studies. This is true for circadian rhythm disorders, except for the delayed sleep-wake phase disorder, which is relatively more common among sleep disorders.

What each one out of this family has in common, as the name suggests, is some form of abnormality of the circadian rhythm. A normal human circadian rhythm is a process that oscillates and re-occurs every 24 hours, regulated by the circadian clock. These rhythms control our core body temperature, hormone secretion, alertness levels, and regulate the sleep pattern in response to our exposure to light. The purpose of this is to make sure we do the right things at the right times: we fall asleep when it’s dark outside and wake up in the morning.

Abnormalities of this rhythm have a few variations: our sleep onset can be delayed or advanced; our sleep nonrestorative, stuck by jet-lag or shift-jobs, scattered throughout the day, or sometimes “run free” of the standard 24-hour rhythm. The last two disorders are often grouped into a subcategory called the “sleep-wake rhythm disorders.”

What are Sleep-Wake Rhythm Disorders?

The two disorders that fall under this category are irregular sleep-wake rhythm disorder and non-24-hour sleep-wake disorder. These two neurological disorders are typically the rarest forms of all circadian rhythm disorders; their prevalence is practically unknown in otherwise healthy people, without the presence of another condition. However, the incidence rate among blind individuals, the elderly and people who have Alzheimer’s is significantly higher between these disorders.

Irregular Sleep-Wake Rhythm Disorder

The main characteristic of the irregular sleep-wake rhythm disorder is its unpredictable sleep pattern, with sleep periods occurring randomly throughout the 24-hour cycle. People who have this condition sleep a few times a day for shorter periods that can last anywhere from one to four hours, but their daily sleep sums up to eight or nine hours overall. They take multiple naps over the day but usually sleep the longest at nighttime.

While this disorder doesn’t impair the length of sleep an individual gets per day, the uncontrollable, scattered manner of it results in struggles with handling daily responsibilities; shifts at work and tasks requiring attentiveness can be compromised by an unpredictable, spontaneous sleep urge in the middle of the day. It can quickly put you and the people around you in danger. Besides that, if continued over a longer timespan, irregular sleep-wake rhythm disorder can lead to sleep deprivation, risking other potential complications for your health.

The exact cause of the irregular sleep-wake rhythm disorder is unknown, but infrequent light exposure and unpredictable mealtimes are the two factors believed to contribute to its development. Since these stimuli have a direct impact on the circadian rhythm, their infrequency lessens its ability to time sleep properly. Such a situation may happen when the patient lives in a nursing home, hospital, or has some debilitating condition that deters them from going outside and getting enough sunlight on a steadier, more regular basis.

Another possible factor could be age. Our body gradually stops producing certain circadian rhythm regulating hormones as we get older, making it harder for our brains to differentiate sleep time from wake time. Aside from that, Alzheimer’s disease and dementia are believed to be related to the irregular sleep-wake rhythm disorder; it is much more prevalent in patients who have one of these neurological conditions than in otherwise healthy people. In people under the age of 60 who don’t have another medical condition, the incidence rate is estimated to be under 1%, making this sleep disorder very rare.

Symptoms include:

•         Difficulties falling asleep
•         Waking up after sleeping for only 1-4 hours, even at night
•         Excessive daytime sleepiness
•         Unpredictable but very strong sleep urge
•         Having a fragmented sleep manner, napping a few times during the day

Diagnosis and treatment

In order to diagnose irregular sleep-wake rhythm disorder, a doctor will start by taking your medical history and asking to hear your subjective impressions about the problem you came to address. A sleep diary is something you can start even before you go to your first appointment. Simply record everything you notice about your sleep pattern for a few weeks. How often you sleep, for how long, at which times of day, whether you are sleepy during daytime or not – all of these can be useful for a specialist to narrow down your symptoms much faster. Although used as a subjective overview, the information provided in a sleep log is often much more detailed and precise because it was fresh when you recorded it.

To rule out some other sleep disorders, the doctor might order polysomnography. This test is performed during the night, or during the patient’s usual sleep time; it tracks all the major bodily processes that occur during sleep, monitored by a sleep specialist. It could help determine whether or not you have the irregular sleep-wake rhythm disorder by tracking the circadian rhythm markers in the body – melatonin production and core body temperature oscillations.

The treatment of irregular sleep-wake rhythm disorder usually consists of a combination of behavioral therapy, phototherapy and melatonin supplementation.

• Behavioral changes include re-associating your bed with sleep – setting up a comfortable atmosphere in the bedroom and sticking to a planned daily bedtime and waking up schedule. Your eating pattern also needs to be regular and predictable.
• Phototherapy is a treatment using bright light in the morning or as needed until noon, to help the circadian rhythm boost your alertness level and prolong your time awake until nightfall.
• Melatonin is a hormone naturally secreted in our brains that serves a purpose in inducing sleep. Supplementing the prescribed dose of melatonin in the evening, before bedtime, helps cue your body to fall asleep and maintain it for longer than a few hours.

Non-24-Hour Sleep-Wake Disorder

The other neurological sleep-wake condition is known for causing the usually 24-hour long circadian rhythm to stretch beyond that time frame, moving the person’s sleep time later and later, seemingly at free will. This time frame gets progressively longer over time and causes fatigue and excessive sleepiness.

Non-24-hour sleep-wake disorder is caused by anomalies in the suprachiasmatic nucleus, the area of our brain that maintains the circadian clock. As mentioned above, this clock normally responds to light and synchronizes the body with external light-dark times of the day. Occasional disturbances in this cycle may happen prompted by travel, shift work, illness and so forth, usually when our light exposure changes, but then fall back in place after a bit of adjustment. However, in people with the non-24-hour sleep-wake disorder, this function is impaired, for two possible reasons:

1. The brain’s response to light in the patient with non-24-hour sleep-wake rhythm is abnormal, or there is little to no exposure to light. Melatonin levels might also be higher than average.
2. The person is blind. People with blindness can’t use light as a cue for alertness, as usually regulated by the circadian rhythm, which makes them more prone to this disorder.

The non-24-hour sleep-wake disorder is highly prevalent in blind individuals; up to 70% of them also have this disorder. The exact incidence rate of this disorder among sighted people is unknown, but those with current issues or a history of delayed sleep-wake phase disorder are prone to developing the non-24-hour sleep-wake disorder as well, pushing their already late bedtime even later. If this keeps going on for long enough, the person will get stuck, going back and forth between night owl and early bird sleep schedule, forming full circles before starting new rounds. This wheel results in excessive sleepiness and exhaustion, making any social life or work shift impossible to maintain for longer than a day.

Sleep scientists have recently begun researching the possibility of a genetic predisposition towards developing the non-24-hour sleep-wake disorder, but no significant evidence has yet linked the two.

Symptoms include:

•         Bedtime moving later and later as time goes by
•         Waking up progressively later as well
•         Difficulty onsetting sleep
•         Current issues or a history of the delayed sleep-wake phase disorder
•         Insomnia
•         Depression
•         Excessive daytime sleepiness
•         Unsatisfactory quality of sleep
•         Feeling isolated from other people

Diagnosis and treatment

As with irregular sleep-wake rhythm disorder, after questionnaires, a physical exam and a thorough medical history, your doctor might suggest using a sleep tracking tool. Actigraphy is a device worn around the wrist to record your sleep-wake cycles – this method is used when polysomnography isn’t available or necessary.

As far as the treatment goes, a combination of melatonin supplements and light therapy is frequently used for patients with the non-24-hour sleep-wake disorder. The procedure is standard – melatonin is used in the evening to help with sleep onset, and light therapy is used in the morning, to alert the body and keep it awake until bedtime. However, unlike the other circadian rhythm disorders, non-24-hour sleep-wake disorder has to be treated even after optimal results have been achieved; that is, even when the circadian rhythm gains its usual functionality back. If the treatment stops abruptly and the new, balanced sleep hygiene isn’t properly maintained, the non-24-hour sleep-wake disorder often recurs. For blind people with this disorder, carefully timed and dosed melatonin is the most effective and frequently used method of therapy. Maintaining the normal circadian rhythm is especially difficult for them as well; regular medical help is often needed.

Tips for Maintaining Healthy Sleep

In addition to virtually all methods used for treating sleep disorders, some behavioral changes are a safe bet to keep your sleep in check and make sure past issues don’t return in the future. Try to follow these guidelines:

• Don’t procrastinate sleep. Some adjustments to your schedule are fine once in a while, but no treatment or medication will eradicate issues caused by poor organization or complete neglect of your sleep. Take responsibility to avoid unnecessary complications.
• Abusing substances, doctor approved or not, is another no. Just because your sleep pills might have been prescribed at some point, using them while disregarding the doctor’s instructions will do more harm than good. Steer clear of alcohol, caffeine, antihistamines, and other drugs before sleep.
• Make sure you get out of the house during sunlight. It will help maintain the healthy circadian rhythm, plus any physical activity that you can fit into your day is worth it – exercise has been shown to boost sleep among other systems in your body, like immunity and metabolism.
• In the late afternoon and evening, try dimming the lights, especially in the bedroom. Lowering the light levels will be suggestive to the circadian rhythm, preparing you for nighttime and sleep.
• Do daytime activities away from your bed. By limiting the use of your bed to sleep-related activities, you will establish the relationship between the two in your mind. Falling asleep at night will be easier when your body is trained to expect sleep simply by being in bed.

Do you ever feel like you’re meant to be on a different temporal schedule? While everyone else is rising at dawn to begin their workday, you find yourself feeling drowsy and prepared to hit the snooze button, and the opposite occurs as well. People often describe you as a night owl, and despite your ability to adapt and feel alright, it’s likely you’re experiencing a sleep-wake phase disorder.

Sleep-wake cycle refers to our daily pattern which consists of optimally recommended 16 hours of wakefulness and 8 hours of sleep during the night. Our body’s circadian rhythm controls the sleep-wake cycle. Circadian rhythm is controlled by the body’s inner clock located in the brain which controls many biological functions such as hormone release, body temperature, and sleep-wake cycle. Our biological cycles are usually synchronized with the daily cycle of light and dark, which affects our sleeping and waking time. Beside disorders of the sleep-wake phase, our body’s circadian rhythm can be disrupted due to working in shifts, jet lag, etc.

Just like with other disorders of circadian rhythm, sleep-wake phase gets disrupted when our circadian rhythm is not aligned with normal sleep routine. People who suffer from this disorder have a strong biological urge to stay up when most of the other people are sleeping and to sleep when others are already fully awake. This disorder can sometimes be mixed with insomnia, or be prescribed to someone’s laziness or late night binge-watching habits, but the reality is that it is also a type of disorder which has a strong impact on everyday life since it can be hard for those people to socialize or hold a job with that particular lifestyle.

There are two main types of this disorder, advanced and delayed sleep-wake phase syndrome, for both cases, the best thing that you can do is to go to a sleep clinic and let them perform a sleep study on you. You might be asked to write a sleep diary for a few weeks or to wear an actigraph to track your sleep. All this is needed so that the doctors can set the correct diagnose, as these disorders are often caused by others or mixed with them due to similar symptoms.

Excessive daytime sleepiness and a struggle with maintaining a sleep routine are common symptoms of both types of sleep-wake phase disorder, and we are now going to discuss both of them.

Delayed Sleep-Wake Phase Disorder

DSPD stands for delayed sleep-wake phase disorder which is also known as DSPS, delayed sleep-wake syndrome. People who have been diagnosed with this disorder usually have their sleep pattern delayed by at least two or more hours. That means that the circadian rhythm of those people is shifted to later at night and in the morning too. Their sleep is generally healthy, there are not any disruptions or issues while they are asleep, but the fact that it occurs later than normal or socially acceptable can be a problem for them once it starts hindering their job or other activities. Since they are usually a minority in society, they have to struggle to fulfill expectations and do things on time. Getting up early to go to school or work can be challenging for them, and many people with normal sleep cycle are having problems to understand that. Parents, employers and even some doctors can sometimes show the lack of understanding for this disorder, which can be an additional aggravating factor for people dealing with this it.

People with DSPD prefer going to bed late, and when they are on their own schedule without any obstacles, they can get the desired amount of quality sleep time and function as normal as everyone else. The solution to this problem is not simply going to bed earlier, because these people really cannot fall asleep earlier; it is not something that they can easily control or change on their own. People with DSPD who are trying to live as “normal” as possible and go to work etc. are usually sleep deprived, which then triggers some other complications.

Symptoms of DSPD resemble the ones of insomnia, and people’s daytime functioning is jeopardized and followed by severe fatigue and daytime sleepiness. Around 10% of people who believe to have chronic insomnia actually have DSPD. We suggest consulting a sleep specialist at a sleep clinic to set you a correct diagnose and examine your sleep habits.

When it comes to age, teenagers and adolescents are especially affected by this disorder, around 7% to 16% of them have it, and girls experience it more often than boys. It is hard to tell what can be the cause of DSPD, and there are probably some genetic predispositions to it since around 40% of people with this disorder have a family history of DSPD. DPSD should not be considered a psychological disorder, since it more of a neurological disorder, but sometimes, living with DPSD can cause stress and lead to mental diseases such as depression. Environmental conditions, (such as lack of exposure to morning sunlight), other health problems, medications, substance abuse, or other sleep disorder can trigger DSPD

Most common symptoms include:

• Troubles with falling asleep at the preferred time of night
• Being unable to wake up at desired or socially acceptable time
• Chronic fatigue and daytime sleepiness
• People who experience this stable but delayed sleep routine for more than seven days can consider their condition for a sleep-wake phase disorder.

When it comes to treatment or cure for DSPD, timed melatonin has shown great results when used in teens, and it can also be an effective solution for adults. Melatonin is a hormone naturally produced by our body which helps to regulate our sleep-wake cycle by sending signals to our body when our bedtime is approaching. Although it is widely available in the form of a supplement, sleepers should not use it on their own. They should always consult a sleep specialist for the recommended dosage and timing. In theory, another possible treatment is bright light therapy which provenly enhances and changes the circadian rhythm, but it has not been yet scientifically tested and validated as a treatment for DSPD. After waking up at a desired time in the morning, a person that undergoes light therapy should be exposed to bright light, and in the evening hours, bright light should be avoided. Light therapy in combination with cognitive behavioral therapy should be highly efficient among teens and younger adults.

Advanced Sleep-Wake Phase Disorder

Contrary to people who have DPSD and are considered night owls, people with ASPD, advanced sleep-wake phase disorder or syndrome (ASPS), are known as early birds. Their sleep cycle is also out of balance but in a different way. They usually fall asleep several hours before regular bedtime and wake up hours before everyone else.

People with ASPD are already feeling sleepy in the afternoon, and their preferable bedtime is somewhere between 6 PM and 9 PM, which means that they will wake up naturally between 2 AM and 5 AM. Just like with people with DSPD, their sleep is healthy, good quality and not disrupted. All processes of circadian rhythm occur earlier for them, the release of hormones including melatonin, body temperature curve also, and that is used for detecting this syndrome.

Unlike people with DSPD, those with ASPD have no problem with working and functioning normally during the morning hours. For them, the problem occurs during the afternoon and especially evening hours when they start struggling to stay awake and “shutting down.” Missing those few hours of sleep during the early evening will eventually result with sleep deprivation, and even when they are sleep-deprived, people with ASPD will still wake up way earlier than everyone else.

ASPD is also often mixed with insomnia or depression, people start to worry about waking up so early, they are not feeling good about themselves, and that may lead to developing a secondary form of insomnia.

For people with ASPD, it can be a bit easier to organize their life around their early bird lifestyle, since they are the ideal workers for notorious early morning shifts. They should not push themselves to stay awake in the late afternoon by drinking gallons of coffee or taking some stimulants to stay up. The same applied to morning hours; sleeping pills and alcohol should not be used as a way of “help” to prolong their sleep time.

This disorder is not so common since it affects only 1% of middle-aged people, but it is more common among seniors, regardless of their sex. ASPD also runs in families, so genetics are most likely the primary cause of it.

Main symptoms that are signals for ASPD are:

• Falling asleep in the afternoon hours
• Waking up between midnight and 5 AM
• Functioning normally as an early bird for more than a week

ASPD is a disorder with whom people can live if they can adjust to it, as it does not hinder everyday life functioning as much as DSPD. But if it is bothering you and jeopardizing your social life, consult with a doctor, preferably with a sleep specialist. They will examine your family medical history and probably perform a sleep study, for example, polysomnogram, which will follow your brain waves, heart rhythm, and breathing while you are sleeping. It will show if any other sleep disorders caused or increased the effects of ASPD, some of them might be sleep apnea or periodic limb movement disorder.

You will probably have to wear a device called actigraph on your wrist, for around one or two weeks. This device measures and records sleep activity during that time. Some other methods and tests may be included, but these are the most common ones.

When it comes to treatment, as we mentioned, sometimes it is not necessary if people are able to adjust their life to their sleep pattern. Try looking at it in a positive way – a lot of things can be done in the morning or while others are sleeping, and you will be more productive and have more time for yourself. Also, try consulting with a sleep specialist in behavioral counseling. They will provide you with some useful tips such as, for example, not making any plans for evenings, avoiding afternoon shifts or shift work in general, also avoiding caffeine during the late afternoon and not using any pills to help you stay asleep longer.

But, if you want to try ”fixing” it, bright light therapy during the evening hours can help with resetting their inner clock. The light should be brighter than regular indoor lighting, and there are specialized light boxes or portable devices that you can try out for that. You should practice bright light therapy for around two hours before the desired bedtime, at least for one week. Melatonin supplement is another option, but you will have to ask your doctor to prescribe you the optimal dosage.

Polysomnography stands out as one of the top approaches for detecting and pinpointing sleep disorders. This overnight test is conducted in a sleep laboratory, allowing medical professionals to observe different bodily functions during sleep, such as brain waves, respiration rates, muscle activity, and eye movements. Nevertheless, the cost of this procedure might be prohibitive for many, and its duration could conflict with individuals’ work commitments or other responsibilities.

Because of that, the first diagnosis options often include more accessible stuff. One of the most popular approaches to quickly identifying the presence of a sleep disorder is through various questionnaire-style tools. The advantage of these tools is that they often don’t require any formal training, and you can theoretically find them online and answer them before bringing the results to the doctor. Many of these questionnaires and scales have been translated into multiple languages for added accessibility.

However, criticisms have been made over the years about the subjective nature of potential answers. According to critics, it’s far too easy to misremember something or answer in a biased way, making the tests inaccurate. In this article, we will be looking into how this subjective nature manifests using one of the most popular diagnostic tools for sleep disorders out there – the Epworth Sleepiness Scale – as an example. Let’s get into it.

How Does the Epworth Sleepiness Scale Work?

The Epworth Sleepiness Scale (or ESS for short) was developed for adults by Dr. Murray Johns in 1990. It was named after the Epworth hospital in Melbourne, where he had previously (in 1988) established a sleep center. The modified version from 1997 is the one that sees professional use today and requires a license to be used. The primary purpose of the ESS is to measure average sleep propensity (ASP, known elsewhere as excessive daytime sleepiness) through the application of a simple and accessible questionnaire.

The questionnaire consists of 8 questions that the patient must answer and rate on a scale of 0-3 (meaning there are four different responses to each question). A rating of 0 means the patient would never doze off in that scenario. A score of 1 indicates a slight chance of dozing, while 2 and 3 correspond to “moderate” and “high” chance of falling asleep. This rating determines how likely the patient is to fall asleep or doze off in various situations. Here’s the full list, as it’s important to be aware of one crucial factor:

–          Sitting and enjoying a good book

–          Sitting, idle, in a public place (such as a park)

–          Watching television

–          Lying down to get some rest in the afternoon

–          Sitting and holding a conversation with someone

–          Sitting, inactive, after having lunch (without any alcohol involved)

–          Being a passenger in a vehicle for an hour with no breaks

–          In a car, stuck in traffic for around 5 minutes

If you look at official information about the ESS, you may come across the word “somnificity.” This term was also introduced by Dr. Johns, somewhere around 2002. Somnificity is a measure of how much a specific activity or posture contributes towards you falling asleep, or how much it hinders the prospect of sleeping for a majority of people. The ESS questions introduce scenarios with different levels of somnificity to provide a varied selection of situations and help doctors get an insight into the patient’s sleep propensity and sleeping habits.

You may also notice that no timeframe is referenced by the questionnaire (as in, you’re not asked to specifically look at the last week, for example). Instead, it’s presented as remembering these situations “in recent times.” This was specifically arranged so the period (often referred to as the “recall period”) is adaptable to what the patient can remember, which helps increase response accuracy. The only situation in which this doesn’t apply, and a clearer timeframe would be introduced, is treatment progress monitoring. The doctor may want you to remember how likely you were to fall asleep since the treatment started so that they can compare it to results from before the treatment plan began. For example, CPAP treatment for obstructive sleep apnea is guaranteed to cause a drop in the patient’s ESS score, as that treatment consolidates the sleep architecture of the patient, preventing fragmented sleep (a huge potential cause of fatigue, here as a result of blocked airways)

How Are ESS Scores Interpreted?

As mentioned before, each of the eight questions has four potential answers (0-3). These numbers will either be written in a small box next to the question, or the option to tick one of four checkboxes will be present. Other times (though much less often), these answers can be provided electronically or via phone or personal interview. It is of utmost importance to answer every single question as honest as possible because, without those answers, the whole test becomes invalid. The main modification of the upgraded ESS version from 1997 is the added instruction that says just that. Additionally, it’s not allowed to explain each question in detail for the patient, as this can potentially cause bias in their answers. If the patient answers the questions using half-values (such as responding with 1.5 instead of 1), it is recommended not to interrupt their questionnaire, and just accept the result. However, if the end result includes a half-point, round it up to the next integer.

Originally, the average score range was considered to be anywhere between 2 and 10 points (established by Dr. Johns himself). However, after more data, the lower limit was pushed towards zero points and is the average score range you will encounter these days. A resulting score higher than 10 points indicates an increased average sleep propensity or excessive daytime sleepiness. Increased ASP is almost always caused by a sleeping disorder, and so this test can often be used as a preliminary, “filtering” method to determine which patients need to be looked into further. The higher the score goes, the more sleepy the person is during the day, and the more fatigue endangers their overall health and safety. Here’s a brief list that can give you a rough idea on how severe your sleeping problems (and subsequent EDS) are:

–          A score between 0 and 5 points indicates a lower level of normal daytime sleepiness. Naturally, this is the best score you can get.

–          A score between 6 and 10 points indicates a higher level of normal daytime sleepiness. There is still nothing to worry about with this score, as it is considered in the “safe” range and doesn’t point towards sleeping disorders.

–          A score of 11 or 12 is the breaking point at which doctors may conclude you have a potential sleeping disorder. While nowhere close to severe, this score indicates a small amount of excessive daytime sleepiness.

–          A score between 13 and 15 points reaches the “moderate” level of excessive daytime sleepiness. While the interpretation can often resemble that of light EDS (depending on your doctor), this is already a troublesome result. There is no doubt that a person with this many points has a sleeping disorder.

–          A score between 16 and 24 points is considered a clear indicator of severe EDS. This level of fatigue is incredibly dangerous for the patient, and a more thorough diagnosis plan should begin as soon as possible. Methods include a Multiple Sleep Latency Test (or MSLT for short), polysomnography, etc.

Oddly enough, gender and age contribute almost nothing as factors towards the overall score. However, ethnicity does affect things – African-Americans have a noticeably higher average ESS score than most Caucasian Americans. Other significant contributors include depression or sleep-disordered breathing, which can alter the result to some degree. A large number of score reports collected from the general population so far indicate an above-average ASP. It corresponds to the fact that depending on individual demographics, a percentage ranging between 10% and 40% suffer from excessive daytime sleepiness in the United States. Almost every single person with narcolepsy gets a score that indicates moderate or severe EDS.

Criticisms and Downsides to the Epworth Sleepiness Scale

The biggest concern that plagues many critics of the ESS is its inherent subjectivity. Much like the Pittsburgh Sleep Quality Index (PSQI for short) or Stanford Sleepiness Scale (SSS), the Epworth sleepiness scale is susceptible to various forms of bias or inaccuracy. There are no guarantees that the patient will remember all their sleeping habits and patterns well enough to provide a good answer. As a result, the ESS is not meant to be used as the only diagnostic method in scenarios where the person’s ASP may cause legal problems or similar obstacles – in these cases, seek out additional tools, to get more substantial info. It is also unsuitable for diagnosing patients with cognitive impairments that are unable to provide precise answers as a result of their condition.

A common consequence of excessive daytime sleepiness is drowsy driving, one of the riskiest yet routinely performed activities, especially for working adults. The problem here is that the ESS can’t predict the exact amount of fatigue the person feels or how much it hinders their road performance – at least until the scores start hitting values of 15 or higher. At that point, it can be argued that the level of EDS is definitely a massive problem for any potential drivers.

Additionally, the ESS is not precise enough to detect which specific sleeping disorder the patient is dealing with. An increased average sleep propensity is a symptom of basically every sleeping disorder, making it hard to determine a single condition. Instead, the ESS is a good “first” test, a way to disqualify people without dangerous levels of excessive daytime sleepiness, since their likelihood of having a sleep disorder is very small. On top of that, it doesn’t specify what the major contributing factors may be for that potential sleeping disorder, making it less-than-ideal as a standalone diagnostic tool. Always ask for further examination if your score is 11 or higher, in case the doctor doesn’t mention it.

Note: If you’re unsure about any part of the ESS questionnaire, don’t write down your answers at home. Consult your doctor so they can know what’s happening early on, and ask them to supervise your answering process. Also, if you’re worried that you may have a sleeping disorder, don’t hesitate to open and maintain a sleep journal. Sleep tracking is one of the most helpful methods of contributing to a proper diagnosis.

Translations and Reception of the Epworth Sleepiness Scale

The original language used for the development and application of the ESS was English, as it was created in Australia. However, its incredible ease of use and accessibility even without formal training (you basically know enough about the procedure now to answer all of those questions yourself even before a doctor’s appointment) have led to its authorized translation into many different languages. It is very important to keep the translation as close as humanly possible in meaning to the original. The questions are all very deliberately worded to produce the most accurate answers, and dodgy translation, even if it’s tiny inaccuracies, can invalidate the whole procedure. Copyright protects the ESS from any changes, although special circumstances can justify it – with written permission, of course.

Overall, the ease with which a doctor or researcher can conduct ESS testing (for an individual patient or subject, or an entire group of people) has led to its widespread use in clinics all around the globe. It’s considered one of the most reliable subjective sleepiness scales, especially for keeping track of patient progress as a result of regular treatment.

The struggle with lack of sleep can be exhausting and difficult, yet have you ever considered its potential effectiveness as a method of torture and interrogation? It appears we consistently downplay the impact of sleep deprivation on both our physical health and mental wellbeing, despite frequent discussions about its repercussions. While we often willingly sacrifice a night’s sleep for binge-watching, enduring the consequences the following day and eventually recovering, the long-term psychological damage inflicted by forced sleeplessness is hard to comprehend.

We differ two types of sleep deprivation, partial and total. Total one only occurs during some emergency cases, while partial one can be caused by, for example, shift working. Total sleep deprivation is not so common, and many things are still unknown about it, but it can appear as a consequence of interrogation and torture. It is harder to lie when you are mentally drained and tired, and interrogators know that; that is why they prefer inspecting their subjects while they are tired. But forced and severe sleep deprivation does not necessarily mean that someone will speak the truth just because they are in such condition because it can mess up their mental state and lead to many irrational statements.

When you think about many other ways of torture, sleep deprivation may even sound like a tame and mild way to break someone’s will, but when an expert does it, it can last for days and be extremely severe. Keeping someone awake for days leaves no visible or physical harms, only mental ones, and it is a preferred way of torture by regimes who claim to respect human rights and international laws. But, just because it is more “subtle,” it does not mean that it should be legal.

Is Sleep Deprivation Legal?

Police interrogations are never a pleasant experience, but whether you are guilty or not, be sure that the officers who are interrogating you will do anything they can to get at least a glimpse of your confession. The interrogation environment is their advantage, they keep their suspects for hours in rooms with bright lighting and without windows. They control when or if you will eat and drink, and most importantly, will you get a chance to sleep or not.

Studies have shown that sleep-deprived people are more likely to confess things that they did not do, in comparison to those who got enough sleep.

Although currently, the eighth amendment protects US citizens from unusual and cruel punishments, sleep deprivation is not an illegal form or interrogation. Most courts interpret this amendment in a way that it can only be applied after someone is already convicted. But, in 2014. United Nations published a report in which this way of interrogation was defined as torture, but that only refers to extreme cases of sleep deprivation that last up to 180 hours, which could hardly ever happen during any police interrogation.

The United Kingdom, for example, recently banned interrogation of suspects who did not have the opportunity to sleep at least eight hours in previous 24, mostly because a large number of cases with false confessions is being returned to courts. In the US, 25% of cases turned out to be wrongly prosecuted due to false confessions; those mistakes are later proven and corrected thanks to DNA evidence.

Sleep Deprivation As a Means of Brainwashing

One way of attempting to “brainwash” prisoners was sleep deprivation, and it was widely used during the Korean war, but the CIA also used it as a part of their experiments with mind control.

Brainwashing is considered a mind-controlling process or an act that tends to control the human mind using mostly some psychological techniques. Brainwashing should result in the subject’s reduced ability to think independently, it should control its attitudes, acts, and thoughts until it basically becomes a marionette. The concept and idea of brainwashing were conceived during the 1950s to explain how the Chinese government managed to force people to cooperate with them. Today is brainwashing widely discredited, but it remained a popular subject of many spy novels and related literature.

The term brainwashing comes from Mandarin word xi-nao, xi stands for the word wash, while nao is a brain, as simple as that. This term was first introduced to Americans thanks to the journalist Edward Hunter and his article from 1950. in Miami Daily News. In this article, he writes about how Mao Zedong and his Red Army used ancient techniques to convert Chinese people to mindless communists.

After the US soldiers confessed some shocking things, the American public was horrified, and it was hard to find a reasonable explanation for their statements expect for brainwashing. That is when the idea of mind control blossomed in all fields of pop culture with movies such as The Manchurian Candidate and many others which featured brainwashing of POWs. It quickly became the subject of books, articles and even the American Psychiatric Association gave it credit, including brainwashing among dissociative disorders. So, did Chinese communists manage to find a way to control minds and free will? Of course, they did not.  

Many tried explaining the brainwashing process as some mysterious practice that could not be understood, but to scientists who were working on the case of the American POWs when they got back from Korea, it was pretty clear that the soldiers were tortured. One of the psychiatrists who worked with veterans reported the main criteria for brainwashing or thought reform as it was referred to by Mao Zedong. The process of brainwashing trapped American soldiers in Korean camps included deprivation of sleep and food, forced standing, exposure to communist propaganda and solitaries.

Sleep Deprivation Through History

It appears that people even centuries ago knew about the effects of sleep loss on mental health, and used it as a technique of torture and investigation. Some groups refuse to acknowledge sleep deprivation as a method of torture, but instead, they call it enhanced interrogation technique. However, extreme sleep deprivation can cause hallucinations, schizophrenia, and psychosis which can lead to wrong statements and false confessions.

Considering what we all know today, we can only assume how many people were falsely accused due to something they said while they were severely sleep deprived. So now we are going to go back through history to see how forced sleep deprivation was used as a form of torture in a few known cases.

Witch Hunting in 16th Century Scotland

Back in the notorious times of witch hunting, women who were accused of witchcraft and sorcery were hunted nationwide, captured and judged. Before people could convict them, they needed a confession from those women. To get anything that could be used against them, people tortured them by sleep depriving them for days until they begin to hallucinate. Everything that they did or said during those hallucinations or psychotic episode was considered as their confession and usually used against them as proof that they were practicing witchcraft. It sounds ridiculous from today’s point of view, but back in the days’ people were led by mass hysteria, ignorance, rumors, fear, and panic.

Japanese War Camps

There were around 175 war camps in Japan, but many more in countries that were occupied by Japan such as Thailand, China, Hong Kong, and Korea, in them civilians were mixed with military personnel (POW).

It is estimated that during the Second World War around 140.000 of military personnel were captivated since it was believed that they know some critical information. During their interrogations, many different ways of torture were used including sleep deprivation, blindfolding, meal restrictions, etc.

Apartheid in South Africa

The racial segregation movement known as Apartheid began in 1948. in South Africa and was abandoned in 1994. A famous case of sleep deprivation included a psychotherapist John Schlapobersky who was tortured in this way during the 1960s and kept awake for a whole week. He reported having hallucinations after only two nights, and after the third one, he started dreaming awake, which can be considered as a form of psychosis. Among other things, he described feeling distortion of people, time and place.

British Army

One of the most famous Britain’s POW facilities during the second world war was London Cage, run by the PWIS, prisoners of the war interrogation system. There were nine cages like that across Scotland and Southern England.

In 1971. British army performed an operation called Demetrius when 350 people were arrested because they were suspected of being involved with the Irish republican army. Prisoners reported that they were deprived of sleep, beaten, starved and abused.

Sleep deprivation was recognized as one of the five illegal interrogation methods used by the British army. Other four included hooding, wall-standing, drink and food deprivation and subjection to noise.

US Military

Before 2009. sleep deprivation was not considered for an illegal form of torture, and allegedly the US military used sleep deprivation to torture their prisoners. It was regarded as a non-physical way of torture, but although it does not leave any physical traces of harm, the United Nations (UN) still look at it as a way of torture because their definition of torture implies both, physical and mental pain or suffering.  

Effects of Long-Term Sleep Deprivation

• Hypertension – lack of sleep elevates the risk of hypertension. During sleep, our body regulates the release of stress hormones, which implies that sleep loss intensifies the effect of stress on our body. Also, higher blood pressure, heart rate, and inflammations are all side effects that put additional strain on the heart.
• Diabetes – everything less than 5 hours per night is far from enough, and it contributes to the development of type 2 diabetes. Sleep restriction hinders the way our body processes glucose and the amount of insulin which is produced.
• Heart attack and stroke – sleep deprivation causes a higher risk of cardiovascular problems, researchers believe that that happens because sleep loss disrupts the work of certain brain parts which are in charge of controlling the circulatory system.
• Immunity – our immune system is sensitive to our bad sleeping habits, and it performs its best only when we are getting an adequate amount of sleep. Sleep deprivation will lower the production of antibodies and make us more vulnerable to viruses and diseases.
• Anxiety and depression – many people are easily irritated if they did not get a chance to sleep well during the last night, but more extended or chronical sleep deprivation is associated with clinical depression as a major cause of it. Panic attacks and anxiety are also common symptoms of sleep disorders, and just like with depression, sometimes it can be difficult to determine what was the primary cause, sleep disorder or anxiety.
• Memory – scientists believe that while we are sleeping our brain is settling down all the things we previously experienced, and transferring some information from our short-term memory to the long-term memory. That is why a lack of sleep will hinder our ability to recall some memories.
• Brain function – just one sleepless night leads to fatigue, lack of focus, but when our brain is not able to properly rest for a while, our mental abilities can significantly decrease. Also, our motor-functions, balance, and reflexes will suffer, we will be more prone to injuries and accidents. Drowsy driving is one particularly dangerous example of it.
• Psychiatric disorders – an extreme lack of sleep will affect more than just the sharpness of our mind since it can lead to many different psychiatric disorders. Common symptoms of prolonged sleep deprivation include hallucinations, disorientation or paranoia, and they can often be confused or associated with schizophrenia.

Nowadays, it appears irrelevant whether our homes are in bustling metropolises or tranquil rural areas, as the necessity of the daily commute seems unavoidable.

In cities it appears that we have everything just around the corner, but when your job or school is in one part of your town, you live in second, your boyfriend in third and you take yoga classes or whatever in some other area, commute becomes an important thing that takes quite some time. And people who live in the countryside know it well too, whether they want to supply themselves with groceries, go to work or drive their kids to school, they also spend a significant amount of their time in transportation.

Commuting is cutting off a significant part of our day, and it can be a very stressful, boring and exhausting experience that can affect our health and sleep. Longer commute time has been connected to sleep deprivation, especially in cities that have bad public transit systems. Americans already have a huge problem with sleep deprivation since the number of people who sleep less than 7 hours is continually rising. With that in mind, it seems that workers who commute longer sleep less in order to try and get everywhere on time.

How Long Do We Commute?

For example, if you work from 9 to 5, you are going to leave your house at least half an hour earlier, if you are lucky enough and live somewhat close to your job so you can walk or drive quickly to it. Many people travel longer to work, if they catch rush hour in the morning, or later in the afternoon when the majority is going back home from work, those 8 hours of work time can quickly turn into 10 hours, or more, all together with commuting. It can be somewhat more comfortable if you are sitting in your car, listening to your favorite radio station or music, but people who have to use subways or buses often do not have that luxury even to sit. Except for a few lucky ones, most people have no other choice than to stand and squeeze with others. People also often have to combine two or more means of transportation, whether they travel from suburbs or a different city, and that all adds up to that time we spend at work, because we commute mostly for our work, and we cannot do many other productive things while commuting.

If we count that we work 40 hours per week, that means that we spend a quarter of our week at work, without counting in the commute time. According to the newest data released by US American Community Survey, the average American will spend 26 minutes while commuting to work in one way, so that is approximately one hour per day, and that number has only grown during the past decade. Twenty-six minutes in one way does not sound so bad, but if you do that five days a week, for 52 weeks in a year, that is around 9 and a half days wasted in traffic each year. The duration of one average holiday we spent commuting each year, but at the moment for the majority it is impossible to avoid that.

Long distance commuting delivered a category of people called mega-commuters, which refers to people who travel 90 minutes or more in one way, only 3% of Americans fall into this group which spends at least three hours commuting each day.

All means of transportation can be bad for our sleep, but researches have shown that people who commute using public transit are suffering more from it. Those commuting by bus are feeling the most negative impact since they tend to develop depression and anxiety.

Longer Commute = Shorter Sleep?

As commuting became a part of our everyday life, it also became one of the things that cause our sleep deprivation. A study based on the data collected from the American Time Use survey showed that each minute of commuting means 0.2205-minute less of sleep time. Another study examined the sleep habits of commuters who use Long Island railway transit. Questionnaires were left at each station and researchers collected answers from 21.000 people during the six consecutive weekdays. They came to the conclusion that longer commute hinders people’s ability to get enough sleep each night. According to their results, people who commuted longer than 75 minutes were sleeping for 97 minutes longer during the weekend than on weekdays, they also napped more often during their commute in comparison to those who needed 45 minutes or less to get to work.

The US Census publishes data about commute times for each state every five years. Those rates were combined with CDC’s data on sleep deprivation for every country in an attempt to find a correlation between the lack of sleep and commute time. It is considered that around 35.2% of Americans are sleep-deprived, while the average commute time is 26 minutes in one way. When the numbers are compared on the state level, there is a clear connection between those two, states that are on the top of sleep-deprived countries are also the ones with the longest commutes, such as Hawaii, New York, Maryland, and Georgia.

Comparison of states that have the shortest average commute distance to work and the lower percentage of the sleep-deprived population also confirms this connection. Some of those states are Nebraska, South Dakota, Montana, Idaho, Iowa, and Kansas, their citizens are getting enough sleep without wasting too much of their time on the commute.

When it comes to the battle of the different cities in the US, none is ideal in terms of commute and sleep, but when the numbers got compared, some of them stood out. The Brooking Institution did the review of quality of public transit which was then compared to CDC’s data on sleep deprivation in top 500 states in the US to see how the best and worst cities for the commute in public transit correlated with the worst and best cities for sleep. The criteria used for this survey included the number of available jobs within the 90 minutes predicted for the commute and the number of people who live within 0.75 miles of a bus stop or any station.

The main question was, how convenient and accessible it is to use public transit in certain cities. As it was expected, there is not a city that has public transportation available to each one of its residents, and the same is with sleep since over one-third of the Americans are getting less than 7 hours of sleep each night.

Some of the cities that have the worst public transit also have the above average percentage of sleep-deprived people. The average national sleep deprivation among Americans is now 35.2%, and it keeps rising, so take a look at this chart below to see which cities are the worst for sleep and commute. For example, residents of Palm Bay, Florida, are more sleep deprived than the average citizen of the US, they have a small percentage of jobs that are accessible with public transit which means that they need to wait longer just to be able to board on.

On the other hand, cities with higher coverage of public transit such as San Jose, Fresno, Salt Lake City or Tucson, have a below the average level of sleep-deprived population. For example, 90% of people who live in Salt Lake City live near the station or stop of some public transit, and they have 58.9% of jobs accessible within the 90 minutes. Their average commute time is below average at 22.5 minutes while the wait time during the rush hour is bearable 8.5 minutes. Sleep deprivation is also below the national average at 32%, which is not significantly lower but it is an improvement.

Effects of Commuting

Commuting is one of those annoying aspects of our modern and urban lives, we want to make it everywhere, but in order to get somewhere we have to commute, sometimes more than once in a day, sometimes longer than predicted, which all affects our daily to-do schedule. Besides sleep deprivation, here are some main negative impacts of commuting on our life.

• Time – many things that are lost can be easily compensated, but time is not one of them, and commuting is nothing but a huge waste of our time. We lose time being stuck in traffic on the roads and in public transit too. New York, for example, has a problem with subway delays which significantly increase commute duration. Some offices allow their workers to stay longer at work, to compensate for the time loss due to commute, but that is just cutting off your personal time even more.
• Pollution – exposure to air pollution coming from vehicles is one of the leading causes of asthma, cardiovascular diseases, and cancer. One slightly “cleaner” solution is to use trains, but they are not as widespread as other means of transportation.
• Stress – as we mentioned, commuting can be stressful since we are under constant pressure of getting somewhere on time. However, many unpredicted things can happen and prolong our commute, but that is not the only cause of stress. A study from 2004. showed how longer commute affects health, the researchers examined the saliva from people who commute with the subway from New Jersey to Manhattan and came to the conclusion that longer commute can be connected to higher levels of a stress hormone called cortisol.
• Immunity – many things can have an impact on the way our immune system works, and if you keep getting sick and catching up on every possible virus, this can be the result of stress, unpleasantly long commutes and the fact that we get in touch with many microbe-ridden surfaces while we are commuting. We advise always wearing an antibacterial gel and listening to some relaxing music to combat stress.

Napping Commuters

Many people find the commute necessary but not so pleasant experience, and it is hard for them to relax enough to fall asleep at a public place, surrounded by strangers. On the other hand, some people sleep in a sitting position with no problem in subways, trains, buses, without worrying too much about missing their stop. But, how is it possible that most of them wake up just on time when they need to get out?

It is somewhat similar to setting an alarm clock; once we set it, our brain gets prepared to wake up at a particular time each day. If we regularly commute within a specific time-based schedule, it will become a habit for our body and our internal clock will get used to it if we repeat it each day at the same time, it will become a routine. Another reason can be the fact that although we are napping, we still can partially hear the station announcements because our brain is not completely turned off during those naps since we tend to wake up often for a few seconds.

If this is not something that is working for you, and you have slept over your stop, it could be because you have a deep sleep or your body is not so used to it, or that you are not repeating often enough that it can become a pattern. But there is no reason to worry, snoozing your stop is also one way of training yourself to wake up at a certain time. If not, you can always set the alarm on your smartphone approximately three to five minutes before predicted time for your stop.

Tossing and turning all night? You’re not alone. **Sleep trouble** hits folks all over the globe. The big sleep stealers include **insomnia**, **sleep apnea**, jittery legs, wonky sleep clocks, and constant sleepiness. Ignoring these sneak thieves doesn’t just make you yawn; it could seriously mess with your health. Think: **brain fog**, squirrel attention, skyrocketing stress, the blues, grumps, bulging waistlines, racing hearts, and even sugar troubles. Your mood, how you crush it during the day, and feeling tip-top? All ride on getting good sleep. For those eager to **kick sleepless nights to the curb** and boost their everyday vibe, here’s your playbook. Dive in, and you’ll unlock secrets to snoozing better that most folks wish they knew. Stick around, and you’ll find out why catching those Z’s will flip your world right side up.

Adequate detection is essential when it comes to different health and sleep disorders. That’s why clinicians and researchers have tried to develop the best method for detecting sleep problems in the general population. A perfect detection technique should be cheap, easy to administer, quick, and it should give the most accurate results. It is tough to accomplish all of the mentioned criteria, so some parts need to be sacrificed to get the adequate technique. Pittsburgh sleep quality index (PSQI) is a method made to asses the sleep quality in individuals.

What is the Pittsburgh Sleep Quality Index?

PSQI is a self-reported questionnaire about sleep. It looks into one month period and tries to rate your sleep quality based on your answers. PSQI is relatively new, as it was developed by Buysse and colleagues at the University of Pittsburgh in 1988. It has been created after the observation that it is widespread that people who suffer from mental disorders also have a much higher prevalence of sleep problems. For instance, people with a generalized anxiety disorder (GAD) are much more likely to have troubles falling asleep, as well as maintaining it and going back to it after they have been awoken. They are also more likely to report a sleep that wasn’t restorative, as they feel tired after waking up.

PSQI consists of 19 self-report items, and it may also include five related questions for your bed partner. However, only these 19 items reflect a final score, of which 4 are open-ended questions while 15 require a rating of 0 to 3. Questions are grouped into seven individual components, that then produce a score. Seven areas that it looks into are subjective sleep quality, sleep latency (the time it takes you to fall asleep), sleep duration, sleep efficiency (how much time of total bedtime you spent sleeping), sleep disturbances, the use of sleep medication, and daytime functionality. PSQI is practical to use as it only takes 5 to 10 minutes, and you don’t need to be additionally trained to interpret the scores.

Questions cover a wide area of sleep. First, you’ll be asked to state your usual bed and rising time, as well as how long it takes you to drift away and how much rest you get. Other questions might be about your nighttime wakings, nightly trips to the bathroom, snoring, coughing, problems with breathing, feeling hot or cold, having bad dreams or body pains. Some questions include the use of medication and alcohol. There are also some items to rate your energy levels during the day, as well as how much of a mental effort it takes to do things daily. You’ll rate those questions on a scale from “very good” to “very bad,” and there are usually four options to choose from so that you can pick the one that suits you best.

Each segment is rated from 0 to 3, 0 meaning that there are no sleep disturbances and 3 with the least sleep quality. That means that the overall score can range between 0 and 21. PSQI score of over five is considered to indicate sleep problems in a person taking the test, and the higher the score, the worse the quality of sleep.

Is Pittsburgh Sleep Quality Index Reliable?

PSQI is one of the most widely used health-assessment tools in both clinical and non-clinical populations. It is also applicable everywhere around the Earth, so it has been translated to over 55 languages so far.

Validity and reliability of PSQI have been widely confirmed. It can distinguish between people with regular sleeping patterns and the ones who have sleeping problems pretty accurately. However, it can not give us an answer on what exactly is wrong with our sleep. For that to happen, further sleep study called polysomnography is needed.

Like all self-report health questionnaires, PSQI has its strengths and flaws. Its primary advantages are that it is cost-effective, easy to administer, and it has high patient compliance. However, it is self-reported, so it is a subjective reality of a person who fills it. It is possible that they can exaggerate or minimize scores, and the way that it is administered can affect the ratings as well. Also, two people with the same score can have very different sleep conditions. As it is relatively new, it needs more investigating before giving a final verdict of its quality.

One systematic review from 2018 tried to look into the dimensionality of the PSQI. While it is a useful tool, they found a few shortcomings, and they concluded that the various PSQI factor structures might need further investigation.

PSQI is not used as a diagnostic tool, but as a sleep quality assessment. If you get a score that indicates poor sleep quality, an objective diagnosis technique is needed. That’s when polysomnography comes in place. It is an overnight sleep study conducted in a sleep facility. You’ll be observed throughout the night, with a bunch of electrodes attached to you to monitor your brain waves, limb and chest movement, respiration, heart rate, as well as snoring and other noises you might produce during the night. After that, a sleep specialist goes through the obtained information, and they discuss further treatment based on their findings. PSQI is mainly used for that, to determine who has sleep problems that require further objective investigation. It saves a lot of money, since questions are self-explanatory, so no specialist is needed while filling it. It is a kind of like an advanced sleep diary, with specific questions to assess your sleep quality adequately.

One study from 2008 also looked at the effectiveness of PSQI and Epworth sleepiness scale compared to polysomnography findings and found that the objectiveness of these questionnaires is not at the satisfying level.

Should We Make the Pittsburgh Sleep Quality Index Shorter?

Lengthy questionnaires tend to bore the participants, and they might be more inaccurate. An article from 2018 suggests that maybe we need to shorten the PSQI. They had a group of 1246 college students who filled both standard and short versions of the survey. In contrast to the 19 item questionnaire, this new version had only 13 items. It turned out that the short PSQI was just as reliable at predicting sleep problems in younger adults as the standard PSQI.

If you are having sleep problems, taking a PSQI might show you where you stand. You should aim to develop a healthy sleep routine to improve the quality of your nightly rest. Go to bed and wake up at the same time every day, make your bedroom free of distractions and don’t use the electronic devices one hour before bedtime. Try to do something that relaxes you to help you fall asleep faster, and you should always try to lead a healthy lifestyle. Eating right and exercising are very important for good sleep, and proper rest is also essential for your health and the overall quality of life.

It’s widely acknowledged that infants have a deep affection for slumber, yet they frequently show a fondness for crying and wailing until they are soothed and laid down to sleep by their caregivers. The task of holding and rocking a baby for extended periods daily can turn into a tiresome and sore experience for new parents quite swiftly. Consequently, the market is brimming with a variety of products designed to act as an extension of a parent’s caring hand, aiming to lull their infants to sleep effortlessly.

Babies spend most of their day snoozing, up to 18 hours each day, and proper sleep is essential for their growth and healthy development. Their needs are quite basic at this age, and it all comes down to eat, sleep, poop, repeat cycle. The most important thing that parents should consider when shopping for sleep products for their baby is safety, and they should follow age restrictions for certain products and avoid anything that could potentially lead to SIDS.

Products for babies are usually designed to be enough cute and likable to melt parents hearts and wallets because often they tend to exaggerate and buy too much stuff for their baby. The amount of various options and products is so big that it is difficult to even start from somewhere, but we are going to focus on the products that are widely used and parent-approved as a sleep aid.

White Noise Machine for Babies

White noise machines first gained the sympathy of adults, but quickly it turned out that they can be highly beneficial for babies too. Those humming sounds resemble the sounds from a womb and work perfectly as a lullaby. One of the most popular parenting books, The happiest baby on the block, written by a pediatrician, strongly recommends the use of these machines, but parents have to be careful with them. Some research hinted that white noise machines could be harmful to babies hearing if they are played at a high volume, if they are too close to the baby or if they are played too long. Experts suggest placing the machine further from the crib keeping the volume in a mid-range. The same goes for all kinds of music players, lullaby apps or nature sound machines.

Blackout Curtains

Perhaps you did not expect to find curtains on this list, but they are in fact more meaningful than you would assume. Blackout curtains and shades proved to be parents best friends when it comes to baby’s daytime naps, no matter how sunny it is outside, they will keep baby’s nursery room dark enough and cozy by blocking even the smallest traces of sunlight. If you imagine them as some black or ugly brown curtains, you are wrong, they come in various colors and patterns designed especially for kids so that they can easily fit into the vibe of your nursery room.

Experts suggest using these curtains after the newborn phase, which usually lasts for the first three months of baby’s life. During the infant phase, babies should develop their internal clock and distinguish daytime for napping from nighttime for sleeping. Once you start using blackout curtains, when you find that it is the right time for your baby to wake up, slightly open the curtains to let in some sunlight and wait for your baby to wake up naturally.

Swaddle Blankets and Sleep Sacks

Since the regular loose blankets can lead to SIDS, it is recommended to avoid using them in baby’s cribs or bassinets, instead, swaddling blankets and sleep sacks are a much better and safer solution. Swaddling can calm down the baby and promote deep sleep as it creates a cozy and safe environment which acts like a mother’s womb. The proper way of swaddling, according to The American Academy of Pediatrics (AAP), is when the infant is laying on its back, well wrapped. They also advise parents not to leave their swaddled babies without supervision and to stop swaddling them once they start rolling on their side intentionally. Parents should always consult their pediatrician on this topic, and also when they consider switching from swaddling blankets to sleep sacks. Many parents skip the swaddling and go with sleep sacks from the very beginning, which is nothing wrong. Sleep sacks come in various sizes so that they can fit any baby between a newborn and a toddler. They are looser than the swaddling blankets and were brought to use as an exchange for regular blankets. Babies love sleeping in their sleep sacks which keep them warm enough and also signal when it is bedtime.

Night Light

Newborns are not afraid of the dark, they are already used to it after spending months in a womb, but older babies and even toddlers can develop a fear of the dark and have nightmares because of it. Not all the babies love sleeping in the dark, so if you notice that your child is waking up often at night, scared and disoriented, you should consider using a dim night light. Nowadays night lights are designed to be children-friendly, and they come in all sorts of cartoon characters, animals, shapes and colors. The light should not be cool-toned but rather warm or yellow-toned, and it should not be placed too close to the baby, put it next to the changing table or rocker chair, it can be helpful during nighttime diaper changes and feeding.

Baby Swings

Highly popular baby sleep aids are swings – they come in many forms and swing in all possible directions to imitate parents natural movements and cradling. Unlike cribs and bassinets, baby swings are not intended for sleeping, so parents should limit the time their babies spend in them and always keep an eye on them. Spending too much time in swings or bouncy seats can cause the baby’s soft head to become flat if the baby falls asleep in them, parents should transfer them to a more firm and flat sleeping surface. Many infant swings now incorporate some extra features such as vibration, lights, music, hanging plush toys, so that they can calm down even the fussiest babies. Swings are suitable for all the babies that cannot sit up on their own, usually those are the babies up to six months old. When parents notice that their babies can push up on all four or they can roll on the side, they should stop using baby swings as they are no longer safe.

Baby Sleep Monitors

Most parents use some form of baby monitors which can be were useful when they are not in the same room with the baby. Baby monitors or alarms use a radio system to listen to the sounds baby is producing from a remote distance, some allow two-way communication so that parents can use them as walkie-talkies and talk to their babies. Recently these monitors have been significantly improved and upgraded so that they can even follow some of the baby’s vital signs, play music or record a video. Video baby monitors or baby cams are particularly popular as they can record even during the night when the lighting is low as they have a night vision feature. They are a bit pricier, and some pediatricians claim that they provide a false feeling of security, but most parents love them as it gives them a sense of security and they can sleep more soundly and careless.

Pacifiers

One efficient way of calming down the babies and preparing them for sleep is to use a pacifier. They can be made out of rubber, silicone or plastic, their shape mimics the nipple and infants simply love using them. Sucking is a natural instinct for babies, and that is why most of them suck their thumb or fingers, while others opt for pacifiers which may represent a feeling of comfort and security for older babies. If a baby uses a pacifier at naptime and bedtime, it can lower down the risk of SIDS. Parents should never force their babies to use pacifiers or use tricks such as covering them in sugar to get babies to start using them. They should be cleaned and replaced often, as they are germ collectors and can make the baby sick.

Keep in mind that if babies get used to pacifiers too soon, they may have problems with adapting to breastfeeding, that is why parents should start giving pacifiers to babies after they are at least one month old. Teaching babies to stop using pacifiers is another struggle as most of them don’t obey. Keep in mind that children older than 2 years who still use pacifiers may have teeth problems.

Overnight Diapers

Once babies can connect more hours of sleep during the night without waking up to be fed, they will start waking up for a diaper change. Due to this, parents should switch to overnight diapers, which come in all sizes and are designed to provide extra leak protection and enough comfort for babies so that there is no need to interrupt their sleep.

Oils and Lotions

Massages are a great way to calm babies and prepare them for sleep, and many parents use non-scented oils because there is a lower risk of allergic reactions. Essential oils are also popular and known for promoting sleep, but there are yet no scientifically backed up evidence that they can help babies sleep, although some studies have shown that certain scents such as lavender really soothe and relax babies and promote deeper sleep. This is not a huge surprise since lavender is well known for its sedative features and it is widely used among people who have sleep problems.

Except for massages, essential oils and lotions can be used during bathtime – just put a few drops of lavender or chamomile in the water. You can also diffuse these oils in the nursery room at bedtime. When babies start teething, they often have pains that wake them up during the night, so parents can use their fingers to rub a drop of clove oil diluted in 1 tablespoon of carrier oil into the baby’s gums. Roman chamomile oil is also great for teething aches, and it can be rubbed directly on gums.

Gliders and Rocking Chairs

If you are a new parent, you might be surprised and confused by many products that look similar or claim to do the same thing such as rocking chairs and gliders – the difference is in the way they move. Gliders can swivel, but most of them run back and forward while rocking chairs rock in an arc. Most parents agree that gliders provide a smoother ride and there is no chance that they will trap your toes which can happen with rockers. A matching ottoman is often available at an additional cost. These types of chairs have been around for ages, and you would typically expect to see a grandma knitting in them, but they are now more popular among mothers. Rockers and gliders are no longer made out of bare wood, they are padded and covered with cushions to create a comfortable retreat for mothers while they are breastfeeding or soothing their baby. Although they come in various designs, they are a bit bulky and require some extra space, so some parents do not even consider buying them, but we advise trying them first and then decide if you should give them a chance or not.

At 2 in the morning, you’re wide awake in your bed despite having tossed and turned for hours, uncertain if sleep will ever come. If this scenario sounds familiar, take comfort in knowing you’re not the only one. Nearly everyone encounters sleeplessness at some stage in their life. Insomnia, the condition marked by challenges in either falling asleep (known as sleep-onset insomnia) or remaining asleep (referred to as sleep maintenance insomnia), broadly refers to any issues related to sleeping.fall asleep

There are a few things that can help you with falling asleep faster and improving your sleep quality. We’ve all heard advice that a glass of warm milk before bed can help you sleep. But is it just an old myth that has been passed down by generations, or does science confirm this? The answer is not simple as it is a little bit of both, so read on to learn more about it.

Why Milk?

What makes milk such a good sleep aid candidate? As it turns out, milk is rich in nutrients that can help people sleep. One of those nutrients is tryptophan. Tryptophan is an essential amino acid used as a building block for many of the body’s proteins. One of the most common ones is serotonin, also known as the hormone of happiness. It is a precursor for melatonin, a hormone that has a role in our sleep/wake cycles. Melatonin is mostly produced at night, and it signals our brain that it is a time to go to sleep. Its production peaks during the night, and then it slowly fades as we approach the dawn. During the day, the production stops, and then it begins again in the evening, thus regulating when we should go to sleep, and when is the time to be alert and do our daily activities.

Beside tryptophan, milk is also rich in calcium that has many functions in the human body and cell functioning, and it is also important for sleep maintenance. However, researchers agree that the amounts found in milk are not enough to affect sleep. There is also a problem of a blood-brain barrier, as it doesn’t let tryptophan enter the brain easily. The blood-brain barrier is there to protect the brain from getting damage if something dangerous enters our bloodstream, but it also keeps larger molecules away, that could potentially be beneficial.  Foods rich in carbohydrates induce the production of insulin which makes it easier for tryptophan to go to the brain. On the other hand, foods that contain lots of protein make it harder to happen, and milk is full of protein. Adding a little honey to your glass of warm milk might help, but it is less likely that you will enjoy benefits to your sleep from the physical perspective, but rather from a psychological one.

Since our bodies can’t produce tryptophan by themselves, we need to ingest it. Other foods rich in tryptophan include various fishes like salmon and cod, sunflower, chia, and other seeds, eggs, almonds, cashews, pistachios, spinach, beans, lentils, pork, chicken, turkey and many more. Tryptophan was long blamed for a food coma that many people experience after the Thanksgiving dinner since it is rich in tryptophan. We now know that you would need to eat around 40 pounds of turkey for it to have such an effect, so there is something other besides that phenomenon, and scientists are still trying to figure out what that is.

Milk’s Sleep Inducing Abilities

If levels of tryptophan are not high enough to help us sleep better, is drinking a warm glass of milk before bed for better sleep just a myth? Maybe not. As we said earlier, there is more to this than only the physical consequences of macronutrients. Researchers suggest that drinking milk before bed might remind people of those toddler days, when their caregiver would feed them before bedtime. This association is embedded deeply in our brains, and it evokes the feelings of calm and relaxation. It might also be due to your bed routine. If this is your usual activity before you go to bed, your brain knows it, and it starts to prepare for sleep as you drink your milk. Taking that few minutes to drink it may also help you unwind, away from screens and technology, and if you are relaxed, you are more likely to fall asleep faster.

The research of the effects that warm milk has on sleep started almost 50 years ago, in 1972. Researchers wanted to see the impact that the warm milk drink called Horlicks had on nightly rest. There were three groups of people studied, where one didn’t have anything to drink before bed, while the others had warm water or Horlicks. The results showed that the subjects who drank Horlicks before bed had less nocturnal movements, therefore concluding that they had better quality sleep.

A 2007 study looked into the effects fermented milk had on the sleep patterns of the elderly. Twenty-nine healthy subjects aged 60-81 had either fermented milk or a placebo drink before bed. There was an observable effect in sleep efficiency and a decrease of waking episodes in the group who had fermented milk, hinting that it could potentially be helpful to the sleep quality in seniors.

A 2015 article discovered that the milk that was harvested at night had higher amounts of tryptophan and melatonin. Night milk was administered to mice at various concentrations, and they were also given day milk to compare the effects. The animals given night milk showed decreased spontaneous locomotion and also impaired coordination and motor balance. The mice needed less time to fall asleep, and they had a longer sleep duration. It also looked like the night milk helped with some anxiety disturbances, as they behaved better in an elevated plus maze test. These are promising results, and it puts night milk as a potential natural aid for sleep and anxiety problems.

Combining milk with other sleep-inducing activities might be helpful for seniors according to a 2014 study. The researchers examined the effects the leisure-time physical activity and drinking milk had on older adults. It turned out that doing both of these activities significantly reduced the time that it took to fall asleep. Individuals who participated in both activities had less difficulty initiating sleep that people who did only one of these actions.

Although macronutrients don’t seem to play a role in sleep for otherwise healthy adults, it looks like the elderly, or individuals with some vitamin or melatonin deficiency could benefit from drinking a glass of milk. Vitamins B and D, as well as magnesium and potassium, could contribute to better sleep.

Tips For Better Sleep

We’ve mentioned some things that could help you sleep, and here is a short list of behavior and activities you can practice if you want to enjoy better sleep:

• Set a regular sleeping schedule and stick to it. That means going to sleep and waking up at the same time every day, even on weekends. This way, your brain will get used to your sleep dynamics, and you’ll enjoy better quality sleep.
• Develop a relaxing bedtime routine. Drinking a glass of milk can work for you, or you can try a non-caffeinated tea. You need to find what suits you best, and you can try reading, taking a hot bath, tending to a hobby, meditation, doing light yoga exercises, breathing exercises, or listening to mellow music. These activities work for most people, so try them out, and you can even combine them if it suits you.
• Create a sleep-promoting environment. Your bedroom should be cool, dark, and free of distractions. To achieve this, you can buy blackout curtains, try out white noise machines or use earplugs. Also, make sure that you are comfortable in your bed, so if you feel like it, invest in a new mattress, pillow, and bedding.
• Eat well and exercise regularly. We can’t stress out enough how important these are for your sleep and overall health. Enjoy a mixed diet with lots of fruits and vegetables for optimal results. Exercise moderately few times each week, and consider incorporating weight training at least once a week. Just make sure not to do it too close to bedtime, as they can raise your cortisol levels, and leave you feeling awake and alert afterward.
• Limit your caffeine, nicotine, and alcohol consumption. All of these ingredients are stimulants that can leave you wide awake in your bed, so avoid using them in the afternoons and close to bedtime.
• Finally, if you can’t seem to get a good night’s sleep no matter what you try, maybe it’s time to visit your doctor. These general tips can help in some cases, but if you are suffering from a sleep disorder, you need professional help. They’ll asses your situation, find what’s causing your sleep problems, and prescribe you the necessary treatment.

Since the dawn of humanity, difficulties with sleep have constantly plagued us. Back in ancient times, treating any ailment was significantly more challenging, leading to the demise of many from what we nowadays deem minor health nuisances. The most ancient documents available reveal that, centuries back, people resorted to alcohol and assorted herbal concoctions (like teas, broth, or smokable blends) to ease the sleep disturbances they frequently encountered. In today’s world, it’s all too easy to overlook the value of modern medicine, leaning on a variety of prescription and non-prescription medications to tackle insomnia and other sleep-related issues.

Today, we will examine the history of how sleep medication has developed, as we feel it’s crucial to understanding how we developed our knowledge on sleep as a subject. Some methods we now recommend for those trying to maintain a healthy sleep schedule were unintentionally practiced many years ago by many people, simply as a part of daily life. The purpose of this article is to shed some light on how we’ve come to understand how sleep medicine “evolved” over the years, and help the people without a strong budget for direct medical therapy find some relief through the use of these tried-and-true, healthy habits. Let’s get into it:

The Earliest Records of Improvised Sleep Medicine

While modern sleep medicine can be traced to the mid-1800s, people have been experimenting with various substances for insomnia relief and general sleep enhancement for centuries prior. Try to remember advice from your grandparents you’d dismiss as superstition and dodgy ideas, and imagine the long line of other things people have attempted just to get some amount of healthy sleep. Remember that in those days, they didn’t have sleep-destroying factors such as blue light, but the lack of reliable modern medicine made it much harder to control a potential (and likely undiagnosed) sleep disorder.

Before we could develop even the most basic sedatives and decrease the time it takes a person to fall asleep, our ancestors regularly relied on alcohol as the main substance for relieving insomnia. While it may seem like alcohol was safer in the old days, before people had modern-day workplace safety concerns or traffic problems, alcohol remains, to this day, an incredibly risky short-term solution for sleeping problems. The initial buzz after a dose or two tends to decrease sleep onset latency (how long it takes you to fall asleep), but the consequences for our circadian rhythm and regular hormone production are only negative and serious enough to justify complete avoidance of alcohol. Drinking alcohol before bedtime almost always results in fragmented sleep, as melatonin production is crippled and body temperature fluctuates enough to wake the person up in the middle of the night.

Alcohol wasn’t the only option for people back then – many sought relief in various combinations of herbs that were considered sleep-friendly. These herbs would either be turned into teas and “sleeping potions,” or they would end up being eaten or smoked by the person trying to relax. To this day, various herbs are used in natural sleeping aids and tea mixtures under the (often justified and fulfilled) promises of easier relaxation and better sleep quality. While these sleep aids may not have the impact of prescription drugs, they’re far less risky for our body due to an absence of horrific side-effects. Herbs we use for sleep improvement these days include lavender, valerian (its root, to be specific), passion flower, etc. Opiates were a popular method of dealing with insomnia, and their use also extends to modern times, although their effectiveness is highly questionable.

It should be noted that our ancestors had much healthier daily habits than we do in modern times. If we look into isolated tribes still living without electricity or significant contact with any outside societies, it’s easy to make a connection between how they live and certain important pieces of advice we share with those trying to deal with insomnia (or any similar sleep disorder). Think about how often you’ve been told to exercise more in order to live healthier, or how healthy your diet could be if you discard sugar-heavy or greasy food. A lot of this lifestyle advice has been around for a very long time. Any current sleep medicine you run into works much better if you also reorganize your daily routine to include some of these healthy habits. Not only do they help you sleep easier, but you also gain other health benefits that improve your life, such as a stronger immune system and a higher daily energy level.

Formal Chemistry and Subsequent Breakthroughs

Around the mid-1800s, certain drugs were developed to serve a primarily anesthetic purpose. Diethyl ether (often referred to as just “ether”) was an anesthetic developed in the early nineteenth century, and it was often used (or more specifically, abused) to help someone fall asleep, despite how rare the actual prescriptions were. The first substance that was regularly prescribed for insomniacs is chloral hydrate, according to popular belief. While its sedative potency wasn’t all that impressive, it was a very frequent choice for decreasing sleep onset latency, and the first such drug that saw clinical use for treating sleep-disordered patients. There were other substances that saw use as improvised sleep aids during that period, particularly depressants like ammonium bromide, sodium bromide, and potassium bromide. Other options included morphine, an opium derivative that saw plenty of use in pain relief and sleep relaxation.

With the transition into the twentieth century, a new generation of drugs and substances entered the scene. As early as 1903, we saw the introduction of barbiturates (the salts derived from barbituric acid), the first of which was barbital. Barbiturates were prescribed very liberally by doctors, and not just for sleep disorders like insomnia. On top of sleep issues, they were used to treat anxiety and many other psychiatric conditions, as well as to sedate unruly or violent people. The main problem with barbiturates was that they were highly addictive, which led to many overdose cases – and subsequent deaths. The rich and famous often abused barbiturates without a proper prescription, which led to something resembling a “craze,” as the awareness of this drug was spread through pop culture thanks to film stars.

Around the 1960s, another heavy hitter appeared in the world of sleep medicine – benzodiazepine receptor agonists (often shortened to “benzodiazepines” for convenience). The most popular drug of this category was Diazepam, known more commonly under the name Valium. Valium’s popularity led it to become the single most prescribed drug between 1969 and 1982, in the United States. Benzodiazepines are considered one of the most effective categories of drugs for relieving anxiety or panic attacks and relaxing a patient’s muscles and still see use in epilepsy treatment, among other things. Their overdose risk is significantly less threatening than that of barbiturates, but their side-effects eventually saw them abandoned as a solution to insomnia in favor of drugs developed slightly later.

Over-the-counter sleeping aids were not represented at all until somewhere around 1980 when antihistamines received a stamp of approval from the FDA as a viable OTC sleep aid. Before that, they were used only through prescription, starting around the 1940s.

In the nineties, a category of drugs similar to benzodiazepines arrived onto the market, specifically targeting insomnia. They performed a similar job to benzodiazepines but had an improved chemical structure, which came with several important benefits. For one, these drugs were much safer to use, with fewer and less severe side-effects. They were named “non-benzodiazepines,” but a common name used for many of them is Z-drugs, as the names of drugs in this category often start with the letter Z. Commonly used examples include zaleplon (otherwise known as Sonata) and zolpidem (with its alternate name of Ambien). These drugs get prescribed to this day, as they’re very reliable.

More recently, we’ve seen a variety of drugs get introduced (and reintroduced). A derivative of zopiclone known as Lunesta (or eszopiclone) received FDA approval during the 2000s. The most promising, cutting edge sleep medication includes drugs such as ramelteon (a melatonin agonist) and suvorexant (an orexin agonist). Older drugs are being recreated and pushed onto the market in forms that make them less risky and more effective. Drugs like Circadin can potentially introduce melatonin into the body in a way that makes it much easier to metabolize. Overall, the state of sleep medicine keeps improving exponentially, following the pace of general technological advancement. With some luck, we might discover reliable cures to one or more sleep disorders that currently lack one.