Can't sleep well, Frequent awakening, Unrefreshed sleep

Humans are like other living creatures requiring daily basic needs - food, shelter, clothes, and medicine. But one thing frequently overlooked is our sleep quality. We spend 1/3 of our life asleep; it is a necessary daily routine we need to do from birth until death. We slept a lot while we were young. When we grow up, our brain is more aware of our surroundings, so we tend to sleep less.

The sleep mechanism involves chemicals such as GABA, a sleep-promoting neurotransmitter in the brain. The sleep promotion mechanism has to once-daily suppress the wakefulness mechanism by activating a cluster of brain cells near the optic nerve to initiate and maintain the sleep state. Our brains begin to enter sleep mode during 3-6 pm. Light regulates circadian rhythms; exposure to late afternoon light will delay your sleep onset. Most of the time, we sleep 6-8 hours a day. We feel refreshed if we have adequate quality sleep.

Individual sleep time requirement has a genetic basis. Some people may need more; some may need less. Morning coffee to keep you awake is usually not necessary. If you merely want to enjoy the taste of it, drink one before 10 am. The caffeine in a cup of coffee can last up to 12 hours and interfere with your sleep onset and sleep maintenance. In addition, coffee can aggravate stomach acid reflux, which can also interrupt your sleep. Do not take sleeping pills if you cannot fall asleep. Chronic benzodiazepines, e.g., Xanax, Ativan, or Restoril use, can impair memory and increase fall risk at night in the elderly. Try meditation which can slow down your brain activities. You may not easily fall asleep on the first trial, but eventually, you will succeed.

The body can partially compensate for a sleep deficit. However, if the sleep-wake cycles begin to fluctuate, it will affect your life quality. Sleep deprivation can lead to depression, hypertension, diabetes, heart disease, stroke, and obesity. When this is the case, you will need considerable help.

Classification of sleep disorders:

1. Sleep-related breathing disorders
2. Disease group with sleep problems or insomnia, sleep disturbances, frequent awakenings, and delayed sleep onset (insomnia disorder)
3. Sleep-related movement disorders
4. Diseases of falling asleep readily but hard to wake up (Hypersomnolence)
5. Sleep-disordered behavior (Parasomnia)
6. Circadian rhythm sleep-wake disorder

Of the six groups, the first is the most frightening because the patient would stop breathing periodically during sleep, causing a drop in blood oxygen.

The synthesis of cellular energy currency, adenosine triphosphate (ATP), requires oxygen. At the same time, the body must dispose of the metabolic product, carbon dioxide (CO2), through exhalation. The higher the metabolic rate our body builds up, the more carbon dioxide and acidic byproducts will be released into our blood. The cellular acidic milieu will perturb physiologic mechanisms, more easily causing headaches, weakness, drowsiness, mood swings, heart attack, brain disease, diabetes, and high blood pressure.

For the assessment of a sleep disorder, it is necessary to perform a sleep test called polysomnography. Non-invasive skin sensors record brain waves and other physiologic parameters throughout the night.

The components of a sleep test are:

1. Brain wave recordings give information on sleep quality, how long your REM (Rapid Eye Movement) sleep is, and whether you have seizure disorders. The differences in the frequency and amplitude of the brain wave patterns are categorizable as alpha, beta, delta, and theta waves. REM sleep is the time when vivid dreams occur. It is the period when the brain organizes and consolidates our memory. It is like a virtual metaverse of life. During REM sleep, we dream of walking, jumping, working, or even having sex with a stranger. The brain sends inhibitory signals to the spinal cord, preventing bodily movement. If there is a malfunction in this circuit, we will involuntarily act out the dream, just like an actor or actress in Hollywood films playing out the dream scene. We could sleepwalk or do unusual behavior that may end in a tragedy. Real-life examples are a father who threw a child out of the window because he thought it was a ball or an Indian man who cut his genitalia because he dreamed of slicing a lamb. During the sleep test, the brain waves and muscle waves can provide the necessary information. A sleep test can tell us about the heart and breathing conditions during REM sleep. If you have sleep apnea, the blood oxygen will drop and worsen during REM sleep.
2. The breathing exam assesses the changes in the temperature and airflow through the nostrils. Monitoring the chest and abdominal wall excursions can detect whether you stop breathing or not; and whether the breathing cessation is due to brain lesions or airway obstruction.
3. A heart exam is to check if you have arrhythmias or ischemic heart disease. The low blood oxygen level can cause the heart to overwork during sleep.
4. Oxygen and carbon dioxide monitoring to quantify how much the body is affected by abnormal breathing.
5. Eye movement monitoring to check when you enter REM sleep. Your eyes quickly move back and forth during this sleep state. If you have abnormal movements during this period, you may have a degenerative brain condition such as Parkinson's disease.
6. Leg muscle movement exam checks if any sleep movement disorders common in iron-deficient patients, such as pregnant women or those taking antidepressants, are present.
7. The snoring test is to assess if you need an oral appliance.

If you fall asleep or doze off readily during the day, a workup for narcolepsy is essential. If left untreated, narcolepsy can lead to physical harm or a fatal accident because you may fall asleep at the wheel while driving. A daytime sleep study, the Multiple Sleep Latency Test (MSLT), is crucial for diagnosing narcolepsy. In the test, you try to relax and take multiple naps spaced throughout the day. The average time it took to fall asleep and the occurrence of REM sleep are determined. The test can quantify sleepiness and the alertness of pilots, commercial drivers, or those who do high-risk jobs.

Frequent urination at night is associated with sleep apnea from the extra secretion of heart natriuretic peptide because of stress caused by sleep-induced hypoxia, increasing urine output. Sleep apnea treatment can help reduce nighttime urine output so you can have a more restful, less interrupted sleep.

Sleep is as essential as food, drink, and medication. People who sleep less than 6 hours or more than 8 hours have a higher risk of chronic disease and death than those who sleep 6-8 hours daily. If you try all the sleep tricks and nothing works, you should consult a sleep specialist to get to the root of the sleep problems. It is crucial to resolve sleep disorders as soon as possible because sleep is not supposed to be un-restful or un-refreshed.