#as i kept looking at results i had to keep mentally adjusting my maximum limit id pay lol
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how much money will i spend for one (1) pair of pants
#the answer may surprise you! as well as me .#i am Trying . to get a pair of vintage bell bottoms but every idiot who sells vintage clothing is like well thats gonna be 150 dollars#you are hurting vintage clothing when you do this!!!! it makes them very sad to cost so much#anyway might have found a nice pair of corduroys perhaps. gonna wait and see if the ebay person sends me an offer#as i kept looking at results i had to keep mentally adjusting my maximum limit id pay lol#i also hate when people usually on depop are like 'vintage 1970s' and then the very next word is 'inspired'#which means its NOT vintage and is from like forever 21 but bc of your wording its grouped with vintage clothes#anyway. none of this is really a big deal#like this is the most non-problem problem to have. but i just like bitching abt things and telling you my latest things im doing
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How much sleep do you need? Is your answer based purely your definition of a good night’s sleep, or have you been guessing, hoping the answer is right for you?
Poor sleep health impacts your quality of life and can make you susceptible to a range of chronic diseases. That’s why getting it right is so important.
Let’s take a deep dive into the significant benefits of sleep quality, the disasters of not getting enough, and how to address poor sleep habits.
Disclosure:
Ask the Dentist is supported by readers. If you use one of the links below and buy something, Ask the Dentist makes a little bit of money at no additional cost to you. I rigorously research, test, and use thousands of products every year, but recommend only a small fraction of these. I only promote products that I truly feel will be valuable to you in improving your oral health.
The Importance of Sleep
How important is sleep? How can I know if I’m getting enough sleep?
Possibly more than any other waking activity, your body’s overall health is tied to the sleep quality you enjoy each day. I like to refer to this as sleep ability.
In this fast-paced world, one condition from which we cannot escape is stress.
We constantly hear this word as it relates to both good and bad things in our lives: how we can minimize it, how we can use it to our benefit, how it’s the root cause of multitudes of diseases and disorders…
In a review written on the Physiology of Sleep, researchers find significant connections between stress and sleep problems. Your immune system’s response to stress, both acute and chronic, can lead to severe changes in your mood and emotional health as well as your physical health.
As they put it: “Recovery from acute stress usually involves a reparative sleep rebound characterized in REM sleep and SWS [slow-wave sleep]. Exposure to chronic stress leads to fragmented sleep.”
One example in the review is how cortisol levels fluctuate during different ranges of sleep cycles. Cortisol is typically known as the “stress hormone.”
Chronic sleep loss may accelerate consequences of too much glucocorticoid, a strong steroid hormone with powerful anti-inflammatory effects. These include issues like cognitive deficits and decreased carbohydrate tolerance.
And stress isn’t the only thing that hurts sleep quality. Other factors that can be killing your sleep quality include:
Undiagnosed sleep apnea or UARS (upper airway resistance syndrome)
Mouth breathing during sleep
Use of certain medications or illicit drugs
Too much screen time in the evening
Caffeine consumption
Buildup of household and commercial chemicals in the air
Sleeping hot
Smoking
I wrote a book a few years ago called The 8-Hour Sleep Paradox. In it, I talk about the misconception of there being a magical amount of hours to sleep, when most people aren’t getting significant enough sleep quality for that time limit to matter.
If I can leave you with anything of note today, I want it to be this: If you are getting up after 8 hours of sleep and don’t feel rested, day after day, something needs to change.
The good news is that understanding how to improve your sleep can give you a new spring in your step each morning.
What affects your sleep?
All living systems maintain a steady state of chemical and physical conditions internally. This is known in biology as “homeostasis.” Simply put, there is a proper balance in all living things.
In humans, there are a number of factors that, when kept within certain limits, allow us to live life to the very fullest.
Variables like the fluid balance in our body, body temperature, blood sugar level, and sodium and potassium levels are vital to experiencing optimum health.
Proper homeostasis requires a consistently healthy diet, level of physical activity, response to stress, and yes, sleep.
The balance between sleeping and waking is regulated by homeostasis.
The timing of our sleep is controlled by:
Circadian rhythm
Sleep-wake homeostasis (sleep-wake cycle)
Individual will (to a lesser extent than the other two)
Let’s look at more about those first two items.
1. Circadian Rhythm (Body or Internal Clock)
Even if the body is placed in a situation with constant darkness or constant light, our internal clock will continue to function. This means we experience somewhat consistent times of wakefulness and tiredness.
Our temperature fluctuates throughout a 24-hour period, and melatonin levels increase and decrease.
A restorative sleep episode is highly influenced by this rhythm. It’s the reason we’re typically sleepier at night.
Changes in light significantly affect our internal clock. Blue light, like that coming from our smartphones, tablets and computers, produces the strongest effect. That’s why limiting or ceasing electronic media use a few hours before bed is so important.
2. Sleep-Wake Homeostasis
The longer we’re awake, the more we want to sleep. Homeostasis, as discussed earlier, makes this occur. Humans seem to reach maximum sleepiness after 30 hours of waking. A proper sleep-wake cycle is vital to your health.
Sleeplessness is stressful and is known to cause cognitive impairment, meaning problems with thinking and learning processes.
Perhaps the better question to ask is, “What doesn’t affect your sleep?”
Here is a short list of factors that we may or may not consider when thinking about how well we sleep, and how we can address sleep problems.
What you ate today and yesterday
How your day progressed in general
The amount and type of exercise you got
The amount of caffeine or alcohol consumed
The mattress you sleep on
The pillow you use
Possible sleep disturbances through the night
These are all factors that we can control. However, other things occur in our lives that can’t as easily be controlled.
Dangers of Sleep Deprivation
Just one night of interrupted sleep wreaks havoc on our energy levels, mood, and hormone regulation. Chronically interrupted sleep affects our mental health, accelerates the aging process, and makes us more susceptible to all kinds of diseases.
In 2005, a research study on how sleep deprivation impacts the brain cited this list of “broad cognitive performance effects of sleep deprivation”:
Involuntary microsleeps occur (uncontrollable periods of 10-30 seconds of sleep)
Attention, short-term recall and mental performance suffer, resulting in errors in judgment and processing
Response time slows (for instance, the types and severity of damages/injuries incurred in accidents due to sleep deprivation comparable to those of at or above legal alcohol limits were detected)
Learning new tasks was more difficult
Performance requiring divergent thinking deteriorates
Subjects were more likely to keep working on solutions they’d already proven don’t work while trying to solve simple tasks
Tasks may be begun well, but performance deteriorates as task duration increases
There is growing neglect of activities judged to be nonessential (loss of situational awareness)
Another sleep study in 2008 found that sleep deprivation had out-of-balance levels of 2 hormones: leptin and ghrelin. These hormones affect appetite, “possibly explaining the increased BMI observed with short sleep duration.”
In short: Being sleep-deprived for as little as one night can have massive impact on how we think, learn, and even digest food.
10 Tips for Better Sleep
It’s possible for you to hack your sleep routine by creating a healthy sleep environment.
Unfortunately, many jump to the option of sleeping pills, assuming nothing else will work. As a society, we are conditioned to reach for a pill bottle without trying natural, chemical-free, easy changes to our daily routines.
I would recommend you take prescription sleep aids ONLY after all other options have been exhausted (no sleep puns intended), with little or no success.
Before speaking to your doctor, keep a sleep diary for at least 2 weeks.
List how long you slept each night, whether sleep felt sound or fitful, and even note the weather on nights the sky was not clear. This will provide a starting place for your physician to evaluate the best path for you.
Here is a list of simple suggestions to decrease sleep disturbances and upgrade your current sleep environment — no medication required.
1. Make your bedroom a truly restful place.
The practice of using the bedroom for everything from homework to stressful phone calls to TV watching can cause your brain to associate that area with wakefulness. Instead, seek to create an oasis that you use for rest and other stress-free pleasure.
Avoid doing tasks in your bedroom, particularly in your bed, that require you to stay awake and alert.
Do your best to eliminate all lights, especially electronic lights. A very dark room with no light pouring in or emanating from equipment, clocks, charges, etc. can promote restful, peaceful sleep.
Finally, invest in a mattress and pillow that allow you to get a great night’s sleep. For some, this means an adjustable bed for sleeping at an angle. For others, it may just look like finally getting around to replacing the 30-year-old mattress making you sore every night.
2. Keep the temperature between 66-68 degrees.
A cool room allows you to sleep more soundly. As an extra step, I like to keep my mattress cool with the chiliPAD Cube 3.0 and let blankets do the insulation.
3. Eliminate screens 1-2 hours before bed.
For thousands of years, our bodies were programmed to sleep because of triggers like darkness and a general “slowing down” as bedtime approached.
But for a little over half a century, we’ve interrupted these biological signals with television and, now, mobile devices. These screens not only put out a lot of blue light (even with “night shift” settings on) but can also mimic the faster pace your brain has evolved to associate with wakefulness.
For a good night’s sleep, read a book, have a cup of hot (caffeine-free) tea, or listen to a podcast…
Whatever you do, put away the screen. I recommend two hours before bed as a good starting point, but at least 60 minutes before you lay down is a good idea.
I enjoy using my Kindle Paperwhite at night to read, which does use a gentle light but isn’t the same as staring at a screen. It’s also worthwhile to invest in blue blocking glasses like Carbonshade if you know you’re going to be staring at a screen most of the day.
4. Invest in a quality air filter.
Did you know the EPA says that indoor air pollution can be 2-5 times higher (up to 100 times higher) than outdoors?
These air pollutants come from everything from cookware to personal care products and even mold.
Regardless of how great the ventilation in your house is, chances are, you’re breathing in toxins overnight.
The higher your toxic load, the harder your body has to work to stay “clean.” This is especially significant during sleep, when your body’s cleaning its cells from top to bottom.
The Molekule and AirDoctor Pro are my two favorite filters. I even bring one with me when I travel! I don’t even want to think about the toxins living in a hotel.
5. Avoid power naps.
Avoid napping during the daytime. Some are fans of power napping in the afternoon, but if it hinders your nighttime sleeping, they should go.
6. Consider what dietary patterns interrupt your sleep.
Avoid heavy meals just before you go to sleep, as digesting food (particularly any type of carbohydrates) will boost your blood sugar and may result in more energy when you don’t need it.
Stop drinking caffeinated drinks 6-8 hours before bedtime, as caffeine in the afternoon and evening disrupts your circadian rhythm.
7. Stop smoking.
Better sleep is just one of the huge number of reasons to quit smoking.
Smokers:
Are more likely to develop sleep-disordered breathing
Experience more sleep disturbances, daytime sleepiness, and related problems to sleep deprivation like accidents and depression
Fall asleep slower than healthy counterparts
Stay in light sleep more and have trouble getting into deeper levels of sleep
Fortunately, quitting smoking can eliminate all of these risks.
8. Use mouth tape.
Once you’re ready to go to sleep, one of the worst things that can disrupt your perfected sleep routine is nighttime mouth breathing.
Mouth breathing can lead to a more easily collapsed airway (like that seen in sleep apnea), snoring, and dry mouth, among other things.
Using mouth tape is a great way to stop that from happening. My favorites are Somnifix (the “Cadillac” of mouth tape) as well as the more budget-friendly Nexcare Tape.
9. Practice breathing and muscle relaxation techniques.
Breathing exercises turn your attention to the natural pattern of your breathing, in and out. As you inhale, think of tense areas of your body; when you exhale, imagine releasing the tension from the area(s) you thought of.
Guided imagery is another way of turning focus from the stresses of the present. Think of a peaceful place, such as the beach or a favorite vacation spot. Allow your mind to dwell there. Take in the atmosphere as you breathe calmly and slowly.
10. Keep a consistent sleep schedule.
Going to bed around the same time each night and waking about the same time the next day will benefit you in many ways.
It keeps your body clock (circadian rhythm) ticking consistently and results in more restful sleep.
The 8-Hour Paradox: How long should you sleep?
Be honest here, did you respond by saying, “Yep, I need my 8 hours every night!”?
I think you’ll be surprised by what constitutes a good night’s sleep. Actually, your sleep quality far outweighs the exact quantity of sleep you get each night.
Sleep is a naturally recurring state of mind and body, when your body has greatly decreased ability to react to stimuli (as opposed to being awake).
When you sleep, the majority of your body’s systems restore strength: muscular, nervous, immune, and skeletal systems all receive a much needed boost.
Polyphasic vs. Monophasic Sleep
Like their roots indicate, polyphasic sleep occurs multiple times in a 24-hour cycle, while monophasic sleep happens in a single interval of time every 24 hours.
Polyphasic sleep used to be much more common in previous centuries, as farmers found the most effective patterns might involve two shorter sleep sessions rather than one long session.
When it’s been studied in humans, polyphasic sleep doesn’t seem to result in a reduction of work quality or even energy. What’s more, people on polyphasic sleep cycles sleep less total hours each day and seem not to suffer negative consequences.
There are other sleep patterns, known as chronotypes. These occur based on a number of factors, such as gender of the individual, genetics, and formed habits. These sleep patterns can change over the course of your life.
While there are “accepted” amounts of sleep times per day, there are actually many ways to experience good quality sleep — and not all of them add up to 8 hours.
There are other extreme chronotypes that can occur, considered circadian rhythm sleep disorders.
Recommended Sleep Times
In 2015, the National Sleep Foundation updated, through the work of a multidisciplinary expert panel, the recommendations of the amount of sleep needed at different life stages.
Newborns (0-3 months): Sleep range narrowed to 14-17 hours each day (previously it was 12-18)
Infants (4-11 months): Sleep range widened two hours to 12-15 hours (previously it was 14-15)
Toddlers (1-2 years): Sleep range widened by one hour to 11-14 hours (previously it was 12-14)
Preschool-age (3-5): Sleep range widened by one hour to 10-13 hours (previously it was 11-13)
School-age children (6-13): Sleep range widened by one hour to 9-11 hours (previously it was 10-11)
Teenagers (14-17): Sleep range widened by one hour to 8-10 hours (previously it was 8.5-9.5)
Younger adults (18-25): Sleep range is 7-9 hours (new age category)
Adults (26-64): Sleep range did not change and remains 7-9 hours
Older adults (65+): Sleep range is 7-8 hours (new age category)
While it should be noted that sleep habits will certainly vary during different stages of your life, high quality sleep is the most important factor in our overall body health.
For instance, say your preschooler is sleeping soundly and consistently 9 hours a night and is alert and active throughout his/her waking hours. In that case, there is no need to force them to sleep an extra hour or two.
For healthy school-age children, s/he is likely getting the amount of sleep necessary for healthy development.
Stages of Sleep
There are four stages of sleep in a normal night. These sleep stages include stage 1 (light sleep), stage 2 (sound sleep), stage 3 (deep sleep), and REM (rapid eye movement/dreaming).
Stage 1 — The lightest stage of non-REM (Rapid Eye Movement) sleep. This is the time when you can be easily awakened by even soft sounds or disruptions. During muscle relaxation, brain activity slows. Drifting in and out of sleep and muscle spasms, or jerks, can occur during this time, when you may feel like you’re falling.
Stage 2 — This is a more well-defined stage of non-REM sleep. You’re more soundly asleep, and cannot be as easily awakened. Eye rolling stops, and your brain continues to slow. Body temperature drops in this stage and heart rate begins to slow.
Stage 3 — Known as deep, non-REM sleep. This time of deep sleep is definitely the most reparative for the body. Sudden arousal is rare at this point. Occurrences of talking in your sleep, sleepwalking and night terrors occur during this deepest stage. This stage is sometimes divided into 3 & 4, but isn’t truly differentiated enough to classify separately.
REM stage — The part of our sleep known as REM (Rapid Eye Movement) is often called the dreaming stage. Eyes move quickly from side to side, and our brain waves pick up in activity from stages 2 and 3. Though we can be awakened a little easier during this stage of sleep, we will feel the most tired or groggy as a result.
Dreaming: Why and How
Much is known about the role of sleep in regulating our metabolism, blood pressure, brain function, and other aspects of health. But it’s been harder for researchers to explain the role of dreams.
It’s been said that although our bodies need rest and sleep, we never stop thinking; our brain remains active. Although the proof is not definitive, our dreams appear to be autobiographical, based on recent occurrences in our lives.
Here are some interesting beliefs and theories about dreams from the article referenced above, “The Role of Dreams”.
Dreams could be a way we confront emotional drama in our lives, making connections to our feelings that we would consciously put together.
When we dream, the amygdala (part of the brain linked to survival instinct and fight-or-flight response) is the most active. There is a theory suggesting this time of heightened activity in the amygdala is the brain’s way of getting us ready to deal with a threat.
Our minds aren’t restricted when we sleep, like they can be while we’re awake. Dreams can facilitate our most creative thinking.
Research has found that sleep helps store memories. There is still much to discover about this, but “dreams may help the brain more efficiently store important information while blocking out stimuli that could interfere with memory and learning.”
A 1983 article in Nature magazine states, “…the function of dream sleep (more properly REM sleep) is to remove certain undesirable modes of interaction in networks of cells in the cerebral cortex.”
Authors Francis Crick and Graeme Mitchison delve into the functions of dreams and how they serve the brain. Here are some quotes from the article that may explain why dreaming matters so much.
“Although we dream for one or two hours every night, we do not remember most of our dreams.”
“Modern theories have usually proposed that sleep and dreams save energy or have various restorative functions, either to replenish the brain biochemically in some way, or to reclassify or reorder the information stored in it.”
“…major difference between REM and non-REM sleep lies in the dreams associated with them. For most people the few dreams found in non-REM sleep tend to have a rather thought-like character. During REM sleep, on the other hand, dreams occur more frequently and usually have a perceptual vividness and the illogical episodic character with which we are all familiar.”
Sleep Tracking Options & Limitations
As a sleep medicine dentist, I’ve invested a lot of time testing the latest sleep apps and tech designed to help people discover how well they’re sleeping.
Unlike even 10 years ago, when this technology was too pricey for most consumers, there are now good choices for just about any budget.
While you’ll find a comprehensive breakdown of the available products in that article, here are the basics you should know:
To get a baseline, I recommend starting with SnoreLab, which is available in both free and paid versions on the App Store and Google Play Store. Snoring isn’t the only factor in poor quality sleep, but many people who don’t sleep also snore a lot.
When it comes to wearable or other similar sleep tech, there are several options that do a decent (although not perfect) job. My favorites are the Oura Ring and Apple Watch, and I’m constantly on the lookout for better and more informative options.
No home sleep app or tech can currently replace the need for a sleep study performed by a specialist. These can take place at home or at a sleep clinic, but if you find you’re waking up tired, even after trying to improve your sleep, it’s probably time to see a sleep doctor. Your dentist or general practitioner can refer you to a reputable provider in your area.
8 Common Sleep Disorders
1. Sleep Bruxism
Bruxism, or teeth grinding, is a sleep-related movement disorder that involves clenching the jaw muscles to grind upper and lower teeth together.
Besides the effects on your teeth and gums, grinding is disruptive to sound sleep. Unlike the more habitual act of grinding your teeth during waking hours, nighttime bruxism could be linked to another serious sleep disorder: sleep apnea.
2. Snoring
When you sleep, air crosses over the tissues in your throat, which are relaxed. Due to several factors, that air can ‘rattle’ over those relaxed tissues and produce a soft or loud noise.
One way sleep can be disrupted by snoring is if the noise of your sleep partner wakes you up. However, a possibly more serious disorder of snoring is sleep apnea.
3. Sleep Apnea
Although not an uncommon topic, sleep apnea is still a greatly ignored topic among many.
This occurs when your upper airway is partly or totally blocked, cutting off your regular breathing for a short period, and causes you to awaken and ‘catch your breath’.
Left untreated, sleep apnea can result in daytime sleepiness, and severe cases have been linked to increased risk of stroke or heart attack. It’s also been associated with high blood pressure.
I’ll discuss sleep apnea later in this article.
4. Restless Legs Syndrome
A more common issue for middle-aged and older adults, restless legs syndrome can affect just about any age. It’s sometimes known as periodic limb movement disorder.
Symptoms of discomfort in the feet and legs occur most often in the evening and through the night, which disturbs sleep and prevents deep sleep. Many people will continuously move their legs or thrash them around, even while they are sleeping.
5. Narcolepsy
Thought to affect approximately 1 in 2,000 people, narcolepsy is characterized by:
Excessive sleepiness
Hallucinations
Sleep paralysis
Episodes of cataplexy (partial or total loss of muscle control, sometimes triggered by a strong emotion)
Currently, there is no known cure. However, patients have been able to lead normal lives through the use of meds and some behavioral treatments that will lessen or improve symptoms.
6. Insomnia
Temporary, short-term insomnia can happen because of factors such as jet lag, or even when too much caffeine is consumed before bedtime. Extra stressful events can also bring on bouts with insomnia, though most of the time these occurrences don’t last long.
If, however, stress is left unchecked, the effects can turn into depression or extreme anxiety. When an individual experiences these more serious conditions, sleep will elude them, usually because nighttime can be associated with darkness or loneliness.
Insomnia is typically classified as “primary” or “secondary.” Primary insomnia isn’t caused by other factors and occurs on its own, while secondary insomnia may be due to medication use or other medical conditions.
7. REM Sleep Behavior Disorder
First officially recognized in 1986, REM Sleep Behavior Disorder (RBD) is a condition in which people enact their dreams in REM sleep, rather than staying immobile in bed.
These episodes can manifest in ways that injure the person with the disorder or their sleeping partner. Some people with this condition will actually attack those in their bedroom or home while dreaming, for instance, they’re protecting them from an intruder.
It’s most common in males and often comes after years, sometimes decades, of a “prodrome” (early sign or symptom) of frequent movement and jerking movement during sleep.
Like insomnia, this condition can occur on its own or occur as a sign of a neurological condition. So far, the most effective treatment identified is the medication Clonazepam, a benzodiazepine typically used for panic disorders and seizures.
Unfortunately, this drug comes with the strongest warning available from the FDA regarding potential addiction and side effects, known as a black box warning.
8. Circadian Rhythm Disorders
In the various circadian rhythm disorders, the internal body clock discussed above is interrupted or broken in some way.
The most well-known of these disorders include:
Narcolepsy
Delayed Sleep Phase Disorder (DSPD): Seen most commonly in teens and young adults, people with DSPD get stuck in a routine of the most “awake” part of the day being between 2-5 AM. Daytime work and sleep schedules often decline as a result.
Advanced Sleep Phase Disorder (ASPD): The inverse of DSPD, advanced phase sleep happens often in the elderly when bedtimes become earlier and wakefulness happens earlier. For instance, a person will go to bed before 9 PM and wake up between 2-5 AM on a regular basis. This also tends to result in complaints of insomnia and daytime sleepiness.
Jet Lag: This happens when the biological clock is at odds with the time of day, often after travel. Flying east, rather than west, is typically easier for circadian rhythm adjustments, as it’s typically simpler to wait to sleep than it is to fall asleep earlier.
Sleep Apnea: A 21st Century Epidemic?
As a sleep medicine dentist, understanding, diagnosing and treating patients with sleep apnea is especially important to me.
Much more than simply being disturbed by your sleep partner’s snoring is the need to discover the cause of the snoring.
An estimated 18-22 million Americans deal with sleep apnea, with some studies stating as high as 80 percent of moderate to severe cases go undiagnosed.
There are a lot of misconceptions about sleep apnea, like that it isn’t common in women or that it only occurs in overweight or obese people. However, far more people may be enduring it in silence.
Many studies strongly indicate that undiagnosed sleep apnea is independently associated with increased likelihood of:
Hypertension
Cardiovascular disease
Stroke
Sleep bruxism
Daytime sleepiness
Motor vehicle accidents
Diminished quality of life
A 1994 study of 147 adult men and women suffering found that mean blood pressure was higher in patients with sleep apnea. The variability of the blood pressure during sleep was significantly greater in participants with sleep apnea or history of snoring compared to those without.
Another sleep study performed in 2000 found a link between patients with Obstructive Sleep Apnea (OSA) and significantly increased risk of heart disease, especially stroke risk.
In a radio interview with Marianne Russo, I discuss the connection between ADHD and sleep apnea in children and teens. Here are some important facts about ADHD and Sleep Apnea in a younger population:
40-60% of children that have sleep apnea have some form of ADHD
Sleep apnea and sleep disorders are a major cause of behavioral issues in children and teens
It’s possible that many cases of ADHD are actually misdiagnosed sleep apnea cases
Sleep apnea is far more prevalent in children than we originally thought, perhaps as common in children and teens as in adults
Teeth grinding at any age is an indication of a struggle to keep the airway open at night
I’ve long thought this massive increase in sleep apnea at all ages might be associated with some 21st century changes, such as:
Comfortable beds that make back sleeping preferable
Lack of vitamin K2 in the diet, leading to an underdeveloped jaw and smaller airway that’s more susceptible to collapsing
Prevalence of a sedentary lifestyle
Other Sleep Issues
Though these aren’t classified as “disorders,” these other sleep problems can lead to poor sleep quality.
Issues with Sleeping while Pregnant
Most pregnant women have problems with extra tiredness during the first and third trimesters of pregnancy. This can be due to morning sickness keeping them from rest or frequent bathroom trips as the baby grows and pushes on the bladder.
It is important for expectant moms to try their best to get rest throughout the duration of the pregnancy. And after the baby is born, when life steps up to a whole new pace, high sleep quality is even more important.
Especially with the possibility of postpartum depression, which also interrupts sleep, I encourage mothers to keep their bodies as well rested as is possible.
Sleepwalking
Also known as somnambulism, this behavior most commonly happens in children. They appear dazed; they may walk around or wander, and sometime will talk, without having any memory of it when they awake.
Sleepwalking typically occurs within the first couple of hours of sleep, and is relatively short in length.
Although sleepwalking can happen as a result of an illness or fever, it can also be triggered by lack of sleep, poor quality of sleep (due to sleep apnea, bruxism, etc.). The disorder has also been known to be hereditary.
Night Terrors (aka Sleep Terrors)
As undesired as the name implies, this sleep disorder is characterized by sudden flailing, screaming, or jerking while asleep. Most episodes are as short seconds to a few minutes, but may last longer.
Like sleepwalking, night terrors are more common in children. They child may be hard to wake up from the event, and then be groggy or distressed when they finally come out of it.
There is no cause for alarm if the occurrences are occasional. However, if night terrors become more frequent, seem to cause abnormal sleepiness during the day, or continue beyond teen years or into adulthood, you should consult your doctor.
Bedwetting
Both children and adults may suffer from frequent bedwetting. Childhood bedwetting usually begins as a result of potty training, but can continue if too much urine is being produced.
Causes of adult bedwetting are numerous but generally have to do with urine production, bladder problems, and unconscious arousal during sleep.
Sleep Paralysis
Though it’s not well-understood, sleep paralysis happens when a person “wakes up” but is unable to move their body.
Sleep paralysis is often accompanied by brief hallucinations, the most frequent of which tend to be about aliens or “repressed” sexual abuse memories.
But don’t worry — the little green guys are (probably) just in your head.
Sleep-Related Eating Disorders
A fairly rare occurrence, eating disorders during sleep often result in overeating and weight gain. Patients may not realize they’re eating during the night until they discover repeated evidence during waking hours.
FAQs
Q:
How can I fall asleep right away? Is that a good benchmark to aim for?
A: Simple tips include:
No caffeine consumption 6-8 hours before bed
Utilize relaxation and/or breathing exercises
Stay away from electronic media for a couple of hours before bed
Enjoy a warm bath
It’s not a bad benchmark to work towards, but good sleep doesn’t happen just because you’re a person who can quickly drop off. In fact, short “sleep latency” (the time it takes to fall asleep) can signify exactly the opposite.
In general, you should fall asleep about 10-15 minutes after laying down. Much shorter or longer than that, and there may be a cause for concern.
Q:
Can a lack of sleep be deadly?
A: Yes, lack of or poor sleep can cause life-threatening problems. It affects not only physical but also mental health.
Sleep deprivation and poor sleep habits rob your body of the recharging and restoring it desperately needs. It will wear you down both physically and emotionally to serious levels if the deprivation continues long enough.
Sleep apnea can be a symptom of more serious issues with blood pressure and other heart problems. It’s not typically fatal on its own but can lead to fatal consequences, left untreated.
Q:
What parts of the brain are involved in the sleep cycle process?
A: While the way the brain controls sleep and wakefulness is not fully known, there are some things we do know.
The shut down of arousal signals in the brain is controlled by a specific area of the hypothalamus.
Neurons in the hypothalamus pinpoint the areas that make us feel awake, and inhibit the activity occurring there.
Q:
How do genetics impact sleep?
A: In a 2012 study, the authors state:
“It is now clear that sleep is genetically controlled. Although environmental factors can impact the duration and intensity of sleep, genetic regulation is borne out by the heritability of sleep trais, the identification of specific genetic polymorphisms that affect these traits, and the existence of familial sleep disorders.”
Q:
Do white noise machines help with sleep?
A: Yes! Using a noise generator is a great way to improve the stability and quality of your sleep. It can also make you less aware of noise that could otherwise wake you up.
Key Takeaways: Sleep
Sleep is paramount to well-being. Our bodies desperately need it. However, how much sleep we need changes over the course of our lives.
In general, it is more beneficial to focus on how to improve quality of sleep rather than length of sleep.
Tracking your sleep can be a great way to find a baseline for the quality of your sleep. Take advantage of modern tech by finding a sleep app or tracker that suits you. These can also point to warning signs of bigger health issues you need to address.
Don’t ignore the signs of bad sleep. Whether by a sleep tracker, or just the fact that you never feel rested when you wake, there are some serious health problems that can be detected during sleep. If you have a sleep partner, ask them to listen and observe you, on occasion, during sleep.
Do you snore more than just a light, intermittent amount?
Do you grind your teeth?
Do you experience periods of time without breathing, then take in a gasping breath?
Do you have stretches of time that you are fitful, thrashing legs or jerking?
Do you feel worn out when you wake up the next day?
These can indicate a number of physical problems, some mild and others very serious.
The good news is that once you identify a disorder, it can be treated. Whether the answer is being fitted for a night guard to temporarily address bruxism (teeth grinding) or a CPAP machine to treat sleep apnea, the outcome will be better, more sound, sleep.
Your dentist may also fit you with an oral appliance to help with airway position for sleep apnea.
Read Next: Sleep Apnea: The Real Reason You Grind Your Teeth?
21 References
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Saper, C. B., Cano, G., & Scammell, T. E. (2005). Homeostatic, circadian, and emotional regulation of sleep. Journal of Comparative Neurology, 493(1), 92-98. Abstract: https://onlinelibrary.wiley.com/doi/abs/10.1002/cne.20770
Durmer, J. S., & Dinges, D. F. (2005, March). Neurocognitive consequences of sleep deprivation. In Seminars in neurology (Vol. 25, No. 01, pp. 117-129). Copyright© 2005 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Abstract: https://www.ncbi.nlm.nih.gov/pubmed/15798944
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Roehrs, T., & Roth, T. (2008). Caffeine: sleep and daytime sleepiness. Sleep medicine reviews, 12(2), 153-162. Abstract: https://www.ncbi.nlm.nih.gov/pubmed/17950009
Wetter, D. W., Young, T. B., Bidwell, T. R., Badr, M. S., & Palta, M. (1994). Smoking as a risk factor for sleep-disordered breathing. Archives of internal medicine, 154(19), 2219-2224. Abstract: https://www.ncbi.nlm.nih.gov/pubmed/7944843
Phillips, B. A., & Danner, F. J. (1995). Cigarette smoking and sleep disturbance. Archives of internal medicine, 155(7), 734-737. Full text: https://www.researchgate.net/profile/Fred_Danner/publication/265907045_Cigarette_Smoking_and_Sleep_Disturbance/links/54207d470cf241a65a1e2bfe/Cigarette-Smoking-and-Sleep-Disturbance.pdf
Zhang, L., Samet, J., Caffo, B., & Punjabi, N. M. (2006). Cigarette smoking and nocturnal sleep architecture. American Journal of Epidemiology, 164(6), 529-537. Full text: https://pdfs.semanticscholar.org/31dc/3fa9f6eca36b6df702cba0ff4d3fd5a00c78.pdf
Carney, C. E., Buysse, D. J., Ancoli-Israel, S., Edinger, J. D., Krystal, A. D., Lichstein, K. L., & Morin, C. M. (2012). The consensus sleep diary: standardizing prospective sleep self-monitoring. Sleep, 35(2), 287-302. Full text: https://www.sleepfoundation.org/articles/healthy-sleep-tips
Stampi, C. (1989). Polyphasic sleep strategies improve prolonged sustained performance: a field study on 99 sailors. Work & Stress, 3(1), 41-55. Abstract: https://psycnet.apa.org/record/1989-35663-001
Porcu, S., Casagrande, M., Ferrara, M., & Bellatreccia, A. (1998). Sleep and Alertness During Alternating Monophasic and Poilyphasic Rest-Activity Cycles. International journal of neuroscience, 95(1-2), 43-50. Abstract: https://www.ncbi.nlm.nih.gov/pubmed/9845015
Roenneberg, T., Wirz-Justice, A., & Merrow, M. (2003). Life between clocks: daily temporal patterns of human chronotypes. Journal of biological rhythms, 18(1), 80-90. Full text: https://www.researchgate.net/profile/Till_Roenneberg/publication/10917322_Life_between_Clocks_Daily_Temporal_Patterns_of_Human_Chronotypes/links/00b4951bb6e6c5c55d000000/Life-between-Clocks-Daily-Temporal-Patterns-of-Human-Chronotypes.pdf
Schenck, C. H., & Mahowald, M. W. (2002). REM sleep behavior disorder: clinical, developmental, and neuroscience perspectives 16 years after its formal identification in SLEEP. Sleep: Journal of Sleep and Sleep Disorders Research. Full text: https://pdfs.semanticscholar.org/c31a/8bdaf1fbdacc7bfd5c1fcecc1cf042ad5dda.pdf
Young, T., Peppard, P. E., & Gottlieb, D. J. (2002). Epidemiology of obstructive sleep apnea: a population health perspective. American journal of respiratory and critical care medicine, 165(9), 1217-1239. Full text: https://www.atsjournals.org/doi/full/10.1164/rccm.2109080
Hla, K. M., Young, T. B., Bidwell, T., Palta, M., Skatrud, J. B., & Dempsey, J. (1994). Sleep apnea and hypertension: a population-based study. Annals of internal medicine, 120(5), 382-388. Full text: https://annals.org/aim/article-abstract/707176/sleep-apnea-hypertension-population-based-study
Dong, J. Y., Zhang, Y. H., & Qin, L. Q. (2013). Obstructive sleep apnea and cardiovascular risk: meta-analysis of prospective cohort studies. Atherosclerosis, 229(2), 489-495. Abstract: https://www.atherosclerosis-journal.com/article/S0021-9150(13)00268-2/fulltext
McNally, R. J., & Clancy, S. A. (2005). Sleep paralysis, sexual abuse, and space alien abduction. Transcultural psychiatry, 42(1), 113-122. Full text; https://pdfs.semanticscholar.org/0f82/3da7bbd0f103c4f37d92e084d6e528e16241.pdf
Schenck, C. H., & Mahowald, M. W. (1994). Review of nocturnal sleep‐related eating disorders. International Journal of Eating Disorders, 15(4), 343-356. Abstract: https://www.ncbi.nlm.nih.gov/pubmed/8032349
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Sleep: How Much Do You Need? Sleep Deprivation, Remedies & More
How much sleep do you need? Is your answer based purely your definition of a good night’s sleep, or have you been guessing, hoping the answer is right for you?
Poor sleep health impacts your quality of life and can make you susceptible to a range of chronic diseases. That’s why getting it right is so important.
Let’s take a deep dive into the significant benefits of sleep quality, the disasters of not getting enough, and how to address poor sleep habits.
Disclosure:
Ask the Dentist is supported by readers. If you use one of the links below and buy something, Ask the Dentist makes a little bit of money at no additional cost to you. I rigorously research, test, and use thousands of products every year, but recommend only a small fraction of these. I only promote products that I truly feel will be valuable to you in improving your oral health.
The Importance of Sleep
How important is sleep? How can I know if I’m getting enough sleep?
Possibly more than any other waking activity, your body’s overall health is tied to the sleep quality you enjoy each day. I like to refer to this as sleep ability.
In this fast-paced world, one condition from which we cannot escape is stress.
We constantly hear this word as it relates to both good and bad things in our lives: how we can minimize it, how we can use it to our benefit, how it’s the root cause of multitudes of diseases and disorders…
In a review written on the Physiology of Sleep, researchers find significant connections between stress and sleep problems. Your immune system’s response to stress, both acute and chronic, can lead to severe changes in your mood and emotional health as well as your physical health.
As they put it: “Recovery from acute stress usually involves a reparative sleep rebound characterized in REM sleep and SWS [slow-wave sleep]. Exposure to chronic stress leads to fragmented sleep.”
One example in the review is how cortisol levels fluctuate during different ranges of sleep cycles. Cortisol is typically known as the “stress hormone.”
Chronic sleep loss may accelerate consequences of too much glucocorticoid, a strong steroid hormone with powerful anti-inflammatory effects. These include issues like cognitive deficits and decreased carbohydrate tolerance.
And stress isn’t the only thing that hurts sleep quality. Other factors that can be killing your sleep quality include:
Undiagnosed sleep apnea or UARS (upper airway resistance syndrome)
Mouth breathing during sleep
Use of certain medications or illicit drugs
Too much screen time in the evening
Caffeine consumption
Buildup of household and commercial chemicals in the air
Sleeping hot
Smoking
I wrote a book a few years ago called The 8-Hour Sleep Paradox. In it, I talk about the misconception of there being a magical amount of hours to sleep, when most people aren’t getting significant enough sleep quality for that time limit to matter.
If I can leave you with anything of note today, I want it to be this: If you are getting up after 8 hours of sleep and don’t feel rested, day after day, something needs to change.
The good news is that understanding how to improve your sleep can give you a new spring in your step each morning.
What affects your sleep?
All living systems maintain a steady state of chemical and physical conditions internally. This is known in biology as “homeostasis.” Simply put, there is a proper balance in all living things.
In humans, there are a number of factors that, when kept within certain limits, allow us to live life to the very fullest.
Variables like the fluid balance in our body, body temperature, blood sugar level, and sodium and potassium levels are vital to experiencing optimum health.
Proper homeostasis requires a consistently healthy diet, level of physical activity, response to stress, and yes, sleep.
The balance between sleeping and waking is regulated by homeostasis.
The timing of our sleep is controlled by:
Circadian rhythm
Sleep-wake homeostasis (sleep-wake cycle)
Individual will (to a lesser extent than the other two)
Let’s look at more about those first two items.
1. Circadian Rhythm (Body or Internal Clock)
Even if the body is placed in a situation with constant darkness or constant light, our internal clock will continue to function. This means we experience somewhat consistent times of wakefulness and tiredness.
Our temperature fluctuates throughout a 24-hour period, and melatonin levels increase and decrease.
A restorative sleep episode is highly influenced by this rhythm. It’s the reason we’re typically sleepier at night.
Changes in light significantly affect our internal clock. Blue light, like that coming from our smartphones, tablets and computers, produces the strongest effect. That’s why limiting or ceasing electronic media use a few hours before bed is so important.
2. Sleep-Wake Homeostasis
The longer we’re awake, the more we want to sleep. Homeostasis, as discussed earlier, makes this occur. Humans seem to reach maximum sleepiness after 30 hours of waking. A proper sleep-wake cycle is vital to your health.
Sleeplessness is stressful and is known to cause cognitive impairment, meaning problems with thinking and learning processes.
Perhaps the better question to ask is, “What doesn’t affect your sleep?”
Here is a short list of factors that we may or may not consider when thinking about how well we sleep, and how we can address sleep problems.
What you ate today and yesterday
How your day progressed in general
The amount and type of exercise you got
The amount of caffeine or alcohol consumed
The mattress you sleep on
The pillow you use
Possible sleep disturbances through the night
These are all factors that we can control. However, other things occur in our lives that can’t as easily be controlled.
Dangers of Sleep Deprivation
Just one night of interrupted sleep wreaks havoc on our energy levels, mood, and hormone regulation. Chronically interrupted sleep affects our mental health, accelerates the aging process, and makes us more susceptible to all kinds of diseases.
In 2005, a research study on how sleep deprivation impacts the brain cited this list of “broad cognitive performance effects of sleep deprivation”:
Involuntary microsleeps occur (uncontrollable periods of 10-30 seconds of sleep)
Attention, short-term recall and mental performance suffer, resulting in errors in judgment and processing
Response time slows (for instance, the types and severity of damages/injuries incurred in accidents due to sleep deprivation comparable to those of at or above legal alcohol limits were detected)
Learning new tasks was more difficult
Performance requiring divergent thinking deteriorates
Subjects were more likely to keep working on solutions they’d already proven don’t work while trying to solve simple tasks
Tasks may be begun well, but performance deteriorates as task duration increases
There is growing neglect of activities judged to be nonessential (loss of situational awareness)
Another sleep study in 2008 found that sleep deprivation had out-of-balance levels of 2 hormones: leptin and ghrelin. These hormones affect appetite, “possibly explaining the increased BMI observed with short sleep duration.”
In short: Being sleep-deprived for as little as one night can have massive impact on how we think, learn, and even digest food.
10 Tips for Better Sleep
It’s possible for you to hack your sleep routine by creating a healthy sleep environment.
Unfortunately, many jump to the option of sleeping pills, assuming nothing else will work. As a society, we are conditioned to reach for a pill bottle without trying natural, chemical-free, easy changes to our daily routines.
I would recommend you take prescription sleep aids ONLY after all other options have been exhausted (no sleep puns intended), with little or no success.
Before speaking to your doctor, keep a sleep diary for at least 2 weeks.
List how long you slept each night, whether sleep felt sound or fitful, and even note the weather on nights the sky was not clear. This will provide a starting place for your physician to evaluate the best path for you.
Here is a list of simple suggestions to decrease sleep disturbances and upgrade your current sleep environment — no medication required.
1. Make your bedroom a truly restful place.
The practice of using the bedroom for everything from homework to stressful phone calls to TV watching can cause your brain to associate that area with wakefulness. Instead, seek to create an oasis that you use for rest and other stress-free pleasure.
Avoid doing tasks in your bedroom, particularly in your bed, that require you to stay awake and alert.
Do your best to eliminate all lights, especially electronic lights. A very dark room with no light pouring in or emanating from equipment, clocks, charges, etc. can promote restful, peaceful sleep.
Finally, invest in a mattress and pillow that allow you to get a great night’s sleep. For some, this means an adjustable bed for sleeping at an angle. For others, it may just look like finally getting around to replacing the 30-year-old mattress making you sore every night.
2. Keep the temperature between 66-68 degrees.
A cool room allows you to sleep more soundly. As an extra step, I like to keep my mattress cool with the chiliPAD Cube 3.0 and let blankets do the insulation.
3. Eliminate screens 1-2 hours before bed.
For thousands of years, our bodies were programmed to sleep because of triggers like darkness and a general “slowing down” as bedtime approached.
But for a little over half a century, we’ve interrupted these biological signals with television and, now, mobile devices. These screens not only put out a lot of blue light (even with “night shift” settings on) but can also mimic the faster pace your brain has evolved to associate with wakefulness.
For a good night’s sleep, read a book, have a cup of hot (caffeine-free) tea, or listen to a podcast…
Whatever you do, put away the screen. I recommend two hours before bed as a good starting point, but at least 60 minutes before you lay down is a good idea.
I enjoy using my Kindle Paperwhite at night to read, which does use a gentle light but isn’t the same as staring at a screen. It’s also worthwhile to invest in blue blocking glasses like Carbonshade if you know you’re going to be staring at a screen most of the day.
4. Invest in a quality air filter.
Did you know the EPA says that indoor air pollution can be 2-5 times higher (up to 100 times higher) than outdoors?
These air pollutants come from everything from cookware to personal care products and even mold.
Regardless of how great the ventilation in your house is, chances are, you’re breathing in toxins overnight.
The higher your toxic load, the harder your body has to work to stay “clean.” This is especially significant during sleep, when your body’s cleaning its cells from top to bottom.
The Molekule and AirDoctor Pro are my two favorite filters. I even bring one with me when I travel! I don’t even want to think about the toxins living in a hotel.
5. Avoid power naps.
Avoid napping during the daytime. Some are fans of power napping in the afternoon, but if it hinders your nighttime sleeping, they should go.
6. Consider what dietary patterns interrupt your sleep.
Avoid heavy meals just before you go to sleep, as digesting food (particularly any type of carbohydrates) will boost your blood sugar and may result in more energy when you don’t need it.
Stop drinking caffeinated drinks 6-8 hours before bedtime, as caffeine in the afternoon and evening disrupts your circadian rhythm.
7. Stop smoking.
Better sleep is just one of the huge number of reasons to quit smoking.
Smokers:
Are more likely to develop sleep-disordered breathing
Experience more sleep disturbances, daytime sleepiness, and related problems to sleep deprivation like accidents and depression
Fall asleep slower than healthy counterparts
Stay in light sleep more and have trouble getting into deeper levels of sleep
Fortunately, quitting smoking can eliminate all of these risks.
8. Use mouth tape.
Once you’re ready to go to sleep, one of the worst things that can disrupt your perfected sleep routine is nighttime mouth breathing.
Mouth breathing can lead to a more easily collapsed airway (like that seen in sleep apnea), snoring, and dry mouth, among other things.
Using mouth tape is a great way to stop that from happening. My favorites are Somnifix (the “Cadillac” of mouth tape) as well as the more budget-friendly Nexcare Tape.
9. Practice breathing and muscle relaxation techniques.
Breathing exercises turn your attention to the natural pattern of your breathing, in and out. As you inhale, think of tense areas of your body; when you exhale, imagine releasing the tension from the area(s) you thought of.
Guided imagery is another way of turning focus from the stresses of the present. Think of a peaceful place, such as the beach or a favorite vacation spot. Allow your mind to dwell there. Take in the atmosphere as you breathe calmly and slowly.
10. Keep a consistent sleep schedule.
Going to bed around the same time each night and waking about the same time the next day will benefit you in many ways.
It keeps your body clock (circadian rhythm) ticking consistently and results in more restful sleep.
The 8-Hour Paradox: How long should you sleep?
Be honest here, did you respond by saying, “Yep, I need my 8 hours every night!”?
I think you’ll be surprised by what constitutes a good night’s sleep. Actually, your sleep quality far outweighs the exact quantity of sleep you get each night.
Sleep is a naturally recurring state of mind and body, when your body has greatly decreased ability to react to stimuli (as opposed to being awake).
When you sleep, the majority of your body’s systems restore strength: muscular, nervous, immune, and skeletal systems all receive a much needed boost.
Polyphasic vs. Monophasic Sleep
Like their roots indicate, polyphasic sleep occurs multiple times in a 24-hour cycle, while monophasic sleep happens in a single interval of time every 24 hours.
Polyphasic sleep used to be much more common in previous centuries, as farmers found the most effective patterns might involve two shorter sleep sessions rather than one long session.
When it’s been studied in humans, polyphasic sleep doesn’t seem to result in a reduction of work quality or even energy. What’s more, people on polyphasic sleep cycles sleep less total hours each day and seem not to suffer negative consequences.
There are other sleep patterns, known as chronotypes. These occur based on a number of factors, such as gender of the individual, genetics, and formed habits. These sleep patterns can change over the course of your life.
While there are “accepted” amounts of sleep times per day, there are actually many ways to experience good quality sleep — and not all of them add up to 8 hours.
There are other extreme chronotypes that can occur, considered circadian rhythm sleep disorders.
Recommended Sleep Times
In 2015, the National Sleep Foundation updated, through the work of a multidisciplinary expert panel, the recommendations of the amount of sleep needed at different life stages.
Newborns (0-3 months): Sleep range narrowed to 14-17 hours each day (previously it was 12-18)
Infants (4-11 months): Sleep range widened two hours to 12-15 hours (previously it was 14-15)
Toddlers (1-2 years): Sleep range widened by one hour to 11-14 hours (previously it was 12-14)
Preschool-age (3-5): Sleep range widened by one hour to 10-13 hours (previously it was 11-13)
School-age children (6-13): Sleep range widened by one hour to 9-11 hours (previously it was 10-11)
Teenagers (14-17): Sleep range widened by one hour to 8-10 hours (previously it was 8.5-9.5)
Younger adults (18-25): Sleep range is 7-9 hours (new age category)
Adults (26-64): Sleep range did not change and remains 7-9 hours
Older adults (65+): Sleep range is 7-8 hours (new age category)
While it should be noted that sleep habits will certainly vary during different stages of your life, high quality sleep is the most important factor in our overall body health.
For instance, say your preschooler is sleeping soundly and consistently 9 hours a night and is alert and active throughout his/her waking hours. In that case, there is no need to force them to sleep an extra hour or two.
For healthy school-age children, s/he is likely getting the amount of sleep necessary for healthy development.
Stages of Sleep
There are four stages of sleep in a normal night. These sleep stages include stage 1 (light sleep), stage 2 (sound sleep), stage 3 (deep sleep), and REM (rapid eye movement/dreaming).
Stage 1 — The lightest stage of non-REM (Rapid Eye Movement) sleep. This is the time when you can be easily awakened by even soft sounds or disruptions. During muscle relaxation, brain activity slows. Drifting in and out of sleep and muscle spasms, or jerks, can occur during this time, when you may feel like you’re falling.
Stage 2 — This is a more well-defined stage of non-REM sleep. You’re more soundly asleep, and cannot be as easily awakened. Eye rolling stops, and your brain continues to slow. Body temperature drops in this stage and heart rate begins to slow.
Stage 3 — Known as deep, non-REM sleep. This time of deep sleep is definitely the most reparative for the body. Sudden arousal is rare at this point. Occurrences of talking in your sleep, sleepwalking and night terrors occur during this deepest stage. This stage is sometimes divided into 3 & 4, but isn’t truly differentiated enough to classify separately.
REM stage — The part of our sleep known as REM (Rapid Eye Movement) is often called the dreaming stage. Eyes move quickly from side to side, and our brain waves pick up in activity from stages 2 and 3. Though we can be awakened a little easier during this stage of sleep, we will feel the most tired or groggy as a result.
Dreaming: Why and How
Much is known about the role of sleep in regulating our metabolism, blood pressure, brain function, and other aspects of health. But it’s been harder for researchers to explain the role of dreams.
It’s been said that although our bodies need rest and sleep, we never stop thinking; our brain remains active. Although the proof is not definitive, our dreams appear to be autobiographical, based on recent occurrences in our lives.
Here are some interesting beliefs and theories about dreams from the article referenced above, “The Role of Dreams”.
Dreams could be a way we confront emotional drama in our lives, making connections to our feelings that we would consciously put together.
When we dream, the amygdala (part of the brain linked to survival instinct and fight-or-flight response) is the most active. There is a theory suggesting this time of heightened activity in the amygdala is the brain’s way of getting us ready to deal with a threat.
Our minds aren’t restricted when we sleep, like they can be while we’re awake. Dreams can facilitate our most creative thinking.
Research has found that sleep helps store memories. There is still much to discover about this, but “dreams may help the brain more efficiently store important information while blocking out stimuli that could interfere with memory and learning.”
A 1983 article in Nature magazine states, “…the function of dream sleep (more properly REM sleep) is to remove certain undesirable modes of interaction in networks of cells in the cerebral cortex.”
Authors Francis Crick and Graeme Mitchison delve into the functions of dreams and how they serve the brain. Here are some quotes from the article that may explain why dreaming matters so much.
“Although we dream for one or two hours every night, we do not remember most of our dreams.”
“Modern theories have usually proposed that sleep and dreams save energy or have various restorative functions, either to replenish the brain biochemically in some way, or to reclassify or reorder the information stored in it.”
“…major difference between REM and non-REM sleep lies in the dreams associated with them. For most people the few dreams found in non-REM sleep tend to have a rather thought-like character. During REM sleep, on the other hand, dreams occur more frequently and usually have a perceptual vividness and the illogical episodic character with which we are all familiar.”
Sleep Tracking Options & Limitations
As a sleep medicine dentist, I’ve invested a lot of time testing the latest sleep apps and tech designed to help people discover how well they’re sleeping.
Unlike even 10 years ago, when this technology was too pricey for most consumers, there are now good choices for just about any budget.
While you’ll find a comprehensive breakdown of the available products in that article, here are the basics you should know:
To get a baseline, I recommend starting with SnoreLab, which is available in both free and paid versions on the App Store and Google Play Store. Snoring isn’t the only factor in poor quality sleep, but many people who don’t sleep also snore a lot.
When it comes to wearable or other similar sleep tech, there are several options that do a decent (although not perfect) job. My favorites are the Oura Ring and Apple Watch, and I’m constantly on the lookout for better and more informative options.
No home sleep app or tech can currently replace the need for a sleep study performed by a specialist. These can take place at home or at a sleep clinic, but if you find you’re waking up tired, even after trying to improve your sleep, it’s probably time to see a sleep doctor. Your dentist or general practitioner can refer you to a reputable provider in your area.
8 Common Sleep Disorders
1. Sleep Bruxism
Bruxism, or teeth grinding, is a sleep-related movement disorder that involves clenching the jaw muscles to grind upper and lower teeth together.
Besides the effects on your teeth and gums, grinding is disruptive to sound sleep. Unlike the more habitual act of grinding your teeth during waking hours, nighttime bruxism could be linked to another serious sleep disorder: sleep apnea.
2. Snoring
When you sleep, air crosses over the tissues in your throat, which are relaxed. Due to several factors, that air can ‘rattle’ over those relaxed tissues and produce a soft or loud noise.
One way sleep can be disrupted by snoring is if the noise of your sleep partner wakes you up. However, a possibly more serious disorder of snoring is sleep apnea.
3. Sleep Apnea
Although not an uncommon topic, sleep apnea is still a greatly ignored topic among many.
This occurs when your upper airway is partly or totally blocked, cutting off your regular breathing for a short period, and causes you to awaken and ‘catch your breath’.
Left untreated, sleep apnea can result in daytime sleepiness, and severe cases have been linked to increased risk of stroke or heart attack. It’s also been associated with high blood pressure.
I’ll discuss sleep apnea later in this article.
4. Restless Legs Syndrome
A more common issue for middle-aged and older adults, restless legs syndrome can affect just about any age. It’s sometimes known as periodic limb movement disorder.
Symptoms of discomfort in the feet and legs occur most often in the evening and through the night, which disturbs sleep and prevents deep sleep. Many people will continuously move their legs or thrash them around, even while they are sleeping.
5. Narcolepsy
Thought to affect approximately 1 in 2,000 people, narcolepsy is characterized by:
Excessive sleepiness
Hallucinations
Sleep paralysis
Episodes of cataplexy (partial or total loss of muscle control, sometimes triggered by a strong emotion)
Currently, there is no known cure. However, patients have been able to lead normal lives through the use of meds and some behavioral treatments that will lessen or improve symptoms.
6. Insomnia
Temporary, short-term insomnia can happen because of factors such as jet lag, or even when too much caffeine is consumed before bedtime. Extra stressful events can also bring on bouts with insomnia, though most of the time these occurrences don’t last long.
If, however, stress is left unchecked, the effects can turn into depression or extreme anxiety. When an individual experiences these more serious conditions, sleep will elude them, usually because nighttime can be associated with darkness or loneliness.
Insomnia is typically classified as “primary” or “secondary.” Primary insomnia isn’t caused by other factors and occurs on its own, while secondary insomnia may be due to medication use or other medical conditions.
7. REM Sleep Behavior Disorder
First officially recognized in 1986, REM Sleep Behavior Disorder (RBD) is a condition in which people enact their dreams in REM sleep, rather than staying immobile in bed.
These episodes can manifest in ways that injure the person with the disorder or their sleeping partner. Some people with this condition will actually attack those in their bedroom or home while dreaming, for instance, they’re protecting them from an intruder.
It’s most common in males and often comes after years, sometimes decades, of a “prodrome” (early sign or symptom) of frequent movement and jerking movement during sleep.
Like insomnia, this condition can occur on its own or occur as a sign of a neurological condition. So far, the most effective treatment identified is the medication Clonazepam, a benzodiazepine typically used for panic disorders and seizures.
Unfortunately, this drug comes with the strongest warning available from the FDA regarding potential addiction and side effects, known as a black box warning.
8. Circadian Rhythm Disorders
In the various circadian rhythm disorders, the internal body clock discussed above is interrupted or broken in some way.
The most well-known of these disorders include:
Narcolepsy
Delayed Sleep Phase Disorder (DSPD): Seen most commonly in teens and young adults, people with DSPD get stuck in a routine of the most “awake” part of the day being between 2-5 AM. Daytime work and sleep schedules often decline as a result.
Advanced Sleep Phase Disorder (ASPD): The inverse of DSPD, advanced phase sleep happens often in the elderly when bedtimes become earlier and wakefulness happens earlier. For instance, a person will go to bed before 9 PM and wake up between 2-5 AM on a regular basis. This also tends to result in complaints of insomnia and daytime sleepiness.
Jet Lag: This happens when the biological clock is at odds with the time of day, often after travel. Flying east, rather than west, is typically easier for circadian rhythm adjustments, as it’s typically simpler to wait to sleep than it is to fall asleep earlier.
Sleep Apnea: A 21st Century Epidemic?
As a sleep medicine dentist, understanding, diagnosing and treating patients with sleep apnea is especially important to me.
Much more than simply being disturbed by your sleep partner’s snoring is the need to discover the cause of the snoring.
An estimated 18-22 million Americans deal with sleep apnea, with some studies stating as high as 80 percent of moderate to severe cases go undiagnosed.
There are a lot of misconceptions about sleep apnea, like that it isn’t common in women or that it only occurs in overweight or obese people. However, far more people may be enduring it in silence.
Many studies strongly indicate that undiagnosed sleep apnea is independently associated with increased likelihood of:
Hypertension
Cardiovascular disease
Stroke
Sleep bruxism
Daytime sleepiness
Motor vehicle accidents
Diminished quality of life
A 1994 study of 147 adult men and women suffering found that mean blood pressure was higher in patients with sleep apnea. The variability of the blood pressure during sleep was significantly greater in participants with sleep apnea or history of snoring compared to those without.
Another sleep study performed in 2000 found a link between patients with Obstructive Sleep Apnea (OSA) and significantly increased risk of heart disease, especially stroke risk.
In a radio interview with Marianne Russo, I discuss the connection between ADHD and sleep apnea in children and teens. Here are some important facts about ADHD and Sleep Apnea in a younger population:
40-60% of children that have sleep apnea have some form of ADHD
Sleep apnea and sleep disorders are a major cause of behavioral issues in children and teens
It’s possible that many cases of ADHD are actually misdiagnosed sleep apnea cases
Sleep apnea is far more prevalent in children than we originally thought, perhaps as common in children and teens as in adults
Teeth grinding at any age is an indication of a struggle to keep the airway open at night
I’ve long thought this massive increase in sleep apnea at all ages might be associated with some 21st century changes, such as:
Comfortable beds that make back sleeping preferable
Lack of vitamin K2 in the diet, leading to an underdeveloped jaw and smaller airway that’s more susceptible to collapsing
Prevalence of a sedentary lifestyle
Other Sleep Issues
Though these aren’t classified as “disorders,” these other sleep problems can lead to poor sleep quality.
Issues with Sleeping while Pregnant
Most pregnant women have problems with extra tiredness during the first and third trimesters of pregnancy. This can be due to morning sickness keeping them from rest or frequent bathroom trips as the baby grows and pushes on the bladder.
It is important for expectant moms to try their best to get rest throughout the duration of the pregnancy. And after the baby is born, when life steps up to a whole new pace, high sleep quality is even more important.
Especially with the possibility of postpartum depression, which also interrupts sleep, I encourage mothers to keep their bodies as well rested as is possible.
Sleepwalking
Also known as somnambulism, this behavior most commonly happens in children. They appear dazed; they may walk around or wander, and sometime will talk, without having any memory of it when they awake.
Sleepwalking typically occurs within the first couple of hours of sleep, and is relatively short in length.
Although sleepwalking can happen as a result of an illness or fever, it can also be triggered by lack of sleep, poor quality of sleep (due to sleep apnea, bruxism, etc.). The disorder has also been known to be hereditary.
Night Terrors (aka Sleep Terrors)
As undesired as the name implies, this sleep disorder is characterized by sudden flailing, screaming, or jerking while asleep. Most episodes are as short seconds to a few minutes, but may last longer.
Like sleepwalking, night terrors are more common in children. They child may be hard to wake up from the event, and then be groggy or distressed when they finally come out of it.
There is no cause for alarm if the occurrences are occasional. However, if night terrors become more frequent, seem to cause abnormal sleepiness during the day, or continue beyond teen years or into adulthood, you should consult your doctor.
Bedwetting
Both children and adults may suffer from frequent bedwetting. Childhood bedwetting usually begins as a result of potty training, but can continue if too much urine is being produced.
Causes of adult bedwetting are numerous but generally have to do with urine production, bladder problems, and unconscious arousal during sleep.
Sleep Paralysis
Though it’s not well-understood, sleep paralysis happens when a person “wakes up” but is unable to move their body.
Sleep paralysis is often accompanied by brief hallucinations, the most frequent of which tend to be about aliens or “repressed” sexual abuse memories.
But don’t worry — the little green guys are (probably) just in your head.
Sleep-Related Eating Disorders
A fairly rare occurrence, eating disorders during sleep often result in overeating and weight gain. Patients may not realize they’re eating during the night until they discover repeated evidence during waking hours.
FAQs
Q:
How can I fall asleep right away? Is that a good benchmark to aim for?
A: Simple tips include:
No caffeine consumption 6-8 hours before bed
Utilize relaxation and/or breathing exercises
Stay away from electronic media for a couple of hours before bed
Enjoy a warm bath
It’s not a bad benchmark to work towards, but good sleep doesn’t happen just because you’re a person who can quickly drop off. In fact, short “sleep latency” (the time it takes to fall asleep) can signify exactly the opposite.
In general, you should fall asleep about 10-15 minutes after laying down. Much shorter or longer than that, and there may be a cause for concern.
Q:
Can a lack of sleep be deadly?
A: Yes, lack of or poor sleep can cause life-threatening problems. It affects not only physical but also mental health.
Sleep deprivation and poor sleep habits rob your body of the recharging and restoring it desperately needs. It will wear you down both physically and emotionally to serious levels if the deprivation continues long enough.
Sleep apnea can be a symptom of more serious issues with blood pressure and other heart problems. It’s not typically fatal on its own but can lead to fatal consequences, left untreated.
Q:
What parts of the brain are involved in the sleep cycle process?
A: While the way the brain controls sleep and wakefulness is not fully known, there are some things we do know.
The shut down of arousal signals in the brain is controlled by a specific area of the hypothalamus.
Neurons in the hypothalamus pinpoint the areas that make us feel awake, and inhibit the activity occurring there.
Q:
How do genetics impact sleep?
A: In a 2012 study, the authors state:
“It is now clear that sleep is genetically controlled. Although environmental factors can impact the duration and intensity of sleep, genetic regulation is borne out by the heritability of sleep trais, the identification of specific genetic polymorphisms that affect these traits, and the existence of familial sleep disorders.”
Q:
Do white noise machines help with sleep?
A: Yes! Using a noise generator is a great way to improve the stability and quality of your sleep. It can also make you less aware of noise that could otherwise wake you up.
Key Takeaways: Sleep
Sleep is paramount to well-being. Our bodies desperately need it. However, how much sleep we need changes over the course of our lives.
In general, it is more beneficial to focus on how to improve quality of sleep rather than length of sleep.
Tracking your sleep can be a great way to find a baseline for the quality of your sleep. Take advantage of modern tech by finding a sleep app or tracker that suits you. These can also point to warning signs of bigger health issues you need to address.
Don’t ignore the signs of bad sleep. Whether by a sleep tracker, or just the fact that you never feel rested when you wake, there are some serious health problems that can be detected during sleep. If you have a sleep partner, ask them to listen and observe you, on occasion, during sleep.
Do you snore more than just a light, intermittent amount?
Do you grind your teeth?
Do you experience periods of time without breathing, then take in a gasping breath?
Do you have stretches of time that you are fitful, thrashing legs or jerking?
Do you feel worn out when you wake up the next day?
These can indicate a number of physical problems, some mild and others very serious.
The good news is that once you identify a disorder, it can be treated. Whether the answer is being fitted for a night guard to temporarily address bruxism (teeth grinding) or a CPAP machine to treat sleep apnea, the outcome will be better, more sound, sleep.
Your dentist may also fit you with an oral appliance to help with airway position for sleep apnea.
Read Next: Sleep Apnea: The Real Reason You Grind Your Teeth?
21 References
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Saper, C. B., Cano, G., & Scammell, T. E. (2005). Homeostatic, circadian, and emotional regulation of sleep. Journal of Comparative Neurology, 493(1), 92-98. Abstract: https://onlinelibrary.wiley.com/doi/abs/10.1002/cne.20770
Durmer, J. S., & Dinges, D. F. (2005, March). Neurocognitive consequences of sleep deprivation. In Seminars in neurology (Vol. 25, No. 01, pp. 117-129). Copyright© 2005 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Abstract: https://www.ncbi.nlm.nih.gov/pubmed/15798944
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Wetter, D. W., Young, T. B., Bidwell, T. R., Badr, M. S., & Palta, M. (1994). Smoking as a risk factor for sleep-disordered breathing. Archives of internal medicine, 154(19), 2219-2224. Abstract: https://www.ncbi.nlm.nih.gov/pubmed/7944843
Phillips, B. A., & Danner, F. J. (1995). Cigarette smoking and sleep disturbance. Archives of internal medicine, 155(7), 734-737. Full text: https://www.researchgate.net/profile/Fred_Danner/publication/265907045_Cigarette_Smoking_and_Sleep_Disturbance/links/54207d470cf241a65a1e2bfe/Cigarette-Smoking-and-Sleep-Disturbance.pdf
Zhang, L., Samet, J., Caffo, B., & Punjabi, N. M. (2006). Cigarette smoking and nocturnal sleep architecture. American Journal of Epidemiology, 164(6), 529-537. Full text: https://pdfs.semanticscholar.org/31dc/3fa9f6eca36b6df702cba0ff4d3fd5a00c78.pdf
Carney, C. E., Buysse, D. J., Ancoli-Israel, S., Edinger, J. D., Krystal, A. D., Lichstein, K. L., & Morin, C. M. (2012). The consensus sleep diary: standardizing prospective sleep self-monitoring. Sleep, 35(2), 287-302. Full text: https://www.sleepfoundation.org/articles/healthy-sleep-tips
Stampi, C. (1989). Polyphasic sleep strategies improve prolonged sustained performance: a field study on 99 sailors. Work & Stress, 3(1), 41-55. Abstract: https://psycnet.apa.org/record/1989-35663-001
Porcu, S., Casagrande, M., Ferrara, M., & Bellatreccia, A. (1998). Sleep and Alertness During Alternating Monophasic and Poilyphasic Rest-Activity Cycles. International journal of neuroscience, 95(1-2), 43-50. Abstract: https://www.ncbi.nlm.nih.gov/pubmed/9845015
Roenneberg, T., Wirz-Justice, A., & Merrow, M. (2003). Life between clocks: daily temporal patterns of human chronotypes. Journal of biological rhythms, 18(1), 80-90. Full text: https://www.researchgate.net/profile/Till_Roenneberg/publication/10917322_Life_between_Clocks_Daily_Temporal_Patterns_of_Human_Chronotypes/links/00b4951bb6e6c5c55d000000/Life-between-Clocks-Daily-Temporal-Patterns-of-Human-Chronotypes.pdf
Schenck, C. H., & Mahowald, M. W. (2002). REM sleep behavior disorder: clinical, developmental, and neuroscience perspectives 16 years after its formal identification in SLEEP. Sleep: Journal of Sleep and Sleep Disorders Research. Full text: https://pdfs.semanticscholar.org/c31a/8bdaf1fbdacc7bfd5c1fcecc1cf042ad5dda.pdf
Young, T., Peppard, P. E., & Gottlieb, D. J. (2002). Epidemiology of obstructive sleep apnea: a population health perspective. American journal of respiratory and critical care medicine, 165(9), 1217-1239. Full text: https://www.atsjournals.org/doi/full/10.1164/rccm.2109080
Hla, K. M., Young, T. B., Bidwell, T., Palta, M., Skatrud, J. B., & Dempsey, J. (1994). Sleep apnea and hypertension: a population-based study. Annals of internal medicine, 120(5), 382-388. Full text: https://annals.org/aim/article-abstract/707176/sleep-apnea-hypertension-population-based-study
Dong, J. Y., Zhang, Y. H., & Qin, L. Q. (2013). Obstructive sleep apnea and cardiovascular risk: meta-analysis of prospective cohort studies. Atherosclerosis, 229(2), 489-495. Abstract: https://www.atherosclerosis-journal.com/article/S0021-9150(13)00268-2/fulltext
McNally, R. J., & Clancy, S. A. (2005). Sleep paralysis, sexual abuse, and space alien abduction. Transcultural psychiatry, 42(1), 113-122. Full text; https://pdfs.semanticscholar.org/0f82/3da7bbd0f103c4f37d92e084d6e528e16241.pdf
Schenck, C. H., & Mahowald, M. W. (1994). Review of nocturnal sleep‐related eating disorders. International Journal of Eating Disorders, 15(4), 343-356. Abstract: https://www.ncbi.nlm.nih.gov/pubmed/8032349
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Sleep: How Much Do You Need? Sleep Deprivation, Remedies & More
How much sleep do you need? Is your answer based purely your definition of a good night’s sleep, or have you been guessing, hoping the answer is right for you?
Poor sleep health impacts your quality of life and can make you susceptible to a range of chronic diseases. That’s why getting it right is so important.
Let’s take a deep dive into the significant benefits of sleep quality, the disasters of not getting enough, and how to address poor sleep habits.
Disclosure:
Ask the Dentist is supported by readers. If you use one of the links below and buy something, Ask the Dentist makes a little bit of money at no additional cost to you. I rigorously research, test, and use thousands of products every year, but recommend only a small fraction of these. I only promote products that I truly feel will be valuable to you in improving your oral health.
The Importance of Sleep
How important is sleep? How can I know if I’m getting enough sleep?
Possibly more than any other waking activity, your body’s overall health is tied to the sleep quality you enjoy each day. I like to refer to this as sleep ability.
In this fast-paced world, one condition from which we cannot escape is stress.
We constantly hear this word as it relates to both good and bad things in our lives: how we can minimize it, how we can use it to our benefit, how it’s the root cause of multitudes of diseases and disorders…
In a review written on the Physiology of Sleep, researchers find significant connections between stress and sleep problems. Your immune system’s response to stress, both acute and chronic, can lead to severe changes in your mood and emotional health as well as your physical health.
As they put it: “Recovery from acute stress usually involves a reparative sleep rebound characterized in REM sleep and SWS [slow-wave sleep]. Exposure to chronic stress leads to fragmented sleep.”
One example in the review is how cortisol levels fluctuate during different ranges of sleep cycles. Cortisol is typically known as the “stress hormone.”
Chronic sleep loss may accelerate consequences of too much glucocorticoid, a strong steroid hormone with powerful anti-inflammatory effects. These include issues like cognitive deficits and decreased carbohydrate tolerance.
And stress isn’t the only thing that hurts sleep quality. Other factors that can be killing your sleep quality include:
Undiagnosed sleep apnea or UARS (upper airway resistance syndrome)
Mouth breathing during sleep
Use of certain medications or illicit drugs
Too much screen time in the evening
Caffeine consumption
Buildup of household and commercial chemicals in the air
Sleeping hot
Smoking
I wrote a book a few years ago called The 8-Hour Sleep Paradox. In it, I talk about the misconception of there being a magical amount of hours to sleep, when most people aren’t getting significant enough sleep quality for that time limit to matter.
If I can leave you with anything of note today, I want it to be this: If you are getting up after 8 hours of sleep and don’t feel rested, day after day, something needs to change.
The good news is that understanding how to improve your sleep can give you a new spring in your step each morning.
What affects your sleep?
All living systems maintain a steady state of chemical and physical conditions internally. This is known in biology as “homeostasis.” Simply put, there is a proper balance in all living things.
In humans, there are a number of factors that, when kept within certain limits, allow us to live life to the very fullest.
Variables like the fluid balance in our body, body temperature, blood sugar level, and sodium and potassium levels are vital to experiencing optimum health.
Proper homeostasis requires a consistently healthy diet, level of physical activity, response to stress, and yes, sleep.
The balance between sleeping and waking is regulated by homeostasis.
The timing of our sleep is controlled by:
Circadian rhythm
Sleep-wake homeostasis (sleep-wake cycle)
Individual will (to a lesser extent than the other two)
Let’s look at more about those first two items.
1. Circadian Rhythm (Body or Internal Clock)
Even if the body is placed in a situation with constant darkness or constant light, our internal clock will continue to function. This means we experience somewhat consistent times of wakefulness and tiredness.
Our temperature fluctuates throughout a 24-hour period, and melatonin levels increase and decrease.
A restorative sleep episode is highly influenced by this rhythm. It’s the reason we’re typically sleepier at night.
Changes in light significantly affect our internal clock. Blue light, like that coming from our smartphones, tablets and computers, produces the strongest effect. That’s why limiting or ceasing electronic media use a few hours before bed is so important.
2. Sleep-Wake Homeostasis
The longer we’re awake, the more we want to sleep. Homeostasis, as discussed earlier, makes this occur. Humans seem to reach maximum sleepiness after 30 hours of waking. A proper sleep-wake cycle is vital to your health.
Sleeplessness is stressful and is known to cause cognitive impairment, meaning problems with thinking and learning processes.
Perhaps the better question to ask is, “What doesn’t affect your sleep?”
Here is a short list of factors that we may or may not consider when thinking about how well we sleep, and how we can address sleep problems.
What you ate today and yesterday
How your day progressed in general
The amount and type of exercise you got
The amount of caffeine or alcohol consumed
The mattress you sleep on
The pillow you use
Possible sleep disturbances through the night
These are all factors that we can control. However, other things occur in our lives that can’t as easily be controlled.
Dangers of Sleep Deprivation
Just one night of interrupted sleep wreaks havoc on our energy levels, mood, and hormone regulation. Chronically interrupted sleep affects our mental health, accelerates the aging process, and makes us more susceptible to all kinds of diseases.
In 2005, a research study on how sleep deprivation impacts the brain cited this list of “broad cognitive performance effects of sleep deprivation”:
Involuntary microsleeps occur (uncontrollable periods of 10-30 seconds of sleep)
Attention, short-term recall and mental performance suffer, resulting in errors in judgment and processing
Response time slows (for instance, the types and severity of damages/injuries incurred in accidents due to sleep deprivation comparable to those of at or above legal alcohol limits were detected)
Learning new tasks was more difficult
Performance requiring divergent thinking deteriorates
Subjects were more likely to keep working on solutions they’d already proven don’t work while trying to solve simple tasks
Tasks may be begun well, but performance deteriorates as task duration increases
There is growing neglect of activities judged to be nonessential (loss of situational awareness)
Another sleep study in 2008 found that sleep deprivation had out-of-balance levels of 2 hormones: leptin and ghrelin. These hormones affect appetite, “possibly explaining the increased BMI observed with short sleep duration.”
In short: Being sleep-deprived for as little as one night can have massive impact on how we think, learn, and even digest food.
10 Tips for Better Sleep
It’s possible for you to hack your sleep routine by creating a healthy sleep environment.
Unfortunately, many jump to the option of sleeping pills, assuming nothing else will work. As a society, we are conditioned to reach for a pill bottle without trying natural, chemical-free, easy changes to our daily routines.
I would recommend you take prescription sleep aids ONLY after all other options have been exhausted (no sleep puns intended), with little or no success.
Before speaking to your doctor, keep a sleep diary for at least 2 weeks.
List how long you slept each night, whether sleep felt sound or fitful, and even note the weather on nights the sky was not clear. This will provide a starting place for your physician to evaluate the best path for you.
Here is a list of simple suggestions to decrease sleep disturbances and upgrade your current sleep environment — no medication required.
1. Make your bedroom a truly restful place.
The practice of using the bedroom for everything from homework to stressful phone calls to TV watching can cause your brain to associate that area with wakefulness. Instead, seek to create an oasis that you use for rest and other stress-free pleasure.
Avoid doing tasks in your bedroom, particularly in your bed, that require you to stay awake and alert.
Do your best to eliminate all lights, especially electronic lights. A very dark room with no light pouring in or emanating from equipment, clocks, charges, etc. can promote restful, peaceful sleep.
Finally, invest in a mattress and pillow that allow you to get a great night’s sleep. For some, this means an adjustable bed for sleeping at an angle. For others, it may just look like finally getting around to replacing the 30-year-old mattress making you sore every night.
2. Keep the temperature between 66-68 degrees.
A cool room allows you to sleep more soundly. As an extra step, I like to keep my mattress cool with the chiliPAD Cube 3.0 and let blankets do the insulation.
3. Eliminate screens 1-2 hours before bed.
For thousands of years, our bodies were programmed to sleep because of triggers like darkness and a general “slowing down” as bedtime approached.
But for a little over half a century, we’ve interrupted these biological signals with television and, now, mobile devices. These screens not only put out a lot of blue light (even with “night shift” settings on) but can also mimic the faster pace your brain has evolved to associate with wakefulness.
For a good night’s sleep, read a book, have a cup of hot (caffeine-free) tea, or listen to a podcast…
Whatever you do, put away the screen. I recommend two hours before bed as a good starting point, but at least 60 minutes before you lay down is a good idea.
I enjoy using my Kindle Paperwhite at night to read, which does use a gentle light but isn’t the same as staring at a screen. It’s also worthwhile to invest in blue blocking glasses like Carbonshade if you know you’re going to be staring at a screen most of the day.
4. Invest in a quality air filter.
Did you know the EPA says that indoor air pollution can be 2-5 times higher (up to 100 times higher) than outdoors?
These air pollutants come from everything from cookware to personal care products and even mold.
Regardless of how great the ventilation in your house is, chances are, you’re breathing in toxins overnight.
The higher your toxic load, the harder your body has to work to stay “clean.” This is especially significant during sleep, when your body’s cleaning its cells from top to bottom.
The Molekule and AirDoctor Pro are my two favorite filters. I even bring one with me when I travel! I don’t even want to think about the toxins living in a hotel.
5. Avoid power naps.
Avoid napping during the daytime. Some are fans of power napping in the afternoon, but if it hinders your nighttime sleeping, they should go.
6. Consider what dietary patterns interrupt your sleep.
Avoid heavy meals just before you go to sleep, as digesting food (particularly any type of carbohydrates) will boost your blood sugar and may result in more energy when you don’t need it.
Stop drinking caffeinated drinks 6-8 hours before bedtime, as caffeine in the afternoon and evening disrupts your circadian rhythm.
7. Stop smoking.
Better sleep is just one of the huge number of reasons to quit smoking.
Smokers:
Are more likely to develop sleep-disordered breathing
Experience more sleep disturbances, daytime sleepiness, and related problems to sleep deprivation like accidents and depression
Fall asleep slower than healthy counterparts
Stay in light sleep more and have trouble getting into deeper levels of sleep
Fortunately, quitting smoking can eliminate all of these risks.
8. Use mouth tape.
Once you’re ready to go to sleep, one of the worst things that can disrupt your perfected sleep routine is nighttime mouth breathing.
Mouth breathing can lead to a more easily collapsed airway (like that seen in sleep apnea), snoring, and dry mouth, among other things.
Using mouth tape is a great way to stop that from happening. My favorites are Somnifix (the “Cadillac” of mouth tape) as well as the more budget-friendly Nexcare Tape.
9. Practice breathing and muscle relaxation techniques.
Breathing exercises turn your attention to the natural pattern of your breathing, in and out. As you inhale, think of tense areas of your body; when you exhale, imagine releasing the tension from the area(s) you thought of.
Guided imagery is another way of turning focus from the stresses of the present. Think of a peaceful place, such as the beach or a favorite vacation spot. Allow your mind to dwell there. Take in the atmosphere as you breathe calmly and slowly.
10. Keep a consistent sleep schedule.
Going to bed around the same time each night and waking about the same time the next day will benefit you in many ways.
It keeps your body clock (circadian rhythm) ticking consistently and results in more restful sleep.
The 8-Hour Paradox: How long should you sleep?
Be honest here, did you respond by saying, “Yep, I need my 8 hours every night!”?
I think you’ll be surprised by what constitutes a good night’s sleep. Actually, your sleep quality far outweighs the exact quantity of sleep you get each night.
Sleep is a naturally recurring state of mind and body, when your body has greatly decreased ability to react to stimuli (as opposed to being awake).
When you sleep, the majority of your body’s systems restore strength: muscular, nervous, immune, and skeletal systems all receive a much needed boost.
Polyphasic vs. Monophasic Sleep
Like their roots indicate, polyphasic sleep occurs multiple times in a 24-hour cycle, while monophasic sleep happens in a single interval of time every 24 hours.
Polyphasic sleep used to be much more common in previous centuries, as farmers found the most effective patterns might involve two shorter sleep sessions rather than one long session.
When it’s been studied in humans, polyphasic sleep doesn’t seem to result in a reduction of work quality or even energy. What’s more, people on polyphasic sleep cycles sleep less total hours each day and seem not to suffer negative consequences.
There are other sleep patterns, known as chronotypes. These occur based on a number of factors, such as gender of the individual, genetics, and formed habits. These sleep patterns can change over the course of your life.
While there are “accepted” amounts of sleep times per day, there are actually many ways to experience good quality sleep — and not all of them add up to 8 hours.
There are other extreme chronotypes that can occur, considered circadian rhythm sleep disorders.
Recommended Sleep Times
In 2015, the National Sleep Foundation updated, through the work of a multidisciplinary expert panel, the recommendations of the amount of sleep needed at different life stages.
Newborns (0-3 months): Sleep range narrowed to 14-17 hours each day (previously it was 12-18)
Infants (4-11 months): Sleep range widened two hours to 12-15 hours (previously it was 14-15)
Toddlers (1-2 years): Sleep range widened by one hour to 11-14 hours (previously it was 12-14)
Preschool-age (3-5): Sleep range widened by one hour to 10-13 hours (previously it was 11-13)
School-age children (6-13): Sleep range widened by one hour to 9-11 hours (previously it was 10-11)
Teenagers (14-17): Sleep range widened by one hour to 8-10 hours (previously it was 8.5-9.5)
Younger adults (18-25): Sleep range is 7-9 hours (new age category)
Adults (26-64): Sleep range did not change and remains 7-9 hours
Older adults (65+): Sleep range is 7-8 hours (new age category)
While it should be noted that sleep habits will certainly vary during different stages of your life, high quality sleep is the most important factor in our overall body health.
For instance, say your preschooler is sleeping soundly and consistently 9 hours a night and is alert and active throughout his/her waking hours. In that case, there is no need to force them to sleep an extra hour or two.
For healthy school-age children, s/he is likely getting the amount of sleep necessary for healthy development.
Stages of Sleep
There are four stages of sleep in a normal night. These sleep stages include stage 1 (light sleep), stage 2 (sound sleep), stage 3 (deep sleep), and REM (rapid eye movement/dreaming).
Stage 1 — The lightest stage of non-REM (Rapid Eye Movement) sleep. This is the time when you can be easily awakened by even soft sounds or disruptions. During muscle relaxation, brain activity slows. Drifting in and out of sleep and muscle spasms, or jerks, can occur during this time, when you may feel like you’re falling.
Stage 2 — This is a more well-defined stage of non-REM sleep. You’re more soundly asleep, and cannot be as easily awakened. Eye rolling stops, and your brain continues to slow. Body temperature drops in this stage and heart rate begins to slow.
Stage 3 — Known as deep, non-REM sleep. This time of deep sleep is definitely the most reparative for the body. Sudden arousal is rare at this point. Occurrences of talking in your sleep, sleepwalking and night terrors occur during this deepest stage. This stage is sometimes divided into 3 & 4, but isn’t truly differentiated enough to classify separately.
REM stage — The part of our sleep known as REM (Rapid Eye Movement) is often called the dreaming stage. Eyes move quickly from side to side, and our brain waves pick up in activity from stages 2 and 3. Though we can be awakened a little easier during this stage of sleep, we will feel the most tired or groggy as a result.
Dreaming: Why and How
Much is known about the role of sleep in regulating our metabolism, blood pressure, brain function, and other aspects of health. But it’s been harder for researchers to explain the role of dreams.
It’s been said that although our bodies need rest and sleep, we never stop thinking; our brain remains active. Although the proof is not definitive, our dreams appear to be autobiographical, based on recent occurrences in our lives.
Here are some interesting beliefs and theories about dreams from the article referenced above, “The Role of Dreams”.
Dreams could be a way we confront emotional drama in our lives, making connections to our feelings that we would consciously put together.
When we dream, the amygdala (part of the brain linked to survival instinct and fight-or-flight response) is the most active. There is a theory suggesting this time of heightened activity in the amygdala is the brain’s way of getting us ready to deal with a threat.
Our minds aren’t restricted when we sleep, like they can be while we’re awake. Dreams can facilitate our most creative thinking.
Research has found that sleep helps store memories. There is still much to discover about this, but “dreams may help the brain more efficiently store important information while blocking out stimuli that could interfere with memory and learning.”
A 1983 article in Nature magazine states, “…the function of dream sleep (more properly REM sleep) is to remove certain undesirable modes of interaction in networks of cells in the cerebral cortex.”
Authors Francis Crick and Graeme Mitchison delve into the functions of dreams and how they serve the brain. Here are some quotes from the article that may explain why dreaming matters so much.
“Although we dream for one or two hours every night, we do not remember most of our dreams.”
“Modern theories have usually proposed that sleep and dreams save energy or have various restorative functions, either to replenish the brain biochemically in some way, or to reclassify or reorder the information stored in it.”
“…major difference between REM and non-REM sleep lies in the dreams associated with them. For most people the few dreams found in non-REM sleep tend to have a rather thought-like character. During REM sleep, on the other hand, dreams occur more frequently and usually have a perceptual vividness and the illogical episodic character with which we are all familiar.”
Sleep Tracking Options & Limitations
As a sleep medicine dentist, I’ve invested a lot of time testing the latest sleep apps and tech designed to help people discover how well they’re sleeping.
Unlike even 10 years ago, when this technology was too pricey for most consumers, there are now good choices for just about any budget.
While you’ll find a comprehensive breakdown of the available products in that article, here are the basics you should know:
To get a baseline, I recommend starting with SnoreLab, which is available in both free and paid versions on the App Store and Google Play Store. Snoring isn’t the only factor in poor quality sleep, but many people who don’t sleep also snore a lot.
When it comes to wearable or other similar sleep tech, there are several options that do a decent (although not perfect) job. My favorites are the Oura Ring and Apple Watch, and I’m constantly on the lookout for better and more informative options.
No home sleep app or tech can currently replace the need for a sleep study performed by a specialist. These can take place at home or at a sleep clinic, but if you find you’re waking up tired, even after trying to improve your sleep, it’s probably time to see a sleep doctor. Your dentist or general practitioner can refer you to a reputable provider in your area.
8 Common Sleep Disorders
1. Sleep Bruxism
Bruxism, or teeth grinding, is a sleep-related movement disorder that involves clenching the jaw muscles to grind upper and lower teeth together.
Besides the effects on your teeth and gums, grinding is disruptive to sound sleep. Unlike the more habitual act of grinding your teeth during waking hours, nighttime bruxism could be linked to another serious sleep disorder: sleep apnea.
2. Snoring
When you sleep, air crosses over the tissues in your throat, which are relaxed. Due to several factors, that air can ‘rattle’ over those relaxed tissues and produce a soft or loud noise.
One way sleep can be disrupted by snoring is if the noise of your sleep partner wakes you up. However, a possibly more serious disorder of snoring is sleep apnea.
3. Sleep Apnea
Although not an uncommon topic, sleep apnea is still a greatly ignored topic among many.
This occurs when your upper airway is partly or totally blocked, cutting off your regular breathing for a short period, and causes you to awaken and ‘catch your breath’.
Left untreated, sleep apnea can result in daytime sleepiness, and severe cases have been linked to increased risk of stroke or heart attack. It’s also been associated with high blood pressure.
I’ll discuss sleep apnea later in this article.
4. Restless Legs Syndrome
A more common issue for middle-aged and older adults, restless legs syndrome can affect just about any age. It’s sometimes known as periodic limb movement disorder.
Symptoms of discomfort in the feet and legs occur most often in the evening and through the night, which disturbs sleep and prevents deep sleep. Many people will continuously move their legs or thrash them around, even while they are sleeping.
5. Narcolepsy
Thought to affect approximately 1 in 2,000 people, narcolepsy is characterized by:
Excessive sleepiness
Hallucinations
Sleep paralysis
Episodes of cataplexy (partial or total loss of muscle control, sometimes triggered by a strong emotion)
Currently, there is no known cure. However, patients have been able to lead normal lives through the use of meds and some behavioral treatments that will lessen or improve symptoms.
6. Insomnia
Temporary, short-term insomnia can happen because of factors such as jet lag, or even when too much caffeine is consumed before bedtime. Extra stressful events can also bring on bouts with insomnia, though most of the time these occurrences don’t last long.
If, however, stress is left unchecked, the effects can turn into depression or extreme anxiety. When an individual experiences these more serious conditions, sleep will elude them, usually because nighttime can be associated with darkness or loneliness.
Insomnia is typically classified as “primary” or “secondary.” Primary insomnia isn’t caused by other factors and occurs on its own, while secondary insomnia may be due to medication use or other medical conditions.
7. REM Sleep Behavior Disorder
First officially recognized in 1986, REM Sleep Behavior Disorder (RBD) is a condition in which people enact their dreams in REM sleep, rather than staying immobile in bed.
These episodes can manifest in ways that injure the person with the disorder or their sleeping partner. Some people with this condition will actually attack those in their bedroom or home while dreaming, for instance, they’re protecting them from an intruder.
It’s most common in males and often comes after years, sometimes decades, of a “prodrome” (early sign or symptom) of frequent movement and jerking movement during sleep.
Like insomnia, this condition can occur on its own or occur as a sign of a neurological condition. So far, the most effective treatment identified is the medication Clonazepam, a benzodiazepine typically used for panic disorders and seizures.
Unfortunately, this drug comes with the strongest warning available from the FDA regarding potential addiction and side effects, known as a black box warning.
8. Circadian Rhythm Disorders
In the various circadian rhythm disorders, the internal body clock discussed above is interrupted or broken in some way.
The most well-known of these disorders include:
Narcolepsy
Delayed Sleep Phase Disorder (DSPD): Seen most commonly in teens and young adults, people with DSPD get stuck in a routine of the most “awake” part of the day being between 2-5 AM. Daytime work and sleep schedules often decline as a result.
Advanced Sleep Phase Disorder (ASPD): The inverse of DSPD, advanced phase sleep happens often in the elderly when bedtimes become earlier and wakefulness happens earlier. For instance, a person will go to bed before 9 PM and wake up between 2-5 AM on a regular basis. This also tends to result in complaints of insomnia and daytime sleepiness.
Jet Lag: This happens when the biological clock is at odds with the time of day, often after travel. Flying east, rather than west, is typically easier for circadian rhythm adjustments, as it’s typically simpler to wait to sleep than it is to fall asleep earlier.
Sleep Apnea: A 21st Century Epidemic?
As a sleep medicine dentist, understanding, diagnosing and treating patients with sleep apnea is especially important to me.
Much more than simply being disturbed by your sleep partner’s snoring is the need to discover the cause of the snoring.
An estimated 18-22 million Americans deal with sleep apnea, with some studies stating as high as 80 percent of moderate to severe cases go undiagnosed.
There are a lot of misconceptions about sleep apnea, like that it isn’t common in women or that it only occurs in overweight or obese people. However, far more people may be enduring it in silence.
Many studies strongly indicate that undiagnosed sleep apnea is independently associated with increased likelihood of:
Hypertension
Cardiovascular disease
Stroke
Sleep bruxism
Daytime sleepiness
Motor vehicle accidents
Diminished quality of life
A 1994 study of 147 adult men and women suffering found that mean blood pressure was higher in patients with sleep apnea. The variability of the blood pressure during sleep was significantly greater in participants with sleep apnea or history of snoring compared to those without.
Another sleep study performed in 2000 found a link between patients with Obstructive Sleep Apnea (OSA) and significantly increased risk of heart disease, especially stroke risk.
In a radio interview with Marianne Russo, I discuss the connection between ADHD and sleep apnea in children and teens. Here are some important facts about ADHD and Sleep Apnea in a younger population:
40-60% of children that have sleep apnea have some form of ADHD
Sleep apnea and sleep disorders are a major cause of behavioral issues in children and teens
It’s possible that many cases of ADHD are actually misdiagnosed sleep apnea cases
Sleep apnea is far more prevalent in children than we originally thought, perhaps as common in children and teens as in adults
Teeth grinding at any age is an indication of a struggle to keep the airway open at night
I’ve long thought this massive increase in sleep apnea at all ages might be associated with some 21st century changes, such as:
Comfortable beds that make back sleeping preferable
Lack of vitamin K2 in the diet, leading to an underdeveloped jaw and smaller airway that’s more susceptible to collapsing
Prevalence of a sedentary lifestyle
Other Sleep Issues
Though these aren’t classified as “disorders,” these other sleep problems can lead to poor sleep quality.
Issues with Sleeping while Pregnant
Most pregnant women have problems with extra tiredness during the first and third trimesters of pregnancy. This can be due to morning sickness keeping them from rest or frequent bathroom trips as the baby grows and pushes on the bladder.
It is important for expectant moms to try their best to get rest throughout the duration of the pregnancy. And after the baby is born, when life steps up to a whole new pace, high sleep quality is even more important.
Especially with the possibility of postpartum depression, which also interrupts sleep, I encourage mothers to keep their bodies as well rested as is possible.
Sleepwalking
Also known as somnambulism, this behavior most commonly happens in children. They appear dazed; they may walk around or wander, and sometime will talk, without having any memory of it when they awake.
Sleepwalking typically occurs within the first couple of hours of sleep, and is relatively short in length.
Although sleepwalking can happen as a result of an illness or fever, it can also be triggered by lack of sleep, poor quality of sleep (due to sleep apnea, bruxism, etc.). The disorder has also been known to be hereditary.
Night Terrors (aka Sleep Terrors)
As undesired as the name implies, this sleep disorder is characterized by sudden flailing, screaming, or jerking while asleep. Most episodes are as short seconds to a few minutes, but may last longer.
Like sleepwalking, night terrors are more common in children. They child may be hard to wake up from the event, and then be groggy or distressed when they finally come out of it.
There is no cause for alarm if the occurrences are occasional. However, if night terrors become more frequent, seem to cause abnormal sleepiness during the day, or continue beyond teen years or into adulthood, you should consult your doctor.
Bedwetting
Both children and adults may suffer from frequent bedwetting. Childhood bedwetting usually begins as a result of potty training, but can continue if too much urine is being produced.
Causes of adult bedwetting are numerous but generally have to do with urine production, bladder problems, and unconscious arousal during sleep.
Sleep Paralysis
Though it’s not well-understood, sleep paralysis happens when a person “wakes up” but is unable to move their body.
Sleep paralysis is often accompanied by brief hallucinations, the most frequent of which tend to be about aliens or “repressed” sexual abuse memories.
But don’t worry — the little green guys are (probably) just in your head.
Sleep-Related Eating Disorders
A fairly rare occurrence, eating disorders during sleep often result in overeating and weight gain. Patients may not realize they’re eating during the night until they discover repeated evidence during waking hours.
FAQs
Q:
How can I fall asleep right away? Is that a good benchmark to aim for?
A: Simple tips include:
No caffeine consumption 6-8 hours before bed
Utilize relaxation and/or breathing exercises
Stay away from electronic media for a couple of hours before bed
Enjoy a warm bath
It’s not a bad benchmark to work towards, but good sleep doesn’t happen just because you’re a person who can quickly drop off. In fact, short “sleep latency” (the time it takes to fall asleep) can signify exactly the opposite.
In general, you should fall asleep about 10-15 minutes after laying down. Much shorter or longer than that, and there may be a cause for concern.
Q:
Can a lack of sleep be deadly?
A: Yes, lack of or poor sleep can cause life-threatening problems. It affects not only physical but also mental health.
Sleep deprivation and poor sleep habits rob your body of the recharging and restoring it desperately needs. It will wear you down both physically and emotionally to serious levels if the deprivation continues long enough.
Sleep apnea can be a symptom of more serious issues with blood pressure and other heart problems. It’s not typically fatal on its own but can lead to fatal consequences, left untreated.
Q:
What parts of the brain are involved in the sleep cycle process?
A: While the way the brain controls sleep and wakefulness is not fully known, there are some things we do know.
The shut down of arousal signals in the brain is controlled by a specific area of the hypothalamus.
Neurons in the hypothalamus pinpoint the areas that make us feel awake, and inhibit the activity occurring there.
Q:
How do genetics impact sleep?
A: In a 2012 study, the authors state:
“It is now clear that sleep is genetically controlled. Although environmental factors can impact the duration and intensity of sleep, genetic regulation is borne out by the heritability of sleep trais, the identification of specific genetic polymorphisms that affect these traits, and the existence of familial sleep disorders.”
Q:
Do white noise machines help with sleep?
A: Yes! Using a noise generator is a great way to improve the stability and quality of your sleep. It can also make you less aware of noise that could otherwise wake you up.
Key Takeaways: Sleep
Sleep is paramount to well-being. Our bodies desperately need it. However, how much sleep we need changes over the course of our lives.
In general, it is more beneficial to focus on how to improve quality of sleep rather than length of sleep.
Tracking your sleep can be a great way to find a baseline for the quality of your sleep. Take advantage of modern tech by finding a sleep app or tracker that suits you. These can also point to warning signs of bigger health issues you need to address.
Don’t ignore the signs of bad sleep. Whether by a sleep tracker, or just the fact that you never feel rested when you wake, there are some serious health problems that can be detected during sleep. If you have a sleep partner, ask them to listen and observe you, on occasion, during sleep.
Do you snore more than just a light, intermittent amount?
Do you grind your teeth?
Do you experience periods of time without breathing, then take in a gasping breath?
Do you have stretches of time that you are fitful, thrashing legs or jerking?
Do you feel worn out when you wake up the next day?
These can indicate a number of physical problems, some mild and others very serious.
The good news is that once you identify a disorder, it can be treated. Whether the answer is being fitted for a night guard to temporarily address bruxism (teeth grinding) or a CPAP machine to treat sleep apnea, the outcome will be better, more sound, sleep.
Your dentist may also fit you with an oral appliance to help with airway position for sleep apnea.
Read Next: Sleep Apnea: The Real Reason You Grind Your Teeth?
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