YOUR GUIDE TO Healthy Sleep

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1 YOUR GUIDE TO Heathy Seep

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3 Your Guide to Heathy Seep NIH Pubication No Originay printed November 2005 Revised August 2011

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5 Contents Introduction...1 What Is Seep?...4 What Makes You Seep?...7 What Does Seep Do for You?...12 Your Learning, Memory, and Mood...12 Your Heart...13 Your Hormones...14 How Much Seep Is Enough?...19 What Disrupts Seep? Is Snoring a Probem? Common Seep Disorders Insomnia...35 Seep Apnea...38 Restess Legs Syndrome...47 Narcoepsy...48 Parasomnias (Abnorma Arousas)...51 Do You Think You Have a Seep Disorder? How To Find a Seep Center and Seep Speciaist Research For More Seep Information...60 Contents

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7 Introduction 1 Think of your daiy activities. Which activity is so important you shoud devote one-third of your time to doing it? Probaby the first things that come to mind are working, spending time with your famiy, or doing eisure activities. But there s something ese you shoud be doing about one-third of your time seeping. Many peope view seep as merey a down time when their brains shut off and their bodies rest. Peope may cut back on seep, thinking it won t be a probem, because other responsibiities seem much more important. But research shows that a number of vita tasks carried out during seep hep peope stay heathy and function at their best. Whie you seep, your brain is hard at work forming the pathways necessary for earning and creating memories and new insights. Without enough seep, you can t focus and pay attention or respond quicky. A ack of seep may even cause mood probems. Aso, growing evidence shows that a chronic ack of seep increases your risk of obesity, diabetes, cardiovascuar disease, and infections. Introduction

8 2 Despite growing support for the idea that adequate seep, ike adequate nutrition and physica activity, is vita to our we-being, peope are seeping ess. The nonstop 24/7 nature of the word today encourages onger or nighttime work hours and offers continua access to entertainment and other activities. To keep up, peope cut back on seep. A common myth is that peope can earn to get by on itte seep (such as ess than 6 hours a night) with no adverse effects. Research suggests, however, that aduts need at east 7 8 hours of seep each night to be we rested. Indeed, in 1910, most peope sept 9 hours a night. But recent surveys show the average adut now seeps fewer than 7 hours a night. More than one-third of aduts report daytime seepiness so severe that it interferes with work, driving, and socia functioning at east a few days each month. Evidence aso shows that chidren s and adoescents seep is shorter than recommended. These trends have been inked to increased exposure to eectronic media. Lack of seep may have a direct effect on chidren s heath, behavior, and deveopment. Chronic seep oss or seep disorders may affect as many as 70 miion Americans. This may resut in an annua cost of $16 biion in heath care expenses and $50 biion in ost productivity. Your Guide to Heathy Seep

9 3 What happens when you don t get enough seep? Can you make up for ost seep during the week by seeping more on the weekends? How does seep change as you become oder? Is snoring a probem? How can you te if you have a seep disorder? Read on to find the answers to these questions and to better understand what seep is and why it is so necessary. Learn about common seep myths and practica tips for getting enough seep, coping with jet ag and nighttime shift work, and avoiding dangerous drowsy driving. Many common seep disorders go unrecognized and thus are not treated. This booket aso gives the atest information on seep disorders such as insomnia (troube faing or staying aseep), seep apnea (pauses in breathing during seep), restess egs syndrome, narcoepsy (extreme daytime seepiness), and parasomnias (abnorma seep behaviors). SZE-PING It s important to te your doctor what you are experiencing, so you can hep your doctor diagnose your condition. Introduction

10 4 What Is Seep? Seep was ong considered just a bock of time when your brain and body shut down. Thanks to seep research studies done over the past severa decades, it is now known that seep has distinct stages that cyce throughout the night in predictabe patterns. How we rested you are and how we you function depend not just on your tota seep time but on how much seep you get each night and the timing of your seep stages. Your brain and body functions stay active throughout seep, and each stage of seep is inked to a specific type of brain waves (distinctive patterns of eectrica activity in the brain). Your Guide to Heathy Seep Seep is divided into two basic types: rapid eye movement (REM) seep and non-rem seep (with three different stages). (For more information, see Types of Seep on page 5.) Typicay, seep begins with non-rem seep. In stage 1 non-rem seep, you seep ighty and can be awakened easiy by noises or other disturbances. During this first stage of seep, your eyes move sowy, your musces reax, and your heart and breathing rates begin to sow. You then enter stage 2 non-rem seep, which is defined by sower brain waves with occasiona bursts of rapid waves. You spend about haf the night in this stage. When you progress into stage 3 non- REM seep, your brain waves become even sower, and the brain produces extremey sow waves amost excusivey (caed Deta waves).

11 5 Stage 3 is a very deep stage of seep, during which it is very difficut to be awakened. Chidren who wet the bed or seep wak tend to do so during stage 3 of non-rem seep. Deep seep is considered the restorative stage of seep that is necessary for feeing we rested and energetic during the day. Types of Seep Non-REM Seep Stage 1: Light seep; easiy awakened; musces reax with occasiona twitches; eye movements are sow. Stage 2: Eye movements stop; sower brain waves, with occasiona bursts of rapid brain waves. Stage 3: Occurs soon after you fa aseep and mosty in the first haf of the night. Deep seep; difficut to awaken; arge sow brain waves, heart and respiratory rates are sow and musces are reaxed. REM Seep Usuay first occurs about 90 minutes after you fa aseep, and onger, deeper periods occur during the second haf of the night; cyces aong with the non-rem stages throughout the night. Eyes move rapidy behind cosed eyeids. Breathing, heart rate, and bood pressure are irreguar. Dreaming occurs. Arm and eg musces are temporariy parayzed. Types of Seep During REM seep, your eyes move rapidy in different directions, even though your eyeids stay cosed. Your breathing aso becomes more rapid, irreguar, and shaow, and your heart rate and bood pressure increase. Dreaming typicay occurs during REM seep. During this type of seep, your arm and eg musces are temporariy parayzed so that you cannot act out any dreams that you may be having. What Is Seep?

12 6 You typicay first enter REM seep about an hour to an hour and a haf after faing aseep. After that, the seep stages repeat themseves continuousy whie you seep. As you seep, REM seep time becomes onger, whie time spent in stage 3 non-rem seep becomes shorter. By the time you wake up, neary a your seep time has been spent in stages 1 and 2 of non-rem seep and in REM seep. If REM seep is severey disrupted during one night, REM seep time is typicay onger than norma in subsequent nights unti you catch up. Overa, amost one-haf of your tota seep time is spent in stage 2 non-rem seep and about one-fifth each in deep seep (stage 3 of non-rem seep) and REM seep. In contrast, infants spend haf or more of their tota seep time in REM seep. Graduay, as they grow, the percentage of tota seep time they spend in REM continues to decrease, unti it reaches the one-fifth eve typica of ater chidhood and aduthood. Why peope dream and why REM seep is so important are not we understood. It is known that REM seep stimuates the brain regions you use to earn and make memories. Anima studies suggest that dreams may refect the brain s sorting and seectivey storing new information acquired during wake time. Whie this information is processed, the brain might revisit scenes from the day and mix them randomy. Dreams are generay recaed when we wake briefy or are awakened by an aarm cock or some other noise in the environment. Studies show, however, that other stages of seep besides REM aso are needed to form the pathways in the brain that enabe us to earn and remember. Your Guide to Heathy Seep

13 What Makes You Seep? 7 Athough you may put off going to seep in order to squeeze more activities into your day, eventuay your need for seep becomes overwheming. This need appears to be due, in part, to two substances your body produces. One substance, caed adenosine, buids up in your bood whie you re awake. Then, whie you seep, your body breaks down the adenosine. Leves of this substance in your body may hep trigger seep when needed. A buidup of adenosine and many other compex factors might expain why, after severa nights of ess than optima amounts of seep, you buid up a seep debt. This may cause you to seep onger than norma or at unpanned times during the day. Because of your body s interna processes, you can t adapt to getting ess seep than your body needs. Eventuay, a ack of seep catches up with you. The other substance that heps make you seep is a hormone caed meatonin. This hormone makes you naturay fee seepy at night. It is part of your interna bioogica cock, which contros when you fee seepy and your seep patterns. Your bioogica cock is a sma bunde of ces in your brain that works throughout the day and night. Interna and externa environmenta cues, such as ight signas received through your eyes, contro these ces. Your bioogica cock triggers your body to produce meatonin, which heps prepare your brain and body for seep. As meatonin is reeased, you fee increasingy drowsy. Because of your bioogica cock, you naturay fee the most tired between midnight and 7 a.m. You aso may fee midy seepy in the afternoon between 1 p.m. and 4 p.m. when another increase in meatonin occurs in your body. Your bioogica cock makes you the most aert during dayight hours and the east aert during the eary morning hours. Consequenty, most peope do their best work during the day. Our 24/7 society, however, demands that some peope work at night. Neary one-quarter of a workers work shifts that are not during the daytime, and more than two-thirds of these workers have probem seepiness and/or difficuty seeping. Because their work schedues What Makes You Seep?

14 8 are at odds with powerfu seep-reguating cues ike sunight, night shift workers often find themseves drowsy at work, and they have difficuty faing or staying aseep during the dayight hours when their work schedues require them to seep. The fatigue experienced by night shift workers can be dangerous. Major industria accidents such as the Three Mie Isand and Chernoby nucear power pant accidents and the Exxon Vadez oi spi have been caused, in part, by mistakes made by overy tired workers on the night shift or an extended shift. Night shift workers aso are at greater risk of being in car crashes when they drive home from work during the eary morning hours, because the bioogica cock is not sending out an aerting signa. One study found that one-fifth of night shift workers had a car crash or a near miss in the preceding year because of seepiness on the drive home from work. Night shift workers are aso more ikey to have physica probems, such as heart disease, digestive troubes, and infertiity, as we as emotiona probems. A of these probems may be reated, at east in part, to the workers chronic seepiness, possiby because their bioogica cocks are not in tune with their work schedues. See Working the Night Shift on page 9 for some hepfu tips if you work a night shift. Other factors aso can infuence your need for seep, incuding your immune system s production of hormones caed cytokines. Cytokines are made to hep the immune system fight certain infections or chronic infammation and may prompt you to seep more than usua. The extra seep may hep you conserve the resources needed to fight the infection. Recent studies confirm that being we rested improves the body s responses to infection. Your Guide to Heathy Seep Peope are creatures of habit, and one of the hardest habits to break is the natura wake and seep cyce. Together, a number of physioogica factors hep you seep and wake up at the same times each day.

15 9 Consequenty, you may have a hard time adjusting when you trave across time zones. The ight cues outside and the cocks in your new ocation may te you it is 8 a.m. and you shoud be active, but your body is teing you it is more ike 4 a.m. and you shoud seep. The end resut is jet ag seepiness during the day, difficuty faing or staying aseep at night, poor concentration, confusion, nausea, and generay feeing unwe and irritabe. See Deaing With Jet Lag on page 10. Working the Night Shift Try to imit night shift work, if that is possibe. If you must work the night shift, the foowing tips may hep you: Increase your tota amount of seep by adding naps and engthening the amount of time you aot for seep. Use bright ights in your workpace. Minimize the number of shift changes so that your body s bioogica cock has a onger time to adjust to a nighttime work schedue. Get rid of sound and ight distractions in your bedroom during your daytime seep. Use caffeine ony during the first part of your shift to promote aertness at night. If you are unabe to fa aseep during the day, and a ese fais, tak with your doctor to see whether it woud be wise for you to use prescribed, short-acting seeping pis to hep you seep during the day. Night Shift What Makes You Seep?

16 10 Deaing With Jet Lag Your Guide to Heathy Seep Be aware that adjusting to a new time zone may take severa days. If you are going to be away for just a few days, it may be better to stick to your origina seep and wake times as much as possibe, rather than adjusting your bioogica cock too many times in rapid succession. Eastward trave generay causes more severe jet ag than westward trave because traveing east requires you to shorten the day, and your bioogica cock is better abe to adjust to a onger day than a shorter day. Fortunatey for gobetrotters, a few preventive measures and adjustments seem to hep some peope reieve jet ag, particuary when they are going to spend more than a few days at their destination: Adjust your bioogica cock. During the 2 3 days prior to a ong trip, get adequate seep. You can make minor changes to your seep schedue. For exampe, if you are traveing west, deay your bed time and wake time progressivey by 20- to 30-minute intervas. If you are traveing east, advance your wake time by 10 to 15 minutes a day for a few days and try to advance your bed time. Decreasing ight exposure at bedtime and increasing ight exposure at wake time can hep you make these adjustments. When you arrive at your destination, spend a ot of time outdoors so your body gets the ight cues it needs to adjust to the new time zone. Take a coupe of short minute catnaps if you fee tired, but do not take ong naps during the day. Avoid acoho and caffeine. Athough it may be tempting to drink acoho to reieve the stress of trave and make it easier to fa aseep, you re more ikey to seep ighter and wake up in the midde of the night when the effects of the acoho wear off. Caffeine can hep keep you awake onger, but caffeine aso can make it harder for you to fa aseep if its effects haven t worn off by the time you are ready to go to bed. Therefore, it s best to use caffeine ony during the morning and not during the afternoon.

17 11 What about meatonin? Your body produces this hormone that may cause some drowsiness and cues the brain and body that it is time to fa aseep. Meatonin buids up in your body during the eary evening and into the first 2 hours of your seep period, and then its reease stops in the midde of the night. Meatonin is avaiabe as an over-the-counter suppement. Because meatonin is considered safe when used over a period of days or weeks and seems to hep peope fee seepy, it has been suggested as a treatment for jet ag. But meatonin s effectiveness is controversia, and its safety when used over a proonged period is uncear. Some studies find that taking meatonin suppements before bedtime for severa days after arriva in a new time zone can make it easier to fa aseep at the proper time. Other studies find that meatonin does not hep reieve jet ag. Jet Lag What Makes You Seep?

18 12 What Does Seep Do for You? A number of aspects of your heath and quaity of ife are inked to seep, and these aspects are impaired when you are seep deprived. Your Learning, Memory, and Mood Students who have troube grasping new information or earning new skis are often advised to seep on it, and that advice seems we founded. Recent studies revea that peope can earn a task better if they are we rested. They aso can better remember what they earned if they get a good night s seep after earning the task than if they are seep deprived. Study vounteers had to seep at east 6 hours to show improvement in earning. Additionay, the amount of improvement was directy reated to how much time they sept for exampe, vounteers who sept 8 hours outperformed those who sept ony 6 or 7 hours. Other studies suggest that it s important to get enough rest the night before a mentay chaenging task, rather than ony seeping for a short period or waiting to seep unti after the task is compete. Your Guide to Heathy Seep Many we-known artists and scientists caim to have had creative insights whie they sept. Mary Sheey, for exampe, said the idea for her nove Frankenstein came to her in a dream. Athough it has not been shown that dreaming is the driving force behind innovation, one study suggests that seep is needed for creative probemsoving. In that study, vounteers were asked to perform a memory task and then were tested on it 8 hours ater. Those who were aowed to seep for 8 hours immediatey after trying the task and before being tested were much more ikey to find a creative way of simpifying the task and improving their performance, compared with those who were awake the entire 8 hours before being tested. Exacty what happens during seep to improve our earning, memory, and insight isn t known. Experts suspect, however, that whie

19 13 peope seep, they form or strengthen the pathways of brain ces needed to perform these tasks. This process may expain why seep is needed for proper brain deveopment in infants. Not ony is a good night s seep required to form new earning and memory pathways in the brain, but aso seep is necessary for those pathways to work we. Severa studies show that ack of seep causes thinking processes to sow down. Lack of seep aso makes it harder to focus and pay attention. Lack of seep can make you more easiy confused. Studies aso find that a ack of seep eads to fauty decisionmaking and more risk taking. A ack of seep sows down your reaction time, which is particuary important to driving and other tasks that require quick response. When peope who ack seep are tested on a driving simuator, they perform just as poory as peope who are drunk. (See Crash in Bed, Not on the Road on page 16.) The bottom ine is: Not getting a good night s seep can be dangerous! Even if you don t have a mentay or physicay chaenging day ahead of you, you shoud sti get enough seep to put yoursef in a good mood. Most peope report being irritabe, if not downright unhappy, when they ack seep. Peope who chronicay suffer from a ack of seep, either because they do not spend enough time in bed or because they have an untreated seep disorder, are at greater risk of deveoping depression. One group of peope who usuay don t get enough seep is mothers of newborns. Some experts think depression after chidbirth (postpartum bues) is caused, in part, by a ack of seep. Your Heart Seep gives your heart and vascuar system a much-needed rest. During non-rem seep, your heart rate and bood pressure progressivey sow as you enter deeper seep. During REM seep, in response to dreams, your heart What Does Seep Do for You?

20 14 and breathing rates can rise and fa and your bood pressure can be variabe. These changes throughout the night in bood pressure and heart and breathing rates seem to promote cardiovascuar heath. If you don t get enough seep, the nighty dip in bood pressure that appears to be important for good cardiovascuar heath may not occur. Faiure to experience the norma dip in bood pressure during seep can be reated to insufficient seep time, an untreated seep disorder (for exampe, seep apnea), or other factors. Some seepreated abnormaities may be markers of heart disease and increased risk of stroke. A ack of seep aso puts your body under stress and may trigger the reease of more adrenaine, cortiso, and other stress hormones during the day. These hormones keep your bood pressure from dipping during seep, which increases your risk for heart disease. Lack of seep aso may trigger your body to produce more of certain proteins thought to pay a roe in heart disease. For exampe, some studies find that peope who repeatedy don t get enough seep have higher than norma bood eves of C-reactive protein, a sign of infammation. High eves of this protein may indicate an increased risk for a condition caed atheroscerosis, or hardening of the arteries. Your Hormones When you were young, your mother may have tod you that you need to get enough seep to grow strong and ta. She may have been right! Deep seep (stage 3 non-rem seep) triggers more reease of growth hormone, which contributes to growth in chidren and boosts musce mass and the repair of ces and tissues in chidren and aduts. Seep s effect on the reease of sex hormones aso contributes to puberty and fertiity. Consequenty, women who work at night and tend to ack seep may be at increased risk of miscarriage. Your Guide to Heathy Seep Your mother aso probaby was right if she tod you that getting a good night s seep on a reguar basis woud hep keep you from getting sick and hep you get better if you do get sick. During seep, your body creates more cytokines ceuar hormones that hep the immune system fight various infections. Lack of seep can reduce your body s abiity to fight off common infections. Research aso reveas that a ack of seep can reduce the body s response to the fu

21 15 vaccine. For exampe, seep-deprived vounteers given the fu vaccine produced ess than haf as many fu antibodies as those who were we rested and given the same vaccine. Athough ack of exercise and other factors aso contribute, the current epidemic of diabetes and obesity seems to be reated, at east in part, to chronicay short or disrupted seep or not seeping during the night. Evidence is growing that seep is a powerfu reguator of appetite, energy use, and weight contro. During seep, the body s production of the appetite suppressor eptin increases, and the appetite stimuant grehin decreases. Studies find that the ess peope seep, the more ikey they are to be overweight or obese and prefer eating foods that are higher in caories and carbohydrates. Peope who report an average tota seep time of 5 hours a night, for exampe, are much more ikey to become obese, compared with peope who seep 7 8 hours a night. A number of hormones reeased during seep aso contro the body s use of energy. A distinct rise and fa of bood sugar eves during seep appears to be inked to seep stages. Not seeping at the right time, not getting enough seep overa, or not enough of each stage of seep disrupts this pattern. One study found that, when heathy young men sept ony 4 hours a night for 6 nights in a row, their insuin and bood sugar eves matched those seen in peope who were deveoping diabetes. Another study found that women who sept ess than 7 hours a night were more ikey to deveop diabetes over time than those who sept between 7 and 8 hours a night. What Does Seep Do for You?

22 16 Your Guide to Heathy Seep Crash in Bed Not on the Road Most peope are aware of the hazards of drunk driving. But driving whie seepy can be just as dangerous. Indeed, crashes due to seepy drivers are as deady as those due to drivers impaired by acoho. And you don t have to be aseep at the whee to put yoursef and others in danger. Both acoho and a ack of seep imit your abiity to react quicky to a suddeny braking car, a sharp curve in the road, or other situations that require rapid responses. Just a few seconds deay in reaction time can be a ife-or-death matter when driving. When peope who ack seep are tested on a driving simuator, they perform as bady as or worse than those who are drunk. The combination of acoho and ack of seep can be especiay dangerous. There is increasing evidence that seep deprivation and inexperience behind the whee, both particuary common in adoescents, is a etha combination. Of course, driving is aso hazardous if you fa aseep at the whee, which happens surprisingy often. One-quarter of the drivers surveyed in New York State reported they had faen aseep at the whee at some time. Often, peope briefy nod off at the whee without being aware of it they just can t reca what happened over the previous few seconds or onger. And peope who ack seep are more apt to take risks and make poor judgments, which aso can boost their chances of getting in a car crash. Opening a window or turning up the radio won t hep you stay awake whie driving. The bottom ine is that there is no substitute for seep. Be aware of these warning signs that you are too seepy to drive safey: troube keeping your eyes open or focused, continua yawning, or being unabe to reca driving the past few mies. Remember, if you are short on seep, stay out of the driver s seat!

23 17 Here are some potentiay ife-saving tips for avoiding drowsy driving: Be we rested before hitting the road. If you have severa nights in a row of fewer than 7 8 hours of seep, your reaction time sows. Restoring that reaction time to norma can take more than one night of good seep, because a seep debt accumuates after each night you ose seep. It may take severa nights of being we rested to repay that seep debt and make you ready for driving on a ong road trip. Avoid driving between midnight and 7 a.m. Uness you are accustomed to being awake then, this period of time is when we are naturay the east aert and most tired. Don t drive aone. A companion who can keep you engaged in conversation might hep you stay awake whie driving. Schedue frequent breaks on ong road trips. If you fee seepy whie driving, pu off the road and take a nap for minutes. Don t drink acoho. Just one beer when you are seep deprived wi affect you as much as two or three beers when you are we rested. Don t count on caffeine or other tricks. Athough drinking a coa or a cup of coffee might hep keep you awake for a short time, it won t overcome extreme seepiness or reieve a seep debt. What Does Seep Do for You?

24 18 DAPHNE I wake up eary to get ready for schoo. I am tired in the morning, and by the end of the schoo day, I am very tired again. An afterschoo nap seems to refresh me and hep me focus on homework. Without it, I am grumpy and stressed, can t focus, and sometimes get headaches. Your Guide to Heathy Seep

25 How Much Seep Is Enough? 19 Anima studies suggest that seep is as vita as food for surviva. Rats, for exampe, normay ive 2 3 years, but they ive ony 5 weeks if they are deprived of REM seep and ony 2 3 weeks if they are deprived of a seep stages a timeframe simiar to death due to starvation. But how much seep do humans need? To hep answer that question, scientists ook at how much peope seep when unrestricted, the average amount of seep among various age groups, and the amount of seep that studies revea is necessary to function at your best. When heathy aduts are given unimited opportunity to seep, they seep on average between 8 and 8.5 hours a night. But seep needs vary from person to person. Some peope appear to need ony about 7 hours to avoid probem seepiness, whereas others need 9 or more hours of seep. Seep needs aso change throughout the ife cyce. Newborns seep between 16 and 18 hours a day, and chidren in preschoo seep between 11 and 12 hours a day. Schoo-aged chidren and adoescents need at east 10 hours of seep each night. The hormona infuences of puberty tend to shift adoescents bioogica cocks. As a resut, teenagers (who need between 9 and 10 hours of seep a night) are more ikey to go to bed ater than younger chidren and aduts, and they tend to want to seep ater in the morning. This deayed seep wake rhythm conficts with the earymorning start times of many high schoos and heps expain why most teenagers get an average of ony hours of seep a night. As peope get oder, the pattern of seep aso changes especiay the amount of time spent in deep seep. This expains why chidren can seep through oud noises and why they might not wake up when moved. Across the ifespan, the seep period tends to advance, namey reative to teenagers; oder aduts tend to go to bed earier and wake earier. The quaity but not necessariy the quantity of How Much Seep Is Enough?

26 20 deep, non-rem seep aso changes, with a trend toward ighter seep. The reative percentages of stages of seep appear to stay mosty constant after infancy. From midife through ate ife, peope awaken more throughout the night. These seep disruptions cause oder peope to ose more and more of stages 1 and 2 non-rem seep as we as REM seep. Some oder peope compain of difficuty faing aseep, eary morning awakenings, frequent and ong awakenings during the night, daytime seepiness, and a ack of refreshing seep. Many seep probems, however, are not a natura part of seep in the edery. Their seep compaints may be due, in part, to medica conditions, inesses, or medications they are taking a of which can disrupt seep. In fact, one study found that the prevaence of seep probems is very ow in heathy oder aduts. Other causes of some of oder aduts seep compaints are seep apnea, restess egs syndrome, and other seep disorders that become more common with age. Aso, oder peope are more ikey to have their seep disrupted by the need to urinate during the night. Your Guide to Heathy Seep Some evidence shows that the bioogica cock shifts in oder peope, so they are more apt to go to seep earier at night and wake up earier in the morning. No evidence indicates that oder peope can get by with ess seep than younger peope. (See Top 10 Seep Myths on page 22.) Poor seep in oder peope may resut in excessive daytime seepiness, attention and memory probems, depressed mood, and overuse of seeping pis. Despite variations in seep quantity and quaity, both reated to age and

27 21 between individuas, studies suggest that the optima amount of seep needed to perform adequatey, avoid a seep debt, and not have probem seepiness during the day is about 7 8 hours for aduts and at east 10 hours for schoo-aged chidren and adoescents. Simiar amounts seem to be necessary to avoid an increased risk of deveoping obesity, diabetes, or cardiovascuar diseases. Quaity of seep and the timing of seep are as important as quantity. Peope whose seep is frequenty interrupted or cut short may not get enough of both non-rem seep and REM seep. Both types of seep appear to be crucia for earning and memory and perhaps for the restorative benefits of heathy seep, incuding the growth and repair of ces. Many peope try to make up for ost seep during the week by seeping more on the weekends. But if you have ost too much seep, seeping in on a weekend does not competey erase your seep debt. Certainy, seeping more at the end of a week won t make up for any poor performance you had earier in that week. Just one night of inadequate seep can negativey affect your functioning and mood during at east the next day. Daytime naps are another strategy some peope use to make up for ost seep during the night. Some evidence shows that short naps (up to an hour) can make up, at east partiay, for the seep missed on the previous night and improve aertness, mood, and work performance. But naps don t substitute for a good night s seep. One study found that a daytime nap after a ack of seep at night did not fuy restore eves of bood sugar to the pattern seen with adequate nighttime seep. If a nap asts onger than 20 minutes, you may have a hard time waking up fuy. In addition, ate afternoon naps can make faing aseep at night more difficut. How Much Seep Is Enough?

28 22 Top 10 Seep Myths Your Guide to Heathy Seep Myth 1: Seep is a time when your body and brain shut down for rest and reaxation. No evidence shows that any major organ (incuding the brain) or reguatory system in the body shuts down during seep. Some physioogica processes actuay become more active whie you seep. For exampe, secretion of certain hormones is boosted, and activity of the pathways in the brain inked to earning and memory increases. Myth 2: Getting just 1 hour ess seep per night than needed wi not have any effect on your daytime functioning. This ack of seep may not make you noticeaby seepy during the day. But even sighty ess seep can affect your abiity to think propery and respond quicky, and it can impair your cardiovascuar heath and energy baance as we as your body s abiity to fight infections, particuary if ack of seep continues. If you consistenty do not get enough seep, a seep debt buids up that you can never repay. This seep debt affects your heath and quaity of ife and makes you fee tired during the day. Myth 3: Your body adjusts quicky to different seep schedues. Your bioogica cock makes you most aert during the daytime and east aert at night. Thus, even if you work the night shift, you wi naturay fee seepy when nighttime comes. Most peope can reset their bioogica cock, but ony by appropriatey timed cues and even then, by 1 2 hours per day at best. Consequenty, it can take more than a week to adjust to a substantia change in your seep wake cyce for exampe, when traveing across severa time zones or switching from working the day shift to the night shift. Myth 4: Peope need ess seep as they get oder. Oder peope don t need ess seep, but they may get ess seep or find their seep ess refreshing. That s because as peope age, the quaity of their seep changes. Oder peope are aso more ikey to have insomnia or other medica conditions that disrupt their seep.

29 23 Myth 5: Extra seep for one night can cure you of probems with excessive daytime fatigue. Not ony is the quantity of seep important, but aso the quaity of seep. Some peope seep 8 or 9 hours a night but don t fee we rested when they wake up because the quaity of their seep is poor. A number of seep disorders and other medica conditions affect the quaity of seep. Seeping more won t essen the daytime seepiness these disorders or conditions cause. However, many of these disorders or conditions can be treated effectivey with changes in behavior or with medica therapies. Additionay, one night of increased seep may not correct mutipe nights of inadequate seep. Myth 6: You can make up for ost seep during the week by seeping more on the weekends. Athough this seeping pattern wi hep you fee more rested, it wi not competey make up for the ack of seep or correct your seep debt. This pattern aso wi not necessariy make up for impaired performance during the week or the physica probems that can resut from not seeping enough. Furthermore, seeping ater on the weekends can affect your bioogica cock, making it much harder to go to seep at the right time on Sunday nights and get up eary on Monday mornings. Myth 7: Naps are a waste of time. Athough naps are no substitute for a good night s seep, they can be restorative and hep counter some of the effects of not getting enough seep at night. Naps can actuay hep you earn how to do certain tasks quicker. But avoid taking naps ater than 3 p.m., particuary if you have troube faing aseep at night, as ate naps can make it harder for you to fa aseep when you go to bed. Aso, imit your naps to no onger than 20 minutes, because onger naps wi make it harder to wake up and How Much Seep Is Enough?

30 24 Top 10 Seep Myths (continued) Your Guide to Heathy Seep get back in the swing of things. If you take more than one or two panned or unpanned naps during the day, you may have a seep disorder that shoud be treated. Myth 8: Snoring is a norma part of seep. Snoring during seep is common, particuary as a person gets oder. Evidence is growing that snoring on a reguar basis can make you seepy during the day and increase your risk for diabetes and heart disease. In addition, some studies ink frequent snoring to probem behavior and poorer schoo achievement in chidren. Loud, frequent snoring aso can be a sign of seep apnea, a serious seep disorder that shoud be evauated and treated. (See Is Snoring a Probem? on page 30.) Myth 9: Chidren who don t get enough seep at night wi show signs of seepiness during the day. Unike aduts, chidren who don t get enough seep at night typicay become hyperactive, irritabe, and inattentive during the day. They aso have increased risk of injury and more behavior probems, and their growth rate may be impaired. Seep debt appears to be quite common during chidhood and may be misdiagnosed as attention-deficit hyperactivity disorder. Myth 10: The main cause of insomnia is worry. Athough worry or stress can cause a short bout of insomnia, a persistent inabiity to fa aseep or stay aseep at night can be caused by a number of other factors. Certain medications and seep disorders can keep you up at night. Other common causes of insomnia are depression, anxiety disorders, and asthma, arthritis, or other medica conditions with symptoms that tend to be troubesome at night. Some peope who have chronic insomnia aso appear to be more revved up than norma, so it is harder for them to fa aseep. Seep Myths

31 What Disrupts Seep? 25 Many factors can prevent a good night s seep. These factors range from we-known stimuants, such as coffee, to certain pain reievers, decongestants, and other cuprits. Many peope depend on the caffeine in coffee, coa, or tea to wake them up in the morning or to keep them awake. Caffeine is thought to bock the ce receptors that adenosine (a substance in the brain) uses to trigger its seepinducing signas. In this way, caffeine foos the body into thinking it isn t tired. It can take as ong as 6 8 hours for the effects of caffeine to wear off competey. Thus, drinking a cup of coffee in the ate afternoon may prevent your faing aseep at night. Nicotine is another stimuant that can keep you awake. Nicotine aso eads to ighter than norma seep, and heavy smokers tend to wake up too eary because of nicotine withdrawa. Athough acoho is a sedative that makes it easier to fa aseep, it prevents deep seep and REM seep, aowing ony the ighter stages of seep. Peope who drink acoho aso tend to wake up in the midde of the night when the effects of an acohoic nightcap wear off. Certain commony used prescription and over-the-counter medicines contain ingredients that can keep you awake. These ingredients incude decongestants and steroids. Many medicines taken to reieve headaches contain caffeine. Heart and bood pressure medications known as beta bockers can make it difficut to fa aseep and cause more awakenings during the night. Peope who have chronic asthma or bronchitis aso have more probems faing aseep and staying aseep than heathy peope, either because of their breathing difficuties or because of the medicines When medicines didn t work for me, I started making big ifestye changes. Now I try to eat a baanced diet and wak for at east an hour each day. Without doubt, my weight oss and more active ifestye hep me seep better. SZE-PING What Disrupts Seep?

32 26 they take. Other chronic painfu or uncomfortabe conditions such as arthritis, congestive heart faiure, and sicke ce anemia can disrupt seep, too. A number of psychoogica disorders incuding schizophrenia, bipoar disorder, and anxiety disorders are we known for disrupting seep. Depression often eads to insomnia, and insomnia can cause depression. Some of these psychoogica disorders are more ikey to disrupt REM seep. Psychoogica stress aso takes its to on seep, making it more difficut to fa aseep or stay aseep. Peope who fee stressed aso tend to spend ess time in deep seep and REM seep. Many peope report having difficuties seeping if, for exampe, they have recenty ost a oved one, are going through a divorce, or are under stress at work. Menstrua cyce hormones can affect how we women seep. Progesterone is known to induce seep and circuates in greater concentrations in the second haf of the menstrua cyce. For this reason, women may seep better during this phase of their menstrua cyce. On the other hand, many women report troube seeping the night before their menstrua fow starts. This seep disruption may be reated to the abrupt drop in progesterone eves that occurs just before menstruation. Women in their ate forties and eary fifties, however, report more difficuties seeping (insomnia) than younger women. These difficuties may be inked to menopause, when they have ower concentrations of progesterone. Hot fashes in women of this age aso may cause seep disruption and difficuties. Certain ifestye factors aso may deprive a person of needed seep. Large meas or vigorous exercise just before bedtime can make it harder to fa aseep. Whie vigorous exercise in the evening may deay seep onset for various reasons, exercise in the daytime is associated with improved nighttime seep. Your Guide to Heathy Seep If you aren t getting enough seep or aren t faing aseep eary enough, you may be overscheduing activities that can prevent you from getting the

33 27 quiet reaxation time you need to prepare for seep. Most peope report that it s easier to fa aseep if they have time to wind down into a ess active state before seeping. Reaxing in a hot bath or having a hot, caffeine-free beverage before bedtime may hep. In addition, your body temperature drops after a hot bath in a way that mimics, in part, what happens as you fa aseep. Probaby for both these reasons, many peope report that they fa aseep more easiy after a hot bath. Your seeping environment aso can affect your seep. Cear your bedroom of any potentia seep distractions, such as noises, bright ights, a TV, a ce phone, or computer. Having a comfortabe mattress and piow can hep promote a good night s seep. You aso seep better if the temperature in your bedroom is kept on the coo side. For more ideas on improving your seep, check out the tips for getting a good night s seep beow. Tips for Getting a Good Night s Seep Stick to a seep schedue. Go to bed and wake up at the same time each day. As creatures of habit, peope have a hard time adjusting to changes in seep patterns. Seeping ater on weekends won t fuy make up for a ack of seep during the week and wi make it harder to wake up eary on Monday morning. Exercise is great, but not too ate in the day. Try to exercise at east 30 minutes on most days but not ater than 2 3 hours before your bedtime. Avoid caffeine and nicotine. Coffee, coas, certain teas, and chocoate contain the stimuant caffeine, and its effects can take as ong as 8 hours to wear off fuy. Therefore, a cup of coffee in the ate afternoon can make it hard for you to fa aseep at night. Nicotine is aso a stimuant, often causing smokers to seep ony very ighty. In addition, smokers often wake up too eary in the morning because of nicotine withdrawa. What Disrupts Seep?

34 28 Tips for Getting a Good Night s Seep (continued) Your Guide to Heathy Seep Avoid acohoic drinks before bed. Having a nightcap or acohoic beverage before seep may hep you reax, but heavy use robs you of deep seep and REM seep, keeping you in the ighter stages of seep. Heavy acoho ingestion aso may contribute to impairment in breathing at night. You aso tend to wake up in the midde of the night when the effects of the acoho have worn off. Avoid arge meas and beverages ate at night. A ight snack is okay, but a arge mea can cause indigestion that interferes with seep. Drinking too many fuids at night can cause frequent awakenings to urinate. If possibe, avoid medicines that deay or disrupt your seep. Some commony prescribed heart, bood pressure, or asthma medications, as we as some over-the-counter and herba remedies for coughs, cods, or aergies, can disrupt seep patterns. If you have troube seeping, tak to your doctor or pharmacist to see whether any drugs you re taking might be contributing to your insomnia and ask whether they can be taken at other times during the day or eary in the evening. Don t take naps after 3 p.m. Naps can hep make up for ost seep, but ate afternoon naps can make it harder to fa aseep at night. Reax before bed. Don t overschedue your day so that no time is eft for unwinding. A reaxing activity, such as reading or istening to music, shoud be part of your bedtime ritua. Take a hot bath before bed. The drop in body temperature after getting out of the bath may hep you fee seepy, and the bath can hep you reax and sow down so you re more ready to seep. Have a good seeping environment. Get rid of anything in your bedroom that might distract you from seep, such as noises, bright ights, an uncomfortabe bed, or warm temperatures. You seep better if the temperature in the room

35 29 is kept on the coo side. A TV, ce phone, or computer in the bedroom can be a distraction and deprive you of needed seep. Having a comfortabe mattress and piow can hep promote a good night s seep. Individuas who have insomnia often watch the cock. Turn the cock s face out of view so you don t worry about the time whie trying to fa aseep. Have the right sunight exposure. Dayight is key to reguating daiy seep patterns. Try to get outside in natura sunight for at east 30 minutes each day. If possibe, wake up with the sun or use very bright ights in the morning. Seep experts recommend that, if you have probems faing aseep, you shoud get an hour of exposure to morning sunight and turn down the ights before bedtime. Don t ie in bed awake. If you find yoursef sti awake after staying in bed for more than 20 minutes or if you are starting to fee anxious or worried, get up and do some reaxing activity unti you fee seepy. The anxiety of not being abe to seep can make it harder to fa aseep. See a doctor if you continue to have troube seeping. If you consistenty find it difficut to fa or stay aseep and/ or fee tired or not we rested during the day despite spending enough time in bed at night, you may have a seep disorder. Your famiy doctor or a seep speciaist shoud be abe to hep you, and it is important to rue out other heath or psychiatric probems that may be disturbing your seep. What Disrupts Seep?

36 30 Is Snoring a Probem? Long the materia for jokes, snoring is generay accepted as common and annoying in aduts but as nothing to worry about. However, snoring is no aughing matter. Frequent, oud snoring is often a sign of seep apnea and may increase your risk of deveoping cardiovascuar disease and diabetes. Snoring aso may ead to daytime seepiness and impaired performance. Snoring is caused by a narrowing or partia bockage of the airways at the back of your mouth, throat, or nose. This obstruction resuts in increased air turbuence when breathing in, causing the soft tissues in your upper airways to vibrate. The end resut is a noisy snore that can disrupt the seep of your bed partner. This narrowing of the airways is typicay caused by the soft paate, tongue, and throat reaxing whie you seep, but aergies or sinus probems aso can contribute to a narrowing of the airways, as can being overweight and having extra soft tissue around your upper airways. Your Guide to Heathy Seep The arger the tissues in your soft paate (the roof of your mouth in the back of your throat), the more ikey you are to snore whie seeping. Acoho or sedatives taken shorty before seep aso promote snoring. These drugs cause greater reaxation of the tissues in your throat and mouth. Surveys revea that about one-haf of a aduts snore, and 50 percent of these aduts do so oudy and frequenty. African Americans, Asians, and Hispanics are more ikey to snore oudy and frequenty compared with Caucasians, and snoring probems increase with age. Not everyone who snores has seep apnea, but peope who have seep apnea typicay do snore oudy and frequenty. Seep apnea is a JIM My wife noticed that I snored oudy and sometimes stopped breathing in the midde of the night. She was the one who finay pushed me to see a doctor.

37 31 serious seep disorder, and its hamark is oud, frequent snoring with pauses in breathing or shaow breaths whie seeping. (See Seep Apnea on page 38.) Even if you don t experience these breathing pauses, snoring can sti be a probem for you as we as for your bed partner. Snoring adds extra effort to your breathing, which can reduce the quaity of your seep and ead to many of the same heath consequences as seep apnea. One study found that oder aduts who did not have seep apnea, but who snored 6 7 nights a week, were more than twice as ikey to report being extremey seepy during the day than those who never snored. The more peope snored, the more daytime fatigue they reported. That seepiness may hep expain why snorers are more ikey to be in car crashes than peope who don t snore. Loud snoring aso can disrupt the seep of bed partners and strain marita reations, especiay if snoring causes the spouses to seep in separate bedrooms. In addition, snoring increases the risk of deveoping diabetes and heart disease. One study found that women who snored reguary were twice as ikey as those who did not snore to deveop diabetes, even if they were not overweight (another risk factor for diabetes). Other studies suggest that reguar snoring may raise the ifetime risk of deveoping high bood pressure, heart faiure, and stroke. About one-third of a pregnant women begin snoring for the first time during their second trimester. If you are snoring whie pregnant, et your doctor know. Snoring in pregnancy can be associated with high bood pressure and can have a negative effect on your baby s growth and deveopment. Your doctor wi keep a cose eye on your bood pressure throughout your pregnancy and can et you know if any additiona evauations for the snoring might be usefu. In most cases, the snoring and any reated high bood pressure wi go away shorty after deivery. Snoring aso can be a probem in chidren. As many as percent of young chidren, who typicay have enarged adenoids and tonsis (both tissues in the throat), snore on a reguar basis. Severa studies show that chidren who snore (with or without seep apnea) are more ikey than those who do not snore to score ower on tests that measure inteigence, memory, and attention span. These chidren aso have more probematic behavior, incuding hyperactivity. The end resut is that chidren who snore don t perform in Is Snoring a Probem?

38 32 schoo as we as those who do not snore. Strikingy, snoring was inked to a greater drop in IQ than that seen in chidren who had eevated eves of ead in their bood. Athough the behavior of chidren improves after they stop snoring, studies suggest they may continue to get poorer grades in schoo, perhaps because of asting effects on the brain inked to the snoring. You shoud have your chid evauated by your doctor if the chid snores oudy and frequenty three to four times a week especiay if you note brief pauses in breathing whie aseep and if there are signs of hyperactivity or daytime seepiness, inadequate schoo achievement, or sower than expected deveopment. Surgery to remove the adenoids and tonsis of chidren often can cure their snoring and any associated seep apnea. Such surgery has been inked to a reduction in hyperactivity and improved abiity to pay attention, even in chidren who showed no signs of seep apnea before surgery. Snoring in oder chidren and aduts may be reieved by ess invasive measures, however. These measures incude osing weight, refraining from use of tobacco, seeping on the side rather than on the back, or eevating the head whie seeping. Treating chronic congestion and refraining from acoho or sedatives before seeping aso may decrease snoring. In some aduts, snoring can be reieved by denta appiances that reposition the soft tissues in the mouth. Athough numerous over-the-counter nasa strips and sprays caim to reieve snoring, no scientific evidence supports those caims. Your Guide to Heathy Seep

39 33 Common Seep Disorders A number of seep disorders can disrupt your seep quaity and make you overy seepy during the day, even if you spent enough time in bed to be we rested. (See Common Signs of a Seep Disorder on page 34.) More than 70 seep disorders affect at east 40 miion Americans and account for an estimated $16 biion in medica costs each year, not counting costs due to ost work time, car accidents, and other factors. The four most common seep disorders are insomnia, seep apnea, restess egs syndrome, and narcoepsy. Additiona seep probems incude chronic insufficient seep, circadian rhythm abnormaities, and parasomnias such as seep waking, seep paraysis, and night terrors. LAUREN My restess egs syndrome made me ose seep and affected my quaity of ife. But I m in a good pace right now. I m taking the right medicine for me, and I ve adopted a heathy, active ifestye. I am very passionate about taking contro of my heath. Common Seep Disorders

40 34 Common Signs of a Seep disorder Look over this ist of common signs of a seep disorder, and tak to your doctor if you have any of them on three or more nights a week: Your Guide to Heathy Seep It takes you more than 30 minutes to fa aseep at night. You awaken frequenty in the night and then have troube faing back to seep again. You awaken too eary in the morning. You often don t fee we rested despite spending 7 8 hours or more aseep at night. You fee seepy during the day and fa aseep within 5 minutes if you have an opportunity to nap, or you fa aseep unexpectedy or at inappropriate times during the day. Your bed partner caims you snore oudy, snort, gasp, or make choking sounds whie you seep, or your partner notices that your breathing stops for short periods. You have creeping, tinging, or crawing feeings in your egs that are reieved by moving or massaging them, especiay in the evening and when you try to fa aseep. You have vivid, dreamike experiences whie faing aseep or dozing. You have episodes of sudden musce weakness when you are angry or fearfu, or when you augh. You fee as though you cannot move when you first wake up. Your bed partner notes that your egs or arms jerk often during seep. You reguary need to use stimuants to stay awake during the day. Aso keep in mind that, athough chidren can show some of these signs of a seep disorder, they often do not show signs of excessive daytime seepiness. Instead, they may seem overactive and have difficuty focusing and concentrating. They aso may not do their best in schoo.

41 35 Insomnia Insomnia is defined as having troube faing aseep or staying aseep, or as having unrefreshing seep despite having ampe opportunity to seep. Life is fied with events that occasionay cause insomnia for a short time. Such temporary insomnia is common and is often brought on by situations such as stress at work, famiy pressures, or a traumatic event. A Nationa Seep Foundation po of aduts in the United States found that cose to haf of the respondents reported temporary insomnia in the nights immediatey after the terrorist attacks on September 11, Chronic insomnia is defined as having symptoms at east 3 nights per week for more than 1 month. Most cases of chronic insomnia are secondary, which means they are due to another disorder or medications. Primary chronic insomnia is a distinct seep disorder; its cause is not yet we understood. About percent of aduts say they have some symptoms of insomnia within any given year, and about percent of aduts say they have chronic insomnia. Chronic insomnia becomes more common with age, and women are more ikey than men to report having insomnia. Insomnia often causes probems during the day, such as extreme seepiness, fatigue, a ack of energy, difficuty concentrating, depressed mood, and irritabiity. Thus, untreated insomnia can impair quaity of ife as much as, or more than, other chronic medica probems. Chronic insomnia is often caused by one or more of the foowing: n n A disease or mood disorder. The most common causes of insomnia are depression and/or anxiety disorders. Neuroogica disorders, such as Azheimer s or Parkinson s disease, aso can have insomnia as a symptom. Chronic insomnia can resut from thyroid dysfunction, arthritis, asthma, or other medica conditions in which symptoms become more troubesome at night, making it difficut to fa aseep or stay aseep. Various prescribed and over-the-counter medications that can disrupt seep, such as decongestants, certain pain reievers, and steroids. Common Seep Disorders

42 36 n n Seep-disrupting behavior such as drinking acoho, exercising shorty before bedtime, ingesting caffeine ate in the day, watching TV or reading whie in bed, or irreguar seep schedues due to shift work or other causes. Another seep disorder, such as seep apnea or restess egs syndrome. Some peope, however, have primary chronic insomnia. This condition is inked to a tendency to be more revved up than norma (hyperarousa). Peope who have primary chronic insomnia may have heightened eves of certain hormones, higher body temperatures, faster heart rates, and a different pattern of brain waves whie they seep. Doctors diagnose insomnia based mainy on seep history, often by reviewing a seep diary. An overnight seep recording may be required if another seep disorder is suspected. Doctors aso wi try to diagnose and treat any other underying medica or psychoogica probems as we as identify behaviors that might be causing the insomnia. Often, peope who have insomnia enter into a vicious cyce because they ve had troube seeping on previous nights, they become anxious at the sightest sign that they may not be faing aseep right away. That anxiety can make it more difficut for them to fa aseep. The more time they spend in bed not seeping, and watching the cock, the more their anxiety and seepessness increases. To break that cyce of anxiety and negative conditioning, experts recommend going to bed ony when you re seepy. If you can t fa aseep (or fa back to seep) within 20 minutes, get out of bed, go into another room, and do a reaxing activity (such as reading) unti you fee seepy again. Then return to bed. Studies have shown that this reconditioning therapy is an effective way to treat insomnia. Your Guide to Heathy Seep Reaxation therapy is another strategy that works for some peope who have insomnia. Reaxation therapy may incude meditation and other menta reaxation techniques. It aso may incude physica reaxation techniques, such as progressivey tensing and then reaxing each of the musce groups in your body before seep. Another method is to focus on breathing deepy. Reaxation therapy can hep your body and mind sow down so that you can fa aseep more easiy at bedtime.

43 37 Seep restriction therapy aso works for some peope who have insomnia. Cacuate your average seep time over the course of a week, and then imit your nighty seep time to that average. Graduay add more seep time each night unti you achieve a more norma night s seep. You shoud avoid daytime naps onger than minutes during seep restriction therapy. Napping can make it harder to fa aseep at night, which may proong insomnia. In addition, during seep restriction therapy, avoid driving a car or operating dangerous machinery unti you are getting enough seep at night. A of these behaviora changes are part of a treatment caed cognitive behaviora therapy. Cognitive behaviora therapy aso can be used to repace negative thoughts about seep, such as I never fa aseep without seeping pis, with more reaistic positive thinking. Cognitive behaviora therapy is effective in most peope who have chronic insomnia. Some peope who have chronic insomnia that is not corrected by behaviora therapy or treatment of an underying condition may need a prescription medication. You shoud tak to a doctor before trying to treat insomnia with acoho, over-the-counter or prescribed short-acting sedatives, or sedating antihistamines that induce drowsiness. The benefits of these treatments are imited, and they have risks. Some may hep you fa aseep but eave you feeing unrefreshed in the morning. Others have onger asting effects and eave you feeing sti tired and groggy in the morning. Some aso may ose their effectiveness over time. Doctors may prescribe sedating antidepressants for insomnia, but the effectiveness of these medicines in peope who do not have depression is not known, and there are significant side effects. Common Seep Disorders

44 38 To treat their insomnia, some peope pursue natura remedies, such as meatonin suppements or vaerian teas or extracts. These remedies are avaiabe over the counter. Litte evidence exists that meatonin can hep reieve insomnia. Studies with vaerian aso have been inconcusive, and the actua dose and purity of various suppements, extracts, or teas that contain vaerian may vary from product to product. In addition, because meatonin, vaerian, and other natura remedies are not reguated by the Food and Drug Administration, their safety is not monitored. Seep Apnea In peope who have seep apnea (aso referred to as seep-disordered breathing), breathing briefy stops or becomes very shaow during seep. This change is caused by intermittent bocking of the upper airway, usuay when the soft tissue in the rear of the throat coapses and partiay or competey coses the airway. Each pause in breathing typicay asts seconds and may occur times or more each seeping hour. If you have seep apnea, not enough air can fow into your ungs through your mouth and nose during seep, even though breathing efforts continue. When this happens, the amount of oxygen in your bood decreases. Your brain responds by awakening you enough to tighten the upper airway musces and open your windpipe. Norma breaths then start again, often with a oud snort or choking sound. Athough peope who have seep apnea typicay snore oudy and frequenty, not everyone who snores has seep apnea. (See Is Snoring a Probem? on page 30.) Because peope who have seep apnea frequenty go from deeper seep to ighter seep during the night, they rarey spend enough time in deep, restorative stages of seep. They are therefore often excessivey seepy during the day. Such seepiness is thought to ead to mood and behavior probems, incuding depression, and it more than tripes the risk of being in a traffic or work-reated accident. Your Guide to Heathy Seep The many brief drops in bood-oxygen eves that occur during the night can resut in morning headaches and troube concentrating, thinking ceary, earning, and remembering. Additionay, the intermittent oxygen drops and reduced seep quaity together trigger the reease of stress hormones. These hormones raise your bood pressure and heart rate and boost the risk of heart attack, stroke, irreguar heartbeats, and congestive heart faiure. In addition,

45 39 JIM I reaize now that my seep apnea affected my quaity of ife. I fet tired a the time so tired that I coudn t exercise or spend time with my kids. I had other seep apnea symptoms that affected my work headaches, confusion, making errors, etc. Looking back, I know that I shoud have taken it more seriousy and tod my doctor about my symptoms many years before I did. One thing that heps me is physica activity. Now that I am feeing better, I come home from work with enough energy to have an exercise routine. Common Seep Disorders

46 40 untreated seep apnea can ead to changes in energy metaboism (the way your body changes food and oxygen into energy) that increase the risk for deveoping obesity and diabetes. Anyone can have seep apnea. It is estimated that at east miion American aduts have seep apnea, making it as common as asthma. More than one-haf of the peope who have seep apnea are overweight. Seep apnea is more common in men. More than 1 in 25 midde-aged men and 1 in 50 midde-aged women have seep apnea aong with extreme daytime seepiness. About 3 percent of chidren and 10 percent or more of peope over age 65 have seep apnea. This condition occurs more frequenty in African Americans, Asians, Native Americans, and Hispanics than in Caucasians. More than one-haf of a peope who have seep apnea are not diagnosed. Peope who have seep apnea generay are not aware that their breathing stops in the night. They just notice that they don t fee we rested when they wake up and are seepy throughout the day. Their bed partners are ikey to notice, however, that they snore oudy and frequenty and that they often stop breathing briefy whie seeping. Doctors suspect seep apnea if these symptoms are present, but the diagnosis must be confirmed with overnight seep monitoring. (See How Are Seep Disorders Diagnosed? on page 44.) This monitoring wi revea pauses in breathing, frequent seep arousas (changes from seep to wakefuness), and intermittent drops in eves of oxygen in the bood. Your Guide to Heathy Seep

47 41 Like aduts who have seep apnea, chidren who have this disorder usuay snore oudy, snort or gasp, and have brief pauses in breathing whie seeping. Sma chidren often have enarged tonsis and adenoids that increase their risk for seep apnea. But doctors may not suspect seep apnea in chidren because, instead of showing the typica signs of seepiness during the day, these chidren often become agitated and may be considered hyperactive. The effects of seep apnea in chidren may incude poor schoo performance and difficut, aggressive behavior. A number of factors can make a person susceptibe to seep apnea. These factors incude: n n n n n n Throat musces and tongue that reax more than norma whie aseep Enarged tonsis and adenoids Being overweight the excess fat tissue around your neck makes it harder to keep the throat area open Head and neck shape that creates a somewhat smaer airway size in the mouth and throat area Congestion, due to aergies, that aso can narrow the airway Famiy history of seep apnea If your doctor suspects that you have seep apnea, you may be referred to a seep speciaist. Some of the ways to hep diagnose seep apnea incude: n n n n A medica history that incudes asking you and your famiy questions about how you seep and how you function during the day. Checking your mouth, nose, and throat for extra or arge tissues for exampe, checking the tonsis, uvua (the tissue that hangs from the midde of the back of the mouth), and soft paate (the roof of your mouth in the back of your throat). An overnight recording of what happens with your breathing during seep (poysomnogram, or PSG). A mutipe seep atency test (MSLT), usuay done in a seep center, to see how quicky you fa aseep at times when you woud normay be awake. (Faing aseep in ony a few minutes usuay means that you are very seepy during the day. Being very seepy during the day can be a sign of seep apnea.) Common Seep Disorders

48 42 Once a the tests are competed, the seep speciaist wi review the resuts and work with you and your famiy to deveop a treatment pan. Changes in daiy activities or habits may hep reduce your symptoms: n n n Seep on your side instead of on your back. Seeping on your side wi hep reduce the amount of upper airway coapse during seep. Avoid acoho, smoking, seeping pis, herba suppements, and any other medications that make you seepy. They make it harder for your airways to stay open whie you seep, and sedatives can make the breathing pauses onger and more severe. Tobacco smoke irritates the airways and can hep trigger the intermittent coapse of the upper airway. Lose weight if you are overweight. Even a itte weight oss can sometimes improve symptoms. These changes may be a that are needed to treat mid seep apnea. However, if you have moderate or severe seep apnea, you wi need additiona, more direct treatment approaches. Continuous positive airway pressure (CPAP) is the most effective treatment for seep apnea in aduts. A CPAP machine uses mid air pressure to keep your airways open whie you seep. The machine deivers air to your airways through a speciay designed nasa mask. The mask does not breathe for you; the fow of air creates increased pressure to keep the airways in your nose and mouth more open whie you seep. The air pressure is adjusted so that it is just enough to stop your airways from briefy becoming too sma during seep. The pressure is constant and continuous. Seep apnea wi return if CPAP is stopped or if it is used incorrecty. Your Guide to Heathy Seep Peope who have severe seep apnea symptoms generay fee much better once they begin treatment with CPAP. CPAP treatment can cause side effects in some peope. Possibe side effects incude dry or stuffy nose, irritation of the skin on the face, boating of the stomach, sore eyes, or headaches. If you have troube with CPAP side effects, work with your seep speciaist and support staff. Together, you can do things to reduce or eiminate these probems. Currenty, no medications cure seep apnea. However, some prescription medications may hep reieve the excessive seepiness that sometimes persists even with CPAP treatment of seep apnea.

49 43 JIM My doctor prescribed CPAP (continuous positive airway pressure) for me, but it was not easy to use at first. Seeping with a CPAP machine was uncomfortabe for me, so I didn t use it ike I shoud have rarey, if at a. One day at work, I started feeing reay bad, so I went to the hospita. The doctors tod me that since I had not been using CPAP reguary, not enough oxygen was going to my brain, which caused symptoms ike those for a stroke. So, I went back to my doctor and got a different CPAP machine that was more comfortabe for me. It s important to tak with your heath care provider to make sure that your treatment is comfortabe and works for you. Another treatment approach that may hep some peope is the use of a mouthpiece (ora or denta appiance). If you have mid seep apnea or do not have seep apnea but snore very oudy, your doctor or dentist aso may recommend this. A custom-fitted pastic mouthpiece wi be made by a dentist or an orthodontist (a speciaist in correcting teeth or jaw probems). The mouthpiece wi adjust your ower jaw and tongue to hep keep the airway in your throat more open whie you are seeping. Air can then fow more easiy into your ungs because there is ess resistance to breathing. Foowing up with the dentist or orthodontist is important to correct any side effects and to be sure that your mouthpiece continues to fit propery. It is aso important to have a foowup seep study to see whether your seep apnea has improved. Some peope who have seep apnea may benefit from surgery; this depends on the findings of the evauation by the seep speciaist. Removing tonsis and adenoids that are bocking the airway is done frequenty, especiay in chidren. Uvuopaatopharyngopasty (UPPP) is a surgery for aduts that removes the tonsis, uvua, and part of the soft paate. Tracheostomy is a surgery used rarey and ony in severe seep apnea when no other treatments have been successfu. A sma hoe is made in the windpipe, and a tube is inserted. Air wi fow through the tube and into the ungs, bypassing the obstruction in the upper airway. Common Seep Disorders

50 44 How Are Seep disorders diagnosed? Depending on your symptoms, your doctor wi gather information and consider severa possibe tests when trying to diagnose a seep disorder: Your Guide to Heathy Seep Seep history and seep og. Your doctor wi ask you how many hours you seep each night, how often you awaken during the night and for how ong, how ong it takes you to fa aseep, how we rested you fee upon awakening, and how seepy you fee during the day. Your doctor may ask you to keep a seep diary for a few weeks. (See Sampe Seep Diary on page 54.) Your doctor aso may ask you whether you have any symptoms of seep apnea or restess egs syndrome, such as oud snoring, snorting or gasping, morning headaches, tinging or unpeasant sensations in the imbs that are reieved by moving them, and jerking of the imbs during seep. Your seeping partner may be asked whether you have some of these symptoms, as you may not be aware of them yoursef. Seep recording in a seep aboratory (poysomnogram). A seep recording or poysomnogram (PSG) is usuay done whie you stay overnight at a seep center or seep aboratory. Eectrodes and other monitors are paced on your scap, face, chest, imbs, and finger. Whie you seep, these devices measure your brain activity, eye movements, musce activity, heart rate and rhythm, bood pressure, and how much air moves in and out of your ungs. This test aso checks the amount of oxygen in your bood. A PSG test is painess. In certain circumstances, the PSG can be done at home. A home monitor can be used to record heart rate, how air moves in and out of your ungs, the amount of oxygen in your bood, and your breathing effort. Mutipe seep atency test (MSLT). This daytime seep study measures how seepy you are and is particuary usefu for diagnosing narcoepsy. The MSLT is conducted in a seep

51 45 aboratory and typicay done after an overnight seep recording (PSG). In this test, monitoring devices for seep stage are paced on your scap and face. You are asked to nap four or five times for 20 minutes every 2 hours during the day. Technicians note how quicky you fa aseep and how ong it takes you to reach various stages of seep, especiay REM seep, during your naps. Norma individuas either do not fa aseep during these short designated naptimes or take a ong time to fa aseep. Peope who fa aseep in ess than 5 minutes are ikey to require treatment for a seep disorder, as are those who quicky reach REM seep during their naps. It is important to have a seep speciaist interpret the resuts of your PSG or MSLT. See How To Find a Seep Center and Seep Speciaist on page 56. Common Seep Disorders

52 46 LAUREN I started to get weird feeings in my egs at night whie I sept. To fee better, I woud get up and move around and stretch. Then the weird feeings began to happen more often and made me ose seep. I started to think that something was wrong. I decided to go to the doctor and was diagnosed with restess egs syndrome (RLS). Because RLS symptoms can change, I m aways trying to find the right mix of diet, medication, and exercise. Exercise and massage hep me manage my RLS. Yoga heps a ot too, because of a the stretching invoved. Your Guide to Heathy Seep

53 47 Restess Legs Syndrome Restess egs syndrome (RLS) causes an unpeasant pricking or tinging in the egs, especiay in the caves, that is reieved by moving or massaging them. Peope who have RLS fee a need to stretch or move their egs to get rid of the uncomfortabe or painfu feeings. As a resut, it may be difficut to fa aseep and stay aseep. One or both egs may be affected. Some peope aso fee the sensations in their arms. These sensations aso can occur when ying down or sitting for ong periods of time, such as whie at a desk, riding in a car, or watching a movie. Many peope who have RLS aso have brief imb movements during seep, often with abrupt onset, occurring every 5 90 seconds. This condition, known as periodic imb movements in seep (PLMS), can repeatedy awaken peope who have RLS, reducing their tota seep time and interrupting their seep. Some peope have PLMS but have no abnorma sensations in their egs whie awake. RLS affects 5 15 percent of Americans, and its prevaence increases with age. RLS occurs more often in women than men. One study found that RLS accounted for one-third of the insomnia seen in patients oder than age 60. Chidren aso can have RLS. In chidren, the condition may be associated with symptoms of attention-deficit hyperactivity disorder. However, it s not fuy known how the disorders are reated. Sometimes growing pains can be mistaken for RLS. RLS is often inherited. Pregnancy, kidney faiure, and anemia reated to iron or vitamin deficiency can trigger or worsen RLS symptoms. Researchers suspect that these conditions cause an iron deficiency that resuts in a ack of dopamine, which is used by the brain to contro physica sensation and imb movements. Doctors usuay can diagnose RLS by patients symptoms and a tetae worsening of symptoms at night or whie at rest. Some doctors may order a bood test to check ferretin eves (ferretin is a form of iron). Doctors aso may ask peope who have RLS to spend a night in a seep aboratory, where they are monitored to rue out other seep disorders and to document the excessive imb movements. RLS is treatabe but not aways curabe. Dramatic improvements are seen quicky when patients are given dopamine-ike drugs or iron suppements. Aternativey, peope who have mider cases may be treated successfuy with sedatives or behaviora strategies. These Common Seep Disorders

54 48 strategies incude stretching, taking a hot bath, or massaging the egs before bedtime. Avoiding caffeinated beverages aso can hep reduce symptoms, and certain medications (e.g., some antidepressants, particuary seective serotonin reuptake inhibitors) may cause RLS. If iron or vitamin deficiency underies RLS, symptoms may improve with prescribed iron, vitamin B12, or foate suppements. Some peope may require anticonvusant medications to contro the creeping and crawing sensations in their imbs. Others who have severe symptoms that are associated with another medica disorder or that do not respond to norma treatments may need to be treated with pain reievers. Narcoepsy Narcoepsy s main symptom is extreme and overwheming daytime seepiness, even after adequate nighttime seep. In addition, nighttime seep may be fragmented by frequent awakenings. Peope who have narcoepsy often fa aseep at inappropriate times and paces. Athough TV sitcoms occasionay feature these individuas to generate a few aughs, narcoepsy is no aughing matter. Peope who have narcoepsy experience daytime seep attacks that ast from seconds to more than one-haf hour, can occur without warning, and may cause injury. These embarrassing seep spes aso can make it difficut to work and to maintain norma persona or socia reationships. With narcoepsy, the usuay sharp distinctions between being aseep and awake are burred. Aso, peope who have narcoepsy tend to fa directy into dream-fied REM seep, rather than enter REM seep graduay after passing through the non-rem seep stages first. Your Guide to Heathy Seep In addition to overwheming daytime seepiness, narcoepsy has three other commony associated symptoms, but these may not occur in a peope: n Sudden musce weakness (catapexy). This weakness is simiar to the paraysis that normay occurs during REM seep, but it asts a few seconds to minutes whie an individua is awake. Catapexy tends to be triggered by sudden emotiona reactions, such as anger, surprise, fear, or aughter. The weakness may show up as impness at the neck, bucking of the knees, or sagging facia musces affecting speech, or it may cause a compete body coapse.

55 49 SZE-PING At first, I was misdiagnosed with chronic fatigue syndrome, because I was in my forties and narcoepsy symptoms usuay start during the teen years. Because I didn t have any of the symptoms of chronic fatigue syndrome other than seepiness, I went to a neuroogist for hep. He noticed the catapexy (musce weakness) right away, and then I was officiay diagnosed with narcoepsy and then ater on with borderine seep apnea. Even though there is no cure for narcoepsy, you can fee ike you have contro if you manage it we. When you have narcoepsy, you ive your ife differenty. But with a good pan and supportive friends and famiy, it a turns out OK. Common Seep Disorders

56 50 n n Seep paraysis. Peope who have narcoepsy may experience a temporary inabiity to tak or move when faing aseep or waking up, as if they were gued to their beds. Vivid dreams. These dreams can occur when peope who have narcoepsy first fa aseep or wake up. The dreams are so ifeike that they can be confused with reaity. Experts estimate that as many as 350,000 Americans have narcoepsy, but fewer than 50,000 are diagnosed. The disorder may be as widespread as Parkinson s disease or mutipe scerosis, and more prevaent than cystic fibrosis, but it is ess we known. Narcoepsy is often mistaken for depression, epiepsy, or the side effects of medicines. Narcoepsy can be difficut to diagnose in peope who have ony the symptom of excessive daytime seepiness. It is usuay diagnosed during an overnight seep recording (PSG) that is foowed by an MSLT. (See How Are Seep Disorders Diagnosed? on page 44.) Both tests revea symptoms of narcoepsy the tendency to fa aseep rapidy and enter REM seep eary, even during brief naps. Your Guide to Heathy Seep Narcoepsy can deveop at any age, but the symptoms tend to appear first during adoescence or eary aduthood. About 1 of every 10 peope who have narcoepsy has a cose famiy member who has the disorder, suggesting that one can inherit a tendency to deveop narcoepsy. Studies suggest that a substance in the brain caed hypocretin pays a key roe in narcoepsy. Most peope who have narcoepsy ack hypocretin, which promotes wakefuness. Scientists beieve that an autoimmune reaction perhaps triggered by disease, vira iness, or brain injury specificay destroys the hypocretin-generating ces in the brains of peope who have narcoepsy.

57 51 Eventuay, researchers may deveop a treatment for narcoepsy that restores hypocretin to norma eves. In the meantime, most peope who have narcoepsy find some to a of their symptoms reieved by various drug treatments. For exampe, centra nervous system stimuants can reduce daytime seepiness. Antidepressants and other drugs that suppress REM seep can prevent musce weakness, seep paraysis, and vivid dreaming. Doctors aso usuay recommend that peope who have narcoepsy take short naps (10 15 minutes) two or three times a day, if possibe, to hep contro excessive daytime seepiness. Parasomnias (Abnorma Arousas) In some peope, the waking, taking, and other body functions normay suppressed during seep occur during certain seep stages. Aternativey, the paraysis or vivid images usuay experienced during dreaming may persist after awakening. These occurrences are coectivey known as parasomnias and incude confusiona arousas (a mixed state of being both aseep and awake), seep taking, seep waking, night terrors, seep paraysis, and REM seep behavior disorder (acting out dreams). Most of these disorders such as confusiona arousas, seep waking, and night terrors are more common in chidren, who tend to outgrow them once they become aduts. Peope who are seep-deprived aso may experience some of these disorders, incuding seep waking and seep paraysis. Seep paraysis aso commony occurs in peope who have narcoepsy. Certain medications or neuroogica disorders appear to ead to other parasomnias, such as REM seep behavior disorder, and these parasomnias tend to occur more in edery peope. If you or a famiy member has persistent episodes of seep paraysis, seep waking, or acting out of dreams, tak with your doctor. Taking measures to assure the safety of chidren and other famiy members who have partia arousas from seep is very important. Common Seep Disorders

58 52 LAWRENCE It s a scary experience, ying in bed, wanting to get up, but unabe to scary enough to amost make you not want to go to seep anymore. I can remember, as a chid, feeing as though there was a weight on me when I was trying to wake up, and I coudn t move. When I woud try to wake up, I woud kick my egs and fai my arms, sometimes bumping my wife. I reay didn t have contro over my imbs. When the symptoms got reay bad, I went to a seep speciaist, who tod me I had seep paraysis. My doctor prescribed a medicine that has worked great for me. Now, I rarey have seep paraysis maybe 3 times per year. Your Guide to Heathy Seep

59 53 Do You Think You Have a Seep Disorder? At various points in our ives, a of us suffer from a ack of seep that can be corrected by making sure we have the opportunity to get enough seep. But, if you are spending enough time in bed and sti wake up tired or fee very seepy during the day, you may have a seep disorder. See Common Signs of a Seep Disorder on page 34. One of the best ways you can te whether you are getting enough good-quaity seep, and whether you have signs of a seep disorder, is by keeping a seep diary. (See Sampe Seep Diary on page 54.) Use this diary to record the quaity and quantity of your seep; your use of medications, acoho, and caffeinated beverages; your exercise patterns; and how seepy you fee during the day. After a week or so, ook over this information to see how many hours of seep or nighttime awakenings one night are inked to your being tired the next day. This information wi give you a sense of how much uninterrupted seep you need to avoid daytime seepiness. You aso can use the diary to see some of the patterns or practices that may keep you from getting a good night s seep. You may have a seep disorder and shoud see your doctor if your seep diary reveas any of the foowing: n n n n You consistenty take more than 30 minutes each night to fa aseep. You consistenty awaken more than a few times or for ong periods of time each night. You take frequent naps. You often fee seepy during the day or you fa aseep at inappropriate times during the day. Do You Think You Have a Seep Disorder?

60 54 Sampe Seep Diary Name: Today s date (incude month/day/year): Monday* Compete in the Morning Time I went to bed ast night: Time I woke up this morning: No. of hours sept ast night: Number of awakenings and tota time awake ast night: How ong I took to fa aseep ast night: Medications taken ast night: How awake did I fee when I got up this morning? 1 Wide awake 2 Awake but a itte tired 3 Seepy 11 p.m. 7 a.m. 8 5 times 2 hours 30 mins. None 2 Number of caffeinated drinks (coffee, tea, coa) and time when I had them today: 1 drink at 8 p.m. Your Guide to Heathy Seep Compete in the Evening Number of acohoic drinks (beer, wine, iquor) and time when I had them today: Naptimes and engths today: Exercise times and engths today: How seepy did I fee during the day today? 1 So seepy had to strugge to stay awake during much of the day 2 Somewhat tired 3 Fairy aert 4 Wide awake 2 drinks 9 p.m. 3:30 p.m. 45 mins. None 1 * This coumn shows exampe diary entries use as a mode for your own diary notes.

61 55 Do You Think You Have a Seep Disorder?

62 56 How To Find a Seep Center and Seep Speciaist If your doctor refers you to a seep center or seep speciaist, make sure that center or speciaist is quaified to diagnose and treat your seep probem. To find seep centers accredited by the American Academy of Seep Medicine, go to and cick on Find a Seep Center (under the Patients & Pubic menu), or ca To find seep speciaists certified by the American Board of Seep Medicine, go to and cick on Verification of Dipomates of the ABSM. Your Guide to Heathy Seep

63 57 Research Researchers have earned a ot about seep and seep disorders in recent years. That knowedge has ed to a better understanding of the importance of seep to our ives and our heath. Research supported by the Nationa Heart, Lung, and Bood Institute (NHLBI) has heped identify some of the causes of seep disorders and their effects on the heart, brain, ungs, and other body systems. The NHLBI aso supports ongoing research on the most effective ways to diagnose and treat seep disorders. Many questions remain about seep and seep disorders. The NHLBI continues to support a range of research that focuses on: n n n n Better understanding of how a ack of seep increases the risk for obesity, diabetes, heart disease, and stroke New ways to diagnose seep disorders Genetic, environmenta, and socia factors that ead to seep disorders The adverse effects from a ack of seep on body and brain Much of this research depends on the wiingness of vounteers to participate in cinica research. If you woud ike to hep researchers advance science on seep or about a seep disorder you have and possibe treatments, tak to your doctor about participating in cinica research. (For more information, see Cinica Research on page 58.) Research

64 58 Cinica research Researchers can earn quite a bit about seep and seep disorders by studying animas. However, to fuy understand seep and its affect on heath and functioning, as we as how best to diagnose and treat seep disorders, researchers need to do cinica research on peope. This type of research is caed cinica research because it is often conducted in cinica settings, such as hospitas or doctors offices. The two types of cinica research are cinica trias and cinica studies. Cinica trias test new ways to diagnose, prevent, or treat various disorders. For exampe, treatments (such as medicines, medica devices, surgery, or other procedures) for a disorder need to be tested in peope who have the disorder. A tria heps determine whether a treatment is safe and effective in humans before it is made avaiabe for pubic use. In a cinica tria, participants are randomy assigned to groups. One group receives the new treatment being tested. Other groups may receive a different treatment or a pacebo (an inactive substance resembing a drug being tested). Comparing resuts from the groups gives researchers confidence that changes in the test group are due to the new treatment and not to other factors. Your Guide to Heathy Seep

65 59 Other types of cinica studies are done to discover the factors, incuding environmenta, behaviora, or genetic factors, that cause or worsen various disorders. Researchers may foow a group of peope over time to earn what factors contribute to becoming sick. Cinica studies and trias may be reativey brief, or may ast for years and require many visits to the study sites. These sites usuay are university hospitas or research centers, but they can incude private doctors offices and community hospitas. If you participate in cinica research, the research wi be expained to you in detai, you wi be given a chance to ask questions, and you wi be asked to provide written permission. You may not directy benefit from the resuts of the cinica research you participate in, but the information gathered wi hep others and wi add to scientific knowedge. Taking part in cinica research has other benefits, as we. You earn more about your disorder, you have the support of a team of heath care providers, and your heath wi ikey be monitored cosey. However, participation aso can have risks, which you shoud discuss with your doctor. No matter what you decide, your reguar medica care wi not be affected. If you re thinking about participating in a cinica study, you may have questions about the purpose of the study, the types of tests and treatment invoved, how participation wi affect your daiy ife, and whether any costs are invoved. Your doctor may be abe to answer some of your questions and hep you find cinica studies in which you can participate. You aso can visit the foowing Web sites to earn about being in a study and to search for cinica trias being done on your disorder: Cinica Research Research

66 60 For More Seep Information Resources From the Nationa Heart, Lung, and Bood Institute (NHLBI) Nationa Center on Seep Disorders Research Division of Lung Diseases, NHLBI Two Rockedge Centre, Suite Rockedge Drive Bethesda, MD Phone: Fax: Web site: NHLBI Diseases and Conditions Index (DCI) The DCI incudes artices on seep disorders, tests, and procedures, aong with videos, podcasts, and Spanish-anguage artices. Web site: NHLBI Heath Information Center P.O. Box Bethesda, MD Teephone: TTY: Fax: E-mai: Web site: Your Guide to Heathy Seep NIH Office of Science Education Web site (for high schoo suppementa curricuum: Seep, Seep Disorders, and Bioogica Rhythms)

67 61 Resources From Other Seep Organizations American Academy of Seep Medicine (AASM) 2510 North Frontage Road Darien, IL Teephone: Fax: Web site: American Seep Apnea Association 6856 Eastern Avenue, NW., Suite 203 Washington, DC Teephone: Fax: Web site: Narcoepsy Network P.O. Box 294 Peasantvie, NY Teephone: Fax: E-mai: Web site: Nationa Seep Foundation 1010 North Gebe Road, Suite 310 Arington, VA Teephone: E-mai: Web site: Restess Legs Syndrome Foundation th Street, NW., Suite 300 Rochester, MN Teephone: Fax: E-mai: Web site: For More Seep Information

68 62 Notes Your Guide to Heathy Seep

69 Notes 63 Notes

70

71 Discrimination Prohibited: Under provisions of appicabe pubic aws enacted by Congress since 1964, no person in the United States sha, on the grounds of race, coor, nationa origin, handicap, or age, be excuded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity (or, on the basis of sex, with respect to any education program or activity) receiving Federa financia assistance. In addition, Executive Order prohibits discrimination on the basis of age by contractors and subcontractors in the performance of Federa contracts, and Executive Order states that no federay funded contractor may discriminate against any empoyee or appicant for empoyment because of race, coor, reigion, sex, or nationa origin. Therefore, the Nationa Heart, Lung, and Bood Institute must be operated in compiance with these aws and Executive Orders.

72 NIH Pubication No Originay printed November 2005 Revised August 2011

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