Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.
No matter how much sleep you need, if you don't get enough, you will suffer
the effects of sleep deprivation. Research has shown that in tests of driving
ability and hand-eye coordination, people deprived of sleep perform as badly as,
or even worse than, people who are intoxicated. It's no wonder that drowsiness
is a major cause of traffic accidents and deaths.
Individuals vary in their need for sleep. Some people require nine or more
hours of sleep per night, while others may not feel deprived after just five
hours of sleep. But the average adult requires seven to eight hours of sleep per
night.
Are you getting enough sleep? Ask yourself the following questions:
Do you often feel drowsy during the day?
Do you usually fall asleep within the first five minutes after lying
down in bed?
There are over 20 definitions of "sleep" in several dictionaries. The first,
a verb, seems most appropriate:
to take the rest afforded by a suspension of
voluntary bodily functions and the natural suspension, complete or partial, of
consciousness; cease being awake.
Physiologically, sleep is a complex process of
restoration and renewal for the body. Scientists still do not have a definitive
explanation for why humans have a need for sleep. We do know that sleep is not a
passive process or "switching off" of body functions; sleep is believed to be
important in many physiologic processes including the processing of experiences
and the consolidation of memories. It is also clear that sleep is essential, not
only for humans but for almost all animals.
The importance of sleep is
underscored by the symptoms experienced by those suffering from sleep problems.
People suffering from sleep disorders do not get adequate or restorative sleep,
and sleep deprivation is associated with a number of both physical and emotional
disturbances. In addition, sleep is influenced by the circadian rhythms (regular
body changes in mental and physical characteristics that occur in the course of
about 24 hours). These are controlled by brain neurons that respond to light,
temperature and hormones and other signals and comprise the body's biological
clock. This clock helps regulate the "normal" awake and sleep cycles. Disruption
of these cycles can make people sleepy at times people want to be awake. For
example, travelers experience "jet lag"
when they cross time zones. When a New Yorker arrives in Paris at midnight Paris time, his or her body continues to operate
(their biological clock) on New York time. It may take some time (about 1-3 days) to
reset a person's biologic clock, depending on how much it has been altered by
the time change.
There is evidence that some aspects of sleep are under
genetic influence; a gene termed DEC2 is being investigated as causing people
that possess it to require only about 6 hours of sleep. Researchers have only
begun to examine the genetics involved in sleep.
What are the stages of sleep?
There are two general states of sleep: 1) rapid eye movement (REM) sleep, and
2) non-rapid eye movement (NREM) sleep. NREM sleep is further subdivided into
stages (see below).
1. REM sleep (rapid-eye movement): REM sleep is unlike any of the other stages of sleep. It was first described
in 1953 when sleep researchers noticed a unique pattern of brain waves (signals
recorded on an electroencephalogram
(EEG), a type of test that measures the electrical
impulses within the brain). These brain waves had a fast frequency and low
voltage, similar to the brain waves seen in the normal awake state. Other
characteristics of REM sleep include complete inactivity of the voluntary
muscles in the body, with the exception of the muscles that control eye
movements. Rapid eye movements are also observed during REM sleep. People who
are awakened during REM sleep often report that they were dreaming at the time.
About 20% to 25% of sleep time is REM sleep; in infants it can comprise about 40%.
2. NREM (non-rapid eye movement): NREM sleep has traditionally been considered to be divided into 4 stages.
However, new guidelines from the American Academy of Sleep Medicine (AASM)
published in 2007 have recharacterized NREM sleep as occurring in 3 stages,
according to the pattern of brain electrical activity:
Stage N1 sleep, or the transition from wakefulness to deeper sleep. This is
the lightest stage of sleep, and people may not always perceive they are asleep
when in this stage.
Stage N2 sleep is a true sleep state, and accounts for 40% to 50% of sleep
time.
Stage N3 sleep has been called deep sleep, delta sleep, or slow wave sleep.
This stage accounts for about 20% of sleep in young adults.
Sleep typically occurs in cycles that range from 90 to 120 minutes in length,
with 4-5 cycles occurring during each night's sleep. In the first half of the
night, there is a transition from wakefulness into stage N1 sleep, then to
stages N2, and N3. Stages N2 and N3 then reappear, followed by the first instance
of REM sleep. Cycles of stage N2 and REM sleep alternate with each other for the
second half of the night.
Disruptions in the entire sleep cycle or in the individual phases are
believed to account for the various types of sleep disorders.
How much sleep does a person need?
Individuals vary greatly in their need for sleep; there are no established
criteria to determine exactly how much sleep a person needs. Eight hours or more
may be necessary for some people, while others may consider this to be too much
sleep.
The National Institutes of Health (NIH) suggests that most average adults need about 7
to 9 hours of sleep each
night. Newborn babies, by contrast, sleep from 16 to 18 hours a day.
Preschool-aged children typically sleep between 10 and 12 hours a day. Older,
school-aged children and teens need at least 9 hours of sleep a night. Women in
the first trimester of pregnancy have been observed to need a few more hours'
sleep than is usual for them.
Does the amount of sleep we need change as we age?
Changes in the sleep cycle do occur with aging. Deep or slow wave sleep
(Stage N3) sleep declines as we age, while light sleep (Stage N1) increases with
age, so that older adults may spend less time in the more restorative stages of
sleep and more time in lighter sleep. Older people are also more easily aroused
from sleep. While some people believe that older adults need less sleep as they
get older, there is no scientific evidence that older people need less sleep
than younger adults.
Night sweats are severe hot flashes that occur at night and result in a drenching sweat. In order to distinguish night sweats that arise from medical causes from those that occur because one's surroundings are too warm, doctors generally refer to true night sweats as severe hot flashes occurring at night that can drench sleepwear and sheets, which are not related to an overheated environment.
Anxiety is a feeling of apprehension and fear characterized by physical symptoms. Anxiety disorders are serious medical illnesses that affect approximately 19 million American adults.
Bed bugs (from the insect family Cimicidae) are small, reddish-brown tick-like insects that feed by sucking the blood of mammals. They are often found in poorly sanitized areas or in crowded living quarters.
Acne is a localized skin inflammation as a result of overactivity of oil glands at the
base of hair follicles. This inflammation, depending on its location, can take the form
of a superficial pustule (contains pus), a pimple, a deeper cyst, congested pores, whiteheads, or blackheads. Treatments vary depending on the severity of the acne.
Bursitis of the hip results when the fluid-filled sac (bursa) near the hip becomes inflamed due to localized soft tissue trauma or strain. Symptoms include stiffness and pain around the hip joint. If the hip bursa is not infected, hip bursitis can be treated with ice compresses, rest, and antiinflammatory and pain medications.
A stroke results from impaired oxygen delivery to brain cells via the bloodstream. A stroke is also referred to as a CVA, or cerebrovascular incident. Symptoms of stroke include: sudden numbness or weakness of the face, arm or leg. Sudden confusion, trouble speaking or understanding. Sudden trouble seeing in one or both eyes, sudden trouble walking, dizziness, or loss of balance, and/or sudden severe headache with no known cause. A TIA, or transient ischemic attack is a short-lived temporary impairment of the brain caused by loss of blood supply. Stroke is a medical emergency.
Fibromyalgia, formerly
known as fibrositis, causes chronic pain, stiffness, and
tenderness of muscles, tendons, and joints without detectable inflammation. Fibromyalgia patients have an unusually low pain threshold. Symptoms of fibromyalgia include fatigue, abnormal sleep, mental/emotional disturbances, abdominal pain, migraine and tension headaches, and irritable bladder. Treatment of fibromyalgia involves patient education, medication, exercise, and stress reduction.
Depression is an illness that involves the body, mood, and thoughts and affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. The principal types of depression are major depression, dysthymia, and bipolar disease (also called manic-depressive disease).
Restless leg syndrome (RLS or restless legs syndrome) is a common cause for painful legs that typically eases with motion, and becomes worse and more noticeable at rest. This characteristic nighttime worsening can frequently lead to insomnia. Treatment of the symptoms of restless leg syndrome is generally with medication as well as treating any underlying condition causing restless leg syndrome.
Sleep apnea is defined as a reduction or cessation of breathing during sleep. The three types of sleep apnea are central apnea, obstructive apnea (OSA), and a mixture of central and obstructive apnea. Central sleep apnea is caused by a failure of the brain to activate the muscles of breathing during sleep. OSA is caused by the collapse of the airway during sleep. OSA is diagnosed and evaluated through patient history, physical examination and polysomnography. There are many complications related to obstructive sleep apnea. Treatments are surgical and non-surgical.
Post-traumatic stress disorder (PTSD), a psychiatric condition, can develop after any catastrophic life event. Symptoms include nightmares, flashbacks, sweating, rapid heart rate, detachment, amnesia, sleep problems, irritability, and exaggerated startle response. Treatment may involve psychotherapy, group support, and medication.
Bipolar disorder (or manic depression) is a mental illness characterized by depression, mania, and severe mood swings. Treatment may incorporate mood stabilizer medications, antidepressants, and psychotherapy.
Asthma is a common disorder in which
chronic inflammation of the bronchial tubes (bronchi) makes them swell, narrowing the airways. Signs and symptoms include shortness of breath, chest tightness,
cough and wheezing.
Pinworm infection is an intestinal infection caused by a pinworm, seatworm, or threadworm. Female pinworms leave the intestine through the anus and deposit eggs on the skin around the anus while a person is asleep. Pinworm infection is the most common worm infection in the US. Symptoms include anal itching or vaginal itching. Pinworm infection is generally spread by inadequate handwashing from infected persons. Treatment is effective after a diagnosis is made with a pinworm test.
Epilepsy is a brain disorder in which the person has seizures. There are two kinds of seizures, focal and generalized. There are many causes of epilepsy. Treatment of epilepsy (seizures) depends upon the cause and type of seizures experienced.
Chronic fatigue syndrome is a debilitating and complex disorder characterized by profound fatigue that lasts 6 months or longer, is not improved by bed rest, and may be worsened by physical or mental activity.
Snoring, like all other sounds, is caused by vibrations that cause particles in the air to form sound waves. While we are asleep, turbulent air flow can cause the tissues of the nose and throat to vibrate and give rise to snoring. Any person can snore. Snoring is believed to occur in anywhere from 30% of women to over 45% of men. People who snore can have any body type. In general, as people get older and as they gain weight, snoring will worsen. Snoring can be caused by a number of things, including the sleep position, alcohol, medication, anatomical structure of the mouth and throat, stage of sleep, and mouth breathing.
Grief is the feeling one experiences after a loss (of a friendship, death of loved one, job). Complicated grief refers to grief that lasts for more than a year. Mourning describes the customs and rituals that help a bereaved individual make sense of their loss.
Jet lag (desynchonosis) is a temporary disorder that results from travel across time zones. Symptoms include anxiety, constipation, headache, nausea, dehydration, diarrhea, confusion, sweating, irritability, and even memory loss.
Teething in babies typically starts between 4 and 10 months of age. Symptoms and signs of cutting teeth include rash, drooling, decreased sleeping, fussiness, bringing the hands to the mouth, and rubbing the cheek or ear. Acetaminophen and ibuprofen may be used to treat teething pain.
Insomnia is the perception or complaint of inadequate or poor-quality sleep because of difficulty falling asleep; waking up frequently during the night with difficulty returning to sleep; waking up too early in the morning; or unrefreshing sleep. Secondary insomnia is the most common type of insomnia. Treatment for insomnia include lifestyle changes, cognitive behavioral therapy, and medication.
Seasonal affective disorder is a type of depression that tends to occur as the days grow shorter in the fall and winter. Symptoms of seasonal affective disorder include tiredness, fatigue, depression, irritability, body aches, poor sleep and overeating.
Fatigue can be described in various ways. Sometimes fatigue is described as feeling a lack of energy and motivation (both mental and physical). The causes of fatigue are generally related to a variety of conditions or diseases for example, anemia, mono, medications, sleep problems, cancer, anxiety, heart disease, drug abuse, and more. Treatment of fatigue is generally directed toward the condition or disease that is causing the fatigue.
Chronic pain is pain (an unpleasant sense of discomfort) that persists or progresses over a long period of time. In contrast to acute pain that arises suddenly in response to a specific injury and is usually treatable, chronic pain persists over time and is often resistant to medical treatments.
Bruxism is the medical term for teeth grinding. Bruxism may be caused by stress or anxiety and often happens during sleep. Symptoms and signs include jaw pain, headache, and abnormalities in your teeth. Treatment may involve practicing stress-management techniques, cutting back on caffeine and alcohol, avoiding gum chewing, training oneself not to grind the teeth, and wearing a mouth guard.
Eye strain is a symptom caused by looking at something for a long time. Symptoms and signs include redness, light sensitivity, headaches, and blurred vision. Symptoms may be treated by closing the eyes and taking a break from the visual task.
Drugs commonly abused by teens include tobacco products, marijuana, cold medications, inhalants, depressants, stimulants, narcotics, hallucinogens, PCP, ketamine, Ecstasy, and anabolic steroids. Some of the symptoms and warning signs of teen drug abuse include reddened whites of eyes, paranoia, sleepiness, excessive happiness, seizures, memory loss, increased appetite, discolored fingertips, lips or teeth, and irritability. Treatment of drug addiction may involve a combination of medication, individual, and familial interventions.
Stress may be considered as any physical, chemical, or emotional factor that causes bodily or mental unrest and that may be a factor in disease causation. An important goal for those under stress is the management of stress in our lives. Elimination of stress is unrealistic, since stress is a part of normal life. We can however, learn to manage stress through techniques such as exercise, relaxation, meditation, time management, and support systems so that we have control over our stress and its effects on our physical and mental health.
Insomnia is difficulty in falling or staying asleep, the absence of restful sleep, or poor quality of sleep. Insomnia is a symptom and not a disease. The most common causes of insomnia are medications, psychological conditions, environmental changes and stressful events. Treatments may include non-drug treatments, over-the-counter medicines, and/or prescription medications.
How does depression in the elderly differ from
depression in younger
adults?
Depression in later life frequently coexists with other medical illnesses
and disabilities. In addition, advancing age is often accompanied by loss of
social support systems due to the death of a spouse or siblings, retirement, or
relocation of residence. Because of changes in an elderly person's
circumstances and the fact that elderly people are expected to slow down,
doctors and family may miss the signs of depression. As a result, effective
treatment gets delayed. Many seniors find themselves trying to cope with
symptoms that could have been easily treated.
Depression tends to last longer in elderly adults. It doubles their risk of
cardiac diseases and increases their risk of death from illness. At the same
time, depression reduces an elderly person's ability to rehabilitate.
Studies of nursing home patients with physical illnesses have shown that the
pres...
No matter how much sleep you need, if you don't get enough, you will suffer
the effects of sleep deprivation. Research has shown that in tests of driving
ability and hand-eye coordination, people deprived of sleep perform as badly as,
or even worse than, people who are intoxicated. It's no wonder that drowsiness
is a major cause of traffic accidents and deaths. 
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