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Have you ever wondered what happens when you sleep? Interestingly, a lot goes on with your brain and body while you’re catching some Zzz’s.
While you’re snoozing, your mind and body journey through a series of events designed to reduce your consciousness and awareness, relax your muscles and alter your brain waves. Some organs get to power down to minimal functionality to maintain or reset, while others get to work as a cleanup crew after the main event.
These events play out in stages that repeat in cycles several times throughout a typical 7- to 8-hour sleep session. Yet you remain blissfully unaware of what your brain and body are doing throughout all this activity.
So, how many stages of sleep do you go through? And what is a sleep cycle?
A sleep cycle was once thought to have five distinct stages until the American Academy of Sleep Medicine (AASM) reclassified this in 2007. Now, it’s widely accepted there are four stages you go through per sleep cycle.
A cycle of sleep occurs each time your body completes all four sleep stages. Each stage is characterized by how your brain and body behave during that period. The length of time it takes to complete one whole cycle is roughly around
On average, you may go through four to six sleep cycles during the night, or day if you work the night shift.
Within a sleep cycle are three phases of non-REM (NREM) and one rapid eye movement (REM) sleep phase. REM is the deepest level of sleep and happens toward the end of a sleep cycle. It is also when you are most likely to dream.
So, what are the stages of sleep that happen during a sleep cycle?
Stage 1 (N1)
This non-REM sleep phase occurs in the first several minutes after nodding off and is when your mind is still somewhat alert. During this time, your brain shifts into producing alpha and theta waves, and your heart rate and breathing slow down. This stage can last from 1 to 7 minutes.
Stage 2 (N2)
During this stage, electrical activity in the brain increases in bursts. If you had an electroencephalogram (EEG) test at this time, it would show this activity in the form of spikes called “sleep spindles.” During this roughly 25 minutes non-REM phase, you hover between light and deep sleep.
If napping, the end of this stage would be the ideal time to wake up to avoid the groggy feeling often associated with waking during the following two stages.
Stage 3 (N3)
When you shift into this deeper level of sleep, your brain waves slow down, causing eye movement and muscle activity to cease. Lasting roughly 20 to 40 minutes, this non-REM phase is the point in the sleep cycle where waking is most difficult. It is also when an abrupt awakening will cause grogginess and mental fogginess.
In this stage, the body can carry out tissue repair, boost immune function, and store energy for use the next day.
Stage 4 (REM)
The fourth stage of sleep is the rapid eye movement stage, or REM. The first time you go through the REM stage, it lasts about 10 minutes. As you get toward the end of your sleep cycles, REM can last up to an hour.
EEG recorded brain activity during REM is similar to someone awake. Yet muscles remain inactive due to the action of powerful brain chemicals.
This is also the point in the sleep cycle where some scientists say dreaming occurs. Opinions vary on this, as some research suggests dreaming can occur in REM and non-REM sleep stages.
Reaching the REM stage is essential, as it is how the brain processes daily information for long-term memory storage.
Healthy sleep is as critical for your well-being as eating well and exercising, if not more so.
According to the
In addition to physical health, inadequate sleep can worsen depression and other mental health conditions.
For example, research published in the journal Clinical Psychological Science found sleep-deprived people had more difficulty controlling unpleasant memories and persistent unwanted thoughts. The scientists suggest sleep deprivation may disrupt communication between brain regions responsible for memory and emotions.
If you’re having difficulty getting the restful sleep you need, there are a few things you can do to improve both the length and quality of your next snooze session. But first, it’s helpful to determine how much sleep you really need for maximum health benefits.
If you’re looking for ways to improve the length and quality of your sleep cycles, here are a few suggestions that might help:
1. Be consistent in your sleep schedule
Erratic schedules can promote sleep disturbances. Consider having a set bedtime and wake time each day, including days off or on the weekends.
2. Resist the urge to scroll
Although you may enjoy lying in bed and scrolling through social media, research has shown that using electronic devices for at least
3. Avoid large meals, caffeine, and alcohol before bedtime
Caffeine is a known stimulant, but alcohol can also disrupt sleep patterns later in the sleep cycle. Consuming a large meal too close to bedtime can disrupt sleep because it jump-starts the digestion process when your body is trying to rest.
4. Exercise to promote quality sleep
Physical activity during waking hours can help you fall asleep more easily. However, the timing of exercise can matter. If activity tends to boost your energy levels, working out too close to bedtime can hamper your ability to doze off.
It’s probably a best practice to put a 2-hour gap between the end of your workout and bedtime.
5. Change up your sleep location
If you’re having difficulty falling asleep, changing your sleep location by moving to another bed or a comfortable couch might help. For some, a fresh start in another spot is all that’s needed to combat sleeplessness.
6. Get thoughts off your mind and onto paper
Persistent worries can also cause some people to have difficulty falling asleep. If this happens to you, consider keeping a notepad beside your bed to jot down random thoughts that pop up. Writing down your thoughts can ease your mind, especially if you feel like you need to remember them for the next day.
7. Create the ideal sleep environment
Because your sleeping environment can be a factor in sleep duration and quality, consider lowering the temperature in your bedroom, removing any glaring light source, or using a fan or noise machine to block out unwanted sounds.
Sometimes health conditions or medicines can impact sleep quality as well. If you are concerned about the health of your sleep, you might want to talk with a healthcare professional. You can then work together to get your sleep cycles back on track.
Understanding the stages of sleep can help you understand where you’re at in the sleep cycle and pinpoint areas of sleep you can better cultivate for a full and sound rest.
The Importance of Sleep and Understanding Sleep Stages
How much sleep do we need and why is sleep important? Most doctors would tell us that the amount of sleep one needs varies from person to person. We should feel refreshed and alert upon awakening and not need a day time nap to get us through the day. Sleep needs change from birth to old age. The general thought is that newborns through the first year need up to 18 hours daily, 1-3 year olds need 12-15, ages 3-5 need 11-13 hours, 2-12 year olds need 9-11, and teens need 9-10 hours. Adult sleep needs (beginning around 17 years old through the elderly) are generally 7- 8 hours.
Sleep is something most of us take for granted, yet, it is as important to life and health as the air we breathe. When we don’t get enough sleep, we suffer in a multitude of ways. Sleep deprivation causes cognitive loss such as memory, concentration, moodiness, as well as hyperactivity in children. It also can result in health problems including obesity heart disease, hypertension and diabetes. It may also increase the risk of injury, such as motor vehicle crashes.
Sleep Stages are as follows:
During the course of an eight hour sleep period, a healthy sleeper should cycle through the various sleep stages every 90 minutes or so.
Stage N1 (NREM1) sleep is a transition period from being awake to falling asleep. During this time you may have a sudden dream onset. You are drifting off to sleep and may still feel aware of your surroundings and easily be aroused back to wakefulness.
From Stage N1, you will enter Stage N2 where your breathing and heart rate will begin to slow. During the continuous sleep cycles throughout the night, we should spend about half of our sleep time in Stage N2.
Next comes Stage N3, sometimes referred to as Delta Sleep or slow wave sleep, because of the slow delta brain waves, which have been recorded during this sleep stage. N3 sleep is a regenerative period where your body heals and repairs itself. The first episode of Stage N3 lasts from 45-90 minutes. Subsequent episodes of N3 sleep have shorter and shorter time periods as the night progresses.
N3 sleep decreases with age such that elderly people may have no measured N3 sleep at night. This occurs in healthy sleepers and does not indicate a disorder or disease state in itself.
Stage R is referred to as REM sleep or “rapid eye movement” sleep. The first REM sleep episode generally occurs after 90-110 minutes of sleep, cycling about every 90 minutes thereafter. REM sleep periods tend to be longer later in the night. Our heart and breathing rates increase and become irregular. It is during REM sleep that we dream. Many of us will remember dreams from the REM stage. The body creates chemicals that render us temporarily paralyzed so that we do not act out our dreams. . In this stage, the brain is extremely active, and our eyes, although closed, dart back and forth as if we were awake.
During the diagnostic overnight sleep study or Polysomnogram, our sleep architecture is tracked and recorded. With over 80 different sleep disorders, often our diagnoses are partially determined by how we cycle through these sleep stages. As an example, people with narcolepsy fall directly in to REM sleep. People with apnea may have reduced stages N3 and REM when their interrupted breathing causes sleep to be fragmented, possibly alternating between stages N1 and N2 over and over all night.
Understanding the sleep stages, how one should cycle through them and the necessity of achieving healthy sleep hours, is important information for us patients to understand as we strive to become more knowledgeable about our own sleep health.
The information included on this site is for educational purposes only. It is not intended nor implied to be a substitute for professional medical advice. Contact your physician or health care provider when you have health related questions. Never disregard or delay medical advice because of information you have obtained on this site.
Individual perception of the demand
Based on the causes of stress we react either positively or negatively. This reaction can be formed on experience and maturity. For example, sitting on an exam for the first time will arouse different levels of stress to one where you sit a different exam for the fifth time.
Simply put, the situation that one finds themselves in could be the difference between fearing the situation and meeting with its demands. Much of this is placed on the human mind and reaction. Perception is a vital ingredient in meeting with stressful demands.
It is suggested that to develop perception one should be clear of what they are attempting to achieve. Somebody who has a task to complete for a deadline is more likely to be less fearful if they have planned accordingly. Conversely, if somebody has not planned and is not aware of the task demands they are more likely to be fearful of the situation.
Slumber and the brain
Sleep is critical for cognitive function in the short term. Lack of sleep can impair attention, working memory, reaction time and executive function (and wreak havoc on your mood).
But regularly skimping on sleep in midlife can have cumulative impacts, too. After analyzing published studies, Scullin and Donald Bliwise, PhD, at Emory University, concluded that maintaining good sleep quality in young adulthood and middle age is likely to protect against age-related decline in later years (Perspectives in Psychological Science, Vol. 10, No. 1, 2015).
Other research has focused on the role sleep might play in protecting the brain from Alzheimer's disease and related forms of cognitive impairment. Sleep problems are well documented among people with the disorder. They tend to nod off during the day and wake numerous times during the night, says Neylan. "The ability to have sustained periods of wakefulness and sleep appears to be broken down."
Impaired sleep is so common among people with Alzheimer's that researchers are now exploring whether disordered sleep patterns could be an early indicator of the disease.
There is also mounting evidence that the sleep-Alzheimer's link runs both ways. In other words, it's not just that Alzheimer's disease impairs the structure of healthy sleep. Sleeping poorly over the course of the lifespan could also increase the risk for cognitive decline and Alzheimer's disease. Ricardo S. Osorio, MD, at New York University School of Medicine, and colleagues have shown that sleep-disordered breathing such as apnea is associated with an earlier average age for the onset of cognitive impairment (Neurology, Vol. 84, No. 19, 2015). And in a systematic review of more than two dozen studies, Omonigho Bubu, MD, and colleagues found that sleep problems could account for about 15 percent of Alzheimer's disease cases in the population (Sleep, Vol. 40, No. 1, 2017)—a noteworthy number, given that the disease affects approximately five million Americans.
The mechanisms for that association aren't entirely clear, though the chronic inflammation associated with poor sleep could certainly damage neurons, Neylan says. There is also emerging evidence to suggest that sleep has a role in clearing the beta-amyloid proteins that clump together in the brains of people with Alzheimer's disease.
Much of that evidence comes from David Holtzman, MD, at Washington University in St. Louis, and colleagues, who found that beta-amyloid plaques accumulate more quickly in the brains of mice that have been chronically sleep deprived (Science, Vol. 326, No. 5955, 2009).
More recently, Holtzman's team showed that one night of poor sleep can affect beta-amyloid levels in people. They recruited participants to spend a night in the lab and disrupted the sleep of half the participants with a series of loud beeps each time they sank into slow-wave sleep. The next day, the team found those who had disrupted sleep had 10 percent higher levels of beta-amyloid protein in the fluid surrounding their brains and spinal cords (Brain, Vol. 140, No. 8, 2017).
Research from Maiken Nedergaard, MD, at the University of Rochester, and colleagues suggests one possible mechanism for that connection. They've discovered that deep sleep causes glial cells in the brain to shrink. That, in turn, opens up pathways for fluid exchange that flushes away waste products such as beta-amyloid (Science, Vol. 342, No. 6156, 2013). "Sleep is part of the plumbing system of the brain," Neylan notes.
Why sleep is important
Sleep is essential for a person’s health and wellbeing, according to the National Sleep Foundation (NSF). Yet millions of people do not get enough sleep and many suffer from lack of sleep. For example, surveys conducted by the NSF (1999-2004) reveal that at least 40 million Americans suffer from over 70 different sleep disorders and 60 percent of adults report having sleep problems a few nights a week or more. Most of those with these problems go undiagnosed and untreated. In addition, more than 40 percent of adults experience daytime sleepiness severe enough to interfere with their daily activities at least a few days each month — with 20 percent reporting problem sleepiness a few days a week or more. Furthermore, 69 percent of children experience one or more sleep problems a few nights or more during a week.
According to psychologist and sleep expert David F. Dinges, Ph.D., of the Division of Sleep and Chronobiology and Department of Psychiatry at the University of Pennsylvania School of Medicine, irritability, moodiness and disinhibition are some of the first signs a person experiences from lack of sleep. If a sleep-deprived person doesn’t sleep after the initial signs, said Dinges, the person may then start to experience apathy, slowed speech and flattened emotional responses, impaired memory and an inability to be novel or multitask. As a person gets to the point of falling asleep, he or she will fall into micro sleeps (5-10 seconds) that cause lapses in attention, nod off while doing an activity like driving or reading and then finally experience hypnagogic hallucinations, the beginning of REM sleep. (Dinges, Sleep, Sleepiness and Performance, 1991)
Everyone’s individual sleep needs vary. In general, most healthy adults are built for 16 hours of wakefulness and need an average of eight hours of sleep a night. However, some individuals are able to function without sleepiness or drowsiness after as little as six hours of sleep. Others can't perform at their peak unless they've slept ten hours. And, contrary to common myth, the need for sleep doesn't decline with age but the ability to sleep for six to eight hours at one time may be reduced. (Van Dongen & Dinges, Principles & Practice of Sleep Medicine, 2000)
Psychologists and other scientists who study the causes of sleep disorders have shown that such problems can directly or indirectly be tied to abnormalities in the following systems:
Furthermore, unhealthy conditions, disorders and diseases can also cause sleep problems, including:
Pathological sleepiness, insomnia and accidents
Hypertension and elevated cardiovascular risks (MI, stroke)
Emotional disorders (depression, bipolar disorder)
Obesity metabolic syndrome and diabetes
Alcohol and drug abuse
Groups that are at particular risk for sleep deprivation include night shift workers, physicians (average sleep = 6.5 hours a day residents = 5 hours a day), truck drivers, parents and teenagers. (American Academy of Sleep Medicine and National Heart, Lung, and Blood Institute Working Group on Problem Sleepiness. 1997).
Stress is the number one cause of short-term sleeping difficulties, according to sleep experts. Common triggers include school- or job-related pressures, a family or marriage problem and a serious illness or death in the family. Usually the sleep problem disappears when the stressful situation passes. However, if short-term sleep problems such as insomnia aren't managed properly from the beginning, they can persist long after the original stress has passed.
Drinking alcohol or beverages containing caffeine in the afternoon or evening, exercising close to bedtime, following an irregular morning and nighttime schedule, and working or doing other mentally intense activities right before or after getting into bed can disrupt sleep.
If you are among the 20 percent of employees in the United States who are shift workers, sleep may be particularly elusive. Shift work forces you to try to sleep when activities around you — and your own "biological rhythms" — signal you to be awake. One study shows that shift workers are two to five times more likely than employees with regular, daytime hours to fall asleep on the job.
Traveling also disrupts sleep, especially jet lag and traveling across several time zones. This can upset your biological or “circadian” rhythms.
Environmental factors such as a room that's too hot or cold, too noisy or too brightly lit can be a barrier to sound sleep. And interruptions from children or other family members can also disrupt sleep. Other influences to pay attention to are the comfort and size of your bed and the habits of your sleep partner. If you have to lie beside someone who has different sleep preferences, snores, can't fall or stay asleep, or has other sleep difficulties, it often becomes your problem too!
Having a 24/7 lifestyle can also interrupt regular sleep patterns: the global economy that includes round the clock industries working to beat the competition widespread use of nonstop automated systems to communicate and an increase in shift work makes for sleeping at regular times difficult.
A number of physical problems can interfere with your ability to fall or stay asleep. For example, arthritis and other conditions that cause pain, backache, or discomfort can make it difficult to sleep well.
Epidemiological studies suggest self-reported sleep complaints are associated with an increased relative risk of cardiovascular morbidity and mortality. For women, pregnancy and hormonal shifts including those that cause premenstrual syndrome (PMS) or menopause and its accompanying hot flashes can also intrude on sleep.
Finally, certain medications such as decongestants, steroids and some medicines for high blood pressure, asthma, or depression can cause sleeping difficulties as a side effect.
It is a good idea to talk to a physician or mental health provider about any sleeping problem that recurs or persists for longer than a few weeks.
According to the DSM, some psychiatric disorders have fatigue as a major symptom. Included are: major depressive disorder (includes postpartum blues), minor depression, dysthymia, mixed anxiety-depression, seasonal affective disorder and bipolar disorder.
According to a long-term study published in the 2004 April issue of Alcoholism: Clinical and Experimental Research, young teenagers whose preschool sleep habits were poor were more than twice as likely to use drugs, tobacco or alcohol. This finding was made by the University of Michigan Health System as part of a family health study that followed 257 boys and their parents for 10 years. The study found a significant connection between sleep problems in children and later drug use, even when other issues such as depression, aggression, attention problems and parental alcoholism were taken into account. Long-term data on girls isn't available yet. The researchers suggest that early sleep problems may be a "marker" for predicting later risk of early adolescent substance abuse — and that there may be a common biological factor underlying both traits. Although the relationship between sleep problems and the abuse of alcohol in adults is well known, this is the first study to look at the issue in children.
Nightmares are dreams with vivid and disturbing content. They are common in children during REM sleep. They usually involve an immediate awakening and good recall of the dream content.
Sleep terrors are often described as extreme nightmares. Like nightmares, they most often occur during childhood, however they typically take place during non-REM (NREM) sleep. Characteristics of a sleep terror include arousal, agitation, large pupils, sweating, and increased blood pressure. The child appears terrified, screams and is usually inconsolable for several minutes, after which he or she relaxes and returns to sleep. Sleep terrors usually take place early in the night and may be combined with sleepwalking. The child typically does not remember or has only a vague memory of the terrifying events.
In the August 2004 issue of the journal Sleep, Dr. Timothy Roehrs, the Director of research at the Sleep Disorders and Research Center at Henry Ford Hospital in Detroit published one of the first studies to measure the effect of sleepiness on decision making and risk taking. He found that sleepiness does take a toll on effective decision making.
Cited in the October 12, New York Times Science section, Dr. Roehrs and his colleagues paid sleepy and fully alert subjects to complete a series of computer tasks. At random times, they were given a choice to take their money and stop. Or they could forge ahead with the potential of either earning more money or losing it all if their work was not completed within an unknown remainder of time.
Dr. Roehrs found that the alert people were very sensitive to the amount of work they needed to do to finish the tasks and understood the risk of losing their money if they didn't. But the sleepy subjects chose to quit the tasks prematurely or they risked losing everything by trying to finish the task for more money even when it was 100 percent likely that they would be unable to finish, said Dr. Roehrs.
According to the National Commission on Sleep Disorders Research (1998) and reports from the National Highway Safety Administration (NHSA)(2002), high-profile accidents can partly be attributed to people suffering from a severe lack of sleep.
Each year the cost of sleep disorders, sleep deprivation and sleepiness, according to the NCSDR, is estimated to be $15.9 million in direct costs and $50 to $100 billion a year in indirect and related costs. And according to the NHSA, falling asleep while driving is responsible for at least 100,000 crashes, 71,000 injuries and 1,550 deaths each year in the United States. Young people in their teens and twenties, who are particularly susceptible to the effects of chronic sleep loss, are involved in more than half of the fall-asleep crashes on the nation's highways each year. Sleep loss also interferes with the learning of young people in our nation's schools, with 60 percent of grade school and high school children reporting that they are tired during the daytime and 15 percent of them admitting to falling asleep in class.
According to the Department of Transportation (DOT), one to four percent of all highway crashes are due to sleepiness, especially in rural areas and four percent of these crashes are fatal.
Risk factors for drowsy driving crashes:
Late night/early morning driving
Patients with untreated excessive sleepiness
People who obtain six or fewer hours of sleep per day
Medical residents after their shift
According to sleep researchers, a night's sleep is divided into five continually shifting stages, defined by types of brain waves that reflect either lighter or deeper sleep. Toward morning, there is an increase in rapid eye movement, or REM sleep, when the muscles are relaxed and dreaming occurs, and recent memories may be consolidated in the brain. The experts say that hitting a snooze alarm over and over again to wake up is not the best way to feel rested. “The restorative value of rest is diminished, especially when the increments are short,” said psychologist Edward Stepanski, PhD who has studied sleep fragmentation at the Rush University Medical Center in Chicago. This on and off again effect of dozing and waking causes shifts in the brain-wave patterns. Sleep-deprived snooze-button addicts are likely to shorten their quota of REM sleep, impairing their mental functioning during the day. (New York Times, October 12, 2004)
Certain therapies, like cognitive behavioral therapy teach people how to recognize and change patterns of thought and behavior to solve their problems. Recently this type of therapy has been shown to be very effective in getting people to fall asleep and conquer insomnia.
According to a study published in the October 2004 issue of The Archives of Internal Medicine, cognitive behavior therapy is more effective and lasts longer than a widely used sleeping pill, Ambien, in reducing insomnia. The study involved 63 healthy people with insomnia who were randomly assigned to receive Ambien, the cognitive behavior therapy, both or a placebo. The patients in the therapy group received five 30-minute sessions over six weeks. They were given daily exercises to “recognize, challenge and change stress-inducing” thoughts and were taught techniques, like delaying bedtime or getting up to read if they were unable to fall asleep after 20 minutes. The patients taking Ambien were on a full dose for a month and then were weaned off the drug. At three weeks, 44 percent of the patients receiving the therapy and those receiving the combination therapy and pills fell asleep faster compared to 29 percent of the patients taking only the sleeping pills. Two weeks after all the treatment was over, the patients receiving the therapy fell asleep in half the time it took before the study and only 17 percent of the patients taking the sleeping pills fell asleep in half the time. (New York Times, October 5, 2004)
According to leading sleep researchers, there are techniques to combat common sleep problems:
Keep a regular sleep/wake schedule
Don’t drink or eat caffeine four to six hours before bed and minimize daytime use
Don’t smoke, especially near bedtime or if you awake in the night
Avoid alcohol and heavy meals before sleep
Minimize noise, light and excessive hot and cold temperatures where you sleep
Develop a regular bed time and go to bed at the same time each night
Try and wake up without an alarm clock
Attempt to go to bed earlier every night for certain period this will ensure that you’re getting enough sleep
In clinical settings, cognitive-behavior therapy (CBT) has a 70-80 percent success rate for helping those who suffer from chronic insomnia. Almost one third of people with insomnia achieve normal sleep and most reduce their symptoms by 50 percent and sleep an extra 45-60 minutes a night. When insomnia exists along with other psychological disorders like depression, say the experts, the initial treatment should address the underlying condition.
But sometimes even after resolving the underlying condition, the insomnia still exists, says psychologist Jack Edinger, PhD, of the VA Medical Center in Durham, North Carolina and Professor of Psychiatry and Behavioral Sciences at Duke University and cautions that treating the depression usually doesn’t resolve the sleep difficulties. From his clinical experience, he has found that most patients with insomnia should be examined for specific behaviors and thoughts that may perpetuate the sleep problems. When people develop insomnia, they try to compensate by engaging in activities to help them get more sleep. They sleep later in the mornings or spend excessive times in bed. These efforts usually backfire, said Edinger.
From his clinical work and research on sleep, psychologist Charles M. Morin, PhD, a Professor in the Psychology Department and Director of the Sleep Disorders Center at University Laval in Quebec, Canada says that ten percent of adults suffer from chronic insomnia. In a study released in the recent issue of Sleep Medicine Alert published by the NSF, Morin outlines how CBT helps people overcome insomnia. Clinicians use sleep diaries to get an accurate picture of someone’s sleep patterns. Bedtime, waking time, time to fall asleep, number and durations of awakening, actual sleep time and quality of sleep are documented by the person suffering from insomnia.
A person can develop poor sleep habits (i.e. watching TV in bed or eating too much before bedtime), irregular sleep patterns (sleeping too late, taking long naps during the day) to compensate for lost sleep at night. Some patients also develop a fear of not sleeping and a pattern of worrying about the consequences of not sleeping, said Morin. “Treatments that address the poor sleep habits and the faulty beliefs and attitudes about sleep work but sometimes,” said Morin, “medication may play a role in breaking the cycle of insomnia. But behavioral therapies are essential for patients to alter the conditions that perpetuate it.”
CBT attempts to change a patient’s dysfunctional beliefs and attitudes about sleep. “It restructure thoughts — like, ‘I’ve got to sleep eight hours tonight’ or ‘I’ve got to take medication to sleep’ or ‘I just can’t function or I’ll get sick if I don’t sleep.’ These thoughts focus too much on sleep, which can become something like performance anxiety — sleep will come around to you when you’re not chasing it,” said Edinger.
What works in many cases, said Morin and Edinger, is to standardize or restrict a person’s sleep to give a person more control over his or her sleep. A person can keep a sleep diary for a couple of weeks and a clinician can monitor the amount of time spent in bed to the actual amount of time sleeping. Then the clinician can instruct the patient to either go to bed later and get up earlier or visa versa. This procedure improves the length of sleeping time by imposing a mild sleep deprivation situation, which has the result of reducing the anxiety surrounding sleep. To keep from falling asleep during the day, patients are told not to restrict sleep to less than five hours.
Standardizing sleep actually helps a person adjust his or her homeostatic mechanism that balances sleep, said Edinger. “Therefore, if you lose sleep, your homeostatic mechanism will kick in and will work to increase the likelihood of sleeping longer and deeper to promote sleep recovery. This helps a person come back to their baseline and works for the majority.”
A person can also establish more stimulus control over his or her bedroom environment, said Morin. This could include: going to bed only when sleepy, getting out of bed when unable to sleep, prohibiting non-sleep activities in the bedroom, getting up at the same time every morning (including weekends) and avoiding daytime naps.
Finally, a person can incorporate relaxation techniques as part of his or her treatment. For example, a person can give herself or himself an extra hour before bed to relax and unwind and time to write down worries and plans for the following day.
In CBT, said Morin, breaking the thought process and anxiety over sleep is the goal. “After identifying the dysfunctional thought patterns, a clinician can offer alternative interpretations of what is getting the person anxious so a person can think about his or her insomnia in a different way.” Morin offers some techniques to restructure a person’s cognitions. “Keep realistic expectations, don’t blame insomnia for all daytime impairments, do not feel that losing a night’s sleep will bring horrible consequences, do not give too much importance to sleep and finally develop some tolerance to the effects of lost sleep.
According to Edinger, aging weakens a person’s homeostatic sleep drive after age 50. Interestingly, the length of the circadian cycle stays roughly the same over the lifespan but the amplitude of the circadian rhythm may decline somewhat with aging.
American Academy of Sleep Medicine
NIH National Center for Sleep Disorders Research
The MayoClinic.com Sleep Center
(Blake, et al, Psychological Reports, 1998 National Heart, Lung and Blood Institute Working Group on Insomnia, 1998)
David F. Dinges, PhD, Professor of Psychology in Psychiatry, Chief, Division of Sleep and Chronobiology, University of Pennsylvania School of Medicine
Jack Edinger, PhD, of the VA Medical Center in Durham, North Carolina and Professor of Psychiatry and Behavioral Sciences at Duke University
Charles M. Morin, PhD, a Professor in the Psychology Department and Director of the Sleep Disorders Center at University Laval in Quebec, Canada
Timothy Roehrs, PhD, the Director of Research, Sleep Disorders and Research Center at Henry Ford Hospital
Edward Stepanski, PhD, who has studied sleep fragmentation at the Rush University Medical Center in Chicago
To Sleep, Perchance to Get Through a Full 5-stage Cycle
If Hamlet had a ZayZay duvet cover, maybe he wouldn’t have been wandering the castle with insomnia for hours. Maybe the crown prince would have been on top of his game and the play wouldn’t have been a tragedy after all. Do you feel tragic in the morning? It could be because staying in bed with your eyes shut for eight hours does not a good night’s sleep make.
We sleep in cycles that repeat all night, and we need the benefits of each stage for optimal health. Each 5-stage cycle of sleep lasts about 90 minutes, and ideally you wake up at the end of the cycle, post-REM (rapid eye movement), for maximally refreshed feeling. The cycle repeats like this: 1, 2, 3, 4, 3, 2, 1, 5 (REM). Waking from REM is the most beneficial, as it’s the natural end of the cycle, and hovers most closely to wakefulness. All the other stages are considered NREM (no rapid-eye movement).
Each sleep stage is easily identifiable by the brain waves illustrated in this electroencephalogram (ECG) reading.
Stage 1: This stage is called the light sleep stage. Your mind and body are beginning to relax. In this stage, you can be awakened easily, drifting in and out of sleep. The movement of the eyes and the muscles in this stage is relatively slow.
Stage 2: In this stage, your body is going into a meditative state. The movement of the eyes stops, the body temperature drops, the rate at which the heart beats slows down, and the brain waves becomes very slow, with only an occasional burst of rapid waves. This is the stage where the body prepares for a deep sleep.
Stage 3: When you enter the third stage, the brain’s ‘delta waves’ become interspersed with smaller waves, which are faster. In this stage, behaviours known as “parasomnias” can occur: including sleepwalking, night terrors, bedwetting, and even talking in one’s sleep.
This stage is considered to be the ‘deep sleep’ stage, also known as slow-wave sleep. These slow waves indicate muscle relaxation and a slowed breathing rate. This is the stage for growth and healing. Approximately 15-20% of our nights should be in this stage of deep sleep. Although this stage lasts only a few minutes per cycle, it is the stage of sleep from which you are least likely to be woken.
• Muscles receive more blood supply
• Body tissues are repaired and regenerate.
• Energy levels are recharged
• The pituitary gland releases HGH (human growth hormone)
Stage 4: The fourth stage continues the previous stage. The deep sleep continues, the brain continues to produce delta waves. If you wake from this stage, you may feel disoriented.
Stage 5 (REM – rapid eye movement): This is when you dream. Brain waves are at the levels of an awake person. This level is often characterized by the rapid movement of the eyes from side to side, yet the eyes remain closed. The movement of the eyes may be because of the brain activities occurring in this stage, or due to the intense dream.
To get the restful sleep you need these 90 -to-110-minute cycles to be completed continuously, with each stage lasting between 5 to 15 minutes. And unlike a book, you do not pick up where you left off. If your sleep is interrupted, your cycle starts at the beginning. Ever wonder why you feel so disoriented when you wake in the middle of a dream? Now you know. Your cycle wasn’t finished and your brain will have to begin again. And again throw the covers off, and again pull them back on repeatedly until you get it right
The release of HGH in stage 3 is likely the most important part of the deep sleep cycle. For children, this hormone allows them to develop fully. In adults, it’s how our body repairs itself. As we age, we sleep more lightly and achieve less deep sleep and shorter time spans of sleep, although studies show you still need as much sleep as when you were younger. Disorders associated with disruption of the third stage of the sleep cycle include narcolepsy, depression, anxiety, and ADHD.
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How to remember your dreams
From drinking extra water to repeating phrases, there are several techniques that can help you recall your dreams more easily. Just don’t forget the notebook and pen.
Because dream recall is stronger when you wake up in the middle of the night, sometimes practitioners recommend drinking extra water (two to three glasses) right before bedtime. This might help you remember your middle-of-the-night dreams more easily. You might also recall brief dreams, like the kind you get when first falling asleep. You can try repeating the phrase “I’m going to remember my dreams” three times before drifting off as a kind of reminder to your brain to recall your dreams.
When you do wake up, don’t move, talk, or make any other motion. Instead, do your best to recall the dream by going over each moment in your mind. Researchers suggest staying still for at least a few minutes, giving yourself time to sink back into the dream and gather as much information as you can. Then, write it down. Try doing this (along with the repeated phrase) for two weeks to help better remember your dreams.
SHOW NOTES, LINKS, & RESEARCH
The incredible benefits of getting enough and the terrible side effects of not getting enough.
The Brain and The Functions of learnings and memory.
Sleep after learning is essential and like hitting the “save” button after learning. We also now know that it’s important even before learning.
Without sleep the memory circuits become blocked up.
Examine The Hypothesis of the All Nighter
40% deficit in the ability of the brain to make new memories without sleep.
Brain activity is shot almost entirely after sleep deprivation.
He describes it as like Memento the movie. (Great movie BTW)
What is it that causes people to get good sleep and how does it affect our brain?
What in sleep causes these benefits?
As we get older our memory gets work but our sleep does as well and they are related.
Sleep is critical for your emotional and mental health
On less sleep these areas of the brain become irrational.
Video of a subject illustrates this point. - Subject goes from angry to laughing then back to base in about 20 seconds.
Without sleep you can’t take your foot off the emotional gas pedal.
Sleep deprivation is correlated with depression and almost every psychiatric disorder.
The body relies on sleep as well.
75% reduction in NK cell activity even after one bad night of sleep. Immune system will be shot.
Lack of sleep and cancer has been shown to have a strong relationship.
⅔ of Americans do not get their full recommended 8 hours of sleep.
Every disease in developed nations is made worse by lack of sleep.
Short Sleep = Shorter Life
Brain - builds up a toxic buildup in the brain.
Body - No immune system and activities stress chemistry leading to heart disease and cancer.
Naps - A double edged sword. Sleep is not like the bank, you can’t accumulate debt then pay it off as you go about your day.
Sleeping Pills - These are bad!
Long video that goes deep into some of the topics covered above.
Love the concept that we’ve hit on before that sleep actually allows you to integrate in ideas and learnings into what you’ve been doing prior.
Sleep is one of the most important aspects of our life and yet it is increasingly neglected in twenty-first-century society, with devastating consequences. Award-winning professor of neuroscience Matthew Walker provides a fascinating insight into why it is vital we start taking sleep seriously.
The dreaming brain can build stories better than a brain that’s awake
There are certain questions that come up for which we plot a potential course of action or think through a future scenario to solve, Stickgold explains.
That’s what our brains can’t do in the background when we’re awake. But that type of narrative construction (building a story) still requires us to be consciously aware, Stickgold says — which is one feature of dreams. We know they’re happening.
“It might be that you need to bring that sleep-dependent memory processing into consciousness to be able to solve those kinds of problems that require the development of a plan or a narrative or a plot,” Stickgold says — that you need to dream to do that kind of thinking .
Several studies show (what nearly everyone has probably experienced on their own) that our waking experiences show up in our dreams. Other research shows that we are more likely to remember something if we dream about it. (Erin Wamsley, PhD, an assistant professor in the Psychology Department at Furman University in Greenville, South Carolina, explains all of those studies in further depth in a review article in a 2014 issue of Current Neurology and Neuroscience Reports.)
And more research suggests that dreaming does actually help us problem solve.
A set of experiments conducted by Wamsley’s and Stickgold’s group (when Wamsley was at Harvard) showed that when a group of 99 individuals were given the task of navigating a complex maze, those whose performance on the task improved the most when re-tested after a five-hour period were those individuals given the opportunity to take a nap — and more specifically those who reported dreaming about the maze during that nap — compared to when they were simply awake during that time (even if they reported thinking about the maze during that period of being awake).
And perhaps more interesting still, research that looks at the mechanical changes in the brain during sleep and during dreaming align with this thinking, too.
Why You Need All 4 Stages of Sleep - Psychology
Some people need eight hours. Others can exist on four. But the bottom line is that everybody needs sleep - it is as essential as breathing and eating. Yet, despite decades of study, scientists still do not know why we do it.
However, there are some intriguing clues and theories. One obvious clue is that we all feel better after a good night’s sleep, and much worse if deprived of a decent night’s rest. In humans the need for sleep gets so strong after a few days that nothing will keep you awake – with reports of people falling asleep standing up, even whilst being kicked or having intolerably loud music played at them. Within days of having no sleep, people report confusion, forgetfulness and hallucinations. (In case you are wondering, the world record for going without sleep is eleven days.)
But saying that we sleep because we are tired is rather like saying we eat because we are hungry – it is why we sleep, but not necessarily why we need it.
One theory that has emerged in recent years is that sleep helps us to process and consolidate new memories. Our memory system is a psychological wonder, and several studies have suggested that sleep provides some behind-the-scenes maintenance.
For instance, Matthew Walker and colleagues from the University of California gave volunteers aptitude tests like remembering sequences of patterns fired at them on a computer. Half the volunteers learned these patterns in the morning, and half in the evening. To test their memories he got them back into the lab – the morning learners returned after a full day of being awake, the evening learners came back after a night's sleep. Sure enough, those who were allowed to sleep had better recall of the test patterns.
By the way, there is good news for siesta or powernap lovers. Similar comparisons indicate that you can get a memory boost from a daytime nap. So, if you have been studying or working hard in the morning, do not be too hard on yourself if you fancy closing your eyes for a while.
One school of thought is that sleep aids our memories by refreshing and reorganising them without interfering with our waking thoughts. Evidence comes from several studies using methods that record the brain directly. For instance, when rats were trained to find their way around a maze, their brains produced the same activity patterns during sleep as when they had carried out the task – suggesting that the brain was reconstructing the experience.
A rest might help ease bad experiences, too. A study published last year by Walker’s group has posed the intriguing suggestion that the brain might also deal with the memory of unpleasant or traumatic events during sleep (3).
From this we also gain an important insight into the fascinating phenomenon of dreams. These crazy adventures our minds have while we are sleeping may be a product of our memories randomly activating so as to keep them fresh, and of the mind seeking connections between all the things we have recently experienced. This could also explain why hallucinations accompany sleep deprivation. Without the opportunity to reorganise our memories during sleep, dreams intrude into our waking lives, causing difficulty in distinguishing our inner lives from reality.
Much of this is informed speculation. It is likely that as well as fine-tuning our brains, our bodies use this opportunity to carry out a list of housekeeping tasks, for instance, repairing damaged cells.
But some scientists argue that the purpose of sleep may not be restorative. In fact, they argue that the very question "why do we sleep?" is mistaken, and that the real question should be "why are we awake?". If you are safe and warm and fed, it is a waste of energy to be awake and moving around (and possibly getting into trouble). Far better, this argument goes, is to be awake only when you have to and sleep when it suits you (4).
One thing is certain, not only do we have to sleep, but it is good for your mind and body as well. Although everyone needs a different amount of sleep, the average is about seven hours – and people who sleep a lot less than this are at a higher risk of various illnesses, such as heart disease, and a shortened lifespan.
So instead of feeling guilty the next time you fancy a nap, think about how much good it will do you.
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