To coincide with the beginning of daylight saving time and turning our clocks forward, the National Sleep Foundation (NSF) has dedicated the third week in March to Sleep Awareness Week, with March 19 being World Sleep Day 2021. It is a time to “Celebrate Sleep Health,” and to form an understanding of the importance of good sleep habits.
Americans’ Lack of Sleep
According to the NSF’s 2020 Sleep in America poll, on average, Americans feel sleepy three times a week, and 62 percent of those polled try to “shake it off” to get relief. Of those who spend most or all of the week (five to seven days) feeling sleepy, 52 percent report being irritable, 40 percent experience headaches, and 34 percent claim to feel unwell.
The NSF recommends 7–9 hours of sleep each night for adults aged 18–64 and 7–8 hours of sleep each night for adults aged 65 and older.
Circadian Rhythm and How It Affects Sleep
A circadian rhythm is your body’s internal master clock (the suprachiasmatic nucleus) that controls your sleep-wake cycle as well as eating habits, digestion, and body temperature. The word “circadian” means “about a day,” as the cycle repeats every 24 hours. Typically, circadian rhythms are synchronized with the day-night schedule, producing the hormone melatonin, which helps us fall asleep at night and then eases as morning comes, helping us wake up and stay awake.
When Circadian Rhythms Are Out of Synch
When your circadian rhythms are out of sync, you may have trouble falling asleep and staying asleep or waking up too early or during the night. These sleep disruptions may indicate a sleep disorder.
Circadian rhythms can become thrown off by the following conditions:
- Changing work shifts frequently
- Not sticking to consistent sleep and wake times
- Having insufficient light exposure during the day or too much bright light exposure at night
- Poor sleep habits, such as drinking caffeinated beverages or alcohol close to bedtime, not having a bedtime routine, or being on the phone or computer too close to bedtime and into the night
- Traveling across time zones
- Taking certain medications that affect sleep
Common circadian rhythm–related sleep disorders are:
- Delayed sleep phase disorder, occurring when people cannot get to sleep until late at night, waking up late the following day
- Advanced sleep phase disorder, occurring when people fall asleep early in the evening (between 6 pm and 9 pm) and wake, fully rested, in the early hours of the morning
- Jet lag, occurring when people travel by air through multiple time zones and cannot adjust readily to the time change in the new area
- Shift-work disorder, occurring when people work during the night and sleep in the daytime, disrupting the body’s natural circadian rhythm
In addition, an uptick in sleep disturbances neurologists are calling “COVID-somnia” has resulted since the start of the COVID-19 pandemic. This phenomenon has been reported in people recovering from COVID-19 as well as the general population. The same treatments for general circadian rhythm disorders (see below) are effective in treating this latest cause of insomnia.
Diagnosis of Circadian Rhythm Disorders
Talk to your health-care provider if you experience insomnia, daytime sleeplessness, difficulty waking up, depression, or sleep loss. He or she may make a diagnosis using the following methods:
- Physical exam: An exam, which may include blood tests, can detect signs of medical problems that can lead to sleep problems.
- Sleep diary: Your doctor may ask you to keep a sleep diary for a couple of weeks to detect unusual sleep-wake patterns and triggers that may be causing them.
- Sleep study: If it is difficult to detect the reason for your sleep disorder, your doctor may suggest you participate in a sleep study at a sleep center, where you will be monitored to record a variety of activities, including brain waves, breathing, heartbeat, and eye and body movements.
Treatment of Circadian Rhythm Disorders
Treatment options begin with addressing and changing issues and habits associated with insomnia, including stress, medical conditions, medications, and habits. Secondary measures may include cognitive behavioral therapy for insomnia (CBT-I).
CBT-I is part cognitive therapy, which teaches you to recognize and change beliefs, thoughts, and worries that affect your ability to sleep, and part behavioral therapy. Strategies include:
- Stimulus control therapy, such as avoiding naps, setting a consistent bedtime, and removing stimuli such as blue-light devices, including computers, tablets, and TVs, from the bedroom
- Relaxation techniques, such as progressive muscle relaxation and biofeedback and breathing exercises, which help reduce anxiety at bedtime
- Sleep restrictions decrease the time you spend in bed by avoiding daytime naps, causing partial sleep deprivation, and increasing the urge to sleep when you are tired at night
- Remaining passively awake (paradoxical intention) treats learned insomnia and can reduce the worry and anxiety about being able to get to sleep by getting into bed and trying to stay awake
- Light therapy uses light to push back your internal clock if you tend to fall asleep too early in the evening and waken too early in the morning
Your doctor may also prescribe prescription medications to help you get to sleep, stay asleep, or both. Sleeping pills may have side effects, such as causing daytime grogginess or being habit forming, and are sometimes not prescribed for more than a few weeks. There are several prescription medications, however, that can be used long term, including, Lunesta, Ambien, and Sonata.
Over-the-counter medications, such as Tylenol PM, Unisom, or Benadryl, contain antihistamines that can make you drowsy but have adverse side effects, too. They are not intended for long-term use. Talk to your doctor for a safer alternative if you are becoming reliant on these medications.
Herrick Library Resources on Sleep Disorders
The following items can be requested and checked out of Herrick Library via curbside pickup or through the Libby app via OverDrive, where indicated*:
- *The Anxiety First Aid Kit: Quick Tools for Extreme, Uncertain Times, by Rick Hanson
- Better Sleep: Solutions and Treatment for Common Problems, by Holly Strawbridge, Rita Baron-Fause, ad Ana Krieger
- The Book of Sleep: 75 Strategies to Relieve Insomnia, by Nicole Moshfegh
- Rest Assured: Self-Healing for Insomnia and the Stress of Life, (audiobook) by Michael Krugman
- Sleepless in America (DVD), produced by Public Good Projects for National Geographic
Sources: Mayo Clinic, Insomnia, https://www.mayoclinic.org/diseases-conditions/insomnia/diagnosis-treatment/drc-20355173; National Sleep Foundation, 2020 Sleep in America Poll shows Alarming Level of Sleepiness and Low Levels of Action, https://www.thensf.org/2020-sleep-in-america-poll-shows-alarming-level-of-sleepiness/; National Sleep Foundation, Sleep Awareness Week, https://www.thensf.org/sleep-awareness-week/; National Sleep Foundation, Understanding Circadian Rhythms, https://www.thensf.org/what-is-a-circadian-rhythm/; Neurology Today, “Sleep Neurologists Call It ‘COVID-Somnia’—Increased Sleep Disturbances Linked to the Pandemic, https://journals.lww.com/neurotodayonline/fulltext/2020/07090/sleep_neurologists_call_it.1.aspx