You've studied about sleep...
You continue to have trouble sleeping....
studies are tests that watch what happens to your body during sleep. The studies are done to find out what's causing
your sleep problems.
Sleep problems include:
- Sleep apnea, when an adult regularly stops breathing during sleep for 10 seconds or longer. This may be caused by
blocked airflow during sleep, such as from narrowed airways. Or it may be caused by a problem with how the brain signals the
breathing muscles to work.
- Problems staying awake, such as narcolepsy.
- Problems with nighttime behaviors, such as sleepwalking, night terrors, or bed-wetting.
- Problems sleeping at night (insomnia). This may be
caused by conditions such as periodic limb movement disorder, which is an
intense urge to move the legs.
studies can also determine whether you have a problem with your stages of sleep. The two stages of sleep are
non-rapid eye movement (NREM) & rapid eye movement (REM). Normally, NREM and REM alternate 4 to 5 times during a night's
sleep. A change in this cycle may make it hard for you to sleep soundly.
The most common sleep studies are:
This test records several body functions during sleep, including brain activity, eye movement, oxygen & carbon dioxide
blood levels, heart rate & rhythm, breathing rate & rhythm, the flow of air thru your mouth & nose, snoring, body
muscle movements & chest & belly movement.
- Multiple sleep latency
test (MSLT). This test measures how long it takes you to fall asleep. A video camera is used to record movements during
- Multiple wake test (MWT).
This test measures whether you can stay awake during a time when you're normally awake.
studies usually are done in a sleep lab. Sleep labs are
often located in hospitals.
This information will help you understand your choices, whether
you share in the decision-making process or rely on your doctor's recommendation.
Key points in making your decision
The most common form of sleep apnea is obstructive sleep apnea
(OSA). Although doctors use sleep studies to diagnose both obstructive sleep apnea and central sleep apnea, this Decision
Point focuses on obstructive sleep apnea.
Consider the following when making your decision:
- If you snore but do not have other symptoms of sleep apnea,
you may not need a sleep study. Lifestyle changes, such as losing weight (if needed), sleeping on your side, and keeping a
regular sleep schedule may reduce your snoring.
- If you have symptoms of sleep apnea (particularly excessive
snoring or daytime sleepiness), your doctor will probably suggest a polysomnography sleep study. Polysomnography is the only sure way to find out whether you have sleep apnea.
- If you know that you have sleep apnea, you can treat it.
- If you have mild sleep apnea, or more severe sleep apnea without
daytime sleepiness, treatment may or may not reduce your symptoms, complications such as high blood pressure.
- If you have moderate to severe sleep apnea, treatment generally
reduces symptoms of sleep apnea and may reduce your risk of complications.
Why should I have a sleep study?
A sleep study
can give you a positive diagnosis of sleep apnea. This is important because if sleep apnea isn't diagnosed and treated, it
can interfere with your quality of life. If you have sleep apnea, you may be at risk for excessive daytime sleepiness and complications such as high blood pressure, high blood pressure in the lungs (pulmonary hypertension), depression, irregular heart rhythms, heart failure, coronary artery disease & stroke.
Reasons to have a sleep study
- You have symptoms of sleep apnea, particularly excessive snoring
and daytime sleepiness.
- A sleep study that is performed in a qualified sleep lab is
the only sure way to diagnose sleep apnea.
- Correct diagnosis leads to early treatment of sleep apnea that
can reduce your symptoms and risk for complications such as high blood pressure and irregular heart rhythms.
- A complete sleep test can rule out other sleep-related problems,
such as Narcolepsy or periodic limb movement disorder.
- No risks are involved in undergoing a sleep study.
Are there other reasons you might want to have a complete sleep
Reasons not to have a sleep study
- You snore but do not have other symptoms of sleep apnea.
- Treatment of mild sleep apnea may not reduce your symptoms
or your risk of complications.
- You are not comfortable with the treatment options for sleep
apnea and may not seek treatment if you are diagnosed with it.
- Sleep studies are expensive.
- You are willing to try lifestyle changes (such as weight loss)
to reduce your snoring and mild sleep apnea.
- Sleep study results on older adults are more difficult to interpret
than the results of younger people.
Are there other reasons you might not want to have a sleep study?
10 Tips to Get Better Sleep
Set yourself up to get a good night's sleep.
Reviewed by Ann Edmundson,
Want to know how to sleep better? We all
have trouble sleeping from time to time. But you can make it easier to get a good night's sleep every night with these simple
steps. Here are 10 tips for better sleep:We all have trouble sleeping from time to time. But you can make it easier to get
a good night's sleep every night with these simple steps.
- Cut caffeine.
Simply put, caffeine can keep you awake. It can stay in your body longer than you might think -- up to about 14 hours. So
if you drink a cup of coffee at noon and are still awake at midnight, caffeine might be the reason. Cutting out caffeine at
least four to six hours before bedtime can help you fall asleep easier. If you have already had too much caffeine, try eating
some carbohydrates like bread or crackers to help reduce the effects.
- Avoid alcohol as a sleep
aid. Alcohol may initially help you fall asleep, but it also causes disturbances in sleep resulting in less restful
- Relax before bedtime.
Stress not only makes you miserable, it wreaks havoc on your sleep. Develop some kind of pre-sleep ritual to break the connection
between all the day's stress & bedtime. These rituals can be as short as 10 minutes or as long as an hour.
Some people find relief in making a list of all the stressors of the day, along with a plan to deal with them - this can
act as "closure" to the day.
Combining this with a period of relaxation - perhaps by reading something light, meditating, aromatherapy, light stretching,
or taking a hot bath - can also help you get better sleep. And don't look at the clock! That "tick-tock" will just tick you
- Exercise at the right time for you. Regular exercise can help you get a good night's sleep. The timing & intensity of exercise
seems to play a key role in its effects on sleep. If you're the type of person who gets energized or becomes more alert after
exercise, it may be best not to exercise in the evening. Regular exercise in the morning even can help relieve insomnia, according to a recent study.
- Keep your bedroom quiet,
dark & comfortable. For many people, even the slightest noise or light can disturb sleep - like the purring of
a cat or the light from your laptop or TV. Use earplugs, window blinds or curtains & an electric blanket or air conditioner
- everything possible to create an ideal sleep environment. And don't use the overhead light if you need to get up at night;
use a small night-light instead. Ideal room temperatures for sleeping are between 68 & 72 degrees Fahrenheit. Temperatures
above 75 or below about 54 can disrupt sleep.
- Eat right, sleep tight.
Try not to go to bed hungry, but avoid heavy meals before bedtime. An over-full belly can keep you up. Some foods can help,
though. Milk contains tryptophan, which is a sleep-promoting substance. Other foods that help promote sleep include tuna,
halibut, pumpkin, artichokes, avocados, almonds, eggs, bok choy, peaches, walnuts, apricots, oats, asparagus, potatoes, buckwheat
& bananas. Also, try not to drink anything after 8 p.m. This can keep you from having to get up to use the bathroom
during the night.
- Restrict nicotine.
Having a smoke before bed - although it feels relaxing - actually puts a stimulant into your bloodstream. The effects of nicotine
are similar to those of caffeine. Nicotine can keep you up & awaken you at night. It should be avoided particularly near
bedtime & if you wake up in the middle of the night.
- Avoid napping.
Napping can only make matters worse if you usually have problems falling asleep. If you do nap, keep it short. A brief 15-20-minute
snooze about 8 hours after you get up in the morning can actually be rejuvenating.
- Keep pets off the bed.
Does your pet sleep with you? This, too, may cause you to awaken during the night, either from allergies or pet movements.
Fido & Fluffy might be better off on the floor than on your sheets.
- Avoid watching TV, eating
& discussing emotional issues in bed. The bed should be used for sleep & sex only. If not, you can end up associating
the bed with distracting activities that could make it difficult for you to fall asleep.
It is not what we take up, but what we give up, that makes us rich.
Henry Ward Beecher
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Restless Legs Syndrome Sends Nocturnal Blood Pressure Up By Neil Osterweil, Senior Associate Editor, MedPage Today
April 10, 2007
MONTRÉAL, April 10 - Restless
legs syndrome may boost nocturnal blood pressure & exacerbate cardiovascular disease risks, particularly among
older patients, investigators here suggested.
Older adults with restless legs syndrome of long duration may be particularly at risk, reported Paola A. Lanfranchi, M.D., M.Sc.,
of the Hôpital du Sacré Coeur de Montréal & colleagues, in the April 10 issue of Neurology.
Blood pressure surges
related to periodic leg movements during sleep might affect the cardiovascular system of otherwise healthy patients, they
wrote, citing several epidemiologic studies between those with restless legs syndrome &
legs syndrome has been associated in population-based studies with increased risk for coronary artery disease
& hypertension, the mechanisms underlying the increased risk are unknown, the authors wrote.
They enrolled 4 women & 6 men with the syndrome into a study
assessing both heart rate & blood pressure changes associated with periodic leg movements during sleep, with or without
EEG signs of arousal.
The patients, mean age 47.3 + 13.5 years,
spent one night in a sleep lab, during which they were monitored with polysomnography & noninvasive beat-to-beat blood
pressure monitoring. For each participant, 10 periodic leg movements during sleep with microarousals & 10 periodic leg
movements during sleep without microarousals were given cardiovascular analysis.
Both systolic & diastolic blood pressures were
measured within a 25-beat temporal window comprising 10 beats before the onset of each movement & 15 beats afterward.
Blood pressure changes related to periodic leg movements
during sleep were with repeated measure using one-way analysis of variance.
Blood pressure changes associated with periodic leg movements
during sleep with & without microarousals were compared by paired t-tests & the authors used Pearson correlation
coefficients to assess the relationship between cardiovascular changes & clinical & polysomnographic variables.
They found that blood pressure increased significantly
in association with all periodic leg movements during sleep, with an average increase in systolic of 22 mm Hg, and increase
in diastolic of 11 mm Hg.
Changes in blood pressure during periodic leg movements during
sleep were significantly greater when they were also associated with microarousals than when there were no microarousals (P<0.05).
Leg movement without microarousals were significantly associated
with one tachycardia, and one bradycardia, and leg movements with microarousals were associated with one tachycardia but no
The authors also found that both the systolic and diastolic
changes associated with periodic leg movements during sleep increased with the age of the participant and with the duration
of restless legs syndrome.
"Our results show a significant increase in systolic blood pressure
and diastolic blood pressure in association with periodic leg movements during sleep without conventionally defined microarousals,"
they wrote. "However, the magnitude of blood pressure changes was greater when periodic leg movements during sleep were associated
with microarousals and increased with duration of microarousals while appearing independent of periodic leg movements during
sleep characteristics. This implies that the intensity of cardiovascular response might be related to the degree of central
activation and less to the somatomotor response."
They noted that there is a repetitive increase in cardiac afterload
with periodic leg movements during sleep that could further affect cardiac function and contribute to disease progression
in heart transplant recipients and patients with systolic heart failure.
The investigators acknowledged that the study was limited by
the small sample size, which limits the power or correlation analyses. They also noted that the patients in the study had
untreated restless legs syndrome and periodic leg movements during sleep.
What is sleep apnea?
Sleep apnea occurs when you
regularly stop breathing for 10 seconds or longer during sleep. It can be mild, moderate, or severe, depending on the number
of times per hour you stop breathing (apnea) or breathe very slowly (hypopnea). Apnea episodes may occur from 5 to 50 times
What causes obstructive sleep apnea?
A blockage or narrowing of
the airways in your nose, mouth, or throat generally causes obstructive sleep apnea (OSA). This usually occurs when the throat
muscles & tongue relax during sleep & partially block the airway.
Sleep apnea can also occur
if you have bone deformities or enlarged tissues in your nose, mouth, or throat. For example, you may have enlarged tonsils.
During the day when you're awake & standing up, this may not cause problems. However, when you lie down at night, the
tonsils can press down on your airway, narrowing it & causing sleep apnea.
Other factors that make sleep apnea more likely include using certain medicines or alcohol before bed, sleeping on your
back & being obese.
This topic discusses simple snoring. If you stop breathing,
choke, or gasp during sleep, you may have a potentially serious condition called sleep apnea. For more information, see the
topic Sleep Apnea.
What is snoring?
Snoring occurs when the flow of air from the mouth or nose to
the lungs is disturbed during sleep, usually by a blockage or narrowing in the nose, mouth, or throat (airway). This causes
the tissues of the airway to vibrate and knock against the back of the throat, resulting in a noise that can be soft, loud,
raspy, harsh, hoarse, or fluttering.
You may not know that you snore. Your bed partner may notice
the snoring and that you sleep with your mouth open. If snoring interferes with your or your bed partner's sleep, either or
both of you may feel tired during the day.
In the past, snoring was often considered no more than a nuisance
that kept a bed partner awake at night. However, snoring may progress to upper respiratory resistance syndrome and obstructive
sleep apnea, a potentially serious sleep disorder in which you periodically stop breathing during sleep. Because of this,
it is important to see your health professional if you routinely snore.
Snoring is common. About 25% to 50% of men and about
25% to 30% of women snore on a regular basis.1
What causes snoring?
You snore when the flow of air from your mouth or nose to your
lungs makes the tissues of the airway vibrate. This usually is caused by a blockage (obstruction) or narrowing in the nose,
mouth, or throat (airway).
When you inhale during sleep, air enters the mouth or nose and
passes across the soft palate (the back of the roof of the mouth) on its way to the lungs. The back of the mouth-where the
tongue and upper throat meet the soft palate and uvula-is collapsible. If this area collapses enough, the airway becomes narrow
or blocked. The narrowed or blocked passage disturbs the airflow, which causes the soft palate and uvula to vibrate and knock
against the back of the throat, causing snoring. The tonsils and adenoids may also vibrate. The narrower the airway is, the
more the tissue vibrates, and the louder the snoring is.
See illustrations of the tonsils, adenoids, and uvula and the soft palate.
How is it treated?
You may be able to treat snoring through lifestyle modifications
such as losing weight (if necessary), quitting smoking, changing sleep habits (such as sleeping on your side instead of your
back), and avoiding the use of alcohol and sedatives before bed. If nasal congestion is disturbing airflow, nasal dilators
(such as nasal strips), decongestants, or nasal corticosteroid sprays may be used. Oral breathing devices, which push the
tongue and jaw forward to improve airflow, may also be an option. If these treatments do not work, continuous positive airway
pressure (CPAP) or surgery may be tried.
Snoring is not always considered a medical problem, so insurance
may not cover treatment.