Before you read the information regarding sleep, answer the following questions about your current sleep patterns:
1. How many hours a night, on average, do you sleep?
2. How many hours a night, on average, do you lie awake in bed?_
3. When you wake in the mornings, do you feel refreshed and ready to get started on a new day?_
4. If you take a nap or naps during the day, how many hours, on average, do you sleep?_
5. On a scale of 1 to 5, with 1 being excellent and 5 being extremely poor, how would you rate your sleep habits?
Sleep deprivation results in fatigue (no surprise there), irritability, decreased attention span, slower response time, memory gaps, and impaired judgment. Sleep is essential to maintain memory functions. There are two primary types of sleep: rapid eye movement (REM) sleep, during which you dream, and non-REM, or slow-wave sleep. The sleep cycle can be divided into stages that you cycle through approximately every 90 minutes (an ultradian rhythm). Non-REM sleep accounts for 75 percent of your sleep and has four stages. As you progress through the stages, sleep becomes deeper and brain waves become larger. After you reach the deepest level of sleep in stage four, sleep begins to lighten until you reach REM sleep. It appears that different types of learning may be facilitated within the different types of sleep, (See Figure 6-2).
During REM sleep, activity in the brain begins in the pons and other midbrain areas. The pons communicates with the cerebral cortex and the thalamus. The pons also "turns off" motor neurons in the spinal cord, preventing movement.
REM sleep is important to procedural memory formation of tasks such as typing and playing the piano. People who learned a repetitive task were found to be more efficient at the task after sleeping and experiencing REM sleep. In one study, subjects were trained on a task in the evening. During the night, some of the subjects were awakened each time they entered REM sleep, and the rest were awakened each time they entered non-REM sleep. Those who were awakened during REM sleep were just as efficient as they were the evening before. However, those who were awakened during non-REM sleep demonstrated significant improvement in performance over the performance levels of the evening be-fore.3 Another type of memory, called declarative, in which
Figure 6-2 Different types of sleep memories are formed for events such as the vacation you took, people you visited, and conversations you had, also requires REM sleep for consolidation of information.
Recall from earlier chapters that REM sleep makes it possible to transfer new learning to long-term memory. REM sleep occurs earlier and lasts longer for individuals who have participated in intense learning experiences. REM sleep is a required part of the learning process during which the brain's memories are replayed and compacted to conserve space. This allows the brain to conserve space more efficiently. As a point of interest, animals that do not possess the capability for REM sleep, like dolphins, have disproportionately larger brains.
The hippocampus also becomes involved as potential memories encountered during the day and determined to be important enough to store are transferred to long-term memory. One research study used mice to explore the learning process. When mice were introduced to a new environment, the hippocampus' nerve cells began firing. That night, while the mice were in non-REM sleep, the neurons in the hippocampus began to fire again in the same pattern experienced earlier in the day, but in shorter, faster bursts. And like an echo from a canyon wall, the cortex responded with neurons firing in a responsive similar pattern.4
In Chapter 4, you learned that patients under the influence of anesthesia and exposed to word associations on a recording could recall a statistically significant number of the associations. Another study involved participants who learned a complex logic task while an auditory signal, a clicking noise, occurred in the background. During REM sleep after the learning experience, some members of the group were re-exposed to the clicking noise and some were not. Those exposed to the same auditory stimuli during REM sleep retained the information 23 percent better than the group that did not hear the clicking noise during REM sleep. Do you remember the theory of playing records while you sleep to learn a foreign language or other material? The processing of information continues while we are asleep. So, not only do we process events we have experienced throughout the day, but we can subconsciously add to these memories. Many health professionals recommend that loved ones talk to unconscious patients with words of encouragement and support to aid the healing process. And how many of us have soothed a fretful baby back to sleep before he fully wakens by whispering words of love and comfort?
As we age, many people experience a disruption of natural rhythms, especially sleep patterns. We also experience changes in our alertness rhythm, especially men. This could be related to the fact that men experience shorter REM cycles, wake up more frequently, and experience less slow-wave sleep. Women do not seem to suffer as much disruption as men. Another change in natural rhythms accounts for a shift in sleeping times. Elders tend to be more alert in the morning and become drowsier in the afternoon.5
Insomnia is trouble falling or staying asleep and is considered chronic when the symptoms last for more than three weeks. After even one night of interrupted sleep, people complain of irritability, shorter attention span, memory gaps, and impaired judgment. Insomnia can exacerbate these symptoms. More than 50 percent of chronic insomnia cases can be attributed to emotional stress such as depression or anxiety. Typically, depression causes you to awaken early, whereas anxiety may prevent you from going to sleep. Pain, restlessness, or other symptoms of illnesses also can disrupt your sleeping patterns.
Moreover, once your sleep is disrupted, learned insomnia can keep you awake until the pattern is broken. My mother experienced learned insomnia after she moved to the country. The barking of her dog at foraging nocturnal animals would awaken her. She then would get out of bed to check on the dog, and since she was awake, she would treat herself to something sweet to eat. Before too long, she was waking up at about that hour of the night regardless of whether the dog was barking. Her body had "learned" to wake up at an inappropriate time. Irregular sleep patterns, such as staying up late and sleeping in on the weekends, also can disrupt your sleep patterns. In addition, some medications can work on the central nervous system and prevent restful sleep from occurring.
Interestingly, more than 50 percent of those people 65 years old and older experience regular disruptions of sleep cycles. Many elders do not produce sufficient quantities of melatonin or do not have sufficient melatonin receptors in the brain.6 This inhibits the ability to initiate and maintain sleep during the night. Melatonin is produced by the pineal gland in the brain in rhythmical cycles, with high production levels at night and minute quantities produced during the day. See Figure 6-3.
Many seniors whose brains have ceased manufacturing adequate levels of melatonin can benefit from doses of mela-tonin approximately two hours before bedtime. Alzheimer's patients, who also have reduced levels of melatonin, bene-
fit from melatonin supplements as well. If the trouble is going to sleep, but once you fall asleep you can stay asleep, some physicians recommend fast-release melatonin supplements. If you have trouble staying asleep, a controlled-release form of melatonin may help. It may take several days to a week before you see an improvement and begin to reinstate your natural cycle.7 These supplements are somewhat controversial, and you should not take them without your physician's approval because of possible drug interactions and questionable quality control of many over-the-counter supplements.
Research indicates that Alzheimer's patients get less REM sleep than normal adults.
A survey of 1,400 retirees at the National Institute of Health and Medical Research in Paris discovered that half the individuals had breathing problems during sleep, such as snoring or sleep apnea. Approximately 44 percent of older adults also experience periodic limb movement in sleep (PLMS). Symptoms are leg movements and kicks repeated every 20 to 40 seconds throughout the night. Each movement causes the person to arouse enough to prevent restful sleep.8
When your internal clock goes off schedule, sleeping cycles suffer. Sleep is a critical ingredient in the learning process and in our ability to recall information later. "When apnea led to daytime sleepiness, researchers found, the person showed significant loss of short-term memory and alertness on psychological test, the kind of mental slippage that can lead to dementia." Sonia Ancoli-Israel, Director of the Sleep Disorders Clinic at San Diego's Veterans Administration Hospital says, "If you treated sleep problems in people with mild dementia, I think there's a chance their mental deterioration would improve."9
If you suffer from insomnia, you might check with your physician and pharmacist about possible side effects of your medications that may interfere with your sleep cycle. Some drugs, such as some beta-blockers prescribed for hypertension, interfere with the production of melatonin in the brain. Others may interfere with its absorption. Perhaps you can have your doctor prescribe a different type of drug that will not interfere with your production or absorption of melatonin.
Some people use alcohol as an aide to go to sleep. It does relax you initially, but several hours later, when the alcohol is depleted, it results in insomnia. You can use other techniques to induce relaxation and help you fall asleep.
Can't Sleep? Try These Tips:
Plan to avoid insomnia.
Don't watch TV or read before going to bed.
Get some physical exercise during the day.
Avoid caffeine, alcohol, and tobacco.
Avoid illuminated bedroom clocks.
Keep your bed a place for sleep.
Don't sleep late on weekends.
Get up earlier in the morning.
Keep regular bedtime hours.
Sleep on a good, firm bed.
Visualize something boring. Imagine it's time to get up. If you can't sleep, get up. Try progressive relaxation. Count happy thoughts. Rub your stomach. Eat a bedtime snack. Sleep on your back. Wiggle your toes. Take a warm bath. Drink warm milk. Listen to music. Breathe deeply. —list compiled by Oufei Zhao
Not only do you need to get adequate sleep each night, you need to have a regular sleep schedule from day to day. Some helpful hints used in an eldercare facility to facilitate maintenance of a proper sleep schedule may be helpful for you as well:10
• If physically possible, do not remain in bed for more than one hour when not sleeping. Remaining in bed may confuse your circadian sleep/wake cycle.
• Establish and follow a regular wake/sleep cycle. Try to get to bed about the same time each night except on special occasions.
• Match roommates' night and day routines as closely as possible. You may not have a roommate, per se, but if your spouse or other family members keep a different schedule than you, it may interfere with your ability to maintain an uninterrupted sleep cycle.
• No matter how tired or depressed you may be, get out of bed and get busy. You must tire yourself a little in order to be ready for sleep at bedtime.
• Avoid caffeine in beverages, chocolates, and medications. Read the labels. You will be surprised at what has caffeine in it, especially medications.
• Keep the facilities as bright as possible during the day. It will help your overall attitude and literally brighten your day. If you can open the window shades and get some sun, it will assist your circadian rhythms.
• Keep rooms as dark as possible during the night. It will assist you in staying asleep once you get to that blessed state.
• Minimize nighttime noise and disturbances.
• Limit naps to one per day for a maximum of 30 minutes each. If you sleep too much during the day, you will not be ready to sleep at night. Remember how you have to keep little babies up during the day so they will sleep at night if their schedule gets off.
• Encourage clients to go outside and get as much exposure to sunlight as possible. You may need help resetting that biological clock in order to rest.
Because sleep is so essential to your mental capability and quality of life, we tried to include brief descriptions of as many disruptions to a good, restful sleep as possible. You may have found some information about sleep that pertains directly to you. If you rated your sleep satisfaction as a 3, 4, or 5, did you discover any suggestions that might help you to achieve a higher quality of sleep?
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