Sleep, Insomnia and Sleep Apnea



Sleep, you can’t live a productive life without it but we find it increasingly difficult to find the time to do it and to do it effectively. How many times have you heard that to be healthy we need 8 hours of sleep a night? How many times have you woken up in the morning after trying to get those 8 hours of sleep and still felt tired? Does everyone need the same amount of sleep? Why do some people seem to function on only 5 or 6 hours of sleep a night while other need 9 or 10?  What constitutes a good night’s sleep? Is it the quality of sleep or the quantity of sleep that is most important? What actually happens mentally and physically when we sleep? Does exercise or nutrition affect our ability to get a good night’s sleep? What is Insomnia and sleep apnea, their causes and how can they be treated?

The science of sleep, and sleep conditions that affect the quality of our sleep are not well understood by the general public. This article will try to bring clarity to this issue with the hope that a better understanding of sleep and issues that affect it will lead you to a better night sleep.

What happens When we Sleep

When we sleep the body rests and the brain gets “recharged,” but the brain also stays quite active and controls many of the body’s functions including breathing.

Stages of Sleep

When we sleep, we typically drift between two sleep states: (1) Non- REM and (2) REM (rapid eye movement), in 90-minute cycles.

1. Non-REM sleep – This sleep state has three stages and each has distinct features.

Stage 1 – This is the “drowsiness sleep” stage and occurs when we are first falling asleep. We can easily be awakened in this stage.

Stage 2 – In this stage sleep is referred to as our “average sleep”. It is not too deep, not too light, and it’s where you typically spend about half the night.

Stage 3 – This is your “deep sleep” stage. Trying to arouse you in this stage is more difficult and once awakened a person may feel disoriented for a few minutes. It is the stage where the most positive and restorative effects of sleep occur. The body repairs and regenerates tissues, builds bone and muscle, and strengthens the immune system in this stage. Stage three is also the stage where you will sleep walk and talk. About 20 percent of the night is spent in deep stage 3 sleep, and it mostly happens in the first half of the night.

2. REM sleep – is the active sleep state where dreams occur, breathing and heart rate increase and become irregular, muscles groups relax or become paralysed to keep you from acting out your dreams and eyes move back and forth under the eyelids. REM sleep occurs 90 minutes after sleep onset or at the end of the first sleep cycle. The first period of REM typically lasts 10 minutes, with each recurring REM stage lengthening as stage 3 deep sleep gets shorter. The final REM stage may last up to an hour. As a result, most of our deep sleep (stage 3) happens in the first half of our night, most of our REM sleep happens in the second half of the night.

It should be noted that as you get older, you sleep more lightly and get less restorative deep sleep (stage 3). Unfortunately, aging is associated with shorter time spans of sleep, even though studies have shown that the amount of sleep needed doesn’t appear to diminish with age.

Figure 1 illustrates the different stages of sleep.











Why we Need Sleep

Over the years there are many theories put forth on why we sleep. One of the most respected is called the Restorative Theory

This theory states that sleep serves to “restore” what is lost in the body while we are awake. In other wards, sleep provides an opportunity for the body to repair and rejuvenate itself. This theory is supported by the fact that many of the major restorative functions in the body like muscle growth, tissue repair, protein synthesis, and growth hormone release occur mostly, or in some cases only, during sleep. Interestingly, in a recent animal study animals deprived entirely of sleep and not allowed “restorative time” lost all immune function and die in just a matter of weeks.

To further support this theory, it has been determined that other rejuvenating aspects of sleep are specific to the brain and cognitive function. For example, while we are awake, neurons in the brain produce adenosine, a by-product of the cells’ activities. The build-up of adenosine in the brain is thought to be one factor that leads to our perception of being tired. (Incidentally, this feeling is counteracted by the use of caffeine, which blocks the actions of adenosine in the brain and keeps us alert.) Scientists think that this build-up of adenosine during wakefulness may promote the “drive to sleep.” As long as we are awake, adenosine accumulates and remains high. During sleep, the body has a chance to or clear adenosine from the system and restore proper chemical balance, and, as a result, we feel more alert when we wake.

Benefits of Sleep

Though it is still scientifically unclear why we need sleep it is well established that there are many healthy benefits of sleep.

1. Improved Memory – During sleep you can strengthen mental memories or physical practice skills learned while you were awake. This is a process called consolidation.

2. Live longer– many long-term studies have shown that too little sleep is associated with a shorter lifespan due to sickness or disease although it’s not clear if it’s a cause or effect.

3. Curb Inflammation – Inflammation is linked to heart disease, stroke, diabetes, arthritis, and premature aging. Research indicates that people who get less than six hours a night have higher blood levels of inflammatory proteins than those who get more.

4. Creativity – Researchers have found that people seem to strengthen the emotional components of memory during sleep, which may help spur creativity.

5. Cognitive and Physical performance– many studies have linked enhanced or deteriorating mental and physical performance to good or poor sleep patterns.

6. Weight control – Sleep and metabolism are controlled by the same sectors of the brain. When you are sleepy, certain hormones go up in your blood, and those same hormones increase your appetite. Interestingly, researchers found that dieters shed similar amounts of total weight regardless of sleep but dieters who were well rested lost more fat, 56% of their weight loss, than those who were sleep deprived who lost more muscle mass.

7. Avoiding Accidents – Sleeplessness affects physical agility, coordination and balance as well as cognitive reaction time and decision making.

8. Managing Depression – sleep has been found to reduce a person’s anxiety, impatience and stabilize mood. It is felt that sleeps help restore chemical balance in the brain to help those vulnerable to depression.

Chronic Medical Conditions Associated with Deprivation of Adequate Sleep

1. Obesity– Several studies have linked insufficient sleep and weight gain. For example, studies have shown that people who habitually sleep less than six hours per night are much more likely to have a higher than average body mass index (BMI) and that people who sleep eight hours have the lowest BMI.

2. Diabetes– Researchers have found that insufficient sleep may lead to type 2 diabetes by influencing the way the body processes glucose, the high-energy carbohydrate that cells use for fuel. One sleep restriction study found that a group of healthy subjects who had their sleep cut back from 8 to 4 hours per night processed glucose more slowly than they did when they were permitted to sleep 12 hours

3. Heart Disease and Strokes – Studies have found that a single night of inadequate sleep in people who have existing hypertension can cause elevated blood pressure throughout the following day.

4. Mood and depression – In one study, subjects who slept four and a half hours per night reported feeling more stressed, sad, angry, and mentally exhausted. In another study, subjects who slept four hours per night showed declining levels of optimism and sociability as a function of days of inadequate sleep. All of these self-reported symptoms improved dramatically when subjects returned to a normal sleep schedule.


Insomnia is the most common sleep disorder in adults.

Insomnia is a condition that involves the following symptoms;

  • Difficulty falling asleep
  • Waking up frequently during the night
  • Difficulty returning to sleep
  • Waking up too early in the morning
  • Un-refreshing sleep
  • Daytime sleepiness
  • Difficulty concentrating
  • Irritability

Insomnia becomes a clinical problem when;

  • A person experiences trouble falling asleep three or more nights per week
  • Day time functioning is impaired
  • Sleep difficulties have persisted for more than one month.


  • Over 1/3 of the adult public reports insomnia symptoms
  • For around 10% of the population insomnia is a persistent problem that impairs daytime functioning.
  • Insomnia is more common among ;
    • Women
    • Older adults
    • Shift workers
    • People with medical or psychological disorders.


  • Emotional/Mental– stress,  anxiety and depression
  • Physical– Chronic pain
  • Medical –  Respiratory , cardio-vascular and digestive problems
  • Medications – cold and allergies, heart, thyroid, pain, birth control, depression.

Treatment for Insomnia

1. Identify and treat the secondary cause.(ie – emotional, physical, medical, medications)

2. Behaviour Therapy

  • Stimulus Control Therapy: creating a sleep environment that promotes sleep
  • Cognitive Therapy: learning to develop positive thoughts and beliefs about sleep
  • Sleep Restriction: following a program that limits time in bed in order to get to sleep   and stay asleep throughout the night.

3. Relaxation techniques –  such as yoga, meditation, and guided imagery may be especially helpful in preparing the                                                body to sleep.

4. Exercise– done early in the day, can also be helpful in reducing stress and promoting deeper sleep.

5. Nutrition

  • Following a proper balanced diet
  • No heavy meals close to bedtime.
    • Emphasis on minimizing fat, sugar , nicotine, caffeine and alcohol intake.  (Alcohol is known to speed up the onset of sleep but it disrupts sleep in the second half as the body begins to metabolize the alcohol, causing arousal).

6.  Good sleep hygiene – which involves maintaining a regular wake and sleep pattern.

7. Medications/sleep aids (hypnotics) – Sleep medications for the treatment of insomnia are called hypnotics. They                                                                       should only be taken when:

  • The cause of your insomnia has been evaluated
  • The sleep problems are causing difficulties with your daily activities
  • Appropriate sleep promoting behaviours have been addressed

It is important to note the possible side effects of taking hypnotics, such as morning sedation, memory problems, headaches, sleepwalking and a night or two of poor sleep after stopping the medication. Women who are pregnant or nursing should not take hypnotics.

Sleep Apnea

What is Sleep Apnea

Sleep Apnea is a type of sleep disorder characterized by pauses in breathing or instances of shallow or infrequent breathing during sleep. Each pause in breathing, called an apnea, can last from at least ten seconds to several minutes, and may occur 5 to 30 times or more an hour.

An individual with sleep apnea is rarely aware of having difficulty breathing, even upon awakening. Usually, sleep apnea is recognized as a problem by others witnessing the individual during episodes of apnea or is suspected because of its effects on the body. Symptoms may be present for years (or even decades) without identification, during which time the sufferer may become conditioned to the daytime sleepiness and fatigue associated with significant levels of sleep disturbance.

The diagnosis of Sleep Apnea is often confirmed with an overnight sleep test called a  polysomnogram, or “sleep study”

Types of Sleep Apnea

  • Obstructive sleep apnea (84%). It occurs when the soft tissue in the back of your throat relaxes during sleep and blocks the airway, often causing you to snore loudly.
  • Central sleep apnea (.4%) involves the central nervous system and involves the brain failing to signal the muscles that control breathing. People with central sleep apnea seldom snore.
  • Complex sleep apnea (15%) is a combination of obstructive sleep apnea and central sleep apnea.

What Happens During a Sleep Apnea Episode

During each pause in breathing (apnea) the airflow to the lungs stop and the oxygen level in your blood drops. Your brain responds by briefly disturbing your sleep enough to kick start breathing—which often resumes with a gasp or a choking sound. If you have obstructive sleep apnea, you probably won’t remember these awakenings. Most of the time, you’ll stir just enough to tighten your throat muscles and open your windpipe. In central sleep apnea, you may be conscious of your awakenings.

Risk during an Apnea Episode

The breathing pauses (Apnea) reduces blood oxygen levels, which puts additional strain the heart and cardiovascular system by raising blood pressure and therefore increases the risk of stroke or heart attack.

Major signs and symptoms of sleep apnea

  • Pauses in breathing occur while you snore, and if choking or gasping follow the pauses.
  • Fighting sleepiness during the day, at work, or while driving. You may find yourself rapidly falling asleep during the quiet moments of the day when you’re not active.
  • Morning headaches
  • Memory or learning problems and not being able to concentrate
  • Feeling irritable, depressed, or having mood swings or personality changes
  • Waking up frequently to urinate
  • Dry mouth or sore throat when you wake up

Do You Have Sleep Apnea

These questions can help you determine if you should be tested for sleep apnea.



1. Do you snore more than three nights a week? Yes (2 points)
 2. Is your snoring loud (can it be heard through a door or wall)? Yes (2 points)
3. Has anyone ever told you that you briefly stop breathing or gasp when you are asleep? Occasionally (3 points)Frequently    (5 points)
4. What is your collar size? Men- Greater than 17 “  (5 points)Women – Greater than 16”  (5 points)
5. Have you had high blood pressure, or are you being treated for it? Yes (2 points)
6. Do you ever doze or fall asleep during the day when you are not busy or active? Yes (2 points)
7. Do you ever doze or fall asleep during the day when you are driving or stopped at a light? Yes (2 points)

Interpreting the score:

  • 0 to 5: Low probability of sleep apnea. 
  • 6 to 8: It’s uncertain whether you have sleep apnea. You may consider a sleep study to confirm the diagnosis and appropriate treatment
  • 9 +: You may have sleep apnea. You may consider a sleep study to confirm the diagnosis and appropriate treatment

Snoring vs Sleep Apnea

Not everyone who snores has sleep apnea, and not everyone who has sleep apnea snores. So how do you tell the difference between normal snoring and a more serious case of sleep apnea?

The biggest tell tale sign is how you feel during the day. Normal snoring doesn’t interfere with the quality of your sleep (though it may affect your sleep partners quality of sleep considerably ) as much as sleep apnea does, so you’re less likely to suffer from extreme fatigue and sleepiness during the day.




Risk Factors for Sleep Apnea

Risk Factors for Obstructive Sleep Apnea

Risk Factors for Central Sleep Apnea

  • Overweight
  • Male
  • Related to someone who has sleep apnea
  • Over the age of 65
  • Black, Hispanic, or a Pacific Islander
  • A smoker
  • Thick neck (> 17 “)
  • Deviated septum
  • Receding chin
  • Enlarged tonsils or adenoids
  • Allergies or medical conditions that cause nasal congestion or blockage
MaleOver age 65Heart diseaseStrokeNeurologic DiseaseSpinal or brain stem injury

Treatment for Sleep Apnea

Self Help Treatments

Lifestyle modifications can go a long way in reducing sleep apnea symptoms.

  • Weight loss– People who are overweight have extra tissue in the back of their throat, which can fall down over the airway and block the flow of air into the lungs while they sleep.
  • Quitting smoking. – Smoking is believed to contribute to sleep apnea by increasing inflammation and fluid retention in your throat and upper airway.
  • Avoiding alcohol, sleeping pills, and sedatives, especially before bedtime as they relax the muscles in the throat and interfere with breathing.
  • Avoiding caffeine and heavy meals within two hours of going to bed.
  • Maintaining regular sleep hours. Sticking to a steady sleep schedule will help you relax and sleep better. Apnea episodes decrease when you get plenty of sleep.
  • Sleep on your side. Avoid sleeping on your back, as gravity makes it more likely for your tongue and soft tissues to drop and obstruct your airway.

Bedtime tips for preventing sleep apnea

  • The tennis ball trick. In order to keep yourself from rolling onto your back while you sleep, sew a tennis ball into a pocket on the back of your pajama top. Or wedge a pillow stuffed with tennis balls behind your back.
  • Prop your head up. Elevate the head of your bed by four to six inches or elevate your body from the waist up by using a foam wedge. You can also use a special cervical pillow.
  • Open your nasal passages. Try to keep your nasal passages open at night using a nasal dilator, saline sprays, breathing strips, or a neti pot.

Medial Treatment Options

1. Continuous Positive Airflow Pressure (CPAP) Machine

This is the most common treatment for moderate to severe obstructive sleep apnea. The CPAP device is a mask-like machine that provides a constant stream of air that keeps your breathing passages open while you sleep. Most CPAP devices are the size of a tissue box.

In many cases, the patient will experience immediate symptom relief and a huge boost in your mental and physical energy.





2. Dental devices for sleep apnea

Dental devices are usually only effective for mild to moderate sleep apnea Most dental devices are acrylic and fit inside your mouth, much like an athletic mouth guard. Others fit around your head and chin to adjust the position of your lower jaw. Two common oral devices are the mandibular repositioning device and the tongue retaining device. These devices open your airway by bringing your lower jaw or your tongue forward during sleep.

It is very important to get fitted by a dentist specializing in sleep apnea, and to see the dentist on a regular basis for any dental problems that may occur. You may also need to periodically have your dentist adjust the mouthpiece to fit better.

3. Surgery as treatment for sleep apnea

If you have exhausted other apnea treatment options, you may want to discuss surgical options with your doctor or sleep specialist. Surgery can increase the size of your airway, thus reducing your episodes of sleep apnea.

The surgeon may remove tonsils, adenoids, or excess tissue at the back of the throat or inside the nose. Or the surgeon may reconstruct the jaw to enlarge the upper airway. Surgery carries risks of complications and infections, and in some rare cases, symptoms can become worse after surgery.


It is evident that the amount and quality of sleep you get is necessary to live healthy and productive. Early detection of the signs and symptoms of sleep deprivation (insomnia) or sleep apnea is a vital component in managing these conditions. There is something to be said for getting your “beauty” sleep and is an important component, along with a balanced diet and exercise, to a healthy lifestyle.

If you’d like more info please contact Mike.

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