More than just insomnia: When should I consult a doctor about my sleep

Did you know that millions of people around the world suffer from sleep disorders without even realizing it?

Insomnia, snoring, and excessive daytime sleepiness are just the tip of the iceberg.

Why can't I sleep?

You might find easy, simple, and deceiving answers to your confusion. This is what "Ali" thought. But after "Ali" discovered what sleep disorders are, he realized the reasons behind the questions that had long perplexed him: "Why do I feel tired during the day? Why don't I wake up refreshed every day?".

Many people believe that sleep disorders are merely a "state of mind." However, scientific research has proven the exact opposite. Most sleep problems have clear physiological and neurological roots. In this article, we will reveal the scientific facts behind your sleep, and answer your questions: "How can I relax while I sleep? How can I get a peaceful night's sleep? Do I need nutritional supplements or medicinal drugs for sleep?". We will provide you with an accurate medical understanding of everything related to sleep disorders.

Good sleep is the foundation for all bodily functions. When this foundation is disrupted, your overall health is directly affected.

The American Academy of Sleep Medicine (AASM) (1) is a leading professional organization dedicated to the science and clinical research of sleep medicine. Founded in 1975, its membership includes thousands of physicians, scientists, and health professionals specializing in the diagnosis and treatment of sleep disorders. The AASM is the primary source for the classification of sleep disorders (ICSD), provides guidelines and standards for clinical practice, and accredits sleep centers to ensure the highest quality of healthcare. Through its research and educational programs, the academy aims to enhance public understanding of the importance of sleep and its impact on general health.

In this article, we will review the most prominent sleep disorders and their classifications, to provide you with a comprehensive guide that helps you understand when your sleep disturbance is just a passing problem, and when it requires medical intervention.

What is Sleep? And What are its Stages?

Understanding the physiology of sleep is crucial to comprehending how the body and mind function during rest. This complex process can be divided into two main stages: non-rapid eye movement (NREM) sleep and rapid eye movement (REM) sleep.

The Stages of Sleep: The Natural Cycle

According to the American Academy of Sleep Medicine (AASM), the sleep cycle begins with the NREM stage, which consists of three substages:

Stage N1 (Drowsiness): This is the transition phase between wakefulness and sleep. It can last for only a few minutes and is characterized by a slowing of heart rate and breathing, and muscle relaxation.
Stage N2 (Light Sleep): This is the longest sleep stage, lasting about half of the total sleep time. In this stage, the heart rate and breathing slow down further, and the body temperature drops.
Stage N3 (Deep Sleep): Also known as "slow-wave sleep." In this stage, it is difficult to wake a person. Most physical restoration processes occur here, such as tissue repair, bone and muscle growth, and strengthening of the immune system. This explains the importance of sleep, especially at night.

After passing through these stages, the brain enters the REM phase.

Rapid Eye Movement (REM) Sleep

This stage is known as "dream sleep," and it is characterized by increased brain activity, which becomes similar to the state of wakefulness.

Characteristics: The eyes move quickly under closed eyelids, heart rate and breathing increase, and the body experiences temporary paralysis (Atonia) to prevent us from physically acting out our dreams.
Function: This stage is critical for learning, memory consolidation, and cognitive development.

The Full Sleep Cycle

The sleep cycle (NREM then REM) repeats several times throughout the night, with each cycle lasting about 90 minutes. At the beginning of the night, deep sleep (N3) is dominant. As the night progresses, the REM sleep stages become longer, which explains why we often remember the dreams we have in the morning.

Factors Affecting Sleep

Circadian Rhythm: This is an internal clock that regulates the wake-sleep cycle over a 24-hour period. Its regulation is affected by light and darkness; light inhibits the production of melatonin (the sleep hormone), while darkness helps to release it. This explains why we sleep at night and find it difficult to sleep during the day.
Sleep Pressure: This is the accumulation of a chemical called adenosine in the brain during wakefulness, which increases the feeling of drowsiness. This pressure decreases during deep sleep. This is why students and learners realize why we feel drowsy when we start studying. It is due to mental exhaustion. And no matter how many stimulants you drink, they won't help with wakefulness but will increase discomfort during sleep.
Melatonin: A key hormone secreted by the pineal gland in the brain in response to darkness, which helps initiate sleep.

Understanding these mechanisms helps us appreciate the importance of maintaining healthy sleep habits to ensure the body and mind operate at their full capacity. For more clarification, you can watch an educational lecture on the physiology of sleep. (2)

What Are the Causes of Insomnia and Sleep Difficulty?

According to the American Academy of Sleep Medicine (AASM), sleep disorders are classified into seven main categories in the "International Classification of Sleep Disorders" (ICSD-3-TR) (3). Here you will find your answer to the perplexing question: "Why don't I get relaxation and rest during sleep?".

Main Categories of Sleep Disorders

Insomnia Disorders: These are characterized by difficulty falling or staying asleep, or waking up too early, which leads to feelings of unrest during the day. Insomnia is classified as:
- Chronic Insomnia Disorder: Lasts for three months or more.
- Short-Term Insomnia Disorder: Lasts for less than three months.
Sleep-Related Breathing Disorders: This category includes problems with breathing during sleep, which leads to a decrease in sleep quality. It includes:
- Obstructive Sleep Apnea (OSA): This is the most common, and it occurs due to a blockage of the upper airway during sleep.
- Central Sleep Apnea Syndromes: Occur due to the brain's failure to send appropriate signals to the breathing muscles.
Central Disorders of Hypersomnolence: These are characterized by excessive daytime sleepiness that cannot be explained by lack of sleep or other disorders. The most prominent types are:
- Narcolepsy: Characterized by sudden and uncontrollable sleep attacks during the day.
- Idiopathic Hypersomnia: Characterized by excessive daytime sleepiness without a clear cause.
Circadian Rhythm Sleep-Wake Disorders: These disorders occur when the timing of sleep is out of sync with the external environment. They are divided into two main types:
- Intrinsic CRSWDs:
  - Delayed Sleep Phase Disorder: The person's sleep and wake times are chronically delayed.
  - Advanced Sleep Phase Disorder: The person goes to sleep and wakes up too early.
- Extrinsic CRSWDs: This classification usually does not require a doctor's visit and can be managed by following guidelines that we at Al-Bayrouni Pharmacy can direct you to.
  - Shift Work Disorder: Affects people who work night or irregular shifts.
  - Jet Lag Disorder: A temporary disorder that occurs due to traveling across different time zones.
Parasomnias: A group of undesirable events and behaviors that occur while falling asleep, during sleep, or upon waking. They include:
- Sleepwalking: The person performs complex actions while asleep.
- REM Sleep Behavior Disorder (RBD): The person physically acts out their dreams.
- Nightmare Disorder: Involves repeated awakenings due to frightening nightmares.
Sleep-Related Movement Disorders: This category includes repetitive or abnormal physical movements during sleep. Examples include:
- Restless Legs Syndrome (RLS): An uncomfortable sensation in the legs with a strong urge to move them.
- Periodic Limb Movement Disorder (PLMD): Involves repeated, involuntary movements of the legs or arms during sleep.
- Sleep Bruxism: The habit of grinding or clenching teeth during sleep.
Other Sleep Disorders: This category includes disorders that do not fall under the six previous categories, such as insomnia related to a medical condition or psychological disorders.

Understanding these diverse classifications of sleep disorders makes it clear that disturbed sleep is not just a minor nuisance, but an indicator of a medical condition that can affect your health in the long term. While some circadian rhythm disorders, such as those caused by travel or shift work, are relatively external and temporary and can be managed with the help of a pharmacist or an initial consultation, the internal and chronic types of sleep disorders mentioned here—from insomnia to sleep apnea—all require a consultation with a sleep medicine specialist. Do not hesitate to seek medical help; the first step towards treatment is understanding the problem, and the goal is for you to return to enjoying peaceful, restful sleep and regaining your energy and vitality every day.

Global Guidelines for Insomnia Treatment

These guidelines are based on changing certain behavioral and daily habits and are known as Cognitive Behavioral Therapy for Insomnia (CBT-I) (4), which is the most effective long-term method. Here are the most important steps:

1. Good Sleep Hygiene

This is a set of habits that help prepare the body and mind for sleep.

Establish a consistent sleep-wake schedule: Try to go to bed and wake up at the same time every day, even on weekends. This helps regulate the body's biological clock.
Create an ideal sleep environment: Make your bedroom dark, quiet, and cool. Use heavy curtains if necessary and avoid having electronic devices in it.
Avoid screens: Avoid using phones, tablets, and the television for an hour before bedtime. The blue light emitted from these screens can inhibit the production of the hormone melatonin, which is responsible for sleep.

2. Set Aside a Specific Time for Relaxation Before Bed

Dedicate 30-60 minutes before bed to relaxing activities that help you unwind and de-stress.

Read a physical book: Light reading (not work or study-related) helps to clear the mind.
Meditation or breathing exercises: These techniques help calm the nervous system.
Take a warm bath: The heat helps to relax muscles and prepare the body for sleep.

3. Avoid Stimulants and Alcohol

Caffeine and Nicotine: Avoid drinking coffee, tea, and caffeinated sodas in the afternoon. Nicotine is also a powerful stimulant that should be avoided.
Alcohol: Although alcohol may make you feel drowsy initially, it disrupts sleep cycles and leads to frequent awakenings.

4. Regular Physical Activity

Exercise: Regular exercise during the day can significantly improve sleep quality.
Avoid exercise before bed: It is preferable to avoid strenuous exercise 2-3 hours before bedtime, as it increases body temperature and energy levels.

Are Nutritional Supplements Safe to Use?

Yes, this is what we learned from the preceding information in cases of circadian rhythm disorders with external causes, such as changing work shifts and long-distance travel across different time zones, or different sleep hours during summer vacation and evenings with family and friends.

Are there nutritional supplements that help my child sleep safely?

For more information on using the appropriate nutritional supplements to get a peaceful night's sleep and wake up refreshed and vital in the morning, you can visit the Al-Bayrouni Pharmac y website or contact customer service. We are honored by your visit to Al-Bayrouni Pharmacy. Our goal is your health and wellness.

More than just insomnia: When should I consult a doctor about my sleep?