By Chris Mackey

In today’s 24/7, always-connected lifestyle, getting adequate sleep can get overlooked. About 35% of American adults do not get enough sleep and in 2014 an estimated 83 million adults reported getting less than 7 hours of sleep in a 24 hour period (1).  The Centers for Disease Control and Prevention (CDC) has recognized the lack of sleep among American adults as an important public health problem.  Accidents related to sleep deprivation and the established connection between lack of sleep and chronic disease has led to calls for increased monitoring of sleep problems by public health professionals (2).    

What is Sleep?
Sleep is one of those terms with which we are all familiar, but what we probably don’t realize is how complex of a process it is and some lack of research which still exists.  Until as recent as the 1950s, sleep was thought of as a time when the brain was relatively inactive.  We now know that sleep is a period when the brain is very active, and the kind of sleep we get has a significant impact on us when we are awake.  When we sleep, our brains go through five different stages, stages 1, 2, 3, & 4 and REM, or Rapid Eye Movement. 

Stage 1 is characterized by drifting in and out of sleep.  In stage 1 a person can be awakened easily and often experiences sudden muscle contractions.

Stage 2 occurs when our eye movement stops and our brain waves become slower, but with short bursts of faster waves. Adults spend about 50% of their sleep time in stage 2.

Stage 3 is when very slow brain waves, called delta waves, start to appear, again with faster waves interspersed.

Stage 4 is made up of very slow brain waves, almost exclusively delta waves.  Stages 3 and 4 together are referred to as deep sleep.

REM (Rapid Eye Movement) Sleep, is the part of sleep many of us have heard of and it’s the stage that is equated with dreaming.  We spend 2 hours or more in REM sleep every night. (4)

Why do we sleep?
This is a question that reasearch hasn’t completely answered.  It has been shown, however, that the proper amount of sleep has a multitude of benefits.  Lack of sleep, as we all are aware, makes a person drowsy and can affect coordination and concentration.  Excessive sleep deprivation can even cause hallucinations and mood swings.  Sleep appears to give neurons in our brains a chance to repair themselves and replace the energy lost while we’re awake.  Growth hormone is released in children and young adults during sleep and there is a decrease in the breakdown of protein, which are one of the building blocks of all the cells in the body.  Animal studies have shown that adequate deep sleep can improve learning.  The list of benefits from getting adequate sleep is continually being expanded as researchers learn more.(4) 

Sleep and People with Disabilities
As was already stated, sleep is an active neurological process.  It makes sense that individuals with different neurological functioning may have problems with getting adequate sleep.  People with conditions such as epilepsy, cerebral palsy, a traumatic brain injury, Autism, ADHD or an intellectual disability may be more prone to sleep disturbances.  It’s important to talk to a health care professional to determine what changes in habits, time, or other interventions are most helpful (5).  According to the Rehabilitation and Research Training Center (RRTC) on Aging and Disability at the University of Washington, 40% of people with disabilities report long-term difficulties with sleep. Sleep problems are almost 3 times more common in people with chronic conditions such as traumatic brain injury, spinal cord injury, multiple sclerosis, post-traumatic stress disorder and Parkinson’s Disease than in the general population.  People with disabilities often experience secondary conditions such as chronic pain, mood disorders like anxiety and depression and obesity.  These conditions can interfere with sleep and sometimes be caused by lack of sleep.  Another common problem for people with certain disabilities is sleep apnea.  This is when the muscles and soft tissues of the back of the throat relax too much and temporarily block a person’s airway.  As you might guess, sleep apnea can be serious, but it can also be progressive and fatal. 
 
How to Practice Better Sleep Hygiene: General Tips
Sleeping is like washing your hands in a way.  For sleep to be effective, you must follow certain practices:
•    Go to bed at the same time every night and follow a routine.
•    Begin to “power down” at least 15 minutes before bedtime.  This includes having TV, smart phones, laptops, tablets or other electronic devices turned off.  Research has shown that the light from the screens of these devices can trick the brain into stopping the production of melatonin, a hormone essential for getting to sleep.
•    Avoid caffeine, nicotine, alcohol and sugar for at least five hours before bedtime.
•    Avoid eating prior to sleep to allow time to digest, but also do not go to bed hungry, as this can also wake you from sleep.
•    Do not exercise within two hours of bedtime. Stretching, meditation, or a warm bath before bed may help some get to sleep.
•    Keep stress out of the bedroom. For example, do not work or pay bills there.
•    Keep your bedroom quiet, dark and free from extreme temperatures.       
•    If you’re not asleep in 20 minutes, get out of bed and do something relaxing or boring until you feel sleepy.
•    During the day, get regular exercise and sunlight exposure.(3)

Always remember, you should seek the advice of your health care provider if you or a loved one is having trouble sleeping.  Working together you can find a pleasant night’s rest!

References:
 
1.    Centers for Disease Control and Prevention.  “Getting Enough Sleep?”  Online.  https://www.cdc.gov/features/getting-enough-sleep/index.html. 
2.    Centers for Disease Control and Prevention. “CDC Features: Insufficient Sleep Is a Public Health Problem.” Online https://www.cdc.gov/features/dssleep/ .
3.    Jensen, MP and Terrill, A. (2012). How to Sleep Better [Factsheet]. Aging and Physical Disability Rehabilitation Research and Training Center. University of Washington. http://agerrtc.washington.edu/.
4.    National Institute of Neurological Disorders and Stroke.  The National Institutes for Health.  Brain Basics: Understanding Sleep.  Online: https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Understanding-Sleep
5.    Reif, Rosellen, MS, LPCA, CRC, QDD/MHP.  “Sleep Hygiene and Disabilities: Five sneaky reasons that people with disabilities can’t get a good night’s sleep.” April 27, 2016.  Online. http://www.reifpsychservices.com/sleep-hygiene-disabilities.