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No anxiety, no fear, no insomnia, feel your calm

Sleep anxiety OR Sleep problems

Sleep anxiety OR Sleep problems


2021/10/19,by Anita Jones

Think you have a sleep problem? It's actually not so serious.

“Everyone may experience sleep problems.”

The formula for judging the quality of sleep for ordinary people

“Didn't sleep 7-8 hours.”

“A sleepless night of dreaming.”

“Woke up a few times in the middle.”

“Wake up early.”

Several times did not sleep well

"I'm having sleep problems! Ahhhhhhh!"

Everyone is worried about their sleep problems. However, most people's sleep problems are “sleep anxiety” .

P1: Sleeping well = getting enough sleep for 8 hours?

Not everyone needs to sleep until 7-8h, and this measurement is actually entirely unnecessary.

The 7-8 hours of sleep mentioned in the National Sleep Foundation sleep guidelines are averages based on large population surveys and do not apply to everyone. (1) The appropriate amount of sleep actually varies from person to person. Even for the same person, the need for sleep changes at different stages of life (Figure 1). (1)

In addition, there are differences in sleep needs between people themselves. There are some people called sleepless elite, who have very little need for sleep, sleeping only 3.4 hours a day to achieve the effect of a whole night's rest for the average person. Some famous examples are the Renaissance Leonardo da Vinci, former U.S. President Barack Obama and Donald Trump. Scientists speculate that this significant difference is likely to be genetically determined — each person is actually born with how many hours of sleep per night is appropriate. (2)

So, 7-8h of sleep is just an average, not a 【passing level】. For the matter of sleep, it is much more important to be what you are in yourself than to be averaged.

Figure 1

Data source: American Sleep Foundation (ASF)

Only sleep 8h time is also not very good. We need to consider the biological rules.

 The biological clock, or the body's circadian rhythm, is one of the most important factors controlling circadian wakefulness and sleep patterns. The body is influenced by light to secrete different hormones to regulate the rhythm of wakefulness and sleep (Figure 2): early morning sunlight promotes the secretion of dopamine, hyperalgesia and histamine, while suppressing melatonin to help the brain wake up and stay awake and active; while when night comes and it becomes dark, melatonin in the brain starts to be secreted, increasing sleepiness. (3)

Without a circadian rhythm, the risk of certain health problems remains increased even if you get enough sleep for the same number of hours. Studies have shown that circadian sleep disruptions associated with night shifts are associated with altered cardiometabolic and an increased risk of metabolic syndrome and cardiovascular disease. In addition to this sleep and circadian rhythms out of sync can cause metabolic disorders and bring about obesity problems. (4)

Figure 2

The scientific name for most young people who sleep late and wake up late is Delayed Sleep-Wake Phase Syndrome (DSWPS). (5) It may cause the following symptoms :

  • Excessive sleepiness: It is not easy to stay awake during the day, even to the point of sleepiness.
  • Difficulty concentrating: difficulty staying focused as well as thinking and remembering content.
  • Difficulty performing even routine tasks: lack of sleep impairs judgment and execution.
  • Alcohol or drug abuse: risk of abusing sleeping pills, stimulants, or alcohol to fall asleep or stay awake.

P2: Dreaming all night = not sleeping well?

You feel like you've been dreaming all night, but you haven't.

The human sleep structure is divided into two phases: Non-Rapid Eye Movement (NREM) and Rapid Eye Movement (REM). (6) The whole sleep process is actually composed of NREM (divided into three phases: N1, N2, N3) and REM alternating once in a sleep cycle (Figure 3). Each sleep cycle lasts about 90-120 minutes. About 4-6 sleep cycles are performed each night. (6)

According to the American Sleep Foundation, people spend about 50% of their sleep time in the NMER-N2 stage, which lasts about 20 minutes per cycle. (7.8) Most dreams occur during the REM period, and early morning wakefulness is largely concentrated in this period. (7.8) So when one wakes up one remembers the dream and feels as if one has dreamed all night, but in reality, the dreaming time is only about 2 h. (8)

Figure 3

Information source: American Academy of Sleep Medicine (AASM)

Dreaming does not necessarily mean poor sleep quality.

Dreaming is a normal physiological manifestation of human beings, and it is also an important part of normal, healthy sleep. Numerous studies have shown that dreams play a role in facilitating brain functions such as memory and emotional processing. Good sleep is associated with better cognitive function and emotional health, and research has also linked dreams to effective thinking, memory, and emotional processing. (8.9)

However, some dreams may have a negative impact on sleep, such as nightmares. Nightmares contain frightening, threatening or traumatic content that can cause a person to wake up. Most people have nightmares occasionally, but this does not have much effect on the quality of sleep. Only when nightmares frequently occur that they become a sleep problem. Nightmares lead to waking up in the middle of the night and having difficulty falling back asleep after waking up, which affects the continuity of sleep, increases the risk of insomnia, and ultimately leads to a decrease in sleep quality. This does affect mood and thinking in the long run. (10)

To what extent do nightmares require attention?

  • Frequency of being awakened by nightmares: >1 time per week, or >1 time per night.
  • Being affected by the nightmares in terms of energy level, mood or thinking during the day.

How to go to determine how well you sleep standards, see here:

Judgment criteria: sleep quality

  • Sleep quality up to standard :
  • Less than 30 minutes after you going to bed and falling asleep.
  • Usually sleeps soundly throughout the night, waking up ≤ 1 time per night.
  • Being able to fall asleep again within 20 minutes, even if they wake up in the middle the night.
  • Being able to achieve the recommended length of sleep for the appropriate age group.
  • Waking up in the morning feeling energized.

Poor sleep quality :

  • Time to fall asleep after going to bed > 30 minutes.
  • Waking up frequently during sleep (>1 time per night)
  • After waking up in the middle of sleep, you would lie in bed for more than 20 minutes before falling asleep again
  • Spending <85% of the time asleep/laying in bed
  • Feeling tired during the day and having difficulty concentrating. Need caffeine to stay awake.
  • Beginning to have skin problems, puffy, red eyes, dark circles or bags under the eyes.
  • Feel hungry quickly and crave junk food more often.
  • Being more tense, irritable and mentally tired than usual.
  • Being diagnosed with insomnia.

P3: Sleepless = insomnia?

Your inability to sleep is mostly just a delay before going to bed, and it is impossible to fall asleep immediately when you want to sleep.

Due to the lack of entertainment time in daily life, many people like to play cell phones before bedtime and stay up late to catch up on drama and play games. This sacrifice of sleep time for entertainment is known academically as "Revenge Bedtime Procrastination." (11)

Play to the last minute found unable to fall asleep, this kind of [can not sleep], in fact, not called insomnia. It is normal not to be able to sleep at this time. The brain is always in a state of excitement when entertaining, the body is not ready to go to sleep, and now to the point of having to sleep and want to fall asleep immediately, that is not possible.

Criteria for Revenge Bedtime Procrastination:

  • Delayed sleep time, it is resulting in a reduction in total sleep duration.
  • Deliberately staying up late but without a valid reason for staying up late (such as working late or being sick).
  • Awareness of the negative consequences that may result from delaying bedtime.

The standard of insomnia is higher than you think.

True insomnia: insomnia at least three nights per week and <6h of sleep for at least one month.

Insomnia can be simply understood as a Plus version of poor sleep quality. The main difference from poor sleep quality is the quantification of the frequency of insomnia (>3 times/week), the length of sleep (<6h) and the duration (>30 days). If you can meet this criterion, congratulations, go and see a medical for insomnia!

Finally

There are many causes of insomnia, and different types of insomnia have different etiologies. Commonly, short-term insomnia (lasting less than three months) is mostly associated with stressors and disturbances that disrupt bodily functions, such as changes in the sleep environment, death of a loved one, loss of job, use of certain specific medications, etc. Long-term insomnia (lasting more than three months) is more often based on mental health problems (depression, anxiety), neurological dysfunction and sleep disorders (e.g., sleep apnea syndrome, commonly known as snoring). However, most of the common people's "insomnia" can only be described as poor sleep quality at best.

This is of course based on misconceptions about sleep. This includes.

  • Must sleep enough 8h, and use this as a measure of sleep quality standards
  • Dreaming must be a lack of sleep
  • Mistaking staying up late for insomnia, thinking that you should fall asleep as soon as you want to
  • If you have insomnia once in a while, you think you have a sleep problem

Even insomnia or poor sleep for a few nights is normal. A short period of poor sleep will not be too big a problem, do not be too anxious, so do not rush to put a sleep disorder hat on yourself. After all, it is a person who always has insomnia a few times in life.

Finally, I hope you will start to stop "sleep anxiety" tonight.

References:

  1. Hirshkowitz, Max et al. “National Sleep Foundation's sleep time duration recommendations: methodology and results summary.” Sleep health vol. 1,1 (2015): 40-43. doi:10.1016/j.sleh.2014.12.010
  2. He, Ying, et al. "The transcriptional repressor DEC2 regulates sleep length in mammals." Science 325.5942 (2009): 866-870.
  3. Skene, Debra J., and Josephine Arendt. "Human circadian rhythms: physiological and therapeutic relevance of light and melatonin." Annals of clinical biochemistry 43.5 (2006): 344-353.
  4. Beccuti G, Pannain S. Sleep and obesity. Curr Opin Clin Nutr Metab Care. 2011;14(4):402-412. doi:10.1097/MCO.0b013e3283479109
  5. Sack, Robert L et al. “Circadian rhythm sleep disorders: part II, advanced sleep phase disorder, delayed sleep phase disorder, free-running disorder, and irregular sleep-wake rhythm. An American Academy of Sleep Medicine review.” Sleep vol. 30,11 (2007): 1484-501. doi:10.1093/sleep/30.11.1484
  6. Patel AK, Reddy V, Araujo JF. Physiology, Sleep Stages.
  7. National Institute of Neurological Disorders and Stroke. Brain Basics: Understanding Sleep.
  8. Zhao H, Li D, Li X. Relationship between Dreaming and Memory Reconsolidation. Brain Science Advances. 2018;4(2):118-130. doi:10.26599/BSA.2018.9050005
  9. Fogel, S. M., Ray, L. B., Sergeeva, V., De Koninck, J., & Owen, A. M. (2018). A Novel Approach to Dream Content Analysis Reveals Links Between Learning-Related Dream Incorporation and Cognitive Abilities.
  10. Aurora, R Nisha et al. “Best practice guide for the treatment of nightmare disorder in adults.” Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine vol. 6,4 (2010): 389-401.
  11. Magalhães, P., Cruz, V., Teixeira, S., Fuentes, S., & Rosário, P. (2020). An exploratory study on sleep procrastination: Bedtime vs. while-in-bed procrastination. International Journal of Environmental Research and Public Health, 17(16), 5892.

 

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