Please share an interesting fact about the benefits of sleeping better.

People: People who sleep 8 hours every night find it easier to maintain their healthy weight.

When: When we dream our brain wave activity is the same as when we are awake.

A new TipTap: Magnesium is essential for hormone regulation & nerve function. Bedtime supplements can be great!

A new TipTap: Try magnesium at night. It's a good relaxer.

Good: Good matress is essential. Negate light and noise. Avoid late alcohol & don't watch news before sleep.

Sleep: Sleep hygiene, CPAP when advised, mrd when advised are all important for a proper night's rest.

It: It is now known that young people who miss sleep may have higher risk for ms.

Sleeping: Sleeping better can help you lose weight.

Wake: Wake up with aches and pains? May be your mattress. Check out a new one. Too hard isn't good.

People: People who sleep better lose more weight, have better sex lives, and less heart disease.

Start: Start a sleep routine & roll back your bedtime to achieve the number of hours of rest you feel best with.

It's: It's a myth that a good night's sleep must be uninterrupted sleep.

Put: Put a pillow between your legs when sleeping on your side to sleep better.

Drinking: Drinking alcohol causes more frequent awakenings at night and less restful sleep.

Avoid: Avoid external light from computer and other electronics within 2 hours of sleep.

Exercising: Exercising can help your sleep.

Drinking: Myth: drinking alcohol will help you get a good night's sleep. That's false!

Sleep: Myth: sleep medicines are the only way to improve your sleep. That's false!

Adults: Adults need 7 to 8 hours of sleep a night. Sleep early, avoid caffeine, and habituate a good regimen.

When: When you sleep better, you are more creative.

People: People who sleep better live longer. Sleep better means enough time and improved quality.

Take: Take a hot shower 1 1/2 or 2 hours before bedtime and create a calm and dim light an hour before.

Nightmares: Nightmares might be due to medications that you are taking. Common ones are blood pressure meds.

Sleep: Sleep apnea is not a disease of obese people. 30% of people with sleep apnea are non-obese.

Poor: Poor sleeping is associated with increased risk for metabolic disorders such as diabetes.

Avoid: Avoid any light in bedroom at night as your melatonin levels will drop and affect your sleep.

Calcium-rich: Calcium-rich foods help sleep. Examples are milk, yogurt, cheese, kale, and broccoli.

Magnesium-packed: Magnesium-packed foods such as bran from rice, wheat , or oats, helps with sleep.

Banana,along: Banana, along with fortified cereals, chickpeas & fish, have vitamin b6 which helps make melatonin.

Small: Small study finds evidence people may sleep worse around time of full moon.

Sleep: Sleep deprivation may lead to decreased performance, alertness, memory; and cognitive impairment.

Sleep: Sleep deprivation may lead to: hypertension, stroke, heart attack, obesity, depression, moodiness.

Better: Better sleep goes beyond boosting your mood, memory, weight, beauty, skin, whole body, mind & soul!

Sleep: Sleep biology: if you need little sleep as a child you may need little sleep as an adult.

Exercise: Exercise program plus better sleep habits helped people with insomnia sleep longer, better over time.

Participating: Participating in low-intensity yoga sessions twice a week for a month decreased sleep medication use.

Upto: Upto 40 % or more, of people can have insomnia for more than 10 years.

90: 90 % of chronic insomnia usually greater than 3 to 6 months are due to medical, psychiatric, sleep.

Paradoxical: Paradoxical insomnia is when subjective experience of sleep does not correlate with objective measur.

Insomnia: Insomnia affects memory, relations, job performance, concentration, pain, poor health, risk of falls.

Risk: Risk factors for insomnia include older age, female, lonely, psych, medical, smoking, coffee, alcoho.

Insomnia: Insomnia is caused by hyperarousal of autonomic system, more beta, less delta brain waves etc.

Common: Common psych issues in insomnia are anxiety, mood and substance abuse problems.

Common: Common medical issues in insomnia, heart, lung, rheumat, endocrine, kidney, gi, pain, meds.

Common: Common sleep issues with insomnia are circadian rhythm disorders, sleep disordered breathing, rls.

Major: Major depression, substance dependence, heart and lung problems major risk factors for insomnia.

Upto: Upto 40 % of insomnia patients may have high blood pressure of hypertension.

Sleeping: Sleeping less than 6 hours increases risk for high blood pressure, diabetes, attention, memory, slow.

Upto: Upto 40 % of perimenopausal women report insomnia.

Insomnia: Insomnia may predict increased risk of anxiety, major depression, dysthymia, alcohol, drug use.

More: More than 33% of patients with insomnia may have sleep apnea & 33 % of sleep apnea patients insomnia.

Treatment: Treatment of insomnia, treat psych, medical cause, sleep cause, good sleep hygiene, cbti, medications.

Set: Set aside a block of time for "worry" and block of time for "relaxation, meditation".

Older: Older people tend to make more medications which can put them at higher risk for insomnia.

Did: Did you know that women are more likely to experience insomnia then men?

SLEEP: Sleep facts: consistently waking earlier in the morning then desired may be a symptom of depression.

We: We need to sleep - it replenishes a type of brain cell: oligodendrocytes. Get your rest.

Periodic: Periodic limb movement disorder is characterized by periodic episodes of repetitive and highly stere.

RLS,: Rls, speculated etiologies include iron deficiency, folate deficiency, hormonal changes.

Naloxone: Naloxone reactivates RLS symptoms in opioid treated patients; however, Naloxone does not block the a.

Gabapentin: Gabapentin and anticonvulsants, consider first line when “pain” is a significant factor.

RLS: Rls treatment, treatment: ferrous sulfate 325 mg plus 100 mg vitamin c, 1 or 2 hr after meals tid.

RLS: Rls responds to all central Dopamine enhancing agents tested.

The: The risk of developing RLS during pregnancy increases with each successive pregnancy.

RLS: Rls is equally prevalent in girls and boys prior to puberty.

80%: 80% of RLS subjects display plms with large variability night-night and with age.

PLM: Plm = periodic limb movements (s): characteristic limb movements (0.5 - 5 now 10 sec duration) that.

Nocturnal: Nocturnal spell: any behavior that occurs during the hours of sleep.

Seizure:: Seizure: a synchronized abnormal electrical activity in the brain which causes a symptom.

Epilepsy:: Epilepsy: a predisposition to having seizures; usually defined as two or more seizures.

Ictal:: Ictal: the behavioral and/or eeg manifestations of an electrical seizure.

Parasomnia:: Parasomnia: an abnormal, often undesirable, behavior that occurs out of sleep (which is not related.

A: A single eeg will show epileptiform abnormalities in approximately 50% of adult patients with epilep.

Approximately: Approximately 1 in 10 individuals will have a seizure at some point in their lives.

20%: 20% of patients with epilepsy have seizures solely while asleep.

75%: 75% have seizures while asleep and awake.

10: 10 to 30 % of epilepsy patients have comorbid obstructive sleep apnea.

Sleep: Sleep (loss) can increase the rate of seizures.

Vagal: Vagal nerve stimulation in epilepsy may increase sleep related breathing disorder.

Lyrica (pregabalin): Lyrica (pregabalin) can increase slow wave or delta sleep.

Treatment: Treatment of obstructive sleep apnea improves seizure frequency by 50% in 28-70% of patients.

Treatment: Treatment of periodic limb movements of sleep may improve seizure frequency in patients.

NREM: Nrem sleep – control of ventilation entirely metabolic under control of chemoreceptors and ventilato.

REM: Rem sleep – phasic changes affect breathing – not entirely under metabolic control. Lower ventilator.

Rapid: Rapid eye movements during active sleep can be seen as young as 30-31 weeks gestation.

Periodic: Periodic breathing and respiratory pauses are physiological events that commonly occur in preterm in.

After: After 2 months of birth not common to see breathing pauses and periodic breathing.

<: < 6 months, regular breathing, normal muscle tone, rare eye movements, most likely nrem sleep.

As: As we age, the need for adequate sleep still remains…as we get older, we don’t need less sleep!

After: After age 60, only sleep efficiency continued to significantly decrease with all other sleep paramet.

Healthy: Healthy older persons wake up more frequency than do younger persons regardless of circadian phase, .

Day: Day time naps in children are usually give up by age 4.

20-30%: 20-30% of infants, toddlers, and preschoolers have bedtime problems or frequent night wakings.

Children: Children should have a fixed bed time routine, 30 minutes every evening, same exact order of things.

ANY: Any activity that is not sleep when in bed, will train the brain and body that it is ok to not sleep.

Get: Get the child out of bed when they can’t fall asleep for more than 15-20 minutes.

DSPS: Dsps often associated with major depression.

Depression,: Depression, anxiety/autism, adhd most common sleep and psychiatric disorders in children.

Depressive: Depressive symptoms predict insomnia in adolescents, and sleep problems predict later anxiety and de.

For: For children, based on the practice parameters, strongly consider a behavioral type rx over meds.

Children: Children may not present with sleepiness like adults when they have sleep apnea.

Sleep: Sleep is divided into w (wake), nrem (n1, n2 and n3) and rem (rapid eye movements).

Parasomnia: Parasomnia - undesirable motor, or verbal phenomena that arise from sleep or sleep - wake transition.

Sleep: Sleep related eating disorder - a parasomnia characterized by nocturnal involuntary eating or drink.

Adenosine: Adenosine agonists increase sleep and increase eeg slow wave activity during sleep.

Adenosine: Adenosine antagonists (e.g., caffeine) promote waking.

Adenosine: Adenosine antagonists suppress eeg slow-wave activity during sleep.

Cortical: Cortical areas most active during waking exhibit highest levels of eeg swa during subsequent sleep.

Adult: Adult neurogenesis occurs in two brain regions, the subventricular zone (svg) & subgranular zone.

Sleep: Sleep loss of all causes e.g., voluntary, shift work, medical condition, could exacerbate mild osa.

Exogenous: Exogenous melatonin is the prototypical chronobiotic alter of circadian phase through action scn.

Melatonin: Melatonin issues not fda regulated (nutritional supplement) potency more variable; impurities found.

Fertility: Fertility rates are lower in nurses on night shift – risk of anovulatory cycles is greater, .

No: No evidence of teratogenic effects of shiftwork.

Commonly: Commonly used medications in sleep medicine: – to promote sleep – to promote wakefulness – rls.

The: The most common treatments used by chronic insomniacs are over-the-counter (otc) antihistamines.

Fertility: Fertility rates are lower in nurses on night shift.

For: For shift work use caffiene and or modanifil to stay alert at night.

For: For shift work improve quality of sleep with Ambien (zolpidem) like meds during the day.

DSPS,: Dsps, delayed sleep phase syndrome, can't fall asleep, can't wake up early, tired during day.

Instruct: Instruct to take the medication 15 minutes before desired sleep time (not ‘‘bedtime’’).

FDA-approved: Fda-approved for the rx of insomnia: benzodiazepine receptor agonists (bzra) and selective melatonin.

Low: Low dose Doxepin or silenor is also fda approved for rx of insomnia.

Benzodiazepines: Benzodiazepines for insomnia estazolam, flurazepam, quazepam, temazepam, triazolam.

Benzo: Benzo receptor agonists zaleplon, zolpidem, Eszopiclone are also fda approved for insomnia.

Chronic: Chronic insomnia: only Eszopiclone and zolpidem er have been approved without specified “short ter.

–: – eszopiclone: tested for 6 months – zolpidem er: prn use for 24 weeks – doxepin: 12 weeks.

BZRA: Bzra side effects, addiction, daytime sedation, cognitive issues, memory problems, falls, insomnia.

Sleep: Sleep related disorders including somnambulism, sleep related eating and sleep-driving w ambien (zolpidem).

Doxepin: Doxepin or silenor • indicated for sleep maintenance insomnia • 6mg adult, 3mg elderly.

Doxepin: Doxepin contraindications: maoi, narrow angle glaucoma or severe urinary retention.

Doxepin: Doxepin adverse reactions: somnolence/sedation, nausea, and upper respiratory tract infection.

The: The most commonly prescribed medication for the treatment of insomnia in the us = trazodone/desyrel.

There: There are no studies of long-term use of trazodone for treatment of chronic insomnia.

Remeron (mirtazapine): Remeron (mirtazapine) promotes both sleep and appetite (particularly helpful in cancer, aids, etc.).

Remeron (mirtazapine): Remeron (mirtazapine) causes inverse, dose dependent sedation (doses over 15mg are less sedating).

Atypical: Atypical antipsychotics • “all of these agents have significant risks, for rx of insomnia.

OTC: Otc sleep aids valerian, kava-kava, hops, lavender, passion flower, skullcap, melatonin.

Alcohol: Alcohol • chronic insomnia: 6% to 13% • acute insomnia: 15% to 28% (70% women over age 85).

Stimulant: Stimulant Modafinil / provigil – 100 and 200 mg tablets; up to 400 mg – headache, nausea, insomnia.

Dextroamphetamine/: Dextroamphetamine/ dexedrine – 5 mg tablets/5, 10, and 15 mg spansules;up to 60 mg/day – cv effects, .

Methylphenidate: Methylphenidate / Ritalin (methylphenidate) 5, 10, and 20 mg tabs/ 20 mg sr tablets;up to 60 mg/day nervousness, heart.

Pemoline: Pemoline / cylert: off the market in us – 18.75 and 37.5 mg tablets; up to 112.5 mg/day – liver da.

Modanifil: Modanifil fda recognized as a first-line treatment choice for wake promotion (schedule iv).

Caffiene: Caffiene common side effects: gastric stimulation, flushing, sweating, increased heart and respirat.

Caffiene: Caffiene usual dose 50 to 200 mg for wakefulness.

RLS: Rls frequently causes sleep-onset insomnia and occasionally sleep maintenance insomnia.

FDA-approved: Fda-approved medications: pramipexole and ropinirole for rls.

Glycine: Glycine – main spinal cord inhibitory neurotransmitter – responsible for rem muscle atonia/hypotonia.

Growth: Growth hormone secretion – linked primarily to sleep (during n3 sleep) you need "sleep to grow".

Most: Most effective of the non-pharmacologic treatments for insomnia – sleep restriction – stimulus contr.

At: At long-term follow-up, cbt was more effective than pharmacotherapy for insomnia.

Night: Night owl – late bedtime (1-6 am) and late wake time (10 am to 2 pm).

Night: Night shift work – stimulants during night shift – bright light exposure in the workplace.

Chronic: Chronic bronchitis chronic productive cough for three months in each of two successive years.

Emphysema: Emphysema emphysema is defined by abnormal and permanent enlargement of the airspaces that are dista.

Oxygenation: Oxygenation during wakefulness is the major predictor mean and lowest oxygen saturation during slee.

Improves: Improves survival in patients with resting hypoxemia (pao2 < 60 mm hg).

In: In copd – avoid bnz and nbnzra if you can – Ramelteon may be safer.

COPD: COPD risks of death or hospitalization reduced with cpap treatment.

APAP: Apap (autopap) contraindicated in patients with copd.

Oxygention: Oxygention during wakefulness is the major predictor ofmean and lowest oxygen saturation during slee.

Oxygen: Oxygen improves survival in COPD with hypoxemia.

CPAP: CPAP improves survival and decreases exacerbations and hospitalizations in those with overlap syndro.

Nighttime: Nighttime BP may be a better predictor of adverse outcomes than daytime bp.

Heart: Heart attack in osa – peak incidence shifts earlier • 12 am to 6 am (46%).

OSA: Osa increases risk for several arrhythmias – atrial fibrillation, nsvt, complex ventricular ectopy.

CPAP: CPAP can reduce blood pressure, but reductions in bp are small and results are inconsistent.

CPAP: CPAP improves lvef in patients with CHF and osas.

Peak: Peak stomach acid secretion between 10 pm and 2 am.

7%: 7% of healthy adults experience heartburn daily.

CPAP: CPAP in patients with concurrent osa – improved nocturnal acid reflux symptoms by 48%.

Sleep: Sleep disturbances are common in patients with esrd (end stage kidney)on chronic dialysis: 60-80%.

Sleeping: Sleeping sickness caused by trypanosoma brucei gambiense andrhodesiense – transmitted by tsetse fly.

HIV: Hiv treatment medication Efavirenz can cause abnormal or “bad” dreams (24%).

Upto: Upto 90 % of patients with parkinsons disease have insomnia.

Upto: Upto 60 % of psychiatric patients will have insomnia.

>: > 80% of patients with major depressive episode report insomnia.

Insomnia: Insomnia predictive of suicidal thinking, suicidal behavior, and suicide-death.

Polysomnography: Polysomnography (psg) is generally not indicated in the assessment of insomnia.

19.7: 19.7 million visits associated with a hypnotic flurazepam, temazepam, triazolam, estazolam, quazepa.

Better: Better concentration, better weight management, improved sex drive.

The: The nhtsa estimates that over 100, 000 crashes each year are caused by sleepy drivers.

Sleep: Sleep recharges the body ; brain. Get a few good hours.

Considering: Considering melatonin? Know that you need to take it three hours before bed to be affective!