YOUR GUIDE TO

Healthy Sleep

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

National Institutes of Health

National Heart, Lung, and Blood Institute

YOUR GUIDE TO

Healthy Sleep

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

National Institutes of Health

National Heart, Lung, and Blood Institute

NIH Publication No. 06-5271

November 2005
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

National Institutes of Health

National Heart, Lung, and Blood Institute

Written by: Margie Patlak
Contents

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

What Is Sleep? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

What Makes You Sleep? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

What Does Sleep Do for You? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Learning, Memory, and Mood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Your Heart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Your Hormones. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

How Much Sleep Is Enough?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

What Disrupts Sleep? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

Is Snoring a Problem? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

Common Sleep Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36

Insomnia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36

Sleep Apnea. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

Restless Legs Syndrome (RLS) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

Narcolepsy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51

Parasomnias (Abnormal Arousals) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53

Do You Think You Have a Sleep Disorder? . . . . . . . . . . . . . . . . . . . . . . . . 55

How To Find a Sleep Center and Sleep Medicine Specialist . . . . . . . . . . 58

For More Sleep Information. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59

Contents
Your Guide to Healthy Sleep
Introduction

1Introduction

Think of everything you do during your day. Try to guess which

activity is so important you should devote one-third of your time to

doing it. Probably the first things that come to mind are working,

spending time with your family, or pursuing leisure activities. But

there’s something else you should be doing about one-third of your

time—sleeping.

Many people view sleep as merely a “down time” when their brain

shuts off and their body rests. In a rush to meet work, school, 

family, or household responsibilities, people cut back on their sleep,

thinking it won’t be a problem, because all of these other activities

seem much more important. But research reveals that a number of

vital tasks carried out during sleep help to maintain good health and

enable people to function at their best.

While you sleep, your brain is hard at work forming the pathways

necessary for learning and creating memories and new insights.

Without enough sleep, you can’t focus and pay attention or respond

quickly. A lack of sleep may even cause mood problems. In addition, growing evidence shows that a chronic lack of sleep increases

the risk for developing obesity, diabetes, cardiovascular disease, and

infections.

Despite the mounting support for the notion that adequate sleep,

like adequate nutrition and physical activity, is vital to our wellbeing, people are sleeping less. The nonstop “24/7” nature of the

world today encourages longer or nighttime work hours and offers

continual access to entertainment and other activities. To keep up,

people cut back on sleep. A common myth is that people can learn

to get by on little sleep (such as less than 6 hours a night) with no

adverse consequences. Research suggests, however, that adults need

at least 7–8 hours of sleep each night to be well rested. Indeed, in

1910, most people slept 9 hours a night. But recent surveys show

the average adult now sleeps less than 7 hours a night, and more
2

than one-third of adults report daytime sleepiness so severe that it

interferes with work and social functioning at least a few days each

month. As many as 70 million Americans may be affected by chronic sleep loss or sleep disorders, at an annual cost of $16 billion in

health care expenses and $50 billion in lost productivity.

What happens when you don’t get enough sleep? Can you make up

for lost sleep during the week by sleeping more on the weekends?

How does sleep change as you become older? Is snoring a problem?

How can you tell if you have a sleep disorder? Read on to find the

answers to these questions and to better understand what sleep is

and why it is so necessary. Learn about common sleep myths and

practical tips for getting adequate sleep, coping with jet lag and

nighttime shift work, and avoiding dangerous drowsy driving.

Many common sleep disorders go unrecognized and thus are not

treated. This booklet also gives the latest information on sleep 

disorders such as insomnia, sleep apnea, restless legs syndrome, 

narcolepsy, and parasomnias.

“When I think of every step in my life, sleep, or lack of

sleep, was really instrumental in speeding me up or

slowing me down, respectively.”

Vice Admiral Richard H. Carmona, M.D., M.P.H., F.A.C.S., U.S. Surgeon General,

made these remarks at the 2004 National Sleep Conference at the National Institutes

of Health. See conference results and remarks at http://www.nhlbi.nih.gov/meetings/

slp_front.htm.

Your Guide to Healthy Sleep
3Introduction

JEANETTE GUYTON-KRISHNAN 

AND FAMILY

Since they were babies, my kids have

always had the same bedtime routine,

and it seems to help them

get to sleep on time.

We create a relaxing

environment by reading

them stories and

rubbing their

backs before

they go to

sleep. If the

kids don't get

enough sleep,

it really shows.

They don't have

the energy for

school or 

playing.

“

”
What Is Sleep?

4

Sleep was long considered just a uniform block of time when you 

are not awake. Thanks to sleep studies done over the past several

decades, it is now known that sleep has distinct stages that cycle

throughout the night in predictable patterns. How well rested you are

and how well you function depend not just on your total sleep time

but on how much of the various stages of sleep you get each night.

Your brain stays active throughout sleep, and each stage of sleep 

is linked to a distinctive pattern of electrical activity known as 

brain waves.

Sleep is divided into two basic types: rapid eye movement (REM)

sleep and non-REM sleep (with four different stages). (See “Types 

of Sleep” on page 5.) Typically, sleep begins with non-REM sleep.

In stage 1 non-REM sleep, you sleep lightly and can be awakened

easily by noises or other disturbances. During this first stage of

sleep, your eyes move slowly, and your muscle activity slows. You

then enter stage 2 non-REM sleep, when your eye movements stop.

Your brain shows a distinctive pattern of slower brain waves with

occasional bursts of rapid waves.

When you progress into stage 3 non-REM sleep, your brain waves

become even slower, although they are still punctuated by smaller,

faster waves. By stage 4 non-REM sleep, the brain produces

extremely slow waves almost exclusively. Stages 3 and 4 are considered deep sleep, during which it is very difficult to be awakened.

Children who wet the bed or sleep walk tend to do so during stages

3 or 4 of non-REM sleep. Deep sleep is considered the “restorative”

part of sleep that is necessary for feeling well rested and energetic

during the day.

During REM sleep, your eyes move rapidly in various directions,

even though your eyelids remain closed. Your breathing also

Your Guide to Healthy Sleep

becomes more rapid, irregular, and shallow, and your heart rate and
5

Types of 

Sleep

Types of Sleep

Usually first occurs about

90 minutes after you fall

asleep; cycles along with

the non-REM stages

throughout the night.

Eyes move rapidly, with 

eyelids closed.

Breathing is more rapid,

irregular, and shallow.

Heart rate and blood 

pressure increase.

Dreaming occurs.

Arm and leg muscles are

temporarily paralyzed.

Non-REM Sleep REM Sleep

Stage 1: Light sleep; easily 

awakened; muscle 

activity; eye movements 

slow down.

Stage 2: Eye movements stop; 

slower brain waves, 

with occasional bursts 

of rapid brain waves.

Stage 3: Considered deep sleep; 

difficult to awaken; brain 

waves slow down more, 

but still have occasional 

rapid waves.

Stage 4: Considered deep sleep; 

difficult to awaken; 

extremely slow brain 

waves.

What Is Sleep?
6

blood pressure increase. Dreaming typically occurs during REM

sleep. During this type of sleep, your arm and leg muscles are temporarily paralyzed so that you cannot “act out” any dreams that

you may be having.

The first period of REM sleep you experience usually occurs about

an hour to an hour and a half after falling asleep. After that, the

sleep stages repeat themselves continuously while you sleep. As the

night progresses, REM sleep time becomes longer, while time spent

in non-REM sleep stages 3 and 4 becomes shorter. By morning,

nearly all your sleep time is spent in stages 1 and 2 of non-REM

sleep and in REM sleep. If REM sleep is disrupted during one night,

REM sleep time is typically longer than normal in subsequent nights

until you catch up. Overall, almost one-half your total sleep time is

spent in stages 1 and 2 non-REM sleep and about one-fifth each in

deep sleep (stages 3 and 4 of non-REM sleep) and REM sleep. In

contrast, infants spend half or more of their total sleep time in REM

sleep. Gradually, as they mature, the percentage of total sleep time

they spend in REM progressively decreases to reach the one-fifth

level typical of later childhood and adulthood.

Why people dream and why REM sleep is so important are not well

understood. It is known that REM sleep stimulates the brain regions

used in learning and the laying down of memories. Animal studies

suggest that dreams may reflect the brain’s sorting and selectively 

storing important new information acquired during wake time. While

this information is processed, the brain might revisit scenes from the

day while pulling up older memories. This process may explain why

childhood memories can be interspersed with more recent events 

during dreams. Studies

show, however, that other

stages of sleep besides

REM are also

needed to form

the pathways in

the brain that

enable us to

learn and

remember.

Your Guide to Healthy Sleep
7What Makes You Sleep?

Although you may put off going to sleep in order to squeeze more

activities into your day, eventually your need for sleep becomes

overwhelming and you are forced to get some sleep. This daily

drive for sleep appears to be due, in part, to a compound known as

adenosine. This natural chemical builds up in your blood as time

awake increases. While you sleep, your body breaks down the

adenosine. Thus, this molecule may be what your body uses to 

keep track of lost sleep and to trigger sleep when needed. An 

accumulation of adenosine and other factors might explain why,

after several nights of less than optimal amounts of sleep, you build

up a sleep debt that you must make up by sleeping longer than 

normal. Because of such built-in molecular feedback, you can’t

adapt to getting less sleep than your body needs. Eventually, a lack

of sleep catches up with you.

The time of day when you feel sleepy and go to sleep is also 

governed by your internal “biological clock” and environmental

cues—the most important being light and darkness. Your biological

clock is actually a tiny bundle of cells in your brain that responds to

light signals received through your eyes. When darkness falls, the

biological clock triggers the production of the hormone melatonin.

This hormone makes you feel drowsy as it continues to increase 

during the night. Because of your biological clock, you naturally

feel the most sleepy between midnight and 7 a.m. You may also feel

a second and milder daily “low” in the midafternoon between 

1 p.m. and 4 p.m. At that time, another rise occurs in melatonin

production and might make you feel sleepy.

Your biological clock makes you the most alert during daylight

hours and the most drowsy in the early morning hours. Consequently,

most people do their best work during the day. Our 24/7 society,

however, demands that some people work at night. Nearly onequarter of all workers work shifts that are not during the daytime,

and more than two-thirds of these workers have problem sleepiness

What Makes You Sleep?
8

and/or difficulty sleeping. Because their work schedules are at odds

with powerful sleep-regulating cues like sunlight, night shift workers

often find themselves drowsy at work, and they have difficulty

falling or staying asleep during the daylight hours when their work

schedules require them to sleep.

The fatigue experienced by night shift workers can be dangerous.

Major industrial accidents—such as the Three Mile Island and

Chernobyl nuclear power plant accidents and the Exxon Valdez oil

spill—have been caused, in part, by mistakes made by overly tired

workers on the night shift or an extended shift.

Night shift workers also are at greater risk of being in car crashes

when they drive home from work. One study found that one-fifth

of night shift workers had a car crash or a near miss in the preceding year because of sleepiness on the drive home from work. Night

shift workers are also more likely to have physical problems, such as

heart disease, digestive disturbances, and infertility, as well as emotional problems. All of these problems may be related, at least in

part, to the workers’ chronic sleepiness. See “Working the Night

Shift” on page 9 for some helpful tips.

Other factors can also influence your need for sleep, including your

immune system’s production of cellular hormones called cytokines.

These compounds are made in large quantities in response to certain

infectious diseases or chronic inflammation and may prompt you to

sleep more than usual. The extra sleep may help you conserve the

resources needed to fight the infection. Recent studies confirm that

being well rested improves the body’s responses to infection.

People are creatures of habit, and one of the hardest habits to break

is the natural wake and sleep cycle. A number of physiological 

factors conspire to help you sleep and wake up at the same times

each day. Consequently, you may have a hard time adjusting when

you travel across time zones. The light cues outside and the clocks

in your new location may tell you it is 8 a.m. and you should be

active, but your body is telling you it is more like 4 a.m. and you

should sleep. The end result is jet lag—sleepiness during the day,

difficulty falling or staying asleep at night, poor concentration, 

confusion, nausea, and general malaise and irritability. See “Dealing

With Jet Lag” on page 10.

Your Guide to Healthy Sleep
9

Working the

Night Shift

Night Shift

Try to limit night shift work, if that is possible. If you must work

the night shift, the following tips may help you:

● Increase your total amount of sleep by adding naps and 

lengthening the amount of time you allot for sleep.

● Use bright lights in your workplace.

● Minimize your shift changes so that your body’s biological 

clock can adjust to a nighttime work schedule.

● Get rid of sound and light distractions in your bedroom 

during your daytime sleep.

● Use caffeine only during the first part of your shift to promote 

alertness at night.

If you are unable to fall asleep during the day, and all else fails, 

talk with your doctor to see if it would be wise for you to use 

prescribed, short-acting sleeping pills to help you sleep during 

the day.

What Makes You Sleep?
10Your Guide to Healthy Sleep

Dealing With

Jet Lag

Eastward travel generally causes more severe jet lag than 

westward travel because traveling east requires you to shorten

the day, and your biological clock is better able to adjust to a

longer day than a shorter day. Fortunately for globetrotters, a few

preventive measures and treatments seem to help some people

relieve jet lag:

● Adjust your biological clock. Several days before traveling 

to a new time zone, gradually shift your sleeping and eating 

times to coincide with those at your destination. You can 

also adjust your clock by using light therapy. This involves 

being exposed to special lights, many times brighter than 

ordinary household light, for several hours near the time you 

want to wake up. Alternatively, after arrival, spend a lot of 

time outdoors to make sure your body gets the light cues it 

needs to adjust to the new time zone.

● Avoid alcohol and caffeine. Although it may be tempting to 

drink alcohol to relieve the stress of travel and make it easier 

to fall asleep, you’re more likely to sleep lighter and wake up 

in the middle of the night when the effects of the alcohol 

wear off. Caffeine can help keep you awake longer, but 

caffeine can also make it harder for you to fall asleep if its 

effects haven’t worn off by the time you are ready to 

go to bed.

● What about melatonin? Your body produces this hormone 

that makes you drowsy. Melatonin builds up in your body as 

the night progresses and decreases when daylight arrives. 
11What Makes You Sleep?

Melatonin is available as an over-the-counter supplement. 

Because melatonin is considered safe when used over a 

period of days or weeks and seems to contribute to feeling 

sleepy, it has been suggested as a treatment for jet lag. But 

melatonin’s effectiveness is controversial, and its safety when 

used over a prolonged period is unclear. Some studies find 

that taking melatonin supplements before bedtime for several 

days after arrival in a new time zone can make it easier to fall 

asleep at the proper time. Other studies find that melatonin 

does not help to relieve jet lag.

Be aware that adjusting to a new time zone may take several

days. If you are going to be away for just a few days, it may be

better to stick to your original sleep and wake times as much as

possible, rather than adjusting your biological clock too many

times in rapid succession. 

Jet Lag
12

A number of tasks vital to health and quality of life are linked to

sleep, and these tasks are impaired when you are sleep deprived.

Learning, Memory, and Mood

Students who have trouble grasping new information or learning

new skills are often advised to “sleep on it,” and that advice seems

well founded. Recent studies reveal that people can learn a task better if they are well rested. They also can remember better what they

learned if they get a good night’s sleep after learning the task than if

they are sleep deprived. Volunteers had to sleep at least 

6 hours to show improvement in learning, and the

amount of improvement was directly tied to

how much time they slept. In other words,

volunteers who slept 8 hours outperformed those who slept only 

6 or 7 hours. Other studies 

suggest that all the benefits of

training for mentally challenging tasks are maximized

after a good night’s sleep,

rather than immediately 

following the training or

after sleeping for a short

period overnight.

Many well-known

artists and scientists

claim to have had

creative insights

while they slept.

Mary Shelley, for

example, said 

Your Guide to Healthy Sleep

What Does Sleep 

Do for You?
13What Does Sleep Do for You?

the idea for her novel Frankenstein came to her in a dream. Although

it has not been shown that dreaming is the driving force behind

innovation, one study suggests that sleep is needed for creative 

problem solving. In that study, volunteers were asked to perform 

a memory task and then were tested 8 hours later. Those who were

allowed to sleep for 8 hours immediately after receiving the task and

before being tested were much more likely to find a creative way of

simplifying the task and improving their performance compared to

those who were awake the entire 8 hours before being tested.

Exactly what happens during sleep to improve our learning, memory,

and insight isn’t known. Experts suspect, however, that while 

people sleep, they form or reinforce the pathways of brain cells

needed to perform these tasks. This process may explain why sleep

is needed for proper brain development in infants.

Not only is a good night’s sleep required to form new learning and

memory pathways in the brain, but sleep is also necessary for those

pathways to work up to speed. Several studies show that lack of

sleep causes thinking processes to slow down. Lack of sleep also

makes it harder to focus and pay attention. Lack of sleep can make

you more easily confused. Studies also find a lack of sleep leads to

faulty decisionmaking and more risk taking. A lack of sleep slows

down your reaction time, which is particularly significant to driving

and other tasks that require quick response. When people who lack

sleep are tested by using a driving simulator, they perform just as

poorly as people who are drunk. (See “Crash in Bed Not on the

Road” on page 16.) The bottom line is: not getting a good night’s

sleep can be dangerous! 

Even if you don’t have a mentally or physically challenging day

ahead of you, you should still get enough sleep to put yourself in a

good mood. Most people report being irritable, if not downright

unhappy, when they lack sleep. People who chronically suffer from

a lack of sleep, either because they do not spend enough time in bed

or because they have an untreated sleep disorder, are at greater risk

of developing depression. One group of people who usually don’t

get enough sleep is mothers of newborns. Some experts think

depression after childbirth (postpartum blues) is caused, in part, by

a lack of sleep.
14

Your Heart

Sleep gives your heart and vascular system a much-needed rest.

During non-REM sleep, your heart rate and blood pressure progressively slow as you enter deeper sleep. During REM sleep, your heart

rate and blood pressure have boosted spikes of activity. Overall,

however, sleep reduces your heart rate and blood pressure by about

10 percent.

If you don’t get enough sleep, this nightly dip in blood pressure,

which appears to be important for good cardiovascular health, may

not occur. According to several studies, if your blood pressure does

not dip during sleep, you are more likely to experience strokes, 

chest pain known as angina, an irregular heartbeat, and heart

attacks. You are also more likely to develop congestive heart failure,

a condition in which fluid builds up in the body because the heart is

not pumping sufficiently. Failure to experience the normal dip in

blood pressure during sleep can be related to insufficient 

sleep time, an untreated sleep disorder, or other factors. African

Americans, for example, tend not to have as much of a dip in blood

pressure during sleep. This difference may help to explain why they

are more likely than Caucasians to have serious cardiovascular disease.

A lack of sleep also puts your body under stress and may trigger 

the release of more adrenaline, cortisol, and other stress hormones

during the day. These hormones contribute to your blood pressure

not dipping during sleep, thereby increasing the risk for heart 

disease. Inadequate sleep may also negatively affect your heart and

vascular system by the increased production of certain proteins

thought to play a role in heart disease. For example, some studies

find that people who chronically do not get enough sleep have 

higher blood levels of C-reactive protein. Higher levels of this 

protein may suggest a greater risk of developing hardening of the

arteries (atherosclerosis).

Your Hormones

When you were young, your mother may have told you that you

need to get enough sleep to grow strong and tall. She may have

been right! Deep sleep triggers more release of growth hormone,

which fuels growth in children and boosts muscle mass and the

repair of cells and tissues in children and adults. Sleep’s effect on 

the release of sex hormones also encourages puberty and fertility.

Your Guide to Healthy Sleep
15What Does Sleep Do for You?

Consequently, women who work at night and tend to lack sleep are,

therefore, more likely to have trouble conceiving or to miscarry.

Your mother also probably was right if she told you that getting 

a good night’s sleep on a regular basis would help keep you from 

getting sick and help you get better if you do get sick. During sleep,

your body creates more cytokines—cellular hormones that help the

immune system fight various infections. Lack of sleep can reduce

the ability to fight off common infections. Research also reveals

that a lack of sleep can reduce the body’s response to the flu vaccine. For example, sleep-deprived volunteers given the flu vaccine

produced less than half as many flu antibodies as those who were

well rested and given the same vaccine.

Although lack of exercise and other factors are important contributors, the current epidemic of diabetes and obesity appears to be

related, at least in part, to chronically getting inadequate sleep.

Evidence is growing that sleep is a powerful regulator of appetite,

energy use, and weight control. During sleep, the body’s production

of the appetite suppressor leptin increases, and the appetite stimulant grehlin decreases. Studies find that the less people sleep, the

more likely they are to be overweight or obese and prefer eating

foods that are higher in calories and carbohydrates. People who

report an average total sleep time of 5 hours a night, for example,

are much more likely to become obese compared to people who

sleep 7–8 hours a night.

A number of hormones released during sleep also control the body’s

use of energy. A distinct rise and fall of blood sugar levels during

sleep appears to be linked to sleep stage. Not getting enough sleep

overall or enough of each stage of sleep disrupts this pattern. One

study found that, when healthy young men slept only 4 hours a

night for 6 nights in a row, their insulin and blood sugar levels mimicked those seen in people who were developing diabetes. Another

study found that women who slept less than 7 hours a night were

more likely to develop diabetes over time than those who slept

between 7 and 8 hours a night.
16Your Guide to Healthy Sleep

Crash in Bed

Not on the Road

Most people are aware of the hazards of drunk driving. But driving while sleepy can be just as dangerous. Indeed, crashes due

to sleepy drivers are as deadly as those due to drivers impaired

by alcohol. And you don’t have to be asleep at the wheel to put

yourself and others in danger. Both alcohol and a lack of sleep

hamper your ability to react quickly to a suddenly braking car, a

sharp curve in the road, or other situations that require rapid

responses. Just a few seconds’ delay in reaction time can be a

life-or-death matter when driving. When people who lack sleep

are tested by using a driving simulator, they 

perform as badly or worse than those who are drunk. The combination of alcohol and lack of sleep can be especially dangerous.

Of course, driving is also hazardous if you fall asleep at the

wheel, which happens surprisingly often. One-quarter of the

drivers surveyed in New York State reported they had fallen

asleep at the wheel at some time. Often, people briefly nod off

at the wheel without being aware of it—they just can’t recall what

happened over the previous few seconds or longer. And people

who lack sleep are more apt to take risks and make poor judgments, which can also boost their chances of getting in a car

crash.

Here are some potentially life-saving tips for avoiding drowsy driving:

● Be well rested before hitting the road. If you have several 

nights in a row of fewer than 7–8 hours of sleep, your reaction 

time slows. Restoring that reaction time to normal often takes
17What Does Sleep Do for You?

more than 1 night of good sleep, because your sleep debt 

accumulates after each night you lose sleep. It may take 

several nights of being well rested to repay that sleep debt 

and ensure that you are ready for driving on a long road trip.

● Avoid driving between midnight and 7 a.m. Unless you are 

accustomed to being awake then, this period of time is when 

we are naturally the most tired.

● Don’t drive alone. A companion who can keep you engaged 

in conversation might help you stay awake while driving.

● Schedule frequent breaks on long road trips. If you feel 

sleepy while driving, pull off the road and take a nap for 

15–20 minutes.

● Don’t drink alcohol. Just one beer when you are sleep 

deprived will affect you as much as two or three beers 

when you are well rested.

● Don’t count on caffeine. Although drinking a cola or a cup 

of coffee might help keep you awake for a short time, it won’t 

overcome excessive sleepiness or relieve a sleep debt.

Opening a window or turning up the radio won’t help you stay

awake while driving. Be aware of these warning signs that you

are too sleepy to drive safely: trouble keeping your eyes

focused, continual yawning, or being unable to recall driving the

last few miles. Remember, if you are short on sleep, stay out of

the driver’s seat!
18Your Guide to Healthy Sleep
19How Much Sleep Is Enough?

Animal studies suggest that sleep is as vital as food for survival.

Rats, for example, normally live 2–3 years, but they live only 

5 weeks if they are deprived of REM sleep and only 2–3 weeks if

they are deprived of all sleep stages—a timeframe similar to death

due to starvation. But how much sleep do humans need? To help

answer that question, scientists look at how much people sleep

when unrestricted, the average amount of sleep among various age

groups, and the amount of sleep that studies reveal is necessary to

function at your best.

When healthy adults are given unlimited opportunity to sleep, they

sleep on average between 8 and 8.5 hours a night. But sleep needs

vary from person to person. Some people appear to need only

about 7 hours to avoid problem sleepiness whereas others need 

9 or more hours of sleep. Sleep needs also change throughout the

lifecycle. Newborns sleep between 16 and 18 hours a day, and 

children in preschool sleep between 10 and 12 hours a day. Schoolaged children and adolescents need at least 9 hours of sleep a night.

The hormonal influences of puberty tend to shift adolescents’ 

biological clocks. As a result, teenagers are more likely to go to bed

later than younger children and adults, and they tend to want to

sleep later in the morning. This sleep–wake rhythm is contrary to

the early-morning start times of many high schools and helps

explain why most teenagers get an average of only 7–7.5 hours of

sleep a night.

As people get older, the pattern of sleep also changes—especially 

the amount of time spent in the deep sleep stages. Children spend

more time than adults in these sleep stages. This explains why 

children can sleep through loud noises and why they might not

wake up when they are moved from the car to their beds. During

adolescence, a big drop occurs in the amount of time spent in deep

sleep, which is replaced by lighter, stage 2 sleep. Between young

How Much Sleep Is Enough?
20

adulthood and midlife, the percentage of deep sleep falls again—

from less than 20 percent to less than 5 percent, one study suggests—

and is replaced with lighter sleep (stages 1 and 2). From midlife

through late life, people’s sleep has more interruptions by wakefulness

during the night. This disruption causes older persons to lose more

and more of stages 1 and 2 non-REM sleep as well as REM sleep.

Many older people complain of difficulty falling asleep, early morning awakenings, frequent and long awakenings during the night, 

daytime sleepiness, and a lack of refreshing sleep. Many sleep 

problems, however, are not a natural aspect of sleep in the elderly.

Because older people are more likely to have many illnesses that can

disrupt sleep, their sleep complaints often may be due, in part, to 

illnesses or the medications used to treat them. In fact, one study

found that the prevalence of sleep problems is very low in healthy

older adults. Other causes of some of older adults’ sleep complaints

are sleep apnea, restless legs syndrome, and other sleep disorders 

that become more common with age. Also, older people are 

more likely to have their sleep disrupted by the need to urinate 

during the night.

Some evidence shows that the biological clock shifts in older people,

so they are more apt to go to sleep earlier at night and wake up 

earlier in the morning. No

evidence indicates that

older people can get by

with less sleep than

younger people.

(See “Top 10 Sleep

Myths” on page 22.)

Poor sleep in older

Your Guide to Healthy Sleep
21How Much Sleep Is Enough?

people is linked to excessive daytime sleepiness, attention and memory problems, depressed mood, and overuse of sleeping pills.

Despite variations in sleep quantity and quality, both related to age

and between individuals, studies suggest that the optimal amount of

sleep needed to perform adequately, avoid a sleep debt, and not have

problem sleepiness during the day is about 7–8 hours for adults and

9 or more hours for school-aged children and adolescents. Similar

amounts seem to be necessary to avoid further increasing the risk of

developing obesity, diabetes, or cardiovascular disorders.

Quality of sleep is as important as quantity. People whose sleep is

frequently interrupted or cut short may not get enough of both nonREM sleep and REM sleep. Both types of sleep appear to be crucial

for learning and memory—and perhaps for all the other restorative

benefits of healthy sleep, including the growth and repair of cells.

Many people try to make up for lost sleep during the week by 

sleeping more on the weekends. But if you have lost too much sleep,

sleeping in on the weekend does not completely erase your sleep debt.

Certainly, sleeping more at the end of the week does not make up for

the hampered performance you most likely had at the beginning of or

during that week. Just 1 night of inadequate sleep can adversely

affect your functioning and mood during at least the next day.

Daytime naps are another strategy some people use to make up for

lost sleep during the night. Some evidence shows that short naps 

(up to an hour) can make up, at least partially, for the sleep missed

on the previous night and improve alertness, mood, and work 

performance. But naps don’t substitute for a good night’s sleep.

One study found that a daytime nap after a lack of sleep at night

did not fully restore levels of blood sugar to the pattern seen with

adequate nighttime sleep. If a nap lasts longer than 1 hour, you may

have a hard time waking up fully. In addition, late afternoon naps

can make falling asleep at night more difficult.
22Your Guide to Healthy Sleep

Top 10Sleep Myths

Myth 1: Sleep is a time when your body and brain shut

down for rest and relaxation.

No evidence shows that any major organ (including the brain) or

regulatory system in the body shuts down during sleep. Some

physiological processes actually become more active while you

sleep. For example, secretion of certain hormones is boosted,

and activity of the pathways in the brain needed for learning and

memory is heightened.

Myth 2: Getting just 1 hour less sleep per night than needed

will not have any effect on your daytime functioning.

This lack of sleep may not make you noticeably sleepy during

the day. But even slightly less sleep can affect your ability to

think properly and respond quickly, and it can compromise your

cardiovascular health and energy balance as well as the ability

to fight infections, particularly if lack of sleep continues. If you

consistently do not get enough sleep, eventually a sleep debt

builds up that will make you excessively tired during the day.

Myth 3: Your body adjusts quickly to different sleep 

schedules.

Your biological clock makes you most alert during the daytime

and most drowsy at night. Thus, even if you work the night 

shift, you will naturally feel sleepy when nighttime comes. Most

people can reset their biological clock, but only by appropriately

timed cues—and even then, by 1–2 hours per day at best.

Consequently, it can take more than a week to adjust to a 

dramatically altered sleep/wake cycle, such as you encounter

when traveling across several time zones or switching from

working the day shift to the night shift.

Sleep Myths
23How Much Sleep Is Enough?

Myth 4: People need less sleep as they get older.

Older people don’t need less sleep, but they often get less sleep

or find their sleep less refreshing. That’s because as 

people age, they spend less time in the deep, restful stages of

sleep and are more easily awakened. Older people are also

more likely to have insomnia or other medical conditions that

disrupt their sleep.

Myth 5: Extra sleep at night can cure you of problems with

excessive daytime fatigue.

Not only is the quantity of sleep important but also the quality

of sleep. Some people sleep 8 or 9 hours a night but don’t feel

well rested when they wake up because the quality of their sleep

is poor. A number of sleep disorders and other medical conditions affect the quality of sleep. Sleeping more won’t 

alleviate the daytime sleepiness these disorders or conditions

cause. However, many of these disorders or conditions can be

treated effectively with changes in behavior or with medical therapies.
24Your Guide to Healthy Sleep

Top 10Sleep Myths

Myth 6: You can make up for lost sleep during the week by

sleeping more on the weekends.

Although this sleeping pattern will help relieve part of a sleep

debt, it will not completely make up for the lack of sleep. This

pattern also will not make up for impaired performance during

the week because of not sleeping enough. Furthermore, sleeping later on the weekends can affect your biological clock so that

it is much harder to go to sleep at the right time on Sunday

nights and get up early on Monday mornings.

Myth 7: Naps are a waste of time.

Although naps do not substitute for a good night’s sleep, they can

be restorative and help counter some of the impaired 

performance that results from not getting enough sleep at night.

Naps can actually help you learn how to do certain tasks quicker.

But avoid taking naps later than 3 p.m., as late naps can interfere

with your ability to fall asleep at night. Also, limit your naps to no

longer than 1 hour because longer naps will make it harder to

wake up and get back in the swing of things. If you take 

frequent naps during the day, you may have a sleep disorder

that should be treated.

Myth 8: Snoring is a normal part of sleep.

Snoring during sleep is common, particularly as a person gets

older. Evidence is growing that snoring on a regular basis can

make you sleepy during the day and more susceptible to diabetes

and heart disease. In addition, some studies link frequent snoring to problem behavior and poorer school achievement in 

children. Loud, frequent snoring can also be a sign of sleep

apnea, a serious sleep disorder that should be treated. (See “Is

Snoring a Problem?” on page 33.)

Sleep Myths

(continued)
25How Much Sleep Is Enough?

Myth 9: Children who don’t get enough sleep at night will

show signs of sleepiness during the day.

Unlike adults, children who don’t get enough sleep at night 

typically become more active than normal during the day.

They also show difficulty paying attention and behaving properly.

Consequently, they may be misdiagnosed as having attentiondeficit hyperactivity.

Myth 10: The main cause of insomnia is worry.

Although worry or stress can cause a short bout of insomnia, a

persistent inability to fall asleep or stay asleep at night can be

caused by a number of other factors. Certain medications and

sleep disorders can keep you up at night. Other common 

causes of insomnia are depression, anxiety disorders, and 

asthma, arthritis, or other medical conditions with symptoms that

become more troublesome at night. Some people who have

chronic insomnia also appear to be more revved up than 

normal, so it is harder for them to fall asleep. 
26Your Guide to Healthy Sleep

I wake up early to get ready for school. 

I am tired in the morning and by the

end of the school day, I am very tired

again. An afterschool nap seems to

refresh me and help me focus on

homework. Without it, I am grumpy and

stressed, can’t focus, and sometimes

get headaches. 

DAPHNE LONDON

“

”
27What Disrupts Sleep?

Many factors can prevent a good night’s sleep. These factors range

from well-known stimulants, such as coffee, to certain pain relievers,

decongestants, and other culprits. Many people depend on the 

caffeine in coffee, soft drinks (for example, colas), or tea to wake

them up in the morning or to keep them awake. Caffeine is thought

to block the cell receptors that adenosine uses to trigger its sleepinducing signals. In this way, caffeine fools the body into thinking it

isn’t tired. It can take as long as 6–8 hours for the effects of caffeine

to wear off completely. Drinking a cup of coffee in the late afternoon consequently may prevent your falling asleep at night.

Nicotine is another stimulant that can keep you awake. Nicotine

also leads to lighter than normal sleep. Heavy smokers also tend to

wake up too early because of nicotine withdrawal. Although alcohol is a sedative that makes it easier to fall asleep, it prevents deep

sleep and REM sleep, allowing only the lighter stages of sleep.

People who drink alcohol also tend to wake up in the middle of 

the night when the effects of an alcoholic “nightcap” wear off.

Certain commonly used prescription and over-the-counter medicines

contain ingredients that can keep you awake. These ingredients

include decongestants and steroids. Many pain relievers taken by

headache sufferers contain caffeine. Heart and blood pressure medications known as “beta blockers” can cause difficulty falling asleep

and increase the number of awakenings during the night. People

who have chronic asthma or bronchitis also have more problems

falling asleep and staying asleep than healthy people, either because

of their breathing difficulties or because of the medicines they take.

Other chronic painful or uncomfortable conditions—such as 

arthritis, congestive heart failure, and sickle cell anemia—can 

disrupt sleep, too.

What Disrupts Sleep?
28

A number of psychological disorders—including schizophrenia,

bipolar disorder, and anxiety disorders—are well known for disrupting sleep. Depression often leads to insomnia, and insomnia can

cause depression. Some of these psychological disorders are more

likely to disrupt REM sleep. Psychological stress also takes its toll

on sleep, making it more difficult to fall asleep or stay asleep.

People who feel stressed also tend to spend less time in deep sleep

and REM sleep. Many people report having difficulties sleeping if,

for example, they have recently lost a loved one, are undergoing a

divorce, or are under stress at work.

Menstrual cycle hormones can affect how well women sleep.

Progesterone is known to induce sleep and circulates in greater 

concentrations in the second half of the menstrual cycle. For this 

reason, women may sleep better during this phase of their menstrual

cycle, but many women report trouble sleeping the night before their

menstrual bleeding starts. This sleep disruption is probably related to

the abrupt drop in progesterone levels in their bodies just before they

begin to bleed. Women in their late

forties and early fifties, however,

report more difficulties sleeping (insomnia) than younger

women. These difficulties

may be because, as they

near or enter menopause,

they have lower concentrations of progesterone. Hot

flashes in women of this

age also may cause sleep

disruption and difficulties.

Your Guide to Healthy Sleep
29What Disrupts Sleep?

Certain lifestyle factors may also deprive a person of needed sleep.

Large meals or exercise just before bedtime can make it harder to 

fall asleep. Studies show that exercise in the evening delays the extra

release of melatonin at night that helps the body fall asleep. Exercise

in the daytime, on the other hand, is linked to improved nighttime sleep.

If you aren’t getting enough sleep or aren’t falling asleep early

enough, you may be overscheduling activities that can prevent you

from getting the quiet relaxation time you need to prepare for sleep.

Most people report that it’s easier to fall asleep if they have time to

wind down into a less active state before sleeping. Relaxing in a hot

bath before bedtime may help. In addition, your body temperature

drops after a hot bath in a way that mimics, in part, what happens

as you fall asleep. Probably for both these reasons, many people

report that they fall asleep more easily after a hot bath.

Sleeping environment also can affect your sleep. Clear your 

bedroom of any potential sleep distractions, such as noises, bright

lights, a television, or computer. Having a comfortable mattress and

pillow can help promote a good night’s sleep. You also sleep better

if the temperature in your bedroom is kept on the cool side. For

more ideas on improving your sleep, check out the “Tips for Getting

a Good Night’s Sleep” on page 30.
30Your Guide to Healthy Sleep

Tips for Getting a

Good Night’s Sleep

● Stick to a sleep schedule. Go to bed and wake up the 

same time each day. As creatures of habit, people have a 

hard time adjusting to altered sleep patterns. Sleeping later 

on weekends won’t fully make up for the lack of sleep 

during the week and will make it harder to wake up early on 

Monday morning.

● Exercise is great but not too late in the day. Try to exercise

at least 30 minutes on most days but not later than 5 or 6 

hours before your bedtime.

● Avoid caffeine and nicotine. Coffee, colas, certain teas, and 

chocolate contain the stimulant caffeine, and its effects can 

take as long as 8 hours to wear off fully. Therefore, a cup of 

coffee in the late afternoon can make it hard for you to fall 

asleep at night. Nicotine is also a stimulant, often causing 

smokers to sleep only very lightly. In addition, smokers often 

wake up too early in the morning because of nicotine 

withdrawal.

● Avoid alcoholic drinks before bed. You may think having an 

alcoholic “nightcap” will help you sleep, but alcohol robs you 

of deep sleep and REM sleep, keeping you in the lighter 

stages of sleep. You also tend to wake up in the middle of 

the night when the effects of the alcohol have worn off.

● Avoid large meals and beverages late at night. A light 

snack is okay, but a large meal can cause indigestion that 

interferes with sleep. Drinking too many fluids at night can 

cause frequent awakenings to urinate.

● If possible, avoid medicines that delay or disrupt your 

sleep. Some commonly prescribed heart, blood pressure, or 

asthma medications, as well as some over-the-counter and 

Good Night’s Sleep
31

herbal remedies for coughs, colds, or allergies, can disrupt 

sleep patterns. If you have trouble sleeping, talk to your

doctor or pharmacist to see if any drugs you’re taking might 

be contributing to your insomnia.

● Don’t take naps after 3 p.m. Naps can help make up for 

lost sleep, but late afternoon naps can make it harder to fall 

asleep at night.

● Relax before bed. Don’t overschedule your day so that no 

time is left for unwinding. A relaxing activity, such as reading 

or listening to music, should be part of your bedtime ritual.

● Take a hot bath before bed. The drop in body temperature 

after getting out of the bath may help you feel sleepy, and the 

bath can help you relax and slow down so you’re more ready 

to sleep.

● Have a good sleeping environment. Get rid of anything 

that might distract you from sleep, such as noises, bright

lights, an uncomfortable bed, or warm temperatures. You 

sleep better if the temperature in your bedroom is kept 

on the cool side. A TV or computer in the 

bedroom can be a distraction and 

deprive you of needed sleep.

Having a comfortable mattress 

and pillow can help promote a 

good night’s sleep.

What Disrupts Sleep?
32Your Guide to Healthy Sleep

● Have the right sunlight exposure. Daylight is key to 

regulating daily sleep patterns. Try to get outside in natural 

sunlight for at least 30 minutes each day. If possible, wake 

up with the sun or use very bright lights in the morning. 

Sleep experts recommend that, if you have problems falling 

asleep, you should get an hour of exposure to morning 

sunlight.

● Don’t lie in bed awake. If you find yourself still awake after 

staying in bed for more than 20 minutes, get up and do some 

relaxing activity until you feel sleepy. The anxiety of not 

being able to sleep can make it harder to fall asleep.

● See a doctor if you continue to have trouble sleeping.

If you consistently find yourself feeling tired or not well rested 

during the day despite spending enough time in bed at night, 

you may have a sleep disorder. Your family doctor or a sleep 

specialist should be able to help you. 

Good 

Night’s 

Sleep

(continued)

Tips for Getting a 

Good Night’s Sleep
33Is Snoring a Problem?

Long the material for jokes, snoring is generally accepted as 

common and annoying in adults but as nothing to worry about.

However, snoring is no laughing matter. Frequent, loud snoring is

often a sign of sleep apnea and may increase your risk of developing

cardiovascular disease and diabetes, as well as lead to daytime

sleepiness and impaired performance.

Snoring is caused by a narrowing or partial blockage of your airways at the back of the mouth and upper throat. This obstruction

results in increased air turbulence when breathing in, causing the

soft tissues in your throat to vibrate. The end result is a noisy snore

that can disrupt the sleep of your bed partner. This narrowing of

the airways is typically caused by the soft palate, tongue, and throat

relaxing while you sleep, but allergies or sinus problems can also

contribute to a narrowing of the airways, as can being overweight

and having extra soft tissue around your upper airways.

The larger the tissues in your soft palate, the more likely you are to

snore while sleeping. Alcohol or sedatives taken shortly before sleep

also promote snoring. These drugs cause greater relaxation of the

tissues in your throat and mouth. Surveys reveal that about one-half

of all adults snore, and 50 percent of these adults do so loudly and

frequently. African Americans, Asians, and Hispanics are more likely to snore loudly and frequently compared to Caucasians, and snoring problems increase with age.

Not everyone who snores has sleep apnea, but people who have

sleep apnea typically do snore loudly and frequently. Sleep apnea 

is a serious sleep disorder, and its hallmark is loud, frequent snoring

linked to intermittent brief pauses in breathing while sleeping.

(See “Sleep Apnea” on page 40.) Even if you don’t experience these

breathing pauses, snoring can still be a problem for you as well as

Tips for Getting a Good Night’s Sleep (continued)

Is Snoring a Problem?
for your bed partner. The increased breathing effort associated with

snoring can impair your sleep quality and lead to many of the same

health consequences as sleep apnea.

One study found that older adults who did not have sleep apnea,

but who snored 6–7 nights a week, were more than twice as likely

to report being excessively sleepy during the day than those who

never snored. The more people snored, the more daytime fatigue

they reported. That sleepiness may help explain why snorers are

more likely to be in car crashes than people who do not snore.

Loud snoring can also disrupt the sleep of bed partners and strain

marital relations, especially if snoring causes the spouses to sleep 

in separate bedrooms.

Snoring also increases the risk of developing diabetes and heart 

disease. One study found that women who snored regularly were

twice as likely as those who did not snore to develop diabetes, 

even if they were not overweight—another risk factor for diabetes.

Other studies suggest persistent snoring may raise the lifetime risk 

of developing high blood pressure, heart failure, and stroke.

About one-third of all pregnant women begin snoring for the first

time during their second trimester. If you are snoring while pregnant,

let your doctor know. Snoring in pregnancy can be associated with

high blood pressure and can have a negative effect on your baby’s

growth and development. Your doctor will routinely keep a close

eye on your blood pressure throughout your pregnancy and can let

you know if any additional evaluations for the snoring might be useful. In most cases, the snoring and any related high blood pressure

will subside shortly after delivery.

Snoring can also be a problem in children. As many as 10–15 

percent of young children, who typically have enlarged adenoids and

tonsils, snore on a regular basis. Several studies show that children

who snore (with or without sleep apnea) are more likely than those

who do not snore to score lower on tests that measure intelligence,

memory, and ability to maintain attention. These children also have

more problematic behavior, including hyperactivity. The end result

is that children who snore do not perform in school as well as those

who do not snore. Strikingly, snoring was linked to a greater drop

in IQ than that seen in children who had elevated levels of lead in

their blood. Although the behavior of children improves after they

34Your Guide to Healthy Sleep
35Is Snoring a Problem?

stop snoring, studies suggest they may continue to get poorer grades

in school, perhaps because of lasting effects on the brain linked to

the snoring. You should have your child evaluated by your doctor if

the child snores loudly and frequently—three to four times a week—

especially if brief pauses in breathing while asleep are noted and if

there are signs of hyperactivity or daytime sleepiness, inadequate

school achievement, or slower than expected development.

Surgery to remove the adenoids and tonsils of children often can

cure their snoring and any associated sleep apnea. Such surgery has

been linked to a reduction in hyperactivity and improved ability to

pay attention, even in children who showed no signs of sleep apnea

before surgery.

Snoring in older children and adults may be relieved by less invasive

measures, however. These measures include losing weight, refraining

from tobacco, sleeping on the side rather than on the back, or elevating the head while sleeping. Treating chronic congestion and

refraining from alcohol or sedatives before sleeping can also stop

snoring. In some adults, snoring can be relieved by dental appliances that reposition the soft tissues in the mouth. Although numerous over-the-counter nasal strips and sprays claim to relieve snoring,

no scientific evidence supports those claims.
A number of sleep disorders can disrupt your sleep quality and 

leave you with excessive daytime sleepiness, even if enough time 

was spent in bed to be well rested. (See “Common Signs of a Sleep

Disorder” on page 37.) More than 70 sleep disorders affect at least

40 million Americans and account for an estimated $16 billion in

medical costs each year, not counting costs due to lost work time

and other factors. The four most common sleep disorders are

insomnia, obstructive sleep apnea (sleep-disordered breathing), 

restless legs syndrome (RLS), and narcolepsy. Additional sleep 

problems include sleep walking, sleep paralysis, night terrors, and

other “parasomnias” that cause abnormal arousals.

Insomnia

Insomnia is defined as having trouble falling asleep or staying

asleep, or as having unrefreshing sleep despite having ample opportunity to sleep. Life is filled with events that occasionally cause

insomnia for a short time. Such temporary insomnia is 

common and is often brought on by stressful situations such as

work, family pressures, or a traumatic

event. A National Sleep Foundation

poll of adults in the United States

found that close to half of the

respondents reported temporary

insomnia in the nights immediately

after the terrorist attacks on

September 11, 2001.

Chronic insomnia is defined as 

having symptoms at least 

3 nights per week for more

than 1 month. Most

cases of chronic

insomnia are secondary, which means

36

Common Sleep Disorders

Your Guide to Healthy
37Common Sleep Disorders

Common Signs of a 

Sleep Disorder

Look over this list of common signs of a sleep disorders, and

talk to your doctor if you have any of them:

● It takes you more than 30 minutes to fall asleep at night.

● You awaken frequently in the night and then have trouble 

falling back to sleep again.

● You awaken too early in the morning.

● You frequently don’t feel well rested despite spending 7–8 

hours or more asleep at night.

● You feel sleepy during the day and fall asleep within 5 minutes

if you have an opportunity to nap, or you fall asleep at 

inappropriate times during the day.

● Your bed partner claims you snore loudly, snort, gasp, or 

make choking sounds while you sleep, or your partner 

notices your breathing stops for short periods.

● You have creeping, tingling, or crawling feelings in your legs 

that are relieved by moving or massaging them, especially in 

the evening and when you try to fall asleep.

● You have vivid, dreamlike experiences while falling asleep or 

dozing.

● You have episodes of sudden muscle weakness when you 

are angry, fearful, or when you laugh.

● You feel as though you cannot move when you first wake up.

● Your bed partner notes that your legs or arms jerk often 

during sleep.

● You regularly need to use stimulants to stay awake during 

the day.

Also keep in mind that, although children can show some of

these same signs of a sleep disorder, they often do not show

signs of excessive daytime sleepiness. Instead, they may seem

overactive and have difficulty focusing and concentrating. They

also may not do their best in school. 

Sleep Disorder
they are due to another disorder or medications. Primary chronic

insomnia is a distinct sleep disorder; its cause is not yet well understood. About 30–40 percent of adults say they have some symptoms

of insomnia within any given year, and about 10–15 percent of

adults say they have chronic insomnia. Chronic insomnia becomes

more prevalent with age, and women are more likely than men to

report having insomnia.

Insomnia often causes problems during the day, such as excessive

sleepiness, fatigue, a lack of energy, difficulty concentrating,

depressed mood, and irritability. Due to all of these potential 

consequences, untreated insomnia can impair quality of life as 

much as, or more than, other chronic medical problems.

Chronic insomnia is often caused by one or more of the following:

■ Another disease or mood disorder. The most common 

causes of insomnia are depression and/or anxiety disorders.

Neurological disorders such as Alzheimer’s or Parkinson’s 

disease can also have insomnia as a symptom. Chronic 

insomnia can result from arthritis, asthma, or other medical 

conditions in which symptoms become more troublesome at 

night, making it difficult to fall asleep or stay asleep.

■ Various prescribed and over-the-counter medications that can 

disrupt sleep, such as decongestants, certain pain relievers, 

and steroids.

■ Sleep-disrupting behavior such as drinking alcohol, exercising 

shortly before bedtime, ingesting caffeine late in the day, 

watching TV or reading while in bed, or irregular sleep 

schedules due to shift work or other causes.

■ Another sleep disorder, such as sleep apnea or restless 

legs syndrome.

Some people, however, have primary chronic insomnia. This condition is linked to a tendency toward being more “revved up” than

normal (hyperarousal). These people may have heightened secretion

of certain hormones, higher body temperatures, faster heart rates,

and a different pattern of brain waves while they sleep.

Doctors diagnose insomnia based mainly on sleep history, often 

by reviewing a sleep diary. An overnight sleep recording may be

required if another sleep disorder is suspected. Doctors also will 

38Your Guide to Healthy Sleep
39Common Sleep Disorders

try to diagnose and treat any other underlying medical or psychological problems as well as identify behaviors that might be causing 

the insomnia.

Often, people who have insomnia enter into a vicious cycle—because

of having trouble sleeping in previous nights, they become anxious

at the slightest sign that they may not be falling asleep right away.

That anxiety can make it more difficult for them to fall asleep. The

more time they spend in bed not sleeping, and watching the clock,

the more their anxiety—and sleeplessness—increases.

To break that cycle of anxiety and negative conditioning, experts

recommend going to bed only when you’re sleepy. If you can’t fall

asleep (or fall back to sleep) within 20 minutes, get out of bed and

go into another room where you can pursue a relaxing activity until

you feel sleepy again. Then return to bed. This reconditioning 

therapy has been shown to be an effective way to treat insomnia.

Another effective behavioral strategy for some people is relaxation

therapy. For example, progressively tense and then relax each of the

muscle groups in your body before

sleep. Another method is to focus

on breathing deeply. Relaxation

therapy can provide a needed

slowing down period so that you

are indeed sleepy when the

desired bedtime arrives.

Sleep restriction therapy also

works for some people who

have insomnia. First, limit

your night’s sleep to 4 or

5 hours, then gradually

add more sleep time

each night until you

achieve a more
normal night’s sleep. Daytime naps should be avoided during this

sleep restriction therapy because napping may prolong insomnia by

making it harder to fall asleep at night. In addition, during sleep

restriction therapy, avoid driving a car or operating dangerous

machinery until you have obtained adequate nighttime sleep.

All these changes in behavior are part of what is called “cognitive

behavioral therapy.” Cognitive behavioral therapy also can be used

to replace negative thinking related to sleep, such as “I’ll never fall

asleep without sleeping pills,” with more realistic positive thinking.

Cognitive behavioral therapy is effective in most people who have

chronic insomnia.

Some people who have chronic insomnia that is not corrected by

behavioral therapy or treatment of an underlying condition may

need a prescription medication. You should talk to a doctor before

trying to treat insomnia with alcohol, over-the-counter or prescribed

short-acting sedatives, or sedating antihistamines that induce

drowsiness. The benefits of these treatments are limited, and they

have risks. Some may help you fall asleep but leave you feeling

unrefreshed in the morning. Others have longer-lasting effects and

leave you feeling still tired and groggy in the morning. Some also

may lose their effectiveness over time. Doctors may prescribe sedating antidepressants for insomnia, but the effectiveness of these medicines in people who do not have depression is not established, and

there are significant side effects.

To treat their insomnia, some people pursue “natural” remedies,

such as melatonin supplements or valerian teas or extracts. These

remedies are available over the counter. There is little evidence that

melatonin can help relieve insomnia. Studies with valerian have 

also been inconclusive, and the actual dose and purity of various

supplements, extracts, or teas that contain valerian may vary from

product to product. In addition, because melatonin, valerian, and

other natural remedies are not regulated by the Food and Drug

Administration, their safety is not scrutinized.

Sleep Apnea

In people who have sleep apnea (also referred to as sleep-disordered

breathing), breathing briefly stops or becomes very shallow during

sleep. This change is caused by intermittent blocking of the upper

airway, usually when the soft tissue in the rear of the throat 

40Your Guide to Healthy Sleep
41

I have sleep apnea. In the past, I used

to arrange my schedule around whether

I’ve had enough sleep. Now

I don’t worry about that.

Starting on continuous 

positive airway pressure and medication 

have changed 

my life—now I’m

excited to wake up

and face each

day after a night

of restful sleep. 

ANNE COLLINS

“

”

Common Sleep Disorders
42

collapses and partially or completely closes the airway. Each breathing stop typically lasts 10–20 seconds or more and may occur 20–30

times or more each sleeping hour.

If you have sleep apnea, not enough air can flow into your lungs

through the mouth and nose during sleep, even though breathing

efforts continue. When this happens, the amount of oxygen in your

blood decreases. Your brain responds by awakening you enough to

tighten the upper airway muscles and open your windpipe. Normal

breaths then start again, often with a loud snort or choking sound.

Although people who have sleep apnea typically snore loudly and

frequently, not everyone who snores has sleep apnea. (See “Is

Snoring a Problem?” on page 33.)

Because people who have sleep apnea frequently arouse from deeper

sleep stages to lighter sleep during the night, they rarely spend

enough time in deep, restorative stages of sleep. They are therefore

often excessively sleepy during the day. Such sleepiness is thought to

lead to mood and behavior problems, including depression, and such

sleepiness more than triples the risk of being in a traffic or workrelated accident.

The many brief drops in blood-oxygen levels can be associated with

morning headaches and decreased ability to concentrate, think properly, learn, and remember. In sleep apnea, the combination of the

intermittent oxygen drops and reduced sleep quality triggers the

release of stress hormones. These hormones in turn raise your blood

pressure and heart rate and boost the risk of heart attack, stroke,

irregular heart beats, and congestive heart failure. In addition,

untreated sleep apnea can lead to altered energy metabolism that

increases the risk for developing obesity and diabetes.

Anyone can have sleep apnea. It is estimated that at least 12–18 

million American adults have sleep apnea, making it as common as

asthma. More than one-half of the people who have sleep apnea are

overweight. Sleep apnea is more common in men. More than 1 in

25 middle-aged men and 1 in 50 middle-aged women have sleep

apnea along with excessive daytime sleepiness. About 3 percent of

children and 10 percent or more of people over age 65 have sleep

apnea. This condition occurs more frequently in African Americans,

Asians, Native Americans, and Hispanics than in Caucasians.

Your Guide to Healthy Sleep
43Common Sleep Disorders

More than one-half of all people who have sleep apnea are not 

diagnosed. People who have sleep apnea generally are not aware

that their breathing stops in the night. They just notice that they

don’t feel well rested when they wake up and are sleepy throughout

the day. Their bed partners are likely to notice, however, that they

snore loudly and frequently and that they often stop breathing

briefly while sleeping. Doctors suspect sleep apnea if these symptoms are present, but the diagnosis must be confirmed with

overnight sleep monitoring. (See “How Are Sleep Disorders

Diagnosed?” on page 44.) This monitoring will reveal pauses in

breathing, frequent sleep arousals, and intermittent drops in levels of

oxygen in the blood.

Like adults who have sleep apnea, children who have this disorder

usually snore loudly, snort or gasp, and have brief stops in breathing

while sleeping. Small children often have enlarged tonsils and adenoids that increase their risk for sleep apnea. But doctors may not

suspect sleep apnea in children because, instead of showing the typical

signs of sleepiness during the day, these children often become agitated and may be considered hyperactive. The effects of sleep apnea in

children may include diminished school performance and difficult,

aggressive behavior.
44Your Guide to Healthy Sleep

How Are 

Sleep Disorders Diagnosed?

Depending on what your symptoms are, your doctor will gather

various kinds of information and consider several possible tests

when trying to decide if you have a sleep disorder:

● Sleep history and sleep log. Your doctor will ask you how 

many hours you sleep each night, how often you waken 

during the night and for how long, how long it takes you to 

fall asleep, how well rested you feel upon awakening, and 

how sleepy you feel during the day. Your doctor may ask you 

to keep a sleep diary for a few weeks. (See “Sample Sleep 

Diary” on page 56.) Your doctor may also ask you if you 

have any symptoms of sleep apnea or restless legs 

syndrome, such as loud snoring, snorting or gasping, morning 

headaches, tingling or unpleasant sensations in the limbs 

that are relieved by moving them, and jerking of the limbs 

during sleep. Your sleeping partner may be asked if you 

have some of these symptoms, as you may not be aware of 

them yourself.

● Sleep recording in a sleep lab (polysomnogram). A sleep 

recording refers to a polysomnogram (poly-SOM-no-gram) 

or PSG test that is usually done in a sleep center or sleep 

laboratory. You will likely stay overnight in the sleep center 

with electrodes and other monitors placed on your scalp, 

face, chest, limbs, and finger. While you sleep, these devices 

measure your brain activity, eye movements, muscle activity, 

heart rate and rhythm, blood pressure, and how much air 

moves in and out of your lungs. This test also checks the 

amount of oxygen in your blood. A PSG test is painless. 

In certain circumstances, the PSG can be done at home. 

A home monitor can be used to record heart rate, how air 

moves in and out of your lungs, the amount of oxygen in your 

blood, and your breathing effort.
45Common Sleep Disorders

● Multiple Sleep Latency Test (MSLT). Particularly useful for 

diagnosing narcolepsy, this test measures how sleepy you 

are during the day. In this test, typically done after an 

overnight sleep recording (PSG), monitoring devices for sleep

stage are placed on your scalp and face. You are asked to 

nap four or five times for 20 minutes every 2 hours during 

times in which you would normally be awake. Technicians 

note how quickly you fall asleep and how long it takes you to 

reach various stages of sleep, especially REM sleep, during 

your naps. Normal individuals either do not fall asleep during 

these short designated nap times or take a long time to fall 

asleep. People who fall asleep in less than 5 minutes are likely

to require treatment for a sleep disorder, as are those who 

quickly develop REM sleep during their naps.

It is important to have a sleep medicine specialist interpret 

the results of your sleep monitoring test (PSG) or MSLT. See

“How To Find a Sleep Center and Sleep Medicine Specialist” 

on page 58.
46

A number of factors can make a person susceptible to sleep apnea.

These factors include:

■ Throat muscles and tongue that relax more than normal while 

asleep

■ Enlarged tonsils and adenoids

■ Being overweight—the excess fat tissue around your neck 

makes it harder to keep the throat area open

■ Head and neck shape that creates a somewhat smaller airway 

size in the mouth and throat area

■ Congestion, due to allergies, that can also narrow the airway

■ Family history of sleep apnea

If your doctor suspects that you have sleep apnea, you may be

referred to a sleep specialist. Some of the ways to help diagnose

sleep apnea include:

■ A medical history that includes asking you and your family 

questions about how you sleep and how you function during 

the day.

■ Checking your mouth, nose, and throat for extra or large 

tissues—for example tonsils, uvula (the tissue that hangs from 

the middle of the back of the

mouth), and soft palate (roof of

your mouth in the back of your

throat).

■ An overnight recording of 

what happens with your 

breathing during sleep 

(polysomnogram, or PSG).

Your Guide to Healthy Sleep
47Common Sleep Disorders

■ A Multiple Sleep Latency Test (MSLT), usually done in a sleep 

center, is used to see how quickly you fall asleep at times when

you would normally be awake. Falling asleep in only a few 

minutes usually means that you are very sleepy during the day.

Being very sleepy during the day can be a sign of sleep apnea.

Once all the tests are completed, the sleep medicine specialist will

review the results and work with you and your family to develop a

treatment plan. Changes in daily activities or habits may help

reduce your symptoms:

■ Sleep on your side instead of on your back. Sleeping on your 

side will help reduce the amount of upper airway collapse 

during sleep.

■ Avoid alcohol, smoking, sleeping pills, herbal supplements, and

any other medications that make you sleepy. They make it 

harder for your airway to stay open while you sleep, and 

sedatives can make the breathing pauses longer and more 

severe. Tobacco smoke irritates the airways and can help 

trigger the intermittent collapse of the upper airway.

■ Lose weight if you are overweight. Even a little weight loss 

can sometimes improve symptoms.

These changes may be all that are needed to treat mild sleep apnea.

However, if you have moderate or severe sleep apnea, you will need

additional, more direct treatment approaches.

Continuous Positive Airway Pressure (CPAP) is the most effective

treatment for sleep apnea in adults. CPAP delivers air into your airway through a specially designed nasal mask attached to a machine

that acts as a pump. The mask does not breathe for you; the flow of

air creates enough increased pressure to keep the airways in your nose

and mouth more open while you sleep. The air pressure is adjusted so

that it is just enough to stop your airways from briefly becoming too

small during sleep. The pressure is constant and continuous. Sleep

apnea will return if CPAP is stopped or if it is used incorrectly.

People who have severe sleep apnea symptoms generally feel much

better once they begin treatment with CPAP. CPAP treatment can

cause side effects in some people. Possible side effects include dry or

stuffy nose, irritation of the skin on the face, bloating of the stomach,

sore eyes, or headaches. If you have trouble with CPAP side effects,
48Your Guide to Healthy Sleep

With restless legs syndrome, there is no

‘magic bullet,’ no cure. It took a while to

find the correct combination of medications for me. From time to time, my 

medications have to be adjusted, but 

my symptoms are well controlled.

BOB BALKAM

“

”
work with your sleep medicine specialist and support staff. Together,

you can do things to reduce or eliminate these problems.

Currently, no medications cure sleep apnea. However, the prescription drug modafinil may help relieve the excessive sleepiness that

sometimes persists even with CPAP treatment of sleep apnea.

Another treatment approach that may help some people is the use 

of a mouthpiece (oral or dental appliance). If you have mild sleep

apnea or do not have sleep apnea but snore very loudly, your doctor

or dentist may also recommend this. A custom-fitted plastic mouthpiece will be made by a dentist or an orthodontist—a specialist in

correcting teeth or jaw problems. The mouthpiece will adjust your

lower jaw and tongue to help keep the airway in your throat more

open while you are sleeping. Air can then flow more easily into

your lungs because there is less resistance to breathing. Following

up with the dentist or orthodontist is important to correct any side

effects and to be sure that your mouthpiece continues to fit properly.

Some people who have sleep apnea, depending on the findings of the

evaluation by the sleep medicine specialist, may benefit from surgery.

Removing tonsils and adenoids that are blocking the airway is done

frequently, especially in children. Uvulopalatopharyngoplasty

(UPPP) is a surgery for adults that removes the tonsils, uvula (the 

tissue that hangs from the middle of the back of the roof of the

mouth), and part of the soft palate (roof of the mouth in the back 

of the throat). Tracheostomy is a surgery used rarely and only in

severe sleep apnea when no other treatments have been successful.

A small hole is made in the windpipe, and a tube is inserted.

Air will flow through the tube and into the lungs, bypassing the

obstruction in the upper airway.

Restless Legs Syndrome (RLS)

Restless legs syndrome (RLS) causes an unpleasant prickling or 

tingling in the legs, especially in the calves, that is relieved by moving

or massaging them. This sensation creates a need to stretch or move

the legs to get rid of these uncomfortable or painful feelings. As a

result, a person may have difficulty falling asleep and staying asleep.

One or both legs may be affected. In some people, the sensations

are also felt in the arms. These sensations can also occur with lying

down or sitting for prolonged periods of time, such as while at a

desk, riding in a car, or watching a movie.

49Common Sleep Disorders
50Your Guide to Healthy Sleep

Many people who have RLS also have brief limb movements during

sleep, often with abrupt onset, occurring every 5–90 seconds. This

condition, known as periodic limb movements in sleep (PLMS), can

repeatedly awaken people who have RLS and reduce their total

sleep time. Some people have PLMS but have no abnormal sensations in their legs while awake.

RLS affects 5–15 percent of Americans, and its prevalence increases

with age. RLS occurs more often in women than men. One study

found that RLS accounted for one-third of the insomnia seen in

patients older than age 60. Children also can have RLS. This condition can be difficult to diagnose in children, and it often is confused with hyperactivity or “growing pains.”

RLS is often inherited. Pregnancy, kidney failure, and anemia related to iron or vitamin deficiency can trigger or worsen RLS symptoms. Researchers suspect that these conditions cause insufficient

iron that results in a lack of dopamine. The brain uses dopamine to

control limb movements. Doctors usually can diagnose RLS by

patients’ symptoms and a telltale worsening of symptoms at night or

while at rest. Some doctors may order a blood test for iron,

although many people who have RLS have normal levels of iron in

their blood but abnormal levels in the fluid that bathes their brain.

Doctors may also ask people who have RLS to spend a night in a

sleep lab where they are monitored to rule out other sleep disorders

and to document the excessive limb movements.

RLS is a treatable but not curable condition. Dramatic improvements are seen quickly when patients are given dopamine-like drugs.

Alternatively, people who have milder cases may be treated successfully with sedatives or by behavioral strategies. These strategies

include stretching, taking a hot bath, or massaging the legs before

bedtime. Avoiding caffeinated beverages can also help reduce symptoms. If iron or vitamin deficiency underlies RLS, symptoms may

improve with prescribed iron, vitamin B12, or folate supplements.

Some people may require anticonvulsant medications to stem the

creeping and crawling sensations in their limbs. Others who have

severe symptoms may need to be treated with pain relievers, such 

as codeine or morphine, or a combination of drug treatments.
51Common Sleep Disorders

Narcolepsy

Narcolepsy’s main symptom is excessive and overwhelming daytime

sleepiness, even after adequate nighttime sleep. In addition, nighttime sleep may be fragmented by frequent awakenings. People who

have narcolepsy often fall asleep at inappropriate times and places.

Although television sitcoms occasionally feature these individuals 

to generate a few laughs, narcolepsy is no laughing matter. People

who have narcolepsy experience daytime “sleep attacks” that last

from seconds to more than one-half hour, can occur without 

warning, and may cause injury. These embarrassing sleep spells can

also make it difficult to work and to maintain normal personal or

social relationships.

With narcolepsy, the usually sharp distinctions between being asleep

and awake are blurred. Also, people who have narcolepsy tend to

fall directly into dream-filled REM sleep, rather than enter REM

sleep gradually after passing through the non-REM sleep stages first.

In addition to overwhelming daytime sleepiness, narcolepsy has

three other commonly associated symptoms, but these may not

occur in all people:

■ Sudden muscle weakness (cataplexy). This weakness is similar 

to the paralysis that normally occurs during REM sleep, but it 

lasts a few seconds to minutes while an individual is awake.

Cataplexy tends to be triggered by sudden emotional reactions,

such as anger, surprise, fear, or laughter. The weakness may 

show up as limpness at the neck, buckling of the knees, or 

sagging facial muscles affecting speech, or it may cause a 

complete body collapse.

■ Sleep paralysis. People who have narcolepsy may experience a 

temporary inability to talk or move when falling asleep or 

waking up, as if they were glued to their beds.

■ Vivid (hypnogogic) dreams. These dreams tend to surface 

when people who have narcolepsy first fall asleep. The dreams

are so lifelike that they can be confused with reality.

Experts estimate that as many as 350,000 Americans have narcolepsy,

but fewer than 50,000 are diagnosed. The disorder is as widespread as
52Your Guide to Healthy Sleep

When you have a sleep disorder, you 

need to discuss your symptoms 

and progress so your doctor 

can know when it’s necessary 

to change the course of treatment. Patient support 

groups are also 

invaluable sources 

of information.

BOB BALKAM

“

”
53Common Sleep Disorders

Parkinson’s disease or multiple sclerosis, and more prevalent than 

cystic fibrosis, but it is less well known. Narcolepsy is often mistaken

for depression, epilepsy, or the side effects of medicines.

Narcolepsy can be difficult to diagnose in people who have only 

the symptom of excessive daytime sleepiness. It is usually diagnosed

with the aid of an overnight sleep recording (PSG) and the MSLT.

(See “How Are Sleep Disorders Diagnosed?” on page 44.) Both tests

reveal signs of narcolepsy—the tendency to fall asleep rapidly and

enter REM sleep early, even during brief naps.

Narcolepsy can develop at any age, but the symptoms tend to

appear first during adolescence or early adulthood. About 1 of

every 10 people who have narcolepsy has a close family member

who has the disorder, suggesting that one can inherit a tendency to

develop narcolepsy. Studies suggest that a neurotransmitter called

hypocretin plays a key role in narcolepsy. Most people who have

narcolepsy lack hypocretin, which promotes wakefulness. Scientists

believe that an autoimmune reaction, perhaps triggered by disease or

brain injury, specifically destroys the hypocretin-generating cells in

the brains of people who have narcolepsy.

Eventually, researchers may develop a treatment for narcolepsy that

restores hypocretin to normal levels. In the meantime, most people

who have narcolepsy find some to all of their symptoms relieved 

by various drug treatments. For example, central nervous system

stimulants can reduce daytime sleepiness. Antidepressants and other

drugs that suppress REM sleep can prevent muscle weakness, sleep

paralysis, and vivid dreaming. Doctors also usually recommend that

people who have narcolepsy take short naps (10–15 minutes) two or

three times a day, if possible, to help control excessive daytime sleepiness.

Parasomnias (Abnormal Arousals)

In some people, the walking, talking, and other body functions 

normally suppressed during sleep emerge during certain sleep stages.

Alternatively, the paralysis or vivid images usually experienced during

dreaming may persist after awakening. These arousal malfunctions

are collectively known as parasomnias and include confusional

arousals, sleep talking, sleep walking, night terrors, sleep paralysis,

and REM sleep behavior disorder (acting out dreams). Most of these

disorders—such as confusional arousals, sleep walking, and night 

terrors—are more common in children, who tend to outgrow them
54

once they become adults. People who are sleep-deprived also may

experience some of these disorders, including sleep walking and sleep

paralysis. Sleep paralysis also commonly occurs in people who have

narcolepsy. Certain medications or neurological disorders appear to

lead to other parasomnias, such as REM sleep behavior disorder, and

these parasomnias tend to occur more in elderly people. If you or a

family member has persistent episodes of sleep paralysis, sleep 

walking, or acting out of dreams, talk with your doctor.

Your Guide to Healthy Sleep
55Do You Think You Have a Sleep Disorder?

At various points in our lives, all of us suffer from a lack of sleep that

can be remedied by making sure we have the opportunity to get

enough sleep. But, if you are spending enough time in bed and still

wake up tired or feel very sleepy during the day, you may have a sleep

disorder. See “Common Signs of a Sleep Disorder” on page 37.

One of the best ways you can tell if you are getting enough good

quality sleep, and whether you have signs of a sleep disorder, is by

keeping a sleep diary. Use the “Sample Sleep Diary” on page 56 to

record the quality and quantity of your sleep; your use of medications, alcohol, and caffeinated beverages; your exercise patterns; and

how sleepy you feel during the day. After a week or so, look over

this information to see how many hours of sleep or nighttime awakenings the night before are linked to your being tired the next day.

This information will give you a sense of how much uninterrupted

sleep you need to avoid daytime sleepiness. You can also use the

diary to see some of the patterns or practices that may keep you

from getting a good night’s sleep.

You may have a sleep disorder and should see your doctor if your

sleep diary reveals any of the following:

■ You consistently take more than 30 minutes each night to fall 

asleep.

■ You consistently awaken more than a few times or for long 

periods of time each night.

■ You take frequent naps.

■ You often feel sleepy during the day—especially if you fall 

asleep at inappropriate times during the day.

Do You Think You Have a

Sleep Disorder?
56Your Guide to Healthy Sleep

Sample Sleep Diary

Complete in the Evening Complete in the Morning

Name

Today’s date Monday

4/10/05

Time I went to bed last night 11 p.m.

Time I woke up this morning 7 a.m.

No. of hours slept last night 8

Number of awakenings and 5 times

total time awake last night 2 hours

How long I took to fall asleep 30 mins.

last night

Medications taken last night None

How awake did I feel when 2 

I got up this morning:

1—Wide awake

2—Awake but a little tired

3—Sleepy

Number of caffeinated drinks 1 drink at

(coffee, tea, soda) and time 8 p.m. 

when I had them today

Number of alcoholic drinks 2 drinks 

(beer, wine, liquor) and time 9 p.m.

when I had them today

Nap times and lengths today 3:30 p.m.

45 mins.

Exercise times and lengths None 

today

How sleepy did I feel 1 

during the day today:

1—So sleepy had to struggle 

to stay awake during much 

of the day

2—Somewhat tired

3—Fairly alert

4—Wide awake 

Example
57Do You Think You Have a Sleep Disorder?
58Your Guide to Healthy Sleep

How To Find a Sleep Center

and Sleep Medicine 

Specialist

If your doctor refers you to a sleep center or sleep specialist, make

sure that center or specialist is qualified to diagnose and treat your

sleep problem. To find sleep centers accredited by the American

Academy of Sleep Medicine, go to http://www.aasmnet.org and 

click on “Find a Sleep Center,” or call 708–492–0930. To find sleep

specialists certified by the American Board of Sleep Medicine, go to

http://www.absm.org and click on “Diplomates of the ABSM.”
59For More Sleep Information

Resources from the National Heart, Lung, and Blood Institute

(NHLBI)

National Center on Sleep Disorders Research

National Heart, Lung, and Blood Institute

National Institutes of Health 

6705 Rockledge Drive

Suite 6022

Bethesda, MD 20892–7993 

Telephone: 301–435–0199 

Fax: 301–480–3451 

E-mail: ncsdr@nih.gov

Web site: http://www.nhlbi.nih.gov/sleep

NHLBI Health Information Center

P.O. Box 30105

Bethesda, MD 20824–0105

Telephone: 301–592–8573

TTY: 240–629–3255

Fax: 301–592–8563

E-mail: nhlbiinfo@nhlbi.nih.gov

Web site: http://www.nhlbi.nih.gov

Garfield Star Sleeper Web site (for children, parents, and teachers)

http://starsleep.nhlbi.nih.gov

NIH Office of Science Education Web site (for high school supplemental curriculum: Sleep, Sleep Disorders, and Biological Rhythms)

http://science.education.nih.gov

Resources from Other Sleep Organizations

American Academy of Sleep Medicine (AASM)

One Westbrook Corporate Center, Suite 920

Westchester, IL 60154

Telephone: 708–492–0930

Fax: 708–492–0943

Web site: http://www.aasmnet.org

For More Sleep Information
60

American Insomnia Association 

(same address/phone as AASM)

E-mail: rmoney@aasmnet.org

Web site: http://www.americaninsomniaassociation.org

American Sleep Apnea Association

1424 K Street, NW

Suite 302

Washington, DC 20005

Telephone: 202–293–3650

Fax: 202–293–3656

Web site: http://www.sleepapnea.org

Narcolepsy Network, Inc.

P.O. Box 294 

Pleasantville, NY 10570

Telephone: 401–667–2523 

Fax: 401–633–6567

E-mail: narnet@narcolepsynetwork.org

Web site: http://www.narcolepsynetwork.org

National Sleep Foundation

1522 K Street, NW

Suite 500 

Washington, DC 20005

Telephone: 202–347–3471

Fax: 202–347–3472

E-mail: nsf@sleepfoundation.org

Web site: http://www.sleepfoundation.org

Restless Legs Syndrome Foundation

819 Second Street, SW 

Rochester, MN 55902–2985

Telephone: 507–287–6465

Fax: 507–287–6312

E-mail: rlsfoundation@rls.org

Web site: http://www.rls.org

Your Guide to Healthy Sleep
Discrimination Prohibited: Under provisions of

applicable public laws enacted by Congress

since 1964, no person in the United States shall,

on the grounds of race, color, national origin,

handicap, or age, be excluded from participation

in, be denied the benefits of, or be subjected to

discrimination under any program or activity (or,

on the basis of sex, with respect to any education program or activity) receiving Federal financial assistance. In addition, Executive Order

11141 prohibits discrimination on the basis of

age by contractors and subcontractors in the

performance of Federal contracts, and Executive

Order 11246 states that no federally funded contractor may discriminate against any employee or

applicant for employment because of race, color,

religion, sex, or national origin. Therefore, the

National Heart, Lung, and Blood Institute must be

operated in compliance with these laws and

Executive Orders.
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

National Institutes of Health

National Heart, Lung, and Blood Institute

NIH Publication No. 06-5271

November 2005

ISBN 1-933236-05-1