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Sleep disorders classification

Insomnia

Insomnia is characterized by a difficulty of falling asleep, frequent or prolonged nocturnal awakenings, or finally prematurely waking up with an inability to sleep again.

Basically, taking more than 30 minutes in average to fall asleep, or spending more than 30 minutes awake in the middle of the night, with a sleep duration of less than 6.5 hours per night represents a problem of insomnia. If you have difficulty staying asleep or falling asleep at least three times a week, you probably have insomnia.

There are different possibilities of cause:

  • Temporary insomnia
  • Poor sleep hygiene
  • Psychophysiological insomnia
  • Bad perception of sleep
  • Insomnia related to a mental disorder
  • Insomnia related to a medical condition
  • Insomnia due to a drug or substance

Hypersomnia

Hypersomnia is characterized by a difficulty of staying awake and an important need to sleep (sleeping too much, too often, and / or at anytime) when it’s not associated with circadian rhythm disorder, respiratory disorder or any other cause of sleep disorder.

Narcolepsy

Narcolepsy is a neurological disorder that affects the control of sleep and wakefulness. People with narcolepsy experience excessive daytime sleepiness and intermittent, uncontrollable episodes of falling asleep during the daytime. These sudden sleep attacks may occur during any type of activity at any time of the day. 

The difference with Hypersomnia lies in the fact that Hypersomnia leads to sleeping excessive amounts of time and having severe difficulty waking up after sleeping (i.e. excessive sleep inertia). People with narcolepsy frequently do not sleep excessive amounts of time, and may find brief naps refreshing. Many people with narcolepsy also experience symptoms related to REM sleep instability such as sleep paralysis.

Sleep disorders related to breathing

We know that not only is the amount of sleep important, but also its quality.

A night breathing issue causes poor sleep quality with frequent nocturnal awakenings (conscious or unconscious). There is two main category of night breathing disorder. 

Obstructive sleep apnea

The most common one is the obstructive sleep apnea. It results from obstruction (partial or complete closure) of the breathing airways. The body makes an important effort to breathe, but the air does not pass. About 9 out of 10 people who experience apnea have obstructive sleep apnea. Often these people snore.

Central sleep apnea

During a central sleep apnea, no effort to breathe is manifested and no volume of air passes through the lungs: the breath is simply no longer. Central apnea is often accompanied by obstructive sleep apnea. “Pure” central apnea is quite rare. Medical problems such as heart failure, stroke, and kidney failure can cause this central sleep apnea syndrome. It can also be caused by chronic intake of medication and drugs such as opioids, especially methadone, hydrocodone and morphine.

Circadian rhythm disorders

Circadian rhythm disorders are characterized by a disruption of the biological clock.

Delayed Sleep Phase Disorder (DSPD)

People with DSPD generally fall asleep some hours after midnight and have trouble waking up in the morning. We are not talking about a deregulation due to lifestyle but about a genetic cause. The syndrome affects 0.5% of the world’s population. If they are allowed to follow their own schedules, e.g. sleeping from 4:00 am to 1:00 pm, their sleep is improved. Attempting to force oneself onto daytime society’s schedule with DSPD has been compared to constantly living with jet lag. An adolescent version may disappear in late adolescence or early adulthood; otherwise, DSPD is a lifelong condition. 

Advanced Sleep Phase Disorder (ASPD)

It is a condition in which patients feel very sleepy and go to bed early in the evening (e.g. 6: 00-8:00 p.m.) and wake up very early in the morning (e.g. around 3:00 a.m.). The syndrome affects 1% of the world’s population.

Irregular Sleep-Wake Rhythm

The irregular sleep-wake rhythm is one of the rarest circadian rhythm disorders. Sleep is divided into three or more short-term episodes of sleep, distributed day and night. A fundamental impairment of the biological clock is suspected. The number of hours of sleep acquired in 24 hours is often equal to that of people who have normal sleep patterns however they are suffering from a lack of deep sleep, which is necessary for the body’s natural regenerative process.

Non-24-Hour Sleep-Wake Disorder

If you have Non-24-hour sleep-wake disorder, you may find yourself gradually going to bed later every night and waking up later each day. It is very rare, and it occurs because the internal clock is not sync with the day and night cycles. Most individuals with this disorder are blind people. But sometimes people who have normal vision can suffer from it.

Muscular issues during sleep

Muscular issues during sleep are benign motor disorders. Sometimes it can be dangerous  because of the external environment around the individual. But most often, these movements are without consequences.

REM Sleep Behavior Disorder

While being asleep, the person begins to mimic his/her nightmare/dream and suddenly begins to speak, shout, gesticulate abruptly. These dreams often have a part of violence, and there is a concordance between what the person dreams and what he/she does.

Periodic Limb Movement Disorder

It is characterized by rhythmic movements of the limbs during sleep. The movements typically involve the legs. Movements occur periodically throughout the night and can fluctuate in severity from one night to the next. These movements are very different from the normal spasms, called hypnic myoclonia, that we often experience initially while trying to fall asleep. It can often cause a partial or full brief awakening, resulting in fragmented sleep. Patients are frequently unaware of these movements.

Sleepwalking

Sleepwalking is manifested in complex and automatic behaviors, including strolling out of bed, during deep sleep.

Nocturnal cramps

Nocturnal cramps are muscle contractions that affect a muscle or a muscle group. They are usually located on the legs, a calf or a foot. The cramps are very painful and they appear spontaneously and involuntarily. They are usually short and can be repeated several times during the night.

Nocturnal Bruxism 

If you get up in the morning with pain in the jaw muscles or with headaches, you may be suffering from bruxism. Bruxism (grinding and clenching of teeth) is a common behavior; reports of prevalence range from 8% to 31% in the general population. Bruxism can cause dental pain and / or make teeth loose; sometimes even pieces of teeth can come off (fracture). Over time, bruxism can destroy bone and soft tissues surrounding teeth.

Sleep paralysis

Sleep paralysis is a state where a person is aware of his incapacity to move despite his desire to do so. It manifests itself when the person is falling asleep or waking up. This can be accompanied by a hypnagogic hallucination.

Psychological issues during sleep

Hypnagogia

Hypnagogic hallucinations are intense and impressive hallucination that occur at the beginning or end of a sleep period. All the senses can be affected, or only some of them. It is often difficult to distinguish between hallucination and reality. Hypnagogic hallucinations are often represented by something scary.

Confusional arousals

Confusional arousals is an episode of confusional state occurring during or after awakening. The person is disoriented in time and space, is slowed down (slowness of ideas, difficulties of speech, difficulties of understanding …). The person can make incoherent remarks, sometimes related to a dream. His behavior may be inappropriate, inconsistent, or even violent.These episodes can be repeated several times a night. They occur most often during the first hours of sleep, and after a nap. There is always a complete or almost complete amnesia of the episode.

Nocturnal emission

A nocturnal emission, informally known as a wet dream or sex dream, is a spontaneous orgasm during sleep that includes ejaculation for a male, or vaginal wetness or an orgasm (or both) for a female. These emission are often associated with erotic dreams.

We remind you that the Circular™ ring is not a medical device and should not be used to diagnose or monitor a pathology.

What is a lucid dream

A lucid dream is a dream in which the dreamer is aware of his own state of dreaming. Knowing how to dream lucidly offers the dreamer the opportunity to exercise deliberate control not only over his actions but also over the content of his dreams and their unfolding. It can be used for many reasons such as helping you to cope with a situation happening in real life.

How does the lucid dream appear

Lucid dreams are classified into two groups depending on the appearance of lucidity. The acronyms DILD and WILD are used for distinction: DILD (dream-initiated lucid dreams) applies to the dreams in which someone becomes aware of his state within an ongoing dream; WILD (wake-initiated lucid dreams) to someone who consciously enters a dream in the waking state. More than 80% of lucid dreams are DILD. 

Although the theoretical limits of lucid dreams are those of one’s imagination, the individual experience and the degree of lucidity both influence the content and tone of the experience.

In some cases, lucid dreaming is characterised by the feeling of leaving the body and observing the environment from a position distinct from it (Out of Body Experiences or OBE).

How does a lucid dream end

The way in which lucid dreams end can be defined by the loss of the consciousness of dreaming. Either it is linked to the disappearance of the dream and the dreamer wakes up, most often involuntarily, sometimes because of too intense emotions; either the dreamer has a lack of attention and is distracted: lucidity then dissipates and he falls back into an ordinary and uncontrolled dream. In some cases, lucidity is lost in an ordinary dream because of the transition from one dream scene to another.

Conclusion

Lucid dreaming is something that can be learned. Motivation is a necessary precondition and there are many methods for lucid dream induction. If you want to know more about how to do so, check out this article about: “How to dream lucidly”.

Understanding polyphasic sleep schedules

If you wish to know more about your circadian rhythm before jumping into this article you can click here.

Monophasic sleep

Polyphasic sleep is known to sleep researchers as a variant of a sleep pattern that is set in opposition to monophasic sleep. In monophasic sleep, an individual or an animal sleeps in a single block during a single wake-sleep cycle of 24 hours. This is the most followed sleep schedule in the world. As doctors recommend getting 7 to 9 hours of sleep each night (referring automatically to monophasic sleep), some argue that this schedule is, in reality a product of our fast paced, sleep deprived modern societies. Our natural environments would suggest otherwise and some clear sleep patterns have been demonstrated amongst babies and the animal kingdom.

Monophasic Sleep Circular

Biphasic sleep

There are plenty of historical evidence pointing to biphasic sleep. That means going to bed early, rising early, then napping for a prolonged period later in the day. In a recapitulation of phylogeny, human babies also sleep polyphasically, and gradually lose their nap slots until they become roughly biphasic around the age of one. Although a majority of westerners do not nap on a regular basis, their alertness shows a slump in alertness in the middle of the day.

A great example of a biphasic sleep schedule is the “siesta” that is very common in Spain, Germany, and various other European countries. Spain specifically closes shops in the middle of the day for a few hours so that people can go home for lunch, napping, and other quiet activities. The siesta schedule consists of 5 hours and 30 minutes of sleep at night and a 20 to 90-minute nap in the early afternoon. This form of sleep matches with our natural Circadian rhythm and is commonly known by scientists to be as healthy as monophasic sleep.

Both monophasic sleep and biphasic sleep are historically common and biologically normal for humans. Research has shown that both types of sleep routines can yield healthy, robust sleep architecture with adequate overall rest. If you feel a lack of concentration in the afternoon, switching to a biphasic schedule might be the right solution. It is also very easy to implement. 

Biphasic Sleep Circular

Polyphasic sleep

Polyphasic sleep, also called segmented sleep, covers all sleep patterns with multiple sleep episodes a day. Polyphasic sleep can be performed in many ways, from a triphasic schedule, suitable for people with non-flexible life-styles, to Uberman or Dymaxion schedules with very strict conditions and great time benefit as one gets only 2 hours of sleep.

Polyphasic sleepers can rest 3 to 6 times during a day. These sleep combinations are broken down into categories including:

  • Dual Core: Dual Core sleep is a derivative of the other schedules but with a core sleep around dusk, a core around dawn, and a number of naps in the afternoon.
  • Triphasic: A nap after dusk, a nap before dawn, and a nap in the afternoon. A Triphasic sleeper typically sleeps between 4 and 5 hours a day.
  • Everyman: A long sleep time of around 3 hours with approximately three 20-minute naps throughout the day.
  • Uberman: Only 3 hours of sleep per day in the form of six 30 minute naps throughout the day.
  • Dymaxion: Only 2 hours of sleep per day, in the form of 30 minute naps every 6 hours.

Everyman Sleep Circular

No one person’s sleep requirements are exactly the same. Some require 8 solid hours of sleep for optimal function. Someone else, however, may lead a productive and healthy life on 5 hours of sleep per night with a short nap or naps during the day.

So what’s the best thing to do?

The first step when reconsidering the way you sleep should always be to see if you are respecting the usual sleep hygiene basics. Exercising regularly and eating a healthful diet, avoiding foods that are sugary, fatty, processed or have caffeine, avoiding spicy foods or having caffeine at bedtime, stopping the use of computers, TVs, cellphones, and other electronic devices at least 1 hour before bed, maintaining a dark and quiet sleeping place.

The best call for an alternate sleep schedule stays the biphasic sleep program.You might consider going for a biphasic sleep schedule if you have a little bit of time in the afternoon to nap and you might gain a little bit of extra time for your day. It greatly helps countering the lack of concentration you might have in the afternoon and is a very healthy sleep schedule. The Circular app and ring can help you adjust to your schedule easily with automatic nap and sleep detection and automatic silenced wake ups. You can start from the programs circle, in the sleep programs.

When it comes to the other polyphasic sleep schedules, there are a couple of disclaimers you have to take into consideration before jumping in. Firstly, there is a lack of scientific literature on their benefits (there are great variants amongst results), and it is a great chance that, on the long run, these programs will make you sleep deprived.

That being said, polyphasic sleep programs suit some people and you can try them for yourself. It won’t hurt you to try for at least the needed adaptation period (usually 10 days) and check how you feel with your new schedule. The risk is when you stick with them for several months. But on the short term, they could be beneficial to you if you need a little extra time in your day and feel like changing your sleep schedule is what can help you reach that goal. 

For some, these come with other great benefits such as having more concentration during the day or even being able to dream lucidly more easily. One thing to keep in mind before starting: you must start with schedules close to the one you are on. Typically, if you are on a monophasic schedule, try the “beginner” programs such as the triphasic or biphasic schedules first. Then move up gradually if you make it past the adaptation periods with no problem. If you feel way too tired then stop the programs and don’t go further. 

The polyphasic sleep community:

https://www.polyphasicsociety.com/polyphasic-sleep/beginners/

What’s the Circadian rhythm

Studies (Mammoth Cave experiment of Kleitman) have shown that isolated individuals during several weeks of the 24-hour light and dark environmental cycle continue to maintain a rhythm in which sleep and waking state alternate over a period of approximately 24 hours. This suggests that the human being has an internal biological clock that saves its rhythm.

And it is also well known that the sleep-waking rhythm schedule of an individual can shift if the individual is exposed to a different light/darkness cycle schedule. This suggests that during the day, the light allows synchronization of your own rhythm with the terrestrial clock.

That’s why moving from several time zones will cause you jet lag. On one side you have your own internal clock that saved the old rhythm and on the other side, the light of your new zone no longer matching with your old rhythm. The light/darkness alternation will force your body to resynchronize its circadian rhythm.

Thus, the rhythmicity of our body comes both from the environment and from eyes/brain mechanisms.

Several body phenomena depend on your circadian rhythm such as:

  • Body temperature
  • Hormones (cortisol, melatonin)
  • Pulse rate and blood pressure
  • The level of awakening
  • Mood
  • Vigilance
  • Memory
  • Intestinal activity

Melatonin Clock Circular
https://www.nzgeo.com/stories/slaves-to-the-rhythm/

Regarding sleep, the Circadian process makes you have powerful physiological signals that promote wakefulness and sleep at specific times of the day. The earth cycle of light influences the production of your body hormones.

Sleep is driven by two independent functions:

  • Adenosine that is produced during the day which is responsible for accumulating sleep pressure and,
  • Melatonin that is produced in the absence of light and which is responsible for making you sleep.

In other words, your sleep synchronizes with the earth’s cycle of light and darkness. This is why night workers tend to have more sleep troubles.

What you should memorize about the relation of the circadian rhythm and your quality of sleep:

  • Nocturnal exposure to artificial light is bad. It will influence and disturb your internal clock. 
  • When your sleep is out of order it is important to reset it by exposing yourself to light (preferably sunlight).
  • Going to bed and always getting up at the same time will strengthen your internal clock and will allow you to fall asleep faster and have a better quality of sleep.

Small tip: When you come back very late after a night out, do not close your windows shutters if you have decided to sleep late. It’s a big mistake even if you do not want to be bothered by the light of the morning. By plunging yourself completely into the darkness when it is supposed to be daytime, your body will not detect daylight in the morning and this will disrupt your biological clock. Your body will act as if you have traveled on different time zone. Consequently, your biological clock will try to adapt to this change and you will suffer from jetlag the next few nights. You will probably not fall asleep at the usual time but much later because of that.

Scientific sources:

  • Sleep and Wakefulness of Kleitman, Nathaniel. Chicago, IL: The University of Chicago Press. 1939.

How much sleep should I get? Sleep demystified. Basics n°5 about sleep

Sleep needs vary across ages and are especially impacted by lifestyle and health. To determine how much sleep you need, it’s important to examine what factors of your own lifestyle are affecting the quality and quantity of your sleep then assessing how you respond to different amounts of sleep. Of course, the quality of your sleep will also impact how much time you need.

But let’s say your sleep quality is good, the National Sleep Foundation assess an adult sleep duration to be between 7 to 9 hours. There is a good chance that it suits you by looking at the distribution diagram below.

Average Sleep Duration Circular

But as you see on the graph it won’t suit everybody since there are exceptions.

The best way to find naturally your sleep need is to assess how you respond to different sleep duration. Do the test without having done sports activity the day preceding. See how you respond to that. If you feel tired, you add another cycle duration to the next night. On the contrary, remove one if you feel good. Once you have found the sleep duration that suits you in normal condition, we advise you to add a cycle on the days of sports activity to help your body restore better.

The easy way is to use the Circular ring. The ring will detect automatically your sleep cycle length, assess how you respond to your current sleep schedule by analyzing several parameters that reflect your energy such as your heart rate variability, your sleep quality, your time to fall asleep, your activity, etc… and recommend you the perfect time you need to sleep. 

Sleeping pills risks and how to fall asleep naturally

Sleeping pills can be taken to catch up when you have a lot of sleep debt or when you are traveling and you must absolutely sleep during a specific period of time. But it should be taken punctually to cope with temporary difficulties and not systematically. A good use of sleeping pills should not exceed a few days. Otherwise, their benefits won’t be miraculous anymore. 

If you take sleeping pills systematically, you might get addicted. This means that your brain will get used to benefiting from their help and will no longer make the effort to fall asleep by itself , resulting in your natural chemical system not working properly. In addition to that, the effectiveness on your brain of the sleeping pills will decrease over time. As a result, you will not be able to fall asleep properly without them and at the same time the pills won’t be effective anymore. (This also applies to natural sleep solutions).

On the one side you will lose your freedom but on the other side you also risk to damage your health because their prolonged use causes undesirable effects such as daytime drowsiness, dizziness, nausea, memory problems, awareness problem, changes in appetite, headache, stomach pain, heartburn and more.

So what should you do to fall asleep without sleeping pills?

Sleep should be prepared during the day. If you follow what is said in this article with a bit of willpower, you will naturally regain a normal sleep without taking any external substances.

Experience both daylight and darkness.

Light influences your body’s internal clock, which regulates sleep and wakefulness. Irregular light exposure can lead to a disruption in your circadian rhythms, making it harder to fall asleep. That’s why if you live in a country where there is not a lot of sun or winters without sun, it is normal for you to have episodes where you sleep badly. It is important to expose your body to bright light or artificial bright light during the day and sleep in a dark room at night. (Click here to know more about Circadian Rhythm)

Respect a regular schedule

The second most important tip is to follow a regular schedule. This means going to bed at the same time each night to regulate your inner clock and to wake up at the end of your sleep. Generally, night people tend to have difficulties falling asleep quickly. And people tend to comfort themselves with the fact that they are not morning people so they can not do anything about it. But this is wrong. To make the changes, you have to be patient. Do it slowly, over days or weeks, and then stick with them for maximum effect. It takes discipline, but it can be done.

If you are a night person, I’ll give you a tip to adapt very quickly. Force yourself to wake up earlier than expected by an hour or two. Tired in the following days, you will be able to easily fall asleep sooner and faster. Once you see the change, stick to this bedtime and you will see that you will adapt very easily.

The Circular app can help you with that because it will analyze for you, your sleep needs and tell you at what time you should go to bed depending on your time to fall asleep and your waking up time.

No nap for you

If you are having naps during the day, get rid of them.

Be active

If you are not already doing physical activity, be active during your day. But be careful, do not do sports too close to the time you go to bed or your system will still be stimulated and you won’t be able to fall asleep correctly. Give your system at least 3 hours before sleeping.

Avoid digital screens

The following factor is the number one cause for extremely high falling asleep time. SCREENS. Digital screens are a plague for sleep and this for two main reasons. Firstly because watching something on a screen requires a lot of effort for your eyes and is very stimulating for your brain. This will make your brain think unnecessarily (even unconsciously) before and during your sleep. And secondly, because the blue light of these screens will disrupt your circadian rhythm. Basically, it will make think your inner clock that it is not time to sleep, and therefore delay your sleep even if you put yourself in the dark. 

So don’t watch digital screens before sleeping. And if you really want to watch your screen, install something to get rid of blue light, lower the brightness to the minimum and do not look at your screen in the dark but rather in a lit room. Finally do not look at your screens in your bed while lying down. Because lying in bed for a long time without sleeping will also disrupt your inner system. The gesture of lying indicates to your system that you want to sleep, so don’t miss your opportunity to sleep.

Be smart about what you eat and drink

Minimizing caffeine, alcohol, and nicotine before sleeping seems logical. But less known, avoid having heavy and late dinner. A light dinner, without quick sugars and red meat but with a portion of slow sugars.

Do not eat within 4 to 6 hours before bedtime. 

Create a comfortable environment of sleep. 

Don’t work too late to free your mind (within 2 hours of the time you want to sleep).

Sleeping in a quiet, dark room and at a cool and comfortable temperature will help you sleep faster. The ideal room temperature for sleep is between 18 – 22 degrees Celsius (64.4 – 71.6 degrees Fahrenheit).

Practice meditation

Meditation and relaxation training will help you improve fall asleep faster and sleep better. There is a simple but powerful breathing method called 4-7-8 method that is used by the military and ancient yogi that will lower your heartbeat, calm yourself and make you fall asleep faster, sleep better and increase your natural defense. 

Here are the steps. Exhale completely through your nose until you completely empty your air. Close your mouth and inhale through your nose until you are completely filled with air (belly and lung) while mentally counting to four. Hold your breath and mentally count to seven. Close your mouth and exhale completely through your nose, and mentally counting to eight. If 4-7-8 is easy for you double the ratio to 8-14-16 and so on. The higher the ratio the better it is. Repeat this cycle 7 times. Do it at least three times a day, the more you do it the better it will be for you.

Do not pay attention to time

People who can’t fall asleep often tend to watch the clock and are obsessed about the fact that they cannot fall asleep. But this behavior causes anxiety and that’s what you want to avoid. So get rid of any clock in your bedroom that shines in the night or forces yourself not to watch it. Even if it is tempting, watching the time is useless. In the end, you will have to wake up at the time you have set and it is not by looking at it that you will fall asleep faster.

Fight anxiety and stress

One of the major cause for falling asleep issues is anxiety and stress. I am anxious myself and I hate it when my brain starts working hard just before sleeping when I have my eyes closed. I then find it hard to relax and to turn off my thoughts.

There are techniques that I have tested and that I can confirm are helping. Try to visualize something that makes you happy and smile while you have your eyes closed. This technique will help you occupy your mind with good thoughts instead of engaging with worries and concerns during pre-sleep time. But if you think of something important and you feel that it develops in your mind. Stand up and write it down on a piece of paper. At first glance, one may think that getting up will make you start over from the beginning but on the contrary, it will allow you to move on and fall asleep more quicker.

But the best techniques to clear your mind before sleeping are still meditation and breathing exercises.

Conclusion

Yes, there are a lot of parameters to take into consideration in order to find good sleep back . But you are certainly doing great on some of these factors. And if you are not, it’s okay. Try to apply these changes one by one. This may take several weeks, but I guarantee you’ll get there!

Scientific sources:

Picture from Ivan Oboleninov / Pexels