- Poor sleep maintenance, or the inability to stay asleep appropriately, and also is frequently manifested as insomnia
- Physical factors such as light, noise, and bed partner can fragment sleep
- Bodily health can also affect sleep; hot flashes of menopause, nocturnal urge to urinate, pain, reflux esophagitis, medications, age, and depression
- Central sleep apnea is a common complication of heart failure, drugs, or brain dysfunction, and it is noted by the inability of the brain to send a signal for the lungs to breathe
- “Spousal arousal,” frequently breaks up a good night’s sleep (if not a marriage!) as snoring or kicking, or tossing and turning due to insomnia. These movements can lead to daytime fatigue in the bed partner. This is particularly interesting in that it is often unrecognized, since both partners feel that they are asleep and awaken in the mornings unrestored, not knowing why.
Many of us long for “good sleep,” so we can experience that rested, alert, and painless feeling the next day. I am frequently asked questions such as: I’m in bed for eight hours so why do I wake up in the morning sleepy anyway? The answer is that sleep includes stages and cycles, and quality sleep must go through these in order to achieve alertness and freedom from tiredness and daytime sleepiness. Also, I have heard patients say that they are teased about snoring heavily, but that they are not aware of it and actually have good daytime function and do not feel sleepy.This is likely because snoring alone is not enough to interrupt sleep unless there is upper airway resistance, enough to interfere with sleep through the vibratory sensation that awakens the body through motion. Snoring, however, is frequently associated with pausing of breath during the night, hypopnea, which means shallow breathing enough to reduce the oxygen tension in the blood. This then leads to oxidative stress, which can lead to unhealthy blood vessel walls and ultimately, vascular disease.
I also hear very often that patients can fall asleep but cannot seem to stay asleep. Abnormalities of sleep initiation and maintenance make up the bulk of what is known as insomnia. Insomnia is disruption of normal sleep. Sleep time is therefore reduced, and sleep deprivation has its consequences. Insomnia is usually involuntary with recurrent difficulty with sleep initiation, (which means getting to sleep), sleep duration, (which means hours of sleep), and sleep consolidation, (which means staying asleep). Sleep quality usually implies being refreshed by sleep, or feeling restored. This is often absent in someone with insomnia.
