• A biological clock in the brain that lines up with the 24 cycle of light/darkness in our day and night
• Regulates when we feel sleepy
• Special cells in the back of the eye send information on how bright it is to the brain
• When it is darker, the brain makes melatonin, a hormone that makes us feel drowsy

Although many factors may play a role, the two most powerful ways to set the body clock are: 

1. Getting sunlight during the first hours of the day leads to earlier rise time/bedtime; getting daylight during the last hours of the day leads to later sleep and rise times. 
2. Getting out of bed at a regular time so the body clock gets a more reliable daily reset. 

• The amount of pressure your body produces to go to sleep
• Based on how much time you spend awake and active in a 24-hour period
• A chemical in the body called adenosine builds up whenever you do activity and more adenosine makes the sleep drive stronger (left figure)
• When you nap, you decrease your stores of adenosine and have less sleep drive (right figure)

Some habits can also lead to less sleep or decrease the sleep drive:

• Staying in bed after the alarm goes off
• Sleeping in in the morning
• Going to bed earlier than usual
• Doing less activity because of how you feel (e.g. less physical activity, cancelling plans, calling in sick to work or an appointment)
• Napping or trying to nap during the day (this uses up the adenosine you have produced)

• Insomnia is the most common sleep problem.
• Most people have short term insomnia at some point in their lives.
• It happens when people have trouble falling asleep or staying asleep even though they had a chance to get a full night of sleep.
• Insomnia can have different causes, symptoms, and severity.
• Insomnia can happen for one night, or may last weeks, months, or years.
• Chronic insomnia is when it lasts more than three months

There are many things people try and many changes people make to control their ability to sleep. Sometimes these things work, and sometimes they may become insomnia amplifiers leading to rigid routines that may not help. What can often occur is lost trust in the ability to sleep. Insomnia amplifiers including things like:

• Changing your sleeping patterns
• Spending too long in bed
• Frequently changing when you go to bed and wake up
• Daytime napping
• Long-term use of medication or substances
• Loss of trust in own ability to sleep
• Alcohol, cannabis, nicotine, caffeine and many other drugs
• Rebound insomnia when you stop using them
• Forced relaxation
• Useful in a stressful moment, but not when 'forcing' yourself to fall asleep.
• Can increase anxiety when it “isn’t working”
• Unhelpful habits meant to control sleep
• Using electronics for distraction, such as TV watching
• Social interaction, like reading emails or social media
• Being overly active when you can’t sleep – getting up to work, eat, wander around, stretch
• Mind games, clock watching
• Making life-narrowing life changes
• Strict routines
• Reducing evening social activities
• Avoiding morning activities

• Narrowing your life and cutting out meaningful activities doesn’t necessarily help with sleep, and can actually make people feel more anxious and isolated. In turn, this anxiety can feed back into the insomnia.

• Obstructive Sleep Apnea

  • A disorder where your breathing stop while you’re asleep due to the passageway for air to go in and out of your lungs being blocked
  • Usually the airway is blocked by the tissue in the back of a person’s throat relaxing and narrowing the airway
  • Sometimes people will snore when this happens
  • During obstructive sleep apnea, the airway can become blocked repeatedly and the brain doesn’t get enough oxygen, and will wake you up briefly
  • Sleep apnea can be very dangerous since your brain is not getting enough oxygen

   Central Sleep Apnea

  • A disorder where your breathing repeatedly stops and starts during sleep because your brain does not send the proper signal to the muscles that control your breathing
  • Less common than obstructive sleep apnea
  • May occur as a result of other conditions, such as heart failure and stroke
  • Treatments may involve treating the existing conditions, or using a device to assist breathing or providing supplemental oxygen

References for more information:

• American Sleep Apnea Association
• National Sleep Foundation

• Circadian rhythm disorders occur when sleep times are not aligned with day and night
• This can include jet lag and shift work syndrome
• When someone has a delayed sleep-wake disorder, their internal clock is shifted later at night and in the morning (go to bed later, wake up later)
• When someone has an advanced sleep-wake disorder, the opposite happens: they tend to have an early bedtime and wake up hours earlier than most people.
• With delayed and advanced sleep-wake disorders, people usually sleep normally as long as they are able to get enough hours of sleep
• Use of sleep aids such as melatonin as well avoidance of blue or white light closer to bedtime can help with anchoring your circadian rhythm

Shift Worker Sleep Disorder

• For individuals who work night shifts, rotating shifts or even early morning shifts, they are prone to developing this condition.
• It can cause chronic sleep deprivation, in which a person never catches up on needed sleep and carries a “sleep debt” with them.
• This sleep loss can cause problem in health, productivity and safety.

 Symptoms:

• Excessive sleepiness when you need to be awake, alert and productive
• Insomnia, or the inability to sleep when you need to
• Sleep that feels unrefreshing or insufficient
• Difficulty concentrating
• Lack of energy
• Irritability or depression

• Sleep Movement Disorders

  • This group of sleep disorders consists of conditions that make your body move before or during sleep
  • Sleep movement disorders can make it hard to fall asleep or stay asleep, or to sleep restfully
  • Bruxism (grinding or clenching the jaw), leg cramps, and restless legs syndrome are the most common types of sleep movement disorders

   Restless Legs Syndrome

  • Restless legs syndrome is often described as a sensation of discomfort in the legs that is different than leg cramps or numbness
  • People sometimes describe it as itchy, crawling, burning, creepy, or throbbing
  • Usually people want to move their legs when they feel this sensation but do not feel the satisfaction that they were expecting

Primary Disorders of Daytime Sleep Disorders

• Excessive daytime sleepiness, excessive time spent sleeping, or trouble staying awake during the day.
• Often fall asleep at times that are inconvenient or dangerous, such as at work or driving.
• The most common disorders under this category is narcolepsy or idiopathic hypersomnia.

Most Common Forms

• Cataplexy is the loss in muscle tone, triggered by emotions such as laughter, surprise, fear or anger. This occurs when the person is awake, and causes feelings of weakness and a loss of voluntary muscle control, resulting in the immediate and full body collapse.
• Excessive Daytime Sleepiness (EDS) is the persistent sense of mental cloudiness (brain fog), lack of energy, persistent drowsiness and extreme exhaustion which continues for prolonged periods of time.
• Disrupted or fragmented nighttime sleep is sleep disrupted by periods of wakefulness, vivid dreams sleep talking and movement.
• Hypnagogic (during sleep onset) or hypnopompic (during waking) hallucinations are vivid, realistic and often frightening dreams that occur on the edge of sleep and wakefulness.
• Sleep paralysis is the temporary inability to move, occurring in the transition between sleep and wakefulness.

Talk to your doctor if you think you are excessively sleepy.

Resources for more information:

• Narcolepsy Network
• Hypersomnia Foundation

Parasomnias

• Undesirable movements, behaviours, perceptions, or dreams that occur during sleep or arousals from sleep without conscious awareness.
• This includes but is not limited to nightmares, night terrors, sleepwalking, confusional arousals, sleep talking, sleep paralysis, impaired sleep-related erections, and more.

Night Terrors

• Waking up abruptly in a frightened state from sleep
• Often accompanied by crying or screaming, with an increase in heartrate and breathing, swearing or flushing of the skin
• Though the individual may appear to be awake, the person is often confused and unable to communicate properly
• Usually brief but can last up to 40 minutes, after which time the person lies down and appears to fall back asleep

Sleepwalking (Somnambulism)

• When the person appears to be awake and moving around with their eyes wide open but is actually asleep
• Wake up with no memory of their actions, or make wakeup in the middle of an episode and appear confused of what happened

Confusional Arousals

• Occur when the person is awaked from a deep sleep during the first part of the night
• This individual wakes up extremely confused, may cry or be completely inconsolable

Nightmares

• Vivid dreams during sleep that cause feelings of fear, terror and anxiety

Sleep Paralysis

• Individual feels that they are unable to move the body or limbs when falling asleep or waking up due to their muscles feeling paralyzed, even though they are awake

REM Sleep Behaviour Disorder

• Individuals act out dramatic and/or violent dreams
• Involves a state of paralysis, however people move the body or limbs while dreaming

If you experience, or are told you have experienced strange sensations or behaviours during sleep, please see your physician as soon as possible.

• Most adults need 7.5-8 hours to function well

• Your bedtime should be the same weeknights and weekends
• Your wake up time should be the same on weekends and during the week

• Napping may help daytime functioning, but too close to bedtime may decrease your need for nighttime sleep
• Limit naps to 20-30 minutes, early in the afternoon
• If you find that you can't fall asleep at bedtime, eliminating even short catnaps may help

• Spend the last hour before bed doing a calming activity such as reading, stretching, warm bath

• The light from the screens of these devices stops your brain from making melatonin
• Use a light filter to block blue light if you must look at a screen

• Physical activity helps with stress and overall sleep quality
• Avoid doing vigorous exercise more than 3 hours before your bedtime

• Limit eating big or spicy meals right before bed, as this can cause indigestion that can make it hard to sleep
• Try a light snack 45 minutes before bed if you’re hungry.
• Limit drinking fluids close to bedtime
• Limit caffeine after 2 pm

• Remove work materials, computers and televisions
• Use your bed only for sleep and intimacy to strengthen the association between bed and sleep

• Mattress should be comfortable and supportive
• Keep bedroom cool
• Keep it quiet
  • White noise/humidifiers/fans
  • Ear plugs
• Keep it dark
  • Blackout curtains
  • Eye shades

Try to get early morning sunlight to reset the circadian rhythm

• All may negatively impact sleep
• Alcohol may help you get to sleep initially, but when it wears off it disrupts sleep
• Nicotine and caffeine are stimulants
• Nicotine has affect on sleep during withdrawal (sleep disturbances)