The Harvard Medical School Guide to a Good

Put your sleep problems to rest with this proven six-step plan How many times have you heard it's important to get a good night's sleep? It sounds simple, but it isn't always easy. Now one of the nation's leading sleep experts gives you a step-by-step program for overcoming sleep problems from insomnia and snoring to restless legs syndrome and sleep apnea. Dr. Lawrence Epstein of Harvard Medical School reveals his proven six-step plan to maximize your nights and energize your days. He explains the health benefits of sleep and identifies signs of sleep problems as he gives in-depth advice on how to: Turn your bedroom into the optimal sleep environment Finally overcome insomnia Silence buzz-saw snoring Relax restless legs Deal with daytime exhaustion Determine if sleep medication is right for you Improve your sleep by improving your child's sleep

Lawrence Epstein, M.D., is the president of the American Academy of Sleep Medicine and regional medical director for the Harvard-affiliated Sleep HealthCenters, the largest provider of sleep-medicine services in New England. He is an instructor at Harvard Medical School and a member of the Division of Sleep Medicine at Brigham and Women’s Hospital of Boston.

Steven Mardon is a professional writer who specializes in health topics.

Preface

xiii

Acknowledgments

xv

PART I Understanding The Need for Sleep

CHAPTER 1 Good Sleep: An Essential Element of Health

3

(8)

You Are Not Alone

4

(1)

Poor Sleep Is a Serious Problem

5

(2)

Dramatic Improvements in Diagnosis and Treatment

7

(1)

Setting Realistic Expectations

8

(3)

CHAPTER 2 The ABCs of Zs: What Happens During Sleep?

11

(16)

Sleep and Brain Waves

11

(7)

Sleep Architecture

18

(1)

The Sleep/Wake Symphony

19

(5)

The Sleep Conductor at Work

24

(3)

CHAPTER 3 How Much Sleep Do I Need—And What Happens If I Don't Get Enough?

27

(12)

Short, Standard, and Long Sleepers

27

(3)

Larks and Owls

30

(2)

Types of Sleep Deprivation

32

(3)

Sleep as a Part of a Healthy Lifestyle

35

(2)

Benefits of Sleep

37

(2)

CHAPTER 4 Sleep and Age: Why Can't I Sleep Like I Used To?

39

(10)

Childhood

39

(3)

Adulthood

42

(3)

From Sixty On

45

(1)

The Big Picture

46

(3)

CHAPTER 5 Sleep Myths and Facts

49

(6)

You Need Less Sleep as You Get Older

49

(1)

Alcohol Helps You Sleep Better

50

(1)

Snoring Is Annoying but Harmless

50

(1)

There's Something Wrong If You Don't Remember Your Dreams

50

(1)

I Can Get by Fine on Five or Six Hours of Sleep

51

(1)

You Can Learn to Get by on Less Sleep

51

(1)

Insomniacs Barely Sleep at All

51

(1)

Falling Asleep During the Day Is a Sign of Laziness

52

(1)

Listening to Self-Help Recordings While You Sleep Can Help You Learn

52

(1)

Napping Is a Bad Habit

53

(1)

It's Possible to Get Too Much Sleep

53

(1)

How I Sleep Doesn't Affect the Rest of My Health

54

(1)

CHAPTER 6 How to Get a Good Night's Sleep: A Six-Step Plan

55

(14)

Recognize the Importance of Sleep

56

(1)

Adopt a Healthy Lifestyle

56

(2)

Maintain Good Sleep Habits

58

(3)

Create the Optimal Sleep Environment

61

(1)

Watch Out for Sleep Saboteurs

62

(3)

Seek Help for Persistent Sleep Problems

65

(4)

PART II Sleep Disorders and Their Treatments

CHAPTER 7 Signs of a Sleep Problem

69

(10)

I Can't Fall Asleep

70

(4)

I Can't Stay Awake

74

(1)

I Can't Get Up in the Morning

75

(1)

I Do Strange Things in My Sleep

76

(2)

I Can't Sleep Because of My Partner

78

(1)

CHAPTER 8 Insomnia and Its Behavioral Treatments

79

(16)

Defining and Classifying Insomnia

79

(4)

Behavioral Treatments for Insomnia

83

(12)

CHAPTER 9 Medications for Treating Insomnia

95

(20)

What Separates One Sleeping Pill from Another

96

(3)

Over-the-Counter Medications

99

(2)

Prescription Medications

101

(9)

My Perspective on Sleep Medication

110

(5)

CHAPTER 10 Alternative Insomnia Treatments

115

(8)

Herbal Supplements

116

(3)

Synthetic Melatonin

119

(1)

Acupuncture

120

(1)

Hot Baths

121

(2)

CHAPTER 11 Sleep-Related Breathing Disorders: Snoring and Sleep Apnea

123

(20)

Simple Snoring

124

(6)

Obstructive Sleep Apnea

130

(10)

Central Sleep Apnea

140

(3)

CHAPTER 12 Movement Disorders: Restless Legs and Periodic Limb Movements

143

(10)

Restless Legs Syndrome

143

(8)

Periodic Limb Movement Disorder

151

(2)

CHAPTER 13 Narcolepsy

153

(14)

Causes of Narcolepsy

153

(2)

Symptoms of Narcolepsy

155

(4)

Diagnosis

159

(2)

Treatment

161

(3)

Living with Narcolepsy

164

(3)

CHAPTER 14 Parasomnias: Sleepwalking and Other Unusual Behaviors

167

(14)

Deep Sleep Parasomnias

168

(4)

REM Parasomnias

172

(4)

Other Parasomnias

176

(5)

CHAPTER 15 Disturbances of Sleep Timing: DSP and ASP

181

(10)

Symptoms of Delayed and Advanced Sleep Phase Disorders

182

(3)

Treatments for DSP and ASP

185

(6)

CHAPTER 16 Challenging Sleep Situations: Jet Lag, Shift Work, and Drowsy Driving

191

(18)

Jet Lag

191

(5)

Shift Work

196

(8)

Drowsy Driving

204

(5)

CHAPTER 17 My Child Doesn't Sleep Well, So I Don't Either

209

(20)

Newborns and Infants

210

(7)

Toddlers

217

(2)

Preschoolers

219

(3)

Young Children

222

(3)

Adolescents

225

(4)

CHAPTER 18 Diagnosis: What to Expect from a Sleep Doctor or Sleep Center

229

(14)

When Should I See a Doctor About My Sleep?

229

(2)

Seeing a Sleep Doctor

231

(5)

The Sleep Center

236

(4)

Getting Your Diagnosis

240

(3)

CHAPTER 19 Health Conditions and Medications That Disrupt Sleep

243

(16)

Cardiovascular Disease

243

(2)

Endocrine Disorders

245

(2)

Neurological Disorders

247

(3)

Respiratory Disease

250

(1)

Mental Illness

251

(2)

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The Harvard Medical School Guide to a Good Night's Sleep

Summary

Author Biography

Table of Contents

Supplemental Materials