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FAQ / Knowledgebase

To understand the nature of sleep and its stages, it’s important to understand the difference between sleep and wakefulness. Being awake is a state of consciousness accompanied by heightened perception, realistic thinking, environmental responsiveness and physical activity. In contrast, sleep is a behavioral state of decreased perception, relatively low responsiveness to the environment and physical inactivity (or rest).

A quiescent body is the most obvious characteristic of sleep, but the brain remains active at varying levels while regulating sleep and performing vital tasks. Indeed, during certain phases of sleep, the brain is more active than during wakefulness.

There are two fundamental sleep states: REM (rapid eye movement) sleep and non-REM sleep. Each is regulated by a different part of the brain; and the difference between those states is as profound as the difference between sleep and wakefulness. REM sleep is regulated from the brainstem, whereas non-REM sleep is regulated from higher brain centers.

As a practical matter, scientists differentiate between the three states (wakefulness, non-REM sleep and REM sleep) by measuring

  • electrical activity in the brain via electroencephalography (EEG)
  • eye movements via electrooculography (EOG)
  • muscle activity via electromyography (EMG)

 

The following are more precise descriptions of the behavioral and physiological changes across these states.

Wakefulness

A waking state may be quiet, physically active or mental active.

Non-REM Sleep

Non-REM sleep has three stages (1, 2 and 3) which are differentiated by their degrees of sensory and motor disconnects from the environment. The magnitude of those disconnects is otherwise known as sleep depth. (Stage 3 is the deepest.) Increasing depth means

  • slowing, mostly homogenous electrical activity in the brain
  • decreased slow-rolling eye movements (ceasing completely in stages 2 and 3)
  • decreased muscle activity (though movement is always possible)
  • decreased respiration and heart rate, but increasing regularity
  • decreased oxygen consumption
  • growth hormone secretion (stage 3)
  • decreased sensitivity of pain receptors
  • stable body temperature control
  • realistic and analytical thought processes (similar to wakefulness)

 

REM Sleep

REM sleep is characterized by varying levels of sensory disconnection from the environment and an inability to move. The important characteristics are

  • rapid and heterogeneous electrical activity within the brain (similar to that of wakefulness)
  • inhibition of voluntary muscles leading to near-paralysis with some irregular twitches
  • rapid eye movements similar to those of wakefulness
  • decreased control of body temperature
  • faster and irregular heart rate and respiration (relative to non-REM sleep)
  • penile tumescence
  • increased oxygen consumption
  • hyper-associative dreaming with bizarre thoughts

 

Although the three states (wakefulness, non-REM sleep and REM sleep) have very distinct physiological characteristics, there may be overlap under certain circumstances. For example, sleepwalking occurs mostly during non-REM deep sleep and presents a behavioral characteristic that is normally associated with wakefulness.

Every human is in one of these three states at any given time. On average, adults are awake for 2/3 of the 24-hour day and asleep for the other 1/3. When sleeping, the relative proportions of sleep states are roughly

  • 50% in light non-REM sleep
  • 20-25% in deep non-REM sleep
  • 20-25% in REM sleep

 

An amazing statistic: In a 90-year lifespan, a person will probably have slept for 30 years and will have spent 10 years dreaming!

How Will SleepRate Help You?

Use SleepRate for a few days to identify sleep-wake patterns and to measure sleep duration, efficiency and structure. If those measurements suggest a condition that warrants further investigation, you’ll be prompted to consult a physician for an in-depth sleep evaluation. Otherwise, SleepRate will provide you with personalized advice on how to improve your sleep.

Find out more about SleepRate. Or, if you’re ready to purchase a SleepRate package, start here.

SleepRate Home Page

 

Sleep needs are determined by different factors, mainly age, individual and genetic characteristics, the duration of previous wakefulness period, as well as an internal biological clock that sets a daily, or circadian rhythm.

Age and sleep: close to birth babies sleep 16 to 18 hours a day in time intervals spread around the clock. The time spent asleep decreases gradually, being around 12-13 hours at 1 year of age, 9 hours during adolescence, and around 8 hours thereafter. The sleep needs remain almost the same during adulthood, only the ability to sleep may decline with aging.
People have individual sleep needs, some of them inherited. Although the average population need is around 7 and a half hours, some people may thrive with as little as 4 or 5 hours of sleep, while others may need as much as 9 and a half hours. No matter what the individual specific needs are, there is a wake-sleep balancing process, which works in such a way that upon waking up the sleep need is exhausted and starts to accumulate as the day unwinds, until one is ready to sleep again. When a person loses sleep the need increases and there is a tendency to fall asleep earlier, or even at otherwise unexpected times during the day.

Another clear factor ruling over sleep is an internal, biological clock. The duration span of this internal clock is individual and is usually slightly longer than 24 hours. Thus, without any external influence the go to bed time might move slightly down each day, causing the wake up time to move accordingly. When this happens, the sleep-wake cycling pattern is called free running. However, the great majority of human beings keep a schedule that is mostly sleeping during the night and being awake during daylight time. The intrinsic clock syncs everyday with external factors like light and dark hours, work schedule, meals, and social cues. The ability of the clock to sync or reset in order to keep in line with the external cues and allow for a regular sleep-wake schedule represents an important component of our quality of life.

Personal motivation can override individual sleep needs in order to keep us awake despite the fact that the body is telling us it is sleep time. This motivation can result from our will to work or study instead of sleeping, or even the ambition to perform better, or the basic need to stay awake in order to be safe, like when driving during late hours, when we actually need to sleep. All scientific findings indicate that severe sleep debt overrides any motivational factors and at last we fall asleep involuntarily.

How can SleepRate help?

SleepRate expertise lies in assessing sleep and how different factors work together to influence a person’s sleep.

SleepRate helps to pinpoint flaws in sleep and help correct them.

When tracking sleep with your Garmin, you will receive a sleep analysis based on your movement patterns.

Setting Up

  1. Make sure the Garmin app and Chrome are installed on the phone you use to track your sleep.
  2. Open the SleepRate app, click on the menu icon at the top left of the screen and select tracking settings.
  3. Click where it says ‘Track with Device’, select Garmin and click ‘Continue’.
  4. A browser window will open asking you to log in to your Garmin account. Be sure to use the same account as in the Garmin app.
  5. You’re then returned to the SleepRate app, there should be a message saying the Garmin account was connected. Click ‘Got It’, then ‘Home’ from the menu icon.

Tracking your sleep

  1. When you’re ready for bed click ‘Track My Sleep’ and follow the instructions on the screen.
  2. In the morning stop sleep tracking in the SleepRate app and answer the morning questions.
  3. Open the Garmin app and sync the app with your phone. Shortly thereafter you should see your results in the SleepRate app.

Contact us if the problem continues.

When tracking sleep with your Fitbit, you will receive a sleep analysis based on your movement patterns.

Set-up Instructions 

  1. Make sure the Fitbit app and Chrome are installed on the phone you use to track your sleep.
  2. Open the SleepRate app, click on the menu icon at the top left of the screen and select tracking settings.
  3. Click where it says ‘Track with Device’, select Fitbit and click ‘Continue.’
  4. A browser window will open asking you to log in to your Fitbit account. Be sure to use the same Fitbit account as in the Fitbit app.
  5. You’re then returned to the SleepRate app, there should be a message saying the Fitbit account was connected. Click ‘Got It’, then ‘Home’ from the menu icon.

Tracking your sleep

  1. When you’re ready for bed click ‘Track My Sleep’ and follow the instructions on the screen.
  2. In the morning stop sleep tracking in the SleepRate app and answer the morning questions.
  3. Open the Fitbit app and sync the app with your phone. Shortly thereafter you should see your results in the SleepRate app.

Contact us in case of any problem.

Your Apple Watch and Connectivity:

When tracking sleep with Apple Watch, you will receive a sleep analysis based on your movement patterns.

1. Do I have to wear my Apple Watch at night to be able to track my sleep?
Yes, you need to wear your Apple Watch in order to measure your heart rate during sleep.

2. I can’t find the SleepRate app on my watch. What should I do?
A) Open the Apple Watch app on your iPhone.
B) Find SleepRate in the app list inside the Apple Watch app.
C) Turn ‘on’ the switch to ‘Show App on Apple Watch’.
D) If the switch is already ‘on’, turn it off and back on again.

3. Does the SleepRate app drain my watch battery while I track my sleep?
No, the SleepRate app uses 0% of your battery during your sleep tracking session, so you don’t need to worry about SleepRate draining your battery.

4. My Apple Watch stopped tracking during the night. What should I do?
Apps on the Apple Watch may get shut down if memory is low, particularly if the app is in the background. To prevent this from happening keep SleepRate in the foreground of the watch, it should be the last thing on the screen when you go to bed. For optimal functioning keep SleepRate in the foreground of the watch until the data transfer is complete.

5. Can I turn Bluetooth off during the night?
Sure, you can disconnect Bluetooth after clicking ‘Start Tracking’ and keep it off throughout the night. Remember to reconnect it before clicking ‘Stop’ at wake-up time. Your sleep data will be transferred right after you stop tracking.

6. Can I track my sleep while the watch is on Airplane Mode?
Yes, you can turn on Airplane Mode after clicking ‘Start Tracking’ and keep it on throughout the night. Remember to turn it off before clicking ‘Stop’ at wake-up time. Your sleep data will be transferred right after you stop tracking.

Messages and Permissions:

1. I am seeing a “Missing Permission” message on my watch. What should I do?
A) Go to ‘Settings’ on your iPhone.
B) Open the ‘Privacy’ options.
C) Open ‘Motion & Fitness’ settings.
D) Grant SleepRate permission by turning the switch on.

2. Why am I being asked for the heart rate permission on Apple Health?
SleepRate uses the heart rate permission on Apple Health in order to provide a reliable data channel from the watch to the iPhone at wake-up time.

3. The “Transfer in Progress” message is displayed on my watch for a long time. What should I do?
Leave your watch in foreground mode as long as possible and don’t let it go to sleep, in order for the transfer session to be completed. Once the transfer is completed the message will disappear.

 

The app isn’t displaying my heart rate data:

When tracking sleep with your Android Wear Watch, you will receive a sleep analysis based on your movement patterns.

If in the morning you receive your Daily Data without information collected by your watch, follow the steps below:

A) Check that Bluetooth is turned on in your phone settings.
B) Confirm your watch is on.
If your watch turned off during the night, it is recommended to set it to ‘Theater Mode’ in order to save power while tracking in future nights.
C) Make sure the watch is in close proximity to the phone to allow data transfer.
Contact us if the problem continues.

 

The app can’t find my sensor:

If you receive a message that the app can’t find your sensor, follow the steps below:

A) Check that the monitor is placed correctly:
•  The belt monitor should be placed tightly but comfortably just below your chest muscles. The sensor should be just above your solar plexus, against a soft tissue (not on the ribs). The chest belt should be firmly against your skin, and the connector should be in a central and upright position.
• Make sure the monitor strap is kept clean.

B) Reset the Bluetooth connection:
Turn Bluetooth off from your mobile phone settings and close the SleepRate app. Turn Bluetooth back on and reopen the app. An alternative is to restart your phone or tablet to start from a clean slate.
You do not need to connect the heart rate monitor through the phone, the app will connect on its own.

C) Contact us if the problem continues and please include which heart rate monitor you are using.

The app can’t detect my heart rate:

If the app cannot detect your heart rate, or in the morning you find an error in your daily data, it means the app did not get proper heart rate information from your heart rate monitor. Please try these steps:

A) Wet the sensor areas:
Make sure you wet the sensor areas of the chest belt before strapping it on. What works even better than water is conductive gel.

B) Make sure the sensor area is kept clean.

C) Contact us if the problem continues and please include which heart rate monitor you are using.

 

The sensor does not connect / I am asked for a PIN:

To successfully connect the contact-free sensor, follow the steps below:

A) Turn off Bluetooth and restart your phone.

B) Unplug the sensor for 30 seconds, then plug it back in. Check that a green light turns on at the top of the sensor.

C) Make sure there are no other mobile devices, Bluetooth devices or wireless electronics around. Then, turn Bluetooth back on in your phone settings.
The phone should not connect to any device. If the phone scans for devices or you are asked for a PIN, click Cancel.

D) Launch the SleepRate app, and follow the steps to track your sleep. The app will search for the sensor and connect after you answer the evening questions.

The app can’t detect my heart rate:

If in the morning after tracking your sleep, you receive a message that the app wasn’t able to detect your heart rate, follow the steps below:

A) Check the sensor is placed correctly:
Position the sensor directly under the mattress, with the green light facing up, about 7 inches from your side of the bed, roughly underneath where your shoulders would be.

B) Make sure there are no other mobile devices, Bluetooth devices or wireless electronics around.

I see ‘lost signal’ notification in the Daily Data screen:

If in the morning you see ‘lost signal’ notifications in your daily data, it means that the heart rate monitor couldn’t pick up your heart rate. This may indicate that you were out of bed at that time.

If this is not the case, please check that the sensor is placed correctly. You can do so by positioning the sensor directly under your mattress with the green light facing up, approximately 7 inches from the side of your bed, and roughly underneath where your shoulders are.

Contact us if the problem continues.

 

The relaxation index provides a measure of how much your mind and body are relaxed and calm, which is the optimal state for healthy sleep. This is an individual measure. Its values range between 0 and 100, with higher values indicating deeper relaxation.

There is no standard for the amount of sleep an individual requires. Each person is unique. In simple terms, you need enough sleep to avoid drowsiness and to perform at optimal efficiency during the day. That need changes with age, so what works best in one stage of your life may not be appropriate for another. At the extremes of a distribution across large populations are normal people who need as little as 4 hours or as much as 12 hours.

A majority of people do very well with 7½ to 8 hours of sleep. But use those numbers only as a starting point until you determine if that range is appropriate for you. Although you can ignore your body’s need for a certain amount of rest through motivation and sheer force of will, doing so isn’t conducive to good health or a vibrant existence.

Our “always on” culture has permeated traditional barriers between work time, family time, playtime, and rest. Sometimes we’re trying to do two or three things at once; or we’re struggling to meet an unnatural (and occasionally unrealistic) expansion of obligations. The result is that more of us are carrying sleep debts or adding to them faster than ever before. Sleeping late on the weekends may seem to help, but in fact it’s only paying interest on the debt, so to speak.

Sleep deprivation can have serious consequences for mental and physical health.

You cannot perceive, in precise terms, how much sleep you actually need. The only way of evaluating that in a scientific manner is to sleep for several nights without wakeup or other constraints. After the sleep debt is replenished, your natural need for sleep will take over and yield an accurate duration.

If you suspect you’re not getting enough sleep, you may need to investigate further by using the SleepRate solution (see below) or by a visiting your physician for professional evaluation.

How Will SleepRate Help You?

SleepRate measures and reports the duration and efficiency of sleep you receive. If you feel you aren’t getting enough restorative sleep, SleepRate will make personalized recommendations to help you sleep better. 

A Light Therapy Box can offer an effective treatment for Delayed Sleep Phase Syndrome. It will mimic outdoor light so you wake up even when it’s dark outside to readjust your biological clock. If you are a “Night Owl”, we recommend that you use a Light Box to help you wake up in the morning. Following are sites recommended by Stanford University to purchase one:

Alaska Northern Lights

Apollo Light

Bio-Brite

Light Therapy Products

To learn more about light therapy, please see this article on Phototherapy and this one on Jet Lag.

A parasomnia that starts as a partial awakening from deep non-REM sleep. It’s characterized by crying, screaming, confusion, fear or autonomic hyperactivity.

A parasomnia that starts as a partial awakening from deep non-REM sleep. It’s characterized by complex motor activity such as walking.

The moment of falling asleep, but can differ according to the specific sleep parameter. For example, behaviors, movement, cognition, electrical activity of the brain and muscle tone are distinct measurements which may not coincide.

The elapsed time from the start of a sleep session (e.g., bedtime) to the first 30 seconds of sleep. The measurement presumes no lasting sleep beyond those 30 seconds.

 

Repetitive sleep interruptions from arousals and awakenings.

 

Sleep with no interruptions from arousals or awakenings.

 

The average number of abnormal respiratory events per hour of recording.

 

The elapsed time from sleep onset to the first REM sleep occurrence.

 

Brief, recurrent and periodic movements of legs and arms during sleep such as foot extensions, big toe extensions or partial flexions at the hip or knee.

Apnea with no airflow through the mouth and nose in spite of persistent respiratory effort.

An unpleasant or frightening dream that usually occurs in REM sleep.

 

A test to determine a person’s propensity to fall asleep.

 

An apnea episode that begins as a central apnea event and becomes an obstructive apnea event.

The average value of all sleep latencies measured during the Multiple Sleep Latency Test (MSLT).

A test to determine a person’s ability to stay awake.

Measurable reductions of airflow through the nose and mouth.

Vivid imagery while awakening from sleep; may accompany narcolepsy.

A transition from sleep to wakefulness.

Vivid imagery while falling asleep; a characteristic of narcolepsy.

A transition from wakefulness to sleep.

A recording of electrical activity resulting from eye movements.

 

A recording of electrical activity of muscle tissue. In whole-night sleep studies (polysomnography or PSG) electrodes are placed on the skin around the chin.

A recording of electrical activity in the brain.

 

Uninterrupted sleep.

 

A form of apnea associated with the lack of respiratory movement due to improper signaling from the brain to the respiratory system.

A sudden loss of muscle tone (a group of muscles or all antigravity muscles) caused by emotional triggers (e.g., laughter, fear, surprise). It is a characteristic of narcolepsy.

A sudden and brief (3-15 seconds) awakening from sleep.

The average number of apneas and hypopneas per hour of sleep.

The lack of airflow through the nose and mouth for at least 10 seconds.

A tendency to fall asleep too early and wake up too soon relative to conventional schedules and personal needs.

To get SleepRate on your iPad, go to the tab in the App Store for “iPhone Apps” and search for SleepRate. SleepRate is not available in the iPad apps section.

 

The sleep therapy provides sleep improvement in about 4-6 weeks. The plans are personalized, they may last more or less depending on your own needs and pace, and usually last until you achieve better sleep.

At this time, we do not have a specific time frame to support Windows phones.

No. All you would need to do is download the SleepRate application onto the new phone and log into your SleepRate account to continue using the program.

Only one person can use the Sleep Therapy plan as it’s based on individual information and results.

SleepRate’s app is compatible with a wide range of Bluetooth-enabled heart rate and movement tracking devices. Some of the most popular devices compatible with SleepRate are:

  • Apple Watch
  • Fitbit
  • Android Wear Watches
  • Garmin Wearables (currently for Android only)
  • Polar H10 and H7
  • Suunto Smart Sensor
  • CardioSport HRM
  • Wahoo TICKR (except TICKR X)
  • Under Armour HRM
  • Hexoskin Smart Shirts

To get more information whether your tracking device is compatible with SleepRate, contact our support team.

For people who live outside of the U.S, we recommend buying a compatible BLE Heart Rate sensor such as the Polar H7, and buying our product without the sensor.

You can pay with all major credit cards as well as PayPal. The checkout process is fast, secure and discreet.

SleepRate has a 30 day satisfaction guarantee. If you are unsatisfied for any reason, let us know and we will issue a full refund. We just ask that you return any device you purchased. Providing us the reason for your return helps us improve our service.

This feature provides a flexible wake up time (within a 20 minute window) to ensure that you wake up at the optimal moment during your sleep cycle.

Recordings of high intensity sound  or noise detected during the night and that were not connected with awakenings from sleep.

Recordings of sound or noise episodes that were connected with awakening from sleep during the night.

Recordings of different sound or noise episodes detected during the night.

Recording of snoring episodes detected during the night. Duration and level of snore – recording

A measure of the overall stress tracked during your nighttime recording. This is an individually determined score that may change, with higher values indicating higher stress.

Your personal rating of your stress during the preceding day.

The reported nap time during the preceding day.

Your personal rating of the sleep quality when you wake up in the morning.

The percentage of time spent asleep out of the total time in bed.

The average hourly number of brief and unnoticed intrusions of wakefulness into sleep.

Total time spent awake during the night after initially falling asleep.

The number of transitions from sleep to wakefulness, lasting more than 15 seconds.

The time you press “End Sleep Tracking”, indicating the real time you woke up and ended your night sleep session.

The time the alarm clock is set and indicates the scheduled wake-up time.

The time it takes to fall asleep.

The time when the recording starts: this is the time when the “Start” button is pressed with the intention of going to sleep.

The percentage deep sleep between falling asleep and waking up times.

The percentage REM sleep between failing asleep and waking up times.

The percentage of light sleep  between falling asleep and waking up times.

The percentage of awake time during the night. This includes the time it took to fall asleep and time spent awake during the night.

The time between going to bed at night and getting up in the morning.

How well you slept, based on the duration of time spent asleep as a percentage of the total time spent in bed at night, and on the continuity of your sleep.

Total time spent sleeping; it excludes the time spent falling asleep and the time spent awake during the night.

This screen displays graphs of specific sleep scores over a period of one week, so trends may emerge.

This screen displays graphs of several sleep scores behavior over a period of one month, making emerging  trends apparent.

This screen displays the relevant sleep data scores available from a single sleep session.

The sequence of sleep cycles and the relative amounts of sleep spent in different stages during an overnight sleep.

A habitual sleep duration shorter than the sleep time needed for a person to perform at his or her optimal level.

An earlier-than-expected morning awakening that may also be a sign of depression.

A tendency to fall asleep earlier and wake up sooner than conventional schedules and personal obligations. Otherwise, Sleep structure is normal.

A tendency to delay falling asleep and to wake up late, relative to conventional schedules and personal daily obligations. Otherwise, Sleep structure is normal.

This step tracks your sleep. Start by answering a few questions about your day, continues with setting your wake up alarm, and then you are ready to start tracking your sleep. To let us accurately get your falling asleep time, we recommend to start tracking when you really intend to go to sleep, and not before. You may use a SleepRate supported Heart Rate Monitor for more accurate and objectively measured results, or you may use the app alone for snore and noise analysis, as well as keeping track of your subjective sleep insights.

To get more accurate results we recommend you use a SleepRate supported Heart Rate Monitor.

In the basic service you can track your nights using the app and track you sleep session results.

The SleepRate app will guide you through a series of step by step, sleep improvement goals, at your own pace, on a path to better sleep and wellbeing.

Track your sleep for at least 6 out of 7 nights, to allow SleepRate to gather baseline information of your sleep. Once this information is received and processed, you will get your sleep assessment report, and a personally tailored sleep improvement plan, if needed.

If you already have a Bluetooth enabled heart rate or movement tracking device, you can buy any of SleepRate’s sleep plans without a sensor.

Insomnia and Behavioral Sleep Medicine Program

In the past three decades research has shown that non-drug treatments for insomnia can improve sleep in all age groups.  Non-drug treatment is also available to enhance the medical treatment of sleep apnea, which is often associated with non-restorative sleep and excessive daytime sleepiness.  Millions of Americans experience difficulties sleeping at night or wake up un-refreshed in the morning.  Many continue to suffer because they are unaware that effective treatments exist.

The Insomnia and Behavioral Sleep Medicine Program at the Stanford Sleep Disorders Clinic is helping people who suffer from insomnia and other sleep disorders.
Cognitive Behavioral Therapy (CBT) for Insomnia
Cognitive behavioral therapy guides patients through a series of changes in sleep-related behaviors. The focus is on addressing the three factors that contribute to the persistence of insomnia:

  1. conditioned arousal,
  2. identifying and eliminating habits that were developed in an effort to improve sleep but have become ineffective, and
  3. reducing sleep-related worry and other sources of heightened arousal.

The therapist identifies the most relevant targets for behavior changes, and helps patients overcome obstacles to making the necessary and often difficult changes in sleep-related behaviors. This means that individual patients can concentrate their energy on changes that are most likely to produce improvements in their sleep. Sometimes the therapist helps patients re-evaluate beliefs about sleep that might be causing unnecessary anxiety.

The majority of patients respond to this treatment fairly quickly. Some experience significant changes after only two therapy sessions. Most improve after four to six sessions, but some might need more. Both group and individual treatments are effective.

Below is a list of some of the instructions and procedures used in this therapy:

Stimulus Control
This set of instructions addresses conditioned arousal. It was developed by Richard Bootzin. They are designed to strengthen the bed as a cue for sleep and weaken it as a cue for wakefulness. The key instructions are:

  • Establish a regular morning rise time. This will help strengthen the circadian clock regulating sleep and wakefulness. Ideally, bedtime should also be regular, but for people with insomnia it is impossible to actually fall asleep around the same time nightly. When insomnia resolves, regular bedtime can further strengthen the circadian rhythm.
  • Go to bed only when sleepy. This will increase the probability that you will fall asleep quickly. It is important to distinguish between fatigue and sleepiness. Fatigue is a state of low energy, physical or mental. Sleepiness is a state of having to struggle to stay awake. Dosing off while watching TV or as a passenger in a car involve sleepiness. People with insomnia often feel tired but “wired” (i.e. not sleepy) at bedtime.
  • If unable to fall asleep, either at the beginning or in the middle of the night, get out of bed and return to bed only when sleepy again.
  • Avoid excessive napping during the day. A brief nap (15 to 30 minutes), taken approximately 7 to 9 hours after rise time, can be refreshing and is not likely to disturb nocturnal sleep.

Sleep Restriction
This procedure, developed by Arthur Spielman, is designed to eliminate prolonged middle of the night awakenings. It doesn’t aim to restrict actual sleep time but rather to initially restrict the time spent in bed. Subsequent steps consist of gradually increasing the time spent in bed. The initial time in bed is usually the average nightly total sleep time over the last week. However, the time allowed in bed should not be less than 5.5 hours, even for people who sleep less than 5.5 hours per night.

For example, consider a person who goes to bed at 11:00 p.m. and gets out of bed at 8:00 a.m. but sleeps on average only 6 hours per night. During the first step of this procedure this person will be in bed only 6 hours (e.g., 12:00 am to 6:00 am). This sounds harsh but after a week or so there will be a marked decrease in time spent awake in the middle of the night.

Usually people experience marked improvement in the quality of sleep after a week of restricted time in bed, but they also realize that that they are not getting enough sleep. In this case, the next step is to gradually extend the time spent in bed by 15 to 30 minutes, as long as wakefulness in the middle of the night remains minimal.

Each new extension of the time in bed is followed for at least a week before progressing to the next extension. The decision as to when to extend the time in bed is based on the percent of the time slept relative to the time spent in bed. This is called sleep efficiency. If the average sleep efficiency is 85% or more, then the time in bed is extended. If it is below 80% then the time is bed is further restricted. Otherwise the time in bed remains unchanged. There are several variants of this procedure, and the therapist chooses the one that best fits an individual patient. In all variants, the procedure continues until one reaches a point after which no further extension is necessary because the amount of sleep obtained is sufficient for optimal daytime function.

Reducing Sleep-Interfering Arousal/Activation
This includes a variety of relaxation techniques, stress management skills, and reducing sleep-related worries. The behavioral sleep medicine specialist uses cognitive therapy to reduce arousal by helping patients shift from “trying hard to sleep” to “allowing sleep to happen.” In addition, the following can also facilitate sleep:

  • Use the hour before bedtime to unwind from the day’s stresses. This down time will allow sleepiness to come to the surface and will therefore facilitate sleep onset. This is a time to engage in activities that are enjoyable yet calming.
  • Avoid clock watching. Turn the clock around so you cannot see the time yet you can still use it as an alarm. A recent study showed that volunteers who were asked to monitor a digital clock at bedtime took longer to fall asleep than those monitoring a similarly looking device that displayed random digits.
  • Avoid exercise within four hours before bedtime.
  • Make sure that the sleep environment is safe, quiet and pleasant.

About Foods and Substances

  • Alcohol: Alcohol speeds sleep onset but this positive effect is counteracted by increased wakefulness in the second half of the night.
  • Stimulants: Caffeine has a rather long half-life (about 6 to 8 hours). People’s sensitivity to the effects of caffeine vary. Those with caffeine sensitivity should be particularly careful to avoid caffeine after lunch. (The amount of caffeine in different drinks and recommendations regarding caffeine consumption can be found on the National Sleep Foundation website.) Certain prescription and non-prescription drugs contain caffeine and when feasible should be avoided close to bedtime. Nicotine and nicotine withdrawal can also interfere with sleep.
  • Eating at night: Digestion slows down during sleep and indigestion, caused by undigested food, can disrupt sleep. Eating in the middle of the night sends the body an alerting signal.

Taking the Biological Clock Into Account
Bed time and rise time should be congruent with one’s circadian clock. When the desired bed time and rise time are not aligned with the circadian clock the therapist can use procedures to shift the circadian clock, such as properly timed exposure to bright light.

Professional help should be sought by people who find it impossible to follow the above recommendations consistently. For example, some people say they never get sleepy. Others find it too hard to get out of bed at the same time every day.

Therapists with special training in sleep disorders and behavioral sleep medicine are best suited to help people with insomnia because they possess knowledge in the science of sleep and the science of behavior change. The American Academy of Sleep Medicine has established a certification in Behavioral Sleep Medicine and maintains a list of certified specialists and their geographic location on its web site.

 

 

How Will SleepRate Help You?

Use SleepRate for a few days to identify sleep-wake patterns and to measure sleep duration, efficiency and structure. If those measurements suggest a condition that warrants further investigation, you’ll be prompted to consult a physician for an in-depth sleep evaluation. Otherwise, SleepRate will provide you with personalized advice on how to improve your sleep.

Shift Work

Our nonstop, 24-hour society requires that some people work during nonstandard times (in the evenings or during the night). This is a difficult burden for people, especially if they have families. Sleep scientists have done considerable research on how to maintain performance at a shift job while reducing potential harm.

There are no easy answers or quick solutions, unfortunately. To minimize the impact from schedule shifts, the following are universal recommendations:

  • Maintain the same schedule each day to minimize the impact of short-term transitions. This means that the weekend schedule should be the same as that of a normal workday. In other words, sleep at the same time every day of the week.
  • Use bright lights at work.
  • Maintain low light levels during normal daylight hours. Wear sunglasses outdoors during daylight hours. Keep your home environment as dark and quiet as is practical.

People who do shift work are at higher risk of developing insomnia. This can happen while on a shift work schedule or after returning to a conventional schedule.

How Will SleepRate Help You?

Sleeprate can track sleep-wake cycles, detect abnormal patterns, and assist you with overcoming problems that people doing shift work encounter frequently.

The gold standard of sleep diagnostic procedures is known as a whole-night polysomnography (PSG). It consists of an overnight stay in a medical facility with a supervising technician who oversees a suite of monitoring mechanisms. A sleep technology expert scores the data offline and a sleep physician interprets the results. In spite of the high cost and the amount of work needed for such a study, the results maybe not be representative of a typical night’s sleep at home.

A representative test requires sleeping in one’s own bed with familiar routines and schedules. That’s of course not possible in a sleep facility. The full lab-based polysomnography should be reserved for sleep disorders that cannot be detected with a partial home study or with other objective methods that allow a patient to remain in his/her normal sleep environment.

A whole-night PSG typically records the following:

  • Signals that enable the evaluation of sleep architecture and quality
    • 6 electroencephalography (EEG) channels (at a minimum)
    • 2 electrooculography (EOG) eye movement channels
    • 1 electromyography (EMG) chin muscle activity channel
  • Signals that enable the evaluation of respiration during sleep
    • mouth and nose airflow
    • nasal pressure
    • chest and abdominal movement (2 channels)
    • oxygen saturation
    • snoring
    • body position
  • Signals that enable the evaluation of limb movements
    • 1-4 EMG channels for muscle activity
  • Other
    • 1-2 electrocardiogram (ECG) channels for heart electrical activity

 

The attending lab technician monitors these recordings overnight and corrects problems with signal quality or disconnections.

A sleep technology expert scores the study afterwards. This is a manual process, though some computerized tools can make the job easier and faster. But overall, whole-night polysomnography is burdensome and expensive; and the scoring process is costly and complicated. As well, there have always been some concerns about recording quality variability and differences in skill levels across sleep technology experts.

Partial sleep studies at home that are administered by sleep clinics seem to be a superior alternative for cost and efficiency reasons. The use of partial sleep studies is increasing, though important quality and reimbursement issues must first be resolved.

 

How Will SleepRate Help You?

Use SleepRate for a few days to identify sleep-wake patterns and to measure sleep duration, efficiency and structure. If those measurements suggest a condition that warrants further investigation, you’ll be prompted to consult a physician for an in-depth sleep evaluation.

Sleep is both universal and fascinating. Although we spend a third of our lives sleeping, scientists don’t fully understand its nature and purpose. The most precise definition available at this time is descriptive: It’s a natural behavioral state (another is wakefulness) governed by the nervous system that is characterized by perceptual disengagement and motor inactivity. The state is cyclical and reversible without intervention. Unlike a coma – a total lack of consciousness – sleep is actually a semi-conscious state. This means that a minimal level of environmental awareness allows an individual to react to certain triggers. For example, a sleeping mother will hear her crying baby; people wake up when hearing their name called; or danger such as a fire or an attack is present or imminent.

We know that sleep has a restorative function and has a major impact on physical health, cognitive performance and mood stability. It seems to be as important as air, food and water for sustaining life. Resting while awake is not a substitute for sleep.

Sleep is a dynamic process with an active brain that changes its state many times each night during different stages of sleep and through sleep cycles.

Most animals sleep, but timing and duration vary tremendously across species. We’re not sure why.

Why Do We Need to Sleep?

Here’s the most simplistic answer: We need to sleep to avoid feeling sleepy.

Researchers have illustrated this need with a simple experiment that shows the impact of sleep debt. When healthy people are forced to stay awake continuously for one or two days, their waking state is eventually interrupted, involuntarily, by short episodes of sleep. Test subjects are incapable of avoiding them. Moreover, other adverse consequences can be observed at the same time:

  • declining cognitive performance
  • disrupted biological rhythms
  • undesirable metabolic changes (e.g., hormone levels)

Scientists have observed, over longer periods of time, that a chronic lack of sleep

  • may cause weight gain
  • adversely impacts learning and memory
  • reduces immunity
  • shortens lifespans

Sleep deprivation is a major public health concern in many countries. One example everyone knows about: accidents caused by sleepy drivers.

On the other hand, quality sleep replenishes the body and mind in several ways. For example, sleep plays a crucial role in children’s growth and development. That’s a reason why young ones need more sleep than adults. Memory consolidation occurs during sleep. Body reserves and energy levels are restored while sleeping.

Interestingly, too much sleep is just as bad as too little sleep.

How much sleep someone needs is difficult to answer precisely, though statistically a majority of people need 7½ to 8 hours.

 

How Will SleepRate Help You?

Use SleepRate for a few days to identify sleep-wake patterns and to measure sleep duration, efficiency and structure. If those measurements suggest a condition that warrants further investigation, you’ll be prompted to consult a physician for an in-depth sleep evaluation. Otherwise, SleepRate will provide you with personalized advice on how to improve your sleep.

 

A sleep facility can be as simple as a normal doctor’s office where sleep physicians consult with patients; or it can be a dedicated center with a sleep laboratory staffed with sleep physicians, psychologists and sleep technicians.

A laboratory typically has a number of bedrooms, each equipped with devices and recorders that capture the physiological signals required to complete a gold-standard sleep study. Additional equipment will record behaviors, noise, snoring and so forth. A central control room allows skilled technicians to monitor simultaneous overnight tests of patients in the bedrooms.

When a patient arrives at the laboratory before his/her normal bedtime, the night technician goes through a standard routine of attaching various types of sensors to the patient’s body. Patients then go to sleep at their usual bedtime and are awakened in the morning by the technician, who then removes the sensors.

A sleep technician scores the raw data immediately after the test. A sleep physician reviews the result, and then interprets the data with clinical information collected before the test.

Accredited sleep centers offer the following services:

 

 

How Will SleepRate Help You?

Use SleepRate for a few days to identify sleep-wake patterns and to measure sleep duration, efficiency and structure. If those measurements suggest a condition that warrants further investigation, you’ll be prompted to consult a physician for an in-depth sleep evaluation.

 

In 2010, public health scientists estimated that 1.5 billion of the world’s population was overweight and 500 million were clinically obese. Current trends for Americans were particularly alarming: The estimate is that 75% of the U.S. population will be overweight or obese by 2020. The basic problem has been growing for a long time: an energy imbalance due to the availability of caloric-rich food and decreasing energy expenditures as a result of sedentary lifestyles in an industrialized society.

But that’s not the entire picture. Scientists have learned about another important factor that was not evident until recently: insufficient sleep. They found compelling evidence that sleep loss leads to metabolic disturbances which increase the positive energy imbalance and result in weight gain. This is actually a vicious circle because excess weight is a cause of sleep apnea, which in turn leads to more sleep disruptions.

Recent studies of healthy volunteers with normal weights show that even short periods of sleep deprivation lead to metabolic disturbances of sugars as well as increased appetites.

Other studies show that abnormal sleep-wake cycles (like those related to shift workers) disrupt biological rhythms for sleeping, hunger and eating. When people don’t eat at their normal meal times (for example, eating at night), they gain weight.

When considering how to approach unwanted weight gain, we must now account for three major factors: nutrition, physical activity and sleep.

 

How Will SleepRate Help You?

Use SleepRate for a few days to identify sleep-wake patterns and to measure sleep duration, efficiency and structure. If those measurements suggest a condition that warrants further investigation, you’ll be prompted to consult a physician for an in-depth sleep evaluation. Otherwise, SleepRate will provide you with personalized advice on how to improve your sleep.

Learn more about SleepRate. Or, if you’re ready to purchase a SleepRate package, start here.

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What should I say to my doctor when I sleep poorly or can’t sleep at all?

Do your best to be concise and clear. State, in succinct terms, how you perceive the problem. For example:

  • “It takes me a very long time to fall asleep.”
  • “I wake up frequently during the night.”
  • “I have trouble waking up in the morning after a sleepless night.”

You may want to ask if your problem could be related to other health issues or to medication you may be taking.

Don’t ask for sleeping pills. Instead, ask if you should consult a sleep specialist or go to a sleep clinic. If your doctor has cost information about these options, ask him/her to share that with you.

Finally, ask for your doctor’s recommendations about how to proceed.

Your doctor will probably ask about your usual sleep-wake schedule, including details about when you go to bed, how long it takes to fall asleep, when you wake up in the morning and naps during the day. In addition, you may be asked about these factors:

  • sleep environment characteristics
  • your preoccupation with your sleep complaints
  • snoring
  • movement during sleep
  • caffeine and alcohol consumption
  • type of job and work schedule
  • overall health
  • nutrition
  • exercise
  • daytime sleepiness
  • your mood

 

Based on this information, your doctor will recommend a treatment or a further workup, which may include seeing a specialist.

How Will SleepRate Help You?

Use SleepRate for a few days to identify sleep-wake patterns and to measure sleep duration, efficiency and structure. If those measurements suggest a condition that warrants further investigation, you’ll be prompted to consult a physician for an in-depth sleep evaluation.

Find out more about SleepRate. Or, if you’re ready to purchase a SleepRate package, start here.

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Two standard tests are used frequently to assess degrees of sleepiness.

Stanford Sleepiness Scale (SSS)

In 1973 sleep scientists at Stanford University developed a subjective measure of alertness called the Stanford Sleepiness Scale. Individuals rate themselves according to one of several statements that most closely describes their level of alertness or sleepiness.

To collect a spectrum of sleepiness indicators across a day, the SSS is administered at two-hour intervals, usually during the waking part of the day. To correlate objective measures and subjective feelings of sleepiness, the SSS may also be administered immediately before and after naps during a multiple sleep latency test.

The SSS uses the following numeric scale:

1:  Feeling active, vital, alert, and wide awake.
2:  Functioning at a high level but not at peak performance. Able to concentrate.
3:  Relaxed and awake, but not fully alert. Still responsive.
4:  Feeling a little foggy and let down.
5:  Foggy and beginning to lose track of things. Difficult to stay awake.
6:  Sleepy and prefer to lie down. Woozy.
7:  Almost in reverie and cannot stay awake. Sleep onset is imminent.

Epworth Sleepiness Scale (ESS)

The ESS is a short questionnaire that measures daytime sleepiness and is useful for the detection of sleep disorders. It was introduced in 1991 at the Epworth Hospital in Melbourne, Australia. The ESS asks for subjects to rate (on a scale of 0 to 3) his/her propensity to fall asleep in eight different situations.

The questionnaire is below.

The following questions refer to sleepiness or the tendency to doze off when relaxed.

How likely are you to doze off or fall asleep in the following situations, in contrast to just feeling tired? This refers to your usual way of life in recent times. Even if you haven’t done some of these things recently, try to work out how they would have affected you.

Use the following scale to choose the most appropriate number for each situation:

0 = would never doze
1 = slight chance of dozing
2 = moderate chance of dozing
3 = high chance of dozing

Situation Chance of Dozing
1. Sitting and reading…………………
2. Watching TV…………………
3. Sitting, inactive in a public place (eg. theatre or a meeting)…………………
4. As a passenger in a car for an hour without a break…………………
5. Lying down to rest in the afternoon when circumstances permit…………………
6. Sitting and talking to someone…………………
7. Sitting quietly after a lunch without alcohol…………………
8. In a car, while stopped for a few minutes in traffic…………………
________________________________________________________________________________________________
Add up all answers    :…………………

 

 

After completion of the questionnaire the scores are added together and the number is assessed on a range to determine the possibility of a sleep disorder.

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Use SleepRate for a few days to identify sleep-wake patterns and to measure sleep duration, efficiency and structure. If those measurements suggest a condition that warrants further investigation, you’ll be prompted to consult a physician for an in-depth sleep evaluation.

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Sleep and stress are connected tightly. Epidemiological studies report a gradual decline in average sleep time in developed countries since the end of the 19th century. That drop has been even more pronounced in the last few decades. At the same time, these studies report a commensurate increase in anxiety. This makes perfect sense because sleep deprivation increases stress, which in turn creates hyperarousal and more sleep difficulties: an inability to fall asleep quickly, insufficient sleep or lack of refreshing sleep.

Poor sleep, hyperarousal and stress are tightly interwoven, so decreasing the hyperarousal level (as expressed by stress measures) during the day is an important aspect of improving sleep.

Stress is a function of many physiological processes, in particular the autonomic (involuntary) nervous system. That system takes care of background functions that sustain life (breathing, rhythm and intensity of heartbeats, body temperature regulation, sweating, digestion and blood flow – to name just a few) and the secretion of certain hormones such as adrenaline and cortisol.

The autonomic nervous system has two sides: sympathetic and parasympathetic. The former stimulates heart activity and prepares individuals to “fight or flee” in response to danger, stress or a need to react quickly. The latter does the opposite and is associated with slowing down, relaxing and restoring – essentially “rest and digest”. Overall, this system keeps the human organism safe and performing optimally.

Stress can be assessed in many ways, but most are subjective questionnaires. A few are invasive (blood tests to assess levels of certain hormones, for example.) The mathematical evaluation of heart rate fluctuations that are governed by the autonomic nervous system provides insight into individual stress levels. In practical terms, it’s a feedback mechanism for looking at ways to change stress levels.

How Will SleepRate Help You?

Use SleepRate for a few days to identify sleep-wake patterns and to measure sleep duration, efficiency and structure. If those measurements suggest a condition that warrants further investigation, you may want to consult a physician for an in-depth sleep evaluation. Otherwise, SleepRate will provide you with personalized advice on how to improve your sleep.

Find out more about SleepRate. Or, if you’re ready to purchase a SleepRate package, start here.

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A narrowing of the airways during sleep may cause airflow turbulence and soft palate vibration that result in snoring. More than a quarter of the population snores occasionally or habitually; and it’s usually worse while supine. It can of course be very annoying for bed partners.

Sometimes snoring has no medical implications and does not impact the sleep quality of the person who snores. (On the other hand, bed partners may suffer serious sleep disruptions). This is known as primary snoring. Snoring can also be a first sign of obstructive sleep apnea. It may be treatable after determining that it is not associated with apnea.

You should see your doctor about snoring if you experience any of the following symptoms:

  • You wake up suddenly while gasping or snorting; and fall back asleep instantaneously.
  • Your snoring is so loud that it annoys your bed partner and he/she can’t sleep.
  • Your mouth or throat is dry and painful at night.
  • You wake up in the morning and feel your sleep was not refreshing.

 

 

How Will SleepRate Help You?

Use SleepRate for a few days to identify sleep-wake patterns and to measure sleep duration, efficiency, structure and snoring. If those measurements suggest a condition that warrants further investigation, you’ll be prompted to consult a physician for an in-depth sleep evaluation. Otherwise, SleepRate will provide you with personalized advice on how to improve your sleep.

Learn more about SleepRate. Or, if you

Cognitive behavioral therapy guides patients through a series of changes in sleep-related behaviors. The goal is to align the three systems that control our ability to sleep:

  1. Sleep Drive – How tired we are, which is related to the number of hours of being awake.
  2. Circadian Clock – Tune our internal biological clock to direct us to go to sleep at the right time.
  3. Flight-or-Fight system – Reduce stress to avoid being hyperaroused when we need to go to sleep.

The CBTI protocol aligns these system through a set of behavioral modifications that changes bed time, wake up time and activities around bed time and wake up time.

The majority of patients respond to this treatment fairly quickly. Some experience significant changes after only two weeks of treatment. Most improve after four to six weeks.

The first stage of the CBTI plan is assessing the sleep. This is done by measuring sleep parameters for about a week. During that time, you need to record in a sleep diary a few crucial parameters (go to bed time, wake up time, time to fall asleep, etc.).  Based on these measurements, a tailored set of behavioral modifications can be applied, and users who follow those modifications show a significant improvement in their sleep.

Here are some examples of behavioral modifications directed by the CBTI program:

Stimulus Control

This set of instructions addresses conditioned arousal. They are designed to strengthen the bed as a cue for sleep and weaken it as a cue for wakefulness. The key instructions are:

  • Establish a regular morning rise time. This will help strengthen the circadian clock regulating sleep and wakefulness. Ideally, bedtime should also be regular, but for people with insomnia it is impossible to actually fall asleep around the same time nightly. When insomnia resolves, regular bedtime can further strengthen the circadian rhythm.
  • Go to bed only when sleepy. This will increase the probability that you will fall asleep quickly. It is important to distinguish between fatigue and sleepiness. Fatigue is a state of low energy, physical or mental. Sleepiness is a state of having to struggle to stay awake. Dosing off while watching TV or as a passenger in a car involve sleepiness. People with insomnia often feel tired but “wired” (i.e. not sleepy) at bedtime.
  • If unable to fall asleep, either at the beginning or in the middle of the night, get out of bed and return to bed only when sleepy again.
  • Avoid excessive napping during the day. A brief nap (15 to 30 minutes), taken approximately 7 to 9 hours after rise time, can be refreshing and is not likely to disturb nocturnal sleep.

Sleep Restriction
This procedure is designed to eliminate prolonged middle of the night awakenings by reducing the time in bed, while keeping the sleep time. For example, consider a person who goes to bed at 11:00 p.m. and gets out of bed at 8:00 a.m. (9 hours in bed) but sleeps on average only 6 hours per night. During the first step of this procedure this person will be in bed only 6 hours (e.g., 12:00 am to 6:00 am). This sounds harsh but after a week or so there will be a marked decrease in time spent awake in the middle of the night.

Usually people experience marked improvement in the quality of sleep after a week of restricted time in bed, but they also realize that that they are not getting enough sleep. In this case, the next step is to gradually extend the time spent in bed by 15 to 30 minutes, as long as wakefulness in the middle of the night remains minimal.

Each new extension of the time in bed is followed for at least a week before progressing to the next extension.

Reducing Sleep-Interfering Arousal/Activation
This includes a variety of relaxation techniques, stress management skills, and reducing sleep-related worries. The following techniques assist  in achieving reduced arousal:

  • Setting a Buffer Zone: Use the hour before bedtime to unwind from the day’s stresses. This down time will allow sleepiness to come to the surface and will therefore facilitate sleep onset. This is a time to engage in activities that are enjoyable yet calming.
  • Relaxation Exercises: Breathing exercises, body scan exercises and similar relaxation techniques can reduce arousal and help falling asleep.

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Learn more about the Insonmnia and Behavioral Sleep Medicine Program at Stanford

How Will SleepRate Help You?

SleepRate has implemented the CBTI system that was developed by Stanford University into the SleepRate Application. The application assesses your sleep and tailors a personalized sleep improvement plan that will help you acquire the behavioral modification according to the CBTI program.

Find out more about SleepRate. Or, if you’re ready to purchase a SleepRate package, start here.

Two fundamental processes work to regulate sleep and wakefulness: the homeostatic sleep drive (known as process S) and the circadian rhythm (known as process C). Together they maintain a continuous dynamic balance between sleep and wake states.

After a morning wakeup – assuming sleep needs are fulfilled – one is typically alert and ready to take on the new day. As the day progresses, process S (the sleep drive) accumulates a sleep need; and by the evening an average person is ready to sleep again. Sleep deprivation increases one’s propensity to fall asleep and spend more time in deep sleep. On the other hand, process C (the circadian rhythm) is independent of previous amounts of sleep and works according to a timer set by an inner clock. It does, however, affect the timing and duration of REM sleep.

Other factors also influence the propensity to sleep or stay awake: motivation, age, environmental cues and social cues.

How Will SleepRate Help You?

SleepRate measures and reports the duration and efficiency of sleep you receive. If you suspect you aren’t getting enough sleep or the right kinds of sleep, the SleepRate can provide you with a detailed analysis and, if needed, guidance on how to improve your sleep.

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Nothing feels better than a solid night of refreshing sleep. Good rest underpins the quality of our lives. Those who are fortunate enough to experience enough peaceful slumber each night don’t realize that its absence has profound negative consequences. The lack of good sleep adversely impacts physical health, mood and performance. Sleep science – a relatively new branch of medicine – was created to understand and treat physical and mental disorders that interfere with sleep.

Sleep disorders can be categorized broadly in one of two ways: medical conditions that originate within sleep; and illnesses and afflictions that originate outside of sleep and cause sleep disruptions. Examples of the latter category are toothaches, arthritis and depression. Disorders in the first category are more difficult to recognize without medical expertise and the use of specialized methods and tools.

The importance of consulting a physician early cannot be overemphasized because many symptoms are common to both sleep disorders and non-sleep ailments. All sleep disorders manifest themselves via one or more of these debilitating symptoms: daytime sleepiness, inability to wake when required, poor performance on cognitive tasks, or inexplicable weight gain over time (to name just a few).

Every person should understand the basics of sleep disorders in the same way we understand well-known conditions such as diabetes, cancer and heart disease. The health risks from insufficient or poor quality sleep are as serious as those of other major diseases.

Sleep disorders may be classified within these subgroups:

  • sleep-related respiratory disorders
  • insomnia
  • circadian rhythm sleep disorders
  • neurological sleep disorders
  • parasomnias
  • miscellaneous sleep disorders

Multiple disorders are often present at the same time because some conditions create a susceptibility to others. The supervision of a physician is always required to diagnose and treat disorders that have an underlying medical cause.

How Will SleepRate Help You?

Use SleepRate for a few days to identify sleep-wake patterns and to measure sleep duration, efficiency and structure. If those measurements suggest a condition that warrants further investigation, you’ll be prompted to consult a physician for an in-depth sleep evaluation. Otherwise, SleepRate will provide you with personalized advice on how to improve your sleep.

Find out more about SleepRate. Or, if you’re ready to purchase a SleepRate package, start here.

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The average need for sleep has remained unchanged throughout modern human existence. But technological advances throughout the last century (especially artificial light) have slowly eroded the duration of our nighttime rest. The recent revolution in computing, communications and media has further eroded average sleep time. An “always on” culture has permeated traditional barriers between work time, family time, playtime and rest. We often struggle to meet an unnatural (and occasionally unrealistic) expansion of obligations.

In the meantime, our need for sleep hasn’t changed. So what’s the impact?

In simplistic terms, we’re sleepier during the day than we should be because we’re carrying sleep debts or adding to them faster than ever before. Sleeping late on the weekends may seem to help, but in fact it’s only paying interest on the obligation, so to speak. The overall impact of daytime sleepiness and reduced energy levels is corrosive. They often cause:

  • low productivity
  • poor performance at school or work
  • high stress and anxiety
  • mood disorders
  • accidents
  • other medical issues

 

Insufficient sleep impacts normal physiological rhythms such as appetite and hunger. This may cause people to eat at times when they would otherwise not do so, and possibly eat more than they should. The resulting disruption to normal metabolic and hormonal balances often causes weight gain. This is a scientific fact, not just coincidental. That’s why obesity and sleep deprivation are together the two biggest public health epidemics in western societies.

The overall cost to society of insufficient sleep is high, whether measured in personal or macroeconomic terms.

How Will SleepRate Help You?

Use SleepRate for a few days to identify sleep-wake patterns and to measure sleep duration, efficiency and structure. If those measurements suggest a condition that warrants further investigation, you’ll be prompted to consult a physician for an in-depth sleep evaluation. Otherwise, SleepRate will provide you with personalized advice on how to improve your sleep.

Find out more about SleepRate. Or, if you’re ready to purchase a SleepRate package, start here.

Typical late-evening routines that end with sleep usually begin with a tired feeling and a habitual unwinding of daily activities and emotions. Assuming the presence of a comfortable bed and environment, most people fall asleep within 20 minutes.

The initial sleep phase sequence is as follows.

  • a relatively short period of non-REM light sleep
  • a relatively long period of non-REM deep sleep
  • a relatively short period (again) of non-REM light sleep
  • a very short period of REM sleep

Then the sequence restarts, sometimes after a very short transition to wakefulness. The sequence repeats 4 to 5 times during the night before the final morning wakeup. A single sequence, known as a sleep cycle, may last from 90 to 120 minutes.

The relative proportion of non-REM and REM sleep changes as the night progresses. Deep non-REM sleep predominates initially, but by the end of the night extended periods of REM sleep prevail. Non-REM sleep during the second half of the night is mostly light, mainly non-REM stage 2.

How Will SleepRate Help You?

Use SleepRate for a few days to identify sleep-wake patterns and to measure sleep duration, efficiency and structure. If those measurements suggest a condition that warrants further investigation, you’ll be prompted to consult a physician for an in-depth sleep evaluation.

Find out more about SleepRate. Or, if you’re ready to purchase a SleepRate package, start here.

FAQ

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A person’s breathing control while awake is both automatic and voluntary. During sleep the voluntary mechanism disappears and respiration is on “autopilot”. At the same time, the absence of wake-state stimuli, normal reduction in muscle tone and reduced lung volume in a recumbent position create conditions that can contribute to sleep-related respiratory disturbances. Normal respiration patterns differ depending on the sleep stage: They are very regular during stages of non-REM deep sleep, but can be irregular during sleep onset and REM sleep.

Normal breathing during sleep should be relatively quiet. This means that fresh air enters the lungs without impediments several times per minute, thus maintaining the body’s metabolic requirements during sleep.

Loud respiratory noise during sleep may indicate the presence of a respiratory disorder. The first clue that something might be wrong is snoring during sleep. This may signal a temporary narrowing or blockage of the upper airways due to relaxation of the airway muscles and pressure from surrounding tissue while in a recumbent position. This narrowing leads to a reduction of air inflow to the lungs called sleep hypopnea, while a complete blockage of those airways is called sleep apnea. Frequently both are described as a single condition called obstructive sleep apnea hypopnea syndrome.

Snoring is always due to some degree of narrowing in the upper airways, but it doesn’t necessarily indicate full-blown obstructive sleep apnea hypopnea syndrome. But a person who snores should, without question, follow up with a physician due to possible health risks.

Another less common breathing problem is known as central sleep apnea. This condition is characterized by a temporary, sometimes cyclic lack of respiratory drive that indicates an absence of proper signaling from the brain to the respiratory system. During sleep, the body “forgets” to breathe for abnormally long periods of time, resulting in irregular respiration.

These disorders interfere with sleep quality and cause daytime sleepiness, performance issues and serious health problems such as hypertension, cardiovascular issues or strokes. Fortunately, effective treatments are available from medical professionals that can improve, to a large degree, a sufferer’s quality of life.

How Will SleepRate Help You?

Use SleepRate for a few days to identify sleep-wake patterns and to measure sleep duration, efficiency and structure. If those measurements suggest a condition that warrants further investigation, you’ll be prompted to consult a physician for an in-depth sleep evaluation.

Find out more about SleepRate. Or, if you’re ready to purchase a SleepRate package, start here.

FAQ

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Many people have problems falling asleep or staying asleep. Approximately 10% of the general population suffers chronic problems and 30-50% had sleep issues at some point in their lives. If the difficulties are not connected to an underlying health problem (e.g., obstructive sleep apnea, mood disorders), the best approach is to follow the rules of good sleep hygiene. They include, among other things, adhering to a regular sleep schedule.

Sometimes the short term use of a sleep medication prescribed by physician – preferably a sleep expert – can help.

Your physician will ask you some background questions about your habits and overall health. Under some circumstances, he/she may order tests to rule out underlying medical conditions that could disturb sleep. Assuming none are found, he/she may prescribe an appropriate sleep medication for not more than two weeks. Additional steps may be needed to alleviate the problem(s).

There are several categories of prescription sleep medication, among them sedatives, anxiolytics and antidepressants. An experienced and knowledgeable clinician will make the best choice for a patient. Sleep medications carry the risk of increasing dependence and tolerance when used over long periods of time. Although newer compounds have fewer such risks, they can cause liver and kidney problems, mood changes and other adverse effects.

How Will SleepRate Help You?

Use SleepRate for a few days to identify sleep-wake patterns and to measure sleep duration, efficiency and structure. It will provide you with personalized advice on how to improve your sleep as well as useful information you should share with your physician during your consultation.

Find out more about SleepRate. Or, if you’re ready to purchase a SleepRate package, start here.

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A partial sleep study is a limited version of a whole-night polysomnography (PSG), the gold standard for clinical sleep evaluation. The differences in the subset are:

  • It has relatively few monitoring channels; and those are devoted to respiratory functions.
  • It can be done outside of a sleep lab (in other words, at home).

 

The focus on respiratory functions makes it ideal for diagnosing sleep-related breathing disorders.

It’s also a less expensive diagnostic procedure and the data it generates is much easier to score than data produced by a whole-night PSG. A trend towards greater use of partial sleep studies is underway, though it cannot always replace a full PSG, especially if sleep problems are more complex or not caused only by respiratory disorders.

In the future, technologies that measure sleep directly will enable other kinds of partial sleep studies. For example, measurements of heart rate fluctuations with portable equipment provide a window into the sleeping brain. Such a technology could supplement others to provide a more comprehensive analysis of sleep outside a lab environment.

How Will SleepRate Help You?

Use SleepRate for a few days to identify sleep-wake patterns and to measure sleep duration, efficiency and structure. If those measurements suggest a condition that warrants further investigation, you’ll be prompted to consult a physician for an in-depth sleep evaluation.

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Unusual nighttime events such as night terrors, sleep talking, or sleepwalking are known as parasomnias. They are mostly harmless, always intriguing, occasionally humorous and often scary. For sleep scientists they represent a very interesting series of naturally-occurring experiments at the boundaries between human states: wakefulness, non-REM sleep and REM sleep. These weird amalgams and overlaps of states cannot always be explained, but they reveal aspects of sleep that could not otherwise be observed.

Non-REM (or Arousal) Parasomnias

Night terrors, sleep talking, and sleepwalking originate in deep sleep, usually during the first third of the night. They occur more frequently in childhood and decrease with age, though a small percentage of adults still experience these events. There appears to be a genetic link to the phenomenon; and scientists have never found an underlying pathology. Treatment is typically not needed unless the episodes are frequent and interfere with the night routines of people who sleep in the vicinity.

In some cases, an overnight sleep study may be prudent to rule out epileptic seizures at night.

As a practical matter, the sleeping environment for someone who experiences parasomnias must be prepared in such a way as to prevent physical injury during episodes – essentially “parasomnia-proofed”, for lack of a better term.

Children experience night terrors frequently, as many parents well know. They scream, cry, become agitated and frightened, and are inconsolable. Any attempt to wake or comfort them makes things worse. There is no actual disruption of sleep; and they retain no memories of dreamlike experiences when they wake at the end of an episode. They may, however, feel and express fear without a specific reason.

Sleep talking and sleepwalking involve complex motor behavior, but represent two extremes on the activity continuum. Talking obviously involves relatively little movement; but sleepwalking is a very agitated state. In spite of that, sleepwalkers rarely leave their abodes. They retain no memory of the event; and there is no disruption of sleep. Treatment is not required for infrequent episodes, but the sleep environment must be made safe.

Episodes start in late childhood and typically stop by the late teens. For an unfortunate few, the episodes persist into adulthood.

REM Sleep Parasomnias

Nightmares are simply bad dreams. They occur mostly in the last part of the night when REM sleep predominates, whereas sleep terrors intrude into the first part of the night. When people wake after a nightmare they can provide a detailed report of the frightful experience.

Sleep paralysis occurs when one wakes up suddenly from REM sleep but is unable to move because REM-related muscle inhibition is still in place temporarily. Though frightening, it’s a harmless phenomenon. The problem may occur sporadically without a known cause; or it may recur within family clusters. In many cases it’s an isolated event, but it can also occur as a symptom of narcolepsy.

REM behavioral disorder presents with agitated motor activity during REM sleep that can put sufferers or their bed partners at risk for injury. This happens when normal muscle inactivation during REM sleep disappears, thus causing apparent violent behavior while sleeping. An overnight sleep study can diagnose the disorder easily. An underlying brain or neurological problem causes this, and sometimes precedes Parkinson’s disease by many years.

How Will SleepRate Help You?

If you don’t have a medical sleep disorder, but feel tired during the day or perceive your sleep isn’t refreshing, use SleepRate for a few days to identify sleep-wake patterns and to measure sleep duration, efficiency and structure. It will provide you with personalized advice on how to improve your sleep.

Learn more about SleepRate. Or, if you’re ready to purchase a SleepRate package, start here.

Sleep Science Table of Contents

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People frequently use over-the-counter (OTC) sleep medications when they have difficulty falling asleep. Those medications can be useful when taken occasionally, but ongoing sleep challenges require an adherence to healthy sleep habits rather than the long-term use of medication.

Many OTC medications are available for sleep. Most are antihistamines (e.g., Benadryl, Unisom). Their sedative properties are actually a side effect of medications originally intended for control of hay fever and other allergies. Unwanted side effects may include daytime drowsiness, dry mouth, dizziness and memory problems.

A plant extract such as valerian may also be used. Its efficacy varies by individual, but sometimes it works well as a sleep aid. Unwanted side effects may include irritability, abdominal discomfort and cardiac problems.

Melatonin, a naturally occurring hormone that regulates sleep-wake cycles, is used often as an OTC sedative.

How Will SleepRate Help You?

Use SleepRate for a few days to identify sleep-wake patterns and to measure sleep duration, efficiency and structure. It will provide you with personalized advice on how to improve your sleep.

Learn more about SleepRate. Or, if you’re ready to purchase a SleepRate package, start here.

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Sleep physicians have two well-established objective tools at their disposal to measure daytime sleepiness.

Multiple Sleep Latency Test (MSLT)

The MSLT measures daytime sleepiness in a sleep lab after a whole-night polysomnography (PSG), which evaluates sleep and identifies sleep disorders such as obstructive sleep apnea. In the morning, the patient remains connected to the polygraph to measure brain activity, eye movement and muscle tonus during four to five 20-minute nap opportunities at 2-hour intervals. The time to sleep onset (if it happens at all) during these opportunities and the sleep stage reached are recorded and compared to normative values. The process yields a validated measure of daytime sleepiness.

Maintenance of Wakefulness Test (MWT)

The MWT is another measure of daytime sleepiness that is also used after a whole-night PSG. Four to five events at 2-hour intervals allow the patient to sit quietly in an armchair in dim light for 45 minutes. He/she is asked expressly to make a maximum effort to remain awake. As with the MSLT, the times to sleep onset (if it happens at all) are recorded, along with the sleep stage reached. Those measurements are compared to normative values to evaluate the degree of daytime sleepiness.

How Will SleepRate Help You?

Use SleepRate for a few days to identify sleep-wake patterns and to measure sleep duration, efficiency and structure. If those measurements suggest a condition that warrants further investigation, you’ll be prompted to consult a physician for an in-depth sleep evaluation.

Learn more about SleepRate. Or, if you’re ready to purchase a SleepRate package, start here.

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Is napping good or bad? We have internal clocks that motivate us to sleep at night and stay awake during the day. But there is an additional point in the daytime when most people feel sleepy: around 2:00 pm. Our bodies and minds are telling us we need a break, but the demands of modern society compel us to ignore that tendency.

Children typically nap during the day until they reach school age. Of course, there seems to be a time in the evening (7-8 pm) during which children simply refuse to sleep. Yet that behavior is consistent with an internal sleep-wake rhythm.

A nap for additional rest or relaxation is useful if one feels the need. It can improve alertness and performance, if not mood as well. The downside might be post-nap grogginess or difficulty falling asleep in the evenings. Napping may be a good strategy for someone who is sleepy, provided the duration is limited to roughly 30 minutes.

If one feels an irresistible need to sleep during the day or has a tendency to fall asleep during inappropriate moments (while driving, during lectures, in the theater), a visit to a physician to check for sleep or medical disorders is prudent.

How Will SleepRate Help You?

Use SleepRate for a few days to identify sleep-wake patterns and to measure sleep duration, efficiency and structure. If those measurements suggest a condition that warrants further investigation, you’ll be prompted to consult a physician for an in-depth sleep evaluation. Otherwise, SleepRate will provide you with personalized advice on how to improve your sleep.

Learn more about SleepRate. Or, if you’re ready to purchase a SleepRate package, start here.

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Melatonin is a hormone secreted by the pineal gland, a small structure in the brain that receives input about light and darkness via optic pathways that originate in the eyes. Secretion starts in the late evening, reach a peak around 3-4 am and cease during daylight.

Sleep science, a relatively new field in medicine, encompasses the evaluation, diagnostic procedures and treatments for all kinds of sleep problems.

People’s biological clocks are usually synchronized with the time zone where they live. When moving quickly across several zones, that synchronization disappears temporarily. This happens only while travelling west or east. North or south journeys have no impact on synchronization because the time zone doesn’t change.

The severity of jet lag complaints generally correlates with the number of time zones crossed and the direction of the travel. Eastbound is generally more troublesome than westbound because the compression of the day-night cycle means a loss of calendar time for recovery. The opposite is true for westbound travel: More time for recovery is available.

These symptoms are typical:

  • insomnia
  • irritability
  • headaches
  • digestive system malfunctions
  • increased urination at night

 

Conditions on flights can compound the problems through increased exposure to dehydration, infection, and other adverse conditions.

Synchronizing a biological clock to a destination time zone generally requires a day for every 1-2 time zones crossed. One can try to prevent or mitigate jet lag by starting the adaptation process a few days before departure or forcing a quicker alignment after arrival. Most do the latter by exposing themselves to bright outdoor light, a powerful tool for resetting an internal clock; and by adhering to sleep hygiene rules. Some advocate using melatonin or other sleep aids for a few days until the symptoms fade away.

How Will SleepRate Help You?

Use SleepRate for a few days to identify sleep-wake patterns and to detect a biological clock that is slow, fast or simply abnormal. If an out-of-sync clock is found, SleepRate recommends ways of dealing with it. It also offers implementation assistance.

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Insomnia is the inability to fall asleep and/or maintain sleep. It’s also a perception of poor sleep quality or a feeling that sleep is not refreshing. The disorder is widespread: Approximately 10% of the general population suffers from chronic insomnia and as many as 30-50% report experiencing it at least once in their lives. The condition becomes more prevalent with age and is more common in women.

There is no standard for the amount of sleep an individual requires. Each person is unique. In simple terms, you need enough sleep to avoid drowsiness and to perform at optimal efficiency during the day. That need changes with age, so what works best in one stage of your life may not be appropriate for another. At the extremes of a distribution across large populations are normal people who need as little as 4 hours or as much as 12 hours.

A majority of people do very well with 7½ to 8 hours of sleep. But use those numbers only as a starting point until you determine if that range is appropriate for you. Although you can ignore your body’s need for a certain amount of rest through motivation and sheer force of will, doing so isn’t conducive to good health or a vibrant existence.

Our “always on” culture has permeated traditional barriers between work time, family time, playtime, and rest. Sometimes we’re trying to do two or three things at once; or we’re struggling to meet an unnatural (and occasionally unrealistic) expansion of obligations. The result is that more of us are carrying sleep debts or adding to them faster than ever before. Sleeping late on the weekends may seem to help, but in fact it’s only paying interest on the debt, so to speak.

Sleep deprivation can have serious consequences for mental and physical health.

You cannot perceive, in precise terms, how much sleep you actually need. The only way of evaluating that in a scientific manner is to sleep for several nights without wakeup or other constraints. After the sleep debt is replenished, your natural need for sleep will take over and yield an accurate duration.

If you suspect you’re not getting enough sleep, you may need to investigate further by using the SleepRate solution (see below) or by a visiting your physician for professional evaluation.

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SleepRate measures and reports the duration and efficiency of sleep you receive. If you feel you aren’t getting enough restorative sleep, SleepRate will make personalized recommendations to help you sleep better.

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Our biological clock tells our body and mind when to go to sleep and when to wake. If that inner clock doesn’t quite synchronize with life’s obligations, normal people will be able to adapt. But they may not always feel great throughout the day.

Owls (or night owls or evening types) feel best and most alert during late hours. They prefer to have their main meal late in the day and usually skip breakfast. A cup of coffee is often their morning meal. But they do need an alarm clock in the morning to ensure they rise to meet their daily obligations.

In contrast, larks (or morning types) wake up early and are at their best during the first part of the day. They eat breakfast and prefer to retire relatively early, after a light dinner.

Owls predominate because humans have an inner clock with a period slightly longer than 24 hours. That causes a tendency to stay up a bit later and wake up later each day. Owl and lark tendencies are natural and are not considered problems, unless they cause sleep deprivation or interference with daily routines.

How Will SleepRate Help You?

Use SleepRate for a few days to identify sleep-wake patterns and to measure sleep duration, efficiency and structure. It will provide you with personalized advice on how to improve your sleep.

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A growing public health concern in many countries is the number of traffic accidents attributable to sleepiness. Drowsiness leads to the same level of impairment as driving under the influence of alcohol; and like alcohol consumption, people seldom perceive the degree of their own impairment. The best estimate is that roughly 25% of fatal accidents are caused by sleep debt. The cost to society of these tragedies is extraordinarily high.

A sleep-deprived individual may be able to avoid falling asleep behind the wheel, but motor coordination, reaction times and judgment are usually compromised significantly. A coffee jolt (or several) will offset sleepiness temporarily, but the safest approach is to stop the vehicle and take a nap.

Unfortunately, there are no sleep-related counterparts to tests that measure blood alcohol levels. That’s why certain professions (professional drivers and airline pilots, to name a few) have regulations that limit operational hours. As well, some states go so far as to screen professional drivers for obstructive sleep apnea hypopnea, a condition that causes daytime sleepiness.

The best approach for society seems to be ongoing education with repeating public warnings about the dangers of driving while drowsy.

How Will SleepRate Help You?

SleepRate measures and reports the duration and efficiency of sleep you receive. If you feel you aren’t getting enough restorative sleep, SleepRate will make personalized recommendations to help you sleep better.

Learn more about SleepRate. Or, if you’re ready to purchase a SleepRate package, start here.

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Daytime sleepiness is the propensity to fall asleep at inappropriate times during the day.

The degree of daytime sleepiness correlates directly to the amount and quality of sleep during the previous night. The duration people need to stay awake varies with each individual; but surveys and research indicate most people perform optimally with 7.5 – 8.5 hours. Any sleep loss leads to immediate sleepiness. By the same token, the opposite is true: An extension of sleep duration can alleviate drowsiness and improve performance.

Sleep quality also counts, though this aspect is usually less obvious. Sleep fragmentation (in other words, the lack of continuity) impacts sleep quality and causes drowsiness. There are many possible causes: sleep-related breathing disorders, periodic limb movement during sleep, other medical ailments accompanied by pain or discomfort (e.g., arthritis, back pain, fibromyalgia), and narcolepsy. And that’s far from a complete list.

Individuals are sometimes unaware of their own daytime sleepiness. It may come to their attention after trying to cope with other problems such as decreased performance, hypertension, excessive weight, snoring, and mood disorders. Fortunately, good objective tests for measuring sleepiness are available. The Multiple Sleep Latency Test (MSLT) and the Maintenance of Wakefulness Test (MWT) are commonly used for this purpose.

Scientifically-validated questionnaires such as the Epworth Sleepiness Scale (ESS) and the Stanford Sleepiness Scale (SSS) are also useful for evaluating sleepiness. As well, alertness can be measured using a visual analog scale (VAS).

If daytime sleepiness is identified as a problem, the underlying cause(s) should be investigated and identified. Appropriate treatment(s) or lifestyle changes can improve sleep duration and quality, thereby leading to better health, improved performance, and a new sense of wellbeing.

How Will SleepRate Help You?

SleepRate measures and reports the duration and efficiency of sleep you receive. If you feel you aren’t getting enough restorative sleep, the service makes personalized recommendations to help you sleep better. When the service detects sleep parameters that fall outside of scientifically-accepted norms for good health, it will let you know. You may want to independently verify this information with a physician.

Learn more about SleepRate. Or, if you’re ready to purchase a SleepRate package, start here.

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Many human physiological functions have a cyclical nature. Cycles with 24-hour patterns are called circadian rhythms. For example, most people are hungry or feel sleepy at the same times each day. A circadian sleep disorder is a disruption of a sleep-wake circadian pattern that may prevent people from meeting daytime obligations or cause daytime sleepiness.

Sleep hygiene is a set of practices that promote and maintain healthy and restful sleep. People with sleep difficulties have been using them for decades to improve their nighttime rest and stave off unwanted symptoms of sleep deprivation during the day. The goal is to prevent sleep issues from interfering with daily life.

Start your hygiene checkup by reviewing your bedroom environment.

  • Your bed is comfortable.
  • The ambient temperature is comfortable.
  • The bedroom air is free of disturbing irritants or odors.
  • The noise level doesn’t annoy or distract you.
  • Use window shades wisely. Keep the room darker by closing the shades when you need to sleep.
  • Keep the television out of the bedroom.

 

Pay attention to the following factors that interfere with sleep.

  • Your intake of stimulants. You may need to reduce or eliminate foods, drinks or medications that keep you awake, particularly in the latter half of the day. The most notorious example is caffeinated coffee, which many people use as “pick me up” to combat sleepiness.
  • Smoking before bedtime. An unhealthy habit which has an additional deleterious impact on sleep that is less well known: Nicotine is a stimulant.
  • Timing and intensity of exercise. Exercise can improve sleep quality, which in turn facilitates physical recovery. But high-intensity exercise that’s too close to bedtime may interfere with your ability to fall asleep.
  • Use of relaxation techniques. Finding a way to unwind at the end of the day can help you to fall asleep at bedtime. Use whatever works best for you.
  • Alcohol as a sleep aid. The use of alcoholic drinks to assist with falling asleep is a popular but misguided notion. Alcohol may indeed help you to fall asleep, but it’s toxic to sleep quality, making your rest inefficient and fragmented.
  • Heavy meal before bedtime. Eating a large or heavy meal before going to bed can make falling asleep difficult.
  • Lying awake for long periods. Use your bed only for sleeping and intimacy. If you can’t fall asleep, get up and do something relaxing, then go back to bed when you feel ready. Lying in bed and not sleeping for long periods of time can exacerbate sleep difficulties.
  • Daytime napping. Don’t nap during the day. Period.

 

If you wake up too early each morning:

  • Check environment factors such as noise, pets, children, etc.
  • If you feel moody, depressed or anxious, consider talking to your physician.

 

If you have trouble falling asleep, find it very difficult to wake up, and are chronically late or irritable, you may be sleep-deprived. To improve things, you need to change your behavior by doing the following:

  • Choose a wake-up time that makes sense in the context of school, work or other obligations.
  • Always wake up at that time. On weekends, don’t let yourself sleep more than 30 minutes past that time.
  • Count backwards from that time based on your sleep needs (at least 7 hours). That’s when you should be in bed and asleep.
  • It may be helpful to limit yourself to 6 hours of sleep initially, and then increase the amount by 15 minutes each week until you reach a duration that satisfies your sleep needs.
  • Follow the other rules of good sleep hygiene.

 

How Will SleepRate Help You?

Use SleepRate for a few days to identify sleep-wake patterns and to measure sleep duration, efficiency and structure. If those measurements suggest a condition that warrants further investigation, you’ll be prompted to consult a physician for an in-depth sleep evaluation. Otherwise, SleepRate will provide you with personalized advice on how to improve your sleep. 

 

Alcohol influences sleep significantly. Its most obvious impact is shortening the time to fall asleep (sleep latency), which is why it is a popular aid for people who have difficulty falling asleep.

As well, it increases the amount of deep sleep during the first half of the night. This may be viewed as a sleep quality “improver” because this type of sleep is restorative. Growth hormone secretion and tissue repair occur during deep sleep.

The downside comes in the second half of the night: fragmented sleep and less overall REM sleep. Lack of REM sleep can cause memory issues, motor skills deterioration and attention deficit. This happens because REM sleep has an important role in promoting learning skills and memory consolidation.

The consumption of alcohol decreases respiratory drive and increases muscle relaxation. This means that alcohol can trigger sleep-related breathing disorders or worsen existing sleep apnea. In addition, it increases a person’s propensity to experience parasomnias such as sleepwalking.

The magnitude of the effects correlates to the amount of alcohol consumed.

How Will SleepRate Help You?

Use SleepRate for a few days to identify sleep-wake patterns and to measure sleep duration, efficiency and structure. Your perception of sleep quality differences after using or not using alcohol will help you to determine when – and how much – alcohol is good for you.

Learn more about SleepRate. Or, if you’re ready to purchase a SleepRate package, start here.

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Sleep & Driving

A growing public health concern in many countries is the number of traffic accidents attributable to sleepiness. Drowsiness has same level of impairment as driving under the influence of alcohol; and like alcohol consumption, people seldom perceive the degree of their own impairment. The best estimate is that roughly 25% of fatal accidents are caused by sleep debt. The cost to society of these tragedies is extraordinarily high.

A sleep-deprived individual may be able to avoid falling asleep behind the wheel, but motor coordination, reaction times and judgment are usually compromised significantly. A coffee jolt (or several) will offset sleepiness temporarily, but the safest approach is to stop the vehicle and take a nap.

Unfortunately there are no sleep-related counterparts to tests that measure blood alcohol levels. That’s why certain professions (professional drivers and airline pilots, to name a few) have regulations that limit operational hours. As well, some states go so far as to screen professional drivers for obstructive sleep apnea or hypopnea, a condition that causes daytime sleepiness.

The best approach for society seems to be ongoing education with repeating public warnings about the dangers of driving while drowsy.

How Will SleepRate Help You?

SleepRate measures and reports the quantity and quality of sleep you receive. If you feel you aren’t getting enough restorative sleep, SleepRate will make personalized recommendations to help you sleep better. If SleepRate suspects that a medical condition is impacting your sleep, it will recommend a visit to a physician.

Find out more about SleepRate. Or, if you’re ready to purchase a SleepRate package, start here.

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Epidemiological studies indicate that throughout the previous century and, mostly during the last decades, there is a clear decline in sleep time and increasing anxiety within the populations living in the developed countries. Those two tendencies are interconnected: sleep deprivation increases an individual’s “stress” and anxiety is related to difficulties falling asleep or maintaining a continuous and refreshing sleep.
There are many measures for stress reduction, mostly subjective, as well as some invasive ones, involving blood tests to assess certain hormone levels. Stress depends on the activity of the involuntary or autonomic nervous system, the part of our nervous system that is active all the time in the background and is taking care of all the automatic activities that sustain life, such as breathing, rhythm and intensity of the heart’s beats, body temperature regulation, sweating, digestion, blood flow and more.

Each heart contraction occurs as a result of the autonomic nervous system modulating the Heart Rate, according to the body’s needs and emotional and cognitive activities. This system has two branches. One of them enhances heart activity, being in charge of making the organism ready to react, a “fight and flight” reaction, obviously connected to danger, increased stress, readiness to act. The other branch is in charge of the opposite, namely, slowing down, relaxation, restoration, in a way a “rest and digest” kind of activity. These two branches, known as the sympathetic and parasympathetic parts, respectively, of the autonomic nervous system, act normally in a continuous balance, aiming to keep the organism safe and performing.

How can SleepRate help?

SleepRate measures the heart rate variation and can calculate a stress level from this signal. By evaluation of stress levels across many nights, you can see trends in stress, and try different stress relieving measures or strategies and follow up their results.

Is napping good or bad? Human beings have a natural tendency arising from their internal clock to sleep during the night and be awake during the day. There is an additional time during the day when people have a normal tendency to sleep: in the early afternoon, around 2pm our bodies and minds tell us they need a break. The modern society in general overlooks this tendency. Children keep napping until school age. There is a time during the day, around 8 pm, when it is almost impossible to fall asleep. This is the forbidden gate!

One may take a nap if one needs some rest and relaxation. A nap can improve alertness and performance as well as mood when it is really needed. The downside might be some grogginess when waking up, or problems falling asleep at night. So napping may be a good strategy for a person who feels sleepy and is sleep deprived, provided it is kept short, around half an hour or so.

If the sleepiness is a new onset with no change in the overall sleep time, it may indicate there is a sleep or medical disorder involved and one should consult a doctor.

What should I ask my doctor when I feel that my sleep is poor or I can’t sleep at night?

Try to be concise and clear. State very briefly what are your problems regarding your sleep, such as: long time to fall asleep, waking up frequently at night, waking as after a sleepless night. You may want to ask if the problem may be connected to some other health problems you might have or with any medication you are taking. Do not ask for sleeping pills, but ask if you should consult a sleep specialist or visit a sleep clinic and what would be the costs related to this. Then you can ask about recommended treatments for your problem.

In response, your doctor should inquire about your sleep-wake usual schedule, including when you go to bed, how long it takes you to fall asleep, when you wake up in the morning, napping during the day. The doctor could also ask for information regarding sleep environment, how preoccupied are you about your sleep complaints, snoring, movement during sleep, caffeine and alcohol consumption, working schedule and type of job, general health, nutrition and exercise habits, daytime sleepiness and mood.

Based on this sleep and medical short history, your doctor may suggest a treatment, and may recommend further workup, including seeing a specialist.

How can SleepRate help?

SleepRate lets you measure your sleep structure, awakenings, arousal index and sleep times. You can bring the results to your doctors for further considerations.

Unusual events occur sometimes at night. These events are intriguing, sometimes funny and other times scary. They are mostly harmless and weird phenomena that we understand only partially and study them, as they represent some kind of a naturally occurring experiment that can teach us a lot.

Night terrors, Sleep talking and Sleep walking are all events that originate in DEEP SLEEP, mostly during the first third of the night. They are frequent during childhood and usually their prevalence decreases with age, although a small percentage of adults experience this kind of events. It appears that there is a genetic component to these phenomena. There is no underlying basic disorder and usually no treatment is needed, unless they are very frequent and interfere with the night routine of those sleeping in the same room, house, or environment. The only reason to perform a sleep test may be to rule out epileptic seizures during the night. The sleep environment has to be proofed so the person who has such an episode does not get hurt.

Night terror is frequent in children; they start screaming, crying, being terribly agitated and frightened, they are disconnected from the environment, inconsolable, and any trial to wake them or to comfort them makes things worse. There is no memory to the event, no sleep disruption, and when they are awake at the end of an episode there is no report of any dreamlike content. Sleep talking and quiet to agitated Sleep walking are an additional spectrum of disorders arising from DEEP Sleep in the first third of the night. There is talking and complex motor behavior from quiet to very agitated, and rarely a person can leave the house during an episode. There is no memory of the event in the morning and no sleep disruption. Treatment is not needed if the episodes are not frequent, but the sleep environment has to be safe. The episodes start in late childhood and usually fade out in the late teens, though for some they persist into adulthood.

Nightmares: these are just bad dreams; usually they occur during the last part of the night, and upon awakening from the episode there is a report of a frightening dream.

Sleep paralysis occurs when someone wakes up suddenly from REM sleep, but is unable to move because the REM related muscle inhibition is still on. It may be frightening, it is harmless, may be sporadic or recurring in family clusters. Sometimes it is an isolated phenomenon, and other times it occurs as one of the symptoms of Narcolepsy.

REM behavioral disorder presents with agitated motor activity that appears during REM sleep, activity can cause injury to the patient or to the bed partner. It appears when the muscle inactivation during REM is lost, and people behave violently during sleep. A sleep study can easily diagnose the disorder . It usually originates in neurological brain problem, sometimes preceding Parkinson’s disease by many years.

Over the counter sleeping aids

Many people use over the counter sleeping aids when having difficulties falling asleep.

Such sleeping aids may be used occasionally, but on a regular basis it is preferable to stick to healthy sleep habits, rather than use any medication.
There are many over the counter medications. Most are antihistamines (like Benadryl, Unisom) and their sedative effect is actually a side effect of a medication aimed originally as an anti-allergy one. Thus, they can cause daytime drowsiness, dry mouth, dizziness and memory problems.
In addition, plant extracts such as Valerian may be used. Their influence differs individually, sometimes they help falling asleep, but they also can cause irritability, abdominal discomfort, and cardiac issues.

Melatonin, a naturally occurring hormone related to the normal regulation of the sleep-wake cycle is also used as an over the counter sedative.

Prescription Sleeping Pills

Falling asleep difficulties and/or difficulties to maintain sleep across the night are very frequent. About 10% of the general population suffers from chronic sleep problems and as many as 30-50% of people have at some time or another in their lives sleep related concerns. The healthy way to deal with these problems, if they are not connected to an underlying health problem such as Obstructive Sleep Apnea or a mood disorder, is to try and adhere to a regular sleep schedule, and implement all sleep hygiene requirements. Sometimes, one can use for a short time a sleeping pill, provided it is prescribed by a physician, preferably a sleep expert.

When asking a physician to help you sleep better, fall asleep faster or stay asleep for an entire night, the doctor will make some inquiries regarding your general health as well as your sleep habits and changes in lifestyle or distressing vents. When needed, some tests may be ordered to rule out any underling medical cause to the sleep disturbance. Then a suitable sleep medication may be prescribed for a period of around two weeks. Additional steps may be needed to improve sleep.

Sleeping pills in general carry the risk of developing dependence and tolerance when used over prolonged periods of time. Newer compounds have less such effects, but they can cause liver or kidney problems as well as mood changes, and more.

Melatonin

Melatonin is a hormone secreted by the pineal gland, a small structure in our brains that receives its input regarding light and dark in the environment via the optic pathways originating in the eyes. The secretion starts in the late evening, is maximal around 3-4 am, and is suppressed during daylight. Melatonin is a factor in the sleep-wake cycle regulation.

It has been used for decades as an aid in treating jet lag and other sleep-wake cycle disorders. Research indicates that its use is beneficial. However, since in the US melatonin is sold as a food additive, its efficiency and side effects have not been checked in extensive clinical trials. Its usage is broad and no severe side effecthave been documented. One has to be aware of possible drug interaction that may exist. When having any health problem that requires medication, it is advised to consult a doctor before taking Melatonin. It is recommended to purchase a product of a known lab to avoid using ineffective or contaminated Melatonin.

How can SleepRate help?

SleepRate is able to detect sleep schedule patterns and sleep structure. Based on these measurements, SleepRate can recommend how to make changes to improve sleep and reduce the need for sleeping aids/pills/medication.

Along human history the mystery of sleep preoccupied the minds and souls of great philosophers and thinkers, poets and artists. The entire understandings regarding sleep were based on observation. Some observations serve as the basis for a branch of the medical science: Sleep Medicine. This relatively new field deals with the overlooked part of human life, sleep time, which represents grossly one third of our lives. People may be aware of how daily events and troubles impact their nights, but they are not necessarily aware of the opposite, how unnoticed sleep problems can influence their whole life including health, physical and mental performance, mood. Thus Sleep Medicine deals with sleep disorders.
Sleep disorders can be the result of an illness that is not directly the result of a faulty sleep- related function. For instance, any disease causing pain, be it an ear infection, tooth pain, or arthritis, may cause very significant sleep problems. Mood disorders, such as increased anxiety, can result in difficulty falling asleep; depression can result in prolonged sleep, but also in early awakenings.

Other sleep disorders originate within sleep itself. The most prevalent one is the Obstructive Sleep Apnea-Hypopnea Syndrome or Sleep Related Breathing Disorder. Others examples are Narcolepsy, REM Behavior Sleep Disorder, Periodic Limb Movement of Sleep.

1. Sleep related breathing disorders

Human muscles lower their level of basic activity during sleep; moreover, during REM sleep their activity is almost completely shut down. The decrease in the muscular activity level affects also the upper airways, which become naturally floppy during sleep, at a time when body position is recumbent. These changes cause the air passages to get narrower, so the inspiration becomes more difficult, resulting in different degrees of compromise of the air inflow. The easiest form is just narrowing, which causes turbulence of the airflow that makes the surrounding soft tissues, such as the soft palate, vibrate and thus produce the bothering snoring sound. As the narrowing of the passages becomes more accentuated, the airflow is compromised and sometimes even stops, causing a hypopnea (partial decrease in airflow) or an apnea (airflow cessation). The resulting respiratory events end when the muscles increase their tone and the airways reopen and allow breathing in. For this to happen, the sleep is shortly interrupted by a short arousal lasting for a few seconds. This arousal is so short that one does not remember it, however when there are many respiratory events that end with an arousal, sleep becomes fragmented. This can lead to increased daytime sleepiness and other medical complications such as hypertension.

Respiratory events are related not only to sleep fragmentation;they are also accompanied by decrease in blood oxygenation, sometimes increase in the levels of carbon dioxide, and increased stress to the cardiovascular system. Thus sleep related breathing disorders have huge impact on health, being causally related to hypertension and other cardiac problems. The cognitive function may be affected, and so can be mood and memory. Another bothering effect is daytime sleepiness.

Breathing related sleep disorder, Obstructive Sleep Apnea-Hypopnea (OSA) syndrome, is prevalent. 4-10% of the population has OSAS and the prevalence increases with age. The disorder is treatable, and when effectively treated, the consequences can be reversed. The great majority (about 75%) of sufferers, however, remain undiagnosed, and thus untreated.

2. Snoring

Snoring occurs when there is a narrowing of the airways during sleep, causing turbulence of the airflow and vibration of the soft tissue in the way, the soft palate, that make the well-known noise. The phenomenon is very frequent, a quarter to more than half the population snore sometimes or habitually, while supine or in every position. It bothers the bed partners. For some there is only snoring (primary snoring), while for others it is a sign of Obstructive Sleep Apnea. Snoring is also treatable, but first one has to rule out the coexistence of Obstructive Sleep Apnea.

When to see your doctor about your snoring, you should report whether:
• You wake up suddenly gasping on a snort at night and fall asleep almost instantaneously after this happens
• You snore so loud that your bed partner gets very annoyed and can’t sleep
• Your throat is dry and painful at night
• Your wake up non refreshed

3. Periodic limb movement in sleep

not so rare sleep disorder of unexplained etiology. The manifestation of this disorder consists of periodic jerks of the legs and or sometimes upper limbs. The jerks may be as subtle as a toe twitch, or as significant as a limb movement lasting around a couple of seconds and recurring every 20 to 60 seconds during light sleep mainly, and continuing for as long as an hour at times. The cause remains unknown; it always accompanies Restless Leg Syndrome, but can be present on its own. It may coexist with other disorders, Obstructive Sleep Apnea included. It may be connected with many short arousals that cause sleep fragmentation and non-refreshing sleep, and it may disturb the sleep of the bed partner. The prevalence increases with age. Sometimes it is connected to iron depletion and treating iron deficiency anemia can improve the symptoms. There are additional medical remedies available and prescribed by sleep physicians or neurologists.

4. Narcolepsy

A sleep disorder that can manifest sometimes as extreme daytime sleepiness and poor sleep, or in its classical form as a tetrad including excessive daytime sleepiness with irresistible napping tendency, hallucinations upon falling asleep, sleep paralysis, and cataplexy. Cataplexy is a sudden partial or total loss of muscle tone caused by a sudden emotion, usually positive, typically laughing. The patient may fall down while being completely conscious, and then unable to move or talk. The disease may be sporadic or may have a genetic background uncovered a few years ago*. Narcolpesy is treated behaviorally with planned naps and symptomatically, using vigilance promoting medications and drugs that can relieve catalepsy. It is a disabling disorder and it goes on for life.

5. Insomnia

Insomnia is defined as complaint of difficulty falling asleep and/or of maintaining sleep, usually leading to the subjective feeling of poor sleep quality and waking up non-refreshed. The disorder is prevalent, the frequency increases with age, and generally is higher in women. Insomnia has important negative consequences, including fatigue, irritability, cognitive problems and memory issues. Population surveys indicate that most Insomnia patients are reluctant to consult their doctor with regard to their sleep problem. Insomnia may be frequent and occur almost on a nightly basis, or can have an intermittent course. The disorder can be primary or caused by a stressful life event, shift work or frequent travel across time zones. Insomnia can be present as a stand-alone disorder or it can coexist with other sleep disorders, such as Obstructive Sleep Apnea, Periodic Limb Movement of Sleep, or it may result from a medical problem, such as arthritis, acute or chronic pain, heart failure, liver disease, diabetes and more, or anxiety and mood disorders. The consequences are extensive, including absenteeism, poor job performance, social problems, inattention, increased accident tendency and more. Usually people try different kind of self administered remedies, when the best approach would be to consult a professional.

The doctor’s approach is to take a proper medical and sleep history, order tests if necessary rule out underlying medical problems, and refer to specific Insomnia treatment when no underlying disease is detected.

The treatment consists mostly of behavioral and cognitive therapy, which have been proved to be most efficient and with long lasting effects. These therapies include keeping a very regular sleep-wake schedule, sticking to sleep hygiene requirements, sleep restriction, stimulus control, stress reduction and certain relaxation procedures. The therapy may include a short course of prescription sleeping pills at the beginning. It is recommended to avoid self-medication with alcohol or other over the counter remedies. A healthy life style including a regular sleep schedule, sleep routine, moderate exercise to keep fitness, avoiding coffee and caffeine-containing foods or beverages, avoiding alcohol at bed time, are all required in order to maintain good night’s sleep in those who suffer from Insomnia.

How can SleepRate help?

SleepRate provides sleep macrostructure and microstructure assessment as well as accurate sleep time, difficulties with falling asleep and sleep-wake schedule

Based on the sleep assessment above, if there is suspicion for a sleep disorder a more in depth sleep study should be performed. If not, treatment for Insomnia, CBTI, relaxation, smart wake up and specific notification can help self-improvement of your sleep.

Sleep evaluation and analysis is a relatively new field in Medicine and has emerged as such after the measurement of the electrical activity of the brain (EEG), performed with sensors place on the surface of the head, became available (in the middle of the twentieth century). Based on this new technology, and the possibility of recording on paper a multitude of physiological signals, the understanding of how the body and the brain function during wakefulness and sleep increased dramatically over a few decades. These studies can serve to advance our understanding of what is normal and what malfunctions occur during sleep. Thus sleep studies are widely used to research normal sleep physiology and to diagnose sleep disorders.
A gold standard of sleep evaluation has evolved and remains the standard language for all sleep experts.

A major change occurred during the last decade of the 20th century: digital recording and signal processing devices have replaced the old paper-based devices. In addition, the miniaturization of the devices became very significant, allowing ambulatory testing of people whose sleep needs to be analyzed. However, a conservative approach to sleep evaluation remains in place.

At the end of 1960s sleep experts created a consensus for standard sleep diagnostics and terminology, based on the state of the art technology and knowledge at that time. A new consensus of the American Academy of Sleep Medicine published in 2008 keeps almost all the old standards, in spite the fact that some of them were arbitrarily based on out-of-date technology: for instance, the standard for sleep scoring is a time interval of 30 seconds that fits the length of the paper page of the polygraph. Thus, very limited advantage from the more accurate new digital recordings can be obtained in evaluating sleep physiology. This also precludes the possibility of automatic reliable sleep scoring. The gold standard approach is time consuming and depends on the personal attention span and expertise of the scorer. The inter-scorer agreement in this respect, regarding “sleep staging”, is around 80%!

Medical sleep studies include:

1. Gold standard sleep study

widely known as a whole night polysomnography (whole night PSG) Requires to record

i. Signals to allow sleep architecture and quality evaluation including the following

1. 6 EEG channels at least (not all labs record all of these)
2. 2 eye movement (EOG) channels
3. 1 chin muscle activity (EMG) channel

ii. Signals to allow evaluation of respiration during sleep

1. Mouth and nose airflow
2. Nasal pressure
3. Chest and abdominal movement ( 2 channels)
4. Oxygen saturation
5. Snoring
6. Body position

iii. Signals to allow evaluation of limb movements)

1. 1-4 limb muscle activity (EMG)

iv. Other

1. Electrocardiogram ECG- the electrical activity of the heart- 1-2 channels

Thus a gold standard PSG is performed in a lab in the presence of a technician who attends the recording and is supposed to correct signal quality or disconnection.

Following the recording, the study is scored, manually, or manually with computerized assistance. The gold standard procedure is time consuming, expensive, the scoring is costly and complicated, the accuracy depends on the quality of the recording (which may be quite poor — remember that the recording includes about 19-20 channels), and also human factors related to the scoring person.

The results of this procedure, in spite of its high cost and work involved, are not representative of a regular sleep night. Indeed, the procedure is cumbersome and influences the sleep of the tested person. A regular sleep night involves the natural sleep environment, one’s own bed and the individual usual schedule. All these are absent in a sleep facility. A gold standard in-lab attended study should be reserved for those sleep disorders that are not detectable when using a partial home study. Other objective methods should be used to evaluate sleep and sleep quality in the usual sleep environment. Obstructive Sleep Apnea-Hypopnea can be diagnosed in either setting; insomnia is very inaccurately evaluated in the sleep facility. There are a few sleep disorders related to excessive sleepiness, neurological disorders, suspected nocturnal seizures, that mandate a test in a dedicated sleep facility.

In view of the high cost of the described procedure and due to the fact that many of the people who need sleep diagnostics suffer from sleep related breathing disorders, there is a continuous pressure to perform partial sleep studies, studies that include only respiratory signals or part of them, studies than can done in the home environment and also are scored easier and more cost effectively.
This new trend is making its way to be widely adopted, but important quality and reimbursement issues remain to be solved in the US. The policy differs in countries around the globe.

2. Partial sleep study

Partial Sleep Study includes a few channels dedicated to respiratory function only. It allows, in most cases, accurate and reliable diagnosis of sleep related breathing disorders. However, when a regular home or in lab partial study is performed, the information regarding sleep micro and macrostructure si lost, making the results less accurate than those of a complete sleep study. This downside of a partial study can be overruled by using sleep structure assessment based on electrocardiogram analysis.

3. Multiple Sleep Latency Test

Multiple Sleep Latency Test is a measure of daytime sleepiness. It is performed in a sleep lab, following a whole night PSG aimed to evaluate sleep and the possibility of a sleep disorder such as Obstructive Sleep Apnea. The next morning, the patient remains at the sleep lab connected to the polygraph to measure brain activity, eye movements and muscle tonus during 4 to 5 twenty minutes nap opportunities at 2 hours intervals. The time to falling asleep, if at all, during these nap opportunities and the sleep state achieved are measured and compared to normal values in order to evaluate the degree of daytime sleepiness.

4. Maintenance of Wakefulness Test

Maintenance of Wakefulness Test is also a measure of daytime sleepiness. Like the Multiple Sleep Latency Test, it is performed after a whole night gold standard PSG. There are 4 to 5 events at 2 hour difference intervals, when the patient is required to sit in an armchair quietly, without doing anything, in dim light and trying to remain awake. Again the time to falling asleep, if at all, during these events, and the sleep state achieved, are measured and compared to normal values in order to evaluate the degree of daytime sleepiness.

How can SleepRate help?

SleepRate has developed and validated a method to study sleep structure based on a single signal, a very robust and easily acquirable one, the Electocardiogram (ECG). One can use a simple instantaneous HR detector available on the market in order to assess sleep structure in the natural sleep environment, one’s own bed.

When there is no medical sleep disorder, SleepRate helps to improve sleep.

Many human functions present a cyclic behavior resulting from the existence of certain inner oscillators that coordinate different function. These inner cycle regulators are called biological clocks. One of the most obvious ones is in charge of the sleep-wake cycle. This clock resides in the Suprachiasmatic Nucleus (SCN) of the brain and its period is between 24 and 25 hours. Thus, without any other additional factors, humans would go to sleep progressively about an hour later each day and wake up an hour later. However, humans live their lives in a 24 hours or day-night recurring pattern called a circadian rhythm. The light arriving to the eyes signals the SCN to reset the sleep wake cycle to a 24 hours one. This influence is mediated by the small pineal gland, which produces a hormone called Melatonin. This hormone is produced in the dark and its secretion is inhibited by light. Melatonin is connected with the sleep-wake cycle. Exogenous Melatonin may be used as an aid to reset the inner clock when needed, for instance when traveling fast over time zones people suffer from jet lag and have to sync their inner clock to their target time.

Evening type-morning type: Owl vs Lark type

The biological clock dictates to our body and minds when to go to sleep and when to wake up. Normal people are adaptive enough to align their schedule with their inner clock. Most human beings have an inner clock whose period is longer than 24 hours, thus most have a tendency to go to sleep at late hours and wake up relatively late. That is why evening type or night owl type people are prevalent. The opposite works for larks: they are morning types, their clock preference is to go to sleep early and wake up early. These two tendencies are natural and they do not represent a problem as long as there is no interference with daily duties and they do not cause sleep deprivation.

Delayed Sleep Phase

The inner clock dictates sometimes a sleep-wake schedule that is different from the usual prevailing one. There are people who go to sleep at very late hours and wake up late. Their inner clock lacks the ability to sync with the prevailing timings. Their sleep is perfectly normal when they sleep according to their individual settings. However, if they try to go to sleep at a time that is very usual for others, they have great difficulty falling asleep. When they go to sleep very late, according to their own timing, they fall asleep easily, and they sleep late if they can afford it; if not, they make it for school or for their job, but they are not at their best; or they are late, and that’s bad as well. So, what is the solution? If they can live according to their inner clock nothing should be done. If not, there are a few ways to deal with the problem, but they are tough to implement and they require commitment, at least for a while.
A decision has to be taken and a commitment to stick to the way are prerequisites. Then, If the delay is not very large, not more than 3-4 hours, one may choose to advance gradually the wake up time and the bed time (by about half an hour a week) while keeping the wake up fixed for the entire week, no matter the fall asleep time, and avoiding napping; also, avoiding bright light in the evening and late hours and exposing to natural light in the morning. Sometimes an additional bright light source should be used in the morning. In addition, strict adherence to sleep hygiene rules is mandatory.
If the delay is greater, the following procedure may be used: a sequential delay in the bed time and wake up time by about 1-2 hours daily (basically moving the cycle backwards through a full day), until the target hours are achieved and then sticking to the new times. When this occurs, again, adherence to sleep hygiene rules is mandatory.

Advanced Sleep Phase

Some have an inner clock that makes them feel sleepy early, and when they give in to their natural tendency, they sleep fine and wake up early. This way they give up on socializing during the late part of the day, when most can afford this, and they are up early for their jobs and this way they are dedicated larks. They pay a price too in giving up spending the end of the day with friends or family. This is quite a price to pay. This tendency, called advanced sleep phase, occurs mainly in the old age, when the clock is advanced naturally, or in a rare inherited state of advanced sleep phase. In both situations one can deal with the problem. The solution is based on gradual delay of the bed time, using exposure to bright light in the evening. Chronotherapy that delays the bed time to the desired time gradually is a possible alternative. Melatonin can be added in the morning as an additional measure to delay the sleep time. In addition, strict adherence to sleep hygiene rules is mandatory except for the napping restriction, which can be alleviated to make staying awake at later hours possible.

Irregular sleep

Sometimes the internal clock does not work; it is broken. In this situation, which may occur very early in life or later, people have a completely chaotic sleep-wake schedule. This is a very rare condition, however, when it occurs, sleep experts and chrono-biologists have to be involved to find the best solution.

How to cope with shift work

The 24 hour a day society requires many to work shifting rounds or night shifts to keep the pace.
This kind of work requirements imposes a great load on every person who needs to work shifts. A great deal of research and trials on how to minimize damage and improve performance did not reach a good solution that can be universally implemented. However, if work shift is needed, then it should allow for regular sleep hours. People should keep regular night shifts or day shifts, if possible.
Sleep-wake schedule should be as regular as possible in order to let workers adapt their sleep-wake pattern to the job requirements. For instance, when working on night shifts, people have to keep performance and attention at a high level, whereas their inner clock is set for sleep. It is recommended to keep the same sleep time during days off. In this way the work and physiology may be kept aligned. It is recommended to have bright light at work during the night, and keep low light and wear dark sunglasses during the day, just to sync the inner clock with the needs. Also, the home sleep environment has to be very quiet during the day.
People who work shifts for long periods of time may be at risk of developing insomnia either while shift working, or later when they return to a usual daily work frame.

Jet lag

People living in a given geographic region have their biological clock synchronized with the local time. When traveling and moving fast across several time zones, the synchronization between the biological clock and the geographical one is lost. This occurs only while travelling either Eastbound or Westbound, and does not occur when travelling in the North or South direction, because such a passenger remains within his home time zone. The severity of the complaints depends upon the direction (Westbound causing less trouble than Eastbound) and the number of time zones crossed. Eastbound has a bigger effect since travelling in this direction one loses time, and this adds to the influence of the time difference between place of origin and destination. The opposite occurs when the destination is Westbound and one gains time relative to the home place. The severity of the symptoms is variable and includes insomnia, irritability, headache, malfunction of the digestive system, the need to urinate during the night, etc. In addition, conditions on the flight can cause increased exposure to infection , dehydration and more. Resetting of the clock to the destination time requires around a day per 1-2 time zones crossed. One can try to prevent jet lag by starting to adapt gradually to the target destination time a few days ahead of travel, or trying to adapt quickly upon arrival. The post-travel adaptation strategy is preferred by most and includes mainly exposure to outside bright light, which is a powerful resetting agent for the biological clock, and sticking to sleep hygiene rules. Some advocate usage of Melatonin or other sleeping aids for a few days, or until the jet lag complaints fade out.

Early wake up

When people wake up early it is either because their sleep needs have been fulfilled or because their actual sleep needs are reduced. When somebody wakes up early while really needing more time asleep and can’t get back to sleep, there is a problem. Sometime a mood problem can explain the difficulty. This problem needs attention, evaluation and appropriate management.

How can SleepRate help?

SleepRate is able to detect sleep schedule patterns and sleep structure. Based on these SleepRate can help assess whether there is a biological clock issue, and supports adherence to changes if needed.

Hygiene is defined as the practice of keeping yourself and the things around you clean, in order to prevent illness and disease.
During more than two decades already, sleep physicians use the term Sleep Hygiene to describe a bunch of measures patients with sleep problems can use to improve their sleep. These measures, when implemented, can also prevent sleep issues from interfering with daily life.

Check your sleep environment and make necessary changes so that:

  • Your bed is comfortable
  • The temperature is comfortable
  • Air quality is good
  • Noise level is acceptable
  • Shades: natural morning light should be a trigger to wake up. Thus, if you have a tendency to wake up late, leave shades open when you go to sleep
  • TV should be kept out of the bedroom

 

If you want to fall asleep easier, think about

  • How many caffeinated drinks, and other substances that keep you awake, you have taken and at what times during the day
  • Do you smoke, do you smoke before bedtime? Consider avoiding this, since nicotine has an arousing effect
  • When and at what intensity do you exercise/jog/run. Good exercise improves sleep and increases the amount of deep sleep, and this facilitates physical recovery. However, high intensity exercise close to bed time may delay your falling asleep.
  • Consider some relaxation strategies before sleep. Learn how to unwind at the end of the day
  • Do not use alcohol to ease your falling asleep. Indeed you may shorten the time it takes you to enter sleep, however your sleep quality may be jeopardized and your sleep will be less efficient and more fragmented
  • What about meals? Do not go to sleep when hungry or after a heavy meal
  • Go to bed only when you are ready to sleep
  • Do not nap during the day

 

If you wake up very early in the morning, when you can afford to sleep more, but you can’t continue sleeping:

  • Find out if something in the environment causes this: noise, light, temperature, children, pets. If so, try to change and see how it works
  • Is your mood low lately? Consider talking about this with your physician

 

If you have problems falling asleep at regular hours and have no problems when you go to sleep very late; your sleep seems fine and you have to wake up for the days duties, and that might be difficult; please understand that your behavior makes you sleep deprived, always late or lacking patience, nervous, irritable . So

  • Decide when you need to get up in the morning in order to deal with your school/work
  • Wake up regularly at that time, with not more than 30 min delay on free days
  • Determine the amount of time you need to sleep, at least 7 hours, and that will indicate the time you should get to bed and sleep.
  • Allow yourself enough sleep time
  • Do not nap during the day
  • Use natural morning light to synchronize your internal clock

How can SleepRate Help?

SleepRate technology enables the assessment of sleep structure and patterns, in the context of the bedroom environment
SleepRate helps changing habits and sleep environment to allow better sleep.

Sleep is vital: without both an adequate time asleep and a good quality sleep, human health, performance and well being are negatively affected.

The adequate sleep time changes with age and is individually predetermined. Humans can overcome their sleep needs if they are motivated enough to do so. This motivation originates in work demands that require long commuting times, sometimes shift work, increasing performance demands. This motivation is served well by the artificial light which makes possible twenty four hours of activity a day. In addition, the media and internet add grounds to extend the wakefulness into the late night time, when people have a natural drive to sleep. Thus in the seventies of the previous century, people spent 2 hours less asleep on average than before the invention of the electric bulb by Edison.

Research shows that life expectancy decreases when human sleep less than their physiological needs. Less sleep causes increased stress and irritability, decreased cognitive performance, memory issues and low mood. Heart diseases may be connected to sleep loss. There is increasing evidence that type II diabetes, overweight, and obesity are connected to the ever growing sleep debt in the Western World. When people are awake during extended time intervals they were supposed to sleep, they eat out of their normal eating times, the caloric intake is increased without even noticing it, and the metabolic balance is disturbed. Also, sleep deprivation causes sleepiness, which in turn triggers a reduction in physical activity that is added to the inactivity connected to the extended time spent near different types of keyboards and remote control devices!
As time spent asleep is reduced, sleepiness gains terrain and the number of inattention spells increases. Many traffic accidents, and as many as 25% of the serious accidents, can be traced back to lack of adequate sleep. Research indicates clearly that sleep loss is as bad for drivers as alcohol intoxication .

How can SleepRate help?

SleepRate allows assessment of sleep time and structure over extended time periods.
If poor sleep structure and duration are detected, SleepRate emphasizes the failure and helps to correct it.

How Much Sleep Do You Need?

There is no standard for the amount of sleep an individual requires. Each person is unique. In simple terms, you need enough sleep to avoid drowsiness and to perform at peak efficiency during the day. That need changes with age, so what works best in one stage of your life may not be appropriate for another. At the extremes of a distribution across large populations are normal people who need as little as 4 hours or as much as 12 hours.

A majority of people do very well with 7 ½ to 8 hours of sleep. But use those numbers as a starting point until you determine if that range is appropriate for you. Although you can ignore your body’s need for a certain amount of rest through motivation and sheer force of will, doing so isn’t conducive to good health or a vibrant existence.

Our “always on” culture has permeated traditional barriers between work time, family time, playtime and rest. Sometimes we’re trying to do two or three things at once; or we’re struggling to meet an unnatural (and occasionally unrealistic) expansion of obligations. The result is that more of us are carrying sleep debts or adding to them faster than ever before. Sleeping late on the weekends may seem to help, but in fact it’s only paying interest on the debt, so to speak.

Sleep deprivation can have serious consequences for mental and physical health.

You cannot perceive, in precise terms, how much sleep you actually need. The only way of evaluating that in a scientific manner is to sleep for several nights without wakeup or other constraints. After the sleep debt is replenished, your natural need for sleep will take over and yield an accurate duration.

If you suspect you’re not getting enough sleep, you may need to investigate further by using the SleepRate solution (see below) or by a visiting your physician for professional evaluation.

How Will SleepRate Help You?

SleepRate measures and reports the quantity and quality of sleep you receive. If you feel you aren’t getting enough restorative sleep, SleepRate will make personalized recommendations to help you sleep better. If SleepRate suspects that a medical condition is impacting your sleep, it will recommend a visit to a physician.

When we look at human beings from a certain perspective, it appears that there are two different normal states of being: sleep and wakefulness. Looking closer into these two different states, it becomes clear that sleep is not a homogeneous entity, but it consists of two very different phases: REM sleep and NonREM sleep, and these are as different as sleep is from wakefulness.
Adult human beings spend about two thirds of their day awake. This state is characterized by different degrees of physical activity or even quiet rest, with muscles being active, mostly in upright position, with brain active and thinking analytically in a very well structured and understandable way, and memory functioning normally. Heart rate and respiration vary according to instantaneous needs, eyes move rapidly to allow visual information coming from the environment. NonREM sleep is very different, as we are quiet and recumbent, muscles at resting, but with moving capability spared. Brain activity is at lowest, thought content is structured and analytical as during wakefulness. Sensory-motor disengagement from the environment is dependent on the sleep depth. There are varying awakening thresholds. Heart rate and respiration are regular and temperature control is similar to that at wake level. Eye movements are absent. By contrast, during REM sleep the body is usually quiet and recumbent, muscle activity is inhibited and normally voluntary muscles are actively kept from contracting, brain is as active and sometimes more so than during wakefulness, but the active centers are different. The thoughts are bizarre and hyper associative, while memory is impaired. Heart rate and respiration are irregular, body temperature is not well controlled, eye movements are present and rapid, resembling wake time. Human beings are dreaming.
Within that one third of our the time we spend sleeping, one quarter to one third is spent in REM sleep, about two thirds in NonREM sleep, and around 5%-10% awake. To complicate things a bit more, NonREM sleep is subdivided into deep sleep and light sleep, with deep sleep taking about one third of the total NonREM time. It seems that we have some law of the “one third” working here: one third of the time sleeping, one third of the sleeping time dreaming , and one third of the non-dreaming time spent in deep sleep. All these thirds try to find a balance and kind of play a game: when one is ready to sleep, one has some winding down routines, one finds the right position and gradually disconnects from the environment, and finally one enters the kingdom of sleep. All these steps take around ten minutes, and then there is a quick slide into a first period of deep sleep via a short light-sleep phase. When time arrives, there is a resurfacing to almost wakefulness sometime and a very short episode of dreaming. All this takes about 90-110 minutes and the process restarts with a second cycle, followed by a third one, until a final wake up occurs after about 5-6 cycles normally. The structure of the described sleep cycles changes across the night, with the amount of NonREM sleep prevailing during the first two thirds of the night and REM sleep towards morning time. Deep sleep is the prevailing type of NonREM during the first two cycles and light sleep takes over thereafter.

How can SleepRate help?

SleepRate can detect sleep structure based on the changes in Heart Rate across sleep stages.
SleepRate facilitates the understanding of individual sleep patterns and provides advise when needed to help improve sleep.

What is Sleep?

Sleep is both universal and fascinating. Although we spend a third of our lives sleeping, scientists don’t fully understand its nature and purpose. The most precise definition available at this time is descriptive: It’s a natural behavioral state (another is wakefulness) governed by the nervous system that is characterized by perceptual disengagement and motor inactivity. The state is cyclical and reversible without intervention. Unlike a coma – a total lack of consciousness – sleep is actually a semi-conscious state. This means that a minimal level of environmental awareness allows an individual to react to certain triggers. For example, a sleeping mother will hear her crying baby; people wake up when hearing their name called; or danger such as a fire or an attack is present or imminent.

We know that sleep has a restorative function and a major impact on physical health, cognitive performance and mood stability. It seems to be as important as air, food and water for sustaining life. Resting while awake is not a substitute for sleep.

Sleep is a dynamic process with an active brain that changes its state many times each night during different stages of sleep and through sleep cycles.

Most animalssleep, but timing and duration vary tremendously across species. We’re not sure why.

Why Do We Need to Sleep?

Here’s the most simplistic answer: We need to sleep to avoid feeling sleepy.

Researchers have illustrated this need with a simple experiment that shows the impact of sleep debt. When healthy people are forced to stay awake continuously for one or two days, their waking state is eventually interrupted by short episodes of involuntary sleep. Test subjects are incapable of avoiding them. Moreover, other adverse consequences can be observed at the same time:

  • declining cognitive performance
  • disrupted biological rhythms
  • undesirable metabolic changes (e.g., hormone levels)

Scientists have observed, over longer periods of time, that a chronic lack of sleep:

  • may cause weight gain
  • adversely impacts learning and memory
  • reduces immunity
  • shortens lifespans

Sleep deprivation is a major public health concern in many countries. One example everyone knows about: accidents caused by sleepy drivers.

On the other hand, quality sleep replenishes the body and mind in several ways. For example, sleep plays a crucial role in children’s growth and development. That’s one reason why young ones need more sleep than adults. Memory consolidation occurs during sleep. Body reserves and energy levels are restored while sleeping.

Interestingly, too much sleep is just as bad as too little sleep.

How much sleep someone needs is difficult to answer precisely, though statistically a majority of people need 7 ½ to 8 hours.

How Will SleepRate Help You?

SleepRate measures and reports the quantity and quality of sleep you receive. If you feel you aren’t getting enough restorative sleep, SleepRate will make personalized recommendations to help you sleep better. If SleepRate suspects that a medical condition is impacting your sleep, it will recommend a visit to a physician.

Find out more about SleepRate. Or, if you’re ready to purchase a SleepRate package, start here.

SleepRate Home Page

The Sleep Deprivation Epidemic

Human beings spend about a third of their lives sleeping and around 8 years dreaming. This third of human existence is hidden and its huge influence on the other 2 thirds is greatly overlooked. Although sleep function and meaning are not entirely understood, there is increasing evidence that this part of human existence is essential and that it is regulated by the nervous system.

Sleep disorders, sleep deprivation, as well as excess sleep, are associated with poor performance, cognitive dysfunction and secondary ill effects on almost every human life aspect, including health, mood, cognitive and physical performance, as well as social coping. Thus poor or insufficient sleep is related with increased cardiovascular morbidity*, neuropsychological deficits* and increased mortality*. The ability to evaluate sleep and diagnose sleep disorders in a simple, scalable, and cost effective way, without sacrificing clinically relevant information regarding sleep efficiency and sleep structure, means being able to reach a larger proportion of those who have unrecognized sleep problems. The spectrum of sleep disorders is wide and includes: (1) widespread abnormalities that are not labeled as diseases, such as Insomnia of many kinds (affecting up to 40% of the population, with a great majority not getting suitable solutions to their burning problem); (2) disorders related to the fact that vital functions, such as breathing, for example, become vulnerable during sleep, which facilitates the onset of Sleep Related Breathing Disorders (estimated to affect 4-9% of the population, yet only 25% of those get diagnosed); (3) intrinsic sleep disorders, such Narcolepsy or (4) secondary sleep disorders resulting from other diseases, such as medical disorders that cause pain, or neurological disorders that cause sleep disruption like Parkinson’s, or mood disorder that lead to Insomnia or to extended sleep, and (5) many others.

Sleep Measurement is painful

A multitude of physiological parameters can be measured during sleep and wakefulness, and some of them are used to allow standard description of different sleep-wake states. Thus, the gold standard sleep disorders diagnostic method is an overnight polysomnography, which requires recordings of electroencephalogram (electrical activity of the brain), electromyogram (electrical activity of muscles), electrooculogram (eye movements), respiratory effort and mouth-nose airflow, as well as electrocardiogram (electrical activity of the heart), oxygen saturation of the blood, limb movements and additional variables, in an attended setting. This procedure is uncomfortable, requires a skilled person to get the patient wired, and the resulting information needs to be recorded,scored, and reviewed by trained personnel. The cost becomes high, the procedure is limited to a single and usually non-representative night.

Even home sleep studies are quite cumbersome and costly, and since they are limited to a single night recording, their results do not reflect the natural sleep pattern of a person. Such studies are increasingly used to diagnose sleep related breathing disorders; however, they do not allow to assess sleep time and needs, sleep quality over time, frequency of difficulties falling asleep or of night-time waking, sleep wake rhythms and cycles. Most people who suffer because of poor sleep, either being aware of it or not, are so used to it that they are not able to understand why they feel lousy during the day. These people do not get the chance to understand what their sleep problems might be.

There is therefore a great need for patient friendly, accurate, cost effective testing. This will allow sleep assessment for multiple nights, reaching a better understanding of sleep schedule and patterns across time periods, evaluation of the inner sleep structure, detection of abnormalities and disorders, all those in order to be able to alleviate problems by recommending a suitable management for the detected problems.

The solution: get to know sleep by heart

The physiological interconnections between the central nervous system and the autonomic nervous system, specifically autonomic cardiovascular control (at the sinus node level – the natural built- in cardiac pacemaker) allow the uncovering of information concerning sleep structure based on noninvasive analysis of the heart rate variability, as detected from the electrocardiogram. Moreover, morphological changes in the cardiac electrical complex occur during respiratory cycles and body position changes. The subtle changes in the electrical signal can now be quantified to allow obtaining a sound respiratory signal and body position data. Power spectral analysis of instantaneous heart rate fluctuations reveals three components: high frequency, low frequency and very low frequency, which are correlates of autonomic nervous system function. Novel techniques of time frequency decomposition of these fluctuations allow quantitative evaluation of transient physiological phenomena as they occur during sleep or wakefulness*. These components display differential profiles in the different sleep stages, allowing for classification of sleep stages from the electrocardiogram. Based on these simple and well known facts, we are employing a sophisticated algorithm, the HC1000P from Hypnocore Ltd., which permits conducting a sleep study based on a single ECG channel. Data recorded from this channel can be automatically scored to obtain information on sleep architecture and efficiency, arousals, autonomic nervous function and respiratory function during sleep. The addition of noninvasive monitoring of oxygen blood saturation made possible to diagnose very accurately and reliably Obstructive Sleep Apnea. Thus the HC1000P provides a powerful new tool for evaluation of sleep in general, and sleep apnea diagnosis in particular. The performance of this new software has been clinically validated, resulting in both FDA and CE clearance. The software is ready for practical use.

How can SleepRate help

Sleep Rate has a solution. The shortcomings of how sleep and sleep disturbance can be measured these days lead SleepRate to offer a new sleep evaluation method that is easy to use repeatedly by any person who feels either unsatisfied with her/his own sleep, is sleepy during the day, or has any other reason to check her/his own sleep. This method is based on the adaptation of Hypnocroe’s powerful HC1000P, to allow sleep assessment based on Heart Rate only.

Now one can use a Smartphone in combination with any device that can capture instantaneous heart rate and our cloud based “MySleepRate” to get a detailed sleep checkup with summary and personal recommendations. This newly available solution results from our vision to make sleep evaluation easy and affordable enough to allow initial evaluation over a few nights, follow up recommendations, implementation and results, with the added flexibility of fine tune-up and re-evaluation at any moment one feels it is required. Thus SleepRate can help sleep better!

Restless leg syndrome is a sleep disorder in which there is an urge or need to move the legs to stop unpleasant tinglings, creeping, crawling sensations in the lower legs, usually between the knee and the ankle which is relieved when legs are moved. These sensation can last for more than an hour and can cause insomnia.

 

Total Sleep Time (TST)

Total Sleep Time (TST) represents the entire time spent sleeping and is the sum of the Deep Sleep Duration, Light Sleep Duration and REM Sleep Duration. TST and relative durations of DS, LS and REM are age dependent.

TST is an extremely important factor that influences wellbeing, physical and cognitive performance and daytime sleepiness. Many of us feel sleepy during the day just because of insufficient sleep. Sleep debt represents an ever growing epidemic in the Western, modern society.

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