A sleep specialist or sleep medicine therapist is a medical doctor who deals with sleep disorders and any condition related to sleep. It is considered a subspecialty within multiple other medical specialties such as neurology, pulmonology, internal medicine, and of course psychiatry.
Why sleep is important
Sleep is as essential as eating and sleeping. Our brains need sleep every night and won’t be able to function without it.
First of all, sleep is essential for learning and performing complex tasks. In order to retain memories and information your brain needs to “consolidate” them. It does this during sleep. So when you miss out on sleep you’re limiting your abilities to learn new information and skills. In multiple studies those who got enough sleep always did better on tests compared to those who didn’t. When it comes to medical interns, those on a “traditional schedule” committed 36% more serious medical mistakes compared to interns who got adequate sleep. Studies have also shown that sleeping less than 6 hours makes you function like you’re intoxicated with alcohol. Probably not a great idea for driving.
It’s not all about the brain as sleeping affects our bodies and our metabolism as well. Those who don’t get enough sleep tend to be more obese than those who do. Sleep is proven to be one of the strongest risk factors for obesity. The weight gain is caused by an alternation of hormones which are a result of a lack of sleep. Another factor is appetite. People who are sleep deprived have greater appetites and eat more calories compare to those who have healthy sleeping patterns. A decrease of the hormone “leptin” causes an increased appetite as this hormone serves to suppress our appetites.
If you’re an athlete so being in shape is something you constantly work on and don’t need to worry about gaining weight then you might worry about performance. A study conducted on basketball players shows that when basketball players get enough sleep their overall performance is improved including speed, accuracy, mental wellbeing, and reaction time. If you’re not such a hardcore athlete and just someone who likes to stay fit don’t think a lack of sleep will spare you any side effects. Another study that included about 3,000 women showed that a lack of sleep is associated with slower reflexes, movements, and difficulty performing certain activities. So whether you’re a high school student looking to get into a top college through studying or through a sporting scholarship it’s important to understand that you shouldn’t work on yourself by sacrificing sleep. Don’t get excess sleep, but by getting enough sleep you’re going to do better in all aspects of your life.
Sleep is important for your cardiovascular health as well. Cardiovascular diseases such as hypertension and arrhythmias are linked with chronic poor sleeping habits. Sleeping less than 7 or 8 hours per night will add to your risk of getting these diseases which can be life threatening. Not to mention that a lack of sleep increases your risk of obesity that will also play a role in increasing your risk for heart disease.
It’s not just hypertension you should be worried about, but type 2 diabetes too. A group of young men were restricted to only sleep 4 hours a night for 6 nights in a row. The result of this was that they developed diabetes symptoms such as increased frequency of urination and increased appetite and water intake. After allowing them to get enough sleep for one week these symptoms resolved completely. Other studies showed a relationship between sleeping less than 6 hours per night and those with type 2 diabetes. There’s a strong relationship between obesity, diabetes, and heart disease so getting enough sleep could protect you from these or at least prevent them from getting worse.
Moving on to psychiatry and moods there’s a very clear and established link between sleep and depression. 90% of patients with depression suffer from sleep disorders. Not getting enough sleep could also result in depression so it works both ways. Both things can lead to each other and if they both occur then it becomes a vicious circle and the patient keeps spiraling until one or both of them are treated. Not getting enough sleep can also get in the way of your hobbies as you’ll be too exhausted to do anything.
You know what sick people are instructed to do in order to get better? Rest. Sleeping is vital for a healthy immune system. If you don’t get enough sleep your immune system gets weaker which puts you at a risk of acquiring infections and if the problem is persistent you might even develop cancer as the immune system protects us from cancers as well. When you get a cold you might get better after staying in bed for two or three days, but I assure you that if you go to work and keep running around all day your cold will last much longer.
Paradoxically sleep increases inflammation, but don’t mistake inflammation for a healthy immune system. Diseases such as Crohn’s disease and Systemic Lupus are autoimmune inflammatory diseases and can be disastrous for our bodies. Patients with Crohn’s who suffer from sleep deprivation were twice as likely to relapse and be in worse condition than those who get enough sleep.
Finally, sleep will affect your interactions with the world around you. If you’re tired you might miss cues in the facial expressions of the people you’re talking to which would normally let you know how they’re feeling. You might end up losing loved ones because of this as they feel like they can’t communicate with you or that you don’t care enough to put in any effort when you’re actually just tired.
Sleep is important regardless of what it is you’re trying to do. If you want to be a great athlete, a brilliant scientist, or simply go on with your day to day life then you need to make sure you get adequate sleep every night.
Why sleep medicine therapists are important
According to the National Institute of Health, over 40 million Americans suffer from sleep disorders. The frightening thing is that most of them go undiagnosed. Imagine 40 million people in America are at risk for all of the things we mentioned above and their overall quality of life is affected. Sleep specialists exist to diagnose and correctly manage sleep disorders. They often work in sleep centers or sleep clinics. These clinics allow them to conduct sleep studies where they can observe a patient as he or she sleeps and record their brain waves allowing them to identify the problem so they can treat it later on.
Sleep types and patterns
In 1929 the EEG was invented. It stands for electroencephalogram. Its more well-known sibling the EKG (electrocardiogram) is used to record heart waves and it’s more popular because heart diseases are more common. EEGs work the same way but instead of recording heart waves they record brain waves. Electrodes are applied to a person’s skull and their brain waves are recorded as they sleep.
Sleep is divided into two main types: REM and non-REM. REM stands for rapid eye movement. Once you fall asleep you first enter NREM. NREM is divided into stages 1, 2, and 3. So when you fall asleep you fall into NREM stage 1. This lasts for a few minutes before you start transitioning into stage 2 of NREM and then you move to stage 3 NREM. As you progress through the stages you sleep deeper and it becomes more difficult to wake you up. You can’t go from stage 3 to REM sleep directly. First you have to go back to stage 2 then you can move to REM sleep. Stage 2 is like a stopping station that allows switching from NREM to REM. In total, REM is about 25% of your sleep and NREM is about 75% of it.
During REM sleep your body becomes paralyzed and you can’t move it at all. This is the stage where you dream and it’s a good thing you can’t move or else you’d be acting out your dreams. During NREM your body is capable of moving, but your brain is basically off or working in the background. A fun way to apply this would be based on how you wake up. If you wake up from a dream or wake up remembering a dream then you probably woke up from a period of REM sleep. If you woke up remembering nothing then you were in a NREM period of sleep. It should be noted that everyone dreams because everyone experiences REM sleep regardless of whether or not they remember those dreams.
History of sleep medicine
Apart from all the science, sleep was always incorporated in people’s lives as a finding. For instance people have known for the longest time that alcohol is associated with sleep even if it’s “bad” sleep. Barbiturates were first manufactured in 1902 and were found to induce sleep. As people took them to help them go to bed, some became addicted and some overdosed and died. So taking excess sleeping pills as a way to kill oneself has been around for quite some time.
The French were the first to explore sleep scientifically and from a medical perspective. This was in 1913 when a French scientist called Henri Pieron wrote a book called “Le problem physiologique du sommeil.” Then came Dr. Nathaniel Kleitman who is regarded as the father of American sleep research. In 1920 Dr. Kleitman questioned the regulation of sleep and the circadian rhythm. It was also he, and one of his students, who discovered the existence of REM in 1953.
It wasn’t until 1958 that a relationship was established between dreaming and REM sleep. This was achieved by one of Dr. Kleitman’s students: Dr. William C. Dement. He discovered this relationship by studying other animals and wrote a paper on it that brought together things found in other sciences such as biochemistry, physiology, and pharmacology. Eventually Michel Jouvet was able to build on this and realize that REM is associated with increased alertness which as we mentioned before is because the brain is actually very active during REM. Michel Jouvet called this phenomenon “paradoxical sleep” because until then people assumed sleep was when the brain shut itself off and rested.
The study of sleep hasn’t stopped since then and there have been many new discoveries since then in the field of sleep just like with the field of psychiatry. These are two fields of medicine where we didn’t know much before, but recently we’ve been making plenty of breakthroughs. It’s always harder to study something you can’t hold with your hands and sleep definitely falls under that category.
Sleep disorders
You would have every right to close this article if I started sleep disorders with anything other than insomnia. So many of us suffer from insomnia or have suffered from it during a period of our lives. Insomnia has been around as long as humans have existed. We just mentioned how barbiturates helped people fall asleep in the early 1900s and were prescribed by doctors. There’s more than just one kind of insomnia. The kind everyone is familiar with is that associated with a difficulty falling asleep. A lot of us stay in bed counting the hours unable to just close our eyes and sleep. There’s another kind where the problem lies in the maintenance. Some have no or a little problem falling asleep, but they wake up frequently throughout the night. Interrupted sleep is just as bad as very little sleep because they’re actually the same thing. If you wake up 6 times a night and your sleep cycles keep getting interrupted then your brain isn’t getting what it needs.
Insomnia could be without an underlying cause and it could be a symptom of another disease. Depression is one common disease that is associated with insomnia, anxiety is another. It’s important to find out if there’s a cause for someone’s insomnia because it’s always better and more definitive to treat the cause than to treat the insomnia symptomatically. There are lots of sleeping pills out there that can treat insomnia ranging from mild hypnotics to very potent drugs. It’s always best to consult a doctor before taking any steps. There’s also a method of management called CBT or cognitive behavior therapy which consists of certain techniques in order to get a person to get more sleep. These are just as efficient as drugs and their effects last longer as you can apply these techniques your entire life. There are also no side effects to CBT.
When diagnosing insomnia it’s important to rule out sleep apnea. This is a condition where the person stops breathing while they’re asleep so their brain forces them to wake up so that they can resume breathing or else they’ll die. There are two kinds of sleep apnea. One is associated with obesity where the airway passages are obstructed because the patient is obese and the other is central where the problem is in the respiratory center in the brain. Treating sleep apnea will cure the insomnia that comes with it.
The opposite of insomnia is hypersomnia. If insomnia means a lack of sleep then hypersomnia must mean sleeping in excess. You don’t want to get too little sleep and at the same time you don’t want to get too much. There are a few causes of hypersomnia. Depression is one of them. Depression can cause somnolence (increased sleepiness) as well as insomnia. Other diseases include African Sleeping Sickness which we can get from mosquito bites (mostly in Africa) and Narcolepsy. Narcolepsy is characterized by sudden deep sleep. A person could be alert one moment and sleeping the next. Scientists have discovered that people with narcolepsy can enter REM sleep at any time.
Another sleep disorder is sleepwalking. People who sleep walk are aware of their environment and surroundings but they’re completely indifferent to them. They have no facial expressions and don’t express any kind of emotions.
There are so many sleep disorders like restless legs, night terrors, and excessive nightmares. More light is being shed on these disorders in recent years as we are starting to know more about sleep and understand it better. It’s truly fascinating to learn about how the mind works and the way it processes information.
Diagnostic tools
In order to diagnose the underlying cause of your problems you might be asked to perform a sleep study. This is where you spend a night at a sleep center and sleep there with electrodes applied to your head so that the staff can read your brainwaves throughout the night and notice any abnormalities. They’ll also be able to monitor your breathing which would be affected in cases of sleep apnea.
Screening for other psychiatric conditions such as depression and anxiety is part of the process as well. So is looking for signs of organic disease which can cause insomnia like hyperthyroidism for example. If there’s excessive sleepiness doctors might suspect African Sleeping Sickness and test for it. Doctors might also suspect that a patient is under the influence of a drug or suffering from withdrawal.
How to become a sleep specialist
You could become a doctor with a subspecialty in sleep or you could be a sleep therapist. To be a doctor you’ll need to get a residency in psychiatry and after that specialize in sleep medicine. Doctors who specialize in sleep are qualified to diagnose the underlying problem affecting your sleep and prescribing drugs if they see that they’re necessary. Sleep therapists will talk you through the whole deal. Often the result of your problems could be psychological because of unprocessed emotional trauma. Through therapy sessions you’ll be able to express how you feel and talk through your emotions which will definitely help. They’ll also help you with sleeping exercises and CBT like we’ve discussed before.
The future of sleep medicine
Sleep medicine is a relatively new science. The first sleep center was established in 1970 which was about 50 years ago. That’s extremely new in the world of medicine. We’ve already come so far in these few years and there’s no doubt that more discoveries about sleep will be made over the next few decades that might revolutionize how we see sleep even further.
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