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Page 3 of 12 ANALYZING THE PROBLEMHow can you help ensure their accurate diagnosis and effective treatment? Tips for analyzing the problem. --Use simple detective work--and, whenever possible, by asking others to observe carefully what happens to you while you sleep: particularly just before and during any abnormal events that you experience. ANALYZE YOUR PROBLEM IN EACH OF THE FOLLOWING ASPECTS: 1. During what stage of sleep do your problems seem to occur? Certain disorders occur specifically in rapid eye movement (REM) sleep, while others are particularly likely to happen in non-REM sleep. How might you be able to tell the difference? • Normal people spend the first 11/2 hours of sleep in progressively deeper stages of non-REM sleep (stage 1 or drowsiness, then stage 2, and then the deepest, soundest stages 3 and 4 which are called ‘slow wave sleep’). Most of our slow wave sleep occurs during the first few hours of sleep. • Next, after about 90 minutes of sleep, the first (and usually briefest) episode of REM sleep occurs, followed by more non-REM sleep, and then, another and longer period of REM sleep, and so on. Since REM episodes tend to lengthen as we continue to sleep, most of our REM sleep occurs during the last few hours of sleep. • In REM sleep, breathing patterns become irregular, rapid eye movements make eyelids flicker, and we experience our most vivid dreaming. Although we probably have dreams in other stages of sleep, they usually are hazier and more difficult to recall. Whether we recall dreaming depends on how quickly we awaken after REM sleep has occurred. Also, some people just don’t remember dreams well. Also, people will normally develop a limp paralysis during REM sleep to prevent them from being able to act out their dreams--but little body twitches and ‘shudders’ still occur. If you’ve watched a dog dreaming, it is easy to relate to these.
Ask yourself (and those who’ve observed your sleep) the following questions: * When do the problems tend to occur? First few hours of sleep (favors slow wave sleep)
Last few hours of sleep (favors REM sleep)
Any time throughout my sleep (favors non-REM stage 2 sleep)
* Are the following noted at the times the problems occur? (all of these favor REM sleep) Irregular shallow breathing Recall vivid dreaming Eyelids flickering Observers feel certain that I was dreaming Wake up unable to move (sleep paralysis)
2. Exactly what do your abnormal sleep behaviors or events involve? Precise observations are a tremendous help in arriving at a correct diagnosis. Ask yourself and any observers the following questions. Then, write down anything that might help clarify your problem, if its cause is still unknown:
- Can I often tell before going to bed that I’ll have a bad night with these problems? (If so, how?)
- Can others often tell when I’m on the brink of having them? (If so, what is it that “tips them off”?)
- Are the abnormal events or behaviors basically the same each time that they occur?
- Are any of the following usually true at the times that they happen? ___ I’m lying on my back. ___ I’m snoring. ___ I’m having trouble breathing. (All these suggest that sleep apnea or other breathing problems could be causing the abnormal event
* Do you ever wake up during or at the end of the episodes? If so: - Am I confused?
- Do I recall dreaming or any other symptoms?
- Am I difficult to wake up at these times?
3. What might have caused the onset of your problems? Try to recall any changes in your life and health that occurred around the time that your problems first occurred.
Ask yourself and others whether any of the following occurred just prior to the time that you first experienced your problems:
- Change in medications, whether prescribed or over the counter (began or stopped taking, or changed dosage).
- Change in my health status (illness, injury, hospitalization).
- Change in my job (different shift, hours/ overtime, new stresses).
- Changes in home and family life (stresses, change in residence, illness of family members).
- Changes in diet, alcohol consumption/ other recreational drugs, or in my weight.
4. What might be aggravating your problem or making it happen more frequently? Ask both yourself and others this simple question: “If I wanted to increase my odds of having a really bad night with more frequent or severe problems of this sort, what could I do?” The answer may help diagnose your difficulty -and simultaneously help identify aggravating factors that you could avoid in order to make your problem much easier to treat.
Do any of the following seem to correlate with your having more frequent or severe problems? | Stress or worry. | Alcohol. | | Sleep deprivation or being overtired. | Nasal congestion. | | Sleeping elsewhere than in my own bed. | Less or more physically active. | | Going to bed earlier or later than usual. | Season of the year; room temperature. | | Getting up earlier or later than usual. | Eating late, or eating certain foods |
Now, apply these questions as they relate to any of the following problems that you have been experiencing.
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