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Various Causes Of Sleeping Disorder

May 30, 2008
This isn't going to surprise any midlife man (which, coincidentally, just happens to be the name of that great book penned by me, and which makes such a great Christmas, Easter, Passover, Purim, Ramadan, Chinese New Year, and birthday gift), or his partner, but sleep in middle age ain't what it used to be.

Now we've known for many years that sleep deteriorates with age: you sleep fewer hours, you sleep less deeply, you have more trouble falling asleep, you wake more easily, you're more tired during the day, you have less REM (rapid eye movement) sleep, and so on. What is surprising, though, according to a study in the Journal of the American Medical Association, is that some of these changes occur much earlier than we previously thought, and that they are also linked to some other surprising metabolic alterations.

Specifically, this study found that, as expected in men (the study didn't examine women), time spent asleep falls steadily from midlife on (at the rate of about 27 minutes a decade), and REM sleep falls significantly after age 50. This is also accompanied by a corresponding rise in cortisol levels (a hormone associated with stress).

What is more surprising, I think, is that there is also a steep, steady fall in "deep" sleep starting early in young adulthood, and that this decline coincides with a fall in growth hormone levels. Why would that matter, given that by middle age, none of us are growing any more?

Well, that depends on how you define growing, because nearly all men do grow in midlife, although not vertically. That is, decreased growth hormone levels are associated with lowered muscle mass and increases in fat tissue, especially around the middle, which is why so many midlife men's bellies look like the Skydome from the side.

Now, although we still don't know which is the cart and which the horse (that is, does the drop in deep sleep lead to a fall in growth hormone, or does the fall in growth hormone lead to less deep sleep), this finding nevertheless leads to the prospect that treating midlife men with growth hormone might not only help them sleep better, it might also help them look better, feel better, and be better proportioned. In fact, studies to determine how this all works are already underway.

To me, though, the more intriguing prospect is that if we could somehow train ourselves to sleep more deeply, then perhaps we midlife guys could also correspondingly increase our growth hormone levels, that is, you could get slimmer just by sleeping more, and, you know, that's one lifestyle change that would be an easy sell to most guys I know.

Restless legs syndrome (RLS) can occur in 2 forms: idiopathic (no cause is known), and secondary (associated with other medical conditions such as kidney failure or anemia). The idiopathic form affects between 1% and 5% of the general population.

Men and women are equally affected, and it is more common in seniors. Also, during the last few months of pregnancy up to 15% of women develop RLS; in most cases, the symptoms disappear after delivery. Complete our questionnaire to see if you suffer from RLS.

The main feature of RLS is the presence of troublesome, but usually not painful, sensations in the legs that produce an irresistible urge to move. It is often difficult to describe these sensations, but terms such as creeping, burning, itching, pulling, or tugging are frequently used. Sometimes sufferers experience sharp "pins and needles" or numb feelings as well.

The symptoms occur or worsen only when the patient is at rest, typically ease with voluntary movement of the affected extremity, yet frequently return again upon resting. Finally, symptoms of RLS are worse in the evening and at night, especially when the sufferer lies down. Restlessness, fidgeting or nervousness manifests as movements of the toes, feet, or legs when the individual is sitting or lying down in the evening.

People with RLS have difficulty in both getting to sleep and staying asleep. Problems in getting to sleep are due to the discomfort and need to move the affected limb, which delays the onset of sleep. Problems with staying asleep are related to periodic limb movements (PLMs) that occur during sleep.

PLMs are jerks that typically occur 20 to 30 seconds apart, on and off throughout the night, which cause sleep disruption and often disturb the bed partner. The affected individual is usually unaware of their own movements or of the accompanying partial arousals or brief awakenings which disrupt sleep. Although most people with restless legs syndrome have PLMs, most people with these nighttime limb movements, especially the elderly, do not have any other features of restless legs syndrome.

Because of difficulty sleeping, people with RLS may be abnormally tired or even sleepy during waking hours. Chronic sleep deprivation and its effects on alertness, mood and mental efficiency can affect work, relationships and recreational activities.

Simple life-style changes can lessen the symptoms of RLS. As caffeine can worsen symptoms, the intake of coffee, tea, and soft drinks containing caffeine should be reduced or eliminated. Also, since the consumption of alcohol and the use of tobacco products increase the duration or intensity of RLS symptoms for most individuals, their use should be reduced or eliminated.

Fatigue and drowsiness tend to worsen the symptoms of RLS. Therefore, implementing a program of sleep hygiene is often helpful to feel well rested and, over time, reduce the RLS sensations. Sleep hygiene includes ensuring that the sleeping environment is comfortably cool (or warm) and quiet, going to bed at the same time every night, and arising at the same time every morning.

A variety of self-directed activities also provide effective, although temporary, relief: walking, stretching, taking a hot or cold bath, massaging the affected limb, applying hot or cold packs, using vibration, performing acupressure, and practicing relaxation techniques (such as biofeedback, meditation, or yoga).

When movement is impossible or restricted, as when travelling, distracting activities can be helpful, such as reading a gripping novel, performing intricate needlework, or playing video games.
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