We try not using medications initially, and we use something called behavioral therapy for insomnia. This changes behaviors people do in bed, none of the tossing and turning. Shelby Harris More Quotes by Shelby Harris More Quotes From Shelby Harris So, sleep deprivation, and sometimes an insomnia, which is a little bit of a different form, but just getting a lack of sleep, can lead to a number of different decrements. Shelby Harris insomniasleepnumbers So someone who is a child usually goes to bed about 8:00 or 9:00 at night, but then when they have a circadian rhythm shift, it shifts later. And this is natural. And they start to go to bed at 11:00, 12:00, 1:00 and they want to sleep later. So we see this a lot in teens. Shelby Harris sleepnightchildren Narcolepsy is a disorder that affects many different areas of life. So in typical patients with narcolepsy, they have something called "excessive daytime sleepiness." So, they're very sleepy during the day. Yet, at night, they're still sleepy, but their sleep is very broken. Shelby Harris brokensleepnight We're not really sure why it [broken circadian rhythm] continues, but when they become adults, we usually have to treat it because many people need to get up early to go to work and they can't be sleeping until 11:00 or 12:00. So we use treatments like bright light therapy, melatonin, things like that that are very effective. Shelby Harris up-earlylightsleep There's a problem for them [teens] when they have to get up and go to school in the morning, they're very sleepy, yet on the weekends, they'll sleep 12 hours, they'll sleep late and then go to bed late and wake up late. And on vacations, it's not a problem. Shelby Harris sleepmorningschool Now circadian rhythms become very interesting and problematic for patients because when you become a teenager, your rhythms actually tend to naturally shift. Shelby Harris teenagerpatientinteresting We haven't really - it's harder for us to set those rhythms. So it's really important to keep a steady bedtime and wake time to really lock in those rhythms. Shelby Harris bedtimelocksimportant People went to bed when the sun went down and they woke up when the sun came up. That's what our bodies are naturally programmed to do. However, with all the new stresses in life with electricity, with technology, we tend to override that system and we'll stay up later and we'll get up earlier or later, and we use alarm clocks, we use the light. Shelby Harris stresstechnologylight So when it comes to circadian rhythms, it's a clock that's basically programmed in our body. So if you think back to times when people lived on farms and we didn't have electricity. Shelby Harris bodypeoplethinking The other option we have are medication treatments. So you'll have the treatments such as Ambien, Lunesta, Sonata, and we'll also have Rozerem and for some patients we use Benzodiazopine/Clonazepam. Things like that to help with anxiety. Shelby Harris anxietyusehelping We'll work on relaxation strategies and also changing the times you go to bed will actually make them sleep a little bit less for a few nights so their body's natural sleep drive starts to kick in. That is very effective in about 60% to 70% of patients who do it, four to eight sessions, not even every week; it works for 60% to 70% of patients. Shelby Harris eightsleepnight I'll work on patient's thoughts about sleep, "So I must get eight hours of sleep tonight or I won't sleep tomorrow." That sometimes - or "I won't function tomorrow." That sometimes makes it very difficult for you to sleep at night Shelby Harris eightsleepnight We have other opposite problems with circadian rhythms that can happen when you - a lot of times with older adults. They start to go to bed at 6:00, 7:00 at night and they wake up at 2:00 in the morning. And they're rhythms actually shift earlier, but sometime it can just kind of miss the mark and shift too much earlier and that's when we need to treat it with bright light. Shelby Harris lightmorningnight So a lot of people who work rotating shifts and they work at night, their bodies are set to want to be awake during the day and sleep at night. So there are some people who have a lot of trouble adjusting their rhythms and they have trouble working the night shift, they're sleepy, they're drowsy driving home. Shelby Harris homesleepnight Now narcolepsy is really hard though because they're very tired during the day, they're sleepy during the day and it's managed mostly with medications. So we use medications to help them sleep better at night and to stay away during the day. But there are behavioral things you can do also by changing diet, exercise, having an actual nap schedule. Shelby Harris tiredexercisesleep There's confusional arousals, there are states in deeper sleep that can happen where people will go and they'll disappear and they'll take on some other persona. They'll commit some crime, but it's all when they are in a very deep stage of sleep. So you really need to have a very thorough evaluation. Shelby Harris arousalsleeppeople There are some that are - REM Behavior Disorder, we'll see some court documented cases. And they really need to have a thorough evaluation with a sleep specialist. Shelby Harris evaluationsleepneeds Some patients will report that they have sleep paralysis. If we see sleep paralysis alone and nothing else, we don't really think all that much of it, but if we see other symptoms, then it might be a red flag for something else that's going on. Shelby Harris red-flagssleepthinking Sleep paralysis is something that is actually very common. Many people have it, I've had it myself. And what happens is, when you're in that REM stage of sleep, your brain is very active. You're dreaming your most during that stage, you're mind, your eyes are moving, there's a lot going on. It's like fireworks going on in your brain. Shelby Harris dreamsleepmoving Now there's some night terrors that happen in adults. And if it starts as an adult and you've never had them before, then there might be other things that are happening; it might be anxiety, depression, stress. And that's when you might have more of a thorough psychological evaluation. Shelby Harris anxietystressnight
