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    [DK.一系列书籍].Sleep.Your.Questions.Answered.pdf

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    [DK.一系列书籍].Sleep.Your.Questions.Answered.pdf

    Sleep Your Questions AnsweredDiscover more atwww.dk.comFront Corbis Larry Williams bl; Pete Leonard/zefa br; Getty Images Mel Yates bc. Back Alamy Images Gary Conner/Phototake Inc. tr; Corbis Jim Cummins tc; LWA-Dann Tardif/zefa tlDon’t let disturbed sleep disrupt your life. Find out how to cope with insomnia and other disorders and sleep more soundly using this question-and-answer guide.Understand what sleep is, why you need it, and the effect that sleep problems can have on the mind and bodyLearn the pros and cons of different treatment options, including medications, therapies, and self-help strategiesMake successful changes to your diet, lifestyle, and environment to promote better sleeping habitsQaYour Questions AnsweredEase stress, sleep soundly, and energize your lifeSleepRenata L. Riha, mdRenata L.Riha,mdISBN 978-0-7566-2618-19 7 8 0 7 5 6 6 2 6 1 8 15 1 5 9 5Printed in Singapore15.95 USA19.95 Canadaflexpaper.studylead.comflexpaper.studylead.comSleepYour Questions Answeredflexpaper.studylead.comflexpaper.studylead.comRenata L. Riha, MDUS medical editor Anne Helena Rennes, MDYour Questions AnsweredSleepflexpaper.studylead.comDorling KinDersley Editor Tom Broder Senior Art Editor nicola rodway US Senior Editor Jill Hamilton cutive Managing Editor Adle Hayward Managing Art Editor nick Harris DTP Designer Traci salter Production Controller Clara Mclean Art Director Peter luff Publisher Corinne robertsDK inDiA Senior Editor Dipali singh Project Editor rohan sinha Editors Ankush saikia, Aakriti singhal Project Designer romi Chakraborty DTP Coordinator Pankaj sharma DTP Designer Balwant singh, sunil sharma Head of Publishing Aparna sharmaEdited for Dorling Kindersley by Philip MorganlonDon, new yorK, MuniCH, MelBourne, DelHiFirst American edition, 2007 Published in the united states by DK Publishing 375 Hudson street, new york, new york 1001407 08 09 10 11 10 9 8 7 6 5 4 3 2 1sD244April, 2007every effort has been made to ensure that the ination in this book is accurate. The ination in this book may not be applicable in each individual case so you are therefore advised to obtain expert medical advice for specific ination on personal health matters. never disregard expert medical advice or delay in receiving advice or treatment due to ination obtained from this book. The naming of any product, treatment, or organization in this book does not imply endorsement by the authors, imprimatur, or publisher, nor does the omission of such names indicate disapproval. The publisher, authors, and imprimatur cannot accept legal responsibility for any personal injury or other damage or loss arising from any use or misuse of the ination and advice in this book. All models featured in photographs are actors. Copyright 2007 Dorling Kindersley limited, londonText copyright 2007 renata l. rihawithout limiting the rights under copyright reserved above, no part of this publication may be reproduced, stored in or introduced into a retri system, or transmitted, in any , or by any means electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of both the copyright owner and the above publisher of this book.Published in great Britain by Dorling Kindersley limited.A catalog record for this book is available from the library of Congress.isBn 978-0-7566-2618-1DK books are available at special discounts when purchased in bulk for sales promotions, premiums, fund-raising, or educational use. For details, contact DK Publishing special Markets, 375 Hudson street, new york, new york 10014 or specialsalesdk.com.Printed and bound in singapore by Tien wah PressDiscover more at www.dk.comflexpaper.studylead.comeveryone knows what sleep is but it is very difficult to define. we spend a third of our lives asleep and a good night’s sleep is integral to our health and well-being. sleep disorders are common within our society and contribute to impaired academic and job perance. They can result in accidents at work and while driving, thereby raising significant public health issues. They can lead to impaired mood and they can affect social adjustment. relationships can be severely affected by the disordered sleep of a bed partner. sleep disorders can also lead to or worsen underlying medical and psychiatric problems. This book attempts to describe the basic processes of sleep and the disorders associated with it. sleep disorders are outlined and treatments discussed. Practical suggestions for getting a good night’s sleep and dealing with common problems that affect sleep throughout life are also presented. if you ever have any concerns at all about your health, lifestyle, or sleep, you should consult a professional. i hope this book will help you know what questions to ask, and what to expect. sleep wellForewordDr. renata l. rihaflexpaper.studylead.comUnderstanding sleepThe rhythms of sleep 10The states of sleep 15Chemicals involved in sleep 18Amount of sleep 21Night owls and early birds 22Dreams and dreaming 24Sleeping well Getting enough sleep 28Sleeping environments 31Sleep promotion 35Sleep disrupters 43Mood and memory 45Sleep diary 46Sleep disordersDisrupted sleep 50Insomnia 53ContentsNarcolepsy and abnormal daytime sleepiness 55Sleep-disordered breathing 58Treating sleep apnea with CPAP 62Snoring 65Limb movement disorders 68Disorders in the timing of sleep 70Reducing the effects of jet lag 72Parasomnias 78Illness, aging, and sleepRespiratory disorders 84Hormonal imbalances, heart disease, and indigestion 90Sleep and cancer 94Sleep and pain 96Sleep and mood disorders 99Could I be depressed 100flexpaper.studylead.comSleep and seasonal affective disorder SAD 104How aging affects sleep 111Sleep and drugs 115Sleep and neurological problemsCommon neurological diseases 118Adults with intellectual disability 123Women and sleepSleep differences between the ss 130Sleep and menstruation 132Sleep and pregnancy 136Sleep patterns during pregnancy 138Early stages of motherhood 140Sleep and menopause 141Children and adolescentsBabies 146From infancy to adolescence 151Sleep hygiene for children 152Sleep problems in children 157How can I tell if my child has a sleep problem 158Bed-wetting 164Adolescent sleep-wake patterns 169Tests and treatmentsInvestigating sleep problems 174Treatments 179Useful addresses 184Index and acknowledgments 185flexpaper.studylead.comflexpaper.studylead.comUnderstanding sleepWe spend about a third of our lives asleep, yet we are still not sure why we sleep. What we do know is that we need enough good-quality sleep to function well while we are awake. The type of sleep we experience, and our sleep requirements, change over time, depending on our activity levels, our health, and our environment. This chapter explores some key aspects of normal sleep in adults.flexpaper.studylead.com10 understanding sleepWhy do we need sleepTQ sleep is important to health, and insufficient sleep can lead to problems with various body systems, including the immune system, the heart and circulatory system, and hormone secretion. also, poor-quality or insufficient sleep can lead to impairment of daytime functioning, excessive daytime sleepiness, and problems with memory.How much do we know about sleepTQ the study of sleep is an evolving science. We know a lot about many disorders of sleep but not enough about others. answers to even the most common questions about sleep are not always simple or straightforward, and sometimes there is no answer at all. studies in sleep and sleep disorders are a relatively new area of research compared with many other areas of human health.the rhythms of sleepWhat is sleepTQ everyone knows what sleep is, but would find it difficult to define. perhaps the scientist robert Mcnish summed it up best when he wrote in The Philosophy of Sleep 1834 “sleep is the intermediate state between wakefulness and death; wakefulness being regarded as the active state of all the animal and intellectual functions, and death as that of their total suspension.” during sleep, our senses are disengaged and we are temporarily unresponsive to our environment. sleep involves processes affecting both our behavior and our physiology the way the body works.flexpaper.studylead.com11the rhythMs of sleepHow long has sleep been studiedTQ the study of sleep and sleep disorders is a relatively new discipline in science and medicine. in 1875, differences in the brain activity of sleeping and awake dogs were studied using electroencephalograms eegs, which recorded electrical impulses in the brain. in 1880, the classic features of narcolepsy a sleep disorder characterized by excessive daytime sleepiness; see p55 were described. specific sleep disorders were identified as interest in sleep, and the of documentation of these disordersthe polysomnogramevolved. the first narcolepsy clinics were set up in 1964, and the use of continuous positive airway pressure Cpap for the treatment of sleep apnea see pp58–61 was introduced in 1981.What are circadian rhythmsCircadian rhythms are the “clocks” of our internal mechanism that determine the phases of our cellular and organ activity over a 24-hour period. The word circadian means “about a day.” Circadian rhythms affect body temperature, organ function, secretion of hormones such as cortisol the primary stress hormone, and sleep. Each rhythm affects the others. In an environment with no time cues such as light, clocks, calendars our body clock completes a cycle that is slightly longer than the natural dayabout 24 hours and 42 minutes, rather than exactly 24 hours. Body temperature Fbody temperature and sleep Our body’s circadian rhythms dictate the rise and fall of our internal temperature over the course of a day. We are most likely to fall asleep when our body temperature is in the downward phase.9am 1pm 5pm 9pm 1am97.597.797.998.198.398.598.7flexpaper.studylead.com12 understanding sleepWhat is the sleep-wake cycleTQ the sleep-wake cycle is the alternation between the states of being awake and being asleep. One theory of sleep states that the amount of sleep we experience depends on the length of time we are awake prior to sleep. so, the longer you are awake and the more tired and sleepy you become, the greater the urge for you to fall asleep and the longer you are likely to sleep in order for your body to attain “normal function” again. some researchers believe there is a separate sleep-wake cycle that runs on its own rhythm but also interacts with the circadian rhythm. Many other theories have been developed in order to define how and why we sleep and what the basic drives to sleep are.What role does cortisol play in the sleep-wake cycleTQ Cortisol is the ‘‘stress response’’ hormone of the body. it has a marked circadian rhythm, and levels in the blood will vary during the day and night. Cortisol levels are at their lowest during slow wave sleep see p17 at night. the highest cortisol levels are in the early morning before sunrise and awakening. this means that your body is prepared to be fully active when you get up.Is environmental temperature important in sleepTQ it is usually more conducive to sleep in a slightly cooler rather than warmer environment, since this matches the dip in core body temperature that occurs during sleep. extremes of temperature hot or cold disrupt sleep.What role does body temperature play in regulating sleepTQ sleep onset is likeliest to occur in the downward phase of the temperature cycle see p11. in other words, we are most likely to sleep when our body temperature is falling. a secondary peak in sleepiness occurs in the afternoon and corresponds to afternoon napping. sleep stops as the body temperature curve rises.flexpaper.studylead.com13the rhythMs Of sleepWhich parts of the brain are involved in sleepTQ the most important part of the brain involved in the coordination of the sleep process is called the reticular activating system ras. it is composed of a large number of nerve cells throughout the brain and is responsible for regulating wakefulness. When the ras neurons switch off, alertness is reduced. there is a significant and continuous interplay between the ras and other sleep-regulating areas in the brain. these include the thalamus, medulla oblongata, hypothalamus, pons, midbrain, spinal cord, pineal gland, raphe nuclei, basal forebrain, hippocampus, and suprachiasmatic nucleus.Why is the suprachiasmatic nucleus importantTQ the suprachiasmatic nucleus is a system of nerve cells responsible for the circadian rhythm. it is strongly affected by light and promotes wakefulness, as shown by the high firing rate of the neurons in the day and low firing rate at night. neurons from the suprachiasmatic nucleus project to many areas of the brain including the thalamus. the suprachiasmatic nucleus also regulates the timing of melatonin secretion from the pineal gland see p18.What role do light and darkness play in regulating sleepTQ light activates special receptor cells at the back of the eye retina, which in turn affect the suprachiasmatic nucleus. this has links to other parts of the brain that regulate sleep and wakefulness, including the pineal gland, which produces melatonin. exposure to light increases wakefulness while darkness has the opposite effect. light is thus important to the regulation of sleep and wakefulness and helps keep our circadian rhythm on track. light is an effective cue for wakefulness in all humans, except those who lack light receptors in the eyes certain s of profound blindness.flexpaper.studylead.com14How is sleep measured and recordedSleep doctors, sleep technologists, and sleep researchers use a system called polysomnography PSG to record a person’s sleep, to diagnose many sleep disorders, and to investigate the differences between normal and abnormal sleep. The PSG is usually pered in a sleep laboratory, which can be part of a hospital or university research setting.Sophisticated equipment is used to collect signals from a sleeping person. An electroencephalogram EEG records brain wave activity. An electro-oculogram EOG records the activity of the eyes and an electromyogram EMG records activity in muscles. Other equipment collects signals related to breathing respiration, and records airflow through the nose and mouth, monitoring your sleep This recording of REM sleep shows the typical rapid eye movements EOG, low muscle tone EMG, and the characteristic brain wave pattern EEG. REM sleep is distinct from NREM sleep in that we have an “active mind inside a paralyzed body.” We often wake up from REM sleep, or just after it in the morning. respiratory effort, movement, and oxygen and carbon dioxide levels. An electrocardiogram ECG monitors heart rate and rhythm. Electrodes placed

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