1) According to the World Health Organization, 1 in 8 people worldwide suffer from a mental illness in any given year.

2) According to the National Institute of Mental Health, 26 million Americans suffer from a mental illness or condition.

3) According to the University of Maryland Medical Center, roughly 50 percent of people who are 65 and older will develop dementia in their lifetime.

4) According to the U.S. Department of Education, 1 in 3 children and youth ages 8-12 suffer from some form of mental illness, including depression, ADHD, and anxiety disorders.

5) According to the American Psychological Association, 50 million Americans suffer from anxiety disorders.

6) According to the U.S. Centers for Disease Control and Prevention, approximately 1 in 5 adults experience a mental illness in any given year.

Brain Health Tips

There are many ways to improve brain health. Some of the most popular include diet, exercise, mental stimulation, sleep, and social interaction. Each one of these has benefits that can help improve your overall cognitive function.

1- Eat a Mediterranean Diet

Brain health is essential for overall well-being. A diet that promotes brain health can help to reduce diseases like Alzheimer’s and dementia, as well as improve mental focus and cognition. The following is a list of foods that have been shown to be beneficial for brain health:

• Foods from the Mediterranean region are believed to be particularly beneficial for the brain. These foods include fruits, vegetables, whole grains, and fish.

• Certain antioxidants found in fruits and vegetables may play a role in protecting the brain against age-related damage. Examples of antioxidants include vitamin C, beta-carotene, and lycopene.

• Omega-3 fatty acids are also important for cognitive health and have been linked with reducing the risk of diseases like Alzheimer’s and dementia. Certain nutrients in nuts and fish, such as the omega-3 fatty acids EPA and DHA, may protect against Alzheimer s.

Some studies have indicated that the consumption of fish may reduce the risk of dementia by 50 percent or more.

2- Exercise Regularly

Regular exercise has long been known to improve cognitive performance, mood, and sleep quality. However, recent studies have shown that regular exercise may also help maintain brain health overall.

Studies have found that people who engage in regular exercise have reduced levels of inflammation in their brains.

Inflammation is a state of ongoing inflammation or protective response that the body produces in response to an infection, injury, or another stimulus.

Increased levels of inflammation are linked with several serious health conditions, including heart disease, stroke, cancer, and Alzheimer’s disease.

Regular exercise has also been shown to reduce the risk of developing dementia and other forms of memory loss.

One study showed that people who exercised for just 30 minutes a day had a 60% lower risk of developing dementia later on in life than those who did not exercise at all.

3-Get Plenty of Sleep

There is a growing body of research demonstrating the links between sleep and cognitive health. Getting enough sleep can help improve memory, focus, and overall brain health. Here are some specific benefits of getting enough sleep:

1) Memory: Getting adequate amounts of sleep can help improve memory function. Studies have shown that people who get less than seven hours of sleep each night have poorer memory skills than those who get more than eight hours of sleep.

2) Focus: Having a good night’s sleep can help you stay alert and focused throughout the day. When you are tired, it becomes harder to concentrate on the tasks at hand.

3) Brain health: A healthy brain requires adequate amounts of rest. When you don’t get enough shut-eye, your brain begins to produce abnormal proteins that can lead to chronic stress and even Alzheimer’s disease.

4- Stay Mentally Stimulated

There is a growing body of evidence that suggests mental stimulation can be beneficial for brain health. Details include activities such as reading, learning new things, playing video games, and working on puzzles.

Mental stimulation has also been shown to improve memory and cognitive abilities. Some examples of how mental stimulation can benefit your brain include:

-Reading helps develop vocabulary and critical thinking skills.

-Learning new things expands our knowledge and cultivates creativity.

-Playing video games challenges your brain and keeps it active.

-Working on puzzles helps increase problem-solving skills and sharpens attention spans.

5- Keep Interacting Socially

Brain health and social interaction go hand in hand. Our brains need social interaction to function at their best.

In fact, it has been shown that people who have strong social networks have a lower risk of developing dementia and other brain diseases. This is because social interaction helps to keep the brain active and healthy.

There are many benefits to having a healthy social life. For instance, it can help to improve moods, relieve stress, and boost your immune system. It can also help you stay informed and connected with the world around you.

Examples of ways that social interaction can benefit your brain include:

-It helps to keep the brain active and healthy by promoting cognitive development, memory recall, and creativity.

-It can help to reduce anxiety and depression symptoms by providing a sense of community or support.

6-Improve Your Blood Pressure

The relationship between blood pressure and cognitive decline is an important one to consider. High blood pressure is a major risk factor for cognitive decline, as it can lead to stroke, heart disease, and other conditions.

Cognitive decline is a gradual process that can significantly impact the ability to function at work and in everyday life.

The details of this relationship are complex, but here are some examples of how high blood pressure might affect cognitive function.

First, high blood pressure might increase the risk of stroke. Strokes are a major cause of cognitive decline, and they can lead to memory problems, difficulty speaking, and more.

Second, high blood pressure can interfere with the flow of blood to the brain. This can damage cells in the brain and lead to decreased mental abilities.

Third, high blood pressure can increase the risk of heart disease.

7- Improve Your Blood Sugar Level

There is a growing body of research linking high blood sugar levels to brain damage, and it’s not just in adults.

According to the American Diabetes Association, nearly 7 million kids under the age of 18 have diabetes, which is a type of metabolic disorder that results from problems with blood sugar control.

While it’s not yet clear how high blood sugar levels lead to brain damage, there are some key details that researchers know about the relationship.

For one thing, high blood sugar levels can damage nerve cells in the brain. In addition, studies have found that people who have type 2 diabetes (the most common form of diabetes) are more likely to experience stroke and other types of brain injury than people who don’t have diabetes.

So far, it’s not clear why these injuries happen, but experts think that high blood sugar levels might play a role.

8-Improve Your Cholesterol Level

Cholesterol is fat found in the body. It is important for brain health because cholesterol helps make membranes that protect nerve cells in the brain.

However, too much cholesterol can contribute to heart disease and dementia. Here are some details about how cholesterol affects brain health:

1) Cholesterol helps make membranes that protect nerve cells in the brain.

2) Too much cholesterol can contribute to heart disease and dementia.

3) There is evidence that high levels of cholesterol are linked with an increased risk of developing dementia.

4) In fact, people who have a high level of cholesterol are 2 to 3 times more likely to develop Alzheimer’s disease than those who have a low level of cholesterol.

5) Lowering your LDL (bad) cholesterol levels may help reduce your risk of developing dementia.

9- Take Care of Your Emotions

Brain health is essential to overall well-being. Proper care of your emotions can have a significant impact on your brain health, including reducing anxiety and depression symptoms.

Here are some details on how taking care of your emotions can affect your brain:

1. Properly managing emotions can help reduce the risk of developing anxiety and depression.

2. Anxiety and depression can have a negative effect on cognitive function and memory, both in the short term and over time.

3. Taking care of your emotions can also help improve focus and concentration, as well as reduce stress levels which can lead to improved sleep quality.

4. Properly managing emotions can also improve relationships by reducing stress levels in both parties involved, leading to improved communication skills.

5. Properly managing emotions can also help you to be a better parent as it improves your ability to understand and predict your child’s needs.

6. Properly managing emotions also leads to happier, healthier relationships with family members, friends, and coworkers.

7. Properly managing emotions can also help you to be a better employee as it improves your ability to work with others and your ability to be an effective leader.

8. Finally, properly managing emotions can lead to more self-confidence which can lead to increased productivity at work and more creativity in personal endeavors.

10- Consider Using Low Dose Aspirin

Recent studies have shown that low-dose aspirin can reduce the risk of dementia. For example, a study published in The Lancet showed that people who took low-dose aspirin (75-325 mg/day) were 40% less likely to develop Alzheimer’s disease over the course of 16 years than those who didn’t take aspirin.

Another study found that people who took low-dose aspirin (75-325 mg/day) were 33% less likely to develop dementia over the course of 10 years than those who didn’t take aspirin.

Given these findings, it is important for people to know about the brain health benefits of low-dose aspirin and consider taking it as part of their brain health regimen. Here are some examples of how low dose aspirin could be helpful for people with brain health concerns:

The first example is that low-dose aspirin can help reduce the risk of stroke. In a study published in the Journal of Neurology, Neurosurgery and Psychiatry, researchers found that people who took low-dose aspirin were less likely to have a stroke over the course of 7 years than those who didn’t take aspirin.

The second example is that low-dose aspirin can help reduce the risk of Alzheimer’s disease. In a study published in the journal Neurology, researchers found that low-dose aspirin can help reduce the risk of Alzheimer’s disease by about 26 percent over 5 years for people who have a certain genetic makeup.

11- Avoid Alcohol Abuse

Alcohol abuse can have a significant effect on brain function and health. In fact, alcohol abuse is one of the leading causes of chronic brain disease.

1) Alcohol abuse can cause several chronic brain diseases, including anxiety, depression, schizophrenia, and dementia.

2) Alcohol abuse can also damage neurotransmitter receptors in the brain. This can lead to problems with memory recall, focus, and coordination.

3) Furthermore, alcohol abuse can increase the risk of developing other mental health issues such as eating disorders and suicidal thoughts.

4) Overall, alcohol abuse has a negative impact on both physical and mental health in individuals. It is important to remember that alcohol abuse is never okay!

12- Avoid Tobacco

Smoking cigarettes has been shown to have a negative effect on the brain, even in the early stages of development.

Studies have found that smoking cigarettes can lead to lower IQ scores, impaired cognitive function, and increased rates of depression and anxiety.

Smoking also causes chronic diseases like cancer, heart disease, and stroke.

There are many ways to avoid tobacco. Some people choose not to smoke at all while others try to quit using various methods such as nicotine replacement therapy or counseling from a healthcare provider.

Whatever the choice, it is important to take care of your brain health in the process.

13- Protect Your Head

Brain health is an important topic to consider when it comes to head protection. It’s not just about preventing injury, but also ensuring that you are protecting your brain against potential damage. Here are some details on how to keep your head safe:

1. Wear a helmet when cycling or skiing. The helmet will protect your head from falling debris and other injuries.

2. Use a seat belt when driving. Seat belts protect the front and rear of the body in a car accident and can also protect the head in a rollover crash.

3. Wear eye protection when shooting firearms. Gunshot wounds to the head can be very serious, and proper eye protection will help prevent serious injury or even blindness.

4. Keep your hands away from your face when playing rugby or football. Backs, knees, and elbows are not designed to protect the head and can cause serious injuries.

5. Do not use hand-held tools or power tools when welding. These tasks put the hands in a very vulnerable position, especially if they are close to the face.

Conclusion

There are many things you can do to keep your brain healthy. Eat a balanced diet, exercise, and get enough sleep. Additionally, challenge your brain with puzzles and games, and stay social and connected.

By following these tips, you can keep your mind sharp and healthy for years to come.

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Here are some tips to help keep your nervous system healthy:

1. Eat a balanced diet that includes plenty of fruits and vegetables.

A balanced diet that includes plenty of fruits and vegetables is key to maintaining a healthy lifestyle. Fruits and vegetables are packed with nutrients that can help improve your cholesterol levels, regulate blood sugar levels, and reduce your risk of developing heart disease or other chronic diseases.

In addition to promoting overall health, eating a balanced diet can also help you look and feel better. A varied selection of fruits and vegetables will give you the vitamins, minerals, fiber, and antioxidants you need to stay energetic all day long.

2. Get regular exercise.

Regular exercise can help improve mood and reduce stress levels. A study published in the journal “Frontiers in Human Neuroscience” found that even 30 minutes of physical activity each day can have a positive impact on mental health [1].

The researchers found that people who exercised reported feeling more relaxed and less stressed, and that these benefits were especially pronounced for people who identified as highly stressed before beginning the study.

In addition, the researchers noted that regular exercise can also help reduce symptoms of depression and anxiety.

According to the Centers for Disease Control and Prevention, getting at least 30 minutes of exercise each day can help improve your overall health. Not only will you feel better physically, but you’ll also see improvements in your mood and stress levels.

Exercise has been shown to be an effective way to reduce symptoms of anxiety and depression, so it’s important to find something that you enjoy doing and stick with it.

3. Get adequate sleep every night.

Sleep is essential for a healthy nervous system. When you don’t get enough sleep, your body can’t function at its best. Lack of sleep can lead to anxiety, depression, and other mental health problems.

The National Sleep Foundation recommends getting at least 7 hours of sleep every night to stay healthy.

If you’re struggling to get enough sleep, make sure to follow these tips:

1) Avoid screens before bedtime: Screens cause light exposure in the evening which can delay your body’s natural sleep cycle. Try to avoid screens within 30 minutes of going to bed.

2) Keep a regular sleep schedule: Sticking to a regular sleep schedule helps regulate your body’s natural sleeping rhythms. waking up and going back to bed on the same schedule each day helps your body learn when it needs rest and wake up time.

4. Avoid alcohol and drugs

Drugs and alcohol can damage the nervous system over time. Alcohol can increase the risk of developing cirrhosis, a serious liver disease. Drug use also increases your risk of developing anxiety, brain fog, depression, and other mental health problems. Taking drugs and alcohol together can further increase your risk of experiencing adverse effects. If you’re struggling with drug or alcohol abuse, it’s important to seek help. Treatment can help you to avoid long-term damage to your nervous system.

5. Reduce stress

Stress is a term often used to describe feelings of anxiety or worry. It can be both mental and physical. The nervous system is affected when stress levels are high, and the body can react in several ways.

The nervous system can create problems such as headaches, fatigue, heart problems, and gastrointestinal issues. However, when stress becomes chronic or excessive, it can have a negative impact on our health.

The nervous system is particularly sensitive to stress and can be damaged in the short term or over time. Here are a few ways to reduce your stress levels:

1. Get enough sleep. Sleep is crucial for overall health and well-being, and it’s especially important for people who are stressed out. When you don’t get enough sleep, your body’s cortisol levels increase, which can lead to weight gain, inflammation, and other problems.

2. Exercise regularly. Exercise has been shown to reduce stress and improve overall mental health by boosting mood and physical activity releases endorphins – feel-good hormones – which can help reduce anxiety and depression symptoms.

3. Take some time for yourself every day. Find something that relaxes you and do it regularly. This could be reading a book, taking a walk, listening to music, or spending time with friends.

4. Practice yoga or another form of relaxation exercise regularly. This will help to improve your flexibility and concentration skills, which will in turn reduce your stress levels.

5. Make sure that you get enough sleep each night. Not getting enough sleep can lead to increased levels of stress hormones in the body, which can further damage your health.

6. Avoid eating foods that make you tense up quickly (such as spicy foods).

5. Keep your blood pressure in check: hypertension can damage the nervous system

High blood pressure (HBP) is a major risk factor for heart disease, stroke, kidney failure, and other conditions.

More than 24 million Americans have hypertension, and the incidence of the condition is rising. High blood pressure is caused by increased levels of blood pressure in the arteries.

The most common cause of hypertension is a high blood sugar level, but it can also be caused by obesity, age, genetics, and muscle mass.

Hypertension can damage the nervous system by increasing your risk of developing stroke, brain hemorrhage, and other conditions.

Proper treatment for hypertension includes lifestyle changes such as weight loss and exercise, medication to lower blood pressure, and ACE inhibitors or angiotensin-converting enzyme inhibitors to prevent heart attack or stroke.

Conclusion

The nervous system is responsible for controlling our body’s muscles, organs, and other systems. A healthy nervous system ensures that our body functions properly. Damage to the nervous system can cause problems with movement, coordination, and health in general.

Exercise is important for a healthy nervous system. It helps to promote circulation and strengthen the muscles.

Sleep is also important for a healthy nervous system. It helps to restore the body’s energy and keep the mind alert.

A healthy diet is another key part of keeping a healthy nervous system. It includes foods that are packed with nutrients and minerals, which help to protect the nerves from damage.

Drugs and alcohol can damage the nerves too, so it’s important to be careful when using them. Mediation can also be helpful for maintaining a healthy nervous system.

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1. What Does the Brainstem Do?

The brainstem serves as a communication point between the body, the spinal cord, and the brain through ascending and descending sensory and motor pathways [1].

Ascending pathways are groups of nerve fibers that bring sensory and motor information from the body (peripheral nervous system) to the brain through the spinal cord, while descending pathways work in the opposite way.

Ascending and descending pathways are also known as ascending and descending tracts of the spinal cord.

The brainstem also contains most cranial nerve nuclei (group of neurons), and therefore, is involved in the processing of efferent (coming from) information of the head.  

As the brainstem is made of the midbrain, pons, and medulla, it performs its functions through these structures.

2. What Does the Midbrain Do?

Midbrain or mesencephalon is the most rostral part (top) of the brainstem, found just below the cerebral cortex and above the pons. It is involved in vision, hearing, sleep, wakefulness, temperature regulation, alertness (arousal), and motor control [2]. 

It is composed of the tectum, the tegmentum, and cerebral peduncles, and receives blood supply from the basilar artery, superior cerebellar artery, and posterior cerebellar artery.

The tectum is divided into the superior colliculi that contain nuclei (group of neurons) involved in visual (vision) reflexes and the inferior colliculi involved in auditory (hearing) reflexes.

The tegmentum is divided into the substantia Negra where dopamine is released to the basal ganglia, and the red nucleus, which is involved, together with the cerebellum, in movement coordination.

The cerebral peduncles are paired structures separated by the interpeduncular cistern (Filled with cerebrospinal fluid) that connects the brainstem to the thalami (plural of the thalamus).

Lesions affecting the midbrain such as infarct, tumor, hemorrhage, or infections, can result in neurological disorders, including Benedikt syndrome, Claude syndrome, Weber syndrome, or Nothnagel syndrome.

These neurological disorders are characterized by palsies (paralysis) and ataxia (movement incoordination).

3. What Does the Pons Do?

The pons or pons Varolii is the structure of the brainstem located between the midbrain and the medulla (Medulla oblongata) and serves as a relay between the cerebral hemispheres and the cerebellum [3].

It is divided into the basilar part of the pons (Basis pontis) and the pontine tegmentum and receives blood supply from branches of the superior cerebellar artery and the pontine branches of the basilar artery.

The basilar part of the pons contains the pontine nuclei (cluster of neurons) that relay motor information coming from the motor cortex in the frontal lobe to the cerebellum. This activity is mediated by the corticofugal fibers.

The pontine tegmentum contains nuclei involved in sleep and wakefulness, breathing, and alertness.

It also contains nuclei of the cranial nerves, trigeminal (V), abducens (VI), facial (VII), and vestibulocochlear (VIII), and therefore, is also involved in the functions of these trigeminal nerves.

Lesions affecting the pons such as infarct, hemorrhage, tumors, or infections, can lead to the following neurological disorders:

• Gasperini Syndrome
• Facial Colliculus Syndrome
• Millard-Gubler Syndrome
• Brissaud-Sicard Syndrome
• Raymond Syndrome
• Foville Syndrome
• Marie-Foix Syndrome
• Locked-In Syndrome
• Tuberculosis Rhombencephalis

These neurological disorders are characterized by palsies (paralysis), ataxia, and symptoms associated with alterations in the function of some cranial nerves, such as loss of taste, loss of pain, temperature sensations on the face, or hearing loss.

4. What Does the Medulla Do?

The medulla (Medulla oblongata) is the part of the brainstem located between the pons and the spinal cord. It is responsible for the body’s involuntary functions (autonomous nervous system) such as cardiovascular function, heart rate, breathing, sleep-wake cycle, vomiting, sneezing, and swallowing [4].

The medulla is composed of the ventral medulla and the medulla tegmentum and receives its blood supply from the posterior inferior cerebellar artery (PICA), the anterior spinal artery, and branches of the distal vertebral artery.

The ventral medulla contains the olive, the pyramidal tracts, and the rootlets (nerve fibers) of the cranial nerve IX (Glossopharyngeal nerve) and XII (Hypoglossal nerve).

The olive is involved in movement coordination and in sound perception, while the pyramidal tracts are involved in the movement of muscles, and the rootlets of cranial nerve IX and XII carry away information from the central nervous system (brain and spinal cord) to the tongue, pharynx, larynx, parotid gland, and sinus.

The medulla tegmentum contains the inferior olivary nuclei and the nuclei of the cranial nerves IX to XII.

Lesions affecting the medulla oblongata such as infarct, hemorrhage, tumors, or degeneration, lead to the following neurological disorders:

• Babinski-Nageotte Syndrome
• Opalski Syndrome
• Wallenberg Syndrome
• Déjerine syndrome
• Wallerian Degeneration
• Demyelinating lesions
• Hypertrophic Olivary Degeneration
• Brainstem Glioma
• Syringobulbia

These neurological disorders manifest with symptoms such hemiparesis/hemiplegia, paralysis of parts of the body (e.g., tongue, soft palate, the pupil of the eye), ataxia, sensory deficits, and slurred speech.

5. What Are the Developmental Anomalies of the Brainstem?

Developmental anomalies of the brainstem are disorders that are originated during embryonic development of the brainstem [4].

The main known developmental disorders of the brainstem are Möbius syndrome (congenital facial diplegia syndrome) and axonal guidance disorders.

5.1. What Is Möbius syndrome?

Möbius syndrome or congenital facial diplegia syndrome is due to the underdevelopment or absence of the nuclei of the abducens cranial nerve (VI) and the facial cranial nerve (VII) resulting in paralysis of one side (unilateral) or both sides (bilateral) of the face muscles [5].

5.2. What Are Axonal Guidance Disorders of the Brainstem?

This group of disorders is associated with abnormal white matter tracts in the brainstem such as ectopic white matter tracts or anomalies in their location [6].

These disorders result in disorders such as horizontal gaze palsy, Joubert syndrome, progressive scoliosis, and pontine tegmental cap dysplasia [4].

Conclusion

The brainstem is made of the midbrain, pons, and the medulla oblongata and plays an essential role in communicating information between the body, the spinal cord, the cerebellum, and the brain.

This information includes instruction related to vision, hearing, sleep, wakefulness, temperature regulation, alertness (arousal), motor control, and the autonomous nervous system.

Lesions such as those caused by trauma, hemorrhage, tumors, or infections can affect the different parts of the brainstem (midbrain, pons, and the medulla oblongata) resulting in paralysis of parts of the body, ataxia, and sensory deficits.

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1. What is A Parasomnia?

A parasomnia is an abnormal behavior that happens during the sleep cycle that manifests with unwanted sensory, motor, or behavioral experiences.

2. What Are The 4 Types of Parasomnias?

According to the International Classification of Sleep Disorders-3, there are 3 main types of parasomnias [2]:

• NREM-Related Parasomnias
• REM-Related Parasomnias
• Other Parasomnias

The normal sleep pattern includes the transition from wakefulness to NREM (Non-REM) sleep and then to REM (Rapid Eye Movement) Sleep and follows a repetition of a cycle that comprises 5 phases measured by electroencephalography (ECG) [3]:

The NREM (Non-REM) sleep include 4 phases:

• Phase 1: light sleep phase characterized by slow eyes’ movement and muscle relaxation.

• Phase 2: this phase is characterized by the cessation of eyes’ movement and the slowdown of the brain waves such as the electrical pulses associated with wakefulness.

• Phase 3: beginning of deep sleep delta waves. At this stage, the delta waves are interrupted by faster and smaller waves.

• Phase 4: characterized uninterrupted delta waves leading to deep sleep.

Rapid Eye Movement (REM) or phase 5 is characterized by rapid eye movements, rise in heart and blood pressure, and dreaming.

2.1. What Are NREM-Related Parasomnias?

Non-REM-related parasomnias are abnormal behaviors that happen during the non-REM sleep phases and that manifest with undesirable sensory, motor, or behavioral experiences.

Non-REM-related parasomnias include confusional arousals, sleepwalking, sleep terrors, and sleep-related eating disorders.

2.1.1. What Are Confusional Arousals?

Confusional arousals or sleep drunkenness are characterized by partial awakenings during phase 3 of the sleep pattern that manifests with the individuals being disoriented, confused, having their eyes open, and without activity.

Confusional arousals can last minutes or a few hours with the individuals not remembering this event upon awakening after sleep. They are commonly found in children than adults.

• What Causes Confusional Arousals?

Confusional arousals are caused by alcohol abuse or intake of medications such as sedatives or hypnotics.

2.1.2. What Is Sleepwalking (Somnambulism)?

Sleepwalking or somnambulism is a partial awakening characterized by an ambulatory behavior such as walking around, walking naked, urinating, or playing a musical instrument, and without realizing it.

Sleepwalking also occurs during phase 3 of the sleep pattern and is frequently associated with sleep apnea and restless leg syndrome.

• What Causes Sleep Walking (Somnambulism)?

Sleepwalking can be caused by a head injury, migraines, vitiligo, encephalitis, chronic pain, or stroke.

It can also be caused by intake of medications such as antidepressants (mirtazapine, amitriptyline, bupropion, or paroxetine), benzodiazepine receptor agonists, antipsychotics (quetiapine or olanzapine), antihypertensives (metoprolol, propranolol), montelukast, topiramate, or fluoroquinolones [4].

2.1.3. What Are Sleep Terrors?

Sleep terrors or night terrors are episodes of sudden fear accompanied by screaming, crying, sweating, and increased heartbeat and breathing. The episodes of sleep terrors can last from 3-5 minutes. Sleep terrors are common in children and disappear by late childhood.

• What Causes Sleep Terrors?

In adults, sleep terrors can be associated with sleep apnea and can be caused by mental health issues or intake of medications [5].

2.1.4. What Are Sleep-Related Eating Disorders?

Sleep-related eating disorders are partial awakenings in which individuals binge eat food or unhealthy food (uncooked food such as raw meat) without realizing it.

• What Causes Sleep-Related Eating Disorders?

Sleep-related eating disorders can be caused by narcolepsy, smoking cessation, encephalitis, substance abuse, autoimmune hepatitis, and certain medications such as sleep medications (e.g., zolpidem), antidepressants (e.g., mirtazapine), and anticholinergics [5]. 

2.1.5. What Is Sexsomnia?

Sexsomnia is characterized by abnormal sexual behavior such as sexual vocalizations, sexual assault, masturbation, sexual intercourse, or fondling the bed partners during stage 3 of sleep.

• What Causes Sexsomnia?

Sexsomnia can be caused by shift work and medications such as selective serotonin reuptake inhibitors (SSRI) [1].

2.2. What Are REM-Related Parasomnias?

REM-related parasomnias are abnormal behaviors that happen during the REM (Rapid Eye Movement) sleep phase.

REM-related parasomnias include REM sleep behavior disorder, recurrent isolated sleep paralysis, nightmare disorder, and Catathrenia.

2.2.1. What is REM Sleep Behavior Disorder?

REM sleep behavior disorder is an episode that manifests with motor activities that can be violent, such as kicking, jumping, punching, yelling.

• What Causes REM Sleep Behavior Disorder?

REM sleep behavior disorder can be caused by an abrupt alcohol withdrawal, an abrupt withdrawal of sedative-hypnotic medications, tricyclic antidepressants, cholinergic medications, selective serotonin reuptake inhibitors (SSRI), biperiden, and monoamine oxidase inhibitor (MAOI).

REM sleep behavior disorder has also been associated with Type 1 narcolepsy, and neurodegenerative diseases such as Parkinson’s disease, frontotemporal dementia, and Alzheimer’s dementia [6]. 

2.2.2. What Is Recurrent Isolated Sleep Paralysis?

Recurrent isolated sleep paralysis is characterized by the incapacity to move muscles upon awakening.

• What Causes Recurrent Isolated Sleep Paralysis?

Recurrent isolated sleep paralysis is caused by extended muscle inactivity associated with the REM sleep phase.

2.2.3. What Is Nightmare Disorder?

A nightmare disorder is characterized by recurrent frightening dreams that seem real resulting in sudden awakening. It is the most common adult parasomnia is a nightmare with a lifetime prevalence of 66.2%

• What Causes a Nightmare?

Nightmares can be caused by stressful events such as post-traumatic stress, or medications (e.g., beta-blockers) [7].

2.2.4. What Is Catathrenia?

Catathrenia is characterized by episodes of recurring groining during the REM phase of sleep.

• What Causes Catathrenia?

Although the causes are unknown, catathrenia can be caused by intake of the sedative, sodium oxybate (Xyrem), used for the management of narcolepsy [8].

2.3. What Are Other Parasomnias

2.3.1. What Is Exploding Head Syndrome?

The exploding head syndrome is characterized by a loud or explosion sound in the head that happens during the wake-sleep transition or upon awakening [9].

2.3.2. What Are Sleep-Related Hallucinations?

Sleep-related hallucinations are episodes of visual, auditory, or tactile hallucinations that happen at the beginning of sleep (Hypnogogic hallucinations) or at awakening (Hypnopompic hallucinations).

2.3.3. What Is Sleep Enuresis (Sleep Bedwetting)?

Sleep enuresis or Sleep bedwetting is characterized by episodes of recurrent and involuntary urination during sleep due to the difficulty waking while with a full bladder.

2.3.4. What Is Sleep Talking?

Sleep talking is characterized by episodes of involuntary talking during the NREM and REM phases of sleep. Although benign, it can disturb the sleep of the partner.

3. How Do You Get Parasomnia?

They are several types of parasomnias that can be caused by mental health issues, physical conditions, medication intake (e.g., antidepressants), post-traumatic stress, sleep disorders, or neurological diseases.

However, some parasomnias are benign and are considered normal variants such as sleep talking.

4. Is Insomnia a Parasomnia?

Insomnia is not classified as parasomnia.

Insomnia is a common sleep disorder characterized by difficulty falling asleep, while parasomnia is an abnormal behavior that happens during sleep and that manifests with unwanted sensory, motor, or behavioral experiences.

5. Why Do I Shout in My Sleep?

Shouting or yelling during sleep may be due to a sleep terror or a REM sleep behavior disorder which are both parasomnias that have yelling as one of the manifestations. However, it is best to seek the advice of a specialist doctor.

6. What Is the difference Between a nightmare and a Night Terror?

A nightmare is characterized by recurrent frightening dreams that seem real resulting in sudden awakening, while a night terror (sleep terror) is an episode of sudden fear accompanied by screaming, crying, sweating, and increased heartbeat and breathing.

In addition, a nightmare is classified as a REM-related parasomnia, while a night terror is an NREM-related parasomnia [1].

Conclusion

Parasomnias can be distressful as they can disturb the sleep of partners or raise worries for the family.

Although not all parasomnias are serious, the treatment of more severe ones aims at dealing with the causes which can be associated with mental health issues, physical conditions, medication intake (e.g., antidepressants), post-traumatic stress, sleep disorders, or neurological diseases.

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In the US, it was estimated that about 21.4 % of adults would experience a mood disorder in their life [1].

In the UK, it was estimated that 1 in 5 people are affected by mood disorders [2].

2- How Do You Know If You Have a Mood Disorder?

Symptoms depend on the type of the mood disorder and may include the following:

• Persistence state of sadness
• Feeling empty or worthless
• Difficulty focusing or too many thoughts
• Loss of interest in thinks you previously enjoyed doing
• Suicidal thoughts
• Loss of appetite
• Weight loss or gain
• Fatigue or excessive energetic movements
• Sleep disorder or Insomnia
• Irritability
• Risk taking behavior

1- What Are the Causes of Mood Disorders?

• Family history

Higher rates of mood disorders were associated with a family history of affective disorders and instability [3].

• Life changing

Life-changing events such as death, trauma, or divorce can be triggers for depression and mood disorders.

• Physical illness

Chronic diseases such as diabetes, cancer, Parkinson’s diseases, and cardiovascular diseases can result in depression and mood disorders in affected individuals.

•  Medications

Some medications can cause mood disorders such as antiepileptic drugs, interferon (IFN), corticosteroids, and digoxin [4][5].

• Substance Abuse

Alcohol, cocaine, opioids (e.g., heroin) can cause mood disorders [6].

• Brain structure and function

Using MRI (Magnetic Resonance Imaging) technology, mood disorders have been associated with alterations in certain regions of the brain including the frontal lobe, the thalamus, the striatum, the parietal lobe, and the hippocampus that are involved in brain connections that control the frontal‐subcortical circuit, the suicide circuit, and the reward circuit [7].

• Previous Diagnosis with Mood Disorder

Some types of mood disorders can result in a progression into different types of mood disorders.

3- What Are the Types of Mood Disorders?

• Major Depressive Disorder (MDD)

Major Depressive Disorder (MDD) or depression is a debilitating mental disorder characterized by a depressed mood (low mood), low self-esteem, and loss of interest in previously enjoyable activities.

Major depression can be due to genetic factors (family history) or health issues.

It was estimated that around 7.1% of US adults had a least one major depression in their life [8].

Major depression was more prevalent in women (8.7%) than men (5.3%).

• Bipolar Disorder (Manic Depression)

Bipolar Disorder is a mood disorder characterized by mood swings between periods of depression (depressive episodes), and elevated mood that can be severe known as mania (manic episode), or less severe known as hypomania.

Sometimes both depressive and mania episodes happen at the same time.

Bipolar symptoms include symptoms associated with depressive and manic episodes:

Depressive Episodes Symptoms

These include a persistent state of sadness, low self-esteem, fatigue, loss of appetite, loss or gain of weight, lack of focus, feeling empty or worthless, guilt, sleep disorders, and suicidal thoughts [10].

Manic Episode Symptoms

These include irritability, mood swings between delirium and euphoria, impulsivity, excessive energetic movements, lack of restraining, fast thoughts, and risk-taking behavior.

Hypomanic Episode Symptoms

These symptoms are characterized by an unjustifiable elevation in mood, a lack of restraining, and a reduced need for sleep.

There are 2 types of bipolar disorder: a severe bipolar disorder known as bipolar I and a less severe one known as bipolar II.

It is estimated that 2.8% of US adults had bipolar disorder during their lifetime [10].

• Cyclothymic Disorder (Cyclothymia)

Cyclothymia is a mood disorder characterized by depressive episodes, elevated mood, and hypomania but without meeting the criteria of bipolar disorder [11].

Symptoms of cyclothymia include depressed mood, irritability, low self-esteem, helplessness, insomnia, fatigue, inability to feel pleasure (anhedonia), lack of motivation, headaches, and suicidal thoughts. 

• Seasonal Affective Disorder (SAD)

Seasonal affective disorder (SAD) is a type of seasonal depression characterized by major depressive episodes in the fall/winter and remissions in spring/summer.

The symptoms include persistent low mood, lack of interest, irritability, lack of energy, irritability, longer hours of sleep, withdrawal from social situations, and craving for carbohydrates.

• Premenstrual Dysphoric Disorder (PDD)

This mood disorder occurs before menstruation with moderate to severe symptoms that include anxiety, depressed mood, irritability, low self-esteem, decreased interest in activities, difficulty focusing, hypersomnia or insomnia, and anger [12].

• Disruptive Mood Dysregulation Disorder (DMDD)

This mental disorder affects children and adolescents and manifests with persistent irritability, anger, and frequent temper outbursts [13].

• Persistent Depressive Disorder (Dysthymia) 

Dysthymia is a mood disorder that has characteristics of moderate depression but that lasts for a longer period (more than two years).

The symptoms include fatigue, insomnia, hypersomnia, eating disorders, and low self-esteem.

It is estimated that 2.5% of US adults had dysthymia during their lifetime [14].

• Depression Induced by Substance Use or Medication

This type of mood disorder is associated with the induction of changes in certain parts of the brain and alterations in the activity of neurotransmitters such as dopamine, serotonin, neuropeptide Y, and corticotropin-releasing factor (CRF).

Symptoms include depressive mood, fatigue, irritability, low self-esteem, insomnia, psychomotor retardation, and suicidal thoughts which can progress to manic symptoms [15].

• Depression Related to Medical Illness

Chronic diseases such as diabetes, cancer, Parkinson’s diseases, and cardiovascular diseases affect the individual purpose and meaning of life which can result in depression [16].

• Atypical Depression

Individuals that are affected by this type of depression have similar symptoms as dysthymia or major depression but have higher reactions to their environment such as positive events or rejection [17].

• Psychotic Major Depression (Psychotic Depression, Depressive Psychosis)

Psychotic Major Depression is characterized by a combination of symptoms of major depression, hallucinations, and dilutions [18].

• Melancholic Depression

This type of depression is mostly biologically caused and is characterized by depressed mood, low self-esteem, fatigue, anorexia, excessive guilt, slow movement, absence of reactions to the environment, and lack of motivation [19].

• Postpartum Depression (Postnatal Depression)

Postpartum Depression is a mood disorder that manifests after childbirth and is characterized by symptoms such as anxiety, sadness, fatigue, sleep disorder, irritability, and the tendency to often cry [20].

3- How Do You Deal with Mood Disorders?

Anti-depressants

For the treatment of depression selective serotonin reuptake inhibitors (SSRI) are used.

Mood Stabilizers

These medications are used to modulate mood swings particularly in individuals with bipolar disorder.

Antipsychotics

These medications are used for the treatment of manic or depressive and manic episodes.

Light Therapy

Light therapy is used for the treatment of seasonal affective disorder (SAD).

Psychotherapy (Talk Therapy)

This involves counseling sessions and cognitive behavioral therapy.

Brain Stimulation Therapy

When treatments with medications are not successful for bipolar disorder patients, electroconvulsive therapy (ECT) may be used, which consists in applying current impulses on the patient scalp or forehead to inhibit or activate the brain [21].

Other brain stimulation therapies are also used such as stimulation Repetitive transcranial magnetic stimulation (rTMS) uses electromagnetic pulses to stimulate specific nerve cells in the brain.

Conclusion

Mood disorders are very common and affect millions of people; however, only half of the people affected with mental diseases receive treatment. Therefore, it is essential to increase awareness, improve detection methods, and make treatment available to all affected individuals to prevent cases of extreme desperation associated with suicidal thoughts.

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It is estimated that about 40 percent of adult men and 24 percent of adult women are regular snorers [1]. 

1. Is Snoring Dangerous?

Although snoring is harmless, it can also be due to a serious health issue when it is associated with obstructive sleep apnea and chronic diseases, such as type II diabetes and high cholesterol.

2. What Are the Causes of Snoring?

Snoring can be due to lifestyles such as smoking, consumption of alcohol and sedatives, or sleep positions but it can also be associated with genetics such as inherited genes that shape the head and neck anatomy of an individual.

Snoring can also be associated with conditions including chronic nasal congestion, obstructive sleep apnea, and hypothyroidism.

• Snoring and Obstructive Sleep Apnea (OSA)

Obstructive Sleep Apnea (OSA) is a condition characterized by intermittent episodes of partial or complete obstruction of the airways due to soft tissue falling at the back of the throat (Upper airway) when sleeping.

It is estimated that approximately 34% of middle-aged men and 17% of middle-aged women are diagnosed with OSA [2].

Obstructive sleep apnea (OSA) can cause cardiovascular diseases through the following mechanisms [3]:

• Sympathetic activation (fight-or-flight response)
• Intrathoracic pressure changes that limit heartbeat
• Oxidative stress causing tissue damage
• Abnormalities in coagulation factors
• Endothelial damage (damage to the blood vessels)
• Inflammatory mediators that lead to defects in the formation of vessels.

• Snoring and Head and Neck Anatomy

The shape of the head and face, the anatomy of the upper airway, and the circumference of the neck are predictors of sleep apnea and snoring in individuals [4].

A large tongue, craniofacial abnormalities, a receding chin, and a small jaw are associated with the reduction of the size of the upper airway which increases the risk of sleep apnea and snoring.

A neck circumference that is higher than 16.5 inches is also a risk factor for sleep apnea and snoring.

Abnormalities in cells that control breathing known as chemoreceptors can also reduce the size of the upper airway.

These anatomical characteristics may be due to inherited genes responsible for increased risk of sleep apnea and snoring [5].

• Snoring and Alcohol

Alcohol consumption increases the relaxation of soft tissues in the upper airway causing sleep apnea and snoring.

A study showed that alcohol consumption increases the severity of snoring, sleep apnea, and the levels of oxygen in blood and tissues (Hypoxia) [6].

• Snoring and Sedatives

Analgesics, anesthetics, opioids, and sedatives can also increase the relaxation of the tongue and soft tissues in the upper airway resulting in sleep apnea and snoring [7].

• Snoring and Smoking

Cigarette smoke can irritate and inflame the nasal cavity and the upper airway making them swell which reduces the capacity of breathing.

Another cause may be associated with nicotine withdrawal during sleep that causes sleep instability that increases the risk of sleep apnea and snoring [8].

• Snoring and Sleep Position

Sleeping on the lateral side is the best position while sleeping on the back is likely to increase sleep apnea and snoring.

This difference is due to gravity that increases the tendency for the tongue and soft tissues to fall to the back of the throat causing obstruction of the upper airway [9].

• Snoring and Chronic Nasal Congestion

Chronic Nasal Congestion is characterized by inflammation and swelling of the nasal cavity and the sinuses that lasts for more than 3 months and resulting in reduced breathing through the nose.

Chronic Nasal Congestion can be caused by sinusitis, nasal polyps, allergic rhinitis, or a deviated nasal septum (wall between the nasal cavities).

A study found that nasal congestion during sleep is a strong risk factor for habitual snoring [10].

• Snoring and Aging

The relaxation of the muscles of the upper airway is a normal event in aging which explains why it is common in the adult population.

However, persistent snoring is an indicator of a potential reduction of oxygen levels in blood and tissue (Hypoxia) associated with sleep apnea.  Persistent hypoxia may increase the process of aging by promoting hallmarks of aging such as stem cell exhaustion, telomere attrition, and epigenetic changes [11].

• Snoring and Being Overweight

Being overweight or out of shape can reduce muscle tone and increase fat deposition around the neck and throat that can promote the obstruction of the upper airway causing sleep apnea and snoring.

• Snoring and Hypothyroidism

Hypothyroidism is a disorder associated with reduced production of the thyroid hormones resulting in symptoms such as weight gain, fatigue, depression, and slow heart rate [12].

Another important characteristic of hypothyroidism is the enlargement of the thyroid known as goiter (neck looking enlarged) that can interfere with breathing by obstructing the upper airway causing sleep apnea and snoring.

3. Why Do I Snore Loud?

Sounding loud is associated with a higher obstruction of the upper airway. The more it is obstructed the more is the breathing difficulty, and therefore, the louder is the snoring.

4- How Is snoring Tested?

• Home Sleep Apnea Test

Portable devices are used to measure the breathing and blood oxygen level while you sleep.

• In-lab sleep study

This is performed in a sleep center where brain waves, breathing, eye movements, blood oxygen, heartbeats, and limb movements are measured.

5. What Are the Best Snoring Solutions?

Snoring can be reduced by tackling the causes that are outlined above.

• Lifestyle changes

– Reducing or stopping alcohol consumption can significantly prevent sleep apnea and snoring.

– Sleeping on the lateral side can reduce snoring.

– In addition to other benefits for health, quitting smoking can also gradually prevent or reduce snoring.

– Losing weight through a healthy diet and exercise.

– Avoiding tranquilizers and sleeping pills.

• Treatment of allergies

Allergies can cause chronic nasal congestion, and therefore, medications that reduce allergies can prevent snoring.

• Surgery

To restore a normal breathing pattern during the night surgery is performed on the nose or the back of the throat.

• Continuous Positive Airway Pressure (CPAP)

This is performed using a device that gently blows room temperature air through a mask or mouthpiece to the back of the throat to prevent breathing pauses.

• Oral Appliance Therapy

This therapy involves the use of a removable oral device and is recommended for individuals who cannot tolerate CPAP and whose OSA is moderate or mild.

Conclusion

Snoring increases with age and can be due to lifestyle which can be reversed by making changes in sleep position, avoiding alcohol and smoking, and having a healthy diet; however, it can become serious and lead to chronic diseases such as cardiovascular diseases and type II diabetes if untreated.

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It can also be caused by environmental factors such as sleeping habits, the safety of the place where you sleep, and the comfort of the bedding and the room where you sleep.

Corresponding to the statistics of the American Sleep Association (ASA), approximately 30% of adults experience short-term insomnia, while 10% of adults suffer chronic insomnia [1]. In the United Kingdom, approximately 50% of adults complain of short-term insomnia, while 10-15% suffer from chronic insomnia [2].

Why Do We Need Sleep?

Sleep is essential to our biological metabolism and for the proper functioning of our nervous system. For instance, insomnia can significantly affect protein metabolism necessary for the function of cells, tissue, and organs. It can also lead to cognitive disorders (e.g., effect on learning and memory), and mood swings.

How Is Sleep Controlled?

Sleep is controlled by the brain through the suprachiasmatic nucleus of the hypothalamus. The sleep pattern occurs through repetition of a cycle that comprises 5 phases measured by electroencephalography (ECG) [3]:

• Phase 1: light sleep phase characterized by slow eyes’ movement and muscle relaxation.

• Phase 2: this phase is characterized by the cessation of eyes’ movement and the slowdown of the brain waves such as the electrical pulses associated with wakefulness.

• Phase 3: beginning of deep sleep delta waves. At this stage, the delta waves are interrupted by faster and smaller waves.

• Phase 4: characterized uninterrupted delta waves leading to deep sleep.

• Rapid Eye Movement (REM): this phase is characterized by rapid eye movements, rise in heart and blood pressure, and dreaming.

Most adults require 7-9 hours’ sleep, while teenagers need 9 hours’ sleep and infants typically sleep for about 16 hours. However, biological, and environmental factors can alter the length and quality of sleep leading to insomnia.

What Are the Biological Causes of Insomnia?

1- Chronic Disease Conditions

Any chronic condition that causes pain can have dramatic effects on sleep. For instance, Rheumatoid arthritis can lead to shorter sleep times and fragmented sleep, resulting in a poor sleep quality that feeds back into a heightening sensitivity to pain, creating a vicious cycle [4].

2- Genetic Factors

Using the genome-wide association study (GWAS) and a genome-wide gene-based association study (GWGAS) in 113,006 individuals, a study identified 3 loci (location of genes on chromosomes) and 7 genes that are associated with insomnia. Among these, a strong association between the developmental gene MEIS1 and insomnia was reported for both males and females [5].

3- Breathing-Associated Conditions

Conditions that prevent proper breathing such as sleep apnoea, asthma, congestive heart failure, and chronic obstructive pulmonary diseases, can all lead to insomnia. Breathing difficulties result in frequent wakening, shorter sleep times, and fragmented sleep, which lead to poor sleep quality.

4- Urinary Conditions

Conditions such as an enlarged prostate and urinary tract infection result in frequent urination at night (Nocturia) that affects sleep quality.

5- Mental Health Disorders

• Anxiety and Depression:

Anxiety and Depression are mental states characterized by psychological symptoms such as low mood and self-esteem, irritability and intolerance to others, difficulty in making decisions, and suicidal thoughts.

A study that analyzed the link between depression and insomnia in 7954 respondents who were questioned about sleep complaints and psychiatric symptoms, found that the risk of developing new major depression was much higher in those who had insomnia at both interviews compared with those without insomnia [6]

• Post-Traumatic Stress Disorder (PTSD)

One of the main characteristics of PTSD is nightmares that relate to previous traumatic events. Nightmares can disrupt sleep, and their repetitive frequency can create a fear of falling asleep [7].

• Chronic Fatigue Syndrome

Insomnia can be caused by chronic fatigue syndrome, an illness characterized by profound disabling tiredness, a diminished capacity to perform routine tasks and sleep disruption that lasts for more than 6 months.

• Headaches and Migraines

A Headache is a symptom of continuous pain in the head, face, or neck that can last from 30 minutes to several hours, while a migraine is a severe form of headache that manifest as an excruciating pain on one side of the head accompanied by a feeling of sickness and an increased sensitivity to light and sound. Pain from headaches and migraines can significantly affect the quality of sleep.

6- Medication

Medications such as diuretics, some steroids (e.g., prednisone), decongestants, beta-blockers, asthma medications (e.g., theophylline) can lead to short-term or long-term insomnia depending on the duration of the treatments. For instance, diuretics can increase the frequency of urination, while prednisone can cause headaches, stomach pain, and sleep disruptions.

7- Stimulants

Caffeine, nicotine, and other central nervous system stimulants increase alertness which prevents the willingness of going to sleep.

8- Restless Legs Syndrome

Restless Legs Syndrome is the urge to move legs due to unpleasant sensations, such as tingling and aching, and that is relieved by movement. This condition can result in sleepless nights, and therefore, contributes to insomnia.

10- Dementia

The sleep hormone melatonin is essential in the synchronization of the circadian rhythms, and in ensuring the quality of sleep. In dementia individuals, melatonin secretion is low or dysregulated which affects sleep and leads to insomnia [8].

What Are the Environmental Causes?

Environmental factors such as the comfort of the bedding and the room where you sleep, are essential for quality sleep. For instance, if the bed is uncomfortable or if your partner is snoring, or your surrounding is noisy, the quality of your sleep will be affected.

What Is the Treatment for Insomnia?

Depending on the causes of insomnia, treatment can include lifestyles changes that promote quality of sleep or cognitive behavioral therapy (OBT). Lifestyle changes can involve improving the quality of the bedding, the room where you sleep, consuming less coffee and nicotine-associated products, and exercising.

Cognitive-behavioral therapy can help improve sleep patterns through the introduction of changes in behaviors and thoughts that interfere with sleep such as maintaining a consistent sleep schedule. For insomnia that is caused by anxiety, depression, and chronic fatigue syndrome, cognitive behavioral therapy can help improve cognitive disorders, behaviors, and develop coping strategies that can also help with sleep.

Conclusion

Insomnia is a serious condition that can have severe repercussions on daily life. If untreated insomnia can lead to mental health problems such as anxiety and depression. Although most of the causes can be prevented through changing lifestyle and environmental factors, some are associated with genetics, aging, and neurodegenerative diseases that require more advanced medical treatments.

References

[1] https://www.sleepassociation.org/about-sleep/sleep-statistics/

[2] Morphy, H., Dunn, K.M., Lewis, M., Boardman, H.F. and Croft, P.R., 2007. Epidemiology of insomnia: a longitudinal study in a UK population. Sleep, 30(3), pp.274-280.

[3] Brown, R.E., Basheer, R., McKenna, J.T., Strecker, R.E. and McCarley, R.W., 2012. Control of sleep and wakefulness. Physiological reviews.

[4] Ohayon, M.M., 2005. Relationship between chronic painful physical condition and insomnia. Journal of psychiatric research, 39(2), pp.151-159.

[5] Hammerschlag, A.R., Stringer, S., De Leeuw, C.A., Sniekers, S., Taskesen, E., Watanabe, K., Blanken, T.F., Dekker, K., Te Lindert, B.H., Wassing, R. and Jonsdottir, I., 2017. Genome-wide association analysis of insomnia complaints identifies risk genes and genetic overlap with psychiatric and metabolic traits. Nature genetics, 49(11), pp.1584-1592.

[6] Ford, D.E. and Kamerow, D.B., 1989. Epidemiologic study of sleep disturbances and psychiatric disorders: an opportunity for prevention?. Jama, 262(11), pp.1479-1484.

[7] Maher, M.J., Rego, S.A. and Asnis, G.M., 2006. Sleep disturbances in patients with post-traumatic stress disorder: epidemiology, impact and approaches to management. CNS drugs, 20(7), pp.567-591.

[8] Liu, R.Y., Zhou, J.N., van Heerikhuize, J., Hofman, M.A. and Swaab, D.F., 1999. Decreased melatonin levels in postmortem cerebrospinal fluid in relation to aging, Alzheimer’s disease, and apolipoprotein E-ε4/4 genotype. The Journal of clinical endocrinology & metabolism, 84(1), pp.323-327.

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