[Prevention and treatment of sleep disorders through regulation] of sleeping habits]

Healthy sleeping habits is a complex balance between behaviour, environment and circadian rhythm. The quality of sleep can be improved by behaviour, e.g. eating tryptophan and carbohydrate rich foods, physical exercise in the afternoon or a cold shower just before going to bed. Total sleep time is maximal in thermoneutrality and decreases above and below the thermoneutrality zone. Thermoneutrality is reached for an environmental temperature of 30-32 degrees C without night clothing or of 16-19 degrees with a pyjama and at least one sheet. Noise also modifies sleep structure and above 50dB shortens total sleeping time. Although subjects do become subjectively accustomed to noise, vegetative cardiovascular reactivity to environmental noise remains unchanged. The spontaneous circadian awake/sleep cycle is 25 hours, slightly longer than the body temperature cycle, but when subjects are exposed to environmental synchronization, the two cycles coincide. In individuals undergoing temporal isolation, the two rhythms become independent often leading to subjective discomfort and fatigue. Certain factors including age can favour internal desynchronization. Other factors may include social contact, stress due to mental work load, and constant lighting which could lengthen the awake/sleep cycle. Caffeine blocks the receptors of adenosine, and thus its effects of inhibiting neurotransmission. Intake 30 to 60 minutes before sleeping shortens total sleep time and increases the duration of stage 2 and shortens stage 3 and 4. Alcohol may act as a relaxing, sedative agent when consumed just before sleeping but can also lead to night-time awakening due to sympathetic activation which does not return to baseline levels until the blood alcohol levels have returned to 0. Nicotine has a biphasic effect on sleep: at low concentrations, it leads to relaxation and sedation and at high concentrations inhibits sleep. A careful study of sleeping habits is the first step in evaluating complains of insomnia or hypersomnia. Before relying on drugs, treatment should start with attention to the sleep environment and personal habits.