There are two types of sleep: rapid eye movement (REM) sleep and non-rapid eye movement (NREM) sleep.

It is during REM sleep that we dream. Except for your eyes and lungs, your body muscles do not move during REM sleep. Typically, we spend more than two hours per night in dreaming. Why we dream or how, is still largely a mystery. Mammals and birds show signs of REM sleep, but reptiles and other cold-blooded animals do not. REM sleep has been found to stimulate those regions of the brain employed in learning, which might explain why adults spend less time in REM sleep than do infants. People who learned a skill and afterward had REM sleep can recall what they learned better than those people deprived of REM sleep.

There are four stages of NREM sleep, distinguishable by EEG waves. Our early sleep is made up of NREM sleep. NREM sleep is considered a “resting state” of sleep, following the intensity of waking brain activity. During NREM sleep, brain activity does not steadily decrease, but rather, activity is still taking place in certain areas of the brain.

REM sleep alternates with NREM about every 90 minutes. People sleeping normally generally have four to five cycles of REM-NREM sleep during the sleep period.

After taking a physical exam and a medical and sleep history, your doctor may suggest one or more of the following tests to diagnose insomnia:

• Sleep Diary: a diary kept for a few weeks to record your sleep patterns

• Epworth Sleepiness Scale: used to assess your daytime drowsiness (see below)

• Polysomnogram: measures your sleep activity

• Actigraphy: A small instrument worn on the wrist like a watch, is often used where a sleep test is not indicated. This instrument is useful in assessing daytime sleepiness, and in evaluating insomnia and other sleep disorders. It is also used to determine the effectiveness of various treatments for sleep disorders.

• Mental Health Exam: Since insomnia could be a symptom of an underlying mental health disorder, a mental health history, basic mental evaluation and a mental status examination may be part of your original assessment.

Epworth Sleepiness Scale

Before the test, do not take any sleeping medication or drink alcohol or caffeinated beverages.

This is a questionnaire that assesses your daytime sleepiness. It asks how likely you are to fall asleep in certain situations, as opposed to just feeling tired. It is scored numerically as follows:

0 = no chance of dozing

1 = slight chance of dozing

2 = moderate chance of dozing

3 = high chance of dozing

The situations are:

Sitting and reading

Watching TV

Riding in a car for an hour without a break

Sitting still in a public place (a meeting or theater)

Sitting and talking to someone

Lying down to rest in the afternoon

In a car, stopped for a few minutes in traffic

Sitting quietly after a non-alcoholic lunch

The participant is asked to score him or herself for each situation, then total the points. The Doctor then helps interpret the results.

This test is designed to reveal possible sleep disorders such as:

• Narcolepsy

• Excessive daytime sleepiness

• Hypersomnia

• Insomnia

• Sleep Apnea and other breathing difficulties

• “Restless Leg Syndrome”

• REM behavior disorder (physically acting dreams out)

If you are having difficulties sleeping, check with your healthcare practitioner. He or she may perform a physical exam and take your medical and sleep history to help isolate the cause of your problem. Other tests may also be required.

It is extremely important that you get a definite diagnosis before treating yourself with over-the-counter medications. Many symptoms are shared in many diseases and conditions. If you end up treating yourself for the wrong thing, treatment of the real problem may be delayed.