Sleep Medicine in New Jersey

woman sleeping in bed

New Jersey’s Sleep Specialists

Sleep medicine is a medical specialty devoted to the diagnosis and treatment of sleep disorders. Riverside Medical Group is the premier sleep medicine institution in northern New Jersey. Our board-certified sleep specialists and state-of-the-art facilities offer top class care and multi-modality treatment of a wide range of sleep disorders. Learn more about the science of sleep, its impacts on our health, sleep disorders, and more here.

All humans need sleep. The brain and nervous system are restored during REM sleep. This is essential for their proper control of body functions while awake. Without proper sleep, the entire body suffers.

Typically, the body naturally knows when it needs to rest. The circadian cycle is the body’s tendency to feel drowsy in the evening, with continued sleepiness throughout the night and into the early morning hours. At this time, the body begins to shift toward wakefulness. There is generally another increase in drowsiness between mid- and late- afternoon, leading to what many refer to as “a second wind.”

Daylight and nighttime play a large role in the circadian cycle – we get sleepy when it gets dark and wake up when the sun shines. However, many of our activities also give cues to our brains that it’s time to go to sleep or wake up. For example, our bedtime routines signal to the body that it’s time for rest, while our morning routines can get us going for the day.

You may be wondering how much sleep you need each night. While the exact amount can vary from person to person, 7-8 hours or more per night is recommended. If you’re not getting enough quality sleep on a regular basis, you may have a sleep disorder.

The Sleep Cycle

During sleep, the brain flows through different sleep stages. There are two types of sleep: REM (rapid eye movement) and NREM (non-rapid eye movement). NREM sleep is composed of three numbered stages.

Sleep Stage Transition

Stage 1 sleep lies between wakefulness and light sleep. It is the moment where people drift in and out of sleep and can be easily awakened. In this stage, the brain transitions from alpha waves to theta. Twitches and sudden jerks typically occur during this stage of sleep.

Stage 2 sleep is a light sleep. It is characterized by a marked decrease in muscle activity and little to no awareness of the person’s surroundings. This stage accounts for 45 to 55% of total sleep in adults.

Stage 3 is known as delta, or slow-wave, sleep and is a stage of deep NREM sleep. This sleep stage is central for the regulation of important hormones such as cortisol and growth hormones. During Stage 3, the body regenerates tissue, builds bone, and grows muscle during this stage.

REM sleep is the stage of sleep in which dreaming occurs. It is characterized by rapid eye movements and increased brain activity. It accounts for 20-25% of total sleep time in adults. REM sleep is also associated with extreme instability of the respiratory and cardiac functions.

Sleep Timing – The Circadian Rhythm

The circadian rhythm is an innate biological mechanism by which we are tuned to a 24-hour sleep-wake cycle. The rhythms are adjusted by the body’s awareness of daylight and night. All life forms have cycles of rest and activity. In humans and higher animals, physiological functions are organized into the circadian cycle (from “circa-” meaning “about” and “-dian” meaning “day”).

The circadian cycle is maintained by internal and external factors. Internal factors are genetically determined and are controlled by the supraoptic nucleus. This is a collection of cells deep in the brain that receives signals generated from external factors, specifically, light and dark (i.e. day and night). In turn, this controls the release of melatonin by the pituitary gland. The cycling of melatonin levels in correspondence with day and night promotes sleep at night and wakefulness during the day.

The cycle also governs multiple physiological functions such as the secretion of hormones, gastrointestinal and cardiovascular functions, alertness, and lethargy.

The Circadian Rhythm

Generally, the cycle dictates an increased tendency towards sleepiness in the late evening hours, which continues to increase throughout the night until early morning hours. Then, that sleepiness starts to decrease while there is a corresponding increase in the tendency to be awake and alert during the daytime hours. The rise of the wakefulness and decline of sleepiness continue until mid-afternoon when for a brief period (shortly after lunch), sleepiness increases while alertness diminishes, until it reverses again until late afternoon.

Therefore, there isn’t a state of 100% sleep or 100% wakefulness. Instead, there is a majority of one or the other that work against each other like yin and yang. Other factors that regulate the sleep-wake cycle include clues and activities that relate to the time of day – routines such as breakfast, lunch and dinner, and getting ready for bed. These are collectively called zeitgebers – a German word that means “time setters”.

The routine necessities of daily life – waking up at a set time in the morning, going to work at a scheduled time, and exposure to sunlight throughout the day – are potent factors in maintaining a normal circadian cycle. However, if these routines are disrupted by something such as a change in schedule, it can cause a disorder called phase delay syndrome.

An example would be a summer recess for a high school student who progressively goes to bed later each night and sleeps later each morning, decreasing exposure to morning sunlight. As a result, when school resumes in the fall, the student will have trouble waking up timely each morning until their routine resets.

Sleep Duration Recommendations


Signs of a Sleep Disorder

Almost 80 million Americans suffer from clinically significant sleep disorders and nearly 90% go undiagnosed and untreated. Many don’t know what good sleep feels like and think because they’ve always slept a certain way, they always will. While we all have periods when we don’t sleep well, prolonged sleep loss can lead to a variety of health conditions. For this reason, it’s important to look for signs of sleep disorders and then seek advice from a sleep specialist to discover the root cause and find a treatment solution.

Signs of a sleep disorder include:

  • Daytime tiredness – You should wake up refreshed with energy throughout the day. Daytime tiredness includes​:
    • A feeling of fatigue
    • Lack of energy
    • Irritability
    • Inability to pay attention at work or in school
    • Lack of interest or motivation to socialize or relate to others
    • Appearing haggard or tired, and having dark circles or bags under the eyes
  • Difficulty waking up – As stated above, you should wake up feeling refreshed. For some, a brief period of grogginess is common, but it should not last long. Once fully awake, you should remain that way throughout the day. However, if you’re unable to wake up in the morning without great difficulty, it could be a sign you didn’t sleep well enough or for an adequate amount of time the night before.​
  • Interrupted sleep – You should sleep soundly for most of the night, with only two to three brief awakenings. Waking up more often, or remaining awake, is a sign of disordered sleeping.​
  • Snoring, choking, or pauses in breathing – This may be difficult for you to be aware of on your own, but these symptoms are very often associated with a serious sleep disorder called sleep apnea.
  • Difficulty falling asleep or staying asleep – Whether you’re unable to fall asleep, you wake too early, or you have a period where you cannot fall back to sleep during the night, ongoing insomnia is a sign that something is wrong.

Sometimes we know exactly why our sleep is interrupted and, therefore, why we are tired the next day. A noise, a head cold, or a crying baby can all wake us up and leave us fatigued. If you are tired and you don’t know why it’s important to keep in mind that you may not realize how often you wake up during the night. If a bed partner indicates you aren’t sleeping peacefully – you toss and turn, or seem to have difficulty breathing, for example – it’s possible you have a sleep disorder that should be evaluated by a professional.

Risks Associated with Poor Sleep in Adults

Poor sleep does more to your body than just make you feel tired. It can lead to a number of changes in the body that can result in more serious illnesses. Persistent sleep loss, defined as fewer than five hours of sleep per night, can have devastating effects on overall health. Many of these health issues can also contribute to poor sleep, leading to a vicious cycle of poor health.

Inadequate rest can cause or worsen the following:

  • Cardiovascular (heart) disease
  • Hypertension
  • Diabetes
  • Obesity
  • Attention Deficit Disorder
  • Depression, anxiety, and other health concerns
  • Car accidents
  • Poor performance at work or job-related accidents

What’s more, lack of sleep can lead to hormonal changes within the body that can increase hunger and cravings for junk food. Overeating or making the wrong food choices can contribute to obesity, which often causes or worsens sleep apnea. Sleep apnea, a common sleep disorder, can result in ongoing, low-quality sleep, leading to even more fatigue.

What Can You Do

In our fast-paced world, it’s easy to think feeling tired is just a fact of life. You may feel like you’ve always been tired, and you’ll always be tired. This simply isn’t so. Most of the time, you should feel rested and alert upon waking, or shortly thereafter.

If you’re not sleeping well or you’re still tired after a full night of rest, it’s time to consult a sleep professional. Doctors who specialize in sleep medicine are able to make a full diagnosis of your sleep issue and provide a structured treatment plan.

You can expect your sleep health provider to utilize a full medical examination to look for things that may contribute to your sleep issues. They’ll check your weight, blood pressure, and heart rate, as well as examine your mouth, throat, tongue, and nose for breathing issues. You may even be prescribed a sleep test in a sleep lab or at home. These tests record data while you’re asleep, giving doctors a better idea of what’s happening when you’re not awake.

Once it is determined why you’re not sleeping properly, a treatment plan will be developed. There are a variety of different approaches available to treat sleep disorders. In many cases, the treatment will not only involve addressing the sleep portion of the problem, but also any underlying health concerns that are caused by or contribute to the sleep disorder.

Learn more about treatments for sleep disorders.

Sleep Basics for Children

Children of all ages need more sleep than adults. Like adults, their brains and bodies use sleep as a time to restore themselves in order to maintain proper function. However, a child’s body is constantly growing, increasing the need for proper rest. A child who does not get adequate sleep during this critical time will face not only immediate health issues but also health issues that will continue to follow them well into adulthood.

The list below outlines the recommended number of hours of sleep through age 25:

Signs of a sleep disorder include:

  • 0-3 months old: 14-17 hours*
  • 4-11 months old: 12-15 hours*
  • 1-2 years old: 11-14 hours*
  • 3-5 years old: 10-13 hours*
  • 6-13 years old: 9-11 hours
  • 14-17 years old: 8-10 hours
  • 18-25 years old: 7-9 hours
  • These total sleep requirements include naps.

Signs of Sleep Disorders in Children

Children can experience difficulty sleeping on occasion, just like adults. A few nights of improper sleep are generally not something to be concerned about. However, prolonged improper sleep should be investigated by a sleep medicine healthcare provider.

Some symptoms need to be immediately evaluated by a sleep specialist as they are likely to mean the child has a serious sleep disorder. These include:

  • Snoring – no child should snore often while they sleep.
  • Parasomnias such as sleepwalking and night terrors
  • Bed-wetting

Habitual snoring (more than three nights per week) in young children is an immediate indicator of a sleep disorder. Parasomnias like sleepwalking and tossing and turning throughout the night that continue past the age of 10 or which pose a safety concern (falling while sleepwalking, for example), should be immediately evaluated by a sleep medicine professional.

Other signs and symptoms which occur during wakefulness and are likely to indicate that your child has a sleep disorder are:

  • Crankiness and irritability
  • Excessive daytime sleepiness or unusual nap patterns
  • Behavioral problems at home or at school
  • Oppositional or defiant behavior
  • Learning disabilities or poor school performance
  • Attention Deficit Disorder/Attention Deficit and Hyperactivity Disorder (ADD/ADHD)
  • Failure to thrive or excessive weight gain and obesity

Recognizing, diagnosing, and treating childhood sleep disorders can be especially challenging for a variety of reasons. For example, younger children are often not able to communicate what they are experiencing. Adults may also be unaware of how restless a child’s sleep is if they appear to be sleeping through the night.

Moreover, many children’s health issues have similar warning signs, leaving a long list of possible conditions to rule out. While this can feel overwhelming, it’s important to look at how a child is sleeping when faced with any type of health condition.

Often parents believe their child will grow out of these behaviors and, in fact, they might. However, because of the serious risks involved with prolonged sleep deficiency in children, these behaviors should not be taken lightly.

Risks Associated with Poor Sleep in Children

Children face severe consequences if they do not routinely get adequate sleep and, if left untreated, these effects can follow them into adulthood. Many of the conditions that result from disordered sleeping can also increase the risk of sleep problems, creating an ongoing and worsening cycle of health concerns.

These are just a few of the health concerns poorly-rested children face:

  • Behavioral problems at school including oppositional behavior, irritability, and an inability to focus can lead to difficulty forming relationships with peers. This can result in anxiety and other mental health concerns that can make sleeping difficult.
  • Obese children are more likely to have other chronic health conditions such as asthma, type 2 diabetes, sleep apnea, and heart disease. They are bulled more often than their peers, leaving them more likely to suffer from emotional issues such as low self-esteem and depression. These mental and physical health concerns all contribute to poor sleeping.
  • Obese children are also more likely to be obese as adults, carrying a higher risk for heart disease, cancer, metabolic syndrome, and type 2 diabetes.
  • Excessive daytime sleepiness can result in dangerous situations for children as they participate in sports and other activities. Fatigued driving is particularly dangerous for young, newly-licensed drivers.
  • Sleep apnea in children is often a result of nasal, sinus, or ear problems, mouth breathing, enlarged tonsils, or thyroid issues. Left untreated, these issues can worsen leading to infections, increased use of antibiotics, and other health concerns.
  • Inadequate rest can make children more likely to catch cold and flu viruses. Illnesses like these can disrupt sleep further and contribute to additional problems in school.

What Can You Do?

A sleep medicine healthcare provider can examine your child to determine the nature of their sleep problems and identify any underlying health issues that may be causing or resulting from improper sleep. The doctor will check your child’s weight, blood pressure, and heart rate, as well as examine their mouth, throat, tongue, and nose for breathing issues. They may even be prescribed a sleep test in a sleep lab or at home. These tests record data while the patient is sleeping, giving doctors a better idea of what’s happening when the child is not awake.

Once a diagnosis is made, a treatment plan can be developed. There are a variety of different approaches available to deal with a sleeping disorder. In many cases, the treatment will involve not only addressing the sleep portion of the problem, but also addressing any underlying health concerns that are caused by or contributing to the sleep disorder.

Learn more about treatments for sleep disorders.