What Is the Worst Drug? introduces viewers to the dangers of fentanyl and the staggering mortality rates of nicotine and alcohol use.

For starters, that is a very complicated question because like, it depends on what kind of worst are you thinking about. And alcohol and nicotine are the most pervasive used drugs and because of that they also are accountable for a lot of deaths and also health issues because of prolonged use of these drugs or binge-like use of alcohol. And right now, in the US we have a very dangerous drug that is fentanyl that is a synthetic opioid that has been mixed into other drugs and is contaminating meth, coke, heroin and fentanyl is very potent and it can cause death.

1. Fentanyl is 50x more potent than heroin and when misused the consequences can be fatal.  Know this is commonly used in OR where there is cardiac rhythm monitors and a RN watching the pt closely with maybe 3 more patients; possible less.   That is how dangerous the drug is!  Fentanyl earns the top spot on this list due to it being the most addictive, most powerful, and most deadly. This fully synthetic opioid is approximately 100 times more potent than morphine and is currently the number one cause of overdose fatality in the United States. Because of its strength, even a minuscule amount of fentanyl can cause a fatal overdose in an individual who has built up opioid tolerance. One kilogram of fentanyl has the potential to kill 500,000 people.

Drugs like methamphetamine and fentanyl are extremely dangerous for an individual who’s using them, but other substances are more dangerous for the population at large because so many people use these substances, and they can have dangerous effects. So, one example of that is nicotine. Smoking causes nearly 500, 000 related deaths a year which is a pretty staggering mortality rate. Alcohol is also used by many people and it can result in health problems, it can result in overdose death, it can also cause people to be in hazardous situations, to get into car accidents as a result of impaired driving. So, at a population level, since it’s much more used it is one of the worst substances.

2. Heroin is a central nervous system depressant and semi-synthetic opiate made from the drug morphine. When used, heroin suppresses breathing and reduces heart rate to dangerously low levels. As a depressant, this opioid is the source of many fatal overdoses and has largely contributed to the ongoing opioid epidemic.

As one of the most dangerous drugs on the planet, heroin may cause breathing cessation, heart infection, liver disease, collapsed veins, and death.The National Institute on Drug Abuse reports drug overdose deaths involving heroin rose from 1,960 in 1999 to 15,469 in 2016.

Any medication you take illegal and for a high especially through your vein is addictive!

3.  Cocaineis a highly addictive stimulant that comes in powder form. When abused, the drug negatively impacts central nervous system functions and can cause stroke, cardiac arrhythmia, cardiac arrest, convulsions, and death. In 2017, drug overdose deaths involving cocaine increased by more than 34%, with almost 14,000 Americans dying from an overdose involving cocaine.

B. Crack cocaine is a form of powdered cocaine that has been chemically manipulated and hardened into a crystalline rock. Being a cheaper alternative to cocaine, crack is widely abused and extremely addictive. In 2016, there were an estimated 432,000 current crack users in the United States alone. The substance acts as a stimulant and causes irreversible bodily damage when abused.

Regardless of how much of the drug is used or how frequently, crack cocaine raises the danger of a heart attack, stroke, seizure, or respiratory failure, all of which can result in sudden death. In addition to the standard risks associated with cocaine use, crack users may experience serious respiratory troubles, including coughing, shortness of breath, lung damage, and bleeding. The heart, liver, and kidneys of long-term users of crack cocaine are severely harmed and users are more likely to be afflicted with infectious illnesses.

4. Methamphetamine  is typically referred to as “meth”, this stimulant ranks within the top five most addictive, illicit drugs in the world. When used, meth produces a rush of euphoria, increased alertness, increased energy, and feelings of invincibility. Long-term meth use can lead to high blood pressure, heart attack, and stroke, in addition to harming your liver and kidneys. Meth can also cause your brain to permanently lose dopamine, which impairs memory, speech, and other mental functions.

Psychotic problems such as mood swings, paranoia, delusions, hallucinations, and violent and aggressive behavior are also likely to arise with prolonged meth use. Even after you have stopped using meth, you may continue to experience memory loss, confusion, and insomnia for months or years. According to the United States Drug Enforcement Administration, methamphetamine was the second-largest contributor to overdose deaths in the United States between May 2019 and May 2020.

5. Oxycodone is an extremely potent opioid prescription drug. It is often available in combination with other analgesics such as aspirin or acetaminophen. Due to it being twice as potent as morphine, oxycodone is highly addictive and life-threatening when abused. As stated in the CDC’s National Vital Statistics Report, oxycodone use ranked first in overdose deaths in 2011 with 5,587 overdose fatalities that year.   It is legal by prescription only.

Oxycodone is commonly used in the hospital for pain.

6. Benzodiazepines  They are a class of prescription drugs used to treat various anxiety and sleep disorders. According to data collected by the National Institute on Drug Abuse, the number of adults filling a benzodiazepine prescription increased 67%, from 8.1 million to 13.5 million between 1996 and 2013. Due to the sedative quality of benzos, they are at high risk for abuse and addiction. Although overdose fatalities from benzodiazepines are not common, the prescription drug is very dangerous when combined with other addictive substances such as alcohol or opioids.

The Rise of Drug Use for Adults Ages 26-49

While young adults ages 18-25 have the highest rates of drug use across the board, drug use among adults ages 26-49 is on the rise:

• The percentage of adults age 26 and older using marijuana daily or almost daily has nearly doubled since 2015.
• Cocaine use and death rates have risen; cocaine-involved overdose rates in the U.S. have risen annually since 2012.
• Meth use is on the rise and overdose death rates climbed more than five-fold for those ages 25 to 54 between 2011 and 2018.
• The nation remains in a prescription and illicit opioids crisis, as 81,230 drug overdose deaths occurred in the U.S.—the highest single year ever reported—in the 12 months ending in May 2020; most of the overdose deaths involved a prescription or illicit opioid.

“The following facts on data by American Addiction Centers:

• According to the National Survey on Drug Use and Health (NSDUH), 19.7 million American adults (aged 12 and older) battled a substance use disorder in 2017.¹
• Almost 74% of adults suffering from a substance use disorder in 2017 struggled with an alcohol use disorder.¹
• About 38% of adults in 2017 battled an illicit drug use disorder.¹
• That same year, 1 out of every 8 adults struggled with both alcohol and drug use disorders simultaneously.¹
• In 2017, 8.5 million American adults suffered from both a mental health disorder and a substance use disorder, or co-occurring disorders.¹
• Drug abuse and addiction cost American society more than $740 billion annually in lost workplace productivity, healthcare expenses, and crime-related costs.²

American Addiction Centers (https://americanaddictioncenters.org/rehab-guide/addiction-statistics)

“

Know the signs of addiction:

Drug addiction symptoms or behaviors include, among others:

• Feeling that you have to use the drug regularly — daily or even several times a day
• Having intense urges for the drug that block out any other thoughts
• Over time, needing more of the drug to get the same effect
• Taking larger amounts of the drug over a longer period of time than you intended
• Making certain that you maintain a supply of the drug
• Spending money on the drug, even though you can’t afford it
• Not meeting obligations and work responsibilities, or cutting back on social or recreational activities because of drug use
• Continuing to use the drug, even though you know it’s causing problems in your life or causing you physical or psychological harm
• Doing things to get the drug that you normally wouldn’t do, such as stealing
• Driving or doing other risky activities when you’re under the influence of the drug
• Spending a good deal of time getting the drug, using the drug or recovering from the effects of the drug
• Failing in your attempts to stop using the drug
• Experiencing withdrawal symptoms when you attempt to stop taking the drug

Recognizing unhealthy drug use in family members

Sometimes it’s difficult to distinguish normal teenage moodiness or anxiety from signs of drug use. Possible signs that your teenager or other family member is using drugs include:

• Problems at school or work — frequently missing school or work, a sudden disinterest in school activities or work, or a drop in grades or work performance
• Physical health issues — lack of energy and motivation, weight loss or gain, or red eyes
• Neglected appearance — lack of interest in clothing, grooming or looks
• Changes in behavior — major efforts to bar family members from entering the teenager’s room or being secretive about going out with friends; or drastic changes in behavior and in relationships with family and friends
• Money issues — sudden requests for money without a reasonable explanation; or your discovery that money is missing or has been stolen or that items have disappeared from your home, indicating maybe they’re being sold to support drug use.

Alcohol Addiction:

People who drink are affected even before they show signs of being drunk, especially when it comes to decision-making abilities.

At first, alcohol causes people to feel upbeat and excited. But this is temporary and they shouldn’t be fooled.

If drinking continues, the effects on the body—and the potential risks—multiply. Here’s what can happen:

• Inhibitions and memory: People may say and do things that they will regret later, or possibly not remember at all. Inhibitions are lost – leading to poor decision making.
• Decision-making skills: When they drink, individuals are more likely to be impulsive. They may be at greater risk for having an alcohol-related traffic crash, getting into fights, or making unwise decisions about sex.
• Coordination and physical control: When drinking leads to loss of balance, slurred speech, and blurred vision, even normal activities can become more dangerous.
• Death: Drinking too much alcohol can also lead to death. If people drink too much, they will eventually get sleepy and pass out. Reflexes like gagging and breathing can be suppressed. That means they could vomit and choke, or stop breathing completely.

And finally, it’s easy to misjudge how long alcohol’s effects last. Alcohol continues to affect the brain and body long after the last drink has been finished. Even after someone stops drinking, alcohol in the stomach and intestine continues to enter the bloodstream, impairing judgment and coordination for hours.

An alcohol blackout is a gap in a person’s memory for events that took place while he or she was drinking. When a blackout happens, a person’s brain does not create memories for these events as they are happening. For people who have had a blackout, it can be frightening to wake up the next day and not remember what they did the night before.

Teens drink for a variety of reasons. Some teens want to experience new things. Others feel pressured into drinking by peers. And some are looking for a way to cope with stress or other problems. Unfortunately, drinking will only make any problems a person has already worse, not better.

Symptoms

Alcohol is a drug!  Alcohol use disorder can be mild, moderate or severe, based on the number of symptoms you experience. Signs and symptoms may include:

• Being unable to limit the amount of alcohol you drink
• Wanting to cut down on how much you drink or making unsuccessful attempts to do so
• Spending a lot of time drinking, getting alcohol or recovering from alcohol use
• Feeling a strong craving or urge to drink alcohol
• Failing to fulfill major obligations at work, school or home due to repeated alcohol use
• Continuing to drink alcohol even though you know it’s causing physical, social, work or relationship problems
• Giving up or reducing social and work activities and hobbies to use alcohol
• Using alcohol in situations where it’s not safe, such as when driving or swimming
• Developing a tolerance to alcohol so you need more to feel its effect or you have a reduced effect from the same amount
• Experiencing withdrawal symptoms — such as nausea, sweating and shaking — when you don’t drink, or drinking to avoid these symptoms

Clinical Symptoms of alcohol poisoning include:

• Confusion
• Difficulty remaining conscious
• Vomiting
• Seizures
• Trouble with breathing
• Slow heart rate
• Clammy skin
• Dulled responses, such as no gag reflex (which prevents choking)
• Extremely low body temperature
• Death.

Alcohol use disorder can include periods of being drunk (alcohol intoxication) and symptoms of withdrawal.

• Alcohol intoxication results as the amount of alcohol in your bloodstream increases. The higher the blood alcohol concentration is, the more likely you are to have bad effects. Alcohol intoxication causes behavior problems and mental changes. These may include inappropriate behavior, unstable moods, poor judgment, slurred speech, problems with attention or memory, and poor coordination. You can also have periods called “blackouts,” where you don’t remember events. Very high blood alcohol levels can lead to coma, permanent brain damage or even death.
• Alcohol withdrawal can occur when alcohol use has been heavy and prolonged and is then stopped or greatly reduced. It can occur within several hours to 4 to 5 days later. Signs and symptoms include sweating, rapid heartbeat, hand tremors, problems sleeping, nausea and vomiting, hallucinations, restlessness and agitation, anxiety, and occasionally seizures. Symptoms can be severe enough to impair your ability to function at work or in social situations.

When to see a doctor:

If you feel that you sometimes drink too much alcohol, or your drinking is causing problems, or if your family is concerned about your drinking, talk with your health care provider. Other ways to get help include talking with a mental health professional or seeking help from a support group such as Alcoholics Anonymous or a similar type of self-help group.

Because denial is common, you may feel like you don’t have a problem with drinking. You might not recognize how much you drink or how many problems in your life are related to alcohol use. Listen to relatives, friends or co-workers when they ask you to examine your drinking habits or to seek help. Consider talking with someone who has had a problem with drinking but has stopped.

Causes:

Genetic, psychological, social and environmental factors can impact how drinking alcohol affects your body and behavior. Theories suggest that for certain people drinking has a different and stronger impact that can lead to alcohol use disorder.

Over time, drinking too much alcohol may change the normal function of the areas of your brain associated with the experience of pleasure, judgment and the ability to exercise control over your behavior. This may result in craving alcohol to try to restore good feelings or reduce negative ones.

Risk factors:

Alcohol use may begin in the teens, but alcohol use disorder occurs more frequently in the 20s and 30s, though it can start at any age.

Risk factors for alcohol use disorder include:

• Steady drinking over time. Drinking too much on a regular basis for an extended period or binge drinking on a regular basis can lead to alcohol-related problems or alcohol use disorder.
• Starting at an early age. People who begin drinking — especially binge drinking — at an early age are at a higher risk of alcohol use disorder.
• Family history. The risk of alcohol use disorder is higher for people who have a parent or other close relative who has problems with alcohol. This may be influenced by genetic factors.
• Depression and other mental health problems. It’s common for people with a mental health disorder such as anxiety, depression, schizophrenia or bipolar disorder to have problems with alcohol or other substances.
• History of trauma. People with a history of emotional trauma or other trauma are at increased risk of alcohol use disorder.
• Having bariatric surgery. Some research studies indicate that having bariatric surgery may increase the risk of developing alcohol use disorder or of relapsing after recovering from alcohol use disorder.
• Social and cultural factors. Having friends or a close partner who drinks regularly could increase your risk of alcohol use disorder. The glamorous way that drinking is sometimes portrayed in the media also may send the message that it’s OK to drink too much. For young people, the influence of parents, peers and other role models can impact risk.

Complications:

Alcohol depresses your central nervous system. In some people, the initial reaction may feel like an increase in energy. But as you continue to drink, you become drowsy and have less control over your actions.

Too much alcohol affects your speech, muscle coordination and vital centers of your brain. A heavy drinking binge may even cause a life-threatening coma or death. This is of particular concern when you’re taking certain medications that also depress the brain’s function.

Excessive drinking can reduce your judgment skills and lower inhibitions, leading to poor choices and dangerous situations or behaviors.

Health Problems That can Arise:

• Liver disease. Heavy drinking can cause increased fat in the liver (hepatic steatosis) and inflammation of the liver (alcoholic hepatitis). Over time, heavy drinking can cause irreversible destruction and scarring of liver tissue (cirrhosis).
• Digestive problems. Heavy drinking can result in inflammation of the stomach lining (gastritis), as well as stomach and esophageal ulcers. It can also interfere with your body’s ability to get enough B vitamins and other nutrients. Heavy drinking can damage your pancreas or lead to inflammation of the pancreas (pancreatitis).
• Heart problems. Excessive drinking can lead to high blood pressure and increases your risk of an enlarged heart, heart failure or stroke. Even a single binge can cause serious irregular heartbeats (arrhythmia) called atrial fibrillation.
• Diabetes complications. Alcohol interferes with the release of glucose from your liver and can increase the risk of low blood sugar (hypoglycemia). This is dangerous if you have diabetes and are already taking insulin or some other diabetes medications to lower your blood sugar level.
• Issues with sexual function and periods. Heavy drinking can cause men to have difficulty maintaining an erection (erectile dysfunction). In women, heavy drinking can interrupt menstrual periods.
• Eye problems. Over time, heavy drinking can cause involuntary rapid eye movement (nystagmus) as well as weakness and paralysis of your eye muscles due to a deficiency of vitamin B-1 (thiamin). A thiamin deficiency can result in other brain changes, such as irreversible dementia, if not promptly treated.
• Birth defects. Alcohol use during pregnancy may cause miscarriage. It may also cause fetal alcohol spectrum disorders (FASDs). FASDs can cause a child to be born with physical and developmental problems that last a lifetime.
• Bone damage. Alcohol may interfere with making new bone. Bone loss can lead to thinning bones (osteoporosis) and an increased risk of fractures. Alcohol can also damage bone marrow, which makes blood cells. This can cause a low platelet count, which may result in bruising and bleeding.
• Neurological complications. Excessive drinking can affect your nervous system, causing numbness and pain in your hands and feet, disordered thinking, dementia, and short-term memory loss.
• Weakened immune system. Excessive alcohol use can make it harder for your body to resist disease, increasing your risk of various illnesses, especially pneumonia.
• Increased risk of cancer. Long-term, excessive alcohol use has been linked to a higher risk of many cancers, including mouth, throat, liver, esophagus, colon and breast cancers. Even moderate drinking can increase the risk of breast cancer.
• Medication and alcohol interactions. Some medications interact with alcohol, increasing its toxic effects. Drinking while taking these medications can either increase or decrease their effectiveness, or make them dangerous.

Marijuana, hashish & other cannabis-containing substances:

People use cannabis by smoking, eating or inhaling a vaporized form of the drug. Cannabis often precedes or is used along with other substances, such as alcohol or illegal drugs, and is often the first drug tried.

Signs and symptoms of recent use can include:

• A sense of euphoria or feeling “high”
• A heightened sense of visual, auditory and taste perception
• Increased blood pressure and heart rate
• Red eyes
• Dry mouth
• Decreased coordination
• Difficulty concentrating or remembering
• Slowed reaction time
• Anxiety or paranoid thinking
• Cannabis odor on clothes or yellow fingertips
• Major cravings for certain foods at unusual times

Long-term use is often associated with:

• Decreased mental sharpness
• Poor performance at school or at work
• Ongoing cough and frequent lung infections

Barbiturates, benzodiazepines and hypnotics:

Barbiturates, benzodiazepines and hypnotics are prescription central nervous system depressants. They’re often used and misused in search for a sense of relaxation or a desire to “switch off” or forget stress-related thoughts or feelings.

• Barbiturates. An example is phenobarbital.
• Benzodiazepines. Examples include sedatives, such as diazepam (Valium), alprazolam (Xanax), lorazepam (Ativan), clonazepam (Klonopin) and chlordiazepoxide (Librium).
• Hypnotics. Examples include prescription sleeping medicines such as zolpidem (Ambien) and zaleplon (Sonata).

Signs and symptoms of recent use can include:

• Drowsiness
• Slurred speech
• Lack of coordination
• Irritability or changes in mood
• Problems concentrating or thinking clearly
• Memory problems
• Involuntary eye movements
• Lack of inhibition
• Slowed breathing and reduced blood pressure
• Falls or accidents
• Dizziness

Complications to the body with these legal and illegal medications:

• Taking part in risky behaviors such as drink driving or unprotected sex
• Changes in behavior such as mood swings or increased aggression toward others
• Impacts on sleep or experiencing insomnia
• Cognitive/memory problems
• Reduced appetite or not eating a balanced diet
• Regular colds and flu
• Long term health impacts such as liver, kidney and heart problems or cancer (depending on the type of drug used and how frequently it was used)

“Drug addiction is one of the most prevalent health-related issues that Americans of all demographics currently face. Drug addiction is a non-discriminatory disease, and it can affect anyone regardless of their sex, gender, age, occupation or current economic standing. The consequences associated with drug abuse are far-reaching and vary significantly depending on the type of chemical substance involved. Some consistent consequences, however, include interpersonal problems, issues at work or school, legal issues, financial insecurity, a range of health-related complications and a rapid deterioration of all other areas of life.

According to a recent study published by the National Institute of Health, it is estimated that 10 percent of all Americans have struggled with a drug abuse disorder of some severity at least once during their lifetimes. Sadly, of these men, women and adolescents, 75 percent reported that they did not seek or receive the professional drug addiction treatment they required. Ten percent of American men and women equate to roughly 23 million individuals.”

Princeton Detox and Recovery Center (https://www.princetondetox.com/10-facts-about-drug-addiction/?swp=drug%20and%20alcohol&campaign=173086)

As the legalization of medical marijuana and marijuana use are both on the rise in the United States, people are not necessarily using alcohol less and may be unaware of the risks of combining alcohol and marijuana, according to researchers.

A new study from Penn State found that compared to people who only drank alcohol, those who used alcohol and marijuana simultaneously were more likely to drink heavier and more often. They were also more likely to experience alcohol-related problems — like impulsive actions they later regretted.

“The results suggest that individuals who simultaneously use alcohol and marijuana are at a disproportionately higher risk for heavy, frequent and problematic substance use,” said Ashley Linden-Carmichael, assistant research professor at the Edna Bennett Pierce Prevention Research Center at Penn State.

The researchers said the findings — recently published in the journal Substance Use and Misuse — also suggest that prevention and intervention programs should take into account not just alcohol, but also if people are using additional substances, as well.

“Right now, a lot of campus programs focus on whether students are drinking, and while sometimes they are asked about other substances, it’s not necessarily whether they’re using these substances simultaneously,” Linden-Carmichael said. “I think we do need to be asking about whether they’re drinking in combination with other drugs, and educating students about how that exacerbates their risk.”

According to the researchers, marijuana use is at an all-time high among young adults in the U.S., possibly leading to people using marijuana and alcohol simultaneously.

“The problem with simultaneous use is that it can affect people cognitively and perceptually, and also have an impact on motor impairment,” Linden-Carmichael said. “There is a burgeoning area of research that is examining why people are using marijuana and alcohol together and what those effects are.”

Healthline states When it comes to drugs, alcohol and weed are among the most commonly used substances. But what really happens when they team up?   Occasionally mixing alcohol and weed — also known as crossfading — likely won’t lead to major health problems. But there are a lot of variables to consider, including which one you use first and how you consume them.  If you aren’t careful, the duo can lead to a case of the spins or a green out, two reactions that can turn a fun night out into a nauseated night in.  It’s also important to remember that people can have very different reactions to the same mix of alcohol and weed. If you’re out in a group, one person’s reaction might be very different than yours.

Drinking before using weed can intensify weed’s effects. This is because alcohol increases the absorption of weed’s main psychoactive ingredient, delta-9-tetrahydrocannabinol (THC).

This generally results in a stronger high. While this might be nice for some folks, it can cause others to green out. This refers to a range of unpleasant physical symptoms that can result from a strong high.

Symptoms of a green out include:

• sweating
• dizziness
• nausea
• vomiting

“Balance” is the latest word on heart-healthy eating, according to the American Heart Association Scientific Statement that encourages people to adapt broad eating habits instead of focusing on single foods — and it’s not one size fits all.

“The World Sleep Society’s annual World Sleep Day is being held on Friday 17 March. This year’s theme is Sleep is Essential for Health.

Sleep is an essential, core pillar of health and is often under-valued and poorly understood. It’s as important as diet and exercise. The Sleep Health Foundation aims to raise the awareness of the importance of sleep and The World Sleep Society’s annual World Sleep Day is a great opportunity to do this.”

Sleep Health Foundation (https://www.sleephealthfoundation.org.au/key-events/world-sleep-day-2023.html)

“Obesity is a complex disease involving an excessive amount of body fat. So what does this mean? When it comes to sleep, can you have too much of a good thing? It’s true a good night’s sleep is essential for health. But oversleeping has been linked to a host of medical problems, including diabetes, heart disease, and increased risk of death.  Know diabetes and heart disease can be linked to obese.

WebMD (https://www.webmd.com/sleep-disorders/physical-side-effects-oversleeping)

When awake, most people exhibit the brain wave patterns that can be classified into two types of waves, beta and alpha. Beta waves are those associated with day to day wakefulness. These waves are the highest in frequency and lowest in amplitude, and also more desynchronous than other waves. That is, the waves are not very consistent in their pattern. This desynchrony makes sense given that day to day mental activity consists of many cognitive, sensory, and motor activities and experiences, and, thus, when awake, we are mentally desynchronous as well. During periods of relaxation, while still awake, our brain waves become slower, increase in amplitude and become more synchronous. These types of waves are called alpha waves. For example, such brain waves are often associated with states of relaxation and peacefulness during meditation and biofeedback.

The first stage of sleep is characterized by theta waves, which are even slower in frequency and greater in amplitude than alpha waves. The difference between relaxation and stage 1 sleep is gradual and subtle. As the sleeper moves to stage 2 sleep theta wave activity continues, interspersed with two unusual wave phenomena. These phenomena, which occur periodically every minute or so, and are defining characteristics of stage 2 sleep, are termed sleep spindles and K complexes. The former is a sudden increase in wave frequency, and the latter is a sudden increase in wave amplitude. Stages 1 and 2 are relatively “light” stages of sleep. In fact, if someone is awoken during one of these stages, he or she will often report no being asleep at all.

Stage 1 is light sleep where you drift in and out of sleep and can be awakened easily. In this stage, the eyes move slowly and muscle activity slows. During this stage, many people experience sudden muscle contractions preceded by a sensation of falling. The first stage of sleep is characterized by theta waves, which are even slower in frequency and greater in amplitude than alpha waves. The difference between relaxation and stage 1 sleep is gradual and subtle. As the sleeper moves to stage 2 sleep theta wave activity continues, interspersed with two unusual wave phenomena. These phenomena, which occur periodically every minute or so, and are defining characteristics of stage 2 sleep, are termed sleep spindles and K complexes. The former is a sudden increase in wave frequency, and the latter is a sudden increase in wave amplitude. Stages 1 and 2 are relatively “light” stages of sleep. In fact, if someone is awoken during one of these stages, he or she will often report not being asleep at all.

In stage 2, eye movement stops and brain waves become slower with only an occasional burst of rapid brain waves.

When a person enters stage 3, extremely slow brain waves called delta waves are interspersed with smaller, faster waves.

In stage 4, the brain produces delta waves almost exclusively.

Stages 3 and 4 are referred to as deep sleep or delta sleep, and it is very difficult to wake someone from them. In deep sleep, there is no eye movement or muscle activity. This is when some children experience bedwetting, sleepwalking or night terrors. In 2008 the sleep profession in the US eliminated the use of stage 4. Stages 3 and 4 are now considered stage 3 by them.

Slow wave sleep comes mostly in the first half of the night, REM in the second half.  Waking may occur after REM.  If the waking period is long enough, the person may remember it the next morning.  Short awakenings may disappear with amnesia.

In the REM period, breathing becomes more rapid, irregular and shallow, eyes jerk rapidly and limb muscles are temporarily paralyzed. Brain waves during this stage increase to levels experienced when a person is awake. Also, heart rate increases, blood pressure rises, males develop erections and the body loses some of the ability to regulate its temperature. This is the time when most dreams occur, and, if awoken during REM sleep, a person can remember the dreams. Most people experience three to five intervals of REM sleep each night.

Infants spend almost 50% of their time in REM sleep. Adults spend nearly half of sleep time in stage 2, about 20% in REM and the other 30% is divided between the other three stages. Older adults spend progressively less time in REM sleep.

“Sleep quality is different from sleep quantity. Sleep quantity measures how much sleep you get each night, while sleep quality measures how well you sleep.

Measuring sleep quantity is simple, as it’s quick to determine if you’re getting the recommended amount of sleep per night (usually defined as 7-9 hours for adults). Measuring sleep quality is a little more of an art than a science. Generally, good sleep quality is defined by the following characteristics:

• You fall asleep soon after getting into bed, within 30 minutes or less.
• You typically sleep straight through the night, waking up no more than once per night.
• You’re able to sleep the recommended amount of hours for your age group.
• You fall back asleep within 20 minutes if you do wake up.
• You feel rested, restored, and energized upon waking up in the morning.”.

Sleep Foundation (https://www.sleepfoundation.org/sleep-hygiene/how-to-determine-poor-quality-sleep)