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To be in the arms of Morpheus

July 26, 2014, DHNS: 21:33 IST
From sleep attacks to insomnia and the restless legs syndrome, getting a good night’s rest can be quite a challenge. Dr Manvir Bhatia shares insights on how to sleep well for good health.

It’s such an integral part of our lives. Yet most of us know so little about sleep. Ever wondered why some manage to “sleep like a baby”, while others toss and turn in their beds every night, waiting for the sleep gods to show some mercy?

Sleep, simply put, is a natural periodic state of rest for the mind and body, with decrease in bodily movement and responsiveness to external stimuli. It is a must because a number of crucial tasks are carried out by the human body during sleep, to maintain good health.

Snoring, gasping, excessive sleepiness during the day, choking in sleep, frequent visits to bathroom in the night, difficulty falling asleep, felling tired or un-refreshed on waking up, leg pain during bedtime, difficulty in keeping the blood pressure and blood sugar levels in check, these are all signs that something is not quite right.

It is really important to recognise the symptoms of sleep disorders early so as to avoid complications. Sleep deprivation is known to lead to high blood pressure, heart disease, brain attack (stroke), diabetes, depression, accidents at work and while driving, even sudden death.

Some sleep disorders may seriously affect the individual’s mental, emotional and physical health. Obstructive sleep apnea (OSA) is a potentially life-threatening disorder in which breathing is interrupted during sleep.

The breathing stops for 10 seconds to a minute or longer and can occur 30 to 100 times per hour during the night. It is more common in males with small chin plus those who are overweight, have nasal obstruction, high BP and family history of OSA.
The common symptoms are loud snoring, with choking or difficulty in breathing at night and increased tiredness/ sleepiness during the day.

Insomnia, the most prevalent sleep disorder, is characterised by an inability to fall asleep and/or by waking up during the night and having difficulty going back to sleep. Insomnia is often a symptom of another problem, such as stress, anxiety, depression, or an underlying health condition.

It can also be caused by lifestyle choices, including the medications you take, lack of exercise, jet lag or even the amount of coffee you drink. It has severe adverse effects on health, and is, often, associated with self-medication leading to dependence on drugs causing sleep.

Then, there’s restless legs syndrome (RLS), a neurological movement disorder that is often associated with a sleep complaint. People with RLS have unpleasant leg sensations and an almost irresistible urge to move the legs.

The urge to move occurs when they are resting or lying down and is usually due to uncomfortable, tingly, aching or creeping sensations. Many patients find this problem difficult to explain, leading to a delay in diagnosis, sometimes for almost 15 years.

It’s not just problems with night-time sleep; some people have “sleep attacks” during the day. Those suffering from narcolepsy may have “sleep attacks” while talking, working or even driving.

Apart from these, abnormal behaviour in sleep - kicking, shouting and the like - can also result in injuries to self or bed partner. There are a host of other sleep disorders, which if diagnosed and treated in time, can improve the quality of life.

Myths and facts

People have quite a few misconceptions when it comes to sleep. For instance, many believe that as the body gets some rest during sleep, the brain shuts down, too. Fact is that specific areas of the brain are very active while you sleep. Also, snoring is not a sign of good sleep, as people would like to believe. It is an indication of some obstruction in breathing.

Those who keep compromising on the sleep time will be surprised to know that even one hour of less sleep can affect the quality of your functioning during the day – be it your attention span, response time, or other mental activities. Unless you are over 75 years – by then you may need less sleep – a full-night’s sleep is a must.

While it’s true that the human body can adjust to different sleep schedules, there’s a limit to how much abuse it can take. If you make a habit out of it, be prepared to face some significant distress.

The long and short of it

If there’s one question that a sleep specialist is asked the most, it is how many hours of sleep does one need? An adult may require anywhere between six to eight hours of sleep.
Recent studies categorise people as short sleepers and long sleepers. Short sleepers, typically, get an eye-shut of five hours or less, but it’s unbroken and of very good quality.

They feel refreshed on waking up and are able to function normally during the day. Short sleepers can be found in all age groups among both, men and women. However, it is very rare for a young child to be a short sleeper. The only problem with such people is that they could have trouble with family and friends if they expect others to follow their pattern of sleep.

Long sleepers, on the other hand, regularly sleep for 10 to 12 hours at night. The quality of sleep is very good, but much longer than most people need. About two percent of men and 1.5 percent of women report sleeping at least 10 hours per night. However, this need for long hours of sleep often tends to disrupt relationships with family and friends.

A sleep diary is a very useful tool for identifying sleep disorders and problems, as well as pinpointing habits that may be contributing to your difficulties.

One can also get a complete sleep study (Polysomnography) done. It is a night time study that evaluates many physiological aspects - brain, eye and muscle activity, breathing patterns, snoring quality and intensity, oxygen requirements, nocturnal seizures or abnormal sleep behaviours.

Learning to sleep well

Regardless of your sleep problems, a consistent sleep routine and improved sleep habits will translate into better sleep over the long term.

Keep a regular sleep schedule. Go to sleep and get up at the same time each day, including the weekends.

Set aside enough time for sleep. Most people need at least seven to eight hours each night in order to feel good and be productive.

Make sure your bedroom is dark, cool and quiet. Cover electrical displays, use heavy curtains or shades to block light from windows, or try a sleep mask to shield your eyes.

Turn off your TV, smartphone, iPad and computer a few hours before your bedtime. The type of light these screens emit can stimulate your brain and interfere with your body’s internal clock.

Consult a specialist Sometimes, despite one’s best efforts, the problems persist. It’s prudent to consult a sleep specialist in any of the following situations:

Your main problem is daytime sleepiness and self-help hasn’t improved your symptoms.

You or your bed partner gasps, chokes or stops breathing during sleep.

You sometimes fall asleep at inappropriate times, such as while talking, walking or eating.

Abnormal behaviour in sleep is resulting in injuries to self or partner.

(The author is senior consultant, neurology and sleep medicine, Neurology & Sleep Centre, New Delhi)

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