Mind your ZZZs... more so if you are a night owl

CHENNAI: Sleep, the body’s natural recharger, is considered one of the quintessential needs for the existence of all living beings. From an era of sleeping in plenty, we have now moved towards a sleep-deprived society. Among those man-made reasons for sleep deprivation such as late-night socialisation, screen time, stress etc., there are a few medical conditions that are very prevalent yet go unnoticed due to the lack of awareness.

Increase in incidence of insomnia

Lack of sleeplessness can lead to several health problems such as the increased risk of heart attacks, sleep apnea, neurological problems, and psychological issues and impact the overall health. The experts say there is an increase in the incidence of insomnia, especially in the younger generation and it is an issue of concern. Insomnia can affect both physical and mental health. A normal young adult would require at least eight hours of sleep and the hours of sleep decrease as the age increases, whereas older people above 60 years would sleep for about six hours.

A recent paper by Michael L Perlis, Department of Psychiatry, Pennsylvania published in Lancet stated that insomnia is highly prevalent in clinical practice, occurring in up to 50 per cent of primary care patients.

“Insomnia can present independently or alongside other medical conditions or mental health disorders and is a risk factor for the development and exacerbation of these other disorders if not treated. In 2016, the American College of Physicians recommended that insomnia be specifically targeted for treatment. The recommended first-line treatment for insomnia, whether the underlying cause has been identified or not, is cognitive behavioural therapy for insomnia,’’ it states.

Dr Babu Ezhumalai, Interventional Cardiologist at Fortis Malar, says the quality of sleep is another factor that can lead to sudden attacks. Youngsters adopt unhealthy lifestyle patterns which lead to staying awake late at night and being unable to wake up early. This works on their blood pressure adding up to the cause of heart attack at a young age. Unfortunately, just like the trend in heart attacks, the incidence of hypertension is rising among young adults more than in older adults. High blood pressure makes your heart muscles thicken, harms your blood vessels, and increases your risk of a heart attack.

Sleep Apnea: A menace to your sleep!

Dr Karthik Madesh, a senior consultant ENT surgeon at Apollo Speciality Hospital, says that apnea causes breathing to cease, usually for a few seconds but occasionally for almost a minute. Obstructive sleep apnea (OSA) is the most prevalent type of sleep apnea, and it occurs when a person is sleeping. With symptoms such as snoring and choking sensation, it can lead to consequences of getting inadequate sleep such as high blood pressure, diabetes, slow reflexes while driving or using machines, cardiovascular risk, cerebrovascular accidents etc. Your health may be impacted more seriously on account of chronic insufficiency of oxygen supply to the brain due to OSA over several years. Sleep apnea is thus two medical disorders rolled into one. OSA happens because of quite a few reasons — obesity, family history of OSA, an oversized tongue that touches the top of the mouth when you are sleeping, the lower jaw being considerably smaller than normal, etc. Obesity can also affect the severity of the disorder.

Restless legs and sleepless nights

Restless leg syndrome (RLS) is a neurological condition that causes insomnia and compromises the quality of life. People suffering from restless leg syndrome perceive unpleasant sensations in their legs when their limbs are at rest. Dr Venkatraman Karthikeyan, Consultant Neurologist, Gleneagles Global Health city says symptoms initially start at night time when the affected person retires to bed. These unpleasant sensations can be nagging, aching, creeping or sometimes burning and get pleasantly relieved by massage to the affected part or when the limbs are moved or rocked. This hinders falling asleep and most patients would either be constantly moving their legs or massaging them until they become too fatigued before falling asleep. Over the years, the condition gets augmented and becomes very severe or may ascend to involve the trunk or sometimes even arms.

The worsening also is noticed when the symptoms start to appear in the evening or late afternoon when the affected person is sitting idle. This condition occurs due to the dysfunction of basal ganglia which is located deep inside the brain. The condition is not associated with any permanent deficits like numbness or weakness as noticed with peripheral neuropathy. Restless leg syndrome can be familial or acquired. Persons with familial RLS have the symptoms early in life but progress gradually unlike the acquired ones that worsen rapidly. RLS affects women more than men and can be noticed in many women during the latter part of pregnancy. Pregnancy-related RLS resolves postpartum. Among other acquired causes are low iron stores in the body, intake of coffee, alcohol, antidepressant, and antipsychotic medications,” added Dr Venkatraman.

Your heart needs a good sleep

Dr Sridhara G, Consultant Interventional Cardiologist, Cardiac Electrophysiology at Manipal Hospital, explains in general, rest is in the form of sleep where we lie down and our brain goes to the subconscious level and our body and mind relax. While we sleep, the sympathetic drive that propels us decreases. Additionally, the vagal drive increases, which helps blood pressure to drop and heart rate to slow down, along with which the reflex energy or nerve impulses emanating from the brain are also reduced. Hormones such as melatonin cool off and the oxidation process that happens comes down.”

He said the excess carbon dioxide and toxins (generated through muscle metabolism, bone metabolism, and haematological metabolism) generated involving different organs in the body get eliminated in the form of deep breathing and urine. There is a false notion that sleeping too much increases weight gain, which is not at all the case. Sleeping gives us the energy to burn the extra calories which we otherwise inadvertently accumulate. Therefore, an adequate amount of sleep indirectly translates into benefits in the form of maintaining cardiovascular health by reducing the risk of heart attacks or strokes at an early age or other vascular disorders.

Mental health and insomnia

There are various causes of insomnia. It can be due to underlying mental health problems like stress, anxiety, depression, alcohol addiction and substance misuse. Dr VU Karthikeyan, a consultant psychiatrist at Dr Mehta’s Hospital, says people with personality characteristics like perfectionism, ambitiousness and people who tend to worry a lot can also develop sleep problems. Youngsters nowadays spend too much time with gadgets and the internet at the cost of sleep. Shift work is also a risk factor for insomnia. Chronic insomnia can affect our mental health resulting in decreased concentration, poor memory, irritability, nervousness, anger outbursts, and poor reasoning and judgement. Sleep problems in school-going children can cause academic problems and decreased work productivity in adults.

He added that many people tend to use over-the-counter sleeping pills to counter insomnia. Using sleeping pills for a prolonged period can cause increased tolerance to those pills resulting in addiction. Sleeping pills should only be used under doctors’ supervision. For most people with sleep problems, practising sleep hygiene can restore their sleep cycle.

Sleep deprivation in long run leads to Alzheimer’s: Expert

Scientific research on Alzheimer’s patients has shown that sound sleep for seven to eight hours every day is absolutely essential. Sleep is the time for the restorative activity for the body and mind; the brain cleanses itself of the abnormal proteins beta-amyloid and tau that are created due to high metabolic activity. Sleep deprivation in the long run accumulates and is detrimental to brain health leading to Alzheimer’s, says Dr Naresh Purohit, executive member of the Indian Academy of Neurosciences.

Sharing his concern on the rise in Alzheimer’s cases in the country, Dr Purohit, Principal Investigator for the Association of Studies for Mental Care, said at a recent event that India is on the cusp of a dementia epidemic with dementia patients projected to spike from the 44 lakh at present to over one crore by 2050. Incidentally, this surge can be ascribed to the growth in our geriatric population as India moves closer to becoming the world’s most populous country, surpassing even China.

He said Alzheimer’s disease (AD) is one of the neuro-degenerative diseases and accounts for sixty to seventy per cent of cases of dementia. Usually, the disease starts slowly and turns worse in due course of time.

“One of the most common symptoms is memory loss, even about the recent events. This is known as shortterm memory loss syndrome. With the advancement of the problem, symptoms of trouble with the loss of motivation, language, mood swing, easily getting lost, issues with behaviour and taking self-care etc are seen among the affected persons,” he added.

Dr Purohit, also Advisor for National Mental Health Programme, averred that in Alzheimer’s patients the ability to switch from a state of wandering mind to attentiveness breaks down leading to memory lapses and disorientation.

He cautions, that there is no cure or medicine to date for this ailment and therefore it is important to take steps to delay the onset of the disease.

He pointed out that medical research has established conclusively that smoking and excess sugar is harmful to the body but it is a big risk factor for developing dementia as well. Interestingly, factors that are linked to the onset of diabetes such as obesity and stress are also the factors that are likely to lead to Alzheimer’s and dementia, he added.

Experts explained that a healthy diet is another indispensable factor in how to delay the onset of neurological age-related conditions like Alzheimer’s. They suggest following a Mediterranean diet that is rich in fruits and vegetables, whole grains, beans, nuts and seeds. Seafood and eating eggs thrice a week while avoiding red meat, processed foods, and white flour, help not only in preventing dementia but also heart disease.

Experts revealed that focussed activity such as practising meditation for a sustained period changes the brain structures and helps patients with memory-related disorders.

“People need to do something that will challenge their brain and make one feel wanted,” experts said.

They emphasised that half an hour of physical exercise every day, whether it be Yoga or even walking is non-negotiable. Such activities help to maintain the fitness of not just the body but also the mind.

They averred that keeping the mind active be it through problem-solving, crossword or even learning languages helps immensely. Social interactions, taking part in clubs and associations and doing charity work especially to keep the mind engaged after retirement are crucial.

Experts clarified that WhatsApping or even being on Instagram is not social interaction.

NOISE THERAPY FOR SOUND SLEEP?

Over the last 20 years, scientists have uncovered evidence that immersive sounds like white, brown and pink noise may help the brain focus, sleep or relax. For people with standard hearing function, brown noise’s better-known and better-studied cousin, white noise, has a more hissing sound than brown noise. Pink noise is a softer version of white noise, playing lower frequencies a bit louder. Violet noise plays higher frequency sounds louder than brown noise and makes a hissing sound.

Scientists have reached conflicting conclusions on whether any particular type of noise can help you sleep better. A 2020 review of 38 studies found limited evidence that white noise can improve sleep, despite the prevalence of white noise machines marketed for sounder nights. Some companies promote white noise machines to help babies sleep, claiming the sound mimics the environment in the womb.

What is brown noise?

The human ear only detects sounds within a certain range of frequencies — those that stimulate the cochlea, a spiral-shaped cavity swirling in our inner ears. When we play brown noise, we hear every frequency that the ear can detect at once, said Dr Daniel Berlau, a professor at the Regis University School of Pharmacy who has studied the impact of white noise on A.D.H.D. Listening to all of these frequencies at once creates an immersive, even smothering, experience that some people may find pleasant, could relieve stress and soothe them to sleep.

Dr Berlau pointed out a simple theory for why people say noise begets sleep — be it pink, white or any shade. Sounds may block out your downstairs neighbour, the traffic and your partner’s snoring. And, experts said, if any form of noise therapy works for you, there’s no harm in using it.

Excessive daytime sleepiness can lead to fatigue, reduce productivity

Experts say that lack of sleep can lead to excessive daytime sleepiness and lack of concentration. The impact of sleeplessness can disrupt daily life in several ways and daytime sleepiness is a major concern though it is not recognised as a public health issue.

A study paper on understanding and approaching excessive daytime sleepiness published in Lancet states that excessive daytime sleepiness is a public health issue. However, it remains largely undervalued, scarcely diagnosed, and poorly supported.

Doctors say that excessive daytime sleepiness can lead to fatigue and reduce productivity and safety in the workplace. In the classroom, children’s education suffers, and on the roads, up to a third of traffic accidents are caused by sleep deprivation.

“EDS might be a consequence of several behavioural issues leading to insufficient or disrupted sleep, as well as a consequence of sleep disorders including sleep apnoea syndrome,” the paper said.

Changes in food, pollution not letting us sleep well

There are conventional and unconventional causes for insomnia or sleeplessness. Unconventional reasons are mostly dietary and lifestyle-related as opposed to traditional causes, which include diabetes, high cholesterol, high blood pressure, and family history.

In recent decades, there has been a rapid increase in the number of bakeries and restaurants all over the city as well as across Tamil Nadu. From a very young age, children have been accustomed to foods that are not home-cooked and confectionery items, and this habit has not ceased to increase. Such lifestyle changes compounded with sleeplessness are attributed to many health issues.

Dr S Aravind, Cardiologist, Apollo Specialty Hospitals said even though the children might engage in sports in high school or college, as they approach their 30s, their priorities change and they adopt a more sedentary lifestyle. “We are witnessing numerous youngsters suffering from cardiac arrest and brain strokes both during and after the COVID-19 pandemic,” he pointed out.

He added that it was caused by the viral infection in those who were predisposed to cardiac arrests. Just like smoking, pollution also can damage the heart. People who travel long on two-wheelers are often exposed to prolonged inhalation of emissions. The pollutants get deployed in their respiratory and intestinal tracts, causing trouble.

Given that air pollution causes upper airway irritation, swelling and congestion, and may also affect the parts of the brain and central nervous system that control breathing patterns and sleep, it seems likely that air pollution is detrimental to sleep.

Lifestyle changes compounded with sleeplessness are behind many health issues, including cardiac arrests and brain strokes witnessed among youth, says Dr S Aravind of Apollo Hospitals.

SYMPTOMS TO WATCH OUT FOR:

• Difficulty in falling asleep

• Daytime fatigue

• Anxiety or irritability

• Unusual breathing pattern

• Lack of concentration

• Brain fogging

TREATMENTS, AS PRESCRIBED BY DOCS:

• Chronotherapy-behavioural therapy

• Dopaminergic agents

• Melatonin supplements

• Assistive breathing device

• Surgical procedures

• Sleeping pills

• Non-pharmacological therapy

• Do not self-medicate

PRACTISING SLEEP HYGIENE IS SIMPLE AND EFFECTIVE

HERE’S HOW:

• Relax before sleep

• Use loose comfortable clothes

• Fix a regular sleep time

• Keep your room cool and non-messy

STEPS FOR BETTER SLEEP

Dr Srinivasa Prasad BV, consultant interventional cardiologist and structural heart intervention specialist, in association with Magniflex India says an adult need at least 7-9 hours of good sleep to remain healthy. So, what are the things we should do to ensure good sleep?

• Lying on one side makes breathing easier and more effective, as it reduces sleep apnea and other related complications.

• Sleeping on a good high-quality mattress and pillows. A good mattress is very crucial; it should possess body-conforming quality, and the pillows should be soft.

• Avoid caffeine, and alcohol before going to bed.

• Get involved in any recreational activity for a longer time before going to bed.

• Create a good sleeping environment – this can be in the form of keeping the lights dull, and calm, and avoid using a phone, or computer for at least 30 45 mins before going to bed.