To sleep! More than perchance to dream

By Smriti Daniel

There's a reason prisoners of war and hostages consider sleep deprivation a form of torture. When deprived of our rest, we tend to become particularly vulnerable; our judgement and ability to reason is affected, even as we experience a simultaneous decline in motor functions. When pushed to its limits, our brain begins to hallucinate and zone out, and we can crumble under the strain.

But even a single sleepless night is enough to leave you cranky, impatient and clumsy. The consequences - both short term and long term - can be fatal, warns Prof. Shyam Fernando of the Faculty of Medicine, University of Colombo, explaining that unfortunately, there are also far more sleep deprived people than you'd expect.

Here Prof. Fernando speaks to MediScene about the importance of getting your eight hours of beauty rest.

  • Why we sleep

Some scientists would have us believe that we need to sleep because we need to dream. A range of disparate theories hypothesise variously that dreams allow our mind to analyse and file away the day's experiences, that they play a critical role in learning, and even that dreaming is a vital creative process.
What we do know is that we go through two distinct phases of sleep. The first - characterised by rapid eye movement - is known as REM sleep, the second, non-REM sleep. On average it takes 90 minutes to complete a full cycle of REM and non-REM sleep. It is during REM sleep that we dream. As dawn approaches, we also tend to sleep more deeply, immersed in REM sleep.

Newborns may spend nearly 20 hours a day sleeping. By adolescence, that figure will decline to about nine hours a day, until it finally settles to about eight hours a day. This sleep-wake cycle changes as we grow older - which explains why a teenager may find it difficult to be alert at 8 a.m. while her elderly grandmother has already been up and about for several hours.

  • Sleep well, live well

When we co-operate with our biological clocks and our body's need for sleep, we function better. However, the pace of modern life has ensured that many will consistently make do with five hours instead - and that this will take an emotional, mental and physical toll on our wellbeing. This is called "sleep debt", Prof. Fernando explains.

In the short term, this kind of fatigue could adversely impact on your performance at work or in school, in the long term it could put you at greater risk for high blood pressure, heart attacks, strokes and even diabetes. And there's no short cut around it; sleeping in on the weekends cannot compensate for the days that you work well into the night. Both children and adults of all ages can fall victim to a sleeping disorder, and are often unaware that their tiredness or drop in performance is related to their sleeping pattern.

Though people are used to the idea that the elderly need less sleep this is not necessarily the case, says Prof. Fernando. The elderly are simply more likely to experience insomnia because of physical illness. Their sleep-wake cycle also has them going to bed much earlier than the rest of us, and consequently getting up earlier.

  • Dangerous behind the wheel

"A sleep deprived driver is as dangerous as a drunk driver," says Prof. Fernando. He explains that the longer we go without sleep, the more likely it is that we will succumb to bouts of 'microsleep' - episodes lasting anywhere between 2 to 20 seconds during which your mind simply zones out. For someone behind the wheel of a car, even a four second nap can make the difference between life and death; and it doesn't help that your reaction time is also slower.

‘Insomnia can really wipe you out emotionally and entally’

Taking some simple precautions can reduce the risk both to yourself and to others. Obviously, a good night's rest is best.

Where possible, avoid driving during the time when you are least alert - usually between midnight and 5 a.m. - and if you have to, make sure you have some company to keep you engaged in conversation. Remember that while caffeine and nicotine might make you feel more alert, their effect is only temporary. Alcohol and certain medications will make it even harder to stay awake.

  • Snoring and Sleep Apnea

Snoring is a common problem. Caused by parts of the nose and throat - in particular, the soft palate - vibrating as you breathe in, snoring affects more men than women. While asleep, alcohol or sleeping tablets can relax your internal muscles even further, resulting in the floppiness that causes that characteristic rumble. Overweight people and those with thick necks (collar size 17") might find that the weight puts more pressure on their airways. Conditions like colds, allergies, nasal polyps, and a misaligned nose could also make natural breathing difficult.

But an interruption in that constant rumbling can indicate another, more serious condition. Sufferers of sleep apnea (pronounced 'ap-nia') may actually stop breathing altogether, mid-snore. Their relaxed throat muscles block their airways briefly many times each night, depriving their bodies of essential oxygen and increasing their risk of high blood pressure, heart attacks and strokes. In the short term, this means a night of troubled sleep and days spent feeling tired and restless.

Simple changes to your lifestyle such as maintaining an ideal body weight, sleeping on your side, avoiding alcohol and keeping your nose and breathing tubes clear are helpful. Effective treatment in the form of the CPAP machine is also available. A continuous positive airway pressure (CPAP) machine delivers a stream of compressed air via a hose to a nasal mask; this air keeps a patient's airway from becoming obstructed. Both patients and their spouses have reported immediate relief - the former from the disturbed sleep associated with sleep apnea, and the latter from their spouse's loud snoring.
However, some patients with sleep apnea need ENT surgery.

  • Insomnia

Sitting wide awake while the rest of the world slumbers can be depressing - insomnia can really wipe you out emotionally and mentally. As a result, you can experience excessive day-time tiredness, clumsiness that results in accidents, recurrent infections, lack of concentration and irritability. These in turn may produce more stress at work or in personal relationships - thereby generating a vicious cycle.
While insomnia is most common in elderly people, a young person may also become prone to sleeplessness as a result of stress. Other common causes include physical illnesses that cause pain, noise in the surrounding environment, depression, shift work, caffeine or alcohol consumption, and side-effects of medication.

Things tend to look very different at three in the morning - especially when you know you still have a whole day's work ahead of you. This same anxiety can keep you from falling asleep the next night, says Prof. Fernando. He believes that with a little patience we can train ourselves to break the cycle. One suggestion is that when you cannot sleep, get up, leave the bedroom and do something else that is relaxing instead of tossing and turning in bed.

Cutting back on caffeine and nicotine is simply common sense, and a little exercise will help you use up some excess energy. Chronic insomnia requires a visit to the doctor who will then suggest appropriate treatment. But for the occasional attack, it is best to be patient with yourself. It helps to identify the things that keep you awake. For instance, a few pages of a book may prove as effective a lullaby. For others, the same book stimulates thought and makes it harder to fall asleep.

  • Other sleep disorders

There are many other different sleep disorders. Narcolepsy, for instance, is an uncommon but debilitating condition that can cause the sufferer to feel uncontrollable sleepiness during the day. Those with restless leg syndrome may feel an unpleasant burning, itching, or tickling sensation and are compelled to move their legs while sleeping. Yet another disorder, not uncommon in children, called Bruxism has sufferers grinding their teeth relentlessly in their sleep. In the end, the wide ranging effects these sleep disorders have on their victims only illustrates the irreplaceable goodness of a full night's sleep.

Sleep clinic in the offing

Sleep disorders are poorly understood in Sri Lanka, says Dr. Chandra Jayasuriya, ENT surgeon at the National Hospital of Sri Lanka who along with her team hopes to open the country's third sleep lab at the National Hospital. Here, patients can be monitored overnight, accurately diagnosed and treated for conditions like sleep apnea.

Dr. Jayasuriya believes this service will be particularly timely, because currently a night at a private sleep clinic in a local hospital can cost up to Rs. 15,000. The department is staging a fund raiser in order to buy equipment for the clinic. "Dummala Warama" is produced by Ranjith Alwis and will be held on December 5 at the Elphinstone Theatre. Tickets are available with the staff of the National Hospital's ENT department.

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