The a to zzzzzz of sleep

CHENNAI: Raghav, who works at an IT firm in Guindy, gets back home in Anna Nagar around 12 am after his regular work shift. After the long day, all that he longs to have is a peaceful sleep. After dinner and routine social media scrolling, it’s about 1.30 am but then the mosquitoes take over and no preventive measures, whether mosquito oils, coils, spray, work to keep them at bay.

Now it is about 2 am. High time he slept. But just as he is about to drift off to sleep come the water lorries blaring their musical horns. Even if he ignores the stray dogs in the area barking non-stop, the temple next to his house has special prayers being organised at 4 am. He does manage to get a wink, finally, only to wake up all groggy and tired, and goes through the day with a sleepy head. Isn’t this the story of most of the residents of Chennai?

That sleep is a basic necessity for the human body was always known. But what was not given enough importance is the duration and quality of sleep. As we moved from old, slow, largely agrarian life to the modern one where productivity and burning ambition are among the buzzwords, 8-hour sleep became the sign of the laggard. Now, one either works through the night, or unwinds by binge watching series or films till sunrise.

It thus is not surprising that the incidence of insomnia and inadequate sleep has been increasing since the dawn of this millennia, so are their effects on a large section of the urban population.

Insomnia and sleep disorders can affect people of all ages. While those in their 50s and above are more likely to experience sleep disturbances due to changes in sleep patterns and health problems that can interfere with sleep, adolescents and young adults may also be at risk due to factors such as school and work schedules, social pressures, the use of electronic devices before bedtime and also due to work shifts.

“The amount of sleep an individual requires can vary depending on factors such as age, activity level, and overall health. The National Sleep Foundation recommends that adults should aim for 7-9 hours of sleep, while school-aged children and teenagers may need more. There is some evidence to suggest that men and women may have slightly different sleep needs, with women tending to require slightly more sleep than men on average,” says Dr M Koushik Muthu Raja, professor, respiratory medicine, and specialist in sleep medicine at Sri Ramachandra Medical Centre and Hospital.

Experts warn that irregular sleep cycles cause disruptions in the basic body functions and add to the burden of several lifestyle diseases. People who don’t get enough sleep often show signs of being exhausted, disengaged and performing poorly at work, lacking in self-care, frequently unwell, high absenteeism, losing interest, and general feeling of unhappiness.

SOUND SLEEP FOR A SOUND BODY…

Sleep, they add, plays a critical role in improving long-term mental health in addition to allowing the organ system to slow down and engage in the healing process. There is also a direct link between sleep and mental wellness, as sleep deprivation will impact your mental and emotional well-being.

“Sleep loss is a significant, yet underappreciated, issue that affects a person’s quality of life, both physically and mentally. Getting a good night’s sleep is incredibly difficult these days. Sleep is frequently misunderstood as assisting your body in relaxing so that it can restart and perform as intended. But it also influences your mental wellness. Because they won’t have time to give their bodies a break, people commonly fall asleep when riding public transport,” says Mumtaj Begam, counselling psychologist at Fortis Hospitals.

Those that work night shifts, such as drivers, security guards, police officers, healthcare providers, daily wage workers, IT workers, etc., tend to have a lot more trouble sleeping, she adds.

Our body develops an active state of unconsciousness that is receptive to internal stimuli while the brain is at rest. What that means is, lack of sleep will eventually result in affecting cognition and it can impact decision-making, language, thinking, and learning. Several studies have shown that persons who lack sleep experience an increase in negative moods and a decrease in positive mood. Children will be more likely to experience it, as they will have a harder time learning and memorising what they learn, says Mumtaj.

Continuous sleep deprivation can affect mood, regulation, behaviour as well as higher mental functions - primarily attention - which in turn impairs other cognitive functions. These deficits can impact an individual’s quality of life, all of which makes sleep quality an important ingredient for improving quality of life.

… AND A HEALTHY BODY, TOO

That is not all. When the quality and duration of sleep is poor, it disrupts body functions. Such individuals are at a high risk of cardiac issues, hypertension, stroke, high blood sugar levels.

“It can pose risk of impairing internal body systems like the cardiovascular system,” says Vaishnavi, a Chennai-based consultant psychologist. “A lot of patients who are referred to the clinical OP by the medical board for neuropsychological assessment are bus drivers and conductors who have had a stroke. Periods of sleep deprivation is in the nature of their job and is definitely an important vulnerability factor contributing to their condition,” she adds.

Understandably, hence, doctors from various fields of medicine have realised the important link between sleep and health, both mental and physical, like how inadequate sleep can be related to incidence of diabetes and hypertension.

“The sleep cycle has an impact on glycaemic control, and inadequate sleep can increase the blood pressure and cause hypertension. Besides memory loss and depression, stroke and heart attack are also associated with lack of sleep,” says Dr K Padmanabhan, general medicine consultant and diabetologist, Fortis Hospital.

Noting how sleep loss is not recognised in the initial stage, Dr Padmanabhan says, “The quality of sleep over the quantity of sleep is more important. However, we have seen that people who sleep for even more than eight hours but have an obstructive sleep, so they feel sleepy during the day.”

Gene makeup plays crucial part, says genomics specialist

Don’t we all know someone who can run like a train engine with just six hours of sleep while we struggle to keep our eyes open even after much longer sleep? Some of us are up and about before the clock strikes six, some others find themselves active and productive only after dinner time. Why is there some much variation in sleeping patterns among individuals?

Studies aiming to answer this very question have reported that our genes may be playing a big role in this. A group of genes called the clock genes regulate our circadian rhythm, the body’s internal clock. Differences or variations in these genes can bring about changes in sleeping patterns," says Deepika Suresh, genomics specialist and chief of staff at Xcode Life.

For example, certain variations make your circadian clock run slower, increasing your tendency to be a night owl. Another interesting example would be the DEC2 gene that influences the production of a protein that regulates wakefulness and arousal. A lucky few have a variation in this gene that allows them to be natural short sleepers.

"Studies suggest that these individuals can get away with an average of 6.25 hours of sleep per night without any adverse health effects. The effect of genes on sleep goes beyond sleep patterns and behaviour. Commonly observed sleep disorders like snoring, obstructive sleep apnea, restless leg syndrome, bruxism, etc., also have genetic influences," she adds.

Learning about the genetic basis of sleep allows room to examine your sleep quality and quantity, and adopt a sleep pattern optimal to your body’s needs. Further, understanding your risk for sleep disorders can help you take proactive measures to reduce the risk or even prevent them.

Night is body’s maintenance hour

To understand the importance of sleep, one needs to look deeper. There are four stages of sleep: The N1 stage that is the superficial stage when one tries to sleep; the N2 stage when one starts to sleep and it progresses; and the N3 stage, when the whole body is at complete rest. Then there is the rapid eye movement (REM) stage, which is when you typically get dreams.

During the first three stages, also known as non-REM stages, is when the body go into maintenance: building muscles and bones, repairing and re-growing tissues, and the immune system is strengthened. In contrast, the brain is much more active during the REM stage, which is when you get dreams. This stage plays an important role in helping the brain with learning.

“Those who struggle to attain the N3 stage might sleep talk or sleep walk, and other disorders can also occur,” says Dr Benhur Joel Shadrach, associate consultant, interventional pulmonology, critical care & sleep medicine, Rela Hospital.

There is a sleep hormone called melatonin that the pineal gland secretes at night, usually around 8-9 pm. The hormone is produced only during darkness. This has several benefits to the body, as it helps organs such as the heart to relax. When one sleeps, the ‘sympathetic nervous system’ takes over and the blood pressure, insulin levels, cholesterol and heart pumping lower to provide rest to the organs.

This apart, there are changes in several other hormones in the body and nervous system when we are sleeping. “When we sleep, the levels of the stress hormones in our body come down. There is a relaxation to the body mentally and physically. This has an effect on our nervous system, as it controls the body functions,” he adds.

When there is hormonal imbalance, people can also suffer from memory loss, lack of concentration, daytime sleepiness, lack of libido, depression and other problems, cautions Dr Benhur, adding: “While sleeplessness once in a while is okay, making it a lifestyle can lead to disorders that affects overall health of an individual.”

Mental health problems impact sleep, and vice versa

Mental health problems can have a major impact on sleep. Sleep disturbance is an important symptom in many conditions, and the pattern in which the disturbance manifests varies from one disorder to another. Also, sleep disturbances can sometimes predispose and exacerbate certain mental health problems.

Psychologists say that treatment of sleep disorders can improve the mental disorder. For instance, working on the rhythm, specifically the sleep-wake cycle, is an important component of treatment for bipolar disorder. “Initial insomnia (difficulty falling asleep at the beginning of the night) is usually associated with anxiety disorders; middle insomnia (difficulty in maintaining sleep) is often associated with disorders causing pain, and medical conditions; and terminal insomnia (early morning awakening) with depression. The latter is also associated with hypersomnia,” explains consultant psychologist Vaishnavi.

She adds that a reduced need for sleep may also be associated with other psychiatric disorders like bipolar disorder and schizophrenia. Sleep disturbances are also reported in other conditions like alcohol dependence syndrome. Some psychiatric medications also tend to have sedative effects and hence are prescribed only at the clinician’s discretion.

Not just binge watching, binge eating too could affect your sleep

Like many in her generation, 25-year-old Deepika has become a night owl. She loves binge watching OTTs late till night, which is when she is hit by midnight cravings. To satiate this, she started eating junk food at odd hours, which has now become a habit for her. After following this routine for a long enough time, Deepika says the use of smartphone delays her sleep, which is made worse by late-night eating.

This is not merely a piece of anecdotal evidence, as doctors see food as another major factor that impacts our sleep. If people do not get sleep, it could be because of the junk food intake, says Dr Benhur Joel Shadrach, associate consultant, interventional pulmonology, critical care & sleep medicine, Rela Hospital. “Junk food impacts the secretion of hormones and can thus affect sleep,” he says.