WHEN THE NATURAL TENDENCY OF SLEEP FAILS: WHAT TO DO?

Updated: Jan 12

Lately, doctors have been bothered with numerous complaints of sleep disturbances. We as medical professionals are in a quick fix to prescribe different sleep medications for our patients without proper investigation into the cause of their sleep disturbance.


Each night when I go to sleep, I die and the next morning, when I wake up, I am reborn”. - Mahatma Gandhi

Sleep, like breathing is a biological rhythm that is actively generated by the brain. During sleep, we normally experience beliefs, feelings and behaviours that we would never maintain during wakefulness. Daily rhythms of sleep and wakefulness are relevant to the health and performance of all 7+ billion humans.


Good sleep can improve your cognition, concentration, productivity and performance. In addition, it can maximize the athletic performance of basketball players. This was evidenced by a study conducted on basketball players during a conference in the USA. Longer sleep hours improved their speed, accuracy, reaction time and well being.


Sleep has also been shown to boost immune function. A study conducted showed people were liable to develop common cold if they had sleep issues. Other examples of conditions linked with insomnia include chronic pain, cancer, diabetes, heart disease, asthma, gastroesophageal reflux disease (GERD), an overactive thyroid, Parkinson's disease and Alzheimer's disease.


Sleep affects emotions and social interactions and reduces a person’s ability to interact socially. Several studies confirmed this using emotional facial recognition tests. Lack of sleep causes people to become less social and lonely. The reason is that the brain has difficulties reading facial expressions and interprets most faces as threatening. As such, these individuals are less likely to engage in conversations with others and may be very irritable.


Along with nutrition and exercise, good sleep is one of the pillars of good health.


Sleep is one of the most significant human behaviors, occupying one-third of human life thus prolonged sleep deprivation can lead to severe physical, cognitive impairment and eventually death.


Sleep may appear to be a passive process, but in fact it is associated with a high degree of brain activation. Wakefulness is a heterogenous state which ranges from being drowsy to being fully alert,all these as a result of complex interactions in the brain.


Sleep is particularly relevant in psychiatry since sleep disturbances can occur in virtually all psychiatric illness and are frequently part of the diagnostic criteria for specific disorders.


There are two stages of sleep

1. Non Rapid Eye Movement

2. Rapid Eye Movement


In Non Rapid Eye Movement (NREM), most physiological functions are markedly lower than that of wakefulness.


REM sleep is a different kind of sleep, characterized by high level of brain activity and physiological activities similar to wakefulness.


In normal persons, NREM sleep is a peaceful state relative to waking. Respiration is similarly affected with a further reduction in blood pressure. Also, episodic, involuntary movements are present in NREM sleep. Blood flow through most of the tissues including the brain reduces. The deepest portions of NREM sleep; stages 3 and 4 are sometimes associated with unusual arousal characteristics.


When a person is aroused 30mins to 1 hour after sleep onset, they are usually disoriented and their thinking disorganized.


The disorganization in stage 3 and 4 may result in specific problems including enuresis, somnambulism and night terrors.


I will not bother you guys with details of the sleep cycle but then each cycle consists of a duration and bodily changes that occur during that period. These sleep patterns change over a person’s lifespan.


Newborns tend to sleep 16 hours a day with brief periods of wakefulness. By age 4 months, theit pattern shifts, so that the total pattern of REM sleep drops less than 40% and entry into sleep occurs with an initial period of NREM sleep. By young adulthood, the distribution of sleep stages is as follows

NREM (75%)

REM (25%)


It is important to note that almost every REM period in men is accompanied by partial or full penile erection. This finding is clinically significant in evaluating the cause of impotence in men.


Sleep Regulation

Many studies support the role of serotonin in sleep regulation. Prevention of serotonin receptors or destruction of the dorsal raphe nucleus of the brain stem which contains nearly all the brain’s serotonergic cell bodies reduces sleep for a considerable period of time.

Ingesting trytophan containing foods like salmon, eggs and milk reduces the time taken to sleep and nocturnal wakenings.


Compared with healthy persons, depressed patients have marked disruptions in sleep hygiene.


There are different kinds of sleep-wake disorders which include


1. Insomnia disorder


2. Hypersomnolence disorder


3. Narcolepsy


4. Breathing related sleep disorders such as Obstructive Sleep Apnea. But this has to be diagnosed and managed by primarily a mental health professional or a physician.


If it is a common finding that a patient’s lifestyle leads to sleep disturbance. This is usually phrased as inadequate sleep hygiene.


Things you can do to establish a good sleep hygiene include


1. Keeping regular hours of bedtime and arousal


2. Avoiding excess caffeine


3. Not eating heavy meals before bedtime


4. Getting adequate exercise


5. Creating an ambient temperature in your room


The focus of sleep hygiene is a modification of the lifestyle and environmental component that may interfere with sleep, and behavior that may improve sleep.


Therefore do not hesitate to see a health care professional if you keep tossing and turning at night. Because the world has to be a better place with you in it.





Thanks for reading!


Eliezer

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