Insomnia

Q: Why is there a need to focus and prioritize on sleep?

A: Sleep, one of the basic building blocks of a sound body and mind is unfortunately the one that is the most compromised by many. Sleep time is constantly allowed to be eroded by work, recreation and virtual activities. Being sleep deprived is proudly proclaimed, equated with toiling harder and made to believe as the new normal.The dangerous repercussions of such ideologies need to be addressed with urgency.

A study conducted in 2010 which surveyed 5600 people from 25 cities in India found that 93 per cent of urban Indians in the age group of 35-65 years were sleep deprived. While 58 per cent of these Indians felt their work suffered from a lack of sleep, 11 per cent said they fell asleep at work. This is a cause for alarm and we need to wake up to the fact that we cannot afford to miss out on our sleep if we wish to maximize our functioning and potential.

Insomnia

Q: How important is sleep for our physical and mental wellbeing?

A: Research has shown that areas of the brain involved in repairing our body's physiological processes are most active during sleep. This continual restoration is extremely vital for maintaining a stable system of functioning. Sleep also functions as an offline processing system, where accumulated information is processed and new memories laid down. Thus, it might make sense that burning the midnight oil might not apply if one wishes to enhance their learning and recall.

Impaired mood regulation, decreased mental agility,micro day time sleep episodes culminating in road traffic accidents are important sequelae of sleep deprivation.

Q. What is the recommended duration of sleep?

A: The optimal duration of sleep varies from person to person. Most recommendations suggest an average of 7 to 8 hours of night time sleep. It is essential to remember that continuity and depth of sleep are as important as the quantity of sleep. The best way to judge whether you are sleeping enough is to wake up spontaneously without the use of an alarm clock, feeling rested, and not feel sleepy during the day.

Q: Can sleep deprivation lead on to physical ailments?

A: Absolutely. Evidence has consistently established the link between chronic sleep deprivation and multiple ailments such as diabetes, hypertension, obesity and dementia.

There are numerous biological changes that have been found in sleep deprived states. Cells of a sleep deprived person have been found to be less responsive to insulin, thus predisposing to hyperglycaemic states. Imbalances strike between satiety- signalling and appetite signalling hormones thus contributing to weight gain. An inefficient cleansing of the brain from accumulated proteins might lead to cognitive decline as well. Thus the impact of sleep on physical functioning cannot be undermined in any way. In fact, sleep has a powerful effect on our immune system. Aiming for good quality sleep is the right way to ensure resilience of our bodies.

Q: What do you think is the commonest cause of sleep disruption in our current scenario?

A: The number one sleep disruptors in today's digital world are the synthetic sources of light emitted by gadgets. It is essential to gain an understanding into our sleep mechanism if we need to put our gadgets down.

Sleep is dictated by our body clock which synchronises with the 24-hour rotation of the earth. The suprachiasmatic nucleus in our brain, receives light cues from the environment and sets our body clock (also known as the circadian rhythm). Melatonin- a sleep hormone, secreted during darkness regulates this rhythm and promotes sleep. Studies now confirm that blue light emitted by screens suppress melatonin and prevent transitioning into sleep.The brain thus remains in a state of wakefulness as it made to perceive the light as day. Aim to put down your gadget at least 1 hour prior to bedtime to help restore your sleep rhythm.

Q: What are the other common contributors of poor sleep?

  • Work shifts and differing schedules go against the circadian rhythm and can thus disrupt sleep.
  • Environmental factors such as high noise levels, uncomfortable bedroom temperatures are other important mediators of impaired sleep
  • Alcohol and caffeine both widely available and accessible are widely known miscreants of sleep
  • Certain medications such as beta blockers, activating antidepressants can impair sleep too.
  • Apart from these common factors, medical conditions such as Sleep apnoea, Restless Leg Syndrome, Psychological conditions such as Depressive Disorders and Anxiety Disorders can present with sleep disturbances as well and need to be evaluated in the face of persisting sleep issues.

Q: When is one said to suffering from Insomnia?

Insomnia is a sleep disorder characterized by difficulties either to fall sleep (a sleep onset of more than 30 minutes), to stay asleep or having early awakenings. Insomnia can either be short term if the difficulties last less than a month or chronic if they persist for more than 3 months, but occurring at least 3 times a week in either case. In all cases if the sleep difficulties persist and cause day time sleepiness, fatigue and impair your functioning, it needs to be evaluated and addressed.

Q: What do I need to do if I have Insomnia? Are medications the only way out?

A: Primarily, the cause of Insomnia needs to be established and thus it is essential to consult your doctor who will be able to decipher and address the etiology.

Numerous non pharmacological interventions are available, failing which a short duration (a maximum of 3-4 weeks) of sleep promoting medications will be considered by your doctor based on his evaluation of your condition. Some conditions might warrant a longer period of use. Discuss with your Doctor and remember to strictly adhere to the recommendations on dosing and duration.

We find that people sometimes inadvertently prolong medication use without regular follow up. We also witness a common trend among some to self-medicate either by borrowing pills from a relative/friend who is on prescription medications. Some try to address their sleep issues by purchasing over the counter anti histamines (commonly used for allergic conditions), cough syrups and sedatives and spiral into a cycle of dependency with dangerous consequences. Some seek alcohol, which though might seemingly appear to aid sleep often destroys the sleep architecture leading to a perpetual insomniac state.

Q: What are the Non Pharmacological approaches to Insomnia?

A: Cognitive Behavioural therapy for Insomnia (CBT-I) has been specifically developed for insomnia that comprises of several components.

Cognitive approaches: target distortions of thought and misconceptions related to insomnia

Behavioural approaches: such as Stimulus Control (teaching to break the maladaptive conditioning between bedtime with behaviours that are incompatible with sleep), Relaxation therapy, Positive Imagery and Educational Approaches such as Sleep Hygiene.

You need to consult a mental health professional trained in these approaches.

Q: How do we ensure Sleep Hygiene?

  • The number one rule is to establish regular bed and wake up times. Retrain to go to bed and to wake up at fixed times every day.
  • Do not use the bed for activities such as working or studying
  • Go to the bed only when tired. Refrain from staying awake in the bed.
  • Maintain a comfortable sleeping environment that's not too hot or cold
  • Reduce noise levels in the bedroom
  • Avoid naps during the day
  • Avoiding caffeine, nicotine and alcohol late in the evening
  • Avoid heavy meals late at night
  • Reduce exposure to artificial lights

Lets resolve to wake up to the fact that we need to attend to our sleep every day.

Article by Dr. Yamini Al. S. Kannappan, MBBS, DPM, DNB (Psychiatry)
Consultant Psychiatrist,
Kauvery Hospital

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