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Good night
• Avoid caffeine in any form after 2pm
• Do not consume tobacco and alcohol
• Walk, jog, run, swim or cycle for 40-60 minutes a day
• Stop all exercise three hours before bedtime
• Meditate before bedtime
• Drink a glass of warm milk before going to bed |
The amount we sleep and wake is not a random occurrence. It is regulated by complex chemical transmitters in our brain. During the day, activity causes a chemical called adenosine to build up in our body. When it reaches a critical level, there is an overwhelming desire to sleep. If you have not been sleeping enough, you can build up a “sleep debt” with high levels of adenosine, causing lack of concentration, daytime drowsiness and sudden attacks of sleepiness. These may be socially inappropriate or cause life-threatening accidents. In children, lack of sleep produces paradoxical changes with irritability, aggressiveness and hyperactivity.
Our spinning world is governed by light and darkness. The changes in the external environment are reflected in our internal biological clock, a bundle of cells in our brains. These respond to darkness by producing a chemical called melatonin, which produces sleep. These cells get confused when the environment has artificial light. The “blue light” produced by televisions, computer monitors and cell phones is particularly harmful.
Infants need 16-18 hours of sleep a day. This drops to 9-10 hours in children and 8-9 hours in teenagers. Adults need 7-9 hours of sleep a day.
Adequate sleep is needed to keep the brain chemicals in balance. Long standing sleep deprivation causes these neurotransmitters to go haywire. The production of leptin, responsible for appetite suppression, decreases and its opposing enzyme ghrelin increases. Appetite increases, along with a craving for carbohydrates. Eventually people become obese, develop glucose intolerance and may actually become diabetic.
Sleep may be disturbed because of concurrent illnesses or social situations. Urinary tract infection or an enlarged prostrate may require frequent visits to the toilet. Infants may require frequent night feeds. The other people sleeping in the room may snore loudly or grind their teeth. Children may suck their thumb. In the silence of the night, these sounds can appear extremely loud.
The common sleep disturbances are:
• Insomnia with difficulty in falling and staying asleep with early rising and intermittent bouts of wakefulness.
• The restless leg syndrome where there is an irresistible urge to move the legs. This can force people to get to up, shake the leg and walk around.
• Sleep apnoea where people stop breathing several times during the night
• Narcolepsy with excessive daytime sleepiness and uncontrollable episodes of falling asleep during the day.
If you feel you have a sleep disorder, correctable causes must be treated first. Any external factors causing a disturbance, like a noisy partner or electronic equipment in the room, must be tackled. Stimulants like caffeine (coffee, tea and cola), should not be drunk after 2pm. Nicotine (cigarettes, snuff and chewing tobacco) stimulate the brain cells so that sleep is disturbed. Alcohol can “knock you out” fast, but the sleep is deep, disturbed, unnatural and arousal occurs within a few hours.
Concurrent medical problems like cardiac failure, renal failure and even bronchial asthma can cause sleep to be uncomfortable and disturbed. The pain in arthritis can cause tossing and turning. Mental changes of Alzheimer’s or early onset dementia can cause lack of restful sleep. Depression makes people wake early. They toss and turn restlessly, unable to sleep again, and have their problems reverberate in their brains. Sleep apnoea sufferers have intermittent episodes in the night when they may snore or stop breathing. They wake up as the carbon dioxide concentration builds up. It may occur because the throat muscles relax too much or because the brain fails to send proper signals to the respiratory centre muscles, ordering them to breathe. It can be fatal.
Lack of sleep should be investigated. A diary should be maintained of the sleep-wake patterns. Medical conditions should be investigated and treated. There are “sleep laboratories” which observe, test, diagnose and treat sleep disorders accurately.
If sleep eludes you, do not lie in bed tossing and turning. Get up and read a book (television is not a good idea) and try not to become anxious and frustrated.
Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in
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