Dr Neetu Jain
Understanding sleep
Normal sleep spans seven to nine hours, but varies per individual. There is no fixed hours of sleep that everyone needs rather a block of uninterrupted sleep. The key is waking up energised. You should feel that you are ready to work, able to concentrate, and do not feel drowsy or have headaches. Sleep occurs in two phases: non-rapid eye movement sleep (NREM), which is further divided into three stages, and rapid eye movement (REM) sleep. Stage three of NREM is the deepest level of sleep. Those who do not reach this level will not feel refreshed when they wake up.
When to seek medical help
Persistent sleep difficulties―trouble falling asleep, waking up frequently and unable to go back to sleep again, feeling exhausted despite having slept, experiencing headaches, or having trouble concentrating―require medical attention. Excessive sleepiness is also not right. People who have narcolepsy unknowingly fall asleep. This results in the loss of muscle tone. Shift workers often struggle with problems because of disrupted sleep patterns. If you have done all that you can to address these problems, it is time to see a sleep specialist, pulmonologist or neurologist, depending on your problem.
Major problems
Insomnia: This is lack of sleep, which could be brought out by reasons such as stress, underlying disease, work pressure, long working hours, excessive screen time, and lifestyle issues like lack of exercise, irregular food habits, and excessive consumption of caffeine, tea or alcohol. Consult a doctor if you have been suffering from insomnia for six months.
Parasomnia: The term refers to a range of problems: abnormal movements and talking while asleep, sleepwalking and hurting yourself or your partner while asleep.
Psychiatric disorders: Mania, post-traumatic stress disorder and anxiety impact sleep. Seek help from a specialist instead of relying on over-the-counter medicines.
Sleep apnoea: This is a condition in which the respiratory tract is obstructed multiple times when you are sleeping. The vibration of the tract causes snoring. When the tract is obstructed, breathing becomes irregular, the oxygen level goes down, and when it reaches a critical limit, people wake up gasping. A person could wake up 10 to 20 times at night, affecting the quality of sleep. Elderly people, overweight men with short necks and a sedentary lifestyle, and people who regularly consume alcohol and tobacco are more prone to apnoea. Post menopause, women are just as likely to have it. Sleep apnoea is of two kinds: obstructive sleep apnoea (caused by muscle relaxation at the back of the throat) and central sleep apnoea (when the brain fails to send signals to breathing muscles).
Maintaining sleep hygiene
Consistent sleep schedule: Fix a time and place to go to sleep. When it is time, switch off all your screens and go to the bedroom. Reduce your consumption of tea and coffee after 3pm. Have an early and light dinner. Exercise regularly.
Maintain a sleep diary: Every day, record your sleeping pattern and exercise schedule. Use a tracking device if maintaining a sleep diary is difficult.
Train the brain: Follow the circadian rhythm, the body’s internal clock that regulates biological processes over a 24-hour cycle.
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Trying medication
Medication can help you regain your circadian rhythm or sleeping cycle. Melatonin, for instance, tells your brain to sleep at a particular time. A range of medicines that aids sleep is available, but they cannot be bought over the counter. Also, medicines can be addictive and the dosage has to be controlled so that you do not feel drowsy the following day. Some people may require sleep-aid medicines throughout their life.
Alternative therapies
These are not recommended, but there could be formulations that help people sleep. Milk, for instance, can be prescribed because it has calcium, which helps induce sleep. Flower-based teas can have a calming effect. But everyone’s body responds differently, so it is always better to seek expert help.
Clear sleep debt
If your body is used to seven hours of sleep but you are getting much less than that, you run up sleep debt. Catching up on sleep on weekends and holidays can help reduce this debt.
Sleep labs
Sleep labs diagnose and monitor sleep disorders by recording brain activity, heart rate, breathing, and other physiological functions during sleep. While not a new concept, they have become more widely available. These are invaluable in identifying sleep issues, and those who undergo studies often experience life-changing improvements. Yet, sleep labs remain underutilised.
Sleep is the best beauty aid
Not sleeping well results in puffy eyes and dull skin. Lack of sleep makes you age faster. Get good sleep and make healthy life choices, and see the difference for yourself.
The mattress myth
Sleep quality is not determined by whether your mattress is soft or firm, or eight or 10 inches thick. Some people sleep best on the floor. The key is personal comfort. However, an overly worn-out mattress can cause body ache. The key is to have bedding that is comfortable for you.
The impact of light
Night and day were once clearly defined. Now, with artificial lighting and constant exposure to screens, your body tells the pineal gland not to secrete melatonin―the hormone that regulates sleep and wakefulness―because of which your brain perceives night as day. If you do not shut down your devices at least an hour before going to sleep, the possibility of getting a good night’s sleep are slim.
Can you trick the brain?
Your brain tells you when it is time to sleep. Listen to it instead of trying to trick it. Most of us who are on social media late into the night are not listening to the brain and body’s signals. Keeping devices out of the bedroom and using a traditional alarm clock can help. The best way to “trick” your brain into sleep mode is to associate your bedroom only with rest. A dark room with heavy curtains, soft music, and no television creates the ideal sleep environment.
Staying awake is not impressive
During my residency, like many peers, I believed that staying awake for 24 to 36 hours was a sign of hard work. In reality, it only led to poor concentration and diminished work quality. There is no glory in sleep deprivation―true success lies in maintaining a healthy lifestyle and prioritising deep sleep every night.
DR NEETU JAIN
senior consultant in pulmonology at Pushpawati Singhania Research Institute (PSRI) Hospital, Delhi, specialises in critical care and sleep medicine. An alumna of Government Medical College, Nagpur, and Batra Hospital and Medical Research Centre, Delhi, she holds a European Diploma in Respiratory Medicine and is a fellow of both the American College of Chest Physicians and the Indian Society of Critical Care Medicine. An avid reader and Indian classical music enthusiast, she emphasises the need to prioritise sleep.