February 20, 2003

Millions of people of all ages and professions are either sleep deprived or have sleep problems. Prescription sleeping pills are readily supplied by doctors but there is no easy cure for the variety of sleep difficulties that have become a worldwide epidemic. T. U. Dawood reports

“Now I lay me down not to sleep
I just get tangled in the sheets
I swim in sweat three inches deep
I just lay back and claim defeat... Lids down, I count sheep
I count heartbeats
The only thing that counts is that I won’t sleep...My mind is racing, filled with lists of things to do and things I’ve done
Another sleepless night’s begun...”
— “Who Needs Sleep?” Song By Barenaked Ladies

Amina (name changed) works six days a week as a maid for an upper-middle class family in Karachi. She’s 38, has five kids and, although married, is the breadwinner for her household. When she works during the week, she gets seven hours of sleep per night in a comfortable bed in a private room in the servants’ quarters. On her day off, she told The Review, she usually doesn’t even get an hour’s rest morning or night. Looking after her husband, children and home exhausts her so that when she returns to work, she is unable to keep her eyes open. Thus, Amina begins every week with a sleep deficit that she’s desperately and usually unsuccessfully trying to reverse. It just accumulates week after week.

Iqbal (name changed) owns a small shop in Saddar. He’s 40 years old and is married with three daughters. His shop was seriously damaged in a robbery three months earlier. Iqbal has been unable to pay for the repairs and has no choice but to shut the shop until the repairs are made. He’s also stressed about supporting his wife and children during this time and, in particular, paying for his eldest daughter’s wedding. These worries plague the shopkeeper so much that he is having difficulty sleeping at night. His persistent insomnia is resulting in further stress and distress in his life. A recent visit to his doctor has Iqbal hooked to a sleep-inducing drug.

Amina’s and Iqbal’s situations are not unusual. Millions of people of all ages and all professions throughout Pakistan are either sleep deprived or have sleep problems. Prescription sleeping pills are readily supplied by doctors, but there is no easy cure for the variety of sleep difficulties that have become a worldwide epidemic. Each hour of sleep you miss accumulates and adds to your “sleep debt.” Drugs can help you stay awake, but they really only temporarily buy more time. Additionally, methamphetamines and what doctors call psycho-stimulants can be easily abused and often result in severe side effects.

WHAT IS SLEEP?
The purpose of sleep is to allow the body to repair and rejuvenate. Sleep also reduces fatigue and stress. Dreaming helps to clear the nervous system.

Sleep is a dynamic process with a complex five-stage “architecture.” You begin your nightly journey by descending into Stage 1, a light sleep which takes place the majority of the night. Your muscles relax, your brain waves are irregular and rapid. In Stage 2, brain waves become larger, with bursts of electrical activity. Then you move into deep sleep (from which you’re more difficult to awake) and rest and restoration. This is Stages 3 and 4, in which the brain produces large, slow waves (sometimes called “delta” or slow-wave sleep). After an hour or so, you shift into a highly active stage characterized by rapid eye movements (REM sleep) in which your brain waves are almost the same as if you were awake. This dreaming stage occurs several times across the course of the night, irrespective of whether you remember your dreams.

About 75 percent of your night is spent in non-REM sleep and about 25 percent dreaming. Patterns of sleep generally look like this: light sleep — deep sleep — REM — light sleep — deep sleep — rest and restoration. REM periods tend to become longer and more plentiful as the night wears on.

NATURE’S CLOCK
Almost everyone’s clock is set for sleep at night, especially in the early morning hours between midnight and dawn. Most people’s clock runs on a 24-hour cycle called “Circadian Rhythms” that is triggered by light and darkness. When it gets dark, your body clock stimulates the Pineal gland which produces melatonin (a chemical that induces sleep). Bright light or sunshine shuts off melatonin production. However, some people are more alert during the morning (“larks”) and others late at night (“owls”). Most people also get drowsy in the middle of the day (between 1 p.m. and 4 p.m.), which is known as the “Siesta Zone.” This is not the ideal time to start a long drive. It is also important to stay off the roads between 2:00 a.m. and 6:00 a.m. when your internal clock makes sleep almost irresistible. Crashes are most likely to happen in these hours.

JET LAG
Jet lag occurs when the body clock of travelers is out of sync with their new environment. Trying to sleep when your body is not tired and struggling to stay awake while the sun is shining, are all typical characteristics. Jet lag is unpreventible, but can be minimized by easing yourself into the new time zone for a few days before you depart, resting as much as possible in transit, and planning a relaxed schedule for your first day or two after arrival.

SHIFTWORK
Shiftworkers or people who work non-traditional schedules have trouble getting enough sleep. Nightworkers are forced to sleep when their clocks are set for wakefulness, so they tend to sleep badly and not enough. They’re more prone to falling asleep on the job than the 9-to-5 employee and are at a very high risk for accidents while driving home in the morning. Diligently maintaining a rigorously regular schedule (for both sleeping and waking activities), even on the weekends, can help the body to adapt.

SLEEP DISORDERS
There is a great variety and quantity of sleep disorders including Bruxism, Fibromyalgia, Sleepwalking, Hypersomnia, and Sleep Terrors, but we will only focus on the most common ones in this article which are sleep apnea, narcolepsy, and insomnia.

Insomnia
Insomnia is difficulty in initiating and/or maintaining sleep. It is a term that is used often to indicate any and all stages and types of sleep loss. Insomnia is not a disorder, but rather a symptom of sleep deprivation.

Generally, one in every four adults suffers from insomnia, and approximately half of all senior citizens. It is also a problem that is prevalent among people with HIV/AIDS.

Chronic insomnia is often associated with psychological problems deeply rooted in stress, anxiety and/or depression. Medically rooted insomnia can be caused by iron deficiency anemia, breathing disorders, kidney dysfunction, diabetes, and in the case of HIV, can be associated with a variety of medication side effects. Insomnia can also be due to poor eating habits, caffeine, and lack of exercise.

Insomnia is a very individual problem and so treatments are case-specific. Common methods used for treatment include behavioral modification, following good sleep practices (see “Tips On A How To Get A Good Night’s Rest”), light therapy, and occasionally medication is prescribed for a short period of time.

Narcolepsy: Irresistible Daytime Sleep Attacks
The classic image of narcolepsy is of a narcoleptic cat on the edge of a pool. The cat keeps following asleep only to fall into the pool. However, each time the feline is put back onto the edge, she immediately falls asleep and the cycle repeats.

Narcolepsy is the frequent and irresistible need to sleep. It affects the part of the brain that regulates sleep and wakefulness, resulting in the sudden onset of REM (dreaming) sleep. Symptoms typically begin between puberty and age 25. They may develop slowly over months or years, and excessive daytime sleepiness is generally the earliest sign. “Sleep attacks” can happen anytime, during a conversation or even while driving, and last a few seconds or more than 30 minutes.

Cataplexy (sudden loss of muscle control) is a common characteristic of narcolepsy. Cataplexy can be triggered by strong emotions, such as anger, laughter or surprise, and it may make narcoleptics so weak at the knees that they literally fall to the ground. Also, some narcoleptics experience sleep paralysis (an inability to move or speak) during the transition into sleep or wakefulness.

Vivid, dream-like images called “hypnagogic hallucinations” are commonly experienced by narcoleptics when they are drifting off to sleep or immediately upon awakening. The images can be mundane or nightmarish and often cause great anxiety.

Narcolepsy afflicts about one in every 2,000 people. Although currently no cure exists, its symptoms can be controlled through lifestyle management and medications.

Sleep Apnea: Snoring That Takes Your Breath Away
Sleep apnea is a potentially life-threatening disorder in which the throat muscles that keep open the breathing passages of a snoozer relax so much that the airway closes. In primary or benign snoring, the sleeper makes loud breathing noises but does not experience episodes of cessation of breath (apnea). In sleep apnea, on the other hand, sometimes even a whole minute passes before the sleeper gasps for air and rouses briefly. To an observer, this sounds like a loud, habitual snore, with dramatic gasps throughout the night.

Sleep apnea primarily affects middle-aged men and overweight people. Sufferers often experience excessive daytime sleepiness, and impaired memory and concentration. This disorder can lead to high blood pressure, increased risk of heart attacks and stroke, and even heart failure in severe cases. A polysomnography sleep test is done to diagnose sleep apnea.

Doctors have identified three basic types of apnea: obstructive, central and mixed. Obstructive apnea involves the throat muscles obstructing the upper airway, thereby stopping breathing for 10 seconds or more. Loud snoring is common and mini-awakenings (usually not remembered) result several hundred times a night as the sleeper gasps for air. This disorder is often treated with a device known as a CPAP (Continuous Positive Airway Pressure), in which a small compressor is used to maintain airflow during the night. In central apnea, which is less common, the airways stay open but the diaphragm and chest muscles stop working. The sleeper must awaken several times a night to resume breathing, sometimes with a gasp, but does not snore. Sufferers may complain of insomnia or restless sleep. Mixed apnea is a combination of obstructive and central apneas.

Can sleeping pills help?
Sleeping pills can be useful temporarily in breaking the sleeplessness cycle of insomnia. They are prescribed in conjunction with conscious changes in stress management and sleep habits. Once the other changes show positive effects, medications are discontinued, usually within two weeks. Prescription sleeping pills come in both shorter and longer-acting forms. The shorter-acting drugs help to induce and solidify sleep, but wear off faster. The longer-acting drugs help maintain sleep through the night, but may cause sleepiness the next day. Non-prescription, or over-the-counter (OTC) sleep aids use antihistamines to induce drowsiness. Enough time must be allowed for the drug to work through your system so there’s no risk of sleepiness during the day.

A good night’s rest
We need sleep to survive. A window on overall health, sleep restores us. Those who sleep fewer than six hours a night don’t live as long as those who sleep seven hours or more.

Changing one’s life-style can help you sleep better. For example, reducing intake of medicines and caffeine, and increasing exercise and consumption of melatonin-rich foods and vitamins.

Medications including antihistamines can disrupt the sleep cycle and cause sleep depravation. Similarly, more than 300 milligrams of caffeine (about three cups of coffee) a day can lead to addiction. Caffeine is also found in colas, chocolates, and some medications.

You may want to try eating things that raise your melatonin production such as oats, sweet corn, rice, ginger, tomatoes, bananas, barley, spirulina seaweed, and soy nuts. Some vitamins and minerals such as B6, niacin amide, calcium, magnesium, or antioxidants, or herbal remedies such as Valerian root, skullcap, passion flower, wood betony, or California poppy, may help you sleep.

If natural methods fail, light therapy at a sleep lab is an effective option. Getting good sleep is a matter of working with one’s light-sensitive biological clock. Using techniques of light therapy (bright light in the morning advances one’s clock), sleep specialists are able to shift biorhythms so patients won’t wake up hours before they should.

In a society driven by extreme energy, high expectations and extensive problems, it is very difficult to obtain a good night’s rest. For millions like Amina and Iqbal, healthful sleep is just a dream.

We at The Review strongly encourage our readers to prioritize sleep needs and try and reduce any sleep debt. Sleep Awareness Week is March 31 - April 6. Wouldn’t it be great if our national sleep debt decreases by then? Sweet dreams.

 

How sleepy are you? How likely are you to doze off or fall asleep in the following situations, in contrast to feeling just tired? This refers to your usual way of life in recent times. Even if you have not done some of these things recently, try to work out how they would affect you today. Use the following scale to choose the most appropriate number for each situation: 0 = no chance of dozing 1 = slight chance of dozing 2 = moderate chance of dozing 3 = high chance of dozing SITUATION                                                     CHANCE OF DOZING Sitting and reading Watching TV Sitting inactive in a public place (e.g. a theater) As a passenger in a car for an hour without a break Lying down to rest in the afternoon when circumstances permit Sitting and talking to someone Sitting quietly after a lunch In a car, while stopped for a few minutes in traffic TOTAL: To check your sleepiness score, total the points. 7-8 is the average score. Below that, you are getting enough sleep, and 9 or above, you need to visit a sleep specialist immediately. T.U.D.

 

How to get a good night’s sleep Nothing is more frustrating than not being able to sleep. Tossing and turning, it is possible to lose sleep when worrying over losing sleep! Whether it’s night noises that are keeping you awake, or your own thoughts, there are things you can do to help get to sleep. Below are some tips that are commonly known as “Sleep Hygiene” * Sleep only when sleepy. This reduces the time you are awake in bed. * If you can’t fall asleep within 20 minutes, get up and do something boring until you feel sleepy. Reading the phonebook or your tax forms are great ways to “bore” yourself to sleep. Keep away from bright light, however, because light gives the brain cues to wake up! * Don’t take naps. Naps can prevent you from being tired at bedtime. If you must have a siesta, make it less than one hour and keep it before 3 pm. * Get up and go to bed the same time everyday even on weekends! When your sleep cycle has a regular rhythm, you will feel better. * Refrain from exercise at least four hours before bedtime Although regular exercise is recommended to help you sleep well, evening exercise can interfere with sleep. Working out in the morning or early afternoon is a better option. * Develop sleep rituals. Help your body out! Give your body cues that it is time to slow down and sleep. Listen to relaxing music, perform basic yoga exercises, or read something soothing for 10 to 15 minutes. * Only use your bed for sleeping. When your bedroom and bed becomes your office and entertainment center, it can impede sleep. In fact, refrain from watching television, eating, doing work or even reading on your bed. This will help ensure that when you go to bed, your body will know that it is time to sleep. * Stay away from caffeine, nicotine and alcohol at least 4-6 hours before bed. Caffeine and nicotine are stimulants that interfere with your ability to fall asleep. Coffee, tea, cola, cocoa, chocolate and some prescription and non-prescription drugs contain caffeine. Cigarettes and some drugs contain nicotine. Although alcohol slows down brain activity and so at first it may seem to help you sleep, its effects wear only in a couple of hours, resulting in fragmented sleep. * Have a light snack before bed. Empty stomachs can interfere with sleep. Heavy meals before bedtime can as well. Eating something light before bedtime is probably the best balance. Dairy products and turkey are highly recommended for sleep strugglers because they contain the natural sleep inducer tryptophan. * Take a hot bath 90 minutes before bedtime. A hot bath raises your body temperature. The drop in body temperature once you are out of the bath, however, may leave you sleepy. * Make sure your bed and bedroom are quiet and comfortable. Most people find it more comfortable to sleep in a cooler room with blankets than a warmer room. If early morning light disturbs you, get a blackout shade or wear an eye mask (like the kind airlines give out). If noise is a problem, wear earplugs, get a “white noise” or “sound” machine, or keep on a fan. * Use sunlight to set your biological clock. Immediately upon waking every morning, go outside and turn your face to the sun for 15 minutes. T.U.D.

 

SLEEP MYTHS MYTH #1: A hot bath in the evening will help you sleep better. True. People with trouble falling asleep might benefit from taking hot baths about 90 minutes before bedtime, researchers speculate. When they get out of the bath, body temperature will drop rapidly, and that might help them to fall asleep faster. MYTH #2: Nightcaps improve your sleep. False. Nightcaps help you get to sleep more quickly, but when the alcohol wears off in just a couple of hours, you’ll have this rebound wakefulness right after the effect. MYTH #3: The right mattress can help determine if you get a good night’s rest. True. It’s not one size fits all, and the right mattress for one person, may be another’s nightmare. Choose wisely. MYTH #4: We need less sleep as we age. False. Although seniors sleep less at a stretch than they did when they were younger, they still need the same amount of sleep. Sleep problems among the elderly are very common, unfortunately. MYTH #5: An afternoon nap is a good way to reenergize oneself. True. There’s increasing evidence that a 15-20 minute nap can improve alertness, sharpen memory and generally reduce the symptoms of fatigue. If you’ve not slept enough the previous night or know you will sleep inadequately later that evening, a nap can be a smart way to help you cope. In fact, it could be the difference between life and death if you’re planning on a long drive with less than your regular quotient of sleep. Please note, however, that a nap is not a substitute for a full night’s sleep; it is only a short-term solution. Furthermore, if getting to sleep or staying asleep at night is a problem, you are not a good candidate for naps. They can further upset your sleep cycle. MYTH #6: Having a cigarette in the evening has no effect on your sleep at night. False. Cigarettes contain nicotine which is a stimulant that can interfere with your ability to fall asleep. MYTH #7: Having a warm glass of milk before going to bed may help you sleep. True. Milk contains tryptophan, which acts as a natural sleep inducer. T.U.D.

 

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For more information, please look at the following helpful websites: The Sleepnet Home Page: www.sleepnet.com Sleep basics, statistics and over 130 links to other sleep websites. National Sleep Foundation: www.sleepfoundation.org Access to sleep and psychology: www.yahoo.com/Medicine/Sleep_Medicine An academic science site on sleep research and psychology. A Good Night’s Rest: www.pacificcoast.com/pcf/healthy/gdslp.html An informative summary on sleep requirements, sleep structure, common sleep problems, naps, stress and sleep, and sleep and the life cycle. Discusses exercise, nutrition, the bedroom environment, and sleep schedules. How to feel rested on too little sleep: www.homearts.com/rb/health/04sleef“TimesEuropalRoman”P.html Redbook Magazine’s site on sleep deprivation, its efforts and techniques to combat the problem. The Sleep Well: www.leland.stanford.edu/~dement Stanford University’s sleep research center provides up-to-date information on all aspects of sleep. Children’s sleep problems: www.psych.med.umich.edu/web/aacap/factsFam/sleep.html Information and suggestions are provided for parents of children whose sleep is disrupted by bedwetting, night terrors, or sleepwalking. Brain Information Services: http://bisleep.medsch.ucla.edu/ An excellent resource for those who are involved in the research and/or treatment of sleep disorders. Provides links to sleep support organizations, the World Federation of Sleep Research Societies, sleep labs, newsletters, articles, and more. Dream Sites: Dreaming is the bodies way of cleansing your soul. If you have a very large “sleep debt,” you will likely sleep too deeply to remember your dreams: www.yahoo.com/scince/psychology/sleep_and_dreams Phantom Sleep Page: www.newtechpub.com Sleep, Dreams, and Wakefulness: ural1195-6.univ-lyon1.fr/home.html Naptime Dreams: http://www.bluemarble.net/~amyloo/dream.html   T.U.D.

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