HYDERABAD: “An overweight and young software professional, who has been living happily with his family, was not being able to concentrate on tasks for quite some time. He was losing his temper, getting irritated at work, and was tending to doze off during office hours. One day, while he was driving his car on Outer Ring Road, he dozed off at the wheels, leading to a minor crash with the road divider. It could have cost his life if the crash was a major one. Such cases are not rare nowadays...” says Dr Vijay Kumar Chennamchetty, senior consultant interventional pulmonologist at Apollo Hospitals.
The quality and quantity of our sleep has much more far-reaching effects on us than what meets the eye. It’s not only about not feeling sleepy at daytime, but also how it affects our brain and body’s rejuvenation process. It can also affect our immunity, as is evident in the following example:
“I treated a young girl who came with recurrent abscesses in her breast every two months despite taking adequate antibiotics.
When I took the detailed history, I came to know that she joined an MBA programme, and was studying late into the night and sleeping for only five hours a day. The increased stress levels brought down sleep’s contribution to reduce immunity in her. After being counselled about the importance of sleeping at least seven hours at night, she miraculously improved and was able to complete her course,” says Dr Nalini Nagalla, senior consultant, pulmonary and sleep disorders, Continental Hospitals.
According to World Health Organisation, the main effects of sleep deprivation include physical effects (sleepiness, fatigue, hypertension) cognitive impairment (deterioration of performance, attention and motivation; diminishment of mental concentration and intellectual capacity and increase of the likelihood of accidents at work and during driving) and mental health complications. Inadequate rest impairs the ability to think, to handle stress, to maintain a healthy immune system, and to moderate emotions.
Can manifest as other health issues
Dr Nalini says that patients might not immediately link their health issues with the quality of their sleep. “In my 20 years of experience as a doctor, I have seen that there are two ways patients present with sleep problems. One group comes directly with complaints of loud snoring and excessive daytime sleepiness. They are somewhat aware of the consequences of snoring and sleep deprivation. The second group of patients go to different specialities with problems like uncontrolled hypertension, uncontrolled blood sugar, heart problems, fatigue, forgetfulness and headaches. When detailed evaluation is done, we find that sleep deficiency is one of the root causes of their problems.”
Dr Vijay Kumar rues that India has a long way to go to get adequate number of sleep specialists. “Sleep medicine sub-speciality in India is in its budding phase. There’s huge dearth of board (ISDA, Indian Sleep Disorder Assosciation) certified sleep disorder specialists. Patients are referred from other specialists to evaluate the signs and symptoms of sleep disorders. We commonly get referrals from cardiology, nephrology and neurology colleagues,” the doctor says.
Why are you not sleeping?
According to the National Institutes of Health (NIH), the following can keep you from getting enough sleep:
Stimulants – Drinking that extra cup of tea/coffee after dinner might have been just enough caffeine to keep you from sleeping well. Certain pain relievers and decongestants, nicotine, soda and tea, and even chocolate all can be culprits preventing you from falling asleep.
Pain – Conditions including arthritis, congestive heart failure and sickle cell anemia can be painful and uncomfortable, making it difficult to fall asleep.
Breathing problems – Having chronic asthma or bronchitis can not only keep you awake, but also can increase the number of times you wake up during the night.
Snoring and sleep apnea – Not breathing for some time during sleep can also destroy your best efforts to get good sleep.
Menstrual cycle hormones – Women experience lower levels of progesterone during part of their menstrual cycle, which can cause them to have trouble sleeping.
Lifestyle choices – Eating large meals, exercising, watching TV or using other electronics with bright screens right before trying to sleep can keep you from falling asleep easily.
(As told by SA Rafi, consultant pulmonologist at Care Hospitals)
Common sleep disorders
Elaborating on the most common sleep disorders, Dr Vijay Kumar says: “Despite their high prevalence, sleep disorders remain poorly identified. Less than five per cent of individuals with insomnia and probably less than one per cent of sleep apnea are correctly diagnosed and treated. The eight most common disorders are – Insomnia, Sleep Apnea, Restless Leg Syndrome, REM Sleep Behavior Disorder, Narcolepsy, Sleepwalking, Sleep Terrors and Jet lag.”
Treatment
Behavioural therapy
Positive airway pressure devices (PAP)
Medicines
Dental appliances
Surgery
(As told by Dr Nalini Nagalla, senior consultant, pulmonary and sleep disorders, Continental Hospitals)
— Kakoli Mukherjee
kakoli_mukherjee@newindianexpress.com
@KakoliMukherje2