Читать книгу Understanding the Language of Silence - Sleep, Sleep Behavior and Sleep Disorders - Dr. Amrit Lal - Страница 5

Science of sleep is fascinating. Sleep is not an option or a volitional activity; it is the very essence of one’s existence - or an area of relevance because all of us sleep. Research has generated enough insight into the functions of this somnolent state that consumes one–third of our lives that some “gurus” of new business management philosophy abhor as waste – a third of life of inactivity and un-productivity in the bed! It is too much for them to swallow, “for there will be enough sleeping in the grave.”

Sleep in is not actually a waste of time since it has a great recuperative potential for productivity – both mental and physical. During daytime work an individual uses up a lot of hormones which keep him/her in good health. These hormones are replenished by the endocrine system when we snooze. Among these, somatotropin (also called growth hormone) is also released during sleep, which helps in the reconstructive task of repairing worn out cells and those cells destroyed during the waking hours. . Release of growth hormone is related, in part, to repair processes that occur during sleep. At the same time certain chemicals in the body, among them peptides, are produced, which not only have sleep-inducing effects but are also known to bolster human immune system by increasing the production of anti-bodies. They also help us fight infections. Other hormone such as thyroid-stimulating hormone is also released prior to sleep. Thyroid hormone makes way for harmonious growth of human body.

Sleep is not an inert psychosomatic state. Although there is a modest decrease in metabolic rate and some other vital functions of the human body, there is no evidence that any major regulatory system of the body, including the brain, shuts down in sleep. On the contrary, brain buzzes with neural activity and endocrine system involved in secretions of certain hormones (such as growth hormone and prolactin and sleep-inducing melatonin) actually increases. Slumber scientists, in particular, have identified and recorded electrical impulses in brain during sleep through electrocephalograms (EEGs) as brain waves which are classified according to their frequencies; electrooculogram (EOG) which measures eyes rate in the eye socket, and, electromyogram (EMG) which measures electrical activity associated with muscles. These measurements, EEGs, EOGs and EMGs, are simultaneously recorded to allow relationships among them to be compared and inferences drawn.

Through the ages, world’s greatest thinkers from Greek philosopher, Aristotle, to Austrian neurologist and founder of psycho-analyst Sigmund Freud, have provided diverse explanations on man’s sleep behavior from their respective perspectives. Sleep was once considered “an irreversible stupefaction – the absence of overt objective behavior which a working individual is capable of.” It has also been romanticized as “death of each day’s life.” But this concept of sleep as a passive state of periodic torpor, during which overt behavior and consciousness remains suspended has been replaced by a new approach – the study of sleep not simply as an absence of wakefulness but a dynamic mode of existence during which the brain buzzes with frenzied activity and many physiological functions are hyper-active.

A lot actually goes on during sleep. Even though slumber scientists are still not very certain about many aspects of sleep but they know that the brain performs critical memory consolidation and other important functions during the night for which it uses sleep as a workdesk to perform much needed maintenance job in the body.

We talk about “good” sleep, “poor” sleep, “light” sleep and “deep” sleep. Sleep behavior is characterized by three salient features, namely, reversibility, recurrence and spontaneity. There is no such thing as “sleeping like a log of wood.” This shows a great heterogeneity in the qualitative aspects of sleep architecture which is as important as total sleep time. Despite spending one-third of our lives asleep, sleep continues to be a complex and mystifying – like the smile of sphinx!

This presentation treats sleep not as a passive state of quiescence but as an active phase of life with inroads into psycho-social and neurological aspects of sleep and pathology of sleep disorder. Under normal circumstances, people in good health (physical, mental and social) tend to sleep well; whereas those in ill health suffer from many sleep maladies. Even a minimal loss of sleep can have deleterious impact on a person’s mind, energy and ability to handle day-to-day demands of modernity. It saps the quality of life that may lead to systemic diseases.

How much sleep we need varies between individuals but generally changes as we age. But it is a myth that sleep disorders affect only adults and the elderly. According to American Academy of Pediatrics sleep disorders affect 20 to 45 percent of children and adolescents, impacting their daily functioning, ability to concentrate and causing irritation and generating a propensity for irritability. When it comes to the elderly, because of their peculiar genesis and ramifications, sleep disorders in this group of population deserve a specific mention. The elderly not sleeping well, fragmented sleep marked by frequent arousals and repeated rounds of bath room for urination throughout the night and, finally, waking up in the early hours of the morning is quite a phenomenon and particularly exhausting. These are manifold geriatric problems. Also, the fact which has a significant impact on physiology and psychology of aging as well as sociology of old age has to be reckoned in any discussion of sleep disorders in the elderly, because the incidence of sleep disorders rise with age and changes in life events. In a National Institute of Aging study of 9,000 persons aged 65 and above, over half of the men and women reported at least one chronic sleep disorder. (Sleep, 1995; 18). The elderly not only require sufficient total sleep time but sleep that is in harmony with the individual’s circadian rhythm (daylight and darkness at night) because problems with proper sleep regulation in the elderly typically include difficulties in falling asleep, less time spent in sleep and early morning awakenings. As such evaluation of their problems is a multi-dimensional task which includes careful screening for sleep hygiene and other factors that may be contributing to particular sleep disorders.

And today we get 90 minutes less sleep every 24 hours than people got a century ago, mostly because of altering patterns of work where 24-hour shifts make nights look like day through specially designed lighting to induce workers to remain awake at night. Nature crafted nights for rest and relaxation and days for work and activity, but now the demands of modernity have put this pyramid upside down. Today, with more than a third of world population on night shifts, and money markets across various time zones conducting multi-billion dollars transactions around the clock and with tough deadlines imposed on enterprise by global competition, a man’s sleep debt keeps on accumulating. Much of this sleep deprivation is voluntarily as it is considered a mark of success to work long hours – a macho attitude! On this scenario, a 2012 study Center for Disease Control and Prevention, Atlanta, estimated that almost one-third of working adults in America get only six hours or less of sleep at night.

Man basically is the most self-deprived mammalian species on this planet. Reasons for this deprivation are as varied as the manifestations of this development – ranging from work culture round the clock to access to technology and ever shifting work schedules.

Less sleep than what the body needs can cause in serious consequences. Several major disasters have been linked in part with too little sleep in the work place - Nuclear melt-downs at three-mile Island in Pennsylvania, Chernobyl in Russia and the Exxon Valdez in Alaska are in part attributed to sleep deprivations of the workers on the job.

Apart from ill health which adversely affects sleep patterns, bad sleep hygiene such as irregular sleep-wake hours and addiction to nicotine, caffeine and alcohol and some OTC medications such as anti-histamines (anti-allergy medications) and pain killers (mainly, narcotics), make sleep scenario worse confound in actual life. Instead of helping in the solution of the problem, bad sleep hygiene and certain lifestyle become a part of the problem. Under such conditions, when such so-called “sleep help” options fail to deliver, it may well be to turn to a sleep specialist who is specifically trained in sleep medication and can figure out what lies at the root of a particular sleep disorder to navigate a way to improve both quantity and quality of sleep. The earlier one seeks such help, the better one can manage one’s sleep problem.

Already, according to one estimate, pertaining to the United States, there are some 37 million old-aged Americans who suffer from frequent sleep disorders which, if ignored, can manifest in a number of serious age-related conditions ranging from arthritis to diabetes and obesity, heart and lung pathology as well as psychiatric disorders like dementia and depression. However, National Sleep Foundation (NSF) of the United States says that it is the poor health of the elderly comes first and is the real trigger to sleep disorders rather than the other way round. But the general consensus of the medical community is that the association between health and sleep disorders is bi-directional - not a one way alley but a two way street – more severe a medical condition, greater the severity of a sleep disorder and vice versa. In addition, let us not forget, some 20 percent of automobile accidents are as a result of some form of sleep disorder like insomnia and sleeping pills to address it, resulting in outright daytime drowsiness caused by night time sleep deprivation or use of sleeping pills. US congressman Patric J. Kennedy who was caught at 3 AM driving erratically admitted having used at night a particular sleep aid (Ambien) with an anti-histamine (Phenergan): “I simply don’t remember getting out of bed, being pulled over by the police, or being cited for the driving infractions,” said Kennedy later on.

Apart from being an individual health concern, a good night’s sleep is also good for business because a sleep-deprived worker cannot perform optimally. Already, sleep deprivation costs billion of dollars in lost productivity. A 2011 study published in the journal Sleep found that insomnia alone costs $2,280 per worker in lost productivity, adding up to $63.2 billion nationwide in America. According to the Center for Disease Control and Prevention (CDC) in Atlanta, USA, 40.6 million American workers, which is 30% of the civilian workforce in the country, don’t get enough sleep. Also, CDC estimates that the number of sleep deprived Americans is up about 25 percent from 1990. This is to say lack of sleep and high use of prescription and non-prescription anti-sleep regimens have become one of the signature health concerns in America.

Harvard scientists estimated that in 2011, sleep deprivation costs US companies a staggering $63.3 billion in lost productivity per year because of “presentism” to get paid but operating at sub-par levels. And a poll by Harris Foundation in the United States found that those adults with less than 8 hours sleep reported “their concentration was 70 percent of normal, their accomplishment 76 percent of their capability and their quality of work dropped off by 20 percent.”

As of today, we still know very little about sleep. At the basic school level very few, if any, hygiene text books provide any kind of information on sleep, in particular, what occurs in the body during sleep and how these changes or sleep deprivation affect our ability to move, think and learn. Most of what we know about sleep we have learnt in the past 30 years or so. But sleep research is recently gaining recognition. It was only in 1995 that American Medical Association recognized Sleep as a specialty. It is a newer field of research and is generally not taught in medical schools, says Dr. Sara Mednick, a psychologist from the University of California Riverside. Although more than 200 sleep disorders centers exist in the United States, experts estimate 95 percent of those suffering from sleep disorders go undiagnosed. May be sleep disorders are generally ignored by the medical community which is more tuned to addressing other types of medical conditions, say, from arthritis to cancer. It is estimated that of the 37 million older adults reporting sleep disorders, only 7 million gets diagnosed with some kind of sleep disorder, leaving 30 millions to fend for themselves through their sleepless nights. This is a great mismatch between the burden of sleep disorders in the elderly and the attention given to them by the medical community – a situation that needs to be redressed. What is, however, important is not just to enable them sleep but sleep well and sleep safely.

When people cannot sleep well the level of stress is very high. Insufficient sleep degrades performance, focus, agility and concentration and increases proneness to accidents. Center for Disease Control and Prevention (CDC), Atlanta in the US accordingly, has classified insufficient sleep as a Public Health Epidemic, and, in consequence, has emphasized continued public health surveillance of sleep quality, sleep duration, sleep behavior and sleep disorders and their impact on nation’s health.