World Sleep Day 2021 : Regular Sleep, Healthy Future
- Part 1 -

Dr S Pahel Meitei *

Q1. WORLD SLEEP DAY –WHAT IS IT ABOUT ?

World Sleep Day is an annual, global call to action about the importance of healthy sleep and impact of sleep on our health. It is being created and hosted by World Sleep Society.We are celebrating the 14th annual World Sleep Day on 19th of March, 2021, with the theme, “Regular Sleep, Healthy Future”.The message that is sought to be conveyed is that regular good quality sleep improves quality of life.

Q2.WHAT IS THE ROLE OF SLEEP IN OUR LIVES ?

Alongside food, water, and air, sleep is a basic biological requirement for human life. Sleep plays a fundamental role in the effective functioning of nearly all systems of the body. Getting enough quality sleep at the right times helps us protect our mental and physical health, and quality of life. While we are sleeping, our brain is preparing for the next day.

It's forming new neural pathways to help us in learning and memorizing information. Sleep is also the time during which there occur healing and repair of all our organ systems. We spend up to one-third of our lives sleeping. Our sleep normally occurs in cycles whose duration varies from about 60 mins during childhood to 90-120 mins during adulthood. Each sleep cycle is composed of four stages; N1, N2, N3 and REM.

Q3. WHAT HAPPENS IF SLEEP IS DEPRIVED?

Insufficient sleep can directly affect how a person feels during their waking hours. Examples of these symptoms include:
Slowed thinking
Reduced attention span
Worsened memory
Poor or risky decision-making
Lack of energy
Mood changes including feelings of stress, anxiety, or irritability
The consequences depend on the extent of sleep deprivation and whether it is acute or chronic.

Acute sleep deprivation raises the risk of unintentional errors and accidents. Drowsy driving, which involves slowed reaction time and the risk of microsleeps, can be life-threatening. For example, sleep deficiency has played a role in human errors linked to tragic accidents, such as nuclear reactor meltdowns, grounding of large ships, and aviation accidents. People who are sleep deprived are more likely to struggle in school and work settings or to experience mood changes that may affect personal relationships.

Chronic sleep deprivation can contribute to a wide range of health problems.

a. Cardiovascular diseases: High blood pressure, coronary heart disease, heart attack
b. Diabetes: Body’s ability to regulate blood sugar is impaired, increasing the risk of metabolic conditions like diabetes.
c. Obesity : Research has found that people tend to consume more calories and carbohydrates when they do not get enough sleep, which is just one of several ways that poor sleep may lead to problems maintaining a healthy weight.
d. Immunodeficiency: predisposition to infection, poorer response to vaccines, etc.
e. Hormonal abnormalities: Impaired production of growth hormone and testosterone, and increased production stress hormones like noradrenaline and cortisol.
f. Neurocognitive functions: impairments in working memory, executive function, processing speed, and cognitive throughput.
g. Mental health disorders: depression, anxiety, psychosis, impotence, etc.
h. Fertility issues: Infertility in both women and men.

Q4.WHO ARE AT RISK OF SLEEP DEPRIVATION ?

Sleep deficiency affects people of all ages, races, and ethnicities. Certain groups of people may be more likely to be sleep deficient. Examples include people who:

Have limited time available for sleep, such as caregivers or people working long hours or more than one job
Have schedules that conflict with their internal body clocks, such as shift workers, first responders, teens who have early school schedules, or people who must travel for work
Make lifestyle choices that prevent them from getting enough sleep, such as taking medicine to stay awake, abusing alcohol or drugs, or not leaving enough time for sleep
Have undiagnosed or untreated medical problems, such as stress, anxiety, or sleep disorders like insomnia, sleep apnoea (obstructive and central), parasomnias, restless leg syndrome, narcolepsy, etc.
Have medical conditions or take medicines that interfere with sleep

Q5. HOWCOMMON IS SLEEP DEPRIVATION?

About 35% of people do not feel they get enough sleep, impacting both their physical and mental health. Sleep problems constitute a global epidemic that threatens health and quality of life for up to 45% of the world’s population. Insomnia affects between 30-45% of the adult population.

Primary insomnia (insomnia with no underlying condition) affects 1-10% of the general population, increasing up to 25% in the elderly.Obstructive sleep apnea (OSA) affects approximately 4% of the adult population. Restless Legs Syndrome is a common disorder and occurs in between 3-10% of the population.

Known Consequences: Some Statistics

A US study has estimated the annual costs of insomnia to be between $92.5 billion and $107.5 billion.
71,000 people suffer injuries every year due to sleep-related accidents.
1,550 people die because of sleep-related accidents.
46% of individuals with frequent sleep disturbances report missing work or events, or making errors at work, compared to 15% of healthy sleepers.

Q6. WHAT IS INSOMNIA?

Insomnia is a sleep disorder in which you have trouble falling and/or staying asleep.
The condition can be short-term (acute) or can last a long time (chronic).
There are two types of insomnia: primary (not linked to any other health condition or problem) and secondary (to a health condition like asthma, depression, arthritis, cancer, or heartburn; pain; medication; or substance abuse).
Management involves treatment of the underlying cause, cognitive behavioral therapy and medications.

Q7. WHAT IS OBSTRUCTIVE SLEEP APNOEA?

Obstructive sleep apnoea (OSA) is very prevalent, yet under recognized disorder. It is the most common type among sleep-related breathing disorders (other sleep-related breathing disorders being central sleep apnea disorders, sleep related hypoventilation disorders and sleep related hypoxemia disorders) and is characterized by recurrent episodes of upper airway collapse during sleep leading to cessation or significant decrease in airflow in the presence of breathing effort.

These episodes are associated with recurrent oxyhemoglobin desaturations and arousals from sleep. OSA associated with excessive daytime sleepiness is commonly called obstructive sleep apnea syndrome—also referred to as obstructive sleep apnea-hypopnea syndrome. Apart from other anatomical and endocrine causes, obesity is an important modifiable risk factor for OSA.

A 10% increase in body weight is associated with 32% increase in Apnea-Hypopnea Index (AHI: index for diagnosis and grading severity of OSA). A 10% reduce in body weight is associated with 26% reduction in AHI. Weight related changes in AHI are more marked in male then female.

OSA is an independent risk factor for hypertension and other cardiovascular ailments. Untreated sleep apnea may lead to heart diseases, stroke, and vascular dementia. In children, sleep apnea may be the underlying cause of neuropsychological disturbances. Pediatric sleep apnea is typically associated with adeno-tonsillar hypertrophy.

Nocturnal symptoms may include: Snoring, usually loud, witnessed apneas, gasping and choking sensations (that arouse the patient from sleep), nocturia, insomnia (restless sleep), etc. Daytime symptoms may include: Nonrestorative sleep, morning headache, dry or sore throat, excessive daytime sleepiness, daytime fatigue/tiredness, cognitive deficits; memory and intellectual impairment, decreased vigilance, personality and mood changes, including depression and anxiety, sexual dysfunction, including impotence and decreased libido, gastroesophageal reflux, hypertension, etc.

Both adults and children should be formally investigated in sleep centers if sleep apnea is suspected, because both adult and pediatric sleep apnea is treatable and correctable; a correct and precise diagnosis is always required.

Sleep apnea is diagnosed with sleep study (polysomnography: PSG) in the sleep laboratory. There are various levels of sleep study. Some can be done at home with portable machines.

Treatment with non-invasive positive airway (continuous positive airway pressure, or CPAP) ventilation is generally successful. For mild forms of sleep apnea, the application of oral devices can be beneficial. Surgery to remove excessive tissues in the oropharynx may be considered for individuals who cannot tolerate non-invasive equipment or who have obvious obstruction to airflow in the oropharynx by redundant tissue growth or large tonsils.

There is proof that successful correction of sleep apnea with non-invasive positive airway pressure ventilation lowers mean blood pressure and may reduce the risk of myocardial infarction and stroke. Excessive daytime somnolence generally improves with successful treatment of sleep apnea.

Q8. WHAT IS RESTLESS LEG SYNDROME?

Restless legs syndrome (RLS) is a sleep disorder that causes an intense, often irresistible urge to move the legs. This sensation is brought on by resting such as lying down in bed, sitting for prolonged periods such as while driving or at a theatre. RLS typically occurs in the evening, making it difficult to fall asleep and stay asleep.

It can be associated with problems with daytime sleepiness, irritability and concentration. Often, people with RLS want to walk around and shake their legs to help relieve the uncomfortable sensation. It is a treatable condition that responds well to medications.

Q9. WHAT IS NARCOLEPSY?

Narcolepsy is a neurological disorder of sleep regulation that affects the control of sleep and wakefulness. People with narcolepsy experience excessive daytime sleepiness and intermittent, uncontrollable episodes of falling asleep during the daytime. These sudden sleep attacks may occur during any type of activity at any time of the day. Some patients with narcolepsy experience sudden muscle weakness with laughter or other emotions.

Narcolepsy usually begins between the ages of 15 and 25, but it can become apparent at any age. In many cases, narcolepsy is undiagnosed and, therefore, untreated.

Patients with narcolepsy can benefit from a regular and adequate sleep schedule, scheduled daytime naps, avoidance of drugs that produce daytime sleepiness or insomnia, and a psychosocial support group. Screening for depression, hypertension, and obesity are also important components of health maintenance.

Many sleep disorders (eg, sleep apnea, periodic leg movements) can coexist with narcolepsy, thereby contributing to a patient's symptoms. Such disorders should be addressed before initiating narcolepsy-specific medications.

Most of the drugs available to treat narcolepsy target either daytime sleepiness or cataplexy. Therefore, many patients who have both symptoms require more than one drug to manage their disease.

To be continued ...