Focus – Sleep

If you are feeling even just a little bit drowsy during the day or feel like you need a nap in the afternoon, you are not getting enough sleep. And you are probably also not doing your work as well as you should. You may even be endangering yourself and others.

While legions of studies have not been able to pinpoint exactly what happens to our brains while we sleep, it is evident that sleep “recharges our batteries” and gives us the mental and physical energy to cope with life’s challenges. When we don’t get enough sleep or good quality sleep, our batteries do not get the recharge required.

The prefrontal cortex of the brain – the part responsible for most of the higher cognitive functions such as decision-making, reasoning, complex thoughts, memory, logical thinking – is especially vulnerable to sleep deprivation. Studies have illustrated that sleep deprivation can lead to slower thinking, difficulty in learning, concentration problems, impaired judgement and trouble with memory.

Quick facts

• • The nuclear explosion at Chernobyl, the catastrophic Exxon Valdez oil spill and the explosion of the space shuttle Challenger have all been linked to a fatigued workforce.

• • If you sleep less than 7.5 hours a night, you are around 60% more likely to get injured.

• • 20% of all road accidents in, for example, the USA are linked to driver fatigue.

• • A single night of deprived sleep can have the same effect on the brain as a legally intoxicating blood-alcohol level.

How much is enough?

Most of us have been taught to believe that adults need around eight hours of sleep each night. This is an average, as some people might be fine with less, while others might need more. A good rule of thumb is to get enough sleep to prevent you from feeling sleepy or drowsy during the course of the next day.

Getting good sleep on a regular basis is also important. One night of good sleep is not enough to stay attentive and alert. Losing a little sleep every night over time can also be detrimental to work performance.

Getting baby into a sleeping routine is one of the challenges young parents have to face. In most instances, a baby establishes a pattern of sleep within the first three months, and most babies will sleep through around the time of their first birthday.

But some babies, and their exhausted parents, need a bit more help when it comes to sleep time. Some of the tips may be helpful in sending baby off to dreamland.

Swaddling – Wrapping or swaddling especially very young babies give them a great sense of security and will calm most distressed babies down.

Tire them – To encourage older babies to sleep at night, tire them with lots of stimulation, playing, activities and socialising during the day, without overdoing it. If baby needs a nap during the day, keep it to about two hours.

Darken the room at night – Little ones do not develop a fear of the dark until around the age of two. A dimmer switch or a nightlight is more for your benefit than for theirs.

Soothing – A musical mobile that hangs over the cot can be a great help in soothing baby to drift off to sleep. Some babies respond to the soothing sounds of gentle music, a water feature and even the humming sound of household appliances or a computer.

Abba – Put baby in a sling and gently jog him or her up and down. The physical closeness and your heartbeat will help settle baby down.

Get moving – Motion is a tried and trusted method of getting babies to sleep. Rocking baby in your arms, a glider or a rocking chair can achieve this. You can also try bouncing on a ball while holding baby or putting baby in a bouncy seat or swing.

Driving in the car – This is for the really desperate. The motion of the vehicle, the bumping across the road surface and the hum of the engine combine to send baby off to sleep.

What causes insomnia?

A simple description of insomnia is that it happens when the part of the brain used for thinking does not turn off and you can’t fall asleep. It is the body’s way of saying that something isn’t right. Things that may cause insomnia include stress, too much caffeine, depression, financial worries, changes in work shifts and pain from medical problems, such as arthritis.

People who have insomnia may not be able to fall asleep, or they may wake up during the night and not be able to get back to sleep, or they may wake up too early in the morning.

Is insomnia a serious problem?

Insomnia in itself is not a serious health problem, but it can make you feel tired, depressed and irritable. It can also cause a lack of concentration during the day, which can lead to serious mistakes and accidents.

Tips for a good night’s sleep

There are many simple steps you can take to help you fall asleep faster and stay asleep. Try the following:

• • Minimise noise with earplugs and minimise light with window blinds, heavy curtains, or an eye mask. Do not turn on bright lights if you need to get up at night; use a small night-light instead.

• • Avoid large meals within two hours of bedtime. A glass of milk or a light snack is a good choice if you are hungry before bedtime. Milk contains the amino acid L-tryptophan, which is known to help people go to sleep.

• • Get aerobic exercise during the day to reduce stress hormones, but avoid anything too strenuous within three hours of bedtime. Regular exercise may promote deeper sleep.

• • Go to bed at a regular time and avoid napping late in the afternoon. If you need to, take a brief nap for 10 to 15 minutes about eight hours after you got up.

• • Stop working at any task an hour before bedtime to calm mental activity.

• • At bedtime, keep your mind off worries or things that upset you; avoid discussing emotional issues in bed.

• • Consider having pets stay outside of your sleeping area. Having a pet in bed may cause you to wake up if you have allergies or if the pet moves around.

• • Make sure your bedroom is well ventilated and at a comfortable temperature.

• • Keep your bedroom for making love and sleeping only. If you can’t sleep or if you wake up in the middle of the night, go into another room and read a book or watch television until you feel sleepy.

• • Learn a relaxation technique such as progressive muscle relaxation and practise it in bed.

• • Nicotine is a stimulant and should be avoided, particularly near bedtime and upon night awakenings. Stimulants may interfere with sleep.

• • Caffeine should be discontinued at least four to six hours before bedtime. Caffeine is a stimulant that is present in coffee, coke, tea, chocolate and various over-the-counter medications. Consider gradually reducing the amount of caffeine you consume to avoid withdrawal symptoms such as headaches.

• • Alcohol is a depressant and may help you fall asleep, but the subsequent metabolism that clears it from your body when you are sleeping causes a withdrawal syndrome. This withdrawal causes one to wake up and is often associated with nightmares and sweats.

If you are still having trouble sleeping after trying some of these suggestions, tell your doctor about it. There may be an underlying medical condition that is causing your sleep problem.

Sleep apnoea is a disorder in which one repeatedly stops breathing during the night. It has many potential causes, all of which lead the upper airway to collapse while someone is asleep. Treatment of sleep apnoea is necessary to prevent major health problems.

Definition

Obstructive sleep apnoea occurs when the muscles in the back of your throat relax. These muscles support the soft palate, the triangular piece of tissue hanging from the soft palate (uvula), the tonsils and the tongue.

When the muscles relax, your airway narrows or closes as you breathe in, and breathing momentarily stops. This may lower the level of oxygen in your blood. Your brain senses this inability to breathe and briefly rouses you from sleep so that you can reopen your airway. This awakening is usually so brief that you don’t remember it.

You can awaken with a transient shortness of breath that corrects itself quickly, within one or two deep breaths, although this is rare. You may make a snorting, choking or gasping sound. This pattern can repeat itself five to 30 times or more each hour, all night long. These disruptions impair your ability to reach the desired deep, restful phases of sleep, and you’ll probably feel sleepy during your waking hours. Sleep apnoea is diagnosed with an overnight sleep test called a polysomnogram, or a “sleep study”.

Causes

The causes of sleep apnoea range from overweight, obesity and acid reflux to central nervous system disorders and physical abnormalities. No matter what the cause, the results are the same: the throat collapses or becomes obstructed, causing breathing to stop for several seconds.

Sleep apnoea and obesity have an interrelated relationship. There is little doubt that excess weight can cause sleep apnoea: the extra fat and soft tissue in the throat puts pressure on the airway, increasing the chance that the airway passage will collapse. Sixty to seventy percent of sleep apnoea patients are obese.

While obesity is a cause of sleep apnoea, the relationship between sleep apnoea and obesity is even more complex. Additional weight gain is a common sleep apnoea symptom, so obesity can cause sleep apnoea, and sleep apnoea in turn can worsen obesity.

GERD, or gastro-oesophageal reflux disease, is a possible cause of sleep apnoea. GERD symptoms occur due to acid reflux. Stomach acid seeps into the oesophagus (gullet), damaging oesophageal tissue. In cases of severe GERD, acid reflux can cause scarring and tissue damage as far up the throat as the vocal cords. Chronic acid reflux can scar the inside of the throat, causing obstructions that result in sleep apnoea.

Treatment

To prevent the obstruction of the airway, which is the most common cause of sleep apnoea, there is one treatment that is the best option. To keep the upper airway open, it is often necessary to support it with a constant flow of air delivered through a face mask worn while sleeping. This most common treatment is called Continuous Positive Airway Pressure or CPAP.

Once it has been determined by a physician that this is the best treatment option, it is necessary to visit with a provider of durable medical equipment. The CPAP machine will be set with a prescribed pressure, and other equipment — including a humidifier, hosing, and a personally fitted mask — will be issued. It is important to find a mask that is comfortable, with minimal leakage when it is worn. Most individuals who use CPAP are able to tolerate it after a few weeks of regular use.

Other options

Although CPAP therapy is clearly the best option in moderate to severe sleep apnoea, some individuals cannot tolerate it. In this case, other treatment options might be pursued, including:

• • • weight loss

• • • surgery to remove excess tissue in the throat

• • • positional sleep aids (such as “sleep shirts” or wedges)

• • • dental devices to move the lower jaw forward

• • • oxygen support (which is not usually sufficient alone)

Sleep deprivation

There is nothing as refreshing as a good night’s sleep or as frustrating as being deprived of a good night’s sleep. Ask any insomniac! If your sleeplessness lasts longer than a few weeks, you should take a closer look at the situation as you may be experiencing a form of insomnia.

If you have trouble falling asleep, if you wake up frequently during the night or if you awake earlier in the morning than you should, you are suffering from insomnia. Short-term insomnia (a few nights or a few weeks) will probably vanish as soon as your worries end or the stressful situation that causes your sleeplessness passes. Long-term insomnia, however, needs some attention.

Causes of insomnia

• • Pain or discomfort

• • Depression

• • Restless legs syndrome

• • Medication (many prescription and other medicines can interfere with sleep)

• • Medical conditions (arthritis, cancer, heart failure, lung disease, gastroesophageal reflux disease, overactive thyroid, stroke, Parkinson’s and Alzheimer’s disease)

• • Psycho-physiological insomnia (worrying about not sleeping)

• • Sleep apnoea

• • Lifestyle factors (unhealthy eating, drinking and exercising habits)

• • Jet lag

• • Poor sleep habits (irregular sleep schedule, stimulating activities before bed, use of your bed for activities other than sleep)

• • Environmental causes (such as a snoring bed partner, an unsupportive mattress, noise, heat or cold).

Effects of insomnia

Insomnia is a major cause of accidents, both on our roads and in the workplace. In addition, irritability owing to insomnia may harm your relationships with your loved ones. Therefore, it is important to see a health professional if you suffer from insomnia. Together you can determine the cause and decide on a plan of action.

To be constantly tired, to feel weak and depleted of energy owing to sleeplessness is not necessary and can be treated.

Sources

Can’t sleep? Causes, cures, and treatments for Insomnia. Retrieved from: http://www.helpguide.org/articles/sleep/cant-sleep-insomnia-treatment.htm

Insomnia. Retrieved from: http://www.mayoclinic.org/diseases-conditions/insomnia/basics/definition/con-20024293

Revised by M van Os