Caught in a sleep debt

Study reveals Sri Lankans sleep an average of 6.7 hours per day and risk falling prey o a range of ailments :

Not getting enough sleep may not be considered a big deal for thousands of school kids and working adults who sleep late, but have to wake up early. However, depriving oneself of the required amount of sleep doctors recommend can have deadly consequences, health experts warn. Here, Consultant Paediatric Neurologist, Lady Ridgeway Hospital, and Academic Head, Department of Paediatrics, University of Rajarata, Anuruddha Padeniya, explains why sleep is important for good health

Excerpts…

Q: World Sleep Day was observed on March 18. Why is sleep so important that a global day has been set aside to focus on it?

A: Sleep is usually recognised by the state of quietude and immobility accompanying the recombinant position. But neither of these properties is a sine qua non for sleep and even without grasping the true meaning of sleep for our lives, we know that a good night sleep is the key factor for accomplishing a productive day. Through human and animal studies, scientists have discovered that sleep plays a critical role in immune function, metabolism, memory, learning, and other vital functions in the human body. Other than that good sleep provides the best productive workforce for a country and in a sleep deprived nation the economic impact has been also been evident through studies.

A: The average sleep length is between 7 and 8.5 hours per day, which would vary with many reasons, most importantly the age of the individual. Sleep deprivation can be categorised into acute total sleep deprivation and chronic partial sleep deprivation.

The only available study on sleep deprivation on Sri Lankans was done by the AIA Group. The Study conducted among 15 of its markets including Sri Lanka, reveals that though desired average hours of sleep for a Sri Lankan is 7.6, we sleep for only an average of 6.7 hours per day. Although there are many reasons, the recent increasing trend of addiction to social media and to internet among adults, especially those under 30 years, was found to be one of the key causative factors for sleep deprivation among Sri Lankans.

A: Sleep deprivation is not having enough sleep, or when sleep is insufficient to support adequate alertness, performance, and health. It can be further divided into acute and chronic sleep deprivation. Acute sleep deprivation can be defined as reduction in usual sleeping hours lasting for one or two days, whereas chronic sleep deprivation is when an individual routinely sleep less than required for optimal functioning. In other words, sleep deprivation can be due to reduced quantity or quality of sleep.

A: Out of the many causes for sleep deprivation according to the American Academy of Sleep Medicine, voluntary behaviour, working hours and type of the occupation and medical conditions are considered to be the most important. Being unable to sleep is a different entity. It is called insomnia and it can be the reason for sleep deprivation in an individual. It is a sleeping disorder where an individual finds it difficult to fall asleep, even though he has the optimum conditions.

Q: As a neurologist, tell us how lack of sleep can affect our health – physically, mentally, emotionally, and in terms of our behaviour.

A: Insufficient sleep can affect a human in many ways. Acute sleep deprivation can make you irritable, tired and less productive. The effects of chronic sleep deprivation may not be evident instantly but have a more serious impact on an individual physically, mentally, emotionally and also in term of our behaviour. The short term effects include neurological effects, change in vital signs and hormonal changes.

Sleep deprived individual may mimic the behaviour of a drunk person with tremors (shakiness of the body), nystagmus and slurred speech. The studies have found that there is significant decrement of seizure threshold as well as threshold for pain.

Some hormones in the human body follow a circadian rhythm, which means that the secretion of the hormone may depend on the sleep wake cycle of a person. Some of these hormones get affected with insufficient sleep, most importantly in children the growth hormone. These children may not reach their full growth potential and turnout to be shorter than they otherwise would have been.

A: Chronic sleep deprivation would have more long term effects on one’s physical health, adversely affecting the metabolism leading to impaired glucose tolerance, thus increasing the susceptibility to diabetes, obesity and increasing cardiovascular events and morbidity. Compromised immune system is evident by the susceptibility to infections and so on.

A: Psychological impact of sleep deprivation is more evident than the physical effects because the psychological effects are plainly demonstrated in a short time affecting one’s day to day life activities. Restricted sleep time adversely affect the cognitive function of an individual, lowering the stress threshold, impairing the memory and causing trouble in concentrating.

Thus performance on psychomotor vigilant tasks such as driving, performing surgery would be weakened. It is well documented that sleep loss can adversely affect mood. We all know how irritable and tired we become after a sleepless night.

A: According to the AIA Healthy Living Index, sufficient sleep is one of the top five drivers of healthy living but many adults fail to gain enough sleep as a result of hectic lifestyle. This has been facilitated by intensifying usage of technological modalities including the internet and mobile phones.

A: Sleep disorders consist of a large group of disorders and most known is insomnia. Evidence from studies show that women, particularly elderly, are more prone to have insomnia, than men. Sleep deprivation is another entity in which teenagers and people in certain professions including doctors, drivers, shift workers and students are commonly exposed.

Some facts on sleep disorders among children

* More than a third of school children may have sleep problems.

* Disturbed sleep at night makes it harder for children to function and leads to lack of concentration and behavioural problems in the classroom.

* Parents often find it hard to detect that something is wrong.

* Most sleep problems and sleep disorders can be treated. Most can be cured . Some can’t. But they can be managed.

Q: Recent research has pointed to chronic sleep deprivation as one of the causes for the surge in diabetes, heart disorders, mental health problems, depression and constant headaches... Do you agree?

Q. There have been recent claims of persons dying in their sleep due to chronic sleep disorder leading to fatigue and stress. How does sleep death occur?

A: In exceptional circumstances chronic sleep deprivation is known to cause death as in fatal familial insomnia, which is an uncommon genetic disorder. How this occurs is still in debate.

Q. Dementia is also on the rise. Is there a link between Dementia and sleep deprivation?

A: One of the earliest presentations in a patient with dementia is alteration in the sleep wake cycle and the mechanism of this is yet to be found. In an elderly person, there are some changes in the sleep including increased nocturnal wakening and decrease in delta sleep which are considered to be normal with aging.

With dementia patients develop additional sleep changes such as decrease in circadian cycle length.

A: Recent advancement in neurobiology has been able to enclose neural pathways such as the orexin system, which has a role in both sleep and weight gain.

Thus it has been apparent that sleep and obesity are linked. According to latest studies there is evidence in prevalence of obesity, parallel to the rising incident of sleep deprivation.

Q: Sleep disorder and its negative impact on health is still a relatively little understood subject. What steps have been taken to create awareness on this subject among the public?

A: Sleep is not a well studied medical entity in Sri Lanka. Some surveys have been done on obstructive sleep apnoea but still there is a huge gap in studies conducted in view of sleep neurology. We have conducted some workshops regarding sleep and its impact on children and first Sleep Neurology Service in Sri Lanka was established in Lady Ridgeway Hospital for Children Colombo in 2013.

Simultaneously a booklet was published as an educating tool for adults regarding sleep and its effect on the children.

Recently a pilot survey done in selected schools in the Colombo District revealed that the student who received adequate amount of sleep were the ones to perform well both in academics and extracurricular activities.In Sri Lanka schooling children are at a risk of being sleep deprived due to their waking early to go to school and then going to bed late at night after completing their homework and tuition classes.

On top of that, internet and video games have also contributed to the poor quality sleep. Thus both parents and children themselves need proper education on the importance of sleep.

(From Sleep and Your Child’ prepared as a parent education manual on the launch of the Sleep Neurology Services in Sri Lanka at Lady Ridgeway Hospital on March 2013)