Friday, August 28, 2009

To Sleep, Perchance To Dream

A good night's sleep has long been known to be of great value for being alert the next day. Lack of sleep has always, right through human history, been associated with irritability i.e. the grumps but NOW, 

there is increasingly strong evidence that sleep also has a BIG effect on all of our health - our hearts, our lungs, and even our stomachs, 
in addition to our minds.

In fact, chronic poor sleep has recently been found to be positively involved with the decline of heart function, increases in blood pressure, loss of lung function, and a whole lot of other bads - see the title link.

Sound sleep includes having all the stages of sleep (N1, N2, and N3) and there should also be a decent amount of dream sleep (REM). One can actually be getting enough time asleep and still not have restful sleep due to poor sleep architecture. When sleep is well balanced and of a sufficient quantity, that alone is considered a 'good, sound sleep.'

Poor sleep habits, insomnia (inability to fall sleep), frequent arousals, and daytime sleepiness, are all different parts of the picture. Sometimes, other things like snoring (a sign of obstruction to free breathing during sleep), full blown sleep apnea, or restless legs can worsen  the problem.

Poor sleep is also frequently clinically associated with depression, fibromyalgia, hyperactivity, ADD, and can even be caused by various medication side effects.

Sleep apnea (stopping of regular breathing during sleep) is unfavorably linked with obesity and can exacerbate health problems for people who are anyways otherwise living on a slippery slope to poor health. When the apneas and hypopneas are severe they can reduce our blood oxygen levels (oxygen saturation) below the normal level. Even during sleep, the O2 saturation should  stay above 90%. Typically when awake and active, healthy people will have saturations of 100% or close to it . When saturations drop below 90% this is bad for all parts of our bodies and minds. We do need a goodly amount of oxygen to keep ourselves alive and healthy!

Irregular sleep patterns due to other causes can wreak havoc with our health. Those who work nights, students cramming for exams, and even worse working 'switch' shifts, are all in very great danger of permanently ruined health. I find it amazing that in so many medical colleges right around the world, students are routinely forced to work/study for 48-72 hours at a stretch. It seems to be some sort of a rite of passage, a 'trial by fire' with a 'throw them in at the deep end' approach. It is both disgusting and unhealthy. Anyone who chooses thus to burn the candle at both ends is asking for trouble.

Another very bad association of disturbed or poor sleep is with GERD (gastric reflux). Stomach acidity tends to get much worse with poor sleep and when strong acids from the stomach come up the esophagus (swallowing tube) we are in real trouble. It can get so bad that the acid makes its way all the way up to our throats and into our tracheas (breathing tubes) causing cough and lung damage. In the worst cases, a person's teeth can get eaten away by wayward stomach acid!

But there's a lot that we can do to help ourselves to sleep better even without medical intervention and especially when our insurance (if we have any) won't cover the expense of sleep studies, CPAPs, and all the potential associated medication. Here are some tips:

  • Have a regular bedtime.
  • Stay away from stimulants like caffeine (tea, coffee, sodas...) and nicotine.
  • All sleep-aid medications (and most antidepressants) alter sleep architecture towards lighter sleep (that's bad), so avoid them as much as possible.
  • Have a good sleep environment. Blue light is especially calming!
  • Don't watch TV for a couple hours before bedtime.
  • Don't eat anything for at least two hours before bedtime.
  • If you have GERD (acid reflux)  make sure it is well treated, especially before bedtime.
  • Keep your mind relaxed, particularly after dinner. Identify your stressors and deal with them appropriately (a little advice that Hamlet could have used...). Having a blank mind isn't possible for most of us, and no one really knows if that will help one to sleep, but certainly we can identify activities that we find relaxing and concentrate on doing those -  especially after dinner.
  • Try to sleep on your side or stomach as much as possible.
  • Raise the head of your bed by about 6 inches, this will help to keep your acids in the stomach - where they belong.
  • Get out for an early morning walk and make sure that you absorb a solid dose of the early morning sun. The bright light 'sets' your in-built hormonal sleep scheduler and it will help you to feel sleepy at the right time at night.
  • Never, NEVER, drive or operate machinery when you are feeling sleepy!

If you kick a lot, snore heavily, or it's been noticed that you seem to stop breathing while asleep (as, being asleep, you may not have noticed, so try asking your spouse, parents, siblings, kids, or room mates), and when you regularly suffer from excessive daytime sleepiness, lack of alertness, or waking up feeling unrested, then you probably do need to consult a sleep expert. Strangely enough, that's also probably your lung doctor (pulmonologist)!

Eventually, doing a sleep study (polysomnopgraphy) will help to sort out all your doubts -  if you can afford it! Of course, we would want to exhaust all other options first, but for some folks it probably really would help...

We are such stuff
As dreams are made on; and our little life
Is rounded with a sleep.

 Prospero in "The Tempest"

Sam L. Carr

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