Humans are like other living creatures, requiring daily basic needs such as food, shelter, clothes, and medicine. But one thing that is frequently overlooked is our sleep quality. We spend one-third of our lives sleeping; it is a necessary daily routine that we must follow from birth to death. We slept a lot while we were young. When we grow up, our brain is more aware of our surroundings, so we tend to sleep less.
The sleep mechanism involves chemicals such as GABA, a sleep-promoting neurotransmitter in the brain. To initiate and maintain the sleep state, the sleep mechanism must suppress the wakefulness mechanism once daily by activating a cluster of brain cells near the optic nerve. Our brains begin to enter sleep mode between 3 and 6 pm. Light regulates circadian rhythms; exposure to late afternoon light will delay your sleep onset. Most of the time, we sleep 6–8 hours a day.
We feel refreshed if we have adequate quality sleep. Individual sleep requirements have a genetic basis. Some people may need more and some may need less. Morning coffee to wake you up is usually not necessary. If you merely want to enjoy the taste of it, drink one before 10 a.m. The caffeine in a cup of coffee can last up to 12 hours and interfere with your sleep onset and sleep maintenance. In addition, coffee can aggravate stomach acid reflux, which can also interrupt your sleep. Do not take sleeping pills if you cannot fall asleep. In the elderly, chronic benzodiazepine use can impair memory and increase the risk of falling at night. Try meditation, which can slow down your brain's activities. You may not easily fall asleep on the first try, but eventually you will succeed.
The body can partially compensate for a sleep deficit. However, if the sleep-wake cycles begin to fluctuate, it will affect one's quality of life. Sleep deprivation can lead to depression, hypertension, diabetes, heart disease, stroke and obesity. When this is the case, you will need considerable help.
Classification of sleep disorders:
- Sleep-related breathing disorders.
- Sleep problems include insomnia, sleep disturbances, frequent awakenings, and delayed sleep onset.
- Sleep-related movement disorders.
- Hypersomnolence a condition where an individual falls asleep quickly but has a hard time getting up.
- Parasomnia is a sleep behavior disorder.
- Circadian rhythm disorder causes sleep disturbance.
Of the six groups, the first is the most frightening because the patient would stop breathing periodically during sleep, causing a drop in blood oxygen.
The synthesis of the cellular energy currency, adenosine triphosphate (ATP), requires oxygen. At the same time, the body must dispose of the metabolic product, carbon dioxide (CO2), through exhalation. The higher the metabolic rate our body builds up, the more carbon dioxide and acidic byproducts it will release into our blood. The cellular acidic milieu will perturb physiologic mechanisms, more easily causing headaches, weakness, drowsiness, mood swings, heart attacks, brain diseases, diabetes and high blood pressure.
For the assessment of a sleep disorder, it is necessary to perform a sleep test called polysomnography. Non-invasive skin sensors record brain waves and other physiologic parameters throughout the night.
The components of a sleep test are:
- Brain wave recordings give information on the quality of your sleep, how long your REM (Rapid Eye Movement) sleep is, and whether you have seizure disorders. The variations in frequency and amplitude of brain wave patterns are classified as alpha, beta, delta, and theta waves. REM sleep is the time when vivid dreams occur. It is the period when the brain organises and consolidates our memory. It is like a virtual metaverse of life. During REM sleep, we dream of walking, jumping, working, or even having sex with a stranger. The brain sends inhibitory signals to the spinal cord, preventing bodily movement. If this circuit fails, we will involuntarily act out the dream, just like you see in movies. We could sleepwalk or exhibit unusual behavior that may end in tragedy. During the sleep test, the brain waves and muscle waves can provide the necessary information. A sleep test can tell us about the heart and breathing conditions during REM sleep. If you have sleep apnea, a potentially serious sleep disorder in which breathing repeatedly stops and starts, the blood oxygen level will drop and worsen during REM sleep.
- The breathing exam assesses the changes in the temperature and airflow through the nostrils. Monitoring the chest and abdominal wall excursions can detect whether you stop breathing or not and whether the breathing cessation is due to brain lesions or airway obstruction.
- The purpose of a heart exam is to check if you have arrhythmias or ischemic heart disease. The low blood oxygen level can cause the heart to overwork during sleep.
- Oxygen and carbon dioxide monitoring are used to quantify how much the body is affected by abnormal breathing.
- Eye movement monitoring to check when you enter REM sleep. Your eyes quickly move back and forth during this sleep state. If you have abnormal movements during this period, you may have a degenerative brain condition such as Parkinson's disease.
- Leg muscle movement exam check if any sleep movement disorders common in iron-deficient patients, such as pregnant women or those taking antidepressants, are present.
- The snoring test is to assess if one needs an oral appliance.
If one falls asleep or dozes off readily during the day, a workup for narcolepsy is essential. If left untreated, narcolepsy can lead to physical harm or a fatal accident because you may fall asleep at the wheel while driving. A daytime sleep study, the Multiple Sleep Latency Test (MSLT), is crucial for diagnosing narcolepsy. In the test, you try to relax and take multiple naps spaced throughout the day. The average time it took to fall asleep and the occurrence of REM sleep were determined. The test can quantify sleepiness and test the alertness of pilots, commercial drivers, or those who do high-risk jobs.
Frequent urination at night is associated with sleep apnea from the extra secretion of heart natriuretic peptide because of stress caused by sleep-induced hypoxia, increasing urine output. Sleep apnea treatment can help reduce nighttime urine output, allowing you to sleep more deeply and uninterruptedly.
Sleep is as essential as food, drink and medication. People who sleep less than 6 hours or more than 8 hours have a higher risk of chronic disease and death than those who sleep 6–8 hours daily. If you try all the sleep tricks and nothing works, you should consult a sleep specialist to get to the root of the problem. It is critical to address sleep disorders as soon as possible because adequate sleep is necessary for good health.
Author: Dr. Jirayos Chintanadilok, MD, AASM, FACP Pulmonary/Sleep Medicine specialist, MedPark Hospital. Tel: 02 023 3333
Series Editor: Katalya Bruton, Healthcare Content Editor, Dataconsult Ltd., Dataconsult's Thailand Regional Forum at Sasin provides seminars and documentation to update business on future trends in Thailand and the Mekong Region. Tel: 02 233 5606/7
