Are you get­ting enough sleep?

A good night’s rest is prov­ing elu­sive for many of us, as in­som­nia turns into an ur­ban night­mare. But there’s help at hand to get you your share of shut­eye

Hindustan Times - Brunch - - Brunch - by Rhythma Kaul, Rachel Lopez and Aasheesh Sharma

SIX YEARS ago, when 36year-old soft­ware en­gi­neer Me­hul Kohli scored a job with a US-based multi­na­tional, he was both ec­static and re­lieved. He’d strug­gled to get this far and that dream job was fi­nally his. Sure, the hours were er­ratic, but the pay made it all worth­while. Or so it seemed at first.

Then, things started to go wrong. “I’d come back from work at 3am, and it would be at least an hour be­fore I’d get into bed,” Kohli re­calls. “By the time I ac­tu­ally slept it was 4.30am. Though I had time till noon, the light and noise meant I didn’t get sound sleep.” He’d find him­self wak­ing up at 7.30am ev­ery day, un­able to re­turn to bed even though he’d only had three hours of ac­tual shut-eye. It took its toll – poor con­cen­tra­tion and slug­gish­ness had no room in the cor­po­rate world – and Kohli ul­ti­mately had to seek pro­fes­sional help.

Even two decades ago, some­one like Kohli would have had no re­course but to see a psy­chi­a­trist. Reg­u­lar doc­tors were un­pre­pared to deal with sleep prob­lems, and even those di­ag­nosed with any of the 80odd sleep dis­or­ders had no place for spe­cialised test­ing or treat­ment. To­day, how­ever, al­most ev­ery In­dian hos­pi­tal has a sleep cen­tre equipped to di­ag­nose and treat sleep-re­lated prob­lems. Some 300 sleep clin­ics have sprung up in our cities. Kohli went to one, and af­ter a year of

me­di­a­tion and spe­cially de­signed ther­apy, his sleep pat­terns re­turned to nor­mal.


It used to be that sleep was just some­thing you did at the end of the day. Man rose with the sun, milked the cows, tilled the fields, napped dur­ing the hottest hours, worked some more and still had plenty to yawn about by twi­light. Then, as most Western sleep re­searchers be­lieve, the In­dus­trial Rev­o­lu­tion came along and ru­ined it all. A long, con­tin­u­ous work­day can­celled out the si­esta, turn­ing the ur­ban worker from a bi-pha­sic to a mono-pha­sic sleeper, forced to recharge in a sin­gle noc­tur­nal stretch.

In­dian sleep ex­perts be­lieve that the re­cent rise in In­dia’s sleep prob­lems (or at least our re­cent will­ing­ness to seek help for them) stems from the same switch. Bed­time isn’t when the sun sets, it’s when we’re done with TV, lap­top, over­time or 10pm din­ner reser­va­tion. Bed­room lights stay on later in cities, alarm bells ring ear­lier – ev­ery­thing eats into sleep time. “This kind of life­style has wreaked havoc on our bi­o­log­i­cal clock, which is con­trolled by sun­light,” says Dr JC Suri, pro­fes­sor and head of Saf­dar­jung Hos­pi­tal’s depart­ment of res­pi­ra­tory and sleep medicine. “Our body nor­mally gets the sig­nal to sleep when it’s dark, but that hardly hap­pens th­ese days, which leads to sleep dis­tur­bance.”

Oth­ers agree. Dr Preeti Dev­nani

of Jaslok Hos­pi­tal’s Sleep Dis­or­ders Clinic, says that while the body’s daily rhythms do dip in the af­ter­noon (mak­ing you crave a nap), ur­ban life buzzes un­ceas­ingly un­til 1am. Neu­rol­o­gist and di­rec­tor of Delhi’s Neu­rol­ogy and Sleep Cen­tre Dr Man­vir Bha­tia adds that most of us see sleep is­sues as non-is­sues. “While self-med­i­ca­tion for sleep is ram­pant, peo­ple don’t dis­cuss it,” she points out “Even physi­cians didn’t take sleep into con­sid­er­a­tion un­til re­cently.” To make mat­ters worse, In­dia equates rest with lazi­ness, claims Prasad Karnik, tech­ni­cal di­rec­tor at Mum­bai’s In­ter­na­tional In­sti­tute of Sleep Sciences (IISS). “We’re a na­tion in de­nial,” he says. “We think noth­ing’s re­ally wrong if we can’t sleep.”

For most of us, there re­ally might not be any­thing wrong. A nor­mal adult needs seven to eight hours of sleep daily and a child needs about nine. Dr Suri says it’s quite nor­mal to have the oc­ca­sional sleep­less night, or a week or two of trou­bled bed­time. “How­ever, think of con­sult­ing a doc­tor if the symp­toms last for more than a month,” he ad­vises.


At a sleep cen­tre, doc­tors typ­i­cally start by as­cer­tain­ing your sleep his­tory – how you sleep, how of­ten, how long, your snor­ing pat­terns - and looks for un­der­ly­ing causes like med­i­ca­tion or ex­ist­ing con­di­tions like di­a­betes or hy­per­thy­roidism. You may also un­dergo a sleep study, in which tiny elec­trodes are strapped on to your head, face, chest, arms and legs while you are en­cour­aged to sleep for eight hours. The elec­trodes record elec­tri­cal im­pulses to the brain, eye­ball move­ments, nasal flow and pres­sure, heart rhythm, stress or ten­sion in the chest, snor­ing, oxy­gen sat­u­ra­tion and limb move­ment, of­fer­ing real-time data for an ex­pert to an­a­lyse.

It’s an es­sen­tial tool to de­ter­mine the prob­lems you have, or con­firm that there are prob­lems in the first place. “If you think you’ve stayed up all night but were ac­tu­ally asleep, a sleep study will prove para­dox­i­cal in­som­nia,” says Dr Ashim De­sai of the Nova Spe­cialty Surgery chain, which has tied up with Nor­way’s Eurosleep to es­tab­lish In­dia-spe­cific sleep data and raise aware­ness about sleep dis­or­ders.

The most com­mon of the 80-odd sleep dis­or­ders is in­som­nia – trou­ble fall­ing asleep, sleep­ing through the night or wak­ing up ear­lier than the in­tended hour. Other di­ag­noses in­clude ap­noeas or breath­ing prob­lems dur­ing sleep, in­suf­fi­cient sleep syn­drome (which cre­ates a con­di­tion called ab­sen­teeism – you’re phys­i­cally present, but not “quite there”), or de­layed sleep phase syn­drome, (in which the day-night sleep cy­cle has shifted, mak­ing it hard for the per­son to func­tion). Many di­ag­noses also in­clude brux­ism (gnash­ing of teeth in sleep), rest­less leg syn­drome, sleep­walk­ing or chrono­bi­o­log­i­cal dis­or­ders like jet lag.

“A lot of the cases are re­ferred by en­docri­nol­o­gists, car­di­ol­o­gists and neu­rol­o­gists, as th­ese dis­eases are di­rectly linked with sleep de­pri­va­tion,” says Dr MS Kan­war, se­nior con­sul­tant, chest dis­eases, crit­i­cal care and sleep dis­or­ders at In­draprastha Apollo Hos­pi­tal. “Sleep dis­or­ders can in­de­pen­dently lead to di­a­betes and other meta­bolic dis­or­ders.” In­som­nia is par­tic­u­larly wor­ri­some. Dr Bha­tia warns that not only can it be a pre­cur­sor to de­pres­sion, but long-term in­som­nia can ac­tu­ally cause de­pres­sion. Sim­i­larly, many peo­ple think stress causes in­som­nia. “Of­ten it is in­som­nia that causes stress,” says Karnik.


The science of sleep it­self is rel­a­tively re­cent. Mod­ern in­ter­est in the sub­ject was kicked off only 100 years ago with sci­en­tist Henri Pieron’s Le Prob­leme Phys­i­ologique Du Som­meil, and pro­fes­sor Nathaniel Kleit­man’s stud­ies on sleep pat­terns, reg­u­la­tion and de­pri­va­tion in the 1920s. We didn’t dis­cover the all-im­por­tant rapid-eye­move­ment sleep un­til the late ’50s and the world’s first sleep re­search cen­tre was set up at Stan­ford Univer­sity only in 1970. In­dia’s first sleep cen­tre wasn’t set up un­til 1991. Even to­day, most sleep

doc­tors cite aware­ness as the big­gest hur­dle be­tween pa­tients and treat­ment.

But In­dia seems to be wak­ing up to the idea that good sleep is es­sen­tial, and with med­i­cal help, achiev­able too. Dr Dev­nani re­ports an in­crease in pa­tients in the last two years. “There are more ado­les­cents, more young pro­fes­sion­als, more aware­ness and a greater preva­lence of the prob­lems,” she says. Bha­tia sees more mid­dle-aged and el­derly pa­tients – more women than men – who’ve had trou­ble sleep­ing for over a decade, ex­per­i­mented with cock­tails of as many as six types of so­porific pills and now re­alise they need some­one who knows bet­ter.


At Mum­bai’s IISS, where the clinic is open 24/7 and pa­tients visit three times a week even from Pune and Nashik, data­bases on chronic sleep de­pri­va­tion and its ef­fect on cog­ni­tive brain func­tion are al­ready be­ing built for In­dia. They treat dis­or­ders with new tech­nolo­gies like au­dio­vi­sual en­train­ment (AVE), which de­ploys flashes of lights and tone pulses to guide the brain into var­i­ous states of brain­wave ac­tiv­ity. Nova has spe­cialised ap­noea­graphs that “can tell you ex­actly which part of the res­pi­ra­tory sys­tem is caus­ing snor­ing in your case,” says Dr De­sai. And for three years now, In­dian med­i­cal schools have in­cluded sleep fel­low­ships in their cur­ricu­lums.

It’s no longer seen as a priv­i­leged per­son’s prob­lem ei­ther. Karnik ad­mits that while the af­flu­ent are more likely to seek help, sleep dis­or­ders are com­mon across the eco­nomic spec­trum. “Good sleep is a func­tion of your men­tal state and en­vi­ron­ment,” Bha­tia says. “The poor of­ten have trou­ble with the lat­ter.” Dev­nani ex­plains that some eth­nic groups like the peo­ple of the North-East, have cra­nial fea­tures that are pre­dis­posed to ap­noea. The obese are more prone to breath­ing prob­lems. “There are stronger de­mo­graph­ics than economics.”

A BED­TIME STORY And some­times it’s not the shape of your skull or the size of your wallet that’s the prob­lem. When 12-year- old Manav Mishra’s class teacher com­plained to his par­ents that he’d be sleepy through the first half of the school day, the prob­lem lay else­where en­tirely. “We would fin­ish din­ner around 10.30pm and then re­tire to our rooms,” said Manav’s mother Meenal. “We as­sumed that Manav also went off to sleep. But when we kept a watch over him with­out him real­is­ing, it turned out, he was spend­ing time on the com­puter till 1am, chat­ting with friends.” Meenal started sleep­ing in his room, en­sur­ing he was in bed no later than 11pm. “Af­ter a cou­ple of months, the teacher also no­ticed a change.” she says.


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