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
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.
THE LIE OF THE LAND
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.
OPEN YOUR EYES
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.