Rest­less be­hav­iour

The emo­tional and phys­i­cal ben­e­fits of sleep are many, but the lack of it can be dis­as­trous. Melissa Gron­lund delves into the un­der­ly­ing causes of sleep­less­ness and talks to health ex­perts about treat­ment op­tions

The National - News - Arts & Life - - Front Page -

Doc­tor Ir­shaad Ebrahim of the Dubai- based Lon­don Sleep Cen­tre de­scribes the num­ber of cur­rent sleep dis­or­ders as “an epi­demic”.

“It’s so much more im­por­tant than what’s be­ing re­ported in the press: lifestyle, pace of work, de­mands of tech­nol­ogy, screen use – they are harm­ing our sleep/ wake cy­cle.”

The num­ber of sleep clin­ics in the UAE are on the rise, as are do- it- your­self re­sponses such as sleep treat­ments at lux­ury ho­tels and on­line apps for man­ag­ing one’s sleep cy­cle. “It is a re­sponse to de­mand,” says Ebrahim, “just the num­ber of peo­ple seek­ing help”.

El­iz­a­beth Graf, a clin­i­cal psy­chol­o­gist at a pri­vate clinic in New York, says that “re­search con­tin­ues to show the emo­tional and phys­i­cal ben­e­fits of sleep”.

Stud­ies have linked lack of sleep to poor per­for­mance at work, de­pres­sion and over­all health, in­clud­ing links to can­cer. It is not un­com­mon for stud­ies to speak about the “pub­lic health cri­sis” of lack of sleep, in which bil­lions of dirhams are spent tack­ling the sec­ondary ef­fects of poor slum­ber. Oth­ers point to its ef­fect on the econ­omy, and even its role in dis­as­ters such as the nu­clear melt­downs at Three Mile Is­land and Cher­nobyl.

New tech­nolo­gies for imag­ing the brain’s ac­tiv­ity dur­ing sleep have made it eas­ier to un­der­stand REM sleep, or “rapid eye move­ment” sleep, in which most of its ben­e­fits ac­crue. Though it has of­ten been as­so­ci­ated with the for­ma­tion of mem­o­ries, one new sleep study looked at the shrink­ing of synapses in the brain dur­ing sleep to sug­gest that a good night’s rest is an aid to for­get­ful­ness.

Sleep is also a wider cul­tural topic: last year, au­thor Ari­anna Huff­in­g­ton re­leased The Sleep Rev­o­lu­tion: Trans­form­ing Your Life, One Night at a Time, in which she said that tak­ing con­trol of one’s sleep is the key to un­lock­ing a hap­pier, more ful- fill­ing and pro­duc­tive life.

The New York-based artist Shana Moul­ton has dealt with sleep dis­or­ders in her work. In the video Rest­less Legs Saga (2012), her al­ter ego “Cynthia” is af­flicted with Rest­less Leg Syn­drome, or the de­sire to move one’s legs while fall­ing asleep.

Cynthia is plagued by her rest­less legs, while the phar­ma­ceu­ti­cal in­dus­try is on a re­lent­less ad­ver­tis­ing blitz to treat it. “Sleep causes enough dis­rup­tion that peo­ple feel mo­ti­vated to do some­thing about it, as op­posed to their typ­i­cal re­sponses to other psy­cho­log­i­cal dis­or­ders,” says Aam­nah Hu­sain, a psy­chol­o­gist and sleep spe­cial­ist at the Ger­man Neu­ro­science Cen­ter in Dubai.

“There can be a ge­netic com­po­nent to in­som­nia, but that’s rare. Re­cent re­ports have fo­cused on screen time as the cul­prit for poor sleep­ing. Smart­phone and tablet screens emit blue light, a high-in­ten­sity en­ergy source that stim­u­lates peo­ple when they should be go­ing to sleep. Pa­tients are ad­vised to avoid screen use in bed, or at least 30 min­utes be­fore bed­time, and to wear sun­glasses if you re­ally need to check your phone.

But ex­perts say screen time is not the only fac­tor. “The prob­lem is much, much larger,” says Doc­tor Ir­shaad Ebrahim, adding that peo­ple need to slow down more gen­er­ally.

There are a num­ber of tests avail­able on­line to de­ter­mine whether your sleep dis­rup­tion war­rants at­ten­tion. In­som­nia de­notes the in­abil­ity to fall or stay asleep through the night – or sleep of poor qual­ity – where you’ve slept through the night, but do not wake feel­ing re­freshed. Other sleep dis­or­ders in­clude sleep ap­noea, Rest­less Legs Syn­drome and nar­colepsy, or The lead­ing causes are lifestyle, stress, obe­sity and de­pres­sion.”

De­pres­sion is both a cause and a symp­tom of in­som­nia – mean­ing de­pres­sion and in­som­nia can lock you in a cy­cle of poor sleep habits and wors­en­ing symp­toms.

Ebrahim men­tions that “many med­i­cal dis­or­ders get worse at night – ei­ther from sleep per se such as asthma, or from ly­ing un­con­trol­lable day­time sleepi­ness.

For gen­eral in­som­nia, proper sleep hy­giene is the first place to start: lim­it­ing screen use be­fore bed­time, mak­ing sure that the bed is only used for sleep – not work – and most im­por­tantly, stick­ing to a bed­time rou­tine. This means that even after a night of ter­ri­ble sleep, you shouldn’t sleep in for more than half-an­hour to catch up.

For jet lag, re­search sug­gests that rather than re­ori­ent­ing your­self im­me­di­ately to a new time zone, you should let your body feel like it’s had its full night’s sleep – ex­pose your­self only to the sun­light and your break­fast rou­tine (both Sun and food are cues by which the body sets its cir­ca­dian rhythm) at your nor­mal wake-up time. You are bet­ter placed to com­bat sleep changes when you are fully rested.

Melissa Groun­lund

down such as gas­tro-oe­sophageal re­flux”.

Th­ese make it harder to stay asleep, while also ag­gra­vat­ing the med­i­cal con­di­tion.

Ac­cord­ing to the Lon­don Sleep Cen­tre, about 30 to 40 per cent of adults ex­pe­ri­ence in­som­nia an­nu­ally, with sleep­less­ness or the in­abil­ity to sleep be­ing chronic or acute for about 10 to 15 per cent among them. In­som­nia in­creases with age and is more com­mon in women. Ebrahim’s clinic treats sleep dis­rup­tions as­so­ci­ated with preg­nancy, post-preg­nancy and menopause.

Jet lag, a fre­quent char­ac­ter­is­tic of life for many in the UAE, can ex­ac­er­bate in­som­nia, but will not it­self cause it. How­ever, there is ev­i­dence that it af­fects chil­dren more pro­foundly than adults. One woman in the UAE, who grew up be­tween her board­ing school in the United King­dom and her par­ents’ home, says the fre­quent bouts of eight-hour jet lag had a long-last­ing ef­fect on her sleep cy­cle.

Treat­ment op­tions for in­som­nia vary, with CBT, or cog­ni­tive be­havioural ther­apy, be­ing the best known. CBT fo­cuses on chang­ing the thought pro­cesses around sit­u­a­tions that pro­voke anx­i­ety to curb neg­a­tive pat­terns.

For sleep ther­apy, for ex­am­ple, a CBT ap­proach might en­tail the ther­a­pist ask­ing an in­som­niac to con­front his worst fear – a night with­out sleep – and then to show how such an even­tu­al­ity is ac­tu­ally man­age­able.

“CBT is one of the many treat­ment op­tions,” says Graf. “It is im­por­tant to iden­tify the source of in­som­nia, if pos­si­ble. Causes can range from too much caf­feine, or over­stim­u­la­tion be­fore bed from screens, to psy­chi­atric dis­or­ders such as de­pres­sion or bipo­lar dis­or­der. Work­ing on sleep hy­giene and rul­ing out un­der­ly­ing med­i­cal/psy­chi­atric causes can help to treat the prob­lem.”

Suf­fer­ers of in­som­nia in the UAE have of­ten com­plained that there are few treat­ment op­tions in the re­gion be­yond med­i­ca­tion, but the rise in sleep dis­or­der clin­ics has made more types of treat­ment avail­able. Hu­sain says she uses a com­bi­na­tion of CBT and mind­ful­ness ther­apy, which means “be­ing in touch with one’s own senses and one’s body. We abuse our bod­ies a lot”.

“We only pay at­ten­tion to our body when we need some­thing from it or want it to look a cer­tain way,” she says.

For acute in­som­nia, med­i­ca­tion is of­ten needed be­fore ther­apy can be ef­fec­tive. Ebrahim says he tran­si­tions from a med­i­cal ap­proach – once the acute phase is over – to more in­te­grated CBT one.

There are also on­line CBT ther­a­pies such as Sleepio (52 weeks of un­lim­ited ac­cess costs around Dh1,100) or Sleep Healthy Us­ing the In­ter­net (with a join­ing of­fer of Dh475 for the first eight weeks). Th­ese help users track their sleep pat­terns, and also give feed­back to es­tab­lish proper sleep habits.

Stud­ies show that such on­line coun­selling pro­grammes can be ef­fec­tive. “Peo­ple do not have a clear un­der­stand­ing of their own sleep­ing,” says Hu­sain. “They tend to over­re­port or un­der­re­port.”

Any track­ing mech­a­nisms will help peo­ple un­der­stand what is re­ally go­ing on in their bod­ies, though th­ese pro­grammes will be of lim­ited ef­fi­cacy to those with acute sleep dis­or­ders or psy­cho­log­i­cal con­di­tions.

Sleep ben­e­fits are also a new watch­word in the re­lax­ation busi­ness, and a num­ber of lux­ury ho­tels now pro­vide sleep treat­ments to help har­ried guests.

Just re­cently, Park Hy­att in Abu Dhabi launched a sleep treat­ment. It in­cludes med­i­ta­tion, re­flex­ol­ogy mas­sage, head mas­sage and can­dles for an hour to an hour-and-a-half – the prop­erty says it has al­ready be­come pop­u­lar. Other ho­tels are in­creas­ingly of­fer­ing sim­i­lar treat­ments and wellness pro­grammes.

“Ev­ery­one likes a nice mas­sage,” ad­mits Hu­sain. But he warns “that’s not go­ing to treat the un­der­ly­ing prob­lem”.

art­slife@then­ational.ae

Getty Im­ages

Ac­cord­ing to the Lon­don Sleep Cen­tre, about 30 to 40 per cent of adults ex­pe­ri­ence in­som­nia an­nu­ally, with the sleep­less­ness or in­abil­ity to sleep be­ing chronic or acute for 10 to 15 per cent among them.

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