INSOMNIA AND OTHER NIGHTMARES
Want to know what insanity feels like? Try going without sleep for a few days. On International Sleep Day, Monique Verduyn asks why sleep is so vital to our wellbeing, and why it’s sometimes so elusive
Ninety-nine zillion, Nine trillion and two Creatures are sleeping! So ... how about you?” If only bedtime were as fun as Dr Seuss’s Sleep Book. Those of us who regularly find sleep elusive have not had an easy time of late. For two years, global headlines have been dominated by the pandemic. To add to the misery of our times, weather-related natural disasters are on the increase,
Russia has invaded Ukraine, and South Africans are becoming more despairing every day about Eskom’s ability to keep the lights on. Our anxiety levels are in overdrive and, as anyone who’s experienced crippling unease knows, anxiety and slumber do not good bedfellows make.
Friday was International Sleep Day, so it’s pertinent to ask why we need a good night’s rest.
SLEEP LOSS CAUSES WEAR AND TEAR ON THE BODY
Good sleep helps the body remain healthy and stave off disease. During sleep, most systems are in an anabolic state, building up the immune, nervous, skeletal and muscular systems. Without enough sleep, the brain cannot function properly. This can impair our abilities to concentrate, think clearly, and process memories.
Before the 1950s, most people believed sleep was a passive activity during which the body and brain were dormant. But we now know that it’s a period during which the brain is engaged in a number of activities necessary to life, and closely linked to quality of life.
Researchers are spending many of their waking hours trying to learn more about sleeplessness and how it affects mental and physical health.
A recent study by researchers at the University of South Florida looked at the consequences of sleeping fewer than six hours for eight consecutive nights — the minimum duration of sleep that’s necessary for adults.
The biggest jump in symptoms appeared after just one night of sleep loss, with the number of mental and physical problems becoming steadily worse and peaking on day 3. On day 6, participants reported that the severity of symptoms significantly impaired their daily functioning. They described a pile-up of angry, nervous, lonely, irritable and frustrated feelings. They also experienced upper respiratory issues, aches, gastrointestinal problems and other health concerns.
A study by the European Society of Cardiology has shown a clear link between unconscious wakefulness during nighttime sleep and an increased risk of dying from diseases of the heart and blood vessels, particularly in women.
The researchers found that women who often experience unconscious wakefulness had nearly double the risk of dying from cardiovascular problems compared with the general female population.
Worryingly, stressors related to the virus outbreak, financial problems, and changes in daily activities due to societal lockdown have had a profound impact on sleep quality and the rise in sleep disorders, according to Dr Kevin Rosman, a neurologist and director of the Morningside Sleep Clinic in Johannesburg.
“The more anxious people are, the less likely they are to get a good night’s sleep, which for adults is generally between seven and eight hours, unless you are among the small group of the ‘sleepless elite’ who supposedly get by happily on just a few hours. Pandemic worries have been compounded by remote working, with many people working much longer hours at home. This messes with sleep patterns and can have a long-term effect on normal sleep.”
Our circadian rhythm aligns with daylight, promoting alertness during the day and sleep at night. When the body’s
Pandemic worries have been compounded by remote working, with many people working much longer hours at home. This messes with sleep patterns and can have a long-term effect on normal sleep
internal clock is out of sync because we’re staying up later, we experience jet lag — without even getting on a long-distance flight. It takes up to a day to recover for every one hour of change in your normal sleep pattern. A person who usually goes to bed at 10pm but works until midnight three times for one week will take up to two days to recover from each late night.
“If you frequently change your bedtime, you will be constantly jet-lagged as your internal clock is always out of sync and quality sleep will be out of reach,” he says. “It may be hard to fall asleep when you want to, or you may wake up earlier than planned. Your sleep may also be fragmented, and you may feel drowsy or tired during the day.”
When we think of sleep problems, insomnia and sleep apnoea are the first that come to mind, but there are up to 80 different sleep disorders, with new ones being discovered every year, says Rosman.
SOME OF THE MOST COMMON CONDITIONS ARE:
DR KEVIN ROSMAN
A neurologist and director of the Morningside Sleep Clinic
Insomnia
With insomnia you may have difficulty getting to sleep or staying asleep, leaving you feeling tired during the day.
“Insomnia is treated with cognitive behavioural therapy, an effective treatment for chronic sleep problems. It’s recommended as the first line of treatment and has a high rate of success. In some people, depending on the cause of the insomnia, medication may be
required. However, we would always try to control the insomnia without the use of medication.”
Sleep apnea
Sleep apnea is a potentially serious medical condition in which breathing repeatedly stops and starts, causing the body to take in less oxygen. It can also make you wake up during the night. If you snore loudly and feel tired even after a full night’s sleep, you might have sleep apnea.
Treatment often includes lifestyle changes, such as weight loss, and the use of a breathing assistance device at night, such as a continuous positive airway pressure (CPAP) machine. This can ease symptoms and help prevent heart problems and other complications.
Narcolepsy
Narcolepsy affects the brain’s ability to control sleep and wakefulness. If you have narcolepsy, you experience excessive daytime sleepiness and may have uncontrollable episodes of falling asleep during the daytime. These sudden sleep “attacks” happen during any type of activity and at any time of the day. Many medications are available to treat narcolepsy. Making certain lifestyle changes can also help you better manage living with narcolepsy.
Restless legs syndrome
Restless legs syndrome (RLS) causes an uncontrollable urge to move the legs, usually because of an uncomfortable sensation. It typically happens in the evening or night-time hours when you’re sitting or lying down. Moving eases the unpleasant feeling temporarily.
It can begin at any age and generally worsens as you get older. It can disrupt sleep, which interferes with daily activities. Simple self-care steps and lifestyle changes may help relieve symptoms. Medications also help many people with RLS.
Parasomnias
This refers to strange things happening during the night, such as sleepwalking, raiding the fridge in your sleep, night terrors and the alarmingly named exploding head syndrome.
There are numerous causes of parasomnias. Some of these conditions are potentially dangerous, but some are just a nuisance. Parasomnias occasionally lead to reckless actions, self-injury, and even violence against others. There are several historic criminal cases in which the sleepwalking defence was invoked, sometimes successfully, sometimes not — as in the case of Scott Falater, a devout Mormon, who in 1997 stabbed his wife 44 times with a hunting knife.
REM sleep behaviour disorder
During REM sleep, rapid eye movements occur, breathing becomes even, blood pressure rises, and there is paralysis (the body does not move). But the brain is highly active, and its electrical activity is similar to that during wakefulness. With REM sleep behaviour disorder, the paralysis that normally happens during REM sleep is incomplete or absent, allowing the person to “act out” their dreams — talking, making noises and punching, kicking or running movements that relate to the content of their dreams.
“REM sleep behaviour disorder can be the first indication of development of a neurodegenerative disease, such as Parkinson’s disease, multiple system atrophy or dementia with Lewy bodies,” says Rosman. “If you develop this disorder, it’s important to follow up with your doctor.”
Excessive sleepiness
Also known as hypersomnia, this is a condition in which you feel extreme daytime sleepiness despite getting adequate sleep. People who have hypersomnia can fall asleep at any time — even at work or while they are driving.
The most common cause of hypersomnia is a breathing disorder. If, in addition to snoring, you are falling asleep at times you do not want to, you should seek medical attention.
On a positive note, Rosman points out that we are generally bad at estimating how many hours of sleep we’re getting per night. “People underestimate the number by about 50%,” he says. “When they say, ‘I hardly slept last night’, they most likely had a good few hours.”
But if you’re tossing and turning, often have difficulty sleeping, are tired during the day, and you’re struggling to perform regular daytime activities, seek help and make sure there are no serious underlying problems.
Along with healthy eating and exercise, sleep is the biggest single contributor to wellbeing.