Dr Ian Smith, The Sleep Clinic Papworth Hospital
Lack of sleep can be a big problem. In this article, Dr Ian Smith discusses the effects of lack of sleep on one’s health, highlights the more serious problems relating to sleep disorders and sleep deprivation and offers advice on how to get a better night’s rest.
Are sleep disorders common?
It’s the big problem of the modern age – not a week goes by that there isn’t a feature in a magazine or newspaper about how the trappings of the modern age are preventing us getting enough of the ‘right kind’ of sleep. But are we all worrying too much about nothing?
"The increase of media attention on sleep is a good thing, because there is more that can be done to help people with sleep disorders," says Dr Ian Smith of The Sleep Centre at Papworth Hospital, "but there’s much fretting about details, the cosmetic aspects of sleep, and obsessing about getting eight hours which is unhelpful."
Is our 24-hour accessible culture to blame for lack of sleep?
There’s no doubt that our 24-hour accessible culture, with the world on tap at any time, from entertainment to paying your bills, means sleep can suffer. But despite this, Dr Smith says most people sleep quite well and may unfairly blame lack of sleep for all sorts of ills. "Perhaps because of media prompts people come with a shopping basket of symptoms that they blame on poor sleep, like having bad skin, getting fat and generally feeling below par, which may be nothing to do with their sleep," he says. "People may go to bed expecting to wake up feeling better, but if the reason they feel bad is because they’re stressed, sleep alone is not going to sort that out."
How does sleep deprivation affect one’s health?
This is not to say, of course, that sleep isn’t important, and if you do have a genuine problem it’s important to get it checked out. "The purpose of sleep isn’t completely understood," says Dr Smith, "but if you deprive people of sleep for a long time, they become irrational, there’s a tendency to paranoia and the immune system is less effective. So certainly absolute sleep deprivation is very bad for your health in lots of ways."
The affect of lack of sleep on mental health
As well as your health, research has shown that sleep affects mental functions in fascinating ways. Dr Smith cites studies showing that if you teach people a set of rules, then test them an hour later or after a night’s sleep, they do they do better in the second test without any further revision. "So sleep isn’t just rest - the energy use of your brain goes down when you’re asleep, but it is still very active organising factual and emotional information."
In another study, two groups of people were given lists of negative, positive and neutral words to memorise. The people who had had good sleep remembered equally from each group. But the group who’d been sleep deprived remembered only about 50 per cent of the total, and in addition focused on the negative words. "So it seems getting moody and bad tempered if you don’t get enough sleep is partly a defence mechanism, you’re looking out for problems. But in the long term that’s not good for your psyche," says Dr Smith.
How much sleep is enough?
And so to the $64,000 question, how much sleep is enough? Says Dr Smith, it depends entirely on the individual. "It’s a bit like asking how tall should you be," he says. "Some people work absolutely fine on five hours, most people need between seven and eight, and about five per cent of people need 10 or 11 hours to feel well - which can have a huge impact on quality of life. If someone sleeps 11 or 12 hours a night, and has a normal working day of eight hours - that’s about it. There’s no room left for a social life."
So next time you’re worrying about not getting enough sleep, count your blessings and remember Dr Smith’s best advice: "If you abuse your sleep routine you will probably end up paying for it. So have a common sense check, and ask yourself is your lifestyle affecting your sleep? Respect your sleep." And if you are worried about your sleep, go and see your GP. "Untreated some conditions like sleep apnoea and narcolepsy can have serious conseqences," say Dr Smith, "but most sleep disorders respond very well to treatment."
Could your sleeplessness be serious?
There are some very real problems that Dr Smith and his colleagues at The Sleep Centre at Papworth Hospital deal with, including obstructive sleep apnoea, which is when people stop breathing periodically while they’re asleep.
Sleep apnoea tends to happen among snorers who are overweight - when you fall asleep, the muscles that hold your airway open relax, so the airway becomes floppy and vibrates; it’s this vibration that makes the noise of snoring. But in a small group, perhaps one to two per cent of adults, the airway is so floppy that it closes, and that makes you wake up. "The trouble is, sufferers wake up for such a brief amount of time that they forget they’ve woken - and that may be happening 500 times a night. So they’re tired and falling asleep in the daytime and don’t know why."
Obstructive sleep apnoea can be easily and effectively treated with something called continuous positive airway pressure (CPAP). "It’s a mask attached to a small fan device that pushes air into the airway and blows it up, like inflating a bicycle tyre" explains Dr Smith. "So the airway can’t collapse, the interrupted breathing stops, the patient feels better, they are safer on the roads and less likely to suffer from high blood pressure and other consequences of sleep apnoea."
How to get a good night’s sleep
Dr Smith says there are three golden rules to follow if your sleep habits need improvement:
Get regular. Go to bed at the same time and most importantly, get up at the same time every day. "When you get up is when the clock in your brain, which runs the rhythm of your day, is reset," says Dr Smith. "So get up and get daylight at a regular time, and preferably get some fresh air and exercise too."
Can the coffee. "Avoid stimulants, number one being caffeine," says Dr Smith. Caffeine can stay in your system for eight to ten hours, so lay off it from lunchtime. Similarly, watch the drinking. "Alcohol may help you get to sleep initially but as the alcohol level in your blood drops you get a rebound of wakefulness."
Create an atmosphere. "Optimise the situation for going to sleep," says Dr Smith. Your bedroom should be warm, quiet and dark. An hour before bed, make a list of things that are worrying you, or that you need to deal with. "Make the list - you don’t necessarily have to have the solutions - commit it to paper, and then put it to one side and go to bed," says Dr Smith. And leave your laptop downstairs and the TV off. "Working in bed is a hopeless idea, as is watching TV. Getting lots of bright light and mental stimulation means you’re carrying all of that with you when you do turn the light off."
Profile of the author
Dr Ian Smith is a chest physician specialising in ventilatory failure and sleep medicine with expertise in weaning, domiciliary ventilation, sleep apnoea and non-respiratory sleep disorders including the interpretation of polysomnography. He has helped to build Papworth Hospital’s Respiratory Support and Sleep Centre (RSSC) into the largest sleep centre in the UK. He was a co-founder of the MND care network. He holds a general respiratory clinic at Addenbrookes hospital.
Article courtesy of Olivia Abbott, Cambridgeshire Agenda. www.agenda.Britisher.co.uk.
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