'You should keep your sleep time and wake up time fixed.'
'Avoid caffeine-containing drinks after 5 pm.'
'Avoid a heavy dinner.'
'Avoid alcohol or any stimulants, like nicotine.'
Do you own good sleep hygiene?
Lack of sleep hygiene can lead to less or too much sleep and a plethora of medical issues.
Dr Pujan Parikh, a pulmonologist and consultant attached to t Sir HN Reliance Foundation Hospital, Mumbai, works in the hospital's sleep clinic. On the occasion of World Sleep Day, Dr Parikh rues the lack of knowledge on sleep and sheds light on various technical aspects of sleep.
Dr Parikh trained and earned an MD in pulmonary medicine, but then went on to do a fellowship in sleep medicine from the International Institute of Sleep Sciences, Mumbai, and has a keen interest in this field, dealing with an assortment of sleep disorders like sleep-related breathing disorder insomnia, sleep related movement disorder, circadian rhythm disorder.
In Part I of his interview to Vaihayasi Pande Daniel/Rediff.com, he discussed good sleeping practices, over-sleeping and more.
How common are sleep disorders? Is it a function of age? As you get older, you, you start having sleep issues?
Sleep disorders are quite common. Because of lack of awareness, even though the person may be suffering from a sleep disorder, like even a simple sleep apnea, he or she may not know that.
If a patient is snoring, they feel they are having a good sleep. If someone can sleep at any time of the day, anywhere, people feel: 'Oh, he's blessed, he can sleep any time'.
But that is actually wrong. That occurs because of the hypersomnia or the snoring issue related to sleep apnea.
Thirdly, when it is related to insomnia, a lot of patients go to psychiatrists and sometimes they are misdiagnosed and treated with an antidepressant and anti-anxiety medicines, which may not be required, because they may be suffering from PLMD (periodic limb movement disorder, a sleep disorder that causes people to move their limbs involuntarily and repetitively during sleep) or sleep apnea-related insomnia or physiological or paradoxical insomnia.
Is there any way of giving an indication of how common sleep disorders are?
I practice mainly sleep, so obviously I get more sleep patients. But say if 100 patients are coming to the hospital, then 5 to 10 patients, at least, will have some sleep issue. I would say 5 to 10 per cent, but they may or may not come to the hospital for a sleep issue.
Do issues increase with age? Are they connected to age?
Insomnia definitely increases with age.
Sleep apnea as well.
How important is sleep to our health?
It's very important, because there are multiple aspects that affect our day-to-day activities because of the sleep.
If you talk about the endocrine system, then the first is uncontrolled poor sleep leads to rise in blood pressure, sugar levels.
Sleep apnea causes high blood pressure, sugar issues. Uncontrolled sleep apnea brings on weight gain as well, because the growth hormone secretions are affected.
Secondly, it causes cosmetic changes, like a weight gain, early aging, wrinkles because of the deficiency of a growth hormone which is mostly secreted in stage three sleep and when we exercise.
Thirdly, it reduces alertness and efficiency at work.
Fourthly it has a psychiatric aspect, increase in say anger and frustration etc.
What is the minimum amount of sleep one should get? Do naps help if you don't get your minimum hours?
Ideally it should be between six to eight hours. Every individual has their own particular number of hours. But on an average, if you ask me, from the age of 18 to 60, then the six to eight hours of sleep is good enough.
Naps basically do help partially, but not completely because certain stages of sleep don't come during the day time. REM sleep is predominantly in the night sleep and doesn't come during a nap. Ideally it should be a night sleep.
One hears from other doctors that sleep medication is abused in India, because it is easily accessible. So many take it after a flight for jet lag. In your view when is sleep medication justified?
By sleep medication do you mean sedatives or a melatonin.
Sedatives.
Sedatives definitely should not be taken without a prescription. And it is good only if a proven sleep study report shows that there is no sleep disorder and that it is a sleep efficiency issue. That is the time when a sedative should be given.
Secondly, if a patient is suffering from any psychiatric disorders, then this medicine should be given.
What do you mean by sleep efficiency issues?
During a sleep study suppose we ask the patient to sleep at 12 in the night and wake up at 7 in the morning. We calculate the total time in he spent in the bed and out of the total time, how many hours the patient slept.
Basically, sleep efficiency is a percentage of that. Usually, it should be 85 to 90 and above. Supposing we do a study and if the sleep efficiency is 70 per cent, then sedatives are called for.
You said that there can be various causes for hypersomnia. But before I get to the causes of hypersomnia, is it generally bad to sleep longer?
So, no. There are certain people who are long sleepers. Their requirement of sleep hours is more compared to others. If it is not bothering them and is not related to a sleep disorder or OSA (obstructive sleep apnea), which leads to hypersomnia, then that is fine.
But if it is related to narcolepsy (chronic brain disorder that causes excessive daytime sleepiness and disrupted sleep at night) and other things, then it should be treated.
What advice do you give to those suffering sleep anxiety or those whp wake up at night and are not able to get back to sleep?
After proper evaluation -- certain blood tests are required in a sleep study and all that -- the most important thing is sleep hygiene.
You should keep your sleep time and wake up time fixed.
Avoid caffeine-containing drinks after 5 pm. Avoid a heavy dinner. Avoid alcohol or any stimulants, like nicotine. Regular exercise.
Avoid exposure to the blue light at least two hours prior to the desired sleep time. That is a standard safe sleep hygiene practice which we advise.
Usually if someone is having a bit of anxiety related to sleep, then what I suggest is till the time you don't feel sleepy, don't go to bed. It will occur for a week, 10 days, 15 days. But after that it will not happen.
But what happens when you get up in the middle of the night and you can't go back to sleep?
Then that is definitely a sleep disorder. Then we have to figure out what is the exact reason why that is happening.
We call it as a difficulty in maintaining sleep. A proper evaluation is required, like a sleep study, to figure out what is the exact reason.
Is it related to a sleep breathing disorder or some patients get REM sleep apnea that can also lead to this type of issue.
Secondly, if it is related to sleep maintenance, then we have to take a proper history to see if maybe the patient is sleeping during daytime.
Sometimes if the patient is sleeping during the daytime, then that can cause this type of sleep maintenance issue. But this should be seen by a doctor to figure out what exactly is the reason.
Some patients suffer from the advanced sleep-wake phase disorder, which is common in old age, where they sleep early and wake up early in the night.
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