Melomed Articles


14 February 2019 - Dr. Shaheen Kader

Sleeplessness Can Be Put To Rest


For many people, enjoying a good night's sleep is but a pipe dream. Instead of being whisked away to dreamland when tucking into bed and sleeping soundly the whole night through, many dread the mere thought of going to bed - because of sleeplessness.

Sleep disorder
Sleep dysfunction, explains Dr Shaheen Kader, psychiatrist at Akeso Psychiatric Clinic, Milnerton, may either result from a primary sleep disorder or it may be the secondary result of a psychiatric or other medical condition.

The most common sleep disorders usually include the following:
  • Insomnia
  • Sleep-related breathing disorders
  • Central disorders of hypersomnolence
  • Circadian rhythm sleep-wake disorders
  • Parasomnias
  • Sleep-related movement disorders

  • Syndromes, classification systems
    It is important to understand that the term sleep disorder refers to a collection of different syndromes classified according to the mechanism of its pathology or common symptoms. It is also important to note that there are different classification systems as well, Dr Kader points out. 

    Demographics
    According to Dr Kader sleep disorders are common and often go unrecognized in all age groups and both sexes.
    In adults the most common disorder is primary insomnia disorder, where population surveys show a 1-year prevalence of 30-45 percent in adults. In the USA, obstructive sleep apnea is the most common sleep-related breathing disorder affecting 20-30% of men and 10-15% of women. 

    While different sleep disorders tend to affect demographic segments differently, there are disorders for children and adults that are equally prevalent.

    Indeed, some people are more likely than others to develop a sleep disorder, he adds. There are different risk factors for different sleep disorders. Males and individuals with obesity, for example, are more likely to develop breathing related sleep disorders. Patients with depression and other severe mental illnesses are more likely to have a comorbid sleep disorder. And certain sleep disorders, such as narcolepsy, are associated with a genetic predisposition, he explains.

    Psychological effect
    Prolonged inadequate sleep has several effects on an individual's psychological and physiological function, according to Dr Kader. 

    Sleep deprivation results in mood irritability, diminished cognitive function such as impaired attention, concentration and memory. Physiologically, lack of sleep results in higher levels of the hormones norepinephrine and cortisol which are associated with stress and lower levels of thyroxin which is responsible for maintaining a normal metabolic rate. This results in physical changes in appearance (often a debilitated appearance), feelings of lethargy and a significant change in appetite.

    Learning ability
    Dr Deon van Wyk, academic, author and psychologist, stresses that it most important that children and young adults, in particular, get sufficient, deep sleep in order to study optimally. 

    Numerous experiments with students on sleep deprivation consistently show the sleep group outperforms the non-sleep group by about 3 to 1.  Therefore,  sleep loss equals brain drain and it is no surprise that a lack of sleep inhibits learning.  

    Furthermore lack of sleep accelerates parts of the aging process.  For example, if healthy 30-year-olds are sleep-deprived for six days (averaging, in this study, about four hours of sleep per night), parts of their body chemistry soon revert to that of a 60-year-old.  When allowed to recover, it will take them almost a week to get back to their natural 30-year-old system, Dr Van Wyk points out.

    Impact of dreams, nightmares on sleeping patterns
    Dreams are internally generated conscience experiences that seem vivid and real, dreams can also have an impact on sleeping patterns, Dr Kader points out.

    Pleasant dreams do not usually impact negatively on an individual's subjective experience of sleep. Nightmares which are unpleasant dreams, however, do create a negative subjective experience of sleep. This may result in anxiety to sleep or even a fear to sleep.

    Tips to improve sleep hygiene
    This said, there are many ways in which a person can improve sleep hygiene (i.e. actions that tend to improve and maintain good sleep), says Dr Kader. He gives the following tips to put sleep disorders to rest:
  • Sleep only as much as you need to feel completely rested. 
  • Get out of bed immediately once you are awake (say no snooze alarms).
  • Avoid force sleeping.
  • Keep a regular sleep schedule.
  • Exercise regularly for at least 20 min. (This should be done preferably 4-5 hours before bedtime).
  • Avoid caffeinated beverages after lunch.
  • Avoid alcohol near bedtime: no night cap.
  • No smoking within 4 hours of bedtime.
  • Avoid prolonged use of light-emitting screens before bedtime (TV, laptop, iPad).
  • Do not go to bed hungry.
  • Ensure your bedroom environment is comfortable and dark once the bedroom lights are switched off. 


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