August 31, 2008

Pragya wakes up at 8 every morning. “Ideally it should be at 6 a.m.,” she says, as work starts at 9 a.m. and it takes her more than an hour to reach office. But for someone who gets to sleep only by 3 a.m., waking up early is no easy task. “My sleep is determined by that of my three-year-old,” says the 28-year-old.
And between her daughter, office and managing a household, Pragya's sleep is sacrificed. “I am irritable, moody and all I want to do is lie down and rest,” she complains. Sometimes she would be so tired that she has to pinch herself awake to avoid dozing off at meetings with clients, something this PR executive in Delhi cannot afford to do.
“That's when I decided to come to office later than my scheduled time. So instead of 9 a.m., I reach by 10 [at the cost of a part of her salary],” Pragya says. But even after altering her schedule, she does not feel refreshed and says things are only marginally better. She feels she is stuck in a jam.
Arun Kumar's job profile would inspire envy. The 31-year-old regional head of a major oil company in Delhi, who works for at least 15 hours a day, says, “I have to attend calls in the middle of the night as well... and these are quite regular.” Little wonder then that he couldn't sleep well. “I would still feel tired after having slept six hours every night... I would also feel sleepy through the day.”
He was diagnosed with sleep apnoea (temporary cessation of breathing during sleep). Among other things, doctors advised Kumar to exercise regularly and strike a work-life balance. “For once, I tried to cut down my work hours to 12 and began exercising regularly,” he says. Things have improved tremendously since then. Though the problem with snoring remains, Kumar does not doze off during the day any more.
How many of us have woken up in the morning still tired and hoping there was just one more hour to sleep? Nonetheless most of us don't think twice before cutting down on the number of hours of sleep to fit in a few extra hours of work or to attend a party.
Here is a newsflash—cutting down on the hours you sleep does hurt and it can hurt bad. Excessive daytime sleepiness, fatigue, lack of concentration and disorientation—these are just a few things that result from lack of adequate and good quality sleep. Other than lifestyle changes, some causes of sleep deprivation are depression, anxiety, sleep disorders, late night work, jet lag, ailments and disorders like backaches, cardiac problems and asthma.
“The current 24x7 lifestyle has increased anxiety levels manifold. We are anxious to meet deadlines, to meet expectations of our boss and family members. We are anxious to achieve and win. In the bargain we end up with insomnia, depression and behavioural disorders,” says Dr M.S. Kanwar, senior consultant of sleep disorders at Delhi's Indraprastha Apollo Hospitals. Globalisation may have given the economy a leg up in the country, but it has taken a toll on the nation's health. “We are a sleep sick society,” says Dr Vikram Sarabhai of Max Hospital, Delhi.
Studies have shown that the impact of sleep loss is reflected on tasks which are long, monotonous, externally paced, newly learnt, and those which have a memory component. Many road accidents in India, especially among truckers are attributed to sleepy drivers, who have been driving long distances without enough rest.
Road accidents apart, sleepiness and fatigue caused by insufficient sleep take a toll on our output as well. “Is it a wonder that people in their thirties and forties are burning out?” asks Dr Manvir Bhatia, chairperson, sleep medicine, at Sir Ganga Ram Hospital, Delhi.
Contrary to what people would like to believe, sacrificing sleep on a regular basis to add extra waking hours actually brings down productivity in the long run. “A sleep-deprived mind is a mortgaged mind. How can it work to its full capacity?” asks Sarabhai.
The main functions that take a hit when sleep is adversely affected are intelligence, motivation, memory and creativity, leaving a person incapable of achieving his or her full potential. As Dr S. Ramanathan Iyer, consultant sleep medicine expert, Hiranandani Hospital in Mumbai, observes, when people don't get as much sleep as they require, their wake time activities are affected. Which brings us to the question, why do we need sleep?
While theories abound, there is no definite answer to this question. Experts believe that the major function of sleep is to help brain rest and rejuvenate. “Sleep is made for the mind,” explains Sarabhai. Sleep may also help detoxify the brain, by giving the body enough time to detoxify the free radicals or toxins that may develop in the course of the day.
Why do you feel tired and sleepy even after 7-8 hours of sleep? A sleep cycle can be divided into REM (rapid eye movement) and NREM (non-rapid eye movement) sleep, says Kanwar. NREM is further divided into four stages—I, II, III and IV. The last two stages and REM sleep are the ones that help the mind refresh. People who do not spend adequate time in these stages find their quality of sleep disrupted and end up waking up fatigued.
Soujanya started working when she was just 23 and fresh out of college. The thought of joining a software firm in Bangalore was quite exciting. Even the fact that she had to work from 6 p.m. to 3 a.m. did not seem daunting, but only for a while.
“My schedule went right out of the window. All I seemed to do was work and come home by 3.30 a.m. to sleep for a while and then get ready to go back to work by 4.30 p.m.,” says Soujanya. As a result she developed insomnia over a period of time, anxiety levels peaked and she even started developing paranoia.
On top of all that she developed acute gastritis. “I would hardly eat at office. I would get by with a glass of juice on most days,” she says. Along with her health, her interpersonal conduct started going downhill. “I couldn't get along with my colleagues. Even at home, I would get into fights with my folks or with friends,” she says. Finally, three months ago, the 25-year-old called it quits. “I did not even serve my notice period… I just wanted to get out,” she says.
Work can be stressful and, coupled with family responsibilities, things can become difficult. Deepti Pillai is a professional who acts as an interface between her company and its clients. Her typical day starts at 7.30 in the morning. “I long to stay longer in bed… because I know I will feel much better if I slept just one hour extra,” says the 30-year-old. Groggy-eyed and fatigued, Deepti gets ready for the day and readies the day for her husband and three-year-old daughter. “Once my husband leaves and I send my little one to my mother's place, I am off to work by 10,” she says. “Work involves a number of meetings with clients, reports to be filed and finalised; it's like walking a tightrope.”
Work keeps her on her toes through the day till she heads home late in the evening. But the day is nowhere near to getting over because she has to take care of an active three-year-old, who takes up the rest of her time. On an average, Deepti gets 6-7 hours of sleep, but she still doesn't feel refreshed.
Things were even more difficult a year ago, she says. “There were days when I would cry because I was so tired and all I wanted to do was sleep.” Not only did work keep her up, she needed to take care of her infant as well. 
While things may be better now, Deepti wishes there was some more time, especially to exercise. “I get no physical activity and my health is taking a beating because of that,” she says. Caught in a vicious cycle of tiredness and a hectic wake-time schedule, she doesn't know where to take that extra time out. And then there are many who in addition to work have to contend with active socialising, be it work-related or for recreation to unwind after a hectic day.
Sleep deprivation precipitates health problems like obesity, cardiovascular diseases, insulin resistance, high blood pressure, to name a few, which constitute Metabolic Syndrome (MS). Sleep deprived people are two times more at risk of developing MS, says Bhatia. The rising cause of worry is obesity. “Inadequate sleep coupled with bad eating habits and lack of exercise, which many young Indians experience, is a deadly combination,” says Kanwar.
If one doesn't get a good night's sleep, he/she tends to wake up tired with no energy or drive to exercise. Long hours at work or a social do are usually sustained by overeating high-calorie food, which is not burnt by the body fast enough. This gets stored as fat, which in unhealthy amounts can lead to obesity and other ailments and conditions. In fact, it has been seen that 50 per cent of the patients of MS also suffer from sleep apnoea, a common sleep disorder.
Parveen Gupta, 39, would vouch for that. A businessman from Delhi, Gupta had everything going against him. He was grossly overweight, an alcoholic, smoker, led a sedentary life and had a stressful and tense work schedule. “I was irritable, fatigued and my mood would be bad most of the time,” he recalls. But what took him to the doctor eventually was a problem with sleep. “I would snooze as soon as I sat in my car to go to office after 7-8 hours of sleep. And while I would have dozed off only for a few seconds, it would feel I had slept for hours,” says Gupta.
He was advised to get a sleep study done. It was in the sleep lab that the businessman was diagnosed with obstructive sleep apnoea. Gupta was advised the use of continuous positive airway passage machine, and he says ever since that he has got his life back. “I have been asked to lose weight. I have already cut down on alcohol intake and quit smoking three months ago,” he says.
While Gupta is trying to get his health back on track, there are many who are oblivious to their problem and continue to push themselves, putting their life at risk. Several epidemiological surveys indicate a strong association between sleep disturbances or shortened sleep durations to cardiovascular diseases, diabetes mellitus and respiratory disorders. Some studies have found that people who slept less than five hours a night had a three-fold risk of heart attacks.
Another problem that arises in this scenario is of substance abuse. “Many insomniacs who can't sleep resort to taking alcohol or sleep-inducing medication,” says Bhatia. These substances in the long run only add to the problem.
“When they resort to medication to ‘treat' their insomnia, what they don't realise is that insomnia is not a disease, but a condition arising out of some other underlying problem,” explains Bhatia. And the underlying problem could range from a medical condition to lifestyle problems to age. It is your doctor who is best equipped to diagnose the problem. Sleep medicine is a clinical speciality, which is concerned with the diagnosis and treatment of sleep disorder and patients who have problems with daytime alertness.
While sleep medicine helps pinpoint the problem, it is up to the individual to get back on the highway of good health. “The most important thing to do is to listen to your body,” says Dr Manoj Bhatawadekar, psychiatrist at Lokmanya Seva Sangh, Mumbai.
Sarabhai is worried that if society doesn't slow down to catch its breath it would have an adverse effect on human growth and development. “Every generation does better than the previous one and this growth can be attributed to better mental abilities of the new generation,” explains Sarabhai. But he feels that if we continue to abuse and subsequently exhaust our minds and bodies we would be throwing a spanner in the wheels of progress. And people are waking up to the fact.
“Try to sleep early and no matter what time you sleep, wake up at the same time every day,” says Bhatawadekar, who believes this discipline will help the body to get its rhythm in place, and help one sleep and live better. Avoid intake of stimulants such as caffeine (therefore chocolate is out), alcohol and nicotine close to bedtime, advise doctors. Visual stimulants are also a big no-no. Says Bhatawadekar: “A TV has no place in the bedroom. Not only the images on it stimulate the mind and keep it alert, the light-rays from the device also keep you awake.” Same goes for laptops and computers.
“Eating can be disruptive right before sleeping,” says Bhatia. So keep away from large meals close to bedtime. Also dietary changes can cause sleep problems.
And, do not toss and turn in bed trying to get sleep. “If after ten to fifteen minutes of lying down, you can't get sleep, get up and go to another room and try to relax. Read a book perhaps, and return to bed when you feel sleepy,” says Bhatawadekar. And doctors say they can't put enough stress on the importance of physical exercise. “Indulge in vigorous exercise in the morning or late afternoon,” says Bhatawadekar.
One need not be suffering from a sleep disorder or undergoing any treatment to follow these guidelines. Sleep discipline will help restore a normal sleep cycle and keep diseases at bay.

Catch those forty winks
When at work do you feel burnt out, especially around 5 p.m.? Try taking a power nap. This short snooze of 20-odd minutes will take care of irritation and poor performance as the day wears on. Researchers think a burnout may be the brain's way of preserving information that has been processed, but not yet consolidated into memory by sleep.
So to keep the information intact, the brain would benefit with a short nap. It is especially helpful for people who are sleep deprived because the short nap helps them catch up with the restorative part of their sleep cycle that they might have missed in the morning. Dr M.S. Kanwar of Indraprastha Apollo Hospitals, Delhi, says those who sleep less during the night benefit more by taking 90-minute naps. These short naps are especially beneficial in providing a burst of new ideas and energy and tend to eliminate the need for caffeine boosts during the work hours.
Experiments at Harvard University show that a midday snooze reverses information overload and that a 20 per cent overnight improvement in learning a motor skill is largely traceable to a late stage of sleep.
The big thing is that the brain needs a rest every now and then, and apparently, it can refresh itself and go on full steam with just a short, 20-minute power nap.

Don't kid with sleep
Does your teenager get caught for sleeping in class? Children, including teenagers, need at least nine hours of sleep for their physical growth and overall development. “The growth hormone is secreted while they sleep, and thus it is during sleep time that they experience spurts of growth,” explains Dr Manvir Bhatia, chairperson, sleep medicine, at Sir Ganga Ram Hospital, Delhi.
For teenagers, sleep is delayed because of hormonal changes they undergo. “Parents usually lament that teens don't sleep early enough. This is because if they slept at 10 p.m. when they were children, the urge to sleep has moved to 1 p.m. now owing to hormonal changes,” explains Bhatia.
But today there are more distractions than hormones that are keeping young children awake well beyond the witching hour. “Needless to say there is the television, internet, video games, and cellphones that keep them up most of the night,” says Kanwar. After junk food, the current threat to a teen's health is junk sleep. Teenagers are surviving on this low quality sleep, caused by disruptions from electronic gadgets such as cellphones and computer gadgets. The disruption could be a beep or even light rays from these gadgets. Experts say that this phenomenon needs to be nipped in the bud because studies have shown a clear link between inadequate sleep and obesity, which in turn brings along its own set of problems.
Bhatia recalls the case of a 25-year-old patient who is dealing with insomnia. “For this girl, the problem started when she was in the 12th standard preparing for competitive exams. She would study till 3 a.m. and be ready for school by 7.30 a.m.,” she says. She was also juggling tuitions and coaching classes in addition. The girl earned an MBA degree, but at the cost of her sleep and health.
What makes all this worrisome is the lack of physical exercise. “The pressure on these kids is not to perform well just in academics, but they are expected to do well in extra-curricular activities as well,” says Kanwar. What happens in the bargain is that they don't play or exercise. And just like adults, obesity is stalking children as well. “And with it comes the risk of developing cardiovascular risks and type 2 diabetes in children,” he says.

Quickfacts
The leading cause of fatigue is musculoskeletal problems, followed by psychological problems. Women, vegetarians and people in high stress jobs are highly susceptible to chronic fatigue.


Quickfacts
Cough is the body's natural reflex to expel irritants. Severe cough can cause fractured ribs, especially in women with fragile bones.

Quickfacts
Oedema is a condition resulting from the abnormal accumulation of fluids in certain tissues. Women appear to be more susceptible to oedema, especially idiopathic oedema, for which there is no known cause.