Sleep is a very important aspect of our life that is grossly misunderstood, largely undervalued and as a result, ignored. This is fast turning into a major public health hazard due to our modern lifestyles.

Hence, we have brought you a series of articles that highlight sleep physiology, disorders, and modern treatment methods, based on a recent interview with the Medical Director of Indiana Sleep Centre (USA), Clinical Assistant Professor at Marian University in Indianapolis. Dr.Abhinav Singh.

In the previous article, we tried highlighting the importance of sleep and its physiology. If you haven’t read it yet, here’s the link:

Here we are with the next article about the various factors influencing sleep and ways to improve your sleep.

Indu Sree (IS): What are the various hormones influencing sleep?

Dr. Singh: Melatonin, which is an important sleep hormone is produced from the pineal gland on receiving signals from the retina which increases once the amount of light that falls on it dwindles i.e from 7 or 8 pm onwards. Its levels are at peak at 3 am and slowly fade out by the morning like a cycle and thus exists the circadian rhythm. Orexin, histamine, norepinephrine dopamine, and serotonin which are responsible for the wakefulness of an individual, gradually fall in the night while GABA, an inhibitory hormone starts to increase. Morning sunlight is very healthy for staying awake during the day as light inhibits melatonin production. So get good sunlight exposure every day for at least an hour, during the day, around 8 am to noon window.

IS: What are the effects of each stage of sleep on sleep disorders?

Dr. Singh: Several disorders occur in different stages of sleep. Insomnia is the most common sleep disorder. It occurs as a failure to initiate or maintain sleep and leads to a deprivation of both NREM and REM sleep. Sleepwalking, sleep talking, and sleep terrors occur in the 3rd stage of NREM sleep. Nightmares and dream enactment are REM sleep disorders. Around 50-70 percent of people with dream enactment(REM behavior disorder) go on to develop Parkinson's disease which could be considered a precursor to the disease. However, this is still being studied and there isn’t any supporting evidence yet. During the REM stages of sleep, all the muscles are paralyzed hence, snoring and sleep apnea (a condition that affects a person’s ability to breathe while sleeping) worsen during this stage.

IS: Does sleep imbalance at a young age have any effect on the lifespan of an individual?

Dr.Singh: It is one of the biggest predicaments of our time. Sleep is quite fundamental and we have started messing with it. Children of 3-4 years of age fall asleep anywhere because sleep needs are greater than adults and it is during this state that growth hormone release is taking place, helping their brains and bodies mature. Teenagers and adolescents who are in their growth phase tend to get habituated to mobile phones, computer screens, late-night parties, social obligations, cramming all night for exams, and get deprived of sleep.

Getting a good night’s sleep for 7-8 hours for all age groups is suggested to have a positive impact on the body and health. Sleep deprivation in any form, be it in quantity or quality, can affect the body and mind resulting in chronic health issues such as appetite dysregulation, metabolic disorders, anxiety, and memory issues. There is convincing evidence suggesting raised inflammatory markers, elevated calcium, and cholesterol levels in chronically sleep-deprived individuals thus increasing the risk of developing myocardial infarction and arrhythmias. A decrease of even an hour of your sleep every day can decrease your lifespan.

IS: What about Health care professionals and others who do night shifts who tend to have irregular sleep patterns? How can they fix their sleep?

Dr.Singh: Working late nights or doing night shifts does interfere with the sleep cycle. However, for certain individuals, it can't be avoided because that's part of their work lifestyle. So it is always advisable to get a good sleep for 6-7 hours after the shift is done or can divide it into two big chunks of sleep for 4-5 hours.

Bank your sleep upfront! Take a good 30-40 min nap before going to work and while working get at least an hour or so of sleep, whenever possible.

IS: Sleeping during the day vs sleeping during the night. What's your take?

Dr.Singh: If you’ve had a long 24-30 hour call the previous night, it is always advisable to catch up on your sleep the next morning, although it is not ideal to sleep during the day. One doesn’t have a choice in such situations. The goal here is to get a good amount of sleep even if it’s during the day because restoring your sleep is more important than being deprived of it.

I: What is the ideal duration of sleep one should have?

Dr.Singh: The ideal duration of sleep is 9-11 hrs for teenagers,7-9 hrs for adults, and 7-8 hrs for older individuals.

Check out the following link for more details-

https://www.sleepfoundation.org/how-sleep-works/how-much-sleep-do-we-really-need

IS: Are there any effects of oversleeping for more than 12 hours?

Dr.Singh: An acute bout of oversleeping, as in recovering your sleep after a long night shift, post a party or a family gathering is quite normal and the body is trying to reclaim what it has lost.

But if you’re oversleeping for more than 12-14 hours a day regularly then it raises concern for secondary causes like thyroid issues or iron deficiency or any metabolic issues. Common sleep disorders such as snoring and sleep apnea often deplete the quality of sleep and force the individual to sleep longer to compensate with quantity. We look for the quality of sleep during those 12-14 hours. If one is oversleeping due to any such reasons, they must consult a sleep physician.

To summarise, sleep shouldn't be taken for granted and one must understand its significance. When children are deprived of sleep, it can start to affect their growth, metabolism, and memory. Teenagers can get affected with anxiety disorders, depression, or memory issues. Adults can fall at risk of developing Myocardial infarction and arrhythmias at a younger age (heart attack), immunodeficiency, depression, anxiety, and memory-related issues. Never give up on your sleep and always try to restore it.

Coming up next is sleep disorders, various treatment options available, and different types of sleep studies. Happy reading and yes, happy sleeping!

Reviewed by Dr. Abhinav Singh M.D, M.P.H

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