Chai Brady discusses the roadblocks to a good shut-eye
Sleep is one of the most important things to watch in order to maintain a healthy body and mind it’s often said, but despite this age-old wisdom today’s hectic world seems to work against a good night’s rest.
Existing in a time when visual entertainment from TV to the internet is always readily available, many workers answer emails long after they’ve clocked out and shift work defies the body’s natural rhythms, switching off for the night seems increasingly difficult.
While these barriers exist, actual sleeping disorders which can be symptomatic of a hectic lifestyle must also be tackled head on. Ignoring them have many unwanted ramifications both in the short and long term.
There’s no need for doom and gloom though, because there are several simple steps to regain control of when you enter sleep’s gentle embrace. Depending on if there’s a baby in the house, whether your partner snores, or a plethora of other reasons, it’s certainly not always easy to control sleeping patterns but it’s certainly not the end of the world when these issues arise.
Speaking to sleep expert Dr John Garvey, who is the Clinical Director of the Sleep Laboratory at St Vincent’s University Hospital, the importance of your nightly slumber knows no bounds.
According to Dr Garvey the amount of sleep needed depends on the age of the individual. The general consensus among experts is that adults need between 7-9 hours, teenagers should sleep about eight-10 hours and children between six-12 years of age need nine-12 hours. Babies sleep the most, he says, “although their parents might not think so”.
Napping generally isn’t an issue for children aged up to 5 but it may become a problem for teenagers and adults.
“It can often lead to a dysfunctional pattern of sleep where they then have difficulty getting to sleep at night and they feel exhausted during the day again, then need their nap. They reinforce that pattern, so for certain individuals it can have a negative impact,” Dr Garvey tells The Irish Catholic.
“Now there are certain sleep conditions where we will prescribe napping during the day and schedule naps so people can function, but for most of the population that is not something that can be helpful with regard to their overall sleep pattern.”
The most common sleep disorder is insomnia and the issue with many insomniacs is they will have no problem sleeping during the day but just can’t sleep at night. Avoiding that nap during the day may be difficult but ultimately beneficial.
The categories of patients he would see in his clinic fit into three overall categories:
– People who can’t sleep, or have difficulty getting to sleep or staying asleep for whatever reason. That can either be insomnia or circadian rhythm disturbance; so there’s a problem with their body clock.
– The second group is people who sleep enough but feel sleepy during the day, so their sleep is unrefreshing for whatever reason.
– The last group is people who do unusual things in their sleep. This can range from shouting, screaming, acting out their dreams, eating in their sleep or sexual activity in their sleep. They’re less common.
Although insomnia is most common, Dr Garvey says the majority of patients referred to his clinic have a condition known as obstructive sleep apnea. Simply put, it occurs when the throat muscles relax intermittently and obstruct the airway during sleep. The most noticeable sign of this is snoring.
“The snoring is usually a nuisance or an annoyance for the bed partner, or the patient has been observed holding their breathe during sleep,” he says.
“But I also see people who have circadian rhythm disturbances, where their clock has shifted and that’s quite common with teenagers. Kids that are staying awake until 2am at night, can’t get to sleep, and you can’t get them out of bed the following morning.”
Restless legs syndrome is another cause of sleeplessness Dr Garvey observes, which mainly affects older patients. It causes discomfort, generally at night, and stops people getting to sleep or disrupts it. “They just feel that they need to move their legs, they get a discomfort within them and just have to move them in order to get comfortable,” he says.
The more unusual sleep issues can be “extremely disturbing”. A general practitioner will often refer a patient to a specialist when they present with some of these lesser known concerns.
Dr Garvey says: “Sleepwalking is extremely common, 10% of the population will have done it at any stage in their life.
“Usually you kind of grow out of it as you move into adulthood so it’s only about 1% of adults who will sleepwalk, but it can have significant consequences where it creates safety issues for the patient themselves or their bed partner.
“It’s too specific to give a general recommendation but if there’s any concerns with regard to these things a review at a specialist clinic is probably helpful.”
Nowadays many people use smartphone apps to track their sleep, some will have smart watches that monitor their heart rate. They tell the user how many hours of REM and how many hours of deep sleep they’ve had, but Dr Garvey says they aren’t fully accurate.
“Deep sleep is not a standard scientific definition so how we define sleep is either Rapid Eye Movement (REM) sleep which makes up 20-25% of a night’s sleep or non-REM sleep which makes up what’s left,” he says.
“Non-REM sleep, there are different stages to it. So you have stage one, stage two and then you have stage three which is slow wave sleep.
“That staging of sleep varies throughout our lifetime. So older people will have very little slow wave sleep, babies will tend to have more REM.”
It’s not as straightforward as saying you need a certain amount of stage one or stage two sleep for our bodies to be able to do certain things, he says. “I suppose the most important thing that people can do in modern society is facilitate enough time in their lives for sleep, not to get hung up on this app telling me I have this type of sleep”
Regarding the apps he says some have been validated by certain companies but they are not as “robust” as an actual sleep study in a laboratory.
Another thing to watch out for is the ‘nightcap’, although some may find alcohol helps them get to sleep, it often leads to disruptive sleep patterns, particularly if it’s not consumed in moderation. This includes bathroom breaks during the night and subsequently an inability to fall back to sleep, which leads to what is called sleep maintenance insomnia.
Smartphones have also been heralded as a major sleeping roadblock. Dr Garvey agrees but says the issue is much more intricate than just blaming one device or screen.
“The thing that effects our body clocks the greatest is exposure to light. I suppose even our artificial light in comparison to what we have had for centuries – in terms of candlelight – our bodies our biologically tuned to having daylight during the day and darkness at night and disruption to that for any reason can have a negative impact on our sleep.”
The issue of artificial light and screens is just a “single facet” in the modern world which is making it increasingly difficult for people to switch off.
“Over the last 30 years we’ve seen a change from when TV ran from 8-9am to midnight and the national anthem played, now it’s a 24hour entertainment source. Our access to everything has changed, society has moved towards being a 24 hour society.
“I think it is not just a case of excessive screen time, and screen time at an inappropriate time can lead to a disruption of sleep, but we’re increasingly becoming aware of the impact that shift work, let’s say, can have on people’s overall health.
“There’s been a Scandinavian study which looked at shift work in nurses and identified it as a potential carcinogen, I suppose it’s not so much the screen per say but it’s anything that impacts on our sleep in that fashion.”
He adds that regular exercise is recommended for overall good health, this too applies if someone wants to have a better sleep. Exercising just before going to sleep isn’t always the best choice and can lead to difficulty sleeping but many people aren’t affected and doing some exercise during the day is better than doing none at all.
Lack of sleep has several immediate consequences, which anyone who’s only slept a few hours or missed a night will understand, but the long term consequences can be much more severe. This includes developing dimensia.
“I suppose a good example with regard to that was Maggie Thatcher who said that she only required four or five hours sleep each night, I’m not saying it’s cause and effect but she’s an example of somebody who said that that was the case who later in life developed cognitive impairment,” Dr Garvey says.
“We also know that too long a sleep time can have negative effects as well, it can increase your risk of the metabolic syndrome, obesity and diabetes, an optimal amount of sleep is what we should be aiming for.”
He adds there’s also an association between sleep apnea and increased cardiovascular risk, which is most evident in men but “probably does exist in women who are post-menopausal”, but it is “very much an active area of research”.
Fundamentally humans have a need to sleep throughout a third of their lives, with Dr Garvey saying that its importance hasn’t been respected “to the level that we’ve needed to”. In the past few decades it’s received more focus, which isn’t long in the world of medicine, but one thing is for sure, there’s nothing better than a good night’s sleep.