Introduction Causes Diagnosis Conventional treatment Tips for Good Sleep

What happens when we sleep? Symptoms Types Homoeopathic treatment

Sleep is one of the most important physiological functions of the body. The body of a sleeping person apparently appears to be doing nothing other then just lying there, however sleep is an active state which affects not only your physical but also your mental well being. When a person sleeps; his body relaxes and conserves and restores energy in the body.
Often a good nights sleep is an important precursor to feel mentally relaxed, fresh, energetic, faster recovery form illnesses, etc.
Sleep is as important as diet and exercise for overall health.

Globally it has been seen that one in 6 adults gets less than 6 hours of sleep. Research has time and again showed that loss of adequate sleep is a serious matter. Sleep disorders are severely under-diagnosed and under treated. It is true that some people can get by just fine with less sleep suggesting that susceptibility to sleep deficits varies greatly.
But for most people, getting less than six hours sleep translates into a bigger sleep debt than they may realize. One study has showed that if a person misses out on recommended eight hours of nightly sleep for 2 weeks, it adds up to two full nights sleep debt another study showed a person averaging four hours of sleep at night, the brain reacted as though he had not slept at all for three consecutive nights.

And the worse part being people are too tired to realize how sleep-deprived they are and the person develops slow reaction time, weak memory, and other thinking impairments.

Sleep deprivation has been documented as one the most important health risk for developing heart disease, diabetes, obesity and other such lifestyle illnesses. Several large studies have linked sleep deficits with poor work performance, driving accidents, relationship problems, and mood problems like anger and depression, missing work, events and activities.

Sleep deficit is commonly related to too much of stimulants like caffeine, nicotine, alcohol. Other factors known to affect sleep are work related issues like mental pressure from work, long working hours, night shifts, for people working from home; working on the computer until the second he/she goes to sleep.

The sleep cycle can be divided in to following categories:

• NREM Sleep
• REM Sleep

When a person falls asleep the depth of sleep increases, which can be divided into following stages - Stage 1 to Stage 4.
Stage 1: Lightest sleep, the person can be awakened easily during this stage.
Stage 4: Deepest sleep, during this stage the person can be awakened with great difficulty.
These initial four stages of sleep are grouped together and are known as Non Rapid Eye Movement NREM
Following these stages is Rapid Eye Movement REM sleep pattern followed by a period of wakefulness.

Non Rapid Eye Movement NREM
NREM sleep is divided in to 4 stages with increasing depth of sleep. The vital parameters like heart rate and breathing are slow, blood pressure is low and the sleep is relatively sound. On an average about 80% of the sleep is NREM sleep.
NREM (non-rapid eye movement) sleep is dreamless sleep.

Rapid Eye Movement REM
It is a normal physiological stage of sleep characterized by rapid eye movements and involuntary muscle jerks.
It has been observed (in EEG) that during the REM sleep, the brain activity is as high as when a person is awake. All muscles except the diaphragm are very much relaxed and the rate and depth of breathing also increases during REM stage of sleep.
On an average in an adult REM occupies about 20-25 % of total sleep (90-120 minutes). A person experiences about 4 5 episodes of REM per night of sleep. These episodes are shorter at the beginning of the night and longer during the later part of sleep. The episodes of REM can occur at intervals of 1-2 hours apart and may last from 5 minutes to an hour. A brief period of wakefulness follows after each REM. REM duration often varies according to the age e.g. an infant spends about 80% of his sleep in REM.
REM is the sleep when the person dreams.

The cause for sleep disorder can vary form person to person but the end result of this is sleep deprivation hampering the normal functioning of an individual.

Some of the causes can be:

• Substance abuse like alcohol, caffeinated drinks, etc.
• Illnesses like asthma, ulcers, etc. causing discomfort and pain at night.
• Psychiatric and emotional problems like depression, anxiety, chronic stress, etc due to change or loss of job, loss of loved one, etc.
• Environmental factors like excessive light, noise, temperature.
• Night shift workers find it difficult to sleep as their activities run contrary to their biological clocks.
• Many medications are known to cause loss of sleep like blood pressure medicines, antidepressants, etc.
• Research has shown that 50% of the populations above 65 years of age have some form of sleep disorder; however the exact cause is unknown.
• Evidence of genetic basis for narcolepsy has been found.
• Overweight people, or those persons who have some physical abnormality in the nose, throat, or other parts of the upper airway.

Any difficulty in sleeping can be categorized as sleep disorder. Some common occurrences are

• To find it difficult of fall asleep.
• To find it difficult to stay asleep.
• Sleepiness or difficulty in staying awake during the day
• Sleeping for too long.
• To find it difficult to sleep at night or during normal sleeping hours
• Disturbed sleep due to some abnormal behaviors
• To feel un-refreshed after sleep

Some of the telltales signs of a person suffering from some form of sleep disorder or sleep deprivation are:

• Irritability during the day
• Sleepiness during the day
• Difficulty in staying awake when sitting still in one place
• Desire to take a nap during the day
• Performance below potential in various activities
• Difficulty in concentrating on the current task in hand at home, school or work
• Weak memory
• Slow to react
• Frequent emotional outburst at slightest provocation
• Sleepiness or falling asleep while driving
• Need to drink coffee and other such caffeinated drinks to keep you going through the day
• Looking tired as observed by others

The diagnosis of sleep disorder is based on the clinical history and some test like

• Epworth Sleepiness Scale
• Nocturnal Polysomnogram
• Daytime Multiple Sleep Latency Test (MSLT)

Some of the commonest forms of sleep disorders are

• Insomnia
• Narcolepsy
• Sleep apnea sleep disorder
• Restless leg syndrome

Insomnia

Insomnia is the inability to fall asleep or stay asleep. It is a disturbance in sleep which makes sleep feel unrefreshing and insufficient.
Insomnia is not a disease but a symptom; it is equally common amongst young and old. 10% of adults suffer from chronic insomnia and about other 50% have episode of insomnia sometimes.
Normally older people tend to sleep less at night and nap during the day, they also tend to wake during all stages of sleep and this is normal physiological change associated with aging and not insomnia. The phase of deep sleep (Stage 4) lessens and eventually disappears.

Types of Insomnia

• Transient insomnia which lasts from one night to a few weeks. Causes could be jet lag, short-term anxiety, etc.
• Intermittent insomnia is the one when the transient form of insomnia continues to occur from time to time.
• Acute insomnia is the one in which the person consistently does not sleep well on and off for a period of 3 weeks to 6 months.
• Chronic insomnia is when the person does not sleep almost daily for at least a month.

Some common variants of Insomnia

• Sleep Onset Insomnia:
  It is difficulty in falling asleep, usually occurs in those persons who are tensed, continue to think and worry and are not relaxed.
• Sleep Maintenance Insomnia:
  It is difficulty in remaining asleep; the person falls asleep normally but wakes up again after several hours and then finds it difficult to fall asleep again. The person usually keeps on drifting in and out of inadequate sleep. This is more common in older people. Early morning awakening a type of insomnia can be a sign of depression in people of all age group.
• Sleep awake schedule disorder:
  Is commonly found in people who travel from one time zone to other especially from east to west (Jet Lag), working in frequently changing shifts,

Narcolepsy

It is a neurological disorder where the person has a sudden recurrent uncontrollable compulsion to sleep during normal waking hours. It is characteristically associated with episodes of cataplexy (muscle weakness), sleep paralysis and hallucinations. Most people have only few symptoms of narcolepsy, few (10%) have all the symptoms.

The episodes of sleep can be single to many in a day and their duration could be from few minutes to half hour. Cataplexy (sudden episode of muscle weakness without loss of consciousness) can be triggered by sudden strong emotions (fear, joy, anger, etc). The person goes limp suddenly.

Often when one wakes up from sleep or when is about to fall asleep, the person finds that he/she cannot move this is termed as sleep paralysis. This usually gets relieved when touched by somebody or on its own after a few minutes.

When falling asleep or just waking from sleep the person may see images or hear sounds which are not there, this is known as hallucinations. They are similar to dreams but only more intense in experience.

Sleep apnea syndromes

These are group of sleep disorders where the breathing is temporarily interrupted repeatedly during sleep, resulting in decreased level of oxygen and increased level of carbon dioxide in the blood. Since the symptoms occur during sleep they are often first noticed by the sleeping partner.
Often here the breathing becomes slow, shallow and may stop for a brief period lasting from 10 seconds to a minute.

Types of sleep apnea:

• Obstructive Sleep Apnea:
  It is the commonest type of sleep apnea disorder. This type of disorder occurs most often due narrowing of the upper airway resulting from obstruction of upper air way and throat.
  About 2-6 % of middle aged populations globally are affected by this ailment. Obesity, aging tissues, are some of the common causes for obstruction in adults. The condition is aggravated by smoking, alcohol abuse, and lung diseases like emphysema. In children enlarged tonsils or adenoids can be the cause of obstruction.
  Symptoms:
  Snoring
  Episodes of gasping, choking
  Pauses in breathing and sudden awakening
• Central Sleep Apnea:
  This type of sleep apnea is much rarer. It is caused due to the malfunctioning of part of brain which controls breathing (breathing). Normally the brain stem responds to varying levels of carbon dioxide in the blood and accordingly controls the muscles used for respiration. Here in this disorder the response of the brain stem is delayed resulting in prolonged hyperventilation and a pause in breathing. This complaint is seen in people having brain tumors, heart failure, etc.
  Symptoms:
  Snoring is often absent
  Cheyne-Stokes respiration - Breathing gradually becomes more rapid then gradually slows down and later stops for a short period, finally breathing restarts again.
• Mixed Sleep Apnea:
  It is the rarest form and is a combination of obstructive and central sleep apnea. The depleted levels of oxygen due to obstructive apnea lead to dysfunction of brain stem thus causing sleep apnea.

Restless Leg Syndrome

Restless leg syndrome is a central nervous system disorder where the person gets strange sensations in the legs, resulting in disturbed sleep. Genetic tendency, low blood iron levels, etc are some of the common aggravating factors.

Symptoms:
Irritating sensations in the legs (creeping, crawling, tingling, etc)
Uncontrollable urge to move about.
Complaints mostly aggravated in the evening or at night.
Intermittent movement of toes or feet

A multilevel approach is resorted to treatment of sleep disorder. This treatment is largely symptomatic and palliative.

Treatment protocol may consist of a combination of the following options:

• Medication
• Nutritional supplements
• Stress reduction
• Behavior modification
• Cognitive-behavioral therapy
• Relaxation
• Lifestyle changes

Homeopathy can effectively treat sleeplessness and provide excellent relief in most cases. The treatment of the disorder is targeted towards the root cause and hence the relief is more lasting. An important feature about the treatment is that it is not habit-forming like conventional sleeping pills. The medicine does not induce sleep like how the conventional medicine does, instead it calms the mind over a period of time so that the person naturally gets sound sleep at the appropriate time.

In cases where stress is the cause of sleeplessness, the patients stress-management capacity has been seen to improve after treatment. When the cause of the sleeplessness is environmental such as noisy room, mosquitoes, too hard bed or pillow, etc. the same has to be corrected by the patient.

Another key benefit of Homeopathic treatment is that the medicine is without any side-effects whatsoever. Homeopathic treatment is strongly suggested for anyone who is suffering from sleeplessness.

• Avoid napping during the day it may upset the body clock
• Limit caffeine, alcohol, and smoking they interrupt normal sleep pattern
• Check your iron deficiency by taking iron supplement as people having low iron levels have been known to be more prone to sleep disturbances.
• You may try relaxation techniques like meditation, breathing exercises to make the body relax and prepare for sleep
• Avoid large and heavy meals before bedtime. Preferably eat your dinner at least 2 hours before sleeping.
• You may take a light bedtime snacks like cereals, warm milk, and other food substances these contain amino acid tryptophan which helps the body to relax.
• Keeping a journal and jotting down your worries in them before going to sleep helps to prevent recurring thoughts about them during sleep.
• Make sure that the bed in which you sleep is comfortable as per your needs.
• Avoid activities like office work, etc in the bedroom, help your body to identify with bedroom as a place used only for sleep
• Avoid clocks and time peaces which attract your attention and make you feel anxious about time elapsed before you get sleep
• Keep regular sleeping and waking time, this will make body expect sleep at the same time everyday. Keep up the schedule even during weekends.
• Integrate bed time rituals these help the body to slow down and prepare it for sleep. E.g. warm bath before going to bed.
• Do not avoid sleep when you are sleepy
• Avoid self medication and various other over the counter products to put you to sleep.
• Counting sheep and other such mindless and repetitive boring thought help the brain to shut down and go to sleep
• If not sleep get out of bed, do not keep lying down. Do not worry and do something relaxing.
• Avoid stimulating activities like watching TV, job related reading or work at bedtime.
• To help regulate bodys natural biological clock expose yourself to bright light/sunlight soon after awakening
• Exercise daily preferably early in the morning this can help to sleep