Why You Should Keep Your Late-Night and Midnight Snacking Under Control
Why not to eat at Night? Some people have a habit of eating very late at night, eating just before going to bed, or even waking up in the middle of the night to snack on something. These habits though may not seem to be harmful, can be the reason for many metabolic and sleep issues. Nocturnal Eating and Weight Gain Most often, eating late at night is not a result of hunger, but because of habit. Due to the pandemic, many people have started going to sleep late and waking up late in the morning. Staying up until later, makes people want to eat, and very often, they do not choose to eat healthy food, but calorie-rich foods such as chocolates, chips, pizza, etc. When you snack on food during the day, your body gets the chance to burn off the consumed calories, but this does not happen at night. As a result, there is weight gain, since the calories consumed are far more than the number required. Nocturnal Eating and Sleep Delayed Sleep and multiple awakenings: Foods and drinks such as chocolates, coffee, tea, are rich in sugar and caffeine, may not only delay your already delayed bed time but also cause you to wake up several times at night. Acid Reflux and ingestion: People who snack at night tend to snack in large quantities. This can lead to indigestion and acid reflux Acid Reflux tends to get worse at night and may wake you in the middle of the night and cause difficulty falling back to sleep. Heartburn: Excessive eating can cause heartburn and the effects of heartburn exaggerate at night and cause uncomfortable sleep. Nocturnal Eating and Future Health Risks Nocturnal eating habits increase your risk of suffering from Obesity, Diabetes, and Heart Disease. Obesity: Having a calorie intake higher than what is required, leads to weight gain. Eating regularly late at night puts you at a risk of becoming obese which in turn leads to a number of health problems in itself. Diabetes: Nocturnal eating habits also puts you at a risk of developing diabetes later on in life, which will then restrict your food intake and put you at risk of developing secondary infections. Heart Risk: Snacking regularly at night can increase your cholesterol level and build up in your arteries that puts you at risk of developing cardiac risk, high blood pressure, and other heart-related conditions later in life. Avoid Going to Bed Hungry Some people who are on weight-loss diets may think that they must avoid consuming all kinds of food after a certain time in the day, but one must definitely not go to bed on an empty stomach. This is because: Your body may not be able to get enough nutrients to carry out repair and regenerative functions during sleep due to lack of nutrients. Going to bed on an empty stomach can wake you up in the middle of the night, as you may feel hungry, which will then affect your sleep at night and consequently your day time functioning. Certain foods that are rich in tryptophan and melatonin are also recommended to be consumed before going to sleep, as they help to induce sleep and regulate the sleep-wake cycle. Conclusion: In conclusion, one must not eat at night to avoid excessive weight gain, to reduce the risk of being obese, or to develop diabetes and heart disease later on in life. The gap between the last consumed food and bedtime should be sufficient enough to allow digestion and negate any effect of the food consumed on your sleep. To seek help or know more about the ill effects of midnight snacking, you can visit the Neurology and Sleep Centre, the 1st sleep centre in the country accredited by the Indian Board of Sleep Medicine at L-23, Hauz Khas Enclave, New Delhi, Delhi-110016 (INDIA) Or give a call on +91-11-46070321, +91-9643500270
Lack of Enough Sleep at Night Can Cause Incessant Headaches During the Day
Do you often wake up with a headache even if you have slept for enough hours? Do you get a headache in the evening that is only resolved if you go to sleep? Or do you wake up in the middle of the night with a headache? Sleep and headaches are intricately linked with each other. A good night’s sleep is essential for healthy living. During sleep, the body repairs itself so that it can function optimally. Disturbances in the regular sleep patterns can cause inattentiveness during the day and increase incessant headaches. It has been reported that 16 to 20 % of the Indian population has experienced a migraine headache. Link between sleep and headaches Multiple studies have linked the lack of sleep with headaches. A study published in 2011, in The Journal of Pain suggested that the disruption in REM (Rapid Eye Movement) sleep caused excruciatingly painful headaches that did not resolve easily and lasted for a while. REM sleep is essential for regulating mood and memory consolidation. The researchers found that not getting enough sleep causes the body to produce a protein that reduces the body’s threshold of perceiving pain and hence caused the painful headaches. The Hypothalamus controls sleep also plays an important role in the mechanism of headaches. A study published in 2017 in Therapeutic advances in Neurological Disorders also linked the lack of sleep with tension headaches. Moreover, the intricate link between headaches and sleep is further emphasised by the fact that the medication often prescribed for headaches regulates serotonin levels that are a chemical messenger that deals with the pain and control pathways and mood regulation. Types of headaches: There are different kinds of headaches that are linked with a lack of or disturbance in sleep. Tension headache and Migraine headache are often tiggered due to a lack of sleep. Wake up headache is experienced when you don’t get enough sleep and wake up experiencing a dull ache in the temple region of the forehead. Hypnic headaches that account for 0.07 to 0.35% of types of headaches and cluster headaches are other types of headaches that one can experience during sleep. However, more evidence is required to directly link it to the lack of sleep. OSA and Headaches People suffering from Obstructive Sleep Apnea often complain about throbbing headaches after they wake up in the morning. This has been attributed to a lack of oxygen and excess carbon dioxide in the bloodstream due to difficulty in breathing while sleeping. How can you know if your headache is sleep related? Not all headaches are caused due to disturbance or lack of sleep, and hence all headaches cannot be treated in the same manner. To know whether your headaches have been caused due a sleep issue, your sleep specialist would suggest you to keep a sleep and headache diary, where you record the onset of headache and number of hours of sleep to allow them to diagnose your condition. Do’s and Don’ts for healthy sleep to prevent headaches. If you suffer from sleep related headaches, undergoing some simple behavioural changes in your sleep pattern will help you attain restful sleep and consequently reduce headaches. These changes include: Establishing a sleep wake routine Getting between 7 to 8 hours of sleep each night Avoiding caffeine, nicotine, alcohol and other substances that impair sleep Reducing screen time close to bed time Conclusion Enough evidence indicated that sleep and headaches are linked to each other, and hence one must take utmost effort to achieve good quality, restful and enough sleep, in order to avoid sleep related headaches. To seek help or know more about sleep and headaches, you can visit the Neurology and Sleep Centre, the 1st sleep centre in the country accredited by Indian Board of Sleep Medicine at L-23, Hauz Khas Enclave, New Delhi, Delhi-110016 (INDIA) Or give a call on +91-11-46070321, +91-9643500270 References: Durham, P., Garrrett, F., Hawkins, J., Hayden, J., & Campos, J. (2011). REM sleep deprivation promotes sustained levels of proteins implicated in peripheral and central sensitization of trigeminal nerves: role in pain chronification. The Journal of Pain, 12, 31. Fernández-de-Las-Peñas, C., Fernández-Muñoz, J. J., Palacios-Ceña, M., Parás-Bravo, P., Cigarán-Méndez, M., & Navarro-Pardo, E. (2017). Sleep disturbances in tension-type headache and migraine. Therapeutic advances in neurological disorders, 11, 1756285617745444. Dodick, D.W., Eross, E.J. and Parish, J.M. (2003), Clinical, Anatomical, and Physiologic Relationship Between Sleep and Headache. Headache: The Journal of Head and Face Pain, 43: 282-292. Holle, D., Naegel, S., & Obermann, M. (2014). Pathophysiology of hypnic headache. Cephalalgia : an international journal of headache, 34(10), 806–812.
How Much Should an Ent (Ear-Nose-Throat) Specialist Know About Sleep Medicine?
Sleep medicine deals with issues of sleep in patients. Sleep medicine specialists include neurologists, sleep psychologists, pediatricians, dentists, and otolaryngologists or ENT doctors. OSA Vs Snoring Obstructive Sleep Disorder (OSA) is a sleep disorder that occurs due to partial or complete blockage of the airways that lead to fragmented sleep, breathing difficulties and reduction in the patient’s oxygen saturation. Snoring, in general, is normal but certain symptoms like loud snoring, waking up in between sleep with a dry mouth, or with a choking feeling, fatigue, irritability, etc. are signs of obstructive sleep disorder. If a patient is suffering from any of these symptoms then he/she is advised to go visit a sleep specialist. Sleep specialists perform certain tests to monitor breathing and other physiological functions while the person is asleep that include a Polysomnography and home sleeping tests that aid in the diagnosis of Sleep apnea. The sleep specialist then recommends the patient to see an ENT doctor and they further decide the course of treatment. What does an ENT specialist do? An ENT specialist deals with the diagnosis and treatment of disorders associated with the head and neck, particularly the nose, ear, and throat, including problems of swallowing speech, hearing, allergies, sinuses, head and neck cancers. They also deal with breathing issues. Obstructive Sleep Apnea is a disorder that occurs due to obstructed breathing during sleep, and ENT specialists are trained to deal with this issue. Treatment of OSA by ENT specialist To find the source of obstruction, an ENT can perform Drug-induced sleep endoscopy (DISE) along the airway path in patients. When the exact anatomical cause is found, it can be removed by surgery. ENT specialists also treat OSA by prescribing the use of CPAP for adults and oral appliances that relieve airway obstruction. Once the diagnosis of OSA is in progress, the ENT can carry out polysomnography, either by him/herself or with a team of sleep specialists, after which the further course of treatment is decided. After finding the cause of obstruction, ENT can perform surgery to remove the blockage: Adenoidectomy– a surgery to remove swollen adenoid glands if they are causing blockage Tonsillectomy– a surgery to remove tonsils if they are causing obstruction Uvulopalatopharyngoplasty (UPP) – a surgery to remove the uvula and the tissue from the soft palate if it is causing obstruction Septoplasty– a surgery on the nasal septum if it is causing an obstruction. Alternatively, the ENT specialist can also use radiofrequency energy to reduce the size of the enlarged turbinates or enlarged uvula and soft palate. Small pillar implants can also be inserted into the soft palate to treat patients with mild forms of sleep apnea. Conclusion ENT specialist deals with a serious sleep disorder – Obstructive Sleep Apnea (OSA). OSA should not be ignored as it can increase the risk of heart diseases and stroke. If one is experiencing any symptoms of OSA, it is advisable to visit the ENT. To seek help or know more, you can visit the Neurology and Sleep Centre, the 1st sleep centre in the country accredited by the Indian Board of Sleep Medicine at L-23, Hauz Khas Enclave, New Delhi, Delhi-110016 (INDIA) Or give a call on +91-11-46070321, +91-9643500270, References Bastier, P. L., Aisenberg, N., Durand, F., Lestang, P., Abedipour, D., de Santerre, O. G., … & Bequignon, E. (2020). Treatment of sleep apnea by ENT specialists during the COVID-19 pandemic. European annals of otorhinolaryngology, head and neck diseases, 137(4), 319-321. Miller, M. A., & Cappuccio, F. P. (2020). A systematic review of COVID-19 and obstructive sleep apnoea. Sleep Medicine Reviews, 101382. Slowik, J. M., & Collen, J. F. (2020). Obstructive Sleep Apnea. StatPearls [Internet]. Shah, J. A., George, A., Chauhan, N., & Francis, S. (2016). Obstructive sleep apnea: role of an otorhinolaryngologist. Indian Journal of Otolaryngology and Head & Neck Surgery, 68(1), 71-74.
Anxiety Can Cause Lack of Sleep and Lack of Sleep Can Then Worsen Anxiety
Introduction There is a bidirectional relationship between sleep and anxiety. On one hand, sleep deprivation has been found to cause anxiety disorders, while on the other hand, symptoms of anxiety-related disorders like Generalized anxiety disorder (GAD), Panic disorder, and Post-traumatic stress disorder (PTSD) commonly cause recurring nightmares and insomnia that affect the normal sleep cycle. Hence, it has become very difficult to separate what is the cause and what is the effect. Is it stress and anxiety that is making us sleep or less sleep that is making us more anxious? What is Anxiety? Anxiety is the human body’s response that warns us of potential danger, hence anxiety on a small scale is helpful for an individual. However, in anxiety disorders, the individual goes through intense, frequent, and continuous false alarms that may hinder your sleep-wake cycle. About 24% to 36% individuals with insomnia suffer from anxiety disorders. Of the individuals that suffer from PTSD, 68% have difficulty falling asleep. Relation between Sleep and anxiety Human sleep consists of two brain states i.e Non-rapid eye movement (NREM) and rapid eye movement (REM) recurring in cycles. These cycles are regulated by acetylcholine, norepinephrine, serotonin and histamine, and GABA neurotransmitters. Dysfunction of these neurotransmitter systems has been implicated in anxiety disorder. Relation between anxiety and sleep Anxiety is usually considered one of the symptoms of stress. Stress results in sleep arousal especially through the release of Corticotropin-Releasing Hormone (CRH) and Corticotropins. The CRH system dysregulation in the amygdala of the brain causes fear which is a symptom of anxiety. It also activated the HPA axis and sympathetic nervous system and is seen elevated in insomnia patients. Treatment for anxiety and sleep Medication for anxiety disorders usually helps improve sleep, similarly sleep medication has a profound effect on reducing anxiety. Medications for anxiety include antidepressants. Benzodiazepines may be prescribed to reduce feelings of panic. Beta-blockers are used to reduce blood pressure during an episode of anxiety while anticonvulsants are used to relieve the symptoms of anxiety disorders. Psychotherapy like Cognitive Behavioural Therapy (CBT) is helpful to train individuals in converting the panic-causing thoughts to positive ones. This therapy involves challenging negative thoughts, exposure therapy, and learning relaxation skills. CBT for insomnia (CBT-I) has been seen to help in managing anxiety disorders. Succes of this therapy are usually seen within 12 to 16 weeks. Some of the tips given by counselors to manage anxiety disorders include: Learning about the disorder and staying away from potential triggers Sticking to the treatment plan and routine of the disorder Reducing caffeine intake Avoiding consumption of alcohol and recreational drugs Exercising Relaxing and getting better sleep Hence, sleep and anxiety are very much linked to each other. Anxiety, Sleep, and COVID-19 During this COVID-19 out-break, negative emotions such as anxiety, depression, and anger in individuals have increased, due to factors such as getting infected with Covid-19, family members getting infected, loss of jobs, staying at home, physical isolation, and craving for human interaction and bonding. A new term called ‘Coronasomnia’ has been introduced to refer to sleep deprivation during the pandemic. A study published in the Journal of Sleep Research that studied the sleeping habits of people during the pandemic found that those people who had later sleeping schedules or shorter sleep cycles faced insomnia, anxiety, and stress. Conclusion Disturbance in sleep is a common symptom of anxiety disorder. It is not only important to identify and treat sleep disorders among patients with anxiety disorder but also among individuals who are not undergoing treatment for anxiety. To seek help or know more about sleep and anxiety, you can visit the Neurology and Sleep Centre, the 1st sleep centre in the country accredited by the Indian Board of Sleep Medicine at L-23, Hauz Khas Enclave, New Delhi, Delhi-110016 (INDIA) Or give a call on +91-11-46070321, +91-9643500270 References Staner L. Sleep and anxiety disorders. Dialogues Clin Neurosci. 2003 Sep;5(3):249-58. doi: 10.31887/DCNS.2003.5.3/lstaner. PMID: 22033804; PMCID: PMC3181635. Sher L. COVID-19, anxiety, sleep disturbances and suicide. Sleep Med. 2020 Jun;70:124. doi: 10.1016/j.sleep.2020.04.019. Epub 2020 Apr 25. PMID: 32408252; PMCID: PMC719505 Robillard, R., et al. (2020) Profiles of sleep changes during the COVID‐19 pandemic: Demographic, behavioural and psychological factors. Journal of Sleep Research.
Constant Use of Sleeping Pills Over a Long Time Makes Them Lose Their Magic
‘I have been taking sleeping pills for the past 5 years and they don’t seem to work anymore. What should I do now?”, is a common complaint amongst chronic users of sleeping pills. If you find it difficult to fall asleep at night or wake up tired, and use sleeping pills to sleep, you need to consider a few things first. Around 20% of people all over the world suffer from Insomnia and find it difficult to fall asleep at night and complain of waking up at frequent intervals during the night. Over a period of time, lack of sleep leads to other lifestyle diseases such as diabetes, obesity, and hypertension as well as an impact on mental health. Types of Insomnia Insomnia is a common sleep disorder. It may be for a short while (due to stress) or a chronic case (due to underlying conditions like anxiety, depression, or chronic pain). Short-term insomnia usually lasts for a few days or weeks while it is chronic when it persists for a minimum of three nights a week for at least three months. According to a National Health Interview Survey from the United States, around 19% of adults use at least one sleep medication for insomnia. Often, they resort to prescription drugs, dietary supplements containing melatonin, and over-the-counter medications as an aid for relaxing sleep. Are Sleeping Pills really useful? According to the American Academy of sleep medicine, the idea of using sleeping pills as aid is far-fetched as they only help in falling asleep 8 – 20 minutes faster and add around 20 – 35 minutes to the night sleep. Over a period, even lesser than 5 years, the body develops tolerance to the pills and thus it requires it in larger doses than prescribed to get the desired effect. Some prescription sleeping pills include Antidepressants, Benzodiazepines, Z-drugs Sleeping pills should only be used for a short time Sleeping pills are good and helpful only for a short time when one is coping with a difficult situation like a divorce or a death. According to The Journal of the American Medical Association, more than 68% of patients prescribed sleeping pills take them longer than it was advised and in larger doses than it was prescribed. This tendency can be a problem as these controlled substances are addictive. It poses a high risk that the patient may become dependent psychologically on sleeping pills. Use of sleeping pills for longer periods of time or in higher doses increases the chances that the person will experience negative side effects like: headaches dizziness and light headedness nausea and vomiting hallucinations depression daytime drowsiness, etc. How can one stop taking sleeping pills? If one is planning to stop taking sleeping pills, they should contact their doctor or health care provider, because their body may be accustomed to using of the pills and a sudden stop may lead to rebound insomnia or other withdrawal symptoms. How can one sleep better without sleeping pills? Cognitive Behavioural Therapy(CBT), which is a form of short-term counseling is a better alternative to sleep pills. It helps in learning and forming new and healthy habits, allowing one to relax and sleep better. Compared to sleeping pills, it is risk-free. Some tips for better and restful sleep. Establishing a Sleep-wake time table Avoiding substances that impair sleep, like caffeine, nicotine and alcohol Reducing screen time before you go to bed Relaxing with soothing music, a good book or meditation . Shutting off electronic devices at least 30 minutes before bedtime. Staying physically active during the day. Trying to get outside, if possible. Turning your bedroom into a dark, quiet and cool sanctuary. Conclusion In conclusion, sleeping pills should only be used for a very short amount of time and only if the insomnia is being caused by a traumatic event such as an accident, loss of a loved one, divorce, etc. Chronic use leads to a build of tolerance, and dependence and eventually, the effect of the sleeping pills will wear off completely. Hence, alternate behavior therapies instead of sleeping pills should be used. To seek help or know more about how to stop using sleeping pills, you can visit the Neurology and Sleep Centre, the 1st sleep centre in the country accredited by the Indian Board of Sleep Medicine at L-23, Hauz Khas Enclave, New Delhi, Delhi-110016 (INDIA) Or give a call on +91-11-46070321, +91-9643500270 References [a]. Uchimura N. (2012). Nihon rinsho. Japanese journal of clinical medicine, 70(7), 1100–1106. [b]. Reynolds, C. F., 3rd, & O’Hara, R. (2013). DSM-5 sleep-wake disorders classification: overview for use in clinical practice. The American journal of psychiatry, 170(10), 1099–1101. [c]. Schutte-Rodin, S., Broch, L., Buysse, D., Dorsey, C., & Sateia, M. (2008). Clinical guideline for the evaluation and management of chronic insomnia in adults. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 4(5), 487–504. [d]. QuickStats: Percentage of Adults Aged ≥18 Years Who Took Medication To Help Fall or Stay Asleep Four or More Times in the Past Week, by Sex and Age Group — National Health Interview Survey, United States, 2017–2018. MMWR Morb Mortal Wkly Rep 2019;68:1150. [e]. Bertisch, S. M., Herzig, S. J., Winkelman, J. W., & Buettner, C. (2014). National use of prescription medications for insomnia: NHANES 1999-2010. Sleep, 37(2), 343–349. [f]. Choosing Wisely. Sleeping Pills for Insomnia. [g]. American Academy of Sleep Medicine. When to Take a Sleeping Pill for Insomnia. [h].Moore, T. J., & Mattison, D. R. (2018). Assessment of Patterns of Potentially Unsafe Use of Zolpidem. JAMA internal medicine, 178(9), 1275–1277.
Increased Eye Problems in People suffering from Obstructive Sleep Apnea
Introduction The word ‘Apnea’ means cessation of breathing. Obstructive sleep apnea (OSA) is the most common type of sleep apnea, in which the airway becomes narrowed, blocked, or floppy during sleep, thus causing disrupted sleep, loud snoring, and frequent awakening during sleep. The prevalence of OSA is predicted to rise with rising in obesity which is the most common risk factor. While cardiovascular, respiratory, metabolic disorders have been associated with OSA, it is also critical to recognize visual conditions that might be associated with OSA. Why does OSA occur? In OSA, during sleep, the muscles of the airway relax excessively, creating a negative pressure that pulls in the walls of the airway, obstructing or narrowing it, and causing interruptions in breathing. As a result of these obstructing events, oxygen saturation may also be reduced periodically. Desaturation of oxygen leads to the release of inflammatory cytokines and catecholamines, which are responsible for injury repair of blood vessels. Eye problems are seen in OSA sufferers. Ocular manifestations of OSA obtained from the mechanical and vascular effects of the syndrome include floppy eyelid syndrome, nonarteritic anterior ischemic optic neuropathy, central serous retinopathy, and glaucoma. Glaucoma Glaucoma is a condition in which there is chronic neuropathy of the optic nerve. It is the second-largest cause of blindness. People with OSA are more likely to suffer from Glaucoma. This is thought to occur because of recurrent hypoxia, increased vascular resistance, and oxidative stress damage to the optic nerve that happens during episodes of interrupted breathing. Moreover, studies have also shown that there is thinning of the retinal fiber layer, alteration of optic nerve head, choroidal and macular thickness and reduced visual field sensitivity in OSA patients who do not have Glaucoma, putting them at risk of developing it later. Collective data from numerous studies have suggested that patients with Obstructive Sleep Apnea have a 1.67 times higher risk of developing Glaucoma within the first five years of being diagnosed with OSA. According to a study carried out in 2008 and published in Eye among the American Population, around 27% of OSA patients developed Glaucoma. Floppy eyelid syndrome (FES) Floppy eyelid syndrome is a condition in which the upper eyelids easily turn in the upward direction. It is characterized by relaxing floppy eyelids presenting as recurrent or chronic ocular surface irritation and chronic papillary conjunctivitis of upper palpebral conjunctiva (common in obese patients). According to a study published in Sleep Medicine Reviews with FES patients, 96% of patients experienced symptoms associated with OSA. Nonarteritic Anterior Ischemic Optic Neuropathy (NAION) NAION is characterized by a sudden, painless, irreversible, and nonprogressive visual loss. A study published in the American Journal of Ophthalmology found that the chances of the development of NAION in patients with untreated OSA are increased by 16%. It may not be possible to reverse vision loss from NAION, treatment for OSA can help prevent an attack of NAION in the other eye, which occurs in 15 to 18 percent of cases. Central serous retinopathy (CSR) Central serous retinopathy results in an idiopathic detachment of the retina due to serous fluid collection beneath the retina. A study published in Sleep and Breathing found that CSR is associated with OSA. Circulating epinephrine and norepinephrine levels increase in patients with OSA, exerting endothelial dysfunction on the blood-retinal barrier, which may lead to the accumulation of subretinal serous fluid. Conclusion Patients with OSA show increased risk for several vision-threatening ocular conditions. Ophthalmologists may spot signs of visual conditions linked with sleep apnea using a tool such as the Epworth Sleepiness Scale or Berlin Questionnaire or order a sleep study, allowing them not only to detect ocular manifestations associated with OSA at a stage early enough to maintain and restore vision but also to help in the management and prevention of well-known systemic comorbidities. To seek help or know more eye problems associated with OSA, you can visit the Neurology and Sleep Centre, the 1st sleep center in the country accredited by the Indian Board of Sleep Medicine at L-23, Hauz Khas Enclave, New Delhi, Delhi-110016 (INDIA) Or give a call on +91-11-46070321, +91-9643500270 References Park, J. G., Ramar, K., & Olson, E. J. (2011). Updates on definition, consequences, and management of obstructive sleep apnea. Mayo Clinic Proceedings, 86(6), 549–555. Leger, D., Bayon, V., Laaban, J. P., & Philip, P. (2012). Impact of sleep apnea on economics. Sleep medicine reviews, 16(5), 455–462. Gozal, D., & Kheirandish-Gozal, L. (2008). Cardiovascular morbidity in obstructive sleep apnea: oxidative stress, inflammation, and much more. American journal of respiratory and critical care medicine, 177(4), 369–375. Nácher, M., Farré, R., Montserrat, J. M., Torres, M., Navajas, D., Bulbena, O., & Serrano-Mollar, A. (2009). Biological consequences of oxygen desaturation and respiratory effort in an acute animal model of obstructive sleep apnea (OSA). Sleep medicine, 10(8), 892–897. Santos, M., & Hofmann, R. J. (2017). Ocular Manifestations of Obstructive Sleep Apnea. Journal of clinical sleep medicine : JCSM: official publication of the American Academy of Sleep Medicine, 13(11), 1345–1348. McNab A. A. (2007). The eye and sleep apnea. Sleep medicine reviews, 11(4), 269–276. Miyamoto, C., Espírito Santo, L. C., Roisman, L., Moreno, P., Cariello, A. J., & Osaki, M. H. (2011). Floppy eyelid syndrome: review. Arquivos brasileiros de oftalmologia, 74(1), 64–66. Gaier, E. D., & Torun, N. (2016). The enigma of nonarteritic anterior ischemic optic neuropathy: an update for the comprehensive ophthalmologist. Current opinion in ophthalmology, 27(6), 498–504. Stein, J. D., Kim, D. S., Mundy, K. M., Talwar, N., Nan, B., Chervin, R. D., & Musch, D. C. (2011). The association between glaucomatous and other causes of optic neuropathy and sleep apnea. American journal of ophthalmology, 152(6), 989–998.e3. Huon, L. K., Liu, S. Y., Camacho, M., & Guilleminault, C. (2016). The association between ophthalmologic diseases and obstructive sleep apnea: a systematic review and meta-analysis. Sleep & breathing = Schlaf & Atmung, 20(4), 1145–1154. Bendel, R. E., Kaplan, J., Heckman, M., Fredrickson, P. A., & Lin, S. C. (2008). Prevalence of glaucoma in patients with obstructive sleep apnoea—a cross-sectional case series. Eye, 22(9), 1105-1109.
Are Sleep Problems Hereditary? How Your Genetic Makeup Influences Your Sleep
Whether you get a good night’s sleep depends on numerous characteristics. Sleep is an extremely complex behaviour. It is divided into Rapid Eye Movement (REM) and Non-Rapid Eye Movement (NREM) sleep. Dreaming occurs during REM sleep and is important to help us process our emotions. The circadian rhythm and homeostasis are the biological mechanisms that work together to regulate sleep. While factors such as increased screen time, intake of caffeine before bed, lack of physical exercise etc, may leave you tossing and turning and bed, or with insomnia, the question you can ask is whether your poor sleep is all because of your poor sleep hygiene or does poor sleep have a genetic component and is it hereditary? Kids require around 9.5 hours of sleep daily whereas it varies from 7-9 hours in an adult. For older people above the age of 60, the amount of night sleep decreases and is interrupted frequently. Getting regular, quality sleep is an important part of our daily routine for normal functioning and is necessary for vital functions such as memory formation. Genetic Component of Sleep Although a definite set of genes that control sleep are not yet known, there are a few genes that play an important role in maintaining the circadian rhythm. These include the clock genes e.g. Per, Tim, etc. There is also evidence that heredity plays an important role in the quality and quantity of our sleep by the fact that sleep studies have shown that identical twins (that share the same genetic material) have similar hypnograms or sleep graphs. Sleep Disorders and Genetics Very often it has been observed that there is a family history of sleep onset and sleep maintenance disorders. Insomnia: It is a sleep disorder that makes it difficult for the person to fall asleep difficult to stay asleep and difficult to sleep again after waking up at night. About 35% of people that suffer from insomnia have a positive family history. Most often, the mother of the person suffering from Insomnia has also been affected with Insomnia. Fatal Familial Insomnia: It is a rare brain disorder, which is caused by a mutation in the PRNP gene and leads to the degeneration of the brain. It is mostly transmitted genetically and it is very rare for a person without a family history of Fatal Familial Insomnia to suffer from it. Restless legs syndrome (RLS): It is a sleep disorder in which a person experiences an uncomfortable feeling and has the uncontrollable urge to move the legs when he is resting or is inactive. It generally occurs in the evening or at night. Around 40-60% of patients suffering from RLS have a family history of it. Earlier onset of the condition is observed in persons with a positive family history. Genetic linkage studies indicate that RLS1 on chromosome 12q, RLS2 on 14q, RLS3 on chromosome 9p, RLS4 on chromosome 2q; and RLS5 on chromosome 20p are the known chromosome loci that play a role in this disorder. Identical twins often share similar symptoms of RLS. Periodic Limb Movement Syndrome (PLMS): PLMS is a condition of sleep in which the limbs move involuntarily every 10 to 20 seconds while sleeping. It is strongly associated with four genes: MEIS1, BTBD9, MAP2K5, and SKOR1. The genetic variants of these alleles pose a 50% risk for RLS. Variation in BTBD9 alleles is associated only with PLMS. It is indirectly associated with RLS as it decreases ferritin levels and poses a risk for onset of RLS. Conclusion Hence, we can conclude that indeed poor sleep is hereditary. There are some genes that when inherited put the person at a greater risk of developing certain sleep disorders. Thus, it is necessary to trace a patient’s family history in order to manage and treat their sleep disorder effectively. To seek help or know more about sleep and its genetic factors, you can visit the Neurology and Sleep Centre, the 1st sleep centre in the country accredited by Indian Board of Sleep Medicine at L-23, Hauz Khas Enclave, New Delhi, Delhi-110016 (INDIA) Or give a call on +91-11-46070321, +91-9643500270 References Bastien, C. H., & Morin, C. M. (2000). Familial incidence of insomnia. Journal of sleep research, 9(1), 49–54. https://doi.org/10.1046/j.1365-2869.2000.00182.x Bidaki, R., Zarei, M., Khorram Toosi, A., & Hakim Shooshtari, M. (2012). A review on genetics of sleep disorders. Iranian journal of psychiatry and behavioral sciences, 6(1), 12–19. Parish J. M. (2013). Genetic and immunologic aspects of sleep and sleep disorders. Chest, 143(5), 1489–1499. https://doi.org/10.1378/chest.12-1219 Basics, B. (2006). Understanding sleep. National Institute of Neurological Disorders and Stroke, Bethesda.https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Understanding-Sleep Tafti M. (2009). Genetic aspects of normal and disturbed sleep. Sleep medicine, 10 Suppl 1, S17–S21. https://doi.org/10.1016/j.sleep.2009.07.002
How will i know if my CPAP is really helping me Deal with my Sleep Apnea?
If you or your loved one suffers from Sleep Apnea, then you must surely have heard your doctor suggest the use of CPAP or Continuous Positive Airway Pressure Therapy for it. It is a machine that helps to keep the airway free and without obstruction so that you can breathe normally while you sleep through the night. The benefits of CPAP vary among people. Some people may see the effects of CPAP immediately while others may only see it gradually. So how will you know if your CPAP is really working for you? To know if your CPAP is working or not start observing the following symptoms before and after using CPAP:- The Night symptoms of Sleep Apnea include: choking, snoring, nocturia, mouth/throat dryness, Once you start using CPAP, you should compare the quality of night sleep by observing the following symptoms – like how much choking and snoring has decreased, how much mouth dryness or throat dryness has decreased, how much the urination cycle at night decreased, etc. Any improvement in these symptoms will indicate that CPAP is working for you. The Day symptoms of Sleep Apnea include not feeling fresh in the morning, morning headache, dozing off while driving, loss of concentration, etc. If a patient does not get enough sleep at night he’ll be tired, fatigued and sleepy during the day time. After starting the use of CPAP, you must observe and compare to see if there are any improvements in the Day Symptoms of Sleep Apnea as well. Control on current medical condition: People suffering from Sleep Apnea also often suffer from other comorbidities such as diabetes, hypertension, cardiac disorders, etc. If CPAP is working for you, you will see that it helps to keep these medical conditions in check and prevents them from getting worse. Prevention of future medical complications: One of the benefits of CPAP is that long term use has better effects. CPAP can help to prevent future medical complications. Untreated Sleep Apnea is dangerous and will definitely lead to multiple complications in the future. In conclusion, though CPAP helps some people immediately, the benefits of CPAP are not seen immediately in some cases and may take a while longer such as a few weeks to see the effects. In such cases, the patient may get disheartened or frustrated but should not stop the use of CPAP. One must consult with their medical practitioner regarding whether they are using the machine properly or whether there may be a defect in the machine. If Sleep Apnea is left untreated, it can create future medical complications, and hence, it must not be ignored. The longer the CPAP machine is used, the better the effects are seen. If even after long-term use, no benefits are seen, then one must consult with their doctor who would further guide them. Buy it Now! To seek help or know more about CPAP for Sleep Apnea, you can visit the Neurology and Sleep Centre, the 1st sleep centre in the country accredited by the Indian Board of Sleep Medicine at L-23, Hauz Khas Enclave, New Delhi, Delhi-110016 (INDIA) Or give a call on +91-11-46070321, +91-9643500270
A Good Night’s Sleep Helps in Skin Regeneration and Enhances Overall Beauty
Introduction A good night’s sleep is vital when it comes to our skin and beauty. Our skin regenerates at night while sleeping. People who get good quality and quantity of sleep have healthier skin as it can retain moisture well and produce enough collagen. It heals faster than someone who is sleep deprived. It decreases the incidence of skin disorders and acne. Lack of sleep has a devastating effect on the skin and is visible in the form of rough, dull, dry skin, dark circles, and droopy eyelids. According to a visual assessment study published in Sleep in the year 2013, sleep deprived individuals have more wrinkles, paler skin, fine lines, redder and swollen eyes. Effect of sleep deprivation on skin Sleep deprivation over activates the sympathetic nervous system. This then activates the hypothalamic-pituitary-adrenal axis which increases secretion of glucocorticoids. This adversely affects the integrity of lamellar bodies on the keratinocytes of skin, thereby impairing the barrier produced by them. A study published in the Journal of Cosmetics, Dermatological Sciences and Applications in 2017 reveals that acute sleep deprivation for 42 hours led to increase in activity of natural killer cells, decrease in recovery of skin barrier and production of inflammatory cytokines which include plasma interleukin-1β and tumor necrosis factor-α. Other effects of sleep deprivation on the skin: It weakens our immune system, which impairs the integrity of the collagen fibres, thus reducing the strength and integrity of the skin. It causes skin scaling, which occurs due to dehydration. This results in decreased skin translucency indicating a reduced dermal organisation. Chronic poor sleep speeds up intrinsic aging. It also Increase in pore size. It changes in skin tone – Lightness of cheek skin decreases significantly. Ways to improve sleep: Improving your sleep can help you increase the quality of your skin. Relaxing activities a few hours prior to sleep helps in maintaining the circadian rhythm. Staying away from electronic devices (to avoid exposure to blue light) and trying out reading, yoga etc. can serve to be a very fruitful modification. Trying to sleep 15 minutes prior to the normal bedtime on a regular basis can help fix late sleeping habits. Keeping the sleep duration around 7-9 hours gives enough time to the body and the skin to get rid of all the fatigue and regenerate. Avoiding alcohol at night as it alters the production of melatonin and elevation of growth hormone, both of which have an important role in the maintenance of circadian rhythm. Exposing oneself to morning sunlight and bright light during the day helps us to stay awake and avoid irregular daytime naps, thereby fixing our circadian rhythm. Avoiding caffeine consumption in the evening. Conclusion Less sleep also affects us in other ways. It affects our mood, skin, eyes, nose etc, which are important for communication. In the long run, it can decrease our ability to function in society. Thus, it is essential to get regular, good night sleep. It improves our lifestyle and improves self-perception. It has a long-lasting positive impact not only on our beauty but also our mental and physical health and shall help deal with all sorts of age-related disorders in a better way. To seek help or know more sleep and how it affects beauty, you can visit the Neurology and Sleep Centre, the 1st sleep centre in the country accredited by Indian Board of Sleep Medicine at L-23, Hauz Khas Enclave, New Delhi, Delhi-110016 (INDIA) Or give a call on +91-11-46070321, +91-9643500270
Look Out for the Signs of Hypersomnia to Avoid the Impaired Quality of Life
Hypersomnia is a condition wherein the person either suffers from excessive daytime sleepiness (EDS) or spends excessive time sleeping. It is characterized by prolonged nighttime sleep and recurrent episodes of sleepiness during the daytime. The individual suffers from an uncontrolled need to take a nap at inappropriate times such as during work while driving while having a conversation with someone etc. However, even after this nap, they are not relieved from their tiredness. It is seen to affect men more than women. About 4-6% of the population suffers from this disorder and around 15-30% of individuals that suffer from sleep disorders are affected by Hypersomnia. Causes of Hypersomnia Narcolepsy: Narcolepsy accompanied by cataplexy is one of the most common causes of hypersomnia. It is a chronic neurological sleep disorder that is characterized by excessive daytime sleepiness, sudden sleep attacks, sleep paralysis, hallucinations, sleepwalking, and naps that are extremely refreshing unlike in the case of hypersomnia. Nocturnal sleep is disrupted in narcolepsy. Its prevalence is approximately 25 to 50 per 100,000 people in the general population. Insufficient sleep: It is one of the main causes of Hypersomnia and is commonly seen in night shift workers and people with poor sleep hygiene. Medications: People undergoing treatment for some disorders that are taking medications such as antihistamines, tranquilizers, etc can also suffer from hypersomnia. Drug abuse and excessive alcohol intake can also lead to it. Neurological Condition: People suffering from Parkinson’s disease, epilepsy, tumors, obesity, hypothyroidism, brain injuries and other diseases of the nervous system can suffer from Hypersomnia. Psychiatric disorders: Mood disorders such as depression, bipolar disorder, etc cause hypersomnia Genetics: People with a family history of Hypersomnia are at a greater risk of developing it. Central Disorders of Hypersomnia The central disorders of hypersomnia include: Narcolepsy type I – This is characterized by an irresistible need to sleep during the daytime for more than three months. It is accompanied by cataplexy and a decrease in levels of hypocretin-1 in the CSF. Narcolepsy type II – The symptoms for this are the same as that type I excluding cataplexy. In both types of narcolepsy, mean sleep latency is ≤ 8 min and two or more sleep-onset REM periods in multiple sleep latency tests. Idiopathic hypersomnia – It is excessive sleepiness even after uninterrupted 6-7 hours of night sleep for more than 3 months. Neurotransmitters (like dopamine, histamine) and genetics play a role. It is often associated with cognitive dysfunction. Sleep drunkenness and unrefreshing sleep are common symptoms. Kleine-Levin Syndrome – Individuals suffering from this rare disorder experience abnormally long episodes of sleep(16-20 hrs/day) for days or weeks. During these episodes, the person loses normal cognitive and perceptive abilities. Symptoms of Hypersomnia Along with Excessive Daytime Sleepiness, the other symptoms of Hypersomnia include: Anxiety Irritation Restlessness Slow thinking Difficulty in remembering things Slow speech Hallucinations Sleepiness even after 10 hours or more of night time sleep. Diagnosis of Hypersomnia Your medical professional or doctor will be able to diagnose whether you are suffering from Hypersomnia on the basis of a detailed medical history, questionnaires, and sleep studies. The following methods are sued for diagnosis: Polysomnography: This test measure the brain waves, showing the difference between wakefulness and different stages of sleep. Sleep diary: This is done to keep a proper track of sleep duration and its pattern Epworth sleepiness scale: It is a questionnaire that the individual is asked to fill where he has to rate himself on a scale of 0 to 3. A higher score indicates a higher sleep propensity. Multiple Sleep Latency Test: This is used to diagnose excessive sleepiness by measuring the tendency to fall asleep in a controlled setup. Along with these tests, MRI scans, EEG, and blood tests are also useful. Treatment of Hypersomnia There are some behavioral measures that help in the management of Hypersomnia. Dietary changes such as avoiding caffeine and alcohol and lifestyle changes such as regular and scheduled sleep are extremely important for the management of this condition. Behavioral therapies aimed at improving sleep quality are also useful. When these lifestyle changes do not work, medications such as stimulants, antidepressants, monoamine oxidase inhibitors, levodopa, etc are prescribed. Conclusion In conclusion, hypersomnia is a condition that greatly affects the quality of life. Hence, it is important to address it properly with the help of a trained professional. Maintaining healthy sleep, food and other lifestyle habits can help us prevent it. To seek help or know more about Hypersomnia, you can visit the Neurology and Sleep Centre, the 1st sleep centre in the country accredited by the Indian Board of Sleep Medicine at L-23, Hauz Khas Enclave, New Delhi, Delhi-110016 (INDIA) Or give a call on +91-11-46070321, +91-9643500270 References Arand, D. L., & Bonnet, M. H. (2019). The multiple sleep latency test. Handbook of clinical neurology, 160, 393–403. Guilleminault, C., & Brooks, S. N. (2001). Excessive daytime sleepiness: a challenge for the practicing neurologist. Brain: a journal of neurology, 124(Pt 8), 1482–1491. Ohayon M. M. (2008). From wakefulness to excessive sleepiness: what we know and still need to know. Sleep medicine reviews, 12(2), 129–141.