HEALTH & FITNESS

Wake-up call for sleep disorders
Sleep deprivation, whether from disorder or lifestyle, can pose significant risks while performing many ordinary tasks such as driving and operating machinery
There are more than 70 sleep disorders and most of them can be managed successfully
Dr Amit Kumar Mandal
Why should we talk about sleep? The list of human errors/catastrophes because of lack of sleep will explain the reason.
Space shuttle challenger explosion.
Bhopal chemical plant, India.
Chernobyl atomic power station, Russia.

There are more than 70 sleep disorders and most of them can be managed successfully

Alcohol does not cause depression
Melbourne: Contrary to popular belief, alcohol does not cause depression, Australian scientists have found. Researchers also debunk the view that mild to moderate alcohol consumption may reduce the risk of depression.

 

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Wake-up call for sleep disorders
Sleep deprivation, whether from disorder or lifestyle, can pose significant risks while performing many ordinary tasks such as driving and operating machinery
Dr Amit Kumar Mandal

Why should we talk about sleep? The list of human errors/catastrophes because of lack of sleep will explain the reason.

Space shuttle challenger explosion.
Bhopal chemical plant, India.
Chernobyl atomic power station, Russia.

Sleep is a complex and important function of the body and a natural way of restoring body's energy. The normal sleep requirement varies from person to person some sleep more than eight hours a day others need as little as five. The need for sleep decreases as we get older.

Both the number of hours and the structure of the sleep are important. The brain has two processes that work against each other to determine whether someone stays awake or goes to sleep. The homeostatic mechanism is the drive to sleep and the circadian rhythm is designed to bring about and maintain alertness. This means that alertness increases and decreases throughout the day (over a 24-hour cycle) due to a pattern set by the body's internal clock.

SDB in children

Sleep disordered breathing (SDB) in kids includes snoring, frequent arousals during sleep, enuresis and hyperactivity. Presentation may vary according to age of the child. Children with Down Syndrome, midface hypoplasia or neuromuscular disorders are at increased risk for SBD. Tonsillectomy and adenoidectomy are the first-line definitive treatment in children. Other treatment options include rapid maxillary expansion, allergy treatment and CPAP. Importance should be given to early diagnosis and treatment in children since the consequences of untreated SDB could lead to learning difficulties, memory loss, poor growth, depression and risk of hypertension.

A cross-sectional prospective study incorporating parental report about the sleep habits and problems of school-going children was conducted from September 2003 to March 2004 at PGI, Chandigarh, to assess the sleep habits and problems of 103 school-going healthy children (3-10 years) during their visit to hospital for minor illnesses or routine health visits for immunisation. The average duration of daily sleep (nocturnal and daytime nap) was 10.32 1.18 hours and the percentage of children who took regular daytime nap was 28.2 per cent. Co-sleeping, a traditional cultural practice in India was found in 93 per cent of the children. Sleep-related problems were reported in 42.7 per cent children that included nocturnal enuresis (18.4 per cent), sleep talking (14.6 per cent), bruxism (11.6 per cent) nightmares (6.8 per cent), night terrors (2.9 per cent) snoring (5.8 per cent) and sleepwalking (1.9 per cent). Sleep-related problems were notably common if it was nuclear family, mother was younger in age and less educated.

Medical conditions

Some medical conditions may affect a good night's sleep like asthma, coronary heart disease, depression, chronic fatigue syndrome, chronic pain; sleep disorders like restless leg syndrome, narcolepsy, snoring and sleep apnoea; parasomnias like sleep talking and walking, night terrors, nightmares, bedwetting (sleep enuresis) and grinding of teeth (bruxism); grief and stress (60 per cent to 80 per cent of sleep problems may be due to stress and worry).

Lifestyle factors can also influence sleep, like circadian rhythm, sleep disorders like going to sleep late at night, going to sleep too early at night, having an irregular sleep-wake cycle, jet lag and late night shifts may interfere with sleep. Adequate physical activity reduces the time taken to fall asleep and increases the length and amount of deep sleep leading to a more refreshing sleep. Maintaining a well-balanced healthy diet is another way of improving sleep. Alcohol and other drugs such as the caffeine in tea, coffee, cola drinks, cocoa and chocolate, nicotine in cigarettes, alcohol, and the side-effects of medications, may interfere with sleep. Jet lag while travelling across time zones can make it difficult to fall asleep at the appropriate time in a new location.

In a 2004 study from Mumbai, researchers found an estimated prevalence of sleep disordered breathing (SDB) as 19.5 per cent, and that of obstructive sleep apnoea/hypopnoea syndrome (OSAHS) as 7.5 per cent in healthy urban Indian males (35-65 years). The presence of snoring, nocturnal choking, non-refreshing sleep, recurrent awakening, daytime hyper-somnolence and daytime fatigue was each statistically significant for identifying patients with OSAHS. The findings of this study and the high prevalence rates in middle-aged urban Indian men have important public health implications in a developing country with limited health resources. Indian men in this age group have the highest rates of ischemic heart disease and hypertension worldwide.

In the Chennai Urban Rural Epidemiology Study published in 2010, in 358 subjects (20-6 years) randomly selected from South India, researchers found prevalence of snoring and daytime sleepiness at 40 per cent and 59 per cent, respectively. Subjects who snored were men, older, smokers and had higher levels of cardiometabolic risk factors. Subjects with daytime sleepiness had higher body mass index (BMI) and abdominal obesity. Both snoring and daytime sleepiness were more prevalent among subjects with impaired glucose metabolism. Metabolic syndrome (presence of diabetes, dyslipidemia and hypertension) was significantly associated with snoring which means that patients with above disease with snoring should be exained for possible sleep apnea syndrome.

Sleep deprivation, whether from disorder or lifestyle, whether acute or chronic, poses significant cognitive risks in the performance of many ordinary tasks such as driving and operating machinery.

Cognitive risks

Recent experiments reveal that following days of chronic sleep restriction, significant daytime cognitive dysfunction accumulates to levels comparable to that found after severe acute total sleep deprivation.

There are more than 70 sleep disorders and most of them can be managed successfully once these are diagnosed. SDB should be managed by sleep specialists and/or neurologists only. Some of the most common sleep disorders are:

Insomnia: Insomnia refers to the difficulty in initiation, maintenance, duration or quality of sleep. People may experience poor concentration, lower productivity and poorer work quality as a result of insomnia. Many suffer short-term insomnia and end up taking sleeping pills. Most sleeping pills stop working after regular use while long-term use can interfere with good sleep. Many try to solve the problem with alcohol which worsens the situation even more with decreased deep stages of sleep. Mild insomnia can be prevented or cured by practicing good sleeping habits.

Sleep apnea: Sleep apnea is an interruption in breathing during sleep as the windpipe collapses when the airway muscles relax. This leads to decrease in blood oxygen levels and the brain responds by waking up the person enough to tighten the airway muscles and open the windpipe. The person may snort or gasp and then go back to snoring a cycle which is repeated many times during the night leading to disturbed sleep. Patients may develop symptoms like morning headaches, decline in mental functioning, high blood pressure, irregular heartbeats, increased risk of heart attacks/stroke, etc. Patients who have typical symptoms of sleep apnea, like snoring, obesity and excessive daytime sleepiness should seek a sleep specialist and undergo a complete overnight polysomnography study to confirm. Several treatment options are available for treating sleep apnea which includes special devices and surgical options. These mechanical devices are successful in treating such disorders and are always the first choice of treatment. People with sleep apnea should never take sedatives or sleeping pills since they may not wake up enough to breathe.

Restless legs syndrome: This disorder could be hereditary. It causes unpleasant crawling, prickling or tingling sensations in the legs and feet. Commonly seen in the elderly but may be associated with anaemia, pregnancy or diabetes. Drug therapies are available.

Narcolepsy: Patients with narcolepsy have sleep attacks at various times of the day (in the middle of being awake), even if they get a normal amount of sleep at night. The disorder is thought to be due to the brain's inability to regulate sleep wake cycles normally. Usually hereditary, it is sometimes associated with brain damage from a head injury or a neurological disease. Drugs like stimulants and antidepressants can control narcolepsy symptoms.

There is a strong need to increase awareness of various sleep disorders among primary physicians and general public. Patients should be carefully screened done before referring for polysomnography because of its cost and poor access to the general public. Reversible causes (such as hypothyroidism) should be carefully ruled out before prescribing therapy since these may incur prohibitive costs to the general public. Adherence to treatment on a long-term basis remains a major concern and should be addressed for long-term benefits of therapy and a better quality of life.

The writer is Additional Director, Pulmonology, Sleep and Critical Care, Fortis Hospital, Mohali

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Alcohol does not cause depression

Melbourne: Contrary to popular belief, alcohol does not cause depression, Australian scientists have found.

Researchers also debunk the view that mild to moderate alcohol consumption may reduce the risk of depression.

Until now it was believed that alcohol caused people to become depressed, particularly if consumed at excessive levels, according to Prof Osvaldo Almeida, from the University of Western Australia.

"Even one of the diagnoses we have for depressive disorders Substance Induced Mood Disorder is a diagnosis where alcohol plays a role," Almeida said.

"However, because of the observational nature of the association between alcohol and depression, and the risk of confounding and bias that comes with observational studies, it is difficult to be entirely certain that the relationship is causal.

"For example, people who drink too much may also smoke, have poor diets and other diseases that could explain the excess number of people with depression among heavy drinkers," he said.

"We now know that certain genetic variations affect the amount of alcohol people consume. There is one particular genetic variation that affects the enzyme responsible for the metabolism of alcohol," Almeida said.

"This variation produces an enzyme that is up to 80 times less competent at breaking down alcohol. Consequently, people who carry this variation are much less tolerant to alcohol.

In fact, there is now evidence that alcohol-related disorders are very uncommon in this group. "Now, if alcohol causes depression, then a genetic variation that reduces alcohol use and alcohol-related disorders, should reduce the risk of depression.

"The great advantage of looking at the gene is that this association is not confounded by any other factors people are born like that," he said.

The researchers analysed the triangular association between the genetic mutation, alcohol and depression in 3,873 elderly male participants of the study, using data collected over three to eight years. "We found (as expected) that this particular genetic variant was associated with reduced alcohol use, but it had no association with depression whatsoever," Almeida said.

"The conclusion is that alcohol use neither causes nor prevents depression in older men. Our results also debunk the view that mild to moderate alcohol consumption may reduce the risk of depression," he added. PTI

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Health Notes
Coffee may cut womb cancer risk

London: A new study has suggested that the risk of developing womb cancer can be reduced by drinking coffee. The World Cancer Research Fund report says, coffee contains antioxidants which may boost health, the BBC reported. However, experts said that there is not yet enough evidence to recommend drinking coffee to protect against the disease. ANI

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