SLEEP DEPRIVATION AND LONG-TERM CONSEQUENCES

Sandeep Bansal

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Ayesha (30), an IT professional, had been sleeping for barely five hours a night despite a work-from-home schedule. She was experiencing morning headaches regularly, never felt rested, and would be sleepy all day. She also felt irritable. Ayesha blamed it on the stress of work. To feel better, she would binge eat and indulge herself in excessive sugary stuff. It only worsened the symptoms. Finally, it started affecting her relationship and her partner complained about her mood swings. That was a wake-up call to seek medical help.

When she came to the PGIMER, Chandigarh, we found that her symptoms were largely because of sleep deprivation, with a mild sleep apnoea. Lack of sleep was causing her to binge eat. She was counselled about modifications in her lifestyle such as following a strict sleep hygiene with at least seven to eight hours of sleep, fixed routine for eating and sleeping, a low-carb, high-protein diet with good fats, at least 45 minutes of daily physical activity and some yoga and meditation, if possible. Her work productivity, mood swings and energy levels were much better within a month of adopting these lifestyle modifications, the most important of which was following a strict sleep hygiene.

Sleep Hygiene

• One can get better sleep by improving the bedroom environment and sleep-related habits. Called sleep hygiene, it’s an important factor in making consistent sleep a part of daily routine by keeping a regular sleep schedule. Research has found that a late schedule is correlated with a higher risk of weight gain.
• Have enough time to relax and get ready for bed. This includes avoiding caffeinated drinks and spicy foods, or eating late at night. This affects sleep and weight loss.
• Make sure that your bedroom is dark and quiet.
• Avoid screen time at least an hour or more before bed. The blue light from electronic devices affects the sleep rhythm.
• Get adequate exposure to sun, especially after waking up.
• Moderate exercise every day helps.
• Those having trouble falling asleep can use eye masks, special pillows, devices that block blue light and sound, sleep apps, etc, but their effectivity is yet to be scientifically established.

According to a recent Nielsen study, 61 per cent of India’s urban population sleeps for less than seven hours a day.

Work pressure, combined with social factors, is driving a massive sleep deficit with worrying consequences among people from all walks of life. Covid-19 has only added to the woes.

For most adults, seven to eight hours of sleep is considered adequate but recent surveys say this sleeping time has further shrunk to five to six hours due to irregular schedules, increased stress levels, more screen time, and inconsistent physical activity as well as diet patterns. These factors have also affected the quality of sleep. A prolonged cycle can lead to a massive sleep debt, and cause many short-term as well as long-term consequences.

Sleep deprivation leads to a decrease of oxygen in blood. This results in stress on the cardiovascular system that can lead to high blood pressure, irregular heart rhythms and other chronic disorders like diabetes and hypertension. The prolonged lack of sleep also raises the level of stress hormone, cortisol, increasing blood glucose levels. It has been linked to an increased risk of obesity, a weak immune system, raising vulnerability to infectious diseases, mood/psychiatric disorders, dementia and other neurological disorders, besides hypertension, type-II diabetes and stroke. Besides chronic fatigue and increased stress levels, other short-term consequences include problems with learning, memory, mood swings, attention and concentration. These further impair the decision-making capacity and judgment, slow the reaction time and decrease alertness, significantly increasing the risk of accidents while driving or operating machinery.

Adolescents are among the most sleep-deprived and are affected physically, psychologically and emotionally in the long run, making them more prone to erratic and/or aggressive behaviour, depression and substance issues.

A study published in the Indian Journal of Sleep Medicine in 2019 on the incidence and impact of chronic sleep deprivation in Indians with a special emphasis on neuropsychology testing, found that the “incidence of sleep deprivation is the highest in the 31-50 age group at 47.9 per cent, but is worryingly high at 31.6 per cent for those between 16-30 years”. The authors, Vanita C Ramrakhiyani and Sanjay V Deshmukh from the Department of Life Sciences, University of Mumbai, say these high numbers indicate “chronic sleep deprivation among Indian youth, possibly due to the changing lifestyle”.

Those working in BPOs or across different time zones, particulaly in the late night/early morning shifts, are also at risk. The elderly are equally affected due to physical and psychological changes, medical conditions, and medication use. This can result in fragmented sleep and frequent awakenings and/or cause insomnia.

A major factor driving this chronic and continuous sleep deprivation is the excessive use of technology, particularly before going to bed. The Great Indian Sleep Scorecard is an annual nationwide survey being published by the sleep solutions startup Wakefit.co for six years now. This year’s survey revealed that 87 per cent of Indians use their phones before bedtime, while 78 per cent of those in the age group of 25-34 stay up late, browsing social media or binge watching OTT platforms.

The tell-tale signs of sleep deprivation are a feeling of persistent fatigue, excessive daytime sleepiness, difficulty in concentrating, impaired memory, irritability, mood swings, and increased emotional sensitivity. Other signs include frequent yawning, heavy eyelids, blurred vision, increased appetite and cravings for sugary or high-calorie foods, muscle aches, headaches and general discomfort.

The most worrisome part is that people rarely seek treatment for chronic sleep disorders that negatively impact the quantity and quality of sleep. Medical advice is mostly sought after an accident or a near-accident such as sleeping while driving.

A 2019 study by Fitbit across 18 countries found that Indians were the second-most sleep-deprived people in the world, with an average nightly sleep of seven hours and one minute. Basic lifestyle modifications like healthy daytime habits, a regular night routine and sleep schedule, creating a sleep-friendly bedroom environment, and practising relaxation techniques can promote better sleep outcomes.

Magic potions, or are they?

Sleep-supporting vitamins and nutrients like magnesium, Vitamin D and B Complex are quite popular, particularly among youngsters. Many sleep supplements like cannabidiol (CBD), synthetic melatonin, valerian, and chamomile are also available over the counter. “However, there is limited evidence for some of these supplements, and evidence against the use of others,” says Dr Suzanne Bertisch, clinical director of Behavioral Sleep Medicine at Harvard-affiliated Brigham and Women’s Hospital, Boston.

Obstructive sleep apnoea

Another major but often ignored sleep disorder is obstructive sleep apnoea (OSA). It is characterised by the repeated collapse of the upper airway during sleep, leading to interruptions in breathing and fragmented sleep patterns. These breathing pauses, known as apnoeas, can last for several seconds and can occur numerous times throughout the night. As a result, individuals with OSA often experience significant sleep disruption, leading to chronic sleep deprivation. A major consequence is excessive daytime sleepiness. People with OSA often struggle to stay alert during the day, no matter how much sleep they get at night. Studies have shown that individuals with OSA are at a higher risk of workplace accidents and motor vehicle accidents due to their impaired cognitive functions and increased drowsiness. Sleep deprivation due to OSA can also have detrimental effects on mental health.

Diagnosing and treating OSA is crucial. A formal diagnosis is typically made through a sleep study, which involves monitoring various physiological parameters during sleep.

— The writer is Professor, Department of Otolaryngology, PGIMER, Chandigarh