Sleep may appear to be such a mundane component of life that it may feel absurd to even discuss it! It can be one of life's most mundane and underappreciated parts. Getting enough sleep, on the other hand, can be a significant challenge for those who have chronic sleep issues and it can have a negative impact on everything else in life.
One may face issues like Insomnia, Sleep apnea, Restless leg syndrome (RLS), Hypersomnia, Circadian rhythm disorders, Parasomnia. High blood pressure and heart disease are connected to insomnia as poor sleep can lead to harmful habits that harm your heart over time such as increased stress, a lack of drive to be physically active and improper eating choices.
In an interview with HT Lifestyle, Dr Rakesh Rajpurohit, Consultant Pulmonologist at Jain Multispecialty Hospital shared, “Sleep hygiene also plays an important role in maintaining our health and preventing the development of chronic conditions associated with poor sleep such as cardiovascular disease, stroke, type 2 diabetes and some cancers. When patients have sleep abnormalities, there is a reduction in a hormone called leptin. This hormone tells us that we are full and not to eat anymore.”
According to Dr Sushil Jain, Consultant Pulmonologist at Mumbai's Masina Hospital, “Sleep provides time for the body to restore and recharge, playing a key role in nearly all aspects of physical health. For the heart, insufficient or fragmented sleep can contribute to problems with blood pressure and heighten the risk of heart disease, heart attacks, diabetes, and stroke. Sleep is an essential time for the body to recuperate.”
He added, “During the non-rapid eye movement (NREM) sleep stages, heart rate slows, blood pressure drops, and breathing stabilizes. These changes reduce stress on the heart, allowing it to recover from strain that occurs during waking hours. Without sufficient nightly sleep, a person doesn’t spend enough time in the deep stages of NREM sleep that benefit the heart. The same problem can affect people whose sleep is frequently interrupted. As a result, chronic sleep deprivation has been linked to numerous heart problems.”
Elaborating on how sleep is the most important stress buster for all of us, Dr Chandrashekhar Kulkarni, Consultant, Cardiovascular and Thoracic Surgery [CVTS] at Mumbai's Global Hospital, said, “It is of common knowledge that sleep also induces the rearrangement of memories and experiences. This leads to a caring effect on all organ systems including the heart. Autoregulation of blood pressure happens during the time and minor changes in fluid and electrolyte balance leads to reduction of blood pressure. This also has beneficial changes in the endothelial ling of the blood vessels leading to restitution of the elasticity and other properties.”
Asserting that regulation of blood pressure is the most important beneficial effect on the heart contractions with reduced chances of diastolic heart failure, he added, “Hormones like grelin which are important for food cravings and hunger are up regulated in lack of sleep leading to increased frequency of meals at unusual times leading to food cravings and obesity. The carb and fat rich typically consumed in late night or early morning changes the Insulin pattern of secretion leading to predisposition to diabetes. Hence maintaining regular sleep patterns is important to maintain this fine balance.”
Echoing the same, Dr Richa Mittal, Consultant, Pulmonary Medicine at Sir HN Reliance Foundation Hospital, said, “Sleep is an integral part of a hearty, healthy life. It is the time when our body recharges itself and recuperates from the stress that it suffered during the day. A good night’s sleep helps you feeling fresh and alert during the day. Although individual sleep needs may vary, but on an average an adult requires 7 or more hours of sleep per night. The need of a child and adolescents are substantially more, with a teenager requiring 8-10 hours of sleep per day to an infant requiring as long as 12-16 hours per day.”
According to her, sleep disorders are caused by “work schedules, our eating habits, day-to-day stressors, a disruptive bedroom environment, and various medical disorders can all prevent us from getting enough sleep. Anything that disrupts the duration, quality or pattern of our sleep and leads to daytime distress such as impairment in memory, cognition, personality changes, getting tired easily or less energetic”. However, the good news is that almost all these disorders are treatable and therefore knowing the alarming signs and spreading the awareness becomes all the more important so as to diagnose early.
Common symptoms that we should be aware of
Dr Richa Mittal highlighted that sleep disorders be detected at an early stage and said, “Being aware and careful about the warning symptoms helps us to diagnose the disease in us or our loved ones. There are people who have chronic inadequate sleep and their body and brain struggle daily due to it but they aren’t aware of the deficiencies and so disorders in such people is diagnosed only when it’s too late and has turned serious.”
She listed some of the common symptoms of sleep disorders that we should be aware of. These include -
1. Loud snoring, gasping or choking during sleep (as noticed by the bed partner)
2. Extreme tiredness or sleeping frequently or at inappropriate places (such as watching tv or talking to someone) during the day even after more than 7 hours of sleep a night
3. Perpetually taking more than 30 minutes to fall asleep
4. Getting irritated easily, difficulty concentrating at work, frequent attention lapses, trouble thinking clearly or remembering things
5. Waking up several times in the middle of the night and remaining awake, sometimes for hours
6. Waking up too early in the morning
7. An irresistible urge to move your legs, or a tingling or crawling feeling in the legs, particularly at rest, in late evenings or night
8. Suddenly falling asleep during any activity like even while laughing
9. Requiring a stimulant such as caffeine to keep you awake during the day
Important sleep disorders that we should be aware of
1. Sleep apnoea - a breathing disorder which makes you stop breathing for a short period of time during sleep. It happens when your airway gets blocked repeatedly during sleep, causing you to stop breathing for short amounts of time. Sleep apnoea can be caused by certain health problems, such as obesity and heart failure. It affects how much oxygen your body gets while you sleep and increases the risk for many health problems, including high blood pressure, heart attack and stroke.
2. Insomnia - being unable to fall or stay asleep. It refers to trouble falling sleep, staying asleep, or both. As many as 1 in 2 adults experiences short-term insomnia at some point and 1 in 10 adults may have long-lasting insomnia. Insomnia is linked to high blood pressure and heart disease. Over time, poor sleep can also lead to unhealthy habits that can hurt your heart, including higher stress levels, less motivation to be physically active, and unhealthy food choices.
3. Hypersomnia - being unable to stay awake during the day
4. Parasomnia - acting in unusual ways while falling asleep, sleeping, or waking from sleep, such as sleep-walking, talking, eating or nightmares
5. Restless leg syndrome - a tingling or prickly sensation in your legs, along with a powerful urge to move them
6. Circadian rhythm disorders - problems with the sleep-wake cycle that makes it difficult for you to sleep and wake at the right times. Going to bed late and getting up late or going to bed early and getting up too early are some of the patterns. It is commonly seen in shift-workers.
Tips to get a good night's sleep
According to Dr Rakesh Rajpurohit, “When leptin levels are low we eat more and exercise less, leading to weight gain, obesity, and ultimately insulin resistance, which is a state of inflammation. This sets up a vicious cycle and increases the risk for cardiovascular events. Eat complex carbohydrates such as whole-wheat toast or a bowl of oatmeal before bed. These foods will trigger the release of the sleepy hormone serotonin, and they don’t take long to digest. High-protein foods like steak and chicken can also disrupt sleep because they take a long time to break down, which is a problem at bedtime since your digestion slows down significantly. Avoid spicy foods within three hours of bedtime. Do the same with tomato sauce and other acidic foods if they give you heartburn or indigestion.”
Dr Chandrashekhar Kulkarni advised, “Eat early and light at least 2 hours before bed time, have some stress free time before sleep, keep screen off for at least 45 minutes, reflect on your days achievement for positive vibes and also plan for the next day before sleep, exercise routine as per schedule, gainful employment and extracurricular activities like hobbies add more to the satisfaction and the feeling of completeness or usefulness of the day.”
Dr Sushil Jain listed some tips for getting a good night's sleep. They include -
- Create an optimal sleep environment by making sure that your bedroom is comfortable, cool, quiet and dark.
- Think positive. Avoid going to bed with a negative mind set.
- Avoid using your bed for anything other than sleep and intimate relations. Do not watch television, eat, work, or use computers in your bedroom.
- Establish a regular bedtime and a relaxing routine each night by taking a warm bath, listening to soothing music, or reading. Try relaxation exercises, meditation.
- Stop clock watching. Turn the clock around and use only the alarm for waking up. Leave your bedroom if you cannot fall asleep in 20 minutes. Read or engage in a relaxing activity in another room.
- Avoid naps. If you are extremely sleepy, take a nap. But limit naps to less than 30 minutes and no later than 3 p.m.
- Avoid stimulants (coffee, tea, soda/cola, cocoa and chocolate) and heavy meals for at least four hours before bedtime. Light carbohydrate snacks such as milk, yogurt, or crackers may help you fall asleep easier.
- Avoid alcohol and tobacco for at least four hours before bedtime and during the night.
- Exercise regularly, but not within four hours of bedtime if you have trouble sleeping.
- Big dinners make you temporarily drowsy but prolong digestion, which interferes with a good night's sleep. It's best to eat your biggest meal before mid afternoon and have a light evening meal.
- Avoid spicy foods at dinner. Gas-forming foods and hurried eating also cause abdominal discomfort, which in turn interferes with sound sleep.
As per Dr Richa Mittal, “Treatment is tailored as per the disorder but nonpharmacological measures such as regular sleeping schedule, losing extra weight, healthy diet, avoiding caffeine or alcohol and regular exercises or calming activities like Yoga, play a strong role in overall management of these sleep disorders.”
These tips and other elements of sleep hygiene can serve as a foundation for better sleep leading to a healthy heart. If there is a suspicion of sleep disorder then that person shall consult their doctor, who will then advice sleep study after the screening tests. Majority of sleep disorders are diagnosed by overnight sleep study (polysomnography) which measures the breathing effort and airflow, blood oxygen level, heart rate and rhythm, duration of the various stages of sleep, body position and movement of the arms/leg during the sleep.