Role of Sleep in Prevention of Diseases and promotion of health

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 Role of Sleep in Prevention of Diseases
and promotion of health

Lt. Gen. Prof Emeritus Mahmud Ahmad Akhtar, HI(M)
Formal Surgeon General Army / Principal Army Medical College

Sleep is a universal biological imperative for all mammals. Healthy sleep must be regarded along with nutrition and exercise as key pillars for good health. Sleep is essential for survival; sleep loss and sleep disorders are associated with major health problems; including metabolic (diabetes-mellitus etc.), cardio-Vascular disorders (heart attack, strokes), neuro-psychiatric, and neo-plastic disorders as well as neuro-behavioral associated accidents and risks. All these have very high prevalence in Pakistan; are increasing and taking heavy toll on life.

Sleep deprivation for nine days is lethal while lack of food takes fourteen days for loss of life. Doctors should take detailed sleep history from the patient and the sleeping partner. Unfortunately that is generally not done. For prevention of disease and promotion of health, it should be a part of medical checkup.

Adequate healthy sleep (6-9 hours) a day for an adult (more for children) that follow the biological circadian rhythm supplemented by an afternoon nap reduces the incidence of diseases, also improves cognitive function, mental health and saves from mental disorders including dementia. Recent evidence has suggested that the chief purpose of sleep may be to maintain cerebral metabolic homeostasis, clearing waste products that accumulate during wakefulness such as beta-amyloid, a protein known to abnormally accumulate in Alzheimer’s disease. This disorder is increasing in Pakistan.

Total sleep deprivation as well as selective deprivation of non-rapid eye movement (NREM) or rapid eye movement (REM) i.e. quality sleep adversely affects vigilance, attention and cognitive performance and overall quality of life. Insufficient quantity and quality of sleep is a wide-spread public health crisis in children and adults and also responsible for motor vehicle and occupational injuries. Lack of sleep adversely affects students and sports men performances. Lack of sleep also causes increase in weight (obesity) by reducing production of leptin an appetite reducing hormone and increases the appetite increasing hormone ghrelin and also during sleep more calories are spent than being inactive awake. In children, lack of sleep also affects their growth by reducing production of growth hormone produced during REM phase of sleep. Children should have regular early night sleep schedule, lack of which causes behavioral disorders and physical ailments. Unfortunately children sleep late at night and get up early in the morning for school, getting deprivation of sleep. To help diagnose sleep disturbances there is a need to establish sleep laboratories.

Sleep apnea is a cause of hypertension, heart attacks, strokes and abnormal behavior, therefore needs special attention, nasal continuous positive pressure at night is curative in many patients. One should have good sleeping habits and regular sleeping pattern to prevent sleeping disorders.

For good sleep the bed room should be comfortable, pollution free and the bed mattress and pillow should be comfortable. One should keep worries and problems away from the minds in the evenings, have relaxed mind and atmosphere to have a comfortable sleep. Mobiles should be kept away. Darkness and dim light helps in onset of sleep while bright lights inhibit. Do not keep TV in the bed room. Avoid caffeine in the evening and strenuous exercise in late evening. Relaxation exercises, warm bath, milk drink with porridges may be beneficial.  Do not take heavy meal at bed time. It has been established that people who eat late night and during the night suffer more from obesity, heart attacks and strokes.    

Use and misuse of hypnotics (Sleeping Pills)

Lack of sleep may have deleterious effects on health, therefore should be treated. Before a hypnotic is prescribed and where possible, underlying conditions like depression should be treated. Short acting hypnotics are preferable in patients with sleep onset insomnia, when sedation, the following day is undesirable or when prescribing for the elderly patients. Long acting hypnotics are indicated in patients with poor sleep maintenance (early morning wakening) that causes day time effects, when an anxiolytic effect is needed during the day or when sedation the following day is acceptable.

Benzodiazepines are anxiolytic drugs and may be used as hypnotic for short periods as long term use may cause dependence and increase tolerance. In the elderly, these should be used judiciously as there may be ataxia and night falls Zaleplon, Zolpidem and Zopiclone are non benzodiazepine hypnotic (referred to as Z drugs). These are recommended for insomnia causing disabling symptoms for short term only.

Anti Depressants

Tricyclics in small doses have sedative property. These may be used as hypnotics. Mirtazapine is an anti depressant with sedative property, may be used as a hypnotic. Anti histaminic with sedative properties like Promethazine can also be used as hypnotic.

Melatonin is a pineal hormone, used for transient insomnia like jet lag, work shift etc. in adults over the age of 55 for short time. Hypnotic should be used judiciously for short periods only.