To sleep, perchance... By Juliet Pitman

To sleep, perchance...

Sleep disorders leave one feeling exhausted and frustrated. We look at the many facets of this condition and how to treat them.

By Juliet Pitman

Narcolepsy, insomnia, sleep apnoea, restless leg syndrome. Apart from all having peculiar-sounding names, these conditions are all sleep disorders and, in a variety of different ways prevent their sufferers from feeling well-rested. If you’ve ever felt exhausted and in desperate need of sleep, imagine not being able to get to sleep, falling asleep unexpectedly or having severely disturbed sleep and you’ll have some idea of what it’s like to have a sleep disorder.

For sufferers, the road to treatment can be a long and frustrating one – but it’s a journey that starts with understanding the basics of sleep.

 

What is sleep?

The Morningside Sleep Centre in Johannesburg provides diagnosis and treatment for people with sleep and neurological disorders, and conducts research into sleep and neurological conditions. Lead by neurologist Dr Kevin Rosman, who has been Chairman of the Sleep Society of South Africa since 2002, the Centre’s literature describes sleep as “an active highly organised sequence of events and psychological conditions.”

Furthermore, sleep can be divided into two separate and distinctly different stages – non-rapid eye movement (NREM) sleep, which is further divided into four phases (1, 2, 3, 4) and rapid eye movement (REM) sleep. Your body cycles about 4 to 5 times during the night through NREM and REM sleep. The physiological differences of each stage are listed below

1. NREM Sleep: Around 75% of the time you are asleep is spent in the NREM state.

• Stage 1: this is the transitional phase just after you fall asleep during which time you can be easily awakened. It’s a short period.
• Stage 2: this phase accounts for almost half (45%) of NREM sleep and is characterized by a lack of eye movement and two kinds of brain waves called sleep spindles and K-complexes.
• Stage 3: this involves a deeper state of sleep and during this time the person will be difficult to wake. Around 12% of NREM sleep is made up of stage 3 sleep.
• Stage 4: this is very deep sleep and the final phase of NREM sleep. If you wake up during this time you may feel disorientated or very sleepy.

 

2. REM Sleep: most dreaming takes place in REM sleep, a period during which the brain blocks signals to the muscles to prevent you from being able to physically ‘act out’ your dreams. REM accounts for around 20 – 25% of your sleep.

Each of these phases is important but deep sleep possibly offers the most benefits. Studies of sleep deprived people show that the brain naturally attempts to recover deep sleep first and sleep experts know that the worst effects of sleep deprivation occur when people are deprived of deep sleep.

REM sleep is also important because it’s the period during which our brains process emotions, memories and stress. Although its function is not fully understood, it is believed to influence many things, from our ability to learn and develop new skills, to our ability to make proteins. If REM sleep is disrupted one night, your body will go through more REM the next to ‘catch up’.

 

How much is enough?

Your mother may have told you that a good night’s sleep was eight hours long, but the fact is that different people need different amounts of sleep. This may be because their body can operate on less sleep, or that they sleep more ‘effectively’ and are able to get maximum rest from less time spent sleeping. There is a misconception that older people need less sleep but this is not true; they often get less sleep but this is not because their body no longer needs as much. Children, on the other hand, definitely need more sleep than adults. If you were to look at averages, most adults need around 6 - 8 hours to function at their best. Experts suggest that the best way to determine how much sleep you naturally need.

     

When to sleep

Many things influence when we need to sleep and when we feel alert and awake. You may have heard of circadian rhythms. Dr Alison Bentley, head of the Wits Dial-a-Bed Sleep Laboratory describes what these are and how they influence sleep cycles in an article published in Science in Africa magazine: “These are our 24-hour body rhythms including changes in body temperature, plasma levels of various hormones and variables such as heart rate and blood pressure. These increase and decrease during the day and night.” She goes on to explain how simply changing the time you go to bed – for example going to bed in the morning and staying awake at night if you are a shift worker – does not mean your body will be ready to sleep or be wakeful when you want it to be. This also applies to travellers who are going to different time zones e.g. Australia which is nine hours ahead of us. “All the other rhythms need to be changed as well and that can take up to seven days to occur,” she explains.

The point is that sleep is complex, which is perhaps why sleep disorders are so difficult to understand and to treat.

 

Narcolepsy

Narcolepsy is probably one of the strangest sleep disorders. A chronic disorder caused by the brain’s inability to regulate sleep-wake cycles normally, it causes sufferers to experience urges to sleep, and in many cases to actually fall asleep, at various periods throughout the day. They typically remain asleep for a few seconds up to a few minutes, but in some cases can even be asleep for an hour or more.

In addition to falling asleep in this way during the day, people with narcolepsy can experience vivid hallucinations as well as brief periods of total paralysis during the onset of sleep or when they wake up. The cause of the disorder is unknown and at this time there no cure for it. In addition to antidepressant drug therapies, narcoleptics are treated using various behaviour strategies, such as taking short, regular naps during the day and improving the quality of sleep at night.

 

Restless legs syndrome

As its name suggests, Restless Legs Syndrome (RLS) is characterised by unpleasant sensations in the legs and an uncontrollable urge to move them when they are at rest in an effort to relieve these feelings. RLS sensations are often described by people as burning, creeping, tugging, or like insects crawling inside the legs.

RLS is most noticeable in the evening and at night, and can severely disrupt sleep. Although its precise cause is not known, it is associated with low iron levels, end-stage kidney disease in people who are on dialysis and damage to the peripheral neurosystem. Pregnant women also often report experiencing RLS and certain medications, such as anti-nausea, anti-seizure and antipsychotic drugs, as well as some cold and allergy medications, may aggravate symptoms

Again, there is no cure for RLS, but there are drugs that can help to alleviate the symptoms. They include sedatives, pain relievers, anticonvulsants and dopaminergic drugs. In addition, the Restless Legs Syndrome Foundation suggests that sufferers have their iron and vitamin levels checked, remove alcohol and caffeine from their diet, change any medication that may be the cause and identify and try to avoid habits and activities that seem to make RLS symptoms worse.

 

Obstructive sleep apnoea

Described by the Morningside Sleep Centre as “a serious, potentially life-threatening condition that is far more common than is generally understood”, Obstructive Sleep Apnoea (OSA) is characterised by brief interruptions of breathing during sleep. It owes its name to the Greek word, apnoea, meaning “without breath”. The interruptions themselves are known as apnoeas and can last for 10 or more seconds. During this time the soft tissue at the back of the throat collapses, closing the airway. Breathing stops which in turn causes the brain to react by waking the person so that the airways can open again and breathing can resume.

Although sufferers are usually unaware of the process, they can be experiencing it hundreds of times a night, which makes restful sleep impossible. The excessive tiredness (even after what the person thought was a full night’s sleep) is one of the first signs of OSA. Loud snoring, followed by a gasp and then loud snoring again, is another common symptom. Experts at the Morningside Sleep Centre say, “Although the typical OSA patient is overweight, male, and over the age of 40, sleep apnoea affects both males and females of all ages and those of ideal weight.”

 

Insomnia

At some period in their lives, most people have experienced insomnia, or the inability to fall or stay asleep. The condition is so common that it affects one third of the population each year, and around 10% of adults are regular insomniacs. It can last for days, months or even years and sufferers experience extreme fatigue, lethargy, concentration difficulties, poor memory, irritability and a depressed mood as a result.

The causes of insomnia vary widely and include psychological factors such as stress and depression, the use of stimulants such as alcohol and caffeine, keeping erratic hours and environmental factors such as too much noise or light. Many people find that once they’ve experienced a bout of insomnia, they become hyper-vigilant and are unable to fall asleep precisely because they are focusing on the fact that they won’t.

Treatment for insomnia takes many forms. If the problem is acute, your doctor may prescribe sleeping tablets, but many of these are potentially habit-forming and don’t offer a sustainable long-term solution. Natural non habit-forming over-the-counter remedies can provide relief. They include herbal remedies such as chamomile, valerian root, kava kava, lemon balm, passionflower, lavender, and St. John’s Wort. Some people have found essential aromatherapy oils to be of benefit. The ones most commonly used include lavender, jasmine, clary sage, and chamomile. Your homeopath might recommend you try Belladonna, Nux vomica, Hyoscyamus or Chamomilla, depending on your condition and the reasons underlying your insomnia. Relaxation techniques such as yoga and meditation can also be very helpful.