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Disturbed Sleep: How to manage1

P. Priyadarshi, MBBS, MD, FRCP (Edin) Adequate sleep is as important as air and water. Deprivation of sleep over long periods may lead to loss of memory and concentration, irritability, disturbed relationship at work and in family, brain shrinkage, hypertensions, and accidents; and may promote growth of cancers, aging and death. Although sleep requirement varies from person to person, most medical authorities now agree that eight hours sleep is required for a proper functioning of body and mind. Sleep disturbance may be of many types. One may be early waking, say, at 3 am, and not being able to sleep again. Another may be difficulty in getting into sleep. A third variety may be shallow sleep, with repeated waking. Thus there may be qualitatively poor sleep or the total sleep duration may be reduced or both occurring together. For proper management of disturbed sleep, a detailed assessment should be made. Medical conditions disturbing or breaking sleep should be identified and treated. Some common conditions are: coughing at night, breathlessness associated with asthma and heart diseases, back pain due to lumbar spondylosis, arthritic pains in joints, pain in legs (especially calves) due to vascular insufficiency, headache of migraine, heartburn/ acidity, toothache, prostate enlargement and diabetes causing frequency of urination etc. Once these conditions have been taken care of or ruled out, the commonest condition affecting sleep is depression. Often people, who have depression, forcefully deny that they have any depression and refuse to take help for this matter, although they are ready to take sleeping tablets. Depression is low mood. Its symptoms are reduced drive for work, short-temperedness, heaviness in head, feeling tired with lesser amount of work than before etc. Fluoxetin taken in the morning improves day-time energy level, reduces irritability and headache and restores sleep in depressed people. Depression should be diagnosed and treated by a doctor. In many patients specially in those who work in shifts, biological clock may be distorted or damaged. Most of the living beings have biological clock. Even plants have it. It is because of the biological clock that plants like mango tree know that their flowering season has arrived. For restoring biological clock, one important step is to ensure that you expose yourself to bright daylight soon after waking. Late afternoon exposure to daylight is also helpful in restoring sleep rhythm. On the other hand, melatonin is a hormone secreted by pineal gland in response to darkness, which helps in inducing sleep. It is an important regulator of biological clock too. Observance of some simple rules may help have better sleep. 1. Never use your bed (preferably bedroom) for anything but sleeping. 2. A bit of yoga or stretching exercises promotes relaxation and helps sleeping. 3. A warm bath before going into bed is good. Some people are helped by yoganidra and others by chanting a mantra silently in bed. 4. Coir should be soft, firm and large enough. Room should have proper temperature, somewhere between 20 and 28 degrees centigrade, depending on individual choice. Pillows should not be too big. A pillow below the knee is helpful while you are sleeping on your side.
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This article was published in May, 2010 issue of the Eternal India journal, India First Foundation, 5 Hailey Road, New Delhi.

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A two-inch size soft support below the lower back (lumbar region) helps while sleeping supine. A light slow music in the bedroom may be beneficial. There should not be too many things in the bed room which may remind you something and promote thinking at a time when you need to forget them. For some people, bedroom should be perfectly dark and even the tiny blinkers are best avoided. But some people get better sleep in mild light. Blue light, even in low intensity, interferes with sleep by inhibiting melatonin secretion. Daytime sleep more than an hour and late in the afternoon should be avoided. A glass of toned milk 60 minutes before going to bed is helpful. Milk contains rich amounts of tryptophan, which helps in serotonin formation in brain. Serotonin is a calming agent. Dinner should be taken 2-3 hours before sleeping time and should not be fatty, spicy or huge in bulk. One should drink adequate water during the day, but drinking water in the last hour before sleep should be avoided, as it may promote urination. Grapes, a few peanuts and dry fruits in the night may help. Do not take tea, coffee or coke-- drinks which contain caffeinefor few hours before going to sleep. Caffeine is a stimulant and may keep your brain activated while it needs to slow down. Yet some persons who suffer from depression find that tea helps them getting into sleep. Alcohol helps in induction of sleep, but reduces depth of sleep and overall quality. Therefore it is best avoided. Do not enter into any topic (whether talking with your friend, or watching TV or reading a book) which may activate your brain one hour before your planned time to sleep. Reading a bit serious and boring book during this time may help inducing drowsiness. Get on schedule. Advancing waking time leads to advancing the sleep phase of the biological clock. Go to bed and get up at the same time every day. Respect your waking time. Even if you have not had your daily quota of sleep, delaying waking time may distort your biological clock. Do not wait for sleep for hours lying in your bed. This may condition your mind to start waiting for sleep as soon as you get into bed. Those who usually spend four five hours in bed daily waiting for sleep to come, for them the advice is that, if you do not feel sleepy at all sometime after going into bed (say ten minutes), leave bed, start walking in the room itself in a very slow pace. You may continue doing it for an hour or two, but ultimately you are going to get tired and feel sleepy. Then enter into bed and sleep. This time is not wasted. You are burning at least some calories, and secondly you were going to spend whole night sleeplessly even if you had not left the bed.