By all means, sleep with an alarm. But don’t set the alarm to wake you up in the morning. Set it to remind you when it is time to go to bed.
This was the message from Dr Dipankar Datta, senior consultant, ENT and sleep apnea surgeon, speaking at a conference by Manipal Hospital Broadway. “The state of our health rests on a triad — diet, exercise and sleep. People are increasingly conscious about what they eat, and many also work out regularly. Sleep is the most neglected. Since it is free, it is the least valued. There is nothing to flaunt if you sleep five hours or less, like some celebrities do. Chronic sleep deprivation can lead to memory loss, depression, anxiety, Alzheimer’s disease….”
The doctor shared tips for sleep hygiene-
- Maintain a fixed sleep schedule. Set an alarm to remind yourself to go to bed rather than to wake up. Sleeping at irregular hours can disrupt the circadian rhythm, the body’s internal clock, leaving a person feeling perpetually jet-lagged.
- Avoid long afternoon naps. Limit them to half-hour power naps.
- Use the bed only for sleeping. If you watch TV, scroll on your phone, or work on your laptop in bed, the brain stops associating the bed with sleep. You may then lie awake even when you are tired.
- Avoid stimulants like coffee and nicotine (cigarettes) in the evening. Also, keep away from gadgets before going to sleep as exposure to blue light from phone screens, laptops or even e-readers like Kindle can also suppress the production of melatonin, the hormone that regulates sleep.
- Take a shower with lukewarm water an hour before sleeping. You can also play soothing instrumental music, white noise (a steady, flat tone) or use aroma therapy
- Dim the lights of your room, but don’t make it completely dark either. A night lamp is ideal.
- If you are unable to fall asleep, don’t keep lying in bed. Get up, read a book or take a short walk, and try again once you feel sleepy.
Snoring away
While general sleep can be improved with these habits, Datta noted that there are more than 70 recognised sleep disorders. The most common is insomnia, while the second most common is obstructive sleep apnea (OSA), or what laymen call snoring.
OSA occurs when the muscles in your throat, tongue, and soft palate relax too much during sleep, causing the airway to collapse and block air from reaching your lungs. It also involves snoring. As a defence mechanism to the absence of oxygen entering the body, the person tries to wake up after a few seconds, gasping, and the airway is cleared again. This cycle can go on repeatedly all night, causing disturbed and incomplete sleep.
Sleeping pills cannot be used for apnea patients. “In apnea, waking up is the body’s defence mechanism to restore breathing. How will the patient wake up if a pill suppresses that response?” the doctor explained. “The fragmented sleep leads to fatigue, and the person could be nodding during the day, creating a risk of accidents if it happens while driving or handling machines. It can lead to several health complications too, like arrhythmia, depression, Alzheimer’s Disease, infertility and early ageing. And the snoring itself often keeps the spouse awake at night,” says Datta.
Global estimates suggest that China, the United States and India have some of the highest numbers of sleep apnea cases and that around 10 per cent Indian suffer from it. Men tend to develop the problem more as male-pattern obesity increases risk. This is the typical way fat accumulates in men, with excess fat primarily stored in the abdominal area rather than the hips or thighs, as is the case with women. “Plus, women’s health is more neglected in our country, so many women who have OSA go undiagnosed,” Datta said. “After the pandemic, we are also getting many more cases of COMISA (comorbid insomnia and sleep apnoea), where both conditions occur together.”
Care and cure
Symptoms of OSA include loud snoring, pauses in breathing during sleep, followed by choking or gasping sounds as the body tries to restart breathing. Also, look out for a sudden onset or worsening of lifestyle diseases such as hypertension or diabetes.
To confirm the condition, a clinical examination by an ENT specialist and sleep study is conducted. This can be done in the hospital or at home using portable machines. It records the patient’s breathing, oxygen levels and sleep patterns. A sleep endoscopy is also done for doctors to identify whether there are obstructions in the airway. “We now have the technology to perform a surgery to fix the issue,” said Dutta.
To prevent OSA keep your weight under check, avoid smoking and excessive alcohol. “Alcohol is a muscle relaxant and can worsen airway collapse during sleep. If you must drink, keep it minimal and maintain a two-hour gap before going to bed,” said Datta, who is the president-elect of the Indian Association of Surgeons for Sleep Apnea.
Datta also recommended blowing conch shell or playing mouth organ, trumpet or bugle to tone muscles of the lips, cheeks and tongue, that would prevent collapse of the airway.
Children at risk
“Sometimes, children who are unable to pronounce certain words may be tongue-tied. This means the tongue does move forward fully. So when they sleep, the tongue can move back, block the airway and create apnea too,” said Datta.
As a prevention, he suggested children be encouraged to chew food and develop proper jaw structure. “Many kids today are given only soups, juices and mashed food as it is easy for them to eat. But chewing tougher food and breastfeeding strengthen the muscles of the jaw and tongue,” he said.
The meet also had some patients who had undergone the surgery to fix their OSA. “I used to snore so loudly that my wife couldn’t sleep and the sound could be heard on another floor. I was overweight and always tired, despite sleeping the whole night,” said Nainish Tibrewal of Bangur Avenue. “But the surgery has changed my lifestyle completely. Now I can finally sleep soundly.”
Write to saltlake@abp.in