When you come to think about it, we spend nearly a third of our lives sleeping. Aren’t we wasting a lot of living time that could be more profitably spent earning money or enjoying ourselves?
It is often said that the elderly need less sleep than younger adults but this has no proof. One reason that the very young need so much sleep is that the growth hormone is secreted by the pituitary gland in much larger amounts during sleep than when awake. In adults, the division of cells in the skin and in the bone marrow (organs actively reproducing cells) takes place only during sleep.
The body’s functioning is based on an internal clock. This extends over 24 hours and is called the circadian rhythm. If our time schedule is upset, by air travel to another time zone or by changing our working pattern to another shift, then it takes several days for our bodies to adjust to this new time.
There are two phases of sleep and both are believed to be important. Normal or orthodox sleep occupies most of the time. The heart slows, breathing becomes slower and shallower and blood pressure drops. This sleep is deep and it is hard to wake a person.
Then for about 20 minutes in every 1½ hours we enter into the second phase of sleep. This is paradoxical, rapid eye movement, or REM sleep. The blood supply to the brain rapidly increases and is even greater than when awake. The pulse quickens, the blood pressure rises and the breathing is more rapid and deeper. The eyes move rapidly from side to side.
This is the time of dreaming. And we all dream, even if we cannot remember.
There are some well-recognized sleep disorders. Hypersomnia is the onset of extra, apparently normal, sleep that can come at any time but more so at times when we all may feel drowsy. This may be after meals, or when riding in a bus or train, or in a church during a boring sermon. The person feels drowsy then drops off to sleep for a few minutes or even hours.
In narcolepsy, there is a momentary overwhelming compulsion to sleep. The sleep may only last for a moment or two. The person wakes and experiences a feeling of great relief.
While still awake a person may develop a sudden weakness and loss of tone of the muscles. This is usually precipitated by sudden emotion – fear, anger, or pleasure. The muscles become limp, the head falls forward, the knees buckle and the person slumps to the ground. This is cataplexy. There is no loss of consciousness and the attack passes in a second or two.
Sometimes before sleep, while in that twilight stage, the muscles may twitch and there may even be hallucinations of sound or sight. Sometimes on awakening the muscles may be paralyzed for a brief time. As well, the body may feel either too heavy or else so light it could float. These states are so common and experienced by normal persons that they should be regarded as variations of normal.
However, narcolepsy is regarded as a disorder and does respond to treatment. The amphetamine group of drugs abolishes this sudden dropping off to sleep during the day.
Narcolepsy may arise spontaneously or it may follow a head injury or damage to the brain from infection, such as encephalitis.
The commonest sleep disorder is insomnia. This may be difficulty in getting off to sleep or it may be that the sufferer wakes frequently during the night. Early morning awakening, hours before the normal time is the typical pattern of the insomnia due to depression.
Unfortunately we doctors are all too ready to yield to the demands of our patients for the prescription of hypnotic drugs to treat insomnia. Insomnia is not a disease, it is a symptom. It may be due to pain or an itch or a cough. It frequently is due to anxiety or tension as a result of stress.
Old people pose a special problem. They often sleep a lot during the day then cannot get to sleep at night.
Bladder problems can affect women as well as men and cause several trips to the toilet during the night. All of these things may lead a person to complain of insomnia and demand a sedative from the doctor.
Many of the sedatives used to put and keep people asleep work, but at a price. They are useful for a period of a week or so but many of these drugs lead to tolerance – the body gets used to them, and patients need to take increased amounts to achieve the same effect.
As well as tolerance, some of these drugs, especially the barbiturates, may lead to dependence. Most sedative drugs abolish or reduce REM sleep.
When the sedative is stopped, there is a rebound effect and most of the sleep then becomes REM in type.
This is light restless sleep and the person just off sedatives may toss and turn all night and have vivid and frequent nightmares.
Is it little wonder that he is back to the doctor the next day demanding his sleeping tablets so that he can have a decent night’s sleep? But sleep will revert to normal with a little patience from both doctor and patient.
Alcohol is not much better in this regard. It can induce sleep but then later in the night there can be a rebound and the sleep becomes light and restless. If you have insomnia then what needs treatment is the cause. Modify your lifestyle. Go to bed late. If you can’t sleep, then get up and read a book, watch TV or go for a walk.
Then go back to bed later and try again to get to sleep.
Don’t drink tea or coffee as these are stimulants (so are some cola drinks that contain caffeine).
A drink of hot milk or chocolate is preferable. One alcoholic drink won’t hurt but several may later disturb your sleep.