Understanding the Language of Silence - Sleep, Sleep Behavior and Sleep Disorders. Dr. Amrit Lal

comfortable sleep. Among other exogenous causes including behavioral aspects of sleep such as lack of exercise, sedentary living, excessive indulgence in caffeine, alcohol and nicotine play anti-sleep role. Exogenous causes also include daytime napping which is one of major destroyers of nighttime sleep. Sleep deprivation can also shorten lifespan. This emerges from a large population-based 22-year follow up study reported in the journal Sleep in 2007.

      In an earlier large scale study involving 2,889 women also reported in Sleep (2006) found a significant association between sleep behavior and poor daytime performance in a community dwelling of older women. Smokers are more likely than non-smokers to remain awake at night and suffer from daytime sleepiness. Some studies have found that smokers are 4 times as likely as non-smokers to suffer from sleep apnea. Alcohol relaxes and can help initiate sleep, but when its effect wears off it has the opposite effect, causing awakenings and fragmented sleep during remainder period of the night. (Advice: Better don’t take alcohol within 6 hours of bedtime). These causes, both endogenous and exogenous contribute to sleep disorders and their aftermaths, greatly affect the quality of life.

      PATHOGENESIS

      A variety of causes lie at the pathogenesis of sleeplessness in the elderly and other age groups. Among them more important are medical problems, psychiatrist aberration, social disturbances along with poor sleep habits such as extended day-time napping and perverse lifestyles woven around stimulants like nicotine, caffeine and alcohol culture. Inappropriate pseudo remedies based on popular folklores, self-doctoring for over-the-counter (OTC) medications to treat a variety of health issues, including sleep disorders, further complicate the already muddled sleep pathology scenario. It is matter of common observation that seniors, by and large, don’t take note of warnings on many drug labels and exhortations to abstain from alcohol and against driving and operating heavy machinery while taking certain drugs. In fact, such warnings are often ignored summarily even though because of their weaker physiology old people react to such medications more strongly and adversely than younger people.

      Already, according to one estimate, pertaining to the United States, there are some 37 million old-aged Americans who suffer from frequent sleep disorders which, if ignored, can manifest in a number of serious age-related conditions ranging from arthritis to diabetes and obesity, heart and lung pathology and dementia and depression. However, National Sleep Foundation (NSF) of the United States says that it is the poor health of the elderly which comes first and is the real trigger to sleep disorders rather than the other way round. But the general consensus of the medical community is that the association between health and sleep disorders is bi-directional - not a one way alley but a two way street – more severe a medical condition, greater the severity of a sleep disorder and vice versa. In addition, let us not forget, some 20 percent of automobile accidents are as a result of some form of sleep disorder like insomnia and sleeping pills to address it and outright daytime drowsiness caused by night time sleep deprivation or use of sleeping pills. Such sleep-deprived individuals or under the effect of sleep-aids taken at night, perform as if drunk, and no amount of caffeine or cold air can negate the ill effects.

      Apart from ill health of the elderly which adversely affects their sleep architecture, bad sleep hygiene such as irregular sleep-wake hours and addiction to nicotine, caffeine and alcohol and some OTC medications such as anti-histamines (anti-allergy) and pain killers (mainly, narcotics), make sleep scenario worse confound in actual life. Instead of helping in the solution of the problem, bad sleep hygiene and certain, lifestyle and self-diagnosis and self-doctoring become a part of the problem. Under such conditions, when their so-called “sleep help” options fail to deliver, only then they may to turn to a sleep specialist who is specifically trained in sleep medication and can figure out what lies at the root of a particular sleep disorder to navigate a way to improve both quantity and quality of sleep. The earlier one seeks such help, the better one can manage one’s sleep problem.