The Hindu Business Line : Catch some sleep

Doctors, nurses, paramedical staff, air-hostesses, journalists, soldiers, security personnel and those in the hospitality industry have long been facing difficulties associated with sleep deprivation. With a booming IT and ITES (IT Enabled Services) industry and a proliferation of call centres and BPO (business process outsourcing) units all over the country, the number of sleep-deprived people has risen considerably.

The lengthening list of psychological and physiological problems due to lack of sleep only shows that it is no longer just an occupational hazard that individuals must deal with on their own. Sleep plays a vital role in maintaining mental and physical equilibrium, and aiding growth. Studies show that while a sound, regular sleep is indispensable for men and women alike, the effects of sleep deprivation are especially virulent on women, children and adolescents.

Any condition that causes a disturbance in sleep or leads to an individual being unable to complete his quota of required sleep is called a sleep disorder. The reasons are physiological as well as sociological, says Dr N. Ramakrishnan, a certified sleep specialist and founder, Nithra Institute of Sleep Sciences in Chennai.

"Contrary to the common perception of sleep as a passive state, where the body and mind are at rest, it is an active process," he says. Sleep can be divided into various stages, including REM (rapid eye movement) sleep and slow wave sleep. During the latter period, growth hormones are released, while the former is thought to be inextricably linked to memory and learning. Both are crucial for growing children.

However, it's children who are increasingly at risk. At a time when double incomes are a necessity, parents are forced to shake awake their infants to drop them off at childcare centres. As they grow, the pressure to excel in curricular and extra-curricular activities translate into coaching classes, growing workloads and exams, thus eating into sleep time, says Ramakrishnan.

"I make parents and children who come to me analyse how cutting down on sleep is actually setting back performance," he says. They find increased sleepiness during the day, poor attention and retention capacities, and a performance dip, which triggers depression and more effort, prompting a repetitive cycle. As tiredness grows and productivity falls, emotional and behavioural problems also surface.

Women are more affected

"After the elderly, among whom sleep disorders are most common, women are most affected," says Ramakrishnan. He explains that in India the problem is compounded by the dual role that society constrains women to play, as co-breadwinner and homemaker, without concession to added burden.

And then there is the issue of subtle discrimination. "As a professional, I have to prove myself twice over," says S. Chitra, Associate Editor with an Internet magazine in Chennai. While working as news editor in a leading national daily, she checked and re-checked material, conscious that her gender would be brought up, however obliquely, in the context of any slip-up. As a result, even when she wound up and went home, she found herself unable to wind down. Stress is a root cause of insomnia.

Chitra's disrupted sleep patterns led to a persistent feeling of listlessness. A general practitioner prescribed sleeping tablets, "but after an extended period, even the pharmacist refused to supply them to me," she says. . She had to seek psychiatric help and will be happy if she can put insomnia behind her in another couple of years.

This is hardly an exception. Lured by hefty pay cheques, thousands of young women join call centres, BPOs and software institutions. Staying up at work through the night, snatching an hour or two of sleep and then getting up to cope with household chores and family responsibilities, these women usually realise the negative fallout of sleep deprivation very late. "For about 10 years I abused my body, working on and on. I had no idea what it was doing to me," says Chitra.

Among the elderly, loneliness is a leading cause of sleeplessness, adds Ramakrishnan. Take the case of a patient who complained of progressive inability to sleep. Sensitive probing revealed that the problem started when her children had left home to set up their own families.

The cause and effect

Statistics culled by A.C. Nielsen after a global study in late 2004 reveal that as many as 46 per cent of Indians sleep for less than six hours, 40 per cent go to bed between 11 p.m. and midnight, and 64 per cent wake up before 7 a.m.

Inadequate sleep dulls the mind and generates neuro-cognitive problems. It has also been associated with heart disease, high blood pressure, diabetes and a significant weakening of the immune system.

Fatigue is a common physiological symptom. Anxiety, depression and a poor response to emergencies are among behavioural fallout of insufficient sleep.

The most common types of sleep disorder are insomnia and sleep apnea, says Ramakrishnan. Insomnia is characterised by an inability to sleep, or abnormal wakefulness. Daytime symptoms include lethargy, irritability, frequent napping and attention deficiency. It would be wise to seek medical help if symptoms persist beyond four weeks, he advises. Sleep apnea is characterised by brief cessation in breathing during sleep, and symptoms include loud snoring and excessive daytime sleepiness.

Sleep medicine is just 8-10 years old in the West, where there are some free-standing sleep laboratories with specialised personnel and equipment to diagnose the condition and rehabilitate patients with incurable sleep disorders. In India, it is in an embryonic stage. Though some lung and ENT (ear-nose-throat) specialists take cognisance of it, not much attention is paid to the subject as a speciality. Research is poor and data sparse, says Ramakrishnan.

It is to fill this gap that he set up Nithra in 2004 as an institute for diagnosis and management of sleep disorders, and also to train doctors and paramedical personnel in this emerging speciality. "Our mission is to promote awareness of sleep disorders, in particular, the importance of early diagnosis and treatment," he says.

So, how much sleep is enough? There is no categorical answer. Each individual's needs are different. Some thrive on five-six hours of sleep, while others need eight to nine hours. Women tend to sleep a little more than men, adolescents need more sleep than adults and older people a little less than younger ones.

To correct poor sleep habits, Ramakrishnan recommends practising sleep hygiene — undertaking relaxation methods, controlling the sleep environment, avoiding large meals or strenuous exercise just before going to bed and reducing, if not eliminating, intake of alcohol and stimulants like caffeine and nicotine. "With growing awareness will come increasing availability of help," he adds.

Women's Feature Service

Picture by Mahesh Harilal

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