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India is sleep deprived

TV Jayan | Updated on February 28, 2020 Published on February 28, 2020

Sleep deprivation is one of the reasons behind the rising incidence of serious illnesses — diabetes, heart attack and cancer, among others — in young and middle-aged Indians. This is an age group whose sleep hours are often given over to late nights at work, binge watching on TV and smartphones. Medical professionals explain why it’s time to switch off completely, come bedtime

Vivek Gulati* didn’t know it, but he was an owl. The young marketing professional, who tracked European clients for his Gurugram-based firm, worked late into the evenings. Back home he needed to unwind before the telly — watching his favourite Premier League matches or the latest on Netflix. He was up till well after midnight. He was convinced he led a healthy life — he didn’t smoke or drink, was fanatic about his daily workouts and jogged every morning.

And then one recent night, Gulati, just 29, complained of chest pain. Doctors at the neighbouring private hospital later diagnosed it as myocardial infarction, commonly known as a heart attack.

Quite like him, Anand Kishore*, 55, did what he could to stay healthy. He didn’t smoke, was not overweight and did not suffer from diabetes. He walked every day, and even ran a half-marathon. But he slept late — usually at 1am, or even later. Angina and uneasiness in breathing forced him to seek medical help one January morning. Doctors saved his life by performing a surgical procedure that removed the clogs that were constricting the vessels carrying blood to the heart.

“While talking to him, we realised that his job kept him awake till 1 or 2 in the morning almost every day,” says Dr Sameer Kubba, an interventional cardiologist and associate director at Max Hospital in Vaishali, on the outskirts of the Capital.

In the last few years, Dr Kubba has seen several similar cases of young or middle-aged patients with serious health problems. “A large number of young patients have had a heart attack or a stroke or have been diagnosed with diabetes, hypertension or even cancer. Many factors may lead to such diseases, but sleep deprivation is the one that is least talked of,” Dr Kubba says.

This is especially true of the young, warn health experts. They stay up late at night, working on their computers, watching films or listening to music. Some medical practitioners refer to them as night owls — people who are active at night (see box). If they make up for the lost sleep in the daytime, they may not suffer from adverse effects. But those who do not have the luxury of waking up late — working professionals, for instance — end up sleep-deprived.

“Sleeping for less than seven hours a day is associated with an increased risk of cardiovascular diseases, hypertension, diabetes, anxiety and depression, and also certain cancers such as breast cancer in women and prostate cancer in men. Increased use of social media platforms, TV watching and use of computers are keeping people awake well into the night. Even when they hit the bed, they fail to get proper sleep,” says Dr Kubba.

One leads to the other: Sleeping for less than seven hours a day is associated with an increased risk of cardiovascular diseases, hypertension and diabetes   -  Reuters

 

He has also noticed of late that adolescents who do not sleep adequately often develop lifestyle diseases such as obesity.

This is backed by sound scientific research. In 2019, a team of researchers at the Pennsylvania State University in the US carried out an experiment involving 15 people in their 20s. For the study, which appeared in the Journal of Lipid Research, the participants spent a week getting plenty of sleep at home before checking into a sleep lab for a 10-night study. While half the volunteers slept regular hours, the rest spent no more than five hours in bed each night.

It was found that the sleep-deprived participants felt less full than the others after eating a high-fat meal. Scientists know that sleep deprivation disrupts the interplay of two hormones — leptin and ghrelin. While leptin is the chemical that tells the brain when one is full, ghrelin urges the brain to keep eating. Studies have found that in a sleep-deprived person, the leptin levels are low, and ghrelin levels high.

The findings corroborated a 2016 study by researchers in King’s College London which found that sleep-deprived people consumed an average of 385 kcal extra per day, which is equivalent to the calories of about four and a half slices of bread. The team inferred that people put on weight if they didn’t sleep well enough.

A 2019 study funded by the US National Heart, Lung and Blood Institute, which tracked over 2,000 men and women in the 45-84 age group for six years, found that an irregular bedtime and wake-up schedule — getting different amounts of sleep each night — could put a person at a higher risk for conditions such as obesity, high cholesterol, hypertension, high blood sugar and other such metabolic disorders. The study, which appeared in the journal Diabetes Care last year, claimed that for every hour of variability in the time of going to bed and the duration of sleep, a person may have up to a 27 per cent greater chance of experiencing a metabolic abnormality.

“Nature has given us a mechanism which uses sleep to heal the body — particularly inflammations,” Dr Kubba stresses. An inflammation can subside with the help of a good night’s sleep, he adds.

Goodnight, sleep tight

  • Practices that can help one sleep better:
  • Limit daytime naps to 30 minutes. Napping does not make up for inadequate night-time sleep. However, a nap of 20-30 minutes can help improve one’s mood, alertness and performance.
  • Avoid stimulants such as caffeine and nicotine close to bedtime. While some feel alcohol helps one fall asleep, too much close to bedtime can disrupt sleep in the second half of the night as the body begins to process the alcohol.

 

  • Exercise promotes quality sleep. Just 10 minutes of aerobic exercise, such as walking or cycling, can drastically improve night-time sleep quality.
  • Steer clear of heavy food just before sleep. Rich, fatty or fried meals, spicy dishes, citrus fruits and carbonated drinks can trigger indigestion in some people. When this occurs close to bedtime, it can lead to painful heartburn that disrupts sleep.
  • Ensure adequate exposure to natural light. Exposure to sunlight during the day, along with darkness at night, helps maintain a healthy sleep-wake cycle.
  • Establish a regular relaxing bedtime routine. A regular nightly routine helps the body recognise that it is bedtime. This could include taking a warm shower or a bath, reading a book, or doing light stretches. If possible, avoid emotionally upsetting conversations and activities before attempting to sleep.
  • Make sure the sleep environment is pleasant. Mattress and pillows should be comfortable. The bedroom should be cool for optimal sleep. Bright light from lamps, cell phone and TV screens can hamper asleep.
  • (From Sleepfoundation.org.)

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That said, not everybody needs seven hours of sleep. Some have a lifelong short-sleep pattern (of less than six hours) and show no apparent ill-effects. Scientists studying those who are naturally short-sleepers have found that they have at least two genes — DEC2 and ADRB1 — which help them stay healthy despite the shorter sleep hours.

But among others, sleep disruption can lead to three distinct problems — physical, emotional and occupational, warns Dr Manvir Bhatia, a senior neurologist who specialises in sleep medicine and runs a neurology and sleep centre in Delhi. Sleep disruption is rampant among the young, preoccupied as they are with their smartphones and computers, says Dr Bhatia, who set up India’s first sleep laboratory at the All India Institute of Medical Sciences (AIIMS), New Delhi, some decades ago and is the vice-president of the Indian Society for Sleep Research (ISSR), a professional body of sleep scientists in the country.

Indeed, if doctors are seeing more and more cases of people having sleep disorders, it is because of a host of contemporary factors — such as work pressures and lack of adequate exercise and healthy food. But, in recent times, a new risk factor has been added to this — namely, time spent on screens.

Blue screen: Scientists have known for a while that the blue background light that emanates from most digital devices can interfere with a hormone called melatonin, which is vital for inducing sleep   -  ISTOCK.COM

 

Scientists have known for a while that the blue background light that emanates from most digital devices can interfere with a hormone called melatonin, which is vital for inducing sleep.

“Almost 95 per cent of people who complain of sleep problems have increased screen time. Most adolescents and young adults stare at their smartphones, either replying to social media messages or watching something till they sleep off,” says Dr Om Prakash, associate professor of psychiatry at the Institute of Human Behaviour & Allied Sciences, New Delhi.

Dr Prakash recently treated an otherwise healthy young man who had developed severe depression, even though he did not have any apparent risk factors. But he spent 12-14 hours on his computer every day, which affected his sleep at night. “Only a fraction of cases relating to sleep deprivation comes to the fore as only those people who have developed serious clinical symptoms seek help,” Dr Prakash says.

The lack of sleep can also lead to neurodegenerative disorders. Neuroscientist Swamy Subramaniam, whose book on sleep, Mastering Sleep, came out last year, says studies show that even a single night’s sleep loss leads to the accumulation of beta-amyloid — plaques that are implicated in Alzheimer’s Disease.

“Sleep normally takes care of this trash in the brain,” he says.

When people do not have adequate sleep, Dr Bhatia explains, the disruption leads to a misalignment between external time and one’s body clock (the natural system in the body that regulates sleepiness and wakefulness). This imbalance, apart from acting as a trigger for lifestyle diseases and altering a person’s eating habits, also impacts their emotional health. They suffer from mood changes, anger, anxiety and depression, she says.

There are occupational hazards, too. Those who do not sleep enough will be groggy during the day, which will adversely affect their performance at the workplace. Sleep deprivation is also the cause of a number of accidents reported across India almost on a daily basis. “Apart from inflicting self-injury, they are putting others’ lives also at peril,” she says.

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Of course, a host of other factors — from genes and lifestyle to food habits — may lead to health disorders. But sound sleep can mitigate some of them. “We have heard that air pollution leads to cardiovascular problems. This is because air pollution leads to heightened inflammation, which in turn leads to not just heart problems but other ailments as well. But inflammation can be kept in check by proper sleep, to a large extent,” Dr Kubba argues.

According to Subramaniam, in 24 hours, a person feels extremely sleepy thrice: At the onset of sleep, between 3am and 4am, and between 3pm and 4pm. “This is quite true for most people. And during the rest of the day, he or she would be very alert,” he says.

This, he says, may explain why a large number of road accidents take place around 3am or 4am. Dr Bhatia agrees. Truck unions in countries such as the US strictly monitor how much time truck drivers spend off the road to ensure that accidents involving them are minimised, she says.

Crash! A large number of road accidents take place around 3am or 4am — which is when a person is likely to be extremely sleepy   -  The Hindu

 

Subramaniam warns that a “sleep-loss epidemic” may be contributing to the epidemic of diabetes and obesity that the country is already witnessing. “Epidemiological studies in the US have measured an epidemic of sleep deprivation. This could probably be true for India as well, but we have no hard data,” he says.

Scientists have started unravelling what happens to the bodies of sleep-deprived people. One study by researchers at the Hong Kong University last year found that there was discernible DNA damage in people whose sleep got disrupted even for one night. Although additional research is needed, this DNA damage may help explain the increased risk for cancer and cardiovascular, metabolic and neurodegenerative diseases associated with sleep deprivation.

There is cause for concern, for Gen-Z may face a plethora of problems over the years because of their sleeping habits. A limited study by a team of researchers led by Dr Ravi Gupta, associate professor of psychiatry at AIIMS Rishikesh, indicates that children in India are sleeping less than required.

“According to our data, nearly 22 per cent of urban children and 35 per cent of rural children are not getting enough sleep. The situation could be worse among adults,” Dr Gupta says. While room-sharing disrupts the sleep of rural children, homework, watching television and parents staying up late are affecting children in cities, he says.

Dr Gupta thinks that employers should take an initiative to create awareness among employees about the need for proper sleep. “Sleep education is an important measure. ISSR is already taking steps to improve awareness among the masses,” he says.

Among other measures, screen time, certainly, has to be regulated. “Young people stay awake late into the night because of what is known as FOMO — Fear of Missing Out,” Dr Kubba says. Instead, they may actually miss out on life altogether.

*Name changed to protect identity

Clockwork red

  • Just as most people abide by an external time schedule that tells them when to eat, sleep and so on, the body is run by internal clocks. Known as circadian rhythms, these daily cycles keep people on a regular 24-hour routine and are involved in numerous aspects of their well-being. When these biological clocks trip up, bodies are out of sync with the outside world, leading to not just sleep disorders but also obesity, cancer and mental health issues and other problems.
  • While scientists have known about circadian rhythms since 1729, the 2017 Nobel Prize for Medicine was awarded to circadian rhythms researchers.
  • According to scientists, barring three per cent of people who can make do with less than six hours of sleep, everybody else needs around 7.5 hours of sleep a night. It is said that within 7.5 hours, a person completes five 90-minute sleep cycles. While the first few cycles concentrate on cleaning and maintaining the body, heart and brain, during the later cycles the brain files the information taken in during the day to consolidate knowledge and learning.
  • The internal body clock is set using a combination of nature (biology), nurture (social behaviour) and exposure to light. While nearly 70 per cent of the general population conforms to normal patterns of sleeping, 10 per cent are early risers or “morning larks” and 20 per cent are late sleepers or “night owls”.
  • Larks are said to report higher levels of happiness, healthiness, productivity and well-being, with less stress and depression levels than owls. According to one theory, this is because waking up early allows them to have better control over their mornings, giving them adequate time before they rush off to work or school.
  • Owls enjoy some advantages too. Studies routinely describe owls as smarter, more outgoing, good-humoured and more creative than larks, even though they often report lower well-being.
  • Experts say larks or night owls are not at risk of developing any lifestyle-related complications (such as cardiovascular disease or diabetes) if they sleep for an adequate number of hours. “Night owls, who sleep usually around 2am, will not be at risk provided a parent or a career or school does not frequently force them to wake up before 10 am,” says neuroscientist Swamy Subramaniam.

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Published on February 28, 2020
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