Should I be worried if I can’t get enough sleep?

Sleepless at night and worried about dozing off at work? Is lack of sleep a sign of underlying health issues? Should it be a cause of concern?

Don’t worry, you are not alone in this journey. There are many who suffer from sleep issues across the globe. While some worry about their lack of sleep and possible health fallouts, others don’t mind the waking hours so much.

For instance, Dubai-based advocate Anjana Bhatia, 51, is used to sleeping four hours a day.

"Now I believe that my body only requires four hours of sleep. It is something I am getting used to now.”

- Anjana Bhatia

“The nature of my job is that my brain is working overtime. I spend a lot of time understanding my case and preparing. I stay up late doing research, read and see how I can do my best for my client,” said Anjana Bhatia.

Inherited or acquired?

Lack of sleep hasn’t negatively impacted the advocate’s health so far. “It will perhaps start showing me signs later at some point,” Anjana Bhatia said, adding that she had consulted doctors who recommended sleeping tablets. “But I don’t take it. I would rather deal with it in the natural way.”

Speculating on the reasons for not getting enough sleep, Anjana Bhatia said: “I think it has been handed down to me by my parents. My siblings too are all working students. Our lives are hard and busy. We are multi-tasking and so sleep does not get a priority.”

To induce better sleep at night, she started walking in the mornings. “That too has not helped. Now I believe that my body only requires four hours of sleep. It is something I am getting used to now.”

‘Sleep is not a priority for me’

Another Dubai-based expatriate Darwin Perez, 44, barely gets three hours of sleep in a day. This has been the case with him since his high-school days. “I used to work for a fast-food company. I was also studying for my undergraduate studies. So I would not get sleep for long hours.” Perez said his job as a make-up artist has not helped his sleeping pattern either. “I have shoots in the wee hours. I need to be punctual for my clients. So sleep is not a priority for me.”

“I have shoots in the wee hours. I need to be punctual for my clients. So sleep is not a priority for me.”

- Darwin Perez

He said lack of sleep has not impacted his health negatively. “I get tired only when there is an outdoor shoot and it goes on for long hours. It is rare that I feel the need to sleep for longer than four hours.”

Different sleep cycles

What’s sleep?

Sleep is a rest period for the body while the brain remains active. It is essential to re-energise the body and mind as it plays a critical role in the functioning of the brain and the body, besides helping to stave off diseases.

According to Mark Wu, sleep expert and neurologist at Johns Hopkins, “Sleep is a period during which the brain is engaged in a number of activities necessary to life — which are closely linked to the quality of life.”

Why do we sleep?

There are several theories on why we sleep. One theory suggests that inactivity at night is a survival function to stay out of the way of predators. But that was dismissed by the argument it is safer to remain conscious to ward off danger.

The energy conservation theory says sleep helps reduce an individual’s energy demand and expenditure at night when it is not feasible for hunter-gathers to search for food.

One explanation that gained traction from recent studies is that sleep allows the body to repair and rejuvenate itself. The findings show that major restorative functions like muscle growth, tissue repair, protein synthesis and growth hormone release occur mainly, or only, during sleep, a report from the Division of Sleep Medicine at Harvard Medical School said.

How does sleep occur?

There are several internal body clocks, called circadian clocks, in the brain and other organs. They are triggered by daylight and darkness, allowing us to remain alert during the day and sleepy at night with the help of neurotransmitters and hormones released by the brain, according to a report by the Harvard T.H. Chan School of Public Health.

Hormones like melatonin and cortisol control circadian clocks or rhythms. Melatonin makes you sleepy, so the body releases more of these hormones at night and suppresses them during the day.

What happens during sleep? What are the different phases of sleep?

When we are asleep, the brain will repeatedly go through two types of sleep: REM (rapid-eye movement) sleep and non-REM sleep.

Non-REM sleep is the first part, which consists of four stages. Stage 1 is just before falling asleep. Light sleep is the second part, during which breathing, heart rate, muscle movements and brain activity slow down, and body temperature drops.

The third and fourth stages are deep sleep, the more restful and restorative sleep phase. During this phase, the heart rate and breathing are the slowest, and people awakened at this time do not adjust immediately and often feel disoriented for several minutes, according to the Harvard T.H. Chan School of Public Health.

During REM, which tends to occur later at night and early morning, brain activity increases as breathing become faster and heart rate rises. Dreams are most common in this phase. Limbs become temporarily paralysed, so you do not act out the dream. Memory is processed and stored during REM sleep, the Harvard report said.

How’s sleep linked to circadian rhythms?

Circadian rhythms are 24-hour cycles that control the human body’s sleep-wake pattern. These are part of the body’s internal clock and are influenced by light and dark and other factors. These rhythms use hormones like melatonin and cortisol to align sleep and wakefulness with day and night to help the body rest and repair. Since cortisol makes people more alert, the body produces more of it in the morning.

A disruption in circadian rhythms leads to sleeping problems. If the signalling from the body’s internal clock is poor, a person will struggle to fall asleep at night. This results in inadequate or low-quality sleep, leading to health disorders, according to the Sleep Foundation.

Foods that help induce sleep

There are many foods that are said to enhance a good night's sleep.

Almonds , for instance, and many other nuts are an important source of melatonin, which regulates the body's internal sleep clock.

Banana, on the other hand, contains tryptophan and magnesium, both of these properties may help you get a good night’s sleep.

Rice and oatmeal (which is also a known source of melatonin) have been reported to induce drowsiness when consumed before bed.

Turkey contains the amino acid tryptophan, which increases the production of melatonin, which in turn induces sleep.

Dairy products like milk, cottage cheese, and plain yoghurt , are known sources of tryptophan.

Chamomile tea contains apigenin, an antioxidant that binds to certain receptors in the brain that helps to induce sleep.

Kiwis are said to be a source of serotonin, a brain chemical that helps regulate the sleep cycle.

Tart cherry juice is also known to promote sleep.

Fatty fish which has omega-3 fatty acids and vitamin D can improve sleep since it increases the production of serotonin.

Walnuts with their fatty acid makeup also contribute to better sleep.

More studies need to be conducted to conclusively verify the benefits of many of the foods in enhancing sleep quality, but available data shows that many of these foods do help in inducing sleep.

Light, circadian rhythm, melatonin

Sleep is badly affected by light, disturbing sleep cycles, circadian rhythm and melatonin production.

Circadian rhythm is an internal clock, controlled by the circadian pacemaker, that manages multiple processes in the body, including sleep. Light exposure could badly affect the circadian rhythm, according to sleep disorder specialists.

The way light alters circadian rhythm depends on the timing of light exposure. When light is perceived early in the morning, it pushes the sleep schedule earlier. Light exposure in the evening pushes the sleep cycle backwards toward a later bedtime, according to sleep specialists.

Melatonin is a hormone that is naturally made by the body, and its production is closely tied to light. In response to darkness, the pineal gland in the brain initiates the production of melatonin, but light exposure slows or halts that production.

What is Melatonin?

Melatonin is also known as the “sleep hormone”. It plays a role in your natural sleep-wake cycle. At night, melatonin in the blood goes up to its highest natural levels.

Besides regulating your sleep-wake cycle, melatonin also helps you respond to light and darkness — more melatonin is produced when it gets dark to help you sleep. Less melatonin is produced as the sun rises and your eyes are exposed to light to help you wake up.

Which part of the body produces melatonin?

Melatonin production is carried out in the pineal gland. The gut and most parts of the body’s cells also produce this hormone. However, the melatonin made in the pineal gland regulates your circadian rhythm and sleep-wake cycle.

What about melatonin supplements?

Melatonin supplements may help you fall asleep more quickly (when the correct dosage is taken at the right time) and have become a popular alternative to prescription sleep aids.

However, melatonin supplements may also come with some side effects — including daytime sleepiness, irritability, and mild headaches.

Start with the foods you eat. Boosting your melatonin levels the natural way, combined with proper sleep hygiene and a healthy diet, can help you get a good night’s sleep and avoid the side effects that may come with supplements.

It is best to consult your doctor before taking a new supplement or making changes to your medication or supplement routine.

5 foods to avoid before bed to get a good night's sleep

• Spicy food
•  Chocolate
• Tomatoes
• Pizza
• Citrus fruits

What happens to your brain when you’re constantly sleep-deprived?

Sleep deprivation leads to exhaustion and you lose the ability to focus. Your brain just kind of “floats”.

It’s not just your brain. A report by Cleveland Clinic states chronic sleep deprivation affects your appearance. Over time, it can lead to premature wrinkling and dark circles under your eyes.

A landmark study in 2017 suggests chronic sleep deprivation actually triggers the brain to “eat itself”.

The research, conducted by Michele Bellesi of the Marche Polytechnic University in Italy and published in the Journal of Neuroscience, concluded that missing sleep can cause long-term harm.

In animal experiments, one effect of sleep deprivation is that it sends the brain’s immune cells into “overdrive”.

This may be helpful in the short term, but it raises the risk of dementia in the long term, the researchers claimed.

In the study, titled “Sleep loss promotes astrocytic phagocytosis and microglial activation in mice”, Michele Bellesi of Italy’s Marche Polytechnic University and colleagues suggested that a chronic lack of sleep puts people at risk of Alzheimer’s disease and other neurological disorders.

The reason: The brain cells that destroy and digest worn-out cells and debris go into overdrive.

What happens when these worn-out brain cells go on overdrive?

This overdrive mode helps clear potentially harmful debris and rebuild worn circuitry in the short term. This helps protect healthy brain connections. But it’s seen as potentially harmful in the long term.

And this explains why a chronic lack of sleep puts people at risk of Alzheimer’s disease and other neurological disorders,

Mimicking the effects of chronic sleep loss

Bellesi and colleagues compared the brains of mice that had either been allowed to sleep for as long as they wanted, or had been kept awake for a further eight hours.

Another group of mice were kept awake for five days in a row – mimicking the effects of chronic sleep loss.

What is the role of glial cells in the brain?

There are two brain glial cells of interest to sleep researchers — “astrocyte” cells and microglial cells.

Glial cells, also known as neuroglia, form part of the housekeeping system of the brain.

These cells surround the neurones of the central nervous system embedded between them, providing both structural and physiological support. Glia cells do not carry nerve impulses, but they perform key functions.

Using high-density EEG recordings, Bellesi’s team specifically looked at glial cells.

Previous studies show that after a period of sleep deprivation, a gene regulating the activity of these glial cells gets fired up with greater activity.

One glial cell type, known as “astrocyte”, curbs unnecessary synapses in the brain to conduct a re-wiring of the synapses. Another glial cell type, known as a microglial cell, prowls the brain for damaged cells and debris.

In well-rested mice (undisturbed sleep), astrocytes appeared to be active in around 6 per cent of the synapses in their brains.

In sleep-deprived mice – those that had lost eight hours of sleep — showed astrocyte activity in around 8 per cent of their synapses.

In the chronically sleep-deprived animals, the cells were active in 13.5 per cent of the synapses.

What’s the significance of the study?

The research demonstrates a key scientific fact: that sleep loss can trigger astrocytes in the brain to start breaking down more of the brain’s connections, as well as their “debris”.

“We show for the first time that portions of synapses are literally eaten by astrocytes because of sleep loss,” the New Scientist quoted Bellesi as saying. Much of the “remodelling” was of the largest synapses, which are more mature and used more intensively. The team also found that microglial cells were more active after chronic sleep deprivation.

Here’s a more worrying fact: an overdrive in microglial activity has been linked to a range of brain disorders.

“We already know that sustained microglial activation has been observed in Alzheimer’s and other forms of neurodegeneration,” Bellesi added.

Does getting more sleep help to protect the brain?

Whether getting more sleep to “recover” from a few sleepless nights and protect the brain or rescue it from the effects of this glial cell overdrive is unclear from the study. It was also not immediately clear how long the effects of sleep deprivation last.

How much sleep do we need?

Most adults need 7 to 9 hours of sleep daily but some may be okay with 6 hours while others require as many as 10 hours. Older adults require lesser amounts of sleep, 7-8 hours. However, the judge of what is the right amount of sleep required for you is only you. Look out for tiredness. If you feel drowsy during the day, you could be sleep deprived.

What are the treatments for sleep disorders?

Sleep disorders are treated according to their types and intensity.

Insomnia

In insomnia, people have difficulty falling or staying asleep, affecting the quality of sleep. Changing sleep habits and addressing any possible causes, such as stress, medical conditions or medications, can restore restful sleep for many people. Treating insomnia typically involves sleep-inducing medication, cognitive behavioural therapy for insomnia (CBT-i), or a combination of both.

CBT-i is considered a first-line treatment for insomnia and is often provided by a licensed psychologist. It may involve one or more of the following components such as:

• Sleep education and hygiene
• Stimulus control
• Sleep restriction and compression
• Relaxation techniques

Sleep apnea

Sleep apnea occurs when a person's breathing is interrupted during sleep. People with untreated sleep apnea stop breathing repeatedly during their sleep. A variety of treatments are prescribed for people suffering from sleep apnea, including counselling, medications and supplements. They are also often advised to practise sleep hygiene and to get regular exercise. Your healthcare provider might also prescribe some medicines depending on the severity of the symptoms.

Restless legs syndrome

Restless legs syndrome (RLS), also called Willis Ekbom disease causes uncomfortable feelings in the legs, such as itching, prickling, pulling, or crawling. These sensations create an uncontrollable urge to move the legs. The desire to move one’s legs makes falling asleep and staying asleep difficult for many people with RLS. Sometimes, RLS is associated with other medical conditions, such as late-stage kidney disease, iron deficiency, neuropathy, multiple sclerosis, or Parkinson’s disease. RLS may also have a genetic component.

Triggers

Sitting or resting are common triggers for RLS symptoms. Additionally, some substances can make symptoms worse. These include alcohol, caffeine, nicotine and certain medications.

Treatment

Removing the triggers is the first step in managing the symptoms of such patients.

Home care tips

Some of the following practices that can help reduce the symptoms in patients with RLS are:

• Practising sleep hygiene
• Exercises
• Pneumatic pressure therapy

Massage and hot baths

Apart from these home care tips, RLS is also treated with certain medications that your doctor might deem fit for you.

Narcolepsy

Narcolepsy is characterized by severe and persistent daytime sleepiness that can cause seriously impact the everyday activities of the affected person.

Although there is no cure for narcolepsy, some of the symptoms can be treated with medicines and lifestyle changes. Excessive daytime sleepiness and cataplexy (loss of muscle tone) can be controlled in most individuals with several stimulants or wake-promoting medications.

How sleep affects body weight

Researchers have long suggested a link between lack of sleep and changes in metabolism. Sleeping fewer hours was found to increase hunger. Too little sleep is known to trigger a cortisol spike. This stress hormone signals your body to conserve energy to fuel your waking hours.

Sleep duration affects ghrelin and leptin which are hormones regulating hunger.

Leptin, made by fat cells, decreases your appetite. Ghrelin increases appetite, and also plays a role in body weight as it increases food intake and promotes fat storage. It is observed that short sleep duration was linked with an increased risk of obesity. Hormones like leptin and ghrelin are responsible for regulating appetite. Lack of sleep results in weariness and a decrease in physical activity, all of which contribute to weight gain.

Sleep is linked to heart disease, stroke, diabetes and cancers

Heart diseases

Sleep deprivation heightens the risk of heart attacks. In one study, people sleeping less than six hours per night had a 20% higher chance of a heart attack, according to sleepfoundation.org. The heart slows down and recovers during the NREM sleep stage while, REM sleep involves heightened stress and activity. Insufficient sleep can throw off the balance, increasing heart attack risk.

Sleep interruptions have also been linked to heart attack risk. Because both heart rate and blood pressure can abruptly spike upon awakening, frequent sleep disruptions can cause cardiac stress and may induce a heart attack.

Stroke

A stroke occurs when blood flow to the brain is cut off, leading to the death of brain cells from lack of oxygen. Sleep deprivation increases blood pressure, and high blood pressure is considered to be the leading risk factor for strokes. Insufficient sleep also contributes to plaque buildup in the arteries, making it easier for blockages to occur and cause strokes.

Diabetes

Studies have found that lack of sleep worsens glucose metabolism in the body. Poor sleep is associated with prediabetes, a type of glucose intolerance that does not meet the parameters for diabetes. Diabetic patients who have insufficient or troubled sleep may have a harder time controlling their blood sugar. Further, impaired sleep could endanger lives by worsening the hardening of arteries in people with type 2 diabetes.

Cancers

There is no established link between sleep and cancer. However, studies have pointed out that disruptions in the body’s biological clock, which controls sleep, may raise the chances of cancers of the breast, colon, ovaries and prostate.

Sleep is one of the most important aspects to rejuvenate your body, don’t ignore it. But before taking any medications or supplements, you should consult your doctor.