Articles on sleep disorders

Take This Quiz to Check if You Have a Sleep Disorder!

Dr. Sukhant Bagdia, Pulmonologist
The Epworth Sleepiness Scale (ESS) is a scale intended to measure daytime sleepiness that is measured by use of a very short questionnaire. This can be helpful in diagnosing sleep disorders in people complaining of snoring during sleep. It was introduced in 1991 by Dr Murray Johns of Epworth Hospital in Melbourne, Australia. This questionnaire asks you to rate your probability of falling asleep on a scale of increasing probability from 0 to 3 for EIGHT different situations that most people engage in during their daily lives, though not necessarily every day. The scores for the eight questions are added together to obtain a single number. A number in the 0–9 range is considered to be NORMAL while a number in the 10–24 range is considered to be ABNORMAL which indicates that expert medical advice need to be taken.How to SCORE the increasing PROBABILITY of DOZING:0 = no chance of dozing1 = slight chance of dozing2 = moderate chance of dozing3 = high chance of dozingSCORING finally according to following situations:SITUATIONCHANCE OF DOZING1. Sitting and reading_?0__?1__?2__?3_2. Watching TV_?0__?1__?2__?3_3. Sitting inactive in a public place (e.g a theater or a meeting)_?0__?1__?2__?3_4. As a passenger in a car for an hour without a break_?0__?1__?2__?3_5. Lying down to rest in the afternoon when circumstances permit_?0__?1__?2__?3_6. Sitting and talking to someone_?0__?1__?2__?3_7. Sitting quietly after a lunch without alcohol_?0__?1__?2__?3_8. In a car, while stopped for a few minutes in traffic_?0__?1__?2__?3_Total your SCORE and JUDGE your PROBABILITY for Snoring Related Health Problem.

Good Sleep for Good Health

Ms. Swati Kapoor, Dietitian/Nutritionist
Nothing makes you feel more refreshed than a good sleep in night. It is a natural cyclic state of resting for mind and body. There’s more to an ideal 7-8 hrs of sleep than just preparing our bodies for the next day. Adequate sleep is an essential part of good health and plays an important role in all body functions hence ensuring a better mental and physical fitness.The National Sleep Foundation (NSF) reported that good sleep is essential for a person’s health and well being.Lord Chesterfield very well said that “A light supper, a good night's sleep and a fine morning have often made a hero out of the same man, who, by indigestion, a restless night and a rainy morning would have proved a coward."Now, the question is “Can good sleep make good health?”Yes, sleep makes you feel better. Adequate sleep is a key part of a healthy lifestyle. Without it, one becomes more susceptible to health problems, such as heart disease, obesity, depression and many more. Some facts of sleep which lead to a healthy life are -Good Sleep Keeps Heart Healthy: Lack of sleep has been associated with worsening of blood pressure and cholesterol so some experts say that heart will be healthier if one gets between( 7 -9 hours) of sleep each night.Sleep Helps to Make Body Repairs: Sleep is a time for your body to repair damage caused by stress, ultraviolet rays and other harmful exposures. Your cells produce more protein while you are sleeping. These protein molecules form the building blocks for cells, allowing them to repair damage. This is the time when the cells undergo wear and tear and that’s what makes you feel refreshed in the morning.Good Sleep Reduces Stress: When your body is sleeping deficient, it goes into a state of stress. Therefore it is recommended to have good sleep in order to allow your body to cope with day’s stress and manage it in a better way with a relaxed mind. It is found that any amount of sleep deprivation reduces mental performance.Sleep & Weight Loss: Lack of sufficient sleep affects the appetite regulating hormones. It also aggravates cravings for high-fat and carbohydrate rich foods, making a route to weight gain. It also affects the body’s ability to regulate blood sugar levels, a key factor in weight management. So, if you want to be on a healthy weight, make sure you get a good sleep every night.Good Sleep Reduces Depression: Lack of proper sleep and depression is inter-linked. Depression may lead to insomnia and lack of sleep increases depression. Sleep impacts serotonin levels (feel-good hormone) which affect the mood of an individual.Sleep Prevents Cancer: People working for long hours have a higher risk for breast and colon cancer. There is evidence stating that good sleep can alter the balance of hormones in the body which may influence cancer progression.As very well said by Benjamin Franklin, “Early to bed and early to rise, makes a man healthy, wealthy & wise.”

Are You Getting Enough Sleep?

Dr. Darpan Kaur, Psychiatrist
Sleep is a an essential physiological function of the human body. Sleep plays a very important function in restoring the wear and tear of daily life and providing the desired rest and restitution to the body and mind. As we grow older, the quality of our sleep may change. When we are younger as in childhood we tend to have more hours of sound sleep but as we  grow older the number of hours we sleep and the quality of sound sleep can deteriorate significantly. Moreover, the demands of work, professional deadlines, travel stress, physical ill health, excessive gadgets usage before bedtime, mental stress, all of these can contribute towards poor sleep! Some of the common sleep problems are difficulty in falling asleep. difficulty in maintaining sleep, sleep disturbances such as bad dreams excessively, night mares, etc, sleeping too less or too much and not feeling fresh after getting up from sleep. In today's life style of travelling across the globe and night shifts can lead to disturbance in our body's natural circadian rhythm which can lead to jet lag, shift work sleep disorder, etc. Poor sleep quality can also be associated with cardiac events and accidents. Poor sleep can make us inattentive , irritable, distracted, restless, sleepy and groggy at our workplace and study place. A person having chronic untreated sleep problems can also have problems with efficiency and work performance.  Insomnia, Hypersomnia, Parasomnia are types of sleep disorders. Certain medical conditions, medications and substances such as alcohol, cannabis, nicotine can also interfere with sleep. Sleep disturbance is also a part of psychiatric disorders such as adjustment disorder, acute stress reaction, post traumatic stress disorder, depression, mania,psychosis, addictions, etc. Children can have bed wetting and night terrors during sleep. I have written some dos and donts which is not a fully comprehensive list, yet can be helpful for getting good sleep.Dos:It is preferable to stop late night use of gadgets, apps, internet, TV viewing if you are having problems in falling asleep. Learn to switch off from all of these everyday at least an hour before you go to sleep. Practice relaxation daily before going to sleep. Deep breathing exercises while lying on your bed with a focus on breathing slowly and being aware of each breath and slowing down your system with use of some positive images in your mind can help in falling asleep.Late Evening prayers can helpful for sleep based on your own belief systems.Eat light meals at bedtime and drinking a cup of warm milk can help in getting sleep.You may add almonds, cashew nuts, saffron, etc based on your preference. Taking a relaxing shower prior to bedtime can help sleep well. Do cut down on daily intake of excessive consumption of sugar, salt, oil,spices in your diet if you are experiencing severe gastrointestinal discomfort while falling asleep and also waking up at night feeling uneasy, bloated, acidity, pain in abdomen, etc.Monitor  daily intake of tea and coffee and cut down intake if you have problems with sleep.Be positive at bedtime. Live for each day to its fullest ! Tell your mind positive self statements at bed time that " Yes, I am doing good! I am doing fine! Things are great! Life has been good to me! I shall conquer all my problems! No need to worry! Things are in control! Situation will get better! I can work something out! Life is beautiful! I am doing well for myself! Things will change for the best! "' These kind of positive statements said to yourself can help you gain  control over negative defeating thoughts which maybe coming in your mind at bedtime while you stare at the ceiling trying to fall asleep at night especially when you are facing difficult stressful times. Try to cut down on smoking and chewing tobacco. Seek professional help for de-addiction from nicotine and tobacco.Try to cut down on alcohol if you are facing problems in sleep  related to alcohol. Seek professional help in quitting alcohol.  Drugs such as cannabis, cocaine, heroin, etc have harmful consequences on sleep and mental health. Seek professional help to quit from them.Try to have a fixed schedule of sleeping at the same time and waking up at the same time everyday. Pay attention to your bed room, clean the bed room regularly, keep changing sheets regularly and keep replacing old bed sheets, pillows, pillow covers regularly. Pay attention to the right temperature settings and dress in comfortable night clothes as per your preference.Donts:Do not drink excessive caffeine, tea, stimulant drinks before going to sleep or  late evening if you are having problems falling asleep.Tobacco  can interfere with sleep and avoid smoking or chewing tobacco just before going to bed. Alcohol can interfere with sleep and avoid drinking alcohol before going to bed.Do not indulge in drugs such as cannabis , cocaine, heroin,etc as they interfere with sleep.Do not eat heavy meals or drink too much water just before going to bed.Avoid excessive TV viewing or internet viewing just before going to sleep. Avoid excessive texting and playing online games just before going to sleep.Do not do excessive rigorous exercise  very late evening if u are having a persistent problem in falling asleep  as it can switch on certain neurotransmitters and can interfere in falling asleep for some individuals.Do not use your bed for eating, drinking, studying, watching TV, working/surfing on your lap top. Do not sleep with lights and gadgets on as it can cause sleep interference.Do not think and worry excessively about how was your day, who upset you, why u did this or that and why you shouldn't have done this or that. All these ruminations, worries, anxiety just before going to sleep will certainly affect your sleep. Do not cry or pick up quarrels with others before going to sleep as it will affect your sleep quality.Do not keep getting up and checking the phone, alarm clock or the watch to see what is the time again and again.Do not have a varied sleeping schedule which is very erratic where in one day you sleep at eleven pm the second day at one am and third day at three am. Do not take long hours of nap in the afternoon or evening as it then interferes in falling asleep at night. If despite your best efforts, you are not able to get good sleep, kindly consult a psychiatrist. The psychiatrist will screen you for a psychiatric disorder where sleep disturbance may be a predominant symptom such as anxiety disorder, stress related disorder, depression, mania, psychosis, etc. They will assess you and provide you treatment for your sleep problems based on whether you have Insomnia, Hypersomnia or Parasomnia related conditions. After clinically evaluating you, they may suggest some tests, teach you relaxation training, sleep hygiene therapy and psychological therapy targeting the cause of your sleep problems. They may also prescribe you medications for the sleep condition you suffer from.  He/She may also refer you to a Neurologist or  a Sleep Physician as per clinical expertise for conditions such as Sleep Apneas, Nocturnal Epilepsy, Narcolepsy, Restless Leg Syndrome, etc which may need a a comprehensive  evaluation with Sleep Lab based assessments and multidisciplinary interventions.

Weight Loss Can Prevent and Cure Sleep Apnea

Ms. Swati Kapoor, Dietitian/Nutritionist
Apnea literally means "cessation of breath." If you have sleep apnea, your breath can become very shallow or you may even stop breathing while you are asleep. This state of not breathing can occur for 10 seconds in an hour, or in severe cases, the frequency of cessation of breath may further increase. The repeated episodes of apnea (lack of breathing) cause frequent night time awakening.Individuals with this disorder often complain of morning headaches, constant fatigue, and moodiness, and can fall asleep almost anywhere. More seriously, they can fall asleep even while driving. Obstructive sleep apnea is much more common in obese individuals. It is believed that the airway of obese individuals get obstructed by large tonsils, an enlarged tongue and increased fat in the neck. This presses airways when the pharyngeal (throat) muscles are relaxed during sleep. A person's neck circumference is a good predictor of sleep apnea. Obese men with a neck circumference of 17 inches or greater, and women with a neck circumference of 16 inches or greater are more likely to have sleep apnea.The worst part is that it is not only obesity that has an association with sleep apnea, but sleep apnea even results in poor sleep which increases food cravings. Lack of good quality sleep increases the chances of hormonal imbalance by increasing the level of ghrelin hormone. Ghrelin is a hormone known for its effects on appetite and disturbed levels of ghrelin hormone leads to an increased appetite which further leads to weight gain.Individuals with sleep apnea often have elevated blood pressure, high fasting glucose, and high cholesterol. Lack of sleep triggers stress hormones which stimulate the cell’s glycogen to get converted into glucose. This suppresses the function of insulin due to which blood sugar levels shoot up leading to diabetes and heart problems, all of which can worsen with further sleep deprivation. So, it's a vicious cycle. Obesity can lead to sleep apnea, which, itself, then causes derangements of hormones that control eating habits, leading to more weight gain, worsened blood pressure, glucose intolerance, worsened apnea and the cycle goes on and on.So, healthy eating with exercise leads to weight loss and not only helps in preventing such a vicious cycle of health problems but also helps in the cure of sleep apnea.

Lack of Sleep Makes You Gain Weight

Ms. Swati Kapoor, Dietitian/Nutritionist
You are too busy to eat and yet you are putting on weight. Are you getting enough sleep? Maybe this is what really sabotaging your weight and not your diet. Lack of sleep makes us crave more cups of coffee/tea or high sugar food like biscuits to perk us up. All this result in added calories. Besides if you are sleep-deprived, meaning that you are not getting good quality sleep, your metabolism will not function properly. Getting little or disturbed sleep causes hormonal imbalance which leads to weight gain. Sleep is very important. Here are some facts about how sleep might be affecting your health -Lead you to Overeating: Many studies have shown that your diet and your sleep patterns are related. Lack of sleep can lead to disturbed physiology of your body. So, when you do not get enough sleep it may lead to cravings and over-consumption of calories because when you are craving for food it is so easy to get tempted to reach for a cup of coffee and a doughnut for a quick shot of energy. But this will only adds up to your weight so sleeping at least eight hours each night helps you in managing your weight.Hormonal imbalance: Lack of sleep or disturbed sleep increases the chances of getting obese. Many studies have shown that when you do not sleep enough it disturbs your hormonal balance by increasing the level of ghrelin hormone. Ghrelin is a hormone known for its affect on appetite and disturbed level of ghrelin hormone leads to increased appetite. Disturbed hormones level also lead to irritation or frustration feeling without any specific reason.Effects your metabolism: When your body is deprived of sleep your metabolism slows down and will not function properly. It directly affects your weight loss as your body is not working effectively in burning the calories. That slowdown triggers the release of the hormone cortisol, which increases appetite. Your body thinks it needs more energy and that’s why you feel hungry.For better health and to manage your weight it is important to get 8 hours of sleep a night. If you have trouble sleeping try to have a routine of at least 30 minutes exercise during the day and keep pre-bedtime activities relaxing.

Understanding Dental Problems: Bruxism

Dr. Ragini Parmar, Dentist
Have you lately been grinding your teeth at night and keeping your spouse awake? If yes, then you probably suffer from Bruxism. Bruxism commonly known as teeth grinding is a dental condition where one clenches their teeth involuntarily. This could be caused during the day or night. It can be caused by stress, abnormalities with the teeth, or lifestyle problems. It also occurs in conjunction with sleep disorders like sleep apnea. Symptoms of BruxismMost people who suffer from Bruxism are unaware of their condition. Diagnosing Bruxism can be difficult on an individual level. That sounds tough but it doesn’t have to be. You can keep an eye out for symptoms like:If you wake up in the morning with a headache, earache, or a tender jaw, you might be suffering from Bruxism.You might notice some damage on the inside of your cheek or tongue.​The GRINDING sound-A spouse sleeping next to you is more likely to hear you grind your teeth, and can help you diagnose the problem.If you are unsure, whether you suffer from this problem or not, you can consult a dentist. A professional will be able to check your teeth for signs of wear and provide you with the right line of treatment.Since it is an involuntary action, you might even be grinding your teeth very hard when lifting weights. Maybe tone the body and tone down the teeth grinding? It’s only wearing out your teeth.Another common symptom is sensitivity of teeth when having cold or hot foods and water. This feeling might persist even when sucking in air through the mouth.Effects of BruxismBruxism can cause a lot of problems. It can result in wearing down the enamel, breaking or chipping of your teeth, etc. This could result in increased tooth sensitivity, cavities or extreme deterioration of teeth. It is also difficult not to notice it. So keep an eye out! Quite literally. Self-examination is key.Treatment for BruxismDon’t worry, the case of Bruxism is not as hopeless as it sounds. The following cures can be provided:First and foremost, your dentist will provide you with a mouth guard that will protect your teeth and the enamel. Please remember this is the preventive measure and not a permanent solution.If your problem is caused by excess stress, it is imperative for you to reduce your stress levels. This can be done via various methods like physical exercise, prescription of stress relievers, consulting a counsellor, and more. Or taking a few days off. Stacking on office leaves is not helping anybody.If your teeth grinding is caused by sleep disorders, it is important to solve it at the root. You will need to consult a physician regarding treatment for the sleep disorder.In extreme cases, the teeth can be ground down to stumps. This would require immediate attention resulting in affixing dentures or dental implants.These steps will help you in correctly diagnosing and treating your teeth grinding problems. So de-stress, enjoy life, and let your dentist worry about the teeth grinding.

Better Sleep Better Health !!

Dr. Trupti Vedpathak, Psychiatrist
Given that an average person sleeps for 8 hrs in a day, that means we spent on an average one third of our life sleeping. Everyone has problem with their sleep at times. This is perfectly normal. In most cases, this problem often gets resolved by itself; however, if it last for long, it is likely to impact day-to-day functioning and eventually affect the quality of your life. A large percentage of people suffering from sleep disorder often opt for temporary solution by having sleeping pills which later becomes a habit.Following are few easy tips to deal with sleep problems:Establish a routine: Set a strict bedtime schedule by getting up at the same time every day, this will help as your body will start to associate times of the day with sleeping.There should be minimal variations in sleep timings during weekends & holidays.Make your bedroom a calm place: Relax your mind & body by keeping the bedroom dark & quiet & cool.Turn off electrical screens: Mobiles, computers, TV stimulate the brain, making it hard to relax. 'wind down' time of 1 hr before going to bed is preferred.Avoid naps: Do not nap during the day or confine naps to early afternoon; no longer than 40 minutes.Notice what you eat or drink: Avoid tea or coffee after 4pm. No smoking or tobacco for atleast 1 hr before bedtime. Do not eat heavy meals near bedtime. A glass of warm milk or banana or warm bath at bedtime will help induce sleep.Avoid clock gazing: Do not repeatedly look at the clock at night, it will make you more anxious. If an alarm clock is needed, place it in the drawer where it can be heard but not seen.Try to do some exercise: Exercise daily. Do not exercise too close to bedtime, as it can disrupt your sleep.Try to resolve your worries: Write your worries on a piece of paper & allot a time during the day to think over it.Check for physical cause: If any pain,  physical illness or mental illness or medication is making it difficult for you to sleep, see a doctor.Don't force yourself to sleep: This will make you more anxious. If sleep doesn't occur in bed for more than 20 min then move out of bed without switching on the light & return back only when sleepy.Sleep plays a critical role in immune function, metabolism, memory, learning, and other vital functions. So lets SLEEP WELL & STAY HEALTHY..

Insomnia & Sleep Hygiene

Dr. Suhasini Das, Psychiatrist
Sleep is an important component of our daily activities. It not only provides rest to our conscious mind, it is also the 'repair-time' for the body. Adequate sleep is essential for optimal functioning of the mind and body, especially those tasks that involve our cognitive resources like attention and concentration, learning and memory. Newborn infants can spend 16 to 18 hours per day in sleeping in early months of growth which decrease to 6 to 8 hours per day over years. However, with increasing studies, work pressure and responsibilities, we somewhere end up compromising on our sleep which then can have long term effects. Insomnia or difficulty in initiating or maintaining sleep is a common sleep disorder that is encountered very frequently. It can lead to daytime drowsiness, irregular sleep patterns, difficulty in attention and concentration, irritability, use of alcohol to fall asleep, night-time eating behaviours and overall decrease performance and productivity.Insomnia can be the primary disorder or it can be the manifestation of underlying psychiatric illness like depression (most common), anxiety disorders like generalized anxiety disorder, panic disorder, schizophrenia or due to substance use like alcohol, cannabis, cocaine etc. At times, insomnia can be due to certain medical conditions too.What is sleep hygiene?Sleep hygiene basically means doing activities that will help in maintaining sound sleep and full daytime alertness. Before starting any medication for insomnia, it is important that we have a good sleep hygiene. Some of the tips are mentioned below:DOs:Maintain regular sleep timingsMaintain regular exercise schedule Give yourself an hour to wind up before going to bedIf you are preoccupied with something, write it down on a paper and deal with in the morningKeep the bedroom quiet, dark and comfortable.DON'Ts:Avoid afternoon napsExercise just before sleep to wear yourself outEat heavy meal just before sleepDrink coffee or tea at nightSmoke cigarettesWatch television or laptop if you cannot get sleepUse alcohol to fall asleepEat in bedTalk on the phoneWatch the clock If all the above points are followed meticulously, you will notice a significant improvement in your insomnia. If however, your insomnia is chronic or lasting more than 1 month, it is advised that you seek professional help rather than self-medicating. It is also advised not take any sleeping pills without recommendation of doctor as side-effects like drowsiness, dependency, rebound irritability can develop on long-term use without proper guidance.