Blog

McXtra Care Newsletter | August 2019

Section A

MAIN FEATURE

Causes of difficulty in sleeping and Inadequate sleep

Understanding Sleeplessness (Difficulty in sleeping) and its health impact?

‘Somnus’ means sleep in Latin, therefore Insomnia refers to an inability to sleep. Every adult needs around 8 hours of uninterrupted sleep for optimal health, wellness and functioning. Medically when we use the term Insomnia, it includes any of the symptoms below:

• Difficulty falling asleep
• Waking up during the night and having trouble going back to sleep
• Waking up early in the morning before completing required duration and quality of sleep
• Feeling tired upon waking which can further lead to

• Sleepiness and tiredness during the day
• Irritability
• Decreased concentration, performance or memory

Short term (acute) insomnia or episodes of inability to sleep, generally lasts for a few days to few weeks (< 1 month) and settle down once the body clock adjusts with passage of time. The term Chronic Insomnia (long term inability to sleep) is used when present for at least one month or longer. Some international guidelines define Chronic insomnia as present for 3 or more months and at least for 3 nights in a week.

Long term Health Impact of Inadequate sleep

Inadequate duration and quality of sleep deprivation has seen to be associated with increased long term risk of health issues like:

• Hypertension (high BP)
• Heart disease
• Diabetes
• Obesity/weight gain
• Anxiety-depression

Causes of Insomnia

Short term (Acute)

Long term (Chronic)

Lifestyle and Occupational

• Loss or change of job
• Moved to a new place
• Travel-jetlag
• Frequent late night social events
• Working in shifts
• Worry of an event like exam or performance
• Other temporary challenges/problems of daily living

• Sedentary habits (lack of exercise)
• Decreased sunlight/outdoor exposure
• Being overweight/ Obese
• Substance abuse like smoking/alcohol
• Drinking multiple beverage cups in a day (tea/coffee)
• Chronic job or financial stress
• Meal timings and habits
• Bed-time habits

Environmental
(Usually cause short term insomnia but can sometimes cause chronic insomnia also)

• Noise (like a party or social event going on nearby, speeding vehicles, train sound from nearby tracks or planes taking off/landing, noisy fans/AC, loud ticking clocks etc.)
• Light (someone working-studying in the room/house, open curtains-street lights)
• Extreme temperatures (Ideal recommended temperature is 20-24 deg C)

• Too hot like loss of electricity, load shedding, inadequate cooling
• Too cold like a very chilled AC, inappropriate covering/quilt/sheet

• Type of mattress, sheets and pillows (hard, stiff, rough or sagging ones)
• Insects (mosquitoes/bugs)

Short term (Acute)

Long term (Chronic)

Psychological or Emotional

• Death of a loved one
• Relationship issues – divorce, breakup, moving away from someone close/ missing someone
• Arguments/fights/emotional disturbance

• Most common – Anxiety, Depression
• Others – Obsessive compulsive disorders, Fear-Phobias, Bipolar disorder and Schizophrenia
• Loneliness especially in old-age

Short term (Acute)

Long term (Chronic)

Physical condition or illness

• Pain (due to injury, exertion or infection)
• Fever
• Cold (due to blocked nose)
• Cough
• Nausea-Vomiting or Diarrhea
• Indigestion leading to gas and feeling of acidity
• Itchy skin rash
• During menstruation
• Certain medicines/drugs

• Asthma
• Arthritis, Spondylitis, back pain
• Sinus diseases, Nasal allergies (nasal blockage)
• Acid reflux and acid related diseases
• Diabetes, Heart disease
• Urinary problems – frequent night-time urination as seen in enlarged prostate
• Pregnancy, Menopause (hormonal changes)
• Hyperactive Thyroid gland
• Neurological causes: Alzheimer’s, Parkinson’s disease, Migraine, Restless leg syndrome
• Skin – Chronic itching problems
• Certain medicines/drugs

Section B

TRENDING FEATURE

10 Health Solutions for Improving Sleep

Regularize sleep timings: Fixing or regularizing he time one goes to sleep and gets up, should be a goal on most days. Avoid daytime naps (if an afternoon nap is part of your lifestyle then regularize its timing and keep duration under 1 hour, and before 5pm.)

Reduce and restrict gadget use between dusk and bedtime: This is seen mobile phones, kindles, IPads and laptops, which can suppress release of the sleep-promoting hormone melatonin (the blue light from gadgets is largely responsible). Switch on blue light filter on display settings after dusk. Avoid keeping the mobile phone or a watch/clock right next to your bed. Keep it at least a little more than an arm’s length away.

Relaxation tips at bed-time

Try a luke-warm water bath/shower, light reading, listening to music, making a next day-plan (breaking up intimidating tasks, delegating and prioritizing) by preparing a to-do-list/ list for the next day, or writing a day’s diary at bedtime as these can help lower stress, anxiety and head cluttering which can help falling asleep better. However, do not review finances, bills or work related/domestic problems at bed-time.
A simple bedtime lying routine consisting of focusing successively on each section of the body and consciously relaxing each part, followed by focusing on your breath (inhaling and exhaling) and visualizations of positive, serene, pleasing scenes/ visuals, helps to fall asleep.
Never force yourself to sleep: If you are not falling asleep 15-20 minutes after lying in bed, it is better to get up, do some light reading, hear music, or make a to-do list till you feel drowsy (use dim light like a bedside lamp– avoid putting on a bright light).

Bedroom Environment

Bed comfort: Check for comfort of your mattress, pillow, sheets and quilts
Temperature: The room should not be too hot or cold so check fan speed regulators and AC temperatures (maintain at 20-25 deg C)
Noise: Avoid noisily ticking clocks, noisy fans/AC in the room, or use ear plugs
Light: If the room is not dark enough due to reasons beyond your control, use an eye mask
Pests: Get regular pest control done and keep a check for mosquitoes, bed bugs and flies- Insecticide treated mosquito nets are available. Avoid burning coils in the room

Lifestyle Habits:

Avoid consumption of ‘stimulant’ substances after 5 pm like coffee (caffeine), tea, chocolates, high sugar drinks and nicotine (smoking/chewing tobacco) as these prevent you from falling asleep
Alcohol: Though that occasional glass of wine or alcoholic drink relaxes you and gives you good sleep, chronic consumption of alcohol can actually interfere with sleep quality and cause more waking in the night (disturbed sleep). It is best for people suffering from chronic insomnia to try and give up on alcohol, however if for social reasons, you do want to continue having alcohol, then-
- Restrict alcohol to not more than one glass in a day and not more than once or twice a week
- Avoid neat drinks, or gulping drinks
- Do not drink empty stomach
- Give a gap of 2-3 hours between drink and bed-time

Meals and Snacks: As dinner is the last main or heavy meal of the day, a gap of 2 hours is recommended between dinner and bed-time. Avoid going to bed on a heavy stomach.

Bed-time hunger: If feeling hungry at bed-time, a light snack (max: 200 calories) helps you go to sleep, as being hungry also prevents falling asleep. Some light snack options include fruits (apples, banana, kiwis, strawberries, cherries or dried cranberries), yogurt, cereal in warm milk, vegetables or a single cheese slice with a slice of brown bread, boiled egg, whole grain cracker, nuts (almonds, pistachios, or walnuts), herbal/green tea or a protein drink.

Fluid intake: Drink 1.5-2 liters of water a day. Have a glass of water just before bed-time and a sip just before sleeping, to avoid waking from sleep due to thirst. However, do not take too much water or fluids at bed- time as it may cause you to wake up to pass urine. Urinate once just before getting into bed.

Exercise habits
- Exercise for at least 5 days in a week for half hour to 45 minutes/day. Exercise can be brisk walking, jogging, cardio/treadmill, cycling, yoga, swimming, or aerobics
- Keep a gap of minimum 3-4 hours between the end of your daily exercise schedule and your bed-time
- At least 2 hours of sunlight exposure during the daytime helps the circadian rhythm better to enhance falling asleep in the night

Medical evaluation and management
- An underlying medical condition causing sleeping difficulty should be ruled out. Suggestive symptoms on lying down include:
  - Heartburn (acidic feeling in the chest), gas/bloating/nausea/acidity
  - Nasal stuffiness
  - Pain in any part of the body
  - General body itching
  - Breathlessness
  - Cough
  - Headache
  - Restlessness (Restless leg syndrome: abnormal leg sensations causing repeated movement and lack of sleep)
  - Desire to frequently pass urine, all suggest a physical disorder requiring specific treatment
- A psychological evaluation to assess presence of anxiety (typically prevents falling asleep), depression (causes early morning waking before adequate sleep completion) or other mental disorders, should also be done, and if present treated appropriately.

Medicines and Pills – It is important to note that medicines for inducing sleep should not be taken without medical recommendation, prescription and monitoring as inappropriate or over the counter usage may lead to side effects and may end up disturbing sleep on a long term instead of than aiding it.

Medicines being taken for physical disorders like some cold medicines containing caffeine or decongestants, steroids, certain anti-depressants, anticonvulsants, drugs for weight loss or suppressing appetite, drugs treating attention deficit disorders, certain medicines for heart disease, blood pressure and asthma, and hormonal treatments, can also be the cause of insomnia.
Switching to alternate medicines or altering the time of taking these medicines can help in restoring sleep rhythm.

Section C

SPECIAL FEATURE

Snoring – Causes, risk factors and simple lifestyle solutions

What is snoring and why does it happen?

Snoring refers to loud, harsh noises during sleep. This happens due to narrowing of the air passages of the nose, mouth and throat due to falling back of the tongue and relaxation of the throat muscles. It is more commonly seen while sleeping on one’s back.

Who are the people predisposed to snoring?

The following are some of the factors which make a person more likely to snore:

• Male gender and Increasing age
• Alcohol taken late evening, or a late heavy meal/dinner
• Sleeping in dry environments or lack of hydration
• Obesity (more fat around the neck) or being overweight
• Smokers
• Certain medicines: muscle relaxants or antianxiety pills taken at bed-time
• Problems in the nose: Nasal allergies, Heavy cold, Outgrowths or swelling in the nose or when the dividing bone of the nose is slanting (deviated nasal septum -DNS)
• Throat infections, Enlarged tonsils or adenoids (common reason for snoring in children)

What is sleep apnea?

If the air passages of the throat, nose or mouth narrow down to such an extent during sleep that there are moments when breathing stops completely, it is called sleep apnea. The person makes grunting, gasping or choking loud sounds during sleep apnea episodes. This helps the person to momentarily wake up so that air passages open and breathing starts again, though person may not realize or remember the same. These multiple episodes of apnea and waking during sleep prevents deep and restful continuous night sleep.
Snoring in sitting posture as seen in many plane/vehicle passengers is an indication of more airway obstruction and has an even higher risk for sleep apnea.

Does snoring cause any health problems?

People who snore often have a feeling of tiredness in the morning as if they have not slept or rested enough. This may be accompanied by daytime sluggishness, sleepiness or irritability and not able to concentrate optimally. Feeling of dryness in the mouth and nose may also occur.

If sleep apnea is present along with snoring, the feeling of daytime tiredness and sleepiness maybe even more, sometimes with morning headaches. Long term risk of developing diabetes, weight gain, fatty liver, high blood pressure, heart disease and stroke is increased.
Therefore, from both short term and long term health and wellness perspective it is important to look for solutions to reduce and control snoring and sleep apnea.

Health solutions for Snoring

A) Lifestyle measures
- • Train to sleep on your side than on your back. Using an extra pillow to prop up the head or elevating head end of bed can help. If you snore while sitting in flights/vehicles, avoid reclining
- • Avoid heavy meals and alcohol at least 3 hours before bedtime
- • If overweight, consult a nutritionist for a weight loss and exercise plan with a target reduction of at least 2-3 kgs to have an effect on reducing snoring
- • Avoid intake of muscle relaxants and antianxiety/sleeping pills (of benzodiazepine group of medicines)
- • Get a complete medical examination done to rule out the mentioned issues in mouth, throat or nose
- • Treatment of nasal stuffiness due to nasal allergies or cold with decongesting medicines or nasal sprays can help reduce snoring
- • AC and closed dry environment (like seen in flights) can cause drying of air passages and increased tendency to snore. A humidifier spray or saline nasal spray can help. Have a few sips of water just before going to sleep
- • There is some research to suggest that smoking increases snoring risk therefore smokers are advised to restrict and give up the habit

B) Anti-snoring exercises
The aim of these exercises are to
- • Increase the tone and strength of throat, tongue and palate muscles
- • Keep air passages open at all times

5 ANTISNORING EXERCISES (Hold time 5 seconds; 5 repetitions)

Stick the tongue out of the mouth fully as much as possible, then move it to one side and then to the other side as much as possible without curling the tongue. Hold in each position for 5 seconds, and then put back in. Do this at least 5 times.
With the tongue in the mouth, open the mouth wide, hold for 5 seconds and close. Then open wide again, move the lower jaw to one side, hold for 5 seconds, bring back and close. Then open again wide and move lower jaw to the other side, hold for 5 seconds, bring back and close mouth. Repeat this set of 3 exercises 5 times.
Press the tip of the tongue on the roof of the mouth, then move it as back then as front as possible on the roof of the mouth (palate). Repeat this back and forth motion 5 times.
With your index finger in the mouth, push the cheek away from the teeth for 5 seconds then release. Do this on each side around 5 times each.
Pronounce the 5 vowels for 5 seconds each, one by one with full mouth stretch for the particular vowel.

C) Antisnoring pillows and Devices
- • These help to keep the air passages open. (Pillow types shown below)
- • For devices, consult your doctor (physician, ENT or dentist) before ordering or using them. Devices like CPAP (Continuous Positive Airway Pressure) are advocated only after diagnosing sleep apnea through sleep tests at home/sleep clinics
- • Very rarely a surgical correction may be needed

Mind Tickle

Solve the crossword below with the clues given

	Across
	1 – Long term health impact of sleep deprivation can increase risk of ______ disease
	2 – Avoid this in the afternoon to get good night sleep
	3 – Sleep Hormone
	4 – Use this colour phone filter after dusk
	5 – The scientific name for inability to sleep

	Down
	1 – A type of inclined pillow for Snorers
	2 – Episodes of stoppage of breathing during sleep
	3 – Avoid beverages containing this in the evenings
	4 – Weight gain due to lack of sleep long term can lead to this
	5 – You must do this as last thing before sleeping to avoid getting up in the night