The Sandman Must Sometimes be Coaxed.
By Dr. Peter W. Kujtan, B.Sc., M.D., Ph.D.
As infants we spend about half our time engaged in this activity, and then waste another third of our lives continuing to do this same thing. It’s called sleep and without it we are rendered useless. If you don’t get enough or can’t do it properly, you can end up depressed, fatigued and even develop significant heart problems. We are not totally sure why it is so important, but is seems that all mammals require sleep. It may be a form of hibernation, but everyone agrees that a good sleep is very refreshing. Doctors, pilots, police officers and other shift-workers know very well what happens if you try to go without, when all body processes begin to slow down or get confused. Sleep activation is an area of much concern. We do know that a 24 hour rhythm is important, as is light. Most people adopt a particular body posture, in a specific place and need a pre-bed routine for optimal sleep. Our eyes close and our sense of awareness decreases. But our brain is quite active in its own way. In fact, it is the brain that most requires sleep. Brain activity tends to alternate between two very different stages. NREM or “non-rapid eye movement” sleep is a slow and passive activity and decreased muscle tone. It is the first stage of sleep and can be further characterized into sub-types. The more tired you are, the longer NREM sleep onset you tend to experience. REM or "rapid eye movement" is the other major sleep stage. It follows NREM, and in addition to rapid eye movement, activation of muscle tone and genital engorgement occurs. Despite this, it is a deeper stage and more difficult to awaken from. This is also the stage associated with increased brain activity and dreams. Dreams are thought to be a conscious experience that begin with hallucinations where there exists perception of objects without sensory input. During dreaming we deceive ourselves into believing that events are real. Most dream themes revolve around our fears, anxieties and sexuality. Dreaming serves a purpose in brain rejuvenation and development. Not everyone dreams in color either, and we tend to recall dreams more vividly, if we are woken up immediately after the REM phase.
During sleep we go through cycles of alternating NREM-REM phases. For a good night s sleep to occur we humans need at least 3 or more such cycles during the course of a night. Presiding coroners in our area take call for 168 straight hours. During those 7 days, restful sleep is scarce. One of the most disruptive forces in my own life is to receive those 3 a.m. nuisance calls. Obtaining further restful sleep is particularly difficult since my body feels partially rested. Add in frustration when the call is non-vital, and I find that I do better to stay up and write more columns.
There are many disorders associated with sleep including; sleep apnea, restless leg syndrome, snoring, and chronic insomnia. Entire institutes exist to study these problems. Doctor’s order sleep studies frequently to investigate problems. Good sleep hygiene is vital. You should attempt to go to sleep at the same time every day. People traveling through time zones can most appreciate the importance of good sleep hygiene. Teenagers are another case in point, since data now exists to support their late night habits. Adolescents tend to need up to 10 hours of sleep nightly, but tend to fall asleep fairly late and are most rested when they arise in the late morning. This seems to be a hard generalization in a society whose secondary education system revolves around early awakening and learning. On the other end, as we get older our sleep requirements fall. Some 80 year olds function perfectly well on 4 hours sleep. Short daytime naps are acceptable and should be taken with-in 8 hours of early awakening.
Difficulty falling asleep is perhaps the most common problem that patients seek help for. We tend to advocate refraining from caffeine in the evening, avoiding intense exercise late in the evening and attempting to forgo those mini-naps on the couch watching television as the first line of treatment. Using decongestants or other forms of self-medication at night can prevent sleep activation. Some people self medicate with alcohol commonly referred to as a “night-cap” prior to retiring. At times this can make things worse. Generally, we tend to prescribe mild sedatives and good sleep hygiene when things just don’t straighten themselves out. A good example is shift workers. These groups need to adjust their sleep patterns every few weeks, which sometimes leads to problems. The sandman does not always visit every night but if you continually wake up non-rested, it is worth looking into it a little deeper.