We all live in a society that is becoming increasingly demanding on our emotions and our psychology. Despite this it is estimated that we are in general sleeping one hour a night less than 75 years ago and by sleeping less we are increasingly adopting behaviours that increase such emotional demands and fail to allow us to restore our psychological well-being.
Sleep is one of the most important natural therapies that is available to humans and it is for that reason that we often sleep when we have simple infections such as influenza and gastroenteritis. During sleep the brain enters a different series of wave patterns that allow us not only to dream naturally but also to produce and restore some of the essential neuro-chemicals or brain chemicals – serotonin and noradrenaline – that are vital to psychological well being and the prevention of depression and psychological illness. During sleep the brain’s wave patterns change through several cycles. Important is the initial deep slow wave sleep that we start with and which is dependent upon the brain being reasonably rested before sleep.
Throughout sleep we have periods of what is called rapid eye movement (REM) sleep. During this phase of sleep we dream and much of our body is paralysed. REM sleep occurs three or four times during the night and is important for two functions. Firstly neurochemicals are produced during REM sleep and it is important to have several cycles of REM sleep during the night to produce these vital products. Secondly difficult, stressful and unpleasant experiences are processed during REM sleep and taken from the left side of our brain (called the left cortex) where they remain active and are in our recent memory to the right cortex where they enter our long term memory and are “peacefully” stored. It is for this reason that sleep is particularly important if we have stressful or emotionally demanding situations in our lives. In a good sleep pattern the last REM sleep occurs just before we wake and if you wake naturally without an alarm clock and remember your dreams it is a good indicator that you are sleeping enough.
As a family doctor I see a lot of patients and children and teenagers with sleep deprivation. Loosing one hour’s sleep a night is the same as drinking too much alcohol and makes us accident prone, unable to concentrate well and liable to make mistakes at work and be less productive. In our personal relationships it leaves us stressed and irritable and less able to both receive and give pleasure from and to our friends and families. Patients that sleep late at the weekend are also demonstrating that they are sleep deprived and need to catch up from their loss of sleep. Unfortunately not everybody has the ability to catch up in this way and they are then left chronically sleep deprived and prone to depression. The psychological effects of severe sleep deprivation have of course been known to such agencies as the KGB and western intelligence for many years.
Patients often ask me how much sleep they and their children need. In general adults need 8 hours per night and children at the age of 5 need 10 hours decreasing gradually to 8 hours as they become late teenagers. Children who are sleep deprived often show signs of bad behaviour, irritability and cannot concentrate and perform well at school. In particular they seem to have less ability to quietly concentrate on a task and often are over or hyperactive. Restoring their normal sleep pattern can have huge benefits for family life.
Quality of sleep is also important and there are many factors that prevent good sleep. It is particularly important that the brain is rested before sleep so that it enters a correct set of wave patterns at the onset of sleep. Quiet activities such as reading or watching television (but not violent or extremely dramatic films) will generally match the brain’s wave pattern before sleep and are beneficial. Meals containing carbohydrates some 2 hours or so before sleep seem to stimulate good sleep. Increased emotional activities such as worry, thinking about tomorrow’s problems and physical activities such as preparing the families lunch or doing housework just before going to bed are not useful as they increase brain wave activity. In particular computer games and hand held games are very bad as they create intense brain wave activity that takes some 2 hours to decrease and thus disturb normal deep initial sleep. In fact any use of a computer before sleep should be avoided. Alcohol in small quantities upto 50ml is usually beneficial but more than that increases brain activity some 2-3 hours after initial sleep and often wakes patients. Sexual activity produces hormones and changes in the circulation that enhance good sleep.
Sleep also increases our immunological health and allows us to become better at fighting and preventing infections and in preventing malignant disease.
In our next issue I will write a little more about the fascinating world of sleep disorders.
Dr Richard Styles FRCGP
American Medical Centre, Kiev, Ukraine