Sleep and its Importance

Nearly one-third of human life is spent in sleep. Sleep can be defined as an easily reversible state of relative unresponsiveness and serenity which occurs more or less regularly and repetitively each day. The electroencephalography recordings show typical features of sleep which is broadly divided into two broadly different phases: D-sleep (desynchronized or dreaming sleep) – rapid eye movement (REM) sleep, active sleep, or paradoxical sleep S-sleep (synchronized sleep) – NREM sleep, quiet sleep, or orthodox sleep. NREM sleep has four phases – Stage 1, Stage 2 (sleep spindles, k-complexes), Stage 3, and Stage 4. NREM sleep is followed by REM sleep, which is a light phase of sleep. These stages of sleep occur regularly throughout the whole duration of sleep. SLEEP AND AGE The usual sleep duration of a new-born child is 16–18 h/day, with nearly 8–10 h spent in REM sleep. In an 8 h sleep, usually 6–6½ h are spent in the NREM sleep while 1½–2 h are in REM sleep. A younger person may need more sleep. As the age advances, the sleep duration tends to reduce. Depending on the duration of total sleep, two extremes of normal sleeping pattern have been described. Long sleepers – these persons regularly and habitually sleep for more than 9 h/night and this pattern does not cause any symptoms or dysfunctions Short sleepers – these persons regularly and habitually sleep for <6 h/night and this pattern does not cause any symptoms or dysfunctions. FUNCTIONS OF SLEEP The functions of sleep are still far from clear. It had been observed that persons sleeping for 6–8 h per day have significantly lower rates of illness. It has been observed that there is 5%–25% decrease in metabolic rate during night sleep and energy is conserved.[1] Sleep also serves a restorative function for the whole body (during NREM sleep) and for the brain (cognitive functions and REM sleep). COMMON CAUSES OF INSOMNIAS Insomnias are the disorders of sleep initiation or maintenance or poor quality of sleep. The common causes of insomnias are as follows: Medical illness like – painful conditions, cardiac and respiratory diseases, rheumatic and musculoskeletal disease, etc. Substance abuse, intoxication and withdrawal states - alcohol, caffeine, amphetamines Medications such as steroids, propanolol, theophylline, and fluoxetine Psychiatric disorders such as mania, depression, anxiety, and stressful conditions Idiopathic insomnia. Currently, we are seeing lot of cases post-COVID-19 insomnias; the exact cause is still unclear. Digitalization and excess usage of mobile phones, gadgets, i.e., INTERNET ADDICTION is also one of the cause of insomnias. SLEEP HYGIENE Before starting any medications, we explain few basic steps for improving sleep. They are: Regular, daily physical exercises (preferably not in the evening) Minimize day time naps Avoid fluid intake and heavy meals just before bed time Avoid caffeine intake before sleeping hours Avoid regular usage of alcohol and stimulants Avoid watching television and mobile phone while in bed Sleep in a dark, quiet, and comfortable environment Fix regular times for going to sleep and waking up Try relaxation techniques. MEDICATIONS Currently, benzodiazepines are being used as the first choice drugs for treating insomnia. Z class drugs such as zolpidem are having less addiction potential. Newer medications such as melatonin and lemborexant (orexin antagonists) are being used for treating insomnia and are showing promising results.[2,3] A CURSE TO DOCTOR’S Despite constantly explaining to all our patients and family members regarding the importance of sleep, as doctors we do not maintain adequate sleep. We are noticing premature death of doctors in society, which is quite alarming. Due to patient commitments and increased work load, we experience poor quality of sleep, in turn which is one of the risk factors of various morbidities. Let us take a pledge from today to improve our own sleep hygiene and reduce morbidity and mortality. Data availability statement The data supporting the findings of this study will be made available upon reasonable request.