Unpacking Bad Sleep

A little stress is a good thing. Chronic stress, however, is a killer.

Cortisol is one of our key stress hormones.

• A healthy Cortisol level is an essential part of wakefulness; it helps us adapt to our changing circumstances, may even contribute to longevity.
• Normally, stress is a temporary spike – Cortisol rises and then quickly subsides.
• Chronic stress, however, is a killer. One of the ways it kills us is by impairing our sleep –
• typically contributing to insomnia – high cortisol at night preventing sleep
• but often, also to (compensatory) sleep deprivation – think revenge content watching.
• Because sleep is also one of the best ways to combat stress, stress-induced poor sleep becomes a self-propagating vicious cycle.

Strategies to combat stress-induced lack of sleep are as varied as the aspects of stress-linked impact on sleep – this warrants a separate article.

• Sleep Apnea (and it’s sneaky sidekick, snoring).

Breathing is essential for us to continue living.

For many people who have a small airway, are overweight, spend a lot of time on their back, smoke or have a stuffy nose for any reason, normal breathing is often interrupted at night.

The moment this interruption happens, a signal from the brain makes us immediately wake up. This is an evolutionary survival reflex, because if we continue sleeping without breathing, we will die.

A normal, healthy sleeper wakes up as many as 30 times a night (we usually don’t observe most, if not all of these awakenings). For someone suffering from Sleep Apnea, this number can go higher than 120 times.

Countermeasures include some oral exercises, warm beverages, decongestants, warm showers, playing the djeridoo and, if nothing else works, CPAP. To be expanded separately.

• Stimulants

• Caffeine is the commonest sleep blocker we encounter.
  • It acts by attaching to our receptors of Adenosine (the currency of our tiredness).
  • Caffeine takes time to clear from the body – half the caffeine you had in the evening is likely to still remain in your body at bed time.
• There are many other such substances, though:
• Alcohol has the biggest disruptive effect on REM sleep known to man. It also reduces deep sleep.
• Smoking has similar ill-effects on sleep – it directly contributes to Apnea, raises heart rate, keeps awake from nicotine’s stimulating effect and contributes to poor sleep through many other processes.
• Lifestyle

Content consumption: In a 2017 earnings call, Netflix declared a war on sleep.

Be it due to stimulation addiction – our need to stay wired and engaged spilling from the day into the night – or binge-watching as a coping mechanism to deal with the day’s stresses, too much screen time in the night ends up demolishing sleep in two ways:

1. Our brain perceives blue light as the day sky – seeing it, Melatonin production stops, disrupting sleep.
2. Certain types of content can keep our wakefulness hormones (Cortisol, Adrenaline and others) high well into the night, keeping us from easing into sleep. Sitting is the new smoking.

1. Not enough Adenosine.
2. The bidirectional relationship between exercise and sleep: Implications for exercise adherence and sleep improvement Conversely, certain workouts late in the day can shift the temperature and hormonal balance away from sleep.

• Delayed Sleep-Wake Phase Disorder

A complicated term for a prolonged period (weeks to months) when, for various reasons, you choose to sleep at unconventional hours, often with unnatural breaks.

Reasons for this:

1. Shift work: If you work in the day and sleep at night.
2. Jet lag: If night time comes sooner in the place to where you travel than where you travel from (to which your body’s Circadian rhythm is tuned)
3.  Caregiving: New parents (especially mothers) tend to sleep and wake with their babies. Contrary to the adage, adults should never have to ‘sleep like a baby’. This could also be true for other caregiving responsibilities. WHO now classifies any kind of late-night shift work as carcinogenic

The Insomnia Severity Index is a screening quiz for insomnia – a good way to quantify whether For gauging daytime sleepiness, the Epsworth Sleepiness Scale (ESS) tells you how your perceived sense of sleepiness might compare with the average.