With the world in a state of panic and grappling with the increasing number of COVID-19 cases and the side effects of the pandemic, it is no wonder that many people are struggling to cope with stress, work life balance and sleep.
While data from India is lacking, the Centres for Disease Control and Prevention has found that one in three adults suffer from lack of sleep on a daily basis, and on a regular night, most Americans are sleeping two hours less than we were a century ago.
So why is getting no sleep or little sleep really a problem?
“Without a good night’s sleep, you may find it difficult to concentrate and be productive and may become irritable. You may also be at a risk of developing depression, obesity, heart disease and diabetes,” says Dr. Kartikeya Kohli, Associate Consultant, Internal Medicine.
It is common to have sleep problems if you are anxious, have erratic work hours or have unhealthy eating habits. In a fraction of people, it could also be due to a medical condition.
“You can begin improving the quality of your sleep by measuring it first.”
How to Measure Sleep Quality
In order to assess how well you slept, some people find it helpful to understand the stages of sleep.
The stages of sleep are usually categorized through brainwave frequencies and Electroencephalogram (EEG) measurements/ brain activity, eye and muscle movements.
People enter this stage within a few minutes of falling asleep. In the early phase of this stage, you may be easily awakened. Your breathing and heart rate may decrease slightly. This stage aids in physical and mental rest.
This stage occurs a few hours after you fall asleep. At this time, your heart rate may normalize while your breathing may become slower. Your muscles will relax and you will be unaware of external events.
Apart from helping the immune system, memory and learning, this stage is known to be rejuvenating, which is why you may wake up feeling energetic the next day.
Random Eye Movement (REM) Sleep
This stage usually occurs after deep sleep. Here the heart rate increases and breathing is not regular. Dreams occur in this stage and our eyes move in random directions. Our body parts apart from the head and neck seem numb, to prevent enacting our dreams.
The brain is most active in REM sleep. This sleep helps us process the previous day’s events so they can be stored in our memory, and improves learning and emotional health.
To measure your sleep, you can try either of these ways:
Maintain a diary:
Note down the time you went to sleep, what time you woke up and how many hours you slept. If you woke up in between to visit the washroom or were disturbed by a child or loud noises and couldn’t go back to sleep, write that down too.
You can also mention how many hours before bedtime you had a heavy meal or caffeinated drinks. It is also helpful to state how drowsy or energetic you felt the next morning.
“Comparing answers over a period of time should help you understand the relation between your food and drink patterns, the number of hours you need to sleep and the effects in terms of your mood or energy levels the next day. It also helps to have a record to refer to in case you ever need to consult an expert for sleep issues,” says Dr. Kartikeya.
Use a fitness tracker:
A fitness tracker such as Fitbit helps you keep track of your sleep in addition to tracking your step count and activity. It detects that you’re asleep when you haven’t moved for more than an hour. It measures your sleep pattern which includes the time you were asleep, restless (tossing and turning) and awake (as shown below). It gives you insights into the stages of sleep you passed through and also gives you a sleep score than can motivate you to get more sleep the next time!
There are plenty of other sleep tracking apps like Sleep Cycle or Sleep Watch that you can easily install in your phone to get similar data.
“When you begin measuring your sleep quality, you’ll be in a position to manage it better.”
How to Improve Sleep Quality
Limit screen time before bed time:
Our body runs on an internal clock, called the circadian rhythm, which is influenced by exposure to light and darkness. At night, we produce a hormone called melatonin. The levels of melatonin fall when we are exposed to sunlight. To maintain the circadian rhythm or the sleep-wake cycle, it is important to get sunshine in the day and darkness at night.
Any kind of bright light, from a smartphone or a TV will affect the photoreceptors in your eyes and then impact sleep quality.
“Try to define an hour or so before you sleep during which you scroll through your phone or watch movies. The more activity you engage in closer to bedtime, the more awake you will be which disturbs your sleep cycle,” explains Dr. Kartikeya.
You could try apps like Calm or Headspace that have meditation or sound tracks to lull you to sleep rather than scrolling through Facebook or Instagram.
Associate your bed only with sleep:
While working from home, avoid working from your bedroom. If you want to bring your laptop to your room to watch a movie, sit away from the bed. Try to associate your bed only with sleep so that the minute you lay down at the end of a long day, your brain knows that now is the time to rest.
Alter food and drink patterns:
Heavy meals, coffee and alcohol consumption shortly before bed may make it difficult to sleep. The effects of nicotine and caffeine take some time to wear off.
“Avoid drinking coffee after 3-4 pm as caffeine can remain in the blood for 6-8 hours and worsen sleep quality. It stimulates the central nervous system and keeps you awake.“
Drinking alcohol can increase symptoms of sleep apnea and impact production of melatonin, which affects the circadian rhythm.
Experiment with a sleep routine:
This kind of a routine need not begin only at night and can be modified as per your individual needs.
a. Exercise during the day: Physical activity produces adrenaline which energizes you and keeps you awake, which is why it is better to exercise during the day than at night. In some people with insomnia, exercise has been found to have greater benefits than medication!
b. Stick to a sleep schedule: Limit the difference in hours in your sleep cycle on weekends and weeknights. As hard as it can be, try to avoid sleeping till late on the weekends and napping more than 30 minutes during the day.
If you eat dinner two hours before bedtime and can’t help falling asleep soon after, try to read a book or do some cleaning to stay awake until it is time for you to sleep. Sleeping at a set time will help solidify your sleep-wake cycle.
c. Ensure a sleep-conducive bedroom: Your bedroom should be a place where you feel like sleeping. Switch off any bright lights at night, light a scented candle; try to relax by meditating or simply closing your eyes.
“You can also try reading a book or taking a hot shower 90 minutes before sleeping. Hot water is known to be naturally therapeutic and can aid in sleep. If you don’t want to have a proper bath, just dip your feet in hot water. This too can have a soothing effect.”
d. Relax your body and mind: If you don’t fall asleep within 20 minutes, leave your room and do something that doesn’t use up much energy. You can listen to some soft instrumental music or the sounds of a waterfall or just sit in silence. When you’re tired, go back to your room to sleep.
Work on what’s bothering you:
Often we’re unable to sleep because we’re stressed about many things. One way to get some weight off your chest is to write out the situation. Think about the pros and cons and think about it from different angles. Think about what it is that you can do, plan it out and take one step at a time. Working your way through your troubles will ease some of your anxiety and help you rest.
When Might You Need to See a Doctor?
If none of the tips listed above seem to help and you experience sleepless nights for more than a month, consider speaking to a physician.
Take Anshul Pal, 43, for example. Anshul moved to Bangalore early last year for a new job. His wife meanwhile stayed in Delhi. Anshul faced trouble sleeping but put it off thinking he needed time to adjust to the new environment and schedule. But about two months later when he returned to Delhi for a holiday, his sleeping problems persisted.
It was when his wife repeatedly pointed out that he seemed to stop breathing in his sleep that he took it seriously.
“When Anshul explained his restless nights in detail and his wife described his breathless episodes, we did a physical examination and looped in a sleep specialist to assess his condition,” shares Dr. Kartikeya.
“After those evaluations, we did a sleep study through which we confirmed that Anshul had Obstructive Sleep Apnea, a condition in which you experience breathing difficulty at night.”
“I was afraid of the implications of the disorder, but the team explained what lifestyle changes I had to make and recommended a mouthpiece to use,” says Anshul, “which put me at ease.”
In a recent visit before the lockdown, Anshul reported that his sleeping had improved even after returning to Bangalore.
Before approaching a doctor, ask yourself whether you
- Fall asleep while driving
- Cannot concentrate
- Feel drowsy while reading or watching a movie
- Take time to process or understand things
- Feel like you must take a nap almost every day
- Often feel irritable or sensitive
If you answered ‘yes’ to most questions, you may have a sleep problem.
“Remember that many sleep problems can be treated. Don’t delay your visit especially because it means you can get help sooner,” concludes Dr. Kartikeya.
You can check out the following resources for more information: