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Sleep Disorders, an introduction and what we can do.

Sleep Disorders – Causes and Cure

The average human life expectancy is approximately 80 years and out of these 80 years, humans spend 26.7 years sleeping (FastStats - Life Expectancy, 2021). This makes sleep one of the most critical factors in your life. Proper sleep increases your productivity at work, helps you make decisions clearly and allows you to enjoy your daily life. Not only does sleep affects the quality of life logically, but also it affects your overall brain functioning biologically. Proper sleep can help you get rid of many physical, mental and behavioral issues.

On the other hand, a lack of sleep can make you suffer from fatigue or low energy, at day time, reduced decision power, and disturbed moods which lead to various sleep disorders (Medic et al., 2017). The causes of sleep disorder can be underlying medical health issues, mental health problems, serious neurological conditions or simply environmental factors. Sleep disorders can potentially shorten your life span. Fortunately, there are several ways to cope up with sleep disorders.

 

Immune System and Sleep

Recent research in the field of neuroimmunology has revealed that there is a strong relationship between a healthy sleep and improved immunity. Studies have shown that, early nocturnal sleep increases the number of undifferentiated T cells and proinflammatory cytokines (Besedovsky et al., 2012). Increased number of undifferentiated Naïve T cells in the blood is a sign of a strong immunity. These naïve T cells proliferate and differentiate into cells that are capable of removing the antigen upon interacting with antigen. Similarly, cytokines help immune cells find the antigen and fight against it. Presence of more cytokines in the blood indicates a good immunity (Asif et al., 2017). This is why patients suffering from any infection tend to sleep more because it increases the production of cytokines leading to enhanced immune response.

Cause of Sleep Disorders

Abnormal or poor sleep refers to a condition when you cannot enjoy a peaceful continuous sleep at night or during the day. These conditions are commonly known as sleep disorders. The most common sleep disorders include insomnia, apnea, restless leg syndrome (RLS), circadian rhythm disorders, narcolepsy, and parasomnias.

The causes of sleep disorders can cab be divided into four main categories.

Medical

Medical conditions such as asthma, kidney disease, heart failure, heartburn and musculoskeletal disorders can cause sleep disorders in adults (Gupta et al., 2017). Sleep disorders because of a medical cause are often apparent.

Normal sleep can be restored as soon as the medical condition is cured. If you still find it difficult to have a proper sleep after full recovery, the reason might be something else and not the disease.

Psychiatric

Some mental health issues can be the cause of sleep disorders. Depression, general anxiety, apprehension, schizophrenia, bipolar disorder, obsessive-compulsive disorders, phobias and panic attacks happened to be associated with sleep disorders (Costa e Silva, 2006).

If you are experiencing anxiety, pressure, depression, or any phobia, your sleep can be upset, leading to other mental and physical problems. A session with your psychiatrist might help decide the primary cause of sleep deprivation.

Neurological

Apart from some physical and mental health issues, neurological conditions like epilepsy, dementia, headache, brain tumors, Parkinson’s disease, and similar neurodegenerative diseases can cause sleep disorders (Rémi et al., 2019).

Sleep disorders caused by neurological disorders can indirectly be treated by curing the underlying neurological disorder. If you are experiencing excessive or repeated pain in the head, you must immediately consult the specialist to have a thorough brain examination.

Environmental

The reason of disturbed sleep might be just environmental factors such as excess light, increased or decreased temperature, an itchy bed, uncomfortable pillow, humidity, noise, and rays from electron devices. Research has shown that blue light can significantly damage the photoreceptor (Tosini et al., 2016). Edward C. Harding from Imperial College London has concluded that the body tends to have a better sleep at 27–30°C. At this temperature, the body gains thermoneutrality which means the body does not require to spend energy in maintaining the temperature (Harding et al., 2019). Similarly, a study published in the scientific journal Frontier in Neurology concluded that administration of broadband background music (bass, mid, treble) helped patients with insomnia sleep 38% faster than in a normal environment (Messineo et al., 2017).

It is better to set up a cozy environment before you go to sleep. Maintaining temperature, adjusting light intensity according to your needs, using the correct pillow, cleaning your bed and/or covering yourself with a suitable blanket can help you improve your quality of sleep and wake up energetic.

Takeaway

Humans spend 1/3rd of their life sleeping which makes it an essential part of our life. Sleep is a complex biological condition of the body with decreased metabolism and motor activity. Proper sleep can improve your quality of life, while lack of sleep or sleep disorder can disturb your daily routine. The underlying cause of sleep disorder can be some medical condition, mental health problem, neurological disease or simply some environmental factors. It is necessary to understand and cure all the potential causes of sleep disorders to enjoy sound slumber peacefully.


 

References

(US), N. I. of H., & Study, B. S. C. (2007). Information about Sleep. https://www.ncbi.nlm.nih.gov/books/NBK20359/

Asif, N., Iqbal, R., & Nazir, C. F. (2017). Human immune system during sleep. American Journal of Clinical and Experimental Immunology, 6(6), 92–96. http://www.ncbi.nlm.nih.gov/pubmed/29348984

Besedovsky, L., Lange, T., & Born, J. (2012). Sleep and immune function. In Pflugers Archiv European Journal of Physiology (Vol. 463, Issue 1, pp. 121–137). Springer. https://doi.org/10.1007/s00424-011-1044-0

Colten, H. R., Altevogt, B. M., & Research, I. of M. (US) C. on S. M. and. (2006). Sleep Physiology. https://www.ncbi.nlm.nih.gov/books/NBK19956/

Costa e Silva, J. A. (2006). Sleep disorders in psychiatry. Metabolism: Clinical and Experimental, 55(SUPPL. 2). https://doi.org/10.1016/j.metabol.2006.07.012

FastStats - Life Expectancy. (n.d.). Retrieved May 18, 2021, from https://www.cdc.gov/nchs/fastats/life-expectancy.htm

Gupta, R., Das, S., Gujar, K., Mishra, K., Gaur, N., & Majid, A. (2017). Clinical Practice Guidelines for Sleep Disorders. In Indian Journal of Psychiatry (Vol. 59, Issue 5, pp. S116–S138). Medknow Publications. https://doi.org/10.4103/0019-5545.196978

Harding, E. C., Franks, N. P., & Wisden, W. (2019). The temperature dependence of sleep. In Frontiers in Neuroscience (Vol. 13, Issue APR). Frontiers Media S.A. https://doi.org/10.3389/fnins.2019.00336

Hirshkowitz, M., Whiton, K., Albert, S. M., Alessi, C., Bruni, O., DonCarlos, L., Hazen, N., Herman, J., Katz, E. S., Kheirandish-Gozal, L., Neubauer, D. N., O’Donnell, A. E., Ohayon, M., Peever, J., Rawding, R., Sachdeva, R. C., Setters, B., Vitiello, M. V., Ware, J. C., & Adams Hillard, P. J. (2015). National sleep foundation’s sleep time duration recommendations: Methodology and results summary. Sleep Health, 1(1), 40–43. https://doi.org/10.1016/j.sleh.2014.12.010

Kiyohara, Y. B., Tagao, S., Tamanini, F., Morita, A., Sugisawa, Y., Yasuda, M., Yamanaka, I., Ueda, H. R., Van Der Horst, G. T. J., Kondo, T., & Yagita, K. (2006). The BMAL1 C terminus regulates the circadian transcription feedback loop. Proceedings of the National Academy of Sciences of the United States of America, 103(26), 10074–10079. https://doi.org/10.1073/pnas.0601416103

Lo, J. C., Twan, D. C. K., Karamchedu, S., Kai Lee, X., Lynn Ong, J., Van Rijn, E., Gooley, J. J., & Chee, M. W. L. (2019). Differential effects of split and continuous sleep on neurobehavioral function and glucose tolerance in sleep-restricted adolescents. Sleep, 42(5), 1–10. https://doi.org/10.1093/sleep/zsz037

Ma, M. A., & Morrison, E. H. (2019). Neuroanatomy, Nucleus Suprachiasmatic. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/pubmed/31536270

Medic, G., Wille, M., & Hemels, M. E. H. (2017). Short- and long-term health consequences of sleep disruption. In Nature and Science of Sleep (Vol. 9, pp. 151–161). Dove Medical Press Ltd. https://doi.org/10.2147/NSS.S134864

Messineo, L., Taranto-Montemurro, L., Sands, S. A., Oliveira Marques, M. D., Azabarzin, A., & Wellman, D. A. (2017). Broadband sound administration improves sleep onset latency in healthy subjects in a model of transient insomnia. Frontiers in Neurology, 8(DEC), 718. https://doi.org/10.3389/fneur.2017.00718

Rémi, J., Pollmächer, T., Spiegelhalder, K., Trenkwalder, C., & Young, P. (2019). Sleep-Related Disorders in Neurology and Psychiatry. In Deutsches Arzteblatt international (Vol. 116, Issue 41, pp. 681–688). NLM (Medline). https://doi.org/10.3238/arztebl.2019.0681

Tosini, G., Ferguson, I., & Tsubota, K. (2016). Effects of blue light on the circadian system and eye physiology. Molecular Vision, 22, 61–72. http://www.molvis.org/molvis/v22/61

 

Sleep, what it is and why we need some.

What is sleep?

Sleep is a complex biological process in which your body goes into reduced metabolic and motor activity. It is a reversible state of the brain unconsciousness. When the brain or body is tired and exhausted, they tend to go to a restful state known as sleep (US & Study, 2007). The brain has a dedicated small region that controls the sleep-wake cycle known as hypothalamic suprachiasmatic nucleus (SCN). SCN contains various kind of cells, proteins and neurotransmitters that help it interact with different parts of the brain to control the circadian rhythms (Ma & Morrison, 2019).

Stages of a Normal Sleep

There are two phases of sleep - rapid eye movement (REM) sleep and non-REM (NREM) sleep. During the REM sleep, your eyes moves rapidly in random directions, but the brain does not receive any visual information. REM is about 20-25% of sleep in adults. During NERM sleep, blood flow to the brain, body temperature, and sympathetic nerve activity is decreased as compared to wakefulness. It is a dreamless state of the brain and corresponds to 75-80% of the NERM-REM sleep cycle. The whole NERM-REM cycle takes approximately 70-120min and then the cycle repeats itself (Colten et al., 2006).

Human circadian clock is a highly dynamic and complex mechanism on molecular level. Humans anticipate day and night because of the change in the expression level of hundreds of genes that control the rhythm thereby affecting their behavior, physiology and metabolic processes. Interestingly, the 24h sleep-wake cycle is switched from sleep to wakefulness or vice versa by only a single amino acid of the protein called BMLA1 (Kiyohara et al., 2006). This discovery by Paolo Sassone-Corsi, a professor at the University of California, gave a new hope to the treatment of the sleep disorders.

Now that you know, sleep can have a substantial impact on your quality of life, you’re probably  thinking “I need to be sure to sleep properly.” But one question must be popping into your mind, “How much sleep is necessary for the proper functioning of the brain and body?” Well it depends.

How much sleep is necessary?

According to National Sleep Foundation, young adults require 7-9 hours of deep sleep. However, the amount of sleep decreases as you get older. Infants (4-11 months) need 12-15h of sleep, young adults (18-25years) need 7-9h of sleep and older adults (65+ years) sleep only 7h or less (Hirshkowitz et al., 2015). Not only is the amount of sleep significant but also how you sleep can affect you. Recent research published by the Centre for Cognitive Neuroscience, Duke-NUS Medical School, Singapore showed that it is better to sleep in two cycles rather than one long sleep. People with split sleep had better memory, faster processing speeds, positive mood, and improved administrative functions even though the overall sleep hours were less than those with a continuous sleep. In other words, the optimum sleep hours depend upon your age but split sleep i.e., 6h at night and 2h nap at noon, is a great way to increase your mental and physical health and improve the overall quality of life (Lo et al., 2019).

Immune System and Sleep

Recent research in the field of neuroimmunology has revealed that there is a strong relationship between a healthy sleep and improved immunity. Studies have shown that, early nocturnal sleep increases the number of undifferentiated T cells and proinflammatory cytokines (Besedovsky et al., 2012). Increased number of undifferentiated Naïve T cells in the blood is a sign of a strong immunity. These naïve T cells proliferate and differentiate into cells that are capable of removing the antigen upon interacting with antigen. Similarly, cytokines help immune cells find the antigen and fight against it. Presence of more cytokines in the blood indicates a good immunity (Asif et al., 2017). That is why patients suffering from any infection tend to sleep more because it increases the production of cytokines leading to enhanced immune response.

References

(US), N. I. of H., & Study, B. S. C. (2007). Information about Sleep. https://www.ncbi.nlm.nih.gov/books/NBK20359/

Asif, N., Iqbal, R., & Nazir, C. F. (2017). Human immune system during sleep. American Journal of Clinical and Experimental Immunology, 6(6), 92–96. http://www.ncbi.nlm.nih.gov/pubmed/29348984

Besedovsky, L., Lange, T., & Born, J. (2012). Sleep and immune function. In Pflugers Archiv European Journal of Physiology (Vol. 463, Issue 1, pp. 121–137). Springer. https://doi.org/10.1007/s00424-011-1044-0

Colten, H. R., Altevogt, B. M., & Research, I. of M. (US) C. on S. M. and. (2006). Sleep Physiology. https://www.ncbi.nlm.nih.gov/books/NBK19956/

Costa e Silva, J. A. (2006). Sleep disorders in psychiatry. Metabolism: Clinical and Experimental, 55(SUPPL. 2). https://doi.org/10.1016/j.metabol.2006.07.012

FastStats - Life Expectancy. (n.d.). Retrieved May 18, 2021, from https://www.cdc.gov/nchs/fastats/life-expectancy.htm

Gupta, R., Das, S., Gujar, K., Mishra, K., Gaur, N., & Majid, A. (2017). Clinical Practice Guidelines for Sleep Disorders. In Indian Journal of Psychiatry (Vol. 59, Issue 5, pp. S116–S138). Medknow Publications. https://doi.org/10.4103/0019-5545.196978

Harding, E. C., Franks, N. P., & Wisden, W. (2019). The temperature dependence of sleep. In Frontiers in Neuroscience (Vol. 13, Issue APR). Frontiers Media S.A. https://doi.org/10.3389/fnins.2019.00336

Hirshkowitz, M., Whiton, K., Albert, S. M., Alessi, C., Bruni, O., DonCarlos, L., Hazen, N., Herman, J., Katz, E. S., Kheirandish-Gozal, L., Neubauer, D. N., O’Donnell, A. E., Ohayon, M., Peever, J., Rawding, R., Sachdeva, R. C., Setters, B., Vitiello, M. V., Ware, J. C., & Adams Hillard, P. J. (2015). National sleep foundation’s sleep time duration recommendations: Methodology and results summary. Sleep Health, 1(1), 40–43. https://doi.org/10.1016/j.sleh.2014.12.010

Kiyohara, Y. B., Tagao, S., Tamanini, F., Morita, A., Sugisawa, Y., Yasuda, M., Yamanaka, I., Ueda, H. R., Van Der Horst, G. T. J., Kondo, T., & Yagita, K. (2006). The BMAL1 C terminus regulates the circadian transcription feedback loop. Proceedings of the National Academy of Sciences of the United States of America, 103(26), 10074–10079. https://doi.org/10.1073/pnas.0601416103

Lo, J. C., Twan, D. C. K., Karamchedu, S., Kai Lee, X., Lynn Ong, J., Van Rijn, E., Gooley, J. J., & Chee, M. W. L. (2019). Differential effects of split and continuous sleep on neurobehavioral function and glucose tolerance in sleep-restricted adolescents. Sleep, 42(5), 1–10. https://doi.org/10.1093/sleep/zsz037

Ma, M. A., & Morrison, E. H. (2019). Neuroanatomy, Nucleus Suprachiasmatic. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/pubmed/31536270

Medic, G., Wille, M., & Hemels, M. E. H. (2017). Short- and long-term health consequences of sleep disruption. In Nature and Science of Sleep (Vol. 9, pp. 151–161). Dove Medical Press Ltd. https://doi.org/10.2147/NSS.S134864

Messineo, L., Taranto-Montemurro, L., Sands, S. A., Oliveira Marques, M. D., Azabarzin, A., & Wellman, D. A. (2017). Broadband sound administration improves sleep onset latency in healthy subjects in a model of transient insomnia. Frontiers in Neurology, 8(DEC), 718. https://doi.org/10.3389/fneur.2017.00718

Rémi, J., Pollmächer, T., Spiegelhalder, K., Trenkwalder, C., & Young, P. (2019). Sleep-Related Disorders in Neurology and Psychiatry. In Deutsches Arzteblatt international (Vol. 116, Issue 41, pp. 681–688). NLM (Medline). https://doi.org/10.3238/arztebl.2019.0681

Tosini, G., Ferguson, I., & Tsubota, K. (2016). Effects of blue light on the circadian system and eye physiology. Molecular Vision, 22, 61–72. http://www.molvis.org/molvis/v22/61