In the 18th Century, poet Irayimman Thampi penned Kerala’s much loved lullaby ‘Omana thinkal kidavo’ to lull his little nephew Swathi Thirunal to sleep. He likened him to a crescent moon, the lotus, gems, peacocks and even flowers’ nectar. Three centuries later, Kochi seems to be trying to put itself to bed. Sleep labs are now staples at hospitals, hoardings across the city ask you if you’ve had a good night and pharmaceutical companies market assorted sleeping aids. As Kochi grows into an urban haven, its nights are often peopled by the awake. Are we slowly becoming the city that rarely sleeps?
The last decade has seen a definite increase in patients reporting sleep disorders, observes Anand Kumar, Head of Department, Neurology at Amrita Institute of Medical Sciences. Most commonly, people complain of insomnia in varying strengths, dozing off in spurts during the day, or of snoring and sleep apnea. “Insomnia comes in two kinds,” says C.J. John, consultant psychiatrist at Medical Trust Hospital (MTH). “Patients either find it difficult to fall asleep, or find themselves waking up early not feeling rested.” Insomnia is directly linked to the stresses of urban living, for people often brood over their troubles before sleep and that keeps them awake. Besides, most psychiatric problems such as depression and anxiety are invariably accompanied by sleeplessness, he points out.
Lifestyle patterns too dictate our sleep cycles. “The youth today are turning nocturnal. Nights are spent gaming, chatting online or partying. Our bodies are tuned to the solar cycle, so even if you catch up on the lost sleep during the day, it breaks the ‘body clock’ or ‘circadian rhythm’ that we are born with,” says George Mothi Justin, consultant pulmonologist at MTH’s Sleep Lab. Night-friendly youngsters aside, Kochi is also home to a growing population of IT professionals and BPO employees. “Night shifts are a necessary evil for them. While a part of their days must ideally be spent asleep, that’s often spent at the movies or shopping,” says Dr. John.
Sedentary professions and increasing obesity in the city are also culprits for sleep disorders, obstructive sleep apnea in particular. “Fat (adipose) depositions narrow the air passages and hence at night the patient snores loudly, may have difficulty breathing in sleep and may even choke in sleep,” says Dr. George.
With all of the above groups vulnerable to sleep disorders, what is the effect lack of sleep has on our bodies? At its mildest, it leads to short-temperedness, irritability and anger. Road-rage, for instance, is worse among those who lack sleep. “Not sleeping can also affect your memory. Rapid Eye Movement (REM) sleep is one of the stages of a good night’s sleep wherein your memory is consolidated. So students who pull all-nighters actually do more harm than good in their recall at exams,” says Dr. Anand.
Allied problems
Sleeplessness can also aggravate a whole host of allied diseases. “Your immunity falls; blood pressure levels are harder to control; diabetes and asthma can get worse. Your body becomes so vulnerable that wilfully preventing sleep is a method of torture before questioning in prisons,” informs Dr. George. Besides harming the sleepless, the disorder also puts their neighbours at risk. Dr. George recalls a patient in Kochi who fell asleep at the wheel, drove into a canal, and continued on for 200 meters before he awoke. Dr. Mohammad Aslam, consultant pulmonologist at Sunrise Hospital says he’s had many patients who fall asleep at work without their knowledge.
And that’s the catch to most sleep disorders: other than insomnia which the patient himself reports, snoring and sleep apnea are usually caught only if the patient’s bed partners or friends notice them. “Awareness in Kochi has increased tremendously over the last decade,” says Dr. Anand. That has led to many taking sleep questionnaires or checking themselves into hospitals for polysomnographies, a full night’s test that monitors brain, eye and limb movements, nasal airflow, respiration patterns and other parameters. “Over-awareness, though, means that many patients treat themselves. Sleeping pills are easily available over the counter in Kochi. The result is usually an addiction to the pill. What’s worse is that the primary cause goes untreated,” says Dr. John.
With sleep apnea, the solution is usually the Continuous Positive Airway Pressure (CPAP) mask, that pushes air into your airways, keeping one breathing through the night. For more severe cases, the cause may be an abnormality in the facial structure that can be surgically corrected. Sleep clinics in the city are thus, managed collectively by pulmonologists, psychiatrists, neurologists and head-and-neck surgeons. While sleep apnea usually affects middle-aged men, it is often seen in menopausal women too, and if left untreated, can be fatal. There’s a story Dr. Anand likes to tell of dolphins — since they need to constantly rise above the sea to breathe, only one side of their brains sleep at a time; the other remains awake. Given we aren’t dolphins, it may be time for Kochi to sing itself to sleep again.
Warning signs of sleep disorders
Snoring, sporadic movements, or jerking awake during sleep.
Walking, talking or kicking in sleep.
Difficulty waking up in the morning, waking up with a headache or feeling like you’ve had inadequate sleep.
Falling asleep while driving or at work.
Overweight individuals or those with large, thick necks are more prone to sleep disorders.
Sleep hygiene
The average person requires six-eight hours of continuous sleep at night. Others may need only four-five hours. Each person must stick to a regular rhythm of sleep depending on their personal requirement.
Do not exercise, watch television, or plan for the next day just before falling asleep.
The bed must be used only to sleepalone, not to eat or work.
Find a congenial, comfortable place for sleep that is devoid of bright light and noise. Stick to the same place every day.
