HEALTH/ INSOMNIA SPECIAL...GOODBYE GOODNIGHT

GOODBYE GOODNIGHT

    Some mornings, Neena B (name changed) wakes up, opens the corner of her eye, and the floor slowly starts to move around her. It is the most petrifying feeling, but having understood why it happens, the marketing professional has come to terms with her occasionally altered state. Neena is a chronic insomniac. She is among a growing tribe of Indians for whom sleep has become a coveted luxury, rather than something to be taken for granted. The impact of her sleep disorder can be terrible. “Some days I am a complete zombie at work, I function at half-capacity and my colleagues bear the brunt of my irritability,” she says. Apart from the physical effects of sleep deprivation — such as her mild hallucinations, high blood pressure, low immunity and unimaginable fatigue — the accompanying mental stress makes it even more terrifying. “The whole point of insomnia is the fear that comes with it — you start dreading the evening,” she says. “Towards the end of the evening, you begin getting really anxious. You start finding excuses not to get to bed, because you know that once you hit the bed, you will not get sleep. So you start looking for people to call, or watching television… And this further stimulates your senses and sleep gets further away.” Insomnia is an old story. But today, a range of alarming new factors from high stress to over-active minds to hyper-technology, have contributed towards a pandemic that is impacting younger and younger people. Teenagers and even children are finding it difficult to get a good night’s rest and psychiatrists suggest that it’s only going to get worse.
    One of the biggest sleep thieves is technology and the endless gadgets that flicker in our lives. While most people believe that watching television just before going to bed helps them unwind, in fact the opposite is true. “That is why I always recommend not having a television in the bedroom,” says psychiatrist Pervin Dadachinji. “Very often, children don’t want to sleep because they are addicted to some digital game, and that stimulation in turn affects their sleep.” No wonder, counsellors now come across children in the age group of 8 to 15 who suffer from sleep disorders - where they can’t go to sleep, or they can’t sleep alone, or they go into their parents’ room in the middle of the night.
    While enlarged adenoids or tonsils in children lead to sleep issues, otherwise healthy teenagers are not getting restful sleep either. “Teenagers need 10 hours of sleep every night. But increasingly one sees that they are logged on to the Internet or are watching TV late into the night or speaking to friends on the phone. In addition, most have to wake up early to attend tuition classes or go for sports practice. As a result they don’t even get eight hours of sleep,” says Dr P P Bose, a sleep medicine expert who runs the Saans Foundation in Delhi.
    Insomnia can be often be aggravated by external factors like artificial light at night. Our internal body clock is synchronised with the external environment. After it is dark, the body needs rest to repair and heal, and therefore, sleep. Before the invention of the light bulb, people went to bed after sunset. There is documented proof of ‘segmented’ sleep — from sunset to around midnight and then from 1 am till sunrise. People would get up a little later than midnight and then spend an hour awake. They typically used it for writing, reading, praying or sex. Roger Ekrich, a history professor, has researched the history of night and found references to ‘first sleep’ and ‘second sleep’ in works like Canterbury Tales, medical books and personal journals from that era. Of course, the invention of the light bulb opened the night up to a whole lot of new possibilities.
    But the brain still associates darkness with sleep and is unable to produce melatonin, a hormone that manages the body’s circadian rhythm, in the presence of artificial light. “Some other hormones, like the growth hormone or GH, are also secreted at night. Presence of artificial light, be it from your computer screen, television or from the street light outside, can affect the secretion of GH,” says Dr Manvir Bhatia, director of the Neurology and Sleep Centre in Delhi.
    Alaokika Bharwani, a Mumbai psychotherapist who works with Unlimited Potentialities, says, “More and more people are using television to soothe themselves to sleep, not realising that it has the opposite effect. It actually stimulates your mind, because it’s basically light pollution.” Carrying your computer or Kindle to bed is a bad idea. “If we don’t commune more with nature, we will find insomnia rising. And digital technology is really going to get in the way,” he says.
    Are there cures? Insomniacs know that while they may not get completely cured, there are numerous ways to make the problem less acute. Following sleep hygiene is the first thing (see box above). If parents are careful about these basic practices, children are also likely to follow suit. Then, doctors say that they have to tackle the underlying problem that often causes insomnia — depression or anxiety — rather than the symptom of sleeplessness. Anxiety has become a common complaint even among children — caused by anything from exams to a friend not talking to you, performance anxiety over a tennis match, or just an over-active mind.
    Dadachinji says she always resists medicating a child and prefers counselling. When it comes to adolescents and adults, she is more open to medication if needed. She is concerned, however, about the number of general practitioners who are quick to dole out sleeping pills or mild anti-anxiety medication like Restyl, given the high dependency it can cause. After a while, the body gets intolerant to such medication and needs higher and higher doses.
    Insomnia and depression are closely linked. Unfortunately, in some cases, one doesn’t know
which came first. In one case, a man says he knows he was suffering from depression, but then the insomnia took on a life of its own. He would get up in the middle of the night, his mind racing, and go on an eating binge. He would go back to bed, but not wake up fresh. He would then fall asleep at meetings, and this affected his work, leading to more depression. His doctor helped him with Cognitive Behavioural Therapy (CBT), which targets the thoughts. Instead of obsessing about his insomnia, they suggested that he focus on the days when he did get sleep. He would benefit by telling himself: “Let’s not make the statement absolutist. Yes, it’s hard, but it’s not the end of the world. Instead I have to tell myself, one day at a time…”
    Today, in a world ruled by sensory stimulation, sleep is given the least priority when it’s actually the most important thing to help your body recuperate. “I’d say yoga, meditation and breathing techniques can definitely help,” says a healer and counsellor requesting anonymity. “Instead of having gizmos, have more plants - oxygen and carbon levels get balanced, and if nothing else, it’s certainly more soothing to the eye.”
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    —With inputs from Shobita Dhar

Dos
Go to bed at the same time each day and get up at the same time. Get regular exercise, preferably in the morning. There is evidence that regular exercise improves restful sleep. Get regular exposure to outdoor or bright lights, especially in the late afternoon. Keep the temperature in your bedroom comfortable. Keep the bedroom quiet and dark. Use your bed only for sleep and sex. Take medications as directed. It is helpful to take prescribed sleeping pills 1-hour before bedtime, so they cause drowsiness when you lie down, or 10 hours before getting up, to avoid daytime drowsiness. Use a relaxation exercise just before going to sleep like muscle relaxation, imagery, massage, warm bath, etc.
Don’ts
Exercise just before going to bed. Engage in stimulating activity just before bed, such as playing a competitive game Have caffeine in the evening Read or watch television in bed Use alcohol to help you sleep Go to bed too hungry or too full Take another person’s sleeping pills Take over-the-counter sleeping pills, without your doctor’s knowledge Take daytime naps Command yourself to go to sleep. This only makes your mind and body more alert If you lie in bed awake for more than 20-30 minutes, get up, go to a different room (or different part of the bedroom), participate in a quiet activity (e.g. nonexcitable reading or television), and then return to bed when you feel sleepy. Do this as man

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