Wednesday, 10 July 2013

Thing's I learnt at clinic: Physiology Sleep

Sleep, what a marvellous invention. It is just as important as water or food. I have even heard it said that you can survive much longer without food than you can without sleep. So what is so wonderful about it? Why do we need it? Well, when we sleep in particular when we are in deep sleep our bodies are actually hard at work, restoring and even healing. Resetting for the day ahead. Therefore our natural instincts when we are feeling particularly unwell is to sleep and that is our bodies way of fighting off any infections etc. Or think about patients that get put into induced comas when they are in critical conditions or after they have had big surgery. This is done to help promote the body to use its natural resources and heal alongside medical interventions. I have a friend that not long ago developed double pneumonia that went haywire and was put into an induced coma to help him to recover. Luckily this worked and he is now gradually getting back into working. However this was particularly difficult for everyone around him, it's very hard to come to terms with. They just had to keep thinking though that the more he slept the more he was recovering. So this is a good example of what sleep can do. We sleep in 90 minute cycles. Generally it takes around 20 minutes to drift into unconsciousness. During this time we may not feel as though we are going to sleep but our bodies are slowly winding down and relaxing. Then our sleep plateus and we become unconscious, less aware of our surroundings. Then something odd happens, our bodies although partly paralyzed (apart from people that have night terrors or sleep walkers) actually we are highly responsive. No we will not be easy to wake up but our bodies are busy restoring all our systems and muscles. As much as I hate to quote Wikipedia, it says on there that  when we are asleep our 'vital signs indicate arousal and oxygen consumption by the brain is higher than when the sleeper is awake.' Hence why induced comas can aid recovery. Then the process begins again but with less time needed to drift back into deep sleep and longer in restorative sleep and this happens over and over until we wake. Understanding the sleep cycle can help doctors to diagnose sleep problems especially where the sleeper has difficulty getting into deep sleep.

However what happens when people suffer from a lack of sleep? One night will not do any harm, although you will probably feel a bit rough throughout the day. But a constant lack of sleep can really play havoc with our bodies and make them out of tune. Conditions such as insomnia and sleep apnoea mean that the person gets very little deep sleep or restorative sleep as it is also known and as the name suggests that is the sleep that is needed to help our bodies to restore. Meaning that they can feel tired constantly and become unwell because their immune systems are weakend and more susceptible to illnesses. Therefore the quicker they can find cures the better for their long term health.

There was an article in the guardian that suggests that we are a nation in two minds about our sleep. On the one hand as our lives become busier or someone becomes more successful getting less sleep can often be a consequence of that. We stay later at work and start again early the next morning. Often to keep up appearances but often it is because we feel we need to work that long. But the later we work means the longer it takes for us to wind down and perhaps do other jobs around the house. Thus our sleep becomes affected. On the other hand though we are drilled about how getting enough sleep, around 8 hours a night, is what we need to maintain good health and help us looking youthful. Sleeping tablets sales are at an all time high. So we are getting mixed messages about what is good for us and balancing our lifestyle.

However there has been a lot of research done as mentioned in the above article about how we physiologically are not programmed to sleep for 8 hours in a block. This research shows that in Medieval times people would sleep in 2 blocks. They would go to sleep as the sun set, sleep for a few hours then wake, generally " for an hour or so, of quiet wakefulness, sometimes known as a "watch". This period was often used for prayer, or writing or sex, or even visiting the neighbours." This seems to have been quite common until the 1920s and seems to have been affected by street lights and also social events. Before hand the night had always been associated with danger and promiscuity but that all changed when events would go on later. The nighttime became a prime time to socialise as is still apparent today. So whilst 8 hours might be our optimum number of hours that we need to maintain a healthy lifestyle it is actually against our natural physiology to get it all in one go.

But let's face it we are all individuals and will sleep for different lengths of time that suit us and our lifestyles and will consequently change as we grow older. For example teenagers ideally need to sleep for 12 hours a night to be able function well and absorb more information yet as we grow older we need less sleep. The idea of having two blocks of sleep is an alien one and could be more complicated in today's society as unlike in past centuries couples now share a bedroom. You would not want to disturb everyone else in the house so again it is about finding what's right for you and if you do have difficulties with your sleep then finding a good doctor to help you solve it is a must before you become too unwell.

For many people wirh M.E their relationship with sleep can vary greatly. Either suffering from too much sleep or insomnia or both. Sometimes on subsequent days. Creating an inconsistent sleeping pattern that can push the body further off kilter. It is also important to remember that there is a difference between feeling tired or sleepy and feeling fatigued or in a state of post exertional malaise. As mentioned post exertional malaise occurs after activity but does not necessarily create feelings of tiredness. But both sleep and post exertional malaise are big factors in M.E.

I have days when I can sleep for 17 hours, or even more. There have been times when I have been asleep for a long period of time and then thought there is no way I will sleep tonight only to find myself sleeping most of the night too. I very rarely get less than 12 hours, either consequtive or in sections. That seems to be my baseline, which to be fair is better than when 17 hours daily was the norm. If I don't get that amount then I can feel really unwell, sickly, shaking and my speech becomes slurred. But on the other side I can also suffer from insomnia. Usually for a few days or more each month. Leading to yet more feelings of sickness and me trying to make up some sleeping hours during the day. Generally if I go longer than 12 hours of wakefulness then I start to really suffer. So as you can see it can be a real mixed bag and often a surprise which end of the spectrum your'e going to get. Sometimes you might even be lucky and get a "normal" nights sleep. Either way though there is very rarely that sense of feeling refreshed and alert that sleep should bring. Even when you get lots of it which I am prone to do. Most of the time my body craves sleep and I can do little to control it hence the falling asleep in odd places. I'm nursing a cricked neck right now from falling asleep sitting up. However it is just as unhealthy for people to oversleep (more than 8 hours). In my assessment for the clinic I was told that the longer we sleep past that the less effective sleep becomes. In essence undoing some of the hard work that the body has been hard at work doing and leaving you unrefreshed. It's a tough one because when I'm overwhelmingly tired there is no fighting it. Or if I try then I can feel unwell.

I have tried to get into a routine, going to bed at the same time each night and waking up at the same time in the mornings but never had much success. I can generally wake up at roughly the same time, which is a good sign but that's a consequence of a rumbly tummy and trying to time my medications evenly. Again it depends on the type of night I've had, whether insomnia has reared its ugly head or spent the night in terrible pain. Somethings I did learn though to help establish a sleep routine are:

* Good sleep hygiene. No not making sure you've had a wash first. But that your room should be as free from distractions as possible. By that I mean computers, clutter etc not partners. Although if you wish to send them to the couch then that's your perogative. I find this quite difficult because I tend to use distractions for when I'm trying not to focus on the pain and my room  is fairly cluttered because I use the energy that I have on trying to get to the bathroom or downstairs than tidy. Got to get your priorities right.

* Bath, bottle bed- no I don't mean drink yourself to sleep, rather think of it as a baby's routine. Have a bubbly bath to help you to relax, then a warm milky drink (yak) and then go to bed. Basically it's about doing things that tell your brain it's time to sleep.

* No caffiene after 4pm (difficult when you've woken up at 4pm)

* No tv, computer, phone or anything stimulating on the senses including arguments 2 hours before bed. The back light on a light of our technology tricks the mind into thinking it's light outside and therefore physiologically not time to sleep. During the 2 hours before bed you should try to use red light such as a lamp, although of course that's difficult in Summer and thank goodness for sky plus.

* If you are not asleep within 20 minutes either move to another room (difficult if you struggle walking) or sit up and sit quietly until you feel yourself tired once more. Repeat if necessary. This again is to trigger that response that bed equals sleep.

Now here is the most difficult one for me although all of them are tough.

* Try not to sleep during the day! Or if you need to try to sleep as early as possible. Likewise only nap for 20 minutes.

As I said the latter is my weakness but something that I have tried and failed miserabley at. It is so difficult to stop yourself from sleeping when that's what your body is screaming for and can make you feel really panicky. I know that it's against nature and that I probably shouldn't but all I think of is what is best for me in that moment and that's what I find is the best way to deal with this condition. Each day is different, each hour is different, so the more that I can just go with the flow and live in the moment the better. Sorry nature.

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