The Torment of Sleepless Nights

By Audrey Vijaindren

IT'S been a long and tiring day. There's only enough energy for a shower before plunking yourself on the bed. But what happens when sleep is the last thing that comes to you? AUDREY VIJAINDREN learns that an unhealthy lifestyle may be the reason sleep disorders are creeping into Malaysian bedrooms.

Reading and hot showers may help some people wind down before getting that much-needed sleep.

But for many others, it's impossible to get some shuteye, no matter how much hot milk they drink. For these night owls, sleep is a luxury they rarely enjoy.

"Sleep disorders are so common these days, it's a big problem in many houses. Our lifestyle is mainly to blame," says Hospital Universiti Sains Malaysia Sleep Laboratory coordinator, Dr Baharudin Abdullah.

"More and more Malaysians are bogged down with work and family problems. It's impossible to have restful sleep.

"Depression is another reason this ailment is on the rise. People may think sleep problems are not as bad as other sicknesses, but that's not the case."

He says an average working adult must have eight hours of sleep but many people are only getting half of that. And children are also sleeping less because of electronic gadgets and gizmos in their bedroom.

"I'm shocked to find bedrooms furnished with televisions, play stations and computers. Parents may think that's it's a small matter, but it's very bad for young kids.

"It takes an adult ten minutes to fall asleep. It takes children a shorter time. But if they don't wind down early, their brain will still be active and they'll be sleeping way past their bedtime. Slow music is a much better option, at least it puts your brain to sleep."

Obesity, Dr Baharudin says, is another reason for bad sleep.

"Malaysians are eating too much, too late. They tend to overfeed their children as well. This is especially bad if done just before bedtime.

"You should not have a full stomach at least two hours before bedtime, as indigestion disrupts sleep. But many parents are not thinking about this when they tuck their children into bed."

In a study on obstructive sleep apnea syndrome (OSAS) among Universiti Sains Malaysia staff, 16 subjects were diagnosed to have OSAS out of 425 staff members. The OSAS sufferers were all male.

Sleep apnea is a sleep disorder characterised by pauses in breathing during sleep.

Women and the younger staff members had reduced apnea frequency, resulting in shortened apnea duration. Hence, womenfolk were found to be getting more restful sleep than men.

In the study, respondents answered a questionnaire on their tendency to fall asleep while performing daily activities like sitting in the car, talking, driving, stopping at traffic lights, reading and watching television.

"Fat content in the neck, hormonal factors, high testosterone levels and the differences in anatomy make OSAS a more "male disease".

"This is especially evident in middle-aged men, those in their 50s. As we grow older, there's a chance that our muscle tone is more relaxed, causing our airways to not work effectively," says Dr Baharudin.

But women are not entirely clear from danger. It's observed that postmenopausal women are at a greater risk and develop OSAS at a rate similar to that of men.

Dr Baharudin says the main concern with sleep disorders is that it could lead to other ailments.

"People may say it's just a sleeping problem and there's no reason to act fast. But this disorder can develop into other more serious illnesses like hypertension, diabetes, heart disease and impotence.

"OSAS patients also have a tendency to stop breathing while sleeping. Consuming too much alcohol can be a serious problem, as the patient might not be able to get up. There's a great chance of dying in your sleep.

"Taking medication when you have this disorder is also dangerous, particularly sleeping pills and anti-depressants."

He says another danger of sleep disorders is the chance that it could cause fatal accidents.

"It can cause major problems, especially when one is driving or operating heavy machinery. I've even come across doctors who've fallen asleep while performing surgery."

Under-diagnosis and under treating this disease, Dr Baharudin says, is usually the mistake most people make.

"Many think snoring is something normal but it's a sign of sleep disorder. Other symptoms are urinating more than four or five times a night, headaches, tiredness and impotence."

Although sleep disorders come with signs and symptoms, the lack of sleep clinics in the country makes it difficult for sufferers to get help.

"In Western countries, people are more aware of this disease. They have more facilities to help people.

"Here, we just dismiss it as heavy snoring or fatigue. But it's a multi disciplinary disease that could be caused by many problems. It involves different doctors such as neurologists, chest physicians and other specialised doctors. Even the process of testing is tedious. It involves serious expertise."

Unfortunately, it's not normally the patient who comes for help. It's their wives.

"They could be unaware or in denial but many times, men don't come to us for medical help. It's the women who look for help because they can't tolerate the snoring any longer. When couples have to sleep in separate rooms because of loud snoring, it could affect the marriage."

Sleep disturbances is another major problem for the spouse.

"Most people who suffer from sleep disorders wake up many times throughout the night. As a result, they turn the light on or make noise. That affects their partner's sleep pattern, too.

"And they wake up cranky and tired, with headache and a dry throat."

But unfortunately a cure is not available yet.

"The best we can do is to reduce attacks. Surgery to correct any abnormality or obstruction along the breathing passage is the best option available. There's no surgery that can cure 100 per cent, but it can reduce the condition.

"There are also `sleep machines' that can be used to help remedy the condition. But it's inconvenient because the machine has to be used each time you want a peaceful night's sleep, throughout the night," says Dr Baharudin.

But for the night owls out there, these options are something to sleep over.

OTHER SLEEP DISORDERS

INSOMNIA

- Characterised by the difficulty to fall or stay asleep.

Symptoms:

* Poor concentration

* Memory difficulties

* Impaired motor coordination

* Irritability

RESTLESS LEGS SYNDROME

- Related to leg movement causing an unpleasant sensation when lying down.

Symptoms:

* Itchy, tingling feeling in the legs

* A compelling urge to move the limbs to relieve these sensations

* Restlessness, tossing and turning

NARCOLEPSY

- A neurological disorder that affects the control of sleep and wakefulness.

Symptoms:

* Excessive daytime sleepiness

* Cataplexy (temporary loss of muscle tone triggered by emotions such as laughter)

* Hallucination

* Sleep paralysis (temporary paralysis that occurs upon falling asleep or waking up)

CIRCADIAN RHYTHM

- Disruptions in a person's circadian rhythm (internal body clock).

Symptoms:

* Difficulty initiating sleep

* Difficulty maintaining sleep

* Daytime sleepiness

* Poor concentration

RAPID EYE MOVEMENT SLEEP BEHAVIOUR

- Causes irregular breathing, rise in blood pressure and loss of muscle tone (paralysis).

Symptoms:

* Dream-enacting behaviour, sometimes violent

PERIODIC LIMB MOVEMENT

- Characterised by rhythmic movements of the limbs during sleep.

Symptoms:

* Poor sleep

* Daytime sleepiness

* Typically the knee, ankle, and big toe joints all bend as part of the movements, lasting for about two seconds