Sleepless in the silent hours?

In most nights, CA Anil Kumar from Kochi woke up, unable to fall back asleep. He chalked it up to work stress and tried herbal teas, switched off his gadgets earlier, and used over-the-counter sleep aids. But this annoyance turned into a nightly battle. He would wake up groggy, mentally foggy, and his productivity would plummet. One day, Anil briefly nodded off behind the wheel and was jolted awake when his car grazed the highway divider. This scare finally pushed him to seek medical help. Anils story is not rare. Experts recognise this as an escalating epidemic of sleep disorders, vastly underdiagnosed or dismissed as a lifestyle quirk. Sleep is an essential component of health. We spend one-third of our lives asleep, says Dr Sapna Sreedharan, professor of neurology at Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Thiruvananthapuram. She adds that many dont realise that their brain is incredibly active while sleeping. It clears out toxins, consolidates memories, and tunes physiological processes. Dr Prabash Prabhakaran, director and senior consultant (Neurology), SIMS Hospital, Chennai, explains that humans sleep in stages. When we sleep, we go into deep sleep immediately for 30 to 60 minutes, then for a second or two, we wake up thats when we turn around; followed by light sleep again, which lasts around 10-20 minutes. Then a second awakening, and again we enter deep sleep. These stages intercede and repeat around six times throughout an individuals mandatory 7-8.5 hours of sleep. Studies show that one nights bad sleep has its effects lasting for 10-15 days. The brain can adjust to bad sleeping patterns to a limit. Since most organs are connected to sleep, the organs are disturbed when sleep goes off track. These irregular sleep patterns could also lead to mental health issues such as dementia, notes Dr Prabash. Understanding sleep disorders Sleep disorders are classified into insomnia, sleep-related breathing disorders like Obstructive Sleep Apnea (OSA), central disorders of hypersomnolence such as narcolepsy, circadian rhythm disorders, parasomnias like night terrors and sleepwalking, sleep-related movement disorders such as restless legs syndrome, and sleep disturbances that occur as a consequence of neurological or psychiatric illnesses. Almost 60 to 80% of people experience short-term insomnia at some point in their lives, often due to stress or illness. But lasting longer than three months, it turns into a chronic condition, says Dr Sapna. Chronic insomnia can impair memory, reduce concentration, diminish work performance, and increase the risk of cardiovascular disease, anxiety, and depression. OSA has become a lifestyle disease. In OSA, the throat muscles relax excessively during sleep, blocking the airway, explains Dr PS Shajahan, professor of pulmonary medicine at Government TD Medical College, Alappuzha. Central sleep apnea is caused when the brain does not send proper signals to the breathing muscles. Loud snoring is one of the most ignored red flags, he says. Untreated sleep apnea increases the risk of heart attack, stroke, type 2 diabetes, and causes major cognitive impairment. Adding to the list, Dr Prabash says, OSA can lead to uncontrolled hypertension and increased stress levels, leading to heart attacks, heart failures, and atrial fibrillation. Studies suggest that 10 to 20% of Indian adults may suffer from OSA, although diagnosis rates are much lower, particularly in non-urban populations. Young adults are increasingly showing up at clinics with poor-quality sleep, says Dr Aswathy Thazhakottuvalappil, consultant in the department of respiratory medicine at KIMSHEALTH, Thiruvananthapuram. Theres a growing number of young, non-obese individuals with sleep apnea and other disorders. In women, especially, psychological stress, anxiety, and screen addiction play a significant role, she says. These problems are brushed aside as normal stress or overwork. But persistent fatigue, headaches, poor concentration, and morning lethargy should not be ignored. These symptoms can evolve into uncontrolled hypertension, metabolic dysfunction, kidney issues, and stroke. The careful clinical process Dr Sapna notes the diagnoses begin with a detailed history. She asks questions such as When do you go to bed? Do you use your phone late? Do you feel tired during the day? Do you snore? Has your partner noticed pauses in breathing? These details matter. Answers to these are crucial. Dr Prabash adds, A structured self-administered interview is conducted. There is a scoring set on a scale. The answers and scoring help us identify the problems. Eventually leading to polysomnography or multiple sleep latency tests. Dr Sapna says, for suspected apnea or narcolepsy, polysomnography is essential. Level 1 is conducted overnight in a sleep lab. It records electrical brain activity, breathing, oxygen levels, body movements, and heart rhythm. Patients are advised to avoid caffeine and alcohol and to refrain from napping the day of the study. Level 2 and Level 3 studies can be done at home and are used to assess breathing disorders. The usefulness of home-based studies is limited to detecting a subset of disorders, she notes. Treatment: Individualised and Multimodal For chronic insomnia, Cognitive Behavioral Therapy for Insomnia (CBT-I) is considered the gold standard. Dr Sapna notes, It targets the root causes such as unhelpful beliefs and behaviours. In India, access to trained therapists is limited, pushing patients towards long-term use of sleeping pills, which can lead to dependency and cognitive issues. OSA requires mechanical intervention. Continuous Positive Airway Pressure is the most effective therapy for OSA, says Dr Aswathy. We also look at mandibular devices and, in some cases, surgical correction. Treatment is always tailored to the patients condition. A public health priority Doctors agree that sleep needs to be treated as a vital sign, monitored and discussed as routinely as BP or cholesterol. Public health campaigns, better access to sleep studies, and integrated mental health support are crucial to addressing this silent epidemic. On an individual level, citizens can take measures, Dr Prabash points, going to bed and waking up at the same time every day, avoiding caffeinated products after 4 pm, 40 minutes of brisk walking before 3-4 hours of sleeping, no screens two hours before sleeping, a dark room at 23-24 degree celcius. These set rules are a must to be part of ones sleep hygiene, he says. Sleep disorders have been described in literature for centuries Charles Dickens portrayal of Joe, the obese, sleepy coachman in The Pickwick Papers, for instance, is now thought to be one of the earliest depictions of sleep apnea. But societal recognition has lagged far behind. Sleep hygiene should be taught just like balanced diets and physical activity, says Dr Sapna. India is slowly waking up to this reality. But for a meaningful change, we need coordinated effort across medicine, technology, policy, and public behaviour. Sleep disorders - an overview Insomnia: Trouble falling or staying asleep Sleep Apnea: Interrupted breathing during sleep Restless Legs Syndrome (RLS): Urge to move legs while resting Narcolepsy: Sudden episodes of sleep during daytime Circadian Rhythm Disorders: Disrupted internal body clock Parasomnias: Unusual behaviours like sleepwalking or night terrors. Hypersomnia: Excess sleepiness in daytime Rapid Eye Movement (REM): Sleep with rapid eye movement, increased brain activity and dreams REM Sleep Behaviour Disorder: Acting out dreams in REM. Causes and risk factors Biological: Brain or hormonal imbalances Psychological: Anxiety, stress, depression Lifestyle: Irregular schedules, poor sleep hygiene Medical: Asthma, chronic pain, heart conditions Environmental: Noisy surroundings, artificial light exposure Treatmenty options Behavioral Therapy: CBT for insomnia, relaxation exercises Medications: Sleep aids, melatonin supplements, narcolepsy drugs Devices: CPAP machine for sleep apnea Lifestyle Changes: Improve sleep hygiene, consistent routines Light Therapy: Re-align circadian rhythm using timed light exposure Symptoms Daytime sleepiness and fatigue Difficulty focusing or remembering Mood swings or irritability Loud snoring or choking during sleep Strange movements or behaviours at night Diagnostic methods Sleep Diary: Tracking habits and patterns over time Polysomnography: Overnight monitoring in a sleep lab Actigraphy: Wearable device that monitors sleep cycles Home Sleep Test: At-home kit for detecting sleep apnea (Inputs from Unnikrishnan S)