I do not sleep well

I do not sleep well (please do not diagnose me). It is an unspoken practice in our home—we do not ask each other, “How did you sleep last night?” Occasionally, a statement may slip out without thinking, but since both of us have sleep challenges, it is taken for granted that sleep is not something to worry about. The challenge arises when we have guests or are staying with friends. The first question in the morning is - “Did you sleep well?” I have started replying, “Do you want the truth or is it just another ‘How are you this morning?’ question?”

 

I correlate our sleep challenges with our profession. Years of residency and night duties with much sleep deprivation, the stress of medical work, learning to take short naps on theatre beds, trolleys, etc. - all of this plays a role. We had a friend who would come religiously for every Bible study, open the Bible, and go to sleep. That was the only good rest he would get. We encouraged him too!

 

But now, there is a preoccupation with sleep these days, and too many conversations about sleep. Sleep-related behaviours and behavioural traits are now viewed with much apprehension and concern. Many of the behavioural traits of yesterday are now considered disorders, waiting to be labelled as diseases.

How does one differentiate—behavioural traits, disorder, or disease?

 

A trait is a consistent pattern in behaviour, such as “early to bed and early to rise” (we were told this would make us healthy, wealthy, and wise!). Traits are not inherently pathological.

 

A trait may be classified as a disorder when it causes significant distress or interferes with social, occupational, or other important areas of functioning. The behaviour is persistent, intense, not just temporary, and deviates markedly from cultural or societal expectations. 

So, I wonder, is “late to bed and late to rise” (going to bed at 2.00–3.00 AM and rising at 11.00 AM) a disorder?

 

A disease typically implies there is a biological basis: a known physiological, genetic, or biochemical cause. There are objective markers; it can be measured or observed through tests (e.g., brain scans). 

Will sleep disorders become disease? It is a known unknown. We know today that we do not know it today.

Recently, while reading the “Bible of Internal Medicine” (Harrison’s Principles of Internal Medicine, 21st edition), I came across four disorders:

• DSWPD – Delayed Sleep-Wake Phase Disorder: Seen in young people—late to bed and late to rise.
• ASWPD – Advanced Sleep-Wake Phase Disorder: Seen in the elderly—early to bed and early to rise (no more healthy, wealthy, or wise!).
• SWD – Shift Work Disorder: People who are on shift duty and night duties suffer from this.
• JLD – Jet Lag Disorder: Those who travel across time zones end up having this disorder.

Yesterday, these were behaviours. Today, with modernity, work, smartphones, tablets and screens, artificial lights, video games, anxiety, stress, other mental health challenges, and many other factors, we have disturbed the cycle of wakefulness and sleep. 

The circadian rhythm has been thrown into the bins. A circadian rhythm is your body's internal 24-hour clock that regulates sleep-wake cycles and other physical, mental, and behavioural changes, such as hormones, body temperature, and appetite. It is primarily influenced by light and darkness, with the brain's suprachiasmatic nucleus (SCN) acting as the master clock.

And these behavioural traits have become disorders. Will they become diseases tomorrow? The known unknown!

Maybe I should sue my professors for working me so hard and leaving me with a sleep disorder four decades down the line. But then, I am not sure how many mistakes I made because I was sleep deprived. It might be counterproductive!

 

Whatever it is, the data is disturbing. Thirty percent of traffic accidents occur because of sleeping while driving! There is evidence that inadequate sleep can lead to diabetes, obesity, atherosclerosis, altered immune status, cognitive impairments—so much so that the National Academy of Medicine has declared sleep disorders an unmet public health problem.

 

So, what do you do? Evidence says this:

 

“To get better sleep, it is important to build good habits around bedtime. Start by going to bed and waking up at the same time every day—even on weekends. This helps your body’s internal clock stay in sync.

 

Don’t try to sleep more than you usually do. Instead, focus on making the time before bed peaceful. About 30 minutes before you sleep, do something relaxing—like taking a warm bath, listening to calming music, meditating, or anything else that helps you unwind.

 

Keep your bedroom free from distractions like TVs, computers, smartphones, and tablets. If you use an e-reader, try to dim the light and reduce blue light, since bright light—especially blue light—can keep you awake by lowering melatonin, the sleep hormone.

Once you are in bed, avoid thinking about stressful things like work or personal problems. If you cannot fall asleep within 20 minutes, it is okay to get up and do something calming in dim light, like reading or listening to soft music. Just avoid screens and bright lights, as they can make it harder to fall asleep.”

 

But then, there is a greater truth—in the Good Book: “It’s useless to rise early and go to bed late and work your worried fingers to the bone. Don’t you know he enjoys giving rest to those he loves?” and that “There is no rest for the wicked.”

Maybe I should repent of my wickedness!

(My blog will go on hibernation for 2 weeks, an extended sleep time.)