IF SYMPTOMS PERSIST By DR. JOSE PUJALTE JR.

“Sleep sweetly, tender heart, in peace..” — Alfred, Lord Tennyson (1809-92), English poet “To J.S.” (1889)

Dr. Jose Pujalte Jr. Sleep is precious yet taken for granted. Some of us don’t even know that something is wrong with our sleep. However, these are some clues: you wake up tired, not rested; you are irritable with companions and co-workers; you have difficulty remembering or concentrating; you fall asleep at work, during meetings (why even during Zoom meetings), and maybe while your wife (or husband) is talking. The long quarantine has given as this rare opportunity to study our sleep. Let’s secure the knowledge. The Basics of Sleep. It’s not true that we switch ourselves off like machines in sleep. It isn’t that simple. However, we should try to understand sleep because roughly 1/3 of life is spent in shut-eye. For sleep to bring true restoration, a normal pattern must occur. There are six identifiable phases of sleep:

• Wakefulness – the cycle begins with being awake for brief periods of the night. This is normal and it’s hard-wired into us to periodically check what’s going on around us.
• Stage I – light sleep and very easy to rouse.
• Stage II – muscle relaxation, slowing down of brain waves.
• Stage III and IV – deep sleep, even slower brain waves and release of restorative hormones.
• REM Stage - Rapid Eye Movement signals the start of dreaming; brain waves are similar to wakefulness which may mean that the brain is sorting information and memories.

This pattern, when disrupted, results in inadequate sleep. The body also has a built-in clock that makes certain that it follows a natural cycle of waking and sleeping. For many reasons (sleeping for too long at a time, crossing international time zones, cramming into the wee hours during exams), this biological clock can also fail. Sleeping restfully then becomes difficult as long as the body clock is not re-set. Health Reasons for Poor Sleep. As we age, some substances that regulate sleep decrease in amount and effect. These include HGH or human growth hormone (promoting deep sleep) and melatonin (regulating the sleep/wake cycle). Sleep is also affected by the following diseases and conditions:

• Arthritis – joint pain well into the night.
• Heart disease – difficulty in breathing while lying down.
• Diabetes – frequent urination.
• Enlarged prostate – incomplete urination.
• Chronic obstructive pulmonary disease (COPD) – shortness of breath.
• Cancer – pain with a capital “P”.
• High blood pressure – headache, nausea, dizziness.
• Heartburn – stomach or chest pain.
• Asthma – difficulty in breathing.
• Shouting matches – very hard to sleep on same bed.

In general, any condition that causes pain and discomfort, incontinence (both urinary and fecal) interferes with sleep. For example, if the prostate is enlarged or if diabetes is not controlled, that person will get up several times a night to relieve himself. Problems with breathing (COPD, asthma) will of course make sleep impossible. Tips for Better Sleep. Never underestimate the effects of sleep debt. Indeed, we can argue that a measurable element in quality of life is the amount of sleep one gets. The recommended number of hours of beneficial sleep is seven to eight hours a day. Surprisingly, not only too little sleep but also too much of it is bad for health. These tips will make sleep rejuvenating:

• Sleep at the same time each night, even during weekends, if possible.
• Don’t take alcohol, coffee; avoid nicotine at night.
• Exercise lightly in the evening, two to three hours before bedtime.
• Make the room conducive to sleep — not too bright, no loud music.
• Take a warm bath before bedtime.
• Take sleeping pills only when needed (not more than 2 weeks).
• Check causes of snoring – see a doctor (ENT, neurologist, family physician).

Never mind that the greatest Victorian poet was actually rhapsodizing about Death. For all of us who have sleeping problems, isn’t poor sleep a kind of slow death too? Unless we begin to approach sleep in a scientific way, the bed we lie on may already be an open coffin. Dr Pujalte is an orthopedic surgeon. email [email protected]