Professor Morenikeji Komolafe, a consultant neurologist at the Obafemi Awolowo University (OAU), Ile Ife, representing Africa on the governing council of the World Sleep Society, in this interview with Sade Oguntola, says no sleeping problem, including nightmares, should be overlooked because of the short- and long-term effects on health. Excerpts:
What are common misconceptions about sleep?
These include the fact that people who snore are actually sleeping very well or are sleeping peacefully, whereas snoring is a symptom of a sleep condition. There is an obstruction to the airway, which is why the person is snoring; it is a serious health condition and that person needs to go to the doctor. Another is that one can ignore sleep and think that it does not matter, whereas sleep is essential for body function. Ignoring sleep can disorganise the body system, predisposing it to various diseases, including cardiovascular diseases and Alzheimer’s disease. Also, a child who is not sleeping well, sleeps too much, or snores should be taken to the hospital for an assessment. Unfortunately, sleep disorders like nightmares are mistaken for spiritual attacks, but it is not so. Women, during menopause, may experience sleeping problems, particularly because of hormonal effects like hot flushes. Shift workers and long-distance drivers who work at night without adapting their lifestyles stand at risk of developing sleeping problems (excessive daytime sleepiness and falling asleep while driving). So, sleep disorders are common and can affect all age groups and genders, regardless of social background.
How does sleep impact overall brain health and cognitive function?
Sleep is vital to health; it is during sleep that the body is restored. When the body sleeps, the brain is active. It is busy organising our memory; it is filing things into sections in memory. That is why sleep is important for children’s brain function. Children who sleep well are alert the following day and their memory is consolidated. It makes it easier for them to retract information. There is a master clock in the brain, so when we sleep, all the systems of the body are synchronised. Also, hormones released during sleep help the body function. That is why when the sleep system is disorganised, the whole body is disorganised and does not function well.
As individuals grow older, the pattern of sleep changes. For the elderly, sleep is lighter. They tend to go to sleep earlier and wake up earlier. This change in the sleep pattern of the elderly may be mistaken for insomnia. So the elderly should not expect to have the same sleep pattern that they had when they were younger. But people don’t understand this physiological change, thinking that maybe they have a sleep problem. This does not rule out ensuring good sleep hygiene because poor sleep quality can worsen many conditions in the elderly. For example, their blood pressure might not be well controlled if they are not sleeping well. Also, sleep conditions like snoring could predispose them to cardiovascular problems, especially abnormal heart rhythms or arrhythmias.
Signs of a sleep disorder and why they should not be overlooked
Signs of sleep problems include insomnia, which is difficulty falling and staying asleep. Such a person will wake up feeling unrefreshed. Others are excessive daytime sleepiness, irregular breathing or increased movement during sleep, irregular sleep and wake cycles, as well as difficulty falling asleep. Too much sleep, or hypersomnia, is an important disease condition. If it is in a child, he is unable to function academically. Snoring is a symptom of obstructive sleep apnea, which means that oxygen is not getting adequately to the brain and the person may develop an early morning headache, urinate frequently at night and it can also cause abnormal heart rhythm. It can contribute to poor control of blood pressure. A nightmare is a type of parasomnia; it is a type of sleep disorder. The other types are sleepwalking and talking while sleeping. The nightmare is recurrent, disrupts sleep, impairs daytime functioning and causes ongoing distress.
Another sleeping condition is called restless legs syndrome; it causes an uncomfortable sensation in the leg that will wake the person from sleep. It is a signal that there is something wrong with the iron levels in the body, and the treatment includes iron replacement. It also affects children. Children who have restless sleep at night could be a manifestation of iron deficiency. Also, some people, when sleeping, experience uncontrollable twitching, flexing and jerking movements; they act out their dreams. Even when they dream that they are boxing, they will also be doing so in real life. It could lead to injury; they could fall off the beds when sleeping. Those who have it may be at risk of developing Parkinson’s or other neurodegenerative diseases in the future.
So, there are various manifestations of sleep disorders, and those who have them should seek help early because it can be a pointer to more serious health conditions. Likewise, many patients with mental health issues also present with either poor sleep or too much sleep. All sleep disorders can affect overall health, safety and quality of life; none should be overlooked. It is important to report it early to the hospital because it could be something more serious. They can be treated, depending on their cause.
How does technology, such as smartphones and tablets, affect our sleep patterns, particularly these days when people carry their phones with them into bed?
During the day, we have light and during the night, we have darkness. But with technology, we are exposed to bright light, particularly blue light, continuously from our phones, on our TV screens, and even people use it on their beds. In the night, melatonin, a hormone that is supposed to help us sleep, is released. But with exposure to light from technology, there is suppression of melatonin production, and that can shift the body clock forward, delaying the onset of sleep. This exposure to light at night negatively impairs sleep and also affects the circadian rhythm. It is like you are experiencing jet lag, but it is called social jet lag. It is not good for the body, and we advise that people should avoid exposure to light on their screens in the evening or at night to have a good sleep. In a recently published study on adolescent sleep in Nigeria, adolescents in urban areas slept less and had poorer sleep quality. The use of electronic devices at night by urban Nigerian adolescents was associated with poorer sleep.
What role, therefore, does stress play in sleep disturbances, and what strategies can individuals use to manage stress for better sleep?
Stress can negatively impair sleep; when you get to bed, your mind is supposed to be rested. But if there are so many things on your mind, rather than resting, your mind will be thinking of them. That can be a cause of insomnia. It is not advisable to have phones or laptops near your bed. It is important that when we go to bed at night, we do not carry our work or problems to bed. Having nighttime rituals such as taking a warm bath, taking a chocolate drink, or switching your mind off so that your body can be rested is also important for good sleep. Also, make your room comfortable. That way, the mind is rested and you are more creative. If you are not sleeping well and the body and mind are not rested, then the anxiety will be heightened and that can negatively affect the individual’s mental health.
Are there any lifestyle factors or habits that adversely impact sleep quality, based on your encounter with them in practice?
Many lifestyle factors affect sleep quality negatively. In the modern age, we are less active, but physical activity is important for having restorative sleep. Other lifestyle factors include the use of caffeine, heavy meals at night, and irregular bedtimes due to shift work or living conditions in cities. With a heavy meal, the gastrointestinal system will not rest, so you will not have a restful sleep. People who have to wake up very early to beat traffic, particularly in big cities like Lagos, and come back very late may have less than four hours of sleep. That is not adequate sleep and it could have long-term health implications. It is also important that a person’s sleep be continuous, not in fragments; an adult needs at least seven to eight hours of sleep, while primary school children need up to 11 to 14 hours of sleep. Environmental noise from loud generators and speakers from religious centres also prevents people in the neighbourhood from sleeping well. Parents taking care of small children also have poor sleep. Overall, having good sleep hygiene will help our sleep to be better, and it is one of the pillars of good health.
Certain medications and substances, aside from alcohol and caffeine, can affect sleep. What advice do you have regarding these?
It is important to check medication leaflets for their side effects. For some people, their sleep disorder is actually due to taking medications for hypertension. If any medication affects sleep, then the doctor might have to write another one for you. Since caffeine affects sleep and other caffeine-containing drinks, it should be taken early in the morning, say, before noon. Certainly, some people drink alcohol to induce sleep, but it wakes you up later in the day. But then there is also the danger of addiction. Also, alcohol relaxes the neck muscles, making the person snore. Alcohol is not a good thing to take for sleep; we should use other measures, like exercising, to ensure a sound sleep.
Can you discuss the relationship between sleep and mental health issues like depression and anxiety?
Sleep and mental health are intertwined; poor sleep can predispose to mental health issues. Not sleeping at the right time has been associated with poor health. Some of the side effects are poorer cognitive function, lower energy and worse mental health. And then, mental health issues, particularly depression, present with sleep problems. It is also one of the diagnostic criteria for other mood disorders. So, in the treatment of mental problems like anxiety and depression, apart from medications that are given to treat the person, maintaining good sleep hygiene is important. This requires regular sleeping and waking times. A poem we learned from those days says, “Early to bed, early to rise makes a man healthy, wealthy and wise.”
For shift workers and doctors who take night calls, there should be regulations to limit the number of hours they can work at night (the maximum working hours for shift workers should be 52 hours per week). Then, afterwards, there should be provisions to make sure they rest try and recover the lost sleep. As much as possible, they need to maintain a normal sleeping pattern. A lot of healthcare workers in Nigeria work beyond the internationally prescribed limits and this adversely affects their physical and mental health.
What are key habits to help people sleep better?
Keep regular wake times and bed times. This helps us sleep at the best time with respect to our master clock rhythm and helps ensure our sleep is consolidated. Aim for an average of seven to nine hours of sleep each day; avoid watching screens one hour before normal bedtime, if this is unavoidable, choose the lowest brightness. Get outdoor light during the day to strengthen the master clock’s circadian rhythm; do some form of physical activity during the day; avoid alcohol before bedtime as this is associated with disrupted sleep; avoid caffeine and other stimulants in the afternoon and try and sleep in a quiet, cool and dimly lit environment.
Read Also: EFCC arrests IG user for cyberstalking commission’s chairman, Olukoyede