| Health n' lifestyle | Sleep and sleep disorders

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[00:00:16]Thank you very much for keeping it Citizen TV day break it is. In case you're just joining us, we are crossing over to the health and lifestyle segment being Wednesday. We appreciate your time and company. If you have any question, comment, karibu sana, today we are talking about sleep. I know it's coming at a very timely time. We've just woken up and some of you are feeling refreshed and ready for the day. Others are feeling like the night did not really serve its purpose well. You even more tired than you were last night when you went to bed. We want to talk about exactly that. What is quality sleep?

[00:00:50]What is good sleep according to the experts? And did you know that we have something known as sleep disorder? Yes, there are so many people out there who do not know that we have disorders associated with sleep. But of course, I'll also take you through some of the common sleep disorders that we have today and how to manage them. I have with me in studio Dr. Sam Gu. He's a pediatric neurologist. Thank you very much Dr. for creating time to be with us here today.

[00:01:16]>> Thank you very much. Yeah, I was when I was doing the intro, I said actually sleep disorder and yes, even when I was sharing with some few people that I interacted with yesterday that I'm going to be talking about sleep disorder, they were like what is that?

[00:01:29]>> You know, do we have anything like sleep disorder? So, it's good to start there.

[00:01:34]Let's first of all talk about what from your perspective is uh uh you know, sleep disorder.

[00:01:41]Well, um it may help to start with figuring out what is normal in the past instance.

[00:01:47]>> Okay.

[00:01:48]>> Um and when we talk about normal sleep, we take into account um the various stages, the duration and the quality.

[00:01:57]Duration essentially means quantity. So talking about quantity and quality. So sleep by itself is an active process. M >> it's not like a passive situation where the brain switches off. There are actually mechanisms in your brain system that switch you off into sleep which when they don't work so well then you suffer the sleep disorders.

[00:02:23]>> Uh and it's not one even uh situation or event. There are various stages to it.

[00:02:28]So when you're talking about sleep, we categorize largely into slow sleep or nonREM sleep and REM sleep stages.

[00:02:38]>> So when you enter sleep from a state of wakefulness, uh you get into slow sleep, >> feeling a bit drowsy and then getting deep into sleep. uh and that takes about uh 70 to 90 minutes and then you cycle into another stage of sleep called the REM sleep where most uh or rather where dreams happen.

[00:02:59]>> Okay. So you don't when we go to bed dar we just don't sleep. It actually happens in stages. Yeah. That's what you're saying.

[00:03:07]>> They are transitions and and we we we recognize uh three stages of the slow sleep. And we call them slow asleep because the waves of your brain actually start slowing down >> and that goes progressively to the slowest waveform. That's called a delta.

[00:03:24]And that's the most restful part of your sleep.

[00:03:28]>> And then uh every uh cycle of about uh 70 to 110 minutes, you go through a stage of slow to uh to REM sleep and then you start again. Now in the initial part of sleep you have longer more restful slow wave sleep >> and as the night progresses and you have several cycles you may have about five to seven cycles in one night >> you start having less and less of slow sleep >> and a little bit more of the REM sleep the dreams part of sleep >> and that's why >> and is that a good thing or or a bad thing >> that's how it should work actually happen. You deliver restfulness h and it's towards the morning that uh then uh you start having slightly longer REM sleep and that's when your dreams are more vivid.

[00:04:23]>> And if you're woken up in the morning then uh right in the smack in the middle of uh of of your REM sleep then you are likely to remember your dreams. Uh so uh when you talk about uh anomalies or disorders of sleep, you're speaking about um how do you enter into sleep? Is that going right or not? Uh how is your sleep uh processing? Are are you getting the right uh duration of the nonrem sleep and REM sleep? Are they getting interrupted? Do you have phenomena that manifest during that time? uh and uh essentially are you getting the whole the right duration that you should get.

[00:05:04]>> Mhm. So how you enter into sleep, how the cycles present while you're asleep and the duration that you take >> absolutely asleep and just how much >> the parameters >> how much interruption you get in between. Uh and so uh we start by recognizing that uh different age groups require different durations of of sleep to to achieve optimal quantity of sleep.

[00:05:33]>> So uh for uh adults you're talking about 7 to 9 hours of sleep.

[00:05:37]>> 7 to 9 hours.

[00:05:38]>> Yes. For teenagers we may speak to 8 to 10 hours of sleep. And uh for children uh you know schoolgoing children we're talking about uh 10 uh to uh up to 12 hours of sleep. I'm I'm I'm I'm listening and I'm wondering how much of that is even practical. Say even for adults just for example 7 to N hours how many people out there actually sleep for 7 to 9 hours and it's quality sleep that they get and is that something that concerns you as an expert >> and honestly that's the tragedy of our times >> that we've normalized in inadequate sleep >> as being disciplined.

[00:06:17]>> Yeah. Um and that >> in fact the hard workers who tell you sleep less you know we need to be out here you know >> actually you're doing yourself a disservice you've normalized suboptimal functioning >> because you need good sleep for one uh proper uh cognition as in thinking through solving problems even the process of putting things into memory from short-term to long-term memory happens in sleep h resetting emotional regulation H that happens in sleep. H you know your hormones getting the right balance and getting the right production levels in your system that happens in sleep. All your vegetative functions we're talking about the way the heart functions the respiratory system functions the brain functions that gets quite a bit of reset during sleep. So sleep is not it's not a luxury.

[00:07:11]>> People think it's the enemy of progress.

[00:07:13]If you want to make it in life >> Yeah. E don't like you shouldn't be sleeping right now. What we want to talk to they already out here you know >> early birds >> if that was the case and looking at um the durations we've defined that are optimal for sleep.

[00:07:29]>> Yeah.

[00:07:30]>> Say if you're 30 years ideally you should have uh slept for 10 years of your life.

[00:07:36]>> Yes.

[00:07:37]>> Isn't it?

[00:07:37]>> That's a big chunk of your existence. It cannot be that this is allocated to you without meaning.

[00:07:45]>> It is so crucial for your normal functioning and dare you fail to sleep properly for a prolonged duration of time. You'll start seeing gaps in the way you function in your day-to-day activities.

[00:07:58]>> You'll not be answering questions right.

[00:08:00]You'll not be figuring things okay. You know you'll be tired and it manifests in various ways. So when we talk about sleep disorders, >> one of the biggest affliction of our times is just functional sleep deprivation >> manifesting for adults like you said h and schoolgoing children. Uh and uh it's not uncommon to see uh children waiting by the bus stop at 4:00 a.m. in the morning, coming back late with heavy homework and going to bed at 10:00 p.m.

[00:08:31]11:00 p.m.

[00:08:32]>> Uh it's not unusual uh for boarding schools to demand their children to go to sleep at 10 to 11:00 p.m. and wake up by 4 a.m. It's it's just torture. In fact, sleep deprivation is a form of torture. uh if if those people who survived the NYO torture chambers, they speak to it the fact that they were sleepdeprived >> as a torture mechanism h in in Guantanam Bay in in in all those places where torture is is is used.

[00:09:03]>> Sleep deprivation is actually a tool of torture. So uh let's just agree and not normalize uh sleep deprivation and and you know as you've h articulated at the start that uh right now the expectation is that you should sleep less to achieve more.

[00:09:24]>> Yeah.

[00:09:24]>> And that's actually >> you want to make it in life sleep less.

[00:09:28]>> Absolutely not right.

[00:09:29]>> Too much sleep is the enemy of progress.

[00:09:31]And it's good that you've said that because you know just coming to work in the morning you'd be surprised to see just how kids are dozing off in school buses and even in class it speaks something isn't it? Yes. And and I do tell my students >> and even people who are working in offices, you'll see your colleagues, you know, at some point, >> you know, dozing off. It's sending a message about how we're spending our time resting.

[00:09:54]>> And so what that does, for instance, for for for children and adolesccents, >> they go to school, bad sleep, and they get emotionally disregulated.

[00:10:05]uh restlessness in school and all that drama you find in school I think in a big way is on account of sleep deprivation. Uh you get people uh transniting in preparation for exams.

[00:10:17]>> They enter the exam process not cognit cognitively optimal and what that delivers for them are poorer outcomes than they should get. H and then when the exams are over they go and sleep and then the consolidation happens and they remember the silly mistakes they did in exams.

[00:10:36]>> Uh same to people who are functioning uh in the day-to-day work environment.

[00:10:42]>> You're getting uh poorly functioning uh individuals because they are not getting enough sleep. and countries that have embraced and appreciated uh uh the the crucial uh intervention that sleep uh pres represents have actually defined shorter or or rather later school opening for their children. They've defined more flexy times for their workers h and and it's it's high time we also start thinking about it. So remember we started by talking about >> to the employers >> the teachers and the the the school heads.

[00:11:19]>> Yeah.

[00:11:22]We talking about sleep disorders but our starting point is the functional sleep issues that we that we >> bring onto ourselves.

[00:11:31]>> All right. Let's talk about the common disorders that are there. You'd be shocked. You know, somebody could be watching us this morning and there's something they going through without even realizing that these are symptoms of a particular sleep disorder. They are quite a number. And I want you to help us understand the most common ones, how they present, some of the symptoms that somebody could have. You'd heard people say, "I'm a light sleeper. I'm a heavy sleeper. I sleep talk. I sleepwalk."

[00:11:57]These common terms we are used to. But now let's put things into into perspective. The the common sleep disorders that we have today and their symptoms. So it's good we've spoken to uh quantity and quality.

[00:12:10]>> Yeah.

[00:12:10]>> And so disorders mean that we've disrupted or or matters quantity and quality have gone arry. Uh and so when we talk about quantity in the first instance of course we mention functional sleep disorders where our own habits and practices set us up for a poor sleep >> which means the time you go to bed >> the the the the fact that you are on your television or you're on a phone for a much longer time before you get into bed or with your book when you're in bed. H the fact that you take uh alcohol just before bed or coffee late in the evening or afternoon huh or lots of drinks that will essentially make you wake up a lot in the evening that's that's an issue. Uh the fact that we are dealing with lots of challenges now financial stresses uh you know uh and that of course also impairs how you are able to transition into sleep. So that's one big deal and and you could say up to about 50 60% of the population will have that.

[00:13:13]>> Then you talk about >> let me take you back before you get to the other part. You've talked about the gadgets the screen time and the phone and the television just before sleep and I was having a chat with my colleague Sam earlier about exactly what you've said how the gadgets and the devices affect the quality of sleep and you know the the how the brain functions maybe you can you can break it down a little for us to understand. It's a common habit in our households. Once you come back from work or you're watching TV until the time you will go to bed maybe how disastrous that that is for both adults and children.

[00:13:46]>> So remember we recognize that sleep is an active process. So there are mechanisms that that are at play that are supposed to come to switch you off into sleep. They mostly rely on the visual uh inputs and they go into a part of your brain that then gets the hormones right and gets the neural mechanisms that switches you off to sleep.

[00:14:07]>> Uh and so essentially when you sustain yourself on the phone when the time is that you should be going into sleep, you are negating uh these processes that should be getting you into sleep. uh and um that sort of becomes addictive because the business of scrolling and looking at short clips uh h essentially engages a part of your midbrain that gives you some form of reward that keeps you on and on and on h and that's really disastrous because you can get on to that for almost the whole night >> h and that delivers for a huge cohort of people h sleep deprivation without knowing it >> and I think the consequences of it are manifesting in various ways that we cannot even fathom >> and that have implications into the future.

[00:15:01]>> Mh.

[00:15:02]>> So that's that's something worth mentioning. Um the uh the good thing is and and hopefully we'll have a chance to talk about this is uh what then are the measures that uh will help facilitate sleep hygiene.

[00:15:17]>> Yeah. So how do you how do we prepare for bed? I think that would be something we will touch on before we wind up. But one key highlight that I wouldn't want anyone to miss from what you've just shared is that the phones, the gadgets that how we stay on online, whatever it is that we are doing minutes before bed or while in bed is very disastrous. It affects how we transition into sleep.

[00:15:40]And we'll talk about now how then do you prepare for bed. what do you do with your children just moments before bedtime so that you they're more prepared for for for quality sleep but then run us through the most common um you know sleep disorders and how they present. So then the others will be like sleep apnnea that's fairly common >> and sleep apnoa manifests with uh essentially loud snoring.

[00:16:07]>> Oh yeah, >> lots of interruptions in your sleep because you're just not getting enough oxygen uh into the brain. And what happens with uh the sleep process is at one point your respiratory system slow down. the airway uh almost closes and if you have obstruction on your airway either because of obesity or because of ENT challenges then uh you start uh snoring it's essentially air struggling to get through a restricted airway >> and the way snoring works you know it gets loud progressively and then and then somewhere down the line somebody stops breathing you you you wonder if they're still alive or not >> and then they start again >> and and what that means is uh essentially uh you reached a point where your airway actually blocked >> blocked >> completely. That's dangerous >> and the carbon dioxide levels went up and that stimulated your brain and your brain said okay wake up you need to breathe and then you start breathing again.

[00:17:11]>> Is that a dangerous thing? That's dangerous because it has consequences on the way h your heart is functioning because your heart has to beat a little bit faster to keep up the way your vegetative functions are are helping you. You keep on getting interrupted. It means your brain is not getting optimal oxygenation. It may predispose you to stroke and uh we know that at the end of the day you have much less restful sleep. you've slept through the quantity of hours that we've defined >> but you've been interrupted so many times by the anic attacks uh that essentially it's not been fulfilling >> h and so that is one other common manifestation of sleep >> h then we have a variety of other sleep disorders uh that afflict the various stages that we spoke to so you could have nonrem sleep abnormalities >> uh uh like uh sleepwalking uh like um um move leg restless leg uh syndrome.

[00:18:13]>> Uh you could have REM abnormalities. Uh and then we know that commonly uh kids may also get night terror >> which happen in the non nonREM stage of sleep. Mhm. H we know that people struggle with how they enter sleep and so they may take long to achieve sleep and that kind of insomnia is on account of a disruption of the mechanisms that are supposed to switch you into sleep.

[00:18:43]>> Mhm.

[00:18:44]>> H and and then the various interruptions that you get that don't get you a fulfilling sleep. And then >> let me let me take you um step by step so that people understand these disorders and how they present. The reason I I usually like doing this is because my my viewers understand understand it more from the symptoms.

[00:19:01]They don't know the names but anatu oh whatever Dr. is describing is something I have been feeling. So let's begin by saying insomnia. A common phrase people usually like saying I it is it is a condition I'm I'm I'm I'm battling.

[00:19:18]Insomnia very common but then just break it down for us what it is all about and how does it present and what how is the body made up what what the system you know such that you can say that you have insomnia >> so barring um our articulation about functional sleep where you actually by your own habit you're depriving yourself of sleep which in itself is some form of insomnia >> h then there are organic situations where the mechanisms that are supposed to help uh switch you off into sleep are not working the way they should be. And there's a key protein there in the brain called Rexin >> H that essentially functions to do that.

[00:20:01]>> Uh and essentially uh we know that people with uh primary insomnia may have deficits in the production of these proteins.

[00:20:11]>> H and so them entering into sleep is a problem. It takes time >> and that's what actually uh defines insomnia.

[00:20:20]>> So it's wakefulness. You you're awake.

[00:20:22]You're on.

[00:20:23]>> You're on and you're not getting in. And then coupled by secondary causes which means um you know when you get into sleep uh the expectation is that the signaling systems uh some signaling systems have been switched off uh like um you know that deliver uh touch sensations uh noise uh you know vision uh which uh means that if I want to wake you up from sleep I do the contrary, I make noise or I put uh bright light essentially to negate those mechanisms that are being switched off. So it means therefore that u if you have chronic pain for instance you are continuously stimulating a part of your brain called the reticular system that keeps on feeling making you be awake.

[00:21:19]>> So by extension you get insomnia. Uh if you're having health challenges, if you have depression and thoughts which by themselves Yes.

[00:21:29]>> you're thinking about something too much.

[00:21:30]>> Exactly. Stay awake.

[00:21:32]>> Which they by themselves keep on stimulating the reticular system.

[00:21:36]>> H then you see that that then promotes your sense of wakefulness. H so those are many other secondary causes. Uh that essentially also promote uh insomnia. Uh so you are in bed but you are not achieving >> sleeping h that that that >> what about those who are deep sleepers at even if you make those noises even if you switch off switch on the light whatever you do this person will not wake up >> is that a sleep disorder or that is the quality sleep that we we are looking for >> well well not necessarily and remember when we are trying to define what a sleep disorder is uh we've spoken to quantity and also speaking to quality.

[00:22:21]>> And I cannot exactly say that they are completely unarousable.

[00:22:26]>> They are you we cannot all be the same.

[00:22:29]So the level of your entry into you know slow sleep is going to be different for sure and they are variable normals.

[00:22:38]>> Uh when you become completely unarousable then we have to think of other things like maybe you suffer seizuras in sleep. Okay, which is also something we look out for in sleep and there are certain epilepsies and caesar disorders that primarily manifest in sleep. So as as as health workers, you have to have your anti to just be sure that you're not missing something that's off that's not acceptable.

[00:23:08]>> Yeah. Sleeptalking, sleepwalking. What usually happens on a light note there? People would even wake up, go cook and eat and not know that they did that. What usually happens?

[00:23:20]Yeah.

[00:23:20]>> At that time, >> um again the the exact mechanisms at play are difficult to define. H but we know that uh those uh active motor processes that beget such presentations we call them someism >> h are essentially occurring in the slow stage of of sleep.

[00:23:42]>> Okay.

[00:23:42]>> H and same to night terrors where kids wake up and scream and actually engage on on on feeling like something threatening is coming onto them. um and and they've got to do with disruptions of of mechanisms uh of of neuro mechanisms uh during slow sleep. Um studying sleep is a bit challenging because uh you are relying on uh getting feedback from the person who's suffering that condition. And yet if you arouse them out of that middle of of that manifestation, >> then they won't have that sleep anymore.

[00:24:21]So you wouldn't know what has therefore happened but but we know that that's got to do with anomalies right in those various stages of sleep >> distinct from nightmares >> and nightmares happen specifically in the REM stage of sleep and they have minimal motor uh you know physical manifestation you just have the that experience internally without manifesting outwardly. Yes, >> RLS, you know, um, you know, some people don't have quality sleep and the sleep is not the problem. The problem is in the leg.

[00:24:58]>> Connect the dots for us. What does the leg have to do with sleep?

[00:25:03]>> Yeah. So um restless leg syndrome that's what RLS stands for um essentially manifests with the uh sensations that get your legs moving almost constantly uh through sleep. Uh and remember we say that uh for the sleep process to work right there are certain aspects of signaling to the reticular system that need to be switched off. And when you have restless leg syndrome, uh what essentially is happening there is that uh in addition to those unusual sensations you're experiencing, you're essentially uh preventing yourself from getting into sleep. And it's been associated uh with uh uh abnormalities in iron uh metabolism. uh and uh a number of times there's been a suggestion uh that there may be improvements uh if you have ion supplementation uh and it's still an area under study.

[00:26:02]>> Mhm.

[00:26:02]>> Yes.

[00:26:03]>> Uh is excessive sleep a disorder?

[00:26:07]>> Sleep is never enough actually for everyone but for some it's even worse.

[00:26:12]>> Uh absolutely. H because um we've talked about uh quantity >> and given limits isn't it? Uh what's our lower limit uh that's optimal? What's the upper limit that's optimal? And you start overdoing it. Uh you can see then you start having longer stretches of REM sleep. M >> remember that profile of of your sleep scheme at night >> and REM sleep deliver for you more dreams and nightmares. So it's never you're not doing yourself any favor by lying in bed longer because it's not a very restful uh part of your sleep.

[00:26:55]Okay. Uh but alongside that uh we also know that then uh you need your other wakeful systems to get working uh your hormone systems to get back to their wakeful cycle. Uh your motor systems to get moving uh and when you stay in bed for much longer then you're also disrupting that. And the other side of it is that uh uh such individuals are also predisposed to certain uh illnesses >> uh including mental illnesses including uh also risk of stroke. H so both less sleep and more sleep has deletious effects but obviously less sleep is a more common manifestation.

[00:27:40]um and and and so common uh uh we need to have the awareness that for now you may feel like you're chasing your dream.

[00:27:48]Uh but later on people with uh greater sleep uh deprivation then have a greater risk of mental illness. They have a greater risk of cardiac diseases and dying of uh uh heart uh failure. They have a greater risk of uh dementia.

[00:28:05]uh they have a greater risk of uh um erectile dysfunction. In fact, there's even an indication that uh for men your testes shrink a little bit more with sleep deprivation. Uh and that speaks to the hormone dysregulation that happens when you deprive yourself of sleep.

[00:28:26]Common message here is Yeah. Uh sleep deprivation is a problem. Sleep prolongation is also >> is also a problem. Yeah. Yeah. It is that serious.

[00:28:36]>> You may think it's a joke, but Dr. said depriving yourself of sleep can have very severe consequences, you know, in the quality of life that you live. So, you're chasing your dream now, but maybe you may not even be here to enjoy that dream that you're chasing. Let's talk about something you do every day. That is studying sleep. Yeah. So, so sleep studying, what is this all about? How do you study sleep? So um so you you you now know that it's quite a common manifestation in our setup as neurologists and that's because uh poor sleep habits uh sleep challenges uh essentially complicate many other diseases >> h like we know epilepsy gets worse with uh uh sleep deprivation. We know that mental illnesses get worse with uh sleep challenges and by themselves also may manifest with sleep challenges. Uh so uh one of the big deals in our uh practice is to screen for the same through uh just getting to know understand the history. M >> it is so so common that for instance children in school tell you how much they struggle getting enough sleep and that has been normalized. Then there are sleep screening tools that we may undertake just to score the quantity and quality of sleep uh that speaks to when you enter into bed uh what your environment is like uh how much interruption you get how much duration you get out of it and other issues around that. Do you have daytime sleepiness? That will speak to maybe a risk of having a condition like narcolepsy.

[00:30:18]>> Then we may do a formal uh sleep study.

[00:30:22]>> Mhm.

[00:30:23]>> And the gold standard of it is called a polyomnography >> where we study the brain waves h during sleep. We study how you're breathing during sleep. How your eyes are moving, how your muscles are moving, how your heart is is is functioning, how your breathing cycles are like, what part of your body is moving as in essentially understanding what is this uh sleep anomaly that you have.

[00:30:50]>> So polyomnography is the study of sleep.

[00:30:54]>> Absolutely.

[00:30:54]>> Yeah. In simple terms. Yes.

[00:30:56]>> So this polyomnography, how do you do it? The same way you go to a hospital, your your lab, you you're told go bring a specimen and then so so how do you study sleep practically so that uh we see how how it's done?

[00:31:10]>> Well uh what we actually do is uh you have to come in uh for an admission of sorts.

[00:31:18]>> So you've gone to a hospital >> for your sleep to be studied.

[00:31:21]>> That's correct. uh you have to come in for an admission and we have to set you up with the the the sensors that will read all these things.

[00:31:31]>> Uh we'll put uh some cabling on your head to monitor the brain waves. We'll put something on your throat >> while you're asleep.

[00:31:39]>> Yes. We start you off before you sleep.

[00:31:40]Remember, we want to see how you're entering sleep.

[00:31:43]>> Okay.

[00:31:43]>> And whether you're meeting those cycles and how you're cycling through all those cycles. uh we'll set you up with uh things to monitor your heart, your oxygen saturations, your movements. Um it's quite a spectacle.

[00:31:57]>> Uh the side of it is that sometimes uh the only challenge is once we set you up like that, you may not feel to be in your natural self.

[00:32:07]>> Exactly. I was wondering so so do I come at night because that is really when I sleep or >> do I just walk in during the day and then how will I sleep? Do you induce the sleep? you know >> you you come at night we come in the evening we set you up and we read it through the night >> so it has to be in the natural state you don't induce the sleep >> we don't induce the sleep and then there are people who have daytime sleepiness disorders uh like narcolepsy for whom it's not just the night time we also extend that to the day and just monitor how they cycle in and out of this uh sleep h moments that they get >> and such individuals they switch on immediately to REM sleep >> rather than transitioning from nonREM to to to REM sleep and and so recognizing that and solving for that that's that's part of the polyomnography.

[00:33:03]>> Mhm.

[00:33:04]>> Yes. So, so what are what what aspects just to remind us what aspects are you looking at the key things that while this person is asleep and you've set them up with all those you know things that you put uh what what is it that you're looking at to inform what >> we're looking at how your brain waves are working >> are we getting uh you moving from the work full brain waves to the slow wave and are they getting progressively slower into the three various stages of slower sleep are we getting into REM sleep at the right time. What's your proportion of uh slow sleep visav uh non-slow sleep or or REM sleep? H and how many cycles are you getting at night? And through all those stages, what's happening to your oxygen levels?

[00:33:51]>> What is happening to your breathing pattern? What's happening to your eye movements? What's happening to your uh muscle movements? Uh what essentially are you doing? Did you get up to cucki like you mentioned? Did a seiza actually happen during that time?

[00:34:08]>> There are people who harm themselves.

[00:34:10]>> Yes.

[00:34:11]>> While sleeping and they will not remember what happened to them.

[00:34:15]>> Yes.

[00:34:15]>> You know it can be that serious >> and when that is the case you know you entertain more ominous diagnosis like seizures or convulsions. They are epilepsies that essentially just happen on the uh sleep stages. So uh we essentially trying to define all those components uh that uh speak to those various stages of sleep. Uh and at the end of the day we should be able to uh diagnose uh one is your problem entering into sleep or staying asleep and if you're staying asleep is your problem in the nonREM stage of sleep or is it on the REM stage of sleep and what is that problem? Are the waveforms right during that time or not? Do they shoot up to suggest a Caesar or do they h essentially flatten out? Uh what's happening to your oxygen? You you remember we were speaking about sleep apnea. What's happening to that during sleep? What's happening to your carbon dioxide levels? um are we getting dangerously uh prolonged periods when your oxygen levels are really low or your carbon dioxide levels are really high? H are you moving so much more that uh that's just going to disrupt how things are going to work for you in sleep?

[00:35:35]>> H so all those things in totality h give us a polyomnog that uh defines the gold standard of a sleep study >> understanding you in sleep.

[00:35:46]>> Okay, that's interesting. I mean, you know, just having an expert study you while you sleep and they're looking at all those aspects to be able to determine what um disorder you actually have. So, does this apply for the different how do you tell one disorder from another or is there a possibility somebody could be suffering from two types of sleep disorders at the same time or three, you know, how do you determine, you know, insomnia from uh for instance uh sleep apnnea, you know, does that help you? Yes, it does. And remember our first entry is the history and the screening tools.

[00:36:22]>> Yeah.

[00:36:23]>> H that sort of gave us an inkling of which direction we need to look for. H and also what how should we tailor our sleep study for you because if your problems are mostly during the day, we need to make sure we also capture what's happening at day.

[00:36:37]>> Uh if your problems are at a particular time of sleep or are with leg movements, we need to just want to observe what's happening there. So uh at the end of the day it's quite some analysis uh uh of all that uh recording that we've taken that helps us to therefore understand which bits are they uh from sometimes uh from the history you already have an idea and and when you go and do the polyomogram you able to confirm or negate what your thoughts were. uh but essentially it's a whole process that entails many aspects and remember sleep you know speaks to how your body is going to function isn't it and so we also just need to do a proper physical assessment to confirm >> there's nothing else that would be >> the problem >> yeah that so if if we remember we mentioned that things like chronic pain can be a cause of >> sleep disorder >> sleep disorder and and those need to be checked for >> all Right. Or it's it could be stress.

[00:37:39]If there's an issue then maybe counseling or something else. So you you you have to out out rule like any other aspect.

[00:37:48]>> Absolutely >> that could be causing the sleep disorder.

[00:37:51]>> And we need to also uh as a starting point is always confirm that we are adhering to the principles of sleep hygiene.

[00:37:58]>> H. So first of all what's with your habits?

[00:38:01]>> Mhm.

[00:38:02]>> And it speaks to our earlier conversation of what then should you do right >> to deliver good sleep for you.

[00:38:10]>> All right.

[00:38:10]>> Um and we can talk about that.

[00:38:12]>> Yeah, we can we can we can we can go there >> which which essentially means that uh you need to define uh uh very clearly what time you're going into bed. Mhm.

[00:38:23]>> Perhaps need an alarm for going to bed rather than for many people that >> if we agree that uh you need as an adult 7 to 9 hours of sleep and maybe you have to be up for going to work from maybe about 5:30 working backwards uh then it means by 9:30 you should be hitting your sheets.

[00:38:44]>> Uhhuh.

[00:38:45]>> Okay. So it needs to be regular and defined that 9:30 >> you >> bed, >> no phone, no screen, no book. It needs to be a cool room.

[00:38:56]>> No music, >> no music because that again although there there talks about uh uh sleep inducing sounds.

[00:39:06]>> Yes. Then you need to uh uh if possible secure a slightly cooler room uh because lower temperatures help to get you into sleep. Uh the less you cover yourself the better for you.

[00:39:20]>> Uh airy appropriate h then uh you need to have had less fluids the hours to sleep >> before bedtime.

[00:39:30]>> Yes. So that you have less interruptions with your bladder movements. uh you need to avoid alcohol in the evenings.

[00:39:39]>> So, so when will you have alcohol?

[00:39:43]>> If it's not in the evening, what time?

[00:39:45]>> Well, if you can't avoid it, you could say early evening or afternoon work better for you.

[00:39:52]>> Okay.

[00:39:53]>> H and same to H because the halfife of coffee is about 10 hours. It means uh if you're going to hit the sheets at 10 uh p.m. The last time you should be taking coffee is noon.

[00:40:05]>> Noon. Yeah.

[00:40:05]>> Yes. Uh so you have to keep all those things in mind. What are those things that I can essentially take that will impair my sleep later in the day?

[00:40:14]>> You don't want to do your exercises much later into the evening.

[00:40:19]>> H and you want your dinner to be not as heavy as your lunch >> because all those will disrupt how you enter into sleep. and the discomfort and the gut processes that will be at play will really uh not support some of the mechanisms.

[00:40:35]>> Then hopefully then you secure a good stretch of sleep >> and that needs to be your habit whether it's a working day or a holiday or a weekend.

[00:40:46]>> Mhm. You need discipline and and >> absolutely that's when it's actually sleep hygiene >> and you'll find that over time your body just automatically switches off at a particular time and at a particular time in the morning you wake up. You don't need >> without even the alarm.

[00:41:03]>> Yes. and you feel refreshed >> and and that that reset is what you need to actually make your dreams come true, >> you know, to be cognitively h and functioning and and ready for the day physically take you there.

[00:41:20]>> That's what will take you there.

[00:41:22]>> Not sleeping 2 hours two >> two hours a day trying to make to make it to whatever dream you want to make.

[00:41:29]Yeah.

[00:41:30]>> All right. talk to parents and caregivers about children and instilling this hygiene. You know, there's there's a problem especially with how we we help our young ones with their sleep hygiene.

[00:41:42]What do we do different?

[00:41:44]>> It's for parents, it's for caregivers, it's for teachers also.

[00:41:48]>> That the pressure we put on our children to stay up uh one to meet certain academic obligations is just wrong. It does not necessarily deliver better intellectual or academic outcomes.

[00:42:03]>> If anything, it actually worsens the situation. It makes your child uh essentially a zombie during the school uh period. Um and uh you also setting that child up for uh you know all those delterious outcomes that we have spoken to later in life. So it's absolutely crucial that you secure and safeguard the sleep time for your children whether they are in day schools or they are in boarding schools. And you need to start having conversations with school in respect to expectations about uh prep time, about sleeping time, about how much homework they're just getting. uh because we are very very directly and are complicit in impairing the livelihoods of our children. That's that's one thing that we must we need to address ourselves to. Then secondly is to define very clear hours for access to gadgets. Um and we need to agree that beyond a certain duration of time we are not going to be on gadgets. Um and that's critical also in uh helping with the processes that entrain us into sleep. Uh you as an unless you're an emergency doctor or a security person, >> you need not to be woken up uh smack at 2:00 a.m.

[00:43:28]>> So if you have mechanisms or ways in which you really need to uh you know switch off your gadgets, that's absolutely crucial. So that applies to children, it applies to young people, it applies to adults, it applies to everyone.

[00:43:45]>> Mhm. Let me take you back to the polyomnography um the study of sleep. You've done this for quite a while. What is it that you what what trends are you picking concerning things that you're picking from even the people you're interacting with that tells you a lot about our culture and our society that that you really need to highlight this morning?

[00:44:07]Things that you're picking.

[00:44:09]>> So uh a number of times uh about 30 to 40% of the time we have a normal polyomnog >> and the problem is actually in the habit.

[00:44:18]>> Okay.

[00:44:19]>> That's 30 to 40%.

[00:44:21]>> Yes. Um and then there's a variety of people who significantly have or a significant proportion of the population that has sleep >> apnea. Um and also uh nandrem sleep disorders the wakefulness uh the the sleepalking the sleepwalking >> although those are really benign but essentially they evolve out >> and then we also pick a lot of epilepsies >> we see individuals who for a long time have been misdiagnosed to have night terrors or dream nightmares and yet they're actually manifesting testing with uh seizures or convulsions that need to be treated.

[00:45:05]>> Uh so those are really big gaps. We are also seeing >> and this manifested sleep.

[00:45:10]>> Yes. This >> okay. While they sleep. Yeah. Okay.

[00:45:13]>> And uh as a consequence we also seeing uh those who have been affected therefore because of the functional deprivation and all the sleep abnormalities functioning very badly uh during the day. uh kids with uh depression. Uh individuals with depression, refusal to take up roles or manifesting with inorganic sleep issu inorganic uh diseases, frequent tummy pains, >> things that just don't make sense that are not actually there, but it's their way of uh would you say uh speaking to the challenges they are having. Um and and that is uh fairly common uh particularly now that uh we have uh various stages in the CB system that demand an exam process. uh so you have grade six being expected to do exams then I think it's grade 8 and grade nine and and at that time the pressures of the school system are such that look you want to achieve this >> we need to get that out and those kids particularly in second term present to us with a variety of manifestations that are hiding sleep disorders >> and I suspect that uh uh this the the the wholesome uh school unrest that we are seeing >> uh could have also something to do with sleep deprivation.

[00:46:41]>> Yeah, it's communicating something. Yes.

[00:46:43]>> Yeah. Let's talk about treatment. I'm running out of time. It would be unfair if I don't uh give you an opportunity to talk about treatment options and what can be done. You've you've touched a bit about lifestyle changes, but tell us more about now after the diagnosis. Um what treatment options are there for the different disorders that you've uh run us through? So a lot of times the sleep hygiene principles work um that actually stops us moving further. Uh then a number of times we know that if you have um uh sleep apnea uh on account of ENT challenges that needs to be solved for if you are if it's on account of obesity you know you need to work on on on your weight. H all those are very crucial in sorting out for sleep apnea. M >> uh we know that people with underlying secondary issues like neurological diseases and uh the mental health issues need those to be solved for.

[00:47:43]>> Then by extension you've solved for uh sleep disorder.

[00:47:47]>> Uh individuals with conditions like narcolepsy uh require medication and there are all sorts of medications that we use to help uh prevent the daytime sleepiness.

[00:48:00]that's the hallmark of of of that uh uh condition and alongside the behavioral uh uh interventions. Then we also know that when we catch a Caesar on epilepsy, we are also able to provide uh definitive treatment to help prevent whatever is happening for you in sleep.

[00:48:20]So there are different approaches that will be guided by our findings on uh the assessment and polyomography.

[00:48:28]>> But to a large extent I'm I'm finding the solutions come from the lifestyle changes from what you're sharing with us.

[00:48:34]>> Absolutely. Yes.

[00:48:36]>> The adjustments >> we we definitely need to adhere to the principles of sleep hygiene. M the people who have the breathing complications and the snoring are there instances there's a machine that that is used to deal with that.

[00:48:52]>> Um yes and no.

[00:48:56]>> It depends on on what caused your uh breathing disorder.

[00:49:01]>> Hence the reason why you need a proper workup. Um uh but there are uh uh machines that help to uh maintain the pressure in your airway system.

[00:49:12]>> Mhm.

[00:49:13]>> Uh so that you know that uh depression in the airway that happens in sleep is less your airway remains more patent >> than it would love without the machine just enhancing the amount of pressure uh that is on the airway. So that would be one of the machines that we're talking about. There are other uh bits and pieces of gadgets that people speak to but they have not been subjected to trials to confirm their efficacy like those that are supposedly able to uh prop open your nostrils that are supposed to position your your neck and your airways accordingly.

[00:49:54]So different things work for different people differently and some of them are not necessarily a clinical intervention.

[00:50:02]Uh but that said uh you're right there some machines that may just help uh to uh prop up your airway and make it remain >> patterned. But that depends with the diagnosis.

[00:50:13]>> That depends on what it is that the problem for you. Yes.

[00:50:16]>> Surgery can can that be an option in some cases? Yes. Have you had cases that surgery has been >> for ENT conditions? Yes, for ear nose and throat conditions that cause obstruction, we will usually um send the patient to the ENT surgeons for corrective surgery. All right, >> that essentially just helps to change their lives in a big way.

[00:50:40]>> All right. A common habit, Dr. the the there are tablets a medication that people use to assist them to sleep.

[00:50:50]Is that a good thing or a bad thing?

[00:50:52]>> Um one is you should never do that over the counter.

[00:50:55]>> Yeah, >> that happens a lot.

[00:50:57]>> It shouldn't it shouldn't be. H two uh there are various categories of medications that get you into sleep. Uh the one that we would use sometimes is melatonin which is a normal sleep hormone that your body produces that essentially we give it to you to help get you into the process of sleep. Uh sometimes effective and may have to be done uh maybe twice or three times into the night because there's just so much coverage that it gets.

[00:51:28]>> So you have to keep taking it throughout the night. you it may work for you for one intake at the beginning of the night or you may have to take another dose in the middle of the night and you find yourself waking up. But then that has to be for a very specific solution, isn't it? For instance, for kids and individuals who we know have neurological conditions that have sort of uh swapped uh their sleep entrainment. Uh that's a solution. Mhm.

[00:51:54]>> Then h people abuse a group of drugs that we call benzoazipans which are really uh sedatives.

[00:52:04]>> Mhm.

[00:52:05]>> That's not sleep. That's sedation.

[00:52:07]>> Mhm.

[00:52:08]>> Which is different from sleep.

[00:52:09]>> Which is different from sleep. You're essentially switching off everything.

[00:52:13]And uh such drugs in certain doses are actually used for anesthesia.

[00:52:19]>> Yeah.

[00:52:19]>> Yeah. So um and the success and value of them getting you restful sleep is is questionable.

[00:52:29]>> All right.

[00:52:30]>> Um and I know people do take that. Um and there are other drugs that by virtue of their side effects they also sedate you and people also abuse that. Those are drugs for that are used for depression for instance.

[00:52:44]>> Those are drugs that are used for as antihistamines. For instance, people use spirit >> and such like drugs to get into sleep.

[00:52:53]That's inappropriate usage. H and essentially uh to define what you need to do, the right thing to do is uh get an appropriate assessment and a diagnosis.

[00:53:05]>> All right.

[00:53:06]>> And attend to the issues that have been so identified to help you get into sleep.

[00:53:11]>> All right. Thank you so much. Dr. Sam Gu is a pediatric neurologist. We're talking about sleep disorder. disorders.

[00:53:18]We really appreciate your time and company. How is your sleep hygiene? I started there and I'll end it there. How is your sleep hygiene? How long does it take you to go to sleep? How do you sleep? And what is the quality of your sleep? You know, while you're at it, that is something you need to interrogate so that you can be able to have, you know, better outcomes in life.

[00:53:39]Good quality sleep is actually um, you know, something that will help you um, you know, achieve your goals. My name is Safina Chenma. That's how we wrap it up on health and lifestyle this Wednesday.

[00:53:48]We do this again next week. Asant Sana for creating time.