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Sleep: How To Do It Right?

Sleep: How to do it right

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Written by Dr. Ruwanthi Jayasekara

Consultant Respiratory Physician (MBBS, MD Medicine, MRCP UK, ESRS/ Expert Somnologist)

We wake up in the morning, go through the daily routine and finally, sleep at night. This happens day in and day out throughout our lives. We spend about one-third of our lives sleeping. If you consider a person who has lived up to a ripe age of 90, he or she would have spent about 30 years sleeping. 

Why has nature allocated such a considerable amount of time to spend in sleep during the evolutionary process? Surely there must be some great importance.

Keep reading to find out what sleep is, what happens in our body during the long hours we spend in sleep, how many hours and why we should sleep, and how to sleep right and improve the quality of our sleep. Click here to read my other article on sleep disorders regarding how to investigate them, what tests to do and what treatment is available for them.

So, let’s start with the basics - What is sleep ?

Sleep is not one static state. When we sleep, we go through 5-6 sleep cycles every night. Each sleep cycle has several stages as the brain’s EEG or electric current waves change.

stages of sleep

We go to bed and close our eyes. Initially, we drift in and out of sleep during light sleep, and this is stage N1 in sleep. Gradually we enter deeper sleep stages called N2 and N3. These three stages are called NREM sleep, which is Non-Rapid Eye Movement sleep. As we enter deeper sleep stages, the brain EEG waves progressively slow down. Furthermore, the time we spend in N3 is more significant during the night’s first half and reduces in duration as we get closer to the wake-up time.

After the stages of wake, N1, N2 and N3, we enter REM sleep, which is called dreaming sleep. In this stage, our brain waves, again, look very active. However, our body becomes atonic or almost paralysed. In this stage of sleep, we start dreaming, and we remember our dreams only if we are awakened from this stage of sleep.

What is a body clock?

The amount of dreaming sleep increases as the night goes on. As we spend less time in deep sleep towards the early hours of the morning, we also tend to have episodes of waking up in the morning. 

Our body clocks run this pattern of waking up in the morning and sleeping at night, called the circadian rhythm. The central body clock is situated in the brain in the small but essential organ known as the hypothalamus. There is an area with packed neurons called the suprachiasmatic nucleus, which plays a vital role in setting the body clock so that we wake up in the morning and sleep at night. The sun also plays a massive role in maintaining the sleep-wake cycles.  

Many complex neuronal signalling and hormonal interplay go on in the body, especially in the brain, so this cycle happens smoothly. As the sun goes down in the evening and dusk sets in, there is another small organ in the back of the brain called the pineal gland, which secretes a hormone called melatonin. Melatonin is essential in making us feel sleepy. People who take over-the-counter melatonin tablets for sleeping without proper medical advice may have worse sleep patterns than they bargained for due to improper timing or wrong dose.

circadian rhythm and sleep

How much sleep do we need?

how much of sleep do we need?

The amount of sleep we get varies with age, and most young adults report 7-8 hours of sleep. Restricting sleep to 4-6 hours per night negatively impacts our mental and physical skills and performance.

A baby will sleep about 12-16 hours most of the day, and as time goes on, the amount of sleep lessens gradually. A 10–12-year-old child will need about 9 to 10 hours of sleep, and a teen would require 8-10 hours. 

A healthy young adult will need about 7-9 hours of sleep. However, this is a population average. The amount of sleep each person needs is highly individualistic. 

It is essential you find out how many hours of sleep your body needs.  How can you do this? On a holiday,  go to sleep when you feel sleepy and let yourself sleep until you wake up in the morning without an alarm clock. Continue this for several days and calculate how many hours of sleep you need. It may be within the population average of 7-9 hours.

Occasionally, it may also be less than that. Certain people sleep less or more, which may not impact their daytime functioning. If you find out your natural sleep requirement, you must ensure you get this amount of sleep every night of the week.

As ageing sets in, the sleep requirement reduces. An elderly person’s sleep can vary from 5-6 hours of sleep to 7-9 hours. The amount of time spent in deep sleep reduces with age as well. Also, the amount of fragmented sleep tends to increase, especially in the early hours of the morning.

Is it normal to wake up several times during sleep?

Yes! It is normal to wake up several times during any of these stages. We may keep tossing and turning around and go back to sleep. Sometimes, we may remember waking up at night, while other times, we may have no recollection of this. So, if someone thinks that once you fall asleep in the night, you must sleep without any wake periods, that is a myth.

why is sleep so important?

Why do we sleep? Why is it so important?

‘A good laugh and a long sleep are the best cures in a doctor’s book’. Many studies have been done to understand the importance of sleep.

  • Sleep is essential to rest the brain.

Studies have shown that the brain clears unwanted material called neurotoxins from the brain during the sleeping process.

  • Improved physical health

There is also a clear link between good sleep and improved physical health.

  • Helps maintain a balanced mind

Sleep is vital for maintaining a balanced mind. Otherwise, you become angry, irritable, and depressed.

  • Memory consolidation

There are many harmful consequences of inadequate sleep. Increased risk of cancers, infections, increased forgetfulness, poor decision-making power, increased body pains, increased risk of dying early and increased risk of road traffic accidents are some of the negative impacts of poor sleep.

Tips for better sleep

To achieve the best of sleep amidst our busy schedules, we must know how to sleep right. Following are guiding steps to observe, fall asleep quickly and sleep well.

  • Maintain a regular sleep routine – Depending on your work and family schedule, decide what your regular wake-up and bedtime are. Maintain this routine throughout the week. Strictly abiding by a sleep routine can reduce sleep deprivation.
  • Avoid stimulants such as tea, coffee, cola and chocolates about five hours before bedtime
  • Stop smoking
  • Avoid exercise close to bedtime – It will have a stimulating effect on the brain even though you may think that it causes the body to be tired.
  • The last mealtime before bedtime should be 2-3 hours before
  • Utilise between 30 minutes to 1 hour to wind down, take a wash, change into pyjamas, and spend time on self-grooming in preparation for sleep.
  • It would be best if you stopped using devices such as phones, laptops, and iPad at least an hour before bedtime. 
  • The bedroom must be a quiet, dark environment. 
  • It is essential to avoid napping in the daytime. Instead, opt for short, power naps of less than an hour during the daytime.
  • Engage in exercise
  • Maintain a healthy diet 

If you regularly follow these simple but essential steps, good quality sleep can be ensured. However, if you still have difficulty sleeping, have doubts about your sleep hygiene, or want to find out whether you have a sleep disorder, it is best to consult your respiratory consultant. You can consult SLMC registered sleep consultants or respiratory consultants via oDoc, who can assist you towards a healthier sleep routine.

Dr Ruwanthi Jayasekara

SLMC 25147

Chest Physician

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What Goes Wrong in Sleep? An Overview of Sleep Disorders

What Goes Wrong in Sleep? An Overview of Sleep Disorders

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Written by Dr. Ruwanthi Jayasekara

Consultant Respiratory Physician (MBBS, MD Medicine, MRCP UK, ESRS/ Expert Somnologist)

Good sleep is essential for a good life, and we spend about one-third of our lives sleeping. Therefore, it is essential to be aware of disorders that can occur during sleep, how to identify them, and treatments are available for them.

What types of sleep disorders are there?

There are many types of sleep disorders but here are some of the most common ones: 

  • Insomnia (difficulty in falling asleep and/or staying asleep)
  • Sleep related breathing disorders (eg. Sleep apnoea)
  • Central disorders of hypersomnolence (conditions with excessive sleep)
  • Parasomnias (involves unusual and undesirable physical events or experiences that disrupt your sleep)
  • Sleep-related movement disorders 

Let’s take a deeper look into each of the above-mentioned sleep disorders including how each affects the patient and what they can do to prevent them.

types of sleep disorders

Insomnia

People with insomnia find it very difficult to fall asleep and/or sleep well at night despite having a suitable environment and time to sleep. This will result in an impairment in their daytime functioning. In some people, this can be short-term, such as in anticipation of a stressful event like facing an exam or starting a new job. In others, this goes on for many months and years, causing distress to the patient.

Patients with insomnia will be evaluated using 

  • Sleep diaries – These let you measure and record when the patient went to bed, when they woke up during the night and woke up in the morning
  • Actigraphy – It is a wearable sleep test that tracks the patient’s movements while they are sleeping to analyse when they’re asleep and awake
  • Polysomnography (sleep study) – It is a comprehensive test that records brain waves, oxygen level in blood, heart rate, breathing, leg movements, etc during the sleep study.

This condition’s management includes sleep hygiene measures, medication revision and cognitive behavioural therapy.

Sleep-related Breathing Disorders

These conditions are involved with abnormal and difficult respiration during sleep. While some of these sleep-related breathing disorders have low health impacts, others may have serious consequences due to their effects on the patient’s sleep and balance of oxygen and carbon dioxide in their blood.

There are a few types of sleep-related breathing disorders. They are 

  • Obstructive sleep apnoea 
  • Central sleep apnoea
  • Sleep-related hypoventilation disorders
  • Sleep-related hypoxemia

Some risk factors of obstructive sleep apnoea are 

  • Male sex
  • Ageing
  • Obesity
  • Smoking
  • Alcohol use 
  • Certain craniofacial features such as receding jaw or small chin
  • Patients or their bed partners complain of loud snoring
  • Fragmented sleep
  • Getting up frequently to go to the toilet
  • Feeling excessively sleepy in the daytime
  • Feeling irritable and moody in the daytime

Apnoeic Spells and its Treatments

Sometimes a spouse may notice that the patient stops breathing at night for prolonged periods. This phenomenon is known as an apnoeic spell. Patients are evaluated with sleep studies called ‘polysomnography’, tests that evaluate sleep in detail and diagnose the underlying sleep disorder. The first line treatment is CPAP therapy (a device that provides continuous positive airway pressure). Additionally, weight loss with exercise and a healthy diet are also substantial.

Central Disorders of Hypersomnolence

These are a rare group of sleep disorders where patients complain that they are always sleepy during the day and the night. Patients tend to fall asleep in the daytime even after adequate sleep. E.g. Narcolepsy. Some patients with excessive sleepiness may have an underlying undetected medical or psychiatric condition. 

Excessive sleep has a significant detrimental impact on the patient’s life. These patients must be evaluated with sleep studies and blood investigations before starting their treatment.

Circadian Rhythm Sleep-Wake Disorders

Circadian rhythm sleep-wake disorders are a group of disorders where the patient’s body’s clock, which helps to maintain a regular day and night pattern, is affected. 

There are several types of circadian rhythm sleep-wake disorders.

  • Delayed sleep-wake phase disorder

This is where the patient does not fall asleep until the morning and tends to wake up in the afternoon – the patient’s circadian clock is delayed compared to the average population. These patients may struggle to wake up on time for school and work. 

  • Advance sleep-wake phase disorder

On the other hand, this disorder tends to have an early sleep pattern and early rise pattern. There are various types of disorders. Shift workers also suffer from the detrimental effects of not sleeping on time and staying awake when they should be sleeping. 

  • Jet lag disorder 

This is another condition in which people suffer due to crossing time zones. Understanding these conditions is vital as many treatment modalities help reduce these problems.

Parasomnias

Parasomnias are another set of sleep disorders involving a lot of sleep movement. In certain sleep stages, some people have confusional arousals, sleepwalking, sleep terrors, sleep-related eating, violent movements in sleep, acting out dreams, nightmares etc. Patients are evaluated with a sleep diary and polysomnography. These conditions must be identified and treated as many patients suffer from poor sleep and daytime dysfunction due to these issues.

Sleep-related Movement Disorders

Sleep-related movement disorders include restless leg syndrome and periodic limb movement disorder, where the patient has a lot of leg movement at night, leading to disturbed sleep.

How do you prevent sleep disorders from occurring in the first instance?

The baseline management of any sleep disorder is the maintenance of good sleep hygiene practices.

  • Maintain a regular sleeping and waking up time
  • Have regular meals
  • Avoid caffeinated drinks close to bedtime
  • Avoid smoking and alcohol
  • Keep your devices away at least one hour before bedtime

Despite these measures, if a patient feels that they have an issue with their sleep, it is best not to delay diagnosis, as sleep is essential for a healthy life. They can consult experienced sleep specialists via the oDoc app to have a comfortable and convenient consultation in just three taps within the comfort of their own home.

Dr Ruwanthi Jayasekara

SLMC 25147

Chest Physician

Sources

  1. How Is Actigraphy Used to Evaluate Sleep, Sleep Foundation (2022)
  2. Sleep-Related Breathing Disorders, Sleep Foundation (2022)
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5 Home Remedies for Mosquito Bites

5 Home Remedies for Mosquito Bites

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Mosquito bites
“..what hurts more is probably the blisters and bumps they leave behind..” 🦟

The whining of a mosquito is a familiar sound that hovers past our ears these days. Ever noticed how active these creatures are during power cuts at night, buzzing non-stop around us, aiming to make a smooth landing on our skin? 

And what hurts more is probably the blisters and bumps they leave behind. Here are five easy home remedies for those painful mosquito bites that take an eternity to go away.

What happens under your skin after a mosquito bites you?

When a mosquito bites, it uses its long mouthpart; proboscis (which looks like a tiny needle), to prick your skin and suck your blood. When this occurs, its saliva is released into your bloodstream. Your body acknowledges this as an allergen, signalling your immune system to transmit the chemical ‘histamine’ to the area bitten by the mosquito. This is done to remove the allergen from your body. 

The histamine triggers an inflammatory response causing the area around the mosquito bite to swell and itch.  In some people, the bites may develop into an allergy as well.

Mosquito bites a person hand

Do all mosquitoes drink blood?

No, it’s only the female mosquito that drinks blood. This is because proteins present in the human blood are essential for the development of mosquito eggs.

How does a mosquito spread diseases?

When an infected mosquito bites, it transfers the infection via its saliva into your bloodstream, passing the infection onto you. Since mosquitos practise ‘sip feeding’, the process of sucking blood from multiple sources, the infection tends to spread among many people.

Home remedies for mosquito bites​

Here are some natural remedies for mosquito bites that can help reduce the itch and inflammation:

       1. Ice

Apply a bag of crushed ice or an ice pack over your bumps for about 10 mins to reduce the itch and swelling.

       2. Honey

Honey has vital anti-inflammatory properties. Apply a drop of honey onto the affected area. This would help reduce the itch and pain.

      3. Aloe Vera

Aloe vera helps increase the speed of wound healing. To use this on your mosquito bites, cut a small section of an aloe vera plant and apply its gel onto the affected area. Let this dry on your skin and reapply again as necessary.

      4. Onion

This common kitchen vegetable has natural antifungal and antibacterial properties, which helps lower irritations associated with the skin. Cut an onion slice and apply it to the area of mosquito bites for a few minutes. Then, remove the slice and rinse the area thoroughly.

     5. Apple Cider Vinegar

The antimicrobial and antioxidant properties of apple cider vinegar helps treat many skin conditions such as eczema. Add a drop of apple cider vinegar on your bump . If you have several bites, soaking a cloth in cold water and vinegar and applying it to the affected area may give you some relief and reduce itching.

home remedies for mosquito bites

When should you visit a doctor?

You can consult a doctor via oDoc if you experience an allergic reaction to mosquito bites or see the following symptoms of dengue passed on by mosquitos:

  • Fever
  • Nausea
  • Vomiting
  • Aches and pains (behind the eyes, muscles or joints)
  • A rash

With the number of dengue patients increasing in the country, it is vital that you maintain a clean surrounding around your homes and prevent the population of mosquitos. Applying a mosquito repellent such as citronella oil will also help you avoid mosquito bites. If you think you are undergoing a severe allergic reaction caused by mosquito bites you can consult a dermatologist, or if you are experiencing the above dengue fever symptoms, you can consult a GP via the oDoc app.

Sources

  1. 16 Home Remedies for Mosquito Bites, Healthline (2022)
  2. Mosquito Bites: What They Look Like, Why They Itch & Treatment, Cleveland Clinic (2021)
  3. Dengue – Symptoms and Treatment, CDC (2021)
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Is Monkeypox the New Covid? Here’s all you need to know

Is Monkeypox the New Covid? Here's all you need to know

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Source: Reuters

Last week, on the 23rd of July 2022, Dr. Tedros Adhanom Ghebreyesus, the W.H.O.’s director general declared the rising monkeypox cases as a global health emergency. 

If you are wondering what exactly this new virus is, what are its symptoms and how to protect yourself against it, keep reading to uncover the answers to your questions!

What is Monkeypox

What is Monkeypox?

Monkeypox is the disease caused by the monkeypox virus, which belongs to the variola family of viruses (same family as the virus that causes smallpox).

The first traces of human cases of monkeypox dates back to 1970 to a 9-month-old boy in the Republic of Congo. Ever since then, monkeypox cases have been confined to the Central and Western African regions. It was only in 2003 that monkeypox cases began to emerge outside of Africa: the first instance of which was in the USA, where there were cases amongst pets. Fast forward to 2022, more than 15,000 cases have since been discovered in several countries within the year, including the UK, India, Spain, Australia and Singapore.

What are the symptoms of monkeypox?

  • Rash that looks similar to pimples and blisters, appearing on the face, inside the mouth and on body parts such as hands, feet, chest, genitals or anus.
  • Fever
  • Headache
  • Muscle aches and backaches
  • Swollen lymph nodes
  • Chills
  • Exhaustion
Monkeypox symptoms

How does monkeypox spread?

The virus is transmitted via respiratory secretions, droplets and skin to skin contact. You are at high risk especially if you come into contact with broken skin, eyes, nose or mouth of a person infected with monkeypox. Furthermore, monkeypox can also be spread when in contact with virus contaminated objects like bedding and clothing. In addition, although there hasn’t been any scientific evidence that monkeypox is transmitted via sexual fluids, patients with the virus are advised to use condoms during sexual intercourse for eight weeks as a precaution after being infected.

Is there a treatment for monkeypox? Is there a vaccine?

Vaccination against smallpox has proved to be 85% effective in monkeypox prevention. 

Monkeypox is a disease where the presenting rash goes through  multiple stages of healing – typically, symptoms last between 2-4 weeks. Although there have been more severe cases (some leading to death) that were reported in Africa, most cases are mild, sometimes similar to chickenpox. 

How many monkeypox related deaths are there?

As of June 2022, there have been 1595 cases which resulted in 72 deaths in the African Region as a result of monkeypox. 

Should Sri Lankans be worried?

There have been 4 monkeypox cases identified in India so far. If the spread in India tends to rise, Sri Lanka is also at a potentially high risk of a monkeypox outbreak. It is also possible that foreign travellers from other countries could import the virus to the country.

As seen visibly we have forgotten the basic safety rules that we strictly abided by in early 2020, so it’s best to start our healthy habits once again. Safety first, it’s important for us to protect ourselves and carefully identify symptoms to prevent its spread in our country. 

How to prevent catching monkeypox

  • Avoid skin-to-skin or close contact with people who have a rash that looks similar to monkeypox
  • Do not touch the rash or scabs of an infected person 
  • Do not share eating utensils with an infected person 
  • Do not touch bedding, towels or clothing of an infected person
  • Practice hand washing with soap and water or use an alcohol-based hand sanitizer
Preventing monkeypox

Please stay alert if you or anyone you know experiences these symptoms. By doing so, you can take necessary precautions to prevent a serious spread in our country. Stay safe and alert!

You can consult a GP via the oDoc app if you think you have the above symptoms or need further information from a medical professional.

References

  1. About Monkeypox, CDC (2022)
  2. Multi-country monkeypox outbreak in non-endemic countries, WHO (2022)
  3. Multi-country monkeypox outbreak: Situation update, WHO (2022)
  4. India’s 4th Monkeypox Case: Symptoms, Jabs and Global Outbreak Explained, NDTV (2022)
  5. What is monkeypox and how do you catch it? BBC, (2022)
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Is Indigestion Preventable?

Is Indigestion Preventable?

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Ever felt full or bloated after a meal? Ever felt a burning sensation in your stomach right before a delicious meal? Or ever been on a first date where your stomach started making weird, AUDIBLE noises? (Shut up, stomach. Please). If you answered yes to any of these questions, there’s a high chance that indigestion is making your stomach a battlefield! It’s not a great feeling, we know! Read on to discover why this uncomfortable indigestion issue occurs and what you can do to treat it.

painful indigestion

What is indigestion?

Indigestion, dyspepsia or an upset stomach is a persistent pain in your upper abdomen.

Symptoms of indigestion

  • Burning in the stomach or upper abdomen
  • Abdominal pain
  • Feeling bloated
  • Belching and gas
  • Growling stomach
  • Nausea and vomiting
  • An acidic taste in the mouth

How does indigestion occur?

Indigestion occurs when your stomach acid comes into contact with mucosa, the lining of your digestive system. This causes the stomach acid to break down the lining, resulting in irritation and inflammation, which is the painful, burning sensation related with indigestion.

Causes of indigestion

The popular saying, “Too much of anything is good for nothing” applies to indigestion as well.

  • Lifestyle decisions like overeating, eating too quickly, eating fatty or spicy foods are directly linked to indigestion. 
  • Overconsumption of caffeine, alcohol, chocolate and carbonated drinks.
  • Smoking, certain antibiotics and overconsumption of pain relievers 

 

causes of indigestion

Here are some other conditions that cause indigestion

  • Gastritis
  • Peptic ulcers – These are open sores that develop on the inner lining of your stomach and upper portion of your small intestine
  • Celiac disease – It is a condition where your immune system attacks your tissues when you consume gluten
  • Gallstones
  • Stomach cancer
  • Intestinal blockage
  • Diabetes
  • Pregnancy

This is not an exhaustive list of the underlying causes that could cause indigestion. Please consult a gastroenterologist (via the oDoc app) to diagnose the causes for your indigestion for early detection of any other serious underlying conditions.

Is indigestion and gastritis the same thing?

The symptoms of indigestion and gastritis are similar and you may often get confused between the two. However, while indigestion occurs as a result of stomach acid, the main cause for gastritis is a bacteria called Helicobacter pylori.

How do you diagnose indigestion?

A gastroenterologist will first go through your medical history and discuss with you your presenting signs & symptoms. To ascertain  the causes of your indigestion, they  may  prescribe several blood tests and/or X rays of your stomach and small intestine. There are times when your doctor may recommend you to conduct an upper endoscopy to look closely at the inside of your stomach.

What can you do to prevent it?

Foods to avoid

  • Acidic foods like oranges and tomatoes
  • Foods and beverages that contain caffeine

Here are some tips that you can follow:

  • Eat meals in small portions so that your stomach doesn’t have to work too hard to digest it.
  • Practise eating your food slowly.
  • If stress and anxiety bring about your indigestion, take a look at our blog on ways to manage your anxiety.
  • Try quitting smoking and cutting back on consuming alcohol as these irritate your stomach lining.
  • Avoid lying down as soon as you eat
  • Do not exercise with a full stomach.
  • Wait a minimum of three hours after your last meal for the day before going to sleep.
how to prevent indigestion

Indigestion treatment options

If your indigestion does not go away, certain over-the-counter medicines and antacids may help. Please consult a gastroenterologist to know what medicines can help you. You can do so via oDoc from the safety and comfort of your home.

Things to watch out for

If you experience these symptoms, immediately consult a gastroenterologist as it may indicate serious health complications.

  • Vomiting or blood in vomit
  • Black, tarry stools or visible blood in stools
  • Severe abdominal pain
  • Discomfort which is not related to eating
  • Weight loss 
  • Loss of appetite

You can download the oDoc app today for comfortable and convenient consultations with gastroenterologists in the comfort of your home.

References

  1. Indigestion – Symptoms and Causes, Mayo Clinic (2021)
  2. Indigestion – Illnesses and conditions, NHS Inform (2021)
  3. Indigestion – Diagnosis and Treatment, Mayo Clinic (2021)
  4. Indigestion (Dyspepsia): Symptoms, Causes, Diet, and Treatment, Web MD (2022)
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