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Don’t Let Infertility Get in the Way of Parenthood

Don't Let Infertility Get in the Way of Parenthood

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Every couple dreams of starting their own family – to be able to bear a child, nurture them and see them grow is one of those unique goals that every couple hopes to achieve someday. However, when this long-awaited dream stumbles upon a barrier in the form of infertility, it can be very frustrating. But hey, don’t lose hope yet, because there is a solution.

Want to know more? We reveal a very effective fertility treatment to make your parenthood dreams a reality.

In-Vitro Fertilisation

In-vitro fertilisation or IVF is a type of Assisted Reproductive Technology (ART). ARTs are clinical methods used to treat infertility, using procedures involving both egg and sperm. 

This week’s blog explores the ART method – ‘In-vitro Fertilisation’ (IVF). With its usual success rates ranging from 35%-55%, it has become a very popular fertility treatment method for couples worldwide and, increasingly, in Sri Lanka too. 

IVF uses a combination of medicines and surgical procedures to aid the fertilisation process between sperm and egg cells. Additionally, after fertilisation occurs, IVF helps the fertilised egg to implant in your uterus. Babies born using IVF (popularly known as test-tube babies) have been healthy and successfully delivered using this method. 

Is IVF the answer for you?

IVF treatment is designed for couples with infertility and genetic problems. Other medical conditions and issues for which IVF can be used are:

  • Fallopian tube damage/blockage
  • Ovulation disorders
  • Endometriosis – When tissue similar to the uterus lining grows outside the uterus
  • Uterine fibroids – Benign tumours in the uterus
  • Impaired sperm production/function – Low sperm mobility and functionality 
  • Low sperm count
  • Unexplained infertility
  • Fertility preservation for cancer treatment – IVF is suited for you if you are about to undergo cancer treatment (chemotherapy/radiation) that could affect your fertility. IVF can help you store your eggs and embryos for later use.

The IVF Process - How does it work?

In-vitro Fertilisation Process

Let’s break down the IVF process. There are  6 main stages.

Stage 1: Suppressing the menstrual cycle

This is the first step of IVF. As you begin your period, hormone tests and an ultrasound scan will be conducted. Afterwards, you will be prescribed birth control pills for 2-4 weeks to suppress ovarian hormones that prevent ovulation (the process of the female body releasing egg cells). This is done to synchronise the eggs to ensure that more eggs will become mature during the second stage. Finally, once birth control pills are stopped, most women get their periods again.

Stage 2: Ovarian stimulation

Synthetic hormones and medications will be used to stimulate your ovaries. This is crucial as IVF requires a woman to develop multiple eggs rather than a single egg (the typical amount a woman produces each month). Multiple eggs are needed to ensure the success of the treatment, as some eggs may not fertilise or develop normally after fertilisation.

Stage 3: Monitoring of eggs

This stage is when your doctor monitors the development of the eggs in your ovaries before collecting them for fertilisation. Vaginal ultrasound scans and blood tests will be done to assess this.

Stage 4: Collection of eggs

Once the doctor confirms that  your eggs are mature and ready for collection, you would have to undergo a clinical procedure to retrieve your eggs from your ovaries.  The mature eggs are removed using an ultrasound probe and a thin needle which is inserted into your vagina. This surgical procedure usually takes about 20 minutes. After this process, mature eggs are placed in a nutritive liquid and incubated.   

Stage 5: Fertilisation

Fertilisation is when the collected egg and sperm samples are mixed and incubated. After a few days, embryos (fertilised eggs) may develop. 

Stage 6: Embryo transfer

The final stage of IVF involves placing the fertilised eggs into the woman’s uterus. The doctor will place the embryos in your uterus using various tools such as catheters and a syringe. After 2 weeks, couples are advised to take a pregnancy test to check whether they are pregnant. If the embryo implants in your uterus lining, this will then indicate a successful pregnancy.

Cost and Price of IVF Treatments

Although IVF has considerable success rates, it is the most expensive assisted reproductive treatment. However, it has been the most sought-out infertility treatment method by most couples due to its success rates, despite its high prices.

Benefits of IVF

Treatment for infertility with In-vitro Fertilisation

So, now that you know what IVF is and what happens in its process, is it worth it? Let’s find out.

  1. Improved chances of having a healthy baby

Did you know IVF procedures involve conducting tests like preimplantation genetic testing (PGT) on a fertilised embryo before transferring it to the uterus? These tests assess any abnormal number of chromosomes and risks of inherited genetic conditions like cystic fibrosis or Tay-Sachs Disease in embryos. So if you use IVF, the chances of your baby being healthy is higher.

  1. Better chances of conception

If natural reproductive methods haven’t helped you and your partner conceive, it’s maybe the right time to look into IVF treatments. With success rates ranging between 35%-55%, it increases a woman’s chances of conception due to it being conducted in a highly controlled process. Furthermore, IVF enhances the chances of a woman being pregnant beyond her 20s too.

  1. Lower risk of miscarriage

Since tests like PGT are conducted during IVF, they can identify the most genetically viable embryos. Miscarriages mainly occur due to chromosome abnormalities, so IVF’s capability to ensure that the best embryos are placed in a woman’s uterus reduces the possible risk of miscarriages caused by genetic and chromosomal abnormabilities. 

  1. More control over family planning

Advancements in modern science, such as IVF, are unquestionably great innovations. If you are a busy couple or feel that you aren’t ready for parenthood yet, IVF lets you decide when you want to conceive by cryopreserving your eggs or embryos  until you are ready for parenthood.

Risks of IVF Treatments

  1. Multiple births 

If more than one embryo is placed in your uterus, the risk of having multiple births increases. This could cause complications with early labour and the baby’s weight.

  1. Premature births and low birth weight 

Previous research proves that IVF slightly increases the chances of a baby being born early or with a low birth weight, which could be unhealthy for the baby.

       3. Ovarian hyperstimulation syndrome 

This occurs when certain hormones and medications are used to induce ovulation during IVF, and the ovaries become swollen and painful. Symptoms like abdominal pain, nausea, vomiting and bloating would occur.

       4. Miscarriage  

Miscarriage can be a very unpleasant experience. However, despite the advanced tests conducted in IVF, due to various issues in fertilisation, such as the possibility of chromosomal variation and more, even IVF has a similar risk of miscarriage – a percentage similar to women conceiving naturally. Therefore, a successful conception cannot be guaranteed entirely, even with this procedure.

Other risks include possible bleeding and damage to the bowel, bladder and blood vessels during the collection of eggs and an increased risk of cancer and ectopic pregnancy (when the embryo implants outside the uterus). It is vital to be educated about the benefits and risks of IVF to decide whether IVF is the right option for you.

From where can I get IVF treatment?

If you are interested in seeking IVF treatments, you must consult a gynaecologist who will provide you with the necessary advice and information. In addition, they will diagnose any medical conditions or issues that have prevented you from successfully conceiving before recommending this treatment option. 

You can consult a gynaecologist via oDoc to discuss comprehensively with them whether IVF is right for you. They will help you achieve your dream of becoming a parent and educate you on the best option for conception.

In-vitro Fertilisation treatments with oDoc

References

  1. In vitro fertilisation, Mayo Clinic
  2. In vitro fertilisation process, Midwest Reproductive (PA)
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Migraines 101: Symptoms, Causes and Treatments

Migraines 101: Symptoms, Causes and Treatments

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If you are one of the 1 billion people with migraines, you may know how uncomfortable a migraine attack can be. If you are not, how does it feel to be one of God’s favourites?! 

Keep reading to find out the answer to that 😉

Here's what a migraine feels like:

Most people describe it as a pulsating, pounding, dull ache that spreads across their forehead. You can feel the pain on one side of your head or both sides. Sometimes you can even feel it shift. 

What causes a migraine attack?

The direct causes of migraines have still not been identified. However, researchers believe that ‘abnormal’ brain activity affecting nerve signalling, blood vessels and chemicals are the root cause of migraines. Researchers have identified the following as significant triggers for migraines:

  • Severe heat
  • Dehydration
  • Bright lights
  • Unusual smells
  • Hormonal changes in women (oestrogen and progesterone fluctuations) during menstruation, pregnancy or menopause
  • Changes in sleep pattern

Hereditary history of migraines and being a female are some risk factors for developing migraine conditions.

causes of migraine attacks

How does a migraine attack arise?

Stages of migraine

Let’s learn about the process of how a migraine attack occurs and its respective symptoms.

  1. Prodrome Phase

This is the initial stage of a migraine. Usually occurring around 1-2 days before the migraine attack or any other headaches related to it, here are some prodrome symptoms:

  • Food cravings
  • Neck stiffness
  • மனச்சோர்வு
  • Fatigue
  1. Attack Phase

It is during this phase that people have reported extremely uncomfortable sensations. The pain typically begins above your eyes and might spread over to one side of your head, your entire head or shift from side to side. Throbbing in the head may worsen if you exert yourself or move.

Other notable symptoms to look out for during the migraine attack phase include:

  • Increased sensitivity to light and sound
  • Nausea
  • Feeling faint

The symptoms of a migraine attack could last between several hours to two days, depending on the patient.

  1. Postdrome Phase

The migraine attack is followed by the postdrome phase. You may feel sick for up to a day. You may also experience:

  • Extreme tiredness
  • Pain in the head  that increases when you move too quickly or lean over
  • Confusion

You must gain sufficient rest after experiencing a migraine attack to recover effectively.

Now that we have broken down each stage of a migraine, did you also know there are different types of migraines, each with varied symptoms? Keep scrolling to find out more

Different types of migraines that exist

There are two common types of migraines: 

  • Migraine with aura
  • Migraine without aura

Along with the previously mentioned symptoms of a migraine, a person might experience either a migraine with an aura or a migraine without an aura.

Aura? What’s that?

It may sound like a pretty word but, it’s not a comfortable sensation. Aura is a condition that involves minor impairments to your vision, senses and speech for a period of time. Common signs involve blurry vision, coloured spots, neck stiffness, inability to hold your balance, difficulty speaking or forming words.

1. Migraine with aura (Brainstem Aura)

A person who experiences a migraine with brainstem aura would experience pain at the back of the head on both sides. They would face the following symptoms before the main migraine attack happens.

                                        Aura symptoms

  • An aura with visual problems
  • Numbness of body, face and tongue
  • Speech problems
  • Problems with moving

                                     Brainstem symptoms

  • Difficulty talking (unclear speech)
  • Vertigo (a spinning feeling)
  • Ringing in the ears
  • Eye problems in one eye (blind spots, flashes of light, temporary blindness, etc.)

2. Migraine without aura

Although, others may not experience an aura before their migraine attack or headaches. The following are some symptoms of a migraine without aura.

  • Migraine occurs only on one side of the head 
  • Throbbing/pulsating pain in the head
  • Pain gets more intense as you move (Eg: Walking)
  • Becoming sensitive to light
  • Becoming sensitive to sound
  • Nausea with or without vomiting

Treatment and tips for managing migraines

But wait! There’s some good news. Although migraine is not something that can be cured, you can still manage and control migraines from occurring through the following methods. As a result, it may lead to fewer attacks.

  • Adjustments to your lifestyle

You must ensure that you minimise or avoid any migraine triggers mentioned above. Along with this, managing your stress would also help you reduce the intensity of migraines.

  • Keep a journal

Maintaining a journal to list the instances you face migraine symptoms and attacks will help identify your triggers. This will allow you to avoid events and circumstances that trigger these symptoms.

  • Apply a cold compress on your forehead

This method slows down the nerve signals involved with migraine pain and generates a soothing, cool feeling that can help reduce the severe headache.

  • OTC pain or migraine medications

These medications include Nonsteroidal anti-inflammatory drugs (NSAIDs), Paracetamol, etc. These would reduce the intensity of migraine headaches and attacks. It is advisable to consult a doctor and receive a prescription before taking these medications.

  • Stay hydrated

Often when we are out in an environment with severe heat, we may forget to keep ourselves hydrated. Dehydration is a main trigger of migraine attacks. Therefore, ensuring an adequate intake of fluids will rule out the possibility of dizziness and headaches associated with dehydration.

Did any of the above symptoms and triggers sound familiar to you?  Feel like you’ve experienced them? If you have, it is possible that the ‘really bad headache’  you experienced was actually a migraine attack. Consulting a doctor about these symptoms may help diagnosis and treatment of your ailment. .

Consult a GP via the oDoc app to receive expert medical advice on reducing the highly uncomfortable symptoms of migraines and improving your well-being.

Sources

  1. Everything You Want To Know About Migraine, Healthline (2021)
  2. Migraine with brainstem aura, Genetic and Rare Diseases Information Center (2022)
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Menopause: The Great Ending of The Menstrual Cycle

Menopause: The Great Ending of The Menstrual Cycle

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The menstrual cycle – the epitome of the reproductive cycle, which gives birth to life and plays a significant role in the transition from girlhood to womanhood, is considered nature’s phenomenon, gifted to women (minus the agonising PMS symptoms, of course). And after decades and decades of operating the same painful cycle every month, a woman’s menstrual cycle decides to retire into solitude in the mature years of her life.. (great news, right?!) 

But do you know what really happens in this ending stage of a woman’s menstrual cycle? 

This week’s blog unravels the grand (or rather, long-served) ending of this extraordinary cycle: ‘Menopause’. Keep reading as we explain each stage of menopause and how you can prepare for it.

What is menopause?

As the word suggests, menopause involves the permanent pause of a woman’s menstrual cycle. It is the period that indicates the end of a woman’s menstrual cycle, where usually, if a woman has gone 12 months without her menstrual period, she is said to be having her ‘menopause’.

When does menopause occur in a woman’s life?

It usually occurs between the ages 40 and 50.

The female sex hormones - partners in crime

Before we dive in deeper, it’s important to know the two main female sex hormones- oestrogen and progesterone. Oestrogen is responsible for the development of secondary sexual characteristics in a young woman and functions such as menstruation, ovulation and pregnancy. Similarly, progesterone also plays an equally significant role in the menstrual cycle, ovulation and pregnancy. They are indeed two hormones tirelessly working hand in hand in a woman’s body!

The stages of menopause

stages of menopause
  1. Perimenopause

This is the first stage that leads up to menopause. Perimenopause is the period in which a woman’s body makes the transition from having an active menstrual cycle to menopause (menopausal transition). Several changes in hormonal levels occur. In this stage, oestrogen levels begin to rise and fall unproportionately. Furthermore, menstrual cycles may either increase or decrease, causing irregular periods. Women may also have menstrual cycles despite ovaries not releasing an egg (ovulation). During this stage, it is possible for symptoms related to menopause, like hot flashes, vaginal dryness, etc., to be present.

  1. இறுதி மாத விடாய்

Menopause occurs when the female body stops producing the hormones that cause menstrual cycles. These hormones include oestrogen, progesterone, luteinizing hormone and follicle-stimulating hormone. A woman would then not get her period for 12 months consecutively.

       3. Post-menopause

This is the final stage of menopause in which a woman hasn’t experienced her period for over 12 months. The body produces significantly fewer amounts of hormones (oestrogen and progesterone), and women will no longer experience a monthly period nor can get pregnant for the rest of their lives. During this stage, the symptoms of menopause may linger around; however, they are less intense.

Symptoms of perimenopause and menopause

  • ஒழுங்கற்ற மாத விடாய் சுழற்சி

Due to hormonal changes in the perimenopause stage, the duration of time between periods may become longer or shorter. Also, period flows may range from light to heavy, while missing periods are common.

  • Hot flashes and sleep problems

A hot flash is the sudden feeling of warmth in the upper body. These intense feelings spread over the face, neck and chest areas and skin may redden, causing sweating as well. Often, hot flashes may happen at night, causing inconvenience during sleep.

  • Decreased fertility

During the menopausal period, a woman’s ovulation starts to become irregular. This decreases the ability to conceive. Although, it’s important to note that it’s still possible for a woman going through perimenopause to get pregnant, therefore if you are a woman suspecting that you are going through perimenopause and still have your periods regularly, it is advisable to use birth control until you haven’t got your period for more than 12 months.

  • Mood changes

A woman may undergo several mood swings, irritability and an increased risk of depression during the perimenopausal period.

  • Changes in sexual function/libido

As a woman’s testosterone and estrogen levels drop, it becomes more difficult for her to get aroused, and this causes issues with libido and sexual drive.

symptoms of menopause

Other symptoms

  • Loss of bone – Calcium deficiency in bones
  • Vaginal and bladder problems
  • Increased hair growth on areas such as the face, chest, neck

Not having it with menopause? Fret no more, we give you healthy tips to make this period in your life easier below!

Lifestyle changes for better management of menopause

managing menopause

Menopause is a natural process that all women experience once their reproductive cycles reach maturity, and it may be an uncomfortable experience for most women. However, here are some methods in which the symptoms of menopause can be controlled better to reduce its discomfort.

  1. Consume foods rich in vitamin D and calcium

Vitamin D and calcium have proved to improve bone health. As a woman undergoes menopause, hormonal changes result in the weakening of bones, increasing the risk of osteoporosis. Foods like yoghurt, milk, fish and eggs are good sources of these nutrients.

  1. Maintain a moderate/healthy weight

During the menopause period, hormonal changes, aging and lifestyle causes weight gain. This would increase the risk of cholesterol and diabetes.

  1. Exercise regularly

Exercise and work out sessions have been proven to improve sleep and mental health of menopausal women. Therefore, regular exercise may subside the sleep issues menopausal women undergo.

  1. Ensure a consistent intake of a protein-rich diet

Proteins help reduce muscle loss and increase overall body strength in women experiencing menopause.

  1. Consume foods abundant in phytoestrogens such as soya beans, tofu, flaxseeds

Phytoestrogens are a source of dietary oestrogen from naturally occurring plant compounds that have the same function as oestrogen in human bodies. Thus, phytoestrogens may play a vital role in hormonal balance during menopause and reduce symptoms like hot flashes.

When to see a doctor

It is advisable to meet with a gynaecologist if you experience

  • Vaginal bleeding after not having a period for 12 months
  • Recurring or chronic urinary tract infections (UTIs)
  • Bleeding after sex
  • Abdominal pain

These signs may indicate more serious underlying medical conditions that need to be diagnosed to begin early treatment. Every woman’s menopausal period is unique and different to one another. If you are experiencing difficulty managing your uncomfortable menopause symptoms, the SLMC-registered gynaecologists on oDoc will help you navigate them, providing improved health and well-being.

Sources

  1. Menopause – Symptoms and Causes, Mayo Clinic (2020)
  2. Perimenopause – Symptoms and Causes, Mayo Clinic (2021)
  3. 11 Natural Remedies for Menopause Relief, Healthline (2022)
  4. Menopause, The University of Utah (2022)
  5. Bleeding after menopause: Is it normal? Mayo Clinic (2020)
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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
  • அதீத உடல் பருமன்
  • 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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