Sleep as health balancer

How much do you know?

Kelum Palpola - Final Year Medical Student Colombo Medical Faculty

SLEEP: Health encompasses many areas of life. It's not the mere absence of disease, but a collection of mental, physical, social and emotional well-being. Sleep is a wonderful physiological phenomenon that helps us regain balance in all of these aspects.

However, sleep disorders such as insomnia can trouble our lives. (Insomnia can be described as a subjective problem of insufficient sleep, despite an adequate opportunity for sleep)

What are the effects of sleep loss?

A lack of restful sleep can negatively impact an individual's waking hours. Lost sleep can result in a reduced ability to concentrate, daytime sleepiness and irritability. Whatever the cause of sleep loss, it can impair the ability to perform both physical and mental tasks.

Some of the causes of Insomnia

1. Lifestyle factors - Many behaviours can create or worsen sleeping problems. Smoking and drinking caffeinated beverages, for example, interfere with sleep because they involve intake of stimulants such as nicotine and caffeine, which promote wakefulness. Alcohol intake close to bedtime may also result in disruption of normal sleep patterns.

Other lifestyle factors that can contribute to poor sleep include physical activity too close to bedtime and erratic sleep schedules. For example, shift workers often find sleep particularly challenging because they sleep during daylight hours when biological rhythms encourage wakefulness.

2. Environmental factors - Noise, such as that from passing traffic, loud music or even a neighbour's television, can disturb sleep. Too much light or extreme room temperatures also can interfere with sleep.

3. Medical factors - Kidney disease, heart failure, asthma and Parkinson's disease can impair healthy sleep. Conditions that cause pain or discomfort, such as arthritis, can also make it difficult to sleep well.

4. Psychological/psychiatric factors - Most sleep experts consider stress to be the most common cause of short-term sleeping difficulties. School or job-related pressures, family or marriage problems, or a serious illness or death in the family are common triggers. Insomnia can also be caused by depression.

Tips for a good night's sleep

There are many simple steps you can take to help you fall asleep faster and stay asleep. Here are some tips that may be helpful:

1. Minimize noise and minimize light with the use of curtains. Do not turn on bright lights, if you need to get up at night. Use a small night-light instead.

2. Avoid large meals within two hours of bedtime. If you are hungry, a glass of milk or a light snack is a good choice. Milk contains the amino acid L-tryptophan, which has been shown in research to help people go to sleep.

3. Get aerobic exercise during the day to reduce stress hormones, but avoid anything too strenuous within three hours of bedtime. Regular exercise may promote deeper sleep.

4. Go to bed at a regular time and avoid napping late in the afternoon. If you need to nap, take a brief nap for 10-15 minutes about eight hours after you awake.

5. At bedtime, keep your mind off worries or things that upset you; avoid discussing emotional issues in bed.

6. Consider having pets stay outside of your sleeping area. Having a pet in bed with you may cause you to wake if you have allergies or if the pet moves around on the bed.

7. Make sure your bedroom is well ventilated and has a comfortable temperature

8. Keep your bedroom for sleeping, not for reading or watching television. If you can't sleep or if you wake up in the middle of the night, go to another room and read a book or watch television until you feel sleepy.

9. Stimulants may interfere with sleep. Caffeine should be discontinued at least four hours before bedtime. Caffeine is a stimulant that is present in coffee, cola, tea, chocolate and some medications.

10. Alcohol is a depressant and may help you fall asleep, but the subsequent metabolism that clears it from your body when you are sleeping causes a withdrawal syndrome. This withdrawal causes awakenings and is often associated with nightmares and sweats.

If you are still having trouble in sleeping after trying some of these suggestions, tell your doctor about it. There may be an underlying medical condition that is causing your sleep problem.

When should you talk to a doctor?

A sleep disorder is broadly defined as a physical or psychological problem that impairs your ability to sleep or causes increased sleepiness during the day. Almost everybody experience problems with sleep from time to time. However, you might have a sleep disorder if:

1) You regularly experience difficulty in sleeping.

2) You are often tired during the day even though you slept for at least 7 hours the night before.

3) You have a reduced or impaired ability to perform regular daytime activities.

It is important to explore the possible causes of your difficulty with sleeping and/or daytime sleepiness and try to find a solution.

Warning signs

Ask yourself the following questions. Do you:

Fall asleep while driving?

Struggle to stay awake when inactive, such as when watching television or reading?

Have difficulty paying attention or concentrating at work, school, or home?

Have performance problems at work or school?

Often get told by others that you look tired?

Have difficulty with your memory?

Have slowed responses? Have difficulty controlling your emotions?

Feel the need to take naps almost every day?

If you experience one or more of these characteristics continuously, you may not be getting proper sleep at night.

It is important to note that insomnia can be a sleep disorder, or can be a symptom of another problem. Many common sleep problems can be treated with behavioural treatments and increased attention to proper sleep hygiene (mentioned above). Consult your doctor, if you have any concerns about your sleep patterns.

References: American Insomnia Association.

( http://www.americaninsomniaassociation.org ) WebMD Health and Colombo Faculty lectures on the topic)

State subsidy on paying ward patients

CHARGES: Yes, it happens in the Colombo National Hospital, in the Merchants Ward, according to a recent study done by the Colombo University's Economic Department and the Management and Planning Unit of the Ministry of Health.

In this study done in 1999 and the report released recently, it states that the study team found Government charging only Rs. 750 per day per patient in the Merchants ward medical and surgical sections.

Where as the daily cost per patient was in the Medical Unit Rs. 806.57 and Surgical Unit Rs. 1350.54, surgery was being charged separately.

The study team says "currently paying ward charges are fixed too low even to cover costs. Therefore the paying ward patients themselves are subsidized instead of providing a source of revenue for cross subsidizing patients in non-paying wards."

The objective of the study had been to:

1) Estimating the cost of providing paying ward facilities in government hospitals.

2) Comparing cost and revenue of paying wards to ascertain the feasibility of cross-subsidizing non-paying wards.

The report further says: "Government budgetary constraints necessitate considering paying wards as sources of complementary financing. This study examined the feasibility of cost recovery and cross - subsidization in the case of the Merchants ward. This study was also part of a WHO/SEARO study."

Methods: The method used in the study had been what is called the scenario building technique to calculate cost per day for a medical and surgical patient separately.

The technique involves using empherical data and assumptions to quantify a representative situation.

In this case, data was available on the physical attributes of the room and toilet, furniture equipment, use of utilities, staff time, menu, treatment costs etc. Assumptions were incorporated in apportioning staff time and utility charges, and estimating per day costs in the case of durables and capital goods.

Dental profession and the beautiful smile

DENTAL PROFESSION: The highly advanced dental profession is enabling the society to have people with attractive beautiful smiles.

This observation has been made by the Vice-Chancellor of the Peradeniya University Prof. Kapila Gunasekera at the recently held second Annual Aesthetic Dental Conference 2006 at Mahaweli Reach Hotel, Kandy.

In a report regarding this conference sent to us by Dr. V. Vijayakumaran, President of the Academy of Aesthetic and Cosmetic Dentistry, Sri Lanka. It states;

Second Annual Aesthetic Dental Conference 2006

The second conference of the Sri Lankan Academy of Aesthetic and Cosmetic Dentistry was inaugurated by the chief guest Professor Kapila Gunasekera, Vice-Chancellor of the University of Peradeniya at Mahaweli Reach Hotel, Kandy on May 27.

The objectives of this academy is to provide continued education to the young dentists in the field of Aesthetic Dentistry and now it has been affiliated with several international aesthetic dental academies in other countries such as India, Japan, Malaysia, Singapore, China, Canada, Bhutan, Australia, America, Nepal and Asian countries.

This international relationship will bring more opportunities to carry out several collaborative programmes with Sri Lanka and other countries in the field of Aesthetic Dentistry.

Dr. Sushil Koirala the Charter President of the Nepal Academy of Aesthetic and Cosmetic Dentistry explained the importance of uniting all dentists who practise aesthetic dentistry in South Asia.

He mentioned that this unity will provide better opportunity to exchange knowledge and friendship within the dental professionals in South Asia.

He made a historic announcement that the South Asian Academy of Aesthetic and Cosmetic Dentistry has been officially initiated at this meeting and the first conference will be held in Nepal during the month of February 2007.

He thanked the members of the SLAACD and exchanged a SAAACD flag with the Charter President of the SLAACD Dr. V. Vijayakumaran.

The chief guest Professor Kapila Gunasekera, Vice-Chancellor of the University of Peradeniya addressed the gathering and indicated the importance of the smile which brings better understanding between people.

Furthermore, he mentioned that the dental profession have highly advanced and they are providing an excellent treatment to provide beautiful smile of the people.

He appreciated the conference committee for organising a continuous education programme for the dental profession in Sri Lanka using international experts from abroad.

He highlighted that the Peradeniya University Dental Hospital (Teaching) which, the best dental training center in South Asia and having well qualified dental professionals who provide excellent dental education to undergraduate and post graduate dental students and also to provide special training for international dentists.

He congratulated Dr. V. Vijayakumaran for his efficient leadership to sustain the academy with active programs and also to his friendly approach to make international links with dental profession in order to exchange and share the knowledge in dentistry as well as fellowships.

First No, then Yes, on Soya

SOYA: First no, later yes. That's how the US Food & Drugs Administration (FDA) gave approval for soya's health claim for protein.

Dr. Mark Mossina of the American Soybean Association writing on Soya and Health in the ASA News Bulletin of January, 2006 describes this incident thus:-

"The hypocholesterolemic effects of soy protein have been demonstrated in clinical studies for more than 30 years, although until recently few health professionals were aware of this literature.

As late as 1994, the Diet Committee of the American Heart Association concluded that soy protein was ineffective.

However, since the publication of a meta-analysis on the cholesterol lowering effects of soy-protein in 1995, the health professional community has gradually begun to appreciate the effects of soy protein and official recognition came only in Oct. 1999 with an authorization by the FDA to grant the health claim for soy protein.

Sent by Dr. Viraj Peramuna.