Understanding sleep and how to get more of it

Shut-eye is one of the most important and often neglected aspects of wellness says Dr Karine Scheuermaier of the University of Witwatersrand Sleep Laboratory. In fact, she says, that everyone should get at least 7 hours of shut-eye in, every night, and a good night’s rest is just as important as a healthy exercise regime or following a balanced diet. This week is International Sleep Awareness Week but, says Dr Scheuermaier, awareness of the key role played by sleep in our health, should be ongoing.

“In South Africa, there is very little available in the private medical sector in terms of treating sleep disorders,” says Dr Scheuermaier and, in the public sector, naught. Yet, she says, sleep deprivation or disorders can be the root cause of several dangerous conditions. “There are several cognitive impairments that could occur when not getting enough sleep, other conditions such as obesity hypertension and diabetes may take shape or be exacerbated and the risk of, for example, a stroke becomes far greater in the highly prevalent sleep disorder called sleep apnoea.”

Sleeping and eating

She adds that if you do not reset well, you start eating much more. An imbalance in certain hormones called the ghrelin and leptin is manifest. Ghrelin tends to make you feel hungry. Leptin makes you feel satiated. And when we do not sleep enough, we have high levels of ghrelin, lower levels of leptin. “So, we basically eat more but never feel sated. And believe me, when you are sleep deprived, what you are craving is not a salad. You know, it’s usually chips and chocolate bars,” She adds that in many cases, Attention Deficit Hyperactivity Disorder in children could also be ascribed to a lack of sleep.

“When adults do not get enough rest, we tend to be grumpy. Children, on the other hand, show their sleepiness by a lack of focus and attention. So, while there are many instances of true ADHD, I reckon that as much as fifty percent of cases do not have to be medicated with stimulants, as is the treatment norm, but simply get the kids to sleep more,” says Dr Scheuermaier.

“We know that adolescents, for example, need to sleep at a later time and wake up at a later time, which means that in some regions in the world, like Singapore, and now like California, they’ve passed laws to encourage schools to start high school after 8:30 in the morning, because basically you’re losing a whole hour, trying to teach adolescents that should, biologically, still be asleep.” By forcing this unnatural schedule on adolescents leads to chronic sleep deprivation, since they go to bed later than children or adults.  Other strictly controlled studies have shown that even catching on sleep during the weekend is not enough to recover the sleep debt for those adolescents she notes.

Stages of shuteye

There are four stages of sleep. The first stage is the ten minutes or so after falling asleep, followed by the second, a somewhat deeper state into the third, a deep sleep called ‘slow wave sleep’. Rapid eye movement is the fourth stage and usually occurs early morning, it is also when we dream the most vividly. “When we sleep, our brain rids us of less important memories. In stage 3, or slow wave sleep, is when this usually happens. It’s also the state where many talk in their sleep, sleepwalk or even eat.”  While this is frequent in children, in adults, it should raise the possibility of underlying sleep apnoea.

Muscle tone also softens when you’re sleeping. Therefore, sometimes, when the progression between stages of sleep happens too quickly, it feels as if you are falling off the bed for an instant. “During rapid eye movement (REM) sleep the muscle tone decreases so significantly that sleepers are left paralyzed,” says Dr Scheuermaier. It is during this period that the mind deals with deeper emotional issues, ergo more vivid and semi-conscious dreamlike states. “An electroencephalogram (EEG, measuring brain activity) on someone experiencing REM is similar to that of someone who is wide awake,” she notes, and adds that if we were not paralyzed, a real risk of acting out negative emotions exist. “We have seen patients before who have hurt spouses or themselves during REM sleep in instances where their bodies were not experiencing paralysis.”

Screen time and the impact on sleep

Screen time also interferes with a decent night’s rest. Dr Scheuermaier says that we should refrain from staring at our phones or the telly at least an hour before bedtime. “Blue light is the predominant spectrum on screens, and it sends signals to our brain that it is actually ‘awake time’ as opposed to ‘sleeping time’. Thus,” she says. “it impacts sleep cycles and sends mixed messages to your body. You may be tired, but your mind says that it’s time to be out and about.” During level 5 lockdown last year, she adds, there was quite a shift in sleeping patterns, too. “We found that people went to bed later, and rose later too,” says Dr Scheuermaier. Likely because of increased screen consumption but it could also partly driven by people shifting in sleep wake cycles closer to what they would naturally do outside of social obligations.

Weekend work

If you do not get enough time beneath the covers during the week, do not think it is possible to make it up by resting weekends, either. It just does not work like that, says Dr Scheuermaier. “It’s been shown in multiple studies that you never can. There is this accumulated sleep debt that you would never be able to catch up to. We don’t know what the negative impact can be over a long term.” However, she says that people who are chronically sleep deprived over an extended period may be more at risk of developing Alzheimer’s, Parkinson’s disease or other neurodegenerative diseases.”

Author Hein Kaiser

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