By
MEDICINE 2
SCIENTIFIC JOURNAL
CLUB
Faculty of Health Sciences
University of Bamenda, Cameroon
klondiv@gmail.com
NDUNDAT AMINOU VODEGAH
MEDICINE 2
SCIENTIFIC JOURNAL
CLUB
Faculty of Health Sciences
University of Bamenda, Cameroon
aminouvondegah@gmail.com
ANGUH DESTAIN CHEFOR
MEDICINE 2
SCIENTIFIC JOURNAL
CLUB
Faculty of Health Sciences
University of Bamenda, Cameroon
destainchefor@gmail.com
SLEEP
Sleep is defined as
unconsciousness from which a person can be aroused by sensory or other stimuli. It is to be distinguished from coma, which is
unconsciousness from which the person cannot be aroused [1]. Sleep is characterized by altered consciousness,
relatively inhibited sensory activity, inhibition of nearly all voluntary muscles, and reduced interactions
with surroundings. It is also distinguished from wakefulness by a decreased
ability to react to stimuli, but is more easily reversed than the state of
hibernation or of being comatose. [2]
STAGES OF SLEEP
Sleep has
been studied with the aid of a device called electroencephalogram (EEG). This
device monitors brain activity and records it in the form of waves. Based on
these waves, sleep has been classified into two basic categories- slow wave
sleep and REM.
1) Slow-Wave Sleep
So named because in this type of sleep the
brain waves are very strong and of very low frequency. Although
slow-wave sleep is frequently called “dreamless sleep,” dreams and sometimes even nightmares do occur during slow-wave sleep. Most sleep
during each night is of the slow-wave variety; this is the deep, restful sleep
that the person experiences during the first hour of sleep after having been
awake for many hours. This sleep is exceedingly restful and
is associated with decrease in both peripheral vascular tone (the state of contractile tension in the vessel walls) and many other
vegetative functions of the body. This stage last averagely 90min.
2) REM Sleep (Paradoxical Sleep, De-synchronized
Sleep)
In a normal
night of sleep, bouts of REM sleep lasting 5 to 30 minutes usually appear on
the average every 90 minutes. This stage may be absent. As the
person becomes more rested through the night, the durations of the REM bouts increase. This stage is
characterized by the following;
1. It is usually associated with active
dreaming and active bodily muscle movements.
2. The person is even more difficult to arouse by
sensory stimuli than during deep slow-wave sleep, and yet people usually awaken
spontaneously in the morning during an episode of REM sleep.[3]
3. Heart rate and respiratory rate
usually becomes irregular, which is characteristic of the dream state.
Physiologic Effects of Sleep
Sleep has two major
physiologic effects: first, effects on the nervous system itself, and second,
effects on other functional systems of the body. The nervous system effects
seem to be by far the more important [4]. Lack of sleep certainly
does, however, affect the functions of the central nervous system. Prolonged wakefulness
is often associated with progressive malfunction of the thought processes and
sometimes even causes abnormal behavioral activities.
There is
increased sluggishness of thought that occurs toward the end of a prolonged wakeful
period, but in addition, a person can become irritable or even psychotic after
forced wakefulness. Therefore, we can assume that sleep in multiple ways restores
both normal levels of brain activity and normal “balance” among the different
functions of the central nervous system. it is reasonable to assume that the same
effect occurs in the central nervous system because overuse of some brain areas
during wakefulness could easily throw these areas out of balance with the remainder
of the nervous system. We might postulate that the principal value of sleep
is to restore natural balances among the neuronal centers. The
specific physiologic functions of sleep remain a mystery, and they are the
subject of much research.
Table: Average
Recommended Sleep Time According To Age
|
AGE
|
AVERAGE SLEEP TIME
|
|
New born -2months old
|
12-18hrs
|
|
3months-1yr
|
14-15hrs
|
|
1-3yrs
|
12-14hrs
|
|
3-5yrs
|
11-13hrs
|
|
5-12yrs
|
10-11hrs
|
|
12-18yrs
|
8.5-10hrs
|
|
Adults(18+)
|
7.5-9hrs
|
|
|
|
DROWSINESS: CAUSES AND TIPS TO COMBAT DROWSINESS.
So, you have been feeling sleepy and lethargic all the time!
You are not alone. More and more people are joining this ever increasing
community of drowsiness. This sleepiness during the day can make you irritable
and hamper your normal routine. Most of the people look for coffee and energy
drinks to fight off drowsiness. Caffeine may help you stay awake for a while
but what about all those side effects that it brings on with it? You are
becoming unhealthy by fighting your drowsiness this way, with caffeine! Let’s
find out what drowsiness is, what causes it and the healthier ways to fight
drowsiness.
What is
drowsiness?
Drowsiness (alternatively
"sleepiness" or “Somnolence ") is a state of strong desire
for sleep, or sleeping for unusually long periods. It has distinct
meanings and causes. It can refer to the usual state preceding falling asleep [5].
Somnolence is often viewed as
a
symptom rather
than a
disorder by
itself. However, the concept of somnolence recurring at certain times for
certain reasons constitutes various disorders, such as
excessive
daytime sleepiness, and there are
medical codes for somnolence as
viewed as a disorder. Sleepiness can be dangerous when performing tasks that
require constant concentration, such as attending a lecture, driving a
vehicle
etc. When a person is sufficiently
fatigued,
microsleeps may be experienced
[6].
People who are drowsy may fall
asleep in inappropriate situations or at inappropriate times [7].
fig:
Some features of the human circadian
(24-hour) biological
Let’s now have a look
at causes of drowsiness.
Causes of
Drowsiness
These are the common causes of drowsiness in daily life
·
Sleeplessness
(due to stress, depression or any
other reason)
- Sleep disorders such as sleep apnea and
narcolepsy( Disorder of
the nervous system)
- Insomnia
- Hypercalcemia
(too much calcium in blood)
- Hypothyroidism - The body doesn't produce enough hormones that
control how cells use energy
- Hyponatremia
(low blood sodium)
- Diabetes
- Odd working hours (night shifts, working at
weekends or for continuous long hours)
- Migraine
- Other body pain
·
Medicines (such as tranquilizers, sleeping
pills, antihistamines).
Apart from the above causes of drowsiness, there are certain
serious causes too that need immediate medical attention such as head injury,
hypovolemic or hemorrhagic shock, meningitis, stroke etc.
How to Get
Rid of Drowsiness
Now comes the obvious question, how to fight drowsiness! The
first step towards this is treating the cause of your drowsiness. Is it stress,
insomnia or odd working hours or something else? Once you have identified the
cause for your drowsiness, take help of the below remedies to combat
drowsiness.
1. Follow a regular
sleep schedule
This is a must. Because you are not sleeping enough or not
sleeping at the similar time every day, your body rhythm is getting disturbed.
Adequate and undisturbed sleep is the key to stay alert when you need to. So,
how much to sleep and when?
You need between seven to nine hours of sleep every night.
This will make you function at your best and will not make you sleepy during
daytime.It is said that you should aim at going to bed somewhere between 8 PM
to 11 PM depending upon whether you are a night owl or a morning lark! However,
don’t go to sleep after midnight because till few hours before midnight, your
body gets the best deep sleep. As you move towards morning hours, your sleep
becomes lighter. It doesn’t matter whether you have slept at 10 PM or 3 AM; you
are bound to get lighter sleep in the ‘near morning hours’! This will help you
keep away low energy, fatigue, depression and stress.
Maintain a regular wake up time on weekdays as well as
weekends. You may get up an hour later on weekends but don’t make it too late.
If you everyday get up at 6 AM, you may afford to get up at 7 on Sundays but
not at 10 AM! This disturbs your body’s rhythmic sleep cycle.
2. Get sunlight or
bright light
Sunlight regulates your biological clock; it makes your body
alert about work time. However, it might not be always possible for you to get
sunlight. In such times, keep your workplace brightly lighted. This will fight
off drowsiness and keep you alert. Circadian rhythms or the body’s internal
clock are controlled by a part of our brain which is influenced by light.
3. Exercise to avoid
drowsiness
Get some exercise daily, preferably in the morning. The
adrenaline rush will help you stay more alert. One of the major causes of
drowsiness is not getting sufficient physical activity. Our body is made to
work and rest and not to rest always. When you do not move your muscles and all
that’s inside your body, you become sluggish. So, make it a habit to exercise
daily for at least 30 minutes. This will also make you sleep better at night.
Avoid exercising close to bed time though! This will hamper your sleep and make
you sleepier the next day. But what exercises to do?
·
Walk for 30-40 minutes daily
·
Running is a good exercise
·
Cycling too can help
·
Dance to your heart!
In short, do whatever you feel like but move your body for
at least 30-40 minutes a day.
4. Use Acupressure
Points for Sleepiness, Drowsiness
When you feel sleepy and need to become alert, you may also
take help of acupressure along with right breathing. This stimulates your
nervous system and makes you alert almost instantly. remember when you have a wound or a pain somewhere , you stay alert because the pain nerves are continuously sending impulses to your brain.
Press
GV 26 Acupressure point
It is situated at philtrum- the vertical groove between the
base of your nose and the border of the upper lip.
- Press the center of this point with your index
finger firmly.
- While holding the point, inhale deeply, hold for
a couple of seconds and exhale slowly.
- Repeat this three times.
Press GB 20
Acupressure point
It is situated underneath the base of your skull, at the
back of your head.
- Bring your thumbs underneath your skull bones at
both ends.
- Tilt your head back while inhaling deeply.
- Again inhale deeply and tilt your head back,
some more.
- Do this third time, taking the head a little
more backwards.
- This makes three repetitions with head tilting a
little more each time while you inhale thrice.
- Relax and Scratch these points for a couple of
minutes using your nails. Keep inhaling deeply while scratching.
Rub B 23 and B 47
Acupressure points
These points are situated at lower back.
- Take your hands to your lower back.
-
Now briskly rub the points at your lower back
with your thumbs, up and down
- Do this for a minute.
Press and Rub St 36
Acupressure points
It is located four finger widths down from the bottom of the
knee cap, along the outer boundary of your shin bone in the leg. This is also
called the energy point and rejuvenates you.
- Hold the point with both your hands and press
firmly.
- Using your knuckles, briskly rub up and down.
- You can do either of the above.
You need not stimulate all the acupressure points discussed
above. Do any one or two, or all, whatever makes you alert and fights your
drowsiness. You can do them in any order.
5. There’s nothing
wrong in a cup of coffee or tea
Caffeine is bad but only when taken in excessive amounts.
However, some people report problems in falling asleep at night due to tea or
coffee taken in the afternoon. So, check by taking only a little amount for a
day or two. You may also have a cup in the morning but not in the evening or
late evening as it might hamper your sleep at night.
6. Don’t skip
breakfast
This is the most common reason of feeling drowsiness due to
low energy levels. You don’t eat for almost 10-12 hours after your dinner and
if you skip breakfast in the morning, how’s your body going to get its fuel!
However, don’t just overload yourself with heavy foods. Have a balanced
breakfast consisting of fruits, cereals, lean protein and some really energetic
foods such as nuts. All this will help you get the required energy to survive
the day without sleepiness!
8. Keep your work
interesting
When you do the same thing for a long time, it becomes
boring and you feel sleepy. Change your activities several times. Whenever you feel bored while studying a
course, switch to another and come back to the previous subject after some time
to complete it, a chat for couple of
minutes with your friends or a short walk for 5-10 minutes. This helps ward off
drowsiness.
9. Drink plenty of
water
Dehydration can make you feel tired. And when you are tired,
you ought to feel sleepy. So, drink enough water throughout the day. If you can’t
have lots of water, substitute it with healthy drinks such as.
10. Stretch your body
This is not similar to your daily exercise. Stretching your
body when you are feeling sleepy will instantly make you alert. You don’t need
to get a yoga mat or to go outside to do these stretches. Just do simple
stretches while sitting on your chair or standing for a minute or two.
·
Pull your hands together behind your back and
while doing so, stretch out the front of your body. Breathe deeply for some
time and let go of your hands. Do this a couple of times.
·
Stretch your legs straight while sitting
straight.
·
Stand up and sit down without using your hands.
Do it over and over again for a few minutes.
·
Shrug your shoulders while inhaling deeply. Lift
them high up to your ears, hold for few seconds and release them. Do this for a
few times.
·
Hug yourself. Place the right hand on your left
shoulder and the left hand on your right shoulder. Breathe deeply while
releasing the area between your shoulder blades.
11. Keep your surrounding
interesting
So that whenever you feel drowsy, you can look at those
things which make you alert and happy. For example, keep the photographs of
your loving family on your desk. Look at the photograph and think about your
friends and loved ones, kids or wife. As soon as you engage your mind in
something that makes you happy, you will become alert.
12. Use aromatherapy
to fight drowsiness
Scents can keep you alert. You may use wax melt warmers to
keep yourself refreshed with your favorite fragrance or use essential oils.
Sprinkle a drop or two of some scented oil on to your handkerchief and sniff
it. Such fragrances as of peppermint, eucalyptus, and lemon can help keep you
alert.
13. Try taking a
quick nap
If nothing helps you
beat the drowsiness, try a quick nap. It can dispel drowsiness and get you back
on track. However, it can be done only
if you have some space or time in hand. Taking a short 10 minutes nap can make
you more alert and it also improves your performance. It’s a myth that taking a
nap makes you sleep for hours, or you may wake up feeling even worse. The fact
is that naps taken for too long or too late in the day can disturb your body’s
inner clock and make you feel awful. If you nap for only 10 to 20 minutes, you stay in a lighter phase of sleep and wake up
without feeling groggy.
14. Listen to music
Listen to the music that charges you up, some upbeat music while you work. This will
not let you feel drowsy. It can be anything- a dance number, rock or pop music.
But avoid listening to soothing and relaxing musics as this kind of music makes
you feel sleepy as you get relaxed.
15. Quit smoking and
alcohol
Nicotine and alcohol are both stimulants that can
affect your quality of sleep. When you don’t sleep properly at night, you are bound
to feel drowsy during the day. So quit smoking. Limit your consumption of
alcohol and better avoid having alcohol on weekdays or on the days that you
intend to study effectively.
16. Check your medicines.
Excessive daytime sleepiness (WITHOUT
a known cause) may be a sign of a sleep disorder.
Some medicines can affect the quality of sleep at night.
Talk to your doctor and see if your pills could be keeping you up at night or
making you sleepy during the day. Getting restful sleep at night is essential
to fight daytime drowsiness.
17. Avoid heavy carbohydrate meals prior to, or during, study time.
When ordinary proteins are taken, all amino acids are available in blood. This causes traffic jam in the amino acid transport systems in the brain cells. tryptophan ( precursor for melatonin and serotonin) being the bulkiest amino acid is therefore taken up very slowly. However, when carbohydrate rich food is eaten, insulin secretion is increased, which will lower the amino acid concentration in blood. so tryptophan easily enters the brain cells. when tryptophan is available in brain in excess quantity, serotonin may be generated to induce sleep.
There are so many ways to fight drowsiness. Find out the one
that suits you the most and get rid of your daytime drowsiness.
Somnolence is a symptom,
so the treatment will depend on its cause. If the cause is the behavior and
life choices (like working long hours, smoking, mental state), it may help to
get plenty of rest and get rid of distractions. It’s also important to
investigate what’s causing the problem, such as stress or anxiety, and take
steps to reduce the feeling.
REFERENCES
1. Textbook of Medical Physiology –Guyton and Hall
11 th edition, (2006). P 739.
2. Macmillan Dictionary for Students Macmillan, Pan Ltd. (1981), p. 936.
3. Textbook
of Medical Physiology –Guyton and Hall 11 th edition, (2006). P 740.
4. Textbook of Medical Physiology –Guyton and Hall
11 th edition, (2006). P 741.
7. Medlineplus article on drowsiness.
https://www.nlm.nih.gov/medlineplus/ency/article/003208.htm.
9. Table source = Hirshkowitz, Max ; Whiton,
Kaitlyn; et al. (14 January 2015). "National Sleep Foundation’s sleep time
duration .recommendations: methodology and results summary". Sleep Health:
Journal of the National Sleep Foundation (Elsevier Inc).
doi:10.1016/j.sleh.2014.12.010. Retrieved 4 February 2015.
1
other sources
Textbook of biochemistry for medical students sixth edition
Medlineplus article on
drowsiness. https://www.nlm.nih.gov/medlineplus/ency/article/003208.htm
