SLEEP CYCLE, DROWSINESS, AND TIPS TO COMBAT DROWSINESS FOR STUDENTS

 By

LONDE KEVIN KAJUG

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.

5.     Wikipedia, the free encyclopedia, article on somnolence. https://en.wikipedia.org/wiki/Somnolence.

6.     Wikipedia, the free encyclopedia, article on somnolence. https://en.wikipedia.org/wiki/Somnolence.

7.      Medlineplus article on drowsiness. https://www.nlm.nih.gov/medlineplus/ency/article/003208.htm.

8.     CaMESAF article on how to fight drowsiness naturally. http://camesaf.blogspot.com/2016/02/how-to-fight-drowsiness-naturally_2.html

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.

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other sources

 Textbook of biochemistry for medical students sixth edition
  Medlineplus article on drowsiness. https://www.nlm.nih.gov/medlineplus/ency/article/003208.htm