To Sleep, perchance to dream

Getting your "beauty sleep" has long been a phrase used to entice children to bed. However there is now increasing evidence that sleep is vitally important in restoring a healthy, vital body and mind, to wake refreshed and "beautiful" for the day.
Sleep might be considered the poor relation of health issues. We hear much about the importance of exercise, nutrition, and stress management, but almost nothing about sleep. In the past, this third of our lives spent sleeping has been considered a waste of time, associated with inactivity and laziness. Many famous people have boasted about their ability to manage on as little as two hours sleep per night. What they didn’t admit to was the napping that kept them sane. We now know that sleep is as important as the other essentials of life, and any restriction can have a detrimental effect, both physically and emotionally.
Sleep is comprised of two principal parts, initially Non-Rapid Eye Movement (NREM) sleep, followed by Rapid Eye Movement (REM) sleep. NREM sleep has four stages. After a brief period of amnesia just before we fall asleep, we enter stage 1 NREM sleep. This is a very light sleep from which we can be very easily aroused. After about five minutes we drop into level 2 NREM in which we spend a total of 50 percent of our sleep. After a further 15 minutes we progress into level 3 and 4 NREM sleep which is known as "deep sleep". At this time our body slows down, blood pressure drops, our breathing slows, and we cool down. One of the most important features of this early part of the night is the production of growth hormone. This is vitally important for immunity, repair of tissue, production of anti-cancer cells, and in children, growth. After approximately 90 minutes, our brain switches to REM sleep. REM sleep is thought to be important for our mental functions such as memory, decision making, speed of thinking and emotional stability.

The reality of dreams
 

In REM sleep, we do most of our dreaming. We really don’t yet know why we dream, or where dreams come from, but some believe that it acts as a clearing process for unwanted or unused memories. However, dreaming can be a very real experience when we can see, smell and touch, but we are unable to move. As protection against acting out our dreams, we become completely paralysed. We can twitch, but we can’t move. For example, the dog lying on the floor twitching may be dreaming about catching rabbits, but it can’t get up and run!
These stages in our sleep pattern change throughout our life. As a newborn, about 50 percent of our sleep is REM sleep. This reduces to about 25 percent in childhood and adulthood, whilst our deep NREM sleep diminishes as we get older. In addition, these cycles of NREM and REM, vary throughout the night. In the early part of the night we have most of our NREM sleep, and in the latter part of our night we have most of our REM sleep.
What do these changes mean for our health and appearance? Since we always fall asleep into NREM it means that our physical health, with the production of growth hormone, is the first to be restored. Mental and emotional health occurs later in the night. This suggests that if we cut our sleep short, we will function quite well physically, but our mental abilities will falter. When soldiers were deprived of REM sleep over three days, they were able to keep walking, running, jumping and maintaining their physical function, but they were progressively unable to remember simple instructions, make decisions, and became increasingly irritable!
One group in society that is often affected by lack of these important functions of sleep, are shift workers. Most shift workers sleep poorly during the day and consequently generally begin to feel sluggish and lethargic. They may become irritable and depressed, and are more likely in the long term to suffer from physical illnesses such as gastric ulcers, heart disease, and even cancer. There are few regular shift workers who have not had an accident or near miss driving on their way home due to fatigue; this accident being the result of poor concentration or risk taking. Recently, a 22-year old died in a road accident. He wasn’t drunk or drugged, just very tired. He had just come off duty at the local hospital after a night shift. He fell asleep and drove straight off the road into a power pole.

Reasons for poor sleep

There are many reasons why we sleep poorly. It might be the result of illness or pain. It might be stress from work or a relationship, or we have been up and down to our children throughout the night. These all result in insomnia, or poor quantity of sleep. However, there are some causes of poor sleep quality that leave us feeling exhausted and drained in the morning. The most common of these is snoring associated with Sleep Apnoea. Sleep is repeatedly interrupted by episodes of choking at the back of the throat, and subsequent gasping. The other common condition is called Periodic Limb Movements in Sleep. This is often associated with a crawling sensation in the lower legs in the evening and is relieved by stretching or walking. Both of these conditions are likely to result in daytime sleepiness.
What are the consequences of poor sleep? Irritability and low stress tolerance are common, with poor motivation, slower reaction time, faulty judgement, impaired decision-making, increased risk taking and decreased libido. In addition to the tragedy of deaths on the road, sleepiness has also been directly implicated in such major worldwide catastrophes as the grounding of the Exxon Valdez, the Three Mile Island nuclear incident, the nuclear disaster at
Chernobyl, the Challenger Space Shuttle destruction and the Bhopal chemical spill. Of course, sleep deprivation was not the only reason for these accidents, but it was a recognised factor.
How can all this relate to how we feel and look? We all know that after a very late or disturbed night, we look and feel exhausted. Our eyes are droopy with dark rings, and our skin and hair looks dull. What little sleep we have achieved through the night has not restored the elasticity of our skin, which then begins to sag. Whilst this repair in deep NREM sleep affects all parts of the body, it is the skin that we can see, and so often reflects how we feel. Skin repair occurs throughout the day and night, but is more efficient at night. During the day collagen production, the supporting structure of the skin, slows as a result of increased stress hormone, Cortisol. At night, assuming that the sleep is satisfactory, Cortisol production is reduced and skin that might be irritated by the inflammation caused by this Cortisol during the day is allowed to calm down and revive. If sleep is not adequate we will become increasingly stressed, Cortisol levels rise, and we then suffer from an increase in skin infections, rashes, and eczema.

Solving sleep problems

So what can be done about these sleep problems? Simple ‘sleep hygiene’ is a good start. These are measures taken to maintain a regular sleep/wake cycle. They are important but usually insufficient by themselves to restore good sleep patterns. Then there is ‘stimulus control’. Based on the classic ‘conditioned response’ model, it involves strengthening the relationship between bed and sleep, and breaking the negative relationship between bed with wakefulness and anxiety. Although stimulus control is more effective than sleep hygiene, increasingly Sleep Restriction Therapy is being used. This involves increasing the drive to sleep by restricting the allowable time in bed. Sleep consolidation and efficiency improves, as does the confidence in the ability to sleep. The time in bed can then be slowly increased. If snoring and Obstructive Sleep Apnoea (OSA) is the concern, there are a number of ways in which the vibrating airway can be supported to stop the snoring and consequently any OSA.
In summary, sleep is a vitally important part of our lives and should not be looked upon as a waste of time. The effects of poor sleep can have serious consequences on our personal health and physical appearance as well as our safety and our relationships. Fortunately, most sleeping difficulties are treatable, and beauty sleep can be restored.

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