Somnology is one of the most underrated subjects in the field of medicine, says Dr Sushant Meshram, professor and head at department of pulmonary medicine, Government Medical College and Hospital. Having completed fellowship in sleep medicine from John Hopkins Medical University in 2007, Dr Meshram says he is the only certified sleep physician in the region.
Dr Meshram had pushed for a sleep medicine fellowship at Maharashtra University of Health Sciences. But it being non-stipendiary, the program didn’t attract medical students. He demonstrated a role of sleep in Covid infection and lung cancer in his two recent studies.
Better understanding of sleep conditions and more research into the area will help reduce the burden of sleep disorders on society, Dr Meshram told TOI in an exclusive interview. Excerpts:
Q. What is the role of sleep in overall well-being?
A. If we are sleeping an average of 8 hours a day, then we spend 1/3rd part of our life in sleeping. For a common man, there are only two aspects of life – wakefulness and sleep. As a sleep physician or somnologist, there are three aspects of life. The third is the 25% of that 8-hour sleep time. This is called rapid eye movement (REM) phase. The remaining 75% is non-REM. The only commonality between REM and non-REM is that a person is lying down. Physiologically these are two different states of your sleep life. Body is rejuvenated during sleep. The brain is rejuvenated during the 25% or REM phase.
Q. What is peculiar about REM phase?
A. The body tone is zero like a dead body. This is the marker to identify when a person is in REM. The brain is highly active in this phase. The electric waveforms are faster than that in conscious state in REM. Brain metabolism is increased. There is no synchrony between heart, lung and the brain. This is also called dream sleep. During this, the brain rejuvenates and memory consolation takes place. If REM phase is less, problems like poor academic performance, neurological and psychological disorders like dementia, Parkinson’s, depression, anxiety occur. Sleep walking or talking is non-REM as body has some tone. Nature hasn’t give any tone in REM phase. If body moves in REM, we call it REM behavioral disorders. Non-REM rejuvenates entire body including normalizing hormones, diabetes, growth hormone. If non-REM is less, person develops hormonal disorders. Sleep is mostly endocrinological. There are certain hormones which are released exclusively during night sleep. Oxytocin and melatonin are not secreted during day sleep.
Q. What can affect these phases?
A. There are two types of arousals – one related to injury or ailment and other is micro arousal. The brain wakes up for less than 15 seconds in micro arousals but the person is not aware. These micro arousals increase the activities of sympathetic nervous system leading to tension, stress, irritation etc. Ultimately, it causes sugar, BP, heart problems.
Q. What are the causes for these arousals?
A. Sleep disorders like obstructive sleep apnea (OSA) or restless leg syndrome (RLS). There is some awareness about OSA but RLS still remains poorly diagnosed. In RLS, a person has the urge to put weight on legs, rub them against each other or tie them up. If they don’t do it, they are unable to sleep. A RLS patient has frequent micro arousals because of muscle twitching. This hampers the entire cycle of body and brain rejuvenation.
Q. Do this lead to sleep disorders?
A. Symptoms for absence of sound sleep and those for sleep disorders cause many diseases. A patient of OSA, a common condition, goes through the same physiological pain due to snoring as someone who gets strangulated. The pain is not registered because the person is not in a conscious state. I have seen OSA patient’s oxygen level dropping to 29. Since it is happening for years they don’t realize. But the damage is seen in skin, blood pressure, sexual dysfunction, sugar. So there are primary sleep disorders, medical disorders, which are affecting the sleep pattern, and disorders like OSA, which causes arousals and fall in oxygen level.
Q. How these factors harm our health?
A. When our breath is stalled, carbon dioxide gets accumulated. Later, when we breathe in haste, extra oxygen generates free radicals. These free radicals are quite. Take any disease like cancer or any infectious disease, free radicals are behind damage to our cells. These free radicals need to be neutralized. The body has the ability to neutralize them. Melatonin is the strongest anti-oxidant which is secreted only during the sleep.
Q. What is a normal sleep?
A. As per age, each person needs a specific duration of sleep. Depth is identified when a person is able to sleep within 30 minutes once on bed. This is the first stage comprising 5% of total sleep. It is called N1. In N2, all our data is processed. It takes 50% of sleep time. N3 requires 20% time to normalize all body hormones. Up to N3 we are in non-REM. After this, REM, which is 25%, starts where entire endocrinology is normalized as growth hormones are secreted. If REM is less, a person becomes immunologically weak. Depth, duration and continuity of sleep amounts to quality or normal sleep. Sleep and healthy ageing are one of the focus areas these days. We are reluctant to devote time for sleep if we have other commitments or due to screen time.
Q. Does it affect kids too?
A. Lack of proper sleep results in poor academic performance and increase in body weight among kids. As I said, hormonal balance is essential for maintaining your weight. If kids sleep less it leads to hormonal disturbances and obesity. Any amount of gymming wouldn’t help if you are sleep deprived.
Q. What was the impact on Covid patients?
A. Our study results showed that only 40% of Covid19 patients had good sleep quality compared to 73% observed in a healthy population. Significantly, 84% of patients had history of sleep disturbances compared to 34% of healthy people. Covid patients having severe disease based on HRCT score more than 16, 63% had poor quality sleep scores. It suggests history of poor quality sleep relates to more severe Covid disease.
Q. How do lungs get involved?
A. Another study ‘Sleep behavior and the risk of lung cancer; An observational descriptive study’ showed that poor sleep quality and sleep hygiene, irrespective of sleep duration, may lead to increased metastasis in lung cancer. Irrespective of smoking, improper sleep is the most common risk factor for advanced stage lung cancer.