Importance of Sleep for Medical and General Wellness

 

Hasina Adil¹, A.A. Koser¹, Alok Gupta²

¹Department of Physics, Medi-Caps University, Indore, (M.P.), INDIA

²PS India.

 

ABSTRACT:

The aim of this paper is to create awareness about importance of sleep, its need and its effect on overall health to remain happy in today’s world. This can be achieved when people have knowledge about functions of sleep, its type of disorder, its remedies and precautions.  Now a day’s Obesity in youngsters and Cancer especially in women are very common. The reason is inadequate amount of sleep. Late night parties and nightshift works affect directly on their sleep which results in their mood and work style. They become short temper, anger and depressed due to continuous work in competition to go on top position demand more works for which they sacrifice their sleep. This depression last stage motivates youngsters for suicide. All situations can be controlled by monitoring our sleep pattern at home. For this purpose, a genuine sleep monitor of low cost is required so each and every class of people can use and check their sleep for good health.

 

1. INTRODUCTION:

A good sleep is as important as a good food. The sound sleep reflects good mental and physical   health of a person. It keeps people healthy and cheerful by avoiding stress and fatigue. Sleep covers one third of our life span. An individual work performance like memory, learning abilities, cognitive functioning gets affected by poor sleep. A complete sleep is needed for smooth functioning of all biological processes of living organism to live quality of life. It gives support in healthy functioning of nervous, immune, digestive, cardiovascular and endocrine systems of a body. To live quality of life it is necessary to understand and monitor the sleep and sleep behavior of an individual daily.

 

The present life style and work pressure affects the significant parameter of life and causes the serious health related issues. Various researchers have published the data which implicates that 93% Indians are sleep-deprived [1] while going by the global statistics, “20% of people around the world are sleep deprived” [2].

 

This situation is simply because of reason that ranges from lifestyle changes like odd-working hours, to personal obligations and relationship worries. Besides this, the anxiety, tension and nervousness which develop due to work pressure, household issues or personal relationships also affect sleep, leading to sleep disorders. Sleep disorders make people to take sleeping pills for a sound sleep [2]. The stressed work schedules require proper medical care towards having a good sleep as we see shrinking sleeping hours. Sleep disturbance is closely linked to cardiovascular disease including glucose metabolism, hormonal regulation, inflammation and blood pressure [3]. Sleep restores the immune of internal organ system but at same time its depriviation, plays a role in the diseases like cancer, and major depression which increases the risk of suicidal attempts [4].

 

Quality of sleep relates to socio and health related issues.  Sleep apnea and insomnia are among common sleep disorders which constitute to 80 types of known sleep disorders according to American Academy of Sleep Medicine (AASM) [5]. The statistical analysis shows that “72% of Indians are having awakened state one to three times per night and out of that 87% reported that sleep disturbance is affecting their health. The productivity, of approximate 58% Indians suffers due to inadequate sleep while 38% have noticed other falling asleep during work” [1]. The last decade has seen the sleep and sleep related problems as a public health affair, with an increasing focus on the connection between poor sleep quality, chronic disease and socioeconomic factors [6,7].

 

2.       MOTIVATION:

Poor sleep treatment is very expensive and beyond the reach of common man. It is estimated billions of dollars annually on hospital visits due to problems of   inadequate sleep [8]. The present sleep assessment is the Polysomnography (PSG)which comprised of Electroencephalograph (EEG) during which Oximetry, Electromyography (EMG), Electrooculography (EOG), respiration and cardiovascular measures of person are recorded. In addition Electrocardiography (ECG), actigraphy, audio, video or temperature are added as auxiliary recordings for a complete sleep study. The main disadvantages with PSG are its high costs, complex procedure, overnight monitoring in hospital environment which is not natural habitat of person. These are the main reasons for the popularity of low-cost home diagnostic systems [9].

 

A wide range of wearable sleep monitoring devices are commercially available most of them are based on the actigraphy, heart rate, respiration rate monitoring and temperature sensing, come in the form of smart watches, arm night sleep Shirt and smart phones. Limitation of such system is that they are based on some specific parameter such as vibration, heart rate, respiration rate or temperature. Using some of such parameters we cannot predict correct results for example a person suffering from heart disease using pace maker would not get appropriate reading that is based on comparison with R-R Intervals by ECG [10], or a person having Parkinson will not get appropriate reading for the wrist band type of system.

 

3.       SLEEP STAGES AND CLASSIFICATION:

Sleep is the physical activity of body in which three phenomena of physics is involved. First, Potential energy i.e every object on this earth try to gain minimum potential energy which can be achieved when we lying on bed. It is convenient state to sleep. Furthermore, for quality of sleep we must take rest by completely lying down and not by sitting on chairs and take nap on work place. Secondly, Zero gravity i.e we have to sleep flat so that body touches the earth and gravity becomes zero which give a complete rest to our mind, body and store energy. Third, waves are generated of different frequency when we sleep and awake. These waves are large number of electrical signals generated by neurons of our nervous system as they communicate with each other and produced variety of electrical signals which can be read by technique called EEG. These recordings differentiate between the states of awake and sleep. In awake, muscle tone are high and low-voltage fast EEG activity are noticed. “Sleep-related EEG activity varies depending on the stages of sleep. Sleep state is broadly divided into Rapid-Eye Movement (REM) sleep consists of low voltage fast activity in combination with a complete loss of muscle tone (REM muscle atonia) and characteristic rapid eye movements and Non-Rapid-eye movement (NREM) sleep is recorded as high-amplitude low-frequency EEG signal, a reduction in muscle tone compared to wakefulness, and slow rolling eye movements” [11]. NREM sleep is comprised of four stages [12]. Stage 1 NREM sleep (N1), shows theta activity and stage 2 (N2) reveals shallow sleep characterized by sleep spindles. K-complexes; and Stage 3 of NREM sleep (N3), display, high-amplitude delta waves, noted as slow wave sleep. Stage 4 of NREM sleep manifest as deep sleep. Living organism sleep transit from light sleep to deep sleep which remains about 70 minutes before entering the REM stage. Figure 1 shows the complete sleep cycle moving periodically among light sleep stage, deep sleep stage and REM stage during the night and follows this pattern. Sleep cycle repeats four to six times over a night and time period of single cycle is about 90 minutes. These stages are marked by a sleep specialist which uses this recorded PSG data for further treatment (Rechtschaffen, 1968) [13], and hypnogram helps to study the change occur in regular sleep cycle.

 

 

Figure 1: Hypnogram

 

The hypnogram recorded sleep patterns or habits help in identification of different types of sleep disorders. In this way one can check the status of sleep and its quality to improvise their medical and general wellness.

 

4.       SLEEP DISORDERS:

In 2005, International Classification of Sleep Disorders ICSD classify sleep disorders into eight categories and it is recommended by American Academy of Sleep Medicine (AASM).

I.        Firstly, Insomnias in which person feel difficulty in staying asleep, falling asleep, early awakening and poor sleep quality.

II.      Secondly,very common in children sleep related breathing disorders.

III.    Third, Hypersomnias due to sleep related breathing disorder and disturbed nocturnal sleep.

IV.    Fourth, Parasomnias disorders that introduce into the sleep process and are manifestations of central nervous system activation.

V.      Fifth,Circadian rhythm sleep disorders in which people feel energizes and drowsy at particular day or night time.

VI.    Sixth, sleep related movement disorders which include irregular movement of body during sleep.

VII. Seventh, isolated symptoms, apparent normal variants and unresolved issues of individuals.

VIII.           Last, other sleep disorders which does not fall in above mentioned category comes under this as a special case.

 

A well-known sleep apnea is a serious disorder in which people stop breathing repeatedly during their sleep which results in their death as the brain and the rest of body may not get enough oxygen for survival. Elsewhere, researchers used epidemiological data to link sleep deprivation with obesity and diabetes.

 

5.       SLEEP MEASUREMENT TECHNIQUES:

Sleep and its stages are measured by using following techniques in hospitals and sleep centers:

 

5.1. Polysomnography (PSG):

PSG is accurate and standard method for sleep treatment usually performed at night in hospitals which record a minimum of 12 channels and 22 wires attached on patients body [14]. It includes multiple recording of variable datas like electro-encephalogram (EEG), electro-cardiogram (ECG), electro-myogram (EMG), and electro-oculogram (EOG) [15]. It is costly and intrusive treatment. Further, it needs doctors and experts to understand the signals obtained from this complex system [16].

 

5.2) Electroencephalography (EEG):

Electrical signals of the brain are measured by EEG. It is useful as the EEG signals of awake state are different from sleep stage. It generally uses sensors attached to the head near particular frontal, central, occipital portion of the brain through special gel that helps for conduction of electrical signals originating from the neurons of the cortex. It completely read the activity of the brain that can be occur into different stages of sleep.

 

5.3) Electrooculogram (EOG):

EOG measures electro-potential difference between the cornea and retina of the eyes as cornea is positively charged with respect to retina. It helps to identify REM sleep also called dreaming stage. In this sleep eyeballs make attribute movements which can easily be seen.

 

5.4) Electromyography (EMG):

EMG measures changes occur in muscle activity during sleep and wakefulness. It also shows differences in muscles tone within the different stage of sleep. The Leg EMG can also give information about Restless Leg Syndrome (RLS), or Periodic Leg Movements of Sleep (PLMS) with its signals. 

 

5.5) Pulse oximetry:

In fits over fore finger tips or ear lobe to check oxygen level in blood during sleep. It is portable sleep monitor used in sleep apnea and other respiratory problems.

 

5.6) Electrocardiogram (ECG):

ECG detect the electrical signals of the heart as it contracts and expands in the form of the “P” wave, “QRS” complex and “T” wave. It easily shows any abnormalities occur in regular heart signals. It reveals the fact that the average heart rate is slower during NREM stage when compared to the REM stage of sleep.

 

5.7) Actigraphy:

It is used to study sleep–wake patterns in clinical practice in which patient wear device usually on wrist or ankle during the sleep[17], which measure limb movements with the help of motion accelerometers.

 

It has been used for at least 30 years; i.e., since Kupfer et al. [18] reported remarkable correlation between EEG signals, wrist activity, and wakefulness in 1972.Sadeh et al. [19] with conclusion that in normal cases more than 90% results agree with PSG data. The actigraphy is generally used to measure disorders, such as insomnia, periodic limb movements and circadian sleep–wake disturbances [16].

 

6.       CONCLUSIONS:

Recently a wide range of commercial sleep monitoring systems are available in the world market. Personal sleep trackers give useful information about the quality of sleep and help to take steps to improve it. It is of both wearable and non-wearable type. It integrates different sensors to provide information about various sleep stages and its quality. The most of devices are based on the accelerometer, heart rate monitoring or body temperature data as to get the information about the present sleep stage of the person. The Table 1 below shows some of the popular devices and technology used.

 

Table 1: Commercial Sleep Monitors and their technology

Method Product	EEG	EOG	EMG	ECG/Heart Rate	Actigraphy	Body Temperature
iBrain	√
Fitbit				√	√	√
Zeo	√	√	√
Jawbone Up			√		√
M1(Sleep Image)				√	√	√

 

The PSG gold standard is considered as most authentic test available for monitoring the various sleep disorders, but it is expensive, obtrusive and complex to measures sleep in an artificial environment under presence of doctors and its staff for data interpretation. Commercial devices that are available in market detect only sleep and wake stages but none discloses the principles of the algorithm used or the authentic correlation with PSG standard data. The commercially available devices are based on few sensors which has their own limitations such as accelerometer data may change with external vibrations associated. In future, the goal is to develop a home sleep monitor that overcome the limitation of present PSG system and eliminates the requirement of expert for the sleep data interpretation. The system represents the quality of sleep in simplified manner. The present life style and its complexities motivated us to work towards the significant part of life. A good sleep can give you more energy and freshness that you expect when you take rest. Finally, during sleep you do not have to do anything but the bodies do and recover a lot for next day performance.

 

7. REFERENCES:

1.        Siddalingaiah HS, Chandrakala D, Singh A, Sleep pattern, sleep problems and comorbidities among resident doctors at a tertiary care institution in India: a cross sectional study. Int. J. Community Med Public Health, 4(12); 2017: 4477-4484.

2.        Stranges S; Tigbe W; Gómez-Olivé FX; Thorogood M; Kandala NB. Sleep problems: an emerging global epidemic? Findings from the INDEPTH WHO-SAGE study among more than 40,000 older adults from 8 countries across Africa and Asia. SLEEP, 35(8); 2012: 1173–1181.

3.        Mullington JM, Haack M, Toth M, Serrador JM, Meier-Ewert HK, Cardiovascular, inflammatory, and metabolic consequences of sleep deprivation. Prog. Cardiovasc. Dis. 51(4); 2009: 294-302.

4.        Irwin MR, Why sleep is important for health: A psychoneuroimmunology perspective. Annu Rev Psychol 66; 2015: 143-172.

5.        Rinsho N., American Academy of Sleep Medicine, The international classification of sleep disorders, Japanese J. clinical medicine,73(6), 2015: 916-23.

6.        John WS, Daniel JB, Andrew LC, William CD, Rochelle G, Christian G, Cameron DH, Conrad I, Emmanuel M, Merrill MM, Kent EM, Barbara AP, Stuart FQ, Richard SR, Thomas R, Helmut SS, Michael HS, James KW, David PW, History of the development of sleep medicine in the United States. Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine, 1(1): 2005: 61–82.

7.        Roebuck A, Monasterio V, Gederi E, Osipov M, Behar J, Malhotra A, Clifford GD, A review of signals used in sleep analysis. Physiological measurement, 35(1), 2013: R1–R57. doi:10.1088/0967-3334/35/1/R1

8.        Harvey RC and Bruce MA, Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem, Committee on Sleep Medicine and Research, 2006: 424

9.        Oana RV, Natividad MM, Ralf S, Experimental sleep phases monitoring Conference: 2016 IEEE-EMBS International Conference on Biomedical and Health Informatics (BHI)

10.      Development of a sleep monitoring system with wearable vital sensor for home use Masaya Takahashi National Institute of Occupational Safety and Health

11.      Brown RE, Basheer R, McKenna JT, Strecker RE, McCarley RW, Control of sleep and wakefulness. Physiol. Rev., 92(3); 2012: 1087-1187. doi:10.1152/physrev.00032.2011

12.      Wolpert AE, A Manual of Standardized Terminology and Scoring System for Sleep Stages of Human Subjects. Archives of General Psychiatry, 20; 1963: 246.

13.      Ramona OV, Natividad MM, Ralf S, Experimental sleep phases monitoring, IEEE, 2016: 625-628 doi =10.1109/BHI.2016.7455976.

14.      Armon, C.; Roy, A.; Nowack, W. olysomnography: Overview and Clinical Application. Available online:http://emedicine.medscape.com/article/1188764-overview (accessed on 19 May 2016).

15.      Shephard JW, Atlas of Sleep Medicine, Futura Publications Ltd.: London, UK, 1991.

16.      Yunyoung N, Yeesock K and Jinseok L, Sleep Monitoring Based on a Tri-Axial Accelerometer and a Pressure Sensor, Sensors, 2016; 16: 750; doi:10.3390/s16050750

17.      Sadeh A., Sharkey KM, Carskadon M.A., Activity-based sleep-Wake identification: An empirical test of methodological issues. Sleep, 17; 1994: 201–207.

18.      Kupfer DJ, Detre TP, Foster G, Tucker GJ, Delgado J., The application of Delgado’s telemetric mobility recorder for human studies. Behav. Biol., 1972; 7: 585–59

19.      Sadeh A, Hauri PJ, Kripke DF, Lavie P, The role of actigraphy in the evaluation of sleep disorders. Sleep, 18; 1995: 288–302

 

 

 

 

Received on 15.05.2019           Modified on 08.06.2019

Accepted on 28.06.2019         © RJPT All right reserved