World Sleep Day, celebrated in 2023 this Friday (17), has as its theme “Sleep is essential for health”. The first celebration of the date took place in 2008 in order to draw attention to awareness and promotion of sleep health.
This year, the global appeal organized by the world sleep society aims to reduce the weight that sleep problems cause in society, through prevention and treatment.
On this day, professionals from various medical specialties from 70 countries organized themselves to carry out local and national activities that demonstrate that sleep is considered a fundamental pillar of human health, both body and mind.
In Brazil, from March 13th to 19th, health professionals are participating in lectures, courses and dissemination within universities. The general public has information available online about the importance of sleeping well.
The Brazilian Association of Sleep (Absono), the Brazilian Association of Sleep Medicine (ABMS) and the Brazilian Association of Sleep Dentistry (Abros) jointly launched the Sleep Week Booklet – 2023 with explanations and tips for society.
The publication shows that it is during sleep that the main restorative functions occur, such as energy and hormone replacement, tissue reconstitution and protein synthesis.
sleep disorders
There are over 100 sleep disorders. The three Brazilian associations associated with sleep (Absono, ABMS and ABOS) state that having a good night’s sleep will contribute to improving quality of life and may reduce the risk of cardiovascular diseases (arrhythmias and high blood pressure) and diabetes; maintain healthy body weight, avoiding obesity; strengthen the immune system; release hormones; consolidate memory, concentration and learning; regulate mood, lower the risk of depression and anxiety; reduce stress; reduce the number of accidents, such as work and traffic accidents.
Fatigue caused by sleep deprivation or poor quality sleep can be physically, mentally, and emotionally taxing, with mood swings. The behavioral clinical psychologist and Master in Sleep Medicine, Mônica Müller, explains the evolution of poor sleep quality, with four main symptoms. “In initial insomnia, the person has difficulty falling asleep. The second symptom is the difficulty of maintenance. The third is terminal insomnia, with early awakening – the individual wakes up before the desired/scheduled time and cannot go back to sleep. Finally, the fourth symptom is non-restorative sleep, with complaints of fatigue, extreme tiredness, which makes it difficult for the person to function [bem] daytime”.
cognitive disorders
Poor quality sleep can hamper attention, concentration, memory, learning, planning, decision making, logical thinking, imagination, creativity and the ability to retain new information.
With 23 years of experience in the subject, Mônica Müller has noticed patients impacted by the harmful habit of intentional sleep deprivation, caused by the accumulation of tasks. “These are people who work late, who use the night to do other tasks, who often cannot organize themselves during the day. They end up depriving themselves of sleep, because the next day they have to wake up early. They have other commitments. So, it is necessary to consider what fatigue generates this overload. And poor quality sleep, if maintained for a long time like this, will have a negative impact on both mental and physical functioning.”
Mônica details some of the negative consequences of this so-called insufficient sleep syndrome. “They are mood swings, especially for people who are pre-disposed or already have psychiatric disorders, with anxiety and depression being the main ones. She also cites bipolar mood disorder, where sleep deprivation is extremely harmful and can trigger episodes of mania. Fatigue and extreme tiredness must be avoided at all costs.”
Breathing disorders – snoring and apnea
Mônica also made a direct association between cognitive impairment and respiratory disorders, especially sleep apnea, which is the interruption of breathing for ten seconds or more during the night. The disorder is considered serious and dangerous due to the risk of death. “In this respiratory arrest, the person does not have good blood oxygenation. As a result of oxygen desaturation, carbon dioxide ends up being carried to the brain. Impaired circulation in that area literally kills nerve cells.”
This week, the Brazilian Association of Otorhinolaryngology and Cervico-Facial Surgery (ABORL-CCF) released a survey, carried out in February this year, which shows that poor sleep quality represents 25% of complaints in otorhinolaryngology offices in Brazil. The mapping, carried out with 430 physicians from across the country, considered the care provided by these specialists between 2020 and 2023.
Almost 94% of complaints received by otorhinolaryngologists are related to snoring and obstructive sleep apnea. The coordinator of the ABORL-CCF Sleep Medicine Department, Danilo Sguillar, considers the percentage to be quite expressive. “More than 930 million people worldwide suffer from obstructive sleep apnea.” The doctor lists the harmful effects of interruption of breathing: “in addition to respiratory arrest, the most common signs of this problem are loud snoring, daytime drowsiness and cardiovascular and metabolic changes such as high blood pressure, arrhythmia and diabetes”. Therefore, snoring should be considered a sign of apnea.
The ABORL-CCF survey highlights that the predominant age group of patients is between 40 and 65 years old and there is a predominance (85.2%) of the male gender. Fewer complaints to otorhinolaryngologists are insomnia, bruxism, excessive sleepiness and behaviors such as sleepwalking, night terrors and restless legs. Therefore, the category defends good breathing through the nose.
During the pandemic, the study revealed that insomnia gained prominence in offices. It represented 47.7% of the complaints, a higher percentage than snoring and apnea complaints. The doctor projects a picture of improvement. “Now, the more solid information, the vaccination that has been gaining more and more projection, with the fourth and fifth doses, make us create more confidence, a more stable relationship and, obviously, this is reflected in our sleep. So, surely, in the coming months, the coming years, these complaints related to insomnia and nightmares will lose prominence”.
For those who already have apnea, the ENT specialist in Sleep Medicine in Brasília, Aliciane Mota, advises: “in general, the patient can sleep on his side. Most benefit from the lateral decubitus position because there is apnea with a positional component. And when you put yourself on your back, you tend to have more apnea. It is also worth raising the headboard, not with a common pillow. I suggest those in a triangular shape”.
sleep quality
Experts explain that the need and limit of hours of sleep can be different from person to person and are variable at each stage of life, according to hormonal changes. A newborn, for example, spends 14 to 18 hours a day sleeping, considered essential for development, especially neurological. In children, sleep contributes to the release of growth hormone. Adolescence is characterized by a temporary change in sleep patterns. In this age group, adolescents need to sleep more hours (from 8 to 10), with a tendency to sleep and wake up later. In theory, adults need, on average, 8 hours of sleep per day. And with advancing age, they may wake up more often at night and are more likely to sleep and wake up earlier. During the day, naps may be more frequent at this time in life.
Sleep is divided into two phases: non-REM (Rapid Eye Movement) sleep and REM sleep. Sleep stages alternate during the night. In non-REM sleep there are four stages:
1: Transitional sleep: marked by falling asleep. In this transition between being awake and sleeping, there is relaxation of the muscles and can be characterized by naps;
2: Light sleep, with a decrease in heart and respiratory rhythms and body temperature;
3: Intermediate sleep: brain activity begins to decrease and the body begins to enter a deep sleep;
4: Deep sleep: essential for body rest, with the release of hormones and recovery of cells and organs.
After the fourth stage, the body moves into REM sleep, with intense brain activity. It is the phase of dreams, memory fixation and deep rest, essential for recovery and waking up willing.
Recommendations
To sleep well at night, doctors recommend healthy sleep hygiene habits:
· go to the bedroom only when you are sleepy, so as not to ‘fry’ in bed;
· maintain a regular bedtime and wake-up routine;
· reduce noise and keep the environment dark at night;
· if you need to get up at night, use suitable lamps in the environments, avoiding white light;
· maintain a pleasant temperature in the room;
· avoid the use of medication for sleep whenever medically prescribed;
· keep pets out of the bedroom that can disturb sleep;
· about two hours before going to bed, avoid using screens (TV, cell phone and computer);
· avoid heavy eating close to bedtime;
· avoid the use of alcoholic and caffeinated beverages, such as coffee, black, white and mate teas, chocolate, guarana and other thermogenics;
· avoid foods with glucose
· practice physical exercises regularly, but avoid them three to four times before going to bed;
· lose excess body weight;
· do not sleep in excess during the day to accumulate physical and mental fatigue for the night
· do not smoke;
For those who already have trouble falling asleep or staying asleep:
· do not stay awake for a long time in bed;
· when waking up in the middle of the night, avoid checking the time
· if you have cold feet, wear socks to sleep;
· not thinking about daily worries when going to bed;
· avoid discussions and controversies at the beginning of the evening.
Expert professional help
Otolaryngologist Aliciane Mota points out that in the face of sleep disorders, especially apnea, it is essential to urgently seek the help of a professional with expertise in Sleep Medicine. “Look for a doctor. For the treatment, he will need other colleagues in the health field. It can be a physiotherapist, speech therapist, sleep psychologist, dentist. So, there are several arms in the health area collaborating.”
Psychologist Mônica Müller defends the individual analysis of each patient. “It does not mean that all people will receive the same guidelines. Everyone has their own rhythm, their own need for sleep. The specific sleep professional will understand, during treatment, how many hours of sleep that person actually needs”.
And he ends by explaining what a successful treatment is: the patient manages to go to bed with a lot of drowsiness, a lot of tiredness so that he falls asleep quickly and stays asleep throughout the night. It will mostly feel repaired during the day. Being willing to do activities is a very important thermometer”.
habits
A global survey of sleep habits and conditions in more than ten countries, carried out by ResMed in January 2023, with more than 20 thousand individuals, shows that 49% of Brazilians maintain the habit of using screens to try to fall asleep, followed by the practice of reading (34%) and the habit of spending time with a family member or pet (20%) before going to sleep.
