14 March 2022 | NEWS
SLEEP DEPRIVATION: NEW PITFALLS TO AVOID...
Katerina Espa Cervena - psychiatrist and medical director of Cenas.
One third of the population lives with a proven sleep deficit. And for many others, there is the constant stress of trying to get to sleep. Should we be concerned? Dr. Katerina Espa Cervena, a psychiatrist, is the medical director of Cenas, the sleep medicine centre in Geneva. According to her, this lack of rest should be taken seriously, but it should not become an obsession. Very often, the more one chases after sleep, the more evasive it becomes... Interview.
Does the amount of sleep required really vary from one individual to another ?
Yes, in adulthood, the amount of sleep each individual needs varies according to their genetic profile. For those who don’t need much sleep, 5 hours will be quite sufficient. Whereas for heavy sleepers, 9 hours will be necessary. So much so that they may even experience symptoms of sleep deprivation if they only sleep 7.5 hours.
Which part of the population is most at risk from sleep deprivation ?
Sleep needs are different for different population groups. For example, for someone who is no longer working, the chronic sleep debt will be less severe than for a teenager. The recommended sleep duration up to the age of 18 is 9.25 hours. It is a fact that teenagers rarely sleep that much; even without going to bed late, given the time their lessons start, it is difficult for them to meet their sleep needs. In addition, their overexposure to screens before bedtime will further delay falling asleep. A large majority of them are therefore exposed to a sleep deficit. They are clearly the most at risk population. It has been shown that this lack of sleep, at a time when their brains are developing, can lead to poor school performance and inappropriate behaviour.
How do we know if we are getting enough sleep ?
If you do not suffer from daytime fatigue, if you feel perfectly well, do not try to sleep differently! However, if you are tired during the day, the question is whether you are suffering from insomnia or sleep deprivation.
What is the difference between insomnia and sleep deprivation?
It is essential to distinguish between insomnia and sleep deprivation. While both have the same effect on our daily lives, the ways to improve your sleep are not the same. In the case of sleep deprivation, your body or brain does not give your organism the opportunity to sleep for as long as it needs. Sleep deprivation occurs when, for example, there is excessive work or leisure time, and you yourself do not give yourself the possibility of getting enough sleep. Insomnia, on the other hand, is a condition for which you are not responsible; for example, you have difficulty initiating sleep or maintaining it by waking up too early. However, even if it is in your best interests to be treated for this disorder, you won’t actually be missing out on too much sleep, as you are probably managing to reclaim some sleep time in the morning, for example, if your problem is being able to fall asleep at bedtime. In addition, there are other pathologies, such as apnoea, hypersomnia (daytime sleepiness), restless legs syndrome or parasomnia (sleepwalking, nightmares, etc.).
- "OUR NEEDS, AND ALSO « THE ARCHITECTURE », OR QUALITY OF OUR SLEEP CHANGE AS WE AGE PHYSIOLOGICALLY, THE DEEP SLOW WAVE SLEEP PHASES BECOME SHORTER."
— Katerina Espa Cervena - psychiatrist and medical director of Cenas
If we feel tired, when should we start seeking medical advice ?
If, on a continuous basis, for more than three months, you have difficulty falling asleep or staying asleep and this happens more than three times a week, or if you experience excessive tiredness or decreases in performance during the day, it is reasonable to seek advice. Sometimes there may be organic disorders such as those of the thyroid gland. If this is not enough, you can consult a sleep centre, which will carry out a more extensive assessment by analysing the different stages of rest in order to propose the most suitable treatment. In this instance, we are talking about people who suffer from pathologies that affect their sleep. For others, it is possible to improve the quality of their sleep by simply encouraging them to listen to their body's needs more attentively.
How can you train yourself to sleep better ?
Start by identifying the length of sleep that suits you best; intuitively, you may find that eight hours is your ideal average. So make sure you give yourself that ideal daily rest time. And two hours before going to bed, avoid screens or stimulating activities. Biologically, the secretion of a hormone that helps us sleep, melatonin, must begin two hours before falling asleep. If you still want to enjoy watching a relaxing TV series, do so with orange glasses that protect you from blue light. You can also pay attention to your diet. Avoid eating too much fat too late, as this may disturb your sleep.
Can a more comfortable bed also improve the quality of our sleep ?
Yes, comfort is very important. The choice of a mattress is an extremely individual matter. Sometimes spouses have different needs and desires for comfort; if this is the case, it is better to have two different mattresses. An unsuitable mattress, which does not provide sufficient support, may aggravate underlying problems (back pain, neck pain) and therefore disturb the continuity of sleep. Even in the absence of an underlying disease, an uncomfortable mattress that is not suited to the sleeper's morphology (too "soft" or too "firm") can disrupt sleep and cause broken rest or micro-awakenings. The thermal comfort of the bedding also plays an important role: the mattress must be able to evacuate moisture, otherwise night sweats may occur.
What are the repercussions of a lack of sleep on our minds ?
It is now known that insomnia doubles the risk of experiencing a depressive disorder.p>
You say that our sleep evolves over the course of our lifetime.
Indeed, it is important to know that not only our needs, but also the "architecture", i.e. the quality of our sleep, change as we age. Physiologically, the deep slow wave sleep phases become shorter. In my consultations, I frequently observe that people estimate their need for sleep based on their past. They will therefore try to get the same amount of sleep in retirement, even though they don't need as much.
For Tim Cook, the head of Apple, sleep is "something that losers do". Many other leaders point to their short nights as the reason for their success. Can't we save sleep time to perform better ?
We cannot, simply by our own will, change our physiological needs! Look at the biological circadian rhythm (the sleep-wake rhythm that marks the daily life of most animals and plants): it is a widely observable reality. We are made to be active or passive. Sleeping cannot be equated with laziness; it is necessary for recovery.
What are the risks of not getting enough sleep ?
You can feel really bad. It significantly impairs our reaction time and increases the risk of accidents. Our cognitive abilities will also be affected. If you deprive yourself of your physiological needs, you will decrease your ability to remember things. You will clearly evolve below your natural capacity, consistently. I would never recommend that anyone shortens their nights to increase their levels of efficiency!
In the past, your patients sometimes consulted you to reduce their sleep time. This is no longer the case. How do you explain this?
People are becoming increasingly aware of the importance of getting a good night's sleep and the health risks associated with poor sleep. I used to get questions from my patients about how sleep is broken down into phases, with the intention of taking medication to stay awake; I don't get any such requests any more. Now my patients are mainly interested in reducing levels of fatigue and improving their performance.
Does a lack of sleep really accumulate or is it enough to get a few 'normal' nights in a row to restore some balance?
If you deprive yourself chronically, the lack builds up. But the brain and our body have an enormous capacity to recover. One study showed that after eleven days of sleep deprivation, the subjects recovered within three nights.
What do you think about taking melatonin to restore sleep ?
There is a difference between taking it when recommended by a doctor and when it is self-medicated. A few years ago, the European Community authorised the free sale of melatonin. In Switzerland, it can only be obtained on prescription. Melatonin is a very effective hormone with very few side effects. However, if we take it in a way that is not adapted to our biological rhythm, we risk suffering even more. It is essential that a doctor has analysed how an individual’s internal clock functions.
More and more technologies are available on the market to monitor our sleep. Are these "sleep techs" useful?
Many of these gadgets aim to judge the quality of sleep by analysing the phases of sleep. Without putting electrodes on the head, this is impossible. Some of my patients come to me with the sleep phases that their watch has recorded. But this can only measure movement or lack of movement; it doesn’t yet mean that the patient was in a particular sleep phase. Other devices measure heart rate; but this too is approximate. On the other hand, other technologies such as sensors can be used to confirm that someone is suffering from snoring, which may explain some disorders. As for connected mattresses, once apnoea has been diagnosed, they can be used to treat it by temporarily raising the sleeper when snoring occurs.
Don’t we risk no longer sleeping well simply through trying too hard?
Yes, there is a risk of suffering from orthosomnia, a disorder closely associated with connected objects, which is affecting more and more people. It is the obsession with sleeping well. The name of this disease was coined in 2017, at the same time as the democratization of these connected objects tracking sleep. It is inspired by orthorexia, which is the obsessive quest for healthy eating. However, we cannot influence our sleep by our own will alone, as it is managed solely by the brain. However, we can adapt our behaviour, use common sense and, in many cases, our sleep will respond favourably. But there is no need for exaggerated behaviour which risks creating anxiety that will certainly disrupt sleep and becoming a new and perverse search for performance..
