Sleep disorders and biological clock

Insomnia and apnea are the most frequent sleep disorders suffered by the population and they worsened during the pandemic and the months after it. These disorders affect not only the quality of rest, but also the activity during wakefulness.

“Insomnia is closely related to the emotional state and is unleashed by something specific: a couple, economic, work, family crisis, a move, which is recognized as the beginning of the problem,” says neurologist Claudio Aldaz from the National University de Rosario (UNR) in Argentina and highlights that the pandemic was an aggravating factor.

“Patients tell us what they suffered in quarantine, how the day and night became disorganized,” he says. These sleep-wake cycle problems, called “circadian rhythm disorders,” occur when the body’s internal clock, which indicates when to sleep or when to be awake, is out of sync with the environment.

Here appears the sleep phase delay that occurs in people who sleep well but with busy schedules; they can’t do it before 5am and then they wake up at noon. And, on the other hand, there is the phase advance that consists of falling asleep at 8 in the afternoon, for example, and waking up at 4 in the morning. The problem arises when this behavior becomes chronic and it becomes difficult to return to a normal rhythm.

In these cases, the treatment is chronotherapy or therapy of the hours, which consists of fictitiously planning 27-hour days. The person must modify their sleep phase three hours a day and turn around until they reach the best time.

Another problem is hypersomnia whose emblem is narcolepsy, extreme sleepiness during the day and sudden attacks of sleep. People who have it have difficulty staying awake for long periods, no matter what the circumstances. For example, a teacher who falls asleep while teaching or a priest when he celebrates mass.

There is also sleep apnea, which occurs when regular breathing is interrupted during sleep, and snoring is common. This is a very frequent pathology and it is estimated that 4% of the population suffers from it. In some cases the treatment can be upper airway surgery but most are corrected with the use of Cpap (continuous positive airway pressure, or continuous positive airway pressure). This is a device that delivers air at a pressure high enough to prevent the airways from collapsing.

“A patient who suffers a lot of apnea at night already gets up badly. You have a headache, you feel numb, you have trouble paying attention, you have to put in more effort to follow your routine, you have mood swings, you are irritable all day, you get angry about anything, you may suffer from depression and high blood pressure.” The professional details and highlights that if he corrects his apnea he will sleep well all night, he will get up with energy, he will perform better at work, in his studies, he will feel much better and he will also prevent other pathologies more serious than can arise.

Sleep disorders such as insomnia can end up altering the biological clock that regulates our circadian rhythm based on the day-night cycle. (Illustration: Amazings/NCYT)

sleep hygiene

As explained by Dr. Aldaz to Argentina Investiga, there are three causes that trigger these disorders: the predisposing factors that each person brings, those that precipitate it (which can be specific events) and those that perpetuate it and make it chronic. Sleep medicine works on the latter.

The first test done is polysomnography, a test that records certain bodily functions as you sleep. “The patient comes to the office to sleep one night and we monitor him to confirm or rule out the diagnosis.” Based on this, the treatment is decided, which path to take. This is not only pharmacological, there are cases in which ventilatory support is prescribed to correct apnea. Others need cognitive behavioral sleep psychotherapy that begins with a ten-session module.

“There are people who inadvertently play in favor of insomnia,” says the specialist; that is, they have a behavior that roots the problem and makes it worse. To these patients, “the first thing we tell them is to do the best possible sleep hygiene,” he says. There are some basic rules in this regard, including: keeping a regular bedtime, reducing caffeine intake, exercising at the right time, avoiding looking at the clock while trying to sleep, using relaxing bedtime rituals, and learning to Create an environment that encourages sleep.

In principle, it is advisable to carry out a self-examination to evaluate what is done wrong or what is not done and to be able to correct it. “Sometimes they try to comply with everything to the letter and they get tired in a few days, so we tell them to take two or three things that they think they can change and keep them,” he explains and clarifies that insomnia does not improve quickly, it is little by little .

the biological clock

The biological clock changes over time. The newborn eats and sleeps. In general, the young child achieves a structure of nocturnal sleep, taking a nap in the middle of the morning and another in the afternoon. Then he misses his morning nap, in some cases he stays with the afternoon nap and sleeps for a long time at night, which can last up to 10 hours.

Then comes the school stage. “We are immersed in a rhythm that does not give much importance to the hours,” says Dr. Aldaz and exemplifies that in most houses at 6 in the morning there is already movement to bathe, have breakfast, go to school, arrive impeccable, lucid, and focused on 7:30 a.m., which he considers very strict for a boy.

Regarding adolescents and young adults, he expresses that they have great plasticity with sleep. “They go out at night, come back at 8 in the morning, go to bed, sleep until 3 in the afternoon and recover easily.” The problems come when plasticity is lost, for example in young adults. And the old man already has another rhythm, he falls asleep and wakes up early, with several sleep interruptions during the night.

The neurologist maintains that “good sleep” is in a wide range of no less than 5 hours and no more than 10. And he clarifies that the lost hours are not fully recovered. “If we lose three hours of sleep in a month, we lost 90 hours and when we get ready to perform a repair sleep, we can recover something but never that amount of time.”

Regarding the nap, “it is an optional dream, neither good nor bad”, more common in towns and small towns than in large cities. Although it was reviled for a long time as “a waste of time” or “for lazy people”, it is now proven that many people perform better at work if they take a short nap.

Dr. Claudio Aldaz is a neurologist, graduated from the National University of Rosario, with a diploma in Sleep and Wake Disorders from the University of Montpellier (France). He is an adjunct professor of Neurology at the School of Speech Therapy of the Faculty of Medical Sciences and President of the Argentine Association of Sleep Medicine. (Source: Argentina Investiga / National University of Rosario)