REM or rapid eye movement sleep is the fourth or last stage of the different stages of sleep, associated with dreaming and brain development.
Published Aug 11, 2024 | 7:00 AM ⚊ Updated Aug 11, 2024 | 7:00 AM
Dr Manvir Bhatia speaking about sleep. (South First)
There’s a common belief that having a drink when you’re exhausted relaxes you and helps you sleep better. During the inaugural Dakshin Healthcare Summit in Hyderabad, Dr. Manvir Bhatia, director and founder of the Neurology and Sleep Centre in New Delhi, pointed out that the truth is actually quite the opposite of this popular belief.
Dr. Bhatia explained that while alcohol may initially induce sleep, it actually works quite differently from what most people think.
“Alcohol and sleep are like a whole thesis,” she said, “it may help you fall asleep initially, but over time, your body develops a tolerance to it. This means that the same amount of alcohol will no longer have the same effect, leading people to consume more. However, increasing the quantity of alcohol not only fragments your sleep but also worsens the quality of your sleep cycles.”
Dr. Bhatia said alcohol can significantly worsen sleep apnea and snoring, leading to more severe sleep disruptions over time. “After a while, alcohol will have a more harmful effect on your sleep,” she said. She was speaking on the topic, “The Secrets of Longevity – Unravelling the Science,” during the Summit organised by South First and TV9 Network.
Dr. Arvinder Singh Soin, chairman of the Institute of Liver Transplantation and Regenerative Medicine at Medanta, asked Dr. Bhatia about the quality and quantity of sleep needed for rejuvenating the physical and mental self. Dr Bhatia acknowledged that while nutrition and exercise have been in the spotlight for many years, the focus on sleep has only recently gained traction, especially in the United States and Europe.
“Sleep is now a booming industry, growing rapidly into a billion-dollar market, with innovations in everything from sleep environments to customisable mattresses catering to individual needs. I tried out a mattress which is designed so one side becomes cool, as the other side stays warm. It’s amazing what new developments are coming up,” she remarked.
Delving into the science of sleep, she explained that while the general recommendation is seven to eight hours of sleep per night, individual needs can vary. “Just as we have regulation for food, we have regulation for sleep,” she noted. Some people may require less sleep, while others may need more. Quantity is relatively easy to estimate, but quality is more complex to measure.
Dr. Bhatia pointed out that many people have come to rely on gadgets like Fitbits, Apple Watches, and other devices to track their sleep stages. “People come to me with data collected over months, saying, ‘Doctor, you don’t understand, I’m not getting any REM sleep.’
They believe it because their Fitbit or other devices tell them so,” she explained, stressing that people seem to rely on their devices rather than on their own understanding of the needs of their body. REM or rapid eye movement sleep is the fourth or last stage of the different stages of sleep, associated with dreaming and brain development.
She explained that sleep is not a single, unconscious state but a series of stages that we cycle through multiple times during the night. For adults, there is a good understanding of how much time should be spent in deep sleep and REM sleep, with a typical night involving four or five such cycles.
Dr. Bhatia also discussed sleep deprivation, defining it as getting less sleep than the body needs. “This could be voluntary, and nearly 60 percent of the time, people just can’t shut Netflix off. It has a very strong pull, and before they know it, it’s 4 or 5 am” she said.
She mentioned that young people, particularly among people in their 20s and 30s, there are those whose sleep schedules have shifted so drastically that they go to bed at 5 or 6 am and wake up in the afternoon. One case she mentioned involved a young woman trying to study for examinations who was struggling with “brain fog” from disrupted sleep, which left her unable to function effectively throughout the day. Dr. Bhatia said the decline in sleep quality can significantly impair mental and physical health.
Dr. Manvir Bhatia underlined the need for proper sleep at night. Many people, particularly youngsters, have convinced themselves that as long as they get seven hours of sleep, it doesn’t matter what time they go to bed. There is substantial evidence, Dr Bhatia said, that the body is programmed for rest and recovery at night, between 11 pm and 5 am. Cortisol levels, linked to stress and the body’s excitatory system, are supposed to decrease at that time, allowing for relaxation and restorative sleep.
However, if people stay awake at that time, they disrupt this natural rhythm and end up with an overstimulated system. “When you stay awake, you heighten your excitatory system, keeping it in a supercharged mode. This constant state of heightened alertness and stress can be harmful to your health,” she said.
This disruption can lead to various health issues, including increased stress, anxiety, and poor quality of sleep, overall. This affects both mental and physical well-being.
Dr. Manvir Bhatia said that sleep lies at the foundation of good health. She recalled that many experts at the seminar mentioned chronic inflammatory states and metabolic syndrome as the root causes of numerous health issues. She pointed out that sleep physicians believe that poor sleep is the underlying cause of these problems.
“Sleep deprivation, whether by one’s own choice or because of sleep disorders like snoring, or sleep apnea, triggers an inflammatory response in the body. This chronic inflammation can lead to various health complications, making the connection between sleep and overall health increasingly clear. Think about sleep as the soil, and the plant as your life,” she said, citing another physician.
No matter how well-nourished and hydrated one might be, no matter that one gets adequate sunlight and exercise, if one is sleep deprived, then it is as if the soil from which a plant draws nourishment is poor – the plant, that is, your life – will not thrive.
Dr. Manvir Bhatia said the brain goes through a “cleaning” process during sleep. She described the body’s lymphatic system, responsible for clearing waste and toxins from the brain during sleep. This system operates like a vacuum cleaner or housekeeping service, tidying up the brain and removing the junk that accumulates through the day.
This cleaning process is best accomplished by sleep at the right time, during the night. If this process is curtailed, the brain gets cluttered, leading to cognitive issues. She noted that inadequate sleep is recognised as a risk factor for cognitive impairment and dementia.
When patients report memory problems, one of the first things she inquires about is their sleep quality. Memory consolidation, which is essential for storing and recalling information, is a process that heavily depends on good sleep. Without proper sleep, the brain struggles to store new information. Think of the brain as a USB drive, she said, that collects information throughout the day.
At night, during sleep, this information needs to be transferred to a hard disk (long-term memory storage). If this transfer does not happen, the brain fails to store and recall information effectively. This can lead to forgetfulness, which is becoming more common due to information overload and insufficient sleep.
Sound sleep is vital for emotional health, and sleep deprivation can lead to increased anger and irritability, the doctor explained. The amygdala in the brain, a small almond-shaped structure crucial for processing emotions, especially anger, acts like a firing system for these emotions. In contrast, the prefrontal cortex, at the front of the brain, serves as a regulatory “brake” on the amygdala, helping us control emotional responses. This part of the brain is highly evolved in humans and is essential for managing impulses and maintaining emotional balance.
When people are well-rested, the prefrontal cortex functions effectively, allowing control over emotions. In the sleep-deprived person, this regulatory function diminishes. The amygdala becomes more reactive, leading to heightened anger and irritability.
Sleep, the doctor said, affects also our capacity for empathy, kindness, and charity. Well-rested people are better at recognising and responding to the emotions of others, and this makes for smoother social interactions. Sleep deprivation can cause individuals to become more self-centered and less empathetic, as their ability to understand and connect with others’ feelings diminishes. This underscores the need for sound and adequate sleep not just for healthy individuals but also for peaceful social interactions.
Dr Bhatia mentioned that there are three pillars to good health – nutrition, exercise, and sleep. Dr. Arvind Singh Soin asked about maintaining good cognitive function into old age, and Dr Bhatia explained that brain health is closely tied to overall health. She noted that the American Heart Association had earlier outlined ‘Life’s Essential Seven Habits for Heart Health’ without mentioning sleep, which was included later given how crucial it is in maintaining good health.
Conditions like diabetes or hypertension should be closely monitored since they can cause small clots in the brain, which may be too small to cause noticeable strokes. Even so, the clots can impair neural connectivity and gradually damage the brain’s networks.
Social connection, she said, is also important for brain health, especially in the elderly. “Post-COVID, the significance of social connections has become even more evident due to the mental health challenges many people faced during the pandemic. Regular social outings, whether for lunch, tea, or other activities, can have a positive impact on cognitive health. Even simple activities like playing cards can be beneficial,” she said.
Continuous learning and making time to do things that one enjoys are vital to good health in old age, Dr Bhatia said. “Whether it’s solving Sudoku puzzles or picking up a new hobby, the key is to find something that is both mentally stimulating and enjoyable. Engaging in activities that bring joy can help release positive chemicals in the brain, contributing to long-term cognitive health,” she said.
(Edited by Rosamma Thomas)
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