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Quality Sleep...

On World Sleep Day 2024

 

Sleep is part of living, the foundation of good health. It is no different from diet or exercise.World Sleep Day 2024 This is on March 15 under the theme of 'Sleep Equity for Global Health', a campaign for everyone, regardless of race, age, where they live, and what their socioeconomic and economic status is. Everyone needs adequate and quality sleep to lead to complete physical and mental health.

According to the National Sleep Foundation (NSF), adequate sleep duration There are differences according to the age range. As follows:

  • Infants aged 0-3 months should sleep 14-17 hours per night.
  • Babies 4-11 months old should get 12-15 hours of sleep per night.
  • Children 1-2 years old should get 11-14 hours of sleep per night.
  • Children 3-5 years old should get 10-13 hours of sleep per night.
  • Children 6-13 years old should get 9-11 hours of sleep per night.
  • Teenagers aged 14-17 years should get 8-10 hours of sleep per night.
  • Adults aged 18-64 should get 7-9 hours of sleep per night.
  • Seniors from 65 years old and above should sleep 7-8 hours per night.

Dr. Tanupol Wirulahakarun or Dr. Amp President of the Bangkok Association of Obesity Rehabilitation and Education Physicians (BARSO) and Chairman of the Board of Directors of BDMS Wellness Clinic And as Dr. Amp pushes the topic of Lifestyle Medicine, I would like to point out the importance of sleep, not only about duration, but also about sleep quality.

Quality sleep consists of 3 things:

  1. Sleep Duration Appropriate according to age range
  2. Sleep Continuity Starting from going to bed until sleeping (Sleep Latency) until waking up. Quality sleep requires continuity. does not wake up during sleep, the total duration is more than 20 minutes;
  3. Sleep Depth The frequency of brain waves decreases during Delta Waves, which is the time when the body releases a lot of growth hormone to help restore and strengthen the body's functions. In one night's sleep, there should be a deep sleep period of 13-23 % of the total sleep duration. If you sleep for 8 hours, you should have a deep sleep interval of about 65-125 minutes.

 

"Growth hormone is released at its highest level at around 5 p.m. to 1:30 a.m., but it takes almost an hour to reach deep sleep, so we should go to bed from 4 p.m. or 5 p.m. at the latest so that the body can fully recharge growth hormone."

Dr. Amp explained.

 

In general, Our sleep is characterized by a cycle consisting of 2 phases: NREM (Non Rapid Eye Movement) and REM (Rapid Eye Movement, R) phase. Starting with the NREM phase, it consists of 3 sub-phases: the onset of sleep (N1), the sleep phase (N2), and the deep sleep phase (N3) for a total of about 60-70 minutes, then the REM phase or dream sleep phase for about 20-30 minutes, and then the cycle back to the NREM phase (N) again. If we sleep intermittently, do not sleep deeply, or the sleep duration is less than 6 hours a day, it will cause the sleep cycle to be incomplete. It can affect the strength of health.

Sleep problems come in various forms, such as insomnia. Frequent awakening in the middle of the night, decreased sleep efficiency. Obstructive Sleep Apnea (OSA), etc. Finding the cause It requires a history and physical examination to correct the root cause on the spot.

 

Sleep Quality Assessment There are several forms as follows:

1. Taking a Sleep Questionnaire There are various forms depending on the purpose of use, such as: 
  • Pittsburgh Sleep Quality Index (PSQI)

It is a questionnaire used to assess sleep quality, with 19 ranked self-assessment questions and 5 questions for those who sleep with us, which has a score range of 0 to 21 points.

  • Epworth Sleepiness Scale (ESS)

It is a questionnaire that assesses one's level of sleepiness during the day and helps screen for inappropriate behaviors that lead to OSA. If the score is more than 10 points, it is considered to have drowsiness, and if it is more than 18 points, it is considered to have excessive sleepiness/ hypersomnia.

  • Sleep Apnea Scale of Sleep Disorders Questionnaire (SA-SDQ)

It is a questionnaire consisting of 12 questions that help assess sleep apnea and is commonly used to screen for OSA or even study in epilepsy patients.

Sleep questionnaires are often used to assess the severity of the problem or to make an initial assessment for further testing.

 

2. Laboratory tests to find hidden conditions that affect sleep quality, such as:
  • Blood Concentration Testing with Hemoglobin and Hematocrit 

Anemia is associated with sleep quality, especially restless legs syndrome.

  • Thyroid hormone test

Hyperthyroidism can affect sleep, such as prolonged sleep latency. Hypothyroidism can affect overall sleep quality.

  • Insulin like growth factor I (IGF-1) test

IGF-1 hormone levels are used as a fairly accurate indicator of growth hormone levels. People who have trouble sleeping. Whether it's the duration or quality of sleep, there is a decrease in the level of the IGF-1 hormone.

 

3. Polysomnography (PSG)

This test is considered the gold standard for diagnosing sleep problems, especially sleep problems related to the respiratory system, such as obstructive sleep apnea (OSA).

  • Electroencephalogram (EEG) 
  • Electro-oculogram (EOG) 
  • Electromyogram (EMG)
  • Electrocardiogram (ECG)
  • Pulse Oximetry
  • Measurement of the respiratory system, including airflow, chest and abdominal respiratory muscles. (Respiratory Effort)

All of these tests show the physiological effects of different aspects of sleep. As follows:

  • Sleep Architecture Sleep efficiency is displayed by comparing the amount of time spent in bed and the time before entering the REM latency phase, as well as the number of times you wake up. 
  • Stage of Sleep Shows how long you are sleeping compared to the total sleep duration.
  • Body Position to detect abnormal movements of the limbs; 
  • Respiratory Parameters For example, the severity of sleep apnea (Apnea Hypopnea Index (AHI), Respiratory Disturbance Index (RDI)
  • Blood oxygen concentration and heart rate

 

This test can be done either by coming in for an overnight stay at a service center or having a specialist attach a device to the patient at home so that they can sleep comfortably in the home environment. The results of a sleep physiology test will reveal the severity and the exact cause of the sleep problem. To lead to correction on the spot.

 

Dr. Amp would like to leave it. Building good sleep habits, which is the key to treating, caring for and preventing sleep problems, can be started today.

  1. It is recommended to go to bed before 10 p.m. and get at least 8 hours of sleep, with a goal of deep sleep of 20% of the total sleep duration.
  2. Manage anything that may interfere with your sleep, such as wearing earplugs to reduce the sound, or wearing eye patches to reduce light, and adjust the temperature to suit your sleep.
  3. Go to bed only when you feel sleepy. Use the bed only for sleeping. Not used to work. Watch TV or eat 
  4. Exercise regularly because exercise helps you sleep better, but you should avoid exercising 3 hours before bedtime. 
  5. If you have a medical condition. Be sure to check if there are any medications that affect sleep. Try to talk to your doctor about the side effects of the drug.
  6. Avoid caffeinated beverages such as green tea, coffee, cocoa, soft drinks at least 6 hours before bedtime. 
  7. Avoid drinking alcohol and smoking because both reduce the quality of sleep.
  8. Avoid large meals or foods that are difficult to digest at least 3 hours before going to bed to reduce the risk of not getting a good night's sleep due to bloating, abdominal tightness or acid reflux.
  9. Reduce the intake of starch, sugar and fruit at dinner because of higher blood sugar levels. It can interfere with sleep.
  10. Try to do activities that make you feel calm and relaxed before going to bed, such as meditating, meditating, walking, etc.

On the occasion of World Sleep Day 2024, Dr. Amp would like to invite everyone to pay attention to sleep, which is very important in health care and is one of the 'Six Pillars of Lifestyle MedicineWhen sleep problems occur. It needs to be solved on the spot because each person is different. According to the theme of this year's World Sleep Day, and focusing on effective sleep, which will be the beginning of good health.

 

Sleep Equity for Global Health

 

References
  • Paruthi S, Brooks LJ, D'Ambrosio C, Hall WA, Kotagal S, Lloyd RM, Malow BA, Maski K, Nichols C, Quan SF, Rosen CL. Consensus statement of the American Academy of Sleep Medicine on the recommended amount of sleep for healthy children: methodology and discussion. Journal of clinical sleep medicine. 2016 Nov 15;12(11):1549-61.
  • Hirshkowitz M, Whiton K, Albert SM, Alessi C, Bruni O, DonCarlos L, Hazen N, Herman J, Hillard PJ, Katz ES, Kheirandish-Gozal L. National Sleep Foundation’s updated sleep duration recommendations. Sleep health. 2015 Dec 1;1(4):233-43.
  • National Sleep Foundation. What Is Sleep Quality? [Internet]. Washington, DC: National Sleep Foundation; 2020 Oct 28 [cited 2023 Jan 19]. Available from: https://www.thensf.org/what-is-sleep-quality/
  • Intha J, Pramokchon P, Khoenkaw P, Osathanunkul K. Analysis of effective sleep through logistic regression. 2020 Joint International Conference on Digital Arts, Media and Technology with ECTI Northern Section Conference on Electrical, Electronics, Computer and Telecommunications Engineering (ECTI DAMT & NCON). 2020 Mar; doi:10.1109/ectidamtncon48261.2020.9090702 
  • Institute of Medicine (US) Committee on Sleep Medicine and Research; Colten HR, Altevogt BM, editors. Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem. Washington (DC): National Academies Press (US); 2006. 2, Sleep Physiology. Available from: https://www.ncbi.nlm.nih.gov/books/NBK19956/
  • Methipisit T, Mungthin M, Saengwanitch S, Ruangkana P, Chinwarun Y, Ruangkanchanasetr P, Panichkul S, Ukritchon S, Mahakit P, Sithinamsuwan P. The development of sleep questionnaires Thai version (ESS, SA-SDQ, and PSQI): linguistic validation, reliability analysis and cut-off level to determine sleep related problems in Thai population. J Med Assoc Thai. 2016 Aug 1;99(8):893-903.
  • Green ME, Bernet V, Cheung J. Thyroid dysfunction and sleep disorders. Frontiers in endocrinology. 2021 Aug 24;12:725829.
  • Gerstenslager B, Slowik JM. Sleep Study. [Updated 2023 Aug 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK563147/
  • Rundo JV, Downey III R. Polysomnography. Handbook of clinical neurology. 2019 Jan 1;160:381-92.
  • Douglas JA, Chai-Coetzer CL, McEvoy D, Naughton MT, Neill AM, Rochford P, Wheatley J, Worsnop C. Guidelines for sleep studies in adults-a position statement of the Australasian Sleep Association. Sleep Med. 2017 Aug 1;36(Suppl 1):S2-2.
  • Jaehne A, Unbehaun T, Feige B, Lutz UC, Batra A, Riemann D. How smoking affects sleep: a polysomnographical analysis. Sleep medicine. 2012 Dec 1;13(10):1286-92.
  • Zhang Y, Sun Q, Li H, Wang D, Wang Y, Wang Z. Lower serum insulin-like growth factor 1 concentrations in patients with chronic insomnia disorder. Frontiers in Psychiatry. 2023 Apr 21;14:1102642.