An epidemic of insomnia - Daily Nation

A reason to count sheep... and probably grow fat as well

Monday April 21 2014

PHOTO | FILE After a long day during which you strive to meet strict deadlines at work, endure crazy traffic, and suffer unending political theatrics, you end up looking forward to a peaceful and restful night.

PHOTO | FILE After a long day during which you strive to meet strict deadlines at work, endure crazy traffic, and suffer unending political theatrics, you end up looking forward to a peaceful and restful night.  NATION

By JOY WANJA MURAYA
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After a long day during which you strive to meet strict deadlines at work, endure crazy traffic, and suffer unending political theatrics, you end up looking forward to a peaceful and restful night. But for one Nairobi woman, the moment she opens the door to her house, the demons of insomnia follow her in, and so she spends her nights staring at the monotonous white of her ceiling, counting hundreds of sheep and basically being a perfect insomniac.

Julie Wambui knows something is not right with her; she has struggled with this condition since childhood, but now, as technology becomes more pervasive in her life and the pressures of the city take a toll on her, sleep has become a rare fellow in her life.

“When I tell people that I have sleep problems, most of them laugh it off,” she says. “They say they have the same problem as well and that it is not an issue as long as they eventually nod off.”

Those are late sleepers, people who spend the evening watching a game or catching up with friends and do not notice the hour hand going past the midnight mark. Julie, on the other hand, is not a late sleeper. She is a non-sleeper. Period.

If she does not force herself abed, she will easily spend the entire night seated in front of the TV or rummaging through whatever she fancies in the house.

And climbing into bed does not guarantee her any sleep either. If anything, she often spends the night just lying there, listening, painfully, to the nocturnal activities of Nairobi.

She thought she would get used to it, that maybe it was just a phase of life she was going through that would soon be no more, but she was wrong; she tossed and turned through her childhood, primary school, secondary school, and college.

Julie, however, is not alone; thousands — perhaps hundreds of thousands — more are suffering in silence, taking 30-minute naps at night rather than proper sleep.
In the US, where people like Julie receive comprehensive care, the National Institutes of Health (NIH) has an entire unit dedicated to studying sleep deprivation and what it does to the victim. The National Centre on Sleep Disorders Research, therefore, spends taxpayers’ money burning the midnight oil in its devotion to figure out why some of those taxpayers just cannot get enough shut-eye.

And the researchers have a reason to worry; this may not seem like something worth the attention it is receiving, but insomnia has caused a lot of problems in this world, including lost jobs, destroyed careers, and strained relationships.

Kenya, unlike the US, may not have sleep specialists — patients here are normally handled by physicians and psychiatrists — but that does not mean the problem is not as pervasive.

Julie, for instance, knows what it means to go for days without sleep, and when she eventually nods off, it is just for a few minutes before her biological clock triggers its alarm — then she is in for another round of sleeplessness for days on end. She has sought help — “Consulting a psychiatrist for sleep matters earns you severe stigma and discrimination because such doctors are associated with mental illness, which is not such an attractive proposition here,” she says — but other than that she has had to completely overhaul her life and draw up what she calls “a sleep schedule”.

“I retire to bed at 10pm every day, whether I’m sleepy or not. I have no electronic device in my bedroom and often switch off my mobile phone to avoid any distractions.”

So sensitive is she that even a text message in the middle of the night could make her lose sleep till morning.

Julie also wears an eye-mask to bed every night and her choice of house is an almost-sure guarantee that she will doze off, even if for just a few minutes.

“I avoid living in apartments as these have a lot of movement and switch off my house lights from 9pm to wind down for the night.”

Sometimes she takes melatonin, a sleep hormone, to supplement her winks and regulate her sleep-and-wake cycle. Natural melatonin is made by the pineal gland, a tiny organ in the brain that gets its mojo from such foods as meat, grains, fruits, and vegetables, which contain small amounts of the sleep hormone.

Melatonin levels begin to rise in the mid-to-late-evening and remain high for most of the night, but drop in the early morning hours.

Julie, a lawyer who cannot practise properly as a result of her condition and so only does policy consultancy, says she cannot keep up with a regular office job that demands clocking in at 8am and retiring at 5pm.

This is because, after gazing at a lifeless ceiling for hours on end, her melatonin kicks in towards morning, making her a horrible early-riser.

“In my previous job, I had an understanding boss who allowed me flexible hours, which meant arriving at work around 11am and leaving at my pleasure, which would see me stay at work until around 8pm or thereabouts,” Julie says.

On average, scientists say you will spend a third of your life asleep. That means that, if you are among the lucky few who will hit 90 years, you will have spent 30 years lying on a bed somewhere — the average for a 90-year-old is actually 32 years.

That may sound like a lot of time spent doing nothing, but that third of your life could actually be the one thing that keeps you sane. This is because memory and learning are consolidated while you are asleep and the heart and vascular system get a chance to rest. Also, most of the hormones and chemicals that you need daily are made and broken down during sleep cycles.

A 2006 survey by Harvard University found that, globally, more people are sleeping less than six hours a night and that sleep difficulties visit 75 per cent of us at least a few nights a week.

In another study involving Kenyans living in rural areas in 2012, researchers found that a silent epidemic of insomnia was creeping up on the nation, unnoticed and as smooth as they come.

Titled A Reason to Count Sheep: Is Sleep Deprivation a Global Driver of Metabolic Disease?, scientist Dylan Neel’s findings on sleep-related problems in African and Asian countries revealed that both developing and developed nations are in the middle of what he called, perhaps with a tinge of hyberbole, “a global sleeplessness epidemic”.

Sleep deprivation, Dylan noted, is emerging as a significant driver of obesity and diabetes and that, therefore, it is imperative that strategies aimed at improving global sleep habits be developed.

“In Vietnam, 37.6 per cent of the women and 28.5 per cent of the men reported sleep problems. Meanwhile, Tanzania, Kenya, India, and Ghana saw rates of between 4.6 per cent and 12.7 per cent. In a world where obesity rates are expected to rise to 50 per cent by 2030, now more than ever, we all have a reason to go to bed on time.”

Dylan also found out that women were twice as likely to have poor sleep compared to men as 10.8 per cent of the former in Kenya had sleep problems, compared to 3.9 per cent in the latter.

Julie is not astonished by the findings and says the results validate the fact that “Kenya is slowly becoming a sleepless nation.”

That has consultant psychiatrist Lukoye Atwoli worried because, he says, even though there is no magical number of the hours one needs to sleep, those 40 winks are an important aspect of our wellbeing.

“The body takes as much sleep as it needs, depending on the state of health and recent sleep history,” says Dr Atwoli.

However, some groups require more sleep than others, particularly children and convalescents. Whereas infants require about 16 hours of sleep, teens need about nine hours on average while adults are good to go with a range of about seven to eight hours, some scientists advise. Women in the first trimester of pregnancy also need more hours of sleep than usual.

So, what are the effects of lack of enough sleep? Scientists seeking to understand the effect of sleep deprivation subjected 10 rats to total deprivation. All of them died or were euthanised when death seemed imminent within 11 to 32 days.

According to the 1989 study by Everson C.A. and others, the rats showed a debilitated appearance, lesions on their tails and paws, and weight loss in spite of increased food intake.

“In humans, sleep deprivation causes deterioration of attention and concentration and causes irritability and other changes in mental functioning. In the long term, there will be metabolic disorders as well as problems with immunity, increasing the risk of infections,” Dr Atwoli, who is also a lecturer at Moi University’s School of Medicine, says.

Author Gayle Greene, writing in the aptly titled Insomniac, says that even though lack of sleep has been with us since we developed language techniques, we are still yet to conquer the little devil. But he has some advice for those, like Julie, who just cannot seem to get their zzzzzzzzzs together:

“A little warm milk puts you right out. A shot of whisky does the trick. Why don’t you try a hot bath? Have you tried a big plate of pasta?”
Whatever gets you to sleep... zzzzzzzzz!

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