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Sleep – A FAQ

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Do we really need to be making sleep such a priority? Is it really all its cracked up to be?

From scientific studies, we know that our body and mind need an average of about seven to eight hours of sleep. However, sleep is not something we can control but good sleep habits or sleep hygiene is something we can cultivate. Ironically, if we were to put sleep as a priority and harp on it all the time, we then become anxious about sleeping and this may in turn result in difficulties initiating sleep.

What is a piece of sleep research the expert finds to be hugely important, and are there any studies that she or he is sceptical about?

Studies have shown that poor sleep leads to poor quality of life (Evaluation of severe insomnia in the general population: results of a European multinational survey. Chevalier H, et al Journal of Psychopharmacol. 1999;13(4 Suppl 1):S21-4.) and can lead to clinical depression (Am J Epidemiol. 1997 Jul 15;146(2):105-14. Insomnia in young men and subsequent depression. The Johns Hopkins Precursors Study. Chang PP1, Ford DE, Mead LA, Cooper-Patrick L, Klag MJ.)

While I am not skeptical about the studies per se, many studies that showed associations between short sleep duration and increased mortality have been misinterpreted in the media as being conclusive evidences. The research in this area is hardly conclusive and should be interpreted carefully. These media reports, particularly those that went viral on social media, has lead to a hysteria of sorts in individuals who may not sleep up to seven hours or have occasional insomnia, causing them to be anxious and resulting in a self fulfilling prophecy leading to more severe insomnia.

What is the science behind a good night’s sleep and why it is so important?

Sleep plays an important part in both our physical and mental well being. Sleeping is first and foremost the most natural and primitive way of resting which helps the restorative processes for our brains and bodies. Certain hormones in the body are secreted only during sleep and our body reacts to certain hormones differently during sleep. These help with a variety of physiological changes and helps with growth in children, regulation of blood sugar level and keeping our immune system healthy.

We have known for a long time that poor sleep leads to daytime sleepiness and poor concentration leading to poor daytime performance. Later studies shows a relationship between poor sleep and increased risk of obesity, heart disease, high blood pressure, diabetes, and stroke. Poor sleep is also associated with poorer learning abilities, irritation and aggression, and depression.

Why is sleep such a big thing all of a sudden in Singapore – is it just a phase, or is there a reason that you know of behind it?

Sleep has been a big issue all along. Many people afflicted with insomnia have suffered in silence for a long time. However, with information becoming more readily available online and news going viral online, the fact that something we do every night has been neglected and can affect our life in such a big way may come as a huge surprise to many. It is important however to be aware that while we should maintain good sleep hygiene, fretting over sleep will just lead to more anxiety and poorer sleep!

Insomnia – FAQs

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What are the main causes for the low quantity/quality sleep in Singapore? Do some of the factors include the use of technology and psychological problems?
This may differ in different age group.

In teens and youth, it is a natural phenomenon that they tend to sleep later, ie. past midnight. However, they are still expected to wake up early for school resulting in inadequate amount of sleep. They also tend to be on their computers and mobile devices late into the night, further affecting sleep.

For adults in Singapore, it is not uncommon to have less than 7 hours of sleep due to work commitment.

For insomnia, where sleep disturbances are more severe and have disrupted daily functioning, there are usually other psychological or medical issues affecting the sleep 90% of the time. These may be depressive disorders, anxiety disorders or physical pain affecting sleep.

Ironically, in many cases I have treated, the poor sleep is perpetuated by anxiety after the sufferers read on the internet and social media about the consequences of poor sleep, whereas in the past they may have just ignored it and recovered spontaneously.

Has there been an increase in the number of sleep deprivation/insomniac cases? Please provide some statistics to back this up.

There are no studies with regards to an increase in prevalence or cases. However, according to market research, people are spending more for sleeping aids and sleep medications.

In my clinic, there is a general trend for many to become more worried about sleeplessness and to come forward for treatment. This may in fact be due to social media propagation about the consequences of insomnia.

(People in Singapore have so far spent S$1.3 million on sleep aids in 2016 – up from S$1 million in 2011 – according to data from market research firm Euromonitor. These aids include prescribed Western medication, herbal remedies and melatonin products, among others.

What are some of the consequences of low quality/quantity of sleep?

Most of the time, a few days of poor sleep is not related to any long term problems and it is best that individuals leave it be and not be anxious about it to avoid perpetuating the sleep difficulties. Chronic poor sleep and sleep deprivation is associated with physical consequences like obesity in adults and children, diabetes and impaired glucose tolerance, cardiovascular disease and hypertension (high blood pressure). Risks of psychological conditions are increased like Anxiety Disorders, and Depressed mood. Many turn to alcohol use and this may lead to abuse and addiction issues.

Case Studies

Case 1
Mr X is a 23 year old man in University. He keeps awake until 2am to study everyday prior to his exams. After his exams, he realized he could not fall asleep when he tries to sleep at 12am and would watch YouTube or surf the web on his mobile phone in bed. Eventually, he would stay up until 5am in the morning.

Mr X was educated about sleep hygiene (keeping to regular sleep hours and not using devices too late and in bed) and given short term sleeping pills to help a proper sleep cycle. He recovered after two weeks.

Case 2
Mrs G is a middle age lady who has been stressed up with her business. She stayed up at night worrying in bed. As her sleep deteriorated, she read about the consequences of poor sleep on the internet. She became even more anxious and her sleep further worsened. After two months, she started feeling depressed over the situation, lost interest in the things around her, had no energy and felt that life was meaningless.

She was diagnosed with a Depressive Episode with Anxious Distress secondary to her Insomnia. She was treated with an antidepressant and short term sleeping pills. Her mood and sleep recovered in two months and eventually went off all medications following after another half a year.

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