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What happens to your body when you are asleep?

A tired man who did not wake up when someone drew a mustache on his face! (Ulrik Tofte)
A tired man who did not wake up when someone drew a mustache on his face! (Ulrik Tofte)

Going to bed and falling asleep is a gradual progression of stages in which body and brain activity changes. Scientists have been studying this for many years. Besides brain activity, sleep researchers study eye movements and muscle tension to observe a person falling asleep.

During sleep there is reduced or absent consciousness, relatively suspended sensory activity, and inactivity of nearly all voluntary muscles. Our body goes into anabolic state when tissues found within the human body obtain energy for growth and maintenance of our immune and other systems. Anabolism requires energy to occur. Sleep is often thought to help conserve energy, but actually decreases metabolism by only about five to ten percent.

The purposes and mechanisms of sleep are only partially clear and are the subject of intense research. But here is what we know:

1. A night’s sleep has a typical pattern. It is broadly divided into two categories: Non-Rapid Eye Movement or NREM sleep which has four stages (N1 to N4) and Rapid Eye Movement or REM sleep.

2. Sleep proceeds in cycles of NREM and REM, the order normally being N1 → N2 → N3/4 → N2 → REM.

3. Each sleep cycle lasts from 90 to 110 minutes on average. Each stage may have a distinct physiological function. During an eight-hour-sleep, we go through NREM to REM cycle four to six times.

Are you confused? You are not alone. Stay awake and I will tell you more.

First, we undergo NREM sleep, which takes up 75 per cent of sleep time.

Stage 1 finds us dozing off, with our brain waves and muscle activity slowing down. This is light sleep. When woken during Stage 1 and asked if they were asleep, about 80 percent of people will say they were not.

Stage 2, this is an actual moment when you are asleep. Usually comprising about half of sleep time. There are calmer brain wave pattern and no eye movements. Breathing slows and body temperature drops slightly. A person loses touch with his surroundings but can easily be shaken awake.

By Stages 3 and 4, a person is in deep sleep and takes a bit to be woken. Breathing slows even more into a rhythm. Blood pressure and body temperature drop and muscles relax. These two similar stages are called “slow wave sleep,” with the slowest of all brain waves. Much of the body’s regenerative work, like protein building and hormone release, happens at this stage.

Then comes REM sleep. which is dream-heavy period. About 90 minutes after falling asleep, REM sets in. This is the slow wave sleep that is very close to being awake, with brain waves of the same speed or even faster. Most but not all dreams occur in this phase.

There is rapid heart bit, blood pressure rises, eyes move around and breathing becomes rapid and shallow. The body is more or less paralyzed; arm, leg and facial muscles might twitch, but the body won’t move. REM can last from five to 30 minutes.

After REM, NREM starts again. Almost every two hours we go through the whole cycle. As the night progresses, the time spent in REM increases and deep sleep decreases so that when your morning alarm goes off, it’s almost all Stage 1, Stage 2 and REM sleep.

Enough for today? There is a lot to absorb and sleep over. More about sleep next week.

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My New Year’s Resolution: Get enough sleep!

A woman sleeping in bed with an eye mask. (Brand X Pictures)
A woman sleeping in bed with an eye mask. (Brand X Pictures)

Sleeping well is important to our health. Sleeping enough is even more important. As we continue to live a faster and more competitive lifestyle, it is becoming difficult to get enough rest and sleep.

It is estimated that one in six adults report getting less than six hours of sleep nightly. This is related to too much work, stress, caffeine, nicotine, alcohol, 24-hour cable TV, the Internet and email.

A report in the Globe and Mail says that nearly eight in 10 married couples say their partner has a sleep problem, like snoring, insomnia, or incessant tossing and turning. A quarter say sleep difficulties force their mate into separate sleeping quarters. More than 20 per cent say they’re too sleepy for sex.

According to a large British study released some time ago, people who do not get enough sleep are more than twice as likely to die of heart disease. Researchers said lack of sleep appeared to be linked to increased blood pressure which raises the risk of heart attacks and stroke. Diabetes and obesity have also been linked with chronic sleep loss.

Not getting enough sleep can lead to impaired memory and thought processes, depression and decreased immune response, poor work performance, driving accidents, relationship problems, and mood problems like anger and depression. People who are tired and sleepy tend to eat more to stay awake and hence put on weight. They smoke more, drink more coffee and alcohol.

That is a long list of problems. We can avoid all that by sleeping well and sleeping enough.

Infants usually require about 16-18 hours of sleep per day, while teenagers need about 9 hours per day on average. Most adults need about seven to eight hours of sleep per day. The British researchers say that consistently sleeping around seven hours per night is optimal for health. When we sleep, the body rests and restores its energy levels. A good night’s sleep will help us cope with stress, solve problems and recover from illness.

The quality of sleep we get is as important as the quantity. Each morning, after seven to eight hours of sleep we feel tired then it is a sign of poor quality sleep. If this is a chronic problem then you may be suffering from a sleep disorder which requires investigation and treatment. Your doctor can help you by referring you to a sleep clinic.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!

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Be Safe, Do Not Drink and Drive

Alcoholic drink and car keys. (iStockphoto)
Alcoholic drink and car keys. (iStockphoto)

Drivers, here is a recipe for disaster: drugs, alcohol, not wearing a seat belt and speeding.

The highest rate of impaired driving is amongst young drivers aged 19 to 24. This accounts for 56 per cent of all reported criminal incidents.

The rate of impaired driving is at its worse at age 21 and relatively constant for 25 to 44 year olds. Seniors aged 65 years and older have the lowest rates. Statistics show impaired driving was a factor in almost 50 per cent of all incidents causing death.

Here are some other statistics:

-Every 22 minutes someone dies in an alcohol-related motor vehicle accident.

-There is a 200 per cent chance that you or someone in your family will either cause, or be an innocent victim to, a drunk driving accident.

-A lot of young people (15 to 24 ages) are dying before they get old. These are tragic, meaningless deaths.

-In a single year, 522 children under the age of 14 were arrested for driving while intoxicated, (113 of them were under 10 years old).

Driving under the influence of alcohol is the single risk factor for motor-vehicle-related incidents and injury. It is about time we crack down on irresponsible teenagers and adults who drink and drive. Alberta is now in tune with B.C., Ontario and six other provinces in passing laws which will lower the legal limit for blood-alcohol concentration from 0.08 to 0.05 per cent.

If you are caught drunk driving then you may pay a steep fine, lose your license and have your car impounded – all before you set foot in court. So, be warned.

The new legislation in Alberta soon after four teens were killed by an alleged drunk driver just south of Grande Prairie. A 21-year-old Grande Prairie, Alta., man was to face a slew of alcohol-related charges in a devastating crash that left four teens dead and one in serious condition. Matthew Deller, 16, Vincent Stover, 16, Walter Borden-Wilkens, 15, and Tanner Hildebrand, 15, all of Grande Prairie, were killed.
Speeding and not wearing a seat belt are other causes of fatalities on our roads. Again the majority of culprits are kids in their 20s or younger. Six months ago, citing a lack of evidence, cops in Calgary released a 21-year-old driver involved in a high-speed rollover that killed his younger brother and girlfriend.

The original charge included impaired driving. The crash happened shortly before midnight on a Sunday on Stoney Trail at McKnight Blvd. N.E. Two of the five people on board, the driver’s 16-year-old girlfriend and his 20-year-old brother, were not wearing seatbelts and were thrown from the car. They were taken to hospital where both later died.

Few months ago, the town of Magrath, Alta. was in mourning after four teens were killed in a horrific crash on a Sunday. The four – Clay Card, 16, Renzo Dainard, 16, Danae Gough, 14, and Jorden Miller 14 – were in a vehicle that left the road east of Magrath, about 240 km southwest of Calgary, landing upside down and partially submerged in a creek. According to the local Mounties, speed and driver inexperience probably caused the crash.

The holiday season is here. Drinking and partying is part of the Christmas and New Year celebrations. If you drink then don’t drive. If the party is in a hotel then book a room and stay there. Otherwise, take a cab or have somebody (who is not drinking) to drive you home. Wear a seat belt and do not speed.

Have a wonderful, safe Christmas and holiday season and Happy New Year. This column will return in January, 2012.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!

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Four Most Dangerous Groups of Drugs for Seniors

Pharmacist and a senior. (Jupiterimages)
Pharmacist and a senior. (Jupiterimages)

As we get older, our health tends to deteriorate. We need medications to control these adverse changes. Also there is a price to pay in old age if we did not take care of ourselves when we were younger.

A recent study published in the New England Journal of Medicine says that 40 percent of people over 65 take five to nine medications every day. What this means is that hospitalizations for accidental overdoses and adverse side effects are likely to increase among this group.

The study found that every year, about 100,000 people in the United States over age 65 are taken to hospitals for adverse reactions to medications. Most of the patients are there because of accidental overdoses. Sometimes the amount of medication prescribed for them had a more powerful effect than intended.

The four most common groups of medications putting seniors in hospitals are: warfarin, insulin injections, antiplatelet drugs to thin the blood and oral diabetes drugs.

Warfarin accounts for the most visits due to adverse drug reaction. It accounted for 33 percent of emergency hospital visits. Warfarin (Coumadin) is an anticoagulant – popularly referred to as a “blood thinner.” In reality, it does not make the viscosity of the blood thin. What it does is that it acts on the liver to decrease the quantity of a few key proteins in blood that allow blood to clot.

It was initially marketed as a pesticide against rats and mice. Later it was found to be effective and relatively safe for preventing blood clots in humans. It was approved for use as a medication in the early 1950s and now it is the most widely prescribed oral “blood thinner” drug in North America.

Insulin injections were next on the list, accounting for 14 percent of emergency visits. Insulin is a hormone central to regulating carbohydrate and fat metabolism in the body.

Insulin causes cells in the liver, muscle, and fat tissue to take up glucose from the blood, storing it as glycogen in the liver and muscle. When control of insulin levels fails, diabetes mellitus will result. Patients with type 1 diabetes depend on insulin injections.

Antiplatelet drugs like aspirin, clopidogrel (Plavix) and others that help prevent blood clotting were involved in 13 percent of emergency visits. An antiplatelet drug is a member of a class of pharmaceuticals that decrease platelet aggregations and inhibit clot formation. They are effective in the arterial circulation, where “blood thinners” have little effect.

Lastly, diabetes drugs taken by mouth, called oral hypoglycemic agents, which were implicated in 11 percent of hospitalizations. Anti-diabetic medications treat diabetes mellitus by lowering glucose levels in the blood. There are different classes of anti-diabetic drugs, and their selection depends on the nature of the diabetes, age and situation of the person, as well as other factors.

Why do these four groups of medications cause problems?
-the line between an effective dose and a hazardous one is thin.
-they can be difficult to use.
-some require blood testing to adjust their doses.
-blood sugar can be notoriously hard to control.
-warfarin can interact with many other drugs and foods.

The authors of the article say that in order to reduce the number of emergency hospitalizations in older adults we should focus on improving the safety of this small group of blood thinners and diabetes medications, rather than by trying to stop the use of drugs typically thought of as risky for this group. And patients should work with their physicians and pharmacies to make sure they get appropriate testing and are taking the appropriate doses.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!