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Sleep like a baby

Sleep like a baby

This issue focuses on sleeping well - pattern of sleep across different ages, insufficient and disturbed sleep, and the benefits of dreaming

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How to sleep well for your age

While sleep changes don’t always indicate a problem, ageing makes it difficult to recover from lost sleep

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It is often misinterpreted that as you age you are bound to have sleeping issues. This is because many adults complain of sleeping problems as they age, including insomnia, daytime sleepiness and waking up frequently during the night. However, ageing doesn’t necessarily bring sleep problems. Developing healthy sleep habits will help you get enough sleep and age gracefully and happily.

The US Department of Health and Human Services suggests that most adults need seven or more hours of good-quality sleep regularly each night to lead a happy life. However, Dr Satyanarayana Mysore, head of department, pulmonology and sleep medicine, Manipal Hospital, Bengaluru, says that it is normal that the duration of sleep reduces as we age. “It is a myth that we sleep less. Infants tend to sleep for more than ten to 14 hours, and as we keep growing, our sleeping hours are cut down naturally. It is because of various reasons that our routine changes along with the functioning of the body. The elderly do tend to sleep early and wake up early, and some may even manage with less than seven hours of sleep,” he says.

study conducted by US researchers titled Sleep and Human Aging published in Neuron says that the micro and macro-level structure of sleep such as duration of sleep stages including the quality and quantity of sleep oscillations changes as we progress into our older age. These changes in the body are seen because of the changes that occur in the body’s internal clock. The hypothalamus, a part of the brain also called the master clock is made of a group of about 20,000 nerve cells that form a structure called the suprachiasmatic nucleus or SCN which receives direct inputs from the eyes.

Another study conducted to identify age-related changes in objectively recorded sleep patterns across the human life span in healthy individuals published in the journal, Sleep, says that older adults spend a lower percentage of their sleep time in both slow-wave (aka, deep sleep) and Rapid Eye Movement (REM) sleep compared to younger adults, and the time it takes to fall asleep increases slightly as well. The number of arousals and total time awake after falling asleep also increase with age; however, older adults do not experience increased difficulty in their ability to return to sleep following arousals compared to younger adults.

Dr Mysore says that older adults who do not sleep well are more likely to suffer from depression, attention and memory problems, excessive daytime sleepiness and experience more night-time falls. “Insufficient sleep can also lead to serious health problems, including an increased risk of cardiovascular disease, diabetes, weight problems and breast cancer in women,” he points out.

Identifying the underlying sleep problem is a must and helps in overcoming many of these issues which in turn helps in improving the quality of one’s waking life. It is said that melatonin secretion is reduced in older adults and the circadian rhythm becomes weaker. Although these changes are non-pathological, sleep apnea, insomnia, circadian rhythm, sleep-wake disorders and parasomnias are more likely in older adults.

How sleep changes as one ages

According to Dr Pavan Yadav, lead consultant, interventional pulmonology and lung transplantation, Aster RV Hospital, Bengaluru, tells Happiest Health that as one ages, the body produces lower levels of growth hormone, and so older people will likely experience a decrease in slow-wave or deep sleep (an especially refreshing part of the sleep cycle). When this happens, the body produces less melatonin, meaning one will often experience more fragmented sleep and wake up more often during the night. That is the reason why many of us consider ourselves ‘light sleepers’ as we age. People may also:

  • Want to go to sleep earlier in the evening and wake up earlier in the morning.
  • Spend longer in bed at night to get the hours of sleep they need or make up the shortfall by taking a nap during the day.

In most cases, such sleep changes don’t indicate a sleep problem.

Dr Sunil Kumar K, lead and senior consultant, interventional pulmonology, Aster CMI Hospital, Bengaluru, tells Happiest Health that steps often involve focusing on improving sleep hygiene and developing habits that encourage quality sleep.

Tips for falling asleep


  • Exercise: Sleeping faster, longer and better are some of the aftereffects for older people when they exercise regularly. The National Institute on Aging offers helpful tips for exercising safely as an older person
  • Maintain a sleep schedule: Remember that ageing makes it more difficult to recover from lost sleep. Avoid sudden changes in sleep schedules. This means going to bed and waking up at the same time every day and being careful about napping too long
  • Plan a bedtime routine: One must find ways to help relax before bed. Reading a book in a quiet place like a bedroom can also help you sleep healthy
  • Moving bedroom clocks out of view: Anxiously watching the minutes tick by is a sure-fire recipe for insomnia


  • Alcohol and smoking before bed: Alcohol, tobacco, caffeine and even large meals late in the day can make sleep more challenging. Try quitting smoking, reducing caffeine intake and eating dinner at least three hours before bedtime
  • Bedroom distractions: Electronic gadgets and bright lights can affect one’s sleep
  • Exercising right before going to bed


How can older adults take a nap?

Dr Kumar lists down a few sleep tips for older adults who don’t feel fully alert during the day and suggests that a nap may provide the energy they need to perform well for the rest of the day:

Keeping it short: Naps as short as five minutes can improve alertness and certain memory processes. Most people benefit from limiting naps to 15-45 minutes. You may feel groggy and unable to concentrate after a long nap.

Nap early: Nap early in the afternoon. Napping too late in the day may disrupt your night-time sleep.

Find a comfortable place: Try to nap in a comfortable environment preferably with limited light and noise.

Reach out to a doctor

If older adults have not been successful in solving their sleep problems, they must keep a sleep diary and note down when they work out, consume alcohol, caffeine and medications as well as whether they have made any lifestyle changes. These have to be informed to the doctor. The doctor may then refer the person to a sleep specialist or cognitive behavioural therapist for further treatment, especially if insomnia is taking a heavy toll on the mood and health.

Up in the middle of night but can’t go back to sleep?

Environmental, physical and psychological factors can cause sleep deprivation. But is there something one can do to overcome it? We ask experts

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It’s quite common for some people to wake up in the middle of the night to use the restroom or drink a glass of water. But what happens over time when you develop a condition where you get up at night but find it tough to go back to sleep?

Many people develop this condition, which then invariably affects their entire lifestyle. According to a 2010 study of 8,937 people that was published in Sleep Medicine, it was estimated that about one-third of American adults wake up at night at least three times a week. Moreover, more than 40 per cent of that group may have trouble falling back to sleep again (also referred to as sleep maintenance insomnia).

Intermittent sleep is a growing problem for adults worldwide. “Individuals may not perceive intermittent sleep as an immediate threat to the well-being of their body, but if not correctly rectified, it could lead to long-term consequences,” Dr K Vinod, consultant pulmonologist, Veturi Polyclinic and Diagnostic Centre, Bengaluru, told Happiest Health.

Why do you wake up in the middle of the night?

‘Sleep quality in patients with chronic illness’, a 2016 research paper by Mary Kemple, Sinead O’Toole, and Conor O’Toole, found significant evidence that “chronically disturbed sleep can increase the disease burden on patients with chronic illness”. Therefore, irregular sleeping and any form of chronic illness are directly related to each other in a way that the existence of one condition could impact the other.

Dr Vinod says people with underlying lung conditions experience disrupted sleep. “Usually, people with sleep apnoea, who are obese or have a history of snoring, experience a recurrent awakening from sleep,” he says. “Their underlying condition compromises their sleep, restricting them from getting a peaceful sleep. Other things like taking too much stress will also lead to the same thing.”

The timing and length of waking up at night will differ from person to person. For example, some people may experience several breaks, and others may wake up for an extended period as they try to fall asleep again. Experts say restless leg syndrome, nocturia, chronic pain, anxiety and increased consumption of alcohol and caffeine are among the conditions and factors that may cause a person to develop an intermittent sleep pattern.

When you don’t get continuous sleep

Hormones also play a critically important role in ensuring good-quality sleep. Melatonin and cortisol, also called sleep hormone and stress hormone, respectively, are responsible for regulating and maintaining a steady sleep pattern. Not getting continuous sleep will cause hormonal imbalance in the body.

Conditions like sleep-disordered breathing (SDB) and sleep apnoea are linked to poor hormonal balance in the body. Dr Shantanu Tandon, senior ENT surgeon, airway and sleep apnea specialist, Sakra World Hospital, Bengaluru, describes SDB as “a common spectrum of abnormal respiration caused by upper airway obstruction, e.g., apnoeas, hypopneas, etc. Along with behavioural causes such as increased screen time in children, adenoid and tonsillar enlargement and allergies are common causes of SDB.”

Many studies have linked sleep disruptions to neurodegenerative diseases, including Parkinson’s and Alzheimer’s. It is also suggested that long-term consequences of repeated awakenings and difficulty in falling asleep can lead to weight gain, cardiovascular diseases, type 2 diabetes, etc.

When to see the doctor?

If you have been experiencing persistent intermittent sleep for a prolonged period, it is advised that you immediately consult a doctor. You should also see a sleep specialist if you have mood changes during the day, increased daytime sleepiness, loud or continuous snorting, and abnormal breathing patterns during sleep.

Several sleep specialists also recommend maintaining a sleep diary to record your sleeping pattern. It will keep track of your symptoms and aid the doctor in making a precise diagnosis of your condition. You can prevent the early onset of intermittent sleeping by implementing lifestyle changes like changing the sleeping environment, taking less stress, being physically active, following a steady routine prior to bedtime, and so on.

Health benefits of dreaming

Environmental, physical and psychological factors can cause sleep deprivation. But is there something one can do to overcome it? We ask experts

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When American author Katrina Mayer said, “Believe in your dreams, they were given to you for a reason”, she tapped into a lesser-known truth about dreams not just being a mundane by-product of sleep.  Our dreams whether vivid, hazy, nonsensical, or disturbing have not only fascinated us, but they have been a source of intrigue and subject of debate for experts over centuries.

Famed psychoanalysts, Sigmund Freud and Carl Jung saw dreams as buried forbidden desires and symbols of the unknown psychic content respectively.

According to Dr Hozefa Bhinderwala, consulting psychiatrist, at Saifee Hospital Mumbai, India, the content of a dream is something medical science doesn’t have a clear understanding of. It is believed that the creativity of the person and the various sensory inputs they get during the day is what manifests as a part of the dream. But it can be a complete mix and there may or may not be any relevance to a person’s problems.

Dreams — sign of a healthy mind

“Dreaming is a sign of a healthy mind,” says Rashida Mustafa, a clinical and psychoanalytic psychotherapist from Manchester, UK, and a member of the British Psychological Society (BPS).

It’s an alpha function that shows that a person is capable of reflecting on their experiences and composing them into a dream, she adds. “Just like how a hurting body indicates that a muscle is in pain or rising blood pressure tells people that they are angry, dreams reflect what the psyche thinks,” she says.

Empirical neuroscience research suggests that dreams are effective tools the brain uses to process information to deal with stress and trauma and aid in problem-solving as well as memory enhancement.

Research published in The Journal of Neuroscience in 2017 discovered that people who spent more time in the Rapid-Eye-Movement (REM) phase of sleep – the phase in which dreams occur – had reduced fear-related brain activity when they were given mild shocks the following day. The study indicated that getting enough REM sleep before any fearful experiences may reduce the tendency to develop post-traumatic stress disorder (PTSD) as people have an opportunity to practice their responses prior to the actual stressful situations. “The more REM, the weaker the fear-related effect,” the authors write in their paper.

Dream sleep, a healer

Mathew Walker, a scientist, and professor of neuroscience and psychology at the University of California, Berkeley, through his research on overnight therapy and the role of sleep on emotional brain processing, got more clarity on the mechanism of what happens to the brain while dreaming.

The research was published in the Psychological Bulletin in 2016. It indicated that the stress-triggering molecule, noradrenaline is absent in the brain during the REM phase of sleep and at the same time, important emotional and memory-related areas of the brain are reactivated. The research concluded that emotional memory reactivation occurs in the brain without the presence of a key stress chemical, allowing people to reprocess disturbing memories in a calmer environment. Hence boosting the ability to solve problems and process tough emotions that affect waking life.

Dreams activate memory

A 2010 study published in Current Biology reiterated the problem-solving and memory-activation functions of dreaming. During the study, 99 subjects were trained on a virtual-navigation task (A 3D virtual maze) and then retested on the same task five hours after initial training at Beth Israel Deaconess Medical Center in Boston. During the break, some of them were asked to read while others were instructed to try and take a nap. It was observed that subjects who napped the following training and dreamed about the maze, showed a remarkable improvement at solving the task as compared to those who remained awake during the retention interval.

Fatema Hakimi an 18-year-old student from SNDT University, Mumbai, had a similar experience while studying for her exams. “I wasn’t prepared for my chemistry paper and was up till late night trying to memorise the formulas,” she recalls. Incidentally, Hakimi fell asleep and remembers dreaming vaguely about the formulas.  “When I woke up after a few hours I was surprised at my ability to grasp and learn the formulas much faster than a few hours before.”

The Threat Simulation Theory by Antii Revonsuo a Finnish cognitive neuroscientist explains why most people dream of failure regarding an upcoming event important for them. The theory states that dream consciousness is essentially an ancient biological defence mechanism, evolutionarily selected for its capacity to repeatedly simulate threatening events. Threat simulation during dreaming rehearses the cognitive mechanisms required for efficient threat perception and threat avoidance. The brain responds to any potential upcoming perceived danger by initiating a sort of fire drill to deal with the threat effectively during sleep.

Sakina Khorakhiwala a 60-year-old homemaker from Surat says she has terrifying dreams on the eve of any big party or celebration at home. “In the dream, the party is about to begin, and I am totally unprepared! And to top it all I just cannot move so that I can complete the preparations. The feeling is horrible,” she says. Khorakhiwala however adds that the dream drives her into action mode the next day to ensure all the preparations are done.

Dreams revive the mind and body

When people in therapy begin to dream, we see it as a sign of mental growth, says Rashida.

Dr Bhinderwala points out that dreams, Rapid Eye Movement (REM) sleep, and the physical health of a person are interrelated.

He says, dreams can occur in all phases of sleep but only the ones in REM sleep, which is deep sleep, are remembered. So, if you know you are dreaming, it is proof that you are getting enough deep sleep and helping the body to restore itself. “More dreams mean more deep sleep and better physical health,” he says.

Why are dreams bizarre?

“When you dream, although some of your conscious cognitive faculties may be at rest, your executional functioning is not fully operative. Since the reasoning is not completely there, the dream goes from being concrete to bizarre without filtering,” says Dr Bhinderwala.

Freud suggested that the sleeping brain creates a ‘manifest dream’ which consists of everyday images, experiences, and memories. The manifest dream simplifies, reorganises and masks repressed and unconscious wishes. These suppressed and unconscious wishes constitute the ‘latent dream’. The manifest dream uses various symbols and bizarre or unusual images to conceal the latent dream, or what we are really dreaming about.

“I love dreaming!” quips Hakimi. “They transport me into an entirely different realm. I travel to places and experience things that are not a part of my real world and often wonder how boring our nights would be without them.”

Can’t get enough shut-eye?

Environmental, physical and psychological factors can cause sleep deprivation. But is there something one can do to overcome it? We ask experts

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Getting well-rested sleep is one of the most fundamental physiological needs a person must satisfy for better physical, mental and emotional well-being. Experts say that a lack of sleep can affect children and adults alike.

How much sleep does one need?

Centers for Disease Control and Prevention (CDC) recommends that an adult should ideally get at least seven hours of well-rested sleep. According to their estimation, about one in three adults are not able to achieve this. Sleep deprivation also has different patterns among children and adults.

Dr Shantanu Tandon, senior ENT surgeon, airway and sleep apnea specialist, Sakra World Hospital, Bengaluru, says, “According to various sleep data, kids between the age group of three and five should be getting ten to 13 hours of sleep a day, and six to 12-year-olds should sleep nine to 12 hours every night. But, sadly, around 25-35 percent of growing children and adolescents are sleep deprived.”

Furthermore, diagnosing sleep deprivation in children and adults is increasingly difficult due to the unique patterns. While adults convey tiredness and lack of sleep, children cannot. Adding to this, Dr Tandon says, “sleep-deprived kids are often irritable, hyperactive, forgetful and have difficulties with emotional regulation. We also see lack of attention, poor decision-making and decreased memory, all of which can affect academic achievement.”

What happens when you don’t get enough sleep?

Many researchers have also conducted extensive studies on the effect of sleep deficiency. One such research conducted by Sumi Rose and Sonumol Ramanan examines the impact of sleep deprivation on the Academic Performance and Cognitive Functions of college students.

The conclusion of the study states that academic performance and cognitive functions are poor in students who are sleep deprived.

Dr Tandon says, “Sleep deficiencies and sleep apnoea cause an effect on hormones and growth and can cause childhood obesity. Prolonged deprivation can also be associated with depression, anxiety, early-onset hypertension, and heart disease. ADHD and lack of sleep can mimic each other and confuse the diagnosis further.”

Other harmful consequences of sleep deprivation are diabetes, mood fluctuations, low alertness, poor renal function and respiratory issues.

What causes sleep deprivation?

Environmental, physical and psychological factors often play a huge role in causing sleep deprivation. Some of the common reasons that cause the occurrence of sleep deprivation are:

  • Sleeping at the wrong hours of the day
  • Not getting enough sleep
  • Sleep is disrupted/uncompleted
  • Have a pre-existing sleep disorder that causes low-quality sleep (for example, sleep apnoea)
  • Chronic pain
  • Depression
  • Bruxism
  • Substance abuse
  • Fatigue syndrome
  • Narcolepsy
  • Schizophrenia

How is it diagnosed?

Usually, doctors will ask a person multiple questions regarding his/her sleeping patterns. It will help the person get a better grip on the case for the diagnosis. Depending on the type of sleep disorder diagnosed, the doctor will provide a treatment plan. Most doctors emphasise lifestyle changes to correct sleep deprivation.

Consult a doctor

While sleeping patterns differ from person to person and are distinct for different age groups, recommendations for be that one should see a doctor in case of the following:

  • Often feels sleepy during the day
  • Don’t feel rested, refreshed or alert after waking up
  • Have trouble adjusting to a shift in work timings

Ways to fall asleep

To overcome sleep deprivation, people can follow the best way to fall asleep, generally called ‘the sleep hygiene‘ which can help them achieve a good night’s sleep.


  • Eat a small snack before bedtime if hunger disturbs the sleep
  • Low lights to be maintained one to two hours before bedtime
  • Say no to gadgets in bed
  • A warm bath or shower at least 30 minutes to one hour before sleep will help change the body temperature which could help one sleep well
  • Have a bedtime routine. Maintaining habits like brushing teeth can help
  • Have melatonin-rich foods in evening with or after dinner — eg, goji, berries, glass of warm milk


    • Heavy, spicy meals and alcohol, two to three hours before bedtime
    • Excess liquids
    • Consuming caffeine during late evenings
    • Nicotine before bedtime
    • Exercising right before going to bed

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