Tuesday, 10 May 2022 - Framed around the effects of fast-paced changes and their related challenges on “live-work-play” trends, Active Health’s latest series of webinars feature key industry experts and thought leaders as they navigate trending topics to harness health and wellness in building a high performing individual. This webinar, part of a monthly series, focused on sleep. The engaging panel discussion featured Dr Leow Leong Chai, Director of the Singapore General Hospital Sleep Centre; Ms Thian Ai Ling, General Manager of My First Skool; and Dr Julian Lim, Assistant Professor in the Yong Yoo Lin School of Medicine. During the session, the panelists discussed how sleep affects you and your body.
As a sleep specialist, Dr Leow defined good sleep as sleep that is well consolidated. That means that one’s brain waves are cycling through the different stages of sleep (light, deep or Rapid Eye Movement (REM) - on average, a typical person goes through three to four of such cycles every night with minimal or no interruption.
Poor sleep is characterized by fragmented sleep- predominantly light sleep, with very little or even no deep sleep and REM sleep. Dr Leow revealed that this can often be caused by medical conditions like sleep apnea. The inability to enter deep sleep or REM sleep, no matter the sleep duration, makes the victim wake up in the morning still feeling tired or washed out. It is pivotal that one gets the condition(s) treated in order to enjoy quality sleep.
A major symptom of sleep apnea is loud snoring (audible one room away, with the door closed), with some even snoring loud enough that it wakes them up. Dr Leow also shared how many patients with sleep apnea also suffer from high blood pressure. Interestingly, the other symptoms of sleep apnea can occur differently for the two genders. Women, for example, can often attribute insomnia to untreated sleep apnea. Men suffering from this condition typically complain of lethargy and frequent passing of urine at night.
The second most common sleep disorder that Dr Leow observed was insomnia - which refers to one finding it hard to fall and/or stay asleep. He shared that there is primary insomnia, where there is no underlying medical cause; and secondary insomnia, where it is caused by external factors.
Insufficient sleep, i.e. sleeping for less than 6 hours a night, had repeatedly been shown to be associated with reduced lifespans, or in other words, increased mortality rates. People with severe sleep apnea, if left untreated, are two to three times more likely to suffer from heart attacks, stroke, and heart failure.
Recent data even showed that a lack of deep sleep is associated with an increased risk of dementia! He explained that it is possible because deep sleep is the most restorative part of sleep. Current evidence suggests that it is in deep sleep that the brain performs this cleansing function to get rid of the waste products in the brain.
On common perceptions, Dr Leow acknowledged that some might claim that drinking before bed helps them fall asleep at night. He noted that alcohol does help one to fall asleep easier, but it comes with a caveat. As the body breaks down the alcohol, the resultant byproduct tends to interfere with sleep, leaving the drinker with poorer quality sleep, especially if he/she drank too much before bed.
Ms Thian highlighted the importance of having a well-balanced life through exercise, sleep, and nutrition. She emphasized the need for self-discipline and making an intentional effort to dedicate time to these necessary factors.
Ms Thian affirmed that the current lifestyle and busy schedules mean that one would often have to make difficult choices, such as deciding whether to finish outstanding work over having sufficient sleep. Despite her commitments, Ms Thian made it a point to go to bed at a fixed time so that her body is accustomed to a proper sleep cycle.
In her capacity as a leader, Ms Thian also believed that it was important for her colleagues and staff to be sleeping well. The course of the pandemic had been stressful for everyone, so she focused more on the inculcation of a positive mindset. In that regard, her staff embraced the mindset of finding beauty in imperfection. She elaborated that if one is able to end the day on a positive note, it increased the likelihood of better sleep quality.
Moreover, Ms Thian made it a point to participate in physical activities like slow jogging and tennis at least twice a week to achieve a balance between staying active while on a largely sedentary work schedule.
Ms Thian shared that children are losing 90 seconds of sleep year on year. Cumulatively, this means that children are currently sleeping two hours less than their counterparts many decades ago! While acknowledging that children now have access to better nutrition, she also pointed out that it was unlikely that it would have made up for the sleep deficit. Thus, building healthy habits from a young age becomes especially crucial. Cooperation with parents and educators to set up good sleep hygiene practices for our young children is key.
She believed that routine is essential for young children- Even if confined to the house during the pandemic, Ms Thian made sure that they followed a predetermined schedule. Ideally, the family has a shared schedule which allows all family members to wind down and head to bed collectively. However, she also understood that such a scenario could be tough since some parents might not be ready to sleep due to their commitments. As an alternative, Ms Thian advised these parents to establish a routine where the children are accustomed to going to bed on their own at a fixed time. It could be something as simple as brushing your teeth every evening or listening to soft music as a cue for them to go to bed.
Ms Thian shared an initiative at My First Skool, whereby they introduced bedtime reading during the pandemic for parents and children. These reading sessions were delivered at 8pm every weekday. The session served as a cue to prepare the children for sleep.
Apart from routines, Ms Thian also suggested looking at the child’s environment as it plays a role in influencing behaviour change and the adoption of healthy habits. A noisy room with a TV and other digital/smart devices was more likely to be a distraction, which reduces the possibility of better sleep quality.
Echoing Ms Thian’s sentiments, Dr Lim observed that- disappointingly, but perhaps not too surprisingly- a lot of children are giving up sleep time to satisfy their academic commitments. For the purposes of learning, he exclaimed that giving up sleep to study is actually a self-defeating endeavour since it was unlikely that the children would not be retaining the information well. He urged for more education for parents and children on the importance of quality sleep to correct this misconception.
Concurring with Ms Thian as well, Dr Leow noted that the symptoms of sleep deprivation aren’t too dissimilar between children and adults. He debunked the myth that the need for sleep declines with age. While our seniors don’t sleep as well at night, they still need about the same amount of sleep as regular adults. What actually happens is that, as one ages, his/her circadian rhythm deteriorates. As a result, the elderly “catch up” on their sleep by having more frequent naps in the day.
On the flip side, children do need a lot more sleep. Newborns, for example, spend most of their time asleep (REM sleep). Dr Leow theorized that it could be due to their brain needing the dreaming time to form neuro-connections, learn about the environment, or process new things. Thus, it is very important for children to get adequate amounts of sleep.
Just as sleep is important for young children, so is it for adults. Yet, adults face a common barrier which may hinder optimal sleep quality- stress. Stress has a really intimate relationship with sleep. Dr Lim dubbed stress as the “enemy” of sleep. Defining stress as the response to threats, he explained that the triggering of one’s fight or flight response mobilizes the body’s resources to be able to cope with threats. Conversely, sleep is the polar opposite of stress- the body intends to wind down to have some rest.
Dr Lim pointed out that a common misconception was that many often thought they could compartmentalize their stress from the daytime and pack it away at night. Yet, the reality could not be further from the truth. Study findings had strongly suggested that if there were unprocessed thoughts or feelings across the day, or if one was anticipating an event for the following day, it was associated with a negative effect on sleep quality. To manage stress and receive better sleep, Dr Lim advised against looking at the day and night as two separate entities. The ability to manage stress over the daytime is a key to sleeping well at night.
A member of the audience sought clarity on how to snap out of the mentality of delaying sleep to have some “me-time” after work and/or family commitments. To that, Dr Lim remarked that it is about understanding why you are prioritizing the things that you do. If people realize that there is a value to sleep, it may help them reevaluate their priorities.
He suggested approaching the issue like how one would approach exercise - no one is going to hit the gym on a regular basis unless they really understand the long term goals and purposes of why they are doing it. Similarly, by reframing the hours of sleep as a necessary part of maintaining or improving one’s physical health and/or development, one would naturally start prioritizing sleep.
Dr Lim shared that his research has explored mindfulness as a tool to manage stress. The concept of mindfulness comes from ancient Buddhist practices. In the 1970s, American professor Jon Kabat-Zinn sought to adapt some of these oriental principles and ideas into Western secular medicine. He found that his method was quite effective on the chronically ill patients that were not responding well to traditional treatment.
Mindfulness is akin to taking oneself off autopilot mode. An analogy that Dr Lim shared was to think of someone standing on the train platform and observing the trains passing by. The trains represent one’s thoughts. The person on the platform has a choice - either get on the train and get carried away by possible anxiety, or stay on the platform and just watch it roll along. This analogy showed how mindfulness allowed people to be present in the moment by choosing how to respond to thoughts and events around them.
One practical piece of advice Dr Lim suggested was having short timeouts - if people realised that they are getting into a stressful situation or sensed themselves getting worked up, they should take the time to learn and recognise those moments, and take a short pause before choosing how to respond.
It is important to avoid using electronic devices before bedtime - Dr Leow suggested switching off all the electronic devices two hours before going to sleep. The blue light that these appliances emit interferes with the brain, tricking it into thinking that it is still daytime. This causes the release of melatonin, the hormone that induces drowsiness, to be suppressed.
Conversely, it is very important for all of us to expose ourselves to bright light for at least half an hour (ideally outdoors) in the morning to aid in our circadian rhythm. Sadly, there are no shortcuts to quality sleep. There is no running from the amount of sleep that one needs to be properly rested.
Spend some time reflecting on the duration and quality of your sleep, then take it one step further if it isn’t good to figure out the cause and solution. Better beats perfect!
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