In our culture, hard work and achievements are appreciated, and people who say they sleep only little are often admired: after all, they have more hours in the day to dothings. Sleeping may be seen as laziness, or an extra luxury, something you can manage without. Actually, you manage for a surprisingly short period.
Think of all the gadgets we’re offered on the market today to measure and prove our efficacy: there are pedometers, heart rate monitors and such. There’s VO2, maximal oxygen uptake, a goal after goal to reach. These are all fine devices when correctly used. Our autonomous nervous system, however, has two pedals: a gas and a brake. We can only do well when these two are in balance. When the brake does not work, you end up going too fast. In layman’s terms: when you don’t sleep enough, you get stressed and sick. Quite simple but yet hard to remember sometimes.
All mechanisms of illness are not yet known but surprisingly many are. It is known, for instance, that during sleep in the night, our “sanitation mechanisms” work on full force. The amount of blood within us is re-directed, and the liver and kidneys work hard. Also, the cleaning up of the brain is activated during sleep. If the cleansing processes are disturbed, waste products start piling up. In the context of the brain, these waste products are called amyloids. When not properly washed out, they seem to be a risk factor of Alzheimer’s disease.
Everyone knows the feeling after a badly slept night: the headache disturbs concentration, and in the end you don’t feel like the sharpest pencil in the case at all. Luckily, one well-slept night fixes a lot. If sleeplessness continues, it may lead to many sorts of trouble. A low-grade inflammationoccurs as an immediate protective response of the immune system. This weakens the functioning of the immune system and may lead to disturbances in sugar metabolism, type 2 diabetes and metabolic syndrome as well as heart and vascular diseases. Also mood disorders, such as depression and bipolar disease as well as various neurodegenerative diseases and dementias seem to be connected to sleep disturbances. Furthermore, the mechanisms of sleep and pain have a lot in common, and exercise programs tend to fail if the person doesn’t get sufficient rest.
The good news is that the vicious circle can be straightened. This will take effort and re-prioritization, though. The Irish proverb knows that agood laugh and a long sleep are the best cures in the doctor’s book. If you cannot squeeze the laugh yet, try to take care of the sleeping, and the laugh will follow. Better sleep is a good means of easing and minimizing the symptoms of many chronic diseases. There is solid clinical evidence to support this statement, especially with people suffering from dementias or mood disorders. Also in rehabilitation, it has been shown that proper rest leads to better results.
Since we tend to forget the value of sleep, it is a good idea to measure it, just like we measure activity. Luckily, many sports watch manufacturers have already realized this, and there is a multitude of consumer electronics in the market to measure the amount and quality of sleep. Also in professional care, sleep needs to be given the value it deserves. For instance, the elderly tend to suffer from sleep disturbances, but they don’t necessarily have to. The quality of sleep should be one of the overall quality criteria in care homes, because the correlation with sleep to the progression of dementias and overall quality of life has been established in
numerous peer-reviewed articles. Another patient group that would benefit from the measurement of sleep are those with mood disorders, for instance depression or bipolar disease. Changes in sleep mirror changes in their condition, and may even occur before the mood changes. Also in rehabilitation, proper sleep is essential and enables better results.
When sleep is measured professionally in healthcare to support decision making, it must be done with a medical device, a product that is intended for that purpose. The manufacturer of the device must follow a relevant quality system in their development, manufacturing, marketing and service. As consumer electronics lack common quality standards, products from the shelf of the local electronics store are not lawfully applicable to professional use. There is just too much variance in the quality and precision of those devices.
In professional use, the gold standard of measuring sleep is polysomnography, which is based on EEG. The method is precise but requires a set of somewhat clumsy sensors. Therefore, it is only applicable for specialized use in sleep laboratories. Actigraphy is considered the second most reliable method for measuring the quality and quantity of sleep. It is continuous, simple and robust, and therefore commonly used outside the lab, also for long periods. Actigraphy is also widely researched, and its correlation to polysomnography has been proven sufficient.
Actigraphy has a lot of potential in healthcare, in applications where professionals want to know how their patients sleep.