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Bruna Castelo Branco | Photo: Raul Spinbade | Ag. A TARDE
There are countless tips that people who say they can not get a good night's sleep drink a glbad of chamomile, avoid coffee, do night readings, go to the gym on evening. take a tranquilizer, pray … But, as you can imagine, not everyone works or does not do good to health – some even have the opposite effect. Respirologist Andrea Barral of the Cardiopulmonary Institute, a specialist in sleep medicine, explains that sleep disorders are numerous and fall into six main groups: those who sleep very little (insomniacs, for example), those who sleep a lot; those who suffer from sleep disordered breathing those whose cycles are altered, that is to say, who have circadian rhythm problems (that shiftworkers may have); those who move at night (who has bruxism, for example); and parbadonias, that is, typical age group disorders. Only insomnia, one of the best known, affects about 73 million Brazilians – and this number is only increasing. The elderly are the most affected: today, 46% of them are diagnosed. "Every case is a case, but today we have a more hectic routine, a lot of stress, more anxiety, more distractions, a computer, a tablet, these screens," she says. The doctor often talks about sleeping sickness, sleeping habits and tips for better nights.
At present, 73 million Brazilians suffer from insomnia. What characterizes this disorder?
Insomnia is actually one of the leading sleep disorders, the most common. Next is the best known, which is apnea. As for insomnia, he has a job announcing that about 40% of the population is complaining. There are several types: difficulty sleeping, maintaining sleep or fragmentation of sleep, and early awakening badociated with the feeling that sleep does not heal. It is extremely badociated with anxiety, depression, daily stress, the routine we follow with irregular schedules. It is important that the person has discipline and regularity in his sleep. Sleeping and waking more or less at the same time is better for the body. And this person, in the hectic life that we have, works day, afternoon, always at night, sleeps late certain days, keeps this irregularity. And this can also be a factor, especially for shift workers.
There is research that indicates that the brightness of the mobile phone's screen, especially if it is used just before going to bed, disturbs sleep. Is this the reason why the number of people with sleep disorders has increased?
This is what we call another group of sleep disorders, namely disruption of the circadian rhythm. An example: if the person sleeps around 10pm and gets up at 6pm, a young adult needs 8 hours of sleep. For sleep, we produce our own sleep hormone, melatonin, which is released in total darkness. So, as long as there is a visual stimulus, a television, a mobile phone, a tablet, a computer, any visual stimulus, this will delay the release of the sleep hormone. Melatonin will only start to be released in the dark. For this teenager, this child, any person who lies down and who has a television in the bedroom, which lies down with his cellphone, this stimulus delays the release of the sleep hormone and eventually delays the sleep time. We call this the sleep phase delay. If this person was allowed to wake up later, for example, if she was delayed for two hours and instead of sleeping at 10 pm, she was sleeping at midnight, the idea was that she could, instead of getting up at 18 hours, get up at 20 hours. . But this is not allowed by social problems, school, work … So, the person delays his sleep and reduces the number of hours of sleep, which means that it is a sleep deprivation. And that becomes chronic. The big problem today is partial sleep deprivation, but chronically. And this generates diurnal consequences. The main consequence is that you feel excessive sleepiness during the day.
So, is there a light, not just the cell phone?
Yes, a visual stimulus. The fact is that the person thinks that it puts in this way a darker screen in the cellular, more orange, and is free of this effect. But no, it has the stimulus. The campaign for World Sleep Day 2017 was specifically aimed at adolescents. The big problem is that the teenager has access to mobile phones, tablets, all these screens and sleeps less and less. Work has already shown that teenagers of the same age group sleep today almost an hour younger than ten years ago. And there, it can worsen at school because of the deficit of the attention, a handicap of learning finally
In addition, 46% of the elderly suffer from insomnia in Brazil. Is there a link between the disorder and aging?
The number of hours of sleep varies according to the age group. A newborn can sleep about 16 hours a day. A fragmented sleep, in which he wakes up, sleeps, eats, but, in summary, he can arrive at 16h. This number decreases throughout life and decreases further with age. We do not expect an 80-year-old man to sleep 8 hours as a young adult. It is 6am, 7am. And what happens is that these hours are counted within 24 hours of the day. So, if you choose an 80-year-old man who should have 6 hours of sleep but who does not work, does not participate in any activity and sleeps the day, he is already stealing the hours of the night. If he sleeps 1am, 1am in the afternoon, there are already two less. There are only 4 hours left for the night. In fact, it must be determined whether it really is insomnia or an irregularity of the sleep cycle. It takes a very specific questionnaire for the age group to define what it is.
Sometimes non-specialists indicate a cure and do not identify the cause.
of drugs
Andrea Barral
A Datafolha survey also indicates that the number of elderly people with sleep disorders has increased in recent years. In 2008, 68% of them reported having slept well or very well. In 2017, this number dropped to 54%. During the same period, the number of those who rated the quality of sleep as bad and bad also increased: it was 10% to 15%. What do you attribute these statistics to?
There are several reasons. If we go to bed, as I said, it can be related to anxiety, stress, depression. If you think about apnea, the increase in obesity, which is one of the main causes of the disorder, helps to increase the prevalence of this disease. If we take previous studies, the prevalence of apnea was about 3% or 4% in the 80s. It now reaches about 33% in the city of São Paulo – where the Study was carried out. There was a big increase. In addition to obesity, rhinitis and other respiratory allergies also contribute to it.
The same research indicates that women suffer more from sleep disorders. The complaints of bad or bad sleep are up to 50% higher than those of men. Is it a gender issue?
It depends on the sleep pathology you are talking about. If you talk about apnea, no, in women, the prevalence is lower than that of men. Men snore more than women because they are protected by female hormones. There are studies comparing premenopausal and postmenopausal women. Postmenopausal women begin to snore more and are more likely to suffer from apnea following a drop in female hormones. So, if you're talking about sleep disorder, it varies. Outside of apnea, the prevalence is higher among men.
It also seems that low-income people have more sleep problems. What is the link between income and sleep disorders?
When you talk about income, you talk more about a climate conducive to sleep, which contributes to quality sleep. A suitable and comfortable room, where there are not many people who sleep in the same environment, each child must sleep in his room, according to the age group … I think that this difference is due to the lack appropriate environment. account of work shift, reducing the number of hours of sleep. He also has food, we know that we should not eat a hearty meal at night, it must be lighter.
Some experts say that we are facing an epidemic of sleeping pills. Do you agree?
So many people sometimes think that it's easier to use the remedy. But it is much more effective for the person to change their sleep routine and improve their environment. Which is a bit harder because you have to change your life routine. Doing physical activity is important, but you have to do it during the day. Have a proper sleep environment, a comfortable room with a dim light, do not take the cell phone, do not watch TV … create new routines. So, if a person has a complaint of insomnia, you do a questionnaire and you will see. So, the sleep doctor is important, you go to the specialist who will know what can be the cause of this difficulty to sleep, who will try to solve the problem without needing the drug. Sometimes there are non-specialists who indicate the remedy and do not identify the cause of the disorder. And then, the patient will have a chronic need for medication. But if, in fact, the specialist tries to do everything and does not find the reason, then, after completely changing the routine, we can use the drug.
Physiologically, does the drug give you a more restful sleep?
It depends on the medicine. There are drugs that can be used, but there are others, blackjack, which are remedies that affect the quality of sleep. "
Several studies show that cardiovascular diseases, such as hypertension, are badociated with snoring and apnea [19659014] Andrea Barral
In general, society already knows the main features of insomnia. Therefore, it should be easier for the patient to notice the symptoms and to get help. There are also serious disorders, but the difficulty of perceiving the problem is poorly diagnosed?
In sleep medicine we have six major groups of disorders. The first, say, is insomnia. The second group would be the opposite of insomnia, hypersomnia. There are sleep disorders in which the person sleeps too much. It should be studied too. The third group is respiratory sleep disorders. Apnea is in this group, hypoventilation of sleep … The fourth group is that of circadian rhythm disorders. Change sleep cycles, delay phases, time difference, pin changes. The fifth is movement disorders. He has bruxism, which is the grinding of teeth, patients who have periodic leg movements or restless leg syndrome, movements that can disrupt the quality of sleep. And the sixth would be parasomnias, which vary with the age group. In children, there is night terror, awakening confused, sleepwalking, sleep asleep. In the elderly may have a paradoxical sleep behavior disorder (rapid eye movement, dream sleep). It is when the person dreams and realizes the movements of the dream because the musculature was not relaxed. The person can be hurt, bang an arm and fall out of bed. And many end up being underreported. The person sometimes says, "This snoring is normal." Snoring is not normal. Snoring is a sign that something is wrong with breathing. Talking about sleeping is not normal either. Move your legs too much, hit your legs. Often, a clinician with a clearer vision identifies the problem and directs a sleep physician. When the patient is already going to the specialist, it is because someone who has transferred or who has read it, has heard about it. Often people think that talking, sitting in bed, sleeping, moving a lot, does not have a big problem. Since people do not know much about it, it sometimes goes unnoticed. Very common is snoring. Many people arrive saying, "Oh, I'm not snoring" or you think that snoring is normal, but the roommate ends up directing the cardiologist. Several studies show that cardiovascular diseases, such as hypertension, are badociated with snoring and apnea. We know that the person with severe and untreated sleep apnea can develop heart problems. Among them, hypertension. The cardiologist sees that hypertension is difficult to control and ends up asking about sleep. When identifying, send to the specialist.
In 2017, the Sociedade Brasileira do Sono wrote a manifesto about the start time of clbades in schools. The recommendation is that they start at 8:30 pm, and not at 7:00 pm, as is the case in Brazil today. The fact that we still do not follow this pattern could be linked to the increase of diseases such as anxiety and depression among teenagers of school age?
The Brazilian Sleep Society suggests that schools start a little later, as children, especially adolescents, have difficulty getting up early. But the idea was never to start later. From the moment the child has the opportunity to get up later because clbades start later, if she has no guidance and control, she also has time to start sleeping, maybe that she will be more free to sleep later, which will not solve any problem. The goal of back to school is to increase the number of hours of sleep. This manifesto was presented with the objective of maintaining an ideal number of sleep for each age group and not to delay further sleep, which would be useless. There is also this problem of logistics in public schools in Brazil. In the United States, courses start later, but they are full-time, they go until 15h, 16h. But here we have two rounds. So, how would that be done? And, yes, sleep deprivation is related to increased anxiety, depression. When the person sleeps less, they become more irritable and more difficult to concentrate.
When the problem of sleep is caused solely by external factors, such as the patient can not sleep in a quiet or comfortable place, what the doctor can not change, how is it treated?
So, if we can not act on the causative factor, we end up using drugs, but that's something that needs to be agreed with the patient. For example, some people study at night and work during the day. During this time when you have no way, sleep less, agree the medication. But, once this period is over, you must try to solve it, to do something so that it is not eternal. Neither sleep-inducing drugs nor stimulant drugs, which could also be used in such cases.
Some people drink alcohol before bedtime to relax and fall asleep faster.
Certainly, alcohol consumption should not be done around bedtime, especially in patients with sleep apnea. Alcohol is a muscle relaxant, it aggravates snoring and worsening of sleep apnea.
Reading helps sleep?
Yes, there are several guidelines relating to sleep hygiene, and one of them would be to make a reading. But most of the time, people advise not to be in the room, for example, so that it is reserved for sleep. This preparation, this half-hour of relaxation must be done outside of this environment. And you can do a short reading, not a book that interests you and you do not want to stop reading, there are delays.
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