Understanding the Language of Silence - Sleep, Sleep Behavior and Sleep Disorders. Dr. Amrit Lal

      This book is on SLEEP, but not to “sell sleep” because everyone wants a good night sleep - “a divine nap.” Human beings spend one-third of their lives in sleep; they take sleep for guaranteed as a natural gift of life as air and water to enable realize their potential, and, not as a luxury.

      Sleep is one’s life greatest pleasure that enriches virtually every aspect of our being – from our mood to the functioning of our organs. This being so, this presentation treats sleep not as an altogether passive state of quiescence but as an active and vibrant phase of life with inroads into psycho-social and neurological avenues of sleep while unraveling many aspects of sleep which include pathology of sleep disorders which are on the rise perhaps as a price for modernity.

      Nobody wants to be sick. This is a paramount need of all living beings. This fact gets repeated reassertions in a number of research studies on health and also in an epoch-making book “How to Win Friends and Influence People” first published some 72 years back when only 5,000 copies were printed, but since then this book has undergone countless repeat publications to this day (15 million copies sold during 72 years in print). The well-known author of the book, Dale Carnegie, mentions of a survey around 1933 undertaken by the University of Chicago and United Y.M.C.A. School in the Town of Meridian, Connecticut - a typical American town. The survey which took 2 years to complete with a funding of $25,000.00 (a princely sum then) interviewed almost every adult in the town on the basis of 156 questions in the questionnaire schedule. The most amazing finding of the survey revealed Health is the primary interest of adults. Needless to mention sleep plays an integral part in keeping people healthy. A sleep-deprived individual or the one suffering from any other kind of sleep disorder cannot be healthy.

      My field assignments as a public health specialist had taken me to many parts of the world in Asia, Africa and the United States for quite long spells of time and have provided me with firsthand account and a reasonably well insight into public health geriatrics. Interactions with different groups of people from different races and informal discussions with community leaders at local leadership structures further provided me knowledge at the very grass-root level of a variety of health problems and common sleep disorders in various communities. Also, sharing these observations with my peer group and professionals in clinics, hospitals and universities has provided me a number of learning situations than a few books on the subject would have taught me – what it really means to be a victim of some sleep disorder because, at one time, I, myself, had been a victim of insomnia and can thus well empathize. I, therefore dedicate this book to all those who are victims of some sort of sleep disorders with a note of caution that the book is not intended to replace the physician or sleep therapist nor I recommend any sort of self-diagnosis or self-doctoring for medication. This is the work of sleep disorders professionals.

      My professional sojourns in different continents of the world has also made me realize that technical jargon, scientific terminology, visually impressive pie diagrams, histograms, trend lines, graphs and charts, regression analyses, statistical tables and correlations documenting vast amount of technical data and copious references from epidemiological and clinical studies and case histories asterisked by foot notes – impressive as they are when it comes to credibility – have a limited impact when the text filters down to the actual reader where “rubber meets the road.” Against this realization, I have very carefully avoided such perils to quote, display or reproduce information unless where absolutely necessary. But I have provided a glossary of some inescapable terms used in the text. This is understandable because I intend to make this work as something pragmatic and a focused presentation in an easy-to-understand fashion in a way to make it helpful to all interested readers in general and the elderly in particular who bear a heavier burden of sleep maladies.

      Propelled by this realization I have undertaken to present the material in a reader-friendly and concise manner while taking full care that in my quest for being simple, comprehensive and understandable I don’t kill authenticity or miss something vital which could be helpful to sleep deprived community and professional sleep therapist. As such for this project I have reviewed and analyzed a great deal of information on sleep science and pathology of sleep disorders to be able to build a composite sleep scenario of the existing situation with a specific focus on the elderly who, by and large, as said earlier, bear the heaviest burden of this problem. To further make each chapter more understandable, I have prefaced each chapter with three key messages that are relevant to the text in the chapter.

      I believe that a problem is a problem so long as it is not recognized. Recognition of a problem is a step towards its solution. In other words, an awareness of a problem kindles a desire for its solution. This is what I believe and have tried to do through this presentation by winnowing the superfluous, and providing technical details as briefly as possible but taking full care that nothing of substance or relevance is lost.

      The general readers and sleep therapists may find some shortcomings in this presentation. I must confess some inadvertent omissions and commissions which might have unwittingly crept into this work. All those who helped me prepare this presentation are blameless for such faults, but it would have been poorer without their light and lead. For this, I bear the entire responsibility because I don’t claim to present a very scholarly treatise on this vast subject which is not my objective at this stage. There is always a room for improvement. Even perfection can be perfected. This is my candid belief.

      As said above, one of my main thrusts in this presentation is on the elderly and sleep disorders peculiar to them, and while doing so I have exposed myself to the risk of some repetitions of some terms and expressions that are dearer to my vocabulary. This is purposeful because I believe repetitions, in certain circumstances, etch in the message more securely.

      There are a number of “prescriptions” and “proscriptions” explained in the text – prescriptions based on both pharmacological remedies (medication) and non-pharmacological approaches of cognitive and behavioral routes based on sound sleep hygiene. There are also proscriptions exhorting sleep deprived individuals to avoid certain anti-sleep habits, practices and lifestyle.

      Contrary to some myths, it is wrong to assume that the elderly need less sleep even though it is not denied that a mild sleep deterioration of both quantity and quality may be the natural outcome of aging in the elderly. But aging is not merely the passage of time. As Hayflick, Leonard in his book How and Why We Age (New York, Random House (1994) remarked, “It is a manifestation of biological events that occur over a span of time. There is no perfect definition of aging but, as with love and beauty, most of us know it when we experience it or see it.”

      This presentation digs deep into the problem of sleep disorders from psycho-somatic angles in an attempt to resolve this issue and provide a viable option to address this problem, and in doing so discusses both pharmacological route of medication as well as non-pharmacological route such as cognitive and behavioral therapy therapies (or in simple terms - Sleep Hygiene) for better sleep by all concerned. It is to be borne in mind that a treatment modality must target both sleep disorders and co-morbidity which may be the antecedent factors in any type of sleep disorder. This approach optimizes the chances of success for a better quality life and functioning of the humans.

      My aim is to treat sleep not as a passive, dark and inert state, but as an active and dynamic destination – and, during the course of this journey, to clarify many myths about sleep and lingering misconceptions about sleep disorders. The concluding chapter “DESTINATION : SLEEP WITHOUT SLEEPING PILLS” is the high point of my presentation explaining ways to improve one’s quality of sleep, which I am sure, will provide the readers with many easy-to-follow ameliorative measures for sound sleep in their respective situations.

      Because of the peculiar genesis, progression and prognosis of sleep disorders among children an extra chapter as an “epilogue” has been appended for those with children in the family and for therapists and pediatricians to gain further insight into some abstruse angles of the problem as it affects infants and juvenile groups of population.

      I have tried to put across a number of issues, directly or indirectly related to sleep and its aberrations in my preface, introduction and through 15 chapters and an epilogue in a very lucid manner which I hope will make sense to the readers. I believe this presentation makes a helpful reading