Amrita Ahuja, 43, couldn't quite put a finger on it. Despite a healthy diet, regular exercise and a satisfactory family life, she was plagued by constant fatigue. When even pill-popping didn't help, Amrita consulted her physician who chivvied her to a sleep clinic after a battery of tests. The clinic diagnosed Amrita's problem as 'poor quality nocturnal sleep'.

Though no exact figures are available for sleep disorder-affected women in Delhi, doctors are worried that scores of Amritas in the city are currently battling a raft of serious sleep disorders. Obstructive Sleep Apnea or OSA (the cessation of breathing for 10 seconds at least five times per hour of sleep); insomnia; Night Eating Syndrome (NES); Nocturnal Sleep-related Eating Disorder (NS-RED); poor quality sleep; even sleepwalking being just some of them. 

In NS-RED, explain doctors, people eat while they are asleep, often rustling up a dish in the kitchen without recollecting anything later! If NS-RED occurs recurrently, a person can experience weight gain and Type-II diabetes. Similarly, in NES, a person eats during the night in full consciousness and may be unable to sleep till she has tucked in. Both disorders are hybrids of sleep and eating disorders and can trigger depression and weight gain.

"The past five years, especially, have seen a three-to four-fold spiral in the number of cases of women in the city with sleep disorders," elaborates Dr J.D. Mukherji, Head, Department of Neurology at Max Super Specialty Hospital, New Delhi. Adds Dr Ajay Rastogi, Internal Medicine, Fortis Hospital, NOIDA, "Previously, sleep disorders plagued just menopausal or elderly women. Now young girls fall victim to them too."

According to sleep experts, an adult needs eight to 10 hours of uninterrupted, good quality sleep at night to function at his/her optimum best. Inadequate sleep can lead to fatigue, restlessness, depression, loss of appetite, nausea, disinterest in sex and dehydration. "Women not only perform their jobs and family duties better when they're well-rested, but are more likely to maintain a healthy weight as inadequate sleep is a primary source of obesity," says Dr Rastogi.

Recent research also highlights that though both men and women are vulnerable to sleep disorders, they are more common amongst women. Also, about 10 to 15 per cent of women with eating disorders are also affected by sleep-related disorders. "Many of them diet during the day, which leaves them hungry and vulnerable to binge eating at night when their control is weakened by sleep. In some cases, people with sleep-related eating disorders have histories of alcoholism, drug abuse and other sleep disorders too," elaborates Dr Anoop Misra of Fortis Hospital.

So what has led to this unhealthy trend amongst women in metro cities? According to sociologists, changing urban family dynamics and an evolving new professional culture are the culprits. Explains renowned psychologist Dr Sanjay Chugh, "Proliferation of nuclear homes, the emergence of a new BPO-style work culture and a compulsive partying ethos are all taking their toll on the well-being of women." Dr Chugh elucidates that women (more than men) are also biologically predisposed towards sleep problems because of gender-linked factors like menstruation, pregnancy, menopause and motherhood.

However, if it's any consolation, India's urban women are in global company. Dr Meir Kryger, in his book, 'A Woman s Guide to Sleep Disorders', notes that more than 20 million women worldwide have trouble sleeping at night. He also mentions that sleep disorders among women are prone to misdiagnosis and, therefore, mistreatment.

This is corroborated by a study done by Dr Anoop Misra, according to which untreated OSA amongst women dramatically ratchets up the risk of cardiovascular disease and metabolic syndrome, a condition characterized by life-threatening symptoms like high cholesterol, hypertension, insulin resistance, abdominal obesity, heart attacks and even stroke. "It also augments the risk of irregular heartbeats and automobile accidents due to excessive daytime sleepiness," he says. Shockingly, 90 per cent of the people who suffer from OSA are unaware of their illness, according to Dr Misra.

Author Leslie Lundt in 'Sleep and Sleep Disorders in Women: Unique Challenges and Solutions', quotes epidemiological studies to highlight that worldwide insomnia is more common among women than men. Stresses Lundt, "The recognition and treatment of insomnia in women are crucial aspects for maintaining overall health and quality of life. Untreated insomnia can lead to impairments in performance of daily activities and job responsibilities, relationships with family/friends, quality of life, and significant increases in the risk for depression, anxiety and substance abuse."

Sleep researchers report that women's sleep problems differ from men's partly due to their hormones. In a poll conducted by the US-based National Sleep Foundation, women were more likely than men to complain of inadequate sleep (28 per cent vs 19 per cent), to report daytime sleepiness (20 per cent vs 13 per cent) and display symptoms of insomnia (63 per cent vs 54 per cent). "Although not all sleep disorders in women are gender-specific," explains Dr Chugh, "the unique aspects of a woman's physiology and psychiatric makeup do impact her sleep patterns."

An interesting study published in 'Sleep', the official journal of the Associated Professional Sleep Societies, reports that women who undergo abortion are more likely to be treated for sleep disorders. Researchers David Reardon of the Springfield-based Elliot Institute and Priscilla Coleman of the University of Bowling Green, USA, examined medical records for 56,284 low-income women in California who gave birth or underwent an abortion in the first six months of 1989. Their findings reveal that up to four years following abortion/delivery, women who underwent abortions were more likely to be treated for sleep disorders following an induced abortion. The study also highlights that trauma victims often need to battle sleep difficulties.

Lifestyle factors, too, influence sleep, as do moods. Women with mood disorders, such as depression. were more likely to have sleep problems. Women who don't sleep well, Dr Kryger says, are also too tired to exercise, eat properly or have sex.

So where does the solution to the sleep disorders lie? Many factors come into play. Firstly, women must stop thinking of a constant lack of sleep as a badge of honor, opines Joyce Walsleben, a sleep medicine specialist at New York University Medical Center. Also, they must make sleep a priority and obey "sleep hygiene" rules. "Keep a regular sleep schedule of going to bed and waking about the same time daily," advise experts at National Sleep Foundation. Also, it helps to have a relaxing bedtime routine, finish exercising at least three hours before bedtime and avoid caffeine/alcohol a few hours before going to bed.

"We tend to think of sleep in a vacuum," says Dr Misra, "but we really shouldn't. Through the study of sleep and sleep disorders, we can understand women a whole lot better." About time, too. 

June 17, 2007

By arrangement with WFS 

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