Sleep is, along with diet, exercise and mental health, one of the four pillars of health, defends the neurologist and specialist in sleep disorders at the Hospital Clínic de Barcelona Álex Iranzo (Barcelona, 1966). But the pace of life and screens today complicate such a fundamental and vital activity because they are shortening the hours we sleep, which as a general rule should not go below seven. A quarter of the population sleeps less than recommended, warns Iranzo, who has just presented and directs the UB Chair - AdSalutem Sleep and its Disorders, whose objective is research, training and documentation of all this problem.
Does lack of sleep keep neurologists up at night?
(laughs) It gives us work, because it is a very frequent thing. Globally, 25% of the population, both men and women, sleep less than recommended.
How much is recommended?
What is in accordance with the canons of good health is sleeping between seven and nine hours. There are interindividual differences and, obviously, this varies according to age. A three-year-old person does not sleep the same as when they are 10, 18, 25, 40, 60 or 80. There are different physiological needs. Habitually sleeping more than nine hours or less than seven is associated with diseases or predispositions to have different diseases.
How does it help?
With sleep, which seems like a silly thing in the sense that it is useless because you are there passively sleeping, there is a very important neuronal plasticity activity. Toxins are eliminated from the brain, new proteins are created, functions that were quiet while you are awake are now active during sleep. For example, memory. It has been shown that in different phases of sleep you organize the things that you have learned or that you have experienced during that day. You expel those that are not interesting and retain those that will be useful to you. It also has a very important biological activity at an emotional, endocrine, immunological, and respiratory level. It is very easy to know what sleep is for by looking at what happens if you sleep little.
What's happening?
A person who sleeps one, two, three days, two or three hours, or is completely deprived of sleep, the next day does not have the correct memory, is not attentive, is not concentrated, suffers from errors, does not plan. If it is more days, he may have banal infections, such as a cold, herpes or hormonal imbalances. Also lack of emotional stability: common sense or planning. He will make more mistakes, he will be more irritable, less attentive, more prone to fatigue, with loss of libido, etc.
Is it better to have quality or quantity of sleep?
Quality. Sleeping less than six hours on a regular basis makes you more tired the next day, less attentive, and your work and social performance will be worse. But then there is the one who sleeps ten hours or has to take 2-hour naps on Saturdays. This is telling you that even if you slept seven or eight hours during the night, they were not enough. But not because of time, but because of poor quality. You may wake up very frequently, you may have apneas. It's like spending a lot of time doing homework, but doing it wrong.
You have spoken before about 25%. Do we sleep badly in Spain?
We sleep little. In Spain, in Catalonia, in Europe... Practically all over the world. There are studies that say that in the last three years people have been sleeping between an hour and an hour and a half less now than they were 20 years ago. And this for both men and women. We sleep less because work takes time away from sleep. We are in bed and WhatsApp, television, radio, mobile phone, tablet steal our sleep.
The screens…
Tablets or cell phones have a very powerful light that reaches the eyes. It is a light that does not invite you to sleep, but rather to be awake, active.
Of the infinite list of sleep disorders that exist, are there some that worry you the most?
We must try to correct the sleeping habits of the population, giving general rules of common sense, to try to avoid these repercussions. And then, we have the issue of apneas. Many people have breathing pauses while they sleep and do not realize it. Snorers who wake up the next day tired, as if they had had a non-restorative sleep. And they fall asleep in unusual and inappropriate situations, such as during a meeting or while driving. This is very important, for example, in professional drivers, taxi drivers, ambulances, subways, buses, coaches... And there is a topic that here at the Hospital Clínic is a line of research of the neurology service, which is sleep behavior disorder. REM.
What does it consist of?
It has been a line of research since 2006 and we are truly pioneers, let me say, worldwide. We have published more than 80 articles and 10 have been published in the Lancet magazine.
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We saw that when we followed these patients in outpatient clinics, they were developing Parkinson's disease or dementia with Lewy bodies, which are neurodegenerative diseases. The sleep disorder was a warning that the neurodegenerative neurological disorder was going to come. After the diagnosis of REM sleep behavior disorder, we saw that after five years of follow-up, 25% had been diagnosed with Parkinson's, after 10, 75%, and after 14, 90%. We have seen that the patients who lacked their sense of smell were the ones who were going to do it first. What we have now also discovered during these years is that an abnormal protein called synuclein is deposited in the brain. From 2015 until now, we have done several tests on our patients with REM sleep behavior disorder to see if they already had it in their bodies. And we have seen that they have it in the colon, in the intestine, in the submandibular glands, in the skin and that they have it in the cerebrospinal fluid. And 75% of patients have it. There are already antidotes against this protein, because it is the poison of the brain. What we have been trying for five years is to convince pharmaceutical companies that they have this antidote, to test it with our patients, who could have Parkinson's or dementia, but don't have it, to see if we can stop it. With the chair we want to reach out in a very discreet way and without alarming the population, starting with family doctors so that they can refer patients with this disorder to us so we can diagnose them. You have to make a good diagnosis. There is no need to be alarmist, because the 90% who say they have nightmares or move strangely do not have REM dream behavior disorder. It is not very common, but it exists. The treatment is not yet curative, but we managed to slow it down, which is already a lot. And because you increase the quality of life and decrease the patient's poor functionality.
Do men or women sleep better?
Biologically, women sleep a little better than men, in the sense that they have more structured sleep and more deep sleep. But it is true that there are different entities that it predisposes. For example, with menstruation or when there is pregnancy, there are some women who have a tendency to have insomnia or become drowsy, and others do not. Or obesity, which is more common in men than in women, is associated with having apneas. 80% of those who come to the hospital are men. And when epidemiological studies are done, it is also more common in men.
And in the case of children, are there things that should not worry about their sleep?
Sleepwalking, night terrors, are very common in children, but in some children it can be a little dangerous, in the sense that they can fall out of bed or leave the room and have an accident. Precautionary measures must be taken. We see adults and two summers ago we were in traumatology admitting two patients who had rushed out of the room. A 50-something-year-old woman and a 22-year-old boy.
It has a solution?
Yes, with medication. It is not medication for sleeping, because they already sleep, but rather specific to avoid these nightmares and these abnormal behaviors during sleep.
What can we do to sleep better?
First of all, don't get obsessed. Of the applications that tell you what you have slept, in what phase... most are not validated. What you have to have are good schedules. Maintain between seven or nine hours of sleep and make it as comfortable as possible, with a mattress, with a temperature, without noise, common sense. There are people who say that it is good for them to sleep with the radio or watch a little TV. If you have no problems sleeping, welcome. The problem is when you have insomnia. We must tell these people that they have to think of the bed as an instrument for sleeping and only for sleeping.
And as a general rule, in some way, what ritual should you follow to sleep well?
Maintain regular schedules. If you sleep five hours, you will pay for it the next day. But you don't have to be so obsessed, but rather have a little common sense. Sleep is necessary. When there is pathology, then you do have to establish guidelines to do like coaching, but on a medical level. When we have someone who has trouble falling asleep or wakes up very frequently, there are several sleep hygiene rules. One of them is to go to sleep at regular times. And there is one very important thing is that you do not take your problems to bed. What you have to do is at six or seven o'clock write down those problems - personal or logistical -, think about them and explain how you have to solve them so that later you don't transfer it to 3 in the morning when it's on your mind. This chapter is closed, you no longer have to think about this. It is also important not to have heavy dinners due to heavy digestion. And excess alcohol should be prohibited: it makes you sleepy, but it is of very poor quality, very superficial. Physical exercise must also be moderate so as not to stimulate the brain.
Is it insomnia that is taking up the consultations?
Yes, it really is an epidemic. People have a bad time and the next day it has consequences: they are more fatigued, in less humor, more irritable, they wake up bad and continue the day bad.
What should motivate a visit to the doctor?
Having a bad time. That you are not well and that the lack of sleep has a negative impact on you. Chronic lack of sleep or apneas will give you daytime sleepiness the next day. You have to go to the family doctor as the first filter.
