On the occasion of World Sleep Day, Dr. Marc Rey, neurologist and president of the National Institute of Sleep and Vigilance (INVS), gives us his precious advice for sleeping well.
Why doctor – A new survey shows that the Covid-19 epidemic has greatly disturbed the sleep of the French. Is this something you see in your practice?
Doctor Marc Rey – Absolutely. With the first confinement, the sleep disorders of the French were rather homogeneous, with a tendency to go to bed very late and sleep of longer duration. For the second confinement, less intense than the first, there was an improvement in the night time, with a return to normal values. On the other hand, health professionals have observed more fatigue, anxiety and depression, with more fragmented and poorer quality sleep.
Before the pandemic, did the French already suffer from sleep problems? And if so, which ones?
In normal times, 41% of French people suffer from sleep disorders, a figure that has increased over the past twenty years. Patients mainly suffer from insomnia, sleep/wake rhythm disturbances and sleep apnea.
What were the main causes then?
The increase in staggered working hours, obesity, psychological stress and screens are the main factors of sleep disturbance among the French.
Can you tell us a bit more about the role of screens?
It’s the blue light emitted by screens that disrupts sleep: it stops the secretion of the sleep hormone (melatonin), as happens naturally in the early morning, with sunrise. Connecting to your laptop or computer at night in bed delays the secretion of melatonin, therefore also falling asleep.
Are there populations more affected than others by sleep disorders?
First there are the teenagers, because they have a natural tendency to lag: they go to bed later and get up later. During the holidays, some will almost reverse their sleep/wake rhythm, which makes it difficult to resume classes.
Then, women are also much more prone to sleep disorders, because of their hormonal life: the rhythms of the nights change during menstruation, during pregnancy, at the birth of the child and at menopause.
Finally, night workers are generally very affected by sleep problems.
And what about the elderly?
Older people sleep less, but they need less rest. It is therefore a category of the population that has a rather good relationship with sleep. On the other hand, they must avoid falling asleep in front of the television and drowsiness during the day.
From when can we consider that a problem of sleep is pathological?
When one is embarrassed several nights per week, it is necessary to consult.
How to treat pathological sleep disorders?
We must first talk about it at the beginning of the consultation, and not at the end, as is too often the case. Doctors then quickly prescribe sleeping pills and anxiolytics, which are harmful in the long term.
Then there are many pathologies associated with sleep, with a large therapeutic arsenal. For sleep apnea, they are treated with machines. Regarding restless legs syndrome, we go through drugs and iron supplements. Hypersomnia is also treated with medication. Finally, solving insomnia generally involves CBT (behavioural and cognitive therapies).
Have there been advances in terms of care for severe sleep difficulties?
Verry much. Already, sleep has become a university specialty in its own right, with doctors (pneumologist, psychiatrist, neurologist, geriatrician, pediatrician, etc.) who have made it their specialty. Knowledge about sleep has therefore progressed a lot in recent years.
In terms of care, there were first technical advances, for example concerning the treatment of sleep apnea, with much smaller machines and better adapted masks. For hypersomnia, progress has also been considerable in terms of medication. Finally, the diagnoses are much more precise than before.
What do you think of the use of sleeping pills?
The taking of sleeping pills must be quite transient, and only register for a few nights. Sleeping pills are not treatments for insomnia, unlike CBTs. It’s like when you have a toothache: you can take painkillers while you go to the dentist, but you have to consult him to stop the pain permanently.
Are there any mild sleep problems? If so, what solutions can you provide?
Of course: you can have occasional problems falling asleep, just like a few nocturnal awakenings for example. To solve them, you must first know and respect your need for sleep, because not all organisms require the same number of hours of rest. You also have to know if you are more of an evening or more of a morning person. Then, it is necessary to respect a good sleep hygiene, as it is necessary to have a good food hygiene. The mistake is to consider sleep as an adjustment variable.
Can lifestyle impact the quality of our nights?
Completely. To sleep properly, you have to build a quality awakening, with physical activity, if possible outdoors and in the morning, to expose yourself to daylight. Working the brain, laughing and having fun can also help you sleep well. In summary: you must first have a good day to enjoy a good night, and not the other way around.
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