Doctor Irshaad Ebrahim of the Dubai-based London Sleep Centre describes the number of current sleep disorders as “an epidemic”.
“It’s so much more important than what’s being reported in the press: lifestyle, pace of work, demands of technology, screen use – they are harming our sleep/wake cycle.”
The number of sleep clinics in the UAE are on the rise, as are do-it-yourself responses such as sleep treatments at luxury hotels and online apps for managing one’s sleep cycle. “It is a response to demand,” says Ebrahim, “just the number of people seeking help”.
According to Elizabeth Graf, a clinical psychologist at a private clinic in New York, “research continues to show the emotional and physical benefits of sleep”.
Studies have linked lack of sleep to poor performance at work, depression and overall health, including links to cancer. It is not uncommon for studies to speak about the “public health crisis” of lack of sleep, in which billions of dirhams are spent tackling the secondary effects of poor slumber. Others point to its effect on the economy, and even its role in disasters such as the nuclear meltdowns at Three Mile Island and Chernobyl.
New technologies for imaging the brain’s activity during sleep have made it easier to understand REM sleep, or “rapid eye movement” sleep, in which most of its benefits accrue. Though it has often been associated with the formation of memories, one new sleep study looked at the shrinking of synapses in the brain during sleep to suggest that a good night’s rest is an aid to forgetfulness.
Sleep is also a wider cultural topic: last year, author Arianna Huffington released The Sleep Revolution: Transforming Your Life, One Night at a Time, in which she said that taking control of one's sleep is the key to unlocking a happier, more fulfilling and productive life.
The New York-based artist Shana Moulton has dealt with sleep disorders in her work. In the video Restless Legs Saga (2012), her alter ego "Cynthia" is afflicted with Restless Leg Syndrome, or the desire to move one's legs while falling asleep.
Cynthia is plagued by her restless legs, while the pharmaceutical industry is on a relentless advertising blitz to treat it. “Sleep causes enough disruption that people feel motivated to do something about it, as opposed to their typical responses to other psychological disorders,” says Aamnah Husain, a psychologist and sleep specialist at the German Neuroscience Center in Dubai.
“There can be a genetic component to insomnia, but that’s rare. The leading causes are lifestyle, stress, obesity and depression.”
Depression is both a cause of insomnia and a symptom – meaning depression and insomnia can lock you in a cycle of poor sleep habits and worsening symptoms.
Ebrahim mentions that “many medical disorders get worse at night – either from sleep per se such as asthma, or from lying down such as gastro-oesophageal reflux”. These make it harder to stay asleep, while also aggravating the medical condition.
According to the London Sleep Centre, about 30 to 40 per cent of adults experience insomnia annually, with insomnia being chronic or acute for about 10 to 15 per cent among them. Insomnia increases with age and is more common in women. Ebrahim’s clinic treats sleep disruptions associated with pregnancy, post-pregnancy and menopause.
Jet lag, a frequent characteristic of life for many in the UAE, can exacerbate insomnia, but will not itself cause it. However, there is evidence that it affects children more profoundly than adults.
One woman in the UAE, who grew up between her boarding school in the United Kingdom and her parents’ home, says the frequent bouts of eight-hour jet lag had a long-lasting effect on her sleep cycle. Treatment options for insomnia vary, with CBT, or cognitive behavioural therapy, being the best known. CBT focuses on changing the thought processes around situations that provoke anxiety to curb negative patterns. For sleep therapy, for example, a CBT approach might entail the therapist asking an insomniac to confront his worst fear – a night without sleep – and then to show how such an eventuality is actually manageable.
“CBT is one of the many treatment options,” says Graf. “It is important to identify the source of insomnia, if possible. Causes can range from too much caffeine, or overstimulation before bed from screens, to psychiatric disorders such as depression or bipolar disorder. Working on sleep hygiene and ruling out underlying medical/psychiatric causes can help to treat the problem.”
Sufferers of insomnia in the UAE have often complained that there are few treatment options in the region beyond medication, but the rise in sleep disorder clinics has made more types of treatment available.
Husain says she uses a combination of CBT and mindfulness therapy, which means “being in touch with one’s own senses and one’s body. We abuse our bodies a lot”. “We only pay attention to our body when we need something from it or want it to look a certain way,” she says.
For acute insomnia, medication is often needed before therapy can be effective. Ebrahim says he transitions from a medical approach – once the acute phase is over – to more integrated CBT one.
There are also online CBT therapies such as Sleepio (52 weeks of unlimited access costs around Dh1,100) or Sleep Healthy Using the Internet (with a joining offer of Dh475 for the first eight weeks). These help users track their sleep patterns, and also give feedback to establish proper sleep habits.
Studies show that such online counselling programmes can be effective. “People do not have a clear understanding of their own sleeping,” says Husain. “They tend to overreport or underreport.”
Any tracking mechanisms will help people understand what is really going on in their bodies, though these programmes will be of limited efficacy to those with acute sleep disorders or psychological conditions.
Sleep benefits are also a new watchword in the relaxation business, and a number of luxury hotels now provide sleep treatments to help harried guests. Just recently, Park Hyatt in Abu Dhabi launched a sleep treatment. It includes meditation, reflexology massage, head massage and candles for an hour to an hour-and-a-half – the property says it has already become popular. Other hotels are increasingly offering similar treatments and wellness programmes.
“Everyone likes a nice massage,” admits Husain. But he warns “that’s not going to treat the underlying problem”.
Are you at risk?
Recent reports have focused on screen time as the culprit for poor sleeping. Smartphone and tablet screens emit blue light, a high-intensity energy source that stimulates people when they should be going to sleep.
Patients are advised to avoid screen use in bed, or at least 30 minutes before bedtime, and to wear sunglasses if you really need to check your phone.
But experts say screen time is not the only factor. “The problem is much, much larger,” says Ebrahim, adding that people need to slow down more generally.
There are a number of tests available online to determine whether your sleep disruption warrants attention. Insomnia denotes the inability to fall or stay asleep through the night – or sleep of poor quality – where you’ve slept through the night, but do not wake feeling refreshed. Other sleep disorders include sleep apnoea, Restless Legs Syndrome and narcolepsy, or uncontrollable daytime sleepiness.
For general insomnia, proper sleep hygiene is the first place to start: limiting screen use before bedtime, making sure that the bed is only used for sleep – not work – and most importantly, sticking to a bedtime routine. This means that even after a night of terrible sleep, you shouldn’t sleep in for more than half-an-hour to catch up.
For jet lag, research suggests that rather than reorienting yourself immediately to a new time zone, you should let your body feel like it’s had its full night’s sleep – expose yourself only to the sunlight and your breakfast routine (both Sun and food are cues by which the body sets its circadian rhythm) at your normal wake-up time. You are better placed to combat sleep changes when you are fully rested.