Dr. Carlos Glória

Specialist in Pulmonology 
and Intensive Care Medicine
Head of the Sleep Lab
Clinical Director

Because it’s good for you and helps you grow

Sleep Lab at the Alvor Hospital - Even more comprehensive and special

HPA Magazine 10

Sleep is an important physiological function, for its importance in general health as well as for quality of life, including healthy and active growth and aging, due to its restorative, adaptive and behavioural capacity. 
It is estimated that around 60% of the Portuguese population suffers from sleep disorders, which can vary from insufficient sleep time (insomnia or for social reasons), respiratory disturbance during sleep (apnoea or hypopnea), abnormal movements (sleepwalking, grinding teeth, restless legs) or other rarer, but quite serious, pathologies, such as narcolepsy.  
Despite the majority of sleep disorders being treatable, fewer than a third of those who suffer from them seek professional health, even though many of its manifestations begin in infancy – 20 to 30% of children show some type of sleep problem, which tend to continue throughout adulthood and aging.

Sleep deprivation or bad quality sleep cause disruptions of social and professional life by decreased wakefulness, inattention, drowsiness during the day, etc. But the consequences of alterations to sleep also include risks for general health: the incidence of obesity, hypertension and diabetes is higher than in the general population, causing a significant increase in mobility and mortality from cardiovascular disease and the risk of accidents, namely driving accidents, is also increased.
Besides this, and generally speaking, we also know that the quality of sleep interferes with the homeostasis of the immune system and hormonal regulation.
According to Dr Carlos Glória, early intervention in alterations of sleep is fundamental, as these situations can be persistent or perpetuate in time, provoking anxiety in the patient as well as in family members. Sleep disorders are not just an individual problem, because sooner or later, they will interfere with everyone who is in contact with this person.
He explains: there are several elements that, together, can define the quality of sleep. The first is regularity. Having the habit of going to sleep and waking up at the same time during the week is part of what is referred to as “ sleep hygiene ”. The second is the continuity of the sleep period, in order to allow for the sequence of all of the phases of sleep (superficial sleep, deep sleep and REM sleep, when we dream). Lastly, the duration, which despite varying with age, should fulfil at least two complete sleep cycles, which corresponds to a minimum of 6 hours of sleep for adults. Only by meeting all of these requirements can we wake up feeling alert and well-rested.
The study of nocturnal sleep through equipment that monitors multiple variables (polysomnography) is one of the most important aspects of the study of the pathologies associated with sleep. Despite already functioning for over 10 years, the Sleep Lab of the Hospital de Alvor has undergone significant improvements, and is now more complete in respect to the availability of exams.

SLEEP ASSESSMENT TESTS
A Polysomnography or Polygraph Study of Nocturnal Sleep registers a variety of functions that occur during sleep, such as electrical activity of the brain, eye movements, muscular activity, heart rate, respiratory movements and fluxes, levels of oxygen in the blood, among other factors. The analysis of these variables allows for the diagnosis of the majority of sleep pathogens and determines the seriousness. 
The HPA group does three types of polysomnogram. The simplest studies, called level 3, are done in practically all of the units of the Group (Clinics and Hospitals). It is an outpatient exam in which the patient him/herself connects the equipment that will register whether there is apnoea or hypopnoea during the sleep, snoring, oxygen levels, etc. The level 2 polysomnogram is a bit more complex since, although also done as an outpatient exam, also allows for staging the phases of sleep, leg movements, etc. The patient is connected to the equipment at the end of the day, in one of the hospitals, and will sleep at home, just as in the previous study. The most complex is the level 1 polysomnogram. This involves a study in a controlled environment and is done in the hospital. In this exam, the sleep period is also recorded on video, allowing for a more profound analysis and diagnoses of more complex pathologies. 
The Multiple Latency Sleep Test is a daytime exam and measures how quickly the patient falls asleep during the day. It can be useful to assess the degree of sleepiness and exclude other sleep disorders.

Apart from clinical sleep disorders, bad habits can also lead to a bad sleep quality. In order to improve sleep and general well-being, the World Sleep Society has created the following commandments.

THE TEN COMMANDMENTS OF SLEEP HYGIENE FOR ADULTS

01. Establish a regular bedtime and waking time.
02. If you are in the habit of taking naps, do not exceed 45 minutes of daytime sleep.
03. Avoid excessive alcohol ingestion four hours before bedtime, and do not smoke.
04. Avoid caffeine six hours before bedtime. This includes coffee, tea and many sodas, as well as chocolate.
05. Avoid heavy, spicy, or sugary foods four hours before bedtime. 
06. Exercise regularly, but not right before bed.
07. Use comfortable, inviting bedding.
08. Find a comfortable sleep temperature setting and keep the room well ventilated.
09. Block out all distracting noise and eliminate as much light as possible.
10. Reserve your bed for sleep and sex, avoiding its use for work or general recreation.

THE TEN COMMANDMENTS OF SLEEP HYGIENE FOR CHILDREN

01. Make sure your child gets enough sleep by setting an age-appropriate bedtime (preferably before 9:00 pm) and wake time.
02. Keep a consistent bedtime and wake time on weekdays and weekends.
03. Establish a consistent bedtime routine and recommend wearing comfortable clothes in bed, including strong absorbing diapers for infants.
04. Encourage your child to fall asleep independently.
05. Avoid bright lights at bedtime and during the night and increase light exposure in the morning.
06. Keep all electronics, including televisions, computers, and cell phones, out of the bedroom and limit use of electronics before bedtime.
07. Maintain a regular daily schedule, including consistent mealtimes.
08. Have an age-appropriate nap schedule.
09. Ensure plenty of exercise and time spent outdoors during the day.
10. Eliminate foods and beverages containing caffeine, including many sodas, coffee, and tea.

AGE AND HOURS OF SLEEP

WHEN TO SEEK THE HELP OF A SLEEP SPECIALIST

• VENTILATORY DISORDERS DURING SLEEP, SUCH AS SNORING OR SLEEP APNOEA;
• EXCESSIVE DAYTIME DROWSINESS;
• TIREDNESS ON WAKING (OFTEN MORE THAN WHEN GOING TO BED);
• ABNORMAL MOVEMENTS DURING SLEEP, NAMELY OF THE LEGS;
• FREQUENT INSOMNIA;
• NIGHTMARES;

• SOMNAMBULISM (SLEEPWALKING);
• SUDDEN LOSS OR LACK OF STRENGTH, TRIGGERED BY EMOTIONS;
• BRUXISM (GRINDING THE TEETH DURING SLEEP);
• WHEN SUFFERING FROM OTHER PATHOLOGIES CAN BE ASSOCIATED WITH SLEEP DISORDERS: OBESITY, DIABETES, HYPERTENSION, LOSS OF LIBIDO, ETC.