Sleep Disorders - Cracking the Code of Restful Sleep - Q & A session with an expert.
(Focus - Singapore)
Although we have heard it time and again, many of us still fail to acknowledge the significance of a good night's sleep for a healthy and content life. Many of us take restless nights, sleepless hours, and endless tossing and turning lightly, thinking it's just a temporary issue that will go away on its own. However, ignoring these symptoms for too long can lead to serious consequences, such as depression, and heart attack, including chronic sleep disorders that can affect our overall health and well-being.
To learn more about it, we had a short discussion with Dr. Zhao Yi Jin, a renowned Neurologist from Singapore, who stressed that it's never too late to acknowledge the significance of giving importance to our sleep health. During our conversation, she shed light on the various aspects of sleep disorders, their diagnosis, and prospective treatments, underlining the importance of more research in this field.
Dr. Zhao Yi Jing is a Consultant Neurologist currently serving at Mount Elizabeth Medical Centre, Singapore.
Early signs and symptoms include difficulty initiating sleep, difficulty maintaining their sleep, and early awakening. Patients with acute psychological or emotional stressors causing sleep deprivation should also consider seeking medical help.
We understand that sleep disorders usually go undiagnosed, and research shows that 10% of those impacted by insomnia develop chronic insomnia.   What is the reason for the underdiagnosis of insomnia?
Dr. Zhao - I think the underdiagnosis can be due to different reasons. Firstly, patients may not seek treatment as they do not have awareness of it being a medical condition and that medical treatments are available for it. Secondly, primary insomnia is commonly treated by psychiatry, and that may be one of the reasons why patients may not want to seek treatment as well due to the stigma involved. Lastly, patients may not feel it is a significant problem when they are impacted by it and seek treatment too late.
What is the situation in Singapore? Is it underdiagnosed, doctor?
Dr. Zhao - Despite Singapore being a developed country with state-of-the-art medical facilities, there is still a possibility of underdiagnosis as evidenced by the reasons mentioned earlier. Moreover, Singapore is a nation where work stressors are prevalent, leading to a considerable number of individuals experiencing insomnia and sleep deprivation.
What are the early signs and symptoms that should alarm a person to seek medical help?
Dr. Zhao - Early signs and symptoms include difficulty initiating sleep, difficulty maintaining their sleep, and early awakening. Patients with acute psychological or emotional stressors causing sleep deprivation should also consider seeking medical help.
Doctor, studies show that women are disproportionately at risk and are nearly twice as likely to suffer from insomnia than men. 
Dr. Zhao - The role of hormones, a defining characteristic of womanhood, is significant in this matter. Primarily, the demands of pregnancy, postpartum recovery, breastfeeding, and assuming the primary caregiver role for newborns predispose many women to sleep difficulties. These tasks trigger brain changes that may disrupt the sleep-wake cycle. Furthermore, perimenopausal and postmenopausal stages can also adversely affect sleep patterns.
Exploding head syndrome remains a mystery, as there is no conclusive understanding of the condition. One of the primary reasons for this is that the syndrome manifests through various symptoms, not just auditory hallucinations. Patients may also experience abnormal sensations throughout their body.
Do you observe a similar trend in your clinical practice, doctor?
Dr. Zhao - Yes. During the perimenopausal and postmenopausal stages, patients may experience several symptoms that contribute to the development of insomnia. This is particularly true during the perimenopausal phase.
Doctor, twin and family studies have suggested that about a third of the risk of insomnia is inherited.   So, is there any genetic link between insomnia and a family history of sleep disorders?
Dr. Zhao - The classification of genes associated with insomnia is still inadequate. As far as current understanding goes, there exists a range of genes that have been identified to play a role. However, there is no evidence pointing towards a single genome responsible for this condition. Rather, it appears that insomnia may develop from a combination of genetic factors with overlaps observed in other conditions like anxiety, depression, and chronic illnesses such as diabetes and coronary artery disease. It is noteworthy that individuals with a family history of insomnia are at a higher risk of developing the condition.
So how significant is the role of genetics in determining an individual's susceptibility to insomnia?
Dr. Zhao - Compared to many other conditions, the role of genetics in insomnia is relatively minor. Environmental factors play a significant role in the development of this condition. Even if you have a genetic predisposition, it may not necessarily result in insomnia. However, various environmental factors in life can add to the risk of developing it.
Now talking about parasomnias, Exploding Head Syndrome is estimated to occur at least once in about 10 percent of the population. What is the current understanding of the underlying neurological mechanisms that cause exploding head syndrome, doctor?
Dr. Zhao - Exploding head syndrome remains a mystery, as there is no conclusive understanding of the condition. One of the primary reasons for this is that the syndrome manifests through various symptoms, not just auditory hallucinations. Patients may also experience abnormal sensations throughout their body. Although many mechanisms, such as seizures or abnormal electrical activities, have been proposed, none of them have provided a definitive answer to the enigma of exploding head syndrome.
The current state of research on sporadic fatal insomnia (SFI) is still in the early stages, and there is currently no known cure or effective treatment for the disease. However, several experimental treatments have been proposed, including drug therapies and gene therapies, aimed at slowing or halting the disease's progression.
Do you have any patients who are suffering from exploding head syndrome?
Dr. Zhao - No, not at all. Due to the nature of the condition being typically a one-time occurrence, patients may not seek medical attention for it. My knowledge of the condition is primarily from reading about it and accounts from other people.
Similarly, Sporadic fatal insomnia is a rare and fatal neurodegenerative disorder that affects the sleep-wake cycle and cognitive function. So how common is sporadic fatal insomnia in Singapore?
Dr. Zhao - Very rare. Only a few case reports over the years.
And how is it treated?
Dr. Zhao - Unfortunately, there is currently no known cure or effective treatment for sporadic fatal insomnia (SFI). Treatment mainly focuses on managing symptoms and providing palliative care to improve quality of life during the illness's terminal stages.
We understand that there is no cure for this condition right now; what is the current state of research, and are there any potential therapies or treatments in the pipeline?
Dr. Zhao - The current state of research on sporadic fatal insomnia (SFI) is still in the early stages, and there is currently no known cure or effective treatment for the disease. However, several experimental treatments have been proposed, including drug therapies and gene therapies, aimed at slowing or halting the disease's progression. Some of these treatments have shown promise in animal models, but further research is needed to determine their effectiveness in humans. One potential avenue of treatment is the use of anti-prion drugs, which target the prion protein that accumulates in the brain and causes the disease. Another approach involves gene therapy, where researchers are working to develop methods to replace the mutated gene that causes the disease with a healthy version of the gene. Overall, the research on SFI is still in its early stages, and more studies are needed to understand the disease's underlying mechanisms fully. While there are currently no approved treatments for SFI, ongoing research provides hope that new therapies may become available in the future.
Studies have shown that smartphone use disrupts melatonin production that helps control our sleep cycle.   What are your tips and suggestions on creating a healthy balance between the demands of smartphones for online classes, working from home, and the need for adequate sleep?
Dr. Zhao - To promote better sleep hygiene while working from home, it's advisable to set a designated time to end your workday and refrain from returning to work after that time. Similarly, to prepare for a good night's sleep, it's recommended to stop phone usage at least two hours before your planned bedtime. If phone usage is necessary during the day or evening, using a blue light filter can help to minimize disruption to the production of melatonin. By filtering out blue light, the filter helps to mitigate the adverse effects of blue light exposure, which can lead to a delay in the body's natural sleep-wake cycle.
Thank you, Doctor!