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SOME SUCCESSFUL PEOPLE swear by less sleep: Former British Prime Minister Margaret Thatcher famously slept for just four hours a night, as do PepsiCo CEO Indra Nooyi and Yahoo! CEO Marissa Mayer. US President Donald Trump claims he needs only three. Dwayne ‘The Rock’ Johnson get by on three to five.
But sleep doctor Kenny Pang wishes he could ask these famous figures one thing: If they sat in a quiet room all by themselves with nothing to do, would they doze off almost instantly? If the answer is ‘yes’, then these people are categorically not getting enough sleep.
Dr Pang, an ear, nose and throat surgeon at the Asia Sleep Centre at Paragon Medical, is one of the most famous sleep experts in Singapore. Over a decade ago, he pioneered the Pang’s expansion pharyngoplasty used by doctors worldwide to treat snoring and sleep apnea. Last year, he co-published a paper that looked at the phenomenon of sleeplessness among slim Southeast Asian women.
He doesn’t really buy the idea of the “sleepless elite”, a term coined by the Wall Street Journal to describe a supposed 1 to 3 percent of the world’s population who require less sleep. He says there are stages of sleep that one needs to undergo in order to feel refreshed the next day – and four hours is simply too short for these stages to run their course.
Many Singaporeans today complain of sleep deprivation. Studies find that across all age groups, Singaporeans sleep significantly less than their foreign counterparts.
According to reports, Singaporeans are among the most sleep-deprived people in the world. Is the situation so serious that we could call it an ‘epidemic’?
‘Epidemic’ suggests something that comes and goes. ‘Endemic’ suggests something that’s here to stay. So I prefer the word ‘endemic’. And yes it is serious. Sleeplessness is particularly common among those in their 30s to 50s: They’re stressed out at work, they go back late and they may have children to send to school in the morning. So they sleep insufficiently and poorly, which is a double whammy. Sleep is a physiological need. A lot of us think that sleep is a passive activity, and that we sleep to repair our bodies rather than our brains. But sleep is an active process, especially when we're dreaming. Metabolic scans show that when we dream, our brains are more active than when we’re awake, and that the uptake of metabolism in the brain is actually very high. Paradoxically, the more we dream, the more refreshed we will feel the next day… Now the brain is very systematic. When we sleep, it goes from stage one to stage two, three and four, and then into your first dream sleep. For most of us, dream sleep typically occurs in the later half of the night. What that means is that if you sleep at 2am and wake up at 6am and you’ve only slept for four hours, you’re not getting enough dream sleep and that’s bad for you.
How then do you account for the high achievers who say they need just four hours of shut-eye nightly? Is it not like metabolism, in that it varies from one individual to the next?
High-achievers tend to be Type A people who often have a lot to do, which they no doubt do very well. But the next time you interview a CEO who says he or she sleeps for four hours a night, ask them how quickly they fall asleep in a quiet room where they have nothing to do. If they doze off quickly, it's a sign that they’re mortal after all. And, unfortunately, studies have shown that those who sleep less than five hours have a higher risk of mortality… Now there’s also the issue of sleep apnea, in which a person can sleep the requisite seven or eight hours a night, and still feel tired. According to a study conducted by Jurong Health Services, one in three Singaporeans suffers from moderate to severe sleep apnea, and one in 10 is afflicted with severe sleep apnea. That’s a high figure. The problem is, most Singaporeans don’t know they have sleep apnea. So they continue to suffer from it, they keep trying to get sufficient sleep nightly, but the quality of their sleep is incredibly poor. Sleep apnea is a condition in which breathing repeatedly stops and starts. Some of the common symptoms include loud snoring, choking sounds and daytime fatigue. The reason why it tends to affect more Singaporeans than, say, Americans, has to do with our craniofacial skeleton being smaller. I pioneered the Pang’s expansion pharyngoplasty that’s used by doctors around the world to treat men, women and children as young as two. I’ve seen mothers cry when they see their young children finally sleep well after an operation. Unfortunately, in most cases, sleep apnea goes undiagnosed, often for years and years. So if you’re sleeping seven or eight hours, and you still feel tired in the morning, you should see me.
What’s the typical profile of those who suffer from sleep apnea?
Quite a number of sufferers are male and overweight, though, of course, some women and children suffer from it too. Among my patients, approximately 70 percent are adults and 30 percent are children... But don’t be fooled by the weight issue. Not long ago, I co-published a paper with a dentist about a specific sleep disorder that affects mostly slim Asian women. These women have some form of a blocked nose, resulting in a lot of teeth grinding and clenching during their sleep. As a result, they sleep poorly, get frequent neck aches and headaches, and are generally temperamental.
You’ve been treating sleep disorders for 25 years – before the Internet and smartphones came along. Are tech devices a big reason for our sleep deprivation?
Oh, yes, very much so. I’ve seen the number of sleep disorder cases steadily rise by 30 per cent year-on-year for several years now. There are a few reasons for that: Firstly, there is more awareness now thanks to the Internet, and more people are seeking treatment when they suspect they have sleep disorders. Secondly, the blue light emitted from popular devices such as iPads and smartphones is ruining the quality of our sleep. I strongly suggest putting away all your devices at least two hours before bedtime, switching on warm light instead, and reading a book or newspaper instead, to prepare you for sleep. Don’t do anything exciting like play computer games, watch a horror film, or read your profit-and-loss statements.
What about sleep apps? There are quite a few that claim to assess your sleep.
Most of them aren’t accurate. They can be used to somewhat gauge the quality of your sleep from one night to another. But the results are superficial and you wouldn’t know why you’re sleeping badly. Here at Asia Sleep Centre, we use a device that you wear on your wrist and go to sleep with, and when you come back the next day, we’re able to make a very accurate assessment of your sleep.