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THE BOOMING BUSINESS OF SLEEP
By PROSENJIT DATTA
Sleep disorders are becoming a huge business globally because of our current lifestyles and drug makers and other businessmen are rushing to take advantage of this. The next time you are lying in bed desperately trying to get your 40 winks, and counting sheep isn't helping much, you could spend some time instead pondering about this whole business of sleep. The predicament of those suffering from insomnia like you, as well as those with the opposite problem - keeping awake during work hours - has metamorphosed into a big business globally. Serious researchers in research laboratories around the world are trying to unravel the full mysteries of how the brain and body acts during sleep. Other serious researchers are meanwhile trying to come up with better drugs to help you sleep and also keep awake. Meanwhile, an entrepreneur is offering sleep pods to offices in New York where the harassed executive can take a short nap to recharge himself. Drug companies are raking it in as the sale of sleep drugs explode. And sundry others - from makers of special mattresses designed to help you fall asleep to sellers of the apparatus that helps chronic snorers breathe better while sleeping are all making big bucks.
There are no estimates of how big the whole business of sleep disorders is, but here are some numbers that will help you gauge its potential. A study in 2004 estimated that the sale of sleep drugs in the US and Europe alone is more than $ 3 billion and possibly growing at 12-15 per cent per annum. The champion drug in the US for sleep - Ambien made by Sanofi-Aventis - rakes in over $ 1.5 billion by itself and is estimated to control over 80 per cent of the US market. (In Europe, Ambien's market share is lower). The US FDA has just approved generic versions of Ambien's molecule (Zolpidem Tartrate) as the patent of the drug is expiring. A dozen Indian companies are in the fray to supply generics of Ambien in the US market and the market itself is expected to double or even triple as the generics come in. Meanwhile in India, the research agency ORG calculates that the market of hypnotic and anxiolytic drugs (drugs commonly prescribed to help you get a good night's snooze) as well as neurotonics (which keep you alert at work) is worth Rs 1500 crore. That's just money spent on drugs and doesn't include money spent on anything else whether doctor's visits or specialized mattresses.
Sleep has started getting a lot of attention of late simply because people are sleeping less and the effects are showing up in their work. Though the normal man spends nearly a third of his life sleeping, what happens during the state of slumber is still not as well known as doctors and scientists would like. What is known is that there are different stages of sleep and the brain waves function quite differently during the different stages. Research shows that the body and mind is rejevunated during sleep though no one knows the precise mechanism of how this happens. Of late, research has showed that sleep aids memories and chronic lack of sleep can lead to all sorts of problems ranging from reduced immunity to attention deficit disorder to even diabetes. Sleep can also lead to depression. Conversely, depression can also lead to sleep disorders. One full night's lack of sleep has been shown to affect your reflexes much the same way as several pegs of hard liquor. The mind's ability to do work properly after a bad night of sleep is considerably impaired. Stress causes sleeplessness and sleeplessness increases your stress.
There are over a 100 sleep disorders that have been diagnosed and yet only a handful are understood in any way. There are people who have trouble sleeping and there are people who fall asleep but have trouble keeping that way. Then there are the people who have excessive daytime sleepiness - a condition called narcolepsy. Sleep apnea - a condition where breathing ceases for a fraction of a second, interrupting sleep - is a condition that is being diagnosed increasingly these days among snorers. The problem with sleep apnea is that you might think you have got a full night's sleep but you could still be tired during the day simply because you haven't really managed to get proper rest. Sleep apnea is particularly common among the overweight and those who snore a lot. And the only way it can be treated currently is by wearing a special equipment called CPAP (Continuous Positive Airway Pressure) which keeps your airways open while sleeping. Recent research has shown that sleep apnea can be life threatening on occasion and therefore needs to be treated very seriously.
Meanwhile, there is the exotic sounding restless leg syndrome, where a person has the urge to keep moving their limbs while at rest. There are other syndromes too numerous to list. A recent rare side effect of an anti-depressant that has just been discovered is sleep driving - a cousin of sleep walking. Here the person can take the wheel of his car and go for a drive, while in a state of sleep. You can gauge the full dangers of doing that.
In India, by some estimates, sleep disorders are beginning to affect the efficiency and quality of life of half the adult population in urban areas.. The imperatives of a 24/7 job, flying increasingly between different time zones, and jobs where you need to change your body rhythm to keep in touch with people across the globe like call centre workers do, all contribute to increasing sleep disorders.
The average adult requires between seven to nine hours of sleep a day, though some can do with a lot less while some need a lot more. Most adults also don't get enough sleep. In some surveys, it has been reported that over 70 per cent of the working adult population has at least a couple of days of bad sleep episodes in any given week. Given the sheer competitiveness of the world and the impaired efficiency of the sleep deprived, it is little wonder that drug companies are focusing on finding ever newer drugs for both sleep and wakefulness.
Twenty years ago, benzodiazepines like calmpose were the favoured sleep drugs. These, as well as newer drugs in the same class like alprax are still very popular, especially in India. Surprisingly, Ambien, the most popular non-benzodiazepine sleep drug in the US, is not particularly popular in India. However, a lot of serious sleep doctors say that newer drugs like Ambien should be preferred over Benzodiazepines because the latter have a high abuse potential and also cause addiction if used for too long a time. But new research is showing that Ambien too has its side effects and should not be prescribed for anything more than short term use. Newer drugs are being researched which will have no side effects but promote a good night's sleep. A lot of work is going on researching melatonin, a chemical that helps the body regulate sleep-wakefulness cycle and has been shown to help jetlagged passengers. Increasingly, doctors are also trying to figure out whether a person is suffering from other problems that are leading to sleep disorders. Side effects of many common drugs cause sleeplessness as do conditions like depression and anxiety. Treating an underlying disorder often helps a person sleep better without the help of sleep inducing drugs.
Meanwhile, to keep efficiency at full steam even after long hours, the drug called Provigil (Modafinil) has been a boon ever since it was discovered. A drug initially prescribed for people suffering from narcolepsy or excessive daytime sleepiness, Provigil is increasingly being prescribed for people who have to stay awake for long hours without losing their efficiency. Unlike older drugs, Provigil is supposed to have relatively fewer side effects. But doctors caution that this is a relatively new drug and its long term effects on the body are still to be discovered. The problem is that there Provigil has immense off-lable abuse potential. For example, students planning to pull in an overnighter or the executive working late to finish his presentation might be tempted to take this drug to increase his efficiency. The fact that most chemists will sell you this drug without a proper prescription only increases the abuse potential.
There are still lots of doctors who swear by the old remedies - a warm glass of milk, soothing music or a good, warm bath - for helping you sleep properly. Meanwhile, how the lack of one person's sleep can affect a whole lot of others was recently demonstrated in Delhi when a plane full of passengers on an early morning flight were delayed by several hours because their flight crew hadn't got their proper night's sleep in the hotel they were staying in. And flying in that condition would have been contravening the flight safety rules. So the crew went right back to the hotel to get their full sleep while the passengers sweated it out in the plane. Aren't you glad you didn't catch that flight?
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