Sleep is treated as a flexible resource to be traded for work or entertainment. The physiological consequences of short sleep are more concrete than most people assume, and they show up in blood sugar, blood pressure and weight.
Adults need seven to nine hours, and the number who genuinely function well on less is very small.
What Short Sleep Does
The effects are measurable within days of restriction, not only after years.
- Insulin resistance: a few nights of restricted sleep measurably impairs glucose handling in healthy people
- Appetite hormones: leptin falls and ghrelin rises, increasing hunger particularly for carbohydrate
- Blood pressure: loses the normal overnight dip, which is associated with cardiovascular risk
- Immunity: reduced response to infection and to vaccination
- Mood: strongly bidirectional with anxiety and depression
- Memory: consolidation occurs during sleep, so learning is impaired
- Accidents: driving after significant sleep deprivation impairs performance comparably to alcohol
The metabolic effects matter particularly in India, where diabetes risk is already high and urban sleep durations are falling.
Sleep Hygiene That Works
Some of the standard advice matters more than the rest.
- Fixed wake time, including weekends. This anchors the body clock and matters more than a fixed bedtime
- Morning light exposure, which sets the clock for the following night
- No screens for an hour before bed, or at minimum reduce brightness
- Cool, dark, quiet bedroom. In Chennai, adequate cooling genuinely affects sleep quality
- No caffeine after early afternoon, since its effects last six to eight hours
- No alcohol as a sleep aid. It shortens time to sleep and then fragments the second half of the night
- Bed for sleep only, not work or scrolling
- Exercise regularly, though not intensely in the last two hours
The fixed wake time is the most powerful and the most commonly ignored, because people compensate for a poor night by sleeping in, which disrupts the following night.
If You Cannot Fall Asleep
Lying awake trying to sleep reinforces the problem, since the bed becomes associated with frustration.
- If you have not slept within about twenty minutes, get up and go to another room
- Do something quiet and dull in dim light until sleepy, then return
- Do not check the time repeatedly, which increases anxiety. Turn the clock away
- Do not use the phone during this period
- Keep the same wake time regardless of how the night went
- Avoid daytime napping while re establishing a pattern
For persistent insomnia, cognitive behavioural therapy for insomnia is more effective than sleeping tablets in the long term, and its benefits persist after treatment ends. It is the recommended first line treatment, ahead of medication.
The Problem With Sleeping Tablets
Sedative sleeping tablets are widely prescribed and widely continued far longer than intended.
They are effective for short term use, such as during an acute crisis. Beyond a few weeks, tolerance develops, dependence is common, and stopping causes rebound insomnia that convinces people they cannot sleep without them.
In older adults they increase the risk of falls, fractures and confusion substantially, and this is under recognised.
If you have been taking a sleeping tablet nightly for months, that warrants a review and usually a gradual reduction plan alongside behavioural treatment rather than abrupt stopping.
Obstructive Sleep Apnoea
This is common, underdiagnosed, and has substantial cardiovascular consequences.
The airway repeatedly collapses during sleep, causing pauses in breathing, drops in oxygen and brief arousals. The person does not remember waking but never reaches deep sleep.
- Loud snoring, most nights
- Witnessed pauses in breathing, usually reported by a partner
- Gasping or choking awakenings
- Excessive daytime sleepiness, including falling asleep while driving or in meetings
- Morning headache and dry mouth
- Waking repeatedly to pass urine
- Poor concentration and irritability
- Blood pressure that will not come down despite multiple drugs
That last feature is a specific clue. Resistant hypertension should prompt consideration of sleep apnoea. Untreated, it increases risk of hypertension, atrial fibrillation, heart failure, stroke and diabetes.
Getting Sleep Apnoea Diagnosed and Treated
Diagnosis requires a sleep study, either in a laboratory or with a home device, which records breathing, oxygen levels and sleep patterns.
Treatment depends on severity.
- Weight reduction, which can substantially improve or resolve mild cases
- Avoiding alcohol and sedatives, which relax the airway further
- Positional therapy for those whose apnoea occurs mainly on the back
- CPAP: a mask delivering continuous positive airway pressure, the most effective treatment for moderate to severe disease
- Mandibular advancement devices for milder cases
- Surgery where there is a specific anatomical obstruction, particularly enlarged tonsils
CPAP tolerance improves considerably with proper mask fitting and support in the first weeks, which is when most people abandon it. Our pulmonology and ENT departments assess sleep disordered breathing.
Shift Work and Sleep
Shift work is common in Chennai's IT and healthcare sectors and carries genuine health consequences, including higher rates of metabolic and cardiovascular disease.
- Maintain a consistent sleep schedule even on days off where possible
- Use blackout curtains and eye masks for daytime sleep
- Wear dark glasses on the commute home to reduce morning light exposure
- Use bright light during night shifts to promote alertness
- Time caffeine to the early part of the shift rather than the end
- Ask family to protect sleeping hours as they would night time
- Take short naps before night shifts rather than after
Rotating shifts forward, morning to evening to night, is better tolerated than rotating backward, and this is worth raising with employers.
When to Seek Help
See a doctor for any of these.
- Difficulty sleeping most nights for more than a month
- Loud snoring with witnessed pauses in breathing
- Falling asleep during the day when you intend to be awake, particularly while driving
- Acting out dreams physically, which can indicate a neurological condition
- Unpleasant leg sensations at night relieved by moving, suggesting restless legs, which is often related to iron deficiency
- Sleep problems alongside persistent low mood or anxiety
Restless legs is worth mentioning because it is frequently caused by low ferritin and improves considerably with iron correction, which our laboratory can assess.
Sleep is not a luxury to be cut. Fix your wake time, get morning light, keep screens out of the last hour and caffeine out of the afternoon. If you snore loudly with daytime sleepiness or your blood pressure will not come down, get assessed for sleep apnoea.
Our pulmonology department at T. Nagar assesses sleep disordered breathing.
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