SLEEP: interview with Dr Irshaad Ebrahim

Why and how did sleep become your focus as a doctor?

As a young medical student I realised that there was a paucity of knowledge about sleep and soon after qualifying as a doctor, a Professor of Neuropsychiatry invited me to Canada to be his research fellow to study Sleep and its impact in psychiatric disorders. The Canadian weather being what it is, I soon realised I’d be better off in Blightey so made my way back here end enrolled at University College London on the Psychiatry Specialist Training Scheme for Doctors. During my training as a psychiatrist, I continued to be fascinated by the realm of sleep and in particular how sleep – or the lack of it – impacts on mental health and well-being and decided to further my knowledge through research, eventually setting up a stand-alone Sleep Clinic on Harley Street.   


From your experience, what are the most common triggers or issues preventing people from getting a good nights sleep? 

These can be divided into:

  1. Environmental: unhealthy sleep environment, noise, poor ventilation, abnormal temperatures, etc
  2. Self-inflicted: smoking, recreational drug use, alcohol, excessive use of electronic (‘smart’) devices, irregular sleep-wake routines, over-working, poor diet, poor sleep hygiene, etc
  3. Psychological: stress, depression, anxiety
  4. Physiological-Medical: sleep disorders such as Obstructive Sleep Apnoea, Restless Legs Syndrome, Insomnia, etc 


Are there certain hormone changes or effects from disrupted sleep? 

The female hormonal cycle and sleep are closely interrelated and intertwined. During Puberty for example, Luteinising Hormone (LH) is stimulated during sleep but in the Follicular Phase of the Menstrual Cycle, LH is inhibited during sleep – therefore if sleep is disturbed, there is a possibility that reproductive functioning may be adversely affected.  

There have been several population studies on Sleep and the Menstrual cycle and most of these studies have found that women tend to report more sleep disturbance in the time just before and during monthly menstrual periods. Whilst these reports are common, studies of sleep physiology (i.e. sleep testing in sleep  laboratories) have not yielded substantial answers mainly due to the study design or the number of women studied being too small. There are some differences in sleep patterns between the Luteal and Follicular phases of the cycle – for example, REM sleep patterns differ between the two phases with less REM sleep and fewer REM Sleep cycles in the Luteal phase. The higher the levels of Progesterone, the lower the amount of REM Sleep. More recent studies have also found an increase in Stage 2 sleep and the Sleep Spindles associated with Stage 2 Sleep in the Luteal phase. Additionally, in the late Luteal Phase (closer to the onset of menstruation) studies have documented an increase in the number of wakings during the night confirming what many women say about sleep in the pre-menstrual part of the month.


What can you tell us about the Circadian Rhythm? What is it and is it important to think about in your opinion? 

The term Circadian Rhythm refers to our 24 sleep-wake cycle that is regulated by our brain/s sleep-wake clock (The Circadian Clock). The circadian rhythm is most  commonly disrupted by travel across  4 or more time zones – Jet Lag!


In the context of women and their hormonal cycle, Circadian Rhythms for Hormone Secretion and Temperature are superimposed on the hormonal changes of the menstrual cycle. Temperature regulation is one aspect of our 24 hour cycle and Men and Women who are in the follicular phase have very similar 24-hour temperature profiles. However, during the Luteal phase, there is an increase in core body temperature of up to 0.4 degrees Celsius and some researchers think that this might explain why there is more sleep disruption in the Luteal Phase because we need a slight decrease in temperature to help initiate sleep!


Furthermore, disruption of normal circadian rhythms, such as doing shift work, may disrupt the regularity of the menstrual cycle and also reduce fertility.


What are your thoughts on daily mobile phone / device use and sleep issues?

Don’t use devices for at least an hour before bedtime and keep all devices out of the bedroom.


What is your best piece/pieces of advice for someone suffering from sleep issues?


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