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IT may sound strange but the missing link to all these disasters is sleep—or the lack of it. Most of these accidents occurred late at night, the men and women responsible for them were invariably overworked and sleep deprived.

If the list looks small, the reason is that sleep research dates back to a mere 30 years. And if the magnitude of the disasters leaves anything to be desired, add to it the thousands of fatalities that occur on roads, in hospitals and factories across the world because the driver or the doctor or the mechanic could not keep his or her eyes open any longer.

A 2005 poll in the US attributed 10,000 car accidents to sleep deprivation alone. And a September 2000 study done in Australia and New Zealand found that people who drove a car after being awake for around 19 hours, performed worse than people whose alcohol level in blood was 0.5 per cent.

‘‘It takes exactly 10 seconds for a sleep deprived person to fall deeply asleep. And in certain situations, if that sleep lasts even 10 seconds, it can do serious damage,’’ says Dr Sanjay Manchanda, who has studied the subject at St George’s Hospital in Sydney, Australia, and now heads the Sleep Clinic of Sir Ganga Ram Hospital in New Delhi.

It is important to underscore the fact that after the teen years, everyone needs eight hours of quality sleep everyday, say experts.

In effect, it means 33 per cent of life spent in sleep but with anything less, the result is hypertension, irritability, short-time memory loss, obesity, poor control of diabetes poor performance at work, strained relationships and an eventual heart attack. In short term, it leads to poor judgment, poor reaction and poor response to crises.

But perversely, today, at least 33 per cent of the population worldwide suffers from sleep deprivation—in the US the figure is close to 60 per cent—with disagreeable results.

Dr Ashok Mahashur, Head of the Department, Pulmonary Section of Mumbai’s Hinduja Hospital, who is also in charge of the hospital’s Sleep Clinic, recounts the story of a doctor who fell asleep and fell from his two-wheeler while waiting at a traffic signal. ‘‘Examination revealed that he was suffering from Obstructive Sleep Apnea, a sleep disorder which can even cause strokes,’’ he said.

The doctor himself had no clue about it—a situation that most alarms the handful of sleep specialists in the country.

The first Sleep Clinic in the country was opened in 1991 at New Delhi’s Safdarjung Hospital by Dr Jagdish C Suri. But although the number of sleep clinics has grown since— around a 100 across the country—there is little public sensitisation. In India, over 90 per cent of people with sleep disorders go undiagnosed. Worse, ‘‘only 40 per cent of doctors are aware of sleep disorders today,’’ says Dr Sanjay Sobti, Senior Consultant of Sleep Medicine at Indraprastha Apollo Hospitals, New Delhi. The Indian Sleep Disorder Association has around 200 members, says Suri, the founder and president of the association.

This is also the reason why the country has so few specialists in what is a highly developed field abroad. ‘‘Even today, no Indian medical school offers a course in sleep study,’’ says Dr Manchanda, who started out as a pulmonary specialist, and moved to sleep medicine due to his interest in the ‘‘33 per cent of the unknown’’.

Part of the reason is that sleep, even abroad, was considered a natural process for long. And while somnambulism and insomnia made an appearance in literature from Shakespeare to Keats, the scientific nature of sleep was little understood till in 1875, Richard Caton, a surgeon from Liverpool, discovered electrical activity in brains of animals. In 1913, Henri Pieron published Le problemme physiologique du Sommeil. In 1923, German psychiatrist Hans Berger developed electroencephalography. And in 1950s, came the next milestone with US physiologist Nathaniel Kleitman’s work on Circadian rhythms—the biological clock. The clinical aspect of sleep study developed only in 1970s and it was in 1996 that the American Medical Association recognised sleep medicine as a speciality.

Today, over 80 types of sleep disorders are recognised. But broadly, they can be classified into five categories. Of these, insomnia, the inability to go to sleep or sustaining it, and Obstructive Sleep Apnea are perhaps the most prevalent—prompting sleep clinics in India, clustered mostly in New Delhi and Mumbai, to concentrate on them.

Apnea, derived from the Greek word aponia, meaning absence of respiration, is the unnatural stoppage of breathing during sleep. The stoppage—due to obstruction caused by obesity and facial structure—can continue for anything between 5 seconds and three minutes and can lead to heart attacks.

‘‘It is an FDA guideline that every person who snores must undergo a sleep study,’’ says Dr Sobti, ‘‘for one of the warning signals of apnea is snoring, which typically happens when breathing is obstructed.’’

But the high prevalence of apnea is also one of the reasons why sleep, a multi-disciplinary study, is becoming the provenance of pulmonary experts in India. It is also why other equally alarming problems, like narcolepsy and parasomnias, are relatively unknown and under-diagnosed.

The word ‘‘narcolepsy’’ was coined in 1880 by French physician Jean Baptiste Édouard Gélineau from the Greek word narke meaning stupor and lepsis meaning an attack or seizure. Narcrolepsy is a spontaneous attack of sleep at daytime. It is characterised by excessive fatigue and for that very reason, is considered a fallout of stress. Even in countries well up in sleep medicine, it can remain undiagnosed for years. The record, according to the Stanford School of Medicine— which opened the first clinical centre for sleep—is 14 years. But narcolepsy is a nervous disorder, which is genetic in nature. The reason for the daytime sleepiness is that the quality of sleep at night is poor.

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