Music Is Medicine: Sleep Medicine
Dr. Siddhartha Ganguli
Founder and Chairman at Learning Club - Brain & Body Management Consulting
Music Is Medicine
Sleep Medicine
Ever since the English doctor James Parkinson published the first detailed description of his new-found motor disability in ‘An Essay on the Shaking Palsy’ in 1817, perception of the disease named after him did not change much. The ‘British Medical Journal’ (BMJ) & ‘Lancet’ in the UK – and ‘The New England Journal of Medicine’ in the USA, have been the three most authoritative medical journals of the English-speaking world for many decades. Looking up into the 1980’s and 1990’s issues of these journals will reveal that “Parkinson’s Disease” (PD) used to be regarded as a movement disorder or motor disease, caused by degeneration of some portions of the brain responsible for movement.
The medical professionals, in those days, used to be guided only by the symptoms of the disease that were externally visible. Those included: the shaking legs syndrome, rigidity of the bones-muscles-and-joints, tremors in the limbs and their parts, poor posture, affected gait (‘style of walking’), loss of control over how you blink, smile, swallow, or swing your arms while walking, small-cramped handwriting, and so on.
PD, in reality, is a disease where many areas of the brain are involved – not only the ‘motor’ ones. The ‘non-motor’ aspects of PD, not being visible, used to get unnoticed. Gradually, with time, it was recognised that these apparently imperceptible expressions of the disease did cause a lot of inconvenience to the patient. One of these was: disturbed sleep, which gets manifested in three ways: ‘insomnia’ (lack of sleep), ‘sleepiness’ (occasional drowsiness), and ‘REM sleep disorder’ (‘REM’ stands for ‘Rapid Eye Movements’).
Let me elaborate a little so that you can follow.
The term ‘Insomnia’ refers to persistent problems falling and staying asleep. You’re ready for sleep, you go to bed, lie down – but you face difficulty in falling asleep. It is a problem not unknown to many people, in general. But, some PD patients face, what is known in PD parlance, as ‘Sleep Maintenance Insomnia’. The PD patient goes to sleep, but then wakes up after an hour or so, then stays awake facing difficulty in getting sleep. Most physicians suggest medication to ease the problem. I’ve been reading scientific papers, watching technical videos, attending webinars by top specialised PD medical professionals like Dr Ron Postuma of “Parkinson’s Canada” and Dr Gary Leo of Davis Phinney Foundation for Parkinson’s of USA, but nobody talks about ‘Music’ – which could be very effective as ‘Sleep Medicine’.
Going to bed at 10 pm, sleeping at a stretch – undisturbed, and waking up at 3 or 4 am is not good sleep, as you’re sleeping only for 5 to 6 hours which is inadequate for the brain’s rest. One must sleep for 7 to 8 hours out of a 24-hour day. If you have to follow that sleep schedule being a musician (the best time for Riyaaz/practice is from 4 am), then you must go for a nap of 1 to 2 hours during the day. If you have to keep awake for a night-time concert, you must not do it more than once a week. If you’re compelled to perform more than once after mid-night, you must make it up by sleeping during daytime not to incur sleep debt which is bad for both your body & brain health.
For a PD patient, going to bed at 9.30/10 pm, waking up finally at 6 or 7 am – and waking up 5 or 6 times in between is not good sleep either. This is a good case for application of ‘Music’ as ‘Sleep Medicine’. Why a PD patient’s sleep gets affected that way? Neuro-chemical changes, side effects of strong medication, mood disturbance (becoming anxious about the future – progress of the disease), worried about several things, getting old thus bringing changes in the circadian rhythm (day-and-night cycle) – are some of the attributable factors.
An obvious problem faced by a PD patient suffering from ‘Sleep Maintenance Insomnia’ is ‘Daytime Sleepiness’. What is the solution – how to overcome daytime sleepiness? The answer is very simple: engaging oneself in household physical activities which involve energy expenditure, or burning some energy by taking physical fitness activities, even walking indoors (ignoring the pain) – trying to maintain rhythm with a background music with beats (link provided to Jay Jen & Limujii – Dreamland). You can even do household dusting, grooming, mopping the floor, even washing clothes, cleaning dishes & utensils with the background music on. Of course, one has to take the decision of such energy-expending activities depending on the severity of the PD patient’s body tremor. If the body tremor is vigorous, that itself will burn a lot of calories available in the patient’s bio-system without any ROI (‘Return On the Investment’ of energy & effort). Hopefully, if the patient enjoys by more-or-less synchronising his body shaking with the rhythmic beats of the music, energy expenditure will be optimised gainfully.
The third major sleep-related problem faced by a PD patient occurs during the ‘REM Sleep Phase’. Sleep is essentially divided into two phases: ‘REM’ (‘Rapid Eye Movements’) & ‘NREM’ (‘Non-Rapid Eye Movements’). ‘REM’ is the ‘dreaming’ phase when the sleep is not sound as dreams appear and disappear and the brain wave may be 25 to 32 Hz. or cycles/second. During the ‘REM’, possibly the individual’s brain’s ‘Default Mode Network’ (DMN) becomes sub-consciously active. Out of the total sleeping time, REM sleep takes around 25 to 30 percent and the NREM (which is the undisturbed, sound sleeping phase) around 70 to 75 percent. During REM, for a normal person, the brain is active but the body is generally at rest. For a PD patient, however, the REM may manifest strange symptoms like: vocalisation (sleep-talking), vivid dreams, and movements (getting up from the bed unconsciously, sleep walking).
There is still a fourth problem – that is ‘nocturia’: the need to go to the bathroom a few times during the night. This is one of the most common causes of disruption of a PD patient’s sleep. ‘Nocturia’ cannot be avoided. A common problem is the patient wakes up, goes to the bathroom but can release only small amount of urine as the bladder had not been full to the brim. So, the patient must make sure to take enough water during the period when he had his dinner and he goes to bed. This gap should be minimum 60 and maximum 90 minutes. He has to drink the water not the whole in one go, but by sipping in small quantities. This practice would help him to generate adequate urine to be released the first time he visits the washroom. Before going back to the bed again, he should take just a sip (one or two teaspoonful of water) so that next time he goes to the toilet the residue left in the bladder is released if the entire amount had not been passed last time.
Now, my last and most important point. My empirical research on ‘Music Medicine’ is based, to a large extent, on the ancient Indian Medical Science of ‘Ayurveda’. According to the ‘Tridosha’ (Vata-Pitta-Kapha) paradigm of ‘Ayurveda’, sleep requires the blessings of ‘Vata’ (which is ‘Vayu’ or ‘Wind’). Amongst the wind instruments, Indian flute is the best instrument to be played to produce ‘Sleep Medicine’. The PD patient should provide a gap of 60 to 90 minutes post-dinner, before going to bed. Just before going to bed, he should listen to the ‘Sleep Music’ (link provided for 2 scores – you can listen to them alternately if you wish) for 5 to 10 minutes. Hopefully, his sleep problem will be largely reduced and he would not have to take the help of any sleep medication.
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Links have been provided to: (i) [1 Hour] – Jay Jen & Limujii – Dreamland (Vlog – No Copyright Music); (ii) Pt. Hariprasad Chaurasia – Raga Malkauns (Alap (Pseudo Video)); and, (iii) Healing Raga – Bansuri Flute Music, Buddha’s Lounge, 13th October 2021.
[References:
1. Dr Ron Postuma presents “Parkinson’s Disease and Sleep Disorders”, Parkinson’s Canada.
2. “Sleep Disorders in Parkinson’s Disease” – Dr Gary Leo, Davis Phinney Foundation for Parkinson’s, USA.
3. “Sleep and Parkinson’s Disease” with Dr Ron Postuma.
4. “Fatigue and Sleepiness in Parkinson’s Disease” – Pradeep Bollu, MD.
5. “Non-Motor Symptoms of Parkinson’s Disease” (The Mary Hanson Show); Guest: Okeanis Vaou, MD.
6. “Parkinson’s Disease – The Non-Motor Problems” – The Florey Institute.
7. Dr Carlos Singer, “How does Parkinson’s disease affect the urinary system?” National Parkinson’s Foundation.]
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Founder and Chairman at Learning Club - Brain & Body Management Consulting
2 年Thanks for reading & liking!