NEXT ONLINE CONSULTATION: the doctor’s next topic for answer online is sleep. Send your questions on this topic for answer online on Wednesday, July 18. How to send a question and other topics
I have read that siestas are making a comeback in Spain and I am about to go on holiday to Italy, where I hope to enjoy later nights and longer lunches than usual. Are there any rules to having a siesta?
Just as lions retreat beneath the trees, dogs fall asleep by the fire, scorpions hide under stones and birds disappear into the shrubs after eating, so should people seek a few moments of rest after lunch before returning to the urban jungle.
Only humans with their self-imposed social demands assume that evolution has programmed them so that they can wake up in the morning, be immediately alert and stay that way until 14 hours and several heavy meals later. However, we have far more in common with brute beasts than a human resources department cares to admit. Humans would if they could behave as nature intended and disappear from view around midday. Most people (there is considerable individual variation) have two peaks of vitality, of which the second is the greater one. The first peak occurs soon after waking up in the morning but starts to wane before lunchtime. If the lunch is a good one it may be a struggle for those who have enjoyed it to keep the eyes open and concentration focused during the afternoon. Even without a quick nap most people’s intellectual tempo starts to recover by about 3 or 4pm. This second period of vitality is for the majority their most intellectually and physically active period of the day.
I have often recommended to patients that they shouldn’t fight their biological clock, especially if it is accentuated by a heavy lunch. Rather, they should have a short rest: even five or ten minutes can be enough to revitalise someone and can hasten the advent of the second period of vitality. For years I had been a dilapidated but comfortable old chair, so distressed that it could have been a prop in a Lucian Freud painting, that unfortunately failed to survive a recent move. Its loss has sorely affected my office routine.
Advertisement
Some patients have taken my advice rather more literally than I intended. I once gave it to a board director of one of our larger banks. His staff were astounded when they came in one morning to discover that the builders were busily converting the office next door to his into a bedroom. Every day the director returned from his City lunch and locked the door of the bedroom to snooze contentedly until teatime.
There is a lot of evidence that power napping – what used to be described as a quick kip – is invigorating and useful in the office and may be life-saving on the motorway. The period of sleep should be restricted to around 20 minutes, otherwise the patient may find that their ability to sleep at night is reduced. Just as some people find it hard to get going in the morning, so do others find it difficult to get back into top gear if they have had too long an afternoon’s sleep.
Recent news about the return of the Spanish siesta, in which it was reported that hotels are renting out their rooms for an hour at a time, gave scant attention to the established custom of renting a bedroom only for the afternoon. The motivation for hiring these was often sex rather than sleep, but if anyone has this in mind they should beware. Good quality research some years ago showed that the likelihood of a heart attack during or after sex was greatly increased in those who indulged in this when on holiday in the sun or when they were having an affair. Several factors seem to be involved in this increased vulnerability, of which exercise after a heavy meal and excitement were only two.
A reader from Wiltshire has asked how it is that, although she reads that more than two million children worldwide die from pneumonia each year, no attempt has been made to vaccinate her four-year-old son.
Advertisement
Two million children die from pneumonia every year but not all these cases are the result of infection with the pneumococcus bacteria. Streptococcus pneumoniae, the more precise name for the pneumococcus, is an organism that gives rise to potentially fatal cases of pneumonia, meningitis and septicaemia, as well as an enormous number of cases of inflamed ear drums and sinus problems. Fatal infections are especially likely to affect those with a damaged immune system, which includes the very young, who are under two, and the elderly, whose immune system, once they are over 60 or 65, is not what it once was.
Fortunately there are two types of vaccine against the pneumococcus bacterium. One is traditionally given to young children under two, as the other type is only effective in those over this age. The advantage of giving young children up to the age of five the appropriate vaccine is not only that it will protect them but it also increases the immunity of the whole family and those around them. The reader is quite right. Although her child is beyond the usual age when the childhood vaccination programme against pneumococcal infections is usually started, and his immune system will be improving, she should still discuss possible vaccination with her GP. We make inadequate use of this vaccine which is of proven safety and effectiveness. Its use in the developing world, where the immune system is undermined by malnutrition, other infections and sometimes sickle cell anaemia, would save many hundreds of thousands of lives a year.
I certainly recommend that vaccination should be considered for any young child or older member of a family. The type of vaccine used in older people is different from the type used for a course of injections in babies and children up to the age of five. The one currently used in older children and the elderly may need repeating. In those older people who are most vulnerable, a booster may be needed as soon as five years after the first dose. Dr Orin Levine, an international expert on pneumococcal vaccination, said at a meeting in London recently that although one couldn’t be dogmatic, he had doubts about the amount of protection it gave to elderly people seven years after their first antipneumococcal jab. Effective vaccination reduces the chance of pneumococcal septicaemia in adults by 50 per cent and probably has an even greater ability to prevent pneumococcal pneumonia in this age group, but no accurate statistics are available.