Polysomnography: A word long enough to put you to sleep!

So, how did you sleep?

I ask with a greater level of intrigue than simply for the commitment of connecting with you. I ask, because I care. I ask because I am a scientist.

A hundred or so years ago, what we knew about sleep was that we sleep to alleviate sleepiness. Considering that humans spend nearly a third of our lives in the sleeping state, it should come as no surprise that I (and many sleep researchers before me) remain unsatisfied with that deduction. The velocity of sleep research had been exponentiated by Hans Berger’s measurements of the brain’s electrical activity, depicted as waveforms, which he called an electroencephalogram.

Since the tool of electroencephalography (or, EEG) came to the slumber party in the 1920’s, sleep scientists began inquiring into the effects of sleep deprivation on the body, the role of sleep on cognitive power and, remarkably, observing that different stages of sleep occur in cycles through the night. All this is possible with the understanding of the brain as a battery – a component in a circuit that has a finite capacity for work with the inevitable outcome of needing a recharge.

When you are in a state of wakeful awareness, following demands of “to-do” lists and preparing for meetings, your brain may be functioning at maximum capacity. Daydreaming on a walk through a park during lunchtime requires the brain to be far less acutely involved in paying attention. As you read, meditate, or begin drifting off to dreamland, the output of your brain slows down sequentially and allows the initiation of sleep.

A person’s sleep and wakefulness is partially at the mercy of the usual “sleep-hygiene” factors:

  • timing and amount of caffeine intake
  • the stimulation of light exposure and humidity of the sleep environment
  • stressful events in one’s day
  • the body’s apparent chronobiology
  • what was eaten before bed…

The phenomenon of sleep is as unique to your body and lifestyle as the print on your fingertips!

Yet, there are numerous internal decision-makers for adequate or disturbed sleep – some of which the sleeper may not even be aware of.

I work as a collaborator with a team of remarkable clinicians at Ezintsha, a research centre located adjacent to Wits Health Sciences campus, for patients with illnesses like TB or HIV that drive major public health issues in South Africa. The HIV epidemic is currently rather well managed by the early-stage intervention and widespread distribution of antiretroviral therapies across South Africa. This follows nearly three decades of devastation. However, with the prolonged life expectancy and improved quality of life available to people living with HIV, epidemiologists observed the inflation of other devastating epidemics like hypertension, diabetes, metabolic syndrome, and heart attacks.

Cardiometabolic risk indicators like high blood pressure, sugar intolerance and cholesterol imbalances are on the rise, and researchers in HIV-related trials begin to engage with a new class of reported symptoms: those of obstructive sleep apnoea. Obstructive sleep apnoea describes the short-lived but repeated pauses in breathing during sleep, often indicated by snoring. This is frightening to both the patient and housemates who have heard the gasping snores that accompany the breathless event but fear not! Obstructive sleep apnoea is treatable.

So, why is this story important?

Sleep apnoea remains underdiagnosed in the general South African population, despite as many as 30% of people being at risk for this sleep-related breathing disorder. Its side effects include daytime sleepiness, chronic inflammation, reduced motivation, brain fog, changes in mood and of course a further rise in those nasty cardiometabolic risk factors. Cardiometabolic diseases are responsible for one out of every five deaths in South Africa. This is a public health crisis, which we can aim to mitigate with routine diagnostics for obstructive sleep apnoea.

Without the foundation of an EEG, an even more comprehensive sleep measurement tool would never have been possible. Cue, polysomnography! Polysomnography measures brainwaves in various sleep stages, but the addition of other physiological measurements like heart rate, chest and belly movement, blood oxygen levels and air moving through the nose opens the door to diagnosing obstructive sleep apnoea through overnight sleep observation – which is exactly what I do! Polysomnography tells the story of how we sleep – I am simply the reader.

On academic detachment and relational research

A few months ago, I started a postdoctoral position at the University of Cape Town. Becoming part of an environment of active and supportive(!) scholarly exchange made me realise how much I had conditioned myself to work independently so far in my still rather pubescent academic life. While that is not a bad thing per se, I firmly believe that research is inherently relational. It is a form of knowledge production that requires a stimulus beyond stoically practicing data collection and writing in the ways we have learnt to be academically sound.

I have technically been working ‘from home’ for quite some years now. Doing my Masters by dissertation meant that I was only on campus for departmental seminars and irregular meetings with my thesis supervisor. This was after I had done a six-week qualitative research project on refugees in Cape Town and practices of dreaming for my Honours degree, which had given me an appetite for more in-depth research. I missed being part of academic life during my Masters but was really excited to conduct my first long-term ethnographic fieldwork. It allowed me the time and space to immerse myself in a topic for much longer – this time doing research on suburban neighbourhood surveillance groups. I would get a degree for spending my time observing, interviewing and writing – I was thrilled! And it really was a great experience at the time, even if not without ups and downs. I established my routines and enjoyed being able to do so without being impeded by class schedules and other academic obligations.

After embracing my degree certificate for my work, which, thankfully, had not felt torturously laborious for the most part, I worked for a health research organisation for three years remotely. Even though the topics I got to research interested me, my junior status and the fact that the project I was hired to work on did not materialise had me working on bits and pieces of other peoples’ projects. There was therefore no substantial, stimulating exchange with colleagues beyond brief Skype updates. When the situation did not change and funding became even more limited, I pursued my PhD on Tinder dating – another opportunity to spend A LOT of time talking to people about a topic that fascinates me.

I have always embraced a sense of independence. As a younger girl, I envisioned myself growing into a journalist when older, travelling around the world, covering all kinds of exciting topics. The anthropologist I grew to embody instead has roamed the world much less than I would have liked – mostly for funding reasons. I have, however, still managed to go out and explore the very themes I felt strongly about. It has taken a moment, but I feel like I’m getting closer to positioning myself in academia and thinking of myself as a ‘digital anthropologist’ – whatever that may actually mean. Especially through writing many an application in search for a postdoc, summarising my interests concisely over and over helped with that.

Having my first ‘proper’ (as in, fully paid) position pursuing my own research interests and now being part of a lively even if still remotely operating academic environment makes me feel the last years of academic detachment. Particularly so after the past 1.5 years of COVID-19-enforced remoteness. I am hungry for fieldwork and even more hungry for exchanging ideas with other scholars. Scholars, that is, who harbour a collaborative rather than a competitive sentiment – something that is not to be taken for granted.

I got a strong sense of what a collaborative spirit can do when attending my first hybrid workshop on UCT campus the other day. The big screen was not working and the five of us who were present in person were all still looking at our respective computer screens with our facial expressions hidden behind masks. And still, it was a very different feeling from following the same meeting from my kitchen table. The workshop went on for more than three hours, but I felt enlivened by the mere physical proximity of colleagues with whom I could exchange thoughts on our projects located within the same research cluster. It may have been the combination of the ability to share our progress and insecurities within this space, working on a similar research topic and having been deprived of unmediated support for a long time that made for this animating effect.

For me, the takeaway from these experiences is to, yes, embrace the autonomy research allows me when it comes to going to a certain field and approaching a topic in an exploratory manner – even though this autonomy in always also impeded by funding, institutional expectations and the pressures to fit moulds in academia. And the way things have panned out for me also cautions me to value not just my relations to the people I work with when conducting research but also academic environments that offer me space to develop frameworks to think with. Even if it is sometimes hard to admit, at the end of the day, none of it can be done alone.