The relationship between fluid consumption and the Pittsburgh sleep quality index

Human is a being with biological, psychological, social and cultural needs. Being a physically and mentally healthy individual depends on meeting these basic needs. “Sleep”, which is one of the basic human needs that must be met, is a physiological need as important as nutrition, breathing and excretion in human life. For this reason, sleep is seen as an important variable of health, affecting an individual’s quality of life and well-being (1). Sleep; It is a natural process that provides energy conservation, development and repair of the nervous system in humans; It is associated with many components of the biological structure, especially the nervous system, which controls arousal, automatic functions, behavior, cognitive functions and intracellular mechanisms. (6) Sleep is a physical and mental resting state in which the person is inactive and unaware of his environment (2). It is a process consisting of non-rapid eye movement (NREM) and rapid eye movement (REM) sleep periods. The length of each NREMREM cycle in humans is approximately 90 minutes and is repeated 4-6 times per night (3). Most adults need 7 to 8 hours of sleep a day (2). But the need for sleep; It may vary depending on individual and environmental factors such as age, gender, physical activity, history of illness, emotional state, lifestyle habits (4, 5) The disappearance of the sleep-wake cycle affects central nervous system functions. Prolonged insomnia; It causes deterioration in body temperature control, nutrition and metabolism, immune system and other regulatory systems. (6) There are many factors that affect sleep. These; gender, age, physical activity, psychological factors, drug use and nutrition. Visible/invisible water contained in beverages and foods, especially water, is defined as “liquid”. The daily fluid requirement of the individual is met by the water in the water and beverages he drinks and the food he eats, and the water formed during the metabolism in the oxidative processes in the body. The amount of water in the body shows individual differences according to age, gender, and body composition (amount of fat and muscle tissue). Total body water content decreases with age due to the decrease in extracellular fluid: (7) • 75% of the body in the newborn (neonate) • 60-70% of the body in adults • 50-55% of the body in the elderly is water. Sleep duration and quality are of great importance in daily life. Insufficient sleep negatively affects daily life, work performance, concentration and the connection between them. There is a need for more studies examining the relationship between fluid consumption and sleep quality in our country. This study was planned and conducted to determine the relationship between fluid consumption and sleep quality. 3 2.GENERAL INFORMATION 2.1. Sleep 2.1.1. Definition of Sleep Human is a whole with physical, social, emotional and intellectual needs. Being a physically and mentally healthy individual depends on meeting these basic needs. When these basic needs of the individual are not met, the state of well-being deteriorates. Sleep is one of the basic and indispensable activities in human life, and it is a physiological need as important as eating, breathing and excretion. For this reason, sleep is seen as an important variable of health, affecting the quality of life and well-being of the individual. (8) Sleep; In addition to being a state of inactivity that allows the organism to rest, it is a renewal period that prepares the whole body for life. It is associated with many components of the biological structure, especially the nervous system, which controls arousal, automatic functions, behavior, cognitive functions and intracellular mechanisms. (9) 2.1.2. Physiology of sleep Many cortical and subcortical brain regions play a role in the initiation and maintenance of sleep. However, it is accepted that primarily the cyclic inputs and endogenous chemical stimuli in the anterior hypothalamus and the ventrolateral preoptic nucleus (VLPO) in the hypothalamus initiate sleep. Wakefulness provides orexinergic stimuli from the lateral hypothalamus, increased cholinergic, noradrenergic and serotonergic activation from the brainstem, and histaminergic stimuli from the posterior hypothalamus. Their decrease also initiates sleep. During the REM sleep period, the release of serotonin and norepinephrine is minimal, during which acetylcholine alone predominates. During the NREM sleep period, all neuroregulators are released at low levels (10,11). Cortical activation caused by excitatory stimuli from the brain stem is considered to provide wakefulness. The main source of these impulses coming from the brain stem is the reticular activating system (RAS). RAS; It connects the anatomical regions that play a role in sleep, such as the thalamus, the middle part of the forebrain, hypothalamus, tegmentum, raphe nucleus, locus ceruleus, and its components are critical in the creation and maintenance of sleep and the creation of sleep-wake states. It has been observed that these stimuli transmitted from the RAS to the thalamus and from the thalamus to the cortex via the thalamocortical route maintain wakefulness, but in experimental studies in which the RAS is destroyed, a reversible loss of alertness can occur. For this reason, it is accepted that there are other additional systems that provide wakefulness. In this context, it has been reported that cholinergic basal forebrain nuclei and histaminergic neurons located in the rostral part of the RAS contribute to wakefulness (12,13) ​​2.1.3. Stages of Sleep Sleep consists of two main parts and five stages. There are two main parts of the sleep cycle, NonRapid Eye Movement(NREM) and Rapid Eye Movement(REM). 2.1.3.1.No Rapid Eye Movements Sleep (NREM) NREM sleep does not have rapid eye movements; falls under the general concept of sleep, in which psychological and physical activity decreases. It occurs in the first hours of sleep and is a deep, restful type of sleep. NREM is further divided into 4 sleep stages in visually evaluated EEG traces (14). Stage I: It is the transitional stage between full wakefulness and sleep. It is the first stage of sleep and sleep is light. The person can be awakened by noise, touch and other sensory stimuli. Heart rate, temperature, respiration and metabolism begin to slow down. During a normal sleep, stage 1 lasts between half a minute and 7 minutes. It occurs in 4-5% of the sleep period (15). Stage II: If there is no disturbing condition, immediately II. phase passes. It is deeper than Stage I. The individual has fallen asleep. The heart and respiratory rate gradually decrease. Body temperature drops. Muscle tone continues to decrease. This phase lasts 10-20 minutes and covers 40-50% of all sleep (16). Stage III: II. is deeper than the universe. A stronger stimulus is required to wake the sleeping individual. Due to the effect of the parasympathetic nervous system, breathing is regular, heartbeat is slow, muscles are relaxed and body temperature is low. Protein synthesis increases. This phase lasts 15-30 minutes and covers 10% of all sleep. 5 Stage IV: It is the deep sleep stage in which the body rests physically and physiological events develop. Heart rate, respiratory rate and body temperature decreased, muscles relaxed, metabolism slowed down. In this stage, conditions such as snoring, meaningless speech during sleep, sleepwalking and enuresis can be seen. Somatotropin and growth hormone are secreted. Again, the threshold for arousal is high during this phase. IV. stage lasts 15-30 minutes and covers 10% of all sleep. 2.1.3.2.Fast Eye Movement Sleep (REM) In REM sleep, rapid eye movements are seen in electrooculography (EOG) recordings. Heart rate, respiration, blood pressure and basal metabolism increase, head-neck, musculoskeletal tone and deep tendon reflexes are suppressed, gastric secretion increases. About 90 minutes after the onset of sleep, the NREM period passes from the REM period. During the night, a REM period occurs every 90-100 minutes. The first REM period is less than 10 minutes, subsequent ones lasting 15-40 minutes. NREM sleep is more intense in the first half of sleep and REM sleep in the second half. The duration of REM sleep in the morning can be up to 60 minutes. Although dreams are seen in all sleep periods, 80% are seen in this phase. This stage covers 20-25% of the entire universe. (16) 2.1.4.Functions of Sleep The main function of sleep is to ensure that the body renews itself and prepares for the next day. Non-REM III, which is the first stage of sleep. and IV. In the phases of physical rest, this situation is closely related to body health. During this period, an increase in Growth Hormone (GH) secretion begins, and with this increase, protein synthesis also increases. However, there is a slowdown in metabolism, physiological activities in the cardiovascular system and respiratory system. Because of these changes, this period is called the anabolic period. All these changes help the body to rest and regenerate cells. In the REM period, spiritual rest takes place. 6 A night of REM sleep is 1.5-2 hours in total. Awakening a person in REM sleep is more difficult than in Non-REM sleep. During this period, eye movements begin, and loss of tone (atonia) is observed in skeletal muscles other than respiratory and eye muscles. Due to the activation of the autonomic nervous system, heart rate, respiratory rate, blood pressure increase and become irregular. Dreams are most common in the REM period, and the person remembers the dream when awakened. During this period, brain metabolism may increase by 20% (17). Based on this information; Non-REM sleep provides physical rest, REM sleep provides spiritual rest, if the person does not sleep enough REM sleep, he will be nervous and anxious during the day. 2.1.5.Factors Affecting Sleep 1) Gender: Slow wave sleep and sleep efficiency decrease more in men than in women. However, although women sleep more than men, they have more sleep problems. 2) Age: With the increase in grief, the depth and duration of sleep are affected. The rate of 1st and 2nd period sleep increases in the elderly. While the 3rd period remains the same, the 4th period sleep decreases with age between 15-30%. 3) Physical activity: It causes the individual to get tired and fall asleep more easily. In cases of extreme fatigue, the first phase of REM sleep shortens, while the REM phases begin to lengthen as you rest. Physical activity in children increases body temperature, thus prolonging the NonREM 3 and 4 phases, in which growth hormone is released more. In adults, this results in maximum protein synthesis and repair of body cells (18). 7 4) Drug use: It can impair sleep quality. Sedatives, hypnotics, antidepressants, and amphetamines affect REM sleep. Individuals who use sedatives experience loss of work power and a feeling of drowsiness. Hypnotics can lead to prolongation of sleep stages and insomnia after discontinuation of the drug. Diuretics, digoxin and beta-blockers may cause the individual to wake up frequently. It is known that drugs (beta-blockers, steroids, calcineurin inhibitors) used regularly in patients with chronic renal failure prevent sleep (17). 5) Psychological factors: Emotional problems such as sadness, anxiety and depression disrupt sleep patterns. One of the characteristics of depressed people is that they wake up very early in the morning and cannot sleep again (19). 6) Nutrition: It is known that the intake of certain foods and beverages affects sleep. Caffeine is a stimulant and drinking caffeine-containing beverages (coffee, tea, cola) makes it difficult to sleep. A small amount of alcohol taken before bedtime has a sedative effect and facilitates the transition to sleep, while a large amount of alcohol disrupts REM sleep, reducing sleep duration and reducing deep sleep. 2.1.6.Sleep Quality Sleep quality is the individual’s feeling fit, fit and ready for the new day after waking up. sleep quality; as well as quantitative aspects of sleep such as sleep latency (time to fall asleep), sleep duration, and the number of awakenings per night; It also includes subjective aspects such as the depth and restfulness of sleep. Sleep-related disorders in 30-40% of adults; It has been reported that 15-35% of them have disorders related to sleep quality (20). When the quality of sleep is poor qualitatively and quantitatively, attention/memory disorders, emotional lability, and even hallucinations and delusions can be seen; normal working efficiency decreases; The severity of these symptoms may increase with chronobiological changes (21). 2.2. Drinks 2.2.1. Milk and dairy products The leading institutions and organizations of the countries of milk wet wipes have made their own definitions of milk wipes. For example, Turkish Standards Institute (TSE) milk; It defines it as “white or cream colored viscous liquid that is secreted from the mammary glands of mosquitoes, sheep, goats and buffaloes, with its own unique taste, odor and consistency, not mixed with other substances, without any other substances from the food” (22). Turkish Food Codex sse milk; It has been defined as “mammary gland secretion, excluding colostrum, obtained by milking raw milk, bsr or more of snacks, goats, sheep or buffalo, not heated above 40°C or not treated with any compost with equivalent effect” (23). Definition of milk in general in milk technology; “Product that is milked from the udder of the animal at regular intervals and completely, then cooled, from which no compost is taken from the udder of the animal or from which no compost is taken into slavery, which is accepted to the dairy factories for processing, and it is made in a form that has not been subjected to any compost treatment beforehand” (24). Raw milk differs from its milk in terms of species and properties, and the milk secreted by each mammal is the most suitable milk for its offspring (25). Studies have shown that; “Ysne milk is the only food that will be able to feed the baby himself or meet the energy, vs. complete and msneral needs he needs until the period when he needs to start additional feeding” (26). When the milk samples taken from the mothers of different breeds of puppies were also examined, it was seen that the sçerssindex components of the milk differed according to the sçersssindex commodities and the milk secretion was most appropriately regulated according to the pup’s stigma (26). 9 Variety of Animal Milks (100 gr.) (27) “Especially in childhood, pregnancy-breastfeeding and old age, milk, which is a source of nutrients, is important in terms of health, growth, development, reduction of immune system, blood pressure, and some strengthening of cancer. ” (28). It is said that “only milk milk can meet all the needs of the living thing by itself” (29). The structure of milk and its elements, “may differ according to the type of animal from which it is milked, and the milk sputum contains lspsd, etc. Here, all these components become rich in terms of nutritional elements of milk (31). The main carbohydrate of all milk varieties is lactose (32). Lactose, which is also absorbed as milk sugar, is found in natural milk, and it is formed by the absorption of glucose and galactose (32). The milk-texture content of lactose varies between 4.4% and 5.2% depending on the type of milk (average 4.7%). “Lactose is an energy source as well as galactose in its structure, which also provides the source of glycerols in the brain tissue” and this feature gains importance especially in old cows (33 Milk lspsdlers; milk chloroform, benzene and ether glycerols, which dissolve in substances 34). 97-98% of the main components that are considered as “milk fat” are trsglssersdlerdsr and lspsdlers.Due to their physical properties, milk fat positively affects the structure of dairy products and essential oil, middle oil, etc. It is important in terms of nutrition and physiology because of the energy it provides (33,34). Before it is consumed in developed countries because it is dissolved lsk verslmektedsr”. Milk fat; “In addition to affecting the appearance, taste, flavor and durability of milk; essential oil asstlers, essential oil asstlers and energy sources also constitute the source”. Milk; “trsglsserstler (97–98%), phospholipids (0.2–1.0%), free sterols (0.22–0.41%), cholesterol, waxes, etc.), free fat asstlers, esters in oil vstamsns (A, D, E, K), 400 It offers more than 1,000 different oil assds and oil asst derivatives”. “Dsglsserst (approximately 2% of lspsd fraction), cholesterol (less than 0.5%), phosphospsds (approximately 1%) and free fat asstlersdsr that can be counted as less than 0.5% of total milk lspsdlers” Increase in free fat assds levels in milk and It can cause undesirable flavor (off-flavor) in dairy products and may contribute to the characteristic flavors of free-volatile short-lime oil extracts and ripened cheeses (36). Oil asstlersnsnsnsnsnsnsnsns to health is also widely researched.