The Insomnia Blog - Sleep Doctor Michael Breus, PhD

Are You a Ticking Time Bomb?

If someone said to you that your lifetime risk of a heart attack is close to 100 percent, you’d probably want to do everything you can to either prevent that fate or delay it by as long as possible. Right?

Heart attacks continue to be the number one killer of Americans; 1.5 million heart attacks occur in the United States each year with 500,000 deaths. Costs related to heart attack exceed 60 billion dollars per year.

Most of us are aware of the ways in which we can help keep our hearts healthy:

• Eating a sensible, balanced diet high in healthy fats and low in saturated fat.
• Keeping our cholesterol and blood pressure under control.
• Maintaining a regular exercise routine that gets our heart pumping faster.
• Managing stress.

But what about sleep? How does that factor in?

Turns out that sleep factors in big time: a new study shows that poor sleep may worsen heart health by increasing inflammation. Chronic inflammation has gained a lot of attention in recent years due to the associations found between this bodily process and an array of illnesses and disease. While inflammation is a normal physiological process and part of our immune system, when it runs amok it can wreak havoc on our cells and tissues. Which explains why inflammation can play a major role in heart health, as it can lead to restricted blood flow and increase the risk of heart attack and stroke.

This recent study found that regular bouts of insomnia and poor sleep quality may increase inflammation throughout the body, which may be further aggravated by high cholesterol, resulting in heart complications. The specifics:

• After surveying 525 participants on their sleep habits, researchers from Emory University measured their levels of certain inflammatory hormones, including the famous C-reactive protein that’s used as a biomarker for inflammation.
• They found that individuals who regularly got the least sleep were significantly more likely to have high levels of the hormones and consequently, inflammation.
• In fact, adults who slept for six or fewer hours had higher levels of all three inflammatory markers that the researchers measured.
• The researchers at Emory also noticed that men and women with poor sleep quality had higher blood pressures.

Something else that the researchers discovered to their surprise:  men—not women—who experienced poor sleep quality had less flexible arteries. This condition also contributes to hypertension and puts more stress on the heart.

The reason for this could be due to certain hormones or other variables going on in women that help explain the discrepancy. This doesn’t mean women can get away with poor sleep. It just means we need to study the gender differences when it comes to health and their separate risk profiles.

Fibrinogen, one of the other markers observed in this study, forms a fibrous mesh that slows the blood flow, thus increasing blood pressure and potentially causing hypertension. This fibrous mesh quickens the time it takes for your blood to clot, which can cause a stroke or heart attack. 

So it goes without saying that we all need to keep sleep on our list of priorities for keeping our hearts healthy and strong.

Bottom line: Rest up to keep your heart up and running. You may feel like a ticking time bomb as you juggle too many To Dos and run around like mad addressing your commitments and obligations. But that ticking time bomb can be real if you’re simultaneously throwing sleep out the window. Add more minutes to your life just by adding more quality sleep minutes to your time in bed. 

It really could be as easy as that.

Sweet Dreams,

 

Michael J. Breus, PhD

The Sleep Doctor™

www.thesleepdoctor.com

Don’t Get Caught Drowsy Driving this Holiday Season

The statistics speak volumes:

• Approximately one in every six fatal crashes—or 16.5 percent—in the US involves a drowsy driver.
• Ten percent of drivers surveyed by the AAA Foundation for Traffic Safety admitted to falling asleep while driving their vehicle during the past 12 months.
• At least one-quarter of respondents said that they got behind the wheel during the previous four weeks even though it had been hard to keep their eyes open.
• And paradoxically, when asked how acceptable driving while finding it difficult to keep your eyes open was, a whopping 85 percent said it was unacceptable.

Translation: we don’t walk our talk. People who see drowsy driving as unacceptable have done it themselves. 

The authors of this latest study explain that some drivers may not understand the impact not getting enough sleep can have on an your alertness, reflexes, and degree of fatigue.

I couldn’t agree more. Drunk driving is such a strong societal taboo, and yet drowsy driving may arguably be more prevalent—and equally as dangerous. Similar to the effects of alcohol and other drugs, sleepiness decreases awareness, slows reaction time, and impairs judgment. Add that to an existing sleep disorder and you’re looking at a recipe for very serious disaster and harm to yourself and others. Consider these other stats:

• Drowsy drivers are involved in 1 in every 8 crashes in which somebody ends up in a hospital
• One in every 14 crashes in which the vehicle was towed away involves a driver who was drowsy.
• Sleepers with mild sleep apnea are twice as likely to crash their cars.

As we enter the holiday season, this latest survey makes for a good reminder. When you add the stress of family gatherings with copious food and beverage—not to mention sugar highs and sleep deprived lows—it’s enough to leave anyone exhausted at the end of the party. Yet we all need to get home somehow.  It’s practically human nature to underestimate the negative effects associated with fatigue and sleep deprivation and, conversely, overestimate our abilities to overcome them while driving.

This new data underscores the importance of recognizing the power of sleep deprivation and the perils that can await us when we don’t take measures to police our own habits, as well as our wellbeing. It is really very simple: If you are the least bit sleepy, do not put yourself or others in danger.   A designated, sober and well rested driver is something to consider this holiday season.

Sweet Dreams,

Michael J. Breus, PhD

The Sleep Doctor™

www.thesleepdoctor.com

 

Fibro and RLS: The Connection

There are a lot of associations in medicine. If you have X condition, you’re likely to suffer from Y as well. If you’re at risk for A, you’re also at risk for B and probably C as well. Now we have a new connection to consider in my realm: it appears that patients with fibromyalgia have a high prevalence of RLS—restless leg syndrome.

Fibromyalgia is a condition that affects the muscles and soft tissue. It’s considered the most common arthritis-related illness after osteoarthritis, and its hallmark symptoms include chronic pain in the muscles, fatigue, sleep problems, and painful tender points or trigger points at certain parts of the body. It can be difficult to diagnose because there is no single test for the ailment, which is why doctors have to rule out other conditions before diagnosing fibromyalgia.

More than 12 million Americans have fibromyalgia. Most of them are women ranging in age from 25 to 60. Women are 10 times more likely to get this disease than men.

Because of the toll fibromyalgia takes on people physically, it’s no surprise that patients have a harder time getting a good night’s sleep as they endure chronic aches and pain. But the link found between fibro patients and RLS is intriguing. Fibromyalgia and restless legs syndrome share certain features:

• women are more likely to suffer from fibromyalgia and RLS
• there appears to be a genetic component because these conditions run in families.

RLS is equally a mysterious disorder in the sense that we don’t know exactly what causes it and as such, we don’t have a magic bullet for curing it in everyone. Sometimes an iron deficiency can be to blame, for which there is a clear remedy. But many patients with RLS do not fit into a tidy category whereby the direct cause is known. Other problems that are sometimes linked to restless legs syndrome include kidney failure, rheumatoid arthritis, diabetes, nerve damage, anemia, and Parkinson's disease, but most people who seek treatment do not have any of these other problems. Pregnancy accounts for many RLS cases (and contributes to the gender disparity), and women who get RLS during pregnancy often find that the condition vanishes after giving birth.

The scientists who published the study on this newfound association pointed out that the overlap between fibromyalgia and RLS share several characteristics. Both conditions can include sensory alterations, the use of antidepressants that can influence the dopamine system, and beneficial effects for exercise. What’s more, an important implication of the study, according to the researchers, is that restless legs syndrome is treatable with drugs that change the dopamine patterns in the brain.  Physicians are urged to ask fibromyalgia patients about symptoms such as leg movements when they are trying to sleep and unpleasant sensations in their legs.

It goes without saying that alleviating these symptoms can enhance a fibromyalgia patient’s experience with sleep and overall quality of life. And it also should be noted that the recommendations for fibro patients are similar to those who seek relief from RLS (or any sleep disorder for that matter). They include:

• Avoiding tobacco, alcohol, and caffeine.
• Getting regular exercise.
• Keeping your bedroom cool, quiet, and comfortable.

The two problems with this study? For one, the researchers determined the presence of RLS among their participants through questionnaires. They weren’t able to factor out people with RLS that can be attributed to medications they were taking at the time. And second, because of the cross-sectional design of the study, the researchers could not ascertain a simple cause-and-effect relationship. Put simply, further research is necessary to clarify a potential causal relationship between the fibromyalgia and restless legs syndrome.

I am however excited to see research in this area linking these two mysterious disorders and I look forward to more research

 

Sweet Dreams,

 

Michael J. Breus, PhD

The Sleep Doctor™

www.thesleepdoctor.com

 

 

Teen Sleep and Mood, Texting and Emailing

As if we really needed anything else affecting a teen’s mood and sleep, recent research shows that of internet use and texting can have a serious detrimental effect on both sleep and mood.  At a conference in Canada, US researchers explained that:

• More than half of kids and teens who text or surf the internet:
  • Have problems falling asleep (77.5%)
  • Have trouble staying asleep - all participant reported being woken up at least once per night by an electronic device
  • Experience mood, behavior and cognitive problems during the day
    • including ADHD, anxiety, depression, and some learning difficulties.

The study showed that on average, a teenager sends a total of 3400 electronic message per month - that is more than 100 per day! When exactly are they in school? And here was the kicker:  author of the study, Dr. Peter Polos, said that on average, kids were texting or emailing 33.5 times per night to more than 3 different people (3.7)! And these electronic messages would occur anywhere from 10 minutes to 4 hours after the child’s bedtime!

While this is not the first time I have written about this, the data in this study are pretty amazing. What can a concerned parent do?

1. Education is key-letting children know how the use of these electronic devices can affect their sleep and their performance the next day is critical in monitoring of their own behavior.
2. Setting a electronic curfew- 1 hour before bed, kids need to turn off all of the electronic devices that they normally use, and participate in the Power Down Hour™:
   • 20 min of finishing up things to be done for tomorrow (e.g., getting clothes ready, packing up their backpack for school, etc.)
   • 20 min for hygiene-nighttime bath, shower, brushing teeth, washing face, etc. (remember to do these in a dimly lit environment)
   • 20 min for a relaxation ritual: reading a book with a parent, saying nighttime prayers, spending time talking with a parent about their day, etc.
3. Have the device in question out of reach- Charge cell phones in a special room and computers can be turned off or placed on a timer.

Yes, the information superhighway is a great tool for education and communication, and yes, cell phones can keep us in touch with our friends and loved ones, but when these devices begin to invade our sleeping world, as parents we need to adjust access for our kid’s better health. And parents, we can take a tip, and apply these rules to ourselves as well -  my guess is our sleep and mood is also affected by nighttime emailing and texting….

Sweet Dreams,

Michael J. Breus, PhD

The Sleep Doctor™

www.thesleepdoctor.com 

Does Sleep Deprivation Pose A Cancer Risk?

Perhaps nothing is scarier than receiving a diagnosis of cancer, even if it’s caught “early” and therefore “treatable.” Theories abound on ways to prevent cancer and even help heal the body during treatment, from changing one’s diet to managing stress and engaging in mind-body activities like meditation and deep breathing.

But what about paying attention to sleep? Have there been any connections made between sleep and cancer?

There’s no question that getting restful sleep is beneficial for both healthy people and those battling cancer, but now we have evidence that people who sleep less than six hours a night could be more likely to have dangerous polyps in their colon or rectum compared to better-rested patients. The study, which was published by the journal Cancer in October, reflects the first time anyone has ever found a link between sleep duration and risk of polyps, which are tied directly with the risk for colon cancer.

Polyps—the abnormal growths detected during a colonoscopy—can progress to become cancerous tumors, which is exactly what happens in about 10 percent of cases. The stats in particular:

• More than 140,000 Americans will be diagnosed with colorectal cancer this year, and some 51,000 will die from the disease, according to the National Cancer Institute.
• Researchers at Case Comprehensive Cancer Center at Case Western Reserve University in Cleveland studied 1240 men and women who came to their hospital for routine colonoscopy.
• Overall, the researchers found polyps in 338 people, or 27 percent of the entire group.
• Analyzing the sleeping patterns of the subjects, they found a higher rate of these polyps in people who reported getting less than six hours of sleep (29 percent) than in those who said they slept seven or more hours nightly (22 percent).
• The difference in sleep time between polyp patients and those without the lesions was small, only 19 minutes, on average. But more polyp patients reported sleeping much less than six hours, while few said they slept more than seven.

Don’t panic: Even if this newly discovered link is causal, it doesn’t necessarily mean you’ll get colon cancer. Put simply, the findings don’t prove that lack of sleep causes these polyps to occur. The results simply indicate that people who don’t sleep much at night might have the same chance for developing colorectal cancer as other high-risk groups, such as people with a close relative who has been diagnosed with the disease or those with a diet high in red meat.

It’s also fair to remind you that this study is just one in a slew of studies to come. What looks like an effect of sleep might in fact reflect some other factor the researchers were unable to measure.

But I look forward to those studies. Once again, it wouldn’t surprise me to read that sleep and cancer indeed share a unique relationship. Nothing could be simpler than getting more quality Zs in the name of cancer prevention.

 

Sweet Dreams,

Michael J. Breus, PhD

The Sleep Doctor™

www.thesleepdoctor.com

The Survey Says - Get Just Enough Sleep For A Long Life

The old adage rings true: moderation is key. A new study published online in the journal Sleep Medicine reveals the secret to a long life lies in getting “just enough” sleep—not too much and not too little. The findings were based on novel sleep research performed by researchers at the University of California, San Diego who went back to follow up on women who had participated in a sleep study from 14 years ago.

In that earlier study, which was part of the Women's Health Initiative, the researchers examined 459 women living in San Diego ranging in age from 50 to 81 to determine if sleep duration could be associated with mortality. They had used wrist activity monitors to record sleep durations and believed that sleeping 6.5 to 7.5 hours per night would be the ideal number.

What did they find after 14 years?

• Of the original participants, 444 were located and evaluated.
• Eighty-six women had died.
• The surprising discovery: When sleep was measured objectively, the best survival was observed among women who slept 5 to 6.5 hours.
• Women who slept fewer than five hours a night or more than 6.5 hours were less likely to be alive at the 14-year follow-up.

The biggest surprise of all: older women with obstructive sleep apnea (OSA), notoriously linked to increased mortality risk, didn’t seem affectedby it. In other words, sleep apnea does not seem to carry this risk in the older age group, particularly for women.

This doesn’t go to say that older women needn’t worry about sleep disorders, even if they have sleep apnea. I’d like to see the breakdown of how many of the women diagnosed with OSA were treating their condition. Perhaps these women were veteran OSA patients, whose excellent sleep habits, which could have helped with other adverse medical conditions associated with OSA.

What I find interesting is that the “range” in ages of these women 14 years later is 64 to 95, and my guess is that those who died were mostly from the higher age brackets when they entered the study fourteen years ago. Any of these women who made it to 95 likely has more than just good sleep hygiene working for her. I can’t help but wonder, did any of the women who logged more than 6.5 hours a night push 100 years old?

It appears the ideal amount of sleep, at least for the women in this study, may not be as high as previously believed. Fewer than 5 hours a night is probably not enough sleep. Eight hours might be too much. Six to six and a half hours is the average night’s sleep for millions of women, especially moms.

This study does show that there is no one size fits all number for a good night’s sleep.  The magic number varies from one person to the next.

Do you regularly wake up refreshed, ready to meet the day?  Can you stay healthy and fit? If you answer yes to these questions, and don’t have trouble falling asleep more than three nights a week on a regular basis, then you .may have your magic number of hours for sleep (accounting for factors like genetics and environment).

If your answers are no, try to find your magic number and you just might live longer.

Sweet Dreams,

Michael J. Breus, PhD

The Sleep Doctor™

www.thesleepdoctor.com

Underground and Out of Sight

It was amazing to see it happen – watching the rescue of the rescue the Chilean miners one by one.  And how great to have a news story that captivated our attention because of the happy ending!

Imagine being underground for 69 days. I saw that the miners were wearing special glasses provided for them by Oakley when they reached the surface, as they were not accustomed to the sunlight. From a sleep perspective, I wondered what it would be like to live in an environment with no natural light for 69 days.

Natural light helps reset our internal biological clock each morning. This reset helps guide our mood, metabolism, body temperature, immune system, you name it. I know that the miners tried to keep to a strict sleep-wake schedule, which makes sense, but probably had little effect due to a lack of light. We have seen something a little like this before, in the military.  Living in a submarine, you may not see daylight for weeks, sometimes months at a time, and there can be some serious consequences. Granted on a submarine there is plenty of light when needed. But the miners’ conditions provided almost no exposure to light for an extended time. We know that long-term disruption of a mammal’s circadian rhythm has been linked to symptoms of depression, insomnia, headaches and hallucinations. And that is just a short list of the effects.

Could any serious damage have been done to the miners’ sleep cycles while in the mine? It is doubtful. Once they were able to get back “on top” the necessary photons would work their magic and over time re-set the biological clocks of the rescued miners. How long will it take? It could vary but with proper light exposure probably no more than a week.  

It’s pretty amazing to know that we all have that reset button available.  I often talk about darkness as part of my recommendations for getting a good night’s sleep.  But we need to remember that light is important to maintaining good sleep health as well.

Sweet Dreams,

Michael J. Breus, PhD

The Sleep Doctor™

www.thesleepdoctor.com 

 

Do Genes Determine Your Sleep Quality?

In the last decade, science has made enormous strides in decoding the human genome and finding associations between genetic variants and certain conditions, or diseases and disorders. We owe a lot of our individual characteristics, after all, to minor variations in our DNA. So it seems reasonable that small discrepancies in our genomes can mean the difference between being a routinely sound sleeper and a chronic insomniac.

And now we have proof: new research just published in the journal Neurology concludes that people who have a gene variant called DQB1*0602 have a higher chance of developing narcolepsy. It’s not that having this variant dooms a person to narcolepsy, a sleep disorder that causes excessive daytime sleepiness. The association is probabilistic—not deterministic, meaning if you might develop narcolepsy if you have the gene, or you might not. Depending on the population, 12 to 38 percent of those with the variant do not have the sleep disorder and are considered healthy sleepers. Also, people without the gene variant can develop narcolepsy, though this is less common.

Here’s how the study was performed in a sleep lab:

• Ninety-two healthy adults without the gene variant were compared to 37 healthy adults who had the gene variant but did not have any sleep disorders.
• For the first two nights, they spent 10 hours in bed and were fully rested. The next five nights they underwent chronic partial sleep deprivation, also known as sleep restriction, where they were allowed four hours in bed per night.
• During the remaining time, lights were kept on and participants could read, play games, or watch movies to help them stay awake.
• Researchers measured their sleep quality and self-rated sleepiness and tested their memory, attention and ability to resist sleep during the daytime.

The results clearly pointed to the effects the DQB1*0602 gene variant can have on people, as those with the gene variant were sleepier and more fatigued when they were both fully rested and sleep deprived. Their sleep was more fragmented. For example, those with the gene variant woke up on average almost four times during the fifth night of sleep deprivation, compared to those without the gene variant, who woke up on average twice. Those with the gene variant also had a lower sleep drive, or desire to sleep, during the fully rested nights.

The participants with the gene variant also spent less time in deep sleep than those without the variant during both nights.  During the second fully rested night, those with the variant averaged only 34 minutes in stage three sleep, while those without it averaged 43 minutes. That may not seem like a big difference, but every minute counts in sleep.

The two groups performed the same on the tests of memory and attention.

I predict that we’ll find future associations between genes and sleep disorders, which can help us to understand why someone can get away with just 4 hours a night while others require nine hours. Such findings can also help us predict who will be more negatively impacted by challenges to a restful night’s sleep, such a shift work or restless leg syndrome.

It’s important to note that having gene variants isn’t necessarily a “bad” thing; there are lots of variants that give you the edge—the advantage over others. This is true for all kinds of areas in life. Genetic variants help explain why some people can live at very high altitudes and summit Mt. Everest without oxygen.

It’s an exciting time in medicine. Though we can’t change our genes, we can influence how those genes express themselves by addressing our environments. Studies like this latest one doesn’t mean we can throw sleep hygiene out the window. Much to the contrary, it reinforces the need to optimize our sleep hygiene to maximize our sleep quality no matter what kind of genes are dictating our life from deep within.

(For more information about narcolepsy, visit The Narcolepsy Network.) 

Sweet Dreams,

 

Michael J. Breus, PhD

The Sleep Doctor™

www.thesleepdoctor.com