Doctors warn sleep deprivation linked to serious health issues
March 5, 2018
STEAMBOAT SPRINGS — What do obesity, Alzheimers, cancer, periodontitis, high blood pressure, Chernobyl, the Exxon Valdez spill and 20 percent of car accidents have in common?
They are all linked to sleep — more precisely, sleep deprivation.
It's common sense that a good night's sleep is good for one’s health and visibly makes a person feel and perform better the next day. But increasingly, studies are showing the far-reaching potential health consequences of not getting enough sleep.
With much of the disease-related research, there remains an "chicken or the egg" dilemma: Is the negative health symptom or disease caused by a lack of quality sleep or is a lack of quality sleep caused by the disease?
As Dr. Jon Hamilton, a family medicine physician with Steamboat Medical Group, points out you can typically find one study that supports and another that disputes various arguments of causation.
And there are many things associated with sleep that are not necessarily directly caused by a sleep deficiency, noted sleep medicine specialist Dr. Brent Peters, a UCHealth pulmonologist who works in Loveland and Steamboat Springs and serves as the medical director of the UCHealth Sleep Lab in Steamboat.
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However, with a growing wealth of research on sleep, one thing is is undeniable — the importance of a good night's sleep has never been more evident.
"Every day we are finding out new reasons" on why sleep is important, Peters said.
Some of the newest studies are connecting sleep disruption to the buildup of a protein in the brain that is a precursor to Alzheimer's disease. However, it is still being debated whether disrupted sleep is a contributing factor to the disease or an early sign.
Mathew Walker, professor of neuroscience and psychology at the University of California, Berkeley, and author of the book, "Why We Sleep," discussed the linkage in a widely distributed online video.
"We also know that a lack of sleep will lead to an increased development of a toxic protein in the brain that is called beta-amyloid and that is associated with Alzheimer's disease," Walker said, "because it is during deep sleep at night when a sewage system within the brain actually kicks in to high gear, and it starts to wash away this toxic protein, beta-amyloid.
“So if you're not getting enough sleep each and every night, more of that Alzheimer's-related protein will build up,” Walker continues. “The more protein that builds up, the greater your risk of going on to develop dementia in later life."
Walker also points to how sleep can impact the immune system.
"After just one night of four to five hours of sleep, there is a 70 percent reduction in critical anticancer-fighting cells called natural killers cells," Walker said. "And that's the reason that we know that short sleep duration predicts your risk for developing numerous forms of cancer.
"In fact," continued Walker, "the link between a lack of sleep and cancer is now so strong that recently the World Health Organization decided to classify any form of nighttime shift work as a probable carcinogen — so in other words, jobs that may induce cancer because of a disruption of your sleep rate rhythms."
Peters cited a 20 percent reduction in the immune system's general effectiveness in just one night of poor sleep.
Then there are the cardiovascular issues. Disrupted sleep can lead to high blood pressure, and thus hypertension, diabetes and a higher likelihood for a heart attack and stroke.
"It is during deep sleep at night that you receive this most wonderful form of effective blood pressure medication," Walker said. "Your heart rate drops, your blood pressure goes down. If you're not getting sufficient sleep, you're not getting that reboot of the cardiovascular system, so your blood pressure rises."
Walker cites a 200 percent increased risk of having a fatal heart attack or stroke for people getting six hours of sleep or less.
In terms of obesity, explained Peters and Hamilton, it is both the case that a lack of sleep can contribute to obesity, and obesity contributes to sleep apnea, which is the disruption of sleep when the body momentarily stops breathing.
When the body reacts to a need for the opening of airways, it releases adrenalin. Blood pressure rises, the heart rate goes up, and even if a person doesn't fully awaken, their sleep is disrupted and their bodies are stressed.
Elevation can have a worsening effect on sleep apnea, Peters noted. Snoring can be a sign of sleep apnea, Peters said, but it can also just be snoring.
In addition, too little sleep can upset the balance of hormone production — including ones that control appetite, energy metabolism and glucose processing.
Research also shows a link between the amount of sleep you get and the onset of gum disease and periodontitis, which can result in the shifting and loosening of teeth and bone destruction.
There is also growing evidence of a correlation between chronic sleep issues and depression, anxiety and mental distress — beyond the grouchiness and irritability we all feel when we didn't get enough sleep.
Then there's the Chernobyl nuclear meltdown, the nuclear accident at Three Mile Island, the Exxon Valdez oil tanker spill and the explosion of the space shuttle Challenger — all of which investigators found sleep deprivation as a significant factor in the ability of the people in charge to make critical decisions.
Also in the "public safety" category, the Institute of Medicine estimates that drowsy driving is responsible for 20 percent of all motor vehicle crashes.
So what happens during sleep that is so beneficial?
"The body needs to recharge," said Hamilton. "You need to get a good night's rest to get back normal in preparation for the next day."
Humans need six to 10 hours of sleep, Peters said. Some can function on less, and some need more.
So if you think you are one of those people who is just fine on less than seven hours — you are indeed part of a select few — just 2.5 percent of the population. And if you function normally on less than five hours, you are part of a very select 1 percent of the population.
Of course this does vary with age. Teenagers who are growing multiple inches per year and have the highest metabolism of their lives need more sleep. They aren't being lazy — they need more sleep, which is why sleep experts push for school start times not before 8:30 a.m., Peters said.
Cognitive function, which includes concentration, working memory, complex thought, mathematical capacity and logical reasoning are all impacted by sleep deprivation.
Walker cites the "recycle rate of a human being" at about "16 hours of wakefulness."
"Once you get past 16 hours of being awake, that's when we start to see mental deterioration and physiological deterioration in the body," Walker said.
Quality of sleep matters greatly, too, Peters and Hamilton said. You can sleep for eight hours, but if you are waking up every couple hours, your body is not necessarily regenerating as fully as it needs.
And there are a number of things that may be disrupting deep sleep, Hamilton said. Medications can complicate the body's natural sleep, in addition to habitual intake of caffeine, alcohol and tobacco.
Hamilton also cautions against reliance on sleeping pills.
"When you have to sedate yourself at night, something's not right," he said.
While some newer pills are labeled "low-risk," Peters noted that all sleeping pills are habit forming.
If your mind is racing, then you need to look at precisely what it is that is stressing out your brain, said Hamilton, and work to address that.
So, what else can you do to get a better night's sleep?
Hamilton and Peters prioritize several things.
Think like a bear going into hibernation, Peters suggests. Your "cave" should be dark, quiet and cool — 65 degrees is the ideal temperature.
"It's time to put your body and your brain into park and just let them start relaxing," Hamilton said.
Consistency is crucial. Those strict times set for kids going to bed and waking up should continue just as strictly into adulthood, Peters said.
"The body loves a schedule," Hamilton said.
Avoid caffeine, alcohol and tobacco for at least several hours before sleep. Alcohol, which does act as a sedative, can lull us into "false sleep," Hamilton said. While it may help you fall asleep, it does not help you stay asleep.
Get exercise, but do so at least a couple hours before bedtime. Not only does this fight obesity, it tires the body out for better sleep.
Don't eat late, especially not hard-to-digest foods.
Put down the phone and turn off the television. Better yet, keep all electronics out of the bedroom. In addition to stimulating the brain, bright lights trigger awakeness in the brain and can suppress the production of melatonin.
Take a warm bath. It isn't just relaxing, explained Peters, it raises and then lowers the body temperature. This mimics the natural cooling process during which the brain tells the body it's ready to go sleep.
Part of why Peters was drawn to the field of sleep medicine is because of the holistic approach to helping people sleep better. Each patient is unique and requires a comprehensive and creative examination into why they aren't sleeping as well as they should be.
And for Hamilton, ""I can't say enough about the importance of good sleep."