Sleep to be beautiful and healthy.
Sleep is an essential biological function with major roles in recovery, energy conservation, and survival. It is important for vital functions such as neural development, learning, memory, emotional regulation, cardiovascular, anabolic function and cellular toxin removal. We are designed to spend approximately one-third of each day of our lives sleeping, but modern society has compressed that requirement to an unhealthy fraction of the suggested time.
As children, we were told by our parents to go to bed by 8pm or 9pm on school nights. As we grew, the sleep curfew got pushed to 10 pm or even later. Eventually, the 21st century marked the shortest duration of sleep for children and adults, with the average duration decreased by half an hour to an hour more relative to the generation before us. It is not uncommon for teenagers and young adults to sleep 6–7 hours per night while preparing for exams, and for working adults to sleep 6–6.5 hours per night. It does not seem like a lot, but this reduction has significant negative implications on our health. In an attempt to earn money, people are choosing to work overtime and even opt for additional night shifts. Nowadays, with long working hours, internet browsing, and general increased screen time, sleep disturbances have become increasingly common amongst all age groups. Most people are aware of the importance of sleep; however, sleep disturbances, deprivation, and insomnia remain modern significant health issue. I would like to, hopefully, convince you that sleep is essential for optimal health and cannot be reduced despite social pressures.
As recommended by a consensus statement published in The Journal of Clinical Sleep Medicine, a healthy adult should sleep for seven or more hours per night on a regular basis to promote optimal health. Sleeping less than seven hours per night on a regular basis is associated with poor health outcomes such as weight gain, obesity, diabetes, hypertension, heart disease, stroke, depression, and increased risk of death. It has also been reported to be associated with impaired immune function and cognitive performance. Sleep deprivation and impaired quality of sleep can impact your work performance, increase errors, and increase the chances of accidents. Individuals who sleep less than seven hours usually complain of decreased attention, inefficiency at work, and declining cognitive function. Some may experience difficulty with logical reasoning, and complex tasks involving flexible thinking even after a single night of sleep deprivation. Everyone is probably familiar with individuals who claim that they function well on only five or six hours of sleep. Scientists, however, do not agree, and report that only a small percentage of people can function efficiently with that duration and that the majority of people need 7–9 hours regularly. It has also been observed that the people who need less number of hours actually use stimulants such as caffeine or energy drinks in order to function productively.
Is it healthy to sleep more than 9 hours per night? People who are recovering from significant sleep deprivation, sleep debt or illness require more than nine hours of sleep per night. Surprisingly, the question if sleeping more than 9 hours regularly is associated with adverse health outcomes is still not clear. However, sleeping for 8–9 hours is not beneficial if the quality is not good. If you are in bed for 8–10 hours, but wake up several times during the night due to various reasons i.e., empty your bladder, anxiety, etc., it indicates bad quality of sleep.
The effect of acute sleep deprivation can be catastrophic. Studies of cellular level changes such as effects on regeneration of each and every cell of our body show that sleep deprivation results in a powerful drive for sleep that is not always under the control of the individual. This drive allows for sleep to intrude into wakefulness for only a few seconds whenever there is a lack of physical activity, such as driving, forming lapses; these lapses are referred to as microsleep. Microsleep can cause serious consequences. For example, if somebody is driving a car at 60 mph, it will travel more than 250 feet during a three second microsleep period, which can lead to a serious accident.
Sleep and sleep cycles are intricately related to our circadian rhythms. Most people report having a better quality sleep and feeling more refreshed if they sleep in synchronization with circadian rhythms. The body’s master clock, suprachiasmatic nucleus, is located in a part of the brain called the hypothalamus. It regulates our circadian rhythms and is affected by sunlight. After the sunset, pineal gland starts producing melatonin in response to signals from the eyes. Melatonin is responsible for enhanced subjective feeling of sleepiness. Going to bed with natural circadian rhythm when it is dark outside will help synchronize your body’s circadian rhythm. Sleeping between 10pm and 2 am will have the most beneficial effects on the regeneration of brain function and the production of necessary hormones. To maintain the diurnal variations in levels of cortisol in our body, it is very important to adapt to a healthy sleep hygiene. Sleep hygiene becomes especially important for those who suffer from chronic fatigue, shift work sleep disorder, or jet lag. Some of my patients report that they feel more rested, focused, and energetic after an eight hour sleep, if they go to bed at 10 pm instead of 2 am, and science can certainly back up this claim. People with inadequate, or poor quality of sleep, reported having less energy to perform activities of daily living, drowsiness and untimely urge to sleep.
Several studies have shown that shorter sleep duration has been associated with increased risk of cardiovascular problems. The American Heart Association reported that sleep restriction increases the morbidity and mortality as it is a risk factor for various cardiovascular problems. Healthy sleep behavior contributes to heart health along with efforts to address other established factors including blood pressure, cholesterol, diet, glucose profile, physical activity, weight, and smoking. One of the studies conducted in 20,000 adults demonstrated that sleeping less than six hours increases the risk of cardiovascular diseases by 15% and coronary heart disease by 15% relative to those who slept at least seven hours per night. Another study revealed that sleeping less than six hours a night worsens the atherosclerosis in patients who already have coronary artery disease, hypertension, or suffered heart attacks.
Significant associations have also been found between sleep and inflammation. Decreased sleep duration has been linked with increased inflammation and thus, cardiovascular diseases. Even mild sleep deprivation can cause elevation in pro-inflammatory markers, such as c-reactive protein, and cause immunodeficiency, thus decreasing the response of our body to several antigens. For example, only six days of restricted sleep tends to decrease immunity against influenza vaccination and enhances susceptibility to the common cold. Getting adequate sleep improves not only our cellular function and immunity but also helps to eliminate toxins from our body. This process of regeneration and detoxification, subsequently, helps in improving the appearance of your skin.
In our society, one-third of the population falls into the category of Obese and almost two-thirds of people can be described as overweight. Adequate and good quality sleep helps combat this epidemic. Sleep deprivation increases amoutns of stress hormone cortisol which increases appetite, conversely, adequate sleep decreases excess of cortisol and helps control appetite. In addition, people who sleep less and are trying to lose weight, will lose more weight from muscle than fat. Apart from looking rested and looking slimmer which is considered attractive in our society, good quality sleep helps decrease the risk of developing type II Diabetes Mellitus and Obesity. Patients suffering from Obstructive Sleep Apnea (OSA) have multiple episodes of decreased or interrupted breathing impairing the quality of their sleep despite adequate duration of sleep. These episodes during sleep decrease the amount of oxygen in the body and cause significant health issues. OSA has shown to increase the risk of cardiovascular diseases, diabetes, heart failure, and stroke. It can also lead to several accidents due to daytime sleepiness.
With clear knowledge and indications that adequate and good quality sleep are important, here are some tips to restore your sleep so that you feel rested and improve your health. Maintaining sleep hygiene helps in improving our health and long-term outcomes. It is very important to make sleep schedule and maintain it regularly, so that our body adapts to it. Another important step is to limit the use of devices such as tablets, phones, etc, dimming the lights, or switching to night mode from blue light. It will help in the preservation of melatonin which contribute to not only a healthy sleep but longevity of a person. For those who have trouble falling asleep and unwinding after a stressful day, meditating for a short duration, approximately 10 minutes before getting ready to sleep and listening to soothing music helps promote sleep. Meditation stimulates the parasympathetic nervous system in our body, which calms the brain, decreases heart rate, and relaxes the body. 10 minutes of meditation each day helps in sleep induction, stress reduction, and decreases inflammatory responses, altogether promoting a healthy body. Next, make sure that your room is dark, curtains are drawn, and there is no source of light. Decreasing the light stimulus in turn decreases the neural activity of our eyes. Darkness enhances the production of melatonin by the pineal gland. It is also known that exercising regularly helps improve sleep. There is good news for those who have difficulty with exercising vigorously or for long duration. Mild exercise, only for 15 minutes daily, is beneficial for our health and sleep. If you are new to exercise or not able to go to the gym, mild physical activity but on a regular basis is enough to improve your sleep by 20–30%. One should avoid daytime napping if the person has trouble falling asleep in order to maximize sleep drive at night as well.
If an older person with declining memory has been noted to sleep excessively during the day and be awake and agitated at night, it is important to report it to your physician, as it may be an early sign of cognitive impairment and dementia.
That said, a study published in The National Sleep Foundation reported that a 40 minute nap improved performance by 34%, and alertness by 100%. The study was conducted at NASA in military pilots and astronauts. If you are sleep deprived or tired, a quick nap can help restore your alertness and improve performance. Ialways recommend to my patients and friends to opt for a quick nap in case they are fatigued to prevent car accidents. In many cultures, people take naps during the day like siesta and animal kingdom is known to take one to several naps during the day.
Many people may have trouble falling asleep or staying asleep on a regular basis have insomnia. For them, it is especially important to avoid stimulants such as chocolate, caffeine, tea or any energy drinks after 4 pm. If someone has developed insomnia I recommend ruling out possible underlying causes, such as anxiety, depression, or any other stressors in life. The medications that have been known to cause sleep impairment include opioids, antidepressants, glucocorticoids, etc. In older adults, urinary and prostate problems are one of the common reasons of night time awakenings and interference with the quality of sleep. One of the reasons for fatigue in aging men is bad quality of sleep due to declining testosterone. Supplementing with testosterone and restoring the levels to optimal, will help in improving the sleep as well energy and libido. Perimenopausal and menopausal decline in Progesterone levels in women may contribute to sleep problems in many women. Replacing with oral Progesterone at night, when indicated, helps promote restful sleep for women suffering from hormonal imbalances.
Many natural supplements can help restore proper sleep. For a person prone to anxiety, I recommend taking GABA supplements as they work on receptors responsible for anxiety. Valerian root has been for centuries in various cultures for anxiety and sleep and has been helpful to a lot of my patients. L-theanine, an amino acid, is known to have relaxing properties as well. In a study reported in Pharmaceutical Biology in december of 2019, GABA/l-theanine mixture has a positive synergistic effect on sleep quality and duration as compared to GABA or l-theanine alone. Derivatives of amino acid tryptophan converts to serotonin which plays a role is sleep and mood regulations. Supplements with 5-HTP provide tryptophan to help induce sleep. Magnesium glycinate, which penetrates through blood brain barrier can be effective in sleep induction and maintenance. Use of CBD oils (Cannabidiol) have been shown in studies to have anti-anxiety and sleep inducing properties. Finally, using melatonin, starting with 1 mg and gradually titrating up to 20 mg, has been proven to be safe with few side effects and helpful in restoring sleep. Supplementation with melatonin, which declines with aging, shift work, lifestyle changes and due to certain medications and drugs, also provides a strong antioxidant effect and helps to combat free radicals in people with weak immune system. Prescription medications should be used as a last resort and their use should be done under the care of a doctor, as they are associated with multiple side effects, addiction potential and have drug interactions with other medications.
In conclusion, I encourage everyone to review their sleeping patterns and ensure that you take necessary steps to restore this important third of your existence which is meant to regenerate your body, mind, and skin. Talk to your physician if you suffer from sleep deprivation, sleep disturbance or insomnia to establish a personalized approach to finding the underlying cause and the best and balanced plan of care.
In health,
Natasha Fuksina, M.D
