SMC Blog Poor Sleep and its Effects on Common Medical Problems

Sleep should occupy 25% to 33% of our 24-hour day, and most people would like to maximize this peaceful and relaxing time. No one has figured out why we need to sleep, although many hypotheses have been put forward. We do know, however, that if the quantity and quality of our sleep are not good, we don't feel well the next day. Infants usually require at least 12 hours of sleep and more than 50% of the time they are dreaming (REM sleep); adolescents require close to 10 hours of sleep while teenagers need about 8 hours of good consolidated quality sleep. Several studies suggest adults should obtain on average between 6.5 and 8 hours of sleep. These studies have consistently shown multiple medical problems are more likely to occur or worsen if individuals consistently do not achieve this average. This article will discuss the adverse effect of poor quality and/or quantity sleep on the more common medical problems we face today. OBESITY has become epidemic! This problem leads to or complicates the other problems that will be discussed. Chronic sleep deprivation is becoming more prevalent in our "24-hour society." Poor quality and quantity sleep causes an increase in a "hunger hormone" called ghrelin secreted from our stomach and a decrease in a "not hungry hormone" called leptin secreted from our fat cells. One study suggests every extra hour increase in sleep closer to normal was associated with a 50% reduction in the risk of obesity. Growth hormone is needed for proper body metabolism; it is mostly secreted in "deep sleep." Poor quality and quantity of sleep leads to less deep sleep; hence, less growth hormone secretion and possibly slower metabolism and weight gain. Some people who sleep 8 hours of night (good quantity) still have more medical problems because of poor quality sleep from sleep apnea, restless leg syndrome, insomnia, and other sleep disorders. BLOOD PRESSURE is definitely affected by poor sleep; studies have shown high blood pressure is more common in short sleepers getting less than 5 hours of sleep. Multiple awakening during the night from insomnia, sleep apnea, and other sleep disorders increases our adrenaline and is associated with high blood pressure. Untreated sleep apnea not only increases blood pressure, but it is also associated with strokes, heart attacks, irregular heartbeats (atrial fibrillation), and diabetes. Everyone with poorly controlled blood pressure should be asked about snoring and possible sleep apnea. DIABETES can develop as a result of the increase in obesity in our population, but the process also can begin from other factors involved with poor sleep. Our body doesn't properly handle the sugars we eat when our sleep is not good; this causes your sugar to be higher in your blood than in your cells where you need it. Studies have shown improving sleep quantity and quality decreases the risk of developing diabetes, and, in diabetics, the sugar gets into the cells easier and out of the blood which improves diabetic control (blood sugar). Using CPAP to treat sleep apnea lowers the fasting blood sugar significantly. All diabetics should be screened for sleep apnea according to the American Diabetic Association. GERD (indigestion) during sleep affects 10% of our population. It is more common with sleep apnea and CPAP use improves the symptoms. The highest acid production by the stomach occurs within the first several hours of sleep. Shift workers with frequent changing of sleep times have higher acid production and more ulcer disease. Sleeping on your left side has been shown to help with reflux problems at night. Increasing GERD at night worsens asthma symptoms. ASTHMA is made worse by untreated sleep apnea. Anyone with worsening asthma at night should be asked about their snoring and possible sleep apnea. TESTOSTERONE levels are affected by poor sleep, particularly with untreated sleep apnea. In men the levels drop and in women the levels increase, causing significant problems with sexual functioning, polycystic ovarian disease, and infertility, among others. MEMORY LOSS is a frequent complaint of people with poor sleep. Poor concentration and focusing can be a direct result of chronic poor sleep. Attention Deficit Disorder (ADD) is definitely made worse and harder to treat in poor sleepers; but researchers have found that some people diagnosed with this problem actually have a sleep disorder rather than ADD. BEDWETTING in children may be a sign of sleep apnea, particularly if the child snores and has had a period of time with dry nights then starts wetting the bed again. Removing their tonsils in this case can solve the bedwetting problem! FIBROMYALGIA is becoming more prevalent in our society and one of the most common complaints besides muscle pain is: "I can't sleep!" Chronic muscle pain from whatever reason generally improves with better sleep, particularly more REM (dream) sleep. Normally during REM sleep most of our body's muscles are paralyzed which is the ultimate muscle relaxer available without side effects. Improving sleep and increasing exercise have been consistently shown to help in the treatment of fibromyalgia. LIPID DISORDERS can be affected by poor sleep; as discussed above, the body is unable to process sugars properly during poor sleep and this same process causes the triglycerides to increase more than the cholesterol. However, as the triglycerides elevate, the HDL (good) cholesterol drops, which is not good. SHIFT WORKERS notoriously have poor sleep quantity and quality and as a result they have been found to have more cancers, worsening immune function (more infections), GERD, weight gain, mood disorders, and memory problems. THREE of the most common sleep disorders I evaluate on a daily basis are insomnia (30% population), sleep apnea (3-8% population and increasing), and restless leg syndrome. The latter two usually require further evaluation, but insomnia treatment should ALWAYS begin with Ledet's 4 Cardinal Rules:1. WAKE UP the same time in the morning, every morning2. NO NAPS between wake up time and bedroom time (16 hours after wake up time).3. ONLY sleep and sex between bedroom time and wake up time4. OUT OF BED if not achieving #3 and sit in "chill out chair" (COC) till sleepy. COC is for prayer, meditation, and/or listening to relaxing music (without words) in a dark room.People with mind racing problems at bedtime should spend time before the bedroom time, possibly after supper, writing down their "racing thoughts." Michael Ledet, M.D. has been the Medical Director of Springhill Medical Center Sleep Center since its inception in 1990. He treats all types of sleep problems of all ages. He also specializes in Lipidology, the evaluation and treatment of cholesterol problems. Appointments can be made without a referral by calling (251) 445-1850. He has offices in Mobile and Daphne.