Understanding the Language of Silence - Sleep, Sleep Behavior and Sleep Disorders. Dr. Amrit Lal
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meal, compared with the sleep-recovery period with their ability to secrete and respond to the hormone insulin falling by 30 per cent – changes similar to those found in patients with type-2 diabetes. In addition, level of stress hormone, cortisol, rises which mimics levels that are often seen in older people and may be involved in age-related insulin resistance and memory loss, – the men’s blood sugar level taking 40 per cent longer to drop following a high-carbohydrate diet. Of course, blood sugar and hormone concentrations are restored after the sleep recovery period.
Sleep deprivation tends to overeating; some 300 to 500 more calories per day than people who do not. As Orfeu Buxton, a neuroscientist at Brigham and Women Hospital in Boston School comments, “You prefer different foods and more of them and at wrong time of the day … Nobody is eating salad in the middle of the night.” A pattern of insufficient sleep raises risk of obesity and diabetes. In a study conducted under him and published in Translational Medicine (2012), his team allowed volunteers roughly five and half hours of sleep over a period of 3 weeks, “varying timing in a manner similar to the experiences of shift worker or with jet lag.” It was observed that restricting sleep and disrupting circadian rhythm lowered melatonin and spiked glucose levels after the participants took breakfast – “an indication that insulin producing pancreas is not fully doing its job.” In addition, Baxton’s study observed, “participants saw their basal metabolic rate decline by 8 per cent.” This may look insignificant, but other things remaining unchanged, this translates into 10 to 12 pounds a year. Even a single night of inadequate sleep can cause daylong elevation in hypertensive individuals, apart from the fact that inadequate sleep is associated with calcification of coronary arteries (arteriosclerosis) and raised levels of inflammatory factors linked to heart disease.
Hypertension is associated with snoring and sleep apnea and heart failure. Menopause and its accompanying hot flashes, changes in breathing and decreased hormone levels can lead to insomnia. Gastro-esophageal reflex disease (GERD) is another common cause of sleep problem. Diseases like Parkinson’s disease and multiple sclerosis also common causes of sleep problems.
The causes of “primary” sleep order lies within the individual itself. They may be the result of endogenous disturbances in sleep-wake rhythms or because of behavior conditioning. During a medical diagnosis it is important to determine if anxiety and depression were the more likely factors contributing to sleep problems and those with sleep problems more likely to develop health issues.
PRIMARY SLEEP DISORDER
A sleep disorder may be “primary” or may result from a variety of medical and psychiatric conditions. It presents a “catch-22” situation. A bad night sleep may be caused by a medical or psychological condition or medication to address it, but a lack of sleep itself worsens the condition. Some kinds of medications for health problems have well-marked anti-sleep effects. They include, for example, beta-blockers for hypertension, diuretics which are often taken for hypertension or glaucoma, anticholinergics or bronco-dilators for asthma and emphysema/COPD , corticosteroids to treat conditions like rheumatoid arthritis, pain and other conditions, decongestants, diuretics, anti-depressants and some types of cardio-vascular, neurologic, psychiatrist and gastro-intestinal medicines. But medication ‘per se’ continues to be most common plank for treatment of sleep disorders. In particular, some type of medicine to treat insomnia such as sedatives, hypnotics, anti-histamines, anti-depressants, anti-psychotics and anti-convulsants can be ranked among the most common anti-sleep remedies sought by the elderly. More medical conditions demand more medications to address them and more is the likelihood of some type of sleep disorder.
RISK OF CANCER AND NEUROLOGICAL DISORDERS
Risk of cancer may also go up in people who are sleep deprived. A Japanese study of nearly 24,000 women ages between 40 to 79 years found that those who slept less than six hours a night were more likely to develop breast cancer than the women who slept longer. The increased risk may be associated with decreased secretion of melatonin hormone. Among participants in the famous Nurse Health Study in the United States, Eva S. Schernhammer of Harvard Medical School also finds a link between low melatonin and increase risk of breast cancer. In another study involving post-menopausal women with breast cancer who routinely slept less than 6 hours a night may be twice as likely to have more aggressive breast cancer compared with those who slept longer, lead researcher, Cheryl Thompson, Ph.D., of Case Western University at Cleveland, Ohio, U.S., concluded “Cancer is a disease of mistakes in our DNA. Sufficient sleep is responsible for maintaining circadian rhythm, which regulates our body’s natural DNA repair. If that process is frequently disturbed, so is DNA correction.” A good quality of sleep is believed to redress such DNA mistakes.
Much has been reviewed about connection between sleeplessness and neurological disorders like dementia, Alzheimer’s disease and Parkinson disease which may cause irreversible damage to the areas of brain responsible for regulating sleep. Researchers at Washington University School of Medicine in St. Louis, have reported in Journal of American Medical Association (JAMA) Neurology, (March 11, 2013) “sleeplessness precedes Alzheimer’s Disease but do not yet exhibit memory loss or other cognitive problems of full blown disease.” It is a common clinical finding that dementia patients generally have troubled sleep at night, and sleep studies confirm increased fragmentation and sleep onset latency, and decreased sleep efficiency, total sleep time and slow wave sleep. Severity of dementia appears to be associated with the severity of sleep disorder. There is enough evidence to establish that dementia affects sleep architecture differently from the normal aging.
Physiologically speaking, sleeplessness causes increased level of body’s inflammatory chemicals, including C-Reactive protein, tissue necrosis factors and interleukins which are considered precursors of cardio-vascular disease. This has been repeatedly emphasis in the foregoing text.
Sleep is nature’s best analgesia. It is a common observation that sick people, patients after some major surgery and in great pain and those convalesecing sleep longer than healthy people as if their body shuts down to all disturbing distractions to give full attention on healing through sleep. This also underlies the rationale of hospitalizing patients where they can sleep better (and recover faster) without day-to-day tensions and problems.
SLEEP DISORDERS IN THE SENIORS
Seniors suffer the most from sleep disorders. Because of their weakened immune system they are more sensitive to even minor disruption of their routine which can be upsetting for their circadian rhythm to go off the tangent. A systematic diagnosis of the underlying causes of sleep disorders in the elderly is of vital importance. A high use of non-prescription remedies in this population group is also alarmingingly, which according to a survey of the ambulatory elderly subjects, was as much as 50 per cent and included acetaminophen, anti-histamine and alcohol – among other. A non-pharmacological approach involving an immersion in work, social or family commitments, community activities or counseling to allay and inappropriate expectations about sleep (such as statutory “seven or eight hours of sleep every night”), may all be very important. Also equally important is advice on increased physical activity and more time spent in daylight do help keep sleeping pills at bay. Such interventions are well-aligned with a troubled sleeper’s expectations of good sleep. An appropriate Sleep Hygiene provides many such road signs on journey towards sound sleep.
INCREASE IN LONGIVITY
Advances in medical science and public health, better sanitary conditions and progress in different types of immunizations have increased “longevity of life” which manifests in a great surge of geriatric populations everywhere. Worldwide people live longer which accounts for a greater number of health issues typical of old age and with it greater number of sleep disorders such as insomnia, apnea (disoriented sleeping by way of respiratory distress), cardio-vascular diseases, stroke and neurological disorders like dementia, Parkinson Disease, Alzheimer’s Disease and dementia. (Some research, for example, shows that eventually everyone in America will either have Alzheimer’s disease or care for someone who has it). This happens because many older people get less restful sleep than what they need, and because of a number of endogenous causes (for example,