Often when a patient comes to me wanting to improve their health, they have put most of their focus on making changes to their diet and exercise. While nutrition and physical activity are certainly important for overall health, they are only one part of the big picture. One commonly neglected area that I would argue has an even bigger impact on health is SLEEP!
In the modern world, and particularly in the United States, we are very focused on productivity and efficiency. Taking time to rest is often viewed as lazy or wasteful. I am sure we have all heard the common refrain "I can sleep when I'm dead!" In truth, chronically sacrificing sleep is more likely to worsen your productivity and efficiency, and the impact on your health might actually shorten your life.
Sleep is important for a variety of bodily functions including mood, memory, the immune sytem, metabolism, and the cardiovascular system. During sleep, our brains clear toxins, repair, and store memories, and our bodies rest, repair, and conserve energy. Every bodily system requires this period of rest and repair in order to function properly, and therefore all are greatly impacted by sleep deprivation.
The average adult needs at least 7-9 hours of sleep each night. Because sleep is so important for brain development, children need more sleep than adults, and the amount recommended is based on their age (the younger the child, the higher their sleep needs). If you are an adult who has slept less than 7 hours overnight, you are sleep deprived. While our bodies cannot fully recover from a "sleep debt" by sleeping longer on another night, the health impact of sleep deprivation is usually not as significant with occasional sleep deprivation as it is with chronic sleep deprivation.
Sleep deprivation can come from a variety of causes. Some are related to poor sleep habits, others are the result of medical conditions that require intervention.
Insufficient Sleep Window: One of the most common situations that I see is that individuals are not allowing themselves an adequate time period for sleep. They are staying up late to get "just one more thing" done or to finally relax after an over-scheduled day, then they wake up early the next day to start it all over again. These individuals may also suffer from one or both of the types of insomnia listed below, which further decreases their total sleep time.
Sleep-Onset Insomnia: In sleep onset insomnia, an individual may allow adequate time for sleep, but is having difficulty falling or staying asleep. A common cause of difficulty falling asleep is poor sleep hygiene such as not following a consistent winding down routine, using substances such as caffeine or alcohol, or screen use/other light exposure close to bedtime. Difficulty falling asleep can also be due to health conditions such as depression, anxiety, dementia, and more. Certain medications such as stimulants, steroids, and others can also contribute to sleep onset insomnia. Individuals who struggle with sleep onset insomnia may also struggle with maintenance insomnia.
Maintenance Insomnia: This term refers to inadequate sleep due to nighttime wakenings that interrupt sleep. The individual may or may not struggle to fall asleep at the beginning of the night, but then wakes one or more times in the middle of the night. Maintenance insomnia is commonly due to an underlying medical condition, substance use (alcohol, caffeine, other drugs), or medication. Common reasons for maintenance insomnia include sleep apnea, restless leg syndrome, frequent urination overnight (often due to enlarged prostate), anxiety, depression, and dementia.
Disrupted Sleep Architecture: "Sleep architecture" refers to the normal cycle of sleep through the four stages (N1, N2, N3, and REM sleep). Even if an individual does not consciously wake up overnight, if their sleep architecture is disrupted they will still experience the effects of sleep deprivation. This is because normal sleep architecture is required to perform the restorative functions of sleep. Medications and substance use commonly disrupts sleep architecture, as do certain health conditions as listed above. Importantly, even "sleep aid" medications can disrupt sleep architecture. These agents do not induce normal sleep patterns, they cause sedation in which the individual appears to be asleep but is not actually proceeding through the various stages of sleep normally. This is why long term use of sleep aids is not recommended and can be harmful.
Immune system dysfunction leading to increased risk of infections
Hypertension and arrythmias which can lead to heart attack and stroke
Insulin resistance which leads to weight gain and diabetes
Difficulty with attention, concentration, and memory which impedes learning and productivity (often confused for ADHD), and can lead to accidents and injury
Mood instability and depression
CDC statistics show that in Texas in 2020, 35% of adults reported a short sleep duration. This does not even account for those who sleep sufficient hours but have disrupted sleep architecture. Unsurprisingly, the states with the worst sleep habits mirror the states with the highest rates of diabetes and heart disease. Addressing sleep habits is of critical importance for individual and public health.
If you think you have some sleep habits that could be improved, I highly recommend this free app from Veterans Affairs, CBT-i Coach. This app was developed by researchers to help improve sleep in veterans struggling with insomnia and has showed excellent results. It is available for all to use for free. If you would like to learn more about sleep, I highly recommend the book Why We Sleep by Matthew Walker, PhD.
If you are having difficulty sleeping- talk to your doctor right away! You can be evaluated for any underlying medical conditions that may be contributing. If you are taking any medications, these can be reviewed to see if there are any that need to be adjusted to improve your sleep. If you do not currently have a doctor, we are accepting new patients! Visit our website to learn more and become a patient so we can get started on helping you improve sleep right away. I am passionate about helping my patients improve their sleep to reduce their risk of chronic disease and improve their overall health and well-being.