The Truth About Sleep Deprivation

This decade has now been recognised as the sleep decade within the scientific circles and in this post we will cover the “Truth about Sleep Deprivation” and its effects on your health.

Sleep is necessary for detoxification, immunity, tissue repair, regeneration, emotional balancing and most importantly for recuperation of the brain from the day’s activities. We no longer can afford to view any ailment without integrating the science of sleep medicine… Dr Demente, one of the founding fathers of sleep medicine claims that:

“up to 70% of diseases known to mankind are related to sleep disorders.”

The literature on the science of sleep and its effects on health has boomed in the past decade, and research now suggests sleep deprivation plays a role in manifold ‘lifestyle conditions’ that plague developed societies. These include:

• Depression / Anxiety

Depression (a mind state) is associated with an increased ratio of central cholinergic to aminergic neurotransmission (a brain state).  As these two neurotransmitters are involved in the regulation of the REM/NREM sleep cycle it would not be surprising to find that this sleep cycle is impaired in depression or mood disorders.  This is the case as sleep abnormalities associated with depression may reflect a relative predominance of cholinergic activity. Furthermore, antidepressant medications can reduce rapid eye movement (REM) sleep either by their anticholinergic properties or by enhancing aminergic neurotransmission. Intense and prolonged dreams often accompany abrupt withdrawal from antidepressant drugs, a reflection of an REM rebound after drug-induced REM deprivation.

• Reduced work performance

• Reduce cognitive function / Poor concentration

Neurotransmitters such as acetylcholine, noradrenalin, and serotonin, also play important roles in controlling sleep and memory function. Each of these neurotransmitters, in addition to having independent effects on memory are likely to interact with cortisol in important ways that may affect memory consolidation and dreaming.

• Impotence / Low sex drive

Sleep disorders, in particular SAS, and ED are prevalent and may be related in adult men. Either ED or sleep disorders should be considered whenever the other is suspected in adult men. Sleep disorders and ED should also be investigated for the purpose of treating underlying systemic diseases and emotional disorders, and in order to prevent late complications of atherosclerosis.

• Behavioural abnormality / Aggressions

Dream sleep is essential for the maintenance of mental health. It is essential for the sustenance of our rational-egoic sense of identity, our emotional –affect sense of balance and control and our somatic and physiological health. Deprivation of REM sleep can drive a person to suicide and psychosis.

• Hormonal imbalance

sex hormones oestrogen and testosterone influence sleep duration and quality and may account for sex differences in the prevalence of sleep-related disorders. Women have a greater prevalence of insomnia and men have approximately twice the prevalence of sleep apnoea. Middle-aged and elderly women experience higher sleep quality, more slow-wave sleep (SWS), more REM sleep and fewer awakenings compared with age-matched males.

• Increased chance of road accidents (1 in 6)

• Increased chance of falling asleep behind the wheel (1 in 3)

• Substance use disorder

• Obesity and type 2 diabetes

Sleep modulates a major component of the neuroendocrine (sympathovagal balance, cortisol, TSH, glucose, and insulin, Leptin, Ghrelin, NPY) control of appetite (2). Health problems resulting from obesity could offset many of the recent health gains achieved by modern medicine, and obesity may replace tobacco as the number one health risk for developed societies.

Chronic sleep loss as a consequence of voluntary bedtime restriction or as the result of snoring and sleep apnoea is an endemic condition in modern society.

Significant morbidity directly attributable to obesity, are mainly due to heart disease, diabetes, cancer, asthma, sleep apnea, arthritis, reproductive complications and psychological disturbances. The potential impact of recurrent sleep loss on the risk for diabetes and obesity has only recently been acknowledged . In laboratory studies of healthy young adults submitted to recurrent partial sleep restriction, marked alterations in glucose metabolism including decreased glucose tolerance and insulin sensitivity have been demonstrated(1).

Sleep deprivation also alters the neuroendocrine balance of Leptin and Ghrelin. These neuroendocrine abnormalities are  usually correlated with increased hunger and appetite, which may lead to overeating and weight gain. A growing body of epidemiological evidence supports an association between short sleep duration and the risk for obesity and diabetes. Obesity in the vast majority of obese humans is associated with both hyperinsulinemia and hyperleptinemia, which are indicative of insulin and leptin resistance, respectively. Accumulated data now suggest that there is a link between brain function during sleep cycles, Fat and insulin metabolism. Appetite is regulated by an interplay of two hormonal and neural mechanisms within the arcuate nucleus of the hypothalamus. An appetite-stimulating circuit and an appetite-inhibiting circuit (see Fig. 1). Leptin and insulin alike trigger the appetite-inhibitory circuit. Ghrelin and NPY stimulate the appetite circuit.

• Fibromyalgia, fatigue and poor immunity

Fibromyalgia patients complain of diffuse musculoskeletal aches, pains or stiffness associated with tiredness, anxiety, poor sleep, headaches, irritable bowel syndrome, subjective swelling in the articular and periarticular areas and numbness. fibromyalgia is associated with primary sleep disorders (e.g. sleep apnoea, periodic limb movement disorder) . The chronic fatigue syndrome and fibromyalgia have similar disordered sleep physiology, namely an alpha rhythm disturbance (7.5-11 Hz) in the electroencephalogram (EEG) within non-rapid eye movement (NREM) sleep that accompanies increased nocturnal vigilance and light, unrefreshing sleep. Aspects of cytokine and cellular immune functions are shown to be related to the sleep-wake system.

The evidence suggests a reciprocal relationship of the immune and sleep-wake systems. Interference either with the immune system (e.g. by a viral agent or by cytokines such as alpha-interferon or interleukin 2) or with the sleeping-waking brain system (e.g. by sleep deprivation) has effects on the other system and will be accompanied by the symptoms of the chronic fatigue syndrome.

• Stroke & heart attacks – 50%

Sleep apnea and milder forms of sleep-disordered breathing are associated with acute and substantial cardiovascular stress. Respiratory events during sleep (apneas or hypopneas) often cause hypoxemia, sympathetic activation, acute pulmonary and systemic hypertension, and decreased stroke volume. obstructive sleep apnea appeared to be highly prevalent among patients with stroke or transient ischemic attacks.  Increased cytotoxicity and cytokine imbalance has been proposed to be involved Atherogenesis in sleep apnoea.

• Poor Metabolism, Diabetes and Obesity

During sleep, the body must maintain circulating blood glucose levels so that the brain continues to receive adequate substrates, despite the absence of food intake. body adapts to reduced food intake during sleep by inducing a degree of peripheral insulin resistance. During the later stages of sleep, insulin action improves, normalizing circulating glucose levels in preparation for wakefulness and food intake. sleep restriction appears to be accompanied by an alteration( reduction) in appetite control contributing to obesity and type 2 diabetes.

• Poor school performance and Hyperactivity in children

The attention deficit hyperactivity disorder (ADHD) is an heterogeneous, complex and common childhood disorder that causes significant impairment There is substantial evidence that ADHD psychopathology and sleep-wake regulation share common neurobiologic mechanisms. Moreover, there could be an overlap between symptoms of ADHD and certain sleep problems such as obstructive sleep apnea syndrome, restless leg syndrome and periodic limb movements of sleep. Children undergoing evaluation for ADHD should be systematically assessed for sleep disturbances because treatment of sleep disorders is often associated with improved symptomatology and decreased need for stimulants.

• Gastrointestinal disorders

Sleep abnormalities may be associated with inflammatory bowel disease (IBD), chronic inflammatory disorders of the gut. adequate sleep, which is believed to serve as both a protective and restorative function, could potentially calm the inflammatory process. In one study Poor sleep made it harder to cope with GI disease in 41% of IBD and 67% of IBS subjects. Poor sleep patterns may significantly contribute to suboptimal quality of life of patients with IBD, even in those patients with inactive disease.

Sleep Apnea and Snoring  and Insomnia are the 3 most common sleep disorders effecting 70% of population followed by restless led syndrome and childhood sleep disorders.

Why can’t people sleep

Apart from the post-industrialised lifestyle’s shift from regular and consistent work hours to shift and part-time work, greater time spent engaged with distracting and sedentary lifestyle technologies, there are often medical reasons behind a sleep disorder.

These include:

• Patients with chronic lung disease may experience low oxygen levels at night that disturb sleep.

• Patients with asthma may develop wheezing or shortness of breath at night, usually in the early morning hours.

• Patients with heart failure may develop abnormal breathing at night, which disturbs sleep much in the way that sleep apnoea does.

• Patients with Parkinson’s or other neurological diseases may develop disturbed sleep.

• 65% of people with kidney disease develop obstructive sleep apnoea

• Inflammation( systemic or somatic such as joint inflammation)

• Hormonal Imbalance( low progesterone , excess estrogens , low melatonin and high cortisone)

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