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Good sleep habits important for continuing health

There have been several studies linking both too little and too much sleep with health problems. This latest research, which is part of the well-known Nurses’ Health Study, is a very well-designed investigation of more than 71,000 women over 10 years.

Stress hormones to blame?
What is the reason for the correlation between poor sleep behavior and heart disease? We don’t know for sure, but there is much evidence to suggest that chronic sleep deprivation results in an increase of stress hormones circulating in the body, cortisol, in particular.

Cortisol is released in the body during physical and psychological stressed or agitated states. It is very useful in mobilizing individuals to cope with dangerous or threatening conditions in the short term, but when stress hormones are elevated over long periods of time, they can wreak havoc on the body. In fact, chronically elevated cortisol levels are associated with high blood pressure and glucose intolerance, which is a precursor of diabetes, a major risk factor for the development of heart disease.

The study also indicates that sleeping more than nine hours on a routine basis is also related to a higher incidence of heart disease. Here, the association is probably related to the presence of underlying diseases such as depression, chronic pulmonary disease and sleep apneaÖall of which can interfere with the quality of sleep and people may compensate by increasing the amount of time they spend sleeping.

Sleep patterns
Over the course of human evolution, our need for sleep hasn’t varied much. In the last 100 years, as industrialization has intensified, we have experienced a decline of about an hour and a half of sleep each night. The research studies support an eight-hour sleep time as optimal, but some people can still function with a little less time; six-and-a-half to seven hours is sufficient for some people.

Abrupt changes in sleep habits can be distressing, however, as anyone who has experienced jet lag can attest. Our bodies work on a 24-hour cycle, called “circadian rhythms,” which can be measured by the rise and fall of body temperature, the presence of certain hormones in our blood and other biological conditions. All of these are influenced by exposure to sunlight and help determine when we sleep and when we wake.

When traveling to new time zones, our circadian rhythms are slow to adjust and remain on their original biological schedule for two or three days. This results in our bodies telling us it is time to sleep, when it’s actually the middle of the afternoon, or it makes us want to stay awake when it is late at night.

Sleep patterns change as we age. Babies and young children nap frequently during the day, and even as we mature, our bodies experience a slowdown in the afternoon hours. Many adults benefit from a short, 30-minute nap at midday. Many cultures accommodate this slower phase in our daily cycle with afternoon rest periods. As we age, the quality of our sleep changes. Middle-aged and elderly people tend to spend less time in deeper sleep than younger people. By age 60 or 70, many adults experience a steady decrease in the proportion of time spent in deep, so-called ‘delta’ sleep.

Insomnia
Insomnia can have many causes. Some people have trouble falling to sleep; others fall asleep easily but have trouble staying asleep. The latter kind of insomnia is more often related to underlying medical conditions such as heart failure, chronic obstructive pulmonary disease, movement disorders and depression.

If you are experiencing chronic insomnia, It’s a good idea to check with your doctor to determine if your insomnia is a byproduct of another condition. Some medications can also interfere with sleep. Let your doctor know if you are experiencing sleeping problems after beginning a new medication.

Cultivate good sleeping habits

• Get up about the same time every day—even on weekends. Sleeping in on Sunday morning can interfere with a restful sleep Sunday night and impair your effectiveness on Monday.
• Exercise regularly, but if you exercise vigorously, do so at least five to six hours before bedtime.
• Cut down on anything containing caffeine, such as coffee, tea, colas and chocolate, especially later in the day.
• Sleep on a comfortable bed.
• Don’t smoke. Nicotine is a more powerful stimulant than caffeine.
• Drink only in moderation. Do not drink alcohol within several hours of bedtime.
• Strive for quality over quantity. Light dozing is no substitute for a solid, restful sleep.
• Don’t take your worries to bed. Learn to set aside anxieties for times when you can do something constructive to address them.
• Don’t go to sleep stuffed or hungry. Snacks such as bananas, warm milk and cheese may help you fall asleep.
• Develop a relaxing sleep ritual such as reading or listening to music. Give yourself 30 to 60 minutes to wind down from the activity of the day and cue your body to settle down for the night

People who suffer from insomnia that lasts for more than a few days should consult a physician so that the underlying cause can be identified, if possible, then treated.

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Dr. Mohsenin is the medical director of the Yale Center for Sleep Medicine and an associate professor of medicine at the Yale University School of Medicine.