Serious health consequences of sleep deprivation
By Annette M. Zaharoff, MD
Are feeling run down, depressed? Having difficulty concentrating, developing more colds or infections or experiencing more joint or muscle pain? You may not think of these as symptoms of sleep deprivation, but sleep loss may just be part of the problem.
Being chronically short-changed on sleep, one of our most basic human needs, can occur because of health issues, cause new health issues and worsen existing health issues. Sleep deprivation can throw your life out of balance as you shuffle through the day, sleepy, depressed, achy and irritable.
There is good news though: Treating or controlling any underlying sleep disorders or medical conditions and developing sound sleep habits can help restore your health and balance.
Are you sleep deprived?
Many patients and doctors overlook the vital role sleep plays in disease management. Perhaps patients themselves don’t consider sleep loss a medical issue, so they don’t bring it up; or perhaps health care providers focus on the pain and underlying condition without assessing sleep. Evaluating sleep habits can be useful in routine examinations. You can be sleep deprived even when you think you are getting enough sleep. How? Four to six times per night, people with normal sleep patterns cycle through five phases of sleep, spending more minutes in the final and most restorative phase with each cycle. In general, healthy sleepers spend about 20 percent of their sleep time in that restorative phase, which involves rapid eye movements (REM) and dreams. When a stimulus such as noise, light, caffeine or pain repeatedly disrupts the sleep cycle or diminishes REM time, sleep deprivation can result. So even if you spend eight hours in bed, you may be short on restorative sleep, which can leave you tired the next day. Most adults need slightly more than eight hours of sleep in a 24-hour stretch. About 20 percent require less and about 10 percent require more to feel at their best.
What is keeping you up?
Pain is a very common cause of sleep loss. Studies show that the majority of people with rheumatic conditions experience sleep problems. In conditions such a fibromyalgia, 70 to 80 percent of patients report some type of sleep difficulty. Most people with chronic pain do not sleep well, and those who do not sleep well tend to have more chronic pain. When you are sleep deprived, your brain chemistry becomes unbalanced. When you are well rested, your brain sends inhibitory messages to your body to help modulate pain. When your coping mechanisms are worn down by sleep deprivation, you may perceive pain as more intense. Additionally, when you are in acute pain, the body releases stress hormones such as epinephrine and norepinephrine. These hormones can stimulate the brain and interfere with sleep. It can become a vicious cycle of pain, sleep loss and more pain.
While pain can be a major factor in sleep loss, psychological and emotional issues may rob you of sleep as well. Problems with depression, worry and anxiety can also affect your sleep cycle. Nightly worries about sleeping become a self-fulfilling prophecy, creating enough anxiety to disturb the brain chemistry and make for a sleepless night.
If you are experiencing sleep problems and fatigue, consider visiting a sleep specialist for an evaluation. A specialist can accurately diagnose your problem. Along with insomnia, common sleep problems include the following:
Snoring. According to the American Academy of Otolaryngology, 45 percent of adults snore on occasion and 25 percent snore every night. Snoring can lead to fragmented sleep (for the snorer and his or her partner), headaches and fatigue. Snoring can also be a symptom of sleep apnea, although not all people who snore have apnea.
Sleep apnea. Sleep apnea is characterized by interrupted breathing and frequent waking during sleep. Causes can include chronically infected and inflamed tonsils and obesity, which leads to collapse of the airway when a person lies flat. Apnea can lead to daytime sleepiness, headaches, irritability and depression. Losing weight can help relieve apnea caused by obesity; surgery and medical devices may help other causes. Sleeping pills, sedatives and alcohol can worsen the condition.
Restless legs syndrome (RLS). People with RLS experience disturbed sleep because of a creepy-crawly sensation in the legs that occurs at night and tends to go away only when they get up from bed and move. About 12 million Americans have RLS.
Narcolepsy. Narcolepsy is a condition in which people suddenly and involuntarily fall asleep at inappropriate time during the day. People with narcolepsy can experience extreme daytime sleepiness even after having a full night’s sleep.
Consider the following questions to uncover where you may be having trouble.
Can’t fall asleep? Could be anxiety.
Can’t stay asleep? Could be from pain or metabolic conditions such thyroid disease or menopause.
Wake up too early? Could be depression.
Sleepy during the day? Could be sleep apnea, restless leg syndrome or diabetes.
All of the above? Could be narcolepsy.
Treatment
Whether you have a full-blown sleep disorder or chronic sleep loss related to pain, treating the sleep problem can have physical as well as psychological benefits. Depending on your medical history and current health issues, your doctor may prescribe mediation to help. Short-term sleep agents are avoided if longer-term solutions may help.
Reducing pain with appropriate rehabilitation techniques may help. Changing your routine may help. A study including overweight, postmenopausal women who exercised at a moderate intensity for at least 30 minutes every morning and also stretched had less trouble falling asleep. Women who exercised in the evening showed little or no improvement in falling asleep. Researchers theorized that exercising in the morning might adjust the body’s circadian rhythms that govern the sleep-wake cycle and affect the sleep quality.
Medications that modulate brain hormonal levels may be prescribed. Low-dose antidepressants in people with chronic pain may improve serotonin levels, sleep, pain and depression. If acute pain is present, analgesics for a limited time may be appropriate. Discuss the options with your physician to determine what is appropriate for you.
Wake up call
Sleep deprivation can affect your quality of life. Talk to your physician if you feel you may be experiencing a problem. Developing sound sleep habits can help restore health and balance. You might even find a good night’s sleep is the best pain medication of all.
