Many of us are drawn into staying up late at night, sacrificing precious hours of sleep that cause a harm to our health over time. Many view sleep as granted and do not think cutting the hours they sleep takes a toll on their body, and over look the long term health risks. Sadly, these wasted valuable hours of sleep go unnoticed, and no one thinks to change their sleeping habits to get more hours of sleep. Many studies have shown that with insufficient sleep, the risk of acquiring diabetes, obesity, and cardiovascular diseases increases.
Firstly, starting off with obesity, many studies have linked insufficient sleep and obesity. One study has shown that people who sleep less than six hours daily were likely to have excess body weight while compared to those who had an average of eight hours of sleep a night were to have less excess fat. Sleep is an important regulator of neuroendocrine function and glucose metabolism and without sleep, alterations such as decreased glucose tolerance, decreased insulin sensitivity are set to occur.
Secondly, developing diabetes has been shown in those who have reported sleeping less than five hours daily. Less sleep causes a negative influence in blood sugar control and increases the effects of type 2 diabetes. Chronic sleep disturbances would elevate the risk of developing insulin resistance, while diabetes would worsen the quality of sleep. Surprisingly, studies have also shown that long sleep durations (over 9 hours) have also been adversely related to insulin resistance
Lastly, there has been a strong link between cardiovascular diseases and less sleep. Studies have shown that six to seven hours of sleep has been associated with coronary artery calcification which may in the future cause a heart attack. Also, a lack of sleep may cause a hypertension, stroke, coronary heart disease, and an irregular heartbeat.
With all said, it is important to get the normal hours of sleep one needs to perform the normal functions of one daily. Getting the sleep one needs may lead to avoiding the adverse health effect and avoid the expensive health care costs.
Sleep is an important function of the human body. Sleep is a restorative process with different stages having different functions. There are two processes that regulate sleep time and duration which are a homeostatic process and a circadian process. There are two types of sleep which are non-REM and REM. REM stands for rapid eye movement. Non-REM sleep occurs first and has three stages. Stage 1 is a light sleep that lasts for about 5-10 minutes in which the person may be woken up easily. Stage 2 is also a light sleep in which heart rate slows down and body temperature decreases. Brain waves become slower and the body prepares for deep sleep. Stage 3 is considered deep sleep. The brain produces delta waves in this stage. During all 3 stages of non-REM sleep, the body repairs tissue, strengthens the immune system, and builds bone and muscle. During REM sleep, the brain activity increases so this is usually where people will experience dreaming. This phase of sleep begins about an hour and a half after falling asleep and lasts about 10 minutes during the first stage but increases during each cycle of sleep.
The amount of sleep that people need depends on their age and also varies slightly from person to person. For example, newborns 4 to 12 months of age need 12-16 hours of sleep per day while adults 18 years or older need 7-8 hours of sleep per day. If people do not get the recommended amount of sleep per night, they will not function optimally. Sleep deprivation can cause daytime sleepiness, decreased focus, and slower reaction time. Certain medication can cause patients to get less than a normal amount of sleep. These medications include SSRIs, dopamine agonists, stimulants, anticonvulsants, decongestants, steroids, and beta agonists. Patients should be counseled on this side effect and take these medications in the morning if possible to decrease the risk of medication-induced insomnia.
Resources:
Barbato G. REM Sleep: An Unknown Indicator of Sleep Quality. Int J Environ Res Public Health. 2021;18(24):12976. Published 2021 Dec 9. doi:10.3390/ijerph182412976
It's a Friday night. You just got back from a two am night out with your friends, and as you stumble into your bed, you wonder, how messed up am I going to be tomorrow? Sleep is an integral part of our health. However, with modern American society promoting the culture of excessive work habits, partying hard late into the night, and pulling all-nighters to study for exams, one can only wonder what these collective habits have on our health.
What exactly is sleep, and how do humans fall asleep? Essentially, sleep is a period of rest that the body utilizes as a "housekeeping" phase to remove toxins in the brain that build up while awake. As we prepare to sleep, clusters of sleep-promoting neurons in many parts of the brain become active, and neurotransmitters dampen the activity of cells that play a role in arousal or relaxation (4).
The CDC recommends that adults have a minimum of seven hours of sleep at night, and those seven hours should be "good-quality" sleep. Good-quality rest can be quantitatively based on four factors: sleep latency, sleep-waking, wakefulness, and sleep efficiency. Sleep latency is the measurement of how long it takes to fall asleep (the goal here should be 30 minutes or less); sleep-waking is how often you wake up during your sleep session (the goal here should be once or less); wakefulness is how many minutes you spend awake after you first go to sleep (the goal here should be twenty minutes or less); sleep efficiency is the amount of time you spend sleeping in bed (the goal here should be 85% or more). These four factors contribute to the overall sense of your sleep being "good"; you improve your sleep quality by improving these four factors (3).
Sleep also benefits the retention of memory by protecting them from interfering stimuli and consolidating them. The rapid-eye movement or REM sleep is crucial to memory consolidation and metabolic electrophysiological, neurochemical, and genetic mechanisms inside our body. The brain needs a perfect time to settle down the memory consolidation process and enhance it. A minimum standard of proper sleep is necessary to activate slow-wave rest, stabilizing transformed memories and integrating them into long-term memories. Sleep-deprived adolescents are more likely to incorporate misleading memories of past events. Multiple nights of restricted sleep increase false memory formation and is not recommended. Young adults require more sleep hours to avoid abstract eyewitness testimony (2).
Moreover, growing evidence indicates that short sleep duration and poor sleep habits are associated with the onset and development of chronic diseases or illnesses, acute infections, and premature mortality. A lack of sleep can signal immune parameters critical to our resistance to the outside environment. Our T cell proliferation decreases, which means our T helper cell cytokine responses will be lowered (5). Our natural killer cell will respond slower, and activation of proinflammatory pathways increases. For example, sleep can strengthen your immune system to fight against the possible common cold. The Oxford academic journal "Sleep" suggests that those sleeping > 7 hours per night were associated with a lower risk of the common cold. A lack of sleep may lead to an increased susceptibility to the common cold.
Sleep is essential, and while our culture may promote the productiveness of not sleeping, it is cognizant to realize the many detrimental effects not sleeping will have on your body.
References:
(1) Hirshkowitz M, Whiton K, Albert SM, Alessi C, Bruni O, et al. The National Sleep Foundation’s sleep time duration recommendations: methodology and results summary. Sleep Health. 2015;1(1):40–43.
(2) Lo, J, Chong, P, Ganesan S, et al. Sleep Deprivation Increases Formation of False Memory. Journal of Sleep Research. July 5, 2016.
(5) Aric A. Prather, PhD, Denise Janicki-Deverts, PhD, Martica H. Hall, PhD, Sheldon Cohen, PhD, Behaviorally Assessed Sleep and Susceptibility to the Common Cold, Sleep, Volume 38, Issue 9, September 2015, Pages 1353–1359.
Ever thought of how your lifestyle can modify your life? Something as simple as sleep, which many of us take for granted, can completely alter our lives for the good and the bad, depending on how we use it. A lack of sleep is seen to cause problems with skin, such as quicker aging of the skin, as well as being linked to diabetes. It is important to understand what the proper amount of sleep is and how it can benefit and/or harm us.
Sleep is essential for our health, and lacking it can affect our cortisol levels or stress hormone. The stress hormone can interact with our skin and contribute to skin aging. If you are not sleeping well for a long period of time, you can start to see pigmentation related issues because the nutrients you would be getting while asleep aren't being absorbed, so your skin becomes more susceptible to the sun leading to pigmented areas of skin. Skin repairs itself up to three times faster at night than during the day. Throughout the day, your skin is working hard to stop bacteria and viruses from getting in as well as protecting you from UV rays. Your skin starts to slow down when you close your eyes and DNA reproduction occurs in order for the skin to repair itself. Melatonin also increases when you sleep to help fight cellular damage when you're awake.(1) When you're in your deepest form of sleep, human growth hormone (HGH) increases(2) which is essential to healthy cellular function and rebuilding skin tissue. Our skin is also battling inflammation when we are sleeping. Most acne is usually caused by inflammation, bacteria and oil, so this inflammation can actually be lessened when we sleep, which can have a great effect on our skin.(3) Negative stress has been linked to many inflammatory diseases such as acne, arthritis, and depression. Skin issues, such as rosacea, are another example of inflammatory conditions that can be repaired during sleeping when these inflammation levels decrease.
A relationship not widely known about is the lack of sleep and increased risk in diabetes. Having quality sleep is very important in the prevention of diabetes. Restricting our sleep can cause insulin resistance, which is the hormone that helps us to maintain our blood sugar, therefore when we restrict our sleep we contribute to the disease process. When we sleep, the skin not only has time to repair itself, but so does our body. Our body uses the time we sleep to repair the damage that happened earlier in the day such as an increase in sugar levels. Epidemiological studies actually concluded that participants who were sleeping less than seven hours of sleep were at a significantly higher likelihood of becoming either diabetic or pre-diabetic. One study showed that sleep restriction for four hours a night for two nights in a row reduced glucose tolerance by forty percent in healthy individuals.(4) It has been found that sleep restriction causes beta cells in the pancreas to stop becoming sensitive to glucose which affects how much insulin is produced.(5) Sleep restriction also contributes to obesity, especially in older adults whose production of insulin is not working as well. When they are awake, this encourages the person to eat more, and if they don't get enough sleep it hinders their insulin production more. Leptin and Ghrelin are both hormones that influence eating. They work together to regulate appetite. Ghrelin is secreted by cells in the stomach before meal times, making you feel hungry. Leptin, however, is secreted from adipose tissue (fat), and suppresses your appetite after you've eaten. Leptin is also circadian-regulated, peaking at night, so that it suppresses your appetite when asleep. Sleep-deprivation is associated with higher levels of ghrelin along with lower levels of leptin.(6)
Shift work can affect circadian misalignment and affect both sleep and health. Numerous reports have indicated that shift workers have a higher incidence of diabetes, obesity, and cardiovascular events due to the irregular timing of their sleep.(7) An average of 4.8 hours, which is considered short sleep, was associated with night shift workers. “In a study conducted in 2,860 male workers, the relative risk for Type 2 Diabetes for 2 shift workers and 3 shift workers compared to daytime workers was increased. Additionally, in 4,328 workers evaluated, shift work was a risk factor for weight gain.”(8)
Getting enough quality sleep can not only make your body function better, but can also improve your mental and physical health. Sleep hygiene is very important and we can actually train our brain to know when to sleep by trying to go to bed and wake up around the same time each day.(9) It’s best not to look at stressful news or social media before going to bed and to avoid caffeine at least 4-6 hours before bedtime. Next time, you're burning the candle at both ends, keep in mind the importance of getting a good night’s rest and the consequences it can have on your long term health.
References:
(1) BMJ. Night shifts may hinder body's ability to repair DNA damage: Suppression of sleep hormone melatonin likely factor, findings suggest. ScienceDaily. (2017, June 26).
(2) Van Cauter E, Plat L. Physiology of growth hormone secretion during sleep. J Pediatr. 1996;128(5 Pt 2):S32-S37. doi:10.1016/s0022-3476(96)70008-2
(4) Spiegel K, Leproult R, Van Cauter E. Impact of sleep debt on metabolic and endocrine function. Lancet. 1999;354(9188):1435-1439. doi:10.1016/S0140-6736(99)01376-8
(5) Ip M, Mokhlesi B. Sleep and Glucose Intolerance/Diabetes Mellitus. Sleep Med Clin. 2007;2(1):19-29. doi:10.1016/j.jsmc.2006.12.002
(6) Taheri S, Lin L, Austin D, Young T, Mignot E. Short sleep duration is associated with reduced leptin, elevated ghrelin, and increased body mass index. PLoS Med. 2004;1(3):e62. doi:10.1371/journal.pmed.0010062
(7) Huang W, Ramsey KM, Marcheva B, Bass J. Circadian rhythms, sleep, and metabolism. J Clin Invest. 2011;121(6):2133-2141. doi:10.1172/JCI46043
(8) Nedeltcheva AV, Scheer FA. Metabolic effects of sleep disruption, links to obesity and diabetes. Curr Opin Endocrinol Diabetes Obes. 2014;21(4):293-298. doi:10.1097/MED.0000000000000082
There are many factors that play an important role for having a good health and one of those factors is sleep. Sleep is very important not only for our mental health but also for our physical health. There are different ways that sleep has an effect on a daily basis. It can improve our memory and ability to solve problems. It helps regulate certain hormones such as growth hormone, repair of our cells and tissues, regulate sugar levels, and ensure that our immune system is strong and capable of fighting off infections. What happens when you are actually sleeping? Your body goes through two main phases when you are asleep. There is the rapid eye movement (REM) and non-rapid eye movement (NREM) phase. The REM sleep phase is the dream sleep phase which is actually a phase in which the brain is active. The NREM phase is more of the quiet and restful phase of sleep. Normally, these two phases of sleep repeat in a cycle of NREM then the REM phase. The cycle is about 90 minutes long and repeats every 4 to 6 times in a 7 to 8 hours sleep duration.
Similar to other functions in the body, sleep can be disturbed. There are a few sleep disorders that affect our normal sleep patterns. When the normal sleep cycle is interrupted then our body and mind are not rested properly or restored fully. Sleep disorders affect a person’s ability to stay alert and make the proper decisions that are needed to make. Being able to rest properly makes a huge difference in one’s life. If a person is not rested properly, then a person’s well-being is affected.
Narcolepsy is a chronic sleep disorder that presents as daytime sleepiness which can affect a person’s ability to focus on school, work, and other settings as well. The main symptom of Narcolepsy is excessive daytime sleepiness (EDS). Sunosi (Solriamfetol) is FDA approved medication in 2019. It is a dopamine and norepinephrine reuptake inhibitor (DNRI) that is indicated for EDS associated with narcolepsy as well as other conditions. Sunosi may increase the blood pressure therefore it is important to ensure that a patient’s blood pressure is controlled before initiating treatment. It is recommended to initiate 75 mg once daily in adults but one may double the dose after at least 3 days of initial treatment. The maximum dose of Sunosi for the treatment is narcolepsy is 150 mg daily in the morning. Once a patient is on Sunosi, it is important to monitor blood pressure regularly in order to watch out for drug-induced hypertension. This medication is renally adjusted for patients with renal impairment. Overall, patients with renal impairment are at a higher risk of increases in blood pressure. Based on clinical studies, Sunosi does not have a risk for dependence.
Narcolepsy can have a magnificent effect on a patient’s well-being especially when occurring while a patient is performing an activity such as driving. It can also affect a person’s performance at work or school due to a lack of proper sleep. There is no known cause and treatment for narcolepsy is to decrease symptoms but there is no cure for the condition.
Insomnia affects roughly 60 million Americans every year. The defining criteria for chronic insomnia is when a patient has symptoms at least three times a week for at least three months despite adequate opportunity to sleep. Novel medications are being FDA-approved to treat insomnia. A recent medication approved to treat insomnia (specifically in December 2019) is Dayvigo (lemborexant). Dayvigo’s drug class is as a DORA- dual orexin receptor antagonist. The orexin neuropeptide signaling system plays a role in wakefulness. Blocking the binding of wake-promoting neuropeptides orexin A and orexin B to receptors OX1R and OX2R is thought to suppress wake drive.
The Esai Pharmaceuticals small molecule orexin receptor antagonist will be made available in 5 mg and 10 mg doses. There are certain contraindications, warnings, and precautions to be cognizant of. Dayvigo is contraindicated in patients with narcolepsy, a sleep disorder characterized by excessive sleepiness, sleep paralysis, and hallucinations. Warnings and precautions include but are not limited to CNS depressant effects and daytime impairment, sleep paralysis, hypnagogic/hypnopompic hallucinations, and cataplexy-like symptoms, complex sleep behaviors, and worsening of depression/suicidal ideation. It is crucial to note that a patient on Dayvigo needs to be reevaluated if insomnia persists after 7 to 10 days of treatment.
As most other prescription insomnia medications, a very common adverse effect of Dayvigo is drowsiness which occurs in 1 to 10% of patients. Other central nervous system (CNS) adverse reactions of Dayvigo include fatigue, headache, abnormal dreams, nightmares, and sleep paralysis. The FDA’s Division of Risk Management (DRISK) evaluates whether a risk evaluation and mitigation strategy (REMS) for the new molecular entity Dayvigo (lemborexant) is necessary to ensure the benefits outweigh its risks. The primary safety concern associated with the use of lemborexant is somnolence and the potential for next day impairment. The risk is increased if Dayvigo is taken with less than a full night of sleep and with the higher dose (10 mg). DRISK determined that a REMS is not needed to ensure the benefits of Dayvigo outweigh its risks.
A patient on Dayvigo should avoid concomitant use with strong or moderate CYP3A inducers and inhibitors and alcohol consumption. Recommended monitoring is for somnolence in all patients and for excess sedation observed in infants in breastfeeding mothers. The recommended dosage for adults of Dayvigo is 5 mg taken no more than once per night, immediately before going to bed, with at least 7 hours remaining before the planned time of awakening. Effective dosing has not been determined in children and as the elderly are prone to falls, close monitoring should be done when given doses more than 5 mg.
It is important to advise patients to take Dayvigo only when preparing for or getting into bed and only if they can stay in bed for a full night (at least 7 hours) before being active again. Advise patients that the effect of Dayvigo may be delayed if taken with or soon after a meal. In conclusion, on December 20, 2019, Dayvigo became the second FDA-approved dual orexin receptor antagonist (DORA) (the first FDA-approved DORA is Belsomra, August 13, 2014. The advantages of Dayvigo include that it not only helps you fall asleep, but it also helps you stay asleep. It is taken not more than once a night, immediately before going to bed, with at least 7 hours remaining before the planned time of awakening. However, a common disadvantage of Dayvigo is that it can impair daytime wakefulness as it is a CNS depressant with a long t ½. Patients on Dayvigo should be aware that their morning alertness and motor coordination can be impaired in the morning and plan their morning accordingly and consult with their doctor. As a hypnotic, Dayvigo can also cause sleep paralysis and complex sleep behaviors such as sleep-eating and sleep-driving. As patients usually don’t remember complex sleep behaviors, if they are made aware of these events (for example, other people in their household inform them), they should discontinue Dayvigo immediately.
Sleep is a vital part about being human, sleep is responsible for both physical and mental health, immune function, and cognition. The stages of sleep are classified as one stage of rapid eye movement sleep and four stages of non-rapid eye movement. During REM sleep, the body goes through numerous changes including fast breathing, change in body temperature, increased blood pressure, twitching, etc. According to the American Academy of sleep medicine and sleep research society, the average adult (18-60 years old) should get at least 7 hours of sleep. 30 percent of United States’ adults receive less than the recommended 7 hours. Sleep deprivation can be associated with adverse health effects including cardiovascular disease, obesity, and all cause mortality. Insufficient sleep syndrome results from lack of adequate habitual sleep leading to daytime sleepiness. Symptoms of daytime sleepiness include irritability, decreased concentration, attention deficits, reduced vigilance, distractibility, poor motivation, fatigue, lack of energy, restlessness, and incoordination. Sleep deprivation can go unrecognized if patients are not asked about their sleeping habits.
Chronic sleep insufficiency can be attributed to work demands, social and family obligations, medical conditions, and sleep disorders. Failing to prioritize sleep, many individuals are at a higher risk for accidents, reduced general performance, and decreased quality of life. Receiving anywhere between 6 to 9 hours of sleep per night (consistently) or following a sleep schedule in which you sleep and rise at the same time every day, can put you on track into adjusting how much sleep you receive and can lead to a more functional quality of life
Good sleep hygiene is important, usually involves a couple lifestyle changes. It is recommended that patients just starting to get into a good sleep routine, keep a journal. Second, patients should go to bed the same time every night and wakeup the same time every morning, even on the weekends. Next, for patients who have trouble falling asleep should avoid caffeine and naps, it also maybe advised that these patients try melatonin or Benadryl 30 min before bedtime (these over-the-counter options should not be used long-term). Room association should also be implemented. This is when you create a relaxing environment for your bedroom, and you try and reserve the bedroom only for sleep. This means avoiding activities such as working, working out and eating in your room, if possible, if this is not possible, at least avoid doing any of these activities on your bed. This will allow your brain to associate your bed with sleep, creating an easier time falling asleep when it is time to lay down in bed. Finally, avoid screens right before bed. When viewing a screen, the artificial light makes your brain associate it with daytime, preventing your brain from “shutting down”. With modern day technology, the screens we look at includes blue light, this blue light stimulates your brain which also makes it difficult for your brain to wind down and realize that it is time for bed.
The purpose of sleep is important for humans in order to maintain proper function. In many adults, sleep duration has been shortened which has led to impaired cognitive function. This has resulted in car accidents, decreased quality of life, and increased risk for diseases. The concept of sleep is complex and depends on the duration, circadian phase, and the time of day a person may fall asleep. The circadian phase is dependent on the amount of light exposure. This means that people who constantly change the amount of light in their rooms or alter their sleeping schedule will experience changes in their circadian cycle. Symptoms of an affected circadian cycle can include difficulty falling asleep or staying asleep and may even be an indication for a sleep disorder such as insomnia. This can have a negative impact on a person’s health.
Sleep helps to promote recovery of the immune system when a person is sick. It allows the body to relax and conserve energy where it is needed the most. Studies have shown that people who had a shorter duration of sleep (less than 7 hours) were more likely to be associated with more health problems compared to people who slept longer. Children and adolescents are at a higher risk of developing physical and psychological problems when it comes to sleep deficiency. For example, a shorter sleep duration in this demographic has been associated an increased risk of obesity, type 2 diabetes, and cardiovascular disease. Lack of sleep can be correlated to obesity because people who are spending less time sleeping will be more likely to increase their food intake. If a person is sleep deprived, the hormone ghrelin is stimulated, and a person will need to consume more food for energy to keep the body functioning for a longer period of time. Glucose metabolism is also affected by this as well. Obesity is a major risk factor type 2 diabetes. Therefore, not only does the previous statements related to obesity hold true for type 2 diabetes as well, but lack of sleep can decrease the resting metabolic rate and increase post-prandial glucose levels. Sleep can also play a role in cardiovascular diseases such as hypertension. People who acquire enough sleep allow the blood pressure to decrease at night during relaxation and laying in a supine position. This can be coupled with the decrease in sympathetic tone and gives the muscles time to rest and recover.
Promoting healthy sleep hygiene practices can result in an improvement of sleep health. Typically, humans are supposed to sleep for 7-8 hours every night in order to produce optimal functioning. So, if a person is suffering from sleep deprivation, they may be able to train their bodies to restore their natural circadian cycle. The UCSD Center for Pulmonary and Sleep Medicine have recommendations for patients on how they can create a healthy sleep schedule. Some of the recommendations include: not going to bed until you are tired, having a regular bedtime routine that allows you to wind down and prepare your body for sleep (reading, bathing), encouraging the body to wake up at the same time every morning (even on days off), avoid naps and promote a full night’s rest (limit naps to 1 hour and no napping past 3 p.m.), only use bed for sleep and intimacy, avoid caffeine and alcohol, smoking cessation, avoid strenuous exercise before bedtime, and making sure that the room is quiet and dark. All of these can help a person get the required 7-8 hours of sleep each night if they are practice routinely.
References
Phillips, A., Clerx, W. M., O'Brien, C. S., Sano, A., Barger, L. K., Picard, R. W., Lockley, S. W., Klerman, E. B., & Czeisler, C. A. (2017). Irregular sleep/wake patterns are associated with poorer academic performance and delayed circadian and sleep/wake timing. Scientific reports, 7(1), 3216. https://doi.org/10.1038/s41598-017-03171-4
Besedovsky, L., Lange, T., & Haack, M. (2019). The Sleep-Immune Crosstalk in Health and Disease. Physiological reviews, 99(3), 1325–1380. https://doi.org/10.1152/physrev.00010.2018
Vitale, K. C., Owens, R., Hopkins, S. R., & Malhotra, A. (2019). Sleep Hygiene for Optimizing Recovery in Athletes: Review and Recommendations. International journal of sports medicine, 40(8), 535–543. https://doi.org/10.1055/a-0905-3103
The human body’s numerous functions are dictated by an internal bodyclock known by many as the ‘circadian rhythm.’ It is through this intrinsic schedule that our bodies are able to regulate the mechanisms working in tandem with one another--and though the uncanny ability to push our physical forms to peak performance requires a level of wakefulness, the importance of restful sleep cannot be ignored when assessing the overall health of our bodies. Studies have shown a direct correlation between the level of restful sleep a person experiences and their cognitive functions in wakefulness, specifically citing that subjects displayed deteriorating cognitive abilities after exceeding sixteen hours of wakefulness without sleep. Consecutive hours of wakefulness are not the only contributor to poor sleep hygiene; for example, sleep deficits may accumulate after multiple episodes of partial restfulness. Studies have shown that sleep provides the most restorative results when it is unfragmented and consolidated; in order to achieve the most effective level of sleep, the REM (or Rapid Eye Movement) phase of the sleep cycle must be met and satisfied.
Rapid Eye Movement sleep, or REM, is associated with a low-voltage reading on an ECG as well as rapid eye-muscle twitching and movement. This state of sleep is most heavily associated with the phenomenon of dreaming--and while the exact function of REM sleep is still not fully understood, studies show that this stage within the sleep-cycle is most heavily associated with brain activity, sensory-motor connections, and an improvement in memories. However, REM sleep is not the only phase within the sleep cycle that readily benefits the human body’s function. Deep sleep is characterized by a lower readiness to be roused to consciousness, a slower breathing rate & heart rate, and a lack of dreams. During this specific phase of sleep, the body undergoes rejuvenation and tissue repair. A proper, uninterrupted cycle of deep sleep is necessary for the body to recover from the wear and tear of daily activities while also aiding in cognitive functions in a state of consciousness.
Sleep is an integral consequence of our bodies’ natural circadian rhythm and without it, the effects can become catastrophic. According to studies, nearly 35% of American adults rate their quality of sleep as simply “okay” or “fair” while another 45% report that they have difficulty falling asleep at night. There are many factors that can affect sleep disruption, including but not limited to societal, environmental, and genetic factors. Sleep disruption hosts a plethora of physiological detriments, including reduced insulin sensitivity, increased secretion of cortisol, and higher oxygen consumption. The physiological consequences can therefore lead to health complications--especially in patients who have comorbidities such as diabetes. In addition, if a patient suffers from sleep disorders such as obstructive sleep apnea, continued sleep disruption could lead to potentially fatal adverse effects such as heart disease as poor sleep contributes as a risk factor.
While the concept and study of sleep remain elusive, research has drawn the definitive conclusion that sleep remains necessary. Without it, our bodies & natural rhythms would grind to a startling halt, setting free a host of consequences like that of Pandora’s Box.
To understand why sleep is important , we must understand how sleep works and how it affects the body. There are two basic types of sleep which include rapid eye movement or REM as well as non-REM sleep. Non-REM sleep includes deep sleep or slow wave sleep while dreaming typically occurs during REM sleep. Getting enough sleep not only affects a person's mental and physical health, but also can interfere with work, school , and social functioning. An individual might have trouble learning, focusing , or reacting if they are sleep deficient which can greatly influence their life. Sleep deficiency is a common public health problem in the United States, and people in all age groups report not getting enough sleep. Nearly 40% of adults report falling asleep during the day without meaning to, and an estimated 50 to 70 million Americans have chronic sleep disorders. Sleep deficiency is also linked to many chronic health problems including heart disease, kidney disease, high blood pressure, obesity, and depression.
The bodies internal clock controls when someone is awake and when the body is ready for sleep. The body clock typically has a 24-hour repeating rhythm called the circadian rhythm. The first process that interacts to control this rhythm is a pressure to sleep that builds up with every hour that you're awake. This drive for sleep reaches a peak in the evening when most people get ready for bed. A compound called adenosine seems to be linked to this desire for sleep. When an individual is awake, their level of adenosine in the brain continues to rise and while they sleep, the body breaks down adenosine. When it gets dark outside, the body releases a hormone called melatonin and this hormone signals your body that it's time to prepare for sleep and helps you feel drowsy. The amounts of melatonin in the bloodstream peaks as the evening progresses on, and the body releases cortisol when it naturally prepares you to wake up. Adequate sleep every night helps the brain work properly and also improves learning throughout the day. Studies show that sleep deficiency alters activity in some parts of the brain that is responsible for making decisions, solving problems and controlling emotions and behavior.
Ongoing sleep deficiency is linked to an increased risk of heart disease, high blood pressure and stroke. One study of teenagers showed that with each hour of sleep that is lost , the odds of becoming obese goes up. Sleep helps maintain a balance of hormones that make you feel hungry or full, which includes ghrelin or leptin. The level of ghrelin goes up when an individual doesn't get enough sleep, and the level of leptin goes down. This makes someone feel hungrier than they usually would be if they are well rested. Sleep also affects how the body reacts to insulin, and sleep deficiency results in a higher than normal blood sugar level which may increase the risk for diabetes. Lastly, the immune system relies on sleep to stay healthy. Sleep deficiency that is ongoing can cause the immune system to have trouble finding common infections and affects the way it responds to bacteria.
Sleep is something that many patients do not get enough of, which may be due to a busy schedule or even the result of a disease state. Healthy sleep hygiene and a normal sleep schedule is stressed in order for one to live a high quality of life and promote health benefits in the future. Having a normal sleep schedule can prevent a variety of health conditions later on in a patient’s life. Inconsistent sleep can affect circadian rhythm, which is the body’s internal clock regulating body function from the day’s start to its end. Circadian rhythm controls the sleep cycle, brain function, and body metabolism. There are different stages of sleep. There is rapid-eye movement (REM) and non-rapid eye movement (NREM) sleep. The REM stage of sleep is associated with the part of sleep where dreams commonly occur because it is associated with the highest brain activity. Non-rapid eye movement (NREM) sleep has 3 parts to it: N1, N2 and N3. The deepest part within this stage is N3 that controls one’s growth and development. Not getting enough sleep can lead to long term health decline and can result in extreme fatigue and lack of concentration. Due to this fatigue and unregulated body functions, it can affect the body’s stress levels, appetite and hormone balance. This can result in serious chronic conditions like obesity and hypertension. The recommended amount of sleep for an average adult ranges from 7-9 hours, while for children the duration recommended is actually longer since children are still developing. Like diet and exercise, sleep is necessary in order for one to maintain a healthy lifestyle and promote physiological, psychological and emotional well-being. As a pharmacist it is essential to counsel patients on proper sleep hygiene before introducing them to any over the counter products to induce and aid sleep. Pharmacists can counsel patients to set a time for bed, and right before bed counsel patients to prevent any distractions like using the television, social media or any other electronics right before sleeping. A pharmacist can also counsel patients to strictly set aside an area for sleep only, and stress not to do anything in the day in that area, especially work so that the mind registers and understands the area is designated to sleep in only. Eating right before bed should be prevented as much as possible, especially if the patient is to be consuming any excess caffeine or alcohol with their meal. Some patients still have difficulties in sleeping even though they try to practice good sleep hygiene and opt for other alternatives. A pharmacist can recommend a patient to take Melatonin over the counter or use Benadryl or Z-Quill based on patient risk factors. As for prescription products, non-benzodiazepines or the Z-drugs are not generally recommended in the elderly population due to increased risk of falls and altered mental status but can be used as sleep aids in patients. Sleep aids are also not intended for long term use, especially in the elderly population, so counseling these patients is crucial and the role of the pharmacist is essential in the proper treatment of sleep conditions.
Sleep is a need for all sophisticated animals, including humans, in order to function optimally. There are two types of sleep, non-rapid eye-movement sleep and rapid eye-movement (REM) sleep. Non-rapid eye movement sleep is divided into stages 1, 2, 3, and 4. Each stage is unique in that they have variations in brain wave patterns, eye movements, and muscle tone. Sleep begins with a short period of non-rapid eye movement stage 1 sleep progressing through stage 2, followed by stages 3 and 4 and finally onto REM sleep. However, individuals do not remain in REM sleep the remainder of the night but instead cycle between stages of non-rapid eye movement and REM sleep throughout the night. Stage 1 sleep serves as a transitional stage between old and new cycles. This stage usually lasts 1 to 7 minutes and is easily interrupted by a disruptive noise. Stage 2 lasts approximately 10 to 25 minutes each cycle, and will eventually make up between 45 to 55 percent of total sleep time. A more intense stimulus is needed in order to wake a person in stage 2 sleep than stage 1 sleep. Sleep stages 3 and 4 are known as slow-wave sleep. Stage 3 lasts only a few minutes and makes up 3 to 8 percent of sleep. Stage 4, which lasts approximately 20 to 40 minutes, makes up about 10 to 15 percent of sleep. Stage 4 sleep is the hardest to wake a person up from. Finally, after stage 4, comes REM sleep. REM sleep is defined by the presence of desynchronized brain activity, muscle tone, and rapid eye movement. During the initial cycle, the REM period may last only 1 to 5 minutes, but it becomes longer the more the person sleeps.
References
Grandner MA. Sleep, Health, and Society. Sleep Med Clin. 2017;12(1):1-22.
Sleep is a necessary and vital state that serves numerous functions including process of information, improvement in memory, energy conservation, modulation of immune responses, removal of toxic byproducts in the brain, etc. The stages of sleep are classified as one stage of rapid eye movement sleep and four stages of non-rapid eye movement. During REM sleep, the body goes through numerous changes including fast breathing, change in body temperature, increased blood pressure, twitching, etc. An average of seven to eight hours of sleep per day is ideal. There are sleep disorders such as insomnia which affects about one third of adults in the world. Risk factors of sleep deprivation include lifestyle such as shift work, jet lag, excess caffeine, psychosocial factors such as anxiety, etc. Inadequate or disrupted sleep affects waking cognitive functions including performance and cognitive speed. Their psychological well-being as well as emotional, physical health and quality of life can be disturbed. For chronic insomnia, cognitive behavioral therapy has shown long term benefits and medication can be used for short-term treatment. Medications used to treat chronic insomnia are non-benzodiazepines like zolpidem, benzodiazepines like temazepam, and melatonin receptor agonist such as ramelteon. Long term consequences of sleep disruption can even include diseases such as hypertension, cardiovascular diseases, diabetes, and weight related issues. A study done showed that disrupted sleep can be a factor in the development of depression. Insufficient sleep can contribute to changes in the neuroendocrine stress response system. It is important to treat sleep conditions as soon as possible.
References
Medic G, Wille M, Hemels ME. Short- and long-term health consequences of sleep disruption. Nat Sci Sleep. 2017;9:151-161. Published 2017 May 19. doi:10.2147/NSS.S134864
Worley SL. The Extraordinary Importance of Sleep: The Detrimental Effects of Inadequate Sleep on Health and Public Safety Drive an Explosion of Sleep Research. P T. 2018;43(12):758-763.
Written by Justin Ayob and Antonio Ortega
Many of us are drawn into staying up late at night, sacrificing precious hours of sleep that cause a harm to our health over time. Many view sleep as granted and do not think cutting the hours they sleep takes a toll on their body, and over look the long term health risks. Sadly, these wasted valuable hours of sleep go unnoticed, and no one thinks to change their sleeping habits to get more hours of sleep. Many studies have shown that with insufficient sleep, the risk of acquiring diabetes, obesity, and cardiovascular diseases increases.
Firstly, starting off with obesity, many studies have linked insufficient sleep and obesity. One study has shown that people who sleep less than six hours daily were likely to have excess body weight while compared to those who had an average of eight hours of sleep a night were to have less excess fat. Sleep is an important regulator of neuroendocrine function and glucose metabolism and without sleep, alterations such as decreased glucose tolerance, decreased insulin sensitivity are set to occur.
Secondly, developing diabetes has been shown in those who have reported sleeping less than five hours daily. Less sleep causes a negative influence in blood sugar control and increases the effects of type 2 diabetes. Chronic sleep disturbances would elevate the risk of developing insulin resistance, while diabetes would worsen the quality of sleep. Surprisingly, studies have also shown that long sleep durations (over 9 hours) have also been adversely related to insulin resistance
Lastly, there has been a strong link between cardiovascular diseases and less sleep. Studies have shown that six to seven hours of sleep has been associated with coronary artery calcification which may in the future cause a heart attack. Also, a lack of sleep may cause a hypertension, stroke, coronary heart disease, and an irregular heartbeat.
With all said, it is important to get the normal hours of sleep one needs to perform the normal functions of one daily. Getting the sleep one needs may lead to avoiding the adverse health effect and avoid the expensive health care costs.
Refrences:
Sleep and health. Sleep and Health | Need Sleep. https://healthysleep.med.harvard.edu/need-sleep/whats-in-it-for-you/health. Accessed April 6, 2022.
Beccuti G, Pannain S. Sleep and obesity. Curr Opin Clin Nutr Metab Care. 2011;14(4):402-412. doi:10.1097/MCO.0b013e3283479109
Chattu VK, Chattu SK, Burman D, Spence DW, Pandi-Perumal SR. The Interlinked Rising Epidemic of Insufficient Sleep and Diabetes Mellitus. Healthcare (Basel). 2019;7(1):37. Published 2019 Mar 5. doi:10.3390/healthcare7010037
Sleep is an important function of the human body. Sleep is a restorative process with different stages having different functions. There are two processes that regulate sleep time and duration which are a homeostatic process and a circadian process. There are two types of sleep which are non-REM and REM. REM stands for rapid eye movement. Non-REM sleep occurs first and has three stages. Stage 1 is a light sleep that lasts for about 5-10 minutes in which the person may be woken up easily. Stage 2 is also a light sleep in which heart rate slows down and body temperature decreases. Brain waves become slower and the body prepares for deep sleep. Stage 3 is considered deep sleep. The brain produces delta waves in this stage. During all 3 stages of non-REM sleep, the body repairs tissue, strengthens the immune system, and builds bone and muscle. During REM sleep, the brain activity increases so this is usually where people will experience dreaming. This phase of sleep begins about an hour and a half after falling asleep and lasts about 10 minutes during the first stage but increases during each cycle of sleep.
The amount of sleep that people need depends on their age and also varies slightly from person to person. For example, newborns 4 to 12 months of age need 12-16 hours of sleep per day while adults 18 years or older need 7-8 hours of sleep per day. If people do not get the recommended amount of sleep per night, they will not function optimally. Sleep deprivation can cause daytime sleepiness, decreased focus, and slower reaction time. Certain medication can cause patients to get less than a normal amount of sleep. These medications include SSRIs, dopamine agonists, stimulants, anticonvulsants, decongestants, steroids, and beta agonists. Patients should be counseled on this side effect and take these medications in the morning if possible to decrease the risk of medication-induced insomnia.
Resources:
Barbato G. REM Sleep: An Unknown Indicator of Sleep Quality. Int J Environ Res Public Health. 2021;18(24):12976. Published 2021 Dec 9. doi:10.3390/ijerph182412976
Sleep deprivation and deficiency - how much sleep is enough. National Heart Lung and Blood Institute. https://www.nhlbi.nih.gov/health/sleep-deprivation/how-much-sleep. Accessed March 28, 2022.
Sleep
Written by Jerry Lau and Tommy Li
It's a Friday night. You just got back from a two am night out with your friends, and as you stumble into your bed, you wonder, how messed up am I going to be tomorrow? Sleep is an integral part of our health. However, with modern American society promoting the culture of excessive work habits, partying hard late into the night, and pulling all-nighters to study for exams, one can only wonder what these collective habits have on our health.
What exactly is sleep, and how do humans fall asleep? Essentially, sleep is a period of rest that the body utilizes as a "housekeeping" phase to remove toxins in the brain that build up while awake. As we prepare to sleep, clusters of sleep-promoting neurons in many parts of the brain become active, and neurotransmitters dampen the activity of cells that play a role in arousal or relaxation (4).
The CDC recommends that adults have a minimum of seven hours of sleep at night, and those seven hours should be "good-quality" sleep. Good-quality rest can be quantitatively based on four factors: sleep latency, sleep-waking, wakefulness, and sleep efficiency. Sleep latency is the measurement of how long it takes to fall asleep (the goal here should be 30 minutes or less); sleep-waking is how often you wake up during your sleep session (the goal here should be once or less); wakefulness is how many minutes you spend awake after you first go to sleep (the goal here should be twenty minutes or less); sleep efficiency is the amount of time you spend sleeping in bed (the goal here should be 85% or more). These four factors contribute to the overall sense of your sleep being "good"; you improve your sleep quality by improving these four factors (3).
Sleep also benefits the retention of memory by protecting them from interfering stimuli and consolidating them. The rapid-eye movement or REM sleep is crucial to memory consolidation and metabolic electrophysiological, neurochemical, and genetic mechanisms inside our body. The brain needs a perfect time to settle down the memory consolidation process and enhance it. A minimum standard of proper sleep is necessary to activate slow-wave rest, stabilizing transformed memories and integrating them into long-term memories. Sleep-deprived adolescents are more likely to incorporate misleading memories of past events. Multiple nights of restricted sleep increase false memory formation and is not recommended. Young adults require more sleep hours to avoid abstract eyewitness testimony (2).
Moreover, growing evidence indicates that short sleep duration and poor sleep habits are associated with the onset and development of chronic diseases or illnesses, acute infections, and premature mortality. A lack of sleep can signal immune parameters critical to our resistance to the outside environment. Our T cell proliferation decreases, which means our T helper cell cytokine responses will be lowered (5). Our natural killer cell will respond slower, and activation of proinflammatory pathways increases. For example, sleep can strengthen your immune system to fight against the possible common cold. The Oxford academic journal "Sleep" suggests that those sleeping > 7 hours per night were associated with a lower risk of the common cold. A lack of sleep may lead to an increased susceptibility to the common cold.
Sleep is essential, and while our culture may promote the productiveness of not sleeping, it is cognizant to realize the many detrimental effects not sleeping will have on your body.
References:
(1) Hirshkowitz M, Whiton K, Albert SM, Alessi C, Bruni O, et al. The National Sleep Foundation’s sleep time duration recommendations: methodology and results summary. Sleep Health. 2015;1(1):40–43.
(2) Lo, J, Chong, P, Ganesan S, et al. Sleep Deprivation Increases Formation of False Memory. Journal of Sleep Research. July 5, 2016.
(3) “What is Sleep Quality?” Sleep and You. National Sleep Foundation. https://www.thensf.org/what-is-sleep-quality/. Accessed 2021 Aug 27.
(4) “Brain Basics: Understanding Sleep.” Patient and Caregiver Education. NIH. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Understanding-Sleep. Accessed 2021 Aug 27.
(5) Aric A. Prather, PhD, Denise Janicki-Deverts, PhD, Martica H. Hall, PhD, Sheldon Cohen, PhD, Behaviorally Assessed Sleep and Susceptibility to the Common Cold, Sleep, Volume 38, Issue 9, September 2015, Pages 1353–1359.
Natalie Eshaghian & Donna Salib
The Effects of Sleep-Deprivation
Ever thought of how your lifestyle can modify your life? Something as simple as sleep, which many of us take for granted, can completely alter our lives for the good and the bad, depending on how we use it. A lack of sleep is seen to cause problems with skin, such as quicker aging of the skin, as well as being linked to diabetes. It is important to understand what the proper amount of sleep is and how it can benefit and/or harm us.
Sleep is essential for our health, and lacking it can affect our cortisol levels or stress hormone. The stress hormone can interact with our skin and contribute to skin aging. If you are not sleeping well for a long period of time, you can start to see pigmentation related issues because the nutrients you would be getting while asleep aren't being absorbed, so your skin becomes more susceptible to the sun leading to pigmented areas of skin. Skin repairs itself up to three times faster at night than during the day. Throughout the day, your skin is working hard to stop bacteria and viruses from getting in as well as protecting you from UV rays. Your skin starts to slow down when you close your eyes and DNA reproduction occurs in order for the skin to repair itself. Melatonin also increases when you sleep to help fight cellular damage when you're awake.(1) When you're in your deepest form of sleep, human growth hormone (HGH) increases(2) which is essential to healthy cellular function and rebuilding skin tissue. Our skin is also battling inflammation when we are sleeping. Most acne is usually caused by inflammation, bacteria and oil, so this inflammation can actually be lessened when we sleep, which can have a great effect on our skin.(3) Negative stress has been linked to many inflammatory diseases such as acne, arthritis, and depression. Skin issues, such as rosacea, are another example of inflammatory conditions that can be repaired during sleeping when these inflammation levels decrease.
A relationship not widely known about is the lack of sleep and increased risk in diabetes. Having quality sleep is very important in the prevention of diabetes. Restricting our sleep can cause insulin resistance, which is the hormone that helps us to maintain our blood sugar, therefore when we restrict our sleep we contribute to the disease process. When we sleep, the skin not only has time to repair itself, but so does our body. Our body uses the time we sleep to repair the damage that happened earlier in the day such as an increase in sugar levels. Epidemiological studies actually concluded that participants who were sleeping less than seven hours of sleep were at a significantly higher likelihood of becoming either diabetic or pre-diabetic. One study showed that sleep restriction for four hours a night for two nights in a row reduced glucose tolerance by forty percent in healthy individuals.(4) It has been found that sleep restriction causes beta cells in the pancreas to stop becoming sensitive to glucose which affects how much insulin is produced.(5) Sleep restriction also contributes to obesity, especially in older adults whose production of insulin is not working as well. When they are awake, this encourages the person to eat more, and if they don't get enough sleep it hinders their insulin production more. Leptin and Ghrelin are both hormones that influence eating. They work together to regulate appetite. Ghrelin is secreted by cells in the stomach before meal times, making you feel hungry. Leptin, however, is secreted from adipose tissue (fat), and suppresses your appetite after you've eaten. Leptin is also circadian-regulated, peaking at night, so that it suppresses your appetite when asleep. Sleep-deprivation is associated with higher levels of ghrelin along with lower levels of leptin.(6)
Shift work can affect circadian misalignment and affect both sleep and health. Numerous reports have indicated that shift workers have a higher incidence of diabetes, obesity, and cardiovascular events due to the irregular timing of their sleep.(7) An average of 4.8 hours, which is considered short sleep, was associated with night shift workers. “In a study conducted in 2,860 male workers, the relative risk for Type 2 Diabetes for 2 shift workers and 3 shift workers compared to daytime workers was increased. Additionally, in 4,328 workers evaluated, shift work was a risk factor for weight gain.”(8)
Getting enough quality sleep can not only make your body function better, but can also improve your mental and physical health. Sleep hygiene is very important and we can actually train our brain to know when to sleep by trying to go to bed and wake up around the same time each day.(9) It’s best not to look at stressful news or social media before going to bed and to avoid caffeine at least 4-6 hours before bedtime. Next time, you're burning the candle at both ends, keep in mind the importance of getting a good night’s rest and the consequences it can have on your long term health.
References:
(1) BMJ. Night shifts may hinder body's ability to repair DNA damage: Suppression of sleep hormone melatonin likely factor, findings suggest. ScienceDaily. (2017, June 26).
(2) Van Cauter E, Plat L. Physiology of growth hormone secretion during sleep. J Pediatr. 1996;128(5 Pt 2):S32-S37. doi:10.1016/s0022-3476(96)70008-2
(3) Gupta MA, Gupta AK. Sleep-wake disorders and dermatology. Clin Dermatol. 2013;31(1):118-126. doi:10.1016/j.clindermatol.2011.11.016
(4) Spiegel K, Leproult R, Van Cauter E. Impact of sleep debt on metabolic and endocrine function. Lancet. 1999;354(9188):1435-1439. doi:10.1016/S0140-6736(99)01376-8
(5) Ip M, Mokhlesi B. Sleep and Glucose Intolerance/Diabetes Mellitus. Sleep Med Clin. 2007;2(1):19-29. doi:10.1016/j.jsmc.2006.12.002
(6) Taheri S, Lin L, Austin D, Young T, Mignot E. Short sleep duration is associated with reduced leptin, elevated ghrelin, and increased body mass index. PLoS Med. 2004;1(3):e62. doi:10.1371/journal.pmed.0010062
(7) Huang W, Ramsey KM, Marcheva B, Bass J. Circadian rhythms, sleep, and metabolism. J Clin Invest. 2011;121(6):2133-2141. doi:10.1172/JCI46043
(8) Nedeltcheva AV, Scheer FA. Metabolic effects of sleep disruption, links to obesity and diabetes. Curr Opin Endocrinol Diabetes Obes. 2014;21(4):293-298. doi:10.1097/MED.0000000000000082
(9) Centers for Disease Control and Prevention. (2016, July 15). CDC - sleep Hygiene tips - sleep and sleep disorders. Available at: https://www.cdc.gov/sleep/about_sleep/sleep_hygiene.html.
There are many factors that play an important role for having a good health and one of those factors is sleep. Sleep is very important not only for our mental health but also for our physical health. There are different ways that sleep has an effect on a daily basis. It can improve our memory and ability to solve problems. It helps regulate certain hormones such as growth hormone, repair of our cells and tissues, regulate sugar levels, and ensure that our immune system is strong and capable of fighting off infections. What happens when you are actually sleeping? Your body goes through two main phases when you are asleep. There is the rapid eye movement (REM) and non-rapid eye movement (NREM) phase. The REM sleep phase is the dream sleep phase which is actually a phase in which the brain is active. The NREM phase is more of the quiet and restful phase of sleep. Normally, these two phases of sleep repeat in a cycle of NREM then the REM phase. The cycle is about 90 minutes long and repeats every 4 to 6 times in a 7 to 8 hours sleep duration.
Similar to other functions in the body, sleep can be disturbed. There are a few sleep disorders that affect our normal sleep patterns. When the normal sleep cycle is interrupted then our body and mind are not rested properly or restored fully. Sleep disorders affect a person’s ability to stay alert and make the proper decisions that are needed to make. Being able to rest properly makes a huge difference in one’s life. If a person is not rested properly, then a person’s well-being is affected.
Narcolepsy is a chronic sleep disorder that presents as daytime sleepiness which can affect a person’s ability to focus on school, work, and other settings as well. The main symptom of Narcolepsy is excessive daytime sleepiness (EDS). Sunosi (Solriamfetol) is FDA approved medication in 2019. It is a dopamine and norepinephrine reuptake inhibitor (DNRI) that is indicated for EDS associated with narcolepsy as well as other conditions. Sunosi may increase the blood pressure therefore it is important to ensure that a patient’s blood pressure is controlled before initiating treatment. It is recommended to initiate 75 mg once daily in adults but one may double the dose after at least 3 days of initial treatment. The maximum dose of Sunosi for the treatment is narcolepsy is 150 mg daily in the morning. Once a patient is on Sunosi, it is important to monitor blood pressure regularly in order to watch out for drug-induced hypertension. This medication is renally adjusted for patients with renal impairment. Overall, patients with renal impairment are at a higher risk of increases in blood pressure. Based on clinical studies, Sunosi does not have a risk for dependence.
Narcolepsy can have a magnificent effect on a patient’s well-being especially when occurring while a patient is performing an activity such as driving. It can also affect a person’s performance at work or school due to a lack of proper sleep. There is no known cause and treatment for narcolepsy is to decrease symptoms but there is no cure for the condition.
“Sleep Disorders (PDQ®)–Patient Version.” National Cancer Institute, www.cancer.gov/about-cancer/treatment/side-effects/sleep-disorders-pdq.
“Narcolepsy: Causes, Symptoms, Treatments.” Sleep Foundation, 17 Feb. 2021, www.sleepfoundation.org/narcolepsy.
Sunosi. Package Insert. Jazz Pharmaceuticals Inc; 2019
Insomnia affects roughly 60 million Americans every year. The defining criteria for chronic insomnia is when a patient has symptoms at least three times a week for at least three months despite adequate opportunity to sleep. Novel medications are being FDA-approved to treat insomnia. A recent medication approved to treat insomnia (specifically in December 2019) is Dayvigo (lemborexant). Dayvigo’s drug class is as a DORA- dual orexin receptor antagonist. The orexin neuropeptide signaling system plays a role in wakefulness. Blocking the binding of wake-promoting neuropeptides orexin A and orexin B to receptors OX1R and OX2R is thought to suppress wake drive.
The Esai Pharmaceuticals small molecule orexin receptor antagonist will be made available in 5 mg and 10 mg doses. There are certain contraindications, warnings, and precautions to be cognizant of. Dayvigo is contraindicated in patients with narcolepsy, a sleep disorder characterized by excessive sleepiness, sleep paralysis, and hallucinations. Warnings and precautions include but are not limited to CNS depressant effects and daytime impairment, sleep paralysis, hypnagogic/hypnopompic hallucinations, and cataplexy-like symptoms, complex sleep behaviors, and worsening of depression/suicidal ideation. It is crucial to note that a patient on Dayvigo needs to be reevaluated if insomnia persists after 7 to 10 days of treatment.
As most other prescription insomnia medications, a very common adverse effect of Dayvigo is drowsiness which occurs in 1 to 10% of patients. Other central nervous system (CNS) adverse reactions of Dayvigo include fatigue, headache, abnormal dreams, nightmares, and sleep paralysis. The FDA’s Division of Risk Management (DRISK) evaluates whether a risk evaluation and mitigation strategy (REMS) for the new molecular entity Dayvigo (lemborexant) is necessary to ensure the benefits outweigh its risks. The primary safety concern associated with the use of lemborexant is somnolence and the potential for next day impairment. The risk is increased if Dayvigo is taken with less than a full night of sleep and with the higher dose (10 mg). DRISK determined that a REMS is not needed to ensure the benefits of Dayvigo outweigh its risks.
A patient on Dayvigo should avoid concomitant use with strong or moderate CYP3A inducers and inhibitors and alcohol consumption. Recommended monitoring is for somnolence in all patients and for excess sedation observed in infants in breastfeeding mothers. The recommended dosage for adults of Dayvigo is 5 mg taken no more than once per night, immediately before going to bed, with at least 7 hours remaining before the planned time of awakening. Effective dosing has not been determined in children and as the elderly are prone to falls, close monitoring should be done when given doses more than 5 mg.
It is important to advise patients to take Dayvigo only when preparing for or getting into bed and only if they can stay in bed for a full night (at least 7 hours) before being active again. Advise patients that the effect of Dayvigo may be delayed if taken with or soon after a meal. In conclusion, on December 20, 2019, Dayvigo became the second FDA-approved dual orexin receptor antagonist (DORA) (the first FDA-approved DORA is Belsomra, August 13, 2014. The advantages of Dayvigo include that it not only helps you fall asleep, but it also helps you stay asleep. It is taken not more than once a night, immediately before going to bed, with at least 7 hours remaining before the planned time of awakening. However, a common disadvantage of Dayvigo is that it can impair daytime wakefulness as it is a CNS depressant with a long t ½. Patients on Dayvigo should be aware that their morning alertness and motor coordination can be impaired in the morning and plan their morning accordingly and consult with their doctor. As a hypnotic, Dayvigo can also cause sleep paralysis and complex sleep behaviors such as sleep-eating and sleep-driving. As patients usually don’t remember complex sleep behaviors, if they are made aware of these events (for example, other people in their household inform them), they should discontinue Dayvigo immediately.
References-
Dr. Helen Emsellem. Can’t Sleep? Neither Can 60 Million Other Americans. National Public Radio. https://www.npr.org/templates/story/story.php?storyId=90638364
Lemborexant- Food and Drug Administration (FDA). Accessed- 2021 June 22.
RxPrep NAPLEX Review Book 2021. Chapter 68: Sleep Disorders: Insomnia, Restless Leg Syndrome, and Narcolepsy. Page 918.
Sleep is a vital part about being human, sleep is responsible for both physical and mental health, immune function, and cognition. The stages of sleep are classified as one stage of rapid eye movement sleep and four stages of non-rapid eye movement. During REM sleep, the body goes through numerous changes including fast breathing, change in body temperature, increased blood pressure, twitching, etc. According to the American Academy of sleep medicine and sleep research society, the average adult (18-60 years old) should get at least 7 hours of sleep. 30 percent of United States’ adults receive less than the recommended 7 hours. Sleep deprivation can be associated with adverse health effects including cardiovascular disease, obesity, and all cause mortality. Insufficient sleep syndrome results from lack of adequate habitual sleep leading to daytime sleepiness. Symptoms of daytime sleepiness include irritability, decreased concentration, attention deficits, reduced vigilance, distractibility, poor motivation, fatigue, lack of energy, restlessness, and incoordination. Sleep deprivation can go unrecognized if patients are not asked about their sleeping habits.
Chronic sleep insufficiency can be attributed to work demands, social and family obligations, medical conditions, and sleep disorders. Failing to prioritize sleep, many individuals are at a higher risk for accidents, reduced general performance, and decreased quality of life. Receiving anywhere between 6 to 9 hours of sleep per night (consistently) or following a sleep schedule in which you sleep and rise at the same time every day, can put you on track into adjusting how much sleep you receive and can lead to a more functional quality of life
Good sleep hygiene is important, usually involves a couple lifestyle changes. It is recommended that patients just starting to get into a good sleep routine, keep a journal. Second, patients should go to bed the same time every night and wakeup the same time every morning, even on the weekends. Next, for patients who have trouble falling asleep should avoid caffeine and naps, it also maybe advised that these patients try melatonin or Benadryl 30 min before bedtime (these over-the-counter options should not be used long-term). Room association should also be implemented. This is when you create a relaxing environment for your bedroom, and you try and reserve the bedroom only for sleep. This means avoiding activities such as working, working out and eating in your room, if possible, if this is not possible, at least avoid doing any of these activities on your bed. This will allow your brain to associate your bed with sleep, creating an easier time falling asleep when it is time to lay down in bed. Finally, avoid screens right before bed. When viewing a screen, the artificial light makes your brain associate it with daytime, preventing your brain from “shutting down”. With modern day technology, the screens we look at includes blue light, this blue light stimulates your brain which also makes it difficult for your brain to wind down and realize that it is time for bed.
References:
Cirelli, Chiara. “Insufficient Sleep: Definition, Epidemiology, and Adverse Outcomes.” St. John's University -- Academics & Schools -- Libraries, www-uptodate-com.jerome.stjohns.edu/contents/insufficient-sleep-definition-epidemiology-and-adverse-outcomes?search=SLEEP&topicRef=97866&source=see_link.
Maski, Kiran. “Insufficient Sleep: Evaluation and Management.” St. John's University -- Academics & Schools -- Libraries, www-uptodate-com.jerome.stjohns.edu/contents/insufficient-sleep-evaluation-and-management?search=SLEEP&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1#H2140453186
The purpose of sleep is important for humans in order to maintain proper function. In many adults, sleep duration has been shortened which has led to impaired cognitive function. This has resulted in car accidents, decreased quality of life, and increased risk for diseases. The concept of sleep is complex and depends on the duration, circadian phase, and the time of day a person may fall asleep. The circadian phase is dependent on the amount of light exposure. This means that people who constantly change the amount of light in their rooms or alter their sleeping schedule will experience changes in their circadian cycle. Symptoms of an affected circadian cycle can include difficulty falling asleep or staying asleep and may even be an indication for a sleep disorder such as insomnia. This can have a negative impact on a person’s health.
Sleep helps to promote recovery of the immune system when a person is sick. It allows the body to relax and conserve energy where it is needed the most. Studies have shown that people who had a shorter duration of sleep (less than 7 hours) were more likely to be associated with more health problems compared to people who slept longer. Children and adolescents are at a higher risk of developing physical and psychological problems when it comes to sleep deficiency. For example, a shorter sleep duration in this demographic has been associated an increased risk of obesity, type 2 diabetes, and cardiovascular disease. Lack of sleep can be correlated to obesity because people who are spending less time sleeping will be more likely to increase their food intake. If a person is sleep deprived, the hormone ghrelin is stimulated, and a person will need to consume more food for energy to keep the body functioning for a longer period of time. Glucose metabolism is also affected by this as well. Obesity is a major risk factor type 2 diabetes. Therefore, not only does the previous statements related to obesity hold true for type 2 diabetes as well, but lack of sleep can decrease the resting metabolic rate and increase post-prandial glucose levels. Sleep can also play a role in cardiovascular diseases such as hypertension. People who acquire enough sleep allow the blood pressure to decrease at night during relaxation and laying in a supine position. This can be coupled with the decrease in sympathetic tone and gives the muscles time to rest and recover.
Promoting healthy sleep hygiene practices can result in an improvement of sleep health. Typically, humans are supposed to sleep for 7-8 hours every night in order to produce optimal functioning. So, if a person is suffering from sleep deprivation, they may be able to train their bodies to restore their natural circadian cycle. The UCSD Center for Pulmonary and Sleep Medicine have recommendations for patients on how they can create a healthy sleep schedule. Some of the recommendations include: not going to bed until you are tired, having a regular bedtime routine that allows you to wind down and prepare your body for sleep (reading, bathing), encouraging the body to wake up at the same time every morning (even on days off), avoid naps and promote a full night’s rest (limit naps to 1 hour and no napping past 3 p.m.), only use bed for sleep and intimacy, avoid caffeine and alcohol, smoking cessation, avoid strenuous exercise before bedtime, and making sure that the room is quiet and dark. All of these can help a person get the required 7-8 hours of sleep each night if they are practice routinely.
References
Phillips, A., Clerx, W. M., O'Brien, C. S., Sano, A., Barger, L. K., Picard, R. W., Lockley, S. W., Klerman, E. B., & Czeisler, C. A. (2017). Irregular sleep/wake patterns are associated with poorer academic performance and delayed circadian and sleep/wake timing. Scientific reports, 7(1), 3216. https://doi.org/10.1038/s41598-017-03171-4
Besedovsky, L., Lange, T., & Haack, M. (2019). The Sleep-Immune Crosstalk in Health and Disease. Physiological reviews, 99(3), 1325–1380. https://doi.org/10.1152/physrev.00010.2018
Cappuccio, F. P., & Miller, M. A. (2017). Sleep and Cardio-Metabolic Disease. Current cardiology reports, 19(11), 110. https://doi.org/10.1007/s11886-017-0916-0
Vitale, K. C., Owens, R., Hopkins, S. R., & Malhotra, A. (2019). Sleep Hygiene for Optimizing Recovery in Athletes: Review and Recommendations. International journal of sports medicine, 40(8), 535–543. https://doi.org/10.1055/a-0905-3103
The human body’s numerous functions are dictated by an internal bodyclock known by many as the ‘circadian rhythm.’ It is through this intrinsic schedule that our bodies are able to regulate the mechanisms working in tandem with one another--and though the uncanny ability to push our physical forms to peak performance requires a level of wakefulness, the importance of restful sleep cannot be ignored when assessing the overall health of our bodies. Studies have shown a direct correlation between the level of restful sleep a person experiences and their cognitive functions in wakefulness, specifically citing that subjects displayed deteriorating cognitive abilities after exceeding sixteen hours of wakefulness without sleep. Consecutive hours of wakefulness are not the only contributor to poor sleep hygiene; for example, sleep deficits may accumulate after multiple episodes of partial restfulness. Studies have shown that sleep provides the most restorative results when it is unfragmented and consolidated; in order to achieve the most effective level of sleep, the REM (or Rapid Eye Movement) phase of the sleep cycle must be met and satisfied.
Rapid Eye Movement sleep, or REM, is associated with a low-voltage reading on an ECG as well as rapid eye-muscle twitching and movement. This state of sleep is most heavily associated with the phenomenon of dreaming--and while the exact function of REM sleep is still not fully understood, studies show that this stage within the sleep-cycle is most heavily associated with brain activity, sensory-motor connections, and an improvement in memories. However, REM sleep is not the only phase within the sleep cycle that readily benefits the human body’s function. Deep sleep is characterized by a lower readiness to be roused to consciousness, a slower breathing rate & heart rate, and a lack of dreams. During this specific phase of sleep, the body undergoes rejuvenation and tissue repair. A proper, uninterrupted cycle of deep sleep is necessary for the body to recover from the wear and tear of daily activities while also aiding in cognitive functions in a state of consciousness.
Sleep is an integral consequence of our bodies’ natural circadian rhythm and without it, the effects can become catastrophic. According to studies, nearly 35% of American adults rate their quality of sleep as simply “okay” or “fair” while another 45% report that they have difficulty falling asleep at night. There are many factors that can affect sleep disruption, including but not limited to societal, environmental, and genetic factors. Sleep disruption hosts a plethora of physiological detriments, including reduced insulin sensitivity, increased secretion of cortisol, and higher oxygen consumption. The physiological consequences can therefore lead to health complications--especially in patients who have comorbidities such as diabetes. In addition, if a patient suffers from sleep disorders such as obstructive sleep apnea, continued sleep disruption could lead to potentially fatal adverse effects such as heart disease as poor sleep contributes as a risk factor.
While the concept and study of sleep remain elusive, research has drawn the definitive conclusion that sleep remains necessary. Without it, our bodies & natural rhythms would grind to a startling halt, setting free a host of consequences like that of Pandora’s Box.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6281147/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5449130/
To understand why sleep is important , we must understand how sleep works and how it affects the body. There are two basic types of sleep which include rapid eye movement or REM as well as non-REM sleep. Non-REM sleep includes deep sleep or slow wave sleep while dreaming typically occurs during REM sleep. Getting enough sleep not only affects a person's mental and physical health, but also can interfere with work, school , and social functioning. An individual might have trouble learning, focusing , or reacting if they are sleep deficient which can greatly influence their life. Sleep deficiency is a common public health problem in the United States, and people in all age groups report not getting enough sleep. Nearly 40% of adults report falling asleep during the day without meaning to, and an estimated 50 to 70 million Americans have chronic sleep disorders. Sleep deficiency is also linked to many chronic health problems including heart disease, kidney disease, high blood pressure, obesity, and depression.
The bodies internal clock controls when someone is awake and when the body is ready for sleep. The body clock typically has a 24-hour repeating rhythm called the circadian rhythm. The first process that interacts to control this rhythm is a pressure to sleep that builds up with every hour that you're awake. This drive for sleep reaches a peak in the evening when most people get ready for bed. A compound called adenosine seems to be linked to this desire for sleep. When an individual is awake, their level of adenosine in the brain continues to rise and while they sleep, the body breaks down adenosine. When it gets dark outside, the body releases a hormone called melatonin and this hormone signals your body that it's time to prepare for sleep and helps you feel drowsy. The amounts of melatonin in the bloodstream peaks as the evening progresses on, and the body releases cortisol when it naturally prepares you to wake up. Adequate sleep every night helps the brain work properly and also improves learning throughout the day. Studies show that sleep deficiency alters activity in some parts of the brain that is responsible for making decisions, solving problems and controlling emotions and behavior.
Ongoing sleep deficiency is linked to an increased risk of heart disease, high blood pressure and stroke. One study of teenagers showed that with each hour of sleep that is lost , the odds of becoming obese goes up. Sleep helps maintain a balance of hormones that make you feel hungry or full, which includes ghrelin or leptin. The level of ghrelin goes up when an individual doesn't get enough sleep, and the level of leptin goes down. This makes someone feel hungrier than they usually would be if they are well rested. Sleep also affects how the body reacts to insulin, and sleep deficiency results in a higher than normal blood sugar level which may increase the risk for diabetes. Lastly, the immune system relies on sleep to stay healthy. Sleep deficiency that is ongoing can cause the immune system to have trouble finding common infections and affects the way it responds to bacteria.
https://www.nhlbi.nih.gov/health-topics/sleep-deprivation-and-deficiency
Sleep is something that many patients do not get enough of, which may be due to a busy schedule or even the result of a disease state. Healthy sleep hygiene and a normal sleep schedule is stressed in order for one to live a high quality of life and promote health benefits in the future. Having a normal sleep schedule can prevent a variety of health conditions later on in a patient’s life. Inconsistent sleep can affect circadian rhythm, which is the body’s internal clock regulating body function from the day’s start to its end. Circadian rhythm controls the sleep cycle, brain function, and body metabolism. There are different stages of sleep. There is rapid-eye movement (REM) and non-rapid eye movement (NREM) sleep. The REM stage of sleep is associated with the part of sleep where dreams commonly occur because it is associated with the highest brain activity. Non-rapid eye movement (NREM) sleep has 3 parts to it: N1, N2 and N3. The deepest part within this stage is N3 that controls one’s growth and development. Not getting enough sleep can lead to long term health decline and can result in extreme fatigue and lack of concentration. Due to this fatigue and unregulated body functions, it can affect the body’s stress levels, appetite and hormone balance. This can result in serious chronic conditions like obesity and hypertension. The recommended amount of sleep for an average adult ranges from 7-9 hours, while for children the duration recommended is actually longer since children are still developing. Like diet and exercise, sleep is necessary in order for one to maintain a healthy lifestyle and promote physiological, psychological and emotional well-being. As a pharmacist it is essential to counsel patients on proper sleep hygiene before introducing them to any over the counter products to induce and aid sleep. Pharmacists can counsel patients to set a time for bed, and right before bed counsel patients to prevent any distractions like using the television, social media or any other electronics right before sleeping. A pharmacist can also counsel patients to strictly set aside an area for sleep only, and stress not to do anything in the day in that area, especially work so that the mind registers and understands the area is designated to sleep in only. Eating right before bed should be prevented as much as possible, especially if the patient is to be consuming any excess caffeine or alcohol with their meal. Some patients still have difficulties in sleeping even though they try to practice good sleep hygiene and opt for other alternatives. A pharmacist can recommend a patient to take Melatonin over the counter or use Benadryl or Z-Quill based on patient risk factors. As for prescription products, non-benzodiazepines or the Z-drugs are not generally recommended in the elderly population due to increased risk of falls and altered mental status but can be used as sleep aids in patients. Sleep aids are also not intended for long term use, especially in the elderly population, so counseling these patients is crucial and the role of the pharmacist is essential in the proper treatment of sleep conditions.
References:
https://pubmed.ncbi.nlm.nih.gov/28515433/
Sleep is a need for all sophisticated animals, including humans, in order to function optimally. There are two types of sleep, non-rapid eye-movement sleep and rapid eye-movement (REM) sleep. Non-rapid eye movement sleep is divided into stages 1, 2, 3, and 4. Each stage is unique in that they have variations in brain wave patterns, eye movements, and muscle tone. Sleep begins with a short period of non-rapid eye movement stage 1 sleep progressing through stage 2, followed by stages 3 and 4 and finally onto REM sleep. However, individuals do not remain in REM sleep the remainder of the night but instead cycle between stages of non-rapid eye movement and REM sleep throughout the night. Stage 1 sleep serves as a transitional stage between old and new cycles. This stage usually lasts 1 to 7 minutes and is easily interrupted by a disruptive noise. Stage 2 lasts approximately 10 to 25 minutes each cycle, and will eventually make up between 45 to 55 percent of total sleep time. A more intense stimulus is needed in order to wake a person in stage 2 sleep than stage 1 sleep. Sleep stages 3 and 4 are known as slow-wave sleep. Stage 3 lasts only a few minutes and makes up 3 to 8 percent of sleep. Stage 4, which lasts approximately 20 to 40 minutes, makes up about 10 to 15 percent of sleep. Stage 4 sleep is the hardest to wake a person up from. Finally, after stage 4, comes REM sleep. REM sleep is defined by the presence of desynchronized brain activity, muscle tone, and rapid eye movement. During the initial cycle, the REM period may last only 1 to 5 minutes, but it becomes longer the more the person sleeps.
References
Grandner MA. Sleep, Health, and Society. Sleep Med Clin. 2017;12(1):1-22.
Colten, H. (1970, January 01). Sleep Physiology. Retrieved August 01, 2020, from https://www.ncbi.nlm.nih.gov/books/NBK19956/
Sleep is a necessary and vital state that serves numerous functions including process of information, improvement in memory, energy conservation, modulation of immune responses, removal of toxic byproducts in the brain, etc. The stages of sleep are classified as one stage of rapid eye movement sleep and four stages of non-rapid eye movement. During REM sleep, the body goes through numerous changes including fast breathing, change in body temperature, increased blood pressure, twitching, etc. An average of seven to eight hours of sleep per day is ideal. There are sleep disorders such as insomnia which affects about one third of adults in the world. Risk factors of sleep deprivation include lifestyle such as shift work, jet lag, excess caffeine, psychosocial factors such as anxiety, etc. Inadequate or disrupted sleep affects waking cognitive functions including performance and cognitive speed. Their psychological well-being as well as emotional, physical health and quality of life can be disturbed. For chronic insomnia, cognitive behavioral therapy has shown long term benefits and medication can be used for short-term treatment. Medications used to treat chronic insomnia are non-benzodiazepines like zolpidem, benzodiazepines like temazepam, and melatonin receptor agonist such as ramelteon. Long term consequences of sleep disruption can even include diseases such as hypertension, cardiovascular diseases, diabetes, and weight related issues. A study done showed that disrupted sleep can be a factor in the development of depression. Insufficient sleep can contribute to changes in the neuroendocrine stress response system. It is important to treat sleep conditions as soon as possible.
References
Medic G, Wille M, Hemels ME. Short- and long-term health consequences of sleep disruption. Nat Sci Sleep. 2017;9:151-161. Published 2017 May 19. doi:10.2147/NSS.S134864
Worley SL. The Extraordinary Importance of Sleep: The Detrimental Effects of Inadequate Sleep on Health and Public Safety Drive an Explosion of Sleep Research. P T. 2018;43(12):758-763.