Sleep and Chronic Disease
Chronic diseases of various types are the large majority of my clinical practice. As chronic diseases have assumed an increasingly common role in premature death and illness, interest in the role of sleep health in the development and management of chronic diseases has grown. Both insufficient and un-restorative sleep have been linked to the development and progression of a number of chronic diseases and conditions, particularly diabetes, cardiovascular disease, obesity, some types of cancer and depression.
Diabetes Research has found that insufficient sleep is linked to an increased risk for the development of Type 2 diabetes. Specifically, sleep duration and quality have emerged as predictors of levels of Hemoglobin A1c, an important marker of blood sugar control. Recent research suggests that optimizing sleep duration and quality may be important means of improving blood sugar control in persons with Type 2 diabetes. Cardiovascular Disease People living with sleep apnea have been found to be at increased risk for a number of cardiovascular diseases. Notably, hypertension, stroke, coronary heart disease and irregular heartbeats (cardiac arrhythmias) have been found to be more common among those with disordered sleep than their peers without sleep abnormalities. Likewise, sleep apnea and hardening of the arteries (atherosclerosis) appear to share some common physiological characteristics, further suggesting that sleep apnea may be an important predictor of cardiovascular disease. In addition, large cohort epidemiologic studies have shown a positive correlation between sleep duration and increasing coronary artery disease and heart attacks (myocardial infarction). Obesity Laboratory research has found that short sleep duration results in metabolic changes that may be linked to obesity. Epidemiologic studies conducted in the community have also revealed an association between short sleep duration and excess body weight. This association has been reported in all age groups—but has been particularly pronounced in children. It is believed that sleep in childhood and adolescence is particularly important for brain development and that insufficient sleep in youngsters may adversely affect the function of a region of the brain known as the hypothalamus, which regulates appetite and the expenditure of energy. New research has shown that lack of sleep may ‘turn on’ some genetic drivers of weight gain. Depression The relationship between sleep and depression is complex. While sleep disturbance has long been held to be an important symptom of depression, recent research has indicated that depressive symptoms may decrease once disordered sleep has been effectively treated and sufficient sleep restored. The interrelatedness of sleep and depression suggests it is important that the sleep sufficiency of persons with depression be assessed and that symptoms of depression be monitored among persons with a sleep disorder. I’ve discussed the importance of sleep in prior articles but I felt that it should be stressed again due to its paramount importance in optimal health. There are many factors that influence sleep and addressing the underlying causes of sleep disturbance can go a long way to improving overall health. As naturopathic physicians, we are particularly equipped with the knowledge and tools to address the complex physiologic, metabolic and psychologic mechanisms that may be influencing and impairing sleep. References Role of sleep duration and quality in the risk and severity of type 2 diabetes mellitus. Knutson KL, Ryden AM, Mander VA, Van Cauter E. Arch Intern Med 2006;166:1768–1764. Sleep and Diabetes. Swetha Bopparaju and Salim Surani. International Journal of Endocrinology Volume 2010 (2010). A Prospective Study of Sleep Duration and Coronary Heart Disease in Women. Najib T. Ayas, MD; David P. White, MD; JoAnn E. Manson, MD, DrPH; Meir J. Stampfer, MD, DrPH; Frank E. Speizer, MD; Atul Malhotra, MD; Frank B. Hu, MD, PhD Arch Intern Med. 2003;163:205-209. Inflammatory aspects of sleep apnea and their cardiovascular consequences. Kasasbeh E, Chi DS, Krishnaswamy G. South Med J 2006;99:58–67. The link between short sleep duration and obesity: We should recommend more sleep to prevent obesity. Arch Dis Child 2006;91:881–884. Sleep and obesity. Stephen R. Daniels, MD, PhD. The Journal of Pediatrics Volume 154, Issue 6 , Page A3, June 2009. The association between sleep duration and obesity in older adults. S R Patel et al. International Journal of Obesity (2008) 32, 1825–1834. Diagnosing major depressive disorder I: A psychometric evaluation of the DSM-IV symptom criteria. Zimmerman M, McGlinchey JB, Young D, Chelminski I. J Nerv Ment Dis 2006;194:158–163. Symptoms of depression in individuals with obstructive sleep apnea may be amenable to treatment with continuous positive airway pressure. Schwartz DJ, Kohler WC, Karatinos G. Chest 2005;128:1304–1306. Sleep Duration and Breast Cancer: A Prospective Cohort Study. Pia Verkasalo et al. Cancer Res October 15, 2005 65; 9595. A Prospective Study of Sleep Duration and Mortality Risk in Women. Sanjay R. Patel, MD. SLEEP 2004;27(3):440-4. Sleep duration and the risk of breast cancer: the Ohsaki Cohort Study. M Kakizaki. British Journal of Cancer (2008) 99, 1502–1505.