Another class of drugs used to treat insomnia are melatonin receptor agonists. They work at the MT1 and MT2 receptor sites. They promote sleepiness and regulate the circadian rhythm to coordinate the sleep wake cycle. Examples of melatonin receptor agonists are ramelteon and tasimelteon. A warning associated with ramelteon is complex sleep behavior. Sides effects of melatonin receptor agonists include somnolence, and dizziness. They are not a controlled substance. They are to not to be taken with fatty food or fluvoxamine (a strong CYP 1A2 inhibitor that increases the serum concentration of ramelteon and tasimelteon. Tricyclic antidepressants are another class of drugs that can be used to treat insomnia. They work by inhibiting norepinephrine and serotonin reuptake. They also block acetylcholine and histamine receptors, which contributes to side effects. Doxepin is a tricyclic antidepressant that is approved by the FDA for the treatment of insomnia. Doxepin can cause seizures and are not to be used within 2 weeks of a MAO inhibitor. Benzodiazepines like temazepam, estazolam, quazepam, flurazepam, and triazolam can be used to treat insomnia. Benzodiazepine work by enhancing GABA which leading to CNS depression. Warnings associated with benzodiazepines are that use of opioids with benzodiazepines should be avoided because it can lead to sedation, respirator depression and death. There is also a risk of abuse, misuses, and addiction with benzodiazepines. They are considered as C-IV medications. Lorazepam, oxazepam, and temazepam (LOT) are the benzodiazepines recommended for use in older patients as they have a reduced risk of adverse effects. Lastly antihistamines can be used to treat insomnia. They work by blocking the H1 receptor. Side effects of antihistamines are sedation, confusion, memory loss, and peripheral anticholinergic side effects like urinary retention. Its use is also avoided in patients with BPH and glaucoma. Another sleep disorder is restless leg syndrome. This is when there is an urge to move the lower legs and gets worse at night. RLS is believed to be related to a dysfunction of dopamine. Restless leg syndrome is treat with dopamine agonists and gabapentin. The IR formulations of pramipexole and ropinirole are taken 1-3 hours before bedtime. Rotigotine is a dopamine agonist patch that is applied once daily. “Gabapentin enacarbril (Horizant) is an extended release form of gabapentin approved for RLS. It is taken at 5:00PM daily.” (UWorld RxPrep) Another sleep disorder is narcolepsy. This is when there is excessive daytime sleepiness with cataplexy (sudden loss of muscle tone), and sleep paralysis. Patients with narcolepsy experience sleep attacks which can affect them throughout the day at school, work, or in the middle of conversations. It can be diagnosed with “two specialized tests, which can be performed in a sleep disorders clinic, are required to establish a diagnosis of narcolepsy: a polysomnogram (PSG or sleep study)—This overnight test records brain activity, muscle movements, breathing, and eye movements during sleep. It helps determine if REM sleep happens too early in the sleep cycle and checks for other conditions like sleep apnea and multiple sleep latency test (MSLT)—This test measures how quickly a person falls asleep and whether they enter REM sleep. Sometimes, measuring the level of hypocretin in the fluid surrounding the brain and spinal cord can help with diagnosis. To perform this test, a doctor will take a sample of the cerebrospinal fluid using a lumbar puncture (also called a spinal tap) and measure the level of hypocretin-1” (NIH). Narcolepsy is treated with stimulants like modafinil, armodafinil, or sodium oxybate. Other medications that can be used for narcolepsy are pitolisant and solriamfetol.
There are many kinds of sleep disorders. Some examples of sleep disorders are chronic insomnia, restless leg syndrome and narcolepsy. Insomnia is characterized by the difficulty to fall asleep, reduced sleep duration or poor sleep quality. The diagnosis of insomnia can be made if the patient has symptoms at least three times a week for at least three months. Insomnia can decrease quality of life by causing fatigue, decreased concentration and memory. The first thing that is recommended patients do if they experience insomnia is to make some behavioral modifications. These changes include improving sleep hygiene, keeping the bedroom dark, avoiding naps during the day, and / or establishing a night time routine to help the body get ready to sleep. In addition to this it is important to resolve any underlying medical conditions that can lead to or contribute to the insomnia. Some drugs that can worsen insomnia are aripiprazole, atomoxetine, diuretics, fluoxetine, steroids, stimulants, INSTIs, and acetylcholinesterase inhibitors. Some natural products that can be used to help with sleeping are melatonin, valerian, and kava. Melatonin 1-5mg is commonly used to help treat insomnia. Valeria and kava are not recommended because of the risk of hepatotoxicity. Chamomile tea in the evening can help some patients feel calmer and aid in their insomnia. Regarding drug treatment, “sedative-hypnotics are the mainstay of treatment for chronic insomnia, through it is preferable to reserve use when non-drug treatments have failed” (UWorld RxPrep). The drug chosen is to be based on the specific symptoms that is looking to be resolved. Drugs that help with falling asleep are eszopiclone, zolpidem, ramelteon, and zaleplon. Drugs that help with staying asleep are eszopiclone, zolpidem, doxepin, and suvorexant. The drugs that help with both categories are eszopiclone and zolpidem. Patients can self treat with OTC first generation antihistamine like diphenhydramine or doxylamine, but they are not recommended for long term use. According to the Beers Criteria, benzodiazepine, non benzodiazepines hypnotics like zolpidem, and first-generation antihistamines are not recommended for patients older than 65 years. If benzodiazepine have to be used, the ones recommended for patients 65 and older are lorazepam, oxazepam, or temazepam because they have a lower risk of side effects. Examples of non benzodiazepine hypnotics are eszopiclone (Lunesta), zolpidem (Ambien), and zaleplon (Sonata). These drugs are C-IV medications. Warnings a related to these drugs are complex sleep behaviors like sleep walking and sleep driving, increased risk of CNS depression, next day impairment, potential for abuses and dependence, somnolence, dizziness, ataxia, and headache. Because of its risk of complex sleep behaviors, these drugs are contraindicated in patients that have a history of complex sleep patterns. Non benzodiazepine are recommended over benzodiazepines because they have a lower risk for dependence and abuse. They should also not be taken with a fatty meal. Another class of drugs used to treat insomnia are orexin receptor antagonists. Drugs in this class are daridorexant, lemborexant, and suvorexant. These drugs end in -rexant. They work by blocking the orexin neuropeptide signaling system, which result in drowsiness. “Orexin receptor antagonists seem to be devoid of any dependence and tolerance-inducing effects, rendering them a viable option for longer-term treatment” (PubMed). It is contraindicated in patients with narcolepsy. It is not to be taken with food or if there is less than 7 hours of sleep remaining.
Sleep is a vital physiological process that occupies a significant portion of our lives, crucial for maintaining physical, mental, and emotional well-being. Influenced by a complex interplay of factors such as age, genetics, behavior, environment, and societal demands, adequate sleep—defined as a minimum of 7 hours per night for adults—is essential for optimal health. However, the prevalence of chronic sleep deprivation, often driven by modern societal pressures such as work demands, digital distractions, and lifestyle choices, has become a concerning trend. Apart from conditions like obstructive sleep apnea and insomnia, this insufficient sleep pattern is increasingly associated with a spectrum of adverse health outcomes.
Epidemiological and experimental evidence highlights its role in elevating the risk of cardiovascular diseases (hypertension, coronary artery disease), metabolic disorders (obesity, type 2 diabetes), and an overall increased mortality risk. Moreover, emerging data suggest a significant correlation between sleep deprivation and heightened risks of stroke, cancer, and neurodegenerative diseases. Psychologically, inadequate sleep is linked to a range of psychiatric disorders including mood disturbances, anxiety, and depression, underscoring its pervasive impact on human health and well-being. This paper explores the intricate relationship between sleep deprivation and the risk of various diseases, emphasizing the critical need for prioritizing healthy sleep habits amidst modern-day challenges.
Every year, 15 million people worldwide experience a stroke, resulting in nearly six million deaths and leaving another five million permanently disabled. Clinical research indicates that both inadequate and excessive sleep are linked to higher rates of cardiovascular events, including stroke. Hypertension is widely recognized as the foremost modifiable risk factor for stroke. Typically, strokes occur most frequently in the early morning hours, coinciding with a blood pressure pattern that decreases overnight and surges in the morning. This surge in morning blood pressure has been theorized to contribute to heightened cardiovascular and cerebrovascular events by potentially destabilizing vulnerable arterial plaques, leading to their rupture and subsequent clot formation. Numerous studies have documented an association between sleep duration and hypertension. For instance, findings from the Sleep Heart Health Study revealed that sleeping fewer than seven or more than eight hours per night was linked to an increased risk of developing hypertension. This underscores the critical importance of maintaining appropriate sleep duration in mitigating cardiovascular risks, including the likelihood of experiencing a stroke.
Additionally, both the quantity and quality of sleep significantly impact the risk of developing diabetes. Early research by Kuhn et al. in 1969 highlighted that total sleep deprivation led to a notable increase in glucose levels. Subsequent studies and meta-analyses have reinforced these findings, showing that sleeping less than six hours per day is associated with a heightened risk of diabetes. Moreover, research indicates that both insufficient and excessive sleep durations are linked to an increased incidence of diabetes and impaired glucose tolerance. For individuals already diagnosed with diabetes, inadequate sleep—whether too short or too long—has been shown to worsen glycemic control. Studies by Ohkuma et al. underscore this, demonstrating that sleep durations outside the optimal range are associated with higher HbA1c levels in both type 1 and type 2 diabetic patients. Thus, maintaining a balanced sleep duration around seven hours per night is crucial for managing glucose metabolism and reducing the risk of diabetes-related complications.
In summary, the repercussions of disrupted sleep patterns extend beyond well-known risks such as cardiovascular diseases, stroke, and diabetes, encompassing conditions such as atrial fibrillation, obesity, dyslipidemia, cancer, infections, and cognitive decline. Adequate sleep is vital for overall health maintenance. Additionally, proper hydration and nutrition play pivotal roles in supporting well-being. Leading health organizations advocate for establishing regular sleep schedules, creating optimal sleep environments, minimizing screen time before bed, and adopting relaxation techniques to enhance sleep quality. These healthy lifestyle practices are essential for mitigating the adverse effects of sleep deprivation and promoting long-term physical and mental health. Emphasizing optimal sleep hygiene remains crucial as we continue to uncover the intricate connections between sleep and comprehensive wellness.
References:
1.Garbarino, S., Lanteri, P., Bragazzi, N. L., Magnavita, N., & Scoditti, E. (2021a, November 18). Role of sleep deprivation in immune-related disease risk and outcomes. Communications biology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8602722/
3. Ferrari, V. A., Mehta, N. N., Soulen, M., Roberts, D. A., & St John Sutton, M. (2003). Pulmonary venous aneurysms in hereditary hemorrhagic telangiectasia detected by 3-dimensional magnetic resonance angiography. Circulation, 108(17). https://doi.org/10.1161/01.cir.0000092308.57590.8c
Sleep is often undervalued despite its critical role in maintaining overall health and well-being. Beyond providing rest, sleep actively supports brain function, physical health, and is integral to growth and development, particularly in children and teens. Chronic sleep deprivation can lead to a host of health issues and significantly impact cognitive abilities, reaction times, work performance, learning, and interpersonal relationships. The cardiovascular, metabolic, respiratory, and immune systems are also profoundly influenced by sleep, with varying optimal sleep requirements across different age groups.
Research underscores the profound effects of sleep on physical appearance and skin health. In a study involving 60 Caucasian women categorized into poor sleepers and healthy sleepers, poor sleep quality correlated with accelerated intrinsic aging, compromised skin barrier function, and decreased satisfaction with appearance. It's recommended that adults aim for 7 to 9 hours of sleep per night, as sleeping less than 7 hours regularly may increase the likelihood of health issues. Alarmingly, over a third of Americans fall short of this recommendation, which can manifest visibly through paler skin, wrinkles, fine lines, drooping eyelids, red or swollen eyes, and dark circles.
The skin's vitality relies heavily on adequate sleep. Collagen and elastin, essential proteins for skin elasticity, are negatively impacted by sleep deficiency due to weakened immune function and disrupted collagen production. This contributes to the formation of wrinkles and a dull complexion. Conversely, quality sleep supports skin health by promoting cellular repair and maintaining a clear complexion through balanced hydration and oil production.
The body's circadian rhythm, responsible for regulating sleep-wake cycles, also affects skin functions. Nighttime enhances skin repair processes through increased blood flow, elevated body temperature, and efficient repair of UV-damaged skin cells, especially during early morning hours. Conversely, irregular sleep patterns and sleep deprivation are associated with skin issues such as dehydration, reduced skin barrier function, and exacerbated acne.
Establishing good sleep hygiene practices is crucial for optimizing sleep quality. These include maintaining a consistent sleep schedule, creating a conducive sleep environment, regular exercise to promote restful sleep, winding down before bed by avoiding screens, and minimizing activities that induce alertness. Avoiding prolonged periods of wakefulness in bed also helps maintain healthy sleep patterns.
In conclusion, the importance of sleep extends far beyond simple rest. It is a cornerstone of overall health, influencing cognitive function, physical well-being, and even appearance. Adequate sleep supports optimal brain and body function, while chronic sleep deprivation can lead to a myriad of health issues and visibly affect skin health and appearance. By prioritizing good sleep hygiene and understanding the profound impact of sleep on our bodies, we can enhance our quality of life and longevity. Further research into sleep's intricate mechanisms will continue to illuminate its essential role in human health.
Léger D, Gauriau C, Etzi C, Ralambondrainy S, Heusèle C, Schnebert S, Dubois A, Gomez-Merino D, Dumas M. "You look sleepy…" The impact of sleep restriction on skin parameters and facial appearance of 24 women. Sleep Med. 2022 Jan;89:97-103
Sleep is a regenerative process that the body uses as a vital component of longevity. Sleep is an essential process that allows the body, and more importantly the brain, in order to rest, regenerate neurotransmitters, proteins and molecules, and regulate metabolism. Sleep deprivation, or lack of sleep, can be defined as less than 7 hours a night in males and less than 8 in females. Sleep deprivation has psychological consequences that affect mood and behavior, but it can also accelerate signs of aging throughout the body. The mechanism is through the production and buildup of reactive oxygen species (ROS), which inhibits the body’s protective mechanisms such as antioxidants and enzymatic processes. ROS can cause mitochondrial arrest, and therefore cell death, and bind to macromolecules such as proteins and cause degradation (Clatici VG, Oyetakin-White P).
The skin is a sensitive organ that is impacted by ROS from the inner and outer environments. This leads to signs of aging, such as fine lines and wrinkles, decreased moisture, lack of color in the skin, and loss of facial structure noted in the eyelids and around the mouth. A study found that disturbed sleep cycles made subjects appear less healthy, with observed changes in skin texture and a reduced permeability of the skin barrier (Axelsson J, Kahan V).
The impact of sleep on skin barrier function is due to the the lack of the body’s ability to recover and detoxify from free radicals and other chemicals that accumulate durongf the day. Sleep disruption also contributes to neuroendocrine dysregulation, specifically in cortisol, interleukin- 1beta, interleukin- 10, tumor necrosis factor alpha and an increase in natural killer cell activity. This promotes the proinflammatory mechanism in the body and can trigger stress- induced changes in the skin (Altemus M).
Experts recommend between 7 to 9 hours of sleep as adequate for adults, with women needing between 8 to 9 hours (Watson NF). Sleep is crucial to the overall health of our bodies, promoting longevity. However, the impact of sleep disruption causes visual changes in the appearance of our skin, causing aging.
Citations:
Altemus M, Rao B, Dhabhar FS, Ding W, Granstein RD. Stress-induced changes in skin barrier function in healthy women. J Invest Dermatol. 2001;117(2):309-317. doi:10.1046/j.1523-1747.2001.01373.x
Axelsson J, Sundelin T, Ingre M, Van Someren EJ, Olsson A, Lekander M. Beauty sleep: experimental study on the perceived health and attractiveness of sleep deprived people. BMJ. 2010;341:c6614. Published 2010 Dec 14. doi:10.1136/bmj.c6614
Clatici VG, Racoceanu D, Dalle C, et al. Perceived Age and Life Style. The Specific Contributions of Seven Factors Involved in Health and Beauty. Maedica (Bucur). 2017;12(3):191-201.
Kahan V, Andersen ML, Tomimori J, Tufik S. Can poor sleep affect skin integrity?. Med Hypotheses. 2010;75(6):535-537. doi:10.1016/j.mehy.2010.07.018
Oyetakin-White P, Suggs A, Koo B, et al. Does poor sleep quality affect skin ageing?. Clin Exp Dermatol. 2015;40(1):17-22. doi:10.1111/ced.12455
Watson NF, Badr MS, Belenky G, et al. Recommended Amount of Sleep for a Healthy Adult: A Joint Consensus Statement of the American Academy of Sleep Medicine and Sleep Research Society. Sleep. 2015;38(6):843-844. Published 2015 Jun 1. doi:10.5665/sleep.4716
Sleep is a complex physiological process that plays a crucial role in maintaining overall health and well-being. The pathophysiology of sleep involves an intricate interplay of various neurobiological and physiological mechanisms. There are four stages of the sleep cycle, split into two categories: non rapid eye movement and rapid eye movement stage. Stages 1 and 2 involve non rapid eye movement and it is easier to be awoken during these stages. Stage 3 is the deepest part of non rapid eye movement sleep. This is when your muscles and body relax more, and brain waves show slowed down activity which is vastly different from waking brain activity. Deep sleep is thought to play a crucial role in both the body's recovery and the enhancement of effective cognitive processes, including thinking and memory. The last stage belongs to the rapid eye movement category.
Several factors, both internal and external, can influence the pathophysiology of sleep, including stress, environmental factors, and medical conditions. Understanding the underlying mechanisms of sleep is essential for addressing sleep-related disorders and promoting optimal sleep hygiene for overall health and cognitive function. An external factor such as atopic dermatitis has been linked to sleep disturbance and impaired neurocognitive function.
Atopic dermatitis is “a chronic, pruritic and inflammatory, dry skin condition” (1). It is characterized by itchy red dry skin. Atopic dermatitis commonly causes sleep disturbance, especially during uncontrolled flare ups. A cycle of itching and scratching is accompanied by an inflammatory response leading to significant sleep disturbance, especially since itch is often reported to be worse at night (1). Those with atopic dermatitis experience sleep disturbance. Studies show that “over 60% of parents report that AD affects how well they or their child sleep” (1).
The phenomenon of nocturnal itching has prompted theories pointing towards variations in skin barrier function during the night. Transepidermal water loss (TEWL), a gauge of skin barrier integrity, has been linked to the intensity of itch in atopic dermatitis (AD). Studies suggest that the increase in peripheral skin temperature during the night, a mechanism to reduce core temperature, may lead to a corresponding rise in TEWL, potentially heightening nocturnal itch sensations. These nocturnal itch sensations impact sleep quality heavily. A decrease in sleep quality has been shown to affect attention, memory, processing speed, and regulating behaviors. Children who suffer from AD also are more hyperactive and have lower cognitive performance due to inadequate sleep in their early life.
The intricate relationship between sleep and skin health underscores the importance of a holistic approach to well-being. Adequate and quality sleep plays a pivotal role in supporting the body's regenerative processes, including skin repair and maintenance. The reciprocal nature of this connection is evident as disruptions in sleep patterns due to nocturnal itching can adversely impact one livelihood. Moreover, addressing sleep-related issues can be integral in managing certain skin conditions, as seen in the case of nocturnal itching exacerbation.
Recognizing the bidirectional influence between sleep and skin underscores the need for a comprehensive approach to health that encompasses both lifestyle modifications and targeted skincare practices.
References:
Cameron S, Donnelly A, Broderick C, et al. Mind and skin: Exploring the links between inflammation, sleep disturbance and neurocognitive function in patients with atopic dermatitis. Allergy. 2024; 79: 26-36. doi:10.1111/all.15818
In modern day times the act of sleep is often neglected. Trying to fit as many activities as possible in one day is usually compromised by cutting down on sleep time. However, this may be more detrimental to a person’s health than it may seem at first glance. Sleep is a natural state of rest where the body is inactive, the eyes are closed, and the mind is not thinking. It is a reversible state of reduced responsiveness to external stimulation. Overall, it is a essential function to the body’s overall health.
Sleep is an important part of daily routine. A person should spend about one third of their time sleeping. Quality sleep and getting enough sleep is essential to survival, comparable to the essentialities of food and water. Without sleep the brain lacks the ability to function properly and efficiently. Brain functions such as nerve cells communicating wit each other is something that is driven by sleep. Your brain and body stay relatively active while you sleep. Findings even suggest that sleep plays a housekeeping role that removes toxins in your brain that build up while you are awake. Sleep effects almost every system in the body, the brain, the heart, the lungs, metabolism, immune function, mood, and disease resistance. Chronic lack of sleep increases the risk of many chronic disorders such as high blood pressure, cardiovascular disease, diabetes, depression, and obesity.
In a study design testing the effects of chronic poor sleep quality on human skin function and visible signs of ageing. It concluded that beauty sleep is real. The results where good sleepers have significantly lower intrinsic skin ageing scores by SCINEXA. At baseline poor sleepers had significantly higher levels of TEWL. In addition to the good sleeper has a better perception of their appearance and physical attractiveness compares to the poor sleepers.
Defining good sleep can be relative due to the fact sleep necessities change as you age. There is no exact number of hours for good sleep, but we can estimate. Babies initially sleep as much as 16-18 hours per day. This boosts their growth and development f the brain. School aged children and teens on average need about 9.5 hours of sleep per night. Most adults need about 7-9 hours of sleep a night. Elders over 60, tend to have less sleep due to being interrupted multiple times by awakenings. Also, many medications that older adults take interfere with their sleep schedule.
These relative recommended hours of sleep per person in the US is almost never reached by the average working adult. The lifestyle and average 9-5 employee with a family works does not allow for these proper sleep routines. We have jobs that are overnight, which is a whole other issue to a person’s sleep health and overall health. It is essential to find time to sleep an adequate amount each night for a person’s overall wellness and future health. As a society, we need to shift our busy lifestyles to prioritize our health, this includes taking sleep seriously and not for granted.
Many individuals underestimate the importance of sleeping and its major contribution to overall health. During sleep, the body is working to support healthy brain function and to maintain physical health. Sleep also plays a crucial role in supporting growth and development in children and teens. Insufficient sleep over an extended period can increase the risk of chronic health issues. Furthermore, it can impact cognitive abilities, reaction time, work performance, learning, and interpersonal relationships. Sleep has influence on the heart, circulatory system, metabolism, respiratory system, and immune system, and the optimal amount of sleep needed varies upon age.
According to a study done with a sample size of 60 Caucasian women who were categorized as poor sleepers and healthy sleepers, poor sleep quality was seen to be associated with increased signs of intrinsic ageing, diminished skin barrier function and lower satisfaction with appearance. Experts recommend that adults sleep between 7 and 9 hours a night. Adults who sleep less than 7 hours a night may have more health issues than those who sleep 7 or more hours a night. Over a third of the American population regularly gets less than this amount of sleep. Changes in appearance caused by sleep deprivation include paler skin than usual, wrinkles and fine lines around the mouth, hanging corners of the mouth, drooping or hanging eyelids, red or swollen eyes, and dark circles below the eyes. Overall, researchers found that people who are sleep deprived appear sadder and more fatigued than people who have had sufficient sleep.
The skin comprises various proteins, including collagen and elastin, contributing to its elasticity and flexibility. Studies indicate that inadequate sleep weakens the immune system, affecting the production of collagen and its quality. Consequently, this decline in skin health may lead to the development of wrinkles. Furthermore, consistent and high-quality sleep may contribute to maintaining a clear skin complexion. The circadian rhythm, responsible for regulating the body's internal clock and sleep patterns, also influences the functions of various organs, including the skin. During the night, the skin experiences heightened blood flow, raising body temperature and facilitating the repair of damaged skin.
Researchers have discovered that the body is most effective at repairing skin cells damaged by UV sunlight exposure in the early morning. Insufficient sleep and late bedtimes are correlated with adverse changes in skin complexion. Studies on sleep deprivation have observed peeling skin, dehydration, and a glossy appearance. Additionally, going to bed late is associated with reduced skin hydration, increased water loss, and elevated production of oily secretions, potentially contributing to certain types of acne.
Sleep hygeine is important and is characterized as a set of habits or behaviors to improve sleep. Some of these habits include keeping a regular sleep schedule such as waking up and going to bed at consistent times each day, creating a quality sleep environment tailored to an individual's preferences, exercising regularly makes it easier to fall asleep and to stay asleep, winding down in the evening, putting away electronics, and avoid lying awake in bed at night.
Sleep is a fundamental aspect of our health, yet modern lifestyles often neglect its importance, promoting excessive work, late-night activities, and all-night study sessions. Understanding sleep involves recognizing its role in eliminating toxins accumulated in the brain during wakefulness. The CDC recommends seven hours of good-quality sleep, assessing factors like sleep latency, sleep-waking, wakefulness, and sleep efficiency. Quality rest benefits memory retention, with REM sleep crucial for memory consolidation and various physiological processes.
Furthermore, evidence links short sleep and poor sleep habits to chronic diseases, infections, and premature mortality. Immune parameters decline with insufficient sleep, affecting T cell proliferation, natural killer cell response, and proinflammatory pathways. For instance, proper sleep strengthens the immune system against the common cold. In contrast, lack of sleep increases susceptibility.
Beyond physical health, sleep significantly impacts skin health. Quality sleep contributes to cellular repair, DNA reproduction, and inflammation reduction, essential for preventing conditions like acne and rosacea. Moreover, sleep plays a pivotal role in preventing diabetes. Insufficient sleep can lead to insulin resistance, affecting glucose metabolism and contributing to obesity. Leptin and ghrelin, hormones influencing appetite, are disrupted, promoting overeating. Shift work exacerbates these issues, increasing the risk of diabetes, obesity, and cardiovascular events.
The glymphatic system, a perivascular network in the brain active when we sleep, plays a crucial role in clearing waste products and maintaining brain health. This system is analogous to the lymphatic system in the rest of the body. Glymphatic clearance involves the transport of interstitial fluid, removing harmful metabolic waste from the brain. Sleep, particularly during non-rapid eye movement (NREM) sleep, is a primary driver of glymphatic clearance, with the majority of waste removal occurring during this period.
Impaired glymphatic clearance has been linked to neurodegenerative diseases, particularly Alzheimer's disease. Alzheimer's is characterized by the aggregation of proteins like amyloid-beta and tau, leading to plaques and neurofibrillary tangles. The glymphatic system helps remove these protein aggregates from the brain, suggesting its involvement in modulating or protecting against Alzheimer's.
Lifestyle factors such as sleep position, alcohol intake, exercise, omega-3 consumption, intermittent fasting, and chronic stress can modulate glymphatic clearance. Sleep quality, quantity, and the glymphatic system degrade with age, linking impaired glymphatic clearance to the onset of neurodegenerative diseases.
To sum it up, the importance of a good night's sleep is shown by preserving effective glymphatic clearance. Developing therapeutic interventions to regulate glymphatic flow could be a promising avenue for treating neurodegenerative diseases. Understanding the intricate connections between the glymphatic system, aging, and lifestyle choices may provide insights into disease progression and potential interventions.
References:
Léger D, Gauriau C, Etzi C, Ralambondrainy S, Heusèle C, Schnebert S, Dubois A, Gomez-Merino D, Dumas M. "You look sleepy…" The impact of sleep restriction on skin parameters and facial appearance of 24 women. Sleep Med. 2022 Jan;89:97-103
Liu Y, Wheaton AG, Chapman DP, Cunningham TJ, Lu H, Croft JB. Prevalence of Healthy Sleep Duration among Adults--United States, 2014. MMWR Morb Mortal Wkly Rep. 2016 Feb 19;65(6):137-41
Nedergaard M, Goldman SA. Glymphatic failure as a final common pathway to dementia. Science. 2020 Oct 2;370(6512):50-56
Ogilvie RP, Patel SR. The Epidemiology of Sleep and Diabetes. Curr Diab Rep. 2018 Aug 17;18(10):82
Reis C, Dias S, Rodrigues AM, Sousa RD, Gregório MJ, Branco J, Canhão H, Paiva T. Sleep duration, lifestyles and chronic diseases: a cross-sectional population-based study. Sleep Sci. 2018 Jul-Aug;11(4):217-230
Proper sleep habits and a good night’s rest are essential for the body to recover from the day. Many studies have associated inadequate sleep with disease states and worsened cognitive health. For example, hypertension, diabetes, obesity, cardiovascular diseases, and impaired immune system are linked to sleep deprivation studies. Not being able to fall asleep, waking up frequently, or sleeping too much can affect the quality of sleep and overall health. During the night, your heart rate, breathing rate and blood pressure rise and fall, and hormones release which stabilize and repair the body. Simply put, quality sleep helps the body reset for the next day.
A typical sleep cycle consists of 4-5 rem cycles that contain periods of deep sleep and rapid eye movement (REM), where we dream. Based on age and lifestyle factors, the number of hours of sleep vary. Babies need 16 hours a day, children need 10 hours, teenagers need 9 hours, and adults need 7 to 8 hours of sleep. Another factor to consider the number of hours of sleep is gender. Females need more sleep based on their period cycle and should allow themselves more rest throughout the rest. Sleep can be interrupted by many factors such as caffeine late in the day, specific medications, and blue light from electronic screens. This can affect your ability to fall asleep within a 30-minute timeframe and cause you to toss and turn for hours. People with insomnia and anxiety trigger irritability and thoughts from the day that prevent a good night’s sleep.
Sleep hygiene refers to creating a routine and space where your mind can rest and prepare itself for rest. To relax, deep-breathing techniques and yoga can prepare the mind to leave the day behind and ease into relaxation. In this generation with technology, it has become difficult to leave our blue screens in a separate space from our place of rest. Therefore, a non-prescription over-the-counter option is melatonin 5mg tablets that should be taken 30 minutes prior to sleep. This a supplement that aids in sleep. Melatonin is receptor-dependent that has a role in the detoxification of free radicals and its functions include circadian rhythm regulation and sleep. Prescription medication should be prescribed in chronic cases of sleep disturbances. A few other ways to get quality sleep is to create a quiet, dark and comfortable environment, limit screen time, go to sleep at the same time each night and wake up the same time each morning. Overall, adequate sleep with proper sleep hygiene will enable your body to repair itself and prevent or worsen illness and improve cognitive behavior.
Worley, Susan L. “The Extraordinary Importance of Sleep: The Detrimental Effects of Inadequate Sleep on Health and Public Safety Drive an Explosion of Sleep Research.” P & T : a peer-reviewed journal for formulary management vol. 43,12 (2018): 758-763.
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Roquia Ali
Sleep
One of the basic necessities of life is sleep. It is important for growth, repair, and development, and helps us prepare for the day ahead. The sleep cycle is distinguished into two main parts, nonREM and REM. The Non-REM cycle is further divided into four stages. The first stage is the action of falling asleep. The second stage is light sleep, characterized by a decreased heart rate and slower breathing. The third and fourth stages of nonREM sleep are deep sleep. REM stands for rapid eye movement and this stage takes place towards the end of the sleep cycle. In non-REM sleep cycles, the brain waves slow down, however, in the REM sleep cycle, the brain becomes more active. REM sleep is the closest part of the sleep cycle to being awake, with our heart rate and breathing increasing. REM sleep is key in dreaming, brain development, and emotional processing, and helps the body prepare for waking back up. Since REM sleep is important for brain development, newborns and infants require longer sleep to remain sufficient. Infants need around 12 hours of sleep a day, whereas adults need an average of 7-9 hours of sleep. These numbers can be different for each person depending on their health, activities, and age. However, adult life’s distractions and responsibilities can impede sleep, taking away time from our deep sleep and REM sleep. Sleep loss leads to sleep deprivation, which can have negative impacts on waking life. Lack of sleep is linked to a rise in blood pressure and cortisol secretion due to its activation of the sympathetic nervous system. Cognitive impairment can occur as well. This is shown in signs of inattentiveness, slow responses, and lack of alertness and attention. Sleep also impacts memory retention. increases in REM sleep is in relation to longer memory recall. In return, the lack of REM sleep has shown negative effects on memory formation, however, the exact mechanism is unknown. Impacts on mood include depression, anxiety, irritability, and increased stress. in a study done involving obese patients who did not attain an adequate amount of sleep, an extended sleep schedule (from 6.5 hours to 8.5 hours a night) "lowered their energy intake by 270 kcal/day and weight by 0.87 kg compared with controls" (MASKI). This proves that regular and appropriate sleep can help contribute to weight loss and counteract obesity. Lifestyle changes can be made to overcome sleep deprivation. One key component is keeping to a sleep schedule. Set a time to sleep and wake up every day, do not stay up or sleep in. Avoid napping, or limit time to 20 minutes earlier in the day. Avoiding electronics is important for at least 30 minutes before scheduled sleep time. The blue light on computers and phones can decrease melatonin production, making it harder to fall asleep. Nicotine and alcohol can negatively impact one's quality of sleep, so it is best to avoid them. If needed, seeing a sleep specialist can help identify and attack one's obstacles to a good night's sleep
Masaki, Kiran. [Insufficient sleep: Evaluation and management]. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed [08/14/23].
Rasch, B., Born, J.(2013). About Sleep's Role in Memory. {Physiological Reviews}, 93(2),681-766
Everyone always talks about the importance of diet and exercise for good health but sleep also has a critical role in promoting health. Proper and good sleep improves your brain performance, mood, and health. Not getting enough quality sleep regularly raises the risk of many diseases and disorders ranging from heart disease and stroke to obesity and dementia. There are three major factors that encompass healthy sleep: how much sleep, the quality of sleep, and a consistent sleep schedule. There are two basic types of sleep: rapid eye movement (REM) sleep and non-REM sleep. Each is linked to specific brain waves and neuronal activity. We cycle through all stages of sleep several times during a typical night, with increasingly longer, deeper REM periods occurring toward morning. Non-REM is divided into 3 stages. Stage 1 is the changeover from wakefulness to sleep. During this short period lasting several minutes of relatively light sleep, heartbeat, breathing, and eye movements slow, and muscles relax with occasional twitches. Brain waves begin to slow from their daytime wakefulness patterns. Stage 2 is a period of light sleep before you enter deeper sleep. Heart rate and breathing continue to slow, and muscles relax even further, body temperature decreases, and eye movements stop. Brain wave activity slows but is marked by brief bursts of electrical activity. Stage 3 is the period of deep sleep that is needed to feel refreshed in the morning, it occurs in longer periods during the first half of the night. Heartrate and breathing are at their slowest, muscles are relaxing, and being awoken is difficult. REM sleep occurs about 90 minutes after falling asleep, where eyes move rapidly from side-to-side behind closed eyelids. Mixed frequency brain wave activity becomes closer to that seen in wakefulness Breathing becomes fast and irregular, heart rate and blood pressure increase to near waking levels. Most dreaming occurs during REM sleep, and arm and leg muscles become temporarily paralyzed. With increased age, there is decreased REM sleep. During the first few hours of sleep, the body performs tissue growth and repair, allowing healing and restoration to occur. Depriving the body of REM sleep can interfere with learning, memory, and mood. During the last stage of sleep Is when mental recovery and healing occur. It is recommended that children under the age of 5 get 10-16 hours of sleep each day, aged 6-12 get 9-12 hours, and those about the age of 12 get 8-10 hours.
Sleep is a fundamental aspect of human life and vital for overall health and well-being. During sleep, our bodies can undergo crucial restorative processes, affecting various aspects of physical, mental, and emotional health. Despite its significance, many individuals underestimate the importance of adequate and restful sleep. The physical restoration and healing that occurs in our sleep involves tissue and muscle repair and restoration. In addition, our immune system strengthens during this time, thus sleep deprivation can cause the individuals’ immunity to be compromised. Growth hormone is also released during deep sleep, supporting the growth and repair of cells and tissues.
Sleep also has a significant effect on cognitive function and overall mental health. When we sleep, our brains process and organize information from the day, enhancing memory retention. It has been demonstrated that a good night's sleep can improve problem-solving abilities, creativity, and decision-making skills. On the other hand, chronic sleep deprivation can impair cognitive performance, attention, and concentration. Lack of sleep is associated with an increased risk of developing mood disorders, such as depression and anxiety. The relationship between sleep and mental health is bidirectional, as mental health conditions can also disrupt sleep patterns, leading to a vicious cycle.
Sleep is also essential in regulating our emotions. During sleep, our brain processes emotions from the day and helps individuals deal with stressful experiences. A lack of sleep can cause one to not be able to control their emotions and temperament. Inadequate control of stress and keeping the body in a state of high cortisol levels can lead to weight gain. Sleep has a crucial role in maintaining cardiovascular health. Poor sleep quality and inadequate sleep duration have been linked to an increased risk of hypertension, heart disease, and stroke.
In conclusion, sleep is not just a passive state of rest; it is a dynamic process that controls our physical, mental, and emotional well-being. Adequate and restful sleep is crucial for physical restoration, cognitive function, emotional regulation, cardiovascular health, and weight management. Prioritizing sleep and adopting healthy sleep habits are vital steps toward nurturing the foundation of a healthy and fulfilling life.
References:
Watson NF, Badr MS, Belenky G, et al. Recommended Amount of Sleep for a Healthy Adult: A Joint Consensus Statement of the American Academy of Sleep Medicine and Sleep Research Society. Sleep. 2015;38(6):843-844. doi:10.5665/sleep.4716
Cappuccio FP, D'Elia L, Strazzullo P, Miller MA. Quantity and Quality of Sleep and Incidence of Type 2 Diabetes: A systematic review and meta-analysis. Diabetes Care. 2010;33(2):414-420. doi:10.2337/dc09-1124
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.
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.
“Sleep Disorders (PDQ®)–Patient Version.” National Cancer Institute, www.cancer.gov/about-cancer/treatment/side-effects/sleep-disorders-pdq.
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.
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
Sleep Disorders Part 2
Another class of drugs used to treat insomnia are melatonin receptor agonists. They work at the MT1 and MT2 receptor sites. They promote sleepiness and regulate the circadian rhythm to coordinate the sleep wake cycle. Examples of melatonin receptor agonists are ramelteon and tasimelteon. A warning associated with ramelteon is complex sleep behavior. Sides effects of melatonin receptor agonists include somnolence, and dizziness. They are not a controlled substance. They are to not to be taken with fatty food or fluvoxamine (a strong CYP 1A2 inhibitor that increases the serum concentration of ramelteon and tasimelteon. Tricyclic antidepressants are another class of drugs that can be used to treat insomnia. They work by inhibiting norepinephrine and serotonin reuptake. They also block acetylcholine and histamine receptors, which contributes to side effects. Doxepin is a tricyclic antidepressant that is approved by the FDA for the treatment of insomnia. Doxepin can cause seizures and are not to be used within 2 weeks of a MAO inhibitor. Benzodiazepines like temazepam, estazolam, quazepam, flurazepam, and triazolam can be used to treat insomnia. Benzodiazepine work by enhancing GABA which leading to CNS depression. Warnings associated with benzodiazepines are that use of opioids with benzodiazepines should be avoided because it can lead to sedation, respirator depression and death. There is also a risk of abuse, misuses, and addiction with benzodiazepines. They are considered as C-IV medications. Lorazepam, oxazepam, and temazepam (LOT) are the benzodiazepines recommended for use in older patients as they have a reduced risk of adverse effects. Lastly antihistamines can be used to treat insomnia. They work by blocking the H1 receptor. Side effects of antihistamines are sedation, confusion, memory loss, and peripheral anticholinergic side effects like urinary retention. Its use is also avoided in patients with BPH and glaucoma. Another sleep disorder is restless leg syndrome. This is when there is an urge to move the lower legs and gets worse at night. RLS is believed to be related to a dysfunction of dopamine. Restless leg syndrome is treat with dopamine agonists and gabapentin. The IR formulations of pramipexole and ropinirole are taken 1-3 hours before bedtime. Rotigotine is a dopamine agonist patch that is applied once daily. “Gabapentin enacarbril (Horizant) is an extended release form of gabapentin approved for RLS. It is taken at 5:00PM daily.” (UWorld RxPrep) Another sleep disorder is narcolepsy. This is when there is excessive daytime sleepiness with cataplexy (sudden loss of muscle tone), and sleep paralysis. Patients with narcolepsy experience sleep attacks which can affect them throughout the day at school, work, or in the middle of conversations. It can be diagnosed with “two specialized tests, which can be performed in a sleep disorders clinic, are required to establish a diagnosis of narcolepsy: a polysomnogram (PSG or sleep study)—This overnight test records brain activity, muscle movements, breathing, and eye movements during sleep. It helps determine if REM sleep happens too early in the sleep cycle and checks for other conditions like sleep apnea and multiple sleep latency test (MSLT)—This test measures how quickly a person falls asleep and whether they enter REM sleep. Sometimes, measuring the level of hypocretin in the fluid surrounding the brain and spinal cord can help with diagnosis. To perform this test, a doctor will take a sample of the cerebrospinal fluid using a lumbar puncture (also called a spinal tap) and measure the level of hypocretin-1” (NIH). Narcolepsy is treated with stimulants like modafinil, armodafinil, or sodium oxybate. Other medications that can be used for narcolepsy are pitolisant and solriamfetol.
https://www.ninds.nih.gov/health-information/disorders/narcolepsy#:~:text=Narcolepsy%20is%20a%20chronic%20neurological,throughout%20much%20of%20the%20day.
UWorld RxPrep NAPLEX Review 2025 Chapter 67 Sleep Disorders Page 830
Sleep Disorders Part 1
There are many kinds of sleep disorders. Some examples of sleep disorders are chronic insomnia, restless leg syndrome and narcolepsy. Insomnia is characterized by the difficulty to fall asleep, reduced sleep duration or poor sleep quality. The diagnosis of insomnia can be made if the patient has symptoms at least three times a week for at least three months. Insomnia can decrease quality of life by causing fatigue, decreased concentration and memory. The first thing that is recommended patients do if they experience insomnia is to make some behavioral modifications. These changes include improving sleep hygiene, keeping the bedroom dark, avoiding naps during the day, and / or establishing a night time routine to help the body get ready to sleep. In addition to this it is important to resolve any underlying medical conditions that can lead to or contribute to the insomnia. Some drugs that can worsen insomnia are aripiprazole, atomoxetine, diuretics, fluoxetine, steroids, stimulants, INSTIs, and acetylcholinesterase inhibitors. Some natural products that can be used to help with sleeping are melatonin, valerian, and kava. Melatonin 1-5mg is commonly used to help treat insomnia. Valeria and kava are not recommended because of the risk of hepatotoxicity. Chamomile tea in the evening can help some patients feel calmer and aid in their insomnia. Regarding drug treatment, “sedative-hypnotics are the mainstay of treatment for chronic insomnia, through it is preferable to reserve use when non-drug treatments have failed” (UWorld RxPrep). The drug chosen is to be based on the specific symptoms that is looking to be resolved. Drugs that help with falling asleep are eszopiclone, zolpidem, ramelteon, and zaleplon. Drugs that help with staying asleep are eszopiclone, zolpidem, doxepin, and suvorexant. The drugs that help with both categories are eszopiclone and zolpidem. Patients can self treat with OTC first generation antihistamine like diphenhydramine or doxylamine, but they are not recommended for long term use. According to the Beers Criteria, benzodiazepine, non benzodiazepines hypnotics like zolpidem, and first-generation antihistamines are not recommended for patients older than 65 years. If benzodiazepine have to be used, the ones recommended for patients 65 and older are lorazepam, oxazepam, or temazepam because they have a lower risk of side effects. Examples of non benzodiazepine hypnotics are eszopiclone (Lunesta), zolpidem (Ambien), and zaleplon (Sonata). These drugs are C-IV medications. Warnings a related to these drugs are complex sleep behaviors like sleep walking and sleep driving, increased risk of CNS depression, next day impairment, potential for abuses and dependence, somnolence, dizziness, ataxia, and headache. Because of its risk of complex sleep behaviors, these drugs are contraindicated in patients that have a history of complex sleep patterns. Non benzodiazepine are recommended over benzodiazepines because they have a lower risk for dependence and abuse. They should also not be taken with a fatty meal. Another class of drugs used to treat insomnia are orexin receptor antagonists. Drugs in this class are daridorexant, lemborexant, and suvorexant. These drugs end in -rexant. They work by blocking the orexin neuropeptide signaling system, which result in drowsiness. “Orexin receptor antagonists seem to be devoid of any dependence and tolerance-inducing effects, rendering them a viable option for longer-term treatment” (PubMed). It is contraindicated in patients with narcolepsy. It is not to be taken with food or if there is less than 7 hours of sleep remaining.
UWorld RxPrep NAPLEX Review 2025 Chapter 67 Sleep Disorders Page 828
https://pubmed.ncbi.nlm.nih.gov/37086045/
Sleep is a vital physiological process that occupies a significant portion of our lives, crucial for maintaining physical, mental, and emotional well-being. Influenced by a complex interplay of factors such as age, genetics, behavior, environment, and societal demands, adequate sleep—defined as a minimum of 7 hours per night for adults—is essential for optimal health. However, the prevalence of chronic sleep deprivation, often driven by modern societal pressures such as work demands, digital distractions, and lifestyle choices, has become a concerning trend. Apart from conditions like obstructive sleep apnea and insomnia, this insufficient sleep pattern is increasingly associated with a spectrum of adverse health outcomes.
Epidemiological and experimental evidence highlights its role in elevating the risk of cardiovascular diseases (hypertension, coronary artery disease), metabolic disorders (obesity, type 2 diabetes), and an overall increased mortality risk. Moreover, emerging data suggest a significant correlation between sleep deprivation and heightened risks of stroke, cancer, and neurodegenerative diseases. Psychologically, inadequate sleep is linked to a range of psychiatric disorders including mood disturbances, anxiety, and depression, underscoring its pervasive impact on human health and well-being. This paper explores the intricate relationship between sleep deprivation and the risk of various diseases, emphasizing the critical need for prioritizing healthy sleep habits amidst modern-day challenges.
Every year, 15 million people worldwide experience a stroke, resulting in nearly six million deaths and leaving another five million permanently disabled. Clinical research indicates that both inadequate and excessive sleep are linked to higher rates of cardiovascular events, including stroke. Hypertension is widely recognized as the foremost modifiable risk factor for stroke. Typically, strokes occur most frequently in the early morning hours, coinciding with a blood pressure pattern that decreases overnight and surges in the morning. This surge in morning blood pressure has been theorized to contribute to heightened cardiovascular and cerebrovascular events by potentially destabilizing vulnerable arterial plaques, leading to their rupture and subsequent clot formation. Numerous studies have documented an association between sleep duration and hypertension. For instance, findings from the Sleep Heart Health Study revealed that sleeping fewer than seven or more than eight hours per night was linked to an increased risk of developing hypertension. This underscores the critical importance of maintaining appropriate sleep duration in mitigating cardiovascular risks, including the likelihood of experiencing a stroke.
Additionally, both the quantity and quality of sleep significantly impact the risk of developing diabetes. Early research by Kuhn et al. in 1969 highlighted that total sleep deprivation led to a notable increase in glucose levels. Subsequent studies and meta-analyses have reinforced these findings, showing that sleeping less than six hours per day is associated with a heightened risk of diabetes. Moreover, research indicates that both insufficient and excessive sleep durations are linked to an increased incidence of diabetes and impaired glucose tolerance. For individuals already diagnosed with diabetes, inadequate sleep—whether too short or too long—has been shown to worsen glycemic control. Studies by Ohkuma et al. underscore this, demonstrating that sleep durations outside the optimal range are associated with higher HbA1c levels in both type 1 and type 2 diabetic patients. Thus, maintaining a balanced sleep duration around seven hours per night is crucial for managing glucose metabolism and reducing the risk of diabetes-related complications.
In summary, the repercussions of disrupted sleep patterns extend beyond well-known risks such as cardiovascular diseases, stroke, and diabetes, encompassing conditions such as atrial fibrillation, obesity, dyslipidemia, cancer, infections, and cognitive decline. Adequate sleep is vital for overall health maintenance. Additionally, proper hydration and nutrition play pivotal roles in supporting well-being. Leading health organizations advocate for establishing regular sleep schedules, creating optimal sleep environments, minimizing screen time before bed, and adopting relaxation techniques to enhance sleep quality. These healthy lifestyle practices are essential for mitigating the adverse effects of sleep deprivation and promoting long-term physical and mental health. Emphasizing optimal sleep hygiene remains crucial as we continue to uncover the intricate connections between sleep and comprehensive wellness.
References:
1.Garbarino, S., Lanteri, P., Bragazzi, N. L., Magnavita, N., & Scoditti, E. (2021a, November 18). Role of sleep deprivation in immune-related disease risk and outcomes. Communications biology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8602722/
2. Phua, C. S., Jayaram, L., & Wijeratne, T. (2017a, August 8). Relationship between sleep duration and risk factors for stroke. Frontiers in neurology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5550667/
3. Ferrari, V. A., Mehta, N. N., Soulen, M., Roberts, D. A., & St John Sutton, M. (2003). Pulmonary venous aneurysms in hereditary hemorrhagic telangiectasia detected by 3-dimensional magnetic resonance angiography. Circulation, 108(17). https://doi.org/10.1161/01.cir.0000092308.57590.8c
Sleep is often undervalued despite its critical role in maintaining overall health and well-being. Beyond providing rest, sleep actively supports brain function, physical health, and is integral to growth and development, particularly in children and teens. Chronic sleep deprivation can lead to a host of health issues and significantly impact cognitive abilities, reaction times, work performance, learning, and interpersonal relationships. The cardiovascular, metabolic, respiratory, and immune systems are also profoundly influenced by sleep, with varying optimal sleep requirements across different age groups.
Research underscores the profound effects of sleep on physical appearance and skin health. In a study involving 60 Caucasian women categorized into poor sleepers and healthy sleepers, poor sleep quality correlated with accelerated intrinsic aging, compromised skin barrier function, and decreased satisfaction with appearance. It's recommended that adults aim for 7 to 9 hours of sleep per night, as sleeping less than 7 hours regularly may increase the likelihood of health issues. Alarmingly, over a third of Americans fall short of this recommendation, which can manifest visibly through paler skin, wrinkles, fine lines, drooping eyelids, red or swollen eyes, and dark circles.
The skin's vitality relies heavily on adequate sleep. Collagen and elastin, essential proteins for skin elasticity, are negatively impacted by sleep deficiency due to weakened immune function and disrupted collagen production. This contributes to the formation of wrinkles and a dull complexion. Conversely, quality sleep supports skin health by promoting cellular repair and maintaining a clear complexion through balanced hydration and oil production.
The body's circadian rhythm, responsible for regulating sleep-wake cycles, also affects skin functions. Nighttime enhances skin repair processes through increased blood flow, elevated body temperature, and efficient repair of UV-damaged skin cells, especially during early morning hours. Conversely, irregular sleep patterns and sleep deprivation are associated with skin issues such as dehydration, reduced skin barrier function, and exacerbated acne.
Establishing good sleep hygiene practices is crucial for optimizing sleep quality. These include maintaining a consistent sleep schedule, creating a conducive sleep environment, regular exercise to promote restful sleep, winding down before bed by avoiding screens, and minimizing activities that induce alertness. Avoiding prolonged periods of wakefulness in bed also helps maintain healthy sleep patterns.
In conclusion, the importance of sleep extends far beyond simple rest. It is a cornerstone of overall health, influencing cognitive function, physical well-being, and even appearance. Adequate sleep supports optimal brain and body function, while chronic sleep deprivation can lead to a myriad of health issues and visibly affect skin health and appearance. By prioritizing good sleep hygiene and understanding the profound impact of sleep on our bodies, we can enhance our quality of life and longevity. Further research into sleep's intricate mechanisms will continue to illuminate its essential role in human health.
Léger D, Gauriau C, Etzi C, Ralambondrainy S, Heusèle C, Schnebert S, Dubois A, Gomez-Merino D, Dumas M. "You look sleepy…" The impact of sleep restriction on skin parameters and facial appearance of 24 women. Sleep Med. 2022 Jan;89:97-103
Reiter, Russel J et al. “Melatonin: exceeding expectations.” Physiology (Bethesda, Md.) vol. 29,5 (2014): 325-33. doi:10.1152/physiol.00011.2014
Sleep and Skin Aging
Sleep is a regenerative process that the body uses as a vital component of longevity. Sleep is an essential process that allows the body, and more importantly the brain, in order to rest, regenerate neurotransmitters, proteins and molecules, and regulate metabolism. Sleep deprivation, or lack of sleep, can be defined as less than 7 hours a night in males and less than 8 in females. Sleep deprivation has psychological consequences that affect mood and behavior, but it can also accelerate signs of aging throughout the body. The mechanism is through the production and buildup of reactive oxygen species (ROS), which inhibits the body’s protective mechanisms such as antioxidants and enzymatic processes. ROS can cause mitochondrial arrest, and therefore cell death, and bind to macromolecules such as proteins and cause degradation (Clatici VG, Oyetakin-White P).
The skin is a sensitive organ that is impacted by ROS from the inner and outer environments. This leads to signs of aging, such as fine lines and wrinkles, decreased moisture, lack of color in the skin, and loss of facial structure noted in the eyelids and around the mouth. A study found that disturbed sleep cycles made subjects appear less healthy, with observed changes in skin texture and a reduced permeability of the skin barrier (Axelsson J, Kahan V).
The impact of sleep on skin barrier function is due to the the lack of the body’s ability to recover and detoxify from free radicals and other chemicals that accumulate durongf the day. Sleep disruption also contributes to neuroendocrine dysregulation, specifically in cortisol, interleukin- 1beta, interleukin- 10, tumor necrosis factor alpha and an increase in natural killer cell activity. This promotes the proinflammatory mechanism in the body and can trigger stress- induced changes in the skin (Altemus M).
Experts recommend between 7 to 9 hours of sleep as adequate for adults, with women needing between 8 to 9 hours (Watson NF). Sleep is crucial to the overall health of our bodies, promoting longevity. However, the impact of sleep disruption causes visual changes in the appearance of our skin, causing aging.
Citations:
Altemus M, Rao B, Dhabhar FS, Ding W, Granstein RD. Stress-induced changes in skin barrier function in healthy women. J Invest Dermatol. 2001;117(2):309-317. doi:10.1046/j.1523-1747.2001.01373.x
Axelsson J, Sundelin T, Ingre M, Van Someren EJ, Olsson A, Lekander M. Beauty sleep: experimental study on the perceived health and attractiveness of sleep deprived people. BMJ. 2010;341:c6614. Published 2010 Dec 14. doi:10.1136/bmj.c6614
Clatici VG, Racoceanu D, Dalle C, et al. Perceived Age and Life Style. The Specific Contributions of Seven Factors Involved in Health and Beauty. Maedica (Bucur). 2017;12(3):191-201.
Kahan V, Andersen ML, Tomimori J, Tufik S. Can poor sleep affect skin integrity?. Med Hypotheses. 2010;75(6):535-537. doi:10.1016/j.mehy.2010.07.018
Oyetakin-White P, Suggs A, Koo B, et al. Does poor sleep quality affect skin ageing?. Clin Exp Dermatol. 2015;40(1):17-22. doi:10.1111/ced.12455
Watson NF, Badr MS, Belenky G, et al. Recommended Amount of Sleep for a Healthy Adult: A Joint Consensus Statement of the American Academy of Sleep Medicine and Sleep Research Society. Sleep. 2015;38(6):843-844. Published 2015 Jun 1. doi:10.5665/sleep.4716
Sleep is a complex physiological process that plays a crucial role in maintaining overall health and well-being. The pathophysiology of sleep involves an intricate interplay of various neurobiological and physiological mechanisms. There are four stages of the sleep cycle, split into two categories: non rapid eye movement and rapid eye movement stage. Stages 1 and 2 involve non rapid eye movement and it is easier to be awoken during these stages. Stage 3 is the deepest part of non rapid eye movement sleep. This is when your muscles and body relax more, and brain waves show slowed down activity which is vastly different from waking brain activity. Deep sleep is thought to play a crucial role in both the body's recovery and the enhancement of effective cognitive processes, including thinking and memory. The last stage belongs to the rapid eye movement category.
Several factors, both internal and external, can influence the pathophysiology of sleep, including stress, environmental factors, and medical conditions. Understanding the underlying mechanisms of sleep is essential for addressing sleep-related disorders and promoting optimal sleep hygiene for overall health and cognitive function. An external factor such as atopic dermatitis has been linked to sleep disturbance and impaired neurocognitive function.
Atopic dermatitis is “a chronic, pruritic and inflammatory, dry skin condition” (1). It is characterized by itchy red dry skin. Atopic dermatitis commonly causes sleep disturbance, especially during uncontrolled flare ups. A cycle of itching and scratching is accompanied by an inflammatory response leading to significant sleep disturbance, especially since itch is often reported to be worse at night (1). Those with atopic dermatitis experience sleep disturbance. Studies show that “over 60% of parents report that AD affects how well they or their child sleep” (1).
The phenomenon of nocturnal itching has prompted theories pointing towards variations in skin barrier function during the night. Transepidermal water loss (TEWL), a gauge of skin barrier integrity, has been linked to the intensity of itch in atopic dermatitis (AD). Studies suggest that the increase in peripheral skin temperature during the night, a mechanism to reduce core temperature, may lead to a corresponding rise in TEWL, potentially heightening nocturnal itch sensations. These nocturnal itch sensations impact sleep quality heavily. A decrease in sleep quality has been shown to affect attention, memory, processing speed, and regulating behaviors. Children who suffer from AD also are more hyperactive and have lower cognitive performance due to inadequate sleep in their early life.
The intricate relationship between sleep and skin health underscores the importance of a holistic approach to well-being. Adequate and quality sleep plays a pivotal role in supporting the body's regenerative processes, including skin repair and maintenance. The reciprocal nature of this connection is evident as disruptions in sleep patterns due to nocturnal itching can adversely impact one livelihood. Moreover, addressing sleep-related issues can be integral in managing certain skin conditions, as seen in the case of nocturnal itching exacerbation.
Recognizing the bidirectional influence between sleep and skin underscores the need for a comprehensive approach to health that encompasses both lifestyle modifications and targeted skincare practices.
References:
Cameron S, Donnelly A, Broderick C, et al. Mind and skin: Exploring the links between inflammation, sleep disturbance and neurocognitive function in patients with atopic dermatitis. Allergy. 2024; 79: 26-36. doi:10.1111/all.15818
https://www.sleepfoundation.org/how-sleep-works
In modern day times the act of sleep is often neglected. Trying to fit as many activities as possible in one day is usually compromised by cutting down on sleep time. However, this may be more detrimental to a person’s health than it may seem at first glance. Sleep is a natural state of rest where the body is inactive, the eyes are closed, and the mind is not thinking. It is a reversible state of reduced responsiveness to external stimulation. Overall, it is a essential function to the body’s overall health.
Sleep is an important part of daily routine. A person should spend about one third of their time sleeping. Quality sleep and getting enough sleep is essential to survival, comparable to the essentialities of food and water. Without sleep the brain lacks the ability to function properly and efficiently. Brain functions such as nerve cells communicating wit each other is something that is driven by sleep. Your brain and body stay relatively active while you sleep. Findings even suggest that sleep plays a housekeeping role that removes toxins in your brain that build up while you are awake. Sleep effects almost every system in the body, the brain, the heart, the lungs, metabolism, immune function, mood, and disease resistance. Chronic lack of sleep increases the risk of many chronic disorders such as high blood pressure, cardiovascular disease, diabetes, depression, and obesity.
In a study design testing the effects of chronic poor sleep quality on human skin function and visible signs of ageing. It concluded that beauty sleep is real. The results where good sleepers have significantly lower intrinsic skin ageing scores by SCINEXA. At baseline poor sleepers had significantly higher levels of TEWL. In addition to the good sleeper has a better perception of their appearance and physical attractiveness compares to the poor sleepers.
Defining good sleep can be relative due to the fact sleep necessities change as you age. There is no exact number of hours for good sleep, but we can estimate. Babies initially sleep as much as 16-18 hours per day. This boosts their growth and development f the brain. School aged children and teens on average need about 9.5 hours of sleep per night. Most adults need about 7-9 hours of sleep a night. Elders over 60, tend to have less sleep due to being interrupted multiple times by awakenings. Also, many medications that older adults take interfere with their sleep schedule.
These relative recommended hours of sleep per person in the US is almost never reached by the average working adult. The lifestyle and average 9-5 employee with a family works does not allow for these proper sleep routines. We have jobs that are overnight, which is a whole other issue to a person’s sleep health and overall health. It is essential to find time to sleep an adequate amount each night for a person’s overall wellness and future health. As a society, we need to shift our busy lifestyles to prioritize our health, this includes taking sleep seriously and not for granted.
References:
Oyetakin-White P, Suggs A, Koo B, Matsui MS, Yarosh D, Cooper KD, Baron ED. Does poor sleep quality affect skin ageing? Clin Exp Dermatol. 2015 Jan;40(1):17-22. doi: 10.1111/ced.12455. Epub 2014 Sep 30. PMID: 25266053.
https://www.ninds.nih.gov/health-information/public-education/brain-basics/brain-basics-understanding-sleep#:~:text=Sleep%20is%20important%20to%20a,up%20while%20you%20are%20awake.
Many individuals underestimate the importance of sleeping and its major contribution to overall health. During sleep, the body is working to support healthy brain function and to maintain physical health. Sleep also plays a crucial role in supporting growth and development in children and teens. Insufficient sleep over an extended period can increase the risk of chronic health issues. Furthermore, it can impact cognitive abilities, reaction time, work performance, learning, and interpersonal relationships. Sleep has influence on the heart, circulatory system, metabolism, respiratory system, and immune system, and the optimal amount of sleep needed varies upon age.
According to a study done with a sample size of 60 Caucasian women who were categorized as poor sleepers and healthy sleepers, poor sleep quality was seen to be associated with increased signs of intrinsic ageing, diminished skin barrier function and lower satisfaction with appearance. Experts recommend that adults sleep between 7 and 9 hours a night. Adults who sleep less than 7 hours a night may have more health issues than those who sleep 7 or more hours a night. Over a third of the American population regularly gets less than this amount of sleep. Changes in appearance caused by sleep deprivation include paler skin than usual, wrinkles and fine lines around the mouth, hanging corners of the mouth, drooping or hanging eyelids, red or swollen eyes, and dark circles below the eyes. Overall, researchers found that people who are sleep deprived appear sadder and more fatigued than people who have had sufficient sleep.
The skin comprises various proteins, including collagen and elastin, contributing to its elasticity and flexibility. Studies indicate that inadequate sleep weakens the immune system, affecting the production of collagen and its quality. Consequently, this decline in skin health may lead to the development of wrinkles. Furthermore, consistent and high-quality sleep may contribute to maintaining a clear skin complexion. The circadian rhythm, responsible for regulating the body's internal clock and sleep patterns, also influences the functions of various organs, including the skin. During the night, the skin experiences heightened blood flow, raising body temperature and facilitating the repair of damaged skin.
Researchers have discovered that the body is most effective at repairing skin cells damaged by UV sunlight exposure in the early morning. Insufficient sleep and late bedtimes are correlated with adverse changes in skin complexion. Studies on sleep deprivation have observed peeling skin, dehydration, and a glossy appearance. Additionally, going to bed late is associated with reduced skin hydration, increased water loss, and elevated production of oily secretions, potentially contributing to certain types of acne.
Sleep hygeine is important and is characterized as a set of habits or behaviors to improve sleep. Some of these habits include keeping a regular sleep schedule such as waking up and going to bed at consistent times each day, creating a quality sleep environment tailored to an individual's preferences, exercising regularly makes it easier to fall asleep and to stay asleep, winding down in the evening, putting away electronics, and avoid lying awake in bed at night.
References:
https://academic.oup.com/ced/article-abstract/40/1/17/6621145?redirectedFrom=fulltext&login=false#no-access-message
https://www.nhlbi.nih.gov/health/sleep
https://www.sleepfoundation.org/physical-health/beauty-sleep
Sleep is a fundamental aspect of our health, yet modern lifestyles often neglect its importance, promoting excessive work, late-night activities, and all-night study sessions. Understanding sleep involves recognizing its role in eliminating toxins accumulated in the brain during wakefulness. The CDC recommends seven hours of good-quality sleep, assessing factors like sleep latency, sleep-waking, wakefulness, and sleep efficiency. Quality rest benefits memory retention, with REM sleep crucial for memory consolidation and various physiological processes.
Furthermore, evidence links short sleep and poor sleep habits to chronic diseases, infections, and premature mortality. Immune parameters decline with insufficient sleep, affecting T cell proliferation, natural killer cell response, and proinflammatory pathways. For instance, proper sleep strengthens the immune system against the common cold. In contrast, lack of sleep increases susceptibility.
Beyond physical health, sleep significantly impacts skin health. Quality sleep contributes to cellular repair, DNA reproduction, and inflammation reduction, essential for preventing conditions like acne and rosacea. Moreover, sleep plays a pivotal role in preventing diabetes. Insufficient sleep can lead to insulin resistance, affecting glucose metabolism and contributing to obesity. Leptin and ghrelin, hormones influencing appetite, are disrupted, promoting overeating. Shift work exacerbates these issues, increasing the risk of diabetes, obesity, and cardiovascular events.
The glymphatic system, a perivascular network in the brain active when we sleep, plays a crucial role in clearing waste products and maintaining brain health. This system is analogous to the lymphatic system in the rest of the body. Glymphatic clearance involves the transport of interstitial fluid, removing harmful metabolic waste from the brain. Sleep, particularly during non-rapid eye movement (NREM) sleep, is a primary driver of glymphatic clearance, with the majority of waste removal occurring during this period.
Impaired glymphatic clearance has been linked to neurodegenerative diseases, particularly Alzheimer's disease. Alzheimer's is characterized by the aggregation of proteins like amyloid-beta and tau, leading to plaques and neurofibrillary tangles. The glymphatic system helps remove these protein aggregates from the brain, suggesting its involvement in modulating or protecting against Alzheimer's.
Lifestyle factors such as sleep position, alcohol intake, exercise, omega-3 consumption, intermittent fasting, and chronic stress can modulate glymphatic clearance. Sleep quality, quantity, and the glymphatic system degrade with age, linking impaired glymphatic clearance to the onset of neurodegenerative diseases.
To sum it up, the importance of a good night's sleep is shown by preserving effective glymphatic clearance. Developing therapeutic interventions to regulate glymphatic flow could be a promising avenue for treating neurodegenerative diseases. Understanding the intricate connections between the glymphatic system, aging, and lifestyle choices may provide insights into disease progression and potential interventions.
References:
Léger D, Gauriau C, Etzi C, Ralambondrainy S, Heusèle C, Schnebert S, Dubois A, Gomez-Merino D, Dumas M. "You look sleepy…" The impact of sleep restriction on skin parameters and facial appearance of 24 women. Sleep Med. 2022 Jan;89:97-103
Liu Y, Wheaton AG, Chapman DP, Cunningham TJ, Lu H, Croft JB. Prevalence of Healthy Sleep Duration among Adults--United States, 2014. MMWR Morb Mortal Wkly Rep. 2016 Feb 19;65(6):137-41
Nedergaard M, Goldman SA. Glymphatic failure as a final common pathway to dementia. Science. 2020 Oct 2;370(6512):50-56
Ogilvie RP, Patel SR. The Epidemiology of Sleep and Diabetes. Curr Diab Rep. 2018 Aug 17;18(10):82
Reis C, Dias S, Rodrigues AM, Sousa RD, Gregório MJ, Branco J, Canhão H, Paiva T. Sleep duration, lifestyles and chronic diseases: a cross-sectional population-based study. Sleep Sci. 2018 Jul-Aug;11(4):217-230
Proper sleep habits and a good night’s rest are essential for the body to recover from the day. Many studies have associated inadequate sleep with disease states and worsened cognitive health. For example, hypertension, diabetes, obesity, cardiovascular diseases, and impaired immune system are linked to sleep deprivation studies. Not being able to fall asleep, waking up frequently, or sleeping too much can affect the quality of sleep and overall health. During the night, your heart rate, breathing rate and blood pressure rise and fall, and hormones release which stabilize and repair the body. Simply put, quality sleep helps the body reset for the next day.
A typical sleep cycle consists of 4-5 rem cycles that contain periods of deep sleep and rapid eye movement (REM), where we dream. Based on age and lifestyle factors, the number of hours of sleep vary. Babies need 16 hours a day, children need 10 hours, teenagers need 9 hours, and adults need 7 to 8 hours of sleep. Another factor to consider the number of hours of sleep is gender. Females need more sleep based on their period cycle and should allow themselves more rest throughout the rest. Sleep can be interrupted by many factors such as caffeine late in the day, specific medications, and blue light from electronic screens. This can affect your ability to fall asleep within a 30-minute timeframe and cause you to toss and turn for hours. People with insomnia and anxiety trigger irritability and thoughts from the day that prevent a good night’s sleep.
Sleep hygiene refers to creating a routine and space where your mind can rest and prepare itself for rest. To relax, deep-breathing techniques and yoga can prepare the mind to leave the day behind and ease into relaxation. In this generation with technology, it has become difficult to leave our blue screens in a separate space from our place of rest. Therefore, a non-prescription over-the-counter option is melatonin 5mg tablets that should be taken 30 minutes prior to sleep. This a supplement that aids in sleep. Melatonin is receptor-dependent that has a role in the detoxification of free radicals and its functions include circadian rhythm regulation and sleep. Prescription medication should be prescribed in chronic cases of sleep disturbances. A few other ways to get quality sleep is to create a quiet, dark and comfortable environment, limit screen time, go to sleep at the same time each night and wake up the same time each morning. Overall, adequate sleep with proper sleep hygiene will enable your body to repair itself and prevent or worsen illness and improve cognitive behavior.
References:
“The Benefits of Slumber.” National Institutes of Health, U.S. Department of Health and Human Services, 4 Apr. 2018, newsinhealth.nih.gov/2013/04/benefits-slumber#:~:text=Throughout%20the%20night%2C%20your%20heart,can%20affect%20your%20body%20weight
Reiter, Russel J et al. “Melatonin: exceeding expectations.” Physiology (Bethesda, Md.) vol. 29,5 (2014): 325-33. doi:10.1152/physiol.00011.2014
Worley, Susan L. “The Extraordinary Importance of Sleep: The Detrimental Effects of Inadequate Sleep on Health and Public Safety Drive an Explosion of Sleep Research.” P & T : a peer-reviewed journal for formulary management vol. 43,12 (2018): 758-763.
Roquia Ali
Sleep
One of the basic necessities of life is sleep. It is important for growth, repair, and development, and helps us prepare for the day ahead. The sleep cycle is distinguished into two main parts, nonREM and REM. The Non-REM cycle is further divided into four stages. The first stage is the action of falling asleep. The second stage is light sleep, characterized by a decreased heart rate and slower breathing. The third and fourth stages of nonREM sleep are deep sleep. REM stands for rapid eye movement and this stage takes place towards the end of the sleep cycle. In non-REM sleep cycles, the brain waves slow down, however, in the REM sleep cycle, the brain becomes more active. REM sleep is the closest part of the sleep cycle to being awake, with our heart rate and breathing increasing. REM sleep is key in dreaming, brain development, and emotional processing, and helps the body prepare for waking back up. Since REM sleep is important for brain development, newborns and infants require longer sleep to remain sufficient. Infants need around 12 hours of sleep a day, whereas adults need an average of 7-9 hours of sleep. These numbers can be different for each person depending on their health, activities, and age. However, adult life’s distractions and responsibilities can impede sleep, taking away time from our deep sleep and REM sleep. Sleep loss leads to sleep deprivation, which can have negative impacts on waking life. Lack of sleep is linked to a rise in blood pressure and cortisol secretion due to its activation of the sympathetic nervous system. Cognitive impairment can occur as well. This is shown in signs of inattentiveness, slow responses, and lack of alertness and attention. Sleep also impacts memory retention. increases in REM sleep is in relation to longer memory recall. In return, the lack of REM sleep has shown negative effects on memory formation, however, the exact mechanism is unknown. Impacts on mood include depression, anxiety, irritability, and increased stress. in a study done involving obese patients who did not attain an adequate amount of sleep, an extended sleep schedule (from 6.5 hours to 8.5 hours a night) "lowered their energy intake by 270 kcal/day and weight by 0.87 kg compared with controls" (MASKI). This proves that regular and appropriate sleep can help contribute to weight loss and counteract obesity. Lifestyle changes can be made to overcome sleep deprivation. One key component is keeping to a sleep schedule. Set a time to sleep and wake up every day, do not stay up or sleep in. Avoid napping, or limit time to 20 minutes earlier in the day. Avoiding electronics is important for at least 30 minutes before scheduled sleep time. The blue light on computers and phones can decrease melatonin production, making it harder to fall asleep. Nicotine and alcohol can negatively impact one's quality of sleep, so it is best to avoid them. If needed, seeing a sleep specialist can help identify and attack one's obstacles to a good night's sleep
Masaki, Kiran. [Insufficient sleep: Evaluation and management]. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed [08/14/23].
Rasch, B., Born, J.(2013). About Sleep's Role in Memory. {Physiological Reviews}, 93(2),681-766
Alhola, P., & Polo-Kantola, P. (2007). Sleep deprivation: Impact on cognitive performance. Neuropsychiatric disease and treatment. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2656292/
Sleep
Everyone always talks about the importance of diet and exercise for good health but sleep also has a critical role in promoting health. Proper and good sleep improves your brain performance, mood, and health. Not getting enough quality sleep regularly raises the risk of many diseases and disorders ranging from heart disease and stroke to obesity and dementia. There are three major factors that encompass healthy sleep: how much sleep, the quality of sleep, and a consistent sleep schedule. There are two basic types of sleep: rapid eye movement (REM) sleep and non-REM sleep. Each is linked to specific brain waves and neuronal activity. We cycle through all stages of sleep several times during a typical night, with increasingly longer, deeper REM periods occurring toward morning. Non-REM is divided into 3 stages. Stage 1 is the changeover from wakefulness to sleep. During this short period lasting several minutes of relatively light sleep, heartbeat, breathing, and eye movements slow, and muscles relax with occasional twitches. Brain waves begin to slow from their daytime wakefulness patterns. Stage 2 is a period of light sleep before you enter deeper sleep. Heart rate and breathing continue to slow, and muscles relax even further, body temperature decreases, and eye movements stop. Brain wave activity slows but is marked by brief bursts of electrical activity. Stage 3 is the period of deep sleep that is needed to feel refreshed in the morning, it occurs in longer periods during the first half of the night. Heartrate and breathing are at their slowest, muscles are relaxing, and being awoken is difficult. REM sleep occurs about 90 minutes after falling asleep, where eyes move rapidly from side-to-side behind closed eyelids. Mixed frequency brain wave activity becomes closer to that seen in wakefulness Breathing becomes fast and irregular, heart rate and blood pressure increase to near waking levels. Most dreaming occurs during REM sleep, and arm and leg muscles become temporarily paralyzed. With increased age, there is decreased REM sleep. During the first few hours of sleep, the body performs tissue growth and repair, allowing healing and restoration to occur. Depriving the body of REM sleep can interfere with learning, memory, and mood. During the last stage of sleep Is when mental recovery and healing occur. It is recommended that children under the age of 5 get 10-16 hours of sleep each day, aged 6-12 get 9-12 hours, and those about the age of 12 get 8-10 hours.
References
What happens when we sleep, and why we need just the right amount each night. (2023, March 16). www.heart.org. https://www.heart.org/en/news/2023/03/16/what-happens-when-we-sleep-and-why-we-need-just-the-right-amount-each-night
Brain basics: Understanding sleep. (n.d.). National Institute of Neurological Disorders and Stroke. https://www.ninds.nih.gov/health-information/public-education/brain-basics/brain-basics-understanding-sleep
Good sleep for good health. (2022, July 15). NIH News in Health. https://newsinhealth.nih.gov/2021/04/good-sleep-good-health#:~:text=But%20sleep%20is%20as%20important,stroke%20to%20obesity%20and%20dementia.
Sleep
Sleep is a fundamental aspect of human life and vital for overall health and well-being. During sleep, our bodies can undergo crucial restorative processes, affecting various aspects of physical, mental, and emotional health. Despite its significance, many individuals underestimate the importance of adequate and restful sleep. The physical restoration and healing that occurs in our sleep involves tissue and muscle repair and restoration. In addition, our immune system strengthens during this time, thus sleep deprivation can cause the individuals’ immunity to be compromised. Growth hormone is also released during deep sleep, supporting the growth and repair of cells and tissues.
Sleep also has a significant effect on cognitive function and overall mental health. When we sleep, our brains process and organize information from the day, enhancing memory retention. It has been demonstrated that a good night's sleep can improve problem-solving abilities, creativity, and decision-making skills. On the other hand, chronic sleep deprivation can impair cognitive performance, attention, and concentration. Lack of sleep is associated with an increased risk of developing mood disorders, such as depression and anxiety. The relationship between sleep and mental health is bidirectional, as mental health conditions can also disrupt sleep patterns, leading to a vicious cycle.
Sleep is also essential in regulating our emotions. During sleep, our brain processes emotions from the day and helps individuals deal with stressful experiences. A lack of sleep can cause one to not be able to control their emotions and temperament. Inadequate control of stress and keeping the body in a state of high cortisol levels can lead to weight gain. Sleep has a crucial role in maintaining cardiovascular health. Poor sleep quality and inadequate sleep duration have been linked to an increased risk of hypertension, heart disease, and stroke.
In conclusion, sleep is not just a passive state of rest; it is a dynamic process that controls our physical, mental, and emotional well-being. Adequate and restful sleep is crucial for physical restoration, cognitive function, emotional regulation, cardiovascular health, and weight management. Prioritizing sleep and adopting healthy sleep habits are vital steps toward nurturing the foundation of a healthy and fulfilling life.
References:
Watson NF, Badr MS, Belenky G, et al. Recommended Amount of Sleep for a Healthy Adult: A Joint Consensus Statement of the American Academy of Sleep Medicine and Sleep Research Society. Sleep. 2015;38(6):843-844. doi:10.5665/sleep.4716
Cappuccio FP, D'Elia L, Strazzullo P, Miller MA. Quantity and Quality of Sleep and Incidence of Type 2 Diabetes: A systematic review and meta-analysis. Diabetes Care. 2010;33(2):414-420. doi:10.2337/dc09-1124
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