Are You Being Short-Changed?

Sleep expert Dr. James Maas asks these three questions: Do you need an alarm clock in order to wake up in the morning? Do you hit the snooze button a few times before finally getting out of bed? Do you sleep extra hours on the weekend? If so, consider yourself one of the millions of chronically sleep-deprived people.

The National Sleep Foundation’s 2005 Sleep in America Poll showed that U.S. adults are generally sleeping on average 6.9 hours a night, including both weekdays and weekend sleep. Forty percent reported sleeping less than seven hours on weekdays, and 71% were sleeping less than eight hours on weekdays.¹ According to James Maas, at least 63 million American adults are moderately to severely sleep deprived. Forty- million Americans suffer from one or more of the 81 known sleep disorders. Estimates for Australians are that almost 90% of people suffer from a sleep disorder at some time or times in their lives, with 30% suffering a severe or serious disorder.² Nearly every high school and college student needs 9 ½ hours of sleep to be fully alert, yet he or she usually averages only six hours a night.

Sleep deprivation costs Americans more than 100 billion dollars annually. Sleep deprivation induces significant reduction in performance and alertness. Unfortunately, reducing one’s nighttime sleep by as little as 1 ½ hours for just one night could result in a reduction of daytime alertness by as much as 32%.³ Studies suggest that sleeping five or fewer hours per night may increase mortality risk by as much as 15%.⁴

Short-Cut to Serious Trouble

Consider These Facts:

Less Sleep = More Accidents

The Institute of Medicine estimates that drowsy driving is responsible for 20% of all motor vehicle crashes. That means that drowsy driving causes one million crashes, 500,000 injuries, and 8,000 deaths each year in the U.S.⁵ Researchers in Australia and New Zealand report that sleep deprivation can have some of the same hazardous effects as being drunk. They found that sleeping less than six hours a night substantially affects coordination, reaction time, and judgment. They also discovered that people who drove after being awake for 17 to 19 hours performed worse than those with a blood alcohol level of .05%.⁶ That’s the legal limit for drunk driving in most western European countries, though many U.S. states set their blood alcohol limits at .08%. Being awake for 22 hours straight slows your reaction time more than drinking four alcoholic drinks.

Less Sleep = More Cardiovascular Disease

Dr. David White and colleagues of Harvard University studied data collected from five countries and found that if one sleeps less than six to seven hours per night, the risk for heart attack increases sharply. In their studies, individuals who slept about five hours a night had about a 40% higher risk of having a heart attack than did people that slept eight hours a night.7

Immune Suppression

In a study involving nearly 4,033 women under age 65, researchers at the National Cancer Institute reported that women who consistently slept less than seven hours a night had a 47% higher risk of cancer.⁸ A study by the National Cancer Institute found that exercising can reduce a woman’s risk of cancer by as much as 20% and that sleeping less than seven hours a night eliminates the cancer-fighting benefits of exercise.⁹ In some cases, lack of sleep increased the risk for cancer by 50%. Studies show that even partial sleep deprivation decreases natural killer cell activity by 30%.¹⁰ Natural killer cells destroy viruses and cancer cells. Sleep deprivation also affects the immune system in milder ways. A recent study showed that people who averaged less than seven hours of sleep a night were about three times more likely to develop cold symptoms when exposed to the cold-causing rhinovirus than study volunteers who got eight or more hours of sleep. In addition, those individuals who got better quality sleep were the least likely to come down with a cold.¹¹

Fatter

People who sleep six hours a night are 23% more likely to be obese than those sleeping seven to nine hours per night. Other studies from the American Academy of Sleep Medicine showed that about 33% of those who slept less than six hours a night and 26% of those who slept nine hours a night or more were obese. Normal sleepers were the thinnest group.^12,13

More Inflammation

Two hours of sleep deprivation nightly for one week in healthy individuals is also associated with marked activation of the body’s inflammation system. Even partial sleep deprivation increases the levels of alpha-tumor necrosis factor, interleukin-6, and C-reactive protein, all of which are pro-inflammatory agents and markers.¹⁴ This is important because chronic inflammation fuels chronic disease.

Grumpy and Worse

Studies have shown that even partial sleep deprivation has a significant effect on the mood.¹⁵ Researchers from the University of Pennsylvania found that individuals who were limited to only 4 ½ hours of sleep a night for one week reported feeling more stressed, angry, sad, and mentally exhausted. Fortunately, when the subjects resumed normal sleep, they reported a dramatic improvement in mood.¹⁶ Sleep problems might, in turn, contribute to mental disorders. Chronic insomnia may increase an individual’s risk of developing a mood disorder, such as depression or anxiety. In one major study of 10,000 adults, people with insomnia were five times more likely to develop depression.¹⁷ In the same study, people with insomnia were 20 times more likely to develop panic disorder.

Another study showed that insomnia is a reliable predictor of depression, and many other psychiatric disorders, including all types of anxiety disorders. The amount of sleep a person gets also impacts the severity of mental symptoms if they already have either a tendency toward, or an actual, mental disorder. Researchers at Harvard and Berkeley studied the brain scans of participants who were deprived of sleep for 25 hours. In most participants, amygdalae (a part of the brain that is responsible for emotional reactions) activity was 60% higher for sleep-deprived participants than in those participants who slept.¹⁸ When the amygdalae become overactive, fear and emotional responses predominate over reason. Consequently, self-control is impaired.

Types of Sleep

There are two types of sleep: non-rapid-eye-movement sleep (NREM) and REM. The deepest levels of sleep are stages 3 and 4 of NREM sleep, often referred to as slow-wave sleep. During slow-wave sleep there is an increased blood supply to the muscles. Muscles totally relax. The heart rate and respiration slows while blood pressure decreases. Growth hormone is released, which facilitates the entry of amino acids into the cells, and thus promotes protein synthesis in the ribosomes. Consequently, there are faster repair processes and wound healing, healthier joints, stronger muscles, and brighter minds. Growth hormone also promotes fat catabolism. In short, sleep deprivation blunts growth hormone and promotes fat synthesis in the body while reducing protein synthesis.

Rapid-eye-movement (REM) sleep accounts for 25% of a night’s sleep. It first occurs about 90 minutes after falling asleep and then recurs about every 90 minutes, getting longer later in the night. During REM sleep dreams occur, and neurotransmitters are replenished. REM sleep helps to facilitate memory storage and retention. It is essential for preparing the mind for peak daytime performance.

Sleep Impacts the Nervous System

PET brain studies show that sleep deprivation exerts many of the same effects as drinking alcohol upon the prefrontal cortex, the executive command center of the brain. Thus, our ability to choose, plan, and execute ideas is compromised. Studies on sleep-deprived soldiers show that sleep deprivation degrades the higher, more complex mental processes.¹⁹ It especially decreases the efficiency of key areas of the brain involved in speech, language, and memory. Memory lapses, decreased ability to concentrate, and impatience result from inadequate sleep. Sleep deprived individuals do not have the speed or creative abilities to cope with making quick, but logical decisions, nor do they have the ability to implement them well. Adolescents who get less than eight hours of sleep have difficulty with complex tasks.²⁰ Studies have demonstrated that losing an hour of optimal sleep impairs one’s ability to multi-task.^21,22

Restricting sleep below an individual’s optimal time in bed can cause a range of neurobehavioral deficits, including lapses of attention and thought, slowed working memory, and depressed mood. Laboratory studies of healthy adults subjected to sleep restriction have found adverse effects on endocrine functions and metabolic and inflammatory responses.²³ Researchers from the University of Pennsylvania found that after days of chronic sleep restriction below 7 hours per night, significant daytime cognitive dysfunction accumulates to levels comparable to that found after severe, acute, total sleep deprivation.²⁴ They also found that chronic sleep debt is accumulative. Studies show that we need between seven to eight hours of good quality sleep per night.

Sleep, SNS, and Hypertension

Insufficient sleep dysregulates the balance between the sympathetic and parasympathetic divisions of the autonomic nervous system because during deep sleep, sympathetic nerve activity is generally decreased and parasympathetic nerve activity is increased. The sympathetic nerves help to mobilize us to action in times of stress. Blood pressure, heart rate, and blood sugar increase while digestive processes slow down under sympathetic influences. The parasympathetic nerves slow the heart rate, stimulate the digestive process, and help us to take care of our daily needs. We actually need a balance of both systems. However, excessive sympathetic tone and decreased parasympathetic tone can contribute to high blood pressure, diabetes, and electrical disturbances of the heart’s rate and rhythm. The Harvard School of Health, for example, studied 4,800 adults between ages 32-59. The study found that those who averaged less than five hours of sleep per night were about 60% more likely to develop high blood pressure than those who got six or more hours of sleep.²⁵

People who sleep five hours or less a night increase their risk for hypertension based on the NHANES I data from 4,810 people aged 32-86 who did not have hypertension at baseline. Of the younger people aged 32-59 years who slept five hours or less a night, 23.6% developed hypertension compared with 11.8% of those who got seven to eight hours of sleep. Subjects who slept five or less hours per night continued to have a greater risk for hypertension after controlling for factors such as obesity, diabetes, physical activity, salt and alcohol consumption, smoking, depression, age, education, gender, and ethnicity.²⁶

Why is this? Sleep debt leads to a prolonged exposure to greater sympathetic influences. Additionally, an activated sympathetic nervous system also could accentuate structural remodeling in the blood vessels and major organs that regulate blood pressure, including the heart and kidneys. And, an activated sympathetic nervous system increases the renal sodium retention which contributes to elevated blood pressure.

Sleep Impacts the Endocrine System

As mentioned before, deficient sleep increases sympathetic influences and reduces parasympathetic influences. Endocrine glands are vulnerable to these autonomic nervous system influences.²⁷ Normally the anti-inflammatory, adrenal hormone, cortisol, decreases in the evening and rises in the early morning. However, partial sleep deprivation increases cortisol production in the evening.²⁸ This extra cortisol actually inhibits protein synthesis in the brain and muscle cells, joints, gastrointestinal tract, and immune system so that their efficiency is compromised. Cortisol causes, in turn, the release of insulin, and insulin is a storage hormone that promotes fat storage.

The thyroid hormones regulate metabolism—the sum of all the chemical processes that occur inside our body. Thyroid stimulating hormone (TSH) from the pituitary gland stimulates the thyroid gland to produce its hormones. After six days of four-hour sleep time, the normal nocturnal thyroid-stimulating hormone (TSH) rise is strikingly decreased, and the overall mean TSH levels are reduced by more than 30%.²⁹ Consequently, the production of the thyroid hormones is reduced.

The regulation of leptin, a hormone released by the fat cells that signals satiety to the brain and thus suppresses appetite, is strikingly dependent on sleep duration. After six days of bedtime restriction to four hours per night, the plasma concentration of leptin was markedly decreased, particularly during nighttime.³⁰

Sleep Deprivation, Obesity, and Appetite

Research shows that sleep-deprived people may increase their caloric consumption by as much as 15%.³¹ Chronic sleep loss may increase the risk of diabetes because it impairs the way the body disposes of glucose. A study of 28,000 children and 15,000 adults showed that sleep deprivation doubles the risk of obesity in both children and adults.³² Lack of sleep increases the hormone, grehlin, which stimulates the appetite and reduces leptin, the hormone that promotes satiety.(33)

Natural Remedies for Sleep Aids

1. Get at least thirty minutes of physical exercise per day, even if it is in several smaller segments of time. Studies show that daily regular aerobic exercise helps to reduce stress, anxiety, and depression.
2. Gradually reduce caffeine consumption to the point of eliminating it entirely. Caffeine reduces the quality of slow-wave sleep, the most restorative sleep, increases the time it takes to get to sleep, enhances the impact of stressors, and magnifies the effects of stress hormones. A morning dose can interfere with nighttime sleep. It also magnifies the effects of the sympathetic nervous system.
3. Cultivate regularity in rising and retiring. Studies show that fatigue occurs four hours sooner on an irregular schedule than on a regular schedule. According to Dr. James Maas, research shows that if you take two groups of students and have them both get an equal number of hours of sleep, but group one goes to bed on what we call a “yoyo schedule” – they can go to bed at 11 p.m. one night and 3 a.m. the next – and group two goes to sleep at the same time every night, group two will be significantly more alert than group one.³³ Have the room at a comfortable temperature with a little fresh air. The room should be totally dark for optimal production of melatonin, a sleep-promoting, anti-oxidizing, immune-bolstering, and cardiovascular-protecting hormone.
4. Eat a light third meal consisting mainly of fruit or, better yet, skip supper if you are overweight or sedentary. Skipping supper increases the production of growth hormone during deep sleep. This valuable hormone assists in tissue repair, improves efficiency of the immune system, and increases the ability of the body to burn fat.
5. Before retiring, soak in a lukewarm tub of water; then go to bed immediately.
6. Both the herbs hops and passionflower in the form of tea induce sleep. If you are taking medications, check with your pharmacist before taking any herbs in medicinal amounts so as to avoid a possible drug-herb interaction.
7. See your physician if these simple remedies do not help you have restorative sleep.

Spiritual Application: Father Knows Best

God was right when He said, “evening and morning,” in that order, constitute the days of our lives.³⁴ As the great Creator, He knew that we needed the deep restorative sleep of the night as a preparation for the activities of the coming day. Centuries ago the psalmist observed, “It is vain for you to rise up early, to sit up late, to eat the bread of sorrows, for so He gives His beloved sleep.”³⁵ Modern medical research affirms the truth of this time-tested counsel.

1. Brink, S., Sleep: it’s required, www.nwseo.org/pdfs/Sleepart1006, Oct 24, 2006↩
2. Proposal for a national sleep health agenda, www.sleepaus.on.net/nationalsleephealthagenda, June 2003↩
3. Bell, V., How sleep deprivation affects work performance, www.thefabricator.com/Safety/Safety_Article.cfm?ID=1111↩
4. Colten, H.R. and Altevogt, B.M., (editors) Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem. Board on Health Sciences Policy, National Academies Press, 2006↩
5. Ibid↩
6. Labovick, L., Drowsy Driving, www.labovick.com/2007/07/17/drowsy-driving-causes-teen-um-players-crash-car/, June 2007↩
7. Sleep deprivation: a health hazard yet to be taken seriously, www.ehealthnews.eu/content/view/1609/26/↩
8. Gever, J., AACR: Exercise and poor sleep combine as odd cancer risk, www.medpagetoday.com/Cardiology/Prevention/11848↩
9. Exercise, sleep help women fight cancer, www.wral.com/lifestyles/healthteam/story/4004264, Nov 21, 2008↩
10. Irwin, M., et al, partial sleep deprivation reduces natural killer cell activity in humans, www.psychosomaticmedicine.org/cgi/reprint/56/6/493↩
11. Cohen, S., et al, sleep habits and susceptibility to the common cold, Arch of Intern Med, 169(1):62-67, 2009↩
12. Schardt, D., How sleep affects your weight, cspinet.org/nah/08_05/perchance_can↩
13. Study ties amount of sleep to obesity, cbs11tv.com/health/sleep.obesity.study.2.717955, May 7, 2008↩
14. Simpson, N., et al, Sleep and inflammation. Nutr Rev, 65(12 pt. 2):S244-52, 2007↩
15. www.healthysleep.med.harvard.edu/need-sleep/whats-in-it…/mood↩
16. Dinges, D., et al, Cumulative sleepiness, mood disturbance, and psychomotor vigilance decrements during a week of sleep restricted to 4 – 5 hours per night. Sleep, 20 (4): 267–277, 1997↩
17. Neckelmann, D., et al, Chronic Insomnia as a Risk Factor for Developing Anxiety and Depression. Sleep, 30(7): 873-880, 2007↩
18. Weissman, M., et al, The morbidity of insomnia uncomplicated by psychiatric disorders. General Hospital Psychiatry, 19(4): 245–250, 1997↩
19. www.armymedicine.army.mil/reports/mhat/mhat_v/Redacted1-MHATV-OIF-APPENDIX-F↩
20. Enough sleep improves memory, Flinders University, July 25, 2008↩
21. ‘Sleep debts’ accrue when nightly sleep totals six hours or fewer. University Of Pennsylvania Medical Center, March 14, 2003↩
22. Martin, F., et al, The effects of sleep deprivation and stress on fatigue and performance, www.amc.edu.au/ports.shipping/mlm/papers/MartinGrewal-FatiguePresentation↩
23. Banks, S., et al, Behavioral and physiological consequences of sleep restriction. J Clin Sleep Med, 15:3(5):519-28, 2007↩
24. Ibid↩
25. Bakalar, N., Research ties lack of sleep to risk for hypertension. New York Times, April 24, 2009↩
26. Lack of sleep linked to increased risk of high blood pressure, www.medscape.com/viewarticle/530242_7↩
27. Van Cauter, E., et al, The impact of sleep deprivation on hormones and metabolism, cme.medscape.com/viewarticle/50282-5↩
28. Leproult, R., et al, Sleep loss results in an elevation of cortisol levels the next evening. Sleep, 20:865-870, 1997↩
29. Ibid., Van Cauter, E↩
30. Ibid., Van Cauter, E↩
31. Craig, W.J., Don’t Cheat Yourself 24/7, www.vegetarian-nutrition.info/nuggets/cheat_yourself.php↩
32. Obesity in children and adults: sleep deprivation doubles risk, www.medicalnewstoday.com/articles/47181.php↩
33. Bosley, Galen, Get Your Rest, www.wildwoodhealth.com↩
34. Genesis 1:5, 8, 13, The Bible↩
35. Psalm 127:2, The Bible↩