Why ‘Are you sleeping enough?’ is becoming the most common clinical question I ask my patients

Sleep is as important as nutrition to our health and yet I believe it is not given the place it deserves in history-taking and interventions by doctors.

This can be easily evidenced by doing a quick audit across patients' records for ‘Dietary advice given’ against ‘Sleep advice’ for example.

Sleep before you learn!

We know that sleep is important to consolidate memory, but there is also evidence to suggest that sleep is as important before a learning event as it is after. It appears that we are unable to capture new information when we are sleep deprived. Sleep is essential to prepare our brain to engage in learning. Research using MRI scans showed no hippocampal activity in patients deprived of sleep in an experimental setting. Vander Wer et al Nature Neuroscience 2007
In this study, the sleep-deprived brains showed a whopping 40% reduction in the ability to make new memories.

Less sleep, more heart attacks!

Sleep loss is strongly associated with a significant increase in the risk of cardiovascular disease; in fact, it could push some high-risk patients over the edge, as evidenced by a 24% increase in heart attacks worldwide following the loss of one hour of sleep in the day after the spring daylight savings time change. A reverse effect is observed in autumn with a 21% reduction in heart attacks Sandhu A. Open Heart, 2014

Less sleep, more infections, and cancers!

In a 1994 study by Irwyn et al, it was found that sleep deprivation to four hours, for one night in healthy patients correlated with a 72% reduction in natural killer cell activity. This may be the reason for the increased risk of numerous forms of cancer (bowel, breast, and prostate) in people who are chronically sleep-deprived. WHO now considers any form of night shift work as a probable carcinogen. There is also compelling evidence that short sleep is a predictor of increased all-cause mortality. Cappuccio et al. Sleep, 2010

Sleep to reduce the risk of dementia!

Researchers are working on enhancing memory-forming ability by enhancing ‘sleep spindles’ which are brain waves that occur during deep sleep, and relate to the creation of long term memories. Using direct-current brain stimulation during sleep, researchers demonstrated a two-fold increase in recall in young patients and it is hoped that the same technology used in older patients with cognitive impairment could help restore some of their lost brain function. Worsening sleep is starting to be considered inter-related with cognitive impairment and dementia, rather than simply co-existing. Ju YE. Nat Rev Neurol. 2014

So what are the top tips to give our patients for optimal sleep?

  1. Avoid alcohol and caffeine. Alcohol works as a sedative but research has shown that it actually degrades our sleep quality by reducing deep sleep duration. Caffeine has a half-life of 6 hours and a quarter-life of 12 hours.
  2. Regularity going to bed at the same time and waking up at the same time anchors sleep and improves the quantity and quality.
  3. Keep your bedroom cool. A bedroom temperature of 18 degrees seems to be optimal for most people as our body needs to drop its core temperature by about 2 to 3 degrees to initiate sleep and to stay asleep. A hot bath before bed may paradoxically help achieve such a drop quickly before bed.
  4. Complete darkness in the bedroom and avoid using light-emitting devices in the evening.

For all the above reasons, a good sleep history is paramount for a very large array of patient presentations and a good sleep prescription is often all that’s needed! Anyone sleeping less than seven hours or more than nine hours is likely to have ill health effects and even have a slightly shorter life.

Right then. Off to sleep now for a bit!

Amine Boughellam
GP Partner and Co-Founder of SimplyCPD.

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