Q: Well, my friend, after retiring from 38 years of medical practice, I thought I had seen it all. It just goes to show that you can teach an old dog new tricks, because I think you’re on the right rack with this sleep [apnea] issue.
After you tried and tried to get me to the sleep study, and I finally went, I am now wearing my CPAP every night. I feel a whole lot better. I never realized the rut I was in. I tolerated not feeling the best I could for years and thought I was just getting older. I was, but I think my poor sleep pattern made me age faster! I have more energy now, the weight is starting to come off, I’m in a better mood and I’m walking more. All from this one adjunct to my care plan that I never thought in hundred years would make any difference.
I was recently reminded of something I wrote many years ago and have repeated time and again to demonstrate how inexpensive health care can be if we practice the three pillars of good health: a lean diet, invigorating exercise and sound sleep.
The most important of these is sleep. This is not my invention; practitioners from Hippocrates on to the present day have said the same thing in various ways. It involves no tricks, no gimmicks, and nothing much to buy, and it is quite simple in concept. Sleep drives the critical process of repair, replication and restoration of our physiological functions, then intergrades them in neurological associations that allow us to function maximally.
We have to stop thinking about sleep as if it’s “down time” when we are not getting anything done and we are not being productive. In fact, we are “getting done” far more than we think, and in many ways, it’s far more important than certain things we do when we’re awake.
Many people ask me, “How much sleep is enough?” My answer is very simple: You need as much sleep as it takes to not feel sleepy during your day. Current studies bear out what many have suspected for many years: While poor sleep hygiene may not cause many diseases, it does make them worse and more difficult to manage. I do not think it is an overstatement that sound restorative sleep can maintain health, improve outcomes in disease management, and improve the quality of life.
Our own work at The Center for Healthy Aging, both in the Minimally Cognitively Impaired Group [2006-2008] and the Geriatric Assessment Group, have led to a hypothesis that sleep deprivation over time generates so much inflammation that it leads to an accumulation of proteins in the brain that overwhelms the ability of the brain to function clearly. The result are the plaques associated with dementia. Let me be clear: This has not yet been proved, but the more I work on this avenue of inquiry the more sense it makes to me.
In my work, the one consistent pattern I see is that patients tend to go to bed too late and wake up too early, leading to incomplete sleep (to all mothers and shift workers, etc., I hear you!).
For me, I apply the “Backward 8 Rule.” If I have to be up at 6 a.m., I will count back eight hours and make it a point to be in bed between 9:30 and 10 p.m. I always wake up feeling refreshed. This means I have to be disciplined and give up some things I’d like to do after work in order to be in bed at an hour that will allow me to be at my best the next day.
When I discuss this concept with patients, I usually hear that doing this means they “have no life.” Well, life is all about the choices we make, and choosing not to be on the right side of this choice will lead to a negative impact on many chronic conditions, including excess weight, heart disease, depression, dementia and others.
Every year, I know that I will have an increase in appointment requests after Daylight Saving Time goes into effect. I also know that those patients with heart disease are prone to have their heart attacks in the early morning hours after Daylight Saving goes into effect. Yes, that one hour of time can have a big impact on our well-being. I have for years said that Daylight Saving Time should be done away with, as it is an anachronism. Improved nocturnal oxygenation improves memory and thought process.
Around 2005, I provided overnight residency coverage at a newly established sleep center in New York. Later, I was part of the team that evaluated the results of the sleep studies done at the center. It was an amazing experience, as I learned more about how the body really functions than I ever had before. With that background, I stated at a conference that if we really want to cut the cost of health care, we much focus on sound restorative sleep.
In March, I read a study in The Lancet Diabetes & Endocrinology journal, which asserted that “Although a number of epidemiological studies point to a clear association between poor quality sleep and metabolic disorders, until recently, the reason for this association was not clear. However, experimental studies are starting to provide evidence that there is a direct causal link between loss of sleep and the body’s ability to metabolize glucose, control food intake, and maintain its energy balance.”
In other words, continued poor sleep hygiene strikes at the very heart of our metabolism with consequences that we are only now beginning to truly appreciate. The list of diseases that sleep affects grows every year.
It’s time to pay attention. The solution to this country’s small relative return for the health care dollar might be right in front of us.
In upcoming articles, we will discuss some things we can do to improve our sleep.
Dr. Michael Camardi is a geriatrician at the Carilion Center for Healthy Aging and an assistant professor of medicine of the Virginia Tech Carilion School of Medicine. His column runs monthly in Extra.