Sleep: Things to consider when affected by a chronic disease

There is a strong link between lack of sleep and chronic disease. According to the Centers for Disease Control and Prevention (CDC), insufficient sleep has been linked to the development and management of a number of chronic diseases and conditions, including diabetes, cardiovascular disease, obesity, and depression. Sleep and Sleep Disorders

So how much sleep do we need? There are a number of variables that can impact what we need-age, (newborns require 12-18 hours, while adults need 7-9 hours according to the National Sleep Foundation), job, pregnancy to name a view. There are people who are just fine on five hours a night and others who need at least nine. However, the one thing everybody needs is a nap.

According to John Medina, the author of “Brain Rules,” “Napping is normal. Ever feel tired in the afternoon? That’s because your brain really wants to take a nap. There's a battle raging in your head between two armies. Each army is made of legions of brain cells and biochemicals –- one desperately trying to keep you awake, the other desperately trying to force you to sleep. Around 3 p.m., 12 hours after the midpoint of your sleep, all your brain wants to do is nap. Taking a nap might make you more productive. In one study, a 26-minute nap improved NASA pilots’ performance by 34 percent. Don’t schedule important meetings at 3 p.m. It just doesn’t make sense.”

So what happens when we sleep? According to the National Institute of Neurological Disorders and Stroke, our brains are very active during sleep….Nerve-signaling chemicals called neurotransmitters control whether we are asleep or awake by acting on different groups of nerve cells, or neurons, in the brain. Neurons in the brainstem, which connects the brain with the spinal cord, produce neurotransmitters such as serotonin and norepinephrine that keep some parts of the brain active while we are awake. Other neurons at the base of the brain begin signaling when we fall asleep. These neurons appear to "switch off" the signals that keep us awake. Research also suggests that a chemical called adenosine builds up in our blood while we are awake and causes drowsiness. This chemical gradually breaks down while we sleep….During sleep, we usually pass through five phases of sleep: stages 1, 2, 3, 4, and REM (rapid eye movement) sleep. These stages progress in a cycle from stage 1 to REM sleep, then the cycle starts over again with stage 1. We spend almost 50 percent of our total sleep time in stage 2 sleep, about 20 percent in REM sleep, and the remaining 30 percent in the other stages. Infants, by contrast, spend about half of their sleep time in REM sleep.

Many people, including many with chronic conditions, take sleeping medications. However, a recently released study of 10,000 Americans, with matched controls, found that those take prescription sleep medications (such as Ambien, Lunesta) are more likely to develop cancer and are far more likely to die prematurely than those who take no sleep aids. Further, the increased rates start at low levels of prescription use. For those prescribed as few as one to 18 sleeping pills in a year, deaths were more than three and a half times greater than for those who didn’t take the medication. At the highest end, for those who took more than 132 pills a year, the risk of death was five times higher when compared to those not taking the pills. BMJ Open Access Journal

Things to Consider
• You need sleep, but how much you need can vary throughout your life. If you feel you are getting too much or too little, talk to your medical provider .

• Avoid the 3 pm medical appointment if possible, as neither you nor your provider will be at your best.

• Take a nap, even if it’s closing your office door and putting your head on the desk for five minutes. If you find napping interferes with your sleeping at night, limit your nap to no more than 30 minutes.

• Fatigue among caregivers, due to lack of sleep or sleep that is frequently interrupted, is extremely high. Consider the following:
-Arrange for respite care and/or family or friends that can stay overnight several times a week, and/or allow you to take naps.
- Set limits as to what you can do as a caregiver. If possible, encourage the person you are caring for to be more independent and/or accept help from others. Recognize that you may reach a point that the best solution for you and the person you are caring for is some type of long term care facility-such as assisted living or even a nursing home.
- Keep a “sleep log” so you are aware that you have a sleep/fatigue issue.
- Take care of yourself first and foremost because if you don’t, you wont be able to care for anyone else.

• Try to avoid sleeping medication.

• Adopt sleep habits:
- Stick to a sleep schedule
- Monitor what you eat and drink before going to bed. Too little or too much can interfere with sleep, as can what you eat-avoid nicotine, caffeine, alcohol. If you have gastric reflux, don’t eat before going to bed.
- Eliminate electronic devices in the bedroom.
- Be careful watching TV before sleep. If you do watch it, select shows that wont arouse you.
- Listening to soothing sounds and music can help you to relax.
- Meditation, prayer and deep breathing can help to calm your mind. If you wake in the middle of the night, focusing on a meditation can help you return to sleep. Avoid thinking about problems during the night by praying etc.
- Eliminate as many distractions in the bedroom as possible and create an environment that promotes sleep for you-comfortable pillow, bedding, shades, fan, earplugs etc.
- Exercise daily
- Reduce stress as much as possible

For more information on sleep, checkout the National Sleep Foundation