Good Article Relating to Sleep Problems--Interview with a Doctor

Discussion in 'Fibromyalgia Main Forum' started by JLH, Feb 21, 2006.

  1. JLH

    JLH New Member

    Reported February 20, 2006

    The Mystery of Sleep: Science -- Full-Length Doctor's Interview

    Esra Tasali, M.D., a pulmonologist at the University of Chicago, discusses insomnia and every day treatments for restless nights. (RELATES TO FIBROMYALGIA)

    What does sleep deprivation do to a person?

    Dr. Tasali: Humans spend one third of their lives sleeping. Sleep deprivation has significant detrimental effects on our metabolism, on our endocrine function and especially on our carbohydrate metabolism. We performed research studies on healthy volunteers and found less than one week of sleep restriction leads to harmful effects on the body, physiology, and especially a person's carbohydrate metabolism. In less than one week the healthy volunteers became pre-diabetic and glucose intolerant having only been allowed four hours of bedtime each night. The stress hormone cortisol also increases during the night and has harmful effects on the body. Your thyroid hormone levels and growth hormone levels change while you sleep.


    What is the link between lack of sleep and type II diabetes?

    Dr. Tasali: Terrible sleep doesn't indicate diabetes itself, but there are lots of conditions bad quality of sleep can be associated with, and one of them is diabetes. Others could be high blood pressure, fibromyalgia and other painful syndromes, and also mood disorders.

    There is a harmful effect on a person's carbohydrate metabolism when sleep deprivation occurs. We have shown in the experimental sleep deprivation project healthy volunteers can go into a pre-diabetic state and can become insulin resistant when sleep is restricted for less than one week. Fortunately they can recover if they extend their bedtimes after the deprivation.

    We also performed a field sleep study, which compared short sleepers, individuals who reported they sleep less than six and a half hours and long sleepers, those who sleep between seven and a half and eight and a half hours. When we compare these two groups, we found with short sleepers, they are insulin resistant compared to long sleepers. This was true for both females and males. In the study, the volunteers were the same age and had the body mass index.


    What hormonal changes occur during sleep?

    Dr. Tasali: When someone begins to sleep they start in a lighter sleep stage, or stage one sleep, and then they go into deeper sleep stages, or slow wave sleep. Finally, during slow wave sleep, the growth hormone is secreted. It's during that time, the non-REM cycle or slow wave sleep, your heart rate slows down, your blood pressure goes down and you have the dream sleep. In this state, your body has the lowest muscle tone and your heart rate is variable. This cycle repeats itself towards the end of the night, most people have two or three sleep cycles during the night.


    What are the cortisol levels like when someone is sleeping?

    Dr. Tasali: Cortisol has its minimum in the evening hours. It’s called quiet cortisol time, and then it rises in the morning. The peak of cortisol happens in the early morning hours.


    What is replenished in the body during sleep?

    Dr. Tasali: There are different theories about what is replenished during sleep. There is a hypothesis that the brain replenishes the glucose glycogen stores. The rest of the body gets a rest for the night. We know a person's blood pressure and heart rate goes down. People with sleep disorders, such as sleep apnea, don’t have this drop in the blood pressure, affecting their daytime blood pressure. This could cause someone with a sleep disorder to have high blood pressure or hypertension during the day.


    What is the optimum number of sleep hours?

    Dr. Tasali: The recommended sleep hours are eight hours, but people should individualize their sleep needs and have to find out themselves how many hours of sleep is enough for them.


    What happens to someone not getting enough sleep?

    Dr. Tasali: First of all, everyone should individualize his or her sleep need because it can vary from seven hours to even 9 hours per night. If they don’t get enough sleep during the night there are harmful effects on the metabolism, especially the carbohydrate metabolism. They become glucose intolerant and can't tolerate lots of sugar too well. Stress hormone levels increase as well as cortisol levels. If the growth hormone is not well secreted during the night thyroid functions are affected causing cognitive effects. Sleep-deprived people also become sleepy during the day and don't function at 100 percent; their reaction times go down, they are prone to have minor sleep attacks during the day.


    Could someone gain weight by not getting enough sleep?

    Dr. Tasali: Yes. The two major hormones, leptin and ghrelin, are affected during sleep. When the sleep-deprived healthy volunteers in the study were measured for these hormones, the satiety hormone leptin was down, which signals the brain that there are not enough calories. At the same time, the appetite hormone ghrelin went up, which again signals the brain to have more food. People are prone to gain weight if they have access to food and restrict their sleep, because they eat more.


    Why does not getting enough sleep cause metabolic changes?

    Dr. Tasali: There are different hypothesis behind metabolic changes in sleep-deprived people. For example, it’s well known the sympathetic activity increases when you are sleep deprived. Sympathetic activity decreases the leptin hormone and signals your brain, telling it there is not enough energy.


    What other illnesses or conditions could be triggered by too little sleep?

    Dr. Tasali: Sleep apnea is a condition where you stop breathing during the night for a brief amount of time and have the so-called sleep fragmentation, not a restful sleep. It’s a form of sleep deprivation because the sleep changes, maybe not the amount you spend in bed, but the sleep quality decreases. People with sleep apnea have chronic daytime blood pressure and also vascular changes associated with harmful effects on the heart. The immune function could be affected in such a way that the vaccination, influenza vaccination effect decreases if you are sleep deprived.


    Are people who are getting sick more often, actually not getting enough sleep?

    Dr. Tasali: It is a possibility.


    What constitutes insomnia?

    Dr. Tasali: There are different definitions depending on varying criteria. Insomnia is generally defined as problems initiating or maintaining sleep during the night, during the regular nighttime hours. There are is long list of reasons for insomniacs to become insomniac: There is a psychological reason, associated psychiatric disorders or organic disorders such as arthritis or other painful disorders, and there is the sleep apnea explanation.


    What other kind of physical conditions could the symptoms of insomnia be diagnosed as?

    Dr. Tasali: First of all it, people should be asked whether they are following good sleep hygiene. Sleep hygiene consists of a list of things someone needs to do to get a better night of sleep. You need to follow a regular bedtime schedule and wake up time hours every night. As I said, every individual should define their sleep need and follow it. It’s better to avoid caffeine, alcohol, and other medications that could stimulate the body three hours before bedtime. People should use their bedroom and their bed only to sleep because there’s a tendency to eat in bed or use computers or work. This is not good for sleep hygiene. A little bit of regular exercise every day, not too close to bedtime, helps someone fall asleep.


    If someone does smoke, could smoking right before bedtime interrupt sleep?

    Dr. Tasali: Yes.


    Some doctors recommend a warm bath, is it true it could help someone fall asleep?

    Dr. Tasali: Yes. Your body's core temperature should drop to a minimum level and a warm bath would help that. We don’t, however, recommend a hot bath, that would raise the body's temperature to high, but a warm one would relax the body and help an individual fall asleep.


    How do you recover from a sleep debt?

    Dr. Tasali: Sleep more or extend your bedtimes. For example, on the weekends, I can sleep as long as 10 hours or 11 hours straight to recover from the week.


    If you cannot keep regular sleep hours, what do you recommend?

    Dr. Tasali: If your work schedule doesn’t allow you to keep a regular schedule, its better to have sleep restriction over the weekend.


    When are sleeping pills recommended?

    Dr. Tasali: In insomnia, especially when we prescribe sleeping pills, we think them as a last resort. Not only because they aren't successfully helpful, but also because people may become dependant on them. Most sleeping pills available in the market now don’t provide enough deep sleep. Before sleeping pills I would first recommend better sleep hygiene, regular sleep wake schedules, bio relaxation, biofeedback therapy, or stimulus control therapy.


    Do over-the-counter medications help?

    Dr. Tasali: Most of the over-the-counter medications give you a drowsy state the next day or are short acting medications that in the second half of the night you could wake up and not have a good night of sleep. I wouldn’t really recommend sleeping pills unless it’s really necessary.


    This article was reported by who offers Medical Alerts.


    Ivanhoe Broadcast News Transcript with
    Esra Tasali, M.D., Pulmonologist,
    University of Chicago,
    TOPIC: The Mystery of Sleep: Science

  2. elsa

    elsa New Member

    Thank you for researching and posting .... I did not know that the lack of growth hormone release affected how our thyroid functions (ie low thyroid).

    That would explain all the symptoms, not just cognitive but also the low energy and body temperture.

    I have been wondering how I became hypothyroid / thyroid resistant .... As well as all the tons of other fibro patients ... Now I know. It is as common as our sleep disorder ... low GH, ... fibro fog .... etc..

    Thank you so much .....

  3. WoodstocksMusic

    WoodstocksMusic New Member

    and somehow I was beginning to figure out that my sleep problems were causing my other problems and not the reverse...

    I have low energy...body temps are wild...ranging from 95 to about 97 during the day....

    So we have got to find a way to fix the sleep disorder above all else...if pain is keeping you up at night fix the pain so you can sleep!

    such a good article ty for sharing.