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Insomnia Aguidetothehealthrisksofsleepdeprivation SixStepsToSleep.com SecondEdition©2015 2
TableofContents 1.Introduction 2.WhatHappensWhenYouDon’tGetEnoughSleep -EffectsontheBody -EffectsonMood 3.SleepDeprivation:HormonesandMetabolism -SleepandObesity -SleepandDiabetes -SleepandtheImmuneSystem -SleepandCardiovascularDisease 4.UnderstandingInsomnia 5.HowToCureInsomnia -PrescriptionSleepMedications(SleepingPills) -NaturalCuresforInsomnia 6.Summary 3 SixStepsToSleep.com–InsomniaGuide
1.Introduction Theconsequencesofsleepdeprivationarefarreaching.Lackofsleepaffectsphysical andmentalhealth,andcausesanincreasedriskofhumanerrorthatcanbefatal. Twowell-publicizedexamplesofthiswerethe1989ExxonValdezoilspill,and the1986NASAChallengershuttleexplosion.Bothaccidentswerecausedbyfatigue linkedtolackofsleep. Inadditiontosuchmajoraccidents,drowsinessinsleep-depriveddriversissaidtobe thelikelycauseofmorethan100,000crashes,71,000injuriesandmorethan1,500 deathseachyear. Manyairplanecrasheshavebeenlinkedtopilottirednessduetoexcessiveflying hoursacrossdifferenttimezones.Thisevidencepointstoonesimpleconclusion;lack ofsleeppresentsaveryrealdangertohumanlife. Intermsofphysiologicalhealth,studiesshowagrowingcorrelationbetweensleep durationandavarietyofserioushealthproblems,includingobesity,diabetes, hypertensionanddepression.Onamorepersonallevel,lackofsleepaffectsour qualityoflife,leavingusfeelingmiserable,lethargicandstressed. Withthesethingsinmind,itisimportantthatwebegintounderstandthebiologyof sleep;whyweneedsleepandhowwecanbetterthequalityofoursleeptoimprove overallhealthandsafety. 4
Scientistsnowknowthatsleepisn’tsimplyaboutrestandrecovery.Sleepisessential inhelpingmaintainmood,memoryandcognitiveperformance.Sleepalsoplaysa pivotalroleinthenormalfunctionoftheendocrineandimmunesystems.Inshort,the lesssleepapersonhas,themorelikelytheirhealthistodecline. However,eventhoughpoorqualitysleepisendemic,withatleast40million Americanssufferingsleepproblems,60percentoftheadultpopulationhasnever beenaskedabouttheirsleepinghabitsbyaphysician. Withagrowingpoolofknowledgeregardingthenegativeconsequencesofsleep deprivation,improvingsleepqualitymustbecomeahealthpriorityinourlives. 5 SixStepsToSleep.com–InsomniaGuide
2.WhatHappensWhenYouDon’tGetEnoughSleep Throughextensiveanimalresearch,scientistsknowthatthatsleepisessentialfor survival.Inshort,apersoncannotsurviveindefinitelywithoutsleep. Whenwesleep,proteinproductiontakesplacethatprovidesthenecessarybuilding blocksforcellgrowthandrepair.Thebodyrecoversfromstressdamageandthe damagecausedbyultravioletrays,andimmunityisboosted.Withoutsufficientrestthe bodyisweakened,exposingustogreaterriskofpoorhealth. EffectsontheBody Whenhumansdon’tsleepproperly,physiologicalandcognitivefunctionsare negativelyimpacted.Theaffectedfunctionsincludememoryandattention,complex thought,motorresponseandemotionalcontrol. Oneparticularclinicalstudyshowedthatsubjectswhostayedawakeforupto19 hoursscoredsubstantiallyworseonperformanceandalertnessthanthosewhowere legallyintoxicated.Otherstudieshavedemonstratedsimilarresults: 6
-Afteronenightoftotalsleepdeprivation,subjectsscoredsignificantlylowerontests ofjudgment,simplereactiontime,explicitrecallandinversewordreading. -Daytimealertnessandmemoryareimpairedbysleepdeprivation,especiallywhen sustainedoverafewnights. -Gettingthree,fiveorlessthansevenhoursofsleepanightforsevenconsecutive dayscansignificantlyimpairalertnessandmotorperformance. (Source:NationalSleepFoundation–Sleep-WakeCycle,2006) EffectsonMood Afterabadnight’ssleep,itisnormaltofeelprettymiserable.Studieshave shownthatlackofsleepconsiderablyaffectsmood,causinganger,anxietyand sadness. AstudyattheUniversityofPennsylvaniafoundthatwhensubjectswereallowed tosleepjust4.5hoursanightforoneweek,scoresformooddeclinedsteadily duringthetestingperiod. Whenparticipantswereallowedtogetenoughsleep,theirmoodscores improveddramatically.Duringthetestperiodsubjectssaidtheyfeltstressed, angry,sadandmentallyexhausted. Butsleepdeprivationdoesfarmorethanmakeusfeelgrumpyandalittleslower 7 SixStepsToSleep.com–InsomniaGuide
toreact.Inthepastfewyears,investigatorshavefoundthatsleepdeprivation mayhaveharmfulconsequencesforourimmunesystem,contributingtoserious illnessessuchasobesity,diabetesandhypertension. 3.SleepDeprivation:HormonesandMetabolism Whenwesleep,thebodysecretesessentialhormonesthatregulateenergyand controlmetabolicandendocrinefunctions. Sleepdeprivationdampenstheproductionofthyroid-stimulatinghormonesand increasesbloodlevelsofcortisol,ahormonethatcontributestowakefulness. Growthhormoneisalsosecretedduringsleep,whichcontributestochildhood growthandhelpsregulatemusclemassinadults. Thismeansthatwithoutsleepthebodycannotproducethebasichormonal functionsrequiredforthebodytooperateproperly. SleepandObesity 8
Thefactiswearesleepinglessthaneverbefore,anditisaffectingourhealth. Theaveragenight’ssleepdecreasedfromaboutninehoursin1910toabout7.5 hoursin1975,andinthemoderneramillionsofshiftworkersaveragelessthan fivehoursofsleepperworkingday. Researchhasshownthatthisglobalsleepdeprivationtrendishavinganimpact ontheobesityanddiabetesepidemics. AccordingtotheCentersforDiseaseControlandPrevention,about65percent ofAmericansareoverweightorobese.Ofcourse,caloricintakeisamajorfactor inrisingobesity,butsciencehasprovenalinkbetweenlackofsleepandweight gain. Oneinterestingstudyshowsthatlackofsleepimbalancesleptinandghrelin, twohormonesresponsibleforthecontroloffeelinghungerandfullness.Ghrelin isproducedinthegastrointestinaltractandstimulatesappetite;leptinonthe otherhandsignalstothebrainwhenapersonisfull. Lackofsleepcausesthesetwohormonestobecomeimbalancedandoperate ineffectively.Whenapersonissleep-deprived,leptinlevelsdropandghrelin levelsrise;subsequentlyappetiteincreases,leavingapersonfeelinghungry aftertheyhaveeatenandcausingthemtocravefurthercalories. SleepandDiabetes 9 SixStepsToSleep.com–InsomniaGuide
Obesityhasbeendirectlylinkedtodiabetes,andsleepdeprivationlinkedto impairingsugarmetabolism. AstudyconductedattheUniversityofChicagoin1999foundthatasleepdebt accumulatedoveramatterofdaysiscapableofimpairingsugarmetabolism anddisruptinghormonelevels. Afterrestrictingthesleepof11healthyyoungadultstojustfourhourspernight overseveralnights,thegroup’sabilitytoprocessbloodglucosedeclined considerably–insomecasestoapre-diabeticstate,promptingthesubjects’ bodiestoproducemoreinsulin. SleepandtheImmuneSystem Theage-oldtheorythatsleephelpsspeeduprecoveryfromillnessmaynotbe justanoldwives’taleafterall. Studieshaveshownthatlackofsleephasanegativeeffectontheimmune system;withonestudyprovingthatfluvaccinationpatientssubjectedtosleep deprivationtooklongertoattainimmunity. Duringthestudy,flushotswereadministeredtomenwhohadbeenrestrictedto justfourhoursofsleepforfournightsinarow,andtothosewhohadslept normally. Tendaysaftervaccination,thoseinthesleep-deprivedgrouphadasubstantially 10
lowerimmuneresponsecomparedwiththosewhogotadequatesleep,and producedlessthanhalfasmanyflu-fightingantibodies. (Source:NationalSleepFoundation–Sleep-WakeCycle,2006) SleepandCardiovascularDisease Longandshort-termsleepdeprivationisnowknowntocontributeto cardiovasculardisease.Lackofsleepcausesincreasedbloodpressureand increasedriskofstroke,andisassociatedwithariseinbloodpressureduring thenightthatlaststhroughthefollowingday.Evidencealsosuggestsincreased riskofcoronaryheartdiseaseinwomenwhodon’tgetenoughsleep. 4.UnderstandingInsomnia Allscientificevidenceshowsthatsleepdeprivationpresentsconsiderablehealth risksonanumberoflevels,yetstatisticsshowthatapproximately30percentof theAmericanpopulationsuffersfromaformofinsomnia. 11 SixStepsToSleep.com–InsomniaGuide
Butwhatisinsomniaandhowcanitbecured? Insomniaisdiagnosedwhenapersonhasdifficultyinitiatingormaintaining sleep,thatiseithernotbeingabletofallasleep,wakingtooearlyandnotbeing abletogetbacktosleep,orwakingpersistentlythroughthenightand subsequentlyfeelingunrestedandlethargic. Insomniasymptomsincludedaytimefatigue,impairedmoodandjudgment,poor performanceandanincreasedlikelihoodofaccidentsathome,intheworkplace andwhiledriving. Forsomeinsomniaistemporary,perhapscausedbyjetlag,workstress,a majorlifechangesuchasthelossofarelationship,environmentalfactorslike excessivenoiseorbyconsumingtoomuchcaffeineorsugarbeforebed.But somepeoplegoontodevelopchronicinsomnia,whichisgenerallydiagnosedin thosewhostruggletosleepforthreenightsinagivenweek,foramonthor longer.Chronicinsomniaisoftenrelatedtoanunderlyingmedicalorpsychiatric conditionsuchasdepressionoranxiety,butiscommonlycausedbya persistent,unhealthysleep-wakecycle. 5.HowToCureInsomnia Theapproachtotreatmentforinsomniagenerallyfallsintotwocategories: pharmacologicandbehavioral. 12
PrescriptionSleepMedications(SleepingPills) Anestimated10%oftheAmericanpopulationtakessomeformofmedicationto achieveastateofsleep.However,fewpeoplewhotakesleepingpillsreally understandhowthepillswork,andevenfewerunderstandthatsleepingpillsdo notcureinsomnia. Benzodiazepines(alsoknownasbenzodiazepinereceptoragonists)werethe mainpharmacologictreatmentforinsomniaupuntilthe‘90s.Theseincluded populardrugssuchasFlurazepam,Triazolam,andTemazepam. Benzodiazepinesarecentralnervoussystemdepressantsthatareconsidered bythemajorityofphysicianstobemoreactiveinreducinganxiety,inducing musclerelaxationandinhibitingconvulsionsthaninpromotingsleep.Many peopleexperiencesideeffectswhentakingbenzodiazepines,suchasmemory loss,reboundinsomniaandaddiction. Inthemodernera,abenzodiazepinenamedXanaxhasbecomeapopularsleep aidbecauseitiseasilyboughtovertheInternetwithoutprescription.Xanax containsAlprazolam,asubstancethatincreasestheactivityofGABAinthe brainandthereforeincreasesitscalmingeffectonthebrain.Thishelps decreaseanxietyandpanicbycausingdrowsinessandrelaxationofthe muscles,whichisofcourseconducivetosleep.However,Xanaxishighly addictive,andisonlyrecommendedforshort-termuse.Itisbynomeansacure forinsomniaandshouldnotbeself-prescribed. 13 SixStepsToSleep.com–InsomniaGuide
Inthe‘90s,nonbenzodiazepines(ornonbenzodiazepinereceptoragonists)were introduced.Thesesleepingpills,whichincludeZolpidemandZaleplon,havethe advantageofbeingmuchshorter-actingcompoundswithlesslikelihoodfor daytimesleepinessorimpairmentofmemory.However,theymaystillcause sideeffectsinsomepeople,includingreboundinsomnia,addiction,drowsiness, dizziness,lightheadednessanddifficultywithcoordination. TheDangerofSleepingPills Sleepingpillsarehighlyeffectiveinhelpingpeoplefallasleepquickly,andin helpingpeoplestayasleepfortherecommendedeighthours.However,sleeping pillsaregenerallyaddictiveandineffectiveatcuringinsomnia,withthemajority ofpatientsexperiencingreboundinsomnia. Anothersideeffectofsleepingpillsissleepiness,whichisoftenfarmoredifficult tocopewiththanthesleepinesscausedbylackofnaturalsleep.Sowhilea personmaysleepfallasleepquicklyandstayasleepfortherequiredduration whentakingsleepingpills,theirqualityoflife(daytime)isimpairedby sleepiness,whichinturnaffectscognitiveabilityandrendersthemedication largelycounterproductive. Recentevidencehashighlightedserioushealthissuesrelatingtotheregular consumptionofsleepingpills.AstudyheadedupbyDr.DanielKripke,ofthe ScrippsClinic,compared10,529peoplethattooksleepingpillswithtwiceas manywhodidn’t. Thestudyrevealedthatthosetakingprescriptionswereata35%increasedrisk 14
ofcancercomparedwiththenon-prescriptiongroup.Thestudyprovedthatthe riskofdevelopinglymphoma,lung,colonorprostatecancerassociatedwith sleepingpillswasgreaterthantheeffectfromsmoking. Inshort,sleepingpillsareashort-termfix,notaninsomniacure.Regular consumptionofsleepingpillsislikelytocausesideeffectsandaddiction,and mayleadtohealthproblems. NaturalCuresForInsomnia Consideringthatsleepisanaturalpartofthehumanlifecycle,itseemsquite surprisingthatsomanypeoplehavetroublesleeping. Thatsaid,thereasonfortheprevalenceofinsomniaisquiteclear.Inthe moderndaysleephasbecomelessofapriority,muchtothedetrimentofour health.Mostpeoplesimplydon’tallowthebodytoprepareforsleepproperly,or providethebodywithalifestyleandenvironmentconducivetohealthysleep. Theonlyproven,sustainablecureforinsomniaisthepracticeofgoodsleep hygiene,whichisoftenaccompaniedbyotherholistictherapiessuchas meditationtohelptemperstressandanxietyandpromotehabitualrelaxation. Goodsleephygieneisessentialtoachievingdeep,restorativesleep.Someof thekeypracticesinvolvedincludemaintainingaregularsleep-wakecycle, avoidingstimulantslateintheday,ensuringadequateexposuretonatural 15 SixStepsToSleep.com–InsomniaGuide
daylightandmaintaininganenvironmentconducivetosleep;dark,cooland noise-free. Sleephygieneexpertsoftenincludebehavioraltherapywithintheirprograms. OnesuchtherapyisStimulus-Control,whichconditionsthepatienttosolely associatethebedandbedroomwithsleep.Ifunabletosleep,thepatientis instructedtogetoutofbed,andtoavoideating,readingorwatchingtelevisionin bed. AnotherpathwayisRelaxationTherapy,whichincludesmusclerelaxation, brainwavemeditationandbreathingtechniques.Thesetechniquesentrainthe braintofallasleepfasterandstayasleepforlonger. Sleep-RestrictionTherapyalsoplaysapartingoodsleephygiene.Inthis practicethepatientisrequiredtowakeatthesametimeeachday,regardlessof theamountofsleepachievedduringthenight.Thisresultsinsleepdeprivation, whichenablestheindividualtofallasleepfasterthefollowingnight,andsoon andsoforth,subsequentlybreakingthecycleofhabitualinsomnia. Nomatterhowbadthecycleofinsomnia,withthecorrectsleephygiene methods,thecyclecanbebroken,thebodyclockreadjustedandthebrain remappedtoahealthysleep-wakecycle. 16
6.Summary Cuttingbackonsleepisanextremelycommonresponsetothepressurewe faceinourmodernindustrialsociety.Butresearchshowsthatsleepdeprivation disruptshormonalandmetabolicfunctionwhich,ifnotaddressed,cancause cardiovascularproblems,weightgainandpsychologicalissues. Sleepisadynamicactivitythatisasessentialtogoodhealthasexerciseanda gooddiet.Sleepdeprivationisdangerous,andmustbeaddressedquicklyto ensurethemindandbodyfunctionhealthilyinthelongterm. Ifyouaresufferingfrominsomnia,orhaverecentlybeenstrugglingtosleep,itis importantthatyouaddresstheunderlyingissuesquicklyinsteadofusingpillsor othersleepaidstotemporarilymasktheproblem. MySixStepsToSleepprogram,basedonmypersonal15-yearbattlewith insomniahashelpedover100,000peoplecurethemselvessafelyandnaturally ofinsomnia. Theprogramcombinesprovengoodsleephygienemethodology,cognitive behavioraltherapyandbrainwavemeditation.Thispowerfulthree-pronged 17 SixStepsToSleep.com–InsomniaGuide
approachretrainsthebodytofallasleepfasterandsleepdeeperforlonger,and permanentlyrestoresahealthysleep-wakecycle. >>Clickheretogetstarted&startsleepbettertonight<< Allrightsreserved.PeterLitchfield/SixStepsToSleep.com2015©.Nopartofthispublication 18
maybereproduced,distributed,ortransmittedinanyformorbyanymeans,including photocopying,recording,orotherelectronicormechanicalmethods,withoutthepriorwritten permissionofthepublisher,exceptinthecaseofbriefquotationsembodiedincriticalreviews andcertainothernon-commercialusespermittedbycopyrightlaw. Theinformationforthisdocumentwascompiledusingresearchstudiesandinformation suppliedbyTheNationalSleepFoundation(www.sleepfoundation.org)andPeterLitchfield (founderofsixstepstosleep.com). 19 SixStepsToSleep.com–InsomniaGuide