Sleep:The Third Pillar of Health – Tufts

“Sleep disruption has some evident short-term consequences,” says Ordovs. “We feel tired, moody, stressed and, of course, sleepy. If we don’t have enough quality or quantity of sleep, which unfortunately is common in our society, our quality of life in the short and long term suffers. In addition, it affects other behavioral factors involved in chronic diseases such as the quality of our diet and our physical activity. Therefore, sleep must be considered as the third pillar of health in combination with nutrition and physical activity.”

SLEEP TROUBLES: Inadequate sleep can come from trouble with either quantity, quality, or both

Insomnia, which can include difficulty falling asleep, difficulty staying asleep throughout the night, or waking up too early in the morning, affects as many as 30 to 35 percent of adults in the U.S., according to the American Association of Sleep Medicine. It is more common in women, people under stress, and people with certain medical and mental health problems (including depression), as well as older adults. According to some sources, chronic insomnia affects 57 percent of older adults in the U.S. Studies show that insomnia negatively affects work performance, impairs decision-making, and can damage relationships. If it takes you 30 minutes or more to fall asleep, or if you’re awake for 30 minutes during the night, at least three times a week for three months, you have chronic insomnia and should seek treatment. The recommended first-line treatment for insomnia is cognitive behavioral therapy, a short-term, goal-oriented psychotherapy.

Sleep Apnea is a common and serious sleep disorder in which people temporarily stop breathing for short periods of time while they are sleeping. The muscles of the upper airway relax during sleep, allowing the tissue at the back of the throat to collapse and block the passage of air to the lungs. People with this condition may snore loudly or make choking or gasping noises, and the oxygen-deprived brain may wake them multiple times throughout the night to restart breathing; they are often unaware they are not sleeping soundly but may wake up feeling unrefreshed and suffer with fatigue throughout the day. Sleep apnea is associated with serious negative long-term consequences, including high blood pressure, heart disease, stroke, diabetes, and depression. Risk for sleep apnea goes up with BMI. Getting diagnosed with an in-lab sleep study or at-home sleep apnea test is critical. This condition is managed using continuous positive airway pressure (CPAP) therapy, an oral appliance, or surgery.

Circadian Rhythm Disorders occur when people’s internal sleep-wake schedule does not align with darkness and light. This misalignment can be caused by jet lag, shift work, damage to the brain, or frequently going to bed and getting up at different times. Delayed sleep phase disorder, seen most often in adolescents and young adults, is characterized by the need to stay up very late and sleep late. Advanced sleep phase disorder, more common among older adults, is characterized by falling asleep and awakening early. These conditions can be diagnosed by a doctor’s evaluation and are usually treated with behavior change and controlling light exposure, although a doctor may prescribe sleep aids and/or drugs to stimulate the brain.

Restless Legs Syndrome causes an overwhelming urge to move one’s legs which interferes with falling asleep. This neurological sleep disorder should not be ignored and can be managed through medication and lifestyle changes.

Parasomnias include sleepwalking, sleep talking, and sleep eating disorder; sleep terrors, nightmares, and sleep hallucinations; sleep paralysis (being briefly unable to move while falling asleep or waking up); confusion arousals (in which people are very confused and behave strangely upon awakening); and the potentially dangerous REM sleep behavior disorder, in which people act out vivid dreams as they sleep. These conditions may interrupt sleep. They can be treated using medication and/or behavioral therapy and lifestyle changes.

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