By Anne Harding
Is one of your favorite sayings "I'll sleep when I'm dead"? You may want to reconsider. Far from being a time-wasting, eight-hour sentence in a useless void, the research is pretty clear on this point: Sleep is crucial for good health. It helps memory and mood, keeps you trim, strengthens your immune system, fights inflammation and keeps your heart and blood vessels in tip-top shape.
"When you're sleeping you're regulating hormone levels, you're regulating insulin levels, your blood pressure is being kept under control, there are a lot of things going on, and if you're not getting enough sleep you're throwing these things out of whack," says Shelby Freedman Harris, Psy.D., director of behavioral sleep medicine at Montefiore Medical Center's Sleep-Wake Disorders Center, in New York City.
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While you're snoozing, the body repairs damaged tissue, produces crucial hormones and strengthens memories -- a process called consolidation, which helps you perform a new skill better after sleeping than you would if you spent an equivalent amount of time awake. (Take that, all-nighters!)
"It's a way for the body to integrate everything that happened over the past waking day and to kind of prepare for the next day," says Virend K. Somers, M.D., a professor of medicine and cardiovascular diseases at the Mayo Clinic in Rochester, Minn., who studies sleep and heart health.
Hopefully, you're convinced that sleep is good for you. So what happens when age-old culprits like insomnia or sleep apnea -- or newer ones like a jam-packed schedule -- cause you to chronically lose sleep? That's right, they may affect your health -- particularly your heart. (In general, short stretches of sleep deprivation -- when taking care of a new baby, for example -- can be challenging, but aren't thought to have a long-term effect on health).
Why Your Heart Needs A Good Night's Sleep
Short sleepers, typically defined as people who get less than six hours of sleep a night, as well as people who don't spend enough time in the deepest stages of sleep, are at higher risk of heart attacks and strokes than those who get at least seven hours.
A 2011 study in male Japanese factory workers found those who slept less than six hours a night had a five-fold increased heart attack risk over a 14-year span compared with those who logged between seven and eight hours a night. Another published in 2011 found that healthy men 65 and older with normal blood pressure were nearly twice as likely to develop hypertension during the study if they spent less time in the deepest sleep stage (known as slow-wave sleep) compared with those who spent the most time deeply asleep.
There's also some limited evidence that short-term sleep deprivation may be harmful to those with heart problems. In 2012, Swedish researchers reported that hospital admissions for heart attacks increased by about four percent in the week after the spring transition to daylight saving time compared to other weeks. This is when we "spring forward" and set our clocks an hour ahead -- meaning many of us lose an hour of sleep.
It's not clear why sleep may affect the heart, or if there is some unidentified factor that affects your cardiovascular system and ability to sleep. But one nighttime problem is a known heart hazard -- sleep apnea. People who have sleep apnea tend to snore and have upper airway collapse during sleep. This causes them to snort and gasp for breath, without really waking up enough to be aware of it.
"It's as if somebody's choking you, so your heart rate goes up, your blood pressure goes up, and instead of having a daily cycle in which everything slows down at night, instead everything is higher during the night," says Charles Czeisler, M.D., the Baldino Professor of Sleep Medicine at Harvard Medical School, in Boston. "Over time, even your daytime blood pressure is higher." In fact, he adds, many experts think sleep apnea may account for one-third of all cases of high blood pressure among adults.
If you're not feeling rested during the day and your bed partner says you snore, you should ask your doctor about sleep apnea. "There's enough evidence out there suggesting that sleep apnea is bad that people need to take it seriously," Dr. Somers says.
People with less severe sleep apnea may be able to get their symptoms under control by just adopting strategies that prevent them from sleeping on their back, for example sewing a tennis ball into the front pocket of a T-shirt and wearing it backwards, Harris says. There are even shirts that you can buy with built in padding to prevent back sleeping.
For more severe cases, a device can help prevent the lower jaw from falling backwards into the airway, Dr. Somers says, or a face mask that delivers pressurized air into the nose (called continuous positive airway pressure, or CPAP) can keep the airway open at night.
Is Lack Of Sleep Making You Fat?
Recent research also suggests that a lack of sleep could be contributing to problems like diabetes and weight gain, both serious health hazards. Some studies have linked shorter sleep to a greater likelihood of obesity, but whether or not sleeping less is a cause or effect of obesity remains unclear.
What we do know is that sleep deprivation reduces sensitivity to insulin, the key blood-sugar-regulating hormone, while making it harder metabolize blood sugar properly. Short sleep also boosts levels of hormones that make us hungry, while reducing secretion of the hormones that help us feel full. So it makes sense that being starved for sleep could lead to weight gain -- even if only for the fact that being awake longer gives us more time to eat.
When people are sleep deprived and eat a cookie, their blood sugar goes higher and they're more resistant to the effect of insulin than if they ate the same cookie after a good night's sleep, says Dr. Czeisler. "If you're on a diet to lose weight and you're sleeping five to six hours a night, 75 percent of the weight you lose will be lean body mass."
That means just 25 percent of the weight you're losing is fat, he added; when people sleep enough, fat accounts for 50 percent of weight lost.
"A lot of people who don't get enough sleep often say they have trouble losing weight, or they have this slow weight gain," notes Montefiore's Harris. Often, she adds, people who start getting treatment for sleep apnea find that once they're sleeping better, it's easier for them to lose weight -- and losing weight may help lessen sleep apnea symptoms.
"You don't have to be overweight to have sleep apnea, but if you are, sometimes losing at least 10 percent of your body weight can reduce the severity of your sleep apnea," Harris says.
How To Get A Better Night's Sleep
Say you clamber into bed, prepared for a healthy seven or eight hours and then stare at the clock for four of them. Is all lost? If you have trouble sleeping for a few days here and there, taking steps to improve your sleep should get you back on track. And you can be assured that you have plenty of company. According to the National Sleep Foundation's 2011 Sleep in America Poll, 60 percent of U.S. adults say they have sleep problems every night, or almost every night.
The first step for anyone with sleep problems should be to take a careful look at your sleep hygiene, Harris says. This means organizing your surroundings and activities to promote sleep as bedtime approaches. Skip caffeine after noon, she advises (and don't forget that diet soda, herbal teas and chocolate can contain caffeine, too). Avoid alcohol or heavy meals within three hours of bedtime.
"Exercise is great for sleep, especially falling asleep," Harris adds. You'll get the most benefit by working out five to six hours before bedtime. A hot shower or bath about an hour and a half before bedtime can also be helpful.
Reserve your bed for sleep and sex. "If you can't sleep, get out of bed, go somewhere else, do something quiet, calm and relaxing, go back to bed when you're sleepy again," Harris says.
Go to bed and wake up at the same time -- within a half hour -- every day, Harris advises.
Finally, don't make your Facebook page, BlackBerry or TV your final destination of the evening. Using these devices for communication is clearly eating into our sleep time, Dr. Somers says. "People are spending more time being connected than sleeping." Texting friends, playing computer games or just watching TV stimulates our brains and bodies at a time when we should be winding down, and the extra light we expose ourselves to when we peer at a screen could be throwing off our body clocks.
This is because when it gets dark, our bodies release a hormone called melatonin that helps make us sleepy, and pre-bedtime bright light exposure -- especially exposure to the blue light emitted by screens large and small -- weakens melatonin release.
"I have a lot of patients say, I'm just watching YouTube videos on my iPhone at night," Harris says. "It might be calming, but it's actually doing something to the melatonin in your brain. I usually tell people to cut off screen time an hour before going to bed."
People with long-standing, chronic insomnia need more than a sleep hygiene tune up, Harris says. A few sessions of cognitive behavioral therapy (CBT), a type of counseling designed to help people change the way they think about challenging situations -- like insomnia -- and respond more positively to them, can be helpful, according to Harris. Four to eight sessions are usually enough.
"In the sleep field we actually recommend that patients do that first, because it's short-term and it's better than getting hooked on a pill," she adds. However, if CBT doesn't help, medications may be necessary. "They have a place certainly," says Dr. Somers, "but they need to be used carefully and thoughtfully."
But what if you seem to thrive on six hours of sleep a night? "There's no question that there's a range of sleep needs, like there's a range of every physical function, but exactly what the normal boundaries of that range are I don't know, and I don't think anyone can say for certain," Dr. Somers says.
"The best way to be sure that you're sleeping enough," he adds, "is to wake up spontaneously without the use of an alarm clock and to feel rested when you wake up. If those things happen and you're not feeling sleepy during the day, then you're probably sleeping enough."
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