The lat­est of sleep research is report­ing that the impact of trou­bled sleep is far more reach­ing in its impact of phys­i­cal and psy­cho­log­i­cal health than pre­vi­ously thought. Hence, sleep should be con­sid­ered a key domain of healthy behav­iour and healthy sleep should be pro­moted with the same kinds of edu­ca­tion and inter­ven­tions as other notable chal­lenges to well-being.

The lat­est APA Mon­i­tor (a monthly pro­fes­sional pub­li­ca­tion of the Amer­i­can Psy­cho­log­i­cal Asso­ci­a­tion) concludes:

A large body of research now shows that chron­i­cally get­ting too lit­tle sleep dis­rupts many aspects of phys­i­cal health, includ­ing hor­mone reg­u­la­tion, glu­cose metab­o­lism, insulin resis­tance, inflam­ma­tion processes, pain per­cep­tion and immune func­tion, to name a few (Jan 2013, 44, 1).

A sam­ple of studies

Fol­low­ing is a sum­mary of research into sleep dis­or­ders, begin­ning as far back as 1938.

In the ear­li­est sleep research, a Uni­ver­sity of Chicago physi­cist (Nathan Kleit­man, PhD, co-discoverer of REM sleep and con­sid­ered the founder of sleep researcher) sequestered him­self and a col­league in a cave for 32 days, attempt­ing to reset their bod­ies to a 28-hour clock.

Despite Kleitman’s con­clu­sions that sleep dis­rup­tion had a more sig­nif­i­cant and wide­spread impact than loss of men­tal sharp­ness or other rel­a­tively mild con­se­quences, sleep research strug­gled for recog­ni­tion for the next five decades.

Then, in 1991, a report in the Jour­nal of Clin­i­cal Inves­ti­ga­tion found that healthy peo­ple, sub­jected to sleep depri­va­tion, expe­ri­enced upset glu­cose tol­er­ance and insulin resis­tance. And that these issues resolved after sleep was recov­ered and returned to nor­mal. Dozens of stud­ies find­ing sim­i­lar con­clu­sions soon followed.

Chal­lengers to the sig­nif­i­cance of these find­ings, how­ever, rightly con­cluded that all sleep depri­va­tion stud­ies to date focused on extreme sleep loss akin to repeat­edly stay­ing up all night with­out any sleep at all (e.g. the total depri­va­tion of Kleit­man and his col­league in a Ken­tucky cave).

Research on trou­bled sleep

The call being out for more research into trou­bled, or par­tial and dis­rupted sleep, was clear. The kind of sleep where one or two hours of sleep a night is spent awake is far more com­mon in the pop­u­la­tion and is some­times char­ac­ter­is­tic of cer­tain work­ing groups (e.g. shift workers).

Answer­ing this call, the first study of the impact of par­tial sleep loss occurred in 1999. Since then, sub­se­quent stud­ies have con­firmed the effects of par­tial sleep loss. A sum­mary follows.

1. The “car­diometa­bolic trap”

Par­tial sleep loss is asso­ci­ated with “sub­stan­tial and clin­i­cally sig­nif­i­cant changes in appetite reg­u­la­tion, hunger, food intake, glu­cose metab­o­lism and blood pres­sure con­trol” (Amer­i­can Jour­nal of Human Biol­ogy). A sig­nif­i­cant asso­ci­a­tion also occurs between short sleep dura­tion (less than six hours per night) and either more obe­sity or a higher body mass index. This asso­ci­a­tion is strongest among chil­dren and ado­les­cents, sug­gest­ing they are espe­cially vul­ner­a­ble to the effects of lost sleep. This asso­ci­a­tion is thought to stem from lack of sleep skew­ing people’s dietary choices. Indeed, one study found that sleep com­plaints includ­ing dif­fi­culty falling asleep, dif­fi­culty stay­ing asleep, non-restorative sleep and day­time sleepi­ness were all sig­nif­i­cantly asso­ci­ated with greater total caloric intake.

2. Pro­mot­ing diabetes

A 2012 study exam­ined the rela­tion­ship of dis­rupted sleep and dia­betes. Uni­ver­sity of Cal­i­for­nia researchers uncov­ered a mol­e­c­u­lar clue to the mod­er­a­tion of this rela­tion­ship, con­clud­ing that peo­ple who do not get enough sleep have a 30 per­cent reduced abil­ity to respond to insulin. Fur­ther, the bio­chem­i­cal processes that sleep loss set in motion were reversible.

3. Neg­a­tive impact on mood and pain perception

The ill effects of too lit­tle sleep is now known to neg­a­tively impact mood and lead to exag­ger­ated pain per­cep­tion. As well, lev­els of socia­bil­ity and opti­mism decrease with con­tin­ued peri­ods of dis­rupted sleep.

4. Inci­dence of cancer

Among indi­vid­u­als with sleep apnea and other dis­or­dered breath­ing dur­ing sleep, the inci­dence of can­cer is known to be higher, and this pop­u­la­tion expe­ri­ences more deaths from cancer.

5. Immune response to vaccines

Even the body’s immune response to vac­cines is weaker if the recip­i­ent is short on sleep” con­cludes a recent study in the jour­nal Sleep. These researchers gave 125 healthy adults a series of hepati­tis B shots, mea­sur­ing sleep dura­tion and qual­ity of sleep for a period of time before and after each shot, and the results showed that peo­ple who slept less dur­ing the study had lower anti­body response to the vac­cine and, there­fore, poten­tial sus­cep­ti­bil­ity to hepati­tis infection.

How do we improve sleep?

Despite the con­se­quences of trou­bled sleep being bet­ter doc­u­mented and known, devel­op­ing and imple­ment­ing behav­ioural inter­ven­tions to improve sleep is a major challenge.

Some sci­en­tists point to the chal­lenges brought about by “social” or “tech­no­log­i­cal” jet lag. Elec­tronic devices, new media, and other mod­ern tech­nol­ogy devel­op­ments cre­ate entic­ing ways to put off bed­time. One researcher comments:

The phys­i­o­log­i­cal chaos that ensues when the body’s inter­nal clock, which is set by our expo­sure to sun­light and night-time dark­ness, is out of sync with our “social clocks,” which are set by the demands and temp­ta­tions of mod­ern life, from early-morning alarms to the late lure of “The Daily Show”…Staying up later and sleep­ing later on week­ends, then wrench­ing one’s sched­ule back in time at the begin­ning of each work­week, is akin to trav­el­ing from New York to Den­ver every Fri­day night, then return­ing every Mon­day morning.

It’s also impor­tant to con­sider who is most at risk to expe­ri­ence lack of good sleep. In recent years researchers have found that insuf­fi­cient sleep is related to “a con­stel­la­tion of fac­tors includ­ing socioe­co­nomic sta­tus, race and eth­nic­ity, and work­place and neigh­bor­hood conditions.”

As it cur­rently stands, good sleep hygiene, edu­ca­tion about the impact and sever­ity of trou­bled sleep and the impor­tance of healthy sleep pat­terns, may be our best strate­gies to improve sleep. But new chal­lenges are con­stantly pre­sent­ing them­selves. Con­cludes Dr. Car­pen­ter in the Mon­i­tor article:

Fix­ing some sleep prob­lems may seem as sim­ple as fol­low­ing a few key “sleep hygiene” guide­lines but there is still a dis­con­nect. The temp­ta­tion to check one more mes­sage, read one more arti­cle or watch one more episode is pow­er­ful and insidious.

For cus­tomers and clients of Home­wood Human Solutions

Home­wood Human Solu­tions’ cus­tomers and clients have access to a wide vari­ety of proac­tive and effec­tive inter­ven­tions designed to improve sleep, includ­ing: edu­ca­tional mate­ri­als, indi­vid­ual counselling/coaching, group/team work­shops, work redesign, and spe­cific behav­ioural inter­ven­tions. For shift­work­ers, our Plan Smart Lifestyle and Spe­cialty Coun­selling ser­vices offer a spe­cific Shift Work Sup­port coach­ing pro­gram with a key focus being sleep hygiene and mak­ing shift work part of a healthy and reward­ing work life. Shift Worker Support