To sleep, perchance to stay healthy
Do you feel groggy after lunch, ready for a siesta? Does riding the bus or vanpool send you into a snooze? Do you zonk out while reading or watching TV?
If you’re nodding your head — or even more telling, if you’re nodding off — you could be suffering from sleep deprivation. Nearly one out of three Americans are not getting the 7½-to-8 hours of sleep we need. Some of us get even fewer than 6 hours of shut-eye on a regular basis.
But is losing a little sleep really such a big deal?
Actually, it is. Just ask Dr. Alon Avidan
, an associate professor of neurology and director of the UCLA Sleep Disorders Center
, one of the nation’s leading facilities for diagnosing and treating patients and conducting sleep research. Part of the UCLA Health System, the center’s modern facilities are situated in what used to be the emergency room for UCLA’s old hospital.
Dr. Avidan, an authority on insomnia, sleep apnea and numerous other disorders, can cite a long list of serious health problems linked to insufficient sleep. "If you don’t get enough sleep, you’re going to be at high risk for diabetes and have a greater propensity for obesity," he said. "Chronic insomnia — having difficulty initiating sleep and staying asleep through the night — can put patients at risk for depression and anxiety." Then there’s heart disease, skin lesions, suppressed immune function … the list goes on.
Taking an even more direct hit on health is the increasingly prevalent sleep apnea, when a person stops breathing repeatedly during sleep. "Obstructive sleep apnea is kind of the silent killer of the 21st century," said Avidan, describing how it interferes with the flow of oxygen to the lungs and brain. Sleep apnea in children, whose young brains are still developing, can lead to irreversible damage.
Dr. Alon Avidan, director of the UCLA Sleep Disorders Center.
And then, a source of particular fascination for Avidan, there’s sleepwalking and its siblings in a class of disorders called "parasomnias."
"People do weird things at night," said Avidan. "It’s always been thought that sleep is a very passive process, but we now find evidence that sleep is very active," and sometimes even life-threatening.
While sleepwalking is often viewed with amusement, there have been incidents of "suicidal somnambulism," in which sound-asleep sufferers have walked off high-rise balconies to their deaths.
In nocturnal eating syndrome, Avidan explained, a person "gets up in the middle of the night, eats and goes back to bed, not having any recollection of it when they wake up the next day and find food containers on the kitchen counter." Or, even more disturbing, they find empty medicine bottles or evidence that they turned on the stove and cooked a meal in their sleep. Meanwhile, they are gaining weight, which puts them at risk for many other health problems.
In the parasomnia, REM Sleep Disorder (RBD) — dubbed "the Dr. Jekyll and Mr. Hyde Syndrome" — people who are perfectly nice during the day act out violent dreams at night, injuring themselves and others. "They kick, scream, run, punch," said Avidan. "We’ve seen patients who ended up in the emergency room with facial lacerations and wrist fractures." Then there’s sexsomnia, whose slumbering subjects become sexually aggressive and even violent with their bed partners — the cause for more than one marital breakup.
And while some physicians may show skepticism and tell patients, "It’s all in your head," sleep science has proof. In overnight sleep studies conducted at UCLA, patients are hooked up to devices that monitor breathing, snoring, muscle movement, heart function and electrical activity in the brain as they sleep. Simultaneously, video and audio recordings are made. The resulting report, called a polysomnogram, is used to diagnose conditions like RBD, visible in brain wave and other data that show that the patient was indeed asleep even as he or she was punching and kicking.
The sleep center, founded in the 1960s, has a half-century of history of scientific research on sleep. UCLA researchers, Avidan said, pioneered studies in "staging sleep" — tracking activity like EEG brainwave patterns and "actually being able to say, ‘Okay, this is sleep, and this is wakefulness.’ Determining which specific brain areas are responsible for REM sleep and elucidating the mechanism and the neuroanatomy of sleep happened here." A focus of current studies is to determine how major debilitating syndromes, including diabetes, depression, heart failure in adults and Sudden Infant Death Syndrome are influenced by brain mechanisms during sleep.
Insomnia is a common cause of sleep deprivation.
And UCLA research continues to help unravel that most basic of mysteries: why we need sleep in the first place. Said Avidan, "There are something like 13 theories about why we sleep," all of which probably have some validity. The "metabolic homeostatis" theory has sleep responsible for keeping our systems humming along smoothly. Another perspective points to the contribution of sleep to healthy immune function, the subject of much research by Dr. Michael Irwin
, professor of psychiatry and director of UCLA’s Cousins Center for Pyschoneuroimmunology. "There’s also a restorative function to sleep," Avidan said. "A lot of cellular repair takes place during sleep." Dr. Jerome Siegal
, who has conducted sleep research for nearly three decades, suggests that sleep is a state of "adaptive inactivity"
that makes for efficient overall energy use.
Basic scientific research, coupled with increasingly sophisticated diagnostics, have informed ever more effective treatments for sleep disorders. Just as importantly, Avidan said, research makes clear to patients and their doctors that "sleep problems are actually disease states — not something that needs to be psychoanalyzed — and that they can be treated."
One of Avidan’s patients suffered for years, not knowing why he woke night after night punching walls … and sometimes his wife. As a desperate measure, the man took to restraining himself in bed every night with a seatbelt across his chest, handcuffs, and ropes around his ankles. It wasn’t until the man underwent a sleep study at UCLA’s sleep center that he was properly diagnosed with RBD, which can be treated very effectively with medications.
Research also helps convince patients with sleep apnea to seek treatment — especially when it comes to using a mask-like Continuous Positive Airway Pressure (CPAP) device. "I explain to patients that it’s almost like a reverse vacuum cleaner, with air pressure expanding the airways. But when they look at it, they say, ‘Doc, you’re crazy!' to recommend it," said Avidan. "But I show them the data of what happens when their oxygen is low and what it does to their brain. Then a light turns on and they're, 'well ....' because they see there's direct damage."
And while Avidan said that his peers in the medical community are increasingly waking up to sleep disorders as a significant factor in health and well-being, he is intent on spreading the word even more. To supplement the 1½ to 2 hours of instruction on sleep disorders that medical students get in four years, he has developed curriculum and online teaching modules in sleep science for medical students and staff, including 16 seminars he teaches every year.
Avidan added, "Physicians are not really equipped with the knowledge to treat sleep problems in themselves." For example, medical residents work notoriously long hours. "What happens when they are sleep-deprived on the job after a night of being on-call?"
For more information, visit the UCLA Sleep Disorder Center website,
where you’ll also find educational materials
on sleep disturbances and treatments.