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Are You Getting Enough Healthy Sleep?

An interview with sleep expert Charles Czeisler, PhD, MD

By Lauren Del Sarto

While we all know we need to get a good night’s sleep, many of us don’t realize what good sleep is, or how well we are actually sleeping, says Harvard Medical School Professor of Sleep Medicine Charles Czeisler, PhD, MD, FRCP. “Eighty-five percent of people with sleep disorders are undiagnosed and untreated which can be detrimental,” he states, as more and more studies correlate sleep deficiency with devastating diseases like Alzheimer’s, heart disease, and even obesity.

I spoke with Dr. Czeisler in anticipation of his January 18 appearance as part of the Leonore Annenberg Lecture Series at Eisenhower Medical Center. The lecture is free, open to all, and an important one to attend. While you think you may know all there is to know about a good night’s sleep (eight hours, dark room, no electronics, etc.), his presentation – and some of the things I learned from him –may surprise you:

  • Sleep apnea is the leading known cause of high blood pressure;
  • People with undiagnosed sleep disorders have a 200-300% increased risk of depression, chronic anxiety disorders, cardiovascular disease and diabetes;
  • In the spring when we turn our clocks ahead and lose an hour, there is a 5% increase in heart attacks – and a 5% decrease in the fall when we turn our clocks back;
  • Sleeping five hours or less a night increases the risk of calcification of the coronaries over a five-year period by 300%;
  • Kids under one who are getting less than 12 hours of sleep a day have a 200-300% increased risk of being overweight when they go to pre-school, and sleep deprived 7th graders have an increased risk of obesity when they are in their 30s.

Czeisler finds that the correlation between sleep deficiency and cognitive decline is the most surprising information for people. “One of the most common reasons for institutionalization of cognitive decline patients is not the disease itself, but the inversion of the sleep-wake cycle associated with these conditions,” he notes. “With Alzheimer’s, the internal clock specifically deteriorates – even with caretakers who may be awakened by a wandering parent or patient,” and while many know that sleep disorders are more common in patients with cognitive decline, many don’t realize that sleep disorders may actually be the cause.

Scientists have recently discovered a lymphatic system in the brain that cleanses the brain of toxic metabolized-like amyloid beta buildup which happens with extended wakefulness.

“When we sleep, the cells in the brain shrink which allows the lymphatic system to cleanse out those toxins more effectively,” says Czeisler. “These are all very recent discoveries and are helping us make sense of the clinical observations, and to understand how lack of sleep and sleep disorders are related to cognitive decline.”

The study of sleep medicine is a fairly new discipline and while there are exciting breakthroughs, Czeisler says what amazes him most is how little people put into practice what they already know. That is why he and his team have launched the Sleep Matters Initiative — to educate consumers and to encourage more people to get tested for sleep disorders.

“We are talking about a devastating illness and yet 85% of the people with it are undiagnosed or untreated. Our goal is to provide people with the latest educational material. We are going to focus on what is known about the impact of sleep deficiency and why getting enough sleep is so important for the brain and the body, and what happens to those systems when we are chronically deprived of that sleep – not only duration, but timing and quality as well.”

Educating practitioners is also a goal. “Sleep apnea is the leading known cause of high blood pressure with over one-third of cases caused by sleep apnea,” he adds. “However, if you go to your doctor’s office, you are more likely to get a large dose of expensive blood tests than a $300 test for sleep apnea.” According to Czeisler, if you test positive you have a 70-90% chance of actually having sleep apnea. “Certainly every doctor’s office should offer sleep screening.”

Through the initiative, over 25,000 individuals across the country have been screened so far including first responders and school children. “When we implement validated questionnaires, we find that 30-40% of the populations have disorders.” He described testing among 5,000 Ohio firefighters. Some were randomly assigned to get sleep screenings and some were not. “What we found was that the group that received the program had a 24% reduction in injury rate and a 46% reduction in disability usage over the following year which saved the city over two million annually in replacing people because of disability.” Several participants also wrote letters about how the diagnosis and treatment completely changed and improved their lives. “So these programs can be very impactful.”

In January, Dr. Czeisler will be presenting what people should know about sleep and what we can do to improve our own sleep health for successful aging. “When you change the culture of sleep, it can make an extraordinary difference in people’s lives,” he concludes. “The results are making a huge impact — even beyond our greatest expectations.”

If you feel that you or a loved one may benefit from sleep disorder testing, speak with your primary care physician or specialist and request a test. The in-home or in-lab testing process is covered by most insurance. For more information visit healthysleep.med.harvard.edu/healthy/matters.

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