Lack of sleep seriously affects health

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Lack of sleep seriously affects health

While society develops a night owl lifestyle, chronic diseases and mental disorders are among the various health problems associated with sleep deprivation. The July 2019 issue of "Mutations" magazine focuses on the effects of sleep on the health of the population.

With only 6h42 of sleep on average, the French do not get enough sleep. This sleep time, which is less than the minimum of seven hours recommended daily, tends to decrease over the years. The population has thus shortened its nights by 1h05 compared to 2010 and 1h23 compared to 1986.

However, lack of sleep seriously damages health, according to the July 2019 issue of the magazine "Mutations". The latest issue of this quarterly magazine published by the Mutualité Française analyses the effects of sleep on the health of the population, in particular, the repercussions of sleep deprivation.

"Awakening blue light"

"In general, the decrease in sleep time is more significant for people under 40 years of age, a population that willingly puts itself in sleep deprivation through meaningful night-time activities, such as viewing screens. Their bright blue light delays the biological clock with disconcerting ease," says Jean-Pierre Giordanella, a public health physician and author of a 2006 report on sleep for the Ministry of Health.

Sylvie Royant-Parola, psychiatrist, agrees: "Screens allow relational activities, exchanges with real-life friends or digital, even at night, which contributes to delaying or breaking sleep.

For this sleep specialist, "there is an incompressible sleep time below which there is a significant impact on vital functions, cardiovascular functioning, immune function and metabolic regulation".

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Biological clock out of control

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People who work at night are particularly affected by these health problems: their work rhythm is antagonistic to the human biological clock "which seeks, whatever happens, to promote sleep at night and wakefulness during the day", explains Claude Gronfier, neurobiologist at Inserm.

In 2006, this expert coordinated a report from the National Agency for Food, Environmental and Occupational Health Safety (Anses) on the risks of night work. "What we know for certain is that the latter can disrupt sleep and alertness, and induce a metabolic syndrome characterized by the simultaneous presence of at least three out of five biological parameters, related to waist circumference, blood pressure, triglyceridemia, cholesterol levels and blood sugar levels," adds Claude Gronfier. "Among its likely effects are the risk of cancers, for example breast cancer, but also pathologies such as coronary heart disease, overweight, obesity and type 2 diabetes. Other possible health impacts include impaired cognitive function, high blood pressure, stroke, anxiety, depression, etc.

In addition to the disruption of their biological clock, these people often have difficulty achieving total darkness in their rooms. In the end, "their sleep is not of good quality, it is fragmented, and disturbed by the sounds of life".

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Daytime sleepiness

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"Anything that fragments sleep prevents it from deepening and generates drowsiness during the day. In addition to drowsiness, this has harmful consequences on the cardiovascular system, which is never at rest and suffers from repeated oxygen depletion," says Dr. Valérie Cochen de Cock, neurologist at the Beau Soleil mutual clinic in Montpellier, where a report was produced illustrating the management of sleep disorders by a multidisciplinary team.

Equipped with a continuous positive pressure (CPAP) mask, used to treat sleep apnea, Delphine Peneranda, 48, is hospitalized for a sleepiness check-up: "I am tired, I have memory loss, I do not feel at my maximum intellectual capacity and I have already realized that I died a few seconds while driving. It is this last reason that also led a 21-year-old girl, Ophelie Cheval, to this establishment: "I am constantly fighting against sleep. As I travel a lot, it is the occupational medicine that has guided me here," she says.

Adolescents under pressure

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Sleep disorders can start even earlier. Young people are victims of "intense social pressure", especially in adolescence, a period during which they have to get up earlier and work more, whereas they would need to sleep "nine hours a night", says Dr Jean-Luc Martinot, child psychiatrist and research director at Inserm. For this specialist, young Westerners sleep "two hours less than they should".

This accumulated fatigue gradually leads to a shift between weekday and weekend schedules. This phenomenon begins around the age of 14, when teenagers start going to bed late and get up late on weekends. "For those who systematically have a significant delay every Saturday evening, from about an hour and a half to two hours, there is a decrease in the volume of grey matter in several regions of the brain," says Dr. Jean-Luc Martinot. "The lower the volume of grey matter in the frontal areas, the lower the teenager's grades," he adds. At 16 years of age, anxiety disorders may appear.
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Acting on lifestyles

To reverse this general trend, it is necessary to act on lifestyles. "If we take the dominant cultural injunctions, the popular lifestyle is the abolition of sleep! Dalibor Frioux, philosopher, castigates. In these representations, sleeping is synonymous with boredom, waste of time, obstacles to a night life made up of experiences and enriching encounters..." Faced with health issues and social inequalities (cramped and noise-prone housing, bright environments, etc.), defending the value of sleep is "an eminently political issue", says Dalibor Frioux.

As Jérémie Peltier, Director of Studies at the Jean-Jaurès Foundation, points out, "France is the second largest consumer of sleeping pills in Europe". "Their regular intake results in memory loss, but above all has no effect on the ability to sleep naturally afterwards," says Jérémie Peltier. Fatigue and sleep should therefore be "restored to a place in the public debate". Municipal campaigns could be an opportunity to address "subjects related to noise pollution and light pollution", proposes Jérémie Peltier, while raising the idea of a public health campaign to promote sleep.

How to get to sleep during the heat wave?

Some studies have shown that there seems to be an ideal temperature for sleep. When the temperature is very high, however, it takes longer to fall asleep and once sleep is reached, its quality is altered because it can be fragmented (alarm clocks or microwakes).

In many parts of the world where it is always hot during long summers, people are almost all equipped with air conditioners. However, this is not the case everywhere. It is also not always possible to have well air-conditioned rooms for various reasons and, above all, it is preferable not to overuse them (of the air conditioner). Here are some useful tips.

What you can do where you sleep

1. Do everything you can to prevent excessive heat accumulation in your environment. During the day, close the blinds or shutters to prevent sunlight from heating the room. Keep windows closed if the outside temperature is much higher than the inside temperature. At night, if the temperature is lower outside than inside, open the windows.

2. If you live in a building, you can pass this point]. Remember that heat (hot air) moves from top to bottom, it rises. So, if you live in a multi-storey house, it is better to live lower. All you have to do is transfer your room to a room on the ground floor, or sleep temporarily on the sofa....

3. In the worst case, in some parts of the world, people end up sleeping outside because it is simply not possible to cool their homes at night. If you find yourself in such a situation, remember to protect yourself properly against mosquitoes and other insects.

4. This last point is probably the most critical in terms of safety. Some people sleep in a motor vehicle and operate the air conditioning. This can be very dangerous if the vehicle is not in motion, as there may be an accumulation of carbon monoxide.

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Before going to bed

1. A shower or bath before bedtime can help. Strangely enough, some people prefer to take hot showers and hot baths when the ambient temperature is very high. The problem with hot showers is that they increase humidity, which could make the situation in your home worse.

2. For some people, spraying water with a mist or similar gadget that creates a fine mist can help.

Improve your sleep environment

1. Having light and seasonal bedding and light pyjamas (or not wearing them) are certainly conditions not to be neglected. In particular, there are pajamas made of materials that wick away perspiration, which can be very helpful. It is also advisable to choose a quality mattress, which simply optimizes comfort. Whether it is hot or cold, it will help you to sleep.

2. You can also use a fan as most people do, although it is generally advisable to avoid sleeping with a fan.

If you wake up sweating and your sheets and pillowcases are damp, remember to take a short shower and change them.

Preparing for future heat waves

Remember that when you sweat a lot, you lose both water and electrolytes. This can be dangerous. Make sure you refuel and don't get dehydrated. Avoid excessive and unprotected exposure to the sun. Indeed, sunburn will not help you in your quest for sleep.

All these tips are to be completed with the following points/aspects:

  •     Sleep as often as possible in your usual night time slot (important for circadian rhythm).
  •     Drink plenty of cold liquids (including plenty of water) and eat lighter, more frequent meals.
  •     When you get out of the shower, leave your hair slightly wet or place a cold compress on your head before going to bed.
  •     If you use fans, make sure there is a way for air to circulate, keeping the chamber door open.
  • To increase the (cooling) efficiency, you can also place an ice cube pan in front of the fan.
  •     Play relaxing music, it can be soothing even on a hot night.

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The brain literally begins to "eat" itself when it lacks sleep

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The brain literally begins to eat itself when it does not get enough sleep. We know that sleeping is very important: it allows us to restore our energy levels. But it is also important to know that our brains change state when we sleep, to eliminate the toxic by-products of neural activity left during the day.

It is also possible that this same process may begin to occur in people who are chronically sleep-deprived, but in an exacerbated manner. Indeed, researchers have found that insufficient sleep causes a considerable loss of neurons and synaptic connections in the brain, and sleep recovery may not be able to repair the damage caused.

A team led by neurologist Michele Bellesi, from the Polytechnic University of Marche in Italy, examined mammalian brains when they are subjected to poor sleep habits.

As with all cells in your body, the neurons in your brain are constantly refreshed by two different types of glial cells: cells that are often considered to be the glue of the nervous system. Microglial cells are responsible for the elimination of old and worn cells, through a process called phagocytosis (literally "devouring", in Greek). And the work of astrocytes is to eradicate unnecessary synapses (connections) in the brain to refresh and reshape its internal wiring system.

This process occurs when we sleep, in order to eliminate daily neurological wear and tear. But now it seems that the same thing happens when we start to run out of sleep... Unfortunately, when that happens, the brain begins to eliminate too many elements and begins to harm itself. "We are demonstrating for the first time that portions of synapses are literally consumed by astrocytes due to lack of sleep," explains Bellesi.

To explain this, scientists analyzed the brains of four groups of mice:

  •     One group was able to sleep for 6 to 8 hours (well rested mice)
  •     Another group was awakened periodically (spontaneously awakened)
  •     A third group was kept awake for 8 hours overtime (sleep deprived)
  •     And one last group was kept awake for 5 consecutive days (chronically sleep-deprived)

When researchers compared astrocyte activity in the four groups, they identified activity in 5.7% of brain synapses in well rested mice and 7.3% in spontaneously awake mice.

In sleep-deprived and chronically sleep-deprived mice, scientists noticed something different: astrocytes had increased their activity to literally eat parts of the synapses (just like microglial cells that eat waste), a process known as astrocyte phagocytosis. In the brains of sleep-deprived mice, astrocytes were found to be active in 8.4% of synapses and in chronically sleep-deprived mice, 13.5% of their synapses showed astrocyte activity.

Most of the synapses that were devoured in the two groups of sleep-deprived mice were the largest synapses, which tend to be the oldest and most used. But when the team checked the activity of the microglial cells in the four groups, it found that it had also increased in the sleep-deprived group.

This discovery is worrying, as previous research has shown that too much microglial cell activity is linked to brain diseases such as Alzheimer's, as well as other forms of neurodegeneration.

"We find that astrocytic phagocytosis, mainly presynaptic elements in large synapses, occurs after acute and chronic sleep loss, but not after spontaneous awakening, suggesting that the latter can promote the cleaning and recycling of used components of heavily used synapses," the researchers explain. "On the other hand, only chronic sleep loss activates microglial cells and promotes their phagocytic activity... suggesting that prolonged sleep disruption can promote microglia," they add.

It remains to be seen whether this same process is occurring in the human brain and whether sleep catch-up could repair the damage caused.
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Sleeping more on weekends could increase your life expectancy

Sleeping more on weekends helps your body recover from a difficult week, could have beneficial consequences on your overall health and increase your life expectancy. In any case, this is what a recent study shows. Research including more than 38,000 adult participants showed that the mortality rate among young adults and middle-aged people sleeping less than five hours per night was 52% higher than those who sleep 6-7 hours per night (reference group). While participants who caught up on this sleep deprivation on the weekend did not show an increase in the mortality rate compared to the reference group.

However, beware of misinterpretations. This study does not prove that "catching up" on weekend sleep is enough to recover from the consequences of possible overwork or a severe lack of sleep during the week. But one of the members of the research team, Torbjörn Åkerstedt from Stockholm University (Sweden), says that these results offer interesting opportunities.

"The hypothesis is that weekend sleep can be a catch-up sleep," Åkerstedt told The Guardian. However, he pointed out that for the time being, this is only a working hypothesis.

Although in the past we have seen many studies on the relationship between sleep and health, the balance between sleep and health during the week and on weekends has not often been taken into account. It is therefore mainly for this reason that the researchers wanted to devote this study to this specific question. In total, this involved the use of data from more than 38,000 participants. The latter were responsible for reporting their sleep hours on working days as well as on days of rest.

The team also used statistical models to eliminate influences such as gender, body mass index, physical activity, alcohol consumption and differences between smokers and non-smokers.

The "small sleepers" in the sample involving persons under 65 years of age, i.e. those who slept less than five hours per night (week and weekend), had a 52% higher mortality rate than the reference group (6-7 hours per night). The calculation of the mortality rate is based on death records over a 13-year period, but it is important to note that sleep patterns were measured only once, at the beginning of this period.

However, the researchers report that "the mortality rate of people who sleep less during the week, but recover during weekends by sleeping at least 7-8 hours, did not differ from that of the reference group". This difference in mortality rate was also non-existent for people over 65 years of age. Indeed, for this older age group, no link has been shown between sleep duration and mortality.

According to the researchers, this may be due to the fact that they may be less sensitive to shorter sleep.

Moreover, there is another interesting conclusion: individuals who slept more than nine hours per night also had a higher mortality rate than the reference group. According to the authors of the study, this may be due to the fact that spending more time in bed may reflect potential underlying health problems.

With a reasonable sample size, and a marked difference in early mortality rates for those who do not catch up on their weekend sleep, this research deserves to be taken seriously. However, as mentioned, the study did not receive long-term follow-up, and therefore does not take into account possible changes in sleep over time. As a result, it may not be representative of the overall population.

Regarding the criticism of other expert researchers in the field, most said that the study was very interesting, but that more research is needed before we can have a more accurate idea of how longer weekend sleep can compensate for a deficit during the week.

Michael Grandner of the University of Arizona, who was not involved in the study, however, wanted to warn against using weekends to recover sleep debt. He explained that this could be compared to eating a salad after several hamburgers: it is certainly healthier, but not enough to compensate for all the negative effects of your previous bad meals.

The best advice you can get is to know the "amount" of sleep you need (experts recommend between seven and nine hours per night, depending on the individual). Once you have determined the ideal number of hours, force yourself to respect it. However, if you are short of sleep for any reason, don't hesitate to use your days off to restore a certain balance. The research was published in the Journal of Sleep Research.

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