Importance of sleep on health

Park et al.1 inferred in their 2019 study that women exposed to artificial light at night (ALAN) while sleeping were associated with an increased risk of obesity. The research was conducted in a cohort of 43,722 women for a period of 5.7 years and the researchers concluded that a weight gain of 5 kg or more (RR, 1.17; 95% CI, 1.08-1.27; P< 0.001), BMI increase of 10% or more (RR, 1.13; 95% CI, 1.02-1.26; P= 0.04), incident overweight (RR, 1.22; 95% CI, 1.06-1.40; P= 0.03), and obesity (RR, 1.33; 95% CI, 1.13-1.57; P< 0.001) were associated with exposure of ALAN secondary to shorter duration of sleep.

One possibility is exposure to ALAN while sleeping could disrupt sleep and decrease sleep duration. A meta-analysis conducted on the sleep outcomes of 125,198 children showed a strong and consistent association between poor sleep quality (OR= 1.46; 95% CI 1.14-1.88), inadequate sleep quantity (OR=2.17; 95% CI 1.42-3.32) and excessive daytime sleepiness (OR=2.72; 95% CI 1.32-5.61) with the use of bedtime electronic media devices2.

Therefore, it’s time to start sleeping with turning off the lights and avoid the use of bedtime electronic media devices.
The National Sleep Foundation with the help of different organizations and multidisciplinary expert panels has recommended sufficient sleep durations for different age groups. The recommended sleep duration for newborns (0-3 months) is 14-17 hours, infants (4-11 months) is 12-15 hours, toddlers (1-2 years) is 11-14 hours, preschoolers (3-5 years) is 10-13 hours, school-aged children (6-13 years) is 9-11 hours, teenagers (14-17 years) is 8-10 hours, young adults (18-25 years) and adults (26-64) is 7-9 hours and older adults (≥65 years) is 7-8 hours3.
Based on cross-sectional and longitudinal studies, inadequate quality and duration of sleep increase the risk of various health conditions including obesity, type 2 diabetes, hypertension, cardiovascular diseases, immune function impairment and dementia4,5.

Causes of sleep disruption include lifestyle factors (excessive caffeine intake, alcohol use, drug abuse, jet lag, shift work), environmental factors (exposure to excessive noise and light), psychosocial factors (anxiety, care-giving to terminally ill patients), medical conditions (pain, chronic kidney disease, diabetes, neurodegenerative disease, restrictive lung disease, psychiatric conditions and use of certain medications) and sleep disorders (obstructive sleep apnea, restless leg syndrome, narcolepsy and insomnia)4.
Insomnia is the most common sleep disorder, which refers to the difficulty of initiating and maintaining sleep with associated daytime somnolence6. Both pharmacological and non-pharmacological interventions are adopted to treat insomnia.

Pharmacotherapy includes non-benzodiazepines (zolpidem, eszopiclone, zaleplon, zopiclone), benzodiazepines (estazolam, triazolam, temazepam, flurazepam), sedating antidepressants (trazodone, amitriptyline), atypical antipsychotics (risperidone, quetiapine, olanzapine), melatonin receptor agonists (ramelteon), orexin receptor antagonist (suvorexant), and H1 antagonists (diphenhydramine, doxylamine)6,7.

Non-pharmacological interventions can be used alone or in combination with pharmacotherapy that encompass sleep hygiene education (recommendation of daily exercise and avoiding coffee in the evening), sleep psycho-education, relaxation training, sleep restriction therapy, stimulus control therapy, and cognitive therapy, which are all a part of cognitive-behavioral therapy for insomnia (CBT-I)7.

Likewise, some foods, supplements and beverages include barley grass, rice, wheat flour, whole grains, lettuce, chamomile, valerian root, L-tryptophan, fish, tart cherry, walnut, kiwi, asparagus, Lingzhi, ginseng, maca, Schisandra wine and milk were studied for promoting sleep7,8.
It is vital to have adequate sleep quality and duration, which could be achieved by practicing good sleep hygiene and the consumption of certain foods. If symptoms persist, it is advisable to seek professional advice.

References


1. Park YM, White AJ, Jackson CL, Weinberg CR, Sandler DP. Association of Exposure to Artificial Light at Night While Sleeping With Risk of Obesity in Women. JAMA Internal Medicine. 2019;179(8):1061-1071.
2. Carter B, Rees P, Hale L, Bhattacharjee D, Paradkar MS. Association Between Portable Screen-Based Media Device Access or Use and Sleep Outcomes: A Systematic Review and Meta-analysis. JAMA Pediatrics. 2016;170(12):1202–1208.
3. Hirshkowitz M, Whiton K, Albert SM, Alessi C, Bruni O, DonCarlos L, Hazen N, Herman J, Katz ES, Kheirandish-Gozal L, Neubauer DN, O’Donnell AE, Ohayon M, Peever J, Rawding R, Sachdeva RC, Setters B, Vitiello MV, Ware JC, Adams-Hillard PJ. National Sleep Foundation’s sleep time duration recommendations: methodology and results summary. Sleep Health: Journal of the National Sleep Foundation. 2015;1(1):40-43.
4. Medic G, Wille M, Hemels ME. Short- and long-term health consequences of sleep disruption. Nature and Science of Sleep. 2017;9:151–161.
5. Yilmaz D, Tanrikulu F, Dikmen Y. Research on Sleep Quality and the Factors Affecting the Sleep Quality of the Nursing Students. Current Health Sciences Journal. 2017;43(1):20–24.
6. Worley SL. The Extraordinary Importance of Sleep: The Detrimental Effects of Inadequate Sleep on Health and Public Safety Drive an Explosion of Sleep Research. Pharmacy and Therapeutics. 2018;43(12):758–763.
7. Pigeon WR, Bishop TM, Marcus JA. Advances in the management of insomnia. F1000Prime Reports. 2014;6:48.
8. Zeng Y, Yang J, Du J, Pu X, Yang X, Yang S, Yang T. Strategies of Functional Foods Promote Sleep in Human Being. Current Signal Transduction Therapy. 2014;9(3):148–155.