Burning the Candle at Both Ends

March 13, 2012 in General, Health, Health Claims, Immune System by Joyce Bunderson

On Sunday evening more than one billion people around the world lost an hour of sleep due to the change to Daylight Savings Time. As a result of that one-hour shift, epidemiologists can expect to see jumps in numbers of heart attacks and fatal car crashes this week. It happens every year. As a matter of fact, sleep deprivation has been linked to numerous public health issues.

Last week I enjoyed watching one of Harvard Public Health Forums as a webinar. The webinar was called: FIGHTING THE CLOCK: How America's Sleep Deficit Is Damaging Long-term Health. Four top professors/authorities on sleep comprised the panel that shared an interesting perspective on the growing concern for America’s sleep deficit.

They began the forum by defining the triad of health: diet, exercise and sleep. It brought me back a couple of decades when I was being interviewed for a public health position. The interviewers essentially asked me the question: “What do you think are the important aspects of public health.” In essence, my response of ‘diet, exercise and adequate sleep’ gave them an opportunity to harshly and openly ridicule me, which they eagerly pounced upon. They stepped right into a one upmanship conversation between the three interviewers; seemingly designed to make me appear rather foolish for mentioning sleep as an aspect of public health. It actually was a little embarrassing. Sleep had been included as an important aspect of health in my UCLA public health education. The sleep issue was not the only issue in which UCLA public health was ahead of the learning curve. Certainly, with all the new research and with the ‘frosting on the cake’ Harvard’s Public Health Forum, I feel powerfully vindicated.

The distinguished MDs and PhDs from Harvard’s medical schools, labs, and hospitals provided many different perspectives on the consequences of sleep deprivation, and shared many interesting statistics about sleep. Included were facts about the increase in intake of soda, sweets and high calorie junk foods when subjects are sleep deprived. Among the research results that Dr. Hu shared is why sleep deprivation is correlated with increased calorie intake. He explained how the ‘hunger/satiety’ appetite hormones are influenced. Sleep deprivation increase the production of the ghrelin hunger hormone, which sends signals to the brain that you need more calories – it often drives us toward the high-calorie sugary foods. Another appetite hormone, leptin, is affected in the opposite direction of ghrelin – sleep deprivation reduces the production of leptin. Since leptin is a satiety hormone, if the amount of leptin goes down, you feel increased hunger. Yikes!! A double whammy. Both hormones react to sleep deprivation to make you feel hungrier. This is not what we need during an obesity epidemic.

A third hormone that Dr. Hu spoke of is cortisone, a stress hormone. Sleep deprivation drives cortisone up and the cortisone increases the heart rate and blood pressure. The increase in cortisone is especially dangerous; in addition, cortisone not only contributes to weight gain and obesity, but to especially dangerous abdominal weight gain, which is linked to type 2 diabetes and cardiovascular disease.

During the forum, the speakers referred to the data of more than 180,000 nurses, in the famous nurses studies, conducted over a 20-plus year period. The longer the duration of shift work of the nurses the higher the rate of diabetes. The speakers were making the point that there is a substantial increased risk of diabetes for shift workers. Certainly the fact that diabetes is also at epidemic proportions, this sleep deprivation issue is extremely important.

Charles A. Czeisler, PhD, MD, is a distinguished Professor of Sleep Medicine at Harvard Medical School. He used Daylight Savings Time to illustrate some of the harm of sleep deprivation. Dr. Czeisler said that each year when we ‘spring forward’ there is a 6% to 17% increase in motor vehicle crashes beginning on the Monday after the beginning of Daylight Savings Time – it’s a great way to study about 1.5 billion people each year. If you’re counting the fatal and alcohol related crashes, there is a 17% increase.

Czeisler says that Sweden has shown for 20 years, using myocardial infarction data that there is a 5% increase in heart attacks in the week following day light savings time – this is just a one-hour loss. One of the most interesting facts that he shared was the corresponding decrease in the ‘fall back’ in the autumn; there is a 5% drop in heart attacks. He said, “That is how sensitive our biological systems are.”

The webinar included a panel whose participants have had a wide range of relevant experience in evaluating the effects of sleep deprivation.  Individual panelists spoke extensively about how sleep deprivation affects the care medical professionals provide, amplifying the above data on medical effects of sleep loss. Some of their additional data is listed below.

Many of the issues discussed will help you realize how important it is that your doctor is well rested. A few that I remember are:

  • When the physicians work 30 consecutive hour shifts twice a week, often with more than one 12-hour shift thrown in between the 30-hour marathon shifts their medical errors double.
  • Serious diagnostic risk of error rises 460%
  • 17% increased risk of stabbing themselves with a needle
  • 168% increased risk of a ‘driving home’ vehicle crash
  • When the physician professor is on call for his student physicians, the evening before surgery, the professor/surgeon has a 170% increased risk of causing patient problems.  Note: We should be asking if our surgeon is on call the night before our surgeries.

The forum panel says that health care workers are like other people whose work suffers from sleep deprivation. The problem is that the health care workers don’t want to change. Part of the problem is that it is tradition in physician training and part of the problem is that it allows for life-style factors (e.g. nurses having more days off for family needs). Dr. Leape said that the policies are probably not going to change from within. The changes will have to be mandated from outside the medical community. He says that it will likely take a grass roots movement. Essentially, the public will demand control of hours the same way that truck drivers and airline pilots are regulated.  The European union has a 48-hours per week rule and it appears that those new physicians are learning more not less when they’re not sleep deprived. Some of our physicians are working 84 to 96 hours per week.

There’s another related issue with the physicians and it’s a ‘badge of honor’ issue. If you complain about hours, it’s a real ‘no-no.’ Many define themselves by an ‘ability to take the sleep deprivation.’ A type of ‘one-upmanship’ with hours worked also exists. The panel members said that those who have lost a loved one due to medical errors might be able to drive the necessary clear actionable ways to make a change.

The panelists also spoke on the effects on children and how they learn.  They reported on changes that already are happening across the nation in individual schools/school districts. Understanding the sleep needs the children have, they are striving to protect the necessary sleep, especially for adolescents going through puberty.

One study showed that parents who did not set a strict bed time – an ‘absolute 10 PM latest’ bedtime had children with an increased risk of depression and suicidal ideation. Children with a set strict bedtime were less affected. The panel recommended taking the TV out of the bedroom. Actually, the panel eventually said to get all the technology out of the bedroom to end texting, TV, and games instead of sleeping. The panel did say that the poor sleep is correlated with reduced academic performance.

Another driver of change is the knowledge of how productivity rises and accidents decrease with improved shifts and opportunities for sleep. Industry is already learning the benefits of improved shifts.

During the questions phase of the presentation the panel spoke to the issue of the immune system being affected by sleep deprivation. People are more likely to get pneumonia when sleep deprived.

The Huffington Post sponsored the forum and moderator, Alana B. Elias Kornfeld, Editor In Chief of their Healthy Living, said that when someone is not feeling well at the Huffington Post they are told to ‘get some sleep.’ Good for them!!!

By now you can see why my usual posts about diet and exercise have to be expanded to include attention to getting good sleep, regularly. All three are connected in surprising ways, as discussed above. Getting the health benefits of sleep is not any easier than getting one’s diet and exercise under control. All three legs of the health stool face a similar struggle. The first step is awareness of the health costs of inadequate diet, exercise, or sleep. The next step is making the changes and developing new habits. Then, as illustrated by sleep, (whether it is your healthcare provider or yourself) developing the new habits is an important way to improve one’s health.

Burning the candle at both ends should become a one upmanship game that we forcefully decline to play. I no longer care as much about being embarrassed by comparisons to those who seem to be getting away with little sleep. I am now much more likely to stick with what I know the research has made so clear; so compelling. We all need proper sleep. We can all benefit by making the development of healthy sleep habits a priority now.