Nathaniel F. Watson, MD; Ashgan A. Elshinawy, DO; and C. Michael Gibson, MD, examine complications patients encounter with sleep disorders, including for insomnia, and the impact on their quality of life.
C. Michael Gibson, MD: I have a lot of doctors who follow me on Twitter. I asked, “How many of you have had a sleep-disturbance-related accident or know someone who has?” This goes for all health care professionals. I was dumbfounded that about 20% of people said they had fallen asleep at the wheel, or knew someone who had and had been in a collision. Nate, talk to us about some of the complications from insomnia and sleep disorders.
Nathaniel F. Watson, MD: It’s a huge problem. When you’re not able to have a normal level of alertness throughout the day, that’s going to have implications in functioning—social, workplace, or otherwise. Fall-asleep crashes kill about 7000 to 8000 people a year in the United States. It’s a huge problem, and it’s underappreciated. Anytime you have an accident where there’s a lack of an evasive maneuver—usually it’s a single vehicle that drifts off the road—you’re probably dealing with a fall-asleep crash. Performance in your job or at school will suffer. We mentioned the risk of accidents, depression, anxiety, and substance abuse. This can be found more frequently in patients with insomnia and sleep disorders. You also have increased risk and severity of cardiovascular diseases. Sleep is as important as diet and exercise to overall health and well-being. We’ve been shouting that from the rooftops for many years, to get people to elevate it to thinking the way they think about diet and exercise, as far as being maximally healthy.
C. Michael Gibson, MD: Ashgan, we heard about some of the really dangerous things like crashes, but what about the quality of life associated with insomnia and sleep disorders? How are they related?
Ashgan A. Elshinawy, DO: I see that issue come up in my practice often. Nate alluded to this a little when he mentioned the work and the school performance. I have a lot of students, especially college and graduate students, who come to see me in my office. Very intelligent geniuses come to see me, and they’re struggling to stay awake in class or during Zoom meetings or to focus on their studies past 11 PM. They have a very irregular sleep schedule, and it’s affecting their quality of life and their performance at school.
The other thing I notice is that when people have a long-term sleep disorder that’s undiagnosed, untreated, or suboptimally treated, they sometimes resort to drinking alcohol a little more frequently than they should. They use it as a sleep aid, as a crutch. A lot of people will turn to marijuana. It’s becoming legal just about everywhere, but there’s no guidance behind it for some of these people. They’re just reaching out and getting it from a friend, online, or from the neighborhood store. There’s no supervision or guidance, which is a little alarming based on what they report to me and what they disclose to me. We first try to undo a lot of that to get them on a more healthy path. Unfortunately, 1 of the complications from a chronic sleep disorder is that they’re desperate to treat.
C. Michael Gibson, MD: As a cardiologist and someone who cares for patients after a heart attack, they have a lot of PTSD [post-traumatic stress disorder] after that episode of being in the intensive care unit or coronary care unit. It’s very anxiety provoking. They have a lot of sleep problems after their MI [myocardial infarction]. They’re related to being short of breath and having to sleep on pillows. This is a big problem in our cardiology practice. How many hours of sleep a night do we need? Can you get too much sleep?
Nathaniel F. Watson, MD: That’s a great question. A number of years ago, I led a task force that was assessing the optimal amount of sleep to support health. We looked at all different aspects of human physiology—immunologically, cardiovascular health, mental health, cancer, and pain—and went down the line from all aspects of human disease. We began to assess what impact the various sleep durations had on these and the epidemiology of these various diseases. We looked at animal model studies to see the impact of sleep deprivation on these systems. One thing that’s very clear is that short sleep is definitely bad for you, certainly less than 6 hours but even less than 7 hours. The important thing to remember is that when somebody self-reports 7 hours of sleep, they’re reporting time in bed, but they’re probably sleeping less than that. A lot of studies that looked at this were based on self-reporting sleep duration. You have a pretty strong case for short sleep, but for long sleep there are no animal studies that suggest that sleep extension in animals has any untoward effect on their functioning. In fact, you get to a point that once an animal is sleep satiated, you can’t force them to keep sleeping.
There’s no animal model data showing that sleep extension is bad, but you have some epidemiological evidence suggesting that sleep durations higher than 9 hours are associated with cardiovascular disease, diabetes, and mortality. This probably means a couple of things. One, sicker people live a more sedentary lifestyle and may be self-reporting more sleep. It’s by virtue of their illness, and it’s not the result of the sleep itself. Of course, that’s always the challenge with epidemiological studies, which is the notion of causality. That’s why we look to animal model studies to see if there’s causality. My sense is that you can’t sleep too much. In fact, there are circumstances—if you’re recovering from illness or when you’re younger—where longer sleep is totally normal. It’s been an ongoing debate in sleep medicine, but my sense is that less sleep is definitely bad for you. We came up with a recommendation of 7 or more hours of sleep on a regular basis to support optimal health, based on that effort.
C. Michael Gibson, MD: I was sleep deprived for almost 40 years as a physician. I stopped taking calls 2 years ago, and I’ve never felt better. It was life changing because when you’re tired and exhausted, you think that you’re hungry. What do you do? You eat, and you put on some weight. Then you get obstructive sleep apnea, and that makes you sleepier. All these things are interim, but a lot of it begins with sleep. That’s why I was interested in our discussion about the bidirectionality of all this. This is all closely related. Thank you for this provocative segment.
Transcript Edited for Clarity