The implications of sleep - or lack of it - extend far beyond whether one feels rested or not the next morning. Good sleep, say experts in the field, is not a luxury; it is essential to good health.
At the UCLA Sleep Disorders Center - as well as within other medical divisions and centers at UCLA - specialists are examining these ties between sleep and health. "If you don't get enough sleep, you're going to be at high risk for diabetes and have a greater propensity for obesity," says neurologist and sleep specialist Alon Avidan, M.D., M.P.H., director of the center. "Chronic insomnia - having difficulty initiating sleep and staying asleep through the night - can put patients at risk for depression and anxiety." Then there's heart disease, skin lesions, suppressed immune function ... the list goes on.
Dr. Avidan and colleagues have, for example, been investigating the complicated interplay between sleep and quality of life in people with Parkinson's disease. For these patients, sleep problems such as sleepiness and insomnia are very common.
"Our findings reveal that in patients with Parkinson's disease, those who report more significant sleep disturbances, especially daytime sleepiness and difficulties maintaining sleep, are at higher risk of diminished quality of life," says Dr. Avidan. And that, he suspects, may affect the progression of their disease. "Given our results, physicians who care for patients with Parkinson's disease need to screen patients for sleep complaints and, if present, entertain a treatment strategy to address those complaints."
Sleep difficulties not only put our physical selves at risk, but also our psychological selves. In a 2008 study published in the American Journal of Psychiatry, researchers at the Cousins Center for Psychoneuroimmunology in UCLA's Semel Institute for Neuroscience reported that sleeplessness can be a key factor in triggering depression, particularly in older adults with a prior history of depression. "If an older adult has a sleep disturbance, they have a four-fold higher risk of having a depression recurrence," says Michael R. Irwin, M.D., the Cousins Professor of Psychiatry and Biobehavioral Sciences and director of the Cousins Center.
The reason for this may be because sleep problems increase inflammation, which has been linked to mood problems, but also, Dr. Irwin adds, because insomnia and other problems can lead to fatigue and the disruption of social relationships, "which can drive depression risk." The results suggest that "treatment of sleep disturbance may prevent depression recurrence, and early identification of those with sleep disturbance and treatment of those sleep problems may prevent depression from developing."
In addition to depression, Dr. Irwin notes that the inflammation associated with sleeplessness can contribute to such conditions as heart disease and arthritis, among other autoimmune disorders. "Physical and psychological stress brought on in part by grinding work, school and social schedules is keeping millions of Americans up at night," Dr. Irwin says. "America's sleep habits are simply not healthy. Our findings suggest even modest sleep loss may play a role in common disorders that affect sweeping segments of the population."
These issues are among those explored at the UCLA Sleep Disorders Center. By day, the state-of-the-art center serves as an outpatient clinic and research facility where physicians study the biology and neurobiology of sleep and treat patients with a range of sleep problems including insomnia, obstructive sleep apnea, excessive daytime sleepiness, restless legs syndrome, parasomnias (such as REM-sleep behavior disorder and sleep walking), narcolepsy and shift-work sleep disorder.
That research has led to some interesting new findings in important areas of sleep medicine, including determining the proper treatment of insomnia in the elderly. "Before our work," Dr. Avidan says, "doctors thought that the use of hypnotics" - prescription sleep aids used to treat insomnia - "would worsen the propensity for falls in older patients. We found that patients who use hypnotics may have improved sleep and less falls, and it is the untreated insomnia that places these patients at higher risk of falling."
While the center during the day operates as a clinic to treat patients and conduct research, each night it transforms to a sleep laboratory with eight private rooms where patients with the most vexing sleep problems are recorded and evaluated using digital polysomnography equipment. Though the nature of the setting might make it difficult for people who already have difficulty with sleep to achieve a restful night, "we are still able to capture sufficient recorded data to make an accurate assessment and diagnoses of their sleep problems," Dr. Avidan says.
It is really just within the last few decades that physicians have learned to appreciate the negative consequences of sleep disorders on a person's health, notes pulmonologist and sleep specialist Ravi Aysola, M.D., of the sleep medicine program in the Division of Pulmonary and Critical Care Medicine. "The medical evidence now proves what our mothers have always known to be true: A good night's sleep makes us healthy and happy."
That is a truism with which Dr. Avidan would heartily agree. "The bottom line is that sleep disorders can be as serious as any other major health problem, such as diabetes or heart disease," he says. "But what many people fail to realize is that treatment for sleep disorders is available and can lead to improved quality of life."