Wednesday, 27 September 2017

#ClinicSpeak & #BrainHealth: poor sleep and increased mortality

Poor sleep is the Big Elephant in the room; we need to do something about it. #ClinicSpeak #BrainHealth

Summary: We as a society are chronically sleep deprived. Sleep deprivation is associated with a large number of medical problems. Improving your sleep hygiene should reduce these problems and improve your quality of life. 

One of my patients sent me the link to the Guardian article below. I suggest you read and digest its contents; it is medical writing at its best. It summarises the science about poor sleep hygiene and discusses a list of common maladies that are associated with poor sleep. The following is a short list:

1. Obesity, metabolic syndrome, hyperglycaemia and hypertension
2. Stress, anxiety and depression
3. Reduced concentration, poor memory and dementia (Alzheimer's disease)
4. Cardiovascular disease: myocardial infarction
5. Increased risk of common infections
6. Reduced quality of life
7. Increased risk of making errors of judgement 
8. Reduced reaction times

The article highlights that at a population level we are chronically sleep deprived. Some of the factors driving this epidemic are cultural, i.e. 24/7 entertainment, stimulants (caffeine) and macho culture of burning the candle at both ends. It is quite clear that sleep deprivation is reducing our productivity and making us sick. 

I sent the article to my wife to read and she said that she hopes I take note. I am a veteran insomniac and have very poor, in fact shocking, sleep hygiene. I probably have 4-5 hours of sleep a day during the week and slightly more on weekends. In short, this is not good for me. I always feel tired and to get through a typical work day I have to consume 8-10  Nespresso capsules; any more than this and I get a caffeine tremor and anxiety. I am typically so wired by the end of the day that when I get home it takes me several hours to relax. Day 1 of restricting myself to two cups of coffee per day. 

I find exercise really helps reset things. When I was training for marathons I would be forced to go to bed early and would sleep like a baby and wake refreshed. The problem is that my exercise patterns have also become erratic; I have become a weekend warrior. 

Why I am telling you all this? Sleep hygiene is one of the issues that we address as part of our Brain Health initiative and is central to the holistic management of MS. I believe that I should practice what I preach; i.e. if I am to tell my patients to improve their sleep hygiene I need to improve my own. I am saying this to you, as I am making multiple typos having just completed an overnight trans-Atlantic flight during which I only got 3 hours of restless sleep. Time to have a sleep? 

Poor sleep is a major problem for pwMS. When I did a survey on sleep problems in pwMS on the blog a few years ago it showed that the majority of pwMS have sleep problems. The reasons for poor sleep were numerous with many people having more that one problem. I spend a lot of my clinic time addressing poor sleep in pwMS. I, therefore, urge you to assess your own sleep, if it is disturbed to identify why you are sleeping poorly and to then try and address the problems. 

When we get our group clinics off the ground one of them will be dedicated to sleep hygiene. Sorting out poor sleep usually means we have to sort out all your other symptomatic problems. 


Rachel Cooke. The shorter your sleep, the shorter your life: the new sleep science. The Guardian Sunday 24 September 2017 08.00 BST.

16 comments:

  1. Your late night tweeting and dedication to your work hasn't gone unnoticed Dr Giovannoni. Being a night owl is a hard habit to get out of. I'll take heed of this article and try to get in to a better sleeping pattern. Turning my phone off at night time would be a good start

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  2. Olha para o que eu digo não olhes para o que eu faço ....lolll

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    1. Look at what I say do not look at what I do, for our non-Portuguese readers similar to the English do what I say, not what I do.

      Diolch

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    2. Forgot to turn English brain mode ....lol

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  3. Speaking of sleep, melatonin is contradicted to MS, isn't that so?
    Are benzos safe (for not too long periods of use)?

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    1. There is a trial of melatonin for nocturia in MS currently running at BrAMS (Bristol and Avon MS) in UK.
      Benzodiazepines not a great idea even short term, I believe possible dementia risk? Temazepam used to be given out like sweeties 25 years ago, literally, they were bright yellow gel filled capsules. Then someone twigged that drug addicts were injecting the gel ;-)

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  4. It's darker in the mornings currently so I'm sleeping in until 6am, previously I would be awake about 4.30am. I need to invest in some blackout curtains for the bedroom.

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  5. lol i swear i have not slept since 2015....

    i don't have ms and my lack of sleep is due in part to my obsessive dedication to work and in part to stress.. i suspect not too indifferent to the various mouse docts and neuros on barts' team.

    my excuse is that my partner has ms, therefore a reduced life expectancy (if things don't go as well as we fight for) and therefore i need something to die from earlier than extremely old age.

    what are your (barts' team) excuses? :D

    incidentally, my partner's mum has had some lung related disease and, i strongly suspect, always expected to go before her husband. unfortunately, her husband died before her, unexpectedly, in his early 70s (too young to die in this day and age).

    can't win, hey?

    i read prof g's blog on that new medium about life being a terminal disease. what age do you want to make it to?

    my grannie is aged 92 and i'm not sure there is much joy in that either. she has survived 2 husbands, all her siblings and 90% of her friends...

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    1. Re: "my grannie is aged 92 and i'm not sure there is much joy in that either. she has survived 2 husbands, all her siblings and 90% of her friends..."

      This is what we call shrinking social capital. I agree it is not nice when you life shrinks down to a small space and repetitive daily routine without the enrichment you get from people and new experiences. Older people get lonely and tired of life; they describe themselves as being fatigued. It doesn't have to be like this; I know of 90+ people who are very active. It is a mindset.

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    2. My Mum is 90 & in the past year especially has had massive losses in her social capital. Although she has mobility issues & is now housebound, I believe the thing that keeps her going is her innate curiousity about the world. She reads the newspaper each day & loves to keep up with the latest movies. She loves a good political argument but is fast running out of people to have them with! I find the same trait in myself helps greatly in living with MS. I involve myself in arts, literature & everything else that piques my curiousity. I feel sure that engagement on the arts can really help those of us with MS & can form part of our holistic well being. I just need to sort out my sleep patterns to start some research into this! I read this piece on the guardian & really need to omprove tbis but MS is a bugger - i would LOVE to sleep a whole 6/7 hours without waking. I only manage 3 hours without some MS twitch or symptom waking me up. I'm looking forward yo hearing more about holistic issues - maybe I'll forward my research paper on Psychosocial Flourishing with MS (it won the MS Trust prize a couple of years ago). Best regards.

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    3. Exactly Professor G!

      I have a patient who is 102 years old. Everyday we walk a bit over a quarter mile!

      I've went with her to some seniors church dances, community center and more.

      Its a problem in care provision as well. Sure, I've had patients for years on end and then one day family makes a decision and they are no longer part of my life. Some pass. But know what? I enriched their lives and more so perhaps, they mine.

      It sometimes seems to me that more and more populations are treating aging as a condition, like a disease... ITS NOT.

      Which brings me to a new topic that is a wall coming at many an MS patient. Geriatric MS. It seems to be being completely neglected.

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    4. "Jane Wednesday, September 27, 2017 8:30:00 pm My Mum is 90 & in the past year especially has had massive losses in her social capital."

      That's exactly what happened to my grannie too... she was extremely active up until about a year ago, she travelled world wide and at the age of 90 would spend 6 months in Australia with us and 6 months in Europe with her other daughter and family.... a minor decline in health led to a cascade of issues and she is now as your mum sounds. She has vision and hearing problems and she had those for years but lived fine with them... until something broke the camel's back and it all went downhill very quickly.

      It's heartbreaking.

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  6. From a study a few years ago
    https://www.nih.gov/news-events/news-releases/brain-may-flush-out-toxins-during-sleep
    possible reason for "waking up and feeling refreshed"

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  7. "I am a veteran insomniac and have very poor, in fact shocking, sleep hygiene"

    Money never sleeps...
    Gordon Gekko

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  8. Sadly it's all a bit close to home. My Wife has had broken sleep for years due to nerve pain and lately she wakes every 20 mins or less for water, consequently I have broken sleep. My Wife sleeps in the day and has become nocturnal, whereas I go to work for three days a week and become like a zombie. This is just another where MS effects more than the person with MS and I have wondered for a long time what health implications it has for me.

    Regards as always.

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