#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.

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