Dr Deborah Lee from Dr Fox Online Pharmacy analyses insomnia in the UK and why getting enough sleep is vital for healthy ageing
Sleep is as vital for good health as diet and exercise. Getting enough sleep should not just be an afterthought or an optional extra – it’s an emergency. And below, I’ve set out some of the reasons why.
Sleep is a time for metabolic regulation & detoxification
Far from being inactive, we know that during sleep, the body undertakes an intense program of metabolic regulation. Glucose homeostasis, for example, depends on the duration and quality of sleep. Sleep improves insulin sensitivity and stimulates insulin production by pancreatic islet cells. Leptin and ghrelin – the hormones that regulate appetite and satiety are also produced during sleep. These are vital for the control of our body weight.
A short sleep duration has been found to be strongly correlated with an increased risk of type-2 diabetes.
During sleep, the brain undergoes a detoxification process resulting in improved memory and brain function.
Chronic sleep deficiency has such a marked effect on well-being that scientists liken it to alcoholic intoxication. Lack of sleep negatively affects mood, emotions, concentration and productivity at work.
Moreover, not getting enough sleep can reduce our lifespan. In a 2019 cohort study of over 50,000 adults followed up for up to 16 years, those who slept less than 7 hours per night had a reduction of 1-3 healthy, disease-free years of life, as compared to those who obtained 7- 8.5 hours of sleep per night. In those with severe sleep disturbance, this was further reduced by 3-6 years.
Many doctors do not understand the importance of sleep
Despite the unquestionable importance of sleep, it has not received the attention it deserves from the medical profession. Recent research indicates that primary care doctors do not regularly assess sleep and feel uncertain about the diagnosis of insomnia.
In one study, 75% of patients had been suffering from insomnia for over a year, but only 11.1% had discussed this with their doctor. This could be for a number of reasons, including the fact that other symptoms, such as depression or pain, can mask insomnia.
However, GPs have described their knowledge of sleep and sleep disorders as ‘fair’ or ‘poor.’ This may be due to a lack of sleep tuition in the undergraduate medical curriculum, and difficulty accessing education about sleep as part of continuous professional development.
Public health does not always give sleep a priority either. In one American review of health questionnaires used in 121 primary care facilities, only 43% contained questions about sleep, in comparison to 100% which contained questions on smoking and alcohol.
Insomnia in the UK – the size of the problem
Insomnia remains a major UK health problem, with 67% of adults saying they have disrupted sleep and 23% of adults only sleeping for 5 hours or less per night. Around half of UK adults feel they are not getting enough sleep, but a similar percentage – 51% – admit they are not trying to do anything about it. 13% take sleeping pills, and 13% use alcohol to try and help them sleep.
Insomnia in older people
Older people over 60 are more likely to develop insomnia. For every decade of life, a person over 50 loses 27 minutes of sleep per night. Older people have less slow wave and less REM sleep, meaning they tend to have more periods of wakefulness in the night and wake up in the morning unrefreshed.
Although medications such as benzodiazepines and Z- drugs (such as zopiclone) can help sleep, these are associated with drug dependency and withdrawal symptoms. These drugs are also associated with an increased risk of falls. Doctors prefer to try and improve insomnia through non-pharmacological methods.
Older people are also at increased risk of sleep disorders, such as circadian rhythm sleep disorder, sleep-disordered breathing, periodic limb movements and restless legs syndrome. In REM sleep behaviour disorder, linked to Parkinson’s Disease and Lewy Body dementia, patients act out their dreams and lash out with limb movements during sleep.
First-line management of insomnia in the elderly does not involve using sleep medication. Older people, as all adults, should be advised to be fastidious about their sleep hygiene and bedtime routine.
Link between insomnia & Alzheimer’s Disease
Insomnia is a common finding in patients with Alzheimer’s Disease (AD). Sleep is vital for the removal of excess beta-amyloid and tau proteins from the brain. In fact, research suggests that abnormal sleep increases the risk of AD, but also that AD causes sleep abnormalities – so this is a two-way phenomenon. Disturbed sleep can occur many years before the onset of cognitive decline and has even been shown to increase the risk of AD by 50%.
AD patients often have wakeful periods during the night, during which they may get up and wander. Consequently, they feel tired and often nap during the day. AD patients often experience ‘sundowning’ – meaning they become restless and agitated in the early evening. Sleep medication may be necessary for those with AD. The drug, Belsomra is sometimes used, which inhibits orexin – a neurotransmitter involved in the sleep-wake cycle.
Why sleep is vital for healthy ageing
What is meant by healthy ageing? This can be defined as growing old but staying free of disease, maintaining a high level of cognitive and physical function, and being actively engaged with everyday life.
However, various studies have shown that poor sleep efficiency and reduced sleep quality are predictors of mental and physical deterioration. In one study, those with less than 80% sleep efficiency almost doubled their mortality risk. To improve the disease burden in the elderly, improve quality of life, and maximise longevity, we must ensure that both the adult population and their doctors understand the seriousness of getting 7-hours of good quality sleep per night.
Final thoughts – the emergency of sleep
Too often, sleep is not given the priority it deserves. We get into bed, have another bad night, and just hope tomorrow night will be better. It never seems serious enough to bother the doctor. But it’s time to face the facts – insomnia is as bad for our health as smoking and drinking. If we want to age healthily, we must get enough good sleep. It’s also time the medical profession took insomnia seriously.
Sleep is not an optional extra – it’s an emergency.
• What steps can a person take to improve their sleep?
• How can we best help our patients to sleep better?
References
1. https://www.cdc.gov/pcd/issues/2013/13_0081.htm#:~:text=Sleep%20may%20play%20an%20important%20role%20in%20metabolic,critical%20to%20health%20as%20diet%20and%20physical%20activity
2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3289068/
3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4651462/
4. https://pubmed.ncbi.nlm.nih.gov/29415200/#:~:text=Persons%20who%20did%20not%20have,who%20reported%20severe%20sleep%20disturbance
5. https://www.sleepfoundation.org/insomnia/older-adults
