It wasn’t until I reflected upon how many times the highway rumble strip had potentially saved my life that I sought the help of a physician trained in sleep medicine. Prior to that, no doctor had ever asked me about my intractable insomnia.
Sleep is increasingly being recognized as an underappreciated vital sign. An estimated 50 to 70 million Americans may have a sleep disorder, and according to the Centers for Disease Control and Prevention, a third of U.S. adults report getting less than the recommended amount of sleep. Meanwhile, one study found that only 43 percent of primary care physicians routinely inquired about sleep vs. the 79 percent who discussed healthy diet.
We tend to consider sleep as an afterthought, but an arsenal of evidence continues to demonstrate sleep’s complex interrelatedness to high blood pressure and cardiovascular disease, type 2 diabetes, obesity, depression, chronic pain, and even dementia. In fact, last year, the American Heart Association added sleep to its list of health and lifestyle factors, now called Life’s Essential 8 (other factors include nicotine exposure, physical activity, diet, weight, blood glucose, cholesterol, and blood pressure). A recommended 7 to 9 hours of sleep is felt to optimize cardiovascular health for adults.
The American College of Cardiology also recently highlighted new research demonstrating that “young people who have more beneficial sleep habits are incrementally less likely to die early” and that “about eight percent of deaths from any cause could be attributed to poor sleep patterns.”
We also understand that sleep architecture changes across the lifespan and that the decline in melatonin that occurs with aging and the onset of menopause may lead to a marked increase in sleep disturbances. This may further exacerbate cognitive decline as well as one’s risk for depression.
Sleep affects every organ system, and a reciprocal relationship between the immune system, sleep, and the central nervous system—where sleep enhances our immune defenses, and “afferent signals from immune cells promote sleep”—may provide a survival advantage: a “neurally integrated immune system that might anticipate injury and infectious threats.”
The evidence clearly falls in favor of assessing a patient’s sleep health. But how do we investigate potential sleep disturbances?
The Centre for Addiction and Mental Health (CAMH) in Canada distills sleep disorder categories down to the basics, with a little humor:
- problems initiating and maintaining sleep (insomnia)
- problems of too much sleep (hypersomnia, excessive sleepiness)
- circadian rhythm problems
- “things that go bump in the night” (parasomnias such as sleep paralysis)
Standardized sleep screening questionnaires developed by experts such as the American Academy of Sleep Medicine (AASM) can help identify sleep disorders among patients.
If we don’t ask, we won’t know, just as my doctors never knew.
Emily Kahoud is a medical student.