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Lack of Sleep Can Raise Blood Pressure Over Time
Risk increased as sleep duration decreased, researchers found.
By Jennifer Thomas June 9
MONDAY, June 8 (HealthDay News) -- Middle-aged adults who don't get enough sleep are at increased risk of developing high blood pressure, a new study has found.
A lack of sleep can raise your blood pressure over time, a new study suggests.
(ABC News Photo Illustration)
Over the course of five years, Kristen L. Knutson of the University of Chicago and colleagues collected health information, such as blood pressure readings, and measured the sleep duration of 578 adults with an average age of 40. Sleep duration was measured using surveys and a sensor worn on the wrist that records periods of rest and activity.
Adults who slept fewer hours than other study participants were significantly more likely to have higher blood pressure readings, the researchers found.
Adults who slept less were also more likely to develop high blood pressure as time passed. After five years, each hour of reduction in sleep duration was associated with a 37-percent increase in the odds of developing high blood pressure, or hypertension, according to the study findings published in the June 8 issue of the Archives of Internal Medicine.
The average amount of sleep a night among study participants was six hours. Only 1 percent averaged eight or more hours per night, the researchers said.
"Identifying a novel lifestyle risk factor for high blood pressure could lead to new interventions to prevent or reduce high blood pressure," Knutson's team wrote. "Laboratory studies of short-term sleep deprivation have suggested potential mechanisms for a causal link between sleep loss and hypertension."
High blood pressure contributes to 7 million deaths worldwide each year, and the condition affects one-third of Americans, according to background information provided in the report.
The authors also pointed out that sleep deprivation affects the body's stress response, which can raise the risks of developing high blood pressure.
The study, which excluded patients taking medication for high blood pressure and controlled for age, race and sex, also found that black men had higher blood pressure levels than women or white men. In addition, black men tended to get fewer hours of sleep, the researchers found.
"These two observations suggested the intriguing possibility that the well-documented higher blood pressure in African Americans and men might be partly related to sleep duration," the study authors concluded.
The Wall Street Journal just wrote about the problems of chronic sleep deprivation, along with the most common causes. Included in their list of "sleep stealers" are:
Noise, temperature -- can interrupt sleep
Light -- can confuse body clock
These problems can be solved at The Complete Sleeper, which sells products that make your bedroom dark and quiet.
Ask readers of this newspaper if they're getting adequate sleep, and many would probably say "Ha!"
Twenty percent of Americans sleep less than six hours a night, and nearly one-third have lost sleep worrying about financial concerns, according to the National Sleep Foundation, which recommends that adults get seven to nine hours. "Our society thinks sleep is for slackers," says Darrel Drobnich, the organization's chief program officer.
Millions of Americans aren't getting enough sleep, and even those that are may not be getting the most restful sleep possible. Health columnist Melinda Beck tries out the Zeo, a gadget that monitors and tracks brain waves during the different stages of sleep.
But all that lost sleep is taking an insidious toll. Chronic, inadequate sleep raises the risk of cardiovascular disease, depression, diabetes and obesity. It impairs cognitive function, memory and the immune system and causes more than 100,000 motor-vehicle accidents a year. Sleep deprivation also changes the body's metabolism, making people eat more and feel less satisfied.
Studies presented at the American Association of Sleep Medicine's annual meeting in Seattle this week also found that inadequate sleep is associated with lower GPAs among college students and with elevated levels of visfatin, a hormone secreted by belly fat that is associated with insulin resistance.
What many people don't realize is that even if they log respectable time in bed (known as TIB among sleep researchers), they may be getting poor-quality sleep, with not enough of the restorative phases. REM, the Rapid Eye Movement phase in which dreaming occurs, is crucial for consolidating memories, learning, creativity, problem-solving and emotional balance. Deep, or slow-wave sleep, when the body secretes human growth hormone, is critical for development and physical repair. Both REM and deep sleep decline with age and are highly vulnerable to disruptions, from caffeine and alcohol to anxiety and a variety of sleep disorders.
One tip-off that you haven't gotten enough restorative sleep is trouble waking up and excessive daytime sleepiness (a condition known as EDS). "People say, 'Oh, I don't have a sleep problem. I can fall asleep anywhere, anytime' -- but that means you are excessively sleepy," says Charles Czeisler, a professor of sleep medicine at Harvard Medical School.
Other symptoms of sleep deprivation include mood changes, difficulty focusing or remembering and a chronic need for caffeine, which can then create a vicious circle of dependence and disruption. That would be me.
Finding out what's going on in your sleep generally requires spending the night in a professional sleep lab hooked up to lots of wires and monitors. But I've been testing a new home-sleep monitor called the Zeo Personal Sleep Coach that lets people track their sleep patterns nightly in their own bedrooms.
You sleep wearing a soft headband with sensors that monitor your brain waves and send signals wirelessly to a device that looks like a sleek clock radio. It displays whether you are awake or in light sleep, deep sleep, or REM sleep, in real time, all through the night.
"If you can measure it, you can manage it," says Stephan Fabregas, one of two recent Brown University graduates who invented the Zeo because they were looking for a way to wake up feeling less groggy after late nights.
Of course, not everyone needs a fancy gadget to tell them whether they are sleeping properly. But I was stunned by my results: The Zeo showed that I woke up numerous times and was awake for long stretches of the night, without having any recollection. (Perception of time is often distorted at night -- many people with insomnia actually sleep more than they think they do.) Even though I was in bed for six or seven hours each night, I was averaging only about four hours of real sleep and very little REM or deep sleep. No wonder I feel so tired!
The Zeo stores the information on a memory card you can upload to a Web site, which helps track your sleep patterns and sends daily coaching tips for getting better sleep. The $399 device comes with six months of daily email coaching, which can be extended at a cost of $99 for each additional six months. (Currently, it's available only online at www.myzeo.com.)
To help you keep track of your sleep, the Zeo also gives you a "ZQ" score every morning, based on the quantity and quality of your sleep the night before. There's no ideal ZQ -- you're comparing your own score from night to night. But the average for people in their 20s is 86; for those in their 40s, it is 74; and for those in their 50s, it is 67, since sleep quality declines with age.
My ZQs bounced from the 40s to a dismal 15 the first week. Switching to decaf after 3 p.m. and making an effort to get to bed earlier helped me bring my score into the 50s the second week. ("Having caffeine even first thing in the morning can induce changes in brain activity during sleep," says Kenneth Wright, director of the Sleep and Chronobiology Lab at the University of Colorado at Boulder and one of Zeo's scientific advisers.) I also noticed that the nights when I had the longest stretches of wakefulness were those when my column was due -- probably a sign that I was still thinking about it long after turning in.
Everybody's sleep and sleep disruptors are different. Todd Johnson, a 40-year-old border-patrol agent in Caribou, Maine, and one of ZEO's early testers, found that reading before he went to bed helped reduce his wake time and bring his ZQ from the 20s into the 60s. "You can try something that night and see the results in the morning," he says. Another early tester, Tim Guirl, who teaches at a community college in Seattle, found that he had more restorative sleep if he didn't exercise too close to bedtime and eliminated a large late-night snack.
Other recommendations from Zeo include reducing noise, light and disruptive influences like pets in the bedroom; having a "power-down" hour before bedtime with no email, no Internet use, no cellphones and no BlackBerrys; and keeping a consistent sleep schedule. And if you find yourself awake and worrying, Zeo recommends getting out of bed and writing down what you're thinking about in a "worry journal."
Zeo says its brain-wave results are similar to those from professional sleep labs -- but only about 140 people have tested it so far. And the Zeo isn't designed to diagnose actual sleep disorders, which plague an estimated 70 million Americans -- you need to see a doctor for that.
To see if something besides drinking coffee and thinking great thoughts was affecting my sleep, I underwent a sleep study at the Sleep Health Center connected with Brigham and Women's Hospital in Brighton, Mass. A polysomnography, as such tests are called, measures brain waves like the Zeo, but also heart rate, respiratory rate, oxygen saturation, body positions and movements. It took about 45 minutes to have all of the sensors and wires attached -- and then a little longer to get comfortable enough to sleep.
To my surprise, the study found that I had a fairly severe case of Periodic Limb Movements, episodes of involuntary muscle movements in the night. About 10% of adults have PLMs. Many don't even notice; sleep partners are often bothered more than the sleepers themselves. But PLMs can be very disruptive if they are accompanied by arousals from sleep. I was averaging 42 arousals per hour. According to David White, another Harvard sleep physician who prescribed the study for me, PLMs can be due to an iron deficiency or medication side effects, and they are often related to "restless-leg syndrome," which causes an irresistible urge to move the legs, day or night. Medications like Requip can minimize the movements; I'm going to give them a try.
The study also showed I had some obstructive sleep apnea, in which the airway narrows, especially when the muscles relax in sleep. People with OSA stop breathing momentarily until a lack of oxygen alerts the brain, which wakes them up with a gasp. These mini arousals can occur as often as 70 times an hour, leaving the sufferer exhausted and at risk for heart disease, stroke and atherosclerosis. An estimated 4% of men and 2% of women have OSA. One telltale sign is having a shirt-collar size larger than 17 inches. Another sign is loud snoring, although I certainly don't do that. ("Women never snore -- they all deny it," says Dr. White.)
The Zeo sleep monitor lets people track their sleep patterns at home.
The most effective treatment is a Continuous Positive Airway Pressure machine, which blows air through the nose to keep the airway open. My OSA isn't that bad -- yet. Other remedies include a dental appliance that helps prop the airway open and losing weight, which helps reduce the airway blockage.
Dr. White is also chief medical officer for Philips Home Healthcare, which makes a watch-like monitor, called an Actiwatch, that tracks whether the wearer is moving or still, roughly corresponding with sleep. The Actiwatch doesn't show sleep phases; it generally diagnoses problems with jet lag and body clocks. I wore one for a week, and although I'm still a night owl, it showed nothing amiss in that area.
All in all, "there are plenty of ways you can improve your sleep," Jason Donahue, another Zeo founder, tells me cheerily. This week, I'm starting in on Zeo's tips on keeping disturbances in the bedroom to a minimum. The dog may have to find a new place to sleep.
See tip #3: "Your sleeping environment makes a huge difference to the quality of your sleep."
All of this and more can be yours...at The Complete Sleeper..where you can get everything you need for an ideal sleep environment (sleep masks, earplugs, sound conditioners and blackout liners).
Would you like to sleep like a baby without taking drugs? Americans spend upwards of 3 billion dollars a year on sleep medications, but to avoid the side effects, there are a number of natural remedies you can try first. Read on to learn some of the ways to get a good quality night's sleep.
1. Relaxing Rituals to Rest Easy In Chinese Medicine, nighttime is yin time—or, simply, when the body takes care of itself instead of your desires. Proper sleep is required for your body to repair itself and regenerate. To reach deep, restful sleep, your spirit and heart must be calm. Excessive worry, anxiety, and depression can all disturb the spirit and activate the mind—making it near impossible to fall asleep and stay asleep. Rituals to sooth your spirit and induce a sleep response before bed include soaking your feet in Epson salts for 15 minutes, writing all of your thoughts in a journal to get them out of your head, and practicing relaxation before bed, like the Stress Release meditation below.
2. When Food Disturbs Sleep When you eat late, you wake up tired. Your body will be busy digesting your dinner while you are trying to sleep, so you won't feel rested in the morning. Do not eat anything for at least three hours before bedtime. Also, cut back on eating bacon, cheese, chocolate, ham, potatoes, tomatoes, and sausage, especially before bed. These foods contain tyramine, which inhibits neurochemicals like norepinephrine and can cause insomnia. And, of course if you have sleep problems, caffeine should be cut out.
Eat for sleep! Try eating more grains at dinner; carbohydrates tend to make people sleepy. Another snooze snack is a warm cup of milk; because milk is rich in the amino acid tryptophan, it can sometimes aid in deep sleep. Mix in natural vanilla flavoring for a soothing snack. Or if you prefer, eat 1 cup of natural yogurt an hour before bedtime.
3. A Peaceful Place for Sleep Your sleeping environment makes a huge difference to the quality of your sleep. Do everything you can to create a quiet and cozy atmosphere. Ideally, your bedroom should be located in the quietest area of your home. Keep the décor minimal. Lighting should be dim and any music that is played should be soothing. Research has found that lavender, vanilla, and green apple are among the best scents to help lower anxiety and induce sleep, making these smells a good choice for a scented candle or heated essential oil. Try to limit your pets to outside of the bedroom because their movements will keep with your body from fully relaxing into deep R. E. M. sleep. As much as possible, your bedroom should be only for sleep.
4. Exercise Enables Sleep People with regular exercise routines often sleep better and have fewer incidents of insomnia than those don't get regular physical activity. Exercise promotes sleep and improves sleep quality by altering brain chemistry. Exercising moderately for 20 to 30 minutes three times a day, combined with meditation or tai chi in the evening, will not only help you fall and stay asleep, but will also increase the amount of time you spend in R.E.M. sleep. In fact, for some people, exercise alone is enough to overcome sleep problems. Exercise in the morning or afternoon, but do not exercise for at least two hours before bed. 5. Herbs to Sleep Tight A calming tea before bedtime can ensure a good night's sleep. Drink valerian or passionflower (or passiflora) tea before bedtime every night for one month. Simply steep 1 to 2 tablespoons of the dried herbs in one cup of hot water and drink just before bed. Or look for one with the traditional Chinese herbs zizyphus or jujube seed, bamboo shavings, and oyster shell, which soothe the mind and spirit.
You might also try Calm-Fort/Sleep formula with useful herbs like lily bulbs, polygala and turmeric that help manage stress and calm the spirit while relieving restlessness and insomnia.
6. A Sleep-Friendly Meditation I had one patient with insomnia who also felt anxious and even a little depressed. In addition to acupuncture and herbal therapies, I decided to teach her a stress release meditation that she could do before bedtime to help with her anxiety. I am happy to report that she is now sleeping like a baby.
Try this Stress Release meditation, which works for the majority of my patients who have sleeping problems:
Sit comfortably or lie down on your back. Slow your respiration to deep, abdominal breathing. Utter the word "calm" in your mind with every exhalation. Focus on relaxing each area of your body in sequence, from the top of your head to your toes. Starting with the top of your head, inhale and then exhale while visualizing your scalp muscles relaxing. Say "calm" in your mind. Repeat this with each body part as you move down through all body parts, front, back, and sides, in succession: your face, throat, chest, arms, stomach, abdomen, thighs, knees, legs, ankles, until finally you reach your feet. When you've relaxed your feet, visualize all the tension in your body leaving through your toes as dark smoke. Practice this for at least 15 minutes before bedtime.
It will have you sleeping in no time. If you do better with meditative visualizations that are narrated, try my Stress Release CD.
I hope you find the ways to resting easy and waking up refreshed!
May you stay healthy, live long, and live happy!
-Dr. Mao
Visit The Complete Sleeper, where you can get everything you need for an ideal sleep environment (sleep masks, earplugs, sound conditioners and blackout liners).
Here's a great article by the National Sleep Foundation entitled "The Sleep Environment". It relates the importance of the products offered by The Complete Sleeper. Here's the article:
The Sleep Environment
Does that drip, drip, drip of the faucet keep you up at night? Do you need to keep your fan running because "white noise" helps you sleep? Have you ever tossed and turned because you were too hot, or too cold? What about the barking dog or cat that jumps onto your bed – have they ever disrupted your zzz’s? Most of us recognize that the sleep environment can greatly affect how (and if) we sleep, but are you doing everything you can to make your bedroom a sleep haven? Learn about the do’s and don’ts of the sleep environment and then get tips for making your bedroom more sleep-friendly.
Noise
Noises at levels as low as 40 decibels or as high as 70 decibels generally keep us awake. That means that a dripping faucet can steal your sleep, as well as the next door neighbor’s blaring stereo. But the absense or presence of a familiar noise can have as great an impact on your sleep as out-of-the-ordinary noises – studies show that sirens and traffic noise from a city street can actually become soothing to longtime city sleepers (they will cringe at the thought of sleeping in the serene desert or mountain climate) just as the absence of the tick, tick, tick of your favorite clock while you try to sleep at a hotel can become a sleep stealer.
What to do: Try to block out unwanted sounds with earplugs or use "white noise" such as a fan or an air conditioner. Take your favorite clock with you when you travel in order to recreate familiar sounds that help you sleep (as long as they won’t keep your neighbors awake!)
Temperature
In most cases, temperatures above 75 degrees Fahrenheit and below 54 degrees will disrupt sleep, but even sleep researchers fail to agree on the ideal temperature for sleep. The point at which sleep is interrupted due to temperature or climate conditions varies from person to person and can be affected by bed clothes and bedding materials selected by the sleeper. In general, most sleep scientists believe that a slightly cool room contributes to good sleep. That's because it mimics what occurs inside the body when the body's internal temperature drops during the night to its lowest level. (For good sleepers, this occurs about four hours after they begin sleeping.)
What to do: In general, sleep scientists recommend keeping your room slightly cool -- but achieving the ideal temperature isn’t always simple. What do you do if you and your partner disagree about room temperature? Turning the thermostat down at night in cold weather saves on fuel bills and sets the stage for sleep. Blankets, comforters or electric blankets can lock in heat without feeling too heavy or confining. Or the heat-seeking partner might dress in warmer bedclothes while the warmer partner might opt not to wear sleep clothes or bed covering. In summer, a room that's too hot can also be disruptive. In fact, research suggests that a hot sleeping environment leads to more wake time and lighter sleep at night, while awakenings multiply. An air conditioner or fan can help, and a humidifier can provide relief if you’re suffering from a sore throat or dryness in your nose.
Light
Much of our sleep patterns – feeling sleepy at night and awake during the day – are regulated by light and darkness. Light - strong light, like bright outdoor light (which is brighter than indoor light even on cloudy days) - is the most powerful regulator of our biological clock. The biological clock influences when we feel sleepy and when we feel alert. As a result, finding the balance of light and darkness exposure is important. Bright light helps to keep you awake during the day, but during sleep, bright lights can be disturbing.
What to do: Make sure to expose yourself to enough bright light during the day. Find time for sunlight, or purchase a lightbox or light visor to supplement your exposure to light. At bedtime, think dark: a dark bedroom contributes to better sleep. Try light-blocking curtains, drapes or an eye mask. If you find yourself waking earlier than you'd like, try increasing your exposure to bright light in the evening. It may delay sleep onset but as little as one to two hours of evening bright light exposure may help you sleep longer in the morning. Also, make sure to avoid light if you wake up in the middle of the night to go to the bathroom. Minimize light by using a low illumination night light.
Sleeping Surface
For the most part, we know people sleep better when horizontal and not cramped by space. Not much research has been done to understand the sleeping surface, but it is clear that it plays a role in getting a good night’s sleep. For example, tossing and turning on a lumpy 20-year-old mattress that doesn’t provide support for your back or neck can impede you from getting the sleep you need and make you very sleepy (and stiff) the next day. Mattress experts say that too often consumers believe that ultra-firm mattresses are good for them, but research on patients with back pain found this was not true and a more supple, comforting mattress may lead to better sleep.
Also, know your pillow: research shows that pillows house thousands of fungal spores which can trigger allergies and compromise a weakend immune system. The research shows that synthetic pillows held a greater amount of bacteria than feather pillows – one study found that synthetic pillows had as much as five times more dust-mite fecal matter than feather pillows (feather pillows have thick casing to keeps feathers in). So, not only can a pillow affect your posture and quality of sleep, but it can also affect your allergies or asthma and make it very difficult to get a good night’s rest.
What to do: Give yourself enough space to sleep. If you share a bed with a partner, make sure it is large enough to give both of you room to move around. Replace an old mattress with a new one, and choose a pillow and mattress that fits you best (soft, firm, thick, thin?) and will be comfortable throughout the whole night. Consumer Reports recently found that consumers who spent 15 minutes or more testing each mattress at the store were more likely to be happy with their purchase. Also, consider encasing your pillow in a plastic cover under your pillowcase to keep dust-mites from interfering with your sleep and allergy or asthma symptoms.
Other Factors
Bed partners with sleep disorders can negatively impact your sleep. Have you ever been kept awake by your partner’s snoring? Or been jolted out of a sound sleep by your partner’s restless movements? If so, you’re not alone. According to NSF’s 2005 Sleep in America poll, 67% of respondents reported that their partner snores, 27% said their intimate relationship was affected because they were too sleepy, and 38% said they have had problems in their relationship due to their partner’s sleep disorder.
What to do: Start off by talking to your partner about the problem. If he/she has not sought treatment for a potential sleep disorder, encourage them to see a doctor. Consider ear plugs if snoring prevents your sleep. Try to create a sleeping arrangement that is comfortable for both you and your partner. Keep the lines of communication open.
TVs, computers, and work in the bedroom are sleep stealing culprits. NSF’s 2005 Sleep in America poll found that 87% of respondents watched TV within an hour of going to bed at least a few nights a week. Doing work, watching TV and using the computer, both close to bedtime and especially in the bedroom, hinders quality sleep. Violent shows, news reports and stories before bedtime can be agitating. The sleep environment should be used only for sleep and sex.
What to do: Avoid highly engaging activities such as watching dramatic TV or doing work close to bedtime. Keep the TV and computer out of your bedroom! Make your bedroom a place that is centered around sleep.
Cats and dogs can be cuddly in bed, but they may be interfering with your sleep. Anyone who has slept with another person in their bed knows that sharing a sleeping space can be disruptive, but when your four-legged friend gets added to the mix, it becomes even more complicated! While a pet can make your sleep environment more comfortable, it is not mindful of whether it is interfering with your sleep.
What to do: Think about providing your dog or cat with a bed in your bedroom, instead of sharing your bed. Well-rested pet owners will have more energy and love to give to their pets!
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