Restful Sleep: A Key Anti-Aging Initiative

By STEPHEN HOLT, MD
LLD(Hon.), ChB, FRCP, MRCP(UK), FACP, FACG,FACN, FACAM.

INSOMNIA
40% of Americans: intermittent insomnia
15% of adults: severe or chronic insomnia
30% of chronic insomniacs have no identifiable underlying disorder
Sleep deprivation causes premature aging
Sleep problems increase with age

Sleep Changes with Age
Sleep architecture (stages) changes
Greater nocturnal disturbances
More disorders interfere with sleep
Daytime napping

Causes of Sleep Problems with Age
Poor sleep habits: irregular patterns with altered circadian rhythm
Medical illness: cardiovascular disease, arthritis, Alzheimer’s, menopause
Psychological distress: family deaths, physical limitations, psychiatric disorders
Sleep disorders: apnea, restless legs n Retirement: increased downtime

SLEEP 101
Stage 1 : Light, drifting sleep, slow EM, muscle relaxation (cascade of events)
Stage 2 : EM stop, slow brain wave, bursts of sleep spindles
Stage 3: delta waves, small fast waves
Stage 4: deep sleep, dominant delta waves, no EM, no muscle contraction
Stage 5: REM sleep, rapid breathing, eye jerks, limb paralysis and dreams

SLEEP 101
Passage through all 5 stages n
Each cycle of 2 hours duration
Restarts with Stage 1 n
Repeat cycles are shorter with increased amounts of REM sleep
50% sleep time in Stage 2, 20% REM n Infants 50% REM, REM declines with age

Sleep Assessment: “BEARS”
Bedtime: sleep induction
Excessive drowsiness: impaired cognition
Awakening: frequent or early morning n Regularity and sleep duration
Snoring, sleep apnea and somnambulism

Medical Disorders Reduce Sleep
Arthritis
Osteoporosis
Heartburn
Cancer
Parkinson’s
Dementia
Cardiac Ischemia, PVD
COPD
CHF
Alzheimer’s
Incontinence n
GERD

Common Causes of Insomnia
n Stress n Depression, Anxiety n Physical Illness n Caffeine
n Irregular schedules n Circadian rhythm disorders n Drugs n Pain

Syndrome of Sleep Deprivation
OBTRUSIVE
Drowsiness
Poor memory
Lack of motivation
General fatigue
Poor concentration
Behavior problems
“Blues” or depression
Accidents

UNOBTRUSIVE
DRUG EVENTS
OBESITY
SYNDROME X, DIABETES
HORMONAL CHANGE
PREMATURE DEATH

ADVERSE DRUG EVENTS

ADVERSE DRUG EVENTS

ADVERSE DRUG EVENTS: Resources
Kripke , D.F. www.thedarksideofsleepingpills.com
Search www.ncbi.nlm.nih.gov/Pub/Med/
Holt, S. The Sleep Naturally Plan, Wellness Publishing, NJ, 2003

ADVERSE DRUG EVENTS
OTC : Sominex , Nytol , Unison, Theraflu
BENZODIAZEPINES : Halcion , Prosom , Restoril
NONBENZODIAZEPINES: Ambien , Sonata, Lunesta
SEDATING ANTIDEPRESSANTS: Desyrel , Amitriptyline , Nortriptyline
MELATONIN: Incorrect use?

ADVERSE DRUG EVENTS
All cause prolonged drowsiness, most cause lightheadedness, dizziness, headache, or GI upset
All involve development of tolerance
All cause variable dependence
Not safe in pregnancy, childhood, etc
Eating disorders, sleepwalking, driving

OBESITY
Sleeplessness causes obesity
Average sleep duration fallen n Study, December 7, 2004, Ann. Int. Med
Decrease leptin , increased ghrelin
Carbohydrate craving with sleep loss
The Sleep Naturally Plan
A new innovation in weight loss

METABOLIC SYNDROME X

SYNDROME X, Y, AND Z.

PATHOPHYSIOLOGY-X CAUSES PREMATURE AGING
Insulin resistance
Obesity
High blood LDL
Low blood HDL
Slow clearance of fats from blood
Inflammation
Cholesterol synthesis
Hyperglycemia
Blood clotting
Hypertension
Hyperuricemia
Homocysteine
Carcinogenesis

DIABETES
Sleep deprivation in young healthy males results in abnormal glucose tolerance
Metabolic Syndrome X is a principal forerunner of type 2 Diabetes Mellitus
Carbohydrate metabolism has major effects on sleep cycles

HORMONAL CHANGE
Biorhythms are closely linked to hormonal secretion
PMS and menopause symptoms are linked closely to sleep deprivation
PCOS (Syndrome X of the ovaries)
Estrogen dominance?
Chemical messengers (interleukin)

PREMATURE DEATH
Sleeping drug usage associated with increased mortality
CPSI: 1959, ACS, 1m sample, 50% more of those “often” taking sleeping pills died compared with matched age, sex and health status who never took these drugs
CPSII: 1982, ACS, 1.1m sample, similar outcome as CPSI
Reference: Kripke , DF et al. Mortality hazard associated with prescription hypnotics. Biol Psychiatry. 1998;43:687-693

PREMATURE DEATH
CPSII: Individuals match for age, sex, race, education and 32 health risk factors who reported taking sleeping tablets 30 times per month had 25% greater mortality n Up to 15% increased mortality from infrequent use of sleeping pills
Conclusion: 30/month =risk of 1 pack cig/d Causal relationship? suicide, CVS, cancer
Reference: Kripke , DF et al. Mortality associated with sleep duration and insomnia. Arch Gen Psych

THE SLEEP NATURALLY PLAN

SLEEP NATURALLY: Phase 1
Medical consultation important
Abnormal sleep events, e.g. sleepwalking, narcolepsy and sleep apnea, should not be self-managed
Regular sleep schedule important with sleep modification programs e.g. bed deprivation.
Regular bedtime routines and sleep hygiene.

SLEEP NATURALLY: PHASE 2
Environmental controls and good gadgets
Posture, beds, clever pillow supports, chiropractic adjustment
Regular exercise at the right time of the day
Care with drugs and diet
Alcohol, caffeine, smoking, illicit drug use, diet pills, diuretics are enemies of restful sleep.
Nutritional support is part of FIRST LINE OPTION

SYNERGISTIC SUPPLEMENTS FOR CASCADE OF SLEEP
HERBS: Valerian, Chamomile, Ashwagandha , Passion flower, Lemon Balm, Catnip, Skullcap, Hops
HORMONES: Melatonin
NUTRIENTS: Amino acids, 5-HTP, Magnesium, Niacin (B3), Pyridoxine (B6), Folic Acid

RED FLAG SIGNS & SYMPTOMS
Talk to the bed partner
Disruptive snoring, irregular breathing
Co-existing psychiatric disorders
Dependence on drugs to sleep
Greater than 1 month without sound sleep
Mood disorder with sleep deprivation
Inappropriate daytime sleeping
HERBS FOR SLEEP
VALERIAN: sedative, anti- myoclonus , GABA breakdown inhibition, carminative, no hangover cf benzodiazepines, adaptogenic
CHAMOMILE : calming, analgesic, anti-inflammatory, antioxidant, carminative
ASHWAGANDHA: nervine , adaptogenic , mild sedative, “Indian Ginseng”
PASSIONFLOWER: nervine tranquilizer

HERBS FOR SLEEP
LEMON BALM: sedative, anti-spasmodic, nervine , value in depression, GI soothing
CATNIP: mild sedative, anti-anxiety
SKULLCAP: anti-anxiety without drowsiness, adaptogenic
HOPS: sedative-hypnotic, smooth muscle relaxation, close cousin of marijuana

MELATONIN
The “vampire” of hormones
Decline with age
Shortens sleep induction time and reduces awakening, without increased sleep time
Valuable with irregular schedules, jet lag
Side effects: fatigue, depression, BP?, fertility, caution in sleep apnea?
Powerful antioxidant

NUTRIENTS
MAGNESIUM: EEG changes and muscle relaxation, calcium?
AMINO ACIDS: glycine,5-HTP: benefits in depression, weight control and CNS disease
B VITAMINS: classic anti stress combination of B3 B6 with folate , anti homocysteine , obligatory for neurotransmitter synthesis e.g. serotonin

CONCLUSION
Without restful sleep health cannot prevail
Sleep problems cause mental and physical disease with high economic cost
Drugs for sleep cause mental and physical disease with high economic cost
Ways of reducing the use of hypnotic drugs is an important public health initiative
FIRST LINE management of sleep disorders involves lifestyle change and nutritional support with synergistic supplements

OLD ADVICE IS GOOD ADVICE
” THE TREATMENT OF INSOMNIA BY DRUGS IS ALWAYS TO BE AVOIDED AS MUCH AS POSSIBLE”
– H.C. WOODS, 1893, cited by D.F. Kripke

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