Insomnia Is Not a Trivial Concern

If you’ve struggled with chronic insomnia for years, even if you have some reliable management strategies, you may occasionally find yourself talking about insomnia with people whose looks and responses suggest it can’t be such a big deal.

“Aren’t there pills for that?” “My doctor says that’s self-inflicted. You just THINK you can’t sleep.” Here’s some new research that shows why persistent insomnia is a serious problem deserving of concern and treatment.

Talking about insomnia with friends.If you’ve struggled with chronic insomnia for years, even if you have some reliable management strategies, you may occasionally find yourself talking about insomnia with people whose looks and responses suggest it can’t be such a big deal.

“Aren’t there pills for that?”

“My doctor says that’s self-inflicted. You just THINK you can’t sleep.”

Here’s some new research that shows why persistent insomnia is a serious problem deserving of concern and treatment.

Benefits of Sleep

First, though, let’s review the central role sleep plays in maintaining well-being. In the past, people thought that nothing much happened during sleep and that the human brain essentially shut down at night. How wrong that notion was!

Many critical functions occur during sleep. Sleep enables the shoring up of the immune system and the repair of injuries. During sleep, memories are consolidated and brain waste is pruned. Negative emotion is processed during REM sleep. After a full night’s sleep you awaken in a more positive mood. During sleep energy is conserved. In the morning you awaken feeling rested and restored, and your brain is primed to learn and retain new information.

When sleep is disrupted, whatever the reason, the critical functions that take place during sleep may be compromised. In the case of chronic insomnia, common symptoms during the daytime—tiredness and lack of stamina; moodiness; and impaired attention, concentration, and memory—are suggestive of compromise. They cut down on the quality of our day-to-day lives.

Effects of Persistent Insomnia Over Time

Chronic insomnia also has several more insidious effects.

It increases the odds of our developing depression and anxiety. A new meta-analysis of studies on insomnia as predictor of mental illness has found that chronic insomnia makes us nearly 3 times as likely to develop major depressive disorder and over 3 times as likely to develop an anxiety disorder as people without insomnia.

Insomnia and Chronic Pain

Insomnia intensifies and increases susceptibility to pain. Past research has suggested that the relationship between insomnia and pain is bidirectional, with painful conditions interfering with sleep and sleep disturbances worsening painful conditions. But recent longitudinal studies (studies involving repeated observations over time) suggest that more often it’s insomnia symptoms that predispose us to chronic pain or to the worsening of painful conditions.

Insomnia and Heart Disease

Insomnia, especially when accompanied by objectively measured short sleep duration (less than 6 hours), makes us more susceptible to heart, or cardiovascular, disease (CVD). Meta-analyses have found that people with insomnia are between 33% and 45% more likely to develop and/or die of CVD than people without insomnia.

A new study of sleep duration and atherosclerosis (plaque formation in arteries) has found that short sleepers are 27% more susceptible to atherosclerosis than people who sleep 7 to 8 hours a night, and those whose sleep is highly fragmented are at even greater risk (34%) for plaque build-up.

A disorder that has so many negative effects on quality of life and long-term health cannot be dismissed as a minor annoyance. It’s important to get treatment for insomnia as soon as possible, with cognitive behavioral therapy or, in cases that don’t respond to CBT, medication.

Talking About Things We Know

Despite what you might infer from the fact that I blog about insomnia, I don’t go around seeking opportunities to talk about the problem in my everyday life. Sleep disorders now get quite a bit of attention in popular media, but most of us know the topic has the appeal of moldy leftovers for the good sleepers of the world — and they are in the majority.

Occasionally, though, conversations turn to talk about sleep, at a party or a meeting or anywhere in casual conversation. And who better than us to raise people’s awareness about the problem of insomnia since we’re the ones with all the experience?

If you’ve talked about insomnia with your family, friends, or acquaintances, what has been their reaction?

“Sleep Was Easier to Give Up Than the Job”

Several people I interviewed for The Savvy Insomniac blamed their insomnia on stress at work. A trial lawyer attributed his nighttime wake-ups to “mostly job related stress.” A 52-year-old woman on Social Security disability saw her insomnia as resulting from 14 years of shift work as a dispatcher with emergency services.

Work can interfere with sleep in many ways, including shortening sleep duration. The CDC has just released a report on the categories of work most likely to shorten people’s sleep. Here’s what they are and how they may relate to chronic insomnia.

Persistent trouble sleeping can develop from years of shift workSeveral people I interviewed for The Savvy Insomniac blamed their insomnia on stress at work. A trial lawyer attributed his nighttime wake-ups to “mostly job related stress.” A 52-year-old woman on Social Security disability saw her insomnia as resulting from 14 years of shift work as a dispatcher with emergency services.

Work can interfere with sleep in many ways, including shortening sleep duration. The CDC has just released a report on the categories of work most likely to shorten people’s sleep. Here’s what they are and how they may relate to chronic insomnia.

Occupations Associated With Short Sleep

The findings are based on surveys conducted on working adults in 2013 and 2014. By telephone, workers answered questions about the kind of work they did and how much sleep they normally got in 24-hour period. In all, the CDC analyzed the responses of nearly 180,000 people. The data show a high percentage of workers in these five broad categories typically slept less than 7 hours a night:

  1. Production (printing workers, plant and system operators, supervisors, and production workers), about 43%
  2. Healthcare Support (nursing, psychiatric, and home health aides), about 40%
  3. Healthcare Practitioners and Technical (health technologists and technicians, health diagnosing and treating practitioners), about 40%
  4. Food Preparation and Food-Related (supervisors, food preparation and serving workers, cooks), about 40%
  5. Protective Service (fire fighting and prevention workers, law enforcement officers), about 39%

Occupations Involving Shift Work

The jobs in all five categories often involve shift work. Round-the-clock operations in hospitals, factories, restaurants, and police and fire departments make it necessary for some employees to work at times when we’re normally at rest. In other work situations employees regularly rotate from one shift to the next.

Shift work is known to interfere with sleep, contributing to shortened sleep and excessive sleepiness. It disrupts circadian rhythms and has a negative effect on health, contributing to a rise in certain cancers, obesity, and impaired glucose tolerance. It also increases the risk of injury.

Could Shift Work or Work-Related Short Sleep Lead to Chronic Insomnia?

Lynda, the retired dispatcher on disability, felt there was a direct link between her insomnia and her work in emergency services. Day jobs she’d held previously gave her “no trouble sleeping at night.” But the dispatch job was different:

I really do believe that the shift work was a major contribution to my sleeping problems. I base this on comparisons with my coworkers. I don’t know any policeman, fireman, or dispatcher who didn’t have trouble sleeping while swinging shifts on a regular basis. I loved this line of work because it was always rewarding to be able to help someone, or be responsible for saving someone’s life. Sometimes, depending on the size of the catastrophe, it could be very intense. You could feel the adrenaline pumping. . . . It just gave you a great feeling knowing that YOU were the one who made a difference. I guess that would explain why I couldn’t sleep after coming off of working something major. Sleep was easier to give up than the job.

How It Could Happen

The neurocognitive model of insomnia suggests how chronic insomnia might develop from work-related stress and short sleep. In fact any stressful situation can trigger acute (or temporary) insomnia, including stress at work. But acute insomnia does not necessarily become chronic. Sleep can—and, in many people, does—return to normal once the situational triggers for insomnia get resolved.

But in the five categories of jobs identified by the CDC, less-than-perfect conditions of employment may be a given when you accept the job. Want to work in emergency services? Fine. You’ll work rotating shifts.

If you find this situation stressful because it interferes with your sleep, you may be tempted to resort to measures that often make sleep worse—using alcohol to get to sleep, for example, or spending long stretches lying awake in bed.

Lying awake in bed often leads to worry and rumination, and to high-frequency brain activity during sleep onset and beyond. Eventually you wind up conditioning arousal in your body and brain. Et voilà, you’re saddled with chronic insomnia—all because you were a good citizen and willing to work around the clock.

I never had an easy time working split shifts and I avoided other jobs that might disrupt my sleep. People like Lynda are more adaptable. But . . . at what cost?

If you’ve had a job that shortened or otherwise interfered with your sleep, how did you manage the situation, and were their any long-term effects?

Insomnia: Are GABA and Glutamate Involved?

Sleep is regulated by the brain. So it makes sense to look inside the brain to find out what might be hampering insomniacs’ ability to fall and stay asleep. Is there some substance under- or overrepresented in our brains? Something that keeps us conscious when our brains should be turned off?

A study published in PLoS One last month suggests a role for two important neurotransmitters, gamma-aminobutyric acid (GABA) and glutamate. Here’s a bit of background and what the new research tells us about the neurobiology of insomnia.

Insomnia may be characterized by reduced GABA and increased glutamate activity at bedtimeSleep is regulated by the brain. So it makes sense to look inside the brain to find out what might be hampering insomniacs’ ability to fall and stay asleep. Is there some substance under- or overrepresented in our brains? Something that keeps us conscious when our brains should be turned off?

A study published in PLoS One last month suggests a role for two important neurotransmitters, gamma-aminobutyric acid (GABA) and glutamate. Here’s a bit of background and what the new research tells us about the neurobiology of insomnia.

GABA, Hypnotist of the Brain

GABA is the most important inhibitory neurotransmitter of the central nervous system. Found throughout the brain, GABA-producing neurons help us fall and stay asleep. When the GABA neurons start firing, we get sleepier and sleepier and suddenly the lights go out. Most sleeping pills today—zolpidem (Ambien), eszopiclone (Lunesta), zaleplon (Sonata), and temazepam (Restoril)—work by enhancing the GABA system.

A deficiency of GABA might cause symptoms of insomnia. Two studies, published in 2008 and 2012, respectively, found lower levels of GABA in insomniacs’ brains than in the brains of normal sleepers. Both studies were conducted using magnetic resonance spectroscopy (MRS). MRS is similar to MRI but different in that it can determine the concentration of various neurotransmitters in the brain.

Results of the first study showed that insomniacs’ average brain GABA levels were lower by nearly 30 percent. Results of the second study were confirmatory, showing that insomniacs had significantly less GABA in two areas of the cerebral cortex. But in a third study, also published in 2012, insomniacs were shown to have higher levels of GABA in the occipital cortex than normal sleepers.

Current Study: Evidence for GABA’s Role Is Mixed

One difference between the studies showing reduced and increased brain GABA was the time when data were gathered. In the first two studies, the brain scans were administered in the morning. In the third, participants’ brains were scanned a few hours before bedtime.

So for the current PLoS One study, investigators scanned the brains of their subjects (20 insomnia patients and 20 good sleepers) twice: after they got up in the morning and in the evening before they went to bed. Prior to the scans, participants were screened with sleep-related questionnaires and spent two nights in a sleep lab. There, they underwent polysomnography to determine, objectively, how long and how solidly they slept.

On both nights in the lab, the insomniacs slept significantly less than the good sleepers. The first night, it took them longer to fall asleep and they awakened more frequently. On the second, they spent a significantly lower percent of the night in deep sleep. In short, their sleep was disrupted in all the ways insomniacs’ sleep typically is.

But the brains of the insomnia patients did not have any more or any less GABA than the brains of the normal sleepers. The one correlation that did emerge was between GABA in an area called the anterior cingulate cortex and objectively short sleep. Investigators concluded that reduced GABA levels may be a trait marker of objective sleep problems.

A Role for Glutamate

Glutamate plays a role opposite GABA. It’s the major excitatory neurotransmitter in the brain, found in abundance everywhere. When glutamate-producing neurons are firing, we’re alert and thinking and taking in the world around us.

Investigators in the current study compared the amount of brain glutamate in insomnia patients and controls in the morning and in the evening. Here, they found a significant difference: glutamate levels in the insomnia patients increased from morning to evening but did not increase in the normal sleepers. So higher levels of glutamate in the evening may reflect the hyperarousal many insomniacs experience at bedtime.

I wouldn’t bet the farm on it, though. The problem with these and other MRS studies is that they’re small (and very costly) and the results may or may not be confirmed in the next study down the line. Insomnia symptoms (or short sleep) may have something to do with reduced levels of GABA and increased glutamate at bedtime—and that’s all we can say for now.

Tips for Avoiding Colds When You’re Short on Sleep

The evidence is now solid: short sleepers are far more susceptible to colds than average sleepers. Results of a study published this month in the journal Sleep show that people who sleep 6 hours or less are over 4 times as likely to catch a cold as people who get over 7 hours a night.

Here’s more, including steps you can take to dodge the bullet this year as cold and flu season begins.

Short sleepers and insomnia sufferers need to be proactive in reducing susceptibility to coldsThe evidence is now solid: short sleepers are far more susceptible to colds than average sleepers. Results of a study published this month in the journal Sleep show that people who sleep 6 hours or less are over 4 times as likely to catch a cold as people who get over 7 hours a night.

This may come as no surprise. If you’ve got insomnia, or if you’re naturally a short sleeper, you’ve probably had quite a few colds and suspected it had something to do with your sleep. You’re right: sleep shores up the immune system, and getting too little leaves you vulnerable to getting sick.

Here’s more about it and steps you can take to dodge the bullet this year as cold and flu season begins.

Importance of This Study

Other studies have shown that response to the flu vaccine is impaired in people whose sleep is partially restricted, and that short and inefficient sleep—as assessed by study participants themselves—confers lower resistance to illness.

But in the new study of 164 healthy volunteers, it was participants’ natural sleep behavior that was assessed (rather than their sleep being arbitrarily restricted). Also, their sleep was measured objectively. In addition to filling out sleep diaries for a week, at night they wore wristwatch-type devices designed to monitor sleep duration and continuity.

Participants also underwent 2 months of health screenings during which researchers collected information about their temperament, lifestyle, and habits. Following sleep assessment, participants were sequestered and given nasal drops containing a cold virus. Researchers then collected mucus samples daily for 5 days to monitor for cold development.

Perhaps more surprising than the main result was the fact that no other variable taken into account (smoking and alcohol consumption, for example) was as predictive of the likelihood of catching a cold as sleep duration.

“It didn’t matter how old people were, their stress levels, their race, education or income,” said Aric Prather, lead author of the study, quoted in ScienceDaily. “It didn’t matter if they were a smoker. With all those things taken into account, statistically sleep still carried the day.”

When Getting More Sleep Isn’t Easy

The take-away here is something you’ve heard before: if you want to stay healthy, get more sleep. I’m all in favor of that—when it’s possible. I’ve spent quite a bit of time studying and writing about how to get more sleep. Take a look at some of my suggestions by exploring the topic cloud to the right of this blog. (My book, The Savvy Insomniac, contains still more suggestions).

But for all the ways sleep can be improved by adopting changes in habits, mindset, and lifestyle (and, some will argue, with medication), some aspects of sleep are less amenable to change than others. Sleep length and sleep quality, for example, are partially determined by genetic factors. Twin studies suggest the heritability of sleep length and sleep quality is about 40 to 50 percent: similar to the heritability of general intelligence. No matter how much you’d like to be an 8-hour sleeper, it may not be in the cards.

The advice to get more sleep could be useful for people who willingly short themselves on sleep. It might translate into a resolve to go to bed earlier, in turn helping people stay healthy.

But getting more sleep is not such a straightforward matter for short sleepers or insomniacs, who can’t get the amount or quality of sleep we want even when given the opportunity. Going to bed earlier most likely will not do the trick. That usually tends to make insomnia worse.

Neither can we know when situations will arise that cause stress and interfere with sleep. For all we practice good sleep hygiene, it may be impossible to get anything approaching 7 hours’ sleep a night.

Tips for Avoiding Colds and Flu

We can be otherwise proactive in shoring up our immune systems to avoid colds and flu:

  1. Get a flu shot. Flu shots are available at pharmacies and doctors’ offices now.
  2. Get moderate to vigorous exercise at least 5 days a week. Results of two well-controlled studies showed that healthy young and older women who walked briskly 35 to 45 minutes a day 5 days a week for 12 to 15 weeks experienced about half the days with cold symptoms as women in the sedentary control groups. Regular exercise appears to boost the immune system in ways that reduce susceptibility to colds over the long term.
  3. Eat a balanced diet, minimizing sugar and simple carbohydrates. If you’re trying to lose weight, don’t restrict your caloric intake too drastically. Immune function is suppressed during times of very low caloric intake and quick weight loss. Gradual weight loss is more congenial to a healthy immune system.
  4. Reduce your exposure to germs. Viruses are mostly spread through the air (via coughing and sneezing) and then inhaled. Touching surfaces that harbor viruses—public computers and doorknobs, for instance—and then absentmindedly touching your face can also result in infection. Wash your hands with soap and water frequently and at length, and make liberal use of hand sanitizer. When a family member is sick at home, avoid sharing towels, and wipe down telephones and faucets often.

 

Is Short Sleep an Inborn Trait?

We’re often warned about getting less than 7 to 8 hours of sleep a night. Short sleepers—variously defined as people who sleep 5 hours and less or less than 6—are more susceptible than normal sleepers to a host of problems: cardiovascular disease, obesity, diabetes, cancer, and dementia. Many people with insomnia fall within that 5- to 6-hour range. Rarely do we get encouraging news about our prospects for a healthy life.

But recent research on genetic mutations tells a different story. Not only does it begin to explain some of the differences in sleep duration among human beings. It also suggests that short sleep may not necessarily have adverse effects on our health and quality of life.

Sleep differences in fraternal twins may occur due to different DNA sequencingWe’re often warned about getting less than 7 to 8 hours of sleep a night. Short sleepers—variously defined as people who sleep 5 hours and less or less than 6—are more susceptible than normal sleepers to a host of problems: cardiovascular disease, obesity, diabetes, cancer, and dementia. Many people with insomnia get just 5 or 6 hours of sleep a night. Rarely do we get encouraging news about our prospects for a healthy life.

But recent research on genetic mutations tells a different story. Not only does it begin to explain some of the differences in sleep duration among human beings. It also suggests that short sleep may not necessarily have adverse effects on our health and quality of life.

Short Sleep but Not Insomnia

One of these studies was published in the journal Science in 2009. In it, investigators were looking at the DNA sequences of people who naturally tended to wake up early. They located a genetic mutation in a mother and daughter who typically slept 6 to 6½ hours a night.

The women’s nights were consistently shorter than the nights of other members of their family, who did not have the mutation and who slept about 8 hours. Yet they woke up feeling well rested in the morning, with no sign of insomnia at night or fatigue during the day.

The mutation occurred in a protein (known as BHLHE41) in which one amino acid was substituted for another. This genetic variant did not interact in the usual way with nearby genes controlling circadian rhythms. So the expectation might be that this variant would have some effect on the timing of sleep, and it did. The mother and daughter were early awakeners. But it also affected the duration of their sleep, predisposing them to shorter sleep.

More Genetic Variants

Then in August 2014 another team of researchers, examining the DNA sequencing in twins and unrelated subjects, announced the discovery of 2 new genetic variants of the same protein, BHLHE41. These researchers were looking for genetic factors in humans that confer resistance to sleep loss. One of the 2 variants they identified had a big impact on both sleep and performance after sleep deprivation.

The carrier of the novel variant was a 27-year-old man whose fraternal twin, also male, did not have the mutation. The sleep-related differences between the twins were fascinating:

  1. The carrier twin slept an average of 5 hours a night—over an hour less than his brother.
  2. Despite his shorter nights, the carrier had a similar amount of nonrapid eye movement sleep (NREM sleep) as his twin. NREM sleep is composed of light sleep and deep sleep, which is associated with restorative processes.
  3. After going 38 hours without any sleep at all, the carrier twin slept 8 hours while his brother slept 9½. Yet an analysis of brainwaves showed that the carrier had higher delta power during NREM sleep, suggesting greater sleep drive.

Response to Sleep Deprivation

The brothers’ response to sleep loss was fascinating, too. After a full night without sleep, they underwent standardized testing every 2 hours to measure their cognitive vulnerability to sleep deprivation.

It wasn’t the more normal sleeper who fared better on the tests. It was the short sleeper—the carrier of the mutation—who had “significantly fewer average lapses of performance” on the tests. Based on these results and results of other studies, the researchers conclude that this novel variant of the BHLHE41 is associated both with short sleep and resistance to the effects of sleep loss.

Whether it also protects people from the health problems linked to short sleep remains to be seen. But regarding obesity, the study is reassuring. The body mass index (BMI) of the noncarrier twin was on the heavy side of “healthy,” but the carrier’s BMI was well within the healthy range.

We hear a lot about the problems associated with short sleep. But occasionally some bit of research comes along showing that our prospects for healthy lives may not be so bad after all.

Short Sleep: A Dose of Perspective on the Risks

A woman attending a talk I gave on insomnia was worried about developing Alzheimer’s because she wasn’t getting enough sleep.

“Sometimes I sleep only 4 hours a night,” she said, “and I’m really lucky when I get 5.”

There’s a lot of talk these days about the health risks that accumulate if we sleep less than 7 or 8 hours a night. But reports that appear in the popular media can make the risks sound greater than they actually are.

short sleep may increase the risk of health problems but not that muchA woman attending a talk I gave on insomnia was worried about developing Alzheimer’s disease because she wasn’t getting enough sleep.

“Sometimes I sleep only 4 hours a night,” she said, “and I’m really lucky when I get 5.”

After the talk I asked for details. Did she have trouble falling asleep? No. Did she wake up frequently at night? No again.

“When I fall asleep,” she said, “I’m out cold.”

What about her energy and alertness during the daytime? I asked. Did she feel tired, out of sorts, or foggy in the brain? No, no, and no. Then what was the problem?

“I read online that you’re supposed to get 7 or 8 hours of sleep,” she said, “but I can’t, no matter what. I read that people who don’t sleep enough get Alzheimer’s, and I don’t want to. I want more sleep.”

The Elusive 7 or 8 Hours

There’s a lot of talk these days about the health risks that accumulate if you sleep less than 7 or 8 hours a night.

  • Cardiovascular Disease. Short sleep (sometimes defined as less than 6 hours of sleep a night, and other times defined as less than 5 hours of sleep a night) is linked to increased blood pressure and hypertension, and a greater risk of heart attack and stroke.
  • Cancer. Short sleep duration makes you more vulnerable to breast cancer, colorectal cancer, and prostate cancer.
  • Dementia and Alzheimer’s. A study of healthy older adults found that short sleep was associated with greater age-related brain atrophy and cognitive decline. Another study found that short sleep and poor sleep quality were associated more beta-amyloid in the brain (the main component of the amyloid plaques found in Alzheimer patients).

No wonder short sleepers are worried these days. Who wants a sentence of any of these illnesses hanging over their head?

Interpreting the Numbers

If you read reports of studies that appear in the popular media, it’s easy to misinterpret the results. Let’s say you learn that people with insomnia (who may be short sleepers and who also experience daytime impairments) are twice as likely to develop depression as people who sleep well (research has shown this to be true). “Twice as likely” might make it sound as though if you have insomnia, your risk for developing depression is pretty high.

But often missing from these reports is mention of the actual number of people who do develop depression at some time in their lives—information that could help you put the study results in perspective. Let’s say the lifetime risk of developing major depression in the US is about 17 percent (as shown in a study by Blazer et al in 1994). This figure, which would include both people with and without insomnia, indicates that most people—83 in 100—will never experience major depression in their lifetime.

Now let’s imagine (because I haven’t been able to lay my hands on actual figures) that among people who sleep well, the lifetime risk of developing major depression is 12 percent. If people with insomnia are “twice as likely” to develop depression, then 24 percent of insomnia sufferers will go on to develop major depression at some time in their lives, and 76 in 100 will not. In other words, your odds of dodging the bullet are 3 to 1 in your favor. “Twice as likely” does not sound so bad after all.

Minimizing Risk

I don’t mean to downplay the significance of research exposing links between short sleep or insomnia and increased vulnerability to Alzheimer’s or any other illness. If sleeping less than 5 or 6 hours compromises health, we need to know it, and to understand why and how to minimize the risk.

I am suggesting that the results of these studies may not be as alarming as they seem at first glance. Beyond that, if they cause you to worry about your sleep, they do more harm than good. How long you sleep is determined in large part by genetic factors resistant to change. And—let’s face it—the last thing you need is one more worry to shorten your nights still further.

So what’s the secret to healthy aging if you clock 5 or 6 hours of sleep at best? You’ve heard it time and time again: get as much sleep as you can, eat healthful meals, and exercise daily.

If you’re a naturally short sleeper, what concerns do you have about your health?

Short Sleepers, Steer Clear of Colds and Flu!

Cold and flu season has arrived. If you have insomnia or your sleep is on the short side of normal, it’s a good idea to take extra precautions to avoid these nasty bugs.

Why? Research shows that poor and short sleepers are more susceptible to infection than people who sleep a solid 7 to 8 hours. This heightened vulnerability has to do with the immune system, which is seemingly compromised in short sleepers, just as it’s compromised in the sleep deprived.

Here’s a quick explanation of why we short sleepers need to go the extra mile to stay healthy, followed by a list of suggestions for how to do it.

Short sleepers and people with insomnia should take extra measures to avoid colds and fluCold and flu season has arrived. If you have insomnia or your sleep is on the short side of normal, it’s a good idea to take extra precautions to avoid these nasty bugs.

Why? Research shows that poor and short sleepers are more susceptible to infection than people who sleep a solid 7 to 8 hours. This heightened vulnerability has to do with the immune system, which is seemingly compromised in short sleepers, just as it’s compromised in people who are sleep deprived.

Here’s a quick explanation of why we short sleepers need to go the extra mile to stay healthy, followed by a list of suggestions for how to do it.

Sleep Fortifies the Immune System

Like other bodily systems, the immune system needs constant grooming to function well. The shoring up of systems takes place mostly during sleep, when other internal processes requiring energy go offline. This frees up metabolic resources to tend to other important matters, such as the one we’re exploring now: boosting our adaptive immune response to invading viruses.

When the body detects a virus, during sleep this triggers a series of events involving the production and mobilization of specialized chemicals and defender cells. They work together to produce antibodies tailored to fight that virus. In the process they forge a sort of long-term immunological memory. A goodly store of antibodies is tantamount to a standing army, ready to spring into action whenever the virus rears its head.

Deep sleep—sometimes reduced in short sleepers and insomniacs—plays a critical role in the operation. Just as deep sleep enables the cementing of facts we’ve learned or experiences we’ve had into long-term memory, so it facilitates the building of antibodies and strengthens immunological memory. Insufficient deep sleep may hamper the formation of antibodies and result in a less vigorous immune response.

Short Sleep and Immune System Compromise

Researchers have long hypothesized the existence of a link between poor or short sleep and compromised immunity, and recent studies lend support to the claim. The results of these three studies speak volumes:

  1. When 143 healthy men and women were given nasal drops containing a virus, those who slept less than 7 hours on average were almost 3 times more likely to develop a cold. People who experienced more wake time at night were over 5 times more likely to develop a cold.
  2. When 125 healthy men and women received the standard 3-dose hepatitis B vaccination series, people with shorter sleep duration produced fewer antibodies and were less likely to be protected from hepatitis B after the final immunization.
  3. In a large prospective study of sleep length and pneumonia risk, women who slept an average of 5 hours or less (and those who slept 9 hours or more) were significantly more likely to develop pneumonia.

What’s a Short Sleeper to Do?

“Get plenty of sleep” was W.C. Fields’ famous cure for insomnia, and, yes, here the advice is apt. But if “plenty of sleep” is not in the cards for all of us, we can still take steps to avoid coming down with colds and flu. As rhinoviruses are spread through the air and contact with objects bearing germs, here are recommendations from one who’s been there, done that, and decided that in this case, vigilance bordering on obsessiveness is the right way to go.

  • Get a flu shot—the earlier, the better. If you’re 65 or older and haven’t had one already, get the pneumonia vaccine.
  • Wash your hands with soap and warm water frequently and at length.
  • Put a little bottle of hand sanitizer in your car and in every handbag you carry. Use it in lieu of washing your hands—after handling money, touching doorknobs, signing for purchases with credit cards.
  • Clean public surfaces like computer keyboards and telephones with antiseptic wipes.
  • Out and about, avoid using your hands when possible. Light switches can be turned on and doors pushed open with forearms, elbows, and shoulders.
  • Carry a gauze mask or a scarf you can wrap around your mouth and nose if you’re going to be traveling by plane or using public transportation and happen to sit near someone who’s sick.
  • When a family member is sick at home, avoid sharing towels, and wipe down telephones and faucet handles often.
  • Get regular exercise. (Exercise, too, has a protective effect against colds.)

Some of these suggestions may sound a bit extreme. Yet if it’s true that short sleepers are more vulnerable to colds and flu, why not err on the side of caution this time?

What measures do you take to avoid colds and flu? Please share them!

A Sleep-Friendly Diet, Part II

You wouldn’t think dietary choices would differentiate people who have trouble falling asleep from people who have trouble staying asleep. But apparently they do.

This is the conclusion of researchers at the University of Pennsylvania, who looked at data collected from over 4,500 participants in a national health survey. The diet of people with sleep-onset insomnia is different from the diet of people with sleep-maintenance insomnia, and both groups make different dietary choices than people who sleep well. It’s possible that making changes to your diet will improve your sleep.

Drinking coconut milkYou wouldn’t think dietary choices would differentiate people who have trouble falling asleep from people who have trouble staying asleep. But apparently they do.

This is the conclusion of researchers at the University of Pennsylvania, who looked at data collected from over 4,500 participants in a national health survey. The diet of people with sleep-onset insomnia is different from the diet of people with sleep-maintenance insomnia, and both groups make different dietary choices than people who sleep well. It’s possible that making changes to your diet will improve your sleep.

A Common Finding

Both types of insomnia sufferers have diets low in dodecanoic acid. This saturated fatty acid (a.k.a. lauric acid) is abundant in coconuts and coconut oil. Added to the diet, lauric acid increases high-density lipoprotein cholesterol (HDL) without affecting levels of low-density lipoprotein (LDL). Not only is cooking with coconut oil a wise choice when it comes to protecting your heart; it may also improve your sleep. Palm kernel oil (not regular palm oil) is also high in lauric acid.

If You Have Trouble Falling Asleep

Insomnia at the beginning of the night is associated with eating fewer foods containing alpha carotene, selenium, and calcium. The U-Penn study doesn’t show that eating more of these nutrients will necessarily improve your sleep—but neither does it rule out the possibility. So if you’re prone to tossing and turning when you go to bed, try eating more of these foods:

  • Carrots, pumpkin, and squash. These orange vegetables contain lots of alpha carotene.
  • Fish and seafood, meat, Brazil nuts, and sunflower seeds. These foods are high in selenium, which enhances immune function, lowers the risk of chronic inflammation, and is likely beneficial to sleep.
  • Dairy products, dark leafy greens, and calcium-fortified cereals and beverages. These foods contain lots of calcium, which tends to lower blood pressure and may also improve sleep.

If You Have Trouble Staying Asleep

On average, according to this study, the diet of people who experience middle-of-the night awakenings is high in salt. If you’re aiming for fewer wake-ups, try cutting down on salt. A low sodium diet also helps prevent high blood pressure.

Middle-of-the-night awakenings are also associated with diets low in butyric acid, vitamin D, and lycopene, nutrients you can obtain by eating these foods:

  • Whole fruits and vegetables and whole grains. Eating these foods leads to increased production of butyric acid in the gut and guards against inflammation of the digestive tract and cancer.
  • Fish and vitamin D-fortified cereals and soy products. Your body also produces vitamin D when you’re exposed to sunlight.
  • Tomatoes, guava, watermelon, papaya, and grapefruit. These foods are high in lycopene. Low levels of lycopene are also associated with very short sleep (less than 5 hours a night).

These foods are nutritious and healthful for many reasons. Will eating more of them improve your sleep? You’ll never know unless you try them out.

(Part I of this two-part series was published on May 5.)