Michael Abrahams | Why sleep matters

The importance of getting a good night’s sleep is woefully underrated. We repeatedly see articles and videos about the importance of a healthy diet and getting enough exercise, but not much about sleep. The truth is, along with nutrition and exercise, quality sleep is one of the pillars of health. I have often heard people boast about how little sleep they get. But getting by on just a few hours a night is not something to be proud of.

Sleep is an essential function. It allows our bodies and minds to recharge and remain healthy. While we sleep, we conserve energy through an extended period of reduced activity. During this time, growth hormones are released, which are necessary for the body’s tissues to grow and to repair damage. The amount and quality of sleep we get exerts a profound influence not only on our cognitive function and behaviour, but also on our cardiovascular, respiratory, immune, endocrine and other systems, as well as on our metabolism. We all have a circadian clock, a natural oscillation that repeats every 24 hours, which functions as our body’s internal timekeeper. It plays a significant role in regulating sleep-wake cycles and other bodily functions, and good quality sleep helps maintain this cycle and keep us healthy.

I am a physician, and I am proud of my vocation. The field of medicine has significantly contributed to the well-being of many. But while I take pride in the achievements of this distinguished profession, something I observed in my training made no sense to me. We were taught in physiology that sleep is important for our physical and mental well-being and that getting adequate sleep is vital for us to function. However, during my internship and residency, my colleagues and I were expected to manage patients adequately with minimal sleep. Interestingly, research on medical students and physicians has demonstrated the incongruity between what we were taught and the lifestyles many of us chose or are forced to embrace.

MEDICAL ERRORS

A 2020 study published in JAMA examined overworked physicians and found that doctors with moderate, high, and very high sleep-related impairment were 54 per cent, 96 per cent, and 97 per cent, respectively, more likely to report clinically significant medical errors. Another study examining the academic performance of medical students found that students with poor sleep had significantly lower GPAs, compared with students with quality sleep. On the other hand, getting enough sleep has been shown to enhance cognitive function, the ability to register and organise memories, focus, concentration, information processing, problem-solving skills, and to reduce stress. Lack of sleep can also adversely affect our interactions with others, as sleep deprivation can cause irritability and even exacerbate conditions such as depression and anxiety.

Studies have shown that not getting enough sleep can alter the levels of hormones that control hunger. Sleep deprivation increases levels of ghrelin, a hormone that makes us feel hungry, and decreases levels of leptin, a hormone that makes us feel full, causing us to feel hungrier and overeat, especially foods with higher levels of sugar and fat. Less sleep also decreases our ability to respond to insulin, the hormone that lowers blood sugar. The increased food intake, combined with decreased physical activity that accompanies sleep debt, along with the inadequate response to insulin, increases the likelihood of becoming overweight or obese. Indeed, a study published in 2020 in Obesity Research and Clinical Practice journal found that adults who slept fewer than seven hours per night had a 41 per cent increased risk of developing obesity.

ATHLETIC PERFORMANCE

Research has also found that adequate sleep can maximise athletic performance by enhancing fine motor skills, reaction time, muscular power and muscular endurance. In contrast, lack of sleep may increase the risk of injury and motivation to exercise. Low sleep quality and duration also increase your risk of developing heart disease. An analysis of 19 studies found that sleeping fewer than seven hours per day resulted in a 13 per cent increased risk of death from heart disease. Poor sleep also increases the risk of developing hypertension, especially in persons with obstructive sleep apnoea, a condition characterised by interrupted breathing during sleep. Inadequate sleep also negatively affects the immune system, elevating the risk of contracting the common cold and other infections, and developing chronic diseases.

We must implement healthy sleep hygiene practices and make it a habit to get a good night’s sleep. Experts recommend that adults get at least seven hours of sleep per night. However, sleep needs can vary significantly from person to person depending on factors such as activity level, health status, and age. For example, infants need significantly more than adults, requiring between 12 and 16 hours.

It is advisable to commit to a regular and relaxing sleep schedule in a comfortable bedroom environment. Exercising regularly and early in the day and getting 20 minutes of exposure to natural light in the morning have been found to contribute to a good night’s rest later on. Daytime naps, if taken, should be less than 90 minutes in duration. Caffeine, nicotine, alcohol and large meals should be avoided in the hours before bed. Caffeine and nicotine are stimulants and can take hours to wear off. Alcohol can induce relaxation and sleepiness, but it interferes with the quality and duration of sleep. Heavy meals have the potential to cause issues such as indigestion and acid reflux, which can make it harder to fall and stay asleep. We should also avoid using electronics with screens in the hour before going to sleep, as the light interferes with the production of melatonin, a hormone that helps with the timing of your circadian rhythms and with sleep.

According to biohacker Prashant Desai, quality sleep is the biggest biohack for longevity. Indeed, a study involving over 170,00 adults found that men who got adequate sleep lived about five years longer than those who did not, while for women it was about two years greater. If you are not getting enough quality sleep, the time to start is now.

Michael Abrahams is an obstetrician and gynaecologist, social commentator, and human-rights advocate. Send feedback to columns@gleanerjm.com and michabe_1999@hotmail.com, or follow him on X , formerly Twitter, @mikeyabrahams.