Sunday, July 27, 2008

Sleep: A Critical Yet Under-addressed Component of Health

Sleep is critical for human life.

Grossly disrupted or disturbed sleep is often an early indicator that something is going wrong. Many neurological and endocrinological problems have disturbed sleep as a symptom.

Disturbed sleep can cause physical distress as well as mood and psychological issues(*). And physical distress, as well as psychological and emotional issues, can also cause disturbed sleep.

Teasing out what is causing what and, more importantly, addressing the issues that need to be addressed, can be a daunting task.

Profoundly disturbed sleep can cause physiological stress, immune dysfunction, endocrine suppression, and other changes which in turn can contribute to difficulty sleeping, thus setting up a relentless slow-motion downward death-spiral of health.

Some seemingly psychiatric issues can be a direct result of a neurological sleep disorder such as narcolepsy causing depression and/or hallucinations or a secondary psychological effect from the chronic stressful (and sometimes horrific) symptoms manifesting directly from the sleep disorder.[1,2]

And of course, we must always be alert to psychiatric symptoms which can occur as side-effects from the medications given to alleviate the sleep symptoms. [3,4]

Many parents of young children with mood disorders have commented on their child having sleep problems since infancy. I know that was the case with my own baby. They then comment about the baby’s irritability, then the toddler having low frustration tolerance, the child spacing out and being emotionally fragile, taking comments the wrong way, and even being mildly paranoid. We are not imagining things.

Sleep disturbances can cause issues such as these in otherwise healthy individuals. In an interesting study by Yoo et al (2007) using an fMRI [5] showed that sleep deprivation caused a disconnect between the rational thinking part of the brain and the emotional (affective) part of the brain. Their amygdala (that part of the brain we call the primitive part or the one involved in phobias and the “fight or flight” response) is more activated with sleep deprivation. The people emotionally over-react to negative stimuli… and there is less involvement of the medial prefrontal cortex which should have dampened that response.

Another study showed that circadian rhythm problems and genes controlling this may be involved in mania, depression and bipolar disorder. [6, 7]

As you can see, there can be far-reaching consequences for disordered sleep, including endocrine disruption of our normal diurnal hormone secretions! [7, 8]

Aside from adverse effects on the endocrine system, grossly disturbed sleep can affect the immune system, impair metabolic functions, and accelerate aging. [9, 10]

From our personal experience, profound sleep disturbance came years before our daughter’s severe diagnosis of “mental illness.” When the dust settled and many underlying issues were addressed, our daughter’s sleep was finally improved as well.

It was only one piece of her complex puzzle—but a very important piece.
In some parts of the world, sleep studies are part of the routine diagnostic arsenal for children displaying behavioral or “mental” problems for no obvious psychological reason. In many other countries, the expense of sleep studies excludes them from being routine.

In my opinion, however, it is very difficult to fully treat non-psychologically based (maybe psychologically based ones as well) apparent mood and psychotic disorders without also addressing the sleep component.

As my own daughter’s numerous biological issues were addressed one by one, and every major symptom resolved, we noticed that the last one remaining was the same as the first one we saw: a biological sleep disorder.

Helpful Links:
(I'd like to add to the suggested product list: NutraSleep (by Source Naturals) and Extended-Release Melatonin see also: Sleep: Timing of Melatonin, Light, Dark, and Use of Other Aids)

Related Entries:

Relevant Books


1. Diagnostic and therapeutic challenges in narcolepsy-related psychosis. Kondziella D, Arlien-Soborg P. J Clin Psychiatry. 2006 Nov;67(11):1817-9.

2. Schizophrenia and narcolepsy: A review with a case report. Kishi Y, Konishi S, Koizumi S, Kudo Y, Kurosawa H, Kathol RG. Psychiatry Clin Neurosci 2004;58(2):117-124.

3. Mania in a Boy Treated With Modafinil for Narcolepsy Am J Psychiatry 162:813-814, April 2005

4. Search on potential side-effects on hypnotics.

5. The human emotional brain without sleep--a prefrontal amygdala disconnect. Curr Biol. 2007 Oct 23;17(20):R877-8 Yoo SS, Gujar N, Hu P, Jolesz FA, Walker MP. 

6. Circadian Rhythms Factor in Rapid- Cycling Bipolar Disorder Ellen Leibenluft, M.D. May 1, 1996 Psychiatric Times. Vol. 13 No. 5 

7. Gene Controlling Circadian Rhythms Implicated In Bipolar Disorder ScienceDaily (Mar. 22, 2007) 

8 Circadian patterns of growth hormone and cortisol secretions in narcoleptic patients. Besset A, Bonardet A, Billiard M, Descomps B, de Paulet AC, Passouant P. Chronobiologia. 1979 Jan-Mar;6(1):19-31 

9. Metabolic and endocrine effects of sleep deprivation. Copinschi G. Essent Psychopharmacol. 2005;6(6):341-7 

10. Impact of sleep and sleep loss on neuroendocrine and metabolic function. Van Cauter E, Holmback U, Knutson K, Leproult R, Miller A, Nedeltcheva A, Pannain S, Penev P, Tasali E, Spiegel K. Horm Res. 2007;67 Suppl 1:2-9. Epub 2007 Feb 15. 

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Last Updated: 11 February 2011


Alix said...

What a well-written, well-researched and referenced article. Great insights into what causes sleep disorders and what sequelae they can lead to. It makes a complicated problem even more complicated.

I think one of the biggest barriers to figuring all this out is how stove-piped all the medical professions are - each one has their own drill and only uses the one drillbit they have. God forbid they trade and cross-pollinate to figure out complex medical problems. Mayo and other cross-functional health institutions get us part way there, but the folks who represent the preventative aspects, organic aspects and holistic aspects of disease are left out. Sadly the group that is left out of the room is the key to understanding 90% of the illness out there - how it began and how to treat the cause.

Tiv said...

If anyone is into the gut dysbiosis theories in mental health, there is some interesting research here:

"Systemic Bacterial Invasion Induced By Sleep Deprivation"


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