One More Reason Why Sleep Matters

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Of the three stages of sleep, it is the deep stage 3 restorative sleep — where mental, emotional and physical repair is thought to occur — that should be of interest to people seeking respite from the effects of chronic disease.

Deep stage 3 restorative sleep occurs when brain wave activity, measured in neural pulses in cycles per second (or Hz), is at its deepest. In this third stage, more than half of our brain activity is characterized by delta waves (0.5-4 Hz). This is no cat-nap; at this stage, a sleeping person has most difficulty waking up, and when awakened is most likely to be sleepy and disoriented which is called sleep inertia.

Reaching and consistently maintaining an adequate amount of this deep, restorative sleep is necessary for human health. Restorative sleep helps us offset energy depletion and fatigue, supports growth and physical development, and helps brain health and function.

When illness and disease affect us — such as the pain so often associated with rheumatic disease — sleep can be disrupted. Unfortunately, the cause and effect dynamic between sleep and disease can be complex, differing from disease to disease, and from person to person.

But of the many possible causes of sleep disturbance,  a few are most common.

What can cause sleep disturbance

Depression, stress or anxiety can cause disruption to natural sleep cycles, such as daytime sleeping or wakeful nights. Anyone dealing with any rheumatic condition should not feel they are alone or wrong to experience this as a result of coping with their primary illness, and should talk to their physician about how holistic treatments or medications can be used to manage both depression and sleep disruption.

Medication itself could be another cause; certain drugs may disrupt sleep stages or unexpectedly cause nighttime awakenings. Your physician and pharmacist can work with you to find out which medications may work for you, and which to avoid alone or in combination with others.

Sleep apnea is an increasingly prevalent primary sleep disorder (and potentially very serious) that can be a cause of sleep disturbance with symptoms of non-restorative sleep, daytime fatigue/sleepiness and exacerbation of chronic pain symptoms during the day/night. As well untreated severe sleep apnea is a known risk factor for cardiovascular health. Sleep apnea is not the same as snoring, and can only be diagnosed by a physician.

Poor sleep habits including an irregular sleep schedule, excessive daytime napping, using nicotine/alcohol/caffeine throughout the day and spending time in your bedroom for activities other than sleep (technology, stress and worrying) can negatively impact ones ability to get a good night's sleep. 

Poor diet and exercise habits can also affect our physiological ability to get a good quality and quantity of sleep. So can our broad range of lifestyles and activities; excessive 'screen-time', a noisy home life, the presence of a spouse or child with poor sleep habits — all these factors can disrupt the quantity, quality and timing of sleep. Sometimes it's singular factors, or even circumstance.

Sleep loss and rheumatic conditions

In isolation, any one of these causes of sleep disturbance could be treatable. In rheumatology, however, these factors often co-exist and interact in complex ways, alongside disease symptoms that themselves cause sleep disturbance, making the pursuit of healthy sleep patterns much more difficult. It is thought that there is a bidirectional relationship between chronic pain and sleep disturbance with 90% of chronic pain patients experiencing poor sleep.

On the other hand it is also now believed that targeting sleep and improving the quantity and quality of sleep by working on behavioural management of sleep — and identifying and treating an underlying primary sleep disorder — can improve one's ability to cope with their chronic pain with improved function.

In a vicious cycle, a dysfunctional immune system (which drives the autoimmune response, responsible for many rheumatic diseases) can disrupt sleep, which in turn impairs the immune system. 

This is why many lupus sufferers experience a particularly maddening combination of fatigue and sleep disturbance. Lupus' many and varied symptoms compromise sleep quality, which in turn results in a worsening of existing fatigue symptoms. Extreme fatigue disrupts work and personal life, which results in stress and symptomatic flare-ups, which further disrupt sleep patterns.

The question from people suffering from rheumatic conditions (as well as other chronic, painful conditions like fibromyalgia) is how to reverse this cycle?

Work with your physician to focus on sleep

The priority is to recognize that sleep cannot be ignored, or even temporarily put aside. Like nutrition and exercise, sleep needs to be made a critical element in your treatment and disease management regime every day. If you suffer from arthritis, lupus or another rheumatic condition, and you feel your sleep is compromised, you should consult with your doctor immediately.

You should also be aware of other factors in your life responsible sleep disturbance, such as physical and emotional stress, your diet, medications, physical fitness and exercise habits.

It may seem that sleepy people have it good if they can (apparently) shut down and sleep at the drop of a hat. Unfortunately, this is not the case; excessive daytime sleepiness is not the opposite of a sleepless night; it actually may be a manifestation (and consequence) of sleep disturbance.

During the day, when you should be maintaining wakeful 'beta-wave' brain activity and performing high- level cognitive functions (like remaining conversationally alert, or driving a vehicle), you may instead feel barely able to fight the urge to nod off, which is the body wanting to skip directly through a relaxed (but alert) state into the first stage of sleep.

Unless you suffer from sudden drops in blood pressure, a lack of oxygen, or have taken a narcotic, this is typically a sign to you and everyone around you that your body needs sleep.

Although science does not yet definitively understand why humans need sleep, and the relationship between disease and sleep, we have not yet discovered an animal that doesn't need recovery sleep...and all animals suffer severe consequences from a lack of sleep.

Humans are animals — if your sleep patterns are off, seek help from your physician today!