The Importance of Sleep – Part II

Last week we learned some of the basics of sleep, including what makes us sleep.  Today I thought we could talk about why sleep is so important, and how much sleep we really need.

Why is sleep so important?
The truth is that we don't really know enough about why we sleep.  However, we do have good research to show many of the benefits of sleep, and the problems associated with too little sleep.

How does sleep affect your brain function and emotional health?
Sleep is one of the things that keeps your brain functioning properly.  Sleep deficiency actually changes the activity in some parts of the brain.  Studies have shown that getting a good night's sleep improves your ability to learn.  Whether that is learning to play an instrument, a new language, perfecting your tennis game, learning math or reading, it is all improved with sleep.  Other benefits shown in research include improved attention, decision making, problem solving, and creativity.  Sleep deficiency has been linked to depression, suicide, and risk-taking behavior.   

There is also a direct link between sleep and the creation of long-term memories.  You have untold numbers of short term memories every day.  While you are sleeping, your brain determines what information can be discarded, and what is useful enough that it should be stored as long-term memories.

If you are not getting enough sleep, your brain cannot move short-term memories into long-term storage.  Your brain also uses the time during sleep to clear out the clutter of unimportant information gathered throughout the day, in order to prepare for another day of learning.   
 
What about your physical health?
Here are a few of the physical problems associated with sleep deficiency…

• Increased risk of heart disease, high blood pressure, kidney disease, diabetes, and stroke.
• Increased risk of obesity, through several mechanisms.
• Lower immune function, leading to trouble fighting common infections.
• Sleep is important to support healthy growth and development in children and teens.

What about productivity, performance, and safety?
People who are sleep deficient are less productive at work and school, even with a loss of only 1-2 hours a night. They take longer to complete tasks, have a slower reaction time, and make more mistakes.
If you are sleep deficient, you can have brief moments of sleep during the day, called microsleep.  Have you ever driven somewhere and then realized that you don't remember part of the trip?  Maybe you had a brief episode of microsleep.

Studies also show that being sleep deficient harms your ability to drive as much as, or maybe even more than, being drunk. Sleep deficiency has been linked to numerous tragic accidents involving planes, trains, and automobiles.  An NTSB study focused on the effects of alcohol and drugs in trucking accidents actually showed that sleep deprivation was a much larger problem, with 40% of fatal accidents due to a simple lack of sleep.

How much sleep do we need?

Age	Recommended Amount of Sleep
Infants 4-12 months old	12-16 hours a day (includes night time and naps)
1-2 years old	11-14 hours a day (includes night time and naps)
3-5 years old	10-13 hours a day (includes night time and naps)
6-12 years old	10-12 hours per night
13-18 years old	9-10 hours per night
Adults over 18	7-8 hours per night

I hope I have convinced you of the significant importance of sleep on your health.  Next week, we will talk about some strategies for getting the sleep that you need.

If you have any questions about the importance of sleep, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor

The Importance of Sleep – Part I

Getting too little sleep, called sleep deficiency, can lead to some serious physical and mental health problems, and can also put you at higher risk for injuries, and even a higher risk of death.  Sleep, just like breathing, eating, and drinking, is a basic human need.  Sleep plays a very important role in your health and well-being for your entire lifetime. 

Sleep deficiency is a common problem in the U.S., in all age groups, but the signs and symptoms of sleep deficiency can vary quite a bit in different age groups.

Adults with sleep deficiency will typically be tired or sleepy during the day, falling asleep when they shouldn't.  Adults may also have trouble focusing or reacting, and often feel more worried or anxious.

Children who are not getting enough sleep will often be overly active (hyperactive), and can have problems paying attention.  They also can have significant behavioral problems.  Children who are not getting enough sleep sometimes get diagnosed with ADD or ADHD (Attention Deficit Disorder/Hyperactivity), because the symptoms are the same.  Sometimes they just need more sleep!

Let's talk first about the normal sleep cycles and how sleep works.

Types of Sleep
There are two basic types of sleep; REM (rapid eye movement) and non-REM.  Non-REM includes 4 different stages of sleep including slow wave or deep sleep.  REM sleep is the stage of sleep during which you dream.  If you are getting enough sleep, you should cycle between REM and non-REM sleep about 4-5 times during the night.

What Makes You Sleep?
An important part of your sleep is your internal body clock, which is called the circadian rhythm.  This internal clock follows a 24 hour repeating cycle.  This cycle affects everything in your body, including all of the things that control your sleep.

Your circadian rhythm changes depending on your age.  For instance, teens have a different peak time for melatonin production, which is later in the evening than adults or younger children.  This explains why your teenager likes to stay up late at night and sleep later in the morning!  Younger children tend to sleep more in the early evening.   Adults usually get sleepy earlier in the evening and get up earlier.

There are three things that typically make you sleep.  The first is adenosine, which is a chemical that acts on nerve cells in the brain.  The level of adenosine builds up in your brain throughout the day.  Once the levels of adenosine in the brain get to a certain level, this signals your body to shift toward sleep.  While you are sleeping, your body breaks down adenosine.  The next day, the same cycle starts again.

The second is related to the way in which light and dark affect the circadian cycle of your body.  As the light wanes in the evenings, this triggers your body to release melatonin, which signals your body that it is time to sleep.  As the light starts to return in the morning, the light sends signals through your eyes to your brain which help you to wake up.  The light also signals your body to release a hormone called cortisol which prepares your body to wake up.   Lastly, the light also stops the release of melatonin.  This is why it is so much harder to wake up when it is still dark in the early morning.

The third is exercise.  Studies show that exercise significantly improves sleep, even in people with chronic insomnia.  The exact mechanisms through which exercise improves sleep are not well understood, but we have some ideas.  Exercise triggers changes in your body temperature, and that heating up then cooling down may be part of the explanation.  We know that exercise causes changes in the chemical levels in your brain, improving the balance of chemicals that affect anxiety, depression, and arousal from sleep.  Exercise also can help to keep your circadian rhythm on the right 24 hour cycle.

Sleep and how it affects our lives is a really big topic, which we can't cover in one Health Tip.  Now that you understand the basics of sleep, next week we'll talk more about why sleep is so important and how much sleep you really need.

If you have any questions about the importance of sleep, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor

Shingrix Shingles Vaccine - What You Should Know

Most of you have heard of shingles.  It is a painful, blistery rash caused by a virus.  Did you know that shingles is caused by the same virus that causes chicken pox?  When you have chicken pox, although the infection seems to go away completely, the virus actually stays in your nerve cells, alive but in an inactive state.  Many years later, this exact same virus can become reactivated, probably due to lowered immunity.  This reactivated virus travels down the nerve fibers to cause the shingles rash.
  

The most common serious complication of shingles is called post-herpetic neuralgia (PHN).  This causes severe pain in the area in which the shingles rash was present, lasting long after the rash is gone, sometimes even lasting years.

There has been a vaccine available for shingles since 2006, called Zostavax.  Unfortunately, Zostavax only reduced the risk of shingles by 51%, and was only recommended routinely for patients 60 or over.

There is now a new shingles vaccine, called Shingrix.  This vaccine is more than 90% effective at preventing shingles, and can also be given at an earlier age.  Shingrix is given in 2 doses, separated by 2 to 6 months.  Because it is so much more effective, Shingrix is now the preferred vaccine for prevention of shingles.  Here's what you need to know about this vaccine.

Who should get the Shingrix vaccine?

All healthy adults 50 years and older.  You're never too old to get Shingrix.                 
You should get the Shingrix vaccine even if you...   

• Have already had shingles in the past, because it does help prevent future shingles outbreaks.

• Have received Zostavax vaccine in the past, as long as you wait 8 weeks in between.

• Don't remember having chicken pox, because studies show that 99% of Americans over 40 years old have had chicken pox, even if they don't remember having it!

• In adults 50 to 69 years old who got two doses, Shingrix was 97% effective in preventing shingles, and 91% effective in preventing post-herpetic neuralgia. 

• In adults 70 years and older who got two doses, Shingrix was 91% effective in preventing shingles, and 89% effective in preventing PHN.

Why is the Shingrix vaccine important?

• Your risk for shingles and the painful complication of post-herpetic neuralgia, increases as you get older, so it is important to have strong protection against shingles in your older years.

What are the possible side effects of the Shingrix vaccine?

• Most people will have some soreness in the arm where the vaccine was given, for 2-3 days.

• Some people will have mild redness or swelling where they got the shot, for 2-3 days.

• Fewer people have fatigue, headache, muscle pain, nausea, or low grade fever, for 2-3 days.

If you want to learn more, you can go to https://www.cdc.gov/vaccines/vpd/shingles/public/shingrix/

If you have any questions about Shingrix Shingles Vaccine, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor

Shingles

I'm sure that most of you have heard of shingles, but you may not actually know that much about it.  Shingles is a rash which is a concentrated area of blisters that typically scab over in 7 to 10 days.  The rash then slowly clears up completely over the next 2-3 weeks.  This rash is typically quite painful, although the severity of the pain can vary from one person to another.

What causes Shingles?
Shingles is caused by the varicella-zoster virus, which is the exact same virus that causes chicken pox.  After you recover from having chicken pox, the virus enters your nerves, where it can lie dormant for years and years.  Later on in life, the virus can be reactivated to cause shingles.

Reactivation of the virus can happen for many reasons, usually related to low immunity.  Once the virus is reactivated, it travels down the nerve and causes a rash on the skin wherever that nerve comes to the skin surface.   It is usually only reactivated in one nerve at a time. This is why the rash usually develops on one side of the body, often on the face or torso, in a horizontal line that is fairly small in area.

Is Shingles contagious?
Since the shingles rash contains live varicella-zoster virus in the blisters, a person with shingles can actually transmit this virus to anyone who is not immune to chicken pox.  Once exposed, this person would get chicken pox, not shingles.  Shingles is contagious until all blisters have scabbed over.  Chicken pox can be dangerous for some people, so people with shingles should be careful not to expose others.

Who is at risk for Shingles?

• Anyone older than 50, with the risk increasing the older you get.
   
• Anyone with a disease that weakens the immune system.
    
• Anyone taking medications which suppress the immune system.  This includes cancer treatments, medications to prevent transplant rejection, steroids, and many of the newer medications to treat autoimmune diseases.

What are the possible complications of Shingles?

• Post herpetic neuralgia is the most common complication of shingles.  This causes pain, sometimes severe, that can last from weeks up to years, after the shingles rash improves.
   
• Vision loss can happen if the shingles rash affects the eye.
   
• Skin infections are not uncommon if the shingles blisters are not treated properly.
   
• Neurologic problems such as inflammation in the brain, facial paralysis, or balance or hearing problems can happen, depending on which nerve is actually affected.

Can you prevent Shingles?
There is a very good vaccine to prevent shingles.  Next week I will tell you all about it!

If you have any questions about Shingles, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor

Lead Poisoning

There has been significant press coverage recently regarding lead poisoning.  I thought this might be an interesting topic for our Health Tip this week.

What is lead poisoning?

Lead poisoning is the result of lead build up in the body.  Once lead is taken into the body, it distributes throughout the body.  It can damage the nervous system, kidney function, immune system, reproductive systems, and the heart and blood vessels.  Lead is stored in your bones, and can be released along with calcium during pregnancy, leading to exposure of the unborn fetus to lead.
Infants and young children are especially sensitive to lead, even at very low levels, which can cause severe and long lasting effects on both physical and mental development.  It can contribute to serious behavioral problems, learning deficits, lowered IQ, slowed growth, hearing problems, anemia, and even death.

How do people get exposed to lead?

• Lead-based paint - Any house that was built prior to 1978 is very likely to contain some lead-based paint. 
• Water - Public water supplies are sometimes contaminated.  Lead is also the most prevalent toxicant in U.S. school drinking water.  Lead release from plumbing is the main source of lead in water at schools.
• Air - This decreased after lead was removed from gas, but there are still sources that contaminate air.

Who is at risk for lead poisoning?

• Age less than 6 years.
• Anyone living in an older home, and/or remodeling an older home.
• Having a hobby like making stained glass or refinishing old furniture.
• Living in developing countries where the rules are much less strict about exposure to lead. 

What can you do to protect your family from lead poisoning?

• If your home was built before 1978, check regularly for peeling paint, and fix problems promptly.  Try not to sand the paint, as this can generate dust which contains lead and can get everywhere.  If you are remodeling an older home, wear a mask and keep children well away from any area being renovated.
• If you have older plumbing containing lead pipes or fittings, you can find effective and affordable water filters which are specifically designed to remove lead.  Make sure the particular filter you purchase is designed to remove lead (pitcher filters usually are not).  Use filtered water for drinking and cooking.
• Eat a healthy diet.  A diet with enough calcium, vitamin C, and iron can help lower lead absorption.
• Talk with your doctor about when lead testing might be recommended for your child.
• Find out if the water at your child's school has been tested for lead.  If not, consider sending a water bottle with your filtered water to school with them.

You can find more information at https://www.cdc.gov/nceh/lead/publications/books/plpyc/contents.htm.
If you have any questions about lead poisoning, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor