Dr. Brown: Hello everyone and thank you for joining us for today's Science of Sleep Facebook
Q and A. My name is Dr. Marishka Brown and I’m the Director of the National Center on Sleep Disorders
Research at the Heart Lung and Blood Institute. The Science of Sleep Series is a three-part
series designed to explore NIH research on the impact of sleep on our health at every age. It
is co-hosted by the National Heart Lung and Blood Institute, the Eunice Kennedy Shriver National
Institute on Child Health and Development and the National Institute on Aging. Our topic for today
is sleep health and middle aged adults and it's my pleasure to be joined today by Dr. Philip Cheng
who will be answering your questions. Dr. Cheng an assistant is an Assistant Scientist at the Thomas
Roth Sleep Disorders and Research Center at Henry Ford Health Systems in Detroit, Michigan. Dr.
Cheng is a clinical psychologist with expertise in sleep and circadian medicine, particularly,
with respect to shift work disorders and insomnia. He is interested in sleep and circadian medicine
and the wide reaching impact on mental health, physical health, safety, and quality
of life. Today, Dr. Cheng will be sharing his expertise on sleep issues and middle age adults.
Dr. Cheng: Thank you Marishka, it is always a pleasure to see you and speak with you
and I’m quite excited to be here to talk about the signs of sleep and to share some of
my research and our insights around sleep health.
Dr. Brown: Fantastic! So before we get started I want to let everyone know that
we will be sharing resources and links on Facebook throughout today's conversation. I also want to be
clear that the information given or discussed is not medical advice. We are sharing insights from
the latest research as well as resources on this topic. If you need medical advice, please speak
to your medical provider. As this is a quick Q and A, a let's get to it! So, Dr. Cheng, the Science
of Sleep Series has been discussing sleep across the lifespan. Last week, we focused on sleep in
children and teens. So, can you give us a little bit more insight on sleep health issues among
middle-aged adults? Are there particular risk factors for sleep issues in this population?
Dr. Cheng: Absolutely…and I’m really glad you used the term “risk factors.”
Before I dive in, I’ll just say that oftentimes there's a misconception that
sleep problems are normative with aging… and I just want to say that it's not the case.
Although with many misconceptions, there is a nugget of truth…and I would say that the nugget
of truth in that misconception… is that there are just some normative things that change with
aging that do increase risk factors for a range of sleep difficulties and disorders. But at the
end of the day, those are still disorders and do still warrant medical and clinical attention.
So sleep issues do tend to occur…but when they are disorders, they are problems that need to
get taken care of. So one of those issues is normative changes in just our sleep system
and our circadian rhythms… and that can increase risk for insomnia. For example,
one of the other things that can happen is we can also see increases in risk factors
for insomnia. So stress is certainly a big part of that…and as we get into middle age, there can
be specific developmental challenges that can happen. For example, mental issues, divorce,
and sometimes physiological issues… like going through perimenopause, for example. And these are
all things that can increase our risk factors for insomnia, specifically.
Another thing that can happen is, our circadian rhythms age along with our other physiological
systems. We sometimes see shift workers also start to develop difficulties with the night shift
schedule…and that, in particular, can be very problematic. Especially, as we are going into
another surge in covid 19 patients… and you know needing around-the-clock care. We really want to
be able to take care of our shift workers, as well. And then just commonly with aging, we see
that medical conditions start to come up…and of course that comes with taking medications
and all of these can also increase our risk for sleep problems. As we know,
sleep is something that really is affected by and affects multiple domains of our lives…
and so with the development of medical conditions we may see a deterioration of sleep, as well.
Dr. Brown: So okay… to be fair, we're talking about a huge group of people when we say
“middle aged Americans” or “middle age adults.” So really that's a lot of different people… covering
a lot of different life events, both biological and social. Some you just mentioned. And so
what does the research tell us about the sleep health of these various middle age populations?
Dr. Cheng: Yeah, that's a great question and I would say there are certainly,
certain demographics that are going to be… for one reason or another…more at risk for sleep problems,
as they enter the sort of large swath of time that that we call “middle age.”
I did talk about women earlier and I would say that women, in particular, because of the
perimenopause that can happen in the middle age range… that can increase
risk for insomnia, like I mentioned. But one problem, that has been under recognized… so far,
until recently is sleep apnea. So until recently, many doctors would have viewed or seen sleep apnea
as mostly a male disease and that has resulted in many more men than women getting diagnosed with
obstructive sleep apnea. But the emerging studies now show that sleep apnea in women is likely to be
underestimated and under-treated, as are signs and symptoms of sleep apnea in pre-menopausal women.
And these signs can be very different compared to men and so that's a demographic that we want to
be especially thoughtful of as we learn more about them. Another area, thinking about women in sleep,
is pregnancy. So pregnant women often suffer from sleep disordered breathing,
particularly, sleep apnea. And they often are at higher risk for both gestational diabetes
and hypertensive disorders in pregnancy… and these are leading causes of maternal illness and death
worldwide. So another reason why we really want to be thinking about women's health .
And then, I will also say… something that has been quite prevalent and highlighted during
the COVID-19 pandemic… are just marginalized individuals. We are now seeing more and more,
that there are racial disparities in sleep health… and these disparities can be magnified
when marginalized individuals start to develop comorbidities… or just morbidities, in general.
And we start to see sleep health declining. The bi-directional relationship of that can
further widen the health disparity gaps. And you know, we've already seen this in COVID-19…
not just with the diagnosis or infection rates, that are much higher in black Americans,
for example… as well as other marginalized individuals. But also that the consequences
of COVID-19, even if it isn't infection but rather, for example, quarantine or
loss of job and loss of wages… these all contribute to health and sleep health.
Dr. Brown: Phillip, thank you so much that was some great information. Particularly
around the health of women, shift workers, and disparities broadly…
such as, socioeconomic status as well as racial ethnic minorities. So much of your
research explores the intersection between sleep and mental health among middle middle-aged adults,
particularly the space of insomnia and shift work. So how do these relate to one another?
Dr. Cheng: Absolutely, insomnia… and just in general… poor sleep really affects how well
you can think how well you can respond to stress. So things like you reacting to the way people are
talking to you or just small daily stressors impact how you work, your ability to think
clearly, your ability to learn. Even if you're someone who's in in school or learning… you're
learning the ropes of a new profession, for example. And even just things like
how well you can get along with others ,that have ramifications for how you're perceived and whether
or not you are provided further opportunities for growth at your place of employment, for example.
Now, scientists are still trying to tease apart all of the mechanisms
…that go from poor sleep health… to these large and important outcomes that we care about.
But we have discovered that sleep disruption, in particular, is important because it affects
a lot of different aspects of human functioning... down to the level of neurotransmitters and stress
hormones…among other things that can really just wreak havoc in the brain and can impair
our ability to think and to regulate our emotions. And insomnia, in particular, can amplify
these mechanisms to really increase our risk for psychiatric disorders. Now, we've known for a
long time that insomnia disorder is almost like a gateway disorder. It can really increase robustly
the risk for psychiatric problems… depression being one of the most well documented
areas. And so not only is insomnia highly comorbid with depression…we
also have seen, over the years of research…that when we treat the depression, the insomnia may not
necessarily go away… and when you have lingering insomnia, it really puts us at much higher risk to
relapse in terms of our depression, it shortens the time between episodes of depression, and it
also worsens our depression, or our trajectory of depression, and so all of these things point
to how important it is to take care of our sleep. And I’ll say, some of our more recent
studies have shown that, when we treat insomnia… and we follow these people over time… that
those who got treatment compared to those who did not get a an effective treatment are doing
much better. And in particular, there's a study that we published recently looking at how people
are doing during COVID-19, in particular. And people who got an active treatment,
compared to a control treatment, were just doing much better. They had much less stress,
they had less insomnia, of course… but also less depression. And reported better global health.
Dr. Brown: Wow! That's amazing, Phillip… to be treated pre-pandemic
and be able to sustain that throughout . So, one of the things that I find fascinating
about sleep as a science is that it is both behavior as well as underlying physiology.
And so since our behaviors can impact sleep health, what are a few examples of things
that can be done to actually improve your sleep? Dr. Cheng: Absolutely, that's a great question.
I'll start off by saying that…the way I’ll answer that is… essentially about sleep hygiene, which is
a set of behaviors that are good for your sleep health. Whenever, I talk about sleep hygiene,
I like to emphasize that sleep hygiene alone is not an effective treatment for sleep disorders.
So if you suspect that you may have insomnia, or know that you have insomnia, just know that
these behaviors by themselves are not are necessarily sufficient in treating your symptoms.
I sometimes like to use the analogy, that if you have an infection… keeping the infections
clean is of course important, but depending on how bad the infection is…you need treatment
and not just cleaning. So some of the things that we value in terms of behaviors for healthy sleep
are things like regularity of sleep. Meaning, going to bed at around the same time every day,
waking up at around the same time, getting enough sleep. So there's now consensus evidence…
or consensus… among the sleep community that for adults, you want to be somewhere between
7 to 9 hours. Sometimes people have that magic 8 number in their minds. But 7 to 9 is sort of where
we think people should be at. And watching what you're having before sleep. So things
like avoiding caffeine and alcohol. Making sure you're not getting too much light… that's been
a very popular area of research… especially thinking about blue light. And of course,
physical activity, watching your stress. Those can be very important things to think about.
Dr. Brown: Thank you so much for that, Philip! And time certainly
flies when you're having fun… we are at time… so that is it for us today. Thank you everyone
who joined us and thank you very much Dr. Cheng for highlighting the important aspects
about the science of sleep for middle age adults. For more information and
resources about the science of sleep series please visit www.nia.nih.gov/scienceofsleep.
You can also continue this conversation online, using the hashtag #scienceofsleep.
Thank you very much, everyone! And we will see you next week. Take care, everyone.