Dr. Cathy Alessi spoke about the need for sleep and the different stages of sleep.
“About one-third of our lives are spent sleeping,” said Dr. Cathy Alessi at a Palisades Alliance for Seniors talk on Monday at the Palisades Library community room.
The sleep expert quoted renowned sleep researcher Allan Rechtschaffen, who said: “If sleep doesn’t serve an absolutely vital function, it is the greatest mistake evolution ever made.”
Scientists have determined that sleep or rest is essential to every living creature. “But scientists don’t know for sure why we sleep,” said Alessi, a professor of medicine at the David Geffen School of Medicine at UCLA, whose specialties include internal, geriatric and sleep medicine. “We know that sleep is important for the brain and to give the body time to rejuvenate muscles and tissues and to process emotions.”
She said researchers suspect that during the day the brain is developing synapses between axons, but during sleep, there is a “cleaning” of toxins.
Alzheimer’s disease is characterized by the presence of amyloid plaques and tau tangles in the brain. Research suggests that sleep deprivation can increase the levels of amyloid in the cerebral spinal fluid, which also bathes the brain. Poor sleep may also be associated with increased brain levels of tau.
The immune system does not perform as well, and a person can take longer to recover from an illness if he or she doesn’t have adequate sleep.
“Sleep is an active process,” said Alessi, who explained there are two stages: 1. Non-REM and 2. REM (rapid eye movement).
During sleep, an individual cycles through three stages of Non-REM sleep and then in REM.
The first stage of Non-REM is the lightest sleep and the period where one falls “asleep,” which is followed by stage two. Then comes deep sleep. It is difficult to wake someone from this stage, but it is also an essential stage for restoring energy.
Dreaming occurs during REM. Eye movement increases, there are increases in heart and blood pressure and the brain paralyzes the muscles, so we don’t act out our dreams. This is a time when our body appears to be processing emotions and stress. Interestingly, newborns have much more REM than adults.
During a night’s sleep, people move between the different stages, but the majority of sleep is spent in stage two of Non-REM Sleep.
Typically, during a night’s sleep, the first part is usually spent moving into deeper sleep, and the second half is more REM sleep.
How much sleep do individuals need? A 2015 National Sleep Foundation study recommended that newborns need 12 to 18 hours; infants need 14-15 hours; toddlers need 12-14 hours; preschool children need 11 to 13 hours, school-age children need 11 to 13 hours; teenagers need 8½ to 9½ and adults need 7 to 9 hours.
Alessi stressed that each individual is different, but those guidelines came out after people started bragging about how little sleep they needed, saying “I only sleep four hours a night.”
The doctor said, “Sleep is important and lack of it could be detrimental for your health.”
Sleep deprivation could result in 1) obesity; 2) diabetes; 3) hypertension; 4) high cholesterol; and 5) more accidents.
“It is thought that the Exxon Valez accident might have been a problem with sleep deprivation,” said Alessi, an Illinois native who received her undergraduate degree at the University of Illinois and her medical degree at the University of Illinois College of Medicine.
The doctor then examined three common sleep disorders, speaking first about sleep apnea. People who snore may suffer from this, which essentially means the person is not breathing effectively.
“The brain goes ‘red alert, red alert’ you’re not getting enough oxygen and wakens you over and over,” Alessi said, noting that a doctor may request an overnight sleep test, making it possible to get a PAP (positive airway pressure) machine that keeps the airways open at night.
One patient who received one and started receiving restful nights of sleep said, “I didn’t realize I was walking through my life in a fog.”
Restless leg syndrome, which can become more prevalent in older adults, was described as an urge to move your legs at night. Patients will say, “I get up and walk around and it gets better.” Those people should see a doctor, because that syndrome will also rob them of a good night’s sleep.
Insomnia, which is described as trouble falling asleep, staying asleep and then waking up early.
“Insomnia is more likely to cause depression and weight gain,” Alessi said. “We all occasionally have trouble sleeping, but chronic is usually three months or longer.”
Most doctors will recommend sleep hygiene steps:
- Set a regular time to go to bed and to get up every morning.
- Avoid caffeine late in the day, and while alcohol is well-known to help you fall asleep faster, too much close to bedtime can disrupt sleep in the second half of the night as the body begins to process the alcohol.
- Make sure the bedroom is only for sleeping and intercourse.
- Avoid substances that interfere with sleep.
- Exercise regularly.
- Make sure the sleep environment is comfortable.
- Have adequate exposure to natural light during the day.
- Limit daytime naps.
“People who have chronic insomnia have tried the tips,” Alessi said, but sleeping medication is not always the answer because “The risks associated with sleeping pills may include falls and fractures and memory impairment.”
She said that if a patient has been on a med for along period of time, that a doctor will slowly try to decrease the dosage and work with behavioral treatment.
The 3P Model, known as the Spielman model, is the first articulated model of insomnia and is based on three factors: predisposition, precipitating factors and the perpetuating factor.
Predisposition includes a person’s biology and psychology; and a precipitating factor could be a life stress such as a medical illness. Perpetuating factors refer to how an insomniac has coped with sleeplessness; be it pills or long daytime naps.
After the talk, Alessi was asked about marijuana as a sleep aid. “Not a lot of research has been done,” she said, and when pressed to give some sort of recommended drug for insomnia responded, “We don’t know what is going to be safe because it is different with each person.”
She was asked about melatonin. “For insomnia, it’s not that great, but it is relatively benign,” she said. “There is some research that says there’s an increase with mood.”
The doctor was asked about jet lag. “You feel poorly if you make at least a two-time-zone change,” she said. If you are only going to be gone for a few days, “It’s recommended not to switch the body clock.”
If it is a longer trip, “The hardest adjustment seems to be from West to East Coast,” she said. “Usually if you have bright light exposure in the morning it helps, but the timing matters.”
Dr. Cathy Alessi spoke about insomnia, sleep apnea and restless leg syndrome at the Palisades Library community room on October 7.
(Upcoming Palisades Alliance for Seniors programs include “Resilient Neighborhoods” on October 21 and “Social Security” on November 4.)