18. Mar, 2016

EFFECTS OF EXCESSIVE SLEEP AND PROLONGED BEDREST

The average person will spend up to one-third of our lives sleeping. Sleep is a basic human need, much like eating and drinking, and is crucial to our overall health and well-being.

Research shows that people with idiopathic hypersomnia can sleep twice that much but is sleeping more than normal good for you?

The short answer is no. Consistently sleeping for more than nine hours or fewer than eight hours a day has a negative impact on physiological, psychological and cognitive functions. We also know that long periods of bed rest (in the case of idiopathic hypersomnia and long sleepers1 that would be time spent asleep) also have detrimental effects on the body2.

In Bedřich Roth’s extensive studies on idiopathic hypersomnia he “noted that some of his patients had other symptoms as well as excessive sleep, sleepiness or sleep drunkenness. While none of these symptoms were attributed to the etiology of idiopathic hypersomnia they would in most cases contribute to the burden of the disease. More recent studies show that patients with idiopathic hypersomnia become tired and sleepy in both over and under stimulating conditions “… given that the patients feel tired in the presence of over-stimulating conditions (a loud environment, strangers and flashing light), and feel sleepy in under-stimulating conditions (darkness, left alone or listening to a conversation). Basically, it appears in this study that the patients would feel all right only during holidays, in a nice landscape with sun and friends. One may wonder if they use, in this case, the motivation ⁄ mood system to stay awake rather than the usual arousal systems”. This would suggest if patients are constantly relying on their motivation/mood system to stay awake rather than the usual arousal systems then depression, anxiety and associated psychological difficulties including irritability, emotional and mental lability and fatigability would be an obvious consequence”3

It is clear that the “other” symptoms noted over the years in patients with idiopathic hypersomnnia eg: increased heart rate, gastrointestinal/digestive issues, postural (orthostatic) hypotension, fainting episodes (syncope), depression, anxiety, irritability, diminished lidido in men, peripheral vascular symptoms such as cold hands and feet, difficulty with body temperature and even cognitive dysfunction are in fact all symptoms that are experienced by people who are bedridden for long periods.

So what exactly are the symptoms of people who are bedridden for long periods?

Researchers from Swansea University wrote a very interesting three part series on the physiological and psychological effects of bedrest. The first article discussed what happens to the cardiovascular, respiratory and haematological systems which includes disruption to water balance, skeletal muscle atrophy (muscle wasting), dehydration, increased heart rate, cardiac deconditioning (weakening of the heart muscles) and postural (orthostatic) hypotension2.  Because the major role of the cardiovascular, respiratory and haematological systems is to deliver oxygen and nutrients to all areas of the body, the detrimental effects of bedrest have a negative impact on every organ system. The second and third articles explore how immobility specifically affects the digestive, endocrine, renal, reproductive, nervous, musculoskeletal and immune systems, skin and self-perception4,5.  Prolonged bedrest can disrupt the body’s circadian rhythms, leaving you more prone to illness and deprives you of sunlight exposure, which can compromise your immune system. Yes, even the skin in fact all of those areas of the body including our brain are negatively affected by prolonged periods of being horizontal.

As well as the physiological effects the three part series also discusses the psychological effects of prolonged bedrest.

People with idiopathic hypersomnia have no control over the amount they sleep. It is common for patients to constantly miss important family events, work opportunities, or even just simple things like being able to read a book, walk the dog or enjoy a day in the sunshine. This causes patients an enormous amount of distress and often causes family and friends to become resentful. The lack of physical and mental stimulation can leave patients feeling lonely and isolated.

“Several studies have reported that long periods of bedrest have negative psychological effects on individuals and their family. These include symptoms of depression, anxiety, forgetfulness and confusion. These symptoms could be partly due to the lack of personal control imposed by bedrest…

 A person’s lack of control over their environment has long been linked to increased levels of stress and the release of stress hormones such as corticosteroids... It has been suggested that control, or the lack of it, directly influences health through physiological changes..

Prolonged bedrest often deprives patients of environmental and social stimulation, which may lead to increased anxiety, confusion and depression2

In the research referred to above3 it is suggested that people with idiopathic hypersomnia may use “the motivation ⁄ mood system to stay awake rather than the usual arousal systems” if this is the case it would place an added burden on a patients already compromised stress levels and psychological wellbeing.

It is important to note that long sleepers and people with idiopathic hypersomnia are not simply bedridden for long periods they are actually asleep for long periods so they are not only at risk of what happens as a result of being bedridden for long periods they are also at risk of the health problems associated with actually sleeping longer than is recommended. 

A recent study by the University of Sydney it was shown that sleeping for more than 9 hours puts you at a higher risk of dying young6,7. In fact they found that smoking, alcohol and less sleep were slightly less harmful than being physically inactive and sleeping too much. Other research 8, 9, 10 has found a link between excessive sleep (more than 8- 9 hours) and a higher risk of depression, obesity, headaches, back pain, heart disease, diabetes, brain dysfunction, infertility and stroke. More research is needed as it can be difficult to pinpoint which is the cause and which is the effect with regards to excessive sleep and health problems.

What makes idiopathic hypersomnia stand out from other conditions is that there is no obvious cause. Unlike in other medical conditions and other sleep disorders the sleep in patients with idiopathic hypersomnia is normal and usually very deep. But idiopathic hypersomnia is not simply a label that is available to doctors that can’t find the cause of a patient’s excessive sleep. Idiopathic hypersomnia is an independent clinical entity, ie: it is a standalone neurological sleep disorder. Idiopathic hypersomnia (particularly polysymptomatic idiopathic hypersomnia) is characterised by a number of symptoms and clinical features, excessive sleep is just one of them11. There are a number of causes of excessive sleep including poor quality sleep that also have symptoms associated with prolonged bedrest so it is important that all of these are indentified and treated appropriately.

So if we know that prolonged time spent in bed and sleeping in excess of 9 hours is dangerous what does that mean for people with idiopathic hypersomnia?

People with idiopathic hypersomnia sleep in excess of 10 hours over a 24 hour period.  While medication can help to reduce the amount patients sleep our research shows that it is not reduced by much. Part of the reason for that is the ineffectiveness of the medications available to patients but also because most patients find that sleep restriction (less than 9 hours) can make them feel worse. In fact patients report experiencing symptoms of sleep deprivation when they regularly sleep less than 9 hours so this too has obvious negative consequences. There hasn’t been any research done on why this is the case but considering what we know about prolonged bedrest and excessive sleep we know that if patients don’t restrict their sleep time they are at a serious risk of all sorts of health issues, including an early death!

On this World Sleep Day while it is important to get the message out there that lack of sleep or poor quality sleep is known to have a significant negative impact on our health it is equally as important for people to know that research shows that the negative impact of excessive good quality sleep is no less significant.

 

1. Long Sleeper

2. Effects of bedrest 1: cardiovascular, respiratory and haematological systems.

3. Bedřich Roth, His Life’s Work and the 35th anniversary of the book “Narcolepsy and Hypersomnia

4. Effects of bedrest 2: gastrointestinal, endocrine, renal, reproductive and nervous systems.

 5. Effects of bedrest 3: musculoskeletal and immune systems, skin and self-perception.

6. All-cause mortality effects of replacing sedentary time with physical activity and sleeping using an isotemporal substitution model: a prospective study of 201,129 mid-aged and older adults.

7. If You Sleep Too Much, You’re At A Higher Risk Of Dying Young, Says Study.

8. 8 Health Risks Of Sleeping Too Much

9. Too MUCH sleep could KILL YOU: More than eight hours a night can double risk of stroke

10. Physical Side Effects of Oversleeping

11. Idiopathic Hypersomnia Fact Sheet