Restful sleep—the period each day when our bodies recharge and repair—is a challenge in modern life. As the pandemic has changed our routines and increased people’s stress, sleep is even more elusive.
We spoke with Andrew Westwood, MD, about why sleep is important and how to sleep better. Dr. Westwood is a sleep neurologist and assistant professor at Columbia University. He treats patients with sleep disorders and has a particular interest in the relationship between sleep and neurodegenerative diseases (diseases that damage the nervous system).
Why is Sleep Important?
Without enough rest, people often feel cranky and sluggish, with low energy. Sleep is part of our whole wellness, according to Dr. Westwood. He adds, “Without adequate sleep, our emotional state gets off-kilter, and our quality of life deteriorates.”
While we sleep, our bodies and brains rest but also actively recharge. Our bodies produce certain chemicals and hormones and clear away others while we sleep. In infants and children, important brain development takes place during sleep.
Two hormones—leptin and ghrelin—depend on sleep to manage our weight and metabolism. Leptin affects the sense of fullness, while ghrelin stimulates appetite. These hormone levels change during sleep to help suppress the appetite. When we don’t sleep well, that wakefulness increases the appetite. Relieving your hunger with late-night snacks can then upset the balance of these two hormones.
The importance of sleep for people with chronic conditions
A key part of health is immunity. The immune system is complex. This body system regulates white blood cells, the lymph node system, and other elements to fight off disease.
The immune system also controls inflammation, your body’s response to injury or infection. People with Gaucher disease and other chronic conditions often have chronic inflammation, making sleep even more important. (Learn more about ways to boost your immune system and manage inflammation.)
Sleep’s relationship to inflammation
The relationship between immune communicators called cytokines and inflammatory neuropeptides (chemicals in the nervous system) changes during sleep and wakefulness, Dr. Westwood explains. As a result, you may have different numbers of white blood cells available to fight inflammation when awake and asleep.
Additionally, “when you have inflammation, you become more sleepy,” says Dr. Westwood. “That may be a protective mechanism so that the body can focus internally on where inflammation is coming from. Making sure you allocate yourself time to sleep is important. Most people require seven to eight hours of sleep per night.”
Lack of Sleep Side Effects
About 35% of Americans—more than 1 in 3— don’t get enough sleep, defined as sleeping fewer than seven hours per night. People who sleep too little are significantly more likely to:
- Be inactive or overweight
- Develop problems such as cardiovascular disease, depression, and Type 2 diabetes
- Have chronic conditions like arthritis, asthma, and chronic obstructive pulmonary disease (COPD)
Inactivity and weight gain can lead to sleep apnea, a condition when breathing stops and starts during the night. The apnea can create a vicious cycle, Dr. Westwood explains. “Some people initially may not have it. Then they gain 10 pounds and develop sleep apnea, which contributes to an inability to lose weight. As they become more tired, they exercise less and gain even more weight.”
Sleepiness vs. Fatigue in People With Gaucher’s
Sleepiness is a feeling that you could doze off if you had the chance. Being tired means you are worn out from the day’s activities.
But fatigue is a lack of physical or mental energy, no matter how much rest you get. “Fatigue doesn’t mean you’re falling asleep; it means you’ve run out of steam, mentally or physically” Dr. Westwood explains.
Fatigue is a common symptom among Gaucher patients. If you experience fatigue, talk with your Gaucher specialist to see if you can do anything to improve your energy. Some studies report that enzyme replacement therapy may improve fatigue in people with Gaucher disease.
You may also need a screening with a sleep specialist. This doctor can look for overlapping issues that may cause fatigue, such as:
- Body clock issues
- Hormonal problems, such as low thyroid
- Medication side effects
- Nutritional deficits, such as having low iron or B12 levels
Sleep Solutions for Good Sleep Hygiene
Sleep hygiene refers to habits to take care of your ability to rest. For the best chance at restful sleep, try these three sleep solutions.
1. Prioritize sleep.
The key to good sleep, says Dr. Westwood, is having a routine. During the day, it’s good to get some natural light and be active. Exercise can help you sleep well, but don’t work out too late in the evening—the stimulation may keep you awake.
By midafternoon, limit caffeine, and don’t have a big meal or excessive alcohol in the evening. All of those substances can interfere with sleep.
At bedtime, follow the same routine to put your mind in sleep mode:
- Turn down the lights: Dimming the lights tells your brain that it’s nighttime.
- Stop using screens: Put away your phone, tablet, or computer at least 30 minutes before you go to sleep. The blue light can be disturbing, as can stimulating games or worrisome “doom-scrolling.”
- Take care of personal hygiene: Brush your teeth, wash your face, or do whatever else you need to do to prepare for the night.
2. Wake up at the same time every day.
Devote seven to eight hours a night to sleep. To set your bedtime, count back from your wake-up time and try to be ready to go to sleep at that time.
“Your priority should be having the same wake-up time,” Dr. Westwood advises. “Waking up consistently is easier for most people than trying to fall asleep at the same time.”
You can’t always force yourself to fall asleep on command. But if you wake at the same time, you are likely to get sleepier by your bedtime within a few nights.
3. Handle middle-of-the-night wake-ups.
“If middle-of-the-night waking is a new problem, it’s probably stress-related,” says Dr. Westwood. “While it could be a result of sleep apnea, especially if you’ve gained weight, it’s likely an overactive mind.”
If stress is the problem, try our self-care tips for coping with stress in the time of COVID-19. Increased levels of the stress hormone, cortisol, can interfere with one’s ability to sleep at night.
To eliminate those 3 a.m. wake-ups:
- Keep the same wake-up time: Don’t sleep late, even if your sleep at night is poor.
- Don’t look at the clock: “All clock-watching does is frustrate you,” says Dr. Westwood. If you are awake, get out of bed and do something else.
- Choose a calm and relaxing activity: Do a calming activity for 45 minutes or so. Some people enjoy coloring books, reading, or listening to audiobooks. Or try a short breathing exercise or meditation. “Avoid things that point you in the wrong direction, like an overly stimulating book or watching the news,” Dr. Westwood cautions.
- Stay up until your usual bedtime: The next night, don’t turn in early. Within a few nights, your body clock should catch up.
- Avoid naps: Give yourself the most sleep opportunity at night. Don’t nap during the day if you don’t sleep well at night. (Early-afternoon naps are OK if you still sleep through the night.)
Sleep, Immunity, Vaccinations, and Coronavirus
As a vaccine for COVID-19 becomes available to more people, some are speculating about the effectiveness of vaccines in sleep-deprived people. Dr. Westwood has good news: You don’t need to worry.
It’s true that a vaccination could theoretically be less effective in sleep-deprived individuals. Sleep is involved in making sure the immune system has a good “memory” for a vaccine, Dr. Westwood explains. But there isn’t clinical evidence, he says, that just not sleeping well makes people more prone to sickness.
Dr. Westwood also points out that vaccine testing took place in real-world populations. That means clinical trial participants had the same sleep problems as everybody else—and the vaccines still worked.
When your chance to receive the COVID-19 vaccine arrives, just do your best to get enough rest beforehand. Find out more about what you should know about COVID-19 vaccines.
When to Seek Professional Help for Sleep Problems
In some cases, improving your sleep habits isn’t enough. Poor sleep may indicate a deeper problem. And Gaucher patients may be more prone to experience certain sleep issues.
Consult a doctor who specializes in sleep if you suspect:
Parkinsonisms and REM sleep behavior disorder
People with Gaucher disease may have a higher chance of having Parkinson’s disease or Parkinson’s-like symptoms (Parkinsonisms). Acting out dreams while you sleep—punching, kicking, or moving around—can be an early sign of Parkinsonism.
Doctors can’t cure Parkinson’s, but medication can help manage symptoms and allow you to maintain your quality of life.
Sleep apnea occurs when people stop breathing for short periods during sleep. The repeated breathing interruptions is associated with cardiovascular issues and other health risks.
People with Gaucher disease may develop sleep apnea if they have co-existing conditions, in particular obesity, or have residual chronic inflammation as it can cause swelling of the soft tissues of the nose and throat.
Some people with sleep apnea snore or feel sleepy during the day, but up to 1 in 3 people with severe sleep apnea deny feeling significantly drowsy, Dr. Westwood says. A sleep study can identify sleep apnea. Many sleep evaluations begin with home testing which may forgo the need to visit a sleep lab.
Treatments for apnea help keep your airways open so you don’t have interruptions in breathing. Allergy treatments, positive airway pressure (PAP) machines, or oral appliances may help. Some people need supplemental oxygen while they sleep if they have interstitial lung disease (ILD).
Sleep as a Part of Wellness
Wellness today comes from a combination of many different things. Making sleep a priority is part of overall good health.
If you’re experiencing sleep issues or insomnia, it can be easy to fall into a pattern of negativity. You can become more rested by prioritizing good sleep habits as much as you can, and not worrying too much if you sleep poorly for a day or two.
“The relationship between wellness and sleep is complex,” Dr. Westwood says. “But there is no secret hack. It’s really about just getting on with your sleep, not brushing it off, and making it important to your lifestyle. The goal of sleep is for you to function effectively day-to-day.”
- CDC – Basics About Sleep: https://www.cdc.gov/sleep/about_sleep/index.html
- Endocr Dev – Role of Sleep and Sleep Loss in Hormonal Release and Metabolism – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3065172/
- European Respiratory Review – Respiratory manifestations in patients with inherited metabolic diseases: https://err.ersjournals.com/content/22/130/437
- Harvard Medicine – Healthy Sleep: Why Sleep Matters: http://healthysleep.med.harvard.edu/healthy/matters
- Int J Mol Sci. – Molecular Pathways and Respiratory Involvement in Lysosomal Storage Diseases: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6359090/
- Mayo Clinic – Sleep Apnea Diagnosis and Treatment – https://www.mayoclinic.org/diseases-conditions/sleep-apnea/diagnosis-treatment/drc-20377636
- Orphanet J Rare Dis. – Rethinking fatigue in Gaucher disease: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4850725/
- org – Sleep hygiene: https://www.sleepfoundation.org/sleep-hygiene