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Cary A. Presant, M.D. Headshot

To Sleep, Perchance to Dream, That Is the Medical Question

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The title is not exactly the way Shakespeare phrased it, but getting better sleep is worthy of discussing in order to improve our health. Sleep disorders are common in both men and women. Insomnia is a symptom in 30 to 40 percent of adults, and 10 to 15 percent have long lasting chronic insomnia.

The body needs adequate sleep. Recent evidence shows the value of sleep to the body is to clean out waste molecules in the brain, allowing us to function better. Cleaning up your living room is not as important as cleaning up your brain, and sleeping helps you do it.

Deficient sleep is associated with many symptoms. These include nighttime arousals, sleepiness during the day, snoring, morning headaches, decreased concentration, loss of memory, learning disability, personality changes, and even frequent urination at night.

Diagnosing the nature of a sleep disorder is sometimes challenging. Often the primary care physician can sometimes diagnose disorders associated with poor sleep, including stress, anxiety, depression, asthma, heart failure, allergies, high blood pressure, thyroid disease, PTSD, panic disorder, and even Parkinson's disease. Medical therapies for these conditions can improve sleep. Sleep medications may also help. However, if sleep apnea or restless leg syndrome is suspected, patients may be referred to a sleep specialist for a sleep study and for appropriate therapy.

As an oncologist treating cancer, I found recent basic science and clinical studies very important. Hakim and coworkers studied mice who had experimental tumors. If the mice were subjected to sleep disruption (the scientists used a mechanical sweeper during daylight hours to fragment the sleep patterns of the mice), the cancers grew faster and became larger. Also, these tumors in sleep deprived mice were more invasive into normal muscle and subcutaneous tissues of the mice. The reason for the accelerated cancer growth and invasiveness was increased tumor macrophages (inflammatory and immune cells in the body). The authors even identified the gene pathways controlling the macrophages, which may prompt new cancer treatments if pathway-modulating drugs can be developed.

But are sleep disorders associated with cancers in people? Yes, and more than you might think. Short sleep duration was found to increase the incidence of breast cancer by 60 percent. Since colon polyps were 53 percent more frequent in patients with sleep disorders, it is not surprising that colon cancer was also found to be more frequent in patients with disrupted sleep, possibly sleep apnea. Even liver cancer was found to be slightly increased in sleep disorders

So here are my recommendations to you:

• Be aware if you have poor sleep patterns. You can take an online quiz to determine your sleepiness scale, and your risk for sleep apnea. If you sleep less than eight hours and feel sleepy during the day, discuss this with your physician. Also discuss interrupted sleep (awakening at night, having muscle jerks during sleep, or having periods when your breathing stops). Heavy snoring is often associated with interrupted breathing and sleep.

• Have a family member observe you while you sleep to see if you have poor sleep patterns that you yourself may not be noticing.

• Ask your doctor if you should be referred to a sleep specialist.

• If your doctor cannot improve your sleep patterns with medications or lifestyle changes, ask for a referral to a sleep specialist accredited by the American Board of Sleep Medicine, or get a second opinion. See my book Surviving American Medicine for information about where and how to get a second opinion.

• If you have any sleep disorder, be sure your doctor is doing screening tests for cancer, especially breast and colon cancer. Ask specifically about prevention of colon cancer (with colonoscopy or aspirin) or breast cancer (with exercise, tamoxifen, raloxifene, aromatase inhibitors and avoidance of smoking and alcohol excess).

• If you have cancer, discuss with your doctor if you are getting adequate sleep, and get therapy if your sleep is deficient.

With the help of your physicians, you can truly get a perfect night's sleep. Sweet dreams, and good health!

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