Think Science: Sleep, by Nagwa Lamaie
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Slide presentation to accompany TPR's "Think Science" event on November 17, 2017.
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Think Science: Sleep, by Nagwa Lamaie
- 1. Put Cancer to Sleep Sleep Therapy & Research Center James M. Andry, M.D. Nagwa N. Lamaie, M.D.
- 2. Services We Provide Clinic: We clinically evaluate adult & pediatric patients for various sleep disorders, including Sleep Apnea Hypopnea Syndrome (SAHS), insomnia, parasomnias including REM sleep behavior disorder, sleep walking, and nightmares along with hypersomnolence including narcolepsy and others. Sleep Apnea Testing : In lab sleep apnea testing, Polysomnography (PSG). Portable Sleep Apnea Testing (HSAT) Texas School of Sleep Medicine & Technology Accredited by the American Academy of Sleep Medicine (AASM) For the A-STEP Introductory Course for Polysomnographic Trainees and Technicians
- 3. Other Services Sleep Apnea Solutions - Durable Medical Equipment (DME) Oral Appliances / Mandibular Advancement Devices (MAD) for Sleep Apnea Hypopnea Syndrome(SAHS) Clinical Trials Currently Being Conducted Narcolepsy REM Behavior Disorder in Dementia & Parkinson’s Disease
- 4. Breast Cancer Facts The most common cancer in women in the U.S. 2nd leading cause of cancer- related death in women in the U.S. 1 in 8 women will be diagnosed with it All women are at risk. Incidence increases with age Each year it is estimated that over 252,710 women in the United States will be diagnosed with breast cancer and more than 40,500 will die. Although breast cancer in men is rare, an estimated 2,470 men will be diagnosed with breast cancer and approximately 460 will die each year
- 5. Some Causes/Risk Factors of Breast Cancer Gender, age, race, overweight , high fat diet, alcohol use Genetic (DNA) mutations, could be related to lifestyle, age, other factors positive family history( only 5-10 % of cancers are due to an inherited abnormality) History of cancer: breast, uterus, ovaries, cervix Post-menopausal hormone therapy (PHT), exposure to radiation, dense breast tissue
- 6. Sleep
- 7. Research Linking Lack of Sleep to Breast Cancer This examined the relationship between breast cancer and working on rotating night shifts with at least three nights per month during 10 years of follow-up in 78,562 women Moderate increase in breast cancer risk among the women who worked 1–14 years or 15–29 years on rotating night shifts The risk was further increased among women who worked 30 or more years on the night shift
- 8. Even Worse….. Emerging evidence suggests that short sleep is associated with an increased risk of cancer; however, little has been done to study the role of sleep on tumor characteristics The results of this study present a modest association between short duration of sleep and higher grade breast cancer in post-menopausal women Sleep Duration and Breast Cancer Phenotype Journal of Cancer Epidemiology 2013 Post-menopausal women who slept six hours or less per night on average ,for the past 2 years prior to evaluation, had a higher likelihood of cancer recurrence Association of sleep duration & br ca oncotype DX recurrence score Breast Cancer Research and Treatment August 2012 Women who sleep less than six hours a night could be raising the risk of breast cancer by more than 60%
- 9. Sleep & Other Types of Cancer…. In 2007, the International Agency for Research on Cancer (IARC) , a component agency of the World Health Organization (WHO) classified shift work with circadian disruption a probable human carcinogen. Also data suggested that working a rotating night shift at least three nights per month for 15 or more years may increase the risk of colorectal cancer in women & men Nurses’ Health Study Journal of the national cancer institute Twofold risk of developing prostate cancer in men with insomnia Cancer Epidemiology, Biomarkers and Prevention A 50 percent increased risk of colorectal cancer for people sleeping less than six hours per night was found Cancer 2010
- 10. It goes beyond shift work… Research suggests that sleep apnea increases risk of developing any type of cancer Across the country, at least one in 10 individuals experiences some kind of sleep disturbance. Stress, illness, aging and drug treatment are the main culprits Quality as well as quantity of sleep, is essential to healing, proper immune function , mental health, etc.. lack of sleep increases inflammation and disrupts normal immune function
- 12. cancer
- 13. Light at Night(LAN), Melatonin Suppression & Cancer Cells LAN and the consequent decrease in melatonin, may be a major driver of breast cancer Melatonin, may trigger a reduction in the body's production of estrogen. But light interferes with melatonin release allowing estrogen levels to rise. Too much estrogen is known to promote the growth of breast cancers. Melatonin may have antioxidant properties that help prevent cellular damage Nighttime melatonin is a relevant anticancer signal to human breast cancers.
- 14. LIGHT AT NIGHT (LAN) Suppresses the Production of Melatonin Growth and metabolism of human breast cancers growing in rats slowed when the tumors were perfused with melatonin-rich human blood collected during the night. In contrast, growth and metabolism were unchanged in tumors perfused with blood in which melatonin levels had been suppressed because of even a brief LAN exposure.
- 15. A Good Night’s sleep may be one Weapon in the Fight Against Cancer The natural Circadian rhythm consists of daytime exposure to intense sunlight alternating with night- times of near total darkness This sleep-wake cycle is important for the production of melatonin, which acts as an internal biological clock regulating body temperature, endocrine functions, and a number of disease processes including heart attack, stroke, asthma and cancer.
- 16. Walk in the light while you have the Light ….but When it Gets Dark Embrace it for Better Health
- 17. Some Suggestions for Better Sleep Think Behavioral Changes Maintain a regular sleep/wake schedule. Your body will get used to falling asleep and waking up at a specific time if you stick to a routine Wind down, try some relaxation, meditation, avoid stress Stay busy during the day, engage in pleasurable activities Don’t read, watch TV, talk on the phone, check your email, log into Facebook, or do work in bed. Hide the clock Unplug your screens and try to avoid even brief light exposures, try blue light blocking glasses If you get up in the night, forgo the usual bathroom lights for a dim red nightlight. Red light suppresses melatonin production less than other wavelengths Boost melatonin levels naturally by sleeping in complete darkness at night, melatonin boosting snack Try getting exposure to bright light in the morning, so your body gets a clear signal that it’s daytime Avoid caffeine, alcohol, and heavy/spicy/sugary foods 4 to 6 hours before you go to bed Exercise regularly, early in the day Try silicone earplugs, light blocking eye shades Don’t nap, especially if you have trouble falling asleep Keep the bedroom at a comfortable temperature Make sure your room is quiet and dark. Consider extending the dark period at night to 9 or 10 hours. Install room-darkening shades in bedrooms
- 18. Thank You ! Developing Treatments based on this new science is still a work in progress, but try not to lose sleep over it in the meantime…
Editor's Notes
- The study, conducted by University of Connecticut epidemiologist Richard Stevens and colleagues at the University of Haifa, showed that higher population-weighted country-level LAN levels were associated with higher incidence of breast cancer.4 A sensitivity test indicated a 30–50% increased risk of breast cancer in countries with the highest versus lowest LAN levels. No such association was found between LAN and incidence of non-hormone-dependent lung, colorectal, larynx, or liver cancers in women.
- Participants included 101 women with early-stage estrogen-receptor-positive breast cancer. At the start of the study, the women answered a number of health-related questions, including how long they typically slept per night during the two years before their breast cancer was diagnosed. The women also underwent OncotypeDX testing, in which breast tumor tissue is analyzed to determine how active certain genes are. The higher the score (called a recurrence score), the more aggressive the cancer—and the more likely it is to return even after treatment. For instance, a score of less than 18 predicts a low risk for recurrence, while a score of 31 or above indicates a high risk. Findings: Among postmenopausal women, the average recurrence score was 15 for those who routinely slept more than seven hours per night…and 19 for those who slept six to seven hours per night…but the recurrence score soared to 34 for women who usually slept only six hours or less per night. The results held even after researchers adjusted for other factors that could influence the results, such as age, body mass index, physical activity level and smoking. Like what you're reading?Get more with Bottom Line Inc.'s free HealthInsider e-newsletter By subscribing you agree to our terms and conditions and Privacy Policy Interestingly, among premenopausal women, no association was found between sleep and the risk for recurrence. However, it’s well-known that different mechanisms underlie premenopausal and postmenopausal breast cancers. Researchers theorize that sleep may affect gene activity specifically involved in postmenopausal (but not premenopausal) breast cancer, contributing to the development of more aggressive tumors. Also, melatonin, a hormone that helps regulate sleep as well as cell growth and repair, may play a role…and people who sleep less tend to have lower melatonin levels. More research is needed to clarify the connections. The authors point out that while the correlation of sleep duration and recurrence score was strong in post-menopausal women, there was no correlation in pre-menopausal women. It is well known that there are different mechanisms underlying pre-menopausal and post-menopausal breast cancers. The data suggest that sleep may affect carcinogenic pathway(s) specifically involved in the development of post-menopausal breast cancer, but not pre-menopausal cancer. n this study, researchers reviewed the medical records of 101 women diagnosed with early-stage, estrogen-receptor-positive breast cancer. All the women had undergone Oncotype DX testing and had Recurrence Scores. The researchers also asked the women about how long they slept per night in the 2 years before they were diagnosed. The researchers compared the Oncotype DX Recurrence Score for each woman to the average number of hours she slept per night. In postmenopausal women, they found that higher Recurrence Scores were linked to fewer hours of sleep per night: Postmenopausal women who slept 6 hours or fewer per night had higher Recurrence Scores compared to women who slept more hours per night. This difference was statistically significant, which means that it was likely due to the difference in sleep time and not just to chance.
- Cancer Biologist David Blask This study out of Tulane University suggests that : “all of us who live in industrialized society have the potential to have our circadian system disrupted by too much light at night, and this risk is potentially not restricted to a smaller percentage of the population that is exposed because of their occupation”
- Neuroendocrine, immune and oxidative stress could act as biological mediators of the damaging health effects imposed by shift work Compelling evidence from laboratory studies shows that circadian misalignment but also sleep restriction can disrupt and enhance the activity of neuroendocrine stress systems, reduce immune defenses and increase the pro-oxidative status The assessment of neuroendocrine, oxidative and immune stress in the shift worker population is still a limited and novel field, which may have clinical relevance Napping could be a countermeasure to the enhanced neuroendocrine stress, reduced immune defense and cardiovascular risks imposed by shift work.
- Impaired glucose tolerance. Without sleep, the central nervous system becomes more active, something that inhibits the pancreas from producing adequate insulin, the hormone the body needs to digest glucose. A study of healthy young men with no risk factors, went into a pre diabetic state after one week of sleep deprivation. Obesity. Growth hormone (GH) is secreted during the first round of deep sleep. As both men and women age, they naturally spend less time in deep sleep, which lowers GH secretion. Lack of sleep at a younger age, however, could drive down GH prematurely, accelerating as a result the fat-gaining process. Research indicates a lowering of the hormone testosterone as something that would also make the gaining of fat and the loss of muscle Increased carbohydrate cravings. Due to less production of Leptin. This hormone is responsible for telling the body when it is full. However, with decreased production of this hormone, your body will crave calories (especially in the forms of carbs) even though its requirements have been met. Weakened immune system; less white blood cell count , reduces the body’s ability to fight infections.
- Using the same model, researchers are conducting pilot studies of the effects of melatonin and LAN on human prostate cancer. Blask and colleagues -Thomas Jefferson University
- Cancer Epidemiologist Dr. Richard Stevens Exposing the eyes to light at night when melatonin is normally flowing stops its production even from a night light. (see www.lowbluelights.com) The energy efficient compact fluorescent bulbs are more melatonin suppressive than incandescent bulbs. They disrupt circadian rhythms and cause negative health effects from minor annoyances such as headaches, eyestrain, fatigue, and weight gain, to serious effects such as insomnia, sleep disturbances, an increased risk of cancer, and a suppressed immune system.