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Insomnia Means More Than A Bad Night's Sleep

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A new study says men who reported having insomnia and who slept less than 6 hours a night were four times more likely to die over a 14-year period when compared to men who reported sleeping well. Sleep researcher and psychiatrist Alexandros Vgontzas explains the finding.


Up next, insomnia. It may mean more than just a bad night's sleep. You know that feeling. We've all been there, right? You're lying in bed. The pillows are fluffed. The lights are out. The alarm is set. You're just waiting to drift off, but that moment never comes. You're thinking, you know, if I fall asleep right now, I can still get seven hours of sleep, right? And you look at the clock, and it's six hours. And then it's five hours. And, of course, you're still wide awake. And by the morning, instead of being well rested, you feel exhausted.

Well, for people with insomnia, that scenario gets played out night after night, sometimes for years. And researchers have known that insomnia is bad for your health because, you know, it's correlated with diabetes, high blood pressure. But now, there's new research showing that it might increase your risk of death, at least in men.

Joining me now to talk more about it is Alexandros Vgontzas. He is director of the Sleep Research and Treatment Center and professor of psychiatry at Penn State College of Medicine in Hershey, Pennsylvania. Thank you for being with us today.

Dr. ALEXANDROS VGONTZAS (Department of Psychiatry, Penn State College of Medicine in Hershey): Thank you for having me.

FLATOW: So if you don't get how many nights' sleep, what happens to your risk? If you don't get how many hours, I mean? If you don't get six hours?

Dr. VGONTZAS: How many hours, yes.

FLATOW: If you don't get six hours of sleep at night, your risk goes up.

Dr. VGONTZAS: Let me explain that. You described at the beginning, you know, of the program very well for the average person, you know, what is an insomniac and what does he or she feel. It's basically a subjective complaint. I cannot fall asleep. I toss and turn, and et cetera.

In this study, based on some previous findings, we decided to divide insomniacs based on how many hours they're asleep but objectively measured. And I have to clarify that. Usually, you know, in the press, there has been a lot of reports, so many hours of sleep, and you're going to become obese.

FLATOW: Right.

Dr. VGONTZAS: So many hours of sleep. But this is usually self-reported. In other words, you know, how many hours you think you sleep. In our study, we used the objective sleep duration as measured in the sleep lab. Using, you know, brain EEG, brainwaves et cetera. And we used that as a physiological marker of severity.

And what we found is of those who were complain of insomnia and also objectively they were sleeping less than six hours in this single night in our lab, they were those that they had a higher risk of dying from insomnia.

FLATOW: And you found that they had four - they were four times more likely to die.

Dr. VGONTZAS: That's correct. And this risk is independent, you know, of other confounding factors, such as depression, age, education, obesity, smoking, alcohol, sleep apnea, high blood pressure or diabetes. So...

FLATOW: So you figured in sleep apnea into that and still...

Dr. VGONTZAS: Correct, correct. Because that was one of the advantages, you know, of our study that we had objective sleep data for all these 1,741 men and women from central Pennsylvania, and so we could rule out the possible effect of all these other problems, including sleep apnea, because since we've brought up the subject I think we do know that sleep apnea is not good for you in terms of high blood pressure, diabetes and mortality.

What is new in our study is that we focused in the other most prevalent sleep disorder, which is insomnia, which is about 10 percent of the general population. Ten percent of people, you know, they go to their doctors, and they say I have insomnia, help me. So we're talking for a large population.

FLATOW: But you didn't find a correlation with women as such a great risk in the study. Why is that?

Dr. VGONTZAS: Yes. I have to make a comment here and also a comment about press reports, media reports, particular from the UK, that I found a little bit confusing, and I don't think they reflect accurately what we say in our study.

The main finding is, you know, that insomnia of this type, which is about 50 percent of all insomniacs, is associated with increased risk of mortality. We found out in men, because we followed up men for the longest time - about 14 years - and the mortality rate in men was 21 percent. In women, the mortality rate, because we followed them up for a shorter period, it was only five percent.

So our findings as far as women are inconclusive. In other words, it doesn't mean that insomnia is bad only for men. Our data - and we have to speak, you know, with our data - sowed(ph) this finding in men. In women, because of the small sample size, of the small number that they died at the time of the follow-up, our findings are inconclusive.

FLATOW: Mm-hmm.

Dr. VGONTZAS: So reports, you know, they said: Oh, this study found that insomnia kills men but not women, I think, are inaccurate.

FLATOW: Mm-hmm.

Dr. VGONTZAS: And I'm glad to correct that through your program.

FLATOW: People will get a chance. I have about 30 seconds before the break and then we'll come back with you, but I wanted you to talk about what - do you know what insomnia does, why it causes this higher mortality rate?

Dr. VGONTZAS: Well, that's a good question, and we don't have a specific answer. Studies from ourselves and others have shown that this type of insomnia is associated with an activation of the stress system, of the biological stress system, the system that secretes (unintelligible), you know, cortisol and catecholamines. And we found that this type of insomniacs, they have an increased secretion of these stress hormones.

FLATOW: All right.

Dr. VGONTZAS: Stress hormones are good on an acute basis, but on a chronic basis, they can cause a lot of problems, including cardiometabolic disorders.

FLATOW: All right. Well, stay with us. We'll be right back to talk more about sleeping and sleep problems right after this break.

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FLATOW: I'm Ira Flatow. This is SCIENCE FRIDAY, from NPR.

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FLATOW: You're listening to SCIENCE FRIDAY, from NPR. I'm Ira Flatow. We're talking with Alexandros Vgontzas about his study of insomnia, in men especially, which show that there was - that there's a four times more likelihood of death in men who have insomnia. But that doesn't mean, though, that they - that you're going to die from insomnia, does it, Dr. Vgontzas?

Dr. VGONTZAS: No, it does not. No one dies directly from insomnia, but chronic insomnia, based also on my previous comment about the stress hormones can wear you down physically. In other words, you know, it will increase the chances of having cardiovascular problems or metabolic problems such as hypertension, diabetes and other problems that at this moment we have not explored and we do not have the data. So insomnia is not, like, you know, you have a heart attack, but certainly may lead to this kind of problems. So indirectly contributes to your risk of death.

FLATOW: One last question before we let you go is: What can people do? How can we help people with insomnia so that they can sleep better?

Dr. VGONTZAS: I think, you know, the message of the study as well as, you know, three previous studies, where we, for the first time I will say, in a clear way, we have shown that insomnia is not just a psychological problem but has significant physical consequences, is that insomnia is a serious problem. It has to be taken seriously both by patients as well as physicians.

We do have treatments for insomnia today. They are not optimum. They are not perfect. But they - they're there. And I think - I would suggest whoever has a problem should discuss it with their doctor. And if their family physician does not have the specific knowledge of how to treat it, they should be referred to specific centers, primarily sleep centers but with an expertise on insomnia.

FLATOW: So what your take-home message here is: If you have insomnia, it is not a harmless thing.


FLATOW: It's not something to be ignored.

Dr. VGONTZAS: Exactly right. That's really the major message.

FLATOW: And you should seek help from your physician to see what you can do for, you know, as you said before, we hear a lot about people with sleep apnea causing them to lose sleep.

Dr. VGONTZAS: Mm-hmm.

FLATOW: But we don't hear a lot about just plain insomnia, and you're saying that this is just as big a concern. It may have the same kind of consequences.

Dr. VGONTZAS: Exactly right. That's really the major point. I think all these years, there has been a lot of reports about how sleep apnea is bad for you. I think now we're seeing insomnia is equally bad and requires the attention at the individual level as well as, you know, the level of public health policy, federal agencies, industry investing money for new treatments and so forth.

FLATOW: All right, Doctor. Thank you very much for taking time to be with us. And have a good holiday weekend.

Dr. VGONTZAS: Thank you. You too.

FLATOW: Alexandros Vgontzas is director of the Sleep Research and Treatment Center and professor of psychiatry at Penn State University.

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