Dr Dingle's Blog / stroke prevention
A recent large study of 2500 participants (mean age 66 years, 54% women), a higher Omega-3 Index was associated with significantly lower risks for total mortality, for non-CVD and non-cancer mortality, and for total CVD events. Those in the highest omega 3 levels compared to those in the lowest had a 34% lower risk for death from any cause and 39% lower risk for incident CVD. These associations were generally stronger for docosahexaenoic acid than for eicosapentaenoic acid. When total cholesterol was compared it was not significantly related with the health outcomes.
Early studies in the 1980s investigating Greenland Eskimos began the research into the benefits of the omega 3 fatty acids. In Greenland, the fatty acid intake from seafood is high and there is a lower prevalence of autoimmune and inflammatory conditions. Omega 3 has been shown in many studies to help inhibit and even reverse inflammation. The omega 3 fatty acids found in walnuts, flaxseed, butternuts, and fish oils have anti-inflammatory properties, decreasing the amount of arachidonic acid in cell membranes.
Several recent studies have linked higher blood levels and/or dietary intakes of the long-chain n-3 polyunsaturated fatty acids (PUFAs) with greater longevity. Blood omega 3 levels were inversely associated with total mortality rates in the Cardiovascular Health Study, and similar results were seen in the Heart and Soul Study. Consistent with this, there is an inverse relationship between the Omega-3 Index and the rate of telomere attrition, a marker of cellular aging.
Omega 3 fatty acids work through a number of mechanisms, each having different effects, to reduce inflammation. As well recent studies suggest that some of the beneficial effects of fish oil are due, in part, to their antioxidant benefit.
Sleep deprivation also contributes to the physiological state known as fatigue. A fatigued person is accident prone and judgment impaired. After approximately 20 hours of no sleep, reaction times are comparable to having a blood alcohol reading of .08. Staying awake for 24 hours leads to a reduced hand‑to‑eye coordination that is similar to having a blood alcohol content of 0.1. An example of a sleep deprivation accident occurred when a space shuttle mission was aborted 30 seconds before lift‑off because a technician who had worked several consecutive l2hr shifts accidentally released 18,000 pounds of liquid fuel just minutes before the scheduled flight. An investigation of the Challenger space shuttle disaster attributed ground crew fatigue as one of the factors contributing to the disaster. An incident such as this shows the seriousness of the situation and the potential loss of life through human related errors in technical fields. Even operating simple machinery such as forklifts can become extremely dangerous if the operators are not filly alert. Other examples of work related sleep deprivation include a flight which flew 100 miles out over the Pacific before controllers on the ground were able to wake the pilots up using chimes, piped into the cockpit audio. It is common practice for flight attendants to check in on pilots to ensure they do not fall asleep. The Exxon Valdez oil spill occurred on a ship with a crew that had had very little sleep, with the accident happening in the middle of the night.
45 to 80% of all nursing home residents suffer from chronic pain and this pain is strongly linked to insomnia (Dodla and Lyons, 2006). In Japan a survey conducted by Tanaka and Shirakawa (2004) found that one in five Japanese people suffer from insomnia, and within the elderly population one in three suffer, because of this the Japanese government increased the needs of insomnia patients at community health sites and names insomnia a refactory disease of the 21st centuary. A similar Honk Kong based study found 11.9% of Chinese people living in Honk Kong suffer from insomnia approximately three times a week and the females were 1.6 times more likely to show symptoms of insomnia than males (Li et a!. 2002).
Accidents, errors and Risk taking
Studies using card games have found that with little sleep, players get stuck in a strategic rut. Sleepy people keep taking risks, even though it’s obviously not working for them.
A study of musicians who practised a new song had improved in speed and accuracy compared with before a night’s sleep. a good night’s sleep can also improve motor performance.
In a study of 1891 male employees compared with those working 6-8 h day(-1) with good sleep characteristics, positive interactive effects for workplace injury were found between long work hours (>8-10 h day(-1) or >10 h day(-1) ) and short sleep duration (<6 h). This study suggests that long work hours coupled with poor sleep characteristics are synergistically associated with increased risk of workplace injury. Greater attention should be paid to manage/treat poor sleep and reduce excessive work hours to improve safety at the workplace (Nakata 2011).
A study looking at the effect of working “standard shifts” (that is, the traditionally accepted long, sleepless shifts) for hospital interns showed that the interns made 36 percent more serious medical errors during a standard work schedule compared to during an intervention schedule that eliminated extended work shifts. The errors included significantly more serious medication errors and 5.6 times as many serious diagnostic errors. As a consequence, the overall rates of serious medical errors were significantly higher during the standard schedule than during the intervention schedule (Landrigan, 2004). Fortunately, most serious medical errors were either intercepted by people who were awake and concentrating or did not result in clinically detectable harm to the patient. How does this affect you? It might be all right if you could always go into hospital at the beginning of the shift or be operated on only by doctors who had just started a shift.
One study found that interns who worked 24-hour shifts made 36 percent more medical errors than those working 16-hour shifts and five times the number of diagnostic errors, and were 61 percent more likely to accidentally cut themselves during procedures.
The study found that the rates of serious medical errors in two intensive care units “were lowered by eliminating extended work shifts and reducing the number of hours interns worked each week.” By asking interns to work less, the hospitals improved their performance.
A number of studies have highlighted the increased number of motor vehicle accidents associated with young adults driving fatigued. It’s conservatively estimated that at least 112 lives could be saved in Australia if fatigue and falling asleep at the wheel were eliminated.
Several studies have highlighted the increased number of motor vehicle accidents associated with young adults driving while fatigued. Fatigue is estimated to be responsible for 35 percent of road accidents. It’s conservatively estimated that at least 112 lives could be saved in Australia every year if fatigue and falling asleep at the wheel were eliminated. In the United States, the National Highway Traffic Safety Administration (NHTSA) reports that fatigue and sleep deprivation contribute to about 100,000 highway crashes each year, causing more than 1,500 deaths annually (Sullivan, 2003). At a grander level the 1989 Exxon Valdez oil spill off Alaska, the Challenger space shuttle disaster and the Chernobyl nuclear accident have each been attributed to human errors in which sleep deprivation played a role (Grunstein, 2000).
Research on 59 participants, those who were confirmed night owls (preferring late to bed and late to rise) had lower integrity of the white matter in various areas of the brain (Rosenberg et al 2014). Lower integrity in these areas has been linked to depression and cognitive instability.
Many sleep problems but by far the biggest is sleep deprivation and poor sleep. However too much sleep can also be a problem. Over sleeping may also be a problem. In one study sleeping 10 hours or more also increased the mortality rates by one and a half times.
Sleep is as important to the human body as food and water, but most of us don't get enough sleep. Dysoninia (poor sleep) related sleep disorders alone are broken into Intrinsic, Extrinsic and Circadian‑Rhythm sleep disorders including disorders such as but not limited to: "Psychophysiologic Insomnia, Sleep State Misperception Idiopathic Insomnia, Narcolepsy, Recurrent Hypersomnia, Idiopathic Hypersomnia...Restless Legs Syndrome & Intrinsic Sleep Disorder NOS" (MSM, 2001, pp. 27).
Risk factors for sleep related illness are diet, lifestyle, occupation, stress and grief, amongst many others (Helmanis, 2006 pp. 24‑25).
Almost 90 per cent of Australians suffer from some type sleep disorder at some stage of their lives. Of these, 30 per cent suffer from severe sleep disorders. Very few people regularly enjoy the amount, or quality of sleep that they need. The estimated economic costs to the country from this are between 3 and 7 billion dollars annually. There are also huge, unmeasured physical, psychological, emotional and social costs.
Causative factors for insomnia may be multifaceted but generally include some psycho physiologic hyperarousal or emotional distress. Other precursors may be pain, movement disorders, psychiatric disorders, circadium rhythm dysfunction, medication and substance abuse (Billiard and Bentley, 2004). In some cases, the risk of insomnia is subject to a genetic bias. However, specific physiologic indicators for the familial influence have not been fully identified (Parkes and Lock, 2009).
Insomnia is the difficulty initiating or maintaining sleep or both resulting in inadequate quality or quantity of sleep (Tomoda et al, 2009). Insomnia can manifest itself by many symptoms from not being able to sleep at normal hours and low quality and quantity of sleep to sleeping but not finding it refreshing. Other symptoms may include daytime sleepiness, frequent waking, early morning waking and difficulty retuning to sleep (Cureresearch.com, 2005).
Most adults have experienced insomnia or sleeplessness at one time or another in their lives (Straker, 2008). It is estimated that insomnia effects around 30-50% of the general population with 10% experiencing chronic insomnia (Straker, 2008). It has been estimated that in the US that 70 million people suffer sleep problems, and of these, 30 million suffer chronic insomnia (Stahura and Martin, 2006). Recently a survey showed that 1046 of the 2000 adults surveyed experience at least one night of lost sleep due to insomnia symptoms; the survey also concluded that insomnia is a growing issue of concern (Goolsby, 2006).
Insomnia generally affects women more than men and the incidence rate tends to increase with age (Straker, 2008).
There is a clear correlation of age to insomnia (Curless et a!. 1993). A number of surveys have reported between 28% and 64% of post menopausal women suffer from insomnia (Hachul de Campos et al. 2006).
Insomnia can be classified into three categories transient, short-term and chronic insomnia (Tomoda et al, 2009). Transient insomnia are symptoms lasting less than one week, short term insomnia are symptoms lasting between one-three weeks and chronic insomnia are those symptoms lasting longer than three weeks (Tomoda, 2009).
Narcolepsy is a sleep disorder that causes overwhelming and severe day time sleepiness (Retsas et al, 2000). Pathologic sleepiness is characterised by the fact that it occurs at inappropriate times and places (Retsas et al, 2000). These daytime sleep attacks may occur with or without warning and can occur repeatedly in a single day (Edgar et al, 2006). People who suffer from Narcolepsy often have fragmented night time sleep with frequent brief awakenings (Edgar et al, 2006).
Narcolepsy is typically characterised by the following four symptoms:
Excessive daytime sleepiness (90%)
Cataplexy: A sudden and temporary loss of muscle tone often triggered by emotions such as laughter. (75%)
Hallucinations: Vivid dreamlike experiences that occur while falling asleep or upon wakening. (30%)
Sleep paralysis: Paralysis that occurs most often upon falling asleep or waking up. The person is unable to move for a few minutes. (25%) (Retsas et al, 2000)
Interestingly, regular night time sleep schedule and scheduled naps during the day is required for favourable outcomes (Edgar et al, 2006).
Sleep apnoea affects over 12 million Americans with it being more prevalent in men than women (Sjosten et al, 2009). Sleep apnoea not only deprives sleep from the individual but their partners too (Yip, 2001). Sleep apnoea is defined as frequent and loud snoring and breathing cessation for at least 10 second for five or more episodes per hour followed by awakening abruptly with a loud snort as the blood oxygen level drops (Sjorsten et al, 2009). People with sleep apnoea can experience anywhere between 5 apnoeic episodes per hour to several hundred per night (Sjorsten et al, 2009).
Symptoms of sleep apnoea are:
Excessive daytime sleepiness
Obesity is the major cause of sleep apnoea often losing weight is all that is need to treat this disorder (Yip, 2001).
Part 3 and more coming
Eat more nuts and beans
Supplement with omega 3, vitamin C, B, antioxidants like grape seed extract and marine pine bark, coq10, alpha lipoic acid and minerals.
Drink more water
Move more and become more physically active. Just walk a little more
Stand more and sit less
Socialise with positive friends and groups in your spare time instead of watching television
Go to bed earlier and get more sleep
Minimize stress and learn to relax (without drugs and alcohol)
Develop and attitude of gratitude and enjoy life more