The importance of good sleep — sleep that is not fragmented, disturbed or insufficient — is recognized as a cornerstone of wellbeing by almost all health professionals. Scientific studies have shown that fragmented sleep causes chronic inflammation and can contribute to mental health and neurological disorders such as major depression and Alzheimer's disease, a Berkeley News release said.1
Lack of sleep also affects your immune system by decreasing protective cytokines, according to Mayo Clinic.2
Fragmented sleep is associated with atherosclerosis,3 a buildup of fatty plaque in the arteries often called "clogged” or “hardened” arteries that can result in fatal heart disease.4 Cardiovascular disease kills 12,000 Americans a week, which is far more than the reported COVID-19 toll of 1,000 people a day.5
Still, the exact way that poor sleep induces atherosclerosis has not been clear.6 Now, U.C. Berkeley sleep scientists have published an article in PLOS Biology that clarifies some of the mechanisms through which fragmented sleep can cause atherosclerosis.7
Broken Sleep Predicts Hardened Blood Vessels
Broken or fragmented sleep is characterized by awakening during the night, difficulty falling back to sleep and a sense of not being rested upon rising, or "nonrestful sleep." There are many possible causes of fragmented sleep, from stress and anxiety to excessive caffeine and alcohol consumption and other lifestyle factors. Fragmented sleep is also associated with assorted illnesses.8
Recently, sleep specialists from U.C. Berkeley, studying 1,600 subjects, were able to separate the effect of fragmented sleep on atherosclerosis from other common contributors to atherosclerosis such as age, sex, ethnicity, body mass index (BMI), smoking status, blood pressure, use of antihypertensive medication, sleep apnea and insomnia. In the new study the researchers:9
"… test the hypothesis that the impact of fragmented sleep on atherosclerotic pathology is governed, in part, through the novel mediating influence of increased neutrophil and monocyte levels and, furthermore, that this sleep-related disease pathway is robust when multiple alternate cofactors (disease mechanisms) are being controlled for.
To do so, we examined the association between sleep fragmentation (measured using 2 independent sources of objective data: polysomnography [PSG] and multiple nights of wrist-based actigraphy), white blood cell count, and in vivo measures of subclinical atherosclerosis in a diverse sample of the population."
The study is important, the authors wrote, because improving sleep quality may "represent one preventive strategy for lowering inflammatory status and thus atherosclerosis risk, reinforcing public health policies focused on sleep health."10
The study's lead author Raphael Vallat, a postdoctoral researcher at the UC Berkeley sleep center, states, "To the best of our knowledge, these data are the first to associate sleep fragmentation, inflammation and atherosclerosis in humans.”11
Atherosclerosis Begins Before Older Age
According to an editorial in the American Journal of Medicine, heart disease is the leading cause of American adults' deaths, mostly due to atherosclerosis involving the heart and cardiovascular systems:12
"Atherosclerosis is a disease that is associated with living in a modern, industrialized nation. When countries such as China rapidly acquire this lifestyle, the incidence of atherosclerotic vascular disease increases strikingly … Arteriosclerotic cardiovascular disease is now the most common cause of death in the entire world.
Not surprisingly, risk factors for the development of atherosclerotic disease are widespread in the United States and in other resource-rich, technically advanced countries … approximately 30% of Americans aged 20 years or more were diagnosed with hypertension or were taking antihypertensive medications."
Among the risk factors for cardiovascular disease are obesity, poor diet, lack of exercise, high blood pressure and smoking.13 Vallat agrees that atherosclerosis begins before older age, though few may be aware of it, according to News Medical Life Sciences:14
"Unfortunately, this process goes largely unnoticed until the plaque buildup, in middle or old age, suddenly blocks arterial blood flow to the heart, lungs, brain and/or other organs, hence its moniker, 'silent killer,' said Vallat."
Awareness of the risk of atherosclerosis should begin earlier, the study authors explain. "The insidious nature of the disease requires that we pay attention to our sleep hygiene, even starting in early to midlife," Vyoma Shah, a co-lead author of the PLOS study, told News Medical Life Sciences.15
How Does Fragmented Sleep Contribute to Atherosclerosis?
Both clogged arteries and fragmented sleep are correlated with older age.16 For some, the quality and duration of sleep often degrade with age from health conditions such as chronic pain and limb motion conditions, medication usage and sleep conditions like apnea and insomnia.
The aim of the PLOS study was to discover the relationship between the two phenomena and to separate them from other factors that might contribute to atherosclerosis. Here is what the researchers found:17
"Our findings confirm recent seminal work in mice demonstrating that experimentally induced sleep fragmentation, associated with increases in blood levels of monocytes and neutrophils, results in larger atherosclerotic lesions.
Furthermore, these rodent data added mechanistic insight, with sleep fragmentation reducing hypocretin levels in the hypothalamus, signaling bone marrow-related increases in the production of monocytes and neutrophils.
Advancing this research, we establish a sleep fragmentation — white blood cell — atherosclerosis association in a population-based sample of human adults and demonstrate that these effects remained robust when accounting for multiple other common atherosclerosis risk factors.
Finally, we show that this indirect pathway can be quantified with objective sleep metrics, either using 1 week of wristwatch actigraphy or a single night of PSG [polysomnography] recording."
In summation, the researchers write that their findings affirm "a pathway in which the quality of human sleep, specifically the degree of fragmentation, raises inflammatory-related white blood cells, thereby conferring increased risk for atherosclerosis."18
Inflammation Is at the Core of Atherosclerosis Development
Inflammation is at the heart of many negative health conditions, so it is not surprising that the researchers also identify it as part of the atherosclerosis process.19
"[O]ne candidate pathway through which sleep fragmentation can raise atherosclerotic risk in humans may be through raised levels of inflammatory-associated neutrophil and monocyte counts.
This proposal is consistent with findings that insufficient sleep (acute and prolonged) triggers low-grade inflammation, decreases and increases in discrete immune factors, and enhanced upstream signaling mechanisms of inflammation, including those regulated by monocytes.
Moreover, both monocytes and neutrophils have a recognized role in atherosclerosis, including the modulation of proatherogenic reactive oxygen species and neutrophil extracellular traps that encourage monocyte accumulation to the plaque site."
What biochemical actions from fragmented sleep contribute to inflammation? The PLOS authors wrote:20
"What it is about fragmentated human sleep that triggers inflammatory blood cell pathway continues to be defined. Beyond the inhibition of hypocretin production, sleep fragmentation results in hypercortisolemia.
The state of raised cortisol can prevent the inhibition of granulocyte macrophage colony-stimulating factor (GCSF) that otherwise limits neutrophil levels, and may therefore further increase neutrophil production."
Inflammation is a pressing issue that affects people of all age groups and should not be ignored. U.S. adults with obesity, estimated to be around 36.5%, and children with skin and respiratory allergies struggle with high degrees of inflammation.
Common conventional treatments for inflammation include NSAIDs (nonsteroidal anti-inflammatory drugs) but they are associated with undesirable side effects like unwanted weight gain, blurred vision, stomach pain, fatigue and sensitivity to light. Luckily, foods like tomatoes, berries, fatty wild-caught fish, grapes, dark chocolate, broccoli, avocados and peppers fight inflammation naturally.
Other natural treatments for inflammation include the supplements pycnogenol, krill oil, ginger, curcumin, resveratrol and spirulina, the herbs cinnamon, geranium, turmeric, oregano, rosemary and thyme and oils made from clove, rose, eucalyptus, fennel, bergamot and thyme. Green tea and other teas made from ginger, sage, turmeric and oregano also fight inflammation.
Ways to Improve Your Sleep
In addition to its newly described links to atherosclerosis, sleep is crucial for the health of each and every organ in the human body. While once regarded as a waste of time, we now know that every cell in the body has its own biological clock. These cellular clocks, all of which work in tandem to control and maintain biological homeostasis, regulate everything from metabolism to psychological functioning. Here are 33 ways to improve your sleep:
1. Sleep in complete darkness, or as close to it as possible — Even the tiniest bit of light in the room, such as that from a clock radio LCD screen, can disrupt your internal clock.
2. Keep the temperature in your bedroom no higher than 70 degrees F — The optimal room temperature for sleep is 60 to 68 degrees F.
3. Eliminate electric and electromagnetic fields in your bedroom — EMFs can disrupt your pineal gland's production of melatonin and serotonin and harm your mitochondria, producing excessive oxidative damage.
4. Move alarm clocks and other electrical devices away from your bed — Shut down your phone or move it far away from the bed.
5. Adopt a neutral sleeping position — Find your natural sleep position and stick to it.
6. Reserve your bed for sleeping — Avoid working or watching TV in bed.
7. Consider separate bedrooms — A bed partner can impair sleep.
8. Get to bed as early as possible — Your body (particularly your adrenal system) does a majority of its recharging between the hours of 11 p.m. and 1 a.m.
9. Maintain a consistent bedtime, even on the weekends.
10. Establish a relaxing bedtime routine — Meditation, deep breathing, aromatherapy or a massage from your partner are all helpful.
11. Avoid drinking fluids within two hours of going to bed — This will reduce needing to go to the bathroom during the night.
12. Go to the bathroom right before bed — This will reduce chances that you'll wake up.
13. Avoid eating at least three hours before bedtime — Particularly avoid grains and sugars.
14. Minimize use of electronics, during day and night — The more time you spend on electronic devices, the longer it takes to fall asleep.
15. Try controlled breathing before sleep — Slow, deep and steady breathing activates your parasympathetic response.
16. Take a hot bath or shower before bed — A raised body temperature facilitates sleep.
17. Wear socks to bed — Feet have poor circulation and can be cold.
18. Wear an eye mask — Sleeping in complete darkness is important.
19. Put your work away at least one hour before bed — Give your mind a chance to unwind.
20. Avoid TV right before bed — Even better, get the TV out of the bedroom.
21. Listen to relaxation CDs — White noise and nature sounds are helpful.
22. Read something spiritual or uplifting — Avoid anything stimulating.
23. Journal — If you often lie in bed with your mind racing, it might be helpful to keep a journal and write down your thoughts before bed.
24. Reduce or avoid as many drugs as possible — Both prescription and over-the-counter drugs can affect sleep.
25. Avoid caffeine — This is a no-brainer.
26. Avoid alcohol — It disrupts deeper stages of sleep.
27. Exercise regularly, but not within three hours of bedtime — Exercising for at least 30 minutes per day can improve your sleep.
28. Lose excess weight — Being overweight can increase your risk of sleep apnea.
29. Avoid foods you may be sensitive to — This is particularly true for sugar, grains and pasteurized dairy. Sensitivity reactions can cause excess congestion, gastrointestinal upset, gas and both.
30. Have your adrenals checked by a good natural medicine clinician — Insomnia may be caused by adrenal stress.
31. If you are menopausal or perimenopausal, get checked out by a good natural medicine physician — The hormonal changes at this time may cause sleep problems if not properly addressed.
32. Emotional Freedom Techniques — EFT can help balance your body's bioenergy system and is definitely worth a try.
33. Boost your melatonin — Ideally you should increase your levels naturally with exposure to bright sunlight in the daytime (along with full spectrum fluorescent bulbs in the winter) and complete darkness at night.
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