Why Sleep is Essential for Disease Prevention, An Integrative Sleep Doctor Explains

Sleep problems are direct, modifiable risk factors for the top ten causes of death and disability around the world, said Shane Creado, MD, at the 2023 Integrative Healthcare Symposium in New York City.

“Sleep is a weapon,” said Creado. "It’s your variable fountain of youth. And it’s the difference between disability and great quality of life.”

In his presentation, Creado, a sleep medicine doctor and psychiatrist trained in integrative and functional medicine, described sleep as a “cornerstone of integrative medicine” and detailed the crucial role that it plays in preventing disease.

The Relationship Between Sleep and Disease

Sleep and the body’s functioning are closely aligned, explained Creado. Research suggests that even a small loss of sleep can impair the immune system. In fact, one study by Matthew Walker, PhD, a cognitive neuroscientist, found that when participants restricted their sleep to four hours for just one night, their natural killer cell (NKC) activity dropped by 70 percent.

A significant drop in NKC, immune cells that fight off tumors and virus-infected cells, can have a profound impact on the body’s response to threats big and small. According to Creado, the link between lack of sleep and cancer is so strong that the World Health Organization classified nighttime shift work as a probable carcinogen.

“We know that the natural killer cells are our main defense against things like COVID, other viruses, and cancers,” said Creado. “They are our first line of defense.”

In addition to putting patients at risk for cancer, poor sleep is one of the strongest risk factors for obesity, said Creado. While discussing weight with a patient can be uncomfortable, the relationship between obesity and sleep is undeniable and it must be addressed, Creado explained. For instance, one study showed that children with short sleep durations were 89 percent more likely to develop obesity. 

“This can be a dicey topic to bring up but if we truly care about our patients, we have to follow our Hippocratic oath,” said Creado.

Poor sleep goes beyond impacting weight and the immune system, it’s also been associated with heart disease, type 2 diabetes, problems with learning and memory, Alzheimer’s disease, depression, and other mental health issues.

Needless to say, improving sleep has the potential to improve overall health and treat and prevent many forms of disease. And the first step to improving your patients’ sleep, Creado said, is finding out whether they have a problem.

“If we screen patients for sleep disorders during their annual checkups and give them personalized guidelines, we can reduce disease burden right off the bat,” said Creado.

Screening for Sleep Disorders

According to Creado, there are six major categories of sleep disorders: insomnias, sleep-related breathing disorders, central disorders of hypersomnolence, circadian rhythm sleep-wake disorders, parasomnias, and sleep-related movement disorders.

Among the most common sleep disorders is insomnia, experienced by an estimated 10 to 30 percent of the population, according to the Centers for Disease Control. The International Classification of Sleep Disorders – Third Edition defines insomnia as “a repeated difficulty with sleep initiation, duration, consolidation, or quality that occurs despite adequate opportunity and circumstances for sleep, and results in some form of daytime impairment.”

“But what is insomnia really,” asked Creado. “Is it a lack of sleep? Or is it a preponderance of wakefulness?” 

Insomnia, Creado explained, is usually secondary to a vast number of issues. Many patients with anxiety, for example, can’t turn their brain off and have simply forgotten how to sleep. For these patients, anxiety is their main problem, and insomnia follows. 

Screening for insomnia does not have to be complicated. Creado suggested asking patients simple questions such as:

• Do you have difficulty falling asleep or staying asleep or waking up too early?
• Do you feel tired or sleepy during the day?

In addition to asking questions, practitioners can use tools such as the Insomnia Severity Index to diagnose patients. Once a patient is diagnosed, said Creado, further testing can be done to personalize treatment which often includes cognitive behavioral therapy (CBT).

“The goal is to help the brain learn how to sleep,” said Creado.

For sleep-related breathing disorders, Creado said he will ask patients, “Does your partner say you snore or stop breathing, and do you wake up gasping for air or feel refreshed or with dry mouth or morning headache?” Breathing conditions also commonly require a home or in-lab sleep study and a sleep medicine referral, which Creado suggests for most sleep disorders.

According to Creado, there are several baseline tests that are helpful when diagnosing a sleep disorder, including:

• Complete blood count (CBC)
• Comprehensive metabolic panel (CMP)
• Hormone tests
• Nutrient deficiency testing
• Food sensitivity testing
• Urine toxicology

General Tips for Better Sleep

“One of the most common reasons people cannot fall asleep is because they have a busy brain,” said Creado.

Chronic racing, anxious thoughts at bedtime are likely to lead to insomnia. For core calming strategies, Creado suggested scheduling time to worry, writing a to-do list for the next day, and having a routine that allows one to wind down before sleep.

Other natural ways to improve sleep recommended by Creado involved:

• Keeping the bedroom cool
• Avoiding alcohol
• Avoiding caffeine and nicotine
• Reducing napping
• Using a sleep diary
• Using weighted blankets

The Best Supplements for Better Sleep

According to Creado, sedating medications are dangerous for long term use as they can be addictive, have significant side effects, and lower cognitive performance. Instead, Creado uses several supplements with specific doses to help his patients sleep better, among them:

• 5-HTTP: 150 to 3,000 milligrams (mg), up to three times per day with a divided dose
• GABA: 100 to 3,000 mg, one to three times a day
• L-Theanine: 100 to 400mg, one to two times a day
• Vitamin B-6: 10 to 80mg, one to two times a day

To conclude his presentation, Creado stressed the importance of sleep education for integrative physicians. In the future, Creado said he hopes consensus guidelines and training modules are widespread among healthcare professionals. Not only does optimized sleep reduce risk of disease and improve overall well-being, Creado explained, but the application of integrative sleep medicine could also significantly reduce healthcare costs globally.

“We all have a bit of a savior complex, right? We all have a favorite superhero, and we all want to identify with the hero archetype,” said Creado. “So, if we want to save the world, we start by sleeping.”