Sleep and related disorders have been a “Cinderella” subspecialty of medicine for decades. This discipline is rarely mentioned in medical undergraduate education, and related training is mostly attached to other more mature disciplines, and sleep research is seriously underfunded. The reason for the lack of attention to this subject lies in the different nature of sleep disorder-related conditions (including sleep apnea syndrome diagnosed and treated by otolaryngology or cardiology department, restless legs syndrome diagnosed and treated by neurology department or primary medical and health institutions, etc.). There is a lack of understanding of the causes of the disorder and a lack of treatment options.
In recent years, concerns about sleep disturbances have grown. The shift stems in part from three scientists, Michael Rosbash, Jeffrey Hall and Michael Young, who were awarded the 2017 Nobel Prize in Physiology or Medicine for their work on the genetic basis of circadian rhythms. Based on their findings, we know that the body’s molecular clock, a network of timekeeping genes and related proteins, forms a circadian cycle through transcription, translation and degradation. Studies have found that these genes are also associated with bipolar disorder, depression and other mood disorders. Studies have also found that some sleep disorders are early clinical manifestations of Parkinson’s disease, dementia with Lewy bodies, and multiple system atrophy. In addition, the development of portable monitoring devices has enabled medical personnel to assess sleep status in real-world settings, including the home state. Finally, studies on the pathophysiological mechanism of narcolepsy have revealed that the disease is caused by the selective loss of neurons that secrete the wake-promoting neuropeptide orexin, which has led to the development of new drugs for the treatment of insomnia.
Based on these advances, The Lancet and The Lancet Neurology > recently published an album of four papers systematically analyzing various sleep disorders and reviewing the anthropological features of sleep. Despite the diversity of sleep disorders, this album brings together four key messages.
First, sleep disturbance is an underappreciated public health problem. Sleep disturbances are common, cause significant distress to patients and their bed partners, and have profound implications for population health and economic well-being. For example, nearly one-third of adults experience insomnia. Excessive sleepiness during the day can reduce the productivity and safety of office workers, and lack of sleep can affect teaching effectiveness for students and cause up to one-third of traffic accidents.
Second, people with sleep disorders often lack effective treatment options. For example, prescription drugs are the most commonly used form of insomnia treatment, most notably benzodiazepines and so-called “Z-drugs” such as zopiclone, eszopiclone and zapiclone. Come to Plon. However, non-pharmacological treatments such as cognitive behavioral therapy, although considered first-line treatment, are not widely used. In addition, drug dependence is a common condition of long-term use of drugs for sleep disorders, a risk not associated with interview therapy. Sleep hygiene is a growing public concern and could be a key element of this type of cognitive behavioral therapy.
Further, in hospitals and primary care settings, physicians should pay attention to the long-term effects of sleep deprivation on medical conditions such as high blood pressure, diabetes and heart disease. Lack of sleep and too much sleep can have serious adverse effects on many common health problems, leading to increased morbidity and mortality. Therefore, any medical consultation should include the necessary consultation on sleep.
Finally, the incidence of sleep deprivation and sleep disturbances is likely to continue to rise. For example, anthropological surveys have shown that insomnia is inextricably linked to modern lifestyles (in industrialized societies, 10%-30% of the population experience insomnia; in Namibia and Bolivia, hunter-gatherers less than 2% of the population). Psychosocial stressors, alcohol use, smoking, and physical inactivity have all been associated with sleep disturbance. In addition, increased use of electronic devices in the bedroom (especially smartphones used by young adults) during sleep has led to exposure to blue light, which is thought to be a potential cause of sleep-wake rhythm disturbances.
A person spends one-third of their lives sleeping, yet sleep has so far received far less attention from doctors, healthcare professionals, and policymakers. This album will serve as a wake-up call for all, reminding everyone of the importance of good sleep, and emphasizing that modern medicine should pay more attention to the research, assessment and treatment of sleep disorders. END
Title image Copyright © 2022 Historic Images/Alamy Stock Photo
Chinese translation is for reference only, all content in English shall prevail.