Doctor’s Orders: Go Back to Bed

Your doctor could soon be prescribing shut-eye as prevention—and treatment—for ADHD, depression and even obesity

BY ALEXANDRA SIFFERLIN

AFTER BEING DIAGNOSED WITH BRAIN and lung cancer in 2011, Lynn Mitchell was averaging about an hour of solid sleep a night. No one could blame her; her twin diagnoses were serious, and mulling her treatment options caused her mind to race at all hours. Add to that the side effects of her treatment and the pain she was in, and she was paying for all of it in sleep.

In the mornings she was incoherent. She was so tired, she says, that she was slurring her words, and her already disrupted balance—a side effect of the brain cancer—was exacerbated, making basic movements increasingly difficult. When she shared this with her doctors at the Perelman Center for Advanced Medicine at the University of Pennsylvania, she expected them to tell her something else was wrong. She didn’t expect what they said next, however: Go see a sleep therapist.

Mitchell was relieved at how benign it sounded compared with the chemotherapy she had cycled through and the gene-therapy trial she was currently undergoing. Both induced nausea and fatigue—terrible symptoms for anyone but especially someone who can’t sleep them off—and she didn’t welcome the idea of piling on another intense therapy in the name of healing. So yes, Mitchell welcomed the opportunity to do anything that might help her get a more restful night’s sleep. But how, she wondered, would more or better sleep fight her cancer?

The therapist reviewed her evening regimen and worked with her to adjust her habits and cement some new ones. She was told to get under the covers only when she was extremely tired and to stop watching TV in bed. She stopped drinking caffeinated coffee in the evening and learned breathing exercises to relax and help ready her mind for a night of rest. It was all quite simple and commonsense, and, most important to her at that stage in her treatment, it was noninvasive. No extra pills, no additional hours on an IV.

Now Mitchell’s hour of shut-eye has been replaced by seven to nine hours—the recommended amount for healthy adults, though many Americans fall short of that target—and the results have been unmistakable to Mitchell and her doctors. “Once I fall asleep, I sleep soundly,” she says. “I’m alert in the morning, my balance is better, and I feel peppier.”

With her cancer symptoms in check, Mitchell says, she feels as if her treatment response is improving. She also recently found out that her brain cancer is shrinking and her lungs are clear. More than half of cancer patients experience sleep problems, according to the National Cancer Institute, and while better rest can’t take all the credit for Mitchell’s improvement, a growing body of evidence suggests that it can play a crucial role.

That’s why leading physicians are doing what Mitchell’s did: adding sleep therapy to the treatment plan for diseases like cancer, but also for depression and attention deficit hyperactivity disorder (ADHD).

Allan Rechtschaffen, a pioneer of sleep research at the University of Chicago, once said, “If sleep does not serve an absolutely vital function, then it is the biggest mistake the evolutionary process ever made.” Today, research is increasingly proving this to be true.

NATURE’S THERAPIST

The field of sleep therapy to treat or complement the treatment of disease is still rather small, but experts think it will grow—in part because it’s noninvasive but also because it’s very easy and inexpensive to administer.

Mitchell worked with a sleep therapist for about nine weeks, but some research has found that sleep issues—and perhaps some of the problems that come along with them—can improve with sessions of cognitive behavioral therapy for insomnia (CBT-I), the principles of which can be fairly straightforward.

With CBT-I, patients are often told to keep a diary for several weeks leading up to talk-therapy sessions in order to help identify the things possibly interfering with a good night’s rest. They are also instructed to go to bed at roughly the same time every night; eliminate stimuli like TV and bright lights from the street in the bedroom; learn how to relax through things like breathing exercises; and find ways to unwind so that going to sleep feels calming as opposed to stressful.

This kind of therapy is showing some early yet extraordinary promise in the treatment of depression. One study found that curing sleep problems with talk therapy literally doubled the likelihood of a full recovery from depression. The results were so dramatic that some experts are heralding sleep therapy as the first major development in the treatment of depression since the introduction of antidepressant drugs.

“I think it’s increasingly likely that this kind of sleep therapy will be used as a possible complement to standard care,” John M. Oldham, the chief of staff at the Menninger Clinic, a psychiatric hospital, told the New York Times. “We are the court of last resort for the most difficult-to-treat patients, and I think sleep problems have been extremely underrecognized as a critical factor.”

It’s not just depression that is alleviated by sound sleep, and doctors of all disciplines seem to be taking notice. David Rapoport, a professor of pulmonary medicine at the Icahn School of Medicine at Mt. Sinai in New York City, has long seen patients come in because they’re always tired or they have great difficulty falling asleep. But Rapoport says the center is receiving an increasing number of patients sent by their doctor for other diseases that may have at least partial roots in sleep problems—which range from Type 2 diabetes and obesity to ADHD and heart failure.

For instance, mild sleep apnea, which disrupts solid rest, may cause behavioral problems for children at school; if they’re tired from a lack of sleep, they may have a harder time paying attention in class. This, some experts think, may result in a diagnosis of ADHD, when in fact the child may just be exhausted. (Sleep deprivation makes adults groggy, but in kids, it tends to present in the opposite way: children get wired, cranky and wound up, making it difficult for them to sit still and focus.)

“No one is saying ADHD does not exist, but there’s a strong feeling now that we need to rule out sleep issues first,” Merrill Wise, a pediatric neurologist and sleep medicine specialist, told the New York Times. Indeed, studies have shown that kids with ADHD are more likely to have insufficient sleep—and researchers are trying to determine if that’s caused by the ADHD or, in some cases, if it’s the other way around.

The chicken-egg question turns up a lot in the discussion of diseases that are correlated with sleep problems. For instance, doctors and scientists have known for some time that a lack of sleep can interfere with the body’s metabolic functions, suggesting that it can exacerbate, if not cause, Type 2 diabetes and obesity. Lack of sleep can interfere with the neuroendocrine system, causing “increased appetite, enhanced sensitivity to food stimuli, and, ultimately, a surplus in energy intake,” according to a paper published in the journal The Lancet Diabetes & Endocrinology. And in the conclusion of a Lancet study, the researchers urged health professionals to begin prescribing sleep to prevent and treat those metabolic disorders.

Research also suggests that a lack of sleep can lead to problems later on in life. A 2014 study published in the journal Sleep found a link between older men with poor sleep quality and cognitive decline, though exactly why this is the case is not fully understood.

And while the mechanisms between sleep loss and metabolic disorders are well understood, researchers are hard at work trying to understand—and possibly prove—how a lack of sleep can drive other diseases at the biological level. There’s a reason you feel sleepy when you get the flu, for instance. According to David Gozal, an expert in pediatric sleep disorders at the University of Missouri School of Medicine, there are certain molecules in the brain that are responsible for inducing sleepiness, which is a typical reaction to infection. It’s part of the evidence showing that sleep can help fight disease.

“It’s common knowledge that sleep is needed for day-to-day function,” says Rapoport. “What isn’t common knowledge is that it really matters—it’s not just cosmetic.”

THE NEW SLEEP Rx

The message that all people, sick or not, should exercise regularly and eat a healthy diet is well worn, but sleep is the third element of basic self-care and, increasingly, disease prevention and possibly treatment, say sleep experts.

Plus, “it’s probably easier to change than diet or exercise,” says Michael Grandner, a sleep researcher at the University of Arizona College of Medicine. Diet can feel like it’s all about denial and exercise can too often feel like punishment. But what’s not to like about getting more sleep? “It may also give you more of an immediate reward if it helps you get through your day, but we take it for granted.”

The challenge is that sleep is still often looked at as a “get it if you can” luxury as opposed to a critical pillar of health. “Many doctors, lawyers and executives stay up late and get up early and burn the candle at both ends,” says Richard Lang, the chair of executive health at the Cleveland Clinic. “Making sure they pay attention to sleep in the same way they pay attention to diet and exercise is crucial.”

But while 70% of physicians agree that inadequate sleep is a major health problem, only 43% say they counsel their patients on the benefits of adequate sleep. Compare that with 100% of physicians who say they ask their patients about smoking or 93% who say they talk to their patients about their diets.

Yet the Centers for Disease Control and Prevention (CDC) says that “insufficient sleep has major health consequences in adults, adolescents, and young children,” pointing to a growing body of persuasive evidence that adults who get insufficient sleep—meaning less than seven hours a night on a regular basis—are much more likely to die of heart disease, have metabolic disorders like glucose intolerance and have mood disorders. In 2013 the agency called on health experts to begin putting sleep—as a means to prevent illness—center stage. “Sleep should be viewed as being as critical to health as diet and physical activity,” the CDC said in its report.

“Sleep won’t kill cancer, but under certain circumstances, getting better sleep will improve your odds of recovery,” says Gozal. “It will make cancer possibly less aggressive and potentially more responsive to the chemotherapy or treatment so that your body is fighting more effectively.”

Sleep won’t cure cancer, but getting better sleep may improve your odds of recovery.

And though sleep isn’t solely responsible for Mitchell’s turnaround, her doctors think it certainly played a role. Despite her cancer, Mitchell greatly improved her quality of life by prioritizing sleep, and that’s enough to support prescribing better shut-eye.

“Every physician should ask about sleep,” says Gozal. “Sleep is a life-sustaining function, and we should treat it like that.”

HIT THE HAY Sleep therapy is increasingly included in treatment plans for diseases such as cancer, as well as conditions like depression and ADHD.

CLIMBING THE WALLS Unlike adults, children often respond to sleep deprivation by being wired and wound up, which is why it is sometimes misdiagnosed as ADHD.