Poor sleep stresses teens more: study

Adolescents who experience sleep problems and longer sleep duration are more reactive to stress, which could contribute to academic, behavioural and health issues, a new study has warned.
Insufficient sleep and sleep problems contribute to cognitive problems and poor physical health over time, possibly because of disruptions in a key part of the neuroendocrine system that controls reactions to stress and regulates many body processes - the
hypothalamic-pituitary-adrenal axis (HPA axis).
Researchers at University of Alabama at Birmingham (UAB) explored the relationship between sleep and reactivity to stress, specifically as it relates to HPA-axis activity, in adolescents.
The researchers examined two dimensions of sleep - sleep duration and sleep problems from the perspectives of adolescents and their parents, as well as cortisol levels before and after social stress. They also looked at how the results varied based on gender.

"We chose to look at sleep patterns in urban African-American adolescents, due to information we understood from earlier research in the field," said Sylvie Mrug, a professor at UAB.

"This particular population is more likely to experience insufficient sleep, and their functioning is more negatively affected by lower sleep quality, so we knew that finding results for this demographic could be especially important," Mrug added.
The study was conducted on 84 adolescents with an average age of 13. They were given the children's version of a common stress test, called the Trier Social Stress Test, to measure their physiological responses to stress.

This test involves speaking and computing mental math problems in front of an audience. Saliva samples were taken from each participant in order to test cortisol levels before and after the stress test.
Participants then reported on their bed times and wake times and any sleep problems, such as insomnia, daytime sleepiness and general sleep quality, during a regular week. Parents of the adolescents were asked to report on their children's sleep as well.
The adolescents most commonly reported the following sleep problems - the need for multiple reminders to get up in the morning, not having a good night's sleep, feeling tired or sleepy during the day, and not being satisfied with their sleep.

The researchers looked at the cortisol levels of the adolescent participants. Cortisol release during and after the stressful lab test was higher for adolescents who reported more sleep problems and longer sleep duration, and whose parents reported longer sleep duration.
The effects of sleep problems on greater cortisol release during stress were stronger in females than in males, suggesting that adolescent girls may be more sensitive to disrupted and poor quality sleep.
According to Rajput, 40 per cent cases of high blood
pressure are because of sleep apnea, and among the cases of resistive hypertension, where it is not controllable even after 3-4 doses of drugs, 80 per cent are cases of the OSA.

Noting the rise in cases of sleep apnea, Rajput, who has served several institutes including the Army R&R Hospital, Delhi and AFMC, Pune during his 35 year career, said, "About a decade ago, I used to see 2-3 patients a month for sleep apnea. Today I see 2-3 people a day. The jump is tremendous."
According to Astha Ahluwalia, Psychologist, Morpheus Healthcare, "Sleep Apnea is seen to have an effect on the mental health of a person. The difficulty in sleeping and the compromised supply of oxygen to the brain is linked to symptoms of mild depression or anxiety. Irritable moods, short temper, poor concentration, mild cognitive disorientation etc are common with such a problem."

Another phenomenon observed with Sleep Apnea is the stress or worry about chronic breathing problems. This stress leads to anxiety which further worsens sleep, thus making this a viscous sleep deprivation circle, she added.
Sleep apnea is not a life-threatening condition in itself, but it can result in serious problems such as cardiovascular and cerebrovascular diseases.
"There is no cure as such, like in the case of hypertension. You can just control it. There are two ways to control it -- Medical and Surgical. The medical method is used widely and involves the use of CPAP (continuous positive airway pressure) which involves continuous positive airway pressure, which forces air through a mask into the airways so that they do not close.

"Some people have structural anomalies -- Micrognathia (small or retracted jaw) and Retrognathia (decreased jaw size, receding chin). In such conditions, the passage (in throat) becomes narrow. So in such cases, the people can undergo surgery.
He clarified that CPAP is not an artificial breathing procedure and is the most widely accepted treatment for sleep apnea.
"There is also a third method -- Oral appliance. Just like the dentures worn by old people, there are devices that could be worn over the teeth and it is placed in such a way that mandible (lower jaw) does not go backward," Rajput said.

He rued that people in general are not aware that many of the common disorders are caused due to sleep issues and they land up with different specialists instead of a pulmonologist or sleep specialist.