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Is Fragmented Sleep a Predictor of Mortality?

SCOFA-SLeep Age -1

 
Medically reviewed by
Dacelin St Martin, MD
Triple board-certified in Sleep Medicine,
Internal Medicine, and Pediatrics.

 
 
What is Fragmented Sleep? | Where’s the Proof? | How Sleep Age Predicts Mortality | Factors that Contribute to Fragmented Sleep |
Ways to Reduce Sleep Fragmentation | Identify the Problem

 

Overview

Generally speaking, numbers say a lot about an individual. We use metrics to determine mortgage eligibility from a credit score or estimate cardiovascular disease risk based on risk factors.

In contrast, metrics surrounding sleep and its relationship to various health outcomes have recently emerged – particularly the relationship between fragmented sleep and dying.[1]

 

What is Fragmented Sleep?

The term fragmented sleep refers to disrupted sleeping patterns during which an individual wakes up periodically throughout the night. Most people who suffer from fragmented sleep report being unable to get into a deeper sleep, thus, will typically wake up feeling tired most mornings. 

Aside from the lack of productivity associated with waking up groggy or tired, sleep deprivation resulting from fragmented sleep can impact more than just how you feel. 

Studies have demonstrated the physiological and psychological impact of fragmented sleep and how it can be used to predict mortality.

 

Where’s the Proof?

In a review aimed at evaluating life expectancy from sleep studies consisting of 12,000 participants, it was determined that fragmented sleep is the strongest predictor of mortality.[2] Evidence suggests that disrupted short or long sleep patterns (less than 6 hours or more than 9 hours of sleep, respectively) are associated with several comorbidities, namely:

· Cardiovascular disease[3]

· Diabetes Mellitus[4]

· Obesity[5]

· Poor mental health[6]

All of the above conditions attributed to fragmented sleep can, in their way, increase an individual’s risk for earlier death, particularly in the elderly population (over 60 years), which is thought to reach approximately 2 billion in 2050.[1]

 

SCOFA- Sleep Age 2

 

How Sleep Age Predicts Mortality

As we sleep, the brain relaxes and starts working on autopilot, our heart rate drops, and our breathing changes. Any disruption in these normal physiological processes during sleep can facilitate a change in health.

Just as we have heart age calculators that determine cardiovascular health, scientists have utilized machine learning to asses data patterns to predict a person’s sleep age – a projected age calculated by evaluating several factors that contribute to your overall health. 

By comparing your actual age to your sleep age, scientists can predict mortality based on the assumption that the higher your sleep age, the more likely you are to suffer from a health issue.[2]

The study’s results found that people with older sleep ages than their chronological age were at an increased risk of mortality.[2] These results can be backed up using evidence from previous studies that confirm the correlation between poor sleep and worsening conditions that contribute to all-purpose mortality, such as diabetes, obesity, and cancer, to name a few.[7]

 

Factors that Contribute to Fragmented Sleep

Many people experience fragmented sleeping patterns because of many factors, including their jobs, looking after young children, and facing everyday life stresses. 

Fragmented sleep can be a short-term condition that comes to light following an event or stressor that’s added to an individual’s life, such as being a new parent. However, fragmented sleep can also occur due to a more sinister sleep condition that may warrant further treatment. 

1) Sleep Conditions

Sleep disorders such as obstructive sleep apnea,[8] restless legs syndrome,[9] or periodic limb movement disorder[9] can cause you to experience more subtle awakenings. These conditions can, over time, develop into insomnia and start to impact your well-being, from affecting your physical health to disrupting personal relationships.

2) Medication

Several medicines are attributed to sleep disorders, such as insomnia and fragmented sleep. Even medications used to help people sleep, such as hypnotic sedatives that help the continuity of sleep overnight, can result in daytime drowsiness, leading to fragmented sleep.[10]

Conversely, medicines used to promote alertness, such as modafinil or amphetamines, can cause sleep-onset insomnia.[10] One study showed that 61 percent of children with ADHD who take stimulant medicines reported having a shorter sleep duration and considerable variability in sleeping patterns from night to night.[11]

Medicines that can disrupt sleeping patterns include diuretics,[12] antidepressants,[13] blood pressure medicines,[14] and steroids.[15] If you have been experiencing fragmented sleep shortly after initiating a new medication, get in touch with your healthcare provider to discuss alternative treatment options.

3) Lifestyle Factors

Of the factors that potentiate the psychological and physiological mechanisms involved in the development of sleep disorders are the sociocultural, technological, and lifestyle trends that characterize the current era. 

Behavioral lifestyle factors attributed to sleep fragmentation include weight gain, a sedentary lifestyle, and the overconsumption of stimulants such as caffeine, nicotine, and alcohol.

Modern lifestyle behaviors are closely linked to technological advancements that have enabled or encouraged us to be more sedentary, stay up late, and motivate the indulgence in products to maintain alertness or achieve tranquility.[16][17] Combined, these factors cause considerable desynchrony in physiological and behavioral circadian rhythms, causing sleep loss, increased sleepiness, and the inevitable decline in mental and physical performance.

 

Ways to Reduce Sleep Fragmentation

You can help improve sleep, reduce fragmented nights, and enhance your overall well-being in many ways. In line with today’s digital age, you can try using a sleep tracker to help you identify how often you wake up, when you wake up, and how long you wake up. This data can help you understand the pattern (if one exists) of your sleep and give you insight into your current sleep health.

In general, it’s recommended that you avoid exercise for a couple of hours before sleep, avoid exposure to blue light for an hour before bedtime, and set consistent sleep times and waking times. By implementing the above, you should find it easier to fall asleep and stay asleep at night.

However, if you keep waking up multiple times through the night, it’s worth visiting your local healthcare provider for advice tailored to your individual needs and routine. 

Your healthcare provider can help identify if the cause of your sleep disruption is due to an underlying sleep disorder, medication, or lifestyle change, and prescribe you a management plan based on your characteristics and routine.

 

Identify the Problem

Maintaining good sleep should be one of your highest priorities during all stages of life. One can make many healthy changes to facilitate restorative sleep, all of which are simple to implement yet effective at preventing complications. 

If you’re worried about your fragmented sleep and how it can affect your life expectancy, visit your local healthcare provider. They’re there to help, and they may be able to use the newest developments in age calculations to determine your sleep age and formulate a management plan tailored to your requirements.

 

REFERENCES:

  1. Silva, A. A. da. (2016, February 1). Sleep duration and Mortality in the elderly: a systematic review with meta-analysis. BMJ Open. https://bmjopen.bmj.com/content/6/2/e008119
  2. Brink-Kjaer, A., Leary, E. B., Sun, H., Westover, M. B., Stone, K. L., Peppard, P. E., Lane, N. E., Cawthon, P. M., Redline, S., Jennum, P., Sorensen, H. B. D., & Mignot, E. (2022). Age estimation from sleep studies using deep learning predicts life expectancy. Npj Digital Medicine, 5(1). https://doi.org/10.1038/s41746-022-00630-9
  3. Cappuccio, F. P., Stranges, S., Kandala, N. B., Miller, M. A., Taggart, F. M., Kumari, M., Ferrie, J. E., Shipley, M. J., Brunner, E. J., & Marmot, M. G. (2007). Gender-Specific Associations of Short Sleep Duration With Prevalent and Incident Hypertension. Hypertension, 50(4), 693–700. https://doi.org/10.1161/hypertensionaha.107.095471
  4. Cappuccio, F. P., D’Elia, L., Strazzullo, P., & Miller, M. A. (2009). Quantity and Quality of Sleep and Incidence of Type 2 Diabetes. Diabetes Care, 33(2), 414–420. https://doi.org/10.2337/dc09-1124
  5. Cappuccio, F. P., Taggart, F. M., Kandala, N. B., Currie, A., Peile, E., Stranges, S., & Miller, M. A. (2008). Meta-Analysis of Short Sleep Duration and Obesity in Children and Adults. Sleep, 31(5), 619–626. https://doi.org/10.1093/sleep/31.5.619
  6. Daytime Sleepiness, Snoring, and Obstructive Sleep Apnea. (1993). Chest, 103(1), 30–36. https://doi.org/10.1378/chest.103.1.30
  7. Svensson, T., Saito, E., Svensson, A. K., Melander, O., Orho-Melander, M., Mimura, M., Rahman, S., Sawada, N., Koh, W. P., Shu, X. O., Tsuji, I., Kanemura, S., Park, S. K., Nagata, C., Tsugane, S., Cai, H., Yuan, J. M., Matsuyama, S., Sugawara, Y., . . Inoue, M. (2021). Association of Sleep Duration With All- and Major-Cause Mortality Among Adults in Japan, China, Singapore, and Korea. JAMA Network Open, 4(9), e2122837. https://doi.org/10.1001/jamanetworkopen.2021.22837
  8. Erman, M. K. (2006). Selected Sleep Disorders: Restless Legs Syndrome and Periodic Limb Movement Disorder, Sleep Apnea Syndrome, and Narcolepsy. Psychiatric Clinics of North America, 29(4), 947–967. https://doi.org/10.1016/j.psc.2006.09.007
  9. Foral, P., Knezevich, J., Dewan, N., & Malesker, M. (2011). Medication-Induced Sleep Disturbances. The Consultant Pharmacist, 26(6), 414–425. https://doi.org/10.4140/tcp.n.2011.414
  10. Stein, M. A., Weiss, M., & Hlavaty, L. (2012). ADHD Treatments, Sleep, and Sleep Problems: Complex Associations. Neurotherapeutics, 9(3), 509–517. https://doi.org/10.1007/s13311-012-0130-0
  11. Spruyt, K., Raubuck, D. L., Grogan, K., Gozal, D., & Stein, M. A. (2012). Variable sleep schedules and outcomes in children with psychopathological problems: preliminary observations. Nature and Science of Sleep, 9. https://doi.org/10.2147/nss.s29299
  12. Uzu, T., & Kimura, G. (1999). Diuretics Shift Circadian Rhythm of Blood Pressure From Nondipper to Dipper in Essential Hypertension. Circulation, 100(15), 1635–1638. https://doi.org/10.1161/01.cir.100.15.1635
  13. Wichniak, A., Wierzbicka, A., Walęcka, M., & Jernajczyk, W. (2017). Effects of Antidepressants on Sleep. Current Psychiatry Reports, 19(9). https://doi.org/10.1007/s11920-017-0816-4
  14. Shalimova, A., Buriakovska, O., & Isayeva, G. (2021). THE RELATION BETWEEN ANTIHYPERTENSIVE DRUGS AND SLEEP DISORDERS IN PATIENTS WITH HYPERTENSION. Journal of Hypertension, 39(Supplement1), e363. https://doi.org/10.1097/01.hjh.0000748740.02542.7b
  15. Cole, J. L. (2020). Steroid-Induced Sleep Disturbance and Delirium: A Focused Review for Critically Ill Patients. Federal Practitioner. https://doi.org/10.12788/fp.003
  16. Calamaro, C. J., Mason, T. B. A., & Ratcliffe, S. J. (2009). Adolescents Living the 24/7 Lifestyle: Effects of Caffeine and Technology on Sleep Duration and Daytime Functioning. Pediatrics, 123(6), e1005–e1010. https://doi.org/10.1542/peds.2008-3641
  17. Jaehne, A., Loessl, B., Bárkai, Z., Riemann, D., & Hornyak, M. (2009). Effects of nicotine on sleep during consumption, withdrawal and replacement therapy. Sleep Medicine Reviews, 13(5), 363–377. https://doi.org/10.1016/j.smrv.2008.12.003
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