Not-so-Goldilocks and the three nights sleep

Not-so-Goldilocks worked late after a long day, so she finally went upstairs. She lay down in the first bedroom recently vacated by her son who had left the previous day for college, but the bed was too hard. She was only able to sleep for 5 1/2 hours, and she felt like hell in the morning(1).

The next night, Not-so-Goldilocks was so tired she headed up to bed at 9 p.m. She lay in the second bedroom that still had her daughter's stuffed animals arranged on a flower spread, but the bed was too soft. She slept like the dead, unmoving, for 9 1/2 hours, and woke up with her head foggy and her back screaming(2).

On the third night, she dragged her sorry self all the way to the end of the upstairs hall to her own bedroom at her usual bedtime of 11 p.m. Then she flopped down on her pillow-top Sealy mattress, and it was just right. Not-so-Goldilocks fell asleep and awoke refreshed at 6 a.m., her mind clear and her eyes unpuffy. She bounded downstairs for breakfast and coffee, ready to wrestle the world to the ground.
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(1) Researchers at the University of North Carolina's School of Public Health in Chapel Hill found that women who slept six hours or less were at 14 percent greater stroke risk than those who slept seven hours a night.
(2) This same study found that compared to postmenopausal women who slept seven hours, those who dozed nine hours or more had a 60-70 percent higher risk of ischemic stroke.
(3) The Chapel Hill investigators agreed; seven hours of sleep is just right!

Silent brain infarctions

...and no air through the airway means no oxygen to the brain!

Clinically identified stroke represents the tip of the iceberg in terms of cerebral vascular disease by at least an order of magnitude...It is hard to believe, however, that loss of brain tissue should go without consequences. The brain may reorganize functional networks to adapt to lesions and recover function. But with each subsequent stroke, the capacity to do so is diminished.
--Brian J. Murray, MD

Silent brain infarctions or SBIs occur when a small amount of brain tissue is lost due to a lack of oxygenated blood to the area caused by a blockage in its blood supply. While any one such event can pass unnoticed, the cumulative damage from many such events builds up over time until the loss is manifested by neurological symptoms such as confusion or unsteadiness with walking. Nursing homes are filled with old ladies who lost their independence piecemeal in just such a fashion.

Scary new news on SBIs--one-fourth of persons with obstructive sleep apnea (the bedmate who keeps you awake as you lie awake waiting for him to take his next breath) were found in a Japanese study to have evidence of extensive silent strokes on MRI imaging.

How do you know if you've got sleep apnea if no one is lying awake waiting for you to breathe, and then telling you about it in the morning? Excessive daytime sleepiness,* a high red blood cell count, hypertension, and a short, thick neck are often associated with this dangerous condition.
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*As your oxygen levels drop off when you stop breathing, brain sensors rouse you to near consciousness to get you to make that big, annoying (to your bed partner) gasp for breath. While you may not be aware that you are waking up multiple times during the night, the lack of deep levels of sleep leaves you heavy-lidded by early afternoon.

Is frustration frying your brain?

When your teenager awakens in the morning with a fully developed case of rage, do you go there with him, or do you smile benignly at the little darling and turn the other cheek? A study out of Maryland* suggests that your response may significantly influence your risk for a stroke.

I'll bet these Baltimore investigators had a field day with this one. They invited 67 "older subjects" down to the lab for an afternoon of testing. The unsuspecting seniors (ages 55 to 81) were subjected to "repeated interruptions of statements and harassment during mental arithmetic tests," while their vital signs were monitored as the aggravation wore on.

The hot reactors in the group raised their blood pressures along with their ire. These simmering subjects were found to have a significantly increased number of unsuspected little infarcts on subsequent MRI brain scanning (see 'The White Matter Matter' below). In other words, their explosive reactions to life's little unpleasantries had taken a permanent toll on the health of their brains.

Lead investigator Dr. Shari Waldstein concluded, "If these findings are replicated, it may be worthwhile to investigate whether treatment of stress-induced blood pressure responses -- in addition to the resting blood pressure -- can reduce cerebrovascular risk."
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*Waldstein, SR, et al. Stroke. 2004 Jun;35(6):1294-8.

The white matter matter

The brain is divided into two main regions: the superficial gray matter, and the white matter below. Gray matter is the surface control center; the nerve cell bodies in this layer connect to one another via long extensions called axons. These electrical connectors travel through the white matter, so-named because a white, fatty material called myelin surrounds and insulates the axons, one from another.

We have long known that damage to the gray area through stroke or injury results in devastating paralysis and loss of physical functions such as speech. Through the fancy radiological technique of magnetic resonance imaging (MRI), we now know that the white matter is also vulnerable to a patchy sort of damage which, over time, can have a cumulative effect on motor, speech, and thinking skills.

These damaged areas appear on MRI scanning as small bright spots within the large body of white matter. The number of these 'white matter hyperintensities' (WMH) increases with age. WMHs have also been linked to a history of hypertension, migraine, and depression. Microscopic studies done on brains whose owners no longer need them confirm that these areas represent ischemic damage due to a loss of blood supply and fresh oxygen to the tissue. Many bright spots in the brain do not foreshadow a bright future for cognitive functioning. The following two studies have aided researchers in understanding the significance of such MRI findings.

Maryland researchers at Johns Hopkins University scanned the aging brains of 3600 individuals and graded the white matter abnormalities from 0 (no white matter matters to speak of) to 9 (a huge load of stressed-out white matter). Over the next five years, they followed the group for the occurrence of stroke. The higher the grade, the more the brains failed to age in good style. Those whose white matter was heavily spotted and bright (grade 5 or higher) had triple the stroke incidence compared to those whose white matter was scarcely spotted at all.

In 1932, public health authorities in Scotland administered the "Scottish Mental Survey" to all the resident 11 year olds. In 1999, scientists at the University of Edinburgh rounded up a bevy of 78 year olds and compared their current cognitive ability to their pre-teen mental testing as well as their current brain MRI scans.* The scientists found that the amount of white-matter lesions in their subjects' aging Scottish noggins was a better marker for present mental functioning than the early-age IQ scores. Furthermore, the impact of the white matter changes was independent of youthful mental ability.

Don't take it's 'just age' for an answer if bright spots are spotted on your MRI scan. Get cardiovascular risk factors such as elevated blood pressure, cigarette use, elevated blood sugar, and high cholesterol out of your life.
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*Leaper, SA et al. Radiology. 2001 Oct;221(1):51-5.Click here to read