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Effects of Excessive Sleep and Prolonged Bedrest

Did you know that too much good quality sleep and the prolonged immobility that it causes has the same significant negative impact on our health as a lack of sleep or poor quality sleep? In fact research shows that too much sleep increases the risk of dying young!

With slogans like “Good sleep is a reachable dream”, “When Sleep is Sound, Health and Happiness Abound” and “Restful Sleep, Easy Breathing, Healthy Body” it is clear that the focus of World Sleep Day has always been on the importance of getting a good night’s sleep. And quite rightly so, lack of sleep or poor quality sleep is known to have a significant negative impact on our health. But research also shows that prolonged time spent in bed and excessive sleep is equally damaging to our health. Unfortunately for some people like those with the neurological sleep/wake disorders Idiopathic Hypersomnia (IH) and Kleine–Levin syndrome (KLS) sleeping excessively is not a choice.

I decided to take a look at the risks associated with prolonged time in bed (being horizontal) and excessive sleep and I was surprised at what I found. My findings reveal a clear need for more research into the causes and treatment of IH and KLS due to the profound impact these diseases have on sufferers. Sleep is a basic human need, much like eating and drinking, and is crucial to our overall health and wellbeing. The average person will spend up to one-third of their life asleep. Research shows that people with IH sleep a lot more than that - some of them sleep twice that much.

My question is, "Is sleeping more than normal good for you?" The short answer is, no. Consistently sleeping for more than nine hours a day has a negative impact on physiological, psychological and cognitive functions. We also know that long periods of bed rest (in the case of IH that would be time spent asleep and trying to wake up) also has detrimental effects on the body [1].

In Bedřich Roth’s extensive studies on IH [2] he noted that some of his patients had symptoms other than excessive sleep, sleepiness and sleep drunkenness. They included increased heart rate, gastrointestinal/digestive issues, postural (orthostatic) hypotension, fainting episodes (syncope), depression, anxiety, irritability, diminished libido in men, peripheral vascular symptoms such as cold hands and feet, difficulty with body temperature and cognitive dysfunction. More recent studies [3] show that people with idiopathic hypersomnia become tired and sleepy in both over and under stimulating conditions “… given that the patients feel tired in the presence of over-stimulating conditions (a loud environment, strangers and flashing light), and feel sleepy in under-stimulating conditions (darkness, left alone or listening to a conversation). Basically, it appears in this study that the patients would feel all right only during holidays, in a nice landscape with sun and friends. One may wonder if they use, in this case, the motivation ⁄ mood system to stay awake rather than the usual arousal systems”. This would suggest if people with IH are constantly relying on their motivation/mood system to stay awake rather than the usual arousal systems then depression, anxiety and associated psychological difficulties including irritability, emotional and mental lability and fatigability would be an obvious consequence.

While none of the other symptoms (mentioned above) were attributed to the etiology (the cause or origin of disease) of IH it was reported that they would in most cases contribute to the burden of the disease. What I found interesting is, all of those symptoms that Roth identified in his IH patients are in fact symptoms that are experienced by people who are bedridden for long periods.

Researchers from Swansea University wrote a very interesting three part series on the physiological and psychological effects of bedrest. The first article discussed what happens to the cardiovascular, respiratory and haematological systems which includes disruption to water balance, skeletal muscle atrophy (muscle wasting), dehydration, increased heart rate, cardiac deconditioning (weakening of the heart muscles) and postural (orthostatic) hypotension [1]. Because the major role of the cardiovascular, respiratory and haematological systems is to deliver oxygen and nutrients to all areas of the body, the detrimental effects of bedrest have a negative impact on every organ system.

The second and third articles explore how inactivity specifically affects the digestive, endocrine, renal, reproductive, nervous, musculoskeletal and immune systems, skin and self-perception [4,5]. They also found that it can disrupt the body’s circadian rhythms, leaving you more prone to illness and deprives you of sunlight exposure, which can compromise your immune system. So, basically every area of our body is negatively affected by prolonged periods being inactive and horizontal.

As well as the physiological effects the three part series also discusses the psychological effects of prolonged bedrest.

People with IH have little to no control over the amount they sleep. It is common for them to miss important family events, work opportunities, or even just simple things like being able to read a book, walk the dog or enjoy a day in the sunshine. This causes people with IH an enormous amount of distress and often causes family and friends to become resentful. The absence of physical and mental engagement may result in feelings of loneliness and isolation.

Several studies have reported that long periods of bedrest have negative psychological effects on individuals and their family. These include symptoms of depression, anxiety, forgetfulness and confusion. These symptoms could be partly due to the lack of personal control imposed by bedrest…

A person’s lack of control over their environment has long been linked to increased levels of stress and the release of stress hormones such as corticosteroids... It has been suggested that control, or the lack of it, directly influences health through physiological changes..

Prolonged bedrest often deprives patients of environmental and social stimulation, which may lead to increased anxiety, confusion and depression”[1]

In the research referred to above [3] it is suggested that people with IH may use “the motivation ⁄ mood system to stay awake rather than the usual arousal systems” if this is the case it would place an added burden on a person's already compromised stress levels and psychological wellbeing.

It is important to note that people with IH are not simply bedridden for long periods they are actually asleep for long periods so they are not only at risk of what happens as a result of being bedridden for long periods of time they are also at risk of the health problems associated with actually sleeping longer than is recommended.

In a study by the University of Sydney [6,7] it was shown that sleeping for more than 9 hours puts you at a higher risk of dying young. In fact they found that smoking, alcohol and less sleep were slightly less harmful than being physically inactive and sleeping too much. Other research [7,8] found a link between excessive sleep (more than 8- 9 hours) and a higher risk of depression, obesity, headaches, back pain, heart disease, diabetes, brain dysfunction, infertility and stroke. More research is needed as it can be difficult to pinpoint which is the cause and which is the effect with regards to excessive sleep and health problems [8, 9, 10].

What makes IH stand out from other conditions is that there is no obvious cause. Unlike in other medical conditions and other sleep disorders the sleep in people with IH is normal and usually very deep. But IH is not simply a label that is available to doctors that can’t find the cause of a patient’s excessive sleep. IH is an independent clinical entity, ie: it is a standalone neurological sleep disorder. IH is characterised by a number of symptoms and clinical features, excessive sleep is just one of them [11]. There are a number of causes of excessive sleep including poor quality sleep that also have symptoms associated with prolonged bedrest so it is important that all of these are identified and treated appropriately.

So if we know that prolonged time spent in bed (horizontal and inactive) and sleeping in excess of 9 hours is dangerous what does that mean for people with IH?

People with IH generally sleep in excess of 10 hours over a 24 hour period. While medication can help to reduce the amount they sleep, my research shows that it is often not reduced by much. Part of the reason for that is the ineffectiveness of the medications available but also because most people find that sleep restriction (eg: less than 9 hours in a 24 hour period) can make them feel worse. In fact people with IH often report experiencing symptoms of sleep deprivation when they regularly sleep less than 9 hours so this too has obvious negative consequences. There hasn’t been any research done on why this is the case but considering what we know about prolonged bedrest and excessive sleep we know that if people with IH don’t restrict their sleep time they are at serious risk of all sorts of health issues, including an early death!

While it is important to get the message out there that lack of sleep or poor quality sleep is known to have a significant negative impact on our health it is equally as important for people to know that research shows that the negative impact of excessive good quality sleep is no less significant.

*for those of you confused by this post, we are well aware that people with Idiopathic Hypersomnia need to sleep more than 9-10 hours (and usually more) in a 24 hour period. The point of our post is to get doctors and researchers to understand that there are a group of people that simply *cannot* function on less than 9-10 hours sleep (or more), so if they know there are serious repercussions related to prolonged bedrest/excessive inactivity and sleeping excessively then what are they doing about it for this group of people that simply has no choice but to sleep excessively and therefore be inactive for lengthy periods. The attitude many people with IH get from their doctors is "you have idiopathic hypersonmia, no its no big deal, it's not life threatening and it's not doing you any harm like say a *serious* (some even say a "real") medical condition would" however research shows that attitude is clearly very wrong and something obviously needs to be done about it. Also, please keep in mind the point of this post is not about saying sleeping more than 9 hours is “bad for you”. It is however, a fact that there is research that says regularly sleeping 9 hours puts you at a higher risk of dying young and this certainly concerns us which is one reason why we believe Idiopathic Hypersomnia should be taken more seriously. However the main issue we address here is that people who sleep excessively are horizontal and inactive for long periods and it is this prolonged inactivity (not necessarily the sleep) that causes most of the problems mentioned in the post. These issues are relevant to anyone that experiences prolonged bedrest, it just so happens that “prolonged bedrest” for people with Idiopathic Hypersomnia (and Kleine–Levin syndrome (KLS) means they are actually asleep – ie: it is the prolonged time in bed (being horizontal and inactive) that causes the majority of the problems referenced in this post, not the fact that some people are asleep during this time.

First Published for World Sleep Day 18th March 2016

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