When sleep deprivation affects our health it's about more than just feeling tired

In the short term, sleep deprivation can cause many annoying and inconvenient symptoms that impact our day but do not generally affect us long term. However, chronic sleep deprivation – where an individual regular suffers from insufficient sleep – can have more significant consequences that affect our health and well-being.

Weight gain and related diseases
Sleep deprivation affects the production of ghrelin (the hunger hormone) leading us to feel hungry and experience food cravings. Likewise, leptin (the satiety hormone) production is reduced following insufficient sleep which impacts our ability to recognise when we are feeling full. In combination, this results in eating more and as a consequence gaining weight. In addition, regular lack of sleep slows down your metabolism by affecting the ability of adipocytes (fat cells) to respond to insulin and regulate energy. Studies have shown that just 4 days of only 4.5 hours of sleep a night can reduce the adipocytes ability to respond to insulin by 30%. This increases your risk of insulin resistance, type 2 diabetes and obesity.

High blood pressure and cardiovascular disease
Insufficient sleep results in a dysregulation of stress hormones such as cortisol which in turn can elevate blood pressure. Consistently having insufficient sleep, or poor quality sleep, increases your chances of worsening or developing, or worsening existing, high blood pressure. Stress can also increase your heart rate and combined with high blood pressure can put an increased strain on your heart. This, combined with the additional weight-related factors can lead to heart attack or stroke.

Psychiatric disorders
In the short term, sleep deprivation can cause emotional changes including irritability, loss of motivation, anger or sadness. Over time, these can contribute to mood disorders including depression. Sleep deprivation/sleep disturbance and depression have a strong bidirectional relationship, meaning that sleep deprivation is not only a contributing factor for depression, but it can also be a symptom. Melatonin, the hormone that regulates our circadian rhythm (or our 'sleep-wake cycle') has also been shown to be disrupted in patients with depression.
Other psychiatric disorders that can be triggered following long term sleep deprivation include paranoia and confusion, symptoms similar to schizophrenia, panic attacks and hallucinations.

Neurological issues
Whilst we sleep the brain repairs damage, allows neurons to rest, forms new neurological pathways and produces hormones amongst many other functions. If sleep is deprived the brain cannot perform its duties as well. When we are sleep deprived we suffer from forgetfulness as well as feeling unable to focus or concentrate on tasks. Insufficient sleep contributes to reduced cognitive performance and impaired memory as well as impacting decision-making and creativity skills.

A good nights sleep is essential for long term brain health. Studies have shown that not only is sleep crucial for the brain to function properly, but it also allows the clearance of toxic molecules through the glymphatic system (waste clearance). The glymphatic system helps the flow of cerebrospinal fluid in the brain where toxic molecules involved in neurodegenerative disorders may accumulate, with sleep increasing this flow helping to flush out the toxins. It is suggested that a lack of sleep may contribute to the progression of neurodegenerative disorders through a build up of these toxic molecules in the brain.

In addition, New Scientist magazine just explained recent research that showed brain cells that are responsible for digesting worn-out cells go into overdrive in mice that are sleep-deprived. They also showed excessive microglial cell activation following sleep deprivation. Overactive microglial cells have also been observed in Alzheimer's disease and other neurodegenerative disorders.


Sleep is as essential as eating or breathing, but all too often we sacrifice sleep in order to fit in with our increasingly hectic lifestyles. Likewise, many people have undiagnosed sleep disorders and contribute their lack of sleep to other factors. Getting enough sleep is essential for our health and well-being. Adults should aim for approximately 7-9 hours a night, and if you are consistently having issues sleeping it is advisable to see your doctor to discuss your options.

Am I sleep deprived? - 5 signs to watch out for

In an ideal world we'd all be getting 8 blissful hours of sleep a night. However with real-life pressures including work, stress, children and other day to day factors, many of us often find that we are not as well rested as we would like. Other than being annoying or inconvenient, sleep deprivation can have long term effects on our health. It is important to recognise the signs of being sleep deprived to ensure you take positive steps towards getting a bit more shut-eye.

Watch out for these 5 signs that may be an indication of sleep deprivation

1. You're always hungry
If the brain cannot get enough energy due to your lack of sleep, it will need it from food. In addition, a lack of sleep can mess with key appetite hormones – ghrelin (the 'hunger hormone') and leptin (the 'satiety or feeling full hormone'). Increased ghrelin production can leave you craving sugary or fatty foods, whereas the disruption of leptin can stop you feeling the signals of when to stop eating. Over a period of time, this increased appetite combined with a slower metabolism – due to increased insulin resistance – can lead to weight gain.

2. You're emotions are out of whack
When we're exhausted we tend to be less motivated, act without thinking and are less inhibited with our actions and reactions. Being deprived of sleep can make us feel out of control of our emotions, being over-reactive to emotional stimuli that ordinarily would not affect us to the same extent. This may provoke feelings of anger, sadness, anxiety or even giddiness. We are more likely to lash out at others or say something on impulse without processing things thoroughly due to irritability and lower tolerance.

3. You're unable to focus
It's much harder to manage projects or solve problems when you've not had enough sleep. Lack of sleep hinders your ability to react quickly and also affects high level cognitive processing, making you feel 'fuzzy headed' and unable to think clearly. This extends to memory, when we are suffering from lack of sleep we don't pay as much attention when our brain is trying to commit things to memory. This makes it harder to retain facts, or even simply remember where you put your keys. Your motor skills might also be off, being more prone to trip or bump into things due to decreased concentration and lower reaction times. You also might have trouble physically focusing your eyes as fatigue causes eye muscles such as the ocular muscle (moves the eye up/down and side to side) and the ciliary muscle (helps focus the eye) tire out, making it less easy to see clearly.

4. You're feeling under the weather
Your immune system suffers when you're sleep deprived, meaning your body is less able to fight off infections. Cytokines (proteins that help protect against infection and inflammation) are produced whilst you sleep, and being deprived of sleep will increase your chances of catching the common cold. As well as getting sick more often, a lack of sleep can disrupt hormonal balance and result in spots and breakouts. Damaged skin cells are repaired during sleep, and collagen is produced which helps prevent excess wrinkling and keep skin looking young and healthy – it's called 'beauty sleep' for a reason!

5. You're experiencing microsleep
We've all experienced it, your eyes become droopy, your head begins to nod, there's a brief lapse of consciousness then suddenly you enter wakefulness again with a jerk. This phenomenon is known as microsleep – where you enter a temporary state of unconsciousness for a fraction of a second up to a period of 10-30 seconds without realising it or meaning to. It's your body's way of forcing what it needs – sleep – despite your best efforts. At best this can be inconvenient, if you're trying to listen to a lecture or finish what you're reading. But at worst microsleep can be very dangerous, and even life threatening, especially when it occurs during tasks which require alertness such as driving or operating machinery.

What is sleep deprivation and how bad it is?


Everyone knows what it feels like when you've had a (or a few) bad nights sleep – you can't focus, you feel out of sorts emotionally and possibly physically, and you may find yourself nodding off randomly throughout the day. Whilst this is normal occasionally, regularly missing out on the sleep you need can interfere with optimal brain function and overall good health. This is known as chronic sleep deprivation and is becoming more common, and more dangerous, in today's society.

What is chronic sleep deprivation?
Sleep deprivation becomes an issue when individuals regularly do not get the sleep they need and symptoms start to manifest. Chronic sleep deprivation can have significant consequences on general health and well-being as well as long term effects.

What causes sleep deprivation?
Sleep deprivation can occur due to your lifestyle (for example your working hours, family commitments, busy lifestyle or social life) or secondary to a primary sleep disorder that causes wakefulness (such as pain, insomnia, restless legs syndrome etc). Emotional stress or mental health issues such as anxiety can also cause sleep disruption.

How long can you go without sleep?
There are conflicting reports of what the current world record for intentionally going without sleep is, partially due to the fact that the Guinness World Records no longer maintain these records due to fears of adverse effects. The most scientifically documented record is held by Randy Gardner who managed to stay awake for 264.4 hours (11 days and 24 minutes). There have been multiple claims of people beating this record, including over 18 days without sleep, however none were as closely documented as Randy's record and thus may not be accurate.

What are the symptoms of sleep deprivation?
There are multiple signs of sleep deprivation to look out for, but generally they may include feeling tired, hungry, overly emotional (such as irritable, angry, sad, giddy), forgetfulness, inability to focus or concentrate and proneness to illness. You might also experience 'microsleeps' – where the brain forces itself into temporary periods of unconsciousness. Microsleeps are mainly inconvenient but can also be dangerous if it occurs whilst the individual is driving, an all too common occurrence.
More severe symptoms can occur following extreme sleep deprivation including confusion, paranoia, psychosis and hallucinations. The consequences of extreme sleep deprivation can be scary and quite disturbing, and as a result it has been used as a form of torture.

How could it affect me long term?
Prolonged sleep deprivation can contribute to many other conditions including obesity, diabetes, increased susceptibility to illness and reduced immunity, impaired memory, reduced cognitive performance and other neurological and behavioural changes.

Can sleep deprivation kill me?
Although sleep deprivation can be a contributing factor to the cause of death – for example due to falling asleep behind the wheel or leading to other health issues that may result in mortality – it is uncommon for sleep deprivation in itself to lead to death. There have been no documented cases of a healthy human dying purely from sleep deprivation, although it has been shown in occur in laboratory rats so it is deemed possible.
However, a very rare condition called fatal familial insomnia (FFI) can lead to total sleep deprivation and eventually death. An extremely rare genetic abnormality prevents the brain going past stage one of sleep, preventing the restorative processes of both the brain and body. This mutation can also occur spontaneously in patients, known as sporadic fatal insomnia (sFI). The average survival span for this disease is only 18 months from symptom onset, as the patient experiences worsening insomnia, paranoia, panic attacks, hallucinations, weight loss and dementia-like symptoms followed by death.

Treatment for sleep deprivation
Theoretically this is easy – get more sleep. However in practice this can be easier said than done. As well as increasing the amount of sleep, patients also need to maximise the quality of their sleep and ensure any other sleep disorders are treated. Although everyone is different, it is generally advised that adults should get between 7-8 hours of sleep a night.

Helpful resources


When NAFLD progresses – NASH and beyond

Non-alcoholic fatty liver disease (NAFLD), a common liver condition where there is a build up of excess fat in the liver cells, affects an estimated that 5.5 million Australians, including 40% of all adults aged 50 years and above. Left untreated, NAFLD may progress to advanced stages of disease known as non-alcoholic steatohepatitis (NASH).

What is NASH and how does it progress?
NASH includes liver inflammation and damage caused by the accumulation of fat in the liver. Ongoing, intense inflammation can cause liver scarring and thickening, known as fibrosis, which can then progress to cirrhosis following long-term continuous damage to the liver. NASH is one of the leading causes of cirrhosis. This is where scar tissue replaces normal healthy tissue, and irregular bumps (or nodules) form on the liver, replacing the normal smooth tissue and causing the liver to become harder. As healthy liver cells are replaced with the effects of fibrosis and cirrhosis, the liver is unable to function normally and this can result in liver failure.

What are the symptoms?
Similar to simple NAFLD, people with early stages of NASH often have no or few symptoms. Only as the condition worsens are people more likely to experience fatigue, malaise, unexplained weight loss and abdominal pain where the liver is located (lower rind hand side of rib cage). Without symptoms, NASH and it's associated damage can go unnoticed for many years, and is often only picked up in a routine check up or during a blood test for another matter.

What's the difference between NAFLD and NASH?
NAFLD encompasses is the early stages of the disease, chiefly the accumulation of fat in the liver, whereas NASH is the term for the advanced form the includes liver inflammation. NAFLD is generally regarded as benign (harmless) whereas NASH is a more developed condition that can result in significant liver damage and lead to cirrhosis.

In terms of disease progression, the stages are as follows:

  1. NAFLD
  2. NASH
  3. Fibrosis
  4. Cirrhosis

Why doesn't everyone with NAFLD develop NASH?
It remains unknown why some people with NAFLD develop NASH and others don't. A genetic link or an environmental trigger have been suggested however there is currently no conclusive evidence for either hypothesis. Like NAFLD, the most common risk factors for developing NASH include: obesity, insulin resistance and type 2 diabetes, high cholesterol, elevated triglycerides and metabolic syndrome.

What can I do?
There is currently no effective treatment for NASH, although some gains in preventing or reversing the disease can be made through simple lifestyle changes. These include eating a well balanced diet, exercising regularly, avoiding alcohol and losing weight.


Could the gut microbiome predict NAFLD disease?

Simple non-alcoholic fatty liver disease (NAFLD) is relatively benign, however if left untreated it can progress into an advanced stage where additional liver inflammation can cause liver damage. Advanced fibrosis, the thickening and scarring of connective tissue, is an important predictor for liver mortality. However, currently there is no way to predict which patients with NAFLD will progress to the more advanced disease without an invasive liver biopsy.

Exciting new research out of the University of California-San Diego (UCSD) has shown that a stool sample analysis of the gut microbiome may be able to better diagnose NAFLD.

Why the gut microbiome?
The gut microbiome encompasses the trillions of microbes that live in the gut together with their genetic material. Previous studies have shown that a person's gut microbiome may affect their risk for obesity, thus the researchers investigated whether there is link between the gut microbiome and obesity-related liver disease such as NAFLD.

What did they do?
The study involved a total 86 confirmed NAFLD patients that had had a liver biopsy to classify the stage of their NAFLD as mild, moderate or advanced. The team of researchers used the patients stool samples to characterise the gut microbiome, including the presence, locations and relative abundance of various microbe species.

What did they find?
Interestingly, they identified 37 bacterial species that differentiated advanced stage NAFLD from the mild or moderate stages, at an accuracy of 93.6%. They validated this in a second group of 16 patients with advanced NAFLD and 33 healthy volunteers who acted as controls, and found that they could differentiate the NAFLD patients from healthy controls with 88% accuracy by studying the relative abundance of 9 species of bacteria, 7 of which were previously identified on the first study.

What does this mean?
With no current medications available for NAFLD, yet dozens in the pipeline, being able to better diagnose the disease and identify those who have or are at risk of developing NAFLD is a 'critical unmet medical need' says first author Rohit Loomba, UCSD. In turn, this could lead to better selection of patients for clinical trials aimed at preventing and treating the disease.

However, this study was only performed on a small number of patients, in a specialised setting, and further validations are required before a stool sample test could be available for clinical use. That being said, the study does show a 'proof-of-concept' with the potential to be a real benefit to patients.

"We believe our study sets the stage for a potential stool-based test to detect advanced liver fibrosis based simply on microbial patterns, or at least help us minimize the number of patients who have to undergo liver biopsies."

Senior author Dr. Karen E. Nelson, president of the J. Craig Venter Institute

Treating NAFLD – What can I do?


There are currently no medical or surgical treatments to effectively treat non-alcoholic fatty liver disease (NAFLD). However, there are certain lifestyle changes that you can do yourself to help prevent, or reverse, the damage caused by fatty liver.

Lose weight SAFELY
Being overweight or obese is the most common risk factor for NAFLD, and one of the best ways to prevent or reverse the damage caused by fatty liver is to take steps to lose weight. However, rapid weight loss can also be dangerous, and may even contribute to NAFLD. In order to lose weight safely it is recommended not to lose more than ½ -1kg per week.

Avoid alcohol
Heavy alcohol consumption is known to have harmful effects on the liver (as well as other organs) even in people without NAFLD. It is thought that alcohol consumption in patients with NAFLD may accelerate or worsen the disease and should be avoided, or at least limited as much as possible. Emerging observations suggest a possibility that complete alcohol abstinence may not be the best course of action, however, until there has been a more rigorous investigation into the evidence behind this NAFLD patients are advised to avoid any consumption of alcohol.

Eat a healthy, balanced diet
Maintaining a healthy lifestyle is one of the best ways to help prevent or reverse the damage done by NAFLD. This includes eating plenty of fruit and vegetables, increasing the consumption of high-fibre foods, and minimising both sugar and salt consumption. Reducing intake of fried foods, processed foods and saturated fats is also advised.

Partake in regular exercise
Regular physical activity is essential for good health and studies show that even a small amount of exercise each week has benefits over none at all. Aim to do 150-300 minutes of moderate exercise – requires some effort but would allow for conversation to take place – or 75-150 minutes of vigorous exercise – breathing harder – each week. If you are unused to exercising, walking is an excellent, yet gentle, way to start.

Lower your triglyceride levels
People with NAFLD also commonly have elevated triglyceride levels. Triglycerides are a type of fat found in the blood and levels can become elevated if you consume more calories than you burn, have a poor diet, do not exercise enough, drink alcohol or have other coexisting conditions such as obesity, diabetes or metabolic syndrome. Maintaining a healthy lifestyle following the tips above can help lower your triglyceride levels, or you can talk to your doctor about medication options.

Have regular check ups with your doctor
Managing a disease such as NAFLD can be made easier with regular check ups by your doctor or liver specialist. In addition, if you have concurrent conditions such as diabetes or metabolic syndrome it is essential that these are kept under control. Likewise, your doctor will be able to assist you in losing weight safely and developing a healthy lifestyle.

I have Fatty Liver Disease – What does that mean?


What is Fatty Liver Disease?
Fatty liver disease is a common liver condition where there is a build up of excess fat in the liver cells. Although it is normal for the liver to contain some fat, a fatty liver is classified when fat accounts for greater than 10% of the liver by weight. Fatty liver disease may be linked to alcohol abuse (alcoholic liver disease), whereas non-alcoholic fatty liver disease (NAFLD) is defined as a fatty liver when no other obvious cause such as alcohol is present.

NAFLD is relatively common, and its incidence is increasing, particularly in western societies where other conditions including diabetes and obesity are more prevalent. A report commissioned by the Gastroenterological Society of Australia (GESA) and Australian Liver Association (ALA) indicated that an estimated that 5.5 million Australians, including 40% of all adults aged 50 years and above are affected by NAFLD.

Are there any complications?
Simple fatty liver disease, which defines the accumulation of fat in the liver, is a relatively benign condition, although it is associated with an increased risk of cardiovascular disease. If NAFLD is left untreated it may progress to the development of more serious complications including non-alcoholic steatohepatitis (NASH), which encompasses the accumulation of fat with additional liver inflammation. Furthermore, over time an inflamed liver may become scarred and hardened, a condition known as cirrhosis which can lead to liver failure and liver cancer.

What causes NAFLD?
Fatty liver can develop in anyone, however there are certain factors or other pre-existing conditions that can contribute to fatty liver. Obesity is the most common risk factor, with the majority of patients being overweight or obese. Other obesity-related conditions such as diabetes and elevated triglycerides are also associated with increased risk of NAFLD.

In addition, research also suggests that metabolic syndrome, a cluster of disorders that increase the risk of heart disease, diabetes and stroke and is characterised by abdominal obesity, high blood pressure (hypertension), insulin resistance and abnormal cholesterol levels, is associated with the development of fatty liver.

Although the majority of NAFLD patients are middle-aged, fatty liver disease is the most common cause of liver disease in children, due in large part to the rise in childhood obesity. Obesity aside, other factors which may lead to fatty liver include alcohol abuse, malnutrition or rapid weight loss.

How will I know if I have NAFLD?
Most people experience no symptoms or pain with a fatty liver, and even if the disease progresses to NASH, liver damage can go unnoticed and unchecked for many years, even decades. Often it is only as the disease worsens that a patient may experience symptoms including fatigue, confusion, weight loss,weakness and abdominal discomfort.

For this reason, often people only learn they have fatty liver during a medical test for another condition or during a routine check up. Indications may include an unusual blood test, or a slight enlargement of the liver, and further tests including liver function tests, CT scans , ultrasounds or MRIs may be required to rule out other liver diseases. To confirm diagnosis, the doctor may need to take a liver biopsy – where a needle is used to remove a sample of liver tissue that is examined under a microscope.

What can I do to treat NAFLD?
Currently there are no medical or surgical procedures to effectively treat a fatty liver. Scientists are currently researching whether existing medications, particularly for those for diabetes, can be used to address fatty liver disease.

Current recommendations centre around life style changes to help prevent or reverse some of the damage caused by fatty liver, including maintaining a healthy balanced diet, regular exercise and avoiding alcohol.

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