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Sleep disturbances vs. health: mourning behind the onset of disease

Sleep disturbances have a major negative impact on the immune systems of people who recently lost a wife, a recent study from Northwestern Medicine and Rice University. The over-activated immune systems of family members with sleep disorders – and subsequent chronic inflammation – could make them more susceptible to heart disease or cancer, the study authors said. Grieving spouses have a higher risk of developing heart disease or dying within a year of their loved one’s death. The study, Project Heart, compared recent widows or widowers with sleep disorders such as insomnia to married or single people with sleep disorders. The association between sleep disturbances and inflammation was two to three times higher in bereaved spouses. Researchers thought these people are more vulnerable to the negative effects of poor sleep. They’ve been hit twice: the death of a spouse is an acutely stressful event and they have to adjust to life without their spouse’s support, add sleep disturbance to their already stressful situation, and double the stressor. As a result, their immune systems are over-activated.

The research team led the study, published in the journal Psychosomatic Medicine, adding more information to previously published research showing that people who have lost a spouse in the past three months have higher levels of pro-inflammatory cytokines (immune markers that indicates inflammation in the blood) and less heart rate variability. Both increase an individual’s risk for cardiac events, including death. Heart rate variability is the change in time between each heartbeat. Researchers already knew that bereaved people had higher inflammation and a higher risk of heart disease, and that they died within a year of their spouse’s death. But what was it causing? Was it pain or sadness itself, loneliness or sleep? Now they know it’s not the same pain; it is the sleep disturbance that arises from that pain. The main sleep disorder that drove the over-activated immune system was poor sleep efficiency, which can include insomnia, early awakening, or difficulty falling asleep. The study was checked for other factors such as depression, obesity, and concomitant conditions.

The overactive immune system was measured by the level of pro-inflammatory cytokines, which help fight disease in the short term, but are associated with the risk of developing heart disease and cancer in the long term. The study looked at 101 individuals, mean age 67. Half were identified through obituaries after losing a spouse. The other half were the same age but were married or single. One reason for the study is that the researchers used a self-reported sleep measure. The results show the importance of getting treatment for sleep problems for family members. Research leader Dr Chirinos said: “We don’t know if an objective measure of sleep would have the same results, sleep problems could be more damaging to health after losing a spouse. If someone has little sleep problems. after the loss of a spouse, it is important for them to seek treatment. Cognitive behavioral therapy is offered in all sleep clinics and is very effective. Doctors must ask patients about their sleep after spouse dies, it is important to take this problem in advance”.

Personal experiences

The results of this experimental work are well reconciled with those of the pathogenesis of one of the most disabling psychiatric conditions of all, major depression. The theory of cytokines and chronic cerebral inflammation underlying the onset of the depressive process is not new, having been formulated just over 20 years ago. It therefore implies the intervention of the immune system in the appearance of the condition in specific situations. but it can also be responsible for dysregulations that can lead to autoimmunity.

I have seen the appearance of autoimmune disorders in people who have suffered the sudden, often traumatic, bereavement of their spouse. I report the case of G.L., a male, who was widowed at the age of 55 due to the death of his spouse in the sleep, due to a heart attack. After about a year he developed autoimmune myositis. A nurse employed at a private nursing home, M.Z., developed Graves’ thyroiditis about 9 months after traumatically witnessing her husband’s death from heart attack.

During my stay in the United States, I got to know a woman, S.W., who was widowed at the age of 51 due to a car accident involving her husband. She reported sleep disturbances. After the change in her lifestyle, totally dependent on her husband, she developed rheumatoid arthritis about 10 months after her death. I met a second case about a woman, C.R.F, who developed multiple sclerosis after being subjected to defamatory accusations about an alleged murder of her spouse, which never occurred and was legally investigated. Because of this the woman suffered from chronic insomnia.

A few years ago I got to know a patient, C.S.L., age 39 at the time, who developed 10 months after typical psoriasis and moderate Chron’s disease following the sudden death of her mother. Finally, I report the case of another woman, R.B.E., who was widowed at 48 due to an accident in the workplace of her spouse. About a year and a half after bereavement, she developed autoimmune vasculitis and Hashimoto’s thyroiditis.

  • Edited by Dr. Gianfrancesco Cormaci, PhD, specialist in Clinical Biochemistry.

Scientific references

Lancel M et al. Sleep Med Rev. 2020 Oct; 53:101331.

Chirinos DA et al. Psychosom Med. 2019; 81(1):67-73. 

Seiler A et al. J. Psychosom Res. 2018 Sep; 112:40-46.

Smagula SF et al. J Psychosom Res. 2014; 76(5):368-73.

Nseir S, Larkey LK. Death Stud. 2013 Jul; 37(6):495-512.

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