Month: May 2022

Growing evidence suggests that poor sleep is linked to a host of health problems, including a higher risk of high blood pressure, diabetes, obesity, and heart disease. Now, a recent study on people in midlife finds that having a combination of sleep problems — such as trouble falling asleep, waking up in the wee hours, or sleeping less than six hours a night — may nearly triple a person’s risk of heart disease.

"These new findings highlight the importance of getting sufficient sleep," says sleep specialist Dr. Lawrence Epstein, assistant professor of medicine at Harvard Medical School. Many things can contribute to a sleep shortfall, he adds. Some people simply don’t set aside enough time to sleep. Others have habits that disrupt or interfere with sleep. And some people have a medical condition or a sleep disorder that disrupts the quality or quantity of their sleep.

Who was in the study?

The researchers drew data from 7,483 adults in the Midlife in the United States Study who reported information about their sleep habits and heart disease history. A subset of the participants (663 people) also used a wrist-worn device that recorded their sleep activity (actigraphy). Slightly more than half of participants were women. Three-quarters reported their race as white and 16% as Black. The average age was 53.

Researchers chose to focus on people during midlife, because that’s when adults usually experience diverse and stressful life experiences in both their work and family life. It’s also when clogged heart arteries or atherosclerosis (an early sign of heart disease) and age-related sleep issues start to show up.

How did researchers assess sleep issues?

Sleep health was measured using a composite of multiple aspects of sleep, including

• regularity (whether participants slept longer on work days versus nonwork days)
• satisfaction (whether they had trouble falling asleep; woke up in the night or early morning and couldn’t get back to sleep; or felt sleepy during the day)
• alertness (how often they napped for more than five minutes)
• efficiency (how long it took them to fall asleep at bedtime)
• duration (how many hours they typically slept each night).

To assess heart-related problems, researchers asked participants "Have you ever had heart trouble suspected or confirmed by a doctor?" and "Have you ever had a severe pain across the front of your chest lasting half an hour or more?"

A "yes" answer to either question prompted follow-up questions about the diagnosis, which included problems such as angina (chest pain due to lack of blood flow to the heart muscle), heart attack, heart valve disease, an irregular or fast heartbeat, and heart failure.

Poor sleep linked to higher heart risk

The researchers controlled for factors that might affect the results, including a family history of heart disease, smoking, physical activity, as well as sex and race. They found that each additional increase in self-reported sleep problems was linked to a 54% increased risk of heart disease compared to people with normal sleep patterns. However, the increase in risk was much higher — 141% — among people providing both self-reported and wrist-worn device actigraphy data, which together are considered more accurate.

Although women reported more sleep problems, men were more likely to suffer from heart disease. But overall, sex did not affect the correlations between sleep and heart health.

Black participants had more sleep and heart-related problems than white participants, but in general, the relationship between the two issues did not differ by race.

What does this mean for you?

If you have trouble falling or staying asleep, there are many ways to treat these common problems, from simple tweaks to your daily routine to specialized cognitive behavioral therapy that targets sleep issues. These are well worth trying, because getting a good night’s sleep helps in many ways.

"Treating sleep disorders that interfere with sleep can make you feel more alert during the day, improve your quality of life, and reduce the health risks related to poor sleep," says Dr. Epstein.

About the Author

Julie Corliss, Executive Editor, Harvard Heart Letter

Julie Corliss is the executive editor of the Harvard Heart Letter. Before working at Harvard, she was a medical writer and editor at HealthNews, a consumer newsletter affiliated with The New England Journal of Medicine. She … See Full Bio View all posts by Julie Corliss

Acne can be frustrating, especially when it does not go away after your teenage years. Believe it or not, acne can continue to affect adults beyond adolescence, or develop for the very first time in adulthood. This may be particularly distressing for adult women, who are more likely to get acne after the age of 20 compared to men.

What is adult female acne?

Adult female acne can look very similar to teenage acne. While adult acne is commonly thought to affect the jawline and chin, it can appear on any part of the face or trunk. Adult women can have clogged pores, inflamed pus-filled bumps, or deep-seated cysts. Unfortunately, treatment options that worked well in the teenage years may not work as well in adult females with acne, due to triggering factors such as hormonal imbalance, stress, and diet.

There are many reasons adult females can get acne. Hormonal disturbances caused by pregnancy, menstrual cycle, menopause, and oral contraceptives can contribute to acne by modifying the production of certain hormones. These hormones stimulate oil production within the skin, promoting the growth of acne-causing bacteria. Stress can increase the production of substances that activate oil glands within the skin of acne patients. Consumption of dairy and high-glycemic foods is also linked to acne. Certain hair or skin products can clog pores and cause comedonal acne (blackheads and whiteheads). A board-certified dermatologist can help determine the appropriate treatment for the type of acne you have.

Consequences of adult acne and scarring

The extent to which acne causes emotional distress varies, and is not related to the severity of the acne or acne scars. Some women with acne may experience disruption in their personal and professional lives as they fear stigmatization in relationships and employment. Adult females may also be more likely to seek treatment for active acne when acne bumps and scarring persist.

Acne scarring can be disfiguring. Permanent changes in skin texture in the form of pits or raised scars may not be easily concealed with makeup. Raised scars may also lead to skin picking and worsening skin texture and pigment.

Acne can also heal with red or dark spots that may not resolve for weeks to months. The dark spots may persist even longer without proper sun protection, especially on darker skin. Having both acne and dark spots may negatively impact one’s quality of life and self-perception.

The emotional toll associated with acne may include an elevated risk of developing depression compared to patients who do not have acne. Clinical studies show that having severe acne can negatively affect quality of life on par with long-term diseases such as arthritis, diabetes, back pain, and asthma. If you have acne, extensive scarring, or dark spots of any severity that are affecting your mental health, you may benefit from earlier intervention with oral medications.

What are options for treatment and support?

Acne is a medical condition, but it only needs to be treated if the acne or marks left behind from it are bothersome to you. Please see a board-certified dermatologist (in person or virtually) for the best available options if you wish to seek treatment.

Your dermatologist may prescribe a combination of topical (skin) and oral treatments. Some of these medications may not be appropriate if you are pregnant or breastfeeding, or carry risks. Ask your dermatologist about hair and skin products that may be irritating, clogging pores, or promoting oil production in the skin, making your acne worse. Also, avoid skin picking to prevent scarring, and try to minimize emotional and physical stressors.

For individuals with dark spots or scarring, consult a board-certified dermatologist to get a personalized treatment geared to your skin concerns. Use a broad-spectrum, tinted sunscreen daily and reapply it every two hours to help prevent acne marks from worsening. If your acne is causing you significant mental distress, ask your doctor about mental health resources. Additionally, seeking treatment for your acne may help you feel better. Consider joining online or in-person support groups in your area.

For more information, visit the American Academy of Dermatology Acne Resource Center.

Follow Dr. Nathan on Twitter @NeeraNathanMD
Follow Dr. Patel on Twitter @PayalPatelMD

About the Authors

Neera Nathan, MD, MSHS, Contributor

Dr. Neera Nathan is a dermatologist and researcher at Massachusetts General Hospital and Lahey Hospital and Medical Center. Her clinical and research interests include dermatologic surgery, cosmetic dermatology, and laser medicine. She is part of the … See Full Bio View all posts by Neera Nathan, MD, MSHS

Payal Patel, MD, Contributor

Dr. Payal Patel is a dermatology research fellow at Massachusetts General Hospital. Her clinical and research interests include autoimmune disease and procedural dermatology. She is part of the Cutaneous Biology Research Center, where she investigates medical … See Full Bio View all posts by Payal Patel, MD