Sleep, like food and water, is one of the essential pillars of life. “And quality sleep,” says Charles Ferzli of the TMJ & Sleep Therapy Centre in Cary, “is the foundation for a healthy life.

“There’s a reason that we spend a third of our lives sleeping,” he observes, “because sleep—in all its stages—is our body’s mechanism for healing, for growth, and for cognitive processing. When we don’t sleep, we don’t learn, we have trouble remembering things, and we don’t heal. We have more inflammation, we feel more pain, we’re more tired and irritable. We have more anxiety and suffer more from depression.

“Most important,” he adds, “is that it is during sleep that the body heals. This is when humans secrete the hormones that allow children to grow and that allow the body rest, regenerate, and heal itself.

“This is, of course, important at any age. However, as our years accumulate, so do the impacts on our bodies of disease, stress, and the normal wear and tear of daily life. So, if we are to age in a healthy way, nothing is more important than quality sleep.

“Unfortunately,” notes Dr. Ferzli, “aging often contributes to poor sleep. As we get older, the challenges to a good night’s sleep increase, including muscle weakness, illnesses, medicines, and stress. Poor sleep, in turn, exacerbates the health issues we experience with age. So, for too many people quality sleep is an elusive goal rather than a reality.”

An estimated 35 percent of Americans report their sleep quality as ‘poor’ or ‘only fair,’ reports Dr. Ferzli. “In fact, millions of Americans suffer a variety of sleep disorders; the most common one—insomnia—affecting about 70 percent of the population. Millions more suffer other conditions that affect breathing and prevent deep, restful sleep. This is not a minor problem—it’s a health crisis.”

Understanding Sleep Problems

“Given the importance of sleep to our overall health,” says Dr. Ferzli, “the focus of my practice is to understand—and address—the sources of my patients’ sleep problems. And that can be a challenge,” he admits, “because, those causes are not often well understood. And you’ll notice I said causes, because many factors interfere with a healthy sleep cycle, and it’s rarely possible to pinpoint a single ‘cause’ for sleep problems. Rather, there is more likely to be a cascade of causes-and-effects, culminating in severe sleep and health problems. And that chain reaction very often accelerates with age.”

Cascading Consequences

As we grow older, many things contribute to poor sleep, including physical and mental decline, cognitive problems, breathing issues, chronic disease and systemic inflammation, and the cumulative impact of lifestyle factors, such as stress or poor diet. “These things add up,” notes Dr. Ferzli, “and can contribute to a viscous cycle: pain or stress or injury interferes with sleep; poor sleep diminishes our bodies’ ability to heal; and a negative spiral results.

“You could debate whether age alone causes sleep problems or whether poor sleep causes you to age faster. But there’s no question that there’s a relationship. Poor sleep increases inflammation and impairs our ability to heal, and with inflammation comes a whole slew of comorbid conditions, from high blood pressure and diabetes to heart problems and acid reflux—health problems that will shorten your lifespan.”

Furthermore, notes Dr. Ferzli, “there are specific health issues that tend to come with age and that interfere with healthy sleep. Tooth loss and dental issues, for example, affect the proper positioning of the mouth, interfering with healthy breathing. Aging also causes a loss of muscle tone, which can cause the airway to collapse, leading to obstructive sleep apnea. Hormonal changes in women after menopause can also affect the airways, again interfering with healthy sleep.

“Cognitive issues experienced as we age are also connected to disrupted sleep cycles,” explains Dr. Ferzli. “When you don’t sleep well, you don’t get enough oxygen to your tissues—including your brain cells. Without sufficient oxygen, these cells die over time, resulting in neurotransmitters not firing properly. This may result in motor movement disorders such as Parkinson’s or cognitive deficits contributing to dementia or Alzheimer’s. And there is a very high likelihood that if you have severe apnea that you will end up with those conditions. Memory issues, in turn, often interfere with an elderly person’s ability to regain a healthy sleep cycle.”

Among the challenging—and probably inevitable—consequences of aging, notes Dr. Ferzli, is the accumulation, over time, of health issues. “Through our lives, we experience diseases, injuries, and stress—all of which take a toll,” he says, “contributing to systemic inflammation and many problems that interfere with healthy, restorative sleep—including high blood pressure, chronic pain, diabetes, hyper acid reflux, cardiovascular diseases, and stroke.

“And there is a little appreciated problem associated with these health conditions, and that is the role that medications play in sleep impairment. Many medications cause dry mouth,” he explains, “which, in turn, makes some people more prone to cavities and other dental problems. Other medications—such as anti-depressants—interfere with the deep sleep and REM sleep stages, which are critically important for cognitive health, learning, and memory.”

Lifestyle factors, adds Dr. Ferzli, “are of critical importance in supporting healthy sleep—regardless of our age. Poor diets and alcohol use, for example, contribute to inflammation and interfere with breathing while sleeping. Sleep is also compromised by high levels of stress or when people work different shifts. When these lifestyle habits are followed for decades, the cumulative effect can be enormous.” 

Regaining a Good Night’s Sleep

“It sounds overwhelming,” acknowledges Dr. Ferzli, “but the cumulation of problems and issues that impair sleep can be reversed. That is what we do at the Sleep Therapy Centre. It’s a step-by-step process, it takes time and commitment, but often the first steps provide significant, immediate relief and pave the way for long-term success.

“In my practice, the key to healing is education. Sleep problems are not isolated, so treatment requires that both the patient and I have a thorough understanding of the factors contributing to their sleep problems.

“We begin by ruling out issues, such as cancer, allergies, anatomical problems, or certain sleep conditions that require medical care. Next steps include a detailed questionnaire and interview, which help us understand how the sleep cycle is disrupted and what other issues are involved. I help people with sleep-related breathing problems, so our primary goal is to determine if the patient has any airflow disturbances, such as obstructive sleep apnea or upper airway resistance. And our first treatment priority is to optimize their breathing.

“Every patient I see is unique,” observes Dr. Ferzli, “but one thing all my patients have in common is that their health issues are complex. No one has a single, isolated problem; and inflammation is invariably involved. Consequently, our approach is multi-faceted. Often treatment begins with the use of an oral appliance—a powerful tool that not only provides quick relief of painful symptoms and prevents airway collapse but sets the stage for the healing process.

“In the long-term, our goals will include not only reducing inflammation and improving sleep, but eating a healthier diet, and getting rid of problem medications. But meeting those goals is a process—step by step—and we typically work on one goal at a time, focusing on addressing sleep obstructions, proper nasal breathing, and lifestyle issues including diet.

“Ultimately,” acknowledges Dr. Ferzli, “the patient will decide what changes to make. Our job is to guide the process.”