Skin care as you age; poor sleep's link to heart attacks: Upstate Medical University's HealthLink on Air for Sunday, May 14, 2023

Host Amber Smith: Coming up next on Upstate's "HealthLink on Air," a dermatologist discusses how to take good care of your skin as you age.

Ramsay Farah, MD: ... The No. 1 thing we can do is protect ourselves from the sun, right? So that means wearing sunscreens, and starting at an early age in childhood. ...

Host Amber Smith: And a researcher explains the connection between insomnia and heart disease and why it's important to improve your sleep, to reduce your risk.

Hani Aiash, MD, PhD: ... We have 69 percentage decrease in incidence of myocardial infarction if we sleep well. And this is big number, so around 70 percentage decrease in myocardial infarction, if you control insomnia. ...

Host Amber Smith: All that, and a visit from The Healing Muse, coming up after the news.

This is Upstate Medical University's "HealthLink on Air," your chance to explore health, science and medicine with the experts from Central New York's only academic medical center. I'm your host, Amber Smith.

On this week's show, a researcher explains how insomnia can dramatically increase risk for heart disease. But first, a dermatologist talks about caring for aging skin.

From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air."

A huge industry exists around anti-aging skin care products, and it can be overwhelming to figure out what's what. Here to help us understand what's important to know about caring for aging skin is dermatologist Ramsay Farah. Dr. Farah is an associate professor and division chief of dermatology at Upstate.

Welcome back to "HealthLink on Air," Dr. Farah.

Ramsay Farah, MD: Thank you. It's good to be here.

Host Amber Smith: Before we get into the details of skin care, can you explain what happens naturally to human skin as we age?

Ramsay Farah, MD: Sure. Skin changes really are related to environmental factors and genetic makeup, but they're also related to other factors, such as nutrition. I would say the greatest single factor is probably sun exposure, though. And you can see this by comparing areas of your body that have regular sun exposure with areas that are protected from the sunlight, because all of the other factors, like your nutrition and genetic makeup, are the same for your entire skin. But what's different is areas of sun exposure and areas of non-sun exposure. And you can look at your skin and kind of compare the two. So I would say that of all of those factors, it's sun exposure that's the most important thing.

And sun exposure probably accelerates what is already a natural aging process. There are a lot of things that happen with aging that are, like I said, accelerated, but with the sun. So what are some of those things? Well, for one thing, your outer skin layer, which is called the epidermis, it begins to thin. Even though the number of cell layers remains unchanged, the actual cells and the skin becomes thinner.

There's also changes in the connective tissue. So there are fibers in your connective tissue, which is called the dermis, and these fibers are called elastin and collagen fibers. And they naturally degrade, but the sun exposure degrades them as well. And so, certain things happen when that occurs. For example, the blood vessels that are housed within that connective tissue sort of pad. When that pad gets thinner, the blood vessels get more exposed and prone to injury. So oftentimes older individuals find that they bruise much more easily. And the reason is -- in apparent minor trauma of day-to-day activities that we all experience -- those blood vessels now have less of a cushioning, and so they sometimes burst open, and people get bruises and so forth.

And similarly, things like the fat layer, which is also part of our skin, that becomes thinner with aging. That's probably less related to sun exposure than normal aging processes because the sun doesn't necessarily reach that deep down into the skin to affect the fat. But there are natural aging processes that make the fat layers thinner. And so we wind up having less insulation, so to speak, when we get older, and so, we get colder more easily. Also, you know, many medicines are absorbed by our fat layer, and so when the fat layer gets thinner, some of those medicines are not stored or metabolized in quite the same way. So elderly individuals often require smaller doses of a medicine because of those changes in the fat body content. So all of those things occur as we age naturally in all three layers of the skin, the top layer, the epidermis, which gets thinner; the second layer, the dermis, which is our connective tissue, which also gets thinner; and finally, the fat, which is also part of the skin, which also gets thinned as well.

Host Amber Smith: So with the skin thinning as we get older, is that what causes wrinkles?

Ramsay Farah, MD: Well, that's one of the things that causes wrinkles, yes, because you know when the skin thins from sun exposure, the process of the sun exposure really disorganizes those collagen and elastin fibers in the second layer of the skin in the dermis. And so when your connective tissue is disorganized, that's one reason why we get wrinkles.

But of course, on the face, especially -- I mean, we get wrinkles everywhere, but most markedly on the face. One of the other reasons that we get wrinkles on the face is because the muscles of facial expression directly are connected to the skin. And so with a lifetime of smiling and frowning and laughing and muscle movement, those muscles when they create our expression are also bending your skin over and over again. And those movements of the skin bending from the muscles of facial expression in conjunction with the physiologic changes that we just talked about from normal aging and from sun exposure, all of those things mix together and cause us to wrinkle.

Host Amber Smith: So in addition to wrinkles, what about age spots, or I think people have called them liver spots, that kind of emerge? Is that because of the thinning, or is that sun damage?

Ramsay Farah, MD: That's more from sun damage. Those brown spots, they're traditionally called liver spots. The medical term is solar lentigos. And what happens as we age is the number of pigment-containing cells, the melanocytes, the number actually decreases. So what happens is, to compensate, the remaining melanocytes increase in size. And they try to produce pigment, but they produce pigment in a somewhat disorganized way. And because there's less of them, the distribution of the pigment becomes less uniform, and we wind up forming these sun spots, or liver spots, or solar lentigos.

Host Amber Smith: What about sweating? As we age, we don't sweat the same way as when we were young, is that right?

Ramsay Farah, MD: That's right.We don't sweat the same way. Our sweat glands become less physiologically active. And it's, again, it's one of those things that occurs with the normal aging process as well. So, temperature regulation becomes more of an issue when we get older because on one level, we can't retain heat as well because our fat pad lessens, but also when it's really hot, we can't cool down as efficiently because our sweat glands sweat less, right? And so you become more prone to overheating with heat strokes and so forth depending on the environment. But definitely as we age, sweat glands produce less sweat, and so we cool less.

Host Amber Smith: In general, are there ways to prevent this natural occurrence of our skin aging? I'm looking for things that we can do starting in childhood, and I know you're going to talk about sun protection, but in addition to that?

Ramsay Farah, MD: You know, the No. 1 thing we can do is protect ourselves from the sun, right? So that means wearing sunscreens, and starting at an early age in childhood, as you suggested. And it's interesting because a lot of the studies show that quite a bit of the sun damage we see in ourselves as an adult, we've acquired in our childhood. But there's a long latency period of it, so you don't notice it immediately when you're a child playing outside, but decades after is when the chickens come to roost, so to speak, and we start to see it on our skin. So sun protection is the No. 1 thing that we can do starting from early childhood and continuing on into adulthood.

Now the other thing, that we can do is, we can have a healthy lifestyle. And that really, in a roundabout way, not in a very direct way, but in a very real way and meaningful way, has an effect on how we age. And so, what do I mean by lifestyle changes? Well, good sleep habits so that your hormone levels are always more uniform and not going up and down; a good diet that is high in antioxidants, which can help absorb some of the what are called free radicals from developing. And free radicals are the byproduct of sun exposure and other physiologic stresses.

So when the system is stressed, it produces these chemicals called free radicals, and they damage the cells, and they age the cells. And antioxidants, whether they're in your food or whether they're through topical creams, can absorb those free radicals and help decrease the physiologic stress that adds to aging.

So, I think, in short: sunscreen; as healthy a lifestyle as possible with things like a healthy diet that includes antioxidants; and other general measures, like good sleep habits, stress reduction techniques. All of those, I think, over the years do make a difference for sure. And the other thing I want to mention is those healthy lifestyle habits and the antioxidants in our diet, those also promote skin health by improving our immune system. And the immune system is extremely important in skin physiology and also has a function, I think, in the aging process as well.

Host Amber Smith: Upstate's "HealthLink on Air" has to take a short break, but please stay tuned for more information about taking care of aging skin with dermatologist Dr. Ramsay Farah.

This is Upstate's "HealthLink on Air" with your host, Amber Smith. I'm talking with Dr. Ramsay Farah. He's the division chief of dermatology at Upstate, and we're talking about aging skin.

There are many products on the market that promise to reverse aging, and without endorsing one brand over another, can you tell us whether any of them work or actually make visible changes?

Ramsay Farah, MD: Sure. So I think the No. 1 product, and again I don't want to try and repeat myself, is a good sunscreen. So that's one large category that we can recommend.

Another category that one can find over the counter are products that contain what are called retinols. And so I can explain that in a few minutes. But retinols are another large category of products that I think are quite helpful. And then the third category of products are things that contain antioxidants in them, specifically things that contain vitamin C. Vitamin C is one of the more common antioxidants, but there are others.

So I'll go back and give a bit more detail about that. You know, the sunscreens we kind of talked about already and their importance. What I would say is that you really need a sunscreen of about an SPF of 30 and above. I'm partial to the physical sunscreens rather than the chemical sunscreens, and the physical sunscreens contain zinc oxide or titanium dioxide. And the other thing that I would say about the sunscreens is that if you're out in direct sun, you really should apply them every two to three hours to get that SPF number. Otherwise, you're probably only getting half the SPF number. So that's sunscreens.

Now what about the retinols? So the retinols are derivatives of vitamin A, and of course vitamin A is a naturally occurring compound in nature, and we get it through our diet. But vitamin A is extremely, extremely important in our physiology. Every cell in our body has vitamin A receptors, and it does thousands of things, but it's been proven beyond any doubt that applying retinols or retinoids -- and you can think of them as being fairly equivalent. They all go to the vitamin A receptors. So retinols and retinoids have been shown to even skin pigment. They've been shown to help increase skin turnover. They've been shown to help plump up the collagen. And they've been shown to be anti-cancerous. So if you have a product that's over the counter that has a retinol or a retinoid in it, that's another good category of product that you can get for anti-aging purposes.

And then lastly, the issue of the antioxidants. So again, antioxidants kind of absorb all of the bad chemicals that are produced from the stress of living organisms. And you know, when organisms are stressed, they also age. So if you can take those chemicals out, I think you age less. And that's what an antioxidant does. And one of the more common ones, and one of the older ones that was discovered to do this, is vitamin C. So again, without endorsing specific products, you want to look for things that have vitamin C in them.

Other antioxidants are things like zinc or copper or selenium, even vitamin E. So all of those have antioxidants. I'm partial to vitamin C because vitamin C also helps promote collagen production.

There's another broad category of plant-derived antioxidants. For example, curcumin and things like that. But in terms of the products, most of them to date contain things like vitamin C, zinc, copper, selenium, vitamin E. Those are all good antioxidants to look for.

Host Amber Smith: Now, these are products that you put, they're topical? You apply them to your face or your skin? Or are they pills or vitamins that you ingest?

Ramsay Farah, MD: No, I'm specifically talking about topicals. I think there's just been more evidence and more research done in the topical categories. There is a growing body of evidence that taking some of these antioxidants by mouth is also helpful. There's just less work on that being done currently, but it's in progress, and I think we're going to increase our body of knowledge about it. But I'm specifically talking about topicals.

Host Amber Smith: So how do these topicals work if you're also trying to moisturize your skin? Are you supposed to use both products, a moisturizer and the retinols or the antioxidants? Or do the products have moisturizers in them?

Ramsay Farah, MD: No. Most of the products don't have moisturizers in them. Now of course these products come in different formulations. Some of these formulations could be a little more gentle than others, depending on how they've been put together. But generally speaking, the moisturizers are a separate step. But it's a good question to ask because it's been shown that when you moisturize your skin, you actually normalize the physiology of your skin, which means that if you put something else on your skin after it's been moisturized and well hydrated, whatever you're putting on afterwards tends to get absorbed more efficiently.

So I think it's actually quite important to moisturize again for those two reasons. It's one of the ways of promoting your skin health, normalizing the physiology of your skin, and then you increase the potency of what you're putting on your skin afterwards, these antioxidants, for example. And, I do want to add that the retinols and the retinoids, you know, one of their potential side effect is that they can be a little bit irritating. And so it's really very critical for people to moisturize their skin so that it doesn't become too dry with the application of these products.

Host Amber Smith: Well, I think some women are used to wearing makeup and going through a whole facial routine that includes moisturizer, but especially as we get older, is this an important thing for men to do, as well as women?

Ramsay Farah, MD: Yeah, absolutely. So, the physiology is very similar. Men's facial skin can be a little bit thicker. Their muscles of facial expression may also be a little bit thicker. So I mean, the physiology is not completely the same, but it's close enough that what I'm saying really applies to both men and women, absolutely.

Host Amber Smith: If someone wants to start using a moisturizer, are there certain things they should look for that are included in a moisturizer at the drugstore?

Ramsay Farah, MD: Well, rather than look for specific ingredients, I think it's probably better to consider what your skin type is, and then choose your moisturizer accordingly.

So, for example, when you consider your skin type, you should think about the texture, right? And so, for example, normal skin does best with a light kind of non-greasy moisturizer, while dry skin may need a heavier, creamier formulation that kind of locks in that moisture.

And so you sort of want to see what the formulation is, whether it's a very heavy ointmentlike product or it's a very sort of light more lotion-type product depending on your skin texture, just as an example.

The other thing you can consider is whether it has an SPF (sun protection factor), right? So some moisturizers have an SPF, and I think that's very useful. You want to see whether the moisturizer has a fragrance to it or not. And so, for example, if you have very sensitive skin and you have a lot of allergies, you want to try and probably avoid scented moisturizers with fragrances or perfumes.

Also with regard to your skin, if you have a tendency for allergies and sensitive skin, you want to see whether it's been allergy tested. If you have acne-prone skin, you want to make sure that it doesn't cause acne. So for example, the very heavy moisturizers that someone with very dry skin might need, those might make acne worse if you apply them on acne-prone skin. So it should say non-comedogenic, which means it's not going to make acne worse.

And what I would say is, oftentimes it's a little bit of trial and error. I think there are a lot of good products out there, but you want to try and see how it feels on your face, whether you like the way it feels, because if you like it, then you're going to use it. And then you want to see how your face reacts to it. If it reacts well, meaning it absorbs it, and the skin looks plumper, and it looks better, that's great. That's a win. If you find that your skin doesn't do well with it and gets a little bit irritated and red, then you probably want to stay away from that formulation.

Host Amber Smith: What's your advice about face washing for someone age 60 or up?

Ramsay Farah, MD: Well, I think it's important, and I would recommend it if nothing else, the physical act of washing and lathering your skin can act almost like a little bit of an exfoliation process. I think it's important to do that. Again, when someone who is over 60, you probably want gentle hydrating washes versus those foaming washes where someone in their 20s may require those. It's probably better to use warm water rather than really hot water because that can wind up stripping the natural oils from the skin. And if you use cold water, very cold water, that doesn't allow the pores to kind of open up and open up enough so that they can be thoroughly cleansed.

And then, the other thing you want to do is not overuse your cleanser as well. It's almost like putting too much laundry detergent in your washer, right? So, you want to use a moderate amount that's going to cover your face uniformly and you want to sort of rub in a circular motion with that warm water. And I think those are the general recommendations that I would have for someone who's over 60 and interested in washing their face.

But I think it's important, and again, it does promote good skin health. It gets some of the dirt and grime that comes in contact with our skin and our day-to-day activities, especially, for example, if you live in a big city or an urban center with more air pollution. So all of those things are important.

Host Amber Smith: So the face washing once, maybe twice a day? And then moisturize after you pat your face dry?

Ramsay Farah, MD: Yes, so the number of times you wash is dependent on the type of skin, the environment that you live in. But, I think twice a day is a good general rule. If you're going to pick only once a day, I would do it after the day is done because of what we talked about. And again, moisturizing after is a good idea as well, because again, you don't want to strip too much of those natural oils off of your skin.

Host Amber Smith: Well, we talked about the importance of sunscreen starting from a young age. If you're in your 60s or 70s or 80s, and your skin is starting to thin, does sunscreen become even more important, for protecting that thin skin?

Ramsay Farah, MD: Yes. Older skin, remember, we said is thinner. And, thinner skin allows ultraviolet light to penetrate deeper into it comparatively. And so as your skin thins, it becomes more susceptible to that ultraviolet light damage. And so, in some respects, you can make an argument that that's all the more reason to be quite vigilant and use your sunscreens. So yeah, I mean in some sense it becomes much more important, right?

So we want to distinguish the importance of using sunscreens at the different ages, right? So when you are very young, you want to use it to minimize the sun damage that is going to show up decades later, right? And when you're old or older, I should say, you want to use your sunscreens to minimize the risk of the acute injury that you can get, that you'll be more susceptible to as your skin gets thinner with age.

Of course, when we're older and we have that sun damage, our mechanisms of repair are not quite as capable as they were when we were younger. So you want to minimize as much as possible that sun damage because we can't repair it as effectively when we're older.

Host Amber Smith: And I'm guessing the sunburn takes longer to heal and maybe it might be more painful, too?

Ramsay Farah, MD: Yeah. All of that is true. Again, everything takes a little bit longer to heal as we get older because our physiologic repair mechanisms are not quite as robust.

Host Amber Smith: Well, Dr. Farah, thank you so much for making time for this overview about taking care of aging skin.

Ramsay Farah, MD: My pleasure. Thank you.

Host Amber Smith: My guest has been Dr. Ramsay Farah. He's an associate professor and division chief of dermatology at Upstate. I'm Amber Smith for Upstate's "HealthLink on Air."

One thing you can do to reduce your risk of heart disease -- next on Upstate's "HealthLink on Air."

From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air."

Research by an associate professor at Upstate found that insomnia is linked to a substantially higher risk of heart attack. Here to tell about his study is Dr. Hani Aiash. He's an assistant dean of interprofessional research at Upstate, and he holds appointments in neurology, surgery, medicine and cardiovascular perfusion.

Welcome back to "HealthLink on Air," Dr. Aiash.

Hani Aiash, MD, PhD: Welcome. How are you, Amber?

Host Amber Smith: Well, I don't want to alarm listeners, because I think many people struggle with sleep, but please tell us how you found this link. I know your work is listed as a "meta-analysis." What is that?

Hani Aiash, MD, PhD: Meta-analysis is the top of the pyramid of evidence-based medicine, so this is one of the most important studies doing it.

Meta-analysis is a statistical analysis that combines the results of multiple scientific studies, also can be performed when there is multiple scientific studies addressing the same question, with each individual study reporting measurements that are expected to have some degree of error, the general statistical power and more ability to extrapolate fully the greater population's evidence base more likely to observe an effect due to combining small studies into one large study, increase accuracy because small studies are pooled and analyzed also in this study. So meta-analysis, one of the top research methods to study any subjects.

Host Amber Smith: So you take and look at a bunch of studies together.

How many people do you think were part of this whole meta-analysis sample?

Hani Aiash, MD, PhD: Our sample was 1,184, 256 patients, originated from six different countries, U.S., U.K., Norway, Germany, Taiwan and China. This is to increase the general viability of our finding.

Host Amber Smith: Now, did you start out with the idea that insomnia might be connected to heart attack, or myocardial infarction?

Hani Aiash, MD, PhD: Yes, myocardial infarction, is clots (clogs) in our coronary artery, which supply our hearts, which can cause damage and death of our heart muscles. This disease is considered to be the first cause of mortality all over the world. And it's a lot of studies about this disease.

What we are looking for: to prevent. Prevention is very important. There is a lot of causes of myocardial infarction -- modifiable, something we can change, and non-modifiable, something we cannot change.

So if we look at something we can change, it will be great to decrease the incidence and the mortality and morbidity of this horrible disease. The easy stuff we can do to prevent this serious disease is our natural habits or quality of life.

One of them is sleep. Sleep will not cost anything.

Just simple stuff. We can protect at a very low cost with great benefits on prevention.

My background: I practiced medicine as a cardiologist, many countries before I came here, so, always I'm looking for something to decrease this mortality. I saw a lot of people dying from this disease.

So when we said, sleep is medicine, diet is medicine, or food is medicine, this is what we are looking for. So our rationale: to discover very easy stuff and can protect our health, our heart, from very serious disease.

Host Amber Smith: So you thought sleep would have an impact on a person's risk, but how much of an increased risk did you think you might find in people who have insomnia?

Hani Aiash, MD, PhD: We have now evidence. We have a good sample size, 1,180,000 patients. This is very big sample size.

We calculate about the cardiac risk for every patient, as I told you, modifiable -- like diabetes, hypertension, dyslipidemia (imbalance of cholesterol or other lipids), all of this stuff, obviously stress, all of this stuff can induce myocardial infarction.

And also there is non-modifiable, like age. You cannot control your age, you cannot control your family history, you cannot control your race.

But let's go to the calculation. So, insomnia, before we did this research, we don't know exactly how much it can decrease the incidence of myocardial infarction.

But we have these results now as evidence that we have something to say about sleep. Our results denote a lot of stuff, like, we have 69 percentage decrease in incidence of myocardial infarction if we sleep well. And this is big number, so around 70 percentage decrease in myocardial infarction, if you control insomnia.

Host Amber Smith: So you can improve your risk -- that's a huge amount, 70% -- if you're able to get good-quality sleep.

Hani Aiash, MD, PhD: Yes. So, as we said, why sleep? Because as you know, sleep deprivation puts the body under stress.

Triggering the release of ACTH (adrenocorticotropic hormone, involved in stress response) and cortisol (another hormone involved with stress) and this elevation of cortisone and catecholamines, adrenaline and noradrenaline, usually when we sleep, all of these hormones will come down. But during insomnia, the elevated cortisol could accelerate atherosclerosis, leading coronary artery disease, and subsequent MI (myocardial infarctions).

There's a lot of recent studies showing that in one month preceding acute MI, there was a higher concentration of cortisol in the hair compared to the healthy controls. If sleep deprivation leads to higher cortisol, then sufficient sleep will elevate the body from this maladaptive response.

Like a car, you are driving your car 24/7, and you are driving your car 12 hours or 18 hours and there is rest eight hours, what's the difference? The engine will be having trouble.

Also, as I told you, this is very important total, 69 percentage decrease in MI. It's a big number.

Host Amber Smith: Well, let me ask you, if you're saying that people who have poor quality sleep have an increased risk of heart attack, how can you be sure that it's the insomnia that's causing this increased risk as opposed to cotton in the bedsheets or whether or not a person is taking a vitamin at bedtime?

I mean, how do you control for the other things that might interrupt someone's sleep, that may be the cause of the increased risk for heart attack?

Hani Aiash, MD, PhD: We have this systematic review. We compare two groups. One group's insomnia, which is 153,000 people, and the other was non-insomnia.

The other risk factors, or the contributing risk factors, to this from our study, even sleep apnea, we exclude those people, to say that insomnia only is a cause. And after exclusion of other factors and statistical analysis of these factors, we found that insomnia is the reason, and we have statistically significant results that insomnia can do it.

Host Amber Smith: Now, your paper was published in the journal Clinical Cardiology, and I know you presented it at an American College of Cardiology conference recently.

What has been the feedback from your peers about this work?

Hani Aiash, MD, PhD: Really, we have a great, unexpected feedback on this paper in Clinical Cardiology and the World Congress of Cardiology conference. They choose our paper to be one of the first five papers to be orally presented from about 4,000 to 8,000 papers applied to this conference.

Host Amber Smith: So there is a lot of interest.

Hani Aiash, MD, PhD: Yes. And there is a lot of debates between American College of Cardiology conference and Clinical Cardiology because Clinical Cardiology was going to publish the paper early. They told them, no, please wait until we do oral presentation for this paper.

After this paper and presentation and the publication, CNN contacted us, and they did interviews with me, and CBS also, a lot of people doing this for us. And it's cited also in many places, but really we didn't expect all of this great impact for this.

And also, this is very important, that we need to continue our work. After all of this peer review, I am planning to do something like, I hope that we can do it, like sleep campaign, that we want to announce, and we want to make sure that all the patients, all over the world, know the importance of sleep.

So, if I can, I will construct a team between interdisciplinary sleep medicine, respiratory guys and cardiologists, family doctors, psychiatrists, psychologists. It will be great to have this campaign together, work together, to improve. If we have this results for the importance of sleep, we will not stop at this point.

Host Amber Smith: Well, let me ask you a little bit more about sleep. What do you mean by the word "insomnia"? Because I wonder if people with chronic trouble falling asleep are at the same risk as someone who only occasionally tosses and turns.

Hani Aiash, MD, PhD: Insomnia, by its definition, we take the two definitions, of DSM (Diagnostic and Statistical Manual of Mental Disorders) and also about the hours of sleep and also difficulty in initiating sleep. So difficulty to go to sleep and difficulty on maintaining sleep. And if you wake up early, you cannot sleep again. This is the definition of ICD (International Classification of Diseases), but also we added the definition of DSM about the hours of sleep. So we discovered that below five hours of sleep, we have a statistically significant association between "difficulty initiating and maintaining sleep," what we call DIMS, and increased incidence of myocardial infarction, by about 1.13 times greater risk for MI compared to control group.

And also we have the amount of sleep. If the patient who slept five hours or less had the highest association with MI incidence compared to who slept seven to eight hours, it reached about 56% increased risk.

And the longer duration, this is something also, some people think that they will sleep longer, they will protect their heart. No, if you sleep longer than eight hours, you have the same risk of less than five hours. And also if you compare six hours to nine hours, if you sleep six hours to nine hours, your total increases your risk about 70%.

But the ideal sleep hours will be seven to eight hours, which protects your heart more than 56% compared to less than five hours. And also it will decrease the MI if we compare with all our hours. Increased sleep and decreased sleep is harmful.

Host Amber Smith: So, let me back up just a little.

You mentioned DSM and ICD. Those are what the insurance industry uses to code insomnia. So you went to the technical definition of insomnia, but then you went one step further, and you also looked at the amount of sleep, the number of hours. But too little is bad, and too much is bad.

So there's that sweet spot between five and eight hours a night, basically, right?

Hani Aiash, MD, PhD: Seven to eight hours is the best, and below five is very harmful. Below six is a little above nine.

Host Amber Smith: So does a person's underlying health condition also affect how much their risk rises if they have insomnia?

Hani Aiash, MD, PhD: Yes, we have something very interesting: age. Our mean age in this study was 52 years old. We discovered that if you increase age, about 65, you double the risk. If you have diabetes, you have about 100% more. Diabetes and insomnia; this is horrible.

If you have hypertension, same, about 70%. Dyslipidemia (high cholesterol), same.

Usually we said a woman is protected. No, insomnia has no protection for women. If the woman has insomnia, there is 125% more to have MI than others compared. This is big number.

Host Amber Smith: So this is a lot more of a concern for women than men, even.

Hani Aiash, MD, PhD: Yes. And as I told you, most of the people who had underlying diseases, or comorbidities, as we said, like hypertension, diabetes, had higher risk of MI.

Host Amber Smith: What about, I mean, a young, athletic person who appears to be in good health may have insomnia, compared with someone who's overweight and has comorbidities, or other health issues, who also has insomnia? Is their risk the same?

Hani Aiash, MD, PhD: No, of course, as we said, there is calculation of coronary heart disease or MI, as I told you, modifiable and unmodifiable. If you have more risk for this stuff, it'll add value to your incidence of MI, or myocardial infarction -- if you are obese, if you are diabetic (not controlled).

But the issue here, that we discover something beside diabetes and hypertension to be controlled, and we have evidence, we have strong evidence on 1,180,000 patients. So we must respect that: The patient must know that if you are not sleeping well, he's exposed himself to MI, like the same as if he's diabetic and (has) hypertension.

And the doctor, when he interviews the patients or examines the patient, he must ask about insomnia. It's not easy now to ignore this subject because you have evidence that insomnia can cause mycardial infarction, same like diabetes, same like hypertension.

And it will not cost you anything. It's very easy to be treated.

Host Amber Smith: Now, a lot of times, as people age, their sleep quality deteriorates. They wake up a lot, or they don't sleep very restfully. Is that insomnia, or is that different, in terms of your study?

Hani Aiash, MD, PhD: We define insomnia according to the difficulty in achieving sleep, difficulty in maintaining sleep, and if the patient wakes up, he cannot return back to normal sleep or the hours of sleep.

So if he has any of this criteria, yes, he has insomnia.

Host Amber Smith: And so I know your hope is that primary care doctors would start asking their patients about insomnia because that's a risk factor that's modifiable. What can be done to help someone who has trouble falling asleep or staying asleep?

Hani Aiash, MD, PhD: There is a lot of stuff and also, many societies talk about sleep.

So, avoiding uncomfortable temperature: If you sleep in cold weather or hot weather, you'll wake up a lot. Proper sleep hygiene is crucial. And light. Light. As you know, if you have light, it will not help to sleep well. (Avoid) noises. Limitation of the (electronic) screen an hour prior to bed.

Use your bed for sleep, this is the most important. Not using other technology. Avoid heavy meals near bedtimes. Avoid caffeine before bedtimes. And also some studies show that cognitive behavior therapy, CPT, is effective in treating insomnia.

And by the way, it's very important: Sometimes insomnia is the iceberg. We must know what's the cause of this insomnia. It's not to treat the symptoms; we want to treat the disease, so we must investigate also what's the cause of this insomnia. There is a lot of diseases can cause insomnias. So the most important stuff for the primary care doctor or PCP (primary care provider), that he must understand what's going on, not the iceberg. We must go in depth to know, to treat, the cause.

Host Amber Smith: And of course, if someone does treat their insomnia effectively, is there evidence that their risk for heart attack drops?

Hani Aiash, MD, PhD: We need more studies for this.

We need more studies. We diagnosed the problem. Here is a cause. But if we treat these people very well, and they are sleeping well, how much percentage of MI will be decreased? This is a good next study, and I hope that we can do it, but it needs a cohort study or prospective study.

This is very important to address, but we have now evidence that yes, if we treat them, we will decrease the instance about 69 percentage. If they sleep seven to eight hours, they will decrease. If they combine the risk factors diabetic and insomnia, and we control diabetes, and we control the insomnia, we'll decrease the incidence of MI. This is great. Yes.

Host Amber Smith: So what's the message you'd like listeners to come away with regarding your research? What can people do today based on what you've discovered?

Hani Aiash, MD, PhD: My message here is to use our "natural stuff," what we have, to control what we can.

Sleep is medicine.

Food is medicine.

Anti-stress is medicine.

The quality of life is very important to avoid all of this stuff.

If you have sleep disorders, please try to do the natural stuff to control it. If you cannot, go to the doctor, discuss with him, also let him deal with this stuff. If you cannot do this, the doctor must know that maybe he will give you some pills to make you sleep, but don't leave yourself not sleeping well and have a lot of other comorbidities, or many risk factors, and you can be exposed to myocardial infarction.

No. 2, let's return to our health. Our health is bio-psycho-social. If you are (have) well-being, bio-psycho-social well-being, it will be great. Not biologically, not our organs; we are not a group of some organs. We have psychological status, we have social status. All of this status must be well to live well,

Host Amber Smith: Dr. Aiash, thank you so much for making time to tell us about your research.

Hani Aiash, MD, PhD: Thank you very much, Amber. It's my pleasure.

Host Amber Smith: My guest has been Dr. Hani Aiash. He's a researcher at Upstate who also serves as assistant dean of interprofessional research.

I'm Amber Smith for Upstate's "HealthLink on Air."

Here's some expert advice from Dr. Ioana Medrea from Upstate Medical University. At what point should I see an expert about headaches?

Ioana Medrea, MD: About 80% of people have headaches at some point, and the time to see me is when your headaches are interfering with your ability to lead your life. So what does that mean? How would that look like? A lot of people I see have trouble doing their job because their headache is making them have to miss work, or when they're at work, have to step away and not be as productive as they could be.

Another manifestation would be issues with your ability to do your jobs at home, so running errands, cleaning the house, maintaining the house. When you're having significant enough headaches that you're finding yourself avoiding those tasks, that's another sign that it may be time to see a headache specialist.

And the last thing is when it's interfering with your social activities, you are shying away from seeing family, friends, or participating in things you would normally participate in because your headaches are severe enough that you don't want to leave your house. That would be another sign that you need to see someone for your headaches.

Host Amber Smith: You've been listening to neurologist Dr. Ioana Medrea from Upstate Medical University.

And now, Deirdre Neilen, editor of Upstate Medical University's literary and visual arts journal, The Healing Muse, with this week's selection.

Deirdre Neilen, PhD: Poets often break down actions or emotions into smaller components, so the listener or reader can really see or feel. I have two poets here to demonstrate how artful their ability is. First is Jerome Gagnon from Northern California, whose first prize-winning full collection of poetry, "Rumors of Wisdom," appeared last year.

Here is "Invisible Ocean":

It's sometime around 5 am

when I wake him for medicine and water.

Each sip has become a struggle

confounded by almost constant thirst.

Small sips, I say, to minimize choking.

How could I have forgotten how essential it is to swallow?

How we take the world in daily, an act as vital as breathing?

How the world will swallow us whole and expel us

into measurelessness?

How water receives water, a process so pervasive

it becomes almost invisible?

Jasper Kennedy is a trans organizer and avid crocheter whose poem "Starling's Law of the Heart" reveals the miracle that is our heart muscle's function.

The heart is a machine

in a circuit of vessels.

Pump more out, more will return,

get back what you put in,

reap what you sow,

as if anything works that way.

It's a nice idea.

I close my eyes

and my fist is a ventricle

that I tense and relax,

systole and diastole

in the palm of my hand.

I pop up my thumb

and audibly suck in air,

extend my fingers like

I'm holding a water balloon

filling with blood.

Behind my eyelids

I see sparks as I clutch,

current arcing at my wrist

and feel what it's like

to hold the magnitude

of what I've been served

in the flat of my hand

and dish it back out

with a squeeze.

Host Amber Smith: This has been Upstate's "HealthLink on Air," brought to you each week by Upstate Medical University in Syracuse, New York.

Next week on "HealthLink on Air," diagnosis and treatment of early stage kidney disease.

If you missed any of today's show, or for more information on a variety of health, science and medical topics, visit our website at HealthLinkonAir.org.

Upstate's "HealthLink on Air" is produced by Jim Howe, with sound engineering by Bill Broeckel.

This is your host, Amber Smith, thanking you for listening.