What is the magic sleep number

Last year was a lousy year for the flu vaccine. Hospitalizations for flu hit a nine-year high, and the vaccine prevented flu in only 23% of all recipients, compared with 50% to 60% of recipients in prior years.

Why does the flu vaccine work well in some winters and not others? The flu vaccine primes the immune system to attack two proteins on the surface of the influenza A virus, hemagglutinin (H) and neuraminidase (N). Different flu strains have different combinations of these proteins — for example, the strains targeted by recent flu vaccines are H3N2 and H1N1.

Unfortunately, the influenza virus is microbiology’s answer to Miley Cyrus: it can change enough in just one year to become completely unrecognizable. The H and N proteins are genetic chameleons that undergo constant transformation. This process is called antigenic drift, and it regularly flummoxes vaccine makers, public health experts, and your immune system.
Developing the new flu vaccines

Most flu vaccine in the United States is made from chicken eggs, using production methods that date back to 1945. This cumbersome technique requires 6-8 months of lead time to produce enough vaccine for the upcoming flu season. Every February, the World Health Organization and the Food and Drug Administration (FDA) make their best guess as to which flu strains should be covered by next winter’s vaccine, based on a review of circulating flu viruses from over 100 countries. But a lot can change in 8 months, especially with influenza. This past year, the “drifted” H3N2 influenza strain didn’t match up with the vaccine strain, explaining the vaccine’s poor performance.

Can researchers build a better flu vaccine? They probably already have. The FDA has approved two alternatives to traditional egg-based vaccines. One of these, Flucelvax, uses influenza virus grown in kidney cells that were originally obtained from a single cocker spaniel in 1958. The other one, FluBlok, is made by tricking insect cells into pumping out large amounts of hemagglutinin, which is then purified and used in the vaccine. These methods might sound outlandish, but they seem to be safe and effective.

These newer vaccines have several advantages:

They are safe for patients with egg allergies. Because most flu vaccine is made from eggs, many people with egg allergies can’t receive the traditional flu shot.

They don’t require a massive supply of chicken eggs, and could still be made even if a bird flu epidemic wiped out chicken flocks.

They need less manufacturing time than egg-based vaccines, meaning vaccine production could be ramped up quickly in case of a flu pandemic. This also might give the FDA more time to make their decision on which flu strains should go into the vaccine, reducing the risk of a vaccine–flu mismatch like last year’s.

Scientists are also working on a universal flu vaccine, one that might not need to be changed every year. This vaccine takes advantage of the fact that the H protein has two parts: a head region, which is the part that changes rapidly, and a stem region, which stays more or less the same. Small studies of vaccines using chunks of the stem have shown promising results in animals. Trials of these vaccines are just beginning in humans.
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The CDC recommends that all American adults get a flu vaccine every year. Even though the current vaccine is not perfect, there are many good reasons for you to get it. The vaccine does reduce your chance of getting the flu, especially when it matches up well with dominant flu strains.

The benefits of flu vaccine are particularly impressive in older adults. If you are 65 or older, it lowers your risk of death by 48%. One reason for this lowered risk is that getting the flu increases your risk of developing bacterial pneumonia, which is responsible for many hospitalizations and deaths. But this is not the only reason.

Inflammation is bad for your body, and increases your risk of heart attack or stroke. If you’ve ever had full-blown flu, and you remember how feverish, achy, and miserable you felt, you know that influenza is great at filling your body with inflammation. So, as you might expect, another benefit of the flu vaccine is that it reduces your risk of heart attack and stroke.

Most adults, including me, receive the flu shot made from chicken eggs. If you have an egg allergy, you should get Flucelvak or FluBlok instead. If you are between ages 2 and 49, you are eligible for the intranasal vaccine, which is inhaled rather than injected. Because this vaccine contains live virus, it should be avoided if you are pregnant, have a weak immune system, or are around other people with weak immune systems. The intranasal vaccine may also cause wheezing, so you should avoid it if you are asthmatic. Bill Clinton (ex-President). Tracy Morgan (comedian). Cindy Lynn Baldwin (motor vehicle driver). What do these seemingly unrelated individuals have in common? The answer is that each either suffered from sleep deprivation or was victimized by someone who was sleep-deprived.

There is no doubt that all of us have gotten too little sleep at some point in our lives. For some of us, it is an isolated occurrence precipitated by a specific event, such as a death in the family or an upcoming stressful meeting. However, there is increasing evidence that America is becoming a country of chronically sleep-deficient citizens.

According to a recent report from the Centers for Disease Control and Prevention, the percentage of adults sleeping fewer than 6 hours per night has increased by 31% since 1985. There are likely a number of explanations for this. They include the increasing demands of a 24-hour society, the increased use of artificial lighting, changing lifestyles that encourage late-night activities, and the widespread use of electronic devices such as tablets, laptop computers, and smartphones. The latter are particularly bad for sleep health because they emit blue wavelength light, which negatively impacts your body’s natural sleep-wake cycle and interferes with the onset of sleep.
Negative Health Effects of Sleep Deficiency

There are important consequences of insufficient sleep. On an individual level, sleep deficiency makes one more irritable and depressed, slows reaction times, and negatively affects mental and physical performance. In fact, 18 hours of continuous wakefulness has the same adverse effect on reaction time as being legally drunk! (The driver of the truck that hit Tracy Morgan’s vehicle had been awake for 28 hours straight.)

In addition, adequate sleep is necessary for optimal learning and memory. Experiments have shown that staying awake all night impairs the learning of new information. Therefore, the proverbial “all-nighter” that some of us practiced when we were in school probably worsened our test performance rather than helped it.

Chronic sleep deprivation exacts a toll as well. One and a half weeks of 6 hours’ sleep per night can have the same impact as staying awake for 24 hours straight. And just as important as the behavioral consequences of inadequate sleep are its negative effects on health. It is now becoming increasingly evident that sleep deficiency is a risk factor for hypertension, heart disease, diabetes, and — not surprisingly — earlier death. In addition, inadequate sleep changes the levels of the hormones that control appetite, and this leads to increased hunger and a greater tendency for weight gain. Thus, sleep deficiency is a risk factor for obesity!
At Least 7 Hours of ZZZs Nightly

Because both acute and chronic insufficient sleep are bad for health, the CDC’s Healthy People 2020 campaign includes a goal to reduce sleep deficiency. However, the goal doesn’t specify exactly how much sleep is needed. To remedy this omission, the American Academy of Sleep Medicine and the Sleep Research Society, the two leading professional organizations in the fields of sleep medicine and research, released a joint consensus statement.

Based on current evidence, adults should aim for at least 7 hours of sleep a night for optimal health, and that getting fewer than 6 hours of sleep is associated with worse health outcomes. At the same time, there is insufficient evidence to determine whether getting between 6 and 7 hours of sleep a night is bad for health. A similar document from the National Sleep Foundation largely came to the same conclusions.

So, is 7 hours the magic sleep number? Perhaps. Future research may lead to some refinements, but for now, it should be the goal.

Can you make up for being short of sleep for a few days? The answer is not straightforward.  Many individuals get inadequate sleep on workdays and then attempt to recover their lost sleep on weekends. In such cases, there is generally an improvement in mood, as well as mental and physical performance, after “recovery” sleep. However, being able to reverse the effects of inadequate sleep on physical health is less certain. Recent observations indicate that lack of sleep may cause persistent negative effects on heart rate and the secretion of various inflammatory molecules. These may be risk factors for heart disease.
The Remedy is Simple

What can be done about sleep deficiency? The solution is simple: Get more sleep. On a personal level, this means making better lifestyle choices — for example, choosing to go to bed earlier in the evening instead of staying up to watch late-night television. For institutions and employers, this means creating a work environment that values the beneficial results of having employees who are not sleep-deprived: namely, fewer employee sick days, better productivity, and less use of health insurance benefits.

Although the prescription for more sleep appears to be inexpensive with no costly medications required, the personal and logistical hurdles can be formidable. Nevertheless, a target of at least 7 hours of sleep per night can be achieved. If sufficient numbers of individuals, businesses, and institutions make sleep a priority with status equal to good nutrition and fitness, then our society will be healthier and more productive — goals we all value.


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