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| Year : 2004
| Volume
: 6 | Issue : 22 | Page
: 49-54 |
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| Stress hormones and sleep disturbances - electrophysiological and hormonal aspects |
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C Maschke1, K Hecht2
1 Institut für Technische Akustik, TU-Berlin, Germany
2 Institut für psychosoziale Gesundheit (IPSG), Berlin, Germany
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In noise effect research often the awakening reaction is maintained to be the only important health related reaction. The main argument is that sleep represents a trophotropic phase ("energy storing"). In contrast to this awakening reactions or lying awake belong to the ergotropic phase ("energy consuming"). Frequent or long awakening reactions endanger therefore the necessary recovery in sleep and, in the long-run, health. Findings derived from arousal and stress hormone research make possible a new access to the noise induced nightly health risk. An arousal is a short change in sleeping condition, raising the organism from a lower level of excitation to a higher one. Arousals have the function to prevent life-threatening influences or events through activation of compensation mechanisms. Frequent occurrences of arousal triggered by nocturnal noise leads to a deformation of the circadian rhythm. Additionally, the deep sleep phases in the first part of the night are normally associated with a minimum of cortisol and a maximum of growth hormone concentrations. These circadian rhythms of sleep and neuroendocrine regulation are necessary for the physical as well as for the psychic recovery of the sleeper.
Noise exposure during sleep which causes frequent arousal leads to decreased performance capacity, drowsiness and tiredness during the day. Long-term disturbances of the described circadian rhythms have a deteriorating effect on health, even when noise induced awakenings are avoided. Keywords: Nocturnal noise, sleep, awakening reaction, arousal, stress hormones, circadian rhythm, health effects
How to cite this article:
Maschke C, Hecht K. Stress hormones and sleep disturbances - electrophysiological and hormonal aspects. Noise Health 2004;6:49-54 |
| Daily flow of human | |  |
The daily flow of human life is distinguished by circadian rhythms of all functions, and characterized by three cardinal psychobiological states.
The balance of these three cardinal states is the foundation of health and quality of life (Koella 1988, Moore-Ede 1993, Adam et al. 1998, Fischer et al. 2000). Numerous research projects (e.g. Moore-Ede 1993, Hildebrandt 1998, Zulley 1998, Fischer et al. 2000) as well as work done by the German Association for Sleep Research and Sleep Medicine have drawn concerted and concerned attention to the health consequences of a 24-hour non-stop society. Disturbance of the biological and psychosocial rhythms of humans has to be classified as an impairment of health.
Sleep and dreaming sleep are characterized by a component of retrospective experience coupled to the memory together with an objective, biometrically measurable component. Using the biometric component the three cardinal states can be described with relative certainty by various vital parameters.
| Sleep, circadian rhythm and hormones | | |
Sleep is embedded in a 24-hour rhythm (circadian rhythm) and itself is a cyclical process. The time spent in phases of deep sleep (S3 & S4) decreases with the length of time asleep on account of the circadian rhythm, the duration of REM sleep periods (black bars) increases with the time asleep. The cyclic course of the sleep phases is part of an ultradian periodicity. These rhythms also characterize the endocrine regulation and are particularly clear in the case of the hormones.
The ACTH/cortisol concentrations in undisturbed sleep reach an absolute minimum in the early hours of the night (cortisol nadir) and climb up in the second half of the night. The concentrations reach a maximum at the time of morning awakening (Born et al. 1986, 1998, 2000). The relative lowest points of the cortisol concentration occurs at neural level together with the occurrence of REM-sleep. The deep sleep phases in the early part of the night are not only combined with the absolute minimum cortisol concentration but also with the highest secretion of growth hormones. In this way a circadian pattern of neuroendocrine regulation, specific for undisturbed sleep, is established (Born et al. 2000). These circadian rhythms of sleep and neuroendocrine regulation are necessary for the physical as well as for the psychic recovery of the sleeper.
| Sleep polygraphy and noise effect | | |
Night-time noise displays itself in the sleep cyclogram as fragmented sleep progression when intermittent noises occur (e.g. aircraft flight noise) or, in cases of quasi-continuous noises (e.g. road traffic noise), as shallow sleep. Both kinds of noise have the overall result of shortening the times of deep sleep (phases 3 and 4) and the REM phases. The activation instigated by noise may lead to the process of awakening. Effect thresholds for immediate reactions can be found in the [Table - 1].
The informational content of the noise as well as the sound level is important for the person asleep. The alarm function of the sense of hearing may cause awakening even when the noise is very slight if the noise contains information indicating danger. Remarkably high noise levels of 90 dB(A) and more may be slept through, especially by children. The awakening effect is not only dependent on the informational content and the noise level of the occurrence itself but for example also on its distance to the level of background noise in each case.
| Cortisol secretion and noise effects | | |
Apart from the excitation processes of the central nervous and vegetative systems, changes in the secretion of activating hormones are marked characteristics of sleep disturbances. These activation hormones, also referred to as stress hormones, represent a link between noise and health impairment (e.g. Maschke et al. 2000). As observed in studies of stress-oriented traffic noise (Maschke 1992, Maschke et al. 1995, and Braun 1998), the average hormone concentration may be acutely raised by traffic noise at night. At the same time, the quality of the sleep experienced by the test persons and their feeling of well-being next morning is poorer. As few as 16 overhead flights with maximum levels of 55 dB(A) produced a significant increase in the secretion of stress hormones.
| Noise at night and health | | |
The decisive question as to which effect of nighttime noise exposure has to be avoided to maintain good health is a subject of controversy.
Jansen et al. (Jansen 1999), for example, argue that the criterion L max = 60 dB(A) for the awakening threshold in combination with six events per night above the awakening threshold can be firmly held to until clarification of the interconnections between physiological immediate reactions and health. Hecht and Maschke (Hecht 1999) assign the protection of health to undisturbed sleep progression or undisturbed cortisol regulation respectively. From the point of view of the German Environmental Advisory Council of the Environment (SVR 1999) it cannot be excluded that the disturbed sleep progression impairs health and capacity to perform in the long run. In these terms, the pathogenetic mechanism combining night-time noise with the impairment of health is at the center of this discussion. Arousal research has supplied new insight into this subject.
| Arousal - short-term noise instigated activation while asleep | | |
Noise effects can cause functional changes. This process is commonly referred to as activation. Besides the concept of activation, the expression "arousal" has established itself. The branch of medicine pertaining to sleep designates an arousal as a narrowly confined chronological change in condition, raising the organism from a lower level of excitation to a higher one. Under physiological conditions, arousals represent protective reflexes, wherein distinctions have to be made between vegetative, motorial and EEG arousals.
Vegetative arousals may (chronologically limited) be expressed as increased blood pressure, heart rate and changes in respiration, in cerebral blood supply or in endocrine secretion. An increase in sympatheticotonia usually occurs. Vegetative arousals may also occur without EEG arousals!
Motorial arousals occur by changing position, coughing, muscular twitching, and are usually accompanied by EEG or vegetative arousals. EEG arousals contain a chronologically limited reduction of the theta- and delta-waves as well as an induction of alpha- and beta-waves.
Different studies (e.g. surveyed by Maschke in 1997) have shown that (traffic) noise can induce vegetative, motorial and EEG arousals. The data collected for EEG arousals is comparatively large. However, the majority of these studies were conducted before 1980 and are mainly concerned with the awakening reaction (awake stage) instigated by noise, in terms of the definition by Rechtschaffen and Kales which embodies an arousal period of at least 15 seconds. The American Sleep Disorder Association (ASDA) requires an arousal episode of 3 - 30 seconds. Other working groups also include micro-arousals (1-3 seconds) in the definition of an EEG arousal. The consequence is that results obtained from medical sleep research can only be compared with difficulty to the results of noise effects research.
EEG arousals always represent an interruption of the progression of sleep. Should this interruption last for a period of approx. 1 - 4 minutes (Griefahn et al. 1976), the EEG arousal passes into conscious awakening. The time depends on the sleep phase preceding arousal (Hecht 1992). Conscious awakening can be viewed as a cognitive arousal in the sense of intruding thoughts. It may be combined with a delayed reonset of sleep and in this form represents a serious disturbance of the progression of sleep.
The data available on vegetative arousal from noise effects research is modest by comparison, and is even less for endocrine arousals. One of the reasons for this is that measurement of the sequence of endocrine reactions in the blood of the person asleep may itself considerably hamper the progress of sleep.
Findings derived from medical sleep research may make simplified access to endocrine regulation possible. A raised minimum level of cortisol can in fact be regarded as an essential marker substance of chronic stress (Born et al. 2000). This has been confirmed by studies with depressive patients (Deuschle et al. 1997). Moreover, depressive patients suffer from sleep disturbances which include a notable decrease in slow-wave sleep and a reduced secretion of growth hormones (Steiger et al. 1993). Clear evidence exists that certain forms of depression can be traced back to a chronically disturbed circadian rhythm.
The cortisol low point (nadir) occurs in the first part of the night as a result of the circadian rhythm whereas its release in plasma is around a factor 10 higher in the morning (Born et al. 2000). This is why the greatest likelihood of detecting endocrine arousal is in the first half of the night. In addition, the different problems existing between individuals and their circaseptan rhythms can be minimized as far as a cortisol quotient is formed. The said quotient is derived from the cortisol concentration during the first half of the night divided by that of the second half of the night and exhibits a comparative value of approx. 0.2 for undisturbed sleep.
A further important feature of the neuroendocrine regulation during early sleep is its sensitivity to stressful events during the awake state. This could be shown for acute (physical and psychological) stressors (Born et al. 2000). As recognized from the results, the minimum cortisol concentration attained during early sleep may be regarded as a marker substance in terms of overcoming stress.
| Health significance of arousals | | |
Arousals serve the maintenance of homeostasis as an integrated whole. Their assignment is to prevent life-threatening influences or events by the activation of compensation mechanisms. Frequent occurrence of arousals triggered by interoceptive or exteroceptive stimulations leads to a deformation of the circadian rhythms.
Deformation is revealed by a fragmented progression of sleep as well as by an increased cortisol nadir. Sympatheticotonia is increased as a result of the fragmentation of sleep during the night or of the multiple arousal occurrence. Sleep quality suffers as a result and leads to decreased performance capacity, drowsiness and tiredness during the day.
Viewed collectively, long-term disturbance of circadian rhythms has a deteriorating effect on clinical symptoms (Hanly et al. 1989; ZuberiKhokhar, 1996; Biberdorf et al., 1993; Bonnett and Arand, 1995; Mercia and Gaillard, 1991). A disturbance is also indicated by multiple awakening reactions.
For the above reasons, phases awake induced by noise have to be assessed as abnormal and in the long term as a health risk. On the other hand, serious disturbance of the progress of physiological functions already becomes apparent below the awakening threshold. This means there is little sense in deriving a hygienic limiting value for sleep protection solely on the basis of an average experimental awakening threshold.
| Discussion | | |
The endangerment of health by nocturnal exposure to noise is based on the disturbance of endogenous rhythms. The said disturbance is caused by the frequent recurrence of noise induced arousals, calling for greater emphasis on the assignment of noise induced arousals in noise effects research. This is true for both electrophysiological and stress oriented sleep studies. The noise stress studies to date have consisted mainly of the comparison of the catecholamine or cortisol concentrations as summation parameters collected from overnight urine samples and compared with those of control groups (e.g. survey by Ising et al. in 2000). The results are not unequivocal and show both (significant) increases as well as subgroups with lower cortisol values (Harder 1998). In addition to the above, pronounced circa-septan rhythms (weekly recurrences) are observable. Subdivision of the duration of overnight collection and a determination of the cortisol quotients would be essentially more suitable for the assessment of health hazards than assessment in terms of reference values.
In conclusion, it has to be pointed out that devising night-time protection concepts should not be dealt with in terms of one functional parameter. The function systems are loosely coupled together and exhibit different sensitivities towards exogenous and endogenous stimuli.[28]
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Correspondence Address:
C Maschke
Institut fürTechnische Akustik, Technische Unversitat Berlin, Eisteinufei 25, 10587 Berlin
Germany
 Source of Support: None, Conflict of Interest: None  | Check |
PMID: 15070528 
[Figure - 1], [Figure - 2]
[Table - 1] |
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