ANTI-AGING
Author
Dr. Barry Chase DDS
ABSTRACT
“Beauty Is Only Skin Deep” is a 1966 hit single recorded by the Temptations on the Motown label. The song’s theme refers to one’s inner beauty and its value over physical appearance. Inner Beauty in the song refers to one’s soul, one’s values, and the expression of one’s inner being. It is how we present ourselves to the world.
However, in medical terms, one’s inner being, that is, one’s inner physiologic, metabolic, neurologic, and psychologic well-being also contribute to our physical appearance, particularly our young looking, attractive with vibrant skin.
Part 1 of this chapter provides an overview of what medically occurs in the body relating to how Sleep affects the appearance and quality of the skin. The discussion includes the underlying mechanisms that link sleep deprivation, certain sleep disorders, and Chronic Stress to the process of premature aging. Following this discussion a presentation is made of some ways to combat the process and prevent, or reverse, those undesirable effects on the skin.
Part 2 of this chapter presents a remarkable new technique called Epigenetic Orthodontics. The procedure involves stimulating the expression of unexpressed or “sleepy” genes to create structural morphologic changes to the skull and cranio-facial region to enhance facial symmetry and create a bony foundation to support smoother skin and a younger more attractive appearance. Epigenetic Orthodontics has been called Nonsurgical Plastic Surgery. It is an emerging and exciting field in cosmetic facial dentistry and provides yet another approach and a deeper understanding of how cosmetic anti-aging experts can access the growing need and demand by consumers for looking younger as they age.
5.8.1 Sleep, Sleep Deprivation, Sleep Disorders, and Skin Aging
a. Normal Sleep—Sleep Stages and Sleep Cycles:
f. Rapid Eye Movement (REM) Sleep
g. Sleep Disorders, Chronic Stress, and the
Impact on Aging and Skin
h. The Pathophysiology of Stress—the Hyper-Arousal
of the Autonomic Nervous System
5.8.12 Sleep, Aging, and Aging Skin
a. Sleep Quality and Sleep Deprivation
c. Sleep, Human Growth Hormone: Aging and Skin
d. Chronic Stress and Sleep; Cortisol,
Epinephrine, Aging, and Skin
f. Free Radicals, Sleep and Aging
b. Non-medical Cognitive Behavioral Therapy
d. Obstructive Sleep Apnea (OSA) and Aging
f. Oral Appliance Therapy (OAT)
5.8.2 Epigenetic Orthodontics and Dento-Facial Orthopedics:
Non-surgical Facial Esthetic Therapy
5.8.1 SLEEP, SLEEP DEPRIVATION, SLEEP DISORDERS,
AND SKIN AGING
It is not enough to just say that sleep negatively affects the skin and contributes to skin aging, sagging skin, wrinkles, facial unattractiveness, and droopy, tired-looking eyes. Knowing the basics of normal sleep, some sleep physiology, neurology, and endocrinology will prepare you for an understanding that you should, perhaps, readjust your sleep or address a possible sleep disorder. Awareness of sleep hygiene, sleep duration, circadian rhythm, sleep staging, and their neurophysiologic consequences may help one get better sleep, and feel and look better.
The current understanding of the process of sleep and chronic stress only suggests possible future topical therapies for skin anti-aging. They include, in addition to the ubiquitous array of antioxidants (discussed elsewhere in this book), the topical use of beta-blockers such as timolol, angiotensin receptor blockers such as valsartan, glucocorticoid blockers such as mifepristone, and cholinergic modulators including botulinum toxin.1
“I need my beauty rest.” We have heard the common expression. Well, it’s true. Good-quality sleep enhances our physical well-being and promotes a healthy appearance and younger-looking skin. Sleep deprivation affects the skin, especially the facial features of the eyes and mouth. Sleep-deprived individuals have more hanging eyelids, redder, more swollen eyes, dark circles under the eyes, paler skin, increased wrinkles and fines lines, and droopy corners of the mouth.2
We make a great effort to take care of ourselves for the 16 hours or so when we are awake, but often, little attention is put on our sleep. Poor-quality sleep, sleep deprivation, and certain sleep disorders can dramatically affect the way we feel and look. Good nutrition, exercise, and a healthy lifestyle are much of our daily routine. Yet, many people lose the benefits of their daytime efforts to stay healthy with poor sleep habits and poor sleep hygiene, not allowing for enough sleep time, disregarding (or not even being aware) of their circadian rhythm, and ignoring the signs and symptoms of sleep disorders.
Sleep physicians agree that 8 hours is the optimal amount of sleep each night. However, Americans, on average, get about 6.8 hours a night. About 10 percent of Americans have trouble falling asleep and then staying asleep. Others say they don’t have the time, as the 24/7 society forces them to perform more and do more on less sleep. Sleep deprivation takes both a physical and financial toll. Research shows that sleep is catching up with diet and exercise in terms of influencing overall health. Lack of sleep has been linked to obesity, diabetes, and cardiovascular disease. Not getting enough sleep has led to $16 billion in annual healthcare costs and $50 billion in lost productivity.3
During sleep, many brain and bodily functions are recharged, restored, refreshed, energized, and sustained. During the day, the brain uses about 20 percent of the body’s available energy and during sleep recharges the energy potential. The brain makes up 2 percent of a person’s weight. Despite this, even at rest, the brain consumes 20 percent of the body’s energy. The brain consumes energy at ten times the rate of the rest of the body per gram of tissue. The average power consumption of a typical adult is 100 watts; the brain consumes 20 percent of this, making the power of the brain 20 watts.4, 5, 6 The brain also performs certain functions while sleeping to restore and consolidate memory, and to enhance cognitive function and executive decision-making. Additionally, the body restores its immune system and its ability to fight infection and disease. Growth hormone is released during deep sleep, which in children, promotes general growth of the bones and body, and in adults, aids in tissue repair and healing.
It is important to understand some basics about sleep to appreciate the negative effects that poor sleep or sleep disorders can have on the skin and the aging process.
Normal Sleep
a. Normal Sleep—Sleep Stages and Sleep Cycles:
In the course of an eight-hour sleep period, the brain cycles through several sleep stages. There are about four to five complete cycles throughout the night, each cycle lasting approximately 90 minutes to two hours. The human brain is designed to course through the cycles in a continuous fashion so that at the end of the night there is a certain percent of each sleep stage achieved. When one awakens at the end of the eight hours, one should feel energetic, refreshed, clear minded, and ready to begin the day.
During the day one should not be sleepy. There is a difference between sleepiness and tiredness. We get tired as a result of putting in a full day: using energy, being active, and engaged in life’s activities. Excessive daytime sleepiness is not normal. You should not feel sleepy during the day, feeling like you need a nap and being able to sleep at any chance you get. Excessive daytime sleepiness is a sign that you are not getting enough sleep, are sleep deprived, or possibly suffering from a sleep disorder that is causing you to be aroused or awakened throughout the night.
There is a period of time from the moment you lie down, place your head on the pillow, and actually fall asleep. In sleep medicine, that time is called sleep onset or sleep latency. It should take you between 5 to 12 minutes to fall asleep. If you fall asleep immediately, that is often an indicator that you are overtired and oversleepy. People who take longer than 30 minutes to fall asleep are considered to have onset insomnia.
As one transitions from wakefulness to sleep, brainwaves begin to slow down. This is the hallmark of sleep. Lying in bed resting is not the same as sleeping, and one will not get the benefit of sleep. During the day our brainwaves are fast and active (high frequency and low amplitude). The brainwaves during wakefulness are called alpha waves and their frequency, measured on an electroencephalogram (EEG), is about 8–13 Hz (cycles per second). As one falls into sleep the brainwaves slow, and it is only then one acquires the benefits of sleep. During Stage 1 sleep, breathing becomes more regular, the body relaxes, and muscle activity decreases. An individual may experience hypnagogic hallucinations during Stage N1 sleep. These are visual, tactile, and/or auditory sensations sometimes accompanied with muscle twitching or body jerks. Stage 1 sleep is about 5 percent of the total sleep.
In Stage N2 sleep, the body relaxes further and the heartbeat and respiration continue to slow. We experience Stage N2 sleep several different times during the night. Each time we transition from one stage to another, we pass through Stage 2 sleep. By the end of the night, we would have spent about 50 percent of the total sleep time in Stage 2 sleep.
Stage N1 and Stage N2 sleep combined are referred to as “light sleep” and should comprise about 55 percent of the total sleep time. The first cycle of light sleep should last 35 minutes to one hour.
Stage N3 sleep is also called “deep sleep.” It is the time when the body is very still, the heartbeat and breathing are slow and regular, and the person in deep sleep is difficult to arouse. After a period of light sleep we go back into deep sleep again. During the first four hours of our sleep we enter into about four cycles of deep sleep. After the first three hours it is not common to have any more deep sleep in the night. By the end of the last deep sleep, we should have slept about 20 percent of the total sleep in deep sleep. When we get enough deep sleep, and REM sleep, which will be discussed shortly, we can say we have received “quality” sleep.
In normal healthy adults, the major period of Human Growth Hormone (HGH, or GH) release is in the first period of Stage 3 sleep. The hormone is produced by the pituitary gland located at the base of the brain. It functions to promote bone and tissue growth in children, and it helps maintain healthy bodily tissues in adults.7 People who lack GH have difficulty healing, especially after surgical procedures and initiating tissue repair.
If a person stays up all night when he or she normally sleeps, there is no surge in growth hormone release. After a period of sleep deprivation, there is extra hormone released when sleep is resumed, and the pattern departs from the normal pulse during slow-wave sleep.
Stages N1, N2, and N3 collectively are referred to as non-REM sleep.
f. Rapid Eye Movement (REM) Sleep
Rapid Eye Movement Sleep (REM) is also referred to as dreaming sleep. The brainwaves are very active, characterized by low amplitude and high frequency. REM sleep, as a percentage of total sleep, is approximately 20 to 25 percent across childhood, adolescence, adulthood, and into old age.8 During REM sleep our central nervous system “paralyzes” our body so we do not act out our dreams. Sleep study tracings show the eyes create a figure eight movement and the chin lead indicates little to no muscle movement. REM sleep is considered the sleep stage where memory is consolidated, whereby short-term memory is converted into long-term memory in the hippocampus of the brain. Therefore, it is incumbent for us to get good-quality and sufficient REM sleep for learning and memory. College students who “pull all nighters” to study are at a severe disadvantage, as they are robbing themselves of REM sleep and will not be able to remember all that they are studying. Test-takers do better when they get sufficient sleep so as to allow the brain to cycle through all the stages including REM, which occur mostly at the end of our sleeping in the early morning hours.
REM sleep is necessary for clear decision-making and executive function. People who do not get enough REM sleep feel confused, unable to focus, and slow and clouded in their ability to make decisions.
g. Sleep Disorders, Chronic Stress, and the Impact on Aging and Skin
There are many sleep disorders that plague the sleeping person. Of these, two affect aging and skin: Insomnia and Obstructive Sleep Apnea (OSA). It is necessary to understand the pathophysiology of chronic stress as both insomnia and OSA affect the skin as a result of the metabolic impact of stress.
h. The Pathophysiology of Stress—the Hyper-Arousal of the Autonomic Nervous System
There are many functions of the central nervous system that are not in our conscious control, including body metabolism, respiration, heart rate, temperature, emotions, and circadian rhythm, among many others. The division of the central nervous system that controls these physiologic and psychologic functions is the Autonomic Nervous System (ANS). The ANS is a dual system made up of the Parasympathetic and Sympathetic branches. They work in opposition to each other. With respect to skin, the Sympathetic Nervous System (SNS) is most relevant.
The SNS is often referred to as the “fight or flight” system. It is the system that is activated when we are faced with a real, or perceived, threat. The SNS is an evolutionary mechanism that protects us today, much like our primitive ancestors in the past when they were faced with oncoming danger. When stimulated, the SNS causes our heart rate to increase, blood pressure and respiration increase, and blood is diverted away from the digestive system to the skeletal muscles to allow us to be active with a high metabolic voluntary muscular activity.
When we are confronted with danger, the SNS system that is activated is called the Hypothalamic-Pituitary-Adrenal (HPA) Axis. It is the hypothalamus of the brain that receives the signals of the threat. The HPA axis then releases Corticotrophin Releasing Factor (CRF) and vasopressin, which act synergistically, on the pituitary gland at the base of the brain. The pituitary gland is stimulated to release adrenocorticotropic hormone (ACTH). This, in turn, activates the adrenal glands, sitting on top of the kidneys, to release cortisol, a glucocortcoid, epinephrine (adrenaline), a stimulating hormone, and norepinephrine, a neurotransmitter. In normal function, the cortisol acts in a negative feedback mechanism on the hypothalamus and pituitary (to suppress CRH and ACTH production) to shut the HPA axis off.
The Fight or Flight response is activated so quickly that one reacts without engaging conscious thought. William James, the great American psychologist, once remarked, “It is not that we see a bear, become afraid and run; rather we see a bear, run and then become afraid.”9
Vasopressin is a hormone that constricts peripheral blood vessels, increases blood pressure and acts to conserve water. It is the body’s natural anti-diuretic. Epinephrine and norepinephrine are hormones and neurotransmitters. They increase heart rate, increase respiration, dilate the pupils of the eyes, and in effect, stimulate and awaken the body and mind. They are responsible for our brains and consciousness to become vigilant. Both epinephrine and norepinephrine trigger the release of glucose from energy stores, including the liver, and increase blood flow to skeletal muscle. The net effect is to increase the brain’s oxygen and sugar (energy) supply.
Cortisol is a glucocortcoid whose main function is to make glucose available for the brain, generating new energy from stored reserves and diverting energy from low-priority activities, thereby suppressing the immune system. Cortisol also increases blood pressure by increasing the sensitivity to epinephrine and norepinephrine, and it shuts down the reproductive system, decreasing estriol and estrodiol in women and testosterone in men.
In dangerous and stressful situations, the HPA axis protects us as it causes the body, and mind, to spring into action for defense and self-preservation, but it works on a negative feedback system so that as the levels of cortisol, epinephrine, and norepinephrine reach the hypothalamus of the brain, CRF and ACTH are inhibited.
Stress is not altogether bad. Moderate amounts of stress are stimulating and keep us from being bored. An understimulated life leads to poor development, an unwillingness to thrive, depression, and apathy. Stress teaches us mechanisms of coping, as well as responding to our environment and to other people. However, it needs to be in moderate amounts, and should include periods with no stress so that we have time to recover.
Chronic stress, as the name implies, does not refer to the intensity of the stress, but rather, the continued pressure of the stress and the long-term overactivation of the Sympathetic Nervous System (SNS) and the HPA axis.
Stress can cause poor sleep, and poor sleep can cause stress. Chronic stress can lead to weight gain, reduction in sex drive and libido, erectile dysfunction in men, mood disorders, anxiety, hair loss, heart disease, high blood pressure (hypertension), ulcers, and other medical and psychological maladies.10
There are those who find sleep torture. They may have some form of insomnia. There are two types of insomnia: primary insomnia and secondary insomnia. Primary insomnia means that a person is having sleep problems that are not directly associated with any other health condition or problem. Primary insomnia is often of psychological origin. Secondary insomnia is when a person is having sleep problems because of something else, such as a health condition; arthritis, cancer, or heartburn; sleep disorders such as Obstructive Sleep Apnea, restless leg syndrome; acute or chronic pain; poor sleep environment (noises, intrusive light); medication they are taking; or a substance they are using (like alcohol).11
Insomnia also varies in how long it lasts and how often it occurs. It can be short-term (acute insomnia) or can last a long time (chronic insomnia). It can also come and go, with periods of time when a person has no sleep problems (transient insomnia). Acute insomnia can last from one night to a few weeks. Insomnia is called chronic when a person has insomnia at least three nights a week for a month or longer.12
A very important distinction must be made between insomnia and sleep deprivation. In the definition of insomnia, it must be understood that the patient is making an effort to sleep, allowing the necessary time to sleep and creating a favorable environment to sleep. The patient is unable to sleep due to psychological or medical reasons.
Sleep deprivation is when the patient is deprived of sleep, on a voluntary basis, whereby one could sleep if the opportunity was there.
Any insomnia can fall under one of two categories: onset insomnia and maintenance insomnia.
Onset insomnia and is the chronic inability to fall asleep. It is usually defined as the inability to fall asleep in 30 minutes or less. Most often it is chronic-stress induced, but may also be caused by damage to the hypothalamus, the suprachiasmatic nucleus (a small cluster of neuronal cells behind the eyes that are light sensitive and responsible for our circadian rhythm), a decrease in melatonin, or age-related neural dysfunction or atrophy.
People who have onset insomnia cannot get to sleep; pacing the floor, staring at the ceiling, tossing and turning, unable to fall asleep, and then finally falling to sleep in the late night hours of the night only to have to get up and start the day with little sleep. People who have maintenance insomnia are exhausted and fall asleep very quickly (short sleep latency or onset), only to awaken about two hours later and not able to go back to sleep.
A common sleep disorder that will be discussed in some detail is Obstructive Sleep Apnea (OSA). OSA is defined as a time during sleep whereby people have airway collapse and/or blockage with little to no air inspired, causing the person to arouse out of a deep-sleep stage into lighter stages of sleep, resulting in sleep interruptions and fragmented sleep. Snoring is often the common indicator of OSA and should not be ignored, but rather recognized as a sign of pathology.
Sleep Apnea occurs when there is a disruption of breathing causing a decrease or cessation of airflow into the lungs, a desaturation of oxygen in the blood, resulting in an arousal from a deep sleep stage into a lighter stage or an awakening. There are two main types of sleep apnea, Obstructive and Central.
Central Sleep Apnea (CSA) is of neurologic origin and, although often present in many patients in small amounts, is as rare as the primary sleep apnea condition. During CSA the brain stops sending signals to the muscles of respiration, respiration ceases (the patient make no effort to breathe), and airflow stops, resulting in hypoxemia (a decrease of oxygen in the blood). CSA is usually in the elderly, present in patients with several medical co-morbidities.
Related posts:
– THE CELLULAR WATER PRINCIPLE
– BIOACTIVES GREEN AND SUSTAINABLE INGREDIENTS FROM BIOTRANSFORMATION AND BIOFERMENTATION
– CHRONOBIOLOGY OF THE SKIN SKIN CIRCADIAN RHYTHM AND CLOCK GENES: A NEW APPROACH TO SLOWING DOWN THE AGING PROCESS
– GLYCATION, PROTEASOME ACTIVATION, AND TELOMERE MAINTENANCE
– SKIN WHITENER INGREDIENTS
– AMINO ACIDS
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