Could the lack of one of life’s necessities cause accelerated skin aging? Like everything on earth, skin follows the process of aging during its lifetime. Antiaging research, technology, treatments, and product formulations in the pursuit of the prevention of skin aging are currently multibillion dollar per year industries. This amount only continues to expand as consumers continue to invest in preventing and reversing the signs of aging. One important factor affecting skin aging is the impact of sleep. The phrase beauty sleep is accurate, as much beauty is derived from sleep.
Human skin is a robust organ acting as a barrier to protect the body from harmful environmental factors, and it regulates temperature and fortifies immunity. Skin is the largest organ and the first defense against external aggressors – care of the skin is critical for health. In addition to its primary physical functions, skin quality provides a portrayal of beauty and influences the perception of health, cleanliness, and age.
While the common facial effects of a sleepless night are tired-looking skin and dark under-eyes, the skin is compromised in an even more significant way when sleep is neglected. A 2016 study published by the Centers for Disease Control and Prevention (CDC) reports that one-third of Americans are considered poor-quality sleepers. There are over 80 known sleep disorders from which 70 million Americans suffer.
Skin care professionals play a significant role in the health of their clients, but client decisions made away from the spa may be irreversible and certainly out of the professional’s hands. Dietary factors, lifestyle, and stress have all been linked to aged skin. Sleep is equally important.
The results from a lack of sleep are consistent and unavoidable. These include increased health risks and accelerated aging. With a better understanding of the role sleep plays on the skin, we can improve clients’ skin, increase positive treatment outcomes, and increase retention within the practice.
In order to understand how sleep loss can negatively impact the skin, the stages of sleep and the purpose of sleep must be understood.
Sleep is characterized by cycles of light sleep, deeper slow-wave sleep, and rapid eye movement sleep (REM), with each full sleep cycle lasting about 90 to 110 minutes. Sleep cycles repeat throughout the night, and a typical healthy sleeper will go through five sleep cycles per night. A majority of an individual’s sleep is spent in non-REM sleep stages; in fact, only 20% to 25% of an individual’s time asleep is REM sleep.
Cycles of sleep and their sleep stage components recur throughout the night. Without adequate time to sleep through each sleep stage and the required cycles, overall health, including skin health, will be at risk.
Stage N1 (Non-REM 1) of a sleep cycle is considered to be light sleep. As sleep initially begins (N1), the body is in transition between wakefulness and sleep. During this stage, the sleeper is aware of surroundings and shifts into a relaxed state. This phase of the sleep cycle may last up to seven minutes per cycle and equals only 5% of total sleep time. During this cycle, falling asleep gradually occurs. Although this stage exists within a small time frame, none of the other stages can occur without it.
Stage N2 (Non-REM 2) of the sleep cycle is considered to be light sleep. However, during N2, the body begins to disengage from the surroundings. Breathing and heart rate are similar to those when awake, but body temperature drops one to two degrees. The majority of sleep time is spent in stage N2, the stage accounting for nearly 50% of the total sleep cycle.
Stage N3 (Non-REM 3) is deep sleep, where much of the restorative process begins that allows for hormonal regulation, cellular repair, and rejuvenation. During this cycle of sleep, an individual is resistant to waking and, if awakened, may be groggy and disoriented. Deep sleep can last from 45 to 90 minutes. Most research shows that it lasts for more extended periods during the first of the night and shortens with each cycle.
Rapid eye movement sleep (REM) is the final stage of the sleep cycle and is associated with dreaming. All voluntary muscles, except for the eye muscles, become motionless and tranquil. Involuntary movements of the closed eyes occur. During REM sleep, brain activity, heart rate, and blood pressure increase. Time periods for REM sleep lengthen with each sleep cycle. The first period typically lasts 10 minutes and each later REM stage lengthens. While infants can spend up to 50% of their total sleep time in REM, adults spend only 20% to 25% here.
A better understanding of sleep helps understand why adequate daily sleep is vitally important for skin. While life’s demands continue to drive clients further away from a relaxing night, it is still necessary for the body to rest, repair, and grow.
SLEEP, HORMONES, AND SKIN
With impaired sleep, hormone production shifts and metabolism is altered. This produces stress on the entire body, including the skin.
Some of the hormones most impacted by sleep are melatonin, cortisol, insulin, DHEA, estrogen, testosterone, and progesterone. Each of these hormones plays a significant role in skin aging. All of these are negatively affected by sleep deprivation. Adequate levels of each are also necessary for the maintenance and repair of youthful, healthy skin.
Melatonin is a hormone primarily produced by the pineal gland and is the regulator of the circadian clock. Many people only associate melatonin with sleep. However, melatonin is protective against aging. Melatonin has many benefits that include free radical scavenging, protecting skin against ultraviolet damage, and assisting in the repair of ultraviolet damaged skin.
Cortisol is one of the stress hormones and regulates stress response. The internal circadian rhythm ensures high levels in the morning and lower levels in the evening. Cortisol plays an important role in inflammation reduction and metabolism regulation. Stress can significantly impact cortisol’s daily rhythm and effects on sleep and the skin. When the body lacks necessary sleep, stress results, and cortisol production increases. Stress and the accompanying heightened cortisol levels contribute to skin concerns such as dullness, thinning, reduced elasticity, lines, and wrinkles. High cortisol levels also cause the skin to produce more sebum, leading to clogged pores and the development or worsening of acne.
Insulin regulates metabolic processes providing cellular energy. Although enough insulin is mandatory for glucose metabolism and energy creation, too much insulin is associated with insulin resistance, aging, and obesity. With poor-quality sleep, insulin levels and glucose intolerance increase. When the body lacks adequate rest, cortisol increases which, in turn, results in the release of more insulin and resultant insulin resistance and glucose intolerance. Glucose intolerance itself is a physical stress, and this generates a harmful cycle of stress linked to insulin resistance, glucose intolerance, and obesity.
DHEA is a steroid hormone that assists in the production of other hormones, including testosterone and estrogen. With fatigue, stress, or aging, DHEA levels decline. Adequate DHEA levels assist in the production of collagen, while also decreasing collagenase enzymes that destroy collagen. Collagen is a very well-known component of healthy skin. It is the main structural protein in the body and serves as the major component of connective tissue, skin, hair, and bone. In addition to collagen production, DHEA assists in the production of sebum, which aids in moisturizing skin and fortifying the skin barrier.
Estrogen insufficiency causes a reduction in epidermal and dermal thickness. Thin skin is more vulnerable to free radical damage, oxidative stress, and other stressors. Lower estrogen levels result in decreased collagen production, leading to thinned and wrinkled skin. Estrogen levels begin their natural decline in females in the mid to late 30s but are further decreased with sleep impairment.
Testosterone levels affect skin if either too high or too low. For both men and women, the correct balance is essential to overall skin health. For males, testosterone levels drop with advancing age, but these levels are also lowered by poor-quality sleep. When testosterone drops, the skin loses elasticity, dermal thickness, and density.
Progesterone is a hormone that supports skin elasticity and circulation. Progesterone levels start to decline naturally in women in the mid to late 30s. Progesterone also decreases with sleep deprivation, creating difficulty with the attainment of glowing skin.
SLEEP AND SKIN AGING
Aging is a process, and each minute, hour, and day adds to chronologic and functional age. Skin aging includes both intrinsic and extrinsic processes. Intrinsic aging is directly related to internal factors and primarily to the creation of energy within all living cells, including skin cells. Extrinsic aging is directly associated with external factors, such as sun exposure, pollution, blue light exposure, and environmental toxins.
Poor-quality sleep increases intrinsic aging and extrinsic aging. In 2013, the University Hospital Case Medical Center studied 60 pre-menopausal women between the ages of 30 and 49. Half of the study participants were considered poor-quality sleepers, as classified by the Pittsburgh sleep quality index. The study explored the impact of poor sleep and its link to skin aging and compromised recovery from environmental stress. The study involved visual skin assessments, and participants went through several non-invasive skin challenges, including skin barrier disruption and an ultraviolet light exposure test. Participants were required to document their sleep over the one-week period the study was conducted.
The results from this study demonstrated the substantial difference between good-quality and poor-quality sleepers and their relative amounts of skin aging. The results were measured using the SCINEXA skin aging score system. Poor-quality sleepers had an intrinsic age score 50% older than good sleepers. This was visible in uneven pigmentation, fine lines, slackening of the skin, and reduced elasticity.
Extrinsic aging caused by environmental and lifestyle factors accounts for 80% to 90% of all aging. These factors include sun exposure, diet, sleep, smoking, and pollution. Individuals have more control over extrinsic aging.
Cellular repair and renewal begin with sleep onset and are most robust during deep sleep. These processes boost skin integrity and begin the processes of recovery against environmental factors such as ultraviolet exposure. Like poor-quality sleep, ultraviolet damage increases inflammation. These two factors act as dual threats and accelerate aging. Skin DNA damage occurs with photoaging and all types of oxidative stress. DNA repair processes are required to combat photoaging and increased risks of skin cancer development. Repair processes for DNA occur during sleep as the body uses this period to recover and regenerate.
IMPLEMENTING SLEEP KNOWLEDGE INTO THE AESTHETIC PRACTICE
Numerous studies and research support the link between sleep and skin aging. How may this knowledge be incorporated into practice recommendations?
Inquiring about sleep quality should be done during the consultation process or included on intake forms. This information is imperative to determine treatment recommendations and fitness for undergoing procedures. Clients must be educated about the importance of sleep in overall skin health and recovery from treatments and procedures. Impaired sleep impacts results and can even increase the number of treatments required to adequately address a skin concern.
For example, as a skin care professional, you may have determined that a series of medium-depth chemical peels will provide a client with the desired outcome they are seeking for the goal of facial rejuvenation. What timeline should be recommended between these series of peels or the peels within a series?
If this client is a busy working mother whose sleep is often interrupted by her toddler, she may require more time between peels to adequately heal. Even though this client is young and has a cellular renewal much faster than a person in their 50s, a lack of sleep will affect their skin’s ability to re-epithelialize. This client may still be an excellent candidate for a series of chemical peels and may do better if the treatment provider opts for six-week intervals between peels instead of the usual four weeks between peels in the series.
The amount and quality of sleep may affect the results of all treatments. More time will be required for this client to recover from chemical peels than an individual who does not have a disrupted sleep schedule.
PRACTICAL WAYS TO IMPROVE SLEEP
Sleep is important to skin health. Practical tips for improving both may be drawn from the research. In conclusion, the following are recommendations to improve sleep quality and quantity.
Avoid Blue Light in the Evening: Avoid device use, including cell phones and laptops, beginning a minimum of three to four hours before bedtime. Personal devices emit large amounts of blue light, sometimes called high energy visible light, that energizes the brain and interferes with sleep. If the device must be used, turn on the blue light filter (sometimes called night mode), so the screen shows more red light rather than blue light.
Create a Comfortable Sleeping Environment: The room should be cool and comfortable. Remove clutter and distractions from the room, including computers, televisions, and cell phones.
Avoid Caffeine: The stimulation from caffeine can also disrupt the natural body clock. Stimulants such as caffeine should be avoided at least four hours before bedtime. In many people, more avoidance time may be needed.
Alcohol Consumption: Although some may feel drowsy following alcohol consumption or may even feel it assists with falling asleep, alcohol can be very disruptive to the circadian rhythm. When consumed near bedtime or in large amounts, it has been linked to restless sleep and an overall lower quality of sleep. Avoid any alcohol consumption four to five hours before sleep.
Exercise: Regular exercise can improve nighttime rest. Recent reports have shown that exercising three hours before bed is associated with a better night’s sleep due to muscle relaxation.
Diet: Calories should not be consumed three hours before bedtime. Doing so decreases growth hormone levels. As much as 75% of growth hormone is released during sleep. Lowered growth hormone levels are associated with thinning of the skin, wrinkling, and poor skin turgor.
Hot Bath Before Bed: Taking a hot bath (102 to 106 degrees) before bedtime relaxes muscles, which helps induce sleep.
Stress: High stress levels disrupt sleep. Many methods for stress reduction are available and one or more of these should be incorporated into the lifestyle.
Napping: For individuals who have difficulty sleeping, napping throughout the day should be avoided. A tired individual who naps experiences the rapid onset of deeper sleep. This impairs the ability to fall asleep easily at bedtime.
Write it Out: Each evening, thoughts or a remaining to-do list may be written out before bedtime. These should then be put out-of-mind. This practice can help settle the thoughts, allowing the mind to rest at ease.
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Tyler Peters is the education manager for INNOVATIVE SKINCARE overseeing both the global education for iS CLINICAL and the content and outreach through iS UNIVERSITY and iS CLINICAL EDU. Coming from outside the industry gave Peters a unique outlook to learn as much as possible from different perspectives within the industry and throughout the company. Without the preconceived notions that can be formed from being an industry insider, Peters’ approach helped to break the molds of industry education and outreach that has gained the praise of industry professionals globally.