Dr. Jonathan Cedernaes

Dr. Cedernaes is a licensed medical physician (Leg. läkare), has a Ph.D. in medicine, and is an associate professor (docent) in medical cell biology at Uppsala University, Sweden. He is currently a sleep & circadian researcher at Northwestern University in Chicago & Uppsala University in Sweden.

He has co-authored over 60 peer-reviewed articles, and has also co-authored a chapter on the role of circadian rhythms in Harrison’s Principles of Internal Medicine. His research has focused on cognitive and metabolic effects of disrupted sleep and circadian rhythms, both in humans and in animals.

Dr. Cedernaes is also interested in science communication, including about the coronavirus SARS-CoV-2 and COVID-19. He is currently active as a moderator of the Swedish medical doctor Facebook group on COVID-19 research, which has over 21,000 members.

Dr. Cedernaes is also an ambassador for the public outreach committee of the Society for Research on Biological Rhythms (SRBR).

Poor Sleep, Intense Exercise Produces Heart Damage
with  Dr. Jonathan Cedernaes, Ph.D. - MD

[00:04:56]    Why this study, why did you look at the effects of a lack of sleep and intense exercise?

• Prior evidence suggesting that sleep is related to the risk of cardiovascular disease.
• Evidence to suggest that sleep can modify how damaging certain stimuli could be.
• Animal studies show how damage occurs at tissue level during an intense period of sleep deprivation.
• There is a dose dependent relationship between how much sleep you get and risk of various diseases.
• We wanted to study whether exercise could be used as a countermeasure for certain adverse metabolic effects of sleep loss. But at the same time, we were also interested in the fact that exercise is a stressor.
• Exercise can mainly be seen as a positive stressor, but it does add stress to yourself because if you do it at a high enough intensity, you are putting a lot of strain on your cardiovascular system.
• The question was, what are the factors (during heavy exercise) that determine the extent of increase of biomarkers indicating cardiovascular disease?
• One often overlooked factor in many studies was sleep.

[00:10:33]   Which cardiovascular diseases are assigned to people who have sleep deprivation?

• Less amount of sleep is linked to
  • all cause higher cardiovascular mortality and cardiovascular disease
  • higher incidents of hypertension
  • arrythmias

[00:12:05]   Troponins are a group of proteins found in skeletal and heart (cardiac) muscle fibers that regulate muscular contraction. Troponin tests measure the level of cardiac-specific Troponins in the blood to help detect heart injury. It is normal to see Troponins in the blood of people who exercise intensely, because there is a hormetic effect to the heart during training.

[00:15:17]   How much of the phenomenon with the heart and the increased Troponins could be assigned to some metabolic inflexibility?

• Added contractions and increasing stress on the heart leads to these cellular phenomena that then lead to a release of Troponins.
• And we don't really understand what that means, but we do see metabolic changes in those cells, in sleep deprived people.

[00:21:39]   Intensity is a continuous demand on the body to produce a certain amount of energy for a long period of time.

[00:21:19]   Dr. Jonathan Cedernaes explains what the exercise regime and intensity was of the subjects in this particular study.

[00:24:18]   Can people with the genetic predisposition to sleep less contaminate the numbers in the study?

• There is a chronotype of either being a night owl or waking up like a lark in the morning.
• And there are genetic factors that make certain individuals much less susceptible to the effects of sleep deprivation.
• It is quite uncommon that you have these mutations or genetic variations, that leads you to be able to manage without consequence, on 4 hours of sleep.
• The consensus in the sleep community is that the average numbers of hours of sleep to aim for are between 7 to 9 hours.
• There's variability between individuals that some will manage with 6 hours and others will need 10 hours.
• In this study we had people who were of an average in terms of chronotypes.

[00:28:19]   Carl shares his view and experience on adaptation towards sleep habits.

[00:36:37]   Carl and Dr Jonathan Cedernaes has a very interesting discussion on sleep trackers and their reliability vs how a person physically feels after awakening.

[00:42:50]   Carl’s view is that these devices have so many people hunting for targets of sleep quality that don't exist, and they don't line up with how you feel.

[00:44:23]   Heart rate seems not to coincide with depth of sleep.

[00:44:53]   A journal of a French physician from the 1700^s spoke extensively about sleep. The writer also investigated the concept of 1^st and 2^nd sleep. Is segmented sleep a good thing?

• If you don't get enough sleep during the night, there's usually not an issue in trying to take a nap to restore energy levels.
• It is however not ideal to substitute lack of sleep with naps daily.
• The value would lie in improving nighttime sleep.
• Hour long naps during the day can prevent you from building up sleep pressure and change the sleep homeostat.
• On the other hand, short power naps can restore energy levels and prevent post nap grogginess.

[00:47:47]   Carl shares some fascinating facts about caffeine consumption lowering blood sugar levels and the affect it has on i.e., diabetics.

[00:56:49]   What should clinicians and lay people take away from this study?

• Just to point out, the increase of Troponins in a sleep-restricted state was modest in comparison to the levels in a well-rested condition.
• Sleep and training history of individuals should be taken into consideration when looking at these biomarkers.
• For the average person it is just an indication to be more mindful about sleep.
• Intense exercise combined with a chronic lack of sleep could offset detrimental effects.
• Exercise is more optimal for an individual when they get adequate sleep.

[01:00:37]   During some of the most aggressive prostate cancers, oxytocin accumulates in the in the prostate. I'm of the thinking that oxytocin is trying to fix a problem. What if these Troponins actually have a value and are trying to fix the problem?

• Troponins are part of the contract dial system inside the cell.
• They are part of the unit in the muscle that helps the muscle contract.
• Damage to cells can cause release of these biomarkers.
• It doesn't have to mean that that a cell is dying, it just indicates a physiological event that is causing Troponins to be released.
• We therefore know that exercise at a high enough intensity can lead to this release.

[01:02:30] Train less, not more if you're not sleeping well. 

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Debbi Barber & Teresa Berry, RN

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