A lot of it boils down to blood pressure. High blood pressure is a serious contributing factor to cardiovascular incidents (as well as a slew of other negative health risks), and getting a good night's sleep will help keep blood pressure down. This is also why the amount of heart attacks are up around 24% after daylight savings[1]; an hour less sleep means higher blood pressure means higher risk of heart attack (relative to any other 'normal' day).
I can definitely see how the same logic could apply to Mondays. Less sleep, more stress = higher blood pressure = higher risk of heart attacks.
[0] https://www.goodreads.com/book/show/34466963-why-we-sleep
Don’t think late presentation STEMIs are that common to begin with for your argument to have logical sense, this is the worst form of a “heart attack”.
From this single center study presentations > 12 hours only comprised 10%.
https://www.ingentaconnect.com/content/wk/jcarm/2017/0000001...
[0] https://www.cdc.gov/nchs/data/dvs/table14_99.pdf (in the US at least)
The problem obviously with heart attacks is the implications of false negatives and positives are huge, and the tracing from a watch would be less reliable than the gold-standard ECG / EKG.
It is very clear about the fact it cannot detect a heart attack though.
Then there’s these slightly more sophisticated things: https://store.kardia.com/products/kardiamobile6l
> In the Northern Hemisphere, the switch to daylight savings time in March results in most people losing an hour of sleep opportunity. Should you tabulate millions of daily hospital records, as researchers have done, you discover that this seemingly trivial sleep reduction comes with a frightening spike in heart attacks the following day. Impressively, it works both ways. In the autumn within the Northern Hemisphere, when the clocks move forward and we gain an hour of sleep opportunity time, rates of heart attacks plummet the day after.
I don't see a specific study cited, but my ebook copy doesn't seem to have all the footnotes.
I pulled up the article you linked on sci-hub: https://sci-hub.se/https://pubmed.ncbi.nlm.nih.gov/18971502/ The only use of the number "24" refers to hours in the day, and its summary doesn't seem to match your claim:
> The incidence of acute myocardial infarction was significantly increased for the first 3 week-days after the transition to daylight saving time in the spring (Fig. 1A). The incidence ratio for the first week after the spring shift, calculated as the incidence for all 7 days divided by the mean of the weekly incidences 2 weeks before and 2 weeks after, was 1.051 (95% confidence interval [CI], 1.032 to 1.071). In contrast, after the transition out of daylight saving time in the autumn, only the first weekday was affected significantly (Fig. 1B); the incidence ratio for the whole week was 0.985 (95% CI, 0.969 to 1.002
It's caused by sudden stress (e.g. bereavement, illness) which leads to weakening of the heart muscle, causing the heart to bulge out at the apex. It's named 'tako-tsubo' because the heart starts to resemble a round vessel used in Japan to catch octopuses.
Edit: aha--https://www.nature.com/articles/s41467-020-15432-4
Just knowing the pathology of STEMI it's hard to buy that an effect of this size (in the Ireland study) is largely due patient's not seeking care on weekends unless you're somewhere extremely rural as this isn't your average heart attack.
If this was about ACS (acute coronary syndrome) in general I'd be more suspicious that patient delays are a relevant confounder, but we have other literature to support the trend (granted with some conflicting studies).
from [1]: > Many studies have shown an excess of cardiovascular events on Mondays (1,3,10,16,18,19). A relative trough has been seen on Saturdays and Sundays I compared with the expected number of cases. A similar pattern was seen in most subgroups irrespective of age, gender, cardiac medication, and in-fart characteristics (first or recurrent, Q or non-Q, site). The frequency of morning infarction is greater during the working week than on weekends, suggesting a superimposition of work-related stress on endogenous circadian rhythms.
>Circadian variation is found on all days of the week including weekends' when the morning peak is less obvious.
I haven't looked at the methodology of the cited studies but they include 6 references for your perusal.
[0]https://onlinelibrary.wiley.com/doi/abs/10.1002/clc.22 [1]https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.4960261... [2]https://europepmc.org/article/med/12061302
These were synchronized wired clocks ( https://www.natsco.net/industries-served/industries-served-o... /// https://blog.american-time.com/wireless-master-time-clock-vs... ).
> Schools traditionally used wired clock systems for two basic reasons: rock solid reliability and the ability to synchronize school bells to the rest of the system. The wired synchronized system ensured that clocks would all read the same time and bells would ring at the same time every day, no matter what classroom you were in, and that students would arrive to class on time — something teachers could only dream of before installing a synchronized system.
Walker's book—and his accompanying Ted talks and podcasts—instilled a deep sense of sleep anxiety in me, which led to episodes of chronic insomnia (still occurs today). I had never experienced these issues before reading the book. Unfortunately, his message ensures that the insomnia is self-exacerbating, causing a vicious cycle.
Essentially, I find it very wrong for Walker to focus on and overhype the negative aspects of sleep loss as much as he does. Guzey's article [0], also linked above, goes through much of this. Why We Sleep turns into a horror book if you aren't able to sleep for whatever reason. It implies that, from just one bad night's sleep,
1. your immune system will deteriorate significantly
2. the chance that you develop a cancer will increase
3. your mental health will suffer
4. you are more likely to develop anxiety or depression
5. the probability you hurt yourself will increase
6. your mental faculties will be destroyed, you will be unable to reason well
7. you are at higher risk of mortality (!)
8. you are literally closer to death, which the book supports by mentioning fatal familial insomnia (FFI)... a flawed analogy
I was initially ok after reading the book, but the problems really started after I had a bad nights' sleep. I was absolutely terrified the following night, remembering all the awful things that will happen to my body and mind if I do not recuperate the next night. And we all know how easy it is to lose sleep when you are worried. I stayed up until 6 AM that night. Every passing hour made it harder to sleep.
Naturally, this started a cycle. Grumpy and even more anxious the next day ("two days? wow, am I now DOUBLE the chance of cancer and depression?"), sleep began evading me more and more often. The bed became a place of anxiety. Every minute I spent awake, I remembered Walker's book and the terrible things he told me was happening to my body due to the insomnia. This caused an infernal, unending loop of insomnia. Morning birdsong became hell to my ears.
I still sometimes suffer from it to this day, but Guzey's essay really helped. I think some quotes can do my point more justice:
> Your essay on Why we sleep - I can’t thank you enough. I’m a sleep doctor in Oregon and have seen many many patients who have developed severe sleep anxiety and insomnia. Two friends in the sleep field and myself weekly have talked about people that slept well until reading this book.
> I wanted to drop you a line to thank you for all the time and effort involved in debunking Matthew Walker’s book. As someone who works with individuals with insomnia on a daily basis, I know from firsthand experience the harm that Walker’s book is causing. I have many stories of people who slept well on less than eight hours of sleep, read Walker’s book, tried to get more sleep and this led to more time awake, frustration, worry, sleep-related anxiety, and insomnia.
> My patients are coming to me after reading this alarmist book, with insomnia that they did not have before, and worse, harder to treat because although the book has caused these anxieties - they can’t shake their newly built alarmist beliefs they learnt from the very same book.
> Scott slept well his entire life until he listened to a podcast that led him to worry about how much sleep he was getting and the health consequences of insufficient sleep. That night, Scott had a terrible night of sleep and this triggered a vicious cycle of ever-increasing worry about sleep and increasingly worse sleep that lasted for ten months.
The point of the guidelines is to help reduce low value comments and on that note - mentioning voting is against the guidelines https://news.ycombinator.com/newsguidelines.html for the same reason “Please don't comment about the voting on comments. It never does any good, and it makes boring reading.”
What's really normalized is metabolic syndrome. 88% of adult americans have some degree of metabolic dysfunction. High blood pressure, obesity and other ailments are very often a direct result of that. So much so, that the 'normal' range of indicators such as uric acid has been revised and adjusted over the years, because "normal" people had higher levels and still appeared to be fine. Thankfully, we are starting to question that (eg. https://pubmed.ncbi.nlm.nih.gov/24867507/)
First order of business for anyone watching their blood pressure creeping up over the years (even more so if A1C, triglycerides, liver enzymes and uric acid are rising too): cut sugar in all forms. Not just the sugar you personally add to food, not only what's specified as 'added sugar', but all food containing sugar - which is basically all ultra processed foods. It does include sliced bread which is easily broken down into sugar( and is often laced with additional sugar, check ingredients). Leave your sugar 'allowance' to be used by a reasonable amount of fruits.
That may not reverse the problem (although, in my case, it did) but should help tremendously.
They don’t break it down by age which might help show if it’s work related.
Heart attacks are also clearly elevated on Sundays, and not depressed on Saturdays, which might suggest this is related to alcohol.