Don’t Sleep on This, part trois
We’ve all heard the saying about waking up “on the wrong side of the bed,” but as it turns out, there’s quite a bit of truth behind this colloquialism. Americans in general are notoriously sleep deprived; lots of folks experience problems sleeping, not getting enough sleep, not feeling rested, and not sleeping well. This can lead to difficulties functioning during the daytime, and have very unpleasant effects on your work, relationships, and social and family life. Most people know firsthand that sleep affects their mental state, but do you know how closely connected sleep is to mental and emotional health? Sleep deprivation has major effects on your psychological state. The two- sleep and mental health- contribute greatly to one another, generally coexisting in a bidirectional relationship. People with mental health diagnoses are more likely to have insomnia and/ or other sleep disorders, and vice versa. Ultimately, mental health disorders tend to make it harder to sleep well, while at the same time, poor sleep and insomnia can be a contributing factor to the initiation and worsening of mental health issues.
Insomnia and other sleep issues have clearly demonstrated links to depression, anxiety, bipolar disorder, and other conditions like ADHD. In fact, chronic sleep problems affect 50% to 80% of psych patients, as compared to 10% to 18% of typical American adults. Both sleep and mental health are complex issues affected by a multitude of factors, but given their close association, there’s good reason to believe that improving sleep can have a hugely beneficial impact on mental health. In my opinion, helping to ensure a patient gets good sleep is an important component of treating most psych disorders.
Why is sleep so important? If you recall from last week, brain activity fluctuates during sleep, increasing and decreasing during different stages of the sleep cycle. In NREM- non-rapid eye movement- sleep, overall brain activity slows, but there are quick bursts of activity. In REM sleep, brain activity picks up very rapidly, which is why this stage is associated with more intense dreaming. Each stage plays a role in brain health, allowing activity in different parts of the brain to ramp up or down, and this enables better thinking, learning, and memory. Research has clearly demonstrated that all this brain activity while you’re sleeping has profound effects on emotional and mental health.
Sufficient sleep, especially REM sleep, facilitates the brain’s processing of emotional information. During sleep, the brain works to evaluate and remember thoughts and memories, and a lack of sleep is especially harmful to the consolidation of positive emotional content. This can influence mood and lead to emotional reactivity, and has been tied to various mental health issues and the severity thereof. It can even lead to suicidal ideation and behaviors. The old timers thought that sleep problems were strictly a symptom of mental health disorders, but after elucidating what goes on in the brain during sleep, science has made it clear that problems sleeping are not just a consequence of mental health issues, they can also be a cause of the same.
One of the major sleep disorders that people face is insomnia, which is basically an inability to get the amount of sleep needed to function efficiently during the daytime. It may be caused by difficulty falling asleep, difficulty staying asleep, or waking up too early in the morning. About 1 in 3 Americans report difficulty sleeping at least one night per week. Short-term insomnia is very common, and has a multitude of causes: stress, lifestyle, work schedule, travel, or other life events. It can generally be relieved by simple sleep hygiene interventions, things like exercise, a hot bath, warm milk, or changing your bedroom environment. On the other hand, long-term insomnia lasts for more than three weeks, and this should really be investigated by a physician, potentially with referral to a sleep disorder specialist.
Why? Because chronic insomnia is rarely an isolated issue, it’s usually a symptom of another illness, be it medical or psych, that requires investigation. Sometimes insomnia can be caused by obstructive sleep apnea, or OSA, which has also clearly been linked to mental health issues. OSA is a disorder that affects your breathing while sleeping. With OSA, your throat muscles intermittently relax and block your airway, causing you to repeatedly stop and start breathing while you sleep. This leads to a drop in the body’s oxygen levels, creating fragmented and disturbed sleep. In fact, OSA can cause as many as 30 sleep disruptions per hour. Yikes. There are serious repercussions for that. The human body likes oxygen, and it can get a little pissy when it doesn’t get enough of it. People with OSA experience these abrupt awakenings, accompanied by gasping or choking, along with morning headache, daytime drowsiness, difficulty concentrating during the day, forgetfulness, mood changes, high blood pressure, and decreased libido. It’s not good. Unfortunately, OSA occurs more frequently in people with psych disorders, and it’s a serious issue, as it detracts from physical health while simultaneously heightening mental distress. A 2017 study found that people with sleep apnea, when compared to those without, were 3.68 times more likely to have anxiety, 2.88 times more likely to experience severe psychological distress, and 3.11 times more likely to have depression. In addition, it found that their odds of suicidal ideation were 2.75 times higher. Sadly, the same study also found these patients with OSA reported a greater lack of mental health care and support.
Multiple studies recognize the correlation between OSA and poor mood, post traumatic stress disorder, and higher prevalence of psychosis and schizophrenia. The presence of OSA in the schizophrenic population has been found to be as high as 48 percent! Smoking and alcohol consumption further complicate this link between schizophrenia and OSA, as both are very common habits in people with schizophrenia, and both confer an increased risk of sleep apnea. And OSA isn’t just linked to schizophrenia. Existing studies note the prevalence of OSA in bipolar patients to be similar to that of schizophrenia.
There’s also a causal relationship between OSA and depression. Decreased oxygen levels overnight, called nocturnal hypoxia, cause chronic stress, which then increases the production of corticosteroids in response. Higher levels of corticosteroids, in turn, cause mood changes and impaired cognitive function, as well as increased inflammation in the body, all of which contribute to the development of depression. Conversely, patients with depression exhibit lower levels of serotonin, a neurotransmitter that’s also linked to muscle tone of the upper airways. Decreased serotonin levels in the body increase the likelihood that the upper throat will collapse, causing even more episodes of apnea. It can create the perfect sleep storm.
Because OSA and depression share several symptoms, it can be difficult to discern the impact of one disease over the other. Both result in disturbed sleep, fatigue and lethargy, restlessness, and loss of concentration. Given those facts, it should come as no surprise that both OSA and depression are associated with increased vehicle and workplace accidents due to increased fatigue and poor concentration.
Insomnia: Cause and Effect
How well you sleep tells a physician like me a lot. About half of insomnia cases are related to depression, anxiety, or general psychological stress. Very often, the qualities of a person’s insomnia, along with their other symptoms, can be helpful in determining the role of mental illness in their inability to sleep. This is why I always ask patients to tell me about how they’re not sleeping… just knowing you can’t isn’t enough. For instance, early morning wakefulness can be a sign of depression, especially if it comes along with low energy, an inability to concentrate, sadness, and a change in appetite or weight. On the other hand, a sudden dramatic decrease in sleep which is accompanied by an increase in energy- or the lack of need for sleep- can be a sign of mania. Many anxiety disorders are associated with difficulties sleeping, and obsessive compulsive disorder is frequently associated with poor sleep as well. Panic attacks during sleep may suggest a panic disorder, while poor sleep resulting from nightmares may be associated with post traumatic stress disorder.
Sleep and Specific Mental Health Diagnoses
The way that sleep and mental health are intertwined becomes even more apparent when you look at how sleep is tied to a number of specific mental health conditions.
It is estimated that over 300 million people worldwide have depression, a mood disorder marked by feelings of sadness or hopelessness. Around 75 percent of depressed people show symptoms of insomnia, and many people with depression also suffer from excessive daytime sleepiness and hypersomnia, which is sleeping too much. Historically, sleeping problems were seen as a consequence of depression, but in reality, poor sleep may also induce or exacerbate depression, and sleep problems and depressive symptoms are mutually reinforcing. It’s essentially a negative feedback loop, where poor sleep worsens depression that then further interrupts sleep. But on the bright side of that, a focus on improving sleep may also have a corollary benefit of reducing the symptoms of depression.
Seasonal Affective Disorder
You may remember from a few months ago that SAD is a subtype of depression that most often affects people during times of the year with reduced daylight hours, typically fall and winter. It’s closely tied to the disruption of a person’s internal biological clock, or circadian rhythm, that helps control multiple bodily processes, including sleep. It shouldn’t surprise you then that people with SAD experience changes to their sleep cycles, and tend to sleep either too much or too little.
Every year, anxiety disorders affect an estimated 20 percent of American adults and 25 percent of teenagers, creating excess fear or worry that can affect everyday life and create risks for other health issues, including heart disease and diabetes. Anxiety disorders- including social anxiety disorder, panic disorder, specific phobias, OCD, and PTSD- have a strong association with sleeping problems. In these disorders, worry and fear contribute to a state of hyperarousal, when the mind is constantly racing, which is a central contributor to insomnia. Sleep problems may then become an added source of worry, creating anticipatory anxiety at bedtime, which makes it that much harder to fall asleep. It can become a vicious cycle. Research has found an especially strong connection between PTSD and sleep. People with PTSD frequently replay negative events in their mind, suffer from nightmares, and experience a constant state of being on alert, all of which can interfere with sleep. PTSD affects many veterans; at least 90 percent of U.S. veterans with combat-related PTSD have symptoms of insomnia. But sleep problems aren’t just a result of anxiety. Research indicates that poor sleep can actually activate anxiety in people who are at high risk for it, and chronic insomnia appears to be a predisposing trait among people who later go on to develop anxiety disorders.
Bipolar disorder involves episodes of extreme moods that can be both high, with mania, and low, with depression. A person’s feelings and symptoms are quite different depending on the type of episode, but both manic and depressive periods can cause major impairment in everyday life. In people with bipolar disorder, sleep patterns change considerably depending on their emotional state. During manic periods, they usually feel less need to sleep, but during depressed periods, they often sleep excessively. Very often, sleep disruptions continue when a person is between episodes. Research has found that many people with bipolar disorder experience changes in their sleep patterns just before the onset of an episode. There is clear evidence that sleeping problems induce or worsen manic and depressive periods, but that because of the bidirectional relationship between bipolar disorder and sleep, treatment for insomnia can reduce the impact of a person’s bipolar disorder.
Schizophrenia is a mental health disorder characterized by a difficulty in differentiating between what is and is not real. People with schizophrenia are more likely to experience insomnia and circadian rhythm disorders, and these issues can actually be exacerbated by medications that are used to treat schizophrenia. But once again, poor sleep and symptoms of schizophrenia may be mutually reinforcing, so there are potential benefits to stabilizing and normalizing sleep patterns.
ADHD is a neurodevelopmental disorder that involves reduced attention span and increased impulsiveness. While usually diagnosed in children, it may last into adulthood, and is sometimes only formally diagnosed when someone is already an adult. Sleeping problems are common in people with ADHD. They may have difficulty falling asleep, frequent awakenings, and excessive daytime sleepiness. Rates of other sleep disturbances, such as obstructive sleep apnea and restless leg syndrome (RLS) also appear to be higher in people with ADHD. Once again, there is clear evidence of a bidirectional relationship between sleep and ADHD; in addition to being a consequence of ADHD, sleep problems may aggravate symptoms, especially in reduced attention span or behavior problems.
Substance use disorders can also cause problems with sleep. While alcohol is sedating in limited quantities, alcohol intoxication disturbs your sleep patterns and can make you wake up numerous times in the night. Some sedative medications may cause sleepiness during intoxication, but it’s far too easy to develop a dependency on them, and ultimately they’ll disturb sleep and cause serious problems sleeping in people who are misusing or withdrawing from them. Illicit drugs like LSD and ecstasy are also associated with interruptions in sleep.
Keep in mind that many mental health conditions don’t arise in isolation, and that coexisting conditions can influence one another, as well as a person’s sleep. For example, it’s not uncommon for people to experience both depression and anxiety, and people with both conditions have been found to have worse sleep than people with “just” depression or anxiety.
As you can see, poor sleep has clearly been shown to significantly worsen the symptoms of many mental health issues. This is down to the bottom line, that lack of sleep will change your brain, at the very least making it harder to get through the day. At the same time, severe sleep problems can decrease the effectiveness of certain psych treatments. Treatment of sleep disorders has been studied in relationship to schizophrenia, ADHD and other psych issues, and all of the scientific data shows the connection between them. Good sleep is necessary for recovery- or prevention- in both conditions. It’s a multifaceted, bidirectional relationship. Sleep has a very important restorative function in ‘recharging’ the brain at the end of each day, just like we need to charge a mobile phone. You know what happens if you don’t plug that in, right? It dies. Enough said. Poor quality of sleep may seem like a minor symptom, but if it’s chronic, it can be a sign of something much bigger. Good sleep can enhance quality of life and positively contribute to managing any concurrent mental illness. In fact, the relationship between mental health and sleep is so strong that steps to improve sleep may even form part of a preventive mental health strategy.
Next week, we’ll talk about what you can do to help ensure good, restorative sleep. I hope you enjoyed this blog and found it to be interesting and educational. Please feel free to share it with family and friends. Be sure to check out my YouTube channel with all of my videos, and I’d appreciate it if you would like, subscribe, leave comments, and share those vids! As always, my book Tales from the Couch has more educational topics and patient stories, and is available in office and on Amazon.
Thank you and be well people!
Don’t Sleep on This, part deux
Hello, people, welcome back to the blog! Last week, we started a new series on sleep, and talked about some of the theories on why we sleep and what it does for us. This week, we’re going to talk about what induces sleep, the stages of sleep, what’s happening in your brain and body while you’re sleeping, and what can happen when sleep is disrupted.
As I mentioned last week, our bodies regulate sleep in much the same way that they regulate eating, drinking, and breathing, and this is indicative of the critical role sleep plays in our health and well-being. But why do we get sleepy? What tells us when it’s bedtime? Each person has an internal “body clock” that regulates his or her sleep cycle, controlling when they feel tired and ready for bed, versus refreshed and alert. This clock operates on a 24-hour cycle known as the circadian rhythm.
After waking up from sleep in the morning, you become increasingly tired throughout the day as it progresses. These feelings will generally peak in the evening leading up to bedtime. This sleep drive- also known as sleep-wake homeostasis- appears to be linked to adenosine, an organic compound produced in the brain. I mentioned adenosine last week. It builds up throughout the day as you become more tired, and then the body breaks it down during sleep to dispose of.
Light influences the circadian rhythm. The brain contains a special region of nerve cells known as the hypothalamus, and a cluster of cells within it called the suprachiasmatic nucleus, which processes signals when the eyes are exposed to natural or artificial light. These signals help the brain determine whether it is day or night, time to be awake, or time to sleep. As natural light disappears in the evening, the body releases melatonin, a hormone that induces drowsiness. And when the sun rises in the morning, the body will release the hormone cortisol, which promotes energy and alertness. This influence that light has on the brain cannot be underestimated, especially blue light from devices. This is the reason why I always tell patients no screen time on devices right before bed. Blue light exposure just before you want to go to sleep is a surefire way to foul up your sleep cycle. I’ll get more into that in a later blog in this series.
The Sleep Cycle
As you sleep, your brain cycles through four stages of sleep. Stages 1 to 3 are considered non-rapid eye movement (NREM) sleep, also known as quiet sleep, while stage 4 is rapid eye movement (REM) sleep, also known as active sleep or paradoxical sleep. These stages occur multiple times throughout the night, with a full sleep cycle generally lasting about 90 to 110 minutes. The stages are repeated four to five times during a 7 to 9 hour sleep period, with each successive REM stage increasing in duration and depth of sleep.
Each stage has a unique function and role in maintaining your brain’s overall cognitive performance, while some stages are also associated with physical repairs that keep you healthy and get you ready for the next day. Fun fact: there used to be five stages of sleep, but this was changed by the American Academy of Sleep Medicine several years ago.
During the earliest phases of sleep, you’re still relatively awake and alert. During this time, the brain produces what are known as beta waves, which are small, fast brain waves that mean the brain is active and engaged. As the brain begins to relax and slow down, it lights up with alpha waves. During this transition, you may experience strange and vivid sensations, which are known as hypnagogic hallucinations. Common examples of hypnagogic hallucinations include the sensation of falling or of hearing someone call your name. There’s also the myoclonic jerk. No, I’m not referring to the person lying next to you… Ever gone to bed and felt like you’re just about to drift off and then BAM… you’re suddenly startled awake for seemingly no reason at all? That’s a myoclonic jerk.
NREM Stage 1
This first stage of the sleep cycle is a transition period between wakefulness and sleep that typically lasts for around 5 to 10 minutes. During this time, the brain is still fairly active and producing high amplitude theta waves, which are slow brain waves that mainly occur in the frontal lobe of the brain. During this stage, your brain slows down, while your heartbeat, eye movements, and breathing slow with it. During this stage, your body relaxes, but your muscles may twitch.
NREM Stage 2
According to the American Sleep Foundation, people spend approximately 50% of their total sleep time during this stage, which lasts for about 20 minutes per cycle. During this stage, your body prepares for deep sleep. You become less aware of your surroundings, your body temperature drops, eye movements stop, and your breathing and heart rate become more regular. The brain also begins to produce sleep spindles, which are bursts of rapid, rhythmic brain waves that are thought to be a feature of memory consolidation, when your brain gathers, processes, and filters the new memories you acquired the previous day.
NREM Stage 3
This stage is when the brain and body repairs, restores, and resets for the coming day, so getting enough NREM stage 3 sleep is essential to feel refreshed the next day. During this stage, which lasts between 20 to 40 minutes, deep, slow brain waves known as delta waves begin to emerge, so this is sometimes called the delta sleep stage. This is a period of deep sleep where any noises or activity in the environment often fail to wake the sleeping person. During this stage, your muscles are completely relaxed, your blood pressure drops and breathing slows, and you progress into your deepest sleep. It’s during this deep sleep stage that your body starts its physical repairs: cells repair and rebuild, hormones are secreted to promote bone and muscle growth, and your body produces elements to strengthen your immunity to fight off illness and infection. During this stage, your brain is still busy too- it’s consolidating declarative memories, general knowledge, personal experiences, facts and statistics, and other things you have learned that day.
REM Sleep Stage 4
The fourth stage of REM sleep begins roughly 90 minutes after falling asleep. During this time, your brain lights up with activity, your body is relaxed and immobilized, your breathing is faster and irregular, your eyes move rapidly, and you dream. It’s during this stage that your brain’s activity most closely resembles its activity during waking hours, but your body is temporarily paralyzed. That’s a good thing, as it prevents you from acting out your dreams. Memory consolidation also happens during REM sleep, but it’s more about emotions and emotional memories being processed and stored. Your brain also uses this time to permanently cement information into memory, making it an important stage for learning.
I should note that sleep doesn’t progress through the four stages in perfect sequence. When you have a full night of uninterrupted sleep, the stages usually progress as follows:
Sleep begins with NREM stage 1 sleep.
NREM stage 1 progresses into NREM stage 2, followed by NREM stage 3. NREM stage 2 is then repeated, and then finally REM sleep. Once REM sleep is over, the body usually returns to NREM stage 2 before beginning the cycle all over again. The amount of time spent in each stage changes throughout the night as the cycle repeats. A person’s “sleep architecture” is the term used to refer to the exact cycles and stages a person experiences in a night. If you see a sleep specialist for any issues, they often do a sleep study, and will then show you your sleep architecture on what’s known as a hypnogram, a graph produced by an EEG during a sleep study.
There are any number of issues that can interrupt your sleep cycles, causing stages to be cut short and cycles to repeat before finishing. Depending on the culprit, it can happen occasionally or on a chronic basis. Any time you have trouble falling asleep or staying asleep at night, your sleep cycle will be affected. Some factors that may affect your sleep stages and that are commonly associated with interrupted sleep include:
Age: As you age, sleep naturally becomes lighter and you are more easily awoken.
Nocturia: Frequently waking up with the need to urinate. This is big for older men due to prostate issues.
Sleep disorders, including obstructive sleep apnea, when breathing stops and starts during sleep, and restless leg syndrome, a strong sensation of needing to move the legs
Pain: Difficulty falling or staying asleep due to acute or chronic pain conditions, like fibromyalgia
Mood disorders such as depression and bipolar disorder
Other health conditions, including Alzheimer’s disease, Parkinson’s disease, obesity, heart disease, and asthma
Lifestyle habits: Getting little to no exercise, cigarette smoking, excessive caffeine intake, and excessive alcohol use all affect your ability to fall asleep and/ or stay asleep.
So how much sleep do you need? It varies a little from person to person, and it really depends on your age. The CDC suggests the following based on a 24 hour period:
From birth to 3 months: 14 to 17 hours, including naps
From 4 to 12 months: 12 to 16 hours, including naps
From 1 to 2 years: 11 to 14 hours, including naps
From 3 to 5 years: 10 to 13 hours, including naps
From 6 to 12 years: 9 to 12 hours
From 13 to 18 years: 8 to 10 hours
From 18 to 60 years: 7 or more hours
From 61 to 64 years: 7 to 9 hours
65 years and older: 7 to 8 hours
Most adults require between seven and nine hours of nightly sleep. Children and teenagers need substantially more sleep, particularly if they are younger than five years of age, as it is vital for their growth and development.
Work schedules, day-to-day stressors, a disruptive bedroom environment, and various medical conditions can all prevent us from receiving enough sleep. Over time, not getting enough sleep and not cycling through the four stages appropriately can cause any number of health issues, along with difficulty with learning and focusing, being creative, making rational decisions, problem solving, recalling memories or information, and controlling your emotions and behaviors. Keep in mind that it’s important not just to get seven to nine hours of sleep per night, but to ensure that it’s uninterrupted, quality sleep that allows your body to benefit from each of the four stages.
Without enough sleep, your body has a hard time functioning properly. Sleep deficiency is linked to chronic health problems affecting the heart, kidneys, blood, brain, and mental health. Lack of sleep is also associated with an increased risk of injury for both adults and children. In older adults, poor sleep is associated with an increased risk of falls and broken bones. Sleep deficit is even linked to an increased risk of early death. Driver drowsiness is a good example. Specific consequences of sleep deprivation can include mood changes, anxiety, depression, poor memory, poor focus and concentration, poor motor function, fatigue, weakened immune system, weight gain, high blood pressure, insulin resistance, and many chronic diseases, like diabetes and heart disease. The bottom line is that sleep keeps you healthy and functioning well. It lets your body and brain repair, restore, and re-energize.
If you experience any of the following issues, make an appointment to see your healthcare provider, as you may not be getting the sleep you need. They can help determine the underlying cause and improve the quality of your sleep.- If you are having trouble falling or staying asleep at least three nights per week- If you regularly wake up feeling unrested- If your daytime activities are affected by fatigue or issues with mental alertness- If you often need to take a nap to get through the day- If a sleep partner has told you that you snore or gasp when you are asleep- If lack of sleep is affecting your mental well-being
That’s a good place to stop, as next week, I’ll be talking about how sleep affects your mental well-being, and vice versa. I hope you enjoyed this blog and found it to be interesting and educational. Please feel free to share it with family and friends. Be sure to check out my YouTube channel with all of my videos, and I’d appreciate it if you would like, subscribe, leave comments, and share those vids! As always, my book Tales from the Couch has more educational topics and patient stories, and is available in office and on Amazon.
Thank you and be well people!
Why is Sleep Important? Part Deux
When we left part one, I had just explained how lack of sleep can make people fat, and was about to explain how it can also make people ugly. First, just a quick review of the cascade that makes you fat. When you don’t sleep, there is an increase in the hormone ghrelin, which causes hunger, and makes you eat everything in sight at 3am. At the same time, levels of leptin, the hormone that makes you feel full, go way down. So you feel like you’re starving, but you can’t feel full, so you eat and eat and eat. Then, the stress hormone cortisol enters the scene since you’re not sleeping. Cortisol is a bully that pushes insulin around, so insulin picks up his toys and goes home, and this means insulin isn’t around to process all the sugary food you just ate courtesy of ghrelin. With all those sugars floating around, they eventually find their way to fat. But that’s not the end. Cortisol is such a bully that when insulin leaves, it starts picking on growth hormone. Fed up, growth hormone is suppressed, and that’s a bummer, because growth hormone is what repairs, restores, and rejuvenates the body. It builds protein, heals bone, and heals cartilage and connective tissue, as well as parts of the body that are very important to the beauty industry. And at long last, here is where I tell you how lack of sleep can make you ugly.
They did a study centered on determining sleeplessness through imagery. It showed that it took people just four seconds max to look at images and determine which people had not slept. The bottom line is that not sleeping makes you look older. Your skin loses elasticity, making it more wrinkled. Why? Well, remember the 3am date with the Frigidaire? How the stress hormone cortisol crashed the party, bullying insulin and human growth hormone and causing their suppression? Well, without human growth hormone to repair and replenish the cartilage and connective tissue, the skin loses its elastic properties. Without elasticity, the skin wrinkles badly. Also, many restorative and metabolic pathways take place at night. Certain genes present on our chromosomes have specialized jobs. They are involved in creating proteins to restore the skin, connective tissues, cartilage, musculature, and basically to repair the body and fight the aging of the body. The genes that do these jobs turn on at night while sleeping. If you’re not sleeping, those genes can’t do their job normally. All in all, it makes you look old and ugly before your time: your eyes get puffy and bloodshot, your face gets droopy, you have decreased muscle tone and more pronounced wrinkling, and your posture changes, becoming more stooped over. When shown subjects with good sleep patterns, public perception studies show that those subjects are considered more likeable, sexier, more successful, more articulate, healthier, and happier. So now we know, if you don’t sleep, you get fat. If you don’t sleep, you look ugly. And that’s not so good.
Next, let’s talk toxins. In order to be awake with a functioning, metabolizing brain, our body produces waste products, basically like pollution in the brain. These byproducts of metabolism are inflammatory compounds called beta-amyloid and tau proteins, and these are deposited in the brain. These are no bueno; it’s very important that we get rid of these compounds. Why? Both of these proteins are causative factors in Alzheimer’s disease and dementia, and other types of dementia as well. The body has a system, the lymphatic system, and it’s like a garbage disposal system. It coats the entire brain in cerebrospinal fluid and it pushes all the toxins, inflammatory products, beta-amyloid proteins, and tau proteins out and away from the brain, and it takes them away where the liver and the kidney metabolize them and they are ultimately excreted in urine, feces, and sweat. That lymphatic system is critical, but like any system, it can be overloaded. If you don’t sleep, your risk of dementia goes way up, especially if you are chronically sleep deprived. A lot of other things go bad too, but this is a big bad one. You must sleep in order to clear the body of inflammatory products and toxins, and to keep the brain healthy. It is nothing short of critical.
I’ve given you a lot of reasons to give yourself seven to nine hours of sleep each night. During sleep, our bodies undergo transformative changes. Our blood pressure drops, our heart rate drops, our respirations drop. It sets up the conditions that allow us to clear our body of toxins, to heal, to restore, and to grow. But there are plenty more interesting studies related to sleep deprivation that will make you want to give yourself those seven to nine hours. During spring daylight savings time when we lose an hour of an hour of sleep, heart attacks increase by 24 percent. They infer that not sleeping increases the risk of heart attack and stroke, because of hardening of the arteries. If you don’t sleep, arterial repairs aren’t getting done, so there is an increase in blood pressure and heart rate. Couple that with increased levels of uncleared inflammatory products and toxins oozing around the brain and body, and it creates all sorts of problems if it is chronic.
There are also psychiatric reasons that we need to sleep. Essentially, every psychiatric illness either causes sleep disruption or is exacerbated by sleep disruption. Most schizophrenics have an abnormal circadian rhythm that causes them to sleep during the day rather than the night. Sleep deprivation also causes some issues with psychiatric components. If you don’t get enough sleep, you have less empathy, you cannot recognize the pain and suffering of others. You can also lose the ability to understand facial expressions of pain, suffering, happiness, sadness. You can’t effectively ‘read’ someone’s expression or demeanor. Also, impulsivity increases when you do not sleep, and you’re prone to dangerous behaviors. There is no question that depression, anxiety, psychosis, panic disorder, and a host of other psychiatric problems are dramatically increased when people’s sleep wake cycle is impaired. You also can’t effectively concentrate if you do not sleep. Remember our student from part one, Randy Gardner. He deprived himself of sleep and was nearly a basket case by the third day. Speaking of school, I think that kids should not be starting as early as they do. I have seen that they do not regularly get the proper amount of sleep. They should start school at 9am, not before. As it is now, we make these kids get up so early, they are basically in a state where they cannot concentrate because they are sleep deprived, and that’s a huge problem, because this mimics attention deficit disorder. It’s very likely that many kidsdiagnosed with attention deficit disorder and even medicated for it really were just sleep deprived. Also, many studies on learning and sleep have been done. One was set up to study how well students learned a second language. They taught the same cirriculum to all of them, and the results showed that students with adequate sleep had a higher retention rate than sleep deprived students. From that, and many other studies, researchers have confirmed that memory is impaired by not sleeping. They did a similar study focusing on creativity and showed a three-fold decrease in creativity when sleep deprived. We know that the prefrontal cortex of the brain, which does all the decision making, is impaired by sleep deprivation. Scientists believe that the Challenger explosion and the Chernobyl disaster are both a direct consequence of a lack of sleep. There was a pilot program in some county in Minnesota that started school 90 minutes later in the morning, and the number of car crashes in the driving children under age 20 went down, as did the suicide rate.
There is some interesting stuff about the immune system as well. They found that natural killer cells go down in people that don’t sleep. What does all that mean? We all have these primordial cancer cells floating around in us, which are basically little tiny cellular precursors to cancer. But we also have specific immune cells called natural killer cells, and they circulate around and their job is to kill those primordial cancer cells. So, this study showed that if we don’t sleep, the number of those natural killer cells goes down, leaving more primordial cancer cells. This supports all of the studies that have shown that chronically sleep deprived people absolutely do have higher instances of breast, prostate, and colon cancer. Recently, the World Health Organization even went so far as to recognize chronic sleep deprivation as a carcinogen. That’s saying a lot, people. Other immune studies centering on immunizations, flu shots, were completed tolook at antibody response. One group of people were sleep deprived, and the other group was well slept. All were given the same flu shot at the same time. The results showed that the people who were sleep deprived had just half the antibody response of those who were well slept. That’s a dramatic finding. So when you’re chronically sleep deprived, cancer incidence goes up and the ability to mount an immune response goes down. That’s like the perfect storm. This is important, because it has a huge impact on your life, especially now with the coronavirus. If you get fewer than five or six hours a night, your immune system is approximately 40 percent less competent than the immune system of someone who is well swept. Also dramatic, people.
Just a quick review… unless you are among the five percent with a genetic mutation that allows your brain and body to work properly on little sleep, you need to sleep seven to nine hours each night to have optimal health. If you chronically and consistently do not get enough sleep, we have learned that you will overeat and be overweight, you will not be able to learn as well, your concentration and memory will nose dive, you will be less intelligent, and cosmetically, you won’t be very appealing. Basically, fat, dumb, and ugly. That doesn’t sound so great. So you really need to sleep.
Now that you know why you need adequate sleep, here are some tips on how to get it.
– Get into a routine. Go to bed at the same time every day, and try and get up at the same time every day.
– Create the proper environment. Sleep in a quiet place to avoid interference. Also sleep in a dark room, as any light throws off your natural melatonin that tells the body it is time to sleep. A cold room is best for sleep, cool enough to require a comforter. It’s very name tells you why: the weight of a comforter is…well, comforting. You can also buy a weighted blanket; these are great for kids too.
– Situate yourself. Sleep position is important. Many publications say that the best sleep position is on your back with your legs elevated to maintain appropriate spinal cord posture. If you’re unable to sleep that way, then whatever position feels best to you and doesn’t cause pain in the morning is the correct one.
– Blue light is bad. Blue light is emitted from screens on iPads, computers, kindles, etc. You must not have blue light exposure for a minimum of one hour before sleep, so shut it all down at least an hour before you go to bed. This is really important, as the bluelight is very disruptive to the melatonin cycle; it actually tells your body to get up. Speaking of light, there’s nothing as disruptive as bright light in the middle of the night. So if you must get up to use the bathroom in the night, don’t turn on a bright light. Get a dimmer switch and leave it set very very low and only use that.
– Wind down. Consider incorporating a period of time to wind down into your pre-sleep routine. Reading from a book by low light is good, but it must be the old school kind written on paper, not on Kindle or in an e-book. Taking a hot bath is good too. It causes the small capillaries at the skin’s surface to open up, getting blood to the skin surface to radiate heat and cool the body.
– Don’t drink a lot of fluids before sleep, because as your body goes into sleep, if it senses it has to go the bathroom, it wakes the brain, and then you wake up. Your body does have a mechanism for this; the posterior pituitary releases an anti-diuretic hormone to prevent the creation of urine during sleep, but you can override that by drinking too much fluid before sleep. So avoid that.
– Don’t eat big meals before sleep. This also disrupts sleep. A little snack is okay, because you don’t want to go to bed hungry, as that is disruptive as well. Ideally, you really need to have your dinner four to five hours before sleep. Also, along those same lines, don’t have any sugar before bedtime. Sugar tends to inundate the system and then wake you as it’s metabolized, so no sugar before bedtime.
– Alcohol, caffeine, and nicotine. No, no, and no. All are disruptive to sleep architecture. Alcohol: for every drink, you need four hours before going to sleep to not affect sleep. Caffeine: this has a long half life, so you need at least six hours per caffeinated beverage before going to sleep. Nicotine: ideally, you should have four hours before sleeping. This is a tough one, because people who smoke are commonly awakened by withdrawal from nicotine. So if you’re a smoker and you have trouble sleeping, try to quit smoking. I guarantee you’ll sleep and feel better in a short period of time.
– Vitamins and supplements. Magnesium is a calming hormone, so it helps you sleep. Calcium is used to manufacture tryptophan, an amino acid which causes drowsiness, so that helps promote sleep. Vitamin D3 and B vitamins help metabolize calcium, so those are good. You need iron, vitamin E, and melatonin. Also, valerian root is helpful. L-theanine is good, it is another amino acid that has a calming effect.
So now we’ve discussed the risks and repercussions of not sleeping and some tips tohelp you sleep better. If you find you still can’t sleep, consider seeing a physician, especially if you can see that it is impacting your life in a negative fashion.
I’d really appreciate people going to my website, dragresti.com and checking out all of my blogs and sharing them. You can also see all of my videos on tons of different topics on my YouTube channel. Please give me some likes and comments- I love reading comments- and most of all, hit that subscribe button, people! As always, if you want funny, informational, and helpful patient stories, you can find my book, Tales from the Couch available on Amazon.com.Learn More
One of the most important things I deal with in my practice is sleep. Sleep is defined as “a naturally recurring state of mind and body characterized by altered consciousness, relatively inhibited sensory activity, reduced muscle activity, inhibition of nearly all voluntary muscles, and lacking interactions with surroundings.” All animals need to sleep. Evolutionarily, in order to survive and successfully pass on genetics to another generation, sleep is a necessity. Humans are animals in this regard; we’re no different, as we require sleep to live too. And while it is a naturally occuring state, for some people, getting sleep is an absolute battle, fought tooth and nail every night.
Just some fun facts about how a few animals sleep… Can you imagine sleeping for as little as 30 minutes a day? How about for only five minutes at a time? Our giraffe friends can, because that’s exactly what they do. For a large animal in the middle of the open savanna, it’s risky to sleep because of predators. They must remain vigilant, so they nap in short intervals, usually standing up so that they are always ready to run. Dolphins and some of their marine mammal cousins are also unusual in that, unlike us, they must consciously think to breathe, even when they’re sleeping. They also have to be on guard 24/7 for predators or other potential dangers. So how do they do this? Well, they shut down only half of their brain at a time while sleeping. This is called unihemispheric sleep. This prevents them from drowning, while at the same time, allowing them to literally sleep with one eye open and remain on the lookout for potential danger or predators. Great Frigatebirds can stay in flight for months at a time, with their feet never touching ground. This is an impressive feat, but even more so when you think about how they sleep: in 7–12 second bursts. They spend approximately a total of 40 minutes sleeping like this per day while also flying. But when they are on land, they do sleep considerably more.
We humans can’t shut down half of our brains and we can’t fly or sleep underwater, which is a bummer. But really, how important is sleep for humans? Very! Rats are used in research because they accurately portray human systems, and there have been many sleep studies with them. One study showed that rats deprived of sleep for two weeks die. There is even an illness in humans called fatal familial insomnia, where if the people that have it do not sleep, they will eventually die from the cumulative lack of sleep. So let’s talk sleep. Sleep is basically the price we pay for the privilege of being awake, and there’s no way around it. So we have to pay the piper, but what’s the price? How much sleep do we need? The answer is that the vast majority of people need 7 to 9 hours of sleep per night. But, there is an exception. Five percent of the population has a genetic mutation where they only need five hours of sleep per night. Lucky ducks! Fun fact: in the past 50 years, the amount of sleep the average American gets has dropped by about an hour and 15 minutes to an hour and a half each night. That’s actually a lot, and there are consequences in our modern lifestyle. Also, you can’t bank sleep. You can’t say, ‘I slept an extra four hours over the weekend, so I can lose at least four hours of sleep tonight in order to get my big project done at work.” or “I won’t sleep much this week so I can study for a test, but I’ll make up the sleep this weekend.” Nope. It doesn’t work like that. More often than not, you really need to be on a regular sleep schedule, getting about the same number of hours each night. I treat sleep issues more than anything else in my practice. Hands down, every patient who comes in has a problem with sleep. With some people, I can do behavioral management; with others, I use meds or natural supplements. I’ll get to that later. When I’m lecturing, I always get questions about how one spouse gets up early and the other late and is that normal, etc. Yes, that is totally normal. There are certain genetic types, called chronotypes. There are larks, people who get up early, but then go to bed early. And there are night owls, who go to bed very late, and then wake up very late. Your genetic makeup determines what your chronotype is, whether you are a lark or a night owl, it’s perfectly healthy to be either. It doesn’t matter when you sleep, what matters is that you sleep. Ideally seven to nine hours a night. Adolescents sleep more, up to 12 or 14 hours per night, and newborns sleep for 16 or 17 hours each day, mainly because these are growth stages, and that tires the body. But by the time you reach adulthood, age 20 or so, you need that seven to nine hours. It is a myth that older people need less sleep. In reality, they need just as much sleep. The reasons they don’t sleep well can be because they are in pain, have bladder problems and need to use the bathroom, or all the medicines they are on disrupt the sleep architecture. A lot of neurostimulants, diuretics, and other drugs that make them drowsy during the day make it so they do not sleep well at night. It can be a really frustrating mess that’s difficult to untangle.
I want to talk about the reasons why we need sleep. Like many things in life, the reasons why are essentially based on the consequences of not getting it.
The brain makes up just two to three percent of our body mass, but it consumes 25% of the body’s energy. It’s like a car that’s running really fast; as the car burns gas, it makes fumes. Similarly, when the brain is burning calories, it creates waste. That waste is cleaned out when we sleep, and is why most people need 7 to 9 hours per night. Now, some people think they can avoid sleep and just drink coffee or energy drinks, but that’s wrong. One of the byproducts of our brain using all the energy it does is the production of a waste product called adenosine; and it takes sleep to get rid of it. Caffeine blocks the body’s sensors that this toxin is building up, not unlike having a car running in your house. If you ran your car in your garage or house, carbon monoxide would build up and eventually you would die of carbon monoxide poisoning. Caffeine blocks the body’s ability to determine how much adenosine is in it, so the body is tricked into thinking all is well, no need to rest. If it goes on too long, there are consequences to pay, and you eventually collapse.
A story on this topic that I find interesting is one about Randy Gardner, who holds the world record for sleep deprivation. There is some dispute about that, another dude named Tony Wright claims the record is his, but whatever. Anyway, Randy was a high school student in the 50’s and he had a science fair project to do. After much thought, he decided to study sleep deprivation. Randy decides he wants to prove all of his teachers wrong by showing them that people don’t really need sleep. He was normally a pretty affable guy, but right about day two, he started getting moody. Then he started having major problems concentrating at about third or fourth day. On day five, they tell him to start at 100 and to keep subtracting seven. He said “okay, 100 minus 7 is 93, minus 7 is 86, minus 7 is 79, minus 7 is…is…72, minus 7…no, minus 9 is 79, minus 7…wait…what am I adding? I mean…subtracting?” He was totally lost after just three subtractions. When they asked why he stopped, he couldn’t even tell them what he had been doing. And he was not a dumb kid, he was actually a straight A student. It was clear that missing four nights of sleep was clouding his mind to the point that he couldn’t remember simple directions. His inability to concentrate and his short-term memory loss was due to the fact that his brain and body were severely sleep deprived. But he still carried on with the experiment. Then something bizarre started happening around day six and seven. He started checking the windows in his house, making sure they were locked. Then he started looking for people watching him. He was sure that his friends were conspiring against him, and was constantly checking around corners, pulling down shades, and drawing the curtains on the windows in his house. If his mom opened them, he would freak out and hide in his room. Then he started saying that not only were they watching him, they were plotting against him. These people he was referring to were his best friends, but he was sure they had an evil agenda to get him. He still refused to stop his experiment, but his mother convinced him to see his doctor. It backfired: the doctor wanted to give him a B-12 injection, but when the syringe came out, Randy ran out of the room, convinced that the doctor was trying to poison him. He was going downhill very fast. On the eighth day, he started hallucinating, seeing and hearing things that weren’t there. Then he started having problems with pronunciation of simple words; a straight A student couldn’t pronounce everyday words. All because he had not slept, he had not allowed the brain and body to rest, to rid themselves of toxins. Then he stopped recognizing everyday objects. They would put a fork in his hand, and he couldn’t say what it was or what it was used for. By this time, he was like a zombie, walking dead. By the ninth and tenth day, he lost his sense of smell, and then his vision became progressively more blurry. By the eleventh day, he collapsed. He was emotionally, mentally, and physically done. His brain had given out first, then he started to lose normal bodily function, until his body finally gave up. He went 11 days without sleep. That’s 264 hours. 15,840 minutes. They didn’t say how long he finally slept. I suspect he was actually just unconscious at first. And they didn’t say what he got for a grade on his science fair project. I’d like to think it was an A, since the kid basically risked his life for the stupid thing. He went from a smart, gregarious kid to a babbling idiot in eleven days flat.
Lots of bad things happen when people don’t get enough sleep. In sleep deprived adolescents, the suicide rate goes up dramatically. In all ages, but more so in adolescents, the risk of car accidents also goes up considerably. There is also an increased tendency for moral lapses in people who do not get enough sleep; they do things that are typically out of character for them, like rob people or cheat on their spouses. Sleep deprivation also leads to learning problems, regardless of age; studies have shown that the capacity to learn is reduced by 40% when people are sleep deprived. That’s huge! It also causes an inability to recognize facial expressions. You may ask why that’s a big deal. Well, if you can’t tell that you’ve pissed off the big thug on the subway, you might continue to unwittingly irritate him and get yourself beat up… or worse. Reaction times are greatly affected by sleep deprivation; they’re slowed severely. That’s why car accidents increase. But researchers have thoroughly studied sleep and reaction times in sports. Many studies on sleep deprivation come from basketball players. Their accuracy and their performance metrics all go down relative to the hours of sleep missed. Hockey players’ reaction times, after just one night of missed sleep, were off by 30%. A goalie’s reaction time down by 30% is dramatic when it translates to the other team scoring on him 30% more often.
It’s all about getting that seven to nine hours. There are lots of physiological consequences of sleep deprivation. Blood pressure goes up, the risk of heart attack goes up, the risk of stroke goes up, you become obese, and often diabetic as a result. There’s actually a mechanism for it that I’ll explain in a moment. A host of psychiatric and mental illnesses can result from lack of sleep, and studies have shown that people who are chronically sleep deprived die much younger.
Now, let’s talk about your endocrine system. The endocrine system is the collection of glands that produce hormones that regulate metabolism, growth and development, tissue function, sexual function, reproduction, sleep, and mood, among other things. So, it pretty much controls like… everything. In young males, sleep deprivation makes the testosterone levels drop. The ability to produce testosterone is decreased in men who sleep less than six hours a night. What does that mean? Only that their testicles get smaller, they can have erectile dysfunction, and reduced sex drive. In adolescents, it can hamper the development of the bones and muscles, the deepening of the voice, and hair growth; all the stuff that helps boys start to look, sound, and act like men. It has an analagous affect on women, in that fertility goes down and estrogen levels decrease with chronic sleep deprivation. But in a cruel and ironic twist, a decrease in estrogen has been shown to cause insomnia and less productive sleep, or just very poor sleep. So for women, it’s often a vicious cycle.
What else happens to your hormonal system when you do not sleep? I’m sure you can correlate a lot of this stuff with your real life experiences. When you can’t or don’t sleep, do you notice you crave junk food? It’s 3am and you’re standing in the kitchen, scarfing down cold pizza? Or some other high fat or high sugar thing…a big bowl of cereal or ice cream or a doughnut, or three? Or a cinnabun? I love those and I must have one every time I’m at the airport, those are good. Anyway, that’s a distraction- I didn’t mean to bring that up. Remember earlier when I said that I’d explain why obesity is so much more common in people who are sleep deprived? Here we are. So what happens to you’re endocrine system when you don’t sleep? For one thing, you secrete a hormone called ghrelin. Ghrelin is a gnarly beast of a hormone, high on the list of the most hated hormones ever in the history of hormones. It even sounds like the name of a goblin, right? And not a nice goblin. A bad, mean, evil goblin. Ghrelin the gnarly goblin. Why the shade? Ghrelin is the hormone that makes you hungry…and hangry. So here you are, middle of the night, can’t sleep. And all of a sudden you’re starving! Why? Because not sleeping has triggered the release of a crap load of ghrelin, and it’s coursing through your body, making you crave sugary, fatty foods… whatever doesn’t run away when you reach for it is fair game. Ain’t that a bi-otch? But that’s not the worst of it. Ghrelin the goblin has a goody goody cousin named leptin. Leptin is the hormone that makes you feel full. He’s nowhere to be found when the gnarly goblin ghrelin is out on the prowl. So not only are you starving courtesy of ghrelin, but goody goody leptin is home studying, so you won’t be seeing him or feeling full anytime soon. So before you know it, you’ve eaten all the leftover pizza, a bowl of cereal, and a giant bowl of cookies & cream topped with more cookies and whipped cream! And you’re still eyeing the rest of that baked chicken in the fridge. But wait! The hormonal chemical conspiracy isn’t over friends. Without leptin to make you feel full, ghrelin the goblin has made you eat everything that’s not nailed down, but somebody else is coming to join the party…cortisol. Dahn dun duuuuuhhhnnn! Cortisol is the stress hormone, and he gets produced at higher levels when you don’t sleep. When he gets to the party, he pushes insulin around (they have a terrible history; don’t even ask) so insulin feels emasculated, so his levels go down. Why should you care about insulin levels? Well, remember all the carbs and sugar that ghrelin made you gorge on? Insulin is what helps your body break all that down. But since cortisol came to the party, pushing insulin around, all those sugars have nothing to do. What does that sound like? Begins with a “d”? Diabetes! Obvi you don’t become diabetic from one 3am rendezvous with the Frigidaire, but it sets up a diabetes-like condition that leaves those sugars all dressed up with nowhere to go. If that happens chronically, you can end up with diabetes. So what happens to these loose sugars at 3am? They go to fat. It’s squishy and warm there, a great place to land. It’s a whole cascade, a hormonal conspiracy to make you fat and…and…ugly! For real?! How does that happen? The cascade continues! Growth hormone doesn’t get along with cortisol either, so when cortisol shows up, growth hormone is outta there. When growth hormone leaves the party, that’s really a bummer, because he’s what basically restores the body, especially parts of it that are very important to a certain industry…the beauty industry. You now know that not sleeping can make you fat, but how can it make you ugly? Well, check back next week and I’ll tell you!
In the meantime, hop on my website dragresti.com and read some other blogs and like and comment on them, and check out my videos and subscribe to my YouTube channel. If you want more great stories that’ll make you sound really smart at your next cocktail party, check out my book, Tales from the Couch available on Amazon.com.
And people, for better or worse, it seems like the world is re-opening once again, so just please make wise choices. Maintain a little distance, don’t rush out to bars and dance floors to make up for lost time, and if you’re sick, stay home for God’s sake! And bosses, remember the lessons that corona taught us: let your people stay home if they’re sick; don’t make them choose between their health and their livelihood. I’ll now step down off my soapbox. Have a great week!Learn More
10 Secrets to sleeping Better
1.) Get on a schedule and go to bed at the same time every night. Do the same thing before bed every night.
2.) Sleep in a dark, quiet and cool room.
3.) Sleep on your back with a pillow under your feet.
4.) No eating or drinking 2 hours before bedtime.
5.) No caffeine 14 hours before bedtime. No alcohol or nicotine 4 hours before bedtime.
6.) No sugar 2 hours before bedtime.
7.) No blue light from computer, I pad screens 1 hour before bedtime, no bright light of any kind 1hour before bedtime.
8.) Calm your mind before sleep.
9.) Get enough Vitamin D3, Vitamin E, Magnesium, Iron, B complex vitamins and calcium.
10.) Valerian root, Chamomile, L-Theanine and Lavender help you sleep.Learn More