Sleep it off

Sleep is more important for our health and performance than most people realize. We should try to understand it.

Sleep is important. If we sleep well, we feel good. If we don't, we're weak and grumpy all day. Chronic deprivation causes a lot of physical and mental problems, and contributes to many chronic illnesses. It causes a lot of highway carnage and other accidents. It is used as torture, to make people disclose secrets. Extreme sleep deprivation can be fatal.

Routinely sleeping less than six or seven hours degrades the immune system, especially significant during a pandemic. It doubles our risk of cancer. It accelerates Alzheimer's. It disrupts blood sugar metabolism, exacerbating diabetes. It increases coronary artery blockages. It contributes to all major psychiatric conditions, including depression, anxiety, and suicide. It increases appetite while decreasing energy, leading to obesity. If you try to diet while getting insufficient sleep you'll lose muscle, not fat. It shortens your lifespan. It causes decreases in testosterone, and shrinks testicles!

I used to avoid sleep. I resented sleep. It kept me from doing all the things I enjoyed. Sleep is for the weak, I told myself and others, proud of my strength, and showing my extra large coffee mug as a badge of virility and productivity. I didn’t realize it was slow motion suicide.

What is sleep? Through most of human history we assumed it was for rest. It appears to be a whole body shutdown, but it’s not, really. It is much more than unconsciousness. Scientists discovered occasional "rapid eye movements" in sleeping babies in 1952. That led to deeper understanding of phases of sleep we all go through every night, and eventually the dynamics underlying the apparent comatose state where we spend a third of our life.

A useful overview of sleep biology can be found at NIH in "Brain Basics: Understanding Sleep." An amazingly orchestrated train of electrical and chemical processes controls our sleep. Researchers and clinics can read our sleep activities with electrodes on our scalp and muscles, blood pressure, temperature, blood analysis, and even X-rays. Sleep is characterized by chemicals such as melatonin and adenosine, and by electrical signaling identified coarsely as brain waves.

The brain operates by chemical actions which generate electrical signals. These signals can be read with electrodes attached to our head. The signals rise and fall along with the individual chemical reactions as each cell is activated. It’s like a computer, with a CPU performing calculations as directed by its programs, drawing inputs from keyboards and cameras, and using memory to store and retrieve information. We can’t read the exact calculations directly, but can see the results on the monitor, and see clues with measurements.

Brain wave analysis shows characteristic patterns when awake that are high frequency and disorganized, called beta waves. As we fall into sleep, we produce slower waves that are much more organized, or coherent. These cycle into calmer, slower alpha waves as we relax and slip into sleep, and become even slower theta waves in light sleep, and very slow delta waves in our deep sleep phases. The high frequency beta wave "buzz" when awake reappears during sleep when those rapid eye movements begin, indicating the dream state. The incoherence is attributed to multiple parts of the brain operating independently, like a like a microphone in a crowd at a ball game. We're processing many visual and audible inputs, calculating decisions, operating the body, and creatively planning that big project and what's for lunch. It’s a cacophony of activity. The coherence in sleep periods indicates a miraculous cooperation of all those brain areas working in concert like a choir.

One very interesting aspect of this is the same patterns appear in meditation. I adapt meditation to overcome occasional insomnia, which I discuss below. Others have asked if meditation can actually replace sleep. Apparently not, but it can be an effective partner to sleep, as described in a paper by canyouzen.com, “Can Meditation Replace Sleep?” Sleep is essential, but we can exercise some control.

Science and medicine mostly ignored sleep as a therapeutic activity until fairly recently. Sleep disorders are treated with medications, or psychiatrists asking about our relationships with our parents. Mathew Walker is one of the most prolific sleep scientists today. He started medical school but turned to psychiatry research because he was more interested in pursuing unanswered questions than in doling out answers that are the business model of medical doctors. He had performed over two decades of research at Harvard and Berkeley when he published his book "Why We Sleep" in 2017. That book explains the details of sleep and the state of current research to improve our understanding. It’s available wherever you get your books.

I first discovered the importance of good sleep from my studies of dementia, after my father died from Alzheimer's and I learned I inherited his gene that increases my risk for that unhappy ending. Many doctors recommend "more" sleep or "better" sleep, but they never say how much more, or how much better, or why it matters. I found those convincing details in "Why We Sleep."

The short version of this story is we should sleep 7 to 9 hours every night (young people need a little more), and make our sleeping area dark and quiet. A longer version for non academics who want to maximize their health is in Walker's book and in an extensive number of papers, articles and video interviews. They're well worth exploring. I'll try to explain the minimum information here but won't try to reproduce the book. I do hope you'll be motivated to learn more. I recommend three things:

• Read Walker's book

• Get a sleep tracker, and analyze what you're doing after lights out

• Learn to meditate, especially if you have occasional insomnia.

A common misperception is that sleep is for rest. That isn't its purpose. We can rest while watching TV or drinking in a bar. That’s not what we need. And it's not to rest the brain, either. The brain is actually very busy when we sleep, especially during recurring periods called REM, or rapid eye movement sleep. This is when we dream. Sleep seems to be primarily a maintenance cycle, consolidating memories, clearing toxins, and helping us gain understanding of our environment.

We are driven to sleep on fairly regular schedules regulated by internal clocks. It's called circadian rhythm and is a little longer than 24 hours. That schedule actually gets shorter as we age but is longer than 24 hours even in older people. The sun and regular social activities cue the brain to adjust that clock to a schedule that fits our environment. A big adjustment is produced by the rising and setting of the sun. Our circadian rhythm is synced pretty close to the 24 hour schedule of Earth's rotation.

Within that cycle are other cycles that affect out alertness and productivity. Some people tend to rise earlier -- morning people -- and some night owls tend to rise later. That's not really a choice, it's genetic. So when night owls are forced to follow "standard" schedules by job or school, they're at a chronic disadvantage. They should seek circumstances more in tune with their internal clock. Shift workers and jet travelers have a particularly difficult time getting quality sleep.

The Tactics of Sleep

My studies went through "The Alzheimer's Solution" by Sherzai which includes a program called NEURO, a five point plan to avoid Alzheimer's.  The R is for Restore, simply recommending 6 to 9 hours of sleep to produce the brain derived neurotrophic factor hormone which manages brain repairs and clears toxins and the amyloid plaques associated with Alzheimer's. He refers to research, but doesn't get very specific, and refers to a lot of anecdotes from his own practice. Cutting sleep short is damaging, and, no, you can't make it up on weekends. And if you snore, get it treated. It's a good introduction to Alzheimer's risks with a chapter on sleep included for free. He includes a good section on practical recommendations.
- normalize your schedule
- avoid eating late at night
- no caffeine after 2 pm
- avoid exercise 3 hours before bed time
- low light at night, natural light during the day
- don't bring computers or TV to bed
- avoid napping
- meditate at bed time
- sound- and light-proof your bedroom
- get comfortable, reduce meds, get therapy, and treat sleep apnea

Dale Bredesen in "The End of Alzheimer's" also has a section on sleep. He points out why doctors downplay it. During their 5 year residency they exist in sleep deprivation. He knew his reactions were slow, his judgment impaired, learning and memory suffered, adrenaline increased, stress levels never abated, and he would fall asleep talking to patients. But it was required by his employer. It's a very destructive way to train the people we expect to heal us. Unlike Sherzai, he encourages meds -- melatonin, tryptophan, 5-HTP, Prozac, and recommends testing for progesterone and testosterone. Like Sherzai, he does recommend meditation. He recommends many of the same practical tips as Sherzai, but adds avoiding blue light at bed time, which Sherzai also avoids with his advice to not use TV or computers in bed, both blue light emitters, along with LED and fluorescent lighting. (Those who wear glasses can reduce blue light with special blue blocking coatings.)

My heart disease books mention sleep only briefly, if at all. Michael Greger in "How Not To Die" cites a Japanese study that showed those with less than 4 hours of sleep or more than 10 hours for extended periods had 50% higher stroke risk.

Walker gives a much more detailed and comprehensive treatment of the science, and knits it well with brain, heart and mental diseases.

Insomnia

I spent a lot of years as an insomniac -- on purpose. I had so much to do, so little time. I was in a hurry, and the experience was exhilarating. No time to sleep. I resented the little sleep my body demanded. I did find time for bars, and all night pinochle, but little for sleep. And I was successful. School, professional projects, relationships, all went well. But in retrospect, I was mistaking enthusiasm for progress. I now recognize the inefficiencies I ignored at the time. A heart attack can produce an epiphany, and mine did.

I still suffer occasional insomnia from my enthusiasm. It’s hard to tell a busy mind to relax. But I overcame a lifetime of bad habits by improved discipline. I've learned to resist meds to mask my mistakes, but I did try melatonin a few times after news that it might assist covid resistance. I don't think it helped my sleep much, and I did get covid anyway while taking it regularly on a cross country trip to help with jet lag. It was a very mild case, so maybe it helped. But I have learned to treat my insomnia with meditation techniques.

There doesn't seem to be much difference in mental states during sleep and meditation. I plan to write more about meditation, which I have been exploring for several years. But to simplify, meditation instructions say to remain upright or you'll fall asleep. So I thought I could apply meditation techniques in bed to put myself to sleep. It seems to work, though with some odd observations.

Briefly, many cultures have used meditation through their history, often associated with religious practices. Though it does induce ethereal experiences, it seems to be fully explained biologically. The brain is a powerful organ, and we don't seem to use very much of its power. Disciplined meditation exposes some of that power. Insomnia is a case where the undisciplined mind operates the brain on its own, unconcerned by our conscious mind's preference to do other things, like sleep. Meditation teaches the mind to obey by focusing attention on something simpler than our routine activities.

My observations are difficult because memories of what transpires during our sleep are unreliable. I’m never sure if my memories of what happened at night are real or dreams. I occasionally wake in the middle of the night, my mind becomes active, and I apply concentration meditation techniques, usually a combination of relaxing muscles and concentration on my breathing, and still think I was awake for hours. Upon awakening, I check my watch and find I was actually in cycling between light and REM sleep. Was I asleep, as my watch thinks, or in deep meditation that the watch misinterpreted? I’m still working on resolving that. The results seem to show I’m doing alright whether part of my sleep is actually meditation, as I’m seldom tired during the day. I’ll let you know if I’m doing it right in 30 or 40 years.

Health Goals

Walker has some ambitious ideas for technological solutions to the nearly ubiquitous sleep deprivation found in all societies. Wearable sleep trackers that can talk to light and heat controls can make sure our environment is tailored to our circadian rhythms, giving us passive controls of our sleep quality. He doesn’t discuss that that emerging technology might still leave us with undisciplined minds that will continue to resist unconsciousness for one third of our lives. He also suggests that active intervention is as unlikely to work for sleep improvement as it is for weight control or exercise. Cookies are more powerful incentives than broccoli.

He observes that knowledge is not enough. So maybe we have wasted our time by reading this far.

He has observed a powerful incentive to convert healthy new habits to a permanent way of life by exposure to our own data. Seeing the numbers reflecting our biological indicators and observing our health allows us to recognize when our habits become detrimental to our real objectives.

Most of us have a scale. Some track their blood pressure, blood glucose, ketosis, even heart rhythms at home. They may not be quite as accurate as clinical measurements, but they can give clear indications of what is working, and what needs improvement. The exact numbers aren’t as important as the trends. If we listen to the measurements, it’s forms a positive feedback loop.

A very useful device to track our sleep can be found for fairly low cost, and requires very little personal effort to read and use the data. I use a Fitbit Versa watch (about $200 on sale at Costco), which I got initially following instructions of my cardiologist’s physical therapist. He is a former Green Beret, so I might have been more attentive to his orders than I had been for the youngsters who had counselled me through recoveries of joint surgeries. His objective was tracking my activities to make sure I wasn’t slacking off from his exercise orders. But the sleep tracker function came with it and It has become very useful for me to understand the effects of my sleep, and to implement adjustments to improve it. I don’t know exactly how Fitbit determines my sleep stages, but it recognizes the time I hit the bed until I get up pretty accurately, and calculates nighttime periods when I’m awake, including the momentary arousals indicative of sleep apnea, and the periods when I’m in light and deep non-REM sleep, and the periods when in REM. The watch talks to my phone, with an app that gives a clear display of data with diagrams that makes it easy to read and understand. I also pay Fitbit another $10 per month to give me some additional data, including blood oxygen level which I became interested in when it was shown to be an early indicator of covid infection.

There are many devices available that provide sleep measurements, including dedicated bracelets, and rings. I’m sure the technology will continue to improve.

Conclusion

The amount and quality of our sleep is vital to our health. It’s a direct predictor of our physical and mental health. But there are many forces at play that reduce our ability to get enough. Learning how to improve our sleep, and learning to recognize when we need to improve, have a big effect on our health, productivity and longevity. As Spock might have said, Sleep well and live long and prosper.