Sleep like a baby, run like an animal

As a sign of good faith, here are my sleep recommendations:

  1. Be consistent
  2. No naps
  3. No screens before bed

But why those three?

When I was in my teens, I had a romanticized image of sleeplessness. Struggling with frequent bouts of insomnia, I saw myself as a brooding, tortured person staring at the flickering screen of a television while the world slept. As the sun rose, I would slowly get out of bed with the masochistic satisfaction that I had been deprived a basic, animal need and survived. In hindsight, the sleeplessness made me less of a compelling character and more of an asshole.

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Kids today don’t understand scrambled TV

In my 20’s, my insomnia became more just a byproduct of horrible choices. Throughout my college years, and well into my early “professional” life, my sleep mirrored the general state of my life – a chaotic, unpredictable ordeal. I would go nights without sleeping and take power naps in dark supply closets at work or for brief moments in my car. I would spend entire weekends sleeping – waking just long enough to note the shift in the shadows of my bedroom before falling back asleep. There were nights where I would leave the house for a run at midnight – cruising through the desolate streets of Rochester, or Blacksburg, or Baltimore. These were followed by long stretches of time where I couldn’t seem to recover; where pain stop my running made my sleep worse.

My relationship with sleep changed during graduate school. It didn’t stem from some revelation about the health benefits of predictable sleep. Instead, it came from a desire to annoy people whom I found annoying. During my time at Virginia Tech, studying for my PhD in clinical psychology, I found that people took a morbid pride in their own struggle and self-deprivation. It is a pattern I still see in high achievers and something that has always seemed transparently attention-seeking and sad. Look at me, I haven’t slept in weeks. I studied 200 hours this week for a 20-question quiz. All my nutrients are in liquid form because chewing takes away from focusing on this manuscript. Bathroom breaks are for when I am dead.

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If I don’t blink, all that time adds up

It happens, or at least I think it happens, because at that level of academia everybody is smart and everybody is expected to do well. In undergrad, each future graduate student was a relative stud in their program. They were smart and they stood out for doing well. They were the gym class heroes of their classes – big fish in small ponds. Once they got called up to the big leagues, an actual PhD program, they found that their pond had gotten smaller and the fish have gotten larger. With everyone performing at maximum level, subjective measures of sacrifice and torment become the only thing making you stand out. Prior to tests, I would find people standing in the hallway proudly reporting how long they studied and how little they slept the previous night. When a major milestone was on the horizon, a thesis or a dissertation or something of that like, people would loudly broadcast how they sublet their apartment to live in the library and only slept during the brief moments that they allowed themselves to blink. I found it all terribly annoying.getty_479206925_970664970450089_58788

I took the opposite approach. When an exasperated classmate came to me reporting that they were up all night reading and rereading the textbook for the 10th time, I would tell them I forgot we had a test that day. If someone were to feign sympathy for the torment they put their laptop through by writing on it for 16 hours straight, keys melting into their fingers, I would tell them I wrote my manuscript on a series of bar napkins – most of them I left at home.

The truth is, we were both lying. We probably spent the same amount of time preparing and we got similar grades. The common target of reported deprivation was sleep. People love to brag about how little sleep they get because we all know that sleep is one of the greatest things the body does. While this strange dance of deceit was going on in graduate school, I started to notice that on the rare occasion I actually did sleep well I got more done the next day. If I could stay asleep for 6 to 7 hours, I could actually remember most of the stuff I studied. Getting to bed early on a day I ran hard (or, at that time it was more likely road biking) left my body feeling completely healed and ready for another day.

The older I get the more crucial sleep becomes. If I have a bad night of sleep on Monday, the impact of that ripples out to Thursday: my running gets slower, my body feels stiff and heavy, my mood is awful. Since starting this writing project, I’ve become more strict with sleep. I have become more focused on testing what I can do, behaviorally, to improve my sleep quality and what impact it has on the next day. To save you time, my big three recommendations are: Be consistent, don’t nap and turn off your screens. These are not earth shattering or revolutionary ideas – but they work. Why do they work? Well, first we need to know why we sleep.

What we do when we sleep

Humans are, by nature, daytime animals. We are designed to be awake when the sun is out and to sleep when the sun goes away. When we sleep, our brain uses that downtime to tidy up and make repairs. Think of your brain like a 24-hour grocery store. During the day, there is a lot happening – people coming and going, lots of employees, noise, lights, stuff. If you’ve ever gone grocery shopping during a busy time then you know how frustrating it is when a poor employee tries to do something essential for the store (e.g., restock a shelf, make a repair) while you are trying to get your shopping done. To minimize these annoyances, the store generally relegates as much of these routine, essential tasks to late at night when there are no customers, and less employees, around.

Our brains operate much in the same way. During the day, we are trying to balance a lot of stuff. At night, when we are deep into our REM sleep, our brains and our bodies are doing all the necessary upkeep and repair:

  • While sleeping our brains start to wash itself in Acetylcholine, a neurotransmitter that aids in memory, motivation and attention. This is why when you lose sleep (or have been awake for a long time) those are three key areas where you suffer.
  • Our brains also begin to sort and consolidate memories, as well as delete memories we don’t find important. The movement of memories come to us in the form of dreams – we are literally watching our brains move around information. And yes, you do dream – even if you don’t remember it.
  • In our bodies, we see a surge of muscle growth and repair as a result of the spike in growth hormone we experience while sleeping. At the same time, our brains release GABA and glycine, two chemicals that act together to deactivate all your voluntary muscles. This helps you to stay still, not act your dreams out and allow your muscles to repair.

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I couldn’t find interesting chemical pics so here is a puppy

What about when we don’t sleep?

Clearly sleep is important. What are the consequences of bad sleep?

  • We feel tired. We also have noticeable shifts in our mood, our thinking and our ability to concentrate. This is largely due to our brain missing out on that influx of acetylcholine – no bath and our thinking starts stinking (I apologize that rhyme).
  • Chronic sleep loss also leads to depression. This is a multi-headed snake of a problem. First, if we don’t sleep we don’t get the restoration benefits. Also, our brains tend to get cluttered because we aren’t able to effectively consolidate and store our memories. Meanwhile, our bodies are sore because we aren’t allowing them to heal (less sleep = less growth hormone). That leads us to feeling tired and sore – so, we tend to decrease our activity level and increase our isolation. No activity means no spike in our feel good chemicals (serotonin, dopamine, endorphins). No socialization means we feel distressed because at the end of the day we are all social animals.
  • There is one more serious consequence of bad sleep. Our brains have a “cleaning system” – the Glymphatic System. Think of this like our brains sewage system – cleaning out the brain from all of its nasty garbage. The glymphatic system flushes out things like sticky proteins (beta amyloids), free radicals and all of the partially processed junk that is doing our brains no good. This system works in high gear when we sleep. If we lose sleep, this system has less time to work and likely will have stuff left over. Another bad night? More stuff left over. The mess starts to pile up and a build-up of this sewage can lead to serious problems (Alzheimer’s being the most serious).

Two important chemicals to know

So, let’s get some sleep. Before we do that, we need to know two important brain chemicals that put us to sleep. If we can get these two working right, we will be sleeping like professional babies.

  • Adenosine is a chemical that is slowly leaking into your brain while you are awake. This chemical is crucial for putting us to sleep. Adenosine gives us that “sleepy” feeling. Throughout the day, your brain is making and releasing variable amounts of this chemical – little by little when we are inactive and by the bucket when we are stressed or taxed. This ever rising level is called “sleep pressure.” Everyone has a threshold of pressure they have to build to before they can sleep – not nap, not doze, not nod off a bit but get actual, good, deep, restorative sleep.
  • Melatonin is a natural hormone that our brains produce. You can also find melatonin over the counter that mirrors the hormone in our brain. Melatonin does not put us to sleep. Mathew Walker, a sleep scientist, describes melatonin a “the starting official in a 100m race.” The official organizes all of the races (all the actual sleep chemicals, hormones and processes) and fires the starters pistol to indicate they all need to go – but the official does not participate in the race itself. Melatonin controls the timing of sleep and whether or not these sleep-related things go in the correct order.
suprachiasmatic-nucleus
Found it!

Melatonin is a night-time hormone. During the day, when the sun is out, our eyes send a signal to our brain’s Suprachiasmatic nucleus. This completely ridiculously named part of our brains determine: yes or no, is the sun out? Yes – then the SN sends a message to our pineal gland telling it to not make melatonin. No – then the message is not sent and our pineal gland starts pumping out that sweet, sweet melatonin. Ideally, all day we see the sun and our brains don’t release any melatonin. As the sun goes down, and as we have a rising level of adenosine, our pineal gland starts to release melatonin. A few hours post-sunset, these two chemicals have reached a critical point and BOOM, we are off to the sleep races.

Three important things to avoid

We don’t live in the ideal and there are loads of things that get in the way of good sleep. . Here are the three prime culprites that try to make the job of adenosine and melatonin difficult:

  • Caffeine seems like an obvious thing to avoid. Caffeine works, in part, by blocking the receptors that take in adenosine. When we drink coffee or have a soda, that caffeine gets in the way of our brains from feeling the effects of that sleepy chemical. One the caffeine wears off, the receptors are freed up again and we start feeling sleepy. Unfortunately, that blocking effect can last a lot longer than we realize (long after other physiological effects wear off) and can do serious damage to our sleep pressure. Avoid caffeine a long while before bed and if you have chronic sleep problems, avoid caffeine altogether.
  • Sleep medications are a less obvious thing to avoid. Why would you want to avoid sleep medication if you can’t sleep? Part of the problem is in marketing – sleep medications don’t cause sleep, they just sedate you – they remove consciousness but they don’t give you the complex, delicate, replenishing sleep you need. As a result, you miss out on all the restorative benefits of sleep (memory clean up, garbage removal, muscle healing). Additionally, our brains are notoriously lazy. If we take sedatives too frequently to sleep, our brains feel they have license to stop sleeping on their own. We accidentally learn that if we wait long enough, a pill will do the job so our brains stop making the good sleep chemicals.

As an additional note – sedatives are also sometimes dangerous and should be used with caution. Never mix them with a depressant (e.g., alcohol) or a stimulant (e.g., caffeine). Also, never take a sedative if you have untreated sleep apnea or suspected breathing problems. This is a problem I run into daily at the clinic I work in. It is inevitable that a patient will come to me with bags under their eyes demanding a sleeping pill (whichever they most recently saw on TV). When I review their history, they usually either (a) have sleep apnea and refuse to wear a CPAP or (b) have all the signs of sleep apnea and refuse to have a sleep study done. If you aren’t breathing in your sleep, your body will wake up so you don’t die. If you take a medication that pushes you into a sedative state, then your body can’t wake up and YOU WILL SUFFOCATE. Stop trying to take a pill and start fixing the actual problem.

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When people who are inappropriate for sleep meds demand them, this is the offer I make them.
  • Alcohol is another form of sedation and is not real sleep. Alcohol just pulls you out of consciousness but you aren’t actually going through all of the healthy sleep cycles. Once the alcohol wears off you typically rebound and have highly fragmented sleep (waking up frequently). Usually, the periods of being awake are so brief you don’t remember but, trust me, you aren’t sleeping well. Also, if you have sleep apnea or snoring problems, see above.

Now…you promised something about sleeping like a baby?

  1. Get consistent!: The first, and most important, recommendation is to get consistent with your sleep. Establish an extremely stable time to wake up and keep this regardless of weekday or weekend. Our brains operate on a cycle and love predictability. Disrupting this cycle causes our brains to flail around. This can lead to delays in natural melatonin productions, improper balance of certain chemicals that control sleep or a ripple effect in bad sleep behaviors. Gone are the days of sleep deprivation during the week followed by “catch-up” sleep during the weekend. All you are doing is causing exponential damage during the week followed by increasing your potential for depression during the weekend. Stop it.
  1. No naps!: Now that we have established a wake-up time, we need a stable bed time that is 7-8 hours earlier than our waking time. Ta-da, you just developed a sleep window. Outside of that window, do not sleep or go into your bed. Napping, especially within 5-6 hours before sleep, is a good way to dump out all of that sleep pressure. If you nap midday, by bed-time your brain won’t have enough pressure built up. As you fall asleep (if you can fall asleep) you will go into “nap mode” – sleeping for a couple of hours and then waking up again.
  1. No screens!: If we have managed to not nap and to stay active throughout the day, then by night time we should have a good amount of adenosine built up. We are sleepy and ready to go to bed. Now, we need our race official (melatonin) to organize our brains and get things ready for sleep. Remember – melatonin starts to build up once the sun is gone. However, our brains are easily confused. Bright lights, TV screens, phones and computers all give off light that is close enough to sunlight and can cause our pineal glands to stop making melatonin. When you are watching TV right before bed your brain is not getting a build up of good melatonin. Once you turn off the TV and the lights, only then does the sleep process starts and melatonin begins being released. Unfortunately, you are now in a race between falling asleep and getting frustrated/anxious.

An hour before bed, start to dim the lights in your house and turn off your phone, computer or TV. Listen to music, read a book, make lunch for tomorrow – do anything that doesn’t involve bright lights. What you’re doing is allowing your brain to get ready for sleep. You’re giving yourself a cool-down period. Turn off, unplug and let your brain do what it was made to do.

 

A disclaimer – these three things are not magic pills. These three things are like novocaine. They are slow working but very effective. If they don’t work after the first night, be patient and be consistent. Good luck and good night!

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