Part 1: This Thing Called Sleep

Chapter 1 – To Sleep…

Two-thirds of adults throughout developed nations fail to get the recommended 8 hours sleep. Sleeping less than 6-7 hours a night demolishes your immune system, more than doubles your risk of cancer, increases Alzheimer’s Disease chances, disrupts blood sugar levels (classifying as pre-diabetic after one week), increases chances of coronary artery blockage and brittleness, increases psychiatric conditions (depression, anxiety, and suicidality), lack of eating control (hormonal changes), lean body mass decrease instead of fat mass, and a shorter lifespan. Countries where sleep time decreased such as the US, the UK, Japan, South Korea, and several in western Europe are suffering the most from these physical and mental health disorders.

One person dies in a traffic accident every hour in the US due to fatigue error. More than drugs and alcohol accidents combined.

When you are asleep you cannot gather food, socialize, reproduce, nurture or protect your offspring, and it leaves you vulnerable to predation. If sleep wasn’t important there would be heavy evolutionary pressure to prevent sleeping.

Benefits of sleep:

• Sleep enables our ability to learn, memorize, and make logical decisions.
• It also services our psychological health, recalibrates our emotional brain circuits, allowing us to navigate next day social and psychological challenges (REM).
• Dreaming mollifies painful memories and creates a VR space where the brain can meld past and present knowledge, inspiring creativity (REM).
• Sleep assists the immune system by restocking immune cells, helping to fight malignancy, preventing infection, and warding off sickness.
• Sleep reforms the metabolic state by fine-tuning the balance of insulin and circulating glucose.
• Sleep regulates appetite, helping to control body weight through healthy food selection rather than rash impulsivity.
• Sleep maintains a flourishing microbiome.
• Adequate sleep is tied to the fitness of the cardiovascular health, lowered blood pressure, and a healthy heart.

Chapter 2 – Caffeine, Jet Lag, and Melatonin: Losing and Gaining Control of Your Sleep Rhythm

GOT RHYTHM?

Your 24 hour circadian rhythm determines sleep times, wake times, eating and drinking timing preferences, moods, emotions, the amount of urine you produce, body core temperature, metabolic rate, and release of hormones. When removed from light cues by living in a cave, Richardson (in his 20s) ended up with a 26-28 hour day rhythm and Kleitman (in his 40s) was closer to 24 hours. The average circadian rhythm is actually about 24 hours and 15 minutes. The sunlight helps to reset our rhythm every day.

Alongside sunlight, the brain can also use food, exercise, temperature fluctuations, and regularly timed social interactions as cues.

The suprachiasmatic nucleus samples light signals to reset its inherent time inaccuracy, preventing any drift. It is comprised of 20,000 brain cells, but is comparably tiny.

Your biological circadian rhythm coordinates a drop in core body temperature as you near bedtime, reaching the low point 2 hours after expected sleep initiation.

MY RHYTHM IS NOT YOUR RHYTHM

Morning (larks) and evening (owls) types are strongly determined by genetics. Morning types make up approximately 40% of the population, morning types are about 30%, and the remaining 30% are somewhere in between. When an evening type person is forced to get up too early, their PFC, which helps to control high-level thought, logical reasoning, and keeping emotions in check, is in an “offline” state.

Society’s work schedule generally favors the larks and punishes the owls, forcing owls to get up early. Meaning owl performance is far less optimal in the morning. They are also more likely to be sleep deprived. Creating higher rates of depression, anxiety, diabetes, cancer, heart attack, and stroke.

Humans likely evolved to co-sleep as a tribe to reduce collective vulnerability from predators.

MELATONIN

The suprachiasmatic nucleus (SCN) coordinates the pineal gland to release melatonin levels at dusk (peaking at 4am and then decreasing), which is what initiates the biological timing of sleep. However, melatonin doesn’t influence the generation of sleep. Providing the instruction but not actually participating in the process.

Melatonin supplements are rarely useful or even contain the labelled quantity. If you do have legitimate melatonin products you would take it when you are expecting dusk in your new time zone.

HAVE RHYTHM, WON’T TRAVEL

Your SCN can only adjust by about one hour at a time after traveling. It is harder to acclimatize to a new time zone when traveling East than West. East requires you to sleep earlier than you normally would. West requires staying up, which we are already have a longer circadian rhythm to soften the blow.

Jet lag stresses the organs, cells, and major systems of the body. In pilots, learning and memory regions of their brains physically shrunk, short-term memory was significantly impaired, and higher rates of cancer and type 2 diabetes.

SLEEP PRESSURE AND CAFFEINE

Adenosine builds up in the brain creating sleep pressure as long as you are awake. High adenosine concentrations also inhibit wake-promoting regions of the brain.

Caffeine is the 2nd most commonly traded commodity behind oil and latches onto adenosine receptors to block them from adenosine binding. Levels of caffeine peak after 30 minutes of ingesting it and its half life is about 5-7 hours. Even a cup of decaf has about 15-30% of caffeine of a normal coffee. A liver enzyme degrades caffeine eventually, which some people have a slower-acting version of. Once caffeine is cleansed, adenosine buildup floods the receptors and you suffer from a caffeine crash.

IN STEP, OUT OF STEP

The adenosine sleep drive/pressure (Process-S) and the circadian wake drive (Process-C) operate separately from each other. When the adenosine concentrations are high and the circadian rhythm is low, a strong desire for sleep is triggered. Adenosine levels are then cleared during a full night of sleep.

INDEPENDENCE DAY, AND NIGHT

By remaining awake and blocking access to the adenosine drain that opens up during sleep, the brain cannot get rid of chemical sleep pressure and adenosine keeps rising. However, your circadian rhythm pays no attention to whether you are awake or asleep. Meaning alertness will still rise during natural wake times regardless of the excess adenosine. Once the circadian rhythm starts to decline again the sleep pressure catches back up.

AM I GETTING ENOUGH SLEEP?

Could you fall back asleep at 10-11am? Can you function optimally without caffeine before noon? If you could fall back asleep or require caffeine, you are probably sleep deprived.

If you didn’t set an alarm, would you sleep past that time? Do you read and reread information on your computer screen (fatigued, under slept brain)? Do you forget the color of the last few traffic lights?

You may still suffer from these problems if you have a sleep disorder like insomnia or sleep apnea.

Chapter 3 – Defining and Generating Sleep: Time Dilation and What We Learned from a Baby in 1952

SELF-IDENTIFYING SLEEP

Land animals usually adopt a horizontal position, lowered muscle tone, no overt display of communication, sleep is easily reversible (you can wake up easily), and adheres to a circadian rhythm from the SCN.

You know you’re asleep by a loss of external awareness even though your ears, eyes, nose, tongue, and skin are still capable of sensation. The signals are just blocked by the thalamus. You also lose your conscious sense of time.

AN INFANT REVELATION-TWO TYPES OF SLEEP

The gold-standard of sleep recording requires brainwave activity, eye movement activity, and muscle movement activity. Usually converged as a polysomnography (PSG).

THE SLEEP CYCLE

Wake->REM->NREM stage1->2->3 & 4 (slow wave). 90 minute cycles with increased REM during the night.

A theory for the cycles is to find the sweet spot of retention and leaving sufficient room for new information. NREM sleep weeds out and removes unnecessary neural connections and also moves short-term memories to long-term storage. REM plays a role in strengthening those connections by building more abstract patterns.

Going to bed too late loses deep sleep and waking up too early loses REM sleep.

HOW YOUR BRAIN GENERATES SLEEP

Wakefulness has erratic and fast-frequency brain wave activity. Too much uncoordinated activity. Slow wave sleep is far more synchronous and low-frequency. Occasionally sleep spindles occur, which shield the brain from external noise. The more powerful the spindle, the greater the resilience to external noise that would otherwise wake the sleeper.

Deep-sleep brainwaves mostly occur in the frontal lobe and travel to the back. Essentially transporting short-term memories to long-term storage. Waking activity is often considered the reception of the outside sensory world and the deep NREM slow-wave sleep is a state of inward reflection, fostering information transfer and the distillation of memories.

During REM sleep, some areas of the brain are 30% more active than when awake. Looking very similar to a waking brain wave state. Emotions, motivations, and memories are able to pass the thalamic gate and play visually, auditorily, and kinesthetically. While NREM is considered a form of memory reflection, REM is integration, to build a more accurate map of how the outside world works, including innovative insights and problem-solving. Luckily the voluntary skeletal muscles are relaxed to prevent movement.

Species with wider brain stems tend to have longer cycle lengths.

Chapter 4 – Ape Beds, Dinosaurs, and Napping with Half a Brain: Who Sleeps, How Do We Sleep, and How Much?

WHO SLEEPS

Worms emerged during the Cambrian explosion 500mya and happened to sleep. Even bacteria that live longer than 24 hours have been shown to have active and passive phases that correspond with the light-dark cycle of our planet. Possibly a precursor to our circadian rhythm.

ONE OF THESE THINGS IS NOT LIKE THE OTHER

Elephants need 4 hours of sleep, tigers and lions spend 15 hours sleeping, and brown bats sleep for 19 hours.

The relationship between the size of the nervous system, the complexity of the nervous system, and total body mass appear to be a somewhat accurate predictor, with increasing brain complexity relative to body size resulting in greater sleep amounts. Although, some animals resist this trend. Dietary type, predator/prey interactions, the presence of a social network, metabolic rate, and nervous system complexity all have a part to play it appears.

TO DREAM OR NOT TO DREAM

Only birds and mammals (except for dolphins and killer whales), which appeared later in the evolutionary timeline, have REM sleep. Dolphins and killer whales don’t want to be paralyzed while swimming so REM is not advantageous. When seals are on land they have REM sleep but while in the water it is almost gone entirely. However, we may find out that these sea faring mammals undergo a different type of REM sleep.

REM sleep seems to support warm-blooded animals with cardiovascular health, emotional restoration, memory association, creativity, and body-temperature regulation.

If sleep deprived, NREM sleep rebounds harder on the first night of sleep. During the next few nights, REM sleep becomes dominant.

IF ONLY HUMANS COULD

Dolphins can uncouple hemispheres to allow one side to sleep at a time. Birds close one eye, with the opposing half of the brain being asleep, to keep the other eye on danger. When some birds are in a flock they will allow both halves to sleep. As long as they have a row of birds, with the ends of the row only sleeping with half of their brain.

Humans tend to sleep lighter with one side of the brain when in an unfamiliar environment like a hotel. However, REM sleep, regardless of the animal, cannot be split between hemispheres.

UNDER PRESSURE

Starve an organism of food and foraging for food will supersede sleep. Migrating birds will have microsleeps for a few seconds and killer whale mothers and their calves will go without sleep for a few weeks until they return back to their pod.

HOW SHOULD WE SLEEP?

Hunter gatherers seem to sleep biphasically. The Hadza tribe have 30-60 minute naps during summer afternoons with the 7 hours at night (starting at 9pm). Nap time seems to coincide with the afternoon slump we feel. In Greece they would stop work during the middle of the day and nap. Upon removing this practice, there was a 37% increase in risk of death from heart disease over a 6 year period. Working men’s risk went up 60%.

WE ARE SPECIAL

We sleep less than old and new world monkeys, as well as apes. We also have much more REM sleep. (20-25% compared to their 9%). Probably because we have no risk of falling out of a tree while going limp. Fire deters large predators, meaning we could sleep on the ground, and the smoke repelled insects. Sleeping on the ground allowed REM sleep and therefore the ability to build complex neural pathways and high connectivity. Improving sociocultural complexity and cognitive intelligence.

NREM sleep helps transfer newly learned information into long-term storage sites of the brain. REM sleep takes these freshly minted memories and begins colliding them with the entire back catalog of your life’s autobiography. Also allowing us to wake up with new solutions to problems.

Chapter 5 – Changes in Sleep Across the Life Span

SLEEP BEFORE BIRTH

Before birth, a human infant will spend almost all of its time in a sleep-like state resembling REM sleep. Any movement from the baby is most likely due to random bursts of brain activity. They haven’t yet developed the body-paralyzing mechanism of REM sleep. Approximately 6 hours in NREM, 6 hours in REM, and 12 hours of an intermediary sleep state. Near emergence they spend around 2-3 hours a day awake in the womb. In the last 2 weeks of pregnancy, the fetus will ramp up REM to almost 9 hours a day. The last week hits 12 hours of REM.

REM sleep seems to act like an electrical fertilizer by stimulating the growth of neural pathways all over the developing brain. Mass synaptogenesis.

Autism appears to display inappropriate wiring of the brain, especially abnormal synaptogenesis. The circadian rhythms of autistic children are weaker, showing a flatter profile of melatonin. They also sleep less and have 30-50% less REM sleep. Correlational in humans thus far but interesting nonetheless. Alcohol is a powerful suppressor of REM sleep and can cross the placental barrier to the children. Even a few glasses of wine significantly decreased the fetuses REM sleep and suffered a marked depression in breathing.

Almost half of lactating women in Western countries consume alcohol during breastfeeding months, which gets absorbed into mother’s milk of a similar concentration as their bloodstream. Usually an infant would transition straight into REM sleep after being fed but with alcohol it becomes more fragmented, they sleep less, and suffer a 20-30% drop in REM sleep. Stunting brain development.

CHILDHOOD SLEEP

Young children sleep polyphasically. The older they get the more monophasic their sleep becomes. The SCN develops and strengthens the circadian rhythm. Age 3-4 months old a daily rhythm begins to appear. Using daylight, temperature changes, and feedings to structure a rhythm. By one year old the SCN seems to have gripped onto the cues to allow the child to stay awake most of the day. By late childhood, monophasic sleep is dominant.

During a 6 month old’s 14 hour night of sleep there is a 50:50 share of NREM and REM. A 5 year old will have a 70:30 split between NREM and REM during their 11 hours. Stabilizing as 80:20 in the late teens.

SLEEP AND ADOLESCENCE

Early stages are overzealous with creating synapses and connections whereas later stages of childhood are about pruning and remodeling. Most of the structure that nature has determined as important will stay but there is potential for refinement. Personal usage statistics determine this. Deep NREM sleep aids the neural passage into early adulthood. Decreasing once secured. As NREM sleep undergoes its final overhaul and refinement, cognitive skills, reasoning, and critical thinking start to improve. The changes in NREM always precede the cognitive and developmental milestones within the brain by several weeks or months. Always starting from the back of the brain and finishing in the frontal lobe.

Administering caffeine to juvenile rats disrupted NREM sleep, delaying brain maturation, development of social activity, independent grooming, and environment exploration. Schizophrenia, bipolar disorder, major depression, and ADHD are considered developmental disorders. They may be encouraged by sleep issues. Teenagers who developed schizophrenia had abnormal patterns of brain maturation that was associated with synaptic pruning, especially in the frontal lobe where rational, logical thoughts are controlled. Individuals at high risk of schizophrenia also tend to have less NREM sleep. The electrical brainwaves in these individuals during NREM was also abnormal.

Trying to get your adolescent child to sleep at 10pm is the equivalent of you trying to sleep at 7-8pm. Conversely, getting them to wake up at 7am is like you getting up at 4-5am. We should let them sleep in line with their rhythm if we want them to not develop a psychiatric issue. No caffeine should be needed either.

SLEEP IN MIDLIFE AND OLD AGE

Reduced quantity/quality, reduced sleep efficiency, and disrupted timing of sleep all seem to plague adults. NREM declines in the late 20s. The older we get the more fragmented our sleep becomes. Seen to be due to medications, diseases, and weak bladders.

Any individual, no matter what age, will exhibit physical ailments, mental health instability, reduced alertness, and impaired memory if sleep is chronically disrupted.

Circadian timing also changes with age. Getting earlier due to an earlier release of melatonin. The strength of the circadian rhythm and the amount of melatonin released decrease too. Older adults could wear sunglasses in the morning during outdoor exercise and go back outside in the late afternoon without them.

The middle-frontal regions of the brain, which produce the powerful NREM sleep waves, tend to atrophy first in old age. Older adults tend to forget about 50% more in overnight memory tests than young adults.

Just because an older adult sleeps less it doesn’t mean than their need for sleep is less. As similar example is bone density.

Part 2: Why Should You Sleep?

Chapter 6 – Your Mother and Shakespeare Knew: The Benefits of Sleep for the Brain

SLEEP FOR THE BRAIN

Proven as a memory aid before and after learning. Preparing for making new memories, cementing them, and preventing forgetting.

SLEEP-THE-NIGHT-BEFORE LEARNING

The hippocampus acts as a short-term memory storage region by apprehending and binding details together. Take in too much and you run the risk of overwriting memories or creating interference forgetting. Sleeping (specifically stage 2 NREM) appeared to restore the hippocampus’ capacity for learning by shifting information to long-term storage. The more sleep spindles somebody had the more restored participant’s memory were. Inherent learning aptitude is not predicted by the spindles but they do go hand in hand. The researchers noticed a 100-200ms pulse of electrical activity between the hippocampus and the cortex, possibly representing the transaction of memory and refreshment of hippocampus capacity.

Seniors seem unable to generate these sleep spindles to the same degree (40% lower). The fewer the spindles, the lower the capacity for learning new information the next day. Sleep spindle concentration are also greater in the late-morning hours.

SLEEP-THE-NIGHT-AFTER LEARNING

Sleep protects newly acquired information via the process of consolidation. Time spent asleep helped cement newly learned chunks of information whereas the same time spent awake was deeply hazardous to memory retention.

For fact-based memory, the early night slow-wave and sleep spindle filled NREM sleep is superior. Hippocampal memories get shifted to the neocortex. NREM is also responsible for the recovery of information that was in jeopardy of being lost.

Researchers boosted slow wave brain activity via electrical stimulation, resulting in more overall deep brainwaves and sleep spindles. Doubling the number of facts they could remember compared to a control group. Although, REM sleep and wakefulness stimulation appeared to offer no advantage. Auditory entrainment seems to have worked in the lab too but by doing it at home you may cause more harm than good. There was also an experiment that suggested slowly rocking a participant may increase memory retention during NREM.

SLEEP TO FORGET?

Forgetting lowers the brain’s required resources at the cost of removing memories that appear unnecessary. Sleep can preferentially store and forget memories by using meaningful tags to select essential information. Once again, the role of sleep spindles.

SLEEP FOR OTHER TYPES OF MEMORY?

“Muscle memory” performance speed and accuracy improves with a period of sleep. In his typing experiment, sleep had identified difficult transitions in the motor memory and smoothed them out. Instead of being shifted from the hippocampus to the cortex like episodic memories, these procedural memories were moved to brain circuits below consciousness, creating instinctual habits. These improvements seemed to be directly related to stage 2 NREM sleep. Particularly the last few hours of sleep (typically 5-7am) when a large burst of sleep spindles were present above the motor cortex. An infant displays an increase in these sleep spindles when transitioning from crawling to walking.

Reducing sleep by 2 hours reduces time to physical exhaustion by 10-30%, aerobic output is reduced, limb extension force drops, vertical jump height is lowered, and a decrease in peak and sustained muscle strength. Also, impairments in cardiovascular, metabolic, and respiratory capabilities, including faster rates of lactic acid buildup, reductions in blood oxygen saturation, and increases in CO2. Not to mention dramatically increased injury risk. Post performance sleep accelerates physical recovery from common inflammation, stimulates muscle repair, and helps to restock cellular energy in the form of glucose and glycogen.

SLEEP FOR CREATIVITY

REM sleep helps to connect disparate sets of knowledge that assist with problem-solving.

Chapter 7 – Too Extreme for the Guinness Book of World Records: Sleep Deprivation and the Brain

PAY ATTENTION

Falling asleep at the wheel and microsleeps are two of the main reasons for drowsy-driving accidents. Chronically sleep-deprived individuals may have a momentary lapse of concentration (microsleep), where the brain becomes blind to the outside world. A 2-second microsleep is enough to take a car going 30mph from one lane to another.

After 4 hours of sleep for 6 nights, participants performed just as badly as participants who got no sleep for 24 hours straight (400% increase in microsleeps). 10 days of 6 hours sleep resulted in being as bad as 24 hour deprivation.

YOU DON’T KNOW HOW SLEEP-DEPRIVED YOU ARE WHEN YOU ARE SLEEP-DEPRIVED

When participants were asked for their subjective sense of how impaired they were, they consistently underestimated their degree of performance disability. With chronic sleep-deprivation somebody’s baseline will reset and they will get used to that level of impaired performance, lower alertness, and reduced energy levels.

Even after 3 night’s recovery sleep, performance did not return to the observed original baseline. Another experiment showed that people who were sleep-deprived for 19 hours performed as badly as those legally drunk. Performance started to drop after 15 hours. Drivers who were legally drunk and sleep deprived were 30 times more likely to drive off the road than a well-rested and sober group.

16 hours is about the recycle rate of a human brain before it begins to fail. Drunk drivers are often late to brake or make evasive maneuvers whereas sleep-deprived drivers don’t respond at all. Truck drivers are far more likely to be overweight, have a higher chance of sleep apnea, and therefore, have more sleep-deprivation. Truck drivers are 200-500% more likely to be in a traffic accident. On average, when a truck driver loses their life in an accident, they take 4.5 lives with them.

CAN NAPS HELP?

Short sleep bouts taken early reduced the number of microsleeps pilots experienced in the final 90 minutes of flight. In saying that, no amount of napping or drugs will make up for sleeping. They cannot salvage the more complex functions of the brain, including learning, memory, emotional stability, complex reasoning, or decision making.

EMOTIONAL IRRATIONALITY

The amygdala showed a 60% amplification in emotional reactivity in participants who were sleep-deprived (when showed emotionally negative images). After a full night’s sleep, the PFC was strongly coupled to the amygdala, regulating this deep, emotional brain center with inhibitory control. The striatum – associated with impulsivity and reward, and bathed in dopamine – had become hyperactive in sleep-deprived individuals in response to rewarding and pleasurable experiences due to a lack of PFC control. Meaning, the under slept brain isn’t purely forced into a more negative state. It just swings between extreme emotional states due to a lack of inhibition. A major problem causing children to be more depressed, aggressive, bully, and have more behavioral problems. A similar relationship is seen in prison populations where aggression, violence, psychiatric disturbance, and suicide are high.

Hypersensitivity to positive experiences can lead to sensation-seeking, risk-taking, and addiction. Sleep deprivation also determines relapse rates in numerous addiction disorders associated with reward cravings. In adolescents, it may predict drug and alcohol use, even when controlling for anxiety, attention deficits, and parental history of drug use.

There is no major psychiatric condition in which sleep is normal. Many of the same brain regions that are affected in these conditions are also involved with sleep regulation and are impacted by sleep loss. Many of the genes that show abnormalities in psychiatric illnesses are also the same genes that help control sleep and our circadian rhythms. Suggesting a two-way street between psychiatric conditions and sleep-deprivation. By sleep depriving a bipolar depression patient for one night you can cause them to spiral into mania or depression.

30-40% of patients suffering from major depression, seem to feel better after a night without sleep. The 60-70% who don’t feel better will get worse. The reason for this improvement in some patients is most likely due to sleep deprivation amplifying reward circuits, reducing anhedonia.

TIRED AND FORGETFUL?

There was a 40% deficit in the ability of sleep-deprived groups to cram new facts into the brain. The difference between acing an exam and failing miserably. Sleep-deprivation even impacts the DNA and the learning-related genes in the brain cells of the hippocampus. Also, if you don’t sleep well during the first night, there is little evidence of memory improvement after that.

SLEEP AND ALZHEIMER’S DISEASE

Sleep disturbance precedes the onset of Alzheimer’s by several years. The magnitude of sleep disruption will then progress in unison with the severity of symptoms. Over 60% of patients with AD have at least one clinical sleep disorder. AD is associated with beta-amyloid plaques, which are poisonous to neurons. They tend to affect the middle part of the frontal lobe (the same part essential for electrical generation of deep NREM sleep). The buildup of these plaques in this region can affect NREM sleep and result in overnight forgetting as the information cannot be transferred from the hippocampus, even though no plaque buildup is there.

The glymphatic system drains metabolic contaminants from your brain, which is somewhat active during the day but kicked into high gear during sleep. Associated with the pulsing rhythm of deep NREM sleep comes a ten-to-twentyfold increase in effluent expulsion from the brain. The glial cells shrink by up to 60% during NREM sleep, enlarging the space around the neurons and allowing cerebrospinal fluid to clean out metabolic refuse left by the day’s neural activity. Meaning the amyloid protein, tau, and other stress molecules produced by neurons when they combust energy and oxygen during the day can get cleared out.

Chapter 8 – Cancer, Heart Attacks, and a Shorter Life: Sleep Deprivation and the Body

SLEEP LOSS AND THE CARDIOVASCULAR SYSTEM

Progressively shorter sleep was associated with a 45% increase of developing and/or dying from coronary heart disease within 7-25 years from the start of a study looking across different races, genders, and ethnicities across 8 different countries. Adults over 45 who sleep fewer than 6 hours a night are 200% more likely to have a heart attack or stroke during their lifetime. Even one night of a few hours of sleep deprivation will increase systolic blood pressure in healthy individuals.

Those patients that slept less than 6 hours were 200-300% more likely to calcify their coronal arteries over the next 5 years.

If the SNS is active for prolonged periods, such as during sleep-deprivation, the heart beats faster and the blood pressure increases. There is also a chronic increase of cortisol, which constricts the blood vessels, triggering a greater increase in pressure. Growth hormone is also shut off, which usually replenishes the lining of the blood vessels. Making the vessels more likely to undergo atherosclerosis.

SLEEP LOSS AND METABOLISM: DIABETES AND WEIGHT GAIN

The less you sleep, the more you are likely to eat. Your body also becomes less able to manage those calories effectively.

DIABETES

Excessively high levels of blood sugar over weeks or years inflicts harm to the tissues and organs, worsens your health, and shortens your lifespan. Insulin resistance develops, leading to type 2 diabetes. Research has found that type 2 diabetes is much higher in individuals who sleep less than 6 hours routinely. An experiment that limited healthy participants to 4 hours sleep were 40% less effective at absorbing a standard dose of glucose after 6 nights. Sleep deprivation results in cells being far less receptive to insulin.

WEIGHT GAIN AND OBESITY

Inadequate sleep decreased concentrations of leptin and increased ghrelin. Leading participants to lose hunger control. Participants who were deprived (4 nights of 4 and a half hours) ate 300 calories more than those who slept 8 hours. A working year of this schedule would result in 70,000 extra calories (typically 10-15 pounds of weight gain). When participants were offered a buffet with a snack bar, the sleep deprived ate an additional 300 calories of snack food. Sleep loss increases circulating levels of endocannabinoids, which stimulate appetite too.

People often associate the cause of eating more during sleep-deprivation with increased caloric demand while awake, whereas the reality is sleeping is still metabolically demanding. The extra calories consumed while sleep-deprived are likely to be well beyond any extra calories burned while awake. Especially as cravings for sweet, high carbohydrate, and salty snacks increase by 30-40%. This is because the PFC is less active, reducing thoughtful judgments, and regions that drive motivations and desire are amplified. Resulting in high-calorie foods being more desirable. A good night’s sleep leads to better impulse control.

Calming the SNS also results in an improved gut bacterial community. This is because chronic elevated levels of cortisol can cultivate “bad bacteria” to fester. Meaning, insufficient sleep will prevent meaningful absorption of all food nutrients and cause gastrointestinal issues.

3-year-olds sleeping 10 and a half hours or less have a 45% increased risk of being obese by age 7 than those that get 12 hours.

In participants who were on a low calorie diet, both the 8 and a half and 5 and a half hour sleep groups lost weight. However, 70% of the sleep-deprived group’s weight loss came from lean body mass.

SLEEP LOSS AND THE REPRODUCTIVE SYSTEM

The hormonal “aging” of men who only get 5 hours sleep is about 10-15 years. Dropping testosterone levels and virility dramatically. Leaving them feeling tired/fatigued throughout the day, difficulty concentrating, and a dulled libido. Testosterone also plays a role in bone density, muscle mass, and strength. 29% lower sperm count and more deformities.

Routinely sleeping less than 6 hours results in a 20% drop in follicular-releasing hormone in women. A study involving women with irregular nighttime hours and poor sleep had a 33% higher rate of abnormal menstrual cycles and 80% more likely to suffer from issues of sub-fertility that reduced the ability to get pregnant. Those who do manage to get pregnant regardless are more likely to suffer a miscarriage in the first trimester.

When given 5 hours sleep vs 8 hours participants where photographed and judged as being more fatigued, less healthy, and significantly less attractive.

SLEEP LOSS AND THE IMMUNE SYSTEM

Sleep fights against infection and sickness by triggering immune system activity and protection. The immune system also actively stimulates the sleep system. The less sleep somebody gets before facing the common cold virus, the more likely it was that they would catch it. Those sleeping 5 hours on average had a 50% infection rate. Those sleeping more than 7 hours had an 18% infection rate.

The flu vaccine will only be effective if your body generates antibodies. Participants who slept 7-9 hours on average, a week before the vaccine, had a powerful antibody reaction. In contrast, the sleep-restricted produced 50% less of an immune reaction. Even if the participant was allowed 2-3 weeks of recovery sleep they still didn’t go on to develop a proper immune reaction.

NK cells will effectively punch a hole in the outer surface of malignant cancer cells and inject a protein that can destroy it. A single night of 4 hours sleep can reduce NK cells by 70%. Shift work has been associated with breast, prostate, uterus wall or the endometrium, and colon cancer. A European study looking at almost 25,000 individuals demonstrated that sleeping less than 6 hours was associated with a 40% increase in cancer risk.

Ramping up the body’s SNS will often trigger a sustained inflammation response from the immune system. When faced with a real threat, SNS activity will often trigger a similarly transient response from inflammatory activity, in anticipation of bodily harm. However, left switched on chronic inflammation causes manifold health problems, such as those related to cancer. Some cancer cells will lure inflammatory factors into the tumor mass to help initiate the growth of blood vessels that feed it with more nutrients and oxygen. Tumors can also use inflammatory factors to help further damage and mutate DNA of their cancer cells, increasing the tumor’s potency. Inflammatory factors associated with sleep deprivation may also be able to shear some of the tumor from its local moorings, allowing metastasis. Sleep-deprived mice suffered a 200% increase in the speed and size of a cancer growth.

Gozel showed that tumor-associated macrophages are one of the root causes of the cancerous influence of sleep loss. Sleep-deprivation will diminish M1 cells, that otherwise help combat cancer, and boost M2 growth, which promote cancer growth.

SLEEP LOSS, GENES, AND DNA

Thousands of genes require consistent and sufficient sleep for stable regulation. Deprive a mouse of sleep for a day and the activity of these genes will drop by over 200%. After a week of 6 hours of sleep a night, 711 genes were distorted in a group of healthy young men and women. About half of those genes were revved up and half had their expression downregulated. Increasing chronic inflammation, cellular stress, and various factors which cause cardiovascular disease. Genes that were turned down were responsible for stable metabolism and immune response. Short sleep duration also disrupts the activity of genes regulating cholesterol, particularly dropping HDLs.

Insufficient sleep results in more damaged telomere caps and chromosomal damage.

Part 3: How and Why We Dream

Chapter 9 – Routinely Psychotic: REM-Sleep Dreaming

YOUR BRAIN ON DREAMS

During MRI studies of deep NREM sleep, overall metabolic activity shows a modest decrease relative to a resting and awake individual. During REM sleep the following light up: (1) the visuospatial regions at the back of the brain, which enable complex visual perception; (2) the motor cortex, which instigates movement; (3) the hippocampus and surrounding regions, which support autobiographical memory; and (4) the deep emotional centers of the brain – amygdala and the cingulate cortex, which helps to generate and process emotions. The emotional regions are 30% more active in REM sleep compared to when awake. The far left and right sides of the PFC deactivate, which are responsible for rational thought and logical decision-making, sending “top-down” instructions to deeper brain centers, such as those instigating emotions.

If woken from a REM state we can infer the nature of somebody’s dream by using an MRI to look for motor activity, visual activity, or emotional reactivity. Japanese researchers were able to collect subjective dream data whilst recording MRI data, in order to further predict dreams to a somewhat reliable degree. Still far from perfect but pretty good seeing as they only had 3 subjects over several days.

THE MEANING AND CONTENT OF DREAMS

Between 35-55% of emotional themes and concerns that participants were having while they were awake resurfaced during dreams.

Chapter 10 – Dreaming as Overnight therapy

DREAMING-THE SOOTHING BALM

REM sleep dreaming takes the painful sting out of difficult and potentially traumatic, emotional episodes you have experienced during the day, offering emotional resolution the next day. Concentrations of noradrenaline are shut off during this state, meaning you can reprocess emotional experiences without the effect of noradrenaline. REM both helps to remember the details of valuable, salient experiences, integrating them with existing knowledge, and putting them into an autobiographical perspective, and also dissolving the painful emotional charge that had previously been wrapped around those memories. Preventing chronic anxiety every time we remember an uncomfortable experience. REM sleep + dreaming appear to be required to deal with emotional trauma.

PTSD patients have a higher than normal release of noradrenaline which blocks their ability to enter and sustain REM sleep dreaming. The brain’s inability to strip the emotion from the memory will cause nightmares and the strength of the emotional tag will remain high. Meaning there may be repeat nightmares of the trauma experienced. A doctor who prescribed prazosin for high blood pressure in his PTSD patients had the side effect of decreasing noradrenaline and the patients could sleep better, without such a high frequency of the nightmares.

DREAMING TO DECODE WAKING EXPERIENCES

REM sleep helps to increase your ability to discern facial micro-expressions in others. The better the quality of REM sleep, the more precise the tuning within the emotional decoding networks of the brain the next day. REM sleep deprivation seems to cause a flattened state of generalized hypersensitivity without the ability to map gradations of emotional signals from the outside world. Slipping into a default of fear bias, believing even friendlier faces to look menacing.

Imagine REM sleep deprived police officers, nurses, doctors, parents, etc. trying to make decisions based on emotional cues. Before adolescence, these salient assessments are made by parents so REM sleep has less of a retuning effect on them. Once they enter the teenage years they need to navigate the socioemotional world themselves, and the brain starts to double down on this effect. REM sleep still helps brain development and creativity in children though.

Chapter 11 – Dream Creativity and Dream Control

DREAMING: THE CREATIVE INCUBATOR

Deep NREM sleep strengthens individual memories but REM sleep offers the complementary benefit of fusing and blending those elemental ingredients together, in abstract and novel ways. Mendeleev, Otto Loewi, Mary Shelley, and Paul McCartney are all examples of people who found creative inspiration from dreams.

REM-SLEEP FUZZY LOGIC

When woken up during REM sleep, participants solved 15-35% more puzzles compared with NREM awakenings or even daytime waking performance. The way they solved the problems were different too. REM sleep waking also creates more distant associative connections (shortcutting obvious links) that at first glance appear disconnected from logic.

MEMORY MELDING IN THE FURNACE OF DREAMS

REM sleep + dreaming determine creative success. Allowing you to move from learning to comprehension by skipping all the unnecessary connections. Something computers don’t tend to do.

CODE CRACKING AND PROBLEM SOLVING

REM sleep is also capable of creating abstract overarching knowledge and super-ordinate concepts out of sets of information. Infants do this often while establishing grammatical rules. Funnily enough, REM sleep is dominant in infants.

FUNCTION FOLLOWS FORM-DREAM CONTENT MATTERS

Participants who slept and dreamed about elements within a maze task they were a part of showed almost 10 times more improvement than those who dreamed but did not report seeing elements or themes from the maze.

CONTROLLING YOUR DREAMS-LUCIDITY

Unsure whether lucid dreaming is beneficial or detrimental.

Part 4: From Sleeping Pills to Society Transformed

Chapter 12 – Things That Go Bump in the Night: Sleep Disorders and Death Caused by No Sleep

SOMNAMBULISM

Disorders that involve movement (sleepwalking, sleep talking, sleep eating, sleep texting, sleep sex, and occasionally homicide). Unexpected jumps in nervous system activity during deep sleep is a trigger, getting stuck somewhere between deep NREM and waking. Children may experience it more purely due to the fact that they have more deep NREM sleep.

INSOMNIA

The most common sleep disorder (1 out of 9 people) and one that many people believe they have but actually don’t. Being sleep deprived is not insomnia. Insomnia is the inadequate ability to generate sleep despite allowing oneself the adequate opportunity to get sleep. There is sleep-onset insomnia (difficulty getting to sleep) and sleep-maintenance insomnia (difficulty staying asleep). To be properly diagnosed you must have dissatisfaction with quality or quantity, significant distress or daytime impairment, had insomnia for at least 3 days each week for more than 3 months, and no coexisting mental disorders or medical conditions that could otherwise cause what appears to be insomnia. Acute stress may affect sleep quality so it is important to establish these prerequisites.

Twice as common in women than men, with African Americans and Hispanic Americans suffering more too. There is a 28-45% genetic transmission which still leaves psychological, physical, medical, and environmental factors as huge contributors. Bright light at night, the wrong ambient room temperature, caffeine, tobacco, and alcohol consumption can masquerade as insomnia.

The two biggest triggers are emotional concerns or worry and emotional distress or anxiety. Chronic SNS activity results in heart rate increase, blood flow, metabolic rate, stress-negotiating chemicals, and increased brain activation. A common cause due to increased internal temperature from a higher metabolic rate preventing the typical drop in temperature before sleep, cortisol, noradrenaline, and adrenaline raising alertness, and the altered brain activity from increased SNS. The amygdala and hippocampus stay active when they should be ramped down. Resulting in emotion generation and memory recollection when you want to sleep.

Recursive loops of emotional programs, together with retrospective and prospective memory loops, keep playing in the mind, preventing the brain from shutting down and switching into sleep mode.

Patients with insomnia have less powerful electrical brainwaves during deep NREM and more fragmented REM sleep, with brief awakenings.

NARCOLEPSY

The genetic cause appears to be a mutation, so not inherited. The three core symptoms are excessive daytime sleepiness, sleep paralysis, and cataplexy. 1 out of every 2000 people suffers, making it as common as MS. Cataplectic attacks (muscle atonia) are triggered by moderate or strong emotions. Resulting in the patient collapsing in front of you during an exciting event. Being surprised at any time can cause one to collapse. Usually still awake and can still perceive the world around them.

As the brain stem powers down at night, it removes its stimulating influence to the sensory gate of the thalamus. With the closing of the sensory gate, we stop perceiving the outside world, and fall asleep. The sleep-wake switch in the hypothalamus has a direct line of communication with the brain stem. It releases orexin to the brain stem to promote wakefulness, then brain stem then pushes open the sensory gate to the thalamus, allowing the perceptual world in. At night, the sleep-wake switch stops releasing orexin and the gate closes. Scientists have examined narcoleptic patients and observed a 90% decrease in the cells that produce orexin. The receptors are also significantly reduced. This is the reason they never have resolute wakefulness nor quality sleep. Teetering between states.

FATAL FAMILIAL INSOMNIA

No treatment, no cure. The anomaly of a gene called PrNP (prion protein). The protein begins targeting and destroying certain parts of the brain, resulting in rapid brain degeneration. The thalamus is attacked and the gate cannot close for sleep to begin. Seems to be genetically inherited.

SLEEP DEPRIVATION VS. FOOD DEPRIVATION

Rats will die after 15 days of sleep deprivation, on average. They also lost their lives just as fast from REM-sleep deprivation. Deprivation of NREM sleep was also fatal but took 45 days, on average. Despite eating far more during the studies they lost body mass, they couldn’t regulate their core body temperature (getting colder) with the metabolic rate increasing to compensate, and the immune system could not fight infections on the epidermis making wounds appeared. Creating complications ranging from fluid in the lungs, internal hemorrhaging, to ulcers puncturing the stomach lining. Organs like the liver, spleen, and kidneys decreased in size and adrenal glands enlarged. Corticosterone spiked in response. Septicemia from the rats’ own microbiome seemed to be the final blow.

NO, WAIT-YOU ONLY NEED 6.75 HOURS OF SLEEP!

Bad science communication. People reported that hunter gatherer tribes only slept up to 7 hours when they should have reported that they have 7-8.5 hour opportunity. They also used sleep monitoring watches, which aren’t completely accurate and overestimate wake time. The average lifespan of these hunter gatherers is only 58 so you can’t really compare them to us. What usually kills them is intestinal infection from a weak immune system, a consequence of bad sleep. They have limited food, occasional starvation, predators, longer foraging times, etc. Long periods of starvation is known to reduce sleep time.

IS SLEEPING NINE HOURS A NIGHT TOO MUCH?

There is a backward J shape related to death risk once the average sleep amount passes 9 hours. A problem with these excess sleep studies is that sicker individuals will sleep longer to combat cancer and infections.

Chapter 13 – iPads, Factory Whistles, and Nightcaps: What’s Stopping You from Sleeping?

THE DARK SIDE OF MODERN LIGHT

More than a third of our brain is devoted to processing visual information. Our activities would cease once the sun went down. After fire was harnessed, we were able to spend slightly more time around the campfire sharing stories, dancing, and singing. This increase in activity was minimal though as our circadian rhythm still demanded a routine. Gas and oil lamps were the beginning of altering our sleep patterns. In the 1870s, Edison began developing a mass-marketable lightbulb. Incandescent light bulbs and fluorescent bulbs following decades later. Blue LED lights were a recent achievement, and have twice the harmful melatonin suppressing impact as warm, yellow incandescent bulbs.

Our visible light spectrum is 380nm (cooler violet and blues)-700nm (warmer yellows and reds). Sunlight contains a blend of all these colors and everything in between. Scheduled tiredness would occur several hours after dusk, brought on by melatonin release to signal the end of the day. Artificial light fools the suprachiasmatic nucleus and prevents the release of that melatonin from the pineal gland. It tends to distort our inner clock by about 2-3 hours each evening. Artificial evening light can therefore masquerade as sleep-onset insomnia.

A recent survey of over 1500 American adults found that 90% regularly use some form of portable device around 60 minutes or less before bedtime. Another study found that by using an iPad 2 hours prior to bed blocked melatonin levels by 23%. Another study found that compared to reading a book, an iPad suppressed melatonin levels by 50%, delaying the rise by up to 3 hours. The iPad readers had less REM sleep, felt more restless and sleep the next day, and had a 90 minute lag in rising melatonin levels the following day.

TURNING DOWN THE NIGHTCAP-ALCOHOL

Alcohol is a sedative. It binds to receptors within the brain that prevent neurons from firing. It sedates parts of the frontal cortex earlier on and leads to impulse control and behavior restraint being hampered. Alcohol sedates you out of wakefulness but does not induce sleep.

The first effect of alcohol on sleep is that it fragments sleep with brief awakenings, that often go unnoticed. Alcohol is also a powerful suppressor of REM sleep. The aldehydes that are produced as alcohol metabolites block the brain’s ability to generate REM sleep. Alcoholics go long periods of time without dream sleep and create a REM pressure. Occasionally creating hallucinations, delusions, and gross disorientation as the pent-up REM sleep pressure erupts forcefully into wakefulness (delirium tremors). If the alcoholic abstains from alcohol their brain undergoes a REM-sleep rebound.

Participants that had been given alcohol forgot about 50% of the information the sober control group did. Even a group that got 2 nights of natural sleep before a 3rd night of being given alcohol lost 40% of information recall ability. The assimilation of complex knowledge during REM sleep was interfered with. Still vulnerable days later. You would be better off drinking in the morning so that the alcohol is metabolized before you go to sleep.

GET THE NIGHTTIME CHILLS

To successfully initiate sleep, your core temperature needs to decrease by about 2-3 degrees Fahrenheit (1C). The decrease in core temperature is detected by a group of thermosensitive cells situated in the hypothalamus. They deliver a message to the suprachiasmatic nucleus, which adds to the message of fading light, telling it to signal for more melatonin.

The face, hands, and feet have crisscrossing blood vessels, known as arteriovenous anastomoses, that lie close to the skin surface and have a large surface area. Meaning they are excellent at radiating heat to drop the core body temperature when they are warm. Dangling limbs outside the bed is a good way of cooling the body temperature by exposing the air to excess heat. Selectively warming those areas also brings blood to the surface, cooling the core, and making the person fall asleep 20% faster.

Industrialized cultures have severed their relationship with the natural rise and fall of environmental temperature with climate-controlled homes with central heat and air-conditioning, pajamas, and well insulated homes. Our brains do not receive the natural drop in evening temperature within the hypothalamus and our skin struggles to “breathe out” heat when the home temperature and pajamas prevent thermoregulation.

The typical bedroom temperature should be 65 degrees Fahrenheit (18.3C) assuming standard bedding and clothing. It will vary with age, gender, and unique physiology but this is a pretty standard temperature. Lower than 55F (12.5C) can be harmful to sleep unless warm bedding or nightclothes are used.

Hot baths can induce 10-15% more deep NREM sleep in healthy adults.

AN ALARMING FACT

Participants artificially wrenched from sleep by an alarm suffer a spike in blood pressure and a shock acceleration in heart rate caused by an explosive burst of activity from the SNS. Using the snooze feature means you repeatedly subject your body to the same threat over and over. This is a good reason why waking up at the same time everyday is a better alternative to using an alarm. It will help insomnia and generate a stronger circadian rhythm.

The usage of alarm clocks are a testament to our culture’s high stress environment, our obsession with economic productivity, a sign of our exhaustion, and over exposure to artificial light.

Our biased sensitivity to cool blue light is a vestigial carryover from our ancestral past of marine life. The ocean acts as a light filter, stripping away most of the longer, yellow, and red wavelength light.

Chapter 14 – Hurting and Helping Your Sleep: Pills vs. Therapy

SHOULD YOU TAKE TWO OF THESE BEFORE BED?

No past or current sleeping medications induce natural sleep. The older “sedative hypnotics” such as diazepam sedated you. The newer sleeping pills are weaker sedatives but target the same area of the brain as alcohol, knocking out higher function. The deep-sleep brainwave activity of an Ambien-induced sleep lacks the largest, deepest brainwaves. Side effects include daytime grogginess, daytime forgetfulness, performing actions at night while unconscious, and slowed reaction time that can impact motor skills.

The grogginess tends to make people consume more coffee, which makes it harder for them to fall asleep at night. Then they take more sleeping pills which perpetuates the cycle.

Another side effect is rebound insomnia. The brain alters its balance of receptors as a reaction to the drugs and you develop a dependency. Any benefits from “sleep” gained by these drugs are subjective and not objective. Both placebo and sleeping pills made participants fall asleep faster.

SLEEPING PILLS – THE BAD, THE BAD, AND THE UGLY

Natural deep sleep helps cement new memory traces within the brain, part of which require the active strengthening of connections between synapses that make up a memory circuit. Whereas Ambien-induced sleep caused a 50% weakening of the brain-cell connections originally formed during learning. A concerning result when you think about the amount of people under 25 who use them, even though their brains are still developing.

People who use sleep medication are also more likely to die and to develop cancer. 4.6 times more likely to die over a two-and-a-half-year period and it scaled with use. Those taking 132 pills per year were 5.3 times more likely to die over the study period. Occasional users (18 pills per year) were still 3.6 times more likely to die. Zolpidem (Ambien), temazepam (Restoril), eszopiclone (Lunestra), zaleplon (Sonata), and other sedating drugs, such as triazolam (Halcion) and flurazepam (Dalmane). A frequent cause of death is high rates of infection. Which natural sleep helps to decrease by boosting the immune system. Concerning as older adults are more vulnerable and make up 50% of sleeping pill users. Higher chance of car accident, falls at night, heart disease, and stroke are other causes. Not to mention the 30-40% increased risk of cancer during the two-and-a-half-year study period. Restoril had a 60% increased risk.

Sleeping pills themselves may not technically induce cancer. An explanation may be that individuals were suffering prior to the studies and that they worse off they were, the more they consumed. They probably do though… Ambien took 24 months to amass $4 billion in sales profit, discounting the black market. No study has shown sleeping pills to save lives.

DON’T TAKE TWO OF THESE, INSTEAD TRY THESE

Cognitive behavioral therapy for insomnia (CBT-I) has a patient work with a therapist for several weeks and are given techniques to break bad sleep habits and address anxieties that have been inhibiting sleep. Reducing caffeine and alcohol intake, removing screen technology from the bedroom, have a cool bedroom, establish a regular bedtime and wake-up time (even on weekends), go to bed only when sleepy and avoid sleeping on the ouch early/mid-evenings, never lie awake in bed for a significant time period; get out and do something quiet and relaxing until the urge to sleep returns, avoid daytime napping, reduce anxiety-producing thoughts and worries by learning to mentally decelerate before bed, and remove visible clock faces from view.

A more paradoxical method of CBT-I is to restrict time spent in bed, perhaps to 6 hours of sleep at first. This builds a greater sleep pressure – abundance of adenosine. Giving the patient a greater psychological confidence in being able to self-generate and sustain healthy, rapid, and sound sleep. CBT-I should be used as the first-line treatment for all individuals with chronic insomnia.

GENERAL GOOD SLEEP PRACTICES

First of all, go to bed and wake up at the same time of day no matter what. Younger, healthy adults who exercise frequently increase total sleep time, especially deep NREM sleep. Frequent exercise also deepens the quality of sleep, resulting in more powerful brain wave activity. Older adults also saw a great improvement in sleep time and efficiency. However, sleep quality would not change day to day, depending on the amount of exercise of that day. Poor sleep affects exercise performance though, rather than the other way round.

Try not to exercise before bed as this will increase your body temperature an hour or two afterwards.

Caloric restriction (less than 800 calories a day) makes it harder to fall asleep and decreases deep NREM sleep. Eating a high-carbohydrate, low-fat diet for two days decreases the amount of REM sleep dreaming, relative to a low-carbohydrate, high fat diet.

Don’t go to bed too full or too hungry, and shy away from diets that are excessively biased towards carbohydrates (greater than 70% of all energy intake).

Chapter 15 – Sleep and Society: What Medicine and Education Are Doing Wrong; What Google and NASA Are Doing Right

SLEEP IN THE WORKPLACE

Policies exist within workplaces around smoking, substance abuse, ethical behavior, and injury and disease prevention. However, insufficient sleep is tolerated and woefully encouraged. A study across four large US companies found that insufficient sleep cost around $2000 per employee per year in lost productivity. That amount rose to $3500 in those suffering the most serious lack of sleep. Across the board, this massively costs the country, robbing a developed country of approximately 2% of its GDP.

Employers often look for creativity, intelligence, motivation, effort, efficiency, effectiveness when working in groups, emotional stability, sociability, and honesty. All of which are disrupted by insufficient sleep. Shorter sleep amounts predict lower work rate and slow completion of basic tasks. Individuals who sleep less often, complain about having too much work and not enough time to sleep, which is probably due to them not being effective enough during waking hours and having higher rates of stress as a consequence.

Often unaware of their poor work effort and performance. Usually less productive, less creative, less motivated, less happy, typically lazier, and less ethical. Decisions become more emotionally volatile and rash. Employees sleeping less than 6 hours have been shown to be more deviant, more likely to blame other employees for their mistakes, more likely to take credit for other people’s work, and more likely to lie. There is also the case of social loafing”. Those who hide behind the work of a collective and slack off. Taking the selfish path of least resistance.

The lower the quality of sleep a supervisor got, the more likely they were to be more abusive towards the employees and to have less self-control. Employees became less engaged as a consequence. Under-slept managers and CEOs are less charismatic and inspiring. Sleep deprived employees will also find a boss less charismatic and inspiring too. If you want an honest, creative, and hard working environment you need everybody to be well rested. Pay rises usually go to those with more sleep too. Which is ironic since most people would trade sleep for a pay rise.

NASA realized that 26 minute naps improved task performance by 34% and overall alertness by 50%.

THE INHUMANE USE OF SLEEP LOSS IN SOCIETY

Some governments sleep deprive individuals as a form of torture. A bad practice as it degrades their mental faculties, making it difficult to extract accurate information, and creates a loss of memory recall and comprehension. Not to mention the increase in dishonesty, making false confessions 2-4 times more likely.

Long-term sleep deprivation elevates suicidal thoughts and attempts, further cultivates symptoms of depression and anxiety, increases the likelihood of cardiovascular events, genitals are rendered infertile, and the immune system is severely weakened. A barbaric form of mental and physical torture.

SLEEP AND EDUCATION

Children and teenagers are forced to get up and learn far earlier than their brains are capable of. This chronic sleep deprivation in adolescents makes them more susceptible to developing chronic mental illnesses, such as depression, anxiety, schizophrenia, and suicidality.

An experiment that deprived young and healthy participants of REM sleep ended up observing signs of psychosis by the 3rd day. REM sleep is what stands in between being rational and insane. Not a great sign when we expect teenagers to wake up during the most REM sleep rich hours. Terman found that no matter what the age, the longer a child slept, the more intelligently gifted they were.

A school that changed their start time by about an hour found massive improvements to their students’ SAT scores. Potentially changing their life trajectory.

Children from lower-socioeconomic backgrounds are less likely to be taken to school by car and must get up earlier. Perpetuating poverty across generations. Increasing sleep by way of later school start times improves class attendance, decreases substance and alcohol use, and protects teens from the “danger window” between 3-6pm, when schools finish but parents haven’t yet returned. Life expectancy also increased. Possibly due to less car accidents in teenagers aged between 16-18. One area pushed their start time out by an hour and reduced accidents by 70%. ABS only managed a 20-25% decrease and was deemed revolutionary.

An added reason for making sleep a top priority is the link between sleep deficiency and the increase in the diagnosis of ADHD. Symptoms of ADHD (irritable, moodier, more distractible, and unfocused, higher incidence of depression and suicide) are also associated with sleep deprivation. Adderall is an amphetamine with certain salts mixed in, and Ritalin is a similar stimulant called methylphenidate. Many sleep deprived children are misdiagnosed with ADHD and given wake inducing drugs. Child obstructive sleep apnea blocks the airway passage as their breathing muscles relax and result in an oxygen debt, which forces the child to awaken. This prevents them from obtaining adequate NREM sleep. Leading to the child becoming more ADHD-like over time. Sometimes tonsils get removed and their behavior improves. Based on recent surveys it is estimated that approximately 50% of those diagnosed as having ADHD actually have a sleep diagnosis.

SLEEP AND HEALTH CARE

William Halsted, founded the surgical training program at John Hopkins Hospital in May 1889. He influenced how young doctors practically live at the hospital by making them suffer long, consecutive work shifts. The thing was, he was also a helpless drug addict who believed sleep detracted from learning. Residents who worked 30 hours straight would commit 36% more serious medical errors compared to those working 16 hours or less. After a 30 hour shift those residents also made 460% more diagnostic mistakes in the ICU. During their residency 1 out of 5 would make a sleepless-related medical error that caused significant, liable harm to a patient. 1 in 20 would kill a patient due to lack of sleep. Medical errors are the third leading cause of death among Americans after heart attacks and cancer.

Young doctors are 73% more likely to stab themselves with a hypodermic needle or cut themselves with a scalpel, risking blood-borne infectious diseases after a 30 hour shift. Car accidents are also increased by 168%.

Senior medical professionals are 170% more likely to inflict serious harm if they were not able to acquire 6 or more hours sleep. Would you want a surgeon who has the impairments of a legally drunk person working on you?

Limiting residents to 16 hour shifts, with at least 8 hours rest opportunity before the next shift, dropped potential to cause harm by 20%. Furthermore, residents made 400-600% fewer diagnostic errors.

Chapter 16 – A New Vision for Sleep in the Twenty-First Century

Levels of Sleep Intervention: Individual->Educational/Interpersonal->Organizational->Public Policy/Governmental->Societal

INDIVIDUAL TRANSFORMATION

Tech should be able to measure sleep quality and temperature of each room and adjust itself over time, to match the ideal conditions of each person. Increasing total sleep time and deep NREM quality. We could even program the thermostat to change depending on the season and time of day. Matching circadian expectations.

Soon we should be able to engineer LED lights to match wavelengths that represent the time of day by filtering blue light. Matching them with wearable sleep trackers would enable the light to adapt to your rhythm.

Using predictalytics we could give people an estimate of Alzheimer’s likelihood, testosterone decrease, obesity, etc. depending on their sleep hygiene.

EDUCATIONAL CHANGE

Educate children on sleep hygiene and how it can improve their lives. This should improve following generations.

ORGANIZATIONAL CHANGE

Reward good sleep behavior. Lowers sick days, reduces deviance, and improves productivity. Or a sleep credit that can be spent on vacations or money. Calculating sleep total and continuity. Those with insomnia can be offered CBT-I.

Work hours should be a squished inverted-U shape. Everyone would be present between 12-3pm and there would be flexible tail ends on either side to suit chronotypes.

EXAMPLE I-PAIN

The less sleep, or the more fragmented your sleep is, the more sensitive you become to pain. An ICU is a good example of this. Those that are in the ICU are subject to unnecessary beeping, lights, and frequent testing that conflict with their circadian rhythms. Sleep is usually sporadic, REM sleep is low, and pain is perceived more acutely by the brain.

Morphine has safety issues related to cessation of breathing, dependency, and withdrawal. Side effects are nausea, loss of appetite, cold sweats, itchy skin, and urinary and bowel issues, not to mention sedation that prevents natural sleep.

Improving sleep conditions would lessen the dose for pain drugs, improve the immune system, lessen safety risks, reduce drug interactions, and decrease side effects.

Remove any unnecessary beeping equipment and alarms, educate doctors and nurses on the scientific benefits of sleep, ask the patients for their sleep schedule and try to adapt treatments to it, offer earplugs and sleeping masks, use dim, non-LED lighting at night and bright lighting during the day.

EXAMPLE 2-NEONATES

To prevent instability of body temperature, respiratory stress, weight loss, and high rates of infection leading to cardiac instability, neurodevelopment impairment, and death, sleep is essential. However, most neonatal units have bright lights on throughout the night. In several NICUs that restricted light with a cot cover they found a 50-60% improvement in neonate weight gain and significantly higher oxygen saturation levels in the blood. They were also discharged 5 weeks earlier.

PUBLIC POLICY AND SOCIETAL CHANGE

Better public healthcare campaigns and awareness efforts. Maybe even lower health insurance for those that can demonstrate good hygiene. Semiautonomous vehicles that can detect drowsiness.

Appendix: Twelve Tips for Healthy Sleep

• 1. Stick to a sleep schedule. Go to bed and wake up at the same time each day. As creatures of habit, people have a hard time adjusting to changes in sleep patterns. Sleeping later on weekends won’t fully make up for a lack of sleep during the week and will make it harder to wake up early on Monday morning. Set an alarm for bedtime. Often we set an alarm for when it’s time to wake up but fail to do so for when it’s time to go to sleep. 
  2. Exercise is great, but not too late in the day. Try to exercise at least thirty minutes on most days but not later than two to three hours before your bedtime.
  3. Avoid caffeine and nicotine. Coffee, colas, certain teas, and chocolate contain the stimulant caffeine, and its effects can take as long as eight hours to wear off fully. Therefore, a cup of coffee in the late afternoon can make it hard for you to fall asleep at night. Nicotine is also a stimulant, often causing smokers to sleep only very lightly. In addition, smokers often wake up too early in the morning because of nicotine withdrawal.
  4. Avoid alcoholic drinks before bed. Having a nightcap or alcoholic beverage before sleep may help you relax, but heavy use robs you of REM sleep, keeping you in the lighter stages of sleep. Heavy alcohol ingestion also may contribute to impairment in breathing at night. You also tend to wake up in the middle of the night when the effects of the alcohol have worn off.
  5. Avoid large meals and beverages late at night. A light snack is okay, but a large meal can cause indigestion, which interferes with sleep. Drinking too many fluids at night can cause frequent awakenings to urinate.
  6. If possible, avoid medicines that delay or disrupt your sleep. Some commonly prescribed heart, blood pressure, or asthma medications, as well as some over-the-counter and herbal remedies for coughs, colds, or allergies, can disrupt sleep patterns. If you have trouble sleeping, talk to your health care provider or pharmacist to see whether any drugs you’re taking might be contributing to your insomnia and ask whether they can be taken at other times during the day or early in the evening.
  7. Don’t take naps after 3 p.m. Naps can help make up for lost sleep, but late afternoon naps can make it harder to fall asleep at night.
  8. Relax before bed. Don’t overschedule your day so that no time is left for unwinding. A relaxing activity, such as reading or listening to music, should be part of your bedtime ritual.
  9. Take a hot bath before bed. The drop in body temperature after getting out of the bath may help you feel sleepy, and the bath can help you relax and slow down so you’re more ready to sleep.
  10. Dark bedroom, cool bedroom, gadget-free bedroom. Get rid of anything in your bedroom that might distract you from sleep, such as noises, bright lights, an uncomfortable bed, or warm temperatures. You sleep better if the temperature in the room is kept on the cool side. A TV, cell phone, or computer in the bedroom can be a distraction and deprive you of needed sleep. Having a comfortable mattress and pillow can help promote a good night’s sleep. Individuals who have insomnia often watch the clock. Turn the clock’s face out of view so you don’t worry about the time while trying to fall asleep.
  11. Have the right sunlight exposure. Daylight is key to regulating daily sleep patterns. Try to get outside in natural sunlight for at least thirty minutes each day. If possible, wake up with the sun or use very bright lights in the morning. Sleep experts recommend that, if you have problems falling asleep, you should get an hour of exposure to morning sunlight and turn down the lights before bedtime.
  12. Don’t lie in bed awake. If you find yourself still awake after staying in bed for more than twenty minutes or if you are starting to feel anxious or worried, get up and do some relaxing activity until you feel sleepy. The anxiety of not being able to sleep can make it harder to fall asleep.