It is not often that I have the chance to look to Shakespeare for medical guidance. After all, eyes of newts, frog toes and dragon scales are not as popular as they once were. The bard’s weary Dane famously opined, “To die, to sleep, to sleep perchance to dream: ay, there’s the rub, For in that sleep of death what dreams may come when we have shuffled off this mortal coil…” thereby equating sleep with death. For all the troubles people have with getting a really good night’s sleep, might they somehow be thinking the same thing? Despite Hamlet’s eloquence, he has it exactly backwards. Sleep is restorative, enlivening and death-defying. A University of California, San Diego study of more than one million adults found that people who live the longest report sleeping for at least six to seven hours each night. Further, Researchers at the University of Warwick and University College London have found that lack of sleep can more than double the risk of death from cardiovascular disease.
It is actually true that 8 hours of nightly sleep is the standard and for good reason. Proper sleep is absolutely necessary for physical, mental and emotional functioning. Furthermore that 8 hours must be continuous. Sleep deprivation is more than just less hours of total sleep. Interrupted sleep also causes problems. From the body’s perspective, two 4 hour segments with a waking bit in between does not count as 8 hours, but rather as 4 hours. A 4 hour segment followed by 3 and 2 hour pieces also only counts as 4 hours sleep. This is because there is a cyclic pattern of several critical stages of sleep throughout the night. Each stage has distinct physiological functions. Interruption derails that well orchestrated arrangement, to the detriment of health and brain function. Just because someone is not conscious does not mean their sleep is fulfilling its physiological restorative functions. That is evident when a person still feels tired after what seems to be sufficient hours of sleep. More on this when I discuss sleeping pills in part two.
Few of us need to be told what happens when someone is sleep deprived, even by several hours. We all have experienced it first hand. Sleep deprivation alters brain waves resulting in shortened attention span, higher anxiety, impaired memory, and simply put, a grouchy, irritable, snappy, impatient mood. Additionally there are diminished abilities to perform high-level cognitive functions. That is just a fancy way of saying that we can’t think, recall or problem solve as easily. The immune system is also impaired, making the bad sleeper more likely to contract infections. I have often seen people under deadlines skip or loose sleep to reach their goal, only to get the flu or a cold near the finish line, thereby causing more delay than it they keep good sleep habits to begin with!
What actually happens during sleep that makes it such an essential part of good health? When asleep, our brain removes metabolic waste products at a faster rate than when we are awake. During wakeful active time, we make chemicals that are damaging to cells. In sleep, as our overall metabolic rate decreases, we make more molecules that help repair and protect the brain from these harmful chemicals. That is only one aspect of the vast array of benefits of sleep.
During the waking hours, gazillions of bits of sensory info come into the brain from our 5 senses. Our brain takes each one, stores it, compares it to previous stored information, analyzes it, has thoughts about it and generally makes use of it. Then the brain must store all these secondary analyses. All this is a lot of activity. In fact, while waking our brain uses 20% of our calorie consumption.
Think of this process this way – imagine someone at their desk at work. All of this new information is like incoming business calls. In order to process the call, the business person pulls down the chart of pre-existing calls and interactions, finds books related to them and the topic, as well as other charts of people related and so forth. Notes are made for each area. After the call, there is a desk full of stuff needed for the calls. Then another call comes in and the whole cycle happens again. This goes on all day long, call after call. By the end of the day, the desk is full of papers, notes, files, books and references, jumbled together in a mess. The shelves have many empty spots where the books and charts used to be.
During the night, the cleaner comes in and puts all the papers in the right charts, replaces the books and charts and tidies everything up. When the businessman returns the next day, everything is in proper order, ready to start the day. Imagine what would happen to the ability to function at all, let alone efficiently, if the cleaner did not perform his tasks at night while the businessman was away! He would be spending most of his day riffling through papers, charts and books looking for what he needed because nothing was in the right place.
A similar cleaning and organizing process occurs during sleep. All the information that we take in during our waking hours must be collected, connected up to pre-existing memories and analyzed, all of which must be stored in the right places. Waking up with “new” or “inspired” thoughts and ideas is a result of this night time organizing process.
Without proper sleep, we are attempting to start our day with a “messy desk” in our brain. It is no wonder that when sleep deprived, we forget things, get confused and can’t function as well. Chronic sleep deprivation multiplies the problem.
Yet, despite centuries of personal experiences in millions of people that support the need for good sleep, understanding of the exact nature of sleep and how it works still remains a mystery. It is hardly reassuring that after 50 years of research, when William C. Dement, founder of Stanford University’s Sleep Research Center, was asked what he knew about the reason people sleep, he answered, “As far as I know, the only reason we need to sleep that is really, really solid is because we get sleepy.”
Even if we don’t know how we get sleepy, the need for sleep is clear. I can hear many of you make the all too common lament, “I would love to have a good night sleep, but I just can’t seem to manage it.” In the next article, I will discuss some of the ways you can increase your ability to obtain that elusive but precious sleep – “to sleep perchance to dream.”
©2016 Linda Johnston, MD