There’s More to Sleep than Shuts the Eye: Waking Up to All that Sleep Does for Our Health & Well-Being


Every day for most people, something mysterious begins to take shape that still defies scientists in these times.  Although the primary reasons for most basic bodily functions, such as eating and moving, have been known for centuries — sleep, or also known as slumbering or snoozing or napping or crashing — still remains an enigma in many ways.  Yet, there is no single activity that we do more in our life.  It is largely controlled by two bodily systems and one earthly one.  One, the circadian rhythms and sleep/wake homeostasis of our body, tells us that the longer it has been since we slept, the more it is time to close our eyes.  And two, the less light that we perceive, the more our brain (largely through the use of melatonin) tells us it is time for bed.  The average person will sleep for 25 years in their lifetime.  Infants typically sleep average between 14-15 hours a night.  Toddlers spend half of their day horizontal.  Even by the time our kids reach school age, we hope that their daily hours of sleep reaches double digits.

Although researchers acknowledge that there is much to learn, what we do know increasingly sends one clear message.  Sleep is vastly more than simply rest and quietness.  It makes sense.  Why would the human body spend a 1/3 of its time doing something unnecessary?  In 2013, an article was published in the journal of Scientific American entitled, Sleeps Role in Obesity, Schizophrenia, Diabetes…Everything  In it, the authors provide an overview of the growing mountain of studies that point to the amazing potential, and significant risks, associated with different sleep patterns.  Studies (e.g., Chase & Pincus, 2011) have long shown that roughly 90% of people diagnosed with anxiety disorders report sleep-reported problems, the latter potentially causing or worsening the former.  We know that ADHD rates are higher in kids with poor sleep.  We know that psychologically healthy kids look a lot like those diagnosed with ADHD when they are chronically sleep deprived (Paavonen et al., 2009).  If you take kids with obstructive sleep apnea and ADHD symptoms and remove their tonsils and adenoids, the improvement in attention is typically much better than using medication. Shortened sleep duration in young kids is associated with a lifelong risk for obesity (Bell & Zimmerman, 2010).  Long-term sleep deprivation mimics psychosis in healthy individuals.  If you have sleep apnea, your risk for depression is fivefold; if you have depression, the risk of apnea is fourfold.

But sleep is not just about warding off disease and disability.  Good sleep is associated with learning better and remembering more.  It appears that our memory is better if we “sleep on it.”  Taking naps after learning tasks results in greater recollection and retrieval than staying awake.  Dreams, long the source of so many conjectures and theories, appear to not necessarily recreate what actually has happened, but create scenarios about events and tasks that likely serve many purposes.  All of us, including athletes, (especially those in intense, ongoing training) often depend on sleep, including recovery naps, to repair the body.  Exercise often improves sleep.  Sleep often improves exercise.  Roughly two-thirds of our growth hormone, which is involved with muscle development, is secreted during sleep.  Sleep helps control when we feel full, and when it is time to eat in order to prepare for the day.  Sleep appears to regulate our blood sugar.  Studies suggest that going to bed earlier can help make a diet more successful. Even the types of foods and drinks we consume can significantly affect our sleep.

As we get deeper into the mystery, we know that not all sleep is created alike.  There are stages of sleep, and patterns of sleep. Very simplistically, there are five primary stages of sleep—stages 1-4 and the Rapid Eye Movement (REM) phase.  Stages 3 and 4 are considered deep, slow-wave sleep.  The average child gets most of his deep sleep in the first three hours of the night (which diminishes as we get older).  That is when issues, such as sleepwalking and sleep terrors, usually occur.  Kids really aren’t awake when this happens and therefore, can’t remember a thing next morning.  On the contrary, REM sleep, usually occurs for children after the 3rd hour and increases as the night goes on.  This is when nightmares typically arise, which may wake the child up and leave memories in the morning.  And somewhere in the night, we all have a “point of singularity”, which nearly coincides with where our body temperature reaches its lowest point.  At this juncture, our core temperature begins to rise, cortisol secretion increases, and the proportion of REM sleep grows.  Unbeknown to us, it is as if our body begins to prepare for another day.

For many, the science of sleep might be liable to, well, put them to sleep.  But the further into the spindles we get, the more astounding and captivating it becomes.  As Dr. Ruben Naimen noted in her book, Hush:  A Book of Bedtime Contemplations, sleep becomes less about something we do, and more about who we are and the rhythms that we feel.  It seems there is a psychophysiological, meta-physical, even spiritual nature to it all.  Yet unfortunately, sleep appears to have become one more marketed commodity.  In past two decades, artificial sleep aids have sharply risen (NCHS, 2013).  Market research between 1998-2006 indicated sleep aid prescriptions for young adults (ages 18-24) had tripled (Russo, et. al, 2008).  They come by many names, on and off label, prescription and over-the-counter, medication and supplement.  But all concoctions used are intended to onset or enhance sleep, or completely sedate the people who use them.  Meanwhile, many researchers suggest that 80-90% of sleep difficulties could be address through cognitive, behavioral, and lifestyle changes.  Recently, the American Academy of Sleep Medicine (AASM) weighed in on this discussion through a document entitled Five Things Physicians and Patients Should Question. Advice #2:   Avoid use of hypnotics as primary therapy for chronic insomnia in adults; instead offer cognitive-behavioral therapy, and reserve medication for adjunctive treatment when necessary.  Advice #3:  Don’t prescribe medication to treat childhood insomnia, which usually arises from parent-child interactions and responds to behavioral intervention.

The great irony is that despite all our attempts to augment sleep, we are slumbering less than we did just a century before.  Twenty percent less.  There are many arguments why.  Maybe our biological systems are evolving.  Maybe our 24/7 culture and the lure of incessant media and bright lights, whether of a mobile screen or the conventional tube, are just too alluring.  Maybe we think we can “beat the system” and get by just fine without adhering to time-honored needs.  Years ago, I got to know a father who swore he didn’t need any more than 4-5 hours of sleep a night.  He was forty pounds overweight, anxious, irritable, divorced, and felt his only child was slowly parting from him.  I challenged his assumptions about his need for sleep, and mused with him what just a couple of more hours a night could do for his quality of life.  I am not sure if he ever saw how more darkness could lead to more light.

And maybe, just maybe, we simply don’t value sleep like we do so many other things.  I cringed a few years ago when I read a blog written by someone about how to truly be a successful professional.  One of the messages was simple:  get used to living with less sleep.  It seemed like a falsity laden with strong undertones that went well beyond the zzz’s.  It echoed of a message we hear elsewhere, which proclaims that whatever we could find outside of ourselves—money, status, power—is well worth sacrificing what we can find within.  Of course, what he forgot to mention was that even if the false promise was true (which it is not), it is only plausible for the few that could make it as he aspired.  Sleep, on the other hand, is given to everyone, even though for some it seems like a nightmare, not a remedy.  As a father, I never knew just how much I loved my sleep until my first kids were born.  There are times when sleep might just be the most important and productive part of my day.

It is time to reclaim the value of the Betty White party, or counting our sheep, and just getting some old- fashioned shut eye.  It is time to stare down the screen and let it know that the bed is calling.  I think we would all be happier, and really not miss a thing.  And better yet, I (and many others) think that when the demands of the day do come calling, striving for optimal sleep will only allow us to be more productive, healthier, more patient, and more loving than before.  And it could all be free.

* * * * *


Bell, J.F. & Zimmerman, F. J (2010).  Shortened nighttime sleep duration in early life and subsequent childhood obesity.  Archives of Pediatric & Adolescent Medicine, 164, 840-845.

Chase, R. M., & Pincus, D. B. (2011). Sleep-related problems in children and adolescents with anxiety disorders. Behavioral Sleep Medicine, 9, 224-236. doi: 10.1080/15402002.2011606768

Russo A, Miller K, Marder W. Prescription sleep aid use in young adults. Thomson Reuters Research Brief. 2008.


For more sleep tips, especially for youth, check out the following link:



Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.


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  1. Hi James,

    There is a strong link between lack of sleep and mania/psychosis. Psychiatrists say that if you’re manic you have a reduced need for sleep but I think it’s the other way around i.e. lack of sleep can cause mania.

    This link has been noted for centuries …

    Immannual Kant said “The lunatic is a wakeful dreamer.”.

    Arthur Schopenhauer said: “A dream is a short-lasting psychosis, and a psychosis is a long-lasting dream.”

    There is a set of 3 interesting video’s on YouTube, called “Pillow Talk” by Dr Russell Foster. Here’s a link to the start of the series, cutting out the first 17 minutes of intro:

    Well worth watching, especially about the link between sleep deprivation and bipolar/schizophrenia.

    Dr Foster is a Professor of Circadian Neuroscience, and he takes certain assumptions from Psychiatry (e.g. that Schizophrenia is a detectable brain disease) but his findings are really interesting.

    I am convinced that mania/psychosis can be avoided if you get enough sleep, at the right time (syncing up your circadian rhythm to daylight), and of the right quality (not induced by sleeping tablets, which interfere with sleep cycles).



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    • Hi Mike,

      I appreciate the additional resources. I think we are still just beginning to understand the connection between sleep and mental health issues, and also as you noted, just how synchronizing our sleep with natural markers, such as the seasonal light cycle, may be of benefit. I didn’t include it in my article because I struggled to come across the citation, but a couple of years ago I came across a study that indicated that pregnant women whose sleep synchronized better with the seasonal light cycle had infants who slept better. I will be interested to check out the additional video you provided.

      Thanks for your interest.

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        • By the way, there’s a free program called f.lux which automatically tunes colors of your computers screen when the sun sets and rises, based on where your location is. I reduces blue light of the screen when the sun goes down, etc. It available for free for many different operating systems, such as Windows, OS X and Linux and also some mobile devices. Here:

          Currently here in Helsinki, when I’m at work, it goes yellow already soon after 15:00 or so already, but it has a button “disable for an hour”. I may need to press it a couple of times again, but it’ll get better from now on. 😉

          Some ebook readers also these days have options to invert colors to white on black. For instance, the new iOS for iPad and iPhone has iBooks that can switch those colors automatically when you’re in dark, so that in a dark room the background is black and text white.

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          • Also, I live so north, in Finland, that I can’t just stay in bed most of the day, at least if I work at the same time, in order to “synchronize my sleeping schedule with natural cycles”. I have at least these three tools that I think help be during these long and dark winter months:

            1. A “wake up alarm-clock light” that gradually increases the level of light for 30 minutes before the alarm. Then at full light, it outputs sounds of birds chirping, some slightly new ageys tunes, or plain old radio.

            2. At table, when having breakfast, I have a designed “bright light” on.
            3. I think at evenings, this f.lux appilication and other similar techniques are useful.

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          • Hermes,

            You bring up a really important point for the many people that live in parts of the world where the light cycle is skewed in one direction or another, especially studies have indicated increased risk of negative mood, anxiety, and even suicide in these regions. Increasingly, there are tools such as you have mentioned to provide the appropriate light needed and hopefully others will look to access these more appropriately when natural light is not available regularly.

            Thanks for weighing in on this.

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          • One way to improve your mood is to try to spend more time outside during winter season. Which is of course impossible for most working people. Some of it can be compensated by installing the natural light spectrum lamps – they can really make a tremendous difference but are quite expensive.

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          • B, I really agree with your comment about spending time outside during winter. Although I don’t have clear research at hand to cite, I feel that part of the winter blues people feel is not just related to change in temperature/light, but also increased sedentary activities because many do not like getting out in the cold and exercise. I can’t tell you the number of people over the year that have described this as a deterrent

            And yet we are fortunate to live in an age where there is clothing for all seasons no matter how harsh, and are bodies are remarkably adapted to provide warmth, especially during vigorous activities. For me personally, I bike to work year round no matter what the temps are (unless ice and snow cover the roadways) and really prefer to run in the winter temps/precipitation more than any other time of year. There is something deeply moving, deeply spiritual about the quietness and isolation that winter can provide, and nothing spurs thankfulness for a warm place like being in the cold

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          • B, and James, I think that in general for my strength regular exercise has been even more useful than those tools that have to do with light. I live in a place where I’m close to the Helsinki centre, but there’s woods right next to where I live, and I’ve taken it as a habit to go out there in woods after work for an hour, whenever I can. It took some time of habit forming, study on habit forming and so on, but now I love it. It’s amazing how much you actually can change, train your body and so on. I was the biggest nerd who hated anything to do with exercise when I was a kid. 🙂

            I’m actually now interested in hiking quite light-weight in different kinds of areas. I’ve decided I’ll go out to test my clothes in any kind of weather, I’ve been practicing trail running for some time, and now I bought trail running shoes with spikes in them for winter running. 🙂

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          • Awesome, Hermes. I love the idea of experimenting with different types of weather and learning to not only tolerate it, but embrace it. You might have noticed, but trail running and ultramarathons have become a certain passion of mine. You might be interested in my article “In Search of a Hundred Miles of Gratitude” – the first part is on MIA, but the whole series is on my column (June 2014) under the same title at the following link:


            Hope you have a good trail run today or tomorrow. I had a really enjoyable one yesterday with a couple of good friends on the grounds where Abraham Lincoln grew up

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          • James, I’m ashamed to admit I haven’t read your other articles. I didn’t know you’re a trail runner or marathoner. I came in this thread only to talk about the light issue. In any case, I’ll check your other threads! I’m really just getting in these new worlds of train running, and also ultra-light trekking. I’m a life-long nerd that’ll be 40 soon. I know I can conquer the nature as well, or maybe the nature will conquer me, but I hope I’ll enjoy the experience!

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    • James,

      As one who was diagnosed with sleep apnea a year after finishing my psych med taper, I am wondering how mental health professionals screen for sleep disorders? As you alluded to with the kids and ADHD, many adults were misdiagnosed with psych disorders when they turned out to have sleep apnea.

      To elaborate on Duane’s point regarding sleep clinics, before referring a patient for I-CBT with insomnia, they should be automatically screened for sleep breathing disorders and a sleep history should be taken. If someone is suffering from sleep apnea/UARS, doing CBT would be an exercise in extreme futility.

      Duane, dental devices work best for mild and moderate apnea and not as well for people in the severity range. So it is important for folks to be aware of that when choosing a treatment. Another disadvantage of dental devices is that the effectiveness can’t be consistently monitored as it can be with pap machines.

      They are certainly a useful part of treatment, particularly if someone can’t tolerate pap therapy. But at the same time, besides the difficulties in monitoring the effectiveness of treatment, they aren’t without other problems. As with sleep doctors, screen sleep medicine dentists very carefully because there is a difference in quality since so many of them get into the business to make a quick buck.

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    • Yes, I so wish that people wouldn’t ignore, or be fearful of having a sleep evaluation. As AA noted below, there are issues with sleep med as with any other discipline, but the value of a good sleep history, or a polysomnography or MSLT if needed, can be huge, especially for someone who has OSA issues. And then utilizing sleep hygiene, stimulus control, and/or CBT if needed, is such a better road to go than diving immediately into artificial sleep aids. But, as always, these steps require commitment and follow through in a way that filling a prescription does not.

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      • James,

        Forgive me for my manners but I forgot to thank you for your reply to my question about mental health professionals doing to sleep evaluations.

        Regarding your above points about people fearing sleep evaluations, that is true but at the same time, many people on apnea boards spent years on psych meds only to find out they had sleep apnea. Additionally, many people stated that they constantly complained to their physician about sleep only to be blown off for years. So I think it may be a little unfair to blame the patient even though I am sure that wasn’t your intention.

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        • Not my intention to blame, just a hope and an observation in regards to being able to seek out what we all need to be healthy. But I certainly understand how people’s negative experiences affect treatment seeking in other areas. And as I noted in my prior comments, it is unfortunate that many providers do not take sleep concerns seriously, especially again given the irony of just how much of our life sleep dominates for important reasons.

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  2. I was initially put on a neuroleptic for questioning a dream, dream queries aren’t actually “mental illnesses.”

    But I’m quite certain the psychiatric industry knows proper sleep is important. My misdiagnosing psychologist claimed in her medical records that I had sleeping problems. My psychiatrist and neurologist claimed in their medical records that I had sleeping problems. Even a school social worker accused me of forcing my child to “stay up nights studying, and pushing him too hard,” after she was she embarrassed that a child who hadn’t been noticed by the school system when he was young to be gifted, got 100% on his state standardized tests in eighth grade (be had trouble in school after being abused at a disgustingly young age).

    What’s odd is I hadn’t ever had any sleeping problems, and I was a “mean mom” who had my kid in bed by 9. And my child’s “intelligence problem” was a genetic “problem,” not one caused by me pushing him to hard by keeping him up nights.

    The story of my sweet dreams is, in part, that I have a “dreaming out loud” problem. And what’s odd is my medical records imply my doctors all had odd delusions I wasn’t sleeping, and may have been drugging me based upon the grandiose story of my dreams.

    What if all those on the internet making films about how we will all some day hopefully “awaken as one” are onto something? And the psychiatrists theories that defaming and tranquilizing all who dream, think, and find value in their own gut instincts is “appropriate medical care,” are wrong? I’m glad you point out the importance of dreams, but please inform other psychiatrists that dreams are not “psychosis.”

    And please also consider the importance of the psychiatric industry getting out of the business of covering up sexual abuse of children by defaming and torturing victims with their drugs – it has been confessed to me this is the “dirty little secret of the two original educated professions.” “Dirty little secrets” are called such because they are inappropriate behavior, and truly quite inappropriate and unseemly. 85% of “schizophrenics” are actually people who had dealt with traumatic childhood experiences.

    Please work towards getting the child psychiatric practitioners out of the business of covering up sexual abuse of children by defaming and torturing the victims.

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    • I am going to tie AA’s question about how MH professionals screen for sleep –

      “As one who was diagnosed with sleep apnea a year after finishing my psych med taper, I am wondering how mental health professionals screen for sleep disorders?”

      and also further thoughts about your comment that “but I’m quite certain the psychiatric industry knows proper sleep is important.”

      Sadly, I first must admit that my training in sleep was minimal at best until I took on a role at a sleep clinic in a pediatric hospital. It was only then that I began to acquire much more knowledge through my own seeking, and that I learned from ENT, neurology, and other specialties. I would love to believe that the psychiatric industry knows proper sleep is important, but if even if they know (which some do not), this often does not often translate into practice. This also goes for our pediatrician colleagues. In a survey published by Mindell & Owens in 2005, they found that 20-40% of pediatricians and family physicians did not screen for sleep issues in a well-child visit, which is pretty amazing that toddlers are supposed to sleep half of their day. I hate to say it, but I would believe that these numbers are similar for psychologists and psychiatrists.

      In screening for sleep issues on my end, it first involves taking a history of various issues that related to onset/ending, snoring, night awakenings/parasomnias, excessive daytime sleepiness, health issues, bedwetting, etc… I then ask about other factors (e.g., diet, media/technology use, bedtime routine, etc… that may be affecting sleep onset or quality). Then, if needed, I utilize a sleep log, and if all of this still raises questions about a possible OSA or narcolepsy, then I refer on our accredited pediatric sleep lab for a further intensive study

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  3. Actually, dreams can be psychotic.

    Psychosis just means not being in touch with reality.

    Psychosis in a dream is perfectly normal, a consequence of the brain reorganising memory.

    An interesting point is that everyone is regularly psychotic, as everyone dreams.

    Psychosis as a diagnosis is only when you appear to be awake but have such thoughts.

    Psychiatrists should not be diagnosing people based on their dreams.

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    • “Psychiatrists should not be diagnosing people based upon dreams,” exactly my point, but they are. They are also whacking people out of their minds on hypnotic drugs, then using what one may or may not have said while on the hypnotic drug, against them. And they have odd delusions they can judge a person based upon what that person says while whacked out of their mind on nine drugs, all of which have major and moderate drug interaction warnings with each other. The psychiatric practitioners are insane, and unjust.

      But I now understand, historically and still today, a primary function of the psychiatric industry is covering up easily recognized iatrogenesis for the incompetent doctors and child abuse for the religions. But is it really in the best interest of all within a society to have an industry that provides these services for the incompetent medical “professionals” and paternalistic, child abuse covering up religions? I think all within society would be better off if the incompetent doctors were forced out of the profession and the child molesters were put in jail, irregardless of their profession.

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    • Mike, I absolutely agree with your final line. Psychiatrists or any other MH professional should not be diagnosing people based on their dreams. Dreams are one of the most enigmatic, and likely misunderstood, part of our being that exist. As I noted in my piece, they likely serve an organizing or processing function, but I think that it is safe to say we may never fully understand their purpose or representation of what we do in our wakefulness

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