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.
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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: http://www.stmarys.org/related-links
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.