Forget A, B, and C. Let’s skip to the end of the alphabet where Z stands for Zombie. If we’re being honest, most of us occasionally feel like a zombie from sleep deprivation.
Because the detrimental effects of inadequate sleep are so easily felt, we wanted to know how critical sleep is for overall health and to get some tips on getting enough — and good quality — sleep.
Wesley D. Head, M.D., F.C.C.P, Fellow, American College of Chest Physicians, American Thoracic Society, American Academy of Sleep Medicine, and the Society of Critical Care Medicine chatted with us and offered the following advice and commentary.
Pulse: How much quality sleep does a person need each night?
Dr. Head: I’m glad you specified “quality sleep” in your question, because that assumes that we are talking about normal sleep. If someone has a sleep disorder like sleep apnea, then the recommendations for normal sleep don’t work. If someone has ineffective sleep, that is, the sleep one gets does not do what it is supposed to, then the body’s sense of its sleep needs are thrown off.
But if we are talking about normal sleep and how much you need, the simple answer is you should sleep as much as you want too. Your brain knows how much sleep you need and you should let it. That surprises people as they think they would then sleep all the time but really they won’t. Sleep is a natural need like breathing or your heart beating, and we don’t try to regulate how much we breathe or how fast our heart beats. Sleeping in our society is thought of like overeating or being lazy, when really we should think of protecting our sleep like we value our breath or our heartbeats.
So, you should really sleep as much as you want. You can judge how much sleep you need on the last part of a vacation, after you have caught up on your initial sleep debt in the first few days, and then have settled in to what your body likes. You should not intentionally shorten your natural sleep time. If you want to use an alarm clock to prevent accidentally oversleeping through work, that’s OK, but if your alarm gets you up an hour or more before you would naturally get up, you are depriving yourself and you need to go to bed earlier. This is making the amount of sleep you need a priority. This is not brain surgery. It is, however, brain care.
People are hung up on numbers, so if you need a benchmark, the CDC has recommendations- 7-9 hours for adults, 8-10 hours for teens, 9-11 hours for school-aged and even more for younger children. You see there is a range there, and there is variation, but not as much as people think. Some people claim they can get by on five or less hours sleep, but those that really need that little are exceedingly rare. Most people are really sleep-deprived at those levels.
Since this is back to school time, we should talk about teens in particular. Besides having a need for up to ten hours of sleep, teens also suffer from what we call phase delay- their natural sleep cycle is shifted to go to bed later and get up later- as every parent knows. This is confounded by schools that start earlier and earlier- which seems to be to make school schedules agree more with parents’ work schedules. Combine teens that can’t go to sleep until late with earlier start times with sleep needs of up to ten hours and you have the result of a generation of increasingly sleep-deprived teens, with the adverse health effects that go beyond just being sleepy in class. There are policy initiatives that advocate for later school start times for high school and I am fully supportive of them.
Pulse: What are the benefits of adequate sleep?
Dr. Head: Up until a couple of years ago, we really had a poor explanation of why we need to sleep at all. We knew it was important, and we knew you suffered without it, but what sleep actually did was very poorly understood. If you look at the literature from 10 years ago there are all kinds of cockamamie theories about why we sleep- that sleep evolved to force immobility to protect animals from predators, or that it forces animals to conserve energy, or other equally specious theories. All BS. The big breakthrough was a couple of years ago when researchers found that during NREM sleep, the brain cells actively shrink so the fluid around them can flow much faster to flush metabolic waste out of the brain into the cerebrospinal fluid. Just like the kidneys clean waste from the blood, sleep cleans the waste out of the brain. But the kidneys work all the time, and the brain can’t take out its trash while it’s working. It must be offline, just like a computer’s hard drive can’t be repaired while it is the boot disk running a computer. And that is what separates sleep from all other bodily functions- it must shut down consciousness to do its job.
So since sleep is when the brain cleans out the garbage from its daily work, if we don’t let it take [care] of itself, we are making these waste products build up in the brain tissue. Waste products that evolution has unequivocally demanded that all neural tissue be protected from by imposing tremendous vulnerability to allow it to be removed- from worms and insects up to humans. Sleep takes time to do its work, and so far, we haven’t found a way to speed it up.
Pulse: What are the harms of poor sleep?
Sleep research is exploding with associations between all sorts of ailments and poor sleep. The obvious problems of being sleep deprived are being recognized more and more. Businesses are now looking at “presenteeism” as opposed to just absenteeism- employees make it to work to be present but are not working productively due to being excessively sleepy. It seems new detriments to health beyond being just sleepy are being found every month. Sleep disorders are increasingly linked to heart disease, stroke, diabetes, obesity, dementia; the list grows with every journal I get.
Pulse: What are your recommendations for getting a good night’s sleep? Do you advise anything special above and beyond the generally recognized good sleep hygiene habits?
Dr. Head: The sleep hygiene recommendations are all good, and many people have already read up on them by the time they come to see me. The best rule of thumb is to use your bed for sleeping and sex, and get out of it if you’re doing something else. Having a cool room is more important than people realize. A programmable thermostat to significantly drop the temperature is really helpful. I think the comfort of the bed is probably over-emphasized, and I rarely recommend people get a new bed, much to the mattress industry’s distress. I have found personally that pillows can make a difference and are worth investigating.
Caffeine is one of the first things to look at if you are having sleep problems. People are very variable in their sensitivity to caffeine- some people can’t have any after breakfast or it affects their night’s sleep, while others are seemingly almost immune to it. If you are having sleep problems, cutting out afternoon caffeine is a must- its effects can last much longer than people realize.
Controlling light is very important- the room needs to be dark and you need to stay away from screens at bedtime- TVs, iPads, phones, all can throw off your circadian cycle and fool your brain into thinking it is time to be awake, not asleep. If you must read at night, read old-fashioned paper under dim light, and do it as little as possible. Screens can really have a detrimental effect on kids’ already challenged sleep in particular- we make our kids charge their phones outside the bedroom at night. It also keeps them from Snapchatting all night long, which is probably more important than avoiding the light.
Alcohol is a very poor sleep aid, as it will only help with initial sleep onset, and then wreck the rest of the night’s sleep. Exercise is very helpful, but needs to be done at least three or so hours before bedtime, or the increased adrenaline levels can hinder sleep.
Finally, all the FitBit-type sensors are of very limited use in assessing your sleep, because they only measure movement, not sleep. You can and should move during some very desirable stages of sleep. You can be totally inactive during very poor quality sleep or even when you are awake. Studies to evaluate these devices’ correlation with sleep quality are not encouraging. Use them to help you stay active during the day, which will help your sleep, but not to judge your night’s sleep quality.
Pulse: Do you ever recommend an OTC sleep aid like melatonin or diphenhydramine hydrochloride?
Dr. Head: Melatonin is helpful, and as one of the body’s natural hormones, is very safe to help with regulation of the sleep cycle. It is best used every night to tell the brain it is time to go to sleep, rather than as an as-needed pill to knock you out on troublesome nights. It just doesn’t work like that. Almost all other sleep aids have downsides that limit my enthusiasm for anything other than very short-term use. The Ambien class of hypnotics in particular continue to have more and more adverse effects identified as time goes on, and I would not be surprised if their use is restricted even more in the future.
Pulse: When does it become appropriate to consult a sleep specialist?
Dr. Head: Your primary care physician should be your first resource for your sleep problems. They need to be central to any specialty care you receive. Many sleep issues may be handled entirely by your PCP. If you and your doctor are not satisfied with your progress, then specialty care may be appropriate. Your PCP will be in the best position to know if the sleep specialist you need to see is a pulmonologist, or a neurologist, or an otolaryngologist or some other specialist. There is overlap in expertise in sleep disorders and your PCP will be the best to help you navigate through these options with you.
