This book is meant to be read like a sweeping novel. It is not a reference book. I do not want you to skip ahead to the part of the book that you think is most important for you. It’s all important! Think of it as a complete process for understanding and overhauling both your sleep and the way you think about sleep. If you do it my way, you are going to finish this book with a newfound sense of what it means to have healthy sleep.
According to researcher Raymond Rosen, most physicians have received less than two hours of training about the entire field of sleep in their four years of medical education.
Given that our psychiatry lecture about men who fantasize about their wives’ footwear lasted thirty minutes, you can see just how dramatically underrepresented the whole of sleep medicine was in our curriculum.
## Chapter 1: What is Sleep Good For? Absolutely Everything!
There is almost no disease or organ system in which you cannot find some kind of relationship
Sleep as one of the foundational processes within your body that you can actually change.
To me, the three main pillars of good health that we can exert some control over are nutrition, exercise, and sleep.
Sleep is not the absence of wakefulness. Sleep is not a light switch in your braing that is either on or off. Your body is doing amazing things at night while you sleep.
Sleep resides in the brain. If you think your all-nighters or your crazy shift work schedule is no big deal, you might want to sit down before you continue to read. Long-term poor sleep is like bad cosmetic surgery: risky, costly, and not pretty.
### Sleep and the Brain
The brain does have a system for removing waste: the glymphatic system. Discovered in 2015!!
It seems to work better when you sleep on your side.
Also linked to other neurodegenerative disorders.
### Sleep and Obesity.
Up until recently, the connection between sleep and obesity was largely ignored.
Increased body weight could cause poor sleep. And poor sleep, weight gain.
Sleeping fewer than 6/7 hours, and staying past midnight -> obesity.
Sleep ~> leptin, which makes us feel full.
After a poor night sleep, our energy levels are reduced. One compensatory mechanism is for us to eat more in an effort to boost our energy.
With poor sleep comes decreased impulse control and greater risk-taking behaviors.
For every hour of sleep an individual lost, he or she gained 2.1 points on their BMI.
|N: Quantitative!
### Sleep, Your Heart, and Blood Pressure.
Poor sleep increases the risk for heart attack, elevated blood presure, heart failure, and stroke.
Any condition that fragments sleep has the potential to elevate blood pressure.
Complex relationship between lungs and heart.
### Sleep and Mood.
Poor sleep can lead to depression and negative mood consequences
Frequent awakenings during the night, may contribute to worsened mood and negative emotions.
As patients spend more time in bed and withdraw from typical activities, their schedule and sleep-wake cycles become a big mess.
Bipolar patients can have significant issues with sleep. Manic episodes can feature long stretches of time in which the patient is unable to sleep.
### Sleep and Cancer
"I wish I were making this section up".
Poor sleep and breast cancer ???
Shift work
|N: Working during the night, I suppose.
### Sleep and Your Immune System.
Our immune system's function is intimately tied to the amount and quality of our sleep.
|N: Studies giving people the rhinovirus voluntarily!
**I could virtually go organ to organ through the whole body and show you how lack of sleep is harmful**
## Chapter 1 Review.
1. When Sleep is not working properly, you don't work properly
|N: I've long known this as "When you fuck with your sleep, your sleep fucks with you".
2. When people say scientists don't know why we sleep, they're wrong.
## Chapter 2: Primary Drives.
Cold reading: Sex has been on your mind in the last several ~~days~~
### Food, Water, Sleep, and Sex (Not Necessarily in that Order.
"My psychic secret is all about primary drives".
"We have a primary drive for sleep. Because of this, the longer we go without sleep, the more determined our brains are to get it, ultimately to the point where it is no longer a choice".
|N: This "because" is spurious. The sentence doesn't explain shit.
People cannot go on with 4-6 hours of sleep.
"I've slept only two hours in the last fourteen days". Not the case.
Speaking of the Guinness Book of World Records, while they maintain records of virtually every kind of feat imaginable, they no longer recognize sleep-deprivation records. The current record holder, Randy Gardner, set the mark of 11 days and 24 minutes in 1964. During this trial, it became progressively more difficult for Gardner to stay awake. His brain engaged in microsleeps (brief periods of uncontrollable sleep usually lasting less than thirty seconds), and he suffered hallucinations, severe cognitive impairments, and even paranoia. This paranoia has been noted in several sleep-deprivation experiments, the most unfortunate of which was seen in the case of disc jockey Peter Tripp, whose sleep-deprivation publicity stunt of 201 hours seemed to have very lasting psychological effects (not the least of which was a belief that he was an impostor of himself).
True, honest-to-God sleep deprivation is difficult.
If, however, you think you are sleep deprived but you show no tendency to nod off when you are stretched out on a couch, does it really make sense to you, knowing what you know, that you really are sleep deprived?
### The Do-nothing-for-a-really-long-time exercise.
IF YOU ARE SOMEONE WHO believes you are suffering from long-term sleep deprivation, and can’t sleep no matter how hard you try, do this little exercise.
1. Eat a little something and try to use the bathroom. Sleep Exercise 1 is going to take a while.
2. Turn off your cell phone and telephone ringer and ask that your family leave you alone until the experiment is over.
4. Demand total privacy because the situation you’re dealing with is “wicked serious.” Say it just like that and nobody will bother you.
5. Find a comfortable, private place in your house or office to lie down.
6. Kick off your shoes, turn off the lights and lie down there.
7. Do not sleep! Just lie there for the next seven hours.
8. Reflect on your experience.
To put things in perspective, not sleeping for four days and subsequently not being sleepy is analogous to an individual coming into my office saying that he has not eaten for four days and yet strangely feels no hunger and is gaining weight. Yes, I know that toward the end of terminal starvation, the body feels little to no pain, but you get what I mean.
The rats in the dirty cage showed more signs of hyperarousal and did not sleep as well as the rats in the clean cage.
The complaint "I can't sleep" is inaccurate and untrue, so stop reciting this mantra and reinforcing this in your mind-set.
"I don’t sleep. It’s not just me. My mother never slept. She would...”
“No. Stop right there and try again.”
“Uh, I have difficulty sleeping and my mother had difficulties with her sleep too.”
“Much better. Continue.”
Compare sometimes not feeling hungry with getting into bed and simply not feeling like sleeping. Many people are immediately concerned about this development, and the stress it causes may prevent sleep later in the night or even later in the week. For many, the confidence that the boat will right itself when *sleep* is involved simply does not sleep.
Although I often compare the brain’s drive to sleep with its drive to eat, there are subtle differences. Our brains do not technically have the ability to make us eat. We can become terribly hungry and strongly driven to eat, but in extreme cases of anorexia or some kind of volitional hunger strike, an individual could overcome hunger and starve to death. With sleep, however, the brain retains the final say and actually has the power to force sleep on us all.
### How much Sleep Do We Need?
Enough. You need enough sleep.
Questions: How can we get better sleep? Is napping a good thing? How much sleep do we need?
The following are guidelines. Keep in mind that sleep need is as individualized as caloric need.
All through our life, our sleep need is declining.
Young adults: Seven to nine hours.
Older adults, after retirement: Seven to eight hours.
This study did not seem to support the idea that members of modern society were sleeping drastically less than their counterparts from a generation ago.
## Chapter 2 Review.
1. Animalistic primary drives include hunger, thirst, sex, and sleep. Without meeting these needs, you will die (except for sex, the lack of which results in the entire population fizzling out).
2. You sleep. You may not sleep well, but you do sleep.
3. The need for sleep varies from person to person and actually tends to decline as we mature.
4. Something about rats sleeping in dirty cages.
|N: To lotus.
## Chapter 3: Sleepy Versus Fatighed.
Sleepy vs fatigued. High vs low drive to go to sleep.
### Fatigue: "I'm Tired of Being Tired".
Fatigue: Strength drained away.
Trouble finding motivation. Lacking the drive to simply pull a load of laundry?
There are many things that can cause fatigue, other than lack of sleep.
### Sleepiness: “I’m Not Sleeping; I’m Just Resting My Eyes” and Other Falsehoods.
Sleep that is disfunctional can also make you sleepy.
### The Holes in Your Sleep-
Sleeping apnea: The sleeper awakens over and over because of breathing-related difficulties. He may wake up for an incredibly brief moment, so brief that his brain has no awareness of the awakening. But they can fragment sleep so terribly that sleep's restorative effects are all but negated.
Initally, you can compensate with increased quantity. But if that extra sleep becomes dysfunctional, more sleep won’t make a difference. Finally, your sleep is so poor that you feel like you could sleep for a week and not feel rested. You can put as much water into your gas tank as you’d like, but it doesn’t mean your car will run
Scientific studies have established that if an adult sleeps well, usually six to seven hours will suffice. Many of my patients with sleep problems often feel they need nine hours or more of sleep to feel okay.
Six to seven hours is absolutely fine for some people. For adults over the age of sixty-five, as little as five hours could be appropriate according to the 2015 consensus paper by Nathaniel Watson and his colleagues.
The hunter-gatherer cultures mentioned in the last chapter were averaging only about six and a half hours of sleep each night and yet they appeared to be quite healthy and well adjusted.
Bottom line: There is a tremendous amount of dysfunctional sleep out there, causing excessive sleepiness, and people cannot always “sleep more” to fix the problem.
Patients often lie during this questioning. It’s okay. I’m used to waking people up from my waiting room and seven minutes later asking them, “Ever fall asleep in public?” With a straight face, they respond "No". This is why I strongly suggest spouses come along to inject some reality into these appointments.
Sleep quality vs quantity.
A 2015 study published in the Journal of Neuroscience found that sleep deprivation may impair your ability to properly read facial expressions.
### *Why* and *How* We Sleep: The Homeostatic and Circadian Systems.
# Thoughts by Nuño
"We have a primary drive for sleep. Because of this, the longer we go without sleep, the more determined our brains are to get it, ultimately to the point where it is no longer a choice".
|N: This "because" is spurious. The sentence doesn't explain shit.
Annoying sentences. I'm going to keep tab of them at the end:
- Like syndicated episodes of Law & Order, their eating, exercising, and sleeping happen at all hours of the day and night.
- ... the brain retains the final say and actually has the power to force sleep on us all. We hope this doesn’t occur when we are driving home from work.
- ...need only seven to eight hours of sleep, leading them to continually ask, “What do I do with the other sixteen hours of my day? There’s nothing good on TV anymore.”
- 4. Something about rats sleeping in dirty cages.
- Here’s a step-by-step guide to becoming sleep deprived:
Purchase the first season of Breaking Bad.
Stay up too late watching Walt White slowly change from mild-mannered high-school chemistry teacher to ruthless drug kingpin Heisenberg.
Panic when the clock reads three hours before you need to be up for work on Monday.
Go to sleep.
Feel like crap on Monday as you limp along beating yourself up for the TV bingeing.
Vow to go to bed early tonight.
Repeat steps 1 to 6 until Breaking Bad is over and then replace with Mad Men
Goes against my sense of aesthetics.
- Are you falling asleep while you eat? If so, you get a point, but forget the points, videotape yourself, and send a copy to America’s Funniest Home Videos; they love stuff like this, and you might just win some money!
- Are you struggling to stay awake in a car? Give yourself 1 point if you are! Are you the driver? You win! Collect 20 points and proceed directly to Boardwalk, which you may purchase if it’s not already owned.
- Imagine you and your partner are at a party and a flirty acquaintance strikes up a conversation. As you politely converse, your partner gives you “the look,” which basically means “wrap it up or prepare for a painful car ride home.” A 2015 study published in the Journal of Neuroscience found that sleep deprivation may impair your ability to properly read facial expressions. In other words, not getting enough sleep might make you misinterpret threatening looks and lead to a difficult night sleeping on the living room couch.
