Why We Sleep: Unlocking the Power of Sleep and Dreams

Scientists have discovered a revolutionary new treatment that makes you live longer. It has been supported by over 17,000 well-scrutinized scientific reports to date. It enhances your memory and makes you more creative. It makes you look more attractive. It keeps you slim and lowers unhealthy food cravings. It protects you from cancer and dementia. It wards off colds and the flu. It lowers your risk of heart attacks, stroke, and diabetes. It makes you more productive with enhanced focus. You’ll even feel happier, less depressed, and less anxious. Are you interested? It’s a full night of quality sleep.

Two-thirds of adults throughout all developed nations fail to obtain the recommended eight hours of nightly sleep. Routinely sleeping less than six or seven hours a night demolishes your immune system, more than doubling your risk of cancer. Insufficient sleep is a key lifestyle factor determining whether or not you will develop Alzheimer’s disease. Inadequate sleep disrupts blood sugar levels so profoundly that you would be classified as pre-diabetic. Short sleeping increases the likelihood of your coronary arteries becoming blocked and brittle, setting you on a path toward cardiovascular disease, stroke, and congestive heart failure. Sleep disruption contributes to all major psychiatric conditions, including depression, anxiety, and suicidality. Too little sleep swells concentrations of a hormone that makes you feel hungry while suppressing a companion hormone that otherwise signals food satisfaction. Despite being full, you still want to eat more. It’s a proven recipe for weight gain in sleep-deficient adults and children alike. Worse, should you attempt to diet to lose weight but don’t get enough sleep while doing so, it is futile, since most of the weight you lose will come from lean body mass, not fat. The shorter you sleep, the less productive you are, the shorter your life span, and the worse your quality of life. The World Health Organization (WHO) has now declared a sleep loss epidemic throughout industrialized nations.

Unfortunately, the real evidence that makes clear all of the dangers that befall individuals and societies when sleep becomes short have not been clearly demonstrated to the public. It is the most glaring omission in the contemporary health conversation. Dr. Walker’s book is intended to serve as a scientifically accurate intervention addressing this unmet need. It aims to revise our cultural appreciation of sleep, and reverse our neglect of it. He is in love with reuniting humanity with the sleep it so desperately needs. This love affair has now spanned a twenty-plus-year research career that began when he was a professor of psychiatry at Harvard Medical School and continues now as a professor of neuroscience and psychology at the University of California, Berkeley. Dr. Walker describes the problems and causes of our collective sleeplessness and offers us a new vision of sleep in the twenty-first century.

Within the brain, sleep enriches a diversity of functions, including our ability to learn, memorize, and make logical decisions. Benevolently servicing our psychological health, sleep recalibrates our emotional brain circuits, allowing us to navigate next-day social and psychological challenges with composure. Dreaming provides a unique suite of benefits to all species fortunate enough to experience it, humans included. Among these gifts are a consoling neurochemical bath that mollifies painful memories and a virtual reality space in which the brain melds past and present knowledge, inspiring creativity. In the body, sleep revitalizes our immune system, helping fight malignancy, infection, and inflammation. Sleep reforms the body’s metabolic state by fine-tuning the balance of insulin and circulating glucose. Sleep further regulates our appetite, helping control body weight through healthy food selection rather than rash impulsivity. Plentiful sleep maintains a flourishing microbiome within our gut from which we know so much of our nutritional health begins. Adequate sleep is intimately tied to the fitness of our cardiovascular system, lowering blood pressure while keeping our hearts in fine condition. Dr. Walker shows us that “Sleep is the single most effective thing we can do to reset our brain and body health each day”.

There are two governing forces that regulate sleep – the twenty-four-hour circadian rhythm and the sleep pressure of adenosine – which are separate processes that typically align with each other. Everyone generates a circadian rhythm in their suprachiasmatic nucleus of their brain. This internal twenty-four-hour clock within your brain communicates its daily circadian rhythm signal to every other region of your brain and every organ in your body. This helps you determine when you want to be awake and when you want to be asleep. It also controls your timed preferences for eating and drinking, your moods and emotions, the amount of urine you produce, your core body temperature, your metabolic rate, and the release of numerous hormones. This biological clock is reset by sunlight and darkness, but also influenced by food, exercise, temperature fluctuations, and social interaction. For diurnal species that are active during the day, such as humans, the circadian rhythm activates many brain and body mechanisms during daylight hours that are designed to keep you awake and alert. These processes are then downregulated at night. Your circadian rhythm coordinates and is influenced by a drop in core body temperature as you near typical bedtime, reaching its low point about two hours after sleep onset. Although the temperature drop helps to initiate sleep, the temperature change itself will rise and fall across the twenty-four-hour period regardless of whether you are awake or asleep. Wakefulness and sleep are under the control of the circadian rhythm, not the other way around.

Although every human being displays an unyielding twenty-four-hour pattern, the respective peak and trough points are strikingly different from one individual to the next. For some people, their peak of wakefulness arrives early in the day, and their sleepiness trough arrives early at night. These are “morning types or morning larks”, and make up about 40 percent of the populace. Others are “evening types or night owls” and account for approximately 30 percent of the population. They naturally need to go to bed late and subsequently wake up late the following morning or even in the afternoon. The remaining 30 percent of people lie somewhere in between morning and evening types. Evening types are unable to function well in the morning because, despite being awake, their brains remain in a more sleep-like state throughout the morning. This is especially true for the part of their brains, called the prefrontal cortex, that controls high-level thought, logical reasoning, and emotional regulation. When an evening type is forced to wake up too early, the prefrontal cortex remains disabled, and it takes a long time for it to come online and function efficiently. Whether you are a morning type or evening type is largely determined by genetics. If you are a night owl, it’s likely that one or both of your parents is a night owl. Sadly, society treats night owls rather unfairly on two counts. First is the label of being lazy, based on not waking up until later in the day, due to the fact that they did not fall asleep until the early-morning hours. Others will chastise night owls on the erroneous assumption that such preferences are a choice. It is not their conscious fault, but rather their genetic fate. Second is the engrained, unfair playing field of society’s work and school scheduling, which is strongly biased toward early start times that punish night owls and favour morning larks. Although this situation is improving, standard employment and school schedules force night owls into an unnatural sleep-wake rhythm. Consequently, job performance of night owls as a whole is far less optimal in the mornings, and they are further prevented from expressing their true performance potential until late in the afternoon and early evening. Most unfortunately, night owls are more chronically sleep deprived, having to wake up with the morning larks for work and school, but not being able to fall asleep until far later in the night. Greater ill health caused by a lack of sleep therefore befalls night owls. In this regard, a societal change is needed, offering accommodations not dissimilar to those we make for other physically determined differences. We require more flexible work and school schedules that better adapt to all chronotypes, and not just one in its extreme.

Your suprachiasmatic nucleus communicates its repeating signal of night and day to your brain and body using a circulating messenger called melatonin. Instructed by the suprachiasmatic nucleus, the rise in melatonin begins soon after dusk, being released into the bloodstream from the pineal gland, to signal that it is time to prepare for sleep. Melatonin signals the start of sleep in response to darkness, but has little influence on the generation of sleep itself: a mistaken assumption that many people hold. Consequently, melatonin supplements are not effective as a sleeping pill, other than the placebo effect. Notably, most melatonin products are unregulated and are not as advertised, so consumer beware.

The other factor affecting sleep and wakefulness is sleep pressure from the build of adenosine that occurs throughout the day as a byproduct of normal metabolism. One consequence of increasing adenosine in the brain is an increasing desire to sleep. High concentrations of adenosine downregulate the wake-promoting regions of the brain and upregulate the sleep-inducing regions, which creates a “sleep pressure”. This happens to most people after twelve to sixteen hours of being awake. During sleep, the brain has a chance to degrade and remove the adenosine that has built up throughout the day. After about eight hours of healthy sleep, the adenosine clearance is complete. Around the same time as adenosine clearance is completed, the circadian rhythm stimulates wakefulness, and you are ready to start a new 16 hour day of activity with sharp brain function and natural energy.

Caffeine, the most widely used stimulant drug in the world, blocks the signal of adenosine, falsely providing a wakefulness effect while the sleepiness effect of adenosine still exists, but is temporarily muted. Caffeine does this by attaching to the same receptor sites as adenosine, and effectively blocking the adenosine from attaching to those receptor sites, thus blocking the sleepiness signal. Caffeine tricks you into feeling alert and awake, despite the high levels of adenosine that would otherwise seduce you into sleep. Caffeine – which is not only prevalent in coffee, certain teas, and many energy drinks, but also foods such as dark chocolate and ice cream, as well as drugs such as weight loss pills and pain relievers – is one of the most common culprits that keep people from falling asleep easily and sleeping soundly thereafter, typically masquerading as insomnia, an actual medical condition. Levels of caffeine peak around 30 minutes after consumption. The ”jolt” of caffeine does wear off. Caffeine is removed from your system by an enzyme within your liver, which gradually degrades it over time. Based in large part on genetics, some people have a more efficient version of the enzyme that degrades caffeine, allowing the liver to rapidly clear it from the bloodstream. These rare individuals can drink an espresso with dinner and fall fast asleep at midnight without a problem. Others, however, have a slower-acting version of the enzyme. It takes far longer for their system to eliminate the same amount of caffeine. As a result, they are sensitive to caffeine’s effects. One cup of coffee or tea in the morning will last much of the day, and should they have a second cup, even early in the afternoon, they will find it difficult to fall asleep in the evening. Aging also alters the speed of caffeine clearance: the older we are, the longer it takes our brain and body to remove caffeine, and thus the more sensitive we become in later life to caffeine’s sleep-disrupting influence. Be aware that decaffeinated does not mean noncaffeinated. One cup of decaf usually contains 15 to 30 percent of the dose of a regular cup of coffee, which is far from caffeine-free. Should you drink three to four cups of decaf in the evening, it is just as damaging to your sleep as one regular cup of coffee. When the liver finally clears caffeine from your system, you may find yourself in a “caffeine crash” because the adenosine is still present, and increasing throughout the day, and can then access the receptors to stimulate the sleepiness effect. Unless you consume more caffeine to mask the adenosine sleepiness effect, which would start a dependency cycle, you are going to find it very difficult to remain awake. Caffeine, as a stimulant drug, is the only addictive substance that we readily give to our children and teens, in addition to sugar.

After waking up in the morning, if you still feel like you could go back to sleep or if you feel you need caffeine to wake up, then you are not getting enough quantity or quality sleep to clear the adenosine. Consuming caffeine in the morning to wake up is likely self-medicating your state of chronic sleep deprivation. Both of these signs you should take seriously and assess your sleep deficiency. In general, these unrefreshed feelings that compel a person to fall back asleep in the morning, or require the boosting of alertness with caffeine, are usually due to individuals not giving themselves adequate sleep opportunity – at least 8 – 9 hours in bed. When you don’t get enough sleep, one consequence is that adenosine is not completely cleared from the day before, which makes you sleepy in the morning. This sleep debt of adenosine is carried throughout the following day and built upon with newly formed adenosine from daily activity, producing a condition of prolonged chronic sleep deprivation from one day to the next. This outstanding sleep debt results in a feeling of chronic fatigue, manifesting in many forms of mental and physical ailments that are now rife throughout industrialized nations. Of course, if you are giving yourself adequate sleep opportunity of 8 – 9 hours in bed, and still feel sleepy in the morning, then you may be suffering from an undiagnosed sleep disorder, such as insomnia or sleep apnea. Should you suspect your sleep or that of anyone else to be disordered, resulting in daytime fatigue, impairment, or distress, speak to your doctor immediately and seek a referral to a sleep physician.

Jet lag is when our internal clock is disrupted with travel across time zones. You feel tired and sleepy during the day in the new time zone because your body clock and associated biology still thinks it is in the old time zone. At night, you are frequently unable to sleep solidly because your biological rhythm still believes it to be daytime. Adjustment is possible, but a slow process. For every day you are in a different time zone, your suprachiasmatic nucleus can only readjust by about one hour. It is more difficult to acclimate when traveling eastward than flying westward. The eastward direction requires that you fall asleep earlier than you normally would, which is difficult for the brain to accept compared to falling asleep later when you are sleepy. Jet lag places a torturous physiological strain on the brain, and a deep biological stress upon the cells, organs, and major systems of the body. This affects learning and memory, and overall wellbeing.

The gold-standard scientific verification of sleep requires the recording of signals, using electrodes, arising from three different regions: brainwave activity, eye movement activity, and muscle activity. This is called a sleep study or polysomnography. The result of a sleep study is a hyponogram (a sleep graph) that normally shows the cycling between NREM (non-rapid eye movement sleep) and REM (rapid eye movement, or dream sleep) occurring every 90 minutes or so, starting with NREM. While we cycle between NREM and REM every 90 minutes, the ratio of NREM and REM sleep within each 90 minute cycle changes dramatically across the night with REM sleep increasing in duration. NREM sleep is broken down into 4 stages. Stages 1 and 2 are light sleep, as you fall asleep, while stages 3 and 4 are deep, slow-brain-wave sleep.

Waking brainwaves are fast, frantic, and asynchronistic, while deep NREM sleep brainwaves are slow, more regular, and synchronistic. Waking brainwave activity is concerned with the reception of information from the outside sensory world, while deep NREM sleep brainwave activity is a state of inward reflection and information transfer for the purpose of memory. Brainwave activity during REM (dream) sleep is similar to that of wakefulness, fast, frantic, and asynchronistic, and MRI studies show that up to 30 percent more brain activity is observed during REM sleep than wakefulness. During REM sleep, signals of emotions, motivations, and memories (past, present, and future) are all played out on the screen of our visual, auditory, and kinesthetic sensory cortices in the brain. When it comes to information processing, think of the wake state principally as reception (experiencing and constantly learning from the outside world), NREM sleep as reflection (storing and strengthening memories as new facts and skills), and REM sleep as integration (interconnecting these new facts and skills with each other, with all experiences, and in doing so, building an ever more accurate model of how the world works, including innovative insights and problem-solving abilities). While awake, electrodes in a sleep study can record muscle tension, but as you pass into NREM sleep, some of that muscle tension disappears, and when you move into REM sleep, mere seconds before dreaming begins, you are completely paralyzed and all muscle tension is lost – called atonia. By eliminating muscle activity, it prevents you from acting out your dreams. The brain paralyzes the body so the mind can dream safely. This striking dissociation during the dreaming state, where the brain is highly active but the body is immobilized, allows sleep scientists to easily recognize – and therefore separate – REM sleep brainwaves from wakeful ones.

For memorizing fact-based information, a region of the brain called the hippocampus helps apprehend these passing experiences and binds their details together. The hippocampus offers a short-term information store for accumulating new memories; however, it has limited capacity. Deep NREM sleep restores the brain’s capacity for learning, making room for new memories in the hippocampus, while consolidating the short-term memories into long-term memories in the neocortex via the slow delta brainwaves of deep NREM sleep that moves the information from hippocampus to the neocortex. With adequate deep NREM sleep, the cycle repeats each night, clearing out the cache of short-term memories in the hippocampus for the new imprinting of facts the next day, while accumulating an ever-updated catalog of past memories in the neocortex. Even daytime naps, as short as twenty minutes, can offer a memory consolidation advantage, so long as they contain enough deep NREM sleep. Following a night’s sleep, you can even regain access to memories that you could not retrieve before you went to sleep, waking up remembering what you needed to remember the day before. Sound therapy using specific frequencies that induce deep delta brainwaves can help with restorative sleep and memory consolidation. Targeted memory reactivation, which involves learning information you wish to remember, coupled with adequate deep NREM, allows for greater recall in the future. In addition, your brain will continue to improve motor learning skill memories with a full night’s sleep in the absence of further practice. Rather than being transferred from the short-term hippocampus to the long-term neocortex like fact-based information, motor skill memories are moved to brain circuits that operate below the level of consciousness and is related to stage 2 NREM sleep.

The recycle rate of a human being is 16 hours. After 16 hours of being awake, the brain begins to fail. Humans need about 8 hours of sleep each night to maintain cognitive and motor performance. After ten days of just seven hours of sleep, the brain is as dysfunctional as it would be after going without sleep for twenty-four hours. Three full nights of recovery sleep are insufficient to restore performance back to normal levels after a week of short sleeping. The human mind cannot accurately sense how sleep-deprived it is when sleep-deprived. Sleep loss inflicts devastating effects on the brain, linking it to numerous neurological and psychiatric conditions (eg – Alzheimer’s disease, anxiety, depression, bipolar disorder, suicide, and chronic pain), and on every physiological system of the body, further contributing to countless disorders and disease (eg – cancer, diabetes, heart attacks, stroke, infertility, weight gain, obesity, and immune deficiency). No facet of the human body is spared the crippling noxious harm of sleep loss. We are socially, organizationally, economically, physically, behaviourally, nutritionally, linguistically, cognitively, and emotionally dependent upon sleep. No matter what you may have heard in the mainstream media, there is no scientific evidence suggesting that a drug, a device, or any amount of psychological willpower can replace sleep. Power naps may momentarily increase basic concentration under conditions of sleep deprivation, as caffeine can up to a certain dose. However, science shows, that neither naps nor caffeine can salvage more complex functions of the brain, including learning, memory, emotional stability, complex reasoning, or decision-making.

Using MRI technology, Dr. Walker showed that a structure located in the left and right sides of the brain, called the amygdala – a key hot spot for triggering strong emotions such as anger and rage, and linked to the sympathetic nervous system’s “fight or flight” response – showed well over a 60 percent amplification in emotional reactivity in participants who were sleep-deprived. Without sleep our brain reverts to a primitive pattern of uncontrolled emotional reactivity. We produce unmetered, inappropriate emotional reactions, and are unable to place events into a broader or considered context. After a full night of sleep, the prefrontal cortex – the region of the brain associated with rational, logical thought, and decision-making – is strongly coupled to the amygdala, regulating this deep emotional brain center with inhibitory control. With a full night of plentiful sleep, we have a balanced mix between our emotional gas pedal (amygdala) and brake (prefrontal cortex). Without sleep, the strong coupling between these two brain regions is lost. We cannot rein in our negative impulses – too much emotional gas pedal (amygdala) and not enough regulatory brake (prefrontal cortex). Without the rational control given to us each night by sleep, we’re not on a neurological and emotional even keel. Insufficient sleep does not push the brain into a negative mood state and hold it there. Rather, the under-slept brain swings excessively to both extremes of emotional valence, positive and negative. Extremity is often dangerous. Depression and extreme negative moods can infuse an individual with a sense of worthlessness, together with ideas of questioning life’s values, and even suicide. Insufficient sleep has also been linked to aggression, bullying, and behavioural problems in children across a range of ages. Equally problematic issues arise from extreme swings in positive mood. Hypersensitivity to pleasurable experiences can lead to sensation-seeking, risk-taking, and addiction. Sleep disturbance is a recognized hallmark associated with addictive substance use. Insufficient sleep also increases relapse rates in numerous addiction disorders, associated with reward cravings that are unmetered, lacking control from the rational brain’s prefrontal cortex. Relevant from a prevention standpoint, insufficient sleep during childhood significantly predicts early onset of drug and alcohol use. Many of us know that inadequate sleep plays havoc with our emotions. Universal parenting wisdom knows that bad sleep the night before leads to a bad mood and emotional reactions the next day, sometimes leading to violence against children.

There is no major psychiatric condition in which sleep is normal. This is true for depression, anxiety, post-traumatic stress disorder, schizophrenia, and bipolar disorder. Psychiatry has long been aware of the coincidence between sleep disturbance and mental illness; however, it was previously thought that mental illness disrupted sleep, but new science shows that it goes both ways. Many of the brain regions commonly impacted by psychiatric mood disorders are the same regions that are involved in sleep regulation and impacted by sleep loss. Further, many of the genes that show abnormalities in psychiatric illness are the same genes that help control sleep and our circadian rhythms. Dr. Walker suggests that sleep disruption remains a neglected factor contributing to the instigation and/or maintenance of numerous psychiatric illnesses, and has powerful diagnostic and therapeutic potential that we are yet to fully understand or make use of. Studies show that improving sleep quality in patients suffering from several psychiatric conditions using cognitive behavioural therapy for insomnia (CBT-I) can improve psychiatric symptom severity and remission rates. A quote by American entrepreneur E. Joseph Cossman says: “The best bridge between despair and hope is a good night’s sleep.”

Sleep quality – especially that of deep NREM sleep – deteriorates as we age. This is linked to a decline in memory. If you assess a patient with Alzheimer’s disease, the disruption in sleep is far more exaggerated. Sleep disturbance actually precedes the onset of Alzheimer’s disease by several years, suggesting that it may be an early-warning sign of the condition, or even a contributor to it. Following diagnosis, the magnitude of sleep disruption will then progress in unison with the symptom severity of the Alzheimer’s patient. Over 60 percent of patients with Alzheimer’s disease have at least one clinical sleep disorder, most commonly insomnia. We now recognize that sleep disruption and Alzheimer’s disease interact in a self-fulfilling, negative spiral that can initiate and/or accelerate the condition. Alzheimer’s disease is associated with the buildup of a toxic form of protein called beta-amyloid, which aggregates in sticky clumps, or plaques, within the brain. Beta-amyloid plaques are poisonous to neurons, killing the surrounding brain cells; however, they only accumulate in certain parts of the brain, such as those involved in generating deep NREM sleep. Based on PET scan technology, Dr. Walker discovered that the more amyloid plaques in the brain regions involved in deep NREM sleep, the more impaired the deep sleep of the Alzheimer’s patient, and the more severe the memory loss. Furthermore, the purifying work of the glymphatic system is accomplished by cerebrospinal fluid bathing the brain to remove toxic metabolites from the neurons. The glial cells of the brain shrink in size by up to 60 percent during NREM sleep, enlarging the space around the neurons and allowing the cerebrospinal fluid to proficiently clean out the metabolic debris left by the day’s neural activity. One of the toxic metabolites is beta-amyloid protein. Without sufficient sleep, beta-amyloid plaques build up in the brain, especially in deep sleep generating regions, attacking and degrading them. The loss of deep NREM sleep caused by this assault therefore lessons the ability to remove beta-amyloid from the brain at night, resulting in greater beta-amyloid deposition in those regions of the brain; whereby, worsening the progression of memory loss and thus Alzheimer’s disease. Getting too little sleep across the adult lifespan will significantly raise your risk of developing Alzheimer’s disease. By improving someone’s sleep, we can reduce their risk of developing Alzheimer’s disease – or at least delay the onset.

There are more than twenty large-scale epidemiological studies that have tracked millions of people over many decades, all of which report the same clear relationship: the shorter you sleep, the shorter your life. The leading causes of disease and death in developed nations – diseases that are crippling health care system, such as heart disease, obesity, dementia, diabetes, and cancer – all have recognized causal links to lack of sleep.

Unhealthy sleep, unhealthy heart. As we approach midlife, and our body begins to deteriorate and health resilience starts its decline, the impact of insufficient sleep on the cardiovascular system escalates. This shows how important it is to prioritize sleep in midlife – which is unfortunately the time when family and professional circumstances encourage us to do the exact opposite. One night of modest sleep reduction – even just one or two hours – will promptly speed the contracting rate of a person’s heart, hour upon hour, and significantly increase the blood pressure in the vasculature. Beyond accelerating your heart rate and increasing your blood pressure, a lack of sleep further erodes the fabric of those strained blood vessels, especially those that feed the heart itself, called the coronary arteries. These small vessels need to be clean and open wide to supply your heart with blood at all times. Narrow or block those passageways, and your heart can suffer a comprehensive and often fatal attack caused by blood oxygen starvation, colloquially known as a “massive coronary”. One cause of a coronary artery blockage is atherosclerosis, or the narrowing of those small vessels with hardened plaques that contain calcium deposits. Deficient sleep significantly increases the likelihood of plaques in the coronary arteries and thus increases the risk of a coronary heart attack.

An acute stress response from the sympathetic nervous system (fight or flight), which is normally only deployed for short periods of time lasting minutes to hours, can be highly adaptive under conditions of credible threat, like mobilizing the body in response to a physical threat. Survival is the goal, and this stress response promotes immediate action to accomplish just that. But leave the stress system stuck in the “on” position for long durations of time, and sympathetic activation becomes deeply maladaptive, and even deadly. Nearly every experiment that has investigated the impact of deficient sleep on the human body has observed an overactive sympathetic nervous system. For as long as the state of insufficient sleep lasts, and for some time thereafter, the body remains stuck in some degree of a fight-or-flight state. It can last for years in those with an untreated sleep disorder, like obstructive sleep apnea, excessive work hours that limit sleep quality or quantity, chronic stress, or the simple neglect of sleep by an individual.

Due to sympathetic overdrive, as your sleep-deprived heart beats faster, the volumetric rate of blood pumped through your vasculature increases, and with that come the hypertensive state of your blood pressure. Occurring at the same time is a chronic increase in the stress hormone, cortisol, which is triggered by the overactive sympathetic nervous system. One undesirable consequence of the sustained deluge of cortisol is the constriction of blood vessels, triggering an even greater increase in blood pressure. Making matters worse, growth hormone – a great healer of the body – which normally surges at night, is shut off by the state of sleep deprivation. Without growth hormone to replenish the lining of your blood vessels, called the endothelium, they will be slowly stripped of their integrity. Adding insult to real injury, the hypertensive strain that sleep deprivation places on your vasculature means that you can no longer repair those fracturing vessels effectively. The damaged and weakened state of the vasculature throughout your body now becomes systemically more prone to atherosclerosis. Plaques will form, vessels will rupture, and heart attacks and strokes may follow. During deep NREM sleep, the brain communicates a calming signal to the sympathetic nervous system, which calms the heart and relaxes the vasculature, protecting from high blood pressure, heart attack, and stroke.

An intimate and bidirectional relationship exists between your sleep and your immune system. Deep NREM sleep fights against infection, inflammation, sickness, and cancer by enhancing the immune system at night. When you do get sick, the immune system actively stimulates the sleep system, demanding more sleep to upregulate the immune system. Reduce sleep for even one night and the immune system is compromised. Studies show that the less sleep you get before being exposed to a virus, the more likely the virus will infect the body and succeed. Considering that infectious illnesses, such as the common cold, influenza, and pneumonia, are among the leading causes of death in developed countries, doctors and governments would do well to stress the critical importance of sufficient sleep during the flu season. A flu shot is only effective if your body actually reacts to it by generating antibodies, which requires a healthy immune system, which requires healthy sleep. Being sleep deprived limits the effectiveness of a flu shot and most vaccines because the immune system is compromised and not able to properly respond.

Natural killer cells are an elite and powerful squadron within the ranks of your immune system that can target and destroy cancer cells, however, with an immune system compromised from sleep deprivation, these cells are reduced in numbers and efficacy, and the body is more susceptible to cancer. With each passing year of research, more forms of malignant tumors are being linked to insufficient sleep. Part of this is related to an overactive sympathetic nervous system from chronic sleep deprivation that causes prolonged inflammation prone to cancer. Cancer cells use inflammatory factors to their advantage: such for cancer growth, mutating cellular DNA to create new cancer cells, and up-anchoring from localized tissue and spreading to other areas of the body through metastasis. The scientific evidence linking sleep disruption to cancer is now so damning that the World Health Organization has officially classified the nighttime shift as a “probable carcinogen”.

Each cell in your body has an inner core, or nucleus. Within that nucleus resides most of your genetic material in the form of deoxyribonucleic acid (DNA) molecules in helical strands. Segments of these strands of DNA, called genes, encode biological proteins for specific functions. Studies show that sleep deprivation changes gene expression. It downregulates genes for health, such as stable metabolism and optimal immune response, and upregulates genes for disease, inflammation, and cellular stress. Other studies show that short sleep duration will also disrupt the activity of genes regulating cholesterol, particularly a drop in high-density lipoprotein (good cholesterol), which is directly related to cardiovascular disease. DNA strands exist in chromosomes with caps called telomeres that protect the ends of the DNA strands. Poor sleep has been shown to reduce the protective telomere caps and expose the DNA stands to damage, leading to a shortened life.

The less you sleep, the more likely you are to eat and more likely you are to choose unhealthy food, particularly carbohydrates and sugar. In addition, your body becomes unable to manage those unhealthy calories effectively, especially the concentrations of sugar in your blood. In these two ways, sleeping less than seven or eight hours a night will increase your probability of gaining weight, being overweight, or being obese, and significantly increases your likelihood of developing type 2 diabetes and related chronic diseases. The global health cost of preventable diabetes is $375 billion a year, and the cost of obesity is more than $2 trillion. Yet for the under-slept individual, the cost of health, quality of life, and a hastened arrival of death are more meaningful.

Sugar is a dangerous thing – in your diet and circulating in your bloodstream. High levels of sugar in your blood, over weeks or years destroys the tissues and organs of your body, worsens your health, and shortens your life span. Eye disease that can end in blindness, nerve disease that commonly results in amputations, and kidney failure necessitating dialysis or transplants are all consequences of prolonged high blood sugar, as are hypertension and heart disease. But it is the condition of type 2 diabetes that is most commonly and immediately related to unregulated blood sugar. In a healthy individual, the hormone insulin will trigger the cells of the body to swiftly absorb glucose (sugar) from the bloodstream when it increases, such as after eating a meal. If the cells of the body stop responding to insulin, they cannot efficiently absorb glucose from the blood, and the glucose remains in the blood leading to a hyperglycemic (high blood sugar) state. If sustained, the hyperglycemic state of the blood can transition to pre-diabetes, and then full-blown type 2 diabetes. Sleep deprivation contributes to the cells inability to respond to insulin and is therefore a direct contributor to type 2 diabetes. It can also worsen diabetes by creating a sustained sympathetic response that lowers the immune system and increases cardiovascular stress that prevents adequate healing and clearing throughout the body. Recent studies suggest that type 2 diabetes can take 10 years off a person’s life and is largely preventable.

When your sleep becomes short, you will gain weight. Multiple forces conspire to expand your waistline. The first concerns two hormones controlling appetite: leptin and ghrelin. Leptin signals a sense of feeling full. Ghrelin triggers a strong sensation of hunger. An imbalance of either one of these hormones can trigger increased eating and thus body weight. A strong rise in hunger occurs after just one night of short sleep, as leptin (full) decreases and ghrelin (hunger) increases the following day. Sleep loss also increases levels of circulating endocannabinoids – chemicals produced by the body similar to that of cannabis – that increase the desire to snack on junk food. Combine the increase in endocannabinoids with alterations in leptin and ghrelin caused by sleep deprivation and you have a potent chemical brew driving overeating of unhealthy food. Making matters worse, the less an individual sleeps, the less energy they will have and the more sedentary they will choose to be over opting for physical exercise. Overeating junk food, less physical activity, and the added stress from poor sleep, is the perfect recipe for obesity. The encouraging news is that getting enough sleep will help you control body weight. Dr. Walker discovered that a full night sleep repairs the communication pathway between deep-brain areas that unleash unhealthy cravings and the higher-order brain regions that rein in these cravings, suggesting that sleep offers a way of impulse control.

Plentiful sleep also makes your gut happier. Sleep’s role in redressing the balance of the body’s autonomic nervous system, specifically relaxing the sympathetic nervous system, improves gut bacterial composition and function. With the sympathetic nervous system overactive, there is excess cortisol circulating, which cultivates “bad bacteria” in the gut microbiome. As a result, insufficient sleep will prevent the meaningful absorption of all food nutrients and cause gastrointestinal problems. Healthy sleep balances the autonomic nervous system and supports the parasympathetic nervous system (rest and digest), which restores proper microbial composition in the gut.

If you have hopes of reproductive success, fitness, and sexual prowess, you would do well to get a full night’s sleep every night. Sleep deprivation in men shows testosterone reduction so significantly that it effectively ages them 10 – 15 years with regards to those hormone levels. Men who sleep too little or have poor quality of sleep have a 29 percent lower sperm count than those obtaining a full night’s sleep, the sperm themselves have more deformities, and these men also have smaller testicles. Low testosterone is a clinically concerning and life-impacting matter. Males with low testosterone often feel fatigued throughout the day. They find it difficult to concentrate on tasks, as testosterone has a sharpening effect on the brain’s ability to focus. They also have a dulled libido, making an active, fulfilling, and healthy sex life more challenging. Add to this the fact that testosterone maintains bone density, and plays a causal role in building muscle mass and therefore strength, and you can begin to get a sense of why a full night of sleep – and the natural hormonal replacement therapy it provides – is so essential to this aspect of health and an active life for men of all ages.

Routinely sleeping less than six hours a night results in a 20 percent drop in follicular-releasing hormone in women – a critical female reproductive element that peaks just prior to ovulation and is necessary for conception. Sleep deprived women have a higher rate of abnormal menstruation, fertility issues, and miscarriage. Combine these deleterious effects on reproductive health in couples where both parties are lacking sleep, and it’s easy to appreciate why the epidemic of sleep deprivation is linked to infertility. Furthermore, those with sleep deprivation appear more fatigued, less healthy, and less attractive, which complicates intimacy and reproductive potential.

Fatal Familial Insomnia is a very rare condition where the person is unable to generate sleep and dies within 18 months of no sleep without any other cause. This is the strongest evidence we have that a lack of sleep alone will kill a person. There are no known treatments or cures. It involves a prion protein from a genetic mutation that rapidly accelerates brain degeneration as the protein spreads like a virus. One part of the brain that gets damaged is the thalamus, where it remains stuck in the open position not allowing sensory gate closure to promote sleep. No amount of sleeping pills or other drugs can push the thalamic gate closed. In addition, the signals for reduction of heart rate, blood pressure, metabolism, and body temperature, all must pass through the thalamus on their way down the spinal cord to the rest of the body, but are disrupted by the damage to the thalamus. It is simply impossible for the individual to initiate sleep, all systems shut down, and life ends.

Sleep is more problematic and disordered in older adults. The effects of certain medications more commonly taken by older adults, together with coexisting medical conditions, result in older adults being less able, on average, to obtain as much sleep, or as restorative a sleep, as young adults. That older adults simply need less sleep is a myth. Older adults need just as much sleep as they do in midlife, but are simply less able to generate that still necessary sleep. Three key changes are: reduced sleep quantity and quality, reduced sleep efficiency, and disrupted timing of sleep. Deep NREM sleep declines after the late twenties or early thirties. By the time a person is in their seventies, they’ve lost 80 – 90 percent of their deep NREM sleep. Elderly individuals and their doctors fail to connect their deterioration in health to their deterioration in sleep, despite causal links between the two having been known to scientists for decades. Seniors, when visiting their doctors for health issues, rarely ask for help with their sleep or are even asked by their doctor about their sleep. Far more of our age-related physical and mental health ailments are related to sleep impairment than either we, or many doctors, truly realize or treat seriously. Dr. Walker urges individuals, including elderly people, not to seek help with sleep through prescribed sleeping pills that do not address the root causes. He recommends non-pharmacological interventions that are proven to work that your doctor may or may not be aware of.

The older we get, the more frequently we wake up throughout the night. There are many causes, including interacting medications and diseases, but chief among them is a weakened bladder. Older adults therefore visit the bathroom more frequently at night. Reducing fluid intake in the evening can help, but is not a cure-all. Due to sleep fragmentation, older individuals will suffer a reduction in sleep efficiency, defined as the percent of time you were asleep while in bed. Most sleep doctors consider good quality sleep to involve a sleep efficiency of 90 percent. By the time we reach our eighties, sleep efficiency drops below 70 – 80 percent. Studies show that the lower an older individual’s sleep efficiency score, the higher their mortality risk, the worse their physical health, the more likely they are to suffer from depression, the less energy they report, and the lower their cognitive function, typified by forgetfulness. Any individual, no matter what age, will exhibit physical ailments, mental health instability, reduced alertness, and impaired memory if their sleep is chronically disrupted. The problem with aging is that family members observe these daytime features in older relatives and jump to a diagnosis of dementia, overlooking the possibility that bad sleep is an equally likely cause. Not all older adults with sleep issues have dementia, but it is often a causal factor contributing to dementia. Furthermore, the frequent nighttime bathroom visits, while groggy in the dark, increase the risk of falls and fractures. This is further complicated by common blood pressures issues, resulting in getting out of bed light-headed. Tips for safe sleep in the elderly include: have a side lamp within reach that you can switch on easily; use dim, motion-activated night-lights on route to the bathroom; remove obstacles, including rugs, on route to the bathroom; and keep a telephone by your bed with emergency phone numbers on speed dial.

Seniors commonly experience a regression in sleep timing, leading to earlier and earlier bedtimes due to earlier and less concentrated melatonin release that triggers the sleep cycle of the circadian rhythm, which decreases in strength as we get older. Older adults often want to stay awake later into the evening so that they can socialize, read, or watch television. But in doing so, they find themselves waking up in their recliner, having inadvertently fallen asleep mid-evening due to their regressed circadian rhythm. A regressed circadian rhythm means feeling sleepy earlier at night, but also waking up earlier in the morning. Falling asleep in early evening relieves the adenosine sleep pressure and prevents proper sleep from occurring later that night, thus, when waking up naturally early in the morning, there is a higher likelihood of naps again the next day and possibly the next evening. And the cycle continues. There are methods that can help push the circadian rhythm in older adults somewhat later, and also strengthen the rhythm. Older adults who want to shift their bedtimes to a later hour should get bright-light exposure later in the afternoon (rather than early morning) and then keep a well-lit environment until later at night to delay melatonin release. For example, if going outside in the morning, wear sunglasses, but when going outside in the afternoon, choose not to wear sunglasses to ensure light exposure to the suprachiasmatic nucleus. Also, melatonin prescribed by a doctor can be effective in older adults to help boost the strength of the circadian rhythm that naturally decreases with age.

Much of the time in utero, the fetus is fast asleep. It is only when the fetus is in the third trimester that wakefulness emerges – about 2 – 3 hours per day are spent awake in the womb. During this time, while asleep, the fetus increases in REM sleep to about 9 hours per day. In the last week before birth, the fetus peaks at about 12 hours of REM sleep per day. Science shows that REM sleep is required for brain maturation. Dazzling bursts of electrical activity during REM sleep stimulate the growth of neural pathways all over the developing brain through synaptogenesis. Alcohol is one of the most powerful suppressors of REM sleep that we know of. Alcohol consumed by a mother readily crosses the placental barrier, and therefore readily infuses her developing fetus and interrupts their REM sleep and ability to obtain REM sleep for life. Almost half of all lactating women in Western countries consume alcohol in the months during breastfeeding. Alcohol is readily absorbed in a mother’s milk. Concentrations of alcohol in breast milk closely resemble those in a mother’s bloodstream. Newborns will normally transition straight into REM sleep after a feeding. When babies consume alcohol-laced breastmilk, their sleep is more fragmented, they spend more time awake, and they suffer a 20 – 30 percent suppression of REM sleep soon after. Deficient REM sleep in the fetus, thus incomplete synaptogenesis of new neural networks, contributes, in part, to the development of autism in children. Children with autism have a weakened sleep-wake cycle, decreased amounts of melatonin released at night, and 30 – 50 percent less REM sleep. Tracking sleep abnormalities in children offers a new diagnostic hope for early detection of autism.

In contrast to the single monophasic sleep pattern observed in adults of industrialized nations, infants and young children display polyphasic sleep: many short sleeps throughout the day and night, punctuated by numerous awakenings. The older a child gets, the more stable their sleep becomes. This is because the control of the circadian rhythm, the suprachiasmatic nucleus, takes time to develop. Slowly, the suprachiasmatic nucleus begins to latch on to repeating signals, such as daylight, temperature changes, and feedings, establishing a stronger twenty-four-hour rhythm. By four years of age, the circadian rhythm is in dominant command of a child’s sleep behaviour, with a lengthy period of nighttime sleep, usually supplemented by a single daytime nap. Come late childhood, the modern, monophasic pattern of sleep is finally made real. During the fourteen hours of total sleep per day that a six-month-old infant obtains, there is a 50/50 ratio of NREM to REM sleep. A five-year-old will have a 70/30 split across their eleven hours of sleep. That balance finally stabilizes at 80/20 NREM/REM sleep by late teen years and remains so throughout much of adulthood. The decrease in REM sleep as a child ages is due to the fact that the need to create new neural connections becomes less important but rather the refinement of those connections in deep NREM sleep is more important.

Sadly, neither society nor our parental attitudes are well designed to accept that teenagers need more sleep than adults, and they are biologically wired to obtain sleep at different times from their parents – later bedtime and later rising. It’s very understandable for parents to feel frustrated in this way, since they believe that their teenager’s sleep patterns reflect a conscious choice and not a biological edict. Parents would be wise to accept this fact, and to embrace it, encourage it, and praise it, lest we wish our own children to suffer developmental brain abnormalities or force a raised risk of mental illness upon them. It will not always be this way for the teenager. As they age into young and middle adulthood, their circadian schedule will gradually slide back in time. The reason for the delayed bedtime and wake time of teenagers is an evolutionary one. It involves them seeking independence from their parents in preparation to leave the home. This ingenious biological solution selectively shifts teenagers to a later phase when they can, for several hours, operate independently – and do so as a peer-group collective. It is important to appreciate that a teenager wanting to sleep in during the morning is a biological necessity, not a sign of laziness.

Dreams as most of us think of them – those hallucinogenic, motoric, emotional, and bizarre experiences with rich narratives – come from REM sleep, and many sleep researchers limit their definition of true dreaming to that which occurs in REM sleep. However, we can dream in all stages of sleep. In the 1950s and 1960s, recordings using electrodes placed on the scalp gave scientists a general sense of the type of brainwave activity underpinning REM sleep. But we had to wait until the advent of functional MRI brain-imaging machines in the early 2000s before we could reconstruct glorious, three-dimensional visualizations of brain activity during REM sleep. During dreamless, deep NREM sleep, overall brain activity shows a modest decrease relative to that measured in an individual while they are resting but awake. However, something very different happens as the individual transitions into REM sleep and begins to dream. Numerous parts of the brain “light up” on the MRI scan as REM sleep takes hold, indicating a sharp increase in underlying activity. In fact, there are four main clusters of the brain that spike in activity when someone starts to dream in REM sleep: (1) the visuospatial regions at the back of the brain, which enable complex visual perception; (2) the motor cortex, which instigates movement; (3) the hippocampus and surrounding regions, which support autobiographical memory; and (4) the deep emotional centers of the brain – the amygdala and the cingulate cortex – both of which generate and process emotions. The emotional regions of the brain are 30 percent more active in REM sleep compared to when we are awake. There is, however, a pronounced deactivation of other brain regions – specifically, the prefrontal cortex, which manages rational thought and logical decision-making. REM sleep can therefore be considered a state characterized by strong activation in visual, motor, emotional, and autobiographical memory regions of the brain, yet a relative deactivation in regions that control rational thought. After measuring the pattern of brain activity of an individual in REM sleep, scientists often wake them up and obtain a dream report for further analysis.

Dreams have two known functions: nurturing our emotional and mental health, and promoting problem solving and creativity. REM-sleep dreaming offers a form of overnight therapy by taking the painful sting out of difficult, even traumatic, emotional episodes you have experienced during the day, offering emotional resolution when you wake up in the morning. Concentrations of a key stress-related chemical called noradrenaline are completely shut off within your brain when you enter REM sleep – this is the only time of day when this happens. Emotion-specific memory processing during dreaming occurs free of the stress chemical noradrenaline. REM sleep accomplishes two specific goals: (1) sleeping to remember the details of valuable, salient experiences, integrating them with existing knowledge and putting them into an autobiographical perspective; and (2) sleeping to forget, or dissolve, the visceral, painful emotional charge that had previously been wrapped around those memories.

Sleep, and specifically dreaming of specific incidents, is clearly needed in order for us to heal emotional wounds. To do this, noradrenaline must be stopped within the brain. With PTSD patients, this does not happen effectively, leading to possible nightmares. A drug that has a side-effect of stopping noradrenaline in the brain, has proven to allow PTSD patients to move into healthy REM sleep and overcome their nightmares with immense therapeutic potential.

There are regions of the brain whose job it is to read and decode the value and meaning of emotional signals, including facial expressions. Those regions of the brain are recalibrated at night during REM sleep. A dream-starved person cannot accurately decode facial expressions and other emotional signals, which become distorted in their view. Studies show that sleep-deprived people find even gentle, friendly faces menacing as they cannot properly decode facial expressions, which creates a feeling like the world is out to get you. Reality and perceived reality are no longer the same in the eyes of the sleepless brain. By removing REM sleep, you’re removing your ability to read the social world around you in a healthy way. Now think of occupations that require individuals to be sleep-deprived, such as law enforcement and military personnel, doctors, nurses, and those in the emergency services – not to mention the ultimate caretaking job: new parents. Every one of these roles demands the accurate ability to read the emotions of others in order to make critical, even life-dependent decisions. Without REM sleep and its ability to reset the brain’s emotional compass, those same individuals will be inaccurate in their social and emotional comprehension of the world around them, leading to inappropriate decisions and actions that may have grave consequences. REM sleep provides children with opportunities for brain development and creativity, but has less of an impact on emotional intelligence. It isn’t until they are a teenager that this becomes an important effect of REM sleep.

Using a wide-angled dream lens, we can apprehend the full constellation of stored information and their diverse combinatorial possibilities, all in creative servitude. It is both the act of dreaming and the associated content of those dreams that determine creative success. It is REM sleep that builds connections in the brain between distantly related informational elements that are not obvious during the waking day. For example: in a study, Dr. Walker’s participants went to bed with disparate pieces of a jigsaw puzzle and woke up with the complete puzzle in mind. Another example: after years of trying to organize the constituent building blocks of nature, chemist Dmitri Mendeleev, on February 17, 1869, had a dream that led to the periodic table of elements. Informational alchemy conjured by REM-sleep dreaming has led to some of the greatest feats of transformative thinking in the history of the human race. As he slept, Mendeleev’s dreaming brain accomplished what his waking brain was incapable of. It is the difference between knowledge (retention of individual facts) and wisdom (knowing what they all mean when you fit them together). Or, said more simply, learning versus comprehension. REM sleep allows your brain to move into wisdom and comprehension. REM sleep is capable of creating super-ordinate concepts out of sets of information. This is why people are told to “sleep on it” when making a decision on an important problem. Interestingly, this phrase exists in most languages, indicating that the problem-solving benefit of dream sleep is known universally.

Lucid dreaming occurs at the moment when an individual becomes aware that he or she is dreaming and has volitional control of what they are dreaming and how to navigate the dream. Less than 20 percent of the general population are natural lucid dreamers. It is possible that lucid dreamers represent the next iteration in Homo sapiens’ consciousness evolution.

Humans are predominantly visual creatures. More than a third of our brain is devoted to processing visual information, far exceeding that given over to sounds or smells, or those supporting language and movement. For early Homo sapiens, most activities would have ceased after the sun set as they were predicated on vision supported by daylight. The advent of fire, and its limited halo of light, offered an extension to post-dusk activities, but the effect was modest. Gas- and oil-burning lamps, and their forerunners, candles, offered a more forceful influence upon sustained nighttime activities. The influence of man-made light began the reengineering of human sleep patterns, and it would only escalate. The nocturnal rhythms of whole societies became quickly subject to light at night, and so began our advancing march toward later bedtimes. In the mid-1870s Edison Electric Company began developing a reliable, mass-marketable lightbulb that guaranteed modern humans would no longer spend much of the night in darkness, as we had for millennia past. Artificial light will fool your suprachiasmatic nucleus into believing the sun has not yet set, thus melatonin is not released on schedule. By delaying the onset of melatonin, artificial evening light makes it considerably less likely that you’ll be able to fall asleep at a reasonable time, thus masquerading as insomnia. Even a hint of dim light – 8 to 10 lux – has been shown to delay the release of nighttime melatonin in humans. A subtly lit living room, where most people reside in the hours before bed, will hum at around 200 lux. Despite being just 1 to 2 percent of the strength of daylight, this ambient level of incandescent home lighting can have 50 percent of the melatonin-suppressing influence within the brain.

This got even worse with the invention of blue LED lights. The light receptors in the eye that communicate “daytime” to the suprachiasmatic nucleus are most sensitive to short-wavelength light within the blue spectrum. As a consequence, evening blue LED light has twice the harmful impact on nighttime melatonin suppression than the warm, yellow light from old incandescent bulbs, even when their lux intensities are matched. This is compounded with the trend to excessive screen use, such as laptops, tablets, and cell phones, before bed, which all have blue light. In a study, reading a book on an iPad suppressed melatonin by over 50 percent at night and those individuals took far longer to fall asleep compared to those reading a paper book. The iPad readers lost significant amounts of REM sleep following reading, they felt less rested in the morning and sleepier throughout the day, and had a delay in melatonin release that lasted for several days following iPad reading at night. Using LED devices at night impacts our natural sleep rhythms, the quality of our sleep, and how alert we feel during the day, especially in our children who need sleep the most. Limiting exposure to light in the evening is challenging in the modern home, but can involve mood lighting, avoiding screens before bed, and wearing yellow-tinted glasses, or apps on electronic devices, to block out blue light in the evening. Maintaining complete darkness throughout the night is equally critical. The easiest fix is blackout curtains and no nightlights unless needed to navigate to the bathroom, which should then be motion-activated.

The sleep aid industry, encompassing prescription sleep medications and over-the-counter sleep remedies, is worth an astonishing $30 billion a year in the US alone. Numerous triggers that cause sleep difficulties include psychological, physical, medical, and environmental. External factors that cause poor sleep, such as too much bright light at night, the wrong ambient room temperature, caffeine, tobacco, and alcohol, can masquerade as insomnia. However, their origins are not from within you, and therefore not a disorder of you. Rather, they are influences from outside, and, once they are addressed, individuals will get better sleep, without changing anything about themselves. However, insomnia may be a symptom of a disease (eg – Parkinson’s disease) or a side effect of a medication (eg – asthma medication). The two most common triggers of chronic insomnia are psychological: (1) emotional concerns, or worry; and (2) emotional distress, or anxiety. When trying to fall asleep, many worry about the day, or things the next day, or even far in the future, which prevents their brainwaves from relaxing into slower states that promote sleep. The other issue is an overactive sympathetic nervous system keeping the brain and body in an alert state due to stress and anxiety. This involves elevated stress hormones, like cortisol, adrenaline, and noradrenaline, which raises body temperature, heart rate, metabolic rate, and breathing rate, when the opposite should be happening to fall asleep. The bidirectional line of communication between the body and the brain amounts to a vicious, recurring cycle that fuels their thwarting of sleep. Patients with insomnia have a lower quality of sleep, reflected in shallower, less powerful electrical brainwaves during deep NREM. They also have more fragmented REM sleep, peppered by brief awakenings that they are not always aware of, yet still cause a degraded quality of dream sleep. All of which means that insomnia patients wake up not feeling refreshed. Consequently, insomnia patients are unable to function well during the day, cognitively and/or emotionally. You can now understand how physiologically complex the underlying condition is. No wonder the blunt instruments of sleepings pills, which simply and primitively sedate your higher brain, or cortex, are no longer recommended as the first-line treatment approach for insomnia.

Sleeping pills do not provide natural sleep, can damage health, and increase the risk of life-threatening diseases. The older sleeping medications – termed “sedative hypnotics”, such as diazepam – sedated you rather than assisting you to sleep. Most of the newer sleeping pills on the market present a similar situation, though they are slightly less sedating. Sleeping pills, old and new, target the same system in the brain that alcohol does – the receptors that stop your brain cells from firing – by effectively knocking out the higher regions of your brain’s cortex. The sleep that sleeping pills produce is devoid of deep NREM sleep, and thus has negative side effects; including next-day grogginess, daytime forgetfulness, performing actions at night of which you are not conscious, and slowed reaction times during the day that can impact motor skills, such as driving. True even of the newer, shorter-acting sleeping pills on the market, these symptoms instigate a vicious cycle. The waking grogginess can lead people to reach for more cups of coffee or tea to rev themselves up with caffeine throughout the day and evening. That caffeine, in turn, makes it harder to fall asleep at night, worsening the insomnia, causing an increase in sleeping pill consumption, perhaps just a half or a whole sleeping pill more, which starts the process over again the next day. Another deeply unpleasant feature of sleeping pills is rebound insomnia. When individuals stop taking these medications, they frequently suffer far worse sleep than the poor sleep that led them to seek out sleeping pills to begin with. The cause of rebound insomnia is a type of dependency in which the brain alters its balance of receptors as a reaction to the increased drug dose, trying to become somewhat less sensitive as a way of countering the foreign chemical within the brain. This is also known as drug tolerance. But when the drug is stopped, there is a withdrawal process, part of which involves an unpleasant spike in insomnia severity. The majority of prescription sleeping pills are in a class of physically addictive drugs. Dependency scales with continued use, and withdrawal ensues in abstinence. When patients come off the drug for a night and have a miserable sleep as a result of rebound insomnia, they often go right back to taking the drug the following night. Few people realize that this night of severe insomnia, and the need to start retaking the drug, is partially or wholly caused by a drug addiction and the persistent use of sleeping pills to begin with. Much of the public remains unaware of the dangerous side effects of sleeping pills. For example, studies show that Ambien, a common sleep pill, produces sleep that actually erases memories, rather than consolidates them. Doctors are notorious for not properly communicating these sorts of dangers to their patients when prescribing medications, largely because they are not aware of them.

Even more concerning than adverse brain rewiring are negative physiological effects throughout the body that come with the use of sleeping pills – effects that aren’t widely known but should be. Studies show that individuals using prescription sleep medications are significantly more likely to die and to develop cancer than those who do not. The risk of death scales with the frequency of use. One frequent cause of mortality appears to be higher-than-normal rates of infection because sleeping pills do not induce deep restorative sleep that boosts the immune system, so despite sleeping better in their mind, their body is not receiving the benefits. Older adults are the heaviest users of sleeping pills, representing more than 50 percent of the individuals prescribed such drugs, and are also more prone to infection due to a weaking immune system and co-morbidities. Another cause of death linked to sleeping pills is an increased risk of fatal car accidents due to reduced deep restorative sleep and feeling groggy the next day. Higher risk of falls, particularly in the elderly, is a further mortality factor. As is higher rates of heart disease and stroke. The average age for those receiving sleep medication prescriptions is decreasing, as sleep complaints and incidents of pediatric insomnia increase, often due to undiagnosed sleep breathing disorders. Young brains, which are still being developed into their early twenties, will be attempting the already challenging task of neural development and learning under the subverting influence of prescription sleeping pills.

Shouldn’t drug companies be more transparent about the current evidence and risks surrounding sleeping pill use and risks? Unfortunately, Big Pharma can be notoriously unbending within the arena of revised medication indications. This is especially true once a drug has been approved following basic safety assessments, and even more so when profit margins become exorbitant. There is no study to date that has shown that sleeping pills save lives. Dr. Walker believes that the existing evidence warrants far more transparent medical education of any patient who is considering taking a sleeping pill. This way, individuals can appreciate the risks and make informed choices. He is not anti-medication. On the contrary, he desperately wants there to be a drug that helps people obtain truly naturalistic sleep. Many of the drug company scientists who create sleeping medications do so with good intentions and an honest desire to help those whose sleep is problematic. As a researcher, Dr. Walker is keen to help science explore new medications in carefully controlled, independent studies.

Short of prescription sleeping pills, the most misunderstood of all “sleep aids” is alcohol. Many individuals believe alcohol helps them to fall asleep more easily, or even offers sounder sleep throughout the night. Both are resolutely untrue. Alcohol is in a class of drugs called sedatives. It binds to receptors within the brain that prevent neurons from firing their electrical signals. Saying that alcohol is a sedative often confuses people, as alcohol in moderate doses helps individuals liven up and become more social. Your increased sociability is caused by sedation of the prefrontal cortex, early in the timeline of alcohol’s creeping effects. The prefrontal cortex controls our impulses and restrains our behaviour, and alcohol impairs this area first allowing us to be less controlled and more extroverted. Give alcohol a little more time, and it begins to sedate other parts of the brain, dragging them down into a stupefied state, just like the prefrontal cortex. Your desire and ability to stay conscious decrease, and you can let go of consciousness more easily. Sedation, however, is not sleep. Alcohol sedates you out of wakefulness, but it does not induce natural sleep. The electrical brainwave state you enter via alcohol is not that of natural sleep, but rather akin to a light form of anesthesia. Alcohol also fragments sleep with brief unnoticed awakenings, so sleep is not continuous or restorative. Alcohol is one of the most powerful suppressors of REM sleep that we know of. When the body metabolizes alcohol it produces the by-product chemicals aldehydes and ketones. The aldehydes block the brain’s ability to generate REM sleep. People consuming even moderate amounts of alcohol in the afternoon and/or evening are thus depriving themselves of dream sleep.

In alcoholics, the pent-up REM sleep pressure erupts forcefully into waking consciousness, causing hallucinations, delusions, and gross disorientation in a state called “delirium tremens”. Should the alcoholic enter a rehabilitation program and abstain from alcohol, the brain will begin feasting on REM sleep, binging in a desperate effort to recover that which it has been long starved of – an effect called the REM sleep rebound. We observe precisely the same consequences caused by excess REM sleep pressure in individuals who have tried to break the sleep-deprivation Guinness world record (before this life-threatening feat was banned). The overnight work of REM sleep, which normally assimilates complex memory knowledge, is interfered with by alcohol, even if alcohol is consumed days after the information was obtained. Many people enjoy a drink with dinner or afterwards, but it takes your liver and kidneys many hours to degrade and excrete that alcohol, even if you are an individual with fast-acting enzymes for alcohol decomposition. Nightly alcohol will disrupt your sleep, and the annoying advice of abstinence is the best and most honest advice Dr. Walker can offer.

Car crashes rank among the leading causes of death in most developed nations. Operating on less than four hours of sleep, increases your risk of a motor vehicle accident by 11.5 times. This is compounded exponentially when combined with alcohol, such as driving home after the bar late at night or early morning. Evidence shows that drowsy driving alone is worse than driving drunk because when you fall asleep at the wheel, you stop reacting all together, rather than being a late responder like a drunk driver. As a result, car crashes caused by drowsiness tend to be far more deadly than those caused by alcohol or drugs.

There are two main culprits of drowsy-driving accidents. The first is people completely falling asleep at the wheel. The second, more common cause is a momentary lapse in concentration, called a microsleep. These last for just a few seconds, during which time the eyelid will either partially or fully close. Microsleeps are usually suffered by individuals who are chronically sleep-restricted – defined as getting less than seven hours of sleep a night on a routine basis. During a microsleep, your brain becomes blind to the outside world for a brief moment – and not just the visual domain, but in all channels of perception. Most of the time you have no awareness of the event. More problematic is that your decisive control of motor actions, such as those necessary for operating a motor vehicle, will momentarily cease. No conscious response, no motor response. The opportunity for microsleeps occurs in a compounding fashion, not just with complete sleep deprivation, but also with back-to-back nights of truncated sleep, even just a couple of hours short. With chronic sleep restriction over months or years, an individual will actually acclimate to their impaired performance, lower alertness, and reduced energy levels, and highly underestimate their level of impairment because it has become their new normal. Individuals fail to recognize how their perennial state of sleep deficiency has come to compromise their mental aptitude and physical vitality, including the slow accumulation of ill health.

More dangerous are drowsy truckers. Approximately 80 percent of truck drivers in the US are overweight, and 50 percent are clinically obese. This places truck drivers at a far higher risk of obstructive sleep apnea, commonly associated with heavy snoring, which causes chronic, severe, sleep deprivation. As a result, these truck drivers are 200 – 500 percent more likely to be involved in a traffic accident than the general public. And when a truck driver loses his or her life in a drowsy-driving crash, they will, on average, take 4.5 other lives with them. These are not accidents. They are predictable crashes that are a direct result of not obtaining enough quality sleep. As such, they are unnecessary and preventable. Shamefully, governments of most developed countries spend next to nothing on educating the public on the dangers of drowsy driving relative to what they invest in combating drunk driving. If you feel drowsy while driving. Please, please stop. It’s lethal. Shear will is not enough to power through. It is dangerous. Taking a 30 minute nap can help, but when you wake up you will have sleep inertia and still be impaired for another 30 minutes, so wait it out and/or get a cup of coffee; however, the sleep deprivation will relapse, so you will need another break soon to recharge.

Few other areas of medicine offer a more disturbing or astonishing array of disorders than those concerning sleep, as there are over a hundred known. Dr. Walker describes a few common ones. The term “somnambulism” refers to sleep disorders that involve some form of movement. It encompasses conditions, such as sleepwalking, sleep talking, sleep eating, sleep texting, sleep sex, and very rarely, sleep homicide. All these events happen during deep NREM sleep, not REM sleep as expected. Sleepwalking is common in the adult population, and even more common in children.

Narcolepsy is considered to be a neurological disorder that involves excessive daytime sleepiness with spontaneous sleep attacks, sleep paralysis, and cataplexy (brief loss of muscle control triggered by strong emotions, positive or negative). About 1 in 2,000 people suffer from narcolepsy. Sleep paralysis occurs when the body is paralyzed during REM sleep and the brain becomes conscious again, yet paralysis remains. Cataplexy is an abnormal function of the REM-sleep circuitry within the brain, wherein one of its features – muscle atonia – is inappropriately deployed while the individual is awake, rather than asleep and dreaming. We can explain this to an adult patient, lowering their anxiety during the event through comprehension of what is happening, and help them rein in or avoid emotional highs and lows to reduce cataplectic occurrences. However, this is much more difficult in children. The sleep-wake switch in the hypothalamus releases a neurotransmitter called orexin that switches the brain to wakefulness. Once activated by the orexin switch, the brain stem pushes open the sensory gate of the thalamus, allowing the perceptual world to flood into the brain, transitioning you to full, stable wakefulness. When it’s time to sleep, orexin is no longer released, and the brain is switched to sleep mode, whereby the thalamus sensory gate closes off the perceptual world. In narcoleptic patients, the orexin-producing cells are dramatically reduced, as are the orexin receptors, keeping the person in an unstable sleep-wake state. Because the orexin switch is never fully on, full wakefulness is not achieved during the day, and because it is never fully off, properly sleep is not achieved at night. There are no effective treatments for narcolepsy, and due to the relative rarity of the condition, it is not profitable for drug companies to invest their research efforts, which is often a driver of fast treatment progress in medicine.

Insomnia is the most common sleep disorder, with about 1 in 9 people suffering from clinical insomnia, twice as many women than men. Should we relax the stringent clinical criteria for diagnosis and just use epidemiological data as a guide, it is likely that 2 out 3 people will regularly have difficulty falling or staying asleep at least one night a week, every week. Insomnia involves people who give themselves adequate opportunity to sleep, but cannot get enough sufficient sleep quality or quantity. There is sleep-onset insomnia, which is difficulty falling asleep, and sleep-maintenance insomnia, meaning a difficulty staying asleep; both of which must cause a problem for the person and involve daytime sleepiness to be diagnosed. All of us will experience difficulty sleeping every now and then, which may last just one night or several. That is normal. There is usually an obvious cause, such as work stress or relationship issues. Once these problems subside, sleep returns. Such acute sleep problems are generally not recognized as chronic insomnia, since clinical insomnia requires an ongoing duration of sleep difficulty. Insomnia is one of the most pressing and prevalent medical issues facing modern society, yet few speak of it this way, recognize the burden, or feel there is a need to act.

Currently, the most effective treatment for insomnia is cognitive behavioural therapy for insomnia (CBT-I), and it is rapidly being embraced by the medical community as the first-line treatment. Working with a therapist for several weeks, patients are provided with a bespoke set of techniques intended to break bad sleep habits and address anxieties that have been inhibiting sleep. CBT-I builds on basic sleep hygiene principles supplemented with methods individualized for the patient, their problems, and their lifestyle. The obvious methods involve reducing caffeine and alcohol intake, removing screen technology from the bedroom, and having a cool bedroom. In addition, patients must (1) establish a regular bedtime and wake-up time, even on weekends, (2) go to bed only when sleepy, (3) never lie awake in bed for a significant period of time; rather, get out of bed and do something quiet and relaxing until the urge to sleep returns, (4) avoid daytime napping if you are having difficulty sleeping at night, (5) reduce anxiety-provoking thoughts and worries by learning to mentally decelerate before bed, and (6) remove visible clock-faces from view in the bedroom, preventing clock-watching anxiety at night. One of the more paradoxical CBT-I methods used to help insomniacs sleep is to restrict their time spent in bed, perhaps even to just six hours of sleep or less to begin with. By keeping patients awake for longer, they build up a stronger sleep pressure – a greater abundance of adenosine. Under this heavier weight of sleep pressure, patients fall asleep faster, and achieve a more stable, solid form of sleep across the night. In this way, a patient can regain their psychological confidence in being able to self-generate and sustain healthy, rapid, and sound sleep, night after night – something that has eluded them for months if not years. Upon reestablishing a patient’s confidence in this regard, time in bed is gradually increased to 8 – 9 hours. Research shows that CBT-I is more effective than sleeping pills in addressing numerous problematic aspects of sleep for insomniacs. The benefits of CBT-I persist long-term, even after patients stop working with their therapists.

Sleep and physical exertion have a bidirectional relationship. Many of us know of the deep, sound sleep we often experience after sustained physical activity. Exercise offers increased deep NREM sleep for restoration and rejuvenation. Deep NREM sleep offers an increase in performance for next day exercise with more natural energy and better recovery time. All of us should engage in some form of physical exercise to help maintain not only the fitness of our bodies, but also the quality and quantity of our sleep. Sleep, in return, will boost your fitness and energy, setting in motion a positive, self-sustaining cycle of improved physical activity and mental health. For athletes, post-performance sleep accelerates physical recovery from common inflammation, stimulates muscle repair, and helps restock cellular energy in the form of glucose and glycogen. Try not to exercise right before bed. Body temperature can remain high for an hour or two after physical exertion, which can be difficult to drop your core body temperature sufficiently to initiate sleep due to the increased metabolic rate. Take away the bedrock of sleep, or weaken it just a little, and healthy eating and physical exercise become less effective. Eating before bed, especially carbohydrates and sugar, can disrupt deep NREM sleep.

Thermal environment, specifically the proximal temperature around your body and brain, is perhaps the most underappreciated factor determining the ease with which you will fall asleep tonight, and the quality of sleep you will obtain. Ambient room temperature, bedding, and nightclothes dictate the thermal envelope that wraps around your body at night. It is ambient room temperature that has suffered dramatically from modernity. To successfully initiate sleep, your core temperature needs to decrease by about 1 degree Celsius. For this reason, it is better to fall asleep in a room that is too cold, rather than too hot. The decrease in core temperature is detected by a group of thermos-sensitive cells within the hypothalamus, which stimulate the suprachiasmatic nucleus to release melatonin. Your nocturnal melatonin levels are controlled not only by the loss of daylight at dusk, but also the drop in temperature that coincides with the setting sun. Environmental light and temperature therefore synergistically, though independently, dictate nightly melatonin levels and sculpt the ideal timing of sleep. The hands, feet, and head have numerous blood vessels close to the surface of the skin that are remarkable radiating devices that, just prior to sleep onset, jettison body heat in a massive thermal venting session so as to drop your core body temperature. Through climate-controlled homes with central heat and air conditioning, and the use of bedcovers and pajamas, we have architected a minimally varying or even constant thermal tenor in our bedrooms. Consequently, our brains do not receive the cooling instructions within the hypothalamus that facilitates a naturally timed release of melatonin. Moreover, our skin has difficulty “breathing out” the heat it must in order to drop core temperature and make the transition to sleep, suffocated by the constant heat signal of controlled home temperatures. A bedroom temperature of around 18 degrees Celsius is ideal for the sleep of most people, assuming standard bedding and clothing. Hot baths before bed can lower your core temperature, which helps induce sleep more quickly and encourage more deep NREM sleep.

The alarm is another major sleep disruptor. No other species demonstrates this unnatural act of prematurely and artificially terminating sleep, and for good reason. Being awoken by an alarm clock causes a spike in blood pressure and heart rate from the sympathetic nervous system. Waking up at the same time of day, every day, no matter if it is the week or weekend is a good recommendation for maintaining a stable sleep schedule if you are having difficulty with sleep. Indeed, it is one of the most consistent and effective ways of helping people with insomnia get better sleep. This unavoidably means the use of an alarm clock for many individuals. If you do use an alarm clock, do away with the snooze function, and get in the habit of waking up only once to spare your nervous system and heart the repeated shock.

More than 80 percent of public schools in the United States begin before 8:15am and almost 50 percent of those start before 7:20am. As a result, many children and teenagers must wake up at 5:30am or earlier to get ready and possibly catch a bus, and do so five out of seven day a week. This is lunacy. Children and teenagers require more sleep and more sleep in the mornings based on their circadian rhythms. Restricting this is simply dangerous and unproductive. This is not an optimal design for education, nor is it ethical. This is not a model for nurturing good physical and mental health in our children and teenagers. Forced by the hand of early school start times, this state of chronic sleep deprivation is especially concerning considering that adolescence is the most susceptible phase of life for developing chronic mental illnesses, such as depression, anxiety, schizophrenia, and suicidality. It is the lack of REM sleep, which is concentrated in the mornings, that contribute to emotional instability and mental illnesses. Sleep is so important for cognitive development and learning that increasing sleep time of children and teenagers by delaying school start times would prove transformative. Research findings have revealed that increasing sleep by way of delayed school start times wonderfully increases class attendance, reduces behavioural and psychological problems, decreases substance and alcohol use, and increases life expectancy. The leading cause of death of teenagers is traffic accidents. One study showed delayed school start times correlated with a 70 percent reduction in traffic accidents in 16 to 18 year-old drivers. These publicly available findings should have swept the education system in an uncompromising revision of school start times. Instead, they have been largely swept under the rug. If the goal of education is to educate, and not risk lives in the process, then we are failing our children in the most spectacular manner with the current model of early school start times. Without change, we will simply perpetuate a vicious cycle wherein each generation of our children are stumbling through the education system in a half-comatose state, chronically sleep-deprived for years on end, stunted in their mental and physical growth as a consequence, and failing to maximize their true success potential, only to inflict that same assault on their own children decades later.

An added reason for making sleep a top priority in the education and lives of our children concerns the link between sleep deficiency and the epidemic of ADHD (attention deficit hyperactivity disorder). Children with this diagnosis are irritable, moodier, more distractable and unfocused in learning during the day, and have a significantly increased prevalence of depression and suicide ideation. These are the same symptoms of sleep deprivation, however, the sleep issue largely goes undiagnosed by medical doctors, and prescriptions are written for ADHD medications, such as Adderall and Ritalin. Adderall is amphetamine and Ritalin is a similar stimulant called methylphenidate. These are two of the most powerful drugs we know of to prevent sleep and keep the brain wide awake. That is the very last thing the sleep deprived child needs. Not every child that has ADHD has poor sleep, however, studies show that more than 50 percent are just sleep deprived with symptoms masquerading as ADHD. These children are being dosed for years of their critical development with amphetamine-based drugs.

One example of an undiagnosed sleep disorder is pediatric sleep-disordered breathing or child obstructive sleep apnea, which is associated with heavy snoring. Overly large adenoids and tonsils can block the airway passage of a child as their breathing muscles relax during sleep, worsened by obesity and an inflammatory diet. The laboured snoring is the sound of turbulent air trying to be sucked down into the lungs through a semi-collapsed, fluttering airway. The resulting oxygen debt will reflexively force the brain to awaken the child briefly throughout the night so that several full breaths can be obtained, restoring full blood oxygen saturation. However, this prevents the child from reaching and/or sustaining long periods of valuable deep NREM sleep. Their sleep-disordered breathing will impose a state of chronic sleep deprivation, night after night, for months or years on end. As the state of chronic sleep deprivation builds over time, the child will look ever more ADHD-like in temperament, cognitively, emotionally, and academically. Those children who are fortunate to have their sleep disorder recognized, and who have their tonsils and/or adenoids removed if needed, more often than not prove that they do not have ADHD. In the weeks after the operation, a child’s sleep recovers, and with it, normative psychological and mental functioning in the months ahead. A major public health awareness campaign by governments and health organizations – without influence from pharmaceutical lobbying groups – is needed on this issue. Failed by a lack of government guidelines and poor communication by researchers to the public regarding the extant scientific data, many parents remain oblivious to the state of childhood sleep deprivation, so often undervaluing the biological necessity of healthy sleep. When sleep is abundant, minds flourish. When it is deficient, they don’t.

Sleep deprivation degrades many of the key faculties required for most forms of employment. Certain business leaders mistakenly believe that time at work equates with task completion and productivity. Studies show that insufficient sleep robs most nations of more than 2 percent of their GDP – amounting to the entire cost of most countries’ military. It’s almost as much as each country invests in education. If we eliminated the national sleep debt, we could almost double the GDP percentage that is devoted to the education of our children, which should be incentivized at the national level.

Many of the Fortune 500 companies are interested in KPI – key performance indicators, such as net revenue, goal-accomplishment speed, or commercial success. Numerous employee traits determine these measures, such as: creativity, intelligence, motivation, effort, efficiency, effectiveness when working in groups, emotional stability, sociability, and honesty. All of these are systematically dismantled by insufficient sleep. Studies show that shorter sleep amounts predict lower work rates, slower completion speed of basic tasks, less problem-solving abilities, and choosing to seek the easy way out. That is, sleepy employees are unproductive employees and need to work longer to accomplish a goal. Under-slept employees put in less effort for physical appearance in the workplace, generally feel less satisfied with their job, are more emotionally volatile, more rash in their decision-making, and more prone to lying. These individuals also seek opportunities to slack off in groups and hide behind the collective hard work of others. Studies show that an under-slept leader infects their employees with work disengagement and reduced productivity, and cannot effectively inspire and drive their teams with charisma. Allowing and encouraging employees, supervisors, and executives to arrive at work well rested turns them from simply looking busy yet ineffective, to being productive, honest, useful individuals who inspire, support, and help each other. Studies show that those who sleep more, even earn more money.

All of us know that nurses and doctors in hospitals work long, consecutive hours, and none more so than doctors during their resident training years. This tracks back to Dr. William Halsted at John Hopkins Hospital, the creator of the residency program who felt sleep was a dispensable luxury that detracted new doctors from the ability to work and learn. Dr. Halsted practiced what he preached, however, it turned out that he was a cocaine addict, which explained the maniacal structure of his residency program and his ability to forgo sleep. The exhausting residency program style, which persists in one form or another throughout North American medical schools to this day, has left countless patients hurt or dead in its wake – and likely, residents too. Residents would commonly work 30-hour straight shifts. Research shows that this causes residents to commit 36 percent more serious medical errors, such as prescribing the wrong dose of a drug or leaving a surgical implement inside a patient, compared with those working sixteen hours or less. Additionally, after a 30-hour shift without sleep, residents make a whopping 460 percent more diagnostic mistakes in the intensive care unit than when well rested after enough sleep. Throughout the course of their residency, one in five medical residents will make a sleepless-related medical error that causes significant liable harm to a patient. One in twenty residents will kill a patient due to a lack of sleep. A new report suggests that medical errors are the third-leading cause of death among Americans after heart attacks and cancer. Sleeplessness undoubtedly plays a role in those lives lost. After a 30-hour continuous shift, exhausted residents are 73 percent more likely to stab themselves with a needle or cut themselves with a scalpel, risking a blood-born infectious disease, compared to their careful actions when adequately rested. The regulatory boards involved in changing resident work hours are resistant because of the we-suffered-through-sleep-deprivation-and-you-should-too mentality when it comes to training, teaching, and practicing medicine. Studies show that when residents are limited to 16 hour shifts with an 8 hour rest period they cause 20 percent fewer serious medical errors and 400 – 600 percent fewer diagnostic errors.

The decimation of sleep throughout industrialized nations is having a catastrophic impact on our health, our life expectancy, our safety, our productivity, and the education of our children. In addition to our toxic food system, this silent sleep epidemic is the greatest public health challenge we face in the twenty-first century in developed nations. A radical shift in our personal, cultural, professional, and societal appreciation of sleep must occur.

Educating people about sleep – through books, engaging lectures or videos, and word of mouth – can help combat our sleep deficit. Wearables that accurately track sleep and habits that improve or reduce sleep are essential for change. When it comes to the quantified self, it’s the old adage of “seeing is believing” that ensures longer-term adherence to healthy habits. Harnessing smartphones as a central hub to gather an individual’s health data from various sources – physical activity (such as number of steps, or minutes and intensity of exercise), light exposure, temperature, heart rate, body weight, food intake, work productivity, or mood – we show each individual how their own sleep is a direct predictor and cause of their own physical and mental health. You would discover that during the months of the year when you were averaging more sleep, you were sick less; your weight, blood pressure and medication use dropped; and your relationships, as well as sex life, were better. Reinforced day after day, month after month, and ultimately year after year, this nudge could change many people’s sleep neglect for the better. If this even increased your sleep amount by just fifteen to twenty minutes each night, the science indicates that it would make a significant difference across the life span and save trillions of dollars within the global economy at the population level. It could be one of the most powerful factors in a future vision that shifts from a model of sick care (treatment), which is what we do now, to health care (prevention) – the latter aiming to stave off a need for the former. Prevention is far more efficient than treatment, and costs far less in the long run.

We can marry individual sleep trackers with the revolution of in-home networked devices like thermostats and lighting that is tailored to the personalized circadian rhythm of each individual in each bedroom. Thermostats could be dialed down at the right time at night to drop core body temperature and back up again in the morning when it is time to wake up. Lighting with built in blue LED light filters could be dimmed and changed to warm yellow in the evening and back to blue light in the morning to stimulate then supress melatonin appropriate for sleep and wakefulness. The same can be done with LED screens in the home, workplaces, and in vehicles. NASA is already doing this with their astronauts in space.

In addition to analytics with sleep and health trackers, we could use predictalytics that predict your future health and appearance based on your current patterns and habits. This could be used to predict the optimal time to get a flu shot when immunity is highest and antibodies can be optimized based on your sleep. Few people realize that the annual financial cost of the flu in the US is around $100 billion ($10 billion direct and $90 billion in lost work productivity). Even if this software decreases flu infections by just a small percentage, it will save hundreds of millions of dollars by way of improved immunization efficiency by reducing the cost burden on hospital services. By avoiding lost productivity through illness and absenteeism during the flu season, businesses and the economy stand to save billions of dollars and could help subsidize the effort. We can scale this solution globally: anywhere there is immunization and the opportunity to track an individual’s sleep, there is the chance for marked savings to health care systems, governments, businesses, and families – all with the motivated goal of trying to help people live healthier lives.

Generation after generation, our young minds continue to remain unaware of the immediate dangers and protracted health impacts of insufficient sleep. A simple education model would be very helpful. It could take many forms. An animated short movie accessible online, a board game in physical or digital form, or a virtual environment that helps children explore the secrets of sleep. The objective would be to change the lives of those children and, by raising awareness and creating better sleep practices, have those children pass on their healthy sleep values to their own children. Our future generations would enjoy a longer healthier and more productive life, absolved of the mid and late-life diseases and disorders that we know are caused by and associated with chronic short sleep.

At the highest levels, we need better public campaigns educating the population about sleep. For example, on drowsy driving, which would pay for itself immediately in health care savings and lower emergency services costs, as well as lower auto insurance rates and premiums for individuals. Many health insurance companies provide a financial credit to their members for going to the gym – the same could be done with healthy sleep habits that are tracked and submitted. Even with lower insurance paid by the individual in addition to them living healthier lives, health insurance companies would significantly decrease the cost burden of their insured individuals, allowing for greater profit margins.

In this way, Dr. Walker offers us a new vision for sleep in our future. One we can readily embrace, fund, and implement with modest political and social will and desire. First we must understand the basics, accept the problem as it is, and take appropriate action based on the latest evidence. We are all in this together, and our children depend on us.




Fourteen Tips for Healthy Sleep

Stick to a sleep schedule. Go to bed and wake up at the same time each day. As creatures of habit, people have a hard time adjusting to changes in sleep patterns. Sleeping later on weekends won’t fully make up for a lack of sleep during the week and will make it harder to wake up early on Monday morning. Set an alarm for bedtime, if needed.
Exercise is great, but not too late in the day. Try to exercise at least thirty minutes on most days, but not later than two to three hours before your bedtime. Morning is best.
Avoid caffeine and nicotine. Coffee, colas, certain teas, and dark chocolate contain the stimulant caffeine, and its effects can take as long as eight hours to fully wear off. Therefore, caffeine in the late afternoon can make it hard for you to fall asleep at night. Nicotine is also a stimulant, often causing smokers to sleep only very lightly. In addition, smokers often wake up too early in the morning because of nicotine withdrawal.
Avoid alcoholic drinks before bed. Having a nightcap or alcoholic beverage before sleep may help you relax, but alcohol sedates your brain and robs you of REM sleep, keeping you in the lighter stages of sleep. Alcohol ingestion also may contribute to impairment in breathing at night. You also tend to wake up in the middle of the night when the effects of the alcohol have worn off.
Avoid large meals and beverages at night. A light snack is okay, but a large meal, especially with carbohydrates and sugar, can cause indigestion, which interferes with deep sleep. Drinking too many fluids at night can cause frequent awakenings to urinate.
If possible, avoid medicines that delay or disrupt your sleep. Some commonly prescribed heart, blood pressure, or asthma medications, as well as some over-the-counter and herbal remedies for coughs, colds, or allergies, can disrupt sleep patterns. If you have trouble sleeping, talk to your health care provider or pharmacist to see whether any drugs you’re taking might be contributing to your insomnia and ask whether they can be taken at other times during the day.
Don’t take naps after 3pm. Naps can help make up for lost sleep, but late afternoon naps can make it harder to fall asleep at night.
Relax your mind and body before bed. Don’t overschedule your day so that no time is left for unwinding. A relaxing activity, such as reading or listening to music, should be part of your bedtime ritual.
Take a hot bad before bed. The drop in body temperature after getting out of the bath may help you feel sleepy, and the bath can help you relax and slow down so you’re more ready to sleep.
Dark bedroom, cool bedroom, gadget-free bedroom. Get rid of anything in your bedroom that might distract you from sleep, such as noises, bright lights, an uncomfortable bed, or warm temperatures. You sleep better if the temperature in the room is kept on the cool side – about 18 degree Celsius. A TV, cell phone, or computer in the bedroom can be a distraction and deprive you of needed sleep. Having a comfortable mattress and pillow can help promote a good night’s sleep. Use blackout curtains if needed. Individuals who have insomnia often watch the clock. Turn the clock’s face out of view so you don’t worry about the time while trying to fall asleep.
Have the right sunlight exposure. Daylight is key to regulating daily sleep patterns. Try to get outside in natural sunlight for at least thirty minutes each day. If possible, wake up with the sun or use very bright lights in the morning. Sleep experts recommend that, if you have problems falling asleep, you should get an hour of exposure to morning sunlight and turn down the lights before bedtime.
Don’t lie awake in bed. If you find yourself still awake after staying in bed for more than twenty minutes or if you are starting to feel anxious or worried, get up and do some relaxing activity until you feel sleepy. The anxiety of not being able to sleep can make it harder to fall asleep.
If you have difficulty falling asleep or staying asleep, consider trying cognitive behaviour therapy for insomnia (CBT-I) to help relax your mind and implement these tips with a therapist.
If you cannot get a good night’s sleep after trying all of these methods, talk to your family doctor about a referral to a sleep physician for polysomnography (sleep study) to assess for an underlying sleep disorder.

In my experience, sleep has been an issue for as long as I can remember. As a child, I recall not being able to get up for school in the morning. I didn’t know at the time that I was a “night owl”. I couldn’t fall asleep until the wee hours in the morning, and was always exhausted when woken up too early by my parents. They didn’t understand. Before school, I would sometimes run the shower on cold to not waste hot water and then sleep on the bathmat to get an extra ten or fifteen minutes of much needed sleep. This was a huge red flag. Yet went unaddressed until mid-thirties. Throughout my twenties and early thirties, I knew I had insomnia, so I tried every sleep aid and natural option I could find, including CBT-I, sound therapies on Insight Timer with frequencies for delta and theta brainwaves, breathwork, and meditation. The CBT-I, sound therapies, breathwork, and meditation helped me relax and fall asleep a bit easier, but I still woke up repeatedly throughout the night. I was chronically sleep deprived and always exhausted. I snored and I would wake up anxious in the morning at the sound of my alarm. Shear will power and coffee guided me through, but I knew it was not a permanent solution. During dental school, my friends in medical programs introduced me to sleeping pills, which gave me five hours of sedated sleep. This allowed me to survive, but was far from thriving. I eventually met a sleep dentist at a conference who suggested I get a sleep study – something no physician I saw about my sleep, and who prescribed me sleeping pills and anxiety medications related to sleep issues, ever mentioned. The result of the sleep study was obstructive sleep apnea. I had insomnia because my mind was afraid to fall asleep at night because my body would choke on itself. No one thought to look at the root cause of my insomnia, sleep deprivation, snoring, and anxiety. The medical doctors just knew how to prescribe drugs for symptoms. I did the necessary training and treated myself with an oral sleep appliance and a nasal dilator that effectively managed my symptoms of obstructive sleep apnea. My insomnia disappeared. My snoring stopped. My anxiety went away. I completely stopped sleeping pills. I was more naturally energized and productive, and became inspired to help others do the same: discover root causes and work with various health professionals at overcoming issues, like sleep breathing disorders and chronic pain, that fall through the cracks of our health care system. As I became more self-aware through much inner work, I started having nightly lucid dreams. Navigating my extremely vivid and exciting dreams has become an opportunity to choose differently than I had in past experiences and offers potential for learning and rewiring my brain. The lessons I learn from my dreams have been vital in conscious expansion.