I have often joked with my friends that I have to keep quiet about what I do for a living when I’m in social situations. Sleep and psychiatry, it turns out, are two things people have very much on their minds, and in today’s fast-paced society, everyone seems to be stressed by working too much and sleeping too little. I am amazed by the people I meet who exercise regularly, eat healthy, organic food and use meditation apps, only to tell me (in line at Starbucks) that they often only get five to six hours of sleep each night. The tremendous importance of sleep to our well-being has been a lesson I have learned repeatedly in my career as a psychiatrist. I advocate that it should be a vital sign, along with blood pressure and pulse, recorded at every visit to indicate our general state of health.
The effects of not getting enough sleep
Periodically, middle-aged patients come to see me and worriedly ask, “Doc, I think I have Alzheimer’s. I forget movies, words, and walk into rooms and forget why!” Much to everyone’s relief, it usually turns out to be a sleep problem. Sleep is so valuable because our minds package memories and practice for upcoming situations during that time. Myriad studies have tested people by asking them to memorize a list of words before giving them a chance to sleep. The studies consistently show that more sleep results in better recall and an improved ability to learn everything from word lists to emotional responses to swinging a golf club.
Let’s not forget that sleep deprivation is a form of torture. I’ve seen a good many people become emotionally “unstable” – tearful for no apparent reason, over-reactive and irritable – when they’ve had too little sleep. One man knew he needed to catch up on his zzz’s when, after a few nights of poor sleep, he began to cry over a dropped paper clip.
And then there’s the issue of energy – or depression. Do you feel like doing things, but lack the energy, or do you not feel like doing things at all? Fatigue can look very much like depression, and in many instances, there is a fine line between the two. Indeed, a vast proportion of people I have worked with, who have been diagnosed with attention deficit disorder, as bipolar, or with treatment-resistant depression, benefit tremendously from the optimization of sleep.
If you doubt the importance of sleep, consider this: several recent studies have found that sleep can be used as part of a protocol to reverse mild dementia and increase longevity. One recent study at the University of Washington Medicine Sleep Center tested pairs of identical twins who had different sleep patterns. The study results showed that the twin with fewer sleep hours had a less-active immune system. The immune system and inflammation play crucial roles in chronic disease; therefore, enhancing sleep should be a priority for optimal health. What can you do? Sleep more and sleep better. Make sleep your health priority and aim to keep sleep on a regular schedule. Dim lights in the evenings, do not use electronics (especially before and during sleep, and immediately upon waking), keep your bedroom temperature on the cool side, and maintain an overall positive attitude towards sleep. How much sleep is enough? Seven to eight hours per night is ideal, but in the end, the answer is enough sleep so you are not tired the next day (or needing to drink copious amounts of caffeine to help you stay awake and alert). While it is normal to be a little drowsy around 2-3 pm, an irresistible urge to doze off is not normal – this is a marker of fatigue. In addition to the quantity of sleep, look at the quality of your sleep. Does your sleep feel light? How many times a night do you wake? Do you snore, or kick around a lot during the night? A great app to start this investigation is called SnoreLab (free on the iTunes store). It lets you record audio all night so that you can discover either how loudly you might snore, or what happens right before you wake at night. While this does not replace a sleep study, it is an easy way to get a rough idea of what happens at night.
Optimize your sleep hygiene
In the end, sleep is like a Chinese finger trap. The more you pull and force it, the harder it is to achieve. Many sleep hygiene recommendations focus on this concept.
Get your phone out of the bedroom! It's too exciting and it trains you to wake quickly and turn your mind on immediately, which is not good for maintaining a restful sleep. Use an old-fashioned alarm clock; it's far less engaging – at both bedtime and wake time.
Do not toss and turn and stare at the clock, aggravated, hoping to fall asleep eventually. Most commonly, I tell my patients with insomnia to focus on their breath. Breathe in for 4 seconds, hold 4 seconds, breathe out for 7 seconds, hold 4 seconds. Repeat. Try this for 10-15 minutes.
If sleep is still eluding you, get out of bed, and do something relaxing. No tech! A calm book, in a dim light outside of the bedroom, until you start yawning again, then head for the bed. It’s classical conditioning – we need to associate the bed with sleep, not work, arguing, food, television or frustrating tossing and turning. Bed equals sleep, and maybe sex. But that is all.
You spend one-third of your life sleeping, and it affects every aspect of your waking life. From memory to mood, to immunity, to weight loss and diabetes, and even the risk of cancer, sleep has profound effects.
Here's to a good night's rest!
Resources
Morin CM, Hauri PJ, Espie CA, Spielman AJ, Buysse DJ, Bootzin RR. “Nonpharmacologic treatment of chronic insomnia. An American Academy of Sleep Medicine review.” Sleep, Dec 1999: 1134-56. www.ncbi.nlm.nih.gov/pubmed/10617176
Watson, Nathanial and Sina Gharib, et al. “Transcriptional Signatures of Sleep Duration Discordance in Monozygotic Twins.” Sleep, Jan 2017. DOI: academic.oup.com/sleep/article/doi/10.1093/sleep/zsw019/2952682/Transcriptional-Signatures-of-Sleep-Duration
Chronic sleep deprivation suppresses immune system. University of Washington Health Sciences, Jan 27, 2017. www.sciencedaily.com/releases/2017/01/170127113010.htm
Insomnia treatment: Cognitive behavioral therapy instead of sleeping pills. www.mayoclinic.org/diseases-conditions/insomnia/in-depth/insomnia-treatment/art-20046677
Alex Dimitriu, MD
Alex Dimitriu completed medical school and residency in psychiatry at SUNY Stony Brook, and continued his training at Stanford Medical Center with a fellowship in sleep medicine. He is currently in private practice in downtown Menlo Park. He sees patients with a wide variety of conditions, ranging from depression to anxiety, to insomnia and other sleep disorders. He practices an integrative model of psychiatry, which aims to improve various domains of people's lives. He has always believed in the power of the mind and the power of the spirit to heal the body. Practicing a collaborative model, he works with other doctors, therapists and alternative medicine practitioners to achieve truly outstanding outcomes. He works with some of the sharpest minds in Silicon Valley to achieve true optimization and self-improvement.
1225 Crane Street, Suite 205 Phone: 650-326-5888 Email: alex@doctoralex.com Website: Doctor Alex
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