Sleep and Your Health

I’ll begin with sleep basics so we have a common language and understanding of terms.

What is sleep anyway?  Although you sleep daily, you may not have been told what sleep is.  Scientists are still trying to unravel the mysteries of sleep, but as a starting definition, sleep is a mental and physical state that has distinct differences from your waking state:

– Regarding your interaction with the environment, during wakefulness, you’re geared to react to the world around you through your senses.  A slight touch on your arm by a stranger triggers a reaction of withdrawal.  Your name spoken softly across the room catches your ear.  But when asleep, even if you are touched, you’re much less likely to notice it or react to it, other than perhaps to move your position to get more comfortable.  So sleep is a partial isolation from your environment.

– In terms of your brain’s thinking process, when awake your brain is in control.  You observe what is happening around you, decide what it means and react.  When asleep you’re either dreaming and in a fantasy world or simply resting.  So in sleep your thoughts are aimed inwards rather than outwards.

In summary, sleep is an alternate mental and physical state that is inward focused rather than outward focused.

But, that doesn’t mean sleep is a passive activity.  In a coma or when you’re put under for an operation, the brain basically becomes inactive.  But in sleep there is a lot going on.  Sleep is mainly an activity that benefits the brain.  Physical benefits are less critical.  Michael Schwartz, who an expert in measuring sleep in the laboratory, puts it this way: <Michael Schwartz audio>

Sleep Benefits: There are important benefits that you get from sleep:

6 – Important memories are reinforced and unimportant information let go.  This means that you learn better and remember more.

5 – Emotions are processed to help you make sense of the world.  So you become more emotionally balanced and in control. <positive emotional outcry?>

4 – Learned complex tasks and motor skills are reinforced.  So for instance you learn athletic skills or crafts more quickly.

3 – Growth hormones are released <to grow and heal the body.  Appetite hormones are regulated to make it easier to eat healthily and control your weight.

2 – The brain spends time rejuvenating and flushing itself of waste products to ready itself for another day of activity.

1 – And of course, it helps you to feel good, refreshed and alert when you sleep well.  So your relationships improve and you just feel better.

There is not a strong connection between sleep and your health nor sleep and your heart.

The point here isn’t to memorize or worry about not getting these specific benefits because of your insomnia, but just to know that anything you do to improve your sleep is going to benefit you in a way that you will notice and appreciate.

Limitation of benefits:  It’s also helpful to keep the benefits of sleep in perspective and not get unduly worried about sleep’s impact on your well being.  Sleep is but one of many factors that impact your quality of life.  Other factors are your relationships, exercise, diet and mental health.  On top of that is fact that there is much in life that we don’t control: For instance to whom and when and where you were born and what uncontrolled events and unexpected consequences cross your path.  So try not to get overly concerned about your sleep.  Improved sleep by itself in unlikely to dramatically change your life, but it will help take you in the right direction.  There is little or no connection between sleep and your health nor sleep and your heart.

I say this only to help you avoid worrying about sleep as worrying will predictably prevent you from sleeping well. <transition>

Amount of Sleep:

The amount of sleep you need is determined genetically, like your height or shoe size.  When you buy shoes, you judge which shoes to buy by its feel and how it looks.  In the same way, you should judge your sleep by how rested and alert you feel the next day.  The average shoe size for men is size 9.  I would be crazy to insist on a size 9 shoe when my feet are a size 11.  In the same way you should judge your sleep time on how well sleep is working for you, not the average sleep time stated in the media.

Next time you hear an alarming headline on how people get less than the average, remember that just as 50% of the population has a shoe size smaller than the average shoe size, 50% of the population gets less than the average hours of sleep.  Unfortunately, some reporters are not well versed in statistics.  I find it quite amusing but saddened when I see it in the press.

In fact, some insomnia is caused by people worrying that they don’t get the average amount of sleep each night.  If this happens to you, remember he shoe size analogy and enjoy a nice chuckle at yourself.

In addition, the optimum amount of sleep is probably less than we think as Dr. Erichsen explains: Dr. Daniel Erichsen audio>

If that’s not enough for you to rest a little easier, keep in mind that people with insomnia typically underestimate the amount of sleep they are getting by about an hour.  That’s right.  When they put people with insomnia in a sleep lab where they can accurately measure their sleep and ask them the next morning how much sleep they think they got, they typically under estimate the amount of sleep by a full hour.  You might be doing the same.

Knowing how to tell how you’re doing sleep-wise is an important aspect of CBTi  or Cognitive Behavioral Therapy for Insomnia as you don’t aim for a specific time, but rather respond to the body’s signals that you need to be sleeping more less than you are.

Sleep Science:

In terms of sleep science, I’m going to stick with the minimum you need to execute the techniques in this course successfully.  In one of the ironies of life, people who sleep well typically don’t know much about sleep because, well, they don’t need to.  It’s we insomniacs that think that becoming sleep experts will somehow cure us of our sleepiness.  I would like to explain a few aspects of sleep in more detail that will help you with this course.

2 process model of sleep:

The first is the 2 process model for sleep.  Basically this model sees the sleep-wake phenomena as a tug of war between 2 opposing processes.

<megaphone> On one hand, in the left corner, from the moment you wake up in the morning, the brain starts a very slow process of pulling the brain towards sleepiness.  As the day goes on this pressure to sleep goes up and up and gets stronger and stronger.  By bedtime, the brain really, really wants to get some sleep.  This is called sleep pressure. Sleep pressure is caused by the build up of a chemical called adenosine.  For CBTi or Cognitive Behavioral Therapy for Insomnia, this is important to know because part of the methodology is to work with your sleep pressure, not against it.  Caffeine temporarily blocks adenosine from working which is why it helps perk you up.

<megaphone> Opposing this pull towards feeling sleepy, in the opposite corner, is another system that is keeping the brain alert and responsive to your environment.  This pull towards alertness grows during the day to counteract the sleepiness pull.  The level of alertness is controlled by the circadian rhythm.  This is a 24 hour cycle that controls many aspects of your daily life including thirst, hunger, level of alertness, body temperature and alertness.

Around bedtime, the sleepiness factor is pulling hard.  Around the same time the brain releases chemicals that shut down the alertness drive and prepares the brain for sleep.  During sleep, the sleep drive is gradually reduced, and the next morning sleep pressure is at its minimum and the whole process starts up all over again.

You don’t need to memorize the details.  1^st be assured that CBTi works with these natural rhythms and does not try to manipulate them or get you to work against them.  2^nd, it means going to bed when your sleep drive is high, not when your clock shows a certain time.  Listen to your body, not a digital display.  And 3^rd, do things that help the brain switch off its alertness so you can sleep.

Here is how Michael Schwartz explains it <Michael Schwartz audio>

Sleep triggers:

There are a few triggers that inform the brain to cut back on the level of alertness and start sleeping.  The first is light.  Humans are nocturnal, meaning that you’re designed to sleep at night.  So when the intensity of light decreases this is a strong signal to your brain that it should switch over to sleep mode.  In the same way, bright light, especially in the morning is a trigger that alertness should switch into high gear.

Low light levels trigger the release of melatonin, a hormone you have likely heard of, whose role is to trigger reduced levels of alertness in the brain.  This function of melatonin is important to understand because people often take melatonin to help with their sleep. But the only proven use of melatonin is to help shift when sleep starts, not the quality or quantity of sleep.  So for example, if you tend to be a night owl and want to get to sleep earlier, then melatonin may help by triggering sleep early.  Other than that, clinically, melatonin isn’t recommended for insomnia.

Another sleep trigger is the level of stimulation from the environment.  When you stop stimulating activities, the brain knows it can reduce alertness and let sleep take over.  If you maintain stimulating activities right up to bedtime, your brain stays on high alert.  Your response to stimulus is highly personalized as what stimulates you is boring to another.  For instance a good drama movie in the evening makes it hard for me to get to sleep whereas you might find it relaxing.

One way to think of this, is that for your ancestors, sleep was a highly vulnerable state. During sleep we were susceptible to harm from wild animals, snakes & insects, and also from other humans.  You have survival instincts that prevent you from sleeping if you feel at risk. So before bedtime you want to relax and not introduce thoughts or activities that you could perceive as threatening, whatever that might be for you.  This is a core aspect of CBTi and several of the CBTi methods deal with controlling your level of anxiety.

Sleep triggers are important to remember because they direct us what to do and what to avoid in the hour or so before bedtime.

Deeply imbedded:

Our sleep cycle has evolved over millions of years.  Despite amazing progress by humans over the past 80,000 years or so, your DNA remains the same as your ancestors and thus the sleep process, which is genetic, not cultural, remains unchanged.  One of my favorite sayings of my grandmother was that <say in old voice> every generation thinks they’re the ones that discovered sex.  In the same way, you can be mislead into believing that society’s advances somehow make us into different human beings able to out-smart sleep, but genetically you’re unchanged, and sleep is a DNA driven phenomena.  It’s best to work with your sleep processes, not try to bend a multi-million year development into our modern self-concept of what you wish was true.  Sleep is so embedded into your being that very, very few people have a broken sleep mechanism.  If you’re worried that your sleep system is broken, you can safely put that out of your mind.  If you’re still convinced it is, see a healthcare provider and have this issue resolved, otherwise it may interfere with the success of this course.

In a later lesson I’ll talk about different conditions that can affect your sleep and what to do about it.

Brain Regions & Sleep Stages:

Pre-frontal cortex:  <The only brain region I’ll be focusing on is the pre-frontal cortex.  As the name implies, this is the front portion of the brain, behind the forehead.  It controls your ability to plan, analyze and make decisions.  In other words, it’s the part of the brain that creates anxiety about the future and stress about the past.

This is important to know because, anxiety and stress prevent you from sleeping well.  It’s worth noting that while the pre-frontal cortex is extremely active during the day as you make your way through the world with all its challenges, if you’re sleeping well, it pretty much turns off at night.  As an example, during REM or Rapid Eye Movement sleep, the brain is very active except the pre-frontal cortex region.  This is probably why dreams can be so wild and free as the dream is unhindered by the logical, controlling pre-frontal cortex.  One of the roles of CBTi is to reduce the activity in the pre-frontal cortex so it doesn’t interfere with your sleep.

Sleep Stages

Sleep isn’t uniform.  It has different sleep stages.  Although you don’t need to understand the different sleep stages in detail, I want to mention them here so you can understand some experiences you may have with your insomnia.

Before getting into the details, I would like to give you an audio simulation of brain activity during sleep.  Brain activity can be measured with an EEG which measures the electrical activity of the brain.  Here is what a simulation of an alert person’s brain activity at 22 Hz <17:00> <play>.  When you are resting, such as when you wind down before going to bed, your EEG would sound more like this at 18 Hz.  This same frequency is what your brain at during REM or Rapid Eye Movement sleep.

As you drift off to sleep, your brain slows down even more in N1 and N2 sleep at 10 Hz <play>.  Then when you get into your deepest N3 sleep at 2 Hz, it would sound like this <play>.

So here it is all together in a condensed version of what your brain goes through starting with alertness, then to relaxation, then N1, N2, N3 and REM sleep then back to waking up and being alert. <play and name at same time>

Now for the technical details:

The 1^st 3 stages of sleep are called N1, N2 and N3.  Kind of like Dr. Seuss’s Cat in the Hat thing 1 and thing 2.

After you lay down to sleep, you drift into N1 sleep <play Hz>, the doorway to sleep.  This is when you are between wakefulness and sleep and normally lasts 1 to 7 minutes.    As we learned previously, you can’t enter this stage unless your sleep drive is high enough and your alertness level is low enough.

N2 follows N1. <play Hz> It’s where you spend most of your sleep, about 50%.  It has a low level of brain activity when the brain rejuvenates.  N2 usually lasts about 20 minutes in each sleep cycle.

N2 is followed by N3. N3 is also known as deep sleep, slow wave sleep or delta wave sleep.  It is the slowest brain wave pattern we listened to.  It’s the deepest sleep stage and it’s the stage that leaves you feeling well rested in the morning.  Normally you get most of your N3 sleep early in the night so even if you don’t sleep well, you probably got a good dose of N3 sleep.  It’s hardest to wake from this stage, and if you’re woken you will likely feel especially groggy.  You don’t want to get into N3 sleep when napping or you will waken feeling groggy rather than rested and it will make it harder to fall asleep at night.  We will discuss proper napping techniques in a later lesson.

The last stage of sleep is REM or rapid eye movement sleep.  At this stage your brain is active and it’s when you do most of your dreaming.  But while your brain is active, the pre-frontal cortex is pretty quiet.  You do less REM sleeping early in the night and more towards the end of your night.

And now I am going to tell you the most important part about sleep for someone with insomnia.  How many times do you think you wake up at night?……Does that seem excessive to you?  Let’s hear what Michael Schwartz has to say about nighttime awakenings: <Audio from Michael Schwartz>

You may no longer be a spring chicken….sleep and aging – N3 sleep – slow wave – well rested – drops 2% per year – 20s = 20% of sleep.  In 70s down to 2-3% – normal to feel less well rested in themorning.  Night time awakings few when younger in 20s, more and longer in 70s, natural.

I hope you find it reassuring to learn that waking up at night is normal.  Nobody sleeps solid through the night, although good sleepers may not remember waking up because its not important to them and it is not a stress trigger for them as it might be for you.

You have these night time awakenings for survival.  As you learned earlier, sleep was a vulnerable time for our ancestors, so they needed a quick check on the environment to make sure all was well.  If you wake on your own during the night, this is probably when you wake up.  After your brief awakening, you go back to N1 and through the sleep stages all over again.  It takes about 80 to 120 minutes to go through all the stages from N1 to REM.

From a CBTi or Cognitive Behavioral Therapy for Insomnia perspective, the main message is that it helps a lot to have your stress or anxiety under control to enter sleep, and that waking during the night is normal.  In a future lesson we will cover what to do when you can’t get to sleep, either when you go to bed or when you wake in the night and can’t get back to sleep.  In all these stages there is a weak sleep and your heart connection.

Wrap-up:

Now you have a basic understanding of sleep.  We have covered a lot of information.  It will be helpful to review this lesson after you have listened to the other lessons as it will make a lot more sense then and you will likely notice information that didn’t seem important at the time and you forgot, but helps after you have listened to the other lessons.  Also, I might have made some improvements since this recording.

Show notes are available at: sleeptohealthy.com.

I would like to finish with some words of encouragement and advice from Dr. Daniel Erichsen <audio>

Assignment:

And now your assignment.  Each lesson will have an assignment.  You can find the assignments at sleeptohealthy.com.  In fact, sign up for my email newsletter on sleeptohealthy.com and receive the assignments as soon as the lesson is released.  Knowing the assignment ahead of time helps you to focus on what is important during the lesson.

Today’s assignment is to start monitoring your sleep with a sleep journal.  There are easy and complex ways of doing this.  I find the easier approaches work the best.  There are a few samples on Sleep to Healthy.com or search sleep journal on the internet for sample forms.

Your assignment is to find a form you like, print it of and start using it on a daily basis.  This is important for several reasons.

First, it sets a base line you can measure progress or if you are plateauing or back sliding.

Second, it will help shed light on the cause and effect relationship between daytime activities and night time sleep.  You will see better what helps and what hinders your sleep.

Third, it give more accurate information about your sleep so you don’t make assumptions or think things are worse or better than they really are.

And finally, if you ever seek professional help with your sleep, the 1^st thing they are likely to ask about are the facts and details of your sleep.  A sleep journal is about the only way you can give them accurate and reliable information.

I also recommend journaling in a less formal, more wordy fashion.  This means writing or typing your thoughts each day about your sleep.  What you noticed, what you think the causes might be, what effects it has on your sleep and so on.  There are samples on my website sleeptohealthy.com.  Many people including myself learn a lot by writing about issues rather than trying to sort everything out in my brain.

You could try one of the many sleep journal apps for your smart phone.  I don’t make any recommendations, so you are on your own here.

What I don’t recommend is a sleep tracking wearable.  The purpose of a journal is to gather information so you can see the cause and effect of your behaviors and actions on your sleep, not to track your sleep in charts with performance statistics.

I discourage your using sleep wearables because by measuring your performance they can easily start to cause stress and anxiety, and stress and anxiety is the #1 sleep killer.  This isn’t a race or a contest.  As you will learn in the “Sleep Buddy” lesson, your attitude towards sleep should be more like your attitude towards a good friend.  It is not a case of conquering but of enjoying and appreciating.

In the end, do what works for you.  But if you find yourself getting anxious because of your sleep performance, or if you find yourself becoming dependent on your sleep wearable, meaning you think you would not sleep as well without it, then drop it immediately regardless of what you paid for it.  It has turned into your sleep enemy.

Next Lesson:

That wraps up lesson #2 where we learned about what sleep is, how it works and some of the things that interfere with sleeping well such as stress and anxiety.  We learned about what you desire – more and better sleep.  In the next lesson we will learn about the enemy – insomnia.  We’ll learn that insomnia may not be as bad for you as you thought, how you came to have and perpetuate your insomnia and learn what you can do to start correcting your sleepless nights.  <Audio from the next lesson – Dr. Daniel Erichsen – sleep efforts = more insomnia>

Disclosure:

This podcast is not a substitute for advice from a qualified healthcare professional.  The sole purpose of this podcast is to educate and entertain.  As we do not know your particulars, we cannot and do not provide professional or medical advice or services.  We strongly encourage you to consult a healthcare professional before incorporating any ideas in this podcast.  Listeners who use the information in this podcast do so at their own risk.

Outro:

By structuring this as a course on curing insomnia, it keeps you focused on the core skills you need to improve your sleep. You don’t need tons of sleep trivia and people’s opinions about sleep.  You just need to know proven instructions on what you can do today, to sleep better tonight, so you can feel and function better tomorrow. This allows you to repeat lessons as it’s hard to absorb all the knowledge the first time through, and the information will make more sense after you have the context of the whole course.

You, like most people, will likely benefit from repeated listening.  The lessons will be updated based on student feedback. So the next time you listen to the same lesson, it may be improved since last time.  And that’s about it. Thanks for joining my in my sleep class.

I look forward to seeing you again on the next episode of the sleep to healthy podcast. See you then.