At Right Path Addiction Treatment Centers a very high percentage of our patients complain about the quality and quantity of their sleep. This is not surprising as, behind pain, insomnia is the 2nd most common complaint to physicians in America. Unfortunately, in America, the typical physician response is to prescribe a sleeping pill.
In a scenario eerily reminiscent of oxycontin ads 20 years ago, we now watch TV ads for Ambien, Lunesta and Sonata. In the 1st instance, those oxycontin ads contributed to the opioid epidemic and we are now seeing a benzodiazepine epidemic which sadly is not being recognized for what it is.
Despite many years of college, graduate and post-graduate studies I never received any formal didactic training on the state in which I spend about 30% of my life. Sleep. In 2018, insomnia and other sleep disorders have become a global issue affecting humans around the world.
What is the cause of this global issue? Simply, the answer is light. Electric light, television light, computer light, smartphone light etc. These devices have reached the most remote places on Earth and we sleep less because of it. Once any form of light reaches our retinas it is a signal for our brain to awaken Thomas Edison, the inventor of the lightbulb felt that sleep was a bad habit that we would one day get rid of. While he was partially correct (we sleep less), the consequences are poorer physical and mental health.
The 2017 Nobel Prize for Medicine was awarded to 3 scientists who identified the cellular molecular clock that keeps us in sync with the Sun. Our natural biology is to sleep at night and to be awake during the day. When this Circadian rhythm is broken down we begin to break down. Anyone who sleeps less than 6 hours per day is at increased risk for depression, psychosis, stroke, heart disease and diabetes.
Every reader of this paper should do a Google search of the term Sleep Hygiene, absorb the concepts and then honestly apply them to their personal situation. In 2018’s America we sleep, on average, less than 7 hours a night. This is more than 2 hours less than we slept 100 years ago. Every society on the planet is sleeping less. We are all sicker because of this fact.
In 350 BC Aristotle wrote an essay “On Sleep and Sleeplessness” wondering what we were doing and why. Mankind had no more useful insights for the next 2300 years. Only recently have we begun to elucidate what happens when we sleep.
Our brain behavior and purpose changes dramatically when we sleep. We become temporarily paralyzed (we cannot even shiver). Our eyes look around behind closed lids as if we are seeing, and the muscles in our ears move as if we are hearing, even in silence. Both men and women become sexually aroused multiple times. We dream fantastic even frightening things…but what is really going on? Sleep is defined as a behavior marked by diminished responsiveness and mobility that is easily disrupted (unlike coma or hibernation) All living organisms display sleep-like behaviors suggesting that sleep is ancient and that its original and universal function is to preserve life. It is a law of Nature that NO organism can go full throttle 24 hours a day.
Sleep rejuvenates us. It is when our brain moves from recording to editing. We observe and process during the awake state and in sleep we embed the lessons into our cells. In sleep we decide which memories to keep and which ones to lose. Sometimes our brains do not choose wisely. The military has found that after a traumatic mission or fight that it is better for those involved to stay awake and process the event rather than to go to sleep. It is thought to lessen the risk of PTSD.
The 4 Stages of Sleep
There are 4 stages of sleep. Stage 1 is shallow sleep which lasts about 5 minutes. Next, electric messages form deep in the brain called spindles ascend to the cerebral cortex in Stage 2. Our brain remains as active in sleep as it is when awake just differently active. The spindles stimulate the cortex in such a manner as to preserve newly acquired information and to perhaps link it to already stored information in our long term memory. Sleep allows us to make connections we might never make while awake. Hence we say “let me sleep on it”
Stage 2 lasts about 50 minutes during the first sleep cycle. In subsequent cycles, it becomes shorter. Spindles start off fast and strong then taper off as we descend into the deeper stages 3 and 4. Stage 2 comprises about 50 % of our sleeping time.
The cellular rejuvenation and recuperation that living organisms require to cope with being awake occur in Stages 3 and 4. This is when our cells produce most Human Growth Hormone( HGH) which is needed to service bones, nerves and muscle.
Bodily housekeeping functions like a healthy immune system, blood pressure and temperature regulation require sleep in order to maintain health. Lack of sleep leads to disease and /or inability to heal.
Dementia has been linked to sleeplessness and at the cellular level the explanation is amazing. While we are awake our neurons are packed together tightly, but in sleep, these cells literally deflate and allow toxic intracellular waste to be dumped into the space created by the deflation. Only in sleep can this waste (amyloid) be carried away.
In 1953 REM sleep was discovered and the entire science of sleep was upended. REM sleep is distinguished by darting eye movements and sexual organ engorgement. It is the phase in which all vivid dreaming takes place. We experience multiple 5 to 20 minute REM sessions totaling about 20% of all sleep time. We become psychotic believing what we see and accepting weird notions of time, space and people.
Throughout history, we have searched for the meaning and significance of our dreams and even today there is no consensus on their meaning or importance. Everyone dreams and lack of dream recollection is an indication of healthy sleep.
We dream throughout REM sleep but as we age REM decreases as our brains become less pliable. We stop learning as much and hence have fewer memories to process. Our childhood memories are much clearer than adult memories, in most people. During REM sleep all our muscles become paralyzed save for those in our eyes, ears, heart and diaphragm. We do not thermoregulate. Brain production of serotonin and norepinephrine stops.
REM sleep is controlled by the Limbic System, a region of the brain that controls sex drive, aggression, fear, elation, joy and love. Other regions of the brain that control body motion are involved so that we can experience falling or flying. We dream in color unless we are congenitally blind. All men get erections and all women become sexually aroused. We believe our dreams are real.
Fortunately, the brain stem closes down the motor neuron gate and we cannot, save in rare individuals act out our dreams. If we sleep without an alarm our last dream terminates our sleep. Although the amount of time we have slept determines the optimal time to awake, light exposure also sends a message to our brain to awaken.
Sleep disorders are common affecting as many as 80 million Americans. Getting less than 7 hours of sleep leads to fatigue contributing to errors. Every physician who has done a residency likely has lived through years of sleep deprivation. Sadly they know the experience but rarely understand the consequences to their health. This translates into the health of their patients as well. The average physician rarely has a comprehensive understanding of the importance of sleep other than “get a good night’s sleep”. Mainly it ends with a prescription for a pill.
Insomnia is the most common sleep disorder and is the reason why up to 10% of Americans take sleeping pills regularly. Throughout evolution our brains have developed an override system such that sleep can be interrupted by a baby’s cry, the smell of smoke or a frightening noise. In today’s world this ancient override is being constantly triggered by non life-threatening items such as work and financial issues, worries about school and city at night noises. Before the industrial revolution we could just sleep in but not today.
Our brains just do not function well without sleep. Interrogators have long used sleep deprivation as a successful tactic. Sleeplessness causes the body to produce ghrelin, the hunger hormone and leads to obesity. Sleeplessness undermines the whole body.
After year of theorizing on ways to manipulate different phases of sleep, scientists have realized they just don’t know enough to do this at present. This lack of understanding has not deterred Big Pharma and doctors from prescribing medications for sleep.
Many different classes of drugs are used as sleep aids. They ALL cause problems and there exist no reliable unbiased data on overall safety and efficacy. Antidepressants of several classes are used because of a side effect of drowsiness. The same is true of antihistamines and benzodiazepines. The Z drugs ( Ambien, Lunesta and Sonata) affect the GABA portions of the brain ( like benzos) and have potent and dangerous drug interactions let alone issues of dependence, abuse and addiction. All of these medications are associated with drowsiness while awake, bizarre sleepwalking experiences and amnesia. Yet these medications remain very popular and are widely viewed as safe. (they are prescribed by a doctor… Does that sound familiar?)
Reviewing available literature supporting their use is frustrating as it is all funded by the companies producing the drugs.
Best advice is to use more natural products like melatonin and to follow the discipline outlined in sleep hygiene. We need to limit stimulants and everyone should strive to sleep more. Nobody but you, the individual, cares about how much sleep you get unless their safety depends on it. When we sleep it is playtime for our brains. We are at our most intelligent, free and creative best. We should all sleep more.