For World Sleep Day, an expert answers your questions and explains why sleep is essential for good health
When the Covid-19 pandemic hit the United States in spring 2020, its negative impact on sleep habits was so significant that the terms “Coronasomnia” and “COVID-somnia” were coined. Now, as the U.S. transitions from pandemic to endemic, the sleep habits people formed over the past two years — for better or worse — will likely be disrupted again. Add to that anxiety about the war in Ukraine, and the recent change to Daylight Savings, and you have a recipe for a bad night’s sleep.
Patrick M. Fuller, a neuroscientist who studies how the brain regulates sleeping and waking, is a professor in the Department of Neurological Surgery and vice chair for research. In the Q&A below, he discusses what scientists know about sleep and insomnia, why sleep is so important for health (including brain health), and what habits you can adopt to help you get a good night’s sleep.
Why is sleep important for health?
Sleep is the third pillar of health. There’s nutrition, physical exercise and then sleep — all three are interconnected. If you don't sleep well, you start not eating well. For example, people get food cravings when they haven’t slept well, and it’s usually for a high-carbohydrate food like a cookie. And when you are tired, the last thing you want to do is go to the gym. People who are functioning optimally pay attention to all three — they have to be optimized together.
What’s the ideal amount of sleep?
We know from studies that the sweet spot for sleep in terms of health is seven to eight hours a night for most people. Some people swear they get away with four or five hours of sleep. While bona fide “short sleepers” do exist, they comprise a very small percent of the population. The remainder of self-identified short sleepers are mostly just getting by drinking coffee. And not getting enough sleep can raise the risk of health consequences.
Like what? Can poor sleep increase your risk of disease?
Yes. Disrupted or insufficient sleep is linked with seven of the 15 leading causes of death in the U.S., including cardiovascular disease, diabetes, stroke, accidents and cancers. It's simply not good to deprive yourself of sleep as it pervades and supports all aspects of normal body and brain function.
What happens to your brain health when you don’t get enough sleep?
Sleep deprivation affects your ability to remember and concentrate. Sleep-deprived people have a compromised ability to make good decisions. Your reaction time is also reduced. A sleep-deprived driver has the same poor response time as someone who is legally intoxicated. Not getting enough sleep makes us more emotionally unstable. We can have really strong emotions, such as extreme sadness or anger, simply driven by a lack of sleep.
What is insomnia?
Insomnia is a major health condition in which you have trouble falling or staying asleep (or sometimes both). Insomnia can be primary or secondary. Primary insomnia is not associated with any other identifiable medical condition. The diagnosis of primary insomnia is a complex clinical task. It typically requires a full psychiatric and medical exam and a workup in a sleep lab. Secondary insomnia means there is another medical condition, often a neuropsychiatric one, driving the insomnia. Most people have secondary insomnia caused by something else like depression or anxiety.
Also, there are different forms of insomnia. You can have onset insomnia, or the inability to fall asleep. You can have maintenance insomnia, which is difficulty staying asleep. And then there's terminal insomnia, where you wake up too early and can't get back to sleep.
What’s happening in your brain when you have insomnia?
There is now a consensus in the sleep field that insomnia is a state of hyperarousal. Your brain’s arousal system is amped up, and your sleep system can't turn it off.
What are some medical treatments for people with insomnia?
I think of good sleep as being essential for “good wake.” For example, there are some very effective drugs for treating insomnia, but it’s common for people to talk about feeling groggy the next day when taking these drugs. In other words, maybe they had good sleep but not “good wake” the following day. A non-drug treatment like Cognitive Behavior Therapy for Insomnia, or CBTI, has emerged as a highly effective clinical approach for treating insomnia. CBTI is arguably as effective, if not better, than taking a drug in many cases. It gets people to recognize what might be an underlying driver of their insomnia. For example, for people with anxiety, it effectively addresses the underlying cause of the anxiety, which in turn improves sleep, which in turn reduces anxiety.
Does sleep play a role in diseases like Alzheimer’s disease?
One thing that ties almost all neuropsychiatric and neurodegenerative disorders together is some level of wake and sleep disruption. We know that treating sleep disruptions can help stabilize neurologic disorders. But left untreated, sleep disruption may contribute to the progression of the disease. One example is Alzheimer's disease. We know that sleep is disrupted in the early stages of the disease. If we could address that early on, perhaps the progression of the disease could be delayed.
What are some things people can do to get a better night’s sleep?
- Sleep in a dark room (light is very activating for our brains).
- Keep the room temperature cool. Low to mid-60 degrees is optimal.
- Adopt and maintain a specific time to rise in the morning and sleep at night. It’s also important not to deviate from your schedule on the weekends. If you sleep in on the weekend, you are essentially jet-lagged when you get up to go to work on Monday. And, again, aim to get 7-8 hours of sleep every night.
Stay off your electronic devices at least an hour before bedtime. Devices like phones and iPads emit blue light, which is extremely activating for the brain. It’s like having “electrical caffeine” right before you go to sleep.
What should people NOT do if they want a better night’s sleep?
- Don’t drink coffee or caffeine at night.
- Don’t drink alcohol right before bed. It tends to wake people up when its effects wear off.
- Stay off your electronic devices at least an hour before bedtime. Devices like phones and iPads emit blue light, which is extremely activating for the brain. It’s like having “electrical caffeine” right before you go to sleep. And even when you do fall asleep after looking at your device, the brain stays more active.
Any final advice for those who struggle to sleep?
It’s really helpful to have a bedtime routine you enjoy. Your routine should be individualized to what you like and find comforting. So, if you like doing word puzzles, reading or listening to quiet music, that’s great. Some people find a cup of warm milk at bedtime comforting. Others might find warm milk revolting, but like having a cup of herbal tea. Whatever you enjoy. We think of routines as important to kids, but even though we are adults, our brains still like comforting routines, and they can facilitate sleep at night.
And finally, I think we have established as a cultural norm that sleep is expendable to a certain degree. How often have you heard, “I pulled an all-nighter” or “I only need four hours a night of sleep?” Unfortunately, statements like these have become badges of honor in our culture. I think one of the greater gifts we can give ourselves and the next generation is an appreciation and respect for a good night’s sleep.