The Science & Practice Of Perfecting Your Sleep

Key Takeaways

• “Sleep is probably the single most effective thing you can do to reset your body and health” – Dr. Matthew Walker

• Sleep is so significant in our health, you really can’t sacrifice non-REM deep sleep or REM sleep without damage

• “There is no major psychiatric disorder we can find in which sleep is normal.” – Dr. Matthew Walker

• REM sleep is the most predictive of longevity and lifespan

• Any amount of alcohol and THC will disrupt REM sleep

• If you can nap without disruption to your sleep at night – go for it! Otherwise, stay away from naps

• Pro-sleep behaviors: sleep and wake up at regular times, keep the temperature cool, keep the room dark, limit caffeine intake window, do your best to minimize or eliminate alcohol, have a wind-down routine

• Priority of events to improve sleep: behavioral tools (light viewing behavior, caffeine, and alcohol, etc.) – nutrition – supplementation – prescription drugs – brain-machine interface

• Unconventional tips for better sleep:

• Don’t alter your sleep schedule if you have a bad night of sleep

• Have a wind-down routine

• Write down your worries from the day 1-2 hours before sleep

• Remove all clocks from your room and don’t check the time on your phone

Sleep Cycles And Nuances Of REM Sleep

• Sleep is the most fundamental layer of physical and mental health

• “Sleep is probably the single most effective thing you can do to reset your body and health” – Dr. Matthew Walker

• Sleep as a process is complex in terms of physiology

• Our assumption has been that we evolved to sleep but it’s possible that from sleep, wakefulness emerged

• Sleep is separated into two main types: (1) rapid eye movement (REM) sleep and (2) non-REM deep sleep

• Sleep cycles: non-REM and REM play for brain domination throughout the night in 90-minute cycles

• The ratio of non-REM and REM throughout the night: the first half of the night is dominated by non-REM deep sleep; the second half of our sleep is dominated by REM sleep

• If you sleep hours later than usual (maybe because of an event) – you will likely have more REM sleep cycles and less deep sleep

• REM sleep is often called “paradoxical sleep” because the brain is highly active in this stage

• We also see serotonin and norepinephrine shut off during REM sleep, and acetylcholine ramp up

• In REM sleep the brain paralyzes the body so the mind can dream safely without body taking action

• Just before entering REM sleep, the brainstem sends a signal down the spinal cord and locks the voluntary muscles of the body in paralysis

• Only two voluntary muscle groups are not paralyzed: (1) extraocular muscles and (2) inner ear muscle – though the reason these two are spared is unknown

• REM sleep is nature’s emotional regulation and therapy

• Studies have shown an inverse relationship between REM sleep and all-cause mortality: the lower your REM sleep, the higher all-cause mortality

Non-REM Deep Sleep & Stages Of Sleep

• There is really no state in wakefulness that is like true slow waves of non-REM deep sleep

• Deep sleep allows you to save memories in the brain

• Non-REM deep sleep is divided into four stages, increasing in the depth of sleep: stages 1 and 2 are light stages of non-REM deep sleep; stages 3 and 4 are deep stages of non-REM deep sleep

• In stages 1 and 2: heart rate begins to drop, brain wave activity slows down

• In stages 3 and 4: heart rate is low, cells in cortex fire together then go silent

Hormone Regulation During Sleep Cycles

• Sleep should be evolutionarily selected against as during sleep we are vulnerable to predation which one could imagine would have made sleep selected out – but it hasn’t so it must serve a significant function

• Hormone regulation and dysfunction are different during non-REM deep sleep and REM sleep

• During non-REM deep sleep, we get autonomic restoration and regulation of heart rate and blood pressure

• Insulin regulation of metabolism is disrupted in cases where non-REM deep sleep is insufficient

• Growth hormone and testosterone are tied to REM sleep

Sleeping The Whole Night Through Versus Involuntary Disruptions To Sleep

• Sometimes you will wake up in the middle of the night for some reason – maybe to use the restroom, maybe you just wake up

• It’s natural to wake up in the middle of the night, especially with age

• When we finish 90-minute cycles, almost everyone wakes up and changes position because the body has been paralyzed in REM

• Healthy sleep efficiency: of the total amount of time in bed, we want to be asleep approximately 85% or more asleep

• Intervene in fragmented sleep if you are waking up 6-7 times per night, or if wakeful periods are 20-25 minutes

• Uberman schedule: person sleeps in 90-minute bouts throughout day and night

• If you sleep in accordance with the natural sleep cycles mother nature gave us, your health will be better

Light Exposure

• Stack cues for wakefulness early in the day

• In the first half of the day, get at least 30-40 minutes of direct sunlight each morning to feel more alert – can do this even by working next to a window with natural light coming through

• Sleep time and efficiency can increase dramatically if you are working in an area with a window

• If you can do it safely, minimize the time in sunglasses to accurately convey information about time and day to the rest of the body

Caffeine

• It’s best to allow natural signals to wake up the body by delaying caffeine intake 90 minutes after rising

• How does caffeine work to wake us up: caffeine is a psychoactive stimulant that increases dopamine and blocks adenosine (which makes us sleepier)

• Caffeine crash: when coming down from caffeine, you lose the effects of caffeine, and the level of adenosine you suppressed comes rushing in

• The dose and timing of coffee is what makes it helpful or harmful

• The half-life of coffee is 5-6 hours depending on liver enzyme

• Even if you don’t feel the effects of late caffeine intake on sleep, cycles will likely be disrupted – particularly deep sleep

• You might fall asleep and stay asleep well, but increase caffeine intake the next day because you don’t feel rested

• Suggestion for last caffeine intake: 8-10 hours from the time you would like to sleep

Alcohol

• Alcohol is a sedative but not a sleep-aid

• People tend to turn to a “nightcap” or evening drink to help them fall asleep and turn off thoughts and planning

• Negative impacts of alcohol on sleep:

• You lose consciousness quicker but are not achieving quality sleep

• Alcohol fragments sleep so you will wake up many times throughout and will not have continuous sleep

• Alcohol is a potent REM sleep blocker

• Even one single glass of wine with dinner will reduce REM sleep time and can even cause declines in growth hormone release over time

• Timing (e.g., day drinking) and dose make a difference with alcohol but specifics are unknown

Marijuana And CBD

• Marijuana disrupts sleep

• Marijuana consists of THC and CBD (non-psychoactive components)

• Like alcohol, THC blocks REM sleep – when you stop marijuana/THC, REM sleep will resume and even try to regain lost REM sleep

• Another concern about using THC for sleep is withdrawal dependency which induces significant rebound insomnia

• CBD levels are often misreported on label

• In some studies, CBD promotes wakefulness

• It doesn’t seem that CBD is as disruptive as THC – but there isn’t enough information about CBD to make informed suggestions

• Possible avenues CBD may enhance sleep – if at all: (1) thermoregulation, (2) anxiety reduction, (3) may modulate adenosine sensitivity

Melatonin In Naturally Occurring Form Versus Supplement

• Melatonin starts to rise in as dusk approaches, peaking around the time of sleep itself

• Melatonin tells the body when it’s day and night and can help with the timing of sleep but not induce sleep

• Analogy: melatonin is like a race director who calls all racers to the line but doesn’t participate in the race itself

• Darkness triggers the release of melatonin: (1) try dimming lights in the house in the evening; (2) avoid blue light

• Melatonin is not particularly helpful as a sleep aid – a recent meta-analysis showed melatonin only increased sleep by about 4 minutes and sleep efficiency by about 2%

• Potential positive effects of melatonin for some people: may drop core body temperature, potential antioxidant effects, older adults who have a lower reduction of natural melatonin release, may reduce anxiety – or – placebo!

• Problems with melatonin dosing: the amount of melatonin in supplements is orders of magnitude greater than amounts of melatonin naturally released in the system

• There is evidence that melatonin suppress puberty and should be used with caution as a sleep supplement

Sleep Supplements

• There are many forms of magnesium but the two helpful for sleep are: magnesium biglycinate and magnesium threonate

• Huberman’s sleep cocktail:mangesium threonate at 200-400mg 2-3 hours before sleep; theanine 200-400mg; apigenin 50mg – leave out the theanine if you sleepwalk

• We don’t have good studies that have specifically talked about magnesium threonate – and the literature for magnesium for sleep, in general, does not provide compelling evidence

• If you have healthy levels of magnesium, it’s unlikely you need to supplement

• Magnesium has shown benefits in older adults with insomnia

• Valerian root: evidence does not support the use of valerian root for sleep

• Tart cherries: sound studies have shown that consuming tart cherry juice can reduce time awake throughout the night and increase minutes of sleep

• Kiwi fruit: eating kiwi with skin on seems to decrease the speed of time to fall asleep and increase sleep duration – maybe mediated by the GABA system

• Tips for self-experimentation:

• Gauge where you currently are for about one month

• Take a supplement of interest for about one month

• Do the negative experiment – come off the supplement for one month and see if things get worse – if it’s worse, it might be worth taking

Nap

• There is a lot of individual variation in tolerance for naps

• Naps are a double-edged sword: if you struggle with sleep at night, do not nap during the day in order to build up sleepiness and hopefully sleep at night

• If you have fragile sleep and insomnia – don’t nap during the day because you’re releasing healthy sleep pressure that’s built up

• If you nap regularly and sleep well at night, go for it!

• Naps as short as 17 minutes can have great benefits on learning on memory

• Tips for a good nap: keep it brief (20-25 minutes), keep it 7-8 hours before you want to sleep

Can You Sleep Too Much?

• Depression can come from anhedonia, so you stay in bed longer but are not necessarily sleeping more

• Sleep is not a linear relationship: it is true that the shorter your sleep, the shorter your life – however – past 9 hours of sleep the mortality curve rises again

• BUT, being in bed too long may be compensation for fragmented sleep

• Sleep quality and poor sleep efficiency is a predictor of mortality

• When we are sick, we want to sleep more

• Sleep doesn’t seem different than other things in our life – you can overeat, you can over-exercise, you can over-hydrate, etc. – it seems logical you can get too much sleep

Effects Of Sex, Orgasm, & Masturbation On Sleep

• Post-orgasmic increase in prolactin is thought to be a natural sedative

• Sex that results in orgasm (for both people involved) seems to improve pair bonding and can promote pro-sleep hormones

• People will self-report using masturbation as a sleep aid

• Sleep can also help with relationships and sex: estrogen and testosterone are under profound regulation under sleep – too little sleep and sex hormones are significantly disrupted

• Restless nights of sleep trigger more fights and predict higher rates of conflict and less resolution because empathy decreases with sleep

• For every 1 hour of extra sleep, a woman gets, her interest in sexual intimacy increases by 14%

Unconventional Sleep Considerations & “What Ifs”

• If you have a bad night of sleep, do nothing: don’t wake up later, don’t sleep earlier, don’t nap, don’t increase extra caffeine

• Have a wind-down routine: it takes time to gradually unwind and fall into a restful sleep – we do this with kids but stop as we get older

• Don’t count sheep! But do take yourself on a mental walk and visualize nature to get your mind off itself

• An hour or two before bed: write down the things that are bothering you, so you unload your concerns

• Difficulty and anxiety in sleep are not the same as they are during the day – we tend to ruminate and catastrophize disproportionately during sleep

• Remove all clocks from your bedroom and resist checking the time on your phone

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