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Why We Sleep

Table of Contents

Why We Sleep: The New Science of Sleep and Dreams by Matthew Walker

Review

When you are asleep, you cannot gather food. You cannot socialize. You cannot find a mate and reproduce. You cannot nurture or protect your offspring. Worse still, sleep leaves you vulnerable to predation. Sleep is surely one of the most puzzling of all human behaviors. On any one of these grounds—never mind all of them in combination—there ought to have been a strong evolutionary pressure to prevent the emergence of sleep or anything remotely like it. As one sleep scientist has said, “If sleep does not serve an absolutely vital function, then it is the biggest mistake the evolutionary process has ever made.”

This was suggested by so many people that I gave in and bought it. This often leads to disappointment (Sapiens), occasionally delight (Marie Kondo, seriously).

The book is convincing, I have become more careful about sleep. This is despite being interested in running, and therefore already aware of the affects of sleep on recovery and performance in that world. The book is scary enough that some people may even change their behaviour slightly in response!

Rules for self:

  • no evening alcohol
  • no evening caffeine
  • no screens before bed
  • go to sleep early enough that you wake up refreshed when your alarm goes of
  • (but we knew all of this already, right?)

So far the only thing I have actually changed is to stop drinking black tea right before bed (this was stupid). My bed time has been drifting toward 11pm recently, so I am hereby committing to the following changes (enforced by beeminder)

  • stop drinking during the week
  • in bed by 10pm

The author (who studies sleep) believes that sleep affects everything, is really, really important, and getting more of it will reduce obesity, car accidents, Alzheimers, heart attacks, depression, diabetes, etc. I feel like it makes sense to slightly discount this based on the fact that people who study something tend to exaggerate its importance.

The writing can be a bit much at times:

an abundant constellation of nighttime benefits that service both our brains and our bodies.

There were some fascinating bits in here:

In some species, many of the birds in a flock will sleep with both halves of the brain at the same time. How do they remain safe from threat? The answer is truly ingenious. The flock will first line up in a row. With the exception of the birds at each end of the line, the rest of the group will allow both halves of the brain to indulge in sleep. Those at the far left and right ends of the row aren’t so lucky. They will enter deep sleep with just one half of the brain (opposing in each), leaving the corresponding left and right eye of each bird wide open. In doing so, they provide full panoramic threat detection for the entire group, maximizing the total number of brain halves that can sleep within the flock. At some point, the two end-guards will stand up, rotate 180 degrees, and sit back down, allowing the other side of their respective brains to enter deep sleep.

I have had difficulty tracking this down. Everything seems to lead back to this study, which put the ducks in a row. I'm not sure if they do this in the wild? It seems like they would stand in groups in the wild, not in rows. https://www.nature.com/articles/17037 Would love to learn more about this if anyone is aware of other sources.

Dr. Robert Stickgold, conducted a clever study with wide-reaching implications. He had a total of 133 undergraduates learn a visual memory task through repetition. Participants then returned to his laboratory and were tested to see how much they had retained. Some subjects returned the next day after a full night of sleep. Others returned two days later after two full nights of sleep, and still others after three days with three nights of sleep in between. As you would predict by now, a night of sleep strengthened the newly learned memories, boosting their retention. Additionally, the more nights of sleep participants had before they were tested, the better their memory was.

i.e. better retention the longer you wait, without practice. Very surprising. Seems to be this paper https://www.nature.com/articles/nn1200_1237.

Kleitman and Richardson were to be their own experimental guinea pigs. Loaded with food and water for six weeks and a pair of dismantled, high-standing hospital beds, they took a trip into Mammoth Cave in Kentucky, one of the deepest caverns on the planet—so deep, in fact, that no detectable sunlight penetrates its farthest reaches. It was from this darkness that Kleitman and Richardson were to illuminate a striking scientific finding that would define our biological rhythm as being approximately one day (circadian), and not precisely one day. […] their reliably repeating cycles of wake and sleep were not precisely twenty-four hours in length, but consistently and undeniably longer than twenty-four hours. Richardson, in his twenties, developed a sleep-wake cycle of between twenty-six and twenty-eight hours in length. That of Kleitman, in his forties, was a little closer to, but still longer than, twenty-four hours. Therefore, when removed from the external influence of daylight, the internally generated “day” of each man was not exactly twenty-four hours, but a little more than that. Like an inaccurate wristwatch whose time

Dedication.

Highlights

Part 1

Chapter 1

loc: 107 It is no coincidence that countries where sleep time has declined most dramatically over the past century, such as the US, the UK, Japan, and South Korea, and several in western Europe, are also those suffering the greatest increase in rates of the aforementioned physical diseases and mental disorders.

loc: 113 there is a very rare genetic disorder that starts with a progressive insomnia, emerging in midlife. Several months into the disease course, the patient stops sleeping altogether. By this stage, they have started to lose many basic brain and body functions. No drugs that we currently have will help the patient sleep. After twelve to eighteen months of no sleep, the patient will die. Though exceedingly rare, this disorder asserts that a lack of sleep can kill a human being.

> Book idea.

loc: 132 Consider that we have known the functions of the three other basic drives in life—to eat, to drink, and to reproduce—for many tens if not hundreds of years now. Yet the fourth main biological drive, common across the entire animal kingdom—the drive to sleep—has continued to elude science for millennia.

loc: 135 When you are asleep, you cannot gather food. You cannot socialize. You cannot find a mate and reproduce. You cannot nurture or protect your offspring. Worse still, sleep leaves you vulnerable to predation. Sleep is surely one of the most puzzling of all human behaviors. On any one of these grounds—never mind all of them in combination—there ought to have been a strong evolutionary pressure to prevent the emergence of sleep or anything remotely like it. As one sleep scientist has said, “If sleep does not serve an absolutely vital function, then it is the biggest mistake the evolutionary process has ever made.”

loc: 149 an abundant constellation of nighttime benefits that service both our brains and our bodies.

> Abundant constellation?

loc: 210 Part 1 demystifies this beguiling thing called sleep: what it is, what it isn’t, who sleeps, how much they sleep, how human beings should sleep (but are not), and how sleep changes across your life span or that of your child, for better and for worse. […] Part 2 details the good, the bad, and the deathly of sleep and sleep loss. […] Part 3 offers safe passage from sleep to the fantastical world of dreams scientifically explained. […] Part 4 seats us first at the bedside, explaining numerous sleep disorders, including insomnia.

Chapter 2 Caffeine, Jet Lag, and Melatonin

loc: 250 Your twenty-four-hour tempo helps to determine when you want to be awake and when you want to be asleep. But it controls other rhythmic patterns, too. These include your timed preferences for eating and drinking, your moods and emotions, the amount of urine you produce,fn1 your core body temperature, your metabolic rate, and the release of numerous hormones. It is no coincidence that the likelihood of breaking an Olympic record has been clearly tied to time of day, being maximal at the natural peak of the human circadian rhythm in the early afternoon.

loc: 282 Kleitman and Richardson were to be their own experimental guinea pigs. Loaded with food and water for six weeks and a pair of dismantled, high-standing hospital beds, they took a trip into Mammoth Cave in Kentucky, one of the deepest caverns on the planet—so deep, in fact, that no detectable sunlight penetrates its farthest reaches. It was from this darkness that Kleitman and Richardson were to illuminate a striking scientific finding that would define our biological rhythm as being approximately one day (circadian), and not precisely one day. […] their reliably repeating cycles of wake and sleep were not precisely twenty-four hours in length, but consistently and undeniably longer than twenty-four hours. Richardson, in his twenties, developed a sleep-wake cycle of between twenty-six and twenty-eight hours in length. That of Kleitman, in his forties, was a little closer to, but still longer than, twenty-four hours. Therefore, when removed from the external influence of daylight, the internally generated “day” of each man was not exactly twenty-four hours, but a little more than that. Like an inaccurate wristwatch whose time

loc: 315 daylight isn’t the only signal that the brain can latch on to for the purpose of biological clock resetting, though it is the principal and preferential signal, when present. So long as they are reliably repeating, the brain can also use other external cues, such as food, exercise, temperature fluctuations, and even regularly timed social interaction. All of these events have the ability to reset the biological clock, allowing it to strike a precise twenty-four-hour note. It is the reason that individuals with certain forms of blindness do not entirely lose their circadian rhythm. Despite not receiving light cues due to their blindness, other phenomena act as their resetting triggers.

loc: 325 The crossing point is that of the optic nerves coming from your eyeballs. Those nerves meet in the middle of your brain, and then effectively switch sides. The suprachiasmatic nucleus is located just above this intersection for a good reason. It “samples” the light signal being sent from each eye along the optic nerves as they head toward the back of the brain for visual processing. The suprachiasmatic nucleus uses this reliable light information to reset its inherent time inaccuracy to a crisp twenty-four-hour cycle, preventing any drift.

loc: 346 Temperature is just one of many twenty-four-hour rhythms that the suprachiasmatic nucleus governs. Wakefulness and sleep are another. Wakefulness and sleep are therefore under the control of the circadian rhythm, and not the other way around. That is, your circadian rhythm will march up and down every twenty-four hours irrespective of whether you have slept or not. Your circadian rhythm is unwavering in this regard.

loc: 388 Your suprachiasmatic nucleus communicates its repeating signal of night and day to your brain and body using a circulating messenger called melatonin. […] In this way, melatonin helps regulate the timing of when sleep occurs by systemically signaling darkness throughout the organism. But melatonin has little influence on the generation of sleep itself: […] Once sleep is under way, melatonin slowly decreases in concentration across the night and into the morning hours. With dawn, as sunlight enters the brain through the eyes (even through the closed lids), a brake pedal is applied to the pineal gland, thereby shutting off the release of melatonin. The absence of circulating melatonin now informs the brain and body that the finish line of sleep has been reached.

loc: 413 You can see a typical profile of melatonin release in figure 2. It starts a few hours after dusk. Then it rapidly rises, peaking around four a.m. Thereafter, it begins to drop as dawn approaches, falling to levels that are undetectable by early to midmorning.

loc: 433 For every day you are in a different time zone, your suprachiasmatic nucleus can only readjust by about one hour.

loc: 437 You may have noticed that it feels harder to acclimate to a new time zone when traveling eastward than when flying westward. There are two reasons for this. First, the eastward direction requires that you fall asleep earlier than you would normally, which is a tall biological order for the mind to simply will into action. In contrast, the westward direction requires you to stay up later, which is a consciously and pragmatically easier prospect. Second, you will remember that when shut off from any outside world influences, our natural circadian rhythm is innately longer than one day—about twenty-four hours and fifteen minutes. Modest as this may be, this makes it somewhat easier for you to artificially stretch a day than shrink

loc: 447 Scientists have studied airplane cabin crews who frequently fly on long-haul routes and have little chance to recover. Two alarming results have emerged. First, parts of their brains—specifically those related to learning and memory—had physically shrunk, suggesting the destruction of brain cells caused by the biological stress of time-zone travel. Second, their short-term memory was significantly impaired.

loc: 455 After arriving that day, I had real difficulty getting to sleep and staying asleep that night. In part, this was because melatonin was not being released during my nighttime in London. My melatonin rise was still many hours away, back on California time. But let’s imagine that I was going to use a legitimate compound of melatonin after arriving in London. Here’s how it works: at around seven to eight p.m. London time I would take a melatonin pill, triggering an artificial rise in circulating melatonin that mimics the natural melatonin spike currently occurring in most of the people in London. As a consequence, my brain is fooled into believing it’s nighttime, and with that chemically induced trick comes the signaled timing of the sleep race. It will still be a struggle to generate the event of sleep itself at this irregular time (for me), but the timing signal does significantly increase the likelihood of sleep in this jet-lagged context.

loc: 462 Your twenty-four-hour circadian rhythm is the first of the two factors determining wake and sleep. The second is sleep pressure. At this very moment, a chemical called adenosine is building up in your brain. It will continue to increase in concentration with every waking minute that elapses. The longer you are awake, the more adenosine will accumulate. Think of adenosine as a chemical barometer that continuously registers the amount of elapsed time since you woke up this morning.

loc: 468 As a result of that chemical sleep pressure, when adenosine concentrations peak, an irresistible urge for slumber will take hold.fn7 It happens to most people after twelve to sixteen hours of being awake.

loc: 501 Aging also alters the speed of caffeine clearance: the older we are, the longer it takes our brain and body to remove caffeine, and thus the more sensitive we become in later life to caffeine’s sleep-disrupting influence.

loc: 593 While a clinical sleep assessment is needed to thoroughly address this issue, an easy rule of thumb is to answer two simple questions. First, after waking up in the morning, could you fall back asleep at ten or eleven a.m.? If the answer is “yes,” you are likely not getting sufficient sleep quantity and/or quality. Second, can you function optimally without caffeine before noon? If the answer is “no,” then you are most likely self-medicating your state of chronic sleep deprivation.

loc: 602 When you don’t get enough sleep, one consequence among many is that adenosine concentrations remain too high. Like an outstanding debt on a loan, come the morning, some quantity of yesterday’s adenosine remains. You then carry that outstanding sleepiness balance throughout the following day. Also like a loan in arrears, this sleep debt will continue to accumulate. You cannot hide from it. The debt will roll over into the next payment cycle, and the next, and the next, producing a condition of prolonged, chronic sleep deprivation from one day to another. This outstanding sleep obligation results in a feeling of chronic fatigue, manifesting in many forms of mental and physical ailments that are now rife throughout industrialized nations.

Chapter 3 Defining and Generating Sleep

loc: 646 your ears are still “hearing”; your eyes, though closed, are still capable of “seeing.” This is similarly true for the other sensory organs of the nose (smell), the tongue (taste), and the skin (touch). All these signals still flood into the center of your brain, but it is here, in the sensory convergence zone, where that journey ends while you sleep. The signals are blocked by a perceptual barricade set up in a structure called the thalamus (THAL-uh-muhs). A smooth, oval-shaped object just smaller than a lemon, the thalamus is the sensory gate of the brain. The thalamus decides which sensory signals are allowed through its gate, and which are not. Should they gain privileged passage, they are sent up to the cortex at the top of your brain, where they are consciously perceived. By locking its gates shut at the onset of healthy sleep, the thalamus imposes a sensory blackout in the brain, preventing onward travel of those signals up to the cortex.

loc: 675 The first striking result was that the signature pattern of brain-cell firing that occurred as the rats were learning the maze subsequently reappeared during sleep, over and over again. That is, memories were being “replayed” at the level of brain-cell activity as the rats snoozed. The second, more striking finding was the speed of replay. During REM sleep, the memories were being replayed far more slowly: at just half or quarter the speed of that measured when the rats were awake and learning the maze.

loc: 750 A danger resides in this sleep profile wherein NREM dominates early in the night, followed by an REM sleep dominance later in the morning, one of which most of the general public are unaware. Let’s say that you go to bed this evening at midnight. But instead of waking up at eight a.m., getting a full eight hours of sleep, you must wake up at six a.m. because of an early-morning meeting or because you are an athlete whose coach demands early-morning practices. What percent of sleep will you lose? The logical answer is 25 percent, since waking up at six a.m. will lop off two hours of sleep from what would otherwise be a normal eight hours. But that’s not entirely true. Since your brain desires most of its REM sleep in the last part of the night, which is to say the late-morning hours, you will lose 60 to 90 percent of all your REM sleep, even though you are losing 25 percent of your total sleep time.

loc: 817 What you are actually experiencing during deep NREM sleep is one of the most epic displays of neural collaboration that we know of. Through an astonishing act of self-organization, many thousands of brain cells have all decided to unite and “sing,” or fire, in time.

loc: 848 The steady, slow, synchronous waves that sweep across the brain during deep sleep open up communication possibilities between distant regions of the brain, allowing them to collaboratively send and receive their different repositories of stored experience. In this regard, you can think of each individual slow wave of NREM sleep as a courier, able to carry packets of information between different anatomical brain centers. One benefit of these traveling deep-sleep brainwaves is a file-transfer process. Each night, the long-range brainwaves of deep sleep will move memory packets (recent experiences) from a short-term storage site, which is fragile, to a more permanent, and thus safer, long-term storage location.

loc: 870 When it comes to information processing, think of the wake state principally as reception (experiencing and constantly learning the world around you), NREM sleep as reflection (storing and strengthening those raw ingredients of new facts and skills), and REM sleep as integration (interconnecting these raw ingredients with each other, with all past experiences, and, in doing so, building an ever more accurate model of how the world works, including innovative insights and problem-solving abilities).

loc: 877 While awake, even lying in bed and relaxed, there remains a degree of overall tension, or tone, in your muscles. This steady muscular hum is easily detected by the electrodes listening in on your body. As you pass into NREM sleep, some of that muscle tension disappears, but much remains. Gearing up for the leap into REM sleep, however, an impressive change occurs. Mere seconds before the dreaming phase begins, and for as long as that REM-sleep period lasts, you are completely paralyzed. There is no tone in the voluntary muscles of your body. None whatsoever. If I were to quietly come into the room and gently lift up your body without waking you, it would be completely limp, like a rag doll.

loc: 884 This feature, termed “atonia” (an absence of tone, referring here to the muscles), is instigated by a powerful disabling signal that is transmitted down the full length of your spinal cord from your brain stem. Once put in place, the postural body muscles, such as the biceps of your arms and the quadriceps of your legs, lose all tension and strength. No longer will they respond to commands from your brain.

loc: 890 Why did evolution decide to outlaw muscle activity during REM sleep? Because by eliminating muscle activity you are prevented from acting out your dream experience. During REM sleep, there is a nonstop barrage of motor commands swirling around the brain, and they underlie the movement-rich experience of dreams.

Chapter 4 Ape Beds, Dinosaurs, and Napping with Half a Brain

loc: 916 Without exception, every animal species studied to date sleeps, or engages in something remarkably like it. This includes insects, such as flies, bees, cockroaches, and scorpions;fn1 fish, from small perch to the largest sharks;fn2 amphibians, such as frogs; and reptiles, such as turtles, Komodo dragons, and chameleons.

loc: 979 Every species in which we can measure sleep stages experiences NREM sleep—the non-dreaming stage. However, insects, amphibians, fish, and most reptiles show no clear signs of REM sleep—the type associated with dreaming in humans. Only birds and mammals, which appeared later in the evolutionary timeline of the animal kingdom, have full-blown REM sleep. It suggests that dream (REM) sleep is the new kid on the evolutionary block. REM sleep seems to have emerged to support functions that NREM sleep alone could not accomplish, or that REM sleep was more efficient at accomplishing.

loc: 990 fur seals. Partially aquatic mammals, they split their time between land and sea. When on land, they have both NREM sleep and REM sleep, just like humans and all other terrestrial mammals and birds. But when they enter the ocean, they stop having REM sleep almost entirely. Seals in the ocean will sample but a soupçon of the stuff, racking up just 5 to 10 percent of the REM sleep amounts they would normally enjoy when on land. Up to two weeks of ocean-bound time have been documented without any observable REM sleep in seals, who survive in such times on a snooze diet of NREM sleep.

> Due to paralysis in REM

loc: 1,054 Even with half of the brain asleep, dolphins can achieve an impressive level of movement and even some vocalized communication. The neural engineering and tricky architecture required to accomplish this staggering trick of oppositional “lights-on, lights-off” brain activity is rare. Surely Mother Nature could have found a way to avoid sleep entirely under the extreme pressure of nonstop, 24/7 aquatic movement. Would that not have been easier than masterminding a convoluted split-shift system between brain halves for sleep, while still allowing for a joint operating system where both sides unite when awake? Apparently not. Sleep is of such vital necessity that no matter what the evolutionary demands of an organism, even the unyielding need to swim in perpetuum from birth to death, Mother Nature had no choice.

loc: 1,063 When birds are alone, one half of the brain and its corresponding (opposite-side) eye must stay awake, maintaining vigilance to environmental threats. As it does so, the other eye closes, allowing its corresponding half of the brain to sleep.

loc: 1,065 In some species, many of the birds in a flock will sleep with both halves of the brain at the same time. How do they remain safe from threat? The answer is truly ingenious. The flock will first line up in a row. With the exception of the birds at each end of the line, the rest of the group will allow both halves of the brain to indulge in sleep. Those at the far left and right ends of the row aren’t so lucky. They will enter deep sleep with just one half of the brain (opposing in each), leaving the corresponding left and right eye of each bird wide open. In doing so, they provide full panoramic threat detection for the entire group, maximizing the total number of brain halves that can sleep within the flock. At some point, the two end-guards will stand up, rotate 180 degrees, and sit back down, allowing the other side of their respective brains to enter deep sleep.

> I have had difficulty tracking this down. Everything seems to lead back to this study, which put the ducks in a row. I'm not sure if they do this in the wild? It seems like they would stand in groups in the wild, not in rows. https://www.nature.com/articles/17037 (Checked This)

loc: 1,073 humans have a very mild version of unihemispheric sleep—one that is drawn out for similar reasons. If you compare the electrical depth of the deep NREM slow brainwaves on one half of someone’s head relative to the other when they are sleeping at home, they are about the same. But if you bring that person into a sleep laboratory, or take them to a hotel—both of which are unfamiliar sleep environments—one half of the brain sleeps a little lighter than the other, as if it’s standing guard with just a tad more vigilance due to the potentially less safe context that the conscious brain has registered while awake. The more nights an individual sleeps in the new location, the more similar the sleep is in each half of the brain.

loc: 1,084 Whatever the functions of REM-sleep dreaming—and there appear to be many—they require participation of both sides of the brain at the same time, and to an equal degree.

loc: 1,090 Starve a fly and it will stay awake longer, demonstrating a pattern of food-seeking behavior. The same is true for humans. Individuals who are deliberately fasting will sleep less as the brain is tricked into thinking that food has suddenly become scarce.

> Explains fasting causing bad sleep

loc: 1,100 during transoceanic migration. During this climate-driven race across thousands of miles, entire flocks will fly for many more hours than is normal. As a result, they lose much of the stationary opportunity for plentiful sleep. But even here, the brain has found an ingenious way to obtain sleep. In-flight, migrating birds will grab remarkably brief periods of sleep lasting only seconds in duration. These ultra–power naps are just sufficient to avert the ruinous brain and body deficits that would otherwise ensue from prolonged total sleep deprivation.

loc: 1,116 Hunter-gatherer tribes, such as the Gabra in northern Kenya or the San people in the Kalahari Desert, whose way of life has changed little over the past thousands of years, sleep in a biphasic pattern. Both these groups take a similarly longer sleep period at night (seven to eight hours of time in bed, achieving about seven hours of sleep), followed by a thirty- to sixty-minute nap in the afternoon.

> See also: kids, chinese developers

loc: 1,151 there is no biological rhythm—of brain activity, neurochemical activity, or metabolic activity—that would hint at a human desire to wake up for several hours in the middle of the night. Instead, the true pattern of biphasic sleep—for which there is anthropological, biological, and genetic evidence, and which remains measurable in all human beings to date—is one consisting of a longer bout of continuous sleep at night, followed by a shorter midafternoon nap.

loc: 1,161 Harvard University’s School of Public Health decided to quantify the health consequences of this radical change in more than 23,000 Greek adults, which contained men and women ranging in age from twenty to eighty-three years old. The researchers focused on cardiovascular outcomes, tracking the group across a six-year period as the siesta practice came to an end for many of them. […] However, those that abandoned regular siestas went on to suffer a 37 percent increased risk of death from heart disease across the six-year period, relative to those who maintained regular daytime naps. The effect was especially strong in workingmen, where the ensuing mortality risk of not napping increased by well over 60 percent.

loc: 1,180 The total amount of time we spend asleep is markedly shorter than all other primates (eight hours, relative to the ten to fifteen hours of sleep observed in all other primates), yet we have a disproportionate amount of REM sleep, the stage in which we dream. Between 20 and 25 percent of our sleep time is dedicated to REM sleep dreaming, compared to an average of only 9 percent across all other primates!

loc: 1,208 the act of sleeping on solid ground, and not on a precarious tree branch, was the impetus for the enriched and enhanced amounts of REM sleep that developed, while the amount of time spent asleep was able to modestly decrease. When sleeping on the ground, there’s no more risk of falling. For the first time in our evolution, hominids could consume all the body-immobilized REM-sleep dreaming they wanted, and not worry about the lasso of gravity whipping them down from treetops. Our sleep therefore became “concentrated”: shorter and more consolidated in duration, packed aplenty with high-quality sleep. And not just any type of sleep, but REM sleep that bathed a brain rapidly accelerating in complexity and connectivity.

> Seems plausable, but wouldn't it require that we sleep less deeply to avoid being attacked? Like discussed above in the context of lighter sleeping in hotel rooms?

loc: 1,242 The second evolutionary contribution that the REM-sleep dreaming state fuels is creativity. NREM sleep helps transfer and make safe newly learned information into long-term storage sites of the brain. But it is REM sleep that takes these freshly minted memories and begins colliding them with the entire back catalog of your life’s autobiography. These mnemonic collisions during REM sleep spark new creative insights as novel links are forged between unrelated pieces of information. Sleep cycle by sleep cycle, REM sleep helps construct vast associative networks of information within the brain. REM sleep can even take a step back, so to speak, and divine overarching insights and gist: something akin to general knowledge—that is, what a collection of information means as a whole, not just an inert back catalogue of facts. We can awake the next morning with new solutions to previously intractable problems or even be infused with radically new and original ideas.

Chapter 5 Changes in Sleep Across the Life Span

loc: 1,271 Through speech or song, expecting parents will often thrill at their ability to elicit small kicks and movements from their in utero child. Though you should never tell them this, the baby is most likely fast asleep. Prior to birth, a human infant will spend almost all of its time in a sleep-like state, much of which resembles the REM-sleep state. The sleeping fetus is therefore unaware of its parents’ performative machinations. Any co-occurring arm flicks and leg bops that the mother feels from her baby are most likely to be the consequence of random bursts of brain activity that typify REM sleep.

loc: 1,400 the master twenty-four-hour clock that controls the circadian rhythm—the suprachiasmatic nucleus—takes considerable time to develop. Not until age three or four months will a newborn show modest signs of being governed by a daily rhythm. Slowly, the suprachiasmatic nucleus begins to latch on to repeating signals, such as daylight, temperature change, and feedings (so long as those feedings are highly structured), establishing a stronger twenty-four-hour rhythm.

loc: 1,467 When he examined the timeline of changing deep-sleep intensity at each different electrode spot on the head, it was not the same. Instead, the rise-and-fall pattern of maturation always began at the back of the brain, which performs the functions of visual and spatial perception, and then progressed steadily forward as adolescence progressed. Most striking, the very last stop on the maturational journey was the tip of the frontal lobe, which enables rational thinking and critical decision-making. Therefore, the back of the brain of an adolescent was more adult-like, while the front of the brain remained more child-like at any one moment during this developmental window of time.fn14

loc: 1,511 As a nine-year-old, the circadian rhythm would have the child asleep by around nine p.m., driven in part by the rising tide of melatonin at this time in children. By the time that same individual has reached sixteen years of age, their circadian rhythm has undergone a dramatic shift forward in its cycling phase. The rising tide of melatonin, and the instruction of darkness and sleep, is many hours away. As a consequence, the sixteen-year-old will usually have no interest in sleeping at nine p.m. Instead, peak wakefulness is usually still in play at that hour.

loc: 1,553 That older adults simply need less sleep is a myth. Older adults appear to need just as much sleep as they do in midlife, but are simply less able to generate that (still necessary) sleep.

loc: 1,564 Passing into your mid- and late forties, age will have stripped you of 60 to 70 percent of the deep sleep you were enjoying as a young teenager. By the time you reach seventy years old, you will have lost 80 to 90 percent of your youthful deep sleep.

loc: 1,594 A more immediate, though equally dangerous, consequence of fragmented sleep in the elderly warrants brief discussion: the nighttime bathroom visits and associated risk of falls and thus fractures. We are often groggy when we wake up during the night. Add to this cognitive haze the fact that it is dark. Furthermore, having been recumbent in bed means that when you stand and start moving, blood can race from your head, encouraged by gravity, down toward your legs. You feel light-headed and unsteady on your feet as a consequence. The latter is especially true in older adults whose control of blood pressure is itself often impaired. All of these issues mean that an older individual is at a far higher risk of stumbling, falling, and breaking bones during nighttime visits to the bathroom.

loc: 1,610 But what seems like an innocent doze has a damaging consequence. The early-evening snooze will jettison precious sleep pressure, clearing away the sleepiness power of adenosine that had been steadily building throughout the day. Several hours later, when that older individual gets into bed and tries to fall asleep, they may not have enough sleep pressure to fall asleep quickly, or stay asleep as easily. An erroneous conclusion follows: “I have insomnia.” Instead, dozing off in the evening, which most older adults do not realize is classified as napping, can be the source of sleep difficulty, not true insomnia.

loc: 1,626 Having woken up early, many older adults are physically active during the morning hours, and therefore obtain much of their bright-light exposure in the first half of the day. This is not optimal, as it reinforces the early-to-rise, early-to-decline cycle of the twenty-four-hour internal clock. Instead, older adults who want to shift their bedtimes to a later hour should get bright-light exposure in the late-afternoon hours.

loc: 1,672 More generally, these and similar studies have confirmed that poor sleep is one of the most underappreciated factors contributing to cognitive and medical ill health in the elderly, including issues of diabetes, depression, chronic pain, stroke, cardiovascular disease, and Alzheimer’s disease. An urgent need therefore exists for us to develop new methods that restore some quality of deep, stable sleep in the elderly.

Part 2 WHY SHOULD YOU SLEEP?

Chapter 6 Your Mother and Shakespeare Knew

loc: 1,801 The experimental results of Jenkins and Dallenbach have now been replicated time and again, with a memory retention benefit of between 20 and 40 percent being offered by sleep, compared to the same amount of time awake.

loc: 1,886 a Swiss research team recently suspended a bedframe on ropes from the ceiling of a sleep laboratory (stick with me here). Affixed to one side of the suspended bed was a rotating pulley. It allowed the researchers to sway the bed from side to side at controlled speeds. Volunteers then took a nap in the bed as the researchers recorded their sleeping brainwaves. In half of the participants, the researchers gently rocked the bed once they entered NREM sleep. In the other half of the subjects, the bed remained static, offering a control condition. Slow rocking increased the depth of deep sleep, boosted the quality of slow brainwaves, and more than doubled the number of sleep spindles. It is not yet known whether these sway-induced sleep changes enhance memory, since the researchers did not perform any such tests with their participants. Nevertheless, the findings offer a scientific explanation for the ancient practice of rocking a child back and forth in one’s arms, or in a crib, inducing a deep sleep.

> Why? Is it because your brain thinks you are safe in mothers arms, so your sleep deepens?

loc: 1,915 When you are tested the following morning, you will have a quite remarkable bias in your recollection, remembering far more of the items that we reactivated during sleep using the sound cues than those not reactivated. Note that all one hundred of the original memory items passed through sleep. However, using sound cuing, we avoid indiscriminate enhancement of all that you learned.

loc: 2,014 Those who remained awake across the day showed no evidence of a significant improvement in performance. However, fitting with the pianist’s original description, those who were tested after the very same time delay of twelve hours, but that spanned a night of sleep, showed a striking 20 percent jump in performance speed and a near 35 percent improvement in accuracy. Importantly, those participants who learned the motor skill in the morning—and who showed no improvement that evening—did go on to show an identical bump up in performance when retested after a further twelve hours, now after they, too, had had a full night’s sleep. In other words, your brain will continue to improve skill memories in the absence of any further practice.

loc: 2,038 Rather than a transfer from short- to long-term memory required for saving facts, the motor memories had been shifted over to brain circuits that operate below the level of consciousness. As a result, those skill actions were now instinctual habits. They flowed out of the body with ease, rather than feeling effortful and deliberate. Which is to say that sleep helped the brain automate the movement routines, making them second nature—effortless—precisely the goal of many an Olympic coach when perfecting the skills of their elite athletes.

loc: 2,053 Perhaps more relevant to the modern world is the time-of-night effect we discovered. Those last two hours of sleep are precisely the window that many of us feel it is okay to cut short to get a jump start on the day. As a result, we miss out on this feast of late-morning sleep spindles. It also brings to mind the prototypical Olympic coach who stoically has her athletes practicing late into the day, only to have them wake in the early hours of the morning and return to practice. In doing so, coaches may be innocently but effectively denying an important phase of motor memory development within the brain—one that fine-tunes skilled athletic performance.

> Kenyan runners, good at resting

loc: 2,060 The 100-meter sprint superstar Usain Bolt has, on many occasions, taken naps in the hours before breaking the world record, and before Olympic finals in which he won gold. Our own studies support his wisdom: daytime naps that contain sufficient numbers of sleep spindles also offer significant motor skill memory improvement, together with a restoring benefit on perceived energy and reduced muscle fatigue.

loc: 2,072 Obtain anything less than eight hours of sleep a night, and especially less than six hours a night, and the following happens: time to physical exhaustion drops by 10 to 30 percent, and aerobic output is significantly reduced. Similar impairments are observed in limb extension force and vertical jump height, together with decreases in peak and sustained muscle strength. Add to this marked impairments in cardiovascular, metabolic, and respiratory capabilities that hamper an underslept body, including faster rates of lactic acid buildup, reductions in blood oxygen saturation, and converse increases in blood carbon dioxide, due in part to a reduction in the amount of air that the lungs can expire. Even the ability of the body to cool itself during physical exertion through sweating—a critical part of peak performance—is impaired by sleep loss. And then there is injury risk. It is the greatest fear of all competitive athletes and their coaches. Concern also comes from the general managers of professional teams, who consider their players as prized financial investments. In the context of injury, there is no better risk-mitigating insurance policy for these investments than sleep. Described in a research study of competitive young athletes in 2014,fn11 you can see that a chronic lack of sleep across the season predicted a massively higher risk of injury (figure 10

> Drops all the way through to 9h. Might be some confounders at work? Looks like it is 12-18yo, so 9h sleep might make sense! https://www.ncbi.nlm.nih.gov/pubmed/25028798

Chapter 7 Too Extreme for the Guinness Book of World Records

loc: 2,181 Most worrying from a societal perspective were the individuals in the group who obtained six hours of sleep a night—something that may sound familiar to many of you. Ten days of six hours of sleep a night was all it took to become as impaired in performance as going without sleep for twenty-four hours straight. And like the total sleep deprivation group, the accruing performance impairment in the four-hour and six-hour sleep groups showed no signs of leveling out. All signs suggested that if the experiment had continued, the performance deterioration would continue to build up over weeks or months.

loc: 2,190 When participants were asked about their subjective sense of how impaired they were, they consistently underestimated their degree of performance disability. It was a miserable predictor of how bad their performance actually, objectively was.

loc: 2,193 Similarly problematic is baseline resetting. With chronic sleep restriction over months or years, an individual will actually acclimate to their impaired performance, lower alertness, and reduced energy levels. That low-level exhaustion becomes their accepted norm, or baseline. Individuals fail to recognize how their perennial state of sleep deficiency has come to compromise their mental aptitude and physical vitality, including the slow accumulation of ill health.

loc: 2,200 Returning to Dinges’s study results, you may have predicted that optimal performance would return to all of the participants after a good long night of recovery sleep, similar to many people’s notion of “sleeping it off” on the weekends to pay off their weeknight sleep debt. However, even after three nights of ad lib recovery sleep, performance did not return to that observed at the original baseline assessment when those same individuals had been getting a full eight hours of sleep regularly.

loc: 2,215 Operating on less than five hours of sleep, your risk of a car crash increases threefold. Get behind the wheel of a car when having slept just four hours or less the night before and you are 11.5 times more likely to be involved in a car accident. Note how the relationship between decreasing hours of sleep and increasing mortality risk of an accident is not linear, but instead exponentially mushrooms. Each hour of sleep lost vastly amplifies that crash likelihood, rather than incrementally nudging it up.

loc: 2,245 Drowsy driving alone is worse than driving drunk. That may seem like a controversial or irresponsible thing to say, and I do not wish to trivialize the lamentable act of drunk driving by any means. Yet my statement is true for the following simple reason: drunk drivers are often late in braking, and late in making evasive maneuvers. But when you fall asleep, or have a microsleep, you stop reacting altogether. A person who experiences a microsleep or who has fallen asleep at the wheel does not brake at all, nor do they make any attempt to avoid the accident. As a result, car crashes caused by drowsiness tend to be far more deadly than those caused by alcohol or drugs.

loc: 2,254 when a truck driver loses his or her life in a drowsy-driving crash, they will, on average, take 4.5 other lives with them.

loc: 2,259 Shamefully, governments of most developed countries spend less than 1 percent of their budget educating the public on the dangers of drowsy driving relative to what they invest in combating drunk driving.

loc: 2,318 David Dinges has extended an open invitation to anyone suggesting that they can survive on short sleep to come to his lab for a ten-day stay. He will place that individual on their proclaimed regiment of short sleep and measure their cognitive function. Dinges is rightly confident he’ll show, categorically, a degradation of brain and body function. To date, no volunteers have matched up to their claim.

loc: 2,321 We have, however, discovered a very rare collection of individuals who appear to be able to survive on six hours of sleep, and show minimal impairment—a sleepless elite, as it were. Give them hours and hours of sleep opportunity in the laboratory, with no alarms or wake-up calls, and still they naturally sleep this short amount and no more. Part of the explanation appears to lie in their genetics, specifically a sub-variant of a gene called BHLHE41.fn3 Scientists are now trying to understand what this gene does, and how it confers resilience to such little sleep. Having learned this, I imagine that some readers now believe that they are one of these individuals. That is very, very unlikely. The gene is remarkably rare, with but a soupçon of individuals in the world estimated to carry this anomaly.

loc: 2,329 “The number of people who can survive on five hours of sleep or less without any impairment, expressed as a percent of the population, and rounded to a whole number, is zero.”

loc: 2,347 the amygdala—a key hot spot for triggering strong emotions such as anger and rage, and linked to the fight-or-flight response—showed well over a 60 percent amplification in emotional reactivity in the participants who were sleep-deprived. In contrast, the brain scans of those individuals who were given a full night’s sleep evinced a controlled, modest degree of reactivity in the amygdala, despite viewing the very same images. It was as though, without sleep, our brain reverts to a primitive pattern of uncontrolled reactivity. We produce unmetered, inappropriate emotional reactions, and are unable to place events into a broader or considered context.

loc: 2,375 Studies of adolescents have identified a link between sleep disruption and suicidal thoughts, suicide attempts, and, tragically, suicide completion in the days after. One more reason for society and parents to value plentiful sleep in teens rather than chastise it, especially considering that suicide is the second-leading cause of death in young adults in developed nations after car accidents.

loc: 2,387 insufficient sleep during childhood significantly predicts early onset of drug and alcohol use in that same child during their later adolescent years, even when controlling for other high-risk traits, such as anxiety, attention deficits, and parental history of drug use.

loc: 2,409 A research team in Italy examined bipolar patients during the time when they were in this stable, inter-episode phase. Next, under careful clinical supervision, they sleep-deprived these individuals for one night. Almost immediately, a large proportion of the individuals either spiraled into a manic episode or became seriously depressed. I find it to be an ethically difficult experiment to appreciate, but the scientists had importantly demonstrated that a lack of sleep is a causal trigger of a psychiatric episode of mania or depression.

loc: 2,505 There are no “final” exams at the end of the semester in my classes. Instead, I split my courses up into thirds so that students only have to study a handful of lectures at a time. Furthermore, none of the exams are cumulative. It’s a tried-and-true effect in the psychology of memory, described as mass versus spaced learning. As with a fine-dining experience, it is far more preferable to separate the educational meal into smaller courses, with breaks in between to allow for digestion, rather than attempt to cram all of those informational calories down in one go.

loc: 2,510 Dr. Robert Stickgold, conducted a clever study with wide-reaching implications. He had a total of 133 undergraduates learn a visual memory task through repetition. Participants then returned to his laboratory and were tested to see how much they had retained. Some subjects returned the next day after a full night of sleep. Others returned two days later after two full nights of sleep, and still others after three days with three nights of sleep in between. As you would predict by now, a night of sleep strengthened the newly learned memories, boosting their retention. Additionally, the more nights of sleep participants had before they were tested, the better their memory was.

> Better retention the longer you wait. Very surprising. Seems to be this paper https://www.nature.com/articles/nn1200_1237

loc: 2,582 Although the glymphatic system—the support team—is somewhat active during the day, Nedergaard and her team discovered that it is during sleep that this neural sanitization work kicks into high gear. Associated with the pulsing rhythm of deep NREM sleep comes a ten- to twentyfold increase in effluent expulsion from the brain.

loc: 2,587 The glial cells of the brain were shrinking in size by up to 60 percent during NREM sleep, enlarging the space around the neurons and allowing the cerebrospinal fluid to proficiently clean out the metabolic refuse left by the day’s neural activity. […] One piece of toxic debris evacuated by the glymphatic system during sleep is amyloid protein—the poisonous element associated with Alzheimer’s disease. Other dangerous metabolic waste elements that have links to Alzheimer’s disease are also removed by the cleaning process during sleep, including a protein called tau, as well as stress molecules produced by neurons when they combust energy and oxygen during the day. Should you experimentally prevent a mouse from getting NREM sleep, keeping it awake instead, there is an immediate increase in amyloid deposits within the brain. […] Inadequate sleep and the pathology of Alzheimer’s disease interact in a vicious cycle. Without sufficient sleep, amyloid plaques build up in the brain, especially in deep-sleep-generating regions, attacking and degrading them. The loss of deep NREM sleep caused by this assault therefore lessens the ability to remove amyloid from the brain at night, resulting in greater amyloid deposition. More amyloid, less deep sleep, less deep sleep, more amyloid, and so on and so forth.

loc: 2,608 A more radical and converse prediction that emerges from these findings is that, by improving someone’s sleep, we should be able to reduce their risk of developing Alzheimer’s disease—or at least delay its onset. Tentative support has emerged from clinical studies in which middle- and older-age adults have had their sleep disorders successfully treated. As a consequence, their rate of cognitive decline slowed significantly, and further delayed the onset of Alzheimer’s disease by five to ten years.

Chapter 8 Cancer, Heart Attacks, and a Shorter Life

loc: 2,638 A similar relationship was observed in a Japanese study of over 4,000 male workers. Over a fourteen-year period, those sleeping six hours or less were 400 to 500 percent more likely to suffer one or more cardiac arrests than those sleeping more than six hours. I should note that in many of these studies, the relationship between short sleep and heart failure remains strong even after controlling for other known cardiac risk factors, such as smoking, physical activity, and body mass.

> A confounder could be stress?

loc: 2,678 With few exceptions over the past half century, every experiment that has investigated the impact of deficient sleep on the human body has observed an overactive sympathetic nervous system. For as long as the state of insufficient sleep lasts, and for some time thereafter, the body remains stuck in some degree of a fight-or-flight state. It can last for years in those with an untreated sleep disorder, excessive work hours that limit sleep or its quality, or the simple neglect of sleep by an individual. Like a car engine that is revved to a shrieking extreme for sustained periods of time, your sympathetic nervous system is floored into perpetual overdrive by a lack of sleep.

loc: 2,706 In the Northern Hemisphere, the switch to daylight savings time in March results in most people losing an hour of sleep opportunity. Should you tabulate millions of daily hospital records, as researchers have done, you discover that this seemingly trivial sleep reduction comes with a frightening spike in heart attacks the following day. Impressively, it works both ways. In the autumn within the Northern Hemisphere, when the clocks move back and we gain an hour of sleep opportunity time, rates of heart attacks plummet the day after.

> See https://www.apa.org/pubs/journals/releases/apl9451317.pdf "Changing to Daylight Saving Time Cuts Into Sleep and Increases Workplace Injuries" for one example that also links to some related studies. The one referred to seems to be DOI: 10.1056/NEJMc0807104 "Shifts to and from Daylight Saving Time and Incidence of Myocardial Infarction". Both are somewhat convincing, although it would be good to compare to similar areas without daylight savings times to be even more convincing (in this example they even mention that the data would be available to do this due to one province not using daylight savings, but do not supply a graph. Pity. "Daylight Savings Time and Traffic Accidents" DOI: 10.1056/NEJM199604043341416)

> This seems like very good evidence for the dangers of low sleep (and against daylight savings time). In the heart attack paper for example, the number of attacks dropped after the clocks go back, giving people extra sleep – but not enough to make up for the extra heart attacks that occur when the clocks go forward in the first place!

> Checked This

loc: 2,736 Does the state of diabetes impair your sleep, or does short sleep impair your body’s ability to regulate blood sugar, thereby causing diabetes? To answer this question, scientists had to conduct carefully controlled experiments with healthy adults who had no existing signs of diabetes or issues with blood sugar. In the first of these studies, participants were limited to sleeping four hours a night for just six nights. By the end of that week, these (formerly healthy) participants were 40 percent less effective at absorbing a standard dose of glucose, compared to when they were fully rested. To give you a sense of what that means, if the researchers showed those blood sugar readings to an unwitting family doctor, the GP would immediately classify that individual as being pre-diabetic. […] Numerous scientific laboratories around the world have replicated this alarming effect of short sleep, some with even less aggressive reductions in sleep amount.

loc: 2,771 Using precisely this experimental design in a group of healthy, lean participants, Van Cauter discovered that individuals were far more ravenous when sleeping four to five hours a night. This despite being given the same amount of food and being similarly active, which kept the hunger levels of these same individuals under calm control when they were getting eight or more hours of sleep. The strong rise of hunger pangs and increased reported appetite occurred rapidly, by just the second day of short sleeping. At fault were the two characters, leptin and ghrelin. Inadequate sleep decreased concentrations of the satiety-signaling hormone leptin and increased levels of the hunger-instigating hormone ghrelin. […] Some argue that we eat more when we are sleep-deprived because we burn extra calories when we stay awake. Sadly, this is not true. In the sleep-restriction experiments described above, there are no differences in caloric expenditure between the two conditions. Take it to the extreme by sleep-depriving an individual for twenty-four hours straight and they will only burn an extra 147 calories,

loc: 2,854 Three-year-olds sleeping just ten and a half hours or less have a 45 percent increased risk of being obese by age seven than those who get twelve hours of sleep a night. To set our children on a pathway of ill health this early in life by way of sleep neglect is a travesty.

loc: 2,863 When you are not getting enough sleep, the body becomes especially stingy about giving up fat. Instead, muscle mass is depleted while fat is retained. Lean and toned is unlikely to be the outcome of dieting when you are cutting sleep short. The latter is counterproductive of the former.

loc: 2,871 Take a group of lean, healthy young males in their mid-twenties and limit them to five hours of sleep for one week, as a research group did at the University of Chicago. Sample the hormone levels circulating in the blood of these tired participants and you will find a marked drop in testosterone relative to their own baseline levels of testosterone when fully rested. The size of the hormonal blunting effect is so large that it effectively “ages” a man by ten to fifteen years in terms of testosterone virility.

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