I have often joked with my wife, that I have to keep quiet about what I do for a living at any gathering. Sleep and psychiatry, it turns out, are two things people really have on their minds; and in today’s fast times, everyone seems to be stressed by working too much, and sleeping too little. On the other hand, I am equally amazed by people I meet who exercise regularly, eat healthy organic food, use meditation apps, only to tell you, on line at Starbucks, that they often only get 5 to 6 hours a night of sleep in their busy lives. I wonder about myself sometimes, as I savor a good cup of coffee in the morning, after staying up too late reading the night before. A lot of times, I couldn’t even tell you what I read, as boldly fought off sleep to the very last minute, with the power of my smartphone and the internet behind it.
The tremendous importance of sleep to our well being has been a lesson I have learned numerous times in my career as a psychiatrist. I continue to advocate that it should be a vital sign, along with blood pressure and pulse, of our general state of health. It affects everyone, young and old, and here’s some fascinating stories, that have changed my practice of medicine.
The youngest patients, I recall, were the 10 year old kids that came to Stanford, diagnosed with attention deficit disorder (ADHD), with minimal improvement on stimulants, like Ritalin or Adderall, still struggling at home and in school. These kids, it turned out, had stuffy noses, and slept on 3 pillows, fitfully through the night. Something else was going on, their tonsils were huge; and sleep tests confirmed sleep apnea (fragmented sleep because of poor breathing). The tonsils came out, and within several months, I remember to this day being hugged by moms who were so happy that their kids were off medication, sleeping soundly through the night, and not “hyperactive” anymore. Miraculous, I thought.
Then there are the middle aged patients who come worriedly to see me asking the question “Doc, I think I have Alzheimer’s, I forget movies, words, and walk into rooms and forget why!” Much to everyone’s relief, it often turns out to be a sleep problem. Our minds package up memories and practice for upcoming situations in sleep, and the value of sleep is both in quantity and quality. So many amazing studies have tested people, asked to memorize a list of words, then given a chance to sleep. More sleep, has always resulted in better recall, improved ability to learn everything from word lists, to emotional responses, to swinging a golf club. Emotions? Let’s not forget that sleep deprivation is a form of torture – and I’ve also seen so many people become emotionally “unstable” – tearful for no reason sometimes, overreactive, and irritable. One man knew he needed to catch up on his Zzz’s when after a few nights of poor sleep, he would cry over a dropped paper clip.
And the comes the energy or depression question, “Do you feel like doing things and lack the energy, or just don’t feel like doing things at all?” Fatigue can all too often look like depression, and in many instances, there is a very fine line between the two. The next time you’re on your drive home, spacing out at a stopped traffic light, thinking “woe is me, and what’s the point of all this anyway,” ask yourself if what you’re really missing is your bed, and some shut eye. Indeed a very large proportion of people I have worked with, diagnosed as attention deficit, bipolar, or treatment-resistant depression, benefit tremendously from the optimization of sleep.
I have often joked that everything you need to know about sleep, your grandmother taught you. Indeed, this is half true, in the sense that more sleep and more regular hours of sleep are a good thing. Sleep is affected most often by our habits; electronics, television, and late night web surfing to the edges of the internet. Yes we all lack some degree of discipline. But for many people, it is hard to fall asleep despite their best efforts. Anxiety is so often an overlooked factor – and we call this “battlefield sleep” or “thin sleep.” It’s the vigilant sleep one would get, sleeping in a dangerous situation, like a battlefield – with a lot of trouble falling asleep, waking up often and easily, and trouble sleeping in (no matter how late you went to sleep). Life is not a battlefield, but for anxious people, it often can be, and this becomes a nightly pattern, with fatigue and large amounts of caffeine, sometimes alcohol by the day’s end, to counter. And so the cycle repeats, sometimes for decades of people’s lives; and important experiences can often become lost in a sleep deprived, caffeinated blur.
What to do? Sleep more and sleep better. Make sleep your health priority. Focus on habits and the use of electronics, and keep sleep on a regular schedule. Besides the quantity of sleep, look into the quality – does sleep feel light? How many times a night do you wake? Do you snore, or kick around a lot during the night? A great app to start this investigation is called SnoreLab (free on the iTunes store) – which basically records audio all night, and can show you just what happened before you woke at 4AM last night – I use this app myself, and recommend it to everyone. You spend one third of your life sleeping, and it affects every aspect of your waking life, promise. From memory to mood, to immunity, to weight loss and diabetes, and even risk of cancer, sleep has profound effects. Even more exciting, several recent studies have found that sleep can be used as part of a protocol to reverse mild dementia, and increase longevity.
Alex Dimitriu, MD