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What’s the best thing you could do to improve your mental and physical health? Regular exercise is one obvious answer. A healthy diet is another, and increasing your social connectedness yet another. But perhaps the best answer is something else—an activity that is not really a choice, but a necessity; one we spend about a third of our lives doing, if we’re lucky; one that costs us nothing, and yet carries positive benefits that extend far and wide into every realm of functioning, even though, like an erection or an orgasm, it cannot be willed, only allowed and invited.
I’m talking, of course, about sleep.
Like breathing, sleep gets little attention until something goes wrong with it. But like breathing, tending consciously and intentionally to our sleep can bring great benefits.
Contrary to popular belief, sleep is not a passive state of inactivity opposite wakefulness. Rather, sleep is an active, regulated, biologically programmed brain state, “a period of abundant brain activity ... essential to neurologic and general health” that, “cannot be eliminated without deleterious consequences.”
Almost all bodily systems and tissues are affected meaningfully by sleep. “It is quite evident that sleep is essential for many vital functions including development, energy conservation, brain waste clearance, modulation of immune responses, cognition, performance, vigilance, disease, and psychological state.“
Sleep is a naturally occurring daily function, but it holds a deep mystery at its core: We don’t yet know why we sleep. While scientists agree that everyone needs sleep, its core biological purpose—if indeed such a single purpose exists—remains obscure.
On the more proximal, pragmatic level, clarity is also lacking about the brain-related consequences of long-term, chronic sleep loss. This is important because, “chronic partial sleep restriction, from weeks to years, is representative of … the sleep deficiency observed in the developed world.”
Indeed, the conditions of our culture are not friendly to optimal sleep. Noise and light pollution, constant distractions from multiple media, chronic stress, hectic schedules, and long work hours are few of the features of modernity that conspire to undermine sleep. American adults average less than seven hours of sleep per night. About 50 percent of adults experience occasional bouts of insomnia. A recent (2017) report from the Centers for Disease Control and Prevention estimates that, “over one third of the US population sleeps less than the amount recommended by experts consensus. In addition, sleep deprivation is estimated to cost our society approximately US$43-$56 billion per year.”
Moreover, while some 50 to 70 million Americans chronically suffer from disordered sleep, these problems are often ignored. People often fail to report sleep problems to their doctors. Doctors often fail to inquire. (It is ironic that the medical profession, which should be at the forefront of encouraging healthy sleep habits, still endorses the callous tradition of sleep-depriving medical residents as part of their training).
This ignorance has consequences. For example, roughly 95% of the 5 to 10 million Americans with sleep apnea (a potentially serious sleep disorder in which breathing repeatedly stops and starts) “do not know they have sleep apnea and consequently face cardiovascular complications and sudden death.“
Research suggests that a chronic lack of—or poor quality—sleep, “increases the risk of disorders including high blood pressure, cardiovascular disease, diabetes, depression, and obesity.” Even mild sleep deprivation is associated with a vast array of problems, including, “emotional instability, decreased pain tolerance, metabolic disease, immunodeficiency, impaired cognitive performance and memory consolidation.” For example, snoring, a phenomenon thought of by many as benign, is “associated with poor prognosis in individuals who are at risk for cardiovascular disease and also can increase risk of stroke.“
Acute, severe sleep deprivation has been shown in animal research to cause organ failure and death. In humans, brain changes associated with sleep disruption result in, “disruptions in human behaviour across nearly all domains of cognition and affect.“
No wonder then that human beings—ever-inventive with (and equally fascinated by) the tasks of inducing pleasure and inflicting pain—have long ego realized the potential of sleep deprivation as a means of torture.
Many mood and behavior problems commonly diagnosed as mental health disorders involve disrupted sleep as a corollary, consequent, or causal factor. “Sleep abnormalities are robustly observed in every major disorder of the brain, both neurological and psychiatric. Sleep disruption merits recognition as a key relevant factor in these disorders at all levels, from diagnosis and underlying aetiology, to therapy and prevention.”
The upshot of all this is that, health-wise, protecting your sleep both adds benefits and reduces liabilities. And while a few sleepless nights here and there are not an indication of a problem, persistently disrupted sleep is a serious threat to optimal health, and requires attention, and action. if you're not sleeping well, consulting your physician or psychologist is well-advised.
American culture is pill-happy. Our first impulse in treating most health problems is to reach for the medicine cabinet, or inquire about a prescription. Alas, when it comes to treating sleeplessness, we are well-advised to think outside the pillbox. While many medications are available to help improve sleep in the short term, medicating sleeplessness long-term presents considerable risks and drawbacks. Over-the-counter medications are no magic cure. Most contain antihistamines, to which tolerance can develop quickly, reducing long-term effectiveness. In addition, many over-the-counter meds may cause grogginess and mental fog the following day (this is known as the 'hangover effect'). Moreover, “medication interactions are possible ... and much remains unknown about the safety and effectiveness of over-the-counter sleep aids.” Prescription meds are associated with substantially increased mortality and cancer risks. Many lead to the development of tolerance, a pathway to addiction, and may carry multiple noxious side effects, including, ironically, insomnia.
Moreover, persistent insomnia (the most common sleep disorder) is often caused by, “poor sleep hygiene, conditional hyperarousal status, and dysfunctional belief about sleep.” Therefore, “non-pharmacological treatment to correct poor sleep habit or dysfunctional belief about sleep should be firstly performed before prescribing sleeping pills.”
One such useful, empirically supported, non-medical approach is CBT-I, a cognitive-behavioral treatment protocol for insomnia. The treatment involves four main components, as follows:
- Sleep Education, which involves learning basic facts about the anatomy, stages, and mechanisms of sleep.
- Sleep Restriction Therapy, the goal of which is, “to decrease variability in the timing of sleep while increasing the depth of sleep,” by shortening gap between time in bed and time asleep.
- Stimulus Control, designed to “strengthen the bed as a cue for sleep and weaken it as a cue for wakefulness.”
- Sleep Hygiene Training, which involves developing good sleep-related habits and rituals and arranging the sleep environment to minimize distractions.
CBT-I is recognized by the NIH Consensus and State-of-the-Science Statement as a first-line treatment for insomnia. It takes effort and time, but bang-for-your-buck, it may constitute one of the best investments you could make in protecting and improving your health.
To find a therapist, please visit the Psychology Today Therapy Directory.
