Sleep’s Unrivaled Therapeutic Powers: Wakefulness is Over-rated

In recent years, Guinness World Records has stopped listing records for continuous sleeplessness because it was deemed too hazardous. And for good reason - alarming scientific data has emerged about the acute dangers of inadequate sleep - including hal­lucinations, schizophrenia, high blood pressure, stroke and heart attack.

But it was the irrefutable evidence for increased risk of suicide among sleep-deprived people that convinced the scientific advisors at Guinness World Records to officially outlaw future attempts at extreme sleep deprivation.

To put that in context, Guinness gave the thumbs up to “Fearless” Felix Baumgartner’s proposal to attempt to set the world record for a vertical freefall distance as a skydiver. Under sponsorship from Red Bull, he jumped out of a capsule that was orbiting the Earth on the edge of space. Baumgart­ner, wearing a pressurized spacesuit plummeted headfirst straight down covering 24 vertical miles in 4.5 min­utes before deploying his parachute.

Freefalling using nothing but his body and gravity, Felix became the first human to break the sound bar­rier without a vehicle, attaining a top speed of 834 miles per hour. That the experts at Guinness World Records felt okay about sanctioning this potential­ly lethal stunt, but decided that sleep deprivation was too unsafe, should make you think twice about giving your sleep the short shrift. Appallingly, sleep deprivation has also been used for millennia as a cruel form of torture.

Shorter Sleep = Shorter Life

“I’ll sleep when I’m dead,” is a motto made famous by singer/songwriter Warren Zevon. Billionaires Elon Musk and Steve Jobs have also flaunted a sleep machismo, implying that time is money, whereas sleep is a worthless waste of precious hours. World leaders Margaret Thatcher and Ronald Reagan both boasted about the uselessness of sleep and how they got by on only four or five hours nightly. Were these celebrities somehow immune to the effects of insufficient sleep? Is mak­ing a habit of getting lots of luxurious sleep each night just for the weak and lazy?

To the contrary, renowned sleep sci­entist Matthew Walker, Ph.D., author of Why We Sleep, says the “sleep-when- I’m-dead strategy is mortally unwise advice. The shorter your sleep - the shorter your life. I don’t think it’s coincidental that both Reagan and Thatcher went on to develop Alzheim­er’s disease.

If only, when Margaret Thatcher had that bravado about sleep when she was in her 50s, she could have seen herself in later life enfeebled by dementia. I would hope she wouldn’t have been so brave about skimping on sleep.” And it didn’t end well for Steve Jobs and Warren Zevon either, both of whom succumbed to cancer in their 50s.

As Professor Walker states, “There is no biological function in the body or mental process in the brain that is not wonderfully enhanced when you get optimal sleep or demon­strably impaired when you don’t get enough sleep.”

In years past, medical residents were often in the hospital caring for patients up to 16 hours per day. In fact, that’s why new doctors were called residents - traditionally they resided in a teaching hospital during their postgraduate training years. Today, medical education authorities have mandated that training doctors can’t be made to work more than 80 hours per week.

I feel fortunate because I did both my residency and fellowship at the Mayo Clinic, where they have always treated physicians-in-training humanely and have given them a reasonable amount of time off. On the other hand, my friend Peter At­tia, M.D., endured a surgical residen­cy where he typically worked 112 hours a week. Peter calculated that during those five years he averaged about four hours of sleep per night. Incidentally, Peter Attia’s The Drive is a phenomenally great podcast about longevity and fitness.

Why We Sleep

It took Mother Nature 3.6 million years to refine this central feature of our existence that occupies one-third of our lives, and which we refer to as a good night’s sleep. Yet, people today are sleeping fewer hours than ever before in the history of Homo sapiens.

In 1942, a study found that the aver­age American adult was sleeping eight hours per night. Now, this is down to six hours 30 minutes, while we burn the midnight oil staring at digital screens. On a related note, we burn fewer calories per hour watching a screen than we do while asleep - just one of many reasons sleep depriva­tion predisposes to obesity. Within the time span of only 70 years, we have lopped off 20% of our sleep time. Imagine the dire consequences of reducing by 20% some other essential requirement for human life, such as the amount of oxygen in our blood­stream.

Why do we spend so much time sleeping? It must be doing something besides just curing sleepiness. While asleep, we are not hunting or forag­ing for food, not eating, not finding a mate, not reproducing, not protecting our offspring, nor building shelter. And worse yet, during sleep, we are unconscious and largely defenseless against wild animals and enemies. So, if sleep doesn’t serve an absolutely vital set of functions for our health and survival, it’s the dumbest thing Mother Nature ever came up with.

Unsurprisingly, a constellation of ev­idence now makes it abundantly clear that evolution didn’t make a spec­tacular blunder in putting in place this need for an eight-hour night’s slum­ber. Sleep is our greatest life support system, a remarkable health insurance policy that’s free and pleasurable. And compared to a doctor’s prescription, this therapy is painless, free of side effects and generally effective for improving all manner of ailments.

The Glymphatic System Power Washes the Brain During Sleep

The brain is your most active organ: though it accounts for just 2% of your body weight, it burns about 25% of your total calories. Just like a roaring fire throws off a lot of smoke and ash, your busy and powerful brain gener­ates substantial amounts of waste while it’s awake. As in a bustling city, the garbage accumulates during the day, and only at night when the city sleeps does the refuse get hauled away, the debris in the empty streets flushed down the sewers.

In a very similar fashion, while we sleep our brain goes quiet and the glial (glue) cells that surround the neurons shrink down to one-third their normal size, making room for the cerebrospinal fluid to wash through­out the brain and flush out the waste and detritus that accumulated while we were awake. This is the glymphatic system—our brain’s self-cleaning and sewage disposal system, and it’s criti­cally important for keeping our brain healthy, our mind sharp and our mood bright.

Wakefulness clutters the brain with trash, and sleep is the clean and repair mechanism. In other words, sleep is the price we pay for wakefulness. This power-washing of the brain only hap­pens during deep sleep, so when we short-change our sleep time, we are disrespecting our brain.

Deep Sleep Prevents Alzheimer’s

Personally, the disease I fear most is Alzheimer’s, in part because I have one copy of a nasty gene called ApoE4. This is not uncommon, about one in four people is born with a single copy of the ApoE4 gene, which doubles the affected person’s risk of eventu­ally developing Alzheimer’s dementia. But it could be worse, about one in 30 people has two copies of the ApoE4 gene, which increases the risk of Al­zheimer’s by 10-fold.

Regardless, preserving cognition— sharp thinking— is my single highest health priority in life. Accordingly, I make it a habit to get plenty of revital­izing sleep each night. I’m reassured by visualizing the glymphatic system keeping my brain clean and healthy. As a physician who sees the epi­demic of Alzheimer’s that is gathering momentum and sweeping across our culture, the thought of chronic sleep deprivation frightens the daylights out me. It gives me humility to realize without adequate sleep, we are all vul­nerable to terrifying fates like demen­tia and cancer.

One fascinating study used PET nuclear imaging in people over age 70 to assess how much toxic gunk (sci­entifically referred to as beta amyloid protein and tau tangles) had built up in their brains. The people who on av­erage slept less than seven hours per night had strikingly higher amounts of amyloid protein and tau tangles in their brains compared to similar individuals who habitually slept more than seven hours per night.

Shocking studies show that if you are deprived of adequate deep sleep for even one night, you can start to see an accumulation of amyloid in the brain. Thankfully, a great night’s sleep washes away the sludge that had begun to gum up your brain, mak­ing it more receptive and capable by morning. To summarize, new stud­ies clearly show that an insufficient amount of high-quality sleep is one of the principle lifestyle factors causing Alzheimer’s disease. The fact that all therapies for treating Alzheimer’s thus far have failed miserably, makes pre­venting this scourge vitally important.

Emotional First Aid

Sleep is also essential for psycho­logical well-being. After about 16 hours of continuous wakefulness, most people start to note anxiety. Even a few days of inadequate sleep strongly predisposes to depression. Ominously, studies show that chronic insufficient sleep is one of the stron­gest predictors of suicide, especially among teens. Rapid eye movement (REM) sleep is the scientific term for dream sleep. REM sleep dominates the second half of your night’s sleep and it is like overnight psychotherapy, boosting your mood and relieving your anxieties. Professor Walker calls it “emotional first aid.”

Anyone who has raised a child comes to instinctively understand how fundamentally important sleep is for their kid’s emotional well-being. Try to skip the afternoon nap and a normally mild-mannered and content infant launches into non-stop fussing and crying, and is inconsolable for the rest of the day. Disturb one night’s sleep, and a happy well-behaved 4-year-old suddenly morphs into an uncontrol­lable brat, throwing a temper tantrum on the airplane. When our four kids were growing up, Joan made sure that bedtime was kept sacrosanct; and that the nap took precedence over any other afternoon activities. In young children, it is blatantly obvious how inadequate sleep leads to emotional outbursts and grouchy moods.

Somewhere between toddlerhood and the teen years, we abandon the notion that sleep is absolutely essen­tial and non-negotiable for a cheerful attitude and well-adjusted behavior. Worse yet, among some circles of col­lege students and adult overachievers, getting generous amounts of sleep and taking the occasional nap are stigmatized as indolent and slothful behaviors.

Take-Home Message

Sleep is the foundation of good health - it’s even more important than diet or exercise. Sleep de-risks nearly every disease that is killing us in the developed world. Deprive yourself of food, you can survive a month or longer; but go without sleep - you’ll be dead in 12 days, and psychotic in less than half that time.

An explosion of sleep science makes it clear that sleep is not just for curing sleepiness - it’s uniquely effective for preventing and treating many illness­es - mental and physical. For example, getting adequate, high-quality sleep is one of the best and most reliable ways to lower blood pressure. And as discussed, if you are serious about avoiding Alzheimer’s, sleep is one of your surest weapons against it.

Good sleep was designed by Moth­er Nature to be the keystone of robust health. Get to bed by 10 p.m., that’s when your brain is hungry for deep-cleansing, slow-wave sleep. Then sleep for eight hours - the second half of your night is for REM sleep so that you awaken cheerful, refreshed and ready to absorb new information. When you follow this routine, you should be able to wake naturally without an alarm clock.

In Good Health,
James O'Keefe, MD