New Sleep Book Is a Fascinating Read

Matthew Walker, author of the new book Why We Sleep, is on a mission. Elucidating the many benefits of sleep, he’s out to persuade us that the key to health, attainment, and longevity lies in 8 hours of shut-eye every night.

Use of the familiar 8-hour yardstick as a measure of sleep need may give insomnia sufferers pause. We’d be happy to sleep 8 hours a night . . . if only we could.

Don’t let Walker’s prescriptiveness stand in the way of reading his book. Its appeal rests on the author’s account of discoveries relating to the wonderful things sleep does for us—which should be of interest to us all.

Matthew Walker's new book examines why we sleep and dreamMatthew Walker, author of the new book Why We Sleep, is on a mission. Elucidating the many benefits of sleep, he’s out to persuade us that the key to health, attainment, and longevity lies in 8 hours of shut-eye every night.

Use of the familiar 8-hour yardstick as a measure of sleep need may give insomnia sufferers pause. We’d be happy to sleep 8 hours a night . . . if only we could.

Don’t let Walker’s prescriptiveness stand in the way of reading his book. Its appeal rests on the author’s account of discoveries relating to the wonderful things sleep does for us—which should be of interest to us all.

A Sleep Scientist Writes for a Lay Audience

I’ve been following Walker, a professor of neuroscience and psychology at U.C. Berkeley and director of the Center for Human Sleep, for years. He’s done important research on the effects of sleep and sleep deprivation on learning, memory, and emotional memory processing.

With Why We Sleep: Unlocking the Power of Sleep and Dreams, Walker steps outside the world of academia to engage with the general public. That’s a point in his favor, in my book, because research scientists who endeavor to write for a lay audience don’t have much to gain from it personally. No kudos from colleagues, no burnishing of the CV.

Yet now could not be a better time for scientists like Walker to translate their research into terms we can all understand. And it quickly becomes clear that Walker is bent on doing this out of a passionate conviction that as members of a 24/7 culture, many of us are suffering from sleep deprivation.

Knitting Up “the Ravelled Sleave of Care”

For decades scientists have been searching for an answer to the question of why we sleep. It turns out there’s not just one but rather many reasons.

“We sleep for a rich litany of functions,” Walker writes, “an abundant constellation of nighttime benefits that service both our brains and our bodies.”

What are some of the functions sleep performs? It

  • improves our ability to learn, memorize, make logical decisions and choices
  • strips negative experiences of their emotional charge, improving our mood and sense of balance
  • enhances creativity
  • shores up the immune system
  • regulates appetite and gut health
  • lowers blood pressure and maintains heart health

Says Walker, with all the benefits sleep affords living organisms and how damaging the state of wakefulness can be, perhaps the real question is this: Why did life ever bother to wake up?

Diving Into the Research

Why We Sleep has four parts. In part 1 we learn about the basics of sleep. Parts 2 and 3 contain accounts of recent discoveries relating to the functions of sleep and dreams, which Walker presents together with personal anecdotes and easy-to-grasp analogies.

One discovery pertains to the question of why sleep deprivation makes us emotionally reactive and why a good night’s sleep sets us back on an even keel. Walker and others found the answer in the prefrontal cortex—the seat of rational thought that rests just above the eyeballs—and the amygdala, the emotion center deep in the brain. It could only be seen with the help of brain scanning technology.

“After a full night of sleep,” Walker writes, “the prefrontal cortex . . . was strongly coupled to the amygdala, regulating this deep emotional brain center with inhibitory control. . . . Without sleep, however, the strong coupling between these two brain regions is lost. We cannot rein in our atavistic impulses—too much emotional gas pedal (amygdala) and not enough regulatory brake (prefrontal cortex). Without the rational control given to us each night by sleep, we’re not on a neurological—and hence emotional—even keel.”

Caveat for People With Insomnia

Walker’s target audience is the multitude of healthy, normal sleepers who, out of necessity or by choice, do not alot 8 hours of the day to sleep. Insufficient sleep can have dire consequences: microsleeps while driving, often deadly; poor decision making; increased susceptibility to a host of health conditions and illnesses, including depression, stroke, dementia, cancer, diabetes, heart attacks. By dwelling on the alarming results of sleep deprivation studies, Walker means to wake us up to the dangers of “just getting by” on 5 or 6 hours a night.

But what if we’re willing to set aside 8 hours a day for sleep—and regularly do—but all we can sleep is 5 or 6? Lying in bed for 8 hours when we’re only sleeping 5 or 6 is precisely what insomnia sufferers should not do, because this only serves to perpetuate our insomnia.

Keep These Things in Mind

  1. The sleep deprivation literature Walker refers to throughout the book is based on studies of healthy, normal sleepers whose sleep need is presumably in the 7- to 8-hour range. On a steady diet of anything less, they experience sleep deprivation.
  2. The sleep needs of people who want to sleep more but can’t may be different from the needs of those who can sleep but do not sleep their fill.

While Walker’s book contains a short section on insomnia in part 4, Why We Sleep is not the go-to resource if you’re looking for help with insomnia. But it’s an excellent resource if you want to learn about sleep and the benefits it bestows.

Sleep and Body Weight: A Close Relationship

“If you weigh too much, maybe you should try sleeping more.”

This commentary in the journal Sleep caught my eye. Flip as it sounds to a person who would sleep more if she could, it points to a relationship between sleep and body weight that should be widely publicized.

Sleep can also affect your ability to keep weight off. As for the relationship between insomnia and body weight, the latest news is surprising. Read on for details:

Insomnia with short sleep increases susceptibility to overweight“If you weigh too much, maybe you should try sleeping more.”

This commentary in the journal Sleep caught my eye. Flip as it sounds to a person who would sleep more if she could, it points to a relationship between sleep and body weight that should be widely publicized.

Sleep can also affect your ability to keep weight off. As for the relationship between insomnia and body weight, the latest news is surprising. Read on for details:

Sleep Deprivation and Weight Gain

It’s established now that sleep deprivation increases feelings of hunger (or interferes with feelings of satiation). Sleep deprivation occurs when sleep is arbitrarily restricted—as it might be during a research project in a sleep lab, when participants’ sleep is restricted to 4 hours a night—or when work or family responsibilities keep you from getting the sleep you need. Either way, the tendency is to eat more. And the more you eat, the more weight you gain.

People who are chronically sleep deprived don’t only tend to put on weight. They also risk developing metabolic syndrome, which is linked to serious medical problems like heart disease and diabetes.

So if the bathroom scale is inching upward every time you weigh yourself, consider not just changes to diet and exercise but also allowing more time for sleep if—and this an important caveat—you’re actually able to get more sleep. A mere 30 minutes more sleep a night can help with weight loss and greatly improve your long-term health.

Short Sleep and Body Weight

People who are short sleepers by nature—those who routinely sleep less (sometimes quite a bit less) than 6 hours a night—are also more susceptible to weight gain and obesity than those whose nights are longer. A study conducted over a period of 13 years showed that every extra hour of sleep duration was associated with a 50% reduction in risk of obesity.

Short sleep is also associated with impaired glucose tolerance and insulin resistance. Thus short sleepers are more at risk for developing diabetes as well.

Sleep Duration Is Not the Whole Story

But routinely shortened sleep is not the only sleep issue associated with weight problems. Research is showing now that sleep quality is related to the ability to lose weight and keep it off.

Unlike sleep duration, which can be objectively measured with polysomnography, sleep quality cannot be assessed objectively. So it’s typically measured with questions similar to these:

  • Do you regularly have trouble sleeping?
  • What’s the overall quality of your sleep?
  • How often do you experience a sense of well-being during the day?

One recent study found that better sleep quality and being a “morning person” correlated with successful weight loss maintenance. Compared with current enrollees in a weight loss program, people who’d lost at least 30 pounds and kept the weight off for at least a year reported significantly better sleep quality and were more often early risers.

In another study, investigators compared people who maintained a loss of at least 10% of their body weight to people who regained their lost weight. Men (but not women) who were successful at shedding pounds and keeping them off reported significantly better sleep quality (but not more sleep) than the weight regainers.

Do Insomniacs Typically Have Weight Problems?

Not necessarily, if results of the latest study can be believed. Researchers in Germany compared the body mass index (BMI) of 233 patients with “severe and chronic insomnia . . . showing objectively impaired sleep quality” to the BMI of 233 age- and gender-matched good sleepers. The results were surprising:

  • BMI, insomniacs: 23.8 kg/m2 (The “normal” BMI range is 18.5 to 24.9.)
  • BMI, good sleepers: 27.1 kg/m2

On average, the chronic insomniacs weighed significantly less than the good sleepers. If confirmed by other research, the result should be somewhat reassuring to those of us concerned about the consequences of insomnia. It would also lend support to the idea that insomnia has less to do with insufficient sleep than with excessive arousal (or hyperarousal) that may affect us 24/7.

Do you find yourself eating more after a couple bad nights?

Coffee: The Sleepless, Too, Can Enjoy the Benefits

I love coffee and I’m always glad to hear coffee is beneficial to my health. Two new studies—one of humans and the other of mice—add to this growing body of knowledge.

Yet coffee contains caffeine, and people with insomnia are often advised to cut down on caffeine because it interferes with sleep. Is there a middle course the sleepless can steer to avoid the harms and reap the benefits?

Coffee | insomnia sufferers can enjoy health benefits & avoid the harmsI love coffee and I’m always glad to hear coffee is beneficial to my health. Two new studies—one of humans and the other of mice—add to this growing body of knowledge.

Yet coffee contains caffeine, and people with insomnia are often advised to cut down on caffeine because it interferes with sleep. Is there a middle course the sleepless can steer to avoid the harms and reap the benefits?

Decaf is always an option. Caffeinated coffee may be OK, too—if you’re willing to experiment. Here’s more on that following a brief look at the new findings:

Coffee Reduces Mortality

The latest study of coffee and mortality found that coffee drinkers live longer than non-coffee drinkers. In this large, multi-ethnic study, people who drank one cup a day were 12% less likely to die than non-coffee drinkers. The odds were even better for people who drank two or three cups a day: they were 18% less likely to die.

The particular chemical or compound in coffee that protects against heart disease, cancer, respiratory disease, stroke, diabetes, and kidney disease is still unknown. But it probably isn’t the caffeine. Coffee’s life-protecting benefits were significant for people who drank caffeinated coffee and for those who drank decaf. They were significant for smokers and non-smokers; African-Americans, Asians, Latinos, and whites; and people of all ages.

Caffeine Reduces Pain Sensitivity

Pain can interfere with sleep. But a growing body of literature suggests that lack of sleep or poor quality sleep increases our sensitivity to pain, and that insomnia exacerbates existing pain and predicts new-onset pain.

In a new study, Boston researchers found that sleep deprivation in healthy mice increased their pain sensitivity. The greater the sleep deprivation, the more exaggerated were their responses to pain. After a period of normal sleep, their reaction to pain was much less pronounced.

Then, while still in a state of sleep deprivation, the mice were given caffeine or modafinil (a drug that promotes alertness). Their pain tolerance increased, similar to what they experienced after a full period of normal sleep. So if you’re experiencing pain and trouble sleeping, a caffeinated beverage like coffee may reduce your pain more effectively than drugs prescribed for pain relief.

Reaping the Benefits, Avoiding the Harms

It looks like moderate coffee drinking is associated with better health and resilience to pain. But if you’re prone to insomnia, you’ll need to do a bit of experimenting to find out when and how much you can drink without harming your sleep.

Here are some facts to be aware of as you’re figuring it out:

  • The effects of caffeine vary greatly from one person to the next. This is largely attributable to genetic factors. Drinking coffee later in the day may keep you wakeful and degrade the quality of your sleep, or it may not affect your sleep at all.
  • Research has shown that early risers tend to be the most sensitive to caffeine. People who go to bed and wake up somewhat later have less caffeine sensitivity, and the sleep of night owls may not be affected by caffeine at all.
  • People metabolize caffeine at widely varying rates. The average half life of caffeine (the point at which the amount of caffeine in the blood has decreased by half) is 5 to 6 hours. But the half life of caffeine can vary from 2 to 12 hours. Smokers typically metabolize caffeine quickly; pregnant women, slowly. And we all metabolize caffeine more slowly as we age.

Timing Is Important, Too

When you can safely drink your last cup of coffee may depend in part on the insomnia symptoms you have. For example, I have sleep onset insomnia, or trouble falling asleep at the beginning of the night. I find that drinking coffee after 2 p.m. can keep me wakeful so I avoid coffee later in the day.

But Lesley, who comments on my posts from time to time, has trouble with sleep maintenance insomnia, falling asleep easily at the beginning of the night but waking up in the middle of the night. After successfully working to consolidate her sleep with sleep restriction, she worked out for herself a different coffee drinking routine:

I know I’m pretty caffeine sensitive and for a long time drank only decaffeinated drinks. . . . After reading recent research . . . on caffeine’s effects on sleep and the body clock, I’ve now added caffeine back into my daily routine. I have sleep maintenance insomnia plus an early to bed/early to rise body clock, and I commonly struggle to stay awake in the evenings, and even the late afternoon.

But with much experimentation I’ve found that one instant coffee in the late afternoon and another about 2.5 hours before bedtime helps massively, without affecting me getting to sleep. Of course we’re all different in our tolerance to caffeine, and it’s very much trial and error. But it’s an extremely useful tool to be aware of.

Lesley puts it well: with a bit of trial and error experimentation, we insomniacs may be able to have our coffee and drink it, too.

If you’re a coffee drinker, how does it affect your sleep?

11+ Nighttime Activities for Sleep Restriction

Here’s a complaint I often hear from insomniacs going through sleep restriction therapy: it’s hard to stay awake until bedtime. A related frustration comes with suddenly having extra time on your hands.

“I don’t know what to do with myself till 2:30 in the morning!” an insomnia sufferer groused to me.

Here are variations on 11 activities aimed at keeping you awake until the clock says it’s time to head to bed.

Sleep restriction less difficult with enjoyable activities that keep you awakeHere’s a complaint I often hear from insomniacs going through sleep restriction therapy: it’s hard to stay awake until bedtime. A related frustration comes with suddenly having extra time on your hands.

“I don’t know what to do with myself till 2:30 in the morning!” an insomnia sufferer groused to me.

Here are variations on 11 activities aimed at keeping you awake until the clock says it’s time to head to bed.

A Trivial Topic? Think Again

Sleep restriction therapy involves first restricting your time in bed to just the number of hours you’re actually sleeping. Then you gradually add time in bed until you find your ideal sleep window. Normally, this means starting therapy with a later-than-usual bedtime, an earlier-than-usual rise time, or both.

If you’re new to sleep restriction, planning what to do in the run-up to a later bedtime may seem unnecessary.

“I’ll read,” you say, “I’ll watch TV, I’ll catch up with friends on Facebook. I’ll do what I always do at night, only I’ll stay up longer.”

Sticking to the familiar may not work and here’s why:

The first week you’re restricting your sleep you’ll probably feel somewhat sleep deprived. If even mild sleep deprivation is involved, passive activities like watching TV and reading can lead to nodding off well before the prescribed bedtime. This interferes with establishing a regular sleep schedule, which is one thing you’re trying to accomplish. The more you stick to your prescribed bed and wake times, the quicker the therapy will take effect.

Devices with screens (computers, iPads, iPhones) emit blue light, which blocks secretion of the sleep-friendly hormone melatonin. It’s helpful to install an app called f.lux or wear blue-blocker glasses if you use devices at night. Even so, being wedded to the screen in the hour leading up to bedtime is not a good idea, especially for people with sleep onset insomnia (people whose insomnia occurs at the beginning of the night).

Other Constraints on Nighttime Activities

Evening activities have to be quiet unless you live alone. Playing the saxophone may be fun for you but obviously not for other members of the household.

Evening activities can’t require a lot of physical or mental stamina. By then you’re usually low in the tank.

A walk outside might have appeal. But depending on who you are and where you live, it may not be safe to leave home after dark.

The Special Challenge of Sleep Anxiety

What to do in the run-up to bedtime can be especially challenging for sleep onset insomniacs, whose anxiety about sleep tends to escalate the later it gets. Clock watching adds to (or is a part of) that sleep-related anxiety. When undergoing sleep restriction there’s no getting around use of the clock for information about when it’s OK to go to bed.

Waiting until anxiety sets in to decide what to do can be risky. A glass of wine? A sleeping pill? You’re off the rails before you’ve even begun. Why add stress to the sleep restriction process by waiting too long to decide what you’re going to do in the extra time you’re up?

Take it from one who’s been there twice and who, knowing what she knows now, would do it somewhat differently. In the week before you start restricting your sleep (as you’re collecting information about your sleep and recording it in your sleep diary), come up with a list of activities you’re going to do when restriction begins, acquiring any supplies you’ll need in advance. Ideally, these activities should (a) be somewhat enjoyable (or at least tolerable), (b) offer mild mental stimulation, and/or (c) involve some movement.

This list of activities is hardly comprehensive. But maybe it will motivate you to come up with other activities that would suit you as well or better.

  1. Do (or Take Up) an Art or Craft:

  • Needlework (quilting, knitting, crocheting, embroidery).
  • Jewelry or beadwork.
  • Woodworking or leatherworking
  • Calligraphy.
  • Origami.
  • Sewing. Lay out a pattern and cut the fabric.
  • Any artistic activity, such as sketching or watercolor painting, as long as it doesn’t require much clean up.
  1. Make Lists:

  • To-do lists and grocery lists.
  • Travel checklists for different kinds of trips (road trips, air travel [overseas and domestic], business trips, camping.) Printed out before each trip, they make packing a lot easier.
  • Gift lists. Avoid panic during the holidays and at birthdays and other special occasions.
  • A bucket list. Think of everything you’d like to see and do while you’re still able to do it.
  1. Organize or Reorganize:

  • Your tool bench.
  • Your jewelry box(es).
  • Your music. If you have CDs, tapes, albums, or sheet music, arrange them by style, period, composer, or instrument.
  • Your herbs and spices. Group them as powders, whole spices, and herbs, or arrange them alphabetically.
  • The garage or the basement.
  1. Sort and Discard:

  • Books. Do one shelf at a time, separating them into keepers, throw-aways, and give-aways.
  • Clothing in closets and drawers.
  • Old photos. Put the ones you want to keep into albums or photo boxes.
  1. Redecorate:

  • Your walls. Take down wall art and replace it with other paintings, photos, prints, or posters.
  • Your shelves. Replace pottery and art objects with others.
  1. Bake Cookies or a Coffeecake.

  2. Do Light Housework:

  • Dust furniture.
  • Fold or iron clothes.
  1. Prepare for the Day Ahead:

  • Set the breakfast table.
  • Pack lunches.
  • Do prep work for the evening meal.
  1. Do Things You Enjoyed in the Past:

  • Play Solitaire.
  • Do a thousand-piece jigsaw puzzle.
  • Get out a telescope, look at the stars, and identify constellations.
  • Gather every small thing you’ve collected outdoors—flowers, nuts, leaves, shells, stones, feathers, pine cones—and look at them under a microscope.

The following two categories of activities may be too passive for some people but could work if combined:

  1. Look at Publications with Images:

  • Art books.
  • Coffee table books.
  • Catalogs.
  • Family albums.
  • Cookbooks. Use a post-it note to mark every recipe you want to try out.
  1. Using Headphones, Listen to:

  • Music.
  • Books on CD.
  • A podcast. (But avoid looking at screens.)

Before you start to restrict your sleep, make a list of activities you’re going to do in the run-up to bedtime. And who knows? You might even enjoy some of that extra time awake.

If you’ve gone through sleep restriction, what activity did you find was most helpful in keeping you awake till bedtime?

An Ayurvedic Herb for Better Sleep

Might Ayurvedic medicine—traditional medicine practiced in India for 3,000 years—offer an effective treatment for insomnia?

If you’re looking for an alternative treatment vetted by scientists in controlled clinical trials, the answer is no. But an Indian herb called ashwagandha is receiving attention as a substance that might help people with several health conditions, including chronic stress, anxiety, and memory loss. It’s also being studied as a possible sleep aid. Here’s more about it.

Insomnia may respond to treatment with ashwagandhaMight Ayurvedic medicine—traditional medicine practiced in India for 3,000 years—offer an effective treatment for insomnia?

If you’re looking for an alternative treatment vetted by scientists in controlled clinical trials, the answer is no. But an Indian herb called ashwagandha is receiving attention as a substance that might help people with several health conditions, including chronic stress, anxiety, and memory loss. It’s also being studied as a possible sleep aid. Here’s more about it.

Ashwagandha (Withania somnifera)

Ayurvedic medicine is a holistic healing system. Patients are generally prescribed a combination of herbs, special diets, and daily practices aimed at promoting overall health rather than eliminating a specific problem like insomnia.

But the Latin somnifera means sleep-inducing, and ashwagandha powder, prepared from the root, leaves, or whole plant and taken orally, has been prescribed to improve sleep for centuries. A handful of laboratory studies on rodents have provided evidence for ashwagandha’s sleep-inducing effects. Results of some studies suggest that ashwagandha leaf extract may also protect rats from the consequences of sleep deprivation.

Authors of a recently published paper in PLOS ONE have identified a specific component of the ashwagandha leaf that puts mice to sleep. Following is a summary of their findings.

An Active Component That Promotes Sleep

Biologically active components in ashwagandha include withanolides—naturally occurring steroids—and triethylene glycol, or TEG. TEG is currently used in various manufacturing processes, but how it impacts biological systems is largely unknown. In this study, investigators wanted to find out if one or the other of these substances had sleep-inducing effects.

Via a complicated extraction process, the researchers isolated each of these compounds, mixing them with alcohol and water so they could be administered orally to mice. Here are the results:

  • Compared with the alcoholic medium alone, the alcoholic extract containing a high amount of active withanolides had no effect on the sleep–wake system of the mice.
  • Compared with water alone, the extract containing lots of TEG induced a significantly greater amount of non-REM, or quiet, sleep—without affecting the amount or nature of REM sleep.
  • Commercially available TEG was also administered to the mice in 10, 20, and 30-mg doses. The larger the dose, the more non-REM sleep the mice got over a 12-hour period and the more quickly they fell asleep.

The authors conclude that while low to moderate levels of TEG clearly induce sleep in laboratory animals, possible “toxicological properties of TEG need to be studied in detail before its used is advised in humans.”

Meanwhile, Is Ashwagandha Safe for Humans?

It depends on where you ask the question. Indian practitioners of Ayurvedic medicine have been prescribing it for centuries. A handful of scientific studies also attest to the safety of this herb when used short term in therapeutic doses. (Long-term effects are unknown.)

But an article in Medline Plus lists a number of safety concerns. People who are pregnant and breast feeding, who have diabetes, or who have an auto-immune disorder should steer clear of ashwagandha. The herb can interact with various medications and supplements, too.

For a definitive reading on whether ashwagandha could work as a treatment for insomnia we’ll have to wait and see. But it’s widely available as a dietary supplement in powder, capsule, and tablet forms. Of course, dietary supplements are less well regulated by the FDA than prescription medications. Quality is not assured.

But if you’re looking for better sleep and tempted to try ashwagandha, consult a practitioner of Ayurvedic medicine or a naturopath about whether the herb might have something to offer you.

Q&A: Can Poor Sleep Show in the Face?

Can chronic insomnia make you less attractive? speed up the aging of skin? cause irreversible damage to your face?

I heard these concerns as I interviewed insomniacs for my book. But recently I decided to check into them after receiving an email from a woman whose anxiety about her appearance was extreme:

Very worried middle-aged woman

Can chronic insomnia make you less attractive? speed up the aging of skin? cause irreversible damage to your face?

I heard these concerns as I interviewed insomniacs for my book. But recently I decided to check into them after receiving an email from a woman whose anxiety about her appearance was extreme:

 

Ever since it all started eight years ago, my drive has always been an extreme fear of the insomnia’s impact on my physical appearance—especially my face. I just cannot let go of the pain of seeing my face ruined by sleeplessness! . . . Frankly, I look 10 years older than my biological age.

I am so afraid that my face is scarred (it certainly looks that way) and that it cannot recover after all these destructive years!

When we look in the mirror and see drooping eyelids and dark circles under our eyes, do we imagine we look worse than we actually do?

Effects of Sleep Quality on the Skin

There haven’t been any studies comparing the skin of insomniacs with the skin of good sleepers.

But three years ago I blogged about a study involving 60 women, half reporting good quality sleep with a duration of 7–9 hours and the other half reporting poor quality sleep lasting 5 hours or less. (Symptoms of these poor quality sleepers come close to meeting the criteria for a diagnosis of insomnia disorder.)

First the researchers inspected participants’ skin. Then they tested the skin, exposing it to ultraviolet light and subjecting it to a tape-stripping procedure that caused skin barrier disruption. They then observed how long it took participants’ skin to recover from these challenges.

Study Results

Compared with the good sleepers’ skin, the poor sleepers’ skin:

  • Showed more signs of aging skin (e.g., fine lines, uneven pigmentation, flabbiness, and less elasticity)
  • Took significantly more time to recover from the UV light exposure, with redness remaining higher over a period of 3 days

The good sleepers’ skin recovered 30% more quickly than the poor sleepers’ skin.

The study results suggest that insomnia sufferers’ concerns about the health and appearance of our skin are probably valid.

Effects of Sleep Deprivation on the Skin

In another study researchers took photographs to compare the faces of healthy adults in two different situations: (1) when they were well rested and (2) under conditions of sleep deprivation. (Again, acute sleep deprivation is not the same thing as insomnia—and certainly not the same thing as chronic insomnia—but research suggests that insomniacs may suffer from mild sleep deprivation at least some of the time.)

Twenty-three participants, all healthy adults, were photographed in the afternoon after a normal 8-hour night of sleep and again after sleep deprivation (a 5-hour night of sleep followed by 31 hours of continuous wakefulness). The photos were then viewed in a randomized order and rated by 65 untrained observers.

What the Observers Saw

You can probably guess what the results of the study were. Compared with well-rested faces, sleep-deprived faces were perceived as:

  • Less attractive
  • Less healthy
  • More tired

“Apparent tiredness was strongly related to looking less healthy and less attractive,” the researchers wrote. “The fact that untrained observers detected the effects of sleep loss in others” suggests that our sleep history gives rise to signs that can be noted by other people.

In other words, after several bad nights, the pasty complexion and dark circles we notice in the mirror are not just figments of our imagination. Others see them, too—and may judge us as less healthy and less attractive as a result. (Keep in mind, though, that the participants in this study were quite severely sleep deprived when the second round of photos was taken.)

What Can Be Done

If preserving your skin is important, then taking measures to improve your sleep might be one of the best preservatives. CBT for insomnia (or sleep restriction) is the No. 1 treatment for insomnia recommended by sleep experts. Find information about it by clicking “Blog” at the top of this page and typing CBT or sleep restriction in the site search box.

What about products that might help to preserve the skin? A dermatologist once recommended that I use CeraVe Moisturizing Cream. I like it well enough but have no way of knowing if it’s keeping my skin looking younger than it would otherwise be.

If you’ve found a skin product you like, please share it here

When Napping & Caffeine Make Sense

Chronic insomniacs will have heard these messages before: “Don’t nap.” “Avoid caffeinated beverages later in the day.” These are good rules of thumb for most people with insomnia. If you catch yourself drifting off during the 6 o’clock news, it’s better to get up and walk around the block than drink coffee or indulge in a full-blown nap.

But some situations warrant breaking the rules.

sleep deprived insomniacs who must drive should have a nap & caffeineChronic insomniacs will have heard these messages before: “Don’t nap.” “Avoid caffeinated beverages later in the day.” These are good rules of thumb for most people with insomnia. If you catch yourself drifting off during the 6 o’clock news, it’s better to get up and walk around the block than drink coffee or indulge in a full-blown nap.

But some situations warrant breaking the rules. Say you end up pulling an all-nighter to study for a test and have to take a second test later the same day. Or say a family crisis triggers a couple bad nights and the next night you have to drive all the way to St. Paul. If you’ve got to be on your toes despite feeling seriously sleep deprived, then napping and well-timed use of caffeine make sense. Here’s what the research says.

Turning Low Energy into High

It’s normal to feel low energy when you’re short on sleep, and nerve-wracking when the situation calls instead for stamina and alertness. Your first impulse may be to reach for an energy drink. Energy drinks usually deliver what they promise: studies show that caffeine—a main ingredient—can improve attention, reaction speed, information processing, memory, mood, and aerobic performance.

Caffeine quickly moves from your gastrointestinal tract into your bloodstream. It’s at peak strength about 1 hour after you drink it. Caffeine blocks secretion of adenosine, in turn increasing the release of neurotransmitters that promote arousal. Fatigue falls away and your brain comes alive again.

When Caffeine Isn’t Enough

But under conditions of extreme sleep deprivation, caffeine by itself doesn’t work very well. Researchers at the University of Pennsylvania confirmed this and found out more when they conducted a double-blind study on sleep-deprived subjects to compare the effects of caffeine with and without periodic naps.

The participants, 58 healthy men (average age 29), underwent 3 nights of total sleep deprivation. Starting at hour 22, half of the men took a low-dose caffeine pill every hour on the hour, and the other half took a placebo. Half of the caffeine takers were also allowed to take a 2-hour nap every 12 hours and the other half were not. Likewise for the placebo takers.

The participants were tested repeatedly, and here’s what the investigators saw in the group taking only low-dose caffeine:

  • Compared with placebo, the caffeine significantly reduced declines in reaction time and lapses in attention associated with sleep loss, but this effect fell off as participants grew more and more sleep deprived.
  • Compared with placebo, caffeine did nothing to increase the amount of information the sleep-deprived participants could process or improve their working memory.

Adding Naps to Reduce Fatigue & Improve Performance

But taking low-dose caffeine and a 2-hour nap every 12 hours improved participants’ attention, ability to process information, and working memory. These effects held steady through all 3 days of the study. Adding caffeine to the naps also reduced the drowsiness participants felt on awakening from their naps.

The Penn researchers point out that “caffeine at any dose is not a chemical substitute for adequate healthy sleep.” But in situations where people must perform under conditions of sleep deprivation, “brief naps in combination with properly-dosed and well-timed energy products containing caffeine may provide the most benefit.”

Some people with insomnia don’t have an easy time napping, and I’m one of them. But when I’m truly suffering sleep loss—say, when I have jet lag on returning home from a trip—and I have to be up and alert, I turn on the coffee maker, nap if I can, and drink my coffee immediately on waking up.

But Note These Caveats

The effects of caffeine vary greatly from person to person largely due to genetic factors:

  • In this experiment, for example, the peak concentration of caffeine in the blood plasma of participants ranged from 2.0–9.4 mg/l. That’s a very wide range. It suggests that some participants’ behavior was much more impacted by caffeine than others’.
  • Also, some people metabolize caffeine more slowly than others. On average, caffeine has a half-life of 5–6 hours. But its half-life ranges from 2.5–10 hours (and the range is even wider in people who are pregnant, taking antidepressants, or have liver disease). A particular genetic polymorphism causes more women to metabolize caffeine more slowly than men, and more Asians and Africans to metabolize caffeine more slowly than Caucasians.

Are Sleep Restriction and Exercise a Good Mix?

When people ask what insomnia treatment helped me the most, I mention sleep restriction therapy (SRT) and exercise.

But I’d never seen SRT and exercise paired as equal partners in a therapeutic intervention for insomnia until last week. Trolling the Internet, I came across a study conducted in China to determine whether adding an individualized exercise program to SRT would result in better outcomes than SRT alone. The investigators came up with interesting results.

Sleep restriction therapy and exercise are an effective combinationWhen people ask what insomnia treatment helped me the most, I mention sleep restriction therapy (SRT) and exercise.

But I’d never seen SRT and exercise paired as equal partners in a therapeutic intervention for insomnia until last week. Trolling the Internet, I came across a study conducted in China to determine whether adding an individualized exercise program to SRT would result in better outcomes than SRT alone. The investigators came up with interesting results.

Getting Beyond “No” to “Yes”

For some readers neither SRT nor regular exercise will have much appeal.

Sleep restriction may sound difficult if you feel you don’t get enough sleep. Nobody wants to experience sleep deprivation. And sleep deprived is probably how you’re going to feel in the first week or two of therapy. Most people’s sleep eventually improves (and continues to improve following treatment), but the fact remains that in the first few weeks, SRT is not a picnic.

Many insomniacs are likewise turned off at the thought of exercise or physical training.

“Usually when I propose physical training to my patients,” sleep investigator Michael Bonnet told me in an interview, “they don’t like the idea. They’re resistant to the idea of exercise, and this may have contributed to their sleep problem in the first place.”

And just how realistic is it to think that people experiencing mild sleep deprivation will be motivated to step up their level of physical activity? Research has shown that exercise improves sleep, but it’s also shown that poor sleep makes people less willing to exercise. How could an insomnia treatment be set up to avoid these potential snags?

Sleep Restriction, Slightly Modified

The team from China, whose study appeared in Neuropsychiatric Disease and Treatment in October 2015, did so by using a slightly modified version of SRT and offering intensive one-on-one support for the exercise.

Usually people begin SRT by keeping a sleep diary and restricting their time in bed to their average total sleep time (but usually not less than 5 hours a night). In this study, all 71 participants began with a sleep window equal to their average total sleep time plus half an hour. So a person averaging 5 hours of sleep a night began SRT with a 5.5-hour sleep window.

The rest of the 4-week treatment went by the book. Participants used data from their sleep diaries to calculate sleep efficiency at the end of each week and adjusted their sleep windows accordingly.

An Individualized Fitness Plan

In addition to SRT, half of the participants attended weekly help sessions with a fitness counselor. The first week’s session consisted of creating an individualized fitness plan. It included

  • an assessment of the participant’s fitness and information about the benefits of 30 minutes of moderate-intensity exercise at least 5 days a week;
  • setting personal goals and drawing up a plan to do the exercise of their choice; and
  • a prescription for how and when the exercise would be carried out, and a calendar for recording each exercise session and noting weekly follow-up visits with the counselor.

At the follow-up visits the counselor reviewed each participant’s progress, provided support, made adjustments as needed, and encouraged adherence to the fitness plan.

A Better Outcome

After 4 weeks of SRT, the sleep of both groups had improved: participants were falling asleep more quickly, experiencing fewer middle-of-the-night wake-ups, and sleeping 20 to 30 minutes longer every night. They were also more alert during the daytime.

But the sleep efficiency of the exercisers improved significantly more than that of the non-exercisers (20% vs 13%). In other words, the exercisers were spending less time awake in bed.

Also, the exercisers reported significantly less sleepiness and fatigue during the daytime. This might be a direct effect of the increased physical activity during the daytime. But the authors suggest it might also be a sign of improved sleep quality.

These results don’t surprise me. If I hadn’t kept up my workouts on the elliptical trainer during SRT, getting past wakefulness to sleep would have been harder. I’m almost certain my sleep wouldn’t have improved as quickly as it did.

If you’re considering SRT, consider stepping up physical activity as well. It can only help.

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