Are We Really Sleep Deprived?

People with insomnia typically worry about not getting enough sleep. It’s easy to understand why. The media are are full of stories warning of the perils of insufficient sleep: obesity, diabetes, dementia, cardiovascular disease.

But a study of sleep in 3 traditional societies published in October suggests that humans may need less sleep than we think we do—which should give insomniacs food for thought.

Insomniacs may not need as much sleep as they thinkPeople with insomnia typically worry about not getting enough sleep. It’s easy to understand why. The media are full of stories warning of the perils of insufficient sleep: obesity, diabetes, dementia, cardiovascular disease.

The Centers for Disease Control and Prevention for several years declared insufficient sleep to be a public health epidemic (last year they revised the language to “public health problem”). And according to an estimate set forth in Sleepless in America, a documentary released on the National Geographic Channel in December 2014, Americans sleep considerably less than we did 150 years ago.

But a study of sleep in 3 traditional societies published in October suggests that humans may need less sleep than we think we do—which should give insomniacs food for thought.

Making Inferences About Sleep in Times Past

How did people sleep millennia ago? Has electric lighting really had as negative an impact on sleep as sleep experts claim it has?

The scientists and anthropologists who conducted this study couldn’t travel back in time to assess the sleep of our ancestors. So they did the next best thing: study the sleep of 3 hunter–gatherer and hunter–horticultural societies in existence today. These traditional peoples, who live without electricity or any modern technology, live in equatorial regions of Tanzania, Namibia, and Bolivia.

What They Found Out

The investigators used wristwatch-type devices to measure sleep duration and light exposure for 94 adults over a total of 1,165 days. Following are some interesting findings:

  • People in these traditional cultures slept 5.7 to 7.1 hours a night—less than average sleepers in modern industrialized societies like the United States. Yet extensive research has found that although their daily energy expenditure is about equal to that of most Americans, they’re healthier and more physically fit than we are.
  • People did not go to sleep at sunset, as has been assumed about people before the advent of artificial lighting. On average, they went to sleep 3.3 hours after sunset, keeping vigil in the dark except for a small fire and moonlight. So electric lighting is probably not the only reason we like to stay up to watch the late show. Perhaps Thomas Edison did not have as big an impact on sleep as we think.
  • People got their sleep in a single sleep episode uninterrupted by long periods of wakefulness. Daytime naps were the exception rather than the rule. This challenges the idea that early humans had two separate sleep episodes interrupted by a wakeful period in the middle of the night, or that they routinely took daytime siestas.

Relevance to Insomnia

Many people with insomnia say they need 8 hours of sleep a night, and maybe some of us do. Yet although this study by itself is not evidence that we need any less, if it convinced us to revise our beliefs about sleep need downwards, it wouldn’t be a bad thing.

Sleep therapists say that one thing that happens to many insomniacs as their sleep improves is that they let go of the idea that 8 is the magic number. Sleep quality may matter more than the number of hours we get.

Why Such Alarmist Messages?

Sleep isn’t always seen as important—yet it is a pillar of health alongside diet and exercise. But the alarmist tone of some of the messages we hear about not getting enough sleep (“a public health epidemic”), and the fact that healthy sleep is almost always defined as a certain number of hours, is worrisome to people with insomnia and others whose nightly share of shut-eye falls short. How helpful are such messages really?

The cynic in me says the pharmaceutical companies and medical device makers are behind this campaign to insist that we aren’t getting the sleep we need. Because who stands to gain more from convincing us that we’re sleep deprived than the folks who sell Ambien and CPAP machines?

But Americans toward the end of the 19th century were also worried about their sleep. After the Civil War, many were moving off the farm and into the city, where life was more stimulating, and both faster paced and more sedentary, than on the farm. A widely held view was that civilization was evolving faster than the human organism could keep pace with, and good sleep was falling by the wayside.

Are we living in a similar climate today? Do the dire warnings about insufficient sleep fit in with general concerns about the pace of our 24/7 lives, and do they likewise reflect anxiety about social changes and/or fear that we can’t keep up?

I’d like to know what you think.

Q&A: Start Sleep Restriction Right for Best Results

“I’m on Day 4 of SRT and it isn’t going well,” Jenny wrote recently. “I finally had an appointment with a sleep therapist last week. He talked to me about SRT and gave me a 7-hour sleep window, from 11 p.m. to 6 a.m. My usual bedtime is 9:30 so I had some apprehensions. But I started 4 days ago.

“Since then I haven’t slept more than 3 hours a night. It’s really hard for me to stay up till 11, and then when I get in bed I’m wide awake! In the morning I’m so tired I can hardly keep my eyes open! Is this normal? I’m afraid I may be a treatment failure. Any advice?”

Before sleep restriction, keep a sleep diary for a week to ensure successRecently I’ve heard from a handful of people starting out with sleep restriction therapy (SRT), a treatment for insomnia. All were in a similar predicament. Here’s what Jenny wrote:

 

 

 

 

 

 

I’m on Day 4 of SRT and it isn’t going well. I finally had an appointment with a sleep therapist last week. He talked to me about SRT and gave me a 7-hour sleep window, from 11 p.m. to 6 a.m. My usual bedtime is 9:30 so I had some apprehensions. But I started 4 days ago.

Since then I haven’t slept more than 3 hours a night. It’s really hard for me to stay up till 11, and then when I get in bed I’m wide awake! In the morning I’m so tired I can hardly keep my eyes open! Is this normal? I’m afraid I may be a treatment failure. Any advice?

First Few Weeks of Treatment

The first few weeks of SRT are not much fun. Your time in bed is cut short at night and naps are not allowed. It can be hard to figure out what to do during the extra hours you’re up. In the daytime you may feel sleep deprived: exhausted, cranky, off your game.

Is this normal?

Research suggests it’s not abnormal. Results of a study of 16 insomniacs in the UK showed that while their sleep was greatly improved following SRT, during the first few weeks of treatment, they were sleep deprived. Like Jane Fonda said: no pain, no gain!

The Week Before Restriction Begins

Jenny’s experience of the first few days of SRT is not so unusual. But nowhere in her email—or in the others I received—was there any mention of having kept a sleep diary* during the week before treatment. Also, all 4 I heard from were starting SRT with rather generous sleep windows: 6.5, 7, and even 8 hours in bed. Yet they didn’t say how those sleep windows were established.

Maybe sleep diaries were kept—and the writers just didn’t mention them. Or maybe a therapist determined, based on a clinical interview, that starting out with a generous sleep window was the best way to treat insomnia in that particular person. (See my blog on paradoxical insomnia for more on this.)

But I suspect that at least some who wrote had plunged right in to sleep restriction without filling out a sleep diary the week before and that their sleep windows were set arbitrarily. This can make the first week of sleep restriction even rockier than it needs to be—and might lead people to think the treatment is failing and quit.

How Much Do You Sleep?

To set your sleep window (time allowed in bed) at the start of SRT, you need to know how much sleep you’re getting from night to night. Maybe you have a pretty good idea of that already. In reality, though, most insomnia sufferers are not very good at estimating sleep duration.

Keeping a sleep diary during the week before treatment won’t necessarily make your estimate more accurate—but it might. By noting in the diary how many times you wake up each night, how long the wake-ups last, and the variability in your sleep from night to night, you might get a more realistic read on the average number of hours you sleep.

Look Before You Leap

Regardless of whether keeping the diary clues you in to anything you didn’t already know, the results are an indication of how much your time in bed should be restricted at the start of sleep restriction:

  • You discover you’re a 6-hour sleeper? Start SRT with a 6-hour sleep window.
  • You’re sleeping 5 hours 15 minutes a night? Start with a 5.25-hour sleep window.
  • There’s one exception: most sleep experts (but not all) recommend starting SRT with nothing less than a 5-hour sleep window. So 4-hour sleepers are usually advised to start with a 5-hour window.

If you start with a too-small sleep window, you’ll wind up very sleep deprived. But if your sleep window is too generous (as I suspect may have been the case for Jenny and the others who wrote in), you’re likely to continue with the same broken sleep pattern you’ve known from before. This could sour you on sleep restriction even before you’re off the ground.

So keep a sleep diary for a week before starting SRT and set your sleep window accordingly. It’s the quickest path to success.

* Download this sleep diary from the National Sleep Foundation and make several copies for use during SRT.

What was your experience like during the first week of sleep restriction therapy?

An Insomnia Treatment of Her Own

A few weeks ago I got an email from Julie, who’d written to me about her insomnia before. Here’s how she began:

“I am happy to share with you, 5 months later, that I am sleeping peacefully and soundly! It didn’t happen overnight, but my improvement did happen because of the sleep restriction you recommended!”

“This woman is persistent,” I thought, and read on. I discovered that, while Julie’s first attempts at this insomnia treatment were strikeouts, rather than give up, she found ways to modify the sleep restriction protocol so it eventually worked.

Modifying sleep restriction for insomnia can lead to more satisfying sleepA few weeks ago I got an email from Julie, who’d written to me about her insomnia before. Here’s how she began:

“I am happy to share with you, 5 months later, that I am sleeping peacefully and soundly! It didn’t happen overnight, but my improvement did happen because of the sleep restriction you recommended!”

This woman is persistent, I thought, and read on. I discovered that, while Julie’s first attempts at this insomnia treatment were strikeouts, rather than give up, she found ways to modify the sleep restriction protocol so it eventually worked.

“I can now say that I’ve gone over a full month without any bad sleep,” she wrote, “and I’m now sleeping 7 plus hours a night!”

I decided to interview Julie, and here are excerpts from the conversation:

Insomnia Returns

Your insomnia started several months ago. What threw your sleep off track?

A health scare, which later turned out to be a false alarm. I didn’t sleep a wink that night, worrying about all the possibilities. . . . All it took [was] 4 bad nights to send me into the chronic insomnia pattern I experienced for the next 5 months: a few good nights followed by sleepless nights—up and down the roller-coaster.

You decided to try Sleep Restriction Therapy (SRT) for insomnia. What led to that decision?

I’d had an insomnia problem 14 years earlier that lasted for 2 years. It was caused by a bladder problem after the birth of my last baby. . . . I tried SRT but was unsuccessful with it because I needed to cure the bladder problem first.

I never expected to sleep poorly again after what I went through and solved 14 years ago. It was a total shock that the insomnia came back as horribly as before, only this time I couldn’t blame it on my bladder! I decided to take aggressive action. I purchased The Savvy Insomniac, and a book by Dr. Arthur Spielman. Everything I read encouraged me to try SRT again.

A Rocky Start

How much did you restrict your sleep at first, and how did you fare?

To begin SRT, I averaged my previous week’s sleep and came up with 4½ hours. I decided to stay up until 1 am and get up at 5:30. At first, I decided to stay in bed during those 4½ hours whether I was sleeping or not. My results were terrible! I alternated between zero sleep nights and 2 to 3 hours [of sleep]. Determined to force this to work, I started to get out of bed when I wasn’t sleeping. That didn’t work, either. I got an occasional 4-hour night but I was so sleep deprived [that] I didn’t feel comfortable driving at night, which was a deal-breaker for me.

You say that SRT called up lots of anxiety. Can you elaborate?

Being that regimented just threw me for a loop. I really dreaded the evenings. I would be up for hours after my family went to bed, waiting to fall asleep until the right time. For me, staying up later than the gang was . . . stressful. [And] looking at the clock, especially at bedtime, seemed to cause me stress.

Also, there was an 11-mile hike I was looking forward to in a month, and I put pressure on myself to be in good shape by then. Every day that I couldn’t . . . increase my time in bed, I would get discouraged and feel that going on the hike would be an impossibility. I also worried that health-wise it was not good to spend [such a] short time in bed for an extended period—and this was not looking to be a short-term project for me.

Rewriting the Rules

So you decided to make some changes. What were they?

The thing I discovered is I had to do [SRT] in a flexible way that worked with my environment and my personality. I decided to come up with a modified version of SRT, one I could stick with long-term.

First, I needed to be able to go to bed when my family did. . . . And I needed to start with 6 hours [rather than 4½].

I was not going to watch the clock strictly. I [would go] to bed at approximately 11:30 and get up at 5:30, but it worked best if I didn’t look at the clock.

Since even in normal times I usually had a few wake-ups an hour or 2 before it was time to get up, I vowed to get out of bed at one of these wake-ups, or at 5:30, whichever came first.

I did not put a time limit on how long I would keep up this routine, so there was no pressure to improve. I also vowed to make this a background project in my life—do my 6 hours in bed and go about the rest of my life.

How well did your modified protocol work?

I had one of my longest periods of good sleep . . . followed by some “off” nights. Then another record-long period of good nights, followed by 2 weeks of off-and-on.

Once I got past that, things improved at a quicker pace. I went a month with only 1 bad night, then a month with 3 bad nights, then, finally, a month with no bad nights. Two months into the project, I bumped up my time in bed by 15 minutes. Two weeks later, I added 15 minutes more. I’m now up to about 7½ hours’ sleep per night.

Julie’s right where she wants to be with her sleep. The way she got there–and the changes she made to SRT–wouldn’t be helpful for everyone. But my hat’s off to anyone who can take this insomnia treatment and tweak it in ways that work.

If you’ve managed a similar feat, please share your story here.

Does Insomnia Look as Bad as We Think?

I recently attended a talk where the speaker, a photographer, posed a question to the audience. “If you took a series of photos of yourself going about your daily life,” she asked, “are there images you’d feel uncomfortable sharing with other people?”

The first image that came to mind was my face as it must look the minute I crawl out of bed after a slew of insomniac nights. That face isn’t pretty. But would signs of sleep deprivation show up in a photograph?

Fatigue and sleep deprivation show up in the eyes, skin, and mouthI recently attended a talk where the speaker, a photographer, posed a question to the audience. “If you took a series of photos of yourself going about your daily life,” she asked, “are there images you’d feel uncomfortable sharing with other people?”

The first image that came to mind was my face as it must look the minute I crawl out of bed after a slew of insomniac nights, when I’m feeling sleep deprived. (Bouts of insomnia are rare now, but they can still occur if I’m stressed out for several days.) The face I imagine isn’t pretty: furrowed brow; pained eyes; skin that’s inelastic, exposing crow’s feet and other wrinkles that show my age; mouth turned down.

I’m not the only insomniac to imagine the worst. Amy, a stay-at-home mom I interviewed for my book, is convinced after nights of insomnia that she looks like a mess. “I feel like I’ve got black circles under my eyes,” she says. “I feel like my whole aura is going to be sort of repulsive in the world. I don’t even want to go out the door I feel so icky.”

But would the icky way we feel after insomniac nights show up in a photograph, or are we just imagining we look so bad?

The Facts of the Matter

A study from Sweden and The Netherlands confirms that telltale signs of insufficient sleep can be read in the face. When people are severely sleep deprived (in this case, subjects underwent a short night’s sleep followed by a completely sleepless night), it shows up in their eyes, skin, and mouth, and as sadness.

The subjects in this study were probably way more sleep deprived than most people with insomnia. In fact, sleep deprivation may not be the real problem for some insomniacs at all.

Still, alongside other findings, this study adds to the literature suggesting that inadequate sleep not only jeopardizes our health and day-to-day functioning. It can also make us less attractive. (And who thinks this concern is superficial? Not me!)

Facial Cues of Sleep Deprivation

  • Tired eyes are the most revealing sign of fatigue. Drooping eyelids and eyes that are red or swollen are a tip-off that you’re short on sleep.
  • Skin cues are telling, too. All the usual suspects—pale skin, wrinkles, and dark circles under the eyes—are validated in this study as signs of sleep deprivation.
  • Finally, drooping corners of the mouth and overall sadness are marks of fatigue and insufficient sleep.

The take-away? You’ve known it all along. Everything your mother ever told you about your need for beauty sleep is absolutely true.

Does your face look different when you’re short on sleep? How?

A Tip for the Tired and Wired

I recently joined a friend to watch Cloud Atlas at her home. A bad choice for evening entertainment! This is a movie where evil is lurking around every corner.

New research on laboratory mice suggests why arousing activities have such a strong impact on sleep.

horror-movieI recently joined a friend to watch Cloud Atlas at her home. A bad choice for evening entertainment! This is a movie where evil is lurking around every corner, and the suspense in each of the six plotlines tied my stomach up in knots. We turned off the DVD player near bedtime, but unwinding enough to fall asleep took me nearly three hours. Even then my sleep was patchy and unsatisfying.

What we do and what we think about before bedtime has a big impact on our sleep. Aristotle had this figured out back in Ancient Greece. “The intellectual activities which cause wakefulness are those in which the mind searches and finds difficulties rather than those in which it pursues continual contemplation,” he wrote.

New research on laboratory mice suggests why arousing activities have such a strong impact on sleep. Researchers at UT Southwestern Medical Center have discovered two new proteins, one that tracks sleep need and the other that determines how long it takes to fall asleep. Their study, published last month in Proceedings of the National Academy of Sciences, showed that these two processes are separate, and that even mice that were sleep deprived did not fall asleep quickly when placed in an arousing environment.

Tired and Wired

The subjects in this experiment were three groups of mice with identical genes. The control group was allowed to sleep and wake up at will.

The two test groups were deprived of sleep for six hours. During this time, one test group underwent a series of cage changes. With each new cage change, the mice set about vigorously exploring their new surroundings for about an hour. Mice in the other test group were kept awake by a researcher gently tapping the cage or waving a hand in front of their faces.

When finally the mice in the two test groups were allowed to sleep, the second group dropped off right away. But the cage-exchange mice took as long to fall asleep as mice in the well-rested control group.

“The need to sleep is as high in the cage-changing group as in the gentle-handling group,” said Dr. Masashi Yanagisawa, lead author of the study, quoted in Science Daily. “But the cage-changers didn’t feel sleepy at all. Their time to fall asleep was nearly the same as the free-sleeping, well-rested control group.”

Moral of the Story

You can’t always control what happens in the evening, and it’s boring to be a shut-in while others are out having fun. But if sleep is what you’re after, follow the advice offered by Dr. A. Brigham in 1845: “Those who are liable to have disturbed sleep should take especial care that their evenings pass tranquilly.”

What kinds of evening activities typically disrupt your sleep?