20th Anniversary Special – Sleep, perchance to sleep

By | 13th March 2018


I have written a lot over the years about the benefit of regular exercise on all aspects of your health and wellbeing.

For a long time I had believed that there was nothing more important to improve your quality of life. Well that’s not quite right – there are a few riders to that wide-ranging statement.

If you are a political prisoner in the cells of some psychopathic leader, then regular exercise comes well down the list of priorities. Or if you’re starving in some war-ridden, famine state, the last thing on your mind is Saturday’s Parkrun. But when Maslow’s basic functions, freedom, food etc are a given, which is hopefully the case for the vast majority of our patients, then exercise is the main way to improve your quality and quantity of life – unless, of course, you’re a smoker, when all the exercise you take doesn’t quite negate all the damage from cigarettes.

Roughly speaking for every minute you exercise you gain an extra minute of life. So for the average smoker on 20 a day you have to exercise for 3 hours a day just to break even – each cigarette shortens your life by 9 minutes.

So, just to recap with riders in place, if you are a non-smoker living in a peaceful country with free access to air and you are not starving, then exercise is the best way to improve your life – at least it was until I started to research sleep a bit more.

Sleep is an enigma.

I have been pretty expert at sleep from even before when I was born. In fact, to think about it, I was a Ninja zen grandmaster of sleep whilst in the womb consuming a whopping 23 hours a day.

From there on I have had a steady decline down to my now paltry 7 hours a night. Humans as a species are pretty rubbish at sleeping. I only have to spend a few moments tickling Mitzi’s (our bonkers cockerpoo) tummy to realise that dogs are also zen masters of sleep. She is able to go from wide awake to fast asleep in the blink of an eye.

Milly (our cunning caverpoo) has mastered the art of sleeping with her eyes open – a most unsettling habit. Dolphins sleep with half their brain at a time, chimps our closest relatives sleep about 10 hours a night. Even fruit flies get more shut-eye than us. All of which makes you wonder what sleep is actually for and do we really need it?

It looks as though evolution is set on naturally selecting it out. Incredibly, even though a third of our lives is spent indulging in this most relaxing of pastimes it has not been until recently than science has started to unravel why we sleep.

We have known for a long time that sleep is vital to life. If you go a mere night without sleep your brain starts to perform badly, 4 days and you’re not far off a jabbering wreck, 12 days and your brain has lost contact with reality. When Hamlet says ‘To die, to sleep – to sleep, perchance to dream – ay, there’s the rub, for in this sleep of death what dreams may come…” he is pretty close to the truth. Starve yourself for the same period and you lose a bit of weight and become a bit apathetic. Sleep is more vital to health than food!!

What is so strange is that humans often do their best to avoid it.

During the busy periods of my life when I was trying to pack 25 hours of activity into a 24 hour day. The conversation inside my head went something like this –

Ok, I get up at 7 am and get ready for work at 8 am. I’m back home at 7 pm and then have various essentials such as reading to the children, bathing them and so on. That’s usually finished at 9 pm. Then there’s preparatory work for various projects at home and at work. Ok, we’re up to 10 pm. But I also need to build in time with my wife and ‘me’ time. That takes me up to midnight and beyond. So I have to prioritise.

At the time medical science didn’t have a clue about sleep. There were a few ideas that it ‘cleansed’ the brain but little else. I remember a popular TV program chaired by James Burke where he challenged the idea that people needed 8 hours a night. Margaret Thatcher and Winston Churchill both famously only required 4 hours in the land of nod and were then able to function completely normally.

So when I look back at my decision-making processes it is hardly surprising that I identified the only slack in my day was whilst I was sleeping. I concluded that reducing sleep from 8 hours to 7 hours or maybe even less was the best option open to me. The conventional wisdom was that less sleep was actually beneficial – I looked upon this decision to curtail this predominantly wasteful pastime as a win-win.

Move the clock forward to today and medical science is a lot more knowledgeable about sleep. I now realise that my priorities were completely the wrong way round and what I had considered to be a win-win was actually a lose-lose. Once you have read Professor Matthew Walker’s excellent book – Why we sleep – or watched him on YouTube you will understand why. We used to think that when we went to sleep your brain did just that – it slept ie it turned itself off and rested – much like switching off your computer at night-time to make sure it didn’t overheat.

Then some bright spark wired themselves up to an EEG machine just to check what was happening to their brain activity. He found there are periods of rhythmical activity but these are interspersed with periods of high activity mirroring the most active phases when awake. Since then we have discovered that the brain sleeps through 90 minutes cycles with 4 stages of sleep. The most important seem to be deep restorative stages of non-REM sleep and  REM sleeping during which we dream. Dreaming appears to be the brain’s playground for trying out new ideas and scenarios. It turns out that the old adage of going to sleep with a problem and waking up with a solution is absolutely true!!

Most alarming of all is the consequences of not having good restorative sleep. Anyone knows that after a night without sleep you are much more likely to be grumpy and perform badly at work but the problems go well beyond that – you have an increased risk of heart disease, diabetes, high blood pressure, stroke, infections, cancer (due to reduced effectiveness of your immune system), weight gain, depression, anxiety, reduced sex drive, infertility, increased risk of accidents and so on – the list seems endless. Most worryingly your immune system can be affected by simply losing one night’s sleep.

But the real kicker is the effect it has on your risk of developing that most feared disease of all, Alzheimer’s. As you are aware Alzheimer’s Disease is related to plaques being laid down in the brain which interfere with neuronal communication. The latest research suggests that these plaques are cleaned up in the night – i.e. the brain has a self-cleansing system which prevents dementia – but less sleep means the system isn’t able to keep up and plaques get laid down. The evidence is conclusive that impaired sleep significantly increases your risk of dementia possibly by as much as 500%!

I no longer put sleep at the bottom of my priority list, it is number one.

I am totally signed up to ensuring that I get the right amount of sleep each night. James Burke was right about one thing, you can actually get too much sleep – we know that people who sleep too much as well as those who sleep too little die sooner. It may be difficult in terms of oversleeping to distinguish between the chicken and the egg – ie if you’re already ill you need more sleep or whether being habitually in love with sleep actually shortens your life, but conventional wisdom is that humans live longest and healthiest with about 7-8 hours sleep each night.

I mentioned that when I was still a foetus I was rather good at sleeping. I didn’t have to visualise sheep jumping over fences or counting down from a hundred, I just slept. I continued this zen-like state for most of my childhood. It was only when adolescence came along that things started to go awry.

Evolution has engineered teenage brains to have a slightly different sleep pattern from adults, strangely adolescents natural time for bed is an hour or so after adults. It may be this gave them an opportunity to safely spent independent time honing their hunter-gatherer skills away from adults or whatever. So ideally secondary school should run from 11 am to 7 pm to get the best out of teenagers. But school hours are designed for the teachers, not the kids.

I like all adolescents didn’t sleep properly because school hours didn’t suit my body clock, although I didn’t realise it at the time. There followed over the next 2 decades a series of calamitous events affecting my ability to sleep. In order, the stresses went – O levels, AO levels, A levels, living independently at University, drinking too much at University, exams, more exams, yet more exams, house jobs – working 100+ hours per week.

The NHS knew that sleep was a superfluous extra when you could employ a junior doctor for less than a cleaner, GP training, babies, GP on call, kids and phew in my late thirties our children could finally go to bed by themselves and I had relinquished out of hours responsibility and didn’t have to get up in the middle of the night any longer.

I still remember with horror one 72 hour shift as a houseman when I went without sleep. The poor lady who I was interviewing must have wondered what was happening to her. In the first 10 minutes, I asked her name 3 times. Kept repeating the same question and then fell asleep in front of her. The responsibility for her care lay with me – if she had suffered a mishap as a result of my chronic tiredness I would have been liable and could have been struck off by the GMC. The fact that my terms of work demanded I work such inhuman hours would not have been a mitigating factor.

Thankfully today’s NHS would hope the hospital managers responsible for such errors and the doctor would have been exonerated- junior doctors now work under very strict time restrictions to protect them. All in all I now have the luxury of going to bed and expecting a full night’s sleep.

So here are my tips to enjoying a full night’s sleep or if you’re a night worker, a full day’s sleep.

Firstly, barring the calamitous events of my twenties and thirties, the most likely thing that keeps me awake at night is the fear of not sleeping. You toss and turn, clock watch and all you can think about is how awful the following day will be if you don’t get enough sleep. But I know that I only need a couple of hours to be able to function the following day – so if I wake up and I’ve already had a couple of hours I reassure myself that there is nothing to worry about and hey presto as if by magic I go back to sleep.

I now avoid anything too stimulating prior to sleep – including blue lights (which can suppress melatonin the body’s sleep hormone). I go to bed the same time each night, boring but aids sleep, read a little and then sleep when I’m really tired.

That works for me but here is a collection of suggestions which may help you.

Read Matthew Walker excellent book – Why we sleep. He also tells you why you shouldn’t take sleeping tablets – the bottom line is that they don’t work and when you do sleep the quality is poor and not so restorative.

Have regular habits.

Avoid blue light 1-2 hours prior to bed – blue = daylight – your computer, TVs, phones etc produce blue light unless set to night mode.

Turn your mobiles off – I really can’t believe that people ‘do’ social media in the middle of the night.

Avoid caffeine at least 4 hours before bed.

Avoid nicotine an hour before bed.

Avoid alcohol around bedtime – if it does help you to get off to sleep you’re at risk of becoming reliant. Alcohol is a diuretic so its going to wake you up in the night anyway.

Avoid large meals before bed – a light snack is ok. Melatonin is a natural way to promote sleep – salmon and bananas for example are melatonin rich so theoretically should help.

Exercise regularly but not within 2 hours of sleep.

Keep the bedroom calm and tidy – to TV etc.

Keep the bedroom slightly cool. The bedroom should be quiet and dark. The bedroom is for sleep. Go to bed when you’re sleepy.

Don’t nap in the day.

Professor Richard Wiseman has an excellent YouTube video about sleep.

The old saying was an apple a day keeps the doctor away. It should really be — sleep well at night is your doctor’s delight.

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