“Do but consider what an excellent thing sleep is…that golden chain that ties health and our bodies together.”
—Thomas Dekker (1572–1632)
The past 20 years have seen remarkable advances in our understanding of sleep’s health benefits. One area of attention has been immune function, where the evidence is clear. To fight our battles with the microbial world, which includes Corona and other viruses, bacteria, fungi, and more, we must get adequate sleep.
Here’s a quick scan of the evidence. Some cruel studies with rodents demonstrate that they die sooner from a lack of sleep than a lack of food. The cause of death is a total breakdown of immune function. Vaccine studies with both humans and animals demonstrate that if you give a vaccine and then deprive the individual of that night’s sleep, it’s as if they were never vaccinated.
That last piece ties in with sleep’s many functions in the consolidation of memory. We typically think of memory as the list of Spanish verbs to be memorized for tomorrow’s test, how to play the tricky parts of Stairway to Heaven on the Guitar, and the name of the actor who starred in that movie, you know…it’s on the tip of my tongue. But our immune systems, which involve the creation of proteins and mobilization of Pacman like white blood cells to identify and destroy unwanted microbial invaders, perform many of its needed functions when we are passed out and horizontal. It’s memory. We meet the pathogens during the day, and figure out how to get rid of them, while asleep. To get less than the recommended amount, which for adults is between 7-8 hours, more for teens and even more for younger children, is to take our strongest weapons off the battlefield.
As the information about sleep’s restorative properties flows in, we have a cultural disconnect. We sleep deprive our teens and children, and many adults have a misguided machismo about getting by with only four or five hours. It will catch up with you and it’s not pretty. Insufficient sleep, less than six hours for adults, is associated with early death from all causes. It carries greatly increased risks for Alzheimer’s, coronary artery disease, obesity, diabetes, depression and many other medical conditions. We’re also in the midst of epidemics of insomnia (insufficient and poor-quality sleep) and sleep disorders such as apnea (inadequate breath/oxygen while asleep).
The good news is that this is something we can do a lot about. First if you/your bed partner are heavy snorers, feel tired during the day, fall asleep behind the wheel or at the computer, get evaluated by a sleep specialist. Those can be warning signs of sleep apnea, which is treatable.
Now for all of us who have mucked with our sleep, it’s time for corrective action. There are three natural drivers of sleep: our circadian clocks which includes the let-down of melatonin when it grows dark outside and prepares our brains for sleep, sleep pressure which involves the accumulation of the molecule adenosine and which caffeine disrupts, and hormones and chemicals of wakefulness that increase in the early morning hours and make it difficult to fall back when you get up to use the bathroom at 2 a.m..
What follows are 13 sleep-hygiene and behavioral recommendations that support these three regulatory systems.
- Establish and stick to regular wake-up and bedtimes. Make sure you leave adequate hours (at least eight for adults, nine for teens, more for younger children). This will help maintain a healthy and regular circadian cycle.
- Make certain the bed/bedroom are comfortable. Right pillow, sound control, right mattress. Free from distractions.
- Avoid caffeine, nicotine, and other stimulants. Caffeine hangs around for hours, so cut yourself off after the morning dose. Nicotine too, is a stimulant and if you have a smoke in the middle of the night, it’s a problem.
- Keep the bed for sleep…and sex. If you watch TV, play with your devices and have trouble falling asleep, do those things somewhere else. Like in a comfy chair.
- Unplug before bed, both literally and figuratively. Make certain you’ve turned your devices to the blue-blocker/night mode. This is because blue-green spectrum light waves screw up your circadian clock and push back the release of melatonin. You might also want to have the lightbulbs over the toilet you use in the middle of the night be free from those wavelengths. The old incandescent bulbs fit the bill, most LED and fluorescents do not. Also avoid checking work emails and anxiety provoking newsfeeds and social media.
- Keep cool. Our body temperature naturally dips to its lowest point when we’re asleep. Turn down the thermostat, open the window, splash your face and hands with water (it can be warm or cold), wear minimal bed clothes, leave a naked limb or two outside the bed covers.
- Take a bath. In line with number six this causes an overall cooling of body temperature, and many find the soothing scents and relaxing properties helpful.
- Restrict fluids before bed. Force yourself to use the bathroom right before nodding off. This decreases the number of times you get up in the middle of the night.
- Avoid naps. Not a hard and fast rule, but naps, especially long ones, can make it more difficult to fall asleep at night.
- If you can’t fall asleep after 30 minutes, get out of bed and do something dull. Read a textbook in a chair, maybe a jigsaw puzzle, count a jar of jellybeans, and get back in bed when tired. Do not turn on the TV. Do not go online.
- Strange bedfellows… get rid of them or change their behavior. If your spouse, pet(s), children, disrupt your sleep do something.
- Treat pain and medical conditions. If the thing that breaks your sleep is a medical, psychiatric, or dental problem, don’t delay treatment as the loss of sleep will likely make things worse.
- Finally, when you wake up in the middle of the night and can’t fall back asleep, practice any relaxation techniques, body scans, progressive muscle relaxation exercises, counting sheep. A simple one is to count to ten with your breaths, and if your mind wanders to work, the kids, how you’re going to pay the bills, bring it back to the count. Remind yourself that tomorrow is another day and you can worry about things then, but for now stick with counting your breaths and relaxing your body, just let go, breathe.
Bottom line, these are historic and trying days, weeks, and months. But one thing in our armamentarium is sleep, and we need to get enough. So put away the iPad, wash your face and hands, empty your bladder, and go to bed. You’ll feel better in the morning.
Charles Atkins, MD is a psychiatrist, member of the Yale volunteer faculty, and author with a recent book on opioid use disorders, and a PARADE special edition magazine on the Science of Sleep.