Doctor Sleep

Resting in the Real World

"There are no solutions. There are only trade-offs." - Thomas Sowell

Wouldn't It Be Nice

Why do we need a skillset for something that is supposed to occur naturally and in order with the rhythms of the Sun? Because we have artificially inseminated our environment with neurological pollutants that require it. That has its benefits and drawbacks. Artificial light makes for more opportunity to interact socially, engage in nighttime recreation, and even work through the entire 24 hour cycle if our little hearts desire.

This radical departure from our biological rhythms requires more conscious intervention as our biology has not and may never catch up with our technological progress. Ultimately this means the development of robust knowledge, skills, and practices that allow us to more appropriately tune ourselves to how our sleep behavior is contributing to or detracting from the stability of our health and performance. Furthermore, our ability to understand and harmonize with these demands will have a bearing how well we can perform not only in the short term but our ability to remain robust to the demands of long term performance..

Wouldn't it be nice if life listened to our wearables and the whole world shut down at just the right time for us to get our eight hours of shut eye? Wouldn't it be nice if life never threw us curveballs like

What Is Sleep?

It's all too often that we get sucked into worrying over our sleep data without even taking a second to consider what sleep actually is. I'm a huge proponent of bringing clear definitions to bear before we consider a course of action because we have to know what it is we are actually striving for.Normally when I ask students in my Check Engine Light classes what sleep is they answer with correct synonyms or outcomes like rest and recovery but usually don't get to the heart of the physiology. This is essential if we want to have an understanding of what and how we measure this important state of being.

Sleep for all intents and purposes is a biologically occurring state of unconsciousness that is marked by predictable cycles of brain activity. Not all states of unconsciousness are sleep nor are all states of rest and rejuvenation unconscious. The major cycles of sleep we alternate between are REM (Rapid Eye Movement) sleep, and NREM (non Rapid Eye Movement). These cycles occur every 90-120 minutes somewhere between four and six times per night.

Non REM sleep is characterized by light and deep sleep. Deep sleep in particular plays important functions in brain and body. In the brain slow brain waves clear out old connections and metabolic waste. We release important hormones like HGH which helps to heal musculoskeletal tissues like tendons, cartilage, and bones. As well as the regulation of metabolic functions such as blood sugar.

REM sleep, usually characterized by dreams is in terms of brain activity the closest to a waking state. During REM sleep we consolidate memories. organize emotions. This is the time of forming new neurological connections. There is also some evidence that REM sleep is critical in the expression of emotions such as compassion as well as waking mood regulation. Not to mention essential physiological functions like HRV.

These two cycles occur cyclically throughout the course of sleep with most deep sleep occurring in the first phase and most REM occurring in the cycle just before waking. While this short description of sleep barely scratches the surface of sleep physiology having even this cursory understanding can serve as a starting line to begin investigating what might be hindering this essential aspect of health and performance and how to identify more precisely what aspects of our sleep might require our attention.

Full Measure

It's no longer a mystery that sleep is an essential part of doing our best and living longer. There are a multitude of devices that track sleep whether those are wearables like WHOOP or Oura rings or devices that are embedded directly into the mattress. Hypnograms (shown in the picture above) show our sleep architecture. They display when we were in certain phases of sleep, for how long, and if the sleep we got was continuous and of high quality. These devices can be helpful by providing us with data that allows us to see how our behavior effects sleep outcomes.

The flip side is that some of these devices can have questionable validity although the direct to consumer technology is improving all the time. For some, constant tracking can also increase sleep anxiety, especially if you're having trouble or find yourself in a situation where you may not have much power to change the outcome. In my experience, the best use of these measurements is as tools to reflect on our felt experience and calibrate our internal sensibilities so that we can make more informed choices that allow us to adapt appropriately to whatever context we may find ourselves in.

Another useful but less scientifically exact way to track sleep is to use a sleep questionnaire. There are some fancy ones that are used in sleep studies but you can also ask yourself some simple questions when you wake up like:

• Do I want to be awake right now?

• Do I feel excited for my day?

• Am I energized?

• Do I feel rested?

• Is my body stiff and painful?

• What kind of mood am I in?

• Did I dream?

• Is my heart rate higher or lower than yesterday?

These kinds of questions are good places to start internal dialogue that you can match against external markers like sleep trackers or heart rate monitors.

It is essential to measure, yes, but not to the point that we develop neuroticism or get a negative net effect on health and performance. This can be a delicate balance but is a skill that can be honed through regular personal experimentation.

Sleep Skills

For most of us the ups and downs of life do not reconcile easily with the seemingly utopic criteria that we are given for sleep. Shift work, family demands, holidays, and maybe even your dog who got in a fight has a cone on his head because he got stitches and it keeps knocking into the wall when he moves around so he cries all night (hypothetically speaking of course). Regardless of the reason for sleep disruption there are some times in life when, if you'll excuse my French, shit happens. If we know this to be the case it's helpful to develop skills that that will transfer regardless of the environment we might find ourselves in.

Being a skilled sleeper means that you have tried and continue to try things that help me sleep more effectively and measure those against how I feel from day to day.

Stable Levers

If we want to build an adaptable skillset that allows us to manipulate our environment or our behavior in ways that create reliably restful sleep patterns then we have to look at the aspects of sleep that are most invariant. Becoming aware of the aspects that underly our circadian rhythms and what aspects of those we can manipulate, we find stable levers to pull regardless of the circumstances that we may find ourselves in.

• Light. Evolutionarily speaking, the Sun is the king of all biological rhythms and sleep is no exception. According to time of day, changes in brightness and hue of light, tells brain and body whether to be awake and alert or unconscious and resting. For most of our biological history human life was powered by available daylight or the orange and reddish hues of firelight. Playing with ways to limit bright and blue light exposure in the evening and instead create dimly lit (red and orange light seems best) rooms or complete darkness for sleep is an easy place to start. There is not shortage of protocols and tools on the market that can help you manipulate the light in your sleep environment.

• Temperature. Cooling down of the environment and the subsequent cooling of our core body temperature is an essential aspect of falling and staying asleep. Too hot or too cold has been shown to cause restlessness during sleep that interrupts dense, natural cycles of rest. Cooling your bedroom down externally is a good place to start but can be an issue if you sleep with a partner. Low tech solutions range like warm showers (warm not hot has been shown to lower core body temperature even though it raises surface temperature) to mattress technology that artificially cools your mattress. They even have some that account for differences in sleep partner preference.

• Noise. While nighttime is generally quieter than day it was by no means silent in our evolutionary landscape. We evolved with lots of nocturnal creatures are up and handling business. With that said there are some sounds that are clearly disruptive to our sleep. Obviously, the shrill of sirens and alarms wake us up. That's sort of the point. If you're in an urban environment it might be helpful to find ways to cover up or block out those noises. The same goes for hotel rooms. What seems to be the most disruptive is noises that are foreign. While people do vary in sensitivity to noise sounds that we are used to are far less likely to disturb us than ones we are not. Adding white noise whether from a machine or a simple box fan can be helpful or you can go big and use sleep sound tracks specifically designed to help you get to and stay asleep. Shit, these days you can have Lebron James read you a lullaby if it helps. (For real. Check out the app Calm).

• Nutrition. What and when you eat are powerful indicators to your body when it's time to rest and when it's time to wake. My dogs wake up ready for breakfast every day at the same time and they do not own an alarm clock. The timing of our last meal can also play a role in the ease of entry into sleep. Digestion raises core body temperature and can be disruptive in terms of sleep quality. Like any of these factors some people are more sensitive than others so be aware of where you stand (by measuring) and make adjustments accordingly. Last but not least I have to mention alcohol. Any amount of alcohol is disruptive to sleep. Ironically, it is the most commonly reported self-administered sleep aid that people use. That's because it's a relaxant. It may help you more easily fall unconscious but make no mistake it's well established that alcohol extends the time it takes to get into the first real cycle of sleep, creates broken sleep patterns, and is the single greatest contributor to non-obesity sleep apnea. In other words, it doesn't help and is proven to hurt. I'm no prohibitionist by any stretch. Just know the cost of using it and decide if and when it's worth it.

• Routine. When my daughter was a little girl we had a bedtime routine. After dinner take a bath. Then she would brush her teeth and put on pajamas. Then play in her room for a little while before she was read a story. We turned on some music then lights out and good night. All of this build up or should I say shut down, was a progressive signaling to her brain and body that it was time to rest. Predictability is an important part of how our nervous system determines when it's time to rest and is a major factor in quality of sleep. With that said, we don't always have the ability to keep things completely homogenous when it comes to our sleep environment. To that I have a two part answer. The first is a quote from President Teddy Roosevelt, "Do what you can, where you can, with what you have." Second. include staple behaviors in your sleep routine that are possible regardless of your environment. Mine are tuning the lights down and foam rolling or stretching. I can do those at home or on the road teaching.

Nearly any protocol or gadget that is meant to effect sleep or any inhibitor of sleep can be categorized in the above. These "stable levers" offer ways to find aspects of sleep to focus on so that you can experiment over time and find what works best for you.

Experimentation

Running a personal health experiment on sleep (or anything for that matter) is pretty simple.

• Clearly identify what you are trying to change and what you think will change it. (Hypothesis)

• Measure that thing for a period of time. It doesn't need to be perfect, this isn't a university lab.

• After that period of time see what the results were.

• Reflect on that experience. What worked? What didn't? Did something unexpected happen? Might this work in a different context?

• Make an adjustment and try again.

Reflecting on what happened is the most important part of this process and the one that is usually passed over. Take time to think about what happened and why it might have happened.

This is essentially turning your health into a process of continuous experimentation and learning which not only helps you learn about specific health components like sleep but will also create continual opportunities for you to engage with health practices in general.

The Whatabouts

It's at this point when most people get a case of the whatabouts. What about naps? What about supplements? What about staying up to watch the game? Here's the deal. I don't know you. There are some general rules regarding these things that you can find in any multitude of podcasts and YouTube videos of your favorite PhD health influencer. Regardless of anything I or any of those people might say you have to find out how things work for you. Maybe you can tolerate a nap and still have dense, regular, restful sleep. Maybe you can't. How will you know? Try and measure.

Rest On A Budget

One more point to clean this whole topic up. Imagine you have a report card for sleep. If you're a shift worker (you have or currently do work at night), you drink alcohol regularly, eat just before bed, and have a history of head injury your sleep report card is at best a D-. So you don't have room to mess around. You have to do everything right to get your GPA up. If on the other hand you sleep report card is an A+ you've got room to skip class once or twice. You get what I'm saying? Just like report cards change so do sleep patterns. Make choices based on the realities of your situation so you can adapt well over time.

Human life on this planet has never been easy nor perfect but as we've separated ourselves from the cues of the natural environment it has made it difficult to reconcile fundamental aspects of our health with that reality. Sleep is no exception. Regular, restful sleep is one of the most impactful components of any performance longevity skillset. Paying attention to your sleep does not need to be a time consuming endeavor but instead can become as regular a part of your hygiene as brushing your teeth. 

Thanks for reading,

Rob

---