Why We Sleep: Unlocking the Power of Sleep and Dreams
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About this ebook
A New York Times bestseller and international sensation, this “stimulating and important book” (Financial Times) is a fascinating dive into the purpose and power of slumber.
With two appearances on CBS This Morning and Fresh Air's most popular interview of 2017, Matthew Walker has made abundantly clear that sleep is one of the most important but least understood aspects of our life. Until very recently, science had no answer to the question of why we sleep, or what good it served, or why we suffer such devastating health consequences when it is absent. Compared to the other basic drives in life—eating, drinking, and reproducing—the purpose of sleep remains more elusive.
Within the brain, sleep enriches a diversity of functions, including our ability to learn, memorize, and make logical decisions. It recalibrates our emotions, restocks our immune system, fine-tunes our metabolism, and regulates our appetite. Dreaming creates a virtual reality space in which the brain melds past and present knowledge, inspiring creativity.
In this “compelling and utterly convincing” (The Sunday Times) book, preeminent neuroscientist and sleep expert Matthew Walker provides a revolutionary exploration of sleep, examining how it affects every aspect of our physical and mental well-being. Charting the most cutting-edge scientific breakthroughs, and marshalling his decades of research and clinical practice, Walker explains how we can harness sleep to improve learning, mood and energy levels, regulate hormones, prevent cancer, Alzheimer’s and diabetes, slow the effects of aging, and increase longevity. He also provides actionable steps towards getting a better night’s sleep every night.
Clear-eyed, fascinating, and accessible, Why We Sleep is a crucial and illuminating book. Written with the precision of Atul Gawande, Andrew Solomon, and Sherwin Nuland, it is “recommended for night-table reading in the most pragmatic sense” (The New York Times Book Review).
Editor's Note
Sleep more, be more…
What’s the most relaxing way to be more productive? Get more sleep. Learn how to harness the transformative power of good sleep from the top sleep expert, neuroscientist Matthew Walker. You can supercharge your energy, mood, and health.
Matthew Walker
Matthew Walker is a professor of neuroscience and psychology at UC Berkeley, the Director of its Sleep and Neuroimaging Lab, and a former professor of psychiatry at Harvard University. He has published over 100 scientific studies and has appeared on 60 Minutes, Nova, BBC News, and NPR’s Science Friday. Why We Sleep is his first book.
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Reviews for Why We Sleep
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What our readers think
Readers find this title to be an excellent and eye-opening book about sleep. It provides valuable information and insights on the importance of sleep and how it can improve life quality. The book is well-written, informative, and suitable for a broad audience. It offers scientific explanations in a clear and easily understood manner, making it accessible to both science and non-science readers. Many readers have found the book to be life-changing and highly recommend it. Overall, this book is a must-read that can positively impact society by promoting healthier sleeping habits.
- Rating: 4 out of 5 stars4/5Honestly I recommend this book to everyone. Vitally interesting about all the way sleep (NREM and REM) contributes to our overall health, and the ways we start to decline when we don't get enough sleep. Interesting detail about the mechanics of dreaming, too.
- Rating: 4 out of 5 stars4/5If like me you’re a chronic insomniac, or if you’re the parent of a young child or a carer or a shift worker, you may initially be put off by the tone of Why We Sleep. The author’s premise is that we are, as a society and as individuals, joyfully squandering our sleep time with terrible consequences – which he outlines, at length. Still, I gave the book a chance and there is some interesting stuff in here.The health benefits of sleep for physical and mental health are so great that he suggests, not entirely frivolously, that the question should be not why do we sleep, but why do we wake up? We need NREM (non-rapid eye movement) sleep to file away everything we’ve learnt during the day, to process it and move it from short-term to long-term memory. This is why cramming the night before an exam won’t work, because it’s sleep that allows you to properly integrate and retain what you’ve learnt.I found what he said about REM sleep (where we dream) most interesting. This is where we make odd connections, have creative thoughts, gain a fresh perspective. Anyone involved in any kind of artistic project will know that feeling. You hit what seems like an insoluble problem, you go to bed and wake up the next morning with a solution that is not just feasible but feels inevitable. This applies as much in daily life – we talk about ‘sleeping on’ a decision all the time.He’s a big fan of siestas (as am I) and talks about the genesis of the term ‘power nap’ which came from research on the optimum time for airline pilots to rest. It was found that a short sleep at the beginning of a long period of sleep deprivation (eg during a long-haul flight) was the most effective. The FAA decided to institute this as policy but rejected the suggested terms ‘prophylactic napping’ or ‘planned napping’ (the second was considered too managerial, the first, well you can guess). The trouble with the term ‘power napping’ is that it is now colloquially used to suggest a macho alternative to sleep, rather than a short-term expedient when a full-night’s sleep isn’t possible.The book covers the body clock and circadian rhythms and even sleep in other species. The author also shares exhaustive evidence on the dangers of sleep deprivation, both immediate – such as driving while tired – and long-term, through poor health outcomes.My slight qualm about the book is that the author is so evangelical about his position. You are left thinking that all the world’s problems could be solved if only we all got a regular eight hours sleep. He cites lots of research backing up his case but a general reader has no context. It’s a bit like watching a courtroom drama and being totally convinced by the prosecution’s case but not getting to hear the defence.If you do have problems sleeping you are likely to be so frightened by this book that it will keep you awake at night. When was this golden age when everybody got their eight hours? How can we make the comparison? Maybe in past centuries people spent more time in bed (what he calls sleep opportunity) but unless you were wealthy you probably shared a room with several family members (and possibly other fauna). How much quality sleep would you have got in a room where a baby was teething or siblings were fighting or mice were scuttling?The bit I was really excited about getting to was the chapter on insomnia treatments but all the author offered (after much fanfare) was the old cognitive-behavioural chestnut, which among other things insists on no napping (despite his earlier waxing lyrical on the benefits) and, more seriously, no reading in bed.There’s a lot in Why We Sleep and overall I found it an interesting and informative read, albeit one without a miracle cure at the end of it.*I received a copy of Why We Sleep from the publisher via Netgalley.A longer version of this review first appeared on my blog katevane.com/blog
- Rating: 5 out of 5 stars5/5What an engaging exploration into the purpose of sleep! It’s written by a professor of neuroscience and psychology, so while some of the substantiation is biological, more of it is via behavioral and imaging studies.Nature wouldn’t waste an enormous proportion of humans’ (indeed, all creatures’) daily consciousness to sleep -- and in the process put them at enormous vulnerability to predation -- unless there was enormous benefit. This book goes broad and deep into those physical and psychological benefits and the corresponding risks (physical and mental health problems and early death) associated with not getting enough sleep. (And the author shows that we’re terrible judges of whether we’re getting enough.)He notes the differing needs, timing and composition of sleep in infants, children, teens, adults and seniors. He describes the hormones/chemicals that promote wakefulness or sleep, including how we hinder their effects, and stresses that alcohol and sleep meds sedate the brain, which is not sleep. Among other physical aspects, sleep regulates immunity (including the destruction of early cancers and mounting an adequate response to immunization) and metabolism (including appetite and cardiovascular health).But it is the psychological effects that fascinated me. Early in the sleep period (I’ll call it “night”), the sleep cycles are composed predominately of non-REM (NREM) sleep, while later in the night they reverse to predominately REM sleep. NREM sleep serves to move what’s learned/experienced during the day into long-term storage; REM sleep integrates that new material with everything that’s already there; and dreaming (during REM sleep) serves to process emotions and enable creativity (thus truth in the adages to “sleep on it” and that “things will look better in the morning”). A key factor is that the brain does this work each night for the prior waking period, and when it’s impaired by poor sleep or a short sleep, there’s really no make-up opportunity.Life-changing for me and recommended for everyone.
- Rating: 5 out of 5 stars5/5Fantastic book. Very complete explanation of what sleep is and how important it is for productivity and longevity. I will definitely be making changes to get better and longer sleep!
- Rating: 5 out of 5 stars5/5A phenomenally written book which is suitable for a broad audience. The lessons the book provides from a wide range of scientific experiments truly have the power to transform our society with broad-reaching impacts in every corner of the industrialized world. A true must-read.
- Rating: 5 out of 5 stars5/5Great overview of current scientific research insights regarding sleep.
- Rating: 5 out of 5 stars5/5Great book . Helps understand the importance of 8 hour sleep everyday . The tips at the end of the book is simple and easy to start avoiding sleep deprivation. This book is for all ages and is not late for anyone who want to explore this much neglected subject in the gadget crazy world
- Rating: 5 out of 5 stars5/5This book is the Bible of sleep, I recommend everyone to read it, it will open your eyes to something that many consider trivial but in reality is much much more.
- Rating: 5 out of 5 stars5/5This book was extremely interesting and very helpful. I learned so many facts about sleep in general and also about individual and societal problems related to a lack of sleep. It is written extremely well and I never lost interest during the whole book. I highly recommend this book.
- Rating: 4 out of 5 stars4/5This book is packed with information. Each chapter addresses a specific issue pertaining to the power of sleep. There is a lot to take in but chapters can be read individually if you have more interest in one topic over another. You will learn a great deal and will definitely be re-assessing your sleep habits.
- Rating: 5 out of 5 stars5/5I have been searching for a good book on sleep for a long time. A few months back, I read one, but it had too many charts. As a consequence, it was inaccessible for most people. In this book, Matthew Walker breaks down the subject and outlines the sleep process, its importance, and the risks of sleep deprivation. He ended the book with 12 recommendations for improving our sleep. In my opinion, this book is an essential read for anyone. It can very well save your life.
- Rating: 5 out of 5 stars5/5A lot of us think we don't need much sleep. This book debunks that myth. Read it for yourself and realize how you're shortchanging yourself as well as those you love. Sleep affects everything, from creativity to emotional stability to preventing accidents and costly mistakes. Includes tips on how to get better sleep.
- Rating: 5 out of 5 stars5/5Excelente libro. Hay muchas cosas que no comprendía del sueño, no obstante, esto me da un panorama general. No te va a hacer un experto, pero te da las herramientas necesarias para entender y aplicar, a grandes rasgos, los procesos e implicaciones de dormir. Quizá los últimos dos capítulos son algo redundantes, pero bien en general.
- Rating: 4 out of 5 stars4/5A fascinating and alarming book on the effect of even minor sleep deprivation on the brain and body health. The author covers the evolutionary purpose of sleep and what research has uncovered about its uses and effect. Probably the majority of the book covers what happens when human society moves away from established sleep traditions. Every time, the reduction of sleep is linked to increasing rates of both mental and physical ill health. The book ends with the author offering some suggestions for both societal and personal action that can be taken to improve and prioritize sleep and its healthful benefits.
- Rating: 5 out of 5 stars5/5This was a highly readable, popular science book. It did have medical connotations but was largely around the whole subject of sleep. It was interesting to see how societal changes had eroded the idea of healthy sleep patterns. In addition the recent advances in neuroscience allowed for a much greater understanding of what actually happens during sleep. This wasn’t just confined to brain activity but rather other activity as well. The pathophysiology of sleep and sleep disorders was also discussed, and this was also fascinating. It was highly revealing and has made me not one less than eight hours sleep a night!
- Rating: 5 out of 5 stars5/5Well researched. Life changing techniques.
- Rating: 5 out of 5 stars5/5Fascinating science based book on sleep and what science knows about sleep. It was fascinating.
- Rating: 5 out of 5 stars5/5Simple and powerful insights about the importance of sleepI came to believe very strongly that use of sleep aids i.e, particularly medications was counterproductive. That is strongly supported by the findings discussed in this book. In addition there is a lot of insight about major social problems aggrevations by inadequate sleep: Alzheimer's, high blood pressure, obesity, depression, automobile accidents. The list is extensive. I worry a little that the author is a bit of a snake oil salesman, giving sleep way to much credit for what it offers our society.. But sometimes the best answers really are simple. He refers to a great deal of scientific evidence. The author does provide encouraging examples of good results from improving sleep in select groups. If the epidemic of sleep deprivation is half as important as he makes it out to be then it is orders of magnitude more important than Covid for the world's health and well being.
- Rating: 4 out of 5 stars4/5I fell asleep on my couch listening to this audiobook, which I actually think is a testament to how good the book was!
- Rating: 5 out of 5 stars5/5Everyone should read this book. This is the first book I've immediately decided I have to buy a copy of to read again, very soon.
- Rating: 4 out of 5 stars4/5I liked it a lot, almost loved it as far as non-fiction, scientific/medical books go...I've changed my sleeping habits because of this well, clear and concisely written title.
- Rating: 5 out of 5 stars5/5The author has a very clear message: we all need to sleep enough, every night, for a myriad of reasons, and we don't. Solidly backed by science and very convincing. There are a few places where he gets speculative and there I don't find him as convincing. I also would have liked more information on what to do if you have a real sleep problem. Another reviewer mentioned sleep apneu, which indeed was hardly covered, and personally I would have liked some information about the pros and cons of taking melatonin.But these are small details. It has actually made me decrease my intake of coffee, and I stopped feeling bad about making sure I get the sleep I need. Highly recommended.
- Rating: 4 out of 5 stars4/5Technical, but very approachable read on exactly what the titles says - why we sleep. very informative.
- Rating: 5 out of 5 stars5/5You should read this book. The unusual combination of clearly-written and well-sourced, the book addresses from a research perspective what sleep is, how it works, why it’s good for us, and how lack of sleep is bad for us.
- Rating: 5 out of 5 stars5/5nonfiction/health science.
recommended for fans of Malcolm Gladwell and Steven Levitt, but also anyone who works, goes to school, has kids, drives a car, drinks caffeine or alcohol, has parents, competes in sports, has trouble sleeping, or is concerned about Alzheimer's, mental health, blood pressure, heart disease, cholesterol, or basically any other health issue.
Readers are invited to skip through and just read the parts that interest them (check the index or table of contents), or to read all the way through. Busy people will be happy to know that you can pick this up a few paragraphs at a time, and don't necessarily need long uninterrupted chunks of reading time in order to learn and enjoy. - Rating: 5 out of 5 stars5/5Cartea aceasta e una dintre cărțile pe care ar trebui sa le cititi. Este foarte informativa și foarte bine scrisa și probabil vă va schimba viata sau, cel puțin, opinia despre somn.
- Rating: 5 out of 5 stars5/5Incredible read I would recommend it to people who are sleep deprived!!
- Rating: 5 out of 5 stars5/5Simple and direct yet amazing and informative. I wish I had read this book years ago. It teaches you many of the miracles that our body accomplishes through sleep and does so with plenty of scientific fundaments.
I found myself astonished several times when learning about the complex processes that take part while we sleep and why is sleep so necessary to us, yet so undervalued.
It also gave me so much material to discuss with friends and relatives (who most surely think im a nerd).
If you like neuroscience this book is a must! - Rating: 5 out of 5 stars5/5A horror book that all children and adults should read. Go to sleep, people!
- Rating: 5 out of 5 stars5/5An excellent books which helps me to change my sleeping habits and improve life quality.
Book preview
Why We Sleep - Matthew Walker
PART 1
This Thing Called Sleep
CHAPTER 1
To Sleep…
Do you think you got enough sleep this past week? Can you recall the last time you woke up without an alarm clock feeling refreshed, not needing caffeine? If the answer to either of these questions is no,
you are not alone. More than a third of adults in many developed nations fail to obtain the recommended seven to nine hours of nightly sleep.I
I doubt you are surprised by this fact, but you may be surprised by the consequences. Routinely sleeping less than six hours a night weakens your immune system, substantially increasing your risk of certain forms of cancer. Insufficient sleep appears to be a key lifestyle factor linked to your risk of developing Alzheimer’s disease. Inadequate sleep—even moderate reductions for just one week—disrupts blood sugar levels so profoundly that you would be classified as pre-diabetic. Short sleeping increases the likelihood of your coronary arteries becoming blocked and brittle, setting you on a path toward cardiovascular disease, stroke, and congestive heart failure. Fitting Charlotte Brontë’s prophetic wisdom that a ruffled mind makes a restless pillow,
sleep disruption further contributes to all major psychiatric conditions, including depression, anxiety, and suicidality.
Perhaps you have also noticed a desire to eat more when you’re tired? This is no coincidence. Too little sleep swells concentrations of a hormone that makes you feel hungry while suppressing a companion hormone that otherwise signals food satisfaction. Despite being full, you still want to eat more. It’s a proven recipe for weight gain in sleep-deficient adults and children alike. Worse, should you attempt to diet but don’t get enough sleep while doing so, it is futile, since most of the weight you lose will come from lean body mass, not fat.
Add the above health consequences up, and a proven link becomes easier to accept: relative to the recommended seven to nine hours, the shorter your sleep, the shorter your life span. The old maxim I’ll sleep when I’m dead
is therefore unfortunate. Adopt this mind-set, and it is possible that you will be dead sooner and the quality of that (shorter) life will be worse. The elastic band of sleep deprivation can stretch only so far before it snaps. Sadly, human beings are in fact the only species that will deliberately deprive themselves of sleep without legitimate gain. Numerous components of wellness, and countless seams of societal fabric, are being eroded by our costly state of sleep neglect: human and financial alike. So much so that the Centers for Disease Control declared insufficient sleep as a public health epidemic. It may not be a coincidence that countries where sleep time has declined most dramatically over the past century, such as the US, the UK, Japan, and South Korea, and several in western Europe, are also those suffering the greatest increase in rates of the aforementioned physical diseases and mental disorders.
Scientists such as myself have even started lobbying doctors to start prescribing
sleep. As medical advice goes, it’s perhaps the most painless and enjoyable to follow. Do not, however, mistake this as a plea to doctors to start prescribing more sleeping pills—quite the opposite, in fact, considering the evidence surrounding the deleterious health consequences of these drugs.
But can we go so far as to say that a lack of sleep can kill you outright? Quite posssibly—on at least two counts. First, there is a very rare genetic disorder that starts with a progressive insomnia, emerging in midlife. Several months into the disease course, the patient stops sleeping altogether. By this stage, they have started to lose many basic brain and body functions. Few drugs that we currently have will help the patient sleep. After twelve to eighteen months of no sleep, the patient will die.
Second is the deadly circumstance of getting behind the wheel of a motor vehicle without having had sufficient sleep. Drowsy driving is the cause of hundreds of thousands of traffic accidents and fatalities each year. And here, it is not only the life of the sleep-deprived individuals that is at risk, but the lives of those around them. Tragically, one person dies in a traffic accident every hour in the United States due to a fatigue-related error.
Society’s apathy toward sleep has, in part, been caused by the historic failure of science to explain why we need it. Sleep remained one of the last great biological mysteries. All of the mighty problem-solving methods in science—genetics, molecular biology, and high-powered digital technology—have been unable to unlock the stubborn vault of sleep. Minds of the most stringent kind, including Nobel Prize–winner Francis Crick, who deduced the twisted-ladder structure of DNA, famed Roman educator and rhetorician Quintilian, and even Sigmund Freud had all tried their hand at deciphering sleep’s enigmatic code, all in vain.
To better frame this state of prior scientific ignorance, imagine the birth of your first child. At the hospital, the doctor enters the room and says, Congratulations, it’s a healthy baby boy. We’ve completed all of the preliminary tests and everything looks good.
She smiles reassuringly and starts walking toward the door. However, before exiting the room she turns around and says, There is just one thing. From this moment forth, and for the rest of your child’s entire life, he will repeatedly and routinely lapse into a state of apparent coma. It might even resemble death at times. And while his body lies still his mind will often be filled with stunning, bizarre hallucinations. This state will consume one-third of his life and I have absolutely no idea why he’ll do it, or what it is for. Good luck!
Astonishing, but until very recently, this was reality: doctors and scientists could not give you a consistent or complete answer as to why we sleep. Consider that we have known the functions of the three other basic drives in life—to eat, to drink, and to reproduce—for many tens if not hundreds of years now. Yet the fourth main biological drive, common across the animal kingdom—the drive to sleep—has continued to elude science for millennia.
Addressing the question of why we sleep from an evolutionary perspective only compounds the mystery. No matter what vantage point you take, sleep would appear to be the most foolish of biological phenomena. When you are asleep, you cannot gather food. You cannot socialize. You cannot find a mate and reproduce. You cannot nurture or protect your offspring. Worse still, sleep leaves you vulnerable to predation. Sleep is surely one of the most puzzling of all human behaviors.
On any one of these grounds—never mind all of them in combination—there ought to have been a strong evolutionary pressure to prevent the emergence of sleep or anything remotely like it. As one sleep scientist has said, If sleep does not serve an absolutely vital function, then it is the biggest mistake the evolutionary process has ever made.
II
Yet sleep has persisted. Heroically so. Indeed, every animal species carefully studied to date sleeps.III
This suggests that sleep evolved with—or very soon after—life itself on our planet. Moreover, the subsequent perseverance of sleep throughout evolution means there must be tremendous benefits that far outweigh all of the obvious hazards and detriments.
Ultimately, asking Why do we sleep?
was the wrong question. It implied there was a single function, one holy grail of a reason that we slept, and we went in search of it. Theories ranged from the logical (a time for conserving energy), to the peculiar (an opportunity for eyeball oxygenation), to the psychoanalytic (a non-conscious state in which we fulfill repressed wishes).
This book will reveal a very different truth: sleep is infinitely more complex, profoundly more interesting, and strikingly health-relevant. We sleep for a rich litany of functions, plural—an abundant constellation of nighttime benefits that service both our brains and our bodies. There does not seem to be one major organ within the body, or process within the brain, that isn’t optimally enhanced by sleep (and detrimentally impaired when we don’t get enough). That we receive such a bounty of health benefits each night should not be surprising. After all, we are awake for two-thirds of our lives, and we don’t just achieve one useful thing during that stretch of time. We accomplish myriad undertakings that promote our own well-being and survival. Why, then, would we expect sleep—and the twenty-five to thirty years, on average, it takes from our lives—to offer one function only?
Through an explosion of discoveries over the past twenty years, we have come to realize that evolution did not make a spectacular blunder in conceiving of sleep. Sleep dispenses a multitude of health-ensuring benefits, yours to pick up in repeat prescription every twenty-four hours, should you choose.
Within the brain, sleep enriches a diversity of functions, including our ability to learn, memorize, and make logical decisions and choices. Benevolently servicing our psychological health, sleep recalibrates our emotional brain circuits, allowing us to navigate next-day social and psychological challenges with cool-headed composure. We are even beginning to understand the most impervious and controversial of all conscious experiences: the dream. Dreaming provides a unique suite of benefits to all species fortunate enough to experience it, humans included. Among these gifts are a consoling neurochemical bath that mollifies painful memories and a virtual reality space in which the brain melds past and present knowledge, inspiring creativity.
Downstairs in the body, sleep restocks the armory of our immune system, preventing infection and warding off all manner of sickness. Sleep reforms the body’s metabolic state by fine-tuning the balance of insulin and circulating glucose. Sleep further regulates our appetite, helping control body weight through healthy food selection rather than rash impulsivity. Plentiful sleep maintains a flourishing microbiome within your gut from which we know so much of our nutritional health begins. Adequate sleep is intimately tied to the fitness of our cardiovascular system, lowering blood pressure while helping keep our hearts in fine condition.
A balanced diet and exercise are of vital importance, yes. But we now see sleep as a preeminent force in this health trinity. The physical and mental impairments caused by one night of bad sleep dwarf those caused by an equivalent absence of food or exercise. It is difficult to imagine any other state—natural or medically manipulated—that affords a more powerful redressing of physical and mental health at every level of analysis.
Based on a rich, new scientific understanding of sleep, we no longer have to ask what sleep is good for. Instead, we are now forced to wonder whether there are any biological functions that do not benefit by a good night’s sleep.
Emerging from this research renaissance is an unequivocal message: sleep is the single most effective thing we can do to reset our brain and body health each day—Mother Nature’s best effort yet at contra-death. Unfortunately, the real evidence that makes clear all of the dangers that befall individuals and societies when sleep becomes short have not been clearly telegraphed to the public. It is perhaps the most glaring omission in the contemporary health conversation. In response, this book is intended to help address this unmet need, and provide what I hope is a fascinating journey of discoveries. It aims to revise our cultural appreciation of sleep, and reverse our neglect of it.
Personally, I should note that I am rather in love with sleep (not just my own, though I do give myself a non-negotiable eight-hour sleep opportunity each night). I am in love with everything sleep is and does. I am in love with discovering all that remains unknown about it. I am in love with communicating the relevance of it to the public. I am in love with finding any and all methods for reuniting humanity with the sleep it so desperately needs. This love affair has now spanned a twenty-plus-year research career that began when I was a professor of psychiatry at Harvard Medical School and continues now that I am a professor of neuroscience and psychology at the University of California, Berkeley.
It was not, however, love at first sight. I am an accidental sleep researcher. It was never my intent to inhabit this esoteric outer territory of science. At age eighteen I went to study at the Queen’s Medical Center in England: a prodigious institute in Nottingham boasting a wonderful band of brain scientists on its faculty. Ultimately, medicine wasn’t for me, as it seemed more concerned with answers, whereas I was always more enthralled by questions. For me, answers were simply a way to get to the next question. I decided to study neuroscience, and after graduating, obtained my PhD in neurophysiology supported by a fellowship from England’s Medical Research Council, London.
It was during my PhD work, conducted mostly at Newcastle University, that I began making my first scientific contributions in the field of sleep research. I was examining patterns of electrical brainwave activity in older adults in the early stages of dementia. Counter to common belief, there isn’t just one type of dementia. Alzheimer’s disease is the most common, but is only one of many types. For a number of treatment reasons, it is critical to know which type of dementia an individual is suffering from as soon as possible.
I began assessing brainwave activity from my patients during wake and sleep. My hypothesis: there was a unique and specific electrical brain signature that could forecast which dementia subtype each individual was progressing toward. Measurements taken during the day were ambiguous, with no clear signature of difference to be found. Only in the nighttime ocean of sleeping brainwaves did the recordings speak out a clear labeling of my patients’ saddening disease fate. The discovery proved that sleep could potentially be used as a new early diagnostic litmus test to understand which type of dementia an individual would develop.
Sleep became my obsession. The answer it had provided me, like all good answers, only led to more fascinating questions, among them: Was the disruption of sleep in my patients actually contributing to the diseases they were suffering from, and even causing some of their terrible symptoms, such as memory loss, aggression, hallucinations, delusions? I read all I could. A scarcely believable truth began to emerge—nobody actually knew the clear reason why we needed sleep, and what it does. I could not answer my own question about dementia if this fundamental first question remained unanswered. I decided I would try to crack the code of sleep.
I halted my research in dementia and, for a post-doctoral position that took me across the Atlantic Ocean to Harvard, set about addressing one of the most enigmatic puzzles of humanity—one that had eluded some of the best scientists in history: Why do we sleep? With genuine naïveté, not hubris, I believed I would find the answer within two years. That was twenty years ago. Hard problems care little about what motivates their interrogators; they meter out their lessons of difficulty all the same.
Now, after two decades of my own research efforts, combined with thousands of studies from other laboratories around the world, we have many of the answers. These discoveries have taken me on wonderful, privileged, and unexpected journeys inside and outside of academia—from being a sleep consultant for the NBA, NFL, and British Premier League football teams; to Pixar Animation, government agencies, and well-known technology and financial companies. These sleep revelations, together with many similar discoveries from my fellow sleep scientists, will offer proof about the vital importance of sleep.
A final comment on the structure of this book. The chapters are written in a logical order, traversing a narrative arc in four main parts.
Part 1 demystifies this beguiling thing called sleep: what it is, what it isn’t, who sleeps, how much they sleep, how human beings should sleep (but are not), and how sleep changes across your life span or that of your child, for better and for worse.
Part 2 details the good, the bad, and the deathly of sleep and sleep loss. We will explore all of the astonishing benefits of sleep for brain and for body, affirming what a remarkable Swiss Army knife of health and wellness sleep truly is. Then we turn to how and why a lack of sufficient sleep leads to a quagmire of ill health, disease, and untimely death—a wakeup call to sleep if ever there was one.
Part 3 offers safe passage from sleep to the fantastical world of dreams scientifically explained. From peering into the brains of dreaming individuals, and precisely how dreams inspire Nobel Prize–winning ideas that transform the world, to whether or not dream control really is possible, and if such a thing is even wise—all will be revealed.
Part 4 seats us first at the bedside, explaining numerous sleep disorders, including insomnia. I will unpack the obvious and not-so-obvious reasons for why so many of us find it difficult to get a good night’s sleep, night after night. A discussion of sleeping pills then follows, based on scientific and clinical data. Details of new, safer, and more effective non-drug therapies for better sleep will then be described. Transitioning from bedside up to the level of sleep in society, we will subsequently learn of the sobering impact that insufficient sleep has in education, in medicine and health care, and in business. The evidence shatters beliefs about the usefulness of long waking hours with little sleep in effectively, safely, profitably, and ethically accomplishing the goals of each of these disciplines. Concluding the book with genuine optimistic hope, I lay out a road map of ideas that can reconnect humanity with the sleep it remains so bereft of—a new vision for sleep in the twenty-first century.
I should note that you need not read this book in this progressive, four-part narrative arc. Each chapter can, for the most part, be read individually, and out of order, without losing too much of its significance. I therefore invite you to consume the book in whole or in part, buffet-style or in order, all according to your personal taste.
It is worthwhile pointing out that this book is not designed to be a self-help guide. It is not written to target or treat sleep disorders, including insomnia. There are books that do this, and many of them will recommend speaking to a doctor if you suspect you have a sleep disorder. I am also very understanding of, and sympathetic to, those people who struggle with sleep and are most anxious about it. For these individuals, it is possible that their anxiety may increase when reading about the impact of insufficient sleep, including information contained in the book. I therefore want to alert the reader to this possibility, allowing for reader discretion on this matter.
In closing, I offer a disclaimer. Should you feel drowsy and fall asleep while reading the book, unlike most authors, I will not be disheartened. Indeed, based on the topic and content of this book, I am actively going to encourage that kind of behavior from you. Knowing what I know about the relationship between sleep and memory, it is the greatest form of flattery for me to know that you, the reader, cannot resist the urge to strengthen and thus remember what I am telling you by falling asleep. So please, feel free to ebb and flow into and out of consciousness during this entire book. I will take absolutely no offense. On the contrary, I would be delighted.
I
. The Centers for Disease Control (CDC) stipulates that adults need seven hours of sleep or more per twenty-four hours.
II
. Dr. Allan Rechtschaffen.
III
. Cirelli, C., and Tononi, G. (2008). Is sleep essential?
PLoS Biology. 6, e216.
CHAPTER 2
Caffeine, Jet Lag, and Melatonin
Losing and Gaining Control of Your Sleep Rhythm
How does your body know when it’s time to sleep? Why do you suffer from jet lag after arriving in a new time zone? How do you overcome jet lag? Why does that acclimatization cause you yet more jet lag upon returning home? Why do some people use melatonin to combat these issues? Why (and how) does a cup of coffee keep you awake? Perhaps most importantly, how do you know if you’re getting enough sleep?
There are two main factors that determine when you want to sleep and when you want to be awake. As you read these very words, both factors are powerfully influencing your mind and body. The first factor is a signal beamed out from your internal twenty-four-hour clock located deep within your brain. The clock creates a cycling, day-night rhythm that makes you feel tired or alert at regular times of night and day, respectively. The second factor is a chemical substance that builds up in your brain and creates a sleep pressure.
The longer you’ve been awake, the more that chemical sleep pressure accumulates, and consequentially, the sleepier you feel. It is the balance between these two factors that dictates how alert and attentive you are during the day, when you will feel tired and ready for bed at night, and, in part, how well you will sleep.
GOT RHYTHM?
Central to many of the questions in the opening paragraph is the powerful sculpting force of your twenty-four-hour rhythm, also known as your circadian rhythm. Everyone generates a circadian rhythm (circa, meaning around,
and dian, derivative of diam, meaning day
). Indeed, most living creatures on the planet with a life span of more than several days generate this natural cycle. The internal twenty-four-hour clock within your brain communicates its daily circadian rhythm signal to every other region of your brain and every organ in your body.
Your twenty-four-hour tempo helps to determine when you want to be awake and when you want to be asleep. But it controls other rhythmic patterns, too. These include your timed preferences for eating and drinking, your moods and emotions, the amount of urine you produce,I
your core body temperature, your metabolic rate, and the release of numerous hormones. It is no coincidence that the likelihood of breaking an Olympic record has been clearly tied to time of day, being maximal at the natural peak of the human circadian rhythm in the early afternoon. Even the timing of births and deaths demonstrates circadian rhythmicity due to the marked swings in key life-dependent metabolic, cardiovascular, temperature, and hormonal processes that this pacemaker controls.
Long before we discovered this biological pacemaker, an ingenious experiment did something utterly remarkable: stopped time—at least, for a plant. It was in 1729 when French geophysicist Jean-Jacques d’Ortous de Mairan discovered the very first evidence that plants generate their own internal time.
De Mairan was studying the leaf movements of a species that displayed heliotropism: when a plant’s leaves or flowers track the trajectory of the sun as it moves across the sky during the day. De Mairan was intrigued by one plant in particular, called Mimosa pudica.II
Not only do the leaves of this plant trace the arching daytime passage of the sun across the sky’s face, but at night, they collapse down, almost as though they had wilted. Then, at the start of the following day, the leaves pop open once again like an umbrella, healthy as ever. This behavior repeats each and every morning and evening, and it caused the famous evolutionary biologist Charles Darwin to call them sleeping leaves.
Prior to de Mairan’s experiment, many believed that the expanding and retracting behavior of the plant was solely determined by the corresponding rising and setting of the sun. It was a logical assumption: daylight (even on cloudy days) triggered the leaves to open wide, while ensuing darkness instructed the leaves to shut up shop, close for business, and fold away. That assumption was shattered by de Mairan. First, he took the plant and placed it out in the open, exposing it to the signals of light and dark associated with day and night. As expected, the leaves expanded during the light of day and retracted with the dark of night.
Then came the genius twist. De Mairan placed the plant in a sealed box for the next twenty-four-hour period, plunging it into total dark for both day and night. During these twenty-four hours of blackness, he would occasionally take a peek at the plant in controlled darkness, observing the state of the leaves. Despite being cut off from the influence of light during the day, the plant still behaved as though it were being bathed in sunlight; its leaves were proudly expanded. Then, it retracted its leaves as if on cue at the end of the day, even without the sun’s setting signal, and they stayed collapsed throughout the entire night.
It was a revolutionary discovery: de Mairan had shown that a living organism kept its own time, and was not, in fact, slave to the sun’s rhythmic commands. Somewhere within the plant was a twenty-four-hour rhythm generator that could track time without any cues from the outside world, such as daylight. The plant didn’t just have a circadian rhythm, it had an endogenous,
or self-generated, rhythm. It is much like your heart drumming out its own self-generating beat. The difference is simply that your heart’s pacemaker rhythm is far faster, usually beating at least once a second, rather than once every twenty-four-hour period like the circadian clock.
Surprisingly, it took another two hundred years to prove that we humans have a similar, internally generated circadian rhythm. But this experiment added something rather unexpected to our understanding of internal timekeeping. It was 1938, and Professor Nathaniel Kleitman at the University of Chicago, accompanied by his research assistant Bruce Richardson, were to perform an even more radical scientific study. It required a type of dedication that is arguably without match or comparison to this day.
Kleitman and Richardson were to be their own experimental guinea pigs. Loaded with food and water for six weeks and a pair of dismantled, high-standing hospital beds, they took a trip into Mammoth Cave in Kentucky, one of the deepest caverns on the planet—so deep, in fact, that no detectable sunlight penetrates its farthest reaches. It was from this darkness that Kleitman and Richardson were to illuminate a striking scientific finding that would define our biological rhythm as being approximately one day (circadian), and not precisely one day.
In addition to food and water, the two men brought a host of measuring devices to assess their body temperatures, as well as their waking and sleeping rhythms. This recording area formed the heart of their living space, flanked either side by their beds. The tall bed legs were each seated in a bucket of water, castle-moat style, to discourage the innumerable small (and not so small) creatures lurking in the depths of Mammoth Cave from joining them in bed.
The experimental question facing Kleitman and Richardson was simple: When cut off from the daily cycle of light and dark, would their biological rhythms of sleep and wakefulness, together with body temperature, become completely erratic, or would they stay the same as those individuals in the outside world exposed to rhythmic daylight? In total, they lasted thirty-two days in complete darkness. Not only did they aggregate some impressive facial hair, but they made two groundbreaking discoveries in the process. The first was that humans, like de Mairan’s heliotrope plants, generated their own endogenous circadian rhythm in the absence of external light from the sun. That is, neither Kleitman nor Richardson descended into random spurts of wake and sleep, but instead expressed a predictable and repeating pattern of prolonged wakefulness (about fifteen hours), paired with consolidated bouts of about nine hours of sleep.
The second unexpected—and more profound—result was that their reliably repeating cycles of wake and sleep were not precisely twenty-four hours in length, but consistently and undeniably longer than twenty-four hours. Richardson, in his twenties, developed a sleep-wake cycle of between twenty-six and twenty-eight hours in length. That of Kleitman, in his forties, was a little closer to, but still longer than, twenty-four hours. Therefore, when removed from the external influence of daylight, the internally generated day
of each man was not exactly twenty-four hours, but a little more than that. Like an inaccurate wristwatch whose time runs long, with each passing (real) day in the outside world, Kleitman and Richardson began to add time based on their longer, internally generated chronometry.
Since our innate biological rhythm is not precisely twenty-four hours, but thereabouts, a new nomenclature was required: the circadian rhythm—that is, one that is approximately, or around, one day in length, and not precisely one day.III
In the seventy-plus years since Kleitman and Richardson’s seminal experiment, we have now determined that the average duration of a human adult’s endogenous circadian clock runs around twenty-four hours and fifteen minutes in length. Not too far off the twenty-four-hour rotation of the Earth, but not the precise timing that any self-respecting Swiss watchmaker would ever accept.
Thankfully, most of us don’t live in Mammoth Cave, or the constant darkness it imposes. We routinely experience light from the sun that comes to the rescue of our imprecise, overrunning internal circadian clock. Sunlight acts like a manipulating finger and thumb on the side-dial of an imprecise wristwatch. The light of the sun methodically resets our inaccurate internal timepiece each and every day, winding
us back to precisely, not approximately, twenty-four hours.IV
It is no coincidence that the brain uses daylight for this resetting purpose. Daylight is the most reliable, repeating signal that we have in our environment. Since the birth of our planet, and every single day thereafter without fail, the sun has always risen in the morning and set in the evening. Indeed, the reason most living species likely adopted a circadian rhythm is to synchronize themselves and their activities, both internal (e.g., temperature) and external (e.g., feeding), with the daily orbital mechanics of planet Earth spinning on its axis, resulting in regular phases of light (sun facing) and dark (sun hiding).
Yet daylight isn’t the only signal that the brain can latch on to for the purpose of biological clock resetting, though it is the principal and preferential signal, when present. So long as they are reliably repeating, the brain can also use other external cues, such as food, exercise, temperature fluctuations, and even regularly timed social interaction. All of these events have the ability to reset the biological clock, allowing it to strike a precise twenty-four-hour note. It is the reason that individuals with certain forms of blindness do not entirely lose their circadian rhythm. Despite not receiving light cues due to their blindness, other phenomena act as their resetting triggers. Any signal that the brain uses for the purpose of clock resetting is termed a zeitgeber, from the German time giver
or synchronizer.
Thus, while light is the most reliable and thus the primary zeitgeber, there are many factors that can be used in addition to, or in the absence of, daylight.
The twenty-four-hour biological clock sitting in the middle of your brain is called the suprachiasmatic (pronounced soo-pra-kai-as-MAT-ik) nucleus. As with much of anatomical language, the name, while far from easy to pronounce, is instructional: supra, meaning above, and chiasm, meaning a crossing point. The crossing point is that of the optic nerves coming from your eyeballs. Those nerves meet in the middle of your brain, and then effectively switch sides. The suprachiasmatic nucleus is located just above this intersection for a good reason. It samples
the light signal being sent from each eye along the optic nerves as they head toward the back of the brain for visual processing. The suprachiasmatic nucleus uses this reliable light information to reset its inherent time inaccuracy to a crisp twenty-four-hour cycle, preventing any drift.
When I tell you that the suprachiasmatic nucleus is composed of 20,000 brain cells, or neurons, you might assume it is enormous, consuming a vast amount of your cranial space, but actually it is tiny. The brain is composed of approximately 100 billion neurons, making the suprachiasmatic nucleus minuscule in the relative scheme of cerebral matter. Yet despite its stature, the influence of the suprachiasmatic nucleus on the rest of the brain and the body is anything but meek. This tiny clock is the central conductor of life’s biological rhythmic symphony—yours and every other living species. The suprachiasmatic nucleus controls a vast array of behaviors, including our focus in this chapter: when you want to be awake and asleep.
For diurnal species that are active during the day, such as humans, the circadian rhythm activates many brain and body mechanisms in the brain and body during daylight hours that are designed to keep you awake and alert. These processes are then ratcheted down at nighttime, removing that alerting influence. Figure 1
shows one such example of a circadian rhythm—that of your body temperature. It represents average core body temperature (rectal, no less) of a group of human adults. Starting at 12 pm
on the far left, body temperature begins to rise, peaking late in the afternoon. The trajectory then changes. Temperature begins to decline again, dropping below that of the midday start-point as bedtime approaches.
Figure 1: Typical Twenty-Four-Hour Circadian Rhythm (Core Body Temperature)
Your biological circadian rhythm coordinates a drop in core body temperature as you near typical bedtime (figure 1
), reaching its nadir, or low point, about two hours after sleep onset. However, this temperature rhythm is not dependent upon whether you are actually asleep. If I were to keep you awake all night, your core body temperature would still show the same pattern. Although the temperature drop helps to initiate sleep, the temperature change itself will rise and fall across the twenty-four-hour period regardless of whether you are awake or asleep. It is a classic demonstration of a preprogrammed circadian rhythm that will repeat over and over without fail, like a metronome. Temperature is just one of many twenty-four-hour rhythms that the suprachiasmatic nucleus governs. Wakefulness and sleep are another. Wakefulness and sleep are therefore under the control of the circadian rhythm, and not the other way around. That is, your circadian rhythm will march up and down every twenty-four hours irrespective of whether you have slept or not. Your circadian rhythm is unwavering in this regard. But look across individuals, and you discover that not everyone’s circadian timing is the same.
MY RHYTHM IS NOT YOUR RHYTHM
Although human beings display an unyielding twenty-four-hour pattern, the respective peak and trough points are strikingly different from one individual to the next. For some people, their peak of wakefulness arrives early in the day, and their sleepiness trough arrives early at night. These are morning types,
and make up about 40 percent of the populace. They prefer to wake at or around dawn, are happy to do so, and function optimally at this time of day. Others are evening types,
and account for approximately 30 percent of the population. They naturally prefer going to bed late and subsequently wake up late the following morning, or even in the afternoon. The remaining 30 percent of people lie somewhere in between morning and evening types, with a slight leaning toward eveningness, like myself.
You may colloquially know these two types of people as morning larks
and night owls,
respectively. Unlike morning larks, night owls are frequently incapable of falling asleep early at night, no matter how hard they try. It is only in the early-morning hours that owls can drift off. Having not fallen asleep until late, owls of course strongly dislike waking up early. They are unable to function well at this time, one cause of which is that, despite being awake,
their brain remains in a more sleep-like state throughout the early morning. This is especially true of a region called the prefrontal cortex, which sits above the eyes, and can be thought of as the head office of the brain. The prefrontal cortex controls high-level thought and logical reasoning, and helps keep our emotions in check. When a night owl is forced to wake up too early, their prefrontal cortex remains in a disabled, offline
state. Like a cold engine after an early-morning start, it takes a long time before it warms up to operating temperature, and before that will not function efficiently.
An adult’s owlness or larkness, also known as their chronotype, is strongly determined by genetics. If you are a night owl, it’s likely that one (or both) of your parents is a night owl. Sadly, society treats night owls rather unfairly on two counts. First is the label of being lazy, based on a night owl’s wont to wake up later in the day, due to the fact that they did not fall asleep until the early-morning hours. Others (usually morning larks) will chastise night owls on the erroneous assumption that such preferences are a choice, and if they were not so slovenly, they could easily wake up early. However, night owls are not owls by choice. They are bound to a delayed schedule by unavoidable DNA hardwiring. It is not their conscious fault, but rather their genetic fate.
Second is the engrained, un-level playing field of society’s work scheduling, which is strongly biased toward early start times that punish owls and favor larks. Although the situation is improving, standard employment schedules force owls into an unnatural sleep-wake rhythm. Consequently, job performance of owls as a whole is