American journalist David Randall explores the little-known world of sleep in Dreamland: Adventures in the Strange Science of Sleep. From the identification of sleep disorders, now numbering 75, to the $30-billion sleep-medication market, he examines new research into the third of our lives we know the least about.
Q: The mysteries of sleep were less an intellectual than a personal interest for you at first.
A: Yeah. I started sleepwalking about two or three summers ago, and I ran into one of the walls in my apartment. I woke up on the floor on my back, writhing in pain, holding my knee. A couple of days later I went to my doctor and said, “Hey, I started sleepwalking. I ran into a wall. I don’t want to, obviously, do that again. Can you help me out?” and he said, “You know, there’s a lot we know about sleep, but there’s a lot we don’t know. So I could give you some sleeping pills, but we don’t know if they’re going to work or not, so just kind of take it easy.” I decided I needed a little bit more than that. But looking into things it turned out he wasn’t lying—science doesn’t really have the best understanding of sleep.
Q: That’s probably the single-most important thing about what you learned: “What do we know about sleep? Not that much.”
A: Exactly. We’re not even really sure about the most basic thing: why we and every other animal sleep in the first place. As one biologist said, “Either there’s something really important here, or sleep is evolution’s biggest mistake”—shutting down completely while there are predators prowling around. I was amazed to learn how different animals sleep—a giraffe for only an hour and a half. Most hoofed animals, in fact, don’t sleep that much, and again, scientists don’t really know why. Lions and gerbils sleep about the same, when you’d think that a gerbil would never be sleeping at all.
Q: That it would be in a hyper-alert state at all times?
A: Yeah, or find itself a little gerbil knife and sleep with it under its pillow.
Q: Yet sleep’s impact is profound. In terms of health outcomes and general happiness, studies show sleep is more important than what you eat or even your income.
A: Pretty much everything you do during the day you can point at and show the impact of sleep on it. Sleep is now thought of as one of the best forms of preventative medicine: it helps you make better decisions, helps you keep your emotions in check, helps you retain information, and also simply helps you perform at your highest level. At the Olympics every athlete and every coach is aware of sleep. All these athletes, literally at the peak of human abilities, consider sleep one of the biggest parts of their training regimen. And, you know, if it helps them perform at that level, I think it would probably help me a little bit in my life, maybe help me get on the subway in the morning.
Q: One study found a spike in breast cancer rates—74 per cent—among night-shift nurses.
A: That one really hit home. My wife’s mom is a nurse, and she worked in emergency rooms in Philadelphia, and worked night shifts, and she talked about how difficult it was. One of the hardest things is that a lot of people who work these night shifts, they might work one for three weeks, have a week off and then go back to it again, so their bodies can never really get into a rhythm. It impacts you on a cellular level. Again, it’s not solid science yet, but there’s the idea that there’s not enough melatonin, not enough of anything that is part of the body’s natural healing process. The nightly tune-up that we do when we fall asleep, that gets out of whack, and if you do it continuously over 20 or 30 years there are very scary health outcomes. And you may not even think to point a finger at it, and say, “Maybe this has to do with sleeping in a way that’s totally contrary to what my body tells me I should be doing,” the way you probably would say, “I figured that if I worked next to an X-ray machine for 30 years that something would go wrong.”
Q: Is this a case where the frequent remedy, rotating night workers through occasional day shifts, might be worse than the problem? Aren’t many experts arguing that consistency in sleep is more important than the hours slept?
A: Yes, that’s one of the first things doctors will say when somebody asks about a sleep problem. They call it sleep hygiene. It might make you feel like an eight-year-old again, but it’s essentially pick a bedtime and follow it consistently: wake up each morning—no sleeping in on weekends—at that time consistently, and your body will start realizing this is what’s expected now. My wife and I have a five-week-old, and so my own personal sleep is a little bit different right now, but we’re trying to get him on sleep rhythms. I’ve learned, in that endless debate about having the baby in a bassinet or in your bed, what matters is to do the same thing every night, so his brain starts realizing. “This is how it’s going to be.”
Q: Sometimes the effects of sleep deprivation are not what might be expected. The study of medical interns, who often do 30-hour stretches at a time, showed them functioning adequately in hospital. Outside, not so much.
A: People who know they’re sleep deprived can adjust to it in terms of their work. If you’re a doctor, to a certain extent you know what you’re going to be dealing with in the hospital, you know what’s expected of you, you have all this training. Then they leave and start driving, and those interns have horrible accident rates—there’s not that intense, forced focus, and you look down and suddenly you’re driving into a tree.
Q: So what are we doing about our sleep?
A: Fatigue management is big business now. So many companies are realizing it’s a global marketplace and they’re asking more of workers. For the longest time it was just we’ll work harder, drink more coffee, you know, push it to the next level. Now we know there are trade-offs. One fatigue-management-company president told me of a client, a train company that was spending a small fortune in accident costs. Once they put in some simple fatigue-control policies—making sure people have mandatory break times, shift managers doing basic tests on employees to make sure they really were awake—accident costs plummeted. It’s self-interest.
Q: Do the “new economy” firms take matters further?
A: Companies like Google and Nike have nap strategies. Google has amazing algorithms, but somebody had to come up with those, and they don’t want that person to go to Yahoo or Apple because he doesn’t like the working conditions or can’t do his or her best work. So they’re allowing their people to sleep more, even take naps at the office. That gives them a chance to synthesize what they learned, perhaps find a new solution that wasn’t obvious to them in the first place. Research shows a short nap—not just resting or walking away for awhile, but actual sleep—will speed up a solution when you have an intractable problem, or if you’re learning a new technique or a new skill. But not as much as real sleep.
Q: Your dreams change over the night while your brain is processing new demands.
A: Yes, in the first part of the night the brain goes over and over what you’re trying to learn, but deeper into sleep it gets into something more metaphorical. You’re learning a video game where you’re moving incredibly fast down the hillside; at first you might dream literally about skiing, but as you go further into the night the brain will move to, “What else does this remind me of, that I already know?” and maybe you dream of moving sidewalks at the airport. Another way a good night’s sleep beats naps is that the first night, when learning something new, beats all subsequent ones. Insufficient sleep the first night, and it’s going to be much, much more difficult to catch up. Without the strongest foundation possible, the brain has to make up for lost time, building on the skills it’s learning while at the same time forced to shore up what it should have digested earlier. It’s not just practice that makes perfect—it’s practice plus a night’s sleep.
Q: To return to the importance of natural patterns, your book talks about the power of circadian rhythms, which you expect to see play out at the Olympics.
A: Adults naturally come awake at 7 or 8 a.m., start drooping around 2 until 4 (when many people go looking for their afternoon coffee) and get a new jolt of energy around 6, 6:30, that lasts until they get sleepy again around 10 p.m. So in the history of Monday Night Football, when all the other variables are accounted for, West Coast teams playing East Coast teams win a remarkable 70 per cent of the games—because they’re competing, as far as their bodies are concerned, in a peak 6 p.m. time period. Teams have complained about this kind of match-up, so you don’t see it on Monday nights as often as you used to, but there will be two in a two-week span on Sunday nights—New England Patriots and San Francisco 49ers one night, and the next week the San Diego Chargers vs. the New York Jets. If I was a betting man I would definitely favour the 49ers. Those peak periods are when people can swim faster, lift more, throw a football farther. With the Olympics, so many teams and competitors went there early to get on the right time schedule, trying to get their bodies to think that whenever they’re competing it’s time for an upward swing in the circadian rhythm. That’s the real home-field advantage.
Q: Where do you and your wife stand on the contentious idea of sleeping alone. Don’t studies indicate we should abandon the marital bed?
A: That’s the hard thing. Most people are reluctant to think about two separate beds and don’t talk about it. If somebody starts sleeping on the couch all the time, their partner might start thinking, “Are we not close anymore?” But the single bed versus double bed is really up to whoever is in a relationship. It’s dangerous if people think, “Sleeping alone helps me sleep better, and that means something’s wrong with me—I don’t love my partner enough.” People need to think of it as a functional thing: people generally sleep better alone, but sometimes they think, “This person may kick me, but I find their closeness and comfort outweighs that.” I know that’s how my wife thinks, because we talked about it.
Q: Women sleeping with partners are often subject to a double whammy. They sleep more lightly and they’re less likely to snore, so their fate is to listen to deep-sleeping snoring guys beside them.
A: They often suffer the effects of a sleep disorder without having it. Women have it tougher for sleep in other ways too, especially when they become parents. Most women have the responsibility of caring for the baby during the night. At the beginning it’s for feeding, but those responsibilities are rarely renegotiated, so they’re the ones who find themselves waking up again and again, and it tends to be harder for them to go back to sleep. Whereas guys, when they do wake up, they’re usually back to sleep in 20 minutes or so, but it’s maybe 45 minutes to an hour every time a woman wakes up in the night.
Q: What therapies have you found that work for you, and what can you counsel others to embrace or avoid?
A: Well, there’s what we already spoke of, the importance of keeping to natural rhythms as much as you can, and at least to consistency in hours, for you and your children. So going to bed at the same time every night helps out a lot. Then there’s good sleep hygiene—remember that weird phrase? You have to be careful of artificial light. It’s your pituitary gland that measures the light you see around you, and it’s pretty stupid. It’s not much fooled by low light like lamps or candles, which is why you can easily fall asleep reading a book, but bright lights like computer screens and the TV make the pituitary think it’s high noon and it won’t send sleep signals. So try to avoid the computer and watching TV for an hour or half an hour before bed. My wife and I have started turning all the lights down beforehand, to just kind of ease our brains and bodies into thinking it’s time for sleep now. Low temperature helps a lot, which is why people can’t sleep in the humidity, so you can take a cold shower or a really hot one, and then as your body temperature falls back down that’s going to make you sleepy. My gym is near my house, and sometimes I go for a sauna before bedtime. I’ve stopped drinking caffeine completely, and I avoid sleep medication, which is a $30-billion business in my country. But studies show users get maybe 11 minutes more sleep a night—they just don’t realize how minimal the change is. And then try not to think too much about the day or the next day—once you get on that train it’s hard to get off. All this works very well until you have a five-week-old.