Sleep hygiene: how to improve your sleep and productivity?

2024 Author: Seth Attwood | [email protected]. Last modified: 2023-12-16 15:55

Somnology is a fairly young science, and many of its aspects still baffle scientists - from amazing disorders like sexomnia to the question of why we need dreaming at all.

Time recently wrote that almost half of American teens do not sleep as much as necessary. Is sleep deprivation a disease of our time?

- Indeed, the attitude to sleep has changed a lot - and at the end of the 19th century, people slept on average an hour more than we do now. This is associated with the "Edison effect", and the root cause of this is the invention of the light bulb. Now there is even more entertainment that you can do at night instead of sleeping - computers, televisions, tablets, all this leads to the fact that we reduce our sleep time. In Western philosophy, sleep has long been viewed as a borderline state between being and non-being, which has grown into a belief about it as a waste of time. Even Aristotle considered sleep as something borderline, unnecessary. People tend to sleep less, following another Western belief, especially popular in America, that those who sleep less are more efficient in their time. People do not understand how important sleep is for health, for well-being, and normal performance during the day is simply impossible if you do not get enough sleep at night. But in the East there has always been a different philosophy, it was believed there that sleep is an important process, and they devoted enough time to it.

Due to the acceleration of the pace of life, there are more sleep disorders?

- It depends on what counts as a disorder. There is such a concept - inadequate sleep hygiene: insufficient sleep duration or improper, inappropriate sleeping conditions. Perhaps not everyone suffers from this, but a lot of people around the planet do not get enough sleep - and the question is whether this is considered a disease, a new norm, a bad habit. On the other hand, insomnia is quite common today, which is also associated with the "Edison effect", which we talked about earlier. Many people spend time in front of a TV, computer or tablet before bed, the light from the screen displaces circadian rhythms, preventing a person from falling asleep. The frantic rhythm of life leads to the same - we return late from work and immediately try to fall asleep - without a pause, without transitioning to a calmer state from such an agitated state. The result is insomnia.

There are other disorders - apnea, respiratory arrest during sleep, manifested along with snoring, which few people know about. The person himself, as a rule, does not know about them, if the relatives sleeping nearby do not hear the pauses in breathing. We have small statistics for the duration of the measurement, but this disease is probably also more common - apnea is associated with the development of overweight in adults, and given that the prevalence of overweight and obesity is growing, it can be assumed that apnea too. The incidence of other diseases is increasing, but to a lesser extent - in children, these are parasomnias, for example, sleepwalking. Life becomes more stressful, children sleep less, and this can be a predisposing factor. Due to the fact that life expectancy becomes longer, many people live to see neurodegenerative diseases, which can manifest itself as a violation of behavior during the sleep phase with dreams, when a person begins to demonstrate their dreams. This is often the case with Parkinson's disease or before the onset of symptoms. The syndrome of periodic movement, syndrome of "restless legs", when a person feels unpleasant sensations in his legs in the evening, is quite common. It can be pain, burning, itching, which make you move your legs and prevent you from falling asleep. At night, the movement of the legs continues, the person does not wake up, but the sleep becomes restless, more superficial. If the periodic movement of the legs in a dream interferes with a person, then it is considered a separate disease. If it does not disturb his sleep - a person gets enough sleep, feels comfortable, does not wake up often at night, falls asleep calmly, wakes up refreshed in the morning, then this is not a disease.

I wanted to discuss with you the strangest sleep disorders - the Internet mentions the sleeping beauty syndrome, and twenty-four-hour leg syndrome (non-24), when a person sleeps a day every other day, and fatal familial insomnia, and sexomnia, and overeating during sleep. Which of this list are real clinical disorders recognized by science?

“The last three are real. Sleepwalking and sexomnia exist, but they are quite rare - this is a disease of the same kind as sleepwalking, but manifested in specific activity during sleep. Fatal familial insomnia is also a fairly rare disease, it occurs mainly in Italians, and is hereditary. The disease is caused by a certain type of proteins, and this is a terrible disease: a person stops sleeping, his brain begins to break down, and gradually he goes into a state of oblivion - either he sleeps, or does not sleep, and dies. Many insomnia patients fear that insomnia will somehow destroy their brain. Here, the mechanism is reversed: first, the brain is destroyed, and from this the person does not sleep.

Daily cycles of sleep and wakefulness are theoretically possible. When scientists conducted experiments in a cave, where there were no time sensors - no sun, no clock, no daily routine, then their biorhythms changed, and some switched to a forty-eight hour cycle of sleep and wakefulness. The likelihood that a person will sleep twenty-four hours without a break is not very high: rather it will be twelve, fourteen, sometimes sixteen hours. But there is a disease when a person sleeps a lot - the so-called hypersomnia. It happens that a person sleeps a lot all his life, and this is normal for him. And there are pathologies - for example, Kleine-Levin syndrome. It is most common in boys during adolescence when they go into hibernation that can last for several days or a week. During this week, they get up just to eat, and at the same time they are quite aggressive - if you try to wake up, there is a very pronounced aggression. This is also a rare syndrome.

What is the most unusual disease you have encountered in your practice?

- I examined the boy after the first episode of Kleine-Levin syndrome. But there is also a very interesting sleep and wakefulness disorder that is not talked about much - narcolepsy. We know the absence of which substance causes it, there is a genetic predisposition to it, but it probably has autoimmune mechanisms - this is not fully understood. In patients with narcolepsy, the stability of being awake or asleep is impaired. This is manifested by increased sleepiness during the day, unstable sleep at night, but the most interesting symptoms are the so-called cataplexies, when a mechanism is turned on in wakefulness that completely relaxes our muscles. A person experiences a complete drop in muscle tone - if in the whole body, then he falls as if knocked down and cannot move for some time, although he is fully conscious and can retell everything that happens. Or a drop in muscle tone may not completely affect the body - for example, only the muscles of the face or chin relax, hands fall. This mechanism normally works during dreaming, and in these patients it can be triggered by emotions - both positive and negative. Such patients are very interesting - I had a patient who argued with his wife at the reception. As soon as he got irritated, he fell into this unusual state, and his head and arms began to fall.

When do you think science talked more about sleep - in the last century, when it was given excessive attention in connection with psychoanalysis, or now, when these diseases are more and more frequent?

- Before, there was a more philosophical approach to everything - and the study of sleep was reminiscent of philosophical reasoning. People began to think about what causes sleep. There were ideas about sleeping poison - a substance that is released during wakefulness and puts a person to sleep. They searched for this substance for a long time, but never found it; now there are some hypotheses regarding this substance, but it has not yet been found. At the end of the 19th century, our great compatriot Marya Mikhailovna Manaseina, conducting experiments on sleep deprivation on puppies, found out that lack of sleep is fatal. She was one of the first to declare that sleep is an active process.

At that time, many argued about sleep, but few supported their reasoning with experiments. Now a more pragmatic approach is applied to the study of sleep - we are studying specific pathologies, smaller mechanisms of sleep, its biochemistry. The encephalogram, which Hans Berger invented at the beginning of the last century, allowed scientists to use specific brain waves and additional parameters (we always use eye movement and muscle tone) to understand whether a person is asleep or awake - and how deeply. The encephalograph made it possible to reveal that sleep is a heterogeneous process and consists of two fundamentally different states - slow and REM sleep, and this scientific knowledge gave the next impetus to development. At some point, sleep became interesting to doctors, and this process launched the understanding of apnea syndrome - as a factor leading to the development of arterial hypertension, as well as heart attacks, strokes and diabetes mellitus, in general, to a greater risk of death. From this moment, a surge of clinical somnology in medicine begins - the appearance among specialists of equipment and sleep laboratories, most of all represented in America, Germany, France, Switzerland. The doctor-somnologist is not such a rarity there as we have, he is an ordinary specialist. And the appearance of a large number of doctors and scientists led to new research - new diseases began to be described, the symptoms and consequences of previously known ones were clarified.

British journalist David Randall, author of The Science of Sleep, wrote that for a professional scientist dealing with sleep problems is like admitting that he is looking for the missing Atlantis. Do you agree with him?

- The importance of sleep was initially underestimated. Doctors most often ask their patients about everything related to wakefulness. We somehow forget that normal wakefulness is impossible without proper sleep, and during wakefulness there are special mechanisms that support us in a state of activity. Not all experts understand why it is necessary to investigate these mechanisms - the mechanisms of the transition between sleep and wakefulness, as well as what happens during sleep. But somnology is a very interesting area, still concealing many secrets. For example, we do not know exactly why this process is needed, during which we completely disconnect from the outside world.

If you open a biology textbook, there is only one small chapter devoted to sleep. Of the doctors and scientists who are engaged in any specific function of the body, few are trying to track what happens to it in a dream. This is why sleep scientists seem a bit detached. There is no wide dissemination of knowledge and interest - especially in our country. Biologists and doctors do little to study the physiology of sleep during training. Not all doctors know about sleep disorders, a patient may not receive referrals to the necessary specialist for a long time, especially since all our specialists are rare and our services are not covered by the compulsory medical insurance funds. We do not have a unified sleep medicine system in the country - there are no treatment standards, no referral system.

Do you think that in the near future somnology will move from a special medical field to a general one, and a gastroenterologist, an allergist, and a phthisiatrician will be engaged in it?

- This process is already underway. For example, the European Respiratory Society has included sleep apnea, its diagnosis and treatment as a must-know for any pulmonologist. Also, little by little, this knowledge is spreading among cardiologists, endocrinologists. Whether this is good or bad is debatable. On the one hand, it is good when a doctor who is in direct contact with a patient has a variety of knowledge and can suspect and diagnose a disease. If you do not ask a person with persistent arterial hypertension about whether he snores during sleep, you can simply miss the problem and the cause of this arterial hypertension. And such a patient simply will not go to a sleep specialist. On the other hand, there are cases requiring deeper knowledge of a doctor who understands the physiology and psychology of sleep, changes in the respiratory and cardiovascular systems. There are difficult cases when the consultation of a specialist somnologist is required. In the West, such a system is gradually emerging, when they refer to a somnologist only if the diagnostic procedures and selection of treatment, which are done by broader specialists, are not successful. And it happens the other way around, when a somnologist makes a diagnosis, and for the selection of treatment, a patient with apnea is referred to a pulmonologist. This is also a variant of a successful interaction. Somnology is multidisciplinary and requires an integrated approach, sometimes with the involvement of a number of specialists

How speculative do you think the New York Times article that white Americans generally sleep more than people of color. Are genetic and cultural differences possible here?

- No, this is not speculation. Indeed, there are interethnic and interracial differences in both sleep duration and the incidence of various diseases. The reasons for this are both biological and social. Sleep rates vary from four hours to twelve for a person, and this distribution varies across ethnic groups, as do some other indicators. Differences in lifestyle also affect the duration of sleep - the white population tries to monitor their health to a greater extent, to lead a healthy lifestyle. Cultural differences are also possible - Western philosophy claims that you need less sleep and that a successful person can control his sleep (decide when to go to bed and get up). But in order to fall asleep, you need to relax and not think about anything - and adhering to this philosophy at the slightest problems with sleep, a person begins to worry that he has lost control over his sleep (which he never had), and this leads to insomnia. The notion that sleep can be easily manipulated - for example, going to bed five hours earlier or later - is wrong. In more traditional societies, there is no such concept of sleep, so insomnia is much less common.

The desire to control one's life in our society seems to have become excessive. Do you recommend any sleep apps to your patients?

- Sleep regulating devices are in great demand and are common in the modern world. Some can be called more successful - for example, running and light alarms that help a person wake up. There are other gadgets that supposedly catch when a person sleeps more superficially, and when more deeply, that is, according to some parameters, they supposedly determine the structure of sleep. But the manufacturers of these devices do not talk about how the measurements are made, this is a trade secret - therefore, their effectiveness cannot be scientifically proven. Some of these gadgets supposedly know how to wake a person at the most appropriate time for this. The idea is good, there is scientific data on the basis of which such approaches can be developed, but how they are carried out by a specific gadget is not clear, so it is impossible to say anything definite about this.

Many patients begin to worry about the information these gadgets give out. For example, in one young, healthy person, according to the gadget, during the night, only half of the sleep was deep, and the other half was superficial. It should be noted here again that we do not know what this gadget calls surface sleep. Plus, it's okay not to sleep deeply all night. Usually twenty to twenty-five percent of the duration of our sleep is a dream with dreams. Deep slow-wave sleep lasts another twenty to twenty-five percent. In older people, its duration is reduced and it may disappear completely. But the remaining fifty percent can be occupied by more superficial stages - they last long enough. If the user does not have an understanding of the processes behind these numbers, then he may decide that they do not correspond to the norm, and begin to worry about this.

But what is the norm? It only means that most people sleep like this. This is how norms in medicine and biology are built. If you are different from them, it is not at all necessary that you are sick with something - maybe you just did not fall into this percentage. To develop norms, you need to do a lot of research with each gadget.

Can we somehow prolong the phases of deep sleep, which, as is commonly believed, bring more benefits to the body?

- In fact, we don't know much - we have the idea that deep slow-wave sleep restores the body better, that REM sleep is also necessary. But we don't know how important the superficial drowsy first and second stages are. And it is possible that what we call superficial sleep has its own very important functions - related, for example, to memory. In addition, sleep has some kind of architecture - we constantly move from one stage to another during the night. Perhaps, it is not so much the duration of these stages that is of particular importance, but the transitions themselves - how frequent they are, how long, and so on. Therefore, it is very difficult to talk about exactly how to change sleep.

On the other hand, there have always been attempts to make your sleep more effective - and the first sleeping pills appeared precisely as a tool for optimal regulation of your sleep: in order to fall asleep at the right time and sleep without waking up. But all sleeping pills change the structure of sleep and lead to the fact that there is more superficial sleep. Even the most advanced sleeping pills have a negative effect on sleep patterns. Now they are actively trying - both abroad and in our country - various physical influences that should deepen sleep. These can be tactile and audible signals of a certain frequency, which should lead to more slow-wave sleep. But we must not forget that we can influence our sleep much easier - by what we do while awake. Physical and mental activity during the day makes sleep deeper and makes it easier to fall asleep. Conversely, when we are nervous and experience some exciting events just before sleep, it becomes harder to fall asleep, and sleep may become more superficial.

Somnologists have a negative attitude towards sleeping pills and try to avoid their long-term daily prescription. There are many reasons for this. First of all, sleeping pills do not restore the normal structure of sleep: the number of deep sleep stages, on the contrary, decreases. After some time of taking sleeping pills, addiction develops, that is, the drug begins to act worse, but the developed dependence leads to the fact that when you try to cancel sleeping pills, sleep becomes even worse than before. In addition, a number of drugs have a duration of elimination from the body for more than eight hours. As a result, they continue to act throughout the next day, causing drowsiness, a feeling of fatigue. If the somnologist resorts to prescribing sleeping pills, then he chooses drugs with faster elimination and less addiction. Unfortunately, other doctors, neurologists, therapists, and so on, often view sleeping pills differently. They are prescribed at the slightest complaint of poor sleep, and they also use those drugs that are very long-term excreted, for example, "Phenazepam".

It is clear that this is the topic of a whole lecture, and maybe not just one - but still: what happens in our body during sleep - and what happens if we do not sleep enough?

- Yes, this topic is not even a lecture, but a cycle of lectures. We know for sure that when falling asleep, our brain is disconnected from external stimuli, sounds. The coordinated work of the orchestra of neurons, when each of them turns on and falls silent in its own time, is gradually being replaced by synchronization of their work, when all neurons either become silent together, or all are activated together. During REM sleep, other processes occur, it is more like wakefulness, there is no synchronization, but different parts of the brain are involved in a different way, not in the same way as in wakefulness. But in a dream, changes occur in all systems of the body, and not only in the brain. For example, growth hormones are released more in the first half of the night, while the stress hormone cortisol peaks in the morning. Changes in the concentration of some hormones depend precisely on the presence or absence of sleep, others - on circadian rhythms. We know that sleep is essential for metabolic processes, and lack of sleep leads to obesity and the development of diabetes. There is even a hypothesis that during sleep, the brain switches from processing information processes to processing information from our internal organs: intestines, lungs, heart. And there is experimental evidence to support this hypothesis.

With sleep deprivation, if a person does not sleep at least one night, performance and attention decrease, mood and memory deteriorate. These changes disrupt the daily activities of a person, especially if these activities are monotonous, but if you get together, you can get the job done, although the possibility of error is greater. There are also changes in the concentration of hormones, metabolic processes. An important question that is much more difficult to study is - what happens when a person does not get enough sleep every night? Based on the results of experiments on animals, we know that if a rat is not allowed to sleep for two weeks, then irreversible processes occur - not only in the brain, but also in the body: stomach ulcers appear, hair falls out, and so on. As a result, she dies. What happens when a person systematically lacks sleep, for example, two hours a day? We have indirect evidence that this leads to negative changes and various diseases.

What do you think about fragmented sleep - is it natural for humans (they supposedly slept before the electric light) or, on the contrary, harmful?

- Man is the only living being that sleeps once a day. It is rather a social aspect of our life. While we regard this as the norm, it is not the norm for any other animal, and for the human species, apparently, too. Siesta in hot countries testifies to this. Initially, it is common for us to sleep in separate pieces - this is how small children sleep. The building of a single sleep occurs in a child gradually, at first he sleeps several times a day, then sleep gradually begins to shift at night, the child has two periods of sleep during the day, then one. As a result, an adult sleeps only at night. Even if the habit of sleeping during the day persists, our social life interferes with this. How can a modern person sleep several times a day if he has an eight-hour working day? And if a person is used to sleeping at night, some attempts to get sleep during the day can lead to sleep disturbances, interfere with normal sleep at night. For example, if you come home from work at seven or eight and lay down for an hour to take a nap, then falling asleep later at the usual time - at eleven o'clock - will be much more difficult.

There are attempts to sleep less due to the fact that sleep is broken - and this is a whole philosophy. I take this negatively as any attempt to change the structure of sleep. First, it takes us a lot of time to get into the deepest stages of sleep. On the other hand, if a person is used to sleeping several times a day and this does not cause any problems for him, if he always falls asleep well when he wants, does not feel tired and weak after sleep, then this schedule suits him. If a person does not have the habit of sleeping during the day, but he needs to cheer up (for example, in a situation where it is necessary to drive a car for a long time or an office worker with long monotonous work), then it is better to take a nap, fall asleep for ten to fifteen minutes, but not plunge into a deep dream. Superficial sleep refreshes, and if you wake up from a state of deep sleep, then "sleep inertia" may remain - fatigue, weakness, a feeling that you are less awake than you were before sleep. You need to figure out what is best for a particular person at a particular moment, you can try these or those options - but I would not sacredly believe and unconditionally follow these or those theories.

What do you think about lucid dreaming? It seems that now everyone around them is carried away

- Dreams are very difficult to study scientifically, because we can only judge about them by the stories of dreamers. To understand that a person had a dream, we need to wake him up. We know that lucid dreaming is something different as a process from ordinary dreaming sleep. Technologies have appeared that help to turn on consciousness during sleep, to begin to be fully aware of your dream. It is a scientific fact that people who have lucid dreams can give signals by moving their eyes to indicate that they have entered a state of lucid dreaming. The question is how necessary and useful it is. I will not give arguments for - I believe that this dream can be dangerous, especially for people with a predisposition to mental illness. In addition, it has been shown that if one practices lucid dreaming at night, then deprivation syndromes appear, as if a person does not get the usual sleep with dreams. We need to take this into account, because we need sleep with dreams for life, why - we do not know until the end, but we know that it is involved in vital processes.

Could lucid dreaming cause paralysis during sleep?

- During the sleep phase with dreams, including lucid dreaming, it is always accompanied by a drop in muscle tone and inability to move. But upon awakening, muscle control is restored. Sleep paralysis is rare and can be one of the symptoms of narcolepsy. This is a state when, upon awakening, consciousness has already returned to a person, but control over the muscles has not yet been restored. This is a very frightening state, scary if you cannot move, but it goes away very quickly. Those who suffer from this are advised not to panic, but simply to relax - then this state will pass faster. In any case, real paralysis from whatever we do with sleep is impossible. If a person wakes up and cannot move an arm or leg for a long time, most likely a stroke happened at night.

One Bavarian city is developing a whole program to improve the sleep of its inhabitants - with lighting regimes, special schedules for schoolchildren and working hours, and improved treatment conditions in hospitals. What do you think cities will look like in the future - will they take into account all these specific requests for good sleep?

- It would be a good scenario, one might say ideal. Another thing is that not all people are suitable for the same rhythm of work, everyone has their own optimal start time of the working day and the duration of work without interruptions. It would be better if a person could choose when to start working and when to finish. Modern cities are fraught with problems - from bright signs and street lighting to constant noise, all of which disrupt night sleep. Ideally, you should not use the TV and computer late at night, but this is the responsibility of each individual person.

What are your favorite books and films on the topic of sleep? And where about dreams they say, in principle, is wrong?

- There is a wonderful book by Michel Jouvet "Castle of Dreams". Its author more than 60 years ago discovered paradoxical sleep, a dream with dreams. He worked in this field for a very long time, he is well over eighty, and now he is retired, writes fiction books. In this book, he attributed many of his discoveries and discoveries of modern somnology, as well as interesting reflections and hypotheses to a fictional person who lives in the 18th century and tries to study sleep through various experiments. It turned out interesting, and it really has a real relationship to scientific data. I strongly advise you to read it. From popular science books, I like the book by Alexander Borbelli - this is a Swiss scientist, our ideas about the regulation of sleep are now based on his theory. The book was written in the 1980s, quite old, given the speed with which modern somnology is developing, but it explains the basics very well and at the same time in an interesting way.

Who wrote fundamentally wrong about sleep … In science fiction there is an idea that sooner or later a person will be able to get rid of sleep - with pills or exposure, but I do not remember a specific work where this would be told.

Do somnologists themselves suffer from insomnia - and what habits do you have that allow you to maintain sleep hygiene?

- Our wonderful psychologist, who deals with the regulation of sleep and insomnia, - Elena Rasskazova - says that somnologists rarely suffer from insomnia, because they know what sleep is. In order not to suffer from insomnia, the main thing is not to worry about the emerging syndromes. Ninety-five percent of people experience sleeplessness during one night at least once in their lives. It is difficult for us to fall asleep on the eve of an exam, a wedding, or some bright event, and this is normal. Especially if you suddenly have to rebuild the schedule - some people are very rigid in this regard. I myself was lucky in life: my parents adhered to a clear daily routine and taught me to do this as a child.

Ideally, the regime should be constant, without jumps on weekends - this is very harmful, this is one of the main problems of the modern lifestyle. If on the weekend you went to bed at two and got up at twelve, and on Monday you want to go to bed at ten and get up at seven, this is unrealistic. To fall asleep, it also takes time - you need to give yourself a pause, calm down, relax, not watch TV, not be in a bright light at this moment. Avoid sleeping in the afternoon - most likely, it will make it difficult to fall asleep at night. When you cannot fall asleep, the main thing is not to be nervous - I would advise in such a situation not to lie or twirl in bed, but to get up and do something calm: a minimum of light and calm activities, reading a book or household chores. And the dream will come.