Sleep Well

Dr. LEE Wing Ho, Peter, Ph.D.

Director, Clinical Health Psychology Centre

Honorary Consultant in Clinical Psychology

Clinical Psychologist

Health Psychologist

Many people suffer in silence when sleep is disrupted. Sleeping well brings happiness, good cheers, and better concentration. Quality of sleep can bring about slow aging, enhance our ability to lose weight, prevent cancer, and responding at a high level. Sleep regulates most hormone production. Sleep is part of our circadian rhythm, meaning that it occurs under a repeatable, 24-hour process and is determined by the light-dark cycle of our environment. At least 15 percent of our DNA is controlled by circadian rhythm, including your body’s repair mechanisms.

Growth hormone is released during sleep so that our body can maintain and repair muscle damage and decrease belly fat. Sleep helps consolidate memory and changes the brain’s cellular structure by providing a daily wash of cerebral spinal fluid to remove the damaging molecules associated with neurodegeneration.

When we sleep poorly, we suffer consequences beyond the dark circles under our eyes. We would probably be grouchy and no fun to be with. Our key relationships suffer. Work productivity declines. Our cortisol level, a key stress hormone, is higher—and we eat more and store more belly fat. Insulin doesn’t work as well, and blood sugar gets erratic. We are less efficient in clearing bad stuffs out of our brain. Our risk of cancer is increased.

Being a good sleeper can be something which is generally very private—until not being a good sleeper leaks its way into other areas of your life. Indeed, we achieve a vast proportion of bodily healing while asleep. Continuous sleep problems are a catalyst for ill health. Studies show that sleep deprivation encourages cancer, Alzheimer’s disease, depression, and heart disease. Women who get fewer than 4 hours of sleep per night are twice as likely to die prematurely from heart disease. Our environment, our lifestyle, and the decisions we make (either consciously or unconsciously) are determining which genes are getting expressed every second of our lives, and are all intricately dependent on the quality of our sleep. When we don’t sleep well, we get slower, less creative, more stressed, and underperform. Poor sleep renders us to use only a fraction of what we are capable of. Individuals with chronic poor sleep simply get dumber.

Our parietal lobe and the prefrontal cortex actually lose 12 to 14 percent of their glucose when we sleep poorly. These are the areas of the brain we most need for thinking, for distinguishing between ideas, for social control, and for our capacity to differentiate between right and wrong.

A study on individuals with sub-optimal sleep indicated that such individuals took 14 percent longer to complete a task and made 20 percent more errors than individuals who were well rested.

During sleep, the glymphatic system becomes 10 times more active than during wakefulness. Depending on how effective our glymphatic system is working, our brains’ ability to remove harmful waste products becomes deficient and this becomes one of the key causes of Alzheimer’s disease. In contrast, we perform better, make better decisions, and have a better body with adequate sleep. With better sleep, we boost our hormonal function; heal muscles, tissues, and organs damage. It protect us from diseases, and make our mind work at its optimal level.

Particularly in the face of difficult tasks, it would be best for us to plan ahead making sure to get the ideal number of sleep hours we need. Instead of seeing good sleep as an indulgence, we should allow ourselves to feel entitled to it and enjoy a great night’s sleep. We work hard enough in waking as it is. Comes night time, we need to treat ourselves to some incredible sleep because we deserve it and we need it for continual optimal functioning.

So What is Good Sleep?

With an understanding of the irreplaceable value of sleep, we need to define what constitutes good sleep.

The Free Dictionary defines sleep as a “natural periodic state of rest for the mind and body, where eyes are closed and consciousness completely or partially lost, so that there is a decrease in bodily movement and responsiveness to external stimuli”. It’s important to realise that sleep is “a natural periodic state of rest” for the mind and body.

Being awake breaks us and our energy down and being asleep builds us up. Sleep is known to be an elevated anabolic state, heightening the growth and rejuvenation of the immune, skeletal, and muscular systems. Basically, sleep rebuilds us and keeps us youthful. Unless we give our body the right amount of sleep, we will never have the body and life we want to have.

So how much is enough sleep then? The world’s average amounts to 7 to 8 hours of sleep. Research shows that with just 24 hours of sleep deprivation, there is an overall reduction of 6 percent in glucose reaching the brain. With sleep deprivation, we get dumber.

Yet there is no absolute standard as to how much we need to sleep. We should accept that good sleep is an individual matter. The fact that in the daytime we remain consistently alert, focused, and unbothered by fatigue and tiredness, is already a good indicator of good sleep.

Sleep deprivation leading to “brain drain” indicates that the reduction in glucose isn’t shared equally across the brain. Our parietal lobe and the prefrontal cortex lose 12 to 14 percent of their glucose when we don’t sleep. These two areas of the brain are instrumental in helping us distinguish between ideas, social control, and for being able to tell the difference between right and wrong. We could probably recall being impulsive and making poor decisions when we were up late at night – those mistakes we wouldn’t have made if our head was suitably nourished with restorative sleep. With brain drain, we are set up for failure in the first place. When we are tired, we are not ourselves - not the best version of ourselves anyway. Being sleep-deprived will automatically stack the deck against us.

Poor sleep is detrimental to learning. Learning is a big part of our lives whichever stage we’re at. Our ability to learn and retain information is vital to our success. Unfortunately, we often sacrifice sleep in the name of getting this or other things done. We often miss the difference between “working” and being “effective”. College students who are poor sleepers are much more likely to earn worse grades and drop out of classes than their healthy sleeping peers. The Lancet published a paper that looked at a group of physicians and showed that sleep-deprived doctors make more mistakes and are less efficient in handling complicated cases.

The popular and boastful idea of having time to sleep ONLY when we’re dead will only accelerate the day that it becomes our reality. Yet we need to be aware that the impact that sleep deprivation has on our brain will make our life much harder while we are still here to enjoy it.

The glymphatic system is an important group of brain cells supportive of the brain’s health. All the dynamic functions of the human brain result in a lot of waste products, which need to be removed. This waste removal makes room for new growth and development. During quality sleep, this glymphatic system becomes 10 times more active than during wakefulness. With better sleep, we become more efficient in giving our body what it requires, boost our hormonal function; heal our muscles, tissues, and organs; protect ourselves from diseases; and make our mind work at an optimal level.

Human Sleep Cycles

During normal sleep at night, we follow a predictable pattern, moving back and forth between deep, restorative sleep (deep sleep) and more alert stages (non-REM) and dreaming (REM sleep). These stages of REM and non-REM sleep make up a complete sleep cycle. Sleep cycles usually last for 90 minutes each and repeat four to six times per night. And six normal 90-minute sleep cycles would equal 9 total hours of sleep.

Our sleep starts off with an interim period between waking and sleep, i.e. from non-rem sleep (when heart rate slows down and the brain does less complicated tasks) to deep non-rem sleep (when hormones are released and the body makes repairs to bones and skin; blood flow is directed towards muscles, restoring physical energy) and rem sleep (when heart rate and temperature increase, mind is active and dreams are vivid). In human beings, it is the vitally important deep non-rem sleep and rem sleep that most restorative and repair works for stresses coping, energy expenditure and production of reserves are being carried out.

What Affects our Sleep Quality?

Our sleep cycle, or circadian timing system, is impacted by the amount of sunlight we receive during the day. The hypothalamus is the master gland of our body’s hormonal system. It controls our body’s hunger, thirst, fatigue, body temperature, and sleep cycles by serving as a master clock. Sleeping when it’s dark and waking when the sun is up.

A vital compound affected by light exposure is the neurotransmitter serotonin. Serotonin is known to help bring about feelings of happiness and well-being. Many anti-depressant drugs are centered on the function of serotonin because of its positive effect on mood and cognition. It is crucial to regulating your body’s internal clock. Serotonin production is influenced by our diet, activity level, and the amount of natural sunlight we get.

Exposure to natural light results in less sleep deficit. Compared to office workers with direct access to windows at work, office workers who didn’t have access to windows got 173 percent less exposure to natural light and, as a result, slept an average of 46 minutes less each night. The sleep deficit in turn resulted in more reported physical ailments, lower vitality, and poorer sleep quality. Production of serotonin sets us up for a good night’s sleep. The human skin produces serotonin and transforms it into melatonin, which then sends signals to our cells to prepare for sleep. Melatonin is secreted naturally as it gets darker outside. When we get more sunlight exposure during the day, and less light exposure at night, we’re on our way to a magic sleep formula that really works.

Cortisol and Sleep

We need to have a healthy rhythm of cortisol production, i.e. more in the morning and less later in the day. Cortisol gives us the energy and vigor to get up and move around. It enables us to stay awake and be alert. It contributes to our strength, focus, and vitality every day. However, when cortisol is being over- or under-produced, negative functioning can arise.

Cortisol is an adrenal hormone that manages our body’s daily rhythm, charging us up for challenges of the day while allowing us to rest and recoup at night. We naturally have an increase in cortisol in the morning, which is for the purpose of getting up, being active, and enjoying life. Increase in cortisol in the morning allows us to get up, become active and enjoy life. And then there is a natural reduction in cortisol as the day goes on, bottoming out in the evening to set up a great night’s sleep.

Cortisol and melatonin have a somewhat inverse relationship. Essentially, when cortisol is up, melatonin is down. Daytime exposure to sunlight is important as it encourages the production of cortisol. Some of us have peaks of cortisol when it should be low, and low cortisol when it should be peaked. It means physiologically we are tired at night, but yet seem the most alert, while during the morning, when we should feel refreshed, it’s almost impossible to get our feet on the ground away from the mattress.

Our body clock is most responsive to sunlight in the early morning, between 6:00 am. and 8:30 am. Getting direct sunlight outdoors for at least half an hour has been shown to produce most benefits. UVB is the most valuable for human health, as it’s the only wavelength that triggers your body to produce vitamin D.

Avoid Screens before Bedtime

Computers, iPads, televisions, smartphones, etc. kick out a sleep-disrupting blue spectrum of light. The artificial blue light emitted by electronic screens triggers our body to produce more daytime hormones (such as cortisol) and disorients our body’s natural preparation for sleep. The use of light-emitting electronic devices in the hours before bedtime can adversely impact overall health, alertness, and the circadian clock that synchronises the daily rhythm of sleep. In one study, nighttime iPad readers took longer to fall asleep, felt less sleepy at night, had shorter REM and less melatonin. Users of electronic devices, whether to work or to game, should beware: when our sleep is affected our personal functions are also affected.

The reason that addiction to electronic devices increasingly affects the majority of children’s and adult’s life time is the secretion of Dopamine. The pleasure is an end result that we receive from the opioid system. Dopamine is a brain chemical that’s all about seeking. It’s about the hunt. It’s about finding out what’s coming next. And the Internet is a perfect trap. Dopamine is not about pleasure at all; the pleasure is an end result that we receive from the opioid system.

But how can we replace using electronic devices before bedtime? It’s difficult as we are so conditioned to facing the electronic boards when alone and in the evening. And it seems that we have forgotten what else to do in life besides using technology before we go to bed. How about reading a real book? Or talking to your spouse, relatives, brothers and sisters, or catching up with friends! Well, try this: talking and listening to a real person actually brings more joy and gratification.

While hooked on dopamine, dopamine itself is tied to being alert and being awake. Dopamine is tied to motivation and alertness, whereas serotonin is tied to contentment and relaxation.

In combating poor sleep, we need to build an alert awareness of our addiction. Awareness is the key: beware of the potential addiction, the potential adverse impact of poor sleep, and the potential health-demolishing consequences of prolonged poor sleep. Just by realising what’s happening in your brain as you’re scrolling through Facebook, it starts to break the old pattern. Breaking the habit of being on your devices, as replacement of the easy enjoyment is a huge key to breaking out of the bonds of technology before we go to bed. Music, good company, reading, talking, or whatever it may be — you have to test and find what fills that space best for you without disrupting your sleep.

Avoid Unhealthy Associations with Sleep

By the same token, we need to be cautious about building unhealthy associations around sleep. Given poor sleeping habits, we tend to associate poor sleep with anxiety, with agitation, with alertness over relaxation and keeping calm. The brain is activated in that what fires together, wires together. So if our brains are active and alert and anxious for sleep to come while in bed, a paradoxical effect may happen. Whenever we lie in bed and think of going to sleep, our brains become more activated with more alertness and sense of pressure. The harder we try to sleep, the worse it becomes as unwittingly we bring ourselves to a state which is just the opposite state for good and restful sleep. With more anxiety and fear of not sleeping, we actually set off a paradoxical impact, i.e. the more intent we wish to sleep, the less we are able to get to the placid and relaxed sleeping state.

To successfully achieve good sleep, we need to learn to allow sleep to come naturally, dissociate the bed and nighttime from anxiety and tension. Instead of not craving so much for sleep to come, we’d better relax and keep calm despite not sleeping well. Again what fires together, wires together. That’s why we need to associate good sleep with bed time, relax and let sleep happen, rather than pressuring ourselves with “we must sleep”. The more successful we can achieve this non-compulsive approach, the more our brain changes to facilitate good sleep.

Likewise, by not fearing not being able to sleep well, and just letting sleep to come or not, we prepare our bodies and brain for a more nature sleep cycle to gradually emerge.

With success in building a natural sleep cycle, we will have more success in building a more resilient sleep pattern. Success breeds success. With an odd night of not sleeping well, the best we can do is not to pay too much attention, not crave to sleep well, but just allow our fatigue, hormones and natural state of mind to guide us to a good relaxing sleep state.