This sleep series is dedicated to the memory of Darden Burns, a person with ME/CFS/FM, who battled severe sleep issues throughout her illness. Darden took her life after an unexpected relapse left her unable to sleep. Read her story: “To Sleep at Last: A Good-bye to Darden Burns“
“Sleep is the universal health care provider: whatever physical or mental ailment, sleep has a prescription it can dispense.”
The first part of the sleep series uses Matthew Walker’s 2017 book, “Why We Sleep: Unlocking the Power of Sleep and Dreams”, to provide a general overview of sleep.
Walker, a PhD and professor of neuroscience and psychology at the University of California at Berkeley, is in love with sleep and communicating about it – and his enthusiasm shows through in this delightful and well-written book.
The founder and director of the Center for Human Sleep Science at UC Berkeley, Walker is clearly on a mission to wake up America and the world (published in 2017, the book has already been translated several times) to the importance of getting a good night’s sleep. His website is aptly titled, “The Sleep Diplomat“. Walker asserts nothing you can do is more helpful in more ways than getting a good night’s sleep.
“Sleep”, he asserts, “is the single most effective thing we can do to reset our brain and body health each day”. In fact, Walker states that there doesn’t seem to be any organ in the body which does not benefit from sleep (and conversely, which is not harmed by poor sleep).
Getting To Sleep
Daylight / Nighttime
There’s a reason we sleep during the night and are up during the day, and it’s called the suprachiasmatic nucleus. Located at the far end of some optic nerves, this ever-so-small bundle of nerves found in the middle of the brain keeps you up when it’s light, and asleep when it’s dark. When darkness descends, it emits the brain’s signal to go into the sleep stage by emitting melatonin. More on melatonin, later, but it’s important to note that melatonin simply provides the trigger for the sleep cycle to begin. It can help get you to sleep but other than that admittedly crucial step, has no impact on how well you sleep.
We know that evolution abhors simplicity – and variations in our degrees of “nightness” and “dayness” exist. “Morning larks” – people who tend to fall asleep earlier in the evening and wake up earlier in morning – really do exist and make up about 40% of the population. “Night owls” – people who tend not to sleep until late in the evening and like to sleep in – are a real thing too, and make up about 30% of the population. The rest of us exist somewhere in between.
Something called “sleep pressure” actually makes you want to sleep when you haven’t been getting enough. The brain produces a chemical called adenosine which builds up in our brain during the day and is dumped when we sleep. Adenosine turns down the wakefulness-promoting parts of the brain, and turns up the activity of the sleep-inducing parts of the brain.
Because it takes 8 hours of sleep to completely remove this wakefulness-blocking chemical from your brain, many people with chronic fatigue syndrome (ME/CFS) and fibromyalgia (FM) are probably never adenosine-free and thus never fully awake during the daytime. In fact, the author states that a “condition of prolonged, chronic sleep deprivation…results in a feeling of chronic fatigue”.
Throwing these two factors – a chronicity factor and adenosine build-up – together means we naturally reach an energy lull in the early afternoon – a lull this professor thinks we should pay more attention to. Siestas or long mid-afternoon breaks, he believes are extraordinarily healthful things to do.
Our Sleep Cycles
Every ninety minutes, our brains cycle between NREM (deep sleep) and REM sleep – characterized by rapid eye movements. NREM sleep or deep sleep dominates the cycles early in the night, giving way to cycles dominated by REM sleep later. The functioning of this elaborate cycle – more NREM sleep transitioning to more REM sleep later in the night – is dependent, of course, on getting enough sleep. Staying up too late results in a deficit of NREM sleep. Waking up too early results in a deficit of REM sleep.
During sleep, the thalamus blocks sensory signals to the brain so that it can attend to other things, such as learning. It turns out that the “sleep on it” adage is a good one.
NREM or Deep Sleep
With its long, slow, perfectly synchronized waves, deep or NREM sleep looks to Walker like “nocturnal cerebral meditation” or the long, slow swells rippling across a placid ocean surface. Emanating from the middle of our frontal lobes (about the middle of our forehead), the swells transfer data from our short-term to our long-term memory stores in the neocortex.
Your ability to remember something from the past day is a function of early night, deep NREM sleep. The vast amount of information we encounter every day means that the flip side of being able to remember something is the ability to forget other things. We simply can’t incorporate it all at once.
During our NREM-dominated late night/early morning sleep cycles, our brains assess the past day’s events and weed out insignificant details. The more relevant data is passed to long-term storage centers to which the REM stage then builds new connections to foster creativity and learning.
- The first part of the sleep series uses Matthew Walker’s 2017 book, “Why We Sleep: Unlocking the Power of Sleep and Dreams”, to provide a general overview of sleep.
- We sleep largely because of two factors – the suprachiasmatic nucleus in the brain which maintains our circadian rhythms – and something called “sleep pressure” which is triggered by the activation of the sleep centers in the brain by the buildup of adenosine.
- The adenosine is flushed out of the brain when we sleep. Regularly getting less sleep than needed will turn down the brain’s wakefulness regions and activate the brain’s sleepiness centers – leaving one sleepy in the daytime.
- Our brains cycle between deep (NREM) and lighter (REM) sleep. During NREM sleep, the brain transfers significant details of the day into long-term memory stores. During REM sleep, the brain integrates the data into the brain more fully, establishing new connections.
- The old adage “Sleep on it” is actually accurate. Studies show that learning, creativity and even physically mastering tasks are enhanced by a full night’s sleep. These benefits do not occur, though, during poor sleep.
- A nap during the day moves data from short-term storage to long-term storage, replenishing our data stores and our ability to take in information and learn.
- Sleep deprivation results in “micro-sleeps” – short instances when you close your eyes. Micro-sleeps are particularly dangerous during driving. Driving while sleepy is as dangerous as driving drunk.
- Poor sleep affects every part of the body. In the brain, it produces an enhanced fear response and inhibits the pre-frontal cortex in charge of rational thought and planning. Memory and cognition are severely affected.
- Insufficient sleep increases the risk for cardiovascular disease, diabetes, cancer, early death, etc. It reduces our resistance to infections and enhances sympathetic nervous system (fight or flight) activity.
- Insufficient sleep produces brain patterns similar to those seen in mood disorders. Sleep has shown to be disturbed in every mood disorder.
- Insufficient deep sleep prevents the sewage system of the brain – called the glymphatic system – from cleansing the brain of toxins.
- Next up – Pt. II of Walker’s book – dream magic, Walker’s take on sleep drugs, Walker’s suggestions for better sleep.
Buzzing with activity, on the other hand, the brain during REM sleep doesn’t look like it’s asleep at all. In fact, some areas of the brain are more active during REM sleep than during waking.
During REM sleep, the brain experiences – in vivid color and sound – the past experiences of the day. In order to keep us from acting out our dreams, the brain puts our voluntary muscles on lockdown, leaving you as limp as a rag doll.
It’s during REM sleep that the creative juices of the brain get unleashed, as the brain establishes new connections – which enable new insights to pop up when you wake. Not only can intellectual problems get solved but so can physical ones. During REM sleep, the brain might learn how to properly finger that piano piece you had so much trouble with or help you learn another physical movement better. Studies indicate that practicing a piano piece – plus a good night of deep sleep – improves performance by 20% and accuracy by 35%.
This same process also applies to stroke victims (and, of course, people with ME/CFS and FM). Studies show that sleeping well after a stroke allows the brain to better entrain the new brain connections which will enable one to move again. This is all, of course, neuroplasticity in action.
Transferring the motor memories to brain circuits which operate instinctively – below the level of consciousness – allows a learned skill like playing the piano – once it’s learned – seem natural and effortless. That makes one wonder if some of the movement difficulties in ME/CFS/FM – the awkwardness, the discoordination, etc. – could, in part, reflect poor replenishment of these brain circuits during sleep. Because this type of encoded motor learning occurs during the last 2 hours (of an 8-hour sleep) in stage 2 NREM sleep, most of us – unless we are taking naps – may be missing it.
Naps really do help. Studies indicate that absent naps, one’s ability to learn drops dramatically during the day. Take a 20 minute nap, though, and your ability to learn actually increases by the end of the day. During a nap, the hippocampus uses something called sleep spindles (intense bursts of energy) to transfer data from the day to a long-term storage site in the cortex. With their data stores replenished, the nappers were ready to learn again.
Because these spindles are particularly abundant in the late morning, if you’re waking early may be missing out on this integral process.
Staying up all night is one thing. Losing a couple of hours of sleep a night for weeks, months or even years is quite another.
Microsleeps – Remember the increased activity of the sleep-inducing areas of the brain that adenosine triggers? One of the consequences of that is something called a micro-sleep – brief periods in which your eyelids partially or fully close – leaving you temporarily blind to the world.
Four nights of 4 hours of sleep each night results in the same number of micro-sleeps as if you had stayed up all night. Carry that on for 11 days and you’re as impaired as someone who just pulled two all-nighters in a row.
The six-hour sleep a night was not all that much better. Ten days of six-hours of sleep a night was like going without sleep for 24 hours.
It gets worse. Ten days of seven-hour sleep – which many of us would probably love to get – left the brain as dysfunctional as if one had been up for 24 hours.
The testing showed that the participants thought they were in much better shape than they actually were.
Micro-sleeps are not such an overt problem – you probably don’t even know they are occurring – unless you’re doing something like driving a car. Less than five hours of sleep a night increases the risk of getting in a car crash threefold. Because you actually temporarily black out during micro-sleeps, driving sleepy is more dangerous than driving drunk. Two million people fall asleep while driving their car every week. Walker goes on and on about how dangerous it is to drive sleepy. If you have to do so, it’s critical to take naps.
Effects of Poor Sleep
Primitive Emotions Take Hold
Feeling hyper-vigilant? Being snappy for no real reason? Irritated or worried about small issues that didn’t use to bother you? You can chalk up some of that to poor sleep. In what Walker called “the largest effect” he’d measured yet, keeping healthy, young adults up all night resulted in a huge increase in amygdala activity and their own personal reactivity. The now sleep-deprived young adults reacted much more negatively to emotional triggers than before. It was as if, “without sleep, our brain reverts to a primitive pattern of uncontrolled reactivity”.
Further studies, which allowed participants five hours of sleep a night, found that the brake pads of the amygdala’s brake – the prefrontal cortex, which studies suggest has taken a hit in ME/CFS and FM – had run low. Without sleep, the prefrontal cortex – the rational, thinking, organizing – part of the brain had trouble reining in an amygdala that was running amok.
Anger and fear weren’t the only emotions running the show. The sleep-deprived participants traveled an astonishing emotional roller coaster swinging from fear and anger to “punch-drunk” giddiness. It was as if reducing their sleep had knocked them off their emotional center. One of the more dangerous emotions encountered during these dramatic mood swings was depression, including suicidal depression. Studies now show that sleep disruption in adolescents is associated with increased suicidal thoughts.
Besides aggression, suicide and insufficient sleep is also associated with addiction. In fact, in a stunning statement, Walker reports that “there is no major pyschiatric disorder in which sleep is normal”.
Psychiatrists have assumed that mental disorders lead to sleep issues but Walker’s lab has demonstrated that lack of sleep can, by itself, produce neurological patterns in the brain which mimic mental disorders. Many of the brain regions most impacted by poor sleep are the same ones impacted in mental disorders.
Walker does not assert that mental illness is caused by poor sleep but he does argue that the role sleep disruption plays in our emotional well-being has been underappreciated and underutilized diagnostically and therapeutically. Indeed, instituting behavioral practices that improve sleep in people with mood disorders has proven beneficial.
One group of depressed individuals stands out like a sore thumb. About a third of people with depression do better with less sleep – possibly because their mood swings swing them toward happiness instead of anger, etc.
As noted earlier, a lot of learning takes place as the brain moves the day’s data for short-term storage to longer-term data storage and integration sites in the brain. It turns out that sleep deprivation stops the flow of data from short to long-term storage in its tracks.
Because this activity occurs during deep sleep, anything that disrupts deep sleep and keeps someone in shallow sleep prevents the learning process from taking place. Plus, anything that does stick, doesn’t tend to stick around. Recent studies indicate that even our short-term memory storage center – the hippocampus – is affected, indicating that sleep deprivation impacts even short-term memory retention.
Rodent studies indicate that imprinting new information – and one must assume that probably includes doing neuroplastic exercises to change how your brain works – is really difficult when you are sleep-deprived.
Sewage Backing Up
The 2012 discovery of the glymphatic system in the brain helped to answer a problem that had long puzzled researchers: just how does the brain, absent a lymphatic system all its own, get rid of toxins. It turned out that the brain has a glymphatic system (and, it turns out, a kind of lymphatic system – discovered in 2015, as well). The glymphatic system consists of small channels between the glial cells which collect and send waste products out of the brain.
The catch – the glymphatic system only operates during our very deepest sleep stages. If you don’t get deeply asleep, your brain won’t get its nightly roto-rooter cleaning. As you descend into deep sleep, your brain does two weird things. First, the amount of blood in the brain drops – clearing the way for the cerebral spinal fluid to reverse and move upwards into the large ventricles at the base of the brain – presumably to collect the waste products produced by the brain during the day.
Because Alzheimer’s patients have long been known to have problems with sleep – particularly deep sleep – researchers conjecture that their inability to cleanse the brain of toxins may play a role in the disease. Walker noted that depriving mice of deep sleep leads to an immediate increase in amyloid deposits in their brains. (High aggregations of amyloid deposits in the prefrontal regions of Alzheimer’s patients’ brains are associated with deep sleep loss). Walker suggests that identifying and treating sleep disorders early may help delay or even stop the onset of Alzheimer’s and dementia.
My father may have been a case in point. We all knew he had sleep apnea for years, but he refused to get tested, and eventually died of Lewy Body Dementia.
We don’t know what’s causing the exertion problems in ME/CFS and FM but whatever is causing them is not being helped by the poor sleep. Getting less than 6 hours of sleep results in a 10-30% drop in aerobic output and sets us up for a metabolic breakdown which sounds very much like ME/CFS/FM: increased lactic acid build-up, reductions in blood oxygen saturation and increases in two exercise-induced toxins (lactic acid and carbon dioxide) are all associated with poor sleep.
With the body in a kind of cardiovascular, metabolic and respiratory breakdown, it’s no wonder that studies show a huge increase in injury in athletes with chronic sleep issues – and longer recovery times as well.
“Every major system, tissue and organ of your body suffers when sleep becomes short.” Matthew Walker
Walker notes that more than 20 large epidemiological studies have tracked the effects of sleep – or the lack of it – on people over many decades. The decidedly uncomfortable conclusion for sleep-deprived ME/CFS and FM patients – the shorter your sleep, the shorter your life.
The stats are astonishing. Adults 45 or older who sleep less than 6 hours a night are 200 percent more likely to have a heart attack or stroke during their lifetimes. (This is probably due to increased blood pressure – which doesn’t seem to be such a problem in ME/CFS/FM.) Five to six hours of sleep a night makes you 200-300 percent more likely to suffer from calcification of the arteries over the next five years.
“Through this central pathway of an overactive sympathetic nervous system, sleep deprivation triggers a domino effect that will spread a wave of health damage throughout your body”. Matthew Walker
The main driver of this death and destruction is one we’re well aware of – the sympathetic nervous system. Studies by Ute Vollmer-Conna in Australia tightly link the sleep dysfunction in ME/CFS to the SNS. (More on that in a later blog).
Insufficient sleep has also been linked to increased rates of type II diabetes, weight gain (hunger pangs, increased snacking), reduced testosterone, altered gut microbiome, reduced resistance to infections, and several cancers.
“It doesn’t require many nights of short sleeping before your body is rendered immunologically weak”. Matthew Walker
During this time of coronavirus it should be noted that a study found that people sleeping five hours a night were almost 3 x’s more likely to catch a cold when exposed to a common cold virus than people sleeping seven hours or more. Even the effectiveness of a flu shot can be impacted. Even healthy, young people – when restricted to four hours of sleep a night – derive only a little immune boost from a flu shot.
Genetically, poor sleep boosts the production of genes associated with inflammation and cellular stress.
Dying of Poor Sleep?
Since sleep affects virtually every system in the body, the question arises whether you can actually die of poor sleep. The answer to that question is: yes. Thankfully, it occurs only very, very rarely.
In a rare genetic disorder called fatal familial insomnia, a mutation in the prion-related protein (PRPN) gene causes misfolded (and toxic) prions to build up in the thalamus, damaging the nerves there.
Like some other genetic disorders, this one doesn’t show up until middle age, but when it does, it manifests with a vengeance. The disease begins with a rapid onset of insomnia which steadily gets worse until after a couple of months, sleep becomes completely impossible and the person dies.
- Next Up – Pt II – Dream Magic, Walker’s Scoop on Sleep Drugs and his advice on getting better sleep.
- Check out Walker’s beautiful Center for Human Sleep Science website.
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