Presenter: Good morning, this is The Kusnacht Practice. We are reinventing the experience of care. We’re here today with Melissa Nobile, and we’re going to discuss the issue of sleep deprivation and its effect on mental health.
According to a recent survey from the American Academy Of Sleep Medicine (AASM), 85% of the US adults don’t get the recommended seven hours or more sleep every night. British Prime Minister, Margaret Thatcher is famously said to have only slept four hours each night. So why seven hours? And how important is it for individuals to get this amount of sleep? And how much does this vary from person to person?
Melissa Nobile: Well, first of all, we can talk about sleep in general. And sleeping, It’s an innate behaviour, it’s genetically programmed and anchored that all animals need sleep. And then there’s going to be individual differences, cultural differences, political and economical factors that are going to influence people’s habit of sleeping. So, you have giraffes – they sleep two hours a night. And then you have cats, lions, and they’re going to sleep 20 hours a day. And humans, we’re kind of in the middle of the animal range, around 8.2 hours on average. That’s what has been observed usually.
There’s a lot of different theories as to why we need sleep, which might be for later. This average of 8.2 hours of sleep, it’s going to vary between individuals. But it’s also going to vary within individuals, in the course of their lifetime. So, for example, newborn babies. When you’re a baby, the brain is not completely developed, like adult form. So we know that the sleep cycles, the REM and NREM, don’t exist yet. Which is why babies wake up in the night, it’s quite disruptive, difficult to predict, etc.
But they’re still going to sleep quite a lot. It won’t be an eight hour point two average, it’s going to be, maybe, a lot more than that. And then kids, they start to get into a night and day schedule of sleep, and follow what the society has created as the sleep pattern that we want for them. So, daytime awake, night-time sleeping.
When you become a teenager, it’s the phase where the brain is going to change again, so much, through the process of that age in sleep. Synapses are going to change, meaning that information they’ve learnt that is valuable is going to be reinforced during sleep. And information that they don’t need, or synapses in the brain that they don’t need are going to start to disappear. And all this happens during sleep.
So teenagers are going to start to sleep quite a lot again. And for biological reasons too, they’re going to go to bed later. So, usually we see two hours delay compared to when they were kids. And it’s quite interesting, because, at The Kusnacht Practice, we treat mental health and we see that, in teenagers, they’re kind of constantly in this social jet lag because they still have to wake up at 8 a.m. to go to school. Even though the brain is in reconstruction, and technically, they’d need more sleep, and sleep that’s following a different schedule.
And then, when you’re an adult, you’re going to get into a sleep routine that’s usually stable until you become a senior. A that age, we observe again, that sleep becomes fragmented, less deep, and that people sleep less. We don’t really know why, the most likely hypothesis is that it’s due to medication intake, which is quite common at that age.
So, how we sleep, varies within a person, in the course of their lifetime, if we think of the seven hours that you gave, or the 8.2 average that I gave. It’s going to vary from one individual to another, where we each have a different baseline around 8.2 hours.
Humans are all different. So if you think of some humans having blue eyes, some having green. Some women have a 21 day menstruation cycle, others are 35 days. It’s going to be the same with sleep. There’s going to be some variability there. And to answer the last question: yes, sleep is important. Indispensable actually. It’s a vital need for a lot of different reasons.
PR: In the same survey, slightly more than one third actually, 34% of Americans, say that they sleep for seven or more hours only two nights, or fewer, each week; In line with findings from the Centers For Disease Control and Prevention (CDC). And regularly sleeping less than seven hours per day is associated with an increased risk of developing chronic conditions such as obesity, diabetes, high blood pressure, heart disease and strokes, in addition to mental health problems. So this demonstrates how important sleep is for both physical and mental health, doesn’t it?
MN: Yes, absolutely. When someone is diverting away from what their own baseline is, again, usually the average is 8.2 hours, what’s interesting, is that we see a huge difference between the impact it has on them objectively, that we can measure, and that has been observed in labs, and what they report subjectively. So, if it happens for a few nights, where someone’s not sleeping so well, humans have resources, so they’ll manage to compensate.
But, if it becomes more chronic, over time, it’s going to create problems on lots of different psychological and physical factors. So they might start having difficulty with concentration, emotion regulation, memory, creativity, problem solving, and lots of other factors. But subjectively, they’re going to have a tendency to think that they can still perform at the same level.
There’s been some studies on that, that were done. One I can think of, was with individuals that were deprived of different amounts of sleep in a night. So, maybe, it was eight hours of sleep, then four, then two, etc. I don’t know the exact numbers. And then, the next day, they had to drive a car. And they measured the reaction time that it took them to respond to a sudden need to brake, to stop the car. They realised that everybody, when they had to evaluate their performance, they all said they did amazing. They were fine, they were awake, all good, regardless of how much they slept.
But, objectively, we saw very important differences in the reaction time. So there is this objective versus subjective component. And then, physically, we also know that once someone can no longer compensate after the first few days or weeks, etc., the lack of sleep, we’re going to see, increases the risk of cardiovascular diseases. We’re going to see impacts on the brain, hormonal regulation, and a lot of different factors.
PR: The pandemic has also had a negative effect on global sleeping patterns, hasn’t it, with added stresses and worries? With a change in daily routines, the COVID-19 pandemic is also disrupting sleep for Americans. And according to the AASM survey, one in five Americans, actually 22%, are sleeping worse due to the pandemic, and 19% are getting less sleep. Are these factors? And are there any tips that you can give to those struggling? What kind of changes can one make, for instance, in their sleeping environment? What could they do to help? And have you seen an increase in cases of sleep deprivation yourself, since the pandemic began?
MN: So, yes. There’s been an increase since the pandemic began, at least observed in clinics, etc. And it’s not easy to give tips on exactly what someone can do because it depends on the factors that belong to their own life journey. But most people who struggle with insomnia report that it’s not somatic reasons that aren’t keeping them asleep, but it’s an overall cognitive activation that they just cannot stop. So they’re going to have intrusive thoughts or images that keep them awake at night.
So, in terms of sleep environment, because that was your question, one thing people can do, is to, and it might sound really simple, but it’s to keep their space – their home, and specifically their bedroom really clean and tidy. And maybe go through a process of decluttering the house, because what we realise is, in the process of going through their own personal belongings, they’re also cleaning and clearing, which is also going to clear the mind. And sometimes I have seen this work for some people.
And then, it doesn’t exactly answer what people can do in their sleep environment, but in general, if they’re struggling; yoga in the evening, meditation, relaxation techniques, is going to be linked to sleeping problems and can help them just relax. Cultivating gratitude – so, thinking of three positive things that happened in the day. We know that positive emotions are going to facilitate sleeping, falling asleep.
Avoiding stimulants at night, alcohol, nicotine. Avoiding eating too much before bed time. And then, if those things are not working, what we usually do, in a therapeutic process, is to try to find out other underlying factors, such as, maybe, the person has an impulsive temperament. And we know that people who are more impulsive are more likely, in the evening, to have counterfactual emotions of regret because they’ve acted impulsively throughout the day, and maybe, said things they didn’t really want to say etc. And it’s during the night-time that emotions about this are going to resurface.
Or seniors, we see that in the evening, is when regrets are also going to resurface, ‘I should have, maybe, done this in my life. I wish I hadn’t done that etc’. And then we’ll also work in therapy, for example, we’ll explore if the person is using the bedroom for something other than sleep. And if that’s the case we’ll stop that immediately. Because, through the process of ‘cognitive association’, as we call it in therapy, the brain is going to identify the bedroom and the bed with purely sleep, if we don’t do any activities in there. And that’s going to help fall asleep too. And lots of other things we can work on.
PR: The last question Melissa, is how important is exercise in ensuring that one has a good night’s sleep with minimal deprivation, in your opinion?
MN: Sport can be a factor that helps falling asleep. However, it shouldn’t be done, if someone is struggling with sleep, within three hours before going to bed. So, sport is helpful. It can tire you out, it can be part of a good routine. However, not right before bedtime, or it will probably have the opposite effect.
PR: Well thank you very much. Today we had the pleasure of having Melissa with us. Melissa Nobile is our psychologist here at The Kusnacht Practice. And we have been talking today about deprivation of sleep and its effect on mental health. Thank you very much Melissa.
MN: Thank you for having me.