Doctors must prescribe a dream: what you may cost to sleep

Matthew Walker, a leading neuroscientist, on why sleep deprivation increases the risk of cancer, heart attack and Alzheimer's disease, and what can be done about it

Matthew Walker learned to be afraid of the question “What are you doing?” At parties, he marks the end of a pleasant evening; after that, his new acquaintances begin to cling to him like ivy. On an airplane, it usually means that while everyone else is watching movies or reading action novels, he finds himself at the center of a multi-hour meeting of passengers and airline workers interested in his work. “I've already started lying,” he says. - Seriously. I tell people that I train dolphins. It's better for everyone. ”

Walker is a somnolog . More precisely, he is director of the Center for Human Sleep Research at the University of California at Berkeley, a research institute whose goal is, perhaps unattainable, to understand the full range of ways sleep affects us, from birth to death, in illness and in health. Not surprisingly, people begin to consult with him. Blurring the boundary between work and rest is also promoted by the fact that few people are not worried about their own sleep. But most people, looking at the circles under their eyes, do not know even half of everything - and perhaps that is why he stopped telling strangers about his work. When Walker talks about sleep, he cannot, of course, confine himself to banalities like chamomile tea and a warm bath. He is convinced that a "catastrophic sleep loss epidemic" is underway with us, the consequences of which are much worse than anyone could imagine. And this situation, in his opinion, can change only after the intervention of the authorities.

Walker spent the last four and a half years writing “ Why Do We Sleep, ” a complex but urgently needed book detailing the effects of this epidemic. The idea is that when people find out about the connection between lack of sleep and, among other things, Alzheimer's disease, cancer, diabetes, obesity and mental health problems, they will try harder to get eight recommended hours a day (lack of sleep is everything that falls short of seven hours a day). But in the end, not everything depends on the person.

Walker wants the main organizations and legislators imbued with his ideas. “Not a single aspect of our biology remains intact as a result of lack of sleep,” he says. - It penetrates all places. Nor does anyone do anything about it. It needs to be changed: in workplaces and in communities, in homes and families. But when you saw the ministry of health [it comes to Britain - approx. transl.] posted posters about the importance of sleep? When did the doctor prescribe not a sleeping pill for you, but a dream? This needs to be prioritized and stimulated. Lack of sleep costs the UK economy £ 30 billion in lost revenue per year, or 2% of GDP. I could double the budget of the Ministry of Health if he began to pursue a policy of motivating sleep. ”

Why do we not have enough sleep? What happened in the last 75 years? In 1942, less than 8% of people tried to survive, sleeping no more than 6 hours a day. In 2017, almost half the people do this. The reasons seem to be obvious. “First, we electrified the night,” says Walker. - Light greatly reduces our sleep. Secondly, there is a problem with work: not only a vague schedule of starting and finishing work, but also an increase in the time needed to get to the workplace. No one wants to part with the time spent with family or entertainment, so they sleep less. Plays a role and anxiety. We live in a more lonely and depressed society. Alcohol and caffeine have become more available. And all this is the enemy of sleep. ”

But Walker believes that in the developed modern world, sleep is associated with weakness and even shameful. “We put a stamp on the dream. We want to look busy, and one of the ways to express it is to declare how little we sleep. This is a badge of honor. When I give lectures, some people wait until everyone leaves, and then quietly tell me: "I seem to be one of those who need eight to nine hours of sleep." They are ashamed to talk about it for all. They agree to wait 45 minutes instead to confess. They are sure that they are not normal - and this is natural. We criticize people during their sleep, which, in general, is simply necessary. We consider them lazy. No one will say, looking at the sleeping child: "What a lazy baby!" We know that babies need to sleep. But this understanding quickly disappears with age. People are the only living beings who deliberately deprive themselves of sleep for no apparent reason. ” If you are interested, the number of people able to survive without health consequences, sleeping five hours a day, expressed as a percentage of the population and rounded to the whole, is zero.

The science of sleep is still underdeveloped. But the world of somnologists is growing exponentially, thanks to both the demands (diverse and ever-growing consequences of the epidemic) and new technologies (electrical and magnetic brain stimulants), which allows researchers to receive, as Walker says, “VIP access” to the sleeping brain. Walker, 44, was born in Liverpool, and has been working on this issue for more than 20 years - he published his first work at 21. “I would love to tell you how I was interested in the states of consciousness since childhood,” he says, “but in fact, it happened by chance.” He began studying for a medical degree in Nottingham. But he found that medical practice was not for him - he was more interested in questions than answers. He switched to neuroscience, and after graduation he began working on his thesis on neurophysiology with the support of the Medical Research Council. And working there, he stumbled upon the world of dreams.

Matthew Walker in his sleep lab

“I studied the brain waves of people suffering from different types of dementia, but I could not find differences in them,” he recalls. One night, he read a scientific work that changed his life. It described what different parts of the brain are being attacked by various forms of dementia. “Some attacked parts of the brain that controlled a controlled sleep, while others ignored them. I understood my mistake. I measured brainwave activity while patients were awake, and I had to do it when they were sleeping. ” Over the next six months, Walker figured out how to make a sleep lab, and his notes clearly showed clear differences between patients. It turned out that sleep can be a new diagnostic litmus test for various subtypes of dementia.

After that, he became obsessed with sleep. “And only then I wondered: what is a dream, what is it doing? It was always interesting to me, but when I began to read on this topic, the clock began to fly by. No one could answer the simple question: why do we sleep? I decided that this is the greatest mystery of science. I was about to approach her in two years. But it was naive. I did not think that many of the greatest scientific minds were engaged in it throughout his career. Since then, two decades have passed, and I still struggle with this. ” After receiving his doctorate, he moved to the United States. He was a professor of psychiatry at Harvard Medical School, and now he is a professor of neuroscience and physiology at the University of California.

Does this obsession extend to the bedroom? Does he follow his recommendations about sleep? "Yes. I train myself to sleep eight hours every night, and I do it very regularly. The most important thing that I tell people is that it is necessary to go to bed and get up every day at the same time, regardless of anything. I am very serious about sleep, because I saw all the evidence. As soon as you learn that after only one night, when you slept for 4-5 hours, the number of your natural killer cells — the attacking cancer cells that appear in your body every day — drops by 70%, or that lack of sleep is associated with intestinal cancer , prostate and breast, or even the fact that the World Health Organization has attributed night shifts to carcinogens - how can you do otherwise? ”

But there is a spoon of tar. Walker admits that if he cannot sleep, he becomes a “neurotic like Woody Allen.” When, for example, he flew to London in the summer, because of the change of time zones he found himself sitting in his hotel room and could not fall asleep at two in the morning. And his problem was that he knew too much about it. His brain began to work feverishly. "I thought: my Orexin does not turn off, the thalamic sensory access control system is opened, the dorsolateral part of the prefrontal cortex does not turn off, and a melatonin surge does not take another seven hours." What did he do? It turns out that even a world sleep expert behaves as a result of insomnia as we all do. He turned on the light and read a little.

Will the book Why We Sleep make such an impact, as the author hopes? Not sure: concentration is required to read scientific books. I can say that she made a great impression on me. After reading it, I definitely decided to go to bed early - and this mode I follow consciously. In a sense, I was ready for this. I first met Walker a few months ago when he spoke at Somerset House in London, and he impressed me as a passionate and persuasive speaker (our next interview is on Skype, and he talks from the basement of his "sleep center" from which the chain of bedrooms in a long corridor resembles hospital wards). But in a sense, it was unexpected. I'm usually pretty cool about health-related advice. In my head, a voice says, "just enjoy life while it is."

But the evidence provided by Walker is enough to send anyone to bed. Without sleep, there is not enough energy and disease develops. With sleep comes energy and health. More than 20 large-scale epidemiological studies show a clear link: the less you sleep, the shorter your life. Just one example: in adults from 45 years old, sleeping less than six hours a day, 200% more likely to get a heart attack or stroke, compared with people sleeping for 7-8 hours. This is partly due to blood pressure: even one night, with a small lack of sleep, accelerates the pulse of a person and significantly increases blood pressure.

Lack of sleep also undermines the body’s control over glucose. The cells with a lack of sleep in the experiments responded worse to insulin, which led to prediabetes conditions or hyperglycemia. Reducing the duration of sleep, you risk gaining weight. Among the reasons for this is the fact that inadequate sleep reduces the levels of the hormone of satiety, leptin , and increases the levels of the hunger hormone, ghrelin . "I will not argue that the obesity crisis is only due to lack of sleep," says Walker. - This is not true. However, processed foods and a sedentary lifestyle cannot fully explain this epidemic. Something is missing. It is already clear that the third ingredient is sleep. ” Fatigue, of course, affects motivation.

Sleep has a powerful effect on the immune system, so when we have the flu, our first instinct is to go to sleep. Our body is trying to sleep. Shorten sleep at least one night, and your resistance drops sharply. If you are tired, you are more likely to catch a cold. Well-rested people respond better to flu shots. As Walker said, studies show that lack of sleep can affect our immune cells that fight cancer. A large number of epidemiological studies report that night shifts and disruption of circadian rhythms, to which they lead, increase the chances of developing breast, prostate, endometrial and colon cancers.

If you sleep too little in adulthood, this increases your risk of Alzheimer's disease. The reasons for this are difficult to describe briefly, but in general this is due to the deposition in the tissues of a specific protein-polysaccharide complex, amyloid . It accumulates in the brain of people suffering from this disease, and kills the surrounding cells. During deep sleep, these deposits are removed from the brain. A patient with Alzheimer's is forming a vicious circle. Without enough sleep, these plaques accumulate, especially in areas of the brain that are responsible for deep sleep, and then attack them and degrade them. The associated loss of sleep reduces our ability to remove them from the brain at night. More amyloid, less deep sleep; less deep sleep - more amyloid, and so on. In his book, Walker notes, quite "unscientific" that he was always interested in how Margaret Thatcher and Ronald Reagan, who publicly declared that they did not need a dream, as a result suffered from this disease. In general, it turns out that the opinion that adults need less sleep is a myth. And besides dementia, sleep helps us shape new memories and restores the ability to learn.

Also, sleep affects mental health. When mom told you that the morning of the evening was wiser, she was absolutely right. In Walker's book, there is a large section on dreams (which, according to Walker, cannot be analyzed - whatever Freud says). They describe the various ways in which the sleep state is associated with creativity. He also suggests that when we see dreams, we improve our lives. If we sleep in order to remember - then we also sleep in order to forget. Deep sleep is a part of sleep, when we start dreaming is a therapeutic condition in which we remove the emotional tint from our experience, which makes it easier for us to tolerate it. Sleep, and his absence, affect our mood. A brain scan conducted by Walker showed that in people with sleep deprivation, the amygdala , a key area responsible for anger and rage, responded 60% more strongly. In children, lack of sleep is associated with aggression and harassment , in adults - with thoughts of suicide. Lack of sleep is also associated with the restoration of dependence on harmful substances. In psychiatry, the prevailing view is that mental disorders lead to sleep disorders. But Walker thinks it works both ways. Regulation of sleep can improve the health of people suffering, for example, bipolar affective disorder .

Deep sleep was mentioned several times in this description. What is it? We sleep in 90-minute cycles, and only towards the end of each of them do we turn into a state of deep sleep. Each cycle consists of two types of sleep. First, there is a sleep period characterized by slow movements of the eyeballs (slow sleep phase, NREM). It is followed by a REM sleep phase. When we talk about these phases of sleep, Walker's voice changes, as if he becomes bewitched and fascinated by this topic.

“During a slow sleep, your brain goes into a state with a surprisingly synchronized rhythmic pattern,” he says. “A striking unity appears over the entire surface of the brain — as if a deep and slow mantra is being read. Researchers used to mistakenly believe that this state is like someone. But nothing could be further from the truth. At this time there is a processing of a huge amount of information. For the appearance of these brain waves, hundreds of thousands of cells sing in unison and then fall silent, and this is repeated again and again. At this time, your body goes into this wonderful low energy regime, the best medicine for high blood pressure you can imagine. Fast sleep is sometimes called paradoxical, because during it, brain signals are identical to those that occur when you are awake. This is a surprisingly active state. Your heart and nervous system pass through periodic tides of energy; it is not yet clear to us why. ”

If the sleep cycle lasts 90 minutes, does this mean that the popular short-term daytime sleep is useless? “It can help relieve feelings of drowsiness. But to get to deep sleep, you need 90 minutes, and in one cycle all the work is not done. You need to go 4-5 cycles to get all the benefits. ” Is it possible to sleep too much? This is still unclear. “Today there is no convincing evidence. I think 14 hours is too much. Too much water will kill you, as well as too much food - and I think it will eventually turn out that this is also true for sleep. ” Is it possible to check that a person does not have enough sleep? Walker believes that you need to trust instincts. If you want to sleep and after the alarm clock has rung, you do not sleep. The same is true if you need caffeine in the afternoon to stay awake. “I see it all the time,” he says. - I get on the plane at 10 am, when people should be at the peak of activity, but at that time half of the cabin falls asleep. ”

What can a man do? Firstly, one should avoid spending the night without sleep, both at work and in entertainment. After 19 hours of wakefulness, you begin to think as badly as a drunk person. Secondly, it is necessary to argue about a dream, as about the type of work - as about going to the gym (despite the fact that sleep is both free and pleasant). “People use alarm clocks to wake up,” says Walker.So why don't we have an alarm clock that would tell us that we have half an hour to fall asleep? ”We need to return the literal attitude to midnight — as at the time when half the night passed. Schools should consider postponing the start of classes to a later time - this is correlated with an improvement in IQ. Companies should think about the reward for sleep. Productivity increases, motivation, creativity, and level of honesty increase. Sleep can be measured using devices that track it. Some prudent US companies are already giving workers leave when they need it. A sleeping pill must be avoided. Among other things, they are harmful to memory.

Those who seek to achieve the so-called. clean sleep, insist on banning mobile phones and computers in bedrooms - and rightly so, considering how LEDs affect the level of melatonin, a hormone that causes sleep. But Walker thinks technology will save sleep. “In industrial societies there will be a revolution related to the measurement of its indicators,” he says. - We will know everything about our body and with great accuracy. This will be a coup, and we will begin to develop methods to enhance the various components of sleep. Sleep will be treated as preventive medicine. ”

What questions does Walker most want to answer? He is thoughtfully silent. “It's so hard,” he says with a sigh. - Too many of them. I would like to know where we are going, psychologically and physiologically, during sleep. Dreams are the second state of human consciousness, and in this respect we have barely begun our research. But I would also like to know when the dream appeared. I like to put forward an insane theory: perhaps the dream did not appear as a result of evolution. Perhaps, on the contrary, wakefulness appeared from the dream. ” He's laughing. "If I had a medical Tardis, and I could have gone into the past to look at this process, I would have slept more at night."

Sleep in numbers

• Two thirds of adults in “developed” countries do not provide themselves with eight hours of sleep each day recommended by WHO.
• An adult who sleeps 6.75 hours a day will be able to live only up to 60 years old without medical assistance.
• A 2013 study reports that men with sleep deprivation have a 29% lower sperm count than those who sleep regularly and deeply.
• If you are driving a car, having slept no more than five hours, the probability of getting into an accident increases 4.3 times. If you slept 4 hours, this probability increases 11.3 times.
• A hot bath helps you fall asleep not because it warms, but because the dilated vessels radiate heat and your temperature drops. To fall asleep successfully, your body temperature should drop by 1 degree.
• The time to achieve physical exhaustion in athletes who do not get enough sleep to eight hours a day, and especially to six hours, falls by 10-30%.
• There are already more than 100 diagnosed sleep disorders, the most frequent of which is insomnia.
• People who prefer to wake up at dawn make up 40% of the population. People who love to lie down later and get up later, make up 30% of the population. The remaining 30% are somewhere in between.


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