Nothing has changed in decades over the standard recommendation to get a good night’s sleep. Medical science still hasn’t determined exactly what sleep does, but waiting for the mystery to be solved is secondary. Primary is the fact that going without sleep throws your entire system out of balance. Something seemingly far removed from sleep, such as obesity, is actually linked quite closely. It’s now known that the two hormones that regulate appetite, ghrelin and leptin, are thrown out of balance by lack of sleep. When the brain isn’t receiving normal signals about hunger, you wind up overeating. Just as crucial, your brain won’t know when you’ve had enough.
In our parents’ generation, getting the recommended 8 hours of sleep every night was easier. Americans now get an average of 6.8 hours of sleep, edging under the minimum of 7 hours that’s considered healthy. Older adults sleep less, but it’s not because they need less. Current findings indicate that a tiny clump of brain cells in the hypothalamus acts as a “sleep switch,” and these cells decrease as we age. Previously the cause of insomnia in the elderly was unknown. Now it seems that brain changes are involved, which helps to explain why seventy-year-olds on average sleep an hour less than twenty-year-olds.
Our focus, then, is on insomnia rather than sleep itself. For most people, a diagnosable sleep disorder isn’t the problem. In the tradition of Ayurveda, insomnia is rooted in an imbalance of Vata, one of the three doshas, or basic physiological forces. Vata, which is linked to biological motion, causes all manner of restless, irregular behavior. When it is out of balance, people find it hard to keep to a routine in diet, digestion, sleep, and work. Mood swings and anxiety are related to Vata. Without asking anyone to adopt an Ayurvedic perspective, we think it’s helpful to see that Vata links mind and body in a very realistic way. Appetite, mood, and energy levels are all thrown out of balance when sleep—a natural remedy for Vata imbalance—is deprived.
Here’s a chart that shows you how sleep and Vata can go out of balance together.
Both are thrown off by the following:
Anxiety, depression
Overexertion
Staying up late
Cold temperature
Irregular eating, poor nutrition
Emotional upset
Physical aches and pains
Excitement, agitation
Stress
Worry
Grief
Harsh surroundings
Excess noise
Taking advantage of the Vata-sleep connection, you should first recommit to getting a good night’s sleep. Letting a full 8 hours turn into 5 or 6 is a slippery slope. If you have a problem with insomnia, either finding it hard to fall asleep or waking up during the night, don’t turn to pills—sleep aids of every sort are not the equivalent of establishing a natural sleep rhythm.
Instead, our menu of choices is about setting body and mind into the right framework for the brain’s natural sleep switch to be activated.
Reading the menu: As in every section on lifestyle, the menu of choices is divided into three parts, according to level of difficulty and proven effectiveness.
Part 1: Easy choices
Part 2: Harder choices
Part 3: Experimental choices
Please consult this page in the diet section if you need a refresher on what the three levels of choice are about. Ordinarily we say that you should make one change per week total, not one from each lifestyle section. But in the case of sleep, many of the changes are so simple that it’s fine to choose several and let them overlap. Still remember, though, that whatever choices you make are meant to be permanent.
• Make your bedroom as dark as possible. Blackout shades are best. If total darkness is impossible, wear a sleep mask.
• Make your bedroom as quiet as possible. If you can’t achieve perfect silence, wear earplugs. These are also advisable if early-morning noises wake you up.
• Make sure your bedroom is comfortably warm and draft free.
• Take a warm bath before bedtime.
• Drink a glass of warm almond milk before bedtime. (It’s rich in calcium and promotes melatonin, a hormone that helps to regulate the sleep/wake cycle.)
• Meditate for 10 minutes sitting upright in bed, then slide down into your sleeping position.
• Avoid reading or watching TV half an hour before bedtime.
• Take a relaxing walk before you go to sleep.
• Take an aspirin an hour before bedtime to settle minor aches and pains.
• No caffeinated coffee or tea three hours before bedtime.
• Use the evening hours after work as a time to relax.
• Meditate in the evening after you come home from work.
• Find ways to unwind from stress—see our section on stress (this page).
• Be regular in your sleep routine, going to bed and getting up at the same time every day.
• Remove the TV from your bedroom. Keep the bedroom a place for sleeping.
• Attend to signs of anxiety, worry, and depression.
• Don’t take work home with you.
• Get a massage before bedtime from your spouse or partner.
• No alcohol in the evening.
• Buy a more comfortable mattress.
• Experiment with herbs and herbal teas traditionally associated with good sleep: chamomile, valerian, hops, passionflower, lavender, kava kava (note that these are not scientifically proven remedies).
• Cognitive therapy (see this page)
• Get tested at a sleep disorder clinic.
• Sesame-oil massage (see this page)
• Ayurvedic herbal remedies for Vata imbalance (various over-the-counter formulations are available by mail or at health food stores)
The Vata connection links most of the choices to conventional insomnia advice in Western medicine. Only a few things need further explanation. To begin with, the overlooked things that keep many people awake are too much light in the bedroom, too much noise, and minor aches and pains that escape notice until you start to go to sleep. If you have the kind of sleeplessness that’s typified by waking up in the middle of the night or too early in the morning, attend to these three factors as first-line remedies.
The tendency to lose sleep as we age has a Vata link, since according to Ayurveda, this dosha increases with age. It’s prudent not to take sleep for granted even if you have always enjoyed good, sound sleep. Adopt our recommendations early and you will prevent future problems. Lack of sleep has been associated with triggering Alzheimer’s—see this page for a fascinating discussion of the Alzheimer’s-sleep connection, which Rudy played a major part in solving. Lack of sleep is also associated with high blood pressure, which tends to increase by the decade as we age.
Massage is very relaxing, of course, and if you have a very cooperative spouse or partner, they might be coaxed into massaging your neck and shoulders for a few moments at bedtime. Ayurveda advises Abhyanga, a specific daily massage with sesame oil, to settle Vata. It’s a simple if slightly messy procedure. Warm a few tablespoons of pure sesame oil (found in health food stores, but not the darker kind used in Asian cooking). Sitting down with a large towel on the floor to catch drips, lightly massage the oil into arms, legs, neck, and torso.
It’s not necessary to apply more than the faintest film of oil, and the best time is in the morning after you bathe or shower. Abhyanga is considered the sovereign remedy for Vata, and in addition is a good preventive for catching Vata-related diseases like cold and flu, but it requires a good deal of commitment as something you intend to keep up permanently.
Cognitive therapy has sometimes been effective for those who have long-standing insomnia. In such cases there’s almost always a psychological price to pay. Lying awake in bed is unpleasant and discouraging. Insomniacs grow increasingly frustrated. They hate the lack of energy and blurred thinking that lack of sleep brings with it. Cognitive therapy seeks to reverse the negative thinking that has built up as a result of so many negative associations with sleeplessness. Check and see if you find yourself fitting the following mental patterns and behavior.
Fearing the coming night, certain that you won’t fall asleep again
Disliking your bed and bedroom
Worrying that you aren’t sleeping at all
Tossing and turning in frustration
Obsessing about not getting to sleep
Feeling victimized
Blaming every woe on your insomnia
Staying up too late because you know you’re not going to get to sleep anyway
Getting up in the middle of the night to read or watch TV
These ingrained habits of mind and behavior make insomnia worse, so it’s worth experimenting with a few cognitive steps you can take on your own, short of seeking help from a therapist or a sleep-disorder clinic. First comes some positive thinking that the latest science upholds.
• Most insomnia is temporary and stress related. It goes away when daily life gets less stressful.
• Insomniacs do in fact get to sleep at some time during the night, even when they think they haven’t.
• REM (rapid-eye-movement, or deep-dreaming) sleep is a state that can be reached fairly quickly, even in a short afternoon nap.
• Contrary to previous beliefs, you can catch up on sleep deficit by sleeping in longer on the weekends.
• The brain can remain alert on short sleep for a few hours. With as little as 6 hours of sleep, you can be normally alert and functioning for a while before impairment starts to set in.
Focus on these positive thoughts in order to remove some worries about your insomnia. Become realistic about the actual problems it’s causing; don’t pile on new or imaginary ones. Make it your goal to stop fixating on lack of sleep, turning your energies to solving the problem. Second, to overcome a sense of being victimized, write down a list of things you are going to do to solve the problem, and then follow through with them. Third, don’t let your spouse or partner contribute to the problem by keeping the light on after you want to go to sleep, snoring, or moving around too much in a crowded bed. If you can’t sleep separately for whatever reason, enlist your partner in helping you solve this problem.
If you take up insomnia as a challenge rather than an affliction, your frame of mind will change. The solutions we’ve suggested are many, and countless people in your position have learned how to get a good night’s sleep. There’s no reason why you can’t, too.
Science’s inability to explain either the mechanisms or the purpose of sleep has been reduced to a medical school punch line: “the only well-established function of sleep is to cure sleeplessness.” To date, the research on sleep has been focused on the brain more than on the genome. We know that brain activity changes during sleep, and some basic discoveries, such as the need for REM sleep, emerged decades ago. It’s also becoming clear that when normal sleep deteriorates, it is a subtle sign that other things are going on. For example, some people who suffer from severe depression report that the first sign of an oncoming attack is that they no longer sleep well. By attending immediately to their irregular sleep, they can sometimes prevent the attack from arriving.
It has also become clear that sleep rhythms differ from person to person. In sleep research terminology there are “larks” (early risers) and “owls” (late risers) whose sleep habits are set for life. How such habits get set isn’t known, and this may be a fruitful area for epigenetics to explore, since it’s through epigenetic marks that genetic predisposition intersects with experience. Disrupting someone’s natural sleep rhythm is known to have widespread implications for the body. Workers on the night shift, for example, never fully adapt to their unnatural schedule of waking and sleeping. About 8.6 million Americans work the night shift or rotate shifts, and they are at higher risk for cardiovascular disease, diabetes, and obesity. Since the same conditions are associated with inflammation, there could be a strong link there.
Society may also be paying a price by setting the school day too early. Teachers complain that middle school students are in such a drowsy state early in the morning that they are essentially sleeping through first and second periods. Adolescents need more sleep than adults, between 8 and 10 hours, but one study found that only 15 percent of teenagers get 8½ hours or more of sleep per night. Forty percent get 6 hours or less. The typical adolescent pattern of keeping irregular hours and staying up late leads to problems that are easily preventable. The ideal time for an adolescent to go to sleep is 11 p.m. This implies that school should start later. A national debate has started among educators around the subject. At least one school district experimented with starting the school day an hour later and found that test scores rose significantly for middle school students.
Science would benefit by knowing why we actually need to sleep. Does the brain have to rest for a while? Is it resetting itself, or perhaps going into a mode in which it heals potential damage or grows new cells? Evidence points in many directions. Freud’s theory that dreams are disguised messages about the state of a person’s unconscious doesn’t seem to be valid, according to modern psychiatric understanding (there are holdouts, of course). Current belief is that dreams and the images they produce are essentially random. But this, too, is open to conjecture. Neuroscience can hardly improve on Shakespeare’s observation after the guilty Macbeth cannot fall asleep. “Innocent sleep. Sleep that soothes away all our worries. Sleep that puts each day to rest. Sleep that relieves the weary laborer and heals hurt minds. Sleep, the main course in life’s feast, and the most nourishing.”
Any full understanding of sleep must have roots in how we evolved, however. That much is certain; therefore, genes are crucial in some way as yet unknown. Deepak coauthored an article on sleep with an academic expert, Dr. Murali Doraiswamy, professor of psychiatry at Duke University. Because the genetic links between human and animal sleep are fascinating, we thought we’d give you some of the basic insights, even though they don’t apply in any practical way to how you are sleeping.
Their article notes that babies spend most of their days sleeping, but why? Why do creative solutions sometimes arrive in our sleep or soon after waking? (“A problem difficult at night is often solved in the morning after the committee of sleep has worked on it.”—John Steinbeck) Do plants go through rest cycles that are the equivalent of sleep?
Such puzzles have been made more topical by a recent study in mice that showed that one of the roles of sleep may be to clear out the accumulated garbage from the brain. If this is the only explanation, however, then why do we need to spend one-third of our day unconscious—couldn’t evolution have developed a system to clear out trash while we are awake (much like urination or defecation)?
Let’s take a look at some facts that may help us grapple with sleep’s mystery and its insights. Sleep is a state in which the organism’s consciousness is reduced or absent, and it loses the ability to use all nonessential muscles (in deep sleep you are essentially paralyzed and cannot move your limbs). From birth to old age there are dramatic changes in the amount of time humans spend in various sleep stages as well as in overall sleep. Babies sleep for 15 or more hours, which then steadily decreases to 10 to 11 hours for children and adolescents, 8 hours for adults, and 6 hours for the elderly (even though they need the same 8 hours as when they were younger).
The amount of time spent in REM versus non-REM sleep also decreases through life. Premature babies spend almost all their sleep (some 75 percent) in REM sleep, whereas full-term babies typically spend about 8 hours nightly in REM, which drops to about 1 to 2 hours nightly in adults. During REM sleep the brain shows high activity (gamma waves) and high blood flow, sometimes even more than while awake, and scientists believe this is when the brain rehearses and consolidates actions and memories. One can only wonder what a newborn baby, who spends 8 hours in REM sleep, is dreaming about since it has had so little waking experience.
Most animal species studied appear to sleep. Many primates, such as monkeys, sleep as much as we do, about 10 hours. Dolphins and some other marine creatures can sleep with half their brain awake (unihemispherical sleep) to protect themselves from predators—total sleep of both sides of the brain may lead to drowning. There is still debate about whether or not migrating birds may be able to sleep even while flying (with one eye open, much the way humans can take a catnap while standing up). For whatever reason, at least in captivity, carnivores (such as lions) need more sleep than herbivores (such as elephants and cows)—we don’t know if the same applies also to meat-eating versus vegan humans!
All of this interesting stuff illustrates how sleep is programmed into our genes and behaviors. But sleep would seem to be a poor survival trait as far as evolution goes. Because sleep put our ancestors (and other living creatures) at risk from predators, the benefits must outweigh the risks—that’s all that scientists can manage to agree on. Unlike humans, some animals (e.g., newborn dolphins) can survive sleep deprivation for a couple of weeks without apparent harm. However, in most species, after extended sleep deprivation, their body temperature and metabolism become unstable and they die. The longest period a human has survived sleep deprivation is believed to be about two weeks, but many physical and mental deficits occur long before that; driving ability is significantly impaired after one night’s bad sleep.
Finally, sleep is related to mood—strangely enough, sleep deprivation can make people happy and sometimes manic. Decades ago doctors took advantage of this fact in trying to treat depression (a misguided strategy, now that we recognize the link between depression and bad sleep). Numerous creative breakthroughs have been attributed to dreams, such as the tune for the Beatles song “Yesterday” (Paul McCartney), the structure of carbon and benzene (August Kekulé), and the sewing machine (Elias Howe). Indeed, the discovery of acetylcholine, a chemical that regulates many aspects of dream sleep, reportedly came to Otto Loewi in dreams on two consecutive nights in 1921. On the first night, he woke up and scribbled down some notes in his diary that, alas, he couldn’t read in the morning. On the second night, he was lucky enough to write them more legibly. Loewi’s subsequent experiment based on his dreams won him a Nobel Prize. Even Rudy had dreams that helped him find one of the Alzheimer’s genes based on historical photographs adorning the walls of Massachusetts General Hospital near his lab.
Common experience tells us to agree with Shakespeare’s simple conclusion that sleep “knits up the raveled sleeve of care.” Without a fuller understanding of consciousness itself, however, all arguments are adrift in the same darkness we inhabit every time we fall asleep.
When it comes to applying the science of sleep, at this point you may say, “What science?” But there are certainly enough data on sleep deprivation to underscore the need for a good night’s sleep at all ages, with deleterious consequences if you don’t get the proper sleep. Don’t fool yourself into believing that you have trained yourself to do well on less than 7 hours of sleep a night—only a fraction of the adult population falls into this category.
And the genetic connection? We know that the daily, or circadian, rhythm of sleep is maintained by “clock” genes that operate by sophisticated feedback loops. An entire network of these clock genes displays rhythmic activity, although once again, how this activity occurs is unknown. Certain variants in clock genes have been associated with whether you are a morning or an evening person. Attempts to link sleep disturbances with neuropsychiatric disorders have led so far to the identification of gene mutations in clock genes that are associated with rare sleep disorders.
Epigenetics has also been shown to regulate our circadian rhythms and may in fact be closely linked to sleep disorders. Since disruptions of sleep rhythms have been linked to numerous disorders, such as Alzheimer’s, diabetes, obesity, heart disease, cancers, and autoimmune diseases, we must further explore the epigenetic link to sleep regulation.
Progress is being made. A specific clock gene called CLK serves as master regulator of our sleep cycle by epigenetically switching other circadian rhythm (sleep cycle) genes on and off. The fact is that hundreds of genes follow a twenty-four-hour cycle of variable activity, and many of these genes affect your sleep cycle and thus your health. Since epigenetics has already been shown to modify the activities of these sleep cycle genes, it follows that a variety of lifestyle changes that affect our epigenetics most likely influence our sleep cycle.
It will be very important to understand which lifestyle activities, experiences, and exposures allow us to sleep regularly or cause sleep deprivation. At the very least, stress must be involved in sleep deprivation. We’ve previously discussed how stress is a major contributor to epigenetic changes leading to disease. But here we run into a chicken-and-egg question, because sleep deprivation leads to stress and vice versa. More epigenetic findings are in order.
Our recommendations about curing insomnia are also useful if you already enjoy normal sleep, because they can improve its quality. The brain’s sleep switch is geared to two activities that are the opposite of each other: arousal and relaxation. Arousal keeps us awake, and it wakes us up if we’re asleep. If a loud bang in the middle of the night wakes you up, that’s an example of arousal; so is bright light striking your eyes or a dripping faucet.
These external triggers can be managed with a little effort, but there’s the subtle problem of internal arousal, which is more difficult to manage. When worry keeps you awake at night, that’s an example of internal arousal—the brain refuses to relax, let go, and stop thinking. Some internal triggers are physical, such as when pain wakes you up in the middle of the night, or the need to empty your bladder. We think that the Vata connection is useful here, because Ayurveda takes for granted that body and mind work together, which is certainly true when it comes to sleep.
In Western terms, arousal triggers send too many signals to the brain’s feedback loop. Worry, anxiety, and depression are self-perpetuating. Unless a way is found to break their repetitiveness, the same thoughts return obsessively, which interrupts the signal that the brain should be heeding, the signal to go to sleep. The Ayurvedic advice to avoid overstimulating your mind before bedtime is sound advice for our physiology. Stimulus leads to arousal. It’s easy enough to make your evenings more relaxing under normal circumstances, but anxiety and depression pose their own special difficulties. This is especially true when someone has become so habituated to worry or negative thinking in general that the brain’s sleep switch has become sidelined, as it were.
The opposite of arousal is relaxation, an activity that modern people reserve for the fringe of their day. They relax when there’s time left over from work instead of making it a primary activity. What’s needed is a new model of how a high-functioning brain should operate. What can be done to counter the tendency to seek more and more stimulation while drastically depriving ourselves of relaxation?
The most credible version of the fully integrated brain is the one laid out by a Harvard-trained psychiatrist and neuroscientist, Dr. Daniel J. Siegel, now at the UCLA School of Medicine, who has made a career of examining the neurobiology of human moods and mental states. In our book Super Brain we enthusiastically endorsed Siegel’s basic insight that the brain needs a whole “menu” of activities during the day. Please see that discussion for a full discussion of this topic. Here we want to highlight three choices on the menu that too many people are deprived of: “in” time, downtime, and playtime.
We alluded to spending “in time” every day in the section on meditation. As the name says, this is time you spend going inside and experiencing the mind at its calmest and most peaceful, but also its deepest. “Downtime” is spent not thinking about work and duty, simply “vegging out” for a while. Lying on your back in the grass staring at the clouds is the ideal kind of downtime. “Playtime” needs no explanation, but how many of us take a few moments to be playful, to laugh and have fun, every day? Siegel’s research indicates that adding these overlooked brain activities has enormous curative effects when a patient seeks psychotherapy. Their brains aren’t fully functioning because of the lack of certain activities that are totally necessary for a complete and fulfilling life, including normal moods and emotions.
It’s only a matter of time before overstimulation is connected with epigenetic changes and inflammation. Rather than waiting for science to catch up, look at your daily life. If you are exhausted by the end of the day, if you are run ragged with no time to relax, if you don’t laugh or feel the enjoyment of simply being here, these are signals that you should pay attention to. Sleep holds its mysteries, but the benefits of relaxation and the risks of overstimulation are quite clear. As you tip the balance away from arousal, your brain will return to a natural state of balance, and the results can’t help but improve your sleep.