CHAPTER 15: S IS FOR SLEEP: WASH YOUR BRAIN EACH NIGHT
TO HAVE BRIGHTER DAYS

The night is the hardest time to be alive and 4 a.m. knows all my secrets.

POPPY Z. BRITE

CATHY AND KRISTEN

Cathy, 45, was the CEO of a large financial services company and hired us to do a wellness program for her employees. She became passionate about brain health. Over time, I also saw her husband for preventive work. He had a family history of Alzheimer’s disease and wanted to do everything he could to avoid it.

Then I saw their teenage daughter, Kristen, who was anxious about starting at a new school and had panic attacks for the first time in her life. She had frequent bouts where she thought she was going to die: Her heart started pounding out of her chest, she hyperventilated and felt as though she couldn’t get enough air, her hands were cold and sweaty, and she had a sense that something terrible was about to happen to her. The panic attacks caused her to voice suicidal thoughts to her mother, which is when Cathy called me.

As I got to know Kristen, I learned she had many common brain-damaging teenage habits, including a digital addiction (lots of fights happened around her phone), a junk food addiction (it was hard to get her to eat anything healthy), and very poor sleep habits. Yet when Kristen learned about her brain, she became more interested in taking care of it. I had her take our online course, Brain Thrive by 25 (www.brainthriveby25.com) and had her keep a journal about her food and sleep. After three weeks, it became crystal clear to both of us that when Kristen slept more than seven hours a night, her focus was better at school and the panic attacks vanished. This gave Kristen the motivation to engage in brain-healthy sleep habits. She hated the attacks but now knew she had control over them.

As the chief psychiatrist at the National Training Center (NTC) at Fort Irwin in the Mojave Desert, I often saw the effects of sleep deprivation firsthand. The mission of the NTC was to train soldiers for combat in the desert. The war games went for days, and many soldiers became seriously sleep-deprived. If they went for two or more days without sleep, some were brought to me in psychotic states, seeing visions or being delusional. The prescription was generally not medication but sleep.

While you are sleeping, your brain is hard at work performing some very critical functions necessary to keep it operating at optimal levels. For example, during sleep, your brain cleans or washes itself by eliminating cellular debris and toxins that build up during the day (basically taking out the neural trash), consolidates learning and memory, and prepares for the following day. The brain processes that occur during sleep are also important for the health of your immune system, appetite control, and neurotransmitter production.

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When you are sleeping, your brain is hard at work performing some very critical functions necessary to keep it operating at optimal levels.

 

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Getting adequate sleep is vital for your brain, but an estimated 50 to 70 million Americans have some form of sleep disorder.[632] Nearly one-third of us suffer from short-term bouts of insomnia, the most common sleep disorder. And chronic insomnia affects approximately one in 10 people.[633] The rates are even higher among people with psychiatric disorders.[634] In fact, more than 50 percent of the time, insomnia is tied to stress, anxiety, or depression.[635]

Sleep and brain health/mental health issues are tightly linked. Research shows that about 75 percent of people with depression also have insomnia.[636] Sixty-nine to 99 percent of people with bipolar disorder experience insomnia or feel a reduced need for sleep during manic episodes.[637] More than half of the people with anxiety have trouble sleeping.[638] And children with attention deficit disorder/attention deficit hyperactivity disorder (ADD/ADHD) are more likely to experience sleep disorders than kids without the condition.[639]

The relationship between sleep and brain health/mental health issues goes both ways. In general, a night of staring at the ceiling can make you wake up feeling angry, irritable, sad, or stressed the next day; lower your ability to concentrate; and impair your judgment. Over time, sleep problems can lead to a higher risk of depression, ADD/ADHD, panic attacks, brain fog, memory problems, and dementia.[640] For example, teenagers who on average get an hour less of sleep at night are 38 percent more likely to feel sad and hopeless, 42 percent more likely to consider suicide, 58 percent more likely to attempt suicide, and 23 percent more likely to engage in substance abuse.[641] Due to a lack of sleep, shift workers have an increased risk of depression, as well as work-related injuries, cardiovascular disease, diabetes, and obesity.[642]

Having too few hours of sleep can have catastrophic consequences, increasing your risk of a traumatic brain injury (TBI). In a report from the Automobile Association of America (AAA), drivers who slept six to seven hours were 30 percent more likely to be in a car crash than those who got more than seven hours; those who slept for five to six hours a night were 90 percent more likely to have an accident; four to five hours, 430 percent more likely; and those who got less than four hours were 1,150 percent more likely to crash.[643] In another study, soldiers who got seven hours of sleep at night were 98 percent accurate on the range; those who got six hours of sleep were only 50 percent accurate; five hours equaled 28 percent accuracy; and four hours equaled only 15 percent accuracy (they were dangerous).[644]

Sleep apnea —when you snore loudly, stop breathing multiple times at night, then feel excessively tired during the day —is bad for your health. It’s no good for your partner either, since they can’t get a good night’s sleep with all that snoring and snorting. Untreated sleep apnea triples your risk of depression and dementia and makes it hard to lose weight. On SPECT scans, sleep apnea often looks like early Alzheimer’s disease (see scans on the next page). Getting a diagnosis and treatment for sleep apnea is critical to keeping your brain healthy and preventing or minimizing symptoms of mental disorders. The gold standard for treatment is called a continuous positive airway pressure (CPAP) mask, which delivers a steady stream of air through your passageways. Some people are hesitant to use a CPAP machine because they think the mask will be uncomfortable. This is a mistake. Because the brain is so dependent on oxygen, untreated sleep apnea literally kills brain cells, which doesn’t bode well for your mental well-being.

Brain Surface SPECT Scans

BRAIN SURFACE SPECT SCANS

Healthy

Sleep apnea

Sleep Risk Factors
(and the Four Circles They Represent)

All of the four circles contribute to your sleep patterns and can either leave you tossing and turning at night or sleeping peacefully.

• Biological: Conditions like restless leg syndrome or sleep apnea, jet lag, many medications, poor sleep hygiene, or hormonal imbalances (especially hyperthyroidism and low progesterone in women) can get in the way of a good night’s sleep.

• Psychological: Worrying about work or finances, relationship problems, or the health of a loved one can keep you up at night. ANTs (automatic negative thoughts) tend to attack before bed and in the middle of the night.

• Social: Doing shift work, having a job that requires a lot of travel across time zones, staying out too late with friends, guzzling coffee day and night, or looking at your email or scrolling through your social media feed at all hours of the night prevents your brain from getting the restorative sleep it needs.

• Spiritual: If you aren’t in tune with why you want to make sleep a priority, it will be difficult to adopt the habits that will provide better rest.

Chronic insomnia, less than seven hours of sleep for adults and eight hours for teens (psychological circle if stress is keeping you up at night, and social circle if you are staying out late with friends)

HOW MODERN SOCIETY IS STEALING SLEEP AND SELLING A BROKEN SOLUTION

Companies that are open 24/7 and require employees to work odd hours, bars and nightspots that don’t close until 2 a.m., and endless connectivity to the internet can all keep us from getting to bed at a reasonable hour. Similarly, restaurants that serve mega-portions, coffee vendors on nearly every corner selling caffeinated beverages at all hours, and bars pushing alcohol on us can all interfere with a good night’s sleep. With increasing insomnia rates, sleep aid medications have skyrocketed. But the sleep solutions our society is pushing come with a cost. Research showed an association between sleep medications —such as zolpidem (Ambien), eszopiclone (Lunesta), and temazepam (Restoril) —and a more than three-fold increased risk of death.[645] These sleep aids have also been associated with memory issues, confusion, anxiety, depression, and addiction.[646]

THE EVIL RULER WOULD . . .

1. 1. Mess with people’s sleep by making them so addicted to TV and social media that they tune into stressful news before bed, read emails late into the evening, respond to texts in the middle of the night, and tweet outrageous messages and post to Facebook or Instagram at all hours.
2. 2. Encourage people to regularly cross several time zones for work, giving them jet lag.
3. 3. Refuse to give up the outdated practice of the twice-a-year time change that messes with people’s sleep.
4. 4. Advocate caffeine consumption morning, noon, and night to disrupt sleep and create an unhealthy cycle that primes people for symptoms of mental illness.
5. 5. Encourage starting school early to diminish sleep time, which increases many forms of brain health/mental health issues.

THE BENEVOLENT RULER WOULD . . .

1. 1. Limit social media and TV time so people can go to sleep early and get the rest they need.
2. 2. Limit excess travel to reduce the incidence of jet lag.
3. 3. Do away with the twice-a-year time change that messes with your sleep.
4. 4. Encourage people to adopt a brain-healthy sleep regimen that promotes more restorative sleep.
5. 5. Start school later to allow children good sleep.
6. 6. Start days with exercise and hold meetings at work while walking.

PRESCRIPTIONS FOR REDUCING YOUR SLEEP RISK FACTORS
(AND THE FOUR CIRCLES THEY REPRESENT)

The Strategies

1. 1. Love and care about your sleep. Make it a priority and keep track of your sleep each night. There are many apps that can help. I often use Sleep Cycle on my phone or my Fitbit watch. Strive to get seven to nine hours, which is a healthy amount for most people.
2. 2. Avoid anything that hurts your sleep. Beware of health problems that steal your sleep. These include:
   
   • Sleep apnea. It leads you to stop breathing for short periods throughout the night, which robs you of restful sleep and leaves you dragging, unfocused, and forgetful throughout the day.
   
   • Restless leg syndrome.
   
   • Thyroid conditions. Both hypo- and hyperthyroidism can cause sleep problems. See chapter 13 to find out about testing for thyroid issues.
   
   • Congestive heart failure.
   
   • Chronic pain.
   
   • Untreated or undertreated mental health issues, such as obsessive-compulsive disorder (OCD), depression, or anxiety.
   
   • Alzheimer’s disease. Dementia patients “sundown” or rev up at night and wander.
   
   • Chronic gastrointestinal problems, such as acid reflux.
   
   • Enlarged prostate gland (benign prostatic hypertrophy). It causes many trips to the bathroom at night, which interrupts slumber.

   If you suffer from any of these and you find yourself struggling with getting adequate rest, speak with your health-care provider about possible solutions.

1. 3. Beware of bad sleep habits. In our hectic, 24/7 society, we could just as easily ask, “What doesn’t cause sleep deprivation?” A seemingly endless number of reasons cause millions of us to miss out on a good night’s sleep. This list includes some of the most common factors.
   • A bedroom that is too warm. The ideal temperature is personal, but it should be on the cool side.
   • Light in the bedroom. Consider blackout shades if you live in a city, where light pollution is sometimes hard to avoid.
   • Noise. Try earplugs if you live in a noisy neighborhood or sleep with someone who snores.
   • Gadgets by the bed. Put your phone, tablet, digital watch, and more in another spot, or at least turn off the volume. Turn your digital clock toward the wall so you aren’t distracted by glowing numbers.
   • Screens. After sundown, use blue light–blocking glasses or screen settings when you are looking at a screen.
   • Going to bed worried or angry.
   • Medications. Many drugs, including asthma and cough meds, antihistamines, anticonvulsants, and stimulants (such as Adderall or Concerta, prescribed for ADD/ADHD), as well as others, disturb sleep.[647]
   • Naps. Even if you are having trouble sleeping, this is a mistake if you suffer from insomnia. Taking a nap because you feel sleepy during the day interferes with your nighttime sleep cycle.
   • Caffeine. Too much of the stimulant from coffee, tea, chocolate, or some herbal preparations —especially when consumed later in the day or at night —can disrupt sleep. Refrain from using them after 2 p.m.
   • Alcohol, nicotine, and marijuana. Although these compounds initially induce sleepiness for some people, they have the reverse effect as they wear off, which is why you may wake up several hours after you go to sleep —and not be able to return to slumbering.[648]
   • Exercise within four hours of the time you hit the sack. Regular workouts are very beneficial for insomnia, but vigorous exercise late in the evening may energize you and keep you awake.[649]
   • Changes in hormones. Whether due to pregnancy, premenstrual syndrome (PMS), perimenopause, or menopause, these changes can disrupt women’s sleep.
   • Snoring. It can keep you or your spouse awake —or anyone else in the house, if it is really loud.
   • Shift work. Nurses, firefighters, security personnel, customer service representatives, truck drivers, airline pilots, and many others toil by night and sleep by day —at least, they try to sleep. Shift workers are especially vulnerable to irregular sleep patterns, which leads to excessive sleepiness, reduced productivity, irritability, and mood problems.[650] To improve sleep, turn on bright lights while on the job and use blackout blinds or curtains while you sleep during the daytime.
   • Stressful situations. Death, marital conflict, work deadlines, moving, or an upcoming exam can keep you awake at night.
   • Eating close to bedtime. This keeps your GI tract active and your blood pressure high. It also increases the risk of heart attack and stroke.
   • Jet lag. Travel between time zones messes with your body’s natural sleep rhythm. To minimize sleep disruption when traveling, begin altering your bedtime by one hour each night for a few nights before your trip and then get on local time as soon as you land.

1. 4. Engage in regular brain-healthy sleep habits. My nieces, Alizé and Amelie, weren’t getting good sleep when they first came to stay with us. Alizé had bad dreams and trouble sleeping, while Amelie wanted anxiously to sleep with her mom. With healthier daily habits, they both began sleeping better. Brain-healthy sleep habits will make it easier to drift off to dreamland and get a good night’s sleep. We are all unique, so remember that what works for one person may not work for another. Keep trying new techniques until you find something that works for you.
   • Set up your bedroom for sleep: cool, dark, and quiet.
   • Don’t allow pets in your bedroom —or at least keep them off the bed.
   • Address emotional problems before going to sleep. Follow the good advice from Ephesians 4:26 to not “let the sun go down while you are still angry.” Send a positive text or email, or set an intention to deal with the issue the next day. If you forgive the other person first, you may just end the argument. Worriers, devote a before-bed time period (about 10 to 15 minutes) to journal or pray about your nagging concerns, and then stop.
   • Get into a regular sleep schedule. Try to go to bed at the same time each night and wake up at the same time each morning, every day of the week. Getting up at the same time each day, no matter how long you slept, helps to set your internal body clock and prevent insomnia.
   • Read a book —not an e-reader or tablet, as the light keeps your brain alert. Preferably choose something thick or tedious, such as 1 and 2 Chronicles in the Old Testament. If you read Judges in the Old Testament or a murder mystery before bed, it is likely to keep you up.
   • Try sound therapy. It can induce a very peaceful mood. Consider turning on soothing nature sounds, wind chimes, a fan, or soft music. Slow classical music, or any music that has a slow rhythm of 60 to 80 beats per minute, can help with sleep.[651] Check out sleep-enhancing music by Grammy Award–winning producer Barry Goldstein at mybrainfitlife.com.
   • Drink a cup of warm, unsweetened almond milk. Add a teaspoon of vanilla (genuine, not imitation) and a few drops of stevia. The combination may increase serotonin in your brain and help you sleep.[652]
   • Wear socks. Research shows that if your hands and feet are warm, you may fall asleep faster.
   • Refrain from checking the clock if you wake up in the night. If you know what time it is, it can make you anxious.
   • Restrict use of the bed and bedroom for sleep or sexual activity only. Sexual activity releases muscle tension and a flood of natural hormones and boosts well-being. Adults with healthy sex lives also tend to sleep better. If you are unable to fall asleep or return to sleep easily, get up and go to another room.[653]
   • Use lavender to enhance your slumbers. The smell of lavender can decrease anxiety and improve mood and sleep.[654]
   • If you have to resort to medication, stay away from benzodiazepines and traditional sleep medications. I often prescribe trazodone, gabapentin, and amitriptyline with my patients.
   • Create a soothing nighttime routine that encourages sleep. Turn off all electronic devices at least an hour before bedtime, and lower the lights in your house. A warm bath or shower, prayer, or massage can also help you relax. (Download helpful meditations and sleep-promoting hypnosis audios at mybrainfitlife.com.)

Getting Restful Sleep with Hypnosis

Medical hypnosis is a safe and effective tool that can enhance overall health and well-being and promote more restful sleep. The American Medical Association recognized hypnotherapy as a standard medical treatment back in 1958, and the American Psychological Association followed suit by endorsing it as a branch of psychology in 1960. I have been using hypnosis for decades.

When I was an intern at Walter Reed Army Medical Center, many of my patients wanted sleeping pills. As you can imagine, it’s hard to sleep in a busy, noisy hospital. Before I would give them pills, I asked if I could try hypnotizing them first. Almost everyone agreed, and hypnosis was so helpful that many of them did not need sleeping pills at all.

1. 5. Take nutraceuticals that help with sleep. These are often trial and error to determine which ones will help you most. My patients tend to like a combination of melatonin, magnesium, and gamma-aminobutyric acid (GABA). I suggest trying one of the following for several days and taking it 30 minutes before bedtime.
   • Melatonin is a neurohormone that helps regulate the sleep cycle. Darkness triggers melatonin production, while light —natural or artificial —reduces it. Too much light at night or too little light during the day can interfere with the production of melatonin. Taking melatonin has been found to decrease the time it takes to fall asleep, increase sleeping hours, and increase feelings of alertness the following day. People with depression, seasonal affective disorder, or panic disorder tend to have low levels of melatonin. Taking melatonin improved depression and anxiety in a study on postmenopausal women. Melatonin boosts serotonin production, which may play a role in its ability to help with sleep and depression.

     Dose suggestion: 0.3–6 mg a day (less is often better)

   • 5-HTP boosts production of the neurotransmitter serotonin and helps to calm activity in the anterior cingulate gyrus. This makes it especially helpful for worriers and people who can’t seem to turn off their thoughts at bedtime. Research has shown that 5-HTP can be as effective as antidepressant medication.

     Dose suggestion: 50–200 mg a day

   • Magnesium glycinate or citrate is a mineral that plays a vital role in more than 300 biochemical processes in the human body. In the brain, it helps activate GABA receptors, which can help calm the brain and reduce anxious thoughts at bedtime.

     Dose suggestion: 50–400 mg a day

   • GABA is an amino acid that has a calming effect for people who struggle with anxiety or stressful thoughts. It promotes relaxation, which can help with sleep.

     Dose suggestion: 250–1,000 mg a day

BRIGHT MINDS: SLEEP

STEPS TO CREATE MENTAL ILLNESS . . . AND MAKE MY NIECES, ALIZÉ AND AMELIE, SUFFER

1. 1. Don’t care about sleep.
2. 2. Engage in habits that keep you from getting a good night’s rest.
   • Drink coffee or energy drinks in the afternoon and at night.
   • Drink alcohol at night.
   • Don’t get tested for sleep apnea, and if you have it, don’t use the CPAP machine.
   • Use your smartphone, tablet, or e-reader in bed at night, and keep your phone on the nightstand.
   • Eat a big dinner with fatty foods an hour or two before bedtime to increase the likelihood of nighttime heartburn and acid reflux.
   • Do a hard-core cardio class a couple of hours before you go to bed.
   • Keep a night-light on at all times.
   • Take naps in the afternoon.
   • Volunteer for the night shift at work.
   • Travel across time zones on a regular basis.
   • Rely on sleep medication to get the rest you need.
3. 3. Avoid the strategies that encourage restful sleep.

STEPS TO END MENTAL ILLNESS . . . AND KEEP MY NIECES, ALIZÉ AND AMELIE, HEALTHY

1. 1. Care about getting restorative sleep.
2. 2. Avoid anything that hurts your sleep patterns.
3. 3. Engage regularly in healthy habits that promote better sleep.
   • Create a sleep routine and stick to it.
   • Go to bed at the same time each night.
   • Keep your bedroom on the cool side at night.
   • Cut out any caffeinated beverages in the afternoon or evening.
   • Use soothing music to lull you to sleep.
   • Try a pillow with the calming scent of lavender.
   • Aim for seven to eight hours of sleep each night.
   • Give yourself four hours to digest your dinner before going to bed.
   • Practice stress-management techniques like meditation and prayer.
   • Wear a sleep mask to keep light from interrupting your sleep.
   • Consider taking nutraceuticals that promote calmness and help with the production of sleep hormones.

Pick One BRIGHT MINDS Sleep Tiny Habit to Start Today

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1. When my spouse complains that I snore and stop breathing at night, I will get assessed for sleep apnea.
2. When I want to sleep better, I will eliminate caffeine during the day (gradually —to avoid headaches).
3. When I use tech gadgets after sundown, I will make sure they have blue light blockers.
4. When it gets close to bedtime, I will cool the bedroom so it’s a good temperature for sleeping.
5. When I am ready to go to sleep, I will wear a sleep mask or completely darken the bedroom.

6. When I go to bed, I will turn off my tech gadgets so they do not wake me.
7. When I plan my day, I will write down my sleep routine, so I don’t forget it.
8. When I take my supplements, I will include melatonin and magnesium if I have trouble sleeping.
9. When it’s time for bed, I will listen to music or a hypnosis sleep audio.
10. When I worry too much, I will supplement with 5-HTP.

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[632] “Sleep and Sleep Disorder Statistics,” American Sleep Association, accessed August 20, 2019, https://www.sleepassociation.org/about-sleep/sleep-statistics/.

[633] Ibid.

[634] “Sleep and Mental Health,” Harvard Health Publishing, Harvard Medical School, updated March 18, 2019, http://www.health.harvard.edu/newsletter_article/sleep-and-mental-health.

[635] “Sleep Disorders: The Connection between Sleep and Mental Health,” National Alliance on Mental Illness, accessed August 20, 2019, https://www.nami.org/Learn-More/Mental-Health-Conditions/Related-Conditions/sleep-disorders.

[636] David Nutt, Sue Wilson, and Louise Paterson, “Sleep Disorders as Core Symptoms of Depression,” Dialogues in Clinical Neuroscience 10, no. 3 (September 2008): 329–36.

[637] Alexandra K. Gold and Louisa G. Sylvia, “The Role of Sleep in Bipolar Disorder,” Nature and Science of Sleep 8 (June 29, 2016): 207–14.

[638] “Sleep and Mental Health,” Harvard Health Publishing.

[639] Samuele Cortese et al., “Sleep and Alertness in Children with Attention-Deficit/Hyperactivity Disorder: A Systematic Review of the Literature,” Sleep 29, no. 4 (2006): 504–11.

[640] Kristine Yaffe et al., “Sleep-Disordered Breathing, Hypoxia, and Risk of Mild Cognitive Impairment and Dementia in Older Women,” JAMA 306, no. 6 (2011): 613–19.

Yo-El S. Ju, Brendan P. Lucey, and David M. Holtzman, “Sleep and Alzheimer Disease Pathology —A Bidirectional Relationship,” Nature Reviews Neurology 10, no. 2 (February 2014): 115–19.

Wei-Pin Chang et al., “Sleep Apnea and the Risk of Dementia: A Population-Based 5-Year Follow-Up Study in Taiwan,” PLOS One 8 (October 24, 2013): e78655.

Roxanne Sterniczuk et al., “Sleep Disturbance Is Associated with Incident Dementia and Mortality,” Current Alzheimer Research 10, no. 7 (September 2013): 767–75.

[641] Tori Rodriguez, “Teenagers Who Don’t Get Enough Sleep at Higher Risk for Mental Health Problems,” Scientific American, July 1, 2015, https://www.scientificamerican.com/article/teenagers-who-don-t-get-enough-sleep-at-higher-risk-for-mental-health-problems/.

[642] R. Morgan Griffin, “The Health Risks of Shift Work,” WebMD, March 25, 2010, https://www.webmd.com/sleep-disorders/features/shift-work.

[643] B. C. Tefft, “Acute Sleep Deprivation and Risk of Motor Vehicle Crash Involvement,” AAA Foundation for Traffic Safety, December 2016, https://aaafoundation.org/acute-sleep-deprivation-risk-motor-vehicle-crash-involvement/.

[644] Gregory Belenky et al., “The Effects of Sleep Deprivation on Performance during Continuous Combat Operations,” in Food Components to Enhance Performance: An Evaluation of Potential Performance-Enhancing Food Components for Operational Rations, Institute of Medicine (US) Committee on Military Nutrition Research, ed. Bernadette M. Marriott (Washington, DC: National Academies Press, 1994), https://www.ncbi.nlm.nih.gov/books/NBK209071/.

[645] Daniel F. Kripke, Robert D. Langer, and Lawrence E. Kline, “Hypnotics’ Association with Mortality or Cancer: A Matched Cohort Study,” BMJ Open 2, no. 1 (February 27, 2012): e000850.

[646] “Serious Ambien Side Effects: Memory, Depression, and More,” American Addiction Centers, last updated July 25, 2019, https://americanaddictioncenters.org/ambien-treatment/side-effects.

[647] Daniel G. Amen, Memory Rescue (Carol Stream, IL: Tyndale, 2017), 248.

[648] Daniel G. Amen and Tana Amen, The Brain Warrior’s Way (New York: New American Library, 2016), 203.

[649] Ibid., 205.

[650] Ibid., 203.

[651] László Harmat, Johanna Takács, and Róbert Bódizs, “Music Improves Sleep Quality in Students,” Journal of Advanced Nursing 62, no. 3 (May 2008): 327–35.

[652] Amen and Amen, Brain Warrior’s Way, 205.

[653] Ibid.

[654] Namni Goel, Hyungsoo Kim, and Raymund P. Lao, “An Olfactory Stimulus Modifies Nighttime Sleep in Young Men and Women,” Chronobiology International 22, no. 5 (2005): 889–904.

Mark Hardy, Michael D. Kirk-Smith, and David D. Stretch, “Replacement of Drug Treatment for Insomnia by Ambient Odour,” Lancet 346, no. 8976 (September 9, 1995): 701.