Why We Sleep – Book Notes

Why We Sleep: Unlocking the Power of Sleep and Dreams
Matthew Walker

Routinely sleeping less than six or seven hours a night demolishes your immune system, more than doubling your risk of cancer.

First, after waking up in the morning, could you fall back asleep at ten or eleven a.m.? If the answer is “yes,” you are likely not getting sufficient sleep quantity and/or quality. Second, can you function optimally without caffeine before noon? If the answer is “no,” then you are most likely self-medicating your state of chronic sleep deprivation.

When you don’t get enough sleep, one consequence among many is that adenosine concentrations remain too high. Like an outstanding debt on a loan, come the morning, some quantity of yesterday’s adenosine remains. You then carry that outstanding sleepiness balance throughout the following day. Also like a loan in arrears, this sleep debt will continue to accumulate. You cannot hide from it. The debt will roll over into the next payment cycle, and the next, and the next, producing a condition of prolonged, chronic sleep deprivation from one day to another. This outstanding sleep obligation results in a feeling of chronic fatigue, manifesting in many forms of mental and physical ailments that are now rife throughout industrialized nations.

From these clues, I offer a theorem: the tree-to-ground reengineering of sleep was a key trigger that rocketed Homo sapiens to the top of evolution’s lofty pyramid. At least two features define human beings relative to other primates. I posit that both have been beneficially and causally shaped by the hand of sleep, and specifically our intense degree of REM sleep relative to all other mammals: (1) our degree of sociocultural complexity, and (2) our cognitive intelligence. REM sleep, and the act of dreaming itself, lubricates both of these human traits.

Sleep, especially REM sleep and the act of dreaming, is a tenable, yet underappreciated, factor underlying many elements that form our unique human ingenuity and accomplishments, just as much as language or tool use (indeed, there is even evidence that sleep causally shapes both these latter traits as well).

That alcohol also dampened the intensity of REM sleep experienced by the fetus, defined by the standard measure of how many darting rapid eye movements adorn the REM-sleep cycle. Furthermore, these unborn infants suffered a marked depression in breathing during REM sleep, with breath rates dropping from a normal rate of 381 per hour during natural sleep to just 4 per hour when the fetus was awash with alcohol.VIII

far more of our age-related physical and mental health ailments are related to sleep impairment than either we, or many doctors, truly realize or treat seriously.

Due to sleep fragmentation, older individuals will suffer a reduction in sleep efficiency, defined as the percent of time you were asleep while in bed.

all things learned before sleep are generally enhanced the next day.

suicide is the second-leading cause of death in young adults in developed nations after car accidents.

There is no major psychiatric condition in which sleep is normal. This is true of depression, anxiety, post-traumatic stress disorder (PTSD), schizophrenia, and bipolar disorder (once known as manic depression).

Not sleeping enough, which for a portion of the population is a voluntary choice, significantly modifies your gene transcriptome—that is, the very essence of you, or at least you as defined biologically by your DNA. Neglect sleep, and you are deciding to perform a genetic engineering manipulation on yourself each night, tampering with the nucleic alphabet that spells out your daily health story. Permit the same in your children and teenagers, and you are imposing a similar genetic engineering experiment on them as well.

suggest that REM sleep alone, although

I had been developing a theory based on the combined patterns of brain activity and brain neurochemistry of REM sleep, and from this theory came a specific prediction: REM-sleep dreaming offers a form of overnight therapy. That is, REM-sleep dreaming takes the painful sting out of difficult, even traumatic, emotional episodes you have experienced during the day, offering emotional resolution when you awake the next morning.

At the moment he began to dream, his muscle tone would relax and he would release the ball bearings, which would crash on the metal saucepan below, waking him up. He would then write down all of the creative ideas that were flooding his dreaming mind. Genius, wouldn’t you agree?

There are effective treatments, and it is a shame one never arrived in time for Ken Parks prior to that ill-fated evening in May.

(1) establish a regular bedtime and wake-up time, even on weekends, (2) go to bed only when sleepy and avoid sleeping on the couch early/mid-evenings, (3) never lie awake in bed for a significant time period; rather, get out of bed and do something quiet and relaxing until the urge to sleep returns, (4) avoid daytime napping if you are having difficulty sleeping at night, (5) reduce anxiety-provoking thoughts and worries by learning to mentally decelerate before bed, and (6) remove visible clockfaces from view in the bedroom, preventing clock-watching anxiety at night.

But Halsted had a dirty secret that only came to light years after his death, and helped explain both the maniacal structure of his residency program and his ability to forgo sleep. Halsted was a cocaine addict. It was a sad and apparently accidental habit, one that started years before his arrival at Johns Hopkins.