There is a clear distinction between thriving and just getting by. 

During National Sleep Foundation’s Sleep Week, March 2-8, Sigrid Veasey, MD, professor of Medicine and member of the Center for Sleep and Circadian Neurobiology, discussed the role sleep plays in success and health in her talk, “Sleep to Thrive.”

“We wrongly think of sleep in our 24/7 society as the thing that gets in the way of our achievements and what we want to accomplish and not as something we need,” said Veasey.

Pressure to perform in the workplace and other aspects of our lives makes it easy to stigmatize slumber.

After all, sleep takes up much of our lives: on average 40,000 hours by age 10, 60,000 hours by age 20, 115,000 hours by age 40, and 200,000 hours (or more than 23 years) by age 80.

Most adults need eight to nine hours of sleep each night to perform at an optimum level, and few reach that. More than a third of adults regularly sleep less than seven hours each night during their workweek, (shift work, long commutes, chores, family time, etc.). Half of adolescents sleep less than eight hours each night – nine is recommended – and two thirds of adolescents have electronic devices in their bedroom impairing their sleep.

“People will say time and time again, I've been sleeping five hours a night and I've gotten used to it, I can get by on five hours,” said Veasey. “You can't really get by on five hours; it's just that you can no longer perceive your impairment.”

Chronic sleep deprivation, or consistently sleeping less than the recommended number of hours, is often unacknowledged because it is poorly perceived – those experiencing it typically do not realize how sleepy they are, Veasey said.

A sleep test developed by David F. Dinges, PhD, professor and chief, Division of Sleep and Chronobiology, known as the Psychomotor Vigilance test, measures neurobehavioral capability during sleep loss and in clinical studies the test shows that people cannot perceive their impairments when chronically deprived of sleep.

Chronic short sleep leads to inattentiveness and delayed recovery, poor planning, weak integration of information and reasoning. Sometimes this results in minor underperformance in daily tasks, and other times it could cause a life threatening accident behind the wheel or on the job.

Sleep loss tragedies abound with countless loss of life, financial cost, and other unintended consequences, such as in the Exxon Valdez oil spill, Three mile island meltdown at 4 a.m. with workers up all night), the Chernobyl nuclear disaster, and other events.

Individually, chronic sleep loss can also lead to weight gain, metabolism, increased risk of diabetes and certain types of cancer, and potentially chronic sleep loss may impair the brain’s ability to defend itself against Alzheimer's and other neurodegenerative diseases.

The sleep cycle – non-rapid eye movement (REM) followed by REM sleep – lasts about 90-120 minutes, and is done about three or four times depending on how long someone is asleep.

While multiple full cycles in a night is optimal, it's not always possible. If naps are needed, they can be helpful.

“During a nap, complex ideas can consolidate, so there can be a real value in it,” said Veasey. “There is real synthesizing happening, but because nap sleep may not be at the right circadian time for best quality sleep it is not ideal.”

Most importantly, we should do what we can to foster quality sleep, including minimizing the use of stimulants and caffeine, and behaviors that may affect sleep.

“A lot needs to be perfect to sleep well,” said Veasey. “That means considering metabolic disturbances, like high or low glucose, effects of sleeping at high altitude, any neurological injury, stroke, any physiological or psychosocial stress, medicines, alcohol, inflammatory disease, physical activity, and more, all play a huge role on sleep.”

The depth or length of quality sleep is highly dependent on homeostatic drive, which pushes towards sleep, and circadian wakefulness throughout the day. In an ideal case, someone can be awake from 7 a.m. until 11 pm, and achieve a perfect balance of energy throughout the day without any energy slump until a strong circadian push around 10 or 11 pm to sleep.

“It's a beautiful system if everything is aligned right,” said Veasey.

As we all know, we are not always able to align everything right. For example, we are often exposed to ambient light later into the night, delaying our circadian rhythms and sleep times and suppressing melatonin (a risk factor for breast cancer, colon cancer, and other problems). Fortunately, there are computer programs that can remove the blue light on electronic screens after sunset, or rose-colored glasses can be worn.

Veasey, who sees patients at the Penn Sleep Center and researches sleep extensively, including a study published last year that showed that lost sleep can lead to lost brain neurons, explained that, although many of us get poor sleep, there are valuable strategies to help.

A few simple tips to help your sleep include: regular sleep and wake times, relaxing before bed and minimizing stress throughout the day, 8-9 hours of total darkness when you sleep, eat a healthy diet and exercise at least three hours before going to sleep, work and commute efficiently, and remember that caffeine should be consumed sparingly and more than one drink of alcohol can suppress deep sleep and REM sleep.

If those measures do not help, many patients can find successful techniques, treatment, and strategies at a Penn Sleep Center.

Veasey typically suggests behavior changes before suggesting hypnotics/sleeping pills, because the pills have been associated with numerous, dangerous side effects and generally only lead to a minor increase in sleep time and depth and more of a subjective, rather than true, improvement in sleep.

 “You can get by on little bits of sleep and do a lot of stuff OK – you may have a dangerous time driving – but the real challenge is you cannot thrive on little sleep,” she says. “You can’t push the envelope, take things to a new level, you can’t challenge yourself if you’re not getting good quality sleep.” 

Photo above: By Batholith (Own work) [Public domain], via Wikimedia Commons