The Neglected Cornerstone: Our Vicious Cycle of Being Over-activated & Under-slept... and what to do about it.

“The best bridge between despair and hope is a good night’s sleep.” 
- E. Joseph Cossman (American inventor, businessman, & entrepreneur)

“I sleep like a baby - I’m up every two hours.”
- Billy Crystal (comedian, actor)
 

As compelling, truthful, and even heartwarming as the first quote might be, sentiments like this don’t often get very far with an over-caffeinated, overworked, and underslept crowd - which I will admit, includes myself (and possibly, the majority of you all reading this newsletter). We’ve heard it a thousand times. First from our mothers, then from our teachers, and now from every mental health professional who circulates the internet. I can hear the cries of readers coming through my inbox now: “We know, we know! Just get off of it already!”

More than likely, it's the second quote which echoes how most of us feel about sleep. According to experts, more than 40 million Americans are currently suffering from a diagnosable form of insomnia, and if we slightly loosen the strict criteria for diagnosis, we’re looking at roughly every two out of three Americans having trouble regularly getting to sleep or staying asleep... but, c’est la vie, that’s life - right? You snooze, you lose. At least that seems to be the attitude that our western sensibilities demand. However, when you start to look at how different facets of cognitive, emotional, and physical health interact with sleep (and particularly the lack thereof), a bigger picture begins to emerge, one that looks a lot like we’ve neglected a cornerstone to happy, healthy, and lengthy living.

Mental health researchers have known for decades how disastrous poor sleep can be for disorders like anxiety or depression (disrupted sleep is a facet of almost every diagnosable mental health disorder, as defined by the DSM 5), but have largely failed to inform people of the mechanisms behind this interaction, as well as the true extent to which they put their health at risk for sacrificing sleep.  As I have come to find out - thanks in part to the prolific research of Mathew Walker, PhD, sleep scientist and self-titled Sleep Diplomate - the consequences of this error in thinking reach far beyond what I would have ever imagined. For example, when sleeping roughly 5 hours a night, which many of us might classify as “enough,” the brain and body enter a state in which we are much more likely to develop or maintain high blood pressure, relapse on drugs or alcohol, have a heart attack, develop Alzheimer’s disease, or commit suicide (Why We Sleep, 2017). 

It’s shocking to hear that such damage can come from what seems like a relatively benign sleep deficit, but over time things add up - anything under regularly getting 7 hours a night and we begin to enter a state of ‘chronic sleep restriction,’ the effects of which can take years to come back from. ‘Sleep deprivation,’ however (which modern society also regularly practices) is less of a slow burn, and more of an out of the frying pan & into the fire type scenario. After only 16 hours of being awake, many of us will begin to perform similarly on a cognitive assessment to someone who is legally drunk (bringing up major implications for public health and motor vehicle accidents), and for night-shift workers who stay awake while the rest of us are tossing and turning in bed, the likelihood of developing cancer increases significantly, so much so that the CDC is now classifying this particular work shift as a probable carcinogen.

As if all this wasn't bad enough, we have also been proven to be quite terrible at assessing how sleep deprived we actually are (as well as assessing our own cognitive abilities) while in a sleep deprived or chronically sleep restricted state. “With chronic sleep restriction over months or years, an individual will actually acclimate to their impaired performance, lower alertness, and reduced energy levels,” (Why We Sleep, 2017). This acclimatization process from chronic sleep restriction brings to mind the myth about the frog being dropped into a pot of boiling water only to jump right out, versus being dropped in tepid water which is slowly brought up to a boil. In the latter scenario, the frog fails to notice the change due to a slow and steady acclimation - and also because it has easy access to the finer things in life, like caffeine, sugar, and interactive technology. As unlikely as it is that this whole frog scenario would prove out in real life, it seems an uncanny metaphor for the frighteningly real issues we are facing in regards to sleep. 

Already tired of talking about sleep?

Let’s switch gears for a moment and discuss another common thread which has been shown to connect different aspects of mental illness and disease - the sympathetic nervous system. You’ve likely heard of the fight or flight state, in which our nervous system mobilizes different resources and stress hormones in order to help us be on high alert for any threats in our environment. This heightened state of alertness is known as being in a “sympathetic” state, or being “sympathetically activated.”

The inverse of the sympathetic state, in which the nervous system shuts down our stress response to give our brains and bodies the opportunity to digest, sleep, and recover, is known as being in a “parasympathetic” state. Think of it in terms of a light switch. Above the switch is a piece of scotch tape with the word “sympathetic” scribbled on it; below the switch, a piece of tape which reads the word “parasympathetic.” Ideally the switch is in the ‘on’ position for short periods of time when we need to assess real threats or find our way out of dangerous situations. Once we are out of said danger, the switch flips to the ‘off’ position for much longer periods of time so that we can relax and recharge, preparing for the next short burst of exertion we might need. The problem is, we seem to have a particularly tough time finding the “off” position to this stress switch. (For a more detailed discussion of this dynamic, check out this article from Harvard Health.)

As we’re finding out, many different things can push us into a sympathetic nervous state: a significant or traumatic event, being overworked, too much stress or conflict at home, excessive screen time, or - coming full circle now - being sleep deprived. One can imagine how easily this dynamic can become a vicious cycle. While sympathetically elevated, we have a terrible time getting to, and staying, asleep. Consequently, insufficient quantity or poor quality of sleep makes it more likely that we will continue to stay sympathetically activated. “With few exceptions over the past half century, every experiment that has investigated the impact of deficient sleep on the human body has observed an overactive sympathetic nervous system,” says Walker. This cycle has been implicated in the high number of Americans dealing with insomnia, as we have found that one of the side effects of a sympathetic nervous state is the anxious and intrusive thinking which blocks the onset of sleep.

Although constant sympathetic activation might not necessarily sound appealing, having high levels of norepinephrine and cortisol in your system can make you feel alert and focused - especially if you are sleep deprived or chronically sleep restricted. In the case of poor sleep, being sympathetically activated actually might feel like an improvement over the alternative of lethargy, and while being in a sympathetic state doesn't lead to real focus (it leads to vigilance, which we often get confused with focus), it sure beats being lethargic and foggy when you have to complete your to-do list, pick your kids up from soccer practice, or meet your homework deadlines for school

The physical effect of this prolonged state of alertness can be seen in a higher resting heart rate and higher blood pressure, resulting in strained blood vessels. Regularly sleeping less than six hours a night can leave you 200-300% more likely to have calcification of the coronary artery over the next five years, increasing your chances of heart attack. As noted in the introduction, cancer in night-shift workers is also being linked to this interaction between sleep and the sympathetic nervous system, due to the body's heightened immune response while in this state. An immune system stuck in a heightened alert state will produce unnecessary amounts of inflammation, which not only plays a role in cancer, but many other facets of physical and mental health. 

Less frightening, but equally devastating, are the impacts of insufficient sleep on cognitive and emotional functioning. Many of us know “how we can be” when we haven’t gotten enough sleep - more irritable and on edge, and less empathetic and patient. Generally speaking, we become frustrated spouses, reactive parents, and inattentive friends. As it turns out, this transformation in personality isn’t merely a dramatic display of our preference for sleep being violated. Rather, a very significant shift takes place in the functioning of the under-slept brain, making us much more likely to behave and react in an unpredictable manner. “Analysis of the brain scans revealed the largest effects I have measured in my research to date,” reports Walker. “A structure located in the left and right hemisphere, called the amygdala… showed well over a 60% amplification in emotional reactivity in the participants who were sleep deprived.”

If that weren't enough, the scans also revealed that the prefrontal cortex (the part of the brain responsible for many aspects of executive functioning, including impulse control) decouples from the amygdala and other brain structures in the underslept brain. It’s as if the lock which securely holds the caged lion back has been broken by setting one's alarm too early, or getting to bed too late. Being sympathetically activated, the lion will either fight, run, or freeze. These three choices tend to play out in ways you would expect, ranging from the careless and unfortunate, to the tragic and irreversible.

So what are we supposed to do about our overactive nervous systems and sleep restricted nights?

Here are a few Action Steps, Interventions, and Resources you can use to help break the cycle.

Action Steps

• Always give yourself a non-negotiable eight hour sleep window.
• Wind it down: There’s a reason we turn off the burner before we leave the stove. Unfortunately, we don’t practice the same thing with our brains and bodies most nights. Create a wind down routine that starts 30-60 minutes before your desired bed time that involves increasingly less amounts of stimulation. If you want to stop waking up at 1am with racing thoughts, don’t check your work email one last time before bed.
• Limit light (at night): Most of us have heard about limiting blue light, but the reality is that any light coming into the eyes at night will suppress your brain's natural ability to bring on sleep. Around two hours before your desired bedtime, go through the house and start turning off half of the lights in your space. The one-hour mark should be when all screens go off for the night.
• Engage a practice: Sometimes simply limiting external stimulation isn't enough to turn the mental ‘burner’ off, as it were. To take things to the next level for sleep preparation, engaging in a mindfulness or meditation practice right before bed can really seal the deal, especially if you're trying to calm the nervous system. Apps like Insight Timer have many guided sleep meditations that can help push the needle in the desired direction. You can also find many Yoga Nidra (Yogic sleep) practices readily available on YouTube, like this one. Find a quiet and comfortable room, pop in your headphones, close your eyes, and follow along.
• Stop wearing your shades in the morning: Bright sunlight coming through the eyes in the morning is the second half of the light equation. In the morning we use bright light to tell our brains that it is time to be awake and alert, which helps solidify our circadian rhythm. Think of it as setting the ‘count down’ timer for sleep at the appropriate time. (don't look directly at the sun or use any direct light source that can hurt or harm the eyes, simply being outside or opening a window is enough)
• For the occasional time when using your phone after hours is absolutely necessary, here is a link for Apple users showing how to activate “night shift” - a mode on your phone which blocks blue light for you. You can schedule night shift to automatically come on at certain hours of the day. I would recommend setting it to turn on just after sunset, and turn off just after sunrise.

Interventions

Using targeted, non-invasive neuromodulation protocols, Aspen has had very high success in being able to take people out of a sympathetic nervous state, and into a parasympathetic nervous state. If you believe your nervous system might be stuck in the “on” position, and the action steps below seem ineffective or too difficult to carry out, our process might be right for you.

(look to the bottom of this newsletter for more information on how to begin this process)

Resources

• Andrew Humberman is a Neurobiologist teaching at Stanford University. Apart from teaching and doing research, he also makes a pretty darn informative podcast. Here is his episode on mastering sleep through evidence based behavioral modifications. 
• Do yourself a favor and get the paperback or audio version of Matthew Walker’s groundbreaking book Why We Sleep. There are just some things in this world that once you learn, you can’t unlearn - and his book is chock-full of them.

Sometimes getting to sleep or feeling calm enough to rest can feel unattainable or out of reach.

Action steps like intentionally winding down at night limiting your light intake can be amazing tools to begin the process of getting better sleep, but sometimes we need more neurological, cognitive, and therapeutic support to have real success. Our faculty of seasoned neuro and talk therapists specialize in helping people with insomnia, sympathetic activation, addiction, depression, anxiety, trauma & grief, and much more. Our human experience is so complex and stressful, and especially during times like these, it is helpful to have a treatment team that can come alongside you.  

To schedule your appointment and get more information, call us today at (970) 281-7872 or visit aspenneurofeedback.com to get started. 

John VanDeGrift, Director of Neurotherapy

Aspen Neurofeedback