In my experience, you can have the best diet in the world, have the best exercise program and be free from emotional stress, but if you aren't sleeping well, for whatever reason, it is virtually impossible to be healthy.
But how much sleep do you need for optimal health?
In this interview, Dr. Rubin Naimani -- a clinical psychologist, author, teacher, and the leader in integrative medicine approaches to sleep and dreams—sheds light on this question.
Dr. Naiman earned his Ph.D. in Clinical Psychology at Alliant University in San Diego.
During the 1990's, he served as the sleep and dream specialist at Canyon Ranch Health Resort in Tucson for 10 years, where he created the first formal sleep laboratory outside of a hospital setting.
Dr. Andrew Weil was also on the staff at that time. Later, he served as director of sleep programs for Miraval Resort. In a previous interview, we discussed what sleep actually is, the spiritual dimensions of sleep, the primary causes of insomnia, and why sleeping pills are not the answer. Here, Dr. Naiman delves into several of the most frequently asked questions about sleep, starting with:
How Much Sleep Do You Need?
Over the years, I've come to a conclusion that there is no perfect answer to this question because like everything else, the answer depends on a large number of highly individual factors. The general consensus seems to be that most people need somewhere between six and eight hours of sleep each night.
There's compelling research indicating that sleeping less than six hours may increase your insulin resistance and risk of diabetes. And recent studies show that less than five hours of sleep at night can double your risk of being diagnosed with angina, coronary heart disease, heart attack or stroke. Interestingly enough, the same appears to be true when you sleep more than nine hours per night.
The question of the ideal amount of sleep is a topic Dr. Naiman has addressed on numerous occasions throughout his career as a sleep expert, and he agrees; people want a number, but this 'number' must be as individual as the person asking for it.
"I think asking 'how many of hours of sleep should I get?' is like asking, 'Doctor, how many calories should I eat?'" he says. "Of course the answer to that depends on who that person is. It's so individual. It also depends on the quality of those calories. Again, a lot of people are knocking themselves out night after night after night with sleeping pills. They may be getting seven to eight hours, but is it sleep? It looks like sleep. It might feel like sleep, but you know what, it's not really sleep. That's part of the question too—the quality of it."
Insufficient Sleep Puts Your Health at Risk
Dr. Naiman is familiar with the studies showing increased health risks when you sleep more or less than a certain amount, but is still cautious about taking these findings as the final word on the matter.
"There is really interesting data," he says. "I think the data is very strong showing that if you don't sleep enough, you're in trouble."
However, it's important to differentiate between occasional lack of sleep, and a chronic pattern. Everyone loses sleep here and there, and your body is typically resilient enough to allow for that. However, when poor sleep becomes a constant, there's no question your health may be at risk.
"The American Cancer Society did a study of a million American adults, and short sleepers showed a dramatic increase in risk of cancers across the board," Dr. Naiman says. "So we know that there is a mountain of data showing if you don't sleep enough, you're going to get yourself sick...
The other end of it, I think, is a little more suspicious. When you say people are sleeping too much, questions arise like 'why?' It may be that in some of those studies they don't have frank illnesses. These are people who don't qualify clinically as having diabetes or heart disease. But they may have metabolic syndrome; they may have very early stage of underlying chronic inflammatory process."
Potential Causes for Sleeping "Too Much"
One of the first indications that you may be getting sick is that your body tries to rest, as sleeping helps strengthen your immune system. So chronically sleeping longer than the average eight or nine hours could be an early indication that you have an underlying illness your body is trying to recover from.
However, the need for more sleep could also be an individual requirement, or even a sign of your body being in tune with a more natural rhythm…
"The data suggests that if you go back 100 years, people were sleeping an average of nine hours a night," Dr. Naiman says. "People also had a very different relationship with sleep at that time. Sleep patterns were very different. It was routine that people woke up in the middle of the night for about an hour or two. It was called night watch. Everybody did it. People also slept during the day.
Think of the Yin and Yang; the white wave representing in this case waking; the dark Yin wave representing night and sleep. There is a dark Yin sphere within the white wave. This is a place of rest in the middle of waking consciousness and natural rhythms. In the middle of the dark Yin wave, there is a place of Yang, a white sphere suggesting that there is a place where awareness, a kind of waking, awareness in the middle of the night.
When we lose sight of that, we overreact to two things. We tend to overreact to being sleepy during the day, and we tend to overreact to being awake at night. And overreactions cause anxiety."
To Nap or Not to Nap…
According to Dr. Naiman, we're actually biologically programmed to nap during the daytime, typically in the middle of the afternoon. Some European countries still adhere to the daily siesta and close shop for a couple of hours in the middle of the day when the heat is also at its most pressing. Most employers in Western countries, however, do not accommodate daily snoozing, so when the natural tendency to get drowsy sets in, you may try to alleviate it with coffee, or simply fight the urge to take a nap.
The problem is, you're now training your body to resist the urge to sleep, which can then lead to being unable to easily fall asleep at night.
"Also, in the middle of the night, when we falsely assume that any kind of awareness is pathological inside, people get up and go, "Oh crap, its insomnia." I've asked hundreds and hundreds of people over the years… "What's the first thing that comes to your mind when you wake up in the middle of the night?" The most common answer I've gotten over the years is, "Oh, sh*t." People wake up and they curse their wakefulness."
However, as Dr. Naiman explains, occasional waking in the middle of the night, perhaps as many as five times, is actually completely normal. You may pull up the covers or fluff your pillow, then go back to sleep.
"[But] when we learn this automatic judgmental reaction to wakefulness; as soon as there is a spark of it and we judge it, we spin out," he says.
Another common reaction is to look at the clock.
"Patients have actually said to me, "Gosh, I wake up, I get exactly 2:20 every morning." …It's the first thing people—they want to anchor in waking consciousness. They want a sense of control over this ephemeral night consciousness. This addiction to numbers is the problem.
There are nuances with sleep just as there are with waking. There are so many different ways of being awake, different kinds of experiences. Light sleep is fine. Being half awake and half asleep is fine. In fact, I really believe that in any moment in time during the day and at night, it's a mixed percentage. Right now, you and I are talking; we're probably 98 percent awake. I'm just making up a number. There is a restful part of us. We might say we're 2 percent asleep. Closer to bed time it might be 50/50.
What we call being sleepy is being 'part of awake, part asleep.' In the middle of the night when we get up to use the bathroom, we might be 95 percent asleep still and 5 percent awake just to find our way there. We need to allow a mix of these different forms of consciousness."
Guidelines on Optimal Amount of Sleep
Dr. Naiman's recommendation is to simply sleep "enough hours so that your energy is sustained through the day without artificial stimulation, with the exception of a daytime nap." I agree with this functional description rather than trying to come up with a specific numeric range. I would add to that guideline, however, the suggestion to watch out for physical or biological symptoms.
For example, when I push myself and don't get high quality sleep or enough sleep, I'm predisposed to postprandial hypoglycemia. In other words, I have low insulin resistance so when I sleep poorly, it doesn't take much sugar or carbs for it to be easily metabolized and drop my blood sugar—which also makes me really sleepy.
When I get enough sleep, I'm far less susceptible to it.
Dr. Naiman also discusses this, stating that there's solid data showing the connection between insulin resistance and sleep. When participants slept three or four hours less than normal for just a couple of days in a row, they saw a dramatic spike in insulin resistance.
Can You Catch Up on Lost Sleep?
This is another area fraught with confusion. Can you make up for lost sleep by sleeping longer on certain days? According to Dr. Naiman:
"First of all, you can't really bag sleep any more than you can bag oxygen. We just need to replenish it. If you're well slept, you'll be more resilient… If you've under slept and you throw in jetlag on top of that, it gets a lot worse.
In terms of making up for sleep, it is a very common pattern in our world that people short sleep during the week and then sleep in [on the weekend]. It's considered delicious. For me, it's kind of funny. It's like starving yourself during the week and then pigging out on the weekend. It's not the best way to eat, as we know.
You can make up for some lost sleep on the weekend but here is the price: it throws off your circadian rhythm.
Again, the infrastructure of our sleep is this rhythmic drum beat of day and night, of light and darkness, of sun and melatonin and so on. What most people do on the weekend is actually go to bed later and sleep in much later. You really confuse the poor brain. It's almost like shifting it to another season. It's almost like a little bit of stationary jetlag. You're yanking your circadian rhythm around. It's not something that's recommended."
Which brings up the issue of shift work. How does working nights, or worse, alternating between night- and day-shifts affect your health and well-being?
How Shift Work Affects Your Health
The data is quite clear on this point: Engaging in shift work dramatically increases mortality. According to Dr. Naiman, shift work can decrease your lifespan by about seven years on average! Gastrointestinal disorders are also more common among shift workers.
"The yanking back and forth of the circadian rhythm confuses the body about when to eat, when to digest. Those are some of the early signs," Dr. Naiman warns. "We see dramatic increases in depression among shift workers and then we see a slew of other diseases that are associated with compromised immunity. So if you can, avoid it all.
There are things you can do if you need to do shift work. One is stay on the same shift for a stretch of time. It's much harder to yank back and forth. You can create a prosthetic environment. You're basically turning day and night upside down."
According to Dr. Naiman, preliminary data shows that if you increase your melatonin levels during your night shift—effectively turning it into an artificial day—you can minimize some of the detrimental effects of working during the night. You can find melatonin supplements, either in pill or spray form, in virtually every health food store.
"So you make your night into day and your day into night. When you're driving home from work, you put on a pair of sunglasses. You don't want that light telling you it's time to get up. You cover your windows with aluminum foil and you create an artificial night. You disconnect the phone. You do anything and everything to recreate night so that you can sleep. You use melatonin again at that time. You try not to shift back and forth."
Sleep Timing—Does it Matter?
A common natural health understanding is that every hour of sleep before midnight is equal to two hours after midnight. But is that true? According to Dr. Naiman, this notion is likely more metaphoric than factual.
"[R]oughly the first third to first half of sleep is when we get most of our true deep sleep," he says. "… We spend most of the first part of the night truly sleeping, most of the latter part of the night dreaming… In Chinese medicine, they say the best time to get to sleep is roughly 9:00 or 9:30 pm… roughly a couple of hours after sunset, when there have been enough melatonin raised in our brains that will naturally put us out… [But] I've never seen really hard scientific data. I've seen a lot of anecdotal experience. And there is data that suggests that there is a window of heightened opportunity for falling asleep, which can vary depending on your personal circadian rhythm."
The most important aspect of sleep timing appears to be the consistency of going to bed at the same time every night.
Dr. Naiman covers a lot of ground in this interview, so to learn more, please listen to the interview in its entirety, or read through the transcript. He also has a great website, www.DrNaiman.com, where you can read more about all things sleep related. You can also find information about his lectures, which is a wonderful way to learn more about the mystery of sleep, and the most effective solutions.