The Best Sleep Advice - According to Science (Patreon)

[This is a transcript with links to references.]

You’ve all heard that sleeping problems are called “imsomina” but have you heard of “orthosomina”? “Ortho” is the Greek word for straight or correct, and ‘somnia’ means sleep. The term “orthosomina” was coined a few years ago by a group of sleep researchers from Chicago. It’s when people worry about not getting the perfect sleep, an issue that’s been driven by sleep trackers. And along with that, a lot of sleep-advice has sprung up on social media.

For example, if you trust this guy on tiktok, which maybe, just maybe you should not, then pushing this point below your wrist will make you fall asleep. Or maybe those two other points on your palm. Or take magnesium. Elevate your feet? Sleep on your right side, presumably with your feet elevated? That sounds kinda painful. Or maybe try hypnosis. Or something with chamomile. And if none of that works, doesn’t matter because you can live with only two hours of sleep anyway!

Yeah, right.

What do we really know about sleep and what helps with sleep problems, according to science? That’s what we’ll talk about today.

If you came here because you can’t sleep, you’re not alone. Sleep disorders are incredibly common. About 30 percent of adults report at least some insomnia problems. For about 10 percent, insomnia becomes a chronic problem, that’s when it affects them at least three nights a week for at least three months. There are many other sleep problems such as interrupted breathing, but today I’ll only talk about insomnia.

Insomnia can cause a lot of health issues. That’s because it’s during sleep that the brain clears out waste products and builds memory. As a consequence, chronic sleep deprivation can cause neurons to die and increases the risk of dementia.

The issue is not just your brain. Sleep deprivation has been found to trigger heart arrythmia, and is correlated with lots of other health problems, from anxiety and depression to high blood pressure to obesity. Through in all those cases the causation might go both ways, good sleep is clearly a good idea.

Indeed, the most reliable health advice that doctors crank out is: watch what you eat, exercise, sleep well. But while you can watch your diet and work out regularly, good sleep is not a matter of willpower. It’s very much a psychological thing and worrying about it can make it even more difficult to go asleep.

Popping pills can put you in some sort of sleep, but at least the sleeping aids that currently exist don’t restore brain functions remotely as well as natural sleep. Sleeping aids are good for temporary problems, like getting through a period of grief, but are not a permanent fix. Likewise, drinking coffee or taking stimulants can help you function better in the moment, but in the long run, they can’t make up for good sleep.

You could try watching some quantum mechanics lectures on YouTube, but these too have negative consequences for your mental health, such as sudden obsessions with theories of everything, so I wouldn’t recommend that either.

Sleep trackers are now contributing to people’s worry that they’re not sleeping enough, and so are scientists who have found that sleep trackers tend to systematically overestimate how much sleep you really get. Now add to this that another study found that people’s well-being falters if they believe they slept less, even if they didn’t, and there’s a real possibility that I just caused you some sleepless nights.

This of course is the last thing I want, unless you spend your sleepless nights binge-watching my channel, in which case please continue. If not, well, what can you do?

Since sleep is so much psychological, a big part of getting a good night’s sleep is to have realistic expectations about what good sleep is to begin with. So let’s talk about what to expect.

I used to think that good sleep means closing my eyes and waking up eight hours later, a feat I haven’t succeeded with since I learned to walk. I wake up around two or three in the morning most nights, and sometimes I can’t go back to sleep because I worry that I woke up that early!

It wasn’t until last year, yeah, I know this is embarrassing, but it’s true, that I learned it’s totally normal to wake up in the middle of the night.

You see, sleep proceeds in different phases. There’s light sleep, that’s the sleep with rapid eye movements, REM for short. Then there’s an intermediate phase and then there’s deep sleep. But the deep sleep doesn’t last the entire night. One cycle of REM to deep sleep and back might take two to three hours, and we do two or three cycles per night. It’s fairly common to wake up in the light-sleep phase in between, and then go through another cycle.

The next thing to know in terms of reasonable expectations is that how much sleep we need differs wildly from person to person and also throughout life. Among other things, it depends on genetics, age, lifestyle, and overall health.

The typical sleep duration for adults is between seven to nine hours. People who regularly get 5 or fewer hours of sleep are likely to pay for it by declining mental and physical health. However, there are outliers to both ends. Some people need less, some need more than the recommended seven to nine hours. And older adults generally tend to sleep less than younger ones. Like getting older in general, this may not be a good thing, but it’s normal.

It’s also normal to move around somewhat during sleep. The average sleeper moves around 40-50 times a night, and also those weird jerky movements that you sometimes get just before falling asleep are normal. Not being able to recall your dreams is normal, too, and it’s not a sign of either good or bad sleep.

Not normal, however, is the ability to fall asleep anywhere, anytime. It’s called “hypersomnia” and rather than being a sign of healthy sleep, it’s more likely a consequence of chronic sleep deprivation.

A few months ago, a group of sleep researchers look at sleep information and misinformation on TikTok and YouTube. They found that misinformation was widely more popular. The misinformation averaged more than 8 million views per video, while correct information from experts averaged just about three hundred thousand. Yeah, I feel that.

The problem isn’t that experts are generally bad at making videos, at least I don’t think so, the problem is that the truth is boring. And the truth is that there’s no miracle cure for insomnia, no magical button on your wrist to push.

There are a few things that sleep experts say reliably benefit sleep, but they make for poor clickbait.

First and most importantly, your brain didn’t evolve for streetlights and engine noise, so try to sleep in a dark and quit place. Eye covers and earplugs are your friends. There’s also that the body temperature slightly decreases at night, and a warm room can interfere with that, so keep it cool. The US National Sleep Foundation, recommends bedroom temperatures between 18 and 21 degrees Celsius. And keep if well ventilated too because a recent study has found that helps a lot with sleeping through the night.

Next issue is that your biological clock doesn’t know anything about weekends, so try to go to bed and get up each day at the same time.  

Also, that might sound odd, but try to sleep at night. You know, when it’s dark outside. Research on night shift workers has shown that sleeping during the day means on average less sleep and lower sleep quality, and it brings a higher risk of health problems, including depression, diabetes, and breast cancer.

Finally, try to be physically active during the day. Don’t worry if it gets late, several studies  have found that exercising late does not impair sleep.

Then there are the don’ts. First, avoid watching anything on a screen at least one hour before sleep. It’s both because of the blue light that signals your brain to stay alert, and because new information generally keeps your brain active . Though I guess some videos keep it more active than others.

Avoid heavy meals just before bedtime and don’t overdo it with alcohol either. Studies have found that while alcohol makes it easier to fall asleep, it disrupts sleep in the later stages of the night.

Another don’t is that if you can’t sleep, don’t stay in bed. Sleep researchers have found that it’s better to leave bed and return only when you’re tired. They say that makes it easier to fall asleep and improves overall sleep quality. And no, just lying in bed with your eyes closed doesn’t clear your brain the same way as real sleep does, more likely it’s going to drive you nuts.

Besides the do’s and don’ts there are a few so-sos, you know, the kind of thing that’s not great but better than nothing. For example, taking a nap in the afternoon. It can be beneficial to recover from acute lack of sleep, but don’t make a habit of it. If you have a chronic sleep problem, avoid napping, because it’s not the ideal match to a normal biorhythm. So, you know, be smart about it.

The same goes for catching up on sleep on weekends. A study that followed more than 43 thousand adults in Sweden found that catching up on sleep on weekends does a good job preventing health problems. But again, if you have sleep problems already, try to avoid it.

Generally, if your sleep problems are only occasional and not chronic, don’t worry too much about it. While one night of sleep deprivation does cause some immediate problems, such as decreased cognitive performance and an increased risk of cardiovascular problems, scientists have found that once you get a good night’s sleep, cognitive performance and health risks return to baseline.

Ok, so that was a pretty boring list of dos and don’t’s. Isn’t there a tech fix? You know, something you can buy to solve the problem?

Sleep devices are hugely trendy. According to the Global Market Institute, the sleep device market has made over 17 point 9 billion dollars in 2022 and it’s projected to reach more than 95 billion in 2032.

Alongside sleep trackers, especially white noise machines have gained popularity. That the noise is white means that the spectrum of frequencies it contains is flat. There are many natural soundscapes that are close to white noise, for example wind in the trees or falling rain.

It’s a consistent sound that can mask disruptive noises, and that makes it very soothing. It’s plausible that it could create a more conducive environment for sleep. However, the plausible ideas are the ones you need to be most careful with. And indeed, in 2021, a group from the University of Pennsylvania reviewed the scientific studies on the topic. They concluded that the evidence that white noise aids sleep is of poor quality and insufficient.

Some companies are selling other noise machines with slightly different spectrum, called pink or brown noise. Those haven’t been studied for their effects but I’m kinda sceptical. There’s also recently been a study that found that glasses which filter blue light don’t improve sleep quality. So maybe better save the money and support your favourite YouTuber instead.

There are a lot of other funky high-tech sleep devices. For example smart pyjamas embedded with sensors to track changes in posture, or robot pillows that mimic a breathing patternto help induce sleep. But there’s no scientific evidence that they actually help you fall asleep or sleep well.

Even more futuristic, scientists are exploring the possibility of dream management. Yes that’s right, they’re looking for ways to program your dreams. In 2020 a group of researchers at MIT  outlined ways of using sounds and virtual reality to influence what dreams you dream. It won’t be long, and you’ll have to pay for ad-free dreams.

In summary, the scientifically sound sleep advice is the boring one. Sleep in a cold, dark, quiet room. Keep it well ventilated. Go to bed every day at the same time, don’t binge right before bedtime, cut back on the booze, and keep your hands off your phone. Given that I don’t really follow any of that advice, I now think it’s a miracle I don’t sleep far worse than I do and feel much better. I wish you sweet dreams.

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