The Sleep Experiment: Overview

Sleep is one of the most often overlooked issues in medicine.  This is largely because it is not easy to treat it with medicines and the current model for primary care in the US is largely medication based.  Most offices do not have the time or expertise to properly treat insomnia and sleep disturbance.  This is a shame because good sleep is an extremely powerful lifestyle intervention.  Adequate duration, high quality sleep has been shown to be effective at managing weight and reducing food cravings, reducing anxiety and depression, improving metabolism and reducing cardiovascular risk itself.  Further, we sometimes think of good sleep as the “mother” of all other interventions.  When you sleep well, you exercise more and snack less.  We have placed the sleep experiment as the 5th stage of our program because eliminating junk food and initiating exercise programs are effective and quick ways to jump start your metabolism.  But in some cases, we start with the sleep intervention so that we can jump start those other things.

When trying to improve your sleep, the thing to remember is that sleep is a passive process.  This is the one element of your lifestyle program that gets worse, the harder that you try to do it.  As an exercise, try laying down in bed before your typical bedtime and focus on falling asleep as hard as you can.  Of course, I am being a little bit tongue in cheek here because you know intuitively that this would not work.  The more that you focus on trying to make yourself fall asleep, the worse it will go for you.  So, instead of doing that, in the sleep experiment, we are going to try and create the ideal conditions to feel sleepy at just the right time in the evening when your body will naturally want to fall asleep.

Your body has 2 independent processes that determine how sleepy you feel during a 24-hour period.  The first process is called your sleep drive.  The sleep drive is determined by a specific neurotransmitter that builds up throughout the day.  That neurotransmitter reaches its peak in the evening right around your ideal bedtime.  When you fall asleep, that neurotransmitter immediately begins to drop until it’s lowest point just before you wake up in the morning.  The second process is called your wake drive.  The wake drive is mediated by a center in the brain.  It rises and falls on a 24-hour cycle that is linked to your body’s biological clock.  Thus, in a 24-hour period there is an ideal time to fall asleep when the sleep drive is at its peak and the wake drive has begun to fall based on its 24-hour rhythm.  There is also an ideal time to wake up and become active.  So, the goal of our sleep experiment will be to optimize the conditions for sleep by focusing on 5 main concepts:

1.      Evaluate the potential for sleep disorders and associated problems.  Reduce dependence on sleep aides.

2.      Remove obstacles to a healthy night of sleep like caffeine, alcohol, and marijuana.

3.      Create the ideal bedroom environment for a healthy night of sleep by optimizing temperature and reducing sleep anxiety.

4.      Develop an action plan for what to do if you awaken from sleep.

Optimize timing to get into the ideal sleep zone and use natural light and exercise to increase sleep drive throughout the day.