SBB: So what are some of the most dangerous misconceptions about sleep?
SV: People who are desperate to get good, quality sleep will sometimes take anything. Perhaps someone might take a combination of sleeping pills, opiates and alcohol because they are desperate to get a good night’s sleep. But there’s no such thing as medicated sleep that actually works as well as natural sleep…
Alcohol is actually one of the things that messes up people’s sleep more than anything else. The first thing I always tell patients is just to do a test: Take yourself gradually off of any alcohol, day or night and then see your sleep quality. Do you have to get up as frequently in the nighttime to go to the bathroom? Are you awake less at night? Do you end up feeling more refreshed in the daytime? Those are just things to think about. It won’t make a difference for every patient, but it makes a huge difference for many, and the same would be true for opioids, slowly wean and then reassess sleep quality.
SBB: How important is it to go to sleep at the same time every night?
SV: There are two major influences regulating sleep in healthy people. One is circadian — it is the right time for you to sleep. A young person might sleep best from 2 AM until 10 AM. For older people, it may be earlier. But there is a real circadian clock that has set the best time for you to sleep. At the same time, there is a circadian pro-wakefulness influence that will inhibit your sleep. For example, it would be nearly impossible for me to sleep in the daytime. The other part that makes a big difference is the homeostatic factor. The longer you have been awake, the greater the drive to sleep. Taking naps in the afternoon blunt this drive and lessen sleep depth at night. On the other hand, if you are having difficulty falling asleep, take advantage of homeostatic drive and go to bed later and spend just 7 hours in bed.
No one has really done a study that says your bedtime has to be within an hour or within two hours every night. You sometimes hear advice like: Pick a bedtime, and that’s your bedtime for the rest of your life and you think: come on, is that really realistic?
If you think about sleep as being on this circadian rhythm, with homeostatic drive going up on a gradual slope, there’s not going to be a window where you have to get to sleep within an hour each night or it’s not going to work. You have some flexibility in time on either side of a two hour window for going to bed, but you do not have a six-hour window.
SBB: What about light? What’s the impact of light on sleep?
SV: There are acute and chronic effects we believe. The acute effect is that light at the lower frequencies can be directly alerting and can also shift circadian time at different points of the 24-hour circadian cycle. During parts of your circadian cycle, any extra hours of light will suppress melatonin, so that your overall melatonin levels are lower. When you have less melatonin, you can have less of an ability to fight off certain cancers and also have fewer antioxidants. There is indeed a health component to sleeping in darkness — that is, real legit darkness.
Dr. Ulysses Magalang of Ohio State University found that just having a nightlight in the room actually increased insulin resistance and increased weight in humans and does the same thing in mice—it turns pre-diabetic mice into frank diabetic mice. That little teeny bit of light can be enough to knock down really important rhythms and profoundly influence health.