Stress Management, Well-being and Self-Care

clock reads 3:41 AM woman laying awake

Sleep, Sleep Medicine and Stress. Part 1

by James Porter February 12, 2021

This is the first installment of a six-part series on sleep.

I’ve read numerous books on sleep, produced movies on sleep (The Nature of Sleep), produced a CD on Sleep, (Overcoming Stress Related Insomnia) interviewed experts for a podcast on sleep, I exercise daily, I meditate, I consume almost no caffeine and despite all of this, I still have difficulty sleeping. Sometimes I wake up in the middle of the night, after about 5 hours of sleep and find it hard, if not impossible to go back to sleep after that.

Sleep is still largely a mystery. No one really knows why we sleep, exactly how much sleep we need, and what the best ways are to treat insomnia: Did you know that, on average, you only get about 30 minutes extra sleep a night when taking a sleeping pill? Did you know that your insomnia medication may disturb your natural sleep cycles, depriving you of REM sleep? And finally, did you know that in rare cases, sleeping pills can even produce scary side effects that include morning amnesia, sleep driving, having sex while asleep and an increased risk of suicide?

Sleep is a relatively new science. I was shocked when a doctor friend of mine was promoted to being the head of a sleep disorder clinic at a well-known hospital in Connecticut. At that time, he knew virtually nothing about sleep medicine. As he explained it, sleep medicine is not a subject that was taught in Medical Schools (in his day) and his background in internal medicine, was all he needed to qualify for the job.

Stanford professor Dr. William Dement, who was considered the world’s foremost sleep expert, (until he died at age of 91 in June of 2020) alludes to this fact in his book THE PROMISE OF SLEEP. Dement, who was both a Ph.D. and an M.D. just happened to be studying medicine at the University of Chicago where his mentor Dr. Nathaniel Kleitman just happened to be doing research on what would come to be known as sleep cycles (or stages of sleep). And as a result of this happenstance, Dr. Dement wound up becoming the world’s first expert on sleep. He basically just stumbled into this line of work, just like my doctor friend.

Now if you don’t know much about sleep cycles that’s a good place to begin talking about sleep and insomnia. Nobody really sleeps soundly, straight through the night (even if you think you do). There are periods of deep sleep, followed by periods of light sleep, followed by periods of REM sleep (Rapid Eye Movement) where dreaming occurs, followed by periods of wakefulness (whether we realize it or not). All these stages are usually packed into one, roughly 90-minute cycle, that repeats throughout the night.

You can now buy a Fitbit costing less than $100 that will track your sleep cycles throughout the night and, when hooked up to your phone the next morning, will show you exactly what your sleep cycles actually look like.

The first half of the night is mostly devoted to deep sleep. The last 3-4 hours of a so-called “normal” 7 or 8-hour night are devoted mostly to REM sleep (Even though you go through all the stages of sleep every 90 minutes you get much more deep sleep in that 90-minute cycle the first half the night and much less REM sleep. (You can clearly see that on the graphic below.)

Conversely, you get more REM sleep and less deep sleep toward the end of your rest period. (My REM sleep doesn’t even register in the early sleep cycles but is clearly there in the later ones.) Sleep experts will often say that deep sleep restores the body while REM sleep restores the mind. So you need both to feel well rested when you wake up in the morning. And as you may have already guessed, if I’m sleeping 4-5 hours a night, I’m missing out on REM sleep. (And you can clearly see that below.)

Fitbit sleep score     

This is how the Fitbit readout for sleep stages looked on my phone when I woke up this morning. Periods of light sleep, deep sleep, and REM sleep all followed by short periods of wakefulness. (Wakefulness is represented by red bits at the top of the graph.) There’s more deep sleep the first half of the night and more REM sleep the second half.

In this six-part series we will explore how much sleep we REALLY need; The benefits and drawbacks of insomnia medication; The relationship between stress and insomnia and the relationship between insomnia and depression. And finally, I will devote at least one installment to my own personal battle with insomnia and how to use my understanding of sleep cycles to get more REM sleep.

James Porter
James Porter