VENTEUR spoke with Dr. Bruce Bassi, a double board-certified physician in General (adult) and Addiction Psychiatry and the founder and medical director of TelepsychHealth, about sleep health. TelepsychHealth provides virtual mental health treatment across the United States and is based in Jacksonville, FL. Bassi earned a master's degree in biomedical engineering from Columbia University and subsequently graduated from medical school at the University of Michigan. He completed his psychiatry residency at the University of Florida and his addiction psychiatry fellowship at Northwestern University. He enjoys writing and lecturing on the use of technology in medicine to increase clinician efficiency and enhance patient care. Bassi’s clinical interests are treating addiction and sleep disorders.
The amount of sleep we need is genetically programmed, and we cannot train ourselves to get less sleep. Therefore, an entrepreneur should think of a period when they were functioning quite well, had good levels of focus, energy, and positivity, and ask themselves how much sleep they were getting at that time. Most people know a baseline amount of sleep needed to feel that they are functioning well. We generally need less sleep as we age, but most people need at least eight hours. Unfortunately, some anecdotes about individuals who perform well on four hours of sleep perpetuate a myth that we can somehow train ourselves to need less.
This is an excellent question because most people expect what sleep should look like without knowing what "normal" sleep is for most people. An average person should fall asleep in 20-30 minutes if they are not sleep deprived, which is an extended amount of time to sit in bed with your thoughts. Most people, on average, wake up 1-2 times at night to use the restroom. Upon awakening, it is normal to feel somewhat dizzy for some time, but one should feel rested and refreshed in the mornings. Healthy sleep also involves keeping a regular sleep schedule with sleep time and awake times no more than one hour apart throughout the week.
REM sleep is beneficial for your brain and body in a different way than deep sleep. During REM sleep, we have a paralyzed body but a highly active brain. Our brain processes thoughts, feelings, emotions, and experiences during that time. In the first half of the night, we spend more time in non-REM sleep, and as the night progresses, we spend more time in REM. People can have very intense dreams and remember them well in REM sleep. People believe that REM sleep helps facilitate forming and consolidating of particular memories and promotes learning by regulating neuronal synapses.
It is much easier to control our wake-up time with an alarm clock. However, it is much more challenging to maintain consistency with our bedtime. This requires much more discipline, but the rewards do pay off. The amount of time slept before midnight is considered much better quality and more restorative and beneficial than the hours of sleep after midnight. It is easier to dip into the beginning of the night's sleep by taking on projects late at night rather than being in bed. It is helpful to set the alarm during the evening to wind down. The first alarm can be a warning not to start any new projects. The second alarm can be a reminder to wrap up current work. Then the third alarm can be to create a bedtime routine. Over time, one will start getting to sleep much more quickly to help keep a regular sleep schedule.
First, the body and brain need sleep; without it, it has many short-term and long-term implications. Without sleep, we are more impulsive, more irritable, and less focused. There is a surprising amount of data to support that. With sleep deprivation, our judgments and response times are skewed in a way that would be the equivalent of being impaired by alcohol. Because we have less mental energy, we cannot sustain attention on tasks very well, which might lead to irritability indirectly due to not performing up to one's standard. We might also interpret this malaise as having a low mood, experiencing depression, or disinterest due to a lack of sleep. Many patients come to me asking to evaluate for ADHD when they are not sleeping and compensating by drinking a lot of caffeine, which worsens their sleep quality. Sleep deprivation worsens all the symptoms of ADHD and makes people look as though ADHD is much worse.
Every cell in our body needs sleep. However, there is also a lot of data about the physical harm caused by sleep deprivation and shift work. For example, shift work is considered a WHO carcinogen, as it has been linked to colorectal and breast cancer. It also dramatically affects our cardiovascular system, linked to high blood pressure and cardiovascular disease increases the risk of stroke. It is also correlated with obesity, lower immunity, poorer insulin sensitivity, and lowered tolerance to pain. In fact, as a bonus, people who are sleep deprived are rated as less attractive than control groups sleeping usually.
Instead of drinking caffeine in the morning, expose yourself to at least 20 minutes of bright light. This can be sunlight or a lightbox. If it's a cloudy day, you may need exposure for a longer time. This will help immensely with circadian rhythm and help you feel more tired at night when it's time to sleep.
Many people think naps are a sign of laziness. Naps are not bad, but if taken too late in the day, they can affect one's sleepiness at night. They can be highly rejuvenating and an excellent reboot for creativity.
This one is definitely "outside of the box" and may not work for everyone. Since it contains melatonin and tryptophan, it could help with sleep. Though, many of the most effective sleep recommendations come down to the fundamentals of sleep hygiene.
Of course, in addition to the light that shines from screens that disrupts sleep rhythms, laptops and phones are also just significant sources of distraction. They pull you away from a soothing night routine and easily immerse you in work since they are readily accessible and can be taken into bed. Ideally, it would be best to use the bed only for sleep because you want your brain to associate the bed with a pleasant, calming experience and not be filled with thoughts of work, aggravation, and sleepless nights. Unplugging earlier in the night and utilizing "Do Not Disturb" to turn off notifications can be helpful in not being prompted about work-related stressors when trying to fall asleep.
Many types of wearables allow you to monitor sleep quantity and quality. These are not replacements for sleep studies, but they can be an excellent way to gather data that may help establish a routine. If you find that you are getting a sufficient amount of sleep but are still feeling tired throughout the day, then ask your doctor about an at-home sleep study. These are usually covered by insurance and, if not, are relatively inexpensive and convenient as they can be done at home rather than in a sleep lab overnight.
