TASK AT HAND: This week I’m thinking about sleep. An overlooked and neglected component that is vital to our optimal reasoning and performance. Too often we look to the lack of sleep as a badge of honor indicating exemplary endurance. I look back at my years as a researcher, medical student, and on-call intern and how I would consider 30 or 40 hours without sleep a proud achievement. Now, I realize that, in those instances, I failed to care for myself and operated in suboptimal conditions.
We know that sleep restriction and sleep deprivation is linked with the development of diseases like obesity, diabetes, and hypertension. Researchers have shown that severe sleep loss jolts the immune system just as stress does, impairing our ability to properly tackle mental and physical tasks (check out study here). Sleep loss quadruples the risk of stroke (find the study here). Lack of sleep is not a badge of honor; rather, it is a mark of embarrassment reflecting our myopic self-awareness and unwillingness to be our best.
“Lack of sleep is not a badge of honor; rather, it’s a mark of embarrassment reflecting our myopic self-awareness and unwillingness to be our best.”

Today on the Sunday Surgical Scrub, here are three common questions that I have received on sleep recently. Ponder and enjoy!

1. Once in bed, how long should it take me to fall asleep?
This is known as Sleep Onset Latency or Sleep Latency and defined as the length of time that it takes to accomplish the transition from full wakefulness to sleep. If you take less than 5 minutes to fall asleep, you are sleep deprived! The ideal target is between 10 and 15 minutes, which indicates you’re tired enough to sleep but not exhausted as to show signs of daytime sleepiness.
The most important pearl here: once you get to bed, turn off your phone. The never-ending accessibility to the internet and constant messages, notifications, and distractions will disrupt your sleep latency and your subsequent stages of sleep. Your bed should be for sex and sleep. I don’t see the need for a phone here.

2. How much sleep do I actually need?
Most healthy adults need 7 to 9 hours of sleep a night. Although some individuals can function without sleepiness or drowsiness after as little as 6 hours of sleep – known as short sleepers – this represents less than 1% of the population so, chances are, this is not you. Short sleepers are believed to derive this ability from a genetic mutation on the DEC2 gene (check out the study here).
When considering how many hours you need to sleep, I believe there must be a philosophical shift in how you see the objective of sleep. Commonly, we look to how much sleep we need to “get by” or “survive” the next day. Change it up: how much sleep do you need to peak and thrive tomorrow?

3. What’s up with nightmares? What happens when I’m sleeping anyways?
Nightmares are defined as disturbing dreams in which unpleasant visual imagery or emotions wake us up. Contrary to popular belief, fear is not to the main emotion in nightmares; instead, researchers have found that it’s most often feelings of sadness, guilt and confusion (find the study here). Self-reflection, exercise, journaling, meditation are just a few common ways to reconcile the negative emotions that we harbor and can go on to degrade our sleep quality.
This blog post is much too short to describe all the processes and mechanisms that underlie sleep. Further, its unclear exactly why organisms need to sleep. However, it seems that most, if not all, species regularly enter a circadian rest state.

MEDICINE & MACULA: Special mention to an excellent study entitled, Fatigue, Alcohol and Performance Impairment from the journal Nature.


The study looked at sleep loss in terms of equivalent alcohol intoxication. A group of 40 participants were broken up in to two groups: one group was kept awake for 28 hours, simulating pulling an all-nighter, and the other consumed 10-15g of alcohol at 30-minute intervals until their blood alcohol concentration reached 0.10% (legal limit in every state is 0.08%).
Each group was given a performance task that required them to react as quickly as possible to visual cues randomly timed on a computer. After 17 hours of sustained wakefulness, performance was equivalent to a blood alcohol concentration of 0.05%. After 24 hours of sustained wakefulness, performance was equivalent to those with a blood alcohol concentration of 0.10%. According to this study, sleep deprivation is not so much a badge of honor, as an example of public intoxication (study here).

GRATIS: Man is the only mammal that willingly delays sleep. Stop doing it! For your health and engagement, go to sleep!

My best to you,
David Almeida
david@davidalmeidamd.com
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