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We can now amplify the restorative benefits of sleep. Could this help us cope with later nights and early mornings?
We often wear our sleeplessness as a badge of pride – a measure of our impossibly hectic schedules. Thomas Edison, Margaret Thatcher, Martha Stewart and Donald Trump have all famously claimed to get by on just four or five hours’ sleep a night – much less than the seven-to-nine hours recommended to most adults. Many of us are following suit: according to the Centers for Disease Control and Prevention, more than one third of US adults fail to get enough sleep on a regular basis.
The consequences – including impaired memory and decision making, and increased risk of infection and obesity – are well known, but easy to ignore. When our immediate demands exceed the hours in the day, sleep is still our top sacrifice.
But what if we were able to simply optimise the sleep experience so that we enjoyed most of the benefits of deep sleep, in less time?
This possibility may be closer than it sounds, thanks to new ‘sleep optimisation’ techniques. Various experiments across the world have shown that it is possible to boost the efficiency of the brain’s night-time activity – speeding up the descent into deep sleep and enhancing our rest once we get there.
It sounds almost too good to be true. Is it?
A slower beat
On a regular night, the brain cycles through many different stages of sleep, each with a characteristic pattern of ‘brain waves’, in which neurons in different regions of the brain fire together, in synchrony, at a particular rhythm. (It’s a bit like a crowd chanting or beating a drum in unison).
It is notoriously hard to convince sleep-deprived people to make the necessary lifestyle changes
During the rapid eye movement (REM) phases that rhythm is fairly fast – during which time we are most likely to dream. But at certain points our eyes cease to move, our dreams fade and the rhythm of the brain waves drops to less than one ‘beat’ a second – at which point we enter our deepest, most unresponsive state of unconsciousness called ‘slow-wave sleep’.
It is this stage that has been of particular interest to scientists investigating the possibility of sleep optimisation.
Research since the 1980s has shown that slow-wave sleep is essential for the brain’s maintenance. It allows the necessary brain regions to pass our memories from short-term to long-term storage – so that we don’t forget what we have learnt. “The slow waves facilitate the transmission of information,” says Jan Born, director of the Department of Medical Psychology and Behavioural Neurobiology at the University of Tübingen, Germany.
The slow waves may also trigger the flow of blood and cerebrospinal fluid through the brain, flushing out potentially harmful debris that could cause neural damage. They also lead to dips in the stress hormone cortisol and help to rejuvenate the immune system so that it is readier to fight incoming infections.
Such results led scientists including Born to wonder whether we might therefore be able to enhance the benefits of sleep and improve our daytime functioning by boosting the production of those slow waves.
One of the most promising techniques to do so works a bit like a metronome counting the brain into the correct rhythms. Experimental participants wear a headset that records their brain activity and notes when they have started to make those slow waves. The device then plays short pulses of gentle sound, beginning in sync with the brain’s natural slow waves, at regular intervals over the night. The sounds are quiet enough to avoid waking the participant, but loud enough to be registered, unconsciously, by the brain.
Born has led much of the experimental work, finding that this gentle auditory stimulation is just enough to reinforce the right brain rhythms, deepening the slow-wave sleep compared with people receiving sham stimulation. Participants wearing the headset performed better on memory tests, showing increased recall for material they had learnt the day before. It also altered their hormonal balance – reducing their cortisol levels – and led to an improved immune response.
In the trials to date, participants haven’t yet reported unwanted responses to the technique. “We can’t really be sure, but so far there are no obvious side effects,” says Born.
Better sleep, in a store near you
Most of the studies attempting to boost slow-wave sleep have been conducted on small groups of young, healthy participants, so to be certain of the benefits of boosting slow-wave sleep, we would need to see larger trials on more diverse groups. But based on the existing evidence, the technology has already made its way into a handful of consumer devices, mostly in the form of headbands to be worn overnight.
The French start-up Dreem, for instance, has produced a headband (available for around €400 or £330) that also uses auditory stimulation to boost slow-wave sleep using a similar set-up to the scientific experiments – effects have been confirmed in a peer-reviewed trial. The Dreem device also connects to an app that analyses your sleep patternsand offers practical advice and exercises to help you get a better night’s rest. These include things such as meditation and breathing exercises that might ensure you get to sleep quicker and with fewer awakenings during the night. The aim is to improve overall sleep quality across the night for anyone who feels that they could do with a deeper rest.
Philips’s SmartSleep Deep Sleep Headband, in contrast, is very explicitly aimed at making up for some of the ill-effects of sleep deprivation – for people “who, for whatever reason, are simply not giving themselves an adequate sleep opportunity”, says David White, Philips’ chief scientific officer.
The device was first launched in 2018, and like Dreem’s product, it is a headband that senses the brain’s electrical activity and periodically plays short bursts of sound to stimulate the slow oscillations that are characteristic of deep sleep. It relies on smart software that carefully adapts the volume of its sound over time to ensure that it delivers the optimum level of stimulation for the specific user. (The device is currently only available in the US for $399.)
White agrees that the device cannot fully replace a full night’s sleep, but he says that it is notoriously hard to convince sleep-deprived people to make the necessary lifestyle changes. By amplifying the benefits of the sleep they do manage to get, this device should at least help them to function better in daily life. Along these lines, Philips’s own experiments have reportedly confirmed that the SmartSleep boosts slow-wave sleep in sleep-deprived people, and that it mitigates some of the immediate effects like poorer memory consolidation.
Future research may suggest many more innovative ways to optimise our sleep. Aurore Perrault at Concordia University in Montréal has recently tested a gently rocking bed that swayed back and forth every four seconds.
Participants were quicker to enter slow-wave sleep, and spent more time in that crucial sleep cycle, as the brain waves synchronised with the external movement
She says that the technique was inspired by a colleague’s new-born baby being rocked to sleep, leading the team to wonder whether adults may also benefit from gentle movement. Sure enough, they found that the participants were quicker to enter slow-wave sleep, and spent more time in that crucial sleep cycle, as the brain waves synchronised with the external movement. As you might hope, they also reported feeling more relaxed at the end of the night, and this was again accompanied by the expected knock-on benefits for their memory and learning. “That was the cherry on the top,” says Perrault.
If such a bed were brought to market it could serve a similar purpose to the sound-stimulating headbands. Perrault is particularly interested whether it might help older people. The amount of time we spend in short-wave sleep seems to decline as we age, potentially contributing to some age-related memory problems – and she hopes that gently swaying beds may be one way to counteract that.
Still, get some sleep
Although the field is still in its infancy, these studies show that there is a lot of promise in the general concept of sleep optimisation to increase the power of our slumbers (however much or little we get).
Perrault and Born are both optimistic about the potential of the commercial products using pulses of sound to stimulate those regenerative slow waves. Perrault emphasises that we still need larger studies to ensure their effectiveness outside the carefully controlled conditions of the lab – but she welcomes that this research could now benefit a wider population.
“It’s great that they’re trying, more and more, to use external stimulation because we know that it impacts sleep,” says Perrault.
In the future, it will be interesting to see whether sleep optimisation could also bring benefits in the long term. We know that chronic sleep loss can increase the risk of conditions like diabetes and even Alzheimer’s disease – but it’s by no means clear that these new techniques will help reduce those risks.
For now the only guaranteed way of reaping all the benefits of sleep – both long and short-term – is to make sure you get enough of it. Whether or not you decide to give these devices a try, you should attempt to schedule more early nights, and avoid too much alcohol, caffeine and screen time before bed – factors that are all known to damage the quality of our sleep.
Our brains cannot function without a recharge – and anyone hoping to live a happy, healthy, productive life needs to wake up to that fact.
Sleep is a normal and indeed essential part of our lives. But if you think about it, it is such an odd thing to do. At the end of each day we become unconscious and paralysed. Sleep made our ancestors vulnerable to attack from wild animals. So the potential risks of this process, which is universal among mammals and many other groups, must offer some sort of evolutionary advantage. Research in this area was slow to take off. But recently there has been a series of intriguing results that are giving researchers a new insight into why we sleep and what happens when we do it.
Why do I sleep?
Scientists simply don’t know for sure. In broad terms researchers believe it is to enable our bodies and especially our brains to recover. Recently researchers have been able to find out some of the detailed processes involved. During the day brain cells build connections with other parts of the brain as a result of new experiences. During sleep it seems that important connections are strengthened and unimportant ones are pruned. Experiments with sleep-deprived rats have shown that this process of strengthening and pruning happens mostly while they sleep. And sleep is also an opportunity for the brain to be cleared of waste. A group led by Prof Maiken Nedergaard at the University of Rochester Medical Centre in New York discovered a network of microscopic fluid-filled channels in rats that clears waste chemicals from the brain. Prof Nedergaard told us when her research was first published in 2013 that this process occurs mostly when the brain is shut off. “You can think of it like having a house party. You can either entertain the guests or clean up the house, but you can’t really do both at the same time.”
What happens when I don’t get enough sleep?
It seems that a lack of sleep alters the way in which the genes in the body’s cells behave. Researchers at Surrey University in Guildford have found that genes involved in inflammation seem to increase their activity. Dr Malcolm von Schantz, who is involved with the Surrey research, believes that the genes are responding to lack of sleep as if the body is under stress. He speculates that in the distant past in times of stress our ancestors’ bodies would prepare themselves for injury by activating these inflammation genes which would cushion the effects of attacks by wild animals or human enemies. “It puts the body on alert for a wound but no wound happens,” he told Sleep Advice. “This could easily help explain the links between sleep deprivation and negative health outcomes such as heart disease and stroke.” In modern times though preparing for an injury that never happens has no beneficial effect – in fact the consequent activation of the immune system might increase the risk of heart disease and stroke.
Why is it hard to think when I am tired?
The expression “half asleep” might be an accurate description of what is going on in the brain when you are feeling slow-witted. Research suggests that parts of the human brain may well be asleep when it is sleep-deprived. Studies on whales and dolphins show that when asleep they continue to use half of their brain to swim and come up to the surface for air. A study on human patients showed that something similar goes on in our brains. As they became more sleep-deprived, parts of their brain became inactive while they were still awake. What’s more the local sleep areas move around the brain. So although when we go to bed we think one moment we are awake and then there is an abrupt change to sleep – it may well be more of a continuous process.
What is the role of dreaming?
That’s a question that psychiatrists, notably Carl Jung and Sigmund Freud, have tried to answer but with limited success. More recently a team at the ATR Computational Neuroscience Laboratories in Kyoto in Japan has begun trying to answer some of these questions by building the beginnings of a dream-reading machine. They asked volunteers to doze off in an MRI scanner and recorded their brain patterns. The volunteers were then woken up and asked to tell researchers what they were dreaming about. The team then listed 20 separate categories of dream content from these accounts such as dwelling, street, male, female, building or computer screen. The researchers then compared the accounts with the pattern of activity in the area of the brain responsible for processing visual information – and to their amazement they found that there was a correlation. So much so that they could predict which of the 20 different categories they had listed the patient had dreamt of with 80% accuracy. The device is a very rough tool but it may well be a first step to something that can see in more detail what happens in our dreams and so help researchers learn more about why we dream.
How is modern life affecting our sleep patterns?
Several studies show that the light bulb has led people shifting their day and getting less sleep. On average we go to bed and wake up two hours later than a generation ago. The US Centres for Disease Control reported in 2008 that around a third of working adults in the US get less than six hours sleep a night, which is 10 times more than it was 50 years ago. In a later study it was also reported that nearly half of all the country’s shift workers were getting less than six hours sleep. And a study led by Prof Charles Czeisler of Harvard Medical School found that those who read electronic books before they went to bed took longer to get to sleep, had reduced levels of melatonin (the hormone that regulates the body’s internal body clock) and were less alert in the morning. At the time of publication he said: “In the past 50 years, there has been a decline in average sleep duration and quality. “Since more people are choosing electronic devices for reading, communication and entertainment, particularly children and adolescents who already experience significant sleep loss, epidemiological research evaluating the long-term consequences of these devices on health and safety is urgently needed.”
What’s stopping you sleeping?
– One in eight of us keep our mobile phones switched on in our bedroom at night, increasing the risk our sleep will be disturbed.
– Foods such as bacon, cheese, nuts and red wine, can also keep us awake at night.
Many studies report that there is evidence that sleep loss is associated with obesity, diabetes, depression and lower life expectancy – while others, such as Prof James Horne, a sleep researcher at Loughborough University believes that such talk amounts to “scaremongering”. “Despite being ‘statistically significant’, the actual changes are probably too small to be of real clinical interest,” he told Sleep Advice. “Most healthy adults sleep fewer than that notional ‘eight hours’ and the same went for our grandparents. “Our average sleep has fallen by less than 10 minutes over the last 50 years. Any obesity and its health consequences attributable to short sleep are only seen in those few people sleeping around five hours, where weight gain is small – around 1.5kg per year – which is more easily rectified by a better diet and 15 minutes of daily brisk walking, rather than by an hour or so of extra daily sleep.” A team from the universities of Surrey and Sao Paulo in Brazil have spent the past 10 years tracking the health of the inhabitants of Bapendi, a small town in Brazil where modern day lifestyles haven’t yet taken hold. Many of the inhabitants of this town get up and go to bed early. The investigators hope to find out soon whether the old adage “early to bed and early to rise” really does make us, if not “wealthy and wise”, at least “healthy and wise”.
We might feel drowsy as we start to fall asleep, but our brain is still active, and noises or discomfort can disturb us. As we drift into light sleep, an area of the brain called the hypothalamus starts to block the flow of information from our senses to the rest of the brain. But it will still let through noises, which need to be able to wake us up. After about half an hour of light sleep, most of us enter a type of deep sleep called slow-wave sleep. Our brains become less responsive and it becomes much harder to be woken up. But some things will always get through – such as our names being called out loudly. Missing out on parts of our usual sleep cycle reduces the quality and quantity of sleep.
We all have a built-in body clock which tells us when we are tired. It helps synchronise thousands of cells in our body to a 24-hour cycle called the circadian rhythm. The main synchroniser for our body clock is light. Our eyes react to light and dark, even when our eyelids are closed. Daylight prompts our brains to reduce the production of the sleep hormone melatonin. This makes us feel more alert. If we get less sleep during the night, because of going to bed late or waking up early, we’re unlikely to get as much deep sleep as we need.
The wrong temperature
Our core body temperature should drop by half a degree when we are asleep. So as sleep approaches, our body clock makes blood vessels in our hands, face and feet open up, in order to lose heat. But if we get too cold, we get restless and find it hard to sleep. Or if our bedrooms or duvets are too warm, our bodies can’t lose heat, which can also cause restlessness.
Stimulating food and drink
We can have trouble sleeping after we consume food and drink that act as stimulants.
Drinks high in caffeine make it harder to fall asleep and can interfere with our deep sleep. Caffeine can stay in our system for many hours, so our sleep quality can be affected by the caffeinated drinks we consume earlier in the day.
In the course of a night we usually have six to seven cycles of REM (rapid eye movement) sleep, during which our brains process the information we’ve absorbed during the day. This leaves us feeling refreshed. But a night of drinking means we’ll typically have only one to two cycles and wake up feeling tired.
Foods containing a chemical called tyramine, such as bacon, cheese, nuts and red wine, can keep us awake at night. This is because tyramine triggers the release of noradrenaline, a brain stimulant.
A busy mind
Stress is the enemy of sleep. In bed, our mind is left free to wander and anxiety concerning sleep will only make it worse. It’s difficult to keep track of time when you’re lying down in the dark waiting for sleep. People often nod off and wake up again but it feel as if they’re getting no sleep at all. This delivers fragmented sleep with much less time spent in the important deep sleep stages.
Sleep experts recommend that people with this problem get up and do an activity which distracts the mind from worry – such as a puzzle – before trying to sleep again.
Do you like to have a weekend lie-in or a nightcap before going to bed? These habits could actually be harming your sleep.
Relax your mind
Simple breathing exercises can help. Breathe, using your abdomen not your chest, through your nose for three seconds, then breathe out for three seconds. Pause for three seconds before breathing in again. Practise this for ten minutes at night (five minutes is better than nothing).
Some people find that lavender oil, valerian or other herbs help them to sleep.
If you still have problems, you could try massage, aromatherapy, or even acupuncture.
If you still find yourself tossing and turning, abandon the bedroom and find something enjoyable and absorbing to do. Jigsaws are perfect. Don’t go back to bed until you begin to feel sleepy.
Regular exercise is a great way to improve your sleep. Just be careful not to do it close to bed time as exercise produces stimulants that stop the brain from relaxing quickly.
This being the case, exercising in the morning is an excellent way to wake up the body. Going for a run or doing some aerobics releases stimulants into the body, which perks you up.
If you are injured or disabled, you can still benefit from exercise. Check out disability exercise tips.
Create a calm bedroom environment
Your bedroom should be for sleep only. Avoid turning it into an entertainment centre with televisions, computers and stereos.
Two thirds of children have a computer, games machine or TV in their bedroom and could be losing out on sleep as a result.
It’s fine to have a nightcap, but too much alcohol can make you restless. Alcohol is also a diuretic, which means it encourages you to urinate (never welcomed during the night).
Drinking is also more likely to lead to snoring, which can restrict airflow into the lungs. This reduces oxygen in your blood which disturbs your sleep and contributes to your hangover.
Caffeine is a stimulant which can stay in your system for many hours. So avoid sources of caffeine such as coffee, chocolate, cola drinks and non-herbal teas.
Watch what you eat
Eating a large heavy meal too close to bedtime will interfere with your sleep.
Spicy or fatty foods may cause heartburn, which leads to difficulty in falling asleep and discomfort throughout the night.
Foods containing tyramine (bacon, cheese, ham, aubergines, pepperoni, raspberries, avocado, nuts, soy sauce, red wine) might keep you awake at night. Tyramine causes the release of norepinephrine, a brain stimulant.
If you get the munchies close to bedtime, eat something that triggers the hormone serotonin, which makes you sleepy. Carbohydrates such as bread or grain, cereal will do the trick.
Set a regular bedtime and wake up time
Create a habit of going to bed and waking up at the same time each day, even on weekends. This helps anchor your body clock to these times. Resisting the urge for a lie-in can pay dividends in alertness.
If you feel you haven’t slept well, resist the urge to sleep in longer than normal; getting up on schedule keeps your body in its normal wake-up routine.
Remember, even after only four hours, the brain has gained many of the important benefits of sleep.
It’s only natural
Most of us have a natural dip in alertness between 2 – 4pm.
A 15 minute nap when you’re tired can be a very effective way of staying alert throughout the day. Avoid napping for longer than 20 minutes, after which you will enter deep sleep and feel even worse when you wake up.
See a doctor if your problem continues
If you have trouble falling asleep night after night, or if you always feel tired the next day, snore, or stop breathing during sleep you might have a sleep disorder. It is advisable to seek more advice from your doctor. Most sleep disorders can be treated effectively.
Sleep apnea is a common disorder that causes your breathing to stop or get very shallow. Breathing pauses can last from a few seconds to minutes. They may occur 30 times or more an hour.
Sleep apnea is the most common type of sleep disorder. It causes your airway to collapse or become blocked during sleep. Normal breathing starts again with a snort or choking sound. People with sleep apnea often snore loudly. However, not everyone who snores has sleep apnea.
You are more at risk for sleep apnea if you are overweight, male, or have a family history or small airways. Children with enlarged tonsils may also have it.
Doctors diagnose sleep apnea based on medical and family histories, a physical exam, and sleep study results.
A person may not be aware that his/her sleep is interrupted throughout the night due to snoring or obstructions. This is because he/she may not be fully conscious during these occurrences. However if a person feels drowsiness during the day, he/she should consult a doctor about getting a sleep study. People with sleep apnea are at higher risk for car crashes, work-related accidents, and other medical problems. If you have it, it is important to get treatment. Lifestyle changes, mouthpieces and surgery may help treat sleep apnea in many people if their diagnosis is mild. But if the diagnosis is moderate to severe, CPAP is the gold standard of treatment for optimal results.
You talked, we listened, everyone gets what they need. The DeVilbiss IntelliPAP® Platform has been designed with patients and providers in mind, incorporating many of the recommendations solicited through research to optimize patient comfort and adherence. The IntelliPAP combination of comfort, education and adherence tracking with SmartCode® and SmartLink® as well as the patented comfort feature called SmartFlex® help to ensure patient compliance – all in a highly efficient platform that makes great business sense for providers.
What Is the Biologic Fate of Nitrates and Nitrites in the Body?
Exposure to nitrates and nitrites may come from both internal nitrate production and external sources.
Intake of some amount of nitrates is a normal part of the nitrogen cycle in humans.
The mean intake of nitrate per person in the United States is about 40–100 milligrams per day (mg/day) (in Europe it is about 50–140 mg/day).
Nitrate can be synthesized endogenously from nitric oxide (especially in the case of inflammation), which reacts to form nitrite.
Nitrite and nitric oxide can be produced and utilized from exogenous and endogenous sources.
Absorption Nitrates and Nitrites
In the proximal small intestine, nitrate is rapidly and almost completely absorbed (bioavailability at least 92%).
Inorganic nitrate/nitrite can be absorbed via inhalation.
Inorganic nitrate/nitrite does not undergo first pass metabolism.
Distribution Nitrates and Nitrites
Inorganic nitrates/nitrites are distributed widely through the circulation with approximately 25% of absorbed nitrate concentrating in the salivary glands.
Salivary, plasma, and urinary levels of nitrate and then nitrite rise abruptly after ingestion.
An increase in inorganic nitrite levels peaks around 3 hours post ingestion and can be detected about an hour after ingestion.
Metabolism of Inorganic Nitrates and Nitrites
The two main metabolic pathways for inorganic nitrates / nitrites are
The nitrate-nitrite-NO pathway (Figure 1) and
Enterosalivary circulation pathway (nitrate reductase activity of bacteria on the tongue generates nitrite and nitrite which is metabolized to NO in the stomach and circulation).
Approximately 5%–10% of the total nitrate intake is converted to nitrite by bacteria in the saliva, stomach, and small intestine.
In vivo conversion of nitrates to nitrites significantly enhances nitrates’ toxic potency.
This reaction is pH dependent, with no nitrate reduction occurring below pH 4 or above pH 9.
The high pH of the infant gastrointestinal system makes them more susceptible to nitrite toxicity from elevated nitrate/nitrite ingestion.
The metabolic pathway of plasma and tissue nitrates depends on local conditions such as tissue oxygenation, and inflammatory state. In the skin, local conditions also include ultraviolet light exposure.
Nitrate can be reduced to nitrite and nitric oxide when needed physiologically or as part of pathological processes (see Figure 1).
Mammalian metalloproteins and enzymes that have nitrate reductase activity include aldehyde oxidase, heme proteins, mitochondria and xanthine reductase.
The reaction of nitrite with endogenous molecules to form N-nitroso compounds may have toxic or carcinogenic effects.
Excretion Nitrates and Nitrites
Approximately 60% to 70% of an ingested nitrate dose is excreted in urine within the first 24 hours.
About 25% is excreted in saliva through an active blood nitrate transport system and potentially is reabsorbed.
Half-lives of parent nitrate compounds are usually less than 1 hour; half-lives of metabolites range from 1 hour to 8 hours.
In the Fourth National Report on Human Exposure to Environmental Chemicals, urinary levels of nitrate were measured in a subsample of the National Health and Nutrition Examination Survey (NHANES) consisting of participants aged 6 years and older during 2007-2008. The geometric mean for urinary nitrate (in mg/g of creatinine) for the US population aged 6 years and older during 2007-2008 was 47.7, with a 95% confidence interval of 45.9-49.7. Note that these measurements are used in population based public health research and not intended for clinical decision making on individual patients.
Key Points the Biologic Fate of Nitrates and Nitrites in the Body
Exposure to nitrate and nitrites may come from both internal nitrate production and external sources.
Intake of some amount of nitrates is a normal part of the nitrogen cycle in humans.
Nitrate can be reduced to nitrite and nitric oxide when needed physiologically or as part of pathological processes depending on local conditions such as inflammation and tissue oxygenation.
In vivo conversion of nitrates to nitrites significantly enhances nitrates’ toxic potency.
Approximately 5%–10% of the total nitrate intake is converted to nitrite by bacteria in the saliva, stomach, and small intestine.
60-70% of an ingested nitrate dose is excreted in urine within 24 hours.