Insomnia May Be Cured by Sleeping Even Less, Somnologist Argues
15:12 28.06.2024 (Updated: 11:37 01.07.2024)
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The inability to fall asleep is a symptom of insomnia, a disorder that affects 10% to 30% of adults at any given time and up to 50% of people in a given year. Insomnia that lasts longer than a month and is not related to any other issue affects about 6% of the population.
If left untreated, insomnia can lead to daytime sleepiness, a lack of energy, obesity, irritability, and depression.
Sputnik sat down with Russian somnologist Roman Buzunov, Professor, Doctor of Medical Sciences, Honored Doctor of the Russian Federation, to ask about common mistakes in the fight against insomnia, how limiting sleep helps restore healthy sleep, and the benefits of nightmares.
Sputnik: Some anthropologists believe that the skills of creating full-fledged sleeping places, which, among other things, distinguish great apes from many other animals, and better quality sleep contributed to the intensive development of intelligence in great apes. What can be said about this from the point of view of somnology?
― Somnology is a very young science. It began to develop in the mid-1950s, and so far, there are more questions than answers. All medicine, starting from Hippocrates, has covered a path of 2,000 years, unlike somnology, which cannot boast of such an impressive history.
Therefore, what you are asking about has been and remains the subject of research by somnologists, biologists, and other specialists. There is no doubt that quality sleep was of great importance for the evolution of animals.
Let me give you an analogy with the work of a driver mechanic, who during the day drives a car operating at full power and at night carries out its maintenance. Our brain is the same: it is especially active during the day, but at night it also works and restores our physical and mental state. Those brain centers that were responsible for interaction with the environment during the day begin to work with the body at night: restore body functions, improve immunity, remove toxins, etc. - that is, physically restore the body so that it can actively function during the day.
The second extremely important task is information processing. Did the sleep of great apes give them some special evolutionary advantage over other animals? This is an open question, and it is unlikely that large-scale research in this area has been carried out in somnology, especially considering the fact that one of the most important tools of this science, polysomnography, is only a few decades old.
Russian somnologist Roman Buzunov, a professor, Doctor of Medical Sciences, Honored Doctor of the Russian Federation
© Sputnik . Scientific Russia
Sputnik: It is known that humans, on average, sleep less than other great apes. What is this connected to?
― Then it’s worth clarifying: what kind of people and how much exactly do they sleep? The fact is that the duration of sleep can vary greatly from person to person. The average is seven to eight hours, but we know a lot of examples of short sleepers (Napoleon Bonaparte, Margaret Thatcher, Winston Churchill, etc.) who only needed three to four hours, as well as examples of those who, on the contrary, sleep 10–12 hours; as a rule, the body of such people requires more time to recover.
In general, a person’s individual genetically determined sleep norm ranges from four to 12 hours.
Sputnik: So, it doesn’t make sense to train yourself to sleep less, for example, instead of nine hours, some seven?
― How familiar this question is to me! This is a standard request from many businessmen and big executives: “Doctor, let’s make sure I sleep half as much and get much more done.” To which I usually answer, “And if we breathe half as much or drink half as much water, how will it end?”
We can live without breathing for three minutes, without water for seven days, and without sleep for only eleven days. This, by the way, is Randy Gardner's documented world record. Our need for sleep is even stronger than for food because a person can live for about a month without food.
A thoughtless reduction in sleep can be fraught with a variety of consequences: depression, weight gain, hormonal imbalances, etc. When one of my patients began to sleep five or six hours instead of the usual nine hours, she gained 12 kg in weight in a year.
The fact is that in the deep stages of sleep, somatotropin, a growth hormone, is produced. It is responsible for growth only in children, and in adults, it is responsible for mobilizing fat from the depot and converting energy into muscle mass. When there is not enough of this hormone in the body, the food we eat is stored as fat.
In addition, sleep disturbance increases the production of a peptide hormone called ghrelin, which in turn increases appetite.
But that’s not all: due to lack of sleep, sensitivity to leptin, the hormone responsible for the feeling of fullness, decreases. Lack of sleep leads to hormonal imbalance, which causes a person to gain weight.
This is just one example of the harm caused by a lack of sleep. I would strongly advise against conducting similar experiments with sleep on yourself and trying to artificially reduce the amount of sleep.
Sputnik: What other examples are there?
― There are a lot of them. There are, for example, studies on the effect of sleep deficiency on the effectiveness of vaccination. In these works, it was noted that if a person slept little on the eve of such a procedure, for example, less than six hours instead of the usual eight or nine, then their body’s immune response to the vaccine will be much lower. Just one night of sleep deprivation is enough to reduce the immune response and shorten the duration of the vaccination.
Reducing the number of hours of sleep you need is like taking out a bank loan at high interest rates. And the interest in this case is your health. I usually ask my patients a simple question: Are you really willing to pay with your health and quality of life in order to free up a few hours a day?
Sputnik: I have friends who sleep well only in the countryside, but when they get back to Moscow, they again begin to suffer from insomnia. What does somnology say about the impact of living in a metropolis on the quality of sleep?
― What you describe can have a variety of reasons. Typically, insomnia among metropolitan residents is associated with air pollution or large amounts of electromagnetic radiation. But there is also such a thing as negative conditioned reflexes: if your friends associate Moscow with a lot of work, lack of sleep, and constant worry, then for them, arriving in Moscow, or any big city, in itself causes stress, and then insomnia is just around the corner.
When such a person goes to the countryside, their nervous system relaxes there, because for them, “country house” equals “rest.”
When in Moscow, or in any other city, a person cannot fall asleep for a long time and this turns into a chronic story, then there is a risk of forming a persistent conditioned reflex of fear of not falling asleep.
A person goes to bed with the thought “bed means insomnia” and a specific bed in this very house. You are talking about country residents, but I had patients who also could not sleep in Moscow but slept well in climbing hammocks fixed on rocks at an altitude of several kilometers. It is not surprising since such a person associates their own bed with insomnia, and in relation to a hammock, fortunately, such a reflex has not formed.
Literally three months of a provoking factor are enough for a person to form negative conditioned reflexes of fear of not falling asleep: bed means insomnia, negative forecasting (if I didn’t fall asleep today, I definitely won’t fall asleep tomorrow), and maladaptive behavior (increasing the time spent in bed in an attempt to “get” sleep).
Sputnik: How to replace these attitudes with “[the big city] is good” and “bed is sleep”?
― Cognitive behavioral therapy, which I and my colleagues have been doing for the last ten years, helps to cope with such attitudes, with the reflex of fear of not falling asleep, and with insomnia in general.
Our program has several blocks, and the most important of them, no matter how paradoxical it may sound when dealing with insomnia, is limiting sleep, reducing the amount of time spent in bed. Our main task is to cause sleep deficiency in a person in order to provoke drowsiness.
Sputnik: Does it help?
― Yes. The fact is that patients with insomnia often completely forget what true drowsiness is. Even if they say that they are sleepy during the day, this is usually not the case: they are simply overwhelmed, they feel tired, and they are not in the mood, but this is not drowsiness.
If such a person is placed in a chair or laid on a bed, they will not fall asleep immediately, as befits a truly sleepy person. It is useless to ask such people to relax and just go to sleep. This requires a lack of sleep.
Let's say that before insomnia, a person needed eight hours to get enough sleep, and now we tell him to stay in bed for only six hours during therapy, thus accumulating a sleep deficit.
The biggest mistake people make when suffering from insomnia is trying to “sleep” the missing hours, or at least lie in bed. This strategy only leads to worsening sleep disorders. It is enough to keep a person in a sleep deficit for just a few weeks before his reflexes begin to change.
After three weeks, we can form a new positive-conditioned reflex: “bed is sleep.”
The fear of not falling asleep pushes a person into a vicious circle of insomnia, but sleep is something that you simply allow to happen. Forcing yourself to sleep when you have insomnia is a very big and common mistake.
Sputnik: Is it possible to form a reflex for falling asleep with the help of any one object? For example, I looked at a book of a certain color on my shelf or at someone’s photograph and immediately fell asleep for the whole night.
― Such a simple and instant way to go to sleep at night, as you describe, is unlikely to be implemented. After all, proper bedtime and treatment of sleep disorders are a whole complex of measures. I have always liked the expression “Take care of your honor from a young age.” It’s the same with sleep: if you want to sleep well at night, think about it right in the morning.
In my practice, I constantly meet people who complain about poor quality sleep but at the same time live in a three-chair mode: in the morning they sit in a car seat, in the afternoon at work, and in the evening near the TV or with the phone. Add here several cups of brewed coffee a day and lack of physical activity, and sometimes working until late at night. Do you think such a person will sleep well?
There are many factors that cause stimulation of the nervous system, making it difficult to fall asleep. These factors need to be monitored and tried to be eliminated from your life.
Sputnik: At the same time, history is replete with examples of famous people who slept only three to four hours a day and were happy with it. Have you ever encountered such cases in your practice?
― I’ll tell you about two, perhaps, the most popular versions of this story. Very often, when people say that they hardly sleep, they embellish the reality and flaunt their lack of sleep. In fact, they can sleep as much as the rest, but who can prove this?
This is the first option - the so-called Munchausen storytellers. The second option is people with a sleep perception disorder: the person is actually sleeping, but he has a false feeling that he is very sleep-deprived. Such a distorted picture of the duration of one’s sleep often occurs with chronic insomnia.
I regularly see patients who claim that they have barely slept for weeks or even months. But this simply physically cannot happen! You and I are well aware of the already mentioned record of 11 days without sleep. After three days, a person becomes incapacitated - they fall asleep directly in the process of activity, for example, while talking or even standing.
After five days without sleep, a person begins to hallucinate, and sleep is introduced into wakefulness. After nine to ten days a person may forget where they are and even what their name is.
You can say whatever you want that you sleep two hours a day, but in reality it often turns out differently. No one denies the presence of short sleepers in our history, but this, as a rule, means sleeping at least four hours a day, no less.
Sputnik: Can sleep disorders become fatal?
― In rare cases, yes. Such a case could be, for example, the so-called fatal familial insomnia. This is a hereditary disease in which certain gene defects cause proteins in the brain to begin to change, becoming abnormal. Such proteins do not perform their normal functions and, in addition, contactally change neighboring proteins. Thus, other proteins also become pathological. These altered proteins are called prions.
As a result, the sleep centers in the brain are damaged, and, in general, six months to a year after the onset of the disease, a person dies from insomnia.
Sputnik: How exactly does this happen?
― If a person stops sleeping, the functions of higher nervous activity, organs and systems are disrupted, then death occurs. The sleep centers in our brain can also be damaged during a stroke. Lack of sleep after a stroke also leads to death. Any mammal dies without sleep. Similar experiments were carried out with the participation of animals. Long-term lack of sleep leads to disruption of metabolic processes and internal organ functions; immunity collapses; sepsis develops; ulcers appear and the animal dies.
Sputnik: Is it true that people who have nightmares are better able to cope with stressful situations?
― Yes, there are studies in favor of this hypothesis. During dreams, accumulated previous information, usually from the previous day, is processed. During sleep, random access memory works in conjunction with our long-term memory. We apply our knowledge to certain situations, and some kind of multimedia playback of certain situations occurs.
The same applies to stressful situations that the brain plays out during a dream. So if a person periodically has nightmares with different plots, then this is a good training and educational process for the brain. The brain of such a person is better adapted to the environment. Anyone who dreams of various stressful situations approximately understands how they will act in a given situation in reality.
Another thing is intrusive nightmares. We cannot call them useful, and they often fall into the realm of post-traumatic stress disorders.
