Most often, when I ask “how much sleep do you do best with?” the reply is some version of “well, I can get by on . . . “ There is an immense gap between how much sleep we need, versus how much we can get by on. This sleep debt has a broad impact on our health, performance and quality of life.
Right now, one in three of us habitually get 6 hours or less on work nights. This is far below the 7 to 9 hours that most adults need. By Friday, we’ve missed out on 25% of our optimal sleep. Because insufficient sleep has been normalized, I worry that many of us are accidentally living a life of chronic sleep deprivation. We may be choosing long days, without realizing we’re giving up good days.
For many people, sleep comes last, after everything else. If the decision was put in a formula, it’d look like:
24 hours – (tasks + leisure) = time for sleep
Six hours of sleep a night is not enough.
There are five domains impacted by sleep: physical and mental health, physical and cognitive performance, and emotional intelligence. One thing I struggle with in this newsletter is not making it too long – nobody wants 4,000 words! So, for today I’m focusing on other ideas, and will discuss these 5 domains in depth another time. For now, think of your own experience when sleep deprived, which of these five domains shows the deficit the most?
The myth of “overcoming” sleep deprivation.
There’s a myth that with enough XYZ we can ‘push through’ to overcome sleep deprivation. There is no amount of smarts, motivation, determination, or grit that will force a sleepy brain and body to function like a well-rested one.
The other myth is that we can “catch up” on sleep at weekends and be just fine. There’s some terrific research following people with different sleep totals over many weeks, as they live the normalized pattern of insufficient sleep during the workweek, with more on weekends.
Performance declines day by day, so by Friday people are performing measurably worse than Monday. On Mondays people subjectively report feeling better and performing better, after those two nights with more sleep. Objective measures also show a bit of an improvement from the previous Friday. However, over the course of weeks, there is a steady decline in performance. Performance will deteriorate the most in people averaging 6 hours sleep on worknights, compared to those getting 7 or 8 hours nightly.
Why does this myth persist, when the performance decrements are so clear? Basically, our personal baseline of performing well and feeling good shifts downward to a ‘new normal’. If you study someone who is habitually well rested, after the first couple nights of insufficient sleep they will report feeling impaired. But an interesting shift happens after about three nights. They start saying that their performance has returned to normal. Actually, it’s just that their ability to accurately assess has deteriorated too.
The Diagnosis of “Chronic Insufficient Sleep Syndrome”
There is actually a diagnosable disorder called “Chronic Insufficient Sleep Syndrome” as per the International Classification of Sleep Disorders. It’s a hypersomnia, along with narcolepsy, idiopathic hypersomnia, and others. Let’s look at the diagnostic criteria, then unpack them. (Diagnostic criteria A-F in italics. Every criteria must be met. My comments in regular font)
A. Patient has daily periods of irrepressible need to sleep or daytime lapses into sleep, or, in prepubertal children, there’s is a complaint of behavioral abnormalities attributable to sleepiness
That lull in your energy and function after lunch isn’t just your meal, it’s a circadian dip. That dip in energy reflects a dip in core body temperature that we all have. If you are getting sufficient sleep, it should be just that, a slight dip in energy. It should not be an overwhelming inability function well, a need to nap, or inadvertently falling asleep in meetings, at your desk, or behind the wheel.
Note in young children, insufficient sleep can cause “behavioral abnormalities” which typically include hyperactivity or impulse control problems. In our home, when my daughter was little, I knew we’d missed her best bedtime when all of a sudden the quiet bedtime routine became the ‘pajama chase game.’ I suspect that some adults show similar behavioral signs, rather than the explicit sleepiness mentioned here. Over time, diagnostic criteria change, as our understanding develops.
Where are you with this, do you meet criteria A?
B. Patients sleep time, established by personal or collateral history, sleep logs, or actigraphy is usually shorter than expected for age
For adults, the recommended sleep duration is 7 to 9 hours nightly. Sleep need is on a bell curve. Try to identify where you are, what’s your sleep set-point? This may shift slightly over your lifespan.
C. Curtailed sleep pattern is present most days for at least three months
For many adults, they’re sleep deprived on work nights. Which means 5 of 7 nights without the sleep they need. That’s often true for years, not just the 3 months necessary to fulfill this criteria.
D. Patient curtails sleep time by such measures as an alarm clock or being awakened by another person and generally sleeps longer when such measures are not used, such as on weekends or vacations
Being awoken by an external influence is the crux of the matter. It’s such an accepted, unexamined, practice to always wake to an alarm. The key to figure out is “How long would I sleep if nothing woke me up?”
If you sleep longer on days off, then this criteria is met.
It’s important here to differentiate from insomnia. A person with insomnia is unable to sleep during the time they are in bed. A person with insufficient sleep syndrome is able to sleep while they’re in bed, they just aren’t in bed enough hours. The sleep extension we’ll talk about next is not appropriate for people with insomnia, instead check out my last article on Cognitive Behavioral Therapy for Insomnia.
E. Extension of total sleep time results in resolution of the symptoms of sleepiness
Here’s where doing a sleep extension experiment comes in. The goal is to see whether your symptoms of insufficient sleep resolve with more rest.
There are several ways to do this:
A. Think back to a time when you were well-rested. How much sleep were you getting? For many people this is a distant memory, maybe before your kids were born, or before the current job.
B. Slowly increase your time in bed by 15 mins every 3-4 nights until you are waking on your own. A benefit of this approach is that your commitments and lifestyle can gradually change to integrate longer sleep hours.
C. Another approach is to do what I call the “10 by 10 test.” Plan ahead, then for 10 days in a row give yourself 10 hours in bed. You want to use circadian principles such as sleeping at the right time for your chronotype, with the same wake and bed time each day. Do a bedroom tune-up in advance, making sure it’s completely dark, cool, comfortable bed, clean and uncluttered. It’s also helpful to enlist the support of your household and friends, so they don’t interrupt your sleep. By the end of the ten nights you should have a better idea of how much sleep you do best with, and how good you can feel.
F. The symptoms are not better explained by another untreated sleep disorder, the effects of medications or drugs, or other medical, neurologic or mental disorder.
Challenges to Getting Enough Sleep
Getting enough sleep on a long-term basis means you will have less time for other things. There is no getting around this. It is a real challenge when moving from a lifestyle of chronic sleep deprivation to one of being well rested. Our wake hours are full, so full that our routines maintain sleep deprivation. The good news is that we can examine our time use, and choose differently. People in some circumstances such as poverty, caregiving, etc, may have limited opportunity to shift to a lifestyle with sufficient sleep.
Design a Well-Rested Lifestyle
In my view, the ideal time use formula is:
24 hours – (sleep need + restorative leisure) = time available for tasks.
Let’s look at what we can do with each part of that formula. There’s no arguing with the 24 hours, we can only work with sleep, leisure, and tasks. I’d also argue that we can’t (or shouldn’t!) deny our needed sleep. Our set point sleep need is what it is, and choosing to go without is choosing to be impaired. So, the only two factors to adjust are leisure and tasks.
One place there’s the opportunity to make change is with leisure time. Notice I called it restorative leisure. By default we can end up using our leisure time on things that don’t actually add to our quality of life, bring us energy or joy. A solution is to first think through what leisure activities really are worth it. Everyone’s list will be a bit different. For me it’s time casually hanging out with friends, doing creative things like gardening or quilting, or exploring a new place. But like many people, I spend too much time scrolling, which does nothing good. The trick with leisure time is do the things that really add value, and ditch those habits that don’t. Low value leisure takes more time to be restorative than high value leisure. Once you’ve identified your restorative leisure, take steps to make those your default routine. Often people say they don’t have enough time for leisure. In my experience, we need leisure, and it’s going to demand time. Unplanned leisure looks like scrolling and ‘bedtime procrastination,’ while restorative leisure looks like fun.
The other part of the equation to look at is time on task. This includes paid work, and the unpaid work of life – cooking, cleaning, volunteer, commuting, etc. Are there tasks you can stop doing in order to preserve more time for sleep? Stopping a task could look like deciding to do it less often or only on days off, asking someone else to do it, purposefully getting more efficient with it, or deciding it doesn’t need to be done.
When you’re working towards a well-rested lifestyle, think in terms of 15 minute gains. What low quality leisure could you minimize? Are there two 15 minute daily tasks that you could stop? Even 30 minutes more sleep on work nights will add up. And maybe you’ll be able to interate and create more time in another month.
What it comes down to
Ultimately, it comes down to the question “Do you want a long day, or a good day?”
There are two (and only two) options to choose from: be chronically sleep deprived, with long days not at our best. Or shorter days at the top of our game after sufficient sleep. Choose whatever is right for you, my goal with this article is to help make this is a purposeful decision.
Sleep well and Dream big,
Dr. Catherine