Sleep deprivation takes a toll on cardiovascular health, increasing risk of:
- Hypertension (high blood pressure)
- Coronary heart disease, Heart attack, Stroke
- Heart failure
Sleeping less than 6 hours per night leads to a 200% increased risk of having a fatal heart attack or stroke in your lifetime. The mechanisms include:
- Increased heart rate and blood pressure
- Reduced heart rate variability (sign of unhealthy heart)
- Increased inflammation
- Impaired blood vessel function
- Increased calcification and blockage of coronary arteries
Section: 2, Chapter: 8
One key function of REM sleep and dreaming is to help process difficult emotional experiences from waking life. REM sleep:
- Reduces the emotional charge of "painful, even traumatic" experiences
- Disentangles the emotion from the factual details of the memory
- Allows the emotional memory to be stored without the same degree of emotional distress
The mechanism works by:
- Reactivating emotional memory circuits during REM sleep when stress neurochemicals like noradrenaline are suppressed
- Allowing the brain to re-process the experience in this neutral, "safe" environment
- Stripping the memory of its emotional charge so it can be filed away with less distress
Evidence shows people who are able to achieve REM sleep and dream about emotional experiences after a trauma have better long-term mental health outcomes. They are less likely to develop PTSD, depression and anxiety.
Section: 3, Chapter: 10
The composition of sleep changes across the lifespan:
- Newborns spend most of their sleep time in REM sleep
- During childhood and adolescence, the percentage of sleep time in REM declines while time in deep NREM sleep is highest
- In early adulthood, NREM and REM sleep reach the "typical" balance of NREM dominating the early night and REM dominating the late night/early morning
- In old age, time in deep NREM and REM sleep declines, leading to more fragmented, less restorative sleep Understanding how sleep architecture changes across life highlights the critical importance of getting sufficient sleep at each life stage to support brain and body development and functioning.
Section: 1, Chapter: 3
The author describes an event in 1993 where he met a professional pianist at a dinner party. The pianist told him that he would often mentally struggle with a tough musical composition in the evening. Yet when he awoke the next morning, he could play the piece perfectly, as if the dream had worked out the musical puzzle. This intrigued the author and catalyzed his research into sleep and creativity.
Subsequent studies showed that going to bed with an unsolved problem often leads to creative solutions in the morning, thanks to the power of REM sleep and dreaming. The hyper-associative nature of dreaming allows the brain to make non-obvious connections and generate novel solutions. Many famous works of art, music and science were inspired by dreams.
Section: 2, Chapter: 6
"That is, REM-sleep dreaming takes the painful sting out of difficult, even traumatic, emotional episodes you have experienced during the day, offering emotional resolution when you awake the next morning."
Section: 3, Chapter: 9
Caffeine can significantly disrupt sleep by blocking the action of the hormone adenosine, which promotes sleep. Here are some tips to minimize caffeine's impacts on sleep:
- Avoid caffeine in the afternoon and evening, as it takes a long time for the body to fully remove it. Even 6 hours before bed, half the dose of caffeine can still be circulating.
- Be aware that decaf coffee still contains some caffeine (about 15-30% of a regular cup)
- Everyone has a different sensitivity to caffeine based on genetics. If you are very sensitive, you may need to completely avoid it after noon or even eliminate it entirely.
Section: 1, Chapter: 2
- Review key facts right before bed - they are preferentially replayed and strengthened during sleep
- Focus on the toughest, most important facts before sleep - sleep selectively strengthens information that the brain perceives as most critical to remember
- Aim for a full 8 hours of sleep the night after a heavy learning session - the final two hours of an 8-hour night contain the richest dose of REM sleep
- Don't burn the midnight oil cramming - short-changing sleep will prevent adequate memory consolidation and actually cause learning deficits the next day
Section: 2, Chapter: 6
Historically, sleeping pill compounds were blunt instruments that induced a state of sedation and unconsciousness through widespread inhibition of neural activity. Problems with these first-generation sleep drugs included:
- Altered electrical brain wave activity during sleep
- Inhibited restorative slow-wave sleep and dreaming
- "Hangover effect" of morning grogginess and dizziness
Newer "Z-drug" sleeping pills like Ambien are somewhat more selective in their neurochemical effects, but still do not induce truly natural sleep. They tend to:
- Shorten sleep onset latency but do not increase total sleep time
- Leave individuals vulnerable to complex partial amnesia and sleep behaviors
- Cause rebound insomnia when discontinued Current pharmaceuticals are not an adequate long-term solution for sleeplessness. They induce sedation more than naturalistic sleep, and come with significant risks and side effects.
Section: 4, Chapter: 14
"The number of people who can survive on five hours of sleep or less without any impairment, expressed as a percent of the population, and rounded to a whole number, is zero."
Section: 1, Chapter: 1
REM sleep plays a crucial role in brain development in utero and in early infancy:
- By the end of the second trimester, the basic structure to generate REM sleep is in place
- In the last trimester and early infancy, babies spend most of their sleep time in REM sleep
- The REM sleep acts as an electrical fertilizer, stimulating the growth and maturation of neural circuits throughout the developing brain
- Depriving infant animals of REM sleep leads to smaller brains and neural abnormalities This shows REM sleep is essential for normal brain development. Anything that restricts REM sleep in pregnancy or infancy can have detrimental impacts on brain maturation.
Section: 1, Chapter: 5
Ambient bedroom temperature is a powerful but underappreciated modulator of sleep quality. A cool environment helps promote sleep, while a warm environment makes it harder to fall and stay asleep. Key findings include:
The ideal bedroom temperature for sleep is around 65 degrees Fahrenheit (18.3 Celsius). This promotes the drop in core body temperature needed to initiate sleep.
Insomnia patients often have a warmer core body temperature and show less temperature drop before sleep compared to good sleepers. Warming the skin of the hands and feet (eg with a hot bath) helps dissipate body heat and accelerate sleep onset, while a cold bath has the opposite effect.
Section: 4, Chapter: 13
There are two key questions to determine if you are getting sufficient sleep:
- After waking up in the morning, could you fall back asleep at 10 or 11am? If yes, you are likely not getting sufficient sleep quantity and/or quality.
- Can you function optimally without caffeine before noon? If no, then you are most likely self-medicating your state of chronic sleep deprivation. If you answer yes to either question, you should take seriously your lack of sleep and seek to address your sleep deficiency.
Section: 1, Chapter: 1
In animal studies, total sleep deprivation kills rats and flies faster than total food deprivation. Key findings include:
- Rats died after 15 days of total sleep deprivation, on average
- This was about the same time it took for rats to die from total food deprivation
- Rats lost their lives almost as quickly from selective REM sleep deprivation as from total sleep deprivation
- Prior to death, the rats developed skin lesions, weight loss, hypothermia and sepsis (bloodstream infection)
These animal experiments prove that sleep is a life-sustaining biological necessity, not just a "nice to have." Sleep is arguably more essential for survival than food in the short-term. Sleep deprivation essentially causes the body to "self-destruct" through multiple organ failure if pushed to the extreme.
Section: 4, Chapter: 12
REM sleep and NREM sleep are characterized by very different patterns of brain activity:
NREM sleep:
- Dominated by slow, synchronous brain waves
- Reflects a relatively quiescent, inactive brain state
- Plays a key role in memory consolidation and learning
REM sleep:
- Characterized by fast, desynchronized brain waves similar to wake
- Increased activity in visual, motor, emotional and memory centers
- Plays a key role in emotional processing, creativity and memory integration
Switching between NREM and REM sleep through the night allows the brain to carry out distinct but complementary cognitive processes that are vital for learning, memory, emotional health and overall brain function.
Section: 3, Chapter: 9
Sleep before learning refreshes our ability to initially make new memories. The hippocampus acts as a short-term reservoir for accumulating new memories. But there is a limited storage capacity, like a USB memory stick. Sleep effectively "clears room" in the hippocampus for new learning by:
- Replaying and strengthening previously acquired information
- Transferring those memories to long-term storage in the neocortex A nap study showed that the more sleep spindles (bursts of brain activity) participants had during the nap, the more refreshed their hippocampus was upon awakening, allowing them to learn new facts more effectively. This shows sleep is critical before learning to prime the brain to soak up new information.
Section: 2, Chapter: 6
Exposure to artificial light in the evening suppresses the sleep-promoting hormone melatonin and delays the circadian rhythm, making it hard to fall asleep at night. Key issues include:
- Artificial light tricks the SCN into thinking it is daytime, inhibiting the transition to night-mode physiology
- Electronic device use in the last 1-2 hours before bed is especially disruptive due to high levels of short-wavelength blue light
- Light exposure greater than ~10 lux is enough to measurably suppress melatonin, yet typical room lighting is 100-300 lux and phone/laptop/TV screens are 50+ lux
- LED lighting is 2-3x more melatonin-suppressing than incandescent lighting due to its blue-light peak
Solutions include dimming lights and avoiding screens in the last 1-2 hours before bed, using blue-blocking glasses or apps in the evening, and favoring dim red/amber lighting over blue-enriched white lighting at night.
Section: 4, Chapter: 13
Early school start times are fundamentally misaligned with the delayed circadian rhythms of adolescents. The mismatch causes chronic sleep deprivation in middle and high schoolers, with consequences for:
- Academic performance - sleep deprived students have lower grades and test scores
- Mental health - sleep loss is tied to higher rates of anxiety, depression and suicidal thoughts
- Physical health - insufficient sleep impairs immune function, increases obesity risk and stunts growth
- Public safety - drowsy driving is a major cause of car crashes in teen drivers
Studies show delaying school start times (eg from 7:30am to 8:30am) improves:
- Average nightly sleep duration
- Academic performance, especially in morning classes
- Mood and mental health complaints
- Rates of car accidents in student drivers
Giving adolescents the opportunity to sleep in line with their biological needs is a cost-effective way to boost educational outcomes and public health.
Section: 4, Chapter: 16
The circadian rhythm controls the rise and fall of core body temperature, metabolic rate, and release of many hormones. Jet travel across time zones forces the body's internal circadian clock to suddenty adjust, like an old watch being wound back or ahead. This causes cognitive deficits as the brain's deep emotional centers are thrown into disarray. Two frequent travelers anecdotally reported struggling with jet lag after returning from a trip:
- One experienced a 20% deficit in reaction time and concentration a full six days after returning from a trip from London to LA
- Another frequently missed important facts and details at meetings after traveling internationally, as the memory circuits were not functioning properly due to the jet lag
Section: 1, Chapter: 2
Some people are able to achieve a dream state known as "lucid dreaming." Lucid dreamers become aware that they are dreaming while still in the dreams, and can consciously influence the content of their ongoing dreams.
Lucid dreams most often occur during late-morning REM sleep. They appear to arise when portions of the frontal cortex that control logical awareness "reawaken" while the rest of the brain remains in REM sleep.
Potential benefits of lucid dreaming include:
- Enhancing creativity and problem-solving by deliberately incubating dreams on a chosen theme
- Practicing new skills or overcoming challenges in a "virtual reality" environment
- Reducing nightmare frequency by controlling scary content
- Promoting self-awareness and personal growth
However, lucid dreams can also have downsides:
- Becoming so absorbed in fantasy that waking life feels dull by comparison
- Difficulty distinguishing dreams from reality if lucidity "bleeds over" into wake
Section: 3, Chapter: 11
The content of dreams reflects our waking-life experiences, but dreams are not a literal replay of memories. Key features of dream content:
- Predominantly visual and perceptual rather than verbal
- Often highly emotional, especially negative emotions like fear, anxiety and anger
- Frequently bizarre, illogical and nonsensical
- Incorporate fragments of recent waking experiences, but blend them in novel ways
- Tend to feature recurring settings, themes and activities that are personally relevant
Studies suggest only 1-2% of dreams are exact replays of waking experiences. Rather, dreams "meld" and "mash together" fragments of recent autobiographical events in "haphazard, absurd ways" to create a novel dream experience. This remixing of memories may serve an important function for emotional processing and memory integration.
Section: 3, Chapter: 9
Another key function of REM sleep is to promote creativity and problem-solving. The neurological features of REM sleep support:
- Formation of novel, non-obvious connections between distantly related ideas
- "Out of the box" thinking that transcends logical, linear constraints
- Visualization of problems from new angles or perspectivesIncubation of ideas that lead to "eureka" moments of creative insight
Studies show REM sleep enhances performance on creative tasks like anagram word puzzles. People are 15-35% better at "unscrambling" anagrams after awaking from REM sleep compared to NREM sleep or wake. REM sleep is a natural creativity-booster, allowing the brain to "shake off" the logical filters of wake and engage in fluid, associative processing.
Section: 10, Chapter:
Two-thirds of adults throughout all developed nations fail to obtain the recommended eight hours of nightly sleep. Routinely sleeping less than six or seven hours a night demolishes your immune system, more than doubling your risk of cancer. Insufficient sleep is a key lifestyle factor determining whether or not you will develop Alzheimer's disease. Inadequate sleep—even moderate reductions for just one week—disrupts blood sugar levels so profoundly that you would be classified as pre-diabetic. Short sleeping increases the likelihood of your coronary arteries becoming blocked and brittle, setting you on a path toward cardiovascular disease, stroke, and congestive heart failure.
Section: 1, Chapter: 1
Some companies are bucking the trend of chronic sleep deprivation by instituting progressive sleep policies:
- Insurance company Aetna pays employees a bonus if they prove they get at least 7 hours of sleep per night
- Google and Nike have installed "sleep pods" on campus where employees are encouraged to take naps
- Goldman Sachs and McKinsey & Co. have instituted later morning start times and discourage after-hours emails
- NASA found that pilots performed 34% better on simulation tasks after a 26-minute cockpit nap and now sanctions in-flight napping
These forward-thinking organizations recognize the powerful performance and health advantages of a well-rested workforce. By incentivizing sleep as a business priority, they aim to boost productivity, creativity and employee wellness
Section: 4, Chapter: 15
Virtually every organism studied to date sleeps or engages in something remarkably like it, including: Insects, including flies, bees, and cockroaches, and even very simple organisms like nematodes and jellyfish
The universality of sleep across living creatures suggests it evolved with life itself and must serve critical functions. The fact that animals will die if deprived of sleep further proves its life-sustaining importance.
Section: 1, Chapter: 4
The circadian rhythm—the internal twenty-four-hour clock of the brain that times the release of the sleep-promoting hormone melatonin—changes across childhood and into adolescence:
- In young children, melatonin is released early in the evening, allowing them to fall asleep early and wake up early
- In adolescents, the melatonin release shifts later in the evening, making it hard for teens to fall asleep early and wake up early
- Adults settle into an earlier circadian rhythm similar to children, but not as early These changes are biologically hardwired and very difficult for teens to fight, leading to chronic sleep deprivation when school schedules require early wake times.
Section: 1, Chapter: 2
"Sleep is the greatest legal performance-enhancing 'drug' that most people are probably neglecting. Scientists have discovered a revolutionary new treatment that makes you live longer. It enhances your memory and makes you more creative. It makes you look more attractive. It keeps you slim and lowers food cravings. It protects you from cancer and dementia. It wards off colds and the flu. It lowers your risk of heart attacks and stroke, not to mention diabetes. You'll even feel happier, less depressed, and less anxious. Are you interested?"
Section: 2, Chapter: 6
Cognitive Behavioral Therapy for Insomnia (CBT-I) is the gold standard non-pharmaceutical treatment for chronic insomnia. It involves:
- Sleep education to correct misconceptions and shape expectations
- Stimulus control to re-associate the bed with sleepiness rather than wakefulness
- Sleep restriction to increase sleep drive and sleep efficiency
- Cognitive therapy to identify and challenge anxiety-provoking thoughts about sleep
- Relaxation techniques to reduce physiological and mental arousal before bed
Randomized controlled trials show CBT-I improves both sleep onset and sleep maintenance problems. Benefits are often seen within 4-8 sessions and last for months to years after training. Importantly, CBT-I achieves these gains without the risks and side-effects of sleeping pills. It is a safe, effective and durable treatment that addresses the root causes of insomnia.
Section: 4, Chapter: 15
While all animals experience NREM sleep, only mammals and birds engage in REM sleep. Reptiles, amphibians, fish and insects show no signs of REM sleep. This suggests REM sleep emerged later in evolutionary history as a specialized form of sleep. Scientists believe REM sleep evolved to support brain functions that NREM alone could not achieve, such as emotional processing and creativity. REM sleep likely emerged independently in both mammalian and avian lines, suggesting it conveyed significant evolutionary advantages.
Section: 1, Chapter: 4
One of the most immediate impacts of sleep deprivation is worsened concentration and attentional focus. Sleep-deprived individuals experience:
- Lapses in attention, known as "microsleeps"
- Slowed reaction times
- Reduced perceptual and situational awareness
- Impaired decision making and judgment
These concentration deficits scale with the degree of sleep deprivation. Just modest nightly reductions in sleep time (1-2 hours) over a week can lead to the same impairments as a full night of sleep deprivation. This manifests in higher rates of fatal occupational and vehicular accidents.
Section: 2, Chapter: 7
