Tedious, weak, and worst of all "riddled" with errors and oversights. Do not read.
I recommend instead Dreaming: A Very Short Introduction by J. Allan Hobson for information about the REM/dreaming stage of sleep, as well as Restful Sleep by Deepak Chopra for readers interested in practical help for improving sleep quality. Unlike Why We Sleep, both of these books are short, direct, readable and clear.
Sadly, I also have to spend a brief few sentences on Alexey Guzey's devastating criticisms of this book. Alexey's entire post is very much worth reading, but if you want to see just one glaring example of atrocious academic ethics, you can start with a chart Matthew Walker uses in Chapter 6 to prove a linear relationship between sleep loss and sports injury--except that he cuts off the part of the chart that disproves his argument. This is childish middle school stuff, way beneath the line of a Berkeley and Harvard professor, and catastrophic to a "scientist's" reputation. And it's not the only time Walker has been caught doing it! Mendacious, incompetent, or possibly both.[1]
It's worth remembering that nobody makes much money (or career progress) by uncovering fraud in a study, by discovering that a study finding doesn't replicate, by finding that a new pharma med doesn't work, or outlining all the errors, mendacious or otherwise, that are in a best-selling book on sleep. Posts like Alexey's are literally God's work.
Let me pile on my own two cents on Why We Sleep's academic shortcomings, and bring up the astounding fact that throughout the book there is absolutely no acknowledgement anywhere of the work of Cornell University's James Maas, who did pioneering work in this domain in the 1980s and 1990s, and who is likely the world's most well-known sleep researcher. Worse, much of Matthew Walker's discussion of sleep deprivation in this book Maas talked about already, decades ago.[2] The fact that there's no mention of Maas anywhere in Why We Sleep is a shocking omission that brings into question the author's knowledge of his own domain.
When a book is objectively this bad,[3] it can be an intellectually profitable exercise to ask what it is structurally or stylistically that makes it so, and what might be done to make it less so. Obviously we'd have to start by eliminating all mendacious chart crimes, unsubstantiated claims, errors and so forth. We could note the fact that many of the chapters are poorly organized and misleadingly titled. In fact in some ways, the book itself is misleading throughout, as the author frequently wrongfoots the reader by bringing up a topic and then... not actually addressing that topic at all. I'll use Chapter 5 here because it offers so many egregious examples. This chapter is titled "Changes in Sleep Across the Lifespan," and it understandably begins with a discussion of sleep in utero and sleep in infants. But then the author drags us into multi-page tangential discussions of autism, fetal alcohol syndrome and the effects of alcohol in breast milk--all of which are important topics but which have nothing to do with "Changes in Sleep Across the Lifespan." Later there is another unnecessary and off-topic tangent on reduction in NREM sleep leading to schizophrenia among adolescents. Then, yet another off-topic tangent discussing the evils of early school start times. And the tangents don't stop there! A few pages later, in a discussion of changes in sleep in midlife and old age, the author takes us on yet another tangent about how sleep deficits in older adults lead to dementia, but then doesn't even finish the tangent. Instead he triple-wrongfoots the reader by writing that this is "a topic that we shall return to" ...and then never tells the reader when or where in the book! The reader cannot help but wonder if the author is being intentionally cruel.
Okay. It isn't that these aren't topics worth addressing per se, the problem is repeatedly faking out your readers by not writing about what you just told them you would write about, and by not organizing your book in a way that allows you to offer your insights without constant off-topic tangents. These kinds of writing sins throw the reader from the book; the reading experience is no longer organic nor logical.
Even the book's title and subtitle are fundamentally misleading. Why We Sleep: Unlocking the Power of Sleep and Dreams sounds like it might be a really good book (thus kudos to the marketing department--I guess), but in reality this book is mostly about the risks of sleep deprivation. Again, this is fundamentally mendacious: the reader thinks he's getting one thing, but he's not. He's getting something else.
Keep it simple: tell your reader what you intend to write about... and then write about it. Fulfill the ethical bond between writer and audience.
One last thought: it nauseates me that books like this not only exist, but are shoved down our throats by the media-industrial complex. This book sat on the New York Times bestseller list for some 25 weeks. The author got a slot on Rogan. Even Bill Gates puffed his book, although I strongly suspect Gates did not read the entire thing.
I continue to find it a far safer intellectual strategy to avoid all books published in the past few decades, and instead read older books that have survived the entropy of time. Most assuredly this book will not.
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Footnotes:
[1] If I had my way, bestselling authors who do stuff like this should be forced to sit in a room and place a sticker on every single copy of their book confessing their chart and data crimes. Matthew Walker's sticker might say (among a long list of other things), "Please note the chart on page 129. In an inexcusable breach of academic ethics, I removed part of that chart to make my argument appear robust when it most assuredly wasn't. I apologize." Note that certain academics (see for example the infamous Brian Wansink) would be sitting in that room for the rest of their lives.
[2] Maas was also famously known for teaching Psych 101, by far the most popular class at Cornell University. He was also known for "me too" allegations decades before "me too" was even a thing, as he allegedly made sexual advances to a number of female undergrads. Given all this, it is mind-bending that author Matthew Walker doesn't even seem to know who Maas is.
[3] In the interests of brevity (which I've already breached by making this book review as long as I have), I didn't even get into the author's surprisingly pharma-compliant medical world view. See for example his odd fetish for statin meds (Chapter 7) and his lockstep compliance with the now-debunked beta-amyloid model for treating Alzheimers (Chapters 5 and 7). Granted, this book came out in 2017, thus one sincerely hopes the author has reconsidered these views.
[Readers, as always, a friendly warning: the notes and quotes from the text that follow are here to help me order my thinking and better remember what I read. They are almost certainly not worth reading! It's not even worth skimming the bold parts.]
Notes:
Part 1: This Thing Called Sleep
Chapter 1: To Sleep...
* The author tries his best to write in a witty readable style, he follows the rule of three, he inserts jokes here and there, he starts the book out with certain attention-grabbing facts (sleep deprivation causes you to eat more, disrupts blood sugar levels, it's a key factor in Alzheimer's, major factor in traffic deaths etc.).
* The author talks about his journey to become a sleep researcher; he started out attempting a PhD on dementia research and was attempting to examine brainwave activity in older adults in the early stages of dementia and it led him to look into sleep research, as there were indications of perhaps a link between sleep deprivation and many of the symptoms of dementia, like hallucinations, delusions, aggression and memory loss; and then he realized that "nobody actually knew the clear reason why we needed sleep," and so he took a postdoc position at Harvard to do sleep research. ["Nobody actually knew" per the author but he never cites any of the work of James Maas from Cornell's famous sleep research lab. How can an "expert" on this subject have such a gaping, wide-ass hole in his knowledge and leave something this big totally out of his book?]
* On the structure of the book: Part 1 demystifies sleep: what it is, what it isn't, how sleep changes across your lifespan. Part 2 details benefits of sleep for the brain and body, and what lack of sleep can do to damage our health. Part 3 discusses dreams, part 4 discusses sleep disorders, including insomnia. Finally the author shares "a road map of ideas to reconnect humanity with the sleep it remains so bereft of..."
Chapter 2: Caffeine, Jet Lag, and Melatonin
* On the human circadian rhythm, a strange factoid here about how it controls the amount of urine you produce along with an attempt at a witty footnote about why you shouldn't say this at dinner parties, but then he just drops the idea, never telling the reader anything about how it controls the amount of urine you produce, nor giving any additional context about this factoid at all. Very odd.
* Unnecessary sidebar about French geophysicist Jean-Jacques d'Ortous de Mairan, who with his black box experiments proved that plants produce their own internal time. Then on to Nathaniel Kleitman and Bruce Richardson and their experiments in Mammoth Cave on human circadian rhythms, showing that circadian rhythms weren't exactly 24 hours but they were around a day in length; on other cues like sunlight, social activity, feeding, and temperature fluctuations that also signal our internal clock; on its location in the brain in the "suprachiasmatic nucleus," located in the middle of your brain, just above the point where the optic nerves coming from your eyeballs cross over each other and switch sides. According to the author the structure "samples the light signal being sent from each eye along the optic nerves as they head toward the back of the brain for visual processing." This brain structure coordinates various circadian functions like body temperature which rises during the day and declines as bedtime approaches; the author tells us that even if you stayed awake all night your core body temperature would show the same pattern.
* Discussion of morning people and night owls, "larks and owls" as the author calls them, he's quick to criticize the ills of society's work scheduling, which is biased against owls and forces them into an unnatural sleep-wake rhythm; also he claims [without any evidence] that being a night person or a morning person is not your fault, it's your genetic fate, and then suggestion an explanation for why this might be true: thinking about the adaptability of a group of humans such that some would wake up early and someone go to bed late; this would make sure that the group collectively was better defended and less vulnerable.
* On melatonin, a hormone is released at night in your brain, but it doesn't actually influence the generation of sleep itself which is a misconception many people hold; on jet lag and the fact that our circadian cycles are little longer than a day might be one of the reasons why flying west is easier than flying east [I don't think this is as likely a reason as the far simpler reason that it is easier to fall asleep later than it is to force yourself to fall asleep earlier]; on various health risks and poor health statistics for airline flight crews.
* On adenosine, a chemical that's released and builds up in your brain the longer you are awake; it increases "sleep pressure" and after 16 to 18 hours away your adenosine concentrations peak and you'll have an irresistible urge to sleep.
* On caffeine, which the author calls "the most widely used (and abused) psychoactive stimulant in the world." And then strangely he claims it is "The second most traded commodity on the planet, after oil." [Uh, there are no "caffeine futures" traded on the Chicago Merc! Coffee futures, yes, but caffeine futures, nope.] On caffeine's half-life which the author claims is 5-7 hours, and it lengthens as we age. Also comments on the caffeine crash, what happens is your adenosine continuous building up in your body, and it hits you with a wave as the caffeine is broken down in your body, thus you are hit with a forceful urge to sleep. Note also the spider web image here showing spider webs built by spiders on caffeine and other drugs. [I've seen these images before, they never tell you that they likely give the spider gigantic doses, far greater in body mass terms than humans would ever be able to ingest.]
* On the overlapping cycles of adenosine and circadian rhythms and why you can get a second wind even after a long period of being awake; and then two simple clinical sleep assessment questions: 1) After waking up in the morning could you fall back asleep at 10:00 or 11:00 a.m.? If yes you're not getting sufficient sleep quantity or quality. 2) can you function optimally without caffeine before noon? If the answer is no "then you are most likely self-medicating your state of chronic sleep deprivation." Two other questions: 1) If you didn't set an alarm clock would you sleep past that time? And 2) Do you find yourself at your computer screen reading and then rereading the same sentence?
Chapter 3: Defining and Generating Sleep
* On agreed upon observable features that indicate sleep: stereotypical position of lying down, lowered muscle tone, slouching, no responsivity, easily reversible (unlike a coma), adheres to a reliable pattern across 24 hours. But then asking how do you yourself know that you have slept? 1) Loss of external awareness, your sensory input is blocked by the thalamus; 2) you lose track of time while you sleep on a conscious level, although on a non-conscious level the brain still catalogs time with precision. Also comments here on the time dilation we experience during dreaming sleep.
* On Eugene Aserinsky documenting human infant sleeping behavior and discovering REM sleep (with its ocular features) as well as non-REM sleep, playing out in 90 minute cycles. See photo below for a hypnogram. For more of this look to Chapter 6, but a key function of deep non-REM sleep is to weed out and remove unnecessary neural connections. REM sleep strengthens neural connections. Note also that much of the REM sleep occurs closer to your waking time, and so if you wake up say two hours early you might lose 60-90% of all your REM sleep even though you're only losing maybe 25% of your total sleep time; vice versa if you go to bed later and wake up at the same time: you'll thus lose a disproportionate percentage of you NREM sleep.
* Very stretched multipage analogy to describe brainwave activity using a stadium full of people; discussion of waking activity which involves various parts of your brain processing different inputs--this brainwave activity patternless; on slow wave sleep which is in NREM stages 1 and 2; on "sleep spindles," a phenomenon that happens at the end of each slow wave, this supposedly protects the brain from external noises and it helps you shield the brain from external noises and helps keep you asleep [he drops in this idea in two paragraphs but then drops the idea, not giving us any more context]; now back to slow wave brain activity where your brain is self-organizing, going back to his football stadium analogy, he describes a crowd chanting in a lockstep mantra, the author eventually tells us this brainwave activity helps us saves memories, but we will allegedly learn more about this in Chapter 6. Another stretched and weak analogy here where he attempts to explain brain waves via the metaphor of an AM/FM radio, but then has to explain AM/FM radio waves by another analogy of muscle-bound sprinters and lean distance runners; then we return back to the idea that NREM sleep's slow wave brain activity enables packets of information to move around the brain like a file transfer process, moving memory packets from short-term storage in two long-term storage; this is a reflective state that fosters information transfer and memory distillation. No discussion of any mechanisms here, nor any discussion of which brain regions are involved here. [This chapter was frustrating, as the author drops facts without an overarching context, and also his facts don't really sit in any consistent substrate. Also it's curious that in the prior chapter he spends a lot of time describing the location of the suprachiasmatic nucleus, which turns out to perform a rather minor sleep function; here he has an extended discussion of major sleep functions (REM and NREM brain wave activity, etc.), but doesn't discuss any anatomy at all.]
* Now onto REM sleep, REM brainwave activity looks like wakeful brain activity. "Paradoxical sleep" featuring "atonia" or absence of muscle tone, a type of paralysis, thus we cannot act out or move in concert with our dreams., on the eye movements of REM sleep: the author tells us he's going to tell us about this in Chapter 9. [This has happened twice now in this chapter where he's told us he will tell us something elsewhere in the book, but why not just tell us now in a short pair of sentences with a deeper explanation later? This is an indication that the book could be better organized and structured.]
Chapter 4: Ape Beds, Dinosaurs, and Napping with Half a Brain
* When did life start "sleeping"; investigations into other animals; all animals sleep; on differences in sleep from one species to another; trivia here on the number of hours different animals need [elephants need 4 hours squirrels need 7.7 hours, but degus, a related rodent, needs 15.9 hours: why is the other telling us this?]. Guesses as to why there's a differential among animals, brain complexity relative to body size requiring more sleep; also sleep quality versus quantity might be a driver: in other words animals that slept less had better quality sleep, but apparently sleep researchers have dispensed with this last idea; the author then posits that it has to do with "a complex hybrid of factors": whether the animal is omnivore, herbivore, carnivore, on the predator/prey balance within a habitat, metabolic rate, nervous system complexity. Other differences across species, some species do not have REM sleep, only birds and mammals have it; water-based mammals would drown so they don't have REM sleep with its atonia, and partially land aquatic animals like fur seals have REM sleep when on land but don't have it under water. [I can only imagine the lack of rigor in the "studies show science" that determine things like "fur seals have REM sleep when on land but not when underwater," or that "duck-billed platypuses have more REM sleep activity than any other mammal." Note that the author never cites any studies here as he makes these claims, and the book lacks a bibliography.]
* On split-brain sleeping animals: on dolphins, which uncouple their brains and sleep on one half while the other half manages movement, even vocalized communication; something useful for an aquatic animal in non-stop movement. On birds that keep one eye open; on flocks that keep sentries who do halfbrain sleep on either end of a row while the other birds sleep full-brained; "Two reports" [that the author doesn't cite] "suggest humans have a mild version of unihemispheric sleep" that happens when you're sleeping in a new location or an unfamiliar environment.
* Sleep patterns under duress: in starvation foraging for food will supersede sleep; female killer whales after they've given birth to a calf during their journey home do not sleep at all during transit, likewise birds during transoceanic migration only go into micro-sleeps.
* On how humans should sleep: we "are not sleeping the way nature intended." Biphasic sleep is normal per the author, he makes this claim based on hunter-gatherer tribes' behavior; repeated comments here on how absolutely horrible modern society is, forcing us into monophasic sleep; discussion on how the siesta practice exists in societies that are far healthier, like Mediterranean Europe; Homo Sapiens was a ground sleeper unlike most primates; on the pluses and minuses of sleeping in a tree: freedom from lice, fleas, ticks and ground hunting predators, but with the tradeoff of falling. The invention of fire enabled safer ground sleeping, the author also notes that we sleep less than other primates but have a much higher percentage of REM sleep, which he believes accelerated the complexity of our brains, REM sleep is not going to be particularly safe if you sleep in trees because of the loss of muscle tone, etc.
* "From these clues, I offer a theorem: the tree-to-ground reengineering of sleep was a key trigger that rocketed homo sapiens to the top of evolution's lofty pyramid." [You'd think a professor at UC Berkeley would know the difference between a theory and a theorem!] He believes that this enabled greater REM sleep, which then enabled greater sociological complexity and greater cognitive intelligence. [The author the babbles for the remainder of the chapter--mostly evidence-free--on all the advantages of REM sleep and all the things that he thinks REM sleep led to in human development. The biologist Steven J. Gould would read this and call it one gigantic just-so story.]
Chapter 5: Changes in Sleep Across the Life Span
* Infants spend almost all of their time a sleep-like state; the infant's brain is not developed enough to "construct the REM-sleep muscle-inhibiting system" that adults have. In the final trimester "glimmers of real wakefulness emerge" but also the infant remains in tremendously long of states of REM sleep.
* This is supposed to be a chapter about changes in sleep across the lifespan, but now the author is talking about autism; on his (rather implausible) second-order conclusions that deprivation of REM sleep in infancy causes autism; now without advanced warning he's talking about fetal alcohol syndrome [?], on alcohol in breast milk and how that suppresses infants' REM sleep; "REM sleep is not optional during early human life, but obligatory."
* Infant sleep is polyphasic sleep, by age 3 or 4 months some impact of the circadian rhythm begins to take hold. Note this crappy sentence: "By the one year milestone of development, the suprachiasmatic nucleus clock of an infant has gripped the steering reins of the circadian rhythm." Now we (oddly) jump to age 4, where the circadian rhythm is dominant with just a single daytime nap; now a biphasic sleep pattern; also the ratio of NREM to REM sleep shifts from 50/50 at age 6 months to 70/30 by age five, eventually to stabilize at 80/20 by late teens.
* On the "synaptic pruning" of NREM sleep that happens in the adolescent years as it becomes a larger percent of sleep time; the author describes it as an "individualized refinement" of the brain: the "generic brain" becomes individualized, "based on a personalized use of the owner" by way of the synaptic pruning carried out during deep NREM sleep.
* On the research of Irwin Feinberg, who tracked 10 years' worth of longitudinal sleep assessments of children from age 6-8-year-olds, the neurological equivalent of time lapse photography; the other tells us that deep sleep is a driving force of brain maturation.
* Tangent here on reduction in NREM sleep resulting in schizophrenia among adolescents; the author tells us [for the first of many times] about the life-threatening effects of early school start times. Then on to the circadian cycles of teenagers where their wakefulness stays high until late in the evening and they then sleep until late in the morning.
* On sleep in midlife and old age being more "disordered" as the author phrases it [I'll say!]; on the myth that older adults need less sleep; on "the core impairments of sleep that occur with aging": 1) reduced quantity and quality, 2) reduced sleep efficiency and 3) disrupted timing of sleep [as another example of how this book is poorly organized he has a long text section here discussing the last two reasons first and then the first reason last]; he uses a new phrase here "electrical quantity and quality" of deep NREM sleep, without defining it. Elderly people fail to connect their sleep deterioration with their health deterioration; on sleep fragmentation, partly due to weakened bladder elasticity, so we have to get up more often in the night to pee; also risks of falls and fractures while making a bathroom visit at night in a cognitive haze. Also on changes of circadian timing with advanced age; an earlier evening release and peak of melatonin as we get older, which "instructs" the body to expect an earlier start time for sleep; note that dozing in the early evening will take away from sleeping that night; also the change in circadian timing causes older people to wake up early; the author suggests using bright light exposure in the late afternoon to push back the normal rise in melatonin to later to match an average adult sleep onset time. Also possibly limit bright light exposure in the early morning. He also suggests considering taking prescription melatonin.
* Finally he addresses the first of his three "core impairments to sleep" last here: reduced sleep quantity and quality; he connects it to brain atrophy that happens over time, "...we discovered a clear answer, unfolding in a three-part story." [Another style/omit needless words comment here: the author could have described this entire phenomenon in a couple of sentences, but instead he describes how he'll describe the phenomenon in a couple of sentences and then goes on to spend paragraphs describing it.] Basically, the deep sleep generating regions of the brain lose neurons with age; next he says 40% of the explanation for the loss of deep sleep in the elderly remained unaccounted for by our discovery; note also the highly unfortunate comment here about beta amyloid as an important factor that he and his research team have identified. [Unfortunately it appears that this author also got sucked into the fraudulent amyloid scam for what causes Alzheimers: since this book came out in 2017 it parrots that era's official dementia narrative: for a good review of the amyloid scam, see the Midwestern Doctor's excellent work]
* Now doubling back to the myth that older adults need less sleep; based on various misconceptions: older adults don't show as dramatic an impairment in performance on basic response time tasks if deprived of sleep, which led to the (incorrect) assumption that they must therefore need less sleep (in reality they show less impairment in response times because they are already slow! The "floor effect"); also older adults don't show as strong a sleep rebound the next night: this is also incorrectly interpreted to mean they therefore must need less sleep if they have less need of a recovery in sleep the next night. Useful analogy here on this last point: it's like assuming that because you have weaker bones as you age, you therefore somehow need weaker bones as you age.
* Once again he leaves the reader hanging here talking about sleep deficits in older adults leading to dementia, "a topic that we shall return to." [Again, a style critique here: there are a couple of things a kind author can do at a point like this to make his readers suffer a little less through his book: you could tell the reader when you'll return to this topic (tell us which chapter, or even better, precisely which page), and you could also let the reader have a few arresting tidbits about your thinking right now to build a little foreshadowing and perhaps reduce the tedium of the book; Finally, the ideas will be more easily recalled by the reader when you actually do address them later. Don't needlessly make your readers suffer, and make their job easier, not harder.]
Part 2: Why Should You Sleep?
Chapter 6: Your Mother and Shakespeare Knew
* "...most of us do not realize how remarkable a panacea sleep truly is. The following three chapters are designed to help rectify our ignorance..."
* On the benefits of sleep and learning, a "studies show science" study that the author did testing memorization skills of a group that napped in the afternoon versus a group that didn't; the author claims that sleep spindles [recall this is part of Stage 2 NREM sleep from Chapter 3] are important during a nap or during sleep in order to optimize learning, note that older adults do not generate sleep spindles as well as younger adults; also on the benefit of sleep after learning to metaphorically "click save" on newly acquired information.
* On sleeping the night after learning: NREM sleep plays a role in a sort of "real estate transaction" per the author's analogy, where the brain migrates memories from the hippocampal region to the neocortex; also a nuance here where it can also help retrieve corrupted or lost memories, the author uses the analogy of fixing a corrupted hard drive, where sleep offers a recovery service at night again during NREM sleep. A few other "studies show science" type experiments where they test the use of electrical brain stimulation synchronized with brain waves to help improve memory retention, also an absolutely silly study here done where a Swiss research team rocked a bed back and forth, claiming that this helped memory retention when done during NREM sleep. Further comments here on sleep, especially NREM sleep used to help declutter the mind and forget things: see Francis Crick and his view that sleep would help remove unwanted or overlapping copies of information, what he termed "parasitic memories"; the author describes it this way: "...sleep was far more intelligent than we had once imagined. Counter to earlier assumptions in the twentieth and twenty-first centuries, sleep does not offer a general, nonspecific (and hence verbose) preservation of all the information you learned during the day. Instead, sleep is able to offer a far more discerning hand in memory improvement: one that preferentially picks and chooses what information is, and is not, ultimately strengthened."
* So far all of the studies and discussions so far have centered on declarative memory, factual or fact-based memory; now the author switches to procedural memory and skill memories like riding a bike. [I think the author would have helped his readers if he went through a discussion here of the difference between declarative memory, semantic memory, procedural memory, etc.] The author discusses what he calls motor skill memory, where he worked with spinal cord injury and stroke injury patients.
* Note this awkward sentence that never should have survived editing: "After my lecture, a distinguished-looking gentleman with a kindly affect, dressed in a tweed suit jacket with a subtle yellow green hue that I still vividly recall to this day, approached me." This sentence introduces a paragraph of a conversation he had with a piano player, that the author calls one of the most scientifically important conversations of his life: the man tell him I can work on a music piece where I have a mistake or a problem at a certain part of the piece and then when I wake up the next morning and sit back down I can play it, "I can just play." The author says back to him "I knew of no scientific evidence to support the claim." The author summarizes it with "practice makes perfect but practice with sleep makes perfect." "Your brain will continue to improve skill memories in the absence of any further practice. It is really quite magical." The offline learning occurs across the period of sleep but not across equivalent time periods spent awake. [Another thing that strikes the reader here is this guy is spending years researching ideas that are borderline self-evident, anyone's grandmother can tell us these things already. As Nassim Taleb says, don't lecture birds on how to fly.] The author then goes on to say that much of this development happens in the last few hours of sleep.
* On other physical functions hampered by insufficient sleep: aerobic output, sustained muscle strength, vertical jump height, respiratory capabilities, lactic acid buildup, even the body's ability to sweat and cool itself; also there's greater injury risk; also obvious information here that anyone who does weight training of physical training on the benefits of sleep after workouts; also comments here on Andre Iguodala whose sleep was measured by a sleep tracker, and then he looked at his performance differential when sleeping more than 8 hours versus less than 8 hours per night. [Some of these statistics are implausible, and also likely suffer from denominator fallacy: he was +37% in turnovers? From what to what?] Obviously this is a sample of n = 1.
* Final comment in this chapter: just one brief paragraph on sleep driving creativity, as it helps your brain make non-obvious associations and fuse together disparate sets of knowledge; this happens during the dreaming state; then the author tells the reader that there will be more discussion of this later in the book, but [once again!] he doesn't say when or where. [It turns out it will be Chapter 11.]
Chapter 7: Too Extreme for the Guinness Book of World Records
* "In the following two chapters, we will learn precisely why and how sleep loss inflicts such devastating effects on the brain, linking it to numerous neurological and psychiatric conditions (e.g., Alzheimer's disease, anxiety, depression, bipolar disorder, suicide, stroke, and chronic pain), and on every physiological system of the body, further contributing to countless disorders and diseases (e.g., cancer, diabetes, heart attacks, infertility, weight gain, obesity, and immune deficiency). No facet of the human body is spared the crippling, noxious harm of sleep loss." This chapter deals with the "dire" consequences on the brain of inadequate sleep. The next chapter goes over the consequences of inadequate sleep on the body.
* Concentration: the author gives examples of lapses of concentration while driving due to lack of sleep; on microsleeps, where "your brain becomes blind to the outside world for a brief moment" while you have no awareness of this happening.
* On how "you do not know how sleep-deprived you are when you are sleep-deprived." Discussion of people's subjective sense of their sleep impairment, how they consistently underestimate it; also interesting comment here on "baseline resetting": someone who is consistently sleep-deprived will actually acclimate to their impaired performance and consider their lowered alertness and reduced energy levels as a norm; they'll fail to realize they're in a constant state of sleep deficiency and they'll fail to notice the accumulation of health issues and alertness issues.
* On the multiplicative effect of drowsy driving along with alcohol impairment, they magnify the odds and severity of an accident.
* On sleep deprivation and optimal napping schedules for pilots. "Studies show" that the pilot is best off taking a nap the evening right before a long period of time awake; also on "prophylactic naps" taken early during long haul flights; on the birth of the term "power nap" [see my comments below in Chapter 9 on the odd absence of any mention of James Maas throughout this entire book!]; people confusing it with allowing you to go without sufficient sleep.
* On emotional irrationality due to inadequate sleep; the author's study participants would go from irritable to giddy and swing right back, "traversing enormous emotional distances" in a short period of time; various other studies show science linking insufficient sleep to aggression, bullying behavior, problems with substance abuse; also note this intriguing quote: "There is no major psychiatric condition in which sleep is normal." Then a discussion about the "arrow of causality," the author says that "a prevailing view in psychiatry has been that mental disorders cause sleep disruption" while the author suggests that the causal direction is more of a two-way street; that sleep disruption is a "neglected factor" meriting more study; note also this interesting comment on depression and how 30-40% of depressive patients feel better after a night without sleep.
* On students pulling all-nighters; the author does a study using MRI scans and a memorization test; [this particular study has a number of obvious confounding aspects to it] but the author found a [self-evidently obvious] finding that it wasn't good to be sleep-deprived if you're trying to cram new facts into your brain; once again, sleep deprivation interferes in hippocampal function; things that you learn while sleep deprived are forgotten far more quickly; memories formed without sleep are fleeting memories that evaporate rapidly.
* Anecdote here where the author writes an op-ed for the Harvard Crimson lambasting faculty for back-loading a full semester's content into final exams, and therefore making students have to pull all-nighters; the author prefers to divide his classes into thirds and doesn't have final exams, also none of the exams for his classes are cumulative; he also cites rebuttals from faculty and administrators saying that it was the students who didn't budget their time properly. [Honestly when I was in university all the pre-med students bragged all the time about pulling all-nighters. I suspect it was more brag than actual fact.]
* Discussion here of sleep and Alzheimer's; the background is here is fairly repetitive but the author makes the case why there's links between insomnia, other sleep disorders and Alzheimer's; [once again (see above in my discussion on Chapter 5), the author is also caught up in the beta-amyloid paradigm for Alzheimer's which is unfortunate as we've since learned that much of this paradigm is based on fraudulent studies; note this book came out in 2017 so we can't blame the author too much unless he still subscribes to this paradigm. Note also that during the peak beta amyloid era, the only way you could get any research money was by investigating aspects of this paradigm. Just another example of how healthcare research is corrupted from above.]
* [There's an interesting clue here on the death of the beta-amyloid thesis in a paragraph on page 159, where the author scratches his head (but doesn't pursue the thought) on how amyloid plaques don't show up in the hippocampus--which is exactly where the memory loss function disappears first with Alzheimers. There are no plaques there at all!]
* Theories on the lymphatic system in the brain, an idea from doctor Maiken Nedergaard hypothesizing a sort of sewage/lymphatic system in the brain which removes metabolic contaminants generated by neurons via the cerebral spinal fluid, including [unfortunately] amyloid proteins and tau proteins: "Inadequate sleep and the pathology of Alzheimer's disease interact in a vicious cycle. Without sufficient sleep, amyloid plaques build up in the brain, especially in deep sleep generating regions, attacking and degrading them. The loss of deep NREM sleep caused by this assault therefore lessens the ability to remove amyloid from the brain at night, resulting in greater amyloid deposition. More amyloid, less deep sleep, less deep sleep, more amyloid, and so on and so forth." [Again most of this is based on a framework that has been uncovered as fraudulent and a totally wrong direction for Alzheimer's research, it's unfortunate, I hope that if the author were to reprint this book would adjust and correct these sections. Note however that this does not disprove the author's suggestion that there's a clear link between Alzheimer's and sleep deprivation.]
* Finally, note this doozy of a quote: The author attempts to justify a broad social/medical intervention of supplementing deep sleep to "vulnerable members of society during midlife" to help prevent dementia later in life, using this highly unfortunate and specious argument: "But it is worth recalling that we already use this conceptual approach in medicine in the form of prescribing statins to higher-risk individuals in their forties and fifties to help prevent cardiovascular disease, rather than having to treat it decades later." [Is anyone going to tell him?? I think there are two intriguing takeaways from mindless pharma-compliant comments like this: 1) tell a lie (as in "statins reduce cardiac deaths") often enough and it becomes the truth, and 2) if you continue telling that lie after everybody realizes that it's a lie (as people are now waking up to the statin scam) you sound like a flack for the pharma industry, mindlessly parroting embarrassingly stale and dated healthcare "advice."]
Chapter 8: Cancer, Heart Attacks, and a Shorter Life
* The author talks here about how he used to think that sleep is the third pillar of good health alongside diet and exercise, but then decided that it is the foundation on which the other two sit. "The effects of sleep deprivation will seep into every nook and cranny of biology, down into your cells, even altering your most fundamental self--your DNA." On heart disease, obesity, dementia, diabetes and cancer, all with links to a lack of sleep; "Unhealthy sleep, unhealthy heart." The problems escalate as our health resilience declines as we approach midlife; various "studies show science"-type quotes here, like this one: "adults forty-five years or older who sleep fewer than six hours a night are 200 percent more likely to have a heart attack or stroke during their lifetime, as compared with those sleeping seven to eight hours a night." [Annoyingly, the author doesn't give us the denominator so we don't know how much more 200% is, numbers like 100% and 200% sound like "a lot" when conveyed in a form unmoored from a base rate.] Comments here on the link between sleep deprivation and high blood pressure, various pharma-compliant comments here about "the deathly toll it inflicts." [It's worth thinking through H. Gilbert Welch's excellent book Less Medicine, More Health as well as reading through The Midwestern Doctor's Extensive commentary on "The Great Blood Pressure Scam" to get the other side of the story here: how hypertension meds are massively overprescribed, may actually cause more harms than they solve, generally do not improve mortality, the guidelines for prescribing BP meds are unstable and subject to fashion, etc.] So far this chapter is giving me night terrors on the risks of me not sleeping well!
* On how sleep deprivation causes an overactive sympathetic nervous system; it puts us in a stressful fight or flight state; on the stress hormone cortisol which is triggered by this overactive sympathetic nervous system; cortisol constricts blood vessels, further elevating blood pressure; also on growth hormone, the great healer of the body, which is shut off by sleep deprivation.
* The author shares his odium for daylight savings time, saying that it causes a tremendous increase in heart attacks and accidents.
* On sleep loss causing diabetes and weight gain, the author shows the various mechanisms at work here: how sleep deprivation interferes with insulin sensitivity, how it interferes in leptin and ghrelin production, etc. Various trivia and "studies show"-type findings studies illustrating these ideas.
* On sleep loss and the reproductive system; sleep loss reduces testosterone levels, also reduces follicular releasing hormone in women; silly comments here on how unattractive you look when sleep deprived, along with even sillier "studies show science" findings showing yet another patently obvious truth that people look worse when they're not well rested; comments on sleep loss and the immune system; [again, much of this stuff is common sense, they are things a reasonably well-informed person will already know, and this book would be much more readable and less tedious if the author took these already obvious ideas and used them as a jumping-off point, rather than burying readers in trivia they almost certainly know already.] On how sleep makes you more susceptible to cancer, impairing your cancer fighting immune cells; note also cancer as an inflammatory response in the body, a sort of second-order problem if you're sleep deprived; finally a comment here on how the [now radioactive] "World Health Organization has classified nighttime shift work as a 'probable carcinogen.'"
* On sleep loss and damage to your genes and DNA; apparently it interferes in transcription; also on damage to telomeres, these are the endcaps on your genes; the theory here poor sleep quality drives telomere damage, which mimics the damage seen in aging advanced decrepitude; thus those who do not sleep properly will appear to be a higher biological age than someone who sleeps properly. [This part of the chapter appears unrigorous, not supported by very much persuasive discussion, and entirely unsupported by citations or references.]
Part 3: How and Why We Dream
Chapter 9: Routinely Psychotic
* On REM sleep where we are essentially psychotic: hallucinating, delusional, disoriented, affectively labile, and amnesiac about it after we wake up. On REM sleep brainwave activity, discovered in the 1950s and 60s using electrodes placed on the scalp, and then the 2000s when MRI machines were used to visualize REM sleep in three dimensions. On how numerous parts of the brain light up on an MRI scan during REM sleep, four main clusters where activity spikes: the visual/spatial region at the back of the brain, the motor cortex, the hippocampus and surrounding regions (that support "autobiographical memory" as the author phrases it), and fourth, the deep emotional centers of the brain, the amygdala and cingulate cortex, which ironically is 30% more active in REM sleep compared to when we're awake. Likewise on the deactivation of certain brain regions during REM sleep, like the so-called rational and logical sections of the prefrontal cortex.
* The author talks about a team in Japan that did various dream studies, placing participants into an MRI scanner and waking them up periodically to obtain dream reports from them; the researchers were able to "predict with significant accuracy" the dream reports of the patients based on using just the MRI scans of the patients [sadly, if you read this part of the chapter and actually use your own reading comprehension, you'll find that these researchers most assuredly did not "predict with significant accuracy." Nothing of the sort happened. The author engages in a magazine article rendering of a "studies show science" study exaggerating the findings with this sentence, and he should know better.] The study seems implausible on its face and it lacks any specificity at all, even per the author's own words, the "predictions" were you could identify somebody as dreaming about a car but never any specifics at all. The author talks about his unease with the idea of being able to decode and visualize dreams, but this is an exaggeration of what the study was able to do.
* On the meaning and content of dreams. [It's fascinating that there's absolutely no mention here of any of the work of James Maas from Cornell's Sleep Research Center. Maas was also famously known for teaching one of the most popular classes at Cornell, Psych 101... and he was also famously known for losing his reputation in a 1990s-era "me too" moment, as he allegedly made sexual advances to a number of female undergrads! However, Maas was a pioneer on a lot of this stuff the author talks about here and yet he doesn't even seem to know who he is. Note also he is apparently unaware that Maas coined the term "power nap"--recall that the author discusses the "birth" of that term in Chapter 7 with no comment on Maas there either. Nothing on Maas's work in sleep research is to be found anywhere in this book!] The author gives a brief background here on the history of dream research, starting with Aristotle, a discussion of Freud and his book The Interpretation of Dreams, the reader gets a lecture here on how wrong Freud was, how unprovable his unfulfilled/unconscious wish theory was, etc.
* For some reason the author decides to take this as an opportunity to go on a tangent explaining what was unscientific about Freud's theory: lack of predictions, lack of experiments to test or falsify, etc. Still more unfortunately, he contrasts it to "the much more scientific method of carbon dating" [which teaches the reader that this author does not understand carbon dating, certainly not how suspect a measurement tool it can be!] An extended discussion of how dreams can be interpreted with uniform pseudoexplanations using generic interpretations. [This section of the chapter--in fact this chapter in its entirety--is incredibly disappointing: the author tells readers that he's going to talk about the meaning and content of dreams, but what he really does is spill ink on the various pseudoscientific dooferies of Freud instead. Where was the editor here to send this chapter back for a total rewrite?]
* Finally a discussion of Harvard's Robert Stickgold, who elegantly proved that dreams were mostly not "day residue" by having subjects journal their activities and then taking dream reports from them and finding that only 1-2% of them were day residue, although he did find emotional residue in these dreams.
Chapter 10: Dreaming as Overnight Therapy
* In this chapter the author argues that dreams have a function, that they are not simply epiphenomena of REM sleep; the author uses the analogy of a light bulb which has a primary function of creating light, but a secondary function of creating heat as an epiphenomenon [this isn't actually the correct definition of the term but it's helpful nonetheless]; the author argues that dreaming serves two functions: nursing our emotional and mental health (which is this chapter's subject) and problem solving and creativity (the next chapter).
* On how noradrenaline production is shut off during REM sleep; the author posits that emotional and memory processing happen during the dreaming state in an environment free of this stress-related chemical; on the author's "theory of overnight therapy": that REM sleep dreaming causes the mind to remember valuable salient experiences and integrate them, and yet at the same time we sleep to forget or dissolve painful emotional charges wrapped around those memories [this sounds rather unrigorous, untestable and unfalsifiable--ironically it sounds like all of the things he criticized Freud for a chapter ago.] The author offers the results of a test study he did where participants viewed a set of "emotional images" while being scanned by an MRI and were asked to self-report, after a period of REM sleep, how they emotionally felt in response to each image. The MRI scan showed a reduction in activity in the amygdala. The author then writes about Dr. Rosalind Cartwright, who studied dream research with depressive patients, who found that only the patients who were expressly dreaming about the painful experiences were able to gain clinical resolution, in other words the author interprets this to mean that it wasn't enough to have REM sleep or even generic dreaming, but it required REM sleep with specific dreaming about the emotional themes and sentiments of the patient's waking trauma. [The book has veered into some pretty unrigorous territory here. At the least these theories don't really pass the Ockham's razor test.]
* Next the author discusses PTSD; he writes a paper hypothesizing that if the noradrenaline levels in the brains of PTSD patients during sleep could be lowered, those patients should be able to restore healthier quality REM sleep, and thus should experience improvement in PTSD symptoms. He then describes a lucky meeting with Dr. Murray Raskind who had been treating PTSD patients with prazosin to manage their blood pressure, and these patients were not having flashback nightmares; "It turns out that the drug prazosin, which Raskind was prescribing simply to lower blood pressure, also has the fortuitous side effect of suppressing noradrenaline in the brain." Thus Raskind had inadvertently conducted the experiment that the author was trying to conceive of himself. [This is a really interesting finding with regard to PTSD, but I'm not sure that it proves anything about the author's hypotheses above about REM sleep plus dreaming.] Note also that prazosin now is officially approved by the VA for treatment of repetitive traumatic nightmares.
* The author makes a still more aggressive/flimsy claim here that REM sleep is like a master piano tuner adjusting the brain's emotional instrumentation at night so that you can have better facial recognition in the morning, and he goes on to describe an experiment that he did where he had participants judge facial expressions, testing sleep deprived patients versus patients who had a full night of sleep; the claim here is that patients who had full night of sleep with REM sleep "demonstrated a beautifully precise tuning curve of emotional face recognition" where the sleep-deprived patients slipped into a default "fear bias," seeing more menacing faces than actually were there. The author goes on to say that the world became a more threatening and aversive place for these patients who lacked REM sleep. [No discussion here at all about the methodology of his study, how "beautifully precise" is defined, etc., No discussion of any measured degree of improvement, no discussion of a causal mechanism, no discussion of how really this could be more easily explained just by the effects of a good night's sleep, etc. I think it might be interesting, perhaps depressing, to actually look at the study and see how (un?)rigorous it could possibly be.]
Chapter 11: Dream Creativity and Dream Control
* On various dream-inspired leaps of creativity: see Dimitri Mendeleev and his periodic table of elements, Paul McCartney and his song Yesterday, Otto Loewi and his breakthrough on neurotransmitters; Keith Richards on dreaming up the opening riff of Satisfaction, etc. On the central idea that REM sleep somehow produces an associative memory processing or "ideasthesia" as the author calls it.
* The author describes another experiment where study participants were awakened at different stages of REM and NREM sleep throughout the night, intending to catch them in the lingering mental states of those sleep states. They were tested cognitively within 90 seconds after waking, assuming this would capture the functional properties of the sleep stage from which the patient was awakened. "It worked" the author claims, going on to describe the anagram puzzles they gave participants, his claim here is that NREM sleep did not help the participants be especially creative but REM sleep did, as the answers often just popped right out of the participants' minds. [Again the "studies show science" is strong in this one: no discussion of how to measure creativity, or whether an anagram puzzle in reality is a measure of creativity at all, no discussion of whether it is rigorous to wake someone up in a sleep stage and assume they retain some lingering "functional properties" of that sleep stage without overtly stating what those properties might be, etc. Very weak.]
* Also on the distant associative memory capacities that REM sleep drives, where it connects distantly-related concepts with less logic, etc. Again the author cites the [suspect-sounding] anagram solving and semantic priming experiments.
* [Another thought that won't leave me as I grind thought this book is: what is it this book that makes it so tedious to read? The writing style doesn't really work, the book is generally unrigorous, there are very few citations for anything; obviously he's writing it for a lay audience, he's trying to put things in terms that are non-technical, but he uses language that's overly cutesy: see for example page 226, where in a discussion of how REM sleep drives concept connecting, the author writes: "As we enter REM sleep and dreaming takes hold, and inspired form of memory mixology begins to occur. No longer are we constrained to see the most typical and plainly obvious connections between memory units. On the contrary, the brain becomes actively biased towards seeking out the most distant, not obvious links between sets of information." The cutesy writing is poor style on its own, but worse: it does not appear to be factually consistent with the actual study findings, he's putting it in terms that are not only not scientific (okay, this is understandable if you write for a lay audience) but also not even entirely accurate, and therefore not useful at all. Something is very annoying about this writing approach and the resulting lack of apparent rigor in the book. I think possibly another problem here is the author's constant use of "proof by vigorous assertion" throughout this chapter but also elsewhere in the book. I have to think about this some more, at the least to avoid making these types of mistakes in my own writing.]
* Discussion here of lucid dreaming where you have volitional control of what you're dreaming, as well as the ability to manipulate the experience; initially considered a sham, a subjective claim, but then an ingenious experiment where lucid dreamers were placed inside an MRI scanner and were allegedly communicated with via predetermined eye movements, indicating that they were clenching either their left hand or their right hand (neither of which would move because of the muscle tonus phenomenon), while the MRI pictures were able to see (neurologically) that those movements were happening in the brain. [Granted I have highly trustworthy friends who claim they can lucid dream, and I have (so far unsuccessfully) attempted to lucid dream myself, and I want lucid dreaming to be a real thing. But keep in mind that this is once again "studies show science" here, and clenching your hand, or signalling with your eyes that you are clenching your hand, or reading via MRI that someone's brain is trying to clench a hand, is not necessarily proof of lucid dreaming.]
Part 4: From Sleeping Pills to Society Transformed
Chapter 12: Things That Go Bump in the Night
* This chapter reviews the sleep disorders of somnambulism, insomnia, narcolepsy and fatal familial insomnia. [Note here that the author has been criticized for making a "reckless" claim, this condition does not kill you because of lack of sleep it kills you because it is a neurodegenerative disease.] Note also that the author cites repeatedly from a book called Encyclopedia of Sleep, but on page 41 of this very book it expressly claims the opposite! "A disorder called fatal familial insomnia (FFI) is often presented as proof that sleep loss causes death in humans as it does in rats deprived by the forced walking method. However, FFI is a prion disease that affects all body organs and brain cells. There is little evidence that sleep induced by sedation can greatly extend life in FFI patients."
* On somnambulism, on the famous Kenneth Parks case from 1987 where Parks stabbed his family members while sleepwalking and was found not guilty.
* On insomnia: on the distinction between insomnia and being sleep deprived, they are not the same thing because sleep-deprived individuals can sleep if they would just take the time to do so, whereas insomniacs cannot produce sufficient sleep even if they have enough time to do so; see also the idea of "sleep state misperception" or paradoxical insomnia, where we misjudge how poorly we sleep; on other types of insomnia: sleep onset insomnia, sleep maintenance insomnia; On insomnia triggers, which tend to be worry/emotional concerns or anxiety; physiological triggers are an overactive sympathetic nervous system; brain scans of insomniacs versus healthy sleepers show a ramping down of activity in the amygdala and hippocampus as normal sleepers transition towards sleep versus the opposite for insomnia patients; they "could not disengage from a pattern of altering, worrisome, ruminative brain activity." [And, once again, instead of doing the logical thing and sharing it now, the author teases us by saying he will share a non-pharmacological therapy for insomnia in the next chapter.]
* On narcolepsy; considered a neurological disorder, emerges between ages 10 and 20, not heritable but "appears" to be due to a genetic mutation; three core symptoms: excessive daytime sleepiness, sleep paralysis, and cataplexy, often triggered by strong emotions, a type of paralysis not unlike the body paralysis of REM sleep; it is an abnormal functioning of REM sleep circuitry within the brain where muscle atonia is inappropriately deployed while the individual is awake; treatment for the daytime sleepiness attacks of narcolepsy used to be high doses of amphetamine, but now provigil is used but is only marginally effective; for sleep paralysis and cataplexy, antidepressants are often prescribed.
* Fatal familial insomnia [once again, this is another part of the book that is factually inaccurate, it's a neurological disease not a disease of insomnia. You can skip this section, it will just make you dumber.]
* Discussion of various experiments on rats and dogs about sleep deprivation, death ensues as quickly as it would from food deprivation: the animals lost weight developed ulcers, etc.
* Debate here on how many hours of sleep we actually need: the author takes on various publications questioning the 8 hours or 7 hours required; data on pre-industrial tribes; the author distinguishes between "sleep opportunity time" and actual time slept; also distinguishing between the 8 hours that we allegedly need and taking care and not extrapolating this into saying that even more than 8 hours of sleep is better; sleep is not linear in this way.
Chapter 13: iPads, Factory Whistles, and Nightcaps
* "What, precisely, about modernity has so perverted our otherwise instinctual sleep patterns, eroded our freedom to sleep, and thwarted our ability to do so soundly across the night?" The author calls out constant electric light and LED lights, regularized temperature, caffeine, alcohol and work schedules. He further argues that artificial light will push back the internal clock of your sleep schedule, hindering the release of melatonin and thus interfering with the ability to sleep soon after getting into bed; blue LED lights are even worse according to the author, because they communicate "daytime" to the brain, the author also singles out computers and tablets.
* On alcohol: alcohol "fragments sleep"; alcohol-infused sleep is not continuous and not restorative; alcohol suppresses REM sleep. "Nightly alcohol will disrupt your sleep, and the annoying advice of abstinence is the best, and most honest, I can offer."
* On your body's thermal environment: a room that is too cold is better than a room that is too hot, your core temperature needs to decrease by 2°F to initiate sleep; in your hypothalamus this works with naturally fading light and a surge of melatonin to time sleep onset; your melatonin levels are controlled by light levels as well as your body temperature; comments here on how modernity has screwed up our relationship with the natural rise and fall in environmental temperature; some useless comments here on utterly silly studies on participants in thermal bodysuits.
* On alarm clock use; the author talks about the old factory whistle, the idea that humans unnaturally terminate sleep in modernity; comparing someone naturally awakening versus someone awakened by an alarm clock--the alarm triggers a fight or flight response from the body according to the author; comments here also on how in modernity we also have inconsistent wake times from the weekdays to weekends.
Chapter 14: Hurting and Helping Your Sleep
* On sleeping pills: "no past or current sleeping medications on the legal (or illegal) market induce natural sleep." On diazepam, an old school sedative hypnotic, note that most sleeping pills are sedatives; on "rebound insomnia" when you stop taking them, and "rebound grogginess" after you use them because you need more caffeine to wake up the next day; on the physically addictive qualities of these drugs; on the very slight sleep increase from these meds when the benefit is more subjective than objective. Comments here also on them interfering with memory formation; some preposterously implausible "studies show science" here showing a 5x increase in risk of death from sleeping pills if you take more than 132 a year and a 3.6x increase in risk of death if you just take 18 pills a year. [Again, denominator fallacy! He never tells us 3.6x what, Note also these studies don't tell us what actually kills the patients, what the mechanism is, etc., but that doesn't stop the author from hypothesizing that sleeping pills lead to infections, a weaker immune system, car accidents and cancer.]
* The author discusses cognitive behavioral therapy ideas for insomnia to break bad sleep habits: addressing anxieties that interfere in sleep, reducing caffeine and alcohol, eliminating screens from the bedroom, cooling the bedroom, establishing regular bedtimes and wake times, going to bed when sleepy, avoiding sleeping in the mid-evenings/avoid daytime napping; removing clocks from the bedroom. Actually an interesting and not-quite-so-obvious suggestion here: a cognitive behavioral therapy method of reducing your time spent in bed to six hours of sleep or less to begin with, which produces a stronger sleep pressure.
* On good sleep hygiene practices: the author refers to a list of 12 tips [see the appendix below at the end of these review notes] but cites making a consistent bedtime and wake up time "no matter what" as the single most effective practice; followed by exercise and diet management; on not exercising right before bed because your body temperature remains high afterward; better to work out 2-3 hours before bedtime; he doesn't make any definitive recommendations for diet: there's no consistent association between certain food groups and sleep quality other than the practice of avoiding going to bed too full or too hungry and don't eat too many carbs or sugars.
Chapter 15: Sleep and Society
* Predictably dire stats on the percentage of Americans who are sleep deprived; the author cites the inconsistency that there are all sorts of policies at workplaces regarding smoking, ethical behavior, injuries, substance abuse, and so on, but nothing is ever said about insufficient sleep; a bunch of made-up numbers here about the economic costs of insufficient sleep; on how underslept workers perform poorly but also are unaware of their poor performance, "a subjective misperception of ability when sleep-deprived." More goofball claims here, like underslept employees are "more unethical... Studies in the workplace have found that employees who sleep six hours or less are significantly more deviant and more likely to lie the following day than those who sleep six hours or more." Another hilariously implausible "studies show science" study that claims that in the days after a supervisor had slept poorly the employees working for him became less engaged in their jobs as a consequence [???]; also underslept CEOs are less charismatic [?]; on companies that are prioritizing sleep, like Procter & Gamble, Goldman Sachs [wait, what?] Nike and Google that offer sleep hygiene courses, change the lighting in their offices, permit or encourage naps, etc.
* On sleep deprivation used as torture: the author argues that many countries use it, including the US, Iran, Iraq, Israel, Egypt, Libya, Pakistan, Saudi Arabia, Tunisia, Turkey, Myanmar; the author reveals his innocence here arguing that simple "pragmatism" would indicate we shouldn't use sleep deprivation for torture because it won't produce "accurate, and thus actionable, intelligence." [I'm sure the CIA and NSA will immediately follow his recommendations.] Another thing that's perhaps unwittingly naive from the author here: he argues that someone is more likely to confess falsely to something they have not done--not realizing that interrogators would likely actually want this result and will use sleep deprivation to get it. Finally note this interesting quote from Menachem Begin about his sleep deprivation under torture by the KGB in the 1940s: "Anyone who has experienced this desire [to sleep under sleep deprivation] knows that not even hunger or thirst are comparable with it. ...I came across prisoners who signed what they were ordered to sign, only to get what their interrogator promised them. He did not promise them their liberty. He promised them--if they signed--uninterrupted sleep."
* On sleep and education; the author believe children shouldn't be forced wake up so early for their education; that adolescents are under chronic sleep deprivation; that it drives mental health problems and depression; that an early morning model of education damages the intellectual growth of our youth; on the change at many schools to start later; an under-slept brain "is little more than a leaky memory sieve"; later school start times mean a later school and this protects teens from getting into trouble between 3:00 and 6:00 when their parents haven't returned home from work; on the links between sleep deficiency and ADHD; on the irony that ADD meds like Adderall and Ritalin are actually amphetamines/stimulants.
* On sleep and healthcare: on the dangers of underslept doctors and nurses; one of this book's rare interesting stories here about William Stewart Halsted who founded the surgical training program at Johns Hopkins, forcing residents into long consecutive work shifts and low sleep levels, interestingly later it came out that Halsted was a cocaine addict. [Note here this reader has been constantly disappointed in the level of sourcing in this book, but in this case he is extremely disappointed because Halsted sounds like a guy whose biography would be very much worth reading! There are no citations here at all for anything about Halsted, despite the fact that the author goes on about him for two pages; again this is irresponsible academic behavior, but in this particular case it is uniquely frustrating irresponsible academic behavior. Note in the "To Read" section at the very end of this post I've shared a 2010 biography of Halsted that looks interesting. No thanks to this author!]
* Stats here on medical errors for residents after a long shifts, including this one: "After a thirty-hour continuous shift, exhausted residents are 73 percent more likely to stab themselves with a hypodermic needle or cut themselves with a scalpel." Notice also a cute head fake by the accreditation council for graduate medical education which changed guidelines for first-year residents only, not for second to fifth year residents because the data had only been gathered on first year residents and thus there was "no evidence to justify a change" for other residents in years 2-5. [It shouldn't surprise anyone that medical authorities rarely find what they don't wish to find!]
* Finally, the author blames Chernobyl and the Exxon Valdez on sleep deprivation.
Chapter 16: A New Vision for Sleep in the Twenty-First Century
* Discussion here of methods individuals can use to increase sleep quantity and quality: easy ones like removing technology from the bedroom, handling light properly, on having devices to track our sleep, programming a circadian fall and rise in temperature in the home; comments here on NASA and its development of incredibly expensive light bulbs to simulate actual sunlight for space travel; on educating people about sleep, on tracking your own data, etc.
* On educational change: on the idea of actually including some sort of education in school about sleep hygiene; unfortunately the author gives an example here of how 98% of children received instruction on diet, but he leaves out the sad fact that this "education" involved the totally upside-down "food pyramid" and thus children learned all the wrong things to eat. Thus one shudders to think what a centrally-planned sleep hygiene education might look like. But I get the author's point.
* On organizational change and on employees in the workplace; the author has a bit of a harebrained scheme here of having a "sleep credit system" at work with sleep time exchanged for financial bonuses or extra vacation days; "Those with insomnia need not be penalized." On encouraging flexible work shifts, etc.
* Comments here on how sleep factors into patient care; patients are subjected to all sorts of sounds and noises in the hospital, they have uniformly bad sleep in any kind of intensive care environment, their pain tolerance is lower under sleep deprivation; thus we can reduce prescribing narcotic drugs by improving sleep conditions; also there would be fewer postoperative infections because patients' immune systems would function better, etc. The author suggests supplying patients with earplugs and a face mask (even airlines give these away for free) so that they can sleep.
* Another example here of neonatal/NICU care where NICU units tend to have strong lighting on all the time; thus it interferes in infants' normal sleep patterns.
* Final comments on public policy and societal change; the author wants us to spend more on warning people of the dangers of drowsy driving, to change state laws on vehicular manslaughter associated with sleep deprivation, also use smart technology in cars to detect drowsy driving. The author tries to justify the use of a long list of intrusive technology in cars, as well as justify the use of a person's sleep history to make it easier to prove if a person was guilty of drowsy driving here. Note his use of a particularly gross example of below the belt rhetoric: "I know that may sound unwelcome to some of you. But it would not if you had lost a loved one to a fatigue-related accident." Finally bromides here on transforming societal incentives for sleeping better, including ideas like uploading your sleep score to your health profile at your healthcare insurance company. The superficiality and uselessness of this chapter is appalling; the reader just wants to have his precious time back.
* "I believe it is time for us to reclaim our right to a full night of sleep, without embarrassment or the damaging stigma of laziness."
Appendix: Twelve Tips for Healthy Sleep
* I recommend readers skip the entire book and simply note these 12 tips. You'll save hours of your life that you can spend... sleeping.
1) stick to a sleep schedule
2) Exercise, but not too late in the day
3) Avoid caffeine and nicotine
4) Avoid alcohol before bed
5) Avoid large meals and beverages late at night
6) Avoid medicines that delay or disrupt your sleep
7) Don't take naps after 3:00pm
8) Relax before bed
9) Take a hot bath before bed
10) Have a dark, cool, and gadget-free bedroom
11) Have the right sunlight exposure
12) Don't lie in bed awake
To Read:
Gerald Imber: Genius on the Edge: The Bizarre Double Life of Dr. William Stewart Halsted