Sleep and Longevity

Good quality sleep, 6-8 hours per night but not more, is statistically associated with longevity.  Is there a causal connection?  Experiments with rats and data from people doing shift work suggests that yes, there is. But how to get good sleep, and even what good sleep means varies widely from one person to the next.  Different people need more or less sleep, and different sleep schedules can work with different job schedules and life styles.  Regularity is important, and changing sleep patterns from day to day is not good for you.  Melatonin supplements can be an aid to regular sleep, and melatonin is itself a longevity hormone.  If you are one of those people who wakes after a few hours in bed, you need not fight with your body to sleep through the night.  A scheduled period of waking in the middle of the night can be part of a regular daily cycle, and you may find the midnight time is especially good for inspirational or creative activities.

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George was my partner in piano duets and also my buddy in all things concerning health and longevity.  We did yoga and meditation, jogged and cycled and gently competed, never for speed.  We discovered caloric restriction and got skinny together in the mid-1990s.  George worked nights as engineer at a TV station, and didn’t like to sleep during the day.  Some evenings he caught a couple of hours of sleep before reporting for work, some evenings he would just catch a few winks duing his midnight “lunch” break.  A few weeks past his 60th birthday, George fell asleep in front of his TV and never woke up.

I’ve learned to take sleep seriously as a longevity factor.  Just what to do about it isn’t so clear.  (And yes, TV viewing is a mortality risk independent of lack of exercise.)

Sleeping more than 8 hours per night adds 20% to mortality risk, and sleeping less than 6 hours adds 10% [ref].  The added mortality is not associated with any particular disease.

“Shift work [ref] and chronic jet-lag [ref] reduce mental acuity and increase the risk of a number of medical problems including cancer, digestive diseases including peptic ulcers, and sleep disorders.” [ref]

For some people, sleeping in total darkness helps to maintain continuous sleep.  Light is a strong trigger for depressing melatonin, and some researchers say that even the light that gets through the eyelids reduces melatonin in the blood.  Sunlight or bright blue light can help with morning wakefulness, again in some people more than others.

Melatonin is a natural hormone, available inexpensively without prescription, and used by many people to regulate sleep.  In our natural circadian rhythm, melatonin in the blood peaks at bedtime, and makes us feel sleepy.  Conversely, disappearance of melatonin from the blood precedes waking in the mornoing.  You can try melatonin at bedtime to help get to sleep, or if you’re one of those people who wakes after a few hours in bed, you can try melatonin in the middle of the night.  Mice that are given daily melatonin live longer [ref, ref].  Experiment with the dosage.  ½ mg or 1 mg is plenty for most people, and some people find that too large a dose makes them groggy the next day.  Caution: Melatonin can exacerbate sleep apnea in some people.

From WebMD:

“Magnesium apparently plays a key role with sleep. Research has shown that even a marginal lack of it can prevent the brain from settling down at night. You can get magnesium from food. Good sources include green leafy vegetables, wheat germ, pumpkin seeds, and almonds. Check with your doctor before taking magnesium supplements.  Magnesium can interact with many different medications, and too much of it can cause serious health issues.”

Narcotics and alcohol can help you fall asleep, but I think they’re a bad idea, likely to make you sleepy during the day, and need more sleep in the long run.  Not recommended.  I advise avoiding even the new generation of sleep medications (Ambien, Rozerem, etc).

Caffeine can interfere with sleep if taken late in the day, and even if you take it early in the day it might it might not help your energy level in the long run.  Coffee consumption is not associated with increased mortality risk, and may even have a modest longevity benefit [ref].  But habitual consumption of caffeine causes the body to reset to a lower energy level (classic addiction response).  So I use caffeine sparingly, when I’m speaking or writing and I want to assure an enhanced level of alterness and verbal fluency, and I remain sensitive and responsive to very small hits of caffeine.

Finish eating about 3 hours before bedtime, so digestion doesn’t interfere with sleep.  A longer period of fasting before bedtime may be fine, if you are not kept awake by hunger.

 

Apnea

Fifteen years ago, I had no idea that I was stopping breathing frequently during the night until my wife noticed and alerted me.  Sleep apnea is the most common sleep disorder in the world, and increases in prevalence with age.  Statistics are soft because there are more cases unrecognized than on record.

I went in to a clinic, and spent a night there, wired up to a machine that monitored my breathing and heart rate.  I was incredulous when the doctor told me that through the parts of the night when I was asleep, I was in a 3-minute cycle, holding my breath until the CO2 buildup woke me up, gasping as I awoke, gradually calming my breathing, falling back asleep, and beginning the cycle all over.  I didn’t remember any of this, and demanded to see the recording, before I was convinced.

Much later, with focused attention as I was napping during the day, I could observe myself falling into a pattern of holding the breath until I awoke in a panic.  Apnea left me tired sometimes during the day, with occasional bouts of narcolepsy.

Long term risks of apnea include heart disease, stroke and loss of brain cells.  It’s not the oxygen deprivation that is the problem, but the re-oxygenation afterward that causes the damage.

Apnea is a mortality risk, apparently independent of obesity, with which it is strongly associated.  Fat in the neck can cause constriction of the air passage, making it more likely to collapse.  This is “obstructive sleep apnea”.  There is another flavor, “central sleep apnea”, which is unrelated to obesity or the size of the air passage, but comes instead from a failure of the autonomic nervous system.

The standard treatment for apnea, a cash cow for thousands of sleep clinics, is the CPAP machine (continuous positive air pressure), a face mask and pump that pushes air into the lungs.  Many people are helped by CPAP and find it worth the inconvenience and discomfort.  Many more can’t tolerate the CPAP.  (For me, the CPAP made my apnea worse, since I was failing to exhale, rather than to inhale which is more common.  Negative pressure “CNAP” or “INAP” (intermittent negative air pressure) machines do not exist—the acronyms are my own invention.

There are straps that hold the mouth closed and mouthguards that pull the lower teeth out in front of the top teeth.  There are suction devices that pull the tongue out of the mouth (while holding the mouth open enough so you can’t bite your tongue).  There is a surgically-implanted electrical device that stimulates the tongue to push forward at the appropriate point in the breathing cycle.  All of these work for some people.

Further out therapies for apnea include Buteyko breathing, orofacial myofunctional therapy, and singing melismas The latter even has some data behind it.

I’ve kept my apnea under control by re-training myself not to sleep on my back.  It helps, but is not a complete solution.

Tension and anxiety

Some sleep problems are extensions of day problems—anxiety, depression, ennui, overstimulation, work pressures.  These are often better addressed by life changes than by therapies.  But relaxation practices can help: yoga asanas and breathing, meditation, biofeedback, heart rhythm coherence, Alexander technique, martial arts.  Vigorous exercise and time outdoors helps with every aspect of health, longevity, mood, relationships, productivity, creativity…and sleep, too.

Learning to relax has benefits that go well beyond improved sleep.  Many people find that through self-hypnosis or mental relaxation, yoga or meditation techniques, they can relax at night and feel fully rested even on nights when sleep may be elusive.  These same techniques are good for the “power nap”, when a brief submersion of 10-30 minutes can precipitate a boost in alertness, productivity and good humor.

 

Two-phase Sleep

In 1979, I was fortunate to be acquainted with Bryn Beorse, then in the last year of his life, but productive, healthy and quietly charismatic at age 84.  I knew him as a UC Berkeley engineering prof and lifelong advocate of renewable energy from the ocean.  But he was also an unlikely guru, with a small but loving following of meditators and Sufi practitioners.  Bryn told me that his habit and practice was to awake about 1AM and do an hour or two of Sufi exercises and meditations before returning to sleep out the night.  This and other things he said made a lasting impression on me.

Much more recently, I have learned how common it is for people to sleep in 3-4 hour cycles rather than 6-8 hours.  Some say that before the Industrial Revolution, bi-phasic sleep was part of the culture.  A period of wakefulness in the middle of the night is part of the body’s natural rythm for many of us, and if it is so for you, I suggest you might adapt to it rather than fight it.  Use the waking period for something nourishing, sustaining and relaxing.  Yoga or meditation are ideal.  You can read something inspirational, practice singing or playing music, listen to music that contributes to your wellbeing.  For some, it can be a creative time, writing or painting or composing, but I don’t recommend using the time to extend your work day or answer emails.  Creative play is an alternative, but video games less than optimal.  When you feel the first wave of sleepiness return, don’t hesitate to go back to bed.

It’s not so common in America, but through much of Asia and South Europe, mid-day siesta is part of the culture.  People sleep less at night, and nap after lunch.  The right to a two-hour lunch break is written into the Chinese constitution.

Some studies show that sleeping twice a day is more efficient than sleeping once, but the decision will be based on your metabolism and your daily schedule.

 

Bottom line advice

I encourage you to experiment, with the goal of finding a schedule that works best for you.  Check magnesium levels, especially if you have muscle twitches.  Don’t hesitate to take melatonin at bedtime, but avoid sleeping pills.  The body’s biorhythm adapts to a regular pattern, and disruption of that rhythm can be costly.  Good sleep contributes to everything you value about life (as well as its length): alertness, creativity, patience and good humor, productivity, enjoyment and a depth of wellbeing that comes from connecting the inner and the outer life.