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Impacts of lack of sleep

277 points| belkarx | 4 years ago |belkarx.github.io | reply

188 comments

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[+] mikenew|4 years ago|reply
I've struggled with sleep for as long as I can remember. I have improved it considerably in the past year (still not perfect). Out of the dozens upon dozens of things I've tried, here's what I think made the most difference, in order of importance.

1. Very consistent bedtime and wake up time. +/- 30 minutes, but ideally less. Obviously if you struggle with sleep you can't count on falling asleep at the same time, but work at it.

2. Expose yourself to bright, outdoor light every morning.

3. Keep the lights as dim as you can tolerate for ~2 hours before bed. Blue light is technically worse than red, but total light is way more important.

4. Anything you do for ~1 hour before bed should be very passive. For me, reading is good, very particular kinds of TV is okay (can't be too stimulating), or something along those lines. Anything that requires decision making, social interaction, things that get you excited and so on are completely out.

5. Breathe through your nose. It can be hard at first but it gets easier over time. If your nose is constricted you can exhale all your air, hold your breath until you feel the urge to breathe, and then draw in a big breath through your nose. It will open up your nasal passages. Do it a couple times if you need to. If you have sleep apnea that you can't fix that way get a CPAP.

6. Meditation. And it's not really that doing 10 minutes of meditation during the day means you'll magically sleep better; it's more that you learn how to divert the noisy thoughts and focus on something very simple to help you relax at night.

Also, sleep is a temporal problem. If you do everything perfectly for one day your probability of sleeping better at night will go up by some relatively small percentage. Which is discouraging. But if you really work at it for a month it will get significantly better. And by the same token, if you're in a good state, one or two days of disrupted sleep don't cause all that much damage.

EDIT: 7. Forgot to mention this one: keep the room very cold. Matthew Walker (the guy who wrote Why We Sleep, which is a great book) recommends 65F.

[+] sofixa|4 years ago|reply
> Breathe through your nose. It can be hard at first but it gets easier over time

I'm stumped here. Isn't that the normal way to breathe? Why would it be hard, unless you have some medical condition like sleep apnea, which requires treatment in itself?

[+] mettamage|4 years ago|reply
A couple of things worked on there for me as well, but the biggest one for me personally is 0.3mg of melatonin

I started with 3mg, way too much, went to 1.5mg, still too much. Then did 0.7mg, that was fine but still some small side effects. Then 0.4mg that was fine. Then 0.2mg, that didn't work. Then I did 0.3mg and it seemed to be the sweet spot. I can just barely perceive it working and it is just enough to make me feel a bit woozy, which is what I cannot do myself.

[+] hashimotonomora|4 years ago|reply
It may seem paradoxical but also not worrying about sleep itself, not writing down lists, not trying to dissect and optimize sleep, may actually improve your sleep much more. Animals have slept and evolved for literally millions of years. Unless there’s an actual clinical condition, having faith in your own body and just relaxing should be enough. At least that’s my case.
[+] maroonblazer|4 years ago|reply
Meditation has been a big help to me when I wake up in the middle of the night. But sometimes letting thoughts go isn't enough. I've often found that the muscles in my body simply don't want to relax enough for me to be able to fall asleep, so I need to put extra effort into helping them relax.

This can be anything from the traditional 'body scan' where you start at the crown of your head and work your way down, focusing on relaxing every part of your body (head, neck and shoulders are the big ones for me). Or I sometimes imagine getting a full-body massage, and that can do the trick. Of course if you've never had the experience of a full-body massage this likely won't work.

[+] clumsysmurf|4 years ago|reply
I'd also add

8. Don't eat within 2 hours of sleep (at least, maybe more).

9. Exercise earlier in the day, rather than later

[+] raducu|4 years ago|reply
I my case the things that helped the most:

1) Melatonin 300mcg (2 drops) -- usually after 2-3 days, taking it I found I don't need it for another 3-4 days. No tolerance at 300mcg. I've tried other drugs that I still use for when I'm stressed (zolpidem which I actually like recreationally but won't take it when there are others in the house, antihistamines, or benzodiazepines).

I cannot stress how good it feels to know that I have options in case I can't sleep. The same with panic attacks I had a few years ago -- once I knew I had lorazepam/alprazolam in my wallet and I could end any panic attack in 15 minutes, the panic attacks stopped by themselves. Just having the option gives me peace of mind. The same for polydrug usage that helped with my BPD -- having the ability to just change the way you feel was such a blessing and the beginning of the end of BPD for me (70% was dealt with by therapy).

2) Actually fixing the problems in my life -- when I'm happy with my work, my child, my wife, I exercise a little (even just a bike ride in the park), I practice my hobbies, I socialize a little -- in such days I sleep like a baby.

3) The whole sleep sleep hygiene thing -- it's just a cherry on top of the cake, if I had a good streak of days where I was content/happy, I can basically do everything sleep hygiene says but in reverse and still get a great sleep.

[+] agumonkey|4 years ago|reply
I did one thing in the last years: wake up early, and directly go for a walk to the bakery. 45min ~ it was surprisingly mentally refreshing and after 3 days my body got a natural alarm clock as if the reflex of walking was now preset.
[+] munificent|4 years ago|reply
I really like your list, but I also want to point out that humans have way more variability than we realize. A sure fire solution for some will do nothing for others. It doesn't mean it's bad advice, just that context is everything when it comes to health, diet, and fitness for people.

A few other things I would suggest that might help some.

8. Cut down on caffeine. The whole point is that it's a stimulant. I have had many conversations with people where they complained about chronic insomnia but also drank six cups of coffee a day. Caffeine has a longer half life in the body than you expect. Drink less and drink it earlier in the day. Personally, I have only one cup of coffee in the morning, and that's it. If I have any caffeine in the afternoon, I'm up all night.

9. Journaling. If I'm awake with the same anxious thoughts going through my head, I find writing them down helps massively. It's like my brain understands that I don't have to worry about forgetting it in any more and lets it go.

10. Exercise. Doesn't have to be super vigorous, but just going for a walk helps. We are animals. Animals need to move. Gotta get the wiggles out.

[+] wickoff|4 years ago|reply
For me the most impactful thing by far was leaving the phone in the other room. Instant gain of 1-2 hours of sleep per night.
[+] medo-bear|4 years ago|reply
good list

the following addition is gonna sound weird, but here it goes :) one thing that was recommended to me and which worked is eating a handful of sour cherries before sleep. don't get ones in a jar (contains added sugar). instead get frozen ones and defrost them so they are ready before bed

also here is a great podcast about topic of sleep by the author mentioned in advice #7:

https://www.youtube.com/watch?v=gbQFSMayJxk&t=5768s

"Dr. Matt Walker, Professor of Neuroscience and Psychology and the Founder & Director of the Center for Human Sleep Science at the University of California, Berkeley"

[+] fleddr|4 years ago|reply
Can't agree on reading. It's cognitively stimulating, assuming you read something that interests you. I don't know about you, but I can't just close the book and forget about it.
[+] kaiwen1|4 years ago|reply
> Breath through your nose.

I used to be a mouth breather at night due to a nasal passage so narrow that it would essentially close shut on inhale. If the air was very humid - like 100% – I was fine. Otherwise, I would wake several times during the night practically choking from a dry throat. What solved this was a cheap silicone nostril tube insert. It dilates my nostril letting the air flow. It took a few days to build the habit of sleeping with my mouth closed, but this little tube massively improved my sleep.

[+] wenc|4 years ago|reply
I find brown (not white!) noise really helps too. I particularly like Alexa's brown noise mix.

I tell Alexa to "play brown noise" and the droning sound calms my mind in minutes.

Also writing therapy helps -- writing down all the thoughts bothering me and then crumpling it up and chucking it in the trash really helps me let go. There's something about externalizing one's thoughts that helps one let go of them.

[+] citrin_ru|4 years ago|reply
> Expose yourself to bright, outdoor light every morning

Bright outdoor light is a luxury not everybody has. Where I currently live it is cloudy most of the time and feels dark even at noon, especially in winter (when the sun is low). I wonder how people do adapt to such climate.

[+] ipython|4 years ago|reply
If you have problems with breathing through your nose or snoring, go get some breathe right strips. It’s just a metallic strip with adhesive to help keep your nasal passages open - super effective.
[+] veidr|4 years ago|reply
I also significantly improved my sleep with this exact same list (plus fasted cardio every morning and progressive weight lifting 3x/week).
[+] dosethree|4 years ago|reply
re: nose breathing. What i’ve been doing is using Simply Saline (easier than a neti pot) and using breath right strips. Optionally use a mouth guard which can help you avoid mouth breathing
[+] nkozyra|4 years ago|reply
I did sleep studies, medicines (including modafinil which worked but had scary sides), natural supplements (which helped but tended to result in lesser quality sleep).

In the end I needed to make sleep my number one priority and I focused on it for several months.

I slowly built up what worked for me, but likely won't work for you. A lot of being in bed at 10 staring at a dark ceiling for 3+ hours. Getting into meditation (in the am, not evening), exercising but never after noon and not eating after 6. Alcohol in any amount won't prevent my sleep but will vastly deteriorate the quality.

It took tons of trial and error to do what medical professionals couldn't help with. My conclusion is sleep is complicated and highly individual. You need to identify the things that wreck your sleep and pick them off with serious attention to them.

[+] bsza|4 years ago|reply
> Increased (+33%) risk of dementia which is something you should be terrified of

Ah yes, the secret ingredient for a good night's rest. Being terrified.

[+] FabHK|4 years ago|reply
Is this scientific consensus? I remember the Matthew Walker book (Why We Sleep) was heavily criticised.

For example this article + discussion:

https://guzey.com/books/why-we-sleep/

https://news.ycombinator.com/item?id=26684519

https://news.ycombinator.com/item?id=21546850

https://news.ycombinator.com/item?id=22419958

[+] dentalperson|4 years ago|reply
These points and the Guzey essay were discussed in depth in Science Fictions by Stuart Ritchie, which features examples of negligence and fraud in science. Having read and enjoyed the message in Why We Sleep, my first reaction before reading based on the length of the essay was that the motivation was axe-grindy, but the further I read the more it made sense and the more egregious Walker's claims seemed. The lack of a response from Walker is another serious concern (especially after Andrew Gelman highlights this). It seems that he is trying to avoid a Streisand Effect by ignoring it completely. If that is the case, Walker's strategy seems to be working because on the comments on new threads like this, many mention mention Walker but seem unaware of the criticisms.
[+] OzyM|4 years ago|reply
My thoughts exactly. My overall takeaway from sleep research is that although there are some health risks with undersleeping, there are (possibly greater) health risks with oversleeping, plus the prevalence of sleep deprivation is greatly overestimated.
[+] jsrcout|4 years ago|reply
I've had terrible sleep issues forever. Finally got my sleep apnea and insomnia sorted out some years back (CPAP and melatonin+magnesium took care of it for me) and the difference is just incredible. I mean I would worry on a daily basis that I was going to black out at work and hit my head on my desk. (While still putting out decent work most of the time - not completely sure how). I no longer take multi-hour naps several evenings a week after work. I can't overstate the difference it's made in my life.

Anyway, if you suffer from sleep issues, I urge you to take it seriously and do anything in your power to mitigate them.

[+] m463|4 years ago|reply
Another way of saying this is is that time in bed is not equal to time spent sleeping. sleep hygiene is important.

I got a CPAP and it really helped. Another overlooked one is sleeping in a cold room.

[+] bladley|4 years ago|reply
My problem is that I get too much sleep and it's very difficult for me to wake up if there's no meeting scheduled that morning for my flexible remote job or if there's no social pressure to get up. I'll happily sleep 12-14 hours if you let me. I've been this way since I was a teenager, and I'm 25 now.

I know this sounds like I'm complaining about a luxury, and lack of sleep is definitely worse, but it's always made me feel like I'm wasting my days sleeping and missing out on life to a degree.

[+] uoaei|4 years ago|reply
My sleep problem is not that I can't fall asleep when in bed, it's that I can't tell myself to go to the bed to sleep. I think it's some kind of chronic FOMO / productivity bug, but obviously it results in lowered productivity overall because of my effectiveness when fatigued.

Has anyone else addressed this issue in their own lives or know some resources tailored to this problem to learn how to better approach bedtime?

[+] fleddr|4 years ago|reply
I have the same problem. I sleep within 5 minutes but I won't go to sleep. I stay up. I may waste 2 or 3 extra hours doing absolutely nothing productive instead of just going to sleep.

My positive interpretation is that it's introvert me. I need significant alone time and this is the only time slot where I'm not constantly bothered or interrupted.

The negative interpretation is that it's plain addiction. To distractions. News. Updates. Whatever.

Whatever it is, I can't solve it. I need a kick in the butt. Somebody to force me to bed.

[+] darwingr|4 years ago|reply
I have this too. Someone had a good list of things to be doing to optimize your environment. They definitely help. I would add: 1. putting on pyjamas at a certain time every day (e.g. 9:30 pm). 2. not eating anything after 8-9 pm, only drinking water. 3. have other activities like reading to do in the 1-2 hours before bed. 4. no stimulants in the afternoon. No chocolate in the evening. (easy to ignore but makes a big difference).

The biggest psychological bad-habit I had to get over was ignoring my body/mind when I felt tired. If that means falling asleep in weird places, slightly earlier than expected or when there was still something I felt I needed to do, then just accept defeat for that day and let sleep take you over. Allowing my ego to accept defeat at the end of every day, to let sleep be the victor, that is the best way I can frame it for myself. In the end we're creatures that need sleep and to deny my own biology in that regard will lead to my own undoing.

[+] munificent|4 years ago|reply
Yeah, I get stuck in that loop.

The trick that helps is to realize that I will get more done tomorrow if I go right the fuck to sleep tonight.

[+] WilTimSon|4 years ago|reply
I'm not sure how much this will do to change anyone. Sure, it's bluntly stated but, well, most people realize quite well that lack of sleep is awful and dangerous. People don't usually do it because they want to do it. Long hours at work, deadlines, stress, occasional bout of Netflix addiction. Out of all of those, there's only one that's easy to resolve and I'd wager that Netflix isn't usually the biggest contributor to chronic lack of sleep.
[+] brimble|4 years ago|reply
Imagine a medieval king who decided their castle should be lit up like day at nighttime, hundreds of candles in mirror-walled rooms, 365 days a year, and also that the entire castle save only the bed chamber would host the finest entertainers and all the most interesting friends and strangers in the world, party games and amusements in a hundred palace rooms, and a mage who could show the king any wonder of the world in his crystal ball, and a bazaar with the finest goods on display, the best academics, et c., et c., basically on tap, and this wild best-the-world's-ever-seen carnival would never. Close. So that all the king must do is open his bed chamber door, any hour, any day, to be enthusiastically welcomed into a veritable (and sometimes literal) orgy of entertainment. 24. 7. Year-round.

Think that king might have a rather disrupted sleep schedule? It seems obviously insane to live like that, no? Instant reaction is "my god, why would you do that", right?

Consider that a totally ordinary middle class house in the West is arguably worse than that.

No wonder everyone "can't" sleep or "is just a night owl" (sure, some may actually be, not saying zero people are).

Frankly it's a miracle we get anydamnthing done, and sleep at all.

I'd encourage everyone to try candle-only lighting after sundown (or maybe extremely dim candle-temp electric lighting, though if you're just trying it briefly consider the candles, they're a bad idea for a bunch of reasons long-term but fine for a few days—you'd be surprised how little you need, I found two beeswax tapers were the minimum to read by without discomfort, but my eyes are still young-ish), no electric devices whatsoever (there's actually still a ton you can do—card games, board games, play music, read, draw, write, et c.), no whole-room lighting, just for a week or so. See if you're still a "night person" by day 7.

[EDIT] Bonus round on the thought experiment at the top: imagine the king is, despite this questionable decision, actually fairly responsible and leaves the castle to go run the kingdom during the day, most days, retiring to this ultra-carnival-home only late in the day. You'll expect that to go even worse as far as sleep is concerned, right?

[+] lr4444lr|4 years ago|reply
You forgot the most important one: caring for young kids in a nuclear family society with two working parents.
[+] cassianoleal|4 years ago|reply
Also being a night person on a day people's world.
[+] friedman23|4 years ago|reply
As someone that has recently perfected their sleep I'll share my approach for anyone willing to try.

1. Always go to sleep within 30 minutes of a specific time every single day. If this ever starts to drift, take a pill of 100 micrograms of melatonin 3 hours before you intend to sleep to get back on track.

2. Get lights that turn on and off via a smartphone app. Set them to turn on 30 minutes before you intend to wakeup. No alarm.

3. Before sleeping supplement magnesium (most americans are deficient).

I wake up with 0 grogginess every morning. It's amazing.

[+] ssklash|4 years ago|reply
Did you ever used to wake up groggy? I feel like that's been a constant for me since forever.
[+] tatrajim|4 years ago|reply
Just in case anyone cares, this gracefully aging guy has found a reliable way to refreshing sleep every night for many years:

-- Learn some form of qigong meditation (not East Asian myself, but lived there many years). Just before bed, it's a huge help to quality sleep.

-- Practice a calorie restricted diet several times a week. On days I eat ~400 kcal., my sleep heart rate dips 5-10%.

-- Listen at bed time via earphones or otherwise to audible recorded books, selected for the sonority of the narrator and the subject matter -- not too boring, not too arousing.

[+] pkoird|4 years ago|reply
I'd like to expand on that large bit. I really used to have elevated heart rates / anxiety while sleeping. I used to get up with a startle and be unable to sleep afterwards. What I found worked for me was crowd noises. I think it provided me, at a subconscious level, the reassurance that I was not alone (thus safe from predators).

After I married, the startle basically went away :). Turns out, having a human beside you while sleeping works wonder!

[+] holoduke|4 years ago|reply
For me the biggest change in sleep came when I started exercising on a daily base. I started boxing and fitness couple of years back . I sleep 9 hours everyday. Never feel tired during the day, except when I go to bed. Normally takes about 5 minutes to fall asleep. Whereas it used to be hours sometimes when I was younger.
[+] a-and|4 years ago|reply
If there is any meta advice I've learned from developing good sleeping habits it would be "Learn your own nervous system". Anecdotally I've seen varying responses to different lifestyle factors, so experimentation should be part of your plan if you want to optimize your sleep.

I've personally found a lot of success with:

  - Deliberate relaxation - I found the muscle relaxation technique incredibly valuable ( https://www.healthline.com/health/healthy-sleep/fall-asleep-fast )
  - Sleep in a cold, dark room 
  - Limited phone time - mindless scrolling is fine if it helps me relax, but not if it amps me up
What I haven't found matters for me:

  - Strenuous exercise - I've found that training late at night (I compete in powerlifting) and going to bed immediately after leads to very deep, restful sleep
  - Caffeine timing - to an extent timing matters, but daily amount is by far the biggest driver for sleep quality
  - Meditation - it affected sleep adversely and even though very calm and level, I felt substantially more awake after meditation
[+] Terr_|4 years ago|reply
> Increased (+33%) risk of dementia which is something you should be terrified of

Terrified of dementia, yes.

Terrified of a ~2% chance becoming a ~2.6% chance, not quite so much.

[+] kingcharles|4 years ago|reply
I went to jail. One of the things that I didn't expect is how little sleep it is possible to get in some cell blocks.

In prisons there are often lots of jobs or programs available, so people have to be able to get up in the mornings, but in pre-trial detention there is often nothing, so some people tend to stay up all night long.

And if you want to talk to your buddy, but he is on the other end of the cell block, then you need to scream at the top of your lungs for him to hear you. Especially if many others are trying to talk at once. So you basically get a cacophony of people screaming at each other all night. If your block has a TV and a radio, then those might be on maximum volume right outside your cell too.

I would say over eight years I got an average of four hours sleep a night due to these issues. God knows what effect this long-term sleep deprivation has on all these prisoners, but it can't be good for everyone's mental health.

[+] wellthisisgreat|4 years ago|reply
Seeing "caffeine" after substance abuse/addiction is really an eye-rolling moment. Sure sleeping is important. But coffee = substance abuse? Get a life.

On a separate note. 1mg of melatonin does wonders if you help it a bit (don't take it and then stare at the screen). As everyone probably knows by now, the recommended dose is 0.3-1mg so you could get even better results by splitting the 1mg pills, but 1mg works for me.

It's surprisingly difficult to get 1mg melatonin pills, so the life-hack there is to buy the kids version.

Also heavy curtains and total black-out of the bedroom does wonders. Electric light is a pretty effective sleep disruptor

[+] closeparen|4 years ago|reply
In high school and college I was in a vicious cycle of insufficient sleep, lethargy during the day, and panicked heroics the night before deadlines. It worked! I got into and out of a selective institution that way. But my life got immeasurably better once I started working. I would put in an honest day’s effort, leave it wherever it was at the end of the day, unwind all evening, and wake up again when I felt like it (hooray for 11am standup).

Holy shit. The quality of life improvement was unbelievable. It is incredibly tragic to have wasted those years that way.

[+] tzekid|4 years ago|reply
Most of the bad side effects don't show up ( for me at least ) in the first day of no, or next to no sleep.

Against the long-term effects ( and brain / nervous system in general ) I do a 1-month therapy every year of cerebrolysin ( peptide that helps neuro-regeneration ).

I've found that if I can function pretty well if I do a 8 - 9h of sleep every other day, too. It's especially great, because I've got me-time for a whole night, while everybody's asleep. Anybody else tried the "sleep well every other day" thing?

[+] thret|4 years ago|reply
The end of your life is not guaranteed. Your life may be shortened any number of ways unrelated to how much sleep you have had.

Let's say you live to be 90, sleeping 8 hours a day. That's 60 years of actual living time, 20 of which occur between ages 60 and 90. If you sleep 4 hours a day and live to be 90, that's 75 years awake with those extra 15 years spread over your entire life - not just the last third which is likely to be less enjoyable and productive.

[+] belkarx|4 years ago|reply
I see your point, however your life may be worse on average (health and mental state) because of the lower amount of sleep.
[+] bubblecheck|4 years ago|reply
This is my sixth night being 100% homeless (on the streets with no vehicle, no private place to go). Sleep for the past five nights has ranged from non-existent to a few nodding hours in long sleeves laying down in various public places.

Compared to a week ago, I finally started to notice cognitive decline today. My words don't come out as smoothly, and I have gaps in thoughts.

Frankly, it's nothing like it was seven years ago after a bad break-up. That time, I got maybe 2-7 hours of sleep a week for a solid two months or so. It is an awful feeling being wide awake, unable to sleep at all, yet: dead tired, suicidal in a persistent 24hr a day drawing-towards-death sense, utterly afraid and unable to actually follow through.

It's odd to me that my situation then was far, far better than it is now. Sleep these past five homeless evenings with a ruined life -- even missing a few nights and only catching a few hours these past few -- are far better than those restless post-breakup nights seven years ago.

My life fell apart since seven years ago in numerous ways. Programming and participation in technology, generally, for me is completely dead and has been for years now. Perhaps the extended sleep deprivation removed any remaining desire to live. I've certainly been dead inside since then, moreso than in the past.

Still unable to finish suicide. The desire doesn't go away, ever. The terrifying fear of death, however, seems unlikely to ever dissipate, so actually completing suicide seems increasingly unlikely as the decades pass. This has been an ongoing desire since grade school.

I am still awaiting the big sleep. It can't come soon enough.

[+] lai-yin|4 years ago|reply
I understand this won't sit well with a lot of people, but reading a chapter or two of the Bible before bed totally resets my mind and helps me fall asleep almost immediately when I am ready. It calls you to a different realm. Especially the historical books like Judges, Samuel, and Kings.