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The Urgency of Sleep and Well-Being

By Robin Wolpert

0720-sleepThe National Task Force on Lawyer Well-Being urges us to create a national movement toward improving the health of the profession. During the bar year just past, MSBA President Tom Nelson led our statewide efforts  to make it safe to say, “I’m not OK,” and to ask for help in addressing our well-being. The Minnesota Supreme Court, Lawyers Concerned for Lawyers, and the Lawyers Professional Responsibility Board are unified behind this message.

It is challenging, of course, to do what the National Task Force tells us to do. How do we create this change in a profession that glorifies hard work at the expense of our own health and considers sleepless nights a badge of courage? We are shamed for asking for help. We are considered lazy for taking care of ourselves. We are labeled “weak” for admitting that we are anxious and stressed.

And now there is covid-19. We are all experiencing its devastating effects. The rug has been pulled out from under us. It is tough to find a silver lining in these circumstances, but it strikes me that our conversations around well-being have shifted in the past few months. With our lives and careers starkly in jeopardy, it is now OK to say, “I’m not OK.” It is now OK to take steps to protect and enhance our well-being. As I teach CLEs to audiences from around the country, and invite dialogue among perfect strangers, we are refreshingly candid about our state of well-being. And we feel safe in doing so. 

Against this backdrop, I write about one of the most important well-being topics—sleep—and ask you to consider two questions. First, will you make a commitment to yourself to take action to ensure that you get sufficient sleep? As I explain below, your life is at stake—not to mention your ability to meet your professional obligations as a lawyer. Second, will you commit to taking action to ensure that others with whom you interact also get sufficient sleep, especially the next generation of lawyers? As we will see, their lives are at stake as well.

Sleep is the foundation of health

October 31, 2019 was a big day in the field of neuroscience. Dr. Laura Lewis of Boston University and her team published the results of a pathbreaking study in the journal Science, demonstrating how toxins are cleared out of the brain during deep or NREM sleep.1 During deep sleep, our neurons start to synchronize, turning on and off at the same time. When they all turn off, the level of blood flow diminishes and cerebrospinal fluid rushes in, filling the space left behind. The cerebrospinal fluid clears out toxic waste products, including amyloid-beta, which can contribute to neurodegenerative diseases like Alzheimer’s. One in ten adults over the age of 65 now suffers from Alzheimer’s disease.2 Getting too little sleep across the adult lifespan significantly raises the risk of developing this disease.

Sleep is the foundation of good health.3 Every aspect of our physiology is impacted by sleep.4 Cognitive function is severely impaired by “short sleeping.” Moreover, the leading causes of disease and death in the industrialized world are causally linked with lack of sleep—including cardiovascular disease, cancer, diabetes, dementia, and obesity.5 The World Health Organization has declared a sleep loss epidemic throughout industrialized nations. 

Dr. Matthew Walker, one of the world’s most prominent experts on sleep, tells us “the shorter you sleep, the shorter your lifespan.”6 Human beings are the only species that deliberately deprives itself of sleep without legitimate gain.

We are supposed to spend about a third of our day sleeping. If you see this as a waste of time, you might change your mind if you knew what was happening while you sleep.

Sleep and cognitive function

Sleep is critical to memory—both before learning, to prepare your brain to make new memories, and after learning, to cement those memories and prevent forgetting.7 During NREM sleep, the long-range brain waves of deep sleep move memory packets of recent experiences from a short-term, more fragile storage area to a safer long-term storage site.8 It’s like clicking “save” on our email inbox. By contrast, REM or dream sleep integrates and interconnects the past and present emotions, motivations, and memories with each other, generating a more accurate model of how the world works and sparking new creative insights.9 REM sleep strengthens neural connections, giving us wisdom, creativity, emotional resilience, and emotional intelligence.10 

After 16 hours of being awake, the brain begins to fail.11 Humans need 7.5 to 9 hours of sleep each night to maintain cognitive performance. We cannot catch up on our sleep later. The brain does not work like a bank.12 The brain can never recover the sleep it has missed.

Sleeping even seven hours per day for 10 days makes the brain just as dysfunctional as it would be after going without sleep for 24 hours.13 Even worse, the human brain cannot accurately sense how sleep-deprived it is. We are like the person who consumes too much alcohol and says, “Give me the car keys—I’m just fine.”

Going to bed late or getting up early has a surprising impact on our sleep. If we get up a few hours early, we are not just losing 25 percent of our sleep; we’re losing 60 to 90 percent of our REM sleep.14 This is because most of our REM sleep occurs in the late-morning hours of our sleep cycle. Alternatively, if we stay up late, we are losing a significant amount of NREM sleep because the majority of your NREM sleep occurs early in our sleep cycle.

Sleep and health

Every spring, there is a global experiment in which 1.6 billion people from roughly 70 countries are forced to reduce their sleep by one hour.15 It’s called daylight savings time. The result is a 24 percent increase in heart attacks the next day.16 In the fall, when we gain an hour of sleep, the result is a 21 percent reduction in heart attacks the next day. 

Sleep deprivation accelerates our heart rate, increases our blood pressure, and erodes the fabric of strained blood vessels, amplifying the calcification of coronary arteries.17 Adults 45 or older who sleep less than six hours a night are 200 percent more likely to have a heart attack or stroke during their lifetime, compared to those sleeping seven to eight hours a night.18

Sleep loss impairs our immune system, making us more prone to getting the common cold and the flu and reducing the effectiveness of the standard flu vaccination.19 Because short sleeping weakens our immune system, it negatively affects our ability to fight cancer.20 Indeed, in one experiment, getting four hours of sleep for just one night resulted in a 70 percent drop in cancer-fighting immune cells.

Sleep loss increases food consumption, causing weight gain and reducing our ability to manage blood sugar and increasing the likelihood of developing type 2 diabetes.21 Sleep disruption contributes to all major psychiatric conditions, including depression, anxiety, and suicidality.22 

Our gene profile

Insufficient sleep alters the activity of our DNA. An experiment at the Surrey Sleep Research Center focused on the gene activity profiles of a group of healthy young men and women who were getting 8.5 hours for a week.23 After this group was restricted to 6 hours of sleep for one week, a comparison of the profiles before and after the sleep restriction revealed that the activity of 711 genes was distorted. Half of the genes were amplified as a result of the loss of sleep and the activity of the other half was diminished or entirely shut down. The increased activity included genes linked to chronic inflammation, cellular stress, tumor growth, and factors that cause cardiovascular disease. Those turned down included genes that help maintain a stable metabolism and optimal immune responses. 

Sleep disrupters

  1. Alcohol is a sedative—it knocks us out, but does not induce natural sleep.24 Alcohol is one of the most powerful suppressors of REM sleep. Consuming even moderate amounts of alcohol in the afternoon or evening will deprive us of REM sleep and increase our chances of waking up throughout the night.
  2. Caffeine blocks sleep and is one of the most common reasons why people cannot fall asleep.25  It takes a long time for the body to process caffeine, so if we have a cup of coffee after dinner, at 7:30 p.m., 50 percent of that caffeine may still be active at 1:30 a.m.
  3. LED lights disrupt our sleep. Artificial evening light tricks us into believing night is day and winds back our internal 24-hour clock by two to three hours, on average.26 Using LED devices at night such as iPads, phones, and computers disrupts our natural sleep rhythms and hurts the quality and quantity of our sleep.27 

Sleep strategies28

  1. Stick to a sleep schedule and go to bed and wake up at the same time each day.
  2. Sleep in a dark, cool (65 to 67 degrees), gadget-free bedroom. Take a hot bath before bedtime, which will help you relax and drop your core body temperature.
  3. Avoid alcohol, caffeine, and nicotine.
  4. Avoid medications that interfere with sleep, if possible. Sleeping pills are a sedative and do not induce natural sleep.
  5. Try to exercise no later than two to three hours before your bedtime.
  6. Late at night, avoid large meals and beverages, which can interfere with sleep.
  7. A nap as short as 20 minutes can offer a memory consolidation advantage, so long as it contains enough NREM sleep. Note that a nap does not allow an individual to forgo sufficient sleep night after night. Don’t take naps after 3:00 p.m. because it makes it harder to fall asleep at night.
  8. If you can’t sleep, get up and leave your bedroom and do some relaxing activity until you feel sleepy. Then return to your bedroom. This will help reduce any association your brain makes between wakefulness and your bedroom.
  9. Consider “sleep divorce.” If your partner snores loudly or keeps you up at night, consider sleeping in a separate bedroom. If you are worried about decreased opportunities for intimacy, sleep enhances interest in intimacy as well as reproductive capabilities. 


ROBIN WOLPERT, a former MSBA president (2016-17), is the chair of the Minnesota Lawyers Professional Responsibility board, a member of the National Task Force On Lawyer Well-Being, and a member of the executive council of the National Conference of Bar Presidents. 



Notes

1 https://www.scientificamerican.com/article/deep-sleep-gives-your-brain-a-deep-clean1/

2 Matthew Walker, Why We Sleep (2017) at 157.

3 Id. at 164.

4 https://www.ted.com/talks/matt_walker_sleep_is_your_superpower

5 Walker, Why We Sleep at 164.

6 Id. at 4.

7 Id. at 109.

8 Id. at 52.

9 Id. at 53, 75.

10 Id. at 74-75.

11 Id. at 140.

12 Id. at 138.

13 Id. at 140.

14 Id. at 46.

15 Id. at 169. 

16 https://www.businessinsider.com/daylight-saving-time-is-deadly-2018-3 

17 Walker, Why We Sleep, at 166.

18 Id. at 165.

19 Id. at 182-83.

20 Id. at 184.

21 Id. at 169, 171.

22 Id. at 3.

23 Id. at 187-88.

24 Id. at 272.

25 Id. at 28.

26 Id. at 267.

27 Id. at 268-70.

28 Id. at 341-42; https://www.youtube.com/watch?v=CRKv_MG0bqM

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