Long but Good Read on natural sleeping patterns
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March 1, 2007
Broken Sleep May Be Natural Sleep
BYLINE: Walter A. Brown, MD
SECTION: PSYCHIATRY & NEUROLOGY; Pg. 40
LENGTH: 1951 words
HIGHLIGHT: Once again your patient, an accountant and tax specialist, is complaining about his sleep. More nights than not he awakens at about 2 am. An hour goes by, sometimes 2, before he returns to sleep. You've prescribed 4 different hypnotics. Each gave the same unsatisfactory result. For 2 weeks, your patient got the 8 hours of uninterrupted sleep he-and you-seek, but then the old pattern returned. Following your instructions, he avoids caffeine, doesn't exercise after 6 pm, and confines his activities in bed to sleep, but to no avail. You refer him to a sleep laboratory, and the results there are entirely consistent with what he's been telling you. In the sleep lab he falls asleep at 11 pm, awakens at 2:30 am, returns to sleep at 4 am, and awakens for good at 7:30 am. He does not have sleep apnea, restless legs syndrome, or depression.
Your patient seems more concerned as the years go on. You've suggested to him that when he wakes up, he should get out of bed and read until he gets sleepy. But he spends his awake time worrying about why he can't sleep and how his interrupted sleep will affect his work. The length of his time awake appears to be increasing. He insists that his daytime concentration isn't as good as it once was.
At a drug company-sponsored dinner, between the veal marsala and chocolate mousse, you learn that interrupted sleep is among the most common sleep problems and that a new hypnotic promises to be better than previous ones at providing "continuous sleep-consolidated sleep," as the speaker calls it. To her credit, the drug company-sponsored speaker does not shy away from the fact that the new hypnotic works by enhancing gamma-aminobutyric acid transmission, just like the older ones.
Do you subject your patient to yet another drug trial, this time with a more expensive, albeit not very different, agent? Given your patient's misery about his sleep problem and the fact that you've exhausted the available options, such a course is not unreasonable. Yet a recent discovery, not from a drug company laboratory or a university research program but from a historian, suggests that there may be another, very different, way to relieve your patient's problem.
Sleep in times past
In the course of gathering information for his book about night in preindustrial times (At Day's Close: Night in Times Past), A. Roger Ekirch, professor of history at Virginia Polytechnic Institute, uncovered the fact that before artificial illumination was widely used, people typically slept in 2 bouts, which they called first sleep and second sleep.1
In those times, sleep was more closely tied to sunset and sunrise than it is now. Within an hour or so after sunset, people retired to bed, slept for about 4 hours, and then woke up. They remained awake for a couple of hours and then returned to sleep at about 2 am for another 4 hours or so.
Written records from before the first century onward indicate that the period between first and second sleep afforded a chance for quiet contemplation, but people also got out of bed during this interval and did household chores or visited with family and friends. Although diaries, court documents, and literature of the time indicate that this sleep pattern was widely known and acknowledged, until Ekirch's work this bit of history had been lost to the current era. This pattern of sleep is no longer the norm in developed countries, where artificial light extends the day, but anthropologists have observed a similar pattern of segmented sleep in some contemporary African tribes.1 Ekirch notes that the Tiv people of central Nigeria even use the same terms-first sleep and second sleep-used by the Europeans of times past.
Segmented sleep may be the natural pattern
Several lines of evidence suggest that this archaic sleep pattern may, in fact, be the natural sleep pattern-the one most in tune with our inherent circadian rhythms and the natural environment. In the early 1990s, Thomas A. Wehr, MD, then a sleep researcher at the NIMH, and his colleagues reported that when 8 healthy men had their light/dark schedules shifted from their customary 16 hours of light, 8 hours of dark to one in which they were exposed to natural and artificial light for 10 hours each day and confined to a dark room for 14 hours each night (durations of light and dark similar to the natural durations of day and night in winter) a sleep pattern similar to that of the preindustrial era developed.2,3 They slept in 2 bouts of about 4 hours each separated by 1 to 3 hours of quiet wakefulness. Subjects usually woke from their first bout of sleep during a period of rapid eye movement (REM) sleep, when dreaming is most likely. The second bout of sleep was usually lighter than the first, with less stage-4 (deep) and more REM sleep.4 Thus, when freed from the time constraints on night imposed by modern work schedules and artificial illumination, subjects reverted to the segmented sleep of earlier times.
Also suggesting that interrupted or segmented sleep comes to us naturally, many animals that are active during the day-including chimpanzees, chipmunks, and giraffes-sleep at night in 2 distinct bouts separated by several hours.4-6 In fact, Wehr points out, modern humans may be unique among animals in the extent to which their sleep is consolidated.
Wehr, now a Scientist Emeritus at the NIMH, thinks that our current sleep pattern, in which we fall asleep rapidly and expect to sleep (and often do) for an uninterrupted 7 or 8 hours, may be an artifact of both chronic sleep deprivation and artificial light. When the subjects of his experiments shifted from the 16-hour "days" and 8-hour "nights" customary for them (and for everyone else in developed countries) and which depend on artificial light, to the "natural winter" conditions of his experiment, they slept at first for 11 hours and then started sleeping for an average of 8.9 hours, compared with 7.2 hours under ordinary conditions.3
These and other data7 suggest that our current schedules do not allow us the sleep that we require. Wehr also observed that when given 14 hours of darkness, it took subjects at bed rest about 2 hours to fall asleep, compared with the 15 minutes under usual conditions.4 He speculates that under usual conditions, we may fall asleep so quickly because we are chronically sleep-deprived. Natural sleep, Wehr suggests, particularly during relatively long periods of darkness, is characterized by a long sleep latency and "interspersed with periods of wakefulness."4
The discoveries of Ekirch and Wehr raise the possibility that segmented sleep is "normal" and as such they hold significant implications for both the understanding of sleep and the treatment of insomnia. But sleep specialists are, for the most part, unaware of these findings and have not yet incorporated them in clinical practice. Part of the reason lies with the fact that these discoveries have not been widely disseminated. Ekirch's book received a good number of deservedly positive reviews, but it is, after all, history and is not at the top of most reading lists. While Wehr's sleep research is well known to sleep specialists, the thrust of his work has been on uncovering the mechanisms governing sleep. His discovery of segmented sleep was an unexpected, incidental finding from a study examining the influence of photoperiod on sleep and melatonin.2
Challenging current thought
Also working against the clinical application of these findings is the extent to which they fly in the face of current thinking. The general public seems to regard 7 to 8 hours of unbroken sleep as our birthright; anything less means that something is awry. Sleep specialists share this assumption. Sleep researcher J. Todd Arnedt, PhD, clinical assistant professor of psychiatry and neurology at the University of Michigan, acknowledges that the conventional approach to patients who cannot maintain sleep, and the one he uses, is to attempt to consolidate their sleep. He didn't know about the 2 bouts of sleep discovered by Ekirch and Wehr but, in light of that phenomenon, thinks that the conventional approach might not be the best one. He points out that how patients perceive their sleep determines to some extent how in fact they do sleep. He tries to get his patients with insomnia to "stop seeing their sleep as problematic." When they can do that, whatever sleep loss they encounter becomes more tolerable. If patients perceived interrupted sleep as normal, he points out, they might experience less distress when they awaken at night and fall back to sleep more easily.
Wehr agrees. He writes: "When modern humans find that their sleep is . . . interrupted by periods of wakefulness . . . they regard it as being disordered. . . . [A]n alternative explanation could be that a natural pattern of human sleep is breaking through into an artificial world in which it seems unfamiliar and unwelcome."
"Waking up after a couple of hours may not be insomnia," he says. "It may be normal sleep."4
Did the interval between bouts of sleep, common in earlier times, provide something of value or did our ancestors merely tolerate it? To be sure, this period offered our forebears an opportunity for uninterrupted sex, for quiet study, and for household chores.
Ekirch believes that the period of quiet wakefulness also offered a unique opportunity to contemplate dreams. People often awoke from a dreaming state and so were particularly likely to remember their dreams, and thus to gain access to an otherwise unavailable part of mental life. He believes that we may have lost something in our move to consolidated sleep.
Mary Carskadon, PhD, a sleep researcher at Brown University in Rhode Island, did not know of Ekirch's historical findings but did know of the segmented sleep pattern discovered by Wehr and of the fact that some animals take "2 sleeps." Considering these observations, she speculates that "maybe the brain can't keep you asleep for prolonged periods," and she wonders whether the archaic sleep pattern had some functional purpose. Like Ekirch, Carskadon believes that the change in sleep pattern "highlights something humanity might have lost in the hurly-burly times we live in today."
Much as we might envy the more relaxed sleep pattern of our forebears, we are unlikely to revert to it. As Carskadon points out, "It's hard to adapt to 2 bouts of sleep when you have to be at work at 8 am." She does feel, though, that it would benefit patients with interrupted sleep to tell them that such a sleep pattern may be natural.
The accountant troubled by broken sleep could well benefit from learning that the sleep pattern he finds so distressing may be more natural than the solid sleep he desires. And he should be told that in his nocturnal wakefulness he's far from alone. He's in the company not only of giraffes and chipmunks but also of his ancestors and many of his contemporaries. If the usual measures don't suffice to give him the solid sleep he wants, tell him to savor the period before he returns to sleep. It's a time to meditate, have sex, think about dreams. Or, as Wehr says, he can "just lie there and go back to sleep."
A version of this column was previously published in Applied Neurology.
Dr Brown is clinical professor of psychiatry at Brown Medical School, Providence, RI, and Tufts University School of Medicine, Boston, and a practicing psychiatrist.
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This article does not claim that sleeping less is a good thing, but it seems to suggest that sleeping polyphasically may be perfectly natural and beneficial.
I found something interesting when I looked at a few of the animals which sleep the fewest hours per day. The horse and the giraffe sleep no longer than 2 or 3 hours per day, and they usually sleep in bouts of 15 to 30 minutes max throughout the night and day.
Sometimes I get discouraged thinking that polyphasic sleeping is a bunch of bs, but it helps my motivation when I read an article like this every now and then that suggests humans slept polyphasically in the past.
Good luck to anyone who is currently sleeping polyphasically. Hope this helps getting through that adaptation.
I actually just read another great article:
This article not only supports one of the core beliefs of polyphasic sleep (naps are healthly), but it also provides evidence that there are people out there who sleep less than 5 hours of sleep each night. It's cool because the people in the article didn't always sleep less than 5 hours a night. It appears to be something that was required due to their jobs and they adapted to it and can now manage fine with the amount of sleep they get.
Notice how these people also take naps if they can on the weekend or whenever and the naps are never longer than 15 minutes. The one guy even feels refreshed after a 2-3 second microsleep.
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Can your sleep be short but sweet?
BYLINE: Peta Bee
SECTION: FEATURES; Times2; Pg. 8
LENGTH: 1562 words
We should get eight, but many of us get fewer than six hours' sleep. PETA BEE asks experts why the number of hours is important, and meets three people who survive on fewer than five.
We need more sleep but are getting less. A YouGov poll for Five News found that more than two thirds of Britons are failing to get the recommended eight hours a night, and a third manage only six hours or less. Many of us, it seems, lie awake worrying - about finances (more than half of adults), rising fuel bills (37 per cent) and a fear of crime (15 per cent).
Winston Churchill, Margaret Thatcher and Bill Clinton may have managed on just a few hours of sleep each night, plus a few catnaps, but most of us end up feeling tired and grumpy.
Professor Jim Horne, director of the sleep centre at Loughborough University and author of Sleepfaring: A journey through the science of sleep (OUP, £ 14.99), says that the average person needs to sleep for about seven hours a night - though a few people need more, and some manage on only four or five hours.
"If all you need is that amount, fine," says Horne, "but cutting down to five hours or less is certainly not recommended, particularly for people whose lifestyles are already overburdened."
In fact, says Horne, the cumulative effects of too little sleep won't just leave people tetchy - it is potentially risky.
There is plenty of evidence that long-term sleep deprivation can be unhealthy. Horne says that it can affect decision-making and cognitive functioning, and contribute to obesity, metabolic syndrome and related problems.
Last year, a study at Princeton University indicated that missing a whole night's sleep affects the hippocampus - the part of the brain involved in memory forming - and prevents it from forming new cells. Other studies have suggested a link between obesity and lack of sleep, and this year US researchers found that losing three consecutive nights of deep sleep could harm the body's ability to control blood sugar levels, raising the risk of diabetes.
But some experts say that those who sleep less may not be affecting their health adversely in the long term. Indeed, diminished sleep patterns may even instil positive changes in health and attitude - if you handle them well. Here we profile four people who remain sprightly on only four to five hours of sleep a night:
HOWARD BENTHAM, 42, is the presenter of BBC Hereford and Worcester's breakfast radio show. He lives in the Cotswolds with his wife and three children aged 7, 14 and 18. He gets 4 3/4 hours' sleep a night.
I have been presenting breakfast shows for seven years. I was a primary school teacher before doing radio and never got out of the student thing of going to bed at midnight or 1am and getting up at the last possible minute before work.
That had to change virtually overnight. My daughter, Molly, now 7, was born the week I started my first breakfast job. Thankfully, she proved not to be a baby that woke up a lot and my wife, Gail, took care of that side of things.
Now my day runs like clockwork. I'm up at 3.15am. Often I anticipate the alarm and only occasionally am I shocked awake from a deep sleep by it ringing. I have a 30-minute drive to work and am in the studios researching the items to be featured on the programme by 4.30am. My show is on air 6-9am and I often have meetings after that.
I once played sport to a high level, but now find I have little time for exercise other than the odd round of golf and cricket in the summer. Despite the way I live my life, the astounding thing is that I no longer feel as if I'm getting tired.
I still teach three afternoons a week and on those days I have an energy dip between 4.30 and 5.30pm so I frequently have a power nap. Even then, I never shut my eyes for more than 20 minutes and have mastered the art of micro sleeping where I am unconscious for just 2-3 minutes but wake up feeling completely refreshed."
Professor Horne says: Successful people who enjoy life and are on top of their jobs tend to sleep less.However, the 4 3/4-hour sleep that Howard gets is just about the tolerable limit long term.
MARK PERRY, 39, runs a deli and coffee shop, Delizioso, in Cookham, Berkshire. He lives in Bourne End, Buckinghamshire, and has three children aged 14, 12 and 2. He gets between 4 and 4 3/4 hours' sleep a night.
I worked on the London Underground for eight years, four of those as a driver on a Tube train, and my shifts changed my sleeping patterns for good. Before I did that job I had pretty regular seven to eight-hour nights. Now I often sleep for just four hours and the most I get is five.
At weekends, when I have the chance to lie in a little longer, my body clock won't allow it. I'm still awake at 5am, no matter what time I go to bed. Whenever I sleep an extra hour or two, which is rare, I feel awful all day. It's like I have a hangover that I can't shake off. When I first opened the deli in 2005 I was working extremely long hours - we were open until 9pm - and that did start to affect me. My wife and I also had a baby the following year and he contributed to my tiredness with his night-time waking routine. I tried going to bed earlier, but even then I would wake up, staring at the ceiling, at 2 or 3am, which seemed pointless. Now I work fewer hours and the sleep I get seems to suit me.
The shop now closes at 4.30pm and after that I have to rush around getting the vegetables and other fresh stock for the next day as well as doing the banking and accounts. In the evenings I relax by playing my guitar - I'm in a band and often play with them until midnight before making my way home and crashing into bed. I am also sure yoga helps me to relax - I attend a class twice a week and always come out feeling as if any tensions have lifted.
If I get a tired patch during the day it is usually between 10 and 11am. I drink coffee to keep me going, although I don't get through anywhere near as much as when I was driving trains, which could be as much as 15 cups a day. I never take naps during the week, but will do occasionally at weekends. They are never longer than 5-10 minutes.
Even if I don't get round to it because I am rushing around with the kids, it doesn't make any difference. I set my alarm but am always awake before it is due to go off at 5am.
Professor Horne says: A driven man, Mark should cut back on the coffee he relies on for a perk as it is no substitute for sleep. And he should try to get at least one short nap every day - napping is as good as yoga for revitalising the body and mind, if not better.
KYLE CATHIE, 59, is managing director of the book publishing company Kyle Cathie. She has three grown-up children and lives in London. Kyle gets four hours' sleep a night.
I am sure I inherited my sleep patterns from my mother. I recall hearing her up at 2 to 3am when I was young and, although my three siblings and three children sleep regularly, I am similar to my mother. I go to bed at midnight and usually wake up at 4am, feeling fine and itching to get going with the day.
I drink lots of coffee, then do the washing or other household chores and check my e-mails. Just before 7am I'll have a bath, which is my relaxation, and then I head for work at 7.45am.
I eat extremely healthily and get exercise from walking. I have two of my children popping in regularly for meals and a chat. My life is busy. At 2pm every day I hit a tired patch. It just happens and, wham, my energy goes down.
I never sleep at work, but on Fridays and weekends when I'm not in the office I succumb to this tiredness and shut my eyes for 15 minutes. That is usually sufficient. My daughter sometimes sleeps until 1pm because she needs it. I don't. I have no problem nodding off. I don't need sleep aids. I sometimes read in the bathroom before going to sleep because it relaxes me a bit. But then I hit the pillow and I am off."
Professor Horne says: Older people can generally get by with less sleep. Kyle is probably a naturally short sleeper but still needs a nap and I recommend that she does that regularly. But she shouldn't overdo the caffeine in the morning.
HOW TO BECOME A MORE EFFICIENT SLEEPER
To become a more efficient sleeper and avoid sleep taking over your life, take note of the following:
1. "The test of insufficient sleep is whether you are sleepy in the day or if you remain alert through most of the day," says Professor Horne.
2. If you do sleep less at night, catch up with regular catnaps, which are a life-saving habit, says Dr Sara Mednick, the Harvard University psychologist and sleep expert. A six-year Greek study published last year showed how a midday nap could help to prevent heart disease.
3. Professor Derk-Jan Dijk, director of the Sleep Research Centre at the University of Surrey, says that most people who need to catch up on sleep "naturally feel the urge to nap between 1pm and 3pm, which is ideal". One reason this is a prime napping time, says Mednick, is because it's when the sun is at its highest and temperatures peak, making us feel intuitively sleepy.
4. For the chronically tired, two 25-minute naps at lunchtime and after work may be enough to help you catch up on sleep debt. The first 20 minutes of sleep is usually rich in slow-wave sleep and therefore deeply relaxing.
5. Few people need more than 7-8 hours sleep a night and any more than that is just a luxury, not a physiological requirement, Horne says.
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