Sleep Expertise: An Interview With SleepQuest’s Medical Advisor

Preview of his new book, “How to Sleep”

Dr. Rafael Pelayo, our Medical Advisor and author of the new book, How to Sleep, was recently interviewed for an internet program called: Psychologists Off The Clock. Here’s a link to the podcast:

We’ve also provided a few excerpts here:

Early Curiosity About Sleep

My curiosity about sleep began when I was 12 or 13, I had a lucid dream and I became curious about why we dream. Why we sleep? I was interested in animal behavior why do animals sleep, do animals dream? 

People sleep in utero. Just as a simple working definition of sleep, sleep is a natural physiological restorative process, and somehow restores our ability to think and to function. But the question is what's it actually being restored? We don't know the answer.

We know we feel better after we sleep. You're studying, you're reading, and then you fall asleep and then, magically, a few hours later, your brain is recharged, it's refreshed. 

So, it is this wonderful, mysterious, physiological process that goes on and I've come to think of sleep as the ultimate form of self-care. Because, it's what the brain needs or what the brain wants. Your whole body sleeps, but your brain -- your neurology -- seems more involved than ever. 

What Is Sleep?

Initially people thought sleep was this kind of this passive thing. And poets, writers and philosophers always described sleep as this deathlike state. It wasn't until they started looking at brain waves that they realized that sleep was a very rich, active process. And in fact, the sleeping brain may use it more, use more glucose, when it's sleeping than when it's awake.

The brain is not this passive thing. Patients say this all the time: this is why I can't sleep, I can't turn off my brain. Well, your brain is not turned off at all when you sleep. It's actually quite active. It's doing busy work. It's maintenance. Researchers realized that sleep was this active process. Then they came to realize there are two very different kinds of sleep -- REM sleep, linked with dreams, and non-REM sleep.

Sigmund Freud wrote The Interpretation of Dreams and it was published in 1899. The human EEG was not developed until 1924, and it wasn’t until 25 years later that they could actually measure brainwaves. And then they could actually study the brain all night -- and realized that the brain was different at different times of the night.

The Stages of Sleep

80% of our sleep is non-REM, but even that chunk of sleep looks different at different times of the night. It would be light, intermediate and deep sleep -- the sleep stages.

We enter sleep in Stage One. I think of it like a car transmission, the gear that gets the car moving. And Stage One is the stage of sleep that often gets ignored because we’re always more interested in deep sleep.

Delta sleep or slow-wave sleep is only about 10% of the night if you're really healthy and fit. 60% of sleep is Stage Two, but Stage One is what often gets ignored. People in Stage One think they're awake when in fact, that's our lightest level of sleep.

That's something that a lot of patients will say, I've been lying in bed awake for hours. But if you really talk with them in detail, you realize that they've been drifting in and out of sleep. It’s so lightly that they feel like they're awake, but they actually getting some sleep, but it's not a satisfying sleep.

The summation of these different stages is ‘sleep architecture.’ 

REM sleep dominates the last third of the night, however, it is age dependent. For instance, when a baby is born, half of the time that they're sleeping is in REM sleep or active sleep, they spend up to 18 hours dreaming every day. 

The mystery of dreams

Dream researchers have studied people who report they don’t dream. In one study, volunteers slept in a sleep lab; researchers woke them up at various times during the night. 80% of the time, the volunteers reported they were dreaming when woken up. 

So, people who said they don't dream were actually not aware of their dreams, which is different. That finding changed psychoanalysis completely because the central question became, do you recall your dreams? If not, how can we change that?

Why do we dream? There are several different lines of thought about it. One belief is that dreaming has no function at all. However, the more accurate view is that sleep is enhancing our memory. It's a way of testing various brain systems, like creativity. 

The biology of creativity may be tied into dreaming sleep because dreams are very creative spaces in which we can test out ideas. 

Our advantage over other animals is that we can adapt to a changing world. So, how do you make that adaptation? You must take information and incorporate new information to solve a new problem. The ability to adapt to a changing world means that we must process what we've learned, so we can react quickly. 

You know the relief when something just pops in your head that you've been struggling to remember. You’re so happy to get the answer. Dreaming is tied into this issue of memory. Dreaming is also tied to creativity. 

And there's no doubt that dreaming has brought value to our society. It's what inspires people. We talk about a leader having a great vision. Where does that coming from? This comes directly from dreaming. And in every single religion dreams are  written about in their sacred texts.

So, dreaming is very influential to our lives. And yet, some people would argue that it has no function at all. In fact, a lot of our patients are using antidepressants, suppressing the ability to dream. You can get by with dreaming less, but life is better when you dream. 

Let’s talk about insomnia

Insomnia is a symptom that becomes a syndrome. You might have occasional bouts of insomnia, right? Insomnia is simply defined as an interruption of your sleep or an inability to fall asleep or an ability to stay asleep to the point that bothers you the next day.

Many patients will say, I didn't sleep last night. We ask: Why does that bother you? And then they say, because I don't function well, the next day.

They are really complaining about how it impacts their lives when they're awake. Cause if it didn't bother them, it wouldn't be an issue. If you didn't have to sleep, you could just use that time to do other things. Without sleep, you’re not functioning as well as you could. It affects your professional and personal interaction with your loved ones. 

Then, the next time it happens, we think, here I go again. And you get into these vicious cycles.

It's a horrible thing to have insomnia, because people often feel out of control with their sleep. Patients will tell me if I'm lucky I get five hours of sleep. They believe, if I don't sleep well, tomorrow's going to be a bad day. And they expect what's going to happen tomorrow, so it puts pressure on them. 

There are factors that interfere with our sleep. 

Light from devices: when the brain sees this light, it wants to stay awake longer. At the same time, the pineal gland is creating melatonin, a hormone to make us sleepy. This hormone is not going to really work because of the light coming into your eyes.  If you are looking to fall asleep, you want to keep your lights down to some degree. Stop looking at your devices an hour or so before bedtime. Give melatonin a chance to do its work, making you sleepy.

What should we do if we do wake up in the night? First off, don't be upset. Think, what woke you up? If you woke up for a valid reason, then go take care of that, lock the front door. But if you have unresolved issues causing stress, you need to let go of that stress. 

Here’s an example:

Any given day, you have 10 things to do and you get eight of them done. You had a great day, but you lay in bed remembering the two things you didn’t do. 

If it's out of your control, there's no point in dwelling on it now. Instead, give yourself closure on the day’s work, and let yourself relax. Write it down before bedtime, what you accomplished, what you didn’t, then you will feel closure. This regular practice has helped many patients reduce their stress, so they can sleep better at night.

Do you have sleep problems? Talk to a sleep specialist with SleepQuest. We can help!