Mental Health Quotes

Many studies have confirmed what your mother told you: We need to sleep about 7.5 to 8.5 hours a night. Getting significantly less sleep than this, or significantly more, will almost inevitably cause problems in the long run. Even a single night of bad sleep has been found to have deleterious effects on our physical and cognitive performance. Sleep is essential to performance in dangerous tasks, such as driving. [2023] - Peter Attia

Poor or inadequate sleep can help tilt us into metabolic dysfunction. Multiple large meta-analyses of sleep studies have revealed a close relationship between sleep duration and risk of type 2 diabetes and the metabolic syndrome. But it cuts both ways: long sleep is also a sign of problems. People who sleep 11 hours or more nightly have a nearly 50% higher risk of all-cause mortality, likely because long sleep = poor quality sleep, but it may also reflect an underlying illness. Similar risk associations have been found between poor or short sleep and hypertension (17%), cardiovascular disease (16%), coronary heart disease (26%), and obesity (38%). [2023] - Peter Attia

Our ability to obtain deep sleep declines with age, beginning as soon as our late twenties or early thirties, but worsening as we enter middle age. One analysis suggests that the bulk of the changes in adult sleep patterns occur between the ages of 19 and 60 and only minimally decline after that, if one remains in good health (a big if). More research points to the forties and sixties as the decades of life when deep sleep is especially important for the prevention of Alzheimer's disease. People who have slept less during those decades seem to be at higher risk of developing dementia later on. [2023] - Peter Attia

One study found that Ambien (zolpidem) actually decreased slow-wave sleep (deep sleep) without increasing REM, meaning people who take it are basically trading high-quality sleep for low-quality sleep. Older benzodiazepine drugs, such as Valium (diazepam) and Xanax (alprazolam) typically induce unconsciousness without improving sleep quality. Somewhat worryingly, their use has also been associated with cognitive decline, and they're generally not recommended for older adults beyond very short-term time horizons (nor is Ambien). [2023] - Peter Attia

Antagonist inhibitors such as Dayvigo (lemborexant) and Quviviq (daridorexant) have been approved for treating insomnia, and they appear to be promising. They are, however, quite expensive. One drug that we do find helpful for assisting with sleep is trazodone, a fairly old anti-depressant (approved in 1981) that never really took off. At the doses used to treat depression, 200-300 milligrams per day, it had the unwanted side effect of causing users to fall asleep. That side effect is what we want in a sleep medication, especially if it also improves sleep architecture. We have also had good results with the supplement ashwagandha. [2023] - Peter Attia

You should make a longer-term assessment of your sleep quality over the last month. Probably the best-validated sleep questionnaire is the Pittsburgh Sleep Quality Index, a four-page document that asks questions about your sleep patterns over the last month. There's another, even simpler quiz called the Epworth Sleepiness Scale, which asks users to rate how likely they're to fall asleep in certain situations. Yet another helpful screening tool is the Insomnia Severity Index, which provides an opportunity to reflect on and report your experience of sleep problems and their impact on your functioning and well-being. [2023] - Peter Attia

One large-scale survey found that the more interactive devices subjects used during the hour before bedtime, the more difficulties they had falling asleep and staying asleep-whereas passive devices such as TV, electronic music players, and best of all, books were less likely to be associated with poor asleep. Turn off the computer and put away your phone at least an hour before bedtime. [2023] - Peter Attia

This concept of sleep pressure, our need or desire for sleep, is key to many of our sleep tactics. One of the primary techniques that doctors use to treat patients with insomnia is actually sleep restriction, limiting the hours when they're "allowed" to sleep to six, or less. This basically makes them tired enough that they fall asleep more easily at the end of the day, and (hopefully) their normal sleep cycle is restored. Another way to help cultivate sleep pressure is via exercise, particularly sustained endurance exercise (e.g., zone 2), ideally not within 2 or 3 hours of bedtime. Even better is exercise that entails some exposure to sunlight (i.e., outdoors). [2023] - Peter Attia

It's important to mentally prepare ourselves for sleeping. For me, this means avoiding anything that might create stress or anxiety, such as reading work emails or especially checking the news. Another way to turn down the sympathetic nervous system and prepare the brain for sleep is through meditation. There are several good apps that can help with guided meditations, including some that are focused entirely on sleep. [2023] - Peter Attia

Give yourself enough time to sleep-what sleep scientists call a sleep opportunity. This means going to bed at least 8 hours before you need to wake up, preferably 9. Darken the room completely. Make it dark enough that you can't see your hand in front of your face with your eyes open, if possible. If that is not achievable, use an eye shade. I use a silky one called Alaska Bear. Fix your wake-up time-and don't deviate from it, even on weekends. If you need flexibility, you can vary your bed-time, but make it a priority to budget for at least 8 hours in bed each night. [2023] - Peter Attia

Don't obsess over your sleep, especially if you're having problems. If you need an alarm clock, make sure it's turned away from you so you can't see the numbers. And if you find yourself worrying about poor sleep scores, give yourself a break from your sleep tracker. If you find yourself lying awake in bed, unable to get back to sleep, my advice is to stop fighting it. Get up, go into another room and do something relaxing. Fix a cup of tea (noncaffeinated, obviously), and read a (preferably boring) book until you feel sleepy again. If the sleeplessness persists, the most effective treatment is a form of psychotherapy called Cognitive Behavioral Therapy for Insomnia, or CBT-I. Studies of CBT-I techniques have found that they're more effective than sleeping medications. [2023] - Peter Attia

DBT (dialectical behavior therapy) consists of four pillars joined by one overarching theme. The overarching theme is mindfulness, which gives you the ability to work through the other four: emotional regulation (getting control over our emotions), distress tolerance (our ability to handle emotional stressors), interpersonal effectiveness (how well we make our needs and feelings known to others), and self-management (taking care of ourselves, beginning with basic tasks like getting up in time to go to work or school).  [2023] - Peter Attia

Although CBT-I is the best and most durable treatment we have for insomnia, it can have side effects. When people carry out "Sleep restriction therapy", which is a component of CBT-I, they sometimes experience excessive sleepiness, reduced vigilance and slowed reaction time. These effects are especially likely to occur at the beginning of the program, and they disappear when sleep is no longer restricted. Sleep restriction therapy is also meant to be used for a short time (usually 2-4 weeks), and should not be continued if your sleep has not improved substantially in that time. [2021] - Judith R. Davidson

When insomnia occurs at least 3 nights per week and lasts for 3 months or longer, it's technically called "chronic" insomnia (Don't be put off by that label, chronic doesn't mean irreversible!). [2021] - Judith R. Davidson

With insomnia, reaction time may be slower, problem solving, and some aspects of memory may be affected. However, we can usually get the job done--whether it be schoolwork, housework, or job work--although we may feel that it takes extra effort. We are functional, but tired, sad, and irritable. [2021] - Judith R. Davidson

One night of sleep loss doesn't significantly or obviously impair our health system. Staying awake overnight, rather than sleeping, is accompanied by only subtle changes or even enhanced immunity in the short term. There is no clear evidence that a full night awake makes us any more susceptible to infection or disease. When we lose sleep one night, we can recover most of what we've lost the next time we sleep. [2021] - Judith R. Davidson

Although the sleep information obtained from consumer wearable devices is appealing, these trackers are not yet ready for use in Sleep Therapy. They tend to misclassify wakefulness during the night, and they're untested in people with insomnia. [2021] - Judith R. Davidson

For Week 1, set a "threshold bedtime" and "threshold rise time" that will limit your time in bed (sleep restriction): 1) Pick a rise time that you can maintain 7 days per week; 2) Take your total sleep time in hours (to the nearest half hour). If this number is less than 5.0 hours, then replace it with 5.0; 3) Take your threshold rise time and subtract your total sleep time. E.g. if your threshold rise time is 6:00 am and your total sleep time is 6.0 hours, your threshold bedtime will be midnight. Go to bed only when sleepy and not before your threshold bedtime. Leave the bed if you can't fall asleep or go back to sleep within 10-15 minutes. Return when sleeping. Repeat this step as often as necessary during the night. [2021] - Judith R. Davidson

Get out of bed as soon as you wake up in the morning. This applies to the situation of waking up in the mooning earlier than your threshold rise time. Avoid driving and other potentially dangerous activities while sleepy. If sleepiness is overwhelming, you may take a short nap (set aside no longer than 45 minutes) in the afternoon, between 1:00 pm and 4:00 pm. [2021] - Judith R. Davidson

For Week 2, if your sleep efficiency (total sleep time / total time in bed) is 84% or less, set your threshold bedtime 15 minutes later but always give yourself at least 5.0 hours in bed; if your sleep efficiency is 85-89%, keep the same threshold bedtime; if your sleep efficiency is 90-94%, set your threshold bedtime 15 minutes earlier; if your sleep efficiency is 95% or greater, set your threshold bedtime 30 minutes earlier. If your sleep efficiency hasn't improved over 2 weeks, don't continue to restrict your sleep. Otherwise, repeat in Week 3 using the new sleep efficiency. This technique should be doing its work by Weeks 3-4. Your optimal sleep duration is reached when you're getting quite solid sleep (e.g., about 85% sleep efficiency) and you're not feeling overly sleepy during the daytime. [2021] - Judith R. Davidson