How do we sleep?

Dr Neil Stanley is the Manager of the Clinical Research and Trials Unit at the Norfolk and Norwich University Hospital. He took up the post in August 2006 with the aim of developing the Unit into one of the finest clinical trial centre nationally.

Much of Dr Stanley’s previous research involvement centred on the study of sleep. Before joining the Norfolk and Norwich University Hospital, he held the post of Director of Sleep Research at the University of Surrey’s Human Psychopharmacology Research Unit.

Dr Stanley’s research achievements include conducting the five largest, single-centre sleep clinical trials, performing the only known crossover clinical trial and recording the sleep of eight people for six days 18,500 feet up in the Karakorum Mountains of Pakistan. He has made regular appearances in the media talking about sleep and was a scientific advisor to the Channel Four programme 'Shattered’.

Why is sleep so important to the human body?

NS: Sleep is involved in so many aspects of good physical, mental and emotional health. We still don’t know precisely why we sleep. What we do know is that it is a universal phenomenon, animals do it, and we do it. We need to sleep every night and it is important for physical health. If you get a poor night sleep you may increase the risk of cancer, diabetes, obesity, heart disease, depression, suicide and even divorce. So we know it’s crucially important and we should be doing it well every night. We should be trying hard to be doing it.

Do we always have dreams?

NS: We always dream, every night we have five dreams a night but what we don’t always remember our dreams.

So why is it that we only sometimes remember dreams?

NS: We only remember the dreams if we wake up during them. So if you are a good sleeper and don’t wake up you might think you haven’t had a dream. But you will always have four or five dreams a night, everyone does it.

Sometimes people wake up mentally tired, very often they are not able to explain why. Does our mentality rest and relax while sleeping as well?

NS: There are various reasons why we may not feel good when we wake up. Maybe we have not had enough sleep to be sufficiently refreshed. There may be something called sleep inertia, which is the inability to really get up and go after waking, and for some people this can last up to two hours. So it’s maybe that we have had enough sleep but we are not ready to perform for a few minutes or a few hours.

I have read that sleep reflect things that we have done throughout the day, also problems that we face and cannot cope with. Is it for that reason our dreams are so weird sometimes and very often we have troubles understanding and interpreting them?

NS: Certainly. There are aspects of sleep where it’s a case that we learn, remember and also forget things during the night. If you think about it, during the day so many things happen to us that we experience. If we were to remember all of them our brains would rapidly fill up. So we have to forget the unimportant things and remember the important bits. Also, we have to put the emotion with that because of course that is the way we function as human beings. We have to deal with other people and situations, so we have to have the emotional context of the memories. That is the part sleep plays, it allows us to deal with those things that are important, and deal with the emotional context of things that have happened to us during the day.

So in fact dreams are very emotional?

NS: Absolutely.

Does the mind try to sort out problems for us when we sleep?

NS: During the night your brain can solve problems. Certainly, if you give yourself a problem, then it is possible that over the night your brain might find an answer. That might be a creative or a scientific rationale situation you are trying to solve. So because there are less external influences, no sound or light or images, it frees your brain to be able to find those answers.

Dr Stanley, I know that you have conducted some remarkable research on sleep. In particular, I am fascinated by the trial where you recorded people sleeping 18,500 feet up in the Karakorum Mountains of Pakistan. What was the reason for the location?

NS: The situation with doing the work in Pakistan was to look at sleep in high altitude because the higher up the mountain you go the more confounded variables there are to stop you from sleeping. Obviously, its is a great discomfort of actually sleeping in a tent on a mat with temperatures getting down to minus 40 at night. Also, the effects of the high altitude and the possibility of acute mountain sickness occurring.

So in order to allow people to climb quicker and ever higher the study looked at whether you could quicken the acclimatisation to the high altitude using a particular drug to improve sleep. As sleep is important for physical and mental health it will be even more important in such high intensity stressful situation as up a mountain. So the research was looking at strategies for high altitude.

Although, unfortunately despite using a very good sleeping tablet it didn’t work because the disruptive nature of that height and cold was greater than the drug. Of course, we could have used a higher dosage or use a different drug but then you would be affecting the performance the next day which in a safety critical environment of the mountains is not the best idea. Previously, there had been a study at lower altitudes when it had worked, but pushing into higher levels wasn’t going to work.

Did you expect to draw such conclusions?

NS: It’s difficult because very few people go to high altitude and sleep is not a part of the technical and environmental things they talk about. People don’t tend to talk about sleep so we didn’t really know how sleeping at high altitude looked like before. It hadn’t really been looked at how people performed, because they were too busy climbing the mountain so they did not stay at that altitude for longer than you normally would. It was disappointing, but at the same time it was interesting to find these things out.

Would you expect to have the same type of conclusion when people are flying?

NS: The altitude you fly in a plane is about six to eight thousand feet and altitude should not be a problem. Sleeping on an aircraft is a difficult thing to do because of the cramped conditions, poor air and the noise. In the first book in the English language about sleep, which was published in 1830 by Robert Macnish, he said you should never share your bedroom with someone else as they will use up all your good air. So when you consider an aircraft conditions, the air is recycled, muggy and just not a comfortable environment to sleep. This is partly the problem you get with jet lag and not just the time zone change but the manner that you got there. It’s a very unnatural environment.

Some research suggests that we do not even use half of the potential of our brains. Are there any opportunities to use our brains more efficiently why sleeping?

NS: Well, it’s a common misconception that we don’t use all our brain. The brain has many different tasks to do and some of them are conscious, but we now know that all of the brain is involved. Sleep can be a creative time, as I was saying earlier. You can solve problems, but the point of sleep is that the brain relaxes and reduces its activity at night. So unconsciously your brain will do things. But if you consciously try and use your brain more efficiently you are going against the very thing it needs to do, which is to switch off to let you go to sleep.

What advise would you give to people to get a good sleep every night and maximize their day energy potential?

NS: The most important thing is to try and get a good night sleep. Consider that getting a good night sleep is a good thing. Most people don’t, they have their work life, home life, the social life and sleep is the thing that gets compressed. It’s the thing you do after you have done everything else. Whereas, sleep should actually be the central part of the day.

If you start thinking about getting a good night sleep, put into practice what is really common sense. Get as good and comfortable bed as you can possibly afford and a dark cool bedroom. Relax and wind down before you go to bed by not watching TV or using the computer and thinking about work too much.

None of this is anything more than common sense. It’s just that we have forgotten it and have been sold the myth of the twenty four hour always on society, but we can’t do that. Machines maybe able to do 24/7 but humans can’t. So we need to think about doing those things, and not eating late at night, not going to bed angry. All things your mother or grandmother told you are good common sense, but you actually have to do them rather than ignore them. The harder you try to fall to sleep the less likely you are to achieve it. What you have to do is try unconsciously unhook from the day and allow sleep to happen.

Thank you so much for your time and good luck with all your research.