Not sleeping through the night. Looking for non medicated remedies

There's No Substitute for a Good Night's Sleep, UA Expert Says
By Robin TricolesUniversity Communications
March 13, 2018

Consistency is the key to sleeping well, says William "Scott" Killgore, director of the Social, Cognitive and Affective Neuroscience Lab in the Department of Psychiatry.
Consistency is the key to sleeping well, says William "Scott" Killgore, director of the Social, Cognitive and Affective Neuroscience Lab in the Department of Psychiatry.
William "Scott" Killgore
William "Scott" Killgore
Before the morning of Sept. 11, 2001, when two airplanes crashed into New York City's Twin Towers, William "Scott" Killgore knew little if anything about the science of sleep. Two decades later, he knows much more – specifically, how sleep affects human behavior, performance and well-being.

Killgore is the director of the Social, Cognitive and Affective Neuroscience Lab, known as the SCAN lab, in the UA Department of Psychiatry. Trained as a clinical neuropsychologist and research neuroscientist, Killgore researches the parts of the brain involved in emotional processes and cognitive performance. For the past decade, his work has focused on the mental health, well-being and performance of military personnel and combat veterans. His research is funded by the U.S. Department of Defense with the goal of trying to help people recover from traumatic injuries or traumatic stress.

Lo Que Pasa talked with Killgore, a professor in the Department of Psychiatry, about how sleep affects emotions, reasoning and decision making – and how caffeine can only go so far to make up for lack of sleep, a far too common condition.

You started your career studying adolescents and emotional regulation. What made you start studying sleep?

It was an accident. I was at Harvard doing research for my postdoc, and I was studying adolescents and emotional regulation. And then the Sept. 11 attacks happened. Afterwards, I talked with my wife and told her I felt a calling to go into the military. So, I applied to the Army to become a researcher, and they brought me in as an Army research psychologist at the Walter Reed Army Institute of Research. The lab I was assigned to was doing sleep deprivation research. I didn't know anything about sleep, but I learned. At first, I wasn't all that excited about the topic of sleep and sleep deprivation, but then I decided to combine my background in emotion and executive function research and applied it to studying the effects of sleep deprivation. That opened a whole new direction of research that had been virtually unexplored before. I was suddenly fascinated to investigate how lack of sleep affected emotional processing, judgment and decision making. Since then, it has become a rapidly growing area of research.

You say that emotions affect sleep, and sleep affects emotions. What do you mean by that?

The classic way that psychiatry has looked at sleep is that your emotional problems are impairing your sleep. For example, when people have a psychiatric disturbance, such as depression or bipolar disorder, that leads them to have altered levels of arousal and brain functioning, and they can't sleep very well. It was generally assumed that the psychiatric condition led to bad sleep. We take it from the other direction; that is, getting adequate sleep is allowing your emotional circuitry to function normally. So, lack of sleep is altering the normal way that the brain works and can lead to dysfunctional emotional or cognitive functioning.

A lot of our work was built on a study that was conducted at Walter Reed years ago using PET, or positron emission tomography, a type of imaging. That research showed that when people are sleep deprived for 24 hours, the front part of their brain shows a decrease in metabolic activity, so they're essentially not "firing on all cylinders." The prefrontal cortex is the part of your brain that's involved in higher-level decision making, judgment and risk assessment. It regulates your emotions. It also seems to be one of the regions that is most affected when you're sleep deprived. It does most of the things that make us distinctly human.

You also found that sleep deprivation did not necessarily lead to deficits in executive function – that is, self-regulation and the ability to plan. How do you explain that?

This was an unexpected and inconsistent finding. People seem to differ in their ability to resist the effects of sleep loss. Sometimes people can go a night or two without sleep, and they seem okay, which is surprising. So, how are they doing that? I came to the understanding that there are different sections in the prefrontal cortex, which are involved in very different aspects of higher-level cognition. For instance, the dorsolateral prefrontal cortex, which is essentially the top portion, controls what we might call "cool" executive functions – that is, those kinds of cognitions that don't involve emotional reasoning. Interestingly, those areas seem to be pretty resistant to sleep loss in many cases. It looks like other areas of the brain can step in and act almost like a crutch and sustain many of these nonemotional executive functions.

But it's the bottom surface of the prefrontal cortex that plays the biggest part in regulating how you're feeling and how you respond to those feelings. We call these "hot" executive functions. This part of the brain learns from the rewards and punishments of past experience. That system also seems to be sensitive to sleep loss, changing your mood, changing the way you respond to emotionally salient stimuli or events. Most of the time you're not thinking about your mood or emotional status; it's operating down below the surface of conscious awareness, affecting your decisions and judgments. And as you go through life, you sometimes make poor decisions that don't make rational sense because you're lacking sleep. With lack of sleep, the amygdala, the brain's emotional engine, becomes poorly regulated by the prefrontal cortex. The prefrontal cortex normally puts the brakes on your amygdala, but now that you're sleep deprived, these two brain systems are not well-connected. In fact, we found that people who are sleep deprived make emotional decisions that are very similar to the decisions of people who have brain damage in a specific area of the prefrontal cortex. You can make a lot of bad decisions in life when they are made without sufficient sleep.

How about coffee? Does a cup of coffee or two help make up for sleep deprivation?

Back in the Army, we looked at the effects of sleep deprivation on cognition. Could we restore cognition with caffeine? For simple alertness and vigilance, caffeine helps during the first night,, But after about two nights, it's not so helpful anymore. We did a lot of work on the effectiveness of stimulants for restoring other aspects of cognition too. The cool thing that came out of those studies was that you can take the stimulants, and they'll wake you up, but people still have a pattern of behavior, particularly judgment and decision making, that looks a bit like they're brain damaged. Caffeine doesn't seem to restore that. So, you're not making good decisions, but you feel awake, so it can fool you into thinking that you're fine. But you're making decisions just as badly as a sleep-deprived person without any caffeine.

You run a large, busy lab and have a personal life. But you look rested. How do you do it? What's your secret?

Consistency is one of the keys. I go to sleep close to the same time every day and wake up at about the same time every day, seven days a week. First thing in the morning, my wife and I have our coffee outside on the patio and get exposed to the morning sunlight. At night, we keep the bedroom dark, cool and quiet. I also use a light therapy device in the morning for about 30 minutes after I get to work. Your alertness and performance everyday are affected by light. Bright light does at least two things. It resets the circadian rhythm, and we think it activates systems in the brain that keep you alert. But just sitting outside, going out under the sunny sky, will temporarily make you feel more alert than you would otherwise. We have even shown that exposure to light after learning something new can help you to remember it better later.

Is there anything else we should know about sleep?

Get more of it. Nearly everybody needs more sleep. People typically don't get the seven to eight hours of sleep that most experts agree is optimal. Although there is a wide range, people in the U.S. typically get maybe six hours or less on average during weekdays and try to catch up on weekends. But playing catch up doesn't really work – you still carry a bit of a "sleep debt" that takes quite a bit longer to pay off. Most people do best with at least seven hours of sleep on a regular basis. So, most of us are not routinely getting enough, and it's affecting the way we respond to one another socially and emotionally. Nearly everything is harder when you haven't had enough sleep.

Q&A

Hi, @ladybugmg -- thanks for the article you posted and for sharing a bit of your story. That's very challenging when the slightest noise awakens you at night. You certainly have found a great way to make the best of it!

A couple of other discussions you may be interested in about trying to get a good night's sleep are:

- Some tips and discussion about sleep hygiene http://mayocl.in/2nV1XSL
- A member talks about a two-phase sleep pattern he uses http://mayocl.in/2pfHQ0K

Do you feel like the sourdough bread, tea and computer solitaire help you become sleepy, or would you say they are just nice things you do for yourself to make being awakened more pleasant?

I think focusing on the routine helps to focus my mind on it instead of letting my mind think about anything stressful that I am dealing with daily. I am a widow and live alone and am now responsible for many of the household tasks that my late husband managed.

I previously used Sleepytime tea but after it stopped helping, I changed to Tension Tamer.

It would be nice to have a "chat room" in which those who have sleepless night could chat with each other. I am going to try to find one on the Internet so those who deal with it can share with others who are still awake in the middle of the night.

Hi @ladybugmg Nice to e-meet you here on Connect. I went for years with interrupted sleep patterns while my wife's caregiver. The last few months of her life she required mediations every two hours around the clock so that really messed with my bio-clock in a big way. Thankfully, now about 1 1/2 years after her passing, I am just beginning to get a new sleep pattern established. Not there yet, but much closer than I was.

While I am sure others have suggested it here I find white noise a huge help -- and then some nights I change it up to just playing a mix on my iTunes through the night. Both work well for me, but I know every case of sleep challenges are unique to the individual experiencing them.

You can always check caregiving chat groups for those folks who are up at all hours! 🙂 When I first came to Connect I was most active from 2 to 4 am.

Courage, strength, and peace!

Hi try Celestial Sleepy time EXTRA it's great!!

I understand completely because after my late husband had his first heart attack and expecially after he had open-heart surgery I would waken many times during the night to check on him. His slightest movement in the twin bed next to mine would wake me up and then after checking on him, often I could not get back to sleep.

Even though our caretaker roles may still have some influence on our sleepness effected lives, at least I am comforted in that my husband and I were married almost 60 years and try to dwell on the "good" memories, and that helps to sustain me.

There is a passage in the Bible that I read that gives me comfort during those sleepless hours: Ecclesiastes Chapter 3 --To every thing there is a season, and a time to every purpose under the heaven.

Enjoy every day, it is a gift.

Thanks for the suggestion. I didn't know there was an Sleepy Time Extra.

@ladybugmg There are a number of approaches I have read about getting to sleep. I think that what makes them work is that they keep your mind occupied on something non-tension causing. The one I have been using most recently is picking a letter in the alphabet and thinking of every word you can that begins with it. When you run out of words move on to a different letter. It has helped me.

The others I have read about are basically inhaling to a certain count, holding that breath for some number of seconds, and then releasing it in a sustained whoosh. That one has not worked as well for me.

A chat room could be a mixed blessing. If me, I would get so caught up in I would chat for a long time and get no sleep!
JK