Dr. Rubin Naiman, author of Hush: A Book of Bedtime Contemplations, is a clinical psychologist and assistant professor of medicine at the University of Arizona Center for Integrative Medicine directed by Dr. Andrew Weil. As a sleep and dream expert, his focus is how sleeping and dreaming affects your health.
Four years ago, I interviewed Dr. Naiman on the most common causes for insomnia. Here, the discussion revolves around some of the more basic fundamentals of sleeping, and the importance of dreaming.
Early on in his career as a psychologist, Dr. Naiman recognized that it was difficult for people to move forward or to address and heal emotional issues if they were tired or sleepy. He also had an innate fascination with the world of dreams.
Eventually, he shifted his career focus entirely into sleep and dreams, and how it ties into your mental and physical—even spiritual—health.
In basic terms, there are four stages of sleep but the two that are highly restorative are:
- Deep sleep, which you can think of as “true sleep”
- Rapid eye movement (REM) sleep, which is dream sleep
According to Dr. Naiman, one of the best ways of understanding those two types of sleep is to think of them as different kinds of nourishment. “Sleep and dreams are a bit like water and food to the psyche, to the soul, to the mind,” he says. For optimal health, you need both.
Data suggests that the average American sleeps a little under seven hours a night, which actually isn’t enough. Dr. Naiman explains:
“We have to keep in mind that sleep debt accumulates. If somebody is losing, say, an hour of sleep every night, and if they’re sleeping an average of seven hours, at the end of seven days and nights, they will have lost the equivalent of a full night’s sleep.
Millions of us do this. Even though they might not notice an obvious change in their functioning, the reality is they will function as if they’ve been up the entire night. There’s a danger in that, of course, in terms of accidents, performance, and so on. We all need to get the right amount of sleep.”
The ideal amount of sleep varies from person to person, and even season to season. Health conditions, pregnancy, and other factors can also influence your need for more sleep.
Dr. Naiman recommends looking at the quality of your waking day to determine whether you’re getting enough sleep. If your energy is steady and rhythmic through the day, you’re probably getting good-quantity and good-quality sleep.
Why Dreaming Matters
Because most of your REM or dream sleep occurs in the latter third of the night, sleep loss at that time results in what Dr. Naiman refers to as “dream deprivation.” Another factor that contributes to dream deprivation is the routine use of an alarm clock. When it goes off, it will oftentimes wake you out of the tail end of a dream.
“This is like having a really good novel, but tearing off the last few pages. It’d be very, very frustrating,” Dr. Naiman says.
“Dreaming is essential. In recent years, there’s been a lot of research underscoring the fact that dreaming has functions very different from sleep.
I think of the dream as being a digestive and assimilating process for information… In a sense, during REM sleep and dreaming your brain becomes a second gut.
If we think about all of the information that we’re exposed to in the course of a single day – the conversations, the things we read, the things we see, hear, and think about, and all the things we just experience through our senses – all that information can be understood as something we consumed.
What happens in REM sleep is all of this information we’ve metaphorically swallowed is digested and assimilated. It’s sifted through. Again, in its wisdom – and depending on lots of factors — the brain decides what it’s going to keep and what it’s going to let go of.
I think after this information is digested, the process of assimilation shows up metaphorically in the dream, in the images of the dream. The bottom line here is that if you don’t dream well, it has a profoundly negative impact on your memory. In a deeper sense, it’s as if you stopped growing psychologically. You stopped adding to who you are.”
How to Improve Your Sleep Hygiene
To optimize your sleeping and dreaming, one of the most important issues is to make sure you’re going to bed early enough, because if you have to get up at 6:30am, you’re just not going to get enough sleep if you go to bed after midnight.
Dr. Naiman also notes that one common characteristic of really healthy sleepers is that they tend to love sleep—they cherish it and enjoy it. For them, sleep is a source of pleasure.
“I talk to people about falling back in love with sleep,” Dr. Naiman says. “If you love sleep, if you want to have a good relationship with sleep, start dating it. Start courting it. Acknowledge your love of sleep before you get into bed with it. This is the first step, and it’s a critical attitudinal shift. Because we can do all of the right things, but if our heart is not in the right place around sleep, it really won’t help as much.”
More practical factors include making sure your bedroom is dark, quiet, and cool. It also needs to be free of electromagnetic fields. If you keep electronic gadgets in your room, such as a TV, cell phones, and electric alarm clocks, your body may, at an imperceptible level, pick up that your bedroom is actually buzzing with energy. This needs to be addressed by removing as many electromagnetic sources as possible. Make your bedroom an electronic-free zone and make certain all the electronics in your bedroom are turned off before you go to sleep.
This includes making sure your electrical wiring is enclosed in conduits, as this will cancel out potentially dangerous electromagnetic radiation. If you’re really sensitive, it may be wise for you to flip the circuit breaker to your bedroom before going to bed. There are actually newer devices that allow you to do this remotely.
“In terms of alarms, if you have to use an alarm, I think it’s better to opt for some of these newer, gentle alarms that will not blast you out of bed. You can get these for smartphones, or you can get them built into regular alarms. You can also use a dawn simulator that gradually brightens a light to simulate sunrise.
One of the things I strongly recommend, in addition to having sort of a soft, graded alarm system, is to modulate the light that comes out of these digital alarms or digital clocks. Many of them put out pretty intense white or blue light, which is the worst thing for sleep… If you’re going to have light, you want to have a low-blue light, more along the amber or red spectrum of light, that doesn’t suppress melatonin… It’s critical to dial down our lights at night.”
The Importance of Melatonin
If you’re exposed to light at night, even an hour or two before bed, you will suppress your melatonin production. This can have long-term health ramifications that go far beyond insomnia, as besides making you sleepy, melatonin also has potent anti-inflammatory and anti-cancer benefits. When you’re exposed to the blue wavelength of light, your brain receives the signal that it’s daytime, and it responds by suppressing melatonin. Television screens, computer screens, iPad screens, or smartphone screens—all of these emit blue light.
There’s a free program called f.lux that you can download onto your computer that will automatically change the wavelength of the light during evening hours. This can ameliorate some of the adverse effects on your melatonin production, but ideally, you’d want to turn them all off at least an hour or so before bed, and dim any lights around you.
Normally, melatonin levels are very low during the day. They rise up very gradually at night. Melatonin peaks during the last two or three hours of sleep, which is typically when you’re dreaming. Interestingly, melatonin is also a vasodilator—it opens up your peripheral blood vessels, allowing your body to dissipate energy as heat during the night. Our remaining energy is diverted toward cleansing and maintenance as well as immune system functioning.
The best way to optimize your melatonin production is to get exposure to sun light in the morning, safe levels of natural light throughout the day, and then gradually reducing the amount of light as the evening wears on. However, a melatonin supplement can sometimes be helpful. In terms of selecting a high quality product, and when and how to take it, Dr. Naiman offers the following suggestions:
“Most melatonin products are instant-release. Because melatonin has a short half-life of about 45 minutes, you get a spike if you swallow it around bedtime. You get a spike that will come down pretty quickly. It almost is the opposite curve you see in nature. I tend to recommend a sublingual variety (under the tongue), so it’s absorbed quickly but avoids the first liver pass, and also a sustained-release or continued-release variety. This mimics the natural pattern of melatonin release more closely.”
Learning to Slow Down and Rest Is Crucial for Optimal Sleep
According to Dr. Naiman, sleep problems don’t typically occur because of a lack of sleepiness or inadequate sleepiness; they occur as a result of excessive wakefulness. In short, you’re running too hard, too fast. Oftentimes, insomniacs will have cortisol dysrhythmia, where their cortisol levels become elevated at night instead of in the morning. Basically, insomnia can be a side effect of being too hyped up; too frenetic, and not allowing yourself to simmer down and relax.
“Given the context of the velocity of our lives, we tend not to notice how fast we’re going, and we really need to notice that. We need to yield, slow down, and even stop sometimes. When would benefit by installing speed bumps in our daily lives.
The bridge that takes us from waking to sleep is the bridge of rest – true rest. We live in a world that is hyper-aroused. And we’ve forgotten what true rest is. People often confuse rest with recreation. They’ll go to a movie or go on a hike or bowling to ‘rest.’. But these are recreational activities, not true rest.
True rest involves the practice of something that allows us to be receptive, to really slow down. I think the reason a lot of people resist this is because when we start to slow, we start to experience what I’ve called personal turbulence… We descend through a layer of unresolved emotions, thoughts and feelings. Typically when we hit this turbulence, we pull back up into activity.
What I suggest is a way of learning to descend through personal turbulence and touching the ground, the ground of some peace, some quiet, and some inner serenity. That kind of practice is so helpful in getting to sleep… A lot of people who can’t fall asleep complain that they can’t stop the mind. Well, they haven’t given it enough time. If they’re flying really high and fast, that’s fine. But they need more time to descend and a longer landing strip.”
Meditation or yoga can be very useful for this. There are also technologically assisted ways of resting, such as biofeedback and heart rate variability approaches. Ther are various smartphone apps can be helpful in monitoring and assessing your sleep quality. In the end though, it comes down to making a decision as to which has greater value: productivity or rest. Many of us do not realize that productivity cannot be achieved at the expense of rest. Sleep is actually essential for optimal wakefulness, attention, and productivity!
Addressing Sleep Apnea
Another challenge that can rob you of sleep is sleep apnea, which is typically, but not always, related to a mechanical airway obstruction due to being overweight. Sleep apnea deprives your body and brain of oxygen, which can cause very severe health problems over time.
“People who have severe or even moderate to severe sleep apnea I believe need an immediate intervention,” Dr. Naiman says. “In cases like that, I think CPAP could be a lifesaver. There’s no question about it. In all the epidemiologic studies, we found there were very few people over the age of 65 with severe sleep apnea. The researchers realized it’s because they passed away! You can’t live with this for a long time.”
However, CPAP doesn’t necessarily have to be a lifelong treatment strategy. Lifestyle strategies such as exercise and diet can go a long way toward ultimately resolving the issue. Psychological factors may also need to be addressed.
“There’s some evidence that some apnea is associated with upper airway hypertension. The term hypertension here is not related to blood pressure; it’s a literal tension in the voice box or the throat. From an energy medicine standpoint, it’s associated constriction in the throat chakra – people not feeling free to fully express who they are. If you hold excessive tension in that area through the day, it can over-relax or prolapse when you go to sleep.”
Interestingly, one alternative medicine approach for sleep apnea is learning to play the didgeridoo—an aboriginal wind instrument that requires you to learn circular breathing. According to Dr. Naiman, a small number of studies have shown that this appears to be curative for mild apnea. Another is oral myofunctional therapy. The interview I did with Joy Moeller can be really helpful for many with this condition. This technique is based on the neuromuscular re-education or re-patterning of the oral and facial muscles, and includes facial exercises and behavior modification techniques to promote proper tongue position, improved breathing, chewing and swallowing.
Does Daytime Napping Help or Hinder Good Sleep?
Many sleep experts tend to recommend against napping, on the basis that it may interfere with your ability to sleep well during the night. Dr. Naiman, however, disagrees.
“I think if somebody has insomnia, we want to maintain their sleepiness or sleep load. We don’t want them to remain sufficiently sleepy at night. Often if they do nap, they’ll end up napping for an hour or two, which is not good. But the other side of this is using the nap as a way of practicing sleep. If you don’t fall asleep when you’re practicing during the nap, it’s not going to impact the next day. I have various CDs available that offer guidance in practicing sleep.
For people who sleep well, I think the nap is great. It’s a way of descending, of touching down, and of reconnecting with rest during the day. Again, a nap is a nap; it’s not substitution for good night’s sleep. We generally recommend positioning the nap somewhere around the middle of the waking day, about eight hours into it and running for approximately 20 minutes or so. It’s very refreshing. It’s great for memory. It reduces blood pressure. It enhances mood. It’s just all around a good thing to do.”
Dr. Naiman’s new book, Hush: A Book of Bedtime Contemplations, written to be read before bedtime,encourages you to get back in touch with your own inner wisdom about sleep. It’s based on an integration of sleep science, sleep spirituality, and sleep psychology, and includes what Dr. Naiman calls 100 Spiritual Prescriptions for Sleep.
“I think of these as bedtime snacks for the soul,” he says. “You read one or two at night. It doesn’t really provoke a lot of contemplation; it’s meant to invoke sleep to get people to transition from sort of normal patterns of thinking into a way of using thinking to let go of thinking, and of course, to allow the default of sleep to come to the surface.”
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