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  • Laura Terlizzi

What happens when you don't sleep enough?

I have to admit; I was guilty. Guilty of not making sleep a priority. There was always something more pressing, something else needing attention and ranking much higher on the list of importance. In fact, if I’m being honest with myself, sleep did not only not take precedence, it wouldn’t even get factored into my list.

I was also guilty of not giving consideration for the toll this is, or has, taken. Yet, the older I get, I can no longer ignore what my body requires and I’m questioning how much can actually be contributed to lack of sleep?

Have I not only been depriving myself of a few extra minutes, or more accurately, hours of rest time, but have I also been putting myself in harm's way?


If I was to use a simile to compare what running on empty is like, I think about our body’s need for water. Have you ever recognized when you are completely dehydrated? When you’ve brought your body to such a state of thirst that the inside of your mouth feels like a dried-up river bed? Where you can literally feel the tissues tightening and your skin shrinking? Where your physical and mental ability to function goes from being slower and compromised to a rapidly diminishing point of almost no return? When dizziness, headache, lack of focus and attention swiftly take over the ability to function?

Sleep deprivation is like that. And the results can be measured in ways far beyond that which I, for one, realized or gave credit to.

Consequently, when I thought I was getting myself further ahead and accomplishing so much by not sleeping more, in actuality I may have been contributing to putting myself further behind. By neglecting my body’s need for sleep, I may have been reducing my chances of sustainable outcomes.


A recent example of exactly this happened a few weeks ago when I was scheduled to speak and conduct a workshop at a conference. That event was the catalyst that changed my perspective from what I was doing to what I am now trying to have as new and healthier choices and habits.

As with any significant event which takes a lot of planning and developing, there are always opportunities for things to inevitably go…..well…..not as planned! And in this case, that’s exactly what happened. When the audio/visuals did not work as expected and I lost the use of prompts to cue myself, I was at the mercy of an exhausted mental state of mind and a completely sleep-deprived brain. This, due to my own neglect of self-care and lack of attention to what my body required. The result was, at the time when I needed to function at my highest capability, my brain simply took a stand and stopped me from being able to continue. I struggled to deliver the presentation that my fully rested brain would have been able to give without issue. The expression, “I could do it in my sleep” comes to mind right now; however, I don’t think I will ever make that statement again unless plenty of sleep has been a part of my daily regime.


In his national bestselling book, “When the body says no”, Dr. Gabor Mate opens with, “People have always understood intuitively that mind and body are not separable. Modernity has brought with it an unfortunate dissociation, a split between what we know with our whole being and what our thinking mind accepts as truth. Of these two kinds of knowledge the latter, narrower, kind most often wins out, to our loss.” He goes on to say that it is his privilege and primary goal to bring to the reader the findings of modern science that reaffirm the intuitions of-age old wisdom. And his other purpose “was to hold a mirror to our stress-driven society so that we may recognize how, in myriad unconscious ways, we help generate the illnesses that plague us.”


At this point, having recognized that a significant amount of sleep deprivation was part of the equation that had impaired my ability to perform, I view it as a learning opportunity.

Over the past few decades, research has also shown how important quality sleep is. That without it, existing medical conditions can increase in severity or degree and new conditions can develop. Furthermore, that our pain threshold falls by approximately 15% after just one night of insufficient sleep. (H. Pevzner, 2019, Psychology Today)


As noted by D.W. Brooks, MD MBA, “with less sleep the body is unable to produce white cells as well as it should, making the immune system more vulnerable for attack. If sleep deprivation is not solved, the body can manifest long-term serious conditions.” According to a related article by D.W. Brooks and various studies and research done at a number of different institutions including but not limited to; the University of Chicago, Brigham & Women’s Hospital in Boston and University of California- San Francisco; some of the long-term effects of sleep deprivation can include conditions such as obesity, heart disease, hypertension, and diabetes.


According to a board-certified neurologist and double board-certified sleep specialist, Dr. Christopher Winter, “sleep is an amazingly important process that happens in our bodies. Sleep is not the absence of wakefulness. Your body is doing amazing things at night while you sleep.” Dr. Winter, who is dubbed as the “sleep whisperer” also states, “while virtually every system and organ in the body is in some way affected by sleep, sleep resides in the brain. This is where sleep both originates and is controlled.”


So, it’s no wonder that when I’m up all night unwittingly insisting that my brain continue to work far beyond what may be considered a reasonable amount of over-time, things become increasingly difficult. And because I have not allowed myself to learn the art of, and the vital importance of, restful sleep, I have indeed also inadvertently put myself in harm’s way.

The lymphatic system is the brain’s own system for removing waste, and according to Dr. Winter’s book, “The Sleep Solution”, scientists have discovered the main waste product being removed is amyloid-beta which is the protein that accumulates in the brains of Alzheimer’s patients. This is important information and a real wake-up call, no pun intended, for people like myself; those of us who are continually and habitually burning the candle at both ends of the wick.


Rather than continuing to list off the multiple physical ailments and conditions that are either derived from or compounded by lack of sleep, let’s now take a look at how we are affected from a mental health perspective.


Dr. Itzhak Fried, a professor of neurosurgery at the University of California, Los Angeles (UCLA), said in a statement. “We discovered that starving the body of sleep also robs neurons of the ability to function properly. This paves the way for cognitive lapses in how we perceive and react to the world around us.

Study author, Yuval Nir, a sleep researcher at Tel Aviv University in Israel, states, "We were fascinated to observe how sleep deprivation dampened brain cell activity. Unlike the usual rapid reaction, the neurons responded slowly, fired more weakly and their transmissions dragged on longer than usual."


The July 2009 issue of the Harvard Mental Health Letter, updated March 2019 (Harvard Health Publishing) states, “The brain basis of a mutual relationship between sleep and mental health is not yet completely understood. But neuroimaging and neurochemistry studies suggest that a good night's sleep helps foster both mental and emotional resilience, while chronic sleep deprivation sets the stage for negative thinking and emotional vulnerability.” Further, “Although scientists are still trying to tease apart all the mechanisms, they've discovered that sleep disruption — which affects levels of neurotransmitters and stress hormones, among other things — wreaks havoc in the brain, impairing thinking and emotional regulation. In this way, insomnia may amplify the effects of psychiatric disorders and vice versa.”


Eti Ben Simon, a postdoctoral researcher at the University of California, Berkeley states,” Loss of sleep also impairs regions of the brain that support understanding of another’s intent. It makes it harder to consider someone else’s perspective, which is the basis for empathy.”

Sleep restores activity in the prefrontal regions of the brain critical for emotion regulation. From his 2018 research, Ben-Simon also reports that “During REM sleep, neurotransmitters involved in emotional responses, such as noradrenaline and dopamine, are completely absent. This helps to restore a neurochemical balance that supports emotional control the next day.” (Holly Pevzner, June 2019, Psychology Today)


“According to Christopher Barnes, an associate professor at the University of Washington who focuses on fatigue in organizations, lack of sleep affects the part of the brain that’s used for managing emotions. “There are two regions of the brain which are especially important in emotion regulation – the amygdala and the prefrontal cortex. Sleep deprivation leads to decrements in the pre-frontal cortex, and also negatively influences the manner in which the prefrontal cortex and the amygdala work together,” Barnes says. Due to their fatigue, people struggle to regulate their emotions, and further negative feelings often come up, as a result, leading the cycle to continue. “Sleep deprivation can not only lead to the experience of more negative emotions, but also greater variability in mood, and more emotional reactivity,” Barnes clarifies. That’s why insomnia so often coexists with mood swings, grumpiness and erratic behaviour.” (Richard James Havis, Jan. 2018)


Although sleep deprivation can affect us physically, behaviourally and emotionally. it’s also important to look at how it may affect the population of people who are trying to manage certain psychological conditions such as but not limited to: Depression, Bipolar Disorder, Anxiety Disorders and ADHD.


Again, from the July 2009 issue of the Harvard Mental Health Letter, updated March 2019 (Harvard Health Publishing), stated is;

“Studies using different methods and populations estimate that 65% to 90% of adult patients with major depression, and about 90% of children with this disorder, experience some kind of sleep problem.

Studies in different populations report that 69% to 99% of patients experience insomnia or report less need for sleep during a manic episode of bipolar disorder. In bipolar depression, however, studies report that 23% to 78% of patients sleep excessively (hypersomnia), while others may experience insomnia or restless sleep.

Longitudinal studies suggest that insomnia and other sleep problems worsen before an episode of mania or bipolar depression, and lack of sleep can trigger mania. Sleep problems also adversely affect mood and contribute to relapse.


Sleep problems affect more than 50% of adult patients with generalized anxiety disorder, are common in those with post-traumatic stress disorder (PTSD), and may occur in panic disorder, obsessive-compulsive disorder, and phobias. They are also common in children and adolescents. One sleep laboratory study found that youngsters with an anxiety disorder took longer to fall asleep, and slept less deeply when compared with a control group of healthy children.


Insomnia may also be a risk factor for developing an anxiety disorder, but not as much as it is for major depression. In the longitudinal study of teenagers mentioned earlier, for example, sleep problems preceded anxiety disorders 27% of the time, while they preceded depression 69% of the time.

But insomnia can worsen the symptoms of anxiety disorders or prevent recovery. Sleep disruptions in PTSD, for example, may contribute to retention of negative emotional memories and prevent patients from benefiting from fear-extinguishing therapies.

Various sleep problems affect 25% to 50% of children with ADHD. Typical problems include difficulty falling asleep, shorter sleep duration, and restless slumber. The symptoms of ADHD and sleeping difficulties overlap so much it may be difficult to tease them apart. Sleep-disordered breathing affects up to 25% of children with ADHD, and restless legs syndrome or periodic limb movement disorder, which also disrupt sleep, combined affect up to 36%. And children with these sleeping disorders may become hyperactive, inattentive, and emotionally unstable — even when they do not meet the diagnostic criteria for ADHD.


In some respects, the treatment recommended for the most common sleep problem, insomnia, is the same for all patients, regardless of whether they also suffer from psychiatric disorders. The fundamentals are a combination of lifestyle changes, behavioural strategies, psychotherapy, and drugs if necessary.”


Although the reasons for a lack of quality sleep may vary for individuals, for the most part experts seem to agree that general lifestyle changes, such as eating well, regular exercise, managing stress, having a sleep schedule and the avoidance of electronic devices at night, can help to encourage or induce a better night’s sleep.


In conclusion, what is undeniably evident is that our ability to function mentally, emotionally and physically, in sustainable ways, is all significantly impacted by the amount of sleep our body receives.



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