Why we need to wake up to sleep: Award-winning sleep specialist explains the dangers of not getting enough sleep

We caught up with Mary A Carskadon to understand why ‘going to bed’ is not merely a bodily function but a human necessity, the lack of which can have ‘insidious’ consequences


Sushmita Bose

Published: Thu 2 Feb 2023, 9:38 PM

Most of us have been fed on a diet of lines such as “stay awake, life is too short to fall asleep”, and being conditioned to admire those who can get away with less shuteye because they are, apparently, making most of their time. Of late, however, sleep is increasingly being recognised as a “need”, not a “want”, and even less a “luxury”. Lack of quality sleep is being pinpointed as a trigger to health conditions as complex as cancer and dementia, and as commonplace as fatigue and irritability. What is also being talked about is the science of sleep: its biological deconstruction has a telling link to human health.

Mary A Carskadon is the director of the Chronobiology and Sleep Research Laboratory at EP Bradley Hospital, Rhode Island, and has been instrumental in effecting large-scale health policy changes in the United States — particularly in the area of promoting later school timing for adolescents so that their sleep time is not compromised. A PhD holder from Standford, Mary’s early research developed the standard clinical and research measure of sleepiness: the multiple sleep latency test (MSLT).

The day I meet her, Mary is sporting — what she calls — a “rockstar hairstyle”, purplish hues nattily in place over a head of close-cropped grey hair. She’s in the UAE to deliver a series of talks on the efficacy of a good night’s sleep, and why start-of-school timings should be delayed to provide kids with more sleep hours.

Mary’s endearing, almost-grandmotherly charm is replaced with wide-awake resolve the moment she starts speaking — and she’s not even drinking coffee (like I am). “Understand,” she says, “that sleep is more than you think it is. It’s more than just getting home at night, pulling your car into the garage and turning the engine off — and it just sits there, and then you get up in the morning and take it out again. That’s not what’s happening when you go to sleep… It is an active process — you don’t shut down [like your car does], tons of things happen while you’re sleeping.”

Why we should wake up and smell the coffee

A lot of people wish they didn’t have to sleep because they feel if they are sleeping, they are not getting anything done. The problem is they refuse to understand how much sleep can help the rest of your day be so much better, so much more efficient. “I sleep less” does not equal more time, because you use your time so much more poorly when you’re not alert. Many times, when people are anxious or moody, it’s just because of lack of sleep. More importantly, there are insidious consequences of too little sleep… one of the newest findings in the field is that a system in your brain called the glymphatic system — that is like a waste removal system in your brain — is turned on during sleep. If you are not getting your waste removal tonight, or for the next 20 years, there can be a significant amount of buildup, and there is some speculation that some cases of dementia may be a consequence of not having this waste removal system working night after night. There are also other factors: for example, your immune response is lowered if you don’t get enough sleep, and when we think of adolescents, that impacts the development of brain structures and linkages between brain structures… It gives rise to triggers that lead to risk-taking behaviours: driving too fast, substance usage and even self-harm.

When you’re asleep, your memories from the day are consolidated and improved. For students, this is particularly relevant, because it makes their learning better.

How many hours should we sleep?

Like everything else, we’re not built in the same way… different people have different requirements. But there’s a rule of thumb that I tell my students and even grownups: the way to take your temperature on how much sleep you need is go on that weeklong — or two-week-long — holiday, when you’re not having to get up to go to school, or go to work, and see how much you sleep then. Your first few nights, you may sleep much more but then you settle into a pattern that might tell you how much sleep you need. During adolescence, the optimal that’s been shown up in studies is 9 hours and 15 minutes — hard to convince a 15-year-old to sleep that much, eh? (Laughs). If that sounds not “doable”, they should follow a range of 7 and ½ to nine hours.

Caught napping in the middle of the day: what happens?

Part of what helps you fall asleep at night is your sleep pressure that builds every hour you’re awake… your sleep pressure builds and builds and builds. If you take a nap, then that lets some of the pressure off. And then it’s harder to fall asleep at bedtime because you’ve lost that pressure. On the other hand, if you’re chronically sleep deprived, a nap actually could help. But it’s far better not to get in that sleep deprived state.

What happens to all-night-long sector workers?

There are some who can adapt to a different sleep cycle fairly well, but there are many who don’t — and the longer they keep at it, the more likely they are to have heart disease, diabetes, and even cancer. There was a study that revealed nurses working the night shift had a much higher rate of cancer than nurses working the day shifts. It’s inevitable to have people who need to be covering for the rest of us during the nighttime hours, but today these 24-hour services have exploded… we just take it for granted that we need so much more… convenience has become a way of life. Yes, we need first responder services and hospital staff but those who do their scheduling need to be, one, knowledgeable, and two, thoughtful to ensure workers not suffer from lack of sleep’s insidious consequences later on.

How do we make sleep consciousness available to the average individual who believes sleeping is a luxury?

We need partnerships with industries, partnerships with entertainment… when I see Captain Kirk talking about continuous positive airway pressure (CPAP), that I think is the way to go for the message to reach the masses.

Some industries are doing a really good job… sure, for self-serving purposes… take this mattress company in the US… in their TV ads, they have roped in a superstar athlete, talking about how important sleep is, and how this mattress helps him sleep better. That’s how it’s getting into the popular domain.

I’d love to see sleep studies be part of the education system; it can start in the very first year of school in a fun way… Making sleep come across as being cool.


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