Why Can't Americans Sleep

Link of the week

Instead of posting links to a separate Substack, I’ll occasionally post some interesting links here. Today’s link is from the Atlantic, here’s some quotes:

Whenever I interviewed a clinician, psychiatrist, neuroscientist, or any other kind of expert for this story, I almost always opened with the same question: What dogma about sleep do you think most deserves to be questioned?

The most frequent answer, by a long chalk, is that we need eight hours of it. A fair number of studies, it turns out, show that mortality rates are lowest if a person gets roughly seven hours. Daniel F. Kripke, a psychiatrist at UC San Diego, published the most famous of these analyses in 2002, parsing a sample of 1.1 million individuals and concluding that those who reported more than eight hours of sleep a night experienced significantly increased mortality rates. According to Kripke’s work, the optimal sleep range was a mere 6.5 to 7.4 hours.

Also, if a person finds that they feel OK after sleeping 6.5 hours, they don’t need to worry, regardless of what the averages are.

Another declaration I was delighted to hear: The tips one commonly reads to get better sleep are as insipid as they sound. “Making sure that your bedroom is cool and comfortable, your bed is soft, you have a new mattress and a nice pillow—it’s unusual that those things are really the culprit,” Eric Nofzinger, the former director of the sleep neuroimaging program at the University of Pittsburgh’s medical school, told me. “Most people self-regulate anyway. If they’re cold, they put on an extra blanket. If they’re too warm, they throw off the blanket.”

Some things are minor but some practices may be worse, such as watching movies late at night.

“For the medically anxious, it’s tough,” he agreed. “We’re trying to tell patients two things at the same time: ‘You really need to get your sleep on track, or you will have a heart attack five years earlier than you otherwise would.’ But also: ‘Stop worrying about your sleep so much, because it’s contributing to your not being able to sleep.’ And they’re both true!”

From a Stoic perspective, there’s no contradiction. You focus on being “virtuous”, such as following good sleep practices, but don’t care about “externals” such as how one actually sleeps. Later, the article mentions CBT and ACT therapies that touch on similar concepts, e.g. “It’s really less about the pain itself and more about the suffering around the pain, and that’s what we can fix.”

In practice, I find it’s difficult to handle strong sleep deprivation, such as when I only sleep 4 hours. However I often have more mild insomnia such as only sleeping 5 hours, and with some exercise and coffee I can feel alert enough for much of the day.

But after she completes a battery of tests, the results come back normal, pointing to “what I already know,” she writes, “which is that my sleeplessness is psychological.

Not sure it needs to be a binary. There could be smaller physiological causes that don’t show up in common tests but still contribute to insomnia.