For over 30% of our lives, we are sound asleep. While we all need sleep, actually crave sleep, it is an enormously complicated and dynamic process and yet its biological purpose is not well-understood. Clearly there are restorative powers associated with a “good night” of sleep including the removal of metabolic wastes and the increase of brain’s supply of adenosine triphosphate (ATP). It is not just the brain that needs quality and recurring sleep but virtually all of the organs do to reduce risks from high blood pressure, cardiovascular disease, diabetes, depression, and obesity.
According to the National Institute of Neurological Disorder and Stroke, there are broadly two types of sleep (rapid eye movement (REM) and non-REM) which cycle between 4 – 6 times each evening, lasting around 90 minutes for each cycle. Non-REM sleep has three different stages which culminate with REM sleep, which is characterized by elevated brain activity, heart rate and breathing. It is also when one most often dreams. During REM sleep, one is effectively paralyzed which is believed to shield us from actually acting upon our dreams and hurting ourselves. The combination of the pandemic, the elections, and the economic crisis often leave many of us literally short of breath, further disrupting sleep. Interestingly, over the course of a typical day humans take approximately 25k breaths.
Obviously, sleep can be disrupted by a number of environmental and physiological stressors. Notably the Covid-19 pandemic has created a “sleep crisis” for many. Express Scripts reported that in the first month of the pandemic sleep medication prescriptions spiked by 14.8%. Obviously, the presidential election was an enormous contributor to many restless nights over the last few weeks. Oura, which sells the Oura Ring to track personal health data, reported that election night caused the loss of nearly 139 million hours of sleep across the country while increasing our collective heart rates by 1.4 beats/minute that night.
A recent Harris poll for the American Psychological Association (APA) reported that 68% of respondents said the 2020 election was a “significant source of stress.” Quite forebodingly, the APA also reported that the “grief cycle” tends to last at least six months, after which time, individuals start to exhibit more normal sleep patterns. This does not augur well for the nearly 74 million voters struggling with the election’s outcome. As we have now entered into this terribly confusing, disorienting lame duck period between the inauguration and an unlikely Trump concession, clinicians are reporting precipitous declines in worker productivity due to extended poor sleep.
In addition to impairing sleep, stressors also triggers more intense, more vivid dreams. In an effort to better understand the role of dreams, researchers at Cambridge University have created a DreamBank of 38k dreams that have been annotated and digitally curated. While this research is nascent, the goal is to develop better behavioral health diagnostic tools through “dream catcher” technologies. Early results suggest that men tend to have more aggressive, negative dreams. No surprise there. Disturbingly, one of the most common dreams is being attacked by bugs.
In addition to numerous academic studies, there are a handful of commercial initiatives to better understand – and treat – dream disorders. Nightware recently received De Novo FDA clearance for its Apple Watch and iPhone app to diagnose and treat nightmare disorders linked to post-traumatic stress disorders. The promise of such technologies is to address behavioral health conditions that might lead to suicide or other devastating outcomes.
There are several hundred apps, devices, and therapeutics to address issues confronted during the 70% of the time when we are awake, yet there are relatively few (credible) products focused on when we are asleep. Quite clearly the landscape is fundamentally changing in the face of the pandemic. Regulatory frameworks, reimbursement levels and consumer proclivity to use these types of products have meaningfully improved their commercial prospects. Juniper Research suggests that there will be 1.4 billion users of digital therapeutics and wellness apps alone by 2025.
For example, Pear Therapeutics recently released its Somryst prescription digital therapeutic for chronic insomnia. Using cognitive behavioral therapy for insomnia (CBTi) to retrain the brain to better embrace sleep, this product has demonstrated a 45% reduction in symptoms of chronic insomnia. Big Health, another exciting digital therapeutic company (which recently raised a large round of financing), has released its Sleepio product, armed with numerous clinical studies claiming to improve sleep by 76%.
In addition to this class of products, there are a number of traditional medical devices now in the market from mundane sleep monitoring wearables to sleep robots – true story. Somnox is now selling what is claimed to be the first “spoonable” sleep robot that helps regulate breathing and heart rate. Sounds intriguing. Perhaps a more appropriate device might be the headband from Ebb which distributes cooling fluids around one’s frontal cortex to reduce forehead temperature, presumably lowering brain activity. For a mere $500, one could purchase the UrgoNight headgear system which is to be worn just three times a week for 20 minutes at a time during the day to retrain the brain to increase the production of sleep-promoting brain waves. Wow, that sounds slick.
Of course, one could turn to more “traditional” sleep aids like psychedelics which are experiencing a (legal) renaissance as numerous states are now decriminalizing treatments like psilocybin (magic mushrooms) or 3,4-Methylenedioxymethamphetamine (MDMA, the active ingredient in Ecstasy or “molly”). Since this spring, have been three IPOs of biotech companies repurposing psychoactive compounds to treat sleep disorders and depression for what is estimated to be several million Americans with “treatment resistant” conditions.
One very real step to improve sleep conditions for all of us being put forth by the American Academy of Sleep Medicine (AASM) is to get rid of Daylight Saving Time. The AASM argues that simply better aligning biological clocks to “social clocks” (people should wake up with the sun and prepare for sleep when the sun sets) will meaningfully improve everyone’s sleep. Hard to argue with that.
Not to be overlooked is the 2018 study by Mattress Advisor which determined that 58% of respondents slept naked. It is not at all clear if they slept better than those properly attired.
Enjoy your food-induced sleep coma this week…