Most people neglect the very thing we spend almost half our lives doing.

Last week we learned how George used his assumptions as targets to gain control of his life. However George hadn’t slain the dragon. He had put out the fires that this vicious beast laid upon the land. This menace which plagues us daily is Sleep.

George was a terrible sleeper. Thought for thought, his most productive time of the day had actually been from the moment he laid down until the moment he fell asleep. Those two moments were usually hours apart. “Going to bed” generally meant “staying awake” and thinking. A lot.

It was funny because without realizing it, George had actually developed a completely rock solid sleep routine. It was predictable, reproducible, and effective. The only downside is that it was a good routine for someone living somewhere between Japan and Hawaii.

His Circadian rhythm was all off. Sunrise and sunset had no bearing on his day. 10pm may as well have been 3pm. Naps were coveted like a drug addict in need of a fix. He felt he had actually beaten the monkey because “now I only need 5 hours and I’m good”. Except he never even got 5 hrs.

It’s funny how sleep-deprived people always think good sleep is only an hour more than their curent average.

Let’s talk about fixing sleep. As an insider tip, if there’s anything medical you ever wanted to know, find the practice guidelines for that specialty. They are all online and free. I promise it is infinitely more valuable than any biased website or message board for “People with the same problem I’m learning about.” I’ve shared my bias against bias before. As a mental health provider, I consistently see unintentional exposure to bias as a toxic factor. Go to the source first. Then engage the interpretations.

The American Academy of Sleep Medicine practice guidelines are clear- sleep or die. Okay they also see increased mortality with excessive sleep but that is likely confounded by the mortality of people over 60 years old. They optimize the recommendation at 7-8 hours a night for adults. For kids they recommend 9-12 hour for elementary school age and 8-10 hours for teenagers. Sorry “I only need 5 hours and I’m good” guy, science says you don’t realize what you’re missing nor what you’re doing to your body. “My body is trained to go on little sleep.” Yes, and an alcoholic’s body is trained to not be intoxicated after a fifth of vodka. For kids the cry will be “but homework and after-school activities!” If your child had cancer and needed chemotherapy every evening how would you manage it? Think how much we protect an infant’s sleep. Why does that change when school starts? The AASM is saying that a child not getting enough sleep is at risk of mortality, among many other risks. A child’s sleep should be the first priority in setting up their daily schedule.

The guidelines also outline how one should approach sleep management. Here I am only going to focus on Delayed Sleep-Wake Phase Disorder (DSWPD). It is effectively jet leg as though you traveled East. Most people who think they have insomnia have DSWPD. The difference is that DSWPD allows a person to fall asleep and sleep well if they are given the time. “If I could just go to bed at X and sleep until Y I would be PERFECT!” Insomnia is legit no sleep. DSWPD is a disorder of your Circadian Rhythm, your body’s natural sleep cycle which is mediated by hormones and the change in light and darkness.

Their recommendation is only to utilize melatonin to help re-regulate your sleep-wake cycle. Despite being a supplement, you still should consult with your physician first. It is interesting though that they do not recommend sleep-wake scheduling or timed physical exercise. This is not due to those interventions being shown ineffective but rather for a lack of research. Like “no new research”. Research costs money and behavioral interventions don’t yield a product that can make anyone money. That may explain why less research is done. A similar dynamic exists around psychotherapy.

So again, the best literature on behavioral interventions tends to be in personal and professional development. Back to Tim Ferriss and Tools of Titans!

Tim doesn’t have a dedicated sleep routine in the book. Instead it is a video here. I’m going to jump on that instead.

1. Decaffeinated Tea + Apple Cider Vinegar + Honey

Lots of people talking about the value of sour foods in athletics and wellness. Seems to promote recovery.  You don’t have to sell this German on the role of vinegar in food. Tim doesn’t write much about placebo-ing or blinding his life hacks. I wonder how it may contribute here. “A cup of warm milk” may have been the apple cider vinegar of yesteryear. Regardless, as we will see repeat over and over here, if you think it will help you sleep DO IT!

2. Hot Soaking Tub

Again not sure how specifically important hot water or immersion are. The hot water should dilate blood vessels, may increase heart rate to cool you down, and should relax muscle tension. That’s the physical part.

Mentally it’s a beautiful thing. You stop. You lay down. Water gives you a unique activation of touch that you don’t have any other time of your day. It’s usually quiet. And guess what- most people are not accessing input devices while taking a bath! It’s a vacation from the real world.

Tim talks about this kind of Minimum Effective Dose concept a lot. We have assumptions about what is meant by a certain value. For example, to Americans vacation means one week. A getaway is a weekend. “Day trip” consolidates something done in a 24 hr period. These are all assumptions. In Europe vacations are a month long. When values are variable based on environment it should key you in that the value is actually defined by perception. That means you can modify the definition if you want. You can find your Minimum Effective Dose and start considering that vacation. What if you found that you could take 52, one-day vacations a year? What if laying down in a bath for X minutes a night would completely achieve the Minimum Effective Dose that minimalist and tiny house people are changing their lives to achieve.  Unless you approach life as an experiment you’ll never know.

Yeah so take a warm bath. I also will point out the metaphor for a womb. Warm. Water. Confined space. Limited sensory input. There’s a reason we attach words like calm, soothing, relaxing to baths and water in general. Even if you don’t like womb references (thanks Freud for ruining that for us), can I sell you that it is another childhood memory you are accessing? As a baby you were bathed. We see over and over again that actions that create opportunity for parent-child bonding are associated with high emotional value. Feeding creates more face-to-face and skin-to-skin interaction than may happen at any other time. Bathing is similar. Advancing epi-gentics has shown that emotional moments in our lives can translate to changes in our genetic code. Those changes can be transmitted down the line to future generations. It makes sense then that re-engaging those behaviors might elicit a health promoting response.

3. Read Fiction

I love this. It goes back to role intentional, planned fun can play in your life. My guess is most people don’t sit down and read Ulysses or How to Make Friends and Influence People to their kids at night. Why not have some fun, use your imagination, and have something to look forward to at the end of the day. Remember we are buying the idea that regular use of imagination and wellness are essential components to wellness.

4. Hot and Cold Exposure

I will again save detail on thermoregulation for later. He doesn’t mention this in the book and the context of the video implies he does his hot cold cycles at night which would be surprising. Most Titans mention it as a morning routine. Hot I can buy. Maybe he’s saying that he cycles hot bath with hot sauna. If you’ve got a sauna good on ya! Let’s consolidate this to: get into some heat and slow down!

In Tools of Titans, Tim also discusses visual overwriting. He references Jane McGonigal’s recommendation to play 10 minutes of Tetris (hmm that childhood thing keeps popping up) or watching a fun TV show. I think this is a must for any evening. Have fun.

Josh Waitzkin and Reid Hoffman’s also talk about the use of the subconscious during sleep. They like to give their subconscious work to do while they sleep. This is such a great idea. Though I prefer Josh’s as he leaves a gap of many hours between the plant and the harvest. His last action of his work day includes pondering an idea he’d like his subconscious to work on solving. Then first thing in the morning, his creative time, he brainstorms on it. The idea being that the free association brainstorming is informed by the work his subconscious has done.

Don’t undersell the role of the subconscious and the ability to consciously manipulate it.

Other Sleep Ideas

Move Leisure to the Morning

I can’t emphasize how important I think this is. We have a natural habit of back-loading our day with fun. While that is a great idea in terms of wellness, it is extremely vulnerable to any increase in need for productivity. Very few people engage their Minimum Effective Dose for evening leisure. What if you had to top-up your willpower reserves in one hour? What would you do?

Even more interesting, if I moved the start time for everyone’s work back two hours without warning what would they do? Would people binge-watch Netflix? Would they order a pizza and chase it with a pint of Ben and Jerry’s? Likely not. For some reason those behaviors are not what people associate with a morning.

If given the time, people may be more likely to engage wellness promoting activities in the morning.

With that in mind, I would argue that the best way to structure a day is to go to bed as early as possible so that you can make your mornings a time of productivity or wellness. Why not address your body and mind’s needs at the height of your day’s effectiveness? You have no idea what you are missing.

Do not use sedative medication or drugs to fall asleep

As the AASP recommended above, it doesn’t work for DSWPD. Only melatonin and even then it’s weak evidence. While they do use medication for insomnia, that is a medical diagnosis and it should be made by someone who can very clearly tell you what the criteria are and the evidence-based practices to treat it. All sedating medications including cannabis can impair achieving restorative delta sleep. They also teach you to rely on an external mechanism to treat an internal problem. It negates the efforts of your Circadian rhythm. It’s not worth it particularly relative to the profound impact a solid sleep behavior plan can have.

Let’s circle back to George.

Headaches. A high-carb and high-sugar diet. Weight gain. High blood pressure. Irritability. Poor focus and memory. All these were the currency George had traded in return for a Lvl 70 rank on Call of Duty, a robust network of fellow political skeptics on Facebook and an intimate knowledge of the best value food options on Postmates. His health could easily be mortgaged to attempt to combat sleep.

Despite a lifestyle that mortgaged sleep at will, getting more sleep was one of his intial requests when we talked about goals. Even more puzzling was that saying “don’t do these things anymore didn’t help”. It was almost like he was addicted to poor sleep. 

After getting the morning routine under contol we set out to own the night. His natural sleep time was 2am. This was a vestige of the natural Circadian rhythm of all teens. He never unlearned the habits it created. Our first step was to clean up his sleep hygiene. No caffeine after 2pm. No food after dinner. No back-lit electronics 1 hr before bed.

The next step was to not try to go to bed before 2am. This was surprisingly (to him, not me) hard for him to achieve. He REALLY noticed fatigue around 1230am. While he wasn’t falling asleep on the couch- HE WANTED TO GO TO SLEEP! At 1am he started his routine.  He listened to his favorite music. He used Calm to meditate for 10 minutes. He read the Hobbit. Sleeping at 2 am was no problem.

After 2 weeks of sticking to his routine he started marching his sleep time back. Initially it was 30 minutes for the first week. We did it small like this to prove to him it was possible. After that we did an hour a week. There were a few times when this was too big a step so we backed off and hung out at that bedtime for a week or two more.

It was not a perfect experience. He had very tired days. Part of his expectation for himself was that he would not compromise his progress on his morning routine. So we had to supplement sleep. He would go to his car at lunch and catch a 15 minute nap. Same right when he got home from work. Short naps like that don’t achieve delta sleep and so they don’t affect your Circadian rhythm. (PS- this means your non-delta, NyQuil-induced night of sleep is effectively a long nap. Not to mention the lower average oxygenation your blood gets due to the effect of sedatives on your airway).

The turn for George came with a bit of history I had failed to discover previously. He had an absolute association of effective sleep. Most every Saturday he would fall asleep around noon watching DVDs of the Simpsons. It was like clockwork and he loved it “if I could just do that at night”. There were a number of factors contributing to this.

One was that he loved the Simpsons. His mind shut off. He was relaxed. What we learned was that this was unique to past episodes. If he watched new episodes he would be follow it more mentally active. The DVD was also key because he could set it to Play All. This is why watching TV didn’t work. If he could change the channel it kept him from totally shutting off. “Maybe something better is on?” He also had to turn the volume down so big changes in the action didn’t wake him up. He knew all this but didn’t realize he was generating a sleep hygiene plan.

We ported this over to his evening. We found he needed a smaller screen to minimize the light generated. A portable DVD player fixed that. The impact was almost immediate. He was falling asleep with 30 minutes of laying down. Often within 5. If he woke up later he would use his mindfulness techniques to do a body scan in 10 seconds and decide if he was too alert to go right back to sleep. If so he’d fire up the Simpsons. If not it was back to sleep. It seemed his overnight, highly-alert bouts were directly tied to the amount of stress in his life at that time.

I took about 8 months but George soon felt that sleep was under his control. He eventually started going to bed around 9pm and getting up at 5am. This bought him 2 hrs of free time to do what he wanted. He enjoyed the experience of using his free time for something he was proud of doing. Even his leisure time became something others might consider productivity time. His concept of leisure became self-care.

George had learned how to sleep on his terms. It was a small piece of a larger initiative to live on his terms as well.

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