Dying To Sleep

By Dr. Adam Miller

The greatest peace I have ever felt came after three near-death experiences. In 2005, I was sucked into a drainage tunnel after a bridge crumbled in Honduras. On Christmas Eve 2011 I jack-knifed my Landcruiser around a pole in Borneo. The Chinese man who dragged me out of the auto carnage kept saying “you should be dead! you should be dead!” He was right. And most recently, I was bitten by a coral snake while taking a post-jog dip in the South China Sea. No one knows if the Government Hospital’s staff gave me a polyvalent anti-venom as a part of my treatment or not. But I survived. **

In all three instances, when I realized I had danced with death and lived to fight another day, I felt an intoxicating, transcendent blend of peace, and energy. My singular motivation - for about eight hours - was to call family, friends and colleagues and tell them that I loved them. Life was simple and beautiful again. After near-death came gratitude. After near-death came peace. After near-death came a righting of my priorities. Close to death I found more life. And that’s exactly what happens when we completely surrender to sleep.

Most of you, thank God, have not had to endure three life-threatening events. But, did you know that every night you surrender to sleep you are putting yourself in a cold, near-death state? Sleep is the closest most of you will come to death prior to your actual departure from this planet. And the payoff for really going there - seizing great sleep architecture in adequate volumes - is similar to what I experienced after my three accidents. We dip our toes into death’s eternal waters, and receive a fresh outlook, peace of mind and renewed strength for the road ahead.

In deep non-REM stage IV sleep, also called slow wave or delta sleep, we approach death. On EEG, our brain waves show very low frequency activity. Our heart rate and breathing rate both fall to what would otherwise be pathologically slow rates. And like a mini-hibernation our core body temperature drops roughly 2 degrees Fahrenheit. Yet, it’s there, at the chilly bottom of sleep’s ocean, that our pituitary gland releases the most potent rejuvenating chemical known to man - growth hormone. Deep sleep-which makes up 20% of our night at the age of 25 years, but only 3% by age 50 years -is physiologic gold (1). And we cannot afford, especially as we age, to sacrifice even one night of growth hormone therapy. Yet, that’s what I think is happening with increasing frequency amongst my patients.

There are two pillars to any sleep discussion - quantity and quality. It’s well documented that Americans aren’t getting enough sleep (2). What is being overlooked is the assessment and treatment of poor sleep quality. It’s rare - according to my intake forms - for patients to wake up feeling refreshed, even when they’ve been in the rack for 7-8 hours. And on the overnight qualitative sleep testing I do I’m seeing more tossing and turning than ever before. I believe that poor sleep quality is rampant, and is a contributing factor to many modern illnesses - including chronic fatigue and the increasing rate of autoimmune and autoinflammatory diseases.

Light at night; eating late; an irregular sleep schedule; evening alcohol and prescription drugs are all common causes of poor sleep quality (4). But, I think the mind is where the main problem lies. I’m here to prove to your inner skeptic - the one who says that letting go of the day and surrendering to sleep is unproductive - that he’s dead wrong.

The sleep quality problem is primarily due to what I call “clinging to the trophy.” At Wimbledon the Champion doesn’t get to take the trophy home with him (3). He holds it; feels the valence of the article in his sweaty hands; and basks in his reflection on its gleaming gold surface. He gets to be identified in photos with the prize, but is then required to release his grip from the trophy and surrender it back to the greater game’s hands - The All-England Club. This is how we should handle our days. Instead we try to take the results of our day to bed with us. And it’s clear that trophies - whether for MVP or Least Improved - don’t make good bed partners.

The completion of the day is our “game over” moment. It should be a definitive period at the end of a sentence - what the Brit’s call a full-stop. Rather than put a full- stop at the end of our days, however, most of us choose an ellipsis (…). We can’t quite close the door completely on the day and unfinished mental business barges into our bedroom looking for our attention.

How many of you wake up and immediately start worrying about the same things you went to bed fretting over? Ellipsis…. The mental ellipsis at the end of our day comes from being irresponsible with the clock. Oh, we think we are responsible managers of the game clock, but often lack the discipline to walk off of life’s court when the game should be ending. Instead we keep trying to add time to the clock.

We need to re-establish an expiration time to the game we call our work day. We need to live like Champions, hoist our reward for giving our best in a day and then hand the Day’s Trophy off to the world, to God. Here are some thoughts on how to be better at the full-stop.

It’s like a radar constantly surveying your inner and outer world for signals - especially the threatening kind. And the nervous system is tightly coupled to your immune system, which one can think of as your inner Army, Navy, and Air Force. Anything that you think or do that is perceived by your brain as a threat or problem keeps your inner defense systems spinning in a state of readiness - with finger on the problem-solving trigger.

This protective nervous system and immune activity happens largely without your awareness - until you become still. If you allow too many spinning mental wheels at night, a nervous system coup can easily occur.(4) You turn out the light and try to go to sleep, but your body says, “We go to the bathroom. We go to the grocery store. But, we don’t go to sleep. You have to convince me it’s safe to go unconscious and surrender to sleep.” Sleep is not voluntary. Ouch, that hit like a thunderbolt.

Sleep is a negotiation and your nervous system always has the upper hand at this table. Better to balance the checkbook, and return a demanding friend’s phone call or check email in the morning - not at night.

I use a “2 at 2” ritual with my patients. The goal is to resonate with the adrenal glands’ natural downturn in cortisol (stress hormone) production between 2 and 4 pm each day. We take 2 minutes near 2pm each day for deep belly-breathing. Make sure you turn off your computer and your phone and lock your door before doing your “2 at 2.” Rubin Naiman, author of Healing Night, has told me on several occasions, “you fix sleep during the day, not at night.” As a sleep Psychologist, Dr. Naiman knows that small break-pumps during the day go a long way toward convincing the nervous system at night that it’s okay to shut off and surrender to sleep.

Remember, your nervous system is looking for cues from your environment. Make your bedroom a sacred place for sleep and sex only. Invest in this space and keep improving it. If it isn’t welcoming because of clutter, warm temperatures or light debris, then fix it - STAT. Likewise, make sure home is your haven of rest, safety and security - not a second office. Keep your office maximally efficient for work, and remember that’s your field of play for the day’s competition. Once you leave it, the game is over. Stop taking work home. Here’s another way to help with this.

Establish transition spaces. Every Wednesday I stop at a coffee shop on my way home to tidy up loose ends in my medical practice. The coffee shop is a setting that allows me to be productive while reminding me that there’s more to life than my practice. It’s a transition from work mind to home mind. The key is that I’ve stopped taking work home with me from either my office or my transition spaces. Work doesn't’ come home - full stop.

Have transition spaces for active unwinding also. Drop off the dress shoes to get repaired and have a light conversation with the cobbler. Swing by the grocery store and pick up a few things and ask the checkout guy a silly question. Take care of your dry cleaning, or swing into IKEA to get some design ideas. Show your nervous system radar something other than work for 30 minutes, then point your ship home.

Get out all the nervous energy from your busy day out before you set foot in your home. Exercise is the best way to do this. I didn’t say workout. I’m endorsing movement. You know, the whole motion-emotion thing - it’s real. I walk the stairs in my work building or a transition space while listening to a podcast for 30 minutes before I go home. Stuck in a business suit? No excuse. Shed the jacket, tie and dress shirt. Slacks and a t-shirt work just fine even with dress shoes on. Just move for 30 minutes. Then do a quick journal entry.

Dictate or journal a summary of “wouldas, couldas, and shouldas” for the day. I start my daily journal with Three Things I Learned Today either by typing or dictating into the Notes program on my iPhone. This works best when I do it before I leave the office, and I encourage my staff to do this with me. What happens when you end-up with a pile of steamy work dung by the end of your journal entry? Keep reading.

Build in Worry Blocks. I scan ahead to the next two days and block off 30 minute problem-solving blocks on my calendar. Anything I’m worried about I deal with in those designated, but condensed periods of time. My nervous system then knows that I haven’t forgotten about the “kamikaze boss bogey” that popped up on radar earlier in the day.

Make the early morning something you don’t want to miss. The morning has sacred qualities to it. We and the world are both quiet - something that doesn’t happen in the night anymore. It’s a stick and carrot game here. If your early morning wake up carrot is sweet enough it makes the game-clock stick easier to enforce at night. So, embellish that cup of coffee with a walk along the beach before work.

Read. Feed your brain for 30 minutes a day with content you think is cool. When we pay the brain first, through reading, all nervous system negotiations go better. Why? Because the signals get balanced. Maybe you think that you fell way short of the mark at work on a given day. That’s a message of desperation to the brain. If you pick up a book that night and feed your brain information that it likes (and can never be taken from you by any external circumstances) life’s loci of control comes back inside of you. Knowledge is a balancing message of empowerment for the brain (5).

We talked about the “2 at 2” ritual during the working hours. Add to that the habit of high-fiving dusk. Take a few minutes to acknowledge when the earth is shifting to a lower energy state and admit that you should do the same. Most people are so busy they don’t consciously acknowledge dusk. That’s a problem because your nervous system is paying attention to these circadian rhythm cues even when you aren’t. Next, set your game clock. Somewhere between 4pm and 8pm seems like the most appropriate point to (really) call it a day. Be disciplined about your game clock. It’s up to you to shut it down on a regular schedule if you want the deepest, most reparative night of sleep.

Your first yawn of the evening is like a test call from the nervous system - “hey boss, it’s getting late, should I send the boys home for the evening or not?” How you respond after your first big yawn plays a major role in the quality of your sleep. That includes your eating patterns. If you want your nervous system to believe that you’re coming off the battlefield for the night and you want to avoid your second wind - stop feeding the troops at least three hours before bed.

Deal with loneliness before it sets in. Nothing says to the brain “stay on guard” more than the belief that “we are all alone - there is no back up.” Get social events on your calendar and keep them as a priority.

Pray. Hey, every soldier - as the saying goes - prays in a foxhole. If the night feels like a cold, dark, threatening proposition to you,

then bend a knee and say a prayer. Why not?

Better sleep requires a violent counter-cultural disruption of routine. Every evening at 9pm in Vancouver (CA) a cannon is fired to alert the fishermen that the sun has set and it’s time to pull in the lines. The 9 O’ Clock Cannon - as it’s called - is also used by sailors to calibrate their nautical equipment. The first time I heard the canon I crashed my bike in fright. Ignorant of the canon’s purpose, I assumed it was a terrorist’s bomb detonating.

As I rolled over onto my back and opened my eyes - expecting to see 911-like billowing smoke - I instead saw a compassionate Asian man hovering over me. “It’s okay! It’s okay!” He shouted - “it’s not a bomb. It’s the Stanley Park Cannon. You can get up!” After a large exhale I chose to lay on my back and soak in the dusk sky, counting my blessings for a good day and a safe, good night.

Going to bed isn’t enough. We need to take our nervous system completely off-line and die to the day in order to get the most out of our night. May this article serve as canon-fire that levels you into many nights of blissful, surrendered sleep. Don’t jump to your feet and pedal off. Take a minute to lay with this and come back into agreement with nature’s law: rest is not idleness, rest is re-loading. The more you die to yourself, and your day, the greater your “carpe diem” deposit is for tomorrow.

Special Sleep Forces

Here are tools I use to help make dying to sleep a little easier for patients.

I can’t relax and I historically reach for wine as my treatment.

Solution: GABA - the other happy hour. You can take gaba in the form of a pill or powder just before you leave the office or as soon as you get home to help quench the same receptors (GABA) that alcohol works on. The advantage of GABA over alcohol is preservation of high-quality sleep.

I get a second wind at night.

Solution: Mind the FIRST YAWN. Eat early and dial down stimulation. Consider Mood Food ES (Xymogen) after work or right after dinner.

I can’t stop the spinning wheels before bed.

Solution: Journal dump. Try Kava elixir and Hemp tincture in combination after dinner. Try a GABA mocktail (we use Xymogen’s Relax Max). Do 10 minutes of stretching. Go for a 30-60 min. after dinner walk. I also like the lavender supplement Lavela WS in the evening.

I struggle to fall asleep. It’s like I’m wired, but tired.

Solution: Try 1 mg of melatonin, 15mg of Hemp Oil, 400mg of elemental Magnesium and take a 20 minute warm epsom salt bath (1 cup epsom salts and 1/4 cup baking soda). Tranquilent is another product that patient’s- especially women - love for initiating sleep.

Looking for additional guidance on how to get bitten by, slammed into or swallowed up by a better night’s sleep?

Email : info@arisemd.com or call 414 386 2600.

References:

(1) Craig Heller, Secrets of Sleep Science : From Dreams to Disorders, The Great Courses, 2013, page 60-78

(2) 1 in 3 Adults don’t get enough sleep. https://www.cdc.gov/media/releases/2016/p0215-enough-sleep.html

(3) https://en.wikipedia.org/wiki/Venus_Rosewater_Dish

(4) External Factors that Influence Sleep

http://healthysleep.med.harvard.edu/healthy/science/how/external-factors

(5) Dr.Caroline Leaf, Switch On Your Brain, page 71-77, Baker Books 2013