How much should we sleep each night? Why do we always wake up between 3 and 5 when we suffer from insomnia? Is there one position better than the others? And how should we change our bedroom? How should we change our schedule if we are larks or owls? These and many other questions are answered by Loris Bonamassa, sleep coach and sleep manager.
Against the culture of not sleeping
We now schedule almost every single aspect of our days. Except sleep, which never makes it into our agendas. We probably do not even realize that we spend a third of our lives sleeping: of the next ten years, we will spend three in bed. And yet we almost never take an interest in what happens when we sleep, why we sleep and how we sleep. Nor in how much sleep influences all the rest of our time. A consequence, probably, of a culture that makes sleep almost a fault. It is no coincidence that the Italian proverb says “he who sleeps catches no fish”: there is almost a competition to sleep as little as possible. Wrongly so. This is the reminder from Loris Bonamassa, sleep coach and sleep manager, that is, an expert who has been working for years with medical specialists to spread the counterculture of “good sleep” to improve health and performance.
Loris Bonamassa, why should we care about sleep?
“The night should not be considered as the leftover of the day or as the only free time for social life or sport, after work and commitments, as I often hear repeated. Going to the gym at 10 pm, scrolling through news or posts on your phone in bed until midnight and beyond, falling asleep on the sofa or sleeping in the glow of artificial lights are all very common habits, but they have consequences on our body that we cannot even imagine. To understand this, we first need to know the physiology of sleep, and what affects its quantity and quality”.
Let’s start with quantity: how much should we sleep each night?
“The first thing to know is that sleep is made up of cycles of about 90 minutes, so we should always sleep for multiples of this time. In each cycle two phases alternate: the Non-REM phase (orthodox sleep) and the REM phase (paradoxical sleep), in which we dream. How long it is right to sleep is one of the most frequent questions and the answer, for adults, is at least 5 cycles, that is, 7 and a half hours each night. Above all, one should never go below 4 cycles, therefore below 6 hours. Unfortunately, it is increasingly common to sleep for less time, especially during the week from Monday to Friday, without knowing that our cognitive performance is strongly affected: we forget things, we travel a route and have no memory of it, and over time it is as if the brain wears out”.
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What changes in the short term?
“Several studies have been carried out. For example, two groups of people who slept 6 or 8 hours were compared, and substantial differences were observed in terms of reaction times and accuracy: in the second group they were better by 17% and 42%, respectively. Let’s imagine applying these data to a surgeon or to our own professions, whatever they may be…”
But do the 7 and a half hours always apply to everyone?
This amount of time is correct above all for adult men, while for women it reaches as much as 9 hours. Within individual variability we can in any case distinguish short sleepers, for whom 3 to 4 and a half hours per night are truly sufficient — and they are very few —, medium sleepers and long sleepers. To find out what kind of sleepers we are, that is, our hypnotype, we can do an experiment during a relaxed holiday period in which we remove every alarm clock and appointment. In this way we can get to know our circadian clock.
Why do we sometimes wake up in the middle of the night?
Each cycle is divided into several phases. When we fall asleep, after about 40 minutes we reach deep sleep, from which we then gradually re-emerge to reach intermediate sleep and light sleep, which is almost a micro-awakening. After the first cycles, REM sleep gradually increases and this second part is like a sub-wakefulness or a prolonged micro-awakening. From 3-4 am onward, in fact, body temperature and blood pressure begin to rise again, and the whole body prepares for waking. This explains why many people typically wake up between 3 and 5 at night in what is called middle or central insomnia: if there are stressful factors — which during the day, rationally, we are able to control — or physical conditions that disturb us — noises, lights, too high a temperature, an uncomfortable bed or other — we wake up completely and cannot get back to sleep, even for a long time. According to the Italian Academy of Sleep Medicine (AISM), about 10%-15% of the Italian population suffers from chronic insomnia, that is, between 6 and 9 million people, in particular women after menopause.
What does it mean to have quality sleep?
Undisturbed, unfragmented and continuous. We must imagine it as a train: with a precise departure time, which must pass through all the stations and travel for 7 and a half hours in a row. At each station something important for health happens: hormones are released, synapses are formed, memories are consolidated and what is not needed is ‘cleaned up’, and the immune system is put back in order. If you wake up, you start again from the beginning, so lost sleep cannot be recovered. There are several conditions that strongly affect sleep quality: from snoring to dangerous sleep apnea to bruxism and, in particular among women, restless legs syndrome. They are all signs of stress and disturbed sleep.
What is the role of substances such as alcohol? And can melatonin help?
Contrary to what people believe, alcohol does not make you sleep well: it leads to physical sleep, but disturbs brain sleep. Similarly, there are some substances, such as benzodiazepines, that inhibit REM sleep. As for melatonin: our body already produces it on its own thanks to darkness, so introducing it exogenously is not necessary, unless one has a disease or is subject to jet lag for work or works shifts. And in that case a medical consultation is needed, to establish whether it is really necessary, in what doses and how. It should be remembered that, in women, melatonin production decreases during menopause.
What role does artificial light play?
Unfortunately, artificial light, for example that emitted by television and smartphone screens, contributes to dysregulating the endogenous production of melatonin, which occurs mainly between 9 pm and 3 am. Light instead sends a wakefulness message to the brain, because it stimulates serotonin. If you go to bed at midnight, it is clear that you already lose about half of the melatonin you need for good sleep. It is important to remember that light is perceived by the brain even through closed eyelids.
But some people are more active late in the evening and others in the morning…
That’s true, people fall into two main chronotypes: ‘larks’ and ‘owls’. In the latter the circadian clock is shifted a little forward, while in the former it is shifted a little back: managing to align with one’s chronotype improves quality of life, but it is not always possible. It would be important to be able to manage our schedules following our body’s energy curves: so avoid going to the gym at 9 pm if we are larks, and scheduling meetings at 8 am if we are owls.
And is a nap after lunch good or bad?
What English speakers call a power nap, the energizing post-lunch nap of 10-20 minutes, should absolutely not be demonized; on the contrary: large companies have introduced it and set up sleep rooms. Its function is to reset adenosine, the substance that builds up in the body and brain, giving a sense of tiredness. Exposing yourself to sunlight in the morning and taking a walk at lunchtime and in the evening also helps realign with natural light and is decisive for regulating our circadian clock.
Let’s move on to practical tips for perfect sleep…
- First, know how we sleep in each phase of our life: so start from objective data, knowing that sleep is influenced by gender, weight, hormonal phase, and so on.
- Second, the equipment: mattress, pillow and bed base for sleeping well. Position, of course, matters: the correct ones are on your back — especially for women, to improve lymphatic drainage and circulation in the legs — or on your side, but being careful not to put too much pressure on the shoulder. The worst position is on your stomach. For those who suffer from bruxism or clench their teeth, it is also possible to intervene with customized pillows that reduce pressure on the jaw. Clothing is also important.
- Third, the bedroom must have features that promote sleep: electrosmog must be reduced to a minimum and the room temperature controlled, which should not exceed 18°C. And once in bed, no phone, which stimulates wakefulness. Instead, you can do diaphragmatic breathing exercises.
- Fourth, let a few hours pass after dinner before going to bed.
- Fifth, create a ritual: at the end of the day we must allow ourselves to slow down.
