Chapter 1: To Sleep. CHAPTER 1 To Sleep. Do you think you got enough sleep this past week? Can you recall the last time you woke up without an alarm clock feeling refreshed, not needing caffeine? If the answer to either of these questions is "no," you are not alone. More than a third of adults in many developed nations fail to obtain the recommended seven to nine hours of nightly sleep.I I doubt you are surprised by this fact, but you may be surprised by the consequences. Routinely sleeping less than six hours a night weakens your immune system, substantially increasing your risk of certain forms of cancer. Insufficient sleep appears to be a key lifestyle factor linked to your risk of developing Alzheimer''s disease. Inadequate sleep--even moderate reductions for just one week--disrupts blood sugar levels so profoundly that you would be classified as pre-diabetic.

Short sleeping increases the likelihood of your coronary arteries becoming blocked and brittle, setting you on a path toward cardiovascular disease, stroke, and congestive heart failure. Fitting Charlotte Brontë''s prophetic wisdom that "a ruffled mind makes a restless pillow," sleep disruption further contributes to all major psychiatric conditions, including depression, anxiety, and suicidality. Perhaps you have also noticed a desire to eat more when you''re tired? This is no coincidence. Too little sleep swells concentrations of a hormone that makes you feel hungry while suppressing a companion hormone that otherwise signals food satisfaction. Despite being full, you still want to eat more. It''s a proven recipe for weight gain in sleep-deficient adults and children alike. Worse, should you attempt to diet but don''t get enough sleep while doing so, it is futile, since most of the weight you lose will come from lean body mass, not fat. Add the above health consequences up, and a proven link becomes easier to accept: relative to the recommended seven to nine hours, the shorter your sleep, the shorter your life span.

The old maxim "I''ll sleep when I''m dead" is therefore unfortunate. Adopt this mind-set, and it is possible that you will be dead sooner and the quality of that (shorter) life will be worse. The elastic band of sleep deprivation can stretch only so far before it snaps. Sadly, human beings are in fact the only species that will deliberately deprive themselves of sleep without legitimate gain. Numerous components of wellness, and countless seams of societal fabric, are being eroded by our costly state of sleep neglect: human and financial alike. So much so that the Centers for Disease Control declared insufficient sleep as a public health epidemic. It may not be a coincidence that countries where sleep time has declined most dramatically over the past century, such as the US, the UK, Japan, and South Korea, and several in western Europe, are also those suffering the greatest increase in rates of the aforementioned physical diseases and mental disorders. Scientists such as myself have even started lobbying doctors to start "prescribing" sleep.

As medical advice goes, it''s perhaps the most painless and enjoyable to follow. Do not, however, mistake this as a plea to doctors to start prescribing more sleeping pills --quite the opposite, in fact, considering the evidence surrounding the deleterious health consequences of these drugs. But can we go so far as to say that a lack of sleep can kill you outright? Quite posssibly--on at least two counts. First, there is a very rare genetic disorder that starts with a progressive insomnia, emerging in midlife. Several months into the disease course, the patient stops sleeping altogether. By this stage, they have started to lose many basic brain and body functions. Few drugs that we currently have will help the patient sleep. After twelve to eighteen months of no sleep, the patient will die.

Second is the deadly circumstance of getting behind the wheel of a motor vehicle without having had sufficient sleep. Drowsy driving is the cause of hundreds of thousands of traffic accidents and fatalities each year. And here, it is not only the life of the sleep-deprived individuals that is at risk, but the lives of those around them. Tragically, one person dies in a traffic accident every hour in the United States due to a fatigue-related error. Society''s apathy toward sleep has, in part, been caused by the historic failure of science to explain why we need it. Sleep remained one of the last great biological mysteries. All of the mighty problem-solving methods in science--genetics, molecular biology, and high-powered digital technology--have been unable to unlock the stubborn vault of sleep. Minds of the most stringent kind, including Nobel Prize-winner Francis Crick, who deduced the twisted-ladder structure of DNA, famed Roman educator and rhetorician Quintilian, and even Sigmund Freud had all tried their hand at deciphering sleep''s enigmatic code, all in vain.

To better frame this state of prior scientific ignorance, imagine the birth of your first child. At the hospital, the doctor enters the room and says, "Congratulations, it''s a healthy baby boy. We''ve completed all of the preliminary tests and everything looks good." She smiles reassuringly and starts walking toward the door. However, before exiting the room she turns around and says, "There is just one thing. From this moment forth, and for the rest of your child''s entire life, he will repeatedly and routinely lapse into a state of apparent coma. It might even resemble death at times. And while his body lies still his mind will often be filled with stunning, bizarre hallucinations.

This state will consume one-third of his life and I have absolutely no idea why he''ll do it, or what it is for. Good luck!" Astonishing, but until very recently, this was reality: doctors and scientists could not give you a consistent or complete answer as to why we sleep. Consider that we have known the functions of the three other basic drives in life--to eat, to drink, and to reproduce--for many tens if not hundreds of years now. Yet the fourth main biological drive, common across the animal kingdom--the drive to sleep--has continued to elude science for millennia. Addressing the question of why we sleep from an evolutionary perspective only compounds the mystery. No matter what vantage point you take, sleep would appear to be the most foolish of biological phenomena. When you are asleep, you cannot gather food. You cannot socialize.

You cannot find a mate and reproduce. You cannot nurture or protect your offspring. Worse still, sleep leaves you vulnerable to predation. Sleep is surely one of the most puzzling of all human behaviors. On any one of these grounds--never mind all of them in combination--there ought to have been a strong evolutionary pressure to prevent the emergence of sleep or anything remotely like it. As one sleep scientist has said, "If sleep does not serve an absolutely vital function, then it is the biggest mistake the evolutionary process has ever made."II Yet sleep has persisted. Heroically so.

Indeed, every animal species carefully studied to date sleeps.III This suggests that sleep evolved with--or very soon after--life itself on our planet. Moreover, the subsequent perseverance of sleep throughout evolution means there must be tremendous benefits that far outweigh all of the obvious hazards and detriments. Ultimately, asking "Why do we sleep?" was the wrong question. It implied there was a single function, one holy grail of a reason that we slept, and we went in search of it. Theories ranged from the logical (a time for conserving energy), to the peculiar (an opportunity for eyeball oxygenation), to the psychoanalytic (a non-conscious state in which we fulfill repressed wishes). This book will reveal a very different truth: sleep is infinitely more complex, profoundly more interesting, and strikingly health-relevant. We sleep for a rich litany of function s , plural--an abundant constellation of nighttime benefits that service both our brains and our bodies.

There does not seem to be one major organ within the body, or process within the brain, that isn''t optimally enhanced by sleep (and detrimentally impaired when we don''t get enough). That we receive such a bounty of health benefits each night should not be surprising. After all, we are awake for two-thirds of our lives, and we don''t just achieve one useful thing during that stretch of time. We accomplish myriad undertakings that promote our own well-being and survival. Why, then, would we expect sleep--and the twenty-five to thirty years, on average, it takes from our lives--to offer one function only? Through an explosion of discoveries over the past twenty years, we have come to realize that evolution did not make a spectacular blunder in conceiving of sleep. Sleep dispenses a multitude of health-ensuring benefits, yours to pick up in repeat prescription every twenty-four hours, should you choose. Within the brain, sleep enriches a diversity of functions, including our ability to learn, memorize, and make logical decisions and choices. Benevolently servicing our psychological health, sleep recalibrates our emotional brain circuits, allowing us to navigate next-day social and psychological challenges with cool-headed composure.

We are even beginning to understand the most impervious and controversial of all conscious experiences: the dream. Dreaming provides a unique suite of benefits to all species fortunate enough to experience it, humans included.