Dr. Conrad Iber often thinks about a patient whose mental health suddenly plummeted. Soon after graduating from college and starting his first job, the young man began suffering from panic attacks. "It didn't make any sense," recalls Iber, a pulmonologist and sleep expert with M Health Fairview. He puzzled over the drastic change and began prodding for answers. "What's your natural sleep schedule?" he asked the young man. If no alarm clock was involved, Iber's patient would fall asleep about 2 a.m. and wake around 10 a.m. He was able to hew to this schedule as a student, but now needed to get up at 5 a.m. to arrive at work on time. "Suddenly, he's been put in a position where his brain is foggy, he can't perform," Iber says. "Then he gets an anxiety disorder around this." The young man suffered panic attacks so severe that he was hospitalized and put on three medications. But Iber suspected there was a better treatment: More sleep. His patient, it turns out, didn't have a psychiatric disorder. He's simply a night owl, one suddenly thrust into an early bird world.
Iber and fellow Twin Cities sleep experts, like the University of Minnesota's Dr. Michael Howell, are trailblazers in the growing field of sleep medicine. They're using an explosion of new research into sleep to better understand what's really ailing people who complain of a host of symptoms, from depression to weight gain.
The research is also changing the role of doctors who study sleep. More and more, they find themselves advocating for an understanding of "circadian diversity," the variance in the natural sleeping patterns that are hard-wired into our DNA and develop as we age. People who tend to sleep in instead of bounding out of bed at the crack of dawn aren't lazy, sleep doctors argue — they just have a circadian clock that's naturally set later.
This goes back to our days as hunter-gatherers, explains Howell, a sleep medicine doctor and associate neurology professor.
"Think about us as a tribe. If there were 40 or 50 of us, it would be really good for some of us to be early birds and some of us to be night owls, and some of us would be something in between, right?" he says. "OK, you're going to bed, that's fine. I'm going to be up here hanging by the fire, making sure nobody attacks us or eats us."
If we can reach a widely accepted, new understanding of circadian diversity and the importance of sleep, these doctors believe, the social impact will be wide and significant, factoring into the likes of car accident rates, school test scores and teen suicide.
"If you'd asked me 15 years ago — if you'd asked any sleep scientist or sleep medicine clinician — what sleep does, we had some generalities, but we didn't really understand," Iber says. "This whole field has just exploded." Because it has, life is improving for people like his young patient.
Sleep science
Here's what we now know: During our waking hours, our brains are constantly being remodeled, as neurons and synapses make new connections based on what we see or experience. When we sleep, we're able to prune away what isn't useful and hold onto what is.
"We remove what's not important and we reinforce and integrate what is important into the rest of our brain," Iber says. "And things like insufficient sleep or disrupted sleep actually impairs that process."
Our brain's nightly housekeeping also involves removing toxins. Without a sufficient amount of uninterrupted sleep, neurotoxins like beta-amyloid, which is linked to Alzheimer's, begin to build up in the brain.
Finally, it is during sleep that the part of the brain responsible for governing our emotions, the amygdala, connects with the rest of our brain. Without adequate slumber, irritability and mood disturbance measurably rise, Iber explains.
With new knowledge about circadian diversity, sleep doctors' work now can involve convincing supervisors or school officials that a change in schedule may help them have better workers and manage students more easily.
"We talk about how important it is to respect diversity, right? With diversity comes all sorts of new ways of looking at things, all sorts of different backgrounds, lots of new insights. But what aspect of diversity is almost never respected? Circadian diversity. I'm serious," says Howell. "Your circadian rhythm is kind of like your height, your eye color. It's kind of like who you are."
Because circadian issues can be most pronounced during the teenage years, both Howell and Iber have advocated for later high school start times. An international group for night owls, called B-Society, fights for "chronotype equality," while a growing number of jobs, especially in fields like tech, are no longer tied to an 8 a.m. start time.
Not every workplace is flexible, and shift workers or those who rotate between differently timed shifts have their own unique sleep woes. Still, Iber says he has successfully advocated for multiple patients to set a work schedule that better fits their natural sleep cycle.
"We are at a point where I think the public is going to be able to accept this," he says.
Doctors can also help night owls nudge their clocks, using a combination of a low dose of melatonin in the evening and bright light (often using a 10,000 lux light box) in the morning to help them better match the majority schedule.
Napping for success
As more of us recognize sleep's importance, folks who don't necessarily have a problem or disorder are now working to sleep better in order to live more healthfully or even be more competitive.
As a starting punter for the Gophers, Jacob Herbers takes pointers from his head coach, assistant coaches, special teams coordinator — and Howell, his sleep coach. The doctor has him taking all the right steps to sleep better, with regular bedtimes, a plan to visualize connecting with the ball right before drifting off at night and getting bright light in the morning.
Herbers, a mechanical engineering major who joined the team as a walk-on and was awarded a football scholarship in May, has a demanding schedule outside of schoolwork, with weightlifting at 6 a.m., late games and travel for the team. Sleep can be tough to fit in.
He often relies on power naps. Because our sleep cycles follow a 90-minute cycle of light sleep to deep sleep to REM sleep, Herbers is careful to curb naps to less than a half-hour if he doesn't have time for a full hour and a half snooze. That way, he avoids interrupting deep sleep and wakes with more energy in time for evening practice. Focusing on sleep may seem counterintuitive in an aggressive sport like football, but Herbers says it fits with one of coach P.J. Fleck's themes for this season: Restore.
"We go really, really hard in practice," Herbers says, so he and his teammates also need to go hard at recovery. "Nutrition falls into that category, our strength and conditioning falls into that category," he says. "Often the overlooked thing with student athletes is sleep."
While most of us aren't pushing ourselves quite as much as a starting Gopher football player, fall's shorter days and back-to-school responsibilities can easily create many sleep-deprived Minnesotans. It doesn't help that the seasonal change, ushering in the darker months of the year, also makes us actually crave more sleep.
"Human beings do have a slight tendency toward hibernation," says Howell.
Generally, we're only able to tack on a few more minutes at night as fall turns to winter. Still, as these sleep doctors teach, any added time snoozing is often time well spent, for both brain and body.
