The Interview: Sleep Expert Charles Czeisler

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charles czeisler sleep doctor

Photograph by Toan Trinh

To say that Charles Czeisler is worried about what’s going on in your bedroom is an understatement. The Brigham and Women’s Hospital physician, who’s spent a lifetime studying how we snooze, knows that neglecting shuteye is easier than ever in the age of Netflix and predawn sprints to catch the school bus. The simple fact, though, is that good sleep leads to good health, and you and your kids aren’t getting enough of it. Now some encouraging news: There is a fix—but it might not be what you had in mind. As Czeisler explains, sleeping better isn’t about having a firmer mattress or a quieter bedroom (though those things can help). It’s about rethinking how modern society functions. And a good place to start, he says, is with our city’s public schools.

The Boston School Committee wants to launch a pilot program that would push back the start time of high school. Do we make kids get up too early for school?

Yes, and it’s very damaging at a critical stage of their development. How we got to this point is rather bizarre because professor Lewis Terman at Stanford recognized this in 1910, so this is not new. Back then, school in the United States did not start until 9 in the morning; schools in England and Germany were starting at 7 and 7:30. And when Terman compared them, he found that the Europeans were sleeping one to two hours less per night than students were in the United States. I almost fell over when I first read him saying that we must never adopt in the United States the schedules that they have in England and in Germany, because our schoolchildren will not get the sleep they need when they are trying to learn. I was blown away by this.

So how did it get to the point where some kids have to get up before 6 a.m. to get to the bus stop?

School start times slowly moved earlier in tiny increments, 5 to 10 minutes at a time, without anyone taking stock or making any national decision about this. Now it’s starting at 7:15 or 7:20, and many times there are activities before school even begins. We’re telling the kids how important it is to get sleep, but then waking them up at 5.

But does it actually matter? Teenagers are young and healthy, right?

Under the current system, it’s impossible for them to get the sleep that they need. They’re going to be chronically sleep-deprived, and we know sleep deprivation adversely effects learning. We set aside a decade for them to get the education that they need, and then we put a bowling ball around their legs so they can’t achieve what they could be achieving. In fact, a headmaster in Britain did a trial. They started school at 10 in the morning. He said that in his 30 years of working in the education system in Britain, no intervention had as dramatic and positive an impact on the A-level exams than changing school start times, because people are alert in class and can pay attention and learn. Besides that, kids who aren’t getting enough sleep are at greater risk of depression and suicide. Schools that have a later start time have about a 50 percent reduction in motor-vehicle crashes because sleep deprivation plays such a huge role. It also adversely effects the immune system, so kids are at a greater risk of getting sick.

What’s a good place to start when it comes to getting better sleep?

Identify “sleep stealers” in your environment. Sometimes it can be a pet. I had one person describe their pet as a jumping bean—jumping in and out of the bed and disturbing their sleep. Why are you sleeping with this animal? That can actually impair your health by so profoundly disturbing your sleep. But the thought of not having the animal in bed is a nonstarter for many people. And then there are the electronics. People will say, “I wake up, go to the bathroom, and check my phone.” That’s a disaster from the get-go. Before you know it, you send out a couple of tweets, and it’s the morning. It’s very disturbing. That’s why the electronics should really not be in the bedroom.

Are electronics banned in your bedroom?

They’re downstairs in another room charging, just like we are. They should be in a separate room of the house or locked in a cabinet.

Governor Charlie Baker approved a task force to study whether we should do away with springing ahead and falling back. If you could get rid of daylight-saving time, would you?

Yes. The heart-attack rate goes up about 5 percent every time we spring ahead and lose an hour. We know that chronic sleep deficiency has an impact on the cardiovascular system, but the fact that the heart-attack rate goes up in the spring when we set our clocks ahead indicates that there’s also an acute impact. Motor-vehicle crashes also go up by about 17 percent after we spring ahead. So you can actually calculate how many people annually are affected by this procedure. As far as I can see, there’s no justification for it.

If you were tasked with designing the perfect bedroom for sleep, what would it look like? Would you paint the walls black and have a California king?

I wouldn’t have it in a cave because the light-dark cycle helps to synchronize your circadian rhythm. It’s very important that it be quiet because disturbances and noise can obviously interrupt sleep. You should be able to regulate the temperature, because if you’re not in a thermo-neutral environment, it will impair your ability to go into rapid-eye-movement sleep, which is the sleep stage associated with vivid dreaming. So you don’t want it to be stuffy and you want there to be air circulation. You should have a comfortable sleep surface. And in terms of a light, you want it to be completely dark at night. But if you do have to get up to go to the bathroom, you would ideally have motion-sensor path lighting. You don’t want to have to turn on bright lights; you want lighting close to the ground that’s a warm color. And a really high-end bedroom would have shades that open in association with dawn, as the light comes in.

Should employers embrace naps?

Many sleep doctors say naps are bad because they might interfere with nighttime sleep. I don’t happen to subscribe to that. For the average American who is sleep-deprived—when I work with sports teams, for instance—I’m a strong advocate of naps. The siesta cultures have a built-in nap in the middle of the afternoon. They have, let’s say, a five- or six-hour sleep episode at night, and then a one- to two-hour nap during the day, so they get at least seven to eight hours of sleep in a 24-hour period. It’s on a consistent schedule. When we became industrialized, it was not very convenient to have people going off to take a nap and then coming back to the factory.

Is that changing?

People are starting to install nap rooms into offices or work environments. For example, one of the most successful things that I did with the Red Sox is to install a nap room in Fenway Park—and now the players are fighting to get into it.

The Sox aren’t the only team you’ve worked with. You have helped the Bruins, the Celtics, and the Portland Trail Blazers, among others. Any interesting lessons from working with professional athletes?

One of the things that’s interesting is that sleep is taken for granted and they don’t really have a strategy to make sure they get the sleep that they need. It was very surprising to me because they had huge programs around nutrition and, obviously, huge programs around exercise. The third pillar of good health, which is sleep, was just sort of “whenever you have a chance to get it,” with no plan. Many times both acute and chronic sleep deprivation were built into their schedule.

In terms of sleep, who has it worse: a new parent, a Fortune 100 CEO, or an NBA player?

New parents—that’s probably the worst. The parent almost needs to adopt the strategy that if the kid is sleeping, they need to be sleeping.

When you had kids, did you do anything that typical parents might not think of?

[Laughs.] We did a few things that were unusual when we had our three kids. First of all, we drilled a hole through the roof in the nursery and put in a solar collector up top and then a luminaire that did complete dawn-to-dusk transitions so the kids would be exposed to the natural light-dark cycle. And when my wife was breastfeeding—she was working and doing her residency—we would label the breast milk with the time it was pumped, because the children are synchronized to the 24-hour day by the melatonin in the mother’s breast milk. So if the father is giving breast milk that has been pumped by the mother, then you want to label those. Ideally, at 3 a.m. you have breast milk that was pumped around 3 a.m. The child is depending on that temporal signal for their synchronization to the 24-hour day. As I said, we’re not the usual parents.

Does devoting your life to understanding sleep become stressful if you’re lying in bed and having a hard time falling asleep?

Thank God I don’t currently have any issues falling asleep, but it has, at times, been an issue. For example, when my sister died and when my mother died—one of the things that happens with a loss like that is early-morning awakenings. When I was a freshman in college and my mother died, I was suddenly waking up at 3 or 4 in the morning hoping it was just a bad dream.

Is that just a natural part of the grieving process?

It’s something that naturally occurs. Obviously, when I was a freshman, I was 19 and didn’t know what was going on. When my sister died in 2008, I was already a sleep researcher and I knew that when I was suddenly waking up at 4 in the morning there was nothing I could really do about it. But at least I knew what was happening, which is actually reassuring.

How can I beat jet lag?

When traveling across time zones, one thing that will help facilitate resetting your circadian rhythm is melatonin. Another thing I’ll say about jet lag is that many times you can split the difference in your schedule and begin to make changes before you leave—start going to bed a little earlier and waking up a little earlier than usual the week before you leave. You may decide you don’t have to shift at all. If you’re going to Paris to go out to nightclubs, then do not shift to Paris time. If you normally go to bed at midnight here, that’s 6 in the morning in Paris and that’s when the nightclubs close. So you can stay on Boston time and have a blast. And if you’re traveling for business and going eastward, try to schedule your meetings for later in the day if you can.

Let’s say I have a chaotic week coming up at work and I know that I’ll only get four or five hours of sleep each night. Should I clear my weekend schedule when it’s over and snooze until noon?

In the week leading up to it, you should tank up on sleep as much as possible. The military used to have a strategy where they would sleep-deprive soldiers to get them ready for when they had to be sleep-deprived in the field, but that makes it worse. You can’t train for sleep deprivation. It’d be like saying,“Okay, I’m going to starve myself because I’m going to be in a situation where I’m not going to have enough food.” Well, if you’re thin as a rail and you have no reserve, you’re not going to be able to survive. Why do people think they’re going to starve themselves of sleep to get ready for a time without sleep? You want to tank up on sleep—your body and your performance that week will be better if you go into it well rested. Take naps, sleep at night, whatever—just make sure you’re getting your sleep the week before.

But can I make up for it?

You need to be careful about not shifting your circadian rhythm by sleeping in. But studies in kids have shown that if they don’t make up for it by sleeping in, they’re actually worse off the following week. Just try to be as consistent as possible and set aside an adequate amount of time in a cool, dark, and quiet place.

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