Americans are desperate to get more sleep. But are they taking it too seriously?

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Scientists have known for decades that sleep is an important part of staying healthy. But it’s only in recent years, with the rise of wellness culture on social media, that the idea of getting enough sleep has started to outpace the idea of sleeping as little as possible in order to get ahead professionally.

And yet, with the rise in awareness about the importance of sleep, we’re also seeing what the Atlantic magazine recently called an epidemic of insomnia — particularly among millennials.

Dr. Michael Grandner leads the University of Arizona Sleep and Health Research Program. He’s been studying sleep since before it was cool.

Full conversation

MICHAEL GRANDNER: I think that in the past, sleep was seen as a luxury for people who have too much free time on their hands. Sleep is a biological, universal requirement for human life. We don’t sleep because we enjoy it. We don’t sleep because it’s good for you. We don’t sleep because we feel better when we do it. We sleep because actually if we don’t, we’re going to die. And it’s a foundational part of our biology. We don’t really have a choice.

And if you think about it, no one says things like, “Breathing is just a luxury for people with too much free time on their hands.”

But because we’re in a society that often sees sleep as an unproductive use of time — and there is nothing more un-American than an unproductive use of time — we have this discrepancy, this dissonance between our biology and society. Which creates these points of stress where our body wants sleep, but then we don’t want it.

SAM DINGMAN: Yeah. Well, so obviously there are many treatments that people look to when they’re trying to get more sleep. And some of those are pharmaceutical. … Just trying to adjust your diet and get more exercise, those sorts of things.

 I’m particularly interested, though, in talking to you about the more psychological approaches to combating lack of sleep. There is a very common treatment for insomnia called CBT-I (cognitive behavioral therapy for insomnia).

GRANDNER: Yeah, it’s CBT-I. We’ve got decades of data showing that it works. It works really well, and it does as well or better than any pharmaceutical product that’s been on the market so far. But what is it?

So when a patient comes in and says, “I know I’m having trouble sleeping,” it’s kind of like them saying, “I’m having trouble breathing.” Remember, this is a foundational part of your biology. … It’s supposed to be something that you can do. No one ever says, “I have trouble breathing. Oh, I must just be really bad at it. I need more practice. It’s a skill I just never mastered.” No one had to teach you how to do it. Your body already knows how.

But why isn’t it? Something is preventing that. And what CBT-I does is it targets some of the most common ones and gets them out of the way. By far the most common one being a thing called conditioned arousal. So, we have all of these survival mechanisms that in the face of stress we can delay sleep for a while. You know, evolution figured out that this was OK a long time ago. It’s just making it chronic is sort of what makes it a problem. … Because what happens is whatever initially caused that acute insomnia, over time it becomes less relevant. Because what happens is sleep starts to become predictably stressful.

DINGMAN: I’m imagining a scenario where you have come to view going to bed as an obstacle to you overachieving at your job. And so you stay up really late because you want to, you know, get ahead on projects or something like that. And if you tell yourself, “No, no, I’m going to sleep more,” I can imagine coming to view sleep as a source of stress because you think, “Oh, no. Now I’m going to fall behind at work.”

GRANDNER: And that’s how it starts. And then what ends up happening is people are working or on stuff or doing whatever, and they’re like, “OK, fine, I’ll go to bed now.” That they close their laptop or whatever, and they get into bed, and their mind is still going, because they didn’t take time to slow down and wind down.

We’re not machines. We can’t — we’re not just an off switch. And so you carry that energy with you. And so now you’re in bed and now your mind is going. And you do that enough times you program that — that’s what bed does. Once sleep becomes predictably stressful, that predictable stress becomes the very activation that makes it harder to sleep. Which then makes it more predictable that sleep will be stressful. Which then makes you more awake the next night when you’re trying to sleep because you’re predicting stress.

It’s a feedforward leap loop … It’s a vicious cycle where the stress creates sleeplessness, which makes you more stressed, which makes you sleep less, and it creates a cycle. And what CBT-I essentially does, in a nutshell, is breaks the cycle, deprogram that connection and reprogram the bed with sleep. And that’s essentially how it works.

DINGMAN: But as I understand it, Dr. Grandner, if CBT-I — if someone maybe has tried it and it didn’t work or that that method doesn’t sound good to them, you have a different approach which you call ACT, acceptance and commitment therapy.

GRANDNER: So ACT is a therapy modality that’s been around for decades and in the psychotherapy space. But ACT as it applies to sleep, it’s all about accepting that there may be things you cannot change and committing to doing what you can do anyway.

So, for example, sleep does not have to be perfect to be fine. Like, you don’t have to have a perfect diet to not have, you know, Type 2 diabetes and a heart attack at age 50.

… It’s not one extreme or the other. When people lose sleep for a little while and they lose their appetite for one reason or another for sleep, sometimes they start catastrophizing. And that becomes the stress that keeps them awake in the future.

So sometimes but if you say like, “Look I didn’t have a great night tonight. I’ll mostly be fine tomorrow. And you know what. I may go to bed a little bit early the next day. And if I can’t sleep, then by the third day I’ll be a little extra tired, and then it’ll work itself out.” And you have a perspective of accepting some of the ebbs and flows, and you just don’t add stress into the system.

DINGMAN: You know, it’s so interesting the way you’re talking about this. I mean, a moment ago, we were talking about how for a long time in American culture, sleeping was equated with laziness or like being an unproductive person. Like if you’re a person who sleeps, you’re not a good student of life, say. … And it’s almost like now that the culture around sleep has shifted, we’ve taken the values we used to associate with not sleeping and put them on sleeping. Like I have to get sleep and I have to be the best sleeper and I have, I have to do A+ sleep or else I’m sleeping wrong. [LAUGHS]

GRANDNER: Right. But if you look at it, it’s actually the same values. It’s this black and white thinking. … It’s overachiever thinking of: I need to optimize and I need to be maximally successful. What does that mean? That means sleeping. Not at all until maybe I die. Or then actually, no, it means getting eight hours. And if I don’t get it. Like, either way, you create this test that you are set up to fail and then stress about. You are you. You are not your numbers and you are not an idealized version that doesn’t exist. You can strive to be better without always feeling inadequate. And I think it’s this balance. It’s this, you know, if things aren’t perfect, you know, try to be better, but don’t make ourselves crazy in doing so.