The Hacking of the American Mind

by Robert H. Lustig

  Sleeping Your Way to the Top

  As we showed in Chapters 9 and 10, sleep is essential to optimizing serotonin and mood. The brain after a good night’s sleep processes information differently than a sleep-deprived brain, with decreased activity in the amygdala and increased connectivity to the PFC.3 Consistently getting a good night’s sleep corresponds with beneficial changes in the brain, including your memory centers and your Jiminy.4 Conversely, chronic sleep deprivation results in increased dopamine and reduced serotonin, while the increased psychological stress and cortisol of sleep deprivation will decrease serotonin-1a receptors. Stress impedes duration and quality of sleep, which leads to more stress. And round and round we go.

  Sleep deprivation takes its toll on your brain’s capacity to function. In one five-day study,5 adults were randomly selected to be in one of four groups: normal workload + 8 hours of sleep; normal workload + 5 hours of sleep; excessive workload + 8 hours of sleep; and finally excessive workload + 5 hours of sleep. As you might expect, increased workload led to fatigue and sleepiness regardless of sleep duration, but did not alter quantitative work performance or wakefulness tests. Sleep restriction on its own led to a worsening of all cognitive tests. Perhaps not surprisingly, with increased work demands and less sleep, subjects performed markedly worse on all tests, and with actual changes in brain activity along with adverse brain metabolic changes, especially in the PFC. Sleep deprivation also takes its toll on the immune system. If you give a group of a healthy adults a cold virus and isolate them for five days, which factors influence whether or not they get sick? Sleep. Those who slept less were five times more likely to develop colds.6 Could increasing sleep duration turn this around?

  At the present, 35 percent of Americans get less than seven hours of sleep per night (optimally you should get eight), and clinical insomnia (they can’t fall or stay asleep) befalls 23 percent of the adult population.7 Using eight hours as our benchmark, adults maintain a sleep debt of sixty to ninety minutes per night, which is not recompensed by sleeping in on the weekends.8 In fact, your brain has an internal clock, and it doesn’t like to be unwound; it prefers that you go to bed and wake up at the same time every day. Work environments generally value those who come in early and stay late, and those who respond to e-mails at 11:00 p.m. And yet, this can actually worsen an employee’s job performance and overall well-being. In fact, sleep deprivation causes an average of 7.8 days per year in lost work performance, and costs employers about $2,280 per capita, or a total of $83 billion per year in the United States.9 Outside the U.S., employers and governments have picked up on this statistic; most recently France has passed a law that prohibits employees from checking their work e-mails after 5 p.m. and on weekends.10 In contrast, many Americans are perpetually glued to their e-mail during dinner, in traffic, and even while picking up their kids from day care. One enterprising Texas day care put a sign on their door: “GET OFF YOUR PHONE!!! YOUR CHILDREN ARE GLAD TO SEE YOU! ARE YOU HAPPY TO SEE YOUR CHILD?”11

  Most people, when faced with the adverse consequences of their sleep debt, would opt for a quick nap. But unfortunately, while naps acutely improve cognitive functioning, they do not repair the negative mood of chronic sleep deprivation.12 And most people don’t take naps: they drink coffee or take 5-Hour Energy drinks. The caffeine will worsen their chances for restful sleep, and they get the added bonus of kicking their dopamine reward system into overdrive. Let’s see you climb down now. Not sleeping will seriously “harsh your mellow,” thereby skewing your serotonin and any possibility of your achieving Zen. A good night’s sleep is not a luxury; it’s a necessity.

  The Sounds of Sleep

  One of the most significant causes of sleep debt is known as obstructive sleep apnea (OSA). If you’re one of the 35 percent of Americans with sleep debt, you might well be suffering from it. In OSA, the airway collapses while asleep, preventing oxygenation and carbon dioxide exchange (“I can’t breathe . . .”). At its extreme, OSA can irreversibly damage the right side of the heart. It can even kill you, albeit slowly and over years. People normally associate OSA with obesity, and for good reason. The fat around the neck contributes to the collapsing of the airway; and OSA stimulates the hunger hormone ghrelin, causing increased appetite. So OSA and obesity form a vicious cycle of weight gain and metabolic dysfunction, with resultant overeating and depressed mood. But that’s just scratching the surface. Lots of normal-weight people also get OSA, possibly due to reduced muscle tone in the neck closing off the airway, and are at just as much risk for metabolic problems.

  The best way to figure out if you have OSA is to ask your bed partner if you snore. I promise, they won’t lie. The next best way is to record yourself when you sleep. And one final way is to notice if you wake up with a headache not related to how many cocktails you consumed the night before. If you have OSA, what are your options, and will they work?13 The standard mode of medical therapy is continuous positive airway pressure (CPAP): a machine that blows air into the airway with a form-fitting facemask. In one study of three hundred women who suffered from sleep apnea, treatment with a CPAP machine not only helped them to sleep but they also reported a better quality of life, improved moods, better PFC function,14 and decreased levels of anxiety and depression.15 In insomniacs (people who have a hard time falling asleep and staying asleep), cognitive behavioral therapy can also improve clinical depression.16 But CPAP is uncomfortable and noisy, which actually makes getting to sleep harder until people get used to it. Nonetheless, these studies show that when your sleep improves, your mood also improves, and your serotonin is moving in the right direction.

  What about the rest of us who can’t seem to shake the impending doom of tomorrow? Practicing good sleep hygiene can help. Unplugging all electronics in your bedroom is one of the best things you can do for sleep quality. Tossing and turning? The remote is your enemy! No binge-watching Netflix in your bedroom. No TV in there at all. Blackout curtains can help. Understandably, you may not be able to unplug all the electronics in your bedroom (e.g., your alarm clock). There are lots of things you can try to improve sleep hygiene: keeping your bedroom cool and dark, with plenty of fresh air; taking a warm bath or shower before bed; not eating or drinking after dinner; making sure to urinate before getting into bed; and, most importantly, no screen time for one hour before bedtime. This last one might be the most difficult for us to get used to. Many Americans deal with insomnia or try to wind down by bingeing on Netflix after checking their work e-mail, Snapchat, or Facebook. But the blue light emanating from the screen keeps your melatonin (the hormone in your brain that tells you when it’s dark outside) from rising, causing a phase shift in your sleep cycle17 and guaranteeing that you’ll feel awful in the morning. Try picking up a book instead.

  The Myth of Multitasking

  What would happen if we did get enough sleep? Would our stress be lifted? Would our PFCs be any happier—and would we? Apart from sleep, the above studies suggest that there is an additive effect of workload and psychological stress on subjective well-being. Other studies certainly bear this out, as they point to reductions in PFC function and increase in cortisol levels.18 No doubt these effects on the PFC make for diminished executive function (decision making) and increased amygdala activation of more cortisol, driving long-term metabolic dysfunction (e.g., diabetes) and immune system defects (e.g., inflammation).19

  A lot of stress comes from our screens—and not just the blue light that gives us insomnia. Full-blown internet addiction is particularly worrisome and even life-threatening (see Chapter 14), yet many people suffer from a less severe but related problem, commonly known as “multitasking” (simultaneously processing multiple incoming streams of information), e.g., reading live tweets while IM’ing your sister as you watch the latest episode of Game of Thrones. While multitasking existed before the advent of the internet and mobile devices, the combination of these two technologies has shot this practice through the roof. Overall media
use among America’s youth has increased by 20 percent over the past decade, yet the amount of time spent multitasking with media increased by over 119 percent over the same time period.20 Adults who engage in multitasking find themselves increasingly stressed. Many think that multitaskers are gifted people who are to be envied, as they are able to perform several tasks at once without compromising quality of effort or work performance. They are the pride of most companies, as they seem to juggle all the balls, keep the paper moving, take no vacations, and keep coming back for more—the overachievers that make you look like a slacker, and force you to measure up. I guess that’s true, for the entire 2.5 percent of the population that can do this well.21 Those imbued with this innate talent keep their PFCs whirring along despite dissonant information being pelted at them.22 Yet multitasking, like sleep deprivation (which often go hand in hand), eventually takes its toll on the rest of us. In one cross-sectional study,23 heavy media multitaskers were more susceptible to interference from irrelevant stimuli, were less able to screen out irrelevant information, and performed worse on tests of task-switching ability. And multitasking alters blood flow in the PFC as well as other information-processing areas associated with executive function.24 Yup. If you spend too much time creating and retorting with memes, your Jiminy may get hindered. These results argue that multitasking is associated with deficits in fundamental information processing25—in others words, overachieving is accomplished with the help of smoke and mirrors, which may turn out to be a major contributor to our depressed mood all by itself. Multitasking, by increasing psychological stress, is associated with clinical depression26 and might actually increase degenerative changes in the brain.27 But, again, this is correlation, not causation. If you’re a mere mortal, does multitasking cause changes in PFC function, and if so, are they reversible? Or are people with PFC dysfunction more likely not to sleep and multitask instead—say, starting a tweetstorm at 3:20 a.m.? We’re still not sure.

  Nonetheless, cutting down on multitasking to improve brain function and mood has been catching on. The easiest strategy is: TURN OFF YOUR PHONE! ALL CAPS, IDIOT! (Why do you think France banned work e-mails after hours?) Try it. Try to live without your cell phone for five days. The angst that knowing the phone is there but you can’t turn it on or e-mail—the tremor of your hand, the sweat on your brow, the feeling as though a limb has been removed—is more than enough to demonstrate phenomena of both tolerance and dependence, consistent with addiction. Professional blogger Andrew Sullivan beautifully described his descent into cyber-Hades in his article “I Used to Be a Human Being” in New York magazine.28 In the process of rehabilitation, he rediscovered his sense of self. Of course, the problem with doing this is that some of us actually do need to be connected in order to perform our jobs, pay the bills, and keep track of our family members. Worse yet, voice command recognition technology (e.g., Siri, Alexa) has eliminated vast numbers of service jobs around the world, and will continue to do so, which means you can’t disconnect even when you want to. Nonetheless, taking the time to unplug, even for only an hour a day, is one of the most rewarding things you can do, as it’s the path to reduce both dopamine and stress, improve sleep, and hopefully allow your serotonin to do its job.

  Don’t Just Do Something, Stand There

  Another bona fide method to engage your PFC in a meaningful way and give your emotional brain, or the amygdala, a rest is meditation, which is becoming more and more popular everywhere, from the classroom to the boardroom. Meditation has been around for millennia and is practiced in many cultures and religions. For instance, Buddhist meditation practice, where you rid your mind of extraneous thoughts—a ritual closely aligned with attainment of spiritual happiness—has been shown to prospectively increase PFC activity, healing your Jiminy.29 The most recent spin is a non-denominational practice called mindfulness, and we know more about its effects because we’ve been able to actually examine the brain before and after mindfulness practice in an MRI scanner. Based on Buddhist tradition, this technique was adapted by Dr. Jon Kabat-Zinn to help patients deal with chronic pain, and has since become a mainstream method for reducing the effects of stress on the body and the brain.30 The basic premise is to “live in the moment” by learning to observe your thoughts and emotions dealing with the past and future without acting on them. By focusing strictly on the present, recognizing that no one is in control of either the past or the future, you act like a scientist and observe the natural phenomena within your own mind—leaving you in a state of greater peacefulness. A favorite exercise is to eat one raisin—very, very slowly—over about ten minutes. You roll it around on your tongue, explore the rough surface, bite into it in slow motion—and all of a sudden, it isn’t a raisin. By doing so, stress and distractibility diminish. It’s a new experience that you’ve never had before—at least, that’s the concept, ostensibly an enjoyable one, although not everyone agrees (see the Meditation for Real Life series in the New York Times).31

  Mindfulness sounds very New Age (kind of like a brain colonic), but there’s a lot of neuroscience that goes with it,32 including research showing that meditators have clear differences in brain structure. A meta-analysis of studies comparing meditators and non-meditators demonstrates changes in the brain related to the size of the frontopolar cortex and insula (which governs body awareness), the hippocampus (memory), the corpus callosum (transmission between both halves of the brain), and perhaps most importantly the anterior cingulate cortex and prefrontal cortex (the Jiminy Cricket, those areas involved in executive function that keep you from doing stupid things).33 Of course, we are still left with the cause-and-effect question. Does meditation help your PFC? Or do people with better PFCs choose to meditate? Or both? We just don’t have long-term longitudinal data as of yet. However, one study in veterans with post-traumatic stress disorder, as well as traumatic brain injury, did find beneficial effects of mindfulness-based training that lasted three months post-training,34 and mindfulness-based training increases neural connectivity in regions known to play a role in empathy.35 So you feel better and are generally a nicer person. Win-win.

  Like any skill, it takes daily practice to master mindfulness. Those who practice it swear by it, but it’s definitely not something you just dabble in. I am a pretty anxious guy myself, so eight years ago I took the mindfulness-based stress reduction (MBSR) course at the UCSF Osher Center for Integrative Medicine here in San Francisco. I personally found the experience quite valuable, even though I don’t practice it every day like I should. I learned that anxiety is “excitement about the future.” The problem is that the future never comes, and it is almost always worse in my head than it is in reality. Today I would worry about what might happen tomorrow; then tomorrow would come, and I would be focused on the day after that, and so on. So you’re never in control. This is a great way to make yourself miserable. By focusing and spinning out on what might or might not happen tomorrow and what I had done yesterday, I was missing out on the fun and enjoyment of what was happening today. By always focusing on the future and the past, I generated my own chronic stress, and I was always missing out on the happiness of today.

  This realization was a revelation, a lightbulb going off in my brain, and it’s part of the reason why I wrote this book. Whenever my thoughts take me to tomorrow or yesterday and what the future may or may not hold (always leading to anxiety), I instead refocus my attention on what is good (and of course bad) that is happening today. And my self-assessment is that today, right now, is usually pretty darn good. I find that I am much calmer, I fidget less and I am much less distractible. I also stopped eating when I am not hungry, as I am not eating for stress anymore. I revel in today. And tomorrow? Tomorrow will be here soon enough and will take care of itself. I downloaded a stress-reduction app on my iPhone. I have found the best time to use it is when I am on a plane, after pulling away from the gate, and waiting in line for takeoff. I used to feel angst about the wait . . . not any longer.

 
Try it . . . right now. Close your eyes; feel the sensations around you. What do you hear? What do you sense? Do you feel your feet pressing into the floor? Your hands on this book or computer? What do you smell? Focus on right now. Not “What do I need to do tomorrow? What will I have for dinner? What will we do this weekend?” Try this for five minutes and focus on a saying. . . . It can be any saying: “I am here.” “I have enough.” “I am content.” “I am safe.” For these five minutes everything other than your breath is a distraction. Can’t think of a good mantra? Be thankful . . . for five minutes. Make a “gratitude” list of things and people you are thankful for. Harder than you thought, isn’t it? Try it for five minutes a day for thirty days, and see if and how it changes you.