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An Overview of the Book "Why We Sleep" by Matthew Walker

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An Overview on

Publication: 2017
The New York Times Bestseller
The Sunday Times Bestseller

Goodreads: 4.4/5
Barnes & Noble: 4.4/5
Audible.com: 4.8/5
 Contents
Part 1: The basics of sleep (Chapters 1-5)
Part 2: Why should we sleep (Chapters 6-8)
Part 3: Dreams (Chapters 9-11)
Part 4: The dos and don’t for better sleep (Chapters 12-16)
Appendix: 12 tips for healthy sleep
Some criticisms/debated topics of the book.

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 Chapter 1
1. ⅔ of adults in developed nations don’t have the recommended 8 hrs of sleep.
2. Routinely sleeping <6/7 hrs demolishes the immune system, 2 ✕ risk of cancer,
makes prone to Alzheimer’s, and makes people pre-diabetic. It also increases
the chances of cardiovascular diseases, stroke, and heart failure and contributes
to all psychiatric conditions, including depression, anxiety, and suicidality.
3. The lack of sleep can kill you outright — progressive insomnia, drowsy driving.
4. The shorter your sleep, the shorter your life span.
5. There isn’t a single organ/biological function that doesn’t benefit from sleep.
6. Sleep is the single most effective thing we can do to reset our brain and body
health each day—Mother Nature’s best effort yet at contra-death.”

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 Chapter 2
1. 2 factors determine sleep and awake — circadian rhythm & sleep pressure.
2. de Mairan’s Plant experiment and Kleitman and Richardson’s self-experiment
about circadian rhythm (longer than 24 hrs; 24 hrs & 15 mins).
3. The brain uses daylight, food, exercise, temperature fluctuations, and even
regularly timed social interaction as cues (zeitgeber) to drive biological clock.
4. The role of melatonin on our biological clock.
5. How sleep pressure builds up due to adenosine and how caffeine counters it.
6. Caffeine is the most widely used/abused psychoactive stimulant in the world.
7. How Process S & Process C regulate sleep as two independent processes.
8. The SATED questionnaire to determine if you are getting enough sleep.

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 Chapter 3
1. The characteristics of sleep — loss of external awareness, time dilation
2. The sleep cycle — Wake, REM, NREM1, NREM2, SWS.
3. How sleep measurements are taken and interpreted: EEG, PSG, & Hypnograms.
4. Information processing stages: Wake → reception, NREM → reflection (storing
and strengthening of new facts and skills), REM → integration and insights.
5. REM recalibrates the emotional circuits of the brain and fuels creativity.
6. Evolution decided to outlaw muscle activity during REM sleep to prevent us
from acting out our dreams.
7. We don’t know why sleep cycles are repeatable but dramatically asymmetric.

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 Chapter 4
1. Sleep is at least 500 million years “old,” started from worms during the
Cambrian explosion, and is observed in all known species.
2. Why do we sleep? — “Sleep is the state we must enter in order to fix what has
been upset by wake.” — common, widely accepted, but erroneous.
3. Why did life ever bother to wake up? Sleep was the first state of life on this
planet, and wakefulness emerged from sleep (hypothesis).
4. The effects of sleep deprivation can’t be made up later with more sleep.
5. A biphasic sleep routine (7 hrs at night and 30-60 mins in the afternoon)
contributes to a more healthy and longer life. Island Ikaria’s men are four times
as likely to reach ninety as American males.

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 Chapter 5
1. Inside the mother’s womb, a baby’s sleep has 6 hrs of NREM, 6 hrs of REM
(non-paralyzed), and 12 hrs of intermediary sleep (can’t define, not fully wake).
2. Disturbance in REM during this stage halts the growth of the cerebral cortex
and is directly liked to autism spectrum disorder (ASD) (from a rat study).
3. Children develop circadian rhythms after 3-4 months, which fully take effect
around 1 yr. NREM increases gradually, while REM decreases.
4. We should take teenagers’ sleep more seriously. Sleep deprivation at this stage
can cause schizophrenia, bipolar disorder, major depression, and ADHD.
5. Older adults need as much sleep as middle-aged people but can’t generate it.
6. The quality & quantity of NREM and sleep quality decreases as people get old.

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 Chapter 6
1. The benefits of sleep: it enhances memory, attractiveness, and longevity; it
decreases body fat, food cravings, and chances of cancer, dementia, anxiety,
depression, stroke, and diabetes. Sleep is the universal health care provider.
2. Sleep prepares brain for learning, cements memories, and prevents forgetting.
3. NREM2 (last 2 hrs of 8) is directly responsible for the enhancement in motor
skills, speed, accuracy, and task automation.
4. <8(/6) hrs of sleep leads to a reduction in time to physical exhaustion
(10-30%), aerobatic output, limb extension force, vertical jump height, muscle
strength, blood oxygen saturation, cardiovascular, metabolic, and respiratory
outputs...

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5. Post-performance sleep is as important as pre-performance sleep.

Chapter 7
1. No facet of the body is free from the crippling, noxious harm of sleep loss.
2. Concentration is hampered by the slightest of deprivation (drowsy driving).
3. Sleep-deprived people consistently underestimate their performance loss.
4. Even 7 hrs (≠8) for 10 days can make the brain as dysfunctional as 0 hrs a day.
5. 3 nights of recovery sleep are insufficient to recover a week of shortened sleep.
6. Caffeine/naps have immediate benefits but can’t fully make up for night sleep.
7. Naps do not contribute to complex brain functions.
8. Sleep deprivation is a key factor in determining the risk of Alzheimer’s.
9. Sleep elites can function with 6 hrs of sleep due to having the BHLHE41 gene.

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10. Sleep is currently a tool for diagnosis, prevention, and cure — all three fronts.
11. No drug/device/system/function/amount of willpower can replace sleep.

Chapter 8
1. Based on 20+ decades-long large-scale epidemiological studies on millions of
people, lack of sleep has clear causal links to a shorter lifespan and major
diseases like heart disease, obesity, dementia, diabetes, and cancer.
2. In the Northern Hemisphere, the loss of 1 hr of sleep due to the activation of
daylight savings time leads to a spike in heart attack and traffic accident rates.
3. Sleep loss triggers a vicious cycle of food cravings, which leads to weight loss.
4. Sleep loss significantly drops the testosterone level.

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5. Sleep deprivation vastly increases the likelihood of flu and infections and
reduces the body’s response to vaccines.

Chapter 9-11
1. The dream is a flagrantly psychotic state. During a dream, we hallucinate,
become delusional, disoriented, and labile, and then we suffer from amnesia.
2. Dreams can happen in all sleep stages, but the REM ones are most vivid.
3. Can we predict what an individual is dreaming about? (the 2013 study) - No. F.
4. Emotional concerns correlate most with our dreams.
5. 2 Main functions of dreams - nursing our emotional and mental health (theory
of overnight therapy) and problem solving and creativity.
6. Noradrenaline (anxiety-triggering molecule) is only absent during REM sleep.

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7. REM dreams’ goals: preserve valuable details and forget painful memories.
8. Disrupted REM in PTSD patients; dreams can resolve PTSD.

Chapter 12
1. Somnambulism: walking, talking, texting, committing murders during sleep.
2. These events arise from the deepest stage of NREM sleep, not REM.
3. Insomnia: sleep onset and maintenance insomnia.
4. An overactive sympathetic nervous system and higher levels of cortisol,
adrenaline, and noradrenaline are suspected to be responsible.
5. Narcolepsy: overwhelming daytime drowsiness and sudden attacks of sleep.
6. Not always a genetic/inherited condition. Core symptoms: excessive daytime
sleepiness, sleep paralysis, and cataplexy. No effective medicine so far.

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7. Fatal familial insomnia (FFI): total inability to sleep, a progressive condition.
8. Caused by a rogue version of prion protein (PrNP) that affects the thalamus.
9. Sleeping 8 hrs is enough for humans; 9+ hours can have adverse effects.

Chapter 13
1. Longer commute times and sleep procrastination significantly shortens sleep.
2. 5 key factors heavily affect sleep: LED light, regularized temperature, caffeine,
alcohol, and a legacy of punching time cards.
3. iPad suppresses melatonin release by 50% at night and delays release by 3 hrs.
4. Artificial light can cause artificial sleep-onset insomnia (delayed sleep).
5. Alcohol fragments sleep (often unnoticed) and heavily suppresses REM sleep.

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6. The ideal bedroom temperature is 65°F/18.3°C. A hot bath before sleep can
induce 10-15% more deep NREM sleep.
7. The alarm clock is an abuser of your sleep.

Chapter 14
1. No past/present legal/illegal sleeping medication can induce natural sleep.
2. Regular sleep pill users are 4.6x more likely to die. The frequency of use is
directly related to risk of death. Even occasional users (18/yr) bear high risks.
3. CBT-I is now being considered the first-line treatment of insomnia.
4. CBT-I with good sleep hygiene is successful in most cases, though the effective
techniques may differ based on the condition of the patients.

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 Chapter 15
1. REM sleep is what stands between rationality and insanity.
2. We should change our school and office start times with flexible schedules.
3. Disasters caused due to sleep deprivation: Chernobyl neuclear reactor
meltdown, Exxon Valdez oil tanker incident.

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Chapter 16

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 12 tips for healthy sleep
1. Stick to a sleep schedule. Set alarms for both bedtime and wake-up time.
2. Exercise for 30 mins on most days, but 2-3 hours before bedtime.
3. Avoid caffeine (including decafs) and nicotine in the afternoon.
4. One light alcoholic beverage is fine, but not the hard ones or not too many.
5. A light snack before bedtime is fine, but not large meals/beverages late at night.
6. Avoid medicines that delay or disrupt your sleep.
7. Don’t take naps after 3 p.m.
8. Have a relaxing activity before bed (e.g., reading books or listening to music).
9. Take a hot bath before bed.
10. Cool, dark, and gadget-free bedroom with a comfortable mattress & pillows.

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11. 30-60 mins of sun exposure every morning, and dim the lights before bedtime.
12. Don’t lie in bed awake if you can’t sleep for more than 20 mins.

Criticisms of the book

1. The shorter your sleep, the shorter your life span — is not a general rule.
2. All of us should sleep 8 hrs a day — is not a general rule.
3. Sleeping less than 6 hours a night does not double your risk of cancer.
4. Lack of sleep will not outright kill you.
5. Sleep deprivation can be beneficial for the treatment of depression.
6. Too many bold conclusions from epidemiological and self-reported sleep data.
7. The lack of references makes it hard to fact-check.

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8. Misinformation: All species do not sleep, FFI alone doesn’t kill people, ⅔ of
adults in developed nations do not fail to obtain the recommended amount of
sleep, WHO never declared a sleep loss epidemic.
9. Health insurance companies are not equipped to measure sleeping behaviors.
10. Bill Gates disagreed with Walker's claim about sleep time and Alzheimer's.
11. Some critics felt that the style of writing was similar to a horror story.
12. Some of the studies discussed and used in arguments are clearly outdated.
13. The book does not answer the question in its title, “why (do) we sleep?”
Ref: https://guzey.com/books/why-we-sleep/
https://en.wikipedia.org/wiki/Why_We_Sleep#Controversies

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Conclusion
1. The book is well-written and aimed at a general audience.
2. It has a nice blend of facts & figures, research outputs, theories & hypotheses,
and good stories with creative story-telling.
3. It does mention our lack of understanding of sleep and the necessity for more
research, but only marginally.
4. It does (did) a good job at expressing the necessity of sleep and the urgency of
the situation to people.
5. If someone wants to learn about sleep or improve their sleep quality,
this book can be a good place to start!

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