Now imagine arriving in the emergency room and being checked by a physician on night shift - or far worse, after night shift. We can't function normally after 24 hours, let alone perform procedures. It's such a high risk for everyone, and takes such a high physical and emotional toll on doctors. I'm of course speaking from experience. This is a long battle we're still fighting in healthcare worldwide, and we won't stop. Patients deserve good quality service and time. And doctors deserve good quality of life like everyone else. ❤️
I'm still wondering how I survived motherhood (and for that matter, how my son survived me being a mother) where sleep was often broken into two-hour chunks. Really not a good idea to hallucinate while rocking a baby.
I just got a reply from a friend who reads my newsletter (hey David!) who just became a father and has entered that perpetual parental twilight state of neither being awake nor asleep. I don't know how any of you do it - I know your answer might be "well, you have to", but even so. There should be studies done to compare it with, say, the stresses of running a marathon.
My nightlife-loving friends and I used to regularly stay awake for long periods for... reasons. Sometimes I would reach a point where, when I blinked, I would have full dreams during the blinks. Not... ideal, really?
Bloody HELL. Not good at all. So I guess that's microsleeping, except with dreams? Were these normal-duration blinks or the "I'll just shut my eyes for a second zzzz" variety?
Also, yes, sleeping outside. Love the smell, the feel of the air, the darkness and being guided by the light. Have also benefited from an hour or so of rest and reading or listening to classical music in the evening.
Mike, your article is eye-opening! I appreciate how you broke down the effects of sleep deprivation on our bodies and minds. It's fascinating to see the scientific perspective on this topic.
My friend Tony Wright, a British author and consciousness researcher, wrote a book titled "Left In The Dark" that explores similar themes. In his book, Tony outlines his theories on human neurological degeneration and sleep deprivation, claiming that humans are governed by the brain's left hemisphere, which requires more sleep than the right. His theories are based on his own experience of staying awake for 266 hours, a record for sleep deprivation, he claims. Thanks for sharing your knowledge and personal experience!
This reads like a horror story written by your hypothalamus—and I mean that as praise. The hour-by-hour breakdown makes you feel the unraveling as much as understand it. What I love most is how it turns something we trivialize (“I’ll sleep later”) into an act of bodily rebellion. The closing reminder—that sleep can’t be commanded, only invited—lands like wisdom earned through insomnia.
Partly inspired by a series of science articles that Reader's Digest used to run, which were *immensely* popular at the time, one of the most-reprinted pieces from the magazine, and they were bundled together into a book called "I Am Joe's Body". It's now out of print (a second-hand copy is available on Amazon for an astonishing £210!) but the Internet Archive has a text copy here: https://archive.org/details/IAmJoesBody-J.D.Ratcliffe I'm amazed nobody has thought of turning this kind of format of science writing into a newsletter - I'm sure it would be a hit!
Thanks for this Mike. I’m in much need of sleep at the moment. I have both 5mg and the 10mg melatonin tablets, bought in America for jet lag. Which did you use to improve your sleep pattern?
It's a few months later and I hope your sleep has settled down a bit, JP! But if not: based on Jodi's findings, I'd say a smaller dose than either of those might be just as effective and it'll make your tablets last for much longer if you can chop them up!
"Based on a bunch of studies that either favor the lower dose or show no difference between doses, plus clear evidence that 0.3 mg produces an effect closest to natural melatonin spikes in healthy people, plus UpToDate usually having the best recommendations, I’m in favor of the 0.3 mg number. I think you could make an argument for anything up to 1 mg. Anything beyond that and you’re definitely too high. Excess melatonin isn’t grossly dangerous, but tends to produce tolerance and might mess up your chronobiology in other ways. Based on anecdotal reports and the implausibility of becoming tolerant to a natural hormone at the dose you naturally have it, I would guess sufficiently low doses are safe and effective long term, but this is just a guess, and most guidelines are cautious in saying anything after three months or so."<<
Thanks for the mention, Mike! My worst bout of insomnia was a crippling two long years after I got dengue fever, where I'd fall asleep from 5-8am some nights, other nights not at all. The melatonin helped with the sleep changes needed for travels, and I still take low doses now two hours before bed.
But the biggest positive change in sleep for me was treating for my mast cell activation disorder that I did not know dengue 'gifted' me until many years later. That has honestly made the biggest difference of all.
Did you see the recent study about how if you've already got insomnia and add inflammation, it can lead to depression in seniors? Fascinating stuff. Thanks, as always, for an interesting piece!
Thanks, Jodi, for this and for all your writing on battling sleep disorders. I will definitely link in a future part opf this series to your incredible MCAS resource page: https://jodiettenberg.com/mast-cells/
I did not know about the insomnia+ inflammation=depression link! Do you have a link for that recent study? I've found what I *think* is one from 2018: https://pmc.ncbi.nlm.nih.gov/articles/PMC6127743/ But I will keep hunting...
I once went for two straight weeks of 48-hour days to meet a deadline. Haven't recovered from it.
Since you're talking about sleep deprivation, you might consider looking into its effects on depression. Bizarrely, if a severely depressed person is deprived of sleep for a certain period of time their symptoms lift. This is a reliable and well-known effect.
In my own experience there's something like this at play when I try to work. The reason I stayed up so long is that I was so keyed up and anxious that I had to wait until my brain hit a certain amount of sleep deprivation before I could stop avoiding my work, and finally write. The reason my days eventually stretched to 48 hours is that, due to some ugly trick God played on me, that moment where I could write was gradually pushed back--first I had to stay up 18 hours to get it. Then 20, etc... until I had to wake and then stay up for a full 40 hours before it would kick in.
I do not recommend this for anyone ever at all for any reason. Period. But I didn't know any other way to avoid failing.
Anyhow, for you, Mike? If you're not looking at the depression link you should. Happy to talk about it if you want--message me if you're keen on it.
This is fascinating! Yes, absolutely will look into this - I just found a Nature piece on it: https://www.nature.com/scitable/blog/mind-read/an_unconventional_release_from_depression/ From that, it seems to be linked to adenosine release, which tinkers with the electrical activity in the brain. It also seems to be a one-off effect - "however, after 72 hours of sleep deprivation there was no change in adenosine levels, as the astrocyte cells had largely shut down by this point" - so it'd be a bit of a "pull lever to stop the train" thing, and when the train's stopped, it can't go any slower?
In university I did a 24-hr roller-skating and was awake for nearly 40 hrs altogether. Felt not too bad.
Jump forward 25 yrs and I thought I could stay up easily but without the physical activity. Nope. Hallucinated an entire forest on a lot and thought I was moving sideways while going forward.
For my job, I’ve often spent more than a month in a tent or sleeping under the stars before and after bug season. Highly therapeutic. Getting good sleeps while also being aware of disturbances. Eg registered the calls of Long-tailed Ducks migrating overhead; woke up suddenly at 3 am-ish because I’d felt something change—it was cloud moving in. I crawled under a tarp and shortly after rain started.
"...thought I was moving sideways while moving forward" sounds an absolute nightmare. Yikes.
But you've just reminded me (thank you!) of a time I worked night shifts in a pottery and built up a huge sleep debt over a few weeks, then one day I set off for work and when I got to the bottom of my road, I started wondering why I was moving so slowly. Then I realised. It was because I'd walked, rather than taken my bike. I wasn't cycling, but some part of my half-sleep brain thought I was. Just the *weirdest* thing.
Also, rain on tent canvas: holy hell, I've had some lovely sleeps with that going on.
Depends on the year. Some years I’m out spring to fall with breaks in between. Other years there are enough jobs closer to towns that I can stay in motels or bunkhouses and seldom have to be in a tent.
I’m a wildlife biologist or field scientist/ecologist who does contract work for various companies (biologist for hire). Lots of variety.
That does sound weird walking yet partly thinking you were cycling. I wonder how that sort of thing happens in the brain.
I wonder if that 48-hour-mark "I am queen of the world!" feeling was related to what James Horton mentioned in a previous comment, associated with the feeling of goodwill from adenosine release?
(Or possibly not: I just checked the common side effects of adenosine administration and they're "skin flushing, lightheadedness, nausea, sweating, nervousness, numbness, and a sense of impending doom." Yikes.)
Now imagine arriving in the emergency room and being checked by a physician on night shift - or far worse, after night shift. We can't function normally after 24 hours, let alone perform procedures. It's such a high risk for everyone, and takes such a high physical and emotional toll on doctors. I'm of course speaking from experience. This is a long battle we're still fighting in healthcare worldwide, and we won't stop. Patients deserve good quality service and time. And doctors deserve good quality of life like everyone else. ❤️
Absolutely. And I really appreciate the work you're doing in helping deal with that.
(Everyone else reading: Mariana is both a doctor and a medical advocate - https://www.marianacalleja.com/ - and also my better half.)
I'm still wondering how I survived motherhood (and for that matter, how my son survived me being a mother) where sleep was often broken into two-hour chunks. Really not a good idea to hallucinate while rocking a baby.
I just got a reply from a friend who reads my newsletter (hey David!) who just became a father and has entered that perpetual parental twilight state of neither being awake nor asleep. I don't know how any of you do it - I know your answer might be "well, you have to", but even so. There should be studies done to compare it with, say, the stresses of running a marathon.
One of the times I was awake for longest was labouring, giving birth to my son and the period immediately after. It did scary things
My nightlife-loving friends and I used to regularly stay awake for long periods for... reasons. Sometimes I would reach a point where, when I blinked, I would have full dreams during the blinks. Not... ideal, really?
Bloody HELL. Not good at all. So I guess that's microsleeping, except with dreams? Were these normal-duration blinks or the "I'll just shut my eyes for a second zzzz" variety?
Normal blinks!
Also, yes, sleeping outside. Love the smell, the feel of the air, the darkness and being guided by the light. Have also benefited from an hour or so of rest and reading or listening to classical music in the evening.
My other half (Dr Ross, in another comment) just discovered classical music as a wind-down tool! It definitely works.
Fabulous! It works for us too.
That and rain sounds. Note: ocean sounds didn't work for me; loud sounds of dolphins showed up in the night!
Mike, your article is eye-opening! I appreciate how you broke down the effects of sleep deprivation on our bodies and minds. It's fascinating to see the scientific perspective on this topic.
My friend Tony Wright, a British author and consciousness researcher, wrote a book titled "Left In The Dark" that explores similar themes. In his book, Tony outlines his theories on human neurological degeneration and sleep deprivation, claiming that humans are governed by the brain's left hemisphere, which requires more sleep than the right. His theories are based on his own experience of staying awake for 266 hours, a record for sleep deprivation, he claims. Thanks for sharing your knowledge and personal experience!
Thank you! Tony's work is something I definitely need to look into.
This reads like a horror story written by your hypothalamus—and I mean that as praise. The hour-by-hour breakdown makes you feel the unraveling as much as understand it. What I love most is how it turns something we trivialize (“I’ll sleep later”) into an act of bodily rebellion. The closing reminder—that sleep can’t be commanded, only invited—lands like wisdom earned through insomnia.
Glad you enjoyed it, Dave! (If "enjoyed" is the right term for a piece like this, I guess.)
I wrote a couple of other pieces in this style, on similar subjects:
https://everythingisamazing.substack.com/p/heres-what-happens-when-you-get-too
https://everythingisamazing.substack.com/p/like-egg-white-as-it-boils-this-is
Partly inspired by a series of science articles that Reader's Digest used to run, which were *immensely* popular at the time, one of the most-reprinted pieces from the magazine, and they were bundled together into a book called "I Am Joe's Body". It's now out of print (a second-hand copy is available on Amazon for an astonishing £210!) but the Internet Archive has a text copy here: https://archive.org/details/IAmJoesBody-J.D.Ratcliffe I'm amazed nobody has thought of turning this kind of format of science writing into a newsletter - I'm sure it would be a hit!
Thanks for this Mike. I’m in much need of sleep at the moment. I have both 5mg and the 10mg melatonin tablets, bought in America for jet lag. Which did you use to improve your sleep pattern?
It's a few months later and I hope your sleep has settled down a bit, JP! But if not: based on Jodi's findings, I'd say a smaller dose than either of those might be just as effective and it'll make your tablets last for much longer if you can chop them up!
From Jodi's page (https://www.legalnomads.com/jet-lag-tips/):
>>In his 2018 post “Melatonin: Much More Than You Wanted to Know” - https://slatestarcodex.com/2018/07/10/melatonin-much-more-than-you-wanted-to-know/ - over on Slate Star Codex, Scott writes that, “most existing melatonin tablets are around ten to thirty times the correct dose.”
He continues that
"Based on a bunch of studies that either favor the lower dose or show no difference between doses, plus clear evidence that 0.3 mg produces an effect closest to natural melatonin spikes in healthy people, plus UpToDate usually having the best recommendations, I’m in favor of the 0.3 mg number. I think you could make an argument for anything up to 1 mg. Anything beyond that and you’re definitely too high. Excess melatonin isn’t grossly dangerous, but tends to produce tolerance and might mess up your chronobiology in other ways. Based on anecdotal reports and the implausibility of becoming tolerant to a natural hormone at the dose you naturally have it, I would guess sufficiently low doses are safe and effective long term, but this is just a guess, and most guidelines are cautious in saying anything after three months or so."<<
Thanks for coming back to me Mike. Hope you’re well.
Thanks for the mention, Mike! My worst bout of insomnia was a crippling two long years after I got dengue fever, where I'd fall asleep from 5-8am some nights, other nights not at all. The melatonin helped with the sleep changes needed for travels, and I still take low doses now two hours before bed.
But the biggest positive change in sleep for me was treating for my mast cell activation disorder that I did not know dengue 'gifted' me until many years later. That has honestly made the biggest difference of all.
Did you see the recent study about how if you've already got insomnia and add inflammation, it can lead to depression in seniors? Fascinating stuff. Thanks, as always, for an interesting piece!
Thanks, Jodi, for this and for all your writing on battling sleep disorders. I will definitely link in a future part opf this series to your incredible MCAS resource page: https://jodiettenberg.com/mast-cells/
I did not know about the insomnia+ inflammation=depression link! Do you have a link for that recent study? I've found what I *think* is one from 2018: https://pmc.ncbi.nlm.nih.gov/articles/PMC6127743/ But I will keep hunting...
No, it is a new study. I wrote about it here: https://www.patreon.com/posts/136396194
A direct link to the study is here: https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2836538
How did I miss that? Thanky.
I once went for two straight weeks of 48-hour days to meet a deadline. Haven't recovered from it.
Since you're talking about sleep deprivation, you might consider looking into its effects on depression. Bizarrely, if a severely depressed person is deprived of sleep for a certain period of time their symptoms lift. This is a reliable and well-known effect.
In my own experience there's something like this at play when I try to work. The reason I stayed up so long is that I was so keyed up and anxious that I had to wait until my brain hit a certain amount of sleep deprivation before I could stop avoiding my work, and finally write. The reason my days eventually stretched to 48 hours is that, due to some ugly trick God played on me, that moment where I could write was gradually pushed back--first I had to stay up 18 hours to get it. Then 20, etc... until I had to wake and then stay up for a full 40 hours before it would kick in.
I do not recommend this for anyone ever at all for any reason. Period. But I didn't know any other way to avoid failing.
Anyhow, for you, Mike? If you're not looking at the depression link you should. Happy to talk about it if you want--message me if you're keen on it.
J
This is fascinating! Yes, absolutely will look into this - I just found a Nature piece on it: https://www.nature.com/scitable/blog/mind-read/an_unconventional_release_from_depression/ From that, it seems to be linked to adenosine release, which tinkers with the electrical activity in the brain. It also seems to be a one-off effect - "however, after 72 hours of sleep deprivation there was no change in adenosine levels, as the astrocyte cells had largely shut down by this point" - so it'd be a bit of a "pull lever to stop the train" thing, and when the train's stopped, it can't go any slower?
Anyway, thank you! Will investigate.
In university I did a 24-hr roller-skating and was awake for nearly 40 hrs altogether. Felt not too bad.
Jump forward 25 yrs and I thought I could stay up easily but without the physical activity. Nope. Hallucinated an entire forest on a lot and thought I was moving sideways while going forward.
For my job, I’ve often spent more than a month in a tent or sleeping under the stars before and after bug season. Highly therapeutic. Getting good sleeps while also being aware of disturbances. Eg registered the calls of Long-tailed Ducks migrating overhead; woke up suddenly at 3 am-ish because I’d felt something change—it was cloud moving in. I crawled under a tarp and shortly after rain started.
"...thought I was moving sideways while moving forward" sounds an absolute nightmare. Yikes.
But you've just reminded me (thank you!) of a time I worked night shifts in a pottery and built up a huge sleep debt over a few weeks, then one day I set off for work and when I got to the bottom of my road, I started wondering why I was moving so slowly. Then I realised. It was because I'd walked, rather than taken my bike. I wasn't cycling, but some part of my half-sleep brain thought I was. Just the *weirdest* thing.
Also, rain on tent canvas: holy hell, I've had some lovely sleeps with that going on.
How much does your job get you outdoors, then?
Depends on the year. Some years I’m out spring to fall with breaks in between. Other years there are enough jobs closer to towns that I can stay in motels or bunkhouses and seldom have to be in a tent.
I’m a wildlife biologist or field scientist/ecologist who does contract work for various companies (biologist for hire). Lots of variety.
That does sound weird walking yet partly thinking you were cycling. I wonder how that sort of thing happens in the brain.
Melatonin works for me too! I especially like Source Naturals brand from Canada.
Thank you! I was actually looking for a different brand to try, and I found there's a way to get it in the UK. So I'll give that a go.
Wow! And how did you feel after 6 days of it?
I wonder if that 48-hour-mark "I am queen of the world!" feeling was related to what James Horton mentioned in a previous comment, associated with the feeling of goodwill from adenosine release?
(Or possibly not: I just checked the common side effects of adenosine administration and they're "skin flushing, lightheadedness, nausea, sweating, nervousness, numbness, and a sense of impending doom." Yikes.)