Positive Psychiatry - with Rakesh Jain, MD

Magical Sleep: The Ultimate Positive Psychiatry Intervention

• Rakesh Jain, MD

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What if the strongest lever for mental health is the one most of us neglect every night? We make the case that sleep is not a luxury but the biological foundation that makes therapy, medication, and daily life work better. Modern lighting, screens, and social jet lag push a Paleolithic brain into chronic hyperarousal, turning insomnia from a nuisance into a driver of depression, anxiety, substance misuse, and even suicide risk.

We unpack why insomnia often precedes psychiatric illness and how that reframes care from symptom-chasing to true prevention. You’ll hear how sleep loss derails prefrontal control, amplifies amygdala reactivity, blunts reward processing, and narrows cognitive flexibility—then we pivot to solutions. Treat sleep as a system, not a switch: align sleep drive and circadian timing, use light as medicine, and deploy CBT-I to recalibrate the nervous system. Stimulus control, sleep restriction, and cognitive decatastrophizing reduce conditioned arousal, while smart circadian habits and precise melatonin timing support natural onset. Medications have a place, but we discuss architecture trade-offs and how to use them thoughtfully.

Beyond symptom relief, we explore sleep as human capacity building. REM functions like overnight emotional therapy, easing fear memories and restoring psychological flexibility. Deep sleep supports synaptic homeostasis, metabolic clearance, learning, and memory—fuel for creativity and problem-solving. We share practical strategies for adolescents and older adults, the promise of digital CBT-I for access and scale, and a positive psychiatry playbook that treats sleep as preventive medicine and a path to resilience and meaning.

www.JainUplift.com

Rakesh Jain, MD, MPH:

If I asked you what's the most powerful mental health intervention, not the most expensive, not even the most novel, not the most controversial, but the most powerful. And most people would say the most powerful mental health intervention may be medications or psychotherapy, and others might say exercise, mindfulness, or maybe even purpose in life. But today I'm going to make the case that we have been missing something even more fundamental, something so basic, so biological, and so pervasive that when that breaks down, everything else struggles to work. Would you like to guess what we are talking about? Yes, indeed. We are talking about sleep. Sleep indeed is the most powerful mental health intervention we have. Welcome to Positive Psychiatry with Rakesh Jan. This is Rakesh, and this is the podcast about moving beyond symptom reduction towards resilience, flourishing, and of course the entirety of the human experience. And in today's episode, I'm focusing on sleep because I think sleep health may be the most underappreciated pillar in all of modern day psychiatry, and I hate to say it, in all of modern day society. So here's the truth. We are in a global sleep crisis. Did you know that we modern humans are sleeping less than we ever have in recorded history of hundreds of years? So let's start with a simple truth. Humans are sleeping less, and what little sleep they're getting is worse than at any other time in recorded history. And across industrialized nations, average sleep duration has dropped by 60 to 90 minutes per night over the last century. And insomnia disorder now affects 30 to 40% of adults. And chronic insomnia disorder, which is where we healthcare professionals get involved, that's a strikingly large number at 10 to 15%. But here's the most troubling part. Like that wasn't bad enough, right? Sleep problems are in fact no longer confined to adulthood. Children, adolescents, college students, high-functioning professionals, physicians, psychiatrists, nurse practitioners, PAs, social workers, psychotherapists. Gosh, name it, no group is spared. Let's appreciate this is not an individual failure. This indeed is a systems-level biological mismatch. So in this next segment, we will look at what's the evolutionary mismatch and why our brains are confused. Well, our brains evolved for not centuries, for thousands of years, hundreds of thousands of years, evolved under three conditions very dark nights, consistent light dark cycles, and predictable daily rhythms. Guess what? All three of these have been violated by modern day life. So check this out. Artificial lighting delays melatonin secretion. Screens stimulate the arousal system. Shift work disrupts arcadian genes. Social jet lag fractures biological timings. If we are asking a Paleolithic brain to sleep in a 24-7 digital casino that we live in that we call modern day life, honest to God, how could we not have this dramatically rising rates of sleep difficulties? And the brain is responding exactly as biology would have predicted with hyper-arousal. So insomnia is not failure to sleep. It's more complicated than that. It is hyper-arousal. This is a very critical reframing. So insomnia is not because of our laziness, of lack of discipline, or poor motivation. In many ways, insomnia nowadays, for the most part, is a disorder of excessive wakefulness. So neurobiologically, insomnia involves elevated sympathetic tone, increased cortical metabolism at night. These two are the complete opposite of what should be happening. On top of that, we have failure to downshift into parasympathetic dominance, which happens at night. By now you know the balance between sympathetic and parasympathetic system pretty much drives the autonomic nervous system, and disruptions in the ANS are strongly associated with psychiatric disorders and sadly also with cardiovascular disorders, cerebrovascular disorders, and WHO data shows even with increased risk of developing cancer. So the brain is in fact trying to protect us, not sabotage us, but this protection of hyperarousal when it's chronic in fact becomes pathology. It becomes chronic insomnia. I say we now turn our attention to better understanding the human emotional brain when it gets too little sleep. So when we have sleep deprivation, it selectively seems to impair our prefrontal cortical regulation of mood and affect. But hold on, there's more trouble in paradise. Our amygdala does not function well. It is more alert when it shouldn't be, which therefore sets off threat signals. People with sleep difficulties have more irritability. They're more prone to PTSD. They're more prone to anxiety. On top of that, reward processing is impaired. People with sleep difficulties, chronic sleep difficulties, often underappreciate the positives in their life and they become less cognitively flexible. So you can see people with insomnia often are quite irritable with their spouses, with their children, in life in general. This is not their fault. They are living in a paleolithic brain that's being forced to live in this 24-7 circus that we call the modern day life. So we actually do have an explanation of why poor sleep leads to lower frustration tolerance, it amplifies anxiety, it genuinely worsens depression, versus cognition, and because this is an episode on positive psychiatry, it is also an enemy of positive valence, of the ability to feel enthusiastic, energistic, optimistic. All of those things are just impaired very quickly. It can fall apart within a day or two after poor sleep. So blunted pleasure and motivation is sadly also a consequence of sleep difficulties. So in positive psychiatry terms, sleep loss erodes both hedonic and eudaimonic well-being. Both the sense of pleasure, but also the sense of everything is okay. We are now left to perhaps deal with this inconvenient question, which is why does psychiatry historically minimize sleep? Why? I was trained in psychiatry. I was offered exceptionally little training in sleep difficulties. Honestly, why is that mistake being made? Why has sleep been treated as a secondary problem? I think we should talk about that. Part of it is that diagnostic systems prioritize daytime symptoms. We talk about depression, we talk about anxiety. These are generally speaking problems when people are awake and functioning. We often completely forget about the one-third of the person's day. And because we have time-limited visits with our patients, we focus on these symptoms and not sleep, sleep hygiene, sleep wellness, sleep health. On top of that, our medications often cause sedation, but don't necessarily restore the architecture of sleep. So training historically has separated sleep medicine from psychiatry. That's a bad mistake, don't you think? So much of psychiatry is in fact sleep medicine. So here I am in my 60s, trying to catch up as fast as I can to become better at understanding sleep and how to treat it. So sleep has sadly become just a checkbox symptom and not a central target. I say we need to change this. We're now going to transition and talk more about insomnia as a cause, as a consequence, and as a predictor, all under the conversation of positive psychiatry. One more time, this is Rakesh Jan, and you are now listening to this podcast called Positive Psychiatry with Rakesh Jan. Okay. Earlier we talked about why modern humans are sleeping worse than ever, and how biology, technology, and culture have collided in a way that leaves the brain stuck in a state of hyperarousal. Now, I would like to take the conversation deeper and make it even more clinically relevant. Because insomnia is not just something that coexists with mental illness. Insomnia, in fact, can cause mental illness. It's a bi-directional relationship. And by the way, insomnia, when left untreated, it can quietly undermine every other intervention we offer. That's like leaving cash on the table by not thinking about and treating sleep difficulties. Let's look at this old model and examine it against this new model of insomnia. Because for decades, psychiatry has treated insomnia as a secondary symptom. And the logic went something like this Well, if the patient is depressed and having trouble sleeping, treat the depression. Everything else would be better. We thought the same thing about anxiety, about psychosis, everything. We kind of think that sleep is just coming along for the ride. Well, this model initially felt logical, but the problem is it's wrong. It's wrong. Modern longitudinal data shows something else is profoundly important because insomnia often precedes psychiatric illness, not the other way around. Did you hear what I said? It's such an important point. Will you please allow me to repeat it? I kind of wish I knew this. Almost 40 years ago when I started clinical work, insomnia often precedes psychiatric illness and not the other way around. That's the truth. And in many cases, sleep disturbances appear weeks, months, years before things like major depressive episodes or anxiety disorders or substance use disorders and even psychosis. So insomnia is not merely a symptoms, it's a pathophysiologic driver of disorders. So if we look at insomnia as a risk factor for depression, which we should really do, what we find is that prospective studies consistently show that individuals with chronic insomnia have a two to four fold increase in developing major depressive disorder. That's 200 to 400% greater risk. Not only that, if insomnia is present, there's a higher rate of relapse back into depression. And by the way, these folks also have a poorer response to antidepressant medications. So we have three reasons right in front of us. Good reasons that we clinicians should selfishly be thinking about sleep early, often, and repeatedly. And this is not a subtle point. It's a really important point because sleep disturbances impair emotional regulation. They increase negative cognitive bias. They reduce reward sensitivity, which is a major pillar of positive psychiatry, and it amplifies rumination. This is a very unholy quartet of things I just talked about. So let me phrase it another way. Insomnia creates the neurocognitive soil in which depression grows. So from a positive psychiatry perspective, which I truly believe is at your core as well, otherwise, I suspect you won't even be here conversing with me. This is a crucial point. We cannot cultivate hope and meaning and vitality in a person whose brain is biologically exhausted because of sleep difficulties. I'm going to now talk about anxiety and sleep difficulties. And of course, anxiety disorders are primarily a disruption of the threat. No wonder anxiety disorders and insomnia are deeply intertwined. But again, the direction matters. So think about sleep deprivation. It heightens amygdala reactivity, it weakens prefrontal inhibitory control, it increases threat detection and error monitoring. That is a triple trouble. The brain therefore becomes hyper-vigilant. Patients often describe it perfectly. They will say things like, my mind won't shut off. And this is not a metaphor. It's not a metaphor. It's biological reality. So when insomnia persists, worry becomes more rigid, it becomes more sticky. Fear conditioning strengthens until it becomes behaviors. Physiologic arousal remains elevated. So now these folks have other challenges, such as hypertension or impaired glucose tolerance, obesity. So an anxious brain, when it has sleep difficulties, is not calibrating. And the relationship with substance use is also grossly underappreciated because insomnia increases the risk for you got it, alcohol misuse, sedative misuse, cannabis misuse, and quite interestingly, stimulant misuse. And that happens because so many people with insomnia face daytime fatigue, and stimulant misuse is often present. In fact, I often think caffeine misuse and nicotine misuse and other stimulant misuse. I believe insomnia is a significant driver because an exhausted brain is seeking relief. And many patients don't start substances to get high. They think by using these substances they are doing themselves good. But from a positive psychiatry lens, this is a tragic, understandable, but still tragic negative consequence. So when sleep collapses, the brain prioritizes immediate relief over long-term flourishing. And treating insomnia, therefore, is preventive positive psychiatry. Let's keep talking about the misfortune of these patients because insomnia is also involved in suicide risk elevation and the generation of despair. And this is truly one of the more sobering areas of research. So insomnia, particularly when it's combined with short sleep duration and nighttime awakenings and early morning awakenings. Please note I said three things. Short sleep duration, nighttime awakenings, early morning awakenings, is in fact associated with increased suicidal ideations, attempts, and quite sadly, deaths. Therefore, this risk persists even if we control for depression severity. Let's put it in other words, sleep itself, insomnia itself is a provocator of suicidality. This has been very well documented. And sleep fragmentation also increases emotional pain, reduces impulse control, and truly intensifies feelings of entrapment. You have been a clinician long enough to know that when a person feels this intense emotional pain and they have poor impulse control and they feel trapped, they don't feel they have any other way to get out of their morass, out of their challenges, out of this quicksand that their life has become. You can see, can't you, why suicide rates grow up so much. So a brain that has not rested literally loses its capacity to imagine relief. Now, let's talk about some hope. So far, I think I've given you a pretty steady stream of negative information because it is. But I would like to turn our attention in this positive psychiatry podcast to talking about hopefulness and why treating insomnia improves psychiatric outcomes. So when insomnia is treated with whatever means, but hopefully with CBTI, cognitive behavior therapy specifically designed for insomnia, guess what? Four things happen. Antidepressant responses improve, anxiety symptoms diminish, relapse rates drop, and daytime functioning improves. So, sleep treatment does not compete with psychiatric care. In fact, do the opposite. It amplifies it. Now, folks, this is positive psychiatry principle in action. Strengthening a core biological capacity in a patient, in a fellow human being, improves multiple domains all at once. I think we ought to appreciate that insomnia is an early warning signal. A large part of the listenership of this podcast are in fact not clinicians, but highly motivated, educated individuals who really want to embrace the core principles of positive psychiatry. And I think it's really valuable for all of us to appreciate that insomnia is an early warning signal. It is, in fact, one of the most underutilized ideas in psychiatry that sleep changes are the first sign of a relapse. In fact, so early, they come before mood shifts, they come before behavior shifts, they come before the full syndromes emerge. So when a patient says something as straightforward as, I'm not sleeping like I used to, we clinicians should jump at it because this offers us a window of opportunity for prevention. Sleep tracking, clinical sleep tracking, not obsessive sleep tracking, can become a powerful tool for early intervention, relapse prevention, and personalized care. So the vicious cycle and how we can interrupt it is to think in the following manner. We know that insomnia feeds mental illness. We also know mental illness worsens insomnia. So it's a cycle. This cycle needs to be broken. Now the key insight here is we don't need to fix everything at once. But by targeting sleep, what we will achieve for the patient is improving emotional regulation, improving cognitive flexibility, improving energy, and interestingly, improving hope. I know hope is often thought to be a psychological phenomenon, which it is, but it's quite dependent on the internal biology. And sleep being such a major driver of internal biology, hope does become biological. So we have hopefully completely reframed insomnia. I hope I succeeded in that. That it's not just a secondary symptom, it's not a side effect, it's not something to deal with later, but in fact, it's a central driver of mental health and mental illness. So now let's turn our attention to treatment. We'll talk about what actually works, why some interventions fail long term, and how circadian biology and behavior and psychology come together in powerful ways. And this is where science meets practice. So let's do this. Let's continue this conversation because we have just reframed insomnia as a cause, consequence, and predictor of mental illness. But now comes the most important question of all. Of course, the question is what actually works? Not just what sedates, not what knocks people out temporarily, but what restores sleep as a biological system. So now we're going to turn our attention and talk about repairing sleep physiology. Here's the core principle. Sleep is a system, not a switch. Because one of the biggest mistakes we make in clinical practice is to treat sleep like a light switch. Off, on, off, on. But sleep is not binary. Sleep is a complex, self-organizing biological system. And it's governed by two forces. It's governed by our sleep drive, which is how long have you been awake? What kind of sleep debt have you developed? The second is circadian rhythm. This is when your brain believes when it should be asleep. These two have to come together the right way for us to sleep well and to have good sleep health. And of course, when they don't, trouble in paradise occurs. So insomnia does occur when these systems fall out of alignment. And most treatments do fail because they try and override the system instead of resetting it. So now you're going to hear from me, even though I'm a prescribing clinician, I have the power of the pen, the prescribing pad. You're going to hear from me that cognitive behavior therapy for insomnia, also affectionately called CBTI by all of us, is indeed the gold standard. Heck, go ahead. Make it the platinum standard if you would like. Because it's not simply therapy for sleep, it's in fact a neurobiological recalibration strategy. Impressive stuff. Let's talk about it. And CBTI works because it reduces conditioned arousal. Some people just believe because of the way they're being raised or society or their job that this is what sleep is. They get conditioned to be aroused. We have to find a way to reduce it, and CBTI does that. The second thing it does is strengthens the homeostatic drive pressure. So sleep restriction, interestingly, is a critical tool of CBTI. It also helps restore circadian timing. CBTI is very driven towards not just correcting sleep, but correcting sleep at the right time of the 24-hour day for the patient. And finally, it dismantles this issue of fear-based beliefs people have about sleep. All of us, all of us, you, me, every listener, everybody out there, we have some distinct beliefs about sleep, many of them accurate. Sadly, many of them are not. So CBTI does not aim for perfect sleep because that doesn't exist. What does exist is stable sleep, and this distinction matters. So let's talk about it. The first thing we have to touch upon is stimulus control, reteaching the brain what the bed is for. So stimulus control sounds simple, but it is powerful. The goal really is to retrain the brain to associate the bed with sleep. Not with worry, not with rumination, not with scrolling, not with problem solving. Get this. The next thing I want to talk to you about is sleep restriction. I know, I know, that's completely counterintuitive, but it is essential. Are we talking about sleep restriction in someone who's got insomnia? Yes, we are, but hear me out before you think I've lost my mind completely. Because sleep restriction is often the most misunderstood component of CBTI. Sometimes it even sounds cruel. It sounds counterproductive. But here's the reality. Insomnia fragments sleep by spreading it too thin in the 24-hour day. So what sleep restriction does is it consolidates sleep, increases sleep efficiency, and it also strengthens the homeostatic drive. So what you do in sleep restriction is literally decide what time to go to bed, but quite importantly, what time you do have to get out of bed. I know you're tired. I know you like to sleep hard in the morning hours, even though you're supposed to be up at seven. Your best sleep is from 7 to 9, but life won't let you do that, so let's just get up at 7. We're actually restricting your sleep. Obviously, this leads to a great deal of increased sleepiness in the daytime, but that's temporary. That's temporary because this approach, as I said a minute ago, improves sleep consolidation, improves sleep efficiency, and strengthens homeostatic drive to sleep in just a few days. That's why sleep restriction, weirdly, is one of the more powerful ways to help people with insomnia. What about cognitive work? What about these misconceptions we all have and people with insomnia far more than anybody else about, well, their sleep. So we have to disarm this sleep threat narrative most patients have. Many patients are not afraid of insomnia. They're afraid of what insomnia will do to them. It's thoughts like if I don't sleep super well tonight, tomorrow will be ruined, or I won't be able to function at all. Or maybe this problem will never get better. I've got it all my life. See, the problem with these thoughts are these thoughts activate further the threat system. So now they're overactivating and overactivating, overactivated system. You can imagine what happens, right? Yeah, they have more insomnia, they get more worried. So CBTI doesn't argue with these thoughts, it just decatastrophizes them. So instead of telling them, no, you are worrying for all the wrong reasons, is perhaps to ask them simple questions like, okay, you've had insomnia for 15 years. How many times have you actually lost your job because you look tired at work? And most patients will say, Nope, that's never happened before. Or you can say something like, How many times have you fallen flat to the ground while you were in the shower because in the morning you were sleepy? And most patients will laugh and say, that's never happened before. So the gentle challenge to patients in the CBTI mechanism is, you know, let's just put things into context. Let's not argue with your thoughts. Let's just reduce the catastrophization that your brain has created, and let's just reduce it. Let's just reduce it, not eliminate it. We now look at circadian biology because timing is everything, and with sleep, timing is everything. So circadian rhythm is governed primarily by light, and morning light anchors wake time. Morning light advances our circadian phase, and morning light, interestingly, at nighttime, improves sleep quality. Now, evening light, oh the total opposite. Total opposite. If we are exposed to evening light excessively, it delays melatonin secretion. It sadly sustains alertness when I don't want it, and it sadly fragments sleep and creates trouble with sleep onset. So this is not about willpower. So if you command yourself after being overactivated till 10 o'clock at night, and you command yourself, hey, go to sleep by 10:15. You gotta get up at 5. Well, that's not gonna work very well. That's not going to work very well because that's retinal biology. Sleep exposure is the back of our eyeballs. The retinal biology projects directly, did we know this, to the hypothalamus of the human brain. That's the mood center. That is involved in almost everything psychiatry touches. One more reason why we need to appreciate the neurobiology of sleep and the way that CBTI very cleverly retrains the brain. So sleep optimization in some ways begins the moment we wake up, and it should not be discontinued anytime during the day. We should be thinking about that. And talking about thinking about it, can we talk about melatonin? Because melatonin is not a sedative, it's a signal. It's widely misunderstood. So that melatonin you and I produce doesn't knock us out. It just tells the brain, it's biological night, dear brain. And of course, if we suppress it incorrectly by exposing ourselves to light, then guess what? The brain doesn't get the text, the email, that it's time to start thinking about sleep. So it stays over alert, it stays overactivated, it stays over aroused. So what we can do is let's shift the circadian timing. Let's think about improving sleep onset, and sometimes, sometimes external melatonin at low doses given at precise times with clear expectation, that leads to improvement in sleep, but not sedation. The goal of menatolin is not sedation. Not that we've talked about CBTI, and by now I'm really hoping you heard from me from a positive psychiatry perspective. CBTI is the bomb. It is. It's terrific. It checks off all the boxes of a clinician who is deeply interested in positive psychiatry. Let's talk about sleep medications, shall we? And let's be honest with each other. We do know they help. We do know they harm also. Let's have an honest conversation because medications can be helpful. They're not villains. But if we're being honest, a large number of people who are using sleep medications are not getting what they need and often get trapped by these medications. So most hypnotics do reduce sleep latency and they increase total sleep time. But many of them also alter sleep architecture. They suppress REM, they can suppress deep sleep, and quite sadly, they can promote dependence. And that dependence can be either psychological or physiological or both. So, no, I'm not anti-medications. All I will say is there's a time and a place to use them, and the clinician needs to be very thoughtful when to actually deny medications as a treatment option or to delay it, when to offer it very quickly, and when to taper it, when to change it. Now, it is true about 10% of patients who have chronic insomnia can only sleep with the help of medications, and we should not demonize them. We should not make them feel like they are pill-seeking or drug addicts. But we should also be thinking about always thinking about CBTI first, thinking about CBTI second, and no matter whether a patient is or not on medications, CBTI principles should be taught, and we clinicians should be monitoring our patients for our patients' fidelity to CBTI tools and techniques. If medications are used, if we can, let's think about the lowest dose for the shortest period of time and hopefully pick a medication that has the least chance of harming and has the highest chance of a great benefit to harm ratio. That'd be another time to talk about sleep medication in in detail, but right now I think for us to elevate the cause of CBTI is quite important. All right, here's a real challenge, and I will not be dishonest about it, which is finding truly CBTI trained clinicians is very difficult, even in large cities. A lot of people say I do CBTI, but besides giving people a sleep diary, they in fact do not teach patients about CBTI. And that's a shame. That's why digital CBTI and scalable solutions are a major new development in medicine. So when we have well-designed programs, really digital CBTI can help regular CBTI outcomes. It of course improves access, reduces cost, and it can allow us to do population level interventions. And this is positive psychiatry at scale. We should be using science to build capacity and not just to treat illness, right? Capacity on behalf of the patient. Capacity, which literally translates into patient confidence, patient skills, and patient empowerment. So we should talk about integrating treatment because that's the modern sleep prescription. And the future of sleep care really is behavioral recalibration, circadian alignment, helping patients with thought restructuring, and very judicious pharmacology. It definitely is not an either-or, but a thoughtful combination. But it is close to impossible, if not truly flat out impossible, to be a positive psychiatry clinician, a believer in positive psychiatry, and not be an outstanding sleep health expert and advocate. It really is. I am now turning our attention to something even bigger, even brighter, and from a positive psychiatry perspective, I am going to make a statement that I suspect you're going to agree with me, which is sleep optimization is a tool for flourishing, meaning, and creating the best version of the human mind. Yeah, pretty bold statement, but let's see if I can back it up. So if we were to take sleep seriously, and we can appreciate, can't we, that modern day life is really messing with our Paleolithic brains. And we are, for the most part, nearly all of us, struggling to sleep well. We are quite aware now that insomnia predicts and perpetuates mental illness, and that evidence-based treatments do restore sleep as a biological system. But now I really would like to widen our lens because sleep is not just about reducing symptoms. Sleep is about who we become when the brain is finally allowed to do its deepest work. Did you know the deepest work the brain does is not when we're awake, but it's when we're asleep. Did you know it's only when we're asleep that the brain's drainage system, which is called the gymphatic system, opens up. It's completely closed during wake times. Did you know those things? Well, I didn't until just Just the last decade or so. Now you see why, as a positive psychiatry practitioner, I am so positive about controlling and addressing sleep issues. So we do need to move from symptom control to human capacity building. Because traditional psychiatry often asks things like, how do we reduce suffering? But positive psychiatry asks a different, but a complimentary question. How do we build your self-reliance and your self-capacity, dear patient? And sleep is one of those rare interventions that does both. Because by now we have well established, haven't we, that improving sleep means improved mood, improved anxiety, improved cognition. But beyond that, beyond that, improving sleep allows for our emotional depth to return, our curiosity to awaken, our motivation to feel natural again. So sleep does not just fix what is broken, it in fact restores what was dormant. This is why for centuries people have said, if there's a problem, sleep on it. What they're literally saying from a biological perspective is allow your brain to rest properly, because to flourish tomorrow will require that sleep. So how do we integrate REM sleep? REM sleep with emotional integration and psychological flexibility. And of course, REM sleep is one of the most fascinating states that the human brain enters because during REM, emotional memories are reprocessed, right? Fear responses become softened, which tend to work something out really important in our REM sleep. And salience is recalibrated. And of course, patients who have insomnia, they have less REM sleep. They have REM disturbance. So think of REM sleep as overnight emotional therapy. Did you catch that? Let me say that again because that's a big deal. Think about REM sleep as overnight emotional therapy. Sure, the patient is asleep, but the brain is engaging literally in therapy. Because the definition of therapy is improvement. By God, my statement was not a hyperbole, it's accurate. When sleep is disrupted, particularly REM sleep, patients actually feel more emotional pain. They have more trauma memories, and they have more negative affect. So when REM sleep is restored, emotional experiences become more digestible. They assimilate them better. Psychological flexibility increases and their perspective returns. And this, none of what I've said, is in fact a metaphor. This actually is neuroscience. And really, can we deny this obvious fact? Modern-day science is showing us people who experience substantial amounts of healthy deep sleep, they also have higher degrees of neuroplasticity and cognitive renewal. Because deep sleep, also known as slow wave sleep, is where synaptic homeostasis occurs, metabolic wastes are cleared, and learning is consolidated. So the best way to learn something is to do something today, have exceptional sleep tonight, and tomorrow, the odds are much higher. What we learn today will in fact become memory. Because the sad news is a brain that's deprived of deep sleep becomes mentally rigid and cognitively inefficient and emotionally brittle. Really, I don't want to be rigid, inefficient, and brittle. Well, if I don't want to be that, I better have plenty of slow wave deep sleep because I like to be adaptable and efficient and resilient. And by the way, so does everybody else I've ever met. Now, folks, you see why this episode of positive psychiatry is all about sleep. So sleep is also connected to creativity and insight. You've probably heard of a lot of writers who will on purpose stop what they're writing, or poets who are writing, if they're stuck, they stop what they're writing, and they literally get a good night's sleep. And when they wake up, there have been reports by these writers and poets for hundreds of years that, quote unquote, something got solved, something happened, creativity arrived. The truth is, they're right. Sleep and creativity and insight. I think most of us underestimate the role of sleep in creativity, because sleep facilitates associative thinking. It allows for novel connections to emerge. We see things that we didn't see yesterday. Part of it is if it's sleep. Had we had poor sleep, the chances are much lower that would have happened. This is why insights often arrive right in the morning, after rest, and following periods of consolidation. So a well-rested brain solves problems creatively. And if we really do care about innovation and growth and meaning, sleep is not optional. There's one age group that does worry me probably more than others when it comes to sleep problems, and that of course are two groups of people really adolescents and the elderly. So two bookends of human life. So sleep across the lifespan. I think we ought to think about adolescents because they desperately need their circadian protection and their school is not thinking about it. Culture isn't thinking about it. Truthfully, even adults now need consistency and alignment. But older adults need all of that, but they need the preservation of deep sleep and timing. So sleep optimization simply can't be, you know, one size fits all because it's developmentally informed care. But the truth is, across a lifespan, sleep remains predictive of either good or bad. It remains deeply modifiable. There's never been an age group where sleep interventions don't help. And by the way, sleep remains a very powerful modulator of mental health and mental well-being. So if you're a believer in positive psychiatry for adolescents, children, adults, and our elderly, the geriatric population, guess what? Sleep is indeed your very best friend. So finally, we talk about a positive psychiatry sleep prescription. So if I had to summarize a positive psychiatry approach to sleep, it would almost certainly include things like teaching myself, teaching my colleagues, learning myself, asking my colleagues to learn, to teach their patients to respect sleep as foundational human biology. The second point would be if insomnia is detected, even the mildest of insomnia, treat it early, treated directly. Third thing, circadian rhythms have to be restored. They have been shot to smithereens by the industrial revolution humans went through maybe a hundred, hundred plus years ago. But this internet revolution in the last few years has genuinely decimated our circadian timing. The fourth point I would make is if you do use medications, go for it. It's not a crime, it's not medical malpractice. It's just please do consider using them thoughtfully and not reflexively. And finally, let's reframe our belief system about sleep completely. Let's look at sleep as a gift. Let's look at it as a necessity for good mental health and physical health. And let's look at it as an issue of such great importance to talk about sleep the way we are right now needs to happen a lot in modern-day society. Sleep is something we genuinely are in need of talking about as often as we possibly can and to address it as we need to do. So the future of psychiatry, I genuinely believe, is to be sleep aware, to be conscious about sleep, to be thoughtful about sleep. We should all start thinking about sleep as preventive medicine. We should use sleep data. Most everybody now wears a smart watch. If you do get data, use it intelligently. Integrate behavioral and biological care. CBTI is terrific, but sometimes it needs friends. Let's do it. Sometimes the problem with sleep is not with a person, but maybe a couple. Think about what the different biological rhythms might be in a family and try and address it. And of course, educating people that if positive psychiatry and positive mental health is your goal, sleep is one of your very best friends. So at the very end, I will leave you with this thought that the human brain did not evolve just to be productive, it also evolved to be rested. Because rest allows emotions to soften. Rest allows meaning to surface. And rest allows the mind to become more flexible again. And of course, you guessed it, sleep allows for this rest at its deepest level. So in positive psychiatry, we're not just reducing symptoms, are we? We're restoring the conditions for a good life. And it begins quietly and biologically and profoundly with, you got it, sleep health, sleep wellness. Well, thank you, dear friends, for listening to this episode of Positive Psychiatry with Rakesh Jan, and I look forward to talking to you down the road. Goodbye.

Contributor

Rakesh Jain, MD

Host