I understand this is correlation not causation, but we have tons and tons of evidence for the negative effects of sleep deprivation.
Color me highly skeptical that there are negative effects associated with sleeping 8.5+ hours, up to say, 11 hours. Beyond 11 hours of sleep, I can see an argument being made for physical morbidity from lack of movement etc. But 8-9 hours of sleep nightly - my guess would be that people who get only 7 hours of sleep tend to be more successful, have jobs and families, and access to health care. Whereas those sleeping 10 hours a night are less likely to have the income to get health care when necessary.
In other words, I'd be interested to see studies which test the hypothesis that sleep deprivation has a causal effect on morbidity, while excessive sleep only has a correlation.
Let me reveal some of my personal health for this discussion.
I was diagnosed with minor sleep apnea, and my doctor prescribed an anti-snoring mouthguard (a $1000 device that is basically a mouthguard with a screw in it... ugghhh). Costs aside, the device works, and I've been getting LESS sleep recently.
Why? Because 7ish hours of sleep is all I need now... because I'm not getting minor "self-wakeup events" during night. Before this mouthguard, I needed 9ish hours of sleep to feel rested.
The mouthguard definitely works (for my case anyway. I did some research and its apparently because I've got a large tongue or something, which means my snoring / sleep apnea could be cured by a mouth-guard forcing my jaw into a different position). Apparently, other cases of sleep apnea can only be solved with a CPAP, while still other cases of sleep apnea can be solved with a simple "sleeping backpack" (to prevent sleeping on your back).
---------
Undiagnosed Sleep Apnea is associated with longer sleep, less-restful sleep, and a variety of ailments like obesity and high-blood pressure. I don't think cause-and-effect has been figured out yet (maybe obesity causes sleep apnea, or maybe vice versa).
It is quite possible that excessive sleep is correlated with a variety of sleep-issues, like Sleep Apnea. People who fix their sleeping issues may live longer, higher quality lives.
The _Why We Sleep_ book that everyone's been recommending lately (and I will also add my recommendation) says exactly this. There is no known evidence that anyone has ever been harmed by too much sleep. Rather it seems that people who sleep for an extra long time could have some health problem or sleep issue which causes their body to need more.
I suspect I may have a condition similar to yours. I googled anti-snoring mouth guard and came back with $50-100 solutions, but no "bolt" inside that I could see. What differs between these and yours? Can you give more details eg a brand, a picture, or better description?
The doctor gave me a Somnoguard AP2. I'm not entirely sure why it cost me $1000 from them... but that's what it cost from the doctor. Its clearly cheaper online. Perhaps I should have asked for a prescription from them and ordered online... but its too late now.
I also had a take-home sleep study, consultation fees, etc. etc. on there. I think that maybe I just didn't understand my options as a consumer and I did this suboptimally from a financial point of view.
In any case, the overall industry and regulations DON'T want you to be self-diagnosing things. I think it makes sense to go into a sleep doctor, and first order a take-home sleep study. You pretty much get some weird device hooked up into your nose and a few sensors on your head, and they'll take... some kind of sleep measurements. (Brainwaves? The nose thing probably was recording my breathing patterns, I dunno, I'm not a doctor. They did say a microphone was in the device too, so I guess they're recording the noises I make when I sleep).
I know some people with more extreme conditions may need to do a full-scale sleep study in a specific room. But these are more expensive. Its pretty much a hotel-room, except doctors are measuring all sorts of things while you sleep.
After those measurements, the sleep doctor probably will try and figure out which device is appropriate for you. Its pretty clear that the Somnoguard AP2 can only solve minor sleep apnea issues caused by tongue blocking during sleep: it just shifts the jaw forward by about 3mm to 5mm or so and holds it there during sleep.
----------
In any case, I'm overall happy that I've got my problem fixed. My only regrets is that I'm not really used to interacting with doctors. So I'm pretty sure I could have optimized my gameplan better and possibly negotiated a cheaper bill. But at least I've gained experience... I'll know what to do when my next health issue comes up.
I am sure you can find some in this style for even cheaper, maybe around $20. I had sleep apnea for the last 18 months, which got so bad that I couldn't hold down a job or do much of anything. I would sleep around 14 hours a day, which sounds crazy, but every time I hit REM I would just wake up. So, it would take around 12-14 hours to finally accumulate enough REM to not feel totally fatigued. I would typically wake up around 3pm and just loathe around without much energy waiting for the following night's choking spell.
I tried it all. CPAP, sleeping with tennis balls on my back, a backpack, sleeping face down on a massage table, sleeping upside-down (don't try that). Anyways, for me, the mouthguard I linked was the item which provided the most relief. I went as far as to jury-rig the device into extruding my lower jaw out even further than it was designed to by using some screws to separate the top and bottom even more extensively. It actually gave me a terrible underbite, because at night the pressure from my lower jaw pushed my top teeth back further into my mouth. But, I was able to sort of sleep, and it probably saved my life. Sleep apnea is no joke.
I ended up getting three surgeries, the last of which was just last week and from which I am still recovering. It feels like I am finally cured, and boy, does it feel good to finally sleep.
edit - Oh and if you have any questions please feel free to reach out. I have several lifetime's worth of experience in this area now after working so hard to have this resolved. Email is in my bio.
why did you need three surgeries? i had double jaw surgery done and while it improved my jaw, the unresolved issue is my poor TMJ, which the surgeon pointed out. when i sleep on my back, my jaw still falls open and my tongue slides back into my airway.
i am hesitant to use the mouth guard because i don’t want my upper jaw sliding backward. my solution now is to side sleep. help!
Sorry! Try nikk @ getfractals dot com. Changed my bio recently and forgot.
That's pretty insane that you had that surgery; I heard that's one of the most intense treatments they have. Was it specifically for the sleep apnea?
I am very familiar with the jaw falling open/tongue sliding back. I tried a headstrap + mouth taping + mouth guard combo for a while which was often able to keep the jaw in place, but it's finnicky, and sometimes slips, causing the jaw to fall back in deep sleep. Another option I tried were the 'tongue retainers', which pull the tongue forward, but, from the literature I've read, they may or may not prevent the base of the tongue from collapsing backwards. Very subject dependent; I didn't have good results, personally.
Anyways, for my personal case, it turned out that I had enlarged lingual tonsils which were pressing on my epiglottis and causing it to collapse back into my throat. My epiglottis was 'floppy' and collapsed over the airway particularly in REM. The treatment was a lingual tonsillectomy. After that treatment I still didn't feel better and had another endoscopy with a different surgeon which uncovered that my soft palette was collapsing; the treatment for which was this, [0] a treatment which essentially sewed my soft palette down and removed my palatine tonsils.
The whole thing was a nightmare. I'm 5'7 140lbs so maybe 4-5% body fat, in shape, 27 y'o. Outwardly in shape, basically. I'd go to doctors telling them I was not able to achieve refreshing sleep, and they'd tell me I was either depressed or had some psychological disorder. Around four our five dozen doctors told me this. My cries fell completely on deaf ears. To confound things even further, I had four in-lab sleep tests and around 5-6 at-home sleep tests, almost all of which were completely absent of sleep apnea. When pushing for another endoscopy/surgical remedy, one surgeon said, "why would I operate on you? you sleep better than I do." I wanted to cry; so frustrating.
The practitioner that you choose matters; as there are relatively few in the world who understand the complex anatomy of that area and can suggest the particular surgical treatment that's most likely to relieve your symptoms. You'd be surprised to find out that most sleep apnea surgeons provide the same blanket surgery, the UPPP, to all of their patients, independent of the patient's particular problem areas/issues. Not to say UPPP doesn't work for anyone, but, it only addresses correcting a very particular subset of problematic tissues, when the patient may be having collapse in an entirely different part of their airway. The over prescription of the UPPP and most doc's reluctance to attempt to properly diagnose a patient's particular issue is a major reason as to why surgery is often seen as ineffective in sleep apnea treatment and cpap is still the 'golden standard'. I think this will change as cutting-edge research continues to slowly disseminate through the field; but it will probably be a long time before your average sleep surgeon becomes versed in cutting edge techniques.
I am absolutely convinced that Dr Eric Kezirian in Los Angeles saved my life and couldn't recommend him more highly. He has a blog with tons of useful information [1] if you're interested. Even better, I don't think there was a single email I sent him that he didn't respond to within an hour. It's a crazy dichotomy to have an expert surgeon who is also highly available and helpful.
I have to warn you that I spent a lot of money on one of those and it simply did not work.
CPAP was my salvation.
Glad to see it works for some people, but for me I felt scammed by the doctor that after a while simply said "you should find a way to control your jaw while asleep, it's a mental thing".
The doctors at the sleep center were happy to prescribe the CPAP machine (which their "partner" business supplied), as well as prescribing sleep meds and scheduling regular checkups on me.
Interestingly enough, at the end of my sleep study the technician commented to me that I appeared to have a deviated septum and perhaps I should have that looked at. The doctor who reviewed my study didn't mention that and never suggested I see an ENT for a second opinion.
Instead, I was pitched an implanted device that would ostensibly "cure" the apnea (no thank you!).
I did see an ENT, did get surgery and now sleep soundly. I've never gone back to that sleep center where they were only interested in extracting as much money from me as possible.
The first time I tried a CPAP, it just did not work for me.
Instead I bought a "boil-n-bite" mouthguard off of amazon and it worked great! ... for about 6 months or so.
At that point, I went back and pursued a CPAP and by changing from the over-the-nose headgear to the nasal pillows I finally found something that works for me.
("nasal pillows" - a euphamism if I've ever heard one)
Sleep Apnea is literally when you (mildly) choke-yourself while sleeping and can't breath. If the mouth-guard falls off easily and causes a choking hazard, then the mouthguard is worse than the disease.
I know there's online discussion about chin-straps moving the jaw forward. That's closer to something I think I'd be willing to experiment with. I don't see much potential choking hazards or other problems.
At $15 you should try that before forking $1000 (on something that you can get for $150 outside the USA, btw).
Also mouth guard don't cause choking hazard.
I had a dentist prescribed/adjusted MAD which cost $400. I hated that thing. I purchased a $10 nightguard at Target, less intrusive, smaller, more flimsy and flexible version, at target. It works great and last 6 months.
Its not like I'm on Amazon checking prices while the doctor is talking to me. And its not like doctors tell you how much something costs until after they give it to you. These things are mostly "do as the doctor says" and then look at the bill later.
In any case, a lot of the mouthguards are just bruxism / teeth grinding protection. I'll let you know that "pushing the jaw forward" is how my device works.
Other people have linked cheaper stuff from various places online which seem like they push the jaw forward. But most dental-guards I see at Target / CVS / etc. etc. are just bruxism protection, probably not designed for sleep apnea.
------------
Now that I know what I have and can do comparison shopping, the thing that has gotten good reviews seems to be "ZQuiet". Seems to be well reviewed by 3rd party websites, and not super-expensive. $80 or so. https://zquiet.com/
Another person upthread claims they got good results from something from Amazon, but I couldn't find much information about that company or website.
I tried a mouth-guard but found it quite uncomfortable. Had one very vivid dream of coughing up a slurry of screws and other fasteners.
CPAP works well for me (when I use it). ADHD -> low conscientiousness -> not always using the CPAP if there's a minor obstacle. E.g. unfolded laundry on the bed can derail me to the couch since I'm usually very tired / low willpower by the time I go to bed.
I've been thinking of a machine vision project: the system yells at me to get up and go to bed if I fall asleep on the couch. Externalize your rationality through cybernetics.
Matt Walker makes this point in his book (at the risk of sounding like a shill). One group of people who sleep abnormally long hours are those suffering from various illnesses - they sleep more either as a result of the illness or while in recovery. Some of them may die. This group potentially skews results and increases the mortality rate of long sleepers. There is no evidence I'm aware of (nor does the book give any) that oversleeping is harmful in itself.
Every single causal link made in epidemiologic studies will have potential confounders that need to be adjusted for. I'd be shocked if anyone could think of a causal link without a potential confounder, never mind that we may have unknown/unmeasured confounders that aren't even top of mind.
This is exactly what I started writing before I saw your post. :)
(Does that make this a discouraged “me too” post…?)
TFA correlates _more_ sleep with increased mortality, but barely speculates on cause, and lumps too much, and not enough sleep together in discussion. With respect to the question of how more sleep might be bad, the article states: "[...]one can speculate that these folk, who have lower moods and more worry, might struggle to get to sleep or to get up promptly in the morning. Lower scores on extraversion were indirectly linked with increased risk of death, thanks to an association with greater daytime feelings of fatigue (perhaps extraverts’ greater daytime activity levels makes it easier for them to get a satisfying night’s sleep, but this is speculation)."
Anecdotally, I think sleep deprivation increases my neuroticsism and decreases my extroversion, so I feel like positive feedback could exist. This makes it harder to do the things that seem to me to improve sleep and mood, like aerobic exercise, exposing oneself to natural light cycles, and other people, and keeping a consistent personal routine. I feel like I have spent periods in a meta-stable state of insomnia after pushing myself too hard because of crunch time, international travel, etc.
I suspect that "excess" sleep may be correlated with chronic health problems like mood disorders (like depression), or auto-immune disorder. These problems are known to be suggestively correlated with each other, and also with sleep problems.
This stuff seems complicated enough to be pretty hard to figure out, and I think you are right to be skeptical about the direction of causality. Pretty sure not sleeping enough is still bad though.
I know that most forms of clinical depression and the treatment associated with it has the side effect of a desire to sleep longer. 10 hours is a normal amount of time sleeping for people on anti-depressants. I'm not entirely certain whether sleeping closer to 8 would be any better for their mental or physical well being.
When I finally got medical treatment for severe anxiety the sleepiness side effect from my medication was a godsend. I really think it helped me recover just knowing that no matter how horrible I was feeling, I would be asleep in an hour.
It's worth pointing out that the study cited in the article does use an analysis that looks for causality.
The study says "To formally test mediation [...] calculate indirect effects similar to the Sobel method." I think this refers to a paper "Direct and indirect effects in linear structural equation models" by Michael Sobel. I don't understand enough to say what the limitations are of this method -- but it does sound like rather more advanced causal analysis than you typically see in a medical paper.
I'm guessing that the limitation of the Sobel method is "garbage model in, garbage causal inferences out". It'd be interesting to hear from someone who knows the field, who can say whether the model used in this paper was rich enough to test your ideas (about excess sleep versus insufficient sleep).
Came here to write similar causal / correlation point .
If you currently sleep <7 or >9 hours dont take this as a prescription to change your sleep pattern.
I would assume there is an underlying cause to your sleep needs and that solving the underlying cause is the true path to longevity. For example if you're sleeping more because you're recovering from burnout or a major surgery. Then taking the sleep to speed recovery is (i presume) a better choice than artificially restricting sleep in the name of "longevity" ...
It's also possible that those who sleep 8-9 hours are people who need 10+ hours of sleep but settle for 8-9. Whereas those who sleep 7 hours are those who only need 7 hours.
As long as you're getting quality sleep, yes. But if you have sleep apnea or another condition that is affecting quality of sleep, greater quantity might be required to feel rested.
Also there's probably an issue with sleep quality. For instance I bet people who sleep deeper require less sleep, not to mention illness and increase sleep requirements.
> But 8-9 hours of sleep nightly - my guess would be that people who get only 7 hours of sleep tend to be more successful, have jobs and families, and access to health care. Whereas those sleeping 10 hours a night are less likely to have the income to get health care when necessary.
I'd hope that such studies on sleep control for income, employment, education and what not.
Also, could the relationship be reversed. They suggest high anxiety -> less sleep -> higher mortality. But it seems possible high anxiety would also directly link to higher mortality (e.g., high blood pressure), and sleep would be a side effect, not the cause of higher mortality. Same with low conscientiousness (exercise less, eat junk food).
If you haven't already, I highly suggest reading the book Why We Sleep by Matthew Walker, a google sleep scientist and director of the Center for Human Sleep at Berkeley. The book is mainly focused on the causal effects of sleep deprivation, but he also mentions excessive sleep.
> my guess would be that people who get only 7 hours of sleep tend to be more successful, have jobs and families, and access to health care. Whereas those sleeping 10 hours a night are less likely to have the income to get health care when necessary.
I think you may be having a selection bias here: there is a lot of people who sleep 8-9 hours at night who are in high income brackets (I think that’s what you mean by “successful”, even though that’s a debatable metric).
The healthcare problem is a US-specific one, although probably if you are in a union job you’re likely to be getting decent healthcare while working hours that let you sleep.
>I think you may be having a selection bias here: there is a lot of people who sleep 8-9 hours at night who are in high income brackets (I think that’s what you mean by “successful”, even though that’s a debatable metric).
I'd disagree. Numerous studies with large sample sizes show the average sleep in America is 6 hours and change. I'd need to see some hard evidence that there are "a lot" of people, that is, a statistically significant number of high-earners, who sleep 8-9 hours.
In fact, there is evidence to the contrary of your claim:
>Turns out, the difference is pretty negligible — the "successful" people get 12 minutes less than the average American. According to this 2013 Gallup poll, the average American gets 6.8 hours of sleep every night.
Color me highly skeptical that there are negative effects associated with sleeping 8.5+ hours, up to say, 11 hours. Beyond 11 hours of sleep, I can see an argument being made for physical morbidity from lack of movement etc. But 8-9 hours of sleep nightly - my guess would be that people who get only 7 hours of sleep tend to be more successful, have jobs and families, and access to health care. Whereas those sleeping 10 hours a night are less likely to have the income to get health care when necessary.
In other words, I'd be interested to see studies which test the hypothesis that sleep deprivation has a causal effect on morbidity, while excessive sleep only has a correlation.