Overcoming Sleep Deprivation
"How to obtain sufficient sleep – this threatens to be a stubborn problem of the new century...We seem to be drifting toward an age when man must resort to artifice to obtain that share of sleep originally meted out...by nature." (The Washington Post, March 4, 1898.)
"The Centers for Disease Control and Prevention just published their first national survey of sleep... The CDC found that more than a third of American adults are not getting the recommended amount of seven-plus hours of sleep on a regular basis." (The Washington Post, February 19, 2016).
In the opening lines of these Washington Post articles we can see three important historical changes:
1. The threat mentioned by the 1898 writer has become a reality. CDC surveys show that many of us don't sleep enough; data from 2019 and 2023 hint that the problem is getting worse.
2. Clearly we've entered that age of artifically-enhanced sleep. Next time you have trouble drifting off, don't count sheep. Instead, try counting our "artifices": The pills, the melatonin gummies, the folk remedies (warm milk, chamomile tea, mushroom powders, valerian root, sleepy girl mocktails), the 10-hour YouTube recordings and robotic bed companions and brain stimulators and...zzzzzz.
Technology hasn't solved our sleep problems. In this newsletter I'll discuss what we can do when we're sleep deprived. My focus will be on a new study demonstrating surprising benefits from the supplement creatine.
3. The transformative impact of statistics is on full display in the two articles. (Feel free to skip the next three paragraphs if you're more interested in reading about sleep than falling asleep while I geek out.)
In the late 19th century, there were no national surveys of sleep patterns or much of anything else. National data gathered from individuals, apart from the census, came from haphazard inquiries into voting preferences. Like everyone else at the time, that 1898 Washington Post writer could only speak vaguely of an emerging sleep problem and our "drifting" into a new age.
By 2016, journalists at WaPo would be compelled to say more. Want to write about a national trend? You'll need to mention surveys and/or peer-reviewed studies, and sprinkle in some statistics too. For readers, there's nothing unusual about that second article, because we hear about surveys and survey findings all the time. Since the early- to mid-20th century, we've grown accustomed to learning who we are through data.
In short, these articles illustrate two ways society been "statisfied": The routine use of statistical methods to learn about national trends, and the routine dissemination of statistical data on those trends.
How much sleep do we need?
That 1898 writer was slightly off-base. People have been using "artifice" to improve sleep for centuries. Alcohol, opium, and laudanum (opium dissolved in alcohol) are among the more famous examples. One scholar found over 150 recipes for sleep concoctions in 17th and 18th century England alone. Although the implication is that inadequate sleep has always been a scourge, historians say that concerns spiked in the late 19th century, when electric lighting and other products of industrialization began to interfere with our natural circadian rhythms.
Nowadays, as the 2016 Wapo writer suggests, a substantial number of us need more sleep than we actually get. How much exactly? This writer was slightly off-base too. Although a minimum of 7 hours per night is often recommended, experts note that more or less may be needed depending on age, genetics, and other factors, and quality is at least as important as quantity. As Dr. Eric Zhou at Harvard Medical School puts it,
"Some people need less than seven hours, while others might need more... If you awaken refreshed and feel like you have the energy to get through your day, then I would worry less about the exact number of hours you're sleeping,"
Simply put, if you feel good, all day long, you're probably getting enough sleep, regardless of the number of hours.
Why is this important?
Almost everyone has at least an occasional night of poor sleep. The immediate consequences include impaired functioning and heightened safety risks the next day. For instance, dozens of studies show that sleep-deprived health care workers are more likely to make mistakes on the job, and more likely to have an accident on the way home after work.
If we can't avoid sleep deprivation, the next best thing is to manage the effects. Caffeine is the most common strategy for maintaining alertness and energy levels, but it doesn't work for everyone, some people dislike the buzz, and, like other stimulants, caffeine quickly leads to dependence. Wouldn't it be nice to have an effective, buzz-free, non habit-forming chemical that keeps our heads clear after a sleepless night?
The new study
This study, published eight weeks ago in Scientific Reports, was led by Dr. Ali Gordji-Nejad at the Institute of Neuroscience and Medicine in Germany. Dr. Gordji-Nejad and colleagues wanted to know whether a single dose of creatine could offset the effects of sleep deprivation.
Creatine
You may have heard of creatine (cree-uh-TEEN), a supplement that's been widely used since the early 1990s to enhance athletic performance. Globally, the market for the supplement exceeds $400 million and is continuing to grow.
Creatine is an amino acid compound produced by the body as well as absorbed from milk, meat, fish, and mollusks. In our muscles it's transformed into a molecule called phosphocreatine and increases the energy available for intense, short-term physical exertion.
Creatine supplements boost the amount of phosphocreatine in the muscles. Because creatine is an essential, naturally occurring substance, the FDA treats the commercial product as a supplement rather than a drug, and sports organizations permit athletes nearly unlimited use.
Unlike a lot of supplements, there's reliable evidence that creatine does what it's meant to do: Help build muscle and enhance performance. Creatine may also speed up recovery times by promoting the healing of micro-tears in muscle fibers. Among older people, it seems to help alleviate sarcopenia (age-related loss of muscle mass and strength).
So, why would Dr. Gordji-Nejad want to know whether creatine offsets the cognitive effects of sleep deprivation? And why focus on a single dose?
Studies suggest that creatine energizes brain cells too, and there's some limited evidence of cognitive benefits. However, the usual doses are absorbed slowly – in prior studies, at least a week was needed before observing effects. Sleep deprived people need more immediate relief, and so Gordji-Nejad and colleagues explored whether a single, relatively high dose of creatine could do the trick.
Study design
Each of 15 young adult participants spent the night at the researchers' lab. Around 6 p.m., cognitive and metabolic functioning were measured. Creatine or a placebo was taken at 8:30 p.m. The cognitive and metabolic variables were measured again around midnight, 2 a.m., and 4 a.m.
Participants were deprived of sleep throughout the experiment. As the researchers explained, each participant was "supervised, optically monitored, and spoken to whenever initial signs of falling asleep occurred."
Total sleep deprivation was about 21 hours, as participants appeared to have followed instructions to sleep around 11 p.m. and wake around 7 a.m. for two weeks prior to the experiment, including the night before.
Methodologically, this is one of the strongest lab studies I've read all year. In Appendix A, I provide more details about the methods and their merits.
Some key findings
Creatine was absorbed by brain cells, reversed the neural effects of sleep deprivation, and led to a small but significant decline in self-reported fatigue at 2 and 4 a.m. (Participants rated their fatigue on a 20-point scale.)
In addition, from midnight on, creatine led to better cognitive performance as compared to placebo. I'll focus on one example here, the results for the WMT, or word memory test.
For this test, 22 words were presented in pairs (e.g., climate–storm). Participants were shown each pair on a computer screen for five seconds. Then, they were shown the first word from each pair (e.g., climate) and asked to type the second one.
Although we don't ordinarily do tasks like this, the WMT is a useful gauge of how well one can pay attention and learn, two skills that diminish when fatigued. Scoring of the test is objective – the computer records correct answers and speed of response.
In the figure below, performance on each cognitive variable at midnight, 2 a.m., and 4 a.m. have been combined and compared to baseline performance at 6 p.m. The y-axis depicts percentage of improvement or decline relative to baseline. Gray bars are data for placebo; crimson bars are data for creatine.
In this figure, you can see that WMT score and speed of response declined after taking the placebo – as the night wore on, WMT performance got worse. However, after taking creatine, accuracy and speed improved slightly.
Someday, some enthusiastic blogger or unscrupulous marketer is going to see this figure and say: Creatine makes you smarter! That's not quite what the data shows.
Improvement on the WMT and other tasks can be attributed to a practice effect. At baseline these are new tasks. Later in the night, participants benefit from having already done them. What the data suggests is that creatine allows practice effects to emerge, while the placebo doesn't enable those benefits.
The figure above shows data for the other cognitive variables as well. (SPAN refers to a test in which participants see a sequence of 12 numbers, one at a time, and then attempt to type them, in order.) For each cognitive variable, the creatine group improved more than the placebo group did (if the latter improved at all), or, in a few cases, the creatine group declined less than the placebo group did.
Since the testing procedure took about 90 minutes, the study shows benefits lasting roughly 9 hours (from the ingestion of creatine at 8:30 p.m. to the final tests that started at 4 a.m.)
Should you use creatine for sleep deprivation?
The results of the study are exciting. When you're sleep deprived, a single dose of creatine reduces fatigue and cognitive impairment. I trust the data, because the methodology seems strong, and the results are consistent with what we know about creatine. So, should you actually buy supplements and use them when you're sleep deprived?
(Specifically, should you buy creatine monohydrate, the only kind that Gordji-Nejad and colleagues and other researchers have systematically studied?)
Logistically speaking, you can check off all the boxes. Creatine monohydrate is available online as well as in all major pharmacies and some grocery stores in the U.S. You can choose flavors or go flavorless, and the powder dissolves more readily than protein powders. Plus it's cheap. The brand I tried while writing this newsletter, Sixstar (100% creatine monohydrate powder, unflavored), costs just under $20 for 60 servings. The single dose that Gordji-Nejad and colleagues used (0.35 grams per kilogram of body weight) would cost a 150 pound person less than 2 dollars.
I would gladly spend 2 dollars to be more alert after a bad night's sleep. But because Gordji-Nejad and colleagues relied on a high dosage of creatine, we need to ask: Would benefits be seen at lower doses? If not, is the higher dosage safe?
I reached out to Dr. Gordji-Nejad via email this week for his thoughts on this.
First, he speculated that creatine "may be more effective in extreme sleep deprivation, as the neuronal cells are under more stress. We performed a 21-hour subacute sleep deprivation..." In other words, creatine might not help much if you merely lose a few hours of sleep one night and would feel sluggish the next day (but see Appendix B).
At the same time, he suggested that creatine might be helpful under more ordinary circumstances, though ideally at lower doses, and only if it outperforms caffeine:
"Since the dose of creatine has to be very high, taking it is not recommended because of the strain on the kidneys. If future studies show the same cognitive improvement effect even at significantly lower doses (~5g), creatine could also be considered for long work nights. In that case, it has to be investigated whether creatine in small doses actually leads to even better improvements in performance than coffee."
I appreciate Dr. Gordji-Nejad's caution. Not all of the hype around supplements comes from marketing departments; sometimes the researchers themselves are more enthusiastic than the data warrants.
For further insight on safety, I reached out to Mark Christie, author of the Beehiiv newsletter Strength Framework. I like this newsletter because it offers concrete, detailed advice on training and nutrition while describing (and citing) peer-reviewed studies relevant to each recommendation.
Mr. Christie pointed me to a number of studies showing no adverse effects (including strain on the kidneys) resulting from high doses of creatine. That's good news, though he added some caveats:
1. The doses used in these studies were slightly less than what Gordji-Nejad and colleagues used. As Mr. Christie points out, "the large bulk of scientific literature cites safe oral consumption up to 20-25g for a short period of 5 days."
Comparing doses is a bit messy, because Gordji-Nejad and colleagues made adjustments for body weight, but here's an example to put things in context: The dose they used (0.35g/kg body weight) would translate into 28g for someone who weighs 80kg (i.e., 176 pounds). 28g falls just outside the 20-25g range that appears to be safe.
2. There are case reports of kidney damage resulting from short-term creatine use, but only among a few individuals who took extremely high doses or who already had renal disease. Mr. Christie notes that in any case, the public should be made aware of possible side effects such as kidney damage. He concludes, with appropriate caution, that
"With any supplement, we want to start at the lowest dose possible to get positive results and always consult a medical professional before changing your diet or adding a supplement into your daily routine."
Bottom line
If you don't have liver disease, kidney disease, or high blood pressure, you might seriously consider using creatine on rare occasions to offset the effects of sleep deprivation (see Appendix B). Talk to a health care professional first, purchase carefully (buy creatine monohydrate; check for additives), and try a dose within the range that studies have found to be safe (e.g., 20g). Since mild gastrointestinal distress is sometimes reported, I'd recommending starting with an even lower dose (e.g., the conventional 5g) to make sure your stomach tolerates it.
Of course, it would be even better to sleep more. If you have trouble sleeping that's not related to your work schedule, fussy babies, a snoring bed partner, or inconsiderate neighbors, you might consider behavioral strategies often recommended by experts, such as getting more physical activity during the day, taking shorter naps, avoiding caffeine in the evening, turning off screens well before you sleep, and keeping your bedroom dark.
Thanks for reading! (If it's late, turn your screen off now!)
Appendix A: More on methodology
There's a stereotype of Germans as detail-oriented and efficient, and sure, those adjectives apply to this study, but Gordji-Nejad and colleagues' methodology is particularly strong in light of the study's ultimate purpose. For instance:
1. Each participant actually came to the lab twice. On one occasion, they received creatine. On another occasion, at least 5 days earlier or later, they received the placebo. This is called a crossover design, and it's useful for filtering out the effects of individual differences. (In a small study, if one group takes creatine while a separate group takes a placebo, you might not be sure whether the benefits of creatine reflect pre-existing differences between groups. Maybe the creatine group includes healthier people, or people who are more used to sleep deprivation, or whatever.)
2. Participants were comparable in age, health, and sleep quality, as well as in duration of sleep for two weeks prior to the experiment. To prevent bias, neither the participants nor the research assistants knew whether creatine or the placebo was being administered each time.
3. The cognitive and metabolic variables were wisely chosen.
The cognitive variables included things like reaction time, working memory (e.g., the SPAN test), verbal skill (e.g., finding analogies), numerical fluency (e.g., completing number sequences), and logical reasoning.
These skills illustrate what psychologists call "fluid intelligence", or processing abilities that don't rely much on prior knowledge. (In contrast, "crystallized intelligence" refers to acquired knowledge and skills.)
Prior studies show that fluid intelligence is undermined by sleep deprivation. Ultimately, it's what we care about most when we're sleep deprived. I know how to turn my computer on, open Microsoft Word, and type grammatically correct sentences. This is all part of my crystallized intelligence, and it's not going to change anytime soon. But when I'm sleep deprived, I type slowly, I make mistakes, I'm slower to organize my thoughts, etc. In short, my fluid intelligence suffers.
As for the metabolic variables, the researchers used non-invasive brain scanning techniques grounded in spectroscopy to address two questions:
–Did creatine get absorbed into participants' brain cells? In other words, does a single dose of creatine even have the potential to benefit neural processing?
–Did creatine cause changes in brain ATP, pH levels, and other signs that the neural effects of sleep deprivation had been reversed?
Measuring both cognitive and metabolic changes serves a corroborative purpose. Metabolic changes without cognitive ones wouldn't be useful, practically speaking. Cognitive changes without metabolic ones would be useful but mysterious. What Gordji-Nejad and colleagues found, roughly speaking, is that creatine supported cognition in a way that would be predicted due to its molecular impact on brain cells.
Appendix B: A case study
I decided to see for myself whether creatine would offset temporary sleep deprivation, at least subjectively.
Last night, when I got tired around 11:30 p.m. and wanted to sleep, I pushed myself to stay up until 2 a.m. and set the alarm for 6.
I chose this method of "deprivation" because I'm familiar with what would ordinarily happen the next day: I'd have a cup of coffee first thing in the morning, I'd feel fairly good until early afternoon, and then, by 1 or 2 p.m., I'd either need a nap or experience fatigue and diminished functioning.
This time, I took roughly 24g of Sixstar 100% creatine monohydrate with my coffee at 6:15 a.m. This is the dosage Gordji-Nejad and colleagues would've used. Since the researchers found benefits roughly 9 hours after consumption, I assumed a reasonable possibility of observing effects during the time I'd ordinarily crash.
In a word, creatine helped. Not a lot, but I felt distinctively less fatigued, my afternoon nap was shorter and gentler – much less like dropping into an abyss – and I was able to do some cognitive challenging things (like reading up on creatine) with none of the mild brain fog I would've ordinarily experienced.
Obviously this is a limited experiment, with the smallest possible sample, but I found the "data" persuasive. I'm not sure about the safety of creatine at higher doses. I don't know whether tolerance might develop over time, requiring more of the chemical to achieve the same effects. But I would consider using it once in a while, when sleep-deprived, if alertness and daylong energy seem especially important.