Health and Fitness

Why We Get Sick & How to Reverse Sleep Debt

Did you know that koalas sleep 22 hours every night?

On the other hand, giraffes sleep just under 2 hours, usually in brief 5-10 minute snooze sessions.

So, how do you know how much sleep you really need?

I’m here today with sleep specialist Dr. Roger Washington, MD to help figure it out.

You’re about to learn:

  • What to do about sleep debt
  • How to experience euphoria every day
  • Why people high stress careers die prematurely after retiring
  • How much sleep you really need
  • The surprising thing a sleep specialist says about napping
  • And much more…


Abel: A Stanford Medical School graduate and Academy of Family Physicians Fellow, Roger Washington, M.D. has answered the question, “Doctor, Why Am I Sick?” for 30 years. In his first book, Lack of Sufficient Sleep Matters, Dr. Washington decodes the root cause of illness.

Someone walks into your office in Silicon Valley, how can you tell they’re not getting enough sleep?

I ask about sleep habits and their sleep strategy. Everyone has a strategy, even if it’s a disorganized pattern.

I want to hear what their habits are, if they’re getting enough sleep, and if they feel rested when they get up in the morning.

Abel: Are people defensive about their sleep habits? Thriving on a small amount of sleep is something Type-A’s and Silicon Valley types brag about.

It seems that people who are successful entrepreneurs, single mothers—people who often have challenges—they try to meet those challenges by sleeping less and getting more done. They tend to brag about how little sleep they need. That’s something I try to debunk and get people to understand that sleep is much more important.

Abel: How do you debunk that myth?

I talk to them about how they feel when they first get up in the morning. How they feel after lunch—do they go into a “food coma?” How do they feel when they come home from work? Do they have energy for their children? I try to get them to realize that with fatigue, they’re actually cheating themselves, their families, and their work. I try to get them to look at it a little differently.

Abel: For those who say they sleep little and get so much more done, how do you help them realize it’s an illusion?

By the time people come to my office, they’re already ill and they want to know why.

I ask them about their approach to stress. Many people believe that when they get stressed, they have this thing that they do in order to meet their challenges: they make up their mind they’re going to get it done, and they seem to think they’re going to have more energy to get it done. They seem to think it’s extra energy.

You’ve heard of that second wind, maybe at 5 o’clock or 6 o’clock in the evening… maybe they have a trip to pack for, or an exam, or a project for work, and they push themselves to stay awake and then they get this second energy. They feel more awake and alert and ready to get things done.

When I get people to recognize they have this experience, I ask them where they think the energy came from? Motivation, or power of mind?

This energy, do you think it’s free? The first law of thermodynamics suggests that there’s no such thing as extra energy. So, I call it energy borrowing. When you’re borrowing energy, it sets you up to become ill later. Or perhaps not to function as well the next day.

The first law of thermodynamics suggest that there’s no such thing as extra energy. @RWashingtonMD Click To Tweet

When people understand that they can’t have “extra energy,” they can understand they’re borrowing it from their immune system.

Abel: When I performed and toured as a musician, I also worked a day job in consulting.

I’d finish work around 7pm and I was exhausted. But then I’d have to go on stage at 10pm or midnight.

I’d get that second wind, and then you start living the “hair of the dog” lifestyle.

You mention in your book that the crash doesn’t happen during the high stress period, but afterward.

Our bodies seem to wait until vacation to get sick.

That’s how I came about understanding that relationship between sleep and illness. My patients didn’t become ill when they were in the middle of the stress, in the middle of the project, or when they’re partying like a rock star in Vegas. It seemed like if it was really stress, they should get sick in the middle of the problem. That almost never happens.

Look at your own life and see when you become ill, when you get a headache, a migraine, the flu, pneumonia, appendicitis, a kidney stone—it almost always comes 24 – 48 hours after you slow down after having been accelerated.

I talk to patients about their experience when they were pushing themselves. What you realize is that many of them aren’t even stressed during that time. They feel confident and focused, like the college students at competitive schools. They have the ability to focus and get things done.


Have you heard of the Blue Death Phenomenon? It’s what often happens to firemen and policemen… when they retire in their sixties, they don’t live very long after. They die off at a far higher rate than lower-stress professions.

It happens also to career military. If anyone’s going to be stressed, it’s them. But when I interview them, they aren’t stressed. 24 hour shifts are nothing. Back to back, no big deal.

But because it’s not really extra energy—it’s borrowed from their immune systems—when they slow down or retire or finish their big project, that’s when they become ill or die.

Abel: Is that just cumulative cortisol, adrenaline? What are they running on? They’re borrowing from the immune system, but how does that work?

The way to appreciate the system is that you look at how sleep and activity are related. I’ve developed my Washington Sleep Loss Principle: In order to remain healthy, you need to balance your activity with the amount of sleep you get.

Sleep is not for rest. Sleep is for life. @RWashingtonMD Click To Tweet

When you bring a baby home from the hospital, she’s not sleeping because she’s tired. She sleeps because she is growing. The more they need to grow, the more sleep they need to get.

If you take a child to an amusement park and she goes swimming, she gets tired early. She follows her natural rhythm, so she sleeps.

Adults go through the same thing, but we don’t need to grow. We need to make repairs.

It’s while we’re in our deepest stages of sleep—the non-REM sleep, the sleep when it’s hard to wake someone up—that’s the deep sleep during which we produce Human Growth Hormone, which is important for human life.

Adults, if we decide to stay awake and push ourselves, we think it’s survival time and get extra energy to stay alert and survive, but we borrow that energy from the immune system.

If you continue to borrow energy from your immune system, you build up a sleep debt.

Abel: I want people to understand how important it is to get that sleep. It’s one of those parts of health that people often ignore.

They say, “I’ll sleep when I’m dead.” But the irony is that it’s not sleeping that kills you faster.  

If you’re in the middle of the sleep debt, what can you do to improve your situation?

The answer is somewhat complicated, but to make it easy: It is possible to catch up on sleep.

The truth is this: if you have a sleep debt, you can pay it back by sleeping extra when you have the opportunity.

For example, when a college kid comes home from school – and they’re living in mom’s house – they give themselves permission to sleep in with no sense of guilt. They might wake up, but they go back to sleep. They might wake up again and look at the clock and say, “I’m not ready.”  The sun comes up and they go back to sleep.

Their mom knows they’re sleep deprived, so she’s not waking them up. Then they might get up at noon after having slept 13, 14, 15 hours and realize how good they feel after having made up that sleep.

Then maybe the next day they sleep less, and the sleep time will get shorter and shorter until they’ve made up their sleep debt.

Abel: You describe the state of sufficient sleep “euphoric.”

Yes, but we’ve been lied to about what that means. Perhaps you recognized the Greek word for “too much” is hyper, and when it’s “underneath,” it is hypo. The Greek word for “the right amount” is eu. Phoros is greek for “how you carry yourself.” Euphoro means “normal.”

Have you ever felt that ocean spray hit you in the face while standing on a sunny beach, or you’re in a convertible and the breeze runs over you and you feel like “this is a good moment.”

Do you know that feeling? I asked a guy who said, “Yeah, I get that feeling once a year!”

I asked a guy from Australia who said he gets that every day! Euphoria actually feels normal-feeling. It doesn’t mean elated and out of proportion to circumstances. It’s that feeling you get when you realize life is good, and you realize life has been good.

The cornerstone of that feeling – euphoria – is having no sleep debt.@RWashingtonMD #SleepMatters Click To Tweet

The reason for sleeping enough is to have that euphoric feeling every day. In Silicon Valley, we call that bandwidth. You’re interested. Alert. Taking it all in and appreciative of it. That’s the euphoria and the gift of sleeping well.

Abel: What the best way to catch up on sleep? Napping? Extended sleep on Saturday morning? How do you get it in there?

That’s the project I’m working on now, a book called The Euphoria of Sleeping Well: The Sleep Lover’s Guide to Getting More Sleep.

Usually when people ask how much sleep they really need, they want a cheat. So, how much sleep do you need to stay well and be healthy?

The answer: 8 hours minimum.

If you do more, you need more. If you workout twice that day, you’re going to need more sleep that night to be well.

Abel: Do you recommend napping? Power naps? What’s your take?

A nap is cheating. Why do you need a nap? What did you do wrong that you need a nap at 2 in the afternoon. You missed out last night, that’s why you’re tired now.

Abel: So 8 hours is the gold standard.

If you do more, you need to sleep more to be healthy.

For listeners who get to the gym at 4:30am, what’s your stance on physical activity at the expense of sleep?

Let’s do a thought experiment. Let’s say we’re designing a human being so they can adapt and survive challenging and changing circumstances. Let’s say that our human being is 40 years old and he catches his food, and 90% of the time he’s successful.

Now let’s say food becomes more scarce, and now he’s got to run around more and he eats less. Wouldn’t you want to give him an operating system that would allow him to slow his metabolism down? Having a slower metabolism would help you survive longer.

Why would people think that diet and exercise would help them lose weight? The body should fight that. You might lose weight for a little bit and then you plateau because your body will slow down metabolism so you can survive.

Think about someone in your life who was overweight, lost weight, and kept it off for a significant amount of time. It’s not a common phenomenon that people can diet and exercise and keep off the weight.

These are well meaning people that continue to diet and exercise and stop losing weight… Something else is going on.

If you don’t get enough sleep, enough water, enough food, your body is going to adapt. You’re telling your body to go into emergency mode. Your body feels more accelerated, alert, and alive temporarily so you can survive tonight.

Television, partying, whatever you decided to do, if you stay up late it’s going to make you gain weight.

If you stay up late it’s going to make you gain weight. @RWashingtonMD Click To Tweet

So is it better to do exercise or sleep 8 hours? I vote you should sleep 8 hours.

Abel: That’s my advice, too.

There’s a hierarchy, and it’s that you need sleep more than water.

You can get by 2 or 3 days without water, a week without food, but you can’t get by without sleep. Just like breathing, your body will force you to sleep.

Abel: What are the symptoms of sleep debt?

When you wake up in the morning, how many days out of 7 do you wake up feeling refreshed and ready to go? If it’s not 7, then there’s a problem.

If you use an alarm to wake up, you’re planning to sleep less than you need.

If you’re fatigued during the day, you shouldn’t be. You have a sleep debt.

There are not many people who wake up in the morning and are ready to go. If you’re saying: Once I have a shower, I’m fine. Once I have coffee, I’m fine.

If you need a sugary drink in the morning or cereal, it’s a drug. It’s processed carbohydrates. You have a sleep debt.

Abel: What’s your take on sleep drugs?

Some sleep is better than no sleep. If someone is going to take sleep medication, they should have the advice of someone who’s well trained in the uses and benefits as well as problems you can get into: You can get in a lot of trouble. You can become addicted physically and mentally.

You can have problems with amnesia, even blackout—most of the sleep meds (Ambien, Lunesta, Sonata) are all in the same category of drug activity as alcohol. But again, some sleep is better than no sleep.

Abel: Someone came to me (who shall remain nameless). He was hooked on sleep meds, but they wouldn’t always knock him out.

If he didn’t remain asleep, he’d would blackout, sleep-walk, and do extremely strange things.

One night when that happened, he hopped on Ebay during a blackout.

Later that week, $1300 of junk collectable horror movie figurines showed up at his front door.

Those drugs are no joke.

What about valerian, melatonin, and herbal based sleep aids?

Melatonin is something our own brains make, but melatonin by design is weak.

The friend you talked about, he didn’t want to sleep. He took a drug but he didn’t want to sleep, so he fought it.

That’s what most people do who take melatonin… they get a book out, turn on tv, do a few chores. They don’t want to sleep. Melatonin is weak because we need to be able to fight it if there’s an emergency. We have the glutamate system to go to if we need to fight sleep, and we use it.

But those things can work for someone who is really genuinely interested in sleeping.

Abel: What can we do to get in the right mindset for sleep?

Good sleepers look forward to their sleep.

Do what good sleepers do, and look forward to your sleep. When they exercise during the day, they’re like, “Look at me, I’m going to sleep well tonight!”

Abel: With intense exercise, I find sleep comes easily. I wake up rested, powering through the day, and look forward to that recovery.

Why We Get Sick, How to Reverse Sleep Debt & The Blue Death Phenomenon:

Exercise is getting credit for the heavy lifting that sleep is actually doing. @RWashingtonMD Click To Tweet

If you look down at that treadmill, it says 400 calories, what is that really doing? That’s not even a cookie.

But that exercise is going to help you get more of the HGH (Human Growth Hormone) producing deep sleep, and that’s what’s going to make you lose weight and feel healthy.

The exercise is getting credit for what sleep is doing for you.

Abel: Can you explain what exactly our bodies are doing while we sleep?

Just as important as it is to breathe in, it is important to breathe out.

Sleep is for growth and repair. There’s baby-deep sleep, that’s when HGH is produced. The lighter state of sleep is for dreaming. When you get a second wind at night, you forfeit most of your HGH-producing sleep, and you get a lighter sleep from which you can easily be awakened.

If you go to bed at 1am and sleep until 9am, that’s not enough because you’re out of your natural circadian rhythm. You’re in the lighter sleep and not getting HGH production.

Abel: What would you say to shift workers who work through the night? Is there anything you can do to mitigate the damage?

Be consistent. Don’t change up on the weekends because that’s chaotic. You can put yourself into the situation where your body will take on a rhythm and you can get your deep sleep. Just don’t change it up.

Abel: What are surprising things people don’t feel are related to sleep problems, but actually are?

Cancer. Menopause. They don’t have menopausal issues the way we do in places like Spain where they honor sleep.


You can order your copy of his book Lack of Sufficient Sleep Matters: Decode The Root Cause of Your Illness (and get a free chapter) on Dr. Washington’s website at And you can find Dr. Washington on Twitter, too!


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