The best sleep tip that Mark G. Goetting, MD, can offer is that sleep tips usually don’t work.
In a world keen on quick fixes, Dr. Goetting says when it comes to sleep, it’s just not that simple. There are numerous genetic variants, age factors, and environmental considerations, and what works for one person may not work for someone else.
Dr. Goetting is an associate professor in the departments of Pediatric and Adolescent Medicine and Medicine at Western Michigan University Homer Stryker M.D. School of Medicine (WMed). He is board certified in neurology, pediatrics, sleep medicine, behavioral sleep medicine, lifestyle medicine and obesity medicine, and serves as president of the Michigan Academy of Sleep Medicine.
In August, Dr. Goetting will be an expert presenter and panelist on the topic of near-death experiences and dreams at the International Association for Near-Death Studies (IANDS) annual conference in Chicago.
Ahead of the conference, we caught up with Dr. Goetting to talk about misconceptions surrounding sleep, as well as the link between near-death experiences and dreams:
How important is a good night’s sleep for general health and well-being?
Dr. Goetting: Essential would be a fair term to use. The brain cannot function well without sleep. So, it's essential that we have some degree of sleep. Too much sleep creates something once called sleep toxicity or sleep poisoning, which is not a problem most people have. And insufficient sleep creates some issues with health and general function, and a sense of well-being. When you get into extreme sleep deprivation, it can be catastrophic.
There are also a few things to keep in mind. We're flexible with our sleep. For example, if a baby is crying, we can wake up and tend to the baby. If there's an emergency, a tornado or something else, we can postpone sleep, and we can shorten it. We can have catch-up sleep later, which may help in mitigating some of the harm sleep deprivation creates. So, it's negotiable.
What are some misconceptions people often have about sleep?
Dr. Goetting: One of the main misconceptions is that there is one right amount of sleep or a right way to sleep. Some people will look at sleep tracking devices and they may look at written advice to determine whether they are getting proper sleep, but the purpose of sleep, generally, is so you can function well during the day, and if you function well during the day, you're meeting that need, however you achieve it. Variability is the norm.
People expect that they're going to go to sleep some time at night, wake up in the morning, feel refreshed and be awake all day. But there's this substantial number of people where that's just not in the cards. They have this intense wave of drowsiness that may occur, it could be late in the morning or middle of the afternoon, or they may not be able to fall asleep until 3 a.m., and they may get up at noon. These are often genetic variants the person is born with.
What tools are currently available to clinicians to help individuals improve their sleep?
Dr. Goetting: Overall, the best tool that we have is by asking people about their sleepiness and alertness: When can you most easily fall asleep? When is your peak alertness? We can track that subjectively simply by having the person journal, which is often better than wrist-worn actigraphy in understanding a person’s sleep biology. You can have them have a journal where each hour of the day they can rank 1-10 how alert they are on average. You can see some trends that way, and you can counsel them.
What sometimes is missed is the normal variability among individuals. One important viewpoint is from evolutionary biology, which involves looking at all creatures and how they fit into their environment and food supply.
In humans there is the sentinel hypothesis. It starts out that we are on a planet in which there is a lot of dark time. Humans are primarily visual creatures. We can't get food in the dark, so it is most efficient to reduce caloric consumption by sleeping. Also, the night can be dangerous with our poor vision. We would be prone to accidents or attacks from predators. However, we are tribal creatures. So, it is crucial that some people be awake or only lightly asleep at all times for the safety of all.
There are numerous genetic variants people have regarding sleep. There are the "early birds,” programmed to wake at 4 a.m. or so, the "night owls,” who stay up until 2 or 3 a.m., and currently about 20 percent of adults have middle of the night wakings, typically between 1 a.m. and 3 a.m. There are the siesta variants who crave either late morning or afternoon naps. Then there is the hyperarousal variant with sleep that is shallow, allowing easy awakening with any environmental disturbance. Postpartum, many women wake up with the subtle stirring of their babies. We think of the need of middle of the night baby feeding nowadays, but long, long ago this light sleep also protected against predators that would harm the babies or other tribes that would steal them.
The industrial revolution had a dramatic effect on sleep. Ultimately, modernity led to the notion that adults should go to sleep and get up on a similar schedule as their neighbors. Not everyone can do this. The genetics have not changed much in the last 10,000 years.
What is your best tip for individuals looking to improve their sleep?
Dr. Goetting: The best tip is that tips often don't work. There are some people, no matter what, who are going to be good sleepers, and there are some people who will be vigilant light sleepers. Most everyone else is in between. They have some good nights, some bad nights, and they may sleep somewhat at different times, but not extremes.
We often look for kind of simple off-ramps from this biological sleep diversity, and individuals are not necessarily going to be well served by that. There was protection in having sleep at different times. Nowadays though it is less true.
The International Association for Near-Death Studies (IANDS) is holding its annual conference in August where you will be an expert panelist and presenter on the topic of near-death experiences and dreams. What sparked your interest in this area?
Dr. Goetting: I became interested in near-death experiences not intentionally, but through research on resuscitation. When I was working at Henry Ford Hospital in Detroit, we had a large team that did research on CPR. In our hospital we saw many people arrive in cardiac arrest. Our group had a dedicated resuscitation research team that applied techniques first in animal studies. If they worked, we had approved protocols to use them on people who did not respond to standard care. Our goal was to save as many people as possible by improving treatments.
We had 345 patients we studied where we changed the way CPR was done. These patients received regular CPR at first, did not respond, and were declared dead by the emergency department physicians on duty. Some then were put into a research protocol at that point. We altered technical aspects of CPR and measured the effects. In some, we were able to restart the heart.
Over several years of study, we saw quite a few people who regained consciousness. A fraction, perhaps a fourth, described a dramatic experience that had a long-lasting personal effect now called near-death. This was unexpected at the time when we were doing this research.
What are some of the common features of the near-death experience?
Dr. Goetting: Most often there's an out-of-body experience and a sense of being transported into another realm. There's a feeling of rising into space through a big black void and through a bright tunnel. Often the person sees every moment of the previous life at once, a so-called life review. Then there is often a contact with what they describe as sentient spirits, commonly angelic beings. They feel a sense of timelessness and infinite space. Then they are directed to return to their body
It’s not always exactly that way, but those are common features of the near-death experience. We would see it frequently enough that we thought this is a fairly common human phenomenon. But what is it? That just caught everyone's attention as more and more reports came out from many centers.
It's very difficult to study this sort of thing. The question still is, in terms of the brain, is the near-death experience the dying brain or the returning brain? Also, this type of experience can happen with severe trauma in the absence of cardiac arrest. We call this an “apparent death experience”. Further, a very similar experience can be induced by some psychedelics, particularly DMT. This suggests that the brain is somehow programmed for this potential and transformative event.
How does the near-death experience relate to what we know about dreams?
Dr. Goetting: There are some features of near-death experiences and dreams that overlap. One of them is called sleep paralysis, a rapid eye movement sleep phenomenon. This has an a mixture of being awake yet paralyzed with dreamlike mentation. Some will see themselves floating away and they will think, “I’ve got to pull my soul back in or I’ll never wake up.”
Most dreams don’t include powerful or meaningful spirits, but some do. Some will interact with the dead. Some reunite with a loved one or receive spiritual counseling from a saint or guru. Dreams can in a sense be like a séance.
Our panel at the IANDS will include those who do dream training. Often this is part of prolonged grief therapy. Some try to visit a dead spouse or someone else they knew in their lifetime as a child, and they may have these visitations. So, there is some common ground with dreaming and the near-death experience in reuniting with those who have passed on. But it is rare in a dream to go through a tunnel and to have a life review. And the command to go back is generally not in a dream.
What do you hope attendees take away from what you have to share at the conference?
Dr. Goetting: I'm laying a foundation for what occurs in the dying brain with as much scientific clarity as we have in 2025. Humans have a physicality, which is obvious, and part of the physicality is our brain. Without our brain, we do not have a local sense of being. So then, dreams and the near-death experience can be seen as between waking life and death.