In a nation that "Runs On Dunkin", where you can throw a stone in any direction and hit a Starbucks, it's hard to imagine sleep being important. But what many Americans fail to realize, and many doctors fail to recognize, are the adverse effects that lack of sleep, or sleep disorders, can have on an individual. From obesity and diabetes to depression and anxiety, the list includes the various epidemics that have been sweeping the nation for the past two decades. But what can we do? Ignore the bags under our eyes and the nagging daytime fatigue? Or would it be better if we just invested in an eye shade and a prescription for Ambien?
According to the Sleep Doctors, the answer is “No”. Dish sat down with Dr. Bill Noah and Dr. Brian Wind, directors of the Sleep Centers of Middle Tennessee, and pioneers in the field of sleep medicine, to discuss poor sleep habits, sleep disorders, and how to get the best rest of your life (without a prescription sleep aid).
Dish: Are some people just better sleepers than others?
Dr. Brian Wind: No. Many of the problems related to sleep are behavioral in nature. For example, a person who is obese is not exercising good eating behavior. A person who has high blood pressure may have high blood pressure in part because of sedentary behavior. A person who has poor blood sugar control may not watch their diet. All of these health problems, in fact most of them, have at least some significant behavioral component to them. Sleep is very much the same way. Our sleep habits, our sleep behaviors, are what often times sabotage our sleep, and then cause consequences on two levels: health and daytime fatigue.
So what we recommend in terms of the behavioral side is a catchphrase called “Sleep Hygiene”. It’s kind of the pop culture term for healthy sleep habits, so that you can increase the quality of your sleep, thus improving your health and quality of life.
D: So what are some bad sleep behaviors?
BW: Nowadays there are so many things that can sabotage our sleep. And what I’m talking about here is not so much behavioral stuff as it is environmental. The more industrialized a society is, the more distractions they have from healthy sleep. Good examples of this, of course, would be advances in technology. And when I say that, I’m talking about everything from a cell phone, to an iPad, to a mini laptop, to IMing someone, to the old traditional ones, television and movies and those kind of things that people engage in in the evening.
Technology is a big deal. It does a couple of things. Number one, the light exposure causes a stimulation of the internal clock. The brain is tricked into thinking it’s time to be awake. It throws off our sleep/wake cycle. The other thing it does is cause mental stimulation. We refer to a lot of sleep issues as psycho-physiological in nature. If you break it down, there are some psychological factors and some physiological factors.
Let’s say I’m checking email at nine-thirty, ten o’clock at night, thirty minutes before my bed time, and I get some emails that get me mentally stimulated for whatever reason. They’re distressing, upsetting or something that makes me elated. But to get good, healthy sleep, we need to be relaxed in terms of our mental and physical state. So that winding down time that our moms told us about when we were kids really is true. We need that pre-sleep ritual time, where we wind down, our mind clears, our body calms down, and we are prepared for sleep.
D: That makes sense.
BW: Yeah, and of course there are work stressors. People are working longer hours. There’s more shift work, which is horrible for all of us. When you do shift work, you’re going against the grain of what your body wants to do. We are built as humans to sleep during the night and be awake during the day. Some people cope with it a little better than others; they’re the night owl types. But generally speaking, you’re at significant risk for health problems and quality of life consequences if you do shift work.
D: One thing I’ve heard all my life is the importance of sleep schedules. The “Early to bed, early to rise,” kind of thing. Are they that important? And if so, why?
BW: There’s a part in our brain that controls our circadian clock, our sleep/wake cycle, and that part of the brain is looking for a very regular bed time and wake time, day-to-day, seven days a week. Now, some people are more sensitive to changes in that circadian clock than others. These are folks who might stay up a couple hours late one night, or sleep-in a couple of hours late one morning, and it throws their schedule off for weeks or months after that. Other people are not sensitive.
Think about it this way. If you and I got on a plane tomorrow and traveled to LA, crossing two time zones, we’d expect to have a little trouble, a little disruption with our sleep schedules. We call it “jet lag”. People do this all the time on a week-to-week basis. They go to bed at nine o’clock on weeknights, then a couple hours later on weekend nights. They’re effectively jet-lagging themselves within that week without the benefit of seeing the scenery across a couple of time zones.
D: You mentioned wind-down routines a few minutes ago. Can you give me some examples?
BW: It’s more don’ts before bedtime than it is dos. In that four to six hour window before going to sleep, you want to avoid caffeine, alcohol, nicotine, and heavy meals. A light snack is OK. You want to avoid any type of mentally or physically stimulating activity. You don’t want to go to the gym and work out an hour before you’re going to bed. Likewise, as I mentioned, you don’t want to check your email and get yourself all mentally stimulated for whatever reason an hour, thirty minutes, or etc., before you go to bed.
D: So you wouldn’t recommend reading or anything?
BW: Well, the one rule that I’ve found to be correct is that everybody’s different. If a person has found something that works well for them, and they’re getting to sleep well, and staying asleep well, then that’s what they need to do for a pre-sleep routine.
D: Why no heavy meals?
BW: Well, essentially, when we are winding down in the evening, and once we actually go to sleep, our bodies’ systems are supposed to shut down—kind of like a factory shuts down for a certain shift. If you divide the day into eight-hour thirds, about a third of the day our body is supposed to be in rest mode. And the body should not have to digest heavy meals during that time. The brain actually stays pretty busy during sleep replenishing certain neurochemicals—like serotonin—that help with mood, anxiety, and cognitive function—short term memory, attention and focus. So this is why we feel depressed, anxious, jittery, nervous, or down-in-the-dumps when we don’t sleep well, or have fragmented sleep. It’s because we have a shortage in serotonin. It disrupts the flow of certain hormones that are related to our metabolisms. This is why our metabolism gets disrupted when our sleep gets disrupted, and often times people gain weight. That’s where the link to obesity is as well.
D: And are there any kinds of snacks that you would recommend?
BW: Anything that’s light, really. Nothing too high in fat; nothing too high in salt; and nothing too high in sugar. There are certain foods that have tryptophan in them that are actually helpful. For example, warm turkey, warm milk—they have to be warm—have tryptophan in them. It’s why people pass out on Thanksgiving Day, after they eat a big plate of warm turkey. A warm bath is a big help close to bedtime, too, within thirty to sixty minutes. It heats up your core body temperature a bit, and that actually helps with the secretion of melatonin, a hormone that’s secreted by a gland in the brain, and pushes us off to sleep.
D: So basically you’re saying that there are many other options when trying to fall asleep besides popping an Ambien.
BW: The answer to that is a resounding, “Yes”; there are ways to sleep other than taking medication. In fact, I always tell people sleep medications fall into one of two categories: Either they don’t work at all; in which case, why bother taking them? Or they work way too well. Then you’ve got a separate problem on your hands. If not physiologically dependent on this medication, a person certainly develops psychological dependence on it, in that the medication becomes somewhat of a security blanket. These are the people you see freak out when they get down to the last one or two of their Ambien tablets; and the weekend’s coming up, or they’re going to be traveling, and they can’t get in touch with their doctor. They have this security blanket type effect from the medication, and they feel like they cannot sleep without it.
So, the far more preferable way of treating insomnia is with an insomnia treatment program called Cognitive Behavioral Treatment.This treatment program focuses on using tools and techniques like Sleep Hygiene training and other techniques such as restricting the amount of time a person is in bed, engaging in certain behaviors that will make the bed more of a cue for sleeping. For most people who have insomnia, unfortunately their bedroom has become a battleground. They get into bed; their mind turns on; they look at the clock; they go, “Oh my gosh, I’ve gotta get to sleep now. I’ve got this, this, this, and this to do tomorrow; I can’t afford to be tired.” And of course, now they’re mentally stimulated and aroused, and they’re going to have a tough time.
Dr. William Noah: Remember, short term insomnia is a normal human reaction to stress. In other words, when you’re stressed, you’re not going to be able to go to sleep, or you’re going to go to sleep and wake up early, and not be able to fall back to sleep because you’re mind is running about all of these problems and what you’re going to do about them. It’s a normal human reaction. What happens when the stress goes on long enough, whether it’s from a divorce, a sick child, a lost job, or etc., then the stress can switch and become, “I can’t sleep.” Once the stress is “I can’t sleep”, it’s a vicious cycle. It’ll just continue forever until someone interrupts it with a behavioral program. But once they go through the program, they’re free. They don’t need drugs and they don’t need a doctor. They understand what caused their insomnia, and know how to get rest. Isn’t that wonderful?
If you live in Middle Tennessee, be sure also to check out The Sleep Doctors radio show on WTN 99.7, in which Doctors Noah and Wind answer the sleep questions of callers, and provide expert advice on getting better sleep. If you live outside the broadcast range, you can still listen to their shows by going to their website
Part II of the interview will appear next month, and will include a discussion on sleep apnea and where to go if you think you need to be treated for a sleep disorder.