From family responsibilities and work stress to illnesses, there are many factors that can interfere with a good night’s sleep. And when poor sleep happens, it can have immediate negative effects on a patient’s overall health and well-being, increasing the propensity for obesity, heart disease and type 2 diabetes. That is why a good night’s sleep is just as important as physical activity and healthy eating. Yet it can be hard to pinpoint what steps to take to improve sleep hygiene.
The AMA’s What Doctors Wish Patients Knew™ series provides physicians with a platform to share what they want patients to understand about today’s health care headlines.
In this installment, two AMA members who are sleep medicine physicians shared what doctors wish patients knew about getting a good night’s rest. They are:
- Alejandro D. Chediak, MD, Associate Professor of Medicine and Associate Chief of Clinical Affairs in the Division of Pulmonary, Critical Care and Sleep Medicine at the University of Miami Miller School of Medicine. He is also an AMA delegate for the American Academy of Sleep Medicine.
- Ilene Rosen, MD, MSCE, associate professor of medicine in the Division of Sleep Medicine and assistant dean for Graduate Medical Education at the Perelman School of Medicine at the University of Pennsylvania.
“It’s really about how much sleep you need to feel well and to feel refreshed,” said Dr. Chediak. “We know that the extremes—either too little or too much—seem to be associated with poor health outcomes.
“But what we don’t know is: Is it the lack of sleep or is it the poor health outcome that is driving the lack of sleep, or too much sleep?” he added. “It’s like most things. Extremes of diet are not good. Extremes of sleep are not good for your health.”
“The amount of sleep you need is whatever it takes for you to wake up and feel refreshed, focused and vital,” Dr. Chediak emphasized.
The American Academy of Sleep Medicine and the Sleep Research Society determined that most adults need “somewhere between seven and eight hours of sleep,” said Dr. Chediak. “But the coolest study that’s ever been done in terms of how much sleep you need … took young, healthy volunteers and created a chronobiological laboratory where there’s no external light, noise, down cues.”
The researchers “measured what happens when you allow someone to sleep eight hours a night compared to six or four hours,” he said. “The real key here is not just how much they slept, but how many hours were they awake before they slept.”
“It turns out that to have their best performance, you need about eight to 8.2 hours of opportunity to sleep per day at night or during your biological night,” Dr. Chediak said. As a person goes from eight hours of sleep per night one week to six- or four-hours per night other weeks, “there is a measurable decrement in indices of performance, coordination and higher cognitive function.”
“It turns out that 16 hours of sustained wakefulness is the point at which we start to fall apart,” he said. Then, “after 17 or 18 hours of sustained wakefulness, there is clearly a decrement in our ability to perform at our best. “Now that might vary in an older adult. And if you have a sleep disorder, it's definitely going to be different,” Dr. Chediak added, noting that “at the core we really shouldn’t be awake more than 16 straight hours, which leaves us with eight hours of sleep.”
“The mainstay is being consistent—you want to go to bed and get up at the same time every day,” said Dr. Rosen. “That’s very hard for people who have a work schedule that impacts their desired sleep and wake times and then what people do is they mini jet lag themselves every weekend or every time they have a few days off.
“Someone will say: Oh, I can get seven hours of sleep, but I really need eight and a half, so on the weekends I’m going to get 10 each night,” she added. “And then they have trouble getting to sleep the night before they have to go back to work and the cycle of sleep restriction starts over.”
“If you’re awake for a long time in bed, get out of bed and go into another room,” Dr. Rosen said.
“Make sure to sit in a dimly lit room and wait until you feel tired before going back into bed,” she added. “If you don’t have the luxury of having another room to go to, at least get out of your bed and sit in a chair in the room.”
Getting a good night’s sleep is “a gift that many people wish they had. And the worst part of it all is that sleep is natural and very easy to do if they just allowed it to happen,” said Dr. Chediak. “Sleep is not a volitional act. The harder you try, the more anxious you’re going to be and the more you’re going to fail.
“Even though you need sleep and it's the right clock time, you’re going to worry yourself out of it,” he added.
“What has happened with working from home is that our sleep hygiene got a little bit out of whack,” said Dr. Rosen. “So, people are either not sleeping as much at night or have the ability to nap during the day when they didn't before.
“And while naps do have a role in certain situations, for someone who can't get enough sleep at night—for whatever reasons they have—napping a significant amount during the day can also delay your ability to go to bed at your usual time,” she added. “For individuals who are trying to get back on track, the best practice is to avoid napping.
“For people who say, ‘I'm so exhausted. I can't power through,’ this is where strategic consumption of caffeine can be really helpful,” Dr. Rosen added. But avoid that practice “if you’re having insomnia, because you don’t want to have caffeine too late. We typically recommend no caffeine after 2 p.m.”
“Thinking about when and how you’re using caffeine—and even the choice of the brew you use—can actually impact how effective the caffeine is,” she said, noting that “brewed coffee is most effective. Breakfast blend or light roast is also best because the roasting process takes out the caffeine as it brings out the flavor.”
“We now use our smart phones and our tablets for everything, and what we’ve done is put them in the bed near us,” said Dr. Rosen. “When you put light on in the evening, you can confuse your clock so that your clock doesn’t want to be asleep.”
“We always say: ‘Don’t watch TV, it’s stimulating, as there’s a light and noise at the other end of the room,’ but now people are watching Netflix or playing Wordle close to their face using their phone or tablet at night,” Dr. Rosen said. “Not only are these stimulating activities, but also the light that is emitted from these devices gives off wavelength of blue light that tells the brain it is time to be awake.”
“That is the same wavelength that we get from the sun when we go out in the morning, and it tells us it’s daytime,” she said. “And it’s actually blue light from the sun that signals the brain for your circadian clock to be awake, so we are confusing our internal clock by doing things in the evening, overnight and late at night with those electronics.”
“Intrinsic circadian rhythms are designed to promote alertness or not promote alertness,” said Dr. Chediak. “Then, sleep and lack of sleep increases the drive to sleep and competes with circadian alertness rhythm.”
“If you’re perfectly aligned with light-dark cycles, then when it gets dark outside, your circadian rhythm has shut down your alertness centers and you’ve been awake for 12 or 10 hours, so the need to sleep is increasing every minute that you’re awake longer,” he said. “Then the two coincide that your circadian alertness drive is low, and your sleep drive is high because you’ve been awake many hours and you fall asleep quickly and you sleep well.
“As you’re getting closer and closer to the morning, intrinsically your circadian rhythm starts to prepare you to wake up by raising the alertness components of the brain and your sleep debt is being paid because you’ve been sleeping,” Dr. Chediak added. “As your circadian rhythm tries to promote wakefulness, your sleep debt wears off, you wake up and you function during the day. That’s how we’re balanced.”
“You don’t know if you have a sleep disorder or just lack of sleep until you rein it in,” said Dr. Rosen. “What I mean by that is, sticking to the tenets of good sleep hygiene, most humans need about eight hours of sleep—they say the range is seven to nine hours.”
“So, you want to make sure you’re getting at least seven, but if you’re getting seven and you’re still tired, get some more and see what happens,” she added. “Certainly, needing nine hours of sleep is reasonable, so if you’re getting eight, you could still be sleep deprived.”
“But if you do all of those things and you don’t feel better, that’s when you should really seek evaluation,” Dr. Rosen said.
“It’s reasonable to see at least your primary care physician” for help with sleep loss, said Dr. Chediak. “Then if he or she can’t fix it, a sleep doctor can help.” You can also find unbiased helpful information on sleep and its disorders at the American Academy of Sleep Medicine's patient information portal www.sleepeducation.org.
Table of Contents
- Sleep need varies for each person
- Pay attention to how long you’re awake
- Be consistent with sleep
- Get out of bed if you can’t sleep
- Try not to worry about sleep
- Try strategic consumption of caffeine
- Limit exposure to blue light
- Understand circadian rhythm’s function
- Ask your doctor for help with sleep