Transcription:
8 Things You Can Do for a Better Night's Sleep

Melanie Cole (Host): Welcome to Bryan Health Podcast. I'm Melanie Cole and today, we're discussing the link between sleep and dementia. Joining me is Dr. Kevin Reichmuth. He's a Pulmonologist with Nebraska Pulmonary Specialties. Dr. Reichmuth, it's such a pleasure to have you with us today. Tell us a little bit about the health burden and economic impact of sleep disorders. And obviously for our physiological and overall health, we know we need sleep, but why is quality sleep so important?

Kevin Reichmuth, MD, FCCP (Guest): Sure. It's obviously a very critical part of our lives. And certainly an area that I would argue in medicine is one of the least understood. We've made certainly ground over the past decade, as it relates to understanding sleep better. But, to answer your question, it is clear that we have kind of an epidemic of sleep deprivation in our society. It's a combination of how we let things interfere and encroach on our sleep. We don't protect it as much as we really should as a, you know, critical part of our day and how it sets ourselves up for good productivity and functional outcomes and so forth, in our life both, educationally, professionally and even from a family standpoint.

So I would say, financial implications and safety implications and those kinds of things, as it relates to sleep in this epidemic we have of general sleep deprivation for various reasons.

Host: Well, I mean, we all know that we have to sleep for if we didn't, we would not make it, but there are a lot of health conditions that are related to sleep and we're learning more and more about these Dr. Reichmuth about diabetes and obesity and all of these things. Tell us a little bit about what we know now about the health conditions that can result from poor quality sleep.

Dr. Reichmuth: You've named several of them. What we've learned through good epidemiologic studies and it's always difficult when you're trying to link in particular situation, for example, sleep deprivation with a disease state, because there are so many confounding factors. We know, for example, some of the things you mentioned, like diabetes, well activity and our body weight and those kinds of things also confound that. So, it's hard sometimes to find a causal link, but, I think, with a number of studies that have been done and I had done some research when I was at the University of Wisconsin on sleep and diabetes before coming here.

And, one of the things in my study that it looked like was that sleep deprivation as it relates in particular, the study I was looking at was sleep apnea, led to weight gain, which then may have been the intermediary factor that led to increased diabetes. But since then, a number of studies have been done showing that reduced sleep, and again, that can be because of a disease state, like sleep apnea or it can be because of what we choose to do with our sleep, the amount of sleep we choose to get, leads to, as you mentioned, diabetes, weight, gain cardiovascular disease, a number of cardiovascular diseases, coronary artery disease, arrhythmia, such as atrial fibrillation, cerebral vascular disease, such as stroke. And then, the impact on cognitive impairment, cognitive decline, such as dementias, and in particular Alzheimer's disease. Those would be the big things. And then, there've been studies showing that when you have impaired sleep, you have immune dysfunction.

And so studies have looked at how does the immune system work under sleep deprived states and that it's impaired as well and may lead some other disease situations. And so, yeah, there's just so many critical things that happen during sleep, that when it's altered or restricted, that it creates enough physiologic impairment, that it does appear to lead to some potential permanent disease states, like those things we just mentioned.

Host: So the study by Nature Communications that links dementia to those in their fifties and sixties, that get six hours of sleep or less Dr. Reichmuth what's happening in that case? Because it's the amount of sleep along with the quality of sleep. And as you said, there are so many confounding factors and nowadays, even more than there were with the white lights and all of those things and time and electronics and everything.

Tell us a little bit about what we know about the time factor, about how much sleep that we need. I mean, I am a sleeper. I do love my long nights sleeps, but I also like a nap. And so do the time factors combine, do naps count into that, speak about what we know now.

Dr. Reichmuth: I would say we still have a lot to learn on that, but in general, what we know now is, like I always tell patients in my sleep clinic, not everybody is going to need or be able to get eight hours of sleep. But what the data does show is, as you've mentioned, and there's some variability in the, in the different studies looking at this, but consistently getting less than six hours of sleep or certainly five hours of sleep, even as a stronger signal leads to changes in our neurocognitive function.

And they've done different things to look at this and, what we do see as it relates to the study, cited by Nature, which is a very large population based study was that there's an impact on our cognitive and function. So, in the short term, when we get sleep deprived, we've all been there before, where we have problems with concentration and memory recall and those kinds of things.

And when you do that consistently, year after year, decade after decade, there appears to be some, permanent changes in the brain and you can see this on some studies looking at MRIs, including functional MRIs, and the impact on the white matter and so forth. And so, that sets the foundation for the brain not being able to do its job as it relates to cognitive function. And so, in general, we've kind of come to the consensus that people, for the most part, again, depending on age, but in adults need seven to nine hours of sleep. That's kind of where we think it's at. Your question regarding cumulative, for example, if you're getting consistently six hours of sleep and then you take an hour nap in the afternoon, we're still uncertain about that.

Like I tell people, napping, some of the most brilliant people in the history of the world were nappers. In general, we recommend, short periods of napping so that there is something that happens in the brain with a nap that can be good, but what I tell people is that, you probably want to make sure you're getting enough general nighttime blocked sleep and not rely on napping.

On the other hand, if you're getting that amount of sleep and you have the opportunity to take a short nap in the afternoon, you're probably not harming yourself, if it does not adversely impact your nighttime sleep.

Host: And that's a good point. People have always been asking me, how do you sleep at night if you take a nap in the day, but somehow, I don't know my whole family does, but as an exercise physiologist, Dr. Reichmuth, I also know that certain things, as we were talking about what can compound and confound good quality sleep, can affect our good sleep, whether it's exercise at night or alcohol consumption or what we've had for dinner, any of the things. I'd like you to offer now some best advice about getting better sleep, how we know if we need professional help with this and really sleep hygiene, because that's what this field is being called these days and what a growing field it is.

Dr. Reichmuth: I think one of the things and it's not easy for us sometimes when we have a problem in our lives, with how you tackle it, sometimes it seems overwhelming. And a lot of times what I tell patients, the first thing we need to look at it is what things do I have control over that are altering my sleep, that are adversely are keeping me from getting good sleep. And so you're exactly right. Those are hygiene aspects. And so, it's number one, am I maintaining a consistent schedule or am I really, varying a lot because it's hard for the body. We need to find out what's a schedule that's gonna work for us to give us time to get enough sleep and really there's always going to be some things do affect it, travel or whatever.

But for the best we can, be very diligent and protective of that schedule. The things like TV, phones, computers, those kinds of things, not only are there light aspects that can alter circadian rhythm of sleep, but they obviously stimulate the brain.

They start to stimulate and will prevent the brain from going through its normal circuitry to initiate and maintain sleep. And so we really have to, you know, make some hard choices and that, in general, I tell people at least two hours before bed to cut out TV and we may have a few final things we have to do on our phone or whatever, but I try to tell people, at least an hour before you're going to get into bed and absolutely not while you're in bed, should you be engaging in, Twitter, Facebook, Wordle, those kind of things that we get sucked into. And then, having an environment in that bedroom, where we sleep. Really set it up to be environmentally comfortable, comfortable as it relates to the bed, the mattress, the pillow, all those kinds of things. Trying to make it quiet, dark, those kinds of things.

And then on the other end of it is maintaining an awakening time. Allowing you that in time in bed, but not sleeping in beyond the time, because that's going to set you up for failure the next night, if you're sleeping in, too long and you know, sometimes it's nice to lay in bed and you're kind of in and out of sleep for the next several hours before you get out of bed. That can do some harm to getting to bed that following night. And certainly even to our productivity during that day. So I guess, looking at the things you can control and making that schedule, and then sticking to that schedule.

And I think, just like you said, it's avoiding alcohol, at least several hours before bed, caffeine, you know, a lot of people I hear caffeine doesn't affect me. I can drink caffeine. I promise caffeine affects your sleep. Even when you don't feel like you're having it affected. So we really do recommend cutting it out any time, depending on your bedtime, I'd say, seven hours before bed is my preference for caffeine to be eliminated. And then the meals are a big one. You don't want to have a meal within an hour or two of bedtime.

And again, trying to be consistent with meals because meals are one of what we would call the zeitgebers. So one of the things that sets our entire circadian rhythm timing, and so trying to be consistent with your meal time, not everybody's going to have a meal at 6:00 PM, but if you're having a meal at 6:00 PM one time, 9:00 PM the next night, and it's fluctuation, it's hard for our body to set that rhythm. And so trying to be consistent. And exercise is good for sleep. No doubt about it. It's been shown that people who exercise do tend to have better sleep, but just, I think like you stated, exercising too close to bedtime can be a problem.

And so, I certainly recommend people exercise. If you look at the metabolic and even the sleep benefits of exercise and various things, first thing in the mornings, probably one of the best exercise times. Like I tell people, not everybody can do that. And so, whenever you can fit it in, but ideally not right before bedtime.

Host: Not too close to bed for sure. And certainly we have to turn our minds off. Right. It's the anxiety and the stress and the need to feel like we have to answer an email or a text, right then. You've given us a lot to think about Dr. Reichmuth and a lot of really, really good advice. I thank you so much for joining us today and sharing your incredible expertise with us.

And I want to thank our Bryan Foundation partner, Union Bank and Trust. Please visit our website at bryanhealth.org for so much more information, and to get connected with one of our providers. That concludes this episode of Bryan Health Podcast, always for more health tips and updates, please follow us on your social channels. I'm Melanie Cole.