Joey Wahler (Host): It impacts us in a variety of ways, so we're discussing the importance of getting good sleep. Our guest, Dr. Suzanne Wilson, Chief Medical Information Officer for FirstHealth of the Carolinas. This is the FirstHealth and Wellness podcast. Thanks for joining us. I'm Joey Wahler. Hi there, Doctor. Welcome.

Dr. Suzanne Wilson: Good morning.

Host: Great to have you with us. You sound very energetic. I presume that means you got a good night's sleep, yes?

Dr. Suzanne Wilson: Pretty decent. Pretty decent.

Host: Okay. I think, most of us would take that. Speaking of which, first, what exactly is happening when we sleep? It's probably something the average person doesn't think about, right?

Dr. Suzanne Wilson: I would agree. And there's been a lot of science, but I'd kind of summed it into this. Think of sleep as your body's overnight maintenance shift-- repairing cells, balancing and regulating hormones, clearing mental clutter, so you wake up ready to perform. The sleep maintenance shift is basically that stage where your brain kind of goes into a deeper cleaning mode. And this is where the glymphatic system really kicks in, and I'll speak more about that later. But it's like the plumbing network in your brain that clears out the waste and toxins that have built up during the day. We don't always think about that, but your brain has waste and toxins that needs to get out of there.

So, the maintenance shift and the glymphatic system working together is like your brain's own little nightly cleanup crew, making sure you wake up feeling a lot more clear and fresh. And without a good maintenance shift, there is disease correlations that occur that I will speak of. And poor sleep definitely affects your health. So, I think this is a great topic. One I often speak with a lot of my patients on of trying to improve, you improve sleep, you improve a lot of things for people.

Host: Absolutely. So, you just mentioned the brain aspect, which is very interesting. That takes care of the mental side. How about the physical health benefits of getting a good night's sleep?

Dr. Suzanne Wilson: The physical health benefits. I think I break up the way the science kind of shows it. There's cellular repair and immune boost in the hormone regulation. So if you think about you've had an injury, your muscles need repair, or you've been going all day and there's old cells in you. So, things need to get cleaned up. So, it's working better and the cells are healing. And the immune boost, I think, all of us can think about times when we haven't been sleeping well and you get sick easy. So, that nighttime shift of sleep is really also helping improve your ability to stay away from illnesses and infections.

But also, as I touched on, there's a lot of correlation between poor sleep affecting your metabolic health and heart health. It's a correlation, not a causation. So, I want to be careful. But once you get enough correlations, and I see it just after many years in medicine. Poor sleep, it's linked with weight gain, it's linked with diabetes, it's a linked with heart disease, dementia, et cetera. We see all that. And like with your hormones, it really disrupts like your leptin and ghrelin. Those are appetite and hunger hormones with it. And when you don't get good sleep, you're often reaching for food that's not the healthiest. You're wanting more sweets essentially.

And last but not least on the physical benefit is really that brain detox. Sleep activates the brain's cleanup crew, which is very important. It's flushing out the toxins and like the beta amyloid, many people may have heard of that in correlation with Alzheimer's dementia, getting that waste out of there, getting toxins out of there that you don't want buildup so that your brain is functioning at a level you always want it to. So, those are a lot of the physical benefits.

Host: Gotcha. Now, people often hear, of course, about REM sleep light or deep sleep. Maybe they're seeing these things on their fitness trackers nowadays. Can you explain the difference between those in a nutshell?

Dr. Suzanne Wilson: Sure. So essentially, there's four stages of sleep. Your first stage is just light sleep, it's a kind of that transition where you're like, "Oh, I'm ready to go to bed." Your heart rate's going down, you're breathing slower, muscles are relaxing. You're getting warm in your bed, and the brain waves are starting to slow at this point.

And then, there's stage two, which is labeled as deeper light sleep. This is when your body's temperature is dropping, your eye movements are stopping, and your brain activity is really slowing too. And actually, stage two makes up the largest portion of sleep. And then, there's stage three, which is more prominent on the first half of the night. It's slow wave sleep. It's the most restorative stage for your body. This is when the major tissue repairs are occurring, the immune system strengthening, the hormone regulation is occurring, and it's hardest to wake up from this stage. So if you ever tried to, you know, somebody on the shoulder or get them to wake up and they're not, it's probably because they're in stage three.

The last stage is called REM, REM sleep, otherwise known as dream sleep. This becomes more prominent on the second half of the evening. It begins about 90 minutes or to 110 minutes after falling asleep. This is when the brain activity increases to near wake levels in vivid dreaming occurs. But why is room sleep so important? Some people remember their dreams better than others, but this is actually when memory consolidation is occurring, learning is occurring, emotional regulation. It's almost like executive function of your brain is being cleaned up to function. Because I think we've all had a night or a week where you hadn't slept well and like your thoughts aren't snapping like they should be, you're little more emotional or you're quick to snap at people, et cetera, or you have something and you're trying to think about it and it's just not coming to your mind. When you haven't had good REM sleep, these things do occur, and I've seen it out of experience, that it affects us more as we get older. I'll say it that way. That's just my experience there. And also, what's interesting about your dream sleep. Our muscles are actually temporarily paralyzed during this time, and that's really a safety thing so that we don't actually act out our dreams with it. Those are the stages that we see on those trackers. So, that's what they mean.

Host: Okay. Well, many people, as you well know, don't get enough sleep. But for the average adult, how much is considered enough and what are some goals we should be setting to get more?

Dr. Suzanne Wilson: For the average American health wise, I'll say it this way, average American is seven to nine hours of sleep per night on a regular basis for optimal health and performance. And I do want to state that quality of sleep is more important than quantity of sleep, and why this matters. Sleeping less than seven hours consistently, again, is correlated and linked to some of those diseases. I've already said weight gain, diabetes, heart disease, depression, immune impairment, higher accidents, more motor vehicle accidents, et cetera, occur.

Now, on the upper range, most adults do well within the seven to nine. And there are a few groups where more than nine is appropriate, and this is for like those young adults, adolescents are those recovering from a major sleep, debt or illness comes in. But seven to nine is really the key. There is very, very few people that can do well on five hours or less a night, and that's what the science shows.

Host: Okay. Now, speaking of which, after a few nights of below average snooze time, if you will, is there such a thing as catching up on your sleep?

Dr. Suzanne Wilson: Well, the answer is partially yes, but not completely. And I'll kind of explain that. Our studies show that getting extra sleep on the weekends or after a few short nights can help reduce some negative effects like fatigue or low grade inflammation. It may even lower certain health risk compared to staying chronically sleep deprived. So if you are chronically sleep deprived, it means don't ignore it. But there is a catch to all this. Recovery is not a hundred percent effective. Your cognitive performance, your reaction times, your mood can remain impaired even after several nights of makeup sleep. Also, oversleeping can backfire because it leads to grogginess with it. So, think of it this way, why is it hard to fully recover sleep? Debt is like a credit card balance. You can pay back some, but interest in the form of lingering effects still accumulates even after a week of short sleep. Even a full week of recovery may not totally restore all cognitive functions to baseline, thus chronic sleep loss has health effects.

Host: Okay. So, good thing to keep in mind there. Now, how about the top few things disrupting the average person's sleep patterns, and what can be done to improve that either on our own or by seeking professional help?

Dr. Suzanne Wilson: Well, as I looked over the literature, I think these three things come to the top. But let me kind of just touch on in the essence of the last thing you said there about looking for professional help. As a physician, I'm constantly asking my own patients, things about obstructive sleep apnea. Are you a major snorer? Are you chronically waking up when you think you've had good sleep, but you're still sleepy with it, you need to make sure that you're being evaluated for obstructive sleep apnea or other issues by your provider to make sure nothing else is going on. So, please never ignore that.

Now, here are some basic things that you can do on your own. Try to get your body in a good rhythm. And number one is that we see way too much of today, and people just don't realize it is that screen time before bed. And why is that? All of our devices, our phones, our iPads, our computers, well, they emit this blue light and it really tricks your body into thinking that it's still daylight. And when your body still thinks it's daylight, it's not producing melatonin, and that's a hormone that's very well needed for going to sleep. So, the more the blue light, the less the melatonin, that's not good. So, cutting off screen times before bed, number one.

Number two, you got to deal with your stress and anxiety. A lot of people, my patients will often say, "Just my mind's racing. I can't shut my mind off." The best thing I can ever tell people on that, one, is sometimes you have to deal with your issues, but do a brain dump. And a lot of that can be done by journaling. Maybe your mind's just trying to remember something. In that last hour before you go to bed, do a brain dump, journal. Put that stuff down on paper so your brain knows it somewhere that it can look at it later. And also, just having activities to help reduce your anxiety, like stretching, yoga, reading, all that does assist.

And last but not least is you have to get your body into a regular schedule. If people are like, "I'm going to go to bed at 8:00 PM the night, 10:00 PM the next. Oh, I'm going to stay up to midnight and back down," your body doesn't know what to do. Our body craves consistency with our circadian rhythms. So, going to sleep at the same time every night is very important.

Host: Interesting. Okay. Couple of other things. Any sleep myths you hear that are worth debunking?

Dr. Suzanne Wilson: Yes. I have about four or five here, and the one I want to touch on is alcohol. People think, "Well, I'm going to get great sleep. I have whatever they're drinking," it will get you to sleep. But it reduces your fourth stage of sleep, which is your REM sleep. And if you remember what I said, what REM is important for is consolidating memories and learning. All that that you were trying to learn the previous day or connect to other things in your mind gets poo-pooed with alcohol. So, alcohol, like I said, it will get you to sleep, but it won't keep you asleep. It's poor sleep on the second half.

Some other things is I kind of touched on is everybody does not exactly need seven to nine hours. I do want to emphasize that quality of sleep is more important than quantity. So if you got six good hours where you get out of bed and you feel really rested than you probably have been doing a lot of things well there. I think there's also a myth about older adults don't need as much sleep. Really, they do. That seven to nine hours is needed for everybody, even as we get older.

And the one I touched on is about snoring. Please, please, please don't ignore that. Occasional light snoring, yeah, that can be benign. But loud, frequent snoring, it may signal sleep apnea and all that. Why sleep apnea is very important., We see a huge correlation with heart disease and strokes, and it's a stress your body does not need, because you're hypoxic is when sleep apnea occurs, that means low oxygen. So, we want to fix that and we have ways to do that from a medical perspective.

And last one, I kind of think about sleep is everybody thinks I can't exercise before I go to bed. Light exercise-- and I'm going to categorize like, yoga in there-- is fine, but please don't do any heavy hard workouts, probably within four hours of going to bed, that will disrupt your sleep. But mild exercise can actually benefit a lot of people before sleep.

Host: Good to know as well. And then, finally, Doctor, in summary here, if you could give those joining us just one tip. You've covered so much great ground, very comprehensively, but maybe a good place to start, job one, to turn your sleep scenario around starting tonight, what would it be?

Dr. Suzanne Wilson: If it was starting tonight, I'll probably put a few concepts into one. It's really that consistent sleep routine. And that routine includes, one, going to bed the same time, so let's say 10 o'clock is your wish of where you are. Go to bed at 10. And while you're going to bed at 10, plan on having a routine that, I want to say, have a runway that you're setting yourself down where all your screens are going off your phones, your tablets, your TVs, your laptops, at least 30 to 60 minutes, maybe even two hours. Get that blue light out of there so that your body's relaxing and your melatonin is coming up so that you have more in your system, have deeper sleep out, and all that has a very calming activity, et cetera.

And one I'm going to give as a bonus, and I see this over time, is that don't eat a heavy meal before bed. Probably our biggest meal should be our lunchtime and not our evening. Big meals seem to also interrupt sleep. So, it's part of that preparing for sleep, consistent time and have a runway of things that are calming your body. And part of that calming is not putting a big, heavy meal in your belly close to bedtime. That's probably how I would summarize that.

Host: Okay. Well, I'm sure if those joining us right now, Doctor, do any much less all of those things, they will be sleeping better in no time. Folks, we trust you are indeed now more familiar with improving your sleep. Dr. Wilson, thanks so much again. Keep up all your great work, and a good night's sleep tonight, and thanks so much.

Dr. Suzanne Wilson: Thank you.

Host: And for more information, please visit firsthealth.org/sleep. And if you found this podcast helpful, please do share it on your social media. I'm Joey Wahler. And thanks again for being part of the FirstHealth and Wellness podcast from FirstHealth of the Carolinas.