Ashlee Williams, MD (Host): We've all had trouble falling asleep at night, or been awake in the wee hours of the morning staring at the ceiling, hoping sleep will arrive. In fact, according to the CDC, one third of adults in the U.S. aren't getting enough sleep. So what do you do when you can't sleep? Welcome to the Healthier You podcast.

I'm Dr. Ashlee Williams, and today I'm talking with Dr. Keisha Sullivan, a Sleep Specialist at Kaiser Permanente about simple steps that you can take to improve your sleep starting tonight. Welcome Dr. Sullivan. Thank you so much for joining me today.

Keisha Sullivan, DO: Hi, Dr. Williams. Thank you so much for inviting me.

Host: Okay. So how much sleep do we need each night?

Keisha Sullivan, DO: So, you know, I'm sure everybody's heard on average, adults need somewhere between seven and nine hours of sleep. But just as I said, that's an average, right? Some people can function on four hours of sleep. Some people need 10 hours of sleep to function. What you need really depends on your body.

But, it is recommended that for infants and toddlers, they get between 12 and 15 hours of sleep, and that's for the whole day, which includes naps. For school age children, or from ages 3 to 10, they should be getting about 12 hours of sleep. Teenagers should be getting about 9. And then as I said, before adults should be getting about seven to nine hours of sleep.

So that's really the goal for everyone, but everybody's needs are different, and it's really best that you contact your primary care doctor to discuss what's best for you and your family.

Host: Okay, so you mentioned with toddlers and infants having naps during the day. Is there anything that a person can do during the day to improve their sleep at night?

Keisha Sullivan, DO: Yes, so key, sleep hygiene. You want to make sure that you're doing everything you can during the day to maximize your sleep at night. So a couple tricks, discontinuing drinking caffeine after lunchtime. The reason for this is because caffeine blocks what we call adenosine. Adenosine is a hormone that builds up in the brain that actually is sleep promoting. So, over the course of the day, the longer you're awake, the more adenosine that's built up and that makes you sleepier. So if you're drinking caffeine, you know, into the afternoon, you're definitely going to disrupt that process.

You should also avoid drinking alcohol at least four to six hours before bedtime. And the reason for that is because alcohol may help you fall asleep. And, you know, some people do drink it, to help them fall asleep, but it's definitely going to disrupt your sleep at night and it also decreases your deep sleep, studies have found. Some other things you want to make sure is you want to not eat three to four hours prior to bedtime. If you do have to eat, I recommend sticking to snacking that's high in protein such as nuts or maybe a meat maybe, but you want to avoid things that are high in calories and carbohydrates.

One last thing that I just want to recommend is don't get in the bed unless you're sleepy. So in order to create good habits, we want to make sure that our bed only, or I should say our bodies only associate sleep with our beds. So when you get in the bed and you do things like schoolwork and watch TV, your body gets confused.

Am I supposed to be awake or am I supposed to be sleeping? We recommend that the bed is only reserved for two things, sleep and sex. If you're not doing one of those two things, then you should get out of the bed.

Host: So what does a healthy bedtime routine look like?

Keisha Sullivan, DO: So a healthy bedtime routine is definitely the number one way to improve your sleep. A bedtime routine may also be referred to as sleep hygiene. So some of the things that you can do to improve your sleep hygiene would be to avoid electronics. You want to make sure you're not looking at screens at least an hour or two prior to bedtime.

What happens is that blue light that's on that device, actually stimulates the brain and keeps you from sleeping. You also want to make sure that the thermostat is between 60 and 67 degrees Fahrenheit. You want to make sure that the environment is cool, quiet, and dark. So if you do have light coming in from your windows, whether that be from the street lights outside or the natural light, depending on when you actually sleep, it is important that you try to get blackout curtains.

You want to make sure that it's a quiet environment. If you live in the city, you may want to consider listening to white noise to help drown out some of the horns and the other sounds that the city may provide. You also want to make sure that in addition to lowering your body temperature and keeping the room cool, that you're taking a warm bath or a shower. That also helps decrease your core temperature. And the reason for that is because there's vasodilation that occurs of your extremities, which helps release some of that heat, causing your core temperature to decrease. And that also signals for your body, it's time to go to bed. In addition, sometimes we get in the bed and you know, our mind is racing.

It may be hard to relax because of things that occurred over the course of the day. So in that instance, it's very important to try to promote relaxation techniques, whether that be breathing, progressive muscle relaxation, or, just listening to a podcast or white noises. And there's a lot of great apps out there that can help provide some of these programs for you, such as the Calm app and Kaiser actually offers the Calm app for free to our patients.

Host: I love it. The Calm app also has like bedtime stories, which I really love, that really can help you get to sleep. What are your thoughts on melatonin and other over the counter sleep aids? Can that help a person sleep?

Keisha Sullivan, DO: Melatonin, it's widely used, you see them in pharmacies. Unfortunately, they're not regulated, right, by the FDA. Different products may have different amounts of melatonin, despite what's said on the back of the bottle. So it's very important that you talk to your healthcare provider about melatonin that they recommend. But really, not everyone needs melatonin. Melatonin should be reserved for those who either do shift work or have circadian rhythm disorders, and sometimes individuals with disabilities can also benefit from melatonin. But usually for the general population, if you maintain good sleep hygiene, you should be able to sleep effectively and efficiently.

Host: Got it. So what if I am doing great at falling asleep? I've got a routine in place, but I keep waking up in the middle of the night. What would you suggest?

Keisha Sullivan, DO: Yeah, do not look at your clock. Please do not look at your clock. I know that's the first thing we all want to do. It's simple, it's easy, you grab it, but it creates anxiety and stress, right? You look at the clock, you wake up, you're like, it's 3 a.m. I have to get up in 2 hours. You try to go back to sleep, you wake up, look at the clock again, it's 4, now I only have an hour.

My rule of thumb is put the phone on the other side of the room and put the alarm on too, but put it on the other side of the room. That should keep you from having an urge to look at it. Also, you want to make sure that you're cool. You're comfortable. We talked about the temperature of the room. You don't want to get too hot. So you want to make sure that you're wearing nightwear that's breathable. You want to make sure that it's cotton, it's lightweight. You want to make sure that your comforter is also meets your needs, whether you're hot at night or cold.

And, you also want to make sure that you handle things such as pain. So for individuals who either have fibromyalgia, or have arthritis, or any other type of pain issues, it's best that you treat that pain prior to bedtime because that can definitely disrupt and interfere your, in your sleep.

Host: Got it. So when do you think a sleepless night would warrant a trip to seeing your doctor?

Keisha Sullivan, DO: So we all have ups and downs, right? Nobody's sleep is perfect. It waxes and wanes. But you want to see a healthcare provider when it's consistent. When you've done everything that you could do, you maximize your sleep hygiene, your pain is under control. Your temperature is right. You're staying on a schedule. I would go talk to someone. Also, if you notice that you're snoring. If you're choking or gasping in the middle of the night, you also want to talk to your healthcare provider so they can rule out sleep apnea and other conditions that could be causing disruptions in your sleep.

You know, if you ever feel as though you're having trouble breathing, you definitely want to seek medical attention immediately because that's really nothing to play around with.

Host: Definitely. Well, thank you so much, Dr. Sullivan, for this great information. It sounds like there are a few key takeaways for those looking to get a better night's sleep. One: Watch what you eat and drink. Avoid caffeine after lunch, avoid alcohol four to six hours before bed, and have your last meal at least three hours before bed.

Two: Stay away from your bed and bedroom until you're ready to fall asleep. Three: Create a healthy bedtime routine. Turn down that thermostat. Turn off screens at least 30 minutes before bed, and try using breathing techniques to relax your body. And four: Focus on lifestyle changes before trying over the counter sleep aids like melatonin.

And lastly, five: Create a routine that sets you up for seven to nine hours of sleep each night. For more sleep tips from our experts and other healthy living advice, visit kp.org/doctor and listen to more episodes of Healthier You wherever you get your podcasts. If you enjoyed this episode, be sure to share it with others who may find it helpful.

Thank you from all of us at Kaiser Permanente. Be well.