Prakash Chandran (Host): Everyone knows that getting a good night's rest is one of the best ways to optimize your body and brain's performance the following day. But what exactly is happening during sleep that is so beneficial to our health? And, more importantly, how do we protect our sleep health as we age?

Host: Welcome to Happily Ever After 40, a podcast brought to you by ProMedica, where we discuss midlife health and well-being. In this episode, we'll talk about how to improve your sleep health. I'm your host, Prakash Chandran, and joining us today is Dr. Abbey Dunn. She's a sleep medicine physician with ProMedica Physicians. So Dr. Dunn, it's great to have you here today. I mentioned this up at the top, but I'd love to understand why sleep is so important for our health, especially in midlife.

Dr. Abbey Dunn: Definitely. So, as you said, sleep is very important overall for our body's functioning. We all know that we need to get a good night's sleep in order to perform our best and to have our best memory-making ability the next day. We know when we're sleep-deprived that we function poorly. It's hard for us to stay focused on our tasks and we might be very irritable.

What people don't know is that if you are sleep-deprived, you may function as poorly as someone who is intoxicated. Your driving may suffer, we could have more accidents if sleep-deprived. When we're sleeping, our bodies are recovering and recharging for the next day. There's some research now that shows that our brain is actually removing waste products while we sleep, which is very important for our overall cognition, especially as we age. We also know that sleep is important for body's recovery and for metabolism.

Host: So, Dr. Dunn, you kind of mentioned this before, but can you talk a little bit more about what exactly happens when we sleep?

Dr. Abbey Dunn: Yeah. So when we sleep, our brains are quieting down. Our brain waves slow, they're much slower than they are during the day when we're up and interacting with people. Our heart rate actually decreases and our breathing slows as well.

There's two stages of sleep. One is called non-REM sleep, and this is what we go into first. It's what people think of as light sleep, generally. But there actually are some stages of non-REM sleep that are deep sleep. And this sleep is very restorative, and it helps our bodies feel our best the next day. There's also REM sleep, which is our dream sleep or our rapid eye movement sleep. So just like it sounds, when our bodies are in rapid eye movement sleep, there's these eye movements that are flickering under our eyes. Sometimes you can see it, like if you're watching your child sleep or your partner. This is when we're dreaming. We think that dreaming helps consolidate memories. But we also know that we don't need REM sleep, to consolidate our memories, and that it can happen in non-REM sleep as well. When people are in REM sleep, their bodies are generally paralyzed, we can't move, and our breathing actually can become more rapid and irregular. When we're in REM sleep, we go through several cycles each night. So typically, the average person cycles through REM perhaps about four times a night. Usually, towards morning is when we have most of our REM sleep. So, sometimes people will know that they're dreaming closer to the time that they wake up. And that's pretty normal and pretty typical for most people.

Host: Got it. So, you talked about the first stage or the light sleep, non-REM, and then the REM cycles. Is there a general rule of thumb around how much non-REM versus REM that the average person should be getting?

Dr. Abbey Dunn: There are certain percentages. But in general, for most patients, when we talk about it, I don't like to focus on a particular amount. I think it varies, you know, especially as people get older, we're less likely to get more deep sleep, and that's normal and that's okay. Certain medications also can impact how much REM sleep we get. Certain antidepressants actually can suppress REM sleep. And in general, we don't think that's a big problem. People who are on antidepressants can still sleep very well and still have normal memories. So overall, the actual percentages aren't as important as I think the quality of sleep people are getting and how well they feel, how rested they are in the morning. Really, I think it's more important to get an adequate number of hours of sleep rather than trying to focus too much on the overall percentages. I think sometimes, patients will come in with a Fitbit or some kind of sleep tracker and those can be helpful for us to figure out, "Okay, are you getting poor quality sleep? Is there another reason for that?" But in general, I wouldn't focus too much on the actual percentages.

Host: Okay. Makes a lot of sense. Now, you were speaking to this about some of the challenges that people have in maintaining that sleep, especially as they age. I'm 42. I remember I could sleep like a champion when I was in my 20s. And now, like sometimes I will go to sleep and then wake up, stay up in the middle of the night and I'm not sure what's going on. So, I'd love for you to speak to maybe some of the typical sleep challenges for those in midlife.

Dr. Abbey Dunn: Right. I think as people get older, like you said, we develop maybe some not so great habits or we just get so busy and we have so many things on our plate that sometimes we don't make enough time for sleep. So, I think it's important for people to remember that sleep is very important to our health, for our memory, for our thinking and just overall for our bodies to make sure that they are at least giving themselves the time to get adequate sleep.

I think it's important for people to give themselves time to wind down, especially prepare for sleep. It's hard for us to go from go, go, go, doing all sorts of activities, maybe doing work late in the day, especially if people are working remotely, getting on that computer, answering emails, maybe being a little worked up and then trying to immediately go to sleep. It can be very helpful just to give yourself that hour to relax and focus on calming down before bedtime.

As people get older too, we can develop sleep disorders, so things like obstructive sleep apnea are very common. Restless legs, insomnia, those are all sleep disorders that we see very commonly in our clinic. So, I think if people are noticing that they're having a lot of difficulty with sleep, to talk to their doctor or see a sleep specialist if needed.

Host: Got it. That makes a lot of sense. So, you're saying that some of the most common challenges are, as you mentioned, obstructive sleep apnea, restless leg, insomnia. Outside of those, are there just general sleep challenges that people, especially after 40 experience, right? Like, maybe it takes them longer to fall asleep or stay asleep. Are you experiencing that as well?

Dr. Abbey Dunn: Yeah, I think, you know, as we get older, especially for women with hormonal changes nearing menopause or perimenopause, we can see more difficulty with insomnia, for sure. I see lots of women coming to our practice in middle age or, like I said, around menopause having a lot of changes with sleep. For men, I think it's more sleep apnea coming on in middle age. Especially if we're gaining weight as we get older, we can be more at risk for sleep apnea. And other health conditions that may develop, like high blood pressure, may also put people at risk for sleep apnea as well.

Host: Got it. You kind of mentioned that sometimes antidepressants might suppress REM, but are there things that suppress just getting a good night's sleep? Like, for example, right before I went to bed the other night, I had dinner with my uncle, had a glass of red wine, went to sleep very quickly, but then I woke up and I couldn't go back to sleep. Do things like alcohol also have an effect?

Dr. Abbey Dunn: Oh, for sure. Like you said, alcohol can make it easy to fall sleep, but it actually has a fragmenting effect on sleep. So, it's very common for people to have a drink, fall asleep easily, but then wake up several times overnight or just notice that their sleep is poor quality. I usually ask patients to avoid alcohol within a few hours of bedtime. Drinking caffeine is another big one. So usually, I recommend limiting caffeine to one or two cups in the morning, trying to avoid that in the afternoon or after lunch, just because that too can really impact your ability to fall asleep or stay asleep. And also, being aware of things like chocolate that also contain caffeine, but it might be more hidden.

Host: Well, that explains it. Well, thank you very much. And you're already going into some of this, but I wanted to talk in more detail about how we can improve our sleep health routine. You talked about giving yourself the space to wind down, avoiding alcohol, you know, don't necessarily take in caffeine before bed. How do you recommend that people think about giving themselves or setting themselves up best for the best sleep?

Dr. Abbey Dunn: Yeah, I mean, I think routine is very important. So, the best you can, try and keep that sleep schedule regular, and that too can be difficult with the challenges of work, having children, family life. But really, just trying to stick to a schedule as much as you can. In general, our bodies like to stay regular. I usually advise people to avoid sleeping in more than 30 minutes on weekends compared to weekdays, that really can set you up for difficulty sleeping as you go back into the work week. So, I think keeping that regular is very important.

I think that making sure that your bedroom environment is comfortable is another big one. So, just making sure the bed is comfortable, that there's not bright lights from the street coming into your window. In general, avoiding bright lights or even the light from electronic screens within the one hour before bedtime can really help people fall asleep and get better quality sleep. Our brains can interpret that light from the screens as sunlight and make it harder to fall asleep. It can impair our body's own natural melatonin release. So, definitely putting the phone away and not scrolling the cell phone during bedtime is important.

Host: Wow. So many of us, including myself, are guilty of that. So, that's helpful to know. You know, your brain thinks that or can be tricked into thinking that it's daytime and it will make it harder for you to go to sleep and stay asleep. You know, you kind of mentioned making sure that people get enough time of sleep. How many hours would you recommend that someone should be sleeping?

Dr. Abbey Dunn: In general, for most adults, they're going to need somewhere around seven and a half to eight hours. That being said, some people are shorter sleepers and do just fine with less sleep. Some people are going to be long sleepers and require something around nine hours to feel their best, to feel like they're rested in the morning. So, it is a little bit up to the individual to see what your sleep needs are. But in general, that seven and a half to eight hours still holds true for most adults.

Host: Okay. And I have heard before about a thing called a sleep deficit. I'm not sure if that's a myth or not, but is that something that you can speak to?

Dr. Abbey Dunn: Right. Yeah. So if we're sleep-deprived, generally we say sleep deprivation is somewhere around six hours of sleep or less. So if you are sleep-deprived, it's actually really hard for your body to just make that up in one day. So, you can't just sleep an additional two hours the next day and make up for it. It does take time for our body to recover from sleep deprivation, especially if it is chronic. So, people who are sleep-deprived chronically can function and be as sleepy as people who actually have sleep disorders like narcolepsy. So. It is very important to, get enough sleep and keep it regular.

Host: And my final question really is around supplements. I know there's melatonin that some people take to help go to sleep. Is that something that you recommend or other supplements to help you go to sleep or stay asleep?

Dr. Abbey Dunn: Right. Melatonin is very popular. It seems like you could buy it almost in any shop, any street corner in America. I think melatonin is fine for the occasional insomnia. But if you find that you're using it frequently, using it for more than a week or two, definitely talk to your doctor. Melatonin, when it's sold over-the-counter, it's a little bit difficult to know how much you're actually receiving. There's been some studies recently showing that what's labeled on the bottle may not actually be what we're getting, so I think we need to use it with caution. I usually recommend using a lower dose rather than a higher dose. So, starting somewhere around one to three milligrams is a good starting dose for most people. I would say anything above 10 milligrams and you're getting too much, you might have more side effects than actual benefit. And it's important for people to know that the melatonin in your brain is much stronger than the melatonin that you take over-the-counter. So again, giving yourself that hour of screen-free, light-free time close to bedtime is actually going to give you more melatonin likely than you would take in a supplement.

Host: I see. And I guess to extend on that, in general, would you recommend consistent medication, whether it be melatonin or something stronger to help you go to sleep and stay asleep.

Dr. Abbey Dunn: In general, we don't recommend long-term use of any supplement or medication for sleep. So, I think if people are finding themselves using these things frequently, again, bring it up with their doctor, see if there's other options, other alternatives, other causes as to why there's difficulty sleeping, and try and get to that root cause as opposed to trying to use something to cover it up or as a Band-Aid. So I think in rare cases, yes, we know we might have patients on medication long-term, but those are really the exception rather than the rule.

Host: Final question. You've helped tons of people, I'm sure, get a better night's rest. What is one thing that you know to be true that you wish more people knew about sleeping or before they came to see you?

Dr. Abbey Dunn: Again, I think just getting enough sleep, making time for it and getting to the root of the problem early is really important. So, I have a lot of patients who come into clinic with problems that have been going on years and years and just finally they've reached the tipping point. And I think, you know, if they came in much sooner, talked to their doctors, they probably would have felt a lot better years sooner.

Prakash Chandran (Host): Dr. Dunn, thank you so much for talking with us today. Truly informative.

Dr. Abbey Dunn: Thank you.

Host: That was Dr. Abbey Dunn, a sleep medicine physician with ProMedica Physicians. For more information about improving your sleep health, you can visit www.promedica.org. If you found this podcast to be helpful, please share this episode on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thank you so much for listening. My name is Prakash Chandran. And until next time, stay happily ever after 40.