Transcription:
Expert Tips for Better Sleep

Joey Wahler (Host): Many of us are often tired and even after a night's sleep, we don't awake mornings feeling quite as refreshed refreshed as we feel we should. So we're discussing getting better sleep. Welcome to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System; putting knowledge and care within reach so you have everything you need to live your life to the fullest. This episode sponsored by the University of Maryland Medical Center Midtown Campus. Thanks for listening. I'm Joey Wahler. Our guest, Dr. Emerson Wickwire, a Psychologist, Professor and Section Head of Sleep Medicine at the University of Maryland School of Medicine and Sleep Medicine Specialist at UMMC Midtown. Dr. Wickwire. Thanks for joining us.

Emerson Wickwire, PhD (Guest): Thanks so much for having me delighted to be here.

Host: Same here. So let's start with some of the typical causes of lack of sleep or poor sleep from you see.

Dr. Wickwire: Well, those are oftentimes two different things. Although there is some overlap between lack of sleep and poor sleep. Lack of sleep is often attributable to lifestyle choices. The pandemic has highlighted the fact that, generally speaking, we have an awful lot going on and boundaries can be really difficult to maintain. So when we're living busy, pressured lives with lots of competing demands at home or at work, the simple fact is that oftentimes sleep is one of the first things that gets sacrificed in order to meet what we feel are our other life obligations.

Now in terms of sleep quality, sleep quality can be impaired by a myriad number of factors ranging from the foods that we eat, to the amount of caffeine that we consume, even to underlying sleep disorders, such as insomnia, which means trouble falling asleep, or staying asleep, or both, or obstructive sleep apnea, which is a disorder of snoring and problems breathing during sleep, to many, many others.

Host: Well, you mentioned there the pandemic and the impact there. Tell me a little bit more, if you would, about how much of an uptick you're seeing in sleep issues for people in general during these last couple of years or so.

Dr. Wickwire: Globally speaking, during the pandemic, 30 to 40% of individuals are reporting that they are having trouble sleeping. And that's really a staggering number. What that's telling us is that one out of three or more individuals are having trouble sleeping. Now, when we look at what we call population prevalence of insomnia or chronic insomnia, which means that you're having trouble falling asleep, trouble staying asleep, or both, and this tends to occur three or more nights in frequency for three or more months in duration; generally we think about 10% of the population experiences chronic insomnia. Now that's a very high prevalence for an ongoing medical condition to begin with, but what the pandemic numbers are telling us, and this has now been studied fairly extensively.

There have been enough studies published for example, that there have been what are called meta analyses performed and what a meta analysis does, is it synthesizes all of the available studies on a given topic. So, whereas let's say a randomized controlled trial might include 100 or 200 or 300 participants. What a meta analysis does, is it synthesizes. It aggregates the information from all of those studies so that we're looking at thousands of participants in their pooled data. And again, on a global basis, many of us are having trouble sleeping during the pandemic.

Host: Wow. That's pretty eyeopening stuff. So you mentioned lifestyle a moment ago, especially when it comes Doctor to diet and exercise. How much of an impact do those factors have on sleep?

Dr. Wickwire: They can have a huge impact. Now in terms of diet, this is an area of scientific discovery that is really wide open. We know a lot about foods that can negatively impact sleep. And I'm sure our listeners want to hear about those. I'll mention a few in just a sec. We know a little about foods that can potentially help sleep. One of the most important factors about diet and sleep is the timing of sleep.

What I'd like to do is step back and explain to our listeners that sleep is really driven by two processes in our bodies and brain. The first of this, we call process S or in the sleep drive, and it's just like hunger or thirst. It goes up over the course of the day. And the more active that I am and the longer it's been since I last slept, the higher my sleep drive will be. In addition to process S, in a very specific bundle of cells, behind the third eye, in other words, right in the middle of our brain, our bodies are regulated by a circadian rhythm.

You've heard of the Latin carpe diem for seize the day. This is circa diem for about a day. Our bodies function, adult humans bodies function on just about a 24.2 hour cycle. Now, why does this matter in terms of diet? Because the strongest regulator of our body's natural rhythm is light. And this is why when you travel from Baltimore to London or Los Angeles, your body adjusts after a few days because your eyes are exposed to light at a new time. But second to light, the timing that we eat is a massive contributor to what we call our circadian rhythm. In other words, what time our body naturally wants to be awake. For example, if individuals eat their meals or snack or eat their dinner later during the day, that will actually have the effect of pushing their body clock later.

So if you're eating your dinner at eight or nine or 10 or 11 o'clock, your body is going to become intrained to a later sleep-wake schedule. So there are foods that hurt sleep. There are foods that help sleep, and it's really important to time your meals properly based on your natural rhythm.

Host: Interesting. So it's not just about what we're taking in, but when we're doing it during the course of the day. How about exercise and its impact?

Dr. Wickwire: So exercise is important for two reasons. One, it increases the sleep drive. If you remember what controls sleep, one of those factors has to do with this sort of ongoing thirst for sleep that exists in our bodies and brain and the more active that I am, the more calories that I burn, the more my body will crave sleep. I often hear from patients, for example, I don't sleep very well, but geez, I spent five hours working in the backyard last Saturday, and I slept like a rock. Now, the second reason that exercise is important, is exercise reduces stress. And again, thinking back to the past few years, to have been alive on planet earth, we've all absorbed a certain amount of stress and uncertainty and exercise is a wonderful way to dissipate stress and really to foster positive mental health.

Host: So what's the first step and the typical process in evaluating someone, and see if there's something that can be done, number one, and number two, what it might be from a medical standpoint that could be standing in the way?

Dr. Wickwire: There are three characteristics of sleep when we think about assessing sleep complaints. The first is duration. How much sleep are you obtaining? The Centers for Disease Control, the American Academy of Sleep Medicine, the Sleep Research Society, the National Sleep Foundation, every consensus organization that has looked at this issue recommends between seven and eight hours of sleep for adults for optimal health and daytime function. That doesn't mean seven hours in bed. It means seven to eight hours of sleep, which generally will require a minimum of seven and a half to eight hours of time in bed. So the first thing that we look at is sleep duration.

The second thing that we look at is sleep quality. Now, the easiest way to measure your own sleep quality is does it feel like I sleep deeply? And do I feel refreshed when I awaken in the morning. The third factor that we look at is sleep timing. And when do I prefer to sleep? When do I prefer to wake up in the morning? When am I most alert and so on and so forth?

Host: And so if someone feels that sleep is an issue for them, that they're not able to address on their own, what do you do to check out some of the things you just mentioned and when do they know time to see someone?

Dr. Wickwire: Many listeners to this podcast will have questions pertaining to their sleep. And the first thing to do is not talk to Dr. Google, but talk to your primary care physician and let them know some of your concerns. Is it that you're having trouble falling asleep? Is it that you're having trouble staying asleep? For example, your gears are turning, you're awake in the middle of the night, or maybe it's just a problem where you're tossing and turning, and waking up feeling not refreshed. Do you snore, for example. Your primary care physician will have input, and hopefully some guidance onto all of these.

Now when patients come to us, generally, it's not for general health. Although certainly we see patients who want a sleep checkup. It's because patients are experiencing a specific problem, sometimes that they can identify, sometimes that they just know something isn't right. And they're looking for a specific solution.

The two most common sleep disorders that we see and treat are what's called chronic insomnia, which means trouble falling asleep, trouble staying asleep, or both along with the daytime consequences or sleep related breathing disorders, such as obstructive sleep apnea and snoring. Now these breathing conditions essentially mean that we're having partial suffocations on a very frequent basis throughout the night. In fact, we're having breathing pauses somewhere between five and 125 times per hour. So patients who experience conditions like obstructive sleep apnea, are suffocating all night, but they simply don't know it because they're asleep and of course our bed partners are generally asleep as well.

So even though sometimes bed partners are very well aware that we're snoring or not sleeping well or otherwise disrupting their sleep. The fact is that just because your bed partner doesn't know you don't have a problem, it doesn't mean you don't have a problem because your bed partners of course asleep themselves.

There are very effective treatments for these sleep disorders. And many others ranging from restless leg syndrome to narcolepsy or other disorders of chronic severe sleepiness to nightmares and acting out behaviors during sleep, which we call parasomnias. Sleep really impacts every vital organ system in the body. And so there are many ways that it can wrong.

Host: And so what's the first step in assessing, after they come to you once they've seen their GP and been referred?

Dr. Wickwire: My first question to every patient is if I had a magic wand and could change anything about your sleep, what would that be? And the reason that's such a helpful question, is first patients have never really thought about that by and large. And second it tells me the real reason that a patient is in my office. At the University of Maryland Sleep Disorder Center at the Midtown campus, we employ a patient-centered approach. And that means that we're not only interested in attending to the medical factors that doctors care about, but we really want to help patients live improved lives. And our colleagues throughout the country and other sleep disorder centers in the Maryland system and sleep disorder centers everywhere, hopefully employ the same approach.

I've never met a patient who said the reason I'm here is a result on a medical tests that exists in my chart somewhere. But all of my patients will tell me the real reason that I'm here is so that I have more energy to focus at work or I don't want to feel so sleepy when I'm spending time with my grandchildren or I've been so irritable recently, I know it's having a negative impact on the relationships that are most important to me. So we begin with. Really whatmatters to this individual. And then as we solve the medical problems or the sleep disorder problems, what we do is we build these behavioral objectives into our treatment plan, so that hopefully when the patient leaves our practice, sleeping much better and more satisfied as a result of the patient-centered approach that we've employed; they can not only sleep better, but live better too.

Host: Gotcha. And then finally, I want to ask you Doctor about things like herbs, supplements, like melatonin, also meditation, yoga, in a nutshell, anything from that group of remedies that you find effective?

Dr. Wickwire: I recommend mindfulness meditation in many of my patients. Anything that we can do to calm down the sympathetic nervous system is positive for sleep and physical health and mental health more broadly. Whether patients prefer mindfulness or guided meditation or yoga or exercise, all of those from a physiologic standpoint, seek to calm down inflammation in our body and brain.

In terms of herbs, there is some evidence supporting, sleep quality, for example from valerian root, but we want to be very, very careful because these products are not regulated by the food and drug administration. And in fact, studies have been done that demonstrate when you buy over the counter herbal remedies, the actual ingredient don't always correspond with the advertised agreement. So quality control is really important in these unregulated areas.

Your final question had to do with melatonin. Melatonin is a hormone secreted by the pineal gland in the brain. And it's not a sleeping pill per se, but it's a sleep related hormone. It tells our brain that it's about time to sleep. Melatonin in general isn't going to have much impact on your sleep and what melatonin is really good for, has to do with sleep timing, not falling asleep and staying asleep per se.

Host: Interesting. Well very thorough, comprehensive information to say the least. Folks we trust you're now more familiar with how to get better sleep and what to do if you're not. Dr. Emerson Wickwire, Sleep Expert. Thanks so much again.

Dr. Wickwire: My pleasure to be here.

Host: Now this episode is sponsored by the University of Maryland Medical Center. As an academic medical center, UMMC participates in cutting edge research and clinical trials, giving patients access to the newest treatments. With two campuses located in Baltimore City, UMMC is dedicated to providing superior care to communities across Maryland and beyond. The University of Maryland Medical Center, discovering ways to advance medicine worldwide. Find more shows just like this one at umms.org/podcast. That's umms.org/podcast. If you found this podcast helpful, please do share it on your social media. And thanks again for listening to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System.

We look forward to joining you again. Hoping your health is good health. I'm Joey Wahler.