Transcription:
Maintain Your Flame - Stop Burning Your Candle on Both Ends

Cheryl Martin (Host): Are you a woman who's guilty of burning the candle on both ends because of an overwhelming to-do list? And to compensate, you squeeze sleep out of your schedule. Well, today's guest says to maintain your flame, don't skimp on sleep because it's vital for quality of life.

This is WakeMed Voices, a podcast brought to you by WakeMed Health and Hospitals in Raleigh, North Carolina. I'm Cheryl Martin. Joining me is Dr. Vickie Fowler, a family medicine physician at WakeMed Primary Care. Dr. Fowler, thanks for being here today.

Dr Vickie Fowler: Thanks for having me, Cheryl.

Cheryl Martin (Host): Dr. Fowler, it appears it in our busy culture, sleep deprivation is increasing. According to the Centers for Disease Control and Prevention, CDC, about one in three adults here in the US report not getting enough rest or sleep on a daily basis. Does that surprise you?

Dr Vickie Fowler: No, unfortunately, it doesn't, based upon the fact that as a family physician, I see people in my office constantly discussing their poor sleep. And it's a common factor in many of my patients.

Cheryl Martin (Host): What's the potential impact of this, especially for women?

Dr Vickie Fowler: For women, the impact of not getting enough sleep leads to abnormalities in our hormone balance. Women throughout our last time have a cyclical hormone balance through the day and through the month. The impact of not getting enough sleep alters the balance of our normal physiology, and leads to issues with menstrual irregularities, which can ultimately lead to infertility and other adverse health outcomes.

Cheryl Martin (Host): So we're talking about short-term and long-term risks with sleep deprivation.

Dr Vickie Fowler: Yes, it's fascinating. We all know that just one night of loss of sleep, we find ourselves the following day having cravings. And frequently, if you've not gotten enough sleep the night before, we eat to stay awake. Well, that is actually physiologic. In the absence of an adequate amount of sleep, our brain is aware that we're not getting enough glucose. The stress of not sleeping causes us to have these cravings and it increases our appetite and our craving for foods that aren't good for us. The short-term effects are things we feel on a day-to-day basis. The long-term effects are obesity, diabetes, and abnormalities of our normal hormonal cycles.

Cheryl Martin (Host): So what is your response to a common myth that we can learn to get by on a little sleep with no negative effect?

Dr Vickie Fowler: That's interesting. I often feel like as moms and as physicians in training, we're often told that, you know, you can just adjust to less sleep. But the reality is this isn't true. Research has shown that getting less than a necessary amount of sleep alters cortisol levels, thyroid hormone levels and, in women, it can lead to abnormalities in our monthly cycles in terms of estrogen, progesterone, and signals from the brain throughout our body that controls our regular physiology.

Cheryl Martin (Host): So how much sleep is enough?

Dr Vickie Fowler: Time and time again, the studies have indicated it appears that at least seven hours of sleep is critical. We all know about circadian rhythms. At least, we've talked about circadian rhythms. And when we have adequate number of cycles of sleep throughout the night at the adequate time, we feel rested.

So there's two factors. Number one, it's the amount of sleep and, number two, it's the timing of sleep. I want to expand upon that just to emphasize there's evidence that night shift workers have health issues related to the fact that they're not getting sleep in the normal times. For instance, when light hits our eyes in the morning and we have the awareness that we're awake during waking hours, our normal hormonal balance is in check. When we're night shift workers, there's evidence that there's increased problems with obesity, diabetes. So it's not just the amount of sleep, it's also the timing of sleep that makes the difference. Healthy sleep also has recurring cycles of REM sleep and non-REM sleep. And this is really important. One point I do want to bring up is restorative sleep or sleep in which we go through the normal phases of sleep is really critical.

Cheryl Martin (Host): Okay. Now, you're saying that, ideally, a person should get seven hours of sleep. For some, may require more than seven hours. Correct?

Dr Vickie Fowler: It's true. There's a variability. Everybody's a bit different. But under seven hours generally is associated with adverse health outcomes for sure.

Cheryl Martin (Host): So what if I've heard people say, "I can get by on four or five hours of sleep" or "I automatically wake up with just six hours of sleep," should that person try to force him or herself to sleep longer?

Dr Vickie Fowler: Well, no, I mean, there is some debate on this topic and the issue is of course, is the person waking up for other reasons? Do they feel rested when they wake up? Are they using things such as coffee or caffeine to get going in the morning indicating they probably do need additional sleep? I mean, certainly, there is a variability. But definitely, if you're getting four to five hours of sleep and some people, you know, say they get four to five and they are fine, that is not generally associated with good health.

Cheryl Martin (Host): What are some factors in women's lives that affect their quantity and quality of sleep?

Dr Vickie Fowler: We all know that women face a variety of different stages in their life related to their hormones. And we have in our teenage years and early puberty, young women will have disrupted sleep related to the onset of menstrual cycles. And when women are in childbearing age and they're having pregnancies, there's also the difficulty with sleep related to pregnancy. With young children, sleep is often disruptive with waking in at night. And then when women approach menopause, the altered levels of estrogen and progesterone also lead to abnormalities of sleep.

So women, based upon our physiology, have these known factors that are just part of our normal biology. Unfortunately, societal factors where often women are working outside the home, but also are expected to bear the large amount of the housework and the childcare and other factors plus the tendency of women to really have this inborn sacrifice ourselves for others mentality often leads us to shortchange our own health in the interest of caring for others. So in fact, there are physiologic reasons why we have sleep disturbances and there are external stressors that are either put upon us or we put upon ourselves.

Cheryl Martin (Host): So what should a woman do? You made some great points, just the busyness of women's schedules. So what is this woman to do who's juggling so much? What can she do to improve her sleep habits?

Dr Vickie Fowler: Well, basically, the important factors that I discuss with my patients includes looking at things that you can change, looking at factors in your life that you can have some control over. We have recommendations for how to get better sleep and we call that sleep health or sleep hygiene. But part of that involves actually planning a bedtime consistently that allows you to get at least seven to eight hours of sleep. And that's where we have to stand up for ourselves and realize that all of the things that we have on our plate may not be serving us well and may actually be leading to health risks. So we as women need to learn how to say no, how to take things off our plate that aren't necessities so that we can take care of ourselves, have good health and take care of others.

Cheryl Martin (Host): And you're talking about being proactive and having a certain time for going to sleep, even on the weekends being consistent.

Dr Vickie Fowler: Yes. Sleep health involves a consistent sleep schedule, both during the week and on the weekends. I'm as guilty as the next woman to work myself to death during the week and feel like I'm going to make up for it in the weekends. I've done that for decades.

Cheryl Martin (Host): Does that help to make it up on the weekends?

Dr Vickie Fowler: Well, it's nice to get caught up. But in general, that is not going to in the long run make up for the sleep deprivation that you suffered during the week. I want to address many of my patients come in asking for me to help them with weight loss. As we get older, as our metabolism changes, as we go through different decades in our life, it becomes harder for us to lose weight. And many, many of my patients come in asking for assistance with weight loss.

It is very, very difficult to lose weight if you're not getting adequate sleep because of several factors. Number one, your body is not getting adequate rest in order to feel as if you are able to expend energy. I often tell my patients, "If you don't get enough sleep, if you're up late at night, you're basically putting yourself into a stress mode." And when our body's in a stress mode, it holds on to calories. That's just the way our physiology is made. So getting consistent sleep, setting a bedtime that is early enough to get at least seven to eight hours of sleep is one of the major factors that we can control hopefully so that we can have better health and maintain a healthy weight.

Cheryl Martin (Host): I'm really glad that we're talking about this, because I think that a lot of us don't connect the dots that, if we don't get enough sleep, it will affect our health because it appears to be silent. We don't know these things that we can point to. We don't know that problems later we can trace them to not getting enough sleep and so we feel like it's okay.

Dr Vickie Fowler: Right. And it's interesting. There's a lot of actual scientific research that has gone into looking at the effects of lack of sleep and what that does to us in terms of cortisol levels, which I have people that come to me wanting me to measure cortisol levels because they've read about it and they've heard that cortisol is bad and that, "Maybe my cortisol is high." Well, if you're stressed out, if you're not sleeping, if you're burning the candle on both ends, I can look at you and tell your cortisol levels are high. When our cortisol levels are high, it's impossible to lose weight, because our body is basically holding on to sugar and we have elevated insulin levels and we can develop diabetes, high blood pressure, high cholesterol, heart disease in the setting where basically it is created by many of our behaviors, not just what you eat, but also your exercise, your sleep, and your overall health can lead to obesity, diabetes, heart disease, and a lot of chronic health conditions. And by the time you're there, then you've lost that window where you could have prevented those by having better habits early on.

Cheryl Martin (Host): Anything else we can do to improve our sleep habits?

Dr Vickie Fowler: Yes. Beyond being consistent and making sure our bedtime allows seven to eight hours of sleep, it's important that we look at our environment and control different things within our environment. We need to ensure that the area we're sleeping in is quiet, dark, relaxing, comfortable temperature. Most importantly, we need to get our electronic devices out of the bedroom. Ideally, we shouldn't have TVs, computers, smartphones, even in the bedroom. But if you do have them with you and you do have them in the bedroom, turn off all your electronic devices at least 30 minutes before bedtime.

Also, avoid large meals, caffeine and alcohol before bed. I can't tell you the number of patients that tell me they have alcohol to help them go to sleep. It is absolutely true that a drink or two before bedtime will help you go to sleep, but you won't get the restful restorative sleep you need, because alcohol actually adversely affects your REM sleep. And also caffeine, we really need a caffeine curfew. And as we get older, that caffeine curfew gets earlier and earlier in the day.

So those are just some pointers. And if you're going to exercise, which we do recommend daily exercise, please exercise early in the day, because exercise just before bed will also increase your wakefulness and make it harder to get to sleep.

Cheryl Martin (Host): Great tips. Great advice. Thank you so much, Dr. Vickie Fowler, a family medicine physician at WakeMed Primary Care. I'm so glad that you explained how making more time for sleep helps protect our health and our wellbeing.

Dr Vickie Fowler: You're very welcome.

Cheryl Martin (Host): To learn more about WakeMed Primary care or to schedule an appointment, please visit wakemed.org.

This has been WakeMed Voices, brought to you by WakeMed Health and Hospitals in Raleigh, North Carolina. Thanks so much for listening.