Caitlin Whyte (Host): Sleep health is such a mystery for so many of us. And luckily, there are a few things you could be doing to get some better shut-eye. So to give us some tips and tricks to getting better sleep these days, we are joined by Gina Mauldin, a board-certified physician assistant with WakeMed Pulmonology and Sleep Medicine.

 This is WakeMed Voices, a podcast brought to you by WakeMed Health and Hospitals in Raleigh, North Carolina. I'm your host, Caitlin Whyte. Well, Gina, let's start off our episode with a definition here. What is sleep hygiene, and why is it so important?

Gina Mauldin: Sleep hygiene is something that we talk about referring to both our sleep environment and our behaviors. And it's important because poor sleep hygiene really can negatively impact how much sleep we get as well as the quality of sleep that we're getting versus good sleep hygiene can really make a big difference in terms of getting that good quality sleep that everyone wants and setting our body up for success when it comes to falling asleep, staying asleep, and feeling rested the next day.

Host: I'd love to move to the idea of setting the body clock, that circadian rhythm we always hear about. How does that work and how does it relate to sleep?

Gina Mauldin: Yeah. So, this is always one of our favorite topics in sleep medicine. So, circadian rhythm is basically our 24-hour cycle that's part of our body's internal clock that runs in the background. It helps our body carry out all sorts of different processes. And there are different ways that our body uses the circadian rhythms. But then, the most common one that we do think about when we talk about this is going to be our sleep-wake cycle.

And so, when we're looking at our sleep-wake cycle, our body is looking at all these cues to help us know when we need to be awake, when we need to be asleep. And really, light exposure is the most powerful signal to that internal clock to help send those signals to help us know that it's time for having alertness or whether it's time to be ready to fall asleep and stay asleep through the night.

Host: Okay. So, let's get to the good part here. What are some tips, tricks, hacks, I don't know, things we can do to set us up for a good night's sleep?

Gina Mauldin: A lot of it, we kind of have two different categories. So, one category is really what we're doing during the daytime. So if we are not doing the right things during the daytime, that can kind of sabotage our sleep. So, daytime things would involve getting lots of exposure to natural light. So, that can start first thing in the morning. If we can get exposure to natural light right when we wake up, that's a really powerful cue to our body to anchor our wake time and then set us up for success during the day. But then, that light exposure during the day is also really important. So, many times, we're sitting in offices, maybe not with a window. So if we can get outside and get some sunlight, go for a walk, just any light exposure we can get is going to be really helpful to keep signaling to our body that this is daytime. And then, that's going to help set us up for success at nighttime as well.

Other things during the day, we want to avoid napping. A big part of our falling asleep at night is going to be kind of our buildup of our sleep drive during the day. So as we have been awake and we're getting tired, as we get to bedtime, that helps us coast into actually going to sleep. But anytime we nap, we kind of reset that. And so, our body doesn't need the sleep. So for some people, naps are not problematic, but we do want to avoid napping too close to bedtime, taking long naps. If you are having trouble sleeping, we would want to really look at cutting out pretty much all naps. But again, for some people, they end up being able to succeed with a short little nap here and there and still benefit from that.

 And then, other substances, so caffeine is a big one. Generally, advice would be to cut off caffeine after lunchtime. The effects can last for quite a while. And so given all the different ways people can consume caffeine these days, we really want to try to limit that and then keep it in the morning and then have a good cutoff time for that.

 Another daytime activity would be vigorous exercise. So trying to get good exercise, kind of wear yourself out. I always kind of tell my patients, pretend like you're thinking about what you would want to do if you're trying to help a child sleep well. If you keep your child still and quiet, not doing anything, they're going to have a harder time falling asleep. But again, everybody likes to have the kids running around and playing at the park, and then we hope that that's going to result in a good night of sleep. And so, we want to do the same things for ourselves as adults. We want to wear ourselves out, get that good physical activity. Again, we do lots of sitting at work for many people. And so if we can find a good time to get even just walking, it doesn't have to be, you know, big, long gym sessions, but even just a walk during the day or after dinner can be really helpful to get that activity. And so, that's going to be kind of daytime activities.

At bedtime, then the keys that we want to look at are going to be having a really consistent bedtime routine. So, something that's going to be, you know, short enough, but also something that kind of helps wind us down. For some people, that can be a bath or a shower, often reading. Some people like doing yoga, meditation. But in general, things that are going to be kind of calming, quieting.

Everyone is pretty much aware at this point of the recommendations to limit screen time before bedtime. And that is obviously something that pretty much everyone struggles with. But, you know, part of it is calming our minds. And another big piece of it is just the light exposure. So, that light exposure before bedtime is going to make it harder to fall asleep. It's going to make our brain keep thinking that it's still daytime, that it's not time to go to sleep.

For many of my patients, I recommend trying to start in small doses. So if you're currently on screens right up until bedtime, set a shorter goal of 10 or 20 minutes to turn the screens off and then try to lengthen that. If we were all perfect, we would have our screens off when the sun goes down. So, our natural, again, circadian rhythm would be that when the sun goes down, things get dark, we just have candles and campfires and dim lights. But now, we have, you know, all sorts of smart bulbs and fancy electricity and screens. And so, we've definitely changed things, a lot of the technology in terms of the impact on sleep. And that has led to people sleeping shorter amounts of time, having more difficulty with sleep.

So, kind of an interesting thing is if people are really having trouble with circadian rhythm, getting back outside. So, there's some studies that show that camping for a week can actually help kind of retrain your circadian rhythm, get you back in tune with that light and dark cycle.

Host: That is so fascinating.

Gina Mauldin: Yeah. So again, just really trying to use light and dark to our advantage rather than, again, it's not that we're supposed to feel guilty about our screen time, but again, use the way our brain responds to the light in order to help promote that good sleep can just be kind of our superpower rather than looking at it as something that we have to limit ourself with.

 And then in terms of other things with bedtime, we really want to try to make sure that the bedroom is quiet and dark. Also, cool is helpful. And then really, bedtime is very crucial So, we've had several studies coming out just showing us the importance of consistency with our sleep schedule. I think most people tend to stress the sleep amount, which is still really important. But at the end of the day, if you're sleeping eight hours a night, but you're doing it on a very inconsistent schedule, that is not necessarily going to be as good as if you were, say, sleeping seven hours, but being very consistent with that bedtime and the wake time. So, sleep amount is important, but also just really keeping consistent with bedtime and wake time is really a beneficial thing for our brain and for our body.

Host: Wow, some really great tips there, and a lot of perspectives I didn't really think about. So, thank you for sharing those today. But, you know, sometimes bad sleep is actually a sign of a more serious condition. So, what are some common signs and symptoms of sleep disorders we should be aware of?

 Gina Mauldin: Yes, that's a great question. So, I find that a lot of my patients actually live with their symptoms for many years before they seek help. And so, this is something that, you know, in our sleep community, we definitely like trying to raise awareness. Obstructive sleep apnea is one of the most common conditions that we treat. And so, snoring is one of the big symptoms there. And I think, unfortunately, we've normalized snoring as something that happens when you're sleeping well and sleeping deeply and that this is just a normal part of life. Not all snoring is obstructive sleep apnea, but a lot of it is. And we really are not going to know which is which until we do a sleep study. And so, that is one that if there's snoring, especially with other symptoms like daytime sleepiness, waking often in the night, often we have patients taking more bathroom trips in the night, waking up with headaches in the morning, so all of these symptoms, if those are accompanying snoring, we really would recommend looking at doing a sleep study. And things have definitely improved in terms of our technology to test for sleep apnea. So, many people are hesitant to come in, because they're afraid of having to spend the night in the sleep lab, hooked up to all the wires, but we have really improved our testing to where many of our patients actually do their home sleep test where they don't have all the electrodes, all the equipment. We do just have a few smaller ways to evaluate. And so, the ease of diagnosis has actually really improved that process. So, my advice is for anyone who snores and does not feel rested in the morning and has any of those symptoms, being evaluated for obstructive sleep apnea can actually be a big life changing thing.

And then, the other piece is that there are a lot of cardiovascular risk factors that go hand in hand with obstructive sleep apnea. So, we see some worsening of high blood pressure, heart attack, stroke, heart failure, atrial fibrillation and other conditions as well. And so, that's a big reason that we also want to catch this because it can make a big difference in terms of prevention or even improving those things if those are diagnoses that patients have.

Host: Gotcha. Well, on that note, you know, I'm thinking of my boyfriend. He snores sometimes and now I'm like, "Oh, he have sleep apnea?" I mean, how do know when something like that is, you know, serious or when we should go to a sleep medicine specialist?

Gina Mauldin: So, I mean, a good start is always to talk to a primary care provider. If you have primary care, that's a good starting point is to kind of tell them the symptoms you're having, share the story. At the same time, again, especially with sleep apnea, I always just prefer to lean on the side of, if there's concern, check it out. If it's not there, we'll happily sign off on people and send them on their way. We're not trying to diagnose everybody, but you know, if there are symptoms there again, a lot of it is if there are symptoms and you feel that you're not sleeping well, or you're tired during the day, or you find yourself dozing off at stoplights, or you can't stay awake during the movie with the family, a lot of it, these things start to kind of impair your quality of life and your relationships with other people. And so, any of those sorts of things would be red flags that, you know, this is something that is impacting your sleep quality and your life. And, you know, it would be worth trying to come get an opinion from a sleep specialist so that we can try to help dig in.

And if patients aren't sure, we're happy to see people and try to evaluate. I would much rather go through everything and tell somebody that something is normal. But then, you know, many times we go through everything and we do find something. So, we're always happy to see people and try to dig in and figure out what's normal, what's not normal, and help out there.

Host: Yeah, absolutely. Well, Gina, as we wrap up here today, any last thoughts, advice, just maybe something we didn't cover about the world of sleep hygiene?

Gina Mauldin: Again, I think the biggest thing is really just trying to step back from making it a big long list of rules and more trying to set yourself up for success and look at the way that the body succeeds by consistency, using light and dark to our advantage. And so, trying to just put ourselves in an environment to let our brain and our body do its thing is a little bit more helpful than trying to have this environment of guilt where we have all these rules that we feel like maybe we're not following perfectly, but just try to make sleep a positive thing. And then even, sometimes we find that the sleep trackers and all the Fitbits and watches and all of that, sometimes we get a little too focused on sleep. You know, we want to do things that promote good sleep, but there's something to be said for using the good habits, setting yourself up for success, and then someways kind of stepping back and letting your body do what it does best.

Host: I love that. I love that. Back to the old school way.

Gina Mauldin: Yes.

Host: Well, some great information today. Thank you for joining us, Gina. And I hope all of us can get some better rest tonight. To learn more about WakeMed services, please visit wakemed.org. And thank you for listening.

I'm Caitlin Whyte with WakeMed Voices brought to you by WakeMed Health and Hospitals in Raleigh, North Carolina.