7 Tips to Sleeping Well

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for almost 30 years i’ve been helping

people of all ages sleep better

it’s a fun job for a physician because

most patients will improve

but it’s an odd occupation we think

about it because all of us have more

experience

sleeping than practically any other

activity we do you think by now we’re

all expert sleepers

but that’s not the case all of us know

somebody doesn’t sleep well

and there’s some trolling statistics on

any given night half of us don’t think

we slept well

about 30 percent of us have at least

occasional insomnia

more than ten percent of us have chronic

insomnia

and it’s estimated that worldwide one

billion people have obstructed sleep

apnea syndrome

a condition characterized by snoring and

sleep fragmentation

which can increase your risk of heart

attacks strokes policy by the will and

even cognitive decline

over 80 distinct sleep disorders have

been described and unfortunately as the

population gets older

the prevalence of these is only expected

to increase

despite these showing statistics there’s

a lot of good news

modern sleep science now has practical

solutions to help most people sleep

better

when i first meet a patient there are

four main areas about their sleep that i

want to focus on

i want to ask about the amount of sleep

the quality of their sleep

the timing of their sleep and ultimately

their state of mind

with regard to the amount of sleep the

national state foundation recommends

that we get

between seven to nine hours of sleep

every night

so if i meet somebody who tells me that

they are sleepy or tired but when they

get more sleep

they feel better then obviously you want

to try to remove any barriers

to help that person get that additional

sleep

but what if you say that you are asleep

you’re tired no matter how much sleep

you’re getting

then the problem is not the amount of

sleep

just like you can be both overweight and

malnourished

you can sleep a lot but not be sleeping

well

for example if you snore you may have

obstructive sleep apnea which has not

been diagnosed or treated yet

and in that case the more you’re

sleeping the less you’re breathing

and the more tired you’re going to feel

when you wake up you should not

routinely wake up feeling tired

sleeping’s supposed to be refreshing you

don’t leave your favorite restaurant

feeling hungry

why should you be getting out of bed

feeling tired it makes no sense

so if somebody tells me that they’re

tired or sleepy no matter how much sleep

they’re getting

for me that’s a hard stop you can

measure

your sleep patterns over time with any

one of several commercially available

sleep trackers

you can get a home sleep study which

will measure your breathing patterns

your blood oxygen saturation

uh your heart rate and your sleeping

position

you can have a more in-depth detailed

sleep study done in the sleep lab

which will measure your actual brain

waves your muscle activity and your

ventilation

the most common reason a person will

have a sleep study is to look for

obstructive sleep apnea

obstructive sleep apnea can kill you

when somebody dies in their sleep

sleep apnea may have been the culprit

when you have a sleep study what we’re

going to do is going to measure

your breathing and we’ll look for

disruptions of your

breathing while you’re sleeping and we

call these disruptions apneas and

hypopneas

if you have more than five of these

events per hour you meet the minimum

criteria to be diagnosed with sleep

apnea

a hallmark of sleep apnea is snoring

sleeping should be silent you don’t tip

off your presence to predators when your

guard is down

why would you make noise when you’re

sleeping all snoring is due to turbulent

airflow in our throats

when you’re breathing calmly awake you

don’t make noise

not all snoring is due to sleep apnea

another sleep apnea will snore but they

often travel

together there are a lot of good

treatment options for sleep apnea now

and even more options are in development

the most common treatment

is a small air compressor called the

cpap machine

patients sometimes uh say that they

think they’ll be unattractive to their

vet partners if they use one of these

devices

there’s nothing sexy about your snoring

i sometimes joke that

if somebody comes up with a dating app

specifically for people who

use cpap that to be very successful so

we spoke about the amount of sleep

we talk about the quality of the sleep

what about the timing

there’s a whole separate category of

sleep disorders related to sleep timing

called circadian disorders

these are also very treatable ideally

you want somebody to have the same

wake-up time as close as possible on

their work days as they do in their days

off

and when you wake up you want to get as

much light as possible

blight helps to bring predictive future

awakenings an irregular wake-up time

will lead to an irregular falling asleep

time

we want the homeostatic drive to sleep

to synchronize

with their core biological clock this

helps create

that predictable sleep wake schedule

that we’re trying to get

the way to do this the easiest way to do

this is to simply pick the earliest time

you’re motivated to keep

and lock in that same wake up time for

several weeks

initially your body will reject it

because you’ll feel strange to do this

but after a few days the body will start

anticipating that wake up time

the reason we anchor the wake up time

first is because if

the way the brain is wired it’s easier

to push away sleep then to advance sleep

it’s very hard to go to bed early in

fact our brains are most alert about two

hours before you

fall asleep so we spoke about the

amount of sleep quality timing of sleep

what about the state of mind

it may be important to talk about how

you feel about your time when you’re

awake if i want to help you sleep better

what’s your motivation to go to sleep

what’s your motivation to get out of bed

do you look forward to sleeping are you

dreading tomorrow

waking up is biological getting out of

bed is volitional

i want you to understand that your life

is reflected in your sleep and your

sleep reflects your life

sleep is a paradox and the paradox is

that we’re vulnerable being attacked

while we’re sleeping

sleep is as essential for survival as

food and oxygen

so you would think that the animals

would have evolved the way of not

sleeping

but that’s not how it worked at our most

co-evolved ways to protect themselves

while they’re sleeping

and we’re no exception you just can’t

snap your fingers and go from

fully awake to deeply asleep

not gonna work patients often tell me

that their problem is that they can’t

turn off their brain

but that’s a fundamental

misunderstanding of how sleep works

the brain is not meant to be turned off

in fact the sleeping brain is very

active and one things your brain is

doing

is keeping us safe and ready to wake us

up

if anything dangerous is happening

around us

so the brain is going to be in a

vigilant mode whenever it perceives

ourselves to be in danger

and we’ll sleep as lightly as possible

long-term danger and chronic stress are

similar to our brains anytime we’re in a

state of uncertainty

the brain is doing the right thing by

either keeping us awake

or having asleep as lightly as possible

the opposite of being a state of

uncertainty is monotony

and this explains why sleep deprived

people fall asleep easily when they’re

bored

you can learn to put aside your feelings

of stress or anxiety

at bedtime and you can do this with any

one of several mindfulness apps

yoga meditation cognitive behavioral

techniques

they’re all designed to help us be in a

peaceful state of mind

as we get ready for sleeping adults like

children’s the best in states of

serenity

you will need to create your bedroom to

be

a sanctuary for yourself to sleep i

don’t you think of sleep in a new way

the need for food is biological what we

eat is

cultural the need for sleep is

biological

but the way we sleep is learn so there’s

a learning component to sleeping

and it’s easy to prove all of you have

bed partners

you know that each one of you has your

own side of the bed right

every night you have a conversation

about which side you’re going to use

that night

no when you travel as a couple when you

get to your destination

you each put your belongings on the side

of the bed that you know you’re going to

be sleeping in

there’s really nothing to discuss switch

sides and see how you feel

and if you sleep alone rotate your body

in your bed put your feet where your

pillow normally goes

you see how you feel that night same bed

same bedroom same everything you may

even fall out of bed if you do that

so there’s a learned component to

sleeping which also means you can learn

to sleep differently

what i want everyone to hear is this

sleeping is the most

powerful and natural form of self-care

that we have

mild sleep disorders is how severe sleep

disorders start

and these are progressive conditions and

they also run in families

so there’s some things you can do to

help yourself sleep better first

get between seven to nine hours of sleep

every night

do not obsess over the number you can

get a sleep tracker if you like tech

two avoid working right up until the

time you fall asleep

you’re not a machine you have to create

that sanctuary for yourself

insomnia was around long before we’ve

had the internet of cell phones

a good book can also keep us awake so

it’s not likely the screens are the main

reason you’re not sleeping

it may not be helping but the content of

the information you’re receiving is more

likely to keep you awake

than the actual light source if you’re

dreading going to sleep

that’s a clear sign you should be

seeking professional help

three if you have trouble falling asleep

or having trouble

staying asleep stop trying to sleep

okay what you’re doing is forcing

yourself to get yourself awake

sleep will always come

so if you find yourself being frustrated

tossing and turning

get up leave the bedroom and do

something that’s of no personal value

go read the refrigerator warranty if you

get up and do something productive

or entertaining you’re just rewarding

the insomnia

another thing for those of you who have

trouble falling asleep or staying asleep

lock in your wake up time

first all of us have several brief

awakenings during the night

none of us really sleep the entire night

through

it just feels that way because they’ll

remember these brief awakenings

for many of us the only time we’re alone

with our thoughts is when we’re in bed

if you find that your racing thoughts

keeping you awake

schedule some time in the evening away

from your bed

to be alone with your thoughts six

if somebody tells you you snore believe

them they may be saving your life

finally if you’re waking up tired and

sleepy no matter how much sleep you’re

getting

talk to your doctor and ask about

getting a sleep test

i have seen thousands of patients over

the years

and most of them get better when

somebody has a chronic sleep disorder

gets better and it can happen fast it’s

amazing to see the vitality return

i never get tired of seeing it so i wish

you all a good night of sleep tonight

and every night thank you for listening

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