7 Tips to Sleeping Well
[Music]
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
[Music]