Insufficient Sleep – Health Matters

Insufficient Sleep - Health Matters

this ucsd-tv program is presented by university of california television like what you learn visit our website or follow us on Facebook and Twitter to keep up with the latest programs hi everybody I'm dr. David granite and welcome to health matters sometimes we talk about medical disease on the show sometimes you talk about injuries sometimes you talk about normal medical processes some of those affect a few people what we're going to talk about today affects everyone everyone listening sleeps all of you sleep and I dare say many have had a problem with their sleep and it turns out according to the Centers for Disease Control down in Atlanta there's a huge epidemic of people who have problems with their sleeping does it matter there's a matter if you don't get enough sleep aren't you just more productive what does it do to your body what does it do to your thinking what does it do to your functioning well we have an expert with us today to help us through that topic dr. Sean Drummond welcome thank you and as my mother would say you're a real doctor and and dr. Drummond is an associate professor at UCSD and director of the behavioral and sleep medicine program you run a lab in the same field him and really an expert when I was reading to get ready for the show I saw that that you've been interested in sleep since an undergraduate yeah days which I laughed about because I'm thinking every undergraduates interested in sleeping somehow or another right and and so what an interesting topic to me because I'm convinced I don't get enough sleep and I'm certain I look at my kids that somehow we're messing with their sleep and I'm really excited to talk about that what is sleep I mean what is it that all of a sudden our brains our bodies turn off in some way we close our eyes and we're in someplace else yeah that that's an interesting question because sleep sleeps actually not one thing sleep is actually two different states of consciousness and there is one of the states of consciousness which lots of people have heard about which is called REM sleep rapid eye movement sleep this is a stage of sleep where we do most of our dreaming and then there's the second stage of consciousness within sleep which is called non REM sleep and that's more of kind of the early transition stages when you're just falling asleep and then that really deep I'm sleeping like a log sort of sleep and the brain has very different levels of activity in each of those so in non REM sleep the brain is very inactive in REM sleep not surprisingly given that we dream there the brain actually reactivates and becomes very active just like it is in the waking State so why are we sleeping our heart still beat we still breathe our brains are active a good chunk of the time what's the value of sleep why why are we built that for a certain chunk of the day we close our eyes and we go to sleep that's a really good question and I think one of the mysteries of sleeping one of the things I love about studying in is we still don't actually know what all of the functions of sleep are we certainly know a number of them there are a lot of restoration functions that occur in the brain and in the body when we sleep certainly we need sleep in order to have optimal cognitive performance be able to think and do things during the day there's very very good data showing that memory is enhanced by sleep and that long-term memory benefits from if not explicitly needs restful sleep periods in order to store things in long-term memory and then there's lots of medical reasons so the sleep interacts with the Android print system in order to help regulate weight for example and fight off things like diabetes so I we're gonna get into that in death sure something like 25% of the United States population doesn't get enough sleep and I had to look up when enough sleep is because you know since medical school I I'm certain I've gotten enough sleep and and some of the estimates I saw when you're when you're you're a young elementary school kid it's 10 or 11 hours of sleep teenagers at least nine hours of sleep adults seven to nine hours of sleep that means if you go to sleep after Jay Leno is over at 12:30 at night and you're supposed to get eight hours of sleep you should be getting up at 8:30 mm-hmm and I don't think that's what most people do no no I mean the reports are that most people get closer to six and a half or seven to seven and a half hours of sleep and certainly for sort of the average adult the epidemiological data shows very clearly that anything under about seven anything above about ten leads to long-term health consequences so you're right lots of the population isn't in that sweet spot that we need to be in yeah and I mean I know my son when he was in high school gave me that pitch over and over that he needed more sleep and it was ridiculous that they made him get up so early to go to school and now I'm starting to see data that probably high school is starting too early absolutely it is absolutely and and with teenagers it's not just the hours of sleep but it's the timing of their sleep when you're a teenager the body the brain wants to go to bed much later than when you're an adult so 1:00 to 3:00 in the morning and wants to wake up much later the biological night is literally at a different time on the clock then when you're an adult so it really is shifted yeah exactly and you can't just force the shift back not easily I can tell you that so so the kids might be right is that where we're blowing it on what how we built school high school for them in starting classes at 7:30 is ridiculous that we should start later to allow them to get to sleep we have physiologic information that we're ignoring essentially yeah and there's a few school districts around the country that have experimented with this and they've shown that if high schools start later grades go up particularly in the first couple classes of the day behavioral problems go down particularly early in the day so yeah there's very good data to suggest the whole system that should get changed and you know I mean it's sort of political probably impossibility to do it but biologically it would be the thing to do yeah Sports practice would get harder if it started later in the day other issues to it so we've gotten that idea of why we sleep there's some regeneration that goes on the brain seems to want to do have some fun at least well it's REM sleep it's working all day it gets its rest it's fun what are the things that that go wrong and and III have some in my list but we have different words from sleep disorder to insomnia to narcolepsy to I'm tired how do you define it as a sleep expert to what we call the different things that are when sleep is going wrong sleep goes wrong yeah so it's actually fascinating when sleep goes wrong and I think there's a couple big classes of sleep disorders if you will and one of the big classes is insomnia and insomnia essentially is when you either can't fall asleep can't stay asleep or you wake up too early and can't fall back to sleep and that that poor sleep at night has some direct impact during the day so that it messes with you somehow during the day that's insomnia and what do I mean by I can't fall asleep can't stay asleep wake up too early we use a rule of thumb of 30 minutes so if it's more than half an hour to fall asleep on a regular basis more than 30 minutes awake in the middle tonight more than 30 minutes before your alarm clock goes off that's insomnia another big class and probably the most commonly undiagnosed sleep disorder is something called obstructive sleep apnea which is where people stop breathing at night the airway closes down makes it impossible to get air down into the lungs and people stop breathing and this is usually associated with really loud snoring and then a pause in the snoring when the person isn't breathing and then they wake up gasping for air start breathing again fall back asleep and the whole process starts over again that's almost comical on movies or TV the loud snorer or then wakes up but that's really a medical issue yes that's a significant problem so it's so sweet idli pad Neah which generally is a very chronic disease is very bad because not only does it fragment your sleep every time you stop breathing you have to wake up to start breathing again but also if you're not breathing you're not getting oxygen and not getting oxygen clearly is very bad for our heart for our lungs for our brain for basically everywhere in our puts us at risk for strokes and puts us at risk for heart attacks even a more minor things like headaches so it's bad while we're on that topic specifically asleep aperture how does the person who's asleep know that that's happening often they don't we often have the bed partner bringing the person in and say fix them there's something wrong but they the the patient the the person with sleep apnea would know if they consistently wake up feeling like they're short of breath gasping for air sometimes people even hear themselves wake up snoring things like that can be a clue and usually when you're waking yourself up it's gotten to the point where it's pretty bad there's no app that you can put on your phone that listens to your you know there probably is but I don't know it and as we go forward there was one other I encountered that sometimes I think I have it because I bad knees I don't know but restless leg syndrome uh-huh you know I did you go to lie down and you you don't get comfortable it's more than you just don't get comfortable so you know back pain something like that can make you not comfortable restless leg syndrome which kind of happens when you're awake and then it's it's cousin periodic limb movements which happens at night essentially as you lie down and you get this restless creepy crawly kind of achy feeling in your legs and it won't go away unless you move them and when you move them it kind of goes away but then as soon as you relax again it comes back so that's really what restless legs is and that's gonna keep you awake of it and that's gonna keep you awake again there's this I feel like we're getting towards the final common pathway here of all of these lead to you're not getting enough sleep and and then there are those people like me who find themselves waking up to go to sleep so I fall asleep on the couch downstairs and my wife wakes me up so I can get up stared go upstairs so I have to get up to go to sleep uh-huh and and so which I'm sure means again I'm not getting enough sleep but that so final common pathway is sleep at and yeah insomnia the way you described it restless legs all those people are not getting adequate sleep yeah that's right and then that's at night they wake up they're tired what does that do to them all day long well I think you you sort of described at least the major symptom the most common symptom really well which is you're sleepy all day long and so you're more likely to fall asleep when you shouldn't be you know be it on the couch while you're watching TV or when you're at a meeting or a downtime at work or maybe even driving which actually happens and it's pretty frightening so that the excessive sleepiness during the day is is one of the most noticeable consequences I think the other things that we commonly hear people talk about are cognitive problems so problems sort of thinking through and doing things and sometimes this is very specific and people say well my memory is really bad or my concentration is really bad and sometimes it's just how it was so much harder to get through work or school today because it's like I'm in a fog and my brain is walking through mud but what we have figured out a way to self treat it and it's become a multi gazillion dollar business with caffeine yeah absolutely absolutely Ron every corner right and ironically caffeine can actually make your sleep problem at night worse and that's why we get into this little cycle and so one thing people don't often know is that caffeine can affect your sleep for eight to ten hours after you drink it which is long after you feel like it's affecting you right a cup of coffee after dinner very likely to affect your sleep and so there's that cycle right I'm tired I want to get some work done at night I have a cup of coffee at the end of dinner because I'm gonna do some more and then I'm tired again because I didn't get enough sleep cuz the caffeine affected my sleep cycle that's right right and how do you break that it's tough I mean you break it really by weaning yourself back off of the caffeine which then allows you to get better sleep at night which then makes you less likely to need caffeine the next day and of course all of this doesn't happen in one night so there's usually some painful nights when you're you know either fighting through sleepiness because you're not using the caffeine or not sleeping as well as you're sort of building your sleep pattern back up but the the long-term cycle basically ended for example to treat insomnia is to completely change the overall sleep-wake behaviors in ways that are much more consistent with getting good consistent sleep and and that's that's the that the payoff here in this conversation but I want to make sure people really do understand serious illness before we get there sure I came across some information that blew my mind staying up or not not getting good sleep for 18 hours is like having several drinks and if you haven't slept for 21 to 24 hours on the CDC website they say that's like being drunk yeah if you're trying to drive your performance is the equivalent to a drunk driver yes and I'm just thinking about somebody with lack of sleep trying to perform in life whatever it is and performing as if they were flat-out legally drunk that's an astonishing idea that that you put your brain in that position yeah what I like about that comparison is everybody understands blood alcohol content everybody knows that it's bad to try to do things when you're drunk particularly Drive and to say something like if you've been awake for 18 hours which means you're getting six hours of sleep at night you're awake for 18 hours you're driving as if your blood alcohol is 0.05 and when you're awake 21 to 24 you're driving as your visit if your blood alcohol is 0.08 to 0.1 that should mean something to people and and you know because being up to 18 hours is pretty normal I mean you know it's six hours of sleep is it happens exactly driving home from somebody seeing a friend or whatever you get ready you know it's 10 11 o'clock at night you're driving as if you've had a couple of drinks even if you've had nothing that's right that's right and what that means driving is if you had a couple drinks specifically is you haven't people swerve in their lanes the same extent as if they were drunk and people can't stay in the center of their Lane the same way you can't as if you're drunk and so those are pretty those are pretty dangerous drug that's real yeah and you mentioned these so I want to cycle back to it diabetes cardiovascular disease obesity all affected by poor sleep mm-hmm yeah and and actually this is one of the really exciting areas in the last five six seven years and in the sleep field is our understanding of the interaction between sleep and the endocrine system has really grown substantially so so in a nutshell what happens is when you get insufficient sleep two things happen one our body starts to process insulin and glucose differently so that if you in the in the studies that they did when they had people they only gave them four hours in bed a night for I think it was six nights they turned him insulin resistant so they essentially turned them into diabetics from one week of really bad sleep Wow Wow you know as someone I fly places I give lectures that come back there's there's there's plenty of times where I'm going to get in a few hours of sleep here and there that's a that's scary it is that's the good news is it reversed when they started sleeping again and in the other piece I think that that's important for people to know about is is getting too little sleep in this sort of way that we're talking about also affects the the peptides that tell us whether we're hungry or were full so there's a peptide called ghrelin that tells us that we're hungry and there's another peptide called leptin that tells us when were full when we haven't had enough sleep the amount of ghrelin that we our brain secretes goes up the amount of leptin goes down so we get more signals that we're hungry fewer signals that were full and the food we crave is high fat high carbs sugar junk food basically so the potato chips and ice cream I eat just before I go to sleep is okay but it's not your fault thank God I can tell my wife okay and depression for that you know it's it's not the medical problem but it's a medical problem and you know I mean added to by lack of sleep yeah and not just depression so so but we can start there so having insomnia actually puts people at risk for developing depression even if they've never had depression before in their lives and if somebody has had depression and say they've been treated and now they're doing fine a new bout of insomnia puts you at risk for developing more depression and new bouts of depression down the road and the same is true for other anxiety disorders the same is true for post-traumatic stress disorder lots of mental health problems interact with sleep so that they make each other worse and you do a lot of you work at the Veterans Hospital I would think that post-traumatic stress disorder sleep and those issues come up all the time all the time something like ninety percent of patients with posttraumatic stress disorder have insomnia and/or chronic nightmares and so whatever it is it's disrupting their sleep pretty we've set the stage this is a big deal I want to run through some myth or fact type questions and talk to you about how we can help these people are trouble sleeping and what we can give in general so a myth effect getting early to bed makes a whole difference if you just got into bed at 9 o'clock or 10 o'clock it would all be okay myth myth okay and we'll talk about why in a minute you can catch up on your sleep but it's okay you know and Saturday and Sunday I'll catch up on your sleep mostly myth yeah yeah if you take your nap in the middle of the day that'll make up for it not getting a good sleep at night myth okay I drink at night it'll help you go to sleep it will but it will just disrupt your sleep later in the night so good or bad in the and bad and bad okay you got it alright so now we got somebody who's got insomnia let's take sort of routine more typical stuff there's a word I came across in preparing for the show perpetuators things that perpetuate bad sleep I loved it I thought that was it because it really explained what perpetuates the problem what are those things that that that someone can do to figure out what their perpetuators are and then start changing them okay so you're right because this is actually key to fixing it insomnia problem so there's really like four different kinds of things that perpetuate sleep problems one of them are things that people do to try to get extra sleep at night when they know they're not sleeping well so this could be going to bed early like you suggested this could be sleeping in the next morning this could be drinking alcohol to try to help yourself sleep so things you do to try to see maybe I'll get some extra sleep tonight the second kind are things that you do during the day to make up for the fact that you had a bad night of sleep last night so this would be taken out this would be drink caffeine things like that the third type of perpetuating factor are things that you do in bed when you're not sleeping generally it's a time when you would rather be sleeping but it doesn't even have to be so generally things you do in bed when you're not sleeping this could be read watch TV play on the computer or the iPad for a lot of people asleep problems it's stress they really worry problem solve ruminate that sort of stuff in bed and then the fourth type of perpetuating factor is untreated medical or psychological problems that disrupt your sleep and the big problem with all of these things is they lead to a condition where you are in bed and you're awake and so what happens is you start pairing together I'm in bed I'm awake I'm in bed I'm awake I'm in bed I'm awake and pretty soon your brain learns that the bed is a place to be awake not a place to be asleep and this is now what has created something called conditioned arousal which steamrolls the insomnia and really keeps it going you want to be conditioned like I think most people know the Pavlovian bell rings the dog's saliva is exactly right you want to be conditioning when you get into bed you go to sleep right and with insomnia the condition is usually a hundred and eighty degrees from that they get into bed and they're wide awake worrying that doesn't work it doesn't does it just because we're in the modern era you know I could go to bed I'm gonna check my email before I go to sleep that's screen there's something about the screen the the almost addictive technology then you should you're awake a little bit longer is it stimulatory is that the wrong I mean really the wrong thing to be do when you get into bed pull out your laptop or a game yes it is the wrong thing to do for several reasons one the cardinal rule of good healthy sleep is do nothing in bed but sleep so you shouldn't be doing anything else in bed including playing games computer or cell phones or whatever now it can still be a problem if you're in the other room and you check your email and then you go brush your teeth try to get right in bed and it the issue isn't settled scientifically I don't believe about whether the light from the screen is in and of itself disruptive of sleep but what can be is you check that work email and you're like oh really and then your mind starts to roll and that is going to make it much harder for you and I'm picturing people with a phone and they're texting a friend or doing something just before they go into sleep and put the phone down trying go to sleep I mean it yeah you you really want a wind down period before you go to bed and that wind down period can can look very different for different people but it should be unplugging from electronics not engaging in things that you know are stimulating or restful so somebody it might be reading somebody might be watching TV somebody might be chatting with family members whatever it is but it needs to be relaxing if I turn on the TV right now probably there's an ad for some drug to help you sleep there's a categories different categories of drugs that help you sleep I use melatonin when I travel for jetlag because I it helps me get through yeah so are there medications that in general make sense to use or you need to be doing this kind of non medicated evaluation of what's going on with your sleep first and fix that rather than trying to fix it by keeping everything else the same throwing a pillow at sleep medications are useful for very short-term acute effects of I know I have a big interview tomorrow and I have to get some sleep or I just got back into town and I'm kind of jetlag and I just need to get over the hump something like that they're not meant for chronic sleep problems and by chronic I mean maybe for three months are people using them that way absolutely people use them that way but it's it the frontline treatment and even the American Academy of Sleep Medicine which is the the major clinical sleep organization in in North America says that the behavioral interventions for sleep are the frontline treatments not the medications so just all the behavioral stuff that we were just talking about somebody's listening at home and they're having it son yeah they're struggling a little bit they don't know if they've sleep apnea they don't know if there's something else wrong and they don't know if it's affecting maybe their diabetes or even if they don't have health problems they're having trouble losing weight where should they start I mean they've listened to our show that's great should they start by trying to keep a sleep diary so they start by going there internist do they go to you and find a laboratory somewhere that's a sleep research and studies this where do they start oh that's a really good question and I think there are a number of useful websites to get even more information than we've talked about here and the National sign the National Sleep Foundation is a very good website for example that can do that but really I think that if someone is struggling it feels like they have really bad sleep it's impacting them their end of the day but they don't really know what's wrong with theirs it can help to go to a sleep clinic and talk with a specialist of there and get a really thorough evaluation it may or may not involve spending the night in the sleep lab it may simply be an interview filling out some sleep Diaries at home learning more about what's going on so I think if it's difficult for someone to identify the source of their problem that's a good way to go in the short time that we have left I'm just wondering if we made the the world according to Drummond and you got to you know you got to control things where would you like to see things now and then going forward and and or predict I mean where are things gonna go what are we going to learn and where's this whole world over the next several years gonna go so I think I would like to to make sleep health much more in the public consciousness I think it's something that that has not really been out there people sacrifice sleep for productivity it's a false sacrifice and that type of education is something that I would like to see kids spread out more and then simply increasing access to good sleep clinical services so that when people do have sleep problems they can get their sleep problems better and that's just a matter of training more people to do it quite frankly yeah I mean while you've been talking thinking about the work that you do it with the veterans I was trying to picture somebody deployed either on a ship or on the ground and there's it's a war zone how on earth they could ever get proper sleep the stress and anxiety that they're under the caffeine the cigarettes though you know all the stuff the stimulants I can't it's astonishing that somebody comes out of that okay just just that's the ultimate in the wrong sleep habits it absolutely is and we see we see that every single day at the VA that that's what started somebody's sleep problems and now they can't get them fixed until they come see us yeah I was talking to a friend of mine whose husband's in Navy SEALs and he had to wear special sleep mask over his eyes because they'll I mean he it was to transition back to civilian life was brutal and these are the people that were counting on to do so much for their service that I'm so glad that you're there studying all this and try to figure out how to how to make it better and how to help thank you and thank you for educating our our listeners today cuz I'm tired and you know bliss do you going god I got to do a better job and I think a lot of people are going to hear that and realize the same thing and that the the behavioral things that we can do to make a difference for ourselves and sometimes when you need more help it's okay to ask for it absolutely there's things to do thank you so much for for your time today thank you is my honor we've been chatting with dr. Shawn Drummond a sleep expert who does research in this field and as you heard really has a very good approach to understanding what's going on we have trouble sleeping a good chunk of you have insomnia or have sleep difficulty some of this is self induced and as you heard it's it's a false sense that you're going to become more productive or things are gonna get better if you don't sleep if you just steal an extra hour from the night but that's not what happens and it's so scary to think about how driving after 18 to 24 hours is a lot like having several drinks so there's a real problem it affects your health affects your mental health it affects your productivity it affects your memory it affects your thinking it affects all of it so take it seriously and if you don't just keep pushing yourself if you're having a problem ask for help there are centers and there are people you can go to I'm dr. David granite remember knowledge is power that's what we say every episode right here on health matters

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11 thoughts on “Insufficient Sleep – Health Matters

  1. Hello , as a MD, not born in Spain, I open a question , Do people here in Spain live more because they sleep more and may be take a Nap too????

  2. Got to bed at 9.30pm. The sleep cycle should be 10pm-6am. And if your country changes the clocks you may have to go to bed one hour before. Going to bed early is amazing. It gives you an extra 50% of mental focus and clarity in my opinion.

  3. High school starts WAY TOO EARLY for teenagers. There's a movement to start changing high school times.  It's just ridiculous how early some schools start.  The best high school I know starts at 8:45 p.m.  The kids are happy and succeeding.

  4. Back in my school days i always took the later classes due to what he said… i always sleep as often as possible 7 to 9 hours….. rich get good sleep, do not run down their body and eat well, that is why they live long, i am not greedy, i have enough so i sleep, relax and try to eat well…. i had some bad times, but now i do not have to work much to live well, i´m not rich… and srew companis that make people overwork that is why i left the states….

  5. Great information but it seems like the poor working people will die before there time because there is some kind of conditioning taking place by employers and major business to get more out there workers. Which creates more stress and pressure to stay awake to make a living. This world is trapping people into a bad lifestyle. What a nightmare ?

  6. My company requires a handful of us to work 24-hour weekends at least once in sometimes a five week period in addition to three nights a month above and beyond our daily 8-5.

  7. There's a sad self destructive irony in the fact that I'm staying up late to watch this when I've got to wake up early in the morning.

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