Rachel: Welcome to today’s webinar entitled ‘Tired of Being Tired: Sleep Better’. We are fortunate to have Dr. Samantha O’Connell as our presenter.
Dr. O’Connell earned her PhD in Clinical Psychology from Suffolk University and she currently performs neuropsychological assessments for the Integrated Center for Child Development and works as an outpatient therapist for families, couples and individuals across the developmental lifespan, where she specializes in cognitive behavioral treatment.
Without further delay, Dr. O’Connell, I will turn things over to you.
Dr. Samantha O’Connell: Wake up everybody! Hi! Thank you so much for having me to talk about sleep! But if anybody knew me back in my 20s or before, maybe even early 30s, they would say, Dr. O’Connell, Sam, talking about sleep, she used to say you can sleep when you are dead. But that was before I read a lot of the great research that’s out there about, oh, wait a minute, sleep really is important.
And we know this from an anecdotal point. We always know that we are supposed to get more sleep, but before, I guess since the past ten years, I haven’t been so enthused by the research, but it’s piling up, and I have to say I think that we do need some sleep. So I hope that I do not put you to sleep during this webinar, so let’s get going.
What are we going to talk about? So first of all, we are going to talk a little bit about why sleep is important, why should you be listening to this webinar, why really do we need to sleep?
I will talk a little bit about why we are not getting enough sleep, especially these days, and describe the consequences of sleep deprivation; what happens to us when we don’t sleep enough?
I want you all to assess your own sleep behavior and what we call sleep debt.
And then finally, identify some tips that promote better sleep habits.
Now, a side objective that I have here is that we are going to be talking a lot about disordered sleep, which is very different from a sleep disorder. Everybody has disordered sleep. That means not optimal sleep and sleeping conditions.
We all have this from time to time. Over 70 million Americans have chronic sleep problems, but I venture to say that all of us at one time or another have some bad nights or bad weeks or situations that just aren't conducive to having those really great sound sleep nights.
So I want to recognize that this is a part of all of our lives, and also recognize that just talking about what we should be doing can instill a little bit of anxiety, especially when I talk about, oh gosh, all the bad things that can happen if we don’t sleep enough.
So I want to sort of recognize that this happens to all of us and we all have disordered sleep, to some extent, in that if we start worrying too much about not getting enough sleep, that can sort of backfire and turn into a more significant sleep disorder such as insomnia.
So let’s just recognize that we all have this and I hope after this webinar maybe that we will just be a little bit more motivated to make sleep a priority, because it really does matter.
All right! So let’s look at what we should be getting. I want you guys to look at this and think about you and the people in your life, how are we doing. So as you see these numbers, most of you who have had little ones know, and it’s pretty common knowledge that newborns and infants, they need a lot of sleep.
Look over at that right-hand column, 0-3 months, 14-17 hours. They are sleeping a lot. It doesn’t get much better before a year.
And then we will see that toddlers and children, there is a variance there; between 11-14 hours for the younger ones, that’s during prime naptime. And then the doomed 3-5 years, where the naps go away and the kids are still cranky.
Teenagers; now, teenagers are a different beast. Some of my favorite people to work with are teenagers; however, teenagers need their sleep. The average there that’s recommended is about 8-10 hours, but there is some varying literature out there about how much sleep teenagers really need.
And one of the things that’s going on here is that the adolescent brain is -- there is so much going on; there are these processes. I won’t bore you with the neuropsychology of it all, but there are these processed called pruning and myelination and all this stuff happening that makes a teenager’s brain out of whack. And when all that stuff happens, you need more sleep, yet teenagers want to stay up all night, and they want to text, and they want to Twitter and all that stuff. And they want to do it at a time that their parents don’t want them to do it, because of course their developmental task is to do the opposite of what parents say. So that poses a bit of a problem.
And also school schedules often have the teenagers going to sleep -- are going to school before most of the younger kids, and it just put things a little out of whack, so teenagers certainly need a lot of sleep and that doesn’t seem to be conducive with the teenage lifestyle in a lot of home.
And then finally, the adults; so we average need about 7-9 hours. So let's just think about it, how are you guys doing with that? What's interesting with this slide is that the people who are having those newborns and infants who need a lot of sleep are the adults who need less sleep, but what's interesting is the kind of sleep we need is solid 7-8 hours put together.
When we have those newborns or infants, especially in those earliest years, they are waking up a lot, and what we find in adult sleep is that the REM sleep, which is one of the most important stages where consolidation of memories and all that stuff happens, is happening about 90 minutes into the cycle and then the more you sleep, the more that happens. So it certainly can pose a problem when you have children of different ages and waking up at different times, so let me just put out there that it's not easy when we are talking about family life.
All right! So why do we need sleep, right? Why do we need it? We know that it supports healthy brain functioning, we know this. There is a lot of research studies out there now that say that sleep really do make our brains healthier.
And let's talk about emotional well-being; mood, people, how many -- not you of course, but the people who you love and work with. We know who is cranky pants when they haven't had their sleep.
While getting enough sleep certainly isn't going to make you Sally Sunshine, your disposition is not going to change, but we notice that not having enough sleep certainly is a vulnerability factor. And for more people, they become more vulnerable with less sleep, some people are just better at it, but overall, in general, sleep really does affect our emotional well-being.
One of the things it affects the most in terms of your emotionality is what we call emotional regulation. So the more consistent sleep you can get, the more sort of regulated you are. And some of the interesting studies that have been done on emotional regulation and sleep, and we probably see this in our lives, is that people who are sleep deprived act kind of funky sometimes.
Think about at work, they may be the people who are snapping, or snapping at their partners or children, just more cranky.
They are also more likely to be people who burst into tears or have inappropriate laughing. It messes with their emotional regulation. And we will talk a little bit more about the different facets of emotionality that sleep can affect as well.
Now, what about cognitive and physical performance? There have been a lot of different research studies done about that. How much sleep do we actually need to perform well? There are lots of studies with athletes about, is staying up the night before really going to affect our performance?
And what they find is that in terms of the cognitive part that sleep really does affect that. It affects how clearly we think.
And for a lot of us, have you ever woken up and felt like you are just fuzzy? You really need that caffeine in the morning. You are more easily confused. You just can't quite get that brain going. And what we know is that sleep really does affect how we think.
The experts say that it certainly impairs our attention and our decision making, and that we are worst at performing tasks that have to do with logic, like maths and things like that. We are actually worst at them when we don't have enough sleep.
And I noticed that when I don't have enough sleep, I find myself doing some weird things, like leaving the yogurt in the cabinet. Again, before I lose my credibility, I hope that you all are saying, yeah, all right, I do that too. It's just often really related to sleep deprivation.
All right! Physical performance, cognitive performance, we know that sleep affects that, but what is like happening biologically? Well, there is really something that's going on when we sleep, that's restorative.
So like I said before, REM is a stage of sleep and during that stage is when your memories are consolidated, when your learning is consolidated. One of the most important things that are consolidated during that sleep that again starts happening the longer you are asleep, the more chunks of REM you have and the longer you have, but one of the most important things that it consolidates is emotional memories as well. The research really highlights that.
So there is that old bit of advice, don't go to sleep mad, and while I am not discounting that, I also agree with the bit of advice that sleep on it, you will feel better in the morning. You may not feel better, but you might feel more consolidated in terms of making more sense and what's happening to us, especially with regard to emotionality.
In terms of facilitating our learning, when we think about, again, consolidation of our memories and our understanding of what we are doing at work or at home or in school, sleep really does sort of pull it together.
So many of us are maybe procrastinators or maybe during exam times in school we stay up all night and think that that's maybe the best way to go, but what the sleep research tells us is that actually it's not. You are more likely to perform better and remember more if you actually go to sleep before your exams, because you are just not thinking as clearly.
And the biological part is that the things that happen in your brain that have to do with consolidating your memories and pulling them altogether, don't have a chance to happen if you stay up all night. So that's a really important finding.
In terms of memory, there have been some research studies where people are actually more likely to have false memories. So they may give people a list of words and then ask them, was this word on the list, and people who are sleep deprived are much more likely to say, oh yeah, that word is on the list.
Think about the clinical implications of that, we are remembering things that didn't really happen, we are confused more easily; clearly that can affect us at work and elsewhere.
Let's look at the second to last one, protecting the immune system. So we found that sleeping actually can keep you healthier, and there have been some studies that suggest that even things like the common cold, there is a study that tracked 150 people and monitored their sleep habits, and they found that people who got 7 hours of sleep a night were all most three times as less likely to get sick than people who got at least 8 hours of sleep. So that's pretty interesting.
More research is needed, but we are finding stronger and stronger links about immune system and sleep and how it can be a protective factor. So that's a benefit; you are not sick, you don't miss work, your kids don't miss school, and you can just enjoy life more, right? Who wants to be sick?
Another very important one, more and more research is coming in about sleep and weight loss. All right! So what's the connection, right? Well, what they are finding is that people who sleep more, particularly people who sleep fewer than 6 hours, have a 50% greater likelihood of being obese than people who sleep the recommended amount, which was 7-9. Think about that! Fewer than 6 hours have a 50% or greater chance.
So when we are thinking about, all right, staying up all night, we are certainly not staying up all night running marathon, what is happening? And it seems like there is two parts; there is the physiological part to that, and that has to do with hormones. One hormone in particular called leptin; it's the one that says, hey, you are full, stop eating. When you don't get enough sleep, leptin levels actually drop. So the result is that people who are tired are just hungrier.
And the kicker is you are not up craving carrots; you are craving actually high fat, high calorie foods as well. So that really does happen, those late night munchies, there is a biological thing going on with that.
The other part is behavioral, right? So you don't get enough sleep, and we all have these grandiose ideas about what we are going to do, the exercise we are going to engage in, but if you are tired, you are just going to be less likely to have the energy to actually do the things that you want to do in terms of exercising and whatnot. We know that sleep is really important for a lot of these things.
Now, okay, why aren't we getting enough sleep? Okay. Well, there is a lot of reasons; lifestyle issues. Sleep is sacrificed in an effort to get more accomplished. Okay. So we are working longer hours; in some workplaces you are a warrior if you are staying up at night doing your reports, but we really have to think about what we are sort of advocating for at work, because these lifestyle issues are definitely interfering with our work.
Another big reason, undiagnosed and untreated sleep problems. So the two most common are insomnia and sleep apnea. So people with insomnia have trouble falling asleep, trouble staying asleep, and then the anxiety often happens. Oh my gosh, I am not sleeping, I have to get up, I have a presentation, I have to take care of the kids, I have to -- whatever you have to do, anxiety could definitely make the condition worse.
And again, most of us have occasional insomnia, we just sometimes can't sleep. But chronic insomnia, that's the kind that lasts at least three nights per week for more than a month, that can certainly affect us at our work, make us exhausted, really irritable, have difficulty concentrating.
The second one, as I mentioned, was sleep apnea. Now, sleep apnea is people who have a loud snore. Now, everybody who snores certainly doesn't have sleep apnea, ask my husband, probably, but it’s a different kind of snoring, where your breathing also repeatedly stops, they become shallow.
And so if you have apnea, you are not getting enough oxygen, and then your brain disturbs your sleep, and so it’s dangerous. And it can leave you feeling tired and moody and thinking unclearly. And so undiagnosed and untreated sleep disorders such as insomnia and sleep apnea certainly interfere with adequate sleep. It has nothing to do with the bullet point above, it’s not that you staying up late working or partying or whatnot, or just watching Netflix; it’s that there is actually something going on biologically with you.
And then of course the last one, jet lag and circadian factors, those have more to do with our body’s natural rhythms of when we should be sleeping and awake.
Many of us have worked shifts before and some of the most dangerous findings have come from people who are working in overnight, followed by maybe working the first shift, or maybe a third, just that inconsistent shift work can really mess with our rhythms and lead to some of those consequences that I talked about in the slides before.
The other thing here is environmental disruptions. So things like, you may live on a busy street, you may have noisy pets, you may have traffic, you may have a snoring partner, all of these kinds of things. For a lot of families it’s that cellphone right by the bed; that may be your alarm, so you need to have it by your bed, but that also may have the ringing up; you have mail, you have a text message, and so that’s part of the environment that we really think about.
Also associational; when we wake up, or wake up in the middle of the night, are we seeing that phone where we get the work emails, or the bad news about our family members or friends, or the exciting news, whatever it is can certainly disrupt how we are sleeping or how easy it is for us to get back to sleep if our sleep is disrupted.
And then finally, health and emotional issues; anxiety is one of those things. The mind can’t shut off at night, and that’s one of the biggest problems that I see in my practice is that when you just can't shut off those thoughts, then you just can’t get to sleep.
What are the consequences of insufficient sleep and fatigue? Well, we have talked about why we need sleep and so when we don’t have it, we have impaired judgment and memory.
Errors in the workplace. We are not concentrating as well. We are actually not performing as well. Our productivity goes down. We can’t concentrate as well.
There are lots of research studies about slower reaction time and more accidents. So sleeping enough actually could keep you safer. Sleep deprivation has been linked to so many notorious disasters, like the destruction of the space shuttle Challenger, all sorts of things.
Even they found in terms of driving that 1 out of 5 auto accidents in the US results from drowsy driving. So that was a big finding that came out of the Institute of Medicine, that’s 1 million crashes a year that has to do with sleep. Yikes!
Now, we also find that sleeping can make us cranky. And what about the impacts on relationships? Well, when we are cranky that certainly affects our relationship, but what about our sex life? Being tired is like the opposite part of your nervous system that has to be activated to feel like you just want to do it. So when you are tired, you are not feeling aroused. You get it people? That’s a whole different slideshow, but right, I am feeling tired is a real thing.
And also, besides the whole sex life part, when we are just too tired to engage in our day-to-day relationships, whether they are romantic or friendships, no one wants to be around a bump on a log. So not getting enough sleep can be really detrimental to our relationships.
Another one is decreased immune function. So that’s a big one. We actually find that our immune functions are reduced if we are not sleeping enough, which is pretty interesting.
So in terms of, we talked about the common cold one, but there has also been some research about vaccinations and how people who sleep are more likely to have -- be more strongly -- respond more strongly to vaccination. So they will be more effective if you are getting more sleep. So that’s a very interesting finding as well.
We talked about sleeping and its role on waking, and a lot of that has to do with cortisol levels. So cortisol is the hormone associated with stress and it’s also the one associated with body fat, especially in the abdomen area. And so one of the consequences we found of insufficient sleep is an increase in that hormone cortisol.
Also, there have been correlations with an increase of mood disorder, such as anxiety and depression.
And then finally, increased chance for medical conditions; high blood pressure, diabetes, osteoporosis, obesity.
I used to say, as I opened up this webinar saying, that I used to say, oh, you can sleep when you are dead, maybe that was when I was working three, four jobs and trying to have an amazing social life and do everything. But I got to realizing that, oh geez, not sleeping enough could lead you to situations that can shorten your lifespan actually over time. So it certainly made me think a lot about that and also about the quality of what you are doing if you are not sleeping enough.
Another medical condition is pain. Pain makes it hard to sleep. Let’s be real here. And what we found though is that if you have chronic pain or even acute pain from injuries, getting enough sleep can actually make it hurt less. There has been some link found between sleep loss and lower pain threshold. So that’s pretty interesting and pretty helpful to know.
Of course if pain is keeping you up at night, there’s different things that you can do to help yourself get to sleep, but it’s an interesting correlation there.
Let me ask you some of these questions, have you guys ever fallen asleep while doing one of the following: Sitting and reading, watching TV, sitting in a theatre or a meeting, as a passenger in a car? Check, check, check, check. Seriously as Americans we have probably all done these.
Do you have trouble falling asleep, staying asleep, waking too early, getting out of bed in the morning?
Do you have a sleep schedule that varies weekdays versus weekends?
And also, do you snore or wake up gasping for air? That of course could be more indicative of a more serious sleep disorder such as sleep apnea.
The important one here, have you ever fallen asleep while doing something? I had a client in my office the other day, I had done a neuropsychological assessment on a little girl, and her parents were getting the feedback from me, and I must say, it was pretty entertaining during that feedback. I noticed that the father was having these little microsleeps. He was having these little moments of falling asleep.
And of course I could have thought, well, I am totally boring him, but I went to a different place to help preserve my self-esteem, and it was probably more accurate, that he probably wasn’t getting enough sleep.
And what we found out later when the couple was discussing it with me is that he actually had been recently diagnosed with sleep apnea and so his sleep had been disrupted for a long time, where he was waking up due to not being able to breathe multiple times.
Think about how much that affected him, not so much -- not that the falling asleep in my meeting was the biggest thing, but he was trying to be there for his son, he was falling asleep, happening at work, happening at different places.
So think about these questions for you, are these things happening to you? If they are, you may have a pretty significant sleep debt. So what that is, is that each hour of lost sleep adds to your sleep debt, so each hour. I mean, the only way we can get it back is getting more sleep.
We can’t really -- we are not like the camel, we can’t sort of sleep 20 hours and then not sleep. Humans don't work that way, nor do camels in terms of their sleep, but the larger the sleep debt, the more likely you are going to have experiences of these little microsleeps. And these happen while you are driving. You may not even realize, but these are real dangerous, and the definition is right there, unintended episodes of loss of attention that last from a few seconds to 2 minutes. Very interesting and very dangerous, right?
So I hope at this point I haven’t scared you but motivated you. How do we sleep better, okay, what do we do? Unwind early in the evening. Now, that’s hard. Work schedules are hard. People have lots of commitments. But really trying to unwind earlier in the evening is important.
Try finishing eating maybe 2-3 hours before bed, if possible, engage in relaxing activities. It sounds sort of commonsense, but let me ask you all, do we actually do it, or we go, go, go to the last minute and then expecting our brains to just shut off when we get into bed?
One of the helpful tips that I work with my clients on who are trying to get treatment for maybe sleep disorders and they don't want to use medications is developing sleep rituals, a nightly routine. Just like many of you maybe have done with your children, those actually help us too. It’s all about association. Are we associating sleep with a nice calming ritual?
And this last one is hard, maintain a regular sleep and wake up schedule, including weekends. Things come up, but one of the hardest things to do is if you pull a real late night, you want to nap the next day, but napping actually can make it then harder for you to sleep on your regular schedule. So avoiding the nap is actually the way to go and just sort of toughening it through that next day.
Creating a restful place to sleep, a sanctuary. Take some time to really cultivate that place, that dark, quiet, cool comfortable place. If you are going to invest money in anything, invest it in things that make you comfortable while you are sleeping.
Exercise regularly, but finish a few hours before bed. I used to belong to this women’s soccer league, we have a game at 10 o’clock at night, I get home and be ramped up for three hours. It wasn’t working.
Avoid caffeine, nicotine and alcohol close to bedtime. Alcohol is a tricky one. A lot of people come home, unwind with that glass of wine, but if that’s too close -- some people actually when they can’t sleep use more alcohol. And that makes sense, alcohol is a depressant, it makes us sleepier. But what we know about alcohol and sleep is that it’s actually interfering with the quality of sleep. I talked a little bit about those sleep stages and cycles, and they do get out of whack if you are having more of that alcohol induced sleep versus a different kind of sleep.
Again, second to last, avoid napping if it disrupts sleep later. So if you are a napper and your naps work, near adaptive, I mean then great, keep it up, go you.
Some countries they have -- like Spain they have a siesta. Everything literally closes down so you can have a nap. It’s genius! So if that works for you, great! But what I am talking about here is if you are so tired during the day that you have to nap but then you can’t sleep at night, the most important thing is getting on a schedule, which means maybe, again, sucking it up through that nap so that you can be back on a more regular schedule at night.
And finally, use your bedroom here for only sleep and sex. Many of you who may have taken an introductory psychology class way back when, you may remember Pavlov’s Dogs and the dogs that -- they rang a bell and they paired it with the meats, and soon the dogs would start to salivate with just the bell. Bells don’t make us hungry, but it was the expectation that with a bell came meat.
Much is the same with our sleep, if we think our bed -- if we associate our bed with the place where we were typing up our webinar or where we were arguing with our spouse or where we were checking our text message or emails, we are going to start pairing our bed with that stress, and that is not sleep inducing. So really think about using that bed for only sleep and sex.
Now, if you are having a more serious sleep problem, like sleep apnea; if that’s ringing a bell for any of you, definitely seek some help for any medical issues.
And this last one is controversial, if you wake up DO NOT read, turn on the TV or otherwise stimulate your brain. Most of the field says, right, don’t start stimulating your brain, but there is other of us who think, well, wait a minute, is this a chronic sleep problem or just are you anxious or revved up? Because if you are just anxious or revved up, putting on some mindless TV may help you get into that sleep, so it really depends on why are you not able to sleep.
Now, your Achieve Solutions website is an awesome resource. There are so many articles on there that if this has triggered any questions for you, or if you are just sort of interested in sleep and the benefits of sleep and the repercussions of not having enough, I really urge you to go to the Achieve Solutions website, because they have got -- why do all the research yourself, they have done it, and it’s really great.
This is an example of some of the articles we have here; there is a cool quiz, who doesn’t like a quiz; and then some audio clips, so those more visual listeners out there. So certainly go to this website if I have piqued your interest at all.
In conclusion, sleep is a basic biological need. We need it for health, performance, safety. If we are not sleeping, it’s bad, it seems to be really bad for us.
I was wrong in my 20s. It certainly can make us at risk for decreased immune function, risk for depression, all that.
It helps us keep a healthy body weight, and it really -- if we establish those healthy sleep practices, we can prevent some health problems and we can have some good, high quality sleep.