Ask the Experts: Sleep Quality and Quantity
We asked Dr. Knitter, a Pulmonogist at the Center for Pulmonary and Sleep Medicine in Petoskey, our top five questions about sleep. Pulmonologists study the lungs, respiratory system, and conduct sleep studies. For more information on the sleep center, check out their website here.
How important is sleep to one's health?
Every multi-cell organism sleeps. Sometimes it may look from the outside very different from curling up in a comfy bed. So from this perspective alone, if sleep were not absolutely essential, why did it not disappear from a evolutionary perspective eons ago. For our early ancestors sleep was their period of greater risk for being someone else’s meal. Every stage of sleep has a purpose, whether it be rest, repair, learning or rejuvenation. Our culture has not always appreciated the importance of a good night’s sleep. When we don’t get sufficient sleep, it is a debt that our bodies will have to pay in other ways:
• Reduced productivity
• Difficult learning (or increase in forgetfulness)
• Increase risk of accidents
• Lowered sensitivity to pain
• Increase frequency of migraine headaches
• Reduction in basal metabolism (weight gain)
• Increase risk of Alzheimer’s
• Increase risk of Heart Attack
What is the optimum amount of sleep?
According to the National Sleep Foundation below are the most recent recommendations for optimal sleep. Sleep behaves like many biologic systems in that there is a range of normal.
“For adults I would say there is good evidence to support that sleep durations less than 6 hours and over ten hours are worrisome”
As I am trying to make an estimate of what is the ideal for an individual I often use the “desert island” or vacation line of questioning: If you are on (a vacation or desert island) what time do you think you would go to bed and wake up? Below are the recommended sleep quantities per age group:
School-aged Children 6-13 years 9 to 11 hours
Teenagers 14-17 years 8 to 10 hours
Young Adults 18-25 years 7 to 9 hours
Adults 26-64 years 7 to 9 hours
Adults > 65 years 6 to 8 hours
How do I know if I am getting enough sleep?
Pay attention to what your body is telling you.
• Are you having trouble staying awake during the day?
• Have you had an “close calls” while driving? •
Do you fall asleep every time you sit down to relax?
• Are you relying on stimulants (coffee, energy drinks, 5 hour Energy) to make it through the day?
A scoring system we use in the office to gage the degree of sleepiness is the Epsworth Sleepiness Scale (ESS). Check it out for yourself here.
Score < 5 Normal Score
5-8 Mild Sleepiness Score 9-14
Abnormal Sleepiness Score > 14 Severe Sleepiness
The score can also be quite helpful in monitoring treatment response over time. In an ideal setting I would like to see all individuals we treat for sleep issues have a score < 5. One unusual feature of the ESS is the score itself while suggesting an issue with sleep does not correlate with the severity of that issue. The best correlate of this is pain threshold. For one person a paper cut may be the end of the world whereas another may view a broken bone as no big deal. In the same way some individuals are much for sensitive to the consequences of sleep disruption. So if you are getting enough sleep and still feel unusually tired, you might have an issue with your sleep.
When should I seek medical attention about my sleep?
If you are concerned about your sleep I would encourage you to speak with your primary care provider. In many cases the solution may be as simple as a life style or medication adjustment. But there are some symptoms that I would urge an individual to seek an evaluation by a Sleep Specialist.
The problems that I would consider very worrisome for a significant sleep disorder:
• Significant Daytime Sleepiness - ESS score > 10
Sleepiness resulting in injury - workplace or automobile accident
• Loud snoring especially if associated with periods of apnea (not breathing or gasping during sleep)
Excessive movement during sleep especially is resulting in injury to self or bed partner
• Long standing Insomnia (> 3months)
What can I do to improve the quality of my sleep?
Good general advise about getting the best sleep possible:
• Make sleep a priority
As best you can, try and have a consistent time when you got to bed and wake up. I even suggest that people set an alarm clock for their bed time. Make sure that your chosen bed time allows for enough sleep for your needs.
• Have a bedtime routine
The more trouble you have getting to sleep the more critical this routine becomes. We all can benefit from a period of decompression before bed. Screen time (TV, computers, tablets, phones) has no role in your relaxation period before bed. Ideally it should be about 30 minutes before you turn off the lights. Reading, Puzzles, Meditation, crafts are all excellent choices. If you are who of those individual who can’t “shut down” your brain, I suggest journaling. At the end of your wind down period your are literally and figuratively closing the book on your worries.
“Perhaps no item is responsible for more sleep disruption than technology. ”
• Exercise
As long at it is at least 2 hours before bedtime - physical activity is one of nature’s best “sleeping pills.”
• Turn off your phone
It has been shown that having a cell phone within 6 ft of your head can cause sleep fragmentation outside of the endless notifications.
• Reserve the bedroom for sleep
All too often our bedroom becomes our second office, entertainment center or restaurant.
If you are having trouble getting to sleep - get up
My recommendation is 30 minutes. If you are still awake 30 minutes after you turn off the lights, get up, go to another room and repeat the decompression period. A wonderful option for reading material is the recommended maintenance manual for your refrigerator. If you still can’t get to sleep repeat this 30min cycle until you do.
• Don’t use the TV as a sleeping pill
When drowsy brain is exposed to voices it has a hard time going into sleep mode. The same hold true for music. If you need something to lull you off to sleep consider instrumental music or nature/“white noise”. A new fad in sleep relaxation is the idea of Sleep Stories. These are stories read by voice actors with very soothing or monotone character. I feel they have a good deal in common with another recent sleep hack - ASMR. With any sensory input, I always suggest limiting the exposure with a timer.
• Limit caffeine
A reasonable guideline is avoid all caffeinated beverages for at least 6 hours before between. As we age our ability to avoid the sleep disruption of caffeine diminishes. So for many individuals I recommend no caffeine for 10-12 hours before light’s out.
• Limit alcohol
While it might help you get to sleep, the “benefit” of alcohol is very short lived and will result in a rebound insomnia after 3-4 hours.
• Limit napping
The science behind napping does indicate that the optimal duration is 30-60 minutes. As you nap longer then chances that you will disrupt your sleep-wake cycle rises dramatically. I have witnessed first hand a relatively normal sleep cycle become more erratic than a 6 month old’s in a matter of weeks due to prolonged napping.
Are there any resource you recommend people to learn more?
Patient focused education by the American Academy of Sleep Medicine http://sleepeducation.org/