Sleep 101: The Basics Of Sleep

Thursday, August 18, 2011
By Angela Carone, Maureen Cavanaugh

How much sleep do we need? Why do we snore? How do we beat jet lag? We'll talk to a local sleep specialist who can answer some of the most basic questions about how and why we sleep.


Dr. Sonia Ancoli-Isreal is a sleep specialist and professor of psychiatry at UCSD. She directs the Gillin Sleep and Chronomedicine Research Center at UCSD.

If you are interested in participating in the research studies Dr. Ancoli-Isreal mentioned in the interview, visit the Gillin Sleep and Chronomedicine Research Center website.

Read Transcript

CAVANAUGH: A musical about strange occurrences and romance at a sleep disorder clinic has been delighting audiences at the La Jolla playhouse this summer. The run of the sleeping beauty wakes has been extended. One of the draws of the play is its exploration of the mystery of sleep. My guest, doctor Sonia Ancoli-Israel is a sleep specialist and professor of psychiatry at UCSD. She took part in a special audience discussion about the aspects of sleep discussed in the play. It was a popular event. So we invited hoar to come and talk about sleep with us. Thank you so much, Doctor.

WELSH: My pleasure to be here.

CAVANAUGH: Now, we invite our listeners to join the conversation. Our number is 1-888-895-5727. Or you can comment on twitter at KPBS midday. Doctor Ancoli-Israel, you direct the Gillan Sleep and Chronomedicine Research Center at UCSD. Does it make sense to you that a play about sleep disorders seems to have captured the public's attention?

ANCOLI-ISREAL: Absolutely. You know, Maureen, we all have problems sleeping now and then in our lives. And so everybody's always interested in watching and hearing about sleep.

CAVANAUGH: And it's such a mystery.

ANCOLI-ISREAL: In many ways, it is. The bottom line is we still don't know the real reason we sleep. There are lots of theories about it. Like it consolidates memory or it's healing. We know we need it, we don't definitely know why.

CAVANAUGH: How much sleep do we need?

ANCOLI-ISREAL: On average, most adults need 7 to 8 hours of sleep. Different times in our lives, for example adolescents need more. They need about 9 to 10. For adults, plan on 7 to 8.

CAVANAUGH: Sleep links us with most of the living creatures on earth, doesn't it?

ANCOLI-ISREAL: Yes. Every creature needs to sleep. The amounts differ. The time of day or night that we all sleep might differ. But we all need to sleep.

CAVANAUGH: And yet fundamentally, we don't actually know why.



ANCOLI-ISREAL: There's still several million, $64 million question.

CAVANAUGH: Now, there are stages to sleep. What are those stages?

ANCOLI-ISREAL: There are four stages as we define them. The first is the very lightest stage. That's where we're just dozing off, and we be we're not completely asleep yet. But we know we're not quite awake. That's the kind of sleep we do at the theatre or the symphony, or places we should be awake.

CAVANAUGH: That's terrible!

ANCOLI-ISREAL: Yes, it is. And then stage 2 and 3 get progressively deeper with this third stage being our very deepest level. And then the fourth stage is REM, rapid eye movement sleep, and that's our dream sleep.

CAVANAUGH: What is the most common sleep disorder?

ANCOLI-ISREAL: The most common in the general population is insomnia, which we define as difficulty falling asleep or staying asleep, or in the sleep clinics, the most common disorder is sleep apnea where people stop breathing in their sleep. So it wakes them up. And they don't get enough oxygen during the night.

CAVANAUGH: It just reminds me, a lot of people say I didn't get a wink of sleep last night. And yet if you look at them or you live with them, you see that they did get sleep. I mean, maybe not as much as they wanted, but they feel as if they have been awake all night.

ANCOLI-ISREAL: Right. Unfortunately, the thing we most remember is the wake time. We don't remember when we're asleep. We don't know what we're doing when we're asleep because we're asleep at the time. And so we're very poor judges about what goes on or how much we're actually asleep.

CAVANAUGH: That's fascinating. So people can be sleep deprescribed but not necessarily going without sleep night after night after night.

ANCOLI-ISREAL: And almost no one goes without sleep totally. So even people that say oh, you know, I haven't slept in three days, they've slept. They may have slept in very short bout, they may have microsleeps, but they're getting some sleep in there.

CAVANAUGH: Let's talk about sleep apnea, because this is frightening to me. Because it can have some severe consequences.

ANCOLI-ISREAL: It can. So just to describe it so our listener it is understand what we're talking about, sleep apnea is a condition where when you fall asleep, the air way collapses, and the person is still trying to breathe, but the air can't get in or out. They start breathing, they go back to sleep, they stop breathes, and this could happen hundreds of times during the night. The consequences to having such disrupted sleep and not getting oxygen to the brain include greater risk for heart disease, diabetes, hypertension, stroke, even death. And on a short term basis, it affects memory, it affects ability to stay awake or be able to function well during the day.

CAVANAUGH: Is there any way besides being observed in a sleep disorder clinic that someone can tell if they have sleep apnea?

ANCOLI-ISREAL: The only way to know 100% for sure is to get a sleep recording. But you can get a pretty good idea if the person is snoring very loudly, and usually if there's a bad partner, the partner knows. And in combination with that, if the person is very sleepy during the day. Those are two of the most common symptoms.

CAVANAUGH: Does everyone who snores have sleep apnea?

ANCOLI-ISREAL: Absolutely not. And everyone that has sleep apnea doesn't necessarily snore.


ANCOLI-ISREAL: That's right. So if you snore and that's all you have, you don't have to worry too much. But there's also the loudness of the snore, so there's the sort of regular quiet snore, then there's the very loud one that you can hear throughout the house. That one is more likely to be associated with sleep apnea.

CAVANAUGH: I'm speaking with doctor Sonia Ancoli-Israel, she is -- we're talking about all aspects of sleep. Our number here be if you'd like to join the conversation is 1-888-895-5727. In a radio station like this, we have a lot of people who work in shifts. A lot of businesses have that. People who have to be here very early in the morning, some people have to work an entire over night shift. What are the special problems that these people face? I used to be one of them. Even if you get perhaps an adequate amount of sleep?

ANCOLI-ISREAL: Shift work is very difficult because you're trying to be awake at a time when your body and brain wants to be asleep. So you're sort of acting opposite everything that makes sense to your body. We what we try to encourage shift workers to do, especially if you're working night after night after night, is to try to make your work environment as bright as possible, to try to avoid caffeine in the last third of the night, which is of course when you most want it, but it then interferes with your ability to sleep. When you get home, turn off your cellphone and get your friends and family to respect the time that you need to sleep. And perhaps don't try to get all your sleep at once the way we do when we sleep at night. Sleep for about four hours, then get up, do all the things you need to do for your life, and then sleep again for about another three hours before you go back to work in the evening. And sometimes that makes it a little easier to be alert and to work at night.

CAVANAUGH: That's fascinating because that is a chronic problem for some people. As it, as you were saying before, this problem of insomnia. People simply not being able to get to sleep, whether it's in the middle of the day or it's at a proper time when most people go to sleep. What are some of the tips that you give people who are suffering from insomnia?

ANCOLI-ISREAL: The first is to go pato to bed and get up at the same time every time. So even if you don't fall asleep till very early morning hours, don't want try to sleep in. You need a very consistent schedule. Of avoid caffeine after lunch, avoid alcohol because although alcohol may make you sleepy initially, it actually causes insomnia. Don't spend too much time in bed. The insomniac will say I didn't sleep a wink last night, I'm going to go to bed two hours early tonight. But the longer you spend in bed, the more disturbed your sleep is. So if you want eight hours of sleep, you should only be in bed eight and a half hours. So don't extend that time in bed. If you find yourself in bed spending a lot of time tossing and turning, get out of bed. The bed should only be used for sleep. It should not be used for texting or answering e-mails. Or tossing and turning.


ANCOLI-ISREAL: You want to recondition your brain to associate the bed with sleep and relaxation and not tension. And so these are some of the it's more than tips. These are some of the therapies we use. Getting rid of the clock is a very important one. The First, thing we do when we get up in the middle of the night is look at the clock. All that does is put pressure on us. Plus it wakes us up even more. You've got to wake yourself up to comprehend it's 210 in the morning and you want to be asleep.

CAVANAUGH: We are taking your calls at 1-888-895-5727. Sophia is calling from San Diego. And welcome, Sophia, to Midday Edition.

NEW SPEAKER: Oh, thanks. I was just curious if a person has sleep apnea and say they're in an HMO, and the HMO doesn't have a doctor who's board certified in sleep medicine and they're not really getting the -- maybe the specialized care that they should, what would you suggest in that kind of situation?

ANCOLI-ISREAL: Well, Sophia, that's an excellent question. I'm not sure I know the answer to that. I guess you first have to talk to the HMO and see if they're willing to refer you and cover the cost for sending you to a sleep specialist. Or you might contact some of the sleep clinics in town. There are many of them, including the one at UCSD. But there are many others as well. And see if there's something they can work out with you.

CAVANAUGH: Okay. Thank you for that call, Sophia. It just -- all of this talk about not being able to get to sleep and not being fresh during the day, it reminds me of the fact that we are in the end of travel season now. A lot of people take long, long flights, and they have jet lag. Is there any way of handling that so that you don't lose the first couple of days of your precious vacation?

ANCOLI-ISREAL: Right. There's no way to totally avoid it. But there are ways to try to adjust a little faster than we might otherwise. There's something called the jet lag calculator. You can go online and find them. And that helps you determine when you should get exposed to bright light and when you should block exposure. Because bright light is the best cue our body has for shifting our biological clock to adjust to jet lag. That's really the best way. It also is to think about when you're flying. If you're landing in the morning, you want to try to sleep on the plane. If you're landing on the evening, you want to try to stay awake, especially the last 5 or 6 hours of the flight so you're tired enough to go to sleep when you get there. But light is the best way to do it.

CAVANAUGH: No medicine? No pills? Like that that you can take?


CAVANAUGH: We all love that.

ANCOLI-ISREAL: There's no magic bullet ever for sleep. And people are always looking for that. There is a -- something called melatonin that we can buy over the counter. That can be used to help shift rhythms as well. But the timing and the dose of that is very crucial. You can actually make it worse if you use it at the wrong time. So that's harder to explain how to use in a short time period.

CAVANAUGH: We have another caller on the line. Nick is calling from San Diego. Good afternoon, Nick. Welcome to Midday Edition.

NEW SPEAKER: Hi. I'm a small businessman, designer in the terrible economy work a bazillion hours and being stressed: And I find myself not sleeping well unless I just take some Excedrin PM or ben drill or something like that. And in the past, my wife and I had ambien prescribed, then we heard all the horror stories about waking up and walking around with that stuff. Do you do any damage by just taking things over the counter, aspirin type things, that have some sleep medication in them?

CAVANAUGH: Let's find out. Thank you.

ANCOLI-ISREAL: That's a great question, Nick. So all these drugs that you talk about that are over the counter, the PM drugs have diphenhydromine in it, which is essentially a Benadryl. And sometimes they promote sleep. But in the long-term, they actually don't. They request have some side effects. So the older we get, the worse those are. If you're using it night after night and it's helping you, then I wouldn't change it. But in general there are probably more effective treatments out there. And actually things like ambien and all the other drugs that have been approved by the FDA for sleep are -- have been shown to be more effective for insomnia.

CAVANAUGH: I think people are concerned that they're going to start driving to Tijuana and not realize it.

ANCOLI-ISREAL: People are concerned. And there's always a concern. And there are side effects to all medications. The truth is, with all these drugs, they have been used by millions of people, and the number of people who drive or sleep walk is very small. And if you do react that way, that is the wrong drug for you. But if they're used correctly at the right dose at the right time, and they're not mixed with alcohol, they tend to be fairly safe.

CAVANAUGH: Charlotte is on the line from Coronado. Welcome to Midday Edition.

NEW SPEAKER: My question is I wake up frequently in the middle of night to go to the bathroom, and I'm a marathon runner so I drink a lot of water. And when I sleep for a good four hours, and I wake up and go to the bathroom, and I cannot go back to sleep.

ANCOLI-ISREAL: Okay. So there are a couple things. One is my guess is you're probably looking at the clock when you wake up to go to the bathroom, as I said previously. Get rid of that clock. When you wake up, if you don't even open your eye, there's a greater chance you'll fall right back to sleep and you won't need to get up to go to the bathroom. Needing to go to the bathroom rarely wakes you. We usually wake up and then we realize we need to go to the bathroom. So you might try that. And then when you go back to bed, if you haven't fallen asleep in about 20 minutes, and I say about, because you're not looking at the clock. Get out of bed of course leave the bathroom and do something relaxing until you can feel sleepy enough to fall back to sleep. So again, you train your brain to associate the bed with sleeping and not lying there awake.

CAVANAUGH: Thank you for that call. I want to try to squeeze in just one more call. Hi Allen, welcome to Midday Edition.

NEW SPEAKER: Hi, I have a habit of going to bed very late, like 3:00 o'clock in the morning. And I do get 7 or 8 hours sleep because I'm retired and I don't have to get up early. Is there something harmful just because you're a very late owl -- you know, night howl type of approximate other than?

ANCOLI-ISREAL: Absolutely not. As long as you're getting the sleep that you need, it doesn't matter what time you get it. And you're doing absolutely the right thing. If that's when your body wants to sleep, then that's when you should be sleepingly. Sole you're doing well.

CAVANAUGH: Doctor, what's exciting in sleep research?

ANCOLI-ISREAL: Well, I did want to mention a study that we're doing now that's quite exciting. We're looking at Parkinson's disease what effect treating sleep disorders in Parkinson's has on these patients' symptoms. And we are looking for volunteers. And I believe there's a link on the KPBS website. So if you have Parkinson's disease or know someone that does, we would love to hear from you and consider you participating in our study.

CAVANAUGH: I want to thank you so much for talking with us today. I've been speaking with UCSD sleep specialty doctor Sonia Ancoli-Israel. Thank you.

ANCOLI-ISREAL: Thank you so much.