Roughly one-third of American adults don't get enough sleep, according to the Centers for Disease Control.
But there are ways we can better connect with our natural sleep rhythm, according to Dr. Derek Loewy, sleep medicine specialist with Scripps Clinic and director of the insomnia program at the Scripps Clinic Viterbi Family Sleep Center.
Loewy joined Midday Edition on Thursday to talk more about sleep and its importance for our overall health. The interview below has been lightly edited for clarity.
Sleep is something that we all do naturally, of course. So why can it be so hard for us to get a good night's rest?
Loewy: Well, it's interesting. Sleep is something we all do and it's something that we need to do. And yet, it can be such a difficult struggle for many people.
I think part of the reason for that is that sleep can be easily affected by many things. Stress can throw off a night's sleep. Being ill, common cold symptoms can throw off a night's sleep, your neighbor's dog barking can affect your sleep. So in a way, sleep is very vulnerable to disruption. If it occurs on a regular basis, over time, you can develop chronic insomnia or chronic difficulty sleeping.
The good news is that, though, not only is sleep vulnerable in many ways, it's also remarkably resilient. And in a way, it kind of has to be because sleep is a survival behavior. And so I'm always trying to reassure my patients with insomnia that even though sleep is not going well, your sleep system is resilient. And our job is to find a way to help bolster your natural sleep ability.
What are the most important elements to getting a good night's rest?
Loewy: Well, if you're currently sleeping well, the idea is to maintain where you're at. A few key points there would include maintaining a fairly regular sleep/wake schedule, regular bedtime, regular morning wake-up time, at least on weekdays. For people who are working, weekends can be a little bit different because we might stay a little bit later and sleep in, which is fine. But if you're maintaining a regular sleep schedule, let's say five days a week, you're probably doing a good job of keeping your sleep/wake rhythm or circadian rhythm running on time.
Another thing that's helpful is in the morning, when you get up, make sure you access a lot of bright light, open up the window coverings, bring in lots of light into the room. If you have time to be outside at all, do that. Light entering the eyes in the morning, at the same time every day, is an anchoring effect on your sleep-wake rhythm. And so, a consistent morning wake-up time with morning light and, even better, a little bit of exercise is a great way to keep your sleep clock running on time.
We don't want to be doing anything too problematic for sleep late before bedtime. As we all know, caffeine is a stimulant, and caffeine late in the day, for some, can cause difficulty with falling asleep at bedtime.
I'm often asked about exercise too close to bedtime. I feel like the best time to work out is in the morning. The second best time is any other time except too close to bedtime. If it's a cardio workout because you might be getting yourself too pumped up too close to bedtime.
What are some of the consequences of not getting enough sleep?
Loewy: The short-term consequences, I think we're all pretty familiar with that. We just don't feel great the next day. We're kind of dragging, we're sluggish, fatigued, low energy. Maybe our thinking isn't quite there. Our focus, our concentration is less than ideal. Sometimes we can get a little bit irritable.
I think where it becomes more problematic is with chronic sleep difficulty over time. By chronic insomnia, technically, we mean difficulty sleeping most nights of the week for at least three months. But the problem with chronic insomnia is now you're having a negative effect on your immune system and other systems that maintain long-term mental and physical health. And so there, we are concerned about issues related to metabolic syndrome or weight gain.
We're worried about memory effects long term. There's new studies coming out showing that inadequate sleep can impair our memory long term. We've also increased the risk for other issues, cardiac issues, for example. If you are not getting enough sleep on a consistent basis, you're not functioning well during the day, you could be at risk in risky situations such as driving, for example. So there are a lot of consequences, both short-term, mid-range and long-term, of not getting adequate sleep.
In recent years, over-the-counter treatments have become increasingly popular, such as melatonin and THC supplements. Are those effective sleep aids, in your opinion?
Loewy: They can be. For someone who is having sleep problems but has not taken a prescription sleep medication, a great way to start is with melatonin. It's gentle, it's not habit-forming. It has minimal side effects. The key, though, is the type of melatonin. There are long-acting and short-acting. Short-acting is good for falling asleep. Long-acting is better for maintaining sleep. So that's an important point.
As far as THC is concerned, this is a relatively new thing for us. We've only had the legalization of cannabis products for the last couple of years or so, and there isn't really good research on the impact of these products on sleep per se. There's a lot of anecdotal evidence. I was working on a chapter for this topic last year, and what I found was that if you look at THC, it can have a direct benefit on sleep depending on the strain and the dosage. CBD, not so much. CBD is good, more for pain and anxiety but if pain and or anxiety are in the way of sleeping at night, CBD could be beneficial.
And, of course, there are always new products or technologies saying they can improve sleep, everything from smartwatches to weighted blankets. What do you think of those types of solutions?
Loewy: These topics come up a lot here in clinic because, as you mentioned, there is a plethora of products out there for sleep. I try to be very careful about what I recommend or don't. I mean, we're supposed to practice evidence-based medicine, and unfortunately, a lot of these products there isn't a lot of data, good studies to back up their benefit or their effectiveness. So I think the general rule is try and see. Usually, the only downside is the out-of-pocket cost. Rarely though are there any adverse results of using these things, weighted blankets can be helpful for sleep, certainly for anxious patients at night.
There's a variety of sleep apps out there as well. I think those are great. The reason being that it's very difficult lying in bed in the dark and the quiet when you can't sleep because your mind tends to go places and we tend to ruminate or we're anxious or we're stressing about our to-do list, things like that. And the hyperactive mind can definitely interfere with getting into sleep. And I think having something to redirect your attention toward, like an app-guided meditation, a podcast even.
How much does American culture impact sleep? You'll find any number of internet gurus who say sleep when you're dead, work hard, play hard and will claim that they sleep only 4 hours a night to be a highly functioning and productive individual. What are your thoughts on that?
Loewy: I think that's dangerous thinking. I think the thinking that sleep is a waste of time is a bad long-term strategy. There are countless studies that have talked about the long-term effects of chronic sleep deprivation. Now, sleep deprivation along the lines of what you're saying is different than insomnia. For insomnia, these people give themselves ample time at night to get the sleep they need, but they can't in this case. People who artificially deprive themselves of sleep by working, burning the candle at both ends, staying up late, getting up early, trying to be more productive, I think they're at the greatest risk of all for all these sleep disorders that are leading to lack of sleep in terms of short and long-term health. Because the body wants more sleep opportunities, but you're not honoring that.
How many hours of sleep does a person need to stay healthy? And do we need naps?
Loewy: I think the average for the healthy adult, western adult, is probably seven and a half hours at night. Now, you got to consider that that's the average of the normal need, the normal range. There are normal sleepers out there who get by five or 6 hours of sleep without any complaints. I have patients in the insomnia clinic who can't function on less than 9 hours of sleep, so there's a certain amount of relativism to this. But on average, most people should be getting about seven to eight hours most nights of the week.
As far as napping is concerned, if you're really having a hard time falling asleep at bedtime, you should avoid the nap to save your sleep drive for nighttime. However, we do have a circadian dip in the afternoon, the post-lunch dip. And I think that's nature's invitation to us to take a little siesta in the afternoon. And if we use it cautiously, maybe the power nap is 20, 30 minutes. That should not significantly detract from our nighttime sleep. However, like I said, if you do have problems falling asleep at bedtime, you probably should avoid the nap.
