How to Sleep Better with Nancy Foldvary-Schaeffer, DO, MS

Podcast Transcript

John Horton:

Hello, and welcome to another episode of the Health Essentials Podcast. I'm John Horton, your host.

Have you ever found yourself in bed, staring at the ceiling at 2 a.m., wondering why you can't sleep? If the answer is yes, and you're looking for a solution, you're in the right place. We're about to dive into the nitty-gritty of sleep schedules to learn why they get out of whack, and better yet, how you can get them back on track.

Our guide to Snoozeville will be sleep disorder specialist, Nancy Foldvary-Schaefer. She is one of the many experts at Cleveland Clinic who join us weekly to keep our bodies running smoothly. Grab a comfy pillow and settle in for what should be an eye-closing conversation.

Dr. Foldvary-Schaefer, welcome back to the podcast. It's always great to see your name on the guest list.

Dr. Nancy Foldvary-Schaefer:

It's great to be here.

John Horton:

After doing some research ahead of your visit, I'm convinced that a good night's sleep is just an absolute rarity in today's world. Just thinking about all the problems out there, it was enough to keep me up last night.

Dr. Nancy Foldvary-Schaefer:

Sleep problems are just highly prevalent, things that Americans experience, and sleep disorders are grossly underrecognized so you're right, that many of us — almost all of us at some time in our lives — have experienced sleep difficulty, and probably a quarter of the population chronically experiences sleep difficulty, if not more than that.

John Horton:

Wow. Well, that would explain the coffee consumption in this country being through the roof. Everyone needs that extra jolt.

Dr. Nancy Foldvary-Schaefer:

We're good at masking our sleepiness during the day by using excessive caffeine, that's for sure.

John Horton:

Yeah, it seems like a lot of these problems kind of go back to people just having what's called, I guess, a bad sleep schedule. What does that mean? If you have this bad sleep schedule, how's that going to affect our health and daily lives?

Dr. Nancy Foldvary-Schaefer:

Yeah, so when I think about a schedule, I think about the timing of sleep. This is one of the major problems that leads to chronic sleep disruption. The other, I would say, might be called something more like “sleep hygiene,” which we can talk about. The challenge is that human beings are meant to sleep in a certain way over a 24-hour period.

If we are pushing ourselves to be awake later than we naturally would be, or pushing our awakening in the morning to be later, then our sleep circadian rhythm is really not aligned with the other functions in our bodies that work on a 24-hour schedule. This leads to chronic misalignment, which can have a host of long-term consequences, including poor functioning at work, but also heart disease, and brain dysfunction, and mental health issues.

John Horton:

That circadian rhythm, that's our natural kind of body clock, right? We're all kind of programmed to be up when the sun's up and to sleep when it's down.

Dr. Nancy Foldvary-Schaefer:

Yes, yes, but we've got clocks in all of our organs, not just our brains, that regulate our sleep-wake cycle. It's important that our clocks are all sort of aligned, and we're in alignment with the phase of the sun and the moon. It's very easy to imagine groups of people who are not aligned. For example, shift workers are not aligned. We know that shift workers have a host of adverse self-consequences over time, including an increased risk of cancer just from living in a non-aligned situation.

When we're sleeping outside of what's kind of the natural schedule, it's not the same kind of sleep. It's probably not the same level of deep sleep, and it may not be as restorative of sleep. Sleep is just critical to health and wellness, and protecting it is so important to every organ system in our body.

John Horton:

I had never heard that before, with, if you're working one of those off shifts, that can have that much of an effect. That's amazing. It really does drive home the importance of keeping a good sleep schedule.

Dr. Nancy Foldvary-Schaefer:

Yes, yes, yes. Shift workers really can benefit by paying attention to their sleep schedules also. Even though they’re sleeping at times that aren't natural, they also really need to have a stable schedule. One thing we can do to really help keep our schedules as stable as possible is to anchor that wake-up time. Try to set a wake-up time that's the same every day, including workdays, non-workdays, and that'll drive our brains to feel sleepy at kind of around the same time every evening. That's kind of one of the main things we recommend to establish a schedule, like a normal sleep schedule.

John Horton:

Get some consistency, it sounds like. That's real key to making sure that your body is programmed the right way.

Dr. Nancy Foldvary-Schaefer:

Right. Then, of course, avoiding things that will adversely impact on that timing of sleep; and then, the quality of sleep; and then, doing things that will promote good sleep. These are the things we call “sleep hygiene.” Sleep hygiene is sort of the behaviors we have around sleep. For example, drinking alcohol at night is not good for good sleep hygiene. Also, the environment in our bedroom, having the temperature right, and the bedding right, and the noise level down. These are all things that are manageable. They're things we can modify to promote good sleep hygiene and good sleep health.

John Horton:

Dr. Foldvary-Schaefer, what are some signs that folks may have a broken sleep schedule that needs to be fixed?

Dr. Nancy Foldvary-Schaefer:

Yes, if you're going to sleep and waking up at different times every day, that's not a good sleep schedule. Most people who have irregular bedtimes and irregular wake-up times also feel those effects during the day, so they may never feel refreshed after a full night of sleep. Even if they're in bed for eight hours, they still may not feel refreshed.

Furthermore, people may be fatigued across the day. People may feel sleepy during the day, or may just not feel like they're on their A-game cognitively or physically because of chronic misalignment of our sleep schedules with our natural circadian rhythm.

John Horton:

I think you start making little mistakes … I think we had talked before about just driving, how you're more apt to have accidents if you're drowsy. These are all kinds of manifestations of poor sleep that show up in our daily lives.

Dr. Nancy Foldvary-Schaefer:

Yes, yes, so judgment errors. Certainly, mood is very high on the list. Mood can be affected with relatively small amounts of sleep deprivation. Past that, generally, we may experience cognitive impairment, and that can take the form of just poor decision-making, attention-concentration trouble with classically memory problems.

Then, usually, motor control is impaired last, and people can make mistakes on the job with motor control, get behind the wheel and have an accident. There's just so many examples of that. A large percentage of motor vehicle accidents that happen, whether they're leading to injuries or not, are becoming increasingly attributed to drowsy driving.

John Horton:

I know we were kind of laughing about coffee consumption a few minutes ago, but I'm assuming if you're somebody who has to have two, three, four cups in the morning to get going, that might be a sign that your body just doesn't have the zip you need to start the day.

Dr. Nancy Foldvary-Schaefer:

Yes. That's a great example of a sign I think many people can resonate with, and similarly, Mountain Dew™, any colas — but the classic is not your Pepsis™ and Cokes™ — but your Mountain Dew, which has more caffeine in it than other colas. You're right, that if you really need the caffeine to wake you up rather than have that cup of coffee that you enjoy, then it's probably a sign that you're not getting enough sleep, or that the quality of your sleep is inadequate.

John Horton:

See, this is where you know I'm a little bit older. I instantly go to coffee, and I know the younger generation is hitting the Mountain Dews, and the Red Bulls™, and all the other energy drinks. I'm showing my gray hairs a little bit, I think.

Dr. Nancy Foldvary-Schaefer:

It's an epidemic. We're living in a society where sleep deficiency is an epidemic. About 40% of Americans are not getting enough sleep.

John Horton:

Well, that's probably why these energy drinks are everywhere. I feel like you're bombarded with ads for them, and I guess they're needed.

Dr. Nancy Foldvary-Schaefer:

Absolutely, people are not really fully educated yet about the value of sleep. We've come a long way in the last few decades, but sleep is scientifically proven to be so important for every cell and every organ of our body that needs sleep to repair itself during the night to be able to function for the next day. Many healthcare providers really haven't had the benefit of being educated in sleep medicine.

Many of the patients we see, we're explaining this to them for the first time because it's just not yet disseminated and recognized as being as essential to being healthy as it is. It's no less important than to diet and exercise. We spend billions of dollars in the United States every year working on diet and working on exercise. We spend very little effort relatively focusing on good sleep hygiene.

John Horton:

Well, luckily for everybody here today, we have you with us. We are going to start breaking down what people can do to improve their sleep hygiene and their sleep schedules, and get everything back on track. What are some things that folks can do to change their routines and just get that shut-eye that your body so desperately needs?

Dr. Nancy Foldvary-Schaefer:

Yep. Setting a wake-up time, that standard every day, is really important. That may lead to some nights of sleep loss if you go to bed a little bit later and still maintain the same wake-up time, but over the long haul, it's an effective strategy. I think it's important to not let yourself sleep and wake up whenever you need a schedule and try to adhere to that schedule.

John Horton:

From what you just said, then, so if you usually get eight hours of sleep at night, so you get up, you go to bed at 10, you wake up at six, if you stayed up till 11, don't readjust and get up at 7 a.m. Try to stay to that six and just to at least keep your body on that schedule?

Dr. Nancy Foldvary-Schaefer:

Absolutely, absolutely. That way, chronic sleep problems tend to repair themselves because our brain will then adjust to setting a new schedule. When we fail to set a schedule, it's like any other time we're failing to set a schedule. We're not setting our schedule for when we should be studying for exams, right? That's going to be a recipe for failure as well. The schedule should be there as a basis.

Then, there are things we can do in the morning to promote wakefulness, and things we can do toward the evening time to help facilitate sleep. The classic ones that I'm sure you'll recognize and our audience will recognize we'll be eliminating caffeine later in the day. For some people, that's maybe 10 in the morning or noon. Some people are very sensitive to caffeine. For others, it may be closer to 1 or 2 o'clock, but anything later than that is probably not a good use of caffeine, and poorly timed caffeine use.

John Horton:

Yeah. What's funny, you know, too, I got to say, if you drink coffee too late, we've all had that where you have that, you meet somebody, you have a late afternoon cup, and all of a sudden, you go to lay down at night, and just you cannot fall asleep. You realize, it was that coffee.

Dr. Nancy Foldvary-Schaefer:

We do know, and we know that about alcohol, too. We know when we've had just enough that's beginning to start to affect our sleep chronically. Similarly, we want to avoid alcohol probably within about three hours of bedtime. We want to avoid ... it's important to exercise every day, but not within three hours of bedtime. That's too stimulating to facilitate a good night of sleep.

John Horton:

Wow, really? It doesn't make you tired, it gets you revved up enough where you're not going to be able to lie down and just nod off?

Dr. Nancy Foldvary-Schaefer:

Absolutely, and light exposure at night is absorbed through our eyes into our retina, and our brain starts to think it's daytime because we're in a well-lit environment. It's useful, especially for people who have chronic sleep problems, chronic insomnia, shift workers, to begin to dim down the lights within a couple of hours. Get off electronics within a couple hours of planned bedtime, so our brain stops getting that light stimulation and prepares us for sleep.

John Horton:

You hear that all the time, and I take it that's one of those … are we talking TVs, or are we just talking the smartphones and the tablets that everybody seems to have these days, where you just should limit the time you're staring at that right before you go to bed?

Dr. Nancy Foldvary-Schaefer:

We're talking about everything. For people who are prone to insomnia, it's the lighting in your kitchen. You're up till 10 o'clock at night, and the whole house is well-lit. Then, you're going into a dark room and expecting to fall asleep when your brain's had all that light exposure. For people with chronic sleep problems, misalignment, circadian rhythm problems — and shift work is one of those — I like to just help them learn how to gradually set the tone in their home for sleep preparation.

That includes dimming lights throughout the whole house within a couple hours of bedtime, turning the TV off, tapering off electronics, and maybe finding some things to do like reading a little bit, or journaling your worries, or planning your next day so these things aren't on your mind at night. There's plenty of things we can do, meditation, a hot bath, various apps. These, of course, are on electronics, but if we use our blue blockers on electronics, there are some apps like the Calm® app that can help people work through meditation exercises to really set the stage so our brain is not going from wide awake to laying in a bed, trying to sleep, but kind of gradually moving into that zone of being ready for sleep.

John Horton:

It is so wild how the mind works. I used to have a job where I'd work late. I was covering things as a newspaper reporter and you'd file something on a deadline, and you're all revved up, and then you're going home and trying to fall asleep. You just could not do it. You realize that just everything is too active. It takes a while to kind of come down.

Dr. Nancy Foldvary-Schaefer:

Yes, yes. It takes a while for some patients. Others can do it like that, but it's not always so easy. You're right, we just recommend trying some of these strategies, whether it's meditation or a little yoga or prayer or a book. Try and figure out what's right for you because it's not a cookie-cutter approach that works for everyone. We all have different ways of managing bad habits. There are many effective ways, and we just have to find what works for us.

John Horton:

Let me ask you this: with overall sleep in its entirety, are naps something that can help people? Can you catch up in the middle of the day, or is that not going to solve all the problems?

Dr. Nancy Foldvary-Schaefer:

It really depends on the person. Certainly, if you're a chronic insomniac, sleeping during the day is a recipe for chronic insomnia because you're sleeping off some of that sleep debt. You're sleeping off when your brain feels sleepy, rather than holding out until it gets to be at bedtime. Naps can really undermine some people. Whereas others … so for example, the shift worker who's chronically sleep-deprived, they may need a nap just to be able to get to work on time because they may be so sleep-deprived.

Certainly, there are sleep disorders like — we call them the “hypersomnias” — these are people with brain disorders that lead them to be excessively sleepy. For them, a nap might be part of treatment. It might be only a 20-minute nap, but a nap is as effective as a cup of coffee in those people. It really depends on the scenario.

For the general population, we should try to avoid napping during the day unless if we need to for safety reasons, which in turn, will lead to better quality sleep at night.

John Horton:

For how many people … when you get into this routine, does everyone have their own special routine, or do we see some real commonalities?

Dr. Nancy Foldvary-Schaefer:

Well, I think there's common approaches that work well most of the time, but they don't all work for every individual. I think the ones we mentioned is trying to set a similar bedtime and awake time, and not deviating much on the weekends. Deviating on the weekends will lead to sleep deprivation on the weekends, and then having to get up on Monday morning is going to be difficult.

John Horton:

Nobody likes to get up on Monday morning anyway, so you don't want to make it any tougher than it already is sometimes.

Dr. Nancy Foldvary-Schaefer:

Right. I think the relaxation strategies and the various things that can help calm us down are individualized, but the core things we discussed, the avoiding alcohol, heavy exercise, heavy meals late in the day, which can lead to gastroesophageal reflux and awakenings at night, and the caffeine after about noon time, these are basic things that would be healthy for all of us to follow.

John Horton:

If somebody has been having trouble sleeping and they're listening to us today and going, "You know what? I can do these things. I can adjust when I'm drinking caffeine and what I'm eating and set a better schedule and stick with it." If you take those steps, how soon can you see results?

Dr. Nancy Foldvary-Schaefer:

I think, again, that depends, but most of the time, we can see results pretty quickly. Just setting a regular sleep schedule, in the first couple of days, if we're forcing ourselves to wake up, for example, at 7 in the morning when we let ourselves sleep in til 9 if we're not working, those first few days might feel like a struggle because we're acclimating.

After that, I think most people are going to recognize that just setting that normal schedule was a healthy thing, and they start to feel that their sleep quality improves. Certainly stopping alcohol and reducing caffeine and changing the time of exercise. We didn't mention the value of promoting exposure to light in the morning. Light is so good for waking us up in the morning. If you're someone that has the time to exercise or be outside in the morning, just getting a dose of sunlight in the morning is very wake-promoting.

These are all the strategies that work for most people, but it's reasonable that we might have preferences, individual preferences.

John Horton:

You had mentioned exercise in the morning, and I'm a big coffee drinker, as anybody who's listened to this podcast long enough knows. I say, I've found that if I get up in the morning and go for a run, I don't need the coffee. It's something … your body just, you get like an energy jolt that goes through. You can feel it as kind of start going into your day.

Dr. Nancy Foldvary-Schaefer:

It's very alerting. I do have in my practice a few patients with narcolepsy and other hypersomnia disorders. These are central nervous system brain disorders who are runners, and part of their strategy for alerting themselves during the day is a morning run or a morning walk. This is useful and helpful anyway for longevity.

Exercise is good. Light exposure is very, very good anyway, but light exposure in the morning time with some exercise absolutely is wake-promoting for the whole day.

John Horton:

If you're having these problems, it sounds like your No. 1 recommendation is just set a schedule and start there. If you make these other changes and you're not seeing results, when do you go and seek some professional help for your sleep issues?

Dr. Nancy Foldvary-Schaefer:

Well, I think if you've tried some basic things and you're not satisfied with your sleep, you're having poor sleep quality or consequences during the daytime, it's important to talk with your doctor. The way we define most sleep disorders is by duration of symptoms of at least three months. In reality, most people who come to a sleep disorders expert have had symptoms for years. Almost always.

We rarely see people who have just a few days or a few weeks of a problem. Sleep disorders have their way of just becoming chronic by not addressing them early on. I would discuss sleep in your annual visit with your healthcare provider, whether that's a physician or advanced practice nurse. Sleep is part of wellness. If you have a sleep problem, it's important to call attention to that, since sometimes, sleep doesn't make it on the list of the things you're going to talk to your doctor about when you see your doctor once a year. You've got your blood pressure, or medications, or many other things that seem to hit the list. Sleep tends to not hit the list all the time. I think it's important to think about that. When you're planning any doctor's visit, make a mental note as, "How is my sleep doing?" Any provider can begin to do a sleep medicine assessment, and certainly would know when to make a referral to a sleep expert.

John Horton:

Are there any just, really go-to resources that you tell people to search out if they are looking for answers to sleep questions?

Dr. Nancy Foldvary-Schaefer:

Well, on our website, on the Cleveland Clinic Sleep Disorder Center website, there is a significant amount of material about specific sleep disorders and some more general material. We also created a couple of years ago a mobile application that's now on both iOS and Android, and it's called Go to Sleep™. It's a screening tool for the four most common sleep disorders that affect adults in America. That is obstructive sleep apnea, insomnia, insufficient sleep and shift work disorder. These are measured in a scientifically robust way, and you can do those assessments and get your sleep scores. You'll see if you're at risk of any four of those disorders. Then, the app will take you to further questions and little digestible articles that you can read about how to manage those and where to get help, including, it attaches to the directory of the American Academy of Sleep Medicine.

If you're not living in Cleveland area and you need to find a board-certified sleep provider, you can find the closest one near you wherever you are in the United States. That's another great resource.

John Horton:

It sounds like … this is all advice that should help everyone sleep a little better tonight. Before we kind of part our ways or say goodbye, or good night, ideally, do you have any other advice for someone struggling with their sleep schedule?

Dr. Nancy Foldvary-Schaefer:

I think it's just so important to pay attention to your sleep. Many of us just don't recognize that every little cell in our body, billions of cells in our brain, need sleep to function normally. If we're not getting good quality or enough sleep, this will have long-term consequences, and it will have potentially immediate consequences. There's, I think, no threshold that's too low to talk to a healthcare provider.

John Horton:

Sounds like if you're feeling like you have an issue with it, talk to somebody about it because you might be able to get some help and just feel like a more rested and energized you.

Dr. Nancy Foldvary-Schaefer:

Absolutely. We have treatments that are proven to be effective for a host of sleep and wake disorders, and there are many sleep providers available. Most problems are actually fall into the category that's not difficult to treat. I think it's just important to remember to talk about your sleep when you're talking to all your healthcare providers, because it's just foundational to our wellness.

John Horton:

Well, and that is why we have you on. Dr. Foldvary-Schaefer, thank you so much for coming on and sharing so much just fabulous information. I know I will sleep a little easier tonight, just knowing everything that you just told us.

Dr. Nancy Foldvary-Schaefer:

Great. Thanks for having me, John.

John Horton:

Thanks. Bye-bye.

Dr. Nancy Foldvary-Schaefer:

Bye.

John Horton:

Sleep is crucial to our overall health and well-being. If you're consistently not getting enough shut-eye, consider making some changes to your schedule and routine. Think it over — or better yet, sleep on it.

If you liked what you heard today, please hit the subscribe button, and leave a comment to share your thoughts. Until next time, be well.

Speaker 3:

Thank you for listening to Health Essentials, brought to you by Cleveland Clinic and Cleveland Clinic Children's. To make sure you never miss an episode, subscribe wherever you get your podcasts or visit clevelandclinic.org/hepodcast. This podcast is for informational purposes only, and is not intended to replace the advice of your own physician.