The Secret to Sleeping Better with Nancy Foldvary-Schaefer, DO, MS

Podcast Transcript

John Horton:

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

One out of three people don't get the sleep they need on a regular basis. Oftentimes, the reason why comes down to bedtime habits, sometimes referred to as sleep hygiene. It seems that what you do before trying to close your eyes for the night may be the reason why they're staying open longer than they should. To help you get the ZZZs you need tonight and every night, we asked sleep medicine specialists, Nancy Foldvary-Schaefer to join us. She's one of the many trusted experts at Cleveland Clinic who pop into our weekly podcast to share their wisdom. With any luck, what she says will be so enlightening, it'll put you to sleep.

Thanks for stopping by the chat today, Dr. Foldvary-Schaefer. Glad to have you on the podcast.

Dr. Nancy Foldvary-Schaefer:

Absolutely. It's my pleasure.

John Horton:

In talking to some friends ahead of this, I was amazed at how many of them have trouble sleeping. I'm guessing you spend a lot of time every day seeing some very tired people.

Dr. Nancy Foldvary-Schaefer:

Oh yeah. Yeah, I mean, when you think about it, at least 40 percent of us as adult Americans don't get enough sleep, and the most common sleep disorders that are specifically insomnia and sleep apnea affect at least 30 percent of the population. So, across our lifespan, all of us have a high chance of being affected by sleep difficulties.

John Horton:

Well, that is a lot of missed sleep over the course of our lives, which is why we're talking about this today, so we can claw some of that back. So, our topic today is sleeping hygiene, which just strikes me as a funky term that can easily be misunderstood. Can you walk us through what exactly that means?

Dr. Nancy Foldvary-Schaefer:

Sure. "Sleep hygiene" has been a term we've used in sleep medicine for decades. It really refers to the healthy habits, the behaviors and even the environmental factors that one can adjust or modify to help you get a good night's sleep. So, it's the prep work that we continuously do to ensure we sleep well and to protect our sleep.

John Horton:

So why is sleep hygiene just so important for your routine every night?

Dr. Nancy Foldvary-Schaefer:

Well, sleep is foundational to health and wellness. We talk so much about a healthy diet and exercise and forget that sleep is interwoven with good nutrition and good exercise. And now that we live in a 24/7 world, many of us have adopted these habits, these poor sleep hygiene habits that really sabotage us from getting a good night's sleep. And when I say sleep is foundational to health and wellness, we know that enough sleep and good sleep are necessary for cardiovascular health, for metabolic health and now, even for brain health.

John Horton:

You've got me sold on the idea that we really need to focus more on getting good quality sleep. So, we always like to give our listeners some tips that they can use and kind of put into action. So, can you walk us through some things that we can do before bedtime to set up a good night's sleep?

Dr. Nancy Foldvary-Schaefer:

Yes, absolutely. It's very important that we have some winding down or calming time before we expect to fall asleep. Many of us work longer now than we did in the past, or we're used to being on electronics that emit light that can be stimulating or we're choosing to exercise late in the day because that's the only time we can. And so really thinking about how we spend the last hour or two before bedtime is important, and it's more important for people who are prone to having difficulty sleeping. Some people are great sleepers no matter what they do up to the minute they fall asleep.

One thing we promote is standard bedtimes and wake times. And of the two, the one that's actually more important is anchoring the wake-up time. If we establish a set wake-up time, our brains will learn to establish a set bedtime. And keeping bedtimes and wake times consistent is one of the most important features of treating insomnia.

John Horton:

So, will your body just kind of naturally set then? If you wake up at the same time every day, I take it your body knows I need this much sleep, so you'll naturally start getting sleepy at a certain point every night then?

Dr. Nancy Foldvary-Schaefer:

Absolutely. And when we allow ourselves to not have a standard wake-up time, we've all done this to ourselves, when we wake up at a certain time during the work week, we let ourselves sleep in on the weekend or we let ourselves sleep variable timing when we're on vacation, we know then that bedtimes become more erratic. So, this is a very important one.

Another is to think about the environment. Is my bedroom comfortable? Is the bed comfortable? Is the mattress good? Is the pillow comfortable? Is the temperature, right? And is the lighting in the room sufficiently darkened to make this a sleep conducive experience?

John Horton:

When we talk about temperature, what should you look to hit? I know we have that argument all the time in my bedroom because I like it a little cooler and my wife does not. So, what should be the temperature we should look to hit?

Dr. Nancy Foldvary-Schaefer:

Well, our body tempers normally drop during sleep, and so most of the time, we're recommending keeping the bedroom relatively cool, not providing a specific temperature cutoff, but keeping it cooler usually promotes better sleep. And this can be challenging when multiple people sleep in a room. Same with the position of the bed. We have a smart bed now, but my husband doesn't like it when I want it to be up a little bit because he likes it flat. And so there where we go — both people have to be accommodated and that can be challenging.

Other things are, as I mentioned, keeping electronics out of the room and keeping other things out of the bed that shouldn't be in the bed. So, in terms of sleep hygiene, the bed is for sleep and intimate relations. It's not for other things. It's not to use my laptop, it's not to watch movies, it's not to have long conversations. Those things will eventually promote a sloppier sleep hygiene that, in turn, will reduce the quality and quantity of sleep.

John Horton:

So, train your body so that when you're lying in bed, it's for sleeping, period, and that's it.

Dr. Nancy Foldvary-Schaefer:

Other things include prepping yourself related to your activities. So, eating your biggest meal of the day right before bedtime is not good because, number one, our digestive systems don't function as well at night as they do during the day. So, it's not healthy really to be eating late at night or during the night, but also, some people will be affected with reflux or will be uncomfortable when eating late at night. Certainly, we recommend avoiding caffeine, and the timing of that really needs to be individualized. Some people can tolerate caffeine and coffee after dinner. Whereas people who are prone to insomnia either need to avoid it entirely or may need to have a cutoff in the morning by noontime. And alcohol is another one. Alcohol is the most common drug used to help promote sleep, and that's because it does have a sedative-hypnotic effect. However, it metabolizes quickly, and it really wreaks havoc on the quality of sleep, particularly REM sleep. So many people will recognize that their sleep quality is much poorer after drinking alcohol before bedtime compared to having an alcohol-free evening.

John Horton:

Oh, that's interesting because you think the fact that you fall asleep maybe a little more quickly when you have a drink late at night, you think, “Oh, I'm going to sleep better,’ but it sounds like it messes up with everything that happens from the point when you nod off to when you wake up.

Dr. Nancy Foldvary-Schaefer:

Absolutely. It can also increase the duration of sleep apnea episodes, which is one of the more common sleep disorders, and it can make people feel fatigued and sleepy in the morning. So really, we like to avoid alcohol before bedtime, and some people who are really prone to poor sleep choose to avoid it altogether in the evening time.

And I think another important point is to, in addition to planning or managing the sleep environment, it's important that we sort of manage our brains. So, a lot of us don't start thinking about our next day until we're winding down at night. We're so busy that we're not even looking at our calendar for the next day or thinking about, "What do I need to worry about for tomorrow?" until we're in bed winding down. And that can be a challenge for some people who find themselves unable to sleep because their minds are racing, they're planning their next day, they're worrying about things that are upcoming. And so, people who find themselves in that trap of rumination really can benefit from finding time during the daytime to plan the next day. We sometimes suggest keeping a journal. Some people call it a worrying journal. “I'm going to spend 10 or 15 minutes during the day rather than right at bedtime thinking about what I need to do tomorrow,” or “What are the things on my mind that I need to work through?” And then, you can put it away and allow your brain to be free once you get into bed.

John Horton:

That advice seems to go hand in hand with what you said about avoiding electronic devices. I take it, if you start scrolling through social media or emails, that is something else that's just going to get your mind worrying around and going to make it harder for you to nod off.

Dr. Nancy Foldvary-Schaefer:

Absolutely. And there's a lot of literature growing now about how our brains react to and how our emotions react to some of what we read on social media. It can be very anxiety-provoking, and people with anxiety tend to have more insomnia than people who are free of mood disorders.

John Horton:

You had mentioned exercise, and I think a lot of people look at it and you think exercise makes you tired, so if you do it a little later in the day, maybe it'll help you fall asleep, but it sounds like you should do that at a certain point of the day where it shouldn't be close to when you go to bed.

Dr. Nancy Foldvary-Schaefer:

Absolutely. So, exercise is going to rev up those stimulating hormones in the body. And so, it's important to exercise — key important feature of health and wellness — but do it in the afternoon or in the early evening. Doing it within the hour or two before bedtime can trigger insomnia or trigger difficulty falling asleep. And if you're doing that on a regular basis, that can be one of the factors that help promote chronic insomnia disorder.

John Horton:

Now, what about some calming mechanisms that you can do? Yoga is supposed to be really good at night, right?

Dr. Nancy Foldvary-Schaefer:

I think what's really important about this conversation is that we all have different sleep needs, and we all have different hygiene practices, and we all seem to find tips or strategies that kind of work for ourselves. Yoga's not for everyone, but yoga and meditation are great tools that help people relax at night. And now there's so many apps that people are using — again, ideal to not have your phone in bed with you — but on the other hand, some people use calming apps on their phone that help them fall asleep at night. And so, there's always exceptions to the basic rules that really constitute sleep hygiene.

John Horton:

Find what works for you and everybody's going to be a little bit different.

Dr. Nancy Foldvary-Schaefer:

Absolutely.

John Horton:

Well, ahead of this podcast, we asked some folks on Cleveland Clinic's various social media channels if they had sleep-related questions, and our readers and listeners were not disappointed. So, if you've got a minute, let's tackle a few of them.

Dr. Nancy Foldvary-Schaefer:

Alrighty.

John Horton:

All right, so one of our followers on Instagram asked if melatonin is worth trying for sleep.

Dr. Nancy Foldvary-Schaefer:

OK, this is a great question. We get this all the time in the sleep center. So, melatonin is a hormone that is secreted in our brains, and we call it the sleep hormone because it's secreted in advance of anticipated bedtime to help promote us to fall asleep. And melatonin has now become very popular as a sleep aid. And I see patients who are taking it just because they think it's going to make their sleep better, even though they didn't really have a problem falling asleep beforehand. The challenges with melatonin are that melatonin is an excellent treatment for circadian rhythm disorders. So, these are disorders of sleep timing. The night owl who cannot fall asleep until two in the morning. The person who travels a lot across time zones and gets jet lag. The shift worker, very effective when taken at the right dose and time. Timing is key to the effectiveness of melatonin.

There is much less evidence that melatonin works to just promote good sleep, and people who are already good sleepers and/or to treat insomnia in people who have insomnia. There is some data that suggests that it's helpful for insomnia, but others that suggest that it's not helpful at all. What we see in the sleep center these days is that people are going to 5, 10, 20 milligrams of melatonin that can linger in the central nervous system in the morning when you wake up and cause people to be groggy during the day. So it's really important that if you're taking melatonin for your sleep that you get some advice about the timing — when you should take it and what the dose should be or what dose not to exceed in order to perhaps benefit from it, but not get the adverse side effects that may come in the morning time.

John Horton:

Well, that is a full answer. I'm sure that definitely answered the question for our reader there. So, question #2, someone on Twitter wanted to know if it's OK to just sleep for six hours a night.

Dr. Nancy Foldvary-Schaefer:

No.

John Horton:

I like it.

Dr. Nancy Foldvary-Schaefer:

No, it is not.

John Horton:

Very short and simple. So, what should we be aiming for?

Dr. Nancy Foldvary-Schaefer:

Yeah, so the National Sleep Foundation several years ago published recommended times for healthy sleep, and for adults, it's in the range of seven to nine, and that's just a range. Some people are nine-and-a-half-hour sleepers, and they figured that out because they figured out that when they regularly get less than nine and a half hours of sleep, there are daytime consequences. They're tired, sleepy, moody, whatever. There is probably a couple percent of the adult population who are genetically wired to be short sleepers. So, their brains function beautifully on four, five, six hours of sleep. But the vast majority of us, 98 percent of us, I would say, need more than six hours of sleep.

And recent studies have shown that adults who sleep six hours accumulate toxins in the brain that can lead to Alzheimer's disease. We need to sleep seven to eight hours, or in some cases more, in order for our brains to get enough deep sleep to clear the toxins from the brain that accumulate during our waking hours so that we do not develop neurodegenerative diseases. And six hours is not enough based on current science to clear those toxins.

John Horton:

I did not realize there was that much riding on how many hours of sleep I got. That's fascinating.

Dr. Nancy Foldvary-Schaefer:

And the same is true for heart health and metabolic health. Studies show that people who have chronic sleep disorders leading to six hours or less of sleep are more likely to develop hypertension, cardiac arrhythmias, become obese, develop diabetes — and these studies are all currently evolving, but there's a lot of evidence to suggest that short sleep — and that really includes less than seven hours on average for adults — is harmful to your health.

John Horton:

OK, last question we're going to tackle, and this is one of my favorites. We had somebody reach out on Instagram and they said they had been snoring more at night and are even stopping their breathing momentarily at times and she wonders what could be causing that.

Dr. Nancy Foldvary-Schaefer:

Well, those are the classic symptoms of the most common sleep-breathing disorder, which is called obstructive sleep apnea. That is very common. Increases with age, increases as we gain weight. Essentially what happens is that when we fall asleep at night and we lose voluntary control of our airway muscles, the muscles in the back of the throat that control our airway, the airway can get collapsible in sleep. And when the airway collapses enough, we hear people snore. Snoring is the sound that the airway's making trying to keep those airway muscles open so that we have normal breathing. When the airway collapses completely, we call that an apnea. And some people wake up and realize, “I think I've stopped breathing.” More often, a bed partner will say, “You're not breathing.” And we will get nudged to breathe because the snoring culminates in the silence, which is the apnea. And so, this is a common sleep disorder, it's a treatable sleep disorder. Significant sleep apnea poses serious risks to health. And so, anyone with those symptoms should report them to their primary care doctor or see a sleep specialist and get yourself tested.

John Horton:

Those are great tips, and I have a feeling after this talk, all of us are going to sleep a lot better tonight.

Dr. Nancy Foldvary-Schaefer:

I hope so.

John Horton:

Yeah, hopefully. So, before we put this topic to bed, is there anything else you'd like to add for those who are having trouble sleeping?

Dr. Nancy Foldvary-Schaefer:

I would add that if you're having trouble sleeping on a regular basis, more than a couple nights a week for at least three months, it's time to go see a specialist or see your doctor. Once sleep problems continue for at least three months, they become diagnosable sleep disorders. We diagnose chronic insomnia based on at least three months of having sleepless nights. And the sooner we diagnose things, the faster we treat them, and the better people feel, and the more protective sleep becomes for your health. So don't wait years to tackle your sleep problem. Primary care doctors are increasingly aware of how to initiate diagnosis and treatment, and there are sleep centers all around the country that can address these disorders.

John Horton:

Perfect way to wrap things up. So, thanks very much for joining us today and I look forward to having you back on the podcast.

Dr. Nancy Foldvary-Schaefer:

You are very welcome. It was fun.

John Horton:

Your body is wired to fall asleep at night, but that doesn't mean it just happens. Taking some proactive steps before hitting the sheets can help you fall asleep faster and sleep better, so you're fully recharged by morning. Until next time, be well.

Speaker 3:

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