Getting a Good Night's Sleep: The Importance of Sleep Hygiene

Podcast Transcript

Carol Pehotsky (00:05):

Sleep. Let's talk about sleep. We know, as nurses, nursing students, and as a society, we probably don't get enough. I'm joined today by Robon Vanek to discuss tips and tricks for a better night's sleep. 

Hi and welcome to Nurse Essentials, a Cleveland Clinic podcast where we discuss all things nursing, from patient care to advancing your career to navigating tough on-the-job issues. We're so glad you're here. I'm your host, Carol Pehotsky, associate chief nursing officer of Surgical Services Nursing.

Welcome back, everyone. You know, on this journey of getting to be your host of this Nurse Essentials experience, no matter what the topic is, I always find that I'm hearing something, learning something that is really impactful to me no matter the topic. But this topic, I feel like it's all about me and maybe it's all about all of you as well. We're gonna be talking about sleep habits today. I would also invite some of you, maybe you stumbled across here and you're not a nurse. I feel confident what he have to share will be applicable to anyone who's working with improved sleep hygiene, struggling through some things, et cetera, right?

I started my nursing career as a night shift nurse. I chose to do straight nights because I felt that would somehow make it easier versus swinging back and forth. I was not a very pleasant person to be around, so obviously I didn't quite figure it out. And when I switched to days, one of my very best friends in the world pulled aside about a month later and she's like, "I love you no matter what, but you're a lot easier to be around (laughs) now that you work days." So maybe whoever you are, you're listening, you're relating to that. And on that topic, it's my distinct pleasure to introduce you all to Robon Vanek. She is an advanced practice nurse in Cleveland Clinic's Sleep Disorder Center. Robon, thank you so much for joining us today.

Robon Vanek (01:53):

I'm very happy to be here.

Carol Pehotsky (01:55):

Oh, so we could talk for hours about this. I'll try to narrow it down (laughs) to the most important topics. But certainly, we know, again not just for nurses but everybody, sleep deprivation, it- it's basically a public health ep- epidemic, isn't it?

Robon Vanek (02:08):

It is. Absolutely, it is. You know, with sleep deprivation, it's so common. It's estimated that up to 70 million in the United States meet criteria for sleep deprivation.

Carol Pehotsky (02:20):

What?

Robon Vanek (02:20):

Yes.

Carol Pehotsky (02:21):

Wow.

Robon Vanek (02:21):

The US Census Bureau estimates the US population is about 336 million people-

Carol Pehotsky (02:27):

Yeah. Yeah

Robon Vanek (02:27):

... which means one in four or five people are sleep-deprived.

Carol Pehotsky (02:27):

(laughs) Oh, my gosh. 

Robon Vanek (02:27):

That's a lot of people.

Carol Pehotsky (02:30):

That's a lot of people we interact with every day, too. It's like, "Whoo, they woke up on the wrong side of the bed." It's like, "No, they, they never went to bed." (laughs) 

Robon Vanek (02:37):

Indeed. So, sleep is as important as diet and exercise for good health, but sleep is not a priority in our fast-paced society.

Carol Pehotsky (02:46):

No. 

Robon Vanek (02:47):

The amount of sleep time needed varies throughout our lives. For adults, sleep deprivation is when you're not sleeping the recommended seven to nine hours.

Carol Pehotsky (02:56):

Nine? Nine. 

Robon Vanek (02:57):

Seven to nine. 

Carol Pehotsky (02:58):

(laughs) 

Robon Vanek (02:59):

Yep, that's right.

Carol Pehotsky (03:00):

Anybody else feeling that one? (laughs) Oh, boy.

Robon Vanek (03:03):

And/or the quality of sleep is poor. Sleep deprivation can be short term or can be chronic. And when chronic, it can cause or contribute to a variety of health problems.

Carol Pehotsky (03:14):

Sure.

Robon Vanek (03:14):

Sleep deprivation can take different forms. People may not get enough sleep or have good sleep quality. With sleep quality, for example, instead of sleeping, people may stay awake not because of insomnia but because sleep time is not prioritized. 

Carol Pehotsky (03:30):

And, and how m- how many times do we all say for whatever it is, "Oh, I don't have time for that"?

Robon Vanek (03:33):

Exactly.

Carol Pehotsky (03:34):

And this becomes one, one of those many things that we have to make time for, right?

Robon Vanek (03:38):

Absolutely. It is, it should be-

Carol Pehotsky (03:40):

Yeah. (laughs)

Robon Vanek (03:40):

... a priority for all of us. Now, on the other hand, even if asleep, people may not get good sleep quality.

Carol Pehotsky (03:48):

Sure, yeah.

Robon Vanek (03:49):

And there's various reasons for this. There could be untreated sleep apneas or-

Carol Pehotsky (03:53):

Mm-hmm.

Robon Vanek (03:53):

... untreated other sleep disorders. 

Carol Pehotsky (03:55):

Yeah. So I'm guessing I already have some of these, but maybe you can describe for us (laughs) the physical and mental health consequences of not getting that either seven to nine hours or the good quality of sleep you mentioned.

Robon Vanek (04:07):

Right. So when we talk about sleep hygiene, it refers to both the sleep environment and behaviors.

Carol Pehotsky (04:14):

Okay.

Robon Vanek (04:15):

So good sleep hygiene includes setting a very strict sleep schedule. You get up at the same time, you go to sleep at the same time no matter what the day.

Carol Pehotsky (04:23):

(laughs) Tell that to all the teenagers everywhere, right? (laughs) 

Robon Vanek (04:25):

(laughs) Right. So you gotta follow a good bedtime routine-

Carol Pehotsky (04:29):

Mm-hmm.

Robon Vanek (04:29):

... doing the same things at night. So, you really set yourself up for wanting to go to sleep.

Carol Pehotsky (04:35):

Sure.

Robon Vanek (04:37):

Okay. You wanna form healthy sleep habits and optimize the bedroom for your sleep.

Carol Pehotsky (04:37):

Okay.

Robon Vanek (04:42):

It should be quiet, cool, and dark. 

Carol Pehotsky (04:45):

What about white noise or fans? 

Robon Vanek (04:47):

White noise and fans? Absolutely.

Carol Pehotsky (04:49):

Oh, okay.

Robon Vanek (04:50):

Absolutely.

Carol Pehotsky (04:50):

Okay.

Robon Vanek (04:51):

Anything that is improving sleep for any individual.

Carol Pehotsky (04:56):

Okay. So it doesn't have to be quiet, just maybe that distraction-free piece of it?

Robon Vanek (04:59):

Yeah. Yeah. There's been some research with people who live in noisy neighborhoods, right?

Carol Pehotsky (05:00):

Sure, yeah. 

Robon Vanek (05:05):

And in that case-

Carol Pehotsky (05:06):

Mm-hmm.

Robon Vanek (05:07):

... having white noise would be a better option.

Carol Pehotsky (05:09):

Oh, okay. 

Robon Vanek (05:10):

Yeah. So it's really individualized.

Carol Pehotsky (05:12):

I'm really looking for validation here, folks. (laughs)

Robon Vanek (05:12):

(laughs) 

Carol Pehotsky (05:15):

So you mentioned that environment and then we talk a bit more about those habits then.

Robon Vanek (05:21):

Right. So that means making sure that you prioritize sleep, going to bed at-

Carol Pehotsky (05:21):

Mm-hmm. 

Robon Vanek (05:28):

... the same time, getting up at the same time. You know, poor sleep hygiene, it can really negatively impact both the quantity and quality-

Carol Pehotsky (05:36):

Okay.

Robon Vanek (05:37):

... of sleep. And that's what can lead to sleep deprivation, right? 

Carol Pehotsky (05:37):

Sure, okay. 

Robon Vanek (05:41):

So the symptoms of sleep deprivation include daytime sleepiness, fatigue-

Carol Pehotsky (05:48):

Yeah, check. Check.

Robon Vanek (05:49):

... irritability, that you've already talked about-

Carol Pehotsky (05:51):

(laughs)

Robon Vanek (05:52):

... slow reaction times, headaches, trouble thinking, focusing, remembering, all the bad stuff.

Carol Pehotsky (05:57):

Sure. Well, when you think about all the things that a nurse has to do, no matter where, we're nurses, right? They talk about the many hats a nurse has to put on top of his-

Robon Vanek (05:57):

Yes.

Carol Pehotsky (06:06):

... or her head and, and changing them throughout a shift. To have even one of those things going on isn't just about showing up, feeling rested; it's about safety. 

Robon Vanek (06:16):

It is, absolutely. And when you're sleep-deprived, it correlates with 7 out of 15 leading causes of death.

Carol Pehotsky (06:24):

What?

Robon Vanek (06:25):

Yes.

Carol Pehotsky (06:25):

Oh, man. (laughs) 

Robon Vanek (06:25):

Yes. 

Carol Pehotsky (06:25):

Okay?

Robon Vanek (06:27):

So it's not just being able to function and function well and-

Carol Pehotsky (06:30):

Mm-hmm.

Robon Vanek (06:30):

... wearing many hats for a nurse-

Carol Pehotsky (06:32):

Sure.

Robon Vanek (06:32):

... but also-

Carol Pehotsky (06:33):

Their own health. 

Robon Vanek (06:34):

Their own health.

Carol Pehotsky (06:35):

Wow. 

Robon Vanek (06:36):

Heart disease, stroke, hypertension, diabetes, infection, cancer, and it can lead to- 

Carol Pehotsky (06:36):

Cancer? 

Robon Vanek (06:43):

... to the tragedy-

Carol Pehotsky (06:43):

Oh, geez. 

Robon Vanek (06:45):

... of drowsy drowning [inaudible 00:06:45]-

Carol Pehotsky (06:46):

Oh, yeah. Yeah.

Robon Vanek (06:46):

... driving home. 

Carol Pehotsky (06:47):

Uh, you know, if you're, if... We know some of our listeners are still on nursing school. We know some folks are further along in their journey and, you know, I'm sure there's many of us out there, myself included, who had a very close call-

Robon Vanek (06:58):

Yes.

Carol Pehotsky (06:58):

... you know, going down 8:00 AM in a very busy interstate and got very lucky.

Robon Vanek (07:04):

You talk to a room full of nurses-

Carol Pehotsky (07:06):

Yeah.

Robon Vanek (07:07):

... you will see multiple people raise up their-

Carol Pehotsky (07:09):

Raise their hand, yeah.

Robon Vanek (07:09):

... and say, "Yes, that happened to me."

Carol Pehotsky (07:11):

Wow. So we've talked a lot about the physical components, and those are plenty dreadful. But what does that do to our mental health as well?

Robon Vanek (07:19):

Right. So lack of sleep also has mental health repercussions-

Carol Pehotsky (07:23):

Okay.

Robon Vanek (07:23):

... and that include increased risk of depression, anxiety, and general symptoms like loss of motivation or lack of concentration. When tired, it can be harder to manage and process emotions.

Carol Pehotsky (07:36):

Sure. And it's easy to think... There are plenty of other causes for that, but while we're thinking about those causes, are we also... Pr- it's probably not occurring to most of us that... Well, let me at least try a better night's (laughs) sleep and see if that makes a difference.

Robon Vanek (07:50):

Absolutely.

Carol Pehotsky (07:50):

Sure.

Robon Vanek (07:51):

And, you know, there's been research out there that's demonstrated that people can cognitively adapt to chronic sleep restriction-

Carol Pehotsky (07:59):

Mm-hmm. Sure.

Robon Vanek (07:59):

... or getting less than that seven to nine hours-

Carol Pehotsky (08:01):

Okay.

Robon Vanek (08:01):

... that we've been talking about without feeling particularly sleepy, so they think that there's no problem there.

Carol Pehotsky (08:07):

Right. (laughs) I haven't had any problem so far but-

Robon Vanek (08:09):

But maybe their body is showing significant decline-

Carol Pehotsky (08:12):

Oh, sure.

Robon Vanek (08:13):

... physical-

Carol Pehotsky (08:13):

Mm-hmm.

Robon Vanek (08:14):

... health or maybe there's mental performance issues.

Carol Pehotsky (08:14):

Yeah. 

Robon Vanek (08:14):

Yeah. 

Carol Pehotsky (08:17):

Yeah. We fool ourselves into a lot of things, and this would be one of them thinking, "I don't need that. I'm fine," or "I'll have that third cup of coffee and it won't affect me (laughs) et cetera." 

Robon Vanek (08:26):

Exactly. 

Carol Pehotsky (08:26):

Yeah. Yeah. 

Robon Vanek (08:27):

And the effects of sleep deprivation, it really depends on why it happens and how long it lasts. 

Carol Pehotsky (08:33):

Okay.

Robon Vanek (08:33):

So longer lasting sleep deprivation equals more severe effects. And as I've said, poor sleep hygiene can lead to sleep deprivation.

Carol Pehotsky (08:41):

Sure.

Robon Vanek (08:42):

Yeah. 

Carol Pehotsky (08:42):

Sure. Wow. So I'm trying to get that seven to nine hours.

Robon Vanek (08:47):

Yes.

Carol Pehotsky (08:48):

Just because I get that seven to nine hours in bed doesn't mean it's healthy. What does that look like? How do I get to-

Robon Vanek (08:48):

Sure.

Carol Pehotsky (08:54):

... that healthy place?

Robon Vanek (08:55):

So, that is good quality of sleep.

Carol Pehotsky (08:55):

Mm-hmm.

Robon Vanek (08:58):

So, that includes the factors of sleep onset or how long it takes to fall asleep.

Carol Pehotsky (09:03):

Okay.

Robon Vanek (09:04):

So healthy sleep onset on average is usually about 10 to 20 minutes.

Carol Pehotsky (09:09):

Oh, boy. (laughs)

Robon Vanek (09:09):

Yeah. Yeah. I mean, you can go 30 minutes, but-

Carol Pehotsky (09:13):

Okay.

Robon Vanek (09:14):

... beyond that, there's a problem.

Carol Pehotsky (09:15):

Sure. Sure. 

Robon Vanek (09:16):

Another factor of good quality sleep is what people working in sleep medicine called WASO, which is wake after sleep onset. 

Carol Pehotsky (09:25):

Oh, sure. Yeah. Mm-hmm.

Robon Vanek (09:26):

And with good quality sleep, this means sleeping through the night or not having any or many disruptions.

Carol Pehotsky (09:32):

So I wanna go back to the 10 to 20 or 30 minutes to fall asleep. So, it's past 30 minutes, what do I do?

Robon Vanek (09:39):

You get out of bed.

Carol Pehotsky (09:40):

Really?

Robon Vanek (09:40):

You go to another room and you do something boring.

Carol Pehotsky (09:44):

Oh, boy. Okay. And so maybe not pull up the, the old phone? (laughs) 

Robon Vanek (09:47):

No. No. That is, that is not what you to do.

Carol Pehotsky (09:50):

Right. (laughs) 

Robon Vanek (09:50):

Sitting quietly, listening to some very soft music-

Carol Pehotsky (09:55):

Okay.

Robon Vanek (09:55):

... meditating, and then when you feel sleepy, going back into the bedroom to go to sleep.

Carol Pehotsky (10:01):

Like hitting the reset button, trying again?

Robon Vanek (10:03):

Exactly.

Carol Pehotsky (10:03):

Okay. And going back to the WASO-

Robon Vanek (10:06):

Mm-hmm.

Carol Pehotsky (10:08):

... is it I wake up once and that's not good or is... What's sort of a threshold for where we would say, "This is too many times I'm waking up in the middle of the night"?

Robon Vanek (10:15):

Well, it really depends.

Carol Pehotsky (10:16):

Oh, okay.

Robon Vanek (10:17):

Because there are some people who have physical discomfort-

Carol Pehotsky (10:21):

Sure.

Robon Vanek (10:22):

... and that's waking them up.

Carol Pehotsky (10:23):

Yes.

Robon Vanek (10:23):

There are some people who are waking up because of untreated sleep apnea. They can wake up every couple of hours.

Carol Pehotsky (10:29):

Gosh, yeah. 

Robon Vanek (10:30):

Yeah.

Carol Pehotsky (10:30):

Mm-hmm. 

Robon Vanek (10:31):

Sometimes it's having prostate problems and you've got to go-

Carol Pehotsky (10:32):

Mm-hmm.

Robon Vanek (10:36):

... have the bathroom break.

Carol Pehotsky (10:37):

Mm-hmm. Mm-hmm. 

Robon Vanek (10:38):

But if it's more than just one or two times...

Carol Pehotsky (10:42):

Okay.

Robon Vanek (10:42):

And then, it also depends on how quickly people fall back to sleep.

Carol Pehotsky (10:47):

Sure.

Robon Vanek (10:48):

Some people, they just feel wired. They feel so awake-

Carol Pehotsky (10:48):

Mm-hmm.

Robon Vanek (10:51):

... and it's so hard to get back to sleep.

Carol Pehotsky (10:53):

In our house, it's called "I've lost my sleepy." (laughs) 

Robon Vanek (10:55):

(laughs) 

Carol Pehotsky (10:55):

It started with, with our daughter and it's like, "Mom, I lost my sleepy," and [inaudible 00:11:00] transitioned like, "Oh, no, I lost my sleepy. I can't get it back." (laughs) So we talked a little bit at the top of the hour about, you know, there are lots of people... This, obviously, affects 70 million of us-

Robon Vanek (10:55):

Yes.

Carol Pehotsky (11:10):

... in this country alone, but when you think about nurses, nursing aides, all sorts of folks in healthcare, you know, care is needed 24/7. Somebody has to get to work the evening shift, the night shift, so any tips for... Maybe we'll start first with people who do straight nights and then, maybe then we'll talk about people who rotate or swing shift.

Robon Vanek (11:32):

So if the schedule is fixed-

Carol Pehotsky (11:36):

Mm-hmm.

Robon Vanek (11:36):

... so there's no rotation-

Carol Pehotsky (11:37):

Right.

Robon Vanek (11:38):

... that's involved-

Carol Pehotsky (11:38):

Mm-hmm.

Robon Vanek (11:39):

... then keeping the same schedule on work days and on off days is recommended.

Carol Pehotsky (11:44):

(laughs) 

Robon Vanek (11:45):

So if someone works night shift, it's recommended that daytime sleep is maintained, which is difficult-

Carol Pehotsky (11:51):

It is.

Robon Vanek (11:51):

... for a lot of people to do-

Carol Pehotsky (11:52):

Absolutely, yes.

Robon Vanek (11:53):

Families, all of those responsibilities. I've actually only had one gentleman and he was a police officer-

Carol Pehotsky (12:00):

Mm-hmm.

Robon Vanek (12:00):

... and so he slept during the day-

Carol Pehotsky (12:03):

Okay.

Robon Vanek (12:04):

... and he worked at night. One, I've been in the department almost 11 years, so...

Carol Pehotsky (12:04):

(laughs) 

Robon Vanek (12:04):

(laughs) 

Carol Pehotsky (12:10):

Yeah. We don't know what the denominator is, but it's awfully large-

Robon Vanek (12:12):

It is.

Carol Pehotsky (12:13):

... compared to one. Yeah. I mean, I'm sure lots of people are relating to that right now. You get the blackout curtains, there's still that line of light that comes through-

Robon Vanek (12:13):

Mm-hmm.

Carol Pehotsky (12:21):

... you, you sleep with a fan but the neighbors, you know, mows their yard. 2:00 would normally be-

Robon Vanek (12:26):

Right.

Carol Pehotsky (12:26):

... be, be an appropriate time, but it doesn't feel like that when it's my neighbors. So, I, I vividly remember like, "Why are they mowing their yard?" It's like, "Oh, it is 2:00 in the afternoon. I'm the problem."

Robon Vanek (12:36):

Indeed.

Carol Pehotsky (12:37):

You know, I've worked straight nights because my husband was in healthcare and he was working straight nights. And now he's back on days, but he basically... He just stops moving and he falls asleep, but he worked nights forever. And the other thing he really is struggling with is training our friends-

Robon Vanek (12:53):

Right.

Carol Pehotsky (12:53):

... t- to, to help us get to that very, "This is how I sleep whether it's a work day or not." It's, "Well, I didn't think you were working. I thought you maybe wanna g- go out to lunch or what have you." It's like, "No, no, no, that'd be like me calling you at 4:00 in the morning and saying, 'Hey, you wanna grab a drink or you wanna grab dinner?'" 

Robon Vanek (13:08):

Protecting your sleep time.

Carol Pehotsky (13:09):

Yes. 

Robon Vanek (13:10):

Absolutely. And communicating with family and friends-

Carol Pehotsky (13:13):

Yeah.

Robon Vanek (13:13):

... with your loved ones, for sure.

Carol Pehotsky (13:14):

So at least with that, you know, in theory, that one gentleman was probably able to say to his friends and family, "This is my protected time. And I'd be more than happy to interact with you in these hours." When you rotate, though... No. Sometimes, wouldn't, I wouldn't even know when I work, and so how would my loved ones know that? So, what would you recommend for those folks that are constantly changing?

Robon Vanek (13:34):

Well, the American Academy of Sleep Medicine says that this shift shouldn't be more than eight hours-

Carol Pehotsky (13:42):

Mm-hmm. Okay. (laughs) 

Robon Vanek (13:42):

... and more than three in a row.

Carol Pehotsky (13:44):

Sure. Mm-hmm. 

Robon Vanek (13:45):

Okay.

Carol Pehotsky (13:45):

Yeah. 

Robon Vanek (13:46):

We know-

Carol Pehotsky (13:46):

So we're already in trouble there.

Robon Vanek (13:47):

Yes.

Carol Pehotsky (13:47):

Okay. Okay. (laughs) 

Robon Vanek (13:48):

'Cause we do the 12-hour shifts.

Carol Pehotsky (13:50):

Yes. Yeah. 

Robon Vanek (13:51):

So with the rotation, it would be mo- no more than two 12-hour shifts-

Carol Pehotsky (13:58):

Mm-hmm.

Robon Vanek (13:58):

... separated by at least one-

Carol Pehotsky (13:59):

Okay.

Robon Vanek (14:00):

... or more-

Carol Pehotsky (14:01):

Sure.

Robon Vanek (14:02):

... so that there can be recovery time. And that you go in a clockwise rotation, so you go day to night.

Carol Pehotsky (14:11):

Oh, okay. And then... Yeah. Sure. 

Robon Vanek (14:12):

Yeah. Because that it's easier to go around the clock.

Carol Pehotsky (14:15):

Okay, yeah. 

Robon Vanek (14:15):

And then you have a couple of days in between if you are going to be doing-

Carol Pehotsky (14:21):

Sure.

Robon Vanek (14:21):

... a counter-clockwise rotation.

Carol Pehotsky (14:24):

Okay. Yeah. So for those of you who are (laughs) coming into our profession, you're still in nursing school, unfortunately as the new person, sometimes you get what's left over from the schedule, right? But I think it's that piece of how do you work with your leadership to advocate for, "I'm happy to rotate. Is there any chance I can," you know, which isn't always available. But I know lots of nurses who really... They wanna bucket their days they work-

Robon Vanek (14:50):

Mm-hmm.

Carol Pehotsky (14:50):

... to, to stretch out the time they have off. But how effective is that time off if I'm constantly... I, I put too much together and I haven't slept, and so I spend the first two of four days off completely exhausted.

Robon Vanek (15:01):

Well, there's actually some resources out there.

Carol Pehotsky (15:01):

Okay.

Robon Vanek (15:03):

And one, really good one is through the National Institute of Occupational Safety and Health.

Carol Pehotsky (15:03):

Mm-hmm.

Robon Vanek (15:09):

So if you go and look for CDC-

Carol Pehotsky (15:12):

Okay.

Robon Vanek (15:13):

... and shift work, if you search for that online-

Carol Pehotsky (15:15):

Sure.

Robon Vanek (15:16):

... they have fantastic training modules for nurses and others who are working nights, irregular shifts, and long work hours.

Carol Pehotsky (15:16):

Okay.

Robon Vanek (15:23):

So if there is a nursing student or nurses who are working, that is something that I always recommend whenever I'm giving a presentation on shift work-

Carol Pehotsky (15:23):

Sure.

Robon Vanek (15:32):

... disorder. 

Carol Pehotsky (15:33):

Yes. We- we're very fortunate to have lots of resources here, but that's available to everybody [inaudible 00:15:37].

Robon Vanek (15:36):

Absolutely.

Carol Pehotsky (15:37):

Absolutely. Okay. I'm gonna shift gears just a little bit.

Robon Vanek (15:40):

Okay.

Carol Pehotsky (15:41):

What's the deal with napping? Is that a good thing? Is that a bad thi-... I, I am not a napper. I am a terrible napper, so this is really for everybody else. (laughs) It's not for me.

Robon Vanek (15:49):

Not everybody is a napper.

Carol Pehotsky (15:49):

Okay.

Robon Vanek (15:51):

We are all built differently, genetically, right?

Carol Pehotsky (15:51):

Okay. Yeah. 

Robon Vanek (15:54):

So people are nappers and people are not nappers.

Carol Pehotsky (15:57):

Oh, I've never heard that. That's helpful to know. (laughs)

Robon Vanek (15:59):

Absolutely. The American Academy of Sleep Medicine has multiple recommendations, and one of those is napping on the night shift.

Carol Pehotsky (15:59):

Oh, okay.

Robon Vanek (16:06):

But not all people can nap.

Carol Pehotsky (16:09):

Sure.

Robon Vanek (16:10):

So it would be fatigue management. So, what is restoring for each individual-

Carol Pehotsky (16:17):

Sure.

Robon Vanek (16:17):

... when they're working on the night shift? And at least getting out of the light and into a darkened space...

Carol Pehotsky (16:26):

So we'll get some rest even if it isn't sleep?

Robon Vanek (16:28):

Exactly. 

Carol Pehotsky (16:29):

Okay. All right. 

Robon Vanek (16:31):

Exactly. Now, one thing to know is that breast cancer in pre-menopausal women-

Carol Pehotsky (16:37):

Mm-hmm.

Robon Vanek (16:37):

... working night shift, yes, that has been found by the National Institute of Health. The way that it works... I know. Very scary.

Carol Pehotsky (16:47):

Wow, that is super scary.

Robon Vanek (16:48):

The way that it works is that you're exposed to the light-

Carol Pehotsky (16:48):

Okay.

Robon Vanek (16:52):

... that decreases melatonin. Melatonin does a lot of good things. It makes us feel sleepy, but it does a lot more. So, you decrease the melatonin, you get an increase in estrogen.

Carol Pehotsky (17:03):

Oh.

Robon Vanek (17:03):

And so pre-menopausal-

Carol Pehotsky (17:03):

Which can...

Robon Vanek (17:05):

... women-

Carol Pehotsky (17:05):

Yes.

Robon Vanek (17:06):

... have more risk of developing breast cancer.

Carol Pehotsky (17:09):

Oh, my gosh. If they're... Wow. 

Robon Vanek (17:10):

Mm-hmm. Not the same for post-menopausal women.

Carol Pehotsky (17:12):

Oh, interesting. 

Robon Vanek (17:13):

Because we don't have as much-

Carol Pehotsky (17:15):

Oh, right. There's no...

Robon Vanek (17:15):

... estrogen.

Carol Pehotsky (17:16):

Not as much estrogen to go around, that's right.

Robon Vanek (17:18):

Right. So who knew there was a benefit-

Carol Pehotsky (17:22):

Oh, my goodness.

Robon Vanek (17:22):

... to being post-menopausal? 

Carol Pehotsky (17:22):

Right. (laughs) There it is. There it is-

Robon Vanek (17:22):

There it is.

Carol Pehotsky (17:22):

... the one. (laughs) 

Robon Vanek (17:22):

(laughs) 

Carol Pehotsky (17:24):

So in our culture, obviously, there's a lot of sleep deprivation going around and then there's a lot of advice that may or may not be as helpful, right? We know there are people who are drinking coffee all day long and saying, "Oh, it doesn't affect me," or drinking coffee all day and then trying to have a glass of wine or a melatonin and thinking it will just fix everything. So, a lot of people are doing various things to manage their sleep/wake cycle. What would you say to that?

Robon Vanek (17:49):

So when you're drinking and then going to bed-

Carol Pehotsky (17:50):

Mm-hmm.

Robon Vanek (17:53):

... having a nightcap, for example-

Carol Pehotsky (17:56):

Mm-hmm.

Robon Vanek (17:56):

... what happens is that it might help you to fall asleep, but it interferes with REM sleep-

Carol Pehotsky (18:02):

Sure.

Robon Vanek (18:02):

... and then it metabolizes out of your system-

Carol Pehotsky (18:05):

Mm-hmm.

Robon Vanek (18:05):

... and turns to a stimulant and it can wake you up. 

Carol Pehotsky (18:07):

(laughs) There we go.

Robon Vanek (18:08):

Now as far as melatonin is concerned, as long as, you know, it's not a high, high dose-

Carol Pehotsky (18:15):

Okay.

Robon Vanek (18:15):

... then this can be something that's helpful. So, the research is starting to point towards it can be helpful-

Carol Pehotsky (18:22):

Okay.

Robon Vanek (18:23):

... and so I recommend it.

Carol Pehotsky (18:25):

Okay.

Robon Vanek (18:25):

And when I have a pre-menopausal nurse who's-

Carol Pehotsky (18:29):

Sure.

Robon Vanek (18:29):

... working night shift-

Carol Pehotsky (18:30):

Yeah.

Robon Vanek (18:31):

Now, it's not solid that it's going to provide protection, but it can help with sleep-

Carol Pehotsky (18:36):

Mm-hmm.

Robon Vanek (18:36):

... and maybe we will find out over time that-

Carol Pehotsky (18:36):

Sure.

Robon Vanek (18:39):

... it could be a preventative for breast cancer.

Carol Pehotsky (18:41):

And definitely, one of those, the benefits would outweigh any-

Robon Vanek (18:43):

Yes.

Carol Pehotsky (18:44):

... detriment to taking something like that.

Robon Vanek (18:46):

Absolutely.

Carol Pehotsky (18:47):

I'm pretty sure I also know the answer to this question, but it's on everybody's mind. All of us have some sort of device and, you know, it's in some people's hands until right before they go to bed. So a lot of us are really present with our phones or whatever a device that is. What do you have to say about that and, and how to unplug and, really, the benefits of doing that for our sleep?

Robon Vanek (19:08):

So when we talk about these devices-

Carol Pehotsky (19:12):

Mm-hmm.

Robon Vanek (19:12):

... a lot of times what we're thinking about are people who are in bed and they have the phone that's emitting blue light-

Carol Pehotsky (19:13):

Sure.

Robon Vanek (19:19):

... and they're holding it very close to their face.

Carol Pehotsky (19:21):

(laughs) And scrolling away.

Robon Vanek (19:23):

Yes.

Carol Pehotsky (19:23):

Yes.

Robon Vanek (19:24):

And that decreases the secretion of melatonin. 

Carol Pehotsky (19:28):

Okay.

Robon Vanek (19:28):

So that's-

Carol Pehotsky (19:29):

There you go.

Robon Vanek (19:29):

... the hormone-

Carol Pehotsky (19:29):

Yeah. Mm-hmm.

Robon Vanek (19:30):

... that makes us feel sleepy. So while we may think screen time is relaxing, over time these electronic devices, they can create poor habits, bad routines for your brain and your hormones. Routinely not getting enough good quality of sleep can lead to a multitude of health issues-

Carol Pehotsky (19:48):

Mm-hmm.

Robon Vanek (19:48):

... as we've been talking about. So when you have these phones in bed, this can make it more difficult to fall asleep-

Carol Pehotsky (19:56):

Mm-hmm.

Robon Vanek (19:56):

... can impact the amount and quality of REM sleep or-

Carol Pehotsky (19:59):

Mm-hmm.

Robon Vanek (19:59):

... dreaming sleep-

Carol Pehotsky (20:00):

Sure.

Robon Vanek (20:01):

... which is the deepest level of sleep. And it is thought that what is happening during REM sleep is memory consolidation and the brain is clearing of toxins.

Carol Pehotsky (20:10):

Oh. 

Robon Vanek (20:11):

Yes.

Carol Pehotsky (20:11):

There you go. (laughs) 

Robon Vanek (20:13):

So-

Carol Pehotsky (20:13):

If you didn't have enough motivation-

Robon Vanek (20:13):

(laughs) 

Carol Pehotsky (20:15):

... for the last 20 or so minutes, clearing your brain's toxins seems like a pretty good motivation-

Robon Vanek (20:20):

Absolutely.

Carol Pehotsky (20:21):

... for getting a good amount of sleep.

Robon Vanek (20:22):

I hope so. I hope so. 

Carol Pehotsky (20:23):

And what drew you to this work? 

Robon Vanek (20:25):

So when I became a nurse practitioner-

Carol Pehotsky (20:28):

Mm-hmm.

Robon Vanek (20:28):

... I was working in Baltimore, at a federally-qualified health center.

Carol Pehotsky (20:32):

Okay.

Robon Vanek (20:33):

And then, I moved back to Cleveland and I was looking for a position.

Carol Pehotsky (20:38):

Mm-hmm.

Robon Vanek (20:38):

And I had a family friend who spent many years-

Carol Pehotsky (20:42):

Mm-hmm.

Robon Vanek (20:42):

... at the VA in sleep medicine.

Carol Pehotsky (20:44):

Okay. Oh, how about that? Okay.

Robon Vanek (20:45):

So family friend who knows me, he's like, "Robon, you are going to love sleep medicine," and I love sleep medicine.

Carol Pehotsky (20:51):

Clearly. It's very clear. We are all the better for your information today. And for those who live in Cleveland, we have access to a sleep disorder center as well.

Robon Vanek (21:00):

Absolutely.

Carol Pehotsky (21:01):

So I could talk to you about this for hours, but instead I've taken some notes. I'm gonna start this tonight. Everybody else listening, start thinking about your sleep hygiene. I'm hoping you'll spend just a few more minute with us to let us know a little bit more about you as a nurse and human being.

Robon Vanek (21:13):

Sure.

Carol Pehotsky (21:13):

So I hear that you're working on your PhD. 

Robon Vanek (21:16):

I am.

Carol Pehotsky (21:16):

What are you working on?

Robon Vanek (21:17):

So I'm going to Kent State-

Carol Pehotsky (21:19):

Okay.

Robon Vanek (21:20):

... and they have a part-time PhD program.

Carol Pehotsky (21:23):

Oh, nice. 

Robon Vanek (21:23):

So it's going to take me longer, but I can continue to work full-time.

Carol Pehotsky (21:24):

That's wonderful.

Robon Vanek (21:28):

And so I am looking at nurse practitioners-

Carol Pehotsky (21:33):

Okay. 

Robon Vanek (21:34):

... within structural systems. So I'm an APRN on an APRN council that's working at Cleveland Clinic-

Carol Pehotsky (21:42):

Mm-hmm.

Robon Vanek (21:43):

... within a state. There's state rules and laws-

Carol Pehotsky (21:46):

Oh, right, yeah. 

Robon Vanek (21:46):

... within-

Carol Pehotsky (21:47):

The structure of it. 

Robon Vanek (21:47):

The structure of it. And seeing how sharing power within a nurse practitioner council-

Carol Pehotsky (21:54):

Sure.

Robon Vanek (21:54):

... so creating events, like educational events or-

Carol Pehotsky (21:58):

Oh, okay.

Robon Vanek (21:58):

... professional development council so that the nurse practitioners from Cleveland Clinic can benefit from that in thinking about power from a vertical perspective-

Carol Pehotsky (22:10):

Right.

Robon Vanek (22:10):

... which can go up and down. So, people can communicate-

Carol Pehotsky (22:12):

(laughs) Sure, yes.

Robon Vanek (22:13):

... and then rules can come down-

Carol Pehotsky (22:15):

Mm-hmm.

Robon Vanek (22:15):

... as well. So, that's gonna take me awhile but that's what I'm thinking about.

Carol Pehotsky (22:19):

And then you can call me. I'm going to do a different episode about that. (laughs) 

Robon Vanek (22:21):

Absolutely.

Carol Pehotsky (22:22):

And then in, in closing, I like to ask all of our guests. What brings you joy?

Robon Vanek (22:27):

Being involved.

Carol Pehotsky (22:29):

Oh, okay.

Robon Vanek (22:29):

So even having this opportunity-

Carol Pehotsky (22:32):

(laughs) 

Robon Vanek (22:33):

... this is amazing, because I've been talking about shift work disorder-

Carol Pehotsky (22:38):

Sure.

Robon Vanek (22:38):

... at sleep conferences for years. And so this gives me the opportunity to really reach-

Carol Pehotsky (22:44):

Yeah.

Robon Vanek (22:44):

... a larger audience.

Carol Pehotsky (22:46):

Yeah.

Robon Vanek (22:46):

That's why I'm on the APRN council. That's why I'm chair of the research subcommittee. That's why I'm getting my PhD, so being involved-

Carol Pehotsky (22:46):

Wonderful.

Robon Vanek (22:54):

... and communicating and trying to make the world a better place and hopefully help people sleep better.

Carol Pehotsky (22:59):

You've given us a lot of homeworks. So, everybody listening, rewind, take some notes, take better care of your sleep, clear out those brain toxins.

Robon Vanek (22:59):

(laughs) 

Carol Pehotsky (23:07):

Thank you so much for joining me today. 

Robon Vanek (23:08):

It was a pleasure. Thank you so much. 

Carol Pehotsky (23:14):

As always, thanks so much for joining us for today's discussion. Don't miss out. Subscribe to hear new episodes wherever you get your podcast. And remember, we want to hear from you. Do you have ideas for future podcasts or want to share your stories? Email us at nurseessentials@ccf.org. To learn more about nursing at Cleveland Clinic, please check us out at clevelandclinic.org/nursing. Until next time, take care of yourselves and take care of each other. 

The information information in this podcast is for educational and entertainment purposes only and does not constitute medical or legal advice. Consult your local State Boards of Nursing for any specific practice questions.