Your Guide to Great Sleep (in Quarantine and Beyond) With Dr. Michelle Drerup

Podcast Transcript

Nada Youssef:  Hi, thank you for joining us. I'm your host Nada Youssef. We all know that sleep comes with a long list of health benefits, everything from reducing inflammation and stress, improving cognitive function, and more. A good night's sleep also regulates good moods, increases productivity, and gives our immune system a much needed boost. Whether you've had sleeping problems before this global pandemic, or if they've only come on recently, Dr. Drerup is here to share with us a few tips on how to get a great sleep amidst this pandemic. Dr. Michelle Drerup is a psychologist as well as the director of behavioral sleep medicine in Cleveland Clinic. Thank you so much for being with us today.

Dr. Michelle Drerup:  Thank you for having me.

Nada Youssef:  And please remember this is for informational purposes only and it's not intended to replace your own physician's advice. Isolation, school closures, quarantines, and working from home all bring profound changes to normal routines for people of all ages and walks of life. Can you talk to us a little bit about why sleep is vital during a pandemic?

Dr. Michelle Drerup:  Well you mentioned it in your introduction, that sleep has a significant impact on our immune functioning. So number one, as we're wanting to make sure that we're less susceptible to the virus, getting adequate sleep is one way we can do that. There are studies that show that when people are sleep deprived and are exposed to the common cold virus, they have higher rates of acquiring a cold. So we know it has a significant impact on not only immunity, but also our emotional and mental health as well. So while we're under this stress of the current situation, getting adequate sleep can help us deal with that.

Nada Youssef:  Now when you talk about sleep deprivation, are there signs that we can tell right away if we are sleep deprived or if our kids are sleep deprived?

Dr. Michelle Drerup:  One of the most common is that you feel sleepy during the daytime and you feel the need to have a nap or you're dozing off when you're not intentionally doing that. Another common symptom of being sleep deprived is an impact on your mood. So maybe you're more irritable, less patient, more unable to control emotions. That's a symptom, but we have physical symptoms of it in things like feeling hungrier or having headaches, things like that, as well as the emotional or mental state.

Nada Youssef:  Great. Now many are finding themselves fatigued during this time. Can we talk about how to maintain a healthy sleep schedule and a routine during this stressful time, both for adults and kids, if it's different?

Dr. Michelle Drerup:  Yeah. So it's a challenge we're seeing for a lot of our patients, but on the other hand, some of our patients that had sleep problems are actually sleeping better now during the pandemic because they can sleep more according to what their natural circadian tendency is. So say an individual who is more of a night owl and they don't have the long commute in the morning anymore, they can get that extra hour of sleep and it actually feels much better for them and they sleep better. So whatever the schedule it is that you're keeping, it's being consistent with it. So same thing with our kids. If your children are sleeping a little later in the morning, it's keeping consistent with that schedule right now.

Nada Youssef:  Great, and that was actually going to be my next question, because with working from home, some people not working, and schools, everything being done at home, kids are sleeping in and maybe we are sleeping in. It's not a bad thing if it's consistent, then, you're saying?

Dr. Michelle Drerup:  Right. Oversleeping as a problem. So say you're sleeping ... usually you would get eight hours of sleep and that would be fine, and now you find yourself sleeping nine, 10 hours. Oversleeping can actually make us feel more tired, but if it's just that, well, when my kids are off in the summer, they tend to sleep a little later and sleep in a little later and now we're keeping that same schedule, but it's consistent. Say they're going to bed an hour later than they normally would and wake an hour later, just that they're getting an adequate amount of sleep, they're meeting their sleep needs as well as staying consistent with that.

Nada Youssef:  Sure. Now with a lot of meetings, work meetings, school, everything turning virtual like this interview right here, we find ourselves in front of screens a lot and TV, computers. Can this be affecting our sleep and our kids' sleep?

Dr. Michelle Drerup:  It can, especially if we're doing a lot of screen time in the evenings, and so we know that the blue light that's emitted from our screens has an impact on our melatonin production. So that inhibits melatonin production. So trying to avoid screens as much as possible within a couple of hours for bedtime is ideal. During the daytime, the thing to do would be trying to get outside and getting some natural light on days that we have sunlight to help keep our circadian rhythm kind of on track.

Nada Youssef:  Excellent. Now even with a reasonable bedtime, I find myself having fragmented sleep and you wake up in the middle of the night, and what is the best way to go right back to bed or to fall back asleep naturally?

Dr. Michelle Drerup:  So number one, it's do not have your phone next to the bed, because that lures us into, "Oh, I'm just going to check my email real quick," and then you go down the rabbit hole. Other things to do would be trying to do something to distract from maybe some of the stress and worries that are on our minds now. So a lot of people are using different meditation apps or listening to music, something like that to kind of tune our focus to, so some of the thoughts don't start to ramble around in our head.

Nada Youssef:  Okay. So no phones and kind of meditation app or soft symphonies to calm our brains down.

Dr. Michelle Drerup:  Now the phone is oftentimes the way we access those.

Nada Youssef:  Right.

Dr. Michelle Drerup:  So there's a little bit of a conundrum there, but it's really I put the app on it and I let it go and I'm not on my phone scrolling through -

Nada Youssef:  Sure. Now schools are canceled and doing everything at home and we do have some kind of schedule at home, but when summer starts and kids don't have anything to do, would these long term consequences affect our health with sleep disruption?

Dr. Michelle Drerup:  Yeah. I mean in summer hopefully it will be easier for us to have our kids out and active, because that's the best thing for sleep is increased physical activity. So that will increase sleep drive, but also the same thing in terms of a summer schedule is even if it's a delayed schedule, trying to keep consistent with that schedule and trying to find things to keep them engaged and more active during the daytime.

Nada Youssef:  Yeah, and hopefully put them to bed early and make them more tired. I wanted to ask you about dreams. Is there a connection between anxiety and disturbing dreams? Because if you look, many people have been talking about having kind of crazy dreams during this whole pandemic and maybe it's because of the pandemic that's scaring people, or what could it be?

Dr. Michelle Drerup:  Yeah. There definitely is a connection. We saw this post 9/11 as well, that people were having an increase in kind of vivid, disturbing dreams or nightmares, and so there is a connection. One of the theories behind ... we don't know a lot about why we dream still. It's hard to measure because it's when we're sleeping and you're aware of it happening, but one of the things that we believe about dreaming is that you're kind of processing things from the day. It's a way of kind of your brain trying to file away information. So it doesn't always make sense. It's kind of pieces and parts of things, but when we've kind of been more inundated with things that are stressful, it tends to come out in our dreams. So that definitely plays a role.

Things to do to try to decrease that occurrence would be trying to avoid watching the news before bedtime, doing things that are more relaxing and kind of unplugging before bedtime so that's not what you go into the night with, and another reason why we may be actually having more awareness of having these dreams is that if we're spending more time in bed and we're getting more REM sleep ... REM sleep occurs in the latter morning period. If we're waking out of REM, that's when we remember our dreams. So it also could be just in terms of what's happening with the sleep pattern.

Nada Youssef:  I see. Very good. I know we talked about naps a little bit earlier and you mentioned if you're sleep deprived, you're going to want to nap, but are important? I mean now that we're home all the time and we have time to nap, are naps important and how long should they really be?

Dr. Michelle Drerup:  So if you have sleep difficulties at night, they probably should be eliminated to see if that will improve your sleep, if you're having fragmented sleep at night, but we always recommend that naps can be really helpful, but they should be ... we kind of call them smart naps. They should be shorter. They should be earlier in the day. Usually after lunch is a good time for people, because our circadian rhythm is actually pushing us a little more towards sleep at that time, but really limiting it to that idea of a power nap, 15, 20 minutes. When you sleep longer than that, you start to go into deeper stages of sleep, and so people will find if I took an hour and a half, two hour nap, I feel groggy after I wake, I feel worse, and then longer naps are going to be more likely to take away from your night's sleep.

So one thing that you can do if you're feeling tired or sleepy during the daytime is actually combine the benefits of caffeine and having a short nap and we call it a caff nap. So you would drink a little bit of caffeine, take your nap, 15, 20 minute power nap, and so when you're waking up from the nap, the caffeine is actually starting to hit and makes you even more alert.

Nada Youssef:  Now with children, no longer infants that actually need to nap, but children themselves, if they're not napping during the day, is it something that we should be encouraging if they're sleeping late and waking up late? Or do you think naps should only be for whoever is feeling like they need to sleep?

Dr. Michelle Drerup:  Yeah. Really naps aren't necessary after preschool essentially. Most kids are dropping their last nap at the age of five, and so if they're getting an adequate amount of sleep during the night, a nap isn't necessary. Now you might want to nap so that you have a little quiet time or downtime, but yeah, they're not necessary. I think it is important to have time for kids during the daytime where you kind of call it quiet time, and if they fall asleep because they're sleepy, that's okay, but also just kind of unplugging them for a little bit that, "Okay, you can look at your books in your room. You can do something quietly for the next half hour," to get them also comfortable with like, "It's okay to be bored and I can find something to do during that time that I don't need something entertaining me."

Nada Youssef:  Now to the important question, how do we improve our overall sleep and make sure we're getting the best sleep possible right now? Can you give us tips and hints on what to do?

Dr. Michelle Drerup:  So we talked about some of these, and it's kind of combining a lot of these pieces for individuals. So starting with the morning, keeping a consistent wake time. You have to think about that as, "This is my anchor and my sleep drive is going to be building from this time." So if I vary that a lot, then I'm going to not be ready for sleep at the same time every night. So awake time consistently is much more important than, "I should be in bed at X amount of time." So you want to have a goal bedtime, say, "I'm going to aim to be in bed by 11 so if I wake up at seven, I have eight hours," but if you're not sleepy at 11 and you go to bed, you're just going to lay there and start to think. So it's really kind of winding yourself down, having a buffer zone to be ready for bed, but delaying your bedtime if you're not really sleepy. The things that are disruptors now are binge watching Netflix. So I'm just watching a show, "Oh, one more." Now I might've been sleepy, but I kind of blew through that sleepiness. So it's going to keep me awake and I could have fallen asleep earlier. Getting activity, exercise, getting outdoors, getting that light exposure, especially in the morning, during the day, is really important as well.

Nada Youssef:  And many find ourselves late night snacking. Does that affect our sleep?

Dr. Michelle Drerup:  So it can. Late next snacking can be disruptive to sleep. Some people will find especially if they have reflux issues, that will worse than that. It can cause more disturbing nightmares as well and more vivid dreams, and your digestive system is a stimulating process that will keep you awake. Now obviously I think sometimes we like to snack on our sweets, things that might actually have caffeine in them, like chocolate. So really be mindful of that as well.

Nada Youssef:  Now with going back to work and some of the jobs getting their employees back, some daycares opening, can you tell us what we can do to make sure our sleep schedule is on par and that we can wake up early and we're getting our full eight hours of sleep?

Dr. Michelle Drerup:  So let's say you've been going to bed a couple hours later and waking up a couple hours later, as soon as you know, your timeframe of when you're going to be going back into the office, what I would recommend is gradually shifting your bedtime and wake time in 15 to 20 minute increments every couple of nights. So this is oftentimes what we recommend for people with daylight savings time as well, gradually shifting slowly versus, "Okay, well I woke up at 10 o'clock and now I'm going to try to go to bed at 9:00 PM tonight." You're not going to fall asleep. So it's just a gradual shifting of the sleep schedule.

Nada Youssef:  So how many hours should I be sleeping to know that I'm not going to be sleep deprived? And does that change for kids, infants, newborns, and so on?

Dr. Michelle Drerup:  So most adults, the average sleep need is seven to nine hours, but everybody's sleep need is different. So some people will sleep six hours. They feel refreshed. They don't feel sleepy during the day. They function fine, and that might be their sleep need, but on average, most people are in that seven to nine as adults. Now our younger ones, when we're babies, a baby sleeps 14 to 17 hours in 24 hours. They don't sleep that all I one consolidated period, as parents will unfortunately experience and be able to tell you, but then as kids get older, probably our most vulnerable population is our teenage population. They still have a little bit higher sleep need. They should really be getting probably nine to 10 hours a night, and oftentimes they're getting less than even adults based on their obligations and things. So this time of the pandemic is ... one of the things that we're seeing, sleep tracker data has been published looking at this, and that we're actually getting a little more sleep. So there has been a positive thing. It's just trying to figure out how do we maintain this increased sleep time when we go back.

Nada Youssef:  And lastly, do adults and kids both take the same approach to a good night's sleep? Because the way I approach going to bed at night when I can't sleep at 11, like you mentioned, versus my kids can't sleep at 11, telling them not to go on the electronics and just to read a book, is there anything we could do for kids that could be a little bit different or adjusted to help them sleep better?

Dr. Michelle Drerup:  It's funny, because the things that we usually do for kids, we should be doing as adults and we don't do. So for a child, the thing that we do to help train them to sleep is we have a very similar routine that, "Okay, we're going to brush your teeth and get your pajamas on. We read two stories." Most people know I should not let my kid be on the TV to help them fall asleep or to have phone or iPad, but we do that as adults, and so I think we need to be more how we are with our kids and it would help us sleep better. Now there are some great apps out there for kids as well. So some of the things like you're saying, there's different versions of the meditation apps.

I think that would be fine to use, and people are like, "Well what if I have to use that to help me fall asleep, is that a crutch? Is that a bad thing?" Well it's not something that you can take it with you, you can have it wherever you're at. It's not something that is real negative. Yeah, maybe you need it to help you fall asleep, but that's not a problem. It more so becomes problematic if say I rock my child or I rub their back and that helps them fall asleep. Well, then I have to be there. So we want to try to make it so that it can be something that they can do on their own to help them wind down versus having to have somebody present.

Nada Youssef:  So having an app or music, something like that, it's not a bad thing to get used to? It's not bad to fall asleep with the phone on some kind of meditation app?

Dr. Michelle Drerup:  No, and we do it for infants. We have the sound machines. We use those to help them. So very similar idea there.

Nada Youssef:  Excellent. So it sounds like routine and consistency is key for all.

Dr. Michelle Drerup:  Yes.

Nada Youssef:  Thank you so much for your time today, and hopefully this information will help you steer clear of any sleep problems during this pandemic. Is there anything else you wanted to add?

Dr. Michelle Drerup:  I would say that we do have behavioral sleep medicine specialists if someone is really feeling like I'm trying some of these strategies, they're not helping, I'm feeling really anxious about sleep. When someone has more chronic problems, it becomes really about not necessarily other stressors that might be influencing my sleep, but I'm stressed about not sleeping, and that makes me have a lot of anxiety just at bedtime and through the night and it kind of becomes a vicious cycle.

Nada Youssef:  Sure.

Dr. Michelle Drerup:  At the Cleveland Clinic and a lot of other places, there are psychologists like myself that provide ... it's called cognitive behavioral therapy for insomnia, and it's really addressing the behaviors as well as the thoughts that maintain insomnia. So there is help out there, and medications are not necessarily a bad thing short term but don't provide a really good long-term solution, versus cognitive behavioral therapy has really good efficacy, both in the short term, as well as long-term outcome.

Nada Youssef:  Thank you so much for your time. Much appreciated.

Dr. Michelle Drerup:  You bet.

Nada Youssef:  So for more resources on sleep disorders, or to make an appointment with a specialist, please visit clevelandclinic.org/sleep, and for the latest coronavirus news and updates from Cleveland Clinic, please visit clevelandclinic.org/coronavirus. Thank you so much for tuning in. Stay safe.