Clete A. Kushida, MD, PhD is a neurologist and sleep specialist who currently serves as the medical director of the Stanford Sleep Medicine Center and president of the World Sleep Federation. BeWell asked Dr. Kushida to discuss why some of us are not getting the sleep we need, and what we can do about it.
Does the amount of sleep we need change as we age?
Yes. It is not unusual for neonates to sleep 16-18 hours (with 50% REM sleep), whereas the elderly experience fragmented, light sleep lasting on average 6-7 hours including daytime napping.
On average, are we getting as much sleep as we need? Why or why not?
Many individuals are not getting the recommended minimum amount of sleep. While genetics suggest there is some truth to the notion that an "early bird" or "night owl" may function fairly well on less sleep than most of us, many more individuals are sleep-deprived due to a broad range of factors including physical, emotional, and mental stress; increased work and family commitments; the tempting diversions of technology (cell phones, computers, etc.); medical disorders such as pain syndromes or urinary disorders; or sleep disorders such as sleep apnea or periodic limb movement disorders).
Can napping help make up the deficit?
Naps can be helpful in reducing sleep debt temporarily; i.e., a 10-15-minute nap often can reduce daytime sleepiness for the next few hours. However, if the individual has chronic partial sleep deprivation, extended periods of sufficient nighttime sleep is needed.
What non-pharmaceutical solutions would you recommend for people experiencing mild sleep issues?
Most importantly, set bedtime/waking times and keep exposure to bright light at a minimum for the 2-3 hours before bedtime and at a maximum first thing in the morning (30 minutes of bright light within 5 minutes of waking). If you can't fall (or fall back) asleep within 20 minutes, get up and go to another room and do something that makes you drowsy (e.g., reading a boring book in dim light, knitting, etc.). However, to recondition the bedroom environment for sleep, avoid watching the clock and just estimate when about 20 minutes has passed without your being able to fall asleep.
Also, avoid reading/watching TV in bed (unless these activities make you drowsy). Avoid naps — unless you are drowsy and about to get behind the wheel, or you take a nap at the same time for the same amount of time every day and your body is used to this schedule. In addition, avoid caffeine, alcohol, and exercise immediately before bed.
If you are a worrier, consider composing a "worry list" wherein you write down all the things that are bothering you or things that you need to do the next day, and then mentally try to address these things a few hours before bedtime to prevent your mind being flooded by these items when your head hits the pillow. Relaxing bedtime rituals (e.g., warm bath, meditation) before bedtime can also help enhance sleep.
Any final thoughts?
If you have any of the following problems, you should discuss them with your physician or sleep specialist:
- persistent difficulty falling or staying asleep
- restless or frequently disturbed sleep, or unusual behaviors during sleep
- feeling unrefreshed in the morning, with difficulty staying awake during the day
- problems with attention, memory, or mood that appear to be related to daytime fatigue or sleepiness
Interview conducted by Julie Croteau and edited by Dorothy Ryan