Ask A Sleep Doctor: The Questions That Keep You Up At Night
What’s the difference between being fatigued and sleepy? Do melatonin and other sleeping aids work? And what can you do if you just can’t sleep?
Neurologist and sleep specialist W. Chris Winter, author of the book The Sleep Solution: Why Your Sleep is Broken and How to Fix It, talks about how the brain and body regulate sleep. He also gives ideas for controlling your behavior to improve your “sleep hygiene.” Read an excerpt from the book here.
W. Chris Winter, M.D. is author of The Sleep Solution: Why Your Sleep is Broken and How to Fix It (Berkley, 2017). He’s a neurologist and sleep specialist based in Charlottesville, Virginia.
IRA FLATOW: This is Science Friday. I’m Ira Flatow. What’s the first thing you think about every morning, right? What a good night’s sleep. Or, what a bad night I had. Right? Sound familiar?
Sleep is always on our minds, I think. Do you wake up at night and then feel tired in the morning? Does melatonin or any of the gadgets out there really help? Why do we have nightmares? Do they affect our sleep? What happens if we get up in the middle of night? Can we get back to sleep?
How does sleep work? What is the science that goes on in our brains and bodies? And what happens when you don’t get enough sleep? How much sleep should you– I can go on forever. That’s why we’re going to talk about it. We’re going to ask a sleep doctor these questions and yours. Our number– 844-724-8255. You can always tweet us @scifri.
Let me introduce my guest. Chris Winter is a neurologist and a sleep specialist out of Charlottesville, Virginia. He’s author of the new book, The Sleep Solution– Why Your Sleep is Broken and How to Fix It. And I’m very happy to have you on Science Friday, Dr. Winter.
CHRIS WINTER: I’m happy to be back. Thanks for having me.
IRA FLATOW: What is the biggest misconception about sleep?
CHRIS WINTER: I think the biggest misconception about sleep that people have when they come to see me is that they’re actually not sleeping. So the very first question I usually ask a patient or a client or an athlete is, what can I do for you? How can I help you today?
And more often than not, the response is, you’ve got to help me sleep. I can’t sleep. And I think that one of the messages I try to put forth in the book is that you may have significant problems and difficulties with your sleep, but we as a people are not out there not sleeping despite headlines saying things like, why 60 million Americans can’t sleep.
So we may not like the way we sleep. It may take us a long time to fall asleep. We may wake up a lot. We may not perceive our sleep, which is a big problem, but nobody out there is in danger of not sleeping.
IRA FLATOW: Wow. And so there are so many questions people have about it. Let me ask you a couple of my own, first of all. How many hours? Is that a set number? We keep hearing, you’ve going to get x number– I think it’s seven now. And if you don’t, you’re in trouble. Is that true?
CHRIS WINTER: Well, it is. Everybody has a set amount that they need. So what we are essentially doing is trying to figure out– we’re planning a picnic. We’re trying to figure out how many hot dogs and hamburgers to buy.
Maybe there’s a great algorithm that exists out there that for every person who comes to a picnic you need two hot dogs and one hamburger. That doesn’t mean everybody is going to eat two hot dogs and a hamburger. But we use that average to try to figure out how many supplies we need to buy.
So there are people out there who do very well. They thrive on six and a half. When they try to get more, they struggle, which they’ll often interpret as being insomnia. There are people out there who need nine hours. So in general, the average adult under the age of 65 is probably right where you said. Seven, seven and a half, maybe eight hours is ideal for them.
We get into trouble when we start trying to apply this sort of population average to the individual. So it’s sort of like caloric intake. How many calories should I eat? Well, what do you do? Are you a accountant? Are you a professional football player? Are you eight years old, 80 years old? Those things all kind of come into play.
IRA FLATOW: Can you catch up on missed sleep? People say, you know, I’ll sleep a long time on the weekend to catch up. Is that a myth?
CHRIS WINTER: When sleep doctors get together, this is a big topic– the idea of sleep debt and can you repay it. So there was actually– interesting that you should ask– there was a study that was just recently published out of Sweden where they looked at about 38,000 individuals using survey information.
And what made this study unique is instead of asking individuals how much they slept on average, they asked them, how much do you sleep during the week when you’re at work? And how much do you sleep on the weekend? And so they divided people up as being either short, medium– meaning I sleep a short amount of time during the week, but I sleep longer on the weekends– or I’m short, short– I always sleep inadequate amounts.
And they looked at that and found that the people who were sleeping five hours during the week, not getting quite enough sleep but making up for it on the weekend, actually live to be as old as the individuals who are getting the right amount of sleep all the time.
So in my book, I took a stand. And so it’s nice to see this research supported. And my stand was, I think that you can repay a sleep debt. However, it needs to be relatively quickly repaid after you incur it.
So all the sleep I lost in medical school and my residency training is lost and gone forever. I’ll never get that back. But I was trying to chase a bat out of my bedroom a couple of nights ago and was up late trying to figure out the best way to do that, so I’ll try to get some more sleep tonight to make up for that.
IRA FLATOW: All right. We have so many calls. I want to get to some of them. Let me start out with a tweet from Balooonknots who says, is sleep cycle completely interrupted when I get up to use the bathroom at 3:00 AM? I’m going back to sleep, though. Does this negatively affect my required seven-hour sleep cycle?
CHRIS WINTER: It generally doesn’t, and I’ll give you an example. A lot of the professional basketball players I work with aggressively hydrate themselves so much that it’s very difficult for them to make it through the night without getting up to go the bathroom. And when you look at studies of individuals who have brief awakenings, generally speaking, that’s not problematic.
So what I would recommend to that tweeter is they should get up, try to keep lights to a minimum, resist the urge to check your phone to see if anything cool has happened in the two hours since you’ve fallen asleep. And generally speaking, it shouldn’t really interrupt the process.
IRA FLATOW: Let me go to the phones, because as I say, we are lit up in a record amount of time. Let’s go to Miami. Sharon, hi. Welcome to Science Friday.
SHARON: Yes, hi. How are you?
IRA FLATOW: Hey there. Go ahead.
SHARON: My question is, is there any long-term damage or any damage to the body for people who don’t sleep or sleep very little– if they have insomnia, if they only sleep a few hours a night and this goes on month after month, year after year? Is there any kind of damage to the body, any kind of diseases, anything that kicks off autoimmune or anything like that?
IRA FLATOW: Good question. Thank you, Sharon.
CHRIS WINTER: So now we’re back to the most common misperception. And it really stems from the idea that we really have two media messages or two ideas being put out into the public about sleep.
The first is sleep deprivation. Does it exist? Certainly it exists. If you’re working two jobs to pay your rent and you’re only really able to find about three or four hours to spend in bed, you’re going to accrue a sleep debt. And you’re going to be very sleepy because of it. And these are people who fall asleep at work and, God forbid, fall asleep behind the wheel of a car.
She threw in the word “insomnia.” So a lot of people define the word insomnia as somebody who can’t sleep– somebody who hasn’t slept for months. I have patients who literally come to my office on a weekly basis and say they have not slept more than an hour a night for years. And when you look at them, they look fine. They look great, and they’re not at all sleepy.
So the idea of insomnia being the same as sleep deprivation is not true. Insomnia is really two things. Number one, it’s an individual who’s not sleeping when they want to sleep. So this individual goes to bed at 11 o’clock. They want to go to bed 11 o’clock. And now it’s 11:30, and they’re frustrated.
And that’s the second part of insomnia that is important to be there. It has to be there. And that is you have to be frustrated about the fact that you’re not falling asleep when you want to, meaning if I run into somebody who says, look. I go to bed at 10:00. It takes me till around midnight to fall asleep, but I really enjoy lying there resting thinking about my day, what I’m going to do tomorrow. That’s not technically insomnia.
So to answer her question, if you are talking about the medical student or the surgical resident who is literally sleeping two or three hours every other night, falling asleep in the OR standing on his feet, sleeping in broom closets, nodding off during rounds, yes. There probably is long-term problems that go along with that.
If you’re talking about people who have insomnia, insomnia is almost a problem that’s so awful but has virtually no side effects from. When you talk to people who have “suffered,” quote unquote, from insomnia for a long period of time, the issues that they bring to the table are often not terribly related to long-term medical problems. Now, if you have depression, if you have chronic pain, those things may lead to a secondary insomnia.
But like I said, nobody out there is not sleeping. So we have to really define what we’re talking about. And I spent a lot of time writing about that in the book to help you understand, hey, wait a minute. Does it make sense that I haven’t slept for three years, but I can’t nap? I never fall asleep when I rest.
IRA FLATOW: And people are functional doing it.
CHRIS WINTER: And they’re fine. Absolutely.
IRA FLATOW: I know people doing that– getting two or three hours of sleep, and they don’t know the difference.
CHRIS WINTER: But again, that’s not insomnia generally.
IRA FLATOW: That’s not insomnia. Yeah. Let’s go to the phones to Ashling in Medford, Mass. Hi, Ashling. Welcome.
ASHLING: Hi. How are you?
IRA FLATOW: Hi there.
ASHLING: I am a night shift worker in a hospital. And I think traditionally the data has been pretty negative for the long-term effects of that. I’ve been doing this about 10 years, and I’m wondering if there’s any new data on any implications of night shift work. I work a 12-hour shift usually.
And then I guess as an aside, strangely after a night shift, sometimes I can sleep three to four hours and wake up and feel 100% rested. And then over time, I’ll get a huge stretch of sleep– eight, nine hours– and I’ll feel horrendous when I wake up.
IRA FLATOW: All right. We’ll see if we can get an answer for you. Thanks for calling.
CHRIS WINTER: I’m glad she called. In my opinion, there are few things worse and there are few people who are sleepier than shift workers. Unfortunately, I’m not aware of a lot of positive research coming out about shift work, although I think you can look at the Swedish study and kind of infer that, hey. You may be losing out on sleep during times of your work schedule that you might be able to make up for.
But shift work is very hard. The average shift worker in this country is probably losing out on about seven hours of sleep every week compared to the non-shift working individual. And the shift work is particularly difficult. I think she said she was a night-shift nurse. That’s usually about the pinnacle of brutality when it comes to shift work.
Because when you talk to an individual like the caller about her schedule, she’ll often say things like, well, I work three nights then have a day off. And then I come back and work two afternoons, an overnight. You almost need a PowerPoint presentation to understand what’s going on with their schedule.
That is extremely disruptive to the body when it doesn’t understand, when am I supposed to be awake? When am I supposed to be asleep? When should I be eating? When should I be active? When should I be socializing with other people? When should I be in light or in darkness?
And so I think that a lot of the sleep issues she’s describing are exactly what shift workers feel. Their brain does not really understand what is expected of it at any given time during the day. So shift work can be incredibly disruptive and is actually classified by the World Health Organization as a class 2A carcinogen.
So I would say to her, really work hard to work with the individuals who are making her schedule to make it more friendly for shift workers. That’s about what you can do right now until we get rid of shift work altogether in this country, which will be difficult.
IRA FLATOW: Talking with Dr. Chris Winter, author of The Sleep Solution– Why Your Sleep is Broken and How to Fix It. And there are so many questions I don’t know where to go on all of these.
I’m going to go to another tweet who says, what actually is good? Brandon says, what actually is good sleep hygiene? And what really doesn’t matter? Do I really need to keep my laptop off my bed?
CHRIS WINTER: That’s a great question. And again, as we talk about media messages with sleep, there is that perception in a lot of people’s minds that everything about sleep is under their control. With the right sheets, the right mattress, the right level of light in your bedroom, the right thermostat setting, you can solve all of your sleep problems.
I think sleep hygiene is very important. I think that it can probably fix or at least help significantly 25% of people’s sleep problems. And I kind of liken it to a knee injury. You can buy your own brace at the drugstore. You can ice it. You can take some time off of your running, and maybe that will help the problem. Or maybe you find that you really just can’t move your leg.
At some point, you’re going to have to see a sleep specialist. I think a lot of people don’t really understand that when your sleep problem gets to be a certain point, it may be beyond what sleep hygiene can do. So I would say to him, if he says, look. I’m sleeping fantastically. I feel great. I have no health issues or sleep issues.
I’m not sure that the laptop’s that big of a deal, but I would certainly prefer him try to watch TV, try to have that light exposure somewhere outside of the bedroom. But when we’re looking at sort of a global ranking of shift work or sleep apnea or the laptop computer with endless episodes of Friends running during the night, it’s probably a little bit further down the line.
But it is something that you can control. And I will tell you there were studies that showed individuals who were asleep but had that kind of stimulus playing. Your brain is awake and listening to it, even though you don’t think it is. So you will improve the quality of your sleep if you get rid of the laptop and put it somewhere else.
IRA FLATOW: I’m Ira Flatow. This is Science Friday from WNYC Studios. Getting as many questions as I can into Dr. Chris Winter, author of The Sleep Solution. Here’s one that’s been asked a couple of times. Can marijuana help with sleep?
CHRIS WINTER: What I would say about, can marijuana help with sleep, is let’s take a step back. How are we defining help? And a lot of individuals are going to– when you ask them, how do you sleep? I’m a terrible sleeper. I’m a great sleeper.
The criteria for somebody saying that they are a great or terrible sleeper usually fall into one of three categories. Number one is, how quickly can they fall asleep? That’s very upsetting to a lot of people if they are lying in bed for a certain period of time and not becoming unconscious. The second question, as one of your previous callers alluded to, is, how many times do you wake up regardless of how quickly you fall back to sleep?
IRA FLATOW: A lot of people are asking that question about what happens if I wake up a lot same time every night.
CHRIS WINTER: Right. So the third criteria would be, how do you feel the next day? Are you listening to my interview and struggling to stay awake? Do you fall asleep at red lights?
To me, that’s probably the best criteria for trying to figure out how your sleep is. Are you sleepy the next day? If you are hungry and looking for food in a trash can, I’m going to assume that you’re not eating enough or the food you’re eating is not good.
IRA FLATOW: How does this overlap with marijuana?
CHRIS WINTER: So for the marijuana, he’s saying, can it help with sleep? How are we defining help? Do you need something to make you fall asleep faster? Do you feel like you’re waking up a lot during the night? Or are you exhausted the next day and feel like this might somehow improve the quality of your sleep and the way you feel the next day?
I think the answer to the question is, marijuana might sedate you. It potentially might make you stay asleep a little bit longer in terms of awakenings, but that’s never been really scientifically shown. It is not going to make you sleep better and theoretically make you feel better the next day. So how are we defining help?
So to me, I’m not a big fan of medicinal aids to knock you out. Michael Jackson looked for it. He found it didn’t work out very well for him. We can never confuse sedation with sleep. They’re not the same thing.
IRA FLATOW: Let me get a quick question before the break. Caitlin in Manhattan. Hi, welcome.
IRA FLATOW: Go ahead
CAITLIN: Thanks for having me.
IRA FLATOW: You’re welcome.
CAITLIN: I spend– this is kind of related to the last question– a lot of money on melatonin. And I think I just do it by habit. I’m wondering two things. First is, if I stop taking it, is it going to be bad? And also, is there any value in my spending all this money on melatonin at all?
IRA FLATOW: I got about a minute till the break, Doctor. See if we can get that in.
CHRIS WINTER: Great, great question Caitlin. Thanks for calling in. Would stopping it be bad? No. Let’s think about real quickly about what melatonin does in our brain.
Our brains make melatonin. It’s made by this tiny little p-shaped organelle caught our pineal gland, and our bodies make it when sunlight starts to disappear. So you go out camping, eating your s’more. The sun starts to go down. We’re not around artificial light.
As that sun starts to diminish and the light around it starts to go away, we have this surge of melatonin. We call it the dim light melatonin onset. Melatonin is sleep promoting, but it’s not necessarily designed to make us sleep. That’s really adenosine’s job. It’s designed to help us time our sleep with our day-night cycle.
So what happens is a lot of people will take melatonin when they go to bed. Well, the sun has gone down a long time ago when you’ve gone to bed. So what happens over time– as you start convincing your brain that the sun’s going down at 11:30 after the Stephen Colbert show, that’s not when the sun’s going down. So you’re actually traveling yourself westward and actually starting to delay your sleep.
IRA FLATOW: Hang on, I’ll let–
CHRIS WINTER: I would recommend– oh, go ahead.
IRA FLATOW: I have to take a break. We’ll come back and finish the answer after this break. Stay with us. A lot more questions for Dr. Chris Winter after this break.
I’m Ira Flatow. This is Science Friday. We’re talking about sleep with Dr. Chris Winter, author of The Sleep Solution. We’ve been talking about not getting full seven hours, all different kinds of things. And what we haven’t gotten into is this whole idea that your brain needs to sleep to do housekeeping or whatever it’s doing.
And we’ve always heard about REM– Rapid Eye Movement– sleep. If you’re not getting enough sleep, number one, are you not getting enough of that? And two, do you need enough of that?
CHRIS WINTER: Absolutely. I remember being in medical school and a professor saying– we we’re talking about the lymphatic system, which kind of removes waste from our body. And he said, but our brain doesn’t have one. And I remember thinking, the most important organ in your body doesn’t have a means of getting rid of waste?
And what was interesting– they never found it, because when you prepared a cadaver, it made it very difficult to find. So it was only recently that some researchers in Maryland found it. And they named it not the lymphatic system with an L, but the glymphatic system with a G.
So the glymphatic system operates like the lymphatic system to remove waste products from our brain, the biggest one being a protein called beta-amyloid, which is actually the main constituent of plaque in Alzheimer’s disease. So that’s great, really interesting. It kind of makes sense. The universe is suddenly adding up now.
And what’s really cool is that this glymphatic system’s pumping ability is something like 10 times better when we sleep than when we’re awake. So it was this great discovery that lined up with this idea that we’ve always known that people who don’t sleep well tend to have more issues with dementia. And now we have this elegant explanation for why that is probably the case.
IRA FLATOW: What about the– well, we have all kinds of questions. I’ll try to go through them. I only got a couple of questions in. Scott in Miami. Hi, Scott.
SCOTT: Hi. How are you?
IRA FLATOW: Hi there.
SCOTT: First time, long time. I have a question. First of all, I’m a great sleeper. But I’ve always theorized that eating just a little bit– like a gulp of milk or a tiny cookie– would activate the parasympathetic or sympathetic– I always get those mixed up– system and help you gear down to sleep.
IRA FLATOW: Yeah. What about it? Is it bad to eat before you go to sleep?
CHRIS WINTER: I don’t think it’s bad, especially if you’re strategic about what you eat. And I think Scott is making good choices in terms of what he eats. He’s choosing things like milk. Milk has a lot of the proteins that eventually get synthesized into the chemical melatonin we were talking earlier about.
And then he’s also talking about maybe eating a little of a cookie. A cookie is high carb. When we think about Thanksgiving sitting down on the couch after a big meal and watching the Lions get beaten in football every Thanksgiving, that tends to be because carbohydrate tends to spike our insulin and create changes in terms of our brain’s chemistry that make us feel sleepy. There’s a reason why we get really tired after eating that enormous carbohydrate meal.
So I think probably it’s good not to overeat before you go to bed, which Scott’s not doing, and kind of being selective. So hummus, things high in tryptophan– and turkey is not that high in tryptophan, interestingly– high-glycemic index foods like jasmine rice, nuts are fantastic. Montmorency tart cherries– the tart cherry variety grown here in this country– very helpful both in juice and dried form.
Even salmon and game meat is very helpful with sleep. So my son eats a lot of salmon jerky in the evening to help him sleep– so lots of good choices out there.
IRA FLATOW: Let me get back to– in the few minutes we have– the question that we had before the break about melatonin. Is it a good thing to take?
CHRIS WINTER: To me, it’s not a necessary thing to take. And my God, if pediatricians don’t stop giving kids melatonin, I’m not sure what I’m going to do. It’s one of those things where it’s great if you’re going to New Zealand for the Peter Jackson The Hobbit trip of a lifetime and you want to get right to the sightseeing as soon as you land in New Zealand because you live in Baltimore. It’s a great drug for realigning a circadian rhythm.
It’s not really a sedative. So the problem is people use it. They have absolutely no idea what they’re doing with it. And because it’s not an FDA-regulated drug, who knows what you’re getting and what you’re really doing with it?
So the melatonin gummies because your kid won’t sleep and things of that nature– let’s really try to explore why your kid’s not sleeping or why he’s not sleeping the way you want him to and tackle it that way instead of just giving him candy melatonin at night. It’s not really appropriately used for most of what it’s being used for.
IRA FLATOW: I just have a couple of minutes. And I want to end by saying, when should you go to see your doctor about a sleep problem? How do you know you’re in trouble?
CHRIS WINTER: I would say the biggest thing that we have to be very careful of– there’s probably two groups. Number one, you’ve got a partner or you’ve been told because you’ve shared a hotel room with somebody that you stop breathing. It’s interesting.
Sleep apnea patients– these are individuals whose brains cannot breathe and sleep at the same time particularly well, so it’s not a great choice for your brain to have to make. These individuals often feel like they’re great sleepers because every time they sit down, no matter what the circumstance, they fall asleep. So in their mind, I’m a great sleeper because I can lie down on gravel and fall asleep.
If you stop breathing, if people tell you that you snore and choke and your blood pressure is going up and your weight’s problematic, you need to see your doctor about that. It could save your life and make you feel like you’re 20 years old again.
The other group is the group that is excessively sleepy. You’re falling asleep at stoplights. You have to roll your hair up in your car window to keep yourself awake as you’re driving. You’re nodding off in inconvenient times at work, or you’re sneaking out to your car to take naps. Particularly if these things are endangering your job, your livelihood, or your life, you should definitely talk to people about that. The melatonin gummy worm is not going to help you.
IRA FLATOW: Wow. Great, great advice. And also a really interesting book called The Sleep Solution– Why Your Sleep is Broken and How to Fix It. Chris Winter, who is an MD and a neurologist sleep specialist out of Charlottesville, Virginia, thank you for taking time to be with us today.
CHRIS WINTER: I really appreciate it. Thank you so much for having me– and not a fan of electronic medical records. I heard that earlier, so I’m just putting my vote in.
IRA FLATOW: OK. Thank you. Have a good weekend.