The Trouble with Sleep

Updated: Mar 19

“There is no sunrise so beautiful that it is worth waking me up to see it.” – Mindy Kaling

How are you feeling this week? A little fuzzy, maybe tired, or a bit more grumpy? Thanks to the start of Daylight Saving Time, we have sprung forward, losing an hour of our lives, and upending our schedules again. Time changes impact a lot of things, but one of the most important effects can be to our sleep.

Because I am not a doctor, I have invited my good friend, Dr. Ugorji Okorie to help me discuss some important points about sleep. A fellow native of New Orleans, Dr. Ugorji Okorie serves as an Assistant Professor/Attending Physician in the Internal Medicine outpatient clinic at Ochsner-LSU Health Shreveport. Dr. Okorie is also board certified in Lifestyle Medicine and is currently participating in the novel American Academy Sleep Medicine AIRE Fellowship Program which she’ll be completing in June 2021.

Why is sleep important?

Erika-- One of the most common complaints I hear from clients is that they are tired. Often this stems from challenges that are beyond their control, leading to a more existential exhaustion. One client identified it as ennui. Every once in a while, though, it turns out this exhaustion actually comes from a lack of actual rest. Sleep is one of the factors that contributes to a lot of our success, and well as our fumbles. Knowing your sleep needs and maintaining good boundaries around them is important. Sleep affects our mood, our cognitive abilities, and even our physical health. Improper sleep habits can leave you tired and lethargic, but can also take a toll of how well your brain is functioning, how well you regulate your moods, and whether you handle daily stresses productively. Beyond getting too little or restless sleep, total sleep deprivation is considered a form of torture, and can cause symptoms similar to intoxication from drugs and alcohol.

Ugorji-- Sleep is when your brain does its “clean up” of the day--a natural reset after all the cells have completed all their processes and discarded their waste. Thus, sleep is essentially--well, essential. Every day, we use our cell phones and the battery eventually depletes and needs to be re-charged. This is akin to humans and our need for sleep. Our amazing brains take us through our day full of tasks and eventually our “battery” wears out, so our brain needs to recharge. Sleep is obviously linked to our energy and our attention levels throughout our day, but lack of sleep has also been linked to increased risks for obesity, type 2 diabetes, strokes, heart attacks and premature death. Commonly, lack of sleep is linked to secondary causes like habits surrounding our sleep routine. These habits include using electronics too close to bedtime, leaving the TV on while sleeping, or environmental disturbances. However, it should also be known that there are primary sleep disorders that can also play a role in sleep disturbances such as sleep apnea, narcolepsy or circadian rhythm/sleep phase disturbances.

Individual Needs For Sleep

Ugorji--All humans follow a natural circadian rhythm roughly linked to a 24 hr cycle. Melatonin, Adenosine and Cortisol are the three hormones “behind our sleep drive” with our brain producing increasing amounts of Adenosine as the day progresses (which gets broken down during sleep) and our pineal gland secreting Melatonin as the daylight diminishes. By the time the sun rises in the morning, our Melatonin levels have fallen and Cortisol rises which gives us energy to go about our day. We all require different amounts of sleep daily according to our stage in life. Infants and small children usually need between 12-15 hrs of sleep, children in grade school need about 10 hours, while adults and elderly need an average of 7-9 hours nightly. Of course, everyone’s needs may be slightly different. But in general, these are the recommended amounts for adequate functioning.

Erika-- Your own circadian rhythm is called your chronotype. Much like your personality, your chronotype is individual to you, and is inherited, so it can share similarities with people in your family. If you find that you are more alert in the morning (early bird) or at night (night owl), this is thanks to your own natural circadian rhythm. Knowing your chronotype can help you structure your work and life around the optimal resting habits for you, like scheduling meetings in the morning, or saving intensive work for night times. However, because your circadian rhythm can change over your life, look out for habits that once worked, but now don’t fit. Gone are my days of writing until 3am, and now I set time for work in the mornings. Finding the appropriate time to complete tasks so they don’t interfere with your circadian rhythm or chronotype can set you up for successful work and rest.

What changes sleep?

Ugorji--In Sleep Medicine, we like to take the “5 finger approach” when evaluating a patient with sleep complaints. The 5 most common causes of sleep disturbance are:

1). Circadian Misalignment

2). Pharmacologic factors

3). Medical Illnesses

4). Psychiatric/Psychosocial factors

5). Primary Sleep Disorders

Circadian Misalignment in the form of sleep phase syndromes (advanced or delayed) can occur naturally or be behaviorally induced due to irregular work hours (shift work disorder), not going to bed on a regular schedule or via travel when crossing multiple time zones. Certain medications can also harm our sleep, usually in the form of making people drowsy (like antihistamines, muscle relaxers, opioids and beta blockers). Conversely, medications can sometimes contribute to insomnia (such as SSRI’s, steroids, diuretics). Health conditions like restless leg syndrome, congestive heart failure, chronic pain, or bladder issues can also play a role in sleep disturbance if not well controlled. Psychosocial behaviors that can disturb our sleep patterns leading to insufficient sleep include vigorous exercise or use of electronics too close to bedtime, caffeine usage after 2 pm, excess alcohol use, tobacco use or even stressful situations in our life which can periodically cause temporary changes in our sleep cycles (and tends to resolve when the situation improves). Psychiatric factors that commonly cause issues are mental health disorders like anxiety and depression which can interfere with sleep by either causing difficulty falling asleep or sleeping too much; other psychiatric diagnoses that disturb sleep can include schizophrenia, bipolar disorder, PTSD, etc. Primary sleep disorders refer to sleep apnea, narcolepsy or parasomnias and these sleep diagnoses usually require special testing to determine if they are present.

Erika-- If you suspect that your lack of good sleep may be due to a primary sleep disorder, a physical health condition, psychological health condition, or a medicine you are taking, you should talk to your doctor. If your sleep is being disrupted by circadian misalignment or psychosocial factors, start by taking a little inventory. Do you keep a consistent(ish) sleep schedule? Is your sleep environment restful? Are you struggling to get to sleep? Are you staying asleep? Do you wake naturally or use an alarm? Do you feel tired during certain activities, or at certain times during the day? Do you have disruptive thoughts that keep you from resting or give you bad dreams? Answering these questions can give you more insight into what troubles your sleep, and ways to change your sleep patterns.

How do I change my sleep?

Ugorji--Sleep hygiene is important for satisfying sleep. Sleep hygiene encompasses reducing “screen time” at least 1 hour prior to bedtime, avoidance of caffeine after 2 PM, cessation of tobacco products and moderation of alcohol. Ensure that your sleep environment is comfortable which means sleeping in a cool, quiet environment with comfortable bedding. If you find that you get into bed and just “can’t stop thinking”, get out of bed after 20 minutes and go to another room (preferably dimly lit) and read something “boring” like a telephone book or a dictionary. When your eyes start to fall as you become drowsy, take yourself to bed. Repeat this process until you are able to fall asleep. Your bed should only be used for sleep and sex; reading a book in bed is OK. Otherwise, limit all activities not related to those two things to avoid forming negative associations that may hinder your sleep cycle. When having problems with insomnia, create a sleep diary/log and be sure to note down your emotions at the time, what time you get into bed and fall asleep and what time you awaken. If you routinely experience excessive daytime sleepiness, non-restorative sleep despite sleeping more than 7 hours nightly, or a bed partner tells you about issues with snoring, gasping/choking or stopping breathing when sleeping, sleep apnea may be the cause and should be evaluated by a Sleep Medicine professional as soon as possible.

Erika-- If at all possible, be consistent. Because your circadian rhythm can change, think of it like a habit that can be built, broken, or changed. Go to sleep at the same time and wake up at the same time, even on weekends. Make sure your rest environment is conducive to rest, with comfortable fabrics, muted sound, and soft lighting. Some studies have shown that even a tiny amount of light can disrupt the hormone processes that give us good sleep. Kick the TV, tablet, and phone to the curb. If you need an alarm, consider a sunrise alarm that gradually glows brighter over time to mimic the natural process of waking to the dawn. Napping can be a great way to add to your sleep, but it is not a replacement for a good night of restful slumber. Power naps of 20-30 minutes can relieve stress and improve alertness, and naps of 30 minutes to 1 hour help with memory encoding and decision-making. There are also a thousand and one technological solutions to the challenge of sleep deprivation, including wearable technology to monitor sleep, guided meditations, sleepscapes or stories, and ASMR videos online to get you in the sleeping mood, and pillows, pods, and mattresses to do almost anything your body needs.

Good sleep is important, so make sure you know what YOU need to get it.

**Dr. Ugorji Okorie obtained her BS in Biology at Loyola University-Chicago, afterwards completing her Doctor of Medicine degree at Ross University School of Medicine with Magna Cum Laude distinction. She then completed her Internal Medicine Residency at LSU Health Shreveport and currently serves as an Assistant Professor/Attending Physician in the Internal Medicine outpatient clinic at Ochsner-LSU Health Shreveport. Dr. Okorie is also board certified in Lifestyle Medicine and is currently participating in the novel American Academy Sleep Medicine AIRE Fellowship Program which she’ll be completing in June 2021.

**Erika Weed is a doctoral candidate at The George Washington University, studying leadership and trying to reconcile the seemingly competing goals of happiness and success, for herself and others. She has a B.S. in Communications from Winthrop University, and MBA from Queens University of Charlotte, and has been an Executive Coach and Organizational Development Consultant for the last 10 years. Erika founded Ascendry in 2015.

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