Cell phones, stress, and a hyper-scheduled life all put your sleep cycle in danger. Sleep disruption is bad for brain health, wreaks havoc on mood, and even raises the risk of cancer. Dr. Ana Krieger, Chief of Sleep Neurology at Weill Cornell Medicine, has the solutions we need for a better night's sleep.
Dr. Stieg: I'm here again with Dr. Ana Kreiger talking about sleep and its impact on our lives. Tell me a little bit about what circadian rhythm is and then what disruption of that rhythm means for me as a patient.
Dr. Krieger: So circadian rhythm basically stands for that 24 hour cycle in where your sleep period is on a given 24 hour day. So the idea would be that if you sleep from 12 to 6:00 AM that's your sleep cycle on your circadian rhythm. If one day you sleep from 8 to 4:00 AM the next day from 2 to 10:00 AM and then back to midnight, you really have a dysregulation on your circadian rhythm is bad for you. It is bad because we are identifying that the body functions in a 24 hour cycle, much less similar to what we have with the sun and in darkness cycle. So once we disrupt that cycle on a regular basis, it really disrupts our physiology because during that sleep period, all the hormones that get regulated and often I tell patients, the time you wake up is almost the anchor to this rhythm, the circadian rhythm.
Dr. Stieg: Have you noticed that people that work third shift have any greater difficulties?
Dr. Krieger: Well, yes, it is actually a lot of data for shift workers. We have, let's say nurses over 15 years that do night shifts over three times a month. They have higher chance of having breast cancer, prostate — men for prostate cancer, and women, ovarian cancer and colon cancer as well.
Dr. Stieg: I wanted to talk to you a little bit about daytime sleepiness. As a resident I got three hours of sleep a night and I could be out and sitting at a restaurant and just pass right out. Is that daytime sleepiness or is that just sleep deprivation?
Dr. Krieger: Very likely. Just pure sleep deprivation and we are, in the medical profession, we all experienced that. Is this harmful in the long run? We don't actually know, but the only idea is that your brain really needs to sleep. And that's why it doesn't matter where you are. That will be a point where without you willing, you're going to be falling asleep. And that brings our concerning to motor vehicle accidents, right? Many people are sleep deprived in some times they could be more of a danger in the road than people that are actually out drinking alcohol because he can cause the same level or more of impairment.
Dr. Stieg: So as daytime sleepiness a disease or is it just a symptom of me not getting enough sleep?
Dr. Krieger: This is an excellent question because it can be a disease. So we have conditions that we have that called either narcolepsy or hypersomnia, people that are just sleepy during the day. And some people, it doesn't matter how much sleep they get at night, they're very sleepy.
Dr. Stieg: So it's a crossover — cause I was going to bring up narcolepsy. But, that's why I was wondering is there a specific category of daytime sleepiness that we have to deal with?
Dr. Krieger: Yes there are. And sometimes that becomes a bit of a challenge because we see sometimes patients that have a more of an autoimmune process and the brain just becomes very, very sleepy and no matter what you do, the brain can never be fully alert. The majority of cases that we get to see are patients that have sleepiness because of either lack of sleep or an underlying sleep disorder.
Dr. Stieg: I wanted to bring up those concepts of what can we do. We talked a little bit about over the counter things. What about meditation, yoga, exercise? If you want to break them down into each one of those categories tell me, you know, are they good for sleep? How much should you do if it is?
Dr. Krieger: All the other techniques can be very helpful because I think we live in a society that is overworked, overstressed, you know, sleep deprived, overstimulated. So we need to look into each person's life and say, what are the excessive stimulus that you can remove so you can be more productive in? What are the times that you can Institute as a little bit of a break because I think we are in this hyper-drive and that is really not how they fall asleep. So I love when people do meditation, Tai Chi is an amazing exercise for that because it combines some activities, physical and mental.
Dr. Stieg: So you do Tai Chi during the day, but that still helps your sleep? You have to go to bed at 10 o'clock or whatever your normal time is.
Dr. Krieger: Right.
Dr. Stieg: And exercise, I like to exercise at four o'clock in the afternoon because my endorphins kick in and it keeps me going until 10 o'clock
Dr. Krieger: Very good points. So we have to be very mindful in how we allocate. Some people decide to meditate just before they go to sleep. They might be able to fall asleep, but two hours later the brain, the brain feels fully activated. So I think timing and also looking at what is the type of meditation people are doing. There are different types of meditation that may help them fall asleep earlier.
Dr. Stieg: Tell me a little bit about the effects of cell phone use and being online for extended periods of time during the day. Is there any data on what effect this has on our sleep cycle and our brain function?
Dr. Krieger: Yes, it is early data and I think every day basically we get more information on this because again, part of this cycle that we have during the dark hours of the day is where sleep should be allocated. Allowed us to then not have a lot of input of light through the eye. Then you secrete melatonin, which is this dark signaling hormone. It helps consolidate your sleep. So now when people get exposed to a lot of bright lights, particularly devices that give light on the spectrum, the blue spectrum of light, which if you were to look at the measure, the wave land of the light, the the range, they don't stays on that purple, blue and green light is quite activating for the brain and then it disrupts not only your difficulties falling asleep but also disruption disruptions into the cycle as the night progresses.
Dr. Stieg: And is there data on the psychological impact that has or are people more depressed? Are they more anxious? Are they less tolerant?
Dr. Krieger: Well, very interesting. Data is coming out showing that this type of fragmentation sleep decreases. As I mentioned, the tolerance in our people have much more negative behaviors towards any stressful circumstances, so increases the negativity and probably depression. It would be associated with that.
Dr. Stieg: My kids have cell phones. What time of night should I tell them they gotta turn it off?
Dr. Krieger: Well, ideally you want them for one hour before going to bed to stop using our electronics. If they can't, because being realistic, if they have homework assignments and other things that required a computer use, you can actually buy them some blue blocking devices, which are usually goggles they can wear, like they have nice glasses they can wear while they are in the computer and then changes. It basically blocks that wavelength of light that is on the blue spectrum.
Dr. Stieg: There's a lot of over the counter stuff and talk about melatonin and Ambien and all that. Can you comment on these integrative therapies or over the counter therapies? Are they good, bad or not —p articularly melatonin? That's a pretty common one.
Dr. Krieger: Yeah, it is very common and again, melatonin is a natural supplement, so imagine just because the body produces is fine for us to take, but of course you want to take that just as needed. One great use of melatonin is with travel to different time zones. For jet lag, there is a lot of data that shows melatonin over the first three nights on your destination, usually between one and three milligrams you take when you arrive at a destination in terms of bad time. So you do for the first three nights as you go to sleep.
Dr. Stieg: Land in Europe at four o'clock in the afternoon, you shouldn't take it until 10 o'clock—
Dr. Krieger: Until you go to bed. Exactly. Because again, melatonin is this dark signaling hormone and if you're exposing yourself to light, it actually blocks melatonin from working. What do we know is that it would all overexpose to light, so probably we're all secreting less melatonin than what we should, so perhaps that is a benefit to that.
Dr. Stieg: Can you give me the top three things I can do that will help me get to sleep at night?
Dr. Krieger: One of the most important things I would say, number one will be to have a sleep on your schedule and it looks about only 10% of people actually have a schedule for sleep. Most people just sleep whenever they can. So I think be mindful of the awareness that is sleep needs to come on a regular time. The second important aspect is really tried to eliminate the excessive stimulus that we have during the day. It's great, it makes us productive during the day hours but not really at night. So try to minimize that excessive stimulus. And I think the third aspect is try to create an environment for sleep that is really cozy and comfortable. It shouldn't be too hot, you shouldn't be facing lot of work, shouldn't get all the light coming through the environment. So trying to focus on how your bedroom looks like.
Dr. Stieg: In listening to you, I was sitting here thinking, gosh, it's exactly the same advice that I give to patients about leading a normal life. You know, it's called focus and it's called regimentation. All the things that we hate and all the things that get interrupted now by our mobile devices.
Dr. Krieger: Yeah. Sometimes I feel like an old grandma in giving people advice. I have to say in the office and say, What would your grandmother say? Yeah. Because I think it's easy for us to lose focus and lose sight of what do we actually have to do. We look for a quick fix and for sleep there's really no quick fix. We really need to restructure our lives.
Dr. Stieg: Serotonin, dopamine, important neurotransmitters are chemicals in the brain for happiness and joy. Any data on the impact that too much too little sleep has on those chemicals?
Dr. Krieger: So just a lot of data looking at people with normal sleep duration, short sleep duration in looking at how they respond to environmental stress in their response at work. Stress at work, stress at home. Even in traffic you can see people get a lot more edgy, they get a little more violent, they get it sometime even more depressed or hopeless. So we know that the sleep also serves a big role into mood modulation.
Dr. Stieg: It brings up an interesting point, headphones laying in bed and putting on Vivaldi's Four Seasons. Is that good or bad during a sleep cycle?
Dr. Krieger: Also an amazing point. Because we're trying to understand that perhaps sound waves can actually help us sleep, so there is some technology coming out there and being tasked in the same, perhaps specific sound waves can actually get you into the rhythm of sleep.
Dr. Stieg: Probably not The Who.
Dr. Krieger: Not what most people would be listening to at night, but that backs into, let's say white noise machine. Some people use that because in New York City we live in a very noisy environment and some places it's just really very deserving of their sleep.
Dr. Stieg: Tell me about narcolepsy. How common is it? What is it? What do we do about it?
Dr. Krieger: Narcolepsy is uncommon situation where patients really have no control of their sleepiness. It's triggered by emotions most of the time. Sometimes it could be a buckling of the knees or the head. I've had a patient that had narcolepsy and on his birthday, you know, in the midst of celebration, he kept on having cataplexy attacks and it scared everybody they wanted to call 911 but he was well aware of his disease, but nobody else had seen him. So he knew what was happening and for many years we really didn't have good treatments for this. And now we have very good therapy that not only prevents the cataplexy from happening, but wakes people up during the day.
Dr. Stieg: I have some friends that have described to me that they had night terrors. Not having had them, I don't have any personal experience. What is it?
Dr. Krieger: So night terrors are behaviors that come in on the earlier part of the night, frequently in kids. So what happens is that when they get into this very deep stage of sleep, they might actually behave in terms of screaming or they may have some kind of confusional arousals we call. And the parents would be coming rushing to them and say what is happening? But the person would not really relate to them. Confusion arousals, those are typically a concept that we call parasomnia in parasomnias are unusual behaviors that are listed from sleep.
Dr. Stieg: And that falls into the night terror category.
Dr. Krieger: Exactly. It could have be the sleep walking could be sleep talking, i tends to happen on the first third of the night. Could it be very benign? Many kids can present with this as they grow older, this tends to dissipate. Sometimes adults may present with that and when this happens in adulthood in somebody that never had it or maybe that had it and had gone away, we want to evaluate their sleep to see is there any disruption in their sleep cycle that is triggering this abnormal behavior. But most of the time this is really a benign situation mostly in kids and safety is always our biggest concern. But I would say for adults is when we worry the most because they could get out, they could drive, they could get out of the house. So there are very strange behaviors that people can do during the night.
Dr. Stieg: So is that different than a nightmare?
Dr. Krieger: Yes. Because nightmares typically would be coming out of mortar, the dream state, somewhat of REM sleep in sometimes nightmares, people can act them out. Let's say they can hurt somebody in the middle of a dream. So when you have more of a dream enactment type of behavior, we worry about other conditions or either alcohol related neuro behavioral changes, precursor, perhaps a Parkinson's disease—
Dr. Stieg: Are nightmares then reflective of some other disorder?
Dr. Krieger: It's hard to say because I think people sometimes talk about maybe a past experience or a trauma that people might have, but sometimes you feel, look at real life, everybody has a bit of an anxiety. You have a task coming up, you need to take an early flight. So sometimes it is anxiety to then get stored away and may come out and representation during dream sleep.
Dr. Stieg: So I have to admit, I'm fascinated by this concept of night terrors and you talk about people going out and doing things that are non-harmful. You said you've had a lot of patients with night terrors. Can you, I mean obviously with no names, what's one of the most unusual things that somebody has described to you with a night terror?
Dr. Krieger: Well, I had a patient that went to visit a friend that live in a high rise and in the middle of the night she left the apartment undressed and went down the stairs and woke herself up sitting on the stairs, 10 floors below her friend's apartment in the middle of the night undressed. Luckily she didn't close the door so she was able to go back into the apartment without anybody saying it.
Dr. Stieg: So there's really just this kind of complete dissociation between the individual's conscious awareness and what their body is doing.
Dr. Krieger: It is, and it's fascinating for us because even on legal terms, sometimes you know, people can do things, you know, we hear things like people drove cars and got into accidents or injured somebody else. So where is, is this intentional or not? And it's sometimes very hard for us to see because when we monitor sleep during those episodes, you can see the background is sleep, but as you measure electrical and muscle activity, there's so much activity going on that is so hard for us to really be pinpoint and know is this intentional or not. Some people remember, some people say, Oh yes, I woke up and I was eating like a plant in the kitchen. And then I said, what am I doing? Let's just go up to bed. Others say they wake up and they look, you know, lots of crumbles everywhere and they say, I probably got up and used the bathroom or use the kitchen in the middle of the night.
Dr. Stieg: As we talked about earlier, there's just a lot of stuff out there and the medications people can buy. Do you recommend that people go out and do a lot of reading and how reliable is the internet on all this stuff? Or again, do you think it is best to get a sleep expert like yourself?
Dr. Krieger: Well, there are some guides that are made by academics. Sleep centers, I think can be very helpful. I know many institutions like ours, we have our own guide to try to help educate people on their sleep, but a simple process I think would be for patients or people out there to just look into their lives and just be a little more conscious about their routine and see what can they actually do. Because most of the time, when I talk to patients, if I were to ask them, what would be the top three things you could do to improve your sleep, they would be right on target, but they don't want to really, you know, work on that unless somebody tells them to do it.
Dr. Stieg: Ana, it's really been a great pleasure. Thank you so much for enlightening my lack of knowledge on the importance of sleep.
Dr. Krieger: Thank you so much. The pleasure was mine.