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Getting a good night's sleep is everyone's ideal. Yet, 70% of Americans admit to routinely not getting enough sleep and 50-70 million people have a sleep disorder. Clearly, many of us have issues with getting a good night's rest. That is why we have Patrick Fuller as our guest today.

Patrick Fuller is an Associate Professor of Neurology, at Harvard Medical School. Today, he will be talking to us about what causes sleep deprivation and how we can each get some healthy sleep.

Patrick’s laboratory. Patrick is a neuroscientist with an interest on how the brain regulates behavioral states in particular states of wake and sleep.

Efforts in his laboratory is directed in understanding the location and identity of wake and sleep promoting circuitry as well as understanding how these circuits interact with one another to produce normal, healthy cycles of wake and sleep.

They’re also interested how the clock in our brain controls timing of wake and sleep cycles. His intent is that findings from their experimental work will inform the treatment of a wide range of wake and sleep disorders.

Beyond that, he hopes that it will help in the development of things, like better general anesthetics and treatments for a host of neuro psychiatric and neuro degenerative disorders in which sleep and wake are disrupted which contribute to the progression of the disease.

They have uncovered over the years several populations of cells in the brain that are specifically dedicated to the processes of wake and sleep, nothing to do with feeding, eating, sex etc. They are literally devoted in putting us to sleep or waking us up and or maintaining those two states.

 Wake and Sleep. The regulation of both wake and sleep are active processes requiring coordinated activities of distinct cell groups and pathways and transmitter systems in our brain. When these systems aren’t working appropriately it profoundly affects our ability to function normally. Extreme example would be, if our wake promoting circuitry isn’t working correctly or is disrupted, these results in a coma. If our sleep promoting circuitry is disrupted we end up with insomnia or inability to achieve normal sleep.

What could one do to optimize their ability to achieve good sleep hygiene?

It involves adopting and maintaining specific time to rise in the morning and go to sleep at night and not deviating from the schedule on the weekend at least to the extent possible. Having 7 to 8 hours of sleep every night. Avoiding stimulants after the early afternoon, i.e. caffeine. Keeping alcohol consumption in the evening to a minimum. Sleep in a room that is really dark that is set to an optimal temperature – which for humans turns to be from a low to a high 60F range. Stay off electronic devices at least 1 hour before bedtime since it emits a fair amount of shorter wavelength blue light which activates the brain and acts like an “electrical caffeine”. This wavelength could disrupt the sleep hormone melatonin. If one needs to be on their device routinely before bed use the dimmest screen setting possible and consider apps that reduce blue light emission.

Clock in the brain. This little clock controls the sleep-wake cycle or rhythm. The clock does not just determine the timing we wake up and fall asleep but also plays an important role in helping us stay awake during the latter part of the day – evening hours, as well as keeping us asleep during the entire night. The clock confers the ability for us to have a consolidated day time and night time. So the clock at different times of the day provides either a wake-promoting or sleep-promoting influence on the body and brain.

If we shift our sleep time or wake time more often this could really be disruptive for us to consistently achieve a restful mind and sleep since we end up fighting our biological clock.

Post-lunch dip.  This is the time where people feel a little bit groggy or sleepy after lunch. For that time of day, for reasons not fully understood, our sleep drive picks up in the phase of a dropping in alerting influence from the circadian clock giving us this dip that makes us feel a little sleepy, a little tired so people often takes advantage of that in the form of a nap.

Daily Routine. Getting the right number of hours of at least 7 to 8 hours. Once you have this routine, you can customize it to your schedule. Waking up in the morning when the sun is coming up, there’s a good spectral aspect of sunlight that’s coming thru that activates your eyes, energizes the brain. It’s a time of day that works well for our biology, but do what works for you, your family, your schedule, where the goal is more on getting those 7 to 8 hours every night consistently.

If there’s a schedule that works well for you in getting to bed and waking up stick with that time every day, including your weekends.  This makes sleep patterns much more stable and more likely you would achieve a good night sleep every time.

What about people who have a night shift schedule. Raising the social awareness of the importance of good sleep may encourage us to create schedule that are in better alignment with our biology.

Implementing a good sleep hygiene may be tricky to implement, on the other hand once someone recognizes how important sleep is and you start to call it a priority in life and you strive to work on it you win in the end.

Sleep deprived. Making decisions when you’re sleep deprived is one concern.

Sleep loss makes us emotionally labile and disables us to reason optimally. Our ability to be rational depends on our ability to restrain some emotions and be clear-headed. Ideally we want individuals around us who are optimized to be rational. Having a good sleep hygiene makes us better. There’s a social cohering element to all of it. It makes us better at what we do on a day to day basis at whatever capacity we’re functioning in.

When you’re deficient in normal sleep, you have a greater risk of getting sick because your immune system is suppressed, your cognition – ability to remember, reason, concentrate, focus your attention, even compute can get compromised. Your ability to respond quickly or your reaction time is reduced.

Someone who is sleep deprived have as much the same response time from someone who’s legally intoxicated.

In the long term, ample data shows that sleep loss can increase risk for all kinds of diseases and disorders – cardiovascular disease, diabetes, obesity, and even some types of cancer.

 Test you can do at home. If you sit down during the day in a relatively unstimulating environment, i.e. sitting in a couch by yourself, and you fall asleep in less than five minutes that would tell you, you are sleep deprived. We should be able to sit during the day for five minutes without falling asleep. If you’re taking multiple alarms to get you out of bed in the morning there’s an indication that you’re not getting enough sleep. If you need 6 cups of coffee to get you going, it’s also an indication that you’re sleep deprived.

There are people that are having a hard time getting sleep. First thing is to do an honest and objective assessment of your sleeping habit. If you can go on the list and still you’re having a hard time sleeping then it’s time to have a check with a sleep physician.

Have yourself checked. 

Get with a sleep specialist since they’re someone who understands what the EEG should and shouldn’t look like. They understand how complex the diagnosis of the sleep disorder is.

There are a lot of causes of sleep disruption – anxiety, depression, major life stress, etc.  The specialists would also help rule out health issues – cardio vascular disease, substance abuse, etc.

Insomnia is the word people often use and even some misconceptions on what it really means as well as what are the best treatment options are. Self- diagnosed insomnia in the provision of prescriptions of sleeping pills by well-intention but not fully-informed physicians to be a persisting problem.

First point is self-diagnosis. All the people who think they have primary insomnia - not associated with any identifiable medical condition but the pure inability to sleep, 15% of them actually have primary insomnia. Which gives us an idea of how bad we are at self-diagnosis especially that the diagnosis of insomnia is complicated.

An example - insomnia is very common in anxiety. If you provide someone with sleeping pills for anxiety induced insomnia, that would be kind of like treating a fever with a fever reducing agent but not addressing the underlying infection. So it’s really critical that you talk to a sleep physician because they would know how to diagnose these kinds of things definitively.

CBT/ Cognitive Behavioral Therapy. 

It’s a highly effective treatment for insomnia and a much more desirable course of treatment than relying on pills to go to sleep. Our cultural tendency is to take a pill for anything, in case of sleeping pills they have documented side effects. They’re FDA approved, they’re widely prescribed but they have these side effects – sleepwalking, hallucinations, etc., that can be disturbing. For some they would feel hung over the next morning so it defeats the whole purpose of sleeping.

If one thinks they have insomnia, they should in order: assess their sleep hygiene -  if they’re checking all the boxes and they’re still not sleeping well, consider seeing a sleep physician; then try CBT.

For those who have primary insomnia, limit the use of sleeping pills. This is a complex topic but there’s someone who could really help if you’re struggling at home.

Resources

National Sleep Foundation – Sleep Research & Education - https://sleepfoundation.org/

Sleep Research Society – Association for Sleep Scientists - http://www.sleepresearchsociety.org/

National institutes of Health - https://www.nih.gov/

 

How to learn more about Patrick

Websites:

https://sleep.med.harvard.edu/people/faculty/251/Patrick+M+Fuller+PhD

https://connects.catalyst.harvard.edu/Profiles/display/Person/70447

Email:

pfuller@bidmc.harvard.edu