Blair Stone, MD

Are you someone who tosses and turns all night? UPMC pulmonologist, Blair Stone, MD, discusses things you can do to get a better night’s sleep and how to tell it’s time to get some professional help.

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– [Announcer] This podcast is for informational and educational purposes only. It is not medical care or advice. Clinicians should rely on their own medical judgments when advising their patients. Patients in need of medical care should consult their personal care provider.

– Are you someone who tosses and turns all night? Do you think you will never get a good night’s sleep? Our next guest says there are things you can do to change that. Hi, I’m Tonia Caruso. Welcome to this UPMC HealthBeat Podcast. And joining us right now is Dr. Blair Stone. She’s a pulmonologist with UPMC. Thank you so much for joining us.

– Thanks for having me. Happy to be here.

– This is such an important topic for so many people. For some, it can be the great battle to get a good night’s sleep. Others go to sleep and stay asleep all night long. Let’s just talk in general, first: the importance of sleep and how it plays into our health.

– Yeah, sleep is so important to our physical and mental health. So, we know that patients who don’t get enough sleep or who don’t get quality sleep have adverse health outcomes. So, poor sleep and inadequate sleep is associated with diabetes, obesity, weight gain, cardiovascular disease. And, then, we know from a mental health perspective that poor sleep is associated with depression and anxiety. And, I think we all know, right? Like, whenever we have a bad night of sleep, the next day, we feel a little bit groggy. We’re not as sharp. And, so, it can impact our performance during the day or at work. And there are societal impacts from poor sleep as well. So, we know that poor sleep, inadequate sleep, is associated with motor vehicle accidents or just poor job performance, too.

– And is the idea while we’re sleeping, our body is regenerating, resting, and that’s why it’s so important as well?

– Yeah. Definitely.

– What is defined as a good night’s sleep? How many hours are we talking? Can it be different for every person? What does that look like?

– So, when I think about a good night’s sleep, I first think about the duration of sleep, and then I think about, what is the quality of sleep that you’re getting? Duration of sleep really depends on your age. We know infants need like 16 hours of sleep. It might be very fragmented, but they need 16 hours. A teenager, somebody 13 to 18 years of age, they need eight to 10 hours of sleep per night. An adult, somebody who’s over the age of 18, needs on average about seven hours of sleep every night. Now, we know in the population that there are people who we call short sleepers, and they need about five to six hours of sleep at night, and they don’t need to sort of catch up on sleep on the weekends. And, then, there are folks who need 10 to 12 hours of sleep every night. But those short sleepers and those long sleepers are really on the extremes. So, most people, the majority of the population, needs seven hours of sleep if you’re over the age of 18.

– OK. So what if you are not getting these seven hours of sleep? What if you’re someone who you’re up all night, you’re thinking about things, or you might fall asleep, and then you wake up in the middle of the night. Are there things that people could start to incorporate into their routine that might help in this?

– Yeah. So, this kind of goes back to the second part of quality sleep, right? We want people to be able to fall asleep within 30 minutes and then pretty much stay asleep throughout the night. It’s normal to have one to two wakeups at night. You might not know that you’re waking up, but that’s actually normal as long as you’re able to fall back asleep pretty easily. If you’re somebody who’s struggling with, let’s say, like, racing thoughts as you’re trying to go to sleep, or you’re waking up a lot throughout the night, there are things that we can counsel you on to try and improve your sleep. These are things that you can actually do during the day. Some of those things are making sure that you wake up at the same time every day. A lot of people think that you need to go to bed at the same time every night, which is also true, but the most important piece is waking up at the same time each day.

– Wow. Why is that?

– Yeah. Because that really helps to set your internal circadian rhythm and your internal clock. There are two things that kind of go into helping you to fall asleep at night. We wish that sleep was voluntary – we could just press a button and go to sleep – but we can’t. So, we want to line up our internal clock. As well as, we want to line up the sleep pressure that we develop throughout the day.

– All right. Tell me what sleep pressure, that’s a new term for me. Tell me what that means.

– Yeah. We know that the first thing that drives our sleep pattern is the circadian clock. Everybody’s kind of heard about melatonin, and that peaks at night and kind of sets you up to fall asleep. But the second piece that’s really important is sleep pressure. As most of us have experienced when we wake up in the morning, we feel pretty well-rested, right? It would be pretty hard for us to take a nap at, let’s say, 10 a.m. if we wake up at 8 a.m Throughout the day, we build and we build the sleep pressure. And you can think of it almost like a gumband, right? The longer you’re awake, the further you’re stretching that gumband out. By the end of the day, you’ve really stretched that gumband out, and so it snaps back into place. You’re going to kind of snap into sleep, so to say.

– So, the busier you are, the more you’re doing.

– Exactly.

– So that brings in exercise which is a key thing to make you tired. I’ve also read in the past, don’t exercise at night before bed because then you’ll be up all night. True, false, or depends upon the person?

– True and false. So, exercise is so important during the day. We know that it helps to build the sleep pressure and it also helps in our general feeling of health and well-being. You can exercise at night. If you can only find time in the day to exercise at night, it’s OK to do. But don’t do it close to bedtime, right? We want it to be at least one hour away from the time that you’re planning on going to sleep.

– What about diet? Caffeine, alcohol. Are there any sort of general guidelines or best practices regarding that?

– Yeah.

– Time of day, actually.

– Yeah. So, in terms of caffeine, caffeine is a stimulant. Caffeine helps us to stay awake. And, so, when you’re trying to go to sleep, you don’t want a stimulant in your system. So, we generally tell patients, if their normal sleep schedule is to go to bed at 10, we tell them to not take in any caffeine past 2 in the afternoon.

– 2:00?

– Yeah.

– It takes that long for the caffeine to work its way through your system?

– Yeah. And, you know, if you’re feeling sleepy throughout the day, right? There might be something else going on with your sleep that could be contributing to you feeling sleepy.

– Folks will say, “I’m on my third cup of coffee.” Is that OK to have three cups of coffee in the morning?

– It’s OK from a sleep perspective to have caffeine in the morning, but we just try and limit caffeine intake in the afternoon and especially in the evening.

– Right. Now, what about alcohol? It can make you fall asleep, but is it true that then, it can also contribute to waking up?

– Yes. So, alcohol can make you feel very sleepy, and it can make you fall asleep. But it changes the sleep structure, meaning that it changes the type of brainwaves that you have and your general sleep cycles throughout the night, such that you don’t get good, restorative sleep. Getting back to that quality sleep that I had talked about earlier. And, it sets you up for worsening of underlying sleep conditions, too. So, let’s say if somebody has obstructive sleep apnea and they drink alcohol, it’s going to make obstructive sleep apnea a lot worse.

– Screen time. I often hear a lot about that as well. Are there general rules? I think we’re all attached to our phones.

– We are all attached to our phones, our iPads, TVs. Generally speaking, we want to turn screens off at least 30 minutes prior to going to sleep. We know that the blue light that we get from screens can really impact that internal clock that I was talking about and can kind of push the internal clock off such that you want to go to sleep a little bit later. And, then, we definitely don’t recommend TVs on, or screens on, in the bedroom, as you’re falling asleep, once you fall asleep. And that’s because one of the biggest drivers for helping us wake up is light. And light from that TV screen actually gets through your eyelids, goes into your eyeballs, and tells your brain, “Hey, wake up. There’s light going on.” And, so, we tell them to not keep TVs or screens on.

– So what happens? You fall asleep, you’re asleep for a while, then you get up, and you can’t fall back asleep. Do you just lie there and count sheep? What does that look like?

– This is such a common problem for a lot of people who can’t sleep. So, a lot of people lay there, and they’re like, “The longer I lay in bed, the more likely it is that I’m going to be able to fall asleep.” What we actually tell patients to do is, if you can’t fall back asleep within 15 to 20 minutes, get up out of bed, and go do something in low light that is very boring. Read a boring book, maybe put together a boring puzzle in low light until you feel sleepy. Once you feel sleepy, then go back to bed. Because tossing and turning in bed while you’re awake is just going to make yourself more frustrated, and you’re going to associate the bed with being awake.

– So, we just went through and we discussed all of these tips and ideas, but if you’re a shift worker, things are drastically different. Talk to me a little bit about that: the challenges that shift workers face, and then things that can help them as well.

– Yeah, so whenever we talk about shift workers, we’re primarily thinking about folks who work night shift. They have to be awake when their internal clock tells them that they should be sleeping, and they need to sleep during the time that their internal clock says, “Hey, you need to be awake.” So, that really creates a disconnect for them, and it really makes it hard for them to get the amount of sleep that they need. And, so, what we tell folks who work night shift is that your sleep during the day, your sleep space during the day, should be set up to promote good sleep. That means blackout curtains, that means a quiet environment. You might need, like, a white noise machine to try and make the room conducive to sleeping. It should be a cool room, too. And, as you’re coming home, we tell them to try and avoid bright lights. So, that might actually mean like wearing sunglasses in the car as you’re driving home to avoid that sunlight. We also tell shift workers to take a nap prior to going to work so that you’re building up your sleep bucket. Your sleep bucket is full going into work. Contrary to what we tell folks during the day, caffeine at night for shift workers is actually very helpful because it’s a stimulant. It’s going to help them stay awake during work.

– You mentioned melatonin earlier. Over-the-counter sleep aids: Are they good to take? Is there a harm in taking them? I look at them, and they say non-addicting. What should folks be thinking about those?

– Yeah. So, over-the-counter sleep aids, generally as a sleep community, we tend to tell folks to not use over-the-counter sleep aids. There’s two reasons. One is the chemicals that go into over-the-counter sleep aids, although they aren’t necessarily addictive, they can have side effects, and you can build up tolerance to them quickly. A lot of these medications can make you feel very groggy the next day. And, you’ll find that the longer you take over-the-counter sleep aids, the more frequently you need to take them and the higher dosage that you need in order to fall asleep. We have patients who have to wake up in the middle of the night to take these medications, and obviously, that is definitely not ideal. The other part of that for over-the-counter sleep aids is, if you are struggling with poor sleep there are behavioral sort of modifications and lifestyle modifications that we’d want you to try prior to starting a medication.

– How does someone know it is time to go see a doctor? It’s time to go see Dr. Stone. What are the signs, and what should folks be looking for when deciding it’s time I go see a provider.

– I think that if you have general concerns about your sleep, right, you should definitely talk to your primary care doctor about those concerns. Whenever we talk about, like, when should you see a sleep specialist for what we call insomnia, is if you have had trouble falling and staying asleep for longer than a three-month period. We all have times whenever we have stressful situations in our lives, where it’s really difficult to sleep. But, if this is going on for a long time, or it’s impacting your ability to function during the day, then it’s time to see a sleep physician. The other piece of this is if you are getting adequate sleep at night and you still feel sleepy during the day, that’s another sign that you probably need to see a sleep doctor because maybe there’s something that’s impacting that second piece of sleep sufficiency, which is sleep quality.

– So, tell me a little bit about the sleep medicine team at UPMC. Who’s all at the table, who works together?

– At the Comprehensive Lung Center in Oakland, we have a really very comprehensive sleep medicine team. Sleep is complex, so we have pulmonologists who help folks with sleep disorder breathing. We have psychiatrists who can help with insomnia. We have sleep behavioral psychologists who help with that behavioral change piece, which is really so important in helping folks to fall asleep and stay asleep. And, then, we also have ear, nose, and throat surgeons who work with us, too, in case there are any surgical needs.

– Would you find some folks might be surprised that this is tied into pulmonology and breathing? Explain to folks why that is.

– Yeah. So, at night, if you are not getting sufficient sleep quality but you are sleeping for long enough, we think about why are you still sleepy during the day? Is there something that’s interrupting your sleep at night? One of the things that can really interrupt sleep at night is something called obstructive sleep apnea. It’s a very common sleep disorder that we see. It’s tightly linked to folks who have obesity, high blood pressure, diabetes, and because you basically stop breathing or you breathe really shallowly at night, it wakes your body up. It wakes your brain up and says, “Hey, you’ve got to start breathing again.” And, so, we as a sleep community can help to treat obstructive sleep apnea.

– Right. So, what do you like most about your job? What’s a good day on the job for you?

– I love when I see a patient, they’re really struggling with, let’s say, having trouble falling or staying asleep, and we talk about sort of these behavioral changes, setting up a sleep schedule. And they come back and they’re like, “Wow, that really worked for me.” Another really great feeling is when somebody comes to me and they’re sleeping for long enough at night, but they’re super sleepy during the day, we find out they have obstructive sleep apnea, and they become an excellent CPAP user, and they feel great. And they’re like, “I can’t sleep without this.” That’s also a really good day on the job.

– So, as we close, what do you want to say to people about, taking the need for sleep as an important thing that they need to do contributing to their health? And, then, if they are struggling, about seeking help.

– We all know what it feels like whenever you don’t get enough sleep or good sleep. And if it’s happening on a long-term basis, on a weeks-to-months basis, you can imagine the effects that it’s having on your body. And, so, you know, there are resources out there. There is help. We have really great strategies to help you sleep better and feel better.

– Dr. Stone, we thank you so much for coming in and talking with us today. Some really good information. I’m sure it’s going to help lots of people. We thank you for your time.

– Thank you.

– I’m Tonia Caruso. Thank you for joining us. This is UPMC HealthBeat.

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