I am a Sleep Expert, Ask Me Anything

Why are some people more prone to insomnia? I’ve had it since I was a young child, and nothing has worked for me as an adult. Doctors won’t prescribe me sleeping pills either, feeling stuck

Uggh. I am sorry to hear that. I am curious what doctors that you have been to. Some people are more interested in insomnia than others. I would look for a board certifed sleep specialist. Here is a list of accredited sleep centers. https://sleepeducation.org/sleep-center/

Keep in mind also that the goal of sleep is not to be knocked out, but to wake up refreshed. Maybe that is why insomnia meds aren't being prescribed.

If my body automatically wakes up around 6 hours of sleep how do i train it to get 8 hours? Also what are some evidence to support the minimum 8 hour of sleep theory?

It can actually be pretty normal to have an awakening after six hours. The key is trying to go back to sleep instead of thinking to yourself "I feel pretty good, I am going to start my day." The problem with doing that is that you may feel fine in the morning, but there is a good chance that you may "crash" later in the day. While some people are physiologically short sleeper, usually people require at least 7 1/4 hours. Here is a link to some information on amount of sleep. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4434546/#:~:text=Adults%20should%20sleep%207%20or,and%20increased%20risk%20of%20death.

I feel like sleep experts frequently blame the patient or their lifestyle for their sleep problems ..."it is because you are not getting enough exercise, it is because you are eating before bed, it is because you are getting too much screen time, it is because you are too stressed" and so on.

Do you feel that this type of attitude discourages people from seeking treatment? Particularly people who still have sleep issues regardless of what lifestyle they have?

Absolutely! You need to find someone who listens to you and works with you. Here is a list of sleep centers https://sleepeducation.org/sleep-center/.

Hi!

I have an issue where I can be tired and go to bed, but once in bed no longer feel.."it", guess. It's hard to explain. It's almost like some nights my motor won't slow down and shut off and after a few hours of half conscious sleep, I end up with sleep aids. It's not all the time but for about a week every couple months I just suddenly stop feeling myself winding down. It causes anxiety if it happens enough but it's not causing it, as far as I know. I keep it cool, no screen, comfy bed, white noise machine, normal pattern. Is my body just weird and cycles insomnia? Is this even insomnia?

I can't tell you how many people think that they are alone just because they have sleep that may be completely normal! In your case, you are having episodes for about a week every couple of months. That's probably fine, especially if it is not really impacting how you function during the day. It should be reassuring to you to know that a lot of people have a problem sometimes with sleep that isn't what it normally should be. Try not to react to it like it is a problem. If you are really concerned that it might be though, then follow up with PCP or accredited sleep center. https://sleepeducation.org/sleep-center/

...and I do recommend that you write in a journal before bed if you are finding that your brain wont turn off.

Is too much sleep normal? Can you do things to reduce the amount of sleep needed?

Personally, I need 10 hours to feel myself and not drowzy. No upset sleeping conditions either, no apnea or waking up in the night etc. It seems wasteful to sleep this much.

Are you very active? People who are more active tend to need more sleep. I believe that Roger Federer (tennis player) and Tom Brady were known for needing more sleep because they were so active during the day. Just as some people are short sleepers, some people are long sleepers. However most people are NOT. So, if you are needing that much sleep, it is possible that you may need to be evaluated at a sleep center. https://sleepeducation.org/sleep-center/

I seem to only be able to sleep in 3 hour shifts. This means that I normally get either 6 or 9 hours. If I force myself awake in the middle of this cycle I end up all confused and everything aches all during the rest of the time where I would have been asleep.

The problem is that 6 hours isn't enough and I totally run out of energy part way through the day (although I normally feel just fine when I actually first wake up) and 9 hours leaves me feeling kinda lethargic.

Anything you can suggest as to why this happens or if there's anything I can do about it?

That's interesting...the ultradian rhythm for sleep (N1, N2, N3, REM) is usually 90-120 minutes. You seem to be going through two of these cycles (3 hours). I would be interested to see what your actigraphy or diagnostic polysomnogram would show. I would recommend getting evaluated at a sleep center. https://sleepeducation.org/sleep-center/. I am not surprised that you crash later in the day on six hours.

What are your thoughts on Melatonin? I have taken 10mg tablets off and on for the past couple of years. It seems to help but I’m concerned about becoming too dependent on them

Melatonin is not an ideal sleep aid, but no sleep aid is ideal. I would focus first on figuring out why you feel like you need the melatonin. I view insomnia as I view pain, It is not necessarily a symptom, but more of a disease. If you can figure out what is causing your insomnia, you may be able to treat it. And remember, 1) it is more empowering to use cognitive behavioral therapy for insomnia, and 2) 10mg of melatonin could be 3 or 20mg and it may have other things in it. https://www.cnn.com/2023/04/25/health/melatonin-gummies-wellness/index.html

I've learned that taking long deep breaths before and when I'm in bed help me fall asleep. If I don't, usually when I'm about to drift off, I feel like my body 'catches' me and tells me it needs more oxygen first. Does this specific sensation have a term?

There is something called "hypnic jerks" or "sleep starts." It is a feeling like you are falling. These are pretty common as you try to fall asleep. I could see how taking long deep breaths before bed may help, but have never heard that previously.

It’s 10 p.m. ET and our AMA has come to an end. Thank you for all of the insightful questions about sleep. You are welcome to continue chiming in with more questions and we will respond if we can. Thank you to all who joined us tonight!

My sleep is fucked. I woke up today around 8pm, after waking up at 2pm the day before. It seems my internal clock is all over the place, i will get sleepy around one hour later each day. I had this all my life.

Melatonin helps me sleep earlier but I will still get excrssive daytime sleepiness. Meanwhile if i just sleep 8 hours at whenever i feel sleepy i feel fine but obviously that only works when my rhythm is in the morning.

What’s wrong with me and what can be done?

That is called circadian rhythm disorder, free-running type. I am not a big fan of melatonin, but if you and your doctor do decide to use this, it should be used at the same time every night. Consider following up at a sleep center. https://sleepeducation.org/sleep-center/

Also possible that daytime sleepiness has other causes, but difficult to discern without further evaluation.

Thoughts on sleep supplements such as magnesium threonate, glycine, ashwagandha?

I have had a couple of patients swear by all of these. Unfortunately, research is lacking.

I wake up from the back of my throat feeling dry and full of gross flegm. Do you think I have sleep apnea? Family of snorers. Sleep with two pillows and sometimes one.

Waking up with a dry mouth/sore throat is certainly something common in mouth breathers/snorers. Family history can be important when it comes to OSA. People who have OSA often prop themselves up so that they can sleep better. So yeah, it is possible. Consider speaking with your primary care physician or visiting a sleep center. https://sleepeducation.org/sleep-center/

I've had a change in alertness/insomnia recently. To be more specific, I used to sleep very easily and heavy. I was able to fall asleep at the drop of a hat and could sleep through most noise. My difficulty was always waking.

Now, it's almost the opposite. I wake frequently and have difficulty falling back asleep. I had some awful nights where I'd lie in bed with my eyes closed all night and felt like I never fell asleep.

Did an at home sleep test that came back negative for apnea. I talked with a sleep doctor and they told me that these things can change as we age. For context, I am in my mid-30s.

I've been working on sleep hygiene and have been steadily getting better sleep but still have some bad nights.

My question is: can body clocks/sleep habits/alertness change so suddenly like this? It kind of freaks me out and I wish I could get my old superpower of easy deep sleep back.

A negative home sleep test does not rule out obstructive sleep apnea (OSA). I would go to a sleep center. It is possible that you have a milder case. Thing is, the severity of OSA does not correlate with the severity of disease, so mild OSA can cause significant side effects, including lighter sleep.

While sleep does tend to become a little bit more fragmented with age, it should not come on so suddenly.

Thanks for doing this AMA! I have a few questions.

What are the most important sleep hygiene strategies?

If you accumulate significant sleep debt over time, does it ever make sense to just sleep as much as you can or is it better to stick to a routine?

What are some strategies (or meds) for issues with STAYING asleep, not falling asleep?

Sleep hygiene is an essential part of cognitive behavioral therapy for insomnia, so you have the right approach. I can't give you one sleep hygiene tip that it is the most important, but a dark, cold, quiet room is an important start. For me personally, the most important sleep hygeine technique that I use is....brushing my teeth at night. It signals my body that "hey, you know what is next."

While it is (much) better to stick with routine, sometimes people do need to catch up on sleep a bit if you are burning the midnight oil.

The goal of sleep is not to be knocked out, but to wake up refreshed. Medications may knock you out, but if you wake up feeling the same or worse, or if you have rebound insomnia, then wha's the point? Problems falling asleep can have a lot of causes. Problems staying asleep can be from insomnia and obstructive sleep apnea, so consider those things. Also consider that it is normal to wake up at night. Consider 1) are you able to get back to sleep, 2) how long does it take, and 3) does it impact the next day? Don't feel like you are the only one who is waking up during the night. Everyone does. it is how you deal with it that can determine on whether this is a problem or not.

What are the effects of light/moderate/heavy drinking of alcohol on the quality of sleep? And how (if at all) does this vary with age or other factors?

I don’t drink much, a beer and a cocktail at most on an evening, but I found as I got older, my sleep was very shallow, almost as if my brain frequency was the same as being awake.

I stopped drinking completely a few months back and now my dreams are super vivid and I feel I’ve slept really well.

No more than one drink for a woman and two drinks for a man is what is typically recommended. That being said, alcohol impacts everyone differently, so some people may not be able to have even one cocktail. Overall, I would say that alcohol does not help sleep, so the fact that you are sleeping better off alcohol is not at all surprising.

This is such a fundamental question but it seems like most people including myself don't know the answer.

How to quickly fall asleep?

People should generally fall asleep within 30 minutes, but it is not about how quickly you fall asleep, it is about how you feel the next day. In fact, if you are falling asleep the moment that your head hits the pillow, that could be a sing of an underlying problem.

I'm in my early 30s now, but as long as I remember, I have not been able to sleep like a "normal" person unless I am really exhausted.

I usually don't get it in bed until 11ish but don't actually sleep until closer to 1am. I wake up at 6:45 for work and hit the road.

What changes should I make to help me fall asleep quickly?

Early morning exercise, especially with the sunrise, may entrain your circadian rhythm more toward an earlier time to bed. Make sure that the room is cold, dark, and quiet. Circulation with a fan may help. Make sure that your phone is off. Give yourself a reward for your hard day. Do something that relaxes you. Journal writing can help if you have a lot going on so that you don't perseverate on things as you are trying to fall asleep. If you are unable to fall asleep after 30 minutes, reward yourself with a hot bath or shower so that may be able to forget about what bothers you. It will also warm your extremities, which will help to promote heat loss (which helps to promote sleep). Ever try going to bed with cold feet? Its a lot more difficult, isn't it?

Can you comment or offer any insight into potential negative effects of falling asleep to TV? What about device usage such as phones/tablets? What strategies can we use instead to fall asleep?

The reason that I am opposed to falling asleep with a TV is that it is a light source that requires active attention. If you really need something like this, I would recommend a radio, because it is not a light source and does not require active attention. While we are on the topic of TV, I think it is important to not fall asleep in the living room. THere is too much activity, and you are at the mercy of other people in the house. Blue light in tablets is not ideal; but once again, it is the fact that the phone requires active attention as the more likelier reason why it causes insomnia.

If i use codine to stay asleep every once in a while, Am I actually benefiting? or does waking up for a couple of minutes every 3-4 hours ok?

It is normal for people to wake up for a couple of minutes every 3-4 hours. This is much healthier than taking codeine or any other medication.

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I would definitely encourage them to take a day shift! Long term, it is much better for their health. Shift work does get more difficult with age. Sleep can become more fragmented over time with age. They probably don't have much problem falling asleep but can't stay asleep.

While you don't reset your circadian rhythm, you can entrain it by keeping a regular bedtme. Melatonin may be helpful to help keep you on a sleep schedule, but is problematic for long term use, and has its own dangers with longer term use.

Disrupted sleep is caused by sleeping against your body's rising body temperature, so that may be one reason. However, it is also possible that an underlying sleep disorder may be a cause of disrupted sleep, so consider having them follow up with their health care provider.,

What are your thoughts/feelings about power naps (20 minutes or so)?

Power naps can be very beneficial. Anything less than 30 minutes can usually help with alertness without disrupting nighttime sleep.

I have moderate to severe sleep apnea. I use my CPAP religiously. Except....I don't put distilled water in it. Mainly because I had "double pneumonia" a few weeks after using it and I found a tiny bit of mould on the water chamber dispute my best efforts to dry it.in between. I was basically septic and not immunocompromised.

Got a new chamber(and run it dry) and been using it for 5 years. New one coming next month. If I continue using it am I harming my lungs?

The way I see it I am exposed to the same humidity as the room, however at much higher flow rates. No other complaints symptoms. Cpap rules and gives me a new life.

Glad CPAP works for you! You are not harming yourself by using your CPAP without water...just make sure that you the heated humidifier is not turned on. It will not cause your lungs any damage to sleep without your humidifier on, but you may find that it makes your nasal passageways more irritated in drier months. Consider in-room humidifier to help in drier or winter months.