Sleep Hygiene Webinar Follow-up

Sleep Hygiene June 6, 2019

If you attended our recent Sleep Hygiene Webinar you may have noticed that we didn’t have quite enough time to address all of our submitted questions. Luckily, presenter Jamie McGaha was kind enough to pen this follow-up blog answering all of the submitted questions we didn’t get to on-air. Let’s dive into the questions below!

Sleep Hygiene

Why do we put med school students and residents through sleep deprivation!

I don’t know! It’s quite dangerous. In 2003, the Accreditation Council for Graduate Medical Education (ACGME) set a national standard restricting resident workweek to a maximum but not required 80 hours per week (averaged over four weeks) and limiting the longest consecutive period of work to 30 hours in order to reduce the risk of medical errors and overworked staff.

How would you recommend dealing with spouses who have different sleep and wake times?

First talk to one another, what issues do your different sleep wake cycles cause? Is it the fact when one comes to bed the other is awoken? Does your communication and quality time together suffer when you rarely awake at the same time? Does one partner find they complete all of the chores/household or childcare tasks during the day because the other is sleeping? Sometimes, one partner simply a night owl and the other an early riser, sometimes it is job related. Either way, once you have outlined the issues caused by your sleep/wake cycle differences, then you can talk about a plan to tackle them based on why it happens and the issue it brings.

A few suggestions:

– For partners who have opposite work shift schedules, set a chore/errand schedule to divide and conquer your life tasks based on when it is safe for each partner to be awake and still allows them to get 7-9 hours of sleep. For example, if partner A works days and partner B nights, is it possible for partner B to run to the store and pick the kids up from school when they wake up in the late afternoon. Or in order to get quality time in together, could Partner A and B have a light early morning together before A goes to work and B to sleep?  Maybe dinner before B goes on shift is the best time for both to see each other and catch up. Staying organized with your schedules and prioritizing time together as well as getting this accomplished to split your life load it critical, make sure to prioritize those things over other less important things as well (like being on your phone or playing video games).   

– For those partners who one is simply a night owl and the other an early to bed person, talk to each other about what you would like to do/get accomplished earlier in the evening before the earlier person’s bed time and make them a priority to accomplish. If the night owl wakes the early riser up when they come to bed, talk about how they can get into bed with disrupting the other. Both could brush their teeth at the same time earlier in the evening to avoid turning on lights and faucets when the other is sleeping.

Either way, regardless of the issues, TALK. You will not come to a solution without open communication of the issues your sleep patterns are causing.

Menopause is another group of people who suffer severe sleep deprivation, that can last years. Any tips?

An excellent point. Our hormones fluctuations play a huge role in sleep and wake. Menopause is often a time where insomnia can wreak havoc on quality of life.  Hormone replacement therapy is one treatment to combat hot flashes and insomnia caused by changes hormone levels, but it must be something discussed with a healthcare provider to determine if it is a safe treatment option for you.

A few other tips:

  • Lower the temperature of your bedroom at night to between 60-67 degrees
  • Dress in lightweight clothes to improve sleep efficiency. Avoid heavy, insulating blankets and consider using a fan or air conditioning to cool the air and increase circulation.
  • Eat healthy. Avoid large meals, especially before bedtime. Maintain a regular, normal weight. Some foods that are spicy or acidic may trigger hot flashes. Try foods rich in soy as they might minimize hot flashes.
  • Avoid naps during daytime if possible
  • Avoid nicotine, caffeine and alcohol, especially before bedtime.
  • Reduce stress and worry as much as possible. Try relaxation techniques, massage and exercise. Talk to a behavioral health professional if you are depressed, anxious or having problems.

Hi Jamie, have you encountered a patient who has sleep apnea and was nervous about using a CPAP?

I think many people can have a fear or resistance to anything new, especially when we sleep. I think the first line of defense is education on how dangerous not doing anything about sleep apnea can be vs the fear of wearing something at night. Sleep apnea has horrible consequences for our health both short and long term, avoiding addressing it because of not wanting to wear a CPAP is a good way to increase your chances of high blood pressure, heart disease, stroke, automobile accidents caused by falling asleep at the wheel, diabetes, depression, and other ailments. There are several different models of CPAP machines on the market, various masks for nose and mouth, nasal cannulas, etc. Have your patient talk with a sleep medicine doctor about the types of masks to find one that will fit best for them. Additionally, masks are fitted to patients and if the fit is not comfortable or they can’t sleep with it on, they won’t use it. Don’t hesitate to contact your sleep doctor if you need an adjustment or re-fitting for a mask.

Do you feel like wearable technology (ie Fitbit) can accurately measure sleep amount and cycles? I am typically in bed for 8 hours but my Fitbit says I am ‘awake’ for at least an hour throughout the night. Is that normal?

There is a “certain degree of accuracy” with tracking sleep with electronic devices. Several new studies that have been released recently touting the excellent benefits of FitBit to track sleep have actually been sponsored by FitBits’s research and development team. They do point to having independent reviewers from well recognized sleep study programs, but anytime a company is sponsoring its own research I always worry about confirmation bias. Are we really just trying to prove how great we think our device is?

Baron et al., criticized fitness trackers for depending too heavily on users’ movements to determine sleep levels, for a lack of transparency in their sleep-tracking algorithms, and for a tendency to reinforce bad sleep habits by encouraging extended time in bed. The University of Washington’s Dr. Nathaniel Watson, a board-certified neurologist and sleep specialist, says fitness trackers are good at encouraging people to pay attention to the quality and the amount of sleep they’re getting. But he echoed the concerns voiced in Baron et al., saying he’s not convinced that Fitbit has succeeded in solving the device’s precision problems. Fitibit uses movements to track sleep, vs analyzing heart or brain wave rhythms.  So while they may still be helpful, take your FitbIt’s sleep read out with a glass of salty water and understand your sleep/wake cycle and sleep hygiene behaviors.

Baron KG, Abbott S, Jao N, Manalo N, Mullen R. Orthosomnia: are some patients taking the quantified self too far? J Clin Sleep Med. 2017;13(2):351–354.

Office workers have lots of issues…any data on that?

Office workers can have any of the issues discussed in the webinar related to sleep/wake problems. They could be due to a diagnosable sleep disorder, behavioral patterns or life stressors as noted in the talk. The majority of office workers fall into regular 9-5 work schedule category and not into the higher risk shift work population.  That being said, since we covered that 50-70 million American struggle with sleep disturbances, many likely works in office type settings since only 14-15% of the working population works in shift scheduling. Refer back to the 21 Sleep Hygiene tips to help individuals who work on regular day scheduled times to help them get a better sleep routine to be more energized during the day. Always remember for office workers to take frequent rest breaks from compute tasks and maintain good ergonomic desk set up principals. Visit The Back School for further information on ergonomics for office workers.

What about herbal remedies?

Herbal remedies such as melatonin, lavender, Valerian root, Magnesium, chamomile and more have been recommended to help people sleep better.  One or more of these may work for you, but you should always discuss the use of any supplement with your primary care doctor before starting one. Herbal supplements are not regulated by the FDA and can interact with other medications so it is very important to discuss adding anything new into your daily routine to avoid side effects. One issue with research into the use of herbal supplements and sleeplessness is that many studies have not been reproduced with larger samples to determine validity, but it is still worth exploring with your doctor if a natural remedy could work for you.

Sarris J, Panossian A, Schweitzer I, Stough C, Scholey A.  (2011). Herbal medicine for depression, anxiety and insomnia: A review of psychopharmacology and clinical evidence. European Neuropsychopharmacology. 21(12); 841-860,

Any suggestions for those who work night shifts on rotation?

Shift rotation is so hard. Just being on night shifts consistently is linked with adverse health conditions after 5 years, but the constant alternating between day to night shift is likely worse in my opinion.

I do recommend to have 2 consecutive days off if not 3 before a change from day shift to night or vice versa and to begin changing your sleep wake cycle then for the next shift.

Additional tips:

  • Avoid long commutes and extended hours.
  • Take short nap breaks throughout the shift if possible (some workspaces allow this, some don’t). If you can’t nap during shifts, napping before going on to a shift to stay alert.
  • Work with others to help keep you alert.
  • Try to be active during breaks (e.g., take a walk, shoot hoops in the parking lot, or even exercise).
  • Drink a caffeinated beverage (coffee, tea, colas) to help maintain alertness during the shift.
  • Don’t leave the most tedious or boring tasks to the end of your shift when you are apt to feel the drowsiest. Night shift workers are most sleepy around 4-5 a.m.

Exchange ideas with your colleagues on ways to cope with the problems of shift work. Set up a support group at work so that you can discuss these issues and learn from each other.

Here are some tips for sleeping during the day:

  • Wear dark glasses to block out the sunlight on your way home.
  • Keep to the same bedtime and wake time schedule, even on weekends during a shift schedule. When the shift cycle changes have consecutive days off and begin to change your sleep wake cycle hours
  • Eliminate noise and light from your sleep environment (use eye masks and ear plugs).
  • Avoid caffeinated beverages and foods close to bedtime.
  • Avoid alcohol; although it may seem to improve sleep initially, tolerance develops quickly and it will soon disturb sleep.

Is listening to a podcast that is sleep inducing not good?

No it’s not really. Low frequency, low volume level noises are proven best in research to help brain waves slow down. Podcasts typically do not have these, unless you are listening to some type of special podcast that is low level white noise designed to help people sleep…I don’t personally know of any, but they may exist let me know!

One thought

  • Elizabeth Hildreth

    Hi Jamie, thank you for the information on ACGME’s national standard. I have been researching the subject of maximum allowable work hours in the hopes of someday incorporating the information into a policy, but there does not seem to be an agreed upon standard and the working hour maximums range from 12 to 24. Can you provide any additional guidance on how long workers should safely be allowed to work, and taking into account those who may currently be on the higher end of the stated range. Thanks so much.

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