March 2021

Face to Face: How to Get Good Sleep

March 26, 2021    |  

Everyone knows that getting a good night’s sleep is essential if we want to be our best, with a sharp mind, reliable memory, good motor control, a responsive immune system, a positive attitude, and even a fit body. So why don’t we do it?

The short answer is that it’s not entirely our fault. For most of human existence, things were pretty simple. We woke up with the sunrise and got sleepy when it fell, a very predictable rhythm around the day, or circa diem. That’s the Latin phrase from which we get the term circadian rhythm — natural timetables that seem to govern everything alive.

Bruce Jarrell and Emerson Wickwire on Face to Face

Bruce Jarrell and Emerson Wickwire on Face to Face

Human progress began eroding that regular pattern of sleep a long time ago with the invention of everything from the light bulb, which allowed us to work during odd hours of the night, to the computer, whose blue screens suppress our production of melatonin, the chemical that makes us sleepy after the sun goes down.

Along the way, alcohol, cigarettes, pharmaceuticals, poor diets, diminishing exercise, lights everywhere, and simmering undercurrent of stress have combined to rob millions of the sleep they need. Add to that the anxiety and uncertainty brought on by COVID-19, and the problem is that much worse.

We haven’t had time to measure the full effects of the pandemic yet, but in 2014 the Centers for Disease Control and Prevention compiled data for Short Sleep Duration Among U.S. Adults, showing about 35 percent weren‘t getting enough sleep. In Baltimore, that number was 42 percent.

The same study showed short-sleepers were much more likely to suffer from 11 chronic conditions — heart attack, coronary heart disease, stroke, asthma, chronic obstructive pulmonary disease, cancer, arthritis, depression, chronic kidney disease, and diabetes.

What’s more, a study in the journal Sleep found drivers who slept fewer than seven of the previous 24 hours were much more likely to be responsible for vehicular accidents. The National Highway Traffic Safety Administration says in 2017 more than 91,000 crashes and nearly 800 deaths involved drowsy driving.

It’s the same in the workplace. A Harvard Medical School study estimated that insomnia accounted for more than a quarter-million workplace accidents and errors, and more than $30 billion in losses each year. The total cost to the U.S. economy, factoring in lost productivity, is close to $400 billion, according to a recent Rand Corporation study.

A great deal of money also is spent trying to compensate for poor sleep. The global sleeping aids market — everything from supplements and CPAPs (continuous positive airway pressure machines) to Sleep Number beds — totaled nearly $80 billion in 2019 and is projected to more than double by 2030.

To help explain our sleep problems and how to overcome them, University of Maryland, Baltimore (UMB) President Bruce E. Jarrell, MD, FACS, invited sleep expert and University of Maryland School of Medicine professor Emerson Wickwire, MD, to join him on the March 25, 2021 edition of Virtual Face to Face with President Bruce Jarrell

“To a certain extent, obviously, we’re in a much better position as a society than we were six or eight or 10 or 12 months ago. But even so, we’re not out of the woods yet. So, there’s a pervasive sense of uncertainty,” Wickwire explained to the audience.

For many, the pandemic has imposed significant changes in routine — another sleep impediment. “For many professionals, productivity has gone way up. But one of the reasons is that the number of working hours has also gone way up. So we’ve lost the hop in the car and commute to work or walk to work and then commute home at the end of the day, those boundaries are gone,” Wickwire offered.

“It’s been discussed that there are secrets to getting a good sleep,” Jarrell probed. “How do you prepare what your bedroom should be like, and all of those kinds of things? Could you give us your wisdom on what works, what we should be thinking?”

“The first piece is to create a sacred bedroom environment for sleep. That environment should be cool, quiet, dark, uncluttered. This should be a calm, soothing space, to the extent possible devoid of stimuli,” Wickwire responded. “The reason is that we want to create a cave where as we enter that space, through repetition, we train our body and brain that this is a space for sleep. ... It’s one reason why we so strongly encourage patients when they're having trouble sleeping, not to stay in bed. Otherwise, you’re actually practicing, of course, having insomnia through repetition training yourself, that the bed is a place to be awake, which is the opposite of what we want to do.”

The virtual audience was quick to pepper Wickwire with practical questions, from how to handle sleepless kids, to which mechanical and surgical cures for snoring might he recommend, and how long before bedtime should we quit starting at computer and cellphone screens?

“At minimum, 60 to 90 minutes, if you’re a good sleeper and being mindful of your sleep health, 60 to 90 minutes if you are a Type A or if you are a hard driver, if you have a lot of pressures from your daytime work or your family, you may well need more time than that,” Wickwire said.

One audience member asked about trouble getting to sleep. “If your mind doesn’t want to shut down, what can you do when your mind races up with the day’s events? Or perhaps the next day’s events? What can you do to get to sleep?”

“Well, if you waited until you can’t sleep, you've probably waited too long,” Wickwire answered. “And what I mean by that is that it’s not that your brain is overactive only at midnight, it’s probably overactive at noon as well. And so, what we need to do is begin to create some of that rhythm, some of which has become very difficult during COVID for reasons we discussed earlier, so that I can increase my engagement during the working day and then maximize my disengagement during the sleep period.”

“Is it OK to hit the snooze button on the alarm clock?” asked another.

“If you’re needing to snooze, by definition what you're saying is, I am sleep-deprived, and it's a sign that you're not getting enough sleep. And there's only way you can get more sleep, you can go to bed earlier, you can sleep in later, or you can nap. And for most folks going to bed earlier or sleeping in later is a more reliable strategy than napping because most of us have jobs during the day,” Wickwire said. “So, if you're fighting to wake up in the morning, it either means that you’re not getting enough sleep or not enough quality sleep, which of course could be due to an undiagnosed sleep disorder.”

Watch the entire discussion, including questions from the live audience, by accessing the link at the top of the page.