Webinar: Sleep well for your mental health

Dr. Baran: Hello, everybody. First, I just wanted to clarify a very important point. Healthy sleep is very important for mental health. But anyone with or suspected to have a mental health or psychiatric condition should of course consult their physician. We don’t want to imply that poor sleep is the only cause of mental health problems, or that fixing poor sleep is the solution in all cases. However, sleep is a very important component that deserves attention. And I’ll share with you some important information today.

So let’s get started by talking about healthy sleep. Healthy sleep is good for us in many ways. Think of sleep as nightly maintenance for your brain and body. A lot goes on during sleep, and if we don’t get enough of it or if quality is impaired, a lot can go wrong. So what’s poor sleep? Poor sleep is bad for physical as well as mental health. It increases our risks for disorders such as high blood pressure, heart disease, weight gain, type 2 diabetes, as well as mental health problems, including mood disorders, anxiety disorders, and now we suspect dementia as part of that list.

There is a cleansing system in the brain that was discovered in recent years that operates mainly during deep sleep. This clears out waste products, which can accumulate if sleep is insufficient or poor in quality. Again, poor sleep is of course not the only cause of these problems, but can be a significant contributing factor. To elaborate a bit more on this, there’s a strong association between sleep and psychiatric disorders, especially mood and anxiety disorders. And the relationship goes both ways. Poor sleep can cause or worsen mental health problems and mental health problems often include insomnia and poor sleep as a component.
Even one night of poor or insufficient sleep can cause us to become irritable and impulsive and, if poor sleep persists, this compounds the problem over time.

So what does mental health mean to you? Well, mental health is a complex topic and, of course, encompasses emotional health and includes the many complex functions of the brain that govern our thoughts, emotions and behaviors. Big topic, but just to put it in perspective as we embark on this discussion. So here are some key signs and symptoms to watch out for that could relate to poor sleep. And again, of course, these are not exclusive to compromise sleep. It can be caused by other conditions. But poor sleep alone can lead to serious issues.

We all know how it feels after a night of not getting enough sleep. And even one night of poor, insufficient sleep can cause noticeable problems. Drowsiness, irritability, feeling unmotivated, poor attention, feeling stressed, getting stressed by things more readily than we normally would. And then over the long term, of course, this can translate into taking more sick days from work or being late. So it can really lead to a variety of issues.

How can we improve our mental health through sleep? Now, sleep starts with good sleep hygiene. Many of you may know many of these items on here. Some are very widely known and some are not as widely available. Let’s review some of the key ones just to make sure we’re all on the same foundation here. First, it’s very important to follow a routine, a morning and evening routine, be on a schedule. Our brain doesn’t deal well with a moving target of different bedtimes everyday; it really likes to lock in on a certain bedtime/wake-up time. And our sleep is best if we stick to that schedule. Otherwise, it’s like shifting time zones or jet lag. And it really throws off that circadian clock that we have inside our brain that is designed to keep us on schedule. And of course, along those lines, keeping both consistent sleep and wake time, got to get enough sleep.

Most adults need seven to nine hours of sleep. And unless we’re getting that range, you’re going to be running short. Everybody’s different. How do you know if you’re getting enough sleep, and how much sleep do you need? The best way to really understand that is if you’re not playing catch up on days off or weekends, if you’re not sleeping markedly longer, even though you have the opportunity, then you’re probably on a good schedule. That catch-up time over the weekends or on days off or on vacations indicates that you’re running a deficit of sleep, which does add up over time.

You know, if you don’t get enough sleep, night after night after night, it does accumulate. Not in a linear fashion that you have to pay back every minute that you lost. But it does take some time to recover from that. So it’s good to get an understanding of how much you need. And a good target is, the average is eight. So that’s a good target to shoot for. And try to get sufficient sleep on a nightly basis.

Daily exercise, of course, for many reasons, as well as good, deeper sleep.

This is an important point, number five here. A lot of people fall into the habit of being left alone with their thoughts at bedtime and using that time for worrying, thinking, problem-solving. And of course, that’s not consistent with being able to fall asleep and get a good night’s sleep. So, set aside some time in the early evening to reflect on your day, plan the next day, get out your calendar, get your to-do list, get it out of your system. And just by going through that daily exercise of what they call “scheduled worrying and planning time” — that can help keep these thoughts from bothering you when you go to bed because you’ve already addressed them and put them away.

Alcohol and caffeine. These are important enemies of sleep. And let’s start with caffeine. Very widely available, everybody relies on it to some degree. But caffeine, it’s not good enough to avoid caffeine just prior to bedtime. It sticks around in your body, in your bloodstream, for a long time. And you may read that the half life of caffeine is five hours. That doesn’t mean that all the caffeine you’ve consumed is out of your system in five hours. That means half of it is out in five hours. And then the next half is out in five hours, etc. So it can take some time, depending on how much you’re consuming. And when you’re consuming it. It can really persist longer than you may think, up to 10 hours or more from the first consumption. What I would recommend in terms of caffeine as a general rule of thumb is, of course, avoid it in the late afternoons and evenings and limit it to no more than a couple of caffeinated beverages per day. Last one in the early afternoon at the very latest, no later than that. That should keep most people out of trouble. If you’re in the habit of consuming a lot of caffeine, currently, don’t try to cut back too quickly because caffeine withdrawal is a real thing and can cause headaches and make you feel pretty miserable. The best way to back off of caffeine consumption is to just cut back by one caffeinated beverage, one cup of coffee, whatever it may be, once every couple of days. Just gradually ease yourself off it, eliminating the later cups of the day as the first steps.

Alcohol, even though many people think it’s good for sleep, it actually may help you fall asleep initially, but then you pay the price later. It disturbs sleep and the net result is a bad night of sleep because of the alcohol, even though it gives that first impression that it’s helping you. So, it’s best avoided and especially in the evenings. It takes about a few hours for one alcoholic beverage to be metabolized. So best not to drink near bedtime and, of course, it’s for general health purposes to minimize alcohol use anyway.

Eating close to bedtime. We should allow at least three hours between dinner and bedtime. If you go to bed on a full stomach or if you haven’t given your stomach enough time to clear before you go to bed, it will disturb sleep. It can cause reflux, and people are predisposed to that. And even without reflux, not good for sleep. Maybe a small snack may be a good idea. But generally not eating close to bedtime and especially not eating a late dinner, very important.

Another tip, number eight, allow yourself a little time to kind of wind down and ease into bedtime. Don’t go full speed ahead with work, whatever you may be doing, and then expect to jump into bed and fall asleep right away. You have to have a transition time. So about a half hour of a bedtime routine prior to bedtime is a very good idea to just get that transition going and prepare yourself to go to sleep.

Number nine, a big one, electronic screens, whether it’s TV, whether it’s your telephone, whether it’s your tablet, this is bad for a couple of reasons. One, the light stimulates us and can actually make it harder to fall asleep. Just that light exposure does affect our sleep onset. Also, the mental stimulation of reading something interesting or getting caught up in an interesting TV show or YouTube video that can prolong that sleep onset by making you feel more alert than you should and missing the opportunity to go to sleep when you should have.

And, finally, number 10. Very simple, but very important. You want to make sure your bedroom is dark, quiet, cool, simple requirements for good sleep. And just comfort you know, physical comfort is important. And if those are not met, of course, the sleep will also not be at its full quality.

Now moving on, good sleep hygiene and habits are very important. And those basic ground rules I would recommend to everyone. However, these are just a starting point. And they’re not really going to solve the problem if there is a sleep disorder present. And many people have sleep disorders that require attention. No matter how perfect your sleep hygiene may be, unless the sleep disorder is identified and treated, sleep will not be optimal. And there will always be a price to be paid. So let’s go over some of these important symptoms and signs to look out for that may indicate the presence of a sleep disorder. And then I’ll tell you a little bit more about a specific sleep disorder that’s very common, sleep apnea. And we’ll wrap up with that.

Sleepiness and fatigue when inactive, or when you’re just sitting still, are definitely a sign that there’s a problem. Either you’re not getting enough sleep or there’s a problem with your sleep. Many people may brag that they can fall asleep anytime, anywhere. Well, that’s actually not a good thing. That means that there’s a deficit of sleep, and it’s your brain taking the opportunity whenever it can to try to catch up on that. So that’s not a good thing. If you’re feeling drowsy, whenever you sit still, something’s going on.

Taking more than 30 minutes to fall asleep. Normally you should take within 30 minutes to fall asleep. If it’s taking longer than that, there could be an issue with insomnia.

Now snoring, it’s more than just a nuisance. It’s really something that we need to be aware of, and could indicate that there is, indeed, a sleep disorder, specifically sleep apnea going on. And it doesn’t have to be loud to be significant. The gasping awakenings and more severe cases, of course, that can be observed by others. Breathing pauses during sleep are noticed by others and, by the way, most people are not aware that they snore and will adamantly deny that they do despite family members’ comments. So it’s important to keep in mind that some of these are observed by others and the person who is the source is unaware.

Frequent movements during sleep, just fidgeting during sleep and then moving about, that indicates that there may be a problem.

Awakenings to urinate, assuming you’re not consuming a lot of fluids, near bedtime. If you’re having to wake up to go to the bathroom a couple times or more during the night, something could be going on there. That actually can be a sign of sleep apnea, which increases urine production during sleep. You’re a complex mechanism, so another thing to keep in mind and keep an eye out for.

Morning headaches, waking up with headaches, another warning sign to be aware of, another feature of sleep apnea. Waking up unrefreshed. Obviously, if you haven’t gotten a good night’s rest, you’re not going to feel refreshed. Now, of course, if you haven’t gotten enough sleep, you can also feel unrefreshed. So assuming you’re getting a sufficient amount of sleep, but you’re still waking up unrefreshed, still feeling sleepy, fatigued during the daytime, could indicate that there’s a sleep disorder. And, related to that, relying on naps or caffeine to function, of course, that’s a crutch that many people have to rely on to get through the day if there’s a problem with insufficient or problematic sleep.

Alright, so let’s move on to sleep apnea. Again, you may ask, what does sleep apnea have to do with mental health? Well, by way of disturbing sleep and disturbed sleep, setting up issues with mental health, that’s how the connection exists with sleep apnea, sleep and mental health. As I mentioned, many of the signs and symptoms on the prior slide are features of obstructive sleep apnea, which is a sleep disorder that is detrimental to both physical and mental health. Because it’s so common, and often goes undiagnosed for long periods of time, I wanted to mention it here and take the opportunity to tell you a little bit more about it.

Obstructive sleep apnea is caused by the intermittent narrowing of the throat during sleep, requiring increased effort to breathe. When air is forced through the relaxed and narrow throat, the tissues vibrate and create noise, which is snoring. This increased effort to breathe causes very brief awakenings that fragment sleep, causing a number of problems including sleep fragmentation, just broken up sleep. And these awakenings, these very brief awakenings, are too short for the person to be aware of. They just come and go within a matter of seconds. So you think you’re sleeping, but actually the sleep is broken up, and the sleep quality is being diminished by these. And, as a result of this, comes the drowsiness and fatigue when inactive. This also creates cardiovascular stress, and as mentioned earlier, can be a risk factor for the development of those conditions like high blood pressure, heart disease. Risk of stroke is another possibility with sleep apnea. And, of course, it can also cause decreases in blood oxygen levels, which has its own implications and, obviously, it’s not good for our health. So untreated, obstructive sleep apnea can contribute to a number of physical and mental health conditions.

Specifically regarding mental health, it can worsen depression and other psychiatric disorders, making them harder to treat. Even with the appropriate treatments and everything being done properly, if there is a factor of obstructive sleep apnea in the picture, and it is not identified and treated, it’s impossible to have an optimal outcome. But the good news is, sleep apnea is readily diagnosable with a home sleep test, and can be very effectively treated with the subsequent increase in quality of life as well as quality of future health and mental health. So I would recommend that if anyone has concerns about any of the symptoms or things that we discussed today, take your Sleep CheckupTM, to see what’s going on, see if that can provide you some information as a first step. And then depending on what those results may show, then subsequent steps will be outlined with your results. And that’s what we have for today.

Moderator: We do have a couple of questions that came in. First, I wake up in the morning and still I’m tired after sleeping eight hours. Does this mean I’m not getting enough quality sleep?

Dr. Baran: That can indeed mean that you’re not getting enough quality sleep. Now there are some people who need more than eight hours. I mean, everybody is different. And that seven to nine hours is the average that most people need. Some are on the higher end of that, some are on the lower end. So depending on whether modifying the sleep schedule, increasing sleep time a little bit more, making a difference. It could mean that there is an underlying sleep disorder that is diminishing the quality of sleep. So what I would suggest is to watch for any signs and symptoms that could indicate a sleep disorder and just make sure that sleep hygiene and sleep times are optimized, maybe sleeping an extra half hour and seeing if that helps over the course of some time. But certainly if there are any specific symptoms that are obvious, those need to be looked at to evaluate for a sleep disorder.

Moderator: Thank you, Dr. B. And the next question is, how does sleep affect my mental health?

Dr. Baran: Well, you know, again, sleep is an essential component of mental health, and if sleep is poor, then mental health can suffer. Whether or not there is a mental health condition, actual diagnosis or disorder, it’s going to affect our brain’s functioning in so many ways. So, in someone who does not have a mental health disorder, such as depression or anxiety disorder, it’s just going to diminish your quality of functioning, your thinking, your memory, your attention, your motivation, it’s going to affect all those things. And in people who have a mental health condition, then it’s going to make it more difficult to treat and more symptomatic. If you’re not sleeping enough, it’s just going to compound the problem and make it harder to treat, basically.

Moderator: Thank you. Those are all the questions we have. Dr. Baran, I just want to thank you for being our speaker. And thank you, everyone, for attending and taking the time to learn more about sleep and how it impacts other areas of life. This webinar will be sent out by email later this week or early next week. So be sure to be on the lookout for that and feel free to share it with your co-workers, family and friends. We also encourage you to take your Sleep Checkup to determine your personal sleep health. If you have any questions, feel free to reach out to us at sleep@sleepcharge.com. Thank you all and have a great day.

Alp Sinan Baran, MD

Dr. Baran, medical director of Nox Health, is a board-certified psychiatrist and sleep medicine physician with 25 years of experience, spanning academic, military and telemedicine settings.