← Mayo Clinic On Human Optimization
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- [00:02]
A
Just lying in bed, trying to fall asleep over time, that makes it harder for you to get to sleep and to fall and stay asleep better.
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This is Mayo Clinic on Human Optimization, a podcast where we break down the science of human potential to help you understand how purpose driven effort leads to high level performance and long term well being. I'm Dr. Verkamp, Director of High Performance for the Minnesota Twins and a sports medicine surgeon with Mayo Clinic. Why is it that the more we think about falling asleep, the harder it becomes? Our mindset around sleep plays a huge role in our ability to fall asleep, the amount of sleep we get and the quality of that sleep. So how can we use our mindset to our advantage? That's what we'll be discussing in this episode. Our expert guest today is Dr. Banu Kola. Dr. Kola is a professor of psychiatry and psychology with clinical appointments in the center for Sleep Medicine and the Division of Addiction Medicine at the Mayo Clinic, Rochester. He is the author of the Mayo Clinic Guide to Better Sleep, which he co wrote with Dr. Tim Morgenthaler, who's a past guest. He has research interests that include the intersection between psychology, sleep disorders and addiction. And the three big questions that he's going to answer for us today are, number one, what is the connection between sleep and psychology and how does that relationship affect our sleep? And then in section two, our big question is what are the most common mental traps that negatively impact our sleep? And then in the third section, we'll get you answers about what to do when we ask what steps can we take now to optimize our mindset to to help us get the best sleep? Well, Bonnu, thank you so much for joining us today. Looking forward to having this discussion with you.
- [02:09]
A
Thanks for having me.
- [02:10]
B
So I'd like to level set at the beginning here with some definitions so people understand what we're talking about. So when we talk about having the right mindset in regards to sleep, what exactly does that mean to you?
- [02:23]
A
So from a sleep standpoint, I think when people are thinking about getting in the groove or getting in the right mindset for sleep, it can mean many things. Usually it means the wrong things. So people trying to worry too much about am I doing this right? Is this perfect? Have I done everything correctly? So I'm going to immediately fall off to sleep, immediately get into deep restful sleep, wake up rested, and a lot of that is counterproductive. Like with most things, sleep tends to work well. When you have routines, you're sort of following a pattern and sticking to it. And over time those benefits seem to accrue. So from a mindset standpoint, it's one of those things where it has to come naturally, so you think less about it, but at the same time you're doing everything else right, which is having the right routine, having the wind down time, but doing it unconsciously, repetitively and in a disciplined manner.
- [03:25]
B
So that's a great framework, I think, or a general approach to doing this. But I think we often we completely miss this aspect of sleep. We overlook it. We talk a lot about sort of our physical environment. What's the light, what's the noise, what's my batting, what's my temperature? But we don't really talk about this mental environment. Why don't we talk about it more?
- [03:45]
A
I think it's easier to control some of the physical aspects. And there are things you can sort of fine tune there, there are things you can measure, optimize. So it's much easier to control your physical environment, make changes on a day to day basis. With the mental aspect, it is a little more abstract, nebulous. And a lot of times when you get into this pattern of trying to do more with the mental aspect of sleep, it tends to become counterproductive or anxiety provoking. And that I think disrupts sleep, makes it harder. So it's that balance that people are trying to strike, which makes it hard.
- [04:24]
B
So this may be one of those situations where it's addition by subtraction. Maybe the less you do the better rather than the more you do, which is not how we're wired. We tend to want to always add on more. Sometimes our biggest gains though are picked up through subtraction. So help me understand a little bit more about what's going on with the brain during sleep. So during sleep, what's actually happening to the brain that helps improve our mental state the following day?
- [04:56]
A
So when we fall asleep, we go through various stages of sleep. Usually we divide that into non REM and REM sleep. So REM stands for rapid eye movement. That's usually the stage where we're dreaming. We actually dream in non REM sleep too. But in REM sleep our dreams are more vivid. We tend to recollect them when we wake up. And during that time our body is more or less paralyzed. The non REM stage of sleep, we divide into n1, n2, n3 and n3 is the deep restful sleep. N1 is the lighter sleep. We usually fall off to sleep, get into N1, then into N2, then N3 and then get into REM. And we sort of cycle through those in the night with each stage of sleep. We think each of them serves a certain purpose. We are still not very sure as to what the purpose is. Sleep is conserved through evolution. So even the most simple organisms, including jellyfish, which don't have a central nervous system, they sleep. So there is something sleep is doing. What exactly that is, it's still anybody's guess. We think it helps with energy conservation. That is a minimal amount that happens in sleep. In terms of the energy conservation with animals, they put themselves at risk for predation when they're sleeping. So it has to be more than that. We think it could be some degree of memory consolidation. So we form memories during the day. We don't want to keep all of those going through our life, so we need to delete or eliminate some of those. So some of that happens. We call that synaptic pruning. The latest theory is that over time, as we go through the day, we build up toxins in our brain and those need to be cleared, and sleep helps with that function. We call it the glymphatic system. So these are all the theories. What exactly the purpose is, we still don't know.
- [06:45]
B
So all of these things, though, contribute to, kind of help us start off fresh and anew the next day. And I then wonder how that can help give us positive synergy for the following night's sleep. And I'll kind of build the case on where I'm going here. As I do that, I want to ask, how about depression and anxiety? How do those impact sleep? And how does sleep impact depression and anxiety in both directions?
- [07:14]
A
So with sleep, it's one of those things in that to fall asleep at nighttime, we need to stay awake and alert through the entire day. A good analogy that I can think of is like hunger. The longer you go without eating, the hungrier you get. And it's the same with sleep. The longer you go without sleeping, the more that sleep pressure builds. We understand it from a neurochemical standpoint that there is adenosine that builds up over time, that increases sleep pressure. Caffeine is an antagonist, so it counteracts the adenosine. So that's why people feel more awake when they have some caffeine. So you go through the day, you have the circadian system which is keeping us awake, that shuts off at nighttime. The adenosine builds up, the sleep pressure builds up, we fall off to sleep. That's usually how it works with certain conditions. So depression and anxiety, the activating system can be a little overactive, so it can keep us from falling asleep. The active mind gets in the way. So people with depression and anxiety have a lot of sleep problems. Usually with anxiety, it is trouble falling asleep. With depression, it's both trouble falling asleep, staying asleep, and there is a specific signature of early morning awakening. So people getting up earlier than their usual time, which can be part of depression. So both these conditions disrupt sleep at the same time. Insomnia. So difficulty falling asleep or staying asleep, even if you don't have depression or anxiety to begin with, insomnia is a risk factor to developing these conditions. So over time, people have a higher rate of developing depression or anxiety if they have sleep problems.
- [08:50]
B
So it's one of those things where depression, anxiety can have a negative impact on your sleep, poor sleep can have a negative impact on depression and anxiety. So I think that, and that's probably clear and felt by folks that have depression and anxiety related issues. Now my next question, and to get back to my earlier point, is that I wonder if that same thing really impacts all of us and that if we are struggling to relax and fall asleep for whatever reason, we're going to get less sleep and then the next day we're going to be in a worse condition to get good quality sleep. So we have this sort of negative spiral. And is it possible for us to flip that and say, okay, if I can actually conquer some of this and I can improve my mindset around sleep, I can get better sleep, which is then going to make it easier for me to improve my mindset the next day for the next, and actually start to build some positive synergy in the opposite direction.
- [09:49]
A
Absolutely. And that is a lot of what we do when we are treating people with insomnia. So one of the most effective treatments for insomnia is called Cognitive Behavior Therapy for Insomnia, or cbti. What that entails are some behavioral strategies. But an important component of that is also the cognitive part, which is restructuring our thinking about sleep. So if you have a poor night's sleep, you wake up, you're not feeling the best, you start becoming anxious, you start worrying about the next night's sleep. And part of the treatment there is getting people to recognize that this type of thinking, catastrophizing, worrying too much actually is not going to be helpful. It's going to make it harder the next night. And reframing that in that if you have an occasional night here or there where you're sleeping poorly, all of us have that. So if you're in a new environment, you have traveled, you have a new stressor, you'll sleep poorly. But most of us over time will bounce back to sleeping better. So holding onto that, and again, that balance, not worrying too much about it, recognizing that the body will do its thing. You've had one night's poor sleep, but stay awake, stay active, stay alert the next day, the sleep pressure will build up. And if you have one or two nights, actually it can help the third night because the pressure has built up enough where you will in most cases fall off to sleep better have that catch up sleep and things settle down.
- [11:16]
B
So we need to try to avoid the catastrophic thinking of, oh, I had a bad night's sleep last night, now I'm doomed for the week, this whole thing. So because our body, even though sleep is critically important, we've talked about that and we know that that's true in so many areas, our bodies are pretty resilient and that they can handle these acute sleep disruptions or deficiencies reasonably well, chronically can become a huge problem. But if we have a bad night of sleep, don't totally throw in the towel.
- [11:44]
A
Exactly.
- [11:45]
B
All right, great. Well, let's jump into our second section. In this section we'll talk about some of the other mental traps that kind of negatively impact our sleep. So in your experience in counseling patients through this for many years, what are some of the most common psychological traps you see that keep people from falling asleep?
- [12:03]
A
So the first one we already covered a little bit in that if you have a poor night, starting to worry excessively about the next night's sleep. So that kind of catastrophic thinking can get in the way. The other common trap people fall into is spending more time in bed. So when you are sleeping poor, poorly, or have had a bad night, you think, okay, I'm going to catch up. And the way I'll do it is even if I'm not sleeping, I'll spend more time in bed that way. If I'm spending 10 hours and I sleep six, seven hours out of those, I'm getting those six, seven hours. In the extreme short term, it may be a little helpful. That is debatable too. But in the medium to long term, it is really counterproductive again to sleeping well. Once you start spending what we call dead time in bed, where you're doing other things. So watching tv, reading, or just lying in bed trying to fall asleep over time, that makes it harder for you to get to sleep and to fall and stay asleep better. So usually the example I use is it's like water flowing through a riverbank. You really want the water to be deep and still, so the banks to be closer to each other. The more you sort of move those apart so you spend longer time in bed, it becomes really shallow and choppy and not as effective. So people spending too much time in bed with the idea that they will get a sufficient amount because of that, that can be another trap. Other things would include things like excessively monitoring sleep with the current, sleep trackers or other devices, worrying too much about those scores or numbers, worrying about sleep quality and of course, substances. So alcohol, caffeine, tobacco, all of those can get in the way of sleep, a good night's rest.
- [13:49]
B
Can we talk a little bit about some of the other mindsets that I think may be holding people back? And here I'm not talking about rumination or worry right as you're falling asleep, but I mean just general thoughts about sleep. We live in this culture today, this hustle culture, where people almost pride themselves on sleep deprivation. You know, you hear folks bragging, I only need five hours, I only need six. I can get by with this. And that's almost become a badge of honor. How does that impact our thinking around sleep and potentially limit us?
- [14:24]
A
So first off, how much sleep do people need? That is, like with everything else, a bell shaped curve. Most people fall between six to nine hours, median roughly about seven hours of sleep. I usually tell my patients, if you don't have any kind of external pressure, so you let your body go to sleep, when you start feeling drowsy, go off to sleep, wake up on your own without an alarm, that's usually how much you need. When you get less than that, you are really shortchanging yourself again. One or two nights here or there, all of us do that. That's life. You have to travel, work gets in the way, but if you're consistently doing it, you start developing this chronic sleep deprivation. And there are multiple health consequences to chronic sleep deprivation. Metabolic, but also psychological. And we have seen that over time, people become sleepier, reaction times go down, really cognitive performance goes down. So you're gaining some time. But at the same time, it's coming at a very heavy cost in terms of how efficient you are and how effective you are in what you're doing. So trying to educate people about that trade off and trying to get them to recognize that maybe that trade off is really not worthwhile. And prioritizing sleep, getting enough sleep really is going to help them be more efficient.
- [15:47]
B
I like that concept of the trade off. And I'll tell you, for me personally, I've changed how I think about this in the last several years. And obviously you went through medical residency and call shifts and all that. So you're used to some disordered sleeping during your training years. And all physicians are. I remember people asking me, well, how much sleep do you need? How much sleep do you need? And I would always answer that by saying, oh, I can get by with, with five, I'm okay with six, you know. And so I thought, wait, wait a minute though, just getting by, is that what my goal is? And so when I really thought about it, I know I can survive on four, I can get by on five, I'm okay with six hours, I'm pretty good with seven. At eight, I'm great. Like that feels amazing. So then I have to ask myself, okay, which one do I want to do? Do I want to just survive or do I want to be great? What is it? And so it is, it's all about trade offs. And I think often we think, oh well, if I, I'm losing this one hour of productivity if I, if I sleep a little bit longer, but also recognize that if I do that my other however, 16 hours I'm awake are going to be much more productive. And so that, that productivity trade off is usually not quite what we, what we think it is. So my next question, in prepping for this session, I came across a term I'd never heard before. But the moment I heard it I felt very seen and guilty. So this concept of revenge, bedtime procrastination, which I had not heard of, but when I saw it I thought, ooh, I think I know what that is and I think I do it. So can you explain what that is to us and why we may fall victim to it?
- [17:25]
A
So I think the term sort of originated out of China. And the idea there was people were working very long hours, 10, 12 hours, so really had very little time for their own personal care and needs relaxation, things they wanted to do. So the only time they could do it is nighttime. And the revenge was they would create personal time, but at the same time that comes at the cost of going to bed and sleeping. Same thing, poor trade off. You're creating time for yourself, but really taking away from something that is very important to you. And in the short term, one or two days here or there, that might work. But in the long term you're shortchanging yourself again.
- [18:06]
B
I do think a lot of us deal with this, especially in our hyper busy, over connected world and for me, as I've been thinking about this more, I think the answer to this is to create that nighttime ritual. Because I realized one of the reasons for me is that I was going hard and fast all the way up until bedtime and then trying to lay down. And I think, well, I haven't had time to relax. Now I want to relax. So I was using that time. So starting that bedtime ritual 30 to 45 minutes ahead of time was actually would be really helpful.
- [18:36]
A
It would. And again, it's sort of what you prioritize and what is important to you. All of those. It's a balancing act. And that changes from day to day, week to week for all of us, but prioritizing some me time and sleep time, too.
- [18:49]
B
And I think the other key is putting some of that me time maybe earlier in the day. If you don't carve out some white space in your day where you can actually do some of the decompression, you need to. Don't save it all for 10pm right before you're about to go to sleep. Earlier you mentioned sleep trackers. This is a controversial topic for a lot of people. What is your current take on those? And how do you counsel your patients?
- [19:14]
A
So, like with most technology, it is a tool, and it depends on how you use that tool. A lot of trackers, what they're doing is they're measuring movement and sort of inferring sleep. From there, they can do a reasonable job in telling us when we are upright, when we are sort of supine, lying flat, and okay with when we are awake and when we are asleep. When they really start getting into sleep stages, there really isn't any data for us to tell if they're accurate or not. And one of the newer sleep conditions that we deal with is called orthosomnia, where people are actually reasonably good sleepers, but they start tracking their sleep excessively and they don't get a good number or start worrying about the stages, and then their sleep actually deteriorates because of this excessive monitoring. So it can be useful if you're looking at patterns. So making sure you have these routines, you're going to bed roughly at the same time, waking up at roughly the same time. But outside of that, in terms of the sleep scores, the stages of sleep that you're getting, I wouldn't pay too much attention to those from these devices. There's not much validation data and there really isn't much we can do with stages anyway.
- [20:25]
B
Yeah, that's very well said. I think that at some point they'll probably improve and be more valuable. But I've noticed for me personally, I wear one and I use it. It tells me how much sleep I get, which I think is reasonably reliable. So I do like to look at that to see if I'm doing okay. But I have found that my sleep score and the way I feel in the morning didn't really seem to correlate. And then I had to ask myself, what's more important? Am I trying to get a good score on this test, or do I want to feel good in the morning when I wake up? And ultimately I went with, I want to feel good. And so I've essentially sort of disregarded the score for a while. For me personally, that's really what's worked, and that's been really helpful. Can we talk a little bit about bright lights before bed and what that does to us mentally and sort of how that stimulates us? We hear all these recommendations about you need to wear these blue blocker glasses and avoid these certain wavelengths of light and all of that. First of all, how does light impact us? And then what are your recommendations on how we handle that leading up to sleep time?
- [21:30]
A
So a lot of this comes from data which shows that light actually impacts melatonin secretion. Melatonin is this neurohormone that the pineal gland secretes. It's sort of a signaling mechanism for our brain to tell the brain that it's night, start shutting down. So when there is bright light, melatonin secretion can decrease. So the idea there is bright light is decreasing melatonin secretion. So avoid bright light so the melatonin secretion can be appropriate. There's also evidence to show that blue light among the light spectrum has the most impact. That said, the empirical evidence or data actually showing that normal light sources, so a device, just occasional lights at home, television, is that really substantially impacting melatonin secretion? That's actually very weak. So we don't have good empirical data to show that that has a major impact on people's ability to fall asleep or stay asleep. There are lots of commercially available blue light blockers. A lot of screens actually give you the option to turn off the blue light. It won't do you any harm. But I don't think there's convincing evidence that that substantially improves sleep. What is much more important is the content. So if you're looking at something that's activating, so news, social media, whatever it is, and you have an active mind because of the content that is much more likely to impact sleep than just the light.
- [22:55]
B
Okay, what about the concept of decision fatigue, how that plays in? You know, there's sort of this thought that over the course of the day we make a lot of decisions. As we do, we're sort of draining our willpower and our ability to make decisions as we go. So that means that when we get to the end of the day, that's often when our willpower is at its lowest and we might make poor decisions, particularly those that might affect sleep. So how have you seen that decision fatigue play into us being able to fall asleep effectively?
- [23:27]
A
So this is an interesting question because it also has this knock on effect in that if you sleep poorly, your ability to think and make decisions also get impacted. So as you get into later evening, nighttime, and you have run out of willpower, used up your finite amount, and you're making poor decisions. Really the key there is building in these routines where you don't need to think too much about it. So this is just a habit. You keep doing these things day in, day out. So you don't need to then make a decision. Am I doing this or am I prioritizing sleep? This is the routine. You just follow that.
- [24:01]
B
And that really goes back to what you talked about earlier. At the very beginning. It's all about making this habitual, making it automatically, having the routines, then your brain is off. So then if you're experiencing decision fatigue, it's not quite as critical because all the decisions have already been made. You've already decided you have the routine. Okay, so now we'll jump into the third section and we'll start to talk about some solutions. But I'm curious, before we start talking about how to do it, I want to know what our chances of success are. So people who experience any sort of sleep related anxiety or issues falling asleep because of a hyperactive mind, it feels hopeless at times. So is there hope for us?
- [24:52]
A
Absolutely.
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B
Do you think we can get better at it?
- [24:54]
A
Absolutely, yes. So a lot of times the inflection point is, is this chronic insomnia disorder? So insomnia for us is a technical diagnosis. So you've had difficulty getting to sleep, staying asleep, you're waking up earlier than usual. This is happening despite you giving yourself an adequate opportunity for sleep. And if it's happening at least three times a week for three months, that's when we make the diagnosis that three month cutoff is because all of us, when things change so we are stressed, we are in a new environment, we have a new Physical ailment, we will sleep poorly, Most of us will then bounce back. And that tends to happen within one to two months. If it's gone on for three months or longer, it tends to take on a life of its own. And at that point you want to intervene. So when it is less than that, it is falling back on these routines and also worrying less. So trying to get back to a frame of mind that I have slept well before, things will settle down. Not to catastrophize if it's gone on beyond three months. Usually the intervention there is what we talked about, the cognitive behavior therapy for insomnia and a 60 to 70% chance of success with just those behavior and cognitive stress strategies to fix it, even when it's gone on for three months or longer.
- [26:08]
B
Okay, so is that three month time frame, is that a good mark for people to say, all right, maybe I need to get some professional help with this? That's what they should be looking for, something shorter than that. Then we can try some of the things that we're about to talk about. Okay, all right, great. And before you tell us how we do this, I want to set the stage for appropriate expectations. Okay, so what should we be looking for in our sleep? Like, what's a normal thing? I mean, yeah, we would all love to lay down, fall asleep immediately, sleep eight hours solidly, not wake up and feel refreshed every day. That's probably not realistic. So in your mind, what's a goal that we should be shooting for that's achievable?
- [26:51]
A
So couple things. One is just how you're sleeping at nighttime, but much more importantly, how are you functioning the next day? So you want to be able to get to sleep at a relatively easy clip. You want to get a sufficient amount of sleep, wake up reasonably rested. So again, setting expectations there that things are reasonable, not perfect. And with all of this, you're functioning well during the daytime. So the goal there is, am I doing everything that I need to do, even though it's not 100% optimal, am I completing tasks, taking care of things that need to be done with the idea that even if there are short term issues with sleep, I'm functioning well, things will settle down with sleep. So that's sort of the balance to strike there that sleep is okay, I'm functioning well. And once you've achieved that, then starting to think about, can I optimize it more, can I get more at either
- [27:50]
B
end, I like tying it back to how you actually feel and how you function. That's really where the rubber meets the road. Rather than just the. The academic exercises of having the sleep measurements and scores and trackers. We really have to tie it back to how we feel because that's what's most important. That's really the outcome we're trying to achieve here. Okay, so now that you've told us that we can improve, you've told us what a reasonable expectation is or kind of what our goal is, we're aiming to be well functioning during the daytime. How do we do it? Let's put all this together and kind of come up with a framework or a step by step plan that people can look at and try to tackle.
- [28:28]
A
So the first thing is making sure that the physical environment is okay. And I understand you have already talked about that. So the bedroom is quiet, dark, comfortable, all that stuff. The temperature is good.
- [28:39]
B
You can check out our episode with Tim Morgenthaler where we went through all of those. So that's a great spot.
- [28:45]
A
Then making sure from a sort of chemical standpoint. So caffeine intake, cutting it down at around 2pm Alcohol is an interesting thing in that in the short term and in small quantities may help a little bit with sleep, but that can be disruptive. Nicotine, tobacco products, definitely disruptive. So making sure you're eliminating all of that. And then usually the idea is have a meal. It need not be very heavy and not too close to bedtime. So you're not going to bed hungry, but at the same time you're not going to bed with a full stomach. So having some kind of routines with meals that are also relatively consistent. And after that, if you're working, that's okay, but trying to build again, this is personalized for everybody, about 30, 45 minutes where you're actually doing what we would call nighttime rituals. One of the key things here again is consistency. So I usually tell my patients that if your bedtime changes significantly from day to day or weekdays to weekends, there is a little bit of change for all of us. But if it's substantial, that really confuses the brain. It doesn't know when it's time to shut off, when it's time to sort of switch back on. So having some consistency there and importantly, a steady time that you're waking up in the morning and staying active and alert through the day. So not taking naps or borrowing from nighttime sleep and just sticking with those routines without catastrophizing too much when you have a bad night or two here or there.
- [30:17]
B
And if we do that, well, let's say I have a consistent sleep time. I do my 30 to 45 minute nighttime ritual to wind down. When I lay down in the bed, how long should it take me to fall asleep? What's normal there?
- [30:33]
A
So that again varies a lot. Usually if we look at a polysomnogram, so a sleep study definition, Anything longer than 20 minutes we consider is abnormal. But nobody's really doing a sleep study. When you're lying down in bed, it is a subjective feeling. So if it feels like it's taking a reasonable amount of time, it's not too long, that's good enough. And that becomes a subjective call.
- [30:57]
B
Okay, so 10 to 20 minutes is common, but as long as it feels okay to you, there is no one golden number that we need to be striving for. So now for the people who say, okay, I'm trying all this, but I still just can't turn my brain off. I just can't do it. Do you have any other tips or tricks or thoughts for them on how they can sort of slow the mind down?
- [31:18]
A
A lot of this comes down to what people think might work best for them. So what we want here is an ability to sort of control some of these anxiety provoking thoughts or try and calm things down. For some people, that could mean meditating. For others, it could mean progressive muscle relaxation. It could be breathing work, it could be prayer. Sometimes it's reading and reading a book that they find is sort of relaxing, getting them in the right frame of mind. So experimenting with all of that, figuring out what works best for you and building that again into your routine, that I need this thing to calm myself down. So I will consistently do that till it just becomes a habit.
- [31:59]
B
So meditation, prayer, breathing work, reading, and then also muscle work as well. Okay, all right. All great strategies. All right, so let's say I've tried to do all of this and I've been unsuccessful. And I woke up, I just had a terrible night's sleep. Maybe I was traveling or had some delays or whatever. I just woke up, couldn't go back to sleep, got a big thing at work. How do I handle that? Like we already talked about mentally, what I should do, right? Mentally I should say, hey, it's okay, not the end of the world, we'll get back at it tonight. So we talked about the mental approach to that. But what do I do that next day? Let's say I only got two hours of sleep last night. What are some strategies that I can use to get me through this next day till tomorrow night's sleep.
- [32:42]
A
So things that can help you feel more awake, more alert, sort of counteract some of those sleep deprivation consequences, at least in the short term. Caffeine, strategically using that, but again, not overdoing it, where it'll start impacting the next night's sleep, physical activity or exercise, really helpful. The other is just fresh air that can be helpful. So going for a walk, being outside in nature, that can be very helpful too. And a lot of it is also just this mental reframing in that one poor night's sleep is really not going to impact things so much. Very quick story here in that we have all done call and I have at times sort of wondered about am I functioning well the next day? And a lot of times as a resident you would have med students rotate with you and I would check with them about how the rounds went or how the teaching went, where I was teaching them the next day to see if there was any correlation to nighttime sleep. So if I was sleeping better, were they perceiving my functioning to be better? There was no correlation. It could be bad medical students, but I think it's just that there really isn't that much correlation we tend to worry more about.
- [33:56]
B
I think you're right and I love all of those strategies. I think that's fantastic. So getting the physical activity, getting the fresh air, mental reframing, I think are all helpful. One of the mental reframing tricks that has worked. I don't call it a trick, but strategies that's worked for me, you can tell me if this is wrong or unhealthy is that I recognize that there will always be times in my life in the future while I will have poor sleep sleep and then I will have to function the next day doing surgery or seeing clinic or teaching or doing whatever, doing important stuff. And so I actually think, okay, this time, now that I'm functioning on less sleep than is ideal, is actually practice for when this is going to happen in the future. And if I can learn to minimize the impact or the emotional or mental damage that that does on me, then that's going to help make it easier in the future. And I sort of in some ways look at all of residency as that way. Right. I feel like I was trained that I can function without sleep when I have to. I would rather not. I am better with seven hours for sure, and that's my goal. But I know that if I fell short of that, then there was some value in doing hard things. Is that an okay approach or is that unhealthy?
- [35:08]
A
Okay. And if it works for you, go for it. Yeah.
- [35:10]
B
Yeah.
- [35:10]
A
Okay.
- [35:11]
B
But I think the key is recognizing that acute. You don't want to do that chronically, to have that build up long term.
- [35:17]
A
Yes.
- [35:18]
B
Well, this has been an excellent discussion, and I appreciate you sharing these insights with us. I've been taking notes, as you can see, and I'd like to summarize those to kind of run through my main learning points from today. So when you talked about developing the right mindset for sleep and what it is, it's something that has to come naturally. You want to do it, but you need to think less about it. And the key to doing that is making it habitual, making it automatic, and developing a routine. It's one of those areas where we will do better by doing less sometimes rather than trying to add to it and do more. So I think subtraction will be a very valuable tool here for most people, which is counterintuitive to us. It's also interesting to think about how sleep has been preserved throughout our evolution. Right. A lot of people think, well, it seems inefficient, it seems like a waste of time, it doesn't seem productive. But then say, okay, well, why are we still doing it all these years later? So it clearly is critical. We talked about the chicken and egg, how poor sleep can be related to anxiety and depression. It increases our anxiety depression, and then anxiety depression decreases our ability to fall asleep later. So you get this negative synergy. But if we can flip that, we can get positive synergy. So if we can kind of help control our mindset a little bit, maybe we get a little better sleep, which then makes it easier the next day to control our mindset. We also talked about setting your goal and what your outcomes are. And yes, we can all survive on five hours of sleep, but maybe we don't thrive on five. Maybe we need that seven to eight. And so part of it is us deciding what it is we want out of life and then setting things up so that we can achieve that. We also talked about the potential downsides of using sleep trackers and orthosomnia and people becoming very obsessive with it. And so the ultimate goal is high quality sleep so that you feel like you function well in the daytime, not necessarily to crush it on a sleep tracker. So use it as a tool to help you, but you don't have to rely on it. We also talked about the impact of bright light and that you do want to decrease that. But probably as important or more important is the stimulating content that comes with that bright light. So try to, try to turn down that stimulating content. And ultimately our goal is to be reasonable in this, not, not perfection, because we'll never really achieve that. You talked about common traps that we fall into mentally. So catastrophizing being one of them. Another, spending too much time in bed, not sleeping, doing things other than sleep. So keeping the bed for just sleep and sex only and, and nothing else. Substances, alcohol, caffeine and tobacco being the most common. And then also not enough wine downtime. So trying to go from 60 miles an hour to zero instantaneously doesn't work for us. In the third section, when you gave us a plan that was, I think, incredibly helpful. So first step, take care of your physical environment, which we've laid out a lot of examples, how to do that in a previous episode. Second step, make sure we're not having caffeine after 2pm Minimize your alcohol, minimize your nicotine, so take care of your substances. And then the third, establish a good routine. And by the routine you mean have a nice 30 to 45 minute nighttime routine to wind down. Have a similar sleep time every night and try to have a consistent wake time the best you can. And then fourth, ask yourself how you feel in the morning. And if you feel good and you're ready for the next day, then you're winning. You're doing this right. If not, make some adjustments. For the folks that continue to have issues with their mind moving at a rapid pace, some suggestions you offered. Try meditation, prayer, breathing, reading books. Just figure out what works for you and sort of build your own routine. There's no one right way to do it. Figure out what works for you. A little bit of trial and error. So we always like to end with a challenge or a call to action. You've set us up very well. And this one I'm going to be speaking from the heart because I know this is the one that I need to do more than anything. So to the audience, I'm going to challenge you to do the same thing I'm going to be doing for myself. And that's to develop that nighttime ritual. Don't try to go from full speed straight into bed. Immediately create that 30 to 45 minute wind down routine. Figure out what you want to do. And that can be warm shower, brushing your teeth, reading a book, meditating, prayer, changing pajamas, whatever it is you do, figure out what works for you. You need about 30 to 45 minutes to ease from that transition of a crazy chaotic day into sleep. And I think that that'll help one relax you decrease anxiety, help you fall fall asleep a lot faster and then also I think just give you peace and then it'll allow you to handle that decision fatigue at the end of the day a lot better because you've sort of made everything a routine. So absolutely that's going to be the challenge for the audience. Bhanu, thank you so much for joining us today and for having this discussion. We really appreciate having you.
- [39:55]
A
Great to be here.
- [40:00]
B
If you like this episode, please share it with a friend and leave us a review on your podcast app. It really helps others find the show. Got feedback, a question or a topic idea? Email us@OptimizeAYO.edu or leave us a voicemail at 507-538-6272. We might even feature your voice on the show. For more human optimization episodes and resources, check us out online at ce mayo.edu optimize. Remember, long term well being starts with the habits you build today. Live Intentionally perform exceptionally. I'm Dr. Christopher Camp. Thanks for listening.
- [40:56]
A
This podcast is for informational purposes only and should not be relied upon as
- [41:01]
B
medical or legal advice.
- [41:02]
A
Always consult with a qualified healthcare provider for any medical questions. The appearance of any guest does not imply an endorsement of them, their employer, or any entity they represent. The views and opinions are those of the speakers and do not necessarily reflect the views of Mayo Clinic. Reference to any product, service, or entity does not not constitute an endorsement of or recommendation by Mayo Clinic.