Why We Should Get More Sleep with Dr. Ana Krieger

Welcome to Health Matters – your weekly dose of the latest in health and wellness from NewYork-Presbyterian. I’m Faith Salie.

Sleep. We all know the feeling of a good night’s rest. And we’ve also felt the irritable, groggy feeling when that doesn’t happen. And yet, amid a hectic schedule, sleep is often the first thing to go, despite being one of the keys to our health.

I talked to Dr. Ana Krieger, a sleep medicine expert at NewYork-Presbyterian and Weill Cornell Medicine, to better understand just why sleep is so vital, how to make it a top priority, and to find specific steps we can take each day for a better night’s sleep.

Faith: Dr. Krieger, thank you so much for coming on the show.

Dr. Krieger: Thank you for having me. This is very exciting.

Faith: Why do we sleep? And why is it so important?

Dr. Krieger: What we know is that during the daytime, our neurons, which are the brain cells, are very active, coordinating everything that we do. What we’re looking at, what we’re thinking, what we’re speaking, our physiology of the body, learning new information, performing tasks. So sleep is necessary not only to restore the energy balance in the brain, so during the night, the brain kind of cleanses itself from all the toxins that may have accumulated during the daytime work.

Faith: Our brains cleanse toxins? That’s fascinating.

Dr. Krieger: Exactly, and, and we have many cleansing processes in our body through breathing, right? We cleanse, we release acid when we breathe out. We don’t think about that, but we breathe so we can take in oxygen and we release the acid that our body is producing the same way the urine reduces all the toxins that we’re breaking down, breaking in the liver, it can come out in the urine. So the brain has to not only rebuild the energy we need to train, we need to be busy during the day, but we need that break, that interruption to allows that self-cleaning process to happen.

So when we break sleep, we not only interfere with that self-cleansing process that the brain needs to go through, but we also interfere with several other hormonal functions in our body.

Faith: And there’s mental health aspects, right? I actually feel sad when I don’t get enough sleep. First of all, my patience goes out the window and then I start to feel sad.

Dr. Krieger: Absolutely. Mental health is critical. People have a lot of mood instability. People may get more irritable if they don’t sleep, and we see that in kids, right? When kids are sleep deprived, they are able to demonstrate that rather quickly.

Faith: Have you been in my apartment lately? I have a list I keep on the kitchen counter that at night there’s probably five things that I think of, oh yeah, I need to do that tomorrow. That was me snapping at my brain and, and I, and I scribble it down on the counter, and as soon as I know that’s there, I’ll see it in the morning. It helps.

Dr. Krieger: I love it and scientifically that has been proven to help. So we do often recommend this worry list, let’s say, right? So if people have all this rumination at night, they can leave a piece of paper and a pen. Sometimes I even tell, don’t even turn on the light. Whatever thought comes into your head, you can write it down as a bullet point.
And then the next day you take that list and you take perhaps 15 minutes, let’s say, around this time of the day to go through the list and process. One interesting aspect that I noticed in a lot of patients is the fact that the day is so busy that they don’t have time to mentally decompress. So when they hit the pillow, the mind goes crazy. Like all the things that to do, whatever it is, shopping, food, whatever else is part of our life that we couldn’t fit in. So if we carve in a little bit of time, just even 10, 15 minutes a day just to go through that list and reprocess, we start trusting ourselves that we have dedicated time to organize those thoughts, and then we’re able to, when you go to sleep, to then almost bypass that kind of monkey brain situation and then go straight into sleep without feeling that anxiety.

Faith: I think I know your answer, but I’ll just ask it: Are, are we Americans getting good sleep on the whole?

Dr. Krieger: No, we’re not.

Faith: This sounds serious.

Dr. Krieger: Yes, because when I started doing this 25 years ago was when I started having, my sleep clinic patients coming in. We were treating more straightforward sleep disorders, meaning they develop sleep apnea. They have restless legs for whatever underlying reason. But now I can see that a lot of my patients are younger people.

Faith: Can, can you give us a sense of what most American adults’ relationship with sleep looks like? Like how much are they getting?

Dr. Krieger: Six to seven hours. And if we look back about 40 years ago, they were getting eight to nine hours.

Faith: What things are interfering with our ability to get not only good sleep, but let’s start with enough sleep?

Dr. Krieger: We are living through times that impose on us a concept of not only perfectionism, but you know, of extending ourselves to multitasking and doing a lot of things with a high demand that has almost left our personal and physiological needs aside. We became a society focused on performance, forgetting that we are human beings, we’re not computers, right? So we have to take a step back and say, the human being cannot function at that level.

So I think that push for performance and excellence, needs to include how we are meant to function because only by optimizing our personal health, sleep health, and physical health, mental health, we’ll be able to then perform at our best

Faith: Yeah, it sounds like our societal existence right now is pretty stressful. The constant barrage of information and social media doesn’t help so, what happens to us when we are consistently coming up short on sleeping enough?

Dr. Krieger: Well, several things are of concern. So I think one, we spoke about modulation of our mood. We can get more anxious, we can feel even more depressed. We can’t control our ability to respond to stressors the same way. We can also have increases in the sympathetic system, which control blood pressure, heart rate, so the body may feel in that hyperdrive. So that’s kind of the stress response and it can lead to changes in our diet, food choices, and inability to really live a full and healthy life. So we start making unhealthy choices and that becomes a major problem because if people don’t eat well, they may be gaining weight, they feel very anxious,they withdraw from colleagues, they can’t engage, they can’t socialize because they’re so exhausted. So it affects their personal relationships as well as professional relationships.

Faith: When, when you list those symptoms, what concerns you the most? What do you think is the biggest threat to our overall health?

Dr. Krieger: I have to say stress and anxiety, I think that is the biggest issue that I see nowadays tied to our day-to-day life and sleep. People are getting into a rhythm that they can’t break, they don’t know how to break. So they really need a lot of help and support. So that’s my concern when we go into the downhill spiral, is that the individual can no longer help themselves. So it’s so important for us to educate everybody so we are able to preserve a level of function that you can make a small modifications and restore your sleep health.

I think strategies that we can focus on trying to do deep breathing, meditation, yoga, Tai Chi, some of those activities that help the parasympathetic system, which is the antidote to adrenaline, can be very important because we drive in this adrenaline society. I think we have to create a balance. And once we create a balance, it’s easier for people to restore their sleep because they feel more comfortable.

Faith: Okay, so we’ve, we’ve talked about why sleep is so important. Let’s talk about what it means to get good sleep. What does it feel like and look like when someone is getting good sleep? And I know, I mean, my body tells me my eye twitches, like it twitches all day long when I haven’t gotten enough sleep. It’s just like telling me, hello – go to bed!

Dr. Krieger: Exactly. Exactly. And people use and abuse caffeine, right? Which is also big stimulant to try to offset the effects of …

Faith: Dr. Krieger you can’t take away my caffeine!

Dr. Krieger: I don’t drink caffeine, I eat chocolate.

Faith: OK, now you’re bragging. Can we move on? Okay, so you are saying that perhaps someone who is getting a good sleep won’t need caffeine. That’s part of what, what getting a good sleep means. What else is happening?

Dr. Krieger: Exactly. You wake up, you should be waking up, hopefully at the same time every day, feeling energized, not need an alarm. That’s one of the most important aspects, which is almost impossible for us to achieve nowadays. Again, going back to the scenario that sleep is really a natural phenomenon, you shouldn’t be oversleeping because once you sleep the adequate amount that your body needs, which may be eight, eight and a half, nine hours, it’s almost impossible for people to live a regular life nowadays in modern society and do that.

Faith: So if you’re getting enough sleep, you are waking up on your own. you are eating healthfully because your body’s craving the right things. I presume it also means you have enough physical energy to get through your day.

Dr. Krieger: Absolutely. And you get out of bed right away. You ambulate, you get sunlight exposure, physical activity. So the challenge is how to implement that in real life, right? So that’s the role that we play as sleep specialists is how to figure out, this is the ideal scenario. I call it sleep optimization. So you have to one, understand the rhythm, like some people are night owls or others are early birds, so you want to figure out how you can try to live your life, maintaining your rhythm.

The second aspect, you want to respect the rhythm. And then what do you do before going to sleep will affect the rhythm. What is your routine that hour and a half, two hours before going to sleep? Are you exercising too late? Lowering the room temperature is one of the recommendations. Make sure people have the bedroom cold, which also varies – cold could be 71 degrees for somebody and he could be 63 for another person.

Faith: I heard that overhead lights are terrible for inducing sleepiness. So I turn out all the lights in our apartment, a half an hour before we’re putting the kids to bed. And then when my husband occasionally turns them back on, I walk around with like, very dramatically shielding my eyes as if there’s an eclipse I must not see.

Dr. Krieger: I walk around with blue light blocking glasses.

Faith: Oh my gosh, you are showing them to me. You are committed to this!

Dr. Krieger: Oh, I have been for at least 10 years, 9:30 at night.

Faith: You just put them on. You look like you mean business.

Dr. Krieger: Exactly. People say, are you going sailing? No, I’m actually going to sleep.

Faith: So, so you put on glasses to shield from, from light and from, is it the kind of light that screens emit as well?

Dr. Krieger: Yeah, so what happens is that a lot of the lights that we have been using lately, let’s say it’s the lighting in your bathroom or in the kitchen, and in your electronics. They focus a lot on that blue light spectrum. And that is where brain cells are very sensitive to. And that can shift our circadian rhythm, which is your natural rhythm of sleep, to a later time, let’s say. So we have to be careful with light exposure because when we were in nature, we really didn’t have any artificial light exposure, so sleep was naturally linked to a process of darkness. So every light that you have at night will affect your sleep.

Faith: Are there other steps that you can encourage people to take to get good quality sleep?

Dr. Krieger: I think people have to look into their environment before going to sleep. And sometimes patients tell me, oh, but my problem is in the middle of the night. I said, yes, but you have to start from a good ground because if you start well in your sleep, you’re gonna enhance your quality of sleep.

Sometimes people try to spend too much time in bed or during the weekends they try to compensate so they oversleep or they wake up late. And that will lead to a problem, difficulty falling asleep on Sunday night, let’s say. So trying to figure out how to focus on the timing of sleep. Where is prioritizing sleep? Make sure that your sleep is part of your schedule.

Faith: Dr. Krieger, thank you for sharing all this with us.

Dr. Krieger: You’re welcome. This was a pleasure.

Our thanks to Dr. Krieger.

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