Building a Solid Sleep Routine for Health and Longevity: ABC’s of Healthy Sleep Pt. 2

Building a Solid Sleep Routine for Health and Longevity: ABC’s of Healthy Sleep - Part Two

Jeffrey Besecker: This is The Light Inside, I'm Jeffrey Besecker. A good night's rest. When was the last time that you, yourself, have had one? According to the Sleep Foundation, 50 to 70 million people worldwide have ongoing sleep disorders, with insomnia, sleep apnea, and narcolepsy being the most common. Insomnia itself, affects 10-30% of all adults globally. As a world community, sleep is a serious issue.

Sleep deficiency is linked to chronic health problems, including heart disease, kidney disease, high blood pressure, diabetes, stroke, obesity, and yes, depression. And insufficient or excess sleep may be a risk factor for cognitive decline and neural degeneration in aging.

Yet this basic foundation of life comes down to four simple factors. Consistency, regularity, quality, and quantity. The need for quality sleep seems apparent.

However, it's a common and quite normal struggle for each of us. For all of us, the struggle for sleep is a present reality of life.

As part two of our sleep series with neuroscientist and sleep research expert Chelsea Rorscheib, today we discuss the long-term effects of sleep deprivation and its cost on our overall well-being and longevity. And here's the thing, the number one sleep habit that cost us the most?

Maybe you guessed it, sleep procrastination.

I'll sleep when I'm dead might be a common motto for many of us, as we strive to be our best. Yet when it comes to health and longevity, it may not be the best habit or practice. In this installment, Chelsea shares with us her top tips about building a solid sleep routine that promotes long-term health and overall well-being. Chelsea, welcome back.

Give us a little overview on your background so we have that contextual bounds where that expertise might kind of blur those lines a little.

Chelsie Rohrscheib: Sure, sure. If you strip everything back, I'm a neuroscientist. So I did my PhD in neuroscience with a specialization in sleep neuroscience specifically. I dabbled in genetics and then my undergrad is in biomedical science, which is just the science of medicine. So it pretty much encompasses everything in the body. I've also been involved in sleep medicine for a really long time. So working with patients who have sleep disorders, And I'm currently the head of sleep, a sleep disorder diagnostics technology called Wesper. And we essentially do home sleep tests for people who might have insomnia or sleep apnea or any number of those disorders. But a big part of my career has been sleep education and sleep communication. So I do a lot of outreach programs, seminars, I'm somewhat active on social media, and you know, I do the podcast every once in a while as well.

Jeffrey Besecker: Awesome. Well, I am completely honored that you have blessed us with this opportunity and I'm looking forward to that. So Chelsea, we've talked quite a bit about the role sleep irregularities and disorders can play in wreaking havoc on our patterns and habits. Can you discuss some of the more common sleep disorders like apnea and insomnia and their potential impact on our overall health?

Chelsie Rohrscheib: That's a really good question. So most people are not aware of this, but there are over 80 recognized sleep disorders. Some are very rare, but some are incredibly common. The incredibly common ones are first and foremost, insomnia. Most people will suffer from at least one bout of insomnia in their lifetime. Some people have chronic ongoing insomnia and then certain periods in our life such as menopause and older age also make insomnia more common. So insomnia is marked by an inability to first fall asleep, which is called onset insomnia, or an inability to maintain sleep, which is called maintenance insomnia. So people with maintenance insomnia, they may be able to fall asleep initially, but they may find that they wake up frequently or when they do wake up, they cannot fall back to sleep easily. So some people can have onset, some people can have maintenance, and a lot of people have both together. And insomnia is caused by many, many, many different things because the brain is very sensitive. So it can be caused by stress. It can be caused by poor sleep habits. It can be caused by an erratic work schedule. It can be caused by other medical conditions. It can be caused by things that we have no idea what they are. We're not aware of. We call that idiopathic insomnia. There's no seemingly obvious reason a person is having insomnia. When you have insomnia, you're typically not able to achieve enough sleep time. So you're not able to get that seven to nine hours. And you're also typically not able to achieve the quality of sleep. So the depth of your sleep stages and the consistency of your sleep to feel well rested. And in the longer term, that can lead to many chronic health conditions. The second most common sleep disorder, which is rising very, very quickly and may eventually overtake insomnia for the number one spot is sleep apnea, specifically the obstructive type of sleep apnea. And sleep apnea is a sleep breathing disorder where something in the upper airways is obstructing air from entering your lungs when you breathe. So when people are asleep, they have many of these obstructions per hour. And so their blood oxygen levels drop. That's called hypoxia. And when the brain detects hypoxia, it has to initiate something called a cortical arousal in the brain, which is essentially either waking you up fully or bringing you out of a deep stage into a light stage of sleep so that you can normalize your breathing again. So, people with sleep apnea have a lot of micro-arousals or micro-awakenings, where they wake up very, very briefly to normalize their breathing. Usually, they don't even notice that they've woken up. But the point is, if you're waking up multiple times per hour, some people with really severe sleep apnea can wake up hundreds of times per hour. You're not actually sleeping. You're just in a constant state of light sleep. And we know that this massively raises your risk for cardiovascular disease, stroke, diabetes, heart failure, cancer is massively raised for people with sleep apnea, your risk for obesity, dementia and Alzheimer's disease, mental health disorders, you name it. So it's a very dangerous disease to go untreated in the long term. And it's very common. So 20 to 26% of men in America have sleep apnea and 10 to 11% of women in America have sleep apnea. And those rates increase as you age. So the older you get, the more likely you are to develop it. It's also increased in people who are overweight. So even having a slightly elevated BMI increases your risk for sleep apnea.

Jeffrey Besecker: Are there some key ways we can assess when we might be undiagnosed with apnea and what are also some key tips or habits and practices we might institute to help manage that apnea? I know the CPAPs are becoming very popular.

Chelsie Rohrscheib: So sleep apnea has a lot of signs and symptoms. That doesn't mean you'll have all of the signs and symptoms. You may have a few, you may have none, you may have tons. So it exists on a spectrum. All two sleep apnea patients are not created equal. The things that would typically throw up red flags for sleep medical experts would be chronic daytime sleepiness that doesn't seem to improve no matter how much sleep you get. cognitive issues, so difficulty paying attention, difficulty with learning and memory, maybe your mood is low. We also see things like snoring, so about 50% of people with sleep apnea snore because a lot of the things that cause the upper airway obstruction in the first place also can cause that snoring sound as well. I will say that snoring is not a guarantee. People who snore don't necessarily have sleep apnea, but people who don't snore can also have sleep apnea. It's really important to keep that in mind. If your bed partner has ever noticed that you stop breathing during your sleep or gasping or snorting, That's a really important indication. Some less obvious signs that people don't know are related to sleep apnea would be things like a consistent or persistent morning headache. So if you wake up with a headache that kind of goes away over the day, that's a really good sign because hypoxia will cause that headache. Increased nighttime urination. So if you're waking up more than once to use the bathroom, and that's because hypoxia changes the way our kidneys filter urine. Also, for kids, especially in younger people, we see behavioral issues that look a lot like ADD, ADHD, so those range of symptoms. If you have any of those symptoms at all, even if there's only a few, it's definitely worth getting checked out or at least talking to your doctor about getting screened. As far as management, it really depends on how bad your sleep apnea is. Sleep apnea can range from very mild to extremely severe. It also depends on the cause of your sleep apnea. There's many things in your upper airways that can lead to those upper airway blockages. These can range from things like your jaw anatomy, so people who have a very narrow jaw. and a very high palate are more prone to sleep apnea. The size of your tongue, so people who have big tongues are more prone to sleep apnea. Your tonsils, your uvula, your adenoids, your jaw placement can play a big role. So we treat people oftentimes depending on those things. If somebody has huge tonsils, we say, well, let's just take your tonsils out. But if somebody has a tongue that tends to flop back in their throat, we might recommend something like an oral appliance that keeps their tongue at the right position. The standard go-to is usually a CPAP device, which is a machine that connects to a mask that delivers pressurized air into your airways to keep your airways open. That's usually the first line of treatment. Now, people who have very, very mild sleep apnea can do natural things, over-the-counter things. They can try weight loss if they're a little bit overweight. They can try myofunctional therapy, which is oral strengthening exercises they do every single day. They can try things like mouth tapes and nasal strips. They can use special pillows. They can sleep on their side as opposed to on their back. But the important thing is don't try to treat your sleep apnea without knowing what's causing it and how severe it is, because that's really going to limit your ability to actually treat your disorder.

Jeffrey Besecker: There again, what role might stress also play in these cycles?

Chelsie Rohrscheib: So sleep apnea and stress feed into each other. Sleep apnea massively raises your blood cortisol because when you are constantly hypoxic, so your brain is constantly being starved of oxygen, that keeps us in fight or flight mode because your brain thinks you're going to die. So if your cortisol levels are constantly raised, that is going to make you more prone to stress and potentially chronic stress disorders and anxiety. Now the stress itself, and again this feeds into each other, the stress itself is actually going to make it even harder for you as a sleep apnea patient to get any amount of good sleep because the stress can go on to cause things like insomnia on top of your sleep apnea. About 30% or more of sleep apnea patients also have insomnia too. We think it's due to that stress. And when that happens, it's called COMISO, which stands for comorbid insomnia and sleep apnea together. So they feed into each other. And so when you have sleep apnea and that chronic stress together, it raises your risk even more for those chronic health conditions.

Jeffrey Besecker: We exasperate that often if we're mated or partnered in any regard and one or the other might also be experiencing some type of sleep disorder. In that regard, what role do you feel healthy communication of those issues might play as a more nuanced consideration?

Chelsie Rohrscheib: So I think we definitely, as healthcare professionals, we definitely need to educate the public more about sleep disorders and what they mean for individuals in the long term. So I think a lot of people know disorders like sleep apnea exist, but they don't really know what they are and how problematic they are for long-term health. They also really don't understand some of the signs and symptoms that are not so obvious. So I think we really need to educate the public about how common it is, what to look for, and how to actually go about getting assessed and tested. We also need to help people understand that a lot of times these sleep disorders can look like other health problems. It is very, very common for somebody with sleep apnea to come and see me because they assume they just have insomnia because that stress response causes that secondary insomnia to develop, or they have a health condition like a heart arrhythmia or gastric reflux or bruxism, which is teeth grinding, when it's actually the sleep apnea that's causing all those things. informing the public that it exists, but also informing the public that if you have any of these other health disorders, you absolutely should be tested for sleep apnea because if you don't get treated for the sleep apnea, you're not going to improve these other health conditions. We see that a lot in cardiovascular disease and other conditions that are related to the heart.

Jeffrey Besecker: I know from my own relationship with my wife, between our relationship that communicating between those couples, are also essential. We've got a great coming up in a coming up in a future episode, looking at how we communicate. So earmarking that I know within our listening community, the topic of insomnia is one that's fairly prevalent. If you're open to it, Chelsea, I'd like to take a moment to address a question from one of our community members.

Chelsie Rohrscheib: Yeah, absolutely.

Jeffrey Besecker: So Brett W. from Colorado Springs shares this concern. I have so many stressors right now that require my total attention, not just little things, but big things that affect many lives. They're coming at me from all angles. I'd like to add that I can feel Brett's pain. We all struggle with that sense of overwhelm with life. Brett goes on to ask, if there's a magic way to slow down my brain so that I can get a decent night's sleep, I would welcome this input.

Chelsie Rohrscheib: So an overactive brain is one of the top reasons people have insomnia because your brain has to initiate the step-down process where our brain waves slow. Initially we're in a very relaxed state and then your brain switches over into stage one light sleep and it kind of goes deeper and deeper and deeper throughout the night. If you can't shut down your brain, you can't get into that restful state that's needed to make that sleep-wake transition. Now, as insomnia therapists, so they're specialists that practice, they're clinical psychologists that practice therapy specifically for insomnia, they have a whole repertoire of things that you should be doing to slow down your brain and also ensure that you're sleeping well throughout the night. So the first thing is to create a pre-sleep routine. So you need to prioritize helping your brain and body shut down and slow down well before you even get to bed. So that means the 30 to 60 minutes before bed, put all of the stressful things in your life away. You know, if you're really thinking about something you have to do tomorrow, make a list. We know from clinical studies that listing everything out on paper helps you release all of that from your brain. So you don't have to worry about it so much while you're trying to sleep and then focus on doing relaxing activities like reading, listening to relaxing music, maybe take a really warm shower. And then when you get into bed, you can do activities that are clinically proven to help slow down your brain and also help your nervous system enter that parasympathetic rest and relaxation state. The two big ones are meditation, which I realize is a lot to ask because meditation takes time and practice to get good at it. But meditation, even if you have to start with guided meditation, so listening to somebody help you go through the meditation. Meditation is clinically proven to help lower your blood pressure, slow your heart rate, help you get into that parasympathetic state, and help your brain prepare for sleep. So that's one. Another one is deep breathing exercises, which do a lot of the same things that meditation do. So it helps you lower your blood pressure, help lower your heart rate, and help you turn your brain down. You can also do things like mantras. So people will repeat mantras, which are basically positive sayings that you repeat over and over again. Some people do visualizations where they try to capture an image of something in their mind and hold that image. A lot of people use the leaves on a stream where they visualize leaves flowing down a stream. So that also helps. You can take magnesium supplements. You can take Valerian Root, which helps relax you. It promotes GABA, as we talked about earlier. And, you know, if worse comes to worse, if you've done all of these things and nothing is working, if your brain is really feeling overactive, get out of bed. get out of bed. Don't toss and turn. Don't because when you're in bed, you're tossing and turning. You're just frustrating yourself. You're raising your stress levels because you're thinking, oh my God, I can't sleep. What am I going to do? No, get out of bed, go somewhere quiet, dark and comfortable and do one of those relaxing activities. You know, you can start meditating again. You can listen to music, whatever you've got to do, do that for 20 minutes and then get back into bed and try to go back to sleep.

Jeffrey Besecker: Reading instantly does it for me. I will go and sit and, you know, rise from bed and read 15 minutes to a half hour, like clockwork, literally flips the switch for me.

Chelsie Rohrscheib: Yeah, and there's also like it's extremely important for people who are prone to issues to keep a very consistent sleep schedule because like we were talking about earlier, it helps your brain really prepare those chemicals that are needed for initiating sleep. And I think that's really difficult for people with really intense schedules because they just maybe they can't keep a consistent schedule. Maybe they have to work late or whatever. But the closer you can keep to a specific sleep time daily, the better. That's really going to help you. Melatonin supplements can help for a lot of people, not everyone. Melatonin really isn't a sedative. It doesn't knock you out like a sleeping pill.

Jeffrey Besecker: Considered more of a hypnotic.

Chelsie Rohrscheib: Melatonin is a circadian rhythm regulator. It's a timekeeping hormone. So it doesn't make you feel tired. It tells your brain the time of night you need to go to bed. So it helps your brain initiate that chemical cascade with the adenosine and the GABA and everything else to actually help you fall asleep. So without that melatonin signaling that it's bedtime, that cascade can't happen. So taking a very low dose of melatonin can be helpful if you have a really erratic sleep schedule because it gives your brain a little bit more regulation, even if you aren't getting that consistent bedtime. Ideally, you would be using it about an hour before you go to sleep, and ideally you would not be taking more than five milligrams of melatonin.

Jeffrey Besecker: I've seen this buzzword sleep confidence come up and how that helps us to set and establish that healthy relationship when we are experiencing sleep struggles or some sleep disorder.

Chelsie Rohrscheib: Yeah. So one of the biggest issues with chronic insomnia is people basically develop learned behaviors that when I put my head on the pillow, there's no way I'm going to be able to sleep. So even before you get into bed, you're like, yeah, I'm going to have another horrible night and I'm not going to be able to sleep because I'm a chronic insomniac. And that feeds into the insomnia because when you are super negative and pessimistic and you're worried about not getting enough sleep, That raises your stress levels, again, raises your cortisol, stimulates you, and it's problematic. So if you can use those cognitive techniques to kind of train yourself to have more of a positive outlook on sleep, and this is where those mantras really come in. So telling yourself, when I put my head on the pillow, I'm going to feel really relaxed. and I'm going to fall asleep within 20 minutes. And when I am asleep, I'm going to have really successful deep sleep without a bunch of awakenings. And if I do wake up, it's OK. It's not a big deal. I'll just go through my mantras and my sleep routine again, and I will get back to sleep. And even if I don't get enough sleep, that's OK. I'll try to make up for it the next day. So learning that mindset is really, really, really imperative for people who suffer with insomnia.

Jeffrey Besecker: Our listeners like to stay on that cutting edge of new data and information, Chelsea. And I know you yourself thrive on that notion of exploring and looking at the new and transitioning aspect of sleep. Are there any current techniques or interesting things that we might start looking at or that you care to share with us?

Chelsie Rohrscheib: Yeah, sure. So, um, one thing that's really, really important before sleep that we found actually helps to make people fall asleep a lot faster is what we call controlled muscle relaxation. So the military uses this technique to help their soldiers fall asleep quickly too. And we think there's something about this that tricks the brain into relaxing faster. And basically what you're going to do is when you get into bed, you're going to try to tense up all of your muscles. So contract all your muscles for as long as you can, and then slowly go from top to bottom and release your muscles. So, you know, release your, your neck and then your shoulders and then your arms and your hands and your stomach, your thighs, your calves and your feet. And that's, for whatever reason that we're not entirely sure why it works, that slow release of your muscles just helps push your nervous system into that parasympathetic state. Another thing that we're really, really pushing right now is light exposure during the day. And we touched on that a lot earlier. We find that people that do not get sufficient sunlight exposure are actually a lot more prone to sleep issues. So it seems counterintuitive in a lot of ways, but When you wake up within the first 10 to 20 minutes, you do need to expose yourself to sunlight. We show clinically that people who do expose themselves to sunlight have a very dramatic drop in their melatonin, and that sets their circadian rhythm up to be more prepared for sleep later in the day. So that's also really important. And if you live in a climate where you don't get a lot of sunlight, maybe you're super northern, especially in the winter, try using either a UV lamp or they also have UV glasses that you can wear as well. I actually have some because I live in Michigan and it gets very dark during the winter. So in the winter months, I immediately put on my UV blue light glasses to wear for a half an hour first thing in the morning.

Jeffrey Besecker: So that sounds like we're going back to a lot of very basic foundational elements of sleep, just starting from scratch to build better habits.

Chelsie Rohrscheib: Yes. The research is always expanding and we're always learning more things every single year. A lot of it is about what the sleep actually does for the brain and body. And then based off of that, that's when we can start building off of that information to create better sleep habits. Another really interesting technique that we've only really been utilizing in the last few years is actually purposeful sleep deprivation for really, really bad cases of onset insomnia. So if you're somebody who has a very difficult time falling asleep and you've tried literally everything, you've tried supplements, you've tried good sleep hygiene, you've tried meditation, nothing's working for you. we will actually force you to stay awake as long as possible until you're so tired that you're forced to fall asleep as soon as your head hits the pillow. And then we'll slowly roll back your sleep time so that you get to something that looks a little bit more normal. But that is an actual thing we do in sleep therapy that people are not aware of. So tossing and turning and really stressing yourself out, we want you to avoid that at all costs. And consider getting into therapy with a sleep expert, a behavioral sleep practitioner, if you're really struggling. It works better than sleeping medication. We know this through years of clinical studies, and they also have better long-term health outcomes and less health consequences from taking sleeping pills all the time.

Jeffrey Besecker: I want to thank you for sharing such insightful, juicy information with us today. So many great tips and insights to be aware of. Finally, to conclude things today, Chelsea, if you were to offer just one tip or piece of advice that might revolutionize how we approach our sleep habits, what might that be?

Chelsie Rohrscheib: So my main piece of advice, other than keeping to a very consistent sleep schedule, is routine, routine, routine. So everything you should do at night should be a routine that you replicate every single night. So especially that 30 minutes before sleep, if you try to do the same thing consistently every single night, that's really going to signal to your brain that it is time to sleep. The other thing that I always, always push is if you are somebody who has been struggling for years and everything you've done doesn't seem to work, it is so important that you talk to your doctor about getting a sleep study because common sleep issues like insomnia are actually due to other sleep disorders and people don't even know that there's the connections. So it's just like what I was saying about sleep apnea. Oftentimes people with sleep apnea will develop insomnia and they think they only have insomnia. So really making sure there are any underlying sleep issues and also other health conditions. Super, super important. Don't suffer for years. Get yourself checked out because there's a pretty high likelihood that there's something else going on.

Jeffrey Besecker: So back to that old knowledge of starting at one, establishing that basic foundation of consistency. I want to truly thank you for sharing this wealth of information with us. This truly has been such an educational and insightful conversation.

Chelsie Rohrscheib: Oh, no problem at all. It's my absolute passion to help people understand sleep. And honestly, this is a topic I could talk about for days.

Jeffrey Besecker: It truly is fascinating. And ultimately, you know, we work ourselves up in a lather sometimes looking for that magic bullet. And again, it's just returning back to those basics. So thank you for reinforcing that with us. I look forward to many more conversations as we return to some of these topics. I see so many different avenues that we could open that door and look in and unravel to explore.

Chelsie Rohrscheib: Absolutely. I mean, there's sleep affects everything. So cognition, mental health, every other body system. So there's just so many topics that we haven't even covered yet.

Jeffrey Besecker: I know in our pre-conversations and some of our earlier talks, we looked at that avenue of exploring how that affects our longevity. Perhaps that's something we could come back to.

Chelsie Rohrscheib: Mm-hmm. Absolutely. Yeah.

Jeffrey Besecker: Well, thank you, dear. I can feel that passion in my heart and soul, and I truly, truly value that.

Chelsie Rohrscheib: Oh, thank you so much for having me. It was a pleasure.

Jeffrey Besecker: It truly has been a pleasure. We'll talk soon. All right. Great. Thank you so much. Thank you. How important is sleep, you ask? Alongside food, water, and air, next is sleep. Sleep, after all, is a biological requirement of life and a foundational building block for healthy longevity and success. We hope this ABC primer was meaningful in your journey of life. If you think this information will benefit a friend or loved one, please share this series with them. And as always, we're grateful for you, our valued listening community. This has been The Light Inside. I'm Jeffrey Besecker.